| 1. |
- Bondemark, Lars, et al.
(author)
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Long-term stability of orthodontic treatment and patient satisfaction : A systematic review
- 2007
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In: Angle orthodontist. - 0003-3219 .- 1945-7103. ; 77:1, s. 181-191
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Research review (peer-reviewed)abstract
- Objective: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. Materials and Methods: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention, randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies, and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. Results: The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. Conclusions: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design. © 2006 by The EH Angle Education and Research Foundation, Inc.
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| 2. |
- John, Mike T., et al.
(author)
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Mapping Oral Disease Impact with a Common Metric (MOM)—Project summary and recommendations
- 2021
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In: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:3, s. 305-307
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Journal article (peer-reviewed)abstract
- Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact—the dimensions of oral health-related quality of life—capture dental patients’ oral health problems worldwide and regardless of whether the patient currently suffers from oral diseases or intends to prevent them in the future. Using scores for these dimensions, the project Mapping Oral Disease Impact with a Common Metric (MOM) aims to provide four-dimensional oral health impact information across oral diseases and settings. In this article, project authors summarize MOM’s findings and provide recommendations about how to improve standardized oral health impact assessment. Project MOM’s systematic reviews identified four-dimensional impact information for 189 adult and 22 pediatric patient populations that were contained in 170 publications. A typical functional, pain-related, aesthetical, and psychosocial impact (on a 0-8 impact metric based on two items with a response format 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often) was about 2 to 3 units. Project MOM provides five recommendations to improve standardized oral health impact assessment for all oral diseases in all settings.
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| 3. |
- John, M. T., et al.
(author)
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Recommendations for use and scoring of oral health impact profile versions
- 2022
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In: Journal of Evidence-Based Dental Practice. - Philadelphia, PA, United States : Elsevier. - 1532-3382 .- 1532-3390. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited. Aim: We assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them. Methods: Data came from the “Dimensions of OHRQoL Project” and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions’ summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions’ domain scores or OHIP-5′s items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment. Results: Summary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91–0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively. Conclusion: Recommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.
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| 4. |
- Kallunki, Jenny, et al.
(author)
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Comparisons of costs and treatment effects—an RCT on headgear activator treatment of excessive overjet in the mixed and late mixed dentition
- 2022
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In: European Journal of Orthodontics. - Oxford, United Kingdom : Oxford University Press. - 0141-5387 .- 1460-2210. ; 44:1, s. 86-94
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Journal article (peer-reviewed)abstract
- Objectives: To compare the costs and treatment effects of headgear activator treatment of Class II malocclusion with excessive overjet between treatments started in the mixed (MD) and late mixed dentition (LMD).Trial design: Two-arm parallel-group single-centre randomized controlled trial (RCT).Material and methods: A total of 56 children presenting Class II malocclusion with excessive overjet were assessed and invited to an RCT designed as intention-to-treat. The children were randomized, by an independent person not involved in the trial into two groups, treatment with headgear activator in the MD starting at the age of 9 or to treatment with a headgear activator in LMD, starting at the age of 11. The primary outcome measure was to compare the treatment costs between the two groups. Societal costs (the sum of direct and indirect costs) were calculated for successful treatments only and when unsuccessful treatments were included. Secondary outcomes were comparisons of oral health-related quality of life (OHRQoL), dental and skeletal treatment effects, lip closure, and trauma incidence. Data collections were performed before and after treatment, corresponding to a treatment period of 2 years. Blinding was accomplished when assessing outcomes.Results: No group differences in costs were found of successful treatments or when unsuccessful treatments were included. The most pronounced treatment effects in both groups were the reduction of overjet and improved molar relation. Treatment started in MD or in LMD were equal and without significant differences regarding effects on OHRQoL, skeletal effects, lip closure, and incidence of trauma.Harms: No harm was observed, but 8 of 30 children (27%) in the MD and 6 of 21 children (29%) in the LMD group showed unsuccessful results.Limitations: Costs depend on local factors and can thereby not be directly transferred to other settings. It was a single-centre trial and can thus be less generalizable.Conclusions: Regarding costs and treatment effects, there is no difference if headgear activator treatment of excessive overjet starts in the MD or LMD.Clinical trial registration: NCT04508322.
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| 5. |
- Kallunki, Jenny, et al.
(author)
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Early headgear activator treatment of Class II malocclusion with excessive overjet : a randomized controlled trial.
- 2021
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In: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 43:6, s. 639-647
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To compare early headgear activator treatment of Class II malocclusion with excessive overjet with untreated control subjects in terms of the primary outcomes overjet and overbite as well as the effect regarding oral-health-related quality of life (OHRQoL), lip closure, incidence of trauma, and skeletal changes.TRIAL DESIGN: Two-arm parallel group single-centre randomized controlled trial.MATERIAL AND METHODS: A total of 60 children (mean age 9.5 years) presenting a Class II malocclusion with excessive overjet were recruited. The trial was designed as intention-to-treat and the participants randomized by an independent person not involved in the trial to either early treatment with headgear activator or to an untreated control group (UG). Dental and skeletal variables as well as registrations of OHRQoL, lip closure, and incidence of trauma were recorded. For the treatment group, data were registered at baseline before treatment and when treatment was finished, corresponding to approximately 2 years. For the UG, registrations were made at baseline and at 11 years of age. Observers were blinded to treatment allocation when assessing outcomes.RESULTS: Early treatment with headgear activator significantly decreased overjet and improved molar relationship when compared with untreated controls. The effects were primarily due to dentoalveolar changes. Early treatment had no evident effect regarding OHRQoL, lip closure, or incidence of trauma. Lack of cooperation resulted in unsuccessful treatments for 27% of the patients.LIMITATIONS: The trial was a single-centre trial and can thus be less generalizable.CONCLUSIONS: The main treatment effect of early headgear activator treatment of Class II malocclusion with excessive overjet is reduction of overjet.TRIAL REGISTRATION: NCT04508322.
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| 6. |
- Kallunki, Jenny, 1978-
(author)
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Early Treatment of Class II Malocclusion With Excessive Overjet : evaluating oral health-related quality of life, randomised controlled trials on headgear activator treatment and costs
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Class II malocclusion with excessive overjet is one of the most common malocclusions among children and adolescents. In addition to increasing the risk for dental trauma, the malocclusion can also be related to bullying due to the prominent maxillary incisors. The treatment for a Class II malocclusion can be initiated at different ages and with different treatment strategies, but the treatment timing has often been, and still is, discussed within the orthodontic profession and literature. Research reports that an early treatment approach, initiated in mixed dentition and often including an additional phase of treatment in permanent dentition, reduces the incidence of dental trauma. Otherwise, no differences in treatment effects have yet been seen between treatment that is started early in mixed dentition or treatment initiated later in permanent dentition. During the last decades, there has been an increased focus on patient-reported outcomes within orthodontic research. The patient perspective and economic evaluations of performed treatment are areas where knowledge gaps can be found in the available research. This thesis is based on four studies. The studies were designed with high level of methodology and validity as a priority and with the objective to identify and address knowledge gaps related to the impact of Class II malocclusion with excessive overjet and a subsequent early treatment with headgear activator. Firstly, a systematic review addressing treatment effects was performed. This was followed by the implementation of two randomised controlled trials (RCTs) with the aims to evaluate treatment effects and self-perceived oral health-related quality of life (OHRQoL) as well as the cost associated with treatment. In addition, a clinical controlled trial was performed to assess the self-perceived OHRQoL for children with Class II malocclusion with excessive overjet, and compare to children with unilateral posterior crossbite or normal occlusion with no or mild orthodontic treatment need. The papers referred to in this thesis: Paper I. A systematic literature review performed to evaluate the evidence supporting early treatment (before the age of 10) of Class II malocclusion. The search included four data bases and spanned from January 1960 to October 2017. Paper II. A clinical controlled multicenter trial with the objective to investigate the OHRQoL among 9-year-old children in mixed dentition and to compare the self-perceived OHRQoL by the use of the Child Perceptions Questionnaire (CPQ). Evaluation and comparisons were made for children with Class II malocclusion with excessive overjet (EO), children with unilateral posterior crossbite (UPC), and children with normal occlusion (NO) presenting with no or mild orthodontic treatment need. The sample consisted of 229 children, sourced from 19 Public Dental Service Clinics in Sweden and covering a range of demographic areas.A single centre RCT designed to evaluate the effects of headgear activator treatment and the associated costs forms the basis of the final two papers: Paper III. The effects of early headgear activator treatment was compared to an untreated control group. The sample consisted of 60 children presenting with a Class II malocclusion with excessive overjet. Primary outcome was the reduction of overjet and overbite as well as effects regarding oral health-related quality of life, lip closure, incidence of trauma, and skeletal changes.Paper IV. The costs and treatment effects of headgear activator treatment started in the mixed or late mixed dentition was registered and compared. The sample consisted of 51 children starting treatment at 9 or 11 years of age. The primary outcome measure was comparison of the treatment costs between the two groups. Secondary outcomes were comparisons of oral health-related quality of life, dental and skeletal treatment effects, lip closure, and trauma incidence. The following conclusions were drawn: There is medium to high level of evidence, depending on treatment appliance, that early treatment reduces overjet and improves antero-posterior skeletal relationship, but currently, insufficient evidence is available regarding the effects of early treatment on OHRQoL, incidence of trauma, soft tissue profile, or treatment-related costs. There is a knowledge gap with respect to long-term outcome and the stability of early treatment.Children with Class II malocclusion with excessive overjet report significantly lower self-perceived OHRQoL compared to children with unilateral posterior crossbite or normal occlusion, with the domains of social and emotional well-being being most affected. The children in all three groups reported generally low CPQ scores, which implies an overall fairly good self-perceived OHRQoL.Early treatment with headgear activator was successful in reducing overjet and correcting molar relationship. Early treatment did not result in any significant difference regarding self-reported OHRQoL, lip closure, or incidence of trauma when compared to the untreated control group.The costs associated with headgear activator treatment, as well as the treatment effects, were equivalent regardless of whether treatment was started at 9 or 11 years of age. The most pronounced treatment effects were reduction of overjet and correction of molar relationship, whereas the treatment effects regarding OHRQoL, lip closure, and trauma incidences were found to be modest.With costs and treatment effects being equivalent, an early treatment approach can be advocated to enhance trauma prevention.
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| 7. |
- Kallunki, Jenny, et al.
(author)
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Oral health-related quality of life among children with excessive overjet or unilateral posterior crossbite with functional shift compared to children with no or mild orthodontic treatment need.
- 2019
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In: European Journal of Orthodontics. - : Oxford Academic. - 0141-5387 .- 1460-2210. ; 41:2, s. 111-116
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Journal article (peer-reviewed)abstract
- Objectives: To compare Oral health-related quality of life (OHRQoL) among 9-year-old children with excessive overjet (EO) to children with unilateral posterior crossbite (UPC) and children with normal occlusion (NO). Materials and methods: The study sample sourced from 19 Public Dental Service Clinics in Sweden. Reported are baseline data originating from two controlled trials, one regarding UPC and the other focusing on EO. The NO children derive from the same trials. The UPC group comprised 93 children (45 boys and 48 girls), the EO group 71 children (36 boys and 35 girls), and the NO group 65 children (32 boys and 33 girls). In conjunction to a clinical examination, all children completed the Child Perceptions Questionnaire (CPQ8-10) for evaluation of OHRQoL. The CPQ8-10 comprises 25 questions grouped into four domains: oral symptoms, functional limitations, emotional, and social well-being. Validated questions about pain in the jaws and face were also included. Results: The total mean CPQ score was 5.1 for the UPC, 7.4 for the EO, and 4.4 for the NO group, showing a significant difference between the UPC and EO (P = 0.048) and between EO and NO group (P = 0.012). These differences remained when adjusted for the confounders' caries, trauma, enamel defects, and headache. No difference between UPC and NO was found. The EO children also reported significantly higher scores in the domains emotional and social well-being (P = 0.039 and P = 0.012). Limitations: The study would be strengthened if a longitudinal design had been performed. Conclusion: Children with EO reported significantly lower OHRQoL compared to children with UPC or NO. The children generally reported low CPQ scores that imply an overall fairly good OHRQoL.
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| 8. |
- Larsson, Pernilla, et al.
(author)
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Development of an Orofacial Esthetic Scale in Prosthodontic Patients
- 2010
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In: International Journal of Prosthodontics. - : Quintessence Publishing Co Ltd. - 0893-2174 .- 1139-9791. ; 23:3, s. 249-256
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Journal article (peer-reviewed)abstract
- Purpose: Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (DES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scales measurement model. Materials and Methods: After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the DES. Exploratory factor analysis was performed to investigate DES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. Results: Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the DES. Conclusions: The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.
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| 9. |
- Larsson, Pernilla, et al.
(author)
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The Impact of Orofacial Appearance on Oral Health Related Quality of Life : A Systematic Review
- 2021
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In: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:3, s. 271-281
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Journal article (peer-reviewed)abstract
- Esthetics in the orofacial region is important for perceived oral health and a common reason for treatment of discoloured, missing or crowded teeth. As one of the fundamental bricks of a patient's oral health, changes in the domain of orofacial esthetics resides within the Oral Health Related Quality of Life (OHRQoL) of an individual. Four main dimensions, Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact, are suggested to cover the concept of OHRQoL. The aim of this systematic review was to map the impact from oral conditions with principal impact on the Orofacial Appearance dimension of OHRQoL (PROSPERO: CRD42017064033). Publications were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with esthetic treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss or tooth whitening. A search in PubMed (Medline), EMBASE, Cochrane, CINAHL, and PsycINFO June 8, 2017 and updated January 14, 2019, identified 2,104 abstracts. After screening of abstracts, 1,607 articles were reviewed in full text and 33 articles included. These 33 articles reported OHIP-data for 9,409 patients grouped in 63 patient populations. Median orofacial appearance impact scores on a standardized 0 to 8 scale, for populations with treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss and tooth whitening, ranged from 0.13 for tooth wear to 3.04 for tooth whitening populations. In conclusion, a moderate impact for the Orofacial Appearance dimension of OHRQoL was found in patients with different conditions with esthetically related treatment need.
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| 10. |
- Mohlin, Bengt, 1944, et al.
(author)
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TMD in relation to malocclusion and orthodontic treatment.
- 2007
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In: The Angle orthodontist. - : The E. H. Angle Education and Research Foundation. - 0003-3219 .- 1945-7103. ; 77:3, s. 542-8
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this systematic literature review was to evaluate associations between different malocclusions, orthodontic treatment, and signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: This review was part of a project at the Swedish Council on Technology Assessment in Health Care focusing on malocclusion and orthodontic treatment from a health perspective. As a first step, the literature was searched in the Medline and Cochrane Library databases from 1966 to May 2003. A later update was made in January 2005. Human studies in English or in Scandinavian languages were included. RESULTS: Associations between certain malocclusions and TMD were found in some studies, whereas the majority of the reviewed articles failed to identify significant and clinically important associations. TMD could not be correlated to any specific type of malocclusion, and there was no support for the belief that orthodontic treatment may cause TMD. Obvious individual variations in signs and symptoms of TMD over time according to some longitudinal studies further emphasized the difficulty in establishing malocclusion as a significant risk factor for TMD. A considerable reduction in signs and symptoms of TMD between the teenage period and young adulthood has been shown in some recent longitudinal studies. CONCLUSIONS: Associations between specific types of malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.
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