| 1. |
- John, Mike T., et al.
(författare)
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Mapping Oral Disease Impact with a Common Metric (MOM)—Project summary and recommendations
- 2021
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:3, s. 305-307
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Tidskriftsartikel (refereegranskat)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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| 2. |
- John, M. T., et al.
(författare)
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Recommendations for use and scoring of oral health impact profile versions
- 2022
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Ingår i: Journal of Evidence-Based Dental Practice. - Philadelphia, PA, United States : Elsevier. - 1532-3382 .- 1532-3390. ; 22:1
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Tidskriftsartikel (refereegranskat)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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| 3. |
- Kallunki, Jenny, et al.
(författare)
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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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Ingår i: European Journal of Orthodontics. - Oxford, United Kingdom : Oxford University Press. - 0141-5387 .- 1460-2210. ; 44:1, s. 86-94
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Tidskriftsartikel (refereegranskat)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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| 4. |
- Kallunki, Jenny, et al.
(författare)
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Early headgear activator treatment of Class II malocclusion with excessive overjet : a randomized controlled trial.
- 2021
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 43:6, s. 639-647
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Tidskriftsartikel (refereegranskat)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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| 5. |
- Kallunki, Jenny, 1978-
(författare)
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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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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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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| 6. |
- Larsson, Pernilla, et al.
(författare)
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The Impact of Orofacial Appearance on Oral Health Related Quality of Life : A Systematic Review
- 2021
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 48:3, s. 271-281
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Tidskriftsartikel (refereegranskat)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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| 7. |
- Lucchese, Alessandra, et al.
(författare)
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Efficacy of the Cervical Vertebral Maturation Method: A Systematic Review
- 2022
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Ingår i: Turkish Journal of Orthodontics. - : AVES Publishing. - 2528-9659 .- 2148-9505. ; 35:1, s. 55-66
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Forskningsöversikt (refereegranskat)abstract
- Objective: The present systematic review was carried out to evaluate both qualitatively and quantitatively the effectiveness of the cervical vertebral maturation (CVM) method in predicting the pubertal growth spurt.Methods: PubMed, PMC, Scopus, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were searched. The research included every article published from 1970 to June 2019, featuring the keywords: (“cervical vertebrae” OR (“cervical” AND “vertebrae”) AND (“orthodontics” OR “growth and development” OR (“growth” AND “development”) OR (“growth”). The Preferred Reporting Items for Reporting Systematic Reviews and Meta Analyses (PRISMA) protocol was adopted, and quality assessments modified from the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) and the “Standards for the Reporting of Diagnostic Accuracy Studies” (STARD) were performed to conduct this systematic review.Results: Initially, 1284 articles were found. All the articles were then examined, and 43 studies met the inclusion criteria. Sixteen articles had low-quality scores, 25 had moderate scores, and 2 had high scores. The results showed a moderate to high statistically significant correlation between the CVM and other maturation methods.Conclusion: Overall, the CVM method can be considered an effective method and may be used with other skeletal indices for the radiographic assessment of skeletal maturity, and also to identify the growth peak in growing patients.
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| 8. |
- Lucchese, Alessandra, et al.
(författare)
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The Influence of Orthodontic Treatment on Oral Microbiology
- 2021. - 3
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Ingår i: Biological Mechanisms of Tooth Movement. - : John Wiley & Sons. - 9781119608936 - 9781119608912 ; , s. 139-158
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Bokkapitel (refereegranskat)abstract
- The positioning of biomaterials in the oral cavity, such as prostheses or orthodontic appliances, can induce alterations to the oral microbiota. Orthodontic appliances have been associated with increased cariogenic risk and exacerbation of pre-existing periodontal pathologies. This is because different types of brackets, such as conventional, self-ligating, and lingual brackets, or different bracket materials, such as metallic, ceramic, and plastic, or also removable orthodontic appliances, can often cause colonization of bacteria followed by enamel demineralization and gingival inflammation. Hence, insertion of orthodontic appliances may result in an increase in retentive sites at which the bacterial plaque and potentially pathogenic species, such as periodontal or cariogenic bacteria or fungi, are able to proliferate more easily, damaging oral health and potentially general health.Another significant variable for microbial alterations is the duration the device is used inside the oral cavity; for this reason, it is evident that removable appliances have a significantly lower impact on oral microorganisms than fixed orthodontic appliances. Although changes taking place in the microbial system involve all types of orthodontic appliances, changes occur more rapidly during fixed orthodontic treatment; such alterations can be recorded only a few months after the start of treatment and can lead to deterioration in periodontal health. Furthermore, being able to remove the orthodontic appliance in order to clean both the appliance and the teeth seems to be more important for maintaining oral health than the duration of treatment.Considering the variations in the microbiota which occur with the introduction of biomaterials in the oral cavity, in particular orthodontic appliances, it is appropriate for patients to undergo personalized hygiene protocols so that the oral bacterial load is controlled and the risk of developing carious and periodontal disease is reduced.
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| 9. |
- Naraghi, Sasan, et al.
(författare)
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Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines : a randomised controlled trial
- 2021
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 43:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate whether retention is needed after orthodontic treatment of impacted maxillary canines.Trial design: Two-arm parallel group single-centre randomized controlled trial.Materials and methods: Sixty-three patients, 39 girls and 24 boys, were recruited to the study. The inclusion criteria were patients with at least one impacted or unerupted maxillary canine, and moderate irregularity of the maxillary six anterior teeth according to Little’s index (LI). After gaining informed consent from the patient and their custodians, the patients were randomized to one of two groups, i.e. to a non-retention group or a retention group. The randomization process was prepared and carried out by an independent person not involved in the trial and the randomization used blocks of 20 (10 + 10). Primary outcomes were changes in single contact point discrepancy, and LI measured on digitalized three-dimensional study casts 1-year post-treatment. The study casts were anonymized before assessment and the changes were blinded for the assessor. Data were evaluated on an intention-to-treat basis. Thus, all randomized patients were incorporated into the final analysis. In the non-retention group a 10-week interim period was used to detect patients who eventually have a relapse immediately after treatment. If so, the patient got the arch-wire reinserted. Most patients in the retention group received a vacuum-formed retainer and pretreatment spacing cases got a bonded retainer.Results: Mean irregularity change was 0.4 mm in the retention and 1.3 mm in the non-retention group (P < 0.001). Maximum change was 2.5 mm in the retention and 3.2 mm in the non-retention group (P < 0.001). Most changes in the non-retention group occurred during the 10-week interim period. In the non-retention group, one patient developed contact point discrepancy of >2 mm during the interim period and was realigned.HarmsOne patient met the stopping guideline criteria. This patient had the arch wire reinserted for 2 months. After realignment, the patient received a retention appliance.LimitationsThe trial was a single-centre study and short-term changes were evaluated.Conclusions: Changes between the retention and the non-retention group were statistically but not clinically significant. Since satisfactory clinical results 1-year post-treatment were found in the non-retention group, retention does not appear to be needed. The 10-week interim period was useful in detecting patients who might have a relapse immediately after treatment.Trial registration: The trial was not registered.
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| 10. |
- Naraghi, Sasan, et al.
(författare)
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Stability of maxillary anterior teeth after two years of retention in adolescents : a randomised controlled trial comparing two bonded and a vacuum-formed retainer
- 2021
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 43:2, s. 152-158
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Tidskriftsartikel (refereegranskat)abstract
- Background: Retention of the maxillary anterior teeth is commonly recommended to maintain the teeth in their corrected positions. Both fixed and removable retention methods are used, but the certainty of evidence is low.Objective: To evaluate post-treatment changes in irregularity of the maxillary six anterior teeth and single tooth contact point discrepancy (CPD) of three different retention methods.Trial design: Three-arm parallel group single-centre randomized controlled trial.Materials and methods: Ninety patients, 54 girls and 36 boys, were recruited to the study. The inclusion criteria were adolescent patients treated with fixed appliances at least in the maxilla. After gaining informed consent from the patient and their custodians, the patients were randomized to one of three groups: bonded retainer 13–23, bonded retainer 12–22, and removable vacuum-formed retainer (VFR) covering the maxillary teeth including the second molars. The randomization, prepared by an independent person, used blocks of 30. The primary outcomes were changes in single CPD and Little’s irregularity index (LII) measured on digitalized three-dimensional study casts before and after 2-year retention. The study casts were anonymized before assessment and the changes were blinded for the assessor. Data were evaluated on an intention-to-treat basis. Thus, all randomized patients were incorporated into the final analysis.Results: The LII and CPDs increased slightly in all three groups without any statistically significant differences between the groups. The VFR group showed a small intercanine width increase and some more changes of canine rotations than in the other groups.Harms: No harm was observed in any subjects and none of the patients needed retreatment.Limitations: The trial was a single-centre study and short-term changes were evaluated.Conclusions: All three retention methods showed equally effective retention capacity and all the changes found in the three groups were small and considered clinically insignificant. Thus, the null hypothesis was confirmed. All three methods can be recommended.Trial registration: NCT04616755
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