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  • 1.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD). Ministry of Health, Kuwait.
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    Hawthorne effect reporting in orthodontic randomized controlled trials: truth or myth? Blessing or curse?2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 5, p. 475-479Article, review/survey (Refereed)
    Abstract [en]

    Objective To investigate in 10 orthodontic journals how many randomized controlled trials (RCTs) considered the Hawthorne effect, and if considered, to determine whether it was related to the patients or the therapists involved in the trial and, finally, to discuss the Hawthorne effect in an educational way. Materials and methods A search was performed on the Medline database, via PubMed, for publication type ‘randomized controlled trial’ published for each journal between 1 August 2007 and 31 July 2017. The American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, Australian Orthodontic Journal, Dental Press Journal of Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, Journal of Orofacial Orthopedics, Korean Journal of Orthodontics, Orthodontics and Craniofacial Research and Progress in Orthodontics were assessed. Two independent reviewers extracted the data and identified whether the Hawthorne effect was considered or discussed in the articles and whether the Hawthorne effect was related to the behaviour of the patients, the therapists, or both. Results The initial search generated 502 possible trials. After applying the inclusion and exclusion criteria, 290 RCTs were included and assessed. The Hawthorne effect was considered or discussed in 10 of 290 RCTs (3.4%), and all were related to the patients’ and none to the therapists’ behaviour. Conclusions The Hawthorne effect reported in orthodontic RCTs was suboptimal. The researchers’ lack of knowledge about this phenomenon is evident, despite evidence that the Hawthorne effect may cause over-optimistic results or false-positive bias.

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  • 2.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD). Ministry of Health, Kuwait.
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    The reporting of blinding in orthodontic randomized controlled trials: where do we stand?2019In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 1, p. 54-58Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse in 10 orthodontic journals how many randomized controlled trials (RCTs) performed 'single-', 'double-', 'triple-', or 'outcome assessors blinding' and to evaluate, from the number of RCTs that did not conduct blinding, how many could actually have achieved it. Material and methods: Randomized controlled trials published in 10 orthodontic journals between 1 September 2012 and 28 February 2018 were included. A search was performed in PubMed and conducted for publication type 'randomized controlled trial' for each journal. Two reviewers independently analysed each RCT and registered that blinding was performed and included which specific type. It was also evaluated whether misclassifications of blinding items occurred and whether it was possible to achieve blinding among the RCTs that did not perform blinding. Results: After applying the inclusion criteria, 203 RCTs were assessed, and 61.6 per cent of them had used blinding, with the main type being 'outcome assessors blinding' (40.4%) followed by 'single-blinding' (15.3%), 'double-blinding' (2.5%), and 'triple-blinding' (3.4%). In 38.4 per cent of the trials, no blinding was performed; however, 79.4 per cent of them could have achieved blinding. Fifteen RCTs (7.3%) misclassified the blinding in relation to single-, double-, or triple-blinding. Journals followed the CONSORT (AJODO, EJO, JO, OCR) published together significantly more RCTs that performed blinding than journals not following the CONSORT. Conclusions: Blinding of outcome assessors was the most frequent type, as orthodontic trials are often of intervention design and thereby difficult to mask for patients and trial staff. The misclassifications of blinding items may indicate suboptimal knowledge among researchers and peer-reviewers regarding the definitions for diverse blinding types.

  • 3.
    Abdulraheem, Salem
    et al.
    Malmö University, Faculty of Odontology (OD). Al-Jahra Specialty Dental Center, Ministry of Health, Kuwait.
    Schütz-Fransson, Ulrike
    Orthodontic Clinic, Uddevalla Hospital, Jönköping, Sweden.
    Bjerklin, Krister
    Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes?2020In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 42, no 1, p. 52-59, article id cjz020Article in journal (Refereed)
    Abstract [en]

    AIMS: To identify if lower incisor movements after orthodontic treatment are due to the relapse of the orthodontic treatment or due to natural growth. SUBJECTS AND METHODS: The subjects consisted of 92 patients who have had orthodontic treatment, divided into three groups, group 1: 38 individuals had no retainer in the lower jaw. Group 2: 24 individuals had a retainer 0.028 inch, a spring hard wire bonded to the mandibular canines only. Group 3: 30 individuals had a 0.0195-inch Twist-Flex wire, bonded to all mandibular incisors and canines. Study models before orthodontic treatment (T0), immediately after orthodontic treatment (T1), 6 years after orthodontic treatment (T2), and 12 years after orthodontic treatment (T3) were used for the measurements. The wires in groups 2 and 3 were removed after mean 2.6 years (SD 1.49). Little Irregularity Index (LII), inter-canine distance, available mandibular anterior space, and number of crowded incisors were registered. A Tooth Displacement Index (TDI) was developed to measure the tooth displacement directions at T0 and T3. RESULTS: The LII showed equal values before treatment (T0) and at the follow-up registrations (T2 and T3). But about 25 per cent of the tooth displacements at T2 and T3 did not exist before treatment, at T0. This indicates usual growth changes and not relapse of the orthodontic treatment. CONCLUSION: As about 25 per cent of the displaced incisors can be considered as an effect of natural growth, not a relapse of the orthodontic treatment, it is valuable to use a displacement index in combination with other variables for investigations of stability after orthodontic treatment. Importance of the present study is that it is possible to differ between relapse and usual growth changes.

  • 4.
    Abrahamsson, Cecilia
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Henrikson, Thor
    Malmö högskola, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Ekberg, EwaCarin
    Malmö högskola, Faculty of Odontology (OD).
    Masticatory function in patients with dentofacial deformities before and after orthognathic treatment: a prospective, longitudinal, and controlled study2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 1, p. 67-72Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to investigate the self-estimated masticatory ability and masticatory performance in patients with dentofacial deformities before and after orthognathic treatment; in comparison to an age- and gender-matched control group. SUBJECTS AND METHODS: The masticatory ability and masticatory performance were evaluated in 121 consecutive patients (treatment group), referred for orthognathic treatment. Eighteen months after treatment, 98 patients (81%) completed a follow-up examination. Masticatory ability was assessed on a visual analog scale, while the masticatory performance was evaluated by a masticatory test using round silicon tablets. Signs and symptoms of temporomandibular disorders (TMD) were registered by a clinical examination and a questionnaire. The control group comprised 56 age- and gender-matched subjects who were examined at baseline. RESULTS: At the baseline examination, the treatment group had a significantly lower masticatory ability and performance compared with the control group. After treatment, the masticatory ability significantly improved in the treatment group and reached the same level as in the control group. The masticatory performance index increased significantly but was still lower than in the control group. Both the masticatory ability and masticatory performance were affected by the number of occlusal contacts during maximal biting pressure and by the self-estimated overall symptoms of TMD. CONCLUSIONS: Patients with dentofacial deformities, corrected by orthognathic treatment, have a significant positive treatment outcome in respect of masticatory ability and masticatory performance. Furthermore, the occlusion and symptoms of TMD have an impact on both masticatory ability and masticatory performance.

  • 5. Ahlqvist, Jan
    et al.
    Eliasson, S
    Welander, U
    The effect of projection errors on cephalometric length measurements1986In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 8, no 3, p. 141-148Article in journal (Refereed)
    Abstract [en]

    The magnitude of projection errors, calculated theoretically on length measurements in cephalometry was studied. Rotation of the object by up to 5° from the proper position, resulted in errors in length measurements that were usually less than one percent. Rotations of more than 5° may increase the error but imply misalignments of the head that should be evident when positioning the patient. The advantage of extremely long focus film distances seems doubtful.

  • 6. Ahlqvist, Jan
    et al.
    Eliasson, S
    Welander, Ulf
    The effect of projection errors on angular measurements in cephalometry.1988In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 10, no 4, p. 353-61Article in journal (Refereed)
  • 7.
    Algharbi, Muteb
    et al.
    Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Bazargani, Farhan
    Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Dimberg, Lillemor
    Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Do Different Maxillary Expansion Appliances Influence the Outcomes of the Treatment?2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 1, p. 97-106Article, review/survey (Refereed)
    Abstract [en]

    Background and objectives: There is no consensus in the literature regarding which rapid maxillary expansion (RME) design or activation rate benefits the patients the most. Therefore, the primary aim of this systematic review was to see whether there is a difference in the skeletal and dentoalveolar effects of different RME appliances in children and growing adolescents. The secondary aim was to see whether these effects are different when using different activation protocols for these appliances. Data collection and analysis: The search was done in three databases (PubMed, Cochrane Library, and Web of Science). The following inclusion criteria were used: randomized controlled trial, prospective controlled studies, 15 or more patients in each study, human subjects up to 18 years of age, and RME effects had to be assessed by computed tomography/cone beam computed tomography. Study appraisal and synthesis methods: Quality of the methodology was classified according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines as high, moderate, or low. Results: The search resulted in 145 titles and abstracts; 109 of them were excluded based on pre-established criteria. Thirty-six full-text articles were assessed for eligibility and 18 of which satisfied the inclusion criteria. Finally, seven articles were deemed eligible for full inclusion and revealed that all appliances and protocols showed significant expansion in the mid-palatal suture. No evidence was found for the cause of dental tipping. Limitations: In this systematic review, having different age groups in each study and using different anatomical landmarks and outcome measures for assessing the skeletal and dental effects made it difficult to conduct a meta-analysis. Conclusions: There is moderate evidence that all designs produce significant expansion at the mid-palatal suture. However, lack of studies comparing appliances and protocols has been found. Finally, no evidence-based conclusions could be drawn about the appliance effect on teeth tipping.

  • 8.
    Al-Taai, Nameer
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Orthodontics, Department of Odontology, Umeå University, Umeå, Sweden.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology. Orthodontics, Department of Odontology, Umeå University, Umeå, Sweden.
    Ransjö, Maria
    Umeå University, Faculty of Medicine, Department of Odontology. Orthodontics, Department of Odontology, Umeå University, Umeå, Sweden;Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology. Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden.
    Fors, Ronny
    Umeå University, Faculty of Medicine, Department of Odontology. Orthodontics, Department of Odontology, Umeå University, Umeå, Sweden.
    Westerlund, Anna
    Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Craniofacial changes from 13 to 62 years of age2022In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 44, no 5, p. 556-565Article in journal (Refereed)
    Abstract [en]

    Background: In long-term studies of orthodontic, orthognathic, and prosthodontic treatments, control subjects are needed for comparison.

    Objectives: To study the craniofacial (skeletal, soft tissue, and dental) changes that occur in untreated subjects with normal occlusion between13 and 62 years of age.

    Materials/Methods: Thirty subjects with a Class I normal occlusion and harmonious facial profle were studied. X-ray examinations were performed at 13 (T1), 16 (T2), 31 (T3), and 62 (T4) years of age, and data were obtained from cephalograms. In total, 53 angular and linear parameters were measured using superimposition-based and conventional cephalometric methods to describe the craniofacial changes.

    Results: The jaws showed signifcant anterior growth from T1 to T2, and signifcant retrognathism from T3 to T4. The anterior face height andjaw dimensions increased signifcantly until T3. Signifcant posterior rotation of the mandible and opening of the vertical jaw relation, in additionto signifcant retroclination of the incisors and straightening of the facial profle, were found from T3 to T4.Limitations: Given the small sample size at T4, it was not possible to analyse the gender dimension.

    Conclusions/Implications: Craniofacial changes continue up to the sixth decade of life. These changes are consistent, albeit to a lesser extent,with the adolescent growth patterns for most of the studied parameters, with the exceptions of incisor inclination, sagittal jaw position, verticaljaw relation and inclination, and posterior face height.

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  • 9.
    Al-Taai, Nameer
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology.
    Ransjö, Maria
    Umeå University, Faculty of Medicine, Department of Odontology. Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Levring Jäghagen, Eva
    Umeå University, Faculty of Medicine, Department of Odontology.
    Westerlund, Anna
    Department of Orthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dentoskeletal and soft tissue changes after treatment of crowding with premolar extractions: a 50-year follow-up2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 1, p. 79-87Article in journal (Refereed)
    Abstract [en]

    Background: The long-term effects on dentofacial morphology of interceptive treatment with premolar extractions, in the absence of subsequent orthodontic treatment, have not been fully explored.

    Objective: The aim was to investigate the effects of premolar extractions (without subsequent orthodontic treatment) on the dentoskeletal and soft tissue profile of patients aged between 12 and 62 years with Class I malocclusion with severe crowding, as compared to untreated controls.

    Materials and methods: The Extraction group (N = 30 with Class I crowding malocclusion) had their first premolars removed in early adolescence without subsequent orthodontic treatment. The Control group included 30 untreated subjects with Class I normal occlusion. Cephalograms were taken at 12 (T1), 15 (T2), 30 (T3), and 62 (T4) years of age. A superimposition-based cephalometric method was used to assess the dentoskeletal and soft tissue changes.

    Results: There were no significant differences between the Extraction and Control groups in terms of skeletal sagittal relation, incisor inclination, and protrusion, or most of the soft tissue parameters throughout the observation period. However, significant differences were observed between the groups with respect to the vertical relations in T2-T3, such that the Extraction group showed more-pronounced decreases in the ML/NSL, ML/NL, and Gonial angles and more-pronounced increases in facial heights.

    Conclusions and implications: Treatment for subjects with Class I malocclusion with severe crowding by the extraction of four premolars, without subsequent orthodontic treatment, does not affect the long-term dentoskeletal and soft tissue profile, as compared to an untreated Control group. The degree of crowding, rather than changes in dentofacial morphology, is crucial in deciding on extraction therapy.

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  • 10.
    Bayat, Jari Taghavi
    et al.
    Karolinska Inst, Dept Dent Med, Div Orthodont, SE-14104 Huddinge, Sweden.
    Huggare, Jan
    Karolinska Inst, Dept Dent Med, Div Orthodont, SE-14104 Huddinge, Sweden.
    Mohlin, Bengt
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Orthodont, Gothenburg, Sweden.
    Akrami, Nazar
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Determinants of orthodontic treatment need and demand: a cross-sectional path model study2017In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 39, no 1, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Objectives: To put forward a model predicting orthodontic treatment need and demand. Furthermore, to explore how much of the variance in treatment demand could be explained by a set of self-assessed measures, and how these measures relate to professionally assessed treatment need. Subjects and methods: One hundred and fifty adolescents, aged 13 years, completed a questionnaire which included a set of self-assessed measures dealing with self-esteem, such as dental and global self-esteem, various aspects of malocclusion, such as perceived malocclusion and perceived functional limitation, and treatment demand. Treatment need was assessed by Dental Health Component of the Index of Orthodontic Treatment Need grading. Path analysis was used to examine the relations between the measures and if they could predict treatment need and demand. Results: The measures proved to be reliable and inter-correlated. Path analysis revealed that the proposed model had good fit to the data, providing a test of the unique effect of all included measures on treatment need and demand. The model explained 33% of the variance in treatment demand and 22% of the variance in treatment need. Limitations: The specific age group could affect the generalizability of the findings. Moreover, although showing good fit to data, the final model is based on a combination of theoretical reasoning and semi-explorative approach. Conclusions: The proposed model displays the unique effect of each included measure on treatment need and demand, explaining a large proportion of the variance in perceived treatment demand and professionally assessed treatment need. The model would hopefully lead to improved and more cost-efficient predictions of treatment need and demand.

  • 11.
    Bazargani, Farhan
    et al.
    Örebro University Hospital. Örebro University, School of Health Sciences. Department of Orthodontics, Postgraduate Dental Education Center.
    Knode, Vanessa
    Private orthodontic office, Traben-Trarbach, Germany.
    Plaksin, Alexander
    Private orthodontic office, Moscow, Russia.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ludwig, Björn
    Private orthodontic office, Traben-Trarbach, Germany; Department of Orthodontics, University of Saarland, Homburg/Saar, Germany.
    Three-dimensional comparison of tooth-borne and tooth-bone-borne RME appliances: a randomized controlled trial with 5-year follow-up2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 6, p. 690-702Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare the long-term skeletal effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion in growing children, using 3D imaging.

    Materials and methods: In total, 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (SD 1.3), or the TBB group, mean age 9.5 years (SD 1.2). Cone-beam computed tomography records and plaster models were taken before (T-0), directly after (T-1), 1 year after (T-2), and 5 years after expansion (T-3).

    Randomization: Participants were randomly allocated in blocks of different sizes, using the concealed allocation principle in a 1:1 ratio. The randomization list was also stratified by sex to ensure homogeneity between groups.

    Blinding: Due to clinical limitations, only the outcome assessors were blinded to the groups to which the patients were allocated.

    Results: At T-1, the midpalatal suture at its anterior part showed a statistically significant difference between the groups with a mean of 0.6 mm (CI 0.2-1.1) more expansion in the TBB group (P < 0.01). This difference was also more evident in boys at T-1 with a mean of 0.8 mm (CI 0.2-1.4) (P < 0.01). These differences, however, blotted out at T-2 and T-3. The nasal width also showed similar differences between the groups, with a significantly larger expansion in the TBB group by a mean of 0.7 mm (CI 0.1-1.4) (P = 0.03). This group difference in favour of the TBB group was maintained at T-2 (1.6 mm) and T-3 (2.1 mm) (P < 0.01 T-2 and T-3, respectively).

    Conclusions: Skeletal expansion in the midpalatal suture was significantly higher in the TBB group; however, the magnitude of this expansion was around 0.6 mm more and may not be clinically significant. Skeletal expansion at the level of the nasal cavity was significantly higher in the TBB group. There were no differences between boys and girls with regard to skeletal expansion.

  • 12.
    Bazargani, Farhan
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden..
    Lund, Henrik
    Institute of Odontology, Sahlgrenska Academy, Department of Oral and Maxillofacial Radiology, University of Gothenburg, Göteborg, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Sweden.
    Ludwig, Björn
    Private Orthodontic Office, Traben-Trarbach, Germany; Department of Orthodontics, University of Saarland, Homburg/Saar, Germany.
    Skeletal and dentoalveolar effects using tooth-borne and tooth-bone-borne RME appliances: a randomized controlled trial with 1-year follow-up2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 3, p. 245-253Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate and compare the skeletal and dentoalveolar effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion (RME).

    MATERIALS AND METHODS: Fifty-two consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years [standard deviation (SD) 1.3], or the TBB group, mean age 9.5 years (SD 1.2). Cone-beam computed tomography (CBCT) records and plaster models were taken before (T0), directly after (T1), and 1 year after expansion (T2). Dentoalveolar and skeletal measurements were made on the CBCT images. The dental expansion was also measured on the plaster models.

    RANDOMIZATION: Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. The randomization list was also stratified by sex to ensure homogeneity between groups.

    BLINDING: Due to clinical limitations, only the outcomes assessors were blinded to the groups to which the patients were allocated.

    RESULTS: Skeletal expansion in the midpalatal suture and at the level of the nasal cavity was significantly higher in the TBB group. However, the magnitude of the expansion in the midpalatal suture was around 1 mm [95 per cent confidence interval (CI) 0.5-1.7, P = 0.001] more and perhaps not clinically significant. The magnitude of the expansion at the level of the nasal cavity was almost two times higher in the TBB group (95 per cent CI 0.7-2.6, P = 0.001). The dental expansion, alveolar bending, tipping of the molars, and stability 1 year post-expansion did not show any statistically significant differences between the groups. The actual direct cost of the treatment for the TBB group was approximately €300 higher than TB group.

    LIMITATIONS: Double blinding was not possible due to the clinical limitations.

    CONCLUSIONS: In young preadolescents with constricted maxilla and no signs of upper airway obstruction, it seems that conventional TB RME achieves the same clinical results with good stability 1 year post-expansion at lower cost.

    TRIAL REGISTRATION: The trial was not registered.

  • 13.
    Bazargani, Farhan
    et al.
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro Univ Hosp, Örebro, Sweden.
    Dolati, Ali
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Lennartsson, Bertil
    Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden.
    Palatally displaced maxillary canines: factors influencing duration and cost of treatment2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 3, p. 310-316Article in journal (Refereed)
    Abstract [en]

    The purpose of this retrospective study was to assess the relationship between the initial position of palatally displaced canines (PDCs) on panoramic radiographs and the duration of the orthodontic treatment and further to estimate the costs of the treatment. Data from panoramic radiographs and patient records of 66 consecutive patients (mean age 14.9 +/- 1.7 years) with PDC were analysed. The initial position of the canine, the distance between the canine cusp tip and the occlusal plane, and the inclination of the canine were significantly associated with treatment duration both unadjusted and adjusted for background characteristics. The average estimated cost of the treatment of PDC was euro3200 per case. The total annual cost for treatment of PDC in Sweden may therefore be estimated at euro600 0000. In this study, duration of treatment averaged 17 months for canines displaced in impaction zone 1 or 2, 2.6 [95% confidence interval (CI) -1.0 to 6.2] months longer for those in impaction zone 3, and 7.6 (95% CI 4.1-11.1) months longer for canines displaced in impaction zone 4 or 5. This information makes it easier, through study of the panoramic radiograph, to estimate the duration of treatment and to give patients more precise information about the expected length of their treatment.

  • 14.
    Bazargani, Farhan
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthodontics.
    Magnuson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Ludwig, Björn
    Private Orthodontic Office, Traben-Trarbach, Germany; University of Saarland, Homburg, Germany.
    Effects on Nasal Airflow and Resistance Using Two Different RME Appliances: A Randomized Controlled Trial2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 3, p. 281-284Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate and compare the effects of tooth-borne (TB) and tooth-bone-borne (TBB) rapid maxillary expansion (RME) on nasal airflow and resistance. Material and methods: Fifty-four consecutive patients who met the eligibility criteria were recruited from September 2010 to December 2015. Of these 54 subjects, 40 agreed to participate in the part of the study involving evaluation of nasal flow and resistance. The 40 subjects were allocated to either the TB group, mean age 9.7 years (SD 1.5), or the TBB group, mean age 10.2 years (SD 1.4). All subjects performed rhinomanometric registration at baseline (T-0), but only 30 attended the post-expansion registration (T-1), of whom 16 had been randomized to the TB group and 14 to the TBB group. The study outcomes, nasal airflow and nasal airway resistance, were evaluated with linear regression adjusted for baseline variable of the outcome to compare the study groups with complete cases strategy as well as after multiple imputation (MI). Randomization: Participants were randomly allocated in blocks of different sizes, using the concealed allocation principle in a 1:1 ratio. The randomization list was computer generated to ensure homogeneity between groups. Blinding: Blinding was done only for outcome assessor due to clinical limitations. The care providers at the ENT unit who conducted all the rhinomanometry examinations were blinded to which group the patients were allocated to. Results: Complete case analysis showed significantly higher post-expansion nasal airflow values for the TBB group compared with the TB group, mean difference 51.0 cm(3)/s (P = 0.018). The evaluation after MI showed a similar significant mean difference, 52.7 cm(3)/s (P = 0.020) in favour of the TBB group when taking into account the missing values from the T-1 examination. Even reduction in nasal airway resistance showed similar pattern in favour of the TBB group. Limitations: Our results represent the short-term effects. A longer follow-up period would have been preferable. Conclusions: The TBB RME induced significantly higher nasal airway flow and lower nasal resistance values than TB RME. It might be wiser to use TBB RME in cases with constricted maxilla and upper airway obstruction.

  • 15.
    Bazargani, Farhan
    et al.
    Postgraduate Dental Education Center, Örebro, Sweden.
    Magnuson, Anders
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Löthgren, Hanna
    Public Dental Service, Skane County Council, Helsingborg, Sweden.
    Kowalczyk, Agata
    Postgraduate Dental Education Center, Örebro, Sweden.
    Orthodontic Bonding With and Without Primer: A Randomized Controlled Trial2016In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, no 5, p. 503-507Article in journal (Refereed)
    Abstract [en]

    To evaluate the incidence of failure of brackets bonded with and without primer. A single-operator, cross-mouth, randomized controlled trial (RCT). The Orthodontic Department at the Postgraduate Dental Education Centre, A-rebro, Sweden. Ethical approval was granted by the Regional Ethical Review Board, Uppsala, Sweden. The protocol was not published before trial commencement. Fifty consecutive patients requiring bimaxillary orthodontic treatment with fixed appliances and with an equal number of teeth on each side of the dental arch, were included in this RCT. A cross-mouth methodology was applied. In each patient, two diagonal quadrants (i.e. upper right and lower left, or vice versa) were randomly assigned to the primer group (control group) and the contralateral diagonal quadrants to the non-primer group (experimental group). The randomization process was as follows: A computer-manufactured block-randomization list was acquired and stored with a research secretary at the Postgraduate Dental Education Centre. Each time a patient gave consent, the secretary was contacted by e-mail, and information about which quadrants were to be bonded with and without primer was obtained. All incidents of bracket failure and debonding noted in patient records during the 2012-14 observation period were compiled by the other co-author, whom was blinded to the study and did not perform any orthodontic treatment on the study patients. Number of bracket failures over 18 months. Failure rate without primer was 5.5 per cent and with primer 3.1 per cent; P = 0.063, odds ratio (OR) 1.89 [95% confidence interval (CI) 0.97-3.68] in the adjusted model. Younger ages (10-13 years), boys, and mandible were significantly associated with higher failure rates. Interaction tests indicated that younger patients had significantly higher failure rates without (12.1 per cent) than with primer (4.1 per cent), P < 0.001, OR 3.51 (95% CI 1.93-6.38) in the adjusted model. No failure rate differences between study settings were found for older patients (14-18 years). The difference between two groups was powered at 5 per cent. Some clinicians may consider a difference less than 5 per cent clinically significant. Bonding Victory Series (TM) brackets with Transbond (TM) XT with or without Transbond (TM) MIP primer seems overall to work equally well in a clinical setting, except in younger children where lower failure rate was found in the primer setting.

  • 16.
    Bjorksved, Margitha
    et al.
    Publ Dent Hlth Serv, Dept Orthodont, Eskilstuna, Sweden.;Postgrad Dent Educ Ctr, Dept Orthodont, POB 1126, SE-70111 Orebro, Sweden..
    Arnrup, Kristina
    Publ Dent Hlth Serv, Dent Res Dept, Orebro, Region Orebro C, Sweden.;Orebro Univ, Sch Hlth Sci, Orebro, Sweden..
    Bazargani, Silvia Miranda
    Postgrad Dent Educ Ctr, Dept Oral & Maxillofacial Radiol, Orebro, Sweden..
    Lund, Henrik
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Oral & Maxillofacial Radiol, Gothenburg, Sweden..
    Magnusson, Anders
    Inst Postgrad Dent Educ, Dept Orthodont, Jonkoping, Sweden..
    Magnuson, Anders
    Orebro Univ Hosp, Clin Epidemiol & Biostat Unit, Orebro, Sweden..
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Inst Postgrad Dent Educ, Dept Orthodont, Jonkoping, Sweden..
    Bazargani, Farhan
    Postgrad Dent Educ Ctr, Dept Orthodont, POB 1126, SE-70111 Orebro, Sweden.;Orebro Univ, Fac Med & Hlth, Sch Med Sci, Orebro, Sweden..
    Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 487-497Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs). Trial design: Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups. Materials and methods: One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT). Blinding: Due to the nature of this trial, only outcome assessors could be blinded to the intervention group. Results: One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups. Generalizability: Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met. Conclusion: The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups.

  • 17.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Postgraduate Dental Education Centre, Department of Orthodontics, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bazargani, Silvia Miranda
    Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.
    Lund, Henrik
    Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Department of Oral and Maxillofacial Radiology, Göteborg, Sweden.
    Magnusson, Anders
    The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics Unit, Örebro University Hospital, Örebro, Sweden.
    Lindsten, Rune
    Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden; The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Postgraduate Dental Education Center, Department of Oral and Maxillofacial Radiology, Örebro, Sweden.
    Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 487-497Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs).

    TRIAL DESIGN: Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups.

    MATERIALS AND METHODS: One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT).

    BLINDING: Due to the nature of this trial, only outcome assessors could be blinded to the intervention group.

    RESULTS: One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups.

    GENERALIZABILITY: Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met.

    CONCLUSION: The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups.

    CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 18. Björksved, Margitha
    et al.
    Arnrup, Kristina
    Bazargani, Silvia Miranda
    Lund, Henrik
    Magnusson, Anders
    Magnuson, Anders
    Lindsten, Rune
    Bazargani, Farhan
    Open vs closed surgical exposure of palatally displaced canines: a comparison of clinical and patient-reported outcomes-a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 487-497Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare treatment time, patients' perceptions during orthodontic treatment, dental fear and side effects, between open and closed surgical exposures in patients with palatally displaced canines (PDCs).

    Trial Design: Multicentre, randomized controlled trial, with random 1:1 allocation of two parallel groups.

    Materials and Methods: One hundred and twenty patients from three different orthodontic centres were randomized into one of the two intervention arms, open or closed surgical exposure. Both techniques had mucoperiosteal flaps raised and bone removed above the PDCs. In open exposure, tissue was removed above the canine, and glass ionomer - reaching above soft tissue - was built on the crown. The canine was then left to erupt spontaneously, prior to orthodontic alignment. At closed exposure, a chain was bonded to the canine and orthodontic traction was applied under the mucosa until eruption. Orthodontic alignment of the canines was undertaken after eruption into the oral cavity, with fixed appliances in both groups. All participants were treated according to intention to treat (ITT).

    Blinding: Due to the nature of this trial, only outcome assessors could be blinded to the intervention group.

    Results: One hundred and seventeen patients completed the trial. All PDCs were successfully aligned. Total treatment time was equal in the two techniques, mean difference -0.1 months (95% CI -3.2 to 2.9, P = 0.93). The closed group experienced more pain and discomfort during the active orthodontic traction. Dental fear, root resorption and periodontal status did not show any clinically significant differences between the groups.

    Generaiizability: Results of this randomized controlled trial (RCT) can be generalized only to a similar population aged 9-16 years, if exclusion criteria are met.

    Conclusion: The closed exposure group experienced more pain and discomfort mostly during active orthodontic traction. All other studied outcomes were similar between the two exposure groups.

    Clinical Trial Registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 19.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden.
    Arnrup, Kristina
    Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sundell, Anna Lena
    Jönköping University, School of Health and Welfare, HHJ. Oral health. Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gustafsson, Annika
    Department of Paediatric Dentistry, Postgraduate Dental Education Center, Örebro, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed)
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 20.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden;Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Arnrup, Kristina
    Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden;School of Health Sciences, Örebro University, Örebro, Sweden.
    Lindsten, Rune
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sundell, Anna Lena
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gustafsson, Annika
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden;School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed)
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 21.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Lindsten, Rune
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sundell, Anna Lena
    Department of Paediatric Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Gustafsson, Annika
    Department of Paediatric Dentistry, Postgraduate Dental Education Center, Örebro, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients' perceptions: a multicentre, randomized, controlled trial2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 6, p. 626-635Article in journal (Refereed)
    Abstract [en]

    Background: Closed and open surgical techniques are two different main approaches to surgical exposure of palatally displaced canines (PDCs). Because there is insufficient evidence to support one technique over the other, there is a need for randomized controlled trials.

    Objectives: To compare surgery time, complications and patients' perceptions between closed and open surgical techniques in PDCs.

    Trial design: The trial was a multicentre, randomized, controlled trial with two parallel groups randomly allocated in a 1:1 ratio.

    Material and methods: Study participants were 119 consecutive patients from 3 orthodontic centres, with PDCs planned for surgical exposure, randomly allocated according to a computer-generated randomization list, using concealed allocation. Full-thickness mucoperiosteal flap was raised, and bone covering the canine was removed in both interventions. In closed exposure, an attachment with a chain was bonded to the canine and the flap was sutured back with the chain penetrating the mucosa. In open exposure, a window of tissue around the tooth was removed and glass ionomer cement placed on the canine crown, to prevent gingival overgrowth during spontaneous eruption. Patient perceptions were assessed with two questionnaires, for the evening on the day of operation and 7 days post-surgery.

    Blinding: It was not possible to blind either patients or care providers to the interventions. The outcome assessors were blinded and were unaware of patients' intervention group.

    Results: Seventy-five girls and 44 boys, mean age 13.4 years (SD 1.46) participated in the study and got either of the interventions (closed exposure, n = 60; open exposure, n = 59). Surgery time did not differ significantly between the interventions. Complications though were more severe in bilateral cases and the patients experienced more pain and impairment in the open group.

    Conclusion: There were no statistically significant differences regarding surgery time between the groups. Postoperative complications were similar between the groups in unilateral PDCs, but more common in the open group in bilateral cases. More patients in the open group experienced pain and impairment compared to the closed group.

    Trial registration: Trial registration: ClinicalTrials.gov, ID: NCT02186548 and Researchweb.org, ID: 127201.

  • 22.
    Björksved, Margitha
    et al.
    Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Postgraduate Dental Education Center, Department of Orthodontics, P.O. Box 1126, SE-701 11 Örebro, Sweden; School of Medical Sciences, Örebro University, SE-701 82, Sweden.
    Ryen, Linda
    University Health Care Research Center, Örebro University, SE-701 82, Sweden.
    Lindsten, Rune
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. The Institute for Postgraduate Dental Education, Department of Orthodontics, P.O. Box 1030, SE-551 11 Jönköping, Sweden.
    Bazargani, Farhan
    Postgraduate Dental Education Center, Department of Orthodontics, P.O. Box 1126, SE-701 11 Örebro, Sweden; School of Medical Sciences, Örebro University, SE-701 82, Sweden.
    Open and closed surgical exposure of palatally displaced canines: a cost- minimization analysis of a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 498-505Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

    Trial design: A multicentre, two-arm parallel group randomized controlled trial.

    Methods: One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions.The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown reaching above the mucosa through a hole punched in the flap-to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa.The trial ended when the PDC was successfully aligned in the dental arch. Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

    Blinding: Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

    Results: A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

    Generalizability and limitations: Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

    Conclusion: There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.

  • 23. Björksved, Margitha
    et al.
    Ryen, Linda
    Lindsten, Rune
    Bazargani, Farhan
    Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 498-505Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

    Trial Design: A multicentre, two-arm parallel group randomized controlled trial.

    Methods: One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions. The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown - reaching above the mucosa through a hole punched in the flap - to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa. The trial ended when the PDC was successfully aligned in the dental arch.Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

    Blinding: Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

    Results: A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

    Generalizability and Limitations: Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

    Conclusion: There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.

  • 24.
    Björksved, Margitha
    et al.
    Örebro University, School of Medical Sciences. Department of Orthodontics, Public Dental Health Service, Eskilstuna, Sweden; Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
    Ryen, Linda
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Lindsten, Rune
    The Institute for Postgraduate Dental Education, Department of Orthodontics, Jönköping, Sweden; Centre for Oral Health, School of Health and Welfare, Jönköping University, Sweden.
    Bazargani, Farhan
    Örebro University Hospital. Örebro University, School of Medical Sciences. Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
    Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial2021In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 43, no 5, p. 498-505Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

    TRIAL DESIGN: A multicentre, two-arm parallel group randomized controlled trial.

    METHODS: One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions. The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown - reaching above the mucosa through a hole punched in the flap - to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa. The trial ended when the PDC was successfully aligned in the dental arch.Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

    BLINDING: Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

    RESULTS: A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

    GENERALIZABILITY AND LIMITATIONS: Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

    CONCLUSION: There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.

    TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02186548.

  • 25.
    Bondemark, Lars
    et al.
    Malmö University, Faculty of Odontology (OD).
    Abdulraheem, Salem
    Malmö University, Faculty of Odontology (OD). General Dental Practitioner, Ministry of Health, Kuwait.
    Intention to treat (ITT) analysis as reported in orthodontic randomized controlled trials-evaluations of methodology and recommendations for the accurate use of ITT analysis and handling dropouts2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 4, p. 409-413Article in journal (Refereed)
    Abstract [en]

    Objective To systematically evaluate in five orthodontic journals how many randomized controlled trials (RCTs) use intention to treat (ITT) analysis and to assess the methodological quality of the ITT analysis, and finally, to demonstrate in an academic way how outcomes can be affected when not implementing the ITT analysis. Material and methods A search of the database, Medline, was performed via PubMed for publication type ‘randomized controlled trial’ published for each journal between 1 January 2013 and 30 April 2017. The five orthodontic journals assessed were the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontics, European Journal of Orthodontics, Journal of Orthodontics, and Orthodontics and Craniofacial Research. Two independent reviewers assessed each RCT to determine whether the trial reported an ITT or not or if a per-protocol analysis was accomplished. Results The initial search generated 137 possible trials. After applying the inclusion and exclusion criteria, 90 RCTs were included and assessed. Seventeen out of 90 RCTs (18.9%) either reported an ITT analysis in the text and/or supported the ITT by flow diagrams or tables. However, six RCTs applied and reported the ITT analysis correctly, while the majority performed a per-protocol analysis instead. Conclusions Nearly all the trials that applied the ITT analysis incorrectly analysed the results using a per-protocol analysis, and thus, overestimating the results and/or having a reduced sample size which then could produce a diminished statistical power.

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  • 26.
    Bondemark, Lars
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Ruf, Sabine
    Malmö högskola, Faculty of Odontology (OD).
    Randomized controlled trial: the gold standard or an unobtainable fallacy?2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 5, p. 457-461Article in journal (Refereed)
    Abstract [en]

    Background: This article is the result of a debate at the European Journal of Orthodontics Open Session in 2013 in Reykjavik, Iceland. Objective: The aim of this article is to highlight some of the strengths and weakness of clinical orthodontic research, with particular emphasis on randomized controlled trials (RCT). The ultimate aim of improving clinical orthodontic research in general. Design: This article is organized into two sections with arguments for and against RCTs. The backgrounds to evidence-based evaluation and the level or quality of evidence in trials are discussed. The article emphasises what makes high quality clinical research, and gives practical advice including examples of tips and potential pitfalls for those undertaking clinical research. Results and Conclusion: The overriding message is constructive and it is hoped that the article serves as an aid in evaluating, designing, conducting, and reporting clinical research.

  • 27.
    Bondemark, Lars
    et al.
    Malmö högskola, Faculty of Odontology (OD). Univ Giessen, Dept Orthodont, D-35390 Giessen, Germany.
    Ruf, Sabine
    Malmö högskola, Faculty of Odontology (OD).
    RCTs are here to stay: Reply2016In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, no 3, p. 335-335Article in journal (Other academic)
  • 28.
    Christell, Helena
    et al.
    Malmö University, Faculty of Odontology (OD).
    Birch, Stephen
    Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; School of Community Based Medicine, University of Manchester, Manchester, UK.
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    Horner, Keith
    Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, UK.
    Lindh, Christina
    Malmö University, Faculty of Odontology (OD).
    The impact of Cone Beam CT on financial costs and orthodontists' treatment decisions in the management of maxillary canines with eruption disturbance2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background: Examination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear. Objectives: To measure: 1. the proportion of orthodontists' treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2); and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance. Subjects and methods: Orthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case. Results: One hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2. Limitations: Benefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution. Conclusions: For the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.

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  • 29.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dental Research Department, Postgraduate Dental Education Center, Region Örebro County, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Letters to the Editor2016In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, no 2, p. 223-223Article in journal (Refereed)
  • 30.
    Dimberg, Lillemor
    et al.
    Örebro University .
    Arnrup, Kristina
    Örebro University .
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Letters to the Editor2016In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, no 2, p. 223-223Article in journal (Other academic)
  • 31.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Bondemark, Lars
    Faculty of Odontology, Malmö University, Malmö, Sweden.
    The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 3, p. 238-247Article, review/survey (Refereed)
    Abstract [en]

    Background: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life.

    Objectives: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents.

    Materials and methods: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.

    Results: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL.

    Conclusion: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

  • 32.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Arnrup, Kristina
    Örebro University, School of Health Sciences. Postgraduate Dental Education Center, Örebro County Council, Örebro, Sweden.
    Bondemark, Lars
    Department of Orthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 3, p. 238-247Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life.

    OBJECTIVES: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents.

    MATERIALS AND METHODS: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.

    RESULTS: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL.

    CONCLUSION: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

  • 33.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro County Council.
    Arnrup, Kristina
    ostgraduate Dental Education Center, Örebro County Council and School of Health and Medical Sciences, Örebro University.
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 3, p. 238-247Article, review/survey (Refereed)
    Abstract [en]

    Background: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life. Objectives: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents. Materials and methods: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low. Results: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL. Conclusion: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

  • 34.
    Dimberg, Lillemor
    et al.
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro.
    Lennartsson, Bertil
    Department of Orthodontics, Postgraduate Dental Education Center, Örebro.
    Söderfeldt, Björn
    Malmö högskola, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Malocclusions in children at 3 and 7 years of age: a longitudinal study2013In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 35, no 1, p. 131-137Article in journal (Refereed)
    Abstract [en]

    The aim of this longitudinal study was to compare the prevalence of malocclusion at ages 3 and 7 years in a sample of children, exploring the hypothesis that prevalence of malocclusion is higher at 3 than at 7 years of age and may be influenced by sucking habits. The study sample comprised 386 children (199 girls and 187 boys), aged 3 years at study start, sourced from three Public Dental Service clinics in Sweden. Malocclusion was diagnosed by clinical examination, using a specific protocol. Data on allergy, traumatic injuries, sucking habits, and breathing pattern including nocturnal breathing disturbances were obtained by means of a questionnaire answered by child and parent in conjunction with the initial and final clinical examination. The overall prevalence of malocclusion decreased significantly, from 70 to 58% (P < 0.0001): predominantly anterior open bite, excessive overjet, and Class III malocclusion. Although high rates of spontaneous correction were also noted for deep bite, Class II malocclusion and posterior and anterior crossbites, new cases developed at almost the same rate; thus, the prevalence was unchanged at the end of the observation period. Anterior open bite and posterior crossbite were the only conditions showing significant associations with sucking habits. The results confirm the hypothesis of higher prevalence of malocclusion at 3 years of age and clearly support the strategy of deferring orthodontic correction of malocclusion until the mixed dentition stage.

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  • 35.
    Ebrahim, Eman
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Paulsson-Björnsson, Liselotte
    Malmö högskola, Faculty of Odontology (OD).
    The impact of premature birth on the permanent tooth size of incisors and first molars2017In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 39, no 6, p. 622-627Article in journal (Refereed)
    Abstract [en]

    Background: Scientific evidence is insufficient to answer the question of whether premature birth causes altered tooth-crown dimensions. Objective: To evaluate permanent tooth-crown dimensions in prematurely born children and to compare the findings with full-term born controls. Subjects and Methods: Preterm children of 8-10 years of age were selected from the Swedish Medical Birth Register. One group consisted of 36 extremely preterm children (born before the 29th gestational week); the other group included 37 very preterm children (born during gestational weeks 29-32). The preterm children were compared with 41 matched full-term born children. Clinical examination and study casts were performed on all children. Permanent maxillary and mandibular first molars, central incisors, and laterals were measured with a digital sliding caliper on study casts. The tooth-crowns were measured both mesio-distal and bucco-lingual. Results: Both the mesio-distal and bucco-lingual measurements in the maxillary and mandibular first molars had a significantly smaller width in the extremely preterm group compared with the full-term group. The central incisors and lower laterals were significantly smaller mesio-distally in the extremely preterm group compared to the full-term group. A reduction in tooth size of 4-9% was found between the extremely preterm group and the full-term group for both boys and girls. The maxillary first molars and mandibular left first molar were also smaller mesio-distally in the extremely preterm group compared to the very preterm group. The results indicate that the more preterm the birth, the smaller the tooth-crown dimensions. Independent of gestational age girls had generally smaller teeth than boys. Conclusion: Premature birth is associated with reduced tooth-crown dimensions of permanent incisors and first molars.

  • 36. Edman Tynelius, Gudrun
    et al.
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Lilja-Karlander, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Evaluation of orthodontic treatment after 1 year of retention - a randomized trial2010In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 32, no 5, p. 542-547Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to use a randomized controlled trial methodology to evaluate and compare three different retention methods. The capacity of the retention methods to retain orthodontic treatment results was in this first phase analysed on a short-term basis, i.e. after 1 year of retention. The subjects were recruited from adolescents undergoing fixed appliance treatment at an orthodontic clinic in the National Health Service (NHS) in Sweden between 2001 and 2007. Seventy-five patients (45 girls and 30 boys with a mean age of 14.4 years at the start of retention) were randomized into three retention systems; a vacuum-formed retainer in the maxilla and bonded canine-to-canine retainer in the mandible (group V-CTC), a vacuum-formed retainer in the maxilla combined with stripping of the 10 proximal surfaces of the lower mandibular anterior teeth (group V-S), and a prefabricated positioner covering the teeth in the maxilla and mandible (group P). The main outcome measures were: Little's irregularity index (LII), intercanine and intermolar width, arch length, overjet, and overbite. Registrations were made before orthodontic treatment, when the fixed orthodontic appliance was removed, and after 12 months in retention. Differences in means between groups were tested by one-way analysis of variance. After 1 year of retention, no clinically significant difference in retention capacity was found between the three retention methods. Small but significant differences (P < 0.05) were observed between the V-CTC and V-S groups regarding mandibular canine width, mandibular arch length, and overbite. In group P, two patients failed to co-operate.

  • 37.
    Edman Tynelius, Gudrun
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Lilja-Karlander, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Petrén, Sofia
    Malmö högskola, Faculty of Odontology (OD).
    A cost-minimization analysis of an RCT of three retention methods2014In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 36, no 4, p. 436-441Article in journal (Refereed)
    Abstract [en]

    SUMMARY BACKGROUND: There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. MATERIALS/METHODS: To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. RESULTS: The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. CONCLUSIONS/IMPLICATIONS: After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis.

  • 38.
    Edman Tynelius, Gudrun
    et al.
    Malmö högskola, Faculty of Odontology (OD).
    Petrén, Sofia
    Malmö högskola, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Lilja-Karlander, Eva
    Malmö högskola, Faculty of Odontology (OD).
    Five-year postretention outcomes of three retention methods: a randomized controlled trial2015In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 37, no 4, p. 345-353Article in journal (Refereed)
    Abstract [en]

    Objective: Comparison of three different retention strategies 5 years or more postretention. Design, Setting, and Participants: Randomized, prospective, single-centre controlled trial. Forty-nine patients (33 girls and 16 boys) were randomly assigned to one of three retention methods during 2 years by picking a ballot shortly before start of retention treatment. Inclusion criteria were no previous orthodontics, permanent dentition, normal skeletal sagittal, vertical, and transversal relationships, Class I dental relationship, space deficiencies, treatment plan with extractions of four premolars followed by fixed straight-wire appliance. Maxillary and mandibular Little's irregularity index (LII), intercanine and intermolar width, arch length, and overbite/overjet were recorded in a blinded manner, altogether 10 measurements on each patient. Significant differences in means within groups assessed by t-test and between groups by one-way analysis of variance. Interventions: Retention methods: removable vacuum-formed retainer (VFR) covering the palate and the maxillary anterior teeth from canine-to-canine and bonded canine-to-canine retainer in the lower arch (group V-CTC); maxillary VFR combined with stripping of the lower anterior teeth (group V-S); and prefabricated positioner (group P). Results: Maxillary mean LII ranged from 1.8 to 2.6 mm, mean intercanine width 33.6-35.3 mm with a significant difference between groups V-S and P, mean intermolar width 46.8-47.4 mm and mean arch length 21.8-22.8 mm. Mandibular mean LII ranged from 2.0 to 3.4 mm with a significant difference between groups V-S and P, mean intercanine width from 25.4 to 26.6 mm, mean intermolar width from 40.8 to 40.9 mm and mean arch length from 16.9 to 17.3 mm. Mean overbite ranged from 1.8 to 2.7 mm and mean overjet from 3.7 to 4.1 mm. Limitations: A single centre study could be less generalizable. Conclusions: The three retention methods disclosed equally favourable clinical results.

  • 39. Egermark-Eriksson, I
    et al.
    Carlsson, G E
    Magnusson, Tomas
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine.
    Thilander, B
    A longitudinal study on malocclusion in relation to signs and symptoms of cranio-mandibular disorders in children and adolescents.1990In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 12, no 4, p. 399-407Article in journal (Refereed)
  • 40.
    Enerbäck, Hanna
    et al.
    Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lövgren, Mai Lin
    Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Strömberg, Nicklas
    Umeå University, Faculty of Medicine, Department of Odontology.
    Westerlund, Anna
    Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Public Dental Service, Mölndal, Sweden.
    Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 5, p. 477-484Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment.

    TRIAL DESIGN: Three-armed parallel-group randomized controlled trial.

    METHODS: The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis.

    RECRUITMENT: October 2010 to December 2012.

    RESULTS: In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01.

    CONCLUSIONS: To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended.

    LIMITATIONS: The protocol was not registered, and the present study did not use a double-blinded design.

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  • 41. Feldmann, Ingalill
    et al.
    List, Thomas
    Malmö högskola, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö högskola, Faculty of Odontology (OD).
    Orthodontic anchoring techniques and its influence on pain, discomfort, and jaw function: a randomized controlled trial.2012In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 34, no 1, p. 102-108Article in journal (Refereed)
    Abstract [en]

    The aim of this trial was to evaluate and compare perceived pain, discomfort, and jaw function impairment between orthodontic treatments combined with skeletal anchorage and treatment using conventional anchorage with headgear or transpalatal bar. A total of 120 adolescent patients in order to start orthodontic treatment were consecutively recruited and randomized into three groups with different anchorage. Group A underwent installation of a skeletal anchorage (Onplant or Orthosystem implant), group B received headgear, and group C a transpalatal bar. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment from baseline to the end of treatment. Pain scores overall peaked on day 2 and were almost back to baseline on day 7. The site with the highest pain scores during treatment was incisors in contact but with no differences between groups. Pain intensity from molars was significantly less in the skeletal anchorage group A compared to the transpalatal bar group C the first 4 days in treatment and with no sign differences compared to headgear. The results confirm that there were very few significant differences between patients’ perceptions of skeletal and conventional anchorage systems during orthodontic treatment. Consequently, these new appliances were well accepted by the patients in a long time perspective and can thus be recommended.

  • 42.
    Feldmann, Ingalill
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    List, Thomas
    Bondemark, Lars
    Orthodontic anchoring techniques and its influence on pain, discomfort, and jaw function--a randomized controlled trial.2012In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 34, no 1, p. 102-8Article in journal (Refereed)
    Abstract [en]

    The aim of this trial was to evaluate and compare perceived pain, discomfort, and jaw function impairment between orthodontic treatments combined with skeletal anchorage and treatment using conventional anchorage with headgear or transpalatal bar. A total of 120 adolescent patients in order to start orthodontic treatment were consecutively recruited and randomized into three groups with different anchorage. Group A underwent installation of a skeletal anchorage (Onplant or Orthosystem implant), group B received headgear, and group C a transpalatal bar. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment from baseline to the end of treatment. Pain scores overall peaked on day 2 and were almost back to baseline on day 7. The site with the highest pain scores during treatment was incisors in contact but with no differences between groups. Pain intensity from molars was significantly less in the skeletal anchorage group A compared to the transpalatal bar group C the first 4 days in treatment and with no sign differences compared to headgear. The results confirm that there were very few significant differences between patients' perceptions of skeletal and conventional anchorage systems during orthodontic treatment. Consequently, these new appliances were well accepted by the patients in a long time perspective and can thus be recommended.

  • 43.
    Fors, Ronny
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Persson, Maurits
    Umeå University, Faculty of Medicine, Department of Odontology.
    Nickel in dental plaque and saliva in patients with and without orthodontic appliances.2006In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 28, no 3, p. 292-297Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare the content of nickel in the saliva and dental biofilm in young patients with and without orthodontic appliances. The possible influence of a dietary intake of nickel on recorded nickel levels was examined. Nickel content in unstimulated whole saliva and in dental plaque of 24 boys and girls (mean age 14.8 years) with intraoral fixed orthodontic appliances was compared with 24 adolescents without such an appliance. Sample collection was set up to exclude nickel contamination. Diet intake was recorded for the preceding 48 hours to account for the influence of recent nickel content in food. Saliva and plaque were analysed for nickel content using an electrothermal atomic absorption spectrometric (ETAAS) method. The acidified saliva samples were analysed as Millipore-filtered saliva with filter-retained fractions and plaque following dissolution in acids. No significant difference in nickel content of filtered saliva was found between the test and the control samples (P = 0.607); the median values of nickel content were 0.005 and 0.004 mug/g saliva, respectively. On the other hand, a significant difference was found for the filter-retained fraction (P = 0.008); median values for nickel were 25.3 and 14.9 mug/g, respectively. A significant difference in nickel content between test and control samples was also found in plaque collected at various tooth sites (P = 0.001; median values 1.03 and 0.45 mug/g, respectively). A stronger difference was found when comparing plaque collected from metal-covered tooth surfaces than from enamel surfaces of orthodontic patients. No association could be found between calculated dietary intake of nickel and recorded nickel in the test and control samples. It is concluded that nickel release occurs into the dental plaque and components of saliva of orthodontic patients, a situation that may reflect time dependence of its release from orthodontic appliances into the oral cavity and an aggregation of nickel at plaque sites.

  • 44.
    Frilund, Erik
    et al.
    Inst Postgrad Dent Educ, Sweden; Jonkoping Univ, Sweden.
    Sonesson, Mikael
    Jonkoping Univ, Sweden; Univ Malmo, Sweden.
    Magnusson, Anders
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Inst Postgrad Dent Educ, Sweden; Jonkoping Univ, Sweden.
    Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 2, p. 142-149Article in journal (Refereed)
    Abstract [en]

    Background Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking. Objectives To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block. Trial Design Two-arm parallel group, single-centre, randomized controlled trial. Materials and Methods Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon (R) microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis. Results In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion. Harms No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment. Limitations The trial was a single-centre study and long-term effects were not evaluated. Conclusions During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

  • 45.
    Frilund, Erik
    et al.
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Sonesson, Mikael
    Jönköping University, School of Health and Welfare, HHJ. Centre for Oral Health. Department of Orthodontics, Section 4, University of Malmö, Malmö, Sweden.
    Magnusson, Anders
    Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden; Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
    Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 2, p. 142-149Article in journal (Refereed)
    Abstract [en]

    Background

    Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.

    Objectives

    To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.

    Trial Design

    Two-arm parallel group, single-centre, randomized controlled trial.

    Materials and Methods

    Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon (R) microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.

    Results

    In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.

    Harms

    No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.

    Limitations

    The trial was a single-centre study and long-term effects were not evaluated.

    Conclusions

    During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

  • 46.
    Frilund, Erik
    et al.
    Inst Postgrad Dent Educ, Dept Orthodont, Hermansvagen 5,Plan 8, S-55453 Jönköping, Sweden.;Jönköping Univ, Ctr Oral Hlth, Sch Hlth & Welf, Jönköping, Sweden..
    Sonesson, Mikael
    Malmö University, Faculty of Odontology (OD). Jönköping Univ, Ctr Oral Hlth, Sch Hlth & Welf, Jönköping, Sweden..
    Magnusson, Anders
    Inst Postgrad Dent Educ, Dept Orthodont, Hermansvagen 5,Plan 8, S-55453 Jönköping, Sweden.;Jönköping Univ, Ctr Oral Hlth, Sch Hlth & Welf, Jönköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions2023In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 2, p. 142-149Article in journal (Refereed)
    Abstract [en]

    Background Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking. Objectives To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block. Trial Design Two-arm parallel group, single-centre, randomized controlled trial. Materials and Methods Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon (R) microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis. Results In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion. Harms No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment. Limitations The trial was a single-centre study and long-term effects were not evaluated. Conclusions During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

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  • 47.
    Ganzer, Niels
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Dent Serv Reg Gavleborg, Dept Orthodont, Box 57, SE-80102 Gavle, Sweden.
    Feldmann, Ingalill
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Dent Serv Reg Gavleborg, Dept Orthodont, Box 57, SE-80102 Gavle, Sweden.
    Liv, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Bondemark, Lars
    Malmo Univ, Fac Odontol, Dept Orthodont, SE-20506 Malmo, Sweden..
    A novel method for superimposition and measurements on maxillary digital 3D models-studies on validity and reliability2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    Background: Serial 3D models can be used to analyze changes, but correct superimposition is crucial before measurements can be assessed. Earlier studies show that every palatal structure changes due to growth or treatment. Here, we describe a new method that uses an algorithm-based analysis to perform superimpositions and measurements in maxillary 3D models. This method can be used to identify deformations. In a second step, only unchanged areas are used for superimposition.

    Objectives: This study investigates the validity and reliability of this novel method.

    Methods: Digital 3D models from 16 cases were modified by an independent 3D engineer to simulate space closure and growth. True values for tooth movements were available as reference. Measurements and repeated measurements were performed by four observers.

    Results: The total tooth movement had an absolute mean error of 0.0225 mm (SD 0.03). The intraclass correlation coefficient (ICC) was 0.9996. Rotational measurements had an absolute mean error of 0.0291 degrees (SD 0.04 degrees) and an ICC of 0.9999.

    Limitations: Serial models need to be taken with a moderate interval (1 to 2 years). Obvious changed areas in the palate need to be cropped before processing the models.

    Conclusion: The tested method is valid and reliable with excellent accuracy and precision even when changes through growth or orthodontic treatment occur.

  • 48.
    Ganzer, Niels
    et al.
    Department of Orthodontics, Public Dental Service Region Gävleborg, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Feldmann, Ingalill
    Department of Orthodontics, Public Dental Service Region Gävleborg, Gävle, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Liv, Per
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    A novel method for superimposition and measurements on maxillary digital 3D models-studies on validity and reliability2018In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 40, no 1, p. 45-51Article in journal (Refereed)
    Abstract [en]

    Background: Serial 3D models can be used to analyze changes, but correct superimposition is crucial before measurements can be assessed. Earlier studies show that every palatal structure changes due to growth or treatment. Here, we describe a new method that uses an algorithm-based analysis to perform superimpositions and measurements in maxillary 3D models. This method can be used to identify deformations. In a second step, only unchanged areas are used for superimposition. Objectives: This study investigates the validity and reliability of this novel method. Methods: Digital 3D models from 16 cases were modified by an independent 3D engineer to simulate space closure and growth. True values for tooth movements were available as reference. Measurements and repeated measurements were performed by four observers. Results: The total tooth movement had an absolute mean error of 0.0225 mm (SD 0.03). The intraclass correlation coefficient (ICC) was 0.9996. Rotational measurements had an absolute mean error of 0.0291 degrees (SD 0.04 degrees) and an ICC of 0.9999. Limitations: Serial models need to be taken with a moderate interval (1 to 2 years). Obvious changed areas in the palate need to be cropped before processing the models. Conclusion: The tested method is valid and reliable with excellent accuracy and precision even when changes through growth or orthodontic treatment occur.

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  • 49.
    Ganzer, Niels
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Dent Hlth Serv, Dept Orthodont, Gävle, Sweden.
    Feldmann, Ingalill
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Publ Dent Hlth Serv, Dept Orthodont, Gävle, Sweden.
    Petren, Sofia
    Malmö Univ, Fac Odontol, Dept Orthodont, Malmö, Sweden.
    Bondemark, Lars
    Malmö Univ, Fac Odontol, Dept Orthodont, Malmö, Sweden.
    A cost-effectiveness analysis of anchorage reinforcement with miniscrews and molar blocks in adolescents: a randomized controlled trial2019In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 2, p. 180-187Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse cost-effectiveness of anchorage reinforcement with buccal miniscrews and with molar blocks. We hypothesized that anchorage with miniscrews is more cost-effective than anchorage with molar blocks.

    Trial design: A single-centre, two-arm parallel-group randomized controlled trial.

    Methods: Adolescents (age 11–19 years) in need of treatment with fixed appliance, premolar extractions, and en masse retraction were recruited from one Public Dental Health specialist centre. The intervention arm received anchorage reinforcement with buccal miniscrews during space closure. The active comparator received anchorage reinforcement with molar blocks during levelling/alignment and space closure. The primary outcome measure was societal costs defined as the sum of direct and indirect costs. Randomization was conducted as simple randomization stratified on gender. The patients, caregivers, and outcome assessors were not blinded.

    Results: Eighty patients were randomized into two groups. The trial is completed. All patients were included in the intention-to-treat analysis. The median societal costs for the miniscrew group were €4681 and for the molar block group were €3609. The median of the difference was €825 (95% confidence interval (CI) 431–1267). This difference was mainly caused by significantly higher direct costs consisting of material and chair time costs. Differences in chair time costs were related to longer treatment duration. No serious harms were detected, one screw fractured during insertion and three screws were lost during treatment.

    Generalizability and limitations: The monetary variables are calculated based on a number of local factors and assumptions and cannot necessarily be transferred to other countries. Variables such as chair time, number of appointments, and treatment duration are generalizable. Owing to the study protocol, the benefit of miniscrews as a stable anchorage has not been fully utilized.

    Conclusions: When only moderate anchorage reinforcement is needed, miniscrews are less cost-effective than molar blocks. The initial hypothesis was rejected. Miniscrews provide better anchorage reinforcement at a higher price. They should be used in cases where anchorage loss cannot be accepted.

    Trial registration: NCT02644811

  • 50.
    Ganzer, Niels
    et al.
    Department of Orthodontics, Public Dental Service, Gävle; Centre for Research and Development, Uppsala University, Gävle.
    Feldmann, Ingalill
    Department of Orthodontics, Public Dental Service, Gävle; Centre for Research and Development, Uppsala University, Gävle.
    Petrén, Sofia
    Malmö University, Faculty of Odontology (OD).
    Bondemark, Lars
    Malmö University, Faculty of Odontology (OD).
    A cost-effectiveness analysis of anchorage reinforcement with miniscrews and molar blocks in adolescents: a randomized controlled trial2019In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 2, p. 180-187Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse cost-effectiveness of anchorage reinforcement with buccal miniscrews and with molar blocks. We hypothesized that anchorage with miniscrews is more cost-effective than anchorage with molar blocks. Trial design: A single-centre, two-arm parallel-group randomized controlled trial. Methods: Adolescents (age 11–19 years) in need of treatment with fixed appliance, premolar extractions, and en masse retraction were recruited from one Public Dental Health specialist centre. The intervention arm received anchorage reinforcement with buccal miniscrews during space closure. The active comparator received anchorage reinforcement with molar blocks during levelling/alignment and space closure. The primary outcome measure was societal costs defined as the sum of direct and indirect costs. Randomization was conducted as simple randomization stratified on gender. The patients, caregivers, and outcome assessors were not blinded. Results: Eighty patients were randomized into two groups. The trial is completed. All patients were included in the intention-to-treat analysis. The median societal costs for the miniscrew group were €4681 and for the molar block group were €3609. The median of the difference was €825 (95% confidence interval (CI) 431–1267). This difference was mainly caused by significantly higher direct costs consisting of material and chair time costs. Differences in chair time costs were related to longer treatment duration. No serious harms were detected, one screw fractured during insertion and three screws were lost during treatment. Generalizability and limitations: The monetary variables are calculated based on a number of local factors and assumptions and cannot necessarily be transferred to other countries. Variables such as chair time, number of appointments, and treatment duration are generalizable. Owing to the study protocol, the benefit of miniscrews as a stable anchorage has not been fully utilized. Conclusions: When only moderate anchorage reinforcement is needed, miniscrews are less cost-effective than molar blocks. The initial hypothesis was rejected. Miniscrews provide better anchorage reinforcement at a higher price. They should be used in cases where anchorage loss cannot be accepted. Trial registration: NCT02644811

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