Longitudinal analysis of the quality of orthodontic treatment outcome and stability of occlusal traits

Objectives To assess the quality and stability of orthodontic treatment outcome relative to the initial malocclusion. Material and methods The study was performed in one public health care clinic in Finland. Study subjects comprised 51 orthodontic patients (age range 12.7-18.7 years). Pre-treatment medical records and lateral skull radiographs were analysed for malocclusion type. The main reasons for orthodontic treatment were mandibular retrognathia, Class II distal bite, deep bite and crowding. At the end of a retention phase (Examination 1), the quality of treatment outcome was assessed using the occlusal morphology and function index (OMFI) and patients were asked about treatment satisfaction. Stability of occlusal traits and patient satisfaction were re-evaluated after a two-year follow-up (Examination 2). Occlusal characteristics descriptive statistics were performed. Results At Examination 1, all six morphological criteria for acceptability were fulfilled by 76% and all functional criteria by 82% of the patients. All OMFI criteria were met by 67% of the patients. At Examination 2, 68% of the patients fulfilled all morphological and 82% all functional criteria of acceptability. At Examination 2, all the OMFI criteria were still met by 64% of the patients and 92% expressed satisfaction with own occlusion. The main reasons for unacceptability were deficiencies in canine relationship and overbite, in addition to functional protrusion interferences. Conclusions In the evaluated health care clinic, patient satisfaction and the quality of treatment outcome were high. However, deep bite showed a tendency for relapse.Peer reviewe

Craniofacial microsomia - more than a structural malformation

Objectives To analyse the prevalence and distribution of craniofacial microsomia (CFM) cases in Finland and their most frequent comorbidities. The second aim was to analyse the patients' need for specialized healthcare services.Materials and methods Data were gathered from two complementary registers: The Register of Congenital Malformations and the Care Register for Social Welfare and Health Care (Hilmo) of the Finnish Institute for Health and Welfare (THL).Results The prevalence of CFM patients in Finland was 1:10 057. They were evenly distributed across the five university hospital districts. Their most frequently used ICD-10 diagnosis codes were F40-48 (Neurotic, stress-related and somatoform disorders), 60% of patients in adolescent and adult psychiatry; Q67.0 (Facial asymmetry), 43% in plastic surgery; Z00.4 (General psychiatric examination, not elsewhere classified), 31% in child psychiatry; Z31.5 (Genetic counselling), 28% in clinical genetics and Q67.40 (Other congenital deformities of the skull, face and jaw, Hemifacial atrophy), 18% in dental, oral and maxillofacial diseases. Of the patients, 70% had had visits in clinical genetics, 60% in plastic surgery, 41% in dental, oral and maxillofacial diseases, 28% in adolescent/adult psychiatry and 21% in child psychiatry. The majority of the patients' plastic surgery visits were concentrated in one university hospital. Other services were mainly provided by patients' own hospital districts.Conclusions Even though the majority of CFM patients' visits in specialized healthcare services are related to correction of facial asymmetry and ear malformations, the obvious need for psychiatric care was apparent in all age groups.</p

Synnynnäisten kehityshäiriöiden aiheuttamat haasteet oikomishoidossa

Synnynnäisten kehityshäiriöiden ja oireyhtymien aiheuttamat oikomishoitoa vaativat pään ja leukojen alueen ongelmat ovat usein haastavia ja niiden hoito vaatii usein moniammatillista osaamista ja tiimityöskentelyä.</p

Symptoms in the masticatory system and related quality of life in prospective orthognathic patients

Objective: The aim of this study was to investigate the relation between orthognathic patients’ self-reported symptoms in the head and neck region and their quality of life (QoL).Material and methods: Participants included were consecutive patients (n = 50) referred to the assessment of orthognathic treatment need and voluntary first-year university students (n = 29). All participants filled in the Orthognathic Quality of Life Questionnaire (OQLQ) and a structured diary created by the authors. The median values of Orthognathic Quality of Life (OQOL) sum and subscores, satisfaction with oral function and number of awakenings were compared between patients and controls. Further, correlations between the OQOL sum and subscores, satisfaction with oral function and number of awakenings were analyzed.Results: Patients reported significantly more symptoms (p = .013) and woke up significantly more often than the controls (p = .032). Their OQOL sum scores were significantly higher (indicating a lower OQOL) (p = .001), and they were significantly less satisfied with their oral function than the controls (p Conclusions: Experiences of pain and discomfort have a significant impact on patients’ OQOL and well-being.</p

Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy

Objective: To analyse oral health related quality of life (OHRQoL) several years after orthognathic treatment in patients who had Class II malocclusion with retrognathic mandible. Material and methods: The initial study cohort comprised 151 patients with orthognathic treatment in 2007-2011. Of them, 77 patients (Group 1, mean age 41 years, range 19-71 years, 71% women) were clinically examined 6 years (range 4-8 years) after bilateral sagittal split osteotomy (BSSO). Group 2 included 24 former patients (mean 48 years, range 25-79 years, 50% women) who were willing to participate in a structured telephone interview. Group 3 consisted of 22 prospective patients (mean 35 years, range 18-56 years, 86% women) with a recent orthognathic treatment plan and awaiting treatment. QoL was assessed using two questionnaires, OHIP-14 and OQLQ. Results: Based on responses, patients who had received orthognathic treatment (Groups 1 and 2) had better QoL than those awaiting treatment (Group 3). Conclusion: Conventional orthognathic treatment, including mandibular advancement with BSSO, seems to have a positive long-term effect on patients' QoL. More long-term follow-up studies are needed to assess the real impact of treatment on patients' lives in the long run.</p

Association between quality of life and severity of profile deviation in prospective orthognathic patients

Aimto evaluate whether severity of skeletal facial profile deviation assessed by professionals associates with quality of life and psychosocial factors in patients with dentofacial deformities and prospective orthognathic treatment.Materials and methodThe study consisted of 55 patients admitted to orthognathic treatment. Skeletal profile was assessed from lateral head films using cephalometric analysis. The following angles were used to assess the sagittal position of upper and lower jaw and profile: Sella-Nasion-A-point-angle, Sella-Nasion-B-point-angle, and A-point-Nasion-B-point-angle (ANB). For vertical assessment, gonial angle and the angle between Sella-Nasion and mandibular plane were used. Merrifield’s Z-angle was used to assess soft-tissue profile. Severity of skeletal facial profile deviation was assessed with deviation in ANB angle. Orthognathic quality of life (OQoL) and psychosocial factors were defined with four questionnaires: Orthognathic Quality of Life Questionnaire, Symptom Checklist-90, Rosenberg Self-Esteem Scale, and a body image questionnaire.ResultsIncrease in ANB deviation was associated with increased awareness of dentofacial deformity [Orthognathic Quality of Life Questionnaire subscale awareness of dentofacial deformity (OQLQ-AoDD), r = 0.319, P = 0.017). OQOL-AoDD was not found to be equal when ANB angle was divided into three different categories (χ 2 = 6.78, P = 0.034): G1. ANB = 0–4 degrees; G2. ANB 4 degrees. Furthermore, categories G1 and G2 differed significantly (U = 50.5, P = 0.017). Increase in ANB angle was also associated with a more positive body image (r = 0.342, P = .023). There were no significant correlations between other cephalometric variables, quality of life, and psychosocial factors.ConclusionSkeletal facial profile seems to associate with some aspects of orthognathic quality of life. Professional cephalometric analysis of the severity of facial profile deviation correlates with patients’ awareness of their own facial and dental appearance. Patients with more deviating skeletal profile are more aware of their dentofacial deformities compared to patients with normal values.</div

Dental Findings in Primary Dentition of Very Preterm Children: A Retrospective Case-Control Study from Finland

Objective: The aim of this study was to compare the prevalence of dental deviations in primary dentition in very preterm and full-term children.Material and methods: The subjects consisted of 205 very preterm and 205 full-term children. Data were combined from two sources: (1) the register from the Turku University Hospital of children born before the 32nd week of pregnancy or with a birth weight of less than 1,500 g, and (2) public health centre dental registers. All included very preterm (case) children were born in the Turku University Hospital during 2001-2006, and the full-term control children were matched according to age and gender.Results: The prevalence of enamel defects of the all primary teeth was 2.10% in case children and 0.42% in control children (RR= 5.07, 95% CI 1.96-13.13, p=0.001). The prevalences of having at least one enamel defect were 10.73% in case children and 4.39% in control children (RR=2.44, 95% CI 1.22-4.91, p=0.012). The prevalences of missing teeth, supernumerary teeth and teeth with shape anomalies were low in both groups.Conclusions: The results confirm earlier findings that preterm children have a higher incidence of enamel defects in primary dentition compared to full-term children. More studies are needed to elucidate the effect of preterm birth on the number and shape of developing teeth.</p

Malocclusions in primary and early mixed dentition in very preterm children

Objective: To compare the prevalence of malocclusions in the primary and early mixed dentition of very preterm and full-term children. Material and methods: Study subjects consisted of 205 very preterm (90 girls and 115 boys), and 205 age- and gender-matched full-term children. Data were collected from the register of Turku University Hospital (children born before the 37th week of pregnancy with a birth weight of less than 1500 g, and all infants born before the 32nd week of pregnancy) and from public health centre dental registers. Results: In primary dentition, case children had a higher odds of dental crowding (OR = 2.94, 95% CI 1.17-7.35, p = .021), a tendency toward increased overbite (OR = 1.55, 95% CI 0.93-2.59, p = .096), and a lower odds of increased overjet (OR = 0.19, 95% CI 0.07-0.57, p = .003) compared to control children. In early mixed dentition, there were no statistically significant differences in occlusal traits; however, case children were significantly more likely to have received orthodontic treatment (OR = 2.80, 95% CI 1.50-5.23, p = .001) compared to controls. Conclusions: The results indicate that in primary dentition, the prevalence of malocclusion varies between very preterm and full-term children. In early mixed dentition, the distribution of occlusal traits is more similar.</p

A longitudinal study of changes in psychosocial well-being during orthognathic treatment

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n = 22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n = 22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.</p

Does orthognathic treatment improve patients' psychosocial well-being?

Objective: To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed. Materials and methods: Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test. Results: OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function. Conclusions: Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.</p