Search

Introduction To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls. Methods This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory – 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires. Results A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T1, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T2, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T3, there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function). Conclusions The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.

Introduction The reliability of the cervical vertebral maturation (CVM) method has been questioned. The objective of this research was to evaluate the diagnostic reliability of the CVM method to diagnose the mandibular growth spurt using longitudinal records from an alternative database (Iowa Facial Growth Study [IFGS]) using established diagnostic testing methods. Methods Cephalometric films from 43 subjects (males = 20, females = 23) with Class I or Class II skeletal pattern from the IFGS were scanned, digitized, and adjusted for magnification. At least 5 consecutive, annual films were digitized. For each subject, mandibular length (Co-Gn) was measured for each film, and the growth increment between films was calculated. The largest growth increment was the growth spurt. For each subject, the film displaying CVM stage 3 was identified by a blinded examiner viewing the films in random order. Interrater and intrarater repeatability for Co-Gn (intraclass correlation) and CVM staging (weighted kappa) were calculated. Diagnostic tests, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were carried out. The present data were compared with data previously derived from samples of the University of Michigan, Oregon, and Burlington Growth studies (UMGS, OGS, and BGS, respectively). A multilevel logistic regression analysis was also run with the mandibular growth peak as the response variable. Results Interrater repeatability for mandibular measurements (intraclass correlation coefficient [ICC] = 0.91) and CVM staging (k = 0.88) were excellent. Intrarater repeatability for mandibular measurements (ICC = 0.98) and CVM staging (kw = 0.55) were excellent to moderate. The UMGS data demonstrated higher sensitivity with comparable specificity. Accuracy was largely similar. Their PPV and NPV had larger ranges. The OGS and BGS data, compared with the IFGS data, showed that our sensitivity and PPVs were higher, that their specificity was higher, and that the NPV and accuracy were very similar. The regression analysis was applied to age groups 10-11 years through 13-14 years. Only chronological age was significant (P = 0.04). Conclusions Agreement between CVM stage 3 and the maximum mandibular growth spurt is inconsistent. The diagnostic capability of CVM for the mandibular growth spurt is questionable.

Introduction The purpose of this retrospective case-control study was to compare the treatment effectiveness and efficiency of the Invisalign system with conventional fixed appliances in treating orthodontic patients with mild to moderate malocclusion in a graduate orthodontic clinic. Methods Using the peer assessment rating (PAR) index, we evaluated pretreatment and posttreatment records of 48 Invisalign patients and 48 fixed appliances patients. The 2 groups of patients were controlled for general characteristics and initial severity of malocclusion. We analyzed treatment outcome, duration, and improvement between the Invisalign and fixed appliances groups. Results The average pretreatment PAR scores (United Kingdom weighting) were 20.81 for Invisalign and 22.79 for fixed appliances ( P = 1.0000). Posttreatment weighted PAR scores between Invisalign and fixed appliances were not statistically different ( P = 0.7420). On average, the Invisalign patients finished 5.7 months faster than did those with fixed appliances ( P = 0.0040). The weighted PAR score reduction with treatment was not statistically different between the Invisalign and fixed appliances groups ( P = 0.4573). All patients in both groups had more than a 30% reduction in the PAR scores. Logistic regression analysis indicated that the odds of achieving "great improvement" in the Invisalign group were 0.329 times the odds of achieving "great improvement" in the fixed appliances group after controlling for age ( P = 0.0150). Conclusions Our data showed that both Invisalign and fixed appliances were able to improve the malocclusion. Invisalign patients finished treatment faster than did those with fixed appliances. However, it appears that Invisalign may not be as effective as fixed appliances in achieving "great improvement" in a malocclusion. This study might help clinicians to determine appropriate patients for Invisalign treatment.

There is disagreement in the literature concerning the importance of the mouth in overall facial attractiveness. Eye tracking provides an objective method to evaluate what people see. The objective of this study was to determine whether dental and facial attractiveness alters viewers' visual attention in terms of which area of the face (eyes, nose, mouth, chin, ears, or other) is viewed first, viewed the greatest number of times, and viewed for the greatest total time (duration) using eye tracking.Seventy-six viewers underwent 1 eye tracking session. Of these, 53 were white (49% female, 51% male). Their ages ranged from 18 to 29 years, with a mean of 19.8 years, and none were dental professionals. After being positioned and calibrated, they were shown 24 unique female composite images, each image shown twice for reliability. These images reflected a repaired unilateral cleft lip or 3 grades of dental attractiveness similar to those of grades 1 (near ideal), 7 (borderline treatment need), and 10 (definite treatment need) as assessed in the aesthetic component of the Index of Orthodontic Treatment Need (AC-IOTN). The images were then embedded in faces of 3 levels of attractiveness: attractive, average, and unattractive. During viewing, data were collected for the first location, frequency, and duration of each viewer's gaze.Observer reliability ranged from 0.58 to 0.92 (intraclass correlation coefficients) but was less than 0.07 (interrater) for the chin, which was eliminated from the study. Likewise, reliability for the area of first fixation was kappa less than 0.10 for both intrarater and interrater reliabilities; the area of first fixation was also removed from the data analysis. Repeated-measures analysis of variance showed a significant effect (P0.001) for level of attractiveness by malocclusion by area of the face. For both number of fixations and duration of fixations, the eyes overwhelmingly were most salient, with the mouth receiving the second most visual attention. At times, the mouth and the eyes were statistically indistinguishable in viewers' gazes of fixation and duration. As the dental attractiveness decreased, the visual attention increased on the mouth, approaching that of the eyes. AC-IOTN grade 10 gained the most attention, followed by both AC-IOTN grade 7 and the cleft. AC-IOTN grade 1 received the least amount of visual attention. Also, lower dental attractiveness (AC-IOTN 7 and AC-IOTN 10) received more visual attention as facial attractiveness increased.Eye tracking indicates that dental attractiveness can alter the level of visual attention depending on the female models' facial attractiveness when viewed by laypersons.

The purposes of this study were to assess the role of dental attractiveness in background facial attractiveness and to evaluate how facial and dental attractiveness influenced raters' opinions of the integrity, social attractiveness, and intellectual attractiveness of the models.Photographs of male and female individuals rated by peers as unattractive, average, and attractive were combined with oral images of 4 different levels of dental attractiveness (Index of Orthodontic Treatment Need [IOTN] 1, 5, 7, and 10). Sixty-seven participants meeting the inclusion criteria were recruited as raters. Raters viewed closed-lip smile and open-lip, posed smile of 24 models and rated them for facial attractiveness and integrity and multiple social/intellectual attractiveness dimensions using a Visual Analog Scale.Intrarater reliability was fair to excellent. Analysis of variance showed significant 3-way interactions (P 0.0001=aim 1; P 0.005=aim 2) for model sex, facial attractiveness, and dental attractiveness. The contribution of dental attractiveness to facial attractiveness was not fixed or linear, but dependent on dental attractiveness level, background facial attractiveness, and model sex. For both sexes, dental impact on facial attractiveness was neutral or negative when teeth were less than ideal, beginning at IOTN 5 for all background facial attractiveness levels. The impact of dental attractiveness on integrity and social and intellectual attractiveness was also dependent on dental attractiveness level, background facial attractiveness, and model sex. Dental attractiveness can make dramatic differences in Average and Attractive male individuals.The impact of dental attractiveness on facial attractiveness and integrity and social and intellectual attractiveness was dependent on dental attractiveness level, background facial attractiveness, and model sex. The effect of dental esthetics on facial attractiveness was neutral or negative for both male and female individuals when there was a need for treatment (IOTN 5 or higher) for all levels of facial attractiveness. For both male and female models, lower dental esthetics had a greater effect on more attractive faces. Judgments about integrity and social and intellectual attractiveness were strongly affected by dental esthetics, and these effects were more dramatic and consistent for male faces.

The purposes of this study were to quantify bone damage associated with insertion of 2 types of miniscrew implants and to relate the amount of bone damage to monocortical plate thickness.Nondrilling (n = 28) and self-drilling (n = 28) miniscrew implants (6 × 1.6 mm, Dentaurum, Newtown, Pa), and pilot holes (n = 26) were placed bilaterally in the maxillae and the mandibles of 5 adult dogs immediately after death. Bone blocks were cut, bulk stained with 1% basic fuchsin, embedded in methyl methacrylate, sectioned, and mounted. Monocortical plate thickness was measured adjacent to the miniscrew implant insertion site. Damage amounts were quantified at distances of 0 to 0.5 mm (adjacent region) and 0.5 to 1 mm (distant region) from the bone-implant interface. Total fractional damaged area (%), fractional microcracked area (%), and fractional diffuse damaged area (%) were quantified by using standard histomorphometric methods.The mean monocortical plate thickness of the specimens from the mandible (2.2 mm) was significantly (P0.001) greater than that of the maxillary specimens (0.9 mm). In the mandible, the 3 damage parameters were greater with self-drilling miniscrew implants than with nondrilling miniscrew implants; however, there were no differences in the damage parameters in the maxilla.Bone damage accumulation is related to the type of miniscrew implant and the thickness of the bone.

Introduction Comprehension of informed consent information has been problematic. The purposes of this study were to evaluate the effectiveness of a shortened explanation of an established consent method and whether customized slide shows improve the understanding of the risks and limitations of orthodontic treatment. Methods Slide shows for each of the 80 subject-parent pairs included the most common core elements, up to 4 patient-specific custom elements, and other general elements. Group A heard a presentation of the treatment plan and the informed consent. Group B did not hear the presentation of the informed consent. All subjects read the consent form, viewed the customized slide show, and completed an interview with structured questions, 2 literacy tests, and a questionnaire. The interviews were scored for the percentages of correct recall and comprehension responses. Three informed consent domains were examined: treatment, risk, and responsibility. These groups were compared with a previous study group, group C, which received the modified consent and the standard slide show. Results No significant differences existed between groups A, B, and C for any sociodemographic variables. Children in group A scored significantly higher than did those in group B on risk recall and in group C on overall comprehension, risk recall and comprehension, and general risks and limitations questions. Children in group B scored significantly higher than did those in group C on overall comprehension, treatment recall, and risk recall. Elements presented first in the slide show scored better than those presented later. Conclusions This study suggested little advantage of a verbal review of the consent (except for patients for risk) when other means of review such as the customized slide show were included. Regression analysis suggested that patients understood best the elements presented first in the informed consent slide show. Consequently, the most important information should be presented first to patients, and any information provided beyond the first 7 points should be given as supplemental take-home material.

Introduction Computer-based smile esthetic surveys based on slider technology allow more precise control of variables and the possibility of obtaining continuous data. Variations in the perception of smiles from different facial perspectives have not been resolved. The objective of this study was to quantify the ideal and the range of acceptable values for smile variables judged by laypersons from a full-face perspective for comparison with lower-face data. Methods Mirrored and symmetric male and female full faces previously determined by peers to be of average attractiveness were used. Ninety-six laypersons judged these smile variables: smile arc, buccal corridor fill, maxillary gingival display, maxillary midline to face, maxillary to mandibular midline discrepancy, overbite, central incisor gingival margin discrepancy, maxillary anterior gingival height discrepancy, incisal edge discrepancy, and cant. The judges manipulated the variables using adjustable image technology that allowed the variable to morph and appear continuous on a computer monitor. Medians for each smile variable were compiled, and the Fleiss-Cohen weighted kappa statistic was calculated to measure reliability. Multiple randomization tests with adjusted P values were used to compare these data with those for lower-face views. Results Reliability ranged from 0.25 for ideal overbite to 0.60 for upper midline to face, except for upper and lower buccal corridor limits, which each had a kappa value near 0. There were no statistically significant differences between the ratings of male and female raters. The following variables showed statistically and clinically significant differences (>1 mm) when compared with the lower-face view: ideal smile arc, ideal buccal corridor, maximum gingival display, upper to lower midline, and occlusal cant. Although the smile arc values differed because of model lip curvature variations, the principle of tracking the curve of the lower lip was confirmed. For the full-face view, the raters preferred less maximum gingival display, less buccal corridor, more upper to lower midline discrepancy, and less cant of the occlusal plane. Conclusions Reliability was fair to moderate with the exception of the buccal corridor limits. Most variables showed no clinically meaningful differences from the lower-face view. The acceptable range was quite large for most variables. Detailed knowledge of the ideal values of the various variables is important and can be incorporated into orthodontic treatment to produce an optimal esthetic smile.

Introduction: The purpose of this study was to evaluate the perception of facial attractiveness in profile digital photographs that were incrementally altered to produce different combinations of mandibular anteroposterior positions and lower anterior facial heights. The specific aims were to determine whether there is concordance between providers and consumers in their perceptions of facial attractiveness, and to evaluate whether interactions of the anteroposterior and vertical dimensions and the magnitude of these interactions influence perception of facial attractiveness. Methods: Profile digital photographs and cephalograms of 3 men and 3 women were used. The position of the jaw was altered incrementally with Dolphin imaging equipment (Dolphin Imaging and Management, Chatsworth, Calif), and booklets were created. One hundred raters (50 laypersons, 25 oral surgeons, 25 orthodontists) scored the profiles on a visual analog scale. All images were duplicated to test intrarater reliability. Factorial ANOVA with repeated measures and the Tukey-Kramer post-hoc test for multiple comparisons were used to test for differences in facial attractiveness. The level of significance was set at .05 ( P = .05) for all analyses. Results: Intrarater reliability was good (ICC = 0.71), and general concordance was found between providers and consumers in their perceptions of facial attractiveness. Interactions of the anteroposterior and vertical dimensions and the magnitude of change in each dimension influence the perception of facial attractiveness. Conclusions: The results suggest that preferences of facial attractiveness by laypersons, orthodontists, and oral surgeons in central Ohio are generally in agreement. This information might assist clinicians in treatment planning and making recommendations.

Introduction: This purpose of this study was to examine the effects of a structured telephone call after orthodontic appliance placement on self-reported pain and anxiety. Methods: One hundred-fifty orthodontic patients were randomly assigned to 1 of 3 groups and matched for age, sex, and ethnicity. The subjects completed baseline questionnaires to assess their levels of pain (on a 100-mm visual analog scale) and anxiety (Spielberger’s State-Trait Anxiety Inventory) before orthodontic treatment. After the initial archwires were placed, all subjects completed the pain questionnaire and state-anxiety inventory at the same time daily for 1 week. One group also received a structured telephone call demonstrating care and reassurance; the second group received an attention-only telephone call, thanking them for participating in the study; the third group served as a control. Results: Although both telephone groups reported significantly less pain ( P = .005) and state-anxiety ( P = .033) than the control group, there was no difference between the 2 telephone groups ( P > .12 for pain; P > .81 for state-anxiety). Conclusions: A telephone call from a health-care provider reduced patients’ self-reported pain and anxiety; the content of the telephone call was not important.

The purpose of this study was to investigate the glass transition temperatures (T(g)) of representative elastomeric chain products (plastic modules) in the as-received condition and after orthodontic use to determine differences between brands and pigments. Values of T(g) were determined by differential scanning calorimetry. Products were obtained from 3 manufacturers: Rocky Mountain Orthodontics (RMO, Denver, Colo), Ormco (Glendora, Calif), and GH (Greenwood, Ind). Three colors (gray, red, and purple) were selected for each brand-pigment combination to evaluate the as-received products, and test specimens for each brand-pigment combination from the same batches were placed in patients' mouths for 4 weeks to evaluate the products after clinical use (sample size of 7 specimens for both groups of experiments). Results were analyzed statistically by multiple nonparametric Mann-Whitney tests. A post hoc step-down Bonferroni analysis followed, to examine differences in T(g) due to pigmentation within brands and differences due to brands within each pigmentation category. For the as-received products, the RMO modules had mean T(g) ranging from -24 degrees C to -21 degrees C, whereas the Ormco and GH modules had significantly lower mean T(g), ranging from -46 degrees C to -39 degrees C, indicating substantial compositional or polymer structural differences compared with the RMO modules. After clinical use, the RMO products had mean T(g) ranging from -31 degrees C to -25 degrees C, whereas the Ormco and GH products had mean T(g) ranging from -46 degrees C to -30 degrees C. The in vivo specimens also exhibited a second, higher-temperature glass transition of unknown origin. Results suggest that the Ormco and GH products should have greater flexibility than the RMO products and that there should be significant differences in clinical force-degradation behavior for the Ormco and GH products compared with the RMO products.

The difficulty of achieving an ideal or normal occlusion might lie in the pretreatment occlusion, patient-associated factors, and the treatment. The purpose of this study was to identify factors that were related to the treating orthodontist's posttreatment categorization of a case as difficult or easy. Ten orthodontists each identified 10 easy cases and 10 difficult cases that they had treated. The initial malocclusion was measured with the peer assessment rating (PAR) index and the index of orthodontic treatment need (IOTN). Patient and treatment information was obtained from the treatment records. Statistical analysis with parametric or nonparametric testing was performed. Difficult cases had greater severity and need before treatment and greater residual malocclusion and need after treatment. Difficult cases had more chart entries for problems with hygiene and compliance. They were more likely to have had extractions and changes in treatment plan. Difficult cases also required more appointments and a longer treatment duration. Three logistic regression models were developed based on malocclusion severity, patient characteristics, and treatment characteristics. The models support a correlation between greater pretreatment malocclusion severity, 1-phase treatment, and the designation as a difficult case. This study supports a model in which malocclusion severity and factors associated with the patient and the treatment contribute to an orthodontist's categorization of a case as easy or difficult.

Orthodontic studies over several decades have found generally inconsistent opinions among dentists when evaluating orthodontic treatment need. There has also been recent concern that dental school education does not sufficiently prepare dentists to diagnose malocclusion and make appropriate referrals of potential orthodontic patients. The purpose of this study was to investigate the efficacy of using the index of orthodontic treatment need (IOTN) as a tool to improve dental students' ability to assess orthodontic treatment need. Fourth-year dental students were randomly divided into control, sham-control, and experimental groups stratified for mean grade point average. On 2 occasions, the subjects evaluated 30 orthodontic study models with a gold standard previously established by an expert panel of 15 orthodontists for orthodontic treatment need. The experimental group reevaluated the models after IOTN instruction. Kappa statistics, sensitivity, and specificity were calculated for each subject. Analysis of covariance (ANCOVA) showed that the experimental group had significantly higher agreement with the expert panel after IOTN training than did either control group. IOTN is a promising teaching aid for improving educational outcomes for orthodontic referral.

Several occlusal indexes are currently used to ascertain eligibility for orthodontic treatment. A comparison of 3 indexes of orthodontic treatment need was made with the consensus opinion of a panel of 15 experienced orthodontists. Sets of study casts (170) representing the full spectrum of malocclusions were selected. An examiner, calibrated in the Dental Aesthetic Index, the Handicapping Labiolingual Deviation with the California Modification, and the Index of Orthodontic Treatment Need, scored the casts. The panel of orthodontists individually rated the same casts for their degree of orthodontic treatment need. The mean rating of the panel on the need for treatment was used as the gold standard for evaluating the validity of the indexes. Intrarater and interrater reliability was high (kappa > 0.8). Overall accuracy of the indexes, as reflected in area under receiver-operating characteristic curves, was also high: Dental Aesthetic Index, 95%; Handicapping Labiolingual Deviation with the California Modification, 94%; and Index of Orthodontic Treatment Need, 98%. Cutoff points for the indexes that resulted in the closest agreement with the gold standard differed from the published cutoff points for the indexes. The indexes appear to be valid measures of treatment need as perceived by orthodontists. The published cutoff points for the indexes were more conservative in assigning patients for treatment than a panel of orthodontists. However, adjusting the cutoff points moved all 3 indexes into close agreement with the experts.

The purpose of this retrospective longitudinal study was to compare 7 cephalometric measurements of the cranial base in subjects with Class I and Class II skeletal patterns at ages 1 month, 2 years, and 14 years. A sample of 22 Class I and 21 Class II subjects was selected; the inclusion criteria were overjet, ANB, and Harvold unit difference. Analyses of head circumference, crown-rump length, and weight revealed no significant (P.15) differences between the Class I and Class II infant subjects at the initial age (1 month). One angular and 6 linear measurements were first compared with a multivariate analysis of variance, which revealed significant effects for age (P.0001) and the age by skeletal pattern interaction (P =.0266) but not for skeletal pattern (P =.3705). Analyses of variance showed significant (P.0001) age effects for each of the cephalometric variables but no significant skeletal pattern effects (P.10). The anterior cranial base measurement of nasion to sphenoethmoidal suture was the only variable found to have a significant age by skeletal pattern interaction (P.006), which revealed a difference in the timing of its growth spurt that occurred between 1 month and 2 years in the Class I subjects and between 2 years and 14 years in the Class II subjects. There were no significant differences between the skeletal classes at any of the 3 ages evaluated. Conclusions from this study indicate that cranial base growth patterns are similar for Class I and Class II subjects and that the premise of a more obtuse "saddle angle" or cranial base angle in Class II skeletal patterns was not supported.

Introduction There is little valid information about factors that influence a patient's choice of an orthodontic practice. The aim of this study was to determine what orthodontists consider the most important factors for prospective adult patients or parents of prospective adolescent patients when choosing an orthodontic practice. Methods We randomly selected 450 orthodontists from the American Association of Orthodontists' membership list, stratified to represent various regions. They were sent 2 questionnaires: 1 for prospective adult patients (44 questions) and 1 for parents of prospective adolescent patients (51 questions). The orthodontists were asked to answer as they thought their potential patients would. Responses were given on a visual analog scale. Results One hundred twenty-three orthodontists returned the questionnaires. The 3 highest scores were (for adult patients): “a doctor who makes you feel comfortable,” a doctor with a “caring attitude,” and “the doctor's overall reputation.” For the parents of adolescents, orthodontists thought that “a doctor with a caring attitude,” “who makes you feel comfortable,” and “a staff with a caring attitude” were most important. Conclusions Orthodontists thought that the personal characteristics of the doctor and the staff were the most important factors affecting a potential patient's decision in choosing a practice.

Introduction Low general and health literacy in the United States means informed consent documents are not well understood by most adults. Methods to improve recall and comprehension of informed consent have not been tested in orthodontics. The purposes of this study were to evaluate (1) recall and comprehension among patients and parents by using the American Association of Orthodontists' (AAO) informed consent form and new forms incorporating improved readability and processability; (2) the association between reading ability, anxiety, and sociodemographic variables and recall and comprehension; and (3) how various domains (treatment, risk, and responsibility) of information are affected by the forms. Methods Three treatment groups (30 patient-parent pairs in each) received an orthodontic case presentation and either the AAO form, an improved readability form (MIC), or an improved readability and processability (pairing audio and visual cues) form (MIC + SS). Structured interviews were transcribed and coded to evaluate recall and comprehension. Results Significant relationships among patient-related variables and recall and comprehension explained little of the variance. The MIC + SS form significantly improved patient recall and parent recall and comprehension. Recall was better than comprehension, and parents performed better than patients. The MIC + SS form significantly improved patient treatment comprehension and risk recall and parent treatment recall and comprehension. Patients and parents both overestimated their understanding of the materials. Conclusions Improving the readability of consent materials made little difference, but combining improved readability and processability benefited both patients' recall and parents' recall and comprehension compared with the AAO form.

Introduction Few published reports detail the dental changes produced by orthodontic treatment in conjunction with orthognathic surgery. Methods Thirty-four Class II subjects who underwent surgical-orthodontic treatment with mandibular advancement and rigid fixation were selected, and their lateral cephalograms were digitized. Mean skeletal and dental values were calculated for pretreatment, presurgical, and final treatment times. Treatment efficacy as a percentage of an ideal goal achieved also was calculated. Results All data showed significant positive changes in the position of the mandible. The mean changes showed that the maxillary incisors were overretracted presurgically and then returned to a normal position postsurgically, whereas the mandibular incisors were proclined and protruded presurgically and remained so at posttreatment. The efficacy data showed that the incisors were not ideally decompensated in many patients. Conclusions The efficacy data show that presurgical orthodontic treatment often does not fully decompensate the incisors; this then limits the surgical outcome.

Introduction There is little valid information about factors that influence a patient's choice of an orthodontic practice. The aim of this study was to determine what orthodontists consider the most important factors for prospective adult patients or parents of prospective adolescent patients when choosing an orthodontic practice. Methods We randomly selected 450 orthodontists from the American Association of Orthodontists' membership list, stratified to represent various regions. They were sent 2 questionnaires: 1 for prospective adult patients (44 questions) and 1 for parents of prospective adolescent patients (51 questions). The orthodontists were asked to answer as they thought their potential patients would. Responses were given on a visual analog scale. Results One hundred twenty-three orthodontists returned the questionnaires. The 3 highest scores were (for adult patients): “a doctor who makes you feel comfortable,” a doctor with a “caring attitude,” and “the doctor's overall reputation.” For the parents of adolescents, orthodontists thought that “a doctor with a caring attitude,” “who makes you feel comfortable,” and “a staff with a caring attitude” were most important. Conclusions Orthodontists thought that the personal characteristics of the doctor and the staff were the most important factors affecting a potential patient's decision in choosing a practice.

Introduction Low general and health literacy in the United States means informed consent documents are not well understood by most adults. Methods to improve recall and comprehension of informed consent have not been tested in orthodontics. The purposes of this study were to evaluate (1) recall and comprehension among patients and parents by using the American Association of Orthodontists' (AAO) informed consent form and new forms incorporating improved readability and processability; (2) the association between reading ability, anxiety, and sociodemographic variables and recall and comprehension; and (3) how various domains (treatment, risk, and responsibility) of information are affected by the forms. Methods Three treatment groups (30 patient-parent pairs in each) received an orthodontic case presentation and either the AAO form, an improved readability form (MIC), or an improved readability and processability (pairing audio and visual cues) form (MIC + SS). Structured interviews were transcribed and coded to evaluate recall and comprehension. Results Significant relationships among patient-related variables and recall and comprehension explained little of the variance. The MIC + SS form significantly improved patient recall and parent recall and comprehension. Recall was better than comprehension, and parents performed better than patients. The MIC + SS form significantly improved patient treatment comprehension and risk recall and parent treatment recall and comprehension. Patients and parents both overestimated their understanding of the materials. Conclusions Improving the readability of consent materials made little difference, but combining improved readability and processability benefited both patients' recall and parents' recall and comprehension compared with the AAO form.

Introduction Few published reports detail the dental changes produced by orthodontic treatment in conjunction with orthognathic surgery. Methods Thirty-four Class II subjects who underwent surgical-orthodontic treatment with mandibular advancement and rigid fixation were selected, and their lateral cephalograms were digitized. Mean skeletal and dental values were calculated for pretreatment, presurgical, and final treatment times. Treatment efficacy as a percentage of an ideal goal achieved also was calculated. Results All data showed significant positive changes in the position of the mandible. The mean changes showed that the maxillary incisors were overretracted presurgically and then returned to a normal position postsurgically, whereas the mandibular incisors were proclined and protruded presurgically and remained so at posttreatment. The efficacy data showed that the incisors were not ideally decompensated in many patients. Conclusions The efficacy data show that presurgical orthodontic treatment often does not fully decompensate the incisors; this then limits the surgical outcome.