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Background: The rating result reflects not only the performance of the candidate but some extent of the examiner’s preference. Examiner bias could be objective, which means it can’t be changed by the examiner like gender, age, race, educational level, or professional experience. No study about examiner bias was performed in the dental education realm, especially in the orthodontic field. Therefore, this study aimed to figure out possible influencing factors in examiners from examples of the Taiwan Board of Orthodontist examination. Methods: The examiner groups comprised 29 males and 21 females selected from the certificated Taiwan Board of Orthodontists. Every examiner would receive a series of lectures about rating standards before the exam. The score data were collected from 2009 to 2019. Results: As for the univariate regression model of the Taiwan Board of Orthodontist examination, the experienced examiner with a certification of more than 15 years tends to rate more leniently, but female examiners tend to rate harsher. The scores would increase with the examiner’s age in both the univariate regression model of self-prepared and assigned cases. Conclusion: As for the multivariate model of self-prepared exams, the elder and the examiner who work in private practice clinics tend to rate more leniently. As for the multivariate model of the assigned case exam, the score would be only affected by age. However, further studies are necessary to determine the direct relation among these factors.

Background/purpose: The simulated color of restorations plays an important role in improving patient satisfaction. The aim of this study was to test a new intelligent colorimetric solution using the Advanced Reflectionless Technology (ART) monitor and compare them using commercially available shade systems. Materials and methods: Six participants' right maxillary central incisors were tested with three devices, including the AUO Display Plus (Group A), a Canon single-lens reflex camera with eLAB's polar eyes filter (Group E), and the VITA Easyshade V (Group V). Each porcelain tooth was divided into three areas, and was assigned a CIELAB L∗a∗b∗ value by using the VITA Easyshade V. The original data were compared with the CIELAB L∗a∗b∗ obtained using the VITA Easyshade V. A prosthodontist compared the color of the porcelain veneers by eyes and gave the scores from 1 to 3. Results: For the ΔE, the three areas of Group A had the smallest differences between the color of the fabricated teeth and that of the original teeth. Colorimetric analysis indicated that Groups A and V did not differ much in the color of the three areas of the tooth. Groups E and A exhibited significant differences between the cervical third and middle third of the tooth, and Groups E and V exhibited significant differences between the middle third and incisal third of the tooth. Conclusion: Compared with traditional monitors, ART is closer to real images in terms of color, contrast, and detail grayscale. Technicians are able to produce realistic and pleasing colors.

Background/purpose: The objective structured clinical examination (OSCE) is a test designed to test technical, clinical, and practical competency in medicine teaching. This study tried to evaluate the influencing factors of the computer-based tests (CBT) results for dental students. Materials and methods: The 32 5th-year dental students of the dental school of National Taiwan University (NTU) joined preclinical CBT. The contents of CBT included clinical knowledge and practical skills of nine dental specialties. Twenty single-choice questions were played with the PowerPoint 2016 on a desktop, and the playing time for each question was 30 s. Several factors including the gender, age, and dental student admission ways (with or without the skill tests) were evaluated. Also, the comparison between the clerk's grade and CBT scores of nine dental specialties was performed. The students also filled the feedback questionnaire about the examination questions and suggestions for the CBT. Results: There were no significant differences in the mean CBT scores between male and female dental students, between two groups of dental students with or without the skill tests in the admission process, and among three different age groups of dental students. The clerk's scores were not directly related to the CBT scores. Conclusion: The CBT has been well-intentioned in dental education since 2022 in Taiwan. The CBT results revealed that the conjunction of knowledge from the textbook and clinical observation should be enhanced. The guideline should be established to integrate CBT into preclinical education and promote the performance of clinical work of dental students.

Background/purpose: The simulated pre-clinical operation skill test (PCOST) is part of the objective structured clinical examination (OSCE) and designed for clinical practice using manikins, physical typodonts, and instruments in the laboratory. This study tried to evaluate the influencing factors of the PCOST results for dental students. Materials and methods: The 32 5th-year dental students of the dental school of National Taiwan University (NTU) joined the PCOST. The contents of PCOST included two specialties: operative dentistry (OD) and prosthodontics (PS). The examination content of OD was tooth 36 mesio-occluso-distal (MOD) cavity preparation, and that of PS was crown preparation and temporary crown fabrication of tooth 11. Several factors including the gender, age, and dental student admission ways (with or without the skill tests) were evaluated. Each scoring item was calculated. The students also filled the feedback questionnaire about the examination questions and suggestions for the PCOST. Results: For both OD and PS, there were no significant differences in the mean PCOST scores between male and female dental students, between two groups of dental students with or without the skill tests in the admission process, and among three different age groups of dental students. According to the feedback questionnaire from the participated dental students, they were satisfied with the PCOST. Conclusion: The PCOST is a good simulated examination in clinical practice. However, we still need to collect more PCOST data and feedback to revise the guideline of the PCOST, and to promote the performance of clinical works of dental students.

Background/purpose: The SimEx is dental training system that applies new technology in a computerized dental simulator. The purpose of this study was to understand the usability satisfaction of the SimEx dental education and evaluation system by dental students and dentists at Tohoku University. Materials and methods: In this study, the Tohoku University IRB execution number was 2020-3-33. The number of subjects accepted was 59 at Tohoku University and divided into 4 groups based on years of clinical experience (Group A: 0 years; Group B: 1–2 years; Group C: 2–5 years; Group D: at least 5 years), and a total of 58 usability questionnaires were collected. Subjects completed the SimEx Usability Satisfaction Questionnaire after operating the SimEx (EPED Inc., Kaohsiung, Taiwan) course, which contained 16 questions. Results: Among the 58 questionnaires collected by Tohoku University, there were 19 undergraduate students (4th∼6th grade), 12 post-graduate students, 14 residents, and 13 dentists. Significant differences between Group A and Group B, and between Group A and Group D were found (P

Introduction: Tooth wear is a prevalent dental condition among older adults, leading to pain and adversely affecting aesthetics, functionality, and their overall quality of life. This review aims to update the information on tooth wear in older adults from the past five years and to provide guidance on the clinical management of tooth wear in older adults. Methods: A literature search was conducted in three electronic databases, Scopus, Pubmed, and Embase, for English publications from January 2019 to December 2023 on clinical studies with participants aged 65 or above on tooth wear. A total of 307 articles were retrieved and 14 articles were finally included as references for this study. Results: This review highlights the common causes of tooth wear and various risk factors, such as medical conditions, hyposalivation, dietary habits, oral hygiene practices, parafunctional habits, and occlusal factors, associated with tooth wear. It is crucial for oral health care professionals to diagnose and manage tooth wear at an early stage through a risk assessment and a clinical examination to avoid complex restorative procedures. Tooth wear management should prioritize prevention, aiming to control etiological and risk factors while employing non-restorative treatments. Restorative intervention, if indicated, should be simple, minimally invasive, and cost-effective. Tooth wear progression should be monitored regularly to determine if a further intervention is needed. Conclusion: Since the clinical studies on tooth wear in older adults over the past five years are limited and mainly cross-sectional, more interventional clinical studies are warranted to provide more clinical guidance on tooth wear management in older adults.

Background/Purpose: Crestal bone stability, implant rigidity and occlusal loading are issues with small-diameter implants. This article demonstrates the use of two small-diameter implants replacing a missing wide edentulous site and discusses factors that may affect bone changes. Methods: Patients who wanted to restore an edentulous space measuring from 12 to 14 mm wide in the posterior region were offered an alternative treatment option, using two narrow or regular-diameter implants instead of one wide implant. In the study, the crestal bone stability of 12 implants in 6 edentulous sites was assessed by cone beam CTs and periapical radiographs in follow-up visits for up to 4 years. Results: The bone level of all the implants was stable at buccal, lingual, mesial and distal sites, with mean values

Background/Purpose: The objectives of this retrospective study are to analyze post-surgical gingival thickness after connective tissue grafting in the Asian population and to assess its tissue stability for up to approximately 3.5 years. Methods: A total of 111 grafted teeth and 57 nearby nongrafted teeth in 28 Asian patients who had undergone connective tissue grafting surgery were selected. Gingival thickness was measured by transgingival probing. The mean gingival thickness of the grafted teeth was compared with adjacent nongrafted teeth in the same individuals. The mean gingival thickness of the grafted teeth in different tooth types and at various time intervals were statistically analyzed. Results: The average gingival thickness following connective tissue grafting is 1.99 ± 0.62 mm compared to 0.96 ± 0.40 mm with nongrafted teeth (P

This report provides three-phase concept for treating skeletal Class III growing patients with severe space deficiency. Three cases are presented. All had received miniplate-anchored facemask treatment and followed till near completion of growth. Infrazygomatic miniplates were used for both facemask protraction and distalization of the dentition to relieve crowding. With the aid of bone-anchored facemask, maxillary protraction may be continued independent of the orthodontic tooth movement even in late postpubertal growth peak stage. With cephalometric superimpositions using the structural method, we have demonstrated how vertical dental change could affect the skeletal changes and overall clinical outcomes. The persistent mandibular growth during pubertal growth spurt plays a main role in decreasing the effects of maxillary protraction. To keep up with the mandibular growth, we recommend using skeletally anchored facemask long-term till the end of growth spurt. Applying maxillary protraction from infrazygomatic miniplates exposed at the molar area has the merits that it avoids unwanted palatal rotation and that the miniplates maybe used as orthodontic anchorage when indicated. We emphasize the importance of planning the treatment contemplating the skeletal developmental stage and the completion of dental arches. This prolonged orthopedic treatment may contribute to greater long-term effects and stability. Keywords: Class III, Maxillary protraction, Skeletal anchorage

Background/purpose: The licensed dentists in Taiwan should join the post-graduate year training program for dentists (PGYD) since 2010. This study aimed to analyze the project types and the geographical distribution of the PGYD training institutions in Taiwan from 2010 to 2018. Materials and methods: From 2010 to 2018, 735 hospitals and clinics participated in four types of PGYD project including hospital as the single training institution (project A), clinic as the single training institution (project B), hospital as the main training institution in the joint training group (project C), and clinic as the main training institution in the joint training group (project D). The project types and the geographical distribution of the training institutions were analyzed. Results: The 735 PGYD training projects were proposed by the 735 dental institutions. The project number grew from 119 in 2010 to 195 in 2018. The most common project type was project B (307, 41.8%), followed by the project A (249, 33.9%), the project D (101, 13.7%), and the project C (78, 10.6%). Geographically, these 735 main training institutions were located most commonly in northern region of Taiwan (379, 51.6%), followed by the central region of Taiwan (171, 23.3%), southern region of Taiwan (156, 21.2%), and eastern region of Taiwan (29, 3.9%). Conclusion: Hospital or clinic as the single training institution is the two most common PGYD project types in Taiwan from 2010 to 2018. These single or main dental training institutions are mainly located in the northern, central, and southern regions of Taiwan. Keywords: Post-graduate year training program for dentists, Clinical dental training project, Clinical dental training institution, Collaborating dental training institution

Background/purpose: Objective structured clinical examination (OSCE) has found increasingly wide use in the education of clinical dentistry in recent years. The objectives of this study were to find the predictability of OSCE in representing a student's actual ability in a clinical environment and to provide instructors with better ideas to guide an individual student in a certain field. Materials and methods: Thirty-one dentistry students’ qualification OSCE scores were obtained after the conclusion of their dental clerkship in December 2014. The OSCE scores were compared with the various scores given by instructors from different departments during their internship a year later. The correlation was investigated between these two scores. Results: The scores of the first station of OSCE—explaining a treatment plan for the restoration of a missing tooth—were correlated with the scores of prosthodontics in the internship. The scores of the fourth station of OSCE—explaining to a mother regarding the obtainment of a radiograph of her child's tooth—were correlated with the scores of orthodontics. In addition, the total score of the six OSCE stations was correlated with the scores of orthodontics, oral surgery, and pediatric dentistry during dental internship. Conclusion: The results of clerkship qualification OSCE could provide instructors with insights into the needs of the students before their entering internship. Keywords: Clerkship, Internship, Objective structured clinical examination, Need assessment

Background/purpose: Heat pretreatment can improve the cyclic fatigue life of nickel–titanium (NiTi) instruments. This study evaluated the effects of two different heat treatments on the cyclic fatigue resistance and cutting efficiency of ProTaper Universal F2 files. Materials and methods: The files were divided into three groups: no treatment (control), heat treatment at 400°C (HT400) and heat treatment at 600°C (HT600). The phase transformation of the files was evaluated by differential scanning calorimetry. In cyclic fatigue tests, the differences in file performance in four simulated canals among the three groups were assessed. The cutting efficiency was tested at four cutting portions (3 mm, 6 mm, 9 mm, and 12 mm) from the tip of the file. Results: Differential scanning calorimetry showed a prolonged phase transformation of the files only after 600°C treatment. At 3 mm cutting portion, 400°C heat-treated files had significantly better cutting ability than those in the control group. However, the files in the HT600 group had significantly lower cutting efficiency than those in the other two groups at the four tested positions. In the cyclic fatigue test, fatigue lives of the files after 400°C and 600°C treatment were prolonged from 2.1 to 2.8 times and from 1.7 to 5.5 times, respectively. Conclusion: Although 600°C treatment increased resistance to cyclic fatigue, it reduced the cutting efficiency of the files. The 400°C treatment maintained the cutting ability and prolonged the cyclic fatigue life of the files. Therefore, for clinical use of ProTaper Universal F2 files, 400°C pretreatment is a better choice than 600°C pretreatment.

For light-initiated dental hybrid composites, reinforcing particles are much stiffer than the matrix, which makes the surface rugged after inadequate polish and favors bacterial adhesion and biofilm redevelopment. The aim of the study was to investigate the polishing mechanism via the geometric optics approach. Methods: We defined the polishing abilities of six instruments using the obtained gloss values through the geometric optics approach (micro-Tri-gloss with 20°, 60°, and 85° measurement angles). The surface texture was validated using a field emission scanning electron microscope (FE-SEM). Based on the gloss values, we sorted polishing tools into three abrasive levels, and proposed polishing sequences to test the hypothesis that similar abrasive levels would leave equivalent gloss levels on dental composites. Results: The three proposed, tested polishing sequences included: S1, Sof-Lex XT coarse disc, Sof-Lex XT fine disc, and OccluBrush; S2, Sof-Lex XT coarse disc, Prisma Gloss polishing paste, and OccluBrush; and S3, Sof-Lex XT coarse disc, Enhance finishing cups, and OccluBrush. S1 demonstrated significantly higher surface gloss than the other procedures (p

Background/purpose: Recently, dental education has put emphasis on the assessment of clinical competencies using an objective structured clinical examination (OSCE). The purpose of this study was to assess several clinical competencies required for dental graduates by having dental students and residents of different levels take the same set of OSCEs. Materials and methods: Twelve 5th-grade dental students (D5), 12 dental interns (Ri), and 12 1st-year dental residents (R1) were recruited to take the same set of OSCEs composed of six stations: Station 1, explanation of a treatment plan for restoration of a missing tooth; Station 2, taking a study cast impression with alginate; Station 3, explanation of a treatment plan for restoration of an inlay; Station 4, explanation to a mother for taking a radiograph of her child's tooth; Station 5, placement of a rubber dam on a designated tooth and Station 6, explanation of pulpitis diagnosis and treatment. The examinee's performance was graded using both global rating and checklist scores. Results: There were significant differences in the mean global rating and checklist scores of Stations 3, 5, and 6 among the three groups. In Stations 3 and 5, Ri performed best, followed by R1 and D5. In Station 6, R1 performed best, followed by Ri and D5. In Stations 1, 2, and 4, there were no significant differences among the three groups. However, Ri performed better than R1 in Station 1. Conclusion: More emphasis should be placed on professional communication skills in the resident training program.

Background/purpose: Depending on the educational institute to which they are associated, professors of dentistry differ in their objectives and ideals. Thus, reaching a common consensus regarding the requirements that are essential in this field has proven exceedingly difficult. This study sought to provide a reference for the design of clinical courses and the assessment of educational outcomes in the field of dentistry. Materials and methods: This study used the nominal group technique with 12 volunteers recruited from the School of Dentistry, National Taiwan University (Taipei, Taiwan) to identify the essential core competencies required by dental students before graduation. Results: The participants classified the core competencies into two categories, namely, operational and nonoperational, and then prioritized them according to importance. The three most important of nonoperational capabilities were patient–dentist discourse (querying patients and responding to questions), treatment planning, and the ability to deal with medically compromised dental patients. The three most important operational capabilities were cavity filling, infection control, and proper handling of needles. Conclusion: Patient–dentist discourse was identified as the most important duty in dealing with patients on their first visit. Suitable discourse can help to identify the purpose of the current visit and obtain information related to a patient's dental and medical history. It also gives the dental staff an indication of the patient's personality traits and helps in the formulation of an initial treatment plan following the examination.

Tooth transposition is a positional interchange of two adjacent teeth. Transposition most often occurs at maxillary canine. Moving transposed teeth to their normal positions is challenging because this requires bodily movement and translation of one tooth to pass another. This procedure may cause damage to the teeth or supporting structures. We report a case of complete transposition of maxillary canine and lateral incisor. Transposed teeth were successfully moved orthodontically to their normal positions. Multiple mechanics were meticulously applied to achieve complete correction of the tooth positions and to minimize root resorption and/or periodontal defects of canine and lateral incisors. Factors concerning treatment planning for transposed teeth are discussed.

Background/purpose: In order to evaluate properly the effect of different geometric designs of mini-implants on their mechanical behavior, finite element analysis (FEA) has long been a popular tool. The aim of the present study was to set up a standardized mechanical experiment to validate the effectiveness and accuracy of FEA. Materials and methods: Three commercially available mini-implants, Mondeal, Osstem, and Bio-Ray were inserted into artificial bone block with homogeneous density to remove the variability associated with bone. FEA and mechanical tests were performed. Results: For the bending test, a 7.57% error was found between the mechanical test and FEA. For relative and maximum displacements, results from FEA were compatible with those from mechanical tests. The results of the relative displacement from FEA (Mondeal > Osstem > Bioray) were consistent with those from mechanical tests that Mondeal provided the greatest mean displacement before failure, followed by Osstem and BioRay. Furthermore, after simulating a 2-mm cortical bone layer in the FEA test, the pullout resistance increased for all three mini-implants, yet the variations in between decreased dramatically. Conclusion: By incorporating FEA with real mechanical trial experiments, results from FEA have been validated and proved to be effective in studying the stress and strain distribution of mini-implants subjected to loading. FEA helps to evaluate how geometrical designs of mini-screws affect their clinical performance and may be useful in future improvement of screw designs. Based on our results, we have found that in clinical situations, the cortical bone layer plays an important role in the stability of the mini-implants.

Background/purpose: To identify how dentoalveolar changes compensate for proper overbite in extreme vertical facial patterns. Materials and methods: Lateral cephalometric roentgenograms of preorthodontic adult patients with hyperdivergent (n = 49; SN-mandibular plane (MP) angle greater than 38 degrees) and hypodivergent (n = 38; SN-MP angle less than 28 degrees) skeletal patterns were selected. Skeletal-vertical (SV) variables were selected and summarized via stepwise regression methods and principal component analysis (PCA) in these two groups. Multiple regression analyses were performed to determine the relationship between overbite (OB) as the dependent variable and the PCA-derived SV, dental height (DH), and dental inclination (DI) as the independent variables. Results: Hyperdivergent patients have the tendency of anterior open bite. The natural dentoalveolar compensatory mechanism is manifested in shorter upper molar height and larger lower incisor height. Hypodivergent patients have no tendency of anterior deep bite. The shorter upper and lower incisor DHs and larger incisal inclination achieved dentoalveolar compensatory mechanism in these patients. Conclusion: For orthodontically closing the open bite, intruding upper posteriors and extruding lower anteriors are appropriate ways to simulate the natural occurring compensation. To eliminate deep bite in a low mandibular plane patient, intruding upper and lower anteriors and proclining anteriors will achieve good overbite. Imitating the natural dentoalveolar compensation by using temporary anchorage devices at appropriate sites for intruding teeth helps to resolve orthodontic vertical problems.

Background/purpose: Well-constructed and validated evaluation tools have been used for clinical performance assessment (including objective-structured clinical examination) in many countries for years. The aim of performance assessment in dentistry is to evaluate whether dental graduates are clinically competent in essential skills, and these results can be utilized in modifying teaching and training programming. Thus, to improve the reliability of the evaluation tools, inter-rater reliability is weighted heavily. The aim of this study is to investigate the correlation between rater training and rater reliability. Materials and methods: Two sixth-year dental students who had already undergone a half-year of internship completed an 8-minute subgingival root planing procedure, and the students' performance was captured on videotape. Nine faculties from the School of Dentistry, who had participated in developing this case, were invited to observe the recorded video and to rate the two students using a checklist. One month later, after receiving further assessment training (workshop including role-play, rating practice, discussion, etc.), the same nine raters observed the same video again and re-rated the students using the same checklist. Results: Analysis results of inter-rater reliability for the two students in the initial rating were W = 0.770 and 0.763. Results of re-rating (1 month later) were W = 0.891 and 0.827. All results were statistically significant (P

Background/purpose: In Taiwan, dental departments are not currently included in hospital accreditation which began in 1978. In order to prepare dental department for hospital accreditation, a field survey of dental departments in hospitals was carried out in 2007∼2008. Materials and methods: In 2007∼2008, a questionnaire survey (evaluation form) about dental administrative management criteria were mailed to 165 dental departments in Taiwan. After the questionnaires were mailed back, a field survey of dental departments of these hospitals was carried out. We then made a field visit to each hospital to check the answers on the questionnaire. The survey rate is 62%. This research examined 30 of the 93 criteria concerned with dental administrative management, and the results were analyzed. Scores of the criteria in the questionnaire (evaluation form) were on a 5-point scale, from high to low: A indicates totally achieved, B indicates above the average standard, C indicates the average standard, D indicates below the average standard, and E indicates not suitable. We analyzed the percentages of A, B, C, D, and E according to the level of medical center, regional hospital, and district hospital, and then for every criterion respectively. Next, we analyzed the percentages of A∼E for the entire dataset. Results: For overall dental administrative management, most (48%) medical centers received an A, most (43%) regional hospitals received a B, and most (60%) district hospitals received a C. The overall average was B (37%). The percentages above C were 99.8% of medical centers, 94.7% of regional hospitals, and 87.8% of district hospitals. For facilities management, the percentages above C were 100% of medical centers, 92% of regional hospitals, and 84% of district hospitals. For patient safety and quality control, the percentages above C were 99% of medical centers, 97% of regional hospitals, and 91% of district hospitals. Conclusion: For the overall administrative management of dental departments, medical centers were superior to regional hospitals, which were better than district hospitals. In order to elevate the quality, we suggest that dental department should be included in teaching hospital accreditation, and the criteria we used can be taken for reference for the dental department accreditation in the future.

A smooth enamel surface after the removal of a bracket from a tooth is essential for both esthetic demands and the prevention of plaque accumulation. The purpose of this study was to evaluate enamel damage caused by three standardized debracketing techniques. Methods: We established three standardized test devices based on the principles of the squeezing, shearing, and tensile testing methods, which were simulated using a How Plier (TASK 60-306), a Direct Bond Bracket Remover (TASK 60-335 T), and a Lift-Off Debracketing Instrument (3 M-Unitek 444-761), respectively. Thirty teeth in each group were evaluated after debracketing. An optical stereomicroscope and a CCD camera with a computerized image analysis system were used to ascertain the proportion of remnant adhesive area (RAE) on the enamel surface. Fractography was analyzed using a scanning electron microscope. Results: The squeezing debracketing method exhibited the highest debonding force (54.3 ± 7.0 N) and the least damage to the enamel surface (RAE = 99.5% ± 2.4%). The tensile debracketing method preserved most of the adhesive on the enamel surface (RAE = 98.7% ± 3.3%) and required the least debonding force (6.8 ± 1.2 N). However, the shearing debracketing method exhibited a significantly higher debonding force (32.0 ± 8.2 N) and smaller RAE (77.3% ± 33.5%) compared to the tensile debracketing method (p

In Taiwan, dental manpower in hospitals plays an important role in dental education other than clinical service. Questionnaires, as well as a field survey, were conducted to understand the situation of dental manpower in 2007 and 2008. Methods: During the period from 2007 to 2008, questionnaires about dental administration, clinical dental practice, dental education, dental manpower and dental facilities were mailed to the dental departments of 165 hospitals located around Taiwan; 134 completed the questionnaire and mailed it back. The field survey was also carried out by visiting hospitals, to collect and gather information at the local level. There were 102 hospitals within the 134 hospitals which accepted the field survey; the rate was 62.0%. Results: In 2008, the number of dentists working in the hospitals was 1,421, which was approximately 13% of the number of total dentists in Taiwan (9672). Within the 1,421 dentists, 675 were attending staffs and 745 dentists were training residents. Within the 675 attending dentists, 510 (75.6%) had dental specialist certificates and 272 (40.3%) had teaching positions in dental schools. There were 382 dental interns (6th year undergraduate students) taking the training programs in hospitals, most of whom were trained in medical centers (342/382, 89.5%). Moreover, there were 888 dental assistants, 338 of whom were nurses and the other 550 were hospital self-trained personnel. Conclusion: Comparing the dental manpower of different types of hospitals in Taiwan, the medical center was the best, followed by the regional hospital and the district hospital was last. When comparing 2008 with 2002, the numbers of both dentists and auxiliary personnel in Taiwan's hospitals increased with years. Although there were still only 13% dentists working in the hospital, they were responsible for teaching young dentists and doing research in hospitals. In other words, the quality of clinical service, teaching, and research in hospitals would influence the development of young dentists.

Background/purpose: Obvious craters are consistently found on roots when the teeth move against the screws of a temporary anchorage device (TAD) in human studies. In order to understand the dynamics of tissue reactions with this contact during orthodontic tooth movement (OTM), an animal experiment was performed. Methods: Two mongrel dogs were used. In the first animal, the teeth were moved towards the screws for 12 weeks, and a 6-week healing period was used. In the second animal, loading was continued for 18 weeks without a healing period. Results: Screws in contact with a root during OTM remained stable. Damage to the roots was indeed present as shallow dents, although this amount of damage was relatively small compared to the width of the root. A few inflammatory cells were detected in the periodontal structures. Once the force of the load was removed, there was little evidence of ongoing resorption. Conclusions: A root moving towards a screw during OTM leads to crater-like damage. When time was allowed for healing, a trace of labeled cementum was found to have repaired the root surface, although a large portion of the concavity was filled in with alveolar bone, and the periodontal ligament space remained constant. A root moving against a screw produced excessive tipping. To avoid deviation from the predicted biomechanics and damage to the root, extra caution should be used to ensure the best benefits for patients when TADs are used interdentally for distalization of the dentition during orthodontic treatment.

Three-dimensional planning of a dental-implant site is critical when implants are to initially be used as orthodontic anchorage for tooth movement and to later serve as prosthetic abutments. The combined orthodontic and prosthetic implant restorative treatment of an adult patient with multiple missing teeth, an upper midline deviation, and malocclusion is described in this article. Plastic model bases combined with customized position plates allowed the precise transfer of the proposed implant position from the diagnostic arrangement to the original cast to avoid compromising subsequent orthodontic tooth movement.

This case report describes the treatment of a 17-year-old girl with an anterior open- bite and Class III malocclusion, who had a history of thumb-sucking habit in childhood. The multiloop edgewise archwire technique was used on the mandibular arch to facilitate uprighting of the mandibular posterior teeth, change the cant of occlusal plane, close the anterior open-bite, and correct the Class III malocclusion. At the end of treatment, Class I occlusion and correction of the anterior open-bite had been achieved. An examination 8 years 8 months after treatment revealed long-term stability of the treatment results.

Background/Purpose: The age at menarche reflects a pubertal girl's physiologic maturity. The aims of this study were to evaluate the relationship between the age at menarche and skeletal maturation in female orthodontic patients. Methods: Hand-wrist radiographs and lateral cephalometric radiographs from 304 adolescent female subjects (age, 8–18.9 years) were selected from the files of the Department of Orthodontics, National Taiwan University Hospital (NTUH). Hand-wrist bone maturation stages were assessed using the NTUH Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages (CVMS) were determined using the latest CVMS Index. Menarcheal ages were self-reported by the patients and verified by the patients' mothers. The relationships between the NTUH-SMI or CVM stages and menarcheal status were investigated. Results: More than 90% of the 148 subjects who had already attained menstruation had skeletal maturation beyond the NTUH-SMI stage four or CVMS III. However, the subjects who had never experienced menarche mostly had skeletal maturation before NTUH-SMI stage five or CVMS IV. During the period of orthodontic treatment, 19 females experienced their menarche. The mean age at menarche for the 167 female patients in total was 11.97 years. In average, menarche occurred between NTUH-SMI stages four and five or between CVM stages III and IV. The percentage of girls with menses increased from 1.2% at age 9 to 6.6% at age 10, 39.5% at age 11, 81.4% at age 12, 97% at age 13, and 100% at age 14. Compared with the results obtained 20 years previously, we found a downward shift of 0.47 years per decade for the mean age at menarche in female orthodontic patients. Conclusion: The majority of female orthodontic patients have passed the pubertal growth spurt when they experience their menarche. Menarche usually follows the pubertal growth spurt by about 1 year and occurs after NTUH-SMI stage four or CVMS III.

The skeletal maturation status of a growing patient can influence the selection of orthodontic treatment procedures. Either lateral cephalometric or hand-wrist radiography can be used to assess skeletal development. In this study, we examined the correlation between the maturation stages of cervical vertebrae and hand-wrist bones in Taiwanese individuals. Methods: The study group consisted of 330 male and 379 female subjects ranging in age from 8 to 18 years. A total of 709 hand-wrist and 709 lateral cephalometric radiographs were analyzed. Hand-wrist maturation stages were assessed using National Taiwan University Hospital Skeletal Maturation Index (NTUH-SMI). Cervical vertebral maturation stages were determined by the latest Cervical Vertebral Maturation Stage (CVMS) Index. Spearman's rank correlation was used to correlate the respective maturation stages assessed from the hand-wrist bones and the cervical vertebrae. Results: The values of Spearman's rank correlation were 0.910 for males and 0.937 for females, respectively. These data confirmed a strong and significant correlation between CVMS and NTUH-SMI systems (p < 0.001). After comparison of the mean ages of subjects in different stages of CVMS and NTU-SMI systems, we found that CVMS I corresponded to NTUH-SMI stages 1 and 2, CVMS II to NTUH-SMI stage 3, CVMS III to NTUH-SMI stage 4, CVMS IV to NTUH-SMI stage 5, CVMS V to NTUH-SMI stages 6, 7 and 8, and CVMS VI to NTUH-SMI stage 9. Conclusion: Our results indicate that cervical vertebral maturation stages can be used to replace hand-wrist bone maturation stages for evaluation of skeletal maturity in Taiwanese individuals.

Excessive gingival display is often an aesthetic concern for patients and a challenge for clinicians. Multiple causes are possible and focused treatment options should be considered. The aim of this article is to emphasise the importance of interdisciplinary treatment for patients presenting with excessive gingival display. A 49-year-old female patient who suffered from prominent teeth and a gummy smile was diagnosed with skeletal and dental Class II relationships and a hypermobile upper lip. Aesthetically pleasing outcomes and stable occlusal function were achieved as a result of orthodontic treatment and a surgical lip repositioning procedure. The outcome was maintained after a two-year follow-up. [ABSTRACT FROM AUTHOR]