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Background: The use of direct‐to‐consumer (DTC) orthodontic aligners is growing. The purpose of this study was to evaluate the quality of information contained within the websites of DTC orthodontic aligner providers. Methods: Websites that satisfied inclusion criteria were assessed for the presence of specific treatment‐related features. Four validated quality of information instruments and readability tools were used to evaluate the content of the websites. Descriptive statistical analyses and intra‐examiner reliability tests were performed. Results: Twenty‐one websites were evaluated. Few websites referred to the need for pre‐treatment dental health (38.1%) and indefinite post‐treatment retention (23.8%). Most websites (95.2%) were categorized as either 'poor' or 'very poor' according to their DISCERN scores. DISCERN items regarding information bias and treatment risks scored particularly poorly. Cohen's kappa intra‐examiner reliability testing for DISCERN scores was 0.81–0.89. Three websites honoured two out of the four Journal of the American Medical Association benchmarks and 18 honoured one benchmark only. The readability scores indicated 'difficult to read' content. Conclusions: The quality of information contained within the websites of DTC orthodontic aligner providers is poor. Patient consent for DTC aligner treatment based solely on the information contained within the websites is likely to be invalid. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to assess the relative contribution of genes to shape variation in the permanent dental arches in individuals of Western European descent., Methods: The dental casts from 64 monozygotic and 38 dizygotic twins, housed in the Adelaide Dental School's twin record collection, Australia, were assessed. The subjects were of Western European descent, with a mean age of 19.4 ± 5.4 years. Dental casts were scanned using a 3-dimensional scanner (3Shape E4, 3Shape, Copenhagen, Denmark), and landmarks were placed on incisal edges and cusp tips of canines, premolars, and molars. Procrustes superimposition and principal components analysis were applied to examine shape variation. Two-block partial least-squares analysis was used to assess shape covariation between arches. Structural equation modeling was utilized to decompose observed shape variation into genetic and environmental components using the normal assumptions of the twin model., Results: The first 3 principal components (PCs) of the maxillary and mandibular arch were meaningful, accounting for 53% and 50% of the variation in shape space, respectively. The PCs represented shape variability as follows: PC1 - arch depth-width ratio, PC2 - arch taper, canine position (and first premolar rotation for the mandibular arch), and PC3 - incisor displacement and rotation. Genetic modeling indicated that a model incorporating additive genetic and unique environmental factors optimally explained the observed variation for all meaningful PCs. Within shape space, most of the variation in maxillary and mandibular arches exhibited moderate to high heritability (h 2  = 0.61-0.74). Maxillary and mandibular dental arches had strong and significant shape covariation, with high heritability in their reciprocal influences on shape (h 2  = 0.72-0.74; r pls coefficient = 0.87; P <0.05)., Conclusions: In this cohort, dental arch shape variation was predominantly influenced by genetic factors. High covariation and heritability were observed between the maxillary and mandibular dental arches. This information may help inform decisions around orthodontic intervention., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Patients seeking health information on the Internet is commonplace. This scoping review aimed to collate and synthesize the evidence regarding the quality of Web-based orthodontic information., Methods: A systematic search and independent screening process was conducted by 2 independent reviewers across 4 databases. The review was conducted in alignment with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines., Results: Of 661 records identified, 30 publications satisfied the inclusion criteria. Reviewed studies included those related to the information contained within Web sites regarding dental and orthodontist practices, orthodontic interventions, appliances and auxiliaries, orthodontic conditions commonly requiring orthodontic therapy, issues related to patient experience, and advice during orthodontic treatment. A total of 5 quality of information (QOI) instruments and 3 readability tools were employed, with the University of Oxford, United Kingdom (DISCERN) instrument and the Flesch Reading Ease Score tool being the most frequently used. Most studies determined that the QOI contained within evaluated Web sites was poor and provided suboptimal information related to treatment risks and Web site reliability. Most studies indicated that the information was more difficult to read than recommended by guidelines., Conclusions: The QOI of orthodontic information available on Web sites was low to moderate, with the readability of content at a level that was considered challenging for many readers to understand. A recommendation for greater involvement of the dental and orthodontic specialty in Web site development was commonplace. Research is required for the development of validated tools that can determine the accuracy of information in addition to Web site reliability., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to investigate whether there was a difference between the planned and achieved lingual root torque of the maxillary central incisors in patients treated with an initial series of Invisalign (Align Technology, Santa Clara, Calif) aligners in which >10° change in the inclination of these teeth was prescribed via the ClinCheck facility., Methods: The pretreatment, planned, and the digital models after wear of the initial series of aligners regarding adult patients who satisfied selection criteria and were treated using the Invisalign appliance were measured using the Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC)., Results: A sample of 63 patients with 126 maxillary central incisors satisfied the inclusion criteria. The mean accuracy of the planned torque change of the maxillary central incisors that was achieved was 41.9%. A clinically significant shortfall (≥5°) was detected in 78.6% of the incisors, with the majority showing an underexpression between 10°-15°. Linear regression analyses indicated that weekly or biweekly wear protocols or the presence or absence of power ridges did not influence the accuracy of planned torque expression (P >0.05)., Conclusions: The changes in torque expression with an initial series of Invisalign aligners were less than half of what was planned in patients in which at least a 10° change in lingual root torque of these teeth was prescribed. The presence of power ridges and the aligner change protocol did not appear to significantly affect the accuracy of maxillary central incisor torque expression., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Research regarding orthodontic changes using the superimposition of digital study models (DSMs) is commonplace. Information regarding the accuracy of data processing by superimposition software is limited. The study aimed to compare different methods of superimposing DSMs using implant-supported crowns (ISC) as a stable reference structure., Methods: DSMs containing ISCs were sourced from a database of patients treated with clear aligner therapy. The DSM representing the planned treatment outcome was superimposed on the pretreatment DSM. Three tooth points were selected for comparison on the contralateral side of each ISC. Differences in Cartesian coordinates for each tooth point for each arch superimposition method, used by the Geomagic Control X (3D systems, Rock Hill, NC) software system, were recorded. Paired t tests for the reference standard superimposition method best-fit high-resolution using the entire dental arch compared with initial, best-fit low-resolution, and best-fit high-resolution using the ISC only were calculated., Results: The DSMs of 54 dental arches containing ISCs were evaluated. All mean differences for displacements of selected points on the contralateral side to the ISC in the 3 Cartesian planes were <0.05 mm (P <0.05) and below the threshold of clinical significance. In addition, the standard superimposition techniques (initial, best-fit low-resolution, and best-fit high-resolution) resulted in nonstatistically significant and nonclinically significant differences in the position of the ISC., Conclusions: Researchers can be confident that the described superimposition methodologies, with and without ISCs as a stable reference structure, are a valid method for accurately assessing most intraarch dental changes., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine whether the achieved mandibular central incisor lingual root torque (LRT) changes matched the planned changes after treatment with an initial series of Invisalign aligners when ≥10° of torque change was planned., Materials and Methods: A sample of adult patients who underwent treatment with the Invisalign appliance between 2013 and 2021 were evaluated. The pretreatment, planned, and achieved posttreatment digital models were measured using Geomagic Control X metrology software. The effect of age, number of prescribed aligners, sex, the presence of power ridges (PRs), and differing weekly wear protocols (WPs) in relation to the achieved LRT changes were determined., Results: Seventy mandibular central incisors from 35 patients satisfied inclusion criteria. The accuracy of the achieved lower incisor LRT compared with that planned was 58.2%. Underexpression of planned torque changes was observed in most incisors (N = 66; 94.3%), with a clinically significant shortfall (≥5°) observed in 68.6% (N = 42) teeth. Patient age, sex, the WP, or the presence of PRs did not influence the differences between planned and achieved outcomes (P > .05). The prescribed number of aligners was influential in the difference between the planned and achieved torque outcomes (P < .01)., Conclusions: Underexpression of mandibular central incisor root torque was observed in most incisors in patients when ≥10° change in LRT was planned. Lower incisor LRT was not significantly affected by the presence of PRs or differences in WPs., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Objective: The aim of the present study was to compare the changes in overjet and overbite measurements achieved in adolescent patients following an initial series of Invisalign® aligners (Align Technology, San Jose, California) with those planned by orthodontists via its ClinCheck® digital treatment planning facility., Methods: Data provided by Align regarding patients who had completed an initial series of Invisalign® aligner treatment and were less than 18-years old were assessed in relation to pre-treatment, planned and achieved overjet and overbite measurements. Descriptive statistics, Wilcoxon rank-sum, Mann Whitney calculations were computed., Results: A total of 290 patients satisfied inclusion criteria. The median (interquartile range (IQR)) age was 14.17 (13,15.42) years. The median achieved overjet and overbite changes were less than those planned (p<0.01) with 53.33% of the planned median overjet increase achieved and 52.94% of planned median overjet reduction achieved. Additionally, 58.33% of the planned median overbite increase was achieved and 55.55% of the planned median overbite reduction was achieved. A total of 21.52% patients recorded no change or an increase from pre-treatment to the achieved overjet where reduction was planned, whereas 41.67% recorded no change or a reduction in overjet where increase was planned. A total of 18.72% recorded no change or an increase in overbite where reduction was planned, whereas 20.75% recorded no change or a reduction in overbite where increase was planned., Conclusions: Less than 60% of the planned overjet and overbite changes per patient were achieved. Between 18.72 and 41.67% of patients experienced no change or changes in overjet and overbite in the opposite direction to that planned. This is likely to be clinically significant., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Intro: The aim of the current study was to develop and describe a new measuring system for the orientation of a tooth in a digitalized cast of a jaw and provide new angular values for the rotation, torque and tip of maxillary and mandibular teeth., Methods: This retrospective cross-sectional study involved the utilization of a sub-group of extrinsic Euler-angles to derive optimal norm values per tooth in three different planes of orientation ('rotation', 'torque' and 'tip') by evaluating the digital representations of the teeth derived from a database containing over 17,500 patients. The process involved the entry of the .stl files of the jaw pairs into a fully automated software system (Smyl:Ai, Ulm, Germany) whereupon jaw alignment, teeth segmentation, landmark identification and visual validation of input files was conducted prior to calculation of the norm values for the three different planes of orientation., Results: The digital scans in stereolithography (.STL)-file format of the upper and lower dentitions of 1914 individuals with optimal occlusion were chosen and evaluated. New mean (standard deviation) angular values were determined for the rotation, torque and tip of maxillary and mandibular teeth., Conclusion: The findings facilitate the reappraisal of rotation, torque and tip values currently acceptable as ideal. They will inform anthropologists and dental researchers about occlusion and alignment in orthodontic and non-orthodontic patients and provide baseline data for future studies. The methodology will also enable the evaluation of large numbers of data in relatively short timeframes., (© 2024 The Author(s). Orthodontics & Craniofacial Research published by John Wiley & Sons Ltd.)

Introduction: Data regarding the efficacy of deep overbite correction with clear aligner therapy in adolescent patients are lacking. This study aimed to investigate the efficacy of deep overbite reduction in adolescent patients treated with Invisalign (Align Technology, San Jose, Calif) aligners., Methods: This retrospective study investigated a sample of 102 patients aged 10-17 years from a large database. All patients had completed wear of a prescribed series of Invisalign aligners with planned overbite reduction on a nonextraction basis. The predicted, pretreatment, and posttreatment overbite measurement values were obtained from Align Technology's ClinCheck digital facility. Linear modeling, with Bland-Altman plots, was used to compare the effect of age, the use of bite ramps, and the adoption of the eighth-generational (G8) protocol on the difference between predicted and achieved overbite measurements., Results: A total of 102 patients with a mean ± standard deviation age of 13.94 ± 1.53 years satisfied the selection criteria. A mean ± standard deviation of 41.38 ± 30.43% of the predicted overbite reduction was achieved. There were no differences in the predictability of overbite reduction between patients who were aged <14 years or those aged 14-17 years (P = 0.73), between patients prescribed and not prescribed bite ramps (P = 0.25), or between patients prescribed the G8 protocol and not prescribed the G8 protocol (P = 0.65)., Conclusions: The average achieved overbite was less than half of what was planned by the orthodontists via the ClinCheck facility. The age grouping, the provision of bite ramps, and the G8 protocol appear to have little influence on the efficacy of overbite reduction in adolescent patients., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT., Material and Methods: General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross-sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient-reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA)., Results: Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free-text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management., Conclusion: Almost two-thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Introduction: This study aimed to investigate the expression of root angulation in canine, premolar, and first molar teeth adjacent to first and second premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners (Align Technology, Santa Clara, Calif)., Methods: Adult patients (aged ≥18 years) with at least 1 first and/or second premolar extraction in the maxilla and satisfying strict selection criteria were evaluated. Digital models representing pretreatment, predicted, and posttreatment were obtained from Align Technology's digital interface, ClinCheck. The Geomagic Control X (version 2017.0.3; 3D systems, Rock Hill, NC) software facility was used to determine and compare the root angulation of adjacent canine, premolar, and first molar teeth at different time points., Results: The predicted angulation of teeth was significantly different (P <0.02) than that achieved in most patients. When adjacent teeth roots were planned to tip away from the extraction site, there was an overexpression of the movement. When teeth roots were planned to tip into the extraction site, underexpression occurred, and movement was in the opposite direction in some instances. There was no difference in root angulation outcomes according to the prescribed number of aligners, 1- or 2-week wear protocols, and sex (P >0.05). Attachments were influential in controlling angulation in first-premolar extractions (P = 0.05), but optimized attachments were not any more effective than conventional attachments (P >0.05)., Conclusions: The achieved root angulation in teeth adjacent to premolar extraction sites in the maxilla after treatment with an initial series of Invisalign aligners differed significantly from that predicted. Attachments play a minor role in the predictability of root angulation outcomes., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada., Methods: The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages., Results: Almost 30% of the orthodontist's annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances., Conclusions: Most orthodontists prescribe CAT, and its use is based on the malocclusion's complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes., (© 2024. The Author(s).)

Introduction: The extraction of second premolars and associated changes in the volume of the airway have not been previously explored. This retrospective study aimed to compare the volumetric changes of the airway preorthodontic and postorthodontic treatment in relevant extraction and control samples and to identify variables that may influence the outcome., Methods: Cone-beam computed radiography scans of 54 patients with second premolar extraction and 59 nonextraction patients treated in a private orthodontic practice were matched for crowding. The average age for both samples was 15 years. The images were individually landmarked and measured by applying volumetric, linear, and angular parameters. The results were analyzed using repeated measures, such as variance analysis, correlation testing, and regression statistical analyses., Results: There was a statistically significant increase in the airway volume for both groups (P <0.05). The difference in increase between the groups was not statistically significant. Seven variables demonstrated a collectively significant effect on changes to airway volume (F[7,112] = 38.48; P <0.001; r 2  = 0.701), with 70% of the variation predicted by the variables. Multiple regression analyses indicated that changes to the area of minimum constriction (B = 32.45; t = 11.95; P <0.001) and changes to airway length (B = 94.75; t = 7.79; P <0.001) had a statistically significant effect on airway volume., Conclusions: The volume of the airway increased in both the extraction and nonextraction samples. The biggest contributors to the increase were an increase in airway length and an increase in the area of minimum constriction, which likely occurred as a result of natural growth., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

The Long-read RNA-Seq Genome Annotation Assessment Project Consortium was formed to evaluate the effectiveness of long-read approaches for transcriptome analysis. Using different protocols and sequencing platforms, the consortium generated over 427 million long-read sequences from complementary DNA and direct RNA datasets, encompassing human, mouse and manatee species. Developers utilized these data to address challenges in transcript isoform detection, quantification and de novo transcript detection. The study revealed that libraries with longer, more accurate sequences produce more accurate transcripts than those with increased read depth, whereas greater read depth improved quantification accuracy. In well-annotated genomes, tools based on reference sequences demonstrated the best performance. Incorporating additional orthogonal data and replicate samples is advised when aiming to detect rare and novel transcripts or using reference-free approaches. This collaborative study offers a benchmark for current practices and provides direction for future method development in transcriptome analysis., (© 2024. The Author(s).)

Introduction: Interproximal reduction (IPR) is a common adjunct to contemporary orthodontic treatment. This study aimed to carry out a quantitative analysis of IPR prescribed in the refinement phases of clear aligner therapy with the Invisalign appliance (Align Technology, San Jose, Calif)., Methods: The digital treatment plans (DTPs) of a total of 330 patients treated by 11 orthodontists were evaluated. Relevant data regarding patient age, gender, and prescription of IPR in the initial and refined DTPs were obtained from Align Technology's digital interface, ClinCheck. Computational analyses included descriptive statistics, Mann-Whitney U, and Kruskal-Wallis tests., Results: Most (n = 182; 75.2%) of the 242 patients who satisfied inclusion criteria were females. The median (interquartile range [IQR]) age was 29.2 (22.1-40.2) years. More than 60% of the contact sites prescribed IPR related to the initial DTP (n = 1312; 60.4%), with 39.6% (n = 859) recorded in the refinement DTPs. A median (IQR) of 1.1 (0.6-2.1) mm of IPR was prescribed per patient in the initial DTP compared with a median (IQR) of 0.6 (0.3-1.3) mm in the refinement DTPs. The most common site for prescribed IPR in all DTPs was the mandibular anterior region. Almost half (n = 108; 44.6%) of the patients were prescribed IPR at the same contact point site more than once during treatment., Conclusions: Almost 40% of the contact points that were prescribed IPR were in the patients' refinement DTPs. Most IPR was prescribed for the anterior region of the mandible. Almost half of the patients had IPR repeatedly prescribed at the same sites during treatment., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of the present study was to evaluate the quality and readability of content contained within clear aligner therapy (CAT) informed consent forms., Methods: CAT informed consent forms were identified via an online search. The presence of details related to CAT-related processes, risks, benefits and alternatives in each form was recorded. A 4-point Likert type scale was used to determine the quality of content (QOC). The readability of content was evaluated with the Simple Measure of Gobbledegook (SMOG) and Flesch Reading Ease Score (FRES)., Results: A total of 42 forms satisfied selection criteria. Nineteen (45.2%) were authored by companies who provided aligners to patients via clinicians. The QOC regarding CAT-related treatment processes [median 2.0; IQR 0, 2] and benefits [median 2.0; IQR 1, 2] was adequate. The QOC scores regarding treatment alternatives, consequences of no treatment and relapse were poor. There was no difference (P=0.59) in the median (IQR) QOC of the informed consent forms provided by direct-to-consumer (DTC) aligner providers [10 (8.25, 16.25)] and non-DTC aligner providers [12 (10, 14)]. The median (IQR) SMOG score was 12.1 (10.9, 12.7) and FRES was 39.0 (36.0, 44.25)., Conclusions: The QOC of the evaluated forms was incomplete and poor. The content was difficult to read and failed to reach recommended readability standards. Consent is unlikely to be valid if it is based solely on the content of the forms. Clinicians need to be aware of the limitations of informed consent forms for CAT particularly in relation to alternatives, prognosis, risks, and the need for long-term maintenance of results., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: Detailed insight regarding the use of temporary anchorage devices (TAD) in Australia and the United Kingdom (UK) is lacking. The primary aim of the present cross-sectional survey was to investigate TAD usage among UK-based and Australian-based orthodontists. The secondary objectives were to compare TAD-related preferences and protocols between orthodontists in the two countries., Methods: A pilot-tested electronic questionnaire was distributed to members of the British Orthodontic Society and the Australian Society of Orthodontists. Questions pertained to their demographic details, and current use of TADs including protocols, treatment objectives and factors influencing their use., Results: A total of 192 responses were recorded (Australia: 122; UK: 70). One hundred and forty-two respondents (74.0%) reported using TADs as part of their orthodontic treatment, 77.0% in Australia (n=94) and 68.6% in the UK (n=48). Molar protraction was the most common procedure for which TADs were reportedly used (Australia: n=118; 87.2%, UK: n=36; 75.0%). "Loosening" was the most prevalent reported complication overall (n=124; 90.1%). "Confidence", "insufficient postgraduate education" and "availability of equipment" were the factors that most influenced the decision not to provide TADs., Conclusions: Most orthodontists in both countries provided TADs. TAD protocols of orthodontists in both countries were reported. Similarities and differences regarding TAD-related clinical practices and procedures, complications and factors influencing the use of TADs and reasons for not using TADs were explored. Information from the present study can provide baseline data for future related studies in each country and for comparison of TAD usage in other countries., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS)., Design: A cross-sectional online survey., Methods: An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems., Results: Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy., Conclusion: CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To survey treatment-planning practices of orthodontists related to the Invisalign Lite clear aligner appliance (Align Technology, San Jose, Calif)., Materials and Methods: Patients satisfying inclusion and exclusion criteria and treated with Invisalign Lite were selected from a database containing more than 17,000 patients. Relevant data regarding treatment-planning practices were obtained from Align Technology's treatment-planning facility, ClinCheck, and evaluated., Results: Most (n = 135; 79.9%) patients were female and had a median (interquartile range [IQR]) age of 30.5 (23.8, 43.1) years. The median (IQR) number of aligners for the sample was 23.0 (14, 28) for the maxilla and 24 (14, 28) for the mandible. Most (n = 122; 72.2%) patients required at least one additional series of aligners. More locations for interproximal reduction (IPR) were prescribed in the mandible (mean 1.91 [1.78]) than in the maxilla (1.03 [1.78]; P < .024) in the initial accepted plan of all patients. More teeth were prescribed composite resin (CR) attachments in the maxilla (P < .0001) in the initial accepted plan of all patients. Issues regarding tooth position protocols (n = 50; 53.3%) and requirement for additional IPR (n = 68; 45.3%) were reasons for treatment plan changes before acceptance of the initial treatment plan by orthodontists., Conclusions: More than 7 of 10 patients required at least one additional series of aligners after the initial series of Invisalign Lite aligners was completed. Prescription of IPR was more common in the mandible, and prescription of CR attachments was more common in the maxilla., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Introduction: This retrospective investigation aimed to determine whether the achieved changes in the treatment of Class II malocclusion were the same as those planned after the prescribed wear of an initial phase of Invisalign treatment with the mandibular advancement appliance (MAA) (Align Technology, Santa Jose, Calif)., Methods: All patients treated with the MAA and who satisfied inclusion/exclusion criteria were selected from a database of 16,500 patients treated with clear aligners by 16 orthodontists. The pretreatment, planned, and achieved overjet measurements were documented from data provided in Align Technology's software facility, ClinCheck. Changes in intermaxillary anteroposterior (AP) first permanent molar (FPM) relationships were evaluated using Geomagic Control X (3D systems, Rock Hill, SC) metrology software., Results: Most of the 195 patients who satisfied the inclusion criteria were females (n = 104; 53.3%). The mean age was 12.62 ± 2.20 years. The pretreatment overjet was reduced from 6.49 ± 2.86 mm to 4.61 ± 2.22 mm after prescribed MAA wear, which was 42.5% of the planned outcome. The pretreatment AP FPM reduced from 3.14 ± 1.95 mm to 2.24 ± 2.51 mm, which was 31.3% of that planned. Thirty-eight (19.5%) patients experienced an increase in overjet where a reduction was planned., Conclusions: Less than half of the planned overjet reduction and less than a third of the planned AP FPM correction were achieved with the MAA. Almost 20% of patients completed the MAA phase of treatment with an increased overjet despite a reduction being planned., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the quality and accuracy of information contained within the websites of providers of marketed orthodontic products., Materials and Methods: Twenty-one websites of orthodontic appliance and adjunct (product) providers were identified. The website content was assessed via two validated quality-of-information instruments (DISCERN and the Journal of the American Medical Association [JAMA] benchmarks) and an accuracy-of-information instrument. Website content was qualitatively analyzed for themes and subthemes., Results: More than half (n = 11; 52.3%) of the assessed websites contained clinician testimonials. The mean (SD) DISCERN score was 33.14 (5.44). No website recorded the minimum of three JAMA benchmarks required to indicate reliability. The most common content themes related to quality-of-life impact and treatment duration. Just 8% of the statements within the websites were objectively true. The Pearson correlation coefficient indicated that the DISCERN scores were correlated with the accuracy-of-information scores (r = .83; P < .001)., Conclusions: The quality and accuracy of information contained within the websites of the providers of marketed orthodontic products was poor. The combined use of DISCERN and the accuracy-of-information instrument may help overcome the shortcomings of each. Clinicians should check the accuracy of information on orthodontic product provider websites before adding links to those websites on their own sites., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To compare the pre- and postorthodontic treatment volumetric changes of the oral cavity proper (OCP) in extraction and nonextraction patients and to identify influencing variables., Materials and Methods: Pre- and posttreatment cone-beam computed tomography (CBCT) scans of patients undergoing orthodontic treatment with fixed labial appliances and who satisfied the inclusion criteria were individually landmarked. Linear, angular, and volumetric measurements were determined. Descriptive statistics, repeated measure analyses of variance, correlations, and stepwise regression statistical analyses were applied., Results: The CBCT scans of 54 patients who underwent the extraction of second premolars and/or extraction of second primary molars associated with agenic second premolars, and 59 nonextraction patients matched for crowding, were assessed. The mean age for both groups was 15 years. There was a statistically significant increase in the volume of the OCP for both the extraction and nonextraction groups, with the nonextraction group demonstrating a larger increase in the volume of the OCP. Gender, age, changes in mandibular and maxillary arch length, and changes in mandibular and maxillary intermolar width all influenced the change in the OCP volume., Conclusions: The volume of the OCP increased in growing patients with and without the extraction of the second premolars and/or extraction of second primary molars associated with agenic second premolars. Patients who did not have extractions as part of their orthodontic treatment demonstrated a greater overall increase in OCP volume., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances., Materials and Methods: Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated., Results: From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases., Conclusions: Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Objectives: To investigate whether the predicted changes in overbite (OB) and overjet (OJ) in Align Technology's (Santa Jose, Calif) digital treatment plan for the prescribed course of treatment with the Invisalign appliance were consistent with those same changes in OB and OJ measured with the Geomagic Control X (Geomagic US, Research, Triangle Park, NC) metrology software system., Materials and Methods: Geomagic Control X software was used to determine OB and OJ differences between the pretreatment and predicted outcome. STL files for patients satisfying inclusion criteria and undergoing nonextraction orthodontic treatment with the Invisalign appliance. The differences were compared, using the Bland-Altman analysis, to the corresponding data provided by Align Technology's digital treatment-planning interface, ClinCheck., Results: Data regarding 76 adult patients who satisfied strict inclusion criteria were assessed. The Shapiro-Wilks test indicated normality (P > .05). The Bland-Altman analysis showed high levels of agreement between the two measurements, with a bias range of -0.131 to 0.111 for OB and -0.393 to 0.03 for OJ recorded., Conclusions: Clinicians and researchers can be confident that measurement data provided by Invisalign's ClinCheck digital treatment-planning facility concerning OB and OJ changes from the initial to the predicted treatment outcome are valid., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Patients with one or more developmentally absent teeth are routinely encountered in dental practice. Tooth agenesis can be associated with significant functional, aesthetic and psycho-social problems. The present article provides an overview of the prevalence and aetiology of tooth agenesis, as well as the condition's clinical characteristics and management options with reference to the evidence base. A timely diagnosis can facilitate the appropriate planning and management which might not be straightforward, and patient care will likely require multi- and inter-disciplinary input. It is critical that dental care practitioners are aware of the clinical characteristics and management options for tooth agenesis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: To investigate the total number of digital treatment plan (DTPs) and aligners manufactured for clear aligner therapy (CAT) by Invisalign ® from initial treatment planning to the completion of CAT., Design: A retrospective cohort study., Material and Methods: A total of 30 patients, from each of 11 experienced orthodontists, who commenced treatment over a 12-month period, were assessed regarding the number of DTPs and aligners prescribed from initial planning to completion of CAT. Patients were categorised according to the number of aligners prescribed by the initial DTP into mild (<15), moderate (15-29) or severe (>29)., Results: After the application of inclusion/exclusion criteria, 324 patients (71.9% women; median age = 28.5 years) undergoing non-extraction treatment with the Invisalign ® appliance were assessed. The median number of initial DTPs was 3 (interquartile range [IQR] = 2, 1-9) per patient before acceptance by the orthodontist. Most (99.4%) patients required a refinement phase with a median of 2 (IQR = 2, 2-7) refinement plans recorded. A total of 9135 aligners per dental arch, was prescribed in the initial DTP of the 324 patients assessed and 8452 in the refinement phase. The median number of aligners per dental arch prescribed from the initial DTP was 26 (IQR = 12, 6-78) and from the refinement plans was 20.5 (IQR = 17, 0-132)., Conclusion: A median of three initial DTPs and two refinement plans were required for patients undergoing non-extraction treatment with the Invisalign ® appliance. Patients were prescribed almost double the number of aligners initially predicted to manage their malocclusion., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The third named author is the curator of AARD.

Objective: The objective of this study was to examine the relative contributions of genetic and environmental influences on variation in dental arch form in individuals who have largely completed their craniofacial growth., Material and Methods: The subjects of this study comprised dental casts of 50 monozygotic twins and 24 dizygotic twins from the collection of records of twins housed at the Adelaide Dental School, Australia. The subjects were of Western European descent, with an average age of 20.93 ± 5.58 years. Dental casts were scanned using a 3D scanner to analyse the dental arch form. Landmark-based inter-arch and intra-arch measurements were performed. Structural equation modelling was employed to analyse the quantitative data using the normal assumptions of the twin model., Results: Genetic modelling revealed that additive genetic and unique environmental factors best explained the observed variation for all occlusal traits measured, except for mandibular intercanine width. High heritability was observed for most intra-arch occlusal variables (0.61-0.85) including the maxillary and mandibular intercanine and intermolar widths, arch depth and perimeter. In contrast, moderate heritability was found for inter-arch occlusal variables (0.52-0.59) such as overjet and overbite. Sexual dimorphism was evident, with males displaying larger posterior arch width than females (P < 0.05)., Limitations: Our sample was limited to individuals of Western European ancestry., Conclusion: The predominant source of occlusal variation within this group of Australian twins of Western European descent was controlled by genetic effects, and most were highly heritable. Generally, intra-arch occlusal variables showed greater heritability compared with inter-arch occlusal variables., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.)

Objectives: To evaluate the predictability of the Invisalign appliance (Align Technology, Santa Clara, Calif) in leveling the maxillary curve of Spee (COS)., Materials and Methods: A retrospective sample of adult subjects treated with the Invisalign appliance between 2013 and 2019 were selected. Patients were treated nonextraction in the maxillary arch and had either Angle Class I or II malocclusions with a minimum of 14 aligners with no bite ramps. Initial, predicted, and actual outcomes were analyzed with Geomagic Control X software (version 2017.0.3; 3D Systems, Cary, NC)., Results: A sample of 53 cases satisfied inclusion/exclusion criteria. Paired t-tests demonstrated a significant difference between mean predicted and actual maxillary COS leveling with a shortfall of 0.11 mm (SD = 0.37; P = .033). Planned intrusion tended to be more accurate posteriorly with an overexpression of 117% for the first molars. Planned extrusion was the least accurate, with the mid-arch demonstrating expressions of -14% to -48%. These teeth intruded despite a prescribed extrusive movement., Conclusions: The Invisalign appliance did not accurately predict maxillary COS leveling. Planned intrusive movements were overcorrected, and planned extrusive movements were either undercorrected or resulted in intrusion. This effect was most apparent for the upper first molar, which expressed 117% and -48% of planned intrusion and extrusion, respectively., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Background: Social media can provide insight into patient experiences with health care. The aim of this study was to evaluate the content regarding orthodontic retention and retainers on the social media website, Reddit., Methods: A systematic search for relevant content submitted over a 12-month period on the Reddit forum, r/braces, was conducted. Qualitative analysis of the initial posts for themes and subthemes was conducted by two investigators. Responding comments to the initial posts were assessed for supportiveness for each initial poster and alignment with the evidence-base. Quantitative assessment was via descriptive statistics., Results: A total of 271 initial posts and 984 comments satisfied the inclusion/exclusion criteria. All initial posts were by patients. Just 1.12% (n = 11) of the comments appeared to be provided by oral health professionals. Most initial posts were negative (50.18%; n = 136), and most comments were positive (70.42%; n = 693). Alignment with the evidence-base was high among the comments (67.89%; n = 668). Eight main themes were identified with concerns regarding the negative impact of retention and retainers on quality of life, compliance with retention protocols and relapse commonly expressed. Concern regarding fear of relapse when waiting for the initial or renewal of retainers was a novel finding. More negative sentiments about orthodontists were expressed than positive., Conclusions: Reddit is a supportive and reliable environment for patients regarding orthodontic retention and retainers. The content evaluation suggested deficiencies in communication processes between clinicians and patients. Greater engagement of the orthodontic profession in the provision of supportive and evidence-based information on an individual patient basis and through appropriate information channels is required., (Copyright © 2023 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: This retrospective study aims to evaluate the predictability of the Invisalign appliance (Align Technology, Santa Clara, CA) in leveling the maxillary curve of Wilson (COW)., Methods: 53 adult subjects treated by orthodontists who are experienced Invisalign providers, between 2013 and 2019 were selected. All patients had either Angle Class I or II malocclusions and were treated by non-extraction in the maxillary arch with a minimum of 14 Invisalign aligners with no bite ramps or auxiliaries. Initial, predicted, and actual outcomes were analyzed with Geomagic Control X software (3D systems, Rock Hill, SC; Version 2017.0.3)., Results: Despite planning mean (SD) COW leveling of 0.25 mm (1.91), the curve became significantly more pronounced by 1.15 mm (0.85) (P < .001). There was a significant overexpression of buccal inclinations between mean prescribed versus actual values from 0.10 mm (0.39) (P = .007) to 0.29 mm (0.47) (P < .001) from the first premolars to the second molars, respectively. These differences were more pronounced posteriorly. The differences between the predicted and actual arch width values were underexpressed for all teeth except the second molars; a mean underexpression between 0.28 mm (0.92) and 0.60 mm (1.14). The second molars were the only teeth to overexpress with a mean of 0.42 mm (1.02)., Conclusions: Overall mean maxillary COW was not predictably controlled with Invisalign. The appliance tends to overexpress the buccal crown tip regardless of prescribed direction, especially posteriorly. Arch expansion was underexpressed at all levels of the arch except for second molars which overexpressed by almost four times., (Copyright © 2023 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the changes made by orthodontists to the initial digital treatment plan (DTP) regarding the Invisalign appliance provided by Align Technology until acceptance of the plan by the orthodontist., Materials and Methods: The DTPs of subjects who underwent treatment with the Invisalign appliance and satisfied inclusion criteria were assessed to determine the number of DTPs and changes regarding prescription of aligners, composite resin (CR) attachments, and interproximal reduction (IPR) between the initial DTP and the accepted plan. Statistical analyses were calculated via GraphPad Prism 9.0 (GraphPad Software Inc., La Jolla, Calif)., Results: Most of the 431 subjects who satisfied inclusion/exclusion criteria were female (72.85%). More DTPs were required for subjects who had orthodontic extractions (median [interquartile range; IQR]: 4 [3, 5]) compared with those who did not (median [IQR]: 3 [2, 4], P < .0001). The median (IQR) overall number of aligners prescribed in the accepted DTP (30 [20, 39]) was greater than the initial DTP (30 [22,41], P < .001). The number of teeth used for CR attachments increased from the initial to the accepted DTP (P < .001). More CR attachments were observed in extraction treatment DTPs with a prescribed 2-week aligner change protocol compared with nonextraction treatment (P < .0001). The number of contact points with prescribed IPR increased between initial and accepted DTPs (P < .0001)., Conclusions: Significant changes regarding DTP protocols were observed between the initial and accepted DTPs and between nonextraction and extraction-based CAT., (© 2023 by the EH Angle Education and Research Foundation, Inc.)

Introduction: The aim of this study was to investigate the relationship between occlusal contacts, overbite, transverse expansion, and the buccolingual inclination of the teeth with reference to the predicted treatment outcomes and achieved outcomes related to the use of the Invisalign® appliance in mild-to-moderate Class I malocclusions., Material and Methods: The occlusal contacts, overbite, the buccolingual inclination and transverse expansion of the maxillary arch of adult patients satisfying inclusion and exclusion criteria were measured at the initial (pre-treatment), predicted, and achieved treatment stages using metrology software. Pearson correlation coefficients and regression equations were calculated to determine the association between the initial, predicted and achieved changes in occlusal contact against the other variables., Results: Thirty-three patients, who commenced treatment between 2013 and 2018 and satisfied inclusion/exclusion criteria were evaluated. An overall loss of posterior contact was recorded and highlighted by a significantly greater loss of contact from the maxillary buccal occlusal surfaces compared to the palatal occlusal surfaces. The mean [SD] achieved overbite outcome (2.94mm [1.17]) was greater than the predicted (1.74mm [0.87), P<0.001). The buccolingual inclination was significantly increased for the lateral incisors and first and second molars despite a predicted decrease (P≤0.007). Achieved transverse expansion showed significant variation from the predicted. The loss of posterior occlusal contact was correlated with the buccolingual inclination (r=0.70) and transverse expansion (r=0.74) of the posterior teeth., Conclusions: In mild-to-moderate Class I malocclusions, treatment using the Invisalign® appliance resulted in an overall loss of posterior contact. The loss of occlusal contact was correlated with deficiencies in achieved buccolingual inclination and transverse expansion of the posterior teeth. Planned bodily expansion was ineffective as most expansion occurred due to unplanned buccal tipping., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background and Objectives: The aim of the study was to investigate the degree to which the websites of orthodontists in Australia comply with the regulatory frameworks regarding healthcare advertising., Method: The websites of orthodontist practices in Australia were assessed against Section 133 of the National Law and the Australian Health Practitioner Regulation Agency (AHPRA)'s guidelines pertaining to the advertising of regulated health services. Website content was assessed in relation to 5 domains regarding the provision of false and misleading information, the use of offers and inducement without clear terms and conditions, the use of patient testimonials, the creation of unrealistic expectation of benefit and the encouragement of the indiscriminate and unnecessary use of health services., Results: The websites of 166 orthodontist practices and 304 orthodontists satisfying inclusion/exclusion criteria were evaluated. Intra-rater agreement was high, ranging from 0.91 to 0.97. Most websites (80.7%) contravened the Law in one or more domains. The mean number of non-compliant domains per website was 2.2 (95% CI: 1.96 to 2.46). Information that was likely to create unrealistic expectations of orthodontic treatment (74.1%) was the domain most frequently breached with clinical information that only discussed the benefits of treatments contained in 64.5% of websites. Named commercial products were contained within 88.6% of the websites with links to commercial product manufacturers provided by 36.7%., Conclusions: Compliance of orthodontist practices in Australia with ethical, legal and regulatory advertising requirements is lacking. Orthodontists must exercise greater diligence in ensuring that the ethical requirements of preserving patient safety are not jeopardised by the advertising of their healthcare services., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To quantify the predicted occlusal contact outcomes compared with the clinically achieved occlusal contacts following treatment using the Invisalign aligner appliance., Materials and Methods: The occlusal contacts of 33 adult patients presenting with a Class I mild-to-moderate malocclusion (spacing <4 mm or crowding of <6 mm) and treated using the Invisalign appliance were measured at the initial, predicted, and achieved stages of treatment by the metrology software Geomagic Control X. Assessed measurements were related to individual teeth and anterior, posterior, and overall contacts., Results: The mean (standard deviation) difference between the achieved occlusal contact was significantly less than that predicted for overall occlusal contact and posterior occlusal contact (P < .0025). The achieved posterior occlusal contact was also less than pretreatment initial posterior occlusal contact. There was no difference in anterior occlusal contact between the predicted and achieved outcomes (P > .05). The central and lateral incisors displayed no statistically significant difference between the predicted and achieved occlusal contact. The patients with prescribed overcorrection demonstrated a statistically significant difference in predicted occlusal contact compared with those with nonprescribed overcorrection (P ≤ .0025), but no statistically significant difference in achieved occlusal contact., Conclusions: Treatment by the Invisalign appliance in Class I mild-to-moderate malocclusion resulted in a decrease in posterior occlusal contact. Further research is required to account for the deficiencies between the predicted and achieved clinical outcome related to occlusal contact and to determine the corrective changes required in the treatment protocols., (© 0000 by The EH Angle Education and Research Foundation, Inc.)

Background/objective: The valid consent process for medical intervention requires the disclosure of information in a format that is easily understandable by the patient. The aim of this investigation was to assess the readability of orthognathic surgery informed consent forms (OSICFs)., Methods: An online search methodology was conducted to identify OSICFs for analysis. The forms that satisfied inclusion/exclusion criteria were evaluated according to a standardised protocol. The readability of the content was assessed using three validated tools: the Simple Measure of Gobbledegook (SMOG) score, Flesch-Kincaid Grade-Level (FKGL) score and Flesch Reading Ease (FRE) score., Results: Most of the 26 evaluated OSICFs were sourced from websites within the United States (69.2%) and from oral and maxillo-facial surgery practices (76.9%). Two of the assessed forms were template OSICFs available from oral and maxillo-facial professional societies to its members. The scores from the three tools found that the content of 84.6% to 92.3% of the forms were "difficult" to read. The mean (SD) SMOG score for all evaluated OSICFs was 12.31(2.22) [95% CI: 11.42 to 13.21]. The SMOG and FKGL scores were closely correlated (r=0.99, P < 0.0001; 95% CI: 0.9864 to 0.9973). There was no association between SMOG scores and the number of words contained within each consent form (r=-0.047;95% CI: -0.44 to 0.36)., Conclusions: The OSICFs surveyed in this investigation failed to meet recommended readability levels. A significant number of patients are not likely to understand the information contained within the forms. Orthodontists are advised that poor literacy skills of their patients may preclude them from validly consenting to orthognathic surgery treatment procedures., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: The purpose of this cross-sectional study was to survey orthodontic clear aligner therapy (CAT) practices among orthodontists in Australia., Methods: A pilot-tested electronic questionnaire was distributed to 434 full members of the Australian Society of Orthodontists. Questions were related to demographics, use and choice of aligners, digital treatment planning, patient selection, treatment protocols, refinements/finishing, retention, and patient-reported aligner issues. Factors regarding the decision not to provide CAT were also surveyed., Results: The response rate was 54.6%. Most orthodontists (93.13%) provided CAT, which made up 24.17% of their annual orthodontic caseload. The median percentage of initial digital treatment plans (DTP) approved without changes was 0, with 4-6 changes reported by 24.14%. Orthodontists reported a mean of 2.02 ± 1.76 refinements per patient. Orthodontists were least comfortable treating patients with bilateral crossbite (71.28%) and deep overbite (62.56%). DTP challenges regarding tooth attachments and tooth positions and issues regarding patient compliance with CAT wear protocols were commonly reported. More than 1 CAT system was used by most (63.92%), with in-house systems used by 21.63%. Orthodontists rarely or never (63.68%) performed premolar extraction treatment with CAT. Adjunctive interproximal reduction was reportedly mostly carried out to relieve crowding and reduce open gingival embrasures. The view that fixed appliances provide better outcomes was a major influence (71.43%) on the decision for those who did not provide any CAT., Conclusions: CAT practices among orthodontists varied. Further research is required to investigate the challenges in effective CAT provision highlighted in this survey., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs)., Design: A cross-sectional survey on the Internet., Material and Methods: An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0., Results: In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46-10.16; range = 6.7-15.1)., Conclusion: The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.

Background: To analyze the content, reliability, and quality of relevant TikTok videos regarding orthodontic retention., Methods: Six relevant terms were searched on the TikTok social media Web site. Uploaded videos satisfying inclusion/exclusion criteria were assessed for the presence of nine predetermined content domains and categorized as "high-content" (≥5) or "low-content" (<5). Reliability was determined using the DISCERN instrument and quality by the Global Quality Score (GQS). Layperson videos were evaluated for themes using discourse analysis. Intraclass coefficients for content, DISCERN scores, and GQS were calculated for intrarater reliability. Statistical analysis was via IBM SPSS Statistics (version 27.0.0.0; SPSS Inc. Chicago, IL)., Results: Orthodontists uploaded 37.8% and laypersons 34% of the 209 assessed videos. Just 22.1% of videos were considered to be 'high-content.' Quality of life issues related to retainer wear was the domain that was present least often in the videos provided by orthodontists (13.9%) and most often in those uploaded by laypersons (53.5%). High-content videos recorded greater mean GQS and DISCERN scores compared with low-content videos (P < 0.001). Strong positive associations existed between the number of domains present and DISCERN scores (rho = 0.808; P < 0.01) and between GQS and DISCERN scores (rho = 0.67; P < 0.01). Intraclass coefficient scores ranged between 0.92 and 0.98. Dissatisfaction with the need for long-term retainer wear was a prevalent negative theme in layperson videos., Conclusions: The content, reliability, and quality of TikTok videos regarding orthodontic retention were poor. The orthodontic profession must use TikTok effectively to ensure it delivers high-quality information relevant to laypersons' concerns., (Copyright © 2022 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: The social media platform, TikTok, has the potential to disseminate orthodontic information to an enormous global audience. The aim of this investigation was to assess the content, reliability and quality of videos regarding orthodontic clear aligners (OCAs) on the TikTok platform., Methods: Three search terms were used to identify relevant videos. Characteristics such as video source and the number of views were documented. An 8-point information domain score was applied to categorise the videos as "not useful", "slightly useful", "moderately useful" and "very useful". The DISCERN tool and the Global Quality Score (GQS) were used to evaluate video reliability and quality. Intraclass coefficients (ICC) were computed for intrarater reliability. Statistical analyses were via IBM® SPSS®, version 27.0.0.0 (SPSS Inc. Chicago, IL, USA)., Results: Of the 117 videos that satisfied inclusion/exclusion criteria, most were uploaded by laypersons (44.4%) and orthodontists (35.9%). The assessed videos had over 300 million views. The overall mean (SD) number of information domains present in the videos was 1.85/8 (1.73). Most videos were deemed "slightly useful" (54.7%) or "not useful" (26.5%). The overall mean (SD) DISCERN score was 1.8/5 (1.28). The overall mean (SD) GQS was 2.48/5 (0.86). Higher DISCERN scores correlated with higher GQS (r=0.73; P<0.01). ICC scores (0.92-0.94) indicated excellent intrarater reliability., Conclusions: The content, reliability and quality of videos found on TikTok related to OCAs was poor. The orthodontic profession must direct patients to reliable and high-quality resources as well as uploading content onto TikTok to counteract the deficiencies highlighted in this study., (Copyright © 2022 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: This study aimed to survey retention protocols and retainer characteristics among orthodontists practicing in Canada., Methods: An online questionnaire was distributed to 576 orthodontists registered with the Canadian Association of Orthodontists. It included respondents' demographic details, preferred orthodontic retainers and prescribed wear protocol, adjunctive retention procedures, the timing of retention follow-ups, retainer choice in specific situations, and retainer characteristics. Chi-square tests and Fisher's exact tests were used to test the associations between variables., Results: An 18% response rate was recorded (n = 101). Vacuum-formed retainers were the most commonly used retainers in the maxilla (50.5%), whereas bonded retainers were preferred in the mandible (54.5%). An initial full-time removable retainer wear period was commonly prescribed (63.0%-67.0%). Retainer checks were carried out by 85.1%-89.1% of orthodontists for 1 or 2 years after the end of active orthodontic treatment. Only 44.6%-56.4% were comfortable with general dentists continuing retainer checks. Most (72.5%-84.1%) retainers were fabricated in the orthodontists' office laboratory. Indefinite retainer wear was commonly suggested and was significantly influenced by the number of years in practice., Conclusions: Most orthodontists' preferred retainer was the vacuum-formed retainers in the maxilla and the bonded retainers in the mandible. A variety of retention protocols and retainer characteristics was evident among orthodontists that reflect the considerable variation in malocclusion traits we face day-to-day. There seems to be a potential dichotomy between orthodontists being uncomfortable about allowing general dental practitioners to manage retention and orthodontists unwilling to provide retention care indefinitely., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to evaluate the quality of information and readability of online content regarding medication-related osteonecrosis of the jaw (MRONJ)., Study Design: Three search engines were used to identify websites containing information regarding MRONJ. The content was assessed with 5 quality of information and readability tools. Statistical analyses were performed via GraphPad Software (GraphPad Software Inc., La Jolla, Calif, United States)., Results: The Health on the Net (HONcode) seal was present in 2 of the 21 websites that satisfied inclusion/exclusion criteria. The mean JAMA (Journal of the American Medical Association) benchmark satisfied per website was 1.619 out of 4 (standard deviation [SD] = 1.2; 95% confidence interval [CI], 1.07-2.17). The mean overall Quality Evaluation Scoring Tool score was 15.29 out of a maximum 28 (SD = 6.174; 95% CI, 12.48-18.1). The Quality Evaluation Scoring Tool scores of those websites that satisfied ≥3 JAMA criteria were significantly higher than those that did not (P = .01; 95% CI, -11.41 to -1.79). The readability levels of all content ranged from fairly difficult to very difficult., Conclusions: The information related to MRONJ on the Internet is unreliable and too difficult for the general public to read. Authors of online MRONJ information should consider use of quality of information and readability tools to ensure that reliable information is understood by those with poor health literacy skills., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To evaluate the readability of orthodontic treatment informed consent forms (ICFs)., Design: A cross-sectional observational investigation., Methods: An online search strategy was adopted to identify ICFs for orthodontic treatment. The text of each form that satisfied inclusion criteria was modified to a standardised protocol. The readability was evaluated using three validated instruments. GraphPad Software (GraphPad Software Inc., La Jolla, CA, USA) was used for statistical analyses., Results: A total of 59 ICFs were evaluated. The majority were available on the websites of orthodontists (66.1%) and general dentists (27.1%). The scores recorded from the three instruments indicated that the content of 93.2%-98.3% of ICFs was difficult to read. A strong correlation was observed between the Simple Measure of Gobbledegook (SMOG) and the Flesch Kincaid Grade level (FKGL) instruments (r = 0.9782; P < 0.0001). The mean SMOG score for all assessed forms was 11.19 (95% confidence interval [CI] 10.85-11.54). The ICFs authored by the manufacturers of orthodontic appliances provided by clinicians recorded a mean Flesch Reading (FRE) score of 40.14 (95% CI 33.91-46.37) out of a maximum 100. An analysis of the SMOG scores indicated that the content of ICFs authored by national orthodontic societies was more difficult to read than those written by all other authors ( P =0.01; 95% CI -1.6 to -0.2)., Conclusion: The readability of the ICFs was too difficult for a significant number of the population. Many patients will be unable to validly consent to treatment based solely on reading of the content of the evaluated ICFs. A greater effort is required to improve the readability of ICFs to help ensure patient autonomy regarding orthodontic treatment decision-making and management.

Mitochondria carry the remnant of an ancestral bacterial chromosome and express those genes with a system separate and distinct from the nucleus. Mitochondrial genes are transcribed as poly-cistronic primary transcripts which are post-transcriptionally processed to create individual translationally competent mRNAs. Algae post-transcriptional processing has only been explored in Chlamydomonas reinhardtii (Class: Chlorophyceae) and the mature mRNAs are different than higher plants, having no 5' UnTranslated Regions (UTRs), much shorter and more variable 3' UTRs and polycytidylated mature mRNAs. In this study, we analyzed transcript termini using circular RT-PCR and PacBio Iso-Seq to survey the 3' and 5' UTRs and termini for two green algae, Pediastrum duplex (Class: Chlorophyceae) and Chara vulgaris (Class: Charophyceae). This enabled the comparison of processing in the chlorophyte and charophyte clades of green algae to determine if the differences in mitochondrial mRNA processing pre-date the invasion of land by embryophytes. We report that the 5' mRNA termini and non-template 3' termini additions in P. duplex resemble those of C. reinhardtii , suggesting a conservation of mRNA processing among the chlorophyceae. We also report that C. vulgaris mRNA UTRs are much longer than chlorophytic examples, lack polycytidylation, and are polyadenylated similar to embryophytes. This demonstrates that some mitochondrial mRNA processing events diverged with the split between chlorophytic and streptophytic algae.

Objective: To evaluate and compare the content of posts placed on Instagram by orthodontic treatment providers (OTP) and patients regarding orthodontic retention and retainers., Materials and Methods: Six "hashtag" terms related to orthodontic retention were searched on the social media Web site, Instagram. Relevant uploaded posts were evaluated for the presence of nine retainer and retention-related domains. Patient posts were also qualitatively evaluated for themes via discourse analysis. Descriptive and univariate statistical analyses were carried out. Cohen's kappa intrarater reliability testing was performed., Results: Most of the 144 posts that satisfied inclusion criteria were uploaded by OTPs (81.9%). Text and image(s) comprised 86.8% of posts. The most frequently included domain posted by OTPs related to "what is a retainer" and "the importance of wearing a retainer" (49.2%). Posts by OTPs referred to a greater number of domains (P = 0.028), whereas posts by patients recorded comparatively more "quality-of-life"-related content (P = 0.027). Most patient posts were positive (53.8%). The main negative theme within patient posts related to retainer discomfort and the unhappiness associated with the requirement for indefinite retainer wear. The intrarater score was 0.89 for the presence of domains., Conclusions: OTPs appear to use Instagram for posting orthodontic retention-related information more often than patients. The content of Instagram posts differed between OTPs and patients. OTPs must ensure that the content of their Instagram posts is relevant to the concerns articulated in posts uploaded by patients., (Copyright © 2020 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)