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Objective: This study assessed patient's satisfaction after orthodontic treatment in the postgraduate orthodontic clinic of the Dental School at the University of Athens (Athens, Greece), and investigated possible correlations between satisfaction after orthodontic treatment and life satisfaction, alongside the influence of age, gender, severity of initial orthodontic malocclusion and duration of retention period., Material and Methods: Patients aged 12 years and above, who had recently completed comprehensive orthodontic treatment, participated completing two questionnaires: a 37-item questionnaire, validated for assessing orthodontic treatment satisfaction; and the 5-item Satisfaction with Life Scale, a valid and reliable measure of life satisfaction. Scores from each questionnaire were summed for each patient. Demographic details, Index of Orthodontic Treatment Need (IOTN) and the duration of the retention period up to questionnaire completion were collected. Multiple regression analysis assessed the relationship between the questionnaires and the evaluated variables., Results: A total of 150 patients answered the questionnaires, being 82 women (55%) and 68 men (45%). The mean age of patients was 18.87 ± 5.97 years (range: 12-47). Most patients expressed satisfaction with treatment outcomes (grades 5 and 6). Satisfaction with orthodontic treatment showed a significant correlation with life satisfaction (p=0.002), but not with gender, age, dental/esthetic components of IOTN, or the duration of the retention period., Conclusion: Satisfaction after orthodontic treatment exhibited a significant correlation with life satisfaction, but it was not affected by gender, age, dental/esthetic components of IOTN, or the duration of the retention period.

Introduction: Effective risk communication is essential for achieving patient-centered oral health care, but the limited understanding of patients' subjective perceptions of orthodontic-related risks hinders this process. This study aimed to investigate adults' awareness, concerns, and risk-avoidance behaviors about long-term orthodontic risks, exploring their relationship with psychosocial factors., Methods: We included 498 adult patients (mean age, 27.3 ± 6.8 years; women, 75.5%) during their initial visits to the orthodontic department at a hospital in Chengdu, China. Participants' understanding of orthodontic risks was gauged before and after exposure to the Oral Health Education Comics (OHEC), a specifically designed digital tool. Concurrently, we used logistic regression models to investigate the associations between patients' depression, anxiety, self-esteem, perfectionism, and dentofacial esthetics with risk perceptions., Results: Approximately 79.5% of participants initially reported low awareness of orthodontic risks, with most knowledge from online sources. Notably, the percentage of participants with high awareness increased to 64.8% after OHEC. The negative facial soft-tissue change was most concerning for participants: 53.4% showed high concerns, and 28.1% showed high avoidance. Furthermore, linear regression indicated positive associations between depression (β = 0.42 [95% confidence interval {CI}, 0.07-0.77]) and anxiety (β = 0.76 [95% CI, 0.35-1.18]) with orthodontic risk concerns, whereas risk avoidance was positively associated with depression (β = 0.62 [95% CI, 0.27-0.97]), anxiety (β = 1.09 [95% CI, 0.68-1.50]), and perfectionism (β = 0.24 [95% CI, 0.02-0.46])., Conclusions: Findings emphasize the imperative of streamlined risk communication in orthodontics. By incorporating comprehensible tools such as OHEC and integrating psychosocial evaluations, more refined patient-practitioner communication and psychosomatic-based dental care can be achieved., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to compare oral health-related quality of life (OHRQoL) among adolescents granted (G) versus not granted (NG) publicly funded orthodontic treatment., Materials and Methods: Adolescents aged 15-20 years who were granted versus not granted publicly funded orthodontic treatment responded to a web-based survey, assessing OHRQoL in relation to functional impact, psychological impact, and motivators for orthodontic treatment. Before the survey, pretesting of the questionnaire was conducted to ensure its reliability. Differences between the groups were tested using the chi-squared and Mann-Whitney U-tests. Reliability was assessed using Cohen's κ and Pearson's correlation coefficient during the pretest phase., Results: One hundred and forty patients, equally distributed between a G and an NG group, responded to the survey. Gender, age, and demographic distribution were comparable in both groups. All respondents expressed a high subjective treatment need and similar answers regarding functional aspects. Orthodontic treatment motivators (G: 86.2% and NG: 94.7%, p = 0.443) were primarily related to improved self-esteem, overall well-being, facial appearance, and being able to laugh without embarrassment. The NG group expressed a more negative OHRQoL impact due to the appearance of their teeth compared with the G group (p < 0.001) and a negative impact caused by the position of their teeth (p < 0.001)., Conclusions: Orthodontic treatment need indices should aim to reinforce subjective measures as adolescents express similar motivators for orthodontic treatment, regardless of the clinician's objectively based decision about treatment need., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Introduction: Understanding the rationale for adult patients undertaking orthodontic treatment and the impact of appliances on their quality of life has become increasingly important to research efforts and clinical care. This study aimed to understand why adult patients undergo orthodontic treatment and their overall experience with the choice of appliance., Methods: A cross-sectional qualitative study using semistructured interviews with adult patients from 4 private specialist orthodontic practices in the London region involving a purposive homogeneous sampling technique to obtain variation regarding gender, treatment modalities (fixed ceramic [FC], removable aligner [RA], and fixed lingual [FL] appliances), and stages of treatment (early, late, and posttreatment stage) was undertaken. A piloted topic guide was used to standardize data collection. Interviews were audio recorded, and field notes were taken. Data were transcribed verbatim and analyzed using framework methodology until data saturation was reached., Results: A total of 22 participants (FC, 8; RA, 8; and FL, 6), with a mean age of 38.9 ± 11.7 years, with the majority being female (n = 13; 59.1%), were interviewed. Psychosocial and dental health-related factors were reported as the main reasons to seek orthodontic treatment. Social factors and appliance features influence an adult's decision-making in selecting a specific orthodontic appliance. Wearing FC, RA, and FL was seen to have both positive and negative impacts on an adult's quality of life. Functional and psychological factors were the strong influencers on patients' treatment experience., Conclusions: The study highlighted the influence of psychosocial factors and dental health concerns in the decision-making processes of adults seeking orthodontic treatment. FC, RA, and FL appear to affect an adult's quality of life, with functional and psychosocial factors being commonly reported., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to assess the smile attractiveness in patients treated with or without 4 premolar extractions at a 36-year follow-up., Methods: The sample comprised 52 patients with Class I and II malocclusion divided into 2 groups. Group 1 consisted of 15 patients treated without extractions (10 females and 5 males), with a mean pretreatment, posttreatment, and long-term posttreatment (T3) age of 13.2, 15.1, and 49.8 years, respectively. The mean treatment time was 1.9 years, and the mean long-term follow-up period was 34.7 years. Group 2 consisted of 37 patients (25 females and 12 males) treated with 4 premolar extractions, with a mean pretreatment, posttreatment, and long-term posttreatment age of 13.3, 15.7, and 53.6 years, respectively. The mean treatment time was 2.3 years, and the mean long-term follow-up period was 37.9 years. The mean retention time was 2 years for both groups. Frontal smiling photographs were obtained at long-term follow-up. Smile attractiveness was evaluated in an online questionnaire in which the evaluator could rate the smiling photographs with a 10-point scale. The randomly selected evaluator sample consisted of 62 laypeople, 33 dentists, and 89 orthodontists. Independent t tests, 1-way analysis of variance, and Tukey tests were used for intergroup comparisons at P <0.05., Results: The smile attractiveness on the long term was similar in the groups treated with 4 premolar extractions (4.70 ± 1.35) or without extractions (4.51 ± 1.46). Women and orthodontists were more critical in assessing smile attractiveness than men, dentists, and laypeople., Conclusions: After long-term posttreatment, the smile attractiveness was similar in patients treated with 4 premolar extractions or without extractions., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists., Methods: A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests., Results: The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists., Conclusions: At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions., (Copyright © 2024 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Clarification on disabilities that may arise during orthodontic treatment allows patients to have more realistic expectations. This prospective study assessed the impact of fixed orthodontic therapy on adolescents' quality of life over 6 months. A total of 78 adolescents aged 11-17 years were included. Quality of life was measured using the Child Perceptions Questionnaire (CPQ 11-14 , short form) at five moments: before treatment (T0), one week (T1), one month (T2), three months (T3), and six months (T4) after treatment initiation. Multiple and pairwise comparisons were conducted for CPQ 11-14 scores (Friedman and Wilcoxon test; effect size). Changes in the quality of life were assessed as mean differences (T0-T1 and T0-T4) in total and domain scores (Kruskal-Wallis and Mann-Whitney test) (α = 5%). Significant differences were observed between T0 and T4 in the oral symptoms' domain ( p < 0.001), and between T0 and T1, T2, T3, and T4 for emotional well-being ( p < 0.001 for all). Significant differences in impact were also found between T0 and T2, T3, and T4 with regard to social well-being ( p = 0.004, =0.049, and <0.001, respectively). Orthodontic therapy positively impacted the emotional and social aspects of adolescents' quality of life. Negative effects were primarily related to pain, mouth sores, and difficulty biting or chewing. Understanding the symptoms and feelings of orthodontic patients aids professionals in decision-making.

Background: Although there are previous systematic reviews about the oral health-related quality of life (OHRQoL) impact among children and adolescents after orthodontics treatment, there is no definition for the magnitude of these impacts during the therapy., Objective: To systematically analyse the literature on changes in the quality of life of children and adolescents during orthodontic treatment., Limitations: Almost all the studies included in this review are non-randomized clinical trials, which are susceptible to several biases that affect the certainty of evidence obtained, especially by confounding factors and the lack of a control group., Conclusions and Implications: Based on very low certainty of evidence, wearing appliances does not seem to have a significant negative impact during the first year of orthodontic treatment. However, the meta-analytic results suggest that functional limitations in the first 3 months of treatment can be slightly more critical for the impact on the oral health quality of life and consequent patient adherence to treatment., Funding: This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - Brazil (FAPEMIG)., Registration: CRD42021234407., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: To assess the levels of agreement between parents and adolescents about young adolescents' orthodontic treatment demand and to what extent is treatment demand conditioned by family and psychosocial impacts and oral function., Design: This cross-sectional study included 221 adolescents (11-14 years, 54% female) and their parents. A 5-point scale was used to assess orthodontic treatment demand. Adolescents self-administered the Child Perceptions Questionnaire, and parents self-administered the Parental-Caregivers Perceptions Questionnaire and Family Impact Scale. The Index of Orthodontic Treatment Need Dental Health Component (IOTN DHC) was used for determining malocclusion severity. Intraclass correlation coefficient and Cohen's kappa coefficient were used for the assessment of agreement between two informants., Results: The parent-child agreement on children's orthodontic treatment demand was weak, concording in 67.4% of cases. The most common reasons for seeking orthodontic treatment derive from the emotional (EW) and social well-being domains for both informants. In linear regression, the adolescent's reporting of impaired EW and IOTN DHC was the only significant linear predictor of orthodontic treatment demand., Conclusion: Parents cannot correctly assess the orthodontic treatment demand of their children. Impaired EW is the most significant self-reported determinant of adolescents' demand for orthodontic treatment. Family relationships and parental perspective have a low influence., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Introduction: patients´ satisfaction with their dental appearance and tooth colour is often influenced by certain factors which need to be addressed periodically among different populations., Methods: a self-administered questionnaire consisting of sociodemographic data, questions on patients´ satisfaction with tooth colour, perceived malalignment of teeth, non-aesthetic anterior tooth-coloured restoration and presence of tooth fracture were distributed. Data collected was analysed using Statistical Package for Social Sciences (IBM, SPSS version 20). Chi square was used to test the statistical differences at a significance of p> 0.05., Results: a total of 410 patients (M=147, F=263) participated in the study. About 73% had tertiary education while 36.3% were within the modified ISCO-08 Group 2. The respondents that were satisfied with the general dental appearance and tooth shade were 66.3% and 63.5% respectively. More males (65.1%) than females (62.7%) were satisfied with tooth colour while more females (69.1%) were satisfied with dental appearance. The older age group were more satisfied with dental appearance and tooth colour. Awareness of tooth whitening (Over 80%) and the desire to undergo tooth whitening was more among the post-secondary individuals. More of dental patients (73.1%) than medical (59.2%) were satisfied with teeth appearance (p=0.003)., Conclusion: patients are increasingly aware of their dental appearance/tooth colour and the need to improve it with tooth bleaching and/or orthodontic treatment. Female were more dissatisfied with their tooth colour but more satisfied with their dental appearance than the male. Older people were more satisfied with their dental appearance and tooth colour compared to younger age group., Competing Interests: The authors declare no competing interests., (Copyright: Deborah Mojirade Ajayi et al.)

This within subject clinical experiment assessed oral health impacts before and after Invisalign orthodontic treatment and their relationships with personality characteristics. 50 patients (26 females and 24 males; mean age = 27.62 ± 8.25 years, SE = 1.17, 95% CI = 24.71-29.89 years) were assessed before and after treatment with Invisalign orthodontic treatment. Treatment clinical success was evaluated according defined clinical guidelines. Oral health impacts before and after Invisalign orthodontic treatment were measured via the Oral Health Impact Profile (OHIP). Personality features were measured via the NEO Five-Factor Inventory (NEO-FFI). Probability of α = .05 was utilized to identify significant findings. Females scored less OHIP scores after treatment (had less negative impacts) in comparison to baseline OHIP scores (t = 3.782, df = 25, P = .001, 95% CI of mean difference = 2.750-9.327). Among males, openness scores (R 2  = .911, B = 5.235, 95% CI for B = 0.062-10.407, t = 2.601, P = .048) were able to predict OHIP scores before treatment; meanwhile, extraversion (R 2  = .959, B = - 8.224, 95% CI for B = - 14.605-1.843, t = - 3.313, P = .021), openness (R 2  = .959, B = 21.795, 95% CI for B = 10.737-32.853, t = 5.067, P = .004), and conscientiousness (R 2  = .959, B = 10.293, 95% CI for B = 4.796-15.790, t = 4.813, P = .005) scores were useful to predict OHIP scores after treatment (R 2  = .959, P < .05). NEO-FFI scores were not useful to predict OHIP scores before or after treatment among females (P > .05). These findings demonstrate that oral health impacts of Invisalign orthodontic treatment and personality profiles contribution to oral health impacts were different between genders.

Background: Smile forms an imporatnt aspect of facial analysis, as it contributes to overall facial esthetics. Many orthodontists pay more attention to cephalometric radiograph; and profile assessment to improve their patients' esthetics; however, the facial attractiveness of the individuals is obviously improved through enhancing their smiles. This study was aimed at evaluating the impact of analyzing certain smile esthetic parameters on diagnosis and treatment plan for individuals seeking orthodontic treatment., Materials and Methods: An electronic questionnaire with 24 questions arranged on five main axes was designed. These axes included smile arc, smile line, buccal corridors, smile symmetry, and photographic analysis of the smile, with several questions in each axis. The electronic link of the questionnaire was sent to all members of the Iraqi Orthodontic Society in April 2019. The answers were collected after 4 weeks of questionnaire link distribution date., Results: Among the surveyed orthodontists, there was a consistent agreement to assess the smile arc, smile line, buccal corridors, and smile symmetry, with main axes scores (4.14 ± 0.81, 4.1 ± 0.79, 3.86 ± 0.82, and 4.16 ± 0.86 respectively). Moreover, the participants prefer, with 3.89 ± 0.86 main axis score, to use the facial photograph for a less time-consuming and detailed evaluation of smile features., Conclusions: Smile parameters, for example, smile arc, smile line, buccal corridors, and smile symmetry are better to be analyzed using photographs during orthodontic diagnosis and treatment planning., (Copyright © 2020 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the correlations between objective measurements and subjective evaluations of post-treatment facial attractiveness., Methods: Ten orthodontists rated the subjective visual analog scale (VAS) scores of the facial profiles of 95 patients who had undergone orthodontic treatment. Post-treatment cephalograms and photographs were used. Eleven soft tissue measurements and eight maxillary incisor measurements were constructed and analyzed. Correlations between objective measurements and subjective VAS scores were evaluated using Pearson correlation and quadratic regression analysis., Results: The VAS scores of different facial proportions were all correlated with the total VAS score. Among soft tissue measurements, the distances from the upper and lower lips to the E line, H angle, forehead inclination, distance from lower lip to the H line, and pogonion-menton angle were negatively correlated with the VAS scores. The Z angle, with a parabolic distribution, was also correlated with the VAS scores. Among maxillary incisor measurements, the distance from the maxillary incisors to the forehead's anterior limit line and the angulation of the maxillary incisors to the APo line were negatively correlated with the VAS scores., Conclusions: Several soft tissue and maxillary incisor position measurements were correlated with facial profile evaluation and therefore might be used to evaluate facial attractiveness.

Introduction: A randomized controlled trial was undertaken to compare the efficacy of 3 methods of delivering information on short- and long-term recall of information in orthodontic patients and parents., Methods: Participants who received an audiovisual presentation on orthodontic treatment were randomly allocated to 1 of 3 written information groups (leaflets, generic mind map, or participant's customized mind map). A questionnaire was used to assess short- and long-term retention of information (maximum score 30)., Results: Eighty-eight patients (94.6%) and 77 parents (86.5%) completed the study. The average knowledge scores at baseline for the patient groups were 17.71 95 CI 16.28-19.14), 16.58 (14.67-18.49), and 17.37 (15.92-18.81), respectively. The parents' knowledge scores for the 3 groups were 19.06 (17.51-20.62), 19.39 (17.44-21.35), and 18.76 (17.19-20.33), respectively. The short- and long-term knowledge scores improved over baseline in all 3 groups (P <0.0001). The parents achieved higher scores than the patients (P = 0.002) and their rate of forgetting information was less. The knowledge scores of the mind map groups were higher than that of the leaflet group for all cohorts (P = 0.025). No statistical difference was found between the type of mind map. The correlation between patient and parent knowledge scores was significant (P <0.0001) at all 3 time points., Conclusions: Provision of an audiovisual presentation supplemented with 1 of 3 written information methods is an effective way of delivering information. There was a significant improvement in the retention of information with the use of mind maps compared with leaflets. The generic mind map is equally as effective, more consistent in information delivered, and less labor intensive than the individual customized mind map and therefore would be our recommendation. Participation of parents is important because they comprehend and retain information better. In this study, 100% of parents shared information with their children, perhaps improving the patients' recall., (Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.)

Objective: When dealing with the impact of malocclusion on self-esteem, the terms global and dental self-esteem are sometimes used. Although these terms are related to one another, they do not depict the same concept. The aims of this paper were to explore if the two forms of self-esteem are distinguishable, to find out if they represent different factors, and to investigate how they are related to malocclusion. Materials and methods: A sample consisting of 150 adolescents, aged 13 years, completed self-assessed measures of Dental and Global Self-Esteem. Orthodontic treatment need for each individual was assessed by the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC). Data were analysed by factor analyses and a 5 (IOTN-DHC grades) by 2 (global vs. dental self-esteem) ANOVA, with the IOTN-DHC grades as the independent and self-esteem (repeated measure) as the dependent variables. Results: The factor analyses showed that the two forms of self-esteem, based on the measures, are distinguishable. More importantly, the results of the ANOVA revealed that Dental and Global Self-Esteem are differentially related to IOTN-DHC. Specifically, Dental Self-Esteem varied across IOTN-DHC scale while Global Self-Esteem did not. There was no effect of gender. Conclusions: Dental self-esteem is related to malocclusion while global self-esteem is not. These findings have implications in areas where the predictive power of dental self-esteem needs to be considered.

Background: Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown., Aims: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level., Methods: A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed., Results: A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group., Conclusions: The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.

Objective: (1) To assess the psychosocial, functional and aesthetic changes in young adults pre- and post-orthodontic treatment. (2) To assess the changes in quality of life in individuals having malocclusion before and after orthodontic appliance therapy. (3) To evaluate the effect of severity of malocclusion pre- and post-orthodontic treatment on quality of life among males and females., Materials and Methods: This longitudinal study included a convenience sample of 18.1 to 25.3-year-old young adults (n=400). The self-perception of dental aesthetics pre- and post-treatment related to gender variations and severity of malocclusion (Angle's class I, II, III) were also assessed using the Psychosocial Impact of Dental Aesthetics Questionnaire with additions (PIDAQ) according to the needs of Indian ethnic group. Cronbach alpha of each domain at baseline score and Wilcoxon signed ranked test was carried out., Results: Statistically positive psychosocial impacts were observed after orthodontic treatment for the six PIDAQ domains (P<0.001 for all six domains). There was a similar influence of gender and severity on the improvement of scores over the period in all the domains though males showed the least psychological impact on matrimonial concerns both pre- and post-treatment. The severity of malocclusion showed a difference only in functional concerns. There was less improvement in class III malocclusion group as compared to class I and class II groups., Discussion: Orthodontic treatment has a positive psychological impact, as there was a significant improvement in self-esteem and social interaction of the individuals. Significant changes occurred in functional and aesthetic domain measures of quality of life in orthodontically treated cases. The severity of malocclusion has a negative impact on the quality of life and a significant improvement in the quality of life was observed before and after orthodontic treatment with no gender difference., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objectives: To investigate the changes in oral health-related quality of life (OHRQoL) before, during, and after orthodontic treatment, determine the relationship with the original treatment need and evaluate the influence of self-esteem (SE)., Materials and Methods: OHRQoL questionnaires were used in an ongoing observational prospective cohort study at baseline (T0), 1 year after start (T1), and 1 month after the end of active orthodontic treatment (T2). Participants were 11-16-year-old at baseline and 215 complete cases were obtained from a total of 498. OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14), SE was assessed by the Dutch adaptation of the Harter's Self-Perception Profile for Adolescents and treatment need was defined by the Index of Orthodontic Treatment Need (IOTN). The Oral Aesthetic Subjective Impact Scale (OASIS) was included to score perceived treatment need. Data were analyzed with Spearman correlation, Mann-Whitney U-test and linear models for longitudinal data., Results: A significant decrease in IOTN and in OASIS was noted from T0-T1-T2 (P < 0.0001). CPQ results show a decrease from T0 to T2, from T1 to T2 and an increase from T0 to T1 (P < 0.0001). This was valid for the overall CPQ scores and its subdomains except for emotional well-being (EW), which decreases from T0-T1-T2. A correlation was found between baseline SE and the change of total CPQ scores between T0 and T2, also for EW (r = 0.325 and r = 0.354)., Conclusions: OHRQoL ameliorates after orthodontic treatment. High baseline SE works as a protective factor for OHRQoL., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Parents/caregivers play an important role in deciding whether their children will undergo orthodontic treatment or not. Their perceptions also have an influence on other choices involving orthodontic treatment. The purpose of this study was to investigate the difference and correlation between the ratings given by children and their parents or caregivers on their oral health-related quality of life (OHRQoL) before, during and after orthodontic treatment., Methods: In this ongoing observational prospective cohort study, 498 children aged 11 to 16 years-old and one of their parents/caregivers completed questionnaires before (T0), 1 year after start (T1) and 1 month after the end of orthodontic treatment (T2). OHRQoL was scored by using the Child Perception Questionnaire (CPQ 11-14 ) and the Parental-Caregiver Perception questionnaire (P-CPQ). The self-perception of oral aesthetics was evaluated with the Oral Aesthetic Subjective Impact Scale (OASIS) in addition to the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Spearman correlations, Mann-Whitney U-tests and linear models were used to analyze the longitudinal data., Results: At T0, the ratings of parents/caregivers were significantly lower for the total CPQ as well as for the subdomains of oral symptoms, functional limitations and emotional well-being. Parents/caregivers also scored significantly lower at T2 for the total CPQ and the subdomain of oral symptoms. The relations between the scores of children and their parents/caregivers were significant at all three time points, as were the changes in scores, but all of them were at most moderate in size. Parents/caregivers scored significantly lower for OASIS than their children at all time points and only at baseline a significant, weak correlation was found., Conclusion: The reports of parents/caregivers should be seen as important complementary information in OHRQoL research., Trial Registration: This study was approved by the Medical Ethical Commitee of the University Hospitals Leuven and the Katholieke Universiteit Leuven (ML5739), Leuven, Belgium, on the 12th of May of 2009, with the registration number S51642. All procedures performed are in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Introduction: Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment., Materials and Methods: We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance., Results: In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance., Conclusion: Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation., (© EDP Sciences, SFODF, 2018.)

Background: The objective of the study was to evaluate changes in the oral health-related quality of life (OHRQoL) during fixed appliance therapy., Methods: Sixty-one patients requiring fixed appliance therapy participated in the study. OHRQoL was assessed in all participants using the United Kingdom Oral Health-Related Quality of Life (OHRQoL-UK) tool and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), at baseline (T 0 ), 1 week (T 1 ), 1 month (T 2 ), 3 months (T 3 ), and 6 months (T 4 ), after appliance placement. Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the changes at the P<0.05 significance level., Results: There was a significant deterioration in OHRQoL in the first week of treatment based on the OHRQoL-UK measure (P=0.01). The PIDAQ, however, showed significant improvement in OHRQoL throughout the study period (P<0.05)., Conclusion: Fixed orthodontic appliance therapy can significantly improve the OHRQoL of individuals., (Copyright © 2018 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To assess the impact of fixed appliance therapy on the quality of life of a cohort of Brazilian adolescents., Methods: The treatment group was composed of individuals who started orthodontic treatment. The control group was composed of individuals not selected for immediate treatment. Adolescents answered the Brazilian short form of the Child Perceptions Questionnaire (CPQ 11-14 ). Higher scores indicate a greater negative impact on quality of life. Adolescents in the treatment group completed four sets of interviews: prior to appliances' bonding (T1), 1 month (T2), 6 months (T3) and 12 months (T4) after appliances' placement. Adolescents in the control group were assigned to a comparable schedule. Statistics included inter-group comparisons, Friedman and Wilcoxon tests, and mixed-effects models., Results: In the treatment group, the functional limitation score was higher at T1 (p = 0.004) and T2 (p = 0.007) compared to T4. The emotional well-being score was higher at T1 compared to T2 (p < 0.001), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ 11-14 score was higher at T1 compared to T2 (p = 0.005), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ 11-14 score was also higher at T2 compared to T3 (p = 0.001). No significant change was found in the control group. In the mixed-effects models, the interaction between group (treatment) and time was significant for functional limitations (p < 0.001), emotional well-being (p < 0.001), social well-being (p = 0.004) and the overall CPQ 11-14 score (p < 0.001)., Conclusion: Quality of life improved among adolescents undergoing orthodontic treatment. Orthodontists should inform patients what they might expect regarding the physical and the psychosocial repercussions of appliance therapy.

Aim: To assess whether or not childhood overweight is associated with lower levels of compliance during orthodontic therapy with removable appliances., Materials and Methods: Starting in 2011, all upper expansion plates and Sander II appliances were equipped with a Theramon® microsensor chip to assess appliance wear time objectively. According to their pre-treatment, BMI normal weight patients were matched to consecutively treated overweight or obese patients by gender, age, and appliance type. Cooperation was assessed with microelectronic wear time documentation over a period of at least 6 months., Results: A total of 50 patients (25 overweight, 25 normal weight) with upper expansion plates and 64 patients (32 overweight, 32 normal weight) with Sander II appliances were analysed. Spearman Rho coefficients showed an indirect association between BMI and appliance wear time, indicating that the higher the BMI, the less the patients wore their appliances (P < 0.05). Furthermore, both normal- and overweight children wore upper expansion plates significantly more than Sander II appliances (P < 0.05). Although no gender-specific difference was found (P = 0.723), an age-related correlation could be verified, indicating a decrease in wear time with increasing age (P < 0.05)., Conclusions: An increased BMI appears to be a risk factor for less appliance wear during orthodontic treatment with removable appliances. Additional factors which influenced cooperation during treatment with removable appliances were patient age and appliance type.

Introduction: General practitioner dentists and non-orthodontic specialties ought to have the knowledge of the basic principles and practices of orthodontics in order to educate the patients, diagnose their problems correctly and for proper referral. The objective of the present study is to assess the attitude and knowledge of the general practitioner dentists and non-orthodontic specialists towards the basic principles and practices of orthodontics., Methods: This study was performed by presenting a closed questionnaire to a total of 78 participants out of which 46 were general practitioners and 32 were non-orthodontic specialists. A questionnaire consisting of a total of 21 questions was distributed and each question was allocated 0.5 marks for correct response whereas no deduction for wrong answer., Results: In this present study, the total mean score of the evaluation of the questionnaire came out for general practitioner dentist and the non-orthodontic dental specialists was 13.92 and 16.69 respectively. The present study showed a statistically highly significant knowledge and attitude difference between Group A and Group B ( P<0.001)., Conclusions: This study shows a need for a increased clinically oriented education in the undergraduate courses and a multi-disciplinary inter department seminar presentations and forums set up for the post graduation courses for them to understand the scope of each other's specialties.

Background: Self-esteem (SE) is suggested to influence the relationship between orthodontic treatment need and oral health-related quality of life (OHRQoL), but evidence lacks. The aim of the present study was to investigate SE in the relationship between subjective orthodontic need and OHRQoL in children., Methods: This cross-sectional study was embedded in the Generation R Study, a multi-ethnic population-based cohort. In total, 3796 10-year old children participated in the present study. OHRQoL, measured with the Child Oral Health Impact Profile-ortho, and subjective orthodontic need were assessed within parental questionnaires. SE was measured with a modified version of the Harter's self-perception profile rated by the children. The role of SE in the association between SOT and OHRQoL was evaluated with linear regression models. Furthermore, the difference in this association between children with high and low SE was investigated., Results: Higher subjective orthodontic need was associated with lower OHRQoL scores (borderline: β [95% CI] = -0.55 [-0.77, -0.33]; definite: -1.65 [-1.87, -1.54]). Children with lower SE scores showed a stronger relationship between borderline and definite subjective orthodontic need with OHRQoL (β [95% CI] = -0.56 [-0.81, -0.31] respectively -1.68 [-1.94, -1.42]) than children with higher SE scores did (β [95% CI] = -0.51 [-0.97, -0.04] respectively -1.43 [-1.90, -0.95])., Conclusion: The relationship between subjective orthodontic need and OHRQoL is not based on the SE of children. However, SE modifies the relationship between subjective orthodontic need and OHRQoL. Work still needs to be done to find an explanation for the effect modification by SE in the relationship between subjective health perceptions and OHRQoL.

Introduction: The smile is more than a question of well-aligned teeth. Harmonization of the dentition with the soft tissues is the key to a beautiful smile. This abundantly illustrated article looks more closely therefore at the lips and their movements., Materials and Methods: The article begins by explicating the terminology relevant to the lips, then addresses the notions of volume, mobility and aging, and concludes by examining the orthodontic clinical dimension., Discussion: Practitioners must be fully informed when assessing requests for treatment formulated by adult patients and a detailed analysis must be made of the lips at rest and during functioning. Harmony of both the teeth and the soft tissues is indispensable to a beautiful smile. A multidisciplinary approach is often necessary., Conclusion: Restoring the patient's smile therefore obliges the practitioner to think beyond mere problems of dental occlusion., (© EDP Sciences, SFODF, 2018.)

Objective: The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients' thoughts and experiences surrounding orthognathic surgical treatment., Materials and Methods: Using the Twitter search function, with the keywords "jaw surgery," the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed., Results: A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were "recovery," "braces," "swollen," "eat," "liquid diet," and "pain.", Conclusions: The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process., (The Author(s). Published by S. Karger AG, Basel.)

Introduction: We examined the role of adolescent orthodontic patients' psychological well-being attributes (self-esteem, general body image, and positive and negative affects) and the clinical indicators of dental esthetics (orthodontists' ratings on the Index of Orthodontic Treatment Need-Aesthetic Component [IOTN-AC]), and their changes from pretreatment to posttreatment as predictors of the psychosocial impact of dental esthetics., Methods: In this prospective longitudinal study, 1090 adolescent orthodontic patients seeking treatment at the Stomatological Hospital of Chongqing Medical University in China (mean age, 14.25 years; SD, 2.03 years) were assessed before treatment, and 68.99% (n = 752) were assessed after treatment. All subjects completed a questionnaire measuring psychological well-being attributes and 3 components of the Psychosocial Impact of Dental Aesthetics (perceptive, cognitive-affective, and social-functional). Clinical indicators of dental esthetics were measured by 3 orthodontists using the IOTN-AC., Results: Substantial enhancement from pretreatment to posttreatment was found in all 3 Psychosocial Impacts of Dental Aesthetics components, confirming the positive effects of orthodontic treatment on oral health-related quality of life. Psychosocial impact of dental esthetics at baseline and improvement from pretreatment to posttreatment were found to be predicted by the patients' psychological well-being attributes (self-esteem, general body image, and negative affect) and the clinical indicators (orthodontists' rating on the IOTN-AC) at baseline, as well as their pretreatment to posttreatment change. Psychological well-being attributes had comparable or greater contribution to the Psychosocial Impact of Dental Aesthetics at baseline as well as greater improvement after treatment than the clinical indicators. These biopsychological models explained 29% to 43% of the variances in psychosocial impacts of dental esthetics outcome at baseline and about 33% of the variance in pretreatment to posttreatment improvement., Conclusions: This study establishes a biopsychological model for understanding the psychosocial impact of dental esthetics and its improvement after orthodontic treatment among adolescent orthodontic patients. The findings highlight the importance of psychological parameters in orthodontic research and clinical practice., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Pain is an important aspect of oral health-related quality of life (OHRQOL). Understanding how patients' pain experiences during their treatment affect their quality of life (QOL) is important and the absence of pain/discomfort is important for achieving a high QOL., Aim and Objective: The objective of this study was to assess the relationship between pain and OHRQOL among patients wearing fixed orthodontic appliances and to evaluate whether patient motivation and counseling had an effect on the pain and discomfort., Materials and Methods: The McGill-Short-Form with visual analog scale and present pain intensity and Oral Health Impact Profile-14 indices were used to determine the intensity and severity of pain and to evaluate the QOL of 200 adolescents undergoing fixed orthodontic treatment during different phases of treatment., Results: There was a significant correlation found between pain and the QOL of patients undergoing orthodontic treatment. Overall score of OHRQOL increased significantly (mean 43.5 ± 10.9) in the initial phase of treatment where the incidence of severe to moderate pain was reported in 80% patients. Ninety-five percent patients felt pain or discomfort. After 1 day of appliance placement, more than 85% of patients experienced severe to mild pain whereas 9% of patients suffered very severe pain. Pain reduced over a week, and at the end of a month, 10.5% patients had moderate pain whereas majority, i.e., 58% of patients complained of only mild pain (P < 0.05)., Conclusion: Pain is important sequelae of orthodontic treatment and has a significant effect on the QOL of orthodontic patients, especially during the initial phases of treatment. Patient motivation and counseling by the orthodontist have a profounding effect in reducing the pain and discomfort, improving the QOL, and an overall improvement in the patient compliance affecting the successful outcome of the treatment., Competing Interests: There are no conflicts of interest.

Background: Usually, morphological parameters of the teeth are recorded to help assess the indication for orthodontic treatment. It is assumed that significant deviations from average values compromise the quality of life. The aim of this study is to analyse the impact of overbite and overjet on oral health-related quality of life (OHRQoL) of children and adolescents., Patients and Methods: A total of 748 subjects, aged 9.5-15.5 years, participated in the LIFE child project of the University of Leipzig, where they underwent a general medical and dental examination. Overbite and overjet were measured, and aberrations of the OHRQoL were recorded by the probands themselves, who completed the German version of the Child Perceptions Questionnaire (CPQ-G11-14). The OHRQoL is divided into four domains ("oral symptoms", "functional limitations", "emotional well-being" and "social well-being") and is analysed by means of a CPQ score depending on age, gender, socioeconomic status and orthodontic treatment., Results: On average, the participants listed 10.5 (±13.1) problem issues on a CPQ scale ranging from 0 to 140. Subjects with current orthodontic treatment had a CPQ score about 2.5 (±2.4) higher than those without treatment. The aberrations were mainly observed in the domains "oral symptoms" and "functional limitations". Multiple linear regression showed that deviations of the overbite had only little influence on the OHRQoL, but deviations of an overjet-especially of >6 mm increased the CPQ summary score about 6 points., Conclusion: Children and adolescents with overjet deviations of >6 mm in comparison to the norm are associated with significant limitations of the OHRQoL. However, overbite deviations have only little influence.

Assessing changes in patient's psychological health and oral health-related quality of life (OHRQoL) over time during orthodontic treatment may help clinicians to treat patients more carefully. To evaluate changes in mental health, self-reported masticatory ability and OHRQoL during orthodontic treatment in adults, this prospective study included 66 adults (30 men, 36 women; mean age, 24·2 ± 5·2 years). Each patient completed the Korean versions of the State-Trait Anxiety Inventory, Zung Self-Rating Depression Scale, Rosenberg self-esteem scale, key subjective food intake ability (KFIA) test for five key foods and Oral Health Impact Profile-14 (OHIP-14K) at baseline (T0), 12 months after treatment initiation (T1) and debonding (T2). All variables changed with time. Self-esteem and the total OHIP-14K score significantly decreased and increased, respectively, at T1, with a particular increase in the psychological and social disabilities scores. There were no significant differences in any questionnaire scores before and after treatment. The total OHIP-14K score was positively correlated with trait anxiety and depression, and negatively correlated with self-esteem and KFIA at T0, regardless of the treatment duration. Older patients showed a significant increase in the total OHIP-14K score at T1 and T2. OHRQoL worsened with an increase in the treatment duration. Our results suggest that OHRQoL temporarily deteriorates, with the development of psychological and social disabilities, during orthodontic treatment. This is related to the baseline age, psychological health and self-reported masticatory function. However, patients recover once the treatment is complete., (© 2017 John Wiley & Sons Ltd.)

Introduction: In this study, we used Q methodology to assess the concerns of adults seeking orthodontic treatment and to determine individualized interventions to reduce their anxiety., Methods: Statements of concern were derived by in-depth interviews with 70 adult patients. Q sorting methodology was then used to identify the main factors associated with anxiety in a cohort of 40 adults who had not been involved in the first part of the study. The final stage involved a randomized study in which 160 new adult patients were recruited and randomized into intervention and control groups. Participants in the intervention group sorted the statements, after which individualized interventions were implemented. Participants in the control group received routine treatment. The State-Trait Anxiety Inventory was used to measure changes in participants' anxiety levels before and during treatment., Results: In total, 41 statements were identified, and participants were classified according to 5 factors. Factor 1 participants were concerned about the lack of treatment information; factor 2 represented concerns about cost and other people's opinions; factor 3 represented concerns about impact on work related to wearing braces; factor 4 encompassed concerns about treatment effects, pain, and dental fears; and factor 5 reflected concerns about side effects and finding a partner. The mean state anxiety inventory scores for both the intervention and control groups were highest 24 hours after bonding (intervention group, 44.63 ± 4.49; control group, 49.43 ± 5.42). The intragroup state anxiety inventory scores differed significantly across the 6 time points (P <0.01), with the state anxiety inventory scores of the intervention group significantly lower than those of the control group (P <0.01) at all time points except baseline. No significant intergroup or intragroup differences were found in relation to trait anxiety., Conclusions: Adult orthodontic patients expressed diverse concerns. Individualized interventions based on Q methodology may reduce anxiety in this patient population., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Hawley retainers (HRs) and vacuum formed retainers (VFRs) are the most commonly used removable retainers in the orthodontic practice. Patients' cooperation in wearing these appliances is affected by the levels of discomfort and oral impairment. The evidence regarding their acceptably among orthodontic patients is limited., Aims: To compare the acceptability of HRs and VFRs over a 6-month period in a group of fixed orthodontic patients., Trial Design: Two-arm parallel-group randomized controlled trial., Methods: Patients being treated at the Orthodontic Department of Saudi Swiss Consultant Dental Centre, Al-Khobar, Saudi Arabia, who met the inclusion criteria were invited to participate. Inclusion criteria were treatment only with fixed appliances, no lateral expansion treatment, no hypodontia, no cleft lip and palate, no surgical corrections, no extraction-based plans, 18 years old or greater, and willingness to wear maxillary and mandibular removable retainers. Participants were distributed randomly using concealed envelopes into two groups: HR group and VFR group. A pilot-tested questionnaire was filled at three times: 1 week after fitting of the retainer (T1), 3 months and 6 months following appliance fitting (T2 and T3, respectively). Ten questions were given on biting, fitting of the appliance, speech, appearance, oral hygiene, durability, gingival irritation, swallowing, self-confidence, and comfort. Responses were given on a visual analogue scale. Blinding was employed during data analysis., Results: Ninety-four patients were included primarily. Six patients in the Hawley group and two patients in the VFR group failed to complete the study. Therefore, 86 patients were included the analysis (HR group: 41; VFR group: 45). No significant differences were found between the two groups in biting, fitting of the appliance, and hygiene perception, whereas significant differences were detected in speech (P < 0.05), appearance (P < 0.001), gingival irritation (P < 0.001), durability (P < 0.001), swallowing (P < 0.001), self-confidence, and comfort (P < 0.001). No harm to any patient was noticed during the trial., Conclusions: Over a 6-month period of retention, VFR was significantly more acceptable than HR in speech, appearance, gingival irritation, swallowing, self-confidence, and comfort. Subjects in the HR group believed that their retainers were significantly more durable than those in the VFR group at the final assessment. Both retainers were equal regarding fitting of the appliance, biting, and hygiene perception., Registration: Not registered., Protocol: The protocol was not published before trial commencement., Funding: This trial was funded by the Saudi Swiss Consultant Dental Centre., (© The Author 2017. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Background/objective: To assess the validity and reliability of a series of three questionnaires for the quantification of patient perception of fixed appliance orthodontic treatment., Subjects and Methods: The study was carried out at the University of Dundee with content and face validity being assessed using proformas. Initially ten experts (Orthodontic Specialists) assessed content validity with 11 professionals (seven Orthodontic Specialists and four Postgraduates) and 20 patients assessing face validity. Content validity was determined according to the values of item-level content validity index (I-CVI) and scale-level CVI (S-CVI/Ave), while specially designed feedback forms were used for face validation. Internal consistency determined the reliability of the questionnaires according to the value of Cronbach alpha correlation coefficient test. The three questionnaires were then modified according to the recommendations of professionals and patients with seven experts reassessing content validity and ten newly selected patients assessing face validity., Results: The first round of content validity revealed that around half of the items in the questionnaires were not valid. Therefore, the questionnaires were not valid as a whole (S-CVI/Ave = 0.60). After modifying the questionnaires and removing the non-valid items, the new versions of the Pre-treatment, Orthodontic Experience, and Post-treatment Questionnaires showed high levels of face validity, content validity (S-CVI/Ave: 0.99, 0.97, and 0.99, respectively) and good levels of internal consistency (α = 0.86, 0.78, and 0.88, respectively)., Limitation: The patient sample was collected from a single university clinic and from one city within the UK and this could affect the generalizability of the results., Conclusion: Three content valid and reliable questionnaires have been developed and validated for the evaluation of patient perception of fixed appliance orthodontic treatment., Implications: Unlike other tools that assess oral health-related quality of life, this series of three questionnaires assess the perception of fixed appliance orthodontic treatment before, during and after treatment., (© Crown copyright 2016)

Objectives: To identify key measures in predicting orthodontic treatment need and to propose a self-assessment instrument that improves treatment need assessment., Subjects and Methods: The study included 150 randomly selected 13-year-olds. A set of measures linked to a previous study on daily life impact of malocclusion was processed, resulting in an instrument, the Demand for Orthodontic Treatment Questionnaire (DOTQ), which was analysed regarding dimensionality, reliability and validity. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) grading, representing professionally assessed treatment need, were collected from dental records. The instrument's ability to predict treatment need was tested by randomly splitting the dataset into two subgroups, using multiple regression to predict DHC in one of the groups and the prediction equation to calculate predicted DHC in the other. The outcomes were then correlated to detect the predictive power of the DOTQ, and thereby the validity of the prediction., Results: The DOTQ-measures were reliable and highly inter-correlated. A high, significant correlation was found between assessed and predicted treatment need for the subgroups (r = 0.59 and 0.49), confirming the validity of the prediction. Independent variables (the measures) explained 47 per cent (R = 0.69) of the variance in treatment need. Four measures contributed significantly to the prediction, with Treatment Demand being the most powerful predictor., Limitations: The age group and response rate may raise some questions regarding the generalizability of the findings., Conclusions: The DOTQ is able to predict treatment need as assessed by orthodontic consultants. Its incorporation in the treatment need assessment process will acknowledge patients' self-perceived impact of malocclusion., (© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying., (© 2017 John Wiley & Sons Ltd.)

Introduction: Orthodontics aims to improve oral health-related quality of life (OHRQoL). In this systematic review, we examined the evidence for changes in OHRQoL after orthodontic treatment for patients treated before they were 18 years old., Methods: The participants were patients aged less than 18 years. The interventions were nonorthognathic and cleft orthodontic treatment. The comparisons were before and after orthodontic treatment, or nonorthodontic control. The outcomes were validated measures of OHRQoL. The study designs were randomized controlled trials, controlled clinical trials, prospective cohort studies, and cross-sectional or case-control studies. Multiple electronic databases were searched, with no language restrictions; authors were contacted, and reference lists screened. The Newcastle-Ottawa scale was used for quality assessments. Screening, data extraction, and quality assessments were performed by 2 investigators independently., Results: We found 1590 articles and included 13 studies (9 cohort, 3 cross sectional, and 1 case control), with 6 in the meta-analyses. All were judged of low or moderate quality. A moderate improvement in OHRQoL was observed before and after orthodontic treatment (n = 243 participants; standardized mean difference, -0.75; 95% CI, -1.15 to -0.36) particularly in the dimensions of emotional well-being (n = 213 participants; standardized mean difference, -0.61; 95% CI, -0.80 to -0.41) and social well-being (n = 213 participants; standardized mean difference, -0.62; 95% CI, -0.82 to -0.43)., Conclusions: Orthodontic treatment during childhood or adolescence leads to moderate improvements in the emotional and social well-being dimensions of OHRQoL, although the evidence is of low and moderate quality. More high quality, longitudinal, prospective studies are needed., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Expectations of orthodontic treatment may differ between the patient and their parents, as the parents' expectations may not reflect those of the child., Objectives: The aim of this study, therefore, was to determine the expectations of patients and their parents., Materials and Methods: This was a clinic-based, comparative, cross-sectional study involving 110 patients aged between 10 and 19 years, as well as their accompanying parents or guardians. The expectations of both patients and parents were determined using a questionnaire developed by Sayers and Newton., Results: Results showed that the expectations of the patients and parents differed significantly in a number of areas with the parents' expectations often exceeding those of the patients. Both patients and parents were found to be ignorant about some aspects of orthodontic treatment, with 47.3% of patients and 39.1% of parents unaware of the duration of orthodontic treatment and, as such, requiring information from their clinicians., Conclusion: The results highlight the importance of patient education and counseling as well as the need to focus on the individual patient and not assume that their expectations mirror those of the accompanying parent., (Copyright © 2016. Published by Elsevier Masson SAS.)

This case report describes the importance of combining morphological and functional examination with psychological examination in the establishment ofstable mandibular position in the treatment of maxillary protrusion with unstable mandibular position accompanied by unidentified complaints, which ensures safe orthodontic treatment.

Introduction: In this study, we aimed to assess the relationship between normative and perceived orthodontic treatment need associated with quality of life, self-esteem, and self-perception., Methods: The sample included 248 schoolchildren aged 12 years. The normative aspect of orthodontic treatment was assessed by the Dental Health Component and the Aesthetic Component of the Index of Orthodontic Treatment Need. The subjects were further evaluated for their oral health-related quality of life, self-esteem, and self-perception of oral esthetics. The Aesthetic Component of the Index of Orthodontic Treatment Need was considered as the response variable, and generalized linear models estimated by the GENMOD procedure (release 9.3, 2010; SAS Institute, Cary, NC). Model 1 was estimated with only the intercept, providing the basis for evaluating the reduction in variance in the other models studied; then the variables were tested sequentially, considering P ≤0.05 as the criterion for remaining in the model., Results: In the model, self-perception and self-esteem were statistically significant in relation to the perceived need for treatment. The normative need was significantly associated with the outcome variable and was not influenced by independent variables., Conclusions: The normative need for orthodontics treatment was not overestimated by the perceived need, and the perceived need was not influenced by sex and the impact on quality of life., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: The authors conducted a systematic review to assess changes in patients' facial profiles resulting from orthodontic treatment with and without extraction of 4 premolars and to identify cephalometric parameters that can assist decision making in borderline cases., Types of Studies Reviewed: The authors conducted a systematic review of randomized clinical trials and observational studies comparing the 2 types of treatment (with and without premolar extraction) in terms of the changes in facial profile. The authors conducted an electronic search of the databases the Cochrane Library, PubMed MEDLINE, Embase, and Latin-American and Caribbean Health Sciences Literature., Results: The authors identified 1 clinical trial with 26 participants and 5 observational cohort studies, collectively involving 362 participants. The authors assessed cephalometric parameters and esthetic outcomes. Four studies used linear regression analysis to investigate esthetic interaction between treatment strategy and initial lower lip protrusion. The 4 studies determined that if the initial lip protrusion was beyond a determined point, esthetic preferences favored extraction, and if the initial lip protrusion was not to that point, esthetic preferences favored conservative treatment., Conclusions and Practical Implications: The results of the authors' systematic review found no significant differences between the groups in terms of the esthetic outcomes. The cephalometric parameter of initial lip protrusion can help with decision making in borderline cases., (Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: The normative orthodontic treatment need, established by dental professionals during the dental appointment, becomes ineffective when it does not evaluate all the factors that influence the decision-making process, including individuals' perception and satisfaction with their dental appearance. Therefore, the purpose of this study was to investigate the perception of children and their mothers as regards orthodontic treatment need and satisfaction with dental aesthetics and test if these variables are associated with the objective orthodontic treatment needs, assessed by the Dental Aesthetic Index (DAI)., Methods: A cross-sectional study was conducted on 308 children aged 12 years, and their mothers were randomly selected by cluster sampling (primary schools). The variables "orthodontic treatment need," "satisfaction with chewing," and "dental appearance" were assessed by means of a questionnaire. The questions were answered individually at school or home, in cases of children or mothers, respectively. DAI was assessed to make an objective clinical assessment. The variables were dichotomized and statistically analyzed by the chi-square and Fisher's exact tests, contingency coefficient C, and logistic regression., Results: The results of the clinical evaluation (DAI) were statistically associated with the perception of orthodontic treatment need and satisfaction with dental appearance in children (p ≤ 0.01). However, no association was observed with regard to satisfaction with chewing and DAI (p = 0.10). The children's perception of orthodontic treatment need and satisfaction with the appearance of their teeth was statistically associated (p ≤ 0.01) with their mothers' perception. Maxillary overjet, maxillary and mandibular misalignment, and dental crowding were associated with the orthodontic treatment need by children and their mothers, with p value -0.05 and 5 % level of significance. Maxillary overjet was a significant predictor for the perception of orthodontic treatment need in children (OR 1.86, 95 % CI 0.98-3.55) and mothers (OR 3.02, 95 % CI 1.54-5.92)., Conclusions: Children and parents realize the need for orthodontic treatment according to the different types of malocclusion, as noted in the association between orthodontic treatment need and dental appearance perceived by children and their mothers, which was also observed-with low correlation-with regard to DAI.

Objectives: In 2013, a novel material SmartTrack ® was introduced to replace the previous material used for Invisalign ® aligners. We conducted this study to test how this transition was accepted by patients during ongoing Invisalign ® treatment., Methods: We surveyed a total of 72 patients (68 % women, 32 % men, mean age: 29.3 ± 9.2 years) who had worn the new material for a mean of 6 months. They completed a questionnaire with 25 items that compared both materials in terms of pain, pressure upon insertion, comfort, mucosal irritation, phonetics, discoloration, and taste., Results: On a numerical rating scale (NRS) ranging from 0 to 10, the new aligner material was rated by the respondents to cause significantly (p < 0.001) less maximum pain than the old material (2.8 vs. 3.8). Significant reductions were obtained for duration of pain (p < 0.001) and duration of pressure (2.5 vs. 1.9 days; p = 0.001) upon insertion of the aligners. Over 90 % of the respondents indicated less or equal pain during eating, felt that the new material offered a tighter fit, and provided more favorable ratings for impairment, durability, and discoloration. Improved comfort was reported by 50 % of the respondents., Conclusions: The new material was favorably rated by the patients and showed significant reductions in pain intensity, pain duration, and pressure upon insertion. Important clinical parameters like overall comfort and impairment also were improved. The clinical effectiveness of the new material remains to be investigated.

Introduction: The impact of orthodontic treatment on oral health-related quality of life (OHRQoL) in adolescents being treated in orthodontic practices has not yet been explored longitudinally. The aim of this cohort study was to describe the changes in both malocclusion and OHRQoL with orthodontic treatment., Methods: One hundred seventy-four patients (ages, 10-17 years; 64.4% girls; 81.6% European) underwent 2-arch, fixed-appliance treatment in a 4-year prospective study conducted across 19 specialist orthodontic practices throughout New Zealand. They were assessed before treatment, at debond (when 87.4% of the baseline sample were reassessed), and at a mean 21 months postdebond (when 59.4% of the baseline sample were reassessed). OHRQoL was measured using the Child Perceptions Questionnaire, and the Dental Aesthetic Index was used to measure occlusion., Results: Among the 104 patients who took part in all 3 assessments, little change in OHRQoL overall was seen at the end of treatment, despite considerable improvement in malocclusion (with the mean Dental Aesthetic Index score falling from 35.9 at baseline to 21.3 at debond). The mean Child Perceptions Questionnaire 11-14 was slightly greater at debond, and this was most notable in the functional limitations subscale. By the end of the study (21 months postdebond, on average), the decreases in Child Perceptions Questionnaire 11-14 scores were all substantial, especially in the emotional well-being and social well-being subscales., Conclusions: Malocclusion affects orthodontic patients' OHRQoL before treatment. A temporary increase in symptomatic impacts seen by the debond stage appears to ameliorate with time, with the benefits of orthodontic treatment for OHRQoL manifesting themselves some months later., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Currently, few methods are available to measure orthodontic treatment need and treatment outcome from the lay perspective. The objective of this study was to explore the function of an eye-tracking method to evaluate orthodontic treatment need and treatment outcome from the lay perspective as a novel and objective way when compared with traditional assessments., Methods: The scanpaths of 88 laypersons observing the repose and smiling photographs of normal subjects and pretreatment and posttreatment malocclusion patients were recorded by an eye-tracking device. The total fixation time and the first fixation time on the areas of interest (eyes, nose, and mouth) for each group of faces were compared and analyzed using mixed-effects linear regression and a support vector machine. The aesthetic component of the Index of Orthodontic Treatment Need was used to categorize treatment need and outcome levels to determine the accuracy of the support vector machine in identifying these variables., Results: Significant deviations in the scanpaths of laypersons viewing pretreatment smiling faces were noted, with less fixation time (P <0.05) and later attention capture (P <0.05) on the eyes, and more fixation time (P <0.05) and earlier attention capture (P <0.05) on the mouth than for the scanpaths of laypersons viewing normal smiling subjects. The same results were obtained when comparing posttreatment smiling patients, with less fixation time (P <0.05) and later attention capture on the eyes (P <0.05), and more fixation time (P <0.05) and earlier attention capture on the mouth (P <0.05). The pretreatment repose faces exhibited an earlier attention capture on the mouth than did the normal subjects (P <0.05) and posttreatment patients (P <0.05). Linear support vector machine classification showed accuracies of 97.2% and 93.4% in distinguishing pretreatment patients from normal subjects (treatment need), and pretreatment patients from posttreatment patients (treatment outcome), respectively., Conclusions: The eye-tracking device was able to objectively quantify the effect of malocclusion on facial perception and the impact of orthodontic treatment on malocclusion from the lay perspective. The support vector machine for classification of selected features achieved high accuracy of judging treatment need and treatment outcome. This approach may represent a new method for objectively evaluating orthodontic treatment need and treatment outcome from the perspective of laypersons., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists', parents' or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are used during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as "the exceptional normal." Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics., (© 2016 by the American Anthropological Association.)

Introduction: The aim of this study was to evaluate the psychosocial impact of dental esthetics for adults seeking orthodontic treatment., Methods: The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered to 393 adults, aged 18 to 30 years. The participants were divided into 2 groups: an intervention group (received orthodontic treatment) and a control group (rejected orthodontic treatment). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need (IOTN)., Results: The Wilcoxon signed rank test showed no statistically significant difference between the groups for the dental health component (DHC) of the IOTN (P = 0.134). Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTN-DHC grades; self-confidence scores in the control group (F = 1.802; P >0.05) were the exception. Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group. DHC grades, psychological impact, social impact, and aesthetic concern had significant impacts on patients accepting orthodontic treatment., Conclusions: The psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment. Importantly, participants with low self-awareness of the potential psychosocial impact rejected orthodontic treatment, despite the need for severe normative treatment., (Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Aim: To answer the question: is there a correlation between body mass index (BMI), oral health, and patient cooperation during multibracket (MB) appliance therapy?, Materials and Methods: All adolescent MB patients started and finished between 2007 and 2012 were analysed. According to their pre-treatment BMI, patients were divided into one of the following groups: normal weight, overweight, or obese. Using the patients' records, the cooperation during treatment was classified as good, bad, or poor and the treatment duration was calculated. Using pre- and post-treatment photographs, white spot lesion (WSL) formation and gingivitis before and after MB therapy were assessed., Results: Of the 175 subjects, 138 had a normal BMI (79 per cent), 22 were overweight (12.5 per cent), and 15 obese (8.5 per cent). Whereas 42.8 per cent of the normal weight patients showed a good cooperation, only 22.7 per cent of the overweight and 20.9 per cent of the obese patients cooperated sufficiently. On average, normal weight patients were treated for 22.2 months, overweight patients for 23.0 months, and obese patients for 27.7 months. Normal weight patients developed less WSL (41.3 per cent) during MB treatment than overweight (50 per cent) or obese (66.7 per cent) patients. Furthermore, patients with a normal weight or overweight had less gingival inflammation (79.5 per cent) after treatment than obese individuals (93.3 per cent)., Conclusion: An increased BMI appears to be a risk factor for less cooperation, a longer treatment duration, and more oral health-related problems during MB treatment, indicating that these patients require special attention during orthodontic therapy., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)