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Abstract Background Recent years have witnessed a remarkable evolution of clear aligner technology and clear aligners are becoming more and more versatile in treating orthodontic patients. The aim of this study was to develop an objective evaluation system for assessing clear aligner treatment difficulty. Methods A total of 120 eligible patients (100 patients for developing and testing the evaluation system and 20 patients for validating this system) were recruited in this retrospective cross-sectional study. Based on clinical data (dental models, radiographs and photographs), complexity levels of cases were evaluated by two experts and regarded as the gold standard. Difficulty scores were determined through an evaluation system encompassing three domains (dental model analysis, radiographic examinations and clinical examinations). The reliability of the evaluation system was examined through analyzing the agreement between complexity levels and difficulty scores. Moreover, multivariable linear regression test was used to examine the independent association of each variable (e.g. overbite and crowding) with the complexity level. Results The results revealed that the assessment of treatment difficulty by this objective evaluation system substantially matched the gold standard (R2 = 0.80). The multivariable regression test revealed that complexity level was significantly associated with difficulty score (p

Psoriasis is a chronic inflammatory disease that is the result of complex interactions between genetic, enviromental and immunological factors. It is now accepted as a systemic disorder accompanied by co-morbidities, rather than simply a cutaneous disease. Treatment of a patient with psoriasis should be designated not only depending on the extent of the lesions, but also with consideration of patient characteristics, the sites of involvement and the effect of the disease on quality of life. There are several treatment options for psoriasis, and practically every patient will need an individualised approach. Due to the presence of psychiatric disorders, particularly depression and anxiety disorders, often co-occuring with psoriasis, psychological evaluation should not be overlooked. Therefore, psychological interventions and, if needed, psychopharmacological treatment should also be considered as routine components of the treatment plan. This review offers options that can be used in psoriasis and approaches to deciding on the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine which factors correlate with easy and difficult treatments and to assess the use of the Index of Complexity, Outcome & Need (ICON) as an indicator for treatment difficulty. The study was conducted at 2 centers using a retrospective cross-sectional questionnaire-based design. The participants were specialist orthodontic practitioners in Dresden, Germany and Cardiff, UK. Sixteen specialist orthodontists participated. Each supplied 10 completed cases—5 they regarded as being easy and 5 as being difficult. The specialist orthodontists completed a questionnaire and stated up to 5 reasons why they considered the case easy or difficult. Two examiners were calibrated in the use of the ICON. Logistic regression analysis using a forward conditional systematic model with complexity of case (ie, easy or difficult) as the dependent variable demonstrated statistical significance of the following patient-related factors: pretreatment ICON score, number of appointments, and age. Chi-squared testing demonstrated statistical significance of the following factors: cooperation, extent of overbite, presence of dysfunction, extent of overjet, anchorage, angulation of teeth, presence of crossbite, center-line shift, nonextraction treatment, age at start of treatment, compliance during the course of treatment, oral hygiene level. This study indicates that the main distinguishing factors between easy and difficult cases appear to be pretreatment age, number of appointments, and pretreatment ICON score. However, the odds ratios were not sufficiently high for these factors to be strong predictors of difficulty. [ABSTRACT FROM AUTHOR]

The most appropriate timing for the treatment of Class II malocclusions is controversial. Some clinicians advocate starting a first phase in the mixed dentition, followed by a phase 2 in the permanent dentition. Others see no clear advantage to that approach and recommend that the entire treatment be done in the late mixed or early permanent dentition. This study examines how orthodontists, blinded to treatment approach, perceive the impact of phase 1 treatment on phase 2 needs. The sample consisted of 242 Class II subjects, aged 10 to 15, who had completed phase 1 or observation in a randomized clinical trial (RCT). For each subject, video orthodontic records, a questionnaire, a fact sheet, and a cephalometric tracing were sent to five randomly selected reviewing orthodontists blinded to subject group and study purpose. Reviewing orthodontists were asked to assess treatment need, general approach, need for extractions, priority, difficulty, and determinants. Orthodontists agreed highly on treatment need (95%) and moderately on treatment approach (84%) and extraction need (80%). They did not perceive differences in need, approach, or extractions between treated and control groups. Treated subjects were judged as less difficult (p = 0.0001) and to have a lower treatment priority (p = 0.0001) than controls. In ranking problems that affect treatment decisions, the orthodontists ranked dental Class II (p = 0.005) and skeletal relationships (p = 0.004) more highly in control than in treated patients. These data indicate that orthodontists do not perceive phase 1 treatment for Class II as preventing the need for a second phase or as offering any particular advantage with respect to preventing the need for extractions or other skeletal treatments in that second phase. They do view early Class II treatment as an effective means of reducing the difficulty of and priority for phase 2. [ABSTRACT FROM AUTHOR]