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Objective: To examine the orthodontic patient experience having braces compared with Invisalign by means of a large-scale Twitter sentiment analysis., Materials and Methods: A custom data collection program was created that collected tweets containing the words "braces" or "Invisalign" for a period of 5 months. A hierarchal Naïve Bayes sentiment analysis classifier was developed to sort the tweets into five categories: positive, negative, neutral, advertisement, or not applicable. Each category was then analyzed for specific content., Results: A total of 419,363 tweets applicable to orthodontics were collected. Users posted significantly more positive tweets (61%) than they did negative tweets (39%; P ≤ .0001). There was no significant difference in the distribution of positive and negative sentiment between braces and Invisalign tweets (P = .4189). Positive orthodontics-related tweets often highlighted gratitude for a great smile accompanied with selfies. Negative orthodontic tweets frequently focused on pain., Conclusion: Twitter users expressed more positive than negative sentiment about orthodontic treatment with no significant difference in sentiment between braces and Invisalign tweets.

Objective: To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners., Materials and Methods: A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment., Results: Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P < .0001). In general, case confidence increased with increasing experience for both orthodontists and general dentists. After adjusting for experience, there was a significant difference in aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction., Conclusion: There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.

Objective: To determine whether orthodontic treatment with removable aligners vs fixed orthodontic appliances is associated with a different frequency of orthodontically induced external apical root resorption (OIEARR) when genetic, radiographic, and clinical factors are accounted for., Materials and Methods: Three hundred seventy-two orthodontic patients treated with removable aligners (Invisalign) or fixed appliances were genetically screened for interleukin 1B gene (IL1B) (rs1143634), interleukin 1 receptor antagonist gene (IL1RN) (rs419598), and osteopontin gene (SPP1) (rs9138/rs11730582). Twelve clinical variables, potentially associated with OIEARR, were also considered. Subjects were divided according to the presence of radiographically determined OIEARR (>2 mm). The association between OIEARR and appliance type, and radiographic, clinical and genetic factors, was assessed using backward stepwise conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported., Results: Reliability of the methods was adequate. Clinical case complexity (American Board of Orthodontics [ABO] Discrepancy Index) (OR: 1.032; 95% CI: 1.005-1.061; P = .021) and extent of incisor apical displacement in the sagittal plane (OR: 1.478; 95% CI: 1.285-1.699; P = .001) were associated with an increased OIEARR risk. After adjusting for associations between clinical/radiographic/genetic factors, there were no statistically significant differences with respect to OIEARR or type of orthodontic appliance used, whether removable aligners or fixed appliances (OR: 1.662; 95% CI: 0.945-2.924; P = .078). Only subjects homozygous for the T allele of IL1RN (rs419598) were more prone to OIEARR during orthodontic treatment (OR: 3.121; CI: 1.93-5.03; P < .001)., Conclusions: A similar OIEARR predisposition was identified using either removable aligners (Invisalign) or fixed appliances.

Objective: To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population., Materials and Methods: In this prospective, randomized, controlled clinical trial, 42 orthodontic patients were assigned to a text message or control group. Parents of patients assigned to the text message group received a reminder text message one weekday each week. Oral hygiene compliance was measured using bleeding index (BI), modified gingival index (MGI), and plaque index (PI), and visual examination of white spot lesion (WSL) development at baseline (T0), two appointments after baseline (T1), and four appointments after baseline (T2)., Results: BI, MGI, and PI scores were significantly lower in the text message group than in the control group at T2., Conclusion: A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients.

Objective: To discern patients' opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success., Materials and Methods: Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n = 158), first-year dental students (n = 183), and retention patients at orthodontic offices (n = 214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced., Results: Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either "satisfied" or "very satisfied" with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P < .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P = .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be "very satisfied" currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P = .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P < .0001)., Conclusions: Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.

Introduction: Because of the severity of some malocclusions, it is not always possible to treat them without a combination of orthodontics and orthognathic surgery. However, many insurance carriers have difficulty in deciding whether such treatment should be covered. The purpose of this study was to develop a simple method that can be used by insurance carriers to determine when a malocclusion is not correctable by orthodontics alone., Methods: Twenty-eight orthodontists independently evaluated 30 sets of pretreatment dental models (10 with overjet from -6 to 12 mm, 10 with overbite from 60% to 100%, and 10 with transverse discrepancies from single tooth to total arch crossbite) to determine whether the conditions were orthodontically treatable. They were instructed to assume that growth was complete and that the treatment would not seriously compromise facial esthetics., Results: It was the opinion of the orthodontists that a positive overjet greater than 8 mm, a negative overjet of -4 mm or greater, and a transverse discrepancy greater than 3 mm were not orthodontically treatable. However, most orthodontists believed that they could treat all overbite patients without surgery., Conclusions: These data can serve as a simple guideline for helping insurance carriers determine the need for orthognathic surgery.

Approval for state sponsored funding of orthodontic treatment is often decided using an index of malocclusion. The purpose of this study was to determine whether two indices used for prioritizing patients would identify different groups of individuals qualifying for orthodontic treatment funding approval. In addition, the characteristics of patients approved using different indices were compared. The records of 40 patients previously submitted for state medicaid funding approval were evaluated by three study examiners using two orthodontic treatment priority indices, the Salzmann Handicapping Malocclusion Assessment (Salzmann) and the Index of Orthodontic Treatment Need (IOTN). Comparisons were made between state medicaid and study examiner Salzmann scores, rankings, and funding decisions, and between study examiner Salzmann rankings, IOTN rankings, and funding decisions. Correlation and rank correlation coefficients between the state and study examiners' Salzman scores were high (r = 0.74; p < 0.001, and R = 0.77; p < 0.001). Rank correlation analysis of the study examiners' Salzmann and IOTN values demonstrated a weaker relationship (R = 0.40; p < 0.02). Agreement on funding decisions, evaluated by the Kappa statistic, was greater between the two Salzmann evaluations (K = 0.57) than between the study examiners' Salzmann and IOTN evaluations (K = 0.14). As expected, depending on the method used to determine orthodontic treatment funding priority, different patients were likely to be identified for treatment approval. The characteristics of patients whose treatment was approved was closely related to the criteria defined by the method employed.

Flared incisors and deep overbite are challenging to treat orthodontically. This paper describes the use of a three-piece base arch and Class I elastics to correct deep overbite while simultaneously closing spaces. An analysis of the biomechanics and a discussion of the appliance design are presented to help understand how the incisor axial inclination can be corrected and controlled during orthodontic therapy. A clinical example illustrates the treatment sequence.

Biomechanical modifications made to accommodate orthodontic treatment of adult dentitions are generally minor and adhere to the basic laws of physics as they apply to all orthodontic tooth movement. Some adult presentations necessitate changes in treatment strategy from what would otherwise be employed in adolescent patients to achieve similar goals. In other cases, objective themselves may need to be modified because of a lack of growth potential, constraints of treatment mandated by the patient, or the presence of multiple missing or compromised teeth. The possibilities and limitations of orthodontic and dentofacial orthopedic treatment for adults are usually easier to define before beginning therapy than with adolescent patients because the unknown contribution that growth will make has already been discounted. By planning treatment and mechanotherapy taking into account the individual circumstances that may affect the patient's biological response to treatment, realistic goals of orthodontics can be mutually recognized and agreed on by both the provider and the patient before therapy is initiated.

Deep overbite correction and space closure in patients with flared incisors are mechanically difficult to achieve with conventional orthodontic treatment. The purpose of this article is to present an appliance design that allows simultaneous intrusion and retraction of anterior teeth as well as correction of their axial inclinations. A three-piece base arch was used to achieve simultaneous intrusion and space closure. Various clinical situations are discussed and analyzed from a biomechanical standpoint. Sequences of treatment, appliance design, and management of side effects are described in detail. The segmented approach to simultaneous intrusion and space closure is useful for achieving precise control of tooth movements in the anteroposterior and vertical dimensions.

A mathematical model was developed to compare quantitatively the effects of various types of orthodontic expansion on mandibular arch perimeter. Mandibular arch form was modeled with spline interpolation to fit a smooth curve between assigned molar, canine, and incisor positions. Starting with average arch dimensions, intermolar width, intercanine width, and midline arch length were increased individually and in combination in millimeter increments up to 5 mm, and the consequent changes in arch perimeter were measured. Increasing midline arch length by incisor advancement was nearly four times as effective in increasing arch perimeter as was molar expansion; canine expansion had an intermediate effect. Arch perimeter increments increased slightly with successive amounts of expansion for the molar, canine, and incisor. Combinations of molar-canine and canine-incisor expansion yielded results comparable to the total effects achieved by expansion of those teeth individually. Combined molar-canine expansion created increases in arch perimeter that were only slightly less than those generated by incisor advancement alone.