Publications by authors named "Ama Johal"

55 Publications

Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis.

J Clin Sleep Med 2021 Mar 4. Epub 2021 Mar 4.

Department of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, Turner Street, London, United Kingdom.

Study Objectives: The review aimed to identify the factors influencing adherence to oral appliance therapy (OAT) in adults with obstructive sleep apnea.

Methods: The protocol was initially registered with the International Register of Systematic Reviews (Prospero: CRD42019122615), prior to, undertaking a comprehensive electronic search of databases and references, without language and date restrictions. Quality assessment was undertaken using the Cochrane Collaboration's risk of bias tool and Quality in Prognosis Studies (QUIPS) tool.

Results: Studies exhibited low or unclear risk of bias for the domains assessed by the respective quality assessment tools. The influence of independent variables such as disease characteristics, patient characteristics, appliance features, psychological and social factors on adherence levels was also assessed. There were a total of 31 included studies, which consisted of: 8 RCTs, 2 CCTs, 7 prospective cohorts, 11 retrospective cohorts and the remaining three studies were a case-series, case-control and a mixed-methods. All 31 included studies were subject to qualitative analysis, with only 4 studies included in the quantitative analysis. Results of the meta-analysis demonstrated increased adherence with custom-made appliances, with a pooled mean difference of -1.34 (-2.02 to -0.66b) and low levels of heterogeneity (I² = 0%).

Conclusions: A weak relationship was observed between objective adherence and patient and disease characteristics such as age, sex, obesity, AHI, daytime sleepiness to oral appliance therapy. Non-adherent patients reported more side effects with oral appliance therapy than users and tended to discontinue the treatment within the first three months. Custom-made oral appliances were preferred and increased adherence reported in comparison to ready-made appliances. Further research is imperative in order to examine the relationship between psychosocial factors and adherence to oral appliance therapy.
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http://dx.doi.org/10.5664/jcsm.9184DOI Listing
March 2021

The influence of mild versus severe hypodontia on facial soft tissues? A three-dimensional optical laser scanning-based cohort study.

J Orthod 2020 Oct 29:1465312520967016. Epub 2020 Oct 29.

Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Objective: To determine whether there are differences in the facial soft tissue morphology between participants with mild (up to two) or severe (six or more) hypodontia.

Design And Setting: A prospective hospital-based cohort study.

Participants And Methods: Ninety-two participants, aged 11-16 years, with confirmed hypodontia were recruited. Participants were sub-grouped based on the severity (mild, two or less and severe, six or more) and distribution of the missing teeth and age. They underwent a three-dimensional (3D) optical surface scan of the facial soft tissues. Facial surface scans were compared quantitatively, applying landmark measurements and surface-based analysis.

Results: In total, 92 participants, with an equal distribution between the mild (n=46) and severe (n=46) categories, were recruited. Patients with severe hypodontia displayed a reduced alar base, lower facial height, nasolabial angle ( = 0.02) and transgonial width ( < 0.001) compared to those with milder hypodontia. Furthermore, significant differences were observed between mild-male and severe-female groups regarding alar base, lower anterior face height and transgonial width and between mild-male and mild-female groups regarding nasolabial angle and transgonial width.

Conclusion: Significant reductions were seen in the 3D soft tissue morphology of participants with severe hypodontia, in terms of the nasolabial angle, lower facial height, alar base and transgonial widths, emphasising the importance of using facial scanning as a relatively simple non-invasive method of assessment.
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http://dx.doi.org/10.1177/1465312520967016DOI Listing
October 2020

Development of a core outcome set for use in routine orthodontic clinical trials.

Am J Orthod Dentofacial Orthop 2020 Nov 16;158(5):650-660. Epub 2020 Sep 16.

Department of Orthodontics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.

Introduction: A diverse range of outcomes is used in orthodontic research with a focus on measuring outcomes important to clinicians and little consistency in outcome selection and measurement. We aimed to develop a core outcome set for use in clinical trials of orthodontic treatment not involving cleft or orthognathic patient groups.

Methods: A list of outcomes measured in previous orthodontic research was identified through a scoping literature review. Additional outcomes of importance to patients were obtained using qualitative interviews and focus groups with adolescents aged 10-16 years. Rating of outcomes was carried out in a 2-round electronic Delphi process involving health care professionals and patients using a 9-point scale. A face-to-face meeting was subsequently held with stakeholders to discuss the results before refining the core outcome set.

Results: After triangulation, a final list of 34 outcomes grouped under 10 domains was obtained for rating in the e-Delphi surveys. Fifteen outcomes were voted "in" after the second Delphi round involving 274 participants with a further outcome being included after the consensus meeting. These were subsequently refined into a final set of 7 core outcomes, including the impact of self-perceived esthetics, alignment and/or occlusion, skeletal relationship, stability, patient-related adherence, breakages, and adverse effects on teeth or teeth-supporting structures.

Conclusions: A bespoke orthodontic core outcome set encompassing both clinician- and patient-focused outcomes was developed. Incorporating this is the first step into providing a more holistic assessment of the impact of treatment while allowing for meaningful comparisons and synthesis of results from individual trials.
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http://dx.doi.org/10.1016/j.ajodo.2020.05.010DOI Listing
November 2020

Complications, impacts, and success rates of different approaches to treatment of Class II malocclusion in adolescents: A systematic review and meta-analysis.

Am J Orthod Dentofacial Orthop 2020 Oct 2;158(4):477-494.e7. Epub 2020 Sep 2.

Barts and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, London, United Kingdom.

Introduction: We aimed to explore the prevalence and nature of complications associated with Class II correctors in adolescents and their impact on the quality of life (QOL), completion of treatment, and success rate.

Methods: The review was registered in PROSPERO, and a comprehensive electronic search was performed without language or date restrictions. Randomized and nonrandomized trials, prospective cohort and cross-sectional studies, case series, and qualitative research were included. The Cochrane Collaboration's risk of bias tool and the Newcastle-Ottawa scale were used to assess the quality of included studies. Data were grouped according to appliances design: removable functional, fixed functional, hybrid functional, headgear, and fixed maxillary molar distalization appliances.

Results: Data from 27 studies were included, of which 11 were deemed eligible for meta-analysis. Overall, 1676 adolescents were included related to fixed functional (n = 682), removable functional (n = 682), hybrid functional (n = 84), headgear (n = 186), and Carriere (n = 42) appliances. The mean number of emergencies was 0.8 (95% confidence interval [CI], 1.1-2.1) and 2 (95% CI, 0.9-3.0) for removable and fixed designs, respectively. However, the rate of discontinuation was 35% (95% CI, 0.28-0.42) and just 1% (95% CI, 0.01-0.1) for removable and fixed designs, respectively. Other QOL dimensions such as eating, sleep, speech, and emotional domains were significantly impaired during treatment with removable functional appliances.

Conclusions: Removable Class II correctors were associated with a high rate of treatment discontinuation, most likely because of the negative impact on QOL and lack of compliance. More complications were observed with fixed designs, although this did not impact the overall success rates. Further prospective studies are needed to explore patient perceptions and cost-effectiveness to inform treatment decisions better.
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http://dx.doi.org/10.1016/j.ajodo.2020.03.021DOI Listing
October 2020

Development of 'My Retainers' mobile application: Triangulation of two qualitative methods.

J Dent 2020 03 24;94:103281. Epub 2020 Jan 24.

Centre for Oral Bioengineering, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Electronic address:

Objective: Diligent wear of removable orthodontic retainers requires prolonged adherence and is invariably necessary to preserve optimal results. Patient-informed behaviour-change interventions represent a promising and novel means of enhancing adherence to removable retainer wear. The aim of this study was to describe the development of a patient-informed mobile application designed to enhance retainer wear.

Methods: App development encompassed consideration of participant preferences, social media posts, available interventions and behaviour change theories. Qualitative methods including analysis of publicly-available retainer-related posts on Twitter (n = 827) and one-to-one interviews were undertaken. Audio-recorded one-to-one interviews were undertaken to identify patient preferences in relation to features, content and design of the application. A criterion-based purposive sample of participants wearing vacuum-formed retainers for at least 4 years was used (n = 15). Thematic analysis of transcribed data was undertaken. These data were triangulated to inform design and content of the application.

Results: The need to facilitate communication with the treating clinician, responsive reminder and tracking systems, and access to useful and engaging written and visual information, in addition to other personalised and interactive features were considered important. Concerns related to retainer wear shared on Twitter informed an exhaustive list of frequently-asked questions. Application features were mapped to relevant theoretical constructs. Determinants of existing behavioural change theories were also used to link application features to retainer wear and maintenance.

Conclusions: A holistic process involving both patient and professional input can be useful in informing the development of mobile applications. The orthodontic application ("My Retainers") will undergo further scrutiny in relation to its effectiveness in inducing behavioural change and concerning patient experiences prior to finalisation.
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http://dx.doi.org/10.1016/j.jdent.2020.103281DOI Listing
March 2020

Assessment of Psychological Disturbance in Patients with Tooth Loss: A Systematic Review of Assessment Tools.

J Prosthodont 2020 Mar 5;29(3):193-200. Epub 2020 Feb 5.

SFHEA Clinical Senior Lecturer in Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, London, UK.

Purpose: To systematically review the available evidence on screening tools to detect the psychological disturbance in patients with tooth loss and technically successful removable dentures (partial and complete).

Materials And Methods: The study protocol was registered with the National Institute of Health Research Database (I.D. CRD42017082125). The PICOS tool (patients, intervention, control, outcomes measure, and study design) was used to formulate an effective search strategy. Participants were adults (≥ 18), who were edentulous or had significant tooth loss (< 9 remaining teeth). The intervention included undergoing replacement with technically successful dentures (partial or complete). A control group of adults were either edentulous or had significant tooth loss and without dentures. Outcomes included assessing psychological disturbance due to treatment with dentures or due to no treatment using a validated tool. A structured search strategy was used to complete a standard systematic search of the electronic database without any date limit and/or language restriction. Only quantitative studies using a validated measuring tool to screen for psychological distress in adults with significant tooth loss were included. Two authors independently assessed the risk of bias in the included studies. Data homogeneity was assessed in regards to the screening tools to measure psychological disturbance following the management of tooth loss with dentures. The significant level was set at 0.05, using IBM SPSS Statistics 24.0 (SPSS Inc., New York, NY). The psychometric properties and the validation processes of the screening tools were assessed.

Results: From the original 3510 studies identified, only eight studies were found to meet the inclusion criteria. All eight studies used the same questionnaire to screen for the emotional distress of tooth loss. In addition, one study also used the Patient Health Questionnaire-9 (PHQ-9) to screen for the association of depression with tooth loss. Six studies suggested that a significant number of patients have difficulties in accepting tooth loss, were less confident, and had emotional distress related to tooth loss. However, two studies reported no significant link. All studies found a marked impact on functional activities and social interaction. However, four studies had a potentially biased selection process, and the questionnaire used was assessed to be at high-risk of measurement bias, as the development and validation process was not clear. There was also a lack of well-defined control groups in all studies.

Conclusion: Tooth loss could cause psychological disturbance in some patients. To date, there is a lack of available tools that are suitable to screen and measure psychological disturbance in patients with tooth loss. Additional research is required to develop tools to identify and measure such impact and to recommend suitable interventions when needed.
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http://dx.doi.org/10.1111/jopr.13141DOI Listing
March 2020

Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial.

Eur J Orthod 2020 11;42(5):571-579

Centre for Oral Bioengineering, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.

Background: The 'My Retainers' mobile application is a patient-informed intervention designed to enhance removable retainer wear and associated patient experiences during the retention phase.

Objectives: To evaluate the effect of receiving the 'My Retainers' application on objectively assessed thermoplastic retainer (TPR) wear time, stability, periodontal outcomes, patient experiences, and knowledge related to retainers.

Materials And Methods: Eighty-four participants planned for removable retention with TPRs were assigned either to receive the 'My Retainers' application or to control not receiving electronic reminders during the 3-month period. Randomization was based on computer-generated random numbers and allocation was concealed using opaque, sealed envelopes. The primary outcome was objectively assessed retainer wear recorded using an embedded TheraMon® micro-electronic sensor. Secondary outcomes, including irregularity of the maxillary and mandibular incisors, plaque levels, bleeding on probing and probing depth, were assessed at baseline and 3-month follow-up; and analysed using a series of mixed models. Experiences and knowledge related to orthodontic retainers were recorded using questionnaires. The outcome assessor was blinded when possible.

Results: Receipt of the mobile application resulted in slightly higher median wear time (0.91 hours/day); however, this difference was not statistically significant (P = 0.56; 95% confidence interval [CI]: -2.19, 4.01). No significant differences were found between the treatment groups in terms of stability (P = 0.92; 95% CI: -0.03, 0.04), plaque levels (P = 0.44; 95% CI: -0.07, 0.03), bleeding on probing (P = 0.61; 95% CI: -0.05, 0.03) and probing depth (P = 0.79; 95% CI: -0.09, 0.07). Furthermore, similar levels of patient experiences (P = 0.94) and knowledge related to retainers (P = 0.26) were found. However, marginally better levels of knowledge were identified in the intervention group. No harms were observed.

Limitations: A relatively short follow-up period with the study confined to a single-center in a university-based hospital.

Conclusions: Provision of the bespoke 'My Retainers' application did not lead to an improvement in adherence with TPR wear over a 3-month follow-up period. Further refinement and research are required to develop and investigate means of enhancing adherence levels.

Clinical Registration: NCT03224481.
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http://dx.doi.org/10.1093/ejo/cjz088DOI Listing
November 2020

Can socioeconomic and psychosocial factors predict the duration of orthodontic treatment?

Eur J Orthod 2020 06;42(3):263-269

Centre of Oral Bioengineering, Institute of Dentistry, Queen Mary University of London, UK.

Introduction And Objectives: Very little is known about the role of socioeconomic and psychosocial factors in predicting orthodontic treatment duration. Thus, this study aimed to test whether socioeconomic position (SEP) and psychosocial factors, namely, family environment and resiliency can predict orthodontic treatment duration.

Methods: Data were analysed from a hospital-based, prospective, longitudinal study that recruited 145 consecutively selected 12- to 16-year-old male and female adolescents. Baseline SEP and psychosocial data were collected by a validated child self-completed questionnaire before the placement of fixed appliances. Linear regression analysis was used.

Results: The response rate was 98.6 per cent and the dropout was 8.2 per cent. Maternal emotional support was an important predictor of orthodontic treatment duration. Adolescents with high levels of maternal emotional support were more likely to have a shorter orthodontic treatment duration (by nearly four months) than those with low levels of maternal emotional support (P = 0.02). Parental SEP, paternal emotional support, maternal and paternal control, as well as resiliency were not significantly associated with orthodontic treatment duration (P > 0.05). The multivariable regression analysis (including age, gender, and malocclusion severity) confirmed the significance of maternal emotional support as a predictor of orthodontic treatment duration.

Conclusions: Maternal emotional support is an important predictor of orthodontic treatment duration. This may be explained by a higher maternal involvement in the orthodontic treatment, which may have facilitated achieving the required orthodontic treatment outcome in a shorter treatment duration.
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http://dx.doi.org/10.1093/ejo/cjz074DOI Listing
June 2020

Factors influencing adherence to vacuum-formed retainer wear: A qualitative study.

J Orthod 2019 09 31;46(3):212-219. Epub 2019 May 31.

1 Centre for Oral Bioengineering, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Objective: To explore factors influencing adherence to vacuum-formed retainer wear over a minimum period of four years.

Design: A qualitative study based on a randomised controlled trial assessing the effectiveness of orthodontic retainers.

Setting: Institute of Dentistry, Queen Mary University of London.

Participants: Fifteen participants wearing vacuum-formed retainers for at least four years.

Methods: One-to-one semi-structured interviews were undertaken on a criterion-based purposive sample of participants wearing vacuum-formed retainers. The interviews were audio-recorded, transcribed verbatim and analysed using Framework Methodology.

Results: High self-reported levels of adherence in the early stages of retention were linked to a desire to maintain orthodontic outcomes and the negative perception of potential post-treatment changes. However, adherence typically reduced over time due to a combination of factors including the negative impact of retainers on quality of life and pragmatic issues related to retainer wear. Network support was found to be important in the short and long term, with instances of self-directed wear and negative beliefs concerning the importance of retainer wear and predisposition to post-treatment changes. Lack of follow-up appointments and immaturity of participants prompted independent decisions to cease retainer wear.

Conclusions: Six key influencers of prolonged adherence with vacuum-formed retainer wear were identified. Future strategies to improve adherence should account for these while also being responsive to time elapsed since debond and patient age.
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http://dx.doi.org/10.1177/1465312519851196DOI Listing
September 2019

Effects of fixed vs removable orthodontic retainers on stability and periodontal health: 4-year follow-up of a randomized controlled trial.

Am J Orthod Dentofacial Orthop 2018 Aug;154(2):167-174.e1

Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. Electronic address:

Introduction: Our objectives were to compare the stability of treatment and periodontal health with fixed vs removable orthodontic retainers over a 4-year period.

Methods: A 4-year follow-up of participants randomly assigned to either mandibular fixed retainers from canine to canine or removable vacuum-formed retainers was undertaken. Irregularity of the mandibular anterior segment, mandibular intercanine and intermolar widths, arch length, and extraction space opening were recorded. Gingival inflammation, calculus and plaque levels, clinical attachment level, and bleeding on probing were assessed. The outcome assessor was blinded when possible.

Results: Forty-two participants were included in the analysis, 21 per group. Some relapse occurred in both treatment groups at the 4-year follow-up; however, after adjusting for confounders, the median between-groups difference was 1.64 mm higher in participants wearing vacuum-formed retainers (P = 0.02; 95% confidence interval [CI], 0.30, 2.98 mm). No statistical difference was found between the treatment groups in terms of intercanine (P = 0.52; 95% CI, -1.07, 0.55) and intermolar (P = 0.55; 95% CI, -1.72, 0.93) widths, arch length (P = 0.99; 95% CI, -1.15, 1.14), and extraction space opening (P = 0.84; 95% CI, -1.54, 1.86). There was also no statistical difference in relation to periodontal outcomes between the treatment groups, with significant gingival inflammation and plaque levels common findings.

Conclusions: This prolonged study is the first to suggest that fixed retention offers the potential benefit of improved preservation of alignment of the mandibular labial segment in the long term. However, both types of retainers were associated with gingival inflammation and elevated plaque scores.
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http://dx.doi.org/10.1016/j.ajodo.2018.01.007DOI Listing
August 2018

Development and assessment of reliable patient-based hypodontia website.

Patient Prefer Adherence 2018 19;12:1065-1070. Epub 2018 Jun 19.

Oral Bioengineering (Orthodontics), Institute of Dentistry, Bart's and The London School of Medicine & Dentistry, Queen Mary College, London, UK.

Background: The aim of the study was to develop a high-quality valid patient information website with regard to hypodontia and its management, and to test its effectiveness in delivering this information.

Methods: A patient-based hypodontia website was created and placed on the Trust's website. It was then validated using five website assessment tools: Flesch reading ease score, LIDA, DISCERN, Journal of American Medical Association and Health on the Net seal. A cross-sectional prospective design was adopted using a 15-item questionnaire to assess the effectiveness of the newly created hypodontia website in helping participants understand their management. New patients attending their first hypodontia clinic consultation appointment were invited to complete the questionnaire both before and after visiting the website.

Results: The newly created hypodontia website scored well with the website validation tools in comparison with previously assessed hypodontia websites. Forty participants (25 female) took part in the questionnaire study, with a mean age of 15.3 (SD 6.1) years. After visiting the website, 85% of participants felt the website was helpful in understanding hypodontia, with an observed improvement in all domains of the questionnaire, reaching statistical significance (<0.05-0.001) in 10 of the 15 items.

Conclusion: This study found that patients felt that a hypodontia website was effective in improving their perceived knowledge of hypodontia.
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http://dx.doi.org/10.2147/PPA.S153438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016263PMC
June 2018

Orthodontic trial outcomes: Plentiful, inconsistent, and in need of uniformity? A scoping review.

Am J Orthod Dentofacial Orthop 2018 Jun;153(6):797-807

Department of Orthodontics, Barts and the London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom.

Introduction: The selection of appropriate outcomes that matter to both patients and operators is increasingly appreciated, with core outcome sets in clinical trials gaining in popularity. The first step in core outcome set development is the generation of a list of possible important outcomes based on a scoping literature review. Moreover, outcome heterogeneity is known to detract from the findings of systematic reviews and meta-analyses. The aim of this study was to identify the range of outcome domains and specific outcome measures in contemporary orthodontic research.

Methods: Multiple electronic databases were searched from December 31, 2012, to December 31, 2016, to identify clinical trials of orthodontic interventions, with no language restrictions. Abstracts, eligible full texts, and reference lists were screened, and all reported primary and nonprimary outcomes and methods of measurement were recorded.

Results: The search identified 1267 abstracts, of which 189 full-text articles were retrieved, and 164 studies were included in the analysis. A total of 54 outcomes were identified and categorized into 14 outcome domains. The most frequently measured outcomes were patient-reported pain, periodontal health, tooth angulation/inclination changes, and treatment duration, followed by rate of tooth movement and skeletal changes. Outcomes that followed the overall course of treatment were assessed in only 14 studies.

Conclusions: Patient perspectives are increasingly being accounted for in orthodontic trials; however, there is little consistency in outcome selection among them. The identified list of outcomes will be used to inform a ranking exercise with service users and providers to establish an agreed core outcome set for future orthodontic clinical trials.
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http://dx.doi.org/10.1016/j.ajodo.2017.10.022DOI Listing
June 2018

Pain experience in adults undergoing treatment: A longitudinal evaluation.

Angle Orthod 2018 May 6;88(3):292-298. Epub 2018 Mar 6.

Objectives: To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age.

Materials And Methods: A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use.

Results: A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported.

Conclusions: Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.
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http://dx.doi.org/10.2319/082317-570.1DOI Listing
May 2018

Ready-made versus custom-made mandibular advancement appliances in obstructive sleep apnea: A systematic review and meta-analysis.

Authors:
Ama Johal Bahn Agha

J Sleep Res 2018 12 6;27(6):e12660. Epub 2018 Feb 6.

Oral Bioengineering Department, Institute of Dentistry, Queen Mary University of London, London, UK.

Mandibular advancement appliances (MAAs) are an increasingly accepted treatment choice in obstructive sleep apnea management. The ready-made MAAs has questioned the need for a customised MAAs, given the former is more accessible and considerably cheaper. We conducted a systematic review and meta-analysis to evaluate both objective and patient-centred outcomes in relation to ready-made and custom-made MAAs s. Biomedical electronic databases, clinical trials registers and Grey literature were searched to January 2017, for randomised controlled trials. Meta-analyses of clinical trials were conducted for a range of objective (apnea-hypopnea index, treatment response) and subjective scales (daytime sleepiness; quality of life; patient preference and adherence). The review included three randomised controlled trials, which revealed low risk of bias. Custom-made MAAs s achieved a significant mean difference in the apnea-hypopnea index (-3.2; 95% confidence interval -5.18, -1.22; p = .004), daytime sleepiness (-0.98; 95% confidence interval -1.97, 0.01; p = .05), observed mean difference in Functional Outcomes of Sleep Questionnaire scores (0.76; 95% confidence interval 0.14, 1.38; p = .02), self-reported adherence (6.4-7 nights per week and 5-6.3 hr per night) and expressed preference (p ≤ .001) when compared with the ready-made MAAs s. Custom-made MAAs s offer clear definable advantages, demonstrating significant clinical effectiveness, patient preference and adherence.
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http://dx.doi.org/10.1111/jsr.12660DOI Listing
December 2018

What are people tweeting about orthodontic retention? A cross-sectional content analysis.

Am J Orthod Dentofacial Orthop 2017 Oct;152(4):516-522

Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. Electronic address:

Introduction: Social media can offer valuable insights in relation to the perceptions and impact of medical treatments on patient groups. There is also a lack of information concerning patient experiences with orthodontic retainers and little appreciation of barriers to optimal compliance with orthodontic retention. The aim of this study was to describe the content of Twitter posts related to orthodontic retainers.

Methods: Publicly available tweets were prospectively collected over a period of 3 to 4 weeks using a bespoke social media monitoring tool. A total of 7037 tweets were collected, of which 827 were randomly selected for the analysis. Pilot coding was undertaken on a subset of tweets (n = 70), and a coding guide was developed. Tweets were iteratively categorized under the main themes and subthemes. The frequencies of tweets in each theme and subtheme were subsequently determined.

Results: Of 827 tweets, 660 were included in the analysis. The main themes identified included compliance, impact, maintenance, patient-clinician relationship, and positive and negative feelings. Compliance with orthodontic retainers was the most frequently coded theme (n = 248), with most reporting suboptimal compliance. The negative impact of orthodontic retainers on social and daily activities (n = 192) and the maintenance requirements (n = 115) were commonly mentioned. Patients also frequently expressed feelings about their clinician.

Conclusions: Subjective experiences in relation to orthodontic retainers were commonly shared on Twitter. Most of the publicly available tweets portrayed retainer wear in a negative light.
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http://dx.doi.org/10.1016/j.ajodo.2017.04.021DOI Listing
October 2017

Erratum to Development of a core outcome set for orthodontic trials using a mixed-methods approach: protocol for a multicentre study.

Trials 2017 09 1;18(1):407. Epub 2017 Sep 1.

Department of Orthodontics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK.

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http://dx.doi.org/10.1186/s13063-017-2147-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580226PMC
September 2017

Development of a core outcome set for orthodontic trials using a mixed-methods approach: protocol for a multicentre study.

Trials 2017 08 4;18(1):366. Epub 2017 Aug 4.

Department of Orthodontics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 1BB, UK.

Background: Orthodontic treatment is commonly undertaken in young people, with over 40% of children in the UK needing treatment and currently one third having treatment, at a cost to the National Health Service in England and Wales of £273 million each year. Most current research about orthodontic care does not consider what patients truly feel about, or want, from treatment, and a diverse range of outcomes is being used with little consistency between studies. This study aims to address these problems, using established methodology to develop a core outcome set for use in future clinical trials of orthodontic interventions in children and young people.

Methods/design: This is a mixed-methods study incorporating four distinct stages. The first stage will include a scoping review of the scientific literature to identify primary and secondary outcome measures that have been used in previous orthodontic clinical trials. The second stage will involve qualitative interviews and focus groups with orthodontic patients aged 10 to 16 years to determine what outcomes are important to them. The outcomes elicited from these two stages will inform the third stage of the study in which a long-list of outcomes will be ranked in terms of importance using electronic Delphi surveys involving clinicians and patients. The final stage of the study will involve face-to-face consensus meetings with all stakeholders to discuss and agree on the outcome measures that should be included in the final core outcome set.

Discussion: This research will help to inform patients, parents, clinicians and commissioners about outcomes that are important to young people undergoing orthodontic treatment. Adoption of the core outcome set in future clinical trials of orthodontic treatment will make it easier for results to be compared, contrasted and combined. This should translate into improved decision-making by all stakeholders involved.

Trial Registration: The project has been registered on the Core Outcome Measures in Effectiveness Trials ( COMET ) website, January 2016.
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http://dx.doi.org/10.1186/s13063-017-2098-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545003PMC
August 2017

A three-dimensional soft tissue analysis of Class III malocclusion: a case-controlled cross-sectional study.

J Orthod 2018 03 5;45(1):16-22. Epub 2017 Jul 5.

a Institute of Dentistry, Bart's and The London School of Medicine and Dentistry , Queen Mary University of London , UK.

Objective: The present study used the optical surface laser scanning technique to compare the facial features of patients aged 8-18 years presenting with Class I and Class III incisor relationship in a case-control design.

Materials And Methods: Subjects with a Class III incisor relationship, aged 8-18 years, were age and gender matched with Class I control and underwent a 3-dimensional (3-D) optical surface scan of the facial soft tissues.

Results: Landmark analysis revealed Class III subjects displayed greater mean dimensions compared to the control group most notably between the ages of 8-10 and 17-18 years in both males and females, in respect of antero-posterior (P = 0.01) and vertical (P = 0.006) facial dimensions. Surface-based analysis, revealed the greatest difference in the lower facial region, followed by the mid-face, whilst the upper face remained fairly consistent.

Conclusion: Significant detectable differences were found in the surface facial features of developing Class III subjects.
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http://dx.doi.org/10.1080/14653125.2017.1331893DOI Listing
March 2018

Orthodontic treatment modalities: a qualitative assessment of Internet information.

J Orthod 2017 06 23;44(2):82-89. Epub 2017 Apr 23.

a Oral Growth & Development (Orthodontics) , Institute of Dentistry, Bart's and The London School of Medicine & Dentistry, Queen Mary College , London , UK.

Objectives: The present study aimed to determine the quality, accuracy, reliability and usability of Internet information, regarding different orthodontic treatment modalities.

Method: Google AdWords identified five popular keywords: Cosmetic braces, fixed braces, Removable braces, Quick braces and risks. These were entered in five search engines, with the resultant websites analysed using five validated assessment tools. Intra-examiner reliability was assessed, descriptive and inferential analysis of the data undertaken.

Results: Good intra-examiner reliability and consistency was observed. A total of 119 websites were included for analysis, with the keywords cosmetic and fixed braces accounting for 55% of identified websites. Invisalign was the most offered treatment (80%). Specialist orthodontists produced the highest, whilst general dentists advertising short-term options produced the lowest quality scoring websites. LIDA provided the most accurate assessment of quality (mean 62.02, SD 7.48). Regression analysis found a significant relationship between author type and a questions and answer sections with both Discern (P < 0.001) and LIDA (P = 0.002) scores, respectively.

Conclusions: Quality of Information regarding orthodontic treatment was variable, with the highest scoring websites were produced by orthodontic specialists and Invisalign the most offered treatment. There is a clear need for valid and reliable websites to better guide patients.
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http://dx.doi.org/10.1080/14653125.2017.1313546DOI Listing
June 2017

Facial phenotype in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis.

Authors:
Bahn Agha Ama Johal

J Sleep Res 2017 04 26;26(2):122-131. Epub 2016 Dec 26.

Oral Growth and Development Department, Institute of Dentistry, Queen Mary University of London, London, UK.

This systematic review and meta-analysis explores the association between facial phenotype and obstructive sleep apnea-hypopnea syndrome in adults. A comprehensive electronic (Medline via Ovid, Scopus, and Embase) database and reference search were undertaken in relation to imaging modalities for surface craniofacial assessments in subjects with sleep apnea. The outcome measures were surface facial dimensions, morphology and profile. The quality of studies was assessed and a meta-analysis conducted. The studies were weighted using the inverse variance method, and the random effects model was used to analyse data. This systematic review identified eight case-control studies. In five studies (906 participants), adults with sleep apnea showed increased weighted mean differences in neck circumference by 1.26 mm (P = 0.0001) with extensive heterogeneity between studies (I² = 93%). Only two studies (467 participants) shared the following outcomes: mandible length, lower facial height, mandible width and anterior mandible height parameters. The pooled results demonstrated obstructive sleep apnea syndrome was associated with larger parameters than controls. In conclusion, the surface facial assessment was able to demonstrate some characteristic morphological features, facilitating a meta-analysis, in adults with obstructive sleep apnea-hypopnea syndrome. The strength of these findings, however, was limited by the heterogeneity of the studies precluding the identification of a clear phenotype.
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http://dx.doi.org/10.1111/jsr.12485DOI Listing
April 2017

Ready-Made Versus Custom-Made Mandibular Repositioning Devices in Sleep Apnea: A Randomized Clinical Trial.

J Clin Sleep Med 2017 Feb 15;13(2):175-182. Epub 2017 Feb 15.

Sleep and Respiratory Medicine, Edinburgh Royal infirmary, UK.

Study Objectives: To compare the effectiveness of a custom-made (MRDc) versus ready-made (MRDr) mandibular repositioning devices (MRD) in the management of obstructive sleep apnea (OSA).

Methods: A randomized crossover trial design was adopted in which patients with a confirmed diagnosis of OSA were randomly allocated to receive either a 3-month period of ready-made or custom-made MRD, with an intervening washout period of 2 weeks, prior to crossover. Treatment outcomes included both objective sleep monitoring and patient-centered measures (daytime sleepiness, partner snoring and quality of life).

Results: Twenty-five patients, with a mild degree of OSA (apnea-hypopnea index of 13.3 [10.9-25] events/h) and daytime sleepiness (Epworth Sleepiness Scale of 11 [6-16]), completed both arms of the trial. The MRDc achieved a complete treatment response in 64% of participants, compared with 24% with the MRDr (p < 0.001). A significant difference was observed in treatment failures, when comparing the MRDr (36%) with the MRDc (4%). Excessive daytime sleepiness (Epworth Sleepiness Scale ≥ 10) persisted in 33% (MRDc) and 66% (MRDr) of OSA subjects, following treatment. A statistically significant improvement was observed in quality of life scales following MRDc therapy only. Significant differences were observed in relation to both the number of nights per week (p = 0.004) and hours per night (p = 0.006) between the two different designs of device.

Conclusions: The study demonstrates the significant clinical effectiveness of a custom-made mandibular repositioning device, particularly in terms of patient compliance and tolerance, in the treatment of OSA.
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http://dx.doi.org/10.5664/jcsm.6440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263072PMC
February 2017

Effectiveness of bonded and vacuum-formed retainers: A prospective randomized controlled clinical trial.

Am J Orthod Dentofacial Orthop 2016 Sep;150(3):406-15

Reader, honorary consultant orthodontist, and academic lead in orthodontics, Institute of Dentistry, Queen Mary University, London, United Kingdom. Electronic address:

Introduction: The objective of this prospective trial was to compare the clinical effectiveness of bonded retainers with vacuum-formed retainers, in terms of maintaining the results of orthodontic treatment in the lower arch up to 18 months post debond.

Methods: This was a hospital-based, prospective randomized controlled clinical trial in which a total of 82 subjects were randomly allocated using a computer-generated number sequence to 1 of 2 groups, receiving either a vacuum-formed retainer (Essix Ace plastic (120 mm; DENTSPLY Raintree Essix, Sarasota, Fla) or a bonded retainer (0.0175 coaxial archwire (Ortho-Care, UK, Shipley, United Kingdom) bonded in place with Transbond LR (3M United Kingdom, Brachnell, United Kingdom) for the mandibular arch. Each number was placed in an opaque, concealed envelope and chosen randomly by the study subject; this determined the allocation group. Eligibility criteria included patients nearing debond after treatment with 0.022 × 0.028-in slot size preadjusted edgewise fixed orthodontic appliances whose pretreatment records and study models were available to confirm pretreatment labial segment crowding or spacing and who had clinically acceptable alignment at the end of treatment. The main outcome was to investigate the clinical effectiveness of the 2 types of retainers in terms of changes in incisor irregularity at 6 months of retention. The following measurements were recorded at each time point (6, 12, and 18 months) with a digital caliper: Little's irregularity index, intercanine width, intermolar width, arch length, and extraction site opening. Blinding was applicable only at debond because of the permanence of 1 intervention.

Results: The 2 groups were well matched with respect to age, sex, clinical characteristics, and treatment plans. There was a statistically significant difference between the groups for changes in Little's irregularity index at 6 months, with the vacuum-formed retainer group showing greater changes than the bonded retainer group (P = 0.008). There was no statistically significant difference between the groups for changes in Little's irregularity index at 12 and 18 months.There were also no statistically significant changes at any time for intercanine width, intermolar width, arch length, or extraction site opening.

Conclusions: Some relapse is likely after fixed appliance therapy irrespective of retainer choice, and this is minimal in most patients at 6 months after debond. Bonded retainers have a better ability to hold the mandibular incisor alignment in the first 6 months after treatment than do vacuum-formed retainers.

Registration: Not applicable.

Protocol: The protocol was not published before trial commencement.

Funding: There is no funding or conflict of interest to be declared.
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http://dx.doi.org/10.1016/j.ajodo.2016.03.020DOI Listing
September 2016

Royal London space analysis: plaster versus digital model assessment.

Eur J Orthod 2017 06;39(3):320-325

Oral Growth and Development, Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London.

Aim: With the advent of digital study models, the importance of being able to evaluate space requirements becomes valuable to treatment planning and the justification for any required extraction pattern. This study was undertaken to compare the validity and reliability of the Royal London space analysis (RLSA) undertaken on plaster as compared with digital models.

Materials And Methods: A pilot study (n = 5) was undertaken on plaster and digital models to evaluate the feasibility of digital space planning. This also helped to determine the sample size calculation and as a result, 30 sets of study models with specified inclusion criteria were selected. All five components of the RLSA, namely: crowding; depth of occlusal curve; arch expansion/contraction; incisor antero-posterior advancement and inclination (assessed from the pre-treatment lateral cephalogram) were accounted for in relation to both model types. The plaster models served as the gold standard. Intra-operator measurement error (reliability) was evaluated along with a direct comparison of the measured digital values (validity) with the plaster models.

Results: The measurement error or coefficient of repeatability was comparable for plaster and digital space analyses and ranged from 0.66 to 0.95mm. No difference was found between the space analysis performed in either the upper or lower dental arch. Hence, the null hypothesis was accepted. The digital model measurements were consistently larger, albeit by a relatively small amount, than the plaster models (0.35mm upper arch and 0.32mm lower arch).

Conclusion: No difference was detected in the RLSA when performed using either plaster or digital models. Thus, digital space analysis provides a valid and reproducible alternative method in the new era of digital records.
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http://dx.doi.org/10.1093/ejo/cjw052DOI Listing
June 2017

Predicting Agenesis of the Mandibular Second Premolar from Adjacent Teeth.

PLoS One 2015 16;10(12):e0144180. Epub 2015 Dec 16.

Queen Mary University of London, Barts and the London School of Medicine and Dentistry Institute of Dentistry, London, United Kingdom.

Early diagnosis of agenesis of the mandibular second premolar (P2) enhances management of the dental arch in the growing child. The aim of this study was to explore the relationship in the development of the mandibular first molar (M1) and first premolar (P1) at early stages of P2 (second premolar). Specifically, we ask if the likelihood of P2 agenesis can be predicted from adjacent developing teeth. We selected archived dental panoramic radiographs with P2 at crown formation stages (N = 212) and calculated the likelihood of P2 at initial mineralisation stage 'Ci' given the tooth stage of adjacent teeth. Our results show that the probability of observing mandibular P2 at initial mineralisation stage 'Ci' decreased as both the adjacent P1 and M1 matured. The modal stage at P2 'Ci' was P1 'Coc' (cusp outline complete) and M1 'Crc' (crown complete). Initial mineralisation of P2 was observed up to P1 'Crc' and M1 stage 'R½' (root half). The chance of observing P2 at least 'Coc' (coalescence of cusps) was considerably greater prior to these threshold stages compared to later stages of P1 and M1. These findings suggest that P2 is highly unlikely to develop if P1 is beyond 'Crc' and M1 is beyond 'R½'.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144180PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682943PMC
June 2016

A comparison of the efficacy of fixed versus removable functional appliances in children with Class II malocclusion: A systematic review.

Eur J Orthod 2016 Dec 30;38(6):621-630. Epub 2015 Nov 30.

Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, London, UK

Objectives: To systematically compare the efficacy of fixed and removable functional appliances in Class II malocclusion in terms of morphological and patient-centred outcomes.

Search Methods: A comprehensive search of electronic databases without language or time restrictions was undertaken, applying a pre-specified search strategy. Supplementary electronic searching of orthodontics journals and references list of included studies was performed.

Selection Criteria: Randomized (RCTs) and controlled (CCTs) clinical trials involving children under 16 years with Class II malocclusion and overjet more than 5mm were included.

Data Collection And Analysis: A range of clinician- and patient-centred outcomes were evaluated and compared. Risk of bias assessment was carried out using the Cochrane Collaboration tool.

Results: Only four clinical trials were found to meet our criteria, of which two were RCTs, comparing the Herbst and the Twin Block appliances. Two further CCTs, compared the Activator to the Forsus and the Twin Force Bite Corrector, respectively. One study was assessed to be at unclear and the remaining at high risk of bias, precluding meta-analysis. There was also significant clinical heterogeneity in terms of methodology, type of intervention and the measured outcomes. Both modalities were effective in correcting the overjet with little differences found in cephalometric changes and a shortage of data concerning patient-centred outcomes.

Conclusion: There is little evidence concerning the relative effectiveness of fixed and functional appliances or in relation to patient experiences and perceptions of these treatment modalities. Further well-designed clinical trials assessing the relative merits of both clinician- and patient-centred outcomes are needed.
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http://dx.doi.org/10.1093/ejo/cjv086DOI Listing
December 2016

Surgical adjunctive procedures for accelerating orthodontic treatment.

Cochrane Database Syst Rev 2015 Jun 30(6):CD010572. Epub 2015 Jun 30.

Barts and The London School of Medicine and Dentistry, Institute of Dentistry, Queen Mary University of London, New Road, London, UK, E1 1BB.

Background: A range of surgical and non-surgical techniques have received increasing attention in recent years in an effort to reduce the duration of a course of orthodontic treatment. Various surgical techniques have been used; however, uncertainty exists in relation to the effectiveness of these procedures and the possible adverse effects related to them.

Objectives: To assess the effects of surgically assisted orthodontics on the duration and outcome of orthodontic treatment.

Search Methods: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 8), MEDLINE via OVID (1946 to 10 September 2014), EMBASE via OVID (1980 to 10 September 2014), LILACS via BIREME (1980 to 10 September 2014), metaRegister of Controlled Trials (to 10 September 2014), ClinicalTrials.gov (to 10 September 2014), and the World Health Organization (WHO) International Clinical Trials Registry Platform (to 10 September 2014). We checked the reference lists of all trials identified for further studies. There were no restrictions regarding language or date of publication in the electronic searches.

Selection Criteria: Randomised controlled trials (RCTs) evaluating the effect of surgical adjunctive procedures for accelerating tooth movement compared with conventional treatment (no surgical adjunctive procedure).

Data Collection And Analysis: At least two review authors independently assessed the risk of bias in the trials and extracted data. We used the fixed-effect model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors.

Main Results: We included four RCTs involving a total of 57 participants ranging in age from 11 to 33 years. The interventions evaluated were corticotomies to facilitate orthodontic space closure or alignment of an ectopic maxillary canine, with the effect of repeated surgical procedures assessed in one of these studies. The studies did not report directly on the primary outcome as prespecified in our protocol: duration of orthodontic treatment, number of visits during active treatment (scheduled and unscheduled) and duration of visits. The main outcome assessed within the trials was the rate of tooth movement, with periodontal effects assessed in one trial and pain assessed in one trial. A maximum of just three trials with small sample sizes were available for each comparison and outcome. We assessed all of the studies as being at unclear risk of bias.Tooth movement was found to be slightly quicker with surgically assisted orthodontics in comparison with conventional treatment over periods of one month (MD 0.61 mm; 95% CI 0.49 to 0.72; P value < 0.001) and three months (MD 2.03 mm, 95% CI 1.52 to 2.54; P value < 0.001). Our results and conclusions should be interpreted with caution given the small number of included studies. Information on adverse events was sought; however, no data were reported in the included studies.

Authors' Conclusions: This review found that there is limited research concerning the effectiveness of surgical interventions to accelerate orthodontic treatment, with no studies directly assessing our prespecified primary outcome. The available evidence is of low quality, which indicates that further research is likely to change the estimate of the effect. Based on measured outcomes in the short-term, these procedures do appear to show promise as a means of accelerating tooth movement. It is therefore possible that these procedures may prove useful; however, further prospective research comprising assessment of the entirety of treatment with longer follow-up is required to confirm any possible benefit.
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http://dx.doi.org/10.1002/14651858.CD010572.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6464946PMC
June 2015

What factors predict the uptake of orthodontic treatment among adults?

Am J Orthod Dentofacial Orthop 2015 Jun;147(6):704-10

Visiting research assistant, Department of Oral Growth and Development, Institute of Dentistry, Queen Mary University, London, United Kingdom.

Introduction: Our aim was to evaluate the factors that predict orthodontic treatment uptake among adults attending a specialist practice.

Methods: A cross-sectional controlled design was adopted in a private practice setting. The test group included 62 adults seeking fixed orthodontic treatment. The controls were 52 parents of children undergoing orthodontics but who had not undergone treatment themselves. All subjects completed a set of validated questionnaires: the Rosenberg Self-Esteem Scale, the shortened version of the Oral Health Impact Profile, and the demographic and socioeconomic position characteristics. The Dental Health Component and the Aesthetic Component of the Index of Orthodontic Treatment Need were used to assess the severity of the malocclusions.

Results: A 100% response rate was achieved. Subjects without a partner (P <0.001), with a high oral health impact (P <0.001), or with a need for orthodontic treatment (as assessed by the clinician or the subject using the Aesthetic Component of the Index of Orthodontic Treatment Need; P = 0.003 and P = 0.031, respectively) were more likely to have orthodontic treatment than were their counterparts with a partner (odds ratio [OR] = 20.8; 95% confidence interval [CI] = 4.63-93.25), with a low oral health impact (OR = 5.3; 95% CI = 2.36-11.88), or with no treatment need (OR = 3.6 and 4.4; 95% CI = 1.57-8.99 and 1.15-16.77, respectively). Self-esteem and demographic and socioeconomic position characteristics were not significantly associated with orthodontic treatment uptake (P >0.05).

Conclusions: The significance of age, marital status, and the shortened version of the Oral Health Impact Profile in predicting the uptake of orthodontic treatment among adults was demonstrated.
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http://dx.doi.org/10.1016/j.ajodo.2015.01.025DOI Listing
June 2015

Mandibular advancement splint (MAS) therapy for obstructive sleep apnoea--an overview and quality assessment of systematic reviews.

Sleep Breath 2015 Sep 17;19(3):1101-8. Epub 2015 Mar 17.

Centres for Oral Growth & Development & Adult Oral Health, Institute of Dentistry, Queen Mary University of London, London, UK,

Background: To conduct an overview of existing systematic reviews concerning management of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) with mandibular advancement splint (MAS) and assess their methodological quality.

Method: PubMed and relevant Cochrane Library databases (CDSR, DARE, HTA) searches were performed (09.13) to identify systematic reviews investigating the response of adults with OSAHS to MAS therapy. The methodological quality of the included systematic reviews was assessed using AMSTAR, a validated tool for assessing quality.

Results: Eight systematic reviews, four incorporating meta-analyses, were identified evaluating both objective and subjective outcome measures. The effectiveness of MAS therapy was compared to no treatment (n = 1), non-active appliance (n = 6), continuous positive airway pressure (CPAP; n = 5), surgical intervention (n = 3) and a different MAS intervention (n = 4). The quality of the reviews was variable (median = 7, range = 3 to 11), with only two of higher quality (AMSTAR scores >10), one of them a Cochrane review. In this high quality and current review, the overall (pooled) effects for comparison of MAS therapy with inactive appliances, revealed significant benefits of MAS therapy in terms of both daytime sleepiness and objective apnoea-hypopnoea index (AHI) outcomes.

Conclusion: In general, the results from the higher quality reviews concerning the effectiveness of MAS therapy for OSAHS highlight the ability of the intervention to improve OSAHS. Current reporting guidelines for systematic reviews (e.g. PRISMA) and sources of high-quality existing reviews should be closely followed to enhance the validity and relevance of future reviews.
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http://dx.doi.org/10.1007/s11325-015-1148-4DOI Listing
September 2015

Relationships between dental appearance, self-esteem, socio-economic status, and oral health-related quality of life in UK schoolchildren: A 3-year cohort study.

Eur J Orthod 2015 Oct 5;37(5):481-90. Epub 2014 Dec 5.

Dental Public Health, Academic Unit of Dental Public Health, School of Clinical Dentistry, Sheffield, UK.

Objectives: To examine the relationships between dental appearance, characteristics of the individual and their environment, and oral health-related quality of life (OHQoL) in young people over time.

Methods: A total of 374 young people (122 boys, 252 girls) aged 11-12 years from seven different XX schools were recruited at baseline and 258 (78 boys, 180 girls) followed-up 3 years later, aged 14-15 years (69 per cent response rate). Participants completed a measure of OHQoL (CPQ11-14 ISF-16) and self-esteem (SE, CHQ-CF87). A clinical examination was undertaken, including clinician and self-assessed normative measures of need [Index of Orthodontic Treatment Need (IOTN)] and dental caries. The Index of Multiple Deprivation was used to indicate socio-economic status (SES).

Results: There was a general improvement between baseline and follow-up in the measures of malocclusion, as well as OHQoL. Multiple linear regression indicated that there were significant cross-sectional associations at baseline between OHQoL and SES (rho = -0.11; P = 0.006), SE (rho = -0.50; P < 0.001), and self-assessed IOTN (rho = 0.27; P < 0.001). There were significant longitudinal associations between the change in OHQoL and change in SE (rho = -0.46; P < 0.001) and change in the decayed, missing, or filled surfaces (rho = -0.24; P = 0.001). The mean improvement in the total CPQ11-14 ISF-16 score for those with a history of orthodontic treatment was 3.2 (SD = 6.9; P = 0.009) and 2.4 (SD = 8.8; P < 0.001) for those with no history of treatment. The difference was not statistically significant (P = 0.584).

Conclusions: OHQoL improved in young people over time, whether they gave a history of orthodontic treatment or not. Individual and environmental characteristics influence OHQoL and should be taken into account in future studies.
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http://dx.doi.org/10.1093/ejo/cju076DOI Listing
October 2015

The reliability of thermoform retainers: a laboratory-based comparative study.

Eur J Orthod 2015 Oct 27;37(5):503-7. Epub 2014 Nov 27.

**Adult Oral Health, Institute of Dentistry, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Aim: Despite a very significant increase in the use of thermoform retainers, within orthodontics, to date, there is no evidence regarding the quality of fit between the dental cast and retainer. The current study aims to compare the fit of different thermoform retainer materials, under laboratory standardized conditions.

Materials And Methods: A prospective, laboratory-based study design was adopted to compare the fit of four different commercially available thermoform retainer materials. A master dental cast was fabricated in dental stone, to which three and five specific reference points were located on the central incisors and upper first molars, respectively. The master cast was then duplicated to produce a total of 40 such dental casts. The performance of the following four test materials was investigated: ACE, C+ (Raintree Essix Glenroe), True Tain (True Tain Inc.), and Iconic Clear (DB Orthodontics). For each material, 10 thermoform retainers were fabricated within the dental laboratory. Subsequent scanning and analysing of the casts and thermoform retainers was performed in a dedicated area, using the co-ordinate measuring machine, in order to calculate their respective fit at the incisor and first molar regions.

Results: At all eight recorded landmark points, the mean values for the following thermoform materials: ACE, True Tain, and Iconic Clear, a similar trend was observed. At all eight points, there was a significant difference between the performance of the four different materials (P < 0.001), with the greatest difference observed in the mean values in relation to material C+.

Conclusion: Statistically significant differences were observed in the fit behaviour of all four thermoform materials being tested.
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http://dx.doi.org/10.1093/ejo/cju075DOI Listing
October 2015