Orthognathic surgery is a major elective procedure that can pose a significant amount of psychological distress to patients before, during and after surgery. These patients tend to have higher levels of state anxiety and a poor (facial) body image of themselves. Patients less satisfied by their outcomes tend to have had particularly high expectations of surgery beforehand. Therefore, it is important to ensure that there are effective and supportive psychology services in place. Here, we assess the utility and the role of clinical psychology in modern, holistic orthognathic surgery and the tools used to assess patients for further psychological intervention. CPD/Clinical Relevance: Clinicians should be aware of the services available to patients who are transitioning through the orthognathic surgery pathway.
Background It is thought that achieving a normal overjet may help to stabilise the alignment of the maxillary anterior dentition. Little’s Irregularity Index is limited in assessing discrete post-orthodontic changes, fails to account for reciprocal rotations and is not sensitive to dental changes in three planes. A more holistic tool for the assessment of post-treatment change is therefore required. Aim To compare the post-treatment stability of maxillary anterior dental alignment in subjects treated either to a Class I incisor relationship or an increased overjet (> 4 mm) following fixed appliance-based orthodontics using a novel measurement tool. Materials and methods The Orthodontic Alignment Index (OAI) was developed and validated using a panel of 63 raters. The new index accounts for a range of weighted features including contact point displacement, spacing, reciprocal rotations, inclination, angulation and vertical discrepancy. A retrospective cohort study was undertaken at the Institute of Dentistry, Queen Mary University of London. Recruitment took place over a 4-year period. All participants had removable retainers in the maxillary arch only. The stability of maxillary anterior teeth was assessed using Little’s Irregularity Index (LII) and the OAI. Subjects were recruited at least 12 months following completion of dual-arch fixed appliance-based treatment. Results Eighty-two participants were included with a positive correlation observed between LII and OAI at the 12-month post-treatment review with a 1-mm increase in LII associated with a 2-point increase in the OAI (P < 0.001). Limited relapse was observed in both groups: normal overjet group (OAI = 1.28; LII = 0.52); residual overjet group (OAI = 0.88; LII = 0.47). Median regression analysis failed to identify a significant association between an increased overjet at debond and the alignment of the maxillary anterior segment when assessed with OAI (P = 0.389) and LII (P = 0.577). Furthermore, age, gender, extraction protocols and retention regime were not predictive of post-treatment change. Conclusions Using a novel index (OAI) and LII, there was limited post-treatment relapse in alignment of the maxillary anterior dentition over a 12-month period. Based on this retrospective evaluation, achieving a normal overjet at the end of treatment may have little bearing on the post-treatment stability of maxillary anterior alignment at 12 months.
Osteogenesis imperfecta (OI) is a rare genetic condition that affects connective tissue and is primarily characterized by bone fragility. Owing to the progressive nature of the disease, patients require life-long management of the adverse effects and the subsequent complications they can experience. Since the introduction of bisphosphonates as a treatment modality, complications and bone deformities associated with OI have been minimized. However, intravenous bisphosphonates in young patients could present a new era of difficulties for the dental profession. We report on a case of a patient with OI who presented with severe orthodontic crowding and describe the multidisciplinary treatment planning required to minimize potential complications. CPD/Clinical Relevance: General dental practitioners should be aware of the characteristics of osteogenesis imperfecta and the potential complications associated with dental treatment.
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