The literature contains a large number of publications on in vitro bond strength testing of materials used in orthodontics. The results are often quoted by manufacturers to support their products. Little attention has been paid to the detail of the test procedures used. However, a review of the literature revealed a large variation in the methods used for bond strength testing in orthodontics making comparison of papers difficult and often impossible. The case for a possible standard technique is suggested. It is hoped that this will lead to more meaningful testing of new products, which will produce more reliable guidance for the clinical orthodontist.
Aim To evaluate any relationship between ICON, IOTN and PAR. To establish whether or not ICON could replace these indices as a measure of orthodontic treatment complexity, outcome and need. Method The study models of 55 consecutively treated cases were examined and PAR, IOTN and ICON recorded. Results The study showed significant correlations between IOTN and ICON with respect to need and PAR and ICON with respect to outcome. Conclusion It appears that ICON does reflect UK opinion and the current study provides some evidence that ICON may effectively replace PAR and IOTN as a means of determining need and outcome.The PAR Index and IOTN have now become widely used in the UK as orthodontic audit tools. They have provided valuable data to inform political and clinical debate on the quality of GDS orthodontics. The introduction of IOTN in the General Dental Services is currently being considered. In order to assess treatment inputs and outcomes using IOTN and PAR, two different measurement protocols must be learned and this duplication of effort is inefficient.The PAR index has been accused of both undue leniency on poor finishes 1 and undue harshness on treatments with limited aims. 2,3 Experience with IOTN has shown that the need for treatment does not necessarily equate to the complexity of the treatment. It is important to make an assessment of complexity for the following clinical reasons (Richmond et al 4 ):• To identify the most appropriate setting in which a patient should receive treatment.• To allow meaningful assessment of treatment outcomes.• To identify cases that are likely to take longer to treat.• To inform the patient of the likely success.
The first 100 consecutively started cases treated by a specialist registrar in orthodontics were examined and pre- and post-study models were scored using the peer assessment rating (PAR) index. The PAR index proved both simple and reproducible to use: 92 cases had post-treatment records available, 91 patients registered a drop in PAR score, and one patient registered an increase. Of these 92 patients, 38 (41%) were greatly improved, 43 (47%) were improved, and 11 (12%) were made worse or no different (ie they failed to achieve a 30% drop in PAR score). Of the factors examined, only the appliance type used was significantly related to PAR score change. Of the 11 cases apparently made worse, individual examination revealed that four of these represented beneficial occlusal changes but due to limited treatment goals they did not register as improved using the PAR index according to previously agreed criteria. The PAR index measures 'good tooth position' which, although very important, is not the only factor in orthodontic treatment. The use of the PAR index to detect 'good' and 'bad' orthodontic treatment is not without problems. Its use in mixed dentition and adjunctive orthodontic treatments may not always be appropriate.
One concern to both providers and consumers of orthodontic treatment is the length of new patient consultation waiting lists. A possible reason for the excessive length of these lists could be unnecessary referral of patients. This research project aimed to identify whether inappropriate referrals for new patient orthodontic consultations were a significant problem. The study was carried out in two FHSA areas in the north of England in two stages. The first part of the study involved an evaluation of GDP referral patterns to orthodontic secondary care providers. In the second part, information on the patients referred by the dentists was collected. We concluded that there was a marked variation in referral rates between the dentists and many patients were referred unnecessarily. Importantly, there was no association between dentists' referral rate and the number of inappropriate referrals made. It appears that referral guidelines for orthodontic treatment are necessary and they should be directed at all general dental practitioners.
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