738
According to H€agg and Pancherz,4 maximal mandib-
ular growth is associated with peak stage. For this
reason, we had to perform functional treatment while
the patient was in the peak period. Miniplates acceler-
ated this process and helped us to start fixed ortho-
dontic treatment. If we had extracted the
mandibular left first molar instead of the mandibular
left first premolar, we would not have been able to
retract the mandibular incisors as much as desired.
Moreover, the eruption path of the mandibular left
third molar could not be predicted. Extraction of
mandibular third molars and removal of the mini-
plates were performed in the same operation, causing
no additional harm to the patient.
In daily orthodontic practice, the bilateral premolars
are commonly extracted to correct the dentoalveolar
protrusion.5 This allows proper inclination of the
mandibular incisors and relieves periodontal pressures
in the mandibular anterior area. In addition, occlusal
surfaces of premolars are smaller than those of molars.
We usually prefer to extract premolars with caries or
root treatment, and Dr Garrison is correct regarding
the extraction of the maxillary right second premolar
instead of the maxillary right first premolar. During
the treatment process, short-term oral hygiene prob-
lems resulted in caries progression and the need for
root canal treatment. This case also illustrates the nega-
tive effect of orthodontic treatment on the progress of
tooth decay.
Ezgi Cakir
Istanbul, Turkey
Am J Orthod Dentofacial Orthop 2017;152:738
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2017.09.006
REFERENCES
1. Cakir E, Malkoç S, Kirtay M. Treatment of Class II malocclusion with
mandibular skeletal anchorage. Am J Orthod Dentofacial Orthop
2017;151:1169-77.
2. Beckwith FR, Ackerman RJ, Cobb CM, Tira DE. An evaluation of
factors affecting duration of orthodontic treatment. Am J Orthod
Dentofacial Orthop 1999;115:439-47.
3. Mavreas D, Athanasiou AE. Factors affecting the duration of ortho-
dontic treatment: a systematic review. Eur J Orthod 2008;30:
386-95.
4. H€agg U, Pancherz H. Dentofacial orthopaedics in relation to
chronological age, growth period and skeletal development.
An analysis of 72 male patients with Class II division 1 maloc-
clusion treated with the Herbst appliance. Eur J Orthod 1988;
10:169-76.
5. Yao CC, Lai EH, Chang JZ, Chen I, Chen YJ. Comparison of treatment
outcomes between skeletal anchorage and extraoral anchorage in
adults with maxillary dentoalveolar protrusion. Am J Orthod Dento-
facial Orthop 2008;134:615-24.
December 2017  Vol 152  Issue 6
Readers' forum
Oral health-related quality of life in surgery-
first vs traditional orthognathic approach
he article entitled “Surgery-first orthognathic
T approach vs traditional orthognathic approach: oral
health-related quality of life assessed with 2 question-
naires” published in August 2017 was interesting in the
light of contemporary interest in this topic (Pelo S, Gaspar-
ini G, Garagiola U, Cordaro M, Di Nardo F, Staderini E,
et al. Am J Orthod Dentofacial Orthop 2017;152:250-4).
The surgery-first approach reduces the number of treat-
ment phases from 3 to 2 and hence reduces treatment
time and patient discomfort. Even so, an evidence-based
benefit assessment is still not clear with this new
approach.1
We appreciate the authors for publishing data that
will initiate more studies regarding this intangible aspect
of orthognathic/orthodontic treatment. Confusion
persisting among clinicians regarding the application
of generic or condition-specific quality of life measures
for othognathic surgery is reflected here also with the
use of 2 different measures,2 even though the use of
generic measures in orthodontics is questioned by
Marshman and Robinson3 and others.4 However, this
article also has generated some doubts in our mind
which, if clarified, will broaden its scope.
1. The study design is not clear even though test and
control groups were mentioned. Ethics committee
approval is not cited (although it was according to
the Helsinki Declaration). This is essential in any
study involving human participants, and the impor-
tance of mentioning the study design cannot be
overlooked when considering this study for future
systematic review or meta-analysis.
2. There is no mention regarding the outcome assess-
ment using morphometric skeletal, occlusal, and
soft tissue parameters; this causes us to conclude
that the study is ongoing. Quality of life status of
the surgery-first group during the postsurgical
orthodontic phase is very important, and we doubt
that the results were premature to publish.
3. Translation and cross-cultural adaptation of these
psychometric tools were not mentioned, nor was
the existence of such validated tools (OHIP-14 and
OQLQ) in the geographic area of study. Administra-
tion of questionnaires 1 month before surgery and
before bracket placement for the test group does
not make sense when the bracket was placed just
3 days before surgery for this group.
Clarification of the above doubts will be really appre-
ciated.
American Journal of Orthodontics and Dentofacial Orthopedics
Readers' forum
Elbe Peter
R.M. Baiju
Sreejith Kumar
N.O. Varghese
Kottayam, Kerala, India
Am J Orthod Dentofacial Orthop 2017;152:738–739
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2017.09.008
REFERENCES
1. Huang CS, Hsu SS, Chen Y. Systematic review of the surgery-first
approach in orthognathic surgery. Biomed J 2014;37:184-90.
2. Choi WS, Lee S, McGrath C, Samman N. Change in quality of life
after combined orthodontic-surgical treatment of dentofacial
deformities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2010;109:46-51.
3. Marshman Z, Robinson PG. Child and adolescent oral health related
quality of life. Semin Orthod 2007;13:88-95.
4. O'Brien C, Benson PE, Marshman Z. Evaluation of a quality of life
measure for children with malocclusion. J Orthod 2007;34:
185-93.
Authors' response
W e thank Dr Peter et al for their interest in our article
and want to respond point by point.
First, the writers claimed that our study design was
not clear and that ethics committee approval was not
mentioned (although it was according to the Helsinki
Declaration), and that these elements are essential in
any study involving human participants for use in future
systematic reviews or meta-analyses. We agree, but note
that not every study involving human participants must
be approved by an ethics committee, at least not in the
European Union. So-called noninterventional studies
usually do not need approval. In a noninterventional
study, the assignment of the patient to a particular ther-
apeutic strategy is not determined in advance by a trial
protocol, but rather it falls within current practice.
Because no new experimental technique was being stud-
ied, and we were comparing 2 already existing and
somehow equivalent techniques, we believed that this
study would fall in the noninterventional category.
Privacy management was conducted according to Italian
and European Union laws.1
Next, they reported that we did not mention the
outcome assessment using morphometric skeletal,
occlusal, and soft tissue parameters, and they wondered
whether the study is ongoing and publication of the
results premature. We do agree in part. We reported pre-
liminary data, and the study is still ongoing. However,
regarding metrical assessment, this was not in the scope
of this study.
American Journal of Orthodontics and Dentofacial Orthopedics
739
Finally, they questioned why we did not discuss the
translation and cross-cultural adaptation of psychomet-
ric tools or the existence of validated tools (OHIP-14 and
OQLQ) in the geographic area of study and they stated
that the administration of questionnaires one month
before surgery and before bracket placement for the
test group does not make sense when the bracket is
placed just 3 days before surgery for this group. The
questionnaire we used is validated and is used exten-
sively here in Italy, without any adaptation; most of
the adaptations for western populations found in the
literature are mere speculations. We should have stated
clearly that the 1 month preoperative assessment was
to demonstrate that in the control group results were
worse than in the test group; the control group was
already in orthodontic treatment, while in the test group
patients had no brackets (because they were placed only
3 days before the operation). Thus, the preoperative or-
thodontics were negligible. In fact, as you can see in the
tables, before bracket placement test is not present in the
surgery-first group.
Sandro Pelo
Romeo Patini
Gianmarco Saponaro
Am J Orthod Dentofacial Orthop 2017;152:739
Rome, Italy
0889-5406/$36.00
Ó 2017 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2017.09.009
REFERENCE
1. Directive 2001/20/EC of the European Parliament and of the Coun-
cil of 4 April 2001 (April 4, 2001).
Erratum
Erratum to: Favero CS, English JD, Cozad BE, Wirthlin JO,
Short MM, Kasper FK. Effect of print layer height and
printer type on the accuracy of 3-dimensional printed
orthodontic models. Am J Orthod Dentofacial Orthop.
2017;152(4):557-65.
In the above-referenced article, the following acknowl-
edgments should have been included:
This work was supported by the Milton Yellen Memo-
rial Fund of The University of Texas Health Science Cen-
ter at Houston School of Dentistry and a gift from The
Orthodontic Foundation. We thank James Bonham
and Arlen Hurt with Specialty Appliances, Bryce Servine
with 365 Printing, and Chris Kabot with EnvisionTec for
providing 3D-printed archforms, and Dr. Xu Zhang for
assistance concerning statistical analysis.
December 2017  Vol 152  Issue 6