You are on page 1of 2


Editors choice
David L. Turpin, Editor-in-Chief

Randomized clinical trial of orthodontic treatment efciency with self-ligating and conventional xed orthodontic appliances
Padhraig S. Fleming, Andrew T. DiBiase, and Robert T. Lee

Although this is the type of study we all want to see, it has both advantages and disadvantages. This randomized controlled trial (RCT) was designed to compare differences in the duration of orthodontic treatment and the number of visits required by patients being treated with 2 different xed appliances: SmartClip and Victory brackets (3M Unitek, Monrovia, Calif). Although a plethora of advantages of self-ligating bracket systems has been claimed by many manufacturers, perhaps the most compelling potential advantage would be a reduction in overall treatment time. These researchers determined that a sample size of 66 patients was required to demonstrate a clinically meaningful difference, and they used a computergenerated randomization program to allocate the patients into 2 groups before treatment. All subjects were treated according to a predetermined archwire sequence during leveling and alignment. Of the 66 subjects who started treatment, 54 (81.8%) completed the study. The mean duration of orthodontic treatment was 19.92 months overall: 18.32 months in the Victory group and 21.41 months in the SmartClip group. A mean of 15.7 visits was required for those treated with Victory, with 2 additional visits for those treated with SmartClip. The investigators found it interesting that treatment durations varied considerably between clinicians; however, the treatment duration seemed to be quite uniform for individual operators. It seems unlikely, therefore, that a xed appliance system would have a signicant bearing on the duration of orthodontic treatment or on the number of visits required. Moreover, duration is likely to be governed by the skill, experience, and objectives of the treating clinician, noted the authors. Although this study appears to have been carefully managed as originally designed, greater appreciation
Am J Orthod Dentofacial Orthop 2010;137:11A-12A 0889-5406/$36.00 Copyright 2010 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2010.04.008

would have been noted by reviewers if the authors had included the CONSORT statement in addition to the ow diagram as is customary for all RCTs published in the AJO-DO. This statement offers a standard way for authors to prepare reports of trial ndings, facilitating their complete and transparent reporting, and aiding their critical appraisal and interpretation. The recent publication of the CONSORT 2010 Statement now makes the previous version, CONSORT 2001, outdated. Users of the guideline are strongly recommended to refer to this up-to-date version while writing or reviewing reports of RCTs.

Analysis of failure in the treatment of impacted maxillary canines

Adrian Becker, Gavriel Chaushu, and Stella Chaushu

I can remember every patient who had a palatally impacted maxillary canine that I planned but failed to bring into occlusion. Although I was always very concerned with my few failures, I rarely had time to delve into the reasons for them. That is why this article will be of interest to every orthodontist. The purpose of the study was to examine the records of patients with an impacted canine whose original orthodontic treatment did not resolve the impaction. The authors looked at 28 patients who were referred for treatment of at least 1 impacted canine after treatment of the impaction failed once. The patients completed questionnaires, and the collected data are presented in this study. As you might expect, the study described some reasons for failure of eruption in this sample. The mean duration of the failed treatments was 26.2 6 17.2 months, and the reasons most commonly cited for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several subjects, 2 or more reasons for failure were cited. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 6 7.2 months. Repeated surgery was needed in 62.9% of the subjects who had corrective treatment, mostly to redirect the ligature wires. The corrective measures included 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced with dental and skeletal means. For practitioners, the


Editors choice

American Journal of Orthodontics and Dentofacial Orthopedics June 2010

ndings of this study lead to the conclusion that a conebeam computed tomography scan to obtain an accurate positional diagnosis of the impacted canine before treatment might be a good idea.

Oral health-related quality of life in orthognathic surgery patients

Priscila Tayah Garcia Esperao, Branca Helo de Oliveira, sa Marco Antonio de Oliveira Almeida, H. Asuman Kiyak, and Jose Augusto Mendes Miguel

This is a study about the impact of orthognathicsurgical treatment on quality of life as assessed by the oral health impact prole (OHIP) index. A Brazilian version of the OHIP-14 showed psychometric properties similar to those of the original questionnaire. Studies that focus on patients perceptions during the actual treatment phase are rare, probably because treatment with all its inconveniences is transitory, and the focus is usually on the situation after treatment. It is also useful, however, to obtain information related to how undergoing treatment affects patients quality of life. This report describes the ndings of research carried out at the Oral Surgery Clinic of the State University of

Rio de Janeiro. The participants were 20 patients who were planning to have orthognathic-surgical treatment (initial group), 70 patients who were in presurgical orthodontic treatment (presurgical group), and 27 patients who had completed orthognathic surgery and presurgical orthodontics but were still having postsurgical treatment (postsurgical group). The use of standardized instruments for measuring the impact of oral problems and their treatments on oral health-related problems and quality of life is essential because it allows us to evaluate whether clinical procedures have a real benet on peoples lives. These authors found high levels of satisfaction after orthognathic surgery, and patients scored higher on measures of body image (especially on the facial and dental image components) and self-esteem. Nevertheless, a limitation of this study was the lack of control samples to compare the studied groups with normal subjects and the postsurgery group with those who had already completed orthodontics, to put in perspective the magnitude of the oral health impacts. These data support the ndings of previous studies that orthognathic surgery has numerous favorable effects. Sex analysis pointed out that female patients report a greater impact than males of their oral status on quality of life.