To assess color properties of white spot lesions (WSLs) following resin infiltration treatment in vitro. WSLs were artificially created on 30 extracted human teeth. Two groups were formed: (a) control, and (b) resin infiltrant group... more
To assess color properties of white spot lesions (WSLs) following resin infiltration treatment in vitro. WSLs were artificially created on 30 extracted human teeth. Two groups were formed: (a) control, and (b) resin infiltrant group (n = 15, each). Instrumental color measurements were performed using a spectrophotometer and visual color evaluation was performed by three independent evaluators. Color assessment was determined at three time points: baseline (T0), after WSL formation (T1), and after resin infiltrant or control treatment (T2). CIELAB color coordinates were determined and the resultant color difference (ΔE*) was calculated between the time points. Two-way repeated measures analysis of variance (ANOVA) and One-way ANOVA analyses were used to evaluate the color changes. Pearson chi-square analysis was performed to evaluate the visual ratings between treatment and control groups. Level of significance was set p <0.05. After treatment of WSLs there was a significant color...
Research Interests:
To analyze the staining and color changes of a resin infiltrant system used for management of white spot lesions (WSLs). WSLs were artificially created on left buccal halves of 48 extracted human teeth. These sites were then treated with... more
To analyze the staining and color changes of a resin infiltrant system used for management of white spot lesions (WSLs). WSLs were artificially created on left buccal halves of 48 extracted human teeth. These sites were then treated with resin infiltration (RI) while the right halves of the teeth remained as nonresin (NRI) areas. Six groups were formed (n = 8 teeth/group) and were exposed to the following: red wine, coffee, orange juice, combined staining agents, accelerated aging, and distilled water for 1 week. The teeth were then polished with a prophy cup and polishing paste. Color properties were assessed using a spectrophotometer at baseline (T0), after each exposure (T1), and after polishing (T2). Color difference (ΔE*) was calculated between each time point for both halves of the teeth (RI and NRI). Data were analyzed with a two-way analysis of variance with presence of resin infiltration and staining agents as the main effects for each time point pair. Multiple comparisons ...
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Research Interests:
A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty... more
A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty position. Previous studies have identified several factors that contribute to the current shortage. The purpose of this study was to quantify and compare real and perceived differences in income, workload, and other qualitative characteristics between academic and private practice orthodontists. Orthodontic faculty, private practitioners, and residents were surveyed, and their answers were compared statistically. Faculty annual income was less than one half that of private practitioners matched by experience and geography. Faculty reported working an average of 25% more hours per week, and income per hour for full-time faculty was less than one third that of their private-practice colleagues. In addition, faculty perceived that they experienced more stress, encountered more bureaucracy, received less respect, and had a more difficult time achieving board certification than did private practitioners. Despite these findings, both faculty and private practitioners reported high levels of satisfaction in their respective jobs. Orthodontic residents were better attuned to the differences between academics and private practice than were faculty or private practitioners themselves. Residents perceived that it would take an average of 67% longer to pay off their educational debt in a faculty position than in private practice. It is in the best interest of orthodontics to resolve the crisis in education if it is to maintain its well-respected status among dental and medical specialties.
Research Interests:
To develop a novel delivery system by which fluoride incorporated into elastomeric rings, such as those used to ligate orthodontic wires, will be released in a controlled and constant manner. Polyethylene co-vinyl acetate (PEVA) was used... more
To develop a novel delivery system by which fluoride incorporated into elastomeric rings, such as those used to ligate orthodontic wires, will be released in a controlled and constant manner. Polyethylene co-vinyl acetate (PEVA) was used as the model elastomer. Samples (N = 3) were prepared by incorporating 0.02 to 0.4 g of sodium fluoride (NaF) into previously prepared PEVA solution. Another group of samples prepared in the same manner were additionally dip-coated in PEVA to create an overcoat. Fluoride release studies were conducted in vitro using an ion selective electrode over a period of 45 days. The amount of fluoride released was compared to the optimal therapeutic dose of 0.7 microg F(-)/ring/d. Only coated samples with the highest fluoride content (group D, 0.4 g of NaF) were able to release fluoride at therapeutic levels. When fluoride release from coated and uncoated samples with the same amount of NaF were compared, it was shown that the dip-coating technique resulted in a fluoride release in a controlled manner while eliminating the initial burst effect. This novel fluoride delivery matrix provided fluoride release at a therapeutically effective rate and profile.
Research Interests:
To discern patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment... more
To discern patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success. Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n = 158), first-year dental students (n = 183), and retention patients at orthodontic offices (n = 214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced. Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P = .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P = .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.
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Research Interests:
Research Interests:
To investigate American and Canadian orthodontists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions and perceptions on the use of headgear in the treatment of Class II... more
To investigate American and Canadian orthodontists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions and perceptions on the use of headgear in the treatment of Class II malocclusions. An online survey was sent to randomly chosen orthodontists (n = 1000). The study was completed by 948 orthodontists; 62% of the orthodontists indicated that they were using headgear in their practice. Those who were not using the appliance (38%) reported that this was mainly due to the availability of better Class II correctors in the market and lack of patient compliance. Of those who use headgear, 24% indicated that the emphasis on headgear use during their residency was an influential aspect of their decision making (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Nearly a quarter of those who do not use headgear reported that learning about other Class II correctors through continuing education courses was an important factor (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). There was no difference between the headgear users and nonusers in the year and location of practice. Compared with previous studies, this study showed a decline in the use of headgear among orthodontists. Despite a decline, more than half of the orthodontists (62%) believe headgear is a viable treatment. Availability of Class II correctors in the market and familiarity with these appliances though continuing education courses are the reasons for the remaining 38% of orthodontists to abandon use of the headgear.
Research Interests:
The purpose of this study was to investigate the crystallographic characteristics of 3 sets of plasma-sprayed hydroxyapatite (HA) coatings prepared with different degrees of crystallinity on Ti-6Al-4V substrates. X-ray diffraction... more
The purpose of this study was to investigate the crystallographic characteristics of 3 sets of plasma-sprayed hydroxyapatite (HA) coatings prepared with different degrees of crystallinity on Ti-6Al-4V substrates. X-ray diffraction analyses were performed on the coatings to determine mean percent crystallinity, calcium phosphate phases present, average crystallite size, and residual strain. The mean percent crystallinity for the 3 sets of coatings ranged from 49 to 60%. The coatings that achieved the highest crystallinity consisted almost entirely of HA. As the coating crystallinity decreased, increasing amounts of alpha- and beta-tricalcium phosphate and tetracalcium phosphate were detected. The mean HA crystallite size for the 3 sets of coatings ranged from 0.02 to 0.05 micron. Differences in mean interplanar spacing for selected crystallographic planes of HA, compared with the pure ICDD (International Center for Diffraction Data) powder standards, implied that the coatings were in an uneven state of tensile strain.
Research Interests:
Acidogenic bacteria in the dental plaque produce acids while metabolizing carbohydrates. As these acids diffuse through the plaque into the enamel, hydrogen ions are released. During this process, the acidogenic oral pH favors the... more
Acidogenic bacteria in the dental plaque produce acids while metabolizing carbohydrates. As these acids diffuse through the plaque into the enamel, hydrogen ions are released. During this process, the acidogenic oral pH favors the dissolution of the minerals on the enamel surface. The diffusion of calcium and phosphate ions out of enamel produces a chalky white spot lesion. During orthodontic treatment, the formation of white spot lesions around the brackets due to poor oral hygiene has long been a recognized problem. Approximately, 50% of orthodontic patients will develop these lesions during treatment of approximately 2 years. These incipient caries can appear in as little as 2-3 weeks after plaque accumulation in gingival areas of teeth. In this study, a novel approach will be used to develop a fluoride-delivery system to provide fluoride ion release in a controlled and continuous manner in an effort to eliminate the formation of white spot lesions. Our attention is focused on or...
Attractive individuals have been shown to enjoy social and psychological benefits. It is unclear, however, whether dental esthetics affects psychosocial perceptions. Purpose: The purpose of this study was to determine whether smile... more
Attractive individuals have been shown to enjoy social and psychological benefits. It is unclear, however, whether dental esthetics affects psychosocial perceptions. Purpose: The purpose of this study was to determine whether smile attractiveness influences the perception of adolescents when judging a peer's athletic, social, leadership, and academic abilities. Methods: Smiling photographs of 10 subjects (age 10-16) were altered to produce straight and crooked teeth versions of each. One photo of each subject (straight or crooked) was included in each of 2 parallel surveys. One control subject had the same crooked smile in both surveys. 226 peer evaluators were asked to complete one of the digital surveys rating each photo using a 100 point VAS for perceived athletic, social, leadership, and academic skills. Evaluators were not aware that smile appearance was the variable of interest. Differences in ratings between straight and crooked smiles, and differences based on other subj...
The surface and cross-section characteristics of the plasma-sprayed calcium phosphate coatings, along with the microstructures and elemental compositions near the titanium alloy interface, were investigated by scanning electron microscopy... more
The surface and cross-section characteristics of the plasma-sprayed calcium phosphate coatings, along with the microstructures and elemental compositions near the titanium alloy interface, were investigated by scanning electron microscopy for two different dental implants of proprietary compositions: Integral® (Calcitek) and BioVent® (Dentsply). Elemental concentrations (Ca, P, Ti, Al, and V) near the interfaces were obtained by X-ray energy-dispersive spectroscopy. Coating surfaces exhibited a splat deposition topography of greatly differing microstructural scale for the two implants, along with other features characteristic of the plasma-spraying process; cross-sections of the coatings revealed minimal porosity. Some interdiffusion of principally titanium and calcium was found within a narrow region near the ceramic-metal interface, perhaps contributing to chemical bonding.
In orthodontics, light cured resins are widely used for bonding brackets, and faster curing times are advantageous for the orthodontist as well as the patient. Objectives: The purpose of this study was to compare the efficacy of a new... more
In orthodontics, light cured resins are widely used for bonding brackets, and faster curing times are advantageous for the orthodontist as well as the patient. Objectives: The purpose of this study was to compare the efficacy of a new light emitting diode (LED) curing unit which advertises shorter curing times, to that of a conventional LED curing unit. Methods: The groups were (N=3, each): 1) Valo light (V-LED) in plasma emulating mode for 6 seconds and 2) Ortholux LED light (O-LED) for 10 seconds (control). Samples of orthodontic resin were cured according to the manufacturer's recommendations within hollow metal cylinders and the depth of cure was measured using ANSI/ADA specification. Subsequently, Victory Series brackets were bonded onto Macor cubes randomly distributed into the following groups (N=15, each): 1) V-LED in plasma emulating mode for 3 seconds on mesial and distal, respectively and 2) O-LED for 5 seconds on mesial and distal, respectively. At 72h, the shear bon...
Introduction: Enamel decalcification in the form of white spot lesions (WSLs) is a significant risk associated with orthodontic treatment when oral hygiene is poor. The reported prevalence of WSLs in orthodontic patients varies widely due... more
Introduction: Enamel decalcification in the form of white spot lesions (WSLs) is a significant risk associated with orthodontic treatment when oral hygiene is poor. The reported prevalence of WSLs in orthodontic patients varies widely due to the lack of a standardized method of evaluation. The objective of this study was to determine 1) the prevalence of WSLs in patients with fixed appliances using visual examination and the DIAGNOdent, and 2) whether the DIAGNOdent is a reliable tool for detecting WSLs before they become clinically visible. Methods: Patients 6- (n=37) and 12-months (n=35) into treatment were examined for the presence of WSLs. The control group (n=28) consisted of patients who were examined for WSLs immediately after bonding. Upon clinical evaluation, teeth were given a visual score based on the extent of the demineralization and were examined with the DIAGNOdent. Results: The percentages of individuals having at least one WSL were 38%, 46%, and 11% for the 6-month,...
In orthodontic patients with stainless steel crowns (SSCs) bands instead of brackets are used because of inadequate bond strength between the adhesive and metal surface. Aim: The purpose of this study was to compare shear bond strengths... more
In orthodontic patients with stainless steel crowns (SSCs) bands instead of brackets are used because of inadequate bond strength between the adhesive and metal surface. Aim: The purpose of this study was to compare shear bond strengths of brackets bonded to SSCs using various orthodontic adhesives and surface conditioning techniques. Materials and Methods: 120 SSCs were randomly divided into: Group 1: Aluminablasting + Metal Primer (Reliance, Itasca, IL) + Assure (Reliance, Itasca, IL); Group 2: Aluminablasting + Silane Coupling Agent (Pulpdent, Wattertown, MA) + Transbond (3M Unitek, Monrovia, CA); Group 3: Diamond Bur Abrasion + Metal Primer + Assure; Group 4: Diamond Bur Abrasion + Silane Coupling Agent + Transbond; Group 5 (control): Acid Etching + Metal Primer + Assure; Group 6 (control): Acid Etching + Silane Coupling Agent + Transbond. Samples prepared according to their groups were stored in distilled water at 23C. At the end of 24h, brackets were subjected to shear test us...
In orthodontics, facial esthetics is thought to be related to golden proportion. The width of the smile is considered to be ideal when there is a presence of the ‘golden proportion’ between the widths of the eight anterior teeth when... more
In orthodontics, facial esthetics is thought to be related to golden proportion. The width of the smile is considered to be ideal when there is a presence of the ‘golden proportion’ between the widths of the eight anterior teeth when viewed from the front. Therefore, orthodontic treatment with premolar extractions may affect the smile esthetics by changing the golden proportion and the width of smile. Objectives: The purpose of this study was to compare the golden proportions in orthodontic patients who were treated with and without extractions of permanent maxillary first premolars. Methods: The experimental group consisted of orthodontic patients who had bilateral maxillary first premolar extractions (N=8). Patients who completed orthodontic treatment without any extractions or history of missing teeth served as the control (N=12). Standardized photographs were taken of pre- and post-treatment casts showing the teeth from the frontal view for both groups. From the digitally viewed...
Objectives: The purpose of this study was to investigate orthodontists’ opinions and perceptions on the use of HG in the treatment of Class II malocclusions. Methods: An e-mail survey was administered to randomly chosen orthodontists... more
Objectives: The purpose of this study was to investigate orthodontists’ opinions and perceptions on the use of HG in the treatment of Class II malocclusions. Methods: An e-mail survey was administered to randomly chosen orthodontists (n=1000) to explore current trends and opinions related to HG use. Results: 948 out of 1000 orthodontists participated in the study. 60% of orthodontists indicated that they were using HG in their practice. Those who were not using HG listed the availability of better alternatives and the lack of patient compliance as reasons. 1% of these orthodontists who do not use HG indicated “fear of losing patients” as the main reason. However, 25% of these orthodontists who don’t use HG also stated that they would consider other types of appliances due to fear of losing patients to another orthodontist who does not use HG. 47% of those orthodontists who do not use HG consider patient perception of their practice as influential in not choosing this treatment modal...
Objective: To measure ion-release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) after soaking in a simulated body fluid (SBF) at two different pH levels: 4 and 7. Materials and Methods: Four... more
Objective: To measure ion-release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) after soaking in a simulated body fluid (SBF) at two different pH levels: 4 and 7. Materials and Methods: Four BAG-Bonds, two containing fluoride, and two without fluoride were developed. These BAG-Bonds were comprised of a mixture of resin monomers and bioactive glasses (BAGs). The BAGs and the BAG-Bonds were prepared in our laboratory. Various amounts of filler were added to the BAG-Bonds, with the workability of the final material determining the amount of filler added to each. This varied according to BAG composition. Transbond XT was used as a control material. Three disks (10mm x 2mm) of each material were suspended by floss into 3.5 mL of SBF at both pH 4 and 7. Analysis of the ions released into solution was done at different time points. Calcium was measured by atomic absorption analysis, phosphate by UV visible spectrometry, and fluoride with an ion-s...
Use of sol-gel synthesized bioactive glass (BAG) orthodontic cements would be beneficial in preventing decalcification from developing around orthodontic brackets by inducing formation of mineralized apatitic phases on the adjacent... more
Use of sol-gel synthesized bioactive glass (BAG) orthodontic cements would be beneficial in preventing decalcification from developing around orthodontic brackets by inducing formation of mineralized apatitic phases on the adjacent enamel. Cure depths of these experimental cements will be an important factor in their usability. Objectives: This study assessed novel BAG-containing resin-modified glass ionomer cement (BAG-RMGIC) cure depths and compared them with commercially available cement. Methods: GC Fuji Ortho LC served as a control group. Three differing BAG compositions, BAG75 (75% SiO2-21% CaO-4% P2O5), BAG81BF3 (81% SiO2-11% CaO-4% P2O5,-1% B-3%F), and BAG62BF3 (62% SiO2-30% CaO-4% P2O5-1% B-3%F), were each mixed with control powder in 25% and 50% volume fractions to produce six different experimental groups. Cure depth was tested using ISO 9917 methods, by which cement cure depth must be at least 1mm in three consecutive measurements to pass the requirement. Ten procedural ...
Objectives: Smile esthetics is critical when treating patients with a chief complaint of gummy smile. A repeatable method to evaluate soft tissue mobility would be beneficial in identifying etiology of excessive gingival display. The... more
Objectives: Smile esthetics is critical when treating patients with a chief complaint of gummy smile. A repeatable method to evaluate soft tissue mobility would be beneficial in identifying etiology of excessive gingival display. The purpose of this study was to quantify the soft tissue changes that occur upon smiling and to compare changes between males and females using 3-dimensional (3-D) photography. Methods: Subjects between 20 and 35 years of age with no history of orthodontic treatment or maxillofacial surgery were included in the study. 54 participants (n=24 males and n=30 females) had resting and smiling photographs taken with the 3dMDfaceTM camera (3dMD, Atlanta, GA). The two images for each subject were superimposed on stable facial surfaces, landmarks were marked, and measurements were recorded. A repeated-measures mixed-model ANOVA was also utilized to make comparisons between resting and smiling measurements and between males and females. Significance was established a...
Orthodontic programs spend considerable amounts of effort to attract, recruit, and interview the best and brightest applicants. Applicants and programs submit ranked preferences, and resident positions are filled by a computerized... more
Orthodontic programs spend considerable amounts of effort to attract, recruit, and interview the best and brightest applicants. Applicants and programs submit ranked preferences, and resident positions are filled by a computerized matching system (Match). The specific aims of this study were to determine the relative importance of certain factors in applicants' Match ranking of orthodontic programs and differences between orthodontic program directors' perceptions and actual factors cited by applicants influencing their ranking of orthodontic programs. Surveys were mailed to 55 orthodontic program directors and 478 applicants participating in the 2002 orthodontic Match. Forty-nine program director (89%) and 224 applicant (47%) surveys were returned. Rankings and importance of factors cited by applicants in their decision-making process and perceptions of those factors cited by program directors were compared. Applicants' top three factors were: "satisfied current re...
Research Interests: Dentistry, Orthodontics, Humans, Female, Male, and 4 moreMiddle Aged, Questionnaires, Adult, and Analysis of Variance
A new, highly filled primer is currently marketed as a fluoride delivery system effective in reducing white spot lesions in orthodontic patients. However, no studies in the literature support this claim. The purpose of this in-vivo study... more
A new, highly filled primer is currently marketed as a fluoride delivery system effective in reducing white spot lesions in orthodontic patients. However, no studies in the literature support this claim. The purpose of this in-vivo study was to investigate the retention and the efficacy of this primer in reducing the formation of white spot lesions. In each patient for whom premolar extractions were planned (n = 22), 1 premolar was randomly chosen as the experimental tooth for the application of the fluoride delivery system (Opal Seal; Ultradent Products, South Jordan, Utah), and the contralateral tooth was assigned as the control to receive the standard treatment (Transbond XT; 3M Unitek, Monrovia, Calif). After the bonding procedures, separators were placed around the premolar brackets to encourage plaque retention over 8 weeks. After the extractions, the tooth surfaces were evaluated visually and with microhardness techniques for demineralization. Primer retention was also invest...
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White Spot Lesions around the Brackets: An in-Vitro Study. CM FARAH, E. TUFEKCI, PC MOON, O. GUNEY-ALTAY, and SJ LINDAUER, Virginia Commonwealth University - VCU/MCV, Richmond, VA Enamel decalcification ...
Research Interests:
Research Interests: Dentistry, Orthodontics, Nonparametric Statistics, Treatment, Prevention, and 16 moreEsthetics, Humans, North Carolina, Female, Dental Caries, Male, Fluorides, Maryland, Virginia, Mouthwashes, Cariostatic Agents, ORTHODONTIC appliances, Chi Square Distribution, Dentists, Cross Sectional Studies, and Logistic Models
To determine whether there are differences in self-awareness and perception of an individual&amp;amp;amp;amp;amp;amp;amp;amp;#39;s own profile among various groups. Laypeople, orthodontic patients, and first (D1) and third-year dental... more
To determine whether there are differences in self-awareness and perception of an individual&amp;amp;amp;amp;amp;amp;amp;amp;#39;s own profile among various groups. Laypeople, orthodontic patients, and first (D1) and third-year dental (D3) students were surveyed (n = 75 each). The participants answered a questionnaire regarding how they felt about their own profile and teeth. They also chose from among various silhouettes the one that most resembled their own profile. Profile photos of participants were analyzed by two orthodontists who matched the individual to the depicted silhouettes. Agreement between participants and experts was evaluated using the Kappa statistic. Differences among groups in identifying their own profiles and differences among profile types in satisfaction with their appearance were compared using chi2. Overall agreement between the individuals&amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their own profiles and evaluation by orthodontists was 53% (kappa = .15). The four groups were different in their ability to recognize their own profile (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). D3s were most accurate (64%, kappa = .28), followed by D1s (57%, kappa = .10), orthodontic patients (48%, kappa = .19), and laypeople (43%, kappa = .04). Individuals who considered themselves as having a Class II or III profile were less satisfied with the appearance of their profiles (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). Those who considered themselves as having a Class III profile were also less happy with the appearance of their teeth (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). This study suggests that about half the population cannot characterize their own profile. However, subjects who perceived their own profiles as being different from average were more likely to be unhappy with their facial appearance.
Research Interests:
To discern patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment... more
To discern patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success. Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n = 158), first-year dental students (n = 183), and retention patients at orthodontic offices (n = 214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced. Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P = .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very satisfied&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P = .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.
Research Interests:
To develop a novel delivery system by which fluoride incorporated into elastomeric rings, such as those used to ligate orthodontic wires, will be released in a controlled and constant manner. Polyethylene co-vinyl acetate (PEVA) was used... more
To develop a novel delivery system by which fluoride incorporated into elastomeric rings, such as those used to ligate orthodontic wires, will be released in a controlled and constant manner. Polyethylene co-vinyl acetate (PEVA) was used as the model elastomer. Samples (N = 3) were prepared by incorporating 0.02 to 0.4 g of sodium fluoride (NaF) into previously prepared PEVA solution. Another group of samples prepared in the same manner were additionally dip-coated in PEVA to create an overcoat. Fluoride release studies were conducted in vitro using an ion selective electrode over a period of 45 days. The amount of fluoride released was compared to the optimal therapeutic dose of 0.7 microg F(-)/ring/d. Only coated samples with the highest fluoride content (group D, 0.4 g of NaF) were able to release fluoride at therapeutic levels. When fluoride release from coated and uncoated samples with the same amount of NaF were compared, it was shown that the dip-coating technique resulted in a fluoride release in a controlled manner while eliminating the initial burst effect. This novel fluoride delivery matrix provided fluoride release at a therapeutically effective rate and profile.
Research Interests:
To determine the effect of media advertising on consumer perception of orthodontic treatment quality. A survey instrument was designed to evaluate factors influencing consumer selection of an orthodontist and consumer perception of... more
To determine the effect of media advertising on consumer perception of orthodontic treatment quality. A survey instrument was designed to evaluate factors influencing consumer selection of an orthodontist and consumer perception of different forms of media advertising (radio, television, newspaper, magazine, direct mail, and billboard) by orthodontic practices. The surveys were distributed by eight orthodontic offices in and around the Richmond, Virginia area. The survey return rate was 97%. Respondents most often cited dentist and patient referrals as how they learned of the orthodontic practices they visited (50% to 57%). A caring attitude and good practitioner reputation were the top reasons influencing actual selection of an orthodontist (53% and 49%, respectively). Of respondents, 14% to 24% felt that advertising orthodontists would offer a lower quality of care than nonadvertising orthodontists. Newspaper, magazine, and direct mail advertisements were viewed more favorably than radio, television, and billboard advertisements. Chi-square analyses revealed few statistically significant differences in perception between different income and education groups. The majority of patients do not perceive advertising to reflect poorly on the quality of orthodontic care. However, patients with different income and education levels perceive media advertising differently.
Research Interests: Dentistry, Orthodontics, Advertising, Radio, Quality of Mental Health Care, and 19 moreAdolescent, Television, Newspapers, Consumer, Humans, Female, Male, Income, Consumer Perception, Aged, Middle Aged, Adult, Virginia, Communications Media, Educational Status, Postal Service, Choice Behavior, Marital Status, and attitude to health
To compare the opinions of Swedish orthodontists and American orthodontists regarding the association between third molar eruption and dental crowding. A survey was distributed to Swedish orthodontists (n = 230) asking their views on the... more
To compare the opinions of Swedish orthodontists and American orthodontists regarding the association between third molar eruption and dental crowding. A survey was distributed to Swedish orthodontists (n = 230) asking their views on the force exerted by erupting third molars, its relationship to crowding, and their recommendations for prophylactic removal. Results were compared with those from a similar study conducted in the United States. Chi square analysis was used to determine differences in responses to questions between Swedish and American orthodontists. P &lt; or = .05 was considered significant. Both Swedish and American orthodontists believed that lower third molars were more likely than upper third molars to cause force (65% and 58% for Swedish and American orthodontists, respectively) and crowding (42% and 40%, respectively). No statistically significant differences were seen between the answers of American and Swedish orthodontists regarding the role of upper and lower third molars in causing crowding. Although only 18% of Swedish orthodontists &quot;generally&quot; or &quot;sometimes&quot; recommended prophylactic removal of mandibular third molars, 36% of American orthodontists &quot;generally&quot; or &quot;sometimes&quot; recommended removal (P &lt; .0001). Most orthodontists in the United States and Sweden do believe that erupting lower third molars exert an anterior force; however, they also believe that these teeth &quot;rarely&quot; or &quot;never&quot; cause crowding of the dentition. The reason that more American orthodontists recommend prophylactic removal of mandibular third molars remains unexplained.
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To test the null hypothesis that the financial status of a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s orthodontic contract and other patient and appointment characteristics have no influence on... more
To test the null hypothesis that the financial status of a patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s orthodontic contract and other patient and appointment characteristics have no influence on appointment attendance. During a 6-week period, the last appointment of each active, non-Medicaid patient (n = 538) was recorded as either kept or missed. The financial status of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s contract, age, sex, method by which the appointment was made, and the type of appointment scheduled were recorded. Associations between each of these factors and appointment attendance were evaluated using chi(2) analysis. In the case of patients who missed their appointment, attendance at the subsequent reappointment was also evaluated. The overall appointment failure rate was 12.3%. Males (16.2%) were significantly more likely than females (9.5%) to miss appointments (P = .02). Also, appointments made by postcard (28.2%) were more likely to be missed than those made in person (11.8%) or by phone (6.5%) (P = .003). The most significant factor affecting appointment attendance was the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s financial status (P = .0001). Patients with accounts that were overdue (33.3%) or in collections (28.6%) were more likely to miss appointments than those whose accounts were current (10.5%). Of patients who missed their appointment (n = 66), 30% also missed the subsequent reappointment. The null hypothesis was rejected. Patients with delinquent financial accounts were three times as likely to miss an orthodontic appointment as those whose contracts were current. Increased rates of missed orthodontic appointments were also found for males, patients scheduled by mailing a postcard, and patients who had missed their previous appointment.
Research Interests: Contracts, Dentistry, Orthodontics, Adolescent, Humans, and 10 moreChild, Female, Male, Financial, Young Adult, Debt, Adult, Sex Factors, Age Factors, and Socioeconomic Factors
To compare changes in enamel microhardness adjacent to orthodontic brackets after using bonding agents containing various compositions of bioactive glass compared to a traditional resin adhesive following a simulated caries challenge.... more
To compare changes in enamel microhardness adjacent to orthodontic brackets after using bonding agents containing various compositions of bioactive glass compared to a traditional resin adhesive following a simulated caries challenge. Extracted human third molars (n = 10 per group) had orthodontic brackets bonded using one of four novel bioactive glass (BAG)-containing orthodontic bonding agents (BAG-Bonds) or commercially available Transbond-XT. The four new adhesives contained BAG in varying percentages incorporated into a traditional resin monomer mixture. Teeth were cycled through low-pH demineralizing and physiologic-pH remineralizing solutions once each day over 14 days. Microhardness was measured on longitudinal sections of the teeth 100, 200, and 300 µm from the bracket edge and beneath the brackets, at depths of 25 to 200 µm from the enamel surface. Normalized hardness values were compared using three-way analysis of variance. Significantly less reduction in enamel microhardness was found with the experimental adhesives at depths of 25 and 50 µm at all distances from the bracket edge. In all groups, there were no significant changes in enamel microhardness past 125-µm depth. Results varied with the different BAG-Bonds, with 81BAG-Bond showing the smallest decrease in enamel microhardness. The BAG-Bonds tested in this study showed a reduction in the amount of superficial enamel softening surrounding orthodontic brackets compared to a traditional bonding agent. The results indicate that clinically, BAG-Bonds may aid in maintaining enamel surface hardness, therefore helping prevent white spot lesions adjacent to orthodontic brackets.
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To measure ion release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) following immersion into simulated body fluid (SBF) at pH values of 4 and 7. Four BAG-Bonds, two containing fluoride, were... more
To measure ion release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) following immersion into simulated body fluid (SBF) at pH values of 4 and 7. Four BAG-Bonds, two containing fluoride, were developed. Prepared in our laboratory, the BAG-Bonds were composed of a mixture of resin monomers and bioactive glasses (BAGs). Workability of the final BAG-Bonds determined the amount of filler added to each, and this varied according to BAG composition. Commercially available Transbond-XT was used as the control. Three disks (10 mm × 2 mm) of each material were individually suspended in 3.5 mL of SBF at pH 4 and pH 7. SBF was analyzed to measure pH and ions released at 1 hour, 10 hours, and 100 hours. Calcium was measured by atomic absorption analysis, phosphate by ultraviolet visible spectrometry, and fluoride by an ion-specific electrode. The data were compared using a three-way analysis of variance, with P ≤ .05. Significant differences in calcium and phosphate ion release were found between the four BAG-Bonds and the control at multiple time points. Significant changes in pH were also found. There was no measureable release of fluoride from any of the materials. The BAG-Bonds showed the capacity for buffering acidic oral environments and significant release of calcium ions into their surrounding environment, and they hold the potential to be biomimetic bonding agents that may reduce white spot lesion formation.
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To test the null hypothesis that adding Listerine mouthrinse to the standard oral hygiene regimen has no added benefit for orthodontic patients in maintaining proper oral health. Patients within their first 6 months of orthodontic... more
To test the null hypothesis that adding Listerine mouthrinse to the standard oral hygiene regimen has no added benefit for orthodontic patients in maintaining proper oral health. Patients within their first 6 months of orthodontic treatment were assigned either to the brushing + flossing (N = 25) or brushing + flossing + Listerine (N = 25) group. Initially, all of the participants received a prophylaxis and instructions on how to brush and floss. Measurements were recorded for the bleeding, gingival, and plaque indices (BI, MGI, and PI, respectively) that provided baseline values (T1). Subsequent measurements were taken at 3 months (T2) and 6 months (T3). Mean BI, MGI, and PI at T1, T2, and T3 were compared statistically between the groups using repeated measures analysis of variance. The significance level was set at P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = .05. The response profiles for the BI, MGI, and PI over time were significantly different between the two groups. Patients who had Listerine in their daily oral hygiene regimen exhibited significantly lower scores for all three indices at T2 and T3 than the patients who only brushed and flossed. The hypothesis is rejected. This study shows that use of Listerine mouthrinse can reduce the amount of plaque and gingivitis in patients undergoing orthodontic treatment. Adding Listerine to the standard oral hygiene regimen may be beneficial for orthodontic patients in maintaining proper oral health, thus reducing the likelihood that white spot lesions and gingivitis will develop.
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To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment. An analogous survey was developed to evaluate and compare the... more
To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment. An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n = 538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; use of soft tissue lasers. The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists. Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.
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A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty... more
A crisis in orthodontic education exists today because of a shortage of qualified people seeking to pursue careers in academic orthodontics; 35% of orthodontic graduate programs in the United States report having at least 1 vacant faculty position. Previous studies have identified several factors that contribute to the current shortage. The purpose of this study was to quantify and compare real and perceived differences in income, workload, and other qualitative characteristics between academic and private practice orthodontists. Orthodontic faculty, private practitioners, and residents were surveyed, and their answers were compared statistically. Faculty annual income was less than one half that of private practitioners matched by experience and geography. Faculty reported working an average of 25% more hours per week, and income per hour for full-time faculty was less than one third that of their private-practice colleagues. In addition, faculty perceived that they experienced more stress, encountered more bureaucracy, received less respect, and had a more difficult time achieving board certification than did private practitioners. Despite these findings, both faculty and private practitioners reported high levels of satisfaction in their respective jobs. Orthodontic residents were better attuned to the differences between academics and private practice than were faculty or private practitioners themselves. Residents perceived that it would take an average of 67% longer to pay off their educational debt in a faculty position than in private practice. It is in the best interest of orthodontics to resolve the crisis in education if it is to maintain its well-respected status among dental and medical specialties.
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Research Interests: Dentistry, Orthodontics, Biomedical Engineering, Prospective studies, Humans, and 15 moreFemale, Dental Caries, Male, Fluorides, Patients, Parents, Oral Hygiene, Mouthwashes, Cariostatic Agents, ORTHODONTIC appliances, Patient Participation, Dentists, Dental Esthetics, Epidemiologic Studies, and attitude to health
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Teeth with white spot lesions (WSL) might be more prone to enamel loss during bracket debonding. This in vitro study compared enamel loss from teeth with (n = 14) and without (n = 14) WSL after polishing with low-speed finishing burs or... more
Teeth with white spot lesions (WSL) might be more prone to enamel loss during bracket debonding. This in vitro study compared enamel loss from teeth with (n = 14) and without (n = 14) WSL after polishing with low-speed finishing burs or disks (Sof-Lex, 3M ESPE, St Paul, Minn). Debonded surfaces were analyzed with a contact stylus profilometer, and digitized data were compared with baseline readings by using AnSur NT software (Regents, University of Minnesota, Minneapolis, Minn). Specimen surfaces were also examined with a scanning electron microscope. Two-way analysis of variance was performed to analyze the data. In teeth without WSL, the volume losses were 0.16 mm(3) for the bur group and 0.10 mm(3) for the disk group; the mean maximum depths were 47.7 microm for the bur group and 54.3 microm for the disk group. In teeth with WSL, the volume losses were 0.06 and 0.17 mm(3), and the mean maximum depths were 35.1 and 48.7 microm for the bur and disk groups, respectively. There were no significant differences in enamel loss between the 2 groups of teeth without WSL (P =.12). However, in teeth with WSL, the burs removed less enamel than the disks (P = 0.006). Scanning electron microscope examination showed that any damage on the enamel surface was usually located in the cervical third of the teeth. On most specimens, even though tooth surfaces appeared resin-free to the naked eye, there were remnants of it. The differences between groups were so small that they might be clinically insignificant.