Titanium molybdenum (TMA) wires were used for finishing by 43% of the orthodontists whereas 62% of them used stainless steel archwires. EXTRACTION ...
Evaluation of diagnosis and treatment procedures in French orthodontic practices in 2017 M.Balteau1, F. Lefebvre2, H. Bonomi-Dunoyer1, D. Kanter1, D. Wagner1 , Y. Bolender1 1 Department of Dento-Facial Orthopedics, Faculty of Dental Surgery, Strasbourg University, Strasbourg, France 2 Division of Public Health, Methodology and Biostatistics, University Hospitals of Strasbourg, Strasbourg, France
INTRODUCTION Orthodontic practices are constantly evolving worldwide. The aim of this study was to survey diagnosis and treatment procedures in French orthodontic practices in 2017. This study covered all diagnostic methods, the various fixed appliances and prescriptions being used, the type of bracket and slot size, the banding and bonding procedures, the archwires selection, the retention devices and regimens, accelerated orthodontics, aligner therapy and temporary anchorage devices.
METHODOLOGY Based on the last JCO study of orthodontic diagnosis and treatment procedures (1) published in late 2014, this survey was conducted on-line, using a questionnaire of 75 questions, divided in the 3 following components : demographic information, diagnosis and treatments. The questionnaire was field-tested one month earlier through a paper-based pilot study in order to check its feasability. Item #16 of questionnaire
French officially recognized orthodontic specialists were selected among the members of the French Scientific Orthodontic Society (Société Française en Orthopédie Dento-Faciale, SFODF) and the listed specialists in the 2014 French dental directory (Annuaire Dentaire). After checking for valid E-mail addresses, 3 successive E-mails were sent out to 1087 French qualified orthodontists from January to February 2017.
Aligner results
The questionnaire was conceived with a an online survey development software (SurveyMonkey™). Each respondent answered the survey anonymously, and was able to complete partially the questionnaire and to come back to it later as long as he/she used the same computer.
Du fait d’un faible effectif, et du caractère unicentrique du l’étude, la généralisation des résultats n’est pas possible. Si l’apparence revêt aujourd’hui un rôle important dans nos relations sociales, la piste de l’intérêt des chéïlo-rhinoplasties primaires mériterait d’être explorée d’avantage au travers d’études supplémentaires.
Data were processed using the R statistical software system. The sample was characterized by descriptive statistics. Medians were reported instead of means as was initially done in the JCO studies. For most items in this questionnaire, orthodontists were asked whether they used an appliance or procedure « routinely » or « occasionally ». Routine use results are by default expressed below.
RESULTS (1/2) DEMOGRAPHY • A total of 197 orthodontists completed anonymously the questionnaire corresponding to a response rate of 18,1%. • Median age of respondents : 49 years (53% of men, 47% of women). • French orthodontists treat 400 actives cases in their practices (median). • Median age of the youngest patient : 6 year-old; of the oldest patient : 67 year-old. DIAGNOSTIC • For diagnosis, digital records were taken routinely on a moderate basis: 23% used routinely intraoral digital scanners before treatment whereas 4% of the respondents used routinely pre-treatment CBCT’s. • Post-treatment lateral cephalograms were taken routinely by only 46% of the orthodontists. Post-treatment study casts were taken routinely in centric occlusion by 25% of the orthodontists, and in centric relation by 10% of the respondents. FIXED AND REMOVABLE APPLIANCES • 53% of the respondents used routinely Roth prescription brackets whereas 2% of the orthodontists used standard edgewise (0°, 0°) brackets. • 37% used routinely self-ligating brackets (be them active or passive). • 5% recycled their metallic brackets. • The following percentages were identified for the different palatal expansion appliances: Quadhelix (59%) > Hyrax (39%) > slow expansion plate (24%). • 11% of the respondents used headgears. • Class II activators (45%) > functional educator (27%) > bite plates (16%) > Forsus (11%). BANDING AND BONDING PROCEDURES • 6% of the respondents used labial indirect bonding. • 53% of the orthodontists bonded the second molars. • 8% of them banded the second molars. WIRE SELECTION • In the early stages of treatment, 91% of the orthodontists used nickel titanium archwires. • Titanium molybdenum (TMA) wires were used for finishing by 43% of the orthodontists whereas 62% of them used stainless steel archwires. EXTRACTION RATE : 56% of the respondents claimed using extractions in 0-15% of their cases. LINGUAL ORTHODONTICS : Incognito™ is the most commonly used lingual appliance by 17% of respondents, followed by Win™ by 13% of the orthodontists. RETENTION : Essix removable retainers were used by 71% of the orthodontists whereas 22% used a Hawley plate. 83% of the orthodontists bonded a Zachrisson-type mandibular 3-3 retainer. CLEAR ALIGNER TREATMENT : Respondents started 5 clear aligners cases per year (median), 62% of them used this therapy for treating Class I cases with moderate crowding.
Routine use expressed in medians
RESULTS (2/2) SURGICAL-ORTHODONTIC TREATMENT : Each orthodontist started 5 new surgical-orthodontic cases per year (median). ACCELERATED ORTHODONTICS : None reported (0%). SKELETAL ANCHORAGE : The respondents treated 2 new cases per year with skeletal anchorage. 22% of the orthodontists place their TAD’s themselves.
DISCUSSION • It has been difficult to get the E-mail addresses of all officially recognized orthodontists since this information was not made available by French regulatory bodies (Conseil National de l’Ordre). We took as an alternative source of data, the members of the French Orthodontic scientific Society and the listed specialists in the French dental directory. • The response rate to our survey was to our surprise 18.1% whereas the response rate was only 1.9% in the last JCO study. • French orthodontists have less active cases in their practices compared to their American colleagues (400 cases vs 500 cases). • Digital models are gaining increasing acceptance in French practices and will probably in the foreseeable future replace traditional plaster models. 23% of French orthodontists use this procedure pre-treatment whereas 27% of our American colleagues do. • Self-ligating brackets are routinely used by 37% of French orthodontists compared to 32% of our American counterparts. • • • •
Lingual orthodontics is more widely used in France compared to the US. French orthodontists start 5 new aligner cases per year compared to 22 cases in the USA. French respondents start 2 new cases with TAD’s per year compared to 8 cases in the USA. Accelerated treatment was not being implemented by French practitioners as reported in this study.
CONCLUSIONS 1. This nationwide study is the first time comprehensive survey conducted in France. It represents a database for future studies allowing us to define future evolutions of French orthodontics. 2. The comparison of our results with the 2014 JCO study allows us to pinpoint certain French specificities : • French orthodontists were more likely to answer the questionnaire. • French orthodontists have slightly less active cases than American specialists. • French orthodontists are a little bit more likely to use self-ligating brackets. • Lingual orthodontics is more popular in France. • Aligners and TAD’s are less popular in France compared to the USA. [1] Keim, Gottlieb, Vogels. 2014 JCO Study of Orthodontic Diagnosis and Treatment Procedures, Part 1 Results and Trends. J Clin Orthod. 2014 ; 48 (11) : 710–26. .
