The purpose of this study was to evaluate the use of cone-beam computed tomography (CBCT) in postgraduate orthodontic residency programs. An anonymous electronic survey was sent to the program director/chair of each of the sixty-nine United States and Canadian postgraduate orthodontic programs, with thirty-six (52.2 percent) of these programs responding. Overall, 83.3 percent of programs reported having access to a CBCT scanner, while 73.3 percent reported regular usage. The vast majority (81.8 percent) used CBCT mainly for specific diagnostic purposes, while 18.2 percent (n=4) used CBCT as a diagnostic tool for every patient. Orthodontic residents received both didactic and practical (hands-on) training or solely didactic training in 59.1 percent and 31.8 percent of programs, respectively. Operation of the CBCT scanner was the responsibility of radiology technicians (54.4 percent), both radiology technicians and orthodontic residents (31.8 percent), and orthodontic residents alone (13.6 percent). Interpretation of CBCT results was the responsibility of a radiologist in 59.1 percent of programs, while residents were responsible for reading and referring abnormal findings in 31.8 percent of programs. Overall, postgraduate orthodontic program CBCT accessibility, usage, training, and interpretation were consistent in Eastern and Western regions, and most CBCT use was for specific diagnostic purposes of impacted/supernumerary teeth, craniofacial anomalies, and temporomandibular joint (TMJ) disorders.
This study collected information on four main aspects of U.S. and Canadian orthodontic programs: demographic profiles of residents, requirements for graduation, graduate curriculum, and number of faculty and staff members. Program directors at seventy U.S. and Canadian orthodontic programs were invited to participate in a twenty-question survey and to distribute a ten-question survey to their residents. Twenty program directors and eighty-four residents completed the anonymous, online surveys on Qualtrics.com in July-August 2010. The average age of surveyed residents was 29.6 years of age; 73 percent were non-Hispanic white, with 14 percent Asian/Asian-American, 5 percent Hispanic, and 1 percent African American. A small percentage of residents (13 percent) were foreign-trained. The majority of residents (64 percent) were male. There was a wide variety of clinical and didactic requirements in the programs. Almost all programs emphasized treatment with functional appliances and clear aligners. An average of three full-time and ten part-time faculty members were dedicated to each residency program. This survey reveals a potential shortage of minority orthodontic residents currently being trained in orthodontic programs, in addition to several commonalities and differences among the programs' curricula, graduation requirements, and numbers of faculty and staff members. This preliminary survey will hopefully inspire measures to address the discrepancies revealed, particularly the lack of minority students and full-time faculty members.
Objectives of hospital-based post-doctoral general dentistry programs in Canada were assessed by questionnaire. Seventy percent (14 of 20) of the program directors responded. Educational goals and objectives were assessed in professional skills and practice management, public health and preventive dentistry, oral medicine and pathology, special needs patient care, trauma and emergency care, restorative/prosthodontic care, endodontics, orthodontics/pediatric dentistry, oral surgery, periodontics, pharmacology, and functioning in a hospital. High rankings of proficiency were related to primary care, restorative/prosthodontic, endodontic, and surgical care. Emergency care, sedation, and pharmacology were also ranked highly. Lower rankings of proficiency were reported in orthodontics, aspects of public health dentistry, practice management, and advanced oral and maxiliofacial surgery. When the results of the Canadian survey were compared with those of a survey of US post-doctoral general dentistry programs, substantial similarity was seen. The findings support continuing reciprocity in accreditation standards between the Canadian and American Commissions on Dental Education and Dental Accreditation.
Angle's system for classifying molar relationships has been the standard in orthodontics for over a century. The purpose of this study was to determine what orthodontic students are being taught about the terminology of molar relationships and the use of Angle's molar classification system.
An e-mail survey was sent to the department chair or the program director of every orthodontic program in the United States, Canada, and Puerto Rico (n = 80). The survey included photos of models placed into 1/4 cusp, 1/2 cusp, and 3/4 cusp distal occlusions, and the participants were asked to classify them by selecting from a list of terms or writing 1 of their own. They were also asked whether they thought that the Angle molar classification was adequate for communication and diagnosis.
Forty surveys were completed and returned. The results showed that a variety of terminology is being taught, and most educators do not use Angle's system as he defined it. About half of the respondents were dissatisfied with the Angle molar classification system.
A modification of Angle's system that is more descriptive is needed.
Comment In: Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):716-718068567
Comment In: Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):71718068569
Comment In: Am J Orthod Dentofacial Orthop. 2008 Mar;133(3):33618331923
The purpose of this study was to evaluate the changes in orthodontic care patterns over a sixteen-year period in a university clinical setting. The average numbers of students, clinical procedures, and orthodontic appliances were examined from the time period 1988-2003. Appliance number and type were evaluated as a function of increased predoctoral and postdoctoral class sizes, student to faculty ratios, and decreased operating budgets for faculty recruitment. For the period 1988-98, the insertion of orthodontic appliances by dental students remained constant. A permanent increase in the predoctoral class size occurred in 1996 without an increase in faculty support, contributing to a decline in appliance insertions by students from 1999 to 2003. This time period also saw major increases in the postdoctoral class size and a reorganization of the clinical facility that then began to require the pairing of dental students to provide comprehensive care, thus decreasing their clinical exposure to the care of children. The overall clinical experience at the predoctoral level in orthodontic procedures declined, which resulted in a change in clinical requirements and new methods to ensure clinical competency.
Electives are an excellent opportunity to observe dentistry in another country. I chose Toronto in Canada, as it has always struck me as a very modern city and I was particularly interested in observing their recent advances in surgical orthodontics, which I find enthralling. I was aware that Toronto had a large, efficient orthodontic department which was invaluable for my project. I am also interested in the treatment of immunocompromised patients and hoped to visit the new AIDS clinic there.
Comment In: Br Dent J. 1990 Feb 24;168(4):1402310633
To determine whether Canadian and United States (US) orthodontic programs provide training in treating patients with cleft lip and palate (CLP) and craniofacial anomalies (CFA) and whether residents will treat these patients in their future practices.
An email with a personalized link to an anonymous, multi-item, online questionnaire was sent to all 54 Canadian and 335 of the approximately 700 US orthodontic residents. The two questions asked were: "Do you plan to include the treatment of CLP and CFA patients in your practice?" and "Does your program contain formal training in treating patients with CLP and CFA?"
A total of 44 Canadian and 136 US residents responded. In Canada, 30% plan to treat patients with CLP and CFA after graduation, 14% said no, 48% said maybe, and 9% were unsure. In the US, 53% said yes, 7% said no, 36% said maybe, and 4% were unsure. When asked if their program offers formal training in the treatment of these patients, 45% of Canadian residents said yes, 34% said no, and 20% were unsure, whereas 82% of US residents said yes, 12% said no, and 5% were unsure.
Most programs in the US and approximately half in Canada provide training in CLP and CFA, and more than half of US and almost one-third of Canadian residents plan to be involved in the care of patients with CLP and CFA, which is considerably less than those receiving training. Orthodontic programs need to increase the number of postgraduate students who are interested in providing care to CLP and CFA patients after becoming orthodontists.
This study explored the variation between examiners in the orthodontic treatment need assessments of fifth-grade children with a borderline orthodontic treatment need. Each of three groups of children with borderline treatment need (n = 18, 19, and 19, respectively) were examined by one of three groups of orthodontists (33 in each group), whereby each of 56 children had 33 orthodontic treatment need assessments based on a clinical examination. This treatment need determination exercise was subsequently repeated with treatment need determined based on study casts and extraoral photographs. The proportion of positive treatment decisions based on the clinical examination was 49.3, 49.6, and 52.5 per cent, respectively, and 45.7, 46.3, and 50.5 per cent, based on the model assessments. There was a considerable disagreement between examiners in the treatment need assessments, whether assessments were based on a clinical examination or on a model-based case presentation. The average percentage agreement between two orthodontists for the treatment need based on clinical examination was 69, 66, and 61, respectively, corresponding to mean kappa values of 0.38, 0.32, and 0.22. When the model-based assessments were considered, the average percentage agreement between two orthodontists was 62, 58, and 69, respectively, corresponding to mean kappa values of 0.25, 0.16, and 0.37. Linear regression analysis of the orthodontists' treatment propensity as a function of their gender, place of education, years of orthodontic treatment experience, type of workplace, and place of work showed that only the orthodontic experience was influential for the model-based treatment propensity [ß = 0.34 per cent/year (95 per cent confidence interval = 0.01-0.66)].