D2.2023-24 Dossier PDF

English for Dentistry 2
Course Dossier
2023-2024
UIC / Dentistry 2 / 2023-24

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Tabla de contenido
Contents
SPECIALIZATION AND CAREER OPTIONS IN DENTISTRY 3
Use of Specialty Language 4
Do you speak Orthodontics? 4
DEFINING ORTHODONTIC TERMS I 5
DEFINING ORTHODONTIC TERMS II 8
Fixed orthodontic appliance components 11
ORTHODONTICS: POSITION & MOVEMENT 12
MOVEMENTS AND FORCES IN ORTHODONTICS 14
ANGLE, BEGG & TWEED: THE BEGINNINGS OF MODERN ORTHODONTICS 15
COMPETENT AND INCOMPETENT LIPS 17
RESEARCH DESIGN AND CONCEPTS IN DENTISTRY 19
REVIEW OF RESEARCH TERMS AND CONCEPTS 19
Research related to incompetent lips 20
LEVELS OF EVIDENCE 21
QUALITY OF LIFE AND ORTHODONTICS 23
THE QUALITY OF REPORTING OF CLINICAL TRIALS 35
CURRENT STATUS OF REPORTING QUALITY OF RCTS IN ORTHODONTICS 43
RANDOMIZATION AND ALLOCATION CONCEALMENT 44
THE EVIDENCE FOR CLINICAL DECISIONS 45
Issues in orthodontic research 46
REVIEW OF THE HIERARCHY OF EVIDENCE 50
CONTROVERSIES IN ORTHODONTICS 53
READING A RESEARCH ARTICLE EFFICIENTLY, SECTION BY SECTION 54
UNDERSTANDING THE STRUCTURE OF AN INTRODUCTION 55
Common introduction moves 56
UNDERSTANDING THE METHODS SECTION 58
Using of graphics to explain methods 58
Understanding the structure of the Methods section: Outcomes of a 2-phase RCT of early class II
treatment 60
THE RESULTS SECTION: THE HUB OF AN ORIGINAL RESEARCH PAPER 65
UNDERSTANDING THE STRUCTURE OF THE RESULTS SECTION PT I 69
UNDERSTANDING THE STRUCTURE OF THE RESULTS SECTION PT II 70
COMPARING DATA WITHIN AND BETWEEN STUDIES 71
THE DISCUSSION SECTION 73
The Discussion Section: dos and don'ts 75
Identifying IMRaD article sections 76
THE CONSORT CHECKLIST 77
THE CONSORT STATEMENT 77
The CONSORT Checklist applied to Orthodontic RCTs 81
ANSWERING RESEARCH QUESTIONS 1 82
ANSWERING RESEARCH QUESTIONS 2 84
ANSWERING RESEARCH QUESTIONS IN ORTHODONTICS 85
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CITATION IN DENTISTRY LITERATURE 87
EFFECTS OF RAPID MAXILLARY EXPANSION 87
Reading comprehension practice about orthodontic research 89
The effects of shielded brackets on mucosa alteration and comfort in orthodontic patients 89
Testing the use of primer in orthodontic bonding 92

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UIC/ DAL/ Anglès Objective: To recall information about specialization in Dentistry and
Ciències de la salut mld.04.09.20a share opinions about this topic.
SPECIALIZATION AND CAREER OPTIONS IN DENTISTRY
Group Discussion. Share your knowledge and opinions by responding to the following items
about specialization and career options in the field of Dentistry.
1. List all the specialties that you are aware of in the field of dentistry.
2. Describe the rationale underlying the existence of specialties in the field of dentistry.
a. Define the concept, specialty, in the field of Dentistry.
i. Compare it to general dentistry
b. Do you think that there is a need for specialties, as opposed to general dentistry? Why or
why not?
c. What are the (dis)advantages of being a specialist?
d. How is a specialty created and developed?
3. List other career options that are available to dentists.

a. Or, in what types of settings do often dental practitioners work?
4. Which of the specialties/ career options are currently the most popular in the field of
dentistry?
a. Which ones are least popular?
b. Give reasons for your answers.
c. Describe the features of populations that these specialties and settings seem to
attract.
d. Consider characteristics such as personality, age, culture, etc.

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UIC/ Idiomes/ Anglès Objective to become familiar with common orthodontic terms
Ciències de la salut mld.02.07.14
Use of Specialty Language
Do you speak Orthodontics?
I Read the terms in the Wordle below. Identify the words/ phrases that are true orthodontic
terms.
II What is orthodontics and what does it do?
1. Write a definition for orthodontics. Use the phrases below as a guide.

● The field of orthodontics is is concerned with the study and treatment of ____
● The aim of orthodontics is to ____ (short & long term goals)
● Orthodontic treatment mainly consists of ___
2. How does the concept, Quality of Life, relate to orthodontics.
3. Select the option that best completes the sentence below.

The orthodontic appliance in the image on the right was used to ____.
a. stimulate maxillary growth
b. correct crowding, spacing and alignment
c. restrict the lower jaw growth
d. encourage mandibular growth

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DEFINING ORTHODONTIC TERMS I
STUDENT A
Instructions
1. Match the term to the definition. Check your answers. (Teacher will provide
these)
2. Check the pronunciation of the key words.
3. Dictate your orthodontic terms to student B.
4. Then read the definitions (randomly) and Student B has to match the
definition to the term you dictated to them. Make sure your pronunciation is
good!
I Orthodontic terms
1. ideal occlusion
2. normal occlusion
3. competent lips
4. incompetent lips
5. Class II Division 1 malocclusion
6. Class II Division 2 malocclusion
7. overjet
8. overbite
9. crossbite
10. dento-alveolar compensation
STUDENT A Definitions
a. An acceptable variation from ideal occlusion
b. The lips are closed when at rest
c. The lower incisor edges lie posterior to the cingulum of the upper incisors, and the upper central
incisors are retroclined
d. The overlap of the incisors in the vertical plane
e. A deviation from the normal bucco-lingual occlusive relationship between the arches
f. When the position of the teeth has compensated for the underlying skeletal pattern, so that the
occlusal relationship between the arches is less severe
g. The lips are not closed when at rest
h. The lower incisor edges lie posterior to the cingulum of the upper incisors, and the upper central
incisors are upright or proclined
i. Anatomically perfect arrangement of the teeth—a rare condition
j. The distance between the upper and lower incisors in the horizontal plane
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STUDENT B
Instructions
these)
3. Dictate your orthodontic terms to student A.
4. Then read the definitions (randomly) and Student A has to match the
good!
I Student B Definitions
a. The lower molars are mesially positioned relative to the upper molars
b. A wide space between the maxillary central incisors
c. Extraction of the same tooth on the opposite side of the arch to preserve symmetry
d. The lower incisors do not contact the upper incisors or the palatal mucosa
e. Normal relationship of the molars, but line of occlusion incorrect because of malposed teeth,
rotations, or other causes
f. Another term for reverse overjet
g. The lower incisors contact the upper incisors or the palatal mucosa
h. The difference in diameter between (primary canines + first molars + second molars) and (permanent
canines + first premolars + second premolars)
i. When the lower incisors are in front of the upper incisors
j. Extraction of the same tooth in the opposing arch
II Orthodontic terms
1. balancing extraction
2. compensating extraction
3. Class I malocclusion
4. Class III malocclusion
5. open bite
6. complete overbite
7. reverse overjet
8. anterior crossbite
9. leeway space
10. midline diastema

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Now label these pictures appropriately in English.
B.
A.
C.
D.
E.
F. G.
H.
UIC / Dentistry 2 / 2023-24 J.

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I.
U.I.C./ DAL / Anglès Objective: An oral pair practice to familiarize students with
Ciències de la Salut / Dentistry Eng 4 / mks.333 English terminology related to orthodontics.
DEFINING ORTHODONTIC TERMS II
STUDENT A
Instructions
these)
3. Dictate your orthodontic terms to student B.
4. Then read the definitions (randomly) and Student B has to match the
good!
Student A Definitions
a. The most anterior point of the fronto-nasal suture
b. The line joining the porion with the lowermost point of the bony orbit
c. The line passing through the posterior nasal spine and the anterior nasal spine
d. The use of a strip of metal that fits around a tooth in order to attach a fixed appliance
e. The mechanical fixing of a orthodontic bracket to the enamel of a tooth by means of an adhesive agent
f. An element made of metal, plastic, or ceramics that is bonded to a tooth and has a slot to support
orthodontic wire
g. A filament of metal, typically stainless steel or nickel-titanium alloys, used to provide force in
orthodontic appliances
h. The distance from the base of the nose to the point of the chin
i. A three-dimensional reproduction of the dentition made by pouring into an impression mold some liquid
that then hardens
j. A soft receptacle that is designed to fit closely around the dental arches, in order to bond orthodontic
brackets indirectly, for example, or to deliver a bleaching agent to enamel over a period of time
I Orthodontic terms
1. Frankfort plane
2. maxillary plane
3. lower facial height
4. nasion
5. banding
6. bonding
7. bracket
8. wire
9. cast
10. tray
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STUDENT B
Instructions
these)
3. Dictate your orthodontic terms to student A.
4. Then read the definitions (randomly) and Student A has to match the
good!
II Student B Definitions
a. The position of deepest concavity on the anterior profile of the maxilla

b. The position of deepest concavity on the anterior profile of the mandibular symphysis
c. An intraoral device which is used to correct dental problems of crowding, spacing, alignment or
malocclusion and which is only worn for part of the day
d. An intraoral device which is used to correct dental problems of crowding, spacing, alignment or
malocclusion and which is worn permanently over several months or years
e. An appliance which holds a deficient mandible forward in a position that approximates normal
occlusion
f. A fixed appliance bonded to the lingual surface of teeth
g. Any device that is worn on the head and is designed to provide extraoral force to the maxilla in order to
correct skeletal malocclusion
h. A type of headgear designed to restrict mandibular growth in cases of skeletal Class III malocclusion
i. A type of headgear designed to stimulate maxillary growth in the anteroposterior plane
j. An element of headgear, essentially an extraoral archwire
II Orthodontic terms
1. fixed appliance
2. removable appliance
3. lingual appliance
4. functional appliance
5. headgear
6. chin cup
7. facebow
8. reverse headgear
9. Point A
10. Point B

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Now label these pictures appropriately in English.
A. B. C.
F. G.
D. E.
J.
I.
H.
L.
M.
K.

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N.
UIC/ Idiomes / Anglès Objective To become familiar with vocabulary related to
Ciències de la salut mld.571 orthodontic appliances
Fixed orthodontic appliance components
I Match each word to a corresponding number in the image below.
archwire bracket hook rubber band tube

band coil spring loop tie wire
___ in archwire
E ___ Headgear ___

lastic
___ ___
Now explain the function of each item in the image.
Explain the process of placing orthodontic appliances. Elastic

9. ___
( or ___ )
__ 8. ___
_
Tie
___
II Explain the function of each item in the image.
III Describe the process of placing braces.

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ORTHODONTICS: POSITION & MOVEMENT
I Mark the words and phrases that refer to tooth movement/ displacement.
1. If molars are moved/displaced distally and extruded, the mandibular plane angle tends to increase.
2. Straight-pull or high-pull headgear is preferred over cervical headgear, to reduce elongation of maxillary
molars and better control the inclination of the mandibular plane.
3. Skeletal open bite is characterized by excessive anterior face height. The major diagnostic criteria are a short
mandibular ramus and a rotation of the palatal plane down posteriorly. The typical growth pattern shows
vertical growth of the maxilla coupled with downward-backward rotation of the mandible and excessive
eruption of maxillary and mandibular teeth.
4. The keys to successful growth modification would be restraining vertical development and encouraging
anteroposterior mandibular growth, while controlling the eruptions of teeth in both jaws.
5. Eruption of lower teeth is controlled most readily with interocclusal bite blocks, which are easily
incorporated into a functional appliance that also postures the mandible forward. If the bite block separates
the teeth more than the freeway space, force is created against both upper and lower teeth that opposes
eruptions.
6. Vertically-directed extraoral force to the functional appliance gives better control of maxillary growth.
7. If the incisors need to be retracted to reduce lip prominence, space will be required for that.
8. Rarely, excess overjet and Class II buccal segments are due to a distally positioned lower arch, and then
moving it forward is exactly what is needed. Almost always, however, moving the lower incisors anteriorly
more than 2mm leads to instability and relapse.
9. Tipping the crowns distally to gain space is more difficult, and bodily distal movement is more difficult still.
10. The molars can be tipped back farther than that initially, but they tend to come forward again when the other
maxillary teeth are retracted.
11. A nickel-titanium spring, either pulling from a screw or pushing from the anterior arm of a bone anchor,
generates the forces needed for distalization.
12. 2 side effects of treatment are almost inevitable when reverse headgear that attaches to the teeth is used:
forward movement of maxillary teeth relative to the maxilla and downward and backward rotation of the
mandible.
13. When extraoral force is applied against the chin, it is difficult to avoid tipping the lower incisors lingually. If
the mandibular dentition was protrusive initially, of course, uprighting of the incisors is desirable. In most
cases, however, the incisor uprighting is an undesirable side effect and can cause crowding.
14. Displacement of the teeth, as in retraction of protruding incisors, often is termed camouflage.
15. If the upper incisors must displaced far distally and the lower incisors proclined to compensate for
mandibular deficiency, the esthetic result is increased prominence of the nose and an overall appearance of
mid-and lower face deficiency.

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II Fill in the table below with the terms you underlined in the previous page.
Tooth position Tooth movement/displacement Direction of movement
III Write the opposing movements/ forces for the examples in Task II.
IV Discuss the causes of these movements.
V Draw 3 images depicting movements describe in 3 of the sentences from the

previous page. Show other students to see if they can match your image with the
correct sentence.
VI Describe your own dental history (e.g. the movements of your dentition)
using the terms discussed above.

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UIC/ Idiomes/ Anglès Objective to review expressions and vocabulary for orthodontic
Ciències de la salut mld.658 movements and forces
MOVEMENTS AND FORCES IN ORTHODONTICS

Complete each sentence with the words provide below.
advancement crest forward (x2) space

backward differential loaded stationary
bite displacement mesial tip
bodily downward retracting uprighting
1. A typical response to chin cup therapy, showing the downward and ___________
rotation of the mandible accompanied by an increase in facial height.
2. _____________ the molar by ______________ root movement reduces _____________

and might eliminate the need for a prosthesis.
3. Camouflage, achieved in most cases by extracting premolars and then closing

the space by ______________the maxillary anterior teeth while bringing the
mandibular posterior teeth ________________.
4. A labially directed force against a maxillary incisor from a removable appliance will
_____________ the tooth and cause an apparent intrusion of the crown, which
reduces the open ______________________.
5. _____________ growth of the lower jaw, bringing the dentition ______________with it.
6. __________________ of anchor teeth can be minimized by arranging the force

system so that the anchor teeth must move ________________ if they move at all,
while movement teeth are allowed to tip, as in this example of retracting incisors by
tipping them posteriorly. The approach is called "________________ anchorage."
7. Surgical _________________ of the mandible.
8. Translation or bodily movement of a tooth requires that the PDL space be

______________ uniformly from alveolar ________________ to apex.

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UIC/ Idiomes/ Anglès Objective to practice common orthodontic vocabulary and review
Ciències de la salut mld.09.10.12 historical figures in the field of Orthodontics
ANGLE, BEGG & TWEED: THE BEGINNINGS OF MODERN ORTHODONTICS Fill the the
blanks with the vocabulary provided below each text.
In St. Louis in 1900, Angle founded the first post-graduate school of

1
Edward H. Angle, the father of
___________________ in the world, the Edward H. Angle School of
modern orthodontics, was born in Orthodontia, which formally established Orthodontics as a specialty. Angle
Pennsylvania in 1855. contributed to the design of many orthodontic 2______________ and
operations. He is best known for devising the first simple classification
system for 3__________________ , which was based on the 4_____________
molar as the key to occlusion. His classification system is still in use today
for orthodontic 5______________________.
appliances diagnosis first malocclusions Orthodontics
P. Raymond (Paul R.) Begg (1889-1983; Angle College, 1925) was from New
South Wales, Australia. While studying under Angle at the college, Begg
assisted him in teaching the new 6_______________ mechanism. Practicing in
Adelaide, Australia, Begg had difficulties with this appliance in attempting to
Raymond Begg originated the
close extraction 7_________________ and reducing deep 8_______________. popular multiloop technique
He therefore developed his own bracket (1933), which was essentially a and was a longtime leader in
9 Australian orthodontics.
__________________ bracket turned upside down. It was the first bracket
system that used single, round, 10 ________________ wire of .016-in diameter
or less.
Edgewise overbites ribbon-arch spaces stainless-steel
Charles H. Tweed, Jr (1895-1970; Angle College, 1928) (Fig 6), was more
Charles H. Tweed’s name has concerned with dental 11_______________ and unsatisfactory
become synonymous with 12
________________esthetics. His dissatisfaction led him to begin extracting 4
rigid, structured treatment
philosophy.
13
________________ in certain patients after initially following Angle’s
nonextraction dogma. At the 1940 annual meeting of the AAO, Tweed displayed
100 consecutive case records representing patients initially treated nonextraction
and then retreated with 14____________________ of the 4 first premolars.
Tweed’s criterion for facial 15_____________________ was the position of the
16
______________ central incisors, from which developed the Tweed triangle
(1936). His mechanics involved a rigid, time-consuming orthodoxy, and terms such as anchorage
preparation, tip-back bends, and en masse movements became part of the vernacular. His superb results
soon attracted a following.
balance facial mandibular premolars protrusions removal

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Discussion
1. The contributions mentioned above represent important milestones in the growth of

orthodontics as a health science discipline. How did each man’s contribution work to
instigate progress in the field of orthodontics?
2. How do you think they knew that their methods and techniques were successful or reliable,
i.e. on what did they base their beliefs about their practice and treatments?

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UIC/ Idiomes/ Anglès Objective to review genres of dental literature; to read about
Ciències de la saut mld.19.09.13 and discuss opinions of dental terminology
COMPETENT AND INCOMPETENT LIPS1
I Reading. The text below is an extract of an article about incompetent lips.

Read it and discuss the questions in Task II.
Lip seals
Throughout dentistry, the term 'competent lips' implies that the lips are able to contact one
another without strain when the mandible is in rest position. The term 'incompetent lips'
implies that the lips are unable to form an adequate seal under similar unstrained conditions,
i.e. excessive separation of the lips at rest. As a general guideline, which holds for all ethnic
5 groups, lip separation at rest should be no more than 3-4 mm; above this, the lips are termed
incompetent. The terms 'potentially competent' or 'pseudo-incompetent' are used to describe
lip posture when the maxillary incisors are interposed between the upper and lower lips and
the correction of the incisor relationship will permit normal lip posture.
II Discussion
1. Define the words in boldface.
2. Explain the phrase which holds for all ethnic groups (line 4.)
3. How many different lip postures are described in the text?
4. Is this information consistent with what you have learned in your other classes at the UIC?
5. Predict the content of the paragraph that follows the one shown above.
6. Draw a diagram representing of one of the following lip postures: competent lips, incompetent lips,
pseudo-incompetent or potentially competent lips. Show your diagram to your partner to see if he or
she can recognize your depiction.
1
http://www.nature.com/bdj/journal/v209/n3/full/sj.bdj.2010.682.html?foxtrotcallback=true
Page 17 of 95
III Reading. The text below is the paragraph that follows the one seen in Task I. Read it and discuss
the questions in Task IV.
In everyday English, the adjective 'incompetent' refers to an individual not having or showing
the necessary skills to do something successfully, i.e. a layperson's way of describing an
individual as inept or somehow inferior. Unfortunately, the common stereotype of the
individual with increased lower face height and incompetent lip posture is that of an
5 individual of low intelligence; the bully's taunts often follow suit. As such, it may be advisable
for clinicians to avoid using the terms lip 'incompetence' or 'incompetent' in the presence of
patients, particularly younger patients, as this may result in causing unintentional offence.
IV Discussion
1. Define the words in boldface.
2. For whom are these texts (shown in Task I and III) intended?
3. What is the most likely source for this publication?
4. From what type of publication do you think these texts are taken? What words or phrases in the
extracts have led you to your conclusion?
5. What is the overall message of this text?
6. Do you agree with the author’s position? Why or why not?
7. What terms do you think might be more appropriate to use when referring to this condition (e.g.
incompetent lips?)
V Discussing research about lip competence
1. This publication (presented in Tasks I and III) does not include any citations, yet the authors make
several claims about issues related to incompetent lips. List the author’s claims or statements
regarding incompetent lips issues.
2. Discuss the type of evidence that could support the claims that you have listed in question 1.

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UIC/ Idiomes /Anglès Objective: to review common research terms and concepts
REVIEW OF RESEARCH TERMS AND CONCEPTS
RESEARCH DESIGN AND CONCEPTS IN DENTISTRY
Match the following definitions to the vocabulary listed below.

a. Allocated d. case report g. control j. longitudinal m. risk
b. bias e. case-control h. cross-sectional k. outcomes n. sample
c. blind f. cohort i. dropped out l. randomized o. survey
1. _____ 1 patient is studied

2. _____ A population study that usually involves gathering data with a questionnaire; a questionnaire
3. _____ A small part or quantity intended to show what the whole is like; a group that is representative
of a larger group.
4. _____ A type of study in which the data for each individual in a representative population sample are
only taken once.
5. _____ Variables studied/ analyzed/ compared in a study
6. _____ An error in the research design that can distort the research findings
7. _____ Distributed randomly into groups in an experimental study to reduce bias
8. _____ Masked; group allocation is concealed from certain participants
9. _____ Possibility of suffering harm or loss
10. _____ The group that is not assigned the experimental treatment. These subjects take a placebo, the
standard treatment or no treatment at all. In nonexperimental studies, it is a study group used as a
reference for comparison.
11. _____ Timed; a study in which data are taken from each participant at least twice
12. _____ Assigned to a group
13. _____ Withdrew; some subjects abandoned the study
14. _____ In this type of study, groups are formed based on presumed cause of a disease or condition .
The design is depicted below:
1. FORM GROUPS
Group 1:
Group 1: Tooth trauma prevalence
Lower socio-economic status
Group 2: Group 2:
Higher socio-economic status 2. GATHER DATA FROM GROUPS FOR 15 YEARS
Tooth trauma prevalence
3.COMPARE DATA BETWEEN GROUPS
15. _____ In this type of study, groups are formed based on the participants’ disease status or condition;
related risk factors are studied. The design is depicted below:
1. FORM GROUPS
Group 1:
Moderate/ Severe Halitosis
2. STUDY THE PARTICIPANTS’ HISTORY: DO THEY SMOKE? DO THEY HAVE
A POOR DIET? HAVE THEY EXPERIENCED MANY PERIODONTAL INFECTIONS? ETC. Group 2:
No/ Mild Halitosis
3. COMPARE DATA BETWEEN GROUPS

Page 19 of 95
Research related to incompetent lips
Read the descriptions of the following studies about lip incompetence. Then determine the type of
study design (listed below) that was used for each one.
a. Case report c. Cohort study e. Experimental study

b. Case-control d. Cross-sectional/ correlational study f. Survey study
1. _____ A study of 1016 12-year-old Greek children was carried out to assess the relationship
between traumatic injuries of anterior teeth, incisor overjet and lip competence. Data was gathered
by means of oral examination and review of participants’ dental records. The prevalence of dental
injuries was 11%. Of the children with traumatic dental injuries 65% had inadequate lip coverage
compared to 25% in the non-trauma group. These differences were statistically significant (P <
0.001). The authors concluded that incompetent lips are significant predisposing factors to anterior
dental injury in Greek children.
2. _____ This research studied South African student perceptions on the facial
profile of individuals with bimaxillary protrusion. A self-report
questionnaire was distributed to 130 students attending university
institutions. Students were asked to select the 5 most attractive and 5 most
unattractive profiles from among the Silhouetted lateral facial profiles of 30 individuals with
bimaxillary dento-alveolar protrusion. Results indicated that this population preferred exaggerated
bimaxillary protrusive profiles with lip competence and normal overjet/overbite relationships.
3. _____ This study explored a possible link between upper respiratory tract infections (URTIs) and lip
competence in 160 individuals with cerebral palsy (aged 4-18 years). They grouped the participants
according to those with frequent and severe URTIs and those with few and mild URTIs. The dental
records of these individuals were then accessed to determine the presence of lip incompetence. The
findings revealed a highly significant difference in distribution of URTI incidence between those
with and those without competent lips.
4. _____ This article is about an 11-year-old girl with a Class II, Division 1 malocclusion. The patient
presented with lip incompetence and excessive display of gingiva on smiling. Nonextraction
treatment was undertaken with distalization of maxillary molars to correct the Class II relationship.
After 42 months the correction of the malocclusion was successfully completed with a notable
improvement in the patient’s self-esteem.
5. _____ These researchers evaluated the rates of lip incompetence in children with and
without a pacifier sucking habit. They enrolled 80 children (mean age of 2.5 years); forty-
two of the children were identified as frequent pacifier users and 38 did not use
pacifiers. The participants were followed over 3 years. Findings indicated that the
number of children with incompetent lips was greater (p<0.05) in the pacifier group than in the
control group.
6. _____ These investigators evaluated the effects of orthodontic outcomes in adults with severe
skeletal open bite (resulting in incompetent lips) using implant-anchored orthodontics. The
participants were randomly allocated to the treatment group or to the control group, who underwent
conventional orthodontic treatment. Analyses showed that there were no significant differences
between the groups in cephalometric and soft-tissue outcomes, which included the disappearance of
incompetent lips. Therefore, ideal occlusion can be achieved in adults with severe open bite and
incompetent lips with both conventional edgewise and implant-anchored orthodontic treatment.

Page 20 of 95
LEVELS OF EVIDENCE
An evidence-based practice involves searching for and accessing the available evidence, assessing its
validity and then using the “best” evidence to inform decisions regarding care. In order to do this the
reader of dental literature must understand that all evidence is not created equal and that some forms of
evidence are stronger than others. Rules of evidence have been established to grade evidence according to
its strength. Systematic reviews of multiple randomized controlled clinical trials represent the highest
levels of evidence, whereas case reports and expert opinion are the lowest. It should be noted that using
the “rules” or categories of evidence only helps classify studies based on the type of research design. The
quality of each individual study still needs to be assessed for strengths and weaknesses using the
techniques of critical appraisal. The “hierarchy of evidence” was developed to a large extent for questions
related to interventions or therapy. For questions related to diagnosis, prognosis or correlation, other
study designs such as cohort studies or case-control studies will often be more appropriate. For these
types of studies, it is useful to think of the various study designs not as a hierarchy, but as categories of
evidence, where the strongest design which is possible, practical and ethical should be used.
The hierarchy of evidence is sometimes depicted as a pyramid. The top position of the pyramid represents the
highest level of evidence. Discuss where you think the following types of studies belong in the pyramid.
Case-control studies Systematic reviews Randomized controlled trials Cohort studies
Case series and case reports Editorials & expert opinions Cross-sectional studies

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Other IMPORTANT STUDY DESIGN FEATURES TO REMEMBER
The following words are also important research-related vocabulary. You may encounter them in the
literature you access.
Match the terms with their descriptions in the 2nd column.
a. A type of placebo that simulates a technique or procedure rather than

a medication.
1. _____ Cross-over b. Both the experimental group, and the control group undergo or take
both treatments (experimental and control treatments) but at different
2. _____ Null hypothesis times.
c. A type of trial where neither the participant nor the researcher or

3. _____ Sham
individual administering the treatments are masked.
4. _____ Split-mouth d. A statement or proposal that researchers try to disprove with their
experiment, such as, “The experimental treatment will have no effect
5. _____ Systematic review on the patients’ condition.”
e. An integrative research genre—a type of research which involves

6. _____ Open/ open-label accessing, appraising and synthesizing results from many research
studies in order to answer a research question.
7. _____ Convenience
f. A ____ sample is recruited from a population to which the
researcher had easy access, such as a dental researcher’s patients, or
a dental professor’s students.
g. Some of a patient’s teeth receive the experimental treatment, and

other teeth receive the control treatment.
h. No hypothesis is formulated prior to carrying out a research study

because the intention is evident in the stated objective.
☞ Prospective versus Retrospective ☜

The terms, prospective and retrospective, are commonly used to characterize certain
aspects of longitudinal research design. However, there is much variability in the usage of
these descriptors, and this can often cause confusion when referring to research
methodology.
In the literature that we will read for this course (Dentistry English 2), the terms retrospective and
prospective will serve as a reference to when the data was collected.
For this course, we will use the following definitions for our own specific purposes:
● A retrospective study is one that uses data that was collected in another study or in past records before the
present study began; the data may not have been collected by the authors of the current study.
● A prospective study is one in which the researchers themselves have collected data from the subjects for their
current study.

Page 22 of 95
UIC/ Idiomes/ Anglès Objective To practice searching for data (skimming /scanning)
Ciéncies de la salut mld.578 and recognizing types of research.
QUALITY OF LIFE AND ORTHODONTICS

Quality of life (QoL) may be defined as a “person’s sense of well-being that stems from satisfaction
or dissatisfaction with the areas of life that are important to him/her” (Becker et al., 1993). It is not
a new concept; much of the pioneering work was undertaken by Thorndike as early as 1939,
however, it has been a rapidly expanding area across many disciplines over the last 20 years. The
term health-related quality of life (HRQoL) has been used to describe an individual’s assessment of
how the following factors affect his or her well-being: experience of pain/ discomfort, physical
function, psychology (ie, concerning the person’s appearance and self-esteem), and social function
(such as interactions with others). When these considerations focus on orofacial concerns, oral
health-related quality of life (OHRQoL) is assessed.
The physical, social, and psychological consequences of malocclusion and its influence of OoL
have long been topics of research. Moreover, over the past two decades a number of specific
OHRQoL measure have been developed to assess the impact of oral health status on QoL and to
assess the outcomes of oral health care intervention in terms of contribution to QoL. This is
important to provide an understanding of importance of, and priority for, orthodontic care within the
health care spectrum.
I Answer the questions according to the information presented in the text.

1. Quality of Life (QoL) is a term that is commonly understood to mean _____.
a. a person’s ability to be well whether he / she is satisfied or dissatisfied with important areas
of his/her life.
b. an individual’s state of happiness that is related to his or her level of personal satisfaction
with certain aspects of his or her life
c. an innovative way to assess a patient’s performance of important life skills
d. the importance that people place on their capacity to satisfy an area of life or not
2. According to the author, reference to Quality of Life was initially reported _____.
a. approximately two decades ago
b. by Becker et al.
c. in 1939
d. in several fields
3. You are assessing a patient’s current HRQoL and OHRQoL . Check (✔) the statements that are
relevant:
a. _____ I have difficulty hearing my grandchildren without a hearing aid.
b. _____ I don’t understand research about periodontitis.
c. _____ I have trouble pronouncing “s” sounds when I wear my dentures.
d. _____ I feel people don’t accept me because I am overweight.
Match the photo with one
e. _____ My teeth will hurt if I don’t have good oral hygiene. of the statements on the left.
f. _____ I can walk for 3 hours without feeling any discomfort.
g. _____ I don’t think it’s necessary to wear braces.
h. _____ I don’t go to the dentist every year.
i. _____ The other kids at school laugh at me because I have buck teeth.
j. _____ I miss a lot of classes because of migraines.

Page 23 of 95
4. An OHRQoL measure is _____. (Circle 2)
a. a variable that indicates a patient’s quality of life following oral care
b. the impact of oral health care assessment
c. a development that has made orthodontics more important in the area of health care
d. an instrument that can be used to quantify how QoL is influenced by oral health
e. an outcome of malocclusion and/ or other oral health conditions
5. The word, this (the last sentence of the text), refers to _____.
a. QoL as topics of research
b. OHRQoL measures
c. the assessment of OHRQoL
d. impact of oral health on QoL
e. contributions of oral health care to QoL
II Discussion Questions. Discuss the following questions. Write a group answer for the
questions; provide support for your answers.
1. Is there a relationship between malocclusion and QoL or OHRQoL?

a. Describe the relationship (positive, negative, none at all).
b. What factors are related to this association?
2. Does orthodontic-related treatment affect QoL or OHRQoL (during treatment)?

a. In what way (positively, negatively or not at all)
b. What factors influence the relationship?
3. How do perceptions of OHRQoL and/ or orthodontic treatment needs differ among individuals
involved in orthodontic treatment (e.g. practitioners, patients and parents of patients)?
III Searching for answers. Skim and scan through the following abstracts to find evidence
to answer the questions in Task II (above). When you find relevant abstracts, indicate:
● the population (who, from where and how many)

● the type of study design
● general conclusions
● which studies seem to be provide stronger evidence, or are better designed
IV Presenting your findings. Prepare to share your findings with your peers.
Example:
We searched for evidence to answer the question, “…? ”
We found 3 cross-sectional studies, 1 randomized controlled trial, and 2 case reports on this topic.
In general, the results seem to indicate that ….
We recommend further research to study ….
We also recommend…..( what should orthodontists/ education centers/ clinics/ policy-makers do?)

Page 24 of 95
1. Angle Orthod. 2009 May;79(3):585-91.
The impact of malocclusion/orthodontic treatment need on the quality of life.

Liu Z, McGrath C, Hägg U.
Discipline of Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China .
OBJECTIVE: To assess the current evidence of the relationship between malocclusion/orthodontic treatment need and
quality of life (QoL). MATERIALS AND METHODS: Four electronic databases were searched for articles concerning the
impact of malocclusion/orthodontic treatment need on QoL published between January 1960 and December 2007.
Electronic searches were supplemented by manual searches and reference linkages. Eligible literature was reviewed and
assessed by methodologic quality as well as by analytic results. RESULTS: From 143 reviewed articles, 23 met the
inclusion criteria and used standardized health-related QoL (HRQoL) and orthodontic assessment measures. The
majority of studies (18/23) were conducted among child/adolescent populations. Seventeen of the papers were
categorized as level 1 or 2 evidence based on the criteria of the Oxford Centre for Evidence-Based Medicine. An observed
association between HRQoL and malocclusion/orthodontic treatment need was generally detected irrespective of how
they were assessed. However, the strength of the association could be described as modest at best. Key findings and
future research considerations are described in the review. CONCLUSIONS: Findings of this review suggest that there is
an association (albeit modest) between malocclusion/orthodontic treatment need and QoL. There is a need for further
studies of their relationship, particularly studies that employ standardized assessment methods so that outcomes are
uniform and thus amenable to meta-analysis.
2. Am J Orthod Dentofacial Orthop. 2009 Jun;135(6):692.e1-8; discussion 692-3.
Twenty-year study of health gain from orthodontic treatment

Macfarlane TV, Kenealy P, Kingdon HA, Mohlin BO, Pilley JR, Richmond S, Shaw WC.
Aberdeen Pain Research Collaboration, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland.
BACKGROUND: Temporomandibular disorder (TMD) is a common condition. Studies of TMD in relation to orthodontic
treatment did not show an association, but longitudinal studies from adolescence to adulthood are lacking. The aim of
this study was to investigate the relationship between orthodontic treatment and TMD with a longitudinal study design.
METHODS: This prospective cohort study was conducted in South Wales, United Kingdom. The baseline investigation
was carried out in 1981 and involved children aged 11 to 12 years (n = 1018). Follow-up investigations were done in
1984 (n = 792), 1989 (n = 456), and 2000 (n = 337). RESULTS: Overall TMD prevalence increased from the baseline
(3.2%) to age 19 to 20 (17.6%) and decreased by age 30 to 31 (9.9%). TMD prevalence was higher in females at all
follow-up points, except the baseline. Overall, incidences of TMD were 11.9%, 11.5%, and 6.0% at the first, second, and
last follow-ups, respectively. Females were more likely to develop TMD than males (hazard ratio [HR], 2.1; 95% CI, 1.3
and 3.3), and those with high self-esteem were less likely to develop TMD (HR, 0.6; 95% CI, 0.4 and 0.8). There was no
association between orthodontic treatment and new TMD onset. The incidences of persistent TMD were 20.0%, 34.9%,
and 28.0% at the first, second, and last follow-ups, respectively. Females were more likely to have persistent TMD than
males (HR, 2.5; 95% CI, 1.0 and 6.1). There was no association between orthodontic treatment and persistent TMD. The
only significant predictors of TMD in adults aged 30 to 31 were female sex (odd ratio, 3.0; 95% CI, 1.1 and 8.2) and TMD
in adolescence (odds ratio, 4.5; 95% CI, 2.0 and 10.0). CONCLUSIONS: Orthodontic treatment neither causes nor prevents
TMD. Female sex and TMD in adolescence were the only predictors of TMD in young adulthood.
3. Oral Health Prev Dent. 2007;5(1):3-12.
Do malocclusions affect the individual's oral health-related quality of life?

Traebert ES, Peres MA.
Public Health Department, Federal University of Santa Catariana, Brazil.
PURPOSE: To assess the impact of different types of malocclusions on the quality of life in 18-year-old young male adults.
MATERIALS AND METHODS: A cross-sectional survey with a randomly selected sample of 414 young male adults who
applied for military service in the city of Florian6polis in 2003 was carried out. Data on malocclusions were obtained
through the dental aesthetic index variables. The impact of the oral health conditions on the quality of life was assessed,
using the Oral Impact on Daily Performance index. Chi-squared tests were performed and the malocclusions statistically
associated with the impact were included in models of unconditional multiple logistic regression. RESULTS: The incisal
crowding [OR 2.6 (95%CI 1.4-4.8)] (p = 0.002) and the anterior maxillary irregularity greater than 2 mm [OR 2.5 (95%CI
1.3-4.7)] (p = 0.006) had an impact on 'smiling, laughing and showing teeth without embarrassment'. An over-jet
measure greater than 5 mm [OR 3.7 (95%CI 1.2-11.2)] (p = 0.021) had an impact on 'maintaining emotional state without
being irritable'. The molar relationship did not have an impact. CONCLUSIONS: Some types of malocclusions have an
impact on quality of life, especially in terms of satisfaction with appearance.
Page 25 of 95
4. Tohoku J Exp Med. 2007 May;212(1):71-80.
Difference in quality of life according to malocclusion severity in Japanese orthodontic patients.

Tajima M, Kohzuki M, Azuma S, Saeki S, Meguro M, Sugawara J.
Department of Orthodontics, Tohoku University Graduate School of Dentistry, Sendai, Japan.
Although quality of life (QOL) assessment is important in dentistry, it has not been fully investigated in orthodontic
patients. We investigated the health-related generic QOL (entire body health) and disease specific QOL (oral health) in
adult patients with malocclusions at the first visit. One hundred and twenty-seven orthodontic patients and 66 persons
with normal occlusion were recruited for the study. The subjects were divided into the three following groups based on
their treatment: 61 patients in need of surgical correction (SURG), 66 patients in need of non-surgical correction (NONS),
and 66 control subjects with normal occlusion. Their dentofacial morphology was assessed using a specific Severity Score
(SS), which was set up originally based on their cephalometric radiographs and their plaster models of arrangement of
their teeth. The subjects also completed a generic QOL assessment questionnaire, the SF-36, and two disease-specific
QOL instruments. The patients with malocclusions, especially SURG, had lower disease-specific QOL, although the generic
QOL was equal to that of control subjects. Furthermore, in patients with the same severity of dentofacial deformities,
especially SS 4 and SS 5, the borderline cases of surgical correction and non-surgical correction, there were differences
between SURG and NONS in some items of the QOL. The severity of malocclusion evidently plays an important role in
patients' choice of treatment, but also QOL appeared to play a significant role. The QOL assessment may contribute to the
selection of the best treatment for improving QOL, especially for borderline cases with moderate degrees of orthodontic
abnormality
5. Int J Paediatr Dent. 2011 Sep;21(5):369-73. doi: 10.1111/j.1365-263X.2011.01133.x. Epub 2011 May 31.
Comparison of oral-health-related quality of life during treatment with headgear and

functional appliances.
Kadkhoda S, Nedjat S, Shirazi M.
School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
BACKGROUND: Functional and headgear are two well-known approaches in the treatment of skeletal class II
malocclusion in preadolescent children. Assessment of psycho-social impacts of wearing devices during the treatment
period is central to enhancing the quality of healthcare services. AIM: This study aimed to compare oral-health-related
quality of life in two groups consisting of children wearing headgear or functional appliances. We also compared these
groups with a non-malocclusion group. DESIGN: The study population consisted of 187, 11- to 14-year-old children in
three groups of functional (n = 67), headgear (n = 67) and non-malocclusion (n = 53). Children were asked to complete
the translated version of the short form of the Child Perceptions Questionnaire. Total scores and subscale scores of the
three clinical groups were compared through ANOVA.RESULTS: There was no significant difference in mean total scale
score and subscale scores between functional and headgear groups (P > 0.05). Significant differences were found in both
mean total and subscale scores between the malocclusion and non-malocclusion groups (P < 0.001) except oral
symptoms subscale (P > 0.05).CONCLUSIONS: The results of this study reveal that functional and headgear appliances do
not differ in terms of impact on daily life during the treatment. Moreover, both groups have poorer OHQoL compared to
malocclusion group.
6. Clin Exp Dent Res. 2019 Jan 31;5(3):199-204. doi: 10.1002/cre2.170.
Parents' perception of orthodontic treatment need and satisfaction with dental appearance.
Sepp H1, Saag M1, Vinkka-Puhakka H2, Svedström-Oristo AL2, Peltomäki T3.
This study aims to evaluate the prevalence of occlusal traits and to assess parents'/caregivers' satisfaction with child's
dental appearance and perception of orthodontic treatment need in 4-5-year-old Estonians. Clinical records and plaster
casts of 390 children (190 girls and 200 boys, mean age 4.7 years, range 4 - 5 years) were analyzed. Assessed occlusal
traits included deciduous canine and second molar sagittal relationship, overjet, overbite, crowding, midline diastema,
crossbite, and scissor bite. Parents'/caregivers' opinions regarding their child's teeth were determined with a
questionnaire. The most prevalent occlusal traits were symmetrical sagittal relationship in deciduous canines (78.2%)
and molars (75.1%), Class I sagittal relationship in deciduous canines (69.7%) and midline diastema (67.7%).
Asymmetrical sagittal canine relationship was registered in 21.8% deciduous canines and in 24.9% second deciduous
molars. Parents'/caregivers' perceived orthodontic treatment need was related to Class III sagittal relationship in
canines, increased overjet and overbite, negative overbite, and crossbite. Prevalence of most occlusal traits in Estonian
children were in line with those reported in neighboring countries. Parents/caregivers were well able to observe occlusal
traits that deviated from acceptable occlusion.
Page 26 of 95
7. Br Dent J. 2007 Jan 27;202(2):E2.
The impact of two different malocclusion traits on quality of life.

Johal A, Cheung MY, Marcene W.
Department of Orthodontics, Queen Mary's School of Dentistry, Queen Mary, University of London, London, UK
OBJECTIVES: The purpose of this prospective study was to assess the impact of two occlusal traits on the quality of life of
children and their families. METHODS: A total of 180 subjects, which included 90 consecutive patients (aged 13-15 years)
and their parents, were recruited on the basis of predetermined criteria to the following groups: increased overjet,
spaced dentition and control. Each subject and their parent underwent separate supervised completion of a Child or
Parental-Caregiver Perception questionnaire, respectively, which are components of the Child Oral Health Quality of Life
questionnaire. RESULTS: The three groups were shown not to demonstrate any differences in socio-demographic
characteristics. Statistically significant differences were observed between children in the control group and their
counterparts in the increased overjet (p = 0.002) and spaced dentition (p < 0.001) groups. However, no such difference
was detected between children in the increased overjet and spaced dentition groups (p = 0.5). Parents of these children
demonstrated similar statistical findings: p = 0.007, p = 0.003 and p = 0.9, respectively. CONCLUSIONS: Occlusal traits
such as an increased overjet and a spaced dentition have a significant negative impact on both the children's and their
families' quality of life.
8. Am J Orthod Dentofacial Orthop. 2011 Mar;139(3):369-77.
Does psychological well-being influence oral-health-related quality of life reports in children

receiving orthodontic treatment?
Agou S, Locker D, Muirhead V, Tompson B, Streiner DL.
Faculty of Dentistry, King Abdulaziz University, University of Toronto, Toronto, Ontario, Canada.
BACKGROUND: Although the associations between oral biologic variables such as malocclusion and oral-health-related
quality of life (OHRQOL) have been explored, little research has been done to address the influence of psychological
characteristics on perceived OHRQOL. The aim of this study was to assess OHRQOL outcomes in orthodontics while
controlling for individual psychological characteristics. We postulated that children with better psychological well-being
(PWB) would experience fewer negative OHRQOL impacts, regardless of their orthodontic treatment status. METHODS:
One hundred eighteen children (74 treatment and 44 on the waiting list), aged 11 to 14 years, seeking treatment at the
orthodontic clinics at the University of Toronto, participated in this study. The child perception questionnaire (CPQ11-
14) and the PWB subscale of the child health questionnaire were administered at baseline and follow-up. Occlusal
changes were assessed by using the dental aesthetic index. A waiting-list comparison group was used to account for age-
related effects.RESULTS: Although the treatment subjects had significantly better OHRQOL scores at follow-up, the
results were significantly modified by each subject's PWB status (P <0.01). Furthermore, multivariate analysis showed
that PWB contributed significantly to the variance in CPQ11-14 scores (26%). In contrast, the amount of variance
explained by the treatment status alone was relatively small (9%).CONCLUSIONS: The results of this study support the
postulated mediator role of PWB when evaluating OHRQOL outcomes in children undergoing orthodontic treatment.
Children with better PWB are, in general, more likely to report better OHRQOL regardless of their orthodontic treatment
status. On the other hand, children with low PWB, who did not receive orthodontic treatment, experienced worse
OHRQOL compared with those who received treatment. This suggests that children with low PWB can benefit from
orthodontic treatment. Nonetheless, further work, with larger samples and longer follow-ups, is needed to confirm this
finding and to improve our understanding of how other psychological factors relate to patients' OHRQOL.
9. J Orthod. 2004 Mar;31(1):20-7; discussion 15.
Orthodontic treatment and its impact on oral health-related quality of life in Brazilian adolescents.
de Oliveira CM, Sheiham A.
Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, UK.
OBJECTIVE: To assess whether Brazilian adolescents who had completed orthodontic treatment had lower levels of
impacts on their oral health-related quality of life. DESIGN: A cross-sectional study. SETTING: The study was conducted in
public and private secondary schools in Bauru-SP, Brazil. PARTICIPANTS: 1675 randomly selected adolescents aged
between 15 and 16 years. METHODS: Adolescents were clinically examined using the Index of Orthodontic Treatment
Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and
the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess adolescents' oral health-related
impacts. Multiple logistic regression was used in the data analysis. RESULTS: A response rate of 100% was obtained.
Adolescents who had completed orthodontic treatment had fewer oral health-related impacts compared to the other two
groups. They were 1.85 times (95% CI 1.30 to 2.62) less likely to have an oral health impact on their daily life activities
than adolescents currently under treatment or 1.43 (1.01 to 2.02) times than those who never had treatment.
CONCLUSIONS: Adolescents who had completed orthodontic treatment had a better oral health-related quality of life
than those currently under treatment or those who never had treatment.
Page 27 of 95
10. Am J Orthod Dentofacial Orthop. 2010 May;137(5):631-8.
Agreement between mothers and children with malocclusion in rating children's oral
health-related quality of life.
Benson P, O'Brien C, Marshman Z.
Department of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
BACKGROUND: The aim of this study was to compare the assessment of oral health-related quality of life (OH-QoL)
between children with malocclusion and their mothers, by using responses to the child perceptions questionnaire and
the parental-caregivers perceptions questionnaire. METHODS: The study was conducted in 90 children, aged 11 to 14
years, with a malocclusion grade of 4 or 5 according to the index of orthodontic treatment need dental health
component. The children and their mothers completed the questionnaires independently. RESULTS: The mean ratings
were similar for total scores (children, 20.4; mothers, 20.1), oral symptoms (children, 5.2; mothers, 4.7), and social
well-being (children, 4.3; mothers, 4.8). However, the mothers group had a lower mean score for functional limitations
(children, 5.3; mothers, 3.6) and a higher mean score for emotional well-being (children, 5.6; mothers, 7.1). The
correlations between children's and mothers' responses ranged from rs = 0.545 for total score and emotional well-
being to rs = 0.357 for functional limitations. There were good correlations between their responses to global (rs =
0.466) and life overall (rs = 0.427) questions, but poor correlations between the 2 questions, suggesting that these
concepts were considered differently. CONCLUSIONS: Maternal opinions were similar to those of their children for the
overall impact on OH-QoL of malocclusion, but mothers were more dissatisfied with the appearance of their children'
teeth and overestimated the emotional impact of malocclusion. It would be useful to develop a specific measure to
assess OH-QoL in children with malocclusion.
11. Int J Adult Orthodon Orthognath Surg. 1998;13(1):67-77.
Health-related quality of life following orthognathic surgery.

Hatch JP, Rugh JD, Clark GM, Keeling SD, Tiner BD, Bays RA.
Department of Psychiatry, University of Texas Health Science Center at San Antonio 78284-7910, USA.
A randomized controlled trial was conducted to compare the effects of rigid and wire fixation on health-related quality
of life following surgical mandibular advancement in patients with Class II malocclusions. Sixty-four patients randomly
selected to receive rigid fixation with bicortical position screws were compared with 63 patients randomly selected to
receive nonrigid fixation with inferior border wires. Quality of life was measured using the Sickness Impact Profile, a
generic measure of health-related quality of life, and the Oral Health Status Questionnaire, a specific measure of oral
health and function designed for use with orthognathic surgery patients. Patients were evaluated prior to application of
orthodontic appliances, approximately 2 weeks before surgery, and 1 week, 8 weeks, 6 months, 1 year, and 2 years
following surgery. Neither instrument revealed a statistically significant difference in quality of life between wire and
rigid fixation at any time period. The health-related disability associated with Class II malocclusion is modest compared
to many other medical conditions. Nonetheless, orthognathic surgery patients exhibit progressive and statistically
significant improvement in health-related quality of life across a wide variety of functional domains, regardless of the
fixation method used.
12. Am J Orthod Dentofacial Orthop. 2010 Jan;137(1):42-7.
Association of orthodontic treatment needs and oral health-related quality of life in young
adults.
Hassan AH, Amin Hel-S.
Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
BACKGROUND: Our objective was to assess the effect of different orthodontic treatment needs on the oral health-
related quality of life of young adults. METHODS: The study sample comprised 366 young adult orthodontic patients
(153 men, 213 women; age range, 21-25 years). Each participant was assessed for orthodontic treatment need and oral
health-related quality of life by using the dental health component of orthodontic treatment need index and the
shortened version of oral health impact profile questionnaire. RESULTS: Orthodontic patients who had little or no,
borderline, and actual need for orthodontic treatment represented 14.8%, 56%, and 29.2% of the total sample,
respectively. Orthodontic treatment need significantly affected mouth aching, self-consciousness, tension,
embarrassment, irritability, and life satisfaction in both sexes. Also, orthodontic treatment need significantly affected
taste and relaxation in both men and women. However, pronunciation and the ability to do jobs or function effectively
were not significantly associated with orthodontic treatment needs in either sex. CONCLUSIONS: These findings
emphasize the impact of malocclusion on oral health-related quality of life of young adults.

Page 28 of 95
13. Br J Health Psychol. 2007 Feb;12(Pt 1):17-49.
The Cardiff dental study: a 20-year critical evaluation of the psychological health gain from
orthodontic treatment.
Kenealy PM, Kingdon A, Richmond S, Shaw WC.
Centre for Clinical and Health Psychology, School of Human and Life Sciences, Roehampton University, London, UK .
OBJECTIVES: Despite the widespread belief that orthodontics improves psychological well-being and self-esteem, there
is little objective evidence to support this (Kenealy et al., 1989a; Shaw, O'Brien, Richmond, & Brook, 1991). A 20 year
follow-up study compared the dental and psychosocial status of individuals who received, or did not receive,
orthodontics as teenagers. DESIGN: A prospective longitudinal cohort design with four studies of the effect of
orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment
received in a 2 x 2 factorial design. METHODS: A multidisciplinary research programme studied a cohort of 1,018, 11-
12 year old participants in 1981. Extensive assessment of dental health and psychosocial well-being was conducted;
facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre-
treatment need. No recommendations about orthodontic treatment were made, and an observational approach was
adopted. At the third follow-up 337 (30-31 year olds) were re-examined in 2001. RESULTS: Participants with a prior
need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and
satisfaction. However when self-esteem at baseline was controlled for, orthodontics had little positive impact on
psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did
not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self-esteem at outcome
explaining 8% of the variance. Self-esteem in adulthood was more strongly predicted (65% of the variance) by
psychological variables at outcome: perception of quality of life, life satisfaction, self-efficacy, depression, social anxiety,
emotional health, and by self-perception of attractiveness. CONCLUSIONS: Longitudinal analysis revealed that the
observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior
need for treatment assessed in childhood made a small contribution to the prediction of self-esteem 20 years later in
adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model
that included other psychological variables. When prior need for treatment was taken into account there was little
objective evidence to support the assumption that orthodontics improves long-term psychological health.
14. J Orthod. 2010 Sep;37(3):149-61.
Is early Class III protraction facemask treatment effective?

Mandall N, DiBiase A, Littlewood S, Nute S, Stivaros N, McDowall R, Shargill I, Worthington H, Cousley R, Dyer F,
Tameside General Hospital, Ashton-u-Lyne, Lancashire, UK.
OBJECTIVE: To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years
of age.DESIGN: Multicentre, randomized controlled trial.SETTING: Eight UK hospital orthodontic units.SUBJECTS AND
METHODS: Seventy-three patients were randomly allocated, stratified for gender, into an early class III protraction
facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38).OUTCOMES: Dentofacial changes from
lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the
Piers-Harris children's self-concept scale, and the psychosocial impact of malocclusion with an oral aesthetic subjective
impact scores (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The
time points for data collection were at registration (DC1) and 15 months later (DC2).RESULTS: The following mean
skeletal and occlusal changes occurred from the class III starting point: SNA, PFG moved forwards 1.4 degrees (CG
forward 0.3 degrees; P = 0.018); SNB, PFG moved backwards -0.7 degrees (CG forward 0.8 degrees; P<0.001); ANB, PFG
class III base improved +2.1 degrees (CG worsened by -0.5 degrees; P<0.001). This contributed to an overall difference
in ANB between PFG and CG of 2.6 degrees in favour of early protraction facemask treatment. The overjet improved
+4.4 mm in the PFG and marginally changed +0.3 mm in the CG (P<0.001). A 32.2% improvement in PAR was shown in
the PFG and the CG worsened by 8.6%. There was no increased self-esteem (Piers-Harris score) for treated children
compared with controls (P = 0.22). However, there was a reduced impact of malocclusion (OASIS score) for the PFG
compared with the CG (P = 0.003), suggesting treatment resulted in slightly less concern about the tooth appearance.
TMJ signs and symptoms were very low at DC1 and DC2 and none were reported during active facemask
treatment.CONCLUSIONS: Early class III orthopaedic treatment, with protraction facemask, in patients under 10 years
of age, is skeletally and dentally effective in the short term and does not result in TMJ dysfunction. Seventy per cent of
patients had successful treatment, defined as achieving a positive overjet. However, early treatment does not seem to
confer a clinically significant psychosocial benefit.
15. Angle Orthod. 2009 Nov;79(6):1175-81.

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Pain and orthodontic treatment.
Krukemeyer AM, Arruda AO, Inglehart MR.
School of Dentistry, University of Michigan, Ann Arbor, Mich, USA.
OBJECTIVE: To explore whether patients' pain experiences and orthodontists' assessments of their patients' pain levels
are consistent and whether orthodontists are aware of their patients' use of pain medication. MATERIALS AND
METHODS: Survey data were collected from 116 adolescent patients (44 male, 72 female; aged 10 to 19 years; mean
age, 14.27 years) and from their orthodontic care providers. RESULTS: While only 18.0% of these patients agreed that
they had pain during their last orthodontic appointment, 58.5% indicated that they experienced pain for a few days
after their appointment. On average, dentists underestimated the patients' pain during the last appointment (rated on a
5-point scale, with 1 indicating no pain: providers = 2.01 vs patients = 2.28; P = .042), immediately after the last
appointment (1.93 vs 2.34; P = .005), and 1 day (1.77 vs 2.53; P < .001) and 2 days (1.57 vs 2.19; P < .001) after the
previous appointment. Only 26.5% of the patients used pain medication immediately following and 1 day after the last
appointment. Providers underestimated the amount of medication used. CONCLUSION: Orthodontists underestimated
the degree to which orthodontic treatment caused pain for their patients and their patients' use of pain medication.
16. Angle Orthod. 2010 Mar;80(2):367-72.
Perceptions of Dutch orthodontic patients and their parents on oral health-related quality
of life.
Bos A, Hoogstraten J, Zentner A.
Department of Orthodontics, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.
OBJECTIVE: To test the hypotheses that 1) there is no difference between orthodontic patients' and their parents'
reports of patients' oral health-related quality of life, and 2) there are no gender differences. MATERIALS AND
METHODS: The sample consisted of 182 orthodontic patients (age range, 8-15) and their parents. Respondents were
required to complete the Child Oral Health Impact Profile (COHIP). Items were divided into five different subscales, and
scores on all subscales were compared between and within groups. Also, scores on six additional items regarding
treatment expectations and global health perception were compared. Two hypotheses were tested: first, that no
differences between parents and patients would be detected, and second, that no differences between boys and girls
would be found. RESULTS: The first hypothesis could not be rejected. Only a few minor differences between parents
and patients were found. The second hypothesis was rejected. Differences between boys and girls were found on the
subscales Emotional Well-Being and Peer Interaction, indicating that girls experience more effects of oral health on
their quality of life than do boys. CONCLUSIONS: Parents' reports on their children's oral health-related qualities of life
were in agreement with reports of the orthodontic patients. This suggests that parents are suitable alternatives to their
children in surveys measuring oral health-related quality of life.
17. Am J Orthod Dentofacial Orthop. 2011 May;139(5):581-7.
Controlled, prospective trial of psychosocial function before and after mandibular

advancement splint therapy.
Johal A, Battagel J, Hector M.
Barts and The London School of Medicine and Dentistry, Institute of Dentistry, United Kingdom.
OBJECTIVE: The aim of the study was to investigate psychosocial function in patients with obstructive sleep
apnea/hypopnea syndrome (OSAHS), before and after mandibular advancement splint (MAS) therapy.METHODS: In a
prospective, parallel-group study, changes in psychosocial scores were compared before and after MAS therapy for
OSAHS. Patients from the top (MAS treated, n = 40) or bottom (conservatively treated n = 35) of a MAS waiting list
rated quality of life (Short Form 36 [SF-36] Health Survey) and sleepiness (Epworth Sleepiness Scale [ESS]). Both
groups' ratings at baseline were completed while on conservative therapy.RESULTS: Baseline variables did not differ
between groups. At follow-up, psychosocial scores showed improvement in MAS-treated patients, with odds ratios
(confidence interval) of 0.26 (0.09, 0.75) and 0.36 (0.14, 0.92) for sleepiness and energy/vitality domain, respectively.
Statistically significant improvement in the median (range) sleepiness score (10 [1 to 18] to 6 [1 to 14]; P <0.001) and
energy/vitality domain (18 [7 to 20] to 19 [14 to 20]; P = 0.03) were observed with MAS therapy. Reductions were
detected in median apnea-hypopnea index (median [range] 16 [5.2 to 30] to 4.6 [0.8 to 17.2] events/hour; P <0.001),
and oxygen desaturation index (ODI) (11 [3 to 16] to 0 [0 to 5] events/hour; P <0.001) at follow-up with MAS therapy.
Similar changes were observed in the comparison group when they went on to be treated with MAS.CONCLUSIONS:
This study demonstrated that treatment with MAS produced statistically and clinically significant psychosocial and
cardio-respiratory improvements.

Page 30 of 95
18. Eur J Orthod. 2010 Dec;32(6):672-6. doi: 10.1093/ejo/cjp161.
Comparison of orthodontic treatment need by professionals and parents with different

socio-demographic characteristics.
Doğan AA1, Sari E, Uskun E, Sağlam AM.
The aim of this study was to compare the socio-demographic features and self-perception of parents concerning
the malocclusion of their childrenwith the orthodontist's opinion of normative orthodontic treatment need.
The parents of 208 children (101 girls and 107 boys, between 9 and 18 years: mean 12.8 ± 2.5), who
sought orthodontic treatment were asked to score the dental attractiveness of their children using the aesthetic
component (AC) of the Index of Orthodontic Treatment Need (IOTN). These scores were then compared with those of
the orthodontist, who also scored the Dental Health Component (DHC) of the IOTN. The influence of the socio-
demographic features of the parents on both the orthodontist- and parent-rated IOTN scores was assessed. The AC
grade of the IOTN and patient characteristics were tested with the Spearman's correlation coefficient (rho). The
difference between the two dependent variables (orthodontists' and parents' AC grade) was compared using
Wilcoxon's test. A high need for orthodontic treatment was recorded in 74.0 per cent of the subjects. Although
orthodontists rated 51.4 per cent of the patients as having a severe malocclusion on aesthetic grounds, only 33.6 per
cent of parents rated their child malocclusion as severe. Although socio-demographic factors were not related to
the parents' perception of malocclusion, they had an influence on orthodontic treatment need as assessed by the
orthodontist. Parents, in this study population, rated their children's orthodontic treatment need less severely than the
orthodontist regardless of their socio-demographic characteristics. Thus, orthodontists should involve parents in
the orthodontic treatment decision-making process.
19. J Orthod. 2009 Dec;36(4):219-28.
Patients' and parents' expectations of orthodontic treatment.

Hiemstra R, Bos A, Hoogstraten J.
ACTA, Amsterdam, The Netherlands.
OBJECTIVE: To investigate the expectations of children and their primary care-givers towards orthodontic treatment
and to compare the results with those of a UK sample.DESIGN: A questionnaire survey of children and their primary
care-givers attending for their first consultation.SETTING: The Department of Orthodontics at the Academic Centre for
Dentistry Amsterdam (ACTA), the Netherlands.SUBJECTS AND METHODS: A total of 168 subjects (84 patients and 84
parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and
parents and differences between boys and girls were examined using parametric statistical methods. The data from the
Dutch sample were compared with a similar UK sample.RESULTS: Patients and parents shared similar expectations of
orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic
treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and
concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of
orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found
regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with
orthodontic treatment.CONCLUSIONS: Since the expectations of patients and their parents differ on several aspects,
effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis
that Dutch patients' and parents' expectations of orthodontic treatment differ from the expectations of English patients
and parents was supported.
20. J Oral Rehabil. 2009 Jan;36(1):71-8. Epub 2008 Oct 22.
Orthodontic treatment and management of limited mouth opening and oral lesions in a
patient with congenital insensitivity to pain
Paduano S, Iodice G, Farella M, Silva R, Michelotti A.
Department of Dental, Oral and Maxillo-Facial Sciences, University of Catanzaro Magna Graecia, Italy.
Congenital insensitivity to pain is a rare clinical syndrome characterized by dramatic impairment of pain perception
since birth and is generally caused by a hereditary sensory and autonomic neuropathy with loss of the small-calibre,
nociceptive nerve fibres. We report a 9-year-old case, with a generalized congenital insensitivity to pain. The patient
was referred to our Department by a private orthodontist for severe limited mouth opening and multiple oral ulcers
which greatly worsened after starting the orthodontic treatment. The management of his oral lesions of the limited
mouth opening and of the orthodontic treatment are described. The management approach aimed to improve
mandibular range of motion and associated stretching and a self-modeling mouthguard to avoid cheek self-biting. This
protocol allowed continuing the orthodontic treatment to restore the occlusion. Finally, good occlusion, normal
function and better quality of patient's life were achieved.

Page 31 of 95
21. Am J Orthod Dentofacial Orthop. 2009 Sep;136(3):382-92
Effects of malocclusion and its treatment on the quality of life of adolescents.

Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ.
BACKGROUND:The relationship between malocclusion and quality of life (QoL) is complex and not well understood.
The objective of this study was to determine whether malocclusion and its treatment influence an adolescent's general
and oral health-related QoL. METHODS: An observational, cross-sectional design with a longitudinal component was
used. Clinical and self-reported data were collected from 293 participants aged 11 to 14. The children were recruited
from orthodontic and pediatric dental clinics at the University of Washington and a community health clinic in Seattle.
The participants were classified into precomprehensive orthodontic (n = 93), postinterceptive orthodontic (n = 44),
and nonorthodontic comparison (n = 156) groups. Assessments of dental esthetics and occlusion were evaluated with
the Index of Complexity, Outcome, and Need. Three QoL questionnaires were completed: Youth Quality of Life to assess
general QoL, Children's Oral Health-Related Quality of Life to assess oral health QoL, and Treatment Expectations and
Experiences to evaluate participants' expectations for changes in specific aspects of their lives. Nonparametric tests
were used for all analyses. RESULTS: In general, overall and oral health QoL were high in this population. The
instruments were correlated so that when oral health QoL improved, so did general QoL. No differences were found in
these measurements between the university and community health clinics. Nor were there differences between the 3
study groups on general QoL and oral health QoL. There was little effect of malocclusion complexity on any QoL
measure. Both preorthodontic and postorthodontic participants expected improvements in their health, oral function,
appearance, and social well-being after orthodontic treatment; the postinterceptive sample's posttreatment
experiences were consistent with their pretreatment expectations in all domains. CONCLUSIONS: Malocclusion and
orthodontic treatment do not appear to affect general or oral health QoL to a measurable degree, despite subjective and
objective evidence for improved appearance, oral function, health, and social well-being.
22. Eur J Orthod. 2008 Oct;30(5):515-20. Epub 2008 Aug 27.
The impact of orthodontic treatment on the quality of life in adolescents

Bernabé E, Sheiham A, Tsakos G, Messias de Oliveira C.
Unidad de Investigación en Salud Pública Dental, Departamento de Odontología Social, Universidad Peruana Cayetano Heredia, Perú.
The aim of this case-controlled study was to assess the effect of orthodontic treatment on the quality of life of Brazilian
adolescents. Two hundred and seventy-nine 'cases' (106 males and 173 females) and 558 controls (246 males and 312
females) were randomly selected from 15- to 16-year-old adolescents attending all secondary schools in Bauru, São
Paulo, Brazil. A case was defined as having at least one condition-specific impact (CSI) attributed to malocclusion
during the previous 6 months, based on the Oral Impact on Daily Performances index. Conversely, a control was defined
as having no CSI attributed to malocclusion during the same period. Adolescents were also clinically examined for
orthodontic treatment need using the Index of Orthodontic Treatment Need (IOTN) and asked about previous
orthodontic treatment. Binary logistic regression was used for statistical analysis. Females and adolescents with a
definite normative orthodontic treatment need were more likely to report CSI than males and adolescents with no
normative need [odds ratio (OR) = 1.48, 95 per cent confidence interval (CI) = 1.08-2.02 and OR = 2.02, 95 per cent CI =
2.09-4.47, respectively], whereas adolescents with a history of orthodontic treatment were less likely to report CSI than
their counterparts (OR = 0.15, 95 per cent CI = 0.07-0.31). Furthermore, there was an interaction between a history of
orthodontic treatment and the current level of normative need. Brazilian adolescents with a history of orthodontic
treatment were less likely to have physical, psychological, and social impacts on their daily performances associated
with malocclusion than those with no history of orthodontics. Gender was a confounding factor, whereas current level
of normative orthodontic treatment need was an effect modifier. Prospective studies are needed to corroborate the
present findings.

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23. J Sleep Res. 2009 Sep;18(3):321-8. Epub 2009 May 22.
A long-term study of two oral appliances for sleep apnoea treatment.

Ghazal A, Sorichter S, Jonas I, Rose EC.
Department of Orthodontics, University of Freiburg, D-79106 Freiburg im Breisgau, Germany.
Various types of mandibular protrusive appliances have revealed different treatment success in mild-to-moderate
obstructive sleep apnoea (OSA). The present study compared the long-term effect of two different appliances in the
treatment of OSA. A total of 103 patients with OSA were randomized and treated with an IST((R)) or Thornton Anterior
Positioner (TAP()) appliance. They were followed-up after a short-term treatment period of 6 months and long-term
treatment period of over 24 months. Sleep studies in the sleep laboratory were conducted with and without the
appliances, and various questionnaires assessing subjective daytime sleepiness, sleep quality, quality of life and
symptom scores were administered at each time interval. Quality of life, sleep quality, sleepiness, symptoms and sleep
outcome showed significant improvement in the short-term evaluation with both appliances, but the TAP() appliance
revealed a significantly greater effect. After more than 2 years of treatment, sleep outcomes revealed an equal effect
with both appliances. The subjective benefits achieved initially lessened significantly. This study illustrates that both
the IST((R)) and the TAP() appliances are effective therapeutic devices for OSA after a period of over 24 months. Lack
of compliance may be due to insufficient improvement in anticipated subjective symptoms and/or a recurrence of
symptoms over time.
24. Zhonghua Kou Qiang Yi Xue Za Zhi. 2009 Jul;44(7):416-20.
Oral health-related quality of life in patients with fixed appliances

Chen M, Wang DW, Wu LP, Zhu SL, Li YH.
Department of Orthodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou 510055, China.
OBJECTIVE: To assess oral health-related quality of life in patients with fixed appliances. METHODS: Orthodontic
patients were asked to complete the scale of general conditions (Chinese version, questionnaire 1) and oral health
impact profile (OHIP) -14 (Chinese version, questionnaire 2). Baseline data were collected at first visit and thereafter.
The subjects finished questionnaire 2 at the 1st week, 4th week, 12th week and 24th week, respectively, after the fixed
appliance was bonded. Data were analyzed to evaluate the various sample groups with different personal information
and clinical parameters. Results were collated and analyzed using software package SPSS version 15.0. RESULTS: The
most common negative effect was physical pain [55/222 (27.8%)] and psychological discomfort [40/222 (18.0%)],
mainly in the first month. The total scores at five time points were 3, 10, 7, 5 and 4, respectively. No difference was
found in quality of life in patients between sixth month with fixed appliance and without appliance (P > 0.05). Age and
education status affected the quality of life (P < 0.001). CONCLUSIONS: Fixed orthodontic appliance therapy affected
patients' oral health-related quality of life during treatment. The quality of life in the first month of treatment was
mostly compromised and was improved later.
25. Am J Orthod Dentofacial Orthop. 2010 Aug;138(2):152-9.
Oral health-related quality of life and orthodontic treatment seeking.

Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA.
Department of Orthodontics, Rio de Janeiro State University, Rio de Janeiro, Brazil
BACKGROUND: The aim of this study was to assess oral health-related quality of life (OHQOL) in adolescents who
sought orthodontic treatment. A comparison between these adolescents and their age-matched peers who were not
seeking orthodontic treatment provided an assessment of the role of OHQOL in treatment seeking. METHODS: The
sample consisted of 225 subjects, 12 to 15 years of age; 101 had sought orthodontic treatment at a university clinic
(orthodontic group), and 124, from a nearby public school, had never undergone or sought orthodontic treatment
(comparison group). OHQOL was assessed with the Brazilian version of the short form of the oral health impact profile,
and malocclusion severity was assessed with the index of orthodontic treatment need. RESULTS: Simple and multiple
logistic regression analysis showed that those who sought orthodontic treatment reported worse OHQOL than did the
subjects in the comparison group (P <0.001). They also had more severe malocclusions as shown by the index of
orthodontic treatment need (P = 0.003) and greater esthetic impairment, both when analyzed professionally (P =
0.008) and by self-perception (P <0.0001). No sex differences were observed in quality of life impacts (P = 0.22).
However, when the orthodontic group was separately evaluated, the girls reported significantly worse impacts (P =
0.05). After controlling for confounding (dental caries status, esthetic impairment, and malocclusion severity), those
who sought orthodontic treatment were 3.1 times more likely to have worse OHQOL than those in the comparison
group. CONCLUSIONS: Adolescents who sought orthodontic treatment had more severe malocclusions and esthetic
impairments, and had worse OHQOL than those who did not seek orthodontic treatment, even though severely
compromised esthetics was a better predictor of worse OHQOL than seeking orthodontic treatment.

Page 33 of 95
26. Acta Odontol Scand. 2010 Sep;68(5):249-60.
Patients' perceptions of orthognathic treatment, well-being, and psychological or

psychiatric status: a systematic review.
Alanko OM, Svedström-Oristo AL, Tuomisto MT.
Department of Oral Development and Orthodontics, Institute of Dentistry, University of Turku, Finland.
OBJECTIVE: To conduct a systematic review of studies concerning the psychosocial well-being of surgical-orthodontic
patients. MATERIAL AND METHODS: Articles published between 2001 and 2009 were searched using PubMed, Web of
Science, and PsycInfo. Only articles written in English were included. Articles on methodological issues or on patients
with clefts or syndromes or studies in which treatment had included surgically assisted maxillary expansion or
intermaxillary fixation were excluded. The exclusion of articles was carried out in collaboration with two reviewers. To
find new relevant articles, references from all the obtained review articles were hand-searched. Thirty-five articles
fulfilled the selection criteria and were included in this review. RESULTS: The main motives for seeking treatment were
improvements in self-confidence, appearance, and oral function. Patients were not found to suffer from psychiatric
problems. Treatment resulted in self-reported improvements in well-being, even though these improvements were not
found with current assessment methods. Changes in well-being were most often registered using measures designed
for evaluation of the impact of oral health on quality of life (e.g. the Orthognathic Quality of Life Questionnaire and the
Oral Health Impact Profile). CONCLUSIONS: Surgical-orthodontic patients do not experience psychiatric problems
related to their dentofacial disharmony in general. However, subgroups of patients may still experience problems, such
as anxiety or depression, as many studies only report patients' mean problem scores and compare them to controls'
scores or population norms. New assessment methods focusing on day-to-day changes in mood and well-being, as well
as prospective studies with controls, are needed.
Predict aspects of OHRQoL that the authors, Rohor Ingehart & Bagramian
covered under each topic listed in their book (above).

Page 34 of 95
THE QUALITY OF REPORTING OF CLINICAL TRIALS

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UIC/ Idiomes/ Anglès Objective to practice reading comprehension about the clinical
Ciències de salut mld.03.10.12 trials in orthodontics II: assessment of the quality of reporting
clinical trials
Discussion
1. How are the results of an RCT affected if the quality of the study is poor?
2. How can poor reporting of RCTs affect the search for the best evidence?
3. What does Jadad refer to in this context?
4. What does hand-searched mean? Intra-examiner reliability?
5. What is an open trial? How can bias be reduced in this type of study?
Comprehension questions
1. According to the article, _____ considered the highest level evidence to answer questions about
treatment of choice.
a. meta-analyses have always been
b. systematic reviews of well-designed RCTs have not always been
c. Randomized controlled trials are currently
d. Integrative research is not usually
2. Apparently, the need to standardize reporting of RCTs stems from ____.

a. the fact that most RCTs in the field of orthodontics are poorly designed
b. the increasing diversity in types of orthodontic journals
c. the evolving approaches to evaluating and reporting experimental research
d. findings from assessments of internal and external validity in recent clinical trials
3. The less control of factors that researchers maintain when carrying out an RCT, the _____.
a. higher the intervention’s effectiveness seems
b. the better the quality of the research design
c. the easier it is to assess its quality
d. the more effective the study treatment will be
4. According to the text, three of the best indicators for the reporting quality an RCT is _____
a. whether the number of participants who dropped out of the study was included
b. the writing style
c. the type of scale used to assess it
d. the inclusion of described randomization procedures
e. whether the summary scores of both excluded and included trials are provided
f. whether certain participants were aware of which intervention was being administered
g. the empirical evidence and theoretical considerations supporting the findings
5. The authors carried out this study because they wanted to know _____.
a. if the published clinical trials in the field of orthodontics are explained well enough
b. whether research in orthodontics is poorly designed or not
c. why orthodontic research is so badly reported
d. the best way to assess the design of RCTs in orthodontics

Page 41 of 95
7. According to the findings of this study, rate the reporting performance of the clinical trials reviewed.
Indicators Rating
a. Concealed allocation 1 2 3 4 5 (1= poor)

b. Blinding 1 2 3 4 5
c. Randomization protocol described 1 2 3 4 5
d. Low level of bias 1 2 3 4 5
8. Which of the indicators listed above is considered the one to have the most impact on assessing
treatment effect, according to the authors? ______________________
9. Which of the following methods for concealing allocation is considered adequate?

a. Alternate patients receiving the experimental or control treatment
b. Upper quadrants comprise test group and lower quadrants comprise the control group
c. Allocation concealed after recruitment
d. Sealed envelopes

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UIC/ Idiomes/ Anglès Objective to determine the quality of reporting in orthodontics
Ciències de la salut mld.16.11.14 research since the 2003 report
CURRENT STATUS OF REPORTING QUALITY OF RCTS IN ORTHODONTICS

Read the following abstract for a study on the quality of reporting of RCTs in the field of
orthodontics.
Eur J Orthod. 2014 Sep 6. pii: cju050.

Reporting quality of randomized controlled trials in orthodontics-what affects it and did it
improve over the last 10 years?
Sandhu SS1, Sandhu J2, Kaur H3.
Department of Orthodontics and Dentofacial Orthopedics, Genesis Institute of Dental Sciences and Research, Ferozepur , India
OBJECTIVES: to investigate the factors affecting the overall reporting quality and the reporting quality trend
of each item over the last 10 years for orthodontic randomized controlled trials (RCTs). MATERIAL AND
METHODS: MEDLINE, The Cochrane Library, and EMBASE databases were searched (2003-12) to retrieve
studies. Four major orthodontic journals and reference list of included articles were hand searched to identify
additional RCTs. The overall reporting quality for all included RCTs (2003-12) was assessed using
CONSORT, 2001 (ORQs 2001, score 0-20). In addition, CONSORT, 2010 (ORQs 2010, score 0-27), was
used for RCTs published after 2010. Generalized estimated equations (GEEs) model was used for analysis
(ORQs 2001 and ORQs 2010). Cochran-Armitage trend test was used to evaluate the reporting quality trend
of each individual item based on the CONSORT, 2001. RESULTS: Totally 309 relevant studies were
identified, out of which 86 were published after 2010. The median for total ORQs 2001 and ORQs 2010 was
9 (interquartile range 7-12) and 12 (interquartile range 9-15), respectively. Year and journal of publication
were significant predictors for both ORQs 2001 and ORQs 2010. Location, sample size, and multicentre
trials were significant predictors only for ORQs 2001, and not for ORQs 2010. Trend test showed
that reporting quality of four items, namely identification of trial as randomized, sample size, blinding, and
randomization has improved significantly with time. CONCLUSION: There is an improvement in
the reporting quality. However, it is still suboptimal. To improve the reporting quality, the CONSORT
guidelines should be followed strictly.
Discussion
Graph
1. Draw a graph that depicts the general trend in reporting quality of
RCTs in orthodontics as described in this abstract.
2. What criteria did the researchers use to carry out their analysis?
3. In particular, reporting of ___________________________________________________ has

improved.
4. What do the researchers recommend for future reporting practices?
5. List the features of a study that most likely indicate higher reporting quality, according to these
findings.
6. What was the study design of this research paper?

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UIC/ Idiomes/ Anglès Objective to review concepts related to the why and how of
Ciències de la salut mld.19.03.13 randomization practices
RANDOMIZATION AND ALLOCATION CONCEALMENT

Read through the following text, and fill in each blank with a letter corresponding to a phrase that best
completes the sentence. There are 3 extra items.
a. after e. before and until i. ensure the unpredictability
b. allocation concealment f. can always be successfully j. generating a sequence
c. allow discernment of assignments g. cannot always be k. with better prognoses
d. ascertainment bias h. ensure the predictability l. with worse prognoses
Random allocation to intervention groups remains the only method of ensuring that the groups being
compared are on an equivalent footing at study outset, thus eliminating selection and confounding
biases. This technique has allowed RCTs to play a key role in advancing medical science.
The success of randomisation depends on 2 interrelated processes. The first entails 1_____ by which the
participants in a trial are allocated to intervention groups. To 2_____of that allocation sequence,
investigators should generate it by a random process. The second process, 3_____, shields those involved
in a trial from knowing upcoming assignments. Without this protection, investigators and patients have
been known to change who gets the next assignment, making the comparison groups less equivalent.
For example, suppose that an investigator creates an adequate allocation sequence using a random
number table. However, the investigator then affixes the list of that sequence to a bulletin board, with no
allocation concealment. Those responsible for admitting participants could ascertain the upcoming
treatment allocations and then route participants 4_____ to the experimental group if they wanted to
demonstrate that the corresponding treatment was the most effective one. Bias would result. Inadequate
allocation concealment also exists, for example, when assignment to groups depends on whether a
participant's hospital number is odd or even or on translucent envelopes that 5_____ when held up to a
light bulb.
Allocation concealment should not be confused with blinding. Allocation concealment concentrates on
preventing selection and confounding biases, safeguards the assignment sequence 6_____ allocation, and
7_____ implemented. Blinding concentrates on preventing study personnel and participants from
determining the group to which participants have been assigned (which leads to 8_____ ), safeguards the
sequence after allocation, and 9_____ implemented.
Vocabulary focus
Which word or phrase in the text means:
1. an integer that cannot be divided exactly by 2?
2. the same conditions?
3. a surface intended for the posting of public messages?
4. to hide information from?

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UIC/ Idiomes/ Anglès Objective to practice Reading comprehension regarding EBO
THE EVIDENCE FOR CLINICAL DECISIONS
Orthodontics traditionally has been a specialty in which the opinions of leaders

were important, to the point that professional groups coalesced around a strong
leader. Angle, Begg, and Tweed societies still exist, and new ones whose primary
purpose is to promulgate its leader's opinions were formed as late as the 1980s. As
5
any professional group comes of age, however, there must be a focus on evidence-
based rather than opinion-based decisions. The current trend in orthodontics in
that direction is an encouraging indication of professional maturity.
Some important clinical decisions, however, must be made without solid data on
1
0
which to base them. In that circumstance the clinician must use his or her best
judgment, which requires some understanding of the quality of existing data. This
important subject is reviewed in some detail immediately below.
1. Write a heading for each paragraph.
a. ________________________________________
b. ________________________________________
2. Why are Angle, Begg and Tweed mentioned?
3. Why is the era, 1980s, mentioned?
4. What is “the current trend in orthodontics”?
5. What is the author’s stance towards this trend? What words or phrases indicate his stance?
6. The phrase, “solid data” means _____.

a. dense literature c. information in patient charts
b. conclusive evidence d. expert opinion
7. To what does this important subject refer in line 10?
8. According to the text, if there is no solid data, practitioners should base their clinical decisions on
_____.
a. their own clinical expertise and experience
b. existing data
c. their diagnoses
d. positions outlined by professional groups with strong leaders
9. What do you think the next paragraph will be about?

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Issues in orthodontic research
Orthodontics traditionally has been a specialty in which the opinions of leaders were
important, to the point that professional groups coalesced around a strong leader. Angle,
Begg, and Tweed societies still exist, and new ones whose primary purpose is to
promulgate its leader's opinions were formed as late as the 1980s. As any professional
group comes of age, however, there must be a focus on evidence-based rather than
opinion-based decisions. The current trend in orthodontics in that direction is an
encouraging indication of professional maturity.
Some important clinical decisions, however, must be made without solid data on which to
base them. In that circumstance the clinician must use his or her best judgment, which
requires some understanding of the quality of existing data. This important subject is
reviewed in some detail immediately below.
Study Designs
Retrospective versus Prospective Data
Decisions about treatment are based on some combination of a theoretical understanding
of the patient's circumstances (whether or not the theory is correct) and knowledge of the
outcome of previous treatment in similar cases. Poorly conceived views of how the
patient's condition developed lead to poor treatment decisions, which is why the discussion
of etiology in Chapter 5 is an important background for rational treatment planning. The
other part of the equation is equally important: We need to know as thoroughly as possible
what really happens when various treatment procedures are used. Clinical experience
provides important information, but progress occurs only if treatment regimens are applied
systematically and the results are analyzed logically, carefully and thoughtfully.
The unsupported opinion of an expert is the weakest form of clinical evidence. Often the
expert opinion is supported by a series of cases that were selected retrospectively from
practice records. The problem with that, of course, is that the cases are likely to have been
selected because they show the expected outcome. A clinician who becomes an advocate
of a treatment method is naturally tempted to select illustrative cases that show the desired
outcome, and if even he or she tries to be objective, it is difficult to avoid introducing bias.
When outcomes are variable, picking the cases that came out the way they were
supposed to and discarding the ones that didn't is a great way to make your point.
Information based on selected cases, therefore, must be viewed with considerable
reserve.
As the figure illustrates, a hierarchy of quality exists in the evidence on which clinical
decisions are based. Clinical data become available as reports of treatment outcomes. In
the simplest form this is a case report, showing (usually in considerable detail) what
happened in the treatment of a particular patient. A case series requires distilling the
information, to separate the general trend among the patients from individual
idiosyncrasies. The more patients for whom information is available, the more accurately
Page 46 of 95
the general trend can be discerned-but only if the sample of patients being reported is a
reasonable representation of the larger population who might receive treatment of that
type and if the data are analyzed appropriately. The hierarchy of quality in clinical data
reflects, more than anything else, the probability that an accurate conclusion can be drawn
from the group of patients who have been studied.
It's much better, if retrospective cases are used in a clinical study, to select them on the
basis of their characteristics when treatment began, not on the outcome. It's better yet to
select the cases prospectively before treatment begins. Even then, it is quite possible
to bias the sample so that the "right" patients are chosen. After experience with a
treatment method, doctors tend to learn subtle indications that a particular patient is or is
not likely to respond well, although they may have difficulty verbalizing exactly what criteria
they used. But identifying the criteria associated with success is extremely important if the
treatment method is to work well for others, and a biased sample makes that impossible.
One important way to control bias in reporting the outcomes of treatment is to be sure that
all of the treated cases are included in the report.
For this reason, the gold standard for evaluating clinical procedures is the randomized
clinical trial, in which patients are randomly assigned in advance to alternative treatment
procedures. The great advantage of this method is that random assignment, if the sample
is large enough, should result in a similar distribution of all variables between (or among)
the groups. Even variables that were not recognized in advance should be controlled by
this type of patient assignment-and in clinical work, often important variables are identified
only after the treatment has been started or even completed.
An important aspect of any prospective study is keeping track of all the patients once they
have been assigned to a treatment regimen. The other major source of bias in prospective
studies comes from drop-outs, who are likely to be the very patients who were not
responding well to the treatment. Unless these patients are accounted for, the same bias
produced by initially selecting only the "good" patients arises. Random assignment of
patients, as in a randomized clinical trial, avoids the first source of selection bias but does
nothing to control the second one. Data from randomized trials, therefore, must be
reviewed on an "intent to treat" basis that includes all the subjects, using statistical
techniques to estimate data for the ones who dropped out.
Data from randomized clinical trials now determine many clinical approaches in medicine
and are beginning to do so in dentistry. The clinical trials in orthodontics that have been
reported will be referred to in some detail later in this book. Many important clinical
questions, however, do not lend themselves to clinical trial methodology, and inevitably
many issues must be evaluated without randomized controls and/or from retrospective
data. Let's now consider some important issues in evaluating such data.
Historical Control Groups

The best way to know-often the only way to know-whether a treatment method really
works is to compare treated patients with an untreated control group. For such a
comparison to be valid, the two groups must be equivalent before treatment starts. If the
groups were different to start with, you cannot with any confidence say that differences
afterward were due to the treatment.
There are a number of difficulties in setting up control groups for orthodontic treatment.
The principal ones are that the controls must be followed over a long period of time,
equivalent to the treatment time, and that sequential radiographs usually are required for
the controls and the patients. Radiation exposure for untreated children is problematic. At
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present it is very difficult to get permission to expose children to x-rays that will be of no
benefit to them personally. The growth studies carried out in the 1935-65 era in Burlington
(Ontario) in association with the University of Toronto, Ann Arbor by the University of
Michigan, and Cleveland by the Bolton Foundation provide reasonably large archives of
sequential radiographs of untreated children (some of whom had malocclusion). Several
smaller data bases from the same time period also exist.
This historical material is still being used as control data for evaluations of orthodontic
treatment procedures, especially those involving growth modification. How valid is this?
Are children seeking orthodontic treatment more than 50 years later, especially in other
areas of the United States or even in other countries, really comparable with these
historical samples? Probably not as much as one would like. The composition of current
population groups often differs from the relatively homogenous growth study groups,
especially when a current project focuses on children with a particular type of malocclusion
but the comparison is with the mostly normal growth study groups. In addition, the secular
trend in growth over 50 years almost surely has affected expected growth increments.
When historical controls are the best that are available, it is better to have them than
nothing, but the limitations must be kept in mind.
Sample Sizes and Composition

How many subjects does it take to demonstrate a treatment effect? That depends, of
course, on the size of the effect to be detected. The bigger the difference between two
groups, the fewer the subjects that are needed to show it (if variability remains the same).
Statistical analysis calculates the probability that differences are due to chance alone
when the null hypothesis is true. When that probability becomes small enough, we accept
the hypothesis that the groups are different.
In orthodontics, the data for clinical decisions often are from cephalometric analysis. The
differences created by orthodontic treatment usually are not very large and are about the
same magnitude as the variability within the sample. For this reason, although small
cephalometric samples can be analyzed, conclusions based on sample sizes under 20
must be regarded with considerable suspicion, regardless of the statistics. With sample
sizes of 25-30 patients, often it is possible to discern differences that would be important
clinically, and almost always such differences can be demonstrated in sample sizes of 50
or so.
Sample size becomes particularly important when the composition of the groups being
studied is not homogenous. Heterogeneity of the group can relate to age, gender, maturity,
racial/ethnic origin, and other demographic characteristics. It also can relate to
characteristics of the malocclusion being treated. Heterogeneity tends to increase the
observed variability, making it more difficult to detect differences of clinical interest within a
small sample. Angle classification is inadequate not only for orthodontic diagnosis but also
for sorting research subjects. For instance, if you're studying Class II malocclusion, it's not
enough to just select Class II subjects. It will be important to note face height as an
important variable, because subjects with short and long faces grow differently and are
likely to respond differently to treatment aimed at the overjet and Class II occlusion they
share. Other characteristics of the malocclusion also may need to be controlled if sample
sizes are to be kept reasonably small.

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Issues in Data Analysis
Clinical versus Statistical Significance:

Statistical analysis can never flatly confirm or reject the truth of an experimental
hypothesis. It merely calculates the odds that the null hypothesis should be accepted or
rejected. If the analysis shows less than a 5% chance that a difference between groups
could have arisen due to random variation (p < .05), the research hypothesis often is
accepted (or, in terms of the test procedure, the null form of that hypothesis is not
accepted).
There are many possible sources of error in statistical analysis. For clinical studies, the
most likely error arises from applying statistics based on the normal distribution to a data
set that is not distributed like this bell-shaped curve. Wrongly applied statistics tend to
generate incorrect probability values that can lead to incorrect interpretations-in other
words, bad statistics lead to bad conclusions. Transforming the data before analyzing it (by
performing the same mathematical operation on each datum, for instance, taking the
logarithm of each number) often can make normal-distribution (parametric) statistics more
applicable. Many clinical studies, however, require statistics not based on the normal
distribution (often called nonparametric statistics because the data are noncontinuous).
Orthodontics is an excellent example of a clinical area in which both the theoretical
framework for treatment and many treatment techniques have changed dramatically during
the last 25 years. Similar progress has been made in statistics, especially in the analysis of
clinical data. At this point, the use only of t-tests in a clinical study would be analogous to
orthodontic treatment using gold bands and archwires-not wrong but not the best you
could do. The modern clinician should be suspicious of conclusions based on superficial
testing. Fortunately, clinical journals increasingly demand adequate statistical analysis, but
that cannot be taken for granted, and the statistics that appear in some nonreviewed
presentations (prominent on the Internet but often found in the report of presentations at a
meeting and the "clinical" journals) must be examined carefully indeed.
It is important to remember that statistical significance and clinical significance are not the
same. Tests of statistical significance ask questions like, "Is it probable that the difference
between these groups is due only to chance?" Clinical significance asks, "Does that make
any difference in treatment outcome?" Sometimes studies demonstrate statistically
significant differences that are so small that they have no clinical significance. For
example, studies of the size of the mandible with or without treatment aimed at stimulating
its growth almost always show small differences in the ultimate size of the jaws. In some
publications the differences are reported as statistically significant, in others as not
significant. At that level, the argument is over whether average differences of 1-2 mm in
the size of a 120 mm mandible are treatment-related. The more important consideration is
whether it would make any real difference clinically if they were. The clinician's question is,
"Can you stimulate mandibular growth?" The answer has to be based on the magnitude of
the changes as well as the result of statistical analysis. It seems to be, "If you can, not
much."

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REVIEW OF THE HIERARCHY OF EVIDENCE
Study design. The image below shows the
hierarchy of evidence which contextualizes the varying levels of evidence quality provided by different study designs.
Discuss the advantages and disadvantages of using findings from the different types of studies to answer clinical
questions about the best treatment options.
Study design
Randomized clinical trial
Prospective study, non-random assignment
Retrospective study, inclusion based only on pretreatment characteristics
Retrospective study, inclusion based on treatment response
Case reports
Unsupported opinion of expert

Decision-making in orthodontic
treatment
Braces
Extraction
2-phase

Page 50 of 95
Fill in columns 2 and 3 of the table below with the following items.
1. Clinical data of all patients were collected before treatment was started and were followed as
the outcome data emerged.
2. Data are compiled from patients starting at the beginning of their treatment; treatment is not
decided based on patient profile.
3. Data may be screened and chosen for preferred outcome.
4. Data may include individual idiosyncrasies unrelated to the treatment itself.
5. Data was collected by somebody else—there is less control of data collection by present
researcher.
6. General trends can be revealed.
7. It is not always possible to obtain such data ethically.
8. No data or objective evidence is presented .
9. It offers informed ideas from a potentially valuable source of clinical experience.
10. Only the ideal candidates are recruited to undergo the practitioners’ treatment of choice.
11. It shows all ranges of potential outcomes from past similar cases.
Study design Advantage Disadvantage
Randomized clinical trial
Clinical data of all patients were collected

Prospective study, non-random before treatment was started and were
assignment followed as the outcome data emerged
↑
Data was collected by somebody else—
there is less control of data collection by
Retrospective study, inclusion based present researcher.
only on pretreatment characteristics
↑
General trends can be revealed
Retrospective study, inclusion based
on treatment response
Case reports
Unsupported opinion of expert
12. Some evidence, though minimal in quality, is provided—an actual response to treatment is
demonstrated.

Page 51 of 95
Read the following issues to consider in regards to orthodontic research.
1. Control groups
Well-designed experiment must include a control group. The control group and experimental
group need to be as similar as possible in characteristics at baseline.
● Design an RCT design for an orthodontic treatment that includes at least 1 control group.
● Describe the features of each treatment group.
● What are the outcome measures, i.e. what variables do you need to study in each group?
● By what means do you collect the data?
● What difficulties might be encountered when including a control group in orthodontic
research?
● How could these difficulties be resolved?
2. Study population: Size and composition

How many subjects does it take to demonstrate a treatment effect? That depends on the size of the
effect to be detected. The bigger the difference between 2 groups, the fewer the subjects that are
needed to show the effect. Statistical analyses calculate the probability that differences are due to
chance alone.
How large does a study population need to be to demonstrate that an orthodontic treatment is really
effective?
● What data, or which variables, do the researchers need to study and compare to see if 1
treatment is better than the other?
● Discuss how the degree of homogeneity or heterogeneity in a study population of
orthodontic patients could affect a researcher’s analyses.
3. Data analysis
Like the dramatic changes seen in orthodontics over the last 30 years, similar progress has also
occurred in the area of statistics. Clinical journals increasingly demand adequate statistical
analysis, and such analyses must be examined carefully when searching the literature to find
appropriate evidence.
● What does statistical significance actually mean?
● What is a null hypothesis?
● How can statistics be used incorrectly?
● If a treatment is shown to be statistically more effective than another one, does that mean it
is the best treatment?
● What does clinically significant mean?

Page 52 of 95
UIC/ Idiomes/ Anglès Objective to prepare for material related to early treatment in
Ciències de la salut mld.25.10.12 orthodontics
CONTROVERSIES IN ORTHODONTICS
1. Think of some past and present areas for controversies related to the field of orthodontics, and list
them below. Explain what aspects of these areas lead to disagreement among practitioners and
clients.
2. Have any of the controversies you listed been resolved? How were they resolved?
The following text is an excerpt from the article, Orthodontics in 3 millennia. Chapter 12: Two controversies:
Early treatment and occlusion. Read the text and answer the questions that follow.
Norman Wahl
Sequim, Wash
From the beginning, orthodontists have been faced with the decision of when to start treatment. Until the late
20th century, this decision was based on clinical observation, the influence of strong leaders, and (after
midcentury) the results obtained by what Europeans called “functional jaw orthopedics.” Recent findings
questioning the efficacy of early treatment have forced orthodontists to ask themselves whether their
decision to “start now” is being influenced too heavily by practice-management considerations.
(Am J Orthod Dentofacial Orthop 2006;130:799-804)
1. Apparently, the issue related to _____ has been debated for a long time in the orthodontic field.
a. interventions for oral-facial harmony
b. the initial phases of treatments
c. timing of interventions
d. the role of certain leaders
2. Wahl states that orthodontic treatment of choice in the early 20th century usually depended on _____.
(Circle 2)
a. reading professional literature
b. European technology
c. patient assessment
d. the time that treatment was started
e. findings related to functional jaw orthopedics
3. The last sentence suggests that _____.
a. recent research has demonstrated that early treatment is not effective, and is only based on issues related
to practice-management
b. orthodontists are now being forced to use early treatment because they were starting treatment to late
because of practice-management problems
c. orthodontists consider strong practice management to be the answer for any questions about the efficacy
of early treatment
d. the debate about early treatment has not been resolved because research now indicates that it does not
seem to provide as much benefit as practitioners have perceived
4. Write a definition of what you think Early Treatment in orthodontics is.
a. What type of treatment is used?
b. When should it be initiated?

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READING A RESEARCH ARTICLE EFFICIENTLY, SECTION BY SECTION
It is important as health science practitioners to be aware of the genres of literature in their profession to
enable efficient up-dating of their practices. Knowledge is organized and communicated through a
discipline-specific language which all professionals must understand, whether the language used is the
professional’s first or second language. The original research paper is one genre in which the format and
language have a long history of development. To better understand how professionals communicate with
their peers, we will analyze the common content and language that belong to each section of a research
article about experimental research in orthodontics.
The article, Outcomes in a 2-phase randomized clinical trial of early Class II treatment, is a benchmark
article in both the quality of research and reporting style. Read the reference below.
Am J Orthod Dentofacial Orthop 2004;125:657-67
Outcomes in a 2-phase randomized clinical trial of early Class II treatment

J. F. Camilla Tulloch, BDS, FDS, DOrth,a William R. Proffit, DDS, PhD,b and Ceib Phillips, PhD, PHc
From the Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC.
This project was supported by NIH grant DE-08708 from the National Institute of Dental and Craniofacial Research and the
Orthodontic Fund, Dental Foundation of North Carolina.
Discussion
1. Read the list of authors. Do you recognize any of them?
2. What do you know about the University of North Carolina?
3. Why do you think the authors believed this study was necessary?
4. Make predictions about this study’s :

● Patient population (age, sex, oral health condition, population size, etc.)
● Procedures (treatments, groups, timing, etc.)
● Outcome measures
● Likely results
5. Draw a plausible schematic image or outline of this study’s design below.

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UNDERSTANDING THE STRUCTURE OF AN INTRODUCTION
The Introduction of an IMRaD article has two functions:2
● Creating a research space

● Placing the research in context
Creating a research space means justifying the research to the reader. A writer needs to convince the reader
of the need and interest for the research.
Placing the research in context means explaining other studies related to the same topic and providing
definitions or contextual information that will clarify the issues to be studied.
Read the following introduction to the article, Outcomes in a 2-phase randomized clinical trial of
early Class II treatment. Analyse the ways that the authors create a research space and place the research in
context.
Introduction
The optimal timing for treatment of children with Class II malocclusions remains controversial. Some
clinicians believe strongly that beginning treatment in the mixed dentition before adolescence is
advantageous, but others are convinced that early treatment is often a waste of time and resources.
Patients and practitioners seek treatments that provide excellent outcomes by simple and efficient
5 methods. Determining the relative merits of alternative treatments is complex, not only because of
variability in the initial conditions and treatment responses, but also because of differences between
orthodontists in treatment beliefs, goals, techniques, and even skills. Ideally, treatment should be
provided when it would be most effective and efficient, and would produce the least disruption in the
child’s and family’s lives.
1 For children with a Class II problem, the debate is not really whether it can be corrected at various
0
times during a child’s development, because ample evidence from clinical practice suggests it usually can.
Recent reports from several prospective trials clearly demonstrate that some improvement in jaw
relationships can be achieved during early treatment with both headgear and functional appliances. 1-7 The
important questions are: (1) does treatment started in the mixed dentition before adolescence, when
followed by a second phase of treatment in the early permanent dentition during adolescence, provide
1
5 superior results to single-phase treatment delayed until adolescence? and (2) is there enough additional
benefit for patients, parents, and practitioners to justify the greater burden3 of 2-stage treatment? These
questions can best be answered by following children with similar initial problems, who did or did not
have early treatment, to late adolescence and the completion of comprehensive treatment in the
permanent dentition. Studies in which only the response to the initial phase of treatment is evaluated shed
2 no light* on this important question.
0 This article presents data from the second phase of a 2-phase randomized, clinical trial of early
versus later treatment of Class II problems, in which the untreated controls of early treatment and those
who had early headgear or functional appliance treatment all received comprehensive fixed appliance
treatment. The objectives were to assess whether growth modification, after controlling for the finishing
clinician, influenced (1) the end of phase 2 skeletal and dental positions and relationships, and (2) the
2 time in comprehensive treatment or the proportion of children receiving or recommended for more
5
complex treatment.
2
Based on mek.04d4
3
Something that is tolerated with difficulty; obligation 2) to load oppressively; to cause annoyance, stress or inconvenience 3.)
weight; impediment; affliction...

Page 55 of 95
Common introduction moves
Three different “moves” can be found in traditional scientific introductions: Establishing a territory,
Establishing a niche and Occupying the niche.
Analysis. Read the introduction to Outcomes in a 2-phase randomized clinical trial of early Class II
treatment. Locate the moves and sub-moves of this text. Write the line number(s) in the corresponding table,
and note any words or phrases that you feel identify the function.
→ Not all sub-moves are included in every article; if a sub-move is not present, mark an × in the column.
Introduction moves—to create a research space – CARS*
Useful words or phrases for

Moves and sub-moves Line(s) identifying the function.
1. Establishing a territory
1.1 Claiming centrality (importance, interest, relevance)
1.2 Making generalizations about the subject
1.3 Reviewing items of previous research
2. Establishing a niche
2.1 Counter claiming
2.2 Indicating a gap
2.3 Question raising
2.4 Continuing a tradition
3. Occupying the niche

3.1 Outlining purpose / announcing present research
3.2 Announcing findings
3.3 Evaluating research
3.4 Indicating article structure
*This description of Introduction moves has been adapted from the applied linguistics literature (Anthony, 1999; Swales, 1990).
Anthony, L. (1999). Writing research article introductions in software engineering: How accurate is a standard model?
IEEE Transactions on Professional Communication, 42(1), 38-46.
Swales, J. (1990). Genre Analysis: English in academic and research settings. Cambridge: Cambridge University Press.
Comprehension questions for the introduction of Outcomes in a 2-phase randomized

clinical trial of early Class II treatment.
1. The term burden (paragraph 2) most likely refers to factors, such as _____ in this context. (Circle 2)
a. appearance c. cost e. range of materials g. time

b. comfort d. efficiency f. satisfaction h. availability

Page 56 of 95
2. *The phrase, shed no light (paragraph 2), probably means _____.
a. evidence
b. incorrectly
c. clearly explain
d. do not answer
3. According the authors, reaching consensus among orthodontists about the treatment of choice for
Class II malocclusion is not easy because of variability in _____. (Circle 2)
a. orthodontists’ attitudes and experience
b. the complexity of alternative treatment options
c. patient profiles
d. duration of the treatment
e. cost of the treatment
4. According to the text, orthodontists opposing early treatment do not believe _____.
a. that early treatment can correct Class II anomalies
b. early treatment should be applied during preadolescence
c. early treatment of Class II malocclusion is economical or efficient
d. the use of headgear and functional appliances are beneficial
5. The research cited in this introduction most likely comprised _____ studies.
a. observational c. experimental
b. case-control d. cross-sectional
6. The authors cited research in this section to _____.
a. demonstrate the need for their present study
b. prove that early treatment is not warranted
c. support their hypothesis that 2-phase treatment provides superior results to single-phase
treatment
d. confirm knowledge related to 2-phase treatment
7. The aim of this study was to _____.

a. determine the degree of growth modification of early class II treatment
b. evaluate the impact of early treatment outcome on the final results of later phase
c. Class II treatment
d. assess the influence of practitioner skill on growth modification in a 2-stage treatment
e. to observe whether growth was affected during the later stage of treatment
8. To assess the effects of the experimental treatment, the researchers did not evaluate _____. (Circle 2)
a. time spent between placement of appliance after phase 1 and the date the patient was debanded
b. discrepancies among clinician treatment decisions
c. cephalometric values
d. prevalence of cases requiring orthognathic surgery
e. type of orthodontic appliances used during phase 2
9. In the present study, all of the subjects _____.
a. were preadolescent
b. had been enrolled in the first phase of the trial
c. received treatment from the same orthodontist
d. had similar dent-facial anomalies
10. The authors claim that unlike previous research carried out in this area, their present study _____.
a. included follow-up data from the later phase of Class II treatment
b. found that the initial phase of a 2-stage treatment can lead to favorable growth changes
c. more thoroughly describes the outcome of a single-phase treatment for Class II malocclusion
d. hypothesized that treatment for Class II malocclusion is best performed in 2 phases
11. Based on information provided in the 3rd paragraph, draw a rough outline that depicts the design of
this study.
Page 57 of 95
UNDERSTANDING THE METHODS SECTION
Using of graphics to explain methods

I Flow charts. The following image was included in the article, Outcomes in a 2-phase RCT of
early class II treatment by Tulloch et al. Fill in the blanks according to the notes you have taken from the
listening about this RCT. Use the words from the list below (there are some extra words included):
fifteen gender observation phase I

fifty intention to treat overjet > 7mm single
functional appliance multiple own treatment thirteen
_1._
_.__
3. . _4._
_5._
_3._
II The table below was included in6. the article by Tulloch as well. Fill in the blanks with the data
you heard during the listing regarding withdrawals and retention.
7. 1
8. .

Page 58 of 95
II The table below was included in the article by Tulloch. Fill in the blanks with the data you
have read regarding withdrawals and retention.
The retention rate for completeion of the phase 2 portion of the trial was ____% which represents
(n=)_____ subjects out of (n=)_____.
Review the data in Table 1. Which of the reasons for withdrawal from the study did not appear to
be directly related to the treatment?
What was the main reason given for not returning for phase 2 evaluation?
What was the main reason given for not completing phase 2?
Discussion Questions
1. The retention rate for completion of the phase 2 portion of the trial was ____% which
represents (n=)_____ subjects out of (n=)_____.
2. Review the data in Table 1. Which of the reasons for withdrawal from the study did not
appear to be directly related to the treatment?
3. What was the main reason given for not returning for phase 2 evaluation?
4. What was the main reason given for not completing phase 2?

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Understanding the structure of the Methods section: Outcomes of a 2-phase
RCT of early class II treatment
The Methods section answers these general questions:
What was done? What did the researchers look for? How was it done?
But many details are included in the answers to these simple questions so that other groups may reproduce
the study. Information about the following features of the study should be clearly presented in this section:
● study design outcome measures
● setting ethics approval
● study population: size; group divisions consent
● inclusion/ exclusion criteria; data analysis
● procedures: intervention; materials timing; follow up, etc. applications
I Read the Materials and Methods section of the article, Outcomes in a 2-phase RCT of early class
II treatment by Tulloch et al. Find the parts of the texts that relate to the items listed above.
MATERIAL AND METHODS

This study, conducted at the University of North Carolina over 10 years and concluded in 2001,
was a multi-phase, parallel, randomized trial designed to examine the 2 major strategies used to
treat Class II malocclusion: early treatment in the mixed dentition before adolescence, followed
by a second phase of comprehensive treatment in the permanent dentition; and 1-phase
5 treatment during the adolescent growth spurt and early permanent dentition. Children with
overjet of 7 mm or more, still in the mixed dentition, developmentally at least a year before
their peak pubertal growth, and who had received no previous orthodontic treatment, were
enrolled. A moderate range of vertical problems was included, but children with extreme
vertical disproportions (2 standard deviations from published norms) 8 were excluded.
Consent and assent were obtained before randomization.
10
During the first phase of the trial, the children were randomly assigned, by using block
randomization with sex as the stratification factor, to treatment starting in the mixed dentition
(either combination headgear or a modified bionator) or to observation only. A second phase of
comprehensive fixed appliance treatment was planned for all the children when they were in
15 the early permanent dentition. Initial records were taken only after each child had been
randomized to 1 of the 3 groups. Early treatment appliances were delivered within a month of
the initial records. Phase 1 treatment was carried out under the care of a single faculty
orthodontist according to a standard protocol. Records for all children were repeated after 15
months, and the children were then randomized, within their phase 1 treatment group, to 1 of 4
20 orthodontists for completion of orthodontic treatment. The randomization schedules were
maintained in a computer file, and the early treatment group assignment was e-mailed to the
research associate in response to a query as each new subject was added. The report for the
skeletal and dental changes observed in the 3 groups during phase 1 was published in 1997.6
The overall design of the 2 phases of the clinical trial is shown in Figure 1, and patient flow
25 through these 2 phases is described in Table I. This article describes the skeletal and dental
measures observed at the end of comprehensive treatment in the permanent dentition (phase
2) and the treatment outcomes as indicated by PAR scores, the time in treatment, and the
percentages of children requiring more complex treatment involving extractions or
orthognathic surgery.
30 It was hypothesized that differences between treating clinicians might have a greater impact on
subsequent clinical outcomes than would the effect of early growth modification. For this
reason, at the end of phase 1, a second randomization to 1 of 4 clinicians (all orthodontic full-
time faculty) was performed. The child’s early treatment group was used as the stratification
Page 60 of 95
35 factor, so that each of the 4 participating clinicians would provide treatment for approximately
equal numbers of boys and girls (sex was the stratification factor in phase 1) who had or had
not received early treatment. The stratified block randomization was performed in blocks of 8
patients with Proc Plan in SAS.9 The randomization sequence was prepared by the study
biostatistician and given to the study coordinator, who was responsible for assigning subjects to
the next clinician on the list. The allocation sequence was concealed from the clinicians.
40
The criteria for inclusion in phase 2 were completion of phase 1 of the trial and a clinical
assessment that comprehensive orthodontic treatment was warranted. Of the 166 children who
completed phase 1, only 4 (all in the functional appliance group) were judged not to need
further treatment. An additional 17 children failed to return for phase 2 evaluation, and 6
moved during phase 2 treatment (Table I). Two children were not treated at any time by 1 of
45
the 4 finishing clinicians and were excluded from the efficacy analyzable analysis. The retention
rate for completion of the phase 2 portion of the trial was 82.5%.
In the second phase of the trial, all subjects were treated by a full-time faculty member, using a
complete edgewise appliance. The clinicians had from 5 to 30 years’ experience. Two of the 4
50 were diplomates of the American Board of Orthodontics. Each was instructed to follow his or
her own clinical techniques to produce the best possible result for the patient. There were no
restrictions on any treatment methods. Although records were taken at 15 months, patients
were not randomized to their phase 2 orthodontist until they were in the early permanent
dentition, and phase 2 treatment began after that at the orthodontist’s discretion. Headgear or
functional appliance treatment continued for some patients while waiting for the permanent
55
teeth to erupt; 45 children (26 in the control group, 11 in the functional group, and 8 in the
headgear group) had some interim treatment (eg, transverse expansion of the maxillary arch)
as a part of their early phase 2 treatment.
Because of faculty turnover, 19 patients (14%) experienced a change of clinician during phase 2
of the trial. From one-third to three-fourths of their phase 2 treatment time was spent with the
60
second clinician. Because the primary outcomes of the research project related to the clinical
completion of phase 2 treatment and therefore were under the management of the second
clinician, patients were categorized according to the finishing clinician for analysis purposes.
Records were taken for each patient at the end of phase 1 and at the completion or
65 discontinuation of comprehensive treatment. The cephalometric measurements were obtained
from conventional cephalometric radiographs taken at the end of phase 2 by the same
radiographer on the same machine, using a standard technique. Each cephalogram was traced
and digitized, by using the UNC 140-point model, by 1 of 2 experienced research technicians,
who were masked to the early treatment group when analyzing the final cephalogram.
Measurements were made by using an x-y coordinate system, established with the sella-nasion
70
line rotated down 6° anteriorly as the horizontal reference, and the vertical reference a line
through sella perpendicular to the horizontal reference. The method error for the landmarks
ranged from 0.21 mm (maxillary incisor tip) to 0.73 mm (pogonion).
The primary treatment outcomes of the study were a restricted set of 11 cephalometric
75 measures used to describe the position and relationship of the maxillary and mandibular
skeletal and dental units. We limited the number of variables to decrease the redundancy
among many of the available cephalometric measures and to reduce the likelihood of a chance
false-positive finding. Secondary treatment outcomes included the alignment and the occlusion
of the teeth, the duration of treatment, and the complexity of treatment measured as the
extraction rate and the number of patients receiving orthognathic surgery.
80
The alignment and the occlusion of the teeth were assessed with the peer assessment rating
(PAR).10 All dental casts were scored independently at the start of phase 1, the end of phase 1,
and the end of phase 2 by 2 experienced raters. When disagreements occurred, either between
raters or between sessions, they were resolved by discussion. The raters were masked to early
treatment group when evaluating the dental casts from the end of phase 2. The PAR score for
Page 61 of 95
85 each patient at the 3 times was also categorized as excellent (≤ 5), satisfactory (6-10), or less
than satisfactory (>10) by using the guidelines suggested by Richmond et al.11
The time for completing orthodontic treatment was measured first as the time in months
between the placement of any appliance after phase 1 and the date the patient was debanded.
Because some patients had interim appliances before a complete fixed appliance was placed,
treatment time was also recorded as the time in full fixed appliances, excluding any interim
90
appliance.
The extraction rate was calculated as the number of patients in each group having any
permanent teeth, excluding third molars, extracted to facilitate orthodontic treatment. The
surgery rate was the number of patients receiving orthognathic surgery during the trial, either
95
at UNC or elsewhere. In addition, patients were subjectively assessed on completion of phase 2
as needing surgery on the basis of their finishing skeletal and dental relationships. They are
included as a separate category of patients who might have benefited from surgery but did not,
for different reasons, proceed with this plan.
As is frequently done in clinical trials, 2 groups of patients were defined for analysis, an “intent
to treat” (ITT) sample, which comprised all patients (n =166) who had completed phase 1, and
10
0 an “efficacy analyzable” (EA) sample (n=137), which comprised only patients who completed
phase 2 with 1 of the 4 finishing clinicians. Data for the ITT group were imputed with
regression coefficients (Appendix). The level of significance was set at 0.01 for all analyses.
We evaluated the equivalence of the 4 groups finished by the 4 clinicians in several ways. For
the proportion of patients in each early treatment group and sex, the chi-square test was used,
10
5 and for age, the Mantel-Haenszel row mean score statistic was used. A multivariate analysis of
variance (ANOVA) on maxillary, mandibular, interjaw, and dental measures was used to assess
the similarity of these physical characteristics. The multivariate findings were confirmed by a 1-
way ANOVA on each measure. As Table II shows, the 4 groups categorized by the finishing
clinician were quite similar in all characteristics at the beginning of phase 2. A factorial ANOVA,
11
with sex, finishing clinician. and early treatment group as the explanatory factors, was used to
0 assess each end-of-phase-2 cephalometric measure, the PAR score, and the ranked values of the
treatment time measures (Appendix). Comparisons between pairs of treatment groups or
clinicians were performed with the least-squares comparisons in Proc GLM in SAS (Cary, NC).
The proportion of more complex treatments and the proportion of “less than satisfactory”
results were compared among the early treatment groups with the Mantel-Haenszel chi-square
test.

Page 62 of 95
UIC/ Idiomes/ Anglès Objective to practice assessing the methods section
ASSESSING THE METHODS
I Analyzing the Methods section

Answer each question about the methods described in the article, Outcomes in
a 2-phase RCT of early class II treatment. Indicate the part of the text (text
line number) that supports your answer.
Example:
Line ___2___ What is the study design of the study, Outcomes in a 2-phase RCT of early class II
treatment? A multi-phase, parallel, randomized controlled trial
1. Line ______ Did the researchers anticipate withdrawals from their study?
● If so, what methods did they use to account for their data?
2. Line ______ Describe the inclusion and exclusion criteria of this study.
3. Line ______ How many treatment groups were there?

● Indicate the treatment for each group.
4. Line ______ What was the treatment timeline?
5. Line ______ Were any individuals involved in this study blinded?

● Who and how?
6. Line ______ How were the participants randomized into groups?
7. Line ______ Did the relevant participants sign consent forms?
8. Line ______ Were there any procedural changes that occurred?
9. Line ______ Was the allocation to treatment concealed? How?
10. Line ______ What were the outcome measures of this study?
11. Line ______ What were the exact procedures that the practitioners carried out for each treatment?
● On a scale of 1-10, with 10 being the highest score, rate the thoroughness of the
authors’ reporting of the treatments used in this study. Justify your answer.

Page 63 of 95
II Describing outcome measures and assessment procedures.
How often were they

Outcome measures By what means were they assessed? When were they assessed?
assessed?
III Analyzing the methods section of your article

Answer each of the questions in Task I about the methods described in your article. Indicate the
paragraph and line in which you found your answers.

Page 64 of 95
UIC/ IfM/ BCER Objective to analyze the purpose, content and discursive style
Ciències de la salut mld.11.04.18 common to results sections in original research papers.
THE RESULTS SECTION: THE HUB OF AN ORIGINAL RESEARCH PAPER

I Pre-reading. The table below shows the raw data of a study investigating research themes
about medical students. Review the data to predict the types of observations and patterns that the
researchers most likely reported in their study.
Domes
tic Internatio
Theme
(Korea nal Discussion
)
Adjustment 3 -
Anxiety - 3
Attribution 1 - Discuss any patterns you discerned among the data.
Burn out 5 2
Career value 1 - How might these data be organized to highlight your
Coping 1 2 observations?
Depression 6 9
Drinking - 2 Besides tables, what does the results section typically
Drop out 3 1 include? How does this section differ from the other
Ego resilience 1 - ones?
Emotion 1 1
intelligence The results section is usually the shortest section of
Empathy 2 1 an original research paper. Why do you think it is not as
Entering - 3 long as the other sections?
motivation
Ethical belief 1 -
Family variable - 1
Fatigue 1 -
Explain the metaphor used in the title of this document
Happiness 1 -
(The results section: the hub of an original research
Health perception - 2
paper). Describe what each component of the hub might
represent.
Interrelationship 4 1
Leadership - 1
Learning attitude 3 -
Learning 1 4
motivation
Learning strategy 5 -
Learning style 1 3
Major satisfaction 1 -
Mental 1 2
Motivation - 1
Perfectionism 1 -
Performance goal 1 1
Personality 4 1
Personality/trait 1 2
II Reading. Read the text on the next page (page 65) about the purpose, content and discourse commonly
associated with results sections in original research papers.

Page 65 of 95
The purpose, content and discursive style of result sections
Although the results section tends to be shorter than the other sections, it can be
considered the nucleus of an original research paper. This section presents new
data that were obtained from the procedures described in the methods section,
and that will provide the basis for conclusions, articulated in the discussion
5 section, in response to the research questions outlined in the introduction section.
In the results section the findings of the present study are systematically and
clearly stated as they were found; no interpretations of the data are proposed—
this is reserved for the discussion section. At the same time, the results section is much more than a list of numbers
thrown to the readers to decipher themselves. The authors accompany readers to narrate the data that emerged from
1 their work. The purpose of this section as well as the combination of its differentiating features has implications for
0 its content and discursive style. Some main characteristics that are common to results sections in scientific papers are
summarized below.
Content
Most results sections comprise two distinct elements: the textual component and data graphics, such as tables, figures
and graphs. In the text, a description of the results include observations that are most relevant to the topic under
1
5
investigation are highlighted. The text summarizes the general patterns and trends and describes important statistical
details.
Tables, figures and graphs are visual elements that can present detailed results and complex relationships, patterns,
and trends clearly and concisely. The story in these data graphic tools should be narrated by parenthetically
referencing them when describing patterns seen in them. Graphics are used to increase reading efficiency by
enhancing readers’ understanding of the study results and also by reducing word counts (and in turn, reading time.)
2
0 Therefore, information in the text that corresponds to the information shown in tables and figures should not be
redundant. That is, the descriptions should not simply repeat the information listed in the data graphics.
The results should be provided in a logical sequence, often along the time line of the study. If the methods section has
listed procedures or assessments in order, the results section should follow the same sequence. At a more detailed
level, a common organizational move that serves as a rhetorical device to describe the findings comprises 3 steps: (A)
2 State the outcomes, (B) Support with evidence, and (C) Direct readers to figures or tables.
5
Language and discourse
Chatburn (2002) observed that the results of a study do not prove anything. Research results can only confirm or
reject a hypothesis. Evidence cannot draw conclusions; only people, researchers and authors, can. These ideas are
reflected in the results section when it often highlights the data themselves as the agents that produced the
phenomena observed: analysis/ data/ results + found/ showed/ indicated. Emphasis on the findings, rather than
3 the involvement of the researchers, is further noted in the use of the passive voice when referring to observations
0
themselves: an increase of X + was observed/ noted/ detected.
As mentioned earlier, the results section presents findings as they were found, free of researcher bias. Therefore,
descriptions of the results do not generally contain terms or phrases that evoke an emotional tone or influence the
reader towards a certain interpretation of the data presented. The findings are generally announced as neutral
assertions with no use of hedges or boosters. Even when identifying trends or patterns, which requires some
3
5 judgment on the part of the author, these phenomena are considered to be indisputable as evidenced in the data
shown.
The presentation of new data in any scientific paper should be described in past tense, rather than present tense, as
the activity reported pertains specifically to the findings derived under the conditions studied in the research being
presented. This tense use helps to distinguish previously published work from the new data to be evaluated by the
4 reader.
0
Taking a perspective presented in text above, analyze the results (below) reported in an RCT in dentistry education .
Table 4

Page 66 of 95
The results clearly
prove that English for
Dentistry courses
decrease incidence of
dental phobia
among UIC dental
students

Page 67 of 95
III Comprehension and application.
Text line “For example,….”
numbers
a. …… in the observation, Heating the solution increased the rate of solubility of polar solids by 45% but
had no effect on the rate of solubility in solutions containing non-polar solids, researchers draw attention
to a trend they have seen in their data. This point is not debatable. They are just pointing out what the
data has shown.
b. …. the results of the baseline measurement period should be presented prior to the results obtained after
the intervention.
c. ….consider the two statements: Moisture output was greater with system A than with system B. versus
Moisture output is greater with system A than with system B. The latter implies a generalizability to
situations outside of the experiment. This is a subtle but important point.
d. ….in the sentence, Unsurprisingly, subjects with low self-efficacy relapsed sooner than those with high
self-efficacy. The word unsurprisingly is used to provide emphasis or stance about the phenomenon
observed, rather than to merely convey information.
e. ….Watermelon production was 23% [95% CI: 20–26%] higher in plots inoculated with mycorrhizal
fungi as compared to controls (see Figure 2).
… the description, As seen in Table 3, 0,2% of patients reported experiencing no pain during the
f.
treatment; 13% reported having mild pain; 34% reported moderate pain, and 51% reported severe pain.
merely restates data that readers can see in Table 3 without assistance. An observation about the pattern
of pain severity would be expected in the textual component of the results section.
Read through the examples listed in the second column of the table below. Next to each example, write the text line
number(s) to indicate its appropriate location in the text.
The excerpts below were extracted from the same article in which the table in Task I appeared. Read through the texts, and
indicate the article section from which each excerpt was taken. Underline the items in the texts that support your answers.
1. Section ______________________
Based on the results of our analysis, topics about medical students’ mental health were frequently looked into in Korea and
overseas; most were about stress. This indicates that medical students face many mental obstacles in pursuing their
education. However, studies in Korea did not cover drinking, smoking, drugs, or suicide at all; this may reflect cultural
differences. Since these topics can be discovered in the qualitative studies such as in the process of interviewing students
about students’ mental health issues, it is necessary for Korean academic to pay more attention to these matters.
2. Section ______________________
The three elements of education are teachers, learners, and contents. Since the subject of educational activities is for the
learners, it is important to understand the characteristics of the learners before the educational activities are started. The
characteristics of learners refer to behavior characteristics of them. This is largely divided into cognitive and affective
characteristics. Information on learner characteristics is important because it directly or indirectly influences the development
of curriculum, deciding on teaching methods, and guiding students [1]. Furthermore, students have different personalities or
motivations depending on their generation to which they belong [2,3]; this affects teaching methods such as the use of media
technology, or demand for specific instructor guidance and feedback [4,5]. Thus, research on the characteristics of learners is
important in terms of providing the basic data required for the teachers to understand the learners. …….To the best of our
knowledge, no research has analyzed studies on characteristics of Korean or international medical students. Therefore, this
study sought to investigate domestic and international research trends, and execute an in-depth analysis of the findings of
subtopics in this area.
3. Section ______________________
Research trends of studies on medical student characteristics in Korea and overseas by topic are summarized, and mapped
into physical health, mental health, psychological characteristics, cognitive characteristics, social characteristics, and career
(Table 2). Most studies were on medical students’ mental health, 30 from Korea and 34 from overseas. Among subtopics in
mental health, investigations on stress comprised most papers, 10 from Korea and 13 from overseas. Regarding subtopics of
mental health, in Korea, there are no studies about anxiety, drugs, or suicide.
4. Section ______________________
We mapped our review by year of publication, location of research, research design, research subject, objective, research
method, and key results. The topic was categorized according to 6 researchers, who also reviewed key results and made a list
of subtopics based on them.

Page 68 of 95
UIC/ Idiomes/ Anglès Objective to study components of the results section of an RCT in
Ciències de la salut mld.22.11.12 orthodontics
UNDERSTANDING THE STRUCTURE OF THE RESULTS SECTION PT I
STUDENT A
The results section of an article reports the outcome of the study. This section usually includes information
about the following items:
● baseline data—demographic and health-related variables
● number and reason for subject withdrawals, and how the resulting data was calculated
● data described and in graphs and/ or tables
● statistical analyses and comparisons
Skim the Results section of the article, Outcomes in a 2-phase randomized clinical trial of early
Class II treatment. Then decide what the function of each paragraph is.
Now discuss the results with your partner.
Results
There were no differences in the findings between the ITT and EA analyses (Appendix). The data
reported below are from the EA sample, the children who completed phase 2 treatment.
Composite tracings for the 3 early treatment groups before phase 1 and at the end of phase 2 are shown
in Figure 2, and descriptive statistics for the primary cephalometric measures are given in Table III.
5 During phase 2 of the trial, the advantage created during phase 1 treatment in the 2 early treatment
groups was lost, and, by the end of fixed appliance treatment, there was no significant difference between
any of the 3 groups for all anteroposterior and vertical skeletal and dental measures (Table III). The P
values in the table are derived from factorial ANOVA with interactions removed from the final model after
controlling for effects of sex and finishing clinician (see Appendix for full model results).*
1 PAR scores at the beginning of phase 1 and end of phase 2 are given in Table IV, and the percentages of
0 children in each group achieving excellent, satisfactory, and less than satisfactory scores are shown in
Figure 3. There was no difference in average score at the end of phase 2 (P =.35) or distribution of those
achieving excellent, satisfactory, or less than satisfactory scores (P =.59), when comparing the children
who had early treatment and those who did not. There was no statistically significant effect related to the
orthodontist.
1 The total length of phase 2 treatment time including interim treatment after phase 1 and the time spent in
5
fixed appliance treatment excluding interim devices are given in Table V. Comparing the total duration of
treatment beyond phase 1, it appears that this was shorter for patients who had had early treatment
during phase 1. However, the difference in treatment time including interim appliances between the
groups only approached significance (P =.03). When the time in fixed appliances excluding interim
treatment is compared (Fig 4), the average is almost identical for the 3 groups (P =.20). There were
2 significant sex and orthodontist effects for treatment times with and without interim appliances, with
0
boys generally being treated longer in phase 2.
The percentages of patients in each group who had permanent teeth extracted during phase 2 treatment
and the numbers who had orthognathic surgery are shown in Figure 3. The percentage of children who
went on to orthognathic surgery was quite similar in the early treatment and untreated phase 1 groups
2 (P=.69). The percentage of children who had extractions was not statistically significantly different
5 among the 3 groups, but approached the significance level (P =.02). Note the higher percentage of
extractions in the children who had functional appliance treatment in phase 1. For 32 of the 37 patients
who had teeth removed, the extraction pattern was maxillary first premolars with or without mandibular

Page 69 of 95
premolars, the usual pattern to correct Class II malocclusion with tooth movement alone. The other 5
patients had other extraction patterns.
UNDERSTANDING THE STRUCTURE OF THE RESULTS SECTION PT II
STUDENT B
The results section of an article reports the outcome of the study. This section usually includes information
about the following items:
● baseline data—demographic and health-related variables

● number and reason for subject withdrawals, and how the resulting data was calculated
● data described and in graphs and/ or tables
● statistical analyses and comparisons
Skim the Results section of the article, Early treatment for Class II Division 1 malocclusion with the
Twin-Block appliance: A multi-center, randomized controlled (Obrien 2009). Then decide what the
function of each paragraph is.
Now discuss the results with your partner.
Results
One hundred seventy-four patients were enrolled at the start of the project; of these, 89 (41 girls, 48 boys) were
allocated to early treatment, and 85 (39 girls, 46 boys) to later treatment (control). Enrollment started in March
1997 and was completed by August 1999.3 The last data collection was in July 2006. At the start of the study, the
average ages of the children were 9.7 years (SD, 0.98) for the early treatment group and 9.8 years (SD, 0.94) for the
5 adolescent treatment group. The flow of the patients through the study is shown in the Figure. Not all records had
been collected for each patient; this is reflected in the number of subjects reported in the tables. These also show
that data loss was similar for both groups.
Of the patients who had early Twin-block treatment, 13 accepted their occlusion and declined further treatment,
whereas none of the control subjects accepted their occlusion after the 15-month period.
1 The average ages at the start of treatment for the patients who had treatment in the permanent dentition were
0 12.1 years (SD, 1.0) for the adolescent group and 12.41 years (SD, 1.16) for the early treatment group. Apart
from the later start of treatment in the control group, there were also some differences in the appliances used for
the 2 groups. Of those treated early with the Twin-block, 42 (64%) were subsequently treated with fixed
appliances; only 6 (9%) were treated with a further Twin-block and fixed appliances, and 5 (8%) were treated
with a further Twin-block only. In the adolescent treatment group, 45 (61%) were treated with Twin-block and
1 fixed appliances, 14 (19%) with fixed appliances only, and 14 (19%) with Twin-block only. Analysis of
5 extractions showed that 27% of the early treatment group and 37% of the adolescent treatment group had
extractions. However, this was not significantly different logistic regression model, treatment effect: odds ratio
1.32 (95% CI, 0.91-1.90), P 5 0.14.
The cephalometric data are shown in Table I. For the purpose of inclusion of uniform data in systematic reviews, we
also included data using more conventional methods. The means (and standard deviations) for ANB angle at the
2 end of the study were 4.0. (2.0) and 3.8. (2.2) for the early and later treatment groups, respectively. The descriptive
0 data on PAR scores, self-esteem, process, and costs of treatment are included in Table II, with the treatment effects
from the regression models for all continuous primary outcomes shown in Table III. There was no evidence from
the residual analyses that the assumptions underlying the use of multiple linear regression and logistic regression
were not upheld. The results suggest that, after all treatment, the only differences between the groups were
treatment duration and final PAR score; there were no differences in skeletal pattern and self-esteem. The early
2
5 treatment group had significantly higher PAR scores at the end of treatment (P 5 0.002). When we examined the
process data, it appeared that the patients who had early treatment had statistically significantly fewer attendances
in phase 2 than did the adolescent treatment group (P \ 0.001), but when we combined these with the visits that
were necessary in phase 1, they attended statistically significantly more times than did the adolescent treatment
group (P \ 0.016). Similarly, when the duration of treatment was evaluated, we found that the early treatment
Page 70 of 95
3 group had statistically significantly longer overall treatment times than the adolescent treatment group (P \ 0.001).
0 The cost of treatment was also greater (P \ 0.001) for the early treatment group; this additional cost averaged
approximately $900.
Eleven children experienced new dental trauma, 4 (8%) in the early treatment group and 7 (14%) in the adolescent
treatment group. This difference was not statistically significantly different logistic regression model, treatment
effect: odds ratio 1.37 (95% CI, 0.70-2.72), P 5 0.36.
3
5
UIC/ Idiomes/ Anglès Objective to compare findings from studies about early orthodontic
Ciències de la salut mld.28.11.12 treatment for Class II malocclusion
COMPARING DATA WITHIN AND BETWEEN STUDIES
STEP 1a & 1b: Comparing data within a study: Compare outcomes between the treatments
within each study in terms of significance. Write the symbols, > (significantly greater than), =
(similar to--insignificant), or < (significantly less than) in the space provided between 1-phase Tx
and 2-phase Tx.
STEP 2: Comparing data between studies: Compare the findings between the studies.
In the central column, circle ≈ if the findings are similar, ≠ if they are different, and Ø if a
comparison is not applicable.
STEP 1a STEP 2 STEP 1b

Comparison of outcomes Comparison Comparison of outcomes
Outcome
between treatments within the of findings between treatments within the
study between the study
(Tulloch et al.) studies (O’Brien et al.)
> = < ≈ ≠ Ø > = <
Example:
Tooth extraction 1-phase Tx = 2-phase Tx ≈ ≠ Ø 1-phase Tx = 2-phase Tx
(%)
Dental trauma 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
Overall Tx
1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
duration
Surgery (%) 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
Self-esteem 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
Skeletal changes 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
Cost 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
PAR scores 1-phase Tx 2-phase Tx ≈ ≠ Ø 1-phase Tx 2-phase Tx
1. Findings from _____ showed that participants in the early treatment group had shorter duration of treatment
in phase 2 of the study.
a. both studies b. neither study c. Tulloch et al. only d. O’Brien et al. only
2. Which factors that lengthened the phase 2 treatment period were reported? (Circle 2)
a. appliance b. practitioner c. complexity of treatment d. gender e. dental trauma
Page 71 of 95
3. The most common teeth that removed for this type of malocclusion are _____.
a. lower bicuspids b. lower premolars c. upper bicuspids d. upper first molars
4. O’Brien et al. included additional data in a more conventional format (line 28) because they_____.
a. were carrying out a systematic review in this line of research
b. felt the data would be more analyzable for other studies
c. wanted to be able to compare their data with those of Tulloch et al.
d. had not worn conventional orthodontic uniforms systematically throughout the study

Page 72 of 95
UIC/ Idiomes /Anglès Objective to review section-specific content for RCT articles.
THE DISCUSSION SECTION

I Functions of sections. From the list below, identify the functions of the Introduction, Methods, and
Results sections. The remaining ones are typical of a discussion section:
a. _____ to compare results to other studies

b. _____ to show how patients were selected
c. _____ to articulate the aim of the study
d. _____ to interpret the findings of a study
e. _____ to give details on patient characteristics
f. _____ to discuss limitations in the study design
g. _____ to provide detailed statistical results of the trial
h. _____ to describe randomization procedures
i. _____ to put the results of this study in context with other research studies
j. _____ to clearly state main conclusions—implications and recommendations for further research
k. _____ to provide the rationale behind the study
l. _____ to distinguish important results from less important ones—statement of main results
m. _____ to describe and justify the outcome measures used in the study
II Identifying functions. The following text is the discussion section from another recent RCT about
early treatment using a twin-block appliance.
● Scan through the section to identify the elements listed above.
● Identify other information that is presented in the text but not included in the list above.
DISCUSSION
These results suggest that there are minimal benefits of early ‘‘functional’’ or ‘‘growth modifying’’
treatment in the transitional dentition. Treatment starting at this age simply increased the number of
patient attendances, and the duration and the cost of treatment, and resulted in poorer final occlusion.
This finding is similar to those of other studies that evaluated the effects of early treatment. In addition, it
5 provides evidence of little difference in the effects of early treatment whether in ideal conditions in 1
dental school or in the real-world setting of specialist care in the United Kingdom. Furthermore, there
does not seem to be a difference in the results of similar studies involving treatment with the bionator
and this study with the Twin-block.1,2
Although we can suggest that early treatment has limited advantages, we should consider the interim
1 findings
0
immediately after early treatment. These showed that early treatment results in reduction in overjet,
favorable (but small) change in skeletal pattern, and meaningful improvement in the self-esteem of the
treated group. As clinicians, we must evaluate whether the additional course of treatment justifies these
interim changes that are not necessarily stable.
A relevant finding was that 13 patients in the early treatment group declined further treatment; they
1
5 were satisfied with their occlusion. Because we did an intention-to-treat analysis, and they remained in
the data analysis, they did not influence the overall effectiveness of treatment for any analyzed variable.
Nevertheless, we can conclude that 1 benefit of early treatment is that almost 15% of the patients did not
need more complex treatment in adolescence. Whether this justifies early treatment for a child with a
Class II Division 1 malocclusion can be determined by the patient, the parents, and the orthodontist.
2
It was interesting to find clinical differences between the 2 groups in PAR scores, since the final occlusal
0 result for the patients who received early treatment was inferior to that of the adolescent group. When we
compared this finding with another clinical trial of early treatment, we found some differences between
the studies.22 First, our patients’ pretreatment PAR scores were higher, suggesting greater severity of
dental malocclusion. After treatment, our adolescent group had a score that was similar to those of
Page 73 of 95
studies in the United States; however, our early treatment group was not finished to such a high
2 standard.1,22 It is difficult to suggest reasons for this, since differences are unlikely in the operators’
5 expertise in the 2 countries. One reason could arise from the different systems of payment in the United
Kingdom, with care provided at no direct cost to the patient or the parent. It might be that payment
influences the motivation of US patients and that the early treatment group maintained high levels of
cooperation. In the United Kingdom, the burden of 2 courses of treatment might have caused patient
burnout, and cooperation was lost. This, however, is purely conjecture.
3
0 Most of the adolescent group also had a Twin-block functional appliance followed by fixed appliances;
some of these patients were also still in the late mixed dentition at the start of treatment. The differences
in the results can therefore be attributed largely to the older age at which the adolescent group started
treatment rather than to a fundamentally different modality of treatment.
Importantly, this and other studies provide information that we should use as evidence to our patients on
the effects of treatment. They and their parents can now make an informed decision on whether to
3 undergo the additional effort and cost of an earlier start of treatment, which necessitates a midtreatment
5
pause and provides no long-term benefit, when compared with 1 course of treatment during adolescence.
III Analyzing content and language

1. Find examples in the Discussion above of the following actions:
a. Outlining clinical applications of the findings
b. Comparing the findings with those from other studies; expanding on or offering an explanation for any
differences observed.
c. Drawing attention to a potential source of bias; explaining how it was dealt with or the possible effect
on the results and the implications.
d. Presenting the answer to the main research question.
e. Highlighting findings, some of which might be surprising, and providing possible reasons for the
finding.
2. Compare the type of language/ discourse used in this section compared to that used in the Results
section. Find examples of the “authors’ voice” or episodes where they make their stance visible.
IV True or False. Read the statements below. Locate the part of the discussion section above that
relates to the statement. Circle True or False based on the content. Correct the False statements.
1. TRUE FALSE According to the authors, low compliance rates in the US may be associated with
financially-driven motivation.
2. TRUE FALSE Based on the findings from this study, early treatment may be warranted in most
cases despite the additional cost and efforts reported.
3. TRUE FALSE Apparently, early treatment does not require highly specialized skills for it to be
effective.
4. TRUE FALSE In this study, a higher level of treatment complexity was associated with the 1-phase
treatment.
5. TRUE FALSE The researchers claim that the Twin-block is not an appropriate appliance for a 2-
phase treatment due to the age of when it is placed.
6. TRUE FALSE The authors feel that there is no disparity between the US and UK orthodontists’ skills
and knowledge.
7. TRUE FALSE The experimental treatment of this study was more efficient than but as effective as
the control treatment.
8. TRUE FALSE This study corroborates evidence reported in previous studies.
9. TRUE FALSE The interim results of this type of study are good predictors of the second phase outcomes.
10. TRUE FALSE The word, this (line 30) refers to patient burnout.
11. TRUE FALSE The lower the PAR score, the higher the degree of malocclusion.

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UIC/ IfM/ Anglès Objective: to review content and discourse commonly
Ciències de la salut mld.27.11.18 included in the Discussion section.
The Discussion Section: dos and don'ts

I Dos and don’ts when writing a Discussion section. The following items are compiled guidelines related to writing a
Discussion section. Write DO, if you believe the item is a recommended practice, and DON’T if it is not recommendable.
1. _____ Criticize previous studies.

2. _____ Discuss results that were not mentioned in the results section.
3. _____ Explain surprising evidence that your study yielded.
4. _____ Indicate what may have hindered answering the questions.
5. _____ Offer alternative explanations of the data that emerged.
6. _____ Report the results presented in the Results section.
7. _____ Suggest how the findings of the present study might be applied to the current context.
8. _____ Use hedging or boosting devices.
9. _____ Use personal pronouns, such as we.
10. _____ Use the passive voice rather than the active voice.
II Reporting the limitations of a study. The following items are suggestions proposed by Puhan et al. (2012)
regarding the information to include when outlining the limitations of a study. The table that follows contains
explanations that expand on each suggestion. Match each suggestion with an item from the table.
1. _____ Report on all limitations that may have affected the quality of the evidence being presented,
including aspects of study design and implementation.
2. _____ Give the authors' view on how the limitations impact on the quality of the evidence and
discuss the direction and magnitude of bias.
3. _____ Do not restrict the discussion of limitations to aspects of internal validity and discuss where
the limits of applicability of the results may lie.
4. _____ Discuss the strengths of the study that may counterbalance or outweigh (some of) the limitations.
5. _____ Provide suggestions for future research specifically overcoming the limitations of the current study.
TABLE
a. Authors may also consider describing how their study could be repeated and conducted differently to avoid some of the
limitations. Articles acknowledging and putting into context all potentially relevant shortcomings could help shape the research
agenda and may be more likely to be cited because they inform the design and conduct of future studies.
b. Be explicit about the rigor and soundness of the study, in particular how it was implemented, and do not limit the discussion of
this aspect to general statements about study design.
c. For example, a recent study reporting on the association of quality of life of elderly people with nursing home placement and death
discussed the potential mechanism of a selection bias by economic status. The authors concluded that a selection bias based on
economic status was unlikely because access to health care, and thus selection into the study, did not depend on economic status
d. For readers, it is important to learn about potential barriers for applying the evidence, generated in scientific studies, to practice.
This requires a discussion of the setting in which the study took place, how and why the results may differ in another setting
(potential effect modification) and what barriers may exist to adopt new interventions or diagnostic procedures in a setting that is
different from the research setting
e. Readers depend on a candid communication by the authors and may get the impression that the investigators were naive if they are
not reported. If space is limited an online appendix could be considered that describes the limitations as well as their potential
implications in more details.

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Identifying IMRaD article sections
The following sentences have been extracted from different parts of an article entitled, Comparison of arch
dimension changes in 1-phase vs 2-phase treatment of Class II malocclusion. Read and categorize each
extract according to the article section to which it belongs.
A. _____ Although reports have shown that Class II correction can be obtained during an early phase of
treatment, the final outcome after full orthodontic appliances appears to be similar to those who did not
undergo an early phase of treatment irrespective of how it is measured. We found 1 exception: there were more
extractions during phase 2 in the observation group. This is contrary to results from a similar study that found
no difference in extraction rate between similar groups.
B. _____ Analyses were run to determine the maxillary and mandibular arch depths, intercanine and intermolar
widths, and arch perimeters anterior to the first molars. Arch area was determined by connecting the cusps of
the first molars and the canines and the midpoints between the central incisors.
C. _____ At the start of the study, the subjects in the 3 groups had similar characteristics.In phase 2, there were
more subjects in the early treatment groups who elected no phase 2 treatment than in the control group (P =
0.0077). Likewise, fewer phase 2 extractions were performed in the early treatment groups than in the control
group (P = 0.0300). Some subjects were lost as the study progressed; about 80% completed full orthodontic
treatment (phase 2).
D. _____ Chi-squared tests for categorical variables and analysis of variance (ANOVA) were used to test for
early treatment group differences in subject characteristics and baseline cast dimensions.
E. _____ This study supports the notion of sexual dimorphism with respect to arch width increases as noted
previously, with greater increases for boys.
F. _____ Dental arch changes during growth or after treatment are of interest for orthodontists.
G. _____ Each set of models (maxillary and mandibular) was photocopied by placing the models facing the glass
surface of the photocopying machine and having as many teeth touch as possible. The models were
photocopied at a 1:1 ratio, with the only distortion coming from the machine itself. All models were copied on
the same machine by the same investigator (J.R.W.), who was blinded to treatment group.
H. _____ Few studies have examined dental arch changes in patients undergoing phase 1 treatment for a Class II
malocclusion and then full orthodontic treatment. Common phase 1 treatment appliances include headgear and
bionator. Headgear can increase arch length in the maxilla by distalizing the molars during early treatment.
I. In the mandibular arch, DC1 measurements and DC time points were significant in all models (P <0.0001 in all
cases). When modeling mandibular intercanine width (model 1 in Table III), those with mandibular extractions
had significantly larger canine width (P = 0.0188), with extraction contributing approximately 1.32 mm. No
treatment group effects were found (P = 0.93).
J. _____ Maxillary and mandibular cast measurements at DC1 were similar for all 3 treatment groups. Changes
from DC1 values in mandibular and maxillary cast measurements are shown in Fig 3 and Fig 4, respectively.
K. _____ Since previous studies have shown that functional appliances produce mostly dental alveolar changes,
the purpose of this study was to determine the changes in arch dimensions in subjects who underwent phase 1
treatment with either bionator, headgear/biteplane, or no treatment, and then full fixed appliances and
posttreatment retention.
L. _____ The method of digitizing photocopies of dental casts used in this project was shown to be accurate. The
shortcomings of this method are that landmark identification might be inconsistent across time because of
worn cusps or damage to the models; 3-dimensional changes were evaluated with an instrument that can only
determine 2-dimensional changes. Also, we evaluated changes relative to chronologic time and not to dental
age.

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UIC/ Idiomes/ Anglès Objective to practice using CONSORT criteria to assess the methods
Ciències de la salut mld.08.11.12 section of an orthodontics RCT
THE CONSORT STATEMENT

THE CONSORT CHECKLIST
The CONSORT Statement is intended to improve the reporting of a randomized controlled trial (RCT),
enabling readers to understand a trial's design, conduct, analysis and interpretation, and to assess the validity
of its results. It emphasizes that this can only be achieved through complete transparency from authors.
Investigators and editors developed and revised the CONSORT (CONsolidated Standards of Reporting
Trials) Statement to help authors improve reporting of two-parallel design RCTs by using a checklist and
flow diagram. The most up-to-date revision of the CONSORT Statement is CONSORT 2010, which can be
freely viewed and downloaded from this website. All previous versions of the CONSORT Statement are out-
dated.
The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, Discussion,
and Other information. The checklist includes the 25 items selected because empirical evidence indicates that
not reporting the information is associated with biased estimates of treatment effect, or because the
information is essential to judge the reliability or relevance of the findings.
The flow diagram is intended to depict the passage of participants through an RCT. The revised flow
diagram depicts information from four stages of a trial (enrollment, intervention allocation, follow-up, and
analysis).
The diagram explicitly shows the number of participants, for each intervention group, included in the
primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have done
an intention-to-treat analysis.
www.consort-statement.org/
The CONSORT Checklist: Assessing the methods section of an RCT in orthodontics research
1. Read through the checklist section that corresponds to RCT methods. Review the vocabulary.
2. Discuss why each of the items listed should be reported in an RCT.
3. Skim through the Methods section of the article, Outcomes in a 2-phase randomized clinical
trial of early Class II treatment.
a. Scan for the items listed in the CONSORT checklist.
b. If an item is present, write the paragraph & line number in the space provided in the
checklist.
c. Also rate the reporting of the item (1=poor to 3=good). Consider the clarity and
thoroughness of the description.
4. Compare your results with other students.

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Page 78 of 95
Page 79 of 95
CONSORT 2010 FLOW DIAGRAM
Enrollment
Assessed for eligibility (n= )
Excluded (n= )
Not meeting inclusion criteria
(n= )
Declined to participate (n= )
Other reasons (n= )
Randomized (n= )
Allocation
Allocated to intervention (n= ) Allocated to intervention (n= )
Received allocated intervention (n= ) Received allocated intervention (n= )
Did not receive allocated intervention Did not receive allocated intervention
(give reasons) (n= ) (give reasons) (n= )
Follow-Up
Lost to follow-up (give reasons) (n= ) Lost to follow-up (give reasons) (n= )
Discontinued intervention (give reasons) (n= ) Discontinued intervention (give reasons) (n= )
Analysis
Analysed (n= ) Analysed (n= )

Excluded from analysis (give reasons) (n= ) Excluded from analysis (give reasons) (n= )

Page 80 of 95
UIC/ IfM/ Anglès Objective to review CONSORT checklist ítems applied to
Ciències de la salut mld.13.11.18 the Methods Section of Orthodontic RCTs
The CONSORT Checklist applied to Orthodontic RCTs
The following sentences have been extracted from Orthodontic RCT articles. Read each text and
identify the CONSORT checklist item number (from the Methods section) that it represents.
Example:
1. 8b “ in random permuted blocks of 20 patients, ensuring equal distribution in the 2 groups.”
2. _____ “All patients received a soft bonded lingual retainer of 0.022-in (Tru-Chrome multi-stranded wire; Rocky Mountain
Orthodontics, Denver, Colo) that was fabricated intraorally. In the chemical polymerization group, Maximum Cure 2-part
liquid adhesive (Reliance Orthodontic Products, Itasca, Ill) was mixed and applied on the wire and the teeth, and Excel 2-part
paste (Reliance Orthodontic Products) was mixed, loaded on a syringe dispenser, and applied.
3. _____ “Allocation concealment was achieved with sequentially numbered, opaque, sealed envelopes containing the
treatment allocation cards, which were prepared before the trial.”
4. _____ “Baseline information was written on the outside before opening the envelope. The practice manager was responsible
for opening the next envelope in sequence and implementing the randomization process.”
5. _____ “Blinding of either patient or operator was not possible.”
6. _____ “Blinding of either patient or operator was not possible; however, outcome assessment was blind because it was not
possible to distinguish the light cured from the chemically cured composite.”
7. _____ “Comparisons of the survival of lingual retainers bonded with the 2 techniques were carried out with statistical
methods for survival analysis. The log-rank test was used and Kaplan-Meier plots were produced. Hazard ratios (HRs) and
associated 95% confidence intervals (CIs) were calculated using Cox regression modeling. The Nelson-Aalen plot was used
to assess the proportional hazards assumption”
8. _____ “Consecutive patients who had completed orthodontic treatment with fixed appliances were recruited at the private
practice of the first author (N.P.) from April 2009 to November 2010.”
9. _____ “No changes to the methods after trial commencement occurred.”
10. _____ “Not applicable.”
11. _____ “Randomization was accomplished by using the “-ralloc-” command20 in Stata software (StataCorp, College Station,
Tex).”
12. _____ “The following selection criteria were applied: no active caries, restorations, or fractures on the mandibular anterior
teeth; no periodontal disease; and adequate oral hygiene.”
13. _____ “The main outcome was any first-time failure of the lingual retainer. The secondary outcome was the pattern of
failure based on the adhesive remnant. The patients were advised to visit the orthodontist initially at 1, 3, and 6 months after
retainer placement, followed by scheduled appointments at 12, 18, and 24 months. When scheduled appointments were
unfeasible, particularly approaching the end of the trial, an assessment of retainer integrity was made over the telephone.”
14. _____ “This was a parallel-group, randomized, active controlled trial with a 1:1 allocation ratio.”
15. _____ “Calculation of sample size was based on the ability to detect a clinically relevant difference in the risk of first-time
failure (primary outcome) of 20% between the 2 trial arms (15% vs 35% with a 5 0.05 and power of 85%). Foek et al found a
35% failure rate for light-cured lingual retainers; we used this value as our reference for the sample calculation. This
calculation indicated that 93 participants were required in each arm; this was rounded up to 110 to account for losses to
follow-up.”

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ANSWERING RESEARCH QUESTIONS 1
Read the following abstract.
Int J Paediatr Dent 2001 Nov;11(6):430-9

The relationship between erosion, caries and rampant caries and dietary
habits in preschool children in Saudi Arabia.
Al-Malik MI, Holt RD, Bedi R.
OBJECTIVES: The aim of this study was to investigate the possible association between dental
erosion and caries, and variables including socio-economic status, reported dietary practices and
oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study
including dental examination and questionnaire survey was carried out at a number of
kindergartens. SAMPLE AND METHODS: A sample of 987 children (2-5-year-olds) was drawn
from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a
trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors
was drawn from questionnaires distributed to the parents through the schools. These were
completed before the dental examination. RESULTS: Of the 987 children, 309 (31%) showed signs
of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%).
Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup
from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion.
Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a
larger number of significant factors including socio-demographic measures and oral hygiene
practices. CONCLUSIONS: There was no clear relationship between erosion and social class, or
between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating
to both erosion and caries and/or rampant caries were found in this sample of children.
Discussion. Decide which citation represents the best answer to each research question based on the
information provided in the abstract. Give reasons for your choices.
1. What is the prevalence of dental erosion among young children?

a. Al-Malik et al. (2001) found evidence of dental erosion in 31% of a group of 987 young
children in Saudi Arabia.
b. Al-Malik et al. (2001) reported that of the 987 children, 309 (31%) showed signs of erosion.
c. According to Al-Malik et al. (2001), the prevalence of dental erosion among young children
is 31%.
2. What proportion of the pediatric population has severe caries?

a. In 2001, the prevalence of Saudi children who had severe tooth decay was above 30%.
b. According to a study carried out by Al-Malik et al. (2001) caries were diagnosed in 720
(73%) of the children and rampant caries in 336 (34%).
c. In a sample of young Saudi children studied by Al-Malik et al. in 2001 severe caries was
seen in over a third (34%) of that population.

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3. What dietary habits can lead to erosion?
a. Research has shown that vitamin C supplements, frequent consumption of carbonated drinks and the
drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby are all
related to erosion (Al-Malik et al. 2001).
b. Research has shown that dental erosion can be caused when young children drink too many sweet
drinks (Al-Malik et al. 2001).
c. Research has shown that dental erosion among young children is related to the consumption of
vitamin C supplements or carbonated drinks, and the drinking of sweetened drinks when the child is
going to sleep (al-Malik et al. 2001).
4. What impact do oral hygiene habits have on the presence or absence of dental erosion?
a. Al-Malik et al. (2001) did not find a clear relationship between oral hygiene habits and dental
erosion.
b. Al-Malik et al. (2001) reported that oral hygiene habits had no impact on the presence or absence of
dental erosion.
c. Al-Malik et al. (2001) claimed that there was no clear relationship between erosion and social class,
or between erosion and oral hygiene practices.
5. Should parents be advised not to allow their children to drink carbonated beverages?
a. One study has shown that young children who consume excessive quantities of carbonated drinks
have a higher risk of experiencing caries or rampant caries (Al-Malik et al. 2001)
b. One study has shown that the consumption of carbonated drinks and fruit syrups was also related to
caries but they were part of a larger number of significant factors including socio-demographic
measures and oral hygiene practices (Al-Malik et al. 2001).
c. One study has shown that caries experience among young children was related to the consumption of
carbonated drinks but this relation interacted with other factors such as oral hygiene practices (Al-
Malik et al.2001).
6. Is caries experience related to social class?

a. In a study of a sample of young children in Saudi Arabia, Al-Malik et al. (2001) reported a clear
relationship between caries experience and social class.
b. According to a Al-Malik et al. (2001), there is a reverse relationship between caries and social class.
c. According to Al-Malik et al. (2001), there is a clear relationship between caries and social class.

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U.I.C./ Idiomes / Anglès Objective: To practice answering research questions on
Ciències de la Salut / Dentistry mks.254 the basis of short texts using original phrasing and proper citation
form.
ANSWERING RESEARCH QUESTIONS 2

Look at these examples of citations that use the author-year reference format.
Hickel et al. (2001) report that amalgam restorations have slightly better longevity than composites in posterior teeth.
According to Hickel et al. (2001), amalgam restorations have slightly better longevity than composites in posterior
teeth.
Research by Hickel et al. (2001) shows that amalgam restorations have slightly better longevity than composites in
posterior teeth.
Research has shown that amalgam restorations have slightly better longevity than composites in posterior teeth (Hickel
et al. 2001).
Findings from one study has indicated that amalgam restorations have slightly better longevity than composites in
posterior teeth (Hickel et al. 2001).
On a separate sheet, write one sentence that answers the question or questions that follow each
abstract. Use standard author-date citation format to refer to the source. Practice a variety of
sentence forms, following the models above.
NOTE: This is only an exercise. If you were writing a real scientific article it would not be
acceptable to cite a source only on the basis of reading the abstract. You must cite from an article,
not an abstract, because the abstract is only a summary and does not give a full representation of
the work of the authors.
ALSO: You must use your own words. Avoid copying more than two consecutive words, unless it is
a standard expression such as “scaling and root planing”.
Gerodontology 2001 Dec;18(2):95-101

Clinical and behavioural risk indicators for root caries in older people.
Steele JG, Sheiham A, Marcenes W, Fay N, Walls AW.
OBJECTIVE: To investigate the clinical and behavioural factors indicating root caries risk among older people.
DESIGN: Cross-sectional clinical and interview data from the National Diet and Nutrition Survey (aged 65 years and
over) in Great Britain. Logistic regression models of the prevalence of root caries and linear regression models of the
extent of root caries were constructed to quantify the role of a range of clinical and behavioural risk indicators,
including sugars intake. SETTING: A national sample of older British adults, free-living and institutionalised.
PARTICIPANTS: 462 dentate adults aged 65 years or over. RESULTS: Nine or more intakes of sugars per day more
than doubled the odds of root caries being present (OR 2.2-2.4). Other clinical and behavioural factors affecting root
caries included wearing a partial denture in the presence of heavy plaque deposits (OR 2.1-2.6) and infrequent tooth
brushing (OR 2.8-4.1). Linear regression models showed that, amongst those that had root caries, sucking sweets in the
presence of a dry mouth, poor hygiene, partial dentures and living in an institution contributed to the extent of root
caries, as measured by the RCI(d). CONCLUSIONS: Of the factors open to possible clinical or behavioural
intervention, frequent sugars intake, poor hygiene and partial dentures were all associated with large increases in risk.
1) What impact does life in care institutions have on the orodental health of elder people?
2) What is the relationship between sugar consumption and caries experience?

Page 84 of 95
ANSWERING RESEARCH QUESTIONS IN ORTHODONTICS
I Synthesizing findings. The following abstracts summarize 2 other studies related to 1-phase versus 2-phase
orthodontic treatment. Read them and answer the questions on the next page.
Am J Orthod Dentofacial Orthop. 2007 Oct;132(4):481-9.
Timing of Class II treatment: skeletal changes comparing 1-phase and 2-phase treatment.
Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT.
Department of Orthodontics, University of Florida, Gainesville, Fla, USA
INTRODUCTION: Previous studies reported small but significant skeletal changes as a result of early treatment of
Class II malocclusion with headgear and functional appliances. In this study, we report on the skeletal changes for 1-
phase and 2-phase treatment of Class II malocclusion. METHODS: This was a prospective randomized clinical trial
conducted by the Department of Orthodontics at the University of Florida between 1990 and 2000. A total of 261
subjects demonstrating at least a one half-cusp Class II molar relationship and meeting the inclusion criteria were
enrolled in the study and had at least 1 follow-up visit. During phase 1, 86 subjects were treated with a bionator, 95
were treated with a headgear/biteplane, and 80 served as the observation group. For phase 2, all subjects were then
treated with full orthodontics appliances. Skeletal changes were monitored with cephalograms taken at baseline, at the
end of early Class II treatment or observation baseline, at the beginning of fixed appliances, and at end of orthodontic
treatment. RESULTS: Overall skeletal changes at the end of phase 1 treatment were as follows: (1) SNA angle
increased in the bionator (0.51) and the observation groups (0.67), whereas it decreased (-0.50) in the
headgear/biteplane group; (2) SNB angle increased in the bionator (1.36) and the observation groups (0.84), whereas it
remained unchanged (0.19) in the headgear/biteplane group; (3) ANB angle decreased in the bionator (-0.85) and the
headgear/biteplane groups (-0.72), and was unchanged in the observation group; and (4) the mandibular plane angle
increased (1.30) only in the headgear/biteplane group. By the end of full orthodontic treatment, the skeletal differences
in all measurements for all 3 groups were within 1 degrees . Linear regression models showed that, during phase 1,
baseline value and treatment group were significant. However, when the entire treatment period was considered,
treatment group had no effect. CONCLUSIONS: There is temporary skeletal change as a result of phase I treatment
with both appliances but no detectible skeletal difference between 1-phase and 2-phase treatment of Class II
malocclusion by the end of full orthodontic treatment.
2008 Feb;133(2):245-53
Occlusal outcomes and efficiency of 1- and 2-phase protocols in the treatment of Class II
Division 1 malocclusion.
Cançado RH, Pinzan A, Janson G, Henriques JF, Neves LS, Canuto CE.
Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
INTRODUCTION: The purpose of this study was to compare the occlusal outcomes and the efficiency of 1-phase and
2-phase treatment protocols in Class II Division 1 malocclusions. Treatment efficiency was defined as a change in the
occlusal characteristics in a shorter treatment time. METHODS: Class II Division 1 subjects (n = 139) were divided
into 2 groups according to the treatment protocol for Class II correction. Group 1 comprised 78 patients treated with a
1-phase treatment protocol at initial and final mean ages of 12.51 and 14.68 years. Group 2 comprised 61 patients
treated with a 2-phase treatment protocol at initial and final mean ages of 11.21 and 14.70 years. Lateral cephalometric
radiographs were taken at the pretreatment stage to evaluate morphological differences in the groups. The initial and
final study models of the patients were evaluated by using the peer assessment rating index. Chi-square tests were used
to test for differences between the 2 groups for categorical variables. Variables regarding occlusal results were
compared by using independent t tests. A linear regression analysis was completed, with total treatment time as the
dependent variable, to identify clinical factors that predict treatment length for patients with Class II malocclusions.
RESULTS: Similar occlusal outcomes were obtained between the 1-phase and the 2-phase treatment protocols, but the
duration of treatment was significantly shorter in the 1-phase treatment protocol group. CONCLUSIONS: Treatment
of Class II Division 1 malocclusions is more efficient with the 1-phase than the 2-phase treatment protocol.

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II Drafting an answer. Answer the following research questions by citing the studies on the
previous page as well as the other articles we have read about to this topic.
☞ Remember: it is not acceptable to base answers on abstracts only! This exercise is only for
practice.
1. Is Early treatment for Class II malocclusion more effective than adolescent treatment?
2. Is the 2-phase treatment more efficient than a 1-phase treatment?

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UIC/ Idiomes/ Anglès To practice recognizing in-text citations
Ciêncies de la salut mld.19.11.15
EFFECTS OF RAPID MAXILLARY EXPANSION

CITATION IN DENTISTRY LITERATURE
I Discussion
1. Look at the images below and explain the process of this type of orthodontic treatment.
2. The Rapid Maxillary Expansion technique is considered controversial. Explain to a partner:

a. what you know about rapid maxillary expansion in general.
b. why you think this strategy is controversial.
II Reading. Read the text below.
Class II malocclusion is one of the most common orthodontic discrepancies, and it is likely to
produce significant negative esthetic and social effects on children's lives, affect their dental health,
or predispose them to dental trauma.
Evidence is available to support that Class II, division 1 individuals have smaller transverse
maxillary dental or skeletal dimensions. For this reason, it has been proposed that the treatment of
this malocclusion should comprise previous maxillary expansion. It has been reported that after
expansion, a “spontaneous” correction of the Class II malocclusion takes place as a result of a
forward posturing of the mandible.. However, such observations have mostly relied upon clinical
experience, and the research intended to analyze that question is controversial and presents diverse
study methods.
Therefore, the objective of this investigation was to evaluate the effectiveness of rapid maxillary
expansion (RME) on the sagittal dental or skeletal parameters of growing children with Class II
malocclusion through a systematic review of available clinical trials.
1. This text has been taken from the ______________ section of a study.
2. The text has been taken from a _____ study.

a. experimental b. integrative c. observational
3. Suggest ways to improve this text.

Page 87 of 95
III Citation Practice. The following text indicates the spaces where the missing reference numbers
belong. The references are listed below the text, but they are not in the order in which they appear in the
text. Fill in each blank with numbers that correspond to appropriate references. Two of the references are
used twice.
Class II malocclusion is one of the most common orthodontic discrepancies, a.___ , ___ and it is
likely to produce significant negative esthetic b.___ and social c.___ effects on children's lives,
affect their dental health, d.___ or predispose them to dental trauma. e.___
Evidence is available to support that Class II, division 1 individuals have smaller transverse
maxillary dental or skeletal dimensions. f. ___ , ___ For this reason, it has been proposed that the
treatment of this malocclusion should comprise previous maxillary expansion. g.___ , ___ It has
been reported that after expansion, a “spontaneous” correction of the Class II malocclusion takes
place as a result of a forward posturing of the mandible. h.___ , ___ However, such observations
have mostly relied upon clinical experience, and the research intended to analyze that question is
controversial and presents diverse study methods. i.___ , ___
Therefore, the objective of this investigation was to evaluate the effectiveness of rapid maxillary
expansion (RME) on the sagittal dental or skeletal parameters of growing children with Class II
malocclusion through a systematic review of available clinical trials.
REFERENCES
1 de Almeida AB, Leite IC. Orthodontic treatment need for Brazilian schoolchildren: a study using the Dental
. Aesthetic Index. Dental Press J Orthod. 2013;18:103–109.
2 Kalha AS. Early orthodontic treatment reduced incisal trauma in children with class II malocclusions. Evid Based
. Dent. 2014;15:18–20.
3 Kiekens RM, Maltha JC, van't Hof MA, Kuijpers-Jagtman AM. Objective measures as indicators for facial esthetics in
. white adolescents. Angle Orthod. 2006;76:551–556.
4 Lambot T, Van Steenberghe PR, Vanmuylder N, de Maertelaer V, Glineur R. Early treatment with rapid palatal
. expander and 3D Quad Action mandibular appliance: evaluation of a comprehensive approach in 22 patients [in
French]. Orthod Fr. 2008;79:107–114.
5 Lux CJ, Conradt C, Burden D, Komposch G. Dental arch widths and mandibular-maxillary base widths in Class II
. malocclusions between early mixed and permanent dentitions. Angle Orthod. 2003;73:674–685.
6 Marinelli A, Mariotti M, Defraia E. Transverse dimensions of dental arches in subjects with Class II malocclusion in
. the early mixed dentition. Prog Orthod. 2011;12:31–37.
7 McNamara JA Jr, Sigler LM, Franchi L, Guest SS, Baccetti T. Changes in occlusal relationships in mixed dentition
. patients treated with rapid maxillary expansion. A prospective clinical study. Angle Orthod. 2010;80:230–238.
8 McNamara JA Jr. Early intervention in the transverse dimension: is it worth the effort? Am J Orthod Dentofacial
. Orthop. 2002;121:572–574.
9 McNamara JA Jr. Long-term adaptations to changes in the transverse dimension in children and adolescents: an
. overview. Am J Orthod Dentofacial Orthop. 2006;129(4 suppl):S71–S74.
1 Reddy ER, Manjula M, Sreelakshmi N, Rani ST, Aduri R, Patil BD. Prevalence of malocclusion among 6 to 10 year
0 old Nalgonda school children. J Int Oral Health. 2013;5:49–54.
.
1 Seehra J, Fleming PS, Newton T, DiBiase AT. Bullying in orthodontic patients and its relationship to malocclusion,
1 self-esteem and oral health-related quality of life. J Orthod. 2011;38:247–256.
.
1 Urrego-Burbano PA, Jiménez-Arroyave LP, Londoño-Bolívar MÁ, Zapata-Tamayo M, Botero-Mariaca P.
2 Epidemiological profile of dental occlusion in children attending school in Envigado, Colombia [in Spanish]. Rev
. Salud Publica (Bogota). 2011;13:1010–1021.

Page 88 of 95
Reading comprehension practice about orthodontic research
The effects of shielded brackets on mucosa alteration and comfort in orthodontic patients
Am J Orthod Dentofacial Orthop. 2015 Dec;148(6):956-66.
The effects of shielded brackets on mucosa alteration and comfort in orthodontic patients
in the first 3 days of treatment
Pires LP1, de Oliveira AH1, da Silva HF1, de Oliveira PT2, dos Santos PB3, Pinheiro FH4.
Division of Orthodontics, Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada.
Orthodontic patients can experience pain and discomfort on the oral mucosa from trauma caused by
friction with the brackets and the wires. The aim of this study was to investigate whether brackets with
a self-snapping customized plastic shield would induce less mucosa alteration and discomfort than
those without the shield. The overall sample comprised 42 patients (22 female, 20 male) from a
5 government-funded orthodontic practice, with a mean age of 16.7 years. Eligibility criteria included,
among others, no history of mouth ulcers or systemic diseases. Customized shields for the maxillary
and mandibular brackets were fabricated and inserted on one side of the mouth. The primary outcomes
were mucosal and discomfort assessments. As the secondary outcome, the frequency of spontaneous
detachments of the shields was reported. Treatment allocation was mainly implemented using a
1 random number table for selection of the intervention side. Only the raters in charge of assessing the
0 oral mucosa were blinded to the side of the mouth where the shields had been placed. The mucosa
was assessed by 3 calibrated raters at the following time points: immediately before bracket placement
(baseline assessment, T0), 3 days after delivering the shields (direct assessment of intervention, T1),
and 4 days after removal of the shields (indirect assessment of intervention, T2). The raters used a
newly devised yardstick in which the higher the score, the more severe the alteration. Discomfort was
1
5 assessed at T1 and T2 using a visual analog scale. The Mann-Whitney U test was performed at the 5%
level of significance. Of 60 patients, 42 were eligible, and 35 were randomly selected to have one side
of the mouth receive the intervention. Two patients discontinued the intervention at T1, and 5 stopped
at T2. Seven additional patients were recruited and completed all time points. Thus, 42 patients
participated at T0, 40 at T1, and 35 at T2. Thirty-five patients participated at all time points. At T1, no
2 statistically significant difference in terms of mucosa alteration was observed between the 2 sides
0 (median of all differences [MD], 0.0; 95% CI, 0.0-1.0; P = 0.11). The same occurred at T2 (MD, 0.0;
95% CI, 0.0-0.0; P = 1.00). The comfort level was statistically higher at T1 on the shielded side (MD,
14.0; 95% CI, 1.0-36.0; P = 0.04), whereas no difference was observed at T2 (MD, 0.0; 95% CI, 0.0-
1.0, P = 0.81). No serious harm was observed. The customized bracket shields were effective in
reducing discomfort during the first 3 days of orthodontic treatment despite no significant difference in
2 terms of visible mucosa alteration.
5
Comprehension Questions
1. The word, customized (line 3) most likely means _____.
a. traditional b. alloy c. fabricated according to patient measurements d. fixed
2. The text above is _____.

a. an introduction to an article c. a summary of an article
b. an RCT d. an integrative study
3. Label the abstract sections of the text.
4. This was _____ study design. (Circle 3)

a. a non-experimental c. a cohort e. a split-mouth g. a parallel
b. an experimental d. a case-control f. cross-over h. a sham-controlled
Page 89 of 95
5. Draw a schema and timeline that depict the design and procedures of this study.
6. The authors believed their research was warranted because _____.

a. self-snapping customized shields were effective in reducing pain and discomfort in
orthodontic patients
b. of the occurrence of common side effects observed in some orthodontic treatments
c. no evidence regarding the effects of the treatment under study was available
d. no treatment existed for mucosal pain and discomfort that orthodontic patients
experienced within the first 3 days of bracket placement
7. The authors wanted to _____. (Circle 2)
a. determine if their experimental treatment could reduce pain among orthodontic patients
b. improve their patients’ orthodontic experience as they underwent treatment
c. prove that self-snapping customized plastic shields should be used with brackets and wires
d. demonstrate that brackets and wires lead to pain and discomfort due to a design flaw
e. assess whether their treatment could decrease the incidence of oral tissue lesions
8. All of the participants enrolled in this study ______. (Circle all that apply.)
a. were at risk of developing treatment-related trauma
b. received the experimental treatment
c. were most likely over the age of 16 years
d. were screened for relevant diseases
e. underwent baseline assessments
f. were assessed 3 times
9. The main outcome assessed were _____. (Circle all that apply.)
a. the number of times that the shields detached
b. The Mann-Whitney U test
c. self-snapping customized plastic shields
d. patient perceptions
e. signs and severity of tissue trauma
f. frequency of mouth ulcers caused by the experimental treatment
10. By what means were the outcomes measured?
11. How many times were the outcomes assessed?

Page 90 of 95
12. How many patients were initially recruited and screened for this study?
13. The _____ were unaware of treatment assignment.

a. patients in the treatment group
b. patients in the control group
c. attending orthodontists
d. raters assessing the patient discomfort
e. researchers evaluating mucosa alterations
f. all of the options above
g. none of the options above
h. options a and b only
i. options a, b and c
14. There were _____ drop outs in this study.

a. 0 c. between 5 to 10
b. < 5 d. > 10
15. How did this research team deal with withdrawals from the study?
16. One of the null hypotheses for this study could be _____.
a. the use of self-snapping customized plastic shields will be effective in reducing
incidence of mucosa alteration and pain due to orthodontic brackets and wires
b. shielded brackets will prevent any harmful effects of orthodontic treatment
c. bracket shields will have no effect on treatment-related discomfort or tissue trauma
d. the experimental treatment will lead to a lower rate of failures due to detachments than
those reported in standard treatments
17. The findings showed that the experimental treatment was better in terms of ______
compared to the control.
18. Would you recommend the use of this treatment? Why or why not?

Page 91 of 95
UIC/ Dept of Applied Linguistics/ Anglès Objective: to practice reading research in the field of Orthodontics; to apply
Ciències de la salut mld.10.10.19 knowledge related to research design and randomization methods in reading
comprehension
Testing the use of primer in orthodontic bonding
I Read the following text, and then answer the questions that follow.
Orthodontic bonding with and without primer

Stable bonding between brackets and enamel is essential for effective orthodontic treatment as bracket failure
leads to longer treatment time and has economic consequences for both the orthodontist and patient. While the use
of primer in orthodontic bonding is often recommended to ensure enamel adhesion, there is a lack of high-quality
evidence to support this technique. F To evaluate the incidence of failure of brackets bonded with and without
primer. A single-operator, cross--mouth, randomized controlled trial (RCT). The Orthodontic Department at the
Postgraduate Dental Education Centre, Örebro, Sweden. Fifty consecutive patients requiring
bimaxillary orthodontic treatment with fixed appliances and with an equal number of teeth on each side of the dental
arch, were included in this RCT. A cross-mouth methodology was applied. In each patient, two diagonal
quadrants (i.e. upper right and lower left, or vice versa) were randomly assigned to the primer group and the
contralateral diagonal quadrants to the non-primer group. The randomization process was as follows: A computer-
manufactured block-randomization list was acquired and stored with a research secretary at the Postgraduate Dental
Education Centre. Each time a patient gave consent, the secretary was contacted by e-mail, and information about
which quadrants were to be bonded with and without primer was obtained. All incidents of bracket failure and
debonding noted in patient records during the 2012-14 observation period were compiled by the other co-author, whom
was blinded to the study and did not perform any orthodontic treatment on the study patients. Number of bracket
failures over 18 months. Failure rate without primer was 5.5 per cent and with primer 3.1 per cent; P = 0.063, odds
ratio (OR) 1.89 [95% confidence interval (CI) 0.97-3.68] in the adjusted model. Younger ages (10-12 years), boys,
and mandible were significantly associated with higher failure rates. Interaction tests indicated that younger patients
had significantly higher failure rates without (12.1 per cent) than with primer (4.1 per cent), P < 0.001, OR 3.51 (95% CI
1.93-6.38) in the adjusted model. No failure rate differences between study settings were found for older patients
(13-18 years). Bonding Victory Series™ brackets with Transbond™ XT with or without Transbond™ MIP primer
seems overall to work equally well in a clinical setting, except in younger children where lower failure rate was found in
the primer setting.
1. The headings for each abstract section have been removed from the text above; write the letter that corresponds to each
section into the text to indicate where it begins in the abstract.
a. BACKGROUND d. MAIN OUTCOME MEASURES g. RESULTS
b. CONCLUSIONS e. METHODS h. SETTING
c. DESIGN f. PURPOSE i. SUBJECTS
2. This study used a/ an _____ design. (Circle all that apply)

a. crossover c. experimental e. sham-controlled
b. cross-sectional d. non-experimental f. split-mouth
3. Draw a diagram that depicts the study described in the text. Include the number of treatment groups, the treatments,
number of participants, etc. Explain your diagram to another student.

Page 92 of 95
4. In your own words, explain the randomization procedures of this study.
5. In the trial described in the abstract above, _____ were randomly allocated to a treatment group.
a. 50 patients b. portions of the mouth c. bonding techniques d. 2 teeth
6. The generation of the random allocation sequence was _____.

a. performed by the research secretary c. provided to the orthodontists
b. created by a computer d. was communicated by email
7. Put the following procedures in order according to the sequence of when they occurred:
a. 2 orthodontic referral e. ____ request for group assignation
b. ____ delivery of treatment f. ____ signing of consent forms
c. ____ recording of bracket failure g. ____ allocation to groups
d. ____ storage of randomization sequence
8. The researchers of this study took measures to maintain _____ .

a. allocation concealment c. double-blinding throughout the duration of the trial
b. compliance rates d. both a and c
9. The variable that the researchers studied to determine the effectiveness of the treatments was related to _____ .
a. age of the patients b. treatment duration c. failure rates d. type of primer
10. All of the patients _____. (Circle all that apply)

a. actually needed braces f. were asked to provide a consent form once they were allocated to a
b. lived in Europe group
c. received the control treatment g. were younger than 18 years of age
d. were male h. received treatment in a mandibular quadrant
e. received the experimental treatment i. received treatment in their upper right quadrant
11. On day 1 of treatment delivery, _____ aware of group assignment. ( Circle all that apply)
a. only the patients in the control group were
b. only the patients in the experimental group were
c. all the patients in the study were
d. the co-author who performed the orthodontic treatment was
e. the investigator who did not place the brackets was
12. For how long did the researchers collect their data?
13. For how long were data were collected from each patient?
14. How were the data ultimately accessed in order to carry out an analysis for the results?
15. The study design feature that was used to help ensure uniformity of treatment was related to the _____.
a. population size c. randomization protocol
b. clinical setting d. number of orthodontists placing the brackets
16. The analyses revealed a relationship between bracket failure and _____ among the adolescent population sample.
a. gender
b. use of primer
c. absence of primer
d. none of the above
17. Higher failure rates were observed among the brackets located in the______ arches.
a. lower b. upper c. right side of the d. left side of the
18. How would you explain the cause of the finding described in question 17?
19. Based on the findings reported in this abstract, a primer _____ in orthodontic bonding.
Page 93 of 95
a. should always be used c. use leads to significantly lower failure rates
b. should not be used d. may not be necessary for some patient profiles

Page 94 of 95

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English for Dentistry 2

UIC / Dentistry 2 / 2023-24

UIC / Dentistry 2 / 2023-24

SPECIALIZATION AND CAREER OPTIONS IN DENTISTRY

i. Compare it to general dentistry

c. What are the (dis)advantages of being a specialist?

d. How is a specialty created and developed?

3. List other career options that are available to dentists.

UIC / Dentistry 2 / 2023-24

Use of Specialty Language

Do you speak Orthodontics?

II What is orthodontics and what does it do?

1. Write a definition for orthodontics. Use the phrases below as a guide.

2. How does the concept, Quality of Life, relate to orthodontics.

3. Select the option that best completes the sentence below.

UIC / Dentistry 2 / 2023-24

5. Class II Division 1 malocclusion

6. Class II Division 2 malocclusion

10. dento-alveolar compensation

4. Class III malocclusion

10. midline diastema

UIC / Dentistry 2 / 2023-24

UIC / Dentistry 2 / 2023-24 J.

3. lower facial height

a. The position of deepest concavity on the anterior profile of the maxilla

UIC / Dentistry 2 / 2023-24

UIC / Dentistry 2 / 2023-24

Fixed orthodontic appliance components

I Match each word to a corresponding number in the image below.

archwire bracket hook rubber band tube

E ___ Headgear ___

Now explain the function of each item in the image.

Explain the process of placing orthodontic appliances. Elastic

II Explain the function of each item in the image.

III Describe the process of placing braces.

UIC / Dentistry 2 / 2023-24

UIC / Dentistry 2 / 2023-24

IV Discuss the causes of these movements.

V Draw 3 images depicting movements describe in 3 of the sentences from the

UIC / Dentistry 2 / 2023-24

MOVEMENTS AND FORCES IN ORTHODONTICS

advancement crest forward (x2) space

2. _____________ the molar by ______________ root movement reduces _____________

3. Camouflage, achieved in most cases by extracting premolars and then closing

6. __________________ of anchor teeth can be minimized by arranging the force

7. Surgical _________________ of the mandible.

8. Translation or bodily movement of a tooth requires that the PDL space be

UIC / Dentistry 2 / 2023-24

In St. Louis in 1900, Angle founded the first post-graduate school of

UIC / Dentistry 2 / 2023-24

1. The contributions mentioned above represent important milestones in the growth of

UIC / Dentistry 2 / 2023-24

COMPETENT AND INCOMPETENT LIPS1

I Reading. The text below is an extract of an article about incompetent lips.

1. Define the words in boldface.

3. How many different lip postures are described in the text?

1. Define the words in boldface.

3. What is the most likely source for this publication?

5. What is the overall message of this text?

6. Do you agree with the author’s position? Why or why not?

V Discussing research about lip competence

UIC / Dentistry 2 / 2023-24

E _ Headgear _

2. _ the molar by root movement reduces ___