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Biomedical subjects

C D Stephens

Publications and source records attributed to C D Stephens.

At least 55 records · Page 3Linked to original sources
PubMed1993

Orthodontics in the general dental service of England and Wales: a critical assessment of standards.

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

Analysis of Variance↗
PubMed1993

Consultant opinion on orthodontic treatment plans used by dental practitioners: a pilot study.

Prior to 1987, dental practitioners in England and Wales intending to carry out all but the simplest orthodontic treatment within the National Health Service, were required to submit pretreatment study models, details of the orthodontic assessment and the proposed treatment plan to the Dental Estimates Board prior to starting treatment. Models taken at the end of treatment were required by the Board to enable payment to be made. In this pilot study, the acceptability of orthodontic treatment plans used by practitioners working in the General Dental Services was assessed by eight hospital consultants, using information about 40 cases submitted to the Dental Estimates Board in 1987/88. All consultants considered a high proportion of plans to be unacceptable, but agreement between the consultants was variable and some agreed with one another on very few plans. A single scorer used the weighted PAR (Peer Assessment Rating) index to assess the degree of departure from normal occlusion of both pre- and post-treatment models. Using accepted standards, only nine cases were greatly improved (PAR reduction > 70%) and the mean percentage reduction in PAR score was low. Consultant opinion on the appropriateness of treatment planning was not related to the outcome of orthodontic treatment.

Clinical Competence↗
PubMed1993

The spontaneous effects of lower first premolar extraction on the mesio-distal angulation of adjacent teeth and the relationship of this to extraction space closure in the long term.

This study was undertaken to examine the short- and long-term effects of uncontrolled extraction space closure on the angulation of buccal teeth in the lower arch following the extraction of all first premolars. The sample consisted of 20 subjects (12 males, 8 females). Impressions for study models were taken before premolar extraction (mean age 13 years), at monthly intervals during the first year thereafter, and at long-term follow-up (mean 13 years post-extraction). Measurements were made using the Reflex Microscope. Angulations of teeth (canines, second premolars, and first molars) were measured relative to the occlusal plane and to each other. The findings showed that although teeth tended to tip towards the extraction space, the amount of tipping was small (not exceeding 15 degrees in the majority of cases). The tipping was found to be greatest during the first 6 months following premolar extraction. In the long-term, as spaces continued to close, some uprighting was noted especially in the canine angulation. It is concluded that excessive tipping appears to be the exception rather than the rule in lower first premolar extraction cases.

Adolescent↗
PubMed1993

Attitudes of orthodontic postgraduates to MSc research projects--a retrospective survey.

A questionnaire survey of 103 past orthodontic postgraduate students from seven U.K. institutions, was undertaken to determine the perceived value of M.Sc. research projects in relation to the amount of effort required by students to complete their reports. Seventy-nine (76.7 per cent) replies were received. The majority of the respondents (47, 59.5 per cent) had trained at the Eastman Dental Hospital, although this did not markedly affect the results statistically other than where the graduates were given a choice of MSc subject (P < 0.001). Most postgraduates (42, 54.6 per cent) had found their projects interesting and useful, but 42 (54.6 per cent) claimed to have spent more than 30 per cent of their working time producing them. Forty-four (55.7 per cent) commented that they had problems with the project; of these, there were complaints of insufficient time (23.5 per cent), material (14.7 per cent), data (13.3 per cent), inadequate supervision or direction (26.5 per cent), and interference with clinical time (16.4 per cent). Twenty (25.3 per cent) had carried out further work on their projects, but only three (2.9 per cent) had gone on to complete a Ph.D.

Attitude of Health Personnel↗
PubMed1993

Holograms and study models assessed by the PAR (Peer Assessment Rating) Index of malocclusion--a pilot study.

A selection of 30 sets of study models, representing a wide range of malocclusions, was drawn from the records of a clinical orthodontic department. Four holograms were made of each set of models; the study models and their corresponding holograms were then scored using the Peer Assessment Rating (PAR) Index of malocclusion. Significantly lower scores (P < 0.01) were obtained from the holograms, which were ascribed to three out of the seven components which make up the index.

Calibration↗
PubMed1992

Orthodontics in the General Dental Services of England and Wales: the provision of treatment.

A survey has been undertaken on a representative sample of 1210 patients collected from a 5% sampling procedure employed by the Dental Practice Board. Discontinued cases were excluded from the study. It was revealed that the majority of orthodontic treatment was undertaken by practitioners who had in general been qualified for at least 10 years and, in the main, did not possess an orthodontic qualification. The greater proportion of treatment was undertaken using removable appliances, although fixed appliances were used in 43% of prior approval cases and treatments attracted an average fee of 171 pounds (1988 prices). There was a marked variation in the proportion and type of treatment carried out in the various regions within the General Dental Services.

Certification↗
PubMed1992

Optical disguising of orbital deformity with prism and cylinder lenses.

This paper describes the way in which prism and cylinder lenses may be used to disguise orbital dystopia when the affected eye is blind. The lenses used can correct the height of the eye, the opening of the eyelids or the rotation or slant of the eye. Four cases are presented to illustrated this technique, which may be used either instead of, or as an adjunct to orbital surgery. An investigation of these effects is described using a mannikin head fitted with an optician's trial frame, with measuring by the reflex metrograph. This revealed that an inferiorly displaced eye may be elevated by 4 to 5 mm, that the vertical eyelid opening may be widened (or narrowed) by just under 20% and that an adverse slant of the eye may be rotated in either direction by about 4 degrees.

Adolescent↗
PubMed1992

The development of the PAR Index (Peer Assessment Rating): reliability and validity.

The PAR Index has been developed to provide a single summary score for all the occlusal anomalies which may be found in a malocclusion. The score provides an estimate of how far a case deviates from normal alignment and occlusion. The difference in scores between the pre- and post-treatment cases reflects the degree of improvement and, therefore, the success of treatment. Excellent reliability was exhibited within and between examiners (Intraclass Correlation Coefficient, R greater than 0.91). The components of the PAR Index have been weighted to reflect current British orthodontic opinion and is flexible in that the weightings could be changed to reflect future standards and standards currently being achieved in other countries. The PAR Index offers uniformity and standardization in assessing the outcome of orthodontic treatment.

Bicuspid↗
PubMed1992

The ranking of facial attractiveness.

A method of assessing facial attractiveness is described in which facial photographs were ranked by adults in order from the most to the least attractive. The rankings of a group of normal 10-year-old children were compared to those given to a group of similarly aged patients with repaired clefts. Most previous methods have grouped patients into categories, but this tends to obscure individual differences in facial attractiveness: patients with small differences in appearance are generally placed in the same group. In the ranking technique described in this paper these individual differences were not obscured. Those individuals with repaired clefts were consistently judged as being less attractive than those in the normal group. It is suggested that this method could be further developed to assess the cosmetic benefit produced by treatment of facial deformity.

Child↗
PubMed1992

A modification to the incisor classification of malocclusion.

During the study of two-hundred orthodontic cases under treatment in the General Dental Service, four clinicians showed only moderate agreement using the British Standard Classification of Incisor Malocclusion. Cohen's Kappa statistic was used to measure the inter-examiner agreement. The 35 cases in which there was high disagreement between the examiners were scrutinized to determine the source of this disagreement. Following discussion, revised definitions were produced which included the introduction of a Class II-intermediate group. After an interval of 2 months these 35 cases were reclassified using the new definitions. Increased inter-examiner agreement was found. Four examiners (three of whom were common to the original study) then used the modified classification to describe the incisal relationship of 100 cases referred for treatment at Bristol Dental Hospital. The inter-examiner and the intra-examiner agreement were both found to be good. It is recommended that the Incisor Classification of Malocclusion be extended to include a Class II-intermediate group.

Humans↗
PubMed1992

Storage of orthodontic study models in hospital units in the U.K.

Orthodontic study models form an essential part of the dental records of patients undergoing diagnosis and treatment. In order to ascertain the problems encountered by hospital orthodontic units in the utilization and storage of study models, a questionnaire was circulated in February 1991 to members of the Consultant Orthodontists Group. All respondents took pretreatment study models, while 9 per cent took their final study models at some time other than the end of active treatment; 85.5 per cent of respondents stored their study models in their units, but most were beginning to experience difficulties in this regard. There was a wide range for storage times, and only 10 per cent of employing authorities had a stated policy on the storage of study models. There was a highly significant difference (P much less than 0.001) between the time that models are stored at present, and the desired storage times. Most respondents appeared to be rather uncertain about the precise medico-legal requirements concerning model storage. The implications for audit and medico-legal matters are discussed in the light of these findings.

Dental Records↗
PubMed1991

Quality control in orthodontics: indices of treatment need and treatment standards.

Two reliable and valid occlusal indices have been developed to assess treatment need (Index of Treatment Need, IOTN) and the standard of treatment (The PAR Index, Peer Assessment Rating). The IOTN assesses both dental aesthetics and dental health need. The PAR index provides a single summary score for the overall alignment and occlusion. The difference between the pre- and post-treatment scores reflects the degree of improvement and the success of orthodontic intervention and active treatment. Several practical uses of the indices are described: the estimation of treatment need in an unselected and a referred population and the assessment of the standard of treatment in the Hospital and General Dental Services. It has been suggested that the use of the occlusal indices would offer several advantages: (1) uniformity in prescribing patterns, (2) safeguards for the patient, (3) patient counselling and (4) monitoring and promoting standards.

Discriminant Analysis↗
PubMed1991

The initial use of a computer-controlled expert system in the treatment planning of Class II division 1 malocclusion.

A computer based expert system for providing orthodontic advice for Class II Division 1 malocclusion has been developed and evaluated. Treatment plans produced by the system for 31 non-prior approval cases drawn from material provided by the Dental Practice Board were compared with the treatments actually carried out by the practitioners. The shortcomings of the system are discussed.

Decision Trees↗
PubMed1989

Report of a survey conducted by the Consultant Orthodontists Group. The nature and distribution of clinical assistant posts in orthodontics in the United Kingdom in 1987.

This paper describes and discusses the results of a survey, conducted by the Consultant Orthodontists Group in the United Kingdom in 1987, which examined the nature and distribution of clinical assistant posts, and consultants' attitudes to the concept of appointing orthodontic auxiliaries. This survey demonstrated a large regional variation in the number of clinical assistant posts and in the number of 'specialist practitioners' and community orthodontists. More than 90% of consultants teach their clinical assistants how to use removable appliances, headgear and simple fixed appliances. More than 70% of consultants also teach their clinical assistants how to use multi-bracketed techniques and functional appliances. Ninety-one per cent of consultants would give their support to developing regional training schemes for clinical assistants in orthodontics. Eighty-eight per cent of consultant orthodontists favoured the appointment of orthodontic auxiliaries to carry out intra-oral work, and 75% believed that they already had a member of staff capable of doing these duties with some further training.

Attitude of Health Personnel↗