Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : ZC01 - ZC06 Full Version

Orthodontic Diagnostic Tools and Material Usage in Saudi Arabia


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49203.15175
Laila Fawzi Baidas, Lubna Faleh Alfaleh

1. Consultant and Associate Professor, Department of Paediatric Dentistry and Orthodontic, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. 2. Assistant Professor, Department of Dental Health, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

Correspondence Address :
Dr. Laila Fawzi Baidas,
Consultant and Associate Professor, Department of Paediatric Dentistry and
Orthodontic, College of Dentistry, King Saud University, P.O. Box 5967, 11432 Riyadh, Saudi Arabia.
E-mail: lbaidas@ksu.edu.sa

Abstract

Introduction: The evaluation of changes in orthodontic practice over the years, is essential for defining treatment efficacy. Accordingly, shedding light on the profile of orthodontic practice in Saudi Arabia is crucial.

Aim: To investigate current trends in orthodontic practice in Saudi Arabia and the factors affecting choices regarding materials and techniques among orthodontists.

Materials and Methods: This cross-sectional study was conducted from July 2019 to December 2019 at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. An electronic survey of 29 objective questions was sent to 1,500 orthodontic members of the Saudi Orthodontic Society. The survey collected demographic data, diagnostic records and information on the fixed orthodontic appliances used by the respondents. Frequency and percentages were calculated for all variables. Chi-square test was used to determine the effects of factors, including years of experience and place of work, on the choice of diagnosis protocol and fixed appliance material, with the significance set at p-value ≤0.05.

Results: Two hundred and nine respondents completed the survey. The respondents reported a highly significant use of computers for digitising cephalometric analysis, with the traditional method of obtaining study models reported as highly significant (p<0.001). Orthodontists routinely used the MBT preadjusted bracket system (52.6%) and performed direct bonding of the bracket (91.4%). Bonding of the first molars was preferred by 36.4% of the clinicians. Glass ionomer cement was the most frequently used band cement (55.5%), and the most popular archwire material was nickel–titanium shape memory. Clinicians with less than five years of experience used significantly more postcephalometric radiographs (p=0.006) and postorthodontic treatment models (p=0.028). Senior orthodontists (10-15 years of experience) had a higher use of indirect bonding techniques (p=0.05).

Conclusion: This study provides information on the relevant aspects of orthodontists in Saudi Arabia in terms of their individuality, training and techniques used. The findings can be used as a reference for future national surveys to evaluate changes in orthodontic practice in Saudi Arabia.

Keywords

Diagnostic records, Fixed appliance, Orthodontic practice, Saudi orthodontic society

Over the past 10 years, many developments have occurred in orthodontic appliances and components. These comprises of improvement in the bracket system, archwire materials and bonding systems. Rapid progress in the orthodontic field has encouraged orthodontists to select proper treatment mechanics and materials in their practice for patients’ comfort. Therefore, orthodontic knowledge and the assessment of orthodontic procedures and outcomes are essential for defining treatment efficacy (1).

Several studies have presented practitioners’ profiles in many countries with the goal of creating an essential basis for the evaluation of changes in orthodontic practice trends over the years (2),(3),(4),(5),(6),(7),(8),(9),(10),(11),(12). Most of the surveys were conducted in the US and aimed to provide a profile of orthodontists in various aspects (2),(3),(4),(5),(6),(7). These surveys revealed significant changes in the requested diagnostic documentation, work philosophy and usage of technology in orthodontists’ offices. However, to date, no data in Saudi Arabia have been published.

In parallel, there has been an increase in the number of postgraduate programs that educate the young generation of orthodontists whose characteristics and beliefs differ from those of the older generation. Therefore, shedding light on the profile of orthodontic practice in Saudi Arabia is crucial. The first part of this study was conducted using a national survey to evaluate current trends in orthodontic practice in Saudi Arabia. The survey included diagnostic analysis tools and the use of fixed appliance materials, such as bracket selection, banding and bonding materials and archwire types. The factors affecting orthodontists’ diagnosis protocol and choice of materials were also investigated.

Material and Methods

This was a cross-sectional study conducted from July 2019 to December 2019 at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Ethical approval was obtained from the Institutional Review Board (IRB) of the College of Medicine Research Center at King Saud University (#20/0938/IRB) and study followed the STROBE statement protocol.

Sample size calculation: All orthodontists practicing in Saudi Arabia who were members of the Saudi Orthodontic Society (N=1,500) were included in this cross-sectional survey of orthodontic practice. Using the G-power program at an alpha of 0.05 with an effect size of 0.25 and a power of 0.95, authors determined the overall sample size to be at least 197 participants (13).

Inclusion and Exclusion criteria: Respondents Master’s Degree, PhD or Board certification in Orthodontics who work in an academic institution, private practice or the government sector were eligible to participate, but dentists who practice orthodontics were excluded.

A digital survey in English was created using Google Forms, which was then distributed via social media platforms and the Saudi Orthodontic Society to improve response rates. A reminder was sent to the respondents after six to eight weeks through the same social media platforms.

The survey’s questions were developed with the intent of eliciting data on orthodontic practice trends in Saudi Arabia. The survey was adapted with modifications from the studies conducted by O’Connor BM and Keim RG et al., (1),(4),(5). The authors reviewed each question to ensure that the survey questions were clear and had appropriate phrasing. A pilot study was conducted on a sample of 10 orthodontists (not included in the sample size) to determine the questionnaire’s reliability; basing on their responses, the researchers made relevant changes to some questions. Validation with Cronbach’s α=0.08 indicated reasonable internal consistency and acceptable reliability (0.89).

The survey questionnaire included seven sections and 45 questions. The results were divided into two parts. The first part consisted of three sections and 29 objective questions, including demographic data (gender, nationality, qualification, country from where the orthodontic degree was obtained, years in practice, workplace/sector of practice), diagnostic records and fixed orthodontic appliances (bracket prescription, banding and bonding, archwire selection). The second part (not yet been published) will includes 16 questions including functional appliance and headgear, extraction trends, retention protocol and current approaches for orthodontic treatment.

Statistical Analysis

The responses were transformed and analysed using the Statistical Package for the Social Sciences, version 21.0 (Chicago, IL, USA). Descriptive statistics were conducted for all variables; percentages and frequencies were calculated. Chi-square test was used to determine the effect of factors, including years of experience and place of work, on the choice of diagnosis protocol and fixed appliance material, with the significance set at p-value ≤0.05.

Results

A total of 209 (13.9%) responses were received and included in the study. The significance level for the responses to the different questions was set at p-value ≤0.05.

Sociodemographic profile, academic qualification and place of work: (Table/Fig 1) showed that 61.24% of the respondents were Saudi nationals, whereas 38.8% were non-Saudis. With regard to gender, 60.29% of the respondents were male, whereas 39.71% were female. One hundred (47.8%) orthodontists had a board qualification, 78 (37.3%) had a master’s degree in orthodontics and 31 (14.8%) had a PhD. Sixty-six (31.6%) of the respondents completed their residency programme in Saudi Arabia, whereas 50 (23.9%) completed it in Europe. Approximately one-fourth of the participants (26.8%) had more than 15 years of experience, and most (54%) were from the central region. Regarding their place of work, 37% worked in government hospitals, 34.5% worked in private practice and 28.7% were affiliated with academic institutes.

Diagnostic records: The most popular pre-treatment and post-treatment radiographic records were cephalometric and panoramic films. However, pre-treatment cephalometric (91.4%) and panoramic (99%) radiograph records were used more frequently than post-treatment cephalometric (50.2%) and panoramic (65.6%) radiograph records. Bitewings, periapical and occasionally Cone-Beam Computed Tomography (CBCT) radiographs were taken, as needed. Most participants (93.8%) used pre-treatment orthodontic study casts, whereas only 57.9% used post-treatment casts. This study revealed that diagnostic records were taken more frequently as pre-treatment than post treatment records. More than 68.9% of the participants routinely used intraoral and extraoral photographs in their practice (Table/Fig 2).

Of the respondents, 45.5% routinely performed cephalometric analysis, whereas 49.3% did so only occasionally (Table/Fig 2). The results showed a highly significant use of computer digitising (61.2%, p<0.001) compared with other methods (Table/Fig 3). Regarding the methods of obtaining study models, the analysis revealed that the poured study model was the most common and highly significant method amongst the respondents {95.70%, p<0.001; (Table/Fig 4)}.

Fixed appliances used and techniques: The prescription preference for preadjusted straight wire orthodontic brackets was 52.6% for MBT, followed by 44% for Roth and only 3.4% for other prescriptions. Regarding the type of brackets used, most orthodontists (97.1%) reported that a stainless steel (SS) brackets was their first choice in their practice, followed by a ceramic brackets (21.5%). With regard to the most commonly used bracket slot size, most of the respondents reported a preference for the 0.22-inch size (80.9%), and only a few preferred to use the 0.18-inch size (8.6%). The other 10.5% of the participants preferred to use both bracket slot sizes (Table/Fig 5).

Regarding the type of bonding technique used, most participants (91.4%) performed direct bonding of the brackets, whereas 3.3% performed indirect bonding only and 5.3% practiced both. Likewise, 87.6% of the participants used light-cured adhesives for bonding, whereas only 5.3% used chemical-cured adhesives and 7.2% used both. Regarding molar attachments, 40.7% of the participants used molar bands and buccal tube attachments, 36.4% used only a buccal tube attachment and 23% used only molar bands. The most frequently used band cement material was glass ionomer cement (55.5%), followed by light-cured glass ionomer (32.5%). The orthodontists showed a low preference for one-paste compomer cement and zinc phosphate cement (Table/Fig 6).

(Table/Fig 7) provides the details of the preferred orthodontic wires used in the early and finishing stages of treatment and the preferred type of space closure mechanics. Most of the participants chose nickel–titanium (NiTi) shape memory (90%) in the early stage of treatment, followed by thermally activated NiTi (27.8%). The frequency of use of multi-strand SS archwire was very close to that of SS archwire (8.1% and 10.5%, respectively). The most commonly used archwire in the finishing stage was SS (73.2%), followed by beta-titanium (TMA; 37.3%), and only a few participants used shape memory (NiTi; 10.5%). Most respondents (81.8%) reported that they carried out space closures using a power chain; 38.8% used loops and 27.8% used an NiTi coil spring to a lesser extent.

Association between the respondents’ years of experience/place of work and the choice of diagnostic records and fixed appliance technique: A Chi-square test was performed to explore the influence of demographic factors (years of experience and place work) on the choice of diagnostic records and fixed appliance technique. The significant values are presented in (Table/Fig 8), (Table/Fig 9).

When the respondents were asked about the likelihood of using post-treatment cephalometric analysis, a significant difference emerged amongst the responses based on the orthodontists’ place of practice and years of experience. Those who were working in an academic institute and had less than five years of experience tended to routinely use post-treatment cephalometric analysis.

The relationship between years of experience and taking post-treatment models indicated that orthodontists with less than five years and more than 15 years of experience tended to take postorthodontic models routinely (p=0.028). Most respondents stated that they routinely took intraoral and extraoral photographs. However, those who worked in academic institutes or in private practice (p<0.001) were significantly likelier to take photographs of their patients (Table/Fig 8).

(Table/Fig 9) showed that the bonding techniques of the respondents had a significant association with the increase in years of experience (p=0.05), as senior orthodontists (i.e., those with 10-15 years of experience) seemed to have an increased use of indirect bonding techniques compared with others. We also found a significant difference in the use of a different molar attachment, with orthodontists working in private practice having a tendency to use buccal tube attachments (p=0.001).

Discussion

This study aimed to evaluate information and data on a broad spectrum of issues on orthodontists in Saudi Arabia compared with those in other countries. The findings of this study may be used as a reference for future surveys to identify changes in orthodontic practices in the Kingdom.

General Information

A total of 209 orthodontists responded to the survey, with a response rate of 13.9%. Although a follow-up reminder was sent at different intervals via social media and other methods, the response rate was low. The findings were consistent with other studies undertaken amongst orthodontists in Saudi Arabia (14),(15). The low response rate may be attributed to the busy schedules of orthodontists, which prohibited them from answering the survey. Nevertheless, the main strength of our study is that it is the first research conducted on orthodontic practice profiles in Saudi Arabia.

The respondents were mostly men (60.28% vs. 39.72% women), with an unequal male-female ratio of orthodontists; this result is in line with other studies conducted under the same circumstances in Saudi Arabia (14),(15). Of the orthodontists, 61.24% were Saudis; this highlighted the Government’s plan to recruit Saudi Orthodontists into practice. When asked about their qualifications, about one-third of the respondents said that they had completed their residency program in Saudi Arabia. Those trained in Europe, North America (US and Canada) and others (Middle East or Asia) had almost the same distribution, which might explain the practitioners’ diversity of training, which is reflected in their clinical practice.

More than half of the respondents were from the central region of Saudi Arabia, which is attributed to the large population in this region. In addition, most government and private practice centres are concentrated in this region. When the respondents were asked about their place of work, 36.84% said that they worked at government hospitals; 28.71%, at academic institutes and only 34.45% at a private practice. A study by Alqahtani ND et al., and Halwany HS et al., also showed that most respondents worked in government settings. Individuals may prefer government and university based jobs because these are secure and stable with fixed retirement income (14),(16).

Diagnostic Records

Most of the participants preferred taking pre-treatment cephalometric and panoramic radiographs more frequently than post-treatment records, which is similar to the results of other studies. The orthodontist pays closer attention to pre-treatment rather than post-treatment records for medicolegal reasons (5),(8),(9). However, in a Brazilian study (9), almost half of the orthodontists routinely requested post-treatment cephalometric radiographs. We found a significant correlation between orthodontists working in academic institutes or those who had less than five years of experience and taking post-treatment cephalometric radiographs. This was attributed to the importance of taking these complementary radiographs at the end of treatment to show the results, as well as for legal reasons.

In the present study, the participants used CBCT radiographs. In comparison, a study conducted by Keim RG et al., showed that the use of CBCT has increased dramatically in the last six years (5). The other important finding was that the use of computerised cephalometric tracing and analysis was significantly higher than that of other methods. A possible explanation is the availability of cephalometric software tracing programmes in hospitals and private clinics. Moreover, the present study demonstrated that many participants still relied on eyeballing, and this finding is in line with the results of previous researches (4),(5).

Similar to the results of a previous study (5),(8),(17), we found that a diagnostic study cast was more commonly taken before treatment. There was also a highly significant use of poured study models compared with intraoral scanner and digital models, but this finding was not in agreement with that of Keim RG et al., (5). The cost and availability of digital intraoral cameras are possible reasons for their limited use despite the ease of storage and record keeping capability of digital models compared with poured casts.

Statistical analysis showed that 68.2% of the respondents stated that they routinely take intraoral and extraoral photographs, with significant usage reported amongst those who worked in an academic institute or private practice (p-value <0.001). This could be related to the standard protocol followed by university staff and postgraduate students for quality patient care and better documentation. However, the Brazilian study showed a better rate, with 93.4% of the respondents declaring that they routinely used photographs (9).

Fixed Appliances Used and Techniques

i. Bracket prescription, material and slot size

In this study, MBT followed by Roth bracket prescription was the most preferred preadjusted straight-wire orthodontic system. Previous studies have shown the same preference (5),(12). Roth’s philosophy works on the patient’s functional occlusion and on the facial type and reaction to treatment mechanics. The Roth prescription would place the teeth in an overcorrected position, which would later settle down into an idealised position. However, the MBT prescription works on additional palatal root torque for the upper incisors, which improves the incisors’ position after retraction, and adds labial root torque for the lower incisors to prevent forward tipping during levelling (18). However, no clear scientific evidence exists to support this assumption, and there is no difference between MBT and Roth prescription in terms of final tooth position (19),(20),(21).

Metal (SS) was the most commonly used bracket by the respondents. Based on the data, the quality of the material, clinical efficiency, cost and convenience were the factors that affected the selection of bracket type. Amongst all types of brackets, metal brackets demonstrate rigidity, good friction and low cost (22).

Regarding bracket slot size, we found that 80.9% of the respondents used the 0.022-inch slot, and only 8.6% used the 0.018-inch slot, confirming the outcomes of similar national surveys conducted in the US and UK (3),(4),(5),(17). Despite the higher preference for the 0.022-inch-slot bracket, no scientific evidence exists to support one system over the other, aside from the perception of a better treatment outcome (17),(23). The preference for one system over the other can be explained by the fact that orthodontists continues to use the system on which they were trained or that they have not found a convincing reason to change systems. Moreover, most of the orthodontic specialty training programmes in different countries uses a 0.022-inch-slot bracket system.

ii. Bonding and banding techniques

In this study, many orthodontic specialists chose the direct bonding of brackets, a finding that agrees with previous studies (3),(4),(5). The comparison of the effectiveness (accuracy of bracket positioning) and efficiency (total working time and chair time) of the direct and indirect bonding techniques has been widely studied (17). The findings of the present study also showed a significant relation between years of experience and choice of bonding technique. Orthodontists with varying levels of experience sought to preserve their conventional approach of using the direct bonding technique, whereas senior orthodontists (10-15 years of experience) showed the use of indirect bonding technique, which is similar to the results reported by Keim RG et al., (6). The preference for direct over indirect bonding could be due to orthodontists’ unfamiliarity with indirect bonding techniques and the requirements for the laboratory stage and skilled technicians.

Light-cured adhesive was the most preferred material for bonding by the respondents; this finding is in line with the results of Keim RG et al., and Banks P et al., (5),(17). The popularity of a light cure over a chemical cure is attributed to the following benefits: unlimited working time to position the bracket and clean up the flash, immediate archwire placement and more efficient staff utilisation. However, no scientific evidence exists to support the difference in bracket failure rates between adhesive systems (24).

The findings showed a greater preference for using buccal tube attachments over molar bands. In addition, a significantly large number of orthodontists working in private practice favoured the use of molar buccal tube attachments over molar bands. Reduced chair time, a lower risk of periodontal problems, convenience in simultaneous placement with brackets and quicker time to position were the factors that influenced clinicians’ preference for bonding attachments for molars (25),(26). Nevertheless, evidence from randomised clinical trials showed the success of molar bands over tubes in terms of failure rates and post-treatment demineralisation (27),(28).

The most frequently used band luting material was glass ionomer cement, set by an acid-base reaction and light cure. Failure rate and decalcification were the outcome measures for band adhesive. The failure rates of both adhesives were low, and there was no statistically significant difference in enamel decalcification (29),(30). Still, because of insufficient evidence in the literature, there are no firm recommendations for one adhesive over the other (31).

iii. Archwires

Orthodontic treatment includes three main stages: levelling, retraction/space closure and finishing. In terms of preference for levelling archwires, our results showed that NiTi shape memory was favoured by most of the participants, followed by thermally activated NiTi. This result is consistent with that of other studies (5),(8),(11),(12). As this stage of the treatment necessitates a flexible, resilient and highly elastic wire, NiTi wire is highly recommended (32).

Space closure mechanics is the most significant and challenging stage in orthodontics because it requires comprehensive knowledge and understanding of the biomechanical basis of space closure. In the case of extraction or spaced malocclusion cases, space closure mechanics can be classified into two forms: friction mechanics through sliding of the archwire on the bracket slot and frictionless mechanics by loop action. The results of the present study are the same as those of a Brazilian study and a British one, in which most orthodontists used power chain (17),(33). However, the respondents also stated that they used loops at a rate of 38.8%, which contradicts the results of the British study in which loops were not used for space closure (19).

During the last stage of orthodontic treatment, the finishing stage, minor wire bending may be needed to obtain maximum intercuspation of the teeth and maintain the arch form. Thus, the choice of TMA wire can result in more wire bending, and the choice of SS wire can result in more stiffness and torque expression. In this study, the SS archwire was maintained by the respondents at a rate of 73.2%, whereas more flexible wires, such as TMA or NiTi, were used to a lesser extent. The findings of this study agree with those of other research conducted in San Paulo and Malaysia (11),(12). However, our results are not consistent with those of a study done by Keim RG et al., in the US (5), in which they reported that TMA is the common finishing archwire.

Limitation(s)

Although this is the first study to explore and gather information regarding the profile of orthodontic practices in Saudi Arabia, there are a few limitations to be considered. As this was a cross-sectional descriptive study, authors were unable to assess the cause-and-effect relationship related to the country’s progress of orthodontic practice. Another limitation was the small sample size; future studies should be performed with a larger sample that’s representative of all parts of the Kingdom. Finally, the subjective assessment using questionnaires constitutes another study limitation.

Conclusion

In this study, most of the orthodontists routinely used the 0.022-inch MBT pre-adjusted edgewise system and an SS bracket, conventionally bonded using a light-cured composite and mostly performed direct bonding of the bracket. Bonding of the first molars was preferred to banding, and the most commonly used band cement was glass ionomer. NiTi shape memory and SS archwires were amongst the main archwires used, and the power chain was predominantly used to close the space. Furthermore, all diagnostic records were taken more commonly prior to orthodontic treatment. Orthodontists believed that the use of computers for digitising cephalometric analysis was more efficient despite the fact that the conventional method of obtaining study models was still used. This study provides a clear picture of the trends in orthodontic practice in Saudi Arabia, which may serve as the basis for future research. Additional studies are needed to evaluate changes and shifts in trends in orthodontic practice in Saudi Arabia.

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DOI and Others

10.7860/JCDR/2021/49203.15175

Date of Submission: Mar 02, 2021
Date of Peer Review: Apr 13, 2021
Date of Acceptance: Jun 01, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 03, 2021
• Manual Googling: May 29, 2021
• iThenticate Software: Jul 09, 2021 (6%)

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