- Email: [email protected]
The necessity to establish surgical orthodontic fellowship program for orthodontists
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/pio
Original article
The necessity to establish surgical orthodontic fellowship program for orthodontists Rahman Showkatbakhsh a , Abdolreza Jamilian b,∗ a
Associate Professor, Director of Orthognathic Surgery, Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran b Associate Professor, Fellow of Orthognathic Surgery, Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
a r t i c l e
i n f o
a b s t r a c t
Article history:
Introduction: Medical field is developing very rapidly and is becoming more specialized.
Received 1 December 2011
Orthodontics is of no exception. Thus, the purpose of this study was to evaluate the neces-
Accepted 6 February 2012
sity of establishment of surgical orthodontic fellowship program for orthodontists in order to provide them with better insight.
Keywords:
Materials and methods: A 10 multiple choice question survey was taken from 270 orthodontists
Cleft lip and Palate
who participated in the European Orthodontic Society Congress in Istanbul, 2011. The results
Fellowship program
were tabulated and analyzed.
Orthognathic Surgery
Results: 52% of the respondents believed that the knowledge of treatment of orthognathic
Osteogenesis
surgery patients can be significantly improved by adding a fellowship of orthognathic
Surgical Orthodontics
surgery after the residency program.
Syndromes
Conclusion: Adding such program can be very constructive and will give better insight to orthodontists in regards to treatment of orthognathic patients. © 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.
1.
Introduction
As defined by most specialists, orthodontics is the first specialty of dentistry that is concerned with the study and treatment of malocclusions, which may be a result of tooth irregularity, disproportionate skeletal relationships, or both. Nevertheless, over the last few decades, orthodontists have become integral partners with other specialists on the craniofacial team and their presence at virtually all treatment procedures is inevitable. This bilateral interaction necessitates the orthodontist to have some knowledge of other craniofacial specialties. In addition, these days more and more people are seeking for treatment of dentofacial
∗
deformities and syndromes which gives rise to the necessity for an orthodontist to get insight of other specialties. Undoubtedly, orthodontists are efficiently and thoroughly trained in their own field and interdisciplinary studies. However, the vast knowledge of medicine is dramatically increasing day by day, which requires the orthodontists to go into more specific details of each anomaly and increase their knowledge in specific areas. Most medical fields have fulfilled this need by establishing fellowship courses for each subspecialty which allows a specialized physician to develop a particular expertise. Such subspecialty courses and fellowship programs are deemed as necessary in orthodontics in this fast growing medical world.
Corresponding author. No 2713, Vali Asr St. Tehran 1966843133, Iran. E-mail address: [email protected] (A. Jamilian). 1723-7785/$ – see front matter © 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved. doi:10.1016/j.pio.2012.02.002
261
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
An electronic review of the literature revealed various suggestions for improvement of dental and orthodontic curriculum1–8 ; however, no articles discussing the need for fellowship program in the field of orthodontics were found. In an attempt to fill this void in the orthodontic curriculum, establishment of a surgical orthodontics and craniofacial syndromes fellowship program was suggested. To determine the current opinion among orthodontists from different parts of the world a 10-question survey was developed to obtain that information. The questionnaire was randomly distributed among 270 orthodontists who attended 87th congress of the European Orthodontic Society held in Istanbul, Turkey, in 2011. In this article, we present the results of that survey and we offer suggestions for establishment of the fellowship program.
2.
Materials and methods
A 10 question survey focusing on orthodontic surgery knowledge gained during orthodontic residency programs and the need for establishing fellowship of orthodontic surgery and craniofacial syndromes can be seen in Table 1. The participants were 270 attendees of 87th Congress of the European Orthodontic Society (EOS) on June 2011 held in Istanbul, Turkey. In our survey EOS was considered as a small sample of orthodontic community. 6 of the participants did not mention their ages and the mean age of the rest of them was 37.8 ± 9.9 years. The distribution of respondents by their age, gender, continent, and years of experience in the field of orthodontics can be seen in Tables 2–5. It should be mentioned that 300 questionnaires were distributed among the participant; however, 270 of them were received back. The survey questionnaire included 10 multiple choice questions which allowed the respondents to mark their answers. The questions were compiled by two faculty members of orthodontic departments of two universities and were revised by several other orthodontists. The questions mostly involved information about the subject of surgical orthodontics in residency program and the number of orthognathic, distraction osteogenesis (DO), and cleft lip and palate patients or other syndromes whom the orthodontists were involved with during their residency program. The questions then were followed by the efficiency and sufficiency of such involvements. The last three questions focused on surgical orthodontics and the need for establishment of such course for orthodontists. The questionnaire responses were analyzed by using the Statistical Package for the Social Sciences (version 18, SPSS, Chicago, Ill). Descriptive analysis was conducted by using frequencies of the variables. Differences in responses among the four choices in questions 8 and 9 were tested with Marascuilo procedure for post-hoc analysis of the comparisons of multiple proportions (http://www.stattools.net/ Multiprop Pgm.php).
3.
Results
A total of 270 responses were received. Some respondents did not answer some of the questions; therefore, those questions were excluded from the analysis. In response to question 1,
Table 1 – Questionnaire of survey. In your Orthodontic Residency Program: 1- How much did you benefit from orthognathic surgery subject? A) Very Much B) Moderately C) Slightly D) Not at all 2- The number of orthognathic patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 3- The number of Distraction Osteogenesis patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 4- The number of Cleft lip and Palate or syndromic patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 5- Did the course offer assignments that enabled you to practice orthodontic treatment of orthognathic surgery patients? A) Very Much B) Moderately C) Slightly D) Not at all 6- Did the course offer assignments that enabled you to practice orthodontic treatment of distraction osteogenesis (DO) patients? A) Very Much B) Moderately C) Slightly D) Not at all 7- Did the course offer assignments that enabled you to practice orthodontic treatment of Cleft lip and Palate patients or other syndromic patients? A) Very Much B) Moderately C) Slightly D) Not at all 8- How many times did you attend the orthognathic surgery operation rooms as an observer? A) Frequently B) Occasionally C) Rarely D) Not at all 9- To what extent do you think attending orthognathic surgical operations can provide the orthodontists with a better vision of treatment planning? A) Very Much B) Moderately C) Slightly D) Not at all 10- Which of the following do you think can improve your knowledge in treatment of orthognathic surgery patients: A) Add a fellowship of orthognathic surgery in addition to residency program B) Just add some relevant courses to residency program C) Increase the number of relevant national and international congresses D) No improvement needed
only 8.1% of the respondents believed that orthognathic subject was of no benefit to them; while 32.6%, 34.8% and 24.4% answered slightly, moderately and very beneficial respectively. Questions 2, 3 and 4 asked about the number of orthognathic, DO and cleft lip and palate patients treated by the respondents (Fig. 1). The average number was set on 4 patients. As can be seen in Figure 1, 36% of respondents had treated above average number of orthognathic patients, while 51.9% of them claimed that they had never treated a DO patient. As for the cleft lip
Table 2 – Age Distribution of Respondents. Age
Percent
<30 31 – 40 41 – 50 51 – 60 >60 Missing Respondents Total
23.5 46.2 19.7 7.6 3 100.0%
Frequency 62 122 52 20 8 6 270
262
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Fig. 1 – Response to questions 2, 3, and 4.
Table 3 – Gender of Respondents. Gender
Percent
Female Male Missing Responses Total
53.1% 46.9% 100.0%
Frequency 118 104 48 270
Table 4 – Distribution of Respondents by Continent. Continent
Percent
Europe Asia N. America Australia Africa Total
63.0% 28.1% 5.2% 3.0% 0.7% 100.0%
Frequency 170 76 14 8 2 270
Table 5 – Distribution of Respondents based on years of experience in the field of orthodontics. Years
Percent
1 – 10 11 – 20 21 – 30 31 – 40 Missing Respondents Total
67.7 20.8 9.2 2.3 100.0%
Frequency 176 54 24 6 10 270
and palate patients, 31.9% said that they had treated more than average number of patients during their residency period time. Questions 5, 6 and 7 assessed the efficacy of residency course assignments for treatment of orthognathic, DO, and cleft lip and palate patients (Fig. 2). Figure 2 shows that, only 8.8% and 17% of the respondents believed that the residency assignment were not useful for treatment of orthognathic and cleft lip and palate or syndromic patients, while 33.3% of them believed that the assignments were not efficient for treatment of DO patients. Questions 8 and 9 are about frequency of visits to orthognathic surgery operation rooms and the benefits of this attendance (Table 6). Table 6 illustrates that only 17.5% of the respondents had frequently attended the operation rooms; while, 46.1% of them believe that such attendances can be very beneficial for orthodontists since it gives them a better vision of treatment planning. Using the Marascuilo procedure, to perform post-hoc analysis, it was found that in question 8 there was a statistically significant difference between orthodontists who had frequently attended surgery operation rooms and those who had rarely done so (P < 0.001). Same analysis for question 9 revealed that there was a statistically significant difference between orthodontists who believed that there would be a high or moderate beneficial gain from such attendances with respect to those who thought that they would receive only a slight or no benefit (P < 0.0001). Question 10 was asked with the aim of suggestions for improving the knowledge of orthodontists in treatment of orthognathic surgery patients (Fig. 3). 52% of respondents believed that adding a fellowship of orthognathic surgery can be beneficial,
263
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Fig. 2 – Response to questions 5, 6, and 7. while 34.3% believed that just adding some relevant courses to the residency program would be enough. Only 1.5% thought that no improvement is needed. Eight of the participants chose not to answer this question.
4.
Discussion
This survey aims at making clear the need for a surgical orthodontics and craniofacial syndromes fellowship program for orthodontists who wish to treat patients seeking surgical orthodontics and DO, or patients with cleft lip and palate and craniofacial syndromes. The findings of the survey indicate that although many endeavors have been done to familiarize an orthodontist with treatment of orthognathic, DO, and cleft lip and palate or syndromic patients, still a noticeable number of orthodontists have not treated any such patients or had very few numbers of them. As we can see in Figure 1, 9.0% of the respondents claimed that they had never treated an orthognathic patient and 24.6% of them had treated fewer than 4 such patients. The percentages were 29.6% and 17.8% for
treatment of cleft lip and palate or syndromic patients, respectively. 51.8% of the respondents had never treated DO patients. It is believed that the reason for lower number of DO patients is the fact that DO has recently been introduced to the literature and practical practice (Fig. 1). The responses to questions 5, 6, and 7 also support the idea that still we have some orthodontists who find the courses offered during residency as inadequate for enabling the orthodontist to effectively treat orthognathic, DO, and cleft lip and palate or syndromic patients (Fig. 2). This idea is further supported by responses to questions 8, 9, and 10. As Table 6 depicts, 46.1% of the respondents believe that attending orthognathic surgical operations can be very useful for enhancing the vision of an orthodontist. Post-hoc analysis (the Marascuilo procedure), showed that a statistically significant number of orthodontists believed that they will benefit a lot from attending orthognathic surgical operations and it would provide them with a better vision of treatment planning. The authors believe that the opportunity of treating more such patients and more frequent visits to surgical operation rooms can be easier achieved by adding a fellowship course after residency program. The response
Table 6 – Response to questions 8 and 9. Questions 8 Number of times attending operation rooms?
Question 9 How beneficial can it be to attend the operation rooms?
Frequently n (%)
Occasionally n (%)
Rarely n (%)
Not at all n (%)
Total Number
82 (31.3%)
84 (32.1%)
50 (19.1%)
262
Very Much n (%)
Moderately n (%)
Slightly n (%)
Not at all n (%)
Total Number
120 (46.1%)
100 (38.5%)
34 (13.1%)
6 (2.3%)
260
46 (17.5%)
264
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Conflict of interests The authors have reported no conflict of interests.
Riassunto
Fig. 3 – Response to question 10.
to question 10 shows that 52.0% of the respondents agreed with the suggestion and found it useful for improvement of orthodontists’ knowledge. It’s worthy to mention that a number of universities have commenced such courses. With the rapid progress of medical and dental sciences, many researchers have tried to improve the dental curriculum by means of surveys and adding new courses. Stockstill et al1 suggested more standardized curricula in occlusion and temporomandibular dysfunction at the graduate orthodontic residency level. Some recent researches prepared the grounds and led to introduction of implant into the dental curriculum.9–11 In one hand, the mutual interaction between orthodontists and other specialties, like craniofacial team, and on the other the progressive specialization of medical doctors and healthcare professionals, gives way to the creation of specialized and often very technical knowledge domains in orthodontics. The analysis and discussion of the data were based on the assumption that the answers were an accurate and honest representation of what the respondents thought. It is advisable to do such research in other places and gatherings of orthodontists especially in international congresses. Since the questionnaires were distributed randomly among a large number of attendees the inclusion of minor errors was inevitable; thus, we express our apologies for any missing continent in our survey.
5.
Conclusion
The consensus paper sets out the rationale for the introduction of surgical orthognathic and craniofacial syndromes fellowship after residency program. We hope that our findings will be considered by associations of orthodontists all over the world. And we hope that the results will assist in making constructive recommendation for improvement of orthodontists’ knowledge.
Introduzione: Il campo medico si evolve molto rapidamente diventando sempre più specialistico e l’ortodonzia non fa eccezione a questa evoluzione. Lo scopo del presente studio, pertanto, è quello di valutare la necessità di creare un programma post-specializzazione sull’ortodonzia chirurgica per gli ortodontisti allo scopo di accrescere le loro conoscenze in materia. Materiali e metodi: È stato distribuito un questionario composto da 10 domande a 270 ortodontisti che hanno partecipato al Congresso della Società Europea di Ortodonzia tenutosi ad Istanbul nel 2011. I risultati sono stati ordinati e analizzati. Risultati: Il 52% degli ortodontisti che hanno risposto al questionario ritengono che le conoscenze relative al trattamento dei casi ortognatici chirurgici possano essere significativamente accresciute frequentando un corso di chirurgia ortognatica dopo la specializzazione. Conclusioni: Aggiungere un programma post-specializzazione può essere molto costruttivo e offrire agli ortodontisti maggiori conoscenze riguardo al trattamento dei pazienti ortognatici.
Résumé Introduction: Le domaine médical évolue très rapidement et devient de plus en plus spécialisé, l’orthodontie n’étant point une exception. Le but de cette étude est évaluer le besoin de mettre en œuvre un programme post-spécialité, sur l’orthodontie chirurgicale à l’intention des orthodontistes en vue d’accroitre leurs connaissances en la matière. Matériels et méthodes: Un questionnaire (10 questions) a été soumis à 270 orthodontistes qui ont participé au Congrès de la Société européenne d’Orthodontie qui s’est tenu à Istanbul en 2011. Les résultats ont été traités et analysés. Résultats: 52% des orthodontistes qui ont répondu au questionnaire pensent que les connaissances concernant le traitement des cas orthognatiques chirurgicaux peuvent nettement s’améliorer si l’on suit un cours de chirurgie orthognatique après la spécialité. Conclusions: Ajouter un programme post-spécialité peut être très utile et offrir aux orthodontistes plus de connaissances concernant le traitement des patients orthognatiques.
Resumen Introducción: El ámbito médico evoluciona muy rápidamente, tornándose cada vez más especializado y la ortodoncia no es ninguna excepción. El objeto de este estudio es valorar la necesidad de poner en marcha un programa post-especialidad en ortodoncia quirúrgica para los ortodoncistas con el fin de acrecentar sus conocimientos en este terreno. Materiales y métodos: Se ha repartido un cuestionario, con 10 preguntas, a 270 ortodoncistas que participaron en el Congreso de la Sociedad europea de Ortodoncia que se celebró en Estambul en 2011. Los resultados fueron procesados y analizados. Resultados: El 52% de los ortodoncistas que respondieron al cuestionario consideran que los conocimientos que se refieren al tratamiento de los casos ortognáticos quirúrgicos pueden ser
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
incrementados importantemente acudiendo a un cursillo de cirugía ortognática después de la especialidad. ˜ Conclusión: Anadir un programa post-especialidad puede ser muy valioso y susceptible de brindar a los ortodoncistas más conocimientos con respecto al tratamiento de los pacientes ortognáticos.
references
1. Stockstill J, Greene CS, Kandasamy S, Campbell D, Rinchuse D. Survey of orthodontic residency programs: teaching about occlusion, temporomandibular joints, and temporomandibular disorders in postgraduate curricula. Am J Orthod Dentofacial Orthop 2011;139:17–23. 2. Anning RJ, Thomson WM, Quick AN. Orthodontic education programs: an international comparison of students’ views and experiences. Am J Orthod Dentofacial Orthop 2011;139:220–7. 3. Bruner MK, Hilgers KK, Silveira AM, Butters JM. Graduate orthodontic education: the residents’ perspective. Am J Orthod Dentofacial Orthop 2005;128:277–82. 4. Lobbezoo F, van der Zaag J, Visscher CM, Naeije M. Oral kinesiology. A new postgraduate programme in the Netherlands. J Oral Rehabil 2004;31:192–8.
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5. Lindauer SJ, Peck SL, Tufekci E, Coffey T, Best AM. The crisis in orthodontic education: goals and perceptions. Am J Orthod Dentofacial Orthop 2003;124:480–7. 6. Gonty AA. Teaching a comprehensive orofacial pain course in the dental curriculum. J Dent Educ 1990;54:319–22. 7. Brown PN, Kulbersh R, Kaczynski R. Clinical outcomes assessment of consecutively finished patients in a 24-month orthodontic residency: a 5-year perspective. Am J Orthod Dentofacial Orthop 2011;139:665–8. 8. Berkowitz S. The need to establish an on-line cleft palate teaching program for orthodontic residents and practicing orthodontists. Am J Orthod Dentofacial Orthop 2010;137:577. 9. Petropoulos VC, Arbree NS, Tarnow D, Rethman M, Malmquist J, Valachovic R, et al. Teaching implant dentistry in the predoctoral curriculum: a report from the ADEA Implant Workshop’s survey of deans. J Dent Educ 2006;70:580–8. 10. Lang NP, De Bruyn H. The rationale for the introduction of implant dentistry into the dental curriculum. Eur J Dent Educ 2009;13(Suppl 1):19–23. 11. Mattheos N, Albrektsson T, Buser D, De Bruyn H, Donos N, Hjorting Hansen E, et al. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus. Eur J Dent Educ 2009;13(Suppl 1):11–7.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/pio
Original article
The necessity to establish surgical orthodontic fellowship program for orthodontists Rahman Showkatbakhsh a , Abdolreza Jamilian b,∗ a
Associate Professor, Director of Orthognathic Surgery, Department of Orthodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran b Associate Professor, Fellow of Orthognathic Surgery, Department of Orthodontics, Dental Branch, Islamic Azad University, Tehran, Iran
a r t i c l e
i n f o
a b s t r a c t
Article history:
Introduction: Medical field is developing very rapidly and is becoming more specialized.
Received 1 December 2011
Orthodontics is of no exception. Thus, the purpose of this study was to evaluate the neces-
Accepted 6 February 2012
sity of establishment of surgical orthodontic fellowship program for orthodontists in order to provide them with better insight.
Keywords:
Materials and methods: A 10 multiple choice question survey was taken from 270 orthodontists
Cleft lip and Palate
who participated in the European Orthodontic Society Congress in Istanbul, 2011. The results
Fellowship program
were tabulated and analyzed.
Orthognathic Surgery
Results: 52% of the respondents believed that the knowledge of treatment of orthognathic
Osteogenesis
surgery patients can be significantly improved by adding a fellowship of orthognathic
Surgical Orthodontics
surgery after the residency program.
Syndromes
Conclusion: Adding such program can be very constructive and will give better insight to orthodontists in regards to treatment of orthognathic patients. © 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.
1.
Introduction
As defined by most specialists, orthodontics is the first specialty of dentistry that is concerned with the study and treatment of malocclusions, which may be a result of tooth irregularity, disproportionate skeletal relationships, or both. Nevertheless, over the last few decades, orthodontists have become integral partners with other specialists on the craniofacial team and their presence at virtually all treatment procedures is inevitable. This bilateral interaction necessitates the orthodontist to have some knowledge of other craniofacial specialties. In addition, these days more and more people are seeking for treatment of dentofacial
∗
deformities and syndromes which gives rise to the necessity for an orthodontist to get insight of other specialties. Undoubtedly, orthodontists are efficiently and thoroughly trained in their own field and interdisciplinary studies. However, the vast knowledge of medicine is dramatically increasing day by day, which requires the orthodontists to go into more specific details of each anomaly and increase their knowledge in specific areas. Most medical fields have fulfilled this need by establishing fellowship courses for each subspecialty which allows a specialized physician to develop a particular expertise. Such subspecialty courses and fellowship programs are deemed as necessary in orthodontics in this fast growing medical world.
Corresponding author. No 2713, Vali Asr St. Tehran 1966843133, Iran. E-mail address: [email protected] (A. Jamilian). 1723-7785/$ – see front matter © 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved. doi:10.1016/j.pio.2012.02.002
261
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
An electronic review of the literature revealed various suggestions for improvement of dental and orthodontic curriculum1–8 ; however, no articles discussing the need for fellowship program in the field of orthodontics were found. In an attempt to fill this void in the orthodontic curriculum, establishment of a surgical orthodontics and craniofacial syndromes fellowship program was suggested. To determine the current opinion among orthodontists from different parts of the world a 10-question survey was developed to obtain that information. The questionnaire was randomly distributed among 270 orthodontists who attended 87th congress of the European Orthodontic Society held in Istanbul, Turkey, in 2011. In this article, we present the results of that survey and we offer suggestions for establishment of the fellowship program.
2.
Materials and methods
A 10 question survey focusing on orthodontic surgery knowledge gained during orthodontic residency programs and the need for establishing fellowship of orthodontic surgery and craniofacial syndromes can be seen in Table 1. The participants were 270 attendees of 87th Congress of the European Orthodontic Society (EOS) on June 2011 held in Istanbul, Turkey. In our survey EOS was considered as a small sample of orthodontic community. 6 of the participants did not mention their ages and the mean age of the rest of them was 37.8 ± 9.9 years. The distribution of respondents by their age, gender, continent, and years of experience in the field of orthodontics can be seen in Tables 2–5. It should be mentioned that 300 questionnaires were distributed among the participant; however, 270 of them were received back. The survey questionnaire included 10 multiple choice questions which allowed the respondents to mark their answers. The questions were compiled by two faculty members of orthodontic departments of two universities and were revised by several other orthodontists. The questions mostly involved information about the subject of surgical orthodontics in residency program and the number of orthognathic, distraction osteogenesis (DO), and cleft lip and palate patients or other syndromes whom the orthodontists were involved with during their residency program. The questions then were followed by the efficiency and sufficiency of such involvements. The last three questions focused on surgical orthodontics and the need for establishment of such course for orthodontists. The questionnaire responses were analyzed by using the Statistical Package for the Social Sciences (version 18, SPSS, Chicago, Ill). Descriptive analysis was conducted by using frequencies of the variables. Differences in responses among the four choices in questions 8 and 9 were tested with Marascuilo procedure for post-hoc analysis of the comparisons of multiple proportions (http://www.stattools.net/ Multiprop Pgm.php).
3.
Results
A total of 270 responses were received. Some respondents did not answer some of the questions; therefore, those questions were excluded from the analysis. In response to question 1,
Table 1 – Questionnaire of survey. In your Orthodontic Residency Program: 1- How much did you benefit from orthognathic surgery subject? A) Very Much B) Moderately C) Slightly D) Not at all 2- The number of orthognathic patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 3- The number of Distraction Osteogenesis patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 4- The number of Cleft lip and Palate or syndromic patients you were involved with their treatment: (Average = 4) A) Above Average B) Average C) Below Average D) Not at all 5- Did the course offer assignments that enabled you to practice orthodontic treatment of orthognathic surgery patients? A) Very Much B) Moderately C) Slightly D) Not at all 6- Did the course offer assignments that enabled you to practice orthodontic treatment of distraction osteogenesis (DO) patients? A) Very Much B) Moderately C) Slightly D) Not at all 7- Did the course offer assignments that enabled you to practice orthodontic treatment of Cleft lip and Palate patients or other syndromic patients? A) Very Much B) Moderately C) Slightly D) Not at all 8- How many times did you attend the orthognathic surgery operation rooms as an observer? A) Frequently B) Occasionally C) Rarely D) Not at all 9- To what extent do you think attending orthognathic surgical operations can provide the orthodontists with a better vision of treatment planning? A) Very Much B) Moderately C) Slightly D) Not at all 10- Which of the following do you think can improve your knowledge in treatment of orthognathic surgery patients: A) Add a fellowship of orthognathic surgery in addition to residency program B) Just add some relevant courses to residency program C) Increase the number of relevant national and international congresses D) No improvement needed
only 8.1% of the respondents believed that orthognathic subject was of no benefit to them; while 32.6%, 34.8% and 24.4% answered slightly, moderately and very beneficial respectively. Questions 2, 3 and 4 asked about the number of orthognathic, DO and cleft lip and palate patients treated by the respondents (Fig. 1). The average number was set on 4 patients. As can be seen in Figure 1, 36% of respondents had treated above average number of orthognathic patients, while 51.9% of them claimed that they had never treated a DO patient. As for the cleft lip
Table 2 – Age Distribution of Respondents. Age
Percent
<30 31 – 40 41 – 50 51 – 60 >60 Missing Respondents Total
23.5 46.2 19.7 7.6 3 100.0%
Frequency 62 122 52 20 8 6 270
262
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Fig. 1 – Response to questions 2, 3, and 4.
Table 3 – Gender of Respondents. Gender
Percent
Female Male Missing Responses Total
53.1% 46.9% 100.0%
Frequency 118 104 48 270
Table 4 – Distribution of Respondents by Continent. Continent
Percent
Europe Asia N. America Australia Africa Total
63.0% 28.1% 5.2% 3.0% 0.7% 100.0%
Frequency 170 76 14 8 2 270
Table 5 – Distribution of Respondents based on years of experience in the field of orthodontics. Years
Percent
1 – 10 11 – 20 21 – 30 31 – 40 Missing Respondents Total
67.7 20.8 9.2 2.3 100.0%
Frequency 176 54 24 6 10 270
and palate patients, 31.9% said that they had treated more than average number of patients during their residency period time. Questions 5, 6 and 7 assessed the efficacy of residency course assignments for treatment of orthognathic, DO, and cleft lip and palate patients (Fig. 2). Figure 2 shows that, only 8.8% and 17% of the respondents believed that the residency assignment were not useful for treatment of orthognathic and cleft lip and palate or syndromic patients, while 33.3% of them believed that the assignments were not efficient for treatment of DO patients. Questions 8 and 9 are about frequency of visits to orthognathic surgery operation rooms and the benefits of this attendance (Table 6). Table 6 illustrates that only 17.5% of the respondents had frequently attended the operation rooms; while, 46.1% of them believe that such attendances can be very beneficial for orthodontists since it gives them a better vision of treatment planning. Using the Marascuilo procedure, to perform post-hoc analysis, it was found that in question 8 there was a statistically significant difference between orthodontists who had frequently attended surgery operation rooms and those who had rarely done so (P < 0.001). Same analysis for question 9 revealed that there was a statistically significant difference between orthodontists who believed that there would be a high or moderate beneficial gain from such attendances with respect to those who thought that they would receive only a slight or no benefit (P < 0.0001). Question 10 was asked with the aim of suggestions for improving the knowledge of orthodontists in treatment of orthognathic surgery patients (Fig. 3). 52% of respondents believed that adding a fellowship of orthognathic surgery can be beneficial,
263
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Fig. 2 – Response to questions 5, 6, and 7. while 34.3% believed that just adding some relevant courses to the residency program would be enough. Only 1.5% thought that no improvement is needed. Eight of the participants chose not to answer this question.
4.
Discussion
This survey aims at making clear the need for a surgical orthodontics and craniofacial syndromes fellowship program for orthodontists who wish to treat patients seeking surgical orthodontics and DO, or patients with cleft lip and palate and craniofacial syndromes. The findings of the survey indicate that although many endeavors have been done to familiarize an orthodontist with treatment of orthognathic, DO, and cleft lip and palate or syndromic patients, still a noticeable number of orthodontists have not treated any such patients or had very few numbers of them. As we can see in Figure 1, 9.0% of the respondents claimed that they had never treated an orthognathic patient and 24.6% of them had treated fewer than 4 such patients. The percentages were 29.6% and 17.8% for
treatment of cleft lip and palate or syndromic patients, respectively. 51.8% of the respondents had never treated DO patients. It is believed that the reason for lower number of DO patients is the fact that DO has recently been introduced to the literature and practical practice (Fig. 1). The responses to questions 5, 6, and 7 also support the idea that still we have some orthodontists who find the courses offered during residency as inadequate for enabling the orthodontist to effectively treat orthognathic, DO, and cleft lip and palate or syndromic patients (Fig. 2). This idea is further supported by responses to questions 8, 9, and 10. As Table 6 depicts, 46.1% of the respondents believe that attending orthognathic surgical operations can be very useful for enhancing the vision of an orthodontist. Post-hoc analysis (the Marascuilo procedure), showed that a statistically significant number of orthodontists believed that they will benefit a lot from attending orthognathic surgical operations and it would provide them with a better vision of treatment planning. The authors believe that the opportunity of treating more such patients and more frequent visits to surgical operation rooms can be easier achieved by adding a fellowship course after residency program. The response
Table 6 – Response to questions 8 and 9. Questions 8 Number of times attending operation rooms?
Question 9 How beneficial can it be to attend the operation rooms?
Frequently n (%)
Occasionally n (%)
Rarely n (%)
Not at all n (%)
Total Number
82 (31.3%)
84 (32.1%)
50 (19.1%)
262
Very Much n (%)
Moderately n (%)
Slightly n (%)
Not at all n (%)
Total Number
120 (46.1%)
100 (38.5%)
34 (13.1%)
6 (2.3%)
260
46 (17.5%)
264
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
Conflict of interests The authors have reported no conflict of interests.
Riassunto
Fig. 3 – Response to question 10.
to question 10 shows that 52.0% of the respondents agreed with the suggestion and found it useful for improvement of orthodontists’ knowledge. It’s worthy to mention that a number of universities have commenced such courses. With the rapid progress of medical and dental sciences, many researchers have tried to improve the dental curriculum by means of surveys and adding new courses. Stockstill et al1 suggested more standardized curricula in occlusion and temporomandibular dysfunction at the graduate orthodontic residency level. Some recent researches prepared the grounds and led to introduction of implant into the dental curriculum.9–11 In one hand, the mutual interaction between orthodontists and other specialties, like craniofacial team, and on the other the progressive specialization of medical doctors and healthcare professionals, gives way to the creation of specialized and often very technical knowledge domains in orthodontics. The analysis and discussion of the data were based on the assumption that the answers were an accurate and honest representation of what the respondents thought. It is advisable to do such research in other places and gatherings of orthodontists especially in international congresses. Since the questionnaires were distributed randomly among a large number of attendees the inclusion of minor errors was inevitable; thus, we express our apologies for any missing continent in our survey.
5.
Conclusion
The consensus paper sets out the rationale for the introduction of surgical orthognathic and craniofacial syndromes fellowship after residency program. We hope that our findings will be considered by associations of orthodontists all over the world. And we hope that the results will assist in making constructive recommendation for improvement of orthodontists’ knowledge.
Introduzione: Il campo medico si evolve molto rapidamente diventando sempre più specialistico e l’ortodonzia non fa eccezione a questa evoluzione. Lo scopo del presente studio, pertanto, è quello di valutare la necessità di creare un programma post-specializzazione sull’ortodonzia chirurgica per gli ortodontisti allo scopo di accrescere le loro conoscenze in materia. Materiali e metodi: È stato distribuito un questionario composto da 10 domande a 270 ortodontisti che hanno partecipato al Congresso della Società Europea di Ortodonzia tenutosi ad Istanbul nel 2011. I risultati sono stati ordinati e analizzati. Risultati: Il 52% degli ortodontisti che hanno risposto al questionario ritengono che le conoscenze relative al trattamento dei casi ortognatici chirurgici possano essere significativamente accresciute frequentando un corso di chirurgia ortognatica dopo la specializzazione. Conclusioni: Aggiungere un programma post-specializzazione può essere molto costruttivo e offrire agli ortodontisti maggiori conoscenze riguardo al trattamento dei pazienti ortognatici.
Résumé Introduction: Le domaine médical évolue très rapidement et devient de plus en plus spécialisé, l’orthodontie n’étant point une exception. Le but de cette étude est évaluer le besoin de mettre en œuvre un programme post-spécialité, sur l’orthodontie chirurgicale à l’intention des orthodontistes en vue d’accroitre leurs connaissances en la matière. Matériels et méthodes: Un questionnaire (10 questions) a été soumis à 270 orthodontistes qui ont participé au Congrès de la Société européenne d’Orthodontie qui s’est tenu à Istanbul en 2011. Les résultats ont été traités et analysés. Résultats: 52% des orthodontistes qui ont répondu au questionnaire pensent que les connaissances concernant le traitement des cas orthognatiques chirurgicaux peuvent nettement s’améliorer si l’on suit un cours de chirurgie orthognatique après la spécialité. Conclusions: Ajouter un programme post-spécialité peut être très utile et offrir aux orthodontistes plus de connaissances concernant le traitement des patients orthognatiques.
Resumen Introducción: El ámbito médico evoluciona muy rápidamente, tornándose cada vez más especializado y la ortodoncia no es ninguna excepción. El objeto de este estudio es valorar la necesidad de poner en marcha un programa post-especialidad en ortodoncia quirúrgica para los ortodoncistas con el fin de acrecentar sus conocimientos en este terreno. Materiales y métodos: Se ha repartido un cuestionario, con 10 preguntas, a 270 ortodoncistas que participaron en el Congreso de la Sociedad europea de Ortodoncia que se celebró en Estambul en 2011. Los resultados fueron procesados y analizados. Resultados: El 52% de los ortodoncistas que respondieron al cuestionario consideran que los conocimientos que se refieren al tratamiento de los casos ortognáticos quirúrgicos pueden ser
progress in orthodontics 1 3 ( 2 0 1 2 ) 260–265
incrementados importantemente acudiendo a un cursillo de cirugía ortognática después de la especialidad. ˜ Conclusión: Anadir un programa post-especialidad puede ser muy valioso y susceptible de brindar a los ortodoncistas más conocimientos con respecto al tratamiento de los pacientes ortognáticos.
references
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