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Habilitation Thesis GRIGORE T. POPA UNIVERSITY OF MEDICINE AND PHARMACY IASI HABILITATION THESIS CLINICAL, BIOLOGICAL AND EXPERIMENTAL APPROACHES FROM ORTHODONTIC PRACTICE Georgeta Zegan, Professor, DMD, PhD 2019 Georgeta Zegan HABILITATION THESIS 2 Georgeta Zegan HABILITATION THESIS CONTENTS Abstract 5 Rezumat 7 Brief presentation of academic, professional and scientific achievements 9 SECTION I 13 SCIENTIFIC ACHIEVEMENTS FROM THE POSTDOCTORAL PERIOD 13 CHAPTER 1 13 The potential of dental care services and the performance of dental medical 13 undergraduate education 1.1. The common profile of orthodontic patients from the North-Eastern region of Romania 14 1.2. The importance of ways to promote the activity of the private dental office 16 1.3. The assessment of the degree of patients' satisfaction regarding the quality of private 18 dental care services 1.4. The assessment of the degree of patients' anxiety towards dental treatments 20 1.5. The performance level of the students in public dental medical undergraduate education 24 1.6. The orthodontic undergraduate education effectiveness for serving future patients 26 CHAPTER 2 31 Attitudes and behaviors of children and teenagers for oral health and their impact 31 on the quality of life 2.1. The role of the family in the development of the sanogenous behaviors at preschool 32 children 2.2. The role of the community in detection of the communication deficiency at preschool 36 children 2.3. The role of the school in the development of the sanogenous behaviors at 40 schoolchildren 2.4. The correlation between the self-reported oral health of schoolchildren and quality of 45 life 2.5. The correlation between socio-economic status of family and the impact of self- 48 reported OHRQoL of schoolchildren 2.6. The correlation between the impact of self-reported OHRQoL of teenage students and 51 their reasons for starting the orthodontic treatment CHAPTER 3 54 Clinical researches in the pathology of the permanent dentition development 54 3.1. Clinical and therapeutic aspects of hypodontia 54 3.1.1. The prevalence of clinical forms of hypodontia and the correlations on genders 55 3.1.2. The hypodontia patterns and the dental compensations in the remaining free space 57 3.1.3. Diagnostic and therapeutic assessments of familial hypodontia 60 3.2. Clinical and radiological aspects of impacted teeth and risk factors and predictors of 70 treatment CHAPTER 4 76 Clinical and cephalometric researches in the diagnostic and treatment of the dento- 76 maxillary anomalies 4.1. Clinical aspects of dental crowding and necessity factors and predictors of treatment 78 4.2. Cephalometric aspects of the skeletal anomalies 81 4.3. Clinical aspects of crossbite and risk factors and predictors of treatment 85 4.4. The prevalence of orofacial clefts and correlations with social parameters 88 3 Georgeta Zegan HABILITATION THESIS 4.5. The prevalence of facial, occlusal and skeletal asymmetries and correlations with 91 socio-demographic parameters 4.6. The correlation between idiopathic scoliosis, facial asymmetry and dento-maxillary 95 anomaly CHAPTER 5 99 Clinical and biological researches of the biocompatibility of the components of 99 orthodontic appliances 5.1. Prevalence of allergic reactions to orthodontic appliances and their correlations 100 5.2. Biodegradation of NiTi archwires with/without physiognomic coating in the oral 102 environment 5.3. Release of metal ions in the oral environment 106 5.4. The cytotoxic potential of latex-based orthodontic materials 108 CHAPTER 6 112 Experimental researches to improve the quality of orthodontic biomaterials and 112 antibiotics used in oral cavity infections 6.1. Researches for the optimizing quality of the metallic orthodontic devices 112 6.1.1. The influence of hydroxyapatite layer of Titanium-based micro-implant on osseo- 113 integration 6.1.2. The influence of titanium and zinc oxides and silver-doped hydroxyapatite of 116 micro-implants on infections prevention 6.1.3. Electrochemical corrosion rate of new alloy based on Iron 119 6.1.4. Use of the effect of NiTi alloy shape memory in medical equipment 122 6.2. Antibiotic controlled delivery systems for the treatment of oral infections 125 6.2.1. Prescription of antibiotics in dental practice 126 6.2.2. The obtaining of antibiotic-loaded chitosan particles by ionotropic gelation 127 6.2.3. The obtaining of hydrotalcite particles intercalated with antibiotics/ ascorbic acid 131 by co-precipitation SECTION II 135 Directions for future research 135 1. The profile of the future orthodontic patient and the performance of the medical team 135 2. Future health education and its impact on children’s quality of life 135 3. Etiopathogenic and therapeutic implications of dental and eruption anomalies 135 4. Diagnostic and therapeutic management of the patient with dento-maxillary anomalies 136 5. The allergic potential of new orthodontic biomaterials 136 6. Use of nano-particles in dental medicine 136 SECTION III 137 References 137 4 Georgeta Zegan HABILITATION THESIS ABSTRACT The habilitation thesis entitled “Clinical, Biological and Experimental Approaches in Orthodontic Practice” reveals the main scientific achievements after obtaining the title of Doctor of Medicine, the Orthodontic specialty. The thesis is structured in three sections according to the CNATCU recommendations. Before the first section I briefly presented the academic, professional and scientific achievements of my teaching career (25 years), medical (31 years) and research. The first section is dedicated to scientific research carried out during the post-doctoral period (1998-2019), being structured in 6 research fields (6 chapters). This section presents in 123 pages the results of 48 published articles (17 ISI and 31 IDB articles) of personal research and in collaboration with multidisciplinary teams of other universities from Iasi, exemplified in 31 tables and 59 figures. The first chapter was aimed to assess aspects, behaviors and opinions of patients, practitioners and students about orthodontic practice in the context of dentistry practice. The results of the clinical and statistical studies and surveys presented were specific to the geographical area and the investigated period time. Thus, the common profile of the orthodontic patient in the public service was sketched; the marketing methods of competitive private dental clinics/offices were identified; the degree of patients' satisfaction has been established regarding the quality of private dental services; the degrees of patients' anxiety has been identified for some therapeutical procedures, depending on their age and social background; the disadvantages of MCQ tests for students in assessing their medical training were revealed; and a positive feedback from last-year students on their training for a future orthodontic career was identified. The second chapter was conducted in the context of the general development of the child and teenager, which gains skills and behaviors through learning and education from parents, school and community. The presented studies were aimed to assess the degree of education for general and oral health, means of preventing illness and the impact of health on the self-reported physical, psychological and social well-being of children and teenagers. Survey results have shown that the induction of sanogenous behaviors in children is carried out in stages, corresponding to the general growth of the child. Also, parents, school and community have to work together through education. The physical, psychological and social well-being of schoolchildren depends on general and oral health, being maintained in the socio-economic status of the family and accessibility to health services. The third chapter addressed dental anomalies that occurred during the development of permanent dentition due to general factors or during dental eruption due to local factors. Clinical studies aimed at assessing hypodontia and impacted teeth and the damage caused by arcades symmetry, dental occlusion and dental-facial aesthetics. The results showed that the absence of an arcade tooth produces dento-alveolar compensatory movements and occlusal, skeletal and joint imbalances. An important aspect was the presentation of the family inheritance of hypodontia and possible environmental mutagens. Various clinical forms of congenital missing teeth or impacted teeth required interdisciplinary and individualized treatments to restore the dento-maxillo-facial balance. Although these dental anomalies seem simple at first glance, they are frequent in the Romanian population and the complexity of orthodontic, surgical and restorative therapy reveals the severity of these anomalies. The fourth chapter aimed to assess the clinical and therapeutical evaluation of dento- maxillary anomalies characteristic of the investigated population, as well as severe skeletal and 5 Georgeta Zegan HABILITATION THESIS maxillo-facial anomalies. The results of the studies showed that there is a link between the time of identification (the patient’s age at first consultation), the type of dentition, the severity of the dental crowding and/or crossbite and the type of orthodontic treatment instituted. Although these anomalies are visible, patients did not go to the orthodontist when the first signs of the anomaly appeared and so there were discrepancies in the jaw bases (Class II or Class III skeletal) and the treatment was complex. Orofacial clefts and dento-maxillo-facial asymmetries represent difficult orthodontic anomalies due to
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