Bronfenbrenner y la teoría de la ecología del desarrollo humano

Orthodontists strive to balance patients’concerns, occlusion, facial esthetics and ultimately maintaining the results achieved during treatment. Attaining these goals is dependent not only on the practitioners’skills but also on their knowledge of patient preferences and the patient’s willingness to comply with prescribed protocols. Stability of treatment can be affected by time, duration and types of retention appliances.63 Obtaining qualitative data on patient perspectives has been recently emphasized in the literature on research and audit. The assessment of patient satisfaction via questionnaires is becoming a more pertinent means to obtain this data.64

This cross-sectional survey study addressed:

1)

Patient satisfaction with the treatment rendered

2)

Stability and relapse of treatment

3)

Common retention protocols at The University of Western Ontario

4)

Patient compliance with retention protocols, and

5)

Patient satisfaction with the prescribed retainers with respect to:

a.

Appearance

b.

Speech

c.

Ease of maintaining oral hygiene

d.

Ease of maintaining the retainer

e.

Need for replacement retainers, and

f.

Preferred types of retainers.

The study was conducted via an electronic interview format. Issues pertaining to mailed surveys as compared to interview surveys are reported as: low response rates, high levels of missing data on returned surveys, ambiguities in responses65, and under-representation of low socio-economic classes.66 Face-to-

face interview surveys are typically more expensive than mailed ones.67 The study questionnaire was administered in person, at regularly scheduled retention appointments, and did not result in enhanced financial costs to the patients or the clinic. The electronic interview format resulted in a 99% response rate. Sample bias was reduced as all patients returning for one or two-year retention appointments were

requested to participate. Only patients who attended retention appointments responded to the survey, thereby incorporating a different form of sample bias.

Mailed surveys allow larger samples to be surveyed in similar time periods.10,15,67 The sample size used in this study was consistent with previous publications by Sinha, Al-Omiri and Palomares 25,43,45 that used an interview format. The sample consisted of 131 patients between the ages of thirteen years and eight months and sixty years and four months. At the time of the survey, half of the patients were aged seventeen to twenty-one years old. The patients attended the Graduate Orthodontic Clinic at Western University for comprehensive orthodontic treatment and had been debonded one or two years ago. Patients who had their appliances removed a minimum of one year prior to survey completion were recruited because less than one year would be insufficient to provide valuable data on stability and satisfaction.35 Two thirds of the

population was female which is consistent with previous publications that portray that an increased number of females seek orthodontic treatment.68

The most commonly prescribed maxillary retainer was the Essix, followed by the Hawley, and then the bonded retainer. Pratt et al7 report a shift away from the prescription of Hawley retainers and towards Essix retainers over time. The bonded retainer was not frequently prescribed for the maxillary arch. This may be due to the fact that when occlusions are corrected to ideal parameters, the resulting dental overjet and overbite cause mastication forces to be directly applied to the upper fixed retainer, which leads to their frequent failure.69

Many respondents in this study were prescribed more than one type of retainer per arch. In the maxilla, the Essix alone followed by a combination of an Essix and a Hawley and finally a Hawley alone were the most commonly prescribed retainers. Singh et al17 also found that the Essix was most commonly used in both hospital and private orthodontic practices. However, this result varies from the finding by Valiathan20 where the Hawley was identified as the most commonly used maxillary retainer. The second most common maxillary retainer group of Essix and Hawley portrayed a regimen that allows the patient a choice to enhance compliance and also provides a back-up retainer.

In the mandibular arch the most commonly prescribed retainer was the bonded retainer, followed by the Essix and then the Hawley retainer. Similar results were also reported in two studies conducted in the United States.15,20 Renkema et al70 investigated the effectiveness of mandibular canine to canine bonded

retainers and concluded that they are effective in maintaining the alignment of the mandibular anterior region after active orthodontic treatment. Oltramari et al71 published that a well inter-digitating functional occlusion ensures stability after completion of orthodontic treatment. A survey on retention practices in the United Kingdom found that, in private practice vacuum retainers were often used in conjunction with bonded retainers in both arches, particularly the mandible, which could help in stabilizing both posterior and anterior segments.17 In the present study, Essix or Hawley overlays on top of the mandibular bonded retainer were prescribed less than 10% of the time.

There was no association between sample demographics (age, gender or retention time) and type of maxillary or mandibularretainers prescribed. Ten percent of the females and no males reported receiving all three types of maxillary retainers. Previous publications have indicated that more females seek

orthodontic treatment and females tend to be more concerned about milder occlusal issues.72 This may be reflected during the retention phase also, thereby resulting in more retainers being prescribed in response to concerns expressed. Older patients received mandibular Essix retainers and younger patients received mandibular bonded retainers most often. A mandibular bonded retainer that does not require compliance may be prescribed by orthodontists more frequently for younger patients, as it is believed that age

influences compliance.7 Older patients’desires for esthetic retainers may result in an increased prescription of Essix retainers in that age group.14

In document Construyo mi colegio estrategia para la construcción, el desarrollo y la apropiación del “lugar educativo” Sistematización de experiencia pedagógica (página 36-39)