I detta kapitel beskrivs framtagandet av ett kompetensramverk för den nya tandläkarutbildningen i Malmö. Ramverket beskriver vad studenter behöver utveckla för att fungera självständigt som professionella vårdgivare. Genom att koppla kompetenser till utbildningsmål och kursmål säkerställs och synliggörs den förväntade progressionen genom utbildningen. Ett kompetensramverk kan även vara ett värdefullt redskap för lärarna när de utvecklar olika lärandeaktiviteter och ger studenterna en förståelse för komplexiteten i tandläkaryrket. För att kompetensramverket skall vara relevant måste det förankras i både professionella och lokala sammanhang. Det slutliga ramverket består av 6 domäner: evidensinformerad, professionellt omdömesfull, hälsoambassadör, beslutsfattare, kommunikatör, samt medarbetare och ledare. Ramverket illustreras med en figur där varje domän visualiseras med en ikon och förklarande text för att underlätta förståelsen av konceptet.

This chapter outlines the development of a competence-based framework for the new dental program in Malmö. The framework specifies the essential competencies students need to develop to practice independently as professional healthcare providers. By aligning these competencies with educational and course objectives, progression throughout the program is clarified. The framework also serves as a valuable tool for educators in designing effective learning activities and supports students in grasping the multifaceted nature of the dental profession. To ensure continued relevance, the framework is grounded in both professional standards and the local context. The finalized framework compromises six domains: Evidence informed, Decision-maker, Communicator, Acting with professional conduct, Health ambassador, and Collaborator. Each domain is visually represented in an accompanying figure, featuring an icon and explanatory text to enhance conceptual understanding.

Background: Dental crowding affects nearly half of European adolescents and can negatively impact oral health-related quality of life (OHRQoL), particularly emotional and social well-being dimensions. Orthodontic treatment aims to improve function, aesthetics, and psychosocial well-being, yet active treatment may temporarily impair OHRQoL due to pain, dietary restrictions, and oral hygiene challenges. Understanding how conditions affect patients requires both objective and subjective assessments, yet patient reported outcomes remain underreported in orthodontic research, especially when comparing treatment techniques. Objectives: To evaluate and compare OHRQoL, treatment motivation, expectations, quality of care and attention, and satisfaction in adolescents with dental crowding treated with two fixed appliance systems without extractions, and to explore factors associated with satisfaction with treatment outcomes. Trial design: Multicentre, two-arm, parallel-group, superiority randomized controlled trial, with pooled analyses of both treatment groups, sex-stratified comparisons, and analyses exploring associations. Methods: Adolescents (n = 132), 12–17 years, with dental crowding were randomized with 1:1 ratio using computer generated random permuted blocks, stratified by sex, to receive fixed appliance treatment without extractions with either a conventional bracket system (CB; Victory) or a passive self-ligating bracket system (PSLB; DamonQ) at four orthodontic clinics. Primary outcome was Child Perceptions Questionnaire 11-14 (CPQ) score change. Two items were omitted; sensitivity analysis confirmed minimal impact on results. Secondary outcomes were patient experience and satisfaction questionnaires (10-point scale) assessed before treatment (T0), post-alignment (T1), and post-treatment (T2). Because of the nature of the treatments, only assessors could be blinded. Results: Both the CB (♀39, ♂31) and PSLB (♀34, ♂28) groups reported improved OHRQoL (median CPQ score change T0-T2 for total sample: 4.5; r = 0.37, P < .001) with minor intergroup differences. Oral symptoms and functional limitations worsened at T1 then improved by T2 (median change T0–T2 for each domain: 1, r = 0.23, 0.27, respectively, P < .001), whereas emotional and social well-being improved throughout treatment (median change T0–T2 for each domain: 1; r = 0.28, P < .001). Median scores were high for motivation (9) and overall satisfaction with treatment outcomes (≥9), and low for regretting having started treatment (1). Correlations between treatment expectations and satisfaction were observed (ρ = 0.330, P < .001). Minor harms expected during orthodontic treatment included plaque accumulation, chafing and gingivitis. Conclusions: This study indicates that fixed appliance treatment for dental crowding leads to improvements in OHRQoL, with temporary declines during treatment, and high patient satisfaction in the studied sample. Patients reported satisfaction with the changes achieved, dental appearance, and did not regret having started treatment. The results demonstrate possible benefits of treatment, patient-centred care, and support the use of patient reported outcomes in orthodontic practice. Trial registration: ClinicalTrials.gov (NCT05664282) 2022-11-24.

BACKGROUND: When assessing the effectiveness of interventions, randomized controlled trials (RCTs) are considered to generate the highest level of evidence. The CONSORT 2010 recommendations promote clear and transparent reporting of RCTs. However, to perform a complete analysis of methodological errors and risk of bias that RCTs may be subjected to, the Risk of Bias tool 2 (RoB 2) has been constructed.

OBJECTIVES: The aim of this systematic review was to assess the last 55 years of changes in methodological quality of orthodontic RCTs by using the RoB 2 tool.

SEARCH METHODS: The MEDLINE via Entrez PubMed, Web of Science, and Cochrane library databases were searched for orthodontic RCT publications from 1 January 1968 to 31 December 2024.

SELECTION CRITERIA: All RCTs on humans in the field of orthodontics were included. Non-randomized trials, animal studies, orthognathic surgery, syndrome patients, CLP patients, sleep apnea, and in vitro studies were excluded.

DATA COLLECTION AND ANALYSIS: The quality assessment of the studies was conducted using the Cochrane Risk of Bias Tool (RoB2). The RCTs were divided into three time periods, i.e. before CONSORT 2010, from 2011 to 2016, and from 2017 to 2024.

RESULTS: A total of 3135 RCTs were identified, and after excluding studies not fulfilling the criteria, 1231 RCTs were included in the quality assessment. Publications in the later or latest time-period had a larger number with low risk of bias than early ones. However, significant room for improvement remained since, in the latest time period there were relatively many RCTs with high risk of bias (67.6%). The main factors to high bias were unclear or missing information about 'who generated the random allocation sequence and enrolled participants' (selection bias), whether 'ITT or intention-to-treat' was used (attrition bias) as well as omitting reporting of 'all important harms or unintended effects' (other bias). Another factor was that baseline characteristics were missing (selection bias).

LIMITATIONS: The RoB2 tool is complex, and it requires trained individuals to use the tool.

CONCLUSIONS: There remains a need to enhance the quality of RCTs in orthodontics. To reduce the risk of bias, researchers should become well-acquainted with RoB2 before developing research protocols and plans. Specifically, use the 'signaling questions of RoB2' as extensively as possible to aid in designing the plans and protocols concerning the trial's conduct and progression.

REGISTRATION: PROSPERO: CRD42023390206.

Objectives: The objectives are to assess the severity and frequency of clinically relevant external apical root resorption (EARR) ≥ 2 mm during orthodontic treatment with Damon passive self-ligating and Victory conventional standardised fixed appliance systems and to evaluate the relevance of intermediate radiographic examinations for early detection and prevention of severe EARR. Materials and Methods: Adolescents aged 12–17 years with crowded and displaced teeth planned for non-extraction treatment were recruited from three orthodontic clinics. Participants were randomly allocated in a 1:1 ratio to treatment with either Damon Q (n = 35) or Victory (n = 40) using stratified blocks, with allocation concealed. EARR was assessed for all roots from incisors to molars using multiplanar reconstruction in cone beam computed tomography (CBCT) images acquired from various CBCT machines before, during and after treatment. Results: Sixty-two patients were included in the EARR analysis. The upper incisors were the most affected tooth group, with mean EARR values of 0.20 mm for Damon and 0.51 mm for Victory (NS, alpha 1%). The frequency of clinically relevant EARR in this tooth group was 5.0% for Damon and 7.2% for Victory (NS, alpha 5%). Only one case with clinically relevant EARR after treatment was identified in the intermediate radiographic examinations. Conclusions: The overall severity and frequency of EARR were below clinically relevant levels in both treatment groups. The results strengthen the evidence that routine intermediate radiography appears to be of limited relevance for early detection and prevention of severe EARR in non-extraction treatments for adolescents with crowded teeth. Trial Registration: ClinicalTrials.gov: NCT05664282.

Objectives: To assess and compare treatment effects and treatment time in adolescents with crowded and displaced teeth during and after non‐extraction treatments using a passive self‐ligating bracket system (PSLB) and a conventional bracket system (CB).

Materials and Methods: Consecutive adolescents (12–17 years old) with crowded and displaced teeth were randomised through computer generated block randomisation in a two‐arm parallel‐group design, to non‐extraction fixed appliance treatment with either PSLB (Damon Q, n  = 62) or CB (Victory, n  = 70) at four orthodontic clinics. Study models and cephalograms were collected at baseline, post‐alignment and post‐treatment. Primary outcome was assessed with weighted Peer Assessment Rating index (wPAR) and secondary outcomes with Little's Irregularity Index (LII), and as transversal width (mm), incisor inclination (°), position (mm) and treatment time (months).

Results: Intergroup differences in wPAR with mean score reductions of −24.07 (CB) and −22.11 (PSLB), LII upper/lower arch reductions of −9.02/−5.96 (CB) and −8.44/−5.29 (PSLB), and mean treatment times of 21.74 (CB) and 24.35 (PSLB) months were non‐significant (NS). Lateral expansion was greater in the PSLB group during alignment; mean intergroup maxillary differences (MD) were 1.35 at inter‐canines, 1.21 mm at first inter‐premolars, and mandibular MD were 0.75 at first, 0.76 mm at second inter‐premolars ( p  ≤ 0.019). Greater incisor proclination was observed in the CB group (L1NB, MD = 2.28°; ILiML, MD = 2.23°) ( p  ≤ 0.016). Intergroup differences post‐treatment were NS.

Conclusion: Great occlusal treatment outcomes were observed in both groups with no significant difference in treatment time. Although the expansion patterns differed during alignment, no significant intergroup difference remained after treatment.

Trial Registration: The protocol is registered on ClinicalTrials.gov (NCT05664282)

Licensure exams play a crucial role in ensuring the competence of individuals entering a profession, thereby safeguarding the public and maintaining the quality and integrity of the profession. In Sweden, dentists educated outside the European Union seeking to practise dentistry must undergoa re-certification process. The re-certification process includes a theoretical examination where pass marks are set using a three-level Angoff method. This study aimed to determine the consistency of the Angoff ratings using independent panels at two Swedish universities. Two cohorts of panellists were included in the study: one reference and one external. The reference panel was responsible for rating the upcoming theoretical examinations in the proficiency test, which were used to set the pass mark. The external panel, recruited from a dental school at a university in another region in Sweden, provided ratings after the examinations. Three examinations during 2019–2020 were included in this study (267 items in total). There was a strong correlation (ρ ≥ 0.70, p < .001) between the ratings of the two independent panels, with no significant differences in item ratings across the full exams, dental disciplines, and professional qualifications analysed. This suggests that the three-level Angoff method reliably produces similar standards for assessing the competence of the minimally qualified dentist across different institutions. The expectations of the minimally qualified but still acceptable dentist were comparable between the two independent panels across the three theoretical examinations explored. The alignment between the panels indicates valid, reliable standards across institutions, despite the independent syllabi of the two study programmes. However, while there is an alignment, differences in ratings remain. Consequently, involving multiple institutions in future standard-setting processes could help ensure that the standards reflect a broader range of educational practices, supporting the credibility of licensure examinations.

Objectives: To assess inter- and intrarater reliability and agreement for measurements of root lengths using multiplanar reconstruction (MPR) in cone beam computed tomography (CBCT) examinations.Furthermore, to determine whether using MPR from different CBCT machines was a reliable and reproduc-ible method for assessment of root length during orthodontic treatment of adolescents. Materials and methods: A total of 40 CBCT examinations obtained before, during and after orthodontic treatment of 14 adolescents, with fixed appliances from a multicentre randomised controlled trial, were used. All roots from the incisors to the first molars were measured by two independent raters and in accor-dance with a protocol preceded by a multi-step calibration. Reliability was assessed by intra class cor-relation (ICC). Agreement was assessed by measurement error according to the Dahlberg formula and Bland–Altman plot.Results: The number of repeated measurements varied from 436 to 474 for the different timepoints. Good to excellent inter- and intrarater reliability for different tooth groups and timepoints were shown. Measurement error for inter- and intrarater agreement varied between 0.41 mm and 0.77 mm. The Bland–Altman plot with 95% limits of agreement varied between +1.43 mm and −2.01 mm for different tooth groups and timepoints. Conclusions: The results of this study indicate that CBCT using MPR from different machines is a reproduc-ible method for measuring root length during different phases of orthodontic treatment. When interpret-ing root shortening measurements in CBCT using MPR for clinical or research purposes, values below 2 mm should be approached with caution, as they may contain measurement errors

OBJECTIVES: To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems.

MATERIALS AND METHODS: Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale.

RESULTS: Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively).

CONCLUSIONS: Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.

OBJECTIVES: To compare the costs and treatment effects of headgear activator treatment of Class II malocclusion with excessive overjet between treatments started in the mixed (MD) and late mixed dentition (LMD).

TRIAL DESIGN: Two-arm parallel-group single-centre randomized controlled trial (RCT).

MATERIAL AND METHODS: A total of 56 children presenting Class II malocclusion with excessive overjet were assessed and invited to an RCT designed as intention-to-treat. The children were randomized, by an independent person not involved in the trial into two groups, treatment with headgear activator in the MD starting at the age of 9 or to treatment with a headgear activator in LMD, starting at the age of 11. The primary outcome measure was to compare the treatment costs between the two groups. Societal costs (the sum of direct and indirect costs) were calculated for successful treatments only and when unsuccessful treatments were included. Secondary outcomes were comparisons of oral health-related quality of life (OHRQoL), dental and skeletal treatment effects, lip closure, and trauma incidence. Data collections were performed before and after treatment, corresponding to a treatment period of 2 years. Blinding was accomplished when assessing outcomes.

RESULTS: No group differences in costs were found of successful treatments or when unsuccessful treatments were included. The most pronounced treatment effects in both groups were the reduction of overjet and improved molar relation. Treatment started in MD or in LMD were equal and without significant differences regarding effects on OHRQoL, skeletal effects, lip closure, and incidence of trauma.

HARMS: No harm was observed, but 8 of 30 children (27%) in the MD and 6 of 21 children (29%) in the LMD group showed unsuccessful results.

LIMITATIONS: Costs depend on local factors and can thereby not be directly transferred to other settings. It was a single-centre trial and can thus be less generalizable.

CONCLUSIONS: Regarding costs and treatment effects, there is no difference if headgear activator treatment of excessive overjet starts in the MD or LMD.

CLINICAL TRIAL REGISTRATION: NCT04508322.

BACKGROUND AND AIMS: Systematic reviews (SRs) are considered to provide reliable estimates, but flaws in designs, methods of monitoring effects, and outcomes have the potential to bias results. There are several tools for assessing risk of bias (RoB), most of them designed for SRs of beneficial effects. To our knowledge, there is no tool that is adapted specifically to assess RoB in studies of adverse effects associated with orthodontic treatment. To address this, the aim of this study was first to introduce a tool for assessment of RoB in studies of adverse effects associated with orthodontic treatment and, second, to apply it in an SR of external root resorption (ERR) associated with orthodontic treatment with fixed appliance.

MATERIALS AND METHODS: The approach with domains supported by signalling questions was used for the tool. Domains and signalling questions were tailored to the review questions of the SR of studies of ERR after orthodontic treatment using periapical radiography or cone beam computed tomography. Duplicate study selection, data extraction, and RoB assessment using the tool, followed by meta-analyses, were performed.

RESULTS: Using the tool for the assessment of RoB identified shortcomings and report deficiencies of primary studies concerning the presentation of orthodontic treatment, identification of ERR, and analysis of outcomes. RoB assessment resulted in 12 of 32 studies read in full text being included. Reported severe ERR varied across studies between 2 and 14 per cent for all incisors and 10 and 29 per cent for maxillary incisors. Results of ERR related to patients' age and sex, orthodontic diagnosis, and treatment were contradictory. Quality of evidence evaluated by GRADE was low due to study limitations, imprecision, and inconsistency of study results.

CONCLUSIONS: As the tool and its application highlight important issues to consider when planning, conducting, and reporting research, the tool may have a valuable role for quality enhancement of future studies of outcomes of orthodontic treatment. The tool may also serve for authors when planning SRs. Our SR identified a need for studies that use rigorous methodology and transparent reporting.

REGISTRATION: PROSPERO (ID = CRD42018084725).