BY TATE H. JACKSON AND CLARKE STEVENS

STUDY SYNOPSIS
A study just published in the Angle Orthodontist has analyzed 419,363 tweets, shared publicly regarding the patient experience with either traditional fixed appliances or Invisalign®. The data were collected over a period of five months from April to September in 2015 and analyzed by sentiment analysis using Naïve Bayes classifiers.

Tweets were identified by the use of the keywords “braces” or “Invisalign” and filtered using software so that content irrelevant to orthodontics (braces as a term for suspenders in fashion, for example) was excluded. All tweets relevant to orthodontics with either keyword were then classified in sentiment as positive, negative, neutral, or as an advertisement.

 Overall, more tweets about orthodontic treatment were positive (62%) than negative (38%). There was no statistically significant difference in the proportion of positive tweets when comparing traditional braces to Invisalign®. More individuals tweeted about braces than Invisalign®, and 1/3 of all the tweets involving Invisalign® were classified as advertisements. Generally, positive tweets most often focused on gratitude while negative tweets most often focused on pain.

WHAT THE PROFESSORS THINK
The topic and methodology of this study are certainly relevant to those practicing in the era of social media. The use of a simplified sentiment analysis was evidence-based, and the authors used adequate search terms and a human-defined pool of categorized terms of adequate size to train the software for the larger analysis that took place.
 
The authors did not analyze if tweets originated from individuals associated with an orthodontics practice. Although that may be impossible to do effectively, it is important to interpret the data with that fact in mind.
 
Although this study only presents data from one form of social media, it does have some interesting ramifications for practicing orthodontists.
 
First, the fact that more than 400,000 tweets published over a five month period involved orthodontic treatment reinforces the power of social media in the public discourse relative to orthodontics.
 
Second, the majority of tweets were positive in nature, a point that might reassure orthodontists that the profession is viewed favorably. The magnitude of positive sentiment reported (62%) can serve as a sort of evidence-based benchmark for individual practices. If an analysis of a practices’ social media references shows a lower proportion of positive comments, it might be an objective reason for concern on the part of the practice.
 
Third, it is also interesting to note that despite the fact that there were more tweets related to traditional braces overall, there was a much higher proportion of advertising related to Invisalign®.
 
33% of all tweets related to Invisalign® were advertisements, compared to only 7% for braces. Again, for clinicians in practice who want some sort of evidence-based benchmark related to the density of advertising for either traditional braces or Invisalign® using social media, these data give some insight.

Article Reviewed: Noll et. al. Twitter analysis of the orthodontic patient experience with braces vs. Invisalign. The Angle Orthodontist. Online Early, Jan 2017.

BY TATE H. JACKSON AND WILLIAM V. GIERIE

STUDY SYNOPSIS
A study in the Angle Orthodontist has surveyed 1,000 General Dentists and 1,000 Orthodontists – drawn from a list of Invisalign® providers on the company’s website. Those surveyed were asked to rate their confidence using Invisalign® to treat six different cases for which intra-oral photographs were provided: a Deep Bite case, a Posterior Crossbite case, a Anterior Open Bite case, Mild Crowding case, a Severe Crowding case, and a Class II case. Additionally, both Orthodontists and General Dentists were asked about their various treatment planning (e.g. time spent with ClinChecks) and mechanics (e.g. use of Class II elastics or auxiliaries) tendencies with Invisalign®. Finally, demographic and training information, as well as experience in treating cases with Invisalign® was reported.

Overall, both Orthodontists and General Dentists were relatively confident in treating the four cases presented with Invisalign®. Interestingly, General Dentists were significantly more confident when it came to more complex cases: deep bite, severe crowding, and Class II. Orthodontists reported higher confidence in treating mild crowding than General Dentists.
 
Orthodontists were significantly more likely to spend more time reviewing ClinCheck set-ups and were more likely to use refinements and elastics as a part of treatment. Not surprisingly, Orthodontists reported more training and experience using Invisalign® and were more likely than General Dentists to tell patients that their malocclusion was too complex for Invisalign®.

WHAT THE PROFESSORS THINK
This article provides some data for practicing Orthodontists that might be of great use in discussing with patients why orthodontic care is specialized treatment – not just the appliance used to straighten teeth.
 
The use of a specific case records in conjunction with confidence ratings, and not just a survey self-report, gives these data some greater credibility. The use of intra-oral photographs alone had good rationale, since it provided a realistic version of the information that a General Dentist might consider when planning an Invisalign® case. The structure of the survey, asking respondents to give demographic and training information after completing the confidence ratings is helpful since it aids in avoiding bias when reporting confidence.

The fact that the response rate to the survey is not clearly reported is an unfortunate shortcoming of the study – one that, if clarified, would significantly improve the reliability of the results.
 
There are two pieces of information from this study that are most interesting and clinically relevant:

1. General Dentists reported a higher level of confidence in treating more complex cases but also reported using auxiliaries less often. For example, General Dentists used Class II elastics less often than Orthodontists but reported a higher confidence in treating the Class II case. Together, these results suggest a lack of expertise for General Dentists.
2. Orthodontists were more likely to have more training, to have treated more Invisalign® cases overall and in the past 12 months, to spend more time adjusting ClinCheck set-ups, and to use more refinements than General Dentists. All of these points suggest that Orthodontists not only might have more training and experience, but also that they might put more effort in to achieving a more ideal final result.

Article Reviewed: Best et al. Treatment management between orthodontist and general practitioners performing clear aligner therapy. Angle Orthodontist. Online Early Nov 2016.