bluuebunny/crossref_metadata_2025 huggingface dataset:
Modern endodontic principles part 6: managing complex situations
Authors: Taylor Carly , Roudsari Reza Vahid , Jawad Sarra , Darcey James , Qualtrough Alison
Published: August 2017

Clinicians are often faced with endodontic cases that are significantly more challenging than the primary root canal treatment of mature adult teeth. This paper outlines some of the common treatment modalities which can be employed in situations in which either primary treatment has failed, or there is iatrogenic damage or unusual anatomy.

CPD/Clinical Relevance: This paper will provide the reader with advice and techniques for undertaking orthograde endodontic retreatment, hemisection, endodontic surgery and management of teeth with incompletely formed roots.
Resin-bonded bridges – can we cement them 'high'?
Authors: Dayanik Sinem
Published: August 2017

Controversy exists surrounding resin-bonded bridges (RBBs), particularly with regards to abutment preparation. Should the abutments be prepared? If the abutments are prepared what design should be adopted? If there is to be no preparation, will there be space for the restoration? Many factors need consideration when planning for this treatment. This article aims to explore the effect of abutment preparation. In this regard, a literature review was conducted to present the latest available evidence.

CPD/Clinical Relevance: Minimal intervention is key in modern dentistry, so clinicians must be able to make confident decisions in the provision of minimally invasive treatments like the RBB and be aware of the latest evidence.
Return of the great pox
Authors: Scully Crispian , Setterfield Jane F
Published: August 2017

Syphilis is on the increase globally. While recognized more frequently in patients with, HIV/AIDS, it is not unusual among immune competent individuals sometimes presenting with unusual manifestations and/or behaviour. This paper reviews the history and clinical features of syphilis and draws attention to the oral manifestations.

CPD/Clinical Relevance: Syphilis should be in the differential diagnosis of oral ulcers or unusual oral lesions.
Allergy to chlorhexidine
Authors: Pemberton Michael N
Published: August 2017

Chlorhexidine is an effective antiseptic which is widely used in dentistry. Over recent years, it has also been used in other healthcare products as well as in cosmetics. Anaphylaxis to chlorhexidine has been increasingly reported throughout the world, including two incidents in the UK where chlorhexidine-containing mouthwash had been used to wash tooth sockets following recent tooth extraction. Chlorhexidine is under-recognized as a cause of anaphylaxis and dentists should be aware of its potential for serious adverse effects. Dentists need to consider whether the washing out of a tooth socket with chlorhexidine solution should be avoided in the treatment of established dry socket. On current evidence the potential risks of using chlorhexidine as irrigation solution for treating an established dry socket appears to outweigh any known benefit.

CPD/Clinical Relevance: Chlorhexidine has the potential to cause anaphylaxis in the dental surgery.
Counterfeit and non-compliant dental devices: the dangers and how to mitigate them
Authors: Proffitt Edmund
Published: August 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) is dealing with a growing number of counterfeit and non-compliant dental devices and instruments for sale to dental practices in the UK. This paper examines the extent of the issue, the dangers posed by the use of counterfeit and non-compliant products, discusses initiatives to address the problem and how the dental team can identify these products and mitigate the associated risks.

CPD/Clinical Relevance: To ensure that all members of the dental team are aware of the dangers posed by counterfeit and non-compliant dental devices and instruments and how to mitigate such risks.
Spontaneous oral mucosal bleeding unmasking undiagnosed sarcoidosis: a case report
Authors: Kalsi Harpreet , McParland Helen , Cook Richard J
Published: August 2017

Sarcoidosis is a multisystem, non-caseating, chronic, granulomatous disease affecting any organ. In the head and neck region, salivary glands and lymph nodes are most commonly involved. Oral manifestations are rare but these lesions, occasionally haemorrhagic, may be the first sign of systemic disease. It is important to recognize the oral manifestations of sarcoidosis and to be aware of potential secondary disease-driven processes, such as thrombocytopenia. The purpose of this paper is to present a previously undiagnosed case of sarcoidosis, initially presenting with oral manifestations, including mucosal bleeding, and to review the current literature on oral sarcoidosis.

CPD/Clinical Relevance: Oral lesions can be the first sign of undiagnosed systemic sarcoidosis.
Adult dental anxiety: recent assessment approaches and psychological management in a dental practice setting
Authors: Humphris Gerry , Spyt James , Herbison Alice G , Kelsey Thomas W
Published: August 2017

Dental anxiety of patients is a common feature of the everyday experience of dental practice. This article advocates the use of regular assessment of this psychological construct to assist in patient management. Various tools, such as the Modified Dental Anxiety Scale (MDAS), are available to monitor dental anxiety that are quick to complete and easy to interpret. Patient burden is low. A new mobile phone assessment system (DENTANX) is being developed for distribution. This application and other psychological interventions are being investigated to assist patients to receive dental care routinely.

CPD/Clinical Relevance: This article provides evidence and expert opinion on the worth of regular dental anxiety assessment in dental practice using structured tools, such as the Modified Dental Anxiety Scale, and consideration of psychological intervention development.
Modern endodontic principles part 8: the future of endodontics
Authors: Roudsari Reza Vahid , Jawad Sarra , Taylor Carly , Darcey James , Qualtrough Alison
Published: August 2017

Although the principles of endodontics have remained unchanged for many decades, root canal treatment has been subject to major changes in the past few years. This paper outlines the cutting-edge advances including the materials and techniques used.

CPD/Clinical Relevance: This article provides an overview of bioactive materials and insight into regenerative endodontics, vital pulp therapy and intentional replantation.
Pain part 10: headaches
Authors: Chong M S , Renton Tara
Published: August 2017

This last in a series of 10 papers aims to provide the dental and medical teams with an update in headache conditions relevant to dentistry and medicine. Headache is the most common presenting symptom for patients presenting to A&E departments.

CPD/Clinical Relevance: Most of the dental team take for granted their knowledge and ability to manage acute dental pain. However, the education and preparation in managing patients with headache conditions remains poor. Dentists are in a privileged position to be able to advise their patients about common conditions including headaches.
Orthodontic first aid for general dental practitioners
Authors: Sodipo Ibukunoluwa , Birdsall Joanne
Published: August 2017

Orthodontic emergencies occasionally arise and although they can cause discomfort to the patient, they can usually be stabilized by a general dentist and then followed up by the orthodontist.

CPD/Clinical Relevance: Patients undergoing orthodontic treatment may initially present to their general dental practitioner with an orthodontic emergency as opposed to their orthodontist. It is therefore important that general dental practitioners are aware of common orthodontic emergencies and their management.
Mouthwashes: do they work and should we use them? part 2: anticaries, antihalitosis and dry mouth relief efficacy of mouthwashes
Authors: Hodge Penny
Published: August 2017

This article will review the anticaries, antihalitosis and dry mouth relief efficacy of mouthwashes. Fluoride mouthwashes may provide an additional benefit to toothpaste and gel in children with a high risk of dental caries, but toothpaste alone may be a more acceptable mode of delivery. There may be a beneficial effect of fluoride mouthwashes on caries levels in older adults, particularly those at higher risk of root caries. The available data of the antihalitosis effect of mouthwashes neither supports nor contra-indicates their use. The key area where a mouthwash may be of use in the treatment of patients with a dry mouth is through the anticaries effect of fluoride.

CPD/Clinical Relevance: The evidence supporting the use of anticaries, antihalitosis and dry mouth relief mouthwashes is evaluated. This provides guidance for dentists and dental care professionals of when it is appropriate to recommend the use of a mouthwash in these situations.
Evaluation of quaternary ammonium compound disinfectants against mycobacteria in dental practices
Authors: Sandle Tim
Published: August 2017

This paper discusses the use in dental practices of quaternary ammonium compounds (QAC) and alcohol-based disinfectants in relation to bactericidal efficacy against mycobacteria. QAC disinfectants are commonly used in dental practices, although there are concerns about their efficacy against tuberculosis-causing bacteria. The paper discusses a recent study where two QAC products (ready-to-use and saturated wipe liquor presentations) were tested, using a recognized suspension test, at the manufacturer's recommended concentration, under simulated ‘clean’ and ‘dirty’ conditions. The test data indicated that, after a 10-minute contact time, suitable kill of the test organism was not obtained. These findings raise questions about the suitability of QAC disinfectants for dental practices.

CPD/Clinical Relevance: Tuberculosis, a disease caused by Mycobacterium tuberculosis, is increasingly becoming a communicable disease of concern. It is important that dental practices ensure that a suitable level of decontamination takes place between patients. QAC disinfectants may not be suitable for this purpose and alternative biocides, like alcohol, may need to be considered.
Periodontal disease: breaking the downward spiral of the disease process
Authors: Kehily Elaine , Roberts Anthony
Published: August 2017

Periodontal disease is a common disease affecting more than 50% of the world's adult population. It presents a diagnostic and treatment challenge for the dental clinician. A successful treatment outcome can be achieved by early and repeated intervention when signs of disease are evident in the mouth. Gingival bleeding is one of the early signs of gum disease and one which should not be overlooked by the patient or his/her dental care professional. This is usually indicative of the presence of gingivitis, which can lead to periodontitis in susceptible patients.

CPD/Clinical Relevance: A high standard of plaque control is essential throughout treatment for a favourable periodontal outcome and yet it is unfortunate that sometimes, despite the best endeavour of both patients and clinicians, this is not possible. As a consequence of the failure to establish high levels of plaque control, some patients do not respond fully to traditional periodontal therapy and, for some patients, an ongoing deterioration or ‘downward spiral’ continues and adjuncts to non-surgical periodontal therapy are indicated to improve periodontal outcomes.
The importance of correct diagnosis and treatment in endo-periodontal lesions: a two cases comparison
Authors: Bernardi Sara , Frascarelli Christian , Fantozzi Giulia , Caruso Silvia , Gatto Robert , Nardi Gianna Maria , Continenza Maria Adelaide
Published: August 2017

This paper illustrates two endo-periodontal lesions treated with the same standardized protocols with different prognoses. In the first case, the endodontics and periodontal therapies were performed with clinical and radiological healing of the lesion. In the second case, the tooth had to be extracted because of repeated inflammatory processes. In order to investigate the reasons for failure, the extracted tooth was submitted to clearing process, followed by stereomicroscope observation. It revealed a vertical fracture running along the palatal root, not detectable by radiographic examination. This pathway between pulpal and periodontal tissues determined the negative prognosis of the treatment.

CPD/Clinical Relevance: This report aims to highlight how root vertical fractures may not be readily detectable to the standard bi-dimensional radiograph.
Serving the customer–do patient feedback and questionnaires improve quality?
Authors: Keshtgar Asma , D'Cruz Len
Published: August 2017

This review article aims to analyse whether patient feedback and questionnaires improve quality of care. It is recognized that patients cannot assess the medical competence of the clinician, yet patient experience provides an insight into the process of care through the patients' eyes. Patient experience measures are more reliable for use to assess quality than patient satisfaction surveys. It is inappropriate to use patient satisfaction surveys as a basis for remuneration of dentists within the NHS. Patient Reported Outcome Measures (PROMs) have been a successful measure of patient experience in medicine and their introduction to dentistry needs to be considered.

CPD/Clinical Relevance: This article will enable clinicians to understand the importance of patient experience measures as a more reliable way of improving the quality of clinical care than patient satisfaction surveys.
Oral candidosis in the paediatric patient
Authors: Ryan Kevin , Agel Mona , Zaitoun Halla , Hegarty Anne M
Published: August 2017

Oral candidosis can present in childhood with recognizable mucosal changes. It may be associated with predisposing factors or suggest underlying systemic disease such as poorly controlled diabetes or an immunosuppressed state. Investigations are often required and management includes addressing predisposing factors in addition to prescribing topical or systemic antifungal therapy.

CPD/Clinical Relevance: It is important for general dental practitioners to recognize oral mucosal changes related to candidal infection and refer to secondary care for further assessment when appropriate.
The immune system: basis of so much health and disease: 1. overview of immunity and the immune system
Authors: Scully Crispian , Georgakopoulou Eleni A , Hassona Yazan
Published: August 2017

The immune system is the body's primary defence mechanism against infections, and disturbances in the system can cause disease if the system fails in defence functions (in immunocompromised people), or if the activity is detrimental to the host (as in auto-immune and auto-inflammatory states). A healthy immune system is also essential to normal health of dental and oral tissues. This series presents the basics for the understanding of the immune system, this article covering an overview of immunity and the immune system.

Clinical Relevance: Modern dental clinicians need a basic understanding of the immune system as it underlies health and disease.
Type-1 dentine dysplasia – diagnostic and clinical challenges in restorative management
Authors: Rasaratnam Lakshmi , Djemal Serpil
Published: August 2017

Type-1 dentine dysplasia is a rare hereditary condition, associated with an abnormality in dentine formation. Deceptively, teeth have the clinical appearance of normality, however, radiographically, a different picture is seen; with multiple periapical radiolucencies associated with non-carious, unrestored teeth. This article reports the diagnostic and management challenges associated with dentine dysplasia in adults.

CPD/Clinical Relevance: Early diagnosis and preventive advice within primary care are imperative in the long-term outcomes.
The value of cone beam computed tomography in the management of dentigerous cysts – a review and case report
Authors: Allison James R , Garlington Grace
Published: August 2017

Cone Beam Computed Tomography (CBCT) has recently seen an expansion in use, however there are few robust, evidence-based guidelines to inform practitioners. This article reports the case of a large dentigerous cyst in the maxilla affecting the eruption of multiple teeth, considers the use of CBCT in the management of such lesions, and discusses guidelines on the use of CBCT in dentistry.

CPD/Clinical Relevance: As CBCT use increases it is important that practitioners understand the guidelines surrounding its use. Due to the prevalence of dentigerous cysts, it is likely that they will be encountered clinically, and it is important that clinicians referring patients with such lesions are familiar with the principles of managing them.
A predictable alternative to a smile in six months?
Authors: Kalantzis Elizabeth , Waring David T , Malik Ovais H
Published: August 2017

The aim of this article is to explore the use of Incognito™ Lite as an alternative to competitors advertising a ‘Smile in Six Months’ or rather short-term orthodontics for improving dental appearance through tooth movement. The focus is on the varied clinical use of this appliance system and its comparative advantages, disadvantages and placement techniques. Some alternatives are discussed and appraised. Two cases successfully treated with Incognito™ Lite are then presented.

CPD/Clinical Relevance: A reliable and predictable tool for aesthetic alignment of teeth, creating a broader range of treatment options for both the clinician and the patient.
What's new in dentine bonding?: universal adhesives
Authors: Burke FJ Trevor , Lawson Anna , Green David JB , Mackenzie Louis
Published: August 2017

The ability to bond restorations to dentine successfully is central to minimally invasive restorative dentistry. While dentine-bonding agents have gone through a variety of ‘generations’, it is the purpose of this paper to describe the latest dentine-bonding agents, the Universal Bonding Agents. These materials may be considered ‘Universal’ insofar as they may be considered to be capable of being used for direct and indirect dentistry, as well as being suitable for use in whichever etching modality the clinician considers appropriate, namely self-etch, etch and rinse or selective enamel etch. Laboratory investigations and initial clinical studies hold the promise that Universal Bonding Agents are a forward step in the quest for the ultimate bond to tooth substance.

CPD/Clinical Relevance: New Universal Bonding Agents appear to present a promising advance in bonding to dentine.
Supra-therapeutic oral paracetamol overdose in adults: an update for the dental team
Authors: Leader Ross , Hackett James , Al-Naher Ahmed
Published: August 2017

Paracetamol (acetaminophen) is a commonly used analgesic; its ‘over the counter’ availability, low cost and popularity amongst patients often make it the first choice for dental pain. It is in this that its potential toxicity, made more complicated by the ever extending range of paracetamol-containing products, make the understanding of this medication key to the safe management of patients presenting to surgery with dental pain.

CPD/Clinical Relevance: The purpose of this article is to supply dental practitioners with the knowledge to manage patients who present having taken an oral supra-therapeutic paracetamol overdose. Consideration is given to those patients who can be treated safely in primary care and to those who require transfer to Accident and Emergency (A&E).
Low level light therapy in the management of paediatric oral and oropharyngeal mucositis
Authors: McDowall Fiona , O'Murchu Nora , Welbury Richard
Published: August 2017

Oral and oropharyngeal mucositis is a common, debilitating condition experienced by patients undergoing oncology treatment. There are many different management strategies, with low level light therapy (LLLT) an emerging field. Ongoing research on the topic of LLLT for mucositis has resulted in LLLT being included in national clinical guidelines. The number of centres currently using LLLT for paediatric patients with oropharyngeal mucositis is growing, with Glasgow having successfully used this treatment method for a number of years. Across medicine and dentistry, LLLT is coming to the fore and is a treatment modality of which we should all be aware.

CPD/Clinical Relevance: New technologies and treatment modalities are areas with which practitioners should stay up to date. Low level light therapy continues to be a growing research field.
Let's talk about mouth cancer – the story and the facts
Authors: Mc Goldrick Niall , Choileain Orna Ni , MacKessack-Leitch Ewan C , Sammut Stephanie , Lopes Victor
Published: August 2017

Let's Talk About Mouth Cancer is a Scottish charity set up by a group of healthcare professionals with the aim of improving the prognosis of a patient diagnosed with mouth cancer. This article will present the charity's award winning oral health campaigns and the various methods used to empower patients with skills and knowledge to catch mouth cancer early. The social media platforms used in the campaign and the demographic engaged will be discussed, along with the knowledge of mouth cancer signs, symptoms, risk factors and current practice of self-examination in Scotland.

CPD/Clinical Relevance: The incidence of mouth cancer is on the rise in the UK. Dental care professionals in primary and secondary care should be aware of the barriers to early detection, and help to raise awareness of the disease.
Desquamative gingivitis – aetiology, diagnosis and management
Authors: Winning Lewis , Willis Amanda , Mullally Brian , Irwin Christopher
Published: August 2017

The diagnosis and classification of mucosal disease for the busy general dental practitioner can be difficult since many mucosal diseases present with a similar oral appearance. The term desquamative gingivitis (DG) is often used as a descriptive term because the aetiology of the inflammation may originate from multiple oral conditions. In this review article, we discuss oral lichen planus, mucous membrane pemphigoid, and pemphigus vulgaris as the main mucocutaneous diseases associated with DG. The importance of plaque control is emphasized in the initial management of these cases.

CPD/Clinical Relevance: As an oral complaint, patients will likely seek dental advice as their first point of contact for symptoms associated with DG. Therefore, an understanding of potential conditions that are causing their symptoms, as well as some general measures which may help improve their condition, are important.
Evaluation of orthodontic treatment, retention and relapse in a 5-year follow-up
Authors: McGuinness Niall
Published: August 2017

Tofeldt LN, Johnsson A-C, Kjellberg H. Swedish Dental Journal 2007; 31: 121–127.
Bonded versus banded first molar attachments: a randomized controlled clinical trial
Authors: McGuinness Niall
Published: August 2017

Banks P, MacFarlane TV. Journal of Orthodontics 2007; 34: 128–136.
Managing the maxillary canine: 1. diagnosis, localization and interceptive treatment
Authors: McIntyre Grant T
Published: August 2017

Unerupted permanent maxillary canines include normally erupting canines, those that are ectopic and canines that are impacted. The identification of permanent maxillary canines that are developing ectopically in the mid-late mixed dentition ensures that corrective treatment, usually involving extraction of the deciduous canines, is instituted promptly. The first part of this article discusses the normal eruption pathway, methods of localizing the permanent maxillary canine, when to suspect ectopy, monitoring developmentally normal canines and how to normalize the aberrant eruption pathway by extracting the deciduous canines and/or creating space in the buccal segments.
Searching for buried treasure: a review of palatally ectopic canines
Authors: Patel Jayendra , Rahman Shahla , Spencer Richard James
Published: August 2017

Ectopic canines are regularly encountered in general dental practice and often fail to be treated by interceptive measures. Ectopic development can easily be monitored during regular dental examinations and early detection can reduce the patient's need for complex and extensive treatment later. Failure to diagnose ectopic canine development appropriately has been the reason for litigation in the past and may increasingly be a risk if practitioners are unable to identify them. A good understanding of canine development, assessment and management is necessary to be able to recognize ectopic development and avoid untoward sequelae.
Long-term periodontal status of patients with mandibular lingual fixed retention
Authors: McGuinness Niall
Published: August 2017

Pandis N, Vlahopoulos K, Madianos P, Eliades T. European Journal of Orthodontics 2007; 29: 471–476.
The PDQ transmigratory mandibular canine - a lucky escape!
Authors: Borrie Felicity R , McIntyre Grant T
Published: August 2017

This case report demonstrates the amount of movement that can occur with an impacted transmigratory permanent mandibular canine in a relatively short space of time. The treatment of the case is detailed along with a discussion of the potential sequelae of such impacted teeth.
Orthodontic management of a patient with williams syndrome
Authors: Shah Ashish , Hirani Sunil , Hodgkins Jeremy
Published: August 2017

Williams Syndrome is a rare genetic condition with numerous systemic and dental manifestations. This case report highlights the orthodontic management of a 13-year-old female with Williams Syndrome, who presented with hypodontia and other dental anomalies.
Are cephalometric radiographs of any use in orthodontics? a team at acta in the netherlands thinks not
Authors: McGuinness Niall
Published: August 2017

Nijkamp PG, Habets LL, Aartman IH, Zentner A. The influence of cephalometrics on orthodontic treatment planning. European Journal of Orthodontics 2008; 30: 630–635.
‘enter safe zone’: a versatile radiographic and surgical guide for miniscrew-implant placement
Authors: Shah Neelesh , Sivakumar Arunachalam , Valiathan Ashima , Agarwal Sachin , Soni Vivek
Published: August 2017

The use of miniscrew-implants for enhancing orthodontic anchorage has become standard care in many orthodontic practices. The present article describes a 3-dimensional, user-friendly, radiographic and surgical guide for the placement of miniscrew-implants in the safe zone.
A NICE approach to temporary anchorage devices (TADs)
Authors: Sandler Jonathan , Murray Alison
Published: August 2017

This paper will give a background to NICE: including its origins, dental subjects in which it it has taken some interest and specific interest in temporary anchorage devices (TADs). Finally, the paper will discuss recommendation for clinicians involved in treating cases using TADs.
The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence
Authors: McGuinness Niall
Published: August 2017

Bollen AM, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP. J Am Dent Assoc 2008; 139: 413–422.
The correction of a severe high angle class III case: an update on joint orthognathic treatment
Authors: Waring David T , Jones Carl
Published: August 2017

This article intends to outline the patient journey from the first visit to the orthognathic clinic through to the successful completion of surgical and orthodontic treatment. The reader will also learn about current concepts in orthognathic surgical treatment.
Root fracture: an unexpected encounter
Authors: Holm Lindsy , Hirani Sunil
Published: August 2017

This report describes a case where a root fracture in a traumatized upper central incisor was not discovered until after orthodontic treatment had commenced, despite rigorous clinical and radiographic assessment.
Management of the casual orthodontic patient
Authors: Popat Hashmat , Rogers Sheelagh , Eckhardt Charlotte , Knox Jeremy
Published: August 2017

Problems related to orthodontic appliances during treatment, such as the repair of broken appliances, are time consuming, often necessitating extra visits with additional costs in time and materials. They can therefore cause significant delays in treatment progress. Causes associated with appliance problems include patient related factors, such as poor compliance, operator techniques and materials used. As orthodontic patients are often treated in a diverse range of clinical settings, with treatment provided by a number of different clinicians, it is essential that members of the dental team are aware of the problems that can be associated with orthodontic appliances and their management.
Impossible canines?
Authors: Cole Charles , Imthiaz Nishat
Published: August 2017

A transposed tooth is one which is changed in positional location to an adjacent tooth, or one which is erupting in a position normally occupied by a non-adjacent tooth. This article is a series of case reports demonstrating correction of transposed canines, including impacted canines in cases of high difficulty levels.
Canine retraction rate with self-ligating brackets vs conventional edgewise brackets
Authors: McGuinness Niall
Published: August 2017

Burrow SJ. Angle Orthodontist 2010; 80: 626–633.
Book review
Authors: McGuinness Niall
Published: August 2017

Handbook of Orthodontics 1st edn. MT Cobourne and AT DiBiase. St Louis: Mosby Elsevier, 2010 (424pp; $76.95 p/b). ISBN 978-0-7234-3450-4.
Pattern and amount of change of orthodontic correction of upper front teeth 7 years after post-retention
Authors: McGuinness Niall
Published: August 2017

Andren A, Naraghi S, Mohlin BO, Kjellberg H. Angle Orthodontist 2010; 80: 620–625.
A new dimension in managing the troublesome transmigratory canine
Authors: Shaw Karen , Thomson Donald , McIntyre Grant T
Published: August 2017

This case illustrates the benefits of CBCT over plain radiography in accurately localizing an unerupted transmigratory permanent mandibular canine and determining if it was aetiologically responsible for resorption of the permanent mandibular incisors.

Clinical Relevance: The use of CBCT can determine if root resorption is caused by unerupted teeth.
Orthodontics and root resorption part 2
Authors: Parvizi Farnaz , Barker Christopher S , Weiland Frank , Ireland Anthony J , Sandy Jonathan R
Published: August 2017

The aim of this second article in this series of two is to outline the treatment-related factors, which are understood to play an important role in orthodontically-induced inflammatory root resorption (OIIRR). This article will highlight the importance of patient assessment, as well as the long-term effects of OIIRR. It will also discuss future developments, which may improve our understanding of the mechanisms of tooth movement and root resorption.

Clinical Relevance: The orthodontic practitioner should be aware of the iatrogenic effects of treatment mechanics and the need for detailed patient assessment prior to the start of treatment to reduce harmful consequences.
Update on 2D and 3D digital imaging in orthodontics
Authors: Davies Jonathan , Harwood Anne , Whites Eric
Published: August 2017

This article provides an update on two-dimensional (2D) and three-dimensional (3D) imaging in contemporary orthodontics. The use of computed radiography (CR) and direct digital radiography (DR) for two-dimensional intra- and extra-oral imaging are outlined and compared. The advantages and disadvantages of each approach are discussed and various common imaging faults that may be produced are illustrated. 3D Cone-beam computed tomography (CBCT) image production is presented and discussed with consideration to patient dose and its applications in orthodontics. The current SEDENTEX CT guidelines for the appropriate use of this imaging modality are also outlined.

Clinical Relevance: As radiographic imaging is an integral aspect of clinical orthodontics understanding modern 2D and 3D imaging techniques is essential to maximize the benefits and minimize the risks to patients.
Standard edgewise technique and its relevance in contemporary fixed appliance therapy part 3: overbite control and space closure
Authors: McGuinness Niall JP
Published: August 2017

The first two papers in this series looked at the development of the edgewise appliance, the use of first-, second- and third-order bends, and the construction of arch forms. This third and final paper will examine the methods that can be used for overbite control and space closure using standard edgewise and other techniques.

Clinical Relevance: Overbite control is important in orthodontic treatment as good treatment results (especially correct incisor positioning) cannot be achieved without it. Space closure is often accomplished by sliding mechanics, but friction in the appliance may prevent this occurring and methods are shown how to overcome this.
Aesthetic labial orthodontic appliances – an update
Authors: Shah Hemendranath V , Boyd Stephen A , Sandy Jonathan R , Ireland Anthony J
Published: August 2017

This paper will give an update on recent developments in aesthetic archwires, brackets and accessories that are presently available to increase the options available for the provision of an aesthetic labial orthodontic fixed appliance.

Clinical Relevance: In a consumer driven market, the demands for aesthetic orthodontic appliances to correct malocclusions is increasing. Aesthetic labial fixed appliances have the advantage of precise three-dimensional control of tooth movement with the aesthetic requirements demanded by patients.
Evidence on early correction of class III malocclusion
Authors: Misra Sangeeta , Waring David T , Malik Ovais H
Published: August 2017

The presence of high quality evidence on the dentofacial orthopaedic correction of Class III malocclusion is scarce. Long-term follow-up of growth modification has reported mixed results. The aim of this article is to review the literature on the early correction of Class III malocclusion and to provide some clarification on the following important issues: definite types of treatment modalities for treatment of Class III malocclusion; case selection; short-term and long-term effects of different treatment modalities; timing of treatment; success rate and skeletal and dental effect of different treatment modalities.

Clinical Relevance: Early treatment of Class III patients with maxillary deficiency using appliances such as protraction facemasks can be used to maximize maxillary growth potential in appropriate cases. However, correct diagnosis and understanding of the individual growth pattern is imperative in determining the success of early Class III treatment.
The development of orthodontic managed clinical networks in the united kingdom
Authors: Lammiman Elizabeth , Robinson Stephen , Ireland Robert , Cure Richard
Published: August 2017

Managed clinical networks were developed in the UK as an alternative model of healthcare delivery. They are said to focus on the patient journey making best use of available resources, improving access and the quality of care. They are based on a concept pioneered in Scotland and have recently been introduced into dentistry. This paper reviews the historical background and structures of existing UK orthodontic networks.

Clinical Relevance: The recent introduction of managed clinical networks into orthodontics is designed to improve equity of patient access and the quality of care. It is also said to have economic benefits, with services designed to cross geographical, political and National Health Service (NHS) boundaries, providing a way of achieving full coverage of specialist services beyond historical provision based in major population centres. The key principles ensure quality assurance and standardized evidence-based care aiming to improve clinical standards and, ultimately, the allocation of resources.
Treatment efficiency of self-ligating brackets
Authors: Ollivere Peter
Published: August 2017

This article investigates the treatment efficiency of self-ligating brackets in terms of overall treatment times and the number of appointments required compared with conventional ligation bracket systems. Two retrospective studies are reported which may shed further light on the subject.

Clinical Relevance: Treatment efficiency is a highly desirable goal for any bracket system. Establishing the veracity of any claims of superior performance is essential before basing clinical practice on those claims.
The management of patients with cleft lip and palate (CLP) part 1. introduction
Authors: Gillgrass Toby J , Gowans Alan J
Published: August 2017

This paper provides an overview of the historical background to the delivery of care in the UK of patients with cleft lip and palate and the impact of the Clinical Standards Advisory Group (CSAG) report. The paper explains the way cleft services have subsequently changed and describes the current delivery of care following CSAG recommendations within the multidisciplinary team. Following this introductory paper will be a series of papers dedicated to describing and explaining the different roles of each specialist member of the cleft team and key stages of delivery of care within that team.

Clinical Relevance: Introduction and background into the delivery of care of cleft services in the UK. This is an introductory paper of a series of papers intended to increase the depth and breadth of knowledge of the reader into the specialist areas required in the multidisciplinary approach for the care of patients with cleft lip and/or palate.
Useful concepts for critical appraisal: 1. study design
Authors: Suchak Archna , Johal Ama , Wade Angie
Published: August 2017

There is an increasing volume of research undertaken within orthodontics and with this comes a need to evaluate what is available. This short series of three articles aims to help the orthodontist revise basic concepts of critical appraisal and pertinent statistics.

Clinical Relevance: Critical appraisal skills are valuable tools that can aid clinical decision-making. In this first of three articles, we discuss different study designs.
Case series of atypical eruption failure
Authors: Short Laura J , Cross David
Published: August 2017

This case series highlights four clinical cases which presented at a dental hospital with atypical features of primary eruption failure. These patients demonstrate the heterogeneous nature of cases that can present with features of primary eruption failure. These cases are presented with a view to introducing a new classification system as an alternative to the encompassing term ‘primary failure of eruption’.

Clinical Relevance: The aetiology of primary eruption failure is poorly understood and can present the clinician with a diagnostic challenge, being based mainly on a diagnosis of exclusion. This case series presents four cases of primary eruption failure that do not conform to the classical clinical description. A new classification system is proposed that groups cases with common clinical features and may aid diagnosis and management.
Primary surgery in cleft lip and palate part 5
Authors: Gillgrass Toby J , Devlin Mark
Published: August 2017

This article discusses primary surgery for patients with cleft lip and palate, which in the UK would conventionally take place in the first year of life. Current protocols in the United Kingdom are described and some of the history in the surgical specialties that led to their development discussed. The basic principles of the surgery are explained and the impact of surgery on future facial aesthetics, dental development and speech are considered.

Clinical Relevance: Clefting of the lip produces a significant deformity and, although not functionally debilitating, will lead to a significant aesthetic impact, which in our modern day, aesthetically driven society can produce significant psychosocial consequences, even with repair.
A review of osteogenesis imperfecta in relation to orthodontic treatment
Authors: Cala Anna , O'Neill Julian
Published: August 2017

This case report describes a 13-year-old patient suffering from osteogenesis imperfecta (OI) and hypodontia. Different issues related to clinical presentation and orthodontic treatment of patients with OI are discussed in this report.

Clinical Relevance: Dental and orthodontic features associated with OI and their impact on treatment are described in this report. It is important to know these features as patients presenting with OI may require orthodontic treatment.
Mandibular second premolars – the wandering minstrel
Authors: Seager Leonie , Ponduri Sirisha , Robinson Stephen
Published: August 2017

This paper presents a series of five cases in which the mandibular second premolars have taken a different path from normal development. The current literature has been reviewed and the management of these teeth described.

Clinical Relevance: It is essential that, as clinicians, we are equipped with the knowledge to be able to make sound clinical judgements based on the evidence available. This paper discusses the aetiology, management and risks to be considered when presented with ectopic or malpositioned mandibular second premolars.
An overview of speech and language therapy in a cleft lip and palate team part 6
Authors: Nayak Jenny
Published: August 2017

This paper provides an overview of speech and language therapy in a regional cleft lip and palate team. The Specialist Speech and Language Therapist (SLT) is an integral member of the multidisciplinary team and the role is explained here in some detail. SLTs work with children/young people with cleft lip and palate as up to 75% have been reported to have a speech and/or language problem. However, SLTs also work with children/young people with velopharyngeal insufficiency in the absence of an overt cleft palate. Although the focus of an SLT's work is speech, other aspects are examined too, such as language, voice and swallowing. It is crucial that resonance is rated correctly, so that appropriate management of the child/young person's palate can be instigated. SLT assessments are routinely undertaken at designated times in a child's life and this care pathway is described.

Finally, a child or young person's outcome will also be influenced by issues such as his/her hearing and cognitive level, age, motivation and whether or not he/she has velopharyngeal insufficiency. It is also vital that SLTs work closely with colleagues in education and social care to maximize effectiveness.

Clinical Relevance: This article outlines the role of the Specialist Speech and Language Therapist in a cleft lip and palate team.
The dilemma of commissioning: the isle of wight orthodontic managed clinical network: a 3-year review part 2: referral outcomes
Authors: Lammiman Elizabeth , Robinson Stephen , Ireland Robert
Published: August 2017

The key objective of creating the Isle of Wight orthodontic service managed clinical network (IOWOS MCN) was to create an integrated service measuring the referral and outcome data to inform future commissioning and service re-organization. Data were collected as part of a central referral triage process and were analysed from 2006 to 2009. The theoretical orthodontic need was assessed in the IOW population and compared to other methods of assessing need reported in the literature. The IOWOS referral outcomes were then compared to the expected theoretical outcomes. The referral outcomes were described and discussed in the first part of this two-part series. This second part provides an insight into some of the complexities of commissioning orthodontic care by reference to the referral outcome data.

Clinical Relevance: There was a high level of appropriate referral for orthodontic treatment within the IOWOS MCN but the method of calculating orthodontic need is complex.
Orthodontic input for children with cleft lip and palate: CLP series part 8
Authors: Gillgrass Toby J
Published: August 2017

The orthodontist plays a significant role in the management of children with cleft lip and palate. This article summarizes the key stages of input and some of the challenges that may be encountered.

Clinical Relevance: Within the multidisciplinary team, orthodontics treatment is often the most burdensome in terms of appointments and treatment time for children with cleft lip and palate.
What factors might affect the success of fixed appliance therapy in adolescent patients? part 2
Authors: Williams Julie C , Atack Nicola E , Sandy Jonathan , Ireland Anthony J
Published: August 2017

In the first part of this article, the authors addressed patient-related factors that may affect the success of orthodontic treatment within the adolescent. In this second part, operator and appliance factors will be discussed.

Clinical Relevance: The conversational model of consent requires that clinicians disclose all of the appropriate information to patients prior to them making the decision whether to accept or decline treatment. Understanding factors that could affect the outcome with respect to both treatment efficiency and occlusal result will therefore help inform this consent process.
The relevance of autism in orthodontic management
Authors: Casaus Abdullah , Panesar Jaspal
Published: August 2017

Autism is a developmental disorder that can prove to be a barrier in providing orthodontic care due to a difficulty in developing language and communication. The purpose of legislation imposed in regards to mental capacity is to ensure that an individual has the right to autonomy. However, we must carefully balance an autistic patient and guardian's wishes with indications for orthodontic treatment. This article recognizes the difficulties in managing autistic patients and discusses methods to facilitate effective management.

Clinical Relevance: Autistic patients may find difficulty in accessing orthodontic care owing to their inability to socialize and communicate. This article offers novel behaviour management techniques that may aid in tackling this barrier.
Options to preserve teeth displaced by dental cysts
Authors: Cedro Monika , Taylor Nigel
Published: August 2017

These case reports illustrate the management of two patients presenting with a dentigerous cyst and nasopalatine cyst, respectively. Both patients were treated with different surgical approaches and the associated teeth were successfully aligned with orthodontic appliances.

Clinical Relevance: Dental practitioners should be suspicious if teeth are missing past the ideal age of eruption, especially if the contralateral tooth has been erupted for at least 6 months. Initial investigations should involve radiographs to identify presence, or otherwise, of the tooth and prompt referral when appropriate.
’Where did the time go?’ – an analysis of orthodontic care in a district general hospital over a 24-year period
Authors: Hale Lance R O
Published: August 2017

A longitudinal prospective analysis was carried out within a District General Hospital's Orthodontic Department over the entire career of a Consultant Orthodontist, using the IOTN and PAR indices, to monitor continuously the ‘appropriateness’ and ‘quality’ of orthodontic treatment undertaken. Following the retirement of that Consultant, the cumulative results are presented. The results confirm that referrals to the Department were appropriate, demonstrate a generally high standard of treatment for a large number of patients over that period, and a trend towards the treatment of more complex cases, enabling some conclusions to be drawn.

Clinical Relevance: This paper demonstrates the recent level of activity and quality of an Orthodontic Service within a District General Hospital.
Multidisciplinary management of an impacted maxillary central incisor with a severe crown dilaceration
Authors: Walshe Lisa , Scott Ciara
Published: August 2017

An 8-year-old girl presented with an unerupted upper right central incisor. Clinical and radiographic examination revealed a severe crown dilaceration. Her treatment involved a multidisciplinary approach, including surgical exposure, orthodontics and restorative treatment. The outcome was the accomplishment of a vital, functional and aesthetic maxillary central incisor with a good prognosis.

Clinical Relevance: This case report describes how a dilacerated upper incisor, which has failed to erupt and appears to be of poor prognosis, can be aligned with a satisfactory aesthetic and functional outcome. Alignment of the affected tooth improves dental appearance in the medium term and maintains alveolar bone if restorative replacement is required in the longer term.