bluuebunny/crossref_metadata_2025 huggingface dataset:
An update on crown lengthening part 1: gingival tissue excess
Authors: Kalsi Harpoonam Jeet , Hussain Zahra , Darbar Ulpee
Published: August 2017

This is the first article in a two-part series which aims to provide an overview of the different techniques used to increase clinical crown height. In the first paper, the focus will be on the management of patients who present with gingival tissue excess. The different aetiologies are discussed and illustrated with clinical cases, following which a range of procedures that may be employed in the management of these patients are presented. With an increasingly ageing population, more patients are taking regular medications prescribed from their general medical practitioner, and so having a working knowledge of the specific drugs that may cause gingival enlargement is essential.

Clinical Relevance: When patients with gingival tissue excess present in primary or secondary care, a clinician must have a good knowledge of the possible causes of the condition, as well as an idea of how the patient may be managed.
Aesthetic treatment related to clinical need – an illustrated case report
Authors: Worskett Paul
Published: August 2017

Aesthetic treatment may be patient driven and usually by a ‘want’, rather than a ‘need’. This paper describes the management of a patient who presented with aesthetic wants and clinical needs, both of which were caused as a result of unsuccessful aesthetic treatment which the patient had received previously. The diagnostic process, discussion of the treatment plan and clinical procedures, which produced a satisfactory result, are described and illustrated.

Clinical Relevance: This case demonstrates that aesthetic treatment may commit the patient to future dental treatment needs, particularly if treatment provided is poorly planned and carried out to an unsatisfactory standard.
The francis report – implications for the regulator
Authors: Gilvarry Evlynne
Published: August 2017

The professional regulators were identified in the Francis Report as having a central role in maintaining fundamental standards of care. This paper describes the key themes in the Report and the importance of regulatory powers to ensure that the serious failings in patient care highlighted by the Mid-Staffs Inquiry cannot be repeated. The central role of the GDC Standards in the profession's response to the Francis Report is stressed.

Clinical Relevance: The importance of our professional regulator in ensuring adherence to fundamental standards of care is a central tenet of clinical dentistry.
Infraoccluded upper deciduous second molars leading to caries in the permanent dentition
Authors: Rooney Claire , Suida Imran , Spencer Richard James
Published: August 2017

Infraocclusion of primary teeth is a problem that can be recognized early by the general dental practitioner. Allowing affected teeth to deteriorate beyond a point where active intervention would be recommended can make treatment of the condition more complex or may lead to unexpected sequelae. The case described in this report of infraoccluded primary teeth, suffered pathology in adjacent teeth, leading to multiple extractions and fixed orthodontic treatment post surgery. This case highlights the need for early recognition of infraocclusion by the GDP and will suggest interceptive treatment options.

CPD/Clinical Relevance: To highlight the need of interceptive orthodontics in primary care when required.
Facial skin lesions dentists should know
Authors: Sibai Louna , Kudsi Zaki
Published: August 2017

Facial skin lesions are common; patients may present with a nodule, crack, ulcer or abnormal discoloration of the skin that is not normally present. Ideally, dentists should include face examination in their routine clinical examination. Any suspicious lesion should be referred to a dermatologist as an early diagnosis and treatment could be life-saving. This article will discuss the diagnosis and treatment of common lesions of the face.

Clinical Relevance: Dentists should recognize facial lesions, understand the differential diagnosis and refer suspicious lesions for treatment.
Mouth cancer for clinicians part 4: risk factors (traditional: alcohol, betel and others)
Authors: Kalavrezos Nicholas , Scully Crispian
Published: August 2017

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team, in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family.

Clinical Relevance: This article offers the dental team an overview of the main cancer risk factors, namely tobacco and alcohol, betel and other chewing habits, and environmental factors.
Pain part 5b: non-odontogenic dysfunctional pain
Authors: Renton Tara , Egbuniwe Obi
Published: August 2017

Orofacial chronic pain provides a significant challenge to all clinicians and the patients seeking treatment for it. Due to the anatomical and regional complexities, diagnosis can be extremely difficult, and due to the lack of cross specialty training, patients will undergo a variety of treatment under different disciplines. Dysfunctional pain provides a unique challenge for patient management and requires a multidisciplinary team.

Clinical Relevance: Lack of recognition of dysfunctional chronic pain can result in inappropriate dental treatment and further damage. to the patient. Appropriate patient reassurance and referral to an orofacial pain multidisciplinary team is recommended as most of these conditions require medical management.
Warfarin and drug interactions: prescribing vigilance
Authors: Hook J , Millsopp Lynne , Field E Anne
Published: August 2017

A patient taking warfarin presented to the Oral Medicine Clinic at Liverpool University Dental Hospital, having been prescribed metronidazole and miconazole by his general dental practitioner (GDP) for his oral mucosal problem. He subsequently developed bruising on his torso following mild trauma. Having read the drug information leaflet provided with his metronidazole and miconazole, he noted the potential drug interactions between these and warfarin. He therefore stopped his warfarin. The details of this case are outlined, and the potential for significant drug interactions with warfarin are highlighted. The need for dental practitioners to be vigilant concerning drug interactions is emphasized, together with the importance of CPD in relation to drug prescribing.

CPD/Clinical Relevance: This case report, which is of relevance to all dental practitioners, highlights the importance of up-to-date medical and drug histories and the continuing awareness of potential drug interactions. In this case, patient intervention after checking drug information leaflets prevented serious consequences. The importance and potentially serious consequences of significant drug interactions needs to be understood.
Flexible and sectional complete dentures with magnetic retention for a patient with microstomia – a case report
Authors: King Elizabeth , Owens James
Published: August 2017

This case report describes treatment for a patient with microstomia and the development of the index of oral access for restorative dental treatment (IOA).

CPD/Clinical Relevance: An understanding of the causes of microstomia and challenges encountered when treating microstomia patients with an index to aid diagnosis and treatment planning.
Modern endodontic principles part 7: the restorative interface
Authors: Martin Warren , Taylor Carly , Jawad Sarra , Roudsari Reza Vahid , Darcey James , Qualtrough Alison
Published: August 2017

The restoration of endodontically-treated teeth is a topic that has been extensively studied and yet remains controversial. The endodontically-treated tooth can be restored with a wide range of techniques of varying complexity. This article reviews the literature on this topic. Consideration is given to the ferrule and its importance in achieving success. Furthermore, consideration will be given to the use of endodontically-treated teeth as abutments for fixed and removable prostheses and the challenges this presents. Clinical recommendations are presented as guidelines to improve the predictability and outcome of treatment when restoring structurally compromised root-filled teeth.

CPD/Clinical Relevance: The prognosis of endodontically-treated teeth depends not only on the success of the endodontic treatment, but also on the type of reconstruction.
The prosthodontic pathway for patients with anomalies affecting tooth structure
Authors: Laverty Dominic P , Thomas Matthew BM
Published: August 2017

There are a number of anomalies that affect the structure of the dental hard tissues which impact upon the form, function and aesthetics of the dentition. Understanding the challenges these conditions pose will enable dentists to manage the functional and aesthetic problems with restorative techniques better. This article will present cases that demonstrate the different conditions, the restorative challenges experienced and a variety of restorative treatments in the management of these conditions.

CPD/Clinical Relevance: Awareness of different anomalies affecting tooth structure that may present to the dental practitioner is necessary. Clinicians should appreciate the specific restorative challenges that may arise in treating such patients and the possible treatment options that may be available.
Implant dentistry in general practice part 1: introduction
Authors: Nicholson Ken
Published: August 2017

This paper, the first of two, provides an introduction to implant dentistry for the general dental practitioner.

CPD/Clinical Relevance: Implant placement and restoration is becoming more common place in general dental practice to the point where it may already be considered a routine treatment option.
Mouthwashes: do they work and should we use them? part 3: safety of mouthwashes
Authors: Hodge Penny
Published: August 2017

There have been numerous reports in the scientific literature investigating the possible association between alcohol-containing mouthwashes and oral cancer but relatively few epidemiological surveys have taken place and the findings have been equivocal. This article will address the controversial issue of the safety of mouthwashes and provide an objective assessment of the latest scientific evidence.

CPD/Clinical Relevance: The evidence surrounding the safety of ‘over the counter’ alcohol-containing mouthwashes is evaluated. This provides guidance for dentists and dental care professionals of when it is appropriate to recommend mouthwash use to their patients.
Hypercoagulopathy and dento-alveolar surgery: a case of exodontia in a patient with hughes' syndrome
Authors: Petrosyan Vahe , Carr Richard WF , Milton Tim , Revington Peter J
Published: August 2017

Antiphospholipid syndrome is a thrombophilic disorder in which the presence of serum autoantibodies to phospholipid causes disruption of the protein C antithrombotic pathway. Deposition of these autoantibodies in small blood vessels can lead to intimal hyperplasia and acute thromboses. The associated hypercoagulopathy is problematic in dentistry since, if proper haemostasis is not achieved prior to discharge of exodontia patients, excessive haematoma formation may result. This case report and review of the literature discusses the condition in the context of hypercoagulation with reference to a patient undergoing a simple extraction, and suffering post-operative complications amounting to a large haematoma requiring evacuation.

CPD/Clinical Relevance: Post-operative bleeding is one of the most common complications of exodontia. This case report and review of the literature provides the reader with a concise summary of the clotting cascade in parallel with an unusual case of post-operative bleeding.
Case report: metastatic infratemporal soft tissue myeloma presenting as a numb lower lip
Authors: Rice Niamh , Srinivasan Badrinarayanan , Macpherson David
Published: August 2017

This is a case of a patient presenting to his general dental practitioner (GDP) with altered sensation in his lower lip with no obvious cause. Due to a prompt referral, the patient was investigated and diagnosed with an extramedullary presentation of multiple myeloma. A numb lip can present in general dental practice, although this is not common. There are several causes, for example, dental infection or fractured mandible.

CPD/Clinical Relevance: It is very important for the dental practitioner to recognize when there could be a potential sinister underlying cause and prompt referral, under the two week rule referral system, is indicated.
What's new in molar incisor hypomineralization?
Authors: Silva Mihiri J , Kilpatrick Nicky , Crombie Felicity , Ghanim Aghareed , Manton David
Published: August 2017

Molar Incisor Hypomineralization (MIH) poses a significant challenge to clinicians worldwide. Since its description in 2001, extensive research has provided some insight into the condition, its aetiology, natural history and management. An appreciation of the unique clinical features and management considerations of MIH is essential to maximize patient outcomes. Early diagnosis is the first of several key steps in developing an appropriate management plan, which must account for short- and long-term needs of the patient. While traditional caries preventive approaches are important, more proactive restorative strategies may also be useful.

CPD/Clinical Relevance: This review provides clinicians with an update of the recent literature and discusses the contemporary management of MIH.
Facial palsy masquerading as an acute dental abscess
Authors: Razzak Arif , O'Leary Frances , Ahmed Nabeela
Published: August 2017

Facial nerve palsy has specific symptomology, but varied aetiology. Prompt and thorough assessment is required to ascertain if upper or lower motor neurone damage has occurred. This report discusses a 6-year-old female, presenting in the Emergency Department with unilateral facial weakness. Initially thought to be facial swelling relating to her carious dentition, clinical assessment from the maxillofacial team identified that the patient had a unilateral facial palsy, later diagnosed as Bell's palsy. Her delayed presentation was due to initial misdiagnoses in primary care. This case report aims to highlight its aetiology, clinical features and appropriate management.

CPD/Clinical Relevance: To make the general dental practitioner aware of different causes of facial paralysis, and to provide GDPs with an algorithm to follow in the presentation of a facial palsy in the primary care setting.
Early tooth loss in children: a warning sign of childhood hypophosphatasia
Authors: Hughes Sara L , Parkes Rachel C , Drage Nicholas , Collard Mechelle
Published: August 2017

Premature exfoliation of primary teeth may be the first manifestation of this serious condition and the general dental practitioner plays an important role in recognizing dental anomalies and referring patients at an appropriate time. This is imperative to ensuring early diagnosis and good quality patient care. This article describes the case of a 4-year-old boy affected by childhood hypophosphatasia, who presented with premature exfoliation of his primary teeth as the first manifestation of this condition. An overview of the condition is outlined including a discussion of the likelihood of permanent dentition involvement.

CPD/Clinical Relevance: Oral manifestations of hypophosphatasia may be the first and the only signs of this condition and may be the basis upon which a diagnosis is made.
Arteriovenous malformation of the jaws: a black hole for the GDP – a case report
Authors: Shah Kunal , Srinivasan Badrinarayan , Ethunandan Madanagopalan , Pratt Clive
Published: August 2017

We report a case of a mandibular arteriovenous malformation in a 3-year-old child, who attended our department, and have carried out a literature review.

CPD/Clinical Relevance: Arteriovenous malformation (AVM) is a rare condition but clinicians need to be aware of it as this lesion can have potentially life-threatening complications due to massive haemorrhage.
Dual role of subepithelial connective tissue grafting in regeneration of periodontal attachment apparatus
Authors: Kumar Nettemu Sunil , Sowmya Nettem , Singh Vijendra Pal , Verma Madhu B
Published: August 2017

Periodontal plastic and aesthetic surgery are gaining significant momentum owing to the increasing aesthetic demands by patients. Along with the fulfilment of aesthetic needs, it is imperative that clinicians also enhance function. From these two important viewpoints, subepithelial connective tissue grafting remains an optimum treatment choice for periodontists when treating gingival recession defects accompanied by periodontal attachment apparatus breakdown.

CPD/Clinical Relevance: Subepithelial connective tissue grafting is a successful procedure in its dual role of gingival recession coverage and predictable periodontal regeneration.
Tooth wear: screening, diagnosis and management in general dental practice
Authors: Yim Victor Ka Cheong
Published: August 2017

Recent epidemiological data shows that the prevalence of tooth wear (TW) is increasing. Current available assessment tools are either too complicated to carry out on every patient or inadequate in identifying the nature of the condition. Moreover, early onset or localized lesions may be overlooked. This article describes a screening tool which may overcome these problems. This tool involves using the existing Basic Erosive Wear Examination scoring system and a proposed age-related grid. This will lead to an associated pathway, which indicates the recommended level of further investigations and management.

CPD/Clinical Relevance: Early identification and prevention of pathological tooth wear in the primary care setting is the key to slowing down the disease progression.
’Educating the educated’: a report of an undergraduate medical student with multiple carious lesions and poor dietary habits
Authors: Dhadwal Amardeep Singh , Baysa Aylin
Published: August 2017

It is evident in the undergraduate dental curriculum that competent dental students are expected to have a broad knowledge of the intricacies of the human body and its relationship with the oral cavity, but the same cannot be guaranteed for medical students. This case report of a medical undergraduate student who presented with multiple carious lesions and a poor knowledge of the impact of her habits on her oral heath illustrates the importance of using a well-formulated and holistic treatment plan with a focus on oral health promotion and education. The review appointment proved promising with an improved plaque score and dietary analysis. This article provides a brief introduction to the topics and discusses potential future developments that aim to reduce the subjectivity in the analysis process and simplify presentation of evidence to non-dental parties.

CPD/Clinical Relevance: This case re-iterates the need to encompass education and prevention to stabilize and prevent dental caries and teach other future healthcare professionals so that they can utilize and consider this knowledge in the management of their own patients. Moreover, it demonstrates that there may be scope for raising dental awareness and education within the medical profession.
Space maintenance - indications and illustrated cases
Authors: Crawford Nicky L , Murray Andrew M , Sandler P Jonathan
Published: August 2017

Space maintenance should form an integral part of paediatric dentistry and interceptive orthodontics. It has two main aims: the maintenance of space for a future prosthesis, and the limitation of localized crowding. There are many varieties of space maintainer, broadly divided into two groups; fixed or removable. The design and use depend upon the number, size and position of the teeth missing, the teeth present in the mouth and the dental developmental stage the child has reached. Careful patient selection, timing of treatment and regular review is necessary to maximize the benefits. Clinical cases are presented illustrating the use of various space maintainers.
Managing the maxillary canine: 2. treatment options for impacted permanent maxillary canines
Authors: McIntyre Grant T
Published: August 2017

Unerupted permanent maxillary canines include normally erupting canines, those that are ectopic and canines that are impacted. When adolescent and adult patients present with impacted canines, they should be referred to a specialist orthodontist to determine the most suitable treatment option. Part 1 considered the diagnosis and localization of ectopic and impacted canines and detailed the intervention strategies for developmentally normal and ectopic permanent maxillary canine teeth. Part 2 details the contemporary treatment options for impacted maxillary canines. These include surgical exposure and orthodontic traction, long-term monitoring, surgical removal and autotransplantation. The benefits and drawbacks of each is considered in detail.
Comparison of hand-traced and computerized cephalograms: landmark identification, measurement, and superimposition accuracy
Authors: McGuinness Niall
Published: August 2017

Roden-Johnson D, English J, Galleranoc R. Am J Orthod Dentofacial Orthop 2008; 133: 556–564.
Book review
Authors: Irving Fiona
Published: August 2017

Orthodontic Radiographs Guidelines, 3rd edn. By KG Isaacson, AR Thom, K Horner and E Whaites. British Orthodontic Society, 2007.
Treatment of unilateral posterior crossbite with mandibular shift: a case report
Authors: Gupta Seema , Valiathan Ashima , Kumar Sandeep
Published: August 2017

A 17-year-old boy had a skeletal Class III malocclusion with facial asymmetry, a unilateral posterior crossbite and functional shift of the mandible to the left on closure. There was bilateral constriction of the maxilla and crowding in both of the arches. The patient was treated orthodontically with an edgewise appliance and a bonded Hyrax for maxillary expansion. The result of the orthodontic treatment was facial symmetry and optimal occlusion. At the one year follow-up, the condition had been maintained.
Index of complexity, outcome and need scored on plaster and digital models
Authors: McGuinness Niall
Published: August 2017

Veenema AC, Katsaros C, Boxum SC, Bronkhorst EM, Kuijpers-Jagtman AM. European Journal of Orthodontics 2009; 31: 281–286.
Treatment of maxillary horizontal impacted canine – a new method
Authors: Hu Rongdang , McDonald J P , Wang Haiyan
Published: August 2017

The horizontally impacted unerupted canine is considered orthodontically difficult to treat. A treatment method using a modified Nance Palatal Arch with a vertical bar extending into the buccal vestibule area is used to alter the eruption path of the impacted canine crown, hence avoiding interference with the lateral incisor root. The anchorage is re-inforced by the palatal component of the Nance Arch. The results are highly predictable and undesirable side-effects can be minimized. The structure of the special appliance, the treatment mechanism and the sequence of the treatment are described in this article.
Communication in orthodontic practice
Authors: Shargill Inderjit , Asher-McDade Catherine , McDade Gerard
Published: August 2017

This paper describes how improved communication can be learnt through observation, theoretical knowledge and practise. There is robust evidence that medical and dental professionals with good communication skills suffer from fewer complaints and litigation, experience greater clinical satisfaction and create reduced patient stress. In addition, they achieve improved clinical outcomes and earn more than colleagues with inferior communication skills. Theories of non-verbal and verbal communication are discussed. Examples of improving listening skills and reducing poor communication in the clinical setting are described.
A review of the literature relating to transmigrating canines. An illustrated case report
Authors: Sarode Gargi S , Sarode Sachin C , Patil Anuprita
Published: August 2017

Canine impaction is not an uncommon finding in the dental literature, but transmigration of mandibular canines is a rare phenomenon, and some of them are far more extreme than others. We report an extremely rare case of bilateral transmigration of impacted permanent canines crossing the midline of the mandible.

Clinical Relevance: To understand the role of early interception so that the patient can be treated before canines transmigrate in order to avoid surgical extraction, as well as complex orthodontic and restorative therapies.
How to incorporate recent improvements in invisalign into clinical practice
Authors: Bellman Gerry
Published: August 2017

Invisalign is an established technique in the treatment of malocclusion. Over the past few years, modifications have been incorporated into the system to produce more consistent and improved treatment results. Also, AcceleDent has been introduced, which has had a positive influence on the length of treatment time.

Clinical Relevance: Keeping up with advances in the Invisalign technique allows for the best treatment results for our patients.
Diagnosis and treatment of missing upper lateral incisors part 1
Authors: Parvizi Farnaz , Dawson Michael , Day Christian
Published: August 2017

These two articles aim to outline the assessment and explain the treatment options for those patients who present with missing upper lateral incisors. In Part 1, emphasis is placed on the diagnosis and need for a combined orthodontic-restorative approach to provide optimal patient care.

Clinical Relevance: The management of patients with absence of one or both lateral incisors can be an aesthetic and functional challenge. Frequently, a number of different factors need to be considered in order to achieve the best end result. We suggest that a combined orthodontic-restorative approach be considered at the start of the planning process, in order to consider all treatment possibilities.
Methods used to determine demineralization of enamel associated with orthodontic treatment: a review
Authors: Kidiyoor Harshavardhan , Naik Roopak D
Published: August 2017

Demineralization/decalcification of the enamel around orthodontic brackets, seen clinically as white spot lesions, remain a sometimes neglected part of orthodontic care. Even though there are numerous studies on decalcification, most of them are based on subjective evaluation of enamel samples. The various techniques used to determine enamel demineralization associated with orthodontic treatment have not been directly compared and the operator is left with limited choice. Since these techniques have their own limitations, the selection of a protocol for the study of demineralization of enamel should be based on the true merit of the technique and its relevance to the study. Hence, the various methods used to determine demineralization of enamel during orthodontic treatment have been critically evaluated and their application in clinical orthodontics and research discussed.

Clinical Relevance: Dental enamel has very limited regenerative capacity; hence prevention of its demineralization is of prime concern to a dentist in general and to an orthodontist specifically. The appearance of white spots/damage to healthy enamel after orthodontic treatment is both unaesthetic and legally questionable. Further, there is a lack of correlation among the various methods suggested to evaluate enamel demineralization. The current article not only summarizes the various methods but also suggests relevant steps to prevent the demineralization of enamel.
Linear scleroderma ‘en coup de sabre’ and an unusual response to orthodontic treatment
Authors: Akram Ansa Javed , Moore Matthew B , Collin John
Published: August 2017

We present an interesting case of a patient with linear scleroderma of the ‘en coup de sabre’ type who was treated with an upper fixed appliance to align a maxillary canine. It started out as a routine straightforward case of aligning an impacted canine using a conventional technique but developed into a serious orthodontic dilemma.

Clinical Relevance: The atypical response to treatment suggests a possible link between the connective tissue disorder and the orthodontic complications this case developed.
The role of the clinical nurse specialist within the cleft lip and palate team: CLP series part 2
Authors: Beaumont Diane
Published: August 2017

The presence of a clinical nurse specialist within the multidisciplinary cleft team has become commonplace across many regions in the UK, with an aim to improve the quality of nursing care in this patient group. The role of the clinical nurse specialist may commence in the antenatal period, progress through birth and infancy, and extend into childhood in concurrence with the surgical procedures. The initial focus is on early feeding advice and management, and the provision of support to facilitate the exploration of feelings and anxieties in relation to the cleft.

Clinical Relevance: This paper enhances knowledge of cleft lip and palate, and an understanding of the Clinical Nurse Specialist's role within a multidisciplinary setting.
Extensive decalcification of the permanent dentition following long-term, unmonitored, functional appliance wear: case report
Authors: Fitzpatrick William , Barry Siobhan , O'Sullivan Elizabeth
Published: August 2017

We present the case of a healthy 14-year-old female who was referred urgently by her general dental practitioner (GDP) to a consultant paediatric dentist regarding extensive decalcification of her permanent dentition. The patient had commenced orthodontic treatment 18 months earlier with a twin block appliance. She had worn this appliance unremittingly, despite failing to return for follow-up treatment.

Clinical Relevance: The importance of regular dental review and early detection of decalcification in patients undergoing functional appliance therapy is discussed.
Useful concepts for critical appraisal: 3. association, outcomes and errors
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 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 final article, we review ways in which associations and outcomes are commonly presented and discuss various types of error studies.
Labial fenestration of a ‘dilacerated’ maxillary central incisor apex: an orthodontic complication
Authors: Chate Robert AC , Falconer Denis T
Published: August 2017

A case is presented of a ‘dilacerated’ central incisor whose apex perforated the labial alveolus following orthodontic traction subsequent to its surgical exposure, which then necessitated endodontic treatment and an apicoectomy. The literature is reviewed regarding the aetiology and terminology of this complication and the implications for informed consent in such cases are discussed.

Clinical Relevance: This article will clearly differentiate between the two types of incisor root deflections that may occur during development. That is, those with true incisor palatal root dilacerations and those with pseudo-dilacerations which are actually incisors with vestibular root angulations.

The surgical and orthodontic recovery of an unerupted central incisor with a vestibular root angulation is outlined, in particular the management of the manifestation of one of the risks associated with this procedure, namely that of inducing an alveolar fenestration with the apex of the tooth during the process.
Diagnosis and management of tooth size discrepancies in orthodontic patients
Authors: McSwiney TP , Millett DT , McIntyre Grant T
Published: August 2017

A tooth size discrepancy (TSD) indicates disproportion in tooth sizes. TSDs should be considered in treatment planning for the orthodontic patient to ensure an optimal occlusal outcome. The method of calculation of a TSD is explained. The prevalence in orthodontic patients, their aetiology and management are outlined.

Clinical Relevance: Clinicians should be aware of how to diagnose and manage TSDs in orthodontic patients.
Orthognathic surgery: what type of ‘information’ is available to patients on the internet?
Authors: Nunn Rebekka , Sandler Jonathan
Published: August 2017

The Internet has fast become a very easy and familiar way for patients to access healthcare information. In the dental field there are few papers covering this subject and information about the quantity and quality of information available over the Internet is lacking. This paper aims to investigate the information available, to give dental practitioners an appreciation of the amount and variety of information that their patients can access.

Clinical Relevance: As more of our patients turn to the World Wide Web as a source of health information, it is becoming ever more important that we, as health professionals, have an understanding of the amount and quality of the information that is available.
Transmigration of mandibular canine: review of treatment options and report of 13 cases
Authors: Udupa Vadiraj , Prasanna TR , Shetty Chetak , Setty Suhas , R Sathish
Published: August 2017

Intra-osseous migration of a non-erupted mandibular canine is a rare phenomenon. The purpose of this article is to report 13 such cases of transmigration. The article reviews various aetiological hypotheses involved in transmigration, outlines diagnostic pathways for a patient presenting with missing permanent canines with or without over-retained deciduous teeth and discusses various treatment options for transmigration.

Clinical Relevance: The article proposes a difficulty assessing for the orthodontic traction of a transmigrated canine which may help the clinician in treatment planning.
Orthodontic debonding: methods, risks and future developments
Authors: Stewart Samantha Brooke , Chambers Colin P , Sandy Jonathon R , Su Bo , Ireland Anthony
Published: August 2017

The ultimate aims for any clinician at orthodontic debond, following the attainment of a good occlusal result, are to remove all of the attachments, along with the bonding/banding material, as atraumatically as possible whilst minimizing the risks to the operator, assistant and patient during the whole process. This paper reviews the process of debonding following a course of orthodontic fixed appliance therapy, from bracket/band removal through to enamel clean-up. In particular, the risks to both the patient and operator are described at all stages. Future developments are discussed that might help reduce such risks.

Clinical Relevance: Returning the tooth, following orthodontic treatment, to its pretreatment condition is as important as the orthodontic treatment itself. The process of debonding is not without risk and it is vital that all clinicians are aware of these risks, but also what they can do to minimize them as much as possible.
A novel way of correcting class II buccal segment occlusions
Authors: Little Rachel , Spary David
Published: August 2017

This paper presents five clinical cases demonstrating the use of the Upper Begg Lower Straight Wire (SWA) technique. It is a method for correcting Class II buccal segments but not involving the classic Begg technique. It frees the occlusion and tips the upper buccal segment teeth distally, and then a Nance button is used for anchorage reinforcement whilst the teeth are uprighted.

Clinical Relevance: This article outlines an alternative method for correcting Class II buccal segments without the need for extractions.
Unusual presentation of a tooth in a 9-year-old child with cleft lip and palate: a case report
Authors: Edwards Katie , Houghton Nadine , Mitchell Laura
Published: August 2017

Intranasal teeth are an uncommon but definite association with cleft lip and palate. 1 The age of patients and the clinical symptoms surrounding their presentation can vary, as well as their management. A case report of a 9 year-old female with right-sided unilateral cleft lip and palate and associated intranasally erupting supernumerary tooth is presented here.

Clinical Relevance: This case report illustrates that, in cleft lip and palate patients, teeth may present in unusual sites.
Generalized severe idiopathic external root resorption and the importance of pre-treatment radiographs: a case report
Authors: Halai Tina , Milner Natalie , Al-Anqoodi Madiha , Nazir Mariyah
Published: August 2017

This report discusses a case of rare idiopathic root resorption in a 13-year-old female and highlights how an upper standard occlusal radiograph proved to be pivotal in the diagnosis and demonstration of its incidence. Management of the case is described, with discussion of treatment alternatives.

Clinical Relevance: Generalized idiopathic external root resorption is progressive. Before commencing orthodontic treatment, adequate clinical and radiographic examination is essential to facilitate appropriate management. Currently, UK orthodontists do not routinely take an upper standard occlusal radiograph pre-treatment. However, this case highlights the benefit of such diagnostic imaging, in specific circumstances.
Mini-implants in contemporary orthodontics part 1: recent evidence on factors affecting clinical success
Authors: Cousley Richard RJ
Published: August 2017

Orthodontic mini-implants are able to provide reliable anchorage, but are reported to have varying success (stability) rates. Which factors and issues determine mini-implant success and how can this be maximized? This paper provides an interpretation of the relevant research findings, with a particular focus on the latest published studies, to help the orthodontist both understand and maximize his/her mini-implant successes.

Clinical Relevance: An understanding of optimum insertion site, size and technique factors will improve clinical mini-implant success rates.
Mini-implants in contemporary orthodontics part 2: clinical applications and optimal biomechanics
Authors: Cousley Richard R J
Published: August 2017

Since it is well established that orthodontic mini-implants provide stable anchorage in all three dimensions, the focus has progressed to understanding the related biomechanics. This paper describes the key biomechanical advances for mini-implant treatments, especially in terms of optimized movement of the target teeth.

Clinical Relevance: An understanding of the optimum insertion sites and biomechanics improves clinical outcomes in orthodontic mini-implant cases.
Failure of eruption of posterior teeth
Authors: Dunbar Claire , Slattery David
Published: August 2017

Failure of eruption of posterior teeth is rare but has significant clinical implications. There has been a recent re-classification of failure of eruption based on aetiology and presentation. Primary failure of eruption (PFE) affects all teeth distal to the affected tooth and can result in a significant posterior open bite. Mechanical failure of eruption (MFE) is due to ankylosis and the teeth distal to the affected tooth are not affected. Early diagnosis and differentiation between PFE and MFE is essential to ensure that the correct treatment is provided. Two cases are shown that demonstrate MFE.

Clinical Relevance: This article reviews the aetiology for non-eruption and identifies the differences between PFE and MFE.
Assessing the duration of combined orthodontic and orthognathic surgery treatment
Authors: Good John , Jones Ross , Sood Vikas , Kelly Clare
Published: August 2017

Data was collected retrospectively from 44 patients who had orthognathic surgery between May 2012 and October 2014. Treatment was completed by a single consultant surgeon and three orthodontists.

Clinical Relevance: Orthodontists, maxillofacial surgeons and general dental practitioners will all be involved in the care of this patient cohort, thus an appreciation of the process is important for patient-centred care.
A triad of dental anomalies: a rare case report involving the mandibular canines
Authors: Noone Jennifer , Nazir Mariyah
Published: August 2017

The aetiological factors related to many dental anomalies are still uncertain. Clinical descriptive terms may be useful but the distinction between different anomalies is often unclear. This paper describes a case of dental anomaly affecting the mandibular canines. These teeth exhibit a combination of hypoplasia and dilaceration. In addition, the left hand canine is fused with the adjacent lateral incisor. The possible aetiologies will be explored and we will discuss the management options in this unusual case.

Clinical Relevance: This case highlights the diverse nature of dental anomalies. They are often difficult to classify when severe malformation has occurred. It is not always possible to determine the aetiology of dental anomalies. It is important to recognize that the management of dental anomalies may require a multidisciplinary approach.
Molar distalization in orthodontics – a review
Authors: Phulari Basavaraj Subhashchandra
Published: August 2017

Class II malocclusions may be corrected by a combination of restriction or redirection of maxillary growth, distal movement of the maxillary dentition, mesial movement of the mandibular dentition or by enhancement or redirection of mandibular growth.

CPD/Clinical Relevance: To establish a Class I molar relationship and to create space in the buccal segments for non-extraction treatment modalities, distalization of the maxillary first molars may be considered.
Caries associated with orthodontic care part 1: aetiology, prevalence and prevention
Authors: Vanat Maryam , Hyde Amy , Deery Chris
Published: August 2017

The prevalence of demineralization, or enamel caries which is the first clinically recognizable stage of caries, has been reported to be as high as 73% during fixed appliance treatment. It is recognized that wearing an orthodontic appliance increases the caries risk of the individual. The orthodontist can effectively reduce demineralization by applying fluoride varnish at each visit. Selecting patients on their oral hygiene clearly is one factor which can prevent patients suffering from demineralization. Excellent home care with optimal use of fluoride will also help prevent the condition. There is little evidence that fluoride-releasing materials used for bonding orthodontic appliances offer protection from demineralization. The first of these two papers describes the aetiology, prevalence and prevention of demineralization associated with orthodontic care. The second paper will describe the treatments available to manage caries focusing on demineralization post orthodontic treatment.

CPD/Clinical Relevance: Demineralization is the most common complication of orthodontic care. The clinician should understand how to prevent this.
The multidisciplinary management of unerupted maxillary incisors. A report of three cases
Authors: Bharmal Rozana Valiji , Furness Claire , Slattery David , Campbell Catherine
Published: August 2017

An unerupted maxillary incisor can have a major impact on aesthetics and function. To achieve optimum results, early detection, referral and treatment is essential. This article will review the aetiology of delayed eruption and discuss the clinical and radiographic assessment of unerupted maxillary incisors. Three treated cases will be presented that demonstrate the management according to guidelines produced by the Royal College of Surgeons, England. These cases illustrate the importance of early referral as the treatment strategy varies according to the patient's age and stage of root development and late treatment has been shown to have a longer treatment time and increased risk of damage to the incisor.

CPD/Clinical Relevance: This article reviews the aetiology, diagnosis and management of unerupted incisors.
A retrospective analysis of orthognathic treatment in a hospital over five years
Authors: Nandhra Sarabjit Singh , Thickett Eleanor , Power Susan
Published: August 2017

The orthognathic service in some areas of the UK have come under increased pressure due to financial constraints within the NHS. The authors felt it was timely to investigate the cost to the NHS of orthognathic treatment for patients at a District General Hospital (DGH).

CPD/Clinical Relevance: With the rapidly changing landscape of the NHS it is important to understand how current services are operating. This article also gives clinicians information on length/risks of orthognathic treatment.
Origin and type of articles published in four mainstream orthodontic journals: a five-year study
Authors: Tidbury Katy L , Turner Stephen , Ulhaq Aman
Published: August 2017

The aim of this article was to establish the geographic origin and the proportion of full length and research articles in each of four journals over a five-year period: Angle Orthodontist (AO), American Journal of Orthodontics (AJODO), European Journal of Orthodontics (EJO) and Journal of Orthodontics (JO).

CPD/Clinical Relevance: Evidence-based practice is crucial in the management of our patients. Journals remain a conventional way of disseminating scientific literature to a global audience. When considering articles for publication, are certain characteristics thought of more favourably, such as article type (eg research), or geographic origin? This, in turn, may influence the type of articles readers are exposed to, and the journal that authors submit to, consequently posing barriers to a truly global orthodontic community.
Effects of Die Temperature and Moisture Content on the Quality Characteristics of Extruded Rice with Mealworm
Authors: Young Cho Sung , Chatpaisarn Apapan , Hyung Ryu Gi
Published: July 2017

This study aims to make extruded rice snack with high quality in texture and nutrition by adding mealworm. Addition of the mealworm has the merit to fill in high-quality protein and unsaturated fatty acids which are insufficient in rice. Thus, the physicochemical properties were investigated through the process of extrusion cooking. As the extrusion process varied, the die temperatures were set to 120°C and 130°C. Also, the moisture contents were adjusted to 30% and 35%. The specific length, the expansion ratio, and the water absorption index increased as the added content of mealworm became higher. On the contrary, the density, the breaking strength, the apparent elastic modulus, and the water solubility index decreased. As mealworm and moisture content increased, DPPH radical scavenging activity significantly increased but the rancidity decreased. As a result, the addition of mealworm to the extruded rice snack was effective in improving texture, nutrition, and antioxidation.
Effects of Moisture Content and CO2 Gas Injection on Physicochemical Properties of Extruded Soy Protein Isolate
Authors: Kim Na Yeong , Ryu Gi Hyung
Published: July 2017

The objective of this study was to determine the effect of moisture contents (40, 50, 60%) and CO2 gas injection (0 and 800 mL/min) on physicochemical properties of extruded soy protein isolate (SPI). The expansion ratio and the specific length increased, but piece density decreased with the increase in CO2 gas injection from 0 to 800 mL/ min at both 40 and 50% moisture contents. On the contrary, the expansion ratio and the specific length decreased, but piece density increased with the increase in CO2 gas injection from 0 to 800 mL/min at 60% moisture content. Extruded SPI with CO2 gas injection at 800 mL/min had small cell size and higher amount of cell than extruded SPI without CO2 gas injection. The water holding capacity and nitrogen solubility index increased, and the integrity index and the texture decreased with the increase in CO2 gas injection from 0 to 800 mL/min. In conclusion, extruded SPI with the CO2 gas injection at 800 mL/min showed better expansion properties and cell formation than extruded SPI without the CO2 gas injection.