bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
How can we improve orthodontic care for patients with autism and/or learning disabilities?
Authors: Ellis Pamela E , Silverton Sarah , Hollingsworth Lorna 
Published: August 2017

Receiving orthodontic care can be challenging for our patients with autism and/or learning disabilities; being in new places, meeting new people and having treatment can be overwhelming. In this article the authors have worked with carers to understand better the challenges patients with autism and/or learning disabilities face and identify reasonable adjustments which can be made to improve their experience. It is hoped that other orthodontists may adopt these changes in their own services or find similar ways to improve the care of this patient group. Clinical Relevance: Orthodontists encounter patients with autism and/or learning disabilities in their day-to-day practice. This paper outlines reasonable adjustments they can make to improve the experience of these patients.
A simple method for facebow recording for orthognathic surgery
Authors: Jagsi Shreenal , Maggs Roger , Deans Jamie 
Published: August 2017

Orthognathic surgery involving the maxilla generally requires the mounting of models on an articulator. Mounted casts facilitate detailed patient assessment and treatment planning, as well as allowing wafer construction to aid the three-dimensional surgical correction of dento-facial deformities and malocclusion. Systematic error in facebow transfer from the patient to the articulator is a contributing factor in the discrepancy between planned surgical movements and the final surgical result. This paper presents a simple technique that uses mini-spirit levels to allow commercially available semi-adjustable articulators to allow natural head position to be used as the horizontal reference plane rather than anatomical landmarks. We feel that this technique is another step towards error reduction in orthognathic surgery. Clinical Relevance: Many orthognathic centres use commercially available semi-adjustable articulators that use anatomical landmarks to record the horizontal reference plane during facebow recording. These horizontal reference lines can differ significantly from the true horizontal line on which the patient is planned. The cross member of the articulator corresponds to the horizontal reference plane recorded and, if this is different from the true horizontal, then systematic error is introduced into orthognathic surgery.
Maxillary incisor root resorption induced by ectopic canines part 1: prevalence rates and longevity outcomes
Authors: Wong Lilia , Khan Sadaf 
Published: August 2017

Root resorption of maxillary incisors as a result of impacted maxillary canines is a sequelae of canine ectopia that has been reported in the literature in terms of case reports and retrospective case series. However, to our knowledge there has been no work done that consolidates the available information on the subject, particularly since the advent of improved imaging techniques with higher rates of detection of maxillary incisor root resorption. This paper aims to review the prevalence rates of maxillary incisor root resorption induced by impacted maxillary canines, as well as to discuss the diagnosis and prognosis of teeth affected by this phenomenon. Clinical Relevance: Maxillary incisor root resorption induced by ectopic maxillary canines is an issue which may be encountered by all dental specialties; however, the awareness of each stage of management is frequently unknown by clinicians. This paper aims to increase awareness and provide a reference point for appropriate management.
Enlarged parietal foramina – an incidental finding on a lateral cephalogram
Authors: Attard Alan , Cure Richard , Stocker Judith 
Published: August 2017

This is a case report of a 16-year-old girl referred to the oral and maxillofacial department for further assessment of a radiolucent area noted at the posterior aspect of the skull vertex on a lateral cephalogram by her orthodontist. Following assessment, these were diagnosed as enlarged parietal foramina and managed conservatively. CPD/Clinical Relevance: With the increased use of the multiple imaging modalities available in dental practice, in particular the use of cone-beam CT imaging, the clinician should be familiar with the appearances of common pathology, as well as some incidental findings in the traditional dental and maxillofacial region, and adjacent territories. The careful review of medical imaging and referral for further evaluation of ambiguous incidental findings is recommended.
Synovial sarcoma: effect of treatment on root development and eruptive potential – a case report and review
Authors: Begum Aysha , Bister Dirk , Khamashta-Ledezma Leilaq 
Published: August 2017

Overall, the survival rate of people affected by childhood cancer is increasing. It is important for dental professionals to understand the effects cancer treatment can have on growth and dental development. The aim of this case report is to describe the effects of both chemotherapy and radiotherapy on dental development, dental appearance and oral health in a 6-year-old female patient treated for synovial sarcoma. The numerous theories of tooth eruption described in the literature are summarized and this case report shows how, although root development was arrested, tooth eruption still occurred.CPD/Clinical Relevance: The skeletal and dento-alveolar effects of chemotherapy and radiotherapy for treatment of childhood cancers are explored and exemplified by the case reported. The numerous tooth eruption theories that have been described are also discussed. Interestingly in this case report, tooth eruption still occurred despite incomplete root formation.
Caries associated with orthodontic care part 2: management
Authors: Hyde Amy , Vanat Maryam , Deery Chris 
Published: August 2017

It is recognized that wearing an orthodontic appliance increases the caries risk of the individual. The prevalence of demineralization has been reported to be as high as 73%. When demineralization occurs a number of treatments exist: fluoride application, acid microabrasion, casein phosphopeptide-amorphous calcium phosphate (CCP-ACP), resin infiltration and self-assembling peptides. Of these, topical fluoride has the most evidence to support its use. CPD/Clinical Relevance: Demineralization is the most common complication of orthodontic care. The clinician should understand how to manage this when it occurs.
Coronectomy: a case series demonstrating its value in younger patients
Authors: Marshall Sophie , Bryant Catherine 
Published: August 2017

This article describes the value of coronectomy as an alternative to the removal of teeth in the management of younger patients when intervention is required but extraction is associated with a heightened risk of post-operative neuropathy. Three cases are presented of children who underwent a coronectomy procedure which was planned within a multidisciplinary Orthodontic, Oral Surgery and Paediatric Dentistry team at King's College Hospital. None of the children experienced post-operative neuropathy. CPD/Clinical Relevance: This article describes the value of coronectomy (partial odontectomy) as an alternative to the removal of teeth in the management of younger patients when intervention is required but extraction is associated with a heightened risk of post-operative neuropathy.
Assessment of growth in orthodontics
Authors: Songra Goldie , Mittal Tarun K , Williams Julie C , Puryer James , Sandy Jonathan R , Ireland Anthony J 
Published: August 2017

Being able to predict the likely timing and duration of growth accurately, in particular the pubertal growth spurt, is important in orthodontic treatment planning. The different assessments of growth, their advantages and disadvantages will be described. CPD/Clinical Relevance: A knowledge of the typical assessments of skeletal growth is important in the planning and execution of orthodontic treatment.
Orthodontic management of delayed permanent tooth eruption and a case report of hyper-IgE syndrome
Authors: Din Ahmed , Bhatti Nabeel , Sharma Pratik K 
Published: August 2017

This article aims to look at the treatment and management of patients presenting with delayed tooth eruption of the permanent dentition. We describe the case of a 17-year-old girl who presented having been diagnosed with Hyper-IgE syndrome. The patient was positive for the STAT-3 gene and presented with a history of some classic Hyper-IgE features. There was a history of multiple skin abscesses and she was on long-term antibiotics. She presented in the mixed dentition with multiple retained deciduous teeth and a full complement of unerupted and fully formed permanent teeth. This article will describe features of this syndrome and discuss management strategies for patients presenting with delayed eruption. Clinical Relevance: This case study highlights the difficulties in managing patients who present with retained primary dentition at an older age. It also presents a rare case presentation of a patient with Hyper-IgE.
Juvenile idiopathic arthritis – implications on facial growth and contemporary management
Authors: Abela Stefan , Armon Kate , Tewson David , Prince Sharon , Seedat Mohamed-Saeed , Bister Dirk 
Published: August 2017

The aim of the present study was to describe a case with juvenile idiopathic arthritis (JIA) with bilateral temporomandibular joint (TMJ) involvement and long-term facial growth implications, requiring complex surgical treatment and multidisciplinary teams. CPD/Clinical Relevance: Consideration was given to TMJ replacement with alloplastic graft, however, the final management strategy involved bimaxillary surgery.