An obturator prosthesis for a 4-year-old child following treatment of a juvenile trabecular ossifying fibroma with a maxillary resection.

Juvenile trabecular ossifying fibroma (JTOF) is a benign fibro-osseous lesion that usually occurs in the maxilla or mandible. Individuals with JTOF of the maxilla will most commonly require a resection that can result in a significant palatal defect. Appearance and articulatory, masticatory, and deglutitory functions can be restored with a clasp-retained obturator. Providing a prosthetic obturator with adequate retention in situations where the teeth cannot accommodate clasps because of insufficient eruption can be challenging. This article describes a technique that has been developed for such instances-in this situation, a 4-year-old child who had undergone a maxillary resection because of a JTOF.

Restorative dentistry in the young cleft patient.

This clinical paper outlines the role of the restorative consultant in the treatment of young cleft lip and palate patients up to the end of their cleft package of care on their 22nd birthday. The multidisciplinary nature of the care is highlighted, including the role of the general dental practitioner in caring for cleft patients in primary care. The various clinical treatment modalities used in this patient group are described with an emphasis on minimally invasive and adhesive approaches. The role of dental implants and removable prostheses are described. Considerations for long-term maintenance, much of which will take place in primary care, are also included.

The restorative dentistry management of adult cleft patients: 'the adult returner'.

This paper will discuss the management of adult patients with cleft lip and palate who return to care, often many decades after their initial course of treatment. This can be a very complex group of patients to treat as they often present with anxiety about dental care and often have other long-standing psychosocial issues. Working very closely with the multi-disciplinary team and the general dental practitioner is crucial to the successful outcome of care. This paper will outline the most common complaints that these patients may present with and the restorative dentistry solutions that are available to address them.

When (and when not) to use the Dahl Concept.

The Dahl Concept describes the re-establishment of occlusal contacts after the provision of a planned localised appliance or restoration in supraocclusion. Initially developed to create space for prosthetic rehabilitation of anterior teeth suffering from localised wear, the principle has later been successfully applied to a variety of situations, including the Hall technique and resin-bonded bridges cemented in supraocclusion. Despite high levels of success seen in the relevant literature and widespread adoption in specialist care, the wider profession appears to be far more cautious in its use. This article aims to provide a brief summary of the Dahl Concept and discuss the local and general factors that influence its successful implementation in the hope of promoting its increased adoption by the broader dental profession.

Unilateral intrusion in a medically complex patient using an orthodontic mini-implant: A case report.

Orthognathic surgery offers a predictable treatment option for patients with skeletal discrepancies and corresponding dental malocclusions. In cases where surgery is not advised due to significant medical co-morbidity, the orthodontist must approach the treatment using different mechanical modalities. Orthodontic mini-implants can be a valuable adjunct in these cases. We describe a case where a palatal mini-implant was used during orthodontic treatment in a patient with a complex capillary malformation, which precluded surgical correction.

Hypophosphataemic Rickets Secondary to Raine Syndrome: A Review of the Literature and Case Reports of Three Paediatric Patients' Dental Management.

Raine Syndrome (RS) also referred to as lethal osteosclerotic bone dysplasia describes an exceptionally rare autosomal recessive disorder with an estimated prevalence of <1 in 1,000,000. Endocrinological manifestations such as hypophosphataemic rickets depict a recent finding within the phenotypic spectrum of nonlethal RS. The dental sequelae of hypophosphataemic rickets are significant. Spontaneous recurrent abscesses on noncarious teeth result in significant odontogenic pain and multiple dental interventions. The dental presentations of nonlethal RS are less widely described within the literature. Amelogenesis Imperfecta (AI), however, was recently postulated as a key characteristic. This article presents the dental manifestations and extensive restorative and oral surgical intervention of three siblings with hypophosphataemic rickets secondary to Raine Syndrome treated at Great Ormond Street Hospital for Children, a tertiary referral hospital.

Reducing the risk of failure in complete denture patients.

UNLABELLED: This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations. CLINICAL RELEVANCE: Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.

Ceramic materials have similar short term survival rates to other materials on posterior teeth.

DATA SOURCES: PubMed, Cochrane and Picarta databases and references of retrieved articles were searched from 2001-2009. STUDY SELECTION: RCTs, CCTs and case series which compared Class I and Class II ceramic inlay restorations in permanent premolar and molar teeth, other posterior restorations were included. DATA EXTRACTION AND SYNTHESIS: Two authors reviewed all abstracts independently, compared results and reached consensus on inclusion/ exclusion through discussion. Quality assessment of the studies was carried out using Hayashi's criteria. RESULTS: Three studies (two RCTs, one CCR) were included. All three compared ceramic materials to composite resin materials. The outcomes were longevity of the restorations (USPHS criteria in two studies and CDA in one), postoperative sensitivity and colour match. None of the included studies reported sufficient data to calculate the corrected survival rate, so the conclusion that there was no difference between ceramic and other posterior restorations could not be reappraised. Neither of the two RCTs reporting postoperative sensitivity found a difference between the ceramic or composite restorations confirming the previous reviews findings. For aesthetic quality, only the CCR results were considered sufficiently reliable, with no significant difference being found between the materials. CONCLUSIONS: Ceramic materials perform as well as alternative restorative materials for use as inlay restorations. However, a lack of long-term data means that this conclusion can only be supported for periods up to one year for longevity and 57 months for colour match.

Prognostic indicators for conventional complete denture therapy: a review of the literature.

OBJECTIVES: To review the current literature on prognostic indicators for conventional complete denture therapy. DATA: Original articles studying outcome measures and patient satisfaction with conventional complete dentures. SOURCES: Ovid databases from 1988 to present and subsequent review of related articles from the 1960s onwards. Searches were limited to English language only and used a variety of keywords. CONCLUSIONS: There remains a paucity of research in this area. From the best available data, construction of technically correct dentures, a well-formed mandibular ridge and accuracy of jaw relations are positive indicators for success. Patient neuroticism and a poorly formed mandibular ridge are negative indicators for success. Other prognostic indicators have not been shown to be of significant value. There exists a minority of patients who will never adapt to any conventional complete denture. This problem is more acute in the mandible than the maxilla. There is need for further research in this area.