Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities.

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Intraoral 3D Scanning or Dental Impressions for the Assessment of Dental Arch Relationships in Cleft Care: Which is Superior?

OBJECTIVE: This study was undertaken to evaluate intraoral 3D scans for assessing dental arch relationships and obtain patient/parent perceptions of impressions and intraoral 3D scanning. MATERIALS & METHODS: Forty-three subjects with nonsyndromic unilateral cleft lip and palate (UCLP) had impressions taken for plaster models. These and the teeth were scanned using the R700 Orthodontic Study Model Scanner and Trios® Digital Impressions Scanner (3Shape A/S, Copenhagen, Denmark) to create indirect and direct digital models. All model formats were scored by three observers on two occasions using the GOSLON and modified Huddart Bodenham (MHB) indices. Participants and parents scored their perceptions of impressions and scanning from 1 (very good) to 5 (very bad). Intra- and interexaminer reliability were tested using GOSLON and MHB data (Cronbach's Alpha >0.9). Bland and Altman plots were created for MHB data, with each model medium (one-sample t tests, P < .05) and questionnaire data (Wilcoxon signed ranks P < .05) tested. RESULTS: Intra- and interexaminer reliability (>0.9) were good for all formats with the direct digital models having the lowest interexaminer differences. Participants had higher ratings for scanning comfort (84.8%) than impressions (44.2%) (P < .05) and for scanning time (56.6%) than impressions (51.2%) (P > .05). None disliked scanning, but 16.3% disliked impressions. Data for parents and children positively correlated (P < .05). CONCLUSIONS: Reliability of scoring dental arch relationships using intraoral 3D scans was superior to indirect digital and to plaster models; Subjects with UCLP preferred intra-oral 3D scanning to dental impressions, mirrored by parents/carers; This study supports the replacement of conventional impressions with intra-oral 3D scans in longitudinal evaluations of the outcomes of cleft care.

Validation of the volumetric measurement of a simulated maxillary alveolar bone defect using cone-beam computed tomography.

Objective : To determine the accuracy of volumetric measurement of a simulated alveolar bone defect using cone-beam computed tomography (CBCT) scans. Design : Laboratory-based observational study. Setting : University dental teaching hospital. Methods : Scans of a dried skull with an artificially created maxillary bone defect. Main Outcome Measures : The skull was scanned using an i-CAT CBCT scanner (Imaging Sciences International, Hatfield, PA) at 0.2 mm resolution. The superior and inferior aspects of the void were identified, and the volume was calculated by three-dimensional (3D) computational analysis of the CBCT scan using an algorithm created with MATLAB software (The Mathworks Inc., R2009a, Natick, MA). The skull was then scanned using micro computed tomography (micro-CT) at 0.0934 mm resolution, and the volume of the defect was determined using the Studio Max 2.2 program (Volume Graphics, 2012, Heidelberg, Germany). The process was repeated two additional times, and the volumes were compared using a two-sample t test (P < .05). To determine the interobserver reproducibility of the identification of the superior and inferior aspects of the defect, the slices chosen to represent these extremities were selected by four separate observers and the data assessed using an F-test (P < .05). Results : The interobserver reproducibility of the identification of the superior and inferior boundaries of the defect was good (P = .18). The volumes computed from the i-CAT CBCT images were 4.11% lower than those computed from the micro-CT images; however, the difference was not statistically significant (P = .71). Conclusions : 3D volumetric measurement of simulated alveolar bone defects using i-CAT CBCT scans is similar to the volumes determined using micro-CT.

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate.

We aimed to compare the reliability of the Kindelan system using one postoperative radiograph to assess the success of alveolar bone grafts with the use of two occlusal radiographs (before and after operation). This retrospective reliability study took place at Glasgow Dental Hospital cleft unit, and two examiners scored 84 radiographs two weeks apart. The sample was taken from a database of patients having alveolar bone grafts between 2007 and 2010. They had an upper anterior occlusal radiograph taken before the graft and another at a mean of 6 months (range 3-12 months) postoperatively. Kappa scores were used to measure intraobserver and interobserver agreement. Intraexaminer agreement ranged from good to very good using one or two radiographs, and interexaminer agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs was similar, and ranged from good to very good.

Advances in fixed appliance orthodontics.

In 1992, Postlethwaite wrote an article for Dental Update entitled 'Advances in fixed appliance design and use'. In the subsequent years there have been, as in most dental specialties, huge advances in materials. These have resulted in improved efficiency, convenience and simplicity in using fixed appliance orthodontics. This article is intended to be an update in these advances over the last 10 years.

Smile aesthetics and malocclusion in UK teenage magazines assessed using the Index of Orthodontic Treatment Need (IOTN).

OBJECTIVE: There is a significant demand for orthodontic treatment within the UK from adolescent girls, a group known to be influenced by the media portrayal of body form and body image, which may extend to the presentation of malocclusions. This study examined the portrayal of malocclusion in a media type that targets teenage girls under 16 years of age. MATERIALS AND METHODS: A representative selection of 1 month's magazines targeting this group were investigated, and the frequency and severity of malocclusions displayed were assessed. Two calibrated examiners viewed all the smiles (on two occasions) using a modification of Index of Orthodontic Treatment Need (IOTN) and assigned an Aesthetic Component Score to each smile. RESULTS: It was found that the aesthetic score is low (less than 7) for the majority of models (92.8%) indicating no need or a borderline need for treatment. Only 7.2% of models exhibited a definite need for treatment. CONCLUSION: It appears that the portrayal of malocclusion in teenage magazines does not reflect the general treatment need of the adolescent population.

The interdisciplinary management of hypodontia: the relationship between an interdisciplinary team and the general dental practitioner.

This paper will illustrate how the general dental practitioner can provide care for patients with hypodontia. It will demonstrate how an interdisciplinary team works for hypodontia patients and, in particular, for those with severe hypodontia.

The interdisciplinary management of hypodontia: restorative dentistry.

This paper considers the role of restorative dentistry in the management of hypodontia. The paper describes the general restorative considerations common to patients with hypodontia and illustrates the variety of restorative techniques available in the restorative management of hypodontia and oligodontia.

The interdisciplinary management of hypodontia: background and role of paediatric dentistry.

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Varnish or polymeric coating for the prevention of demineralization? An ex vivo study.

OBJECTIVE: The ability of an experimental coating, Odyssey, to prevent demineralisation ex vivo was compared with that of a fluoride varnish, Duraphat and a chlorhexidine-containing varnish, Cervitec. DESIGN: an ex vivo single-blind study. SETTING: Hard tissue research laboratory. MATERIALS AND METHODS: thirty bovine enamel blocks 0.5 cm x 1.5 cm were divided into 6 groups of 5 specimens. The enamel blocks were then allocated to one of 6 surface treatments. INTERVENTIONS: (1) surface left unprepared (control), (2) Duraphat application, (3) Cervitec application, (4) experimental polymer coating, (5) enamel conditioned with 10% citric acid and coated with the experimental polymer coating Odyssey (O + C), (6) enamel etched for 30 sec with 37% phosphoric acid and coated with the experimental coating (O + E). All specimens were cycled for 7 days through a daily procedure of demineralisation for 4 hours and remineralisation for 20 hours, and exposed to an equivalent of 2 months toothbrushing. A single operator blinded to the treatment allocation of each specimen carried artificial lesion depth assessment out using computer-assisted transverse microradiography. RESULTS: The control group had the greatest mean lesion depth (97.16 + 29.8 microm) with the Duraphat group exhibiting the lowest mean lesion depth (24.53 + 15.44 microm). The Duraphat, Odyssey, O + C and O + E groups all had significantly less lesion depth when compared with no surface preparation (p < 0.05 for all comparisons). There were no significant differences between any of the Odyssey groups. CONCLUSIONS: The efficacy of Duraphat application in preventing demineralisation ex vivo has been demonstrated in the present study, but clinical trials are required to assess its usefulness in orthodontic practice.

Modified composite or conventional glass ionomer for band cementation? A comparative clinical trial.

The time to first failure, the position of band failure at deband, and the change in enamel white spot lesions of teeth bonded with a modified composite or a conventional glass ionomer were compared in a randomized half-mouth trial over the full course of orthodontic treatment. One hundred forty band pairs were cemented in 98 subjects. Overall band failure rates of 5% and 2.8% were recorded for the modified composite and the conventional glass ionomer, respectively, with no significant difference found between their times to first band failure. At the end-of-treatment deband, the position of band failure was predominantly at the enamel-cement interface for the modified composite and at the band-cement interface for the conventional glass ionomer (P <.001). A comparison of changes in mean enamel white spot lesion scores during treatment did not reveal significant differences between the cement groups (P =.16).

Daily exposure to fluoride mouthrinse produces sustained fluoride release from orthodontic adhesives in vitro.

OBJECTIVES: To determine firstly, if sustained fluoride release can be achieved from five orthodontic adhesives: Ketac-Cem, Fuji ORTHO LC, Sequence, Transbond and Right-On, with daily exposure to fluoride mouthrinse in vitro, and secondly, if sustained fluoride release can be re-established from the same specimens, after an interruption in mouthrinse exposure. METHODS: Ten brackets were bonded to bovine incisors using each adhesive. Each adhesive group was divided equally into a test and a control sub-group. In phase 1 (42 days), the test sub-groups were exposed for 1min daily to fluoride mouthrinse (225 ppm), followed by immersion in de-ionised water for 42 days to deplete their fluoride reserves. Mouthrinse exposure was then resumed in phase 2 (28 days). Mean cumulative fluoride release (MCFR) was calculated for days 0-21 of phase 1 and for the plateau portion of the fluoride release curves in phase 1 (days 21-42) and phase 2 (days 7-28). RESULTS: During phase 1, the MCFR for each test sub-group was significantly greater than its control (p<0.05). There was no significant difference in MCFR between the curve plateau portion of phases 1 and 2 for all adhesives except Transbond, for which MCFR was less in phase 2 (p<0. 05). CONCLUSIONS: Sustained fluoride release occurred for each adhesive exposed daily to fluoride mouthrinse, at a level significantly greater than its control. After fluoride exhaustion, re-exposure to daily fluoride mouthrinse produced sustained fluoride release levels comparable to those prior to exhaustion, for all adhesives except Transbond.

Fluoride release, microbial inhibition and microleakage pattern of two orthodontic band cements.

OBJECTIVES: To compare, in vitro, the fluoride release, microbial inhibition and microleakage pattern of a conventional glass ionomer cement (Ketac-Cem) and an acid-modified composite (Ultra Band-Lok) for band cementation. METHODS: Fluoride release was measured from cement discs (3.0 mm diameter and 1.5 mm thick) at regular intervals over 40 days using a potentiometric method. Microbial inhibition was determined for each cement using an agar diffusion test against one of four different strains of Streptococcus mutans. Thirty pairs of banded third molars (15 banded pairs for each cement) were thermocycled and microleakage determined by a dye penetration method. The depth of microleakage was assessed by an index applied by two examiners independently to photographic records taken of the mid-buccal aspect of each tooth. RESULTS: The cumulative and daily fluoride release for days 5, 15 and 40 were significantly greater for Ketac-Cem than for Ultra Band-Lok (all p < 0.05). After the initial set, the anti-microbial activity was significantly greater for Ketac-Cem than for Ultra Band-Lok over the following 24 h period for all four strains of S. mutans (all p < 0.05). There was no significant difference between the two cement groups for microleakage at the cement/enamel interface (p = 0.66) but a borderline significance was detected for microleakage at the cement/band interface (p = 0.051). CONCLUSIONS: The fluoride release and anti-microbial activity of Ketac-Cem were greater than that of Ultra Band-Lok. There was no significant difference in microleakage between the cements at the cement/enamel interface but a borderline difference existed between the cements at the cement/band interface.

The absence of any pre-emptive analgesic effect for non-steroidal anti-inflammatory drugs.

Pre-emptive analgesic efficacy of the non-steroidal anti-inflammatory drug, diclofenac sodium, was tested in 21 young, fit, patients undergoing third molar extractions in a double-blind, randomised, cross-over, trial. Pain scores and mouth opening were observed for 1 week after the operation and these did not show any differences following pre- and postoperative oral administration of diclofenac sodium 100 mg (P > 0.05). There were no differences in the patients' preference for the two methods of treatment (P > 0.05). The study suggests that the non-steroidal anti-inflammatory drug diclofenac sodium does not cause any significant pre-emptive analgesic effects in the dose administered.

A lymphoepithelial cyst (branchial cyst) in the floor of the mouth.

Lymphoepithelial cysts are developmental, but their pathogenesis is unknown. The classical explanation is that they are derived from remnants of the branchial arches or clefts. This has been disputed, and it is likely that most arise from epithelium, possibly of tonsillar or salivary origin, that becomes entrapped by lymphoid tissue. This report describes a lymphoepithelial cyst in a 29-year-old man. The cyst was situated on the right side of the floor of the mouth adjacent to the lingual frenum. Its appearance supports both branchiogenic and the entrapment theories.