A retrospective analysis of the patient journey for children with an unerupted maxillary central incisor.

BACKGROUND: Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress. AIM: To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB). DESIGN: A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021. RESULTS: Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%). CONCLUSION: Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption.

A Survey on Alveolar Bone Grafting in Indian Cleft Centers.

OBJECTIVE: To assess the factors influencing the type and timing of Alveolar Bone Grafting (ABG) among cleft centers throughout India. To examine the decision-making criteria for orthodontic treatment and the timing of ABG. DESIGN: Cross sectional survey. METHOD: This survey was based on a convenience-based sample selected from cleft teams across India. The survey was formulated using the SurveyMonkey platform and emailed to 40 cleft teams. The survey included questions on demographics, timing, surgical protocol, orthodontic protocol, radiograph prescription rate, assessment methods for the success of ABG and three scenarios for evaluating the timing of the bone graft. The Chi-squared test was performed to evaluate the difference in opinion between specialists. The inter-examiner reliability was assessed using Kappa statistics. RESULTS: Thirty-five units completed the questionnaire. Most units operate with 1-2 surgeons, with 42.9% of them treating cleft patients for under 5 years. Only 11.4% of centres routinely advised oblique occlusal radiographs for post-surgery evaluation, and 31.4% prescribed CBCT. However, 40% of cleft teams did not perform audits to evaluate the success of ABG, and less than 50% advised radiographs six months post-surgery. Around 26% of centres do not routinely provide orthodontic treatment pre-ABG. The inter-examiner reliability for case scenarios showed poor agreement between the clinicians. CONCLUSION: The survey showed a serious lack of consensus in the ABG treatment among cleft teams in India and emphasises the need for standardised protocols for the treatment of children with cleft palate. There is an urgent need to develop core outcome set in cleft.

Extraction of premolars for orthodontic reasons on the decline? A cross-sectional survey of BOS members.

OBJECTIVE: To obtain the opinion of British Orthodontic Society (BOS) members in relation to possible patterns of prescription of orthodontic extractions over the past 5-10 years and to relate any changes identified to treatment objectives, facial and smile aesthetics, and treatment strategies and adjuncts. DESIGN: Cross-sectional questionnaire. SETTING: On-line survey of BOS members. METHODS: A 14-item on-line questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered demographics, possible changes in frequency of prescribed extractions with specific information concerning the effect of patient age, and the influence of other factors including alternative approaches to space creation, evolving treatment mechanics, smile and facial aesthetics, and retention protocols. RESULTS: Two hundred and eight responses were obtained with 95.6% (n = 199) reporting reduced extraction prescription over the last 5-10 years. Overall, 29.9% and 35.5% felt that their threshold for extractions had increased by more than 2 mm in adolescents and adults, respectively. Facial (n = 145; 69.7%) and smile (n = 127; 61.1%) aesthetics, and increased use of inter-proximal reduction (n = 102; 49%) were the factors most frequently reported as having either a moderate or major influence on this trend. Based on ordinal logistical regression analyses, no significant relationship was found between threshold for extractions and work setting (P = 0.675; O.R. 0.51; 95% CI: 0.39, 1.85) or level of orthodontic experience (P = 0.15; O.R. 1.02; 95% CI: 0.15, 1.05), although a higher threshold for extractions was more likely among users of conventional than self-ligating brackets (P = 0.001; O.R. 4.74; 95% CI: 1.95, 11.5). CONCLUSIONS: A reduced tendency to prescribe orthodontic extractions over the past 5-10 years among British Orthodontic Society members was identified. Comparative clinical research exploring the relative merits of extraction and non-extraction approaches could be timely.

An Evaluation of Alveolar Bone Grafting in the UK and Ireland.

OBJECTIVE: To determine the main factors influencing the timing of alveolar bone grafting among cleft teams in the UK and Ireland, to assess the types of radiographs used to evaluate bone grafting sites pre- and postoperatively and the views of the profession on orthodontic expansion prior to grafting. DESIGN: An online survey consisting of 24 questions was compiled and emailed to 53 orthodontists and surgeons in all 12 Cleft Hub Units in the UK and Ireland. RESULTS: All units in the UK and Ireland responded with 51 responses, 39 complete and 12 partial responses, obtained from cleft surgeons and orthodontists. The majority of units are using dental criteria (75%) as a guide to timing alveolar bone grafting. Most units take a postoperative radiograph at 6 months but the view being taken varied. When asked if four cases were ready for grafting based on their radiographs, there was clear agreement by a significant majority for 3 cases but for 1 only a minimal majority (61%). The most common donor site chosen for the graft is the Iliac crest (92.9%). There was excellent agreement for 2 cases asking when to use expansion but poor agreement for one, 55% saying they would expand and 45% saying no. CONCLUSION: Overall there is good agreement among cleft teams in the UK and Ireland about management of alveolar bone grafting; however, a clearer consensus on preoperative orthodontic expansion may be needed.

Ingestion of an orthodontic archwire resulting in a perforated bowel: A case report.

Accidentally, ingesting components of an orthodontic appliance can result in serious consequences for the patient. This paper presents one such complication, not previously reported, where the patient needed emergency surgery to retrieve part of an orthodontic appliance. This case report highlights the consequences of and possible solutions to prevent patients inhaling or ingesting parts of their appliance.

A Pathological Fracture of the Mandible due to Osteomyelitis following a Full Dental Clearance.

Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.