The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group in terms of perceived need for orthognathic surgery, skeletal and dental change, and psychological impact. DESIGN: A multicentre two-armed parallel randomised controlled trial. SETTING: Six UK hospital orthodontic units. METHODS: A total of 57 patients were randomly allocated into either the BAMP group (BAMPG) (n = 28) or a no treatment control group (CG) (n = 29). OUTCOMES: Data collection occurred at registration (DC1),18 months (DC2) and 3 years (DC3), where skeletal and dental changes were measured from lateral cephalograms and study models. Oral Aesthetic Subjective Impact Score (OASIS) and Oral Quality of Life (OHQOL) questionnaires were used to assess the psychological impact of treatment. RESULTS: The mean age was 12.9 ± 0.7 years and 12.6 ± 0.9 years in the BAMPG and CG, respectively. At DC2, the BAMPG achieved a class III ANB improvement of +0.6° compared with -0.7° in the CG (P = 0.004). The overjet improvement was +1.4 mm for the BAMPG and -0.2 mm for the CG (P = 0.002). There was no evidence of any other group differences for the other skeletal or dental cephalometric outcomes (P > 0.05) or the questionnaire data (OASIS P = 0.10, OHQOL P = 0.75). At DC2, the 18-month follow-up, 22% of the BAMPG achieved a positive overjet. At the 3-year follow-up (DC3), fewer patients in the BAMPG were perceived to need orthognathic surgery (48%) compared with 75% of patients in the CG (P = 0.04), with an odds ratio of 0.31 (95% confidence interval = 0.10-0.95). CONCLUSION: The BAMP technique did not show any social or psychological benefits; however, the skeletal class III improvement in ANB and the overjet change were sufficient to reduce the perceived need for orthognathic surgery by 27% compared with the CG.

Smile makeover treatments.

The demand for aesthetic smile makeover treatments is increasing, especially with the rise in social media use. Historically, healthy tooth structure was sacrificed in order to achieve rapid results but this would invariably lead to compromise of the occlusion and a less-than-ideal result.Multi-disciplinary treatment planning, including the use of orthodontic treatment, is now routinely used in order to achieve optimal results. This paper aims to highlight the importance of a combined orthodontic-restorative planning process to allow a long-term aesthetic and functional result for our patients.

Management of missing maxillary lateral incisors in general practice: space opening versus space closure.

The aim of this paper is to inform the reader of the main principles considered in the management of mild hypodontia involving the absence of one or more maxillary lateral incisors. With increasing demand and limited resources of hospital dental services, general dental practitioners (GDPs) are required to actively participate in the restorative management of mild hypodontia cases. The objectives of this article are to discuss the arguments for and against space opening versus space closure and to highlight key points to consider in treatment planning. The paper discusses advantageous scenarios for both space opening and space closing cases, with the aim of providing the reader with some basic concepts to apply to cases in general practice. Included in the paper is guidance for practitioners on the diagnosis of a missing maxillary incisor via the use of a flow chart and table. It is hoped that this paper will support and enhance the care delivered by GDPs in the restorative management of mild hypodontia patients.

Scope of practice and supervision of orthodontic therapists in the United Kingdom: Part 2: a national cross-sectional survey of orthodontic therapists.

BACKGROUND: Orthodontic therapists (OTs) are the most recent addition to the orthodontic clinical team. The General Dental Council (GDC) and the British Orthodontic Society have formulated guidance and guidelines relating to their scope of practice and level of supervision, however there has been no contemporary UK-based research investigating practice and supervision of OTs. The aim of this study was to investigate the scope of practice and level of supervision of OTs working in the UK. METHOD: Ethical approval was received from the University of Manchester Research Ethics Committee. An anonymous postal questionnaire was dispatched using postal details acquired through the British Orthodontic Societies mailing list. Three mailings of the questionnaire were conducted. RESULTS: A 74% response rate was achieved. OTs routinely conducted 16 of the 20 procedures from their scope of practice. Uncommon procedures included fitting headgear (24%), lingual appliances (27%), inserting or removing temporary anchorage devices (20%), and taking facebow record (18%). A total of 62% of OTs took patient consent for treatment. 59% were supervised through a written prescription with no direct supervision. OTs were directly supervised for only a quarter of their clinical practice. Orthodontists viewing frequency for OTs varied significantly, and was found to be the following: every 2-4 visits (36%), every other visit (35%), and every visit (26%). CONCLUSIONS: OTs mostly carried out the scope of practice as permitted by the GDC. Procedures uncommon to routine orthodontic practice were also uncommon to Orthodontic therapist clinical practice. OTs work mostly through written prescription with no direct supervision.

Scope of practice and supervision of orthodontic therapists in the United Kingdom: Part 1: a national cross-sectional survey of orthodontists.

OBJECTIVE: Since the introduction of orthodontic therapists (OTs), there has been little research on the scope of practice and the level of supervision they receive. This study investigates how OTs are being utilised and supervised, and how this compares with current recommendations. METHODS AND PARTICIPANTS: A postal cross-sectional survey was mailed to all UK General Dental Council (GDC) registered specialist orthodontists. RESULTS: A 59.7% response rate (747) was achieved. 52% of the respondents reported they worked with/employed an OT. The majority of orthodontists worked with an OT in primary care (67%) seeing predominantly NHS (56%) patients and performed a wide range of duties. Orthodontists reported a perceived increase in clinical output (74%) and time available for treatment planning (61%). The majority (85%) of orthodontists indicated they provide a written prescription for the OT. Forty-two per cent reported the prescription did not contain the required information as stipulated by the GDC. CONCLUSIONS: OTs are valued members of the orthodontic team, improving productivity and allowing orthodontists more time for treatment planning. The majority of orthodontists appeared to be working to the BOS and GDC recommendations, with greater awareness needed regarding the provision of a written treatment prescription.

A Predictable Alternative to a Smile in Six Months?

The aim of this article is to explore the use of Incognito™ Lite as an alternative to competitors advertising a 'Smile in Six Months' or rather short-term orthodontics for improving dental appearance through tooth movement. The focus is on the varied clinical use of this appliance system and its comparative advantages, disadvantages and placement techniques. Some alternatives are discussed and appraised. Two cases successfully treated with Incognito™ Lite are then presented. Clinical relevance: A reliable and predictable tool for aesthetic alignment of teeth, creating a broader range of treatment options for both the clinician and the patient.

Class I Correction Using a Combination of an Upper Lingual and Lower Labial Appliance.

No orthodontic system combines aesthetics and comfort which delivers optimal treatment outcomes. This case report outlines how combining an upper lingual and a lower ceramic appliance can provide the best combination ofaesthetics whilst maintaining patien comfort, when undertaking class II camouflage treatment involving extraction of the upper first premolars.

An Overview of the Surgical Correction of Dentofacial Deformity.

The correction of severe dentofacial discrepancies involving a combination of orthodontic and surgical therapies (termed 'orthognathic treatment') is commonplace. There is an abundance of evidence within this field but it is often inconsistent. This article is an evidence-based overview of such treatments and is aimed at the general dental practitioner. It will cover: the timing of treatment; the indications and risks associated with different surgical osteotomies; the magnitude of surgical movements that can be achieved with these procedures; and the importance of mandibular autorotation when planning treatment. Orthognathic treatment is considered to be the gold standard for comprehensive correction of severe dentofacial discrepancies. It is undertaken by a multidisciplinary team of clinicians involving, but not exclusive to, consultants in orthodontics and oral and maxillofacial surgery in secondary and tertiary medical centres throughout the United Kingdom. Clinical relevance: It is imperative that general dental practitioners have a good understanding of orthognathic treatment in order to recognize when such treatments are indicated, to inform the patient of possible treatment modalities and to be able to discuss associated risks in order to make appropriate referrals. Since treatment timing and magnitude of surgical movements have a profound effect on stability of the treatment result, these must be carefully considered by all clinicians involved in patient care to minimize relapse potential.

The Management of the Dilacerated Impacted Maxillary Central Incisor.

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available − orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples. Clinical relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.

Effectiveness of photographs of study models for IOTN scoring.

AIM: The aim'of the present study was to investigate whether the same orthodontic information can be obtained from study models or photographs of study models in order to assess the Index of Orthodontic Treatment Need (IOTN). The study also aimed to assess inter- and intra-examiner reliability in the assessment of orthodontic treatment need. SAMPLE: Thirty sets of start and finish study models, demonstrating a range of malocclusions, were non-randomly obtained from patients treated at the University of Manchester Dental Hospital. The start models demonstrated a range of malocclusions (according to The British Standard Institute Incisor Classification 1983) of varying complexity. METHOD: Six photographic views of each set of study models were taken against a dark background. Millimetric distances were determined by using dividers to measure photographic distances and actual distances in millimeters from a ruler embedded in the image. Four examiners assessed the study models and photographs of the models in a random order and the Aesthetic and Dental Health components of the IOTN were recorded. RESULTS: There were no statistically significant differences in the IOTN scores from photographs of study models compared with IOTN scoresrom study models of the same patient. CONCLUSION: The IOTN scores derived from photographs of study models are valid and reliable measures of malocclusion.

An alternative approach to debonding lingual brackets.

This clinical pearl describes a technique of debonding the lingual brackets with minimum discomfort to the patient. It also reduces the risk of swallowing or aspirating the brackets and decreases the risk of enamel damage.

Lingual Orthodontics: The future?

The increase in demand for adult orthodontics has been mirrored by an increased availability and demand of cosmetic appliances. This article focuses on one type of cosmetic appliance--the lingual appliance. Factors to consider in case selection as well as the advantages and disadvantages of lingual appliances are discussed. This paper also outlines the sequence of treatment using these appliances by way of two treated cases.

The "Floss-Ligature" Ligation Technique.

This clinical pearl describes an alternative technique to aid effective ligation of rotated teeth during the aligning stage of fixed appliance treatment. This technique has the potential to improve patient experience and confidence, by reducing the risk of trauma and discomfort and treatment efficiency, by ensuring complete ligation of even severely rotated teeth.

The invisible Hawley retainer.

UNLABELLED: This paper provides an overview of orthodontic retention. A clinical case is presented using the aesthetic Clearbow® to retain a hypodontia case prior to restorative replacement of a developmentally absent upper right lateral incisor tooth (UR2). CLINICAL RELEVANCE: Orthodontic retention is an important part of treatment. This is especially so in the treatment of multi-disciplinary hypodontia cases. The Clearbow®, aesthetic labial bow provides superior aesthetics in comparison to conventional Hawley retainers.

Transposition of maxillary canine to central incisor site: aetiology, treatment options and case report.

Dental transposition is relatively infrequent anomaly of the developing dentition. This article focuses on canine transposition and explores the aetiology, diagnosis and treatment of this challenging anomaly. Specifically, the management of a case of canine transposition involving an unerupted maxillary central incisor is described.

Invisible orthodontics part 3: aesthetic orthodontic brackets.

UNLABELLED: In this, the third part of the series, aesthetic orthodontic treatment will be considered. The previous two articles have looked at invisible orthodontics with Invisalign and lingual brackets. This article will discuss the properties and use of aesthetic brackets, along with examples of orthodontic treatment cases using the aesthetic brackets. CLINICAL RELEVANCE: Increasing demand for aesthetics during orthodontic treatment has resulted in a significant increase in the use of aesthetic brackets. Clinicians need to be aware of the benefits and drawbacks of aesthetic brackets.

Invisible orthodontics part 2: lingual appliance treatment.

UNLABELLED: The aim of this second article of the three part series is to sum up the current developments in lingual orthodontics. This article attempts to review the development, advantages and disadvantages, bonding techniques, bracket mechanics, patient factors and types of lingual appliance systems available. In addition, the article shows examples of treated cases with lingual appliances. CLINICAL RELEVANCE: Lingual appliances are a useful addition to the armamentarium of invisible orthodontic appliances, with significant developments over the last few years. Clinicians need to be aware of the advances and predictable results achievable with lingual appliances.

Invisible orthodontics part 1: invisalign.

UNLABELLED: This paper discusses the invisible orthodontic treatment modalities of Invisalign aligners, lingual appliances and aesthetic brackets. The first part of this three-part series will discuss Invisalign aligner treatment. The second part will discuss lingual appliance treatment and the third part will focus on aesthetic brackets. The benefits and drawbacks of Invisalign treatment are considered in detail, including examples of treated cases and a review of the literature to date. CLINICAL RELEVANCE: Patients are increasingly requesting more aesthetic forms of orthodontic treatment. Clinicians need to be aware of the indications and limitations of such invisible therapies so that they can fully inform their patients.