Management of chronic neuropathic pain following mandibular advancement surgery.

This report highlights the management of a rare complication, namely allodynia, which arose following mandibular advancement surgery. A 56-year-old female underwent bilateral sagittal ramus advancement osteotomy. Postoperatively, she developed allodynia corresponding to the distribution of the left inferior alveolar nerve. A hierarchical pathway of topical and pharmacological agents followed by ablative techniques was used without success. Eventually, electrical neuromodulation via a motor cortex stimulator was implemented to manage the symptoms. The report serves to outline treatment options available and the risks associated with this treatment.

Mid-line clefts of the cervical vertebrae - an incidental finding arising from cone beam computed tomography of the dental patient.

Cone beam computed tomography (CBCT) is a rapidly emerging imaging modality in dentistry that offers the advantages of high diagnostic yield with short scanning times and a radiation dose significantly lower than conventional CT. Clinical applications of CBCT are numerous and they are being used both within the hospital and the primary care setting. The need for complete interpretation of CBCT images is essential. This report presents two patients for whom CBCT was carried out for orthodontic related purposes and incidental findings of cervical vertebrae clefts diagnosed. CBCT wherever they are undertaken should be reported by someone who has undergone adequate training in their interpretation particularly when machines using a large field of view are employed.

Resorption: within or without? The benefit of cone-beam computed tomography when diagnosing a case of an internal/external resorption defect.

Maxillary canines are the second most common teeth to become impacted, following third molars. Variable levels of incidence have been reported but roughly fall between 1-2.5%. The aetiology of impaction is unknown but both environmental and genetic factors have been suggested. The majority of impacted canines are palatally displaced and such ectopic teeth can be associated with various complications. Rarely this may include cystic or tumourous lesions of the dental follicle or, more commonly, resorption of adjacent teeth. This has a reported incidence of between 12% and 68% depending on the modality of diagnosis and the population sampled. With overlapping teeth causing superimposition on developed images, the diagnostic accuracy of intra-oral radiographs may be reduced. Conventional tomography also exhibits blurring of images and this again reduces its sensitivity. For this reason, Cone Beam Computed Tomography may be beneficial in selected cases of tooth resorption.

The relationship between orofacial clefts and material deprivation in wales.

OBJECTIVE: This study investigated the relationship between material deprivation and the incidence of orofacial clefts (OFC) in South, West, and Central Wales, U.K. DESIGN AND SETTING: The South, West, and Central Wales Orofacial-Cleft Register served as the primary data source for the study. Data on all children born with an orofacial cleft between 1982 and 2003 were geocoded to one of 844 geographic wards. National census data, similarly geocoded, served as the population denominator. Townsend's index of material deprivation was used to assign wards to one of seven levels of deprivation. This permitted investigation of the association of orofacial clefts with material deprivation. RESULTS: Between 1982 and 2003, there were 831 babies born with an orofacial cleft, equating to 109 clefts per 100,000 live births. The incidence of orofacial clefts ranged from 82 per 100,000 (95% confidence interval [C.I.] 64 to 102 per 100,000) in babies born to mothers residing in the least deprived areas to 127 per 100,000 (95% C.I., 112 to 144 per 100,000) in those living in the most deprived areas, a significant linear trend being apparent (p < .001). A statistically significant risk of 1.55 (95% C.I., 1.18 to 2.04) for orofacial clefts was apparent between most and least deprived septiles of deprivation. CONCLUSIONS: This study provides further evidence of an association between material deprivation and orofacial clefts. Further work is required to elicit the degree to which potential risk factors contribute to this association and to determine how deprivation predisposes to orofacial clefts.

Centralization of services: standard setting and outcomes.

OBJECTIVE: To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes. DESIGN: Retrospective analysis. PATIENTS: Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions. MAIN OUTCOME MEASURES: Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index. RESULTS: Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected. CONCLUSIONS: The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.

A new method for the 3D measurement of postoperative swelling following orthognathic surgery.

OBJECTIVE: To describe a new method for measuring facial swelling following orthognathic surgery using a 3D laser-scanning device. DESIGN: Prospective clinical trial. Setting and Sample Population -- University Dental Hospital, Wales College of Medicine, Biology Life and Health Sciences. Three subjects requiring bi-maxillary orthognathic surgery were recruited for the study. EXPERIMENTAL VARIABLES: Laser-scanned images of the subjects were obtained under a reproducible and controlled environment with two Minolta Vivid 900 (Osaka, Japan) optical laser-scanning devices assembled as a stereo-pair. A set of left and right scanned images was taken for each subject and each scan took an average of 2.5 s. 3D laser scans were recorded over six time periods (T1 -- pre-surgical scan, postoperatively: T2 -- 1 day, T3 -- 1 week, T4 -- 1 month, T5 -- 3 months and T6 -- 6 months). OUTCOME MEASURE: Facial scans from different time periods were overlaid onto the baseline (T6) facial scan to determine the reduction and changes in swelling following orthognathic surgery. RESULTS: The results showed that swelling could be accurately quantified following surgery. Furthermore, there was a significant reduction in the amount of swelling 1 month postoperatively. Furthermore, the facial morphology returned to approximately 90% of the baseline facial scan at 3 months. CONCLUSION: The 3D laser-scanning device and the method described was a reliable and accurate measure of facial swelling following surgery.

Kartagener's syndrome: unusual dental morphology.

The present paper describes the dental presentation of a female patient with Kartagener's syndrome. There are no reports in the literature identifying dental anomalies in patients with this condition. The subject presented with the congenital absence of an upper lateral incisor, enamel hypoplasia and aberrant tooth morphology.

Canine transposition following trauma and loss of a central incisor: treatment options.

The aim of this article is to make clinicians aware of the possibility of canine transposition following loss of the upper central incisor. Using two case reports it considers the opportunities for rehabilitation of the occlusion, and discusses surgical, orthodontic and restorative considerations.

An ex vivo evaluation of resin-modified glass polyalkenoates and polyacid-modified composite resins as orthodontic band cements.

OBJECTIVES: The objective of this ex vivo study was to assess the use of resin-modified glass polyalkenoates and polyacid-modified composite resins, as orthodontic band cements. MATERIALS AND METHOD: Plain stainless steel bands were cemented to 350 human extracted third molar teeth using 1 of 7 different cements. Following complete cement cure, half of each sample group was exposed to mechanical stress in a ball mill. Stressed and unstressed samples were tested in tension and the stress at which initial cement failure recorded. The mode of failure was recorded using an adhesive remnant evaluation. RESULTS: The mean band retention stresses offered by the cements studied ranged from 0.96 to 1.56 MPa. Fuji Ortho provided the highest mean band retention stress in "stressed" (1.56 MPa) and "unstressed" (1.45 MPa) states. Exposure to mechanical stress did not appear to significantly influence band retention or mode of cement failure for most cements. Fuji Ortho cement recorded the highest Weibull modulus for all cements tested. Virtually all samples failed at either the cement/enamel or cement band interface. CONCLUSIONS: Significant differences in band displacement stress values and mode of failure were demonstrated between the cements studied. However, generic comparisons were difficult to make.

Extractions as a form of interception in the developing dentition: a randomized controlled trial.

OBJECTIVE: To determine if the extractions of lower primary canines are an effective procedure to relieve crowding of the labial segment. STUDY DESIGN: randomized controlled trial. Subject sample: 83 cases were collected in clinics in Italy, Germany and Wales. The groups were followed over a 2-year period. METHODS: Subjects were randomly allocated to a primary canine non-extraction or extraction group. Dental casts of the patients were collected at the start and at the recall period of the trial. The outcome measures recorded were lower incisor crowding, arch length, intermolar width, overbite, overjet, lower clinical crown heights and lower incisor inclinations. STATISTICS: The Mann-Whitney test was used to compare the differences between the extraction and non-extraction groups. RESULTS: In both groups, crowding reduced 1.27 mm in the non-extraction group and 6.03 mm in the extraction group. The difference between the 2 groups was 4.76 mm (P<0.05). The arch perimeter decreased more in the extraction group by 2.73 mm (P<0.05). As the incisor inclination stayed essentially the same, the loss in arch length was attributed to the molars moving forward. The net gain from extracting deciduous canines was 2.03 mm. CONCLUSIONS: There was a reduction in lower incisor crowding as a result of lower primary canine extraction. However, arch perimeter decreased more in the extraction group leaving less space for the eruption of the lower secondary canines.

Evaluating the cost-effectiveness of orthodontic provision.

The assessment of orthodontic provision is important to determine if treatment was necessary and undertaken appropriately. The ICON objectively quantifies orthodontic treatment need, complexity and outcome and is a valuable occlusal index in the assessment effectiveness of orthodontic care. It is possible to develop cost-effectiveness models by analysing the costs and effectiveness of orthodontic treatment. Several methods are illustrated to compare the orthodontic provision of specialist orthodontists.

A simple tool for rapid access to a symptomatic breast clinic.

AIM: The introduction of a rapid referral system has led to an increase in the number of patients with benign disease using clinic appointments. This situation could delay those patients, who do have cancer but are not referred within these rapid referral guidelines. Existing guidelines fail to benefit those patients with lower risk symptoms. We reviewed prospective audit data from patients referred to a symptomatic breast unit with the aim of introducing a referral schema based upon symptoms, age and relative risk of cancer. METHOD: Demographic details, mode of referral, history and presenting symptoms were collected from each of the 2064 patients referred to the James Cook University Hospital (JCUH) breast unit from April 2001 to March 2002. RESULTS: Odds Ratios (OR) from eight dependent variables gave a 30% improvement in prediction accuracy of breast cancer. From these findings a breast referral schema is presented that is designed to expedite referral from primary care of those patients most at risk. CONCLUSIONS: Use of the schema within primary care could lead to an increase in the early referral of patients with breast cancer.

Quality managing in practice--using ISO 9002.

The value of an International Quality Standard in Orthodontic Practice is discussed. The nature of the process is described and relevant sources presented for further exploration of the subject. The relevance of ISO 9002 to orthodontic practice is highlighted.

Aligning archwires, the shape of things to come?--a fourth and fifth phase of force delivery.

Recent developments in material science have lent themselves to improving orthodontic archwire technology. The pace of change has been great, leaving the clinician a bewildering choice of materials for the purposes of force application. The following article characterises the properties of new archwire formulations and is intended to give guidance in choosing archwire material during the first stage of orthodontic therapy.

A laboratory investigation into cements used to retain orthodontic bands.

A laboratory study is presented where a technique of band retention testing is characterized. A glass polyalkenoate and a zinc phosphate cement were evaluated for band retention under simulated conditions of mechanical stress. In the absence of mechanical and other stresses there was no difference in the two cements for band retention. However, after mechanical stress was applied the glass polyalkenoate cement proved superior to the zinc polyalkenoate cement for band retention (P < 0.05). Weibull analysis is presented and described as a useful adjunct to statistical handling of band retention data.

Fragile X (Martin Bell) syndrome and dental care.

A case is presented, and the literature reviewed, of a child with fragile X syndrome. Dental features associated with this prevalent syndrome are outlined, as are the implications for dentistry of the other clinical features of cardiac anomalies and joint hyperextensibility.