Cleft complications: Severely rotated maxillary permanent central incisors.

The maxillary permanent central incisor (MPCI) has been reported to be rotated in up to 96% of cleft patients. A severely rotated MPCI is highly visible when smiling, drawing attention to a repaired cleft lip, and is often the main presenting complaint of a patient with cleft lip and palate attending for orthodontic treatment. The benefit of interceptive orthodontic treatment to alleviate these concerns must be weighed up against the consequences of adding to the already substantial orthodontic burden likely to be faced by these patients.Despite the high prevalence of this dental abnormality among cleft patients, there is little published in the literature regarding this type of malocclusion. This paper explores the aetiology, presentation and management of this condition, using examples from cases treated within our department. In addition, the commonly found pre-existing anomaly of a short root length is discussed, in combination with the implications this may have upon orthodontic treatment planning for a rotated MPCI.

Positional factors affecting the surgical management of impacted permanent mandibular canines.

OBJECTIVE: To assess which positional factors influence the decision to surgically remove or expose an impacted mandibular canine. Clinical and radiographic assessment are important considerations when treatment planning for the management of impacted mandibular canines. DESIGN: A cross-sectional study. SETTING: The Royal Surrey County Hospital, Guildford, UK. METHODS: The clinical notes and orthopantomogram radiographs were assessed for all patients aged 21 years or under who underwent surgical management of impacted mandibular canine teeth between 2017 and 2019. The following variables were recorded: angulation, horizontal position, vertical height, overlap of the adjacent tooth and bucco-lingual position of the canine. RESULTS: From the 67 patients and 77 canines included, surgical extraction was performed for 48 canines (62%) and surgical exposure was performed for 29 canines (38%). Chi-square and multivariable logistic regression revealed canine angulation to the midline, horizontal position of the canine root apex, vertical height of the canine crown and canine overlap of the adjacent tooth to be associated with the decision to remove or expose an impacted permanent mandibular canine (P < 0.001). The bucco-lingual position of the canine did not influence the decision to remove or expose an impacted permanent mandibular canine (P = 0.159). CONCLUSION: The decision to expose or remove an impacted mandibular canine is guided by its angulation, horizontal position and vertical position, and by the degree of overlap of the adjacent tooth. However, the bucco-lingual position is not related to the decision to surgically remove or expose an impacted permanent mandibular canine.

Product advertisements in orthodontic journals: Are they evidence-based?

INTRODUCTION: Previous research has suggested orthodontic advertisements are poorly supported by evidence. The primary aim of this study was to identify the type and quality of evidence supporting advertisement claims in leading orthodontic journals. METHODS: A cross-sectional study was undertaken to assess all advertisements published between January 2015 and December 2017 in 6 major orthodontic journals. Only advertisements implying superior product performance in clinical practice or patient care were selected for further evaluation. Study variables were collected using a prespecified data collection form. In the presence of a supporting citation, the reference article was obtained, and the quality was assessed in duplicate. Associations between advertisement variables and quality of evidence were explored using contingency tables (Fisher exact test). RESULTS: A total of 1753 advertisements were identified. After the application of eligibility criteria, 124 were included in the final analysis. Advertisements promoting bracket systems predominated. Of these, 34.7% were supported by evidence, of which 10.5% (n = 13) included accessible references. Only 6 out of 13 studies involved orthodontic patients. Primarily expert opinion and observational study types were referenced. Less than 2% of advertisements were supported by high-value evidence. There was an association between the quality of evidence in advertisements and the product category (P = 0.003). CONCLUSIONS: There is a lack of both references and high-value evidence cited in orthodontic manufacturers' advertisements. Without critical appraisal of references cited in advertisements, clinicians need to be cautious before implementing manufacturers' recommendations in clinical practice. Efforts should be made to ensure appropriate high-value evidence is cited in advertisements to support manufacturers' claims.

Mandibular lateral incisor-canine transposition: A case series.

Dental transpositions are rare anomalies, which may present to the general dental practitioner or orthodontist. Transpositions occur less frequently in the mandible compared with the maxilla, with the most common mandibular transposition involving the mandibular lateral incisor and canine. The degree of displacement can vary from a relatively minor deviation to complete transposition of the mandibular lateral incisor with the adjacent canine tooth. Due to their highly visible position at the front of the mouth, treatment, ideally involving alignment of these teeth, is important for aesthetic, social and functional purposes. This case series reports six cases with mandibular lateral incisor-canine transposition. They demonstrate the variety in presentation and subsequent management of the ectopic teeth. The importance of early diagnosis in combination with interceptive treatment is discussed, to reduce the burden of potentially lengthy orthodontic treatment at a later date.

Odontogenic keratocyst: An incidental finding during an orthodontic examination.

For all orthodontic patients, a detailed clinical examination is essential to obtain the correct diagnosis before the formulation of an orthodontic treatment plan. Additional information may be required from radiographs in order to supplement this clinical examination. While orthodontists principally prescribe dental panoramic tomographs for orthodontic patients to confirm the presence, position and morphology of unerupted teeth, the absence or presence of disease within the supporting structures may be overlooked. This case report presents one such instance where the pre-orthodontic radiographic examination of a young male patient revealed the presence of an asymptomatic odontogenic keratocyst in the right posterior body of the mandible.This case report discusses how this incidental finding was diagnosed, managed and how its surgical treatment subsequently affected the orthodontic management of the patient. Furthermore, this case highlights the importance of undertaking a thorough and systematic approach when analysing any prescribed radiographs, in order to reduce the risk of overlooking any evidence of underlying disease.

Orthodontic burden of care for patients with a cleft lip and/or palate.

BACKGROUND: Patients with a cleft lip and/or palate may require multiple episodes of orthodontic treatment, e.g. before alveolar bone grafting, upper arch alignment, orthodontic camouflage and in combination with orthognathic surgery. There is little published regarding the overall orthodontic burden of care for these patients. AIM: To assess the orthodontic burden of care for patients with a cleft lip and/or palate. METHOD: Data were collected retrospectively from all consecutive cleft patients who had completed orthodontic treatment between January 2014 and December 2015 at Great Ormond Street Hospital, London, United Kingdom. RESULTS: Forty-two patients were included in the study: Twenty-three patients with a cleft lip and palate; nine with an isolated cleft palate; eight with cleft lip and alveolus; and two with cleft lip. The mean age of orthodontic treatment commencement was 13.4 years (range = 8.9-18.2 years) with a mean duration of 3.4 years (range = 1.3-8.3 years). An average of 44 appointments were required with an orthodontist (range = 18-98 appointments). CONCLUSION: The orthodontic burden of care for patients with cleft lip and/or palate must not be underestimated. The duration of treatment varies depending on the type of cleft diagnosis and whether orthognathic surgery will be required. From this study, a patient with cleft lip and/or palate required an average of 44 orthodontic appointments and a mean duration of treatment of 3.4 years in order to complete their treatment. This is a considerable burden to patients and their guardians, which they must be informed of before commencement of orthodontic treatment.

Predictors of treatment decisions made by adult orthodontic patients presenting with unerupted permanent teeth.

OBJECTIVE: Unerupted permanent teeth are amongst the most commonly occurring dental anomalies in adults and present unique treatment challenges. The aim of this retrospective study was to (1) identify the prevalence of adult patients with unerupted teeth attending a multidisciplinary clinic and (2) to identify predictors (age, gender, incisor and skeletal classification) which influence the patients treatment decision. MATERIAL AND METHODS: Consecutive adult patients with unerupted permanent teeth attending the Joint Orthodontic-Restorative clinic were identified. Study variables were collected using a prespecified data collection form. Descriptive statistics were employed; Fisher's exact test was used to detect associations between variables and treatment decision outcome. Ordinal logistic regression derived multinomial regression relative risk ratios (RRR) and 95% confidence intervals (CI) were calculated for the effect of age, gender, incisor and skeletal classification on treatment decision/outcome. RESULTS: Sixty-six patients with impacted teeth were identified from a sample of 483. The prevalence of adults with unerupted teeth was 13.7%. The mean age was 30.7 years (SD 11.2). The majority of the sample had a Class I incisor relationship (54.6%) or Class I skeletal base relationship (54.6%), and the most common distribution of impacted teeth was a single unerupted upper right canine (34.9%). Orthodontic treatment (non-extraction or extraction basis incorporating the alignment or removal of impacted teeth) and restorative treatment only were equally favoured. Factors including age, gender, incisor and skeletal classification did not appear to influence or predict the final treatment decision. CONCLUSIONS: In this sample, adults presenting with impacted teeth favoured certain treatment modalities: orthodontic treatment only and restorative treatment only. Factors such as age, gender, incisor and skeletal classification did not influence the outcome.

Production of a new platform based calixarene nanofiber for controlled release of the drugs.

The aim of this study is to develop an electrospun calixarene nanofiber based calixarene for controlled release of hydrophobic drugs. To accomplish this, we have synthesized 5,17-bis-[Methyl-N-Methyltranylate]-25,26,27,28-tetrahydroxycalix[4]arene (Compound 3) of which nanofiber (F-14) was produced by electrospinning. The fabricated multilayered electrospun nanofiber was first characterized in terms of morphology and then drug loading and release kinetics were studied in different physiological pH. For this purpose, we have selected two fluorescent drugs which are thiabendazole (Tbz) and donepezil (Dnp) as model drugs to show the usage of the synthesized nanofiber in drug delivery system. Drug loading and release kinetics were monitored by using fluorescence spectroscopy. According to the results, maximum amount of loaded Dnp onto nanofiber was found to be as 30.529 µg in 20 mM Tris buffer, pH 7.4 end of 120 min. Data showed that loading amount of Tbz onto the nanofiber was measured to be as 1.688 µg to the 2.25 cm2 of surface in 20 mM of Tris buffer, pH 7.4 at the end of 120 min. While max release of Dnp from nanofiber was also 9.720 µg at pH 2.2, that of Tbz from nanofiber was 0.243 µg at pH 7.4 at the end of 90 min. Drug loading to nanofibers was clarified by SEM, TEM, EDX and FT-IR analysis.