Evidence that ectopic upper third molars can result in upper second molar impactions: A case series.

INTRODUCTION: The aim of these four case reports was to illustrate the presence of potential upper second molar impactions associated with ectopic third molars and to highlight that some cases have an atypical radiographic presentation. CASE PRESENTATIONS: Four patients (age range = 7-12 years) with various malocclusions presented to the paediatric and orthodontic departments for treatment to address their presenting complaints. Incidental radiographic findings demonstrated potentially impacted upper second molars associated with ectopic third molars. In all of these cases, a joint paediatric-orthodontic approach was adopted to address their dental health, prevent upper second molar impaction and to treat their malocclusion. DISCUSSION: Careful and systematic review of radiographic imaging was necessary in order to correctly diagnose these cases. These cases demonstrated that it was not always simple to determine impactions, particularly as identification of third molar crypts can be difficult. On occasion, sequential radiographical monitoring is advocated, particularly in patients in the mixed dentition; however, clinicians must be mindful of the risks of ionising radiation as it is not routine practice to irradiate a patient multiple times. CONCLUSION: The series of cases highlights the need for a systematic assessment of OPTs to identify ectopic upper third molars. The input from radiologists is invaluable and if necessary, supplemental three-dimensional cone-beam computed tomography can be performed.

Multidisciplinary management of missing maxillary central incisors in children and adolescents.

Missing maxillary central incisors can impact a patient's psychological wellbeing and smile aesthetics. Comprehensive management of such cases requires a multidisciplinary team approach, often involving orthodontic, paediatric and restorative dental teams. This paper summarises the various management options for these complex patients.

The use of videofluoroscopy in the assessment of the pharyngeal airway in obstructive sleep apnoea.

This prospective cohort study evaluated the use of videofluoroscopy in assessing changes in both antero-posterior (A-P) and transverse pharyngeal airway dimensions in patients with obstructive sleep apnoea (OSA). Forty patients [32 males and 8 females; mean age of 49.3 (SD = 10.79) years] with confirmed OSA, referred for mandibular advancement appliance (MAA) therapy were recruited. Patients received a customized Herbst MAA, adjusted for maximum comfortable protrusion. A standard lateral cephalogram, supine A-P, and transverse videofluoroscopic investigations were performed. Repeat supine videofluoroscopic investigations were undertaken with the MAA in situ. Parametric tests were used to evaluate the study hypotheses as the data were normally distributed. A paired t-test was employed to determine both the impact of posture on the airway using upright cephalometry and supine videofluoroscopy and the effect of MAA insertion on A-P and transverse pharyngeal airway dimensions. Following a change in posture from upright to supine, highly statistically significant (P < 0.001) changes were observed for all lateral pharyngeal dimensions. Statistically significant increases in minimum lingual airway (P < 0.001) and maximum transverse pharyngeal airway (P < 0.001) were found following MAA insertion. A reduction in soft palate area (P = 0.029) and pharyngeal height (P < 0.001) was also noted. Videofluoroscopy offers a useful dynamic assessment of the pharyngeal airway in both the A-P and transverse planes in patients with OSA.

Decontamination procedures for tungsten carbide debonding burs: a cross-sectional survey of hospital-based orthodontic departments.

OBJECTIVE: To determine the current pattern of use and handling of tungsten carbide debonding burs (TCDBs) within UK hospital-based orthodontic departments. DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: Questionnaires were sent to 217 departments within the UK and an overall response rate of 93% was achieved. RESULTS: Most hospital departments (68%) currently use TCDBs designed for a slow handpiece. Just over half (55%) discard their TCDBs after single-use, but only 24% adequately decontaminate new burs prior to initial use. Almost all those that reuse TCDBs decontaminate them in a sterilizer and carry out combinatorial presterilization cleaning. The most common methods are manual cleaning followed by an ultrasonic bath (26%) or washer-disinfector (15%); or alternatively, soaking of burs followed by manual cleaning (13%). For those departments that use only a single method, manual cleaning (29%) or a washer-disinfector (10%) are most common. In terms of sterilizing TCDBs, 58% used a vacuum phase autoclave and 13% a downward displacement. CONCLUSIONS: There is wide variation in the handling of TCDBs in UK hospital-based orthodontic departments. Decontamination of new TCDBs prior to initial use is carried out by less than a third of departments. Despite their classification as reusable devices, just over half discard TCDBs after single use. However, among those that do reuse TCDBs, almost all decontaminate them correctly.

Decontamination of viable Streptococcus mutans from orthodontic tungsten carbide debonding burs. An in vitro microbiological study.

OBJECTIVES: To investigate the effectiveness of currently recommended decontamination procedures on tungsten carbide debonding burs (TCDBs). DESIGN: In vitro microbiological study. SETTING: St George's Hospital NHS Trust, UK. MATERIALS AND METHODS: A total of 240 extracted tooth surfaces were bonded with orthodontic brackets, debonded to leave residual composite and artificially contaminated with Streptococcus mutans. INTERVENTION: Sterilized TCDBs in a slow handpiece were used to remove this composite before random allocation into one of six different decontamination groups of 40 burs each. These included a control group that was not decontaminated and a further five that underwent different methods of presterilization cleaning within the decontamination process (none, manual, ultrasonic, washer disinfector and enzyme soak) followed by sterilization in a vacuum phase autoclave at 134 degrees C for 3 min. MAIN OUTCOME MEASURES: The burs were placed in brain heart infusion (BHI) broths, incubated for 48 h. Following this the broths were inspected for turbidity and microbiological analysis was carried out to detect viable bacterial growth. Data were analysed using the Kruskal-Wallis test for single ordered data. RESULTS: S. mutans was recovered from 39 out of 40 burs in the control group and no burs from the decontamination groups, which was statistically significant (P = 0.001). No differences were found between decontamination groups (P = 0.271). However, skin flora contamination was noted in 17 broths. CONCLUSIONS: The five methods of decontaminating TCDBs investigated in this study were effective in removing viable S. mutans. Other investigations are required to determine if TCDBs can be successfully cleaned of blood and protein residue prior reuse.