Hyaluronic Acid Fillers to Correct Cleft Lip Asymmetry in Adults: Description of Technique and Patient Reported Outcome Measure Using CLEFT-Q.

OBJECTIVE: To determine the efficacy of hyaluronic acid (HLA) lip filler to correct subtle cleft lip asymmetries in adults using a validated patient reported outcome measure (PROM). DESIGN: Prospective cross sectional. SETTING: UK National Health Service. PATIENTS, PARTICIPANTS: Over 18 years old with repaired cleft lip and dissatisfaction of their lip appearance. INTERVENTIONS: HLA lip filler injection. MAIN OUTCOME MEASURES: A validated, cleft specific PROM, the lip module of CLEFT-Q™ prior to treatment and again after six weeks. RESULTS: 24 patients included. A mean total CLEFT-Q™ score pre-procedure was 14.9 (Stand deviation (SD) = 4.91) and 24 (SD = 6.08) post-procedure. Difference in mean total score pre- and post-procedure were statically significant (P = .0001) in all domains on the CLEFT-Q™. No adverse outcomes. CONCLUSION: HLA filler to correct subtle cleft lip asymmetries in adults is a simple low risk technique, which can significantly improve the patient's perception of lip appearance. CONCLUSION: HLA lip filler to correct subtle cleft lip asymmetries in adults is a simple technique, low risk procedure which can significantly improve the patient's perception of lip appearance.

Welsh dental trainees' confidence and competence in completing orthodontic assessments and referrals.

OBJECTIVE: To improve the confidence and competence of newly qualified dentists in Wales in undertaking orthodontic assessments and making orthodontic referrals. DESIGN: Quality improvement project. SETTING: Study days arranged by the Wales Deanery. PARTICIPANTS: The 2018-2019 cohort of dental foundation trainees (DFTs) and dental core trainees (DCTs) in Wales. METHODS: Data were collected prospectively between January and February 2019 utilising a 20-item questionnaire based around knowledge and clinical ability in orthodontic assessment and referrals (Stage 1). In May 2019, the trainees were provided with an e-learning package tailored to the results of the clinical questions and the feedback received in Stage 1. After this, trainees repeated the questionnaire with a simplified Index of Orthodontic Treatment Need (IOTN; Stage 2). RESULTS: There was increased self-reported confidence in 'conducting orthodontic assessments' from 67% to 95% and 'competence in completing orthodontic referrals' from 81% to 92%. At baseline, this cohort were only able to correctly determine dental age and orthodontic treatment need for 40.7% (mean) of the presented linical cases. Following the teaching intervention, this was improved with an average of 70.9% of clinical cases answered correctly. CONCLUSION: Despite the noted improvement in the self-reported confidence and competence in undertaking orthodontic assessments and referrals in this cohort, there is still room for improvement. Hands-on orthodontic experience during dental training improved the self-reported confidence and competence with assessments and referrals. The results of this quality improvement project emphasise the need for regular continuing professional development in the field of orthodontics to maintain competence in utilising IOTN and referring appropriately.

Autotransplantation of a surgically removed canine using a customised 3D-printed surgical template.

Autotransplantation is a treatment option with high reported survival rates to replace failing teeth in the anterior maxilla. This treatment requires a multidisciplinary approach from orthodontists, paediatric dentists, restorative dentists, and oral and maxillofacial surgeons to achieve successful outcomes. Success is dependent on many factors including stage of root development, handling of the periodontal ligament, extra-alveolar time and splinting. This case report presents the novel use of digitally designed and three-dimensional (3D) printed surgical templates to aid intraoperatively and reduce the extra-alveolar time. A preoperative cone-beam computed tomography scan allowed digital planning and construction of surgical templates that replicated the exact root dimensions of impacted maxillary canines. These templates were subsequently 3D printed in resin, sterilised and utilised intraoperatively to aid socket preparation before the surgical autotransplantation.

Development, implementation and feedback for an online speciality membership examination in orthodontics during the COVID-19 pandemic.

Introduction The Royal College of Surgeons of England (RCSEng) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) offer the bi-collegiate Membership in Orthodontics (MOrth) examination, a summative assessment of specialist knowledge, skill and behaviour in orthodontics. The COVID-19 pandemic has had a profound global effect on almost every facet of normal life, including the conduct of face-to-face examinations. We highlight development, implementation and feedback for the bi-collegiate MOrth Part 2 examination delivered remotely to a cohort of candidates in September 2020 by RCSEng/RCPSG.Methods Two anonymised online surveys (Google Forms) were distributed via electronic mail following completion of the examination diet. Forty-two candidates were sent a survey covering four domains and comprising a total of 31 questions. The 20 examiners were sent a survey containing eight questions. In both surveys, free-text responses were also collected. A rating system was used to categorise responses. All survey responses were summarised in an online data collection sheet.Results The response rate was 78.5% (33/42) and 75% (15/20) for candidates and examiners, respectively. Overall, favourable responses in relation to all sections of the assessment were elicited from candidates with the majority (mean 79.8%; 75.8-81.9%) reporting that the online examination format worked well. Equally, favourable responses were reported by examiners. Notably, 80% of examiners felt that the online exam style did not affect the mark a candidate would receive, and 100% were confident that the marks the candidates received were a reflection of their ability and were not affected by the online delivery of the assessment.Conclusions The feedback from both candidates and examiners relating to an online remote assessment of the bi-collegiate MOrth Part 2 was generally positive. Based on the survey responses, this format of a high-stakes examination was acceptable to all stakeholders, and demonstrated a high level of perceived validity and reliability in terms of content.

Removable rapid maxillary expansion.

A novel removable rapid maxillary expansion appliance is described for use in routine clinical practice. The laboratory construction and clinical technique is described, and the advantages of the appliance over conventional rapid expansion devices are highlighted.

How predictable is orthognathic surgery?

There are a number of increasingly sophisticated techniques available for orthognathic treatment planning. All are based on the determination of the skeletal pattern and the position of the dentition. However, they all suffer from difficulties associated with predicting the soft tissue profile. The aim of this retrospective cephalometric investigation was, therefore, to compare the ability to predict accurately the outcome of orthognathic treatment using the 'hand planning' technique and the orthognathic planning and analysis (OPAL) computer program, with an emphasis on the soft tissue profile. Seventy adult subjects were divided into two groups not specific for gender or age: the Class III patients had undergone bimaxillary surgery and the Class II patients sagittal split mandibular advancement. In each group, the pre-treatment and post-debond lateral cephalograms were utilized to calculate the actual orthodontic and surgical movements. These values were then used to produce a prediction using both the hand planning technique and the OPAL program. The resultant predictions were digitized using a customized computer program and compared with the actual outcome. The results show that there was marked individual variation when planning by hand and using the OPAL program. In the mandibular surgery group, hand planning and OPAL were of similar accuracy and few points differed significantly between prediction and outcome. However, for the bimaxillary group, a number of points showed bias and the hand planning technique appeared to be more accurate than the OPAL program, particularly in the region of the lips. Although the usefulness of predictions is acknowledged, these results suggest that they should be used with a certain amount of caution.