Outcomes and prognostic factors that influence the success of tooth autotransplantation in children and adolescents.

BACKGROUND/AIM: Tooth autotransplantation has been advocated for replacement of missing teeth or teeth that are unsuitable for restoration. The aim of this study was to investigate the outcomes and prognostic factors that influenced the success of tooth transplantation in a paediatric population. MATERIALS AND METHODS: Data were extracted from the records of 75 patients (89 teeth). Demographic and prognostic factors were recorded and analysed for the clinical and radiographic outcomes for periodontal ligament (PDL) and pulp healing of transplanted teeth. RESULTS: The mean age at transplant was 13.2 years, and the mean follow-up observation period was 2.6±1.8 years with a range of 12.0 months to 9.9 years. The main reason for transplantation was to replace upper central incisors lost or missing due to dental trauma, hypodontia and dilaceration. Of the 45 teeth that were monitored for pulp revascularization, 75.6% showed clinical and radiographic signs of pulp healing and 24.4% showed signs of pulp necrosis and infection. Pulp healing was significantly related to the stage of root development of the transplant. Favourable PDL healing was observed in 87.6% of the transplants, while 13.5% showed signs of replacement resorption. PDL healing was significantly related to the stage of root formation of the transplanted tooth at the time of the surgery, the ease of handling and placement of the tooth, and the status of the alveolar bone at the recipient site at the time of the surgery. Overall success of tooth transplantation was 87.6%, and the survival rate was 94.4%. CONCLUSIONS: Tooth transplantation carried out in children and adolescents demonstrated high success and survival, with the stage of root development influencing both the pulp and PDL healing of the transplanted teeth.

Limitations of a method used for adolescent assessment of smile aesthetics.

AIMS: To establish whether adolescent orthodontic patients with hypodontia have a preference between the aesthetic outcomes of two treatment strategies for lateral incisor agenesis. MATERIALS/METHODS: Standardized photographs of pre-orthodontic patients with missing lateral incisors were manipulated to produce images that represented space opening and tooth replacement in the lateral incisor space and space closure with canine substitution into the lateral incisor space. Adolescent orthodontic patients with hypodontia were recruited to assess the aesthetics of the images. A control group of subjects without tooth agenesis was recruited. Each examiner undertook two tests to assess the smile aesthetics of the images: (1) rating attractiveness using visual analogue scale (VAS) and (2) choice of preference between pairs of images. RESULTS: Difficulties experienced with image manipulation and poor intra-examiner reliability of the VAS make interpretation of the results challenging. Care should be taken if findings are used to aid clinical decisions, as the validity of the main findings is questionable. Results suggest that although adolescents perceive a difference in the aesthetic result of space opening and space closure for missing lateral incisors, the impact on the smile attractiveness is not clinically significant. When forced to choose between the aesthetics of space opening or space closure, the majority of examiners chose space opening with tooth replacement. No difference was found in smile ratings or preferences between adolescents with hypodontia and those with no missing teeth. CLINICAL IMPLICATIONS: The methods used in this study may not be reliable for adolescent assessment of aesthetics.

Flexibility and access to dental postgraduate speciality training.

Increasingly, there is a clear emphasis on the need for improved access to flexible training. This reflects changing societal attitudes and expectations towards work-life balance and increasing demand for flexible working. The recently published Advancing dental care review: final report (2021) reflects these same demands within dental postgraduate training. Increasing flexible training options has the potential for far-reaching beneficial effects for dental speciality training. There are barriers to accessing speciality training for specific applicant groups and this risks potentially excluding excellent-quality candidates from pursuing speciality training. There is opportunity in utilising and developing flexible training options to support widening access to dental speciality training. Recruitment and working pattern arrangements should reflect these aspirations, ensuring that the best trainees are successful irrespective of their personal circumstances.

Paediatric Dentistry and Orthodontics interface: When should we consider balancing and compensating extractions?

The guidelines regarding balancing and compensating extractions, published by the Royal College of Surgeons of England,1 are based on relatively low-level evidence and it is highlighted in the guidance that further research into these areas is required. This paper aims to appraise the current evidence base regarding balancing and compensating extractions, to aid general dental practitioners in their decision making. General and clinical factors that should be considered in the treatment planning process are discussed throughout.

Dental core training in oral and maxillofacial surgery: a United Kingdom survey of on-call provision.

Introduction Dental core training posts within oral and maxillofacial surgery (OMFS) units often include on-call provision. There is a lack of current data demonstrating the variation of dental core trainee (DCT) involvement in on-call. This variation may influence trainees' experience of training.Aim To examine the provision of on-call cover in OMFS units across the United Kingdom, including trainee involvement, supervision and training.Method Online surveys were distributed in August 2019 to all DCTs, educational supervisors (ESs) and training programme directors (TPDs) in OMFS units to understand trainee involvement in on-call provision, including levels of supervision and perceived educational benefit.Results In total, 167 trainees responded from 69 OMFS units. Responses were received from 102 ESs/TPDs. All trainees experienced on call, with over 75% covering night shifts. Trainees reported minimal difference between support within hours and out of hours (OOH). Qualitative data from trainees and supervisors highlighted the educational value of on-call within normal hours. However, limited supervised training opportunities were reported OOH.Conclusion This survey highlights the educational value of on-call within hours. The perceived level of support does not vary significantly between normal hours and OOH. Some concerns were expressed regarding OOH supervision and prolonged on-call periods.

To accept, or not to accept? A service evaluation to appraise complexity assessment of orthodontic patients referred into a secondary care setting.

Introduction Commissioners in England use the Commissioning for Quality and Innovation (CQUIN) payments mechanism to encourage the best provision of orthodontic treatment. However, CQUIN only use the patient's orthodontic need as a measure of complexity, rather than the levels outlined in the orthodontic commissioning guide published by NHS England. A service evaluation was designed to ascertain a secondary care setting's compliance with the commissioning complexity levels, as a new comparator for CQUIN case-mix assessment.Materials and methods A prospective evaluation was conducted for all new patients referred to the Mid Yorkshire NHS Trust orthodontic department in a 12-month period, using the levels categorised by the commissioning guide. A standard was set to accept no fewer than 80% level 3b patients.Results Of patients accepted for orthodontic treatment, 89.9% were of the highest level 3b complexity. This was compared to only 69.8% of patients having an Index of Orthodontic Treatment Need, Dental Health Component, 5.Conclusion The findings support a recommendation that commissioners should consider complexity based on the commissioning guidance, rather than orthodontic need alone; it is important that the economic drivers of commissioning implementation fairly reflect the specialist work being carried out by the workforce.

A multicenter randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 2: Pain perception.

OBJECTIVE: To compare pain experience between self-ligating and conventional preadjusted edgewise appliance systems with a two-arm parallel trial. MATERIALS AND METHODS: A prospective multicenter randomized controlled clinical trial was conducted in three hospital orthodontic departments. Subjects were randomly allocated to receive treatment with either a self-ligating (3M SmartClip™) or conventional (3M Victory™) bracket system with stratification for operator and center. Standardized protocol was followed for bracket bonding procedure and archwire sequence. Subject pain was recorded using a Verbal Rating Scale to assess discomfort felt on the teeth and soft tissues at the time of the appointment and 1, 3, and 5 days after each archwire change up to the working archwire. Multilevel modeling was used to analyze the data by blinded assessors. RESULTS: One hundred thirty-eight subjects (mean age 14 years 11 months) were enrolled in the study, of which 135 subjects (97.8%) completed the study and 113 (82%) returned the required data regarding pain/discomfort. Perceived pain was statistically higher with the SmartClip™ system compared to the Victory™ system, but this difference was not deemed to be clinically significant. Discomfort was greatest after placement of the initial 0.014-inch nickel-titanium archwire, compared with subsequent wires, and was greatest on day 1, less on day 3, and much less on day 5 after each archwire change. Age and gender did not affect the level of discomfort experienced by subjects undergoing fixed appliance treatment. CONCLUSION: No clinically significant difference in pain experience was found between patients treated with a self-ligating bracket system compared to those treated with a conventional ligation system.

A multi-center randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population: Part 1: Treatment efficiency.

OBJECTIVE: To use a two-arm parallel trial to compare treatment efficiency between a self-ligating and a conventional preadjusted edgewise appliance system. MATERIALS AND METHODS: A prospective multi-center randomized controlled clinical trial was conducted in three hospital orthodontic departments. Subjects were randomly allocated to receive treatment with either a self-ligating (3M SmartClip) or conventional (3M Victory) preadjusted edgewise appliance bracket system using a computer-generated random sequence concealed in opaque envelopes, with stratification for operator and center. Two operators followed a standardized protocol regarding bracket bonding procedure and archwire sequence. Efficiency of each ligation system was assessed by comparing the duration of treatment (months), total number of appointments (scheduled and emergency visits), and number of bracket bond failures. RESULTS: One hundred thirty-eight subjects (mean age 14 years 11 months) were enrolled in the study, of which 135 subjects (97.8%) completed treatment. The mean treatment time and number of visits were 25.12 months and 19.97 visits in the SmartClip group and 25.80 months and 20.37 visits in the Victory group. The overall bond failure rate was 6.6% for the SmartClip and 7.2% for Victory, with a similar debond distribution between the two appliances. No significant differences were found between the bracket systems in any of the outcome measures. No serious harm was observed from either bracket system. CONCLUSIONS: There was no clinically significant difference in treatment efficiency between treatment with a self-ligating bracket system and a conventional ligation system.