Patient reported experiences and treatment outcomes of orthodontic patients treated within secondary care settings in the South West of England during the COVID-19 pandemic.

OBJECTIVE: To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic. DESIGN: Two-phase multicentre service evaluation. SETTING: Secondary care orthodontic departments in the South West of England. MATERIALS AND METHODS: Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic. RESULTS: A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days. CONCLUSION: During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.

Failure of eruption of permanent molars: a diagnostic dilemma.

BACKGROUND: Limited studies have proposed protocols for the management of failure of eruption (FOE) of permanent molars with no clear consensus or guidelines. Accurate diagnosis is challenging but key for successful management. AIMS: Confirm key diagnostic criteria that will aid diagnostic differentiation between primary failure of eruption (PFE) and mechanical failure of eruption (MFE) of permanent molars and identify successful management strategies. DESIGN: Retrospective descriptive study. Patients diagnosed with FOE of permanent molars (excluding impaction) between January 2003 and December 2013 were identified. Patient details and clinical and radiological features of FOE were recorded. Two examiners analysed the data. A diagnosis of PFE or MFE was made based on a combination of current protocols. Management strategies for each were identified and reported as satisfactory/unsatisfactory. RESULTS: Thirty-one patients met the inclusion criteria. Fifteen were classified as PFE and 14 as MFE. One patient was too young to confirm diagnosis, and one patient had delayed eruption. A total of 26% of cases were misdiagnosed which led to unsuccessful orthodontic management. CONCLUSION: We propose a protocol based on the results of this study coupled with existing protocols in the form of a simple flow diagram to aid accurate diagnosis and management of this rare and challenging clinical problem.

A Case Series: The Orthodontic Management of Central Incisors with Horizontal Root Fractures.

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future. Clinical relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

The Ethics of Interproximal Reduction.

Interproximal reduction (IPR) has become particularly popular with the use of removable aligners. Clinical and ethical factors concerning the use of interproximal reduction to facilitate orthodontic alignment are discussed. CPD/Clinical Relevance: An understanding of the aetiological factors of a malocclusion is essential to enable full discussion of the risks and benefits, or the alternatives to IPR.

Prediction of soft-tissue changes after mandibular advancement surgery with an equation developed with multivariable regression.

INTRODUCTION: This was a retrospective cephalometric study in patients undergoing mandibular advancement surgery. Our aim was to provide a more precise estimation of the postsurgical soft-tissue outcomes than can be achieved by using simple ratios of the hard and soft tissues. METHODS: The lateral cephalograms of 64 patients undergoing mandibular advancement, from before and near the end of treatment, were scanned and digitized with a customized software program. Multivariable regression analyses were used to create prediction equations for soft-tissue changes at pogonion, inferior labial sulcus, labrale inferius, and stomion inferius (all in the horizontal plane). RESULTS AND CONCLUSIONS: This method of using multiple explanatory variables appears to be useful in the prediction of soft-tissue changes. At least 96% of the variation of each dependent variable was explained by its relationship with the explanatory variables in the relevant multivariable regression equation, and the results appeared to be clinically useful.

Quadhelix appliance therapy resulting in pyogenic granuloma of the tongue.

This paper describes the examination, diagnosis and treatment of a rapidly enlarging tongue mass presenting in a healthy 12-year-old girl. This mass caused distress to both the patient and her parents and diagnostic uncertainty for her general medical and dental practitioners. The lesion was in fact caused by an orthodontic quadhelix appliance and responded to simple treatment.