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.

Preventing white spot lesions with fluoride pastes.

Design Randomised controlled trial.Study population Patients undergoing routine orthodontic treatment, aged 12 years and older, were randomly allocated to use either Clinpro 5000, Clinpro Tooth Crème or MI Paste Plus for 4 months.Data Analysis Three-way analysis of variance (ANOVA) was used to analyse the Enamel Decalcification Index (EDI) scores of the maxillary and mandibular arches from the right first premolar to the left first premolar at 0.05 level of significance. Fisher-protected least significant difference intervals were used to compare mean EDI scores. Two operators scored photographs independently and their scores were compared by using the t-test; no statistically significant difference (P ≥.05) was found between the operators. Results of each product were analysed individually and amongst themselves. A multilevel mixed-effects Poisson regression was used to model factors predictive of EDI scores for individual teeth.Results Of the 120 subjects enrolled, 100 (35 using Clinpro 5000, 32 using Clinpro Tooth Crème, and 33 using MI Paste Plus) completed the study. The data lends support for Clinpro 5000 providing superior protection against enamel decalcification when compared to Clinpro Crème, and mixed support when compared to MI Paste Plus.Conclusions The use of Clinpro 5000, Clinpro Tooth Crème, and MI Paste Plus all have a reduction effect on white spot lesions when compared to studies reported previously. They found Clinpro 5000 to have a marginally better effect than the two other test pastes.

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.

Cone beam computed tomography--current understanding and evidence for its orthodontic applications?

Cone beam computed tomography (CBCT) is a fast developing technology which provides relatively low-dose, high spatial resolution imaging of the craniofacial complex in three dimensions (3D). During the past decade, the number of CBCT-related publications in the literature has increased significantly, but the crucial question is whether this technology leads to improved outcomes. In this paper, the literature is reviewed and the main applications of CBCT in orthodontics are highlighted, as well as the current evidence and understanding in each area. It is clear that at the present time, despite the popularity of CBCT, there is no clear evidence that the information obtained from these images substantially enhances clinical treatment decisions. Future research on CBCT should focus on interpretation of the images obtained. Visualizing the dentofacial skeleton in ever greater detail may be seductive, but without understanding the implications of findings such as 'minor' external root resorption or having the technical ability to provide treatment at a microscopic level may mean that these images do not have any meaningful impact on clinical practice.

Digital versus plaster study models: how accurate and reproducible are they?

OBJECTIVE: To compare measurements of occlusal relationships and arch dimensions taken from digital study models with those taken from plaster models. DESIGN: Laboratory study SETTING: The Orthodontic Department, Kettering General Hospital, Kettering, UK Methods and materials: One hundred and twelve sets of study models with a range of malocclusions and various degrees of crowding were selected. Occlusal features were measured manually with digital callipers on the plaster models. The same measurements were performed on digital images of the study models. Each method was carried out twice in order to check for intra-operator variability. The repeatability and reproducibility of the methods was assessed. RESULTS: Statistically significant differences between the two methods were found. In 8 of the 16 occlusal features measured, the plaster measurements were more repeatable. However, those differences were not of sufficient magnitude to have clinical relevance. In addition there were statistically significant systematic differences for 12 of the 16 occlusal features, with the plaster measurements being greater for 11 of these, indicating the digital model scans were not a true 11 representation of the plaster models. CONCLUSIONS: The repeatability of digital models compared with plaster models is satisfactory for clinical applications, although this study demonstrated some systematic differences. Digital study models can therefore be considered for use as an adjunct to clinical assessment of the occlusion, but as yet may not supersede current methods for scientific purposes.

An alternative retainer design for cleft patients: the "aesthetic" retainer.

The objective of this report is to describe an original retainer design for retention following orthodontic treatment in cleft lip and palate patients in order to improve the aesthetics of anterior maxillary dentoalveolar cleft defects. The technique incorporates features of both traditional and modern retainer design. The advantages of the technique and fabrication process are described.

An in vitro study into the corrosion of intra-oral magnets in the presence of dental amalgam.

The aim of this investigation was to study the corrosion behaviour and products of uncoated neodymium-iron-boron magnets in the presence of dental amalgam. Microcosm plaques were grown on discs of neodymium-iron-boron magnets or amalgam in a constant depth film fermentor. The biofilms were supplied with artificial saliva and growth was determined by viable counting. The results showed that the neodymium-iron-boron magnets corroded with an average daily weight loss of 0.115 +/- 0.032 per cent. However, when the magnets were in close proximity to the amalgam the amount of corrosion was reduced to a daily loss of 0.066 +/- 0.023 per cent. The highest loss of constituent elements from the corrosion products of the magnets was observed for iron. The composition of the microcosm plaques altered markedly between the two materials with less streptococci and more Veillonella spp. present in the biofilms grown on magnets in the presence of amalgam. The corrosion of neodymium-iron-boron magnets is limited and in the presence of amalgam is reduced further. This suggests that amalgam present in the mouth will not cause an increased clinical risk in terms of biocompatibility with neodymium-iron-boron magnets.

Advances in orthodontics.

There has been tremendous progress in orthodontics since Edward Angle first popularised the fixed orthodontic appliance at the turn of the century. Recent years have seen an increased demand for orthodontic treatment from both adolescents and adults and, in addition, patient and clinician expectations of treatment outcomes continue to rise. A desire for more aesthetic materials has resulted in both smaller and 'tooth-coloured' appliances. Improvements in technology, often outside orthodontics, have also led to the development of new materials. The best example of this was the development of nickel titanium alloy by the NASA space programme, which was subsequently adapted for use in nickel titanium archwires. Other technological advances adopted for use in orthodontics include magnets, computerised imaging systems and distraction osteogenesis. This review paper looks at some of the innovations in the fields of materials as well as in techniques and appliance systems.