Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

Experiences of mentoring ST4-ST5s amongst a group of orthodontic trainers at Bristol Dental School and Hospital.

OBJECTIVE: To explore the experiences of mentoring higher-grade trainees amongst senior orthodontic trainers at Bristol Dental School. DESIGN: Qualitative study using interpretive methodology. SETTING: University of Bristol Dental School. PARTICIPANTS: Six consultant orthodontists, five of whom also have district general hospital experience. METHODS: One-to-one semi-structured interviews were undertaken on a purposeful sample of orthodontic trainers. The interviews were audio recorded, transcribed verbatim and Thematic Analysis was used to analyse the data. RESULTS: Four main themes emerged from the data were. They were: How to Mentor; Mentor-Mentee Pairings; Resources and Success; and Pitfalls of Mentoring. CONCLUSION: The present study revealed that senior trainers have a good understanding of the qualities of a mentor and appreciate the roles which mentors need to perform. They are altruistic in their motives, but would benefit from more time, organisational support and training to help them perform their duties better.

The load/deflection characteristics of thermally activated orthodontic archwires.

The objective of the study was to investigate the load/deflection characteristics of three commercially available thermally active nickel-titanium orthodontic archwires using a standard nickel-titanium archwire as a control. The thermally active wires were Regency Thermal, Orthoform, and Eurotherm and the control was Memory. Round 0.4 mm and rectangular 0.4 x 0.56 mm wires were subjected to 2 and 4 mm of deflection in a water bath at temperatures of 20, 30, and 40 degrees C and forces were measured in three-point bend and phantom head situations. Analysis of variance revealed that, irrespective of the test set up and wire type, wire size had a significant effect (P < 0.001) on the forces produced. An increase in size from 0.4 mm round to 0.4 x 0.56 mm rectangular wire approximately doubled the force values for a given deflection. The effect of wire deflection on the force values varied according to the test system, forces being much higher in the phantom head tests than in the beam tests. In the beam tests, an increase in wire deflection from 2 to 4 mm had no significant effect on the forces exerted, but in the phantom head tests the forces produced by each wire at 4 mm deflection were four to five times greater than those at 2 mm deflection. Each of the thermally active wires produced less force that the non-thermally active wire. However, there was a large variation between the three types of thermally active wire. In the beam tests each 10 degrees C rise in temperature from 20 to 40 degrees C had a highly significant effect on the force produced by each thermoelastic wire (P < 0.001). In the phantom head tests there were significant force increases between 20 and 30 degrees C (P < 0.001), but between 30 and 40 degrees C the forces did not change significantly.