Management of orthodontic emergencies in primary care – self-reported confidence of general dental practitioners

Objective: To determine general dental practitioners’ (GDPs) confidence in managing orthodontic emergencies. Design: Cross-sectional study. Setting: Primary dental care. Subjects and methods: An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios. Main outcome measure Respondents’ self-reported confidence in managing the orthodontic emergency scenarios on a 5‑point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests. Results: The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were ‘confident’ in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self reported confidence. Conclusions: Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations

Effectiveness of en masse versus two-step retraction:a systematic review and meta-analysis

Abstract Background This review aims to compare the effectiveness of en masse and two-step retraction methods during orthodontic space closure regarding anchorage preservation and anterior segment retraction and to assess their effect on the duration of treatment and root resorption. Methods An electronic search for potentially eligible randomized controlled trials and prospective controlled trials was performed in five electronic databases up to July 2017. The process of study selection, data extraction, and quality assessment was performed by two reviewers independently. A narrative review is presented in addition to a quantitative synthesis of the pooled results where possible. The Cochrane risk of bias tool and the Newcastle-Ottawa Scale were used for the methodological quality assessment of the included studies. Results Eight studies were included in the qualitative synthesis in this review. Four studies were included in the quantitative synthesis. En masse/miniscrew combination showed a statistically significant standard mean difference regarding anchorage preservation − 2.55 mm (95% CI − 2.99 to − 2.11) and the amount of upper incisor retraction − 0.38 mm (95% CI − 0.70 to − 0.06) when compared to a two-step/conventional anchorage combination. Qualitative synthesis suggested that en masse retraction requires less time than two-step retraction with no difference in the amount of root resorption. Conclusions Both en masse and two-step retraction methods are effective during the space closure phase. The en masse/miniscrew combination is superior to the two-step/conventional anchorage combination with regard to anchorage preservation and amount of retraction. Limited evidence suggests that anchorage reinforcement with a headgear produces similar results with both retraction methods. Limited evidence also suggests that en masse retraction may require less time and that no significant differences exist in the amount of root resorption between the two methods

The use of osseointegrated implants in orthodontic patients: 1. Implants and their use in children

Implants have been used successfully for the rehabilitation of edentulous adults. However, their use in children is limited because of the special problems of implants relating to continuing growth and development. This, the first of two articles, provides a review of the use of osseointegrated implants in the context of facial growth, and the role of the orthodontist in the management of implant-supported prosthodontic structures. A second article will discuss the role of implants in orthodontics in providing what has been termed ‘absolute anchorage’. </jats:p

The use of osseointegrated implants in orthodontic patients 2. Absolute anchorage

Following the first article which explored the use of restorative implants in orthodontic patients which are later used to replace missing teeth, such as in hypodontia patients, this second paper examines the use of implants in orthodontics to provide ‘Absolute Anchorage’ after highlighting the standard orthodontic approaches to anchorage. It explains the advantages and disadvantages such methods give the specialist in treating full arch orthodontic patients over standard techniques used in modern orthodontics. Three different types of implant used in full arch orthodontic treatment are described in detail; the mid palatal implant, the OnPlant and the mini screw. The methods used in placing the implants and the techniques employed to gain the anchorage required are highlighted. </jats:p

Recovery of sensation after orthognathic treatment: Patients' perspective

Introduction: In this study, we considered patients' self-assessments to establish the recovery of sensory disturbance and the resultant distress over a 6-month postoperative recovery period after orthognathic surgery. Methods: A prospective longitudinal cohort questionnaire survey recruited 47 consecutive patients who met the study criteria (16 years of age or over; single jaw or bimaxillary surgery). A questionnaire to measure perceived facial and oral sensory loss was sent to the participants at 1 week, 6 weeks, and 6 months postsurgery. Results: Thirty-one participants (66%) completed the first questionnaire, and 26 (55%) completed all 3 assessments. The total sample comprised 14 male and 17 female subjects with a mean age of 21.2 years (SD, 4.93 years). There was a marked reduction in the proportion reporting sensory impairment at the 26-week point for both sites, although more so intraorally. At all 3 times, there were high correlations between the extent of sensory loss and the distress associated with it. Conclusions: Change in sensation occurs rapidly in the first 6 weeks postoperatively and more slowly thereafter. The distress caused by sensory loss is strongly related to the amount of sensory disturbance for both the face and the mouth