Management of children with poor prognosis first permanent molars: an interdisciplinary approach is the key

Although there have been continuous improvements in child oral health over recent decades, first permanent molars (FPMs) remain susceptible to early caries and can often be affected by hypomineralisation. We highlight current thinking in caries management and the restoration of hypomineralised FPMs, while also discussing enforced loss of these teeth within the context of interceptive extractions or extractions as part of orthodontic treatment. Compromised FPMs can negatively impact on quality of life for a child and present significant management challenges for the dental team. Although a high-quality evidence base is lacking for the different treatment options, early diagnosis and multidisciplinary treatment planning are key to achieving the best outcomes

Quantitative investigation of the esthetic impact of lip prominence in relation to the esthetic line

Introduction The purpose of this quantitative investigation was to assess the influence of lip prominence in relation to the esthetic line (E-line) on perceived attractiveness and threshold values of desire for treatment. Methods The lip prominence of an idealized silhouette male white profile image was altered incrementally between −16 mm to 4 mm from the E-line. The images were rated on a Likert scale by pretreatment orthognathic patients (n = 75), laypeople (n = 75), and clinicians (n = 35). Results In terms of perceived attractiveness, lips to E-line distance within the ranges of −12 mm to −16 mm and 0-4 mm in relation to the E-line was associated with a reduction in median attractiveness scores to below 4 in the patient and clinician groups of observers; for the lay group, the corresponding ranges were −14 mm to −16 mm and 2-4 mm. Relative lip prominence appears to be viewed as more attractive than lip retrusion. Clinicians were generally least likely to suggest treatment for varying levels of bilabial position. For a number of the images, there was reasonable agreement among clinicians and laypeople regarding whether treatment is required. For the clinician group, the only categories for desire for treatment were at a lip to E-line distance within the ranges of −14 mm to −16 mm and 2-4 mm. Conclusions It is recommended that the range of normal variability of the prominence of the lips and threshold values of the desire for treatment be considered in planning

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

Information for oral and maxillofacial patients:can it be improved?

The aim and objective of this study was to evaluate the quality and readability of leaflet and online Oral and Maxillofacial Surgery patientinformation leaflets (PILs). The quality, readability and grade level of each PIL was assessed using the DISCERN, Flesch Reading Easeand Flesh-Kincaid Grade Level instruments respectively. In total, 140 patient information leaflets were assessed. For both leaflet and onlinePILs, many items of the DISCERN instrument were deemed of low quality and poorly reported. The median overall quality score was 30.2.Variation in the quality and readability scores between leaflet and online PILs and those produced by various societies was evident. Overall,PILs were deemed to be of moderate quality. Online PILs were of lower quality, more difficult to read and aimed at a higher reading age level

Reporting quality of abstracts of randomized controlled trials published in dental specialty journals

Objectives: A widespread assessment of the reporting of RCT abstracts published in dental journals is lacking. Our aim was to investigate the quality of reporting of abstracts published in leading dental specialty journals using, as a guide, the CONSORT for abstracts checklist. Methods: Electronic and supplementary hand searching were undertaken to identify RCTs published in seven dental specialty journals. The quality of abstract reporting was evaluated using a modified checklist based on the CONSORT for abstracts checklist. Descriptive statistics followed by univariate and multivariate analyses were conducted. Results: 228 RCT abstracts were identified. Reporting of interventions, objectives and conclusions within abstracts were adequate. Inadequately reported items included: title, participants, outcomes, random number generation, numbers randomized and effect size estimate. Randomization restrictions, allocation concealment, blinding, numbers analyzed, confidence intervals, intention-to-treat analysis, harms, registration and funding were rarely described. Conclusions: The mean overall reporting quality score was suboptimal at 62.5% (95% CI: 61.9, 63.0). Significantly better abstract reporting was noted in certain specialty journals and in multicenter trials

Impact of Obesity on Orthodontic Tooth Movement in Adolescents: A Prospective Clinical Cohort Study

Obesity is a widespread chronic inflammatory disorder characterized by an increased overall disease burden and significant association with periodontitis. The aim of this prospective clinical cohort study was to investigate the effect of obesity on orthodontic tooth movement. Fifty-five adolescent patients (27 males, 28 females) mean age 15.1 (SD, 1.7) years and mean body mass index 30.2 (3.5) in obese and 19.4 (2.2) kg/m2 in normal-weight groups were followed from start-of-treatment to completion of tooth alignment with fixed orthodontic appliances. Primary-outcome was time taken to complete tooth alignment, whilst secondary-outcomes included rate of tooth movement and change in clinical parameters (plaque/gingival indices, unstimulated whole mouth salivary flow rate, gingival crevicular fluid biomarkers). Data collection took place at baseline (start-of-treatment: appliance-placement); 1-hour and 1-week following appliance-placement; and completion-of-alignment. Results were analyzed by descriptive statistics followed by generalized estimating equation regression modelling. There were no significant differences between groups in time taken to achieve tooth-alignment (mean 158.7 days; SD 75.3; P=0.486). However, at 1-week initial tooth displacement was significantly increased in the obese group (P<0.001) and after adjusting for confounders, obese patients had a significantly higher rate of tooth movement compared to normal-weight (+0.017 mm/day; 95 CI: 0.008,0.025; P<0.001) over the period of alignment. Explorative analyses indicated that levels of the adipokines leptin and resistin, the inflammatory-marker myeloperoxidase and the cytokine receptor for nuclear factor kappa-B ligand (RANKL) were significantly different between obese and normal-weight patients and associated with observed rates of tooth movement. This represents the first prospective data demonstrating a different response in obese patients compared to normal-weight during early orthodontic treatment. These differences in the response of periodontal tissues to orthodontic force in the presence of obesity have potential short and long-term clinical implications