The use of in-house clear aligner production has been adopted in some orthodontic practices as a means of improving efficiency, adaptability, and clinical oversight. Manufacturing appliances within the practice enables modifications to be made more readily in response to treatment progress, and reduces reliance on external providers. When combined with remote patient monitoring (RPM), aligners may be manufactured in batches at defined treatment checkpoints rather than as a complete sequence in advance. This approach facilitates closer matching between appliance design and patient progress, may reduce the number of refinements required, and can help to limit unnecessary use of materials. CPD/Clinical Relevance : The integration of remote patient monitoring with in-house batch manufacturing optimizes clear aligner therapy and creates an adaptive workflow.
This case report details the orthodontic and orthognathic management of a 15-year-old female patient presenting with Class II division 1 malocclusion, mandibular retrognathia, congenital absence of the lower right second premolar (LR5), and impacted third lower molars. Treatment involved upper and lower fixed appliances, space redistribution, and molar uprighting to facilitate the eruption of impacted lower third molars. Following pre-surgical orthodontics, a bilateral sagittal split osteotomy was performed to advance the mandible and achieve skeletal and occlusal correction. The multidisciplinary approach successfully corrected the skeletal discrepancy, improved facial harmony and established a functional occlusion, highlighting the value of closely integrated orthodontic-surgical treatment in managing complex malocclusions. CPD/Clinical Relevance: A multidisciplinary approach is crucial for the effective management of Class II division 1 malocclusion with mandibular retrognathia, hypodontia, and impacted lower third molars, ensuring optimal skeletal correction, occlusal function, and aesthetic balance.
This is the first of two articles exploring the rich history of maxillary expansion to the modern developments of slow maxillary expansion used today in orthodontics. This article provides important references and highlights what limited evidence there is when comparing expansion techniques. CPD/Clinical Relevance: It is important for clinicians to appreciate different expansion methods and appliances, as well as the history behind them.
Substance use among adolescents is an increasing public health concern with clear implications for orthodontic treatment and oral health. Consequences may include poor oral hygiene, reduced compliance, and compromised treatment outcomes. As clinicians who routinely treat adolescents, orthodontists are ideally positioned to recognize early risk behaviours. This article explores the impact of substance use on orthodontic care, reviews available screening tools, and discusses their practical implementation and current challenges. Incorporating validated screening into orthodontic assessments can strengthen safeguarding, facilitate timely intervention, and support comprehensive, patient-centred care. CPD/Clinical Relevance: Integrating substance use screening tools into orthodontic practice enables clinicians to identify and respond to risk behaviours in adolescents, reinforcing safeguarding duties, contributing to fairer outcomes and enhanced overall wellbeing.
Orthodontic treatment and periodontal health have bidirectional implications on each other throughout the treatment journey. The objective of this article is to highlight the importance of periodontal health in orthodontic patients and explore the impact that orthodontic treatment can have on the periodontal status. This article also discusses the options available to prevent and manage periodontal complications associated with orthodontic treatment. CPD/Clinical Relevance: This article provides a summary of the risk factors and the periodontal implications to consider pre-, during and post-orthodontic treatment.
Patients who present with an increased overbite and a high anchorage demand can be difficult to treat simultaneously during orthodontic treatment. This case series discusses how to manage this clinical issue early with the use of a modified Nance palatal arch (NPA) with anterior bite plane (ABP) during the alignment phase. The authors discuss the importance of careful case selection, and the benefits and risks involved when using this appliance. It is important for clinicians to understand the use of a modified Nance palatal arch with an anterior bite plane.
This narrative review describes the role of artificial intelligence (AI) in cephalometric tracing, comparing its accuracy, efficiency, and limitations to manual methods. AI significantly reduces analysis time, especially for novice tracers, and demonstrates high accuracy overall. However, the literature shows that errors persist, reflecting algorithmic and dataset biases. While AI can enhance clinical efficiency, presently it should complement, not replace, orthodontic expertise. Future development and improvements in the use of AI in orthodontics are required. Incorporating AI awareness into orthodontic training programmes is recommended for preparing clinicians for evolving digital workflows. It is important for clinicians to be aware of the evolving role of artificial intelligence in orthodontics.
The use of cone beam CT throughout an orthodontic treatment plan is ever evolving and increasing. This article adds to existing British Orthodontic Society Guidelines on the use of cone beam CT focusing on common orthodontic clinical scenarios, the clinical signs that may justify a cone beam CT and brief guidance on its interpretation. Interpretation of cone beam CT is vital in providing best quality care.
Obstructive sleep apnoea (OSA) affects 12% of the global population and can significantly affect people's quality of life, with the condition leading to an increased risk of cerebrovascular accidents, hypertension and diabetes. An understanding of the disease process is provided and the role of the orthodontist in the management of OSA as part of a multidisciplinary team is discussed. A clear pathway for service provision of a mandibular advancement device (MAD) is also outlined. Orthodontists play an important role in the management of obstructive sleep apnoea, and this article outlines its aetiology and management while providing a clear, structured pathway for service provision.
Naso-alveolar moulding (NAM) can be beneficial for infants with cleft lip and palate (CLP). It helps reshape and reposition deformed nasal cartilage and alveolar processes, non-surgically lengthen the columella, and reduce lip tissue tension before surgery. This article proposes a modified version of NAM where appliance activations could be scheduled once every 4 weeks. In our experience, the reduced-maintenance NAM (ReMNAM) is particularly beneficial for families who live far from the hospital and those living in low- (LIN) and low–middle-income nations (LMIN) because it is more achievable for babies to be brought for a monthly rather than bi-weekly review. NAM can be a beneficial treatment modality for reshaping and repositioning deformed nasal cartilage and alveolar processes in infants born with cleft lip and palate. Awareness of ReMNAM may help to make this intervention more accessible in settings where cost and distance would otherwise make delivery impractical.
In cases of a discrepancy, Bolton analysis should be evaluated to ensure appropriate orthodontic planning. This article presents a case report of a young female patient with conical upper lateral incisors and an impacted upper canine. The treatment plan presented illustrates the importance of evaluating intra-arch dental proportions so that the decision to increase or decrease dental volume ensures adequate aesthetic and functional results.
Interproximal enamel reduction (IPR) has become a commonly used technique in orthodontics for both fixed appliance and aligner-based treatments. There are a range of different methodologies available, all with their own strengths and drawbacks. It is vital for orthodontists to understand indications and clinical scenarios where IPR can prove a useful tool, and situations in which it is not advisable. Understanding the appropriate uses and techniques of IPR will allow orthodontists to integrate it into their own practice and enhance clinical outcomes. It is important to understand the clinical indications, appropriate methodology, and risks associated with using interproximal enamel reduction in orthodontics.
Missing, traumatic loss, or necessitated removal of maxillary central incisors presents a significant challenge to the multidisciplinary dental team. The central incisors have significant role in maintaining optimal smile aesthetics, and achieving acceptable speech and occlusion. This case report outlines a successful, comprehensive approach to managing both the aesthetic and functional challenges associated with missing maxillary central incisors. The treatment plan provided a permanent solution that avoided the need for future prosthetic intervention and preserved alveolar bone, which was particularly advantageous given the patient's age. The report also underscores the importance of careful case selection and collaboration within a multidisciplinary team to address complex dental anomalies. CPD/Clinical Relevance: This case highlights how multidisciplinary planning and orthodontic mesialisation of lateral incisors can provide a permanent, bone-preserving solution for missing maxillary central incisors in growing patients, potentially avoiding future prosthetic interventions.
This article critically evaluates the relationship between orthodontic treatment and periodontal health, emphasizing the importance of ensuring periodontal stability before initiating orthodontic therapy. It reviews biomechanical considerations, the impact of different orthodontic appliances on periodontal parameters, and strategies for mitigating periodontal risks during and after treatment. This article also discusses interdisciplinary collaboration for managing aesthetic outcomes and preventing relapse. Clinical guidelines are proposed to optimize treatment in patients with a history of periodontal disease, focusing on long-term retention and supportive care. CPD/Clinical Relevance: It is crucial to ensure periodontal stability before initiating orthodontic treatment to prevent exacerbation of periodontal disease.
Anterior crossbites are a common problem in the mixed dentition and often indicate the need for early interceptive orthodontic intervention. This article examines various treatment options for correcting anterior crossbites interceptively, discussing their benefits and limitations. CPD/Clinical Relevance: This is clinically relevant for general dental practitioners (GDP) in deciding if paediatric patients with anterior crossbites need an interceptive orthodontic referral.
This article details a novel method for closing re-opened anterior spaces using a modified vacuumed-formed appliance and orthodontic elastics. Two case examples are presented illustrating successful application of this technique, closing the unwanted spaces within a 2-week period. CPD/Clinical Relevance: This article introduces a cost-effective, aesthetic and practical technique for closing re-opened orthodontic spaces within weeks, offering a valuable patient-friendly and tolerable solution to orthodontic relapse in both NHS and private settings.
Temporary anchorage devices (TADs) placed in the infrazygomatic crest (IZC) region of the maxilla, can provide stable and reliable anchorage, enabling various orthodontic tooth movements. IZC TADs are especially useful in cases where traditional methods of anchorage, such as headgear or intermaxillary elastics, may be insufficient or impractical. These anchorage devices are particularly useful in treating Class II malocclusions, allowing for effective molar distalization. When used effectively, IZC TADs can offer a powerful and versatile solution for achieving optimal orthodontic outcomes. Their ability to provide stable and reliable anchorage makes them an invaluable tool in modern orthodontic practice, allowing for precise and efficient tooth movement in a variety of complex cases. Nevertheless, complications associated with IZC TADs are not uncommon. Therefore, careful planning and execution of treatment biomechanics is essential. CPD/Clinical Relevance: In this article, the placement of IZC TADs as well as the relevant biomechanics are addressed and a treated case is presented.
