OBJECTIVES:To determine the effect of gender and Frankfort mandibular plane angle (FMPA) on extraction space closure.SETTING AND SAMPLE POPULATION:A single district general hospital. The sample population were 11- to 18-year-olds undergoing upper and lower fixed appliance therapy following the loss of a premolar in each quadrant.METHODS:A total of 100 patients undergoing upper and lower fixed appliance therapy following the loss of four premolars were randomized with stratification on two age ranges (11-14 years and 15-18 years) and three FMPAs (high, medium and low). Allocation was to one of three treatment groups: conventional, active or passive self-ligating brackets, with an allocation ratio of 1:2:2. All subjects were treated using the same archwire sequence and space closing mechanics. Space closure was measured on models taken every 12 weeks throughout treatment. All measurements were taken by one operator, blinded to bracket type.RESULTS:A total of 98 patients were followed to completion. Data were analysed using linear mixed models and demonstrated no statistically significant difference between bracket types with respect to space closure. Therefore, the data were pooled to determine the effect of gender and FMPA on space closure. At all stages of space closure, there was a significant effect of gender (results are presented as effect size, lower and upper 95% confidence intervals and probability), that is passive [1.064, 0.521, 1.607, 0.001], active [0.825, 0.312, 1.339, 0.002] and total space closure [1.029, 0.527, 1.531, 0.001]. There was no statistically significant effect of FMPA on space closure.CONCLUSIONS:Space closure during fixed appliance therapy is affected by gender but is unaffected by FMPA.

The presentation of alternative treatment plans and the discussion of these options with the adolescent patient is a routine part of both general dental and specialist orthodontic practice. This article will cover the issues involved in obtaining consent for treatment from the adolescent patient and suggests a practical means, if appropriate, to ensure that these patients can give and withdraw consent for their own treatment.

Structured AbstractObjectivesTo compare facial appearance and dento-alveolar relationship outcomes from the CSAG (1998) and CCUK (2013) studies.Setting and sample populationFive-year-olds born with non-syndromic unilateral cleft lip and palate. Those in the original CSAG were treated in a dispersed model of care with low-volume operators. Those in CCUK were treated in a more centralized, high-volume operator model.Materials and methodsWe compared facial appearance using frontal view photographs (252 CCUK, 239 CSAG) and dental relationships using study models (198 CCUK, 223 CSAG). Facial appearance was scored by a panel of six assessors using a standardized and validated outcome tool. Dento-alveolar relationships were scored by two assessors using the 5-Year-Olds' Index. Ordinal regression was used to compare results between surveys.ResultsExcellent or good facial appearance was seen in 36.2% of CCUK compared with 31.9% in CSAG. In CCUK, 21.6% were rated as having poor or very poor facial appearance compared with 27.6% in CSAG. The percentage rated as having excellent or good dento-alveolar relationships was 53.0% in CCUK compared with 29.6% in CSAG. In CCUK, 19.2% were rated as having poor or very poor dento-alveolar relationships compared to 36.3% in CSAG. The odds ratios for improved outcome in CCUK compared to CSAG were 1.43 (95% CI 1.03, 1.97) for facial appearance and 2.29 (95% CI 1.47, 3.55) for dento-alveolar relationships.ConclusionsFacial and dento-alveolar outcomes were better in CCUK children compared to those in CSAG.

This paper discusses the assessment of the developing occlusions of children and adolescents in the general practice setting; that is, reviewing the potential of interceptive orthodontics. In particular we will illustrate the management of these individuals with case examples. We have also provided a handy pull-out guide with this issue of the Journal which can be used in the GDP's surgery for quick reference.

Introduction Traditionally, the academic content of many 3-year full-time postgraduate courses in orthodontics in the UK has been delivered using tutorial and lecture-based teaching. This is often teacher lead rather than learner centred. Even with the advent of teaching modules on the national virtual learning environment, although well liked by students, is still often teacher lead. An alternative on-line approach to learner-centred teaching is to use Wikis.Materials and methods Nine postgraduate students in the first term of their full-time 3-year specialist training programme at Bristol Dental School were divided into three groups and wrote a Wiki on three interrelated topics. This process was repeated in the second term using three different, but still interrelated topics. Following each, they were asked to give detailed feedback on their Wiki topic teaching.Results and discussion The results showed that students felt writing the Wikis was useful for team work, provided a more learner-centred approach, created a body of work in a live format that would be useful for revision and was a welcome variation on traditional teaching methods. The biggest problem encountered was the IT platform used to create the Wikis. The students also felt the Wikis should be assessed as a piece of group work rather than as separate individuals.Conclusions Wiki topic teaching is a useful tool in the teaching of postgraduate orthodontics providing variation and a more learner-centred approach. Further exploration of the available IT platforms is required.

Objective To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate. Design Reliability and reproducibility study. Methods Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds’ index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4 weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with the plaster model scores. Results Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions. Conclusion Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds’ index.

Key Points Stresses that recruiting patients to a RCT has an impact on clinical time. Quantifies the impact of recruiting patients to a large multicentre orthodontic trial. Explores the amount of non-clinic time for research-related administrative tasks. Provides useful information for researchers planning clinical trials and for their managers when considering becoming involved in a clinical trial.

The aim of this investigation was to determine the optimal format for presenting the 5-year-olds' Index reference models for the assessment of dental arch relationships in unilateral cleft lip and palate (UCLP). The 5-year-olds' Index reference models were presented in four different formats: plaster models, coloured acrylic models, and two digital formats, which included three-dimensional digital models (3D), and black and white photographs. These formats were used to rate 45 plaster models of patients born with UCLP by a total of seven examiners comprising experienced and inexperienced examiners. Scoring was undertaken 1 week apart for each format with the patient models reassigned on each occasion to reduce the effect of memory bias. For intra-examiner agreement, the patient models were scored 3 weeks later under similar conditions by the same examiners. The reliability of using the different formats was determined using the plaster reference models as the 'gold' standard for comparison. Analysis of the results using weighted kappa (k) statistics showed the magnitude of agreement for all the formats of the 5-year-olds' Index were good to very good between examiners. The more experienced examiners were consistently more reliable in their scoring using the different formats. This study clearly demonstrated that 3D digital models of the 5-year-olds' Index could prove to be a promising alternative to physical models of the 5-year-olds' Index.

This paper discusses some of the changes to everyday clinical practice necessary when three of the most popular types of self-ligating brackets are used in fixed orthodontic appliance treatment. These include bracket placement, archwire ligation, archwire sequencing, space closure and, in addition, the instruments and materials needed during their use. Clinical tips are highlighted to boost treatment efficiency and ease the transition from conventional to self-ligating brackets.

With improvements in bonding techniques, bracket base design and bond strengths, molar tubes are becoming more popular in orthodontics.1,2 Molar tubes make an attractive alternative to conventional banding due to a reduction in clinical bonding time and ease of placement on partially erupted teeth. The use of molar tubes negates the need for orthodontic separation and subsequent cementation of bands, and offers improved periodontal health.3 Their use on terminal molars, however, should be limited to non-orthognathic cases. This paper presents two cases of peri-operative second molar tube failure during orthognathic surgery. They are presented in the hope that it will highlight the importance of banding the distal terminal molar in orthognathic cases to prevent loss of molar tubes and peri-operative contamination of the surgical wound site.

This is a report on the use of a regional database of patients undergoing orthognathic treatment in the South West of England. The benefits and difficulties of using a regional database are discussed.

Objective: To assess the surgical outcome of 5-year-old subjects with repaired unilateral cleft lip and palate who had been operated on by a single surgeon.Design: Retrospective consecutive outcome study. Setting: The cleft lip and palate center at Frenchay Hospital, North Bristol NHS Trust, U.K.Participants: All patients born with unilateral cleft lip and palate between May 1992 and April 1998 were identified and their study models were located. Main Outcome Measures: The reasons for failing to obtain study models were recorded. The '' test '' study models were combined randomly with a '' gold standard '' set of study models to give a group of 53 for assessment purposes. These study models were assessed twice by two examiners independently using the 5-Year-Olds' Index. The weighted kappa (kappa) statistic and components of variance were used to establish the levels of agreement within and between examiners, as well as between the gold standard and the examiners.Results: Thirty sets of study models out of a possible 43 were located. The most common reason for not obtaining records was poor cooperation. More than 50% of study models were assessed as being good outcomes (index groups 1 and 2), whereas fewer than 20% of the records were evaluated as being poor outcomes (index groups 4 and 5). There was good inter- and intraexaminer agreement and agreement with the gold standard values.Conclusion: Study model collection in this age group can be difficult due to patient cooperation.

OBJECTIVE:To test specific standards set in the newly established cleft lip and palate service in three regions of the U.K. The standards relate to record collection and outcomes.DESIGN:Retrospective analysis.PATIENTS:Records of 31 children, 5 years of age, who were born in 1997 with complete unilateral clefts of lip and palate and were treated by surgeons in three regions.MAIN OUTCOME MEASURES:Record collection standards were measured by collecting dental study models. Outcomes were measured with the 5-Year-Old Index.RESULTS:Of the 31 subjects, 52% had excellent and good outcomes. The 31 cases represented 62% of the total records collected.CONCLUSIONS:The three regions examined fell short of the standards set, but the outcomes were improved compared with previous national outcomes. The failings in record collection need to be rectified. This study provides baseline data for further development of cleft services within three regions.

With the demand for orthodontic treatment increasing, it is inevitable that the practitioner will see a significant number of patients with previously traumatized teeth who require orthodontic treatment. The possible risks and guidelines for the management of these teeth during active tooth movements are discussed. The use of orthodontic appliances in the management of incisors traumatized during active orthodontic treatment is also discussed.

Currently two-thirds of European countries employ orthodontic auxiliaries and the UK is therefore unusual in not permitting their use. There is support from the orthodontic specialty for the concept of delegating routine intra-oral tasks to auxiliary personnel. The following describes a pilot project undertaken to determine the possible training structure for orthodontic auxiliaries. The modular course, which took place over a period of 4 weeks, is described and the results and implications are discussed.