Run-through training: a trainee and trainer perspective

A run-through training pilot has been conducted in orthodontics during which trainees completed 2 years of higher training in the same units in which the first 3 years of specialist training was conducted. This article outlines a trainee and trainer's experience of run-through training in orthodontics. CPD/Clinical Relevance: Young dentists hoping to pursue orthodontic specialist training would be aware of the different training pathways available.

Shark teeth: a case of multiple supernumerary teeth

A 44-year-old male was referred to the Department of Orthodontics at Manchester Dental Hospital. He presented with pain from his heavily restored, lower right second premolar, which had an apical supplemental tooth, visible radiographically. The dentist queried whether the second premolar tooth could be extracted and the supplemental tooth aligned in its place. Clinical examination revealed no relevant abnormalities. The family and medical history were non-contributory. Panoramic tomography revealed multiple supplemental supernumerary teeth in the canine and premolar regions. Cone beam computed tomography and multidisciplinary team input were required to plan the treatment for this unusual case. CPD/Clinical Relevance: These findings highlight the management and treatment options for a case of non-syndromic, multiple supernumerary teeth. Consideration must be given to the risk of damage to adjacent structures if surgically removing supernumerary teeth, and the risk that supernumerary teeth may be ankylosed and not amenable to alignment within the arch.

A review of the eating disorders literature with reference to dentistry

Eating disorders are severe psychiatric illnesses associated with physical and psychological morbidity and mortality. In the UK, around 1 in 9 people are directly affected. Oral healthcare professionals may be among the first to observe the signs and symptoms of an eating disorder because of the recognizable and consistent links with oral pathology and it is important that they are sufficiently informed about the condition, and feel confident in raising it with patients and/or their families. CPD/Clinical Relevance: Oral healthcare professionals may be among the first to suspect that a patient has an eating disorder: they can play a role in diagnosis and appropriate referral, as well as providing appropriate oral healthcare advice.

History of interceptive orthodontics

Interceptive orthodontics refers to all interventions and treatments that can be performed during the primary or mixed dentition with the aim of eliminating or minimizing dento-alveolar and skeletal disharmonies that can interfere with the normal growth and development of occlusion, function, aesthetics and the psychological wellbeing of children. The main purpose of interceptive orthodontics is to prepare an environment that will not interfere with the occlusal development in order to reduce the future need for prolonged complex mechanical orthodontic treatment. According to the American Association of Orthodontics the most suitable age for screening the paediatric population for interceptive intervention is 7 years of age. CPD/Clinical Relevance: To review the progress made in the field of interceptive orthodontics and discuss the current principles of early orthodontic intervention.

The continued development of multiple supernumerary teeth: do they influence orthodontic treatment?

Supernumerary teeth occur in approximately 1–2% of the population. Multiple supernumerary teeth are less common and usually associated with certain medical conditions. Most supernumeraries develop at a similar time to the normal series; however, this article describes the presentation and management of three patients who developed multiple supernumerary teeth during active orthodontic treatment in the permanent dentition. CPD/Clinical Relevance: These cases show development of multiple supernumerary teeth in the both the maxilla and mandible demonstrating a variation of types and effects on the dentition. In particular, multiple supernumeraries in the anterior maxilla and supplementals in the mandibular premolar regions highlight that supernumerary teeth may develop a considerable time after the development of the permanent dentition. These can develop during orthodontic treatment. Consideration, therefore, may be given to closer and longer monitoring of dental development in patients with multiple supernumerary teeth.

Misbehaving mandibular canines

The incidence of permanent canines failing to erupt in the mandible is not as common, and, therefore, not as well reported, as that in the maxilla. Mandibular canines have important functional and aesthetic purposes and knowledge of this uncommon condition is essential for those involved with the management of these cases. This article explores the aetiology, assessment and treatment options available to manage this condition, using examples from treated cases within our department. CPD/Clinical Relevance: An understanding of the aetiology, assessment and various treatment options available to manage impacted and transmigrated mandibular canines will inform better treatment planning.

Missing lateral incisors: implant-related dilemmas

This article provides an overview of the management of developmentally missing lateral incisors. When prosthodontic replacement of the missing lateral is required, wherever possible, implant-supported prostheses are considered the preferred definitive replacement option. The developmentally missing lateral incisor presents a unique aesthetic challenge. Developments in dental implant systems have implications in the management of this particular clinical situation. CPD/Clinical Relevance: To highlight the importance of interdisciplinary dental care, including the orthodontist and restorative dentist, in treatment of patients with missing lateral incisors.

Idiopathic condylar resorption in orthodontics

Condylar resorption (CR) can be categorized into functional and dysfunctional remodelling of the temporomandibular joint (TMJ). The literature describes dysfunctional remodelling of the TMJ as idiopathic condylar resorption (ICR). Idiopathic condylar resorption (ICR) is a well-documented but poorly understood pathological entity that can occur spontaneously or post-orthognathic surgery. It predominantly affects young women, with other risk factors including Class 2 malocclusion with steep mandibular plane angles. It is distinguished by a decreased condylar head volume and ramus height, progressive mandibular retrusion and an anterior open bite. Its aetiology can be categorized into surgical and non-surgical risk factors. These include hormones, systemic disease, trauma, mechanical load and surgical risk factors, such as magnitude and direction of mandibular movement, type of surgical fixation and length of post-operative maxilla-mandibular fixation. ICR is a diagnosis of exclusion, and identified by a combination of clinical, radiographic and haematological findings. Multiple treatment options have been described in the literature, including medical management, orthodontics, orthognathic surgery, TMJ surgery, TMJ and orthognathic surgery combined, and total joint prosthesis reconstruction. Further research is required to better understand the aetiology of ICR and more long-term, controlled, multicentre clinical studies are needed to evaluate the outcomes of surgical and non-surgical management of CR patients. CPD/Clinical Relevance: Idiopathic condylar resorption has many presentations and potential causes that can greatly impact the decisions and outcomes for orthodontic/orthognathic treatment.