Pratik K. Sharma

How to…mechanically erupt a palatal canine

Management of ectopic permanent maxillary canines represents one of the greatest challenges to orthodontists. This paper outlines a variety of techniques and mechanics which may facilitate expedient, predictable and safe eruption of palatal canines. While each method may be useful in isolation, the varying presentations of palatal canines ensure that the ability to apply an array of techniques is essential if successful outcomes are to be consistently achieved.

Incidence and impact of previous orthodontic treatment in patients attending orthognathic combined clinics: a survey.

This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11-26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.

Level of knowledge and understanding of informed consent amongst the training grade group orthodontists in England, Wales and Northern Ireland.

Objective To assess the level of knowledge and understanding of informed consent in UK orthodontic trainees. Design and setting A cross-sectional, written questionnaire-based study. Setting Hospital orthodontic departments in England, Wales and Northern Ireland. Subjects and method A one page questionnaire which covered a range of legal issues pertinent to informed consent was circulated to 207 members of the Training Grades Group (TGG) of the British Orthodontic Society (BOS). The questionnaire consisted of four open questions with 11 responses, which the investigators considered to be ideal, seven closed questions requiring yes/no responses and one question requiring a yes/no response followed by two open responses. Following the initial circulation, a second posting to non-responders was conducted. Results The response rate was 61% (N = 126). The mean number of complete answers to the 21 questions was 13 (62%; median 13; mode 14). There were a low number of complete responses to specific questions in the following areas – explanations patients need from clinicians prior to obtaining consent; how to fully judge if a patient is capable of consenting; how to manage a patient incapable of giving consent; the legal status of fathers consenting on behalf of their children; whether consent forms have to be re-signed if the start of treatment is delayed by six months or more and responsibility for obtaining consent for dental treatment under general anaesthesia. Conclusions There was a disappointingly high proportion of incomplete answers to questions testing the knowledge and understanding of the law as it pertains to informed consent exists amongst members of the TGG of BOS.

Ingestion of an orthodontic archwire resulting in a perforated bowel: A case report

Accidentally, ingesting components of an orthodontic appliance can result in serious consequences for the patient. This paper presents one such complication, not previously reported, where the patient needed emergency surgery to retrieve part of an orthodontic appliance. This case report highlights the consequences of and possible solutions to prevent patients inhaling or ingesting parts of their appliance.

Inter-proximal enamel reduction in contemporary orthodontics.

Inter-proximal enamel reduction has gained increasing prominence in recent years being advocated to provide space for orthodontic alignment, to refine contact points and to potentially improve long-term stability. An array of techniques and products are available ranging from hand-held abrasive strips to handpiece mounted burs and discs. The indications for inter-proximal enamel reduction and the importance of formal space analysis, together with the various techniques and armamentarium which may be used to perform it safely in both the labial and buccal segments are outlined.

A modified occlusal wafer for managing partially dentate orthognathic patients--a case series.

A multidisciplinary approach is essential in orthognathic surgery to achieve stable and successful outcomes. The model surgery planning is an important aspect in achieving the desired aims. An occlusal wafer used at the time of surgery aids the surgeon during correct placement of the jaws. When dealing with partially dentate patients, the design of the occlusal wafer requires modification to appropriately position the jaw. Two cases with partially dentate jaws are presented in which the occlusal wafer has been modified to provide stability at the time of surgery.

Informed consent in orthodontics: A Prospective RCT comparing two methods of information delivery

Objective: To assess the influence of two different methods of information delivery on recall of information during the consent process for orthodontic treatment. Design and setting: A prospective randomized controlled questionnaire based study conducted at the Royal London Hospital and Central Middlesex Hospital. Materials and Methods: 64 patients starting fixed appliance treatment aged between 10 and 15 years were recruited. The control group ( n = 31) and their parents received verbal information only regarding fixed appliance treatment. The study group ( n = 33) and their parents received verbal supplemented with written information concerning fixed appliance therapy. Supervised completion of questionnaires was conducted with subjects and their parents immediately after the consenting process and approximately 6 weeks later. Results: 61 patients and their parents completed the questionnaire (control group n = 30; study group n = 31). The study group was more aware about the possibility of pain from braces, the need for emergency visits or the possibility of breakages compared with the control group (OR 0.92, CI 0.11-0.79). The study group was three times more likely to know the correct answer to how long treatment would take to complete compared to the control group (OR 3.20, CI 1.11-9.22). Furthermore, the study group was 3.5 times more likely to give the correct answer to why it is necessary to wear retainers compared to the control group (OR 3.65, CI 1.16-11.44). Conclusions: Verbal information given to patients about fixed appliance treatment should be supplemented with additional written information.