Resorbable or titanium plates? Which is better for corrective jaw surgery?

Under- or overgrowth of one or both of the jaw bones can lead to reduced function and an unattractive facial appearance, either of which may have lasting and significant psychosocial effects. Treatment of severe cases may require a combination of orthodontic appliances and orthognathic (corrective jaw) surgery. After surgery the cut bone needs to be immobilised to ensure that optimal healing takes place. Titanium plates used for fixation are recognised to be the ‘gold standard’ but recent developments in biomaterials have led to an increased use of bioresorbable plates or screws for corrective jaw surgery. The use of bioresorbable plates for the fixation of facial bones might appear to reduce the need for a further operation for the removal of metal plates. However, whilst resorbable plates do appear to offer certain advantages over metal plates, concerns remain about the stability of fixation, the length of time required for their resorption (being reabsorbed), the possibility of foreign body reactions, and with some of the technical difficulties experienced with resorbable plates. Continue reading

No evidence from RCTs on effectiveness of orthodontic treatment for deep bite and retroclined teeth

Orthodontics is concerned with growth of the jaws and face, development of the teeth, and the way teeth and jaws bite together. Ideally, the lower front teeth bite in the middle of the back surface of the upper front teeth. When the lower front teeth bite further behind the upper front teeth than ideal, this is known as a Class II malocclusion. A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (vertical overlap of the front teeth), which can cause oral problems and may affect appearance. This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. These braces can be removed from the mouth and this approach does not usually require removal of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.

An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth. If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed arch placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).

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No RCT evidence to determine best technique for exposing displaced eye teeth

Permanent canine teeth in the upper jaw usually erupt into the mouth between the ages of 11 to 12 years. In 2% to 3% of young people, the canine teeth fail to erupt (grow down) and become displaced in the roof of the mouth (palate).This can leave unsightly gaps, cause damage to the surrounding roots (which can be so severe that neighbouring teeth are lost or have to be removed) and, occasionally, result in the development of cysts.

Management of this problem is both time consuming and expensive. It usually involves surgical exposure (uncovering), followed by fixed orthodontic braces for two to three years, to move the canine into the correct position. Two surgical techniques are routinely used in the UK: the closed technique involves uncovering the buried tooth, gluing an attachment onto the exposed tooth and repositioning the palatal flap. Shortly after surgery, an orthodontic brace is used to apply gentle forces to bring the canine into its correct position within the dental arch. The canine moves into position beneath the gum. An alternative method is the open technique, which involves surgically uncovering the canine tooth as before, but instead of placing an attachment onto the exposed tooth, a window of gum from around the tooth is removed and a dressing (pack) placed to cover the exposed area. Approximately 10 days later, this pack is removed and the canine is allowed to erupt naturally. Once the tooth has erupted sufficiently for an orthodontic attachment to be glued onto its surface, orthodontic braces are used to bring the tooth in line with the other teeth. Continue reading

Amifostine may relieve symptoms of salivary gland dysfunction in head and neck cancer patients

 

Problems with saliva production and salivary glands are a significant and mostly permanent side effect for people after radiotherapy treatment to the head and neck. When this occurs the condition is known as dry mouth or xerostomia. Dry mouth is not measurable and is a subjective or personal expression of how the mouth feels. It can have other causes and is a consequence of the production of less saliva or by the consistency of saliva. The rate of flow of saliva in an individual’s mouth however can be measured. People who have dry mouth have a reduced quality of life. They can experience issues with taste and general discomfort, difficulties chewing, swallowing and speaking as well as tooth decay, thrush and other infections of the mouth. A wide range of drugs that work in different ways have been used to try and prevent problems with salivary glands caused by radiotherapy. Unfortunately there is currently not enough evidence to show which drugs or which type of drugs are most effective. Continue reading

Children who have sealants applied to their back teeth are less likely to have tooth decay

Although children and adolescents have healthier teeth than in the past, tooth decay (also known as caries) is a problem in some people and places. Most tooth decay in young people occurs on the biting surfaces of back teeth. Tooth decay prevention includes brushing, fluoride supplements (such as tablets), fluoride directly applied to the teeth and dental sealants. Dental sealants aim to prevent bacteria growth that promote tooth decay in grooves of back teeth. Sealants are applied by dentists or dental care team members. The main types used are resin-based sealants and glass ionomer cements. Continue reading

No evidence that treatment of gum disease reduces the number of babies born before 37 weeks of pregnancy

Periodontal disease is a disease of the supporting tissues of the teeth that may affect the gums, periodontal ligament membrane, and bone around the tooth socket. It has been linked with infections, which some researchers believe could lead to or have an impact on a number of conditions, including problems in pregnancy. Periodontal disease is common in women of reproductive age, and gum conditions tend to worsen during pregnancy due to hormonal changes. The treatment involves bringing plaque on the teeth down to minimal levels, to reduce and resolve inflammation of the gums. It could involve counselling on oral hygiene measures, removing the plaque and calculus by using hand instruments (e.g. scale and polish) or ultrasound equipment (e.g. mechanical debridement), sometimes alongside the use of antibiotics or antiseptic mouthwashes or gels. If the nonsurgical treatment is not successful, surgery is sometimes required. This review assessed studies where pregnant women with gum disease were treated using a combination of techniques, with or without antibiotics. Continue reading