Orthodontic diary: Brighton belle

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Orthodontic diary: Brighton belle

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Orthodontic diary: Brighton belle


Orthodontic diary: Brighton belle

Those arriving in Brighton for the British Orthodontic Society's pre-conference radiology course were greeted with glorious sunshine and an alluring sea-side location making hard to enter the portals of the renowned Brighton Conference Centre.

However, the auditorium soon filled with delegates eagerly awaiting presentations from the well known Eric Whaites whose superb seminar focused on justification of the IRMER guidelines, limitation and optimisation principles related to dental radiography and radiation protection.

The last presentation, which was particularly relevant and informative, focused on the use of cone beam CT in orthodontics.

The day's session was concluded with a lively question and answer discussion and an exacting test assessing the knowledge delegates had gained from the day's excellent presentations.

Sunday 19 September
Following a warm welcome from Dr Peter McCallum, the BOC Chairman, the main scientific programme commenced with the opening session which featured fourteen presentations of recently completed Masters research projects.

The types of studies ranged from lab based experiments to randomised clinical trials and this postgraduate session confirmed and highlighted the excellent research which is conducted within orthodontic teaching units in the UK.

Following this session, the Chapman Prize lecture – Medical disorders in orthodontics – was presented by Dr Anjli Patel whose comprehensive address highlighted the importance, considerations and potential impact that medical conditions can have when planning and providing orthodontic treatment.

Key messages from the lecture included: close liaison with patient's medical practitioners and modifying possible treatment plans in these cases.

The afternoon session commenced with a lecture by Dr Hisham Badawi who gave an interesting presentation entitled, 3D orthodontic biomechanics research at the University of Alberta.

The presenter described his on-going experimental research, which aimed to quantify and measure 3-dimensionally, the magnitude of orthodontic forces applied to individual teeth.

Key findings presented were that self-ligation appliances appear to generate lower forces compared with conventional appliances. This could have a potentially significant impact on clinical practice, as it appears that self-ligation appliances could be more efficient in terms of treatment length, duration and pain experienced.

However, in contrast, randomised clinical trials report no difference between the two-ligation systems.

The next lecture, Much ado about facial aesthetics: Extractions, expansion and early treatment controversies was given by Dr Jay Bowman.

This excellent speaker gave a thought-provoking and entertaining presentation addressing the current non-extraction/extraction debate.

The lecturer gave a comprehensive overview and critique of the evidence surrounding the relationship between orthodontic extractions and the proposed detrimental effects on profile, smile aesthetics and the TMJ. In summary there appears to be a lack of evidence to support these assumptions, which are currently based on anecdotal research.

The final lecture, Orthognathic planning – A paradigm shift, was given by Dr Balvinder Khambay and Professor Ashraf Ayoub. Planning of orthognathic cases still remains a subjective process with limited consensus on particular management strategies. This interesting and informative lecture proposed a contemporary approach to planning orthognathic cases and was supported by treated clinical cases.

Monday 20 September
Monday morning began with two presentations about lingual orthodontics. The first, presented by Dr Didier Fillion, described the use of the digital Orapix-straight wire technique. This simplifies bonding up of lingual appliances with precise bracket positioning and customised archwires. The many advantages of the straight wire technique were discussed and the method was then illustrated with two clinical cases.

The second lecture was presented by Dr Guiseppe Scuzzo who outlined the evolution of lingual orthodontics and the advantages of the light lingual system including simplified set up and mechanics. The different stages of treatment were described and again the presentation concluded with some illustrated cases.

Following coffee, Dr Tim Wheeler gave a very amusing and well illustrated presentation on the use of clear plastic aligners. He discussed the types of malocclusion which are possible to treat with aligners alone and those which require a combination of aligners and fixed appliances in order to attain the best clinical results. These cases were largely those which required root parallelism or torque control.

The Rising star presentation was by Dr Badri Thiruvenkatachari who described his research into the Dynamax and twin block appliances in the treatment of Class II division 1 malocclusions.

Sixty four patients were entered into a randomised controlled trial comparing these appliances.

During the trial, data was sent to the data monitoring committee who recommended that the trial be stopped prematurely.

Overjet reduction was found to be greater in the twin block group and more adverse events were found in the Dynamax group. There were no statistical differences in impact on daily life. The audience were reminded of the importance of clinical evaluation of new appliances before use.

Another thought-provoking presentation followed with Dr Friedy Luther discussing scientific misconduct both outside and inside dentistry.

Two recent examples in the scientific literature which gained media attention were discussed before potential problems within the dental field were suggested.

These included poor research such as lack of sample size calculation; lack of blinding or randomisation; together with more sinister issues such as photofixing. T

he presentation was concluded with possible solutions to some of these problems.

Delegates returned after lunch to hear Dr Chris Orr and Dr Peter Huntley speak about the orthodontic-restorative interface and how a joint approach can lead to improved treatment outcomes.

The importance of planning, open communication and a mutual understanding of these cases was emphasised in order to achieve ideal aesthetics and a healthy static and functional occlusion. The presentation was illustrated with numerous examples of cases including the management of tooth wear in a patient with a Class II division 2 deep bite malocclusion; management of adults with uneven gingival margins or black triangles; tooth movement in patients with alveolar atrophy and the treatment of severely tipped molars.

The restorative requirement for space if osseointegrated implants are planned was reviewed and the importance of golden proportion discussed.

Following this was the eagerly awaited sponsored awards and prizegiving, presented by Professor David Bearn.

The first was the Chapman Prize awarded to Anjli Patel for her paper on Medical disorders and orthodontics, which was presented to the conference on the previous day. The Journal of Orthodontics, Scientific Paper of the Year was presented to Fiona Ryan. The ‘Against the Odds' award was presented to Jonty Meisner while Joe Dwyer and Jonathan Hunter received commendations by the judges.

The Geoffrey Fletcher scholarship was awarded to Jinesh Shah.

Following the MOrth examination this year, the BOS medal and first prize for cases submitted was awarded to Omar Yaqoob, whilst Elin Thomas received second prize and Ross McDowall came third.

The IMorth medal to the best candidate in the examination was awarded to Joanne Birdsall and The William Houston Medal for the best candidate in Edinburgh was awarded to Ross McDowall.  Ross McDowall continued his success with the BOS Clinical Effectiveness prize, with second place awarded to Aine Campbell and third prize to Helen Flint.

The BOS Distinguished Nurse Award was presented to Lisa Drzymala and finally, the BOS Distinguished Technician Award was presented to Vaughan Jones.

Following the prize-giving, Dr Ama Johal and Dr Wendy Turner took to the stage to conclude the session with an informative and interesting presentation on the inter-disciplinary management of the periodontally compromised dentition.

The classification of periodontal diseases was reviewed and the importance of initial recognition and stabilisation before treatment was emphasised. Possible indicators to show when treatment can be commenced were described and treatment mechanics and biomechanical considerations discussed. Finally, delegates were reminded of the need for communication and documentation.

Tuesday 21 September
Following the banquet at the Grand Hotel on Monday evening the enthusiasm of Dr Stephen Chadwick as Chair was welcomed.

The session started with the Clinical Pearls, an excellent part of the programme which allows delegates to learn clinical tips from fellow colleagues in a few short minutes which could potentially save hours at the chair side.

The first Clinical Pearl presented by Michael Cheung demonstrated the use of class II elastics and sectional stainless steel arch wires to distalise first molars. A technique found to work particularly well when treating young females.  Lorraine Barreto presented the ‘modified Parkhouse Technique' a method used to create space and distalise the canines on a round stainless steel arch wire. The concomitant incisor proclination favours the use of this technique when treating class III malocclusions.

David Spary presented an incredibly entertaining Clinical Pearl, The use of an invisible unbreakable fixed appliance.  He was proceeded by his registrar, Jigar Patel, who went on to demonstrate a simplified class III appliance, an appliance designed by David Spary which uses occlusal splints, buttons and class III elastics to correct anterior displacements.

Helen Taylor showed that zing string can effectively realign periodontally involved teeth and finally Ansa Akram illustrated the accuracy which can be achieved when using a maxillary model repositioning instrument to aid orthognathic treatment planning.

Following on from the Clinical Pearls was the much awaited three year follow up looking at the effectiveness of early class III orthopaedic treatment.

Dr Rye Mattick, an orthodontic Consultant at Newcastle Dental Hospital, outlined the aims of the multi-centre randomised clinical trial which where to establish whether Class III protraction facemasks provide effective dental and skeletal change; whether there are any socio- psychological benefits from the treatment and finally whether there are any inadvertent effects on the Temporo-mandibular joint. The inclusion criteria comprised Caucasian patients aged 7 -10 years with a class III malocclusion with 3 or 4 incisors in cross-bite. Syndromic patients and patients with a cleft or a MMPA > 35˚ where excluded from the study. Spencer Nute, a Consultant at Southend University Hospital presented the trial profile. 73 participants were recruited to the study of which 30 went on to be randomly allocated to the intervention group and 33 to the control group.

Those allocated to the intervention group were fitted with a bonded RME which had been made on a simple hinge articulator to ensure occlusal balance, to aid comfort and eating and to ensure the forces were distributed evenly.

Protraction headgear was worn in conjunction with the RME for a minimum of 14 hours a day until class I incisors with no buccal crossbites was achieved.

Nicky Mandall, a consultant and clinical lead at Tameside General Hospital presented the results of the multi-centre trial.

Treatment with protraction headgear took on average 8 ½ months to produce a statistically significant increase in the ANB and Overjet. Despite the intervention group reporting an increase in self esteem this was not of statistical significance and encouragingly there were no adverse effects associated with the temporo-mandibular joint when utilising protraction headgear. The results are encouraging and now we wait with bated breath to hear whether the use of protraction headgear reduces the need for orthognathic surgery.

Following coffee, a second tranche of prizes were awarded by Professor David Bearn. Sheri Seymour and Professor Susan Cunningham from the Eastman Dental Institute, were awarded the Research Protocol Award for their research looking at ‘Parents' motivation for seeking orthodontic treatment'. Evelyn Lee, also from the Eastman, was awarded the Houston Postgraduate Research Award for her questionnaire based study looking at ‘Psychological effects of altered sensation in post orthognathic patients'.

Neha Passan, from the Royal London, was awarded the BOC Research Poster prize for ‘Assessment of orthodontic borderline treatment need: Two aesthetic indices compared' Omar Yaqoob was awarded the UTG prize for an excellent presentation on the Use of Clark twin block with/without a labial bow to correct Class II division I malocclusions:an RCT.

Second place was awarded to Ektor Grammatopoulous for a cross-sectional observational study looking at The effects of playing a wind instrument on the occlusion.

Mike Mars was awarded the BOS Distinguished Award for his outstanding contribution to orthodontics, a recognition which was richly deserved.

After which Iain Hathorn, Les Joffe and John Brown were presented with BOS Life Membership awards and the BOS Special Service award was presented to Professor Sue Cunningham, Richard Jones and Alison Newlyn.

The prize session finished with the inauguration of Ray Edler as President of the BOS, a position he will honour following the outgoing of the current President, Liz Devenish in January 2011.

The morning session closed with the prestigious Northcroft Lecture presented by Professor Fraser McDonald.

Despite being head of orthodontics at the Dental Institute, Kings College London, he has found time to publish over 80 papers, 160 abstracts, write three books, supervise a vast number of Master of Science reports and since 1993 he has also been editor of the European Journal of Orthodontics.

His thought-provoking lecture, Where do we go from here? was an apt title for a lecture which outlined the challenges for future training in orthodontics and provision of care in a time of economic uncertainty.

He speculated that TADS will become resorbable, headgear obsolete and diagnostic genetics will form part of our treatment armamentarium as we try to predict those susceptible to root resorption and ectopic canines amongst other things.

Finally, Professor McDonald highlighted the need for more research exploring the psycho-social effects of treatment and, perhaps depressingly, he forewarned of the anticipated rise in annual retention fees and liability insurance.

The afternoon session started with a lecture from Professor Donald Burden, The evidence base for orthognathic surgery.

He presented a recent study with which he has been actively involved that set out to establish the extent of social problems amongst orthognathic patients, whether there is an association between skeletal pattern and psychological status and finally whether there is a need to carry out a psychological screening of potential orthognathic patients prior to commencing treatment.

Interestingly, patients with a skeletal II malocclusion were found to be more anxious, more depressed, and have lower self esteem than all other participants. Perhaps the most interesting and controversial finding was that more control patients (n=5) than orthognathic patients (n=4) required a referral to a psychologist for support based on the subject indicating severe distress.

The study concluded that there is no evidence to justify routine psychological screening.
Dr Emile Rossouw, a renowned international speaker presented experimental and clinical evidence of mini-screw implant anchorage, increasing our understanding in ideal placement and how best to optimise success in his lecture Class II correction: Clinical and research evidence related to orthodontic anchorage.

The penultimate lecture of the day was presented by Dr Jay Bowman, a highly respected orthodontist with a vast amount of experience in mini-screw placement, such that he puts the total number of mini-screws placed by registrants in the BOS TAD audit to shame!

He kindly shared his experiences and knowledge in a thoroughly entertaining talk entitled A spike in the ice: Innovative anchorage concepts with miniscrews.

The scientific programme was brought to a close by an all singing and all dancing lecture by Professor David Bearn, appropriately titled In, out, shake it all about – the BOS Temporary Anchorage Device audit project. Since the launch of the audit in June 2008, 130 centres have registered, with placement of 499 TADs in year 1 and 997 TADs in year 2. The data would suggest that success is associated with longer screws, use of a bur to place a pilot hole, placement of TADS in the maxilla and delayed loading.

Clinicians were encouraged to register with the Audit and update their results regularly, as it will not only benefit all BOS members through provision of more robust data but allow us to try and overtake Dr Jay Bowman in the number of mini-screws placed!
Wednesday 22 September
On Wednesday, the Society hosted the second Orthodontic Commissioning Education Day to be held in parallel with the British Orthodontic Conference. It was aimed at individuals and organisations directly and indirectly involved in commissioning NHS orthodontic services. The session was opened by Dr Richard Jones, chairman of the Orthodontic Practice Committee of the BOS with a lecture ‘2011 and beyond: Update on the political challenges ahead'.

The lecture started gently with a brief background to the Primary Dental Services and the inherent problems associated with it, progressing on to the contentious topic of tendering for orthodontic contracts.

Key issues with regards to continuity of care, completion of services should contracts not be re-commissioned, cross border referrals, financial support for providers and the challenges incurred with rising management costs were outlined.

Members were assured that guidelines for PCT's and providers are on the horizon which will be published and circulated in the New Year in a bid to offer solutions to all the issues discussed.

Sue Gregory, the deputy chief dental officer, outlined the structural changes which are to be imposed following the recently elected coalition government.

Following the proposed abolition of PCTs and SHAs, an autonomous NHS commissioning board is to be created from April 2011 which will be responsible for allocation and accounting of NHS resources. The White Paper, QIPP agenda, the economic climate and the reform of dental contracts all demand greater focus on value for money, both in service quality and cost.

Sohin Shah, commercial lead at the Department of Health and a procurement specialist, illustrated how the procurement process works and how PCT's evaluate value for money – an insight welcomed by orthodontic providers.

Brian Kelly, a senior orthodontic adviser with the dental reference service outlined the process of monitoring orthodontic contracts, through activity monitoring and quality assurance.

Interestingly, 10% of case starts and 20% of completions are submitted without completion of the clinical data set. He urged orthodontic clinicians to complete the FP17 O correctly, showing examples of how this should be done.

John Milne, Chair of the General Dental Practice Committee and a Dentist with a special interest in orthodontics completed the morning session with a lecture, New contract for dentists – where does orthodontics align itself?

After lunch, Mark Shackell, of the British Dental Association, presented his lecture, Clinical engagement: its role in professional and business life. The aims of the coalition Government with regards to devolution of responsibility to the frontline, clinicians assuming responsibility and accountability and the importance of improving the patient experience were discussed.

Finally, the role of the NHS Commissioning Board, the impact of clinical engagement and the BDA response to the White paper was also outlined.

Following on from this Dr Andrew DiBiase, a consultant orthodontist based at Canterbury in East Kent, presented an excellent talk emphasising the importance of robust referral guidelines in a bid to monitor, direct and improve the patient care pathway.

The BOC conference ended with Dr Richard Jones simplifying the role of the PDS and how it differs from an item of service contract in; PDS Revisited: Exploring the misunderstood nature of PDS.

For more information about events organised by the British Orthodontic Society, visit www.bos.org.uk.

Conference reports were authored by

Jadbinder Seehra, FTTA Orthodontics, Queen Victoria Hospital NHS Foundation Trust /Guy's & St Thomas NHS Foundation Trust

Nicola Crawford qualified in dentistry at Sheffield in 2000 and began her specialist registrar training in Orthodontics in Sheffield and Chesterfield in 2006. She gained a MClin Dent in 2008 and MOrth in 2009. She is currently an FTTA at Queen Victoria Hospital, East Grinstead and Guys and St. Thomas Hospital.

Natasha Wright qualified in Dentistry at Sheffield in 2002 and following a year in general dental practice and several senior house officer posts in oral and maxillofacial surgery, restorative dentistry and paediatric dentistry, she embarked on her specialist registrar training in orthodontics at the Royal London Dental Hospital in 2006. In 2008 she was awarded an MSc (Merit) and in 2009 MOrth. Currently she is undertaking a FTTA in orthodontics at Guys and St Thomas's Hospital and Sidcup Hospital.


 Posted on : Wed 13th - Oct - 2010


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