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Objective: To assess static occlusal outcomes for patients with cleft lip and/or palate (CLP) and cleft palate (CP) managed within a UK Regional Cleft Service and to compare with previously published Peer Assessment Rating (PAR) scores from a non-cleft population of patients treated within a UK consultant-led hospital service. Design: Retrospective multicentre study. Setting: Eight orthodontic hospital units within the Spires Cleft Service, UK. Participants: Patients born with CLP or CP between 1985 and 1995 treated within the service. Methods: Patients were assigned to groups by cleft type and whether they were treated by orthodontics only or a combination of orthodontics and orthognathic surgery. PAR was recorded before and after treatment from study models. Results: Data were collected for 171 patients included in the study. Median pre-treatment PAR was 42 and post-treatment 11. Median percentage change in PAR for all patients was 73%, although 12% of cleft patients had a PAR improvement that was worse or no different. Median change in PAR score was 71% for those treated with orthodontics only and 83% for those who had an osteotomy. Median PAR improvement for those treated with orthodontics only was 73% in the cleft lip group, 77% in the CP group, 66% in the unilateral CLP group and 53% in the bilateral CLP group. Median pre- and post-treatment PAR for the cleft group was higher and PAR reduction lower than those published for non-cleft patients. Conclusion: These data demonstrate high severity of malocclusion, complexity of orthodontic treatment and difficulty in achieving an ideal static occlusion for cleft patients. If PAR is to be used to assess orthodontic outcomes in cleft patients the findings of this study should be considered. A higher proportion of cases are likely to be classed as ‘worse or no different’, and a lower percentage change will be expected.

The maxillary canine is commonly displaced or impacted. Monitoring the normal development of the dentition is important to identify and treat potential problems and hence minimise the need for later, more complex therapy. This paper discusses some problems that may occur and the subsequent treatment of these problems, by illustration with five case reports.

Traditional methods of achieving anchorage for orthodontic treatment are dependant on the presence of a sufficient number of teeth with adequate root support. With the success and predictability of osseo-integration, dental implants are being used frequently to obtain absolute anchorage. This case report illustrates the successful use of implants with a combined orthodontic-restorative approach to obtain anchorage in a partially dentate patient to correct a transverse cross-bite (scissor bite) relationship. The implants were subsequently restored to replace missing posterior teeth. The importance of a multi-disciplinary approach to planning and close liaison between the orthodontist, surgeon and restorative dentist during the treatment phase are discussed.

Bar glasses are often used as weapons in interpersonal violence. Violence often erupts spontaneously and assailants use objects close to hand as weapons. After an initial national Accident and Emergency Department study to identify glass designs most often implicated in interpersonal violence, the impact resistance of 1-pint beer glasses was tested in a materials laboratory with a Zwick 5102 pendulum impact tester. Both straight-sided (nonik) glasses (annealed and tempered) and handled tankards (annealed) were tested to destruction. The impact resistance of new glasses was compared with that of glasses subjected to wear. The mean impact resistance of new annealed noniks did not differ significantly although new glasses were significantly more resistant than worn glasses (p0.01). It was not possible to break any of the tempered glasses with the pendulum used (maximum impact energy, 4 J). When noniks had been scratched at the rim to mimic wear, tempered glasses also had the highest impact resistance (p0.01) whereas the mean resistance of the annealed noniks was not significantly different. When tempered glasses failed during testing, they all disintegrated into relatively harmless cubes of glass, particularly the thicker bases of glasses. In contrast, annealed designs fractured leaving sharp shards although the thicker bases remained intact. The mean impact resistance of new annealed noniks was 0.5 J, of worn annealed noniks 0.08 J, of tempered new noniks4 J, of worn tempered noniks 0.18 J, and of tankards, 1.7 J.(ABSTRACT TRUNCATED AT 250 WORDS)