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Objective: This case report presents a female adult patient who exhibits poor oral hygiene, a mutilated dentition with multiple missing teeth, and skeletal asymmetry. Clinical Considerations: Interdisciplinary treatment was necessary to maintain oral hygiene, treat caries, extract residual roots, and upright a horizontally impacted third molar using a miniplate. Additionally, orthodontic mini‐implants were utilized as anchorage to improve sagittal relationship and space closing. Space management was completed with orthodontic treatment, followed by restoration of the multiple missing teeth with dental implants. Conclusion: Consequently, an esthetic smile and functional occlusion were achieved by interdisciplinary treatment using orthodontic skeletal anchorage devices and dental implants. Clinical Significance: Missing mandibular first molar spaces were closed with retraction of the anterior teeth and protraction of the mandibular second molars using orthodontic mini‐implants. The mandibular right third molar, which should have erupted, was protracted with the second molar, while the horizontally impacted mandibular left third molar was uprighted using a miniplate and was protracted with an orthodontic mini‐implant. The missing maxillary lateral incisors were replaced with the maxillary canines, and the maxillary canines were replaced with the maxillary first premolars. The missing maxillary right second premolar and first molar and left first and second molars were successfully restored with dental implants. [ABSTRACT FROM AUTHOR]

Prosthodontic treatment of developmental age patients presents a significant challenge to the dentist. The growth and development of the stomatognathic system must be considered in treatment planning. Temporary prosthetic restorations must be regularly inspected and recemented, and final prosthetic restoration should not be delivered until the growth of the body is complete. In addition, due to the complex nature of morphological and functional disorders during the developmental period, simultaneous prosthetic and orthodontic treatment may be required. The case presented in this article is a 16-year-old boy with severe tooth destruction caused by untreated caries disease and poor oral hygiene. The patient required conservative, endodontic, and surgical treatment to restore the occlusion and aesthetics to allow the proper development of the masticatory organ. This article also presents the treatment case of a young patient with damaged crowns in the upper arch, which were restored with standard root–crown posts and cores and temporary 3D-printed composite crowns. [ABSTRACT FROM AUTHOR]

Background: While cognitive-behavioural therapy (CBT) is a well-established treatment for odontophobia, research is sparse regarding its effect on patients with dental anxiety related to psychological trauma experiences. This study aimed to evaluate changes in symptoms and acceptability of interdisciplinary Torture, Abuse, and Dental Anxiety (TADA) team treatment for patients with odontophobia or dental anxiety. We also wanted to describe the sample's oral health status. The TADA teams offer targeted anxiety treatment and adapted dental treatment using a CBT approach. Methods: The study used a naturalistic, case series design and included 20 consecutively referred outpatients at a public TADA dental clinic. Pre- and post-treatment assessments included questionnaires related to the degree of dental anxiety, post-traumatic stress, generalized anxiety, and depression. Patients underwent a panoramic X-ray before treatment. Before dental restoration, patients underwent an oral health examination to determine the mucosal and plaque score (MPS) and the total number of decayed, missing, and filled teeth (DMFT). Patients were referred to dentist teams for further dental treatment and rehabilitation (phase 2) after completing CBT in the TADA team (Phase 1). Results from the dental treatment in phase 2 is not included in this study. Results: All patients completed the CBT treatment. There were significant improvements in symptoms of dental anxiety, post-traumatic stress, and depression and moderate changes in symptoms of generalized anxiety. Dental statuses were heterogeneous in terms of the severity and accumulated dental treatment needs. The TADA population represented the lower socioeconomic range; 15% of patients had higher education levels, and half received social security benefits. All patients were referred to and started adapted dental treatment (phase 2). Conclusions: TADA treatment approach appears acceptable and potentially beneficial for patients with odontophobia and dental anxiety related to psychological trauma experiences. The findings suggest that further research, including larger controlled studies, is warranted to validate these preliminary outcomes. Trial registration: The study was approved by the regional ethical committee in Norway (REK-Midt: 488462) and by the Data Protection Board at Møre and Romsdal County Authority. [ABSTRACT FROM AUTHOR]

This paper describes the orthodontic treatment of two cases that were successful in winning the William Houston Gold Medal at the Membership in Orthodontics Examinations of the Royal College of Surgeons of Edinburgh in 2022. Both cases discuss the management of palatally impacted maxillary canines and treatment was initiated during the emerging COVID-19 crisis and completed over a 27-month period. The first case describes the management of a 15-year-old female with a Class II division 1 incisor relationship complicated by a palatally impacted upper left canine, moderate upper and lower arch crowding, and a lower centreline discrepancy with an associated right lateral displacement on closure. Treatment involved open surgical exposure of the impacted canine, a quad helix appliance, premolar extractions, and upper and lower fixed appliances. The second case describes the management of a 14-year-old female with a Class III incisor relationship complicated by bilaterally impacted maxillary canines, impeded eruption of the lower right second molar, moderate lower and severe upper arch crowding, and an upper centreline discrepancy. These case reports aim to demonstrate the high standards of care achieved by Orthodontic Specialty Trainee Registrars in the UK and provide aspirational standards for future trainees. [ABSTRACT FROM AUTHOR]

Introduction: The aim of these four case reports was to illustrate the presence of potential upper second molar impactions associated with ectopic third molars and to highlight that some cases have an atypical radiographic presentation. Case presentations: Four patients (age range = 7–12 years) with various malocclusions presented to the paediatric and orthodontic departments for treatment to address their presenting complaints. Incidental radiographic findings demonstrated potentially impacted upper second molars associated with ectopic third molars. In all of these cases, a joint paediatric-orthodontic approach was adopted to address their dental health, prevent upper second molar impaction and to treat their malocclusion. Discussion: Careful and systematic review of radiographic imaging was necessary in order to diagnose these cases correctly. These cases demonstrated that it was not always simple to determine impactions, particularly as identification of third molar crypts can be difficult. On occasion, sequential radiographic monitoring is advocated, particularly in patients in the mixed dentition; however, clinicians must be mindful of the risks of ionising radiation as it is not routine practice to irradiate a patient multiple times. Conclusion: The series of cases highlights the need for a systematic assessment of OPTs to identify ectopic upper third molars. The input from radiologists is invaluable and if necessary, supplemental three-dimensional cone-beam computed tomography can be performed. [ABSTRACT FROM AUTHOR]

Stage IV periodontitis is characterized, apart from high severity/complexity (attachment loss, radiographic bone loss, and deep probing depths), from loss of multiple teeth and/or alterations of the masticatory function. Periodontitis stage IV patients are often characterized by pathologic tooth migration, drifting, flaring, posterior bite collapse, and secondary occlusal trauma. These act as complexity factors not only for the management of periodontitis, but also for the prognosis of the whole dentition, and the majority of these patients present secondary malocclusions that require interdisciplinary treatment with orthodontics. However, the management of stage IV patients is complex and requires coordination between the periodontal and orthodontic specialist, while orthodontic treatment needs to be appropriately adjusted to the specificities of adult periodontally-stable patients with severely reduced periodontium. The aim of the paper is to discuss the orthodontic management of these patients, including conditions that need to be met for orthodontic treatment to start, treatment-related considerations pertaining to appliance choice and mechanotherapy, as well as post-treatment maintenance protocols to ensure long-term stability of the treatment results. Finally, an updated systematic review with meta-analysis is presented that summarizes clinical evidence on the effect of combined periodontal-orthodontic treatment for stage IV periodontitis patients with pathological tooth migration. [ABSTRACT FROM AUTHOR]

Altered passive eruption (APE) is a condition better known as 'gummy smile', patients affected by APE display short and square clinical crowns and an excessive display of gingiva when smiling. APE was classified as type 1 or 2 depending on its features, in type 1 the gingival margin is coronal to the CEJ, the teeth look short and squared, in type 2 the gingival margin seems to be at the right position, it is the bone crest that is not. The position of the bone crest is defined by sub types A and B. In subtype A the bone crest is located 1.5 to 2 mm apical to the CEJ while in subtype B the alveolar bone crest is located near the CEJ and in some cases even above the CEJ. Nowadays a case of APE can be studied and 3D planned with a full support of digital dentistry. Once the process of planning is completed, the surgical stent is produced by a 3D printer, the patient is recalled for fitting the surgical stent and final check -up and the surgical procedure is performed. A case where Vertical Maxillary Excess (VME) and APE were present together is showed and the diagnosis and interdisciplinary treatment demonstrated. [ABSTRACT FROM AUTHOR]

Preserving teeth is a long-term goal for each specialty of dentistry. Many times, it involves the use of interdisciplinary work and team effort to reach the desired goal. With the advancement of age and patient education, many patients have the desire to save their teeth as long as possible. Incorrect brushing techniques can lead to gingival recession, which, over a period of time, can advance to severe attachment loss of periodontal structures, causing complete denudation of the tooth root. Ultimately, it results in dentinal hypersensitivity and, consequently, chronic pulpitis. Over a period of time, it can result in food lodgment and the development of a periodontal pocket. Many times, the patient reports at the advanced stage of the disease when the treatment becomes complicated and requires interdisciplinary approaches. [ABSTRACT FROM AUTHOR]

The aim of our article is to highlight the history of pain management. The multidisciplinary team (MDT) concept in confronting pain was first conceptualized by the Hippocratics, and has evolved through time and become a trend in medicine over recent decades. Documentary research was conducted to unveil the story of the evolution of MDTs. From the early 1950's the idea of an MDT approach to deal with various types of pain was sporadically introduced in medicine. Studies encouraged health institutions to support this concept by providing health professionals with training, alongside the necessary facilities and resources. Specialized care programs started with Dame Cicely Mary Strode Saunders as one of the pioneers. Conclusions. Team work and continuous interdisciplinary treatment of pain have rendered MDTs essential for health systems. Barriers in flexibility, information flow and personal issues give rise to the need for better organization and training. Pain and terminal disease palliation call for MDTs, and educated leaders to run them. Present and future health MDTs are considered necessary in all medical fields. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The treatment management of patients with hemifacial microsomia (HM) includes both surgical and nonsurgical approaches and depends primarily on the degree of deformity of the facial and skeletal structures. In this context, the combined efforts of the maxillofacial surgeon, the orthodontist, and the prosthodontist are essential for a satisfactory functional and esthetic outcome. Case presentation: A 31-year-old man presented with a chief complaint of facial asymmetry. The patient had been diagnosed with HM on the right side, with severe external ear deformity, and hypoplasia of the facial muscles and the zygomatic bone. The intraoral examination showed a Class I molar and canine relationship with a reduced horizontal overlap and an occlusal plane canting. The maxillary anterior teeth were severely worn due to traumatic occlusion. Orthodontic treatment in conjunction with combined orthognathic surgery was planned to address the facial asymmetry. Ramus distraction osteogenesis was carried out, followed by conventional presurgical orthodontic treatment. The treatment was completed by prosthetic rehabilitation for the reconstruction of the maxillary teeth and fine occlusal adjustment. Conclusion: The cooperation between the orthodontist, surgeon, and prosthodontist becomes indispensable when treating complex cases of HM. An interdisciplinary approach should be adopted from the start of treatment, promoting integrated customized care. [ABSTRACT FROM AUTHOR]

Objective: This case report demonstrates an interdisciplinary approach to treat a 26‐year‐old male patient with hyperdivergent Class II skeletal pattern, maxillary transverse deficiency, slight anterior open bite, and multiple hopeless teeth with root rests. Clinical Considerations: An interdisciplinary treatment was required for oral hygiene improvement, caries treatment, extraction of residual roots and hopeless teeth, maxillary expansion using microimplant‐assisted rapid palatal expansion, improvement of skeletal and dental relationship using orthodontic microimplants, and prosthetic restorations with the aid of dental implants. Conclusion: Consequently, esthetic and functional occlusal rehabilitation was achieved. Clinical Significance: Hyperdivergent Class II facial and skeletal patterns with multiple missing teeth can be effectively treated using orthodontic skeletal anchorage. In young adults, the transverse discrepancy can be resolved using MARPE, which is also useful for improving the sagittal and vertical relationships. In the case of multiple missing teeth, orthodontic treatment can provide the proper space to facilitate dental implants to achieve optimal esthetics and function. [ABSTRACT FROM AUTHOR]

Background: Vascular malformations are rare diseases that should be treated in dedicated vascular anomaly centers (VAC). There is only a small amount of data on the diagnostic and therapeutic handling of these patients, before they are referred to a VAC. Purpose: To demonstrate the disease-specific patient characteristics in a German VAC, which are required to determine diagnostic and therapeutic steps. Material and Methods: In a retrospective study, all patients who were treated in the VAC from April 2014 until August 2021 were identified. In total, 593 patients were included in this study. Results: Almost all patients had previously consulted a physician (591/593, 99.7%). A mean of two different physicians had been consulted (range 0–10). Patients with more complex, syndromal vascular malformations had significantly more previous appointments (P = 0.0018). In only 44% (261/593) of patients, the referral diagnosis was made correctly. Most patients had been previously treated for their vascular anomaly: pharmacotherapy (n = 130; 21.9%), compression garments (n = 141; 23.8%), surgical resection (n = 80; 17.3%) and sclerotherapy (n = 68; 11.5%). Fifty-two patients who had been falsely diagnosed had also received therapy prior to their referral to the VAC (8.8%). Most patients received an ultrasound examination in the VAC (n = 464; 78.2%). Most frequently, compression therapy was prescribed (n = 256; 43.2%), followed by sclerotherapy (n = 175, 29.5%) and pharmacotherapy (n = 55; 9.3%). Conclusion: Patients suffering from vascular anomalies often go through a complicated scheduling with numerous outpatient appointments and have a high risk of misdiagnosis and mistreatment prolonging the medical condition. Therefore, patients with vascular anomalies should be treated in a dedicated vascular anomaly center. [ABSTRACT FROM AUTHOR]

A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician. The same lingual arch was later used as an anchorage method for traction of the retained teeth. The final records showed complete resolution of the cyst and retained teeth were successfully Aligned into the oral cavity. [ABSTRACT FROM AUTHOR]

The maxillary permanent central incisor (MPCI) has been reported to be rotated in up to 96% of cleft patients. A severely rotated MPCI is highly visible when smiling, drawing attention to a repaired cleft lip, and is often the main presenting complaint of a patient with cleft lip and palate attending for orthodontic treatment. The benefit of interceptive orthodontic treatment to alleviate these concerns must be weighed up against the consequences of adding to the already substantial orthodontic burden likely to be faced by these patients. Despite the high prevalence of this dental abnormality among cleft patients, there is little published in the literature regarding this type of malocclusion. This paper explores the aetiology, presentation and management of this condition, using examples from cases treated within our department. In addition, the commonly found pre-existing anomaly of a short root length is discussed, in combination with the implications this may have upon orthodontic treatment planning for a rotated MPCI. [ABSTRACT FROM AUTHOR]

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Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow‐up in BCS and identify variables related to improvements in HRQoL. Materials and Methods In a non‐randomised quasi‐experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC‐QLQ‐C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal–Wallis test, Chi‐square and Fisher tests and generalised linear models. Results After 6 weeks, statistically significant differences were apparent in global and cancer‐related health symptoms such as fatigue and pain in the EORTC QLQ‐C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ‐C30) in the multivariable model. Conclusions The results of our study suggest that a 6‐week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial.

A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted bleeding from the lips with evidence of a herpes simplex infection in the region of the right buccal commissure. A diagnosis of oral erythema multiforme (EM) was made after a detailed clinical history and examination by the oral and maxillofacial team. Supportive care was provided alongside management with topical corticosteroids. Within 6 weeks of initial presentation, complete resolution of the lesions had occurred and the patient was able to resume active orthodontic treatment. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground Chronic pain is a complex condition that poses challenges in assessment and treatment. Primary care teams, especially in rural areas, may have a role in managing this population, providing interprofessional care to optimize patient outcomes. Tools are needed to aid these clinicians in assessing chronic pain.Aims The aim of this article is to present the case application of a clinical reasoning framework proposed by Walton and Elliott, which is used to identify drivers of chronic pain in a 61-year-old male patient with a remote history of spinal injury. Furthermore, it aims to demonstrate that an interprofessional, individualized intervention strategy can improve patient outcomes.Methods This case took place in a multidisciplinary primary care team in rural northern Ontario, Canada. An assessment was completed by the author, including collection of the patient’s history, a medication review, and the use of multiple validated patient-reported outcome measures (PROMs), all of which were used in applying the framework.Results Three relevant drivers of his pain experience were identified: central nociplastic, cognitive/belief, and emotional/affective. A pharmacist and social worker then used multimodal interventions to address these drivers, which yielded improvements in scores on multiple validated pain measures but also improved the patient’s self-reported quality of life.Conclusions A clinical reasoning framework can provide a basis for identifying drivers of chronic pain during assessment and guide primary care clinicians to targeted interventions. Broader applications of this framework by primary care providers could serve to increase capacity for managing chronic pain in Canada.

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The case report presents an interdisciplinary treatment of a 65-year-old patient in whom an improper zirconium oxide-based prosthetic crown on tooth 21 resulted in occlusal trauma, causing displacement and extrusion of the tooth as well as its increased mobility to the second degree according to the Miller scale. The change in the position of tooth 21 led to the displacement of the teeth in the lower arch. The traumatic occlusion was eliminated with a short clear aligner treatment of fourteen aligners (seven basic and seven additional) of both arches followed by aligner retention. The treatment lasted 140 days. A clinical improvement in the periodontal condition and long-term increased stabilization of the loose tooth was obtained. After one year of retention, the tooth is still stable, and no sign of periodontal disease or recurrence of the occlusal trauma is noticeable. [ABSTRACT FROM AUTHOR]

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Abstract Background Retinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia. Case presentation We present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained. Conclusion In an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical–orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.

Background There is limited information regarding the effects of pediatric chronic pain management on the number and cost of chronic pain–related emergency department (ED) consultations.Aim This retrospective study aimed to evaluate the number and costs of chronic pain–related ED consultations of children and adolescents with chronic pain conditions at the Montreal Children’s Hospital (MCH).Methods Charts of patients followed by the Edwards Family Interdisciplinary Center for Complex Pain (CCP) of the MCH between April 2017 and December 2018 were reviewed. ED consultations, specialist consultations, medication prescriptions, hospital admissions, and outpatient consultation referrals were assessed for the period of 1 year before and after the patients’ first consultation with the CCP. Associated costs were also calculated.Results One-hundred sixty-eight patients were included in the analysis. Fifty-one percent consulted the ED and had 151 chronic pain–related ED consultations within 1 year before their initial CCP consultation. In the year following their first CCP consultation, 52 patients (31%) consulted the ED, of which 24 consultations were chronic pain–related (84% reduction). There was an 81% reduction in the costs associated with chronic pain–related ED consultations within 1 year after CCP management. In addition, there was a significant reduction in ED interventions within 1 year after CCP management, though there was no change in medication prescriptions, hospital admissions, or subspecialist consultations.Conclusion Children and adolescents with chronic pain conditions had fewer chronic pain–related ED consultations within 1 year after the first evaluation by an interdisciplinary center for complex pain, contributing to reduced ED costs.

Background: Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow‐up in BCS and identify variables related to improvements in HRQoL. Materials and Methods: In a non‐randomised quasi‐experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC‐QLQ‐C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal–Wallis test, Chi‐square and Fisher tests and generalised linear models. Results: After 6 weeks, statistically significant differences were apparent in global and cancer‐related health symptoms such as fatigue and pain in the EORTC QLQ‐C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ‐C30) in the multivariable model. Conclusions: The results of our study suggest that a 6‐week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial. [ABSTRACT FROM AUTHOR]

Background Young adults with chronic pain and symptoms experience disruptions to their social, emotional, physical, and vocational functioning. Interdisciplinary pain rehabilitation programs for pediatric and adult populations are not designed specifically to address the developmental needs of young adults. Methods This article describes the development of a novel intensive interdisciplinary outpatient rehabilitation program tailored to the unique needs of young adults with chronic pain and symptoms. Tailored content included vocational assessment and consultation, financial literacy education, and sexual health education. Results Outcome data demonstrate treatment gains, with reductions in pain interference, pain severity, pain catastrophizing, and depressive symptoms, as well as improvements in mental and physical quality of life, perceived performance, perceived satisfaction with performance, and objective measures of physical functioning. Conclusions The article concludes with clinical recommendations for the management of chronic pain and symptoms in young adults, applicable across multiple treatment settings. [ABSTRACT FROM AUTHOR]

Young patients with a severely traumatized maxillary central incisor have limited possibilities to restore its loss. Autotransplantation of immature premolars has been documented as a predictable long-term outcome with the potential for preservation and regeneration of alveolar bone. They can also be successfully reshaped to the central incisor's morphology using direct composite build-ups. However, tooth transplantation is a technique sensitive procedure and requires good case selection, an understanding of relevant tooth transplantation biological principles and careful execution of the optimal surgical and follow-up protocols. Orthodontists play an important role in cooperation with the surgeon before and after surgery. This includes selection of suitable candidates based on orthodontic evaluation of occlusion and indications for premolar extraction, opening adequate space before transplantation and post-surgical alignment of the transplant for an optimal reshaping and establishing a stable occlusion. The aim of the paper is to present clinical application of autotransplanation of immature premolars to replace a traumatized central incisor in growing patients and to discuss the role of an orthodontist in the interdisciplinary team. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To survey standardization of treatment in Norwegian hospitals and to investigate whether this affected 30-day mortality and quality of life after hip fracture surgery. Findings: Only two out of three hospitals had a standardized clinical pathway for hip fracture patients. A standardized clinical pathway for hip fracture patients was associated with reduced 30-day mortality and higher functional level. Message: A standardized clinical pathway should be implemented at all hospitals treating hip fracture patients. Purpose: A standardized clinical pathway is recommended for hip fracture patients. We aimed to survey standardization of treatment in Norwegian hospitals and to investigate whether this affected 30-day mortality and quality of life after hip fracture surgery. Methods: Based on the national guidelines for interdisciplinary treatment of hip fractures, nine criteria for a standardized clinical pathway were identified. A questionnaire was sent to all Norwegian hospitals treating hip fractures in 2020 to survey compliance with these criteria. A standardized clinical pathway was defined as a minimum of eight criteria fulfilled. Thirty-day mortality for patients treated in hospitals with and without a standardized clinical pathway was compared using data in the Norwegian Hip Fracture Register (NHFR). Results: 29 out of 43 hospitals (67%) answered the questionnaire. Of these, 20 hospitals (69%) had a standardized clinical pathway. Compared to these hospitals, there was a significantly higher 30-day mortality in hospitals without a standardized clinical pathway in the period 2016–2020 (HR 1.13, 95% CI 1.04–1.23; p = 0.005). 4 months postoperatively, patients treated in hospitals with a standardized clinical pathway and patients treated in hospitals without a standardized clinical pathway reported an EQ-5D index score of 0.58 and 0.57 respectively (p = 0.038). Significantly more patients treated in hospitals with a standardized clinical pathway were 4 months postoperatively able to perform usual activities (29% vs 27%) and self-care (55% vs 52%) compared to hospitals without a standardized clinical pathway. Conclusion: A standardized clinical pathway for hip fracture patients was associated with reduced 30-day mortality, but no clinically important difference in quality of life compared to a non-standardized clinical pathway. [ABSTRACT FROM AUTHOR]

Background: Complex scalp defects are regularly reconstructed using microvascular tissue transfer. The latissimus dorsi free flap is one of the workhorse flaps used in scalp reconstruction. These cases necessitate, particularly in the elderly, a close cooperation between plastic surgeons and neurosurgeons. The purpose of this study was to evaluate the suitability of the latissimus dorsi free flap for complex scalp reconstructions and to analyze potential risk factors. Methods: A retrospective study identified 43 patients undergoing complex scalp reconstruction using a latissimus dorsi free flap at our department between 2010 and 2022. Results: The mean patient age was 61 ± 18 years. Defects were mostly caused by oncologic tumor resections (n = 23; 55%), exposure to a cranioplasty (n = 10; 23%) or infection (n = 4; 9%). The most frequent recipient vessels were the superficial temporal artery (n = 28; 65%), external carotid artery (n = 12; 28%) and the venae comitantes (n = 28; 65%), external jugular vein (n = 6; 14%). The reconstructive success rate was 97.7%. There was one total flap loss (2%). Partial flap loss occurred in five cases (12%). Follow-up was 8 ± 12 months. Major complications were seen in 13 cases, resulting in a revision rate of 26%. Multivariate logistic regression identified active tobacco use as the only risk factor for major complications (odds ratio 8.9; p = 0.04). Conclusion: Reconstruction of complex scalp defects using the latissimus dorsi free flap yielded high success rates. Among the potential risk factors, active tobacco use seems to affect the outcome of complex scalp reconstructions. [ABSTRACT FROM AUTHOR]

Introduction: Management of mutilated cases is challenging, and adult patients often require orthodontic correction of occlusion before prosthetic replacement of missing teeth. Objective: To highlight the novel, simple, hygienic, and efficient miniscrew-supported Beta titanium molybdenum alloy (TMA) cantilever spring for uprighting severe mesially tipped molars for interdisciplinary treatment. Diagnosis and Treatment: A 23-year-old male patient presented with skeletal Class I relation, average growth pattern, Class II Division 1 malocclusion with dentoalveolar collapse, crowding, multiple missing, supraerupted teeth, and severe mesially tipped mandibular third molars. MBT appliance with 0.022˝ slot was used to achieve the objectives. 38 and 48 were uprighted and protracted with miniscrew implant-supported TMA cantilever springs to substitute 37 and 47. Mild intrusion of maxillary posterior teeth was done with acrylic bite blocks and transpalatal arch (TPA), followed by prosthetic replacement of missing teeth. Results: The patient had a consonant smile arc and a pleasing soft tissue profile. 38 and 48 were uprighted and protracted with good vertical control, and the mesial pockets were eliminated. 17 and 27 were intruded, and group function occlusion was established. Class I canine relationship, normal overjet, and overbite were achieved. Conclusion: Miniscrew supported TMA cantilevers are efficient for uprighting of severely tipped 38 and 48 without extrusion, unlike the conventional mechanics. 18, 28, 38 and 48 with good root forms can be protracted and substituted as 17, 27, 37 and 47 respectively to minimize or eliminate prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6–93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8–214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. Conclusions: Pancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.

A 16‐year‐old girl developed severe acute periodontitis involving the maxillary central incisor and lateral incisor caused by elastic bands. Periodontal surgical interventions and orthodontic adjustment achieved good outcomes which were maintained for 7 years. This report demonstrates the criticality of correct diagnosis, early periodontal surgery, and interdisciplinary approach. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic pain management multi/interdisciplinary programs attempt to address all elements of the biopsychosocial model. The primary objective of this retrospective study (based on practice-based audit) was to determine the effectiveness of a patient-centered, comprehensive and intense interdisciplinary pain management program in a publicly funded community-based pain clinic in the Greater Toronto Area. Method This retrospective longitudinal study was conducted on 218 carefully selected sequential chronic pain patients, with 158 completing a 3–4-month interdisciplinary program between January 2016 and December 2018. Data collected upon exit, at 6 months and 12 months post-discharge included demographic information, pain characteristics, emotional/functional status obtained by validated instruments and global impression of change (GIC). Additionally, social health outcomes (return to work or school) were retrieved through retrospective chart review. Means of pre-and post-program variables were compared to assess changes of each patient’s “journey”. Results Physical and mental/ emotional health outcomes at exit, 6 months and 12 months post-discharge, showed initial and sustained, statistically and clinically significant improvement from pre-treatment levels, with GIC (much/very much improved) reported as 77%, 58% and 76%, respectively. Additionally, a substantial positive change in social health outcomes was noted particularly in patients on disability (29%), part time workers gaining full time employment (55%), and students (71%) who improved their level of schooling. Conclusion The study showed that careful patient selection in a community-based publicly funded interdisciplinary pain management program can produce significant improvement in pain, physical, mental/emotional health and social function, with sustained long-term outcomes.

Abstract Background An interdisciplinary treatment simulation and smile design before a complex esthetic rehabilitation is important for clinicians’ decision-making and patient motivation. Meanwhile, intervention and interaction are necessary for dental specialists in these complex rehabilitations. However, it is difficult to visualize an interdisciplinary treatment plan by using the conventional method, especially when orthognathic surgery is involved, thus hindering communication between dental specialists. This research aims to establish a 3D digital workflow of interdisciplinary treatment simulation to solve this problem. Methods An interdisciplinary 3D digital workflow of simulated treatment plan for complex esthetic rehabilitation was established. Eleven patients were enrolled and illustrated with their treatment plans using 3D treatment simulation, as well as 2D digital smile design (DSD) plus wax-up. Visual analogue scales (VAS) were used to rate the intuitiveness, understanding, and satisfaction or help between the two methods by patients and dental specialists. Results According to the ratings from the patients, 3D treatment simulation showed obvious advantages in the aspects of intuitiveness (9.7 ± 0.5 vs 6.4 ± 1.4) and treatment understanding (9.1 ± 0.8 vs 6.6 ± 1.5), and the satisfaction rates were also higher (9.0 ± 0.6 vs 7.1 ± 1.8). Dental specialists regarded the 3D digital plans as more intuitive (8.9 ± 0.8 vs 5.9 ± 1.0) and useful to understand the plans from the other specialists (8.9 ± 0.7 vs 6.1 ± 1.0) and helpful to their own treatment plans (8.7 ± 0.9 vs 5.9 ± 1.4). Conclusions The interdisciplinary 3D digital treatment simulation helps both patients and dental specialists to improve treatment understanding, and facilitates dental specialists for decision-making before complex esthetic rehabilitation. Trial registration This study was registered in the National Clinical Trials Registry under the identification number MR-11-20-002862. This is an observational study in which we did not assign the intervention.

Abstract A 16‐year‐old girl developed severe acute periodontitis involving the maxillary central incisor and lateral incisor caused by elastic bands. Periodontal surgical interventions and orthodontic adjustment achieved good outcomes which were maintained for 7 years. This report demonstrates the criticality of correct diagnosis, early periodontal surgery, and interdisciplinary approach.

To find the effect of extraction of the lower first permanent molar in children (aged 8–11 years) on the position and angle of the developing third molar. Retrospective radiographic analysis. Two cohorts of participants were identified: an extraction group, who had extraction of one or more first permanent molars aged 8–11 years; and a non-extraction group, who retained all mandibular teeth. Both cohorts previously had panoramic radiographs taken at mean ages of 9.7 years (T1), before extraction, and 12.12 years (T2). In total, there were 61 third molars with an associated extracted first permanent molar and 60 third molars with an associated retained first permanent molar. A digital radiographic analysis was carried out on the panoramic radiographs to measure the movement of the third molar, vertically and horizontally, and its angle. The magnification of the T1 and T2 radiographs was calibrated. Reliability of the radiographic analysis was confirmed via intra- and inter-rater reliability tests. The extraction and non-extraction groups were compared via independent sample tests The third molar moved significantly more mesial in the extraction group (P < 0.001) and the angle uprighted significantly more than the non-extraction group (P < 0.001). Vertically, the third molar moved inferiorly in both cohorts with no significant difference. In the developing dentition, extraction of the lower first permanent molar encouraged mesial movement and uprighting of the developing third molar. This may improve the likelihood of future eruption of the third molar. [ABSTRACT FROM AUTHOR]

A seven-year-old boy with a repaired bilateral cleft lip and palate, presented with a severe skeletal II base and an extremely prominent premaxilla. He had grossly incompetent lips with lower lip trapping, an 18.5-mm overjet, a deep overbite, markedly retroclined lower incisors, bilateral crossbites and 12-mm-wide alveolar gaps together with 6-mm vertical steps between the extruded premaxillary incisors and the posterior teeth. Before the eruption of the permanent canines, there was an urgency to approximate the opposing cleft alveolar margins and to level the split maxillary occlusal plane, in order to facilitate the successful insertion and subsequent consolidation of secondary alveolar bone grafts. A new functional appliance was therefore designed to achieve this objective, which drew components from Fränkel's FR I and FR III function regulators. Together with a couple of novel components, it created a hybrid appliance, namely the function regulator for juveniles with a bilateral cleft and a prominent premaxilla: the FR-BCPPm. The patient was treated with this appliance and a nocturnal headgear at 7–13 years, together with a concomitant quad helix appliance followed by a transpalatal arch and bilateral bone grafts. He was then treated non-extraction up to the age of 17 years with preadjusted fixed appliances to correct his residual, crowded Class II malocclusion. The marked improvement in his occlusion, dentofacial appearance and his perioral function after a decade of treatment was then followed up over 20 years, during which time mild relapse of the incisor overjet and moderate recurrence of the lower anterior misalignment was noted two years after treatment. While no further relapse was observed at the four-year post-treatment review, by 20 years after treatment, a little further misalignment of the lower anterior teeth was noted, half of which was deemed to be attributable to age-related maturation. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this systematic review was to determine the best treatment alternatives for patients with maxillary lateral incisor agenesis (MLIA) by comparing orthodontic space closure, implant and tooth supported dental prostheses by assessing studies that evaluated their periodontal, occlusal (function) and aesthetic results., Methods: The present systematic review was reported according to the indications of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) incorporating network meta-analysis, and the protocol was registered with PROSPERO (CRD42023487245). The PRISMA systematic search, without restriction on language or initial date, was carried out using electronic databases: MEDLINE (PubMed), Scopus and central register of controlled trials. To assess the aesthetic effects of the different treatment methods, an arm-based network meta-analysis was carried out., Results: The systematic search initially produced 1177 studies. At the end 10 studies met the inclusion criteria. These studies used various methods of treatment for maxillary lateral incisor agenesis including orthodontic space closure, implant-supported and tooth-supported dental prostheses. Data were extracted from the articles selected, and a network meta-analysis was carried out., Conclusions: Within the limits of this network meta-analysis, no significant difference was found regarding the aesthetic results between orthodontic space closure or dental implant. Tooth-supported dental prostheses for MLIA reported worse scores in the periodontal indexes than orthodontic space closure treatment but the impact of orthodontic and prosthetic treatment on periodontal health remained contentious. Furthermore, no signs of TMJ dysfunction were observed in patients treated with either orthodontic space closure or prosthetic replacement., (Copyright © 2024 CEO. Published by Elsevier Masson SAS. All rights reserved.)

The case report presents an interdisciplinary treatment of a 65-year-old patient in whom an improper zirconium oxide-based prosthetic crown on tooth 21 resulted in occlusal trauma, causing displacement and extrusion of the tooth as well as its increased mobility to the second degree according to the Miller scale. The change in the position of tooth 21 led to the displacement of the teeth in the lower arch. The traumatic occlusion was eliminated with a short clear aligner treatment of fourteen aligners (seven basic and seven additional) of both arches followed by aligner retention. The treatment lasted 140 days. A clinical improvement in the periodontal condition and long-term increased stabilization of the loose tooth was obtained. After one year of retention, the tooth is still stable, and no sign of periodontal disease or recurrence of the occlusal trauma is noticeable.

To obtain opinions from orthodontic colleagues nationally on how they currently manage orthodontic patients with oral piercings. The secondary objectives were to assimilate the national opinions from the survey and attempt to generate educational material as an advice sheet and a patient information leaflet for the professionals and the patients respectively for the British Orthodontic Society (BOS). Cross-sectional survey. Primary and secondary care orthodontic providers. Members of the BOS. An electronic questionnaire was developed and circulated to members of the BOS to obtain their opinions on the effects of oral piercings on their patients' orthodontic treatment 'journey'. In addition, the need for the development of informative material around the management of orthodontic treatment and appliances in patients with oral piercings was explored. A total of 110 responses were received. However, only 88 respondents out of 110 attempted all the questions within the survey. There were 22 respondents who attempted it partially. We did include these partial responses well while analysing the results, since many of these offered personalised comments in the free-text boxes within the survey. The most common general complications associated with oral piercings were inflammation of the surrounding tissue and enamel/dentine wear. Moreover, orthodontic complications, reported commonly, were inadequate oral hygiene maintenance, entanglement with the orthodontic appliance causing damage and interference with retainers. Most respondents expressed the need for the development of a web-based patient information leaflet and an advice sheet as educational tool, both of which have been proposed to and agreed by the BOS before submission of this publication. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this case report is to present a novel digital approach of guiding orthodontics and periodontal surgery by creating interim restorations that represent the final shape of the teeth before starting the treatment. Clinical considerations: The patient presented with worn dentition, super‐erupted maxillary and mandibular anterior teeth, and altered passive eruption, all this creating a gummy smile. Following a digital wax‐up design, a digital orthodontic set‐up, and the digital bracket bonding, temporary restorations, and bracket indirect bonding trays were fabricated. Restorations' cementation, bracket bonding, and periodontal surgery were performed the same day. After 14 months of orthodontic treatment, teeth were restored with final ceramic restorations. One year and 6 months was the total treatment duration. Conclusion: Prosthetically guided orthodontic concept allows the use of digital technology to simulate the final outcome of the patient treatment before starting dental therapy. This technique not only improves the communication between specialists, it also reduces treatment time and increases precision and predictability. Clinical significance: The prosthetically guided orthodontics (PGO) concept has the goal to start interdisciplinary therapy with a simulation of the final outcome. Giving the worn teeth their proper size through interim restorations prior to orthodontic therapy will guide the orthodontist from the beginning of the treatment and will improve communications between all the specialists. Through a digital approach, a digital wax‐up and an orthodontic digital set‐up the objectives of treatment can be established early on. [ABSTRACT FROM AUTHOR]

The periodontal therapy of severely damaged teeth that have advanced bone loss, a significant degree of mobility, and often tooth migration and elongation, frequently exposes the dental clinician to difficult decisions regarding the appropriate therapy for the patient. Extensive rehabilitation, with the replacement of periodontally hopeless teeth, has biologic, prognostic, and financial limitations. A possible alternative in such cases is the transreplantation of periodontally hopeless teeth. Ankylosis of the tooth is induced by appropriate extraoral pretreatment and thus the mobility disappears and the alveolar bone is reformed. This little-known technique is described step by step, with reference to a clinical case. [ABSTRACT FROM AUTHOR]

To examine the diagnostic value of orthopantomograms (OPG) in the identification of root resorption of lateral incisors, secondary to an impacted canine, as confirmed by a cone-beam computed tomography (CBCT) scan. Retrospective observational cohort study. South Wales secondary care setting: Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny. A total of 40 consecutive patients with impacted canines between January 2018 and December 2019 were selected. For each patient, one consultant orthodontist examined the OPG in isolation to detect the presence and extent of resorption of lateral incisors. The CBCT report was then studied to confirm the presence and extent of pathology. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values were calculated. In total, 19 maxillary right canines, 18 maxillary left canines, one mandibular right canine and two mandibular left canines were examined. Impactions were more prevalent in the maxilla (92.5%) with higher predilection towards female patients (65%). There was higher prevalence of root resorption in the maxillary right quadrant (57.1%), in concordance with other studies. OPGs were found to have a sensitivity of 81.0% and a specificity of 10.5%, with an accuracy value of 47.5%. Positive and negative predictive values were found to be 50.0% and 33.3%, respectively. The extent of root resorption was incorrectly estimated from the OPG in 84% of cases. Correct estimation occurred in 16% of cases, with overestimation and underestimation occurring in equal proportion (42%). This study demonstrates the limitations of plain film radiographs and the merits of using CBCT in the accurate diagnosis of resorption of lateral incisors with an associated impacted canine. It also gives an indication into the location prevalence of resorption in a small cohort of patients. This preliminary study establishes the basis for future, larger-scale studies where outcomes can be generalisable at a population level. [ABSTRACT FROM AUTHOR]