Abstract: Periodontal research over the last 40 years has been remarkably prolific. We now understand that severe periodontitis affects approximately 10-15% of the population (representing a large number of individuals in the UK) and gingivitis and mild periodontitis affect a majority of people. Microbiological research has identified some of the key pathogens that are implicated in periodontal disease. Plaque bacteria exist in biofilms, which have evolved to protect individual organisms within the subgingival bacterial community. For this reason, root surface instrumentation (RSI) remains the cornerstone of periodontal treatment, and is necessary to disrupt the subgingival biofilm mechanically and reduce the bacterial bioburden. Although bacteria are necessary for periodontal disease to occur, a susceptible host is also required. The immune-inflammatory response that develops in the gingival and periodontal tissues in response to the chronic presence of plaque bacteria results in destruction of structural components of the periodontium leading, ultimately, to the clinical signs of periodontitis. The nature of the host response is determined primarily by genetic factors and environmental and acquired factors such as smoking. The host response is essentially protective in nature, but both under-activity (hypo-responsiveness) and over-activity (hyper-responsiveness) of aspects of the host response can result in enhanced tissue destruction. The purpose of this paper is to review current thinking in periodontics with special reference to periodontal epidemiology, microbiology, and pathogenesis.

Abstract: The discoloured, non-vital anterior tooth is a common aesthetic concern for many patients. It can have a profound effect on their self-esteem, interaction with others and employability. Discoloured non-vital teeth are frequently compromised owing to previous trauma, caries, endodontic therapy and failed restorations. Destructive invasive treatment options are likely to weaken the residual structure of the tooth. This can reduce the prognosis and challenge the long-term viability of the tooth, thereby initiating further prosthetic predicaments. This paper discusses modern approaches to the treatment of discoloured teeth. The importance of preventing and eliminating the potential for discoloration will be highlighted. The paper will include a detailed technical account on the application of the inside/outside bleaching technique, with several clinical examples.

Abstract: This article explores the various treatment options available to replace missing teeth with a fixed prosthesis. It discusses the requirements for each treatment modality and its associated advantages and disadvantages.

Abstract: Many dental practitioners do not use adhesive bridges because of concerns over high failure rates. Techniques for these restorations should be based on the fundamental principles of bridge design which require rigid, accurately fitting frameworks and careful control of the occlusion. The abutments generally require little if any tooth preparation. Greater security will result from more extensive coverage of abutment teeth: the routine use of relative axial tooth movement is a predictable method for creating the space that this approach requires.

Abstract: The correction of transverse maxillary deficiency can be an important component of an orthodontic treatment plan. A number of different techniques are available for the correction of such discrepancies. The aim of this article is to review the methods available to clinicians discussing their indications, advantages and disadvantages.

Abstract: The emerging worldwide problem of bacterial resistance has resulted from overuse and misuse of systemic antibiotics. It is appropriate therefore to review periodontal treatment strategies to determine whether systemic antibiotics have a role to play in the management of periodontitis. For the great majority of patients presenting with periodontal conditions, systemic antibiotics are not indicated. Instead, treatment should focus on mechanical disruption of plaque biofilms, plaque control and risk factor modification. Systemic antibiotics may be indicated in severe spreading infections, some aggressive forms of periodontitis, and necrotizing periodontal conditions. These conditions present infrequently in general practice, most will require referral to a periodontal specialist and the decision to use systemic antimicrobials as part of periodontal management is more appropriately taken within a specialist centre. Systemic antibiotics are not indicated in the vast majority of periodontal conditions encountered in general dental practice.

Abstract: Alzheimer's disease (AD) is the commonest form of dementia, closely associated with age, but also with other causative factors. AD affects half a million people in the UK, and presents dentists with numerous behavioural and clinical challenges. The aetiology, diagnosis and medical treatment for persons with AD are discussed, together with communication strategies and issues related to families and care-givers. Realistic dental treatment planning for patients in early, moderate and late stage AD is considered in conjunction with relevant ethical issues. Dentists have the potential to improve markedly the quality of life for people with AD.

Abstract: Diabetes is a common condition. Its incidence is increasing. It can lead to medical complications including visual impairment, neuropathies, renal and cardiovascular disease. Diabetes can have an adverse effect on oral health and health-care. Conversely, poor oral health can have an adverse effect on blood glucose control. Repeated oral infections can indicate uncontrolled diabetes and lead to its diagnosis. Whereas hyperglycaemia may occur in untreated diabetes, hypoglycaemic episodes are not uncommon in well-controlled diabetes Type 2. The tight glycaemic control required to prevent its long-term complications can be destabilized by infection, anxiety or missed meals.

Abstract: Dentigerous cysts develop from unerupted and impacted permanent teeth. Very rarely, supernumerary teeth are associated with dentigerous cysts and constitute about 5–6% of all dentigerous cysts. Although these cysts are not common in the first decade of life, regular thorough inspection of radiographs is of importance, as indicated by this case report. This case shows how an impacted supernumerary canine developed a dentigerous cyst, engulfing the whole of the maxillary antrum.

Abstract: The surgical management of patients on anticoagulant therapy is often poorly understood in all fields of medicine (not just dentistry). Until now there has been no uniform approach to managing these patients and much of the advice routinely given by medical practitioners and haematologists has fallen behind the recent evidence. Many medical conditions from atrial fibrillation to prosthetic heart valves predispose patients to venous thrombosis and pulmonary embolism (Table 1). In order to prevent these complications, these patients are normally placed on an anticoagulant. By far the most common one in use is Warfarin, which is a derivative of 4 hydroxycoumarin.

Abstract: This paper outlines the current knowledge about the interaction between various groups of drinks and tooth surface loss. It begins by examining how the erosive effects of drinks are assessed in the laboratory and clinically. It then surveys the current erosive effects of various groups of drinks, including carbonated drinks, mineral waters, alcopops, ciders, beers, wine and fruit teas.

Abstract: Bonding to dentine is an integral part of contemporary restorative dentistry, but early systems were not user-friendly. The introduction of new systems which have a reduced number of steps--the self-etch adhesives--could therefore be an advantage to clinicians, provided that they are as effective as previous adhesives. These new self-etch materials appear to form hybrid layers as did the previous generation of materials. However, there is a need for further clinical research on these new materials. Advantages of self-etch systems include, no need to etch and rinse, reduced post-operative sensitivity and low technique sensitivity. Disadvantages include, the inhibition of set of self- or dual-cure resin materials and the need to roughen untreated enamel surfaces prior to bonding.

Abstract: Since the development of the ruby laser by Maiman in 1960, lasers have been widely employed in medicine for a number of years. The purpose of this paper is to summarize potential applications for lasers in dentistry, with special regard to periodontology. This article briefly describes clinical applications of lasers and laser safety. Particularly, the use of a diode laser seems to be promising, especially in already compromised transplant patients, who need to be treated with a technique where the operative and post-operative blood loss, post-operative discomfort and the recurrence of drug-induced gingival overgrowth need to be kept to a minimum or eliminated. Therefore, the use of lasers in periodontology may lead to an alteration in present clinical practice and help to establish the best management strategy because, by maintaining periodontal health, the life quality of patients can be improved.

Abstract: Toothwear may have a multifactorial aetiology but is often localized to the upper anterior teeth. This is normally accompanied by a loss of interocclusal space. This paper aims to outline the management of localized anterior toothwear. It discusses several options available to create space for anterior restoration, with particular reference to the use of the 'Dahl' technique. Dahl described a non-invasive technique to create increased interocclusal space. The increased space eliminates the need for further occlusal reduction during crown preparation which is ideal in the worn dentition. This paper illustrates and describes the clinical applications of Dahl's original technique.

Abstract: This study assesses, by means of a postal questionnaire, the numbers of general dental practitioners who use clinical photography, and the uses to which this is applied. The questionnaire was distributed to 1000 randomly selected GDPs in Great Britain. A response rate of 76% was achieved. Of the respondents, 36% used clinical photography, with 65% of those using an intra-oral 35 mm camera, 18% a digital camera and 12% an intra-oral digital video camera. Principal uses of clinical photography were patient instruction/motivation (72%), medico-legal reasons (68%), treatment planning (63%), and liaison with laboratory (43%).

Abstract: In Class III malocclusion, the overjet is reduced and may be reversed, with one or more incisor teeth in lingual crossbite. In the early mixed dentition, and in older patients with mild skeletal discrepancies, orthodontic treatment usually involves proclining the maxilliary anterior teeth into positive overjet. When the permanent dentition has established, orthodontic therapy is usually aimed at compensating for the underlying mild-moderate Class III skeletal discrepancy by proclining and retroclining the maxillary and mandibular incisors, respectively. In contrast, adolescent and non-growing patients with severe Class III skeletal discrepancies require a combination of orthodontic treatment and orthognathic surgery to correct the underlying skeletal pattern. Adolescent patients with moderately severe skeletal discrepancies require careful treatment planning because they are often at the limits of orthodontic compensation, and further mandibular growth may prevent a stable Class I occlusion from being maintained with growth. In this situation, treatment should be limited to aligning the maxillary arch, accepting that orthognathic surgery will be required to correct the underlying Class III skeletal discrepancy when skeletal growth has been completed. This article will inform dental professionals about the aetiology, assessment, diagnosis and treatment of patients with Class III malocclusions. Specifically, the types of orthodontic treatment that can be completed at the various stages of dental development and skeletal growth will be discussed.

Abstract: Mentoring and Personal Development Plans (PDPs) are educational tools that have been piloted in postgraduate medical education in recent years. Along with another educational tool, performance appraisal, they have been introduced nationally as part of the recent General Medical Practitioner contract of April 2003. In the light of the compulsory Continuing Professional Development and Lifelong Learning Schemes introduced recently by the General Dental Council for all dentists, mentoring and PDPs will surely have important roles to play in postgraduate dental education in the future. This article reviews the roles that mentoring and PDPs have played in postgraduate education recently.

Abstract: This paper presents a case of an anterior mandibular bone defect (synonym: Stafne's bone cavity, static bone cyst, lingual mandibular salivary gland depression) mistaken for periapical pathology and referred for treatment.

Abstract: This case report describes the use of autotransplantation as part of an orthodontic treatment plan where there was early loss of an upper molar tooth secondary to irreversible pulpitis. An impacted lower third molar, which had symptoms of pericoronitis, was transplanted into the upper left second molar socket. Fixed orthodontic treatment, to correct the patient's initial complaint of crowding, was completed in 22 months. The transplanted tooth remained vital and functional throughout.

Abstract: Cemento-ossifying fibroma is an uncommon, benign lesion, which can lead to swelling and deformity of the face. This report describes an uncommon presentation of this lesion with simple and effective measures to diagnose and treat it.

Abstract: Rheumatoid arthritis is a chronic disease affecting the musculo-skeletal connective tissue of the body with a strong predilection for the joints. The temporomandibular joint (TMJ) is commonly affected with rheumatoid arthritis in adults and children, but it is usually among the last joints to be affected. A case report is presented of a patient undergoing orthodontic treatment who developed unilateral condylar changes and whose serum was also positive for rheumatoid factor. The involvement of TMJ in several systemic disorders is a well established fact. When such disorders manifest in an atypical manner, it poses a diagnostic dilemma. This article aims to discuss various disorders causing condylar erosions.

Abstract: The ‘combination syndrome’ may present a considerable clinical and technical challenge to the dental practitioner. This clinical scenario classically relates to changes found in the mouth following use of a maxillary complete denture that has opposed natural mandibular anterior teeth. While this condition was first recognized over 30 years ago, the associated difficulties still pervade the practice of prosthetic dentistry today. The purpose of this article is to describe treatment of two patients who exhibited clinical features of this condition, and review some of the relevant literature on this condition.

Abstract: The assessment of orthodontic provision is important to determine if treatment was necessary and undertaken appropriately. The ICON objectively quantifies orthodontic treatment need, complexity and outcome and is a valuable occlusal index in the assessment effectiveness of orthodontic care. It is possible to develop cost-effectiveness models by analysing the costs and effectiveness of orthodontic treatment. Several methods are illustrated to compare the orthodontic provision of specialist orthodontists.

Abstract: 'Occlusion' is presented within the concept of the articulatory system, and guidance is given on how to avoid unplanned occlusal changes. When and how to examine the occlusion is explained, and this is expanded to cover the needs of restoring a patient to the 're-organized approach'. In addition, the merits of the different types of occlusal records are discussed. In order to avoid a lengthy explanation of the terminology in the text, a glossary is appended; any term that is defined in the glossary is marked by an *.

Abstract: The first paper discussed the clinical features of patients with hypodontia. A range of treatment options were considered with examples given. In this second paper, the implant treatment option for patients is discussed in detail.

Abstract: The models of reflective practice and experiential learning, described within this article, provide the dental practitioner and his/her team with realistic methods by which they can improve their skills and working atmosphere, and also reduce occupational stress. The reflective dentist is one who engages his/her team in a process of discussion regarding a variety of clinical situations, and who learns from both positive and negative clinical experience. This article offers a detailed analysis of reflective practice and experiential learning, and the ways in which application of these procedures can contribute significantly to the continuing professional development of dentists and dental teams.

Abstract: This article describes the uses of the swing-lock retained removable partial denture in partially dentate patients where the potential for achievable retention with a conventionally designed removable partial denture is less than adequate. The article presents two case reports detailing effective use of the swing-lock concept in removable partial denture design and it is hoped that this article will increase the awareness of practitioners to the use of this prosthesis type when planning removable partial dentures.

Abstract: Following the first article which explored the use of restorative implants in orthodontic patients which are later used to replace missing teeth, such as in hypodontia patients, this second paper examines the use of implants in orthodontics to provide 'Absolute Anchorage' after highlighting the standard orthodontic approaches to anchorage It explains the advantages and disadvantages such methods give the specialist in treating full arch orthodontic patients over standard techniques used in modern orthodontics Three different types of implant used in full arch orthodontic treatment are described in detail; the mid palatal implant, the OnPlant and the mini screw The methods used in placing the implants and the techniques employed to gain the anchorage required are highlighted