Biomedical subjects
D Roberts-Harry
Publications and source records attributed to D Roberts-Harry.
Orthodontics. Part 12: Combined orthodontic treatment.
Dentistry is becoming more sophisticated and capable of providing much higher treatment standards than ever before. Treatments previously considered impossible can now be achieved as a direct consequence of these advances. However, this increased complexity of treatment also means that the different branches of dentistry have, as a necessity, become more and more specialised. It is important that the specialities collaborate in a systematic focused way to ensure the optimal treatment outcome with the minimum burden of care for the patient.
Orthodontics. Part 11: orthodontic tooth movement.
Orthodontic tooth movement is dependent on efficient remodelling of bone. The cell-cell interactions are now more fully understood and the links between osteoblasts and osteoclasts appear to be governed by the production and responses of osteoprotegerin ligand. The theories of orthodontic tooth movement remain speculative but the histological documentation is unequivocal. A periodontal ligament placed under pressure will result in bone resorption whereas a periodontal ligament under tension results in bone formation. This phenomenon may be applicable to the generation of new bone in relation to limb lengthening and cranial-suture distraction. It must be remembered that orthodontic tooth movement will result in root resorption at the microscopic level in every case. Usually this repairs but some root characteristics apparent on radiographs before treatment begins may be indicative of likely root resorption. Some orthodontic procedures (such as fixed appliances) are also known to cause root resorption.
Orthodontics. Part 10: Impacted teeth.
This section deals with the important issue of impacted teeth. Impacted canines in Class I uncrowded cases can be improved by removal of the deciduous canines. There is some evidence that this is true for both buccal and palatal impactions. Treatment of impacted canines is lengthy and potentially hazardous. Interceptive measures are effective and preferred to active treatment. Supernumerary teeth may also cause impaction of permanent incisors, their early diagnosis and appropriate treatment is essential to optimise final outcomes. If there are any doubts about impacted teeth it is better to refer too early than too late, this latter option may unnecessarily extend the length of treatment as well as the treatment required.
Orthodontics. Part 9: anchorage control and distal movement.
Anchorage is an important consideration when planning orthodontic tooth movement. Unwanted tooth movement known as loss of anchorage can have a detrimental effect on the treatment outcome. Anchorage can be sourced from the teeth, the oral mucosa and underlying bone, implants and extra orally. If extra-oral anchorage is used, particularly with a facebow then the use of at least two safety devices is mandatory.
Orthodontics. Part 8: Extractions in orthodontics.
Extractions in orthodontics remains a relatively controversial area. It is not possible to treat all malocclusions without taking out any teeth. The factors which affect the decision to extract include the patient's medical history, the attitude to treatment, oral hygiene, caries rates and the quality of teeth. Extractions of specific teeth are required in the various presentations of malocclusion. In some situations careful timing of extractions may result in spontaneous correction of the malocclusion.
Orthodontics. Part 7: Fact and fantasy in orthodontics.
Clinical research has previously lacked good methodology and much opinion was based on anecdote which is widely regarded as the weakest form of clinical evidence. There are few randomised control trials in orthodontics which support or refute areas of dogma. The number of randomised control trials is increasing significantly. There is currently however no good evidence that orthodontics causes or cures temporomandibular joint dysfunction, that appropriate extractions in orthodontics ruin patients' profiles, or that the orthodontist is able to significantly influence facial growth with appliances.
Orthodontics. Part 6: Risks in orthodontic treatment.
Orthodontics has the potential to cause significant damage to hard and soft tissues. The most important aspect of orthodontic care is to have an extremely high standard of oral hygiene before and during orthodontic treatment. It is also essential that any carious lesions are dealt with before any active treatment starts. Root resorption is a common complication during orthodontic treatment but there is some evidence that once appliances are removed this resorption stops. Some of the risk pointers for root resorption are summarised. Soft tissue damage includes that caused by archwires but also the more harrowing potential for headgears to cause damage to eyes. It is essential that adequate safety measures are included with this type of treatment.
Orthodontics. Part 5: Appliance choices.
There are bewildering array of different orthodontic appliances. However, they fall into four main categories of removable, fixed, functional and extra-oral devices. The appliance has to be selected with care and used correctly as inappropriate use can make the malocclusion worse. Removable appliances are only capable of very simple movements whereas fixed appliances are sophisticated devices, which can precisely position the teeth. Functional appliances are useful in difficult cases and are primarily used for Class II Division I malocciusions. Extra-oral devices are used to re-enforce anchorage and can be an aid in both opening and closing spaces.
Orthodontics. Part 4: Treatment planning.
The treatment plan is an integral part of orthodontic management. It should be divided into both treatment aims (what do you want to do?) and plan (how are you going to do it?). The treatment aims will include, for example overjet reduction. The plan will consider how to create space in order to accomplish this as well as the appliance system that will be used.
Orthodontics. Part 3: patient assessment and examination II.
The intra-oral assessment examines the oral health, individual tooth positions and inter-occlusal relationships. When this has been completed in conjunction with the extra-oral examination, a treatment plan can then be formulated.
Orthodontics. Part 2: Patient assessment and examination I.
The patient assessment forms the essential basis of orthodontic treatment. This is divided into an extra-oral and intra-oral examination. The extra-oral examination is carried out first as this can fundamentally influence the treatment options. The skeletal pattern, soft tissue form and the presence or absence of habits must all be taken into account.
Orthodontics. Part 1: Who needs orthodontics?
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Cleft lip and palate services still need to be improved.
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Orthodontic and orthognathic management of a patient with osteogenesis imperfecta and dentinogenesis imperfecta: a case report.
This case report describes a patient's severe Class III malocclusion, managed with a combination of orthodontic and orthognathic treatment. The medical history was complicated by osteogenesis imperfecta and dentinogenesis imperfecta. In addition the patient was a Jehovah's Witness. Patients with osteogenesis imperfecta carry an increased risk of perioperative haemorrhage, and this led to bimaxillary surgery being carried out as two discrete surgical episodes for the patient described. In addition, the risk of enamel fracture led to orthodontic bands being cemented on all teeth. In spite of the increased risks a successful outcome was achieved.
An audit of the Yorkshire Regional Cleft Database.
This study assessed the validity of the Yorkshire regional orofacial cleft database by comparing the computer-based records with locally collated records of primary surgical events for babies born over a 2-year period (1994-1995). One-hundred-and-thirty-two infants with clefts (excluding submucous cleft palate) were identified from the latter source with an equal proportion of unilateral cleft lip/palate and isolated cleft palate births. However, only 62 per cent of cases were recorded on the database and the reporting rate of individual cleft units was highly variable (43-85 per cent). In addition, there was a significant under-reporting of both cleft lip and isolated cleft palate cases (42 and 50 per cent ascertainment, respectively). Consequently, the database figures understated the prevalence of all cleft births, but especially of these two cleft subtypes. Conversely, the relative frequency of combined cleft lip and palate cases was exaggerated. The reasons for such discrepancies and possible improvements to data collection are discussed.
Dental arch relationships in Yorkshire children with unilateral cleft lip and palate.
OBJECTIVE: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. DESIGN: A retrospective study with standardized record collection and blind assessment. SETTING: Regional dental hospital providing secondary and tertiary health care to the local population. PATIENTS: 35 UCLP patients whose primary repair had been performed within West Yorkshire. INTERVENTIONS: Dental casts obtained for each subject within 12 months of their 10th birthday. MAIN OUTCOME MEASURES: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. RESULTS: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. CONCLUSIONS: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.
A 5-year post-operative review of secondary alveolar bone grafting in the Yorkshire region.
The objective of this study was to determine the quality of secondary alveolar bone grafting in the Yorkshire region, and consisted of a retrospective review of patients case notes and radiographs at five surgical units within the Yorkshire region. The subjects were 109 patients who had secondary alveolar bone grafting between 1.9.91. and 31.8.96. The quality of outcome was assessed using a four-point radiographic scale from occlusal radiographs taken at least 3 months post-operatively: Grade 1 = > 75 per cent bony in-fill, Grade 2 = 50-75 per cent bony in-fill, Grade 3 = < 50 per cent bony in-fill, and Grade 4 = no bony bridge. The radiographic assessment scale was assessed for reliability: inter-examiner weighted kappa = 0.622-0.715 and intra-examiner = 0.818-0.943. Grade 1 results were achieved in 63.2 per cent patients receiving orthodontic expansion and in 40 per cent without expansion before grafting. The four-point radiographic scale described is a useful tool in assessing alveolar bone grafting, Orthodontic expansion.