University Dental Hospital of Manchester

ABSTRACTObjectivesThis case series aimed to evaluate the healing potential of apical tissues with large periapical radiolucencies (> 10 mm) after apical microsurgery with L‐PRF. The secondary objectives were to evaluate L‐PRF's benefits and adverse effects as well as to aid in the development of a clinical protocol.Materials and MethodsThis case series was conducted in accordance with the Preferred Reporting Items for Case Reports in Endodontics (PRICE) 2020 guidelines. Thirteen patients with persistent endodontic infections, unresponsive to nonsurgical root canal treatment/retreatment, were treated at the Restorative and Oral Surgery Departments with endodontic microsurgery. L‐PRF preparation followed Choukroun et al. (2001) and the L‐PRF 2018 guidelines under the supervision of an experienced consultant. Postoperative follow‐up included a phone call at 24 h to assess pain, swelling, and daily functions. Sutures were removed at 7 days, and a 6‐month clinical and radiographic review was conducted. The clinical assessment included patient‐reported symptoms and extraoral and intraoral examinations. Periapical radiographs were assessed for periapical healing based on Rud et al.'s (1972) radiographic criteria. Radiographs were reviewed by one clinician under standardized conditions.ResultsHistopathological analyses identified 76.9% (n = 10) radicular cysts and 23.0% (n = 3) periapical granulomas from the 13 cases. At the 6‐month review, 76.9% (n = 10) showed incomplete healing, 15.4% (n = 2) demonstrated complete healing, and 7.7% (n = 1) had incomplete healing at 4 months. All patients remained asymptomatic with no reported complaints. Radiographic assessments showed a significant reduction in the size of periapical radiolucency in all cases. At 24 h, 69.2% (n = 9) reported no pain, while mild pain was noted in 15.4% (n = 2). Swelling was observed in 69.2% (n = 9) and absent in 15.4% (n = 2), with missing records for 15.4% (n = 2).ConclusionL‐PRF appears beneficial in endodontic microsurgery. However, larger, low‐bias studies with extended follow‐up periods are needed for definitive conclusions on its application.

Endodontic-periodontal lesions (EPLs) develop due to the various pathways that allow microbial migration between these two compartments. The authors review the historical and current research on the aetiology, diagnostic pathways, prognostic factors and management strategies for EPLs, emphasising a multidisciplinary approach to managing EPLs. This paper aims to guide clinicians in managing these challenging cases with a combination of endodontic and periodontal therapies.

The use of general anaesthesia (GA) in dental care needs to be cautiously justified and considered. Preparation for GA can take a considerable degree of planning, especially as the increased prevalence of coexisting systemic diseases in people with disabilities can increase the risks and challenges of care delivery. When a GA has been deemed appropriate and consent has been gained for relevant treatment, providing treatment this way requires further considerations related to anaesthesia and dental care. There is also a recovery period after GA, and there can be additional post-operative considerations. This paper details the ‘how’ of delivering care under GA, including the dental team's role in supporting an anaesthetic team, the delivery of dental procedures, and the logistics of post-GA care. CPD/Clinical Relevance: The use of general anaesthesia for patients with disabilities and complex needs requires careful consideration and planning.

Unprofessional behaviour within cardiology has been well documented and commonly occurs within the cardiac catheterisation laboratory, with higher rates in interventional subspecialities. While most trainees have positive experiences and encounters within the catheterisation laboratory, around one in five report experiencing bullying. This not only has a significant negative impact on the individuals directly involved, but also on the wider multidisciplinary team; importantly, it will have a deleterious effect on patient safety. The British Cardiovascular Intervention Society established the Training Culture Focus Group in 2022 to analyse and offer potential solutions to this pressing issue. We recommend that a cohesive approach between trainers and trainees is the most effective way to reduce unprofessional behaviour incidents, thus improving departmental workplace culture and a subsequent reduction in adverse patient safety events.

Over 20 years ago, the McGill consensus statement stated that a mandibular two-implant overdenture should be the first choice of care for our edentulous patients. We have around three million edentulous patients in England and Wales currently, many over the age of 60, and many of whom are not able to wear a satisfactory set of complete dentures, let alone able to eat a normal diet. In 2009, the York consensus statement produced by the British Society of Prosthodontics concluded that "a substantial body of evidence is now available demonstrating that patients' satisfaction and quality of life with implant-supported overdentures in the mandible is significantly greater than conventional dentures". So, why has the NHS ignored these important scientific papers and left our older population in a state of dental neglect? This discussion paper will consider some of the facts and suggest that there may, potentially, be some solutions.

Abstract BackgroundYoung adults are exposed to a variety of risk-related behaviours such as alcohol, smoking, and changes in dietary habits, which may result in unknown outcomes in their oral health. There is limited evidence on whether different risk behaviours are associated with oral health behaviours in the university student population. This study gathers data on the behaviours of students in their first year of university, which will inform the future development of oral health behaviour change interventions for this population.MethodThis longitudinal quantitative survey involved 205 first-year university students, aged 18-24. They completed questionnaires at baseline and a 6-month follow-up interval providing information regarding self-reported oral health status, hygiene routines, risk behaviours (e.g., diet, smoking, alcohol) and attitudes towards digital health.ResultsThe findings show associations between oral health behaviours with risk behaviours including links with oral care routines, bleeding gums, brushing frequency, with exercise, vaping, and unhealthy food and drink intake. Significant changes over the two-time points were also observed, such as the worsening of the self-reported condition of the teeth (p<0.001), reduction in the self-reported condition of the gums (p=0.004), reduced brushing frequency (p=0.003), less regular dental visits (p=0.013), more students intending to visit their previous dentist rather than finding a new dentist at university (p=0.026), and increased consumption of unhealthy non-alcoholic drinks (p=0.003). Positive changes over time include reduced alcohol consumption frequency and units (p=0.030 and p=0.001), fewer instances of binge drinking (p=0.014), and less frequent consumption of unhealthy foods (p=0.034).ConclusionThe findings highlight the complex relationship between oral heal and risk behaviours in this demographic. Poorer oral health behaviours are linked to engagement in risk behaviours. Therefore, oral health behaviours should be targeted alongside other risk behaviours. Tailored interventions should be developed to improve oral health and behaviour among university students.

To evaluate the effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group in terms of perceived need for orthognathic surgery, skeletal and dental change, and psychological impact. A multicentre two-armed parallel randomised controlled trial. Six UK hospital orthodontic units. A total of 57 patients were randomly allocated into either the BAMP group (BAMPG) (n = 28) or a no treatment control group (CG) (n = 29). Data collection occurred at registration (DC1),18 months (DC2) and 3 years (DC3), where skeletal and dental changes were measured from lateral cephalograms and study models. Oral Aesthetic Subjective Impact Score (OASIS) and Oral Quality of Life (OHQOL) questionnaires were used to assess the psychological impact of treatment. The mean age was 12.9 ± 0.7 years and 12.6 ± 0.9 years in the BAMPG and CG, respectively. At DC2, the BAMPG achieved a class III ANB improvement of +0.6° compared with -0.7° in the CG (P = 0.004). The overjet improvement was +1.4 mm for the BAMPG and -0.2 mm for the CG (P = 0.002). There was no evidence of any other group differences for the other skeletal or dental cephalometric outcomes (P > 0.05) or the questionnaire data (OASIS P = 0.10, OHQOL P = 0.75). At DC2, the 18-month follow-up, 22% of the BAMPG achieved a positive overjet. At the 3-year follow-up (DC3), fewer participants in the BAMPG were perceived to need orthognathic surgery (48%) compared with 75% of participants in the CG (P = 0.04), with an odds ratio of 0.31 (95% confidence interval = 0.10-0.95). The BAMP technique did not show any social or psychological benefits; however, the skeletal class III improvement in ANB and the overjet change were sufficient to reduce the perceived need for orthognathic surgery by 27% compared with the CG.