Self-ligating brackets: where are we now?

The current situation regarding self-ligating brackets is reviewed. Recent developments, clinical advantages, and remaining imperfections are described. The question of active versus passive ligation is scrutinized. The evidence regarding treatment efficiency is reviewed. Suggested clinical tips and changes of treatment mechanics are summarized and illustrated. Self-ligating brackets have reached a stage of design and production control, where the advantages are significantly greater than the remaining imperfections.     

Zirconia dental implants: where are we now,and where are we heading?

Despite decades of titanium as the gold standard in oral implantology, the search for alternatives has been growing. High esthetic standards and increasing incidence of titanium allergies, along with a rising demand for metal‐free reconstructions, have led to the proposal of ceramics as potential surrogates. Following numerous experimental studies, zirconium dioxide (zirconia) has earned its place as a potential substitute for titanium in implantology. Yet, despite zirconia's excellent biocompatibility and tissue integration, low affinity to plaque and favorable biomechanical properties, early failures were significantly higher for zirconia implants than for titanium implants. Technical failure as a result of fracture of the material is also a major concern. So far, zirconia implants have been mainly manufactured as one‐piece implant systems because of the material's limitations. Nevertheless, various two‐piece systems have been progressively emerging with promising results. Screw‐retained abutments are desirable but present a major technical challenge. Innovation and technical advances will undoubtedly lead to further improvement in the reliability and strength of zirconia implants, allowing for novel designs, connections and reconstructions. Additional clinical studies are required to identify all relevant technical and biological factors affecting implant success and patients’ satisfaction. However, the evidence for a final verdict is, at present, still incomplete.     

Fractures of the talus: where are we now?

The talus provides a crucial role in ankle stability and joint movement. If the talus is damaged, the collective motion of the foot and ankle becomes compromised, and significant disability or chronic pain can result secondary to complications including post-traumatic osteoarthritis, infection, and avascular necrosis. Talus fractures are challenging to treat due to their multiple articulations, precarious vascularity, and confined anatomical location. Long-term outcomes after talar fractures have historically been poor. Surgical management is advised for most displaced fractures of the talus in suitable patients. Goals of surgical treatment focus on meticulous anatomic reconstruction, preservation of blood supply, and stable fixation to encourage fracture union. This review summarizes the literature findings to provide a clearer view of the recommended management for each type of talus fracture. This article addresses individual talus fracture subtypes, including lateral process, posterior process, head, body, neck, and extrusion of the talus. In each section, we address assessment, management options, and known outcomes. The reader is also reminded of how to assess the commonly missed talus subtype fractures, particularly lateral process, posterior process and the talar head, where high index of suspicion is paramount even following a low-energy injury mechanism. Appropriate counselling is recommended to inform and educate patient about the long-term morbidity associated with talar fractures.     

Cartilage grafting in the knee: where are we now?

Focal cartilage defects in the knee are a common and debilitating pathology. High arthroplasty revision rates in the <55-year-old population continue to make arthroplasty a limited primary surgical option. Advancements in surgical techniques and more robust long-term data on cartilage procedures have increased greatly in the last few years. Results vary and are dependent on matching suitable procedures to lesion and patient type. In this difficult-to-manage group, offering the right procedure to the right patient at the first instance has an important impact on outcomes. In this paper we review the evidence and new guidelines in the management of focal cartilage lesions of the knee.     

Classification of periodontal diseases: where were we? Where are we now? Where are we going?

This paper discusses the past, present and possible future classification of periodontal diseases. It outlines the reasons for using a classification system from a clinical perspective and provides a critical appraisal of the latest classification. The major changes introduced in the 1999 system are discussed alongside the rationale behind the recommended nomenclature.     

Dental biomaterials: where are we and where are we going?

This article reviews the current state of the art for restorative biomaterials by examining the roles of 1) truly biological biomaterials, with respect to the "near-future" of five to ten years, 2) traditional synthetic biomaterials, and 3) performance outcomes for biomaterials. Biological biomaterials are discussed in terms of tissue engineering and stem cell research, self-assembling system opportunities, and nanotechniques or technologies. Future developments for major areas of synthetic biomaterials are considered for bonding systems, composites, VLC curing, ceramics, and cements. Performance outcomes are discussed for all biomaterials in terms of safety, efficacy, and longevity of materials.     

(ii) Distal humeral fractures – where are we now?

Distal humerus fractures are rare complex injuries. Their management is evolving. A working knowledge of the current evidence surrounding their management is useful for all practising orthopaedic surgeons.The methods for treating these fractures have changed due to the increase in the range of osteosynthetic devices available and the use of total elbow replacement as a viable option.In this article we discuss some of the issues and controversies and review the literature relating to their epidemiology, management and outcomes.     

The dental team--PCDs. Where are we now?

Professionals Complementary to Dentistry (PCDs) have varying roles within the dental team, from chairside assisting to the actual provision of clinical treatment. These tasks are closely proscribed at present, but this may change in the future. The modernization of dentistry, the introduction of registration for PCDs, the introduction of workforce development confederations responsible for funding and commissioning training of dentists and PCDs, and a workforce review looking at the whole dental team will all impact upon the working lives of dentists and their teams. These current changes represent an opportunity to improve the functioning and composition of the dental team, which should not be missed.     

Dental caries: an infectious and transmissible disease where have we been and where are we going?

Dental caries is often referred to as an infectious disease, which means different things to different people. Pediatric dentists may be tempted to liken caries to other childhood diseases they encounter yet treat caries from mostly a mechanical or surgical approach. On the other end of the spectrum are clinicians who view the oral cavity as a site teaming with bacteria and think that reducing the overall microbial mass using antimicrobial agents will somehow affect this infectious disease. Here, we argue for another view, that is, to combine the most effective portion of each therapy to yield an effective outcome: the treatment and prevention of dental caries. Because primary teeth are eventually shed, pediatric dentists may be in an advantageous position to implement this approach since restorations to primary teeth need not be as durable as those made to permanent teeth. Moreover, pediatric dentists use sealants extensively and are used to working, for example, with rubber dams, especially in young patients. It may turn out that after more research is completed on the ontogeny of the oral microbial flora, changes or ecological shifts made in childhood become lifelong. More specifically, drastic reductions or eliminations of cariogenic bacteria, along with their sites for colonization in the primary dentition, may prevent or delay their transfer to the permanent dentition. Similarly, reductions in a mother's levels of cariogenic bacteria may delay or interrupt the transfer of cariogenic bacteria to her infant. Here, the goal is to discuss several concepts before their final inception into practices and to stimulate discussion of ideas, reframing the design to meet the demands of everyday practice. Ultimately, the proof will come from a large clinical trial conducted in many practices and patient populations.     

Laser curettage: where do we stand?

The literature suggests that curettage has no benefit beyond traditional scaling and root planing. However, claims abound as to the benefits of curettage with the laser, including less postoperative pain, less bleeding, and reduction in microbial count. This paper explores whether any of these claims are true and whether laser curettage has any benefit in periodontal treatment.