All those attending this year’s three-day British Orthodontic Conference in historic Edinburgh were greeted by unusually glorious weather. The Scottish capital is always a very popular venue amongst delegates, with wonderful sightseeing opportunities coupled with great shopping and nightlife, offering something for everyone, not forgetting of course, some of the finest golf courses in Europe. On the subject of golf, the ever-popular post Conference golf competition was as well contested as ever.It was held at the renowned Archerfield Links Golf Club in East Lothian and was won by Forestadent’s Richard Peterson
The Conference was held at the Edinburgh International Conference Centre, the city’s award winning state-of-the-art, purpose-built conference and exhibition venue, very conveniently located within walking distance of the Conference hotel -The Sheraton - and the city centre.This year in addition to the main Conference programme, the Orthodontic Nurses Group enjoyed a full day’s parallel programme, whilst the Orthodontic Technicians saw their programme extend to a full day for the first time.
Taking centre stage
Sunday 13th September
The Main Scientific Programme
The opening UTG and research session featured seven excellent presentations where the speakers presented the results of their recently completed Masters research projects. This was followed by the Chapman Prize Lecture by Joanne Collins which highlighted the changes in the gender and ethnic balance of the United Kingdom orthodontic workforce. This interesting lecture sparked numerous questions from the audience on the possible effects of these changes on the future of orthodontics which were superbly and succinctly answered by the speaker.
Mithran Goonewardene made a superb start to the Monday afternoon session, detailing the importance of the interdisciplinary management of complex dental problems. He presented cases highlighting the challenges of treating patients with oligodontia and patients following dental trauma, with a particular emphasis on the growing child.
He was followed by Stella Chaushu kept the delegates captivated with her lecture on the treatment of impacted teeth with lingual appliances. She outlined her own personal experiences with adult patients, weighing up the limitations of this approach with the benefits of increased aesthetics that adult patients now frequently demand.
Finally Bjorn Ludwig spoke on current developments and perspectives on mini-implants. With mini-implant treatment at the forefront of orthodontics at present, delegates were eager to listen to this speaker whoseresearch has focused on cortical anchorage with mini-screws and their further clinical development. This informative lecture focused on several key areas including appliance designs, indications, placement techniques and risk factors during placement and orthodontic treatment, leading to the conclusion that mini-screws can become a safe and reliable standard device.
The TGG AGM ran parallel to the BOS AGM, with an excellent delegate turn-out at both meetings. The TGG AGM commenced with a personal and honest view on the future of hospital orthodontic consultancy by Helen Knight. This was certainly an inspiring talk about the positive and rewarding aspects of her time as a Consultant Orthodontist. This was followed by Nigel Hunt presenting an overview on the future of the orthodontic training programme, emphasising the potential changes to the research component of training, to the MOrth examination and to the curriculum and the underlying background to these changes.
In Parallel
Practice Development Session
The Practice Development Session was obviously a popular choice with a superb turnout as its main focus was practitioners’ relationships with their PCT’s. Sue Gregory OBE, Deputy Chief Dental Officer, made an excellent and informative start to the session with ‘Orthodontics: A bright future in your hands’. Sue Gregory has been closely involved with Orthodontists having led the development of the original Bedfordshire PDS pilot.Much of the information Sue Gregory presented was taken from both the Department of Health’s policy documents as well as from her wealth of experience of working with PCT’s. World class commissioning was outlined, which she explained, had the main aim of improving access to NHS dentistry for all. She also stressed the importance of the role of the clinician which she succinctly summarised through the development of clinical networks. The recent Steele report, an independent review of NHS dentistry, released in June 2009 was presented together with the various proposals which aim to further develop NHS dentistry within a flexible network. The overall picture painted was indeed a bright one with excellent news that there has been a temporary increase in the NHS dental budget of 11% increase for 2008/2009 and 8.5% in 2009/2010.
‘What future for Dentistry in the NHS?’ was the title of a presentation given by Andrew Lansley CBE MP, Shadow Secretary of State for Health. He pointed out that as a father of three girls, who have all undergone orthodontic treatment; he has personal experience of orthodontics. What was considered important for the Conservative Party in terms of NHS dentistry was broken down into registration, capitation and prevention with the key aims of service, quality and access. The importance of the relationship between orthodontists and PCT’s was reinforced by Mr Lansley, but he suggested that under a Tory Government, PCT’s will commission for a quality service where payments will be based on results rather than outcomes. The possibility of orthodontic services being commissioned by GDP’s in the future, to mirror medicine, was also discussed. Plans by any future Conservative Government to abandon the 18-week rule were announced to much applause. The presentation was concluded with bold statement of ‘disempowering the bureaucracyand empowering the profession’.
The concluding presentation of the session was given by Margie Taylor, Chief Dental Officer for Scotland with’ A view from Scotland’. This informative presentation provided an overview of the issues pertinent to Scotland with regards to NHS dentistry and thus orthodontics, as well as outlining options for the future. The chief aims in Scotland are focused on better general and dental health, especially amongst poorer communities with the ‘Childsmile’ programme proving a great success in encouraging prevention of dental disease. Other important issues outlined were the necessity of continuing relevant audit and research and encouraging widespread usage of the IOTN index.
The session was concluded with an informative and lively question and answer session, with some extremely useful advice given by the panel, especially with regards to the renewing of contracts and tips on maintaining good relationships with PCT’s.
Gala evening
Following a stimulating day of presentations, the delegates were treated to an excellent Gala evening at the Sheraton Hotel. The event was as popular as ever and a large number of guests enjoyed catching up with their peers
Seat of learning
Monday 14th September
Main Scientific Programme
Delegates turned up in force on Monday morning, despite the previous evening’s revelries, no doubt lured by a presentation outlining the ‘past, present and future of passive self-ligation’ by Alan Bagden. An interesting, as yet unpublished, clinical trial undertaken by Dr Bagden was presented in which he showed a case with moderate crowding which he treated using a split mouth design, in order to compare Damon and conventional brackets. The Damon side demonstrated clinically significantly faster tooth movement. He also demonstrated Degainer therapy with the presentation of several impressive clinical cases showing how space can be created for buccally blocked-out canines which enable eruption through keratinised mucosa. The long-term stability of the case results was reinforced, especially following transverse development; with the presentation of several treated cases up to 6 years after debond.
This was followed by an excellent overview by Adrian Becker of the ‘accurate positional diagnosis of impacted teeth’. Initially it was reinforced that the key to success in treating any tooth is being able to accurately diagnose its initial position. The basic principles of the location of any impacted tooth were outlined, together with radiological principles and other views which may be helpful, including the lateral cepahalometric radiograph which is not always utilised by clinicians. The use of newly emerging cone beam CT was outlined, which was shown to be extremely useful in giving a more accurate image and position of the impacted tooth in more challenging cases.
‘Rising star’ Mariyah Nazir, presented her research ‘a comparison of banded and bonded first molar attachments: a multi-centre RCT’, in a subsequent session chaired by Jayne Harrison. This extremely clinically relevant trial took place in two dental practices and one regional orthodontic department. The sample comprised 78 patients in total with decalcification, discomfort and failure included in the assessment. The results demonstrated that bonded attachments failed six times more that bands and a small but statistically significant increase in the decalcification scale was present in those individuals with bonded attachments. Any discomfort experienced was similar in both groups.
Another excellent presentation followed by Chung Kau who is the associate Professor and Director of the 3D imaging facility at the University Of Texas Health Science Centre (UTHSC), which incidentally is the world’s largest medical centre. The important question ‘has orthodontics changed with the new imaging technologies?’ was asked with a fascinating introduction to the use of 3D imaging in both diagnosis and treatment planning. Published research was also presented including recent research using 3D technology to assess facial differences between Europeans. The use of Cone Beam CT scanning was also explored, including its use in the management of impacted teeth, distraction osteogenesis and for individuals with Gardner’s syndrome.
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Following this were the eagerly awaited sponsored awards and prize giving, presented by David Bearn.
The first prize to be awarded was the Chapman prize, awarded to Joanne Collins, with a prize of £1200 for her research into ‘Changes in the gender and ethnic balance of the United Kingdom workforce’, which was presented to the Conference the previous day.
The ‘Scientific paper of the year’ presented on behalf of Maney publishing, the publishers of the Journal of Orthodontics, was awarded to Joanne Russell.
Keith Pearson of the OSG and Andy Price representing ORMCO, sponsors of the award, presented the ‘Against the Odds’ award to Michael Cheung of Maple House Orthodontics in Slough, whose patient Carly Pink received a £750 travel award. In Michael’s absence, the prize was presented to his Associate- Sarah Felmingham. This year due to the extremely high quality of the entries, two further awards were given to runners-up- Peter Huntley of Quality Orthodontics in the West Midlands and Raja Manesh from the West Lothian area of Scotland with patient prizes sponsored by Philips Sonicare.
The Laurence Usiskin award was presented to Catherine Kao Min Chee. The £1000 prize was awarded for Catherine’s research into thumb sucking in Trinidad and Tobago.
Next were the awards for submitted MOrth cases, with Andrew Shelton being awarded the BOS medal and £800? Badri Thirurenkatacheri was awarded the second place prize of £500 and Kaliopi Kokosali coming third with a prize of £300.
The William Houston medal is bestowed annually to the best candidate at the MOrth examination in Edinburgh and supported by TP Orthodontics.This year was jointly awarded to Helen Flint and Sinead McAvinchey.
David Bearn presented the award of BOS Distinguished Nurse Award to Denise Douglas, who currently works at the Cumberland Infirmary with Consultant Fiona Nixon.
David Tidy was next to the podium to give the BOS Recognition award to Alan Hayward-Dunn from Dodds the Printers who have been printers for the BOS for many years, offering a consistently excellent service and often going above and beyond the call of duty.
The final award was the UTG award, supported by OrthoCare, which was presented to Jadbinder Seehra for his research on ‘Bullying in Orthodontic Patients and its relationship to malocclusion, self-esteem and OHRQoL.’ The session concluded with Jadbinder presenting his excellent work to the Conference delegates.
Following the prize giving, the next presentation was Philip Bensons ‘Experience of treating Class II division 2 malocclusion using two different methods.’ The presentation commenced with an overview of the recent Cochrane Systematic review and randomised control trial on the treatment of Class II division 2 malocclusions. Several interesting clinical cases were presented, all illustrating different treatment approaches. Lastly, possible future research topics were discussed including the impact of fixed appliances on the quality of life, with more emphasis being placed on the role of the child in dental research, as participants rather than just subjects of the research.
Delegates returned re-energised after lunch lured by the prospect of a lecture by Mithran Goonewardene presenting the ‘Periodontal implications of arch expansion- A-Pog and beyond.’ Important issues were raised including the relationship between stability, aesthetics and the extent of tooth movement as well as the gingival response to tooth movement and gingival graft techniques.
Bjorn Ludwig was next on the podium with ‘Adult treatment – the future of orthodontics? Treatment approaches for grown-ups’, a very relevant subject area due to the well documented rise in the numbers of adult orthodontic patients. The presentation focused on lingual appliances, which are becoming increasingly popular due to demands for aesthetic appliance systems by adult patients. The 2D lingual bracket, manufactured by Forestadent, was described, which promises to be a significant development within the world of lingual appliances. The presentation was concluded with a short video of the speaker inserting a mini-screw into his own mouth, which drew both laughter and gasps of surprise from the audience!
‘Class II correction with Invisalign combination treatment’ waspresented by Clark Colville, who has a wealth of experience with the Invisalign system. The role of Invisalign in conjunction with other appliance systems in the correction of Class II skeletal discrepancies was described, thus demonstrating that Invisalign is not just a stand-alone appliance but can also be utilised to treat a broad range of malocclusions and skeletal discrepancies. A range of cases were presented, including a very interesting case of adult molar distalisation.
To conclude the excellent session Daljit Gill presented ‘Smile aesthetics: what are we trying to achieve?’ An evidence-based outline of a number of factors related to the smile were presented, including the anterior and posterior smile lines, gingival aesthetics and ideal tooth proportions. Finally it was emphasised that it is important to remember that there is a wide variation in what is considered the ideal smile, with a definite difference between lay and professional perceptions.
High Commission
Tuesday 15th September
Orthodontic Commissioning Education Day
The BOS hosted its first ‘Orthodontic Commissioning Education Day’, which was held in parallel to the main conference and was aimed at individuals who were either directly or indirectly involved in commissioning NHS orthodontic services. The aim was overall better communication and the sharing of information between all parties involved. The day was very popular with a packed auditorium of delegates who enjoyed a lively discussion after the presentations.
Talk, talk
Tuesday 15th September
Main Scientific Programme
The final day’s programme was opened by Kevin O’Brien and Jonathon Sandler who amused and informed in equal measure with their talk “Orthodontic treatment – when there is no evidence is the salesman king?” The audience was captivated by this humorous lecture discussing the effects of marketing on the clinical practice of orthodontics based around the evaluation of scientific evidence concerned with “new techniques” such as self-ligating bracket systems and temporary anchorage devices. Delegates will long remember the speakers’ ability to highlight the powerful and emotive language often used by marketing companies such as “gentle rolling forces” and “no need for extractions”, when often there is a lack of scientific evidence. They concluded by reminding us as orthodontists not to ignore the evidence as science is a core component of our training as health care professionals.
This was followed by a short presentation on the upcoming WFO in Sydney in 2010 in which the host country’s Simon Freezer showed delegates photographs of the amazing Australian coast – who will be able to resist? He was joined on stage by Jonathon Sandler who gave an overview of the first ever “British Day” to be held at the WFO in Sydney next February.
The main scientific programme continued with Clark Colville who has a wealth of experience with the Invisalign® system who spoke on “profitability and the Invisalign® system”. He stated that with adult orthodontics increasing, Invisalign® is an increasingly popular appliance used in the practice setting and practitioners who are proficient with this system may wonder whether its use in their practice is a wise decision due to the high laboratory fees. Clark Colville concluded that aligners can be profitable with appropriate case selection and showcased the “ideal” cases which included “express type re-treatment cases” and “combination treatment with initial fixed appliances”, thereby decreasing the total number of aligners used.
Jay Kindelan then discussed his recent interest in the management of dental trauma during orthodontic treatment. He highlighted the importance of detailed and thorough history taking and diagnostic measures when assessing the likely effects of previous trauma on active orthodontic treatment. He continued to talk on the importance of multidisciplinary team working particularly with paediatric dental colleagues, endodontic considerations and the use of premolar transplants where anterior teeth have been lost to trauma.
The prestigious Northcroft lecture was presented by Birte Melsen who needed little introduction. She received the Knighthood of Danneborg 1st degree in 2000 and has authored more than 300 publications in the fields of growth and development studied on human autopsy material, bone biology and clinical studies by means of the implant method. Birte Melsen presented the changing spectrum of orthodontics over the past decades. This lecture succinctly summarised the three aspects that have had a significant impact on orthodontics; the distribution of patients; the working brackets and intelligent wires that are dominating advertising and reducing the interest in evidence based treatment approaches and thirdly skeletal anchorage having the potential to widen the spectrum of orthodontics allowing treatments that could not have previously been undertaken with conventional appliances.
After lunch delegates re-filled the auditorium to hear Adrian Becker and Stella Chaushu speak on their recent area of investigation; studying the reasons for failure in the treatment of impacted teeth. The lively speakers showcased an interesting case series, showing a range of treatment failures which the audience could learn important lessons from.
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David Bearn hosted a second wave of prize giving which included:
The UTG prize was awarded to three people; Jadbinderpal Seerha won the first prize; whilst the second went to Helen Flint and the third to Sona Pabari.
Paroo Mistry won the audit prize which was sponsored by Hawley Russell whilst A Ahmed won the Houston Research Prize.
Also presented was the Orthodontic Technician Award for Distinguished Service for 2009 which was bestowed on The Chief Orthodontic Technician at the Royal London Hospital, Kieran McLaughlin.
After 30 years service to dentistry orthodontic nurse Denise Douglass was also honoured with the 2009 Award for Distinguished Service.
The Conference came to a close with the entertaining clinical pearl presentations in which six innovative clinical presentations were shared with the delegates. [names?]
The banquet
The last, and most extravagant, social event was undoubtedly the Conference banquet which concluded with the sounds of The Flying Emperors who encouraged delegates to throw caution to the winds and dance the night away.
The resounding success of this years Conference was thanks largely to the Conference and Meetings Committee and the BOS HQ team who put in a huge amount of hard work which resulted in a well organised, informative and thoroughly enjoyable Conference. Will it be surpassed next year in Brighton?
About the authors:
Monica Cedro qualified from King's College London in 1999 and worked for the community dental service in Camden and Islington before undertaking 2 years of Senior House Officer posts in Oral and Maxillofacial surgery in Oxford and Chichester.She then worked a further year as a Senior House Officer in Oral Medicine at the Eastman Dental Hospital, staying on for a further 1 ½ years as a Clinical Assistant.In 2006 she commenced specialist training in Orthodontics at UCL Eastman Dental Institute, obtaining her MSc in 2008 and the MOrth in 2009.
Sona Pabari qualified in Dentistry at the Manchester University Dental Hospital in 2002. After time spent in general dental practice and the community dental services, she undertook a Senior House Officer post in Oral and Maxillofacial surgery at the Luton and Dunstable Hospital. This was followed by Senior House Officer posts at the Eastman Dental Hospital for a further two years in the fields of Oral Medicine and Paediatric Dentistry. In 2006, she embarked on her specialist registrar training in Orthodontics at the UCL Eastman Dental Institute and was awarded an MSc in 2008 and MOrth in 2009.
