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SCIENCE Volume 2 Number 5 October/November 2026 ISSN 3088-6775

82 83 84

EDITORIAL Evidence, empathy and the future of dental education LETTER TO THE EDITOR RESEARCH Impact of initial correction of Class II division 1 malocclusion with a modified twin block appliance: what difference does it make to the child and parent? Caroline O’Dwyer Declan T. Millett Mairead Harding Claire Laide Michael Cronin

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QUIZ CLINICAL FEATURE Non-surgical peri-implantitis therapy: what now? Erin M. O’Hagan Ioannis Polyzois

CLINICAL TIPS Chairside acrylic temporary crowns

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RESEARCHER PROFILE Strengthening support for a vulnerable population

Yong Yong Foo

Dr Patrick Quinn

ED I TORIAL

Evidence, empathy and the future of dental education Empathy is a vital human skill for dentists – how might it form part of dental education?

Dr Cristiane da Mata BDS MFD (RCSI) Dip TLHE MPH Phd FFD RCSI

Honorary Editor journaleditor@irishdentalassoc.ie

I was recently at the meeting of the Association for Dental Education in Europe (ADEE) in Budapest, where the theme was ‘Evidence and Empathy’, serving as a platform for discussions around oral health professionals’ education. There were some very interesting presentations and debate about the current challenges facing dental education, with artificial intelligence (AI) understandably being one of them. However, there was also considerable discussion about human factors in dentistry, which seem to be related to up to 80% of adverse events in the profession. These include issues such as breakdown in communication, the inability to reflect, or poor situation awareness. Prof. James Field led an interesting discussion on this, and a Dental Non-Technical Skills Framework, being developed by the Faculty of Dental Trainers at the Royal College of Surgeons of Edinburgh, was also presented. This raises an important question: can human factors be taught at dental school? How can we equip our dental students with the ‘so skills’ that will be so important to their practice of dentistry? One of these skills that featured prominently during the meeting was empathy. In the dental profession, we deal with difficult situations every day: patients who are in pain, anxious about treatment, demanding, or experiencing other challenges in their lives that may affect how they receive a diagnosis or treatment plan. “Health professionals must be able to imagine how it feels to experience something that they are not directly experiencing”: this is empathy.1 Empathy, like other psychological characteristics, varies across individuals, and can be measured using a range of established instruments. The evidence suggests that empathy is not entirely fixed and that aspects of empathy can be developed and strengthened through education and experience. However, some studies have shown that empathy may decline during health professional education and the reasons for any decline are likely to be multifactorial. Factors such as workload, stress, the clinical learning environment, and exposure to professional role models have all been suggested as potential influences.2

Th!nk

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Published on behalf of the IDA by Think Media, 537 NCR, Dublin 1. T: +353 1 856 1166 www.thinkmedia.ie Managing Editor Ann-Marie Hardiman ann-marie@thinkmedia.ie Editorial Caoimhe Coolican Advertising Paul O’Grady paul@thinkmedia.ie Design Rebecca Bohan, Tony Byrne

This is important because it suggests that the educational environment itself may play a role in either supporting or undermining empathy. But rather than viewing empathy as something that can simply be taught in a single lecture or course, perhaps we should think of it as a professional skill that needs to be modelled, practised, reflected upon, and reinforced throughout dental education. The widespread use of AI adds another dimension to this discussion. Today’s younger generation has grown up increasingly comfortable interacting with digital technologies, and AI is becoming an integral part of education and healthcare. Could this influence the development of empathic professionals? Could AI provide new opportunities for students to practise communication and understand different patient perspectives? Or could increasing reliance on technology reduce opportunities for human interaction? While we may be able to model and teach aspects of empathy, teaching adults to genuinely understand and care about what another person is experiencing is a much more complex task. Perhaps this is where dental education has an important responsibility. We need to create learning environments in which students do not simply learn about empathy, but regularly see it modelled, practise it, reflect on it, and experience its importance in their interactions with patients. At the end of the day, no matter how well dentists are trained, when empathy is lacking, patients may feel unheard or misunderstood, and this can heighten dental anxiety, erode trust, and negatively influence their willingness to engage with treatment.

References 1. Heyes C. Empathy is not in our genes. Neurosci Biobehav Rev. 2018;95:499-507. 2. Nash DA. Ethics, empathy, and the education of dentists. J Dent Educ. 2010;74(6):567-578.

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JIDA Science is an official publication of the Irish Dental Association. The opinions expressed in JIDA Science are, however, those of the authors and cannot be construed as reflecting the Association’s views. The editor reserves the right to edit all copy submitted to JIDA Science.

82 | Volume 2 Number 5 | October/November 2026

L E TTE R TO THE E D I T OR

Re: Ramasubbu D, Lewney J, Duane B. Piloting the Modified Oral Status Survey Tool in a nursing home setting Dear Editor, We welcome the pilot of the Modified Oral Status Survey Tool (MOSST) in nursing homes. Independent evaluation of inclusive data collection methods in multiple settings is important. However, several interpretations in the article merit clarification. Firstly, the statement that the MOSST is “not currently suitable for providing reliable and valid data at the population level” is not supported by any data. This statement risks conflating limitations of the study design with the measurement properties of the instrument. The study used convenience sampling, restricted participation to residents able to provide consent, reported little evidence of reasonable accommodation, and examined only 78 of 366 residents. These factors limit representativeness and generalisability based on study design but they do not demonstrate in any way that the MOSST itself lacks reliability or validity. Secondly, if a study aims to comment on the psychometric attributes of an instrument, it should engage with the relevant evidence base. The MOSST and the earlier Oral Status Survey Tool (OSST) are distinct instruments, yet OSST literature is cited in place of appropriate MOSST evidence throughout this article. Published MOSST studies report its development, reliability, validity, feasibility, calibration procedures and use by trained non-dental assessors.1 Data on the concurrent validity of the MOSST in older adults also exist.2 Neither appear to have been considered by the authors. Thirdly, the low participation rate should be interpreted primarily as a limitation of the recruitment and consent framework. Residents with dementia or communication support needs were excluded before MOSST assessment because they could not provide consent under the study protocol. Exclusion therefore occurred before, and independently of, assessment with the MOSST. This should be distinguished from inability to undergo the MOSST itself. The MOSST is specifically designed to

maximise inclusion, participation and retention in oral health data collection. Finally, the suggestion that residents’ mouthcare plans would necessarily require dental consultation is too broad. Routine mouthcare plans addressing toothbrushing, denture care, required assistance, communication needs and staff responsibilities can be developed and implemented by trained care staff. Dental consultation is required where diagnosis, treatment planning, disease management, etc., is needed. Suggesting the need for dental input in mouthcare planning potentially builds barriers in care settings. The MOSST was developed to support inclusive, scalable, criteria-based oral health surveillance. We welcome its use and study in broad settings and among a variety of populations. Limitations in recruitment, consent and implementation should not be attributed to the instrument itself. We therefore suggest that the article should be clarified to more accurately distinguish between limitations of study design and limitations of the MOSST instrument. Yours sincerely, Caoimhin Mac Giolla Phadraig and Katrina Byrne

References 1. Byrne K, Daly B, McCallion P, McCarron M, Mac Giolla Phadraig C. The Modiﬁed Oral Status Survey Tool: development and psychometrics for accessible oral health data collection. Community Dent Oral Epidemiol. 2026:1-10. [Published online ahead of print January 7, 2026]. 2. Tayebi-Hillali H, Mac Giolla Phadraig C, Olegário IC, et al. Concurrent validity of the Modiﬁed Oral Status Survey Tool. Gerodontology. 2026:1-9. [Published online ahead of print May 13, 2026].

Honorary Editor

International Editorial Board

Dr Cristiane da Mata BDS MFD (RCSI) Dip TLHE MPH Phd FFD RCSI

Assoc. Prof. Lamyia Anweigi BDS MMedSc MFDS PhD (Qatar)

journaleditor@irishdentalassoc.ie

Dr Ana Cecilia Diniz Viana BDS MD PhD (Brazil) Dr John Macken BDS PGCertMEd PhD MFDS RCSEng ACIEA FHEA (UK)

Deputy Editor

Prof. Leonardo Marchini DDS MSD PhD (USA)

Dr David McReynolds BA BDentSC MFDS RCSEd DChDent (Pros) FFD RCSI

Dr med dent Ramiar Karim BDS MSc Paed Dent (Germany) Dr Elaine Smyth BA BDentSc DChDent (USA)

Editorial Board

Prof. Murali Srinivasan BDS MDS MBA MAS PD (Switzerland)

Dr Meriem Abbas BDS (NUI) MFDS RCSEd PGDip TLHE

Prof. Sayaka Tada DDS PhD (Singapore)

Una Farrell Dip Dental Hygiene Dr Catherine Gallagher MB BCh BAO BDS NUI FDS RCSEng FFD RCSI

jida.scholasticahq.com

Dr Geraldine McDermott BA BDentSc MFDS (RCSI) PGradDip ConSed (TCD) MSc Healthcare Leadership (RCSI)

Irish Dental Association

Dr Clair Nolan BDS (NUI) MSc (Endo) U Lond

Unit 2 Leopardstown Oﬃce Park, Sandyford, Dublin 18.

Dr Adedeji Daniel Obikoya BChD MFDS (RCSI) MSc Dr Judith Phelan BDS (NUI) MDS (NUI) MSc (U Lond) MRD (RCS Eng and Glas)

T: +353 1 295 0072

Dr Patrick Quinn BCL BDS LLM MDPH

F: +353 1 295 0092

Dr Catherine Vaughan BDS (NUI)

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Volume 2 Number 5 | October/November 2026 | 83

RESEARCH

Caroline O’Dwyer BDS MFD DClinDent (Orthodontics) MOrth Specialist Orthodontist Orthodontic Unit, Oral Health and Development

Impact of initial correction of Class II division 1 malocclusion with a modified twin block appliance: what difference does it make to the child and parent?

Cork University Dental School and Hospital University College Cork Declan T. Millett BDSc DDS FDS DOrth MOrth FHEA Professor of Orthodontics/Consultant Orthodontist Orthodontic Unit Oral Health and Development Cork University Dental School and Hospital University College Cork Mairead Harding BDS MDPH PhD FDS PgDipLTHE Professor of Dental Public Health and Preventive Dentistry Oral Health and Development Cork University Dental School and Hospital University College Cork Claire Laide BSc MSc

Précis: Initial correction of Class II division 1 malocclusion with a modified twin block appliance has positive impacts on both child and parent.

Abstract Aim: To assess the impact of initial correction (Phase 1) of Class II division I malocclusion (II/1M) with a modified twin block (MTB) appliance on children and their parents compared to untreated children with II/1M and their parents. Methods: Sixty participants with II/1M received MTB treatment and 47 participants with II/1M served as controls. At baseline (T1) and following MTB treatment or recall (T2), all assessed oral health-related quality of life (OHRQoL) and self-esteem, and rated perceived aesthetic component of orthodontic treatment need (ACIOTN). At T1 and T2, a 3D facial soft tissue image was captured at rest. Similarly, at T1 and T2, a parent assessed perception of their child’s OHRQoL and perception of their child’s AC-IOTN. Appropriate statistical comparisons were made between and within groups. Results: Phase 1 treatment with an MTB was completed by 42 participants; 35 controls were recalled. At T1, groups were similar in age and gender (p>0.05), and mean overjet was 1mm greater in the MTB group (p<0.01). At T2 in the MTB group, child-reported OHRQoL and self-perception of AC-IOTN, and parent perception of their child’s OHRQoL and AC-IOTN improved, as did family quality of life (QoL) (p<0.001); self-esteem remained unchanged. At T1 and T2 for both groups, parents rated their child’s OHRQoL as worse than the child. From T1 to T2, soft tissue changes in both groups and inter-group differences were modest (p<0.05). Conclusion: Phase 1 treatment with an MTB positively impacted child OHRQoL, family QoL, and child and parent perception of AC-IOTN, but did not impact child self-esteem. Changes in 3D facial soft tissue were modest. Child and parent perceptions of OHRQoL and AC-IOTN were discordant. Keywords: Class II division 1 malocclusion, modified twin block appliance, oral health-related quality of life, self-esteem, family quality of life.

3D Imaging Assistant Orthodontic Unit

Journal of the Irish Dental Association Science October/November 2026;2(5):84-92

Oral Health and Development Cork University Dental School and Hospital University College Cork

Introduction Michael Cronin BSc MSc PhD Senior Lecturer School of Mathematical Sciences University College Cork

Corresponding author: Declan T. Millett E: d.millett@ucc.ie

Class II division 1 malocclusion (II/1M), with prominent upper incisors and an increased overjet, affects 25-30% of children and adolescents.1-3 It is commonly associated with bullying, incisor trauma, low self-esteem, and poor oral health-related quality of life (OHRQoL) in the child and associated family.4-8 There is, however, variation in the related perception by child and parent of the aesthetic orthodontic treatment need.9 Growth modification of II/1M with a functional appliance has been shown to improve dentofacial aesthetics, self-esteem, OHRQoL, and perception of aesthetic orthodontic treatment need of both child and parent.5,8-13 The twin block appliance (TBA), or a modification thereof (MTB), is a commonly used and well-tolerated functional appliance for initial correction of II/1M (Phase 1); this aims to achieve a Class I incisor relationship and is typically followed by fixed appliances (Phase 2) to complete treatment.14,15 Treatment with a TBA or MTB principally influences the lower face through combined effects on the orofacial so tissues and muscles of mastication, producing dentoalveolar and skeletal changes.16 Maximum benefit is reaped during the pubertal growth period, and the so tissue effects of TBA/MTB treatment may be monitored in an accurate and non-invasive manner, using threedimensional (3D) imaging.17,18

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RESEARCH

The aim of this study was to assess the impact of initial correction (Phase 1) of II/1M with an MTB on children and their parents compared to untreated children with II/1M and their parents. The primary outcome was: n child-reported OHRQoL.

Sample size The sample size was calculated on the primary outcome of OHRQoL; using data from Johal et al.,6 a sample size of 30 subjects per group (15 females and 15 males) was required to detect a clinically signiﬁcant diﬀerence of 35% in the OHRQoL between the MTB group and the control group, with a power of 80% and p<0.05. To allow for a drop-out rate of up to 50%, we aimed to recruit 60 subjects per group.23

The secondary outcomes were:

Statistical analyses n child-reported self-esteem; n child self-perception of the aesthetic orthodontic treatment need; n 3D so tissue facial images; n family QoL; n parental perception of the child’s OHRQoL; and, n parental perception of the child’s aesthetic orthodontic treatment need.

Materials and methods Ethical approval was granted from the Clinical Research Ethics Committee of the Cork Teaching Hospitals.

Comparisons of patient demographics were made using analysis of variance (ANOVA) and Chi-square tests. ANOVA was used for comparisons of CPQ11-14, PCPQ, CHQ-CF45, and 3D so tissue facial changes at T1 and T2 between groups, and paired t-tests for comparisons within both groups. For AC-IOTN, within- and between-group comparisons were made using Bowker’s test for symmetry and Fisher’s exact test, respectively. Associations between OHRQoL measures, ACIOTN, and 3D so tissue facial change were performed using ANOVA. All statistical analyses were performed in SAS (Version 9.4, Cary, North Carolina, USA). The signiﬁcance level was p<0.05.

Results Study design This was a non-randomised clinical intervention study.

Setting, participants and eligibility This study was undertaken in a State-funded orthodontic service in the Republic of Ireland (RoI). The following inclusion and exclusion criteria were adopted: Inclusion criteria n Children aged 11-14 years with good oral health, an overjet of at least 7mm, and about to commence orthodontic treatment with an MTB; n children with an overjet of at least 7mm awaiting treatment; and, n a parent of each child willing to participate. Exclusion criteria n Previous orthodontic treatment; and, n presence of a craniofacial syndrome.

Intervention Informed consent was obtained from each participant and/or their parent. At the start (T1) and end of MTB treatment, or approximately one year after the initial visit for the control group (T2), each participant completed two validated questionnaires: the Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14) and the Child Health Questionnaire Child Form (CHQ-CF45). These assessed OHRQoL and health-related quality of life (HRQoL), respectively.19,20 Each participant also self-assessed the perception of aesthetic orthodontic treatment need using the Aesthetic Component of the Index of Orthodontic Treatment Need (AC-IOTN), and had a 3D facial soft tissue image recorded at rest (Appendix 1).21 At the same timepoints, the accompanying parent of each participant completed AC-IOTN and the Parental–Caregivers Perceptions Questionnaire (P-CPQ) with respect to their child; details of these outcome measures are provided in Appendix 2.21,22 Details of bite registration, appliance design, and instructions regarding wear are provided in Appendix 3. Participants wearing an MTB were followed until a Class I incisor relationship was achieved.

Study participants MTB group Sixty participants (31 males; 29 females) and a parent of each consented to the study. The non-compliance rate was 30% (11 males; seven females). The final sample comprised 42 patients (20 males; 22 females), with a mean age of 12.6 years (standard deviation (SD) 1.0), and a parent of each. For all 42 participants and their parents, all questionnaire instruments were available at T1 and T2; 3D images at both timepoints were available for 37 patients (18 males; 19 females). Treatment duration with the MTB was on average 8.5 months (range 5-12). Control group Forty-seven participants (22 males; 25 females) with a mean age of 12.5 years (SD 0.7), and a parent of each agreed to participate. At T2, data were available for 35 subjects (15 males; 20 females)/parent pairs. At T2, 26% (seven males; five females) did not re-attend. Participants in the control group were recalled on average at 11 months (range 9-13). Comparisons of groups at T1 and T2 At T1, mean age and gender were similar between groups (p>0.05), but mean overjet was 1mm greater in the MTB group (MTB group: 10.2mm (SD 1.7); control group: 9.2mm (SD 1.5); p<0.01). At T2, the only difference between groups was a significant reduction in the mean overjet (MTB group: 3.1mm (SD 1.3); control group: 8.7mm (SD 1.8); p<0.0001). Study outcomes All comparisons between the MTB group and control group were adjusted for age, gender, and overjet. Child perception of their OHRQoL in MTB and control group at T1, T2, and T2 versus T1 At T1 for both groups (MTB vs control), the self-perceived overall OHRQoL score measured using CPQ11-14 was poor (higher scores), but it was significantly poorer in the control group compared to the MTB group (p<0.035); this was true for the domains ‘Occlusal Symptoms’ (OS) (p<0.025) and ‘Functional Limitations’ (FL)

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RESEARCH

(p<0.005), but not for the domains ‘Emotional Well-being’ (EWB) and ‘Social Wellbeing’ (SWB). Surprisingly, at T2 there was no significant difference between groups for the overall OHRQoL score, or in any of the four domains. When T2 and T1 were compared, in the MTB group, there was a significant improvement in the overall OHRQoL score (p<0.001), and in the OS (p<0.018), EWB (p<0.003), and SWB domains (p<0.005). In the control group, between T2 and T1 there were no significant differences (Table 1). Self-esteem of the MTB and control group at T1, T2, and T2 versus T1 There was no significant difference between or within groups over time (p>0.05). Child perception of AC-IOTN in MTB and control group at T1, T2, and T2 versus T1 At T1, 43% of participants in the MTB group reported a moderate or definite ACIOTN compared to 28% at T2 (p=0.018). In the control group, a moderate or definite AC-IOTN was identified at both timepoints (T1: 28% and T2: 21%; p=0.881) (Table 2). Parent perception of their child’s OHRQoL in MTB and control group at T1, T2, and T2 versus T1 At T1, parents of children in both groups perceived their child to have a poor overall OHRQoL score; for the MTB group, this was rated almost twice that reported for the control group (46.5 vs 25.7; p<0.001). Parents perceived a significant difference in all four domains (OS, FL, EWB, and SWB). At T2, in the MTB group, there was a significant improvement in the parent’s perception of their child’s overall OHRQoL (p<0.001). There was no significant change in the control group (25.7 vs 24.5; p=0.721). When comparing both parental groups at T2, the parents of the control group had a significantly poorer rating of their child’s overall OHRQoL score across all domains (p<0.004) (Table 1). Parent perception of their child’s AC-IOTN in MTB and control groups at T1-T2 At T1, 62% of parents in the MTB group perceived a moderate or definite ACIOTN, and at T2 this had reduced to 12% (p<0.001). At T1, 57% of parents of the control group perceived a moderate or definite AC-IOTN, and at T2 this reduced to 40% but was not significantly different (p=0.202) (Table 2). Family quality of life in MTB and control groups at T1, T2, and T2 versus T1 At T1, the mean family QoL score in the MTB group was significantly poorer (13.6; SD 9.9) than the mean family QoL score in the control group (6.9; SD 7.5, p=0.0008). Following Phase 1 treatment with an MTB, the family QoL improved substantially (13.6 (SD 9.9) to 2.4 (SD 2.3); p<0.0001), but was no different in the control group (6.9 (SD 7.5) to 5.2 (SD 8.3); p=0.221). The mean scores at T2 were significantly different between groups (p=0.0024). Child perception and parent perception of their child’s OHRQoL in MTB and control group at T1 and T2 At T1, in the MTB group, there was a significant difference between selfperception and parental perception of the child’s OHRQoL. Parents perceived that II/1M had a more negative impact on their child’s OHRQoL than the child did; this was true both overall and in each of the domains of OHRQoL (p<0.0001). At T2, although children and parents reported a significant improvement in overall OHRQoL, parents still rated this worse than children (child: 10.2 (SD 7.0) and parent: 15.7 (SD 12.1); p=0.003) (Table 3).

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Similarly, in the control group, parents’ perception of their child’s overall OHRQoL at both timepoints was significantly poorer than their child’s perception (p<0.0011 and p=0.008) (Table 3). Child and parent perception of AC-IOTN in MTB and control group at T1 and T2 At T1, in the MTB group, 46% of children and parents perceived a similar aesthetic orthodontic treatment need (p=0.054). At T2, following MTB treatment, 69% of children and parents perceived a low treatment need, and although 19% of children perceived a moderate need, their parents perceived a low need (p=0.019) (Table 4). At T1, in the control group, 40% of children and parents perceived a similar aesthetic orthodontic treatment need (p=0.040). At T2, 51% of children and parents perceived a low treatment need; 14% of children and 17% of parents perceived a definite need, although this difference was not significant (p=0.262) (Table 4). 3D so tissue linear changes in MTB and control groups from T1 to T2 Mean so tissue linear changes in the lower facial landmarks only differed significantly at the pogonion between treatment and control groups (4.26mm (SD 1.64) and 3.29mm (SD 1.95), respectively; p<0.01) (Appendix 1).

Discussion This study, undertaken in a State-funded orthodontic service in the RoI, appears to be the first to make a direct comparison of OHRQoL, self-esteem, family QoL, AC-IOTN and 3D soft tissue facial changes between nonrandomised samples of those undergoing Phase 1 orthodontic treatment for II/1M and a similarly aged, untreated II/1M group.8,10 This study design has selection bias, and a randomised controlled trial would have been the ‘gold standard’, but was not adopted due to the demands of the waiting list. Regarding the primary outcome measure of OHRQoL, limited evidence exists for children with II/1M before and after MTB treatment compared to those with II/1M awaiting treatment. Previous studies have been cross-sectional, did not have an untreated II/1M control group for comparison, or used a different design of twin block appliance.6,8,12,13 Child-reported outcomes OHRQoL Unsurprisingly, participants in both groups had poor OHRQoL at T1, reflecting the negative impact of increased overjet.5 Self-esteem The absence of a significant difference between or within groups at T1 and T2 likely reflects the complexity of self-esteem as a psychosocial construct, affected by multiple factors. Self-concept, however, has been shown to improve in other studies with Phase 1 functional appliance treatment.5 Child perception of the AC-IOTN A significant improvement was recorded over time in the MTB group, but this measure remained relatively static in the control group. This is indicative of the positive impact of overjet reduction on aesthetic appearance. 3D changes in lower face So tissue pogonion moved forward significantly in the MTB group. This change,

RESEARCH

Table 1: Child and parent individual CPQ domains and overall OHRQoL scores for MTB group and control group at T1 and T2. Child MTB group (mean SD)

Parent

p-value

Control group

n=42

p-value

MTB group (mean SD)

(mean SD) n=35

Domain

T2 vs T1

4.3 (1.9)

3.5 (1.6)

2.4 (2.1)

1.9 (1.9)

0.018

5.1 (2.2)

0.187

3.6 (3.2)

EWB

5.1 (4.8)

3.4 (4.3)

0.003

SWB

2.4 (2.0)

1.4 (2.0)

Overall score

14.2 (7.2)

10.2 (7.0)

p-value

Control group

n=42 T2 vs T1

Domain

4.2 (3.0)

0.139

2.7 (2.9)

0.099

4.5 (3.9)

3.9 (4.3)

0.005

2.1 (2.3)

<0.001

15.4 (9.0)

p-value

(mean SD) n=35

T2 vs T1

8.8 (5.4)

4.0 (2.5)

9.6 (5.5)

4.4 (4.4)

0.371

EWB

15.7 (11.9)

1.6 (2.4)

0.203

SWB

12.5 (10.7)

0.090

Overall score

<0.001

6.1 (4.0)

5.9 (4.8)

0.841

<0.001

7.0 (5.9)

6.6 (7.7)

0.699

3.9 (4.6)

<0.001

7.7 (8.8)

7.2 (9.4)

0.650

12.4 (9.2)

3.4 (3.6)

<0.001

5.0 (6.2)

4.7 (7.8)

0.853

46.5 (28.6)

15.7 (12.1)

<0.001

25.7 (21.9)

24.5 (27.5)

0.721

MTB T1 vs control T1

T2 vs T1

MTB T1 vs control T1

Domain

EWB

SWB

Child perception overall OHRQoL score

Domain

EWB

SWB

Parent perception overall OHRQoL score

p-value

0.025

0.005

0.626

0.171

0.035

p-value

0.011

0.038

<0.001

0.081

0.004

MTB T2 vs control T2 p-value

0.879

0.470

MTB T2 vs control T2

0.812

0.775

0.675

p-value

0.003

0.005

0.008

SD: standard deviation; OS: oral symptoms; FL: functional limitations; EWB: emotional well-being; SWB: social well-being. Statistically significant at p<0.05.

Table 2: Comparison of child perception and parent perception of child’s aesthetic orthodontic treatment need (AC-IOTN) for the MTB group and control group at T1 versus T2. Child

Parent

MTB

T2 n (%)

MTB

Child perception AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

19 (45)

5 (12)

0 (0)

24 (57)

n (%)

Moderate

6 (14)

2 (5)

0 (0)

8 (19)

Deﬁnite

6 (14)

4 (10)

0 (0)

Total

31 (74)

11 (26)

0 (0)

T2 n (%) Parent perception child’s AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

16 (38)

0 (0)

16 (38)

n (%)

Moderate

15 (36)

1 (2)

0 (0)

16 (38)

10 (24)

Deﬁnite

6 (14)

2 (5)

10 (24)

42 (100)

Total

37 (88)

3 (7)

2 (5)

42 (100)

p=0.018

p<0.001

Control

T2 n (%)

Control

Child perception AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

21 (60)

2 (6)

25 (71)

n (%)

Moderate

1 (3)

3 (9)

2 (6)

6 (17)

Deﬁnite

2 (6)

1 (3)

4 (11)

Total

24 (69)

6 (17)

5 (14)

35 (100)

T2 n (%) Parent perception child’s AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

10 (29)

4 (11)

1 (3)

15 (43)

n (%)

Moderate

7 (20)

2 (6)

0 (0)

9 (26)

Deﬁnite

4 (11)

2 (6)

5 (14)

11 (31)

Total

21 (60)

8 (23)

6 (17)

35 (100)

p=0.881

p=0.202

Aesthetic treatment need rated by AC-IOTN: low AC 1-4; moderate AC 5-7; definite AC 8-10.

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Table 3: Comparison between child perception and parent perception of child and parent CPQ domains and overall OHRQoL scores for MTB group and control group at T1 and T2. MTB group

Control group

T1 Child vs parent (mean SD)

p-value

T2 Child vs parent (mean SD)

p-value

T1 Child vs parent (mean SD)

p-value

T2 Child vs parent (mean SD)

p-value

Domain

T1 vs T1

T2 vs T2

Domain

T1 vs T1

T2 vs T2

4.3 (1.9)

8.8 (5.4)

<0.0001

3.5 (1.6)

4.0 (2.5)

0.314

5.1 (2.2)

6.1 (4.0)

<0.143

4.2 (3.0)

5.9 (4.8)

0.073

2.4 (2.1)

9.6 (5.5)

<0.0001

1.9 (1.9)

4.4 (4.4)

0.0002

3.6 (3.2)

7.0 (5.9)

<0.0005

2.7 (2.9)

6.6 (7.7)

0.004

EWB

5.1 (4.8)

15.7 (11.9)

<0.0001

3.4 (4.3)

3.9 (4.6)

0.4165

EWB

4.5 (3.9)

7.7 (8.8)

<0.006

3.9 (4.3)

7.2 (9.4)

0.017

SWB

2.4 (2.0)

12.4 (9.2)

<0.0001

1.4 (2.0)

3.4 (3.6)

0.004

SWB

2.1 (2.3)

5.0 (6.2)

<0.002

1.6 (2.4)

4.7 (7.8)

0.014

Overall score

14.2 (7.2)

46.5 (28.6)

<0.0001

10.2 (7.0)

15.7 (12.1)

0.003

Overall score

15.4 (9.0)

25.7 (21.9)

<0.0011

12.5 (10.7) 24.5 (27.5)

0.008

SD: standard deviation; OS: oral symptoms; FL: functional limitations; EWB: emotional well-being; SWB: social well-being. Statistically significant at p<0.05.

Table 4: The level of agreement between the child perception and parent perception of the aesthetic orthodontic treatment need (AC-IOTN) for MTB group and control group at T1 and T2. MTB T1

MTB T2

Parent

n (%)

Child

Child perception AC-IOTN

Low

Moderate

Deﬁnite

Total

Child

Parent perception child’s AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

12 (29)

5 (12)

7 (17)

24 (57)

Low

29 (69)

0 (0)

2 (5)

31 (74)

n (%)

Moderate

2 (5)

5 (12)

1 (2)

8 (19)

n (%)

Moderate

8 (19)

3 (7)

0 (0)

11 (26)

Deﬁnite

2 (5)

6 (14)

2 (5)

10 (24)

Deﬁnite

0 (0)

Total

16 (38)

10 (24)

42 (100)

Total

37 (88)

3 (7)

2 (5)

42 (100)

Deﬁnite

Total

p=0.054

p=0.019

Control T1

Control T2

Parent Child

Parent

Child perception AC-IOTN

Low

Moderate

Deﬁnite

Total

Low

12 (34)

7 (20)

6 (17)

25 (71)

Moderate

1 (3)

4 (11)

6 (17)

Deﬁnite

2 (6)

1 (3)

Total

15 (43)

9 (26)

11 (31)

Child

Parent perception child’s AC-IOTN

Low

Moderate

Low

18 (51)

5 (14)

1 (3)

24 (69)

Moderate

1 (3)

2 (6)

3 (9)

6 (17)

4 (11)

Deﬁnite

2 (6)

1 (3)

2 (6)

5 (14)

35 (100)

Total

21 (60)

8 (23)

6 (17)

35 (100)

p=0.040

p=0.262

although statistically signiﬁcant, was modest. A wide variation in growth patterns in II/1 M exists.24

waiting list and anticipation of imminent treatment. At T2, however, a significant improvement was recorded in the MTB group parents’ perception of their child’s overall OHRQoL and across the four domains. In contrast, the control group parents’ perception of their child’s overall OHRQoL did not change significantly from T1 to T2, or across any of the domains. These findings may demonstrate the benefit of Phase 1 treatment for a parent’s perception of their child’s OHRQoL – similar to that recorded in a previous study,5 which employed a different twin block design.

Parent-reported outcomes Perception of child’s OHRQoL At T1, the MTB group parents rated their child’s OHRQoL to be signiﬁcantly poorer than control group parents’ ratings, which may be related to time on a treatment

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For children in both groups, the parent-reported OHRQoL was poorer than that reported by the child. This is an area for future research, as findings of previous studies have been equivocal. Family QoL Phase 1 treatment with an MTB significantly improved family QoL, compared to the control group, demonstrating an impact of treatment beyond the patient.5,25 AC-IOTN For the MTB group, parental perception of their child’s AC-IOTN improved significantly; however, this perception worsened insignificantly for the control group. Once again, these findings reflect the perceived aesthetic benefit of Phase 1 orthodontic treatment. Study strengths There are several strengths to this study, which include the following: n a focus on children with II/1M, which is the most referred and treated malocclusion group in the State-funded orthodontic service in the RoI;

Study shortcomings These include: n a relatively short duration; n not adopting a condition-speciﬁc measure of OHRQoL in relation to malocclusion (this study, however, aimed to identify the impact on both the child and parent using a comparable instrument); n non-randomised samples of severe II/1M, with the associated selection bias; n not all subjects in the control group returned for follow-up, due to parent reluctance to attend during the Covid-19 pandemic. Despite this, sample size requirements of 15 males and 15 females in each group were met; and, n demographic data were not collected for parent groups, so assessment of the impact of parent gender on responses was not possible.

Conclusions Phase 1 treatment with an MTB positively impacted child OHRQoL, family QoL, and child and parent perception of AC-IOTN, but did not impact child self-esteem. Changes in 3D facial so tissue were modest. Child and parent perception of OHRQoL and AC-IOTN were discordant.

n its prospective longitudinal nature; n the recording of child- and parent-reported outcomes; and, n the assessment of 3D facial so tissue changes.

References 1

Batista KB, Thiruvenkatachari B, Harrison JE, O’Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev. 2018;3(3):CD003452.

2. O’Brien K, Wright J, Conboy F, et al. Early treatment for Class II Division 1 malocclusion with the twin-block appliance: a multi-center, randomized, controlled trial. Am J Orthod Dentofacial Orthop. 2009;135(5):573-579. 3. Burden DJ, Pine CM. Self-perception of malocclusion among adolescents. Community Dent Health. 1995;12(2):89-92. 4. Schatz JP, Ostini E, Hakeberg M, Kiliaridis S. Large overjet as a risk factor of traumatic

requiring growth modification in a public service setting. J Ir Dent Assoc. 2024;70(2):85-89. 11. O’Brien K, Macfarlane T, Wright J, et al. Early treatment for Class II malocclusion and perceived improvements in facial profile. Am J Orthod Dentofacial Orthop. 2009;135(5):580-585. 12. Alzoubi EE, Hariri R, Mulligan K, Attard N. An evaluation of oral health-related quality of life in orthodontic patients treated with fixed and twin blocks appliances. J Orthod Sci. 2017;6(2):65-70. 13. Khraishi H. A follow-up study investigation changes in oral health-related quality

dental injuries: a prospective longitudinal study. Prog Orthod. 2020;21(1):41.

of life (OHRQoL) in patients undergoing orthodontic treatment for Class II division

5. O’Brien K, Wright J, Conboy F, et al. Eﬀectiveness of early orthodontic treatment

1 malocclusion: a longitudinal study. Trinity College Dublin, School of Dental

with the twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal eﬀects. Am J Orthod Dentofacial Orthop. 2003;124(3):234-339. 6. Johal A, Cheung MY, Marcene W. The impact of two diﬀerent malocclusion traits on quality of life. Br Dent J. 2007;202(2):E2. 7. Göranson E, Sonesson M, Naimi-Akbar A, Dimberg L. Malocclusions and quality of life among adolescents: a systematic review and meta-analysis. Eur J Orthod. 2023;45(3):295-307. 8. Al-Jumah F. The impact of functional appliance treatment on bullying and quality of life in adolescents and their parents. Trinity College Dublin, School of Dental Sciences; Oral Biosciences, 2017. 9. De Sousa ET, da Silva BF, Maia FB, Forte FD, Sampaio FC. Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a crosssectional study. Prog Orthod. 2016;17(1):37. 10. Lemasney N, O’Rourke N, Fahey T, Dobbyn Ross L. A service evaluation of patients

Sciences; 2019. 14. Yaqoob O, Dibiase AT, Fleming PS, Cobourne MT. Use of the Clark Twin Block functional appliance with and without an upper labial bow: a randomized controlled trial. Angle Orthod. 2012;82(2):363-369. 15. Clark W. Design and management of twin blocks: reflections aer 30 years of clinical use. J Orthod. 2010;37(3):209-216. 16. Ehsani S, Nebbe B, Normando D, Lagravere MO, Flores-Mir C. Short-term treatment effects produced by the twin-block appliance: a systematic review and metaanalysis. Eur J Orthod. 2015;37(2):170-176. 17. Proffit WR. The timing of early treatment: an overview. Am J Orthod Dentofacial Orthop. 2006;129(4 Suppl):S47-49. 18. Salloum E, Millett DT, Kelly N, McIntyre GT, Cronin MS. So tissue changes: a comparison between changes caused by the construction bite and by successful treatment with a modified twin-block appliance. Eur J Orthod. 2018;40(5):512-518.

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19. Jokovic A, Locker D, Guyatt G. Short forms of the Child Perceptions Questionnaire for 11-14-year-old children (CPQ11-14): development and initial evaluation. Health Qual Life Outcomes. 2006;4:4.

23. Caldwell S, Cook P. Predicting the outcome of twin block functional appliance treatment: a prospective study. Eur J Orthod. 1999;21(5):533-539. 24. McNamara JA Jr. Components of class II malocclusion in children 8-10 years of age.

20. Landgraf JM, van Grieken A, Raat H. Giving voice to the child perspective: psychometrics and relative precision ﬁndings for the Child Health Questionnaire self-report short form (CHQ-CF45). Qual Life Res. 2018;27(8):2165-2176. 21. Evans R, Shaw W. Preliminary evaluation of an illustrated scale for rating dental attractiveness. Eur J Orthod. 1987;9(4):314-318.

Angle Orthod. 1981;51(3):177-202. 25. Campbell C, Millett D, Kelly N, Cooke M, Cronin M. Frankel 2 appliance versus the modiﬁed twin block appliance for Phase 1 treatment of Class II division 1 malocclusion in children and adolescents: a randomized clinical trial. Angle Orthod. 2020;90(2):202-208.

22. Jokovic A, Locker D, Stephens M, Kenny D, Tompson B, Guyatt G. Measuring parental perceptions of child oral health-related quality of life. J Public Health Dent. 2003;63(2):67-72.

CPD questions

For the MTB group, which of the outcome measures remained unchanged at T2?

To claim CPD points, go to the MEMBERS’ SECTION of www.dentist.ie l A. OHRQoL and answer the following questions: l B. AC-IOTN

l C. Family quality of life l D. Self-esteem

2. From the statements listed, choose the one that is TRUE.

3. From the statements listed, choose the one that is TRUE.

l A. MTB treatment positively impacted family quality of life.

l A. For both groups, parents rated their child’s OHRQoL better than the child.

l B. MTB treatment negatively impacted family quality of life. l C. MTB treatment did not impact family quality of life.

l B. For both groups, parents rated their child’s OHRQoL more poorly than the child. l C. For both groups, parents rated their child’s OHRQoL similarly to the child.

CPD

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Appendix 1 – Recording of 3D facial images 3D facial images were captured using the Dimensional Imaging Di3D system, which consists of six (10 megapixels) digital cameras mounted on a frame. Each subject was seated on a chair centred 90cm in front of the cameras with, where necessary, all make-up removed and hair tied back. Subjects were asked to look straight into their own eyes in a mirror, with the head in a natural position, and to remain still during image capture. Subjects followed the cue described by Zachrisson for “rest” position:

Rest position is the most reproducible facial expression.2 Images were taken in this position at T1 and T2. Nine lower facial landmarks were placed on each 3D image by a trained operator. To assess intra-operator reliability in landmark location, a random selection of 10% of images were re-landmarked a minimum of two weeks aer the original landmarking and their x, y, and z co-ordinates compared to the originals. Diﬀerences were insigniﬁcant (p>0.05). 3D so tissue changes from T1 to T2 for all facial landmarks are given in Table 1.

n say ‘Mississippi’; and, n swallow and say ‘N’.1

Table 1: 3D so tissue linear changes from T1 to T2 for the facial landmarks. Landmark

MTB group

Control group

T1-T2

Mean (mm) (SD)

P-value

Glabella

1.66 (1.33)

1.25 (0.73)

0.346

Nasion

1.30 (1.02)

1.26 (0.81)

0.834

Exocanthion (R)

1.66 (0.80)

1.73 (0.86)

0.893

Mid pupil (R)

1.63 (0.63)

1.45 (0.70)

0.0144

Orbitale (R)

1.64 (0.75)

1.57 (0.80)

0.597

Endocanthion (R)

1.33 (0.69)

1.20 (0.47)

0.378

Endocanthion (L)

1.61 (0.71)

1.13 (0.51)

0.009

Mid pupil (L)

1.85 (0.89)

1.63 (0.74)

0.115

Orbitale (L)

2.01 (0.97)

1.85 (0.87)

0.103

Exocanthion (L)

2.01 (0.91)

1.82 (0.93)

0.087

Pronasale

1.71 (0.88)

1.90 (0.84)

0.109

Subnasale

1.86 (1.05)

1.85 (0.67)

0.004

Alar curvature (R)

2.29 (1.17)

2.17 (0.96)

0.706

Alar curvature (L)

2.68 (1.15)

2.22 (0.98)

0.002

Alare (R)

2.25 (1.16)

2.23 (0.98)

0.988

Alare (L)

2.40 (1.01)

2.51 (1.10)

0.127

Chellion (R)

3.32 (1.48)

3.25 (1.34)

0.716

Christa philtri (R)

2.71 (1.54)

2.43 (1.14)

0.986

Labiale superius

2.74 (1.72)

2.56 (1.46)

0.609

Christa philtri (L)

2.94 (1.63)

2.66 (1.30)

0.8246

Chellion (L)

3.46 (1.80)

3.69 (1.58)

0.421

Lower lip (R)

3.60 (1.53)

3.40 (1.65)

0.911

Lower lip (L)

3.61 (1.71)

3.22 (1.70)

0.811

Sublabiale

4.04 (1.73)

3.28 (1.72)

0.154

Pogonion

4.26 (1.64)

3.29 (1.95)

0.011

Upper face

Lower face

References 1. Zachrisson BU. Esthetic factors involved in anterior tooth display and the smile: vertical dimension. J Clin Orthod. 1998;32(7):432-445.

2. Johnston DJ, Millett DT, Ayoub AF, Bock M. Are facial expressions reproducible? Cle Palate Craniofac J. 2003;40(3):291-296.

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Appendix 2 – Questionnaire instruments

Appendix 3 – Bite registration for modiﬁed twin block (MTB) construction

Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14) and Parental–Caregivers Perceptions Questionnaire (P-CPQ) n Validated questionnaires, each with four domains (functional limitations (FL), occlusal symptoms (OS), emotional well-being (EWB), and social well-being (SWB)). n CPQ11-14 is completed by children aged 11-14 years and P-CPQ by a parent. n P-CPQ also includes the family impact scale, which consists of 14 items and gives an insight on how the malocclusion impacts the family quality of life (family QoL).

Recorded using a Projet bite gauge (Ortho-Care (UK) Ltd, Saltaire, West Yorkshire), with the mandible postured to an edge-to-edge position and open 5mm.

Design of MTB Upper appliance: n Adams clasps (0.7mm hard stainless steel wire) to the first permanent molars and first premolars/first primary molars (0.6mm hard stainless steel wire if primary molars used); n midline expansion screw; and, n acrylic baseplate with buccal blocks inclined at 70o.

Child Health Questionnaire Child Form (CHQ-CF45) The CHQ-CF45 measures 14 unique physical and psychosocial concepts, grouped as: satisfaction with school and athletic ability; appearance; ability to get along with others and the family; and, life overall.

Lower appliance:

Aesthetic Component of the Index of Orthodontic Treatment Need (AC-IOTN)

n Southend clasps (0.7mm hard stainless steel wire) on both lower central incisors; and,

This consists of 10 colour photographs of the anterior teeth in occlusion with varying degrees of aesthetic orthodontic treatment need: 1, 2 (no need); 3, 4 (slight); 5, 6, 7 (moderate); and, 8, 9, 10 (deﬁnite).

n acrylic baseplate with buccal blocks inclined at 70o.

n Adams clasps (0.7mm hard stainless steel wire) to the first permanent molars and first premolars/first primary molars (0.6mm hard stainless steel wire if primary molars used);

Participant instructions regarding the MTB n Wear it full-time, including for eating, and remove it for contact sports, swimming, oral hygiene and cleaning; n turn the upper midline expansion screw as instructed for arch co-ordination; and, n contact the clinic in the event of breakage or loss.

Quiz Submitted by Dr Yong Yong Foo BDS (NUI) MFD RCSI PgCert TLHE A 45-year-old patient presents to your clinic, complaining of his “teeth getting shorter”. Clinical examination reveals anterior non-carious tooth surface loss, with areas of dentine exposure and reduced clinical crown height, as shown in the clinical photos. The patient reports no pain or sensitivity.

1. Which of the following clinical findings, seen in the clinical photos, are most suggestive of erosive tooth wear? A. Matching, well-defined wear facets on opposing teeth. B. Smooth concavities and cupping of tooth surfaces with loss of normal morphology. C. Wedge-shaped cervical defects near gingival margin. 2. A revised version of the Basic Erosive Wear Examination (BEWE 2.0) was published in 2026. What score would this patient be assigned? A. Score 1 – loss of enamel surface texture without a visible defect. B. Score 2 – visible defect involving less than 50% of the surface. C. Score 3 – visible defect involving more than 50% of the surface but less than 2mm in depth. D. Score 4 – an extensive visible defect involving more than 50% of the surface and/or more than 2mm in depth. 3. Which of the following is the most appropriate initial management strategy for a patient with active erosive tooth wear? A. Immediate full-mouth indirect restorations to replace the lost tooth tissue. B. Identification and management of the aetiological factors, preventive measures and regular monitoring, with restorative treatment where indicated. C. Restoration of the teeth with exposed dentine. Answers on page 99 D. Extraction of teeth with significant loss of coronal tooth structure.

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Non-surgical peri-implantitis therapy: what now? Non-surgical therapy can control peri-implantitis and delay the need for surgery when supported by maintenance care. Future management emphasises minimally invasive, regenerative, and technology-assisted approaches to optimise clinical outcomes.

Learning outcomes 1. Describe the main non-surgical treatments for peri-implantitis and their clinical eﬀectiveness. 2. Recognise the role of maintenance care in improving treatment outcomes.

Introduction Peri-implantitis is a plaque-induced condition that causes inflammation and progressive bone loss around implants.1 It is clinically significant because it represents one of the primary causes of implant failure. Its reversible precursor, periimplant mucositis, presents with bleeding on probing (BOP), erythema, swelling, and/or suppuration without bone loss. Peri-implantitis, by contrast, shows BOP and/or suppuration, increased probing depths (PDs), and radiographic bone loss (Figures 1-3). Histologically, lesions extend beyond the junctional epithelium and contain more plasma cells, macrophages, and neutrophils than mucositis.1 Diagnosis relies on detecting disease progression, greater PDs, BOP and/or suppuration on probing (SOP), and bone loss beyond initial remodelling. Without baseline data, indirect criteria apply, including BOP and/or suppuration on gentle probing, PD of ≥6mm and “bone levels ≥3mm apical of the most coronal portion of the intra-osseous part of the implant”.1 Peri-implantitis is influenced by both subject- and implant-level risk indicators. At the subject level, a history of severe periodontitis, diabetes, and smoking increase susceptibility. Implant-level indicators include implant surface

FIGURE 1: Increased probing depths and bleeding on probing around implants supporting a full-arch prosthesis.

Erin M. O’Hagan Final year dental student School of Dental Science, Dublin Dental University Hospital

characteristics, suboptimal restorations, residual cement, improper positioning, insufficient keratinised mucosa, and occlusal overload.2 Overall, disease severity strongly correlates with plaque accumulation, underscoring the importance of plaque control.2 Microbiological studies show that peri-implantitis lesions are dominated by Treponema spp. and Synergistes cluster A, with Campylobacter, Fusobacterium, Gemella, Porphyromonas, Parvimonas, and Treponema spp. present in all samples, and Prevotella, Staphylococcus, and Streptococcus spp. in 60-80% of samples. Higher levels of T. forsythia, P. micra, F. nucleatum, F. necrophorum, and C. rectus distinguish peri-implantitis from periodontitis.3 Prosthesis design significantly affects peri-implant health (Figures 4 and 5). Different design features influence plaque accumulation, cleanability, and the surrounding peri-implant so tissue response. Factors such as emergence profile, angulation, and cervical margin influence plaque retention and so tissue stability, reinforcing the importance of prosthetic-driven implant placement.4 A weak so tissue seal may predispose to disease, while poor prosthetic design can exacerbate inflammation through plaque accumulation and mechanical stress. Effective management requires identifying and addressing prosthetic, local, and systemic risk factors. Strict adherence to personalised oral hygiene and supportive implant maintenance is essential, as regular post-restorative care can prevent or delay disease progression.4 The potential for true re-osseointegration following peri-implantitis treatment remains controversial, with most supporting evidence derived from animal

FIGURE 2: Radiographic FIGURE 3: Implant-retained full-arch prosthesis with early peri-implantitis. bone loss around a threaded implant design.

Ioannis Polyzois DMD PhD FTCD MDentCh MMedSci Consultant Periodontist Dublin Dental University Hospital ORCID: 0000-0002-0921- 0843

Corresponding author: Erin O’Hagan E: eohagan@tcd.ie

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FIGURE 4: Inflamed peri-implant soft tissue.

FIGURE 5: Implant-supported crown with poor cleansability due to contour/design.

histological studies.5 Initial management should begin with non-surgical therapy aimed at reducing biofilm and inflammation via sub-marginal mechanical decontamination, oen supplemented with adjunctive measures.6 Surgical interventions are typically recommended when non-surgical therapies fail, as they provide superior access for thorough decontamination and defect management.1,6 A notable drawback, however, is the frequent occurrence of postoperative gingival recession, which restricts the use of these procedures in aesthetically sensitive areas. Non-surgical debridement remains a low-cost treatment option, but its efficacy is limited in advanced peri-implant disease. Regenerative surgical approaches, although more expensive, may offer long-term cost effectiveness by preserving compromised implants and reducing the need for future replacement. Nevertheless, both non-surgical and conventional surgical therapies oen yield unpredictable outcomes.6 These limitations have prompted a growing interest in minimally invasive, flapless surgical techniques, which aim to enhance therapeutic predictability while reducing morbidity. Successful treatment protocols can yield clinical improvements, including reduced probing pocket depth (PPD) and BOP, as well as stabilisation or regeneration of marginal bone levels. Re-evaluation is recommended approximately six months post treatment to assess healing and determine the need for further surgical intervention. However, relying solely on PPD and BOP may not accurately reflect treatment success. Current evidence supports the use of composite outcome measures, incorporating PPD, BOP, SOP, peri-implant recession, patient-reported outcomes, and marginal bone level changes, to provide a more comprehensive assessment of peri-implantitis therapy.7-9 The aim of this article is to comprehensively evaluate current non-surgical treatment modalities for peri-implantitis, focusing on their clinical efficacy, limitations, and the evolving role of adjunctive and future therapies in optimising non-invasive management. This article explores mechanical decontamination (laser and airabrasive powder), adjunctive chemical decontamination, subgingival drugs, and systemic antibiotics. The majority of the studies discussed are randomised controlled trials (RCTs), in which the control group received conventional scaling and root planing using titanium curettes alone, as this remains the most routinely employed non-surgical periodontal treatment modality.

What is the state of play now? Mechanical decontamination A variety of instruments can be used for sub-marginal instrumentation, including plastic or titanium curettes, sonic and ultrasonic devices, air-abrasive systems, and lasers, with no single method demonstrating clear superiority.7 Of the nine

94 | Volume 2 Number 5 | October/November 2026

FIGURE 6: Labrida BioClean chitosan brush.

RCTs analysed in a systematic review by Cosgarea et al., five investigated laserassisted decontamination (Nd:YAG, diode, Er:YAG, Er,Cr:YSGG), while four examined air-abrasive systems.7 Lasers provided limited short-term advantages: Nd:YAG produced improvements in PD and BOP at three months but not at six; Er,Cr:YSGG achieved greater PD reductions at six months; and, Er:YAG significantly decreased BOP. Nd:YAG also lowered inflammatory markers, although diode laser outcomes were inconsistent. Across devices, mean PD reductions ranged from 0.8 to 1.5mm, with minimal influence on suppuration or bone levels. Rough implant surfaces and cement-retained prostheses complicated decontamination, and only limited data were available on patient-reported outcomes or implant survival. Laser systems, especially Er:YAG and Er,Cr:YSGG, provide effective decontamination with limited disruption to surface topography. Additionally, the Er:YAG-activated electromagnetic device (EM) appears promising for biofilm disruption and facilitating re-osseointegration, although strong independent clinical evidence is still lacking.10 Low-abrasive air-abrasive (AA) powders, such as glycine, erythritol, calcium sodium phosphosilicate, calcium carbonate, and tricalcium phosphate, have demonstrated encouraging results. Glycine powder achieved significantly greater reductions in PD and BOP at three and six months than Gracey curettes used alongside chlorhexidine (CHX) irrigation.11 Erythritol air polishing provided clinical and microbiological outcomes comparable to ultrasonic debridement, with minimal discomfort.12 Combinational approaches, such as glycine mixed with tricalcium phosphate, have shown superior biofilm removal compared with glycine or sodium bicarbonate alone on titanium and zirconia surfaces, while also reducing treatment time.12 Low-abrasive powders like glycine and erythritol preserve implant surface topography, in contrast with more abrasive powders like sodium bicarbonate, which can roughen the surface and potentially hinder reosseointegration. Thus, low-abrasive AA powders offer an effective, minimally invasive, and surface-preserving non-surgical decontamination option. Despite their overall safety, AA devices can occasionally lead to complications, such as subcutaneous emphysema when pressurised air is forced into so tissues, emphasising the importance of accurate technique. Clinicians can use implant-specific sonic or ultrasonic inserts (e.g., plastic, carbon fibre, or silicone-coated tips) for the non-surgical treatment of peri-implantitis, as these effectively disrupt biofilm while minimising titanium surface damage. Evidence also supports the use of chitosan brushes (Figure 6) as adjunctive decontamination tools. Chitosan brushes seem to improve PD and bleeding in the short term.13 Finally, where safe and practical, removing a screw-retained superstructure can also enhance access for implant decontamination.

C L I NI C AL FE AT U R E

Adjunctive chemical decontamination Adjunctive chemical decontamination should be used cautiously due to limited benefits and potential implant surface damage. Agents like CHX, hydrogen peroxide, citric acid, and sodium hypochlorite (NaOCl), as well as photodynamic systems with photosensitisers, provide only modest reductions in PD and BOP, with no consistent superiority.6 Across agents and devices and in combination with a variety of instruments, mean PD reductions ranged from 0.5 to 1.87mm. Furthermore, agents like CHX may impair osteoblast function, while saline, citric acid, and NaOCl-EDTA are more biocompatible. Mechanical-chemical combinations may help in select cases, but evidence is limited. Recently explored compounds like curcumin and xanthohumol show strong antibiofilm activity against P. gingivalis and A. actinomycetemcomitans in 60second treatments, making them promising biocompatible alternatives.14 The electrolytic cleaning process generates hydrogen bubbles on the implant surface, effectively detaching and flushing away bacterial biofilm without damaging the titanium. It is primarily used as a stand-alone decontamination method during surgical treatment of peri-implantitis, but it can also be combined with mechanical instrumentation and regenerative procedures. Clinical evidence has demonstrated that sites treated with electrolysis were inflammation free and showed significant bone fill, supporting re-osseointegration.15 The downside is that it is costly, requiring a power unit and single-use tips. Subgingival drugs in the non-surgical therapy of peri-implantitis Subgingival drugs are used adjunctively with mechanical debridement in nonsurgical peri-implantitis management to reduce bacterial load, inflammation, and PD. Local antimicrobials delivered via gels, chips, or controlled-release systems provide high site-specific concentrations with minimal systemic exposure, but may cause discomfort and require multiple applications. Controlled-release systems, such as biodegradable polymers, hydrogels, and films, maintain therapeutic levels and can release ions (e.g., calcium, phosphate) to create an alkaline, antibacterial environment supporting tissue regeneration.16 CHX chips achieved greater PD reduction (1.76mm vs 1.54mm, p=0.01) and attachment gain (1.47mm vs 1.39mm, p=0.0017) than controls, with more patients showing ≥2mm PD reduction (59% vs 47%).17 Local antibiotics, including minocycline (chitosan-alginate microspheres), doxycycline hyclate (Atridox), and topical metronidazole, significantly reduced PD, BOP, and inflammation in clinical and animal studies.18,19 Overall, subgingival drugs offer modest benefits with no standardised protocol. Implant surface roughness and material influence bacterial colonisation, limiting local antimicrobial efficacy. Advanced systems (hydrogels, microspheres, nanoparticles) and combinations with lasers or photodynamic therapy may enhance biofilm disruption, but high costs, repeated applications, and surface variability restrict routine use. Effective management still depends on early detection, mechanical debridement, patient compliance, and maintenance, with subgingival drugs only as supportive adjuncts.20

Systemic antibiotics as adjuncts to non-surgical therapy Mechanical decontamination remains the cornerstone of non-surgical periimplantitis management, and systemic antibiotics have been explored as adjuncts to improve outcomes. RCTs show that while amoxicillin and metronidazole may yield short-term PPD and BOP reductions, differences versus mechanical therapy alone are not statistically significant. De Waal et al. found no added benefit from antibiotics aer full-mouth debridement with CHX, and Polymeri et al. similarly reported nonsignificant PPD improvements, with only two implants achieving full resolution.21,22 Systematic reviews confirm inconsistent and short-lived benefits, limited mainly to deep pockets.8 Accordingly, the European Federation of Periodontology (EFP) S3-level guidelines do not recommend routine systemic antibiotics in non-surgical peri-implantitis therapy, advising their use only in severe, high-risk cases. Standard care should prioritise mechanical debridement, patient self-care, and supportive maintenance, with surgery indicated when non-surgical measures fail to restore peri-implant health.23

Future directions The evolution of peri-implantitis management is moving towards minimally invasive surgical approaches, combining the benefits of non-surgical and traditional surgical techniques. These methods aim to reduce procedural morbidity while maintaining efficacy, preserve so and hard tissue architecture, and promote regeneration using advanced instruments and autologous biomaterials. Chiang et al. reported that microscope-assisted flap surgery with surface decontamination, bone graing, and membrane placement achieved stable radiographic bone fill and disease resolution over two to four years.24 Microscopeenhanced and laser-assisted regenerative approaches, alongside autologous products like leukocyte- and platelet-rich fibrin (L-PRF), have also shown promise in improving outcomes. Clinical studies demonstrate that L-PRF enhances attachment gains, PD reduction, and implant stability, compared to conventional treatment.25 As with conventional surgical regeneration, defect depth and wall configuration remain key determinants of success in minimally invasive peri-implantitis treatment.

Conclusion Non-surgical therapy is the first-line treatment for peri-implantitis, focusing on biofilm removal, inflammation control, and implant preservation. Mechanical debridement is central, while chemical agents and systemic antibiotics provide minimal additional benefit and should be used selectively. Success relies on individualised maintenance, meticulous oral hygiene, and regular supportive care, as recurrence is linked to poor plaque control. Daily home plaque control is essential for managing peri-implantitis, and adjunctive measures such as oral irrigators or short-term CHX rinses can further support biofilm control. If non-surgical measures fail, surgical or minimally invasive regenerative approaches, using biocompatible biomaterials, microscope-assisted precision, and advanced decontamination can offer more predictable long-term outcomes.

References 1. Berglundh T, Armitage G, Araujo MG, et al. Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol. 2018;45(Suppl. 20):S286-S291.

2. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol. 2018;45(Suppl. 20):S246-S266. 3. Sahrmann P, Gilli F, Wiedemeier DB, Attin T, Schmidlin PR, Karygianni L. The microbiome of peri-implantitis: a systematic review and meta-analysis.

Volume 2 Number 5 | October/November 2026 | 95

C L I NICAL F EATURE

Microorganisms. 2020;8(5):661. 4. Mattheos N, Vergoullis I, Janda M, Miseli A. The implant supracrestal complex and its significance for long-term successful clinical outcomes. Int J Prosthodont. 2021;34(1):88-100. 5. Almohandes A, Carcuac O, Abrahamsson I, Lund H, Berglundh T. Re-

curcumin and xanthohumol on bacterial biofilms developed over dental implant surfaces. Int J Mol Sci. 2023;24(3):2335. 15. Fonseca D, Pons R, de Tapia B, et al. Effect of electrolytic cleaning on mechanical properties for titanium dental implants with surface contamination. Int J Oral Maxillofac Implants. 2025;40(6):725-734.

osseointegration following reconstructive surgical therapy of experimental

16. Steinberg D, Friedman M. Sustained-release delivery of antimicrobial drugs

peri-implantitis. A pre-clinical in vivo study. Clin Oral Implants Res.

for the treatment of periodontal diseases: fantasy or already reality?

2019;30(5):447-456.

Periodontol 2000. 2020;84(1):176-187.

6. Polyzois I. Treatment planning for periimplant mucositis and periimplantitis. Implant Dent. 2019;28(2):150-154. 7. Cosgarea R, Roccuzzo A, Jepsen K, Sculean A, Jepsen S, Salvi GE. Efficacy of

17. Machtei EE, Romanos G, Kang P, et al. Repeated delivery of chlorhexidine chips for the treatment of peri-implantitis: a multicenter, randomized, comparative clinical trial. J Periodontol. 2021;92(1):11-20.

mechanical/physical approaches for implant surface decontamination in non-

18. Yoon SW, Kim MJ, Paeng KW, et al. Efficacy of local minocycline agents in

surgical submarginal instrumentation of peri-implantitis. A systematic review.

treating peri-implantitis: an experimental in vivo study in beagle dogs.

J Clin Periodontol. 2023;50(Suppl. 26):188-211.

Pharmaceutics. 2020;12(11):1016.

8. Liñares A, Sanz Sánchez I, Dopico J, Molina A, Blanco J, Montero, E. Efficacy

19. Park SH, Song YW, Cha JK, et al. Adjunctive use of metronidazole-minocycline

of adjunctive measures in the non surgical treatment of peri implantitis: a

ointment in the nonsurgical treatment of peri-implantitis: a multicenter

systematic review. J Clin Periodontol. 2023;50(Suppl. 26):224-243.

randomized controlled trial. Clin Implant Dent Relat Res. 2021;23(4):543-554.

9. de Waal YCM, Winning L, Stavropoulos A, Polyzois I. Efficacy of chemical

20. Herrera D, Berglundh T, Schwarz F, et al. Prevention and treatment of peri-

approaches for implant surface decontamination in conjunction with sub-

implant diseases – the EFP S3 level clinical practice guideline. J Clin Periodontol.

marginal instrumentation, in the non-surgical treatment of peri-implantitis:

2023;50(Suppl. 26):4-76.

a systematic review. J Clin Periodontol. 2023;50(Suppl. 26):212-223. 10. Monje A, Amerio E, Cha JK, et al. Strategies for implant surface decontamination in peri-implantitis therapy. Int J Oral Implantol. 2022;15(3):213-248. 11. Lupi SM, Granati M, Butera A, Collesano V, Rodriguez y Baena R. Air-abrasive

21. De Waal YCM, Vangsted TE, Van Winkelhoff AJ. Systemic antibiotic therapy as an adjunct to non surgical peri implantitis treatment: a single blind RCT. J Clin Periodontol. 2021;48(7):996-1006. 22. Polymeri A, van der Horst J, Anssari Moin D, Wismeijer D, Loos BG, Laine ML. Non surgical peri implantitis treatment with or without systemic antibiotics:

debridement with glycine powder versus manual debridement and

chlorhexidine administration for the maintenance of peri-implant health

2022;33(5):548-557.

status: a six-month randomized clinical trial. Int J Dent Hyg. 2017;15(4):287-294. 12. John G, Becker J, Schwarz F. Effectivity of air-abrasive powder based on glycine

randomized

controlled

clinical

trial.

Clin

Oral

Implants

Res.

23. Sanz M, Chapple IL, Working Group 4 of the VIII European Workshop on Periodontology. Clinical research on peri-implant diseases: consensus report of Working Group 4. J Clin Periodontol. 2012;39(Suppl. 12):202-206.

and tricalcium phosphate in removal of initial biofilm on titanium and

24. Chiang YC, Sirinirund B, Rodriguez A, Velasquez D, Chan HL. Operating

zirconium oxide surfaces in an ex vivo model. Clin Oral Investig.

microscope-assisted reconstructive strategy for peri-implantitis: a case series

2016;20(4):711-719.

report. Clin Adv Periodontics. 2024;14(3):149-156.

13. Pappolla Sessa C, Pappolla Sessa A, Martín-Vacas A, Docampo-Vázquez C,

25. Schuldt L, Bi J, Owen G, et al. Decontamination of rough implant surfaces

Aragoneses, JM. Mucositis and peri-implant disease treatment with chitosan

colonized by multispecies oral biofilm by application of leukocyte- and

and titanium brushes: a systematic review. J Clin Med. 2025;14(23):8306.

platelet-rich fibrin. J Periodontol. 2021;92(6):875-885.

14. Alonso-Español A, Bravo E, Ribeiro-Vidal H, et al. The antimicrobial activity of

96 | Volume 2 Number 5 | October/November 2026

CL I N I CA L T I P S

Chairside acrylic temporary crowns Chairside acrylic resin temporary crowns offer a practical, durable temporisation option for conservative preparations, and proficiency with this technique remains valuable for general dental practitioners.

Introduction Temporary crowns serve several important functions. They protect the prepared tooth from bacterial and thermal insults, prevent sensitivity, maintain periodontal health, prevent unwanted tooth movement, and maintain masticatory function while the definitive crown is being fabricated.1 Ensuring that a temporary crown is adequate in strength and fit is an essential part of treatment. Chairside acrylic resin has long been used to fabricate temporary crowns and was, for many years, the standard material of choice in clinical practice (Table 1). However, with the introduction of bis-acryl composite systems such as Protemp (Solventum, USA) and Luxatemp (DMG, Germany), which offer convenience, easier handling, and auto-mix delivery, acrylic resin has fallen out of routine use. As undergraduate training has increasingly adopted bis-acryl as the primary material for temporisation, familiarity with acrylic resin techniques has diminished. Bis-acryl materials are suitable for most crown preparations. However, the increasing adoption of minimally invasive dentistry has led to more conservative crown preparations, with restorations such as full gold and monolithic zirconia crowns requiring as little as 0.7-1.0mm of tooth reduction.2,3 In these situations, acrylic resin may provide greater fracture resistance than bis-acryl materials.4 This article does not present new material or techniques; rather, it revisits a method that remains clinically relevant.

Clinical situations in which to consider a chairside acrylic temporary crown: n conservative preparations for full gold or monolithic zirconia crowns; n patients with parafunctional habits and increased occlusal loading; n extended temporisation periods; n cases with marked gingival inflammation or so-tissue trauma, requiring optimal marginal adaptation of the temporary crown to promote gingival healing; and, n temporary bridges where flexural loading may increase fracture risk at the connector. Materials required for an acrylic temporary crown: n polyvinyl siloxane (PVS) or putty impression material; n sectional tray and adhesive; n self-curing acrylic resin (powder and liquid); n petroleum jelly; n finishing and polishing instruments; n shade guide; n Dappen dish, mixing pad, spatula and microbrushes; n temporary cement; n articulating paper; and, n floss.

Table 1: Examples of proprietary self-curing acrylic resin systems used for chairside fabrication of temporary crowns. Brand name

Material type

Manufacturer

Country

DuraLay

Self-cure polymethyl methacrylate (PMMA) powder/liquid

Reliance Dental Mfg

USA

Snap

Self-cure ethyl methacrylate powder/liquid

Parkell

USA

TAB 2000™

Self-cure PMMA powder/liquid

Kerr

USA

Jet Set-4

Self-cure PMMA powder/liquid

Lang Dental Mfg

USA

Trim® Plus

Self-cure PMMA powder/liquid

Harry J Bosworth Company

USA

Unifast III

Self-cure PMMA powder/liquid

GC Corporation

Japan

Yong Yong Foo BDS (NUI) MFD RCSI PgCert TLHE Specialist Registrar in Restorative Dentistry Cork University Dental School and Hospital

Corresponding author: Yong Yong Foo, G103, Restorative Department, Cork University Dental School and Hospital, Wilton, Cork E: yfoo@ucc.ie

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FIGURE 1: Material set-up for prepreparation impression.

FIGURE 5: Homogenous mix of acrylic resin.

FIGURE 2: PVS impression of the tooth pre-op.

FIGURE 6: Checking the flow and consistency of the mix.

Chairside step-by-step technique 1. Pre-preparation (Figure 1) n Apply tray adhesive to the impression tray. Take an impression of the tooth and the adjacent teeth using PVS or silicone putty material (Figure 2). n Select a shade for the temporary crown. 2. Tooth preparation n Carry out tooth preparation (Figures 3 and 4). n Block out any significant undercuts in areas outside of the preparation margins and axial walls where the acrylic could lock during setting.

FIGURE 3: Occlusal view of tooth 26 after crown preparation.

FIGURE 4: Buccal view of tooth 26 after crown preparation.

FIGURE 7: Acrylic temporary crown removed within the impression.

FIGURE 8: Acrylic crown removed from impression. Note the excess material and flash.

n Seat the loaded impression over the prepared tooth and maintain gentle pressure. n Monitor the material until it reaches the rubbery phase: when it holds its shape and remains slightly resilient when pressed with a ﬁngernail, like a ﬁrm rubber eraser, but is not fully set. Remove the impression carefully. The provisional crown should remain within the impression (Figure 7). n Reseat the temporary crown within the impression back onto the tooth. Remove and reseat several times periodically as the material continues to set. 5. Polishing and adjustment

n Apply a thin layer of petroleum jelly on the prepared tooth and adjacent teeth.

n Once fully set, carefully remove the temporary crown from the impression (Figure 8).

3. Mix the acrylic resin

n Remove any excess material with acrylic-trimming burs or polishing discs (Figure 9).

n Refer to the manufacturer’s instructions. n Dispense liquid into a Dappen dish. Add powder until the liquid is saturated. n Mix with a spatula until a homogeneous mix is obtained (Figure 5). n Allow the material to progress to the doughy stage, characterised by a dull appearance, a thick consistency, clinging to the spatula, and forming a slowmoving strand when lifted (Figure 6).

n Seat the crown on the prepared tooth. n Assess margins for gaps or overextension, and adjust or reline as required. n Verify proximal contacts. n Check occlusion in centric and excursive movements with articulating paper and adjust high spots as needed. n Polish the temporary crown using discs, wheels, pumice slurry, or polishing paste.

4. Load the impression and seat over the preparation n Load the acrylic into the tooth space within the impression, ensuring complete crown form coverage without voids. Place a small amount on the back of your hand to monitor setting.

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6. Cementation n Select suitable temporary cement. n Clean and dry the crown’s fitting surface and the prepared tooth.

CL I N I CA L T I P S

FIGURE 9: Flash and excess material removed.

FIGURE 10: Buccal view of cemented acrylic temporary crown.

n Load cement and seat the crown on the tooth with firm pressure. n Remove excess cement. n Recheck occlusion and floss contacts. n Make final adjustments as needed (Figures 10 and 11).

Additional notes n Once the material reaches the rubbery stage, it should be periodically removed and reseated for two reasons:

FIGURE 11: Palatal view of cemented acrylic temporary crown.

Conclusion Chairside acrylic temporary crowns may be a useful alternative for the temporisation of conservative crown preparations, including monolithic zirconia and full gold crowns. Although more sensitive to technique than bisacryl provisionals, the method can be readily incorporated into routine general practice. As minimally invasive dentistry becomes more widely adopted, familiarity with acrylic resin remains a valuable clinical skill.

l to dissipate the exothermic heat of polymerisation and minimise the risk of pulpal irritation; and, l to prevent the acrylic from locking into undercuts, which can make crown removal diﬃcult or impossible without destruction of the crown. n The temperature of the environment matters: a warm room accelerates setting; a cooler environment increases working time.

References 1. Field J, Wassell R. Provisional restorations (Part 1). Br Dent J. 2023;234(11):805809.

submitted to dental laboratories for fabrication of monolithic zirconia crowns. Dent J (Basel). 2021;9(10):112.

2. Shillingburg jr HTS, Sather DA, Wilson jr EL, et al. Fundamentals of Fixed Prosthodontics. 4th ed. Quintessence Publishing Co; 2012:1. 3. Sadid-Zadeh R, Sahraoui H, Lawson B, Cox R. Assessment of tooth preparations

4. Hamza TA, Rosenstiel SF, Elhosary MM, Ibraheem RM. The effect of fiber reinforcement on the fracture toughness and flexural strength of provisional restorative resins. J Prosthet Dent. 2004;91(3):258-264.

Quiz answers 1. B. Smooth concavities, cupping and loss of normal surface morphology are characteristic clinical features of erosive tooth wear. Erosive tooth wear is a chemical-mechanical process involving loss of dental hard tissue following exposure to acids that are not of bacterial origin. Acid-mediated soening of the tooth surface can increase susceptibility to subsequent mechanical wear from attrition or abrasion. Matching wear facets are more characteristic of attrition, while wedgeshaped cervical defects may suggest abrasion.

2. D BEWE 2.0 score 4 is deﬁned as an extensive visible defect involving more than 50% of the surface and/or more than 2mm in depth. The revised BEWE retains the sextant-based screening approach of the original index but introduces score 4 to address the previous “ceiling eﬀect” of score 3, which encompassed a very broad spectrum of tooth wear severity.

3. B Initial management should focus on identifying and controlling the aetiological factors and preventing further tooth surface loss: dietary assessment of the frequency of acidic food and drink consumption, and medical history to consider intrinsic acid exposure, such as gastrooesophageal reﬂux and vomiting. Restorative treatment should be considered when indicated by factors such as progressive loss of tooth structure, functional or aesthetic concerns, pain or hypersensitivity. Questions on page 92

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R E SEARCH ER PRO FILE

Strengthening support for a vulnerable population Dr Patrick Quinn is a Doctoral Student and Specialist Trainee in Dental Public Health at Dublin Dental University Hospital, and Principal Dental Surgeon with the Health Service Executive.

Tell us about your background, what led you to dentistry, and to dental research. I grew up on a dairy farm in Kerry, but was interested in a career in healthcare from a young age. My aunt is a dental nurse, so I had exposure to dentistry growing up. I got into dentistry in UCC and medicine in RCSI, and having never lived away from home I opted for Cork, which was closer. A few years into my career I did a master’s in dental public health, and that was the start of my journey into research. Can you share the primary focus of your recent research and what inspired you to pursue this topic? In the HSE I get frequent requests to provide support to nursing homes and unfortunately there is a limit to the support we can offer due to limited resources. To make the case for change in this area, we need data on the oral health needs of our nursing home residents, and unfortunately we have very little. I set about improving this by undertaking an oral health needs assessment of nursing home residents in my own region, HSE South West. The study uses data collection methods that are more acceptable to groups that might find traditional epidemiological methods challenging. The Modified Oral Status Survey Tool, developed by Trinity College Dublin, involves a simple oral examination to collect data on a range of oral features that are important from a policy and service perspective. The study also uses the recently developed International Association for Disability and Oral Health Universal Case Mix Tool to rate case complexity in the delivery of oral healthcare. The study involves approximately 200 participants from eight randomly selected public nursing homes in Cork and Kerry. What challenges have you encountered during your research, and how have you overcome them? The main challenge has been making sure that the consent aspect of my study is in keeping with the new assisted decision-making legislation. I was fortunate that I had studied law, so I had a fairly good grasp of the legislation, which helped. There were still some areas of uncertainty, but my research steering group and two ethics committees helped me to tease these out, and the result was an approach that is as inclusive as possible while respecting the rights of this vulnerable group. How do you see your research contributing to clinical practice or patient outcomes in dentistry? My research explores the oral health of nursing home residents, but also the barriers that they encounter in accessing oral care. Taking a wide view like this gives us rich data to help us design services with the aim of breaking down these barriers. Once the study is complete, I hope to begin this process in HSE South West so that we can put in place the evidence-based services that this group needs and deserves.

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Are there any misconceptions in the field that your research helps to clarify or correct? A common misconception is that it is unethical to involve groups that might have impaired decision-making capacity in research. In fact, the opposite can be argued: if we exclude these groups from research then we are almost condemning them to poorer-quality services because we know less about their health needs. Of course there are challenges, but these can be overcome by careful attention to research design. Which emerging technologies or methods do you believe will most significantly shape the future of dental research? Artificial intelligence (AI) is already having a significant impact. From an academic perspective, I think that AI has a valuable role as a research tool, but the original thought aspect must come from the researcher. Finding the line can be tricky, but there is a lot of work taking place around guidance in this area and it should hopefully become much clearer over time. How important is interdisciplinary collaboration in your work, and can you give an example where it made a key difference? It has been critical. I involved a wide range of stakeholders in a steering group to help me design the project, and I’m now working closely with a number of Directors of Nursing to make the clinical fieldwork as seamless as possible. This project wouldn’t be possible without the support of my nursing colleagues in the HSE. My research effectively involves going into people’s homes, so it needs to be as respectful as possible. What advice would you give to young dental researchers just starting out in the field? My main advice is not to be afraid of the ethical approval stage, as the ethics committee is an important partner in teasing out the tricky aspects of your project. You will arrive at a stage when you have most of your protocol figured out but some questions remain – engagement with the ethical approval process will help you to figure these out. Outside of your research, how do you maintain balance and well-being in such a demanding field? When I get free time I like to spend it in the garden. I’ve been gardening since I was very young and it’s a quick de-stressor for me – a few hours in the garden is like a few days on holiday. Getting your hands into the soil can be very grounding.