Diagnosis of visceral and cutaneous leishmaniasis using loop-mediated isothermal amplification (LAMP) protocols: a systematic review and meta-analysis

Sensitive, reliable and fast diagnostic tools that are applicable in low-resource settings, at the point of care (PoC), are seen as crucial in the fight against visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL). Addressing the need for a PoC test, several diagnostic tests, including serological and molecular methods, have been developed and evaluated in the past. One promising molecular method, already implemented for diagnosis of a range of diseases, is the loop-mediated isothermal amplification (LAMP) protocol. In this systematic review and meta-analysis, using a comprehensive search strategy, we focus on studies evaluating the performance of LAMP for the diagnosis of leishmaniasis in humans and other mammals such as dogs, compared with microscopy and/or any other molecular diagnostic method. A meta-analysis, pooling sensitivity and specificity rates and calculating areas under the curve (AUCs) in summary receiver operating characteristic (SROC) plots, was conducted on datasets extracted from studies, grouped by clinical condition and sample type. We found high sensitivity and specificity for LAMP when compared with microscopy and PCR using blood samples, with pooled estimate values of > 90% for all subgroups, corresponding to calculated AUC values > 0.96, except for LAMP compared to microscopy for diagnosis of CL. However, only a limited number of studies were truly comparable. Most of the observed heterogeneity is likely based on true differences between the studies rather than sampling error only. Due to simple readout methods and low laboratory equipment requirements for sample preparation compared to other molecular methods, LAMP is a promising candidate for a molecular (near-)PoC diagnostic method for VL and CL.

Early Class II treatment

The treatment of children presenting with a Class II division I malocclusion involves one of two approaches. The first provides treatment in two phases; one of intervention during the mixed dentition (phase I) followed by a second definitive course of appliance treatment in early adolescence (phase II). The second approach involves providing a single course of comprehensive therapy during adolescence. The debate for and against early treatment is discussed alongside key, clinically relevant evidence related to Class II division I malocclusions.

How to … place a lower bonded retainer

Post-orthodontic relapse of lower incisors is a common phenomenon. Sometimes a bonded retainer is fitted to prevent this relapse. In this article, we suggest a handy clinical technique of fitting a lower bonded retainer, which is convenient and easy to carry out.

How to avoid common errors in clinical photography

This paper demonstrates some of the errors commonly seen in both conventional and digital photography when used for clinical purposes, and details how some of these mistakes may be avoided.

Autotransplantation of an impacted third molar: an orthodontic case report

This case report describes the use of autotransplantation as part of an orthodontic treatment plan where there was early loss of an upper molar tooth secondary to irreversible pulpitis. An impacted lower third molar, which had symptoms of pericoronitis, was transplanted into the upper left second molar socket. Fixed orthodontic treatment, to correct the patient's initial complaint of crowding, was completed in 22 months. The transplanted tooth remained vital and functional throughout.

Keeping your eye on the ball

Dentigerous cysts develop from unerupted and impacted permanent teeth. Very rarely, supernumerary teeth are associated with dentigerous cysts and constitute about 5-6% of all dentigerous cysts. Although these cysts are not common in the first decade of life, regular thorough inspection of radiographs is of importance, as indicated by this case report. This case shows how an impacted supernumerary canine developed a dentigerous cyst, engulfing the whole of the maxillary antrum.

How to effectively use a 2 x 4 appliance

A mixed dentition treatment can efficiently and effectively be provided using a 2 x 4 appliance. The indications for early treatment are discussed and advantages of fixed appliances over traditionally used removable appliances illustrated using four case reports.

The potentially fatal vascular anomaly and orthodontic treatment--a case report

Oral vascular lesions are of clinical importance to the dental profession because they pose serious bleeding risks. A case report is presented here where a patient with a complex palatal vascular malformation was successfully treated with fixed appliances. The problems encountered during treatment are discussed.

European Board of Orthodontists: a professional challenge

The background to the formation of the European Board is given and the necessary procedures for obtaining certification of the European Board of Orthodontists (EBO) are described. An example case report is included to give the reader an indication of the type of detail required for each and every case presented. Recommendations are given for prospective candidates who might consider attempting EBO certification in the future.

A randomized clinical trial to compare the effectiveness of canine lacebacks with reference to canine tip

AIM

To assess the effectiveness of canine lacebacks on the proclination of the upper incisors with reference to pre-treatment canine tip.

STUDY DESIGN

Randomized clinical trial.

SAMPLE

Patients receiving upper and lower fixed appliances attending the orthodontic departments of five orthodontic treatment providers. Sixteen patients received canine lacebacks as part of their treatment and 19 patients did not have canine lacebacks.

METHOD

Patients were randomly allocated to receive canine lacebacks or not receive canine lacebacks. Upper study models were collected at the initial archwire placement and then when the working 0.019 x 0.025-inch stainless steel archwire was placed. The start canine angulation, change in upper incisor proclination/overjet, and any mesial movement of the upper first permanent molars during levelling and aligning was measured with a reflex metrograph.

STATISTICS

The effect of the use of canine lacebacks on upper incisor proclination and mesial molar movement was assessed using Student t-tests. Regression analysis was used to evaluate any effect of the initial angulation of the canine.

RESULTS

A mean incisor retroclination of 0.5 mm was observed in the canine lacebacks compared with a mean proclination of 0.36 mm when canine lacebacks were not used (P = 0.025). There was no statistically significant difference between groups for mesial movement of upper first molars (P = 0.99). If the canine was more distally inclined at the start of treatment, the incisors was more likely to procline, regardless of whether or not canine lacebacks were used (P = 0.027).

CONCLUSIONS

The effect of canine lacebacks on preventing upper incisor proclination at the start of treatment is in the order of 1 mm and their effect on mesial molar movement is insignificant. Canines lacebacks have similar effects that are independent of pre-treatment canine angulation.

Rapid correction of anterior crossbite using a fixed appliance: a case report

Anterior crossbite is a commonly encountered problem that is traditionally managed with removable appliances. This paper demonstrates some of the advantages of using fixed appliances to correct these malocclusions. In this case, treatment was completed more rapidly than would have occurred with conventional techniques.

Digital records in orthodontics

In this electronic age there is a general move towards keeping digital records, and many trades and professions now use digital images exclusively. In this article, the advantages (and occasional disadvantages) of the use of digital photography, digital radiography and the latest development--digital study models--in orthodontics are discussed.

The modified twin block appliance in the treatment of Class II division 2 malocclusions

Two case reports illustrate the effective treatment of Class II division 2 malocclusion with modifications to the Twin Block appliance. This approach may reduce the total treatment time and reduce the need for extra-oral anchorage. In each of the cases presented treatment has been carried out on a non-extraction basis with full correction of the malocclusion.

Orthodontics and occlusion

The discipline of orthodontics is directed towards alteration of the occlusion of the teeth and the relationships of the jaws. It is therefore somewhat surprising to find that there is little scientific evidence to support any of the concepts that suggest occlusal goals for orthodontic treatment. Most of the current concepts of orthodontic treatment are based upon personal opinion and retrospective studies. Nevertheless, an attempt is made here to provide a guide to the relationship of orthodontics and the occlusion that is evidence based. Where the evidence is weak, these areas have been highlighted.

Malocclusion, orthodontics and bullying

Bullying is endemic among schoolchildren, and the effects can be devastating and long lasting. The persistently bullied child appears to represent a certain psychological type, with poorly developed social skills and a submissive nature. Physical appearance does appear to play a role, which includes facial and dental appearance, although these tend not to be primary factors. Teasing related to dental appearance appears to be particularly hurtful. There is little evidence of a marked increase in self-esteem following orthodontic treatment in children, but in adults following treatment there is an improvement of body concept. The long-term psychological benefits of orthodontic treatment are difficult to measure but there is an increasing awareness of malocclusion with age.

Comparison of 2 modifications of the twin-block appliance in matched Class II samples

The purpose of this study was to compare the skeletal and dental changes contributing to Class II correction with 2 modifications of the Twin-block appliance: Twin-block appliances that use a labial bow (TB1) and Twin-block appliances that incorporate high-pull headgear and torquing spurs on the maxillary central incisors (TB2). After pretreatment equivalence was established, a total of 36 consecutively treated patients with the TB1 modification were compared with 27 patients treated with the TB2 modification. Both samples were treated in the same hospital department and the same technician made all the appliances. The cephalostat, digitizing package, and statistical methods were common to both groups. The results demonstrated that the addition of headgear to the appliance resulted in effective vertical and sagittal control of the maxillary complex and thus maximized the Class II skeletal correction in the TB2 sample. Use of the torquing springs resulted in less retroclination of the maxillary incisors in the TB2 sample when compared with the TB1 sample; however, this difference did not reach the level of statistical significance.

Does orthodontics damage faces?

With the increasing provision of orthodontic care in this country, certain practitioners have raised concerns regarding the use of elective extractions and retraction mechanics, especially the effects on the facial profile and the TMJ. The non-extraction versus extraction debate spans the history of orthodontics, and the concepts of facial attractiveness are subject to change as fashions change. Within the realms of evidence-based practice, there is little or no evidence to suggest that the philosophies and mechanics of contemporary orthodontics, in the vast majority of cases, cause damage to the profile or are directly linked to the development of TMJ dysfunction.

For four sixes

This article reviews the literature on orthodontic treatment involving extraction of first molars and highlights many of the clinical considerations when treating such cases. Case reports illustrate the potential problems and indicate some solutions.

The apically repositioned flap in tooth exposure

Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques. These procedures aim to facilitate the eruption of the impacted tooth with a minimum of disruption or damage to the tooth itself or adjacent structures. The aim of this paper is to discuss the various surgical methods of exposing impacted teeth and to help to identify where the use of the apically repositioned flap is indicated. Clinical examples are presented and a surgical method for carrying out this procedure recommended.

The apically repositioned flap in tooth exposure

Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques. These procedures aim to facilitate the eruption of the impacted tooth with a minimum of disruption or damage to the tooth itself or adjacent structures. The aim of this paper is to discuss the various surgical methods of exposing impacted teeth and to help to identify where the use of the apically repositioned flap is indicated. Clinical examples are presented and a surgical method for carrying out this procedure recommended.

Piggyback archwires

Commonly, clinicians' principal tool in the alignment phase of orthodontic mechanotherapy is the nickel-titanium wire. During the course of orthodontic treatment, however, there are times when some segments of the dental arch require flexible wires, while the rest would benefit from rigid wires. In this report, we describe a technique where both of these needs are satisfied simultaneously. Specifically, a segment of nickel-titanium wire is piggybacked onto a stainless steel wire in regions where flexibility is desired. This method eliminates the problems associated with the activation, de-activation forces created along a continuous archwire and might be more economical. Clinical pictures illustrate the point.

Orthodontic fixation of mandibular fracture: a case report

The present case illustrates a nonsurgical method of fixing a minimally displaced mandibular fracture with use of an easily prepared orthodontic appliance. This method offers several advantages for both the attending staff and the patient.

A nasal foreign body detected on routine orthodontic radiographs

Films used in orthodontics such as lateral cephalograms and orthopantomograms provide excellent visualisation of the maxillary sinuses and the nose, and therefore should be routinely examined for pathology and foreign bodies. We report a case of a long-standing asymptomatic nasal foreign body detected on routine orthodontic films.

Surgically assisted rapid palatal expansion: a modified approach in a patient with a missing lateral incisor

In conventional surgically assisted rapid palatal expansion, a diastema is opened between the central incisors. A case is presented in which the surgical procedure was modified so that the split of the maxilla occurred in the region of a missing lateral incisor rather than at the midline. This facilitated restoration of the space with a prosthetic tooth almost immediately following surgery.

The effects of Twin Blocks: a prospective controlled study

This prospective controlled study investigated the net effects of the Twin Block functional appliance taking into account the effects of normal growth in an untreated control group. The treatment group consisted of 36 subjects, mean age of 12.4 years, consecutively treated with Twin Block appliances for an average period of 0.9 years. Each subject had immediate pre- and posttreatment lateral cephalograms. The control group consisted of 27 subjects with a mean age of 12.1 years. These patients were observed for a mean time of 1.2 years and had radiographic investigation at the initial consultation and immediately before the start of Twin Block therapy. The data were then annualized and subjected to multiple regression analysis. In the treatment group, a reduction in ANB of 2.0 degrees (p < 0.001) was observed largely because of an increase in SNB of 1.9 degrees (p < 0.001). No statistically significant restraint in the maxillary growth was observed. Treatment resulted in an increase in Ar-Pog of 5.1 mm (p < 0.001) compared with the control group increase in Ar-Pog of 2.7 mm, resulting in a net gain of 2.4 mm. The overjet was reduced by combination of a net maxillary incisor retroclination of 10.8 degrees (p < 0.001), net mandibular incisor proclination of 7.9 degrees (p < 0.001) and forward movement of the mandible. Buccal segment relationships were corrected by means of lower molar eruption, restraint in the eruption of the upper molars and forward growth or repositioning of the mandible. Any possible fossa adaption was not assessed.

Dentistry in Poland

A visit to the Orthodontic Institute in Warsaw was kindly sponsored by American Orthodontics in order to enable a straight wire typodont course to be conducted. The entire orthodontic department turned out for the course, and it proved to be a stimulating and enjoyable few days. This report details the state of orthodontics in Poland and aims to outline various similarities and differences between dental training in Warsaw and in Great Britain, both at undergraduate and postgraduate levels.

Unerupted premolars--an alternative approach

These two cases illustrate variations of an alternative technique for moving unerupted teeth into the mouth. Previously described techniques may damage the tooth or the periodontium and the regular adjustments required can be uncomfortable and are unpleasant for the patient and the operator. The method described provides a stress free alternative which is readily acceptable to patients. Adjustments are rarely needed, but if required they usually involve repositioning a magnet in the removable appliance, a procedure carried out simply by the operator or technician using cold cure acrylic.

Micro-magnetic retainers: an attractive solution to fixed retention

The use of neodymium-iron-boron micro-magnets as a fixed retainer which does not hinder oral hygiene, is reported. A patient with persistent midline spacing treated using this method is described.

Magnets and orthodontics

The first part of this paper is a literature review of magnets and their uses in orthodontics. The biological safety of magnets is considered and a report is given of experiments carried out on rat osteosarcoma cell line UMR-106. The second part of the paper describes a case where neodynium-iron-boron magnets were used to assist eruption of an unerupted, vertically impacted upper right canine. Previously, space was available for this tooth, but it failed to show signs of eruption. Following surgical attachment of a magnet, and the use of a second magnet attached to an upper removable appliance, rapid eruption occurred producing a favourable position for bonding.

Reproducibility of cephalometric measurements

This cephalometric study was undertaken to compare and contrast the errors involved in taking linear and angular measurements using three different methods; hand instruments on tracings, digitization of tracings, and direct digitization of the radiographs. Of the three methods direct digitization of the radiographs proved to be the most reproducible particularly with angular measurements, although statistically significant differences were rarely found. Tracings were advantageous only with linear measurements involving constructed points such as Gonion and Articulare. Traditional methods of measurement using a ruler and protractor compared well with computer based methods involving the digitizer.

Removable retainers: a modification of the Barrer appliance

A useful modification of the Barrer appliance is described to enable final positioning and retention following treatment in both upper and lower arches.

Effect of patient repositioning on cephalometric measurements

The purpose of this study was to assess the contribution to tracing error of positioning the patient within the cephalostat. It was carried out by comparing the differences between repeated measurements from two 'same day' radiographs, with the differences between measurements from two tracings of the same radiograph.

Space maintenance for an upper central incisor during treatment: an aesthetic solution

An aesthetic solution is offered to the problem of space maintenance following the re-opening of space for an upper central incisor.