Objective: To examine the diagnostic value of orthopantomograms (OPG) in the identification of root resorption of lateral incisors, secondary to an impacted canine, as confirmed by a cone-beam computed tomography (CBCT) scan. Design: Retrospective observational cohort study. Setting: South Wales secondary care setting: Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny. Methods: A total of 40 consecutive patients with impacted canines between January 2018 and December 2019 were selected. For each patient, one consultant orthodontist examined the OPG in isolation to detect the presence and extent of resorption of lateral incisors. The CBCT report was then studied to confirm the presence and extent of pathology. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values were calculated. Results: In total, 19 maxillary right canines, 18 maxillary left canines, one mandibular right canine and two mandibular left canines were examined. Impactions were more prevalent in the maxilla (92.5%) with higher predilection towards female patients (65%). There was higher prevalence of root resorption in the maxillary right quadrant (57.1%), in concordance with other studies. OPGs were found to have a sensitivity of 81.0% and a specificity of 10.5%, with an accuracy value of 47.5%. Positive and negative predictive values were found to be 50.0% and 33.3%, respectively. The extent of root resorption was incorrectly estimated from the OPG in 84% of cases. Correct estimation occurred in 16% of cases, with overestimation and underestimation occurring in equal proportion (42%). Conclusion: This study demonstrates the limitations of plain film radiographs and the merits of using CBCT in the accurate diagnosis of resorption of lateral incisors with an associated impacted canine. It also gives an indication into the location prevalence of resorption in a small cohort of patients. This preliminary study establishes the basis for future, larger-scale studies where outcomes can be generalisable at a population level.

The Cwm Taf Community Dental Service (CDS) has previously used a paper system to refer patients to the orthodontic specialists within the Cwm Taf CDS. However, at the beginning of June 2019, an electronic referral system was introduced. Although electronic referrals have had a minimal effect on the overall waiting time for a patient, there has been an improvement in the efficiency of transfer of orthodontic referrals within the CDS. Electronic referral systems have reduced the number of inappropriate referrals, improved patient confidentiality and maintained an accurate record that is accessible from any of the Cwm Taf CDS clinics. CPD/Clinical Relevance: The article highlights the benefits of an electronic referral system with respect to reducing both inappropriate referrals and waiting times.