Resin-based composite (RBC) materials are increasingly being used for the restoration of posterior teeth. The increasing demand for aesthetic, tooth-coloured restorations coupled with the patient's concerns regarding the use of mercury containing restorations, has driven a surge in the use of RBC materials. With the Minamata Convention in 2013 calling for the phase-out of dental amalgam and dental schools increasingly teaching techniques for RBC restorations in posterior teeth, it is likely that the dental profession's reliance upon RBC for the restoration of posterior teeth will only increase. In order to simplify and speed-up the placement of large posterior RBCs, manufacturers have produced a range of materials which can be placed in single or deeper increments, known as bulk-fill RBCs. Over a relatively short period of time many bulk-fill RBCs have been marketed quoting increment depths between 4-10 mm. The placement of these larger increments of RBC may reduce the time needed when placing posterior restorations and thereby reduce technique sensitivity. This article aims to review the properties and handling characteristics of the bulk-fill RBC materials currently available, while advising the optimal techniques of placement.

Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications. However, rare genetic conditions can result in gingival overgrowth with non-plaque-induced aetiology. It is also important to appreciate the potential differential diagnoses of other presentations of enlarged gingival tissues; some may be secondary to localised trauma or non-plaque-induced inflammation and, albeit rarely, others may be manifestations of more sinister diseases or lesions. A definitive diagnosis will then enable an appropriate management strategy. This paper aims to discuss clinical features and diagnoses for conditions presenting with gingival overgrowth and other enlargements of gingival tissues.

The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 (BDJ 2017; 222: 85-91). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.

OBJECTIVES The association of periodontal disease in people diagnosed with rheumatoid arthritis (RA) is emerging as an important driver of the RA autoimmune response. Screening for and treating periodontal disease may benefit people with RA. We performed a systematic literature review (SLR) to investigate the effect of periodontal treatment on RA disease activity. METHODS Medline/PubMed, Embase and Cochrane databases were searched. Studies investigating the effect of periodontal treatment on various RA disease activity measures were included. Quality assessment of included studies was performed and data were grouped and analysed according to RA disease outcome measure and a narrative synthesis performed. RESULTS We identified a total of 21 studies of which 11 were of non-randomized experimental design trials and 10 were randomized controlled trials. The quality of the studies ranged from low to serious/critical levels of bias. RA Disease activity score (DAS-28) was the primary outcome for most studies. A total of 9/17 studies reported a significant intra-group DAS-28 score change. Three studies demonstrated a significant intra-group improvement in ACPA level following NSPT. Other RA biomarkers showed high levels of variability at baseline and following periodontal treatment. CONCLUSION There is some evidence to suggest periodontal treatment improves RA disease activity in the short term, as measured by DAS-28. Further high-quality studies with longer follow up durations are needed. The selection of the study population, periodontal interventions, biomarker, and outcome measures should all be considered when designing future studies. There is a need for well-balanced subject groups with pre-specified disease characteristics. Lay summary What does this mean for patients? This review found 21 research trials which investigated the effect of gum disease treatment on rheumatoid arthritis. The key finding was that treating gum disease in people who have rheumatoid arthritis improves the ‘DAS28’ score, which is a measure of how severe the rheumatoid arthritis is. This is important, as rheumatoid arthritis is incurable and has a significant impact on quality of life. Furthermore, gum disease is more prevalent in people with rheumatoid arthritis, and if untreated can lead to pain, infection, and premature tooth loss. This review highlighted several limitations of the included trials. In addressing these limitations, the review makes important recommendations for future research on this topic to ensure further high-quality findings. Finally, this review makes a strong case that rheumatologists, dentists and people who are affected by rheumatoid arthritis should have a heightened awareness of the link between these two diseases. Screening and treating gum disease should form part of the normal care pathway for people with rheumatoid arthritis.

Traumatic dental injuries are relatively common causes of emergency presentation to general dental practitioners. There are well established guidelines for the management of traumatised teeth, which practitioners should be familiar with and able to deliver. Some teeth, however, are either lost at the time of injury or are found to have a hopeless long-term prognosis despite appropriate treatment. The first article in this two-part series covers the important aspects of maintaining teeth where possible, to preserve the supporting hard and soft tissues. It then describes the replacement of a single tooth lost due to trauma and the relative challenges faced. The second article covers more extensive trauma, involving multiple teeth and where significant supporting tissues are lost. It describes the replacement of teeth, including the hard and soft tissues with implant supported restorations, whilst highlighting the need for a multidisciplinary team in severe cases.