This review examines specific aspects of orthodontic treatment and periodontal health, namely the effects of orthodontic banded attachments on periodontal disease and more specifically the microflora found around the gingival margins. This review highlights critical developments in orthodontic techniques and microbiological advances which have helped clarify the interrelationships between orthodontic appliances and periodontal disease. Suggestions as to how these may be modified are made, as well as targeting specific areas for research.

This study examined features of dental occlusion in patients born with a unilateral cleft lip and palate (UCLP). The intention was to develop a 'Goslon type' index for 5 year old children. The Goslon ranking system was used on longitudinal study models taken at 5 and 10 years of age of the same patients. All patients had UCLP and this had been repaired using a Millard type lip repair and a Veau Wardill or Von Langenbeck palatal closure. There was good intra-examiner agreement for ascribing 5 and 10 year old models to one of five categories (excellent-very poor). Inter-examiner agreement on both sets of models was at worst moderate. Two of the examiners identified up to 93 per cent of 5 year old models which either remained in the same category or deteriorated by 10 years of age. At worse the results demonstrated 70 per cent of cases of 5 years of age remained in the same category or deteriorated by 10 years of age. Consensus agreement has produced five categories of outcome for these 5 year old models. This new index is to be subjected to further validation. This study has therefore provided, for the first time, a mechanism for assessing the results of CLP surgery earlier than indices already available.

Objective This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5. Methods Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes. Results Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5. Conclusions This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the Index was not possible but it appears that it relies on face validity.