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Moebius syndrome is a rare congenital disorder involving complete or partial palsy of cranial nerve VII. Other cranial nerves can also be involved along with limb and orofacial malformations. This case report describes and discusses the clinical manifestations and briefly highlights management options for a patient diagnosed with Moebius syndrome. Clinical relevanceThis report should increase awareness of the clinical manifestations of Moebius syndrome and highlight some of the difficulties associated with the management of such patients.

The aim of this systematic review was to evaluate clinical and microbiological outcomes with the use of azithromycin as an adjunct to non-surgical subgingival professional mechanical plaque removal (PMPR) in the treatment of grade C periodontitis. Online database searches using high-level MeSH terms in a PICO structure were conducted along with hand-searching of relevant periodontal journals. Titles and abstracts of identified studies were independently reviewed by both authors and the full texts of studies meeting the inclusion criteria were independently reviewed. In total, 122 studies were identified through searches, of which 6 were included in the qualitative analysis and 4 in the meta-analysis. Three studies included in the meta-analysis were deemed at low risk of bias and 1 at serious risk. There were conflicting results on whether azithromycin reduced the number of subgingival pathogens or detectable subgingival Aggregatibacter actinomycetemcomitans between the included studies. The meta-analysis revealed a statistically significant probing depth reduction difference in favour of azithromycin compared to the control at 3 months (weighted mean difference [WMD]=−0.39 mm; 95% confidence interval [CI], −0.66 to −0.13 mm; I 2 =0%) and 12 months (WMD=−1.32 mm; 95% CI, −1.71 to −0.93 mm; I 2 =0%). The clinical attachment level change was also statistically significant in favour of azithromycin compared to the control at 3 months (WMD=−0.61 mm; 95% CI, −1.13 to −0.10 mm; I 2 =71%) and 12 months (WMD=−0.88 mm; 95% CI, −1.32 to −0.44 mm; I 2 =0%). Based upon these results, azithromycin offers additional improvements in some clinical parameters when used in conjunction with subgingival PMPR in patients with aggressive periodontitis over control groups. These improvements appear to be maintained for up to 12 months after treatment completion. However, due to a lack of well-designed studies, the conclusions that can be drawn from the available evidence are limited. Trial Registration International Prospective Register of Systematic Reviews Identifier: CRD42020168195

To assess the current literature in regard to two research questions: Does placement of a 2-unit cantilever RRB to replace a missing dental unit improve oral health-related quality of life (OHRQoL) in patients over 18 years old? Are there any differences in OHRQoL between different methods of replacing missing teeth? Methods: Systematic review following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) statement. Data/Sources: MEDLINE via Ovid, Scopus, PsycINFO via Ovid, Cochrane Library, Web of Science and clinicaltrials.gov were searched (Jan 1980 to Nov 2018) using high-level MeSH terms for studies published in English, investigating OHRQoL, using valid indices. Risk of bias (RoB): determined using Cochrane RoB tool and ROBINS-I. Evidence certainty: Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group tool. Results: Study Selection: 280 articles were identified; 270 were excluded after abstract review, 7 after examining full text, leaving 3 articles (3 studies, 188 participants, 172 analysed) included in this review; one RCT and two observational studies. Synthesis of results: There was significant heterogeneity and no meta-analysis was possible. Description of effect: One pre-post study design found provision of 2-unit RRBs significantly reduced the total OHIP-49 score (effect size 0.67), compared with an untreated control. One case-control study found no differences in total OHIP-49 between individuals treated with RRB or implant-supported crown. Major complications related to prostheses reduces OHRQoL. Discussion: Quality of evidence: The overall RoB assessments were one study some concerns and two studies serious This GRADE assessment was moderate for one comparison and low for two comparisons. Clinical significance: A 2-unit cantilever RRB to replace one missing tooth probably results in a large improvement in oral health-related quality of life. Clinicians should ensure that correct investigations and design of the prosthesis is prescribed to help reduce any failures that may impact on OHRQoL.

Dental fluorosis results from excessive intake of fluoride either from water resources or products in early childhood. It results in varying degrees of discoloration and pitting of the teeth. This article aims to highlight the conservative management techniques available for managing the aesthetic impact of fluorosis and highlights what can be achieved conservatively with the use of adhesive dentistry. CPD/Clinical Relevance: Fluorosis can have a huge impact on dental aesthetics, depending on its extent. This in turn can affect a patient's confidence and daily life immensely. In the past, severe fluorosis may have been managed in a more destructive manner with indirect restorations.