Orthodontic treatment, like all aspects of dentistry, exposes the clinician to the risk of malpractice and litigation. Demineralisation of tooth enamel is still one of the main complications of orthodontic treatment and it is essential patients are made aware of this risk during the consent process. There are a variety of fluoride delivery systems (mouthrinse, varnish, bonding system, and elastics), which can be used to prevent white spot lesion (WSL) formation. Glass-ionomer bonding cements (GIC) have also been shown to reduce WSL formation and have the benefit of not relying on patient compliance. However, these materials have not found widespread acceptance, possibly due to handling characteristics. A number of new technologies, principally fillers and coatings, have recently become available with potential antimicrobial and antibiofilm properties. Coatings can be applied to brackets and wires, which prevent bacterial adhesion. However, the longevity of these coatings is questionable. There are a number of methods available aimed at reducing the incidence of WSL, but they all have limitations. Capitalising on technological advances will enable the production of tailor made orthodontic brackets and adhesive systems, which provide long-term protection against WSL without relying on patient compliance.
cian played by Cary Grant, is followed everywhere by a large, silent man. The man is with him as he addresses an anatomy class, as he conducts the student orchestra, as he stands over a patient in the operating room. The man speaks only at rare moments, each crucial, coming to Noah's aid as the voice of wisdom, of conscience, or of the past. When Noah is finally challenged by a university tribunal to defend his relationship with the odd man he calls "my friend," the story comes out: the man is a convicted murderer, executed by hanging and sent 20 years earlier to Noah, a medical student who needed "a cadaver of my own." The "cadaver" awakened as soon as Noah stuck a gloved finger in his mouth, and has never since left his side. Early experiences in the anatomy laboratory underpin later practice in ways that are not easy to articulate. The knowledge gained there guides diagnosis, allows us to link phenomena that seem on the body's surface to be unrelated, and gives us fluency in a discourse that lets us to describe what is happening to our patients. Visualizing the structures hidden beneath the skin allows us to identify conditions otherwise beyond our grasp. Although the overwhelming bulk of the knowledge we use to care for patients is learned outside the lab, and the centrality of the experience wanes even by the end of first year, what we learn in anatomy lab is somehow, quietly, always there. In this issue of MSJAMA, literature professor John Bender recounts his season as an outsider in the lab and describes how the process serves as a ritual entry into the medical profession. Beyond the technical knowledge it affords, anatomy lab links us to the past and begins our socialization to future practice. We dissect knowing that we are making the same cuts and seeking the same structures as physicians centuries earlier. But today, we pride ourselves on taking more from the experience, on engaging with the gift that is the donation. Samantha Stewart and Rita Charon describe anatomy study as an initial confrontation with life and death that will follow us throughout our careers, and discuss a way these early lessons might be retrieved. S. Ryan Gregory and Thomas Cole describe the history of dissection across centuries, while Aaron Tward and Hugh Patterson account for the shift from grave robbing to cadaver donation in the United States. Finally, to launch our new creative writing section murmur, Matthew Ehrlich evaluates his cadaver's chief complaint. The first body in our care has neither the needs nor the agency of a patient, and yet for many of us, it is the body we will envision as we examine the intact surface of each patient who comes to us. Whether it is our initiation into "the professional tribe of physicians" (Bender), "the scientific method" (Gregory and Cole), or "the use of affective responses" (Stewart and Charon), anatomy lab is as much a part of how we see as what we know. "The trouble with you, Elwell," Noah's ally says to his accuser at the end, "is you've never had a cadaver of your own." ON THE COVER
The ultimate aims for any clinician at orthodontic debond, following the attainment of a good occlusal result, are to remove all of the attachments, along with the bonding/banding material, as atraumatically as possible whilst minimizing the risks to the operator, assistant and patient during the whole process. This paper reviews the process of debonding following a course of orthodontic fixed appliance therapy, from bracket/band removal through to enamel clean-up. In particular, the risks to both the patient and operator are described at all stages. Future developments are discussed that might help reduce such risks. Clinical Relevance: Returning the tooth, following orthodontic treatment, to its pretreatment condition is as important as the orthodontic treatment itself. The process of debonding is not without risk and it is vital that all clinicians are aware of these risks, but also what they can do to minimize them as much as possible.
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