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Objective: To improve the confidence and competence of newly qualified dentists in Wales in undertaking orthodontic assessments and making orthodontic referrals. Design: Quality improvement project. Setting: Study days arranged by the Wales Deanery. Participants: The 2018–2019 cohort of dental foundation trainees (DFTs) and dental core trainees (DCTs) in Wales. Methods: Data were collected prospectively between January and February 2019 utilising a 20-item questionnaire based around knowledge and clinical ability in orthodontic assessment and referrals (Stage 1). In May 2019, the trainees were provided with an e-learning package tailored to the results of the clinical questions and the feedback received in Stage 1. After this, trainees repeated the questionnaire with a simplified Index of Orthodontic Treatment Need (IOTN; Stage 2). Results: There was increased self-reported confidence in ‘conducting orthodontic assessments’ from 67% to 95% and ‘competence in completing orthodontic referrals’ from 81% to 92%. At baseline, this cohort were only able to correctly determine dental age and orthodontic treatment need for 40.7% (mean) of the presented linical cases. Following the teaching intervention, this was improved with an average of 70.9% of clinical cases answered correctly. Conclusion: Despite the noted improvement in the self-reported confidence and competence in undertaking orthodontic assessments and referrals in this cohort, there is still room for improvement. Hands-on orthodontic experience during dental training improved the self-reported confidence and competence with assessments and referrals. The results of this quality improvement project emphasise the need for regular continuing professional development in the field of orthodontics to maintain competence in utilising IOTN and referring appropriately.

Autotransplantation is a treatment option with high reported survival rates to replace failing teeth in the anterior maxilla. This treatment requires a multidisciplinary approach from orthodontists, paediatric dentists, restorative dentists, and oral and maxillofacial surgeons to achieve successful outcomes. Success is dependent on many factors including stage of root development, handling of the periodontal ligament, extra-alveolar time and splinting. This case report presents the novel use of digitally designed and three-dimensional (3D) printed surgical templates to aid intraoperatively and reduce the extra-alveolar time. A preoperative cone-beam computed tomography scan allowed digital planning and construction of surgical templates that replicated the exact root dimensions of impacted maxillary canines. These templates were subsequently 3D printed in resin, sterilised and utilised intraoperatively to aid socket preparation before the surgical autotransplantation.

Problems related to orthodontic appliances during treatment, such as the repair of broken appliances, are time consuming, often necessitating extra visits with additional costs in time and materials. They can therefore cause significant delays in treatment progress. Causes associated with appliance problems include patient related factors, such as poor compliance, operator techniques and materials used. As orthodontic patients are often treated in a diverse range of clinical settings, with treatment provided by a number of different clinicians, it is essential that members of the dental team are aware of the problems that can be associated with orthodontic appliances and their management.

A novel removable rapid maxillary expansion appliance is described for use in routine clinical practice. The laboratory construction and clinical technique is described, and the advantages of the appliance over conventional rapid expansion devices are highlighted.