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In part one of this series we described situations where extracting a lower incisor could provide a useful alternative to premolar extractions, in addition to solutions for treatment planning certain types of cases. In part two, we look at some of the problems caused by opting to extract a lower incisor and how they may be overcome. CPD/Clinical Relevance: Part two of this series aims to guide clinicians on potential pitfalls of lower incisor extraction treatment plans and how these can be avoided.

Extraction of a lower incisor as part of an orthodontic treatment plan is still considered one of the more unusual choices in contemporary clinical practice. There are, however, situations where this treatment choice may be either enforced, or it provides an additional option that can both simplify treatment and increase efficiency. This article examines clinical situations where extraction of a lower incisor is necessary for reasons of poor pathology, position, or when actively choosing this incisor for extraction and maintaining the equivalent of three lower incisors is of benefit to the patient. In the first part of this series, we focus on appropriate case selection and aids to planning. The second part of this series concentrates on problems encountered when extracting a lower incisor, and how these are managed. CPD/Clinical Relevance: This two-part series guides clinicians on case selection and management of patients where the final occlusion will result in three lower incisors. It will look at case selection, treatment planning, problems that may be encountered and potential solutions.

Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.

Modernising Medical Careers (MMC) is a programme for change that aims to improve the quality of patients’ care through improvement in postgraduate medical education and training. Its introduction had far reaching affects and many shortcoming due to its failure to take into account the craft specialties. The aim of this paper is to illustrate the impact of MMC on oral and maxillofacial surgical (OMFS) training. An online questionnaire was distributed to OMFS trainees, and data were gathered about current position, year of training, duration and specialties worked during basic surgical training, stage of completion of examinations and courses, and overall satisfaction with training. Comparisons were made between those who had been trained before and after MMC was introduced. Ninety-five trainees (68%) responded. Of these 66 (69%) had basic surgical training before the introduction of MMC and 29 (31%) afterwards. MMC shortened overall time spent on basic surgical training of OMFS trainees by half, to only 1 year. There were similarities between the two groups in terms of the range of specialties experienced. MMC also resulted in more trainees starting higher surgical training without their Membership of the Royal College of Surgeons. There was greater satisfaction with BST for the pre-MMC group than the post-MMC group. It is hoped that the recent changes to training that were implemented after this study will address some of the shortcomings that we have identified.