Papers by James I. J. Green
Objective: To determine whether changes in primary attending (PA) doctor coverage frequency cause... more Objective: To determine whether changes in primary attending (PA) doctor coverage frequency caused an increase in orthodontic treatment time or a decrease in the quality of treatment results in a postgraduate orthodontic clinic. The effect of T1 Peer Assessment Rating (PAR) scores on PA doctor coverage frequency, treatment times, and results was also evaluated. Materials and Methods: A sample of 191 postorthodontic subjects was divided into three groups based on PA doctor coverage (high, medium, or low). Treatment times, treatment results, and other variables were compared between the three PA coverage groups. Additionally, the sample was divided into three groups based on T1 PAR scores. Attending coverage frequency, treatment times, and results were compared between the T1 PAR groups. Results: No statistically significant differences were found in treatment time (P 5 .128) or results (P 5 .052). There were no statistically significant differences in the mean scores for T1 PAR (P 5 .056), T2 PAR (P 5 .602), patient age at T1 (P 5 .747), total appointments (P 5 .128), missed appointments (P 5 .177), or cancelled appointments (P 5 .183). Statistically significant differences were found between the low T1 PAR group and the medium and high T1 PAR groups (attending coverage, P 5 .008; results, P , .001; treatment time, P 5 .001). Conclusions: Under the conditions of this study, variations in PA doctor coverage frequency did not lengthen orthodontic treatment or reduce the quality of treatment results. Low T1 PAR scores were associated with less PA coverage, less change in PAR, and shorter treatment times. (Angle Orthod. 2015;85:1051–1056.)
No. It isn't the International Olympic Committee. London has already had that opportunity. In Sep... more No. It isn't the International Olympic Committee. London has already had that opportunity. In September, London will host the International Orthodontic Congress for a third time and will be the only city in the world yet to do so. The event dates back nearly 90 years and was the first international meeting of a dental specialty but so far it has only been held in four countries: the United States, the United Kingdom, France and Australia. James Green examines the history of the congress and gives a glimpse of what we can expect from the eighth International Orthodontic Congress.
We may not have the flying cars or hoverboards of Robert Zemeckis’ depiction of 2015 – the 1989 f... more We may not have the flying cars or hoverboards of Robert Zemeckis’ depiction of 2015 – the 1989 film Back to the Future Part II – but this year is set to be a landmark year for dental professionals in the UK as London hosts the International Orthodontic Congress for a third time, the only city in the world yet to do so. This article gives an overview of how this international meeting came to be and what we can expect from
the 8th International Orthodontic Congress later this year.
Retention is the phase of orthodontics that aims to preserve teeth in their desired positions aft... more Retention is the phase of orthodontics that aims to preserve teeth in their desired positions after active orthodontic treatment and is achieved with fixed or removable retainers. Fixed retainers offer many advantages over the removable type: reduced need for patient compliance, better aesthetics and predictable long-term stability. The first fixed retainer consisted of a stainless steel wire soldered to bands on the canines or premolars but today they are usually bonded to the teeth with light-cured composite. Many materials and wire diameters have been proposed; this article focuses on the multi-stranded wire retainer, which has become the gold standard for maintaining incisor alignment.
The primary teeth are nature's space maintainers and the development of the permanent dentition c... more The primary teeth are nature's space maintainers and the development of the permanent dentition can be disturbed without them. This article examines dental appliances that preserve space when the primary teeth do not develop or are lost prematurely.
Clasps are retentive removable appliance components that work by engaging the areas beneath the m... more Clasps are retentive removable appliance components that work by engaging the areas beneath the most bulbous parts of a tooth, called undercuts. The first orthodontic clasp consisted of a loop of wire that fitted to the buccal gingival margin but the lack of buccal undercuts in teeth that are not sufficiently erupted led to attempts to design a clasp that would use the mesiobuccal and distobuccal undercuts, which are accessible when a tooth is less well erupted. The first such design was introduced by Victor Hugo Jackson in 1906. The Jackson clasp is a simple orthodontic clasp but with squared corners that engage the mesiobuccal and distobuccal undercuts. Next came the Crozat clasp in 1920. Designed by George B. Crozat, it consists of a plain orthodontic clasp with an additional soldered piece of wire that engages the undercuts. This was followed by the arrowhead clasp by Artur Martin Schwarz in 1938 that consists of a series of arrowheads and engages the mesiobuccal and distobuccal undercuts of two adjacent teeth. In 1949 these concepts were largely eclipsed by a design by Charles Philip Adams that dramatically improved the retention of removable appliances and remains the most popular retention component for removable orthodontic appliances. This article gives a review of the Adams clasp and its related components.
Orthodontics became a discipline in its own right in the late 19th century but the use of applian... more Orthodontics became a discipline in its own right in the late 19th century but the use of appliances to straighten teeth dates back more than 3,000 years. Appliances evolved a great deal over the past two centuries and digital technology means this progress should continue.
Nickel is the metal most likely to cause an allergic reaction and is also present in many orthodo... more Nickel is the metal most likely to cause an allergic reaction and is also present in many orthodontic appliances. This article examines what a nickel allergy is and the considerations involved for patients with the condition.
Traditionally the domain of dental technicians, the preparation of thermoformed retainers is now ... more Traditionally the domain of dental technicians, the preparation of thermoformed retainers is now an additional skill that dental nurses can develop during their career. This article looks at why thermoformed retainers are used, how they are made and legal obligations of dental professionals who provide them.
Epidermolysis bullosa (EB) is a diverse group of disorders with blister formation in response to ... more Epidermolysis bullosa (EB) is a diverse group of disorders with blister formation in response to mechanical trauma. Patients with EB requiring orthodontic treatment need special consideration.
Presentations by James I. J. Green
Today’s fixed orthodontic appliances commonly consist of metal archwires fitted into brackets tha... more Today’s fixed orthodontic appliances commonly consist of metal archwires fitted into brackets that are bonded to the teeth using the acid etch bonding technique, either directly or indirectly. Indirect bracket bonding techniques aim to improve the accuracy and efficiency of bracket placement and involve positioning the brackets on a model in the laboratory. The brackets are then located on the patient’s teeth using a custom made transfer tray or bracket placement jigs and bonded to the acid etched surface of the tooth enamel. This presentation begins with a historic review of fixed orthodontic appliances, from the days of the Etruscans (an ancient Italian civilization that preceded the Romans) who fitted appliances to maintain space and prevent collapse of the dentition up to the most recent developments in digital orthodontic technology. The next part of the presentation looks at the mechanics of pre-adjusted fixed appliances and the methods used to correctly position orthodontic brackets. Then, the advantages and disadvantages of both direct and indirect bracket bonding techniques are reviewed. Finally, the different indirect bracket bonding methods and various bracket placement jigs and transfer tray fabrication techniques are examined.
Nickel is a chemical element that is found in many dental materials used for the production of or... more Nickel is a chemical element that is found in many dental materials used for the production of orthodontic appliances. An allergy to nickel is one of the most common causes of allergic contact dermatitis - an itchy rash that appears when a normally harmless substance touches the soft tissue. Nickel is one of the metals most commonly found in materials that are used to make orthodontic appliance components, with the element being present in stainless steel, nickel-titanium and other alloys. A significant increase in the level of nickel in saliva and serum has been found in patients following the insertion of orthodontic appliances. Nickel is also the metal that is most likely to cause contact dermatitis in patients with orthodontic appliances. The causes and symptoms of a nickel allergy, the ways in which the allergy is diagnosed and how it can be prevented will be explained. The presentation will go on to focus on the nickel content of orthodontic appliance components and examine the alternative products that are either nickel free or have a very low nickel content that are suitable for patients with a nickel allergy.
The Peer Assessment Rating (PAR) index is generally recognised as a rapid, straightforward and ro... more The Peer Assessment Rating (PAR) index is generally recognised as a rapid, straightforward and robust technique to assess orthodontic treatment outcomes. A PAR index assessment is calculated by examining pre-treatment and the post-treatment study models. The system was developed to look at the results of a group of patients, rather than an individual patient because in some cases the index does not correctly represent the result obtained. However, the system is generally accepted as a useful tool for assessing orthodontic treatment outcomes and it is currently a statutory requirement of the NHS orthodontic treatment contract for all providers to monitor treatment outcomes for twenty cases plus 10% of the remainder of their cases each year using this index. This workshop is intended to serve as an introduction or “refresher” to the PAR index and is not a calibration course. Although not currently a mandatory requirement, it is strongly advised that those wishing to provide accurate and reproducible PAR index assessments attend and pass an appropriate calibration test and keep documentary evidence of this. If an individual is not calibrated their results will not be valid or reproducible and should not be used to assess the standard of someone else’s treatment.
A technique used for the design and fabrication of tooth borne orthodontic appliances for patient... more A technique used for the design and fabrication of tooth borne orthodontic appliances for patients with epidermolysis bullosa (EB) is presented. EB is a group of inherited disorders in which skin blisters develop in response to minor injury. In addition to skin blistering, depending on the type of EB that is present, internal blistering can occur in the oral cavity, the larynx and the pharynx. This internal blistering may lead to reduced opening of the temporomandibular joint, tender soft tissues in the oral cavity, reduced saliva production and decreased mobility of the tongue due to the fusion of the tongue to the floor of the mouth. Because of these problems, designing orthodontic appliances for these patients can present challenges that need to be overcome for satisfactory treatment. Conventional orthodontic appliances for patients with EB will almost certainly be intolerable and this lecture looks at the appliances that have been used at Great Ormond Street Hospital and are designed to be free of contact with the mucosa and be completely tooth borne.
Nickel ist ein chemisches Element, welches sich in vielen zahntechischen Werkstoffen zur Herstell... more Nickel ist ein chemisches Element, welches sich in vielen zahntechischen Werkstoffen zur Herstellung von KFO- Geräten – wie z.B. rostfreiem Stahl, Nickeltitan und anderen Legierungen – befindet. Die Nickelallergie ist eine sehr häufig vorkommende Allergie bei Patienten. Sie äußert sich durch Ekzeme sowie entzündliche und juckende Hautrötungen, wenn die nickelhaltige Apparatur mit dem weichen Hautgewebe bzw. der Schleimhaut in Kontakt tritt. Der Nickelanteil kann im Speichel und Serum des betroffenen Patienten nachgewiesen werden. In dem vortrag werden die Ursachen, Symptome, verschiedenen Diagnosearten der Allergie und deren Verhinderung erläutert. Ferner wird dargestellt, in welchen Gerätebestandteilen sich Nickel befindet und welche alternativen Produkte ohne bzw. mit nur einem geringen Nickelanteil (für allergische Patienten) genutzt werden können.
A flap in plastic and reconstructive surgery is a technique where tissue is lifted from a donor s... more A flap in plastic and reconstructive surgery is a technique where tissue is lifted from a donor site and moved to a recipient site with an intact blood supply. The buccinator myomucosal flap is a flap based on the facial and/or buccal arteries. It is a flexible, versatile and well suited to reconstructing soft tissue defects of the oral cavity, oropharynx and nasal septum. Unlike most free flaps, it provides mucosal cover, as opposed to skin cover, and maintains physical sensation. The flap is about 5mm thick, and comprises buccal mucosa, submucosa and buccinator muscle, with the feeding vessels and vascular plexus. A patient requiring this procedure will need to wear a dental appliance to prevent trauma as the flap heals. This presentation will outline what a buccinator myomucosal flap entails and the design and fabrication of appliances that can be used for patients who require the procedure. Additional applications for the appliances featured will also be examined.
Retention is the orthodontic treatment phase that aims to keep teeth in their desired positions f... more Retention is the orthodontic treatment phase that aims to keep teeth in their desired positions following active orthodontic treatment. The vast majority of patients who have had orthodontic treatment will require a retention phase as without it there is a tendency for the teeth to relapse towards their initial positions. The aetiology of this is not fully understood, but it is thought to relate to the periodontium, soft tissue pressures, growth and the occlusion. Therefore, patients will usually need to wear retainers after completing the active orthodontic treatment phase and the thermoformed retainer is one such type. Often named “Essix” retainers after one type of material commonly used to fabricate them, thermoformed retainers have become increasingly popular in recent years due to being more effective than Hawley retainers at holding the correction of the labial segments as well as being more cost-effective. Following the publication of the GDC Scope of Practice in 2009, the preparation of thermoformed retainers is an additional skill that dental nurses can develop. This presentation will examine the advantages and disadvantages of thermoformed retainers; the materials, equipment and techniques used to produce them as well as the legal obligations of dental professionals who provide them.
A technique used for the design and fabrication of tooth borne orthodontic appliances for patient... more A technique used for the design and fabrication of tooth borne orthodontic appliances for patients with epidermolysis bullosa (EB) is presented. EB is a group of inherited disorders in which skin blisters develop in response to minor injury. In addition to skin blistering, depending on the type of EB that is present, internal blistering can occur in the oral cavity, the larynx and the pharynx. This internal blistering may lead to reduced opening of the temporomandibular joint, tender soft tissues in the oral cavity, reduced saliva production and decreased mobility of the tongue due to the fusion of the tongue to the floor of the mouth. Because of these problems, designing orthodontic appliances for these patients can present challenges that need to be overcome for satisfactory treatment. Conventional orthodontic appliances for patients with EB will almost certainly be intolerable and this lecture looks at the appliances that have been used at Great Ormond Street Hospital and are designed to be free of contact with the mucosa and be completely tooth borne.
Retention is the orthodontic treatment phase that attempts to preserve teeth in their desired pos... more Retention is the orthodontic treatment phase that attempts to preserve teeth in their desired positions following the active orthodontic treatment phase. The vast majority of patients who have had orthodontic treatment will need a phase of retention as without it there is a tendency for the teeth to relapse towards their initial positions. Retention can be achieved through the placement of removable or fixed retainers. The use of fixed retainers is intended to minimise the risk of relapse as a non-compliance technique. There are a number of different materials available for the preparation of fixed retainers and the placement of these retainers can be simplified by the use of positioning stents. This presentation will review the types of fixed retainers and positioning stents and the techniques used for preparing them.
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Papers by James I. J. Green
the 8th International Orthodontic Congress later this year.
Presentations by James I. J. Green
the 8th International Orthodontic Congress later this year.
Zusätzlich zu Blasenbildung, abhängig von der Art des EB, die vorhanden ist, Blasenbildung in der Mundhöhle vorkommen, Kehlkopf und Rachen. Diese interne Blasenbildung kann zu einer reduzierten Öffnung des Kiefergelenks, zart weichen Gewebe in der Mundhöhle, reduzierte Speichelproduktion und verringerte Beweglichkeit der Zunge durch die Fusion der Zunge auf den Boden des Mundes.
Wegen dieser Probleme, Gestaltung kieferorthopädischen Geräten für diese Patienten kann Herausforderungen, die es für eine zufriedenstellende Behandlung zu überwinden sein. Konventionelle kieferorthopädischen Geräten für Patienten mit EB wird fast sicher nicht tolerierbar und dieser Vortrage befasst sich mit der Geräte, die am Great Ormond Street Hospital verwendet werden und sind so konzipiert, der Kontakt frei mit den oralen Gewebe.
Aim: To develop a measure for assessing dental arch relationships in BCLP at age 5.
Method: 15 cleft clinicians were surveyed about occlusal features of good and bad outcomes in BCLP. The validity of applying existing indices to 32 sets of study models of BCLP subjects at age 5 was tested. Subsequently, an index, previously developed for 10-year-old BCLP cases, was modified for 5-year-olds. The reliability of this index was tested by 4 examiners. Acceptability was assessed by a new examiner, who applied the index to 29 sets of models of children treated in Scotland.
Results: A new index, BiGOS(5) was developed. Good intra- (mean weighted kappa = 0.61) and inter-examiner (mean weighted kappa = 0.68) reliability was achieved by 4 examiners for 32 models. An unfamiliar examiner achieved good inter- (mean weighted kappa = 0.74) and moderate intra-examiner (weighted kappa = 0.57) reliability using BiGOS(5). Differences in outcome at age 5 in BCLP were detected between two cleft teams.
Conclusion: An Index which can detect differences in dental arch relationship outcome in BCLP at age 5 has been developed.
James authored the BDJ Team articles Dental materials: The multi-stranded wire retainer (April 2015) and Dental materials: The Adams family (December 2014). He is currently a maxillofacial and dental laboratory manager for London's Great Ormond Street Hospital for Children and the North Thames Cleft Centre, a supra-regional network for patients with clefts of the lip and palate from North London, Essex and South and West Hertfordshire. This service is run jointly by Great Ormond Street and the St Andrew's Centre for Plastic Surgery at Broomfield Hospital near Chelmsford so he also works there for part of the time.
James trained at Barts and the London, Queen Mary's School of Medicine and Dentistry in association with Lambeth College and qualified in 2001. After a vocational training year at the Royal London Hospital he spent the following two years at the Eastman Dental Hospital, part of the University College London Hospitals NHS Trust, before transferring to Great Ormond Street in 2004.
James has been the recipient of several awards including the Quintessence Book Prize for the best student from a London teaching hospital, the British Orthodontic Society Technicians Award and the Fellowship of the Orthodontic Technicians Association.
http://www.dta-uk.org
James Green has been elected the ninth president of the Dental Technologists Association (DTA), the professional representative body for dental technologists in the UK. James is currently a maxillofacial and dental laboratory manager for London’s Great Ormond Street Hospital for Children and the North Thames Cleft Centre, a supra-regional network for patients with clefts of the lip and palate from North London, Essex and South and West Hertfordshire. This service is run jointly by Great Ormond Street and the St Andrew’s Centre for Plastic Surgery at Broomfield Hospital near Chelmsford so he also works there for part of the time.