Periodontal plastic and aesthetic surgery are gaining significant momentum owing to the increasing aesthetic demands by patients. Along with the fulfilment of aesthetic needs, it is imperative that clinicians also enhance function. From these two important viewpoints, subepithelial connective tissue grafting remains an optimum treatment choice for periodontists when treating gingival recession defects accompanied by periodontal attachment apparatus breakdown. Clinical relevance: Subepithelial connective tissue grafting is a successful procedure in its dual role of gingival recession coverage and predictable periodontal regeneration.

All dental restorations are liable to failure during function. Failure could be biologic, aesthetic, mechanical or a combination. Ceramic restorations in particular, including metal-ceramics, are prone to mechanical fracture, especially the fracture of veneering porcelain. Fracture of a metal-ceramic restoration jeopardizes function as well as aesthetics. It is equally onerous to manage for both patient and dentist. Optimal management of such cases requires a detailed knowledge of the aetiology behind this phenomenon. The current paper aims to highlight possible causative factors involved in the mechanical failures of metal-ceramic restorations. Clinical relevance: Ceramic fracture in metal-ceramic crowns and fixed partial dentures is routinely encountered in dental clinics. Knowledge of the aetiology is required to diagnose and manage such cases accurately as well as to avoid these errors in future.

We report a case of a mandibular arteriovenous malformation in a 3-year-old child, who attended our department, and have carried out a literature review. Clinical relevance: Arteriovenous malformation (AVM) is a rare condition but clinicians need to be aware of it as this lesion can have potentially life-threatening complications due to massive haemorrhage.

The immune system is the body’s primary defence mechanism against infections, and disturbances in the system can cause disease if the system fails in defence functions (in immunocompromised people), or if the activity is detrimental to the host (as in auto-immune and auto-inflammatory states). A healthy immune system is also essential to normal health of dental and oral tissues. This series presents the basics for the understanding of the immune system, this article covers cells of the immune system (immunocytes). Clinical relevance: Modern dental clinicians need a basic understanding of the immune system as it underlies health and disease.

popularity as an effective treatment for anxiety disorders. The purpose of this article is to determine the applicability of VRET in the treatment of dental phobia of two patients. Two case examples of female dental patients, aged 56 and 24 years, who met the criteria for dental phobia according to the Phobia Checklist, illustrate the use of VRET in the dental setting. VRET that is used as a psychological treatment for dental fear and dental phobia can potentially be given by a non-specialist (for example dental assistant), thereby making it a cost-effective therapy for the treatment of dental phobia. Clinical relevance: This article is the first of its kind to demonstrate Virtual Reality Exposure Therapy (VRET) in the treatment of dental anxiety.

This case describes the oral rehabilitation of a patient following maxillary hemi-section due to squamous cell carcinoma of the palate. Planned treatment was construction of a maxillary implant-supported obturator. Two dental implants were placed in his maxilla to aid the support and retention of an obturator. However, owing to bone availability, their angulation was suboptimal and compromised the retention of the obturator. This case describes alternative implant attachments to aid the retention and stability of implant-retained dentures constructed in cases with suboptimal implant placement. Clinical relevance: This case highlights the importance of careful planning for implant placement, and reinforces the need to plan the prostheses before implant surgery. This case highlights possible difficulties that can arise if implants are non-ideally angulated, and how to adapt restorations to manage such difficulties in cases with maxillary removable prostheses.

Paracetamol (acetaminophen) is a commonly used analgesic; its 'over the counter' availability, low cost and popularity amongst patients often make it the first choice for dental pain. It is in this that its potential toxicity, made more complicated by the ever extending range of paracetamol-containing products, make the understanding of this medication key to the safe management of patients presenting to surgery with dental pain. Clinical relevance: The purpose of this article is to supply dental practitioners with the knowledge to manage patients who present having taken an oral supra-therapeutic paracetamol overdose. Consideration is given to those patients who can be treated safely in primary care and to those who require transfer to Accident and Emergency (A&E).

The first paper of this three-part series discussed periodontal disease pathogenesis and highlighted elements in the clinical assessment which will help the clinician to establish the diagnosis of chronic and aggressive periodontitis. This second paper will focus on the management of chronic and aggressive periodontitis. Finally, the diagnosis and management of chronic and aggressive periodontitis will be reviewed in the third part of the series using two clinical examples. Clinical relevance: This paper aims to provide the general dental practitioner with an understanding of the aim of periodontal treatment, the management of chronic and aggressive periodontitis and the prognosis of periodontally involved teeth.

This is the second-part of this three-part series. The first paper discussed the occlusal and cracked tooth aetiological factors which may be responsible for restoration failure. This paper will outline the restorative options for cracked and root canal-treated teeth. It will also briefly give an overview of some of the potential endodontic complications commonly associated with failed restorations. The third, and final, part of the series will provide an overview of the previous papers and conclude with a case report. Clinical relevance: Failure of amalgam restorations is a commonly encountered clinical problem in general practice and no one case presents in the same way. Therefore, a competent endodontic diagnosis and implementation of the most appropriate, minimally invasive restorative option requires an adequate knowledge of the current literature.

This article aims to provide general dental practitioners (GDPs) with the knowledge to improve their referrals primarily for children who they feel require a dental general anaesthetic. It discusses the impact of a general anaesthetic (GA) on a child and the financial impacts of dental general anaesthetics (DGAs). The risks of DGAs are well recognized and the ways in which the dental team in primary, secondary care and service commissioners can reduce the risk of repeat DGAs are discussed. Clinical relevance: Dentists should be aware of the risks involved in GA and the importance of reducing repeat DGAs.