Hypophosphatasia (HPP) is an inherited metabolic disorder that results in poorly mineralised bones and teeth. Clinical symptoms vary widely from mild dental anomalies to fatal fetal defects. The most common dental symptoms include exfoliation of the primary incisors before the age of three with little or no root resorption, large pulp chambers, alveolar bone loss and thin dentinal walls. There is generally minimal periodontal inflammation associated with the bony destruction and tooth loss. The general dental practitioner is usually the first clinician to spot signs of the milder forms of HPP. Patients diagnosed with dental symptoms in childhood can go on to develop significant morbidity in middle age with chronic bone pain and stress fractures of the long bones. The primary dental care clinician is the key to early diagnosis of such cases, whether they present in childhood or adulthood. Emerging enzyme replacement therapy has considerably changed the landscape of the disease, resulting in astonishing improvements in bone mineralisation and a significant reduction in mortality and morbidity. It is increasingly likely that primary and secondary care clinicians will treat patients with the severe forms of HPP, who would previously not have survived infancy.

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Dental concrescence is a rare dental abnormality resulting in the joining of two teeth at the level of the cementum. This is the first reported case of the orthodontic management of a dental concrescence and the options for patient treatment are discussed. In this case, a compromised occlusal result was accepted with restorative masking of the affected teeth.

The term "mini-screw" is one of a number used to describe small screws, surgically placed through alveolar cortical bone to be used as temporary anchorage devices in orthodontic treatment. They have become increasingly prevalent in the past decade as they confer a number of advantages when compared to traditional intra-oral and extra-oral anchorage reinforcement.There is marked heterogeneity in mini-screw design and placement techniques. This review was constructed with the aim of analysing the success rates of mini-screws with a view to defining a set of guidelines for their selection and application. The validity of this review is compromised somewhat by the use of only one database in collating any relevant articles; the paucity of search terms is also discouraging. However, upon comparison with other relevant papers, 1,2 it does appear that the studies included are representative of the available literature. A detailed analysis of each article would also have been desirable; however, information such as the design of each study was unreported. Given one of the main aims was to discern the success rates of mini-screws, a discussion of what is deemed a success would seem to be appropriate. Although not forthcoming, it is pertinent to realise that 'success' differs in the discussed articles. It is most frequently seen as gaining 'anchorage for required treatment time' and so mobile/displaced mini-screws can still be seen as a success provided they can still be used to reinforce anchorage.Accepting these issues, the quoted success rate of over 80% is comparable with that derived in other reviews on the subject. Of worthy mention is one such paper containing more contemporary data on an additional five studies yielding an increase of over 800 mini-screws in its analysis. 3 However, the overall success rate changes little.When comparing the time allowed for the mini-screw to heal before loading, along with the magnitude of the subsequently applied force, there was considerable variation between the studies and within study groups. Along with the poorer performance observed with mini-screws of less than 1.2mm diameter and 8mm in length, these areas generate further avenues for investigation.Given that this area of orthodontic research is still in its infancy, the data shown here can be seen as a starting point for the design of suitable prospective studies to help elucidate the most efficacious method for mini-screw placement. Nicky StanfordGlasgow Dental School and Hospital, University of Glasgow, Glasgow, Scotland, UK

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