Alzheimer’s disease (AD) is the most prevalent form of dementia. Despite decades of research following several theoretical and clinical lines, all existing treatments for the disorder are purely symptomatic. AD research has traditionally been focused on neuronal and glial dysfunction. Although there is a wealth of evidence pointing to a significant vascular component in the disease, this angle has been relatively poorly explored. In this review, we consider the various aspects of vascular dysfunction in AD, which has a significant impact on brain metabolism and homeostasis and the clearance of β-amyloid and other toxic metabolites. This may potentially precede the onset of the hallmark pathophysiological and cognitive symptoms of the disease. Pathological changes in vessel haemodynamics, angiogenesis, vascular cell function, vascular coverage, blood-brain barrier permeability and immune cell migration may be related to amyloid toxicity, oxidative stress and apolipoprotein E (APOE) genotype. These vascular deficits may in turn contribute to parenchymal amyloid deposition, neurotoxicity, glial activation and metabolic dysfunction in multiple cell types. A vicious feedback cycle ensues, with progressively worsening neuronal and vascular pathology through the course of the disease. Thus, a better appreciation for the importance of vascular dysfunction in AD may open new avenues for research and therapy.

This paper describes the nature and extent of emergencies and breakages recorded in one clinician's orthodontic practice over a 12-year period. As this long-term audit progressed the author's bonding regimen changed to reduce an initially high failure rate and then to cope with even greater bond failure rates as self-ligating brackets and self-etch primer were introduced. Overall, the bracket failure rate was reduced 61% over the 12-year period and 73% from its peak value. This was achieved by rigorous cleaning of the enamel, higher quality etchant, uncontaminated dry air, compomer to protect brackets from occlusal forces, as well as the occasional use of a Nola dry system. CPD/Clinical Relevance: All orthodontic practices need to reduce emergency appointments and breakages at routine visits. This paper, by highlighting the use of a breakage book, gives the clinician a strategy to improve both.

The Invisalign System. Edited by Orhan C Tuncay. New Maiden: Quintessence Books, 2006 (330pp., £140.00 h/b). ISBN 1-85097-127-7.