SJ BDJ 2013 388

LETTERS
and the oldest a gentleman in his sixties

who worked as a caretaker at a school.
For those who wish to help with our
cause, or who would even like to come
and help next year, then please visit our
website, as above. Our latest video for
this camp can be found on YouTube by
searching for Northern Cleft Foundation. Alternatively, just press like on our
Facebook page and follow our progress.
We would like to thank Dr George, Dr
Venkat, all the cleft surgeons from the
UK and all the 48 members of the NCF
2013 camp that worked relentlessly to
provide a brighter future for those who
thought it was beyond their reach. We
of course must also extend our sincere
thanks to all of the individuals who made
generous donations to the Foundation.
J. Parmar, C. Sweet, by email
1. Parmar J. Hands-on training: working with a
charity cleft team in Hyderabad. Br Dent J 2007;
205: 291293.
DOI: 10.1038/sj.bdj.387
MRI SCAN HAZARD

Sir, I came across a case when it was not
possible to perform Magnetic Resonance
Imaging due to previous routine dental
treatment. One of our patients stated that
during the MRI scan procedure the magnet nearly pulled his crowned teeth out.
The procedure was stopped due to the
potential hazard. We tracked the patients
record down and discovered that a nonprecious alloy with high nickel content
(82%) was used in this case to make
cast posts and crowns on 12 and 11. The
interaction between dental restorations
and MRI scans is an interesting topic
which has not received much attention in
the dental literature.
MRI units use strong magnetic fields
and radio-frequency waves to create
images. The magnetic field generated
by the MRI scanner will attract objects
containing ferromagnetic metals (iron,
nickel, cobalt) with considerable force.
While the MRI examination is a very
useful non-invasive imaging technique
with no known side effects, it may
sometimes provide confusing results
due to dental restorations.
Since the MRI scan was introduced in
the 1970s, numerous studies have confirmed that precious alloys, amalgams
and titanium implants generally cause
minimal artefacts. Non-precious dental
376
alloys have the potential of causing

image deformation or image voids.
Dentists are not the only professionals implanting metal devices. Heart
pacemakers and defibrillators, aneurysm clips, cochlear implants, insulin
pumps, vascular stents, artificial joints
etc are widely used in other branches of
medicine. MRI technicians must conduct
a careful evaluation of each patient and
may alter the field strength to ensure the
safety of the procedure. In some cases it
is not possible to perform an MRI scan
due to the risk of device dislodgement
(eg some aneurysm clips) or malfunction
(pacemakers). Extensive dental hardware
with a high content of ferromagnetic
metals, in some rare cases, can become a
reason for a patients ineligibility for an
MRI procedure as well.
Every imaging modality can produce
artefacts. Dental restorations can generate artefacts on both MRI and CT scans,
with CT images being more affected by
dental alloys due to the high attenuation of X-ray beam by metals.6 Severe
image distortion or inability to perform
the MRI scan due to dental restorations are rare problems, but cannot be
completely eliminated. Precious alloys
are superior not only in terms of biocompatibility, but also as they produce
fewer artefacts on the MRI scan.
D. Sinkiewicz, Peterborough
1. Eggers G, Rieker M, Kress B, Fiebach J, Dickhaus
H, Hassfeld S. Artefacts in magnetic resonance
imaging caused by dental material. MAGMA 2005;
18: 103111.
2. Shafiei F, Honda E, Takahashi H, Sasaki T. Artifacts
from dental casting alloys in magnetic resonance
imaging. J Dent Res 2003; 82: 602606.
3. Costa A L, Appenzeller S, Yasuda C L, Pereira F R,
Zanardi V A, Cendes F. Artifacts in brain magnetic
resonance imaging due to metallic dental objects.
Med Oral Patol Oral Cir Bucal 2009; 14: E278E282.
4. Starcuk Z, Bartusek K, Hubalkova H, Bachorec T,
Starcukova J, Krupa P. Evaluation of MRI artifacts
caused by metallic dental implants and classification of the dental materials in use. Measurement
Sci Rev 2006; 6: 2427.
5. Lissac M, Coudert J L, Briguet A, Amiel M. Disturbances caused by dental materials in magnetic
resonance imaging. Int Dent J 1992; 42: 229233.
6. Klinke T, Daboul A, Maron J et al. Artifacts in magnetic
resonance imaging and computed tomography
caused by dental materials. PLoS One 2012; 7: e31766.
DOI: 10.1038/sj.bdj.2013.388
JAW SURGERY ALTERNATIVES

Sir, I recently treated a 14-and-a-halfyear-old boy with an overjet of over
12mm with his lower incisors in contact
with the palatal mucosa. He had previously been told by two consultants and
a specialist orthodontist that he needed

jaw surgery, although one consultant did
suggest a compromise result might be
achieved with functional appliances. We
said in advance that we saw no difficulty
in correcting him with the postural
system that we use called orthotropics.
This was achieved in two years although
the postural training continued for a
further two years, resulting in a correction of the overjet and substantial
forward growth of the whole face.
Overjet correction of this severity has
been achieved with functional appliances in the past but uniquely in this
instance there was no increase in facial
height. One of the greatest concerns
in orthodontics is iatrogenic vertical
growth which is endemic within all
current treatment, reducing the dental
arch length and damaging facial appearance, sometimes severely. As I had never
before seen such a severe case corrected
without an increase in vertical growth,
I thought the profession should be aware
that changing oral posture may have
some merit and wrote a short case report
for the BDJ. Unfortunately, the referees
strongly rejected this saying the quality
of the submission is less than I would
expect from an undergraduate student
and in all likelihood this patient simply
grew favourably. This was clearly
their opinion but I do not know of any
evidence of conventionally treated cases
having achieved an equivalent amount
of favourable growth and one might ask
why not? The other referee dismissed
the result as unremarkable saying all
orthodontists who use functional appliances will have seen patients who have
achieved a similar result, again a matter
of personal opinion unsupported by any
evidence and certainly the general evidence suggests that functional routinely
increase vertical growth.
We should not forget that several hundred children and young adults are sent
for surgery in the UK each year, many of
them much less severe than this one, and
I feel the profession should be allowed to
consider alternative possibilities. Patients
should have choice and perhaps the
personal opinions of these two referees
should not prevent this.
J. Mew, by email
DOI: 10.1038/sj.bdj.2013.389
BRITISH DENTAL JOURNAL VOLUME 214 NO. 8 APR 27 2013
2013 Macmillan Publishers Limited. All rights reserved.

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LETTERS

and the oldest a gentleman in his sixties

MRI SCAN HAZARD

alloys have the potential of causing

JAW SURGERY ALTERNATIVES

a specialist orthodontist that he needed

2013 Macmillan Publishers Limited. All rights reserved.

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