Month: February 2018

The ones that got away – Les Jones

Imagine this scenario…

A person walks into your practice, approaches the front desk and says: ‘Hi, I’m looking for a new dental practice for myself and my family, can you tell me if you’re taking on new patients and, if so, a little bit about the practice?’.

Would your front desk team know exactly what to do and say? I mean exactly?

Do you have a well-developed approach that each member of the front desk has been trained in and feels comfortable delivering? Or is it a bit of a lucky dip?

First things first, leads don’t come any hotter than someone standing in your reception saying they’re looking for a new dental practice. If you lose this person now, you really will have grasped defeat from the jaws of success!

A little while ago, that person in reception was me. I was looking for a new practice for myself, my wife and our four children – six potential new patients all neatly packaged in one enquiry.

I’d done the usual thing and googled ‘dentist in my area’, but then I went one step further and visited three private practices and presented myself as in the scenario above. In fact, I used those exact words.

There’s no easy way to say this, but all three practices were uniformly useless! Not one was able to convert the hottest of leads into new patients for their practice.

Why?

Well, it was clear that none of the practices were prepared for such an enquiry. Not one of them asked me my name or told me theirs. Not one asked if I had any specific dental needs or problems at present. They didn’t explain the approach or principles of their practice. They didn’t offer to show me around or take me to a more private area where we could talk more easily. They didn’t offer me a drink. They didn’t ask about my family. They didn’t ask for any contact details and…critically, they didn’t offer me an initial appointment or consultation.

They did bombard me with a long list of prices that were impossible to follow and they also gave me their ‘welcome pack’ – in each case a folder stuffed with pieces of paper with enough words for a small novel.

And so, one by one, I left, never to be seen again. Six potential new patients disappearing into the ether, leaving a front desk team with no ability to follow up.

If I was the principal/owner of those practices I would be horrified to learn that such a golden opportunity had been lost. But then again, when all is said and done, it would be my fault. The front desk team are only as good as the leadership, training, resources and ongoing support they receive.

So, ask yourself…do you know how many enquiries your front desk is dealing with each week? If you do, do you know what the conversion rate is for those enquiries? Where they came from and how they heard about the practice? Are you confident that, when you’re in surgery, your front desk team have the skills and processes to convert enquiries into patients at a healthy rate?

If you don’t know the answer to these questions, the growth and sustainability of your practice is being left to luck and chance.

In the few years since I made those visits, my family has spent in excess of £8,000 on dentistry and that’s from just one potential enquiry that got away. How many more and how much potential income are you currently losing out on?

Investing in your front desk team could be the best thing you ever do.

Les Jones is the Creative Director at Practice Plan, the UK’s number one provider of practice-branded dental plans. If you are interested in finding out more about how we help practices to become more profitable, call 01691 684165 or visit building.practiceplan.co.uk

Non-profit Beauty Banks to tackle hygiene poverty

As reported on BBC News, Beauty Banks, a non-profit, has been launched in order to provide hygiene products, like oral health products, to those on the streets or living in homes on a below-the-breadline budget.

The launch comes after In Kind Direct released their 2017 Impact Survey, which has revealed that 37 per cent of the UK have had to go without hygiene or grooming essentials due to lack of funds.

Sali Hughes, journalist and author, teamed up with Jo Jones, beauty director at Communications store, is behind the creation of Beauty Banks. Sali said to the BBC: “Some people don’t have enough money to survive, so what’s going to go? The thing that you don’t need to stay alive. But I don’t think having clean teeth is a luxury. Having clean hair isn’t being spoiled – in 2018, in Britain, it’s a right.”

Beauty Banks are teaming up with brands, retailers and the wider community to gather as many toothbrushes, razors and tampons in order to ease the burden of so many in the UK.

The non-profit has plans to set up a women’s refuge and a food bank in Staines in Surrey, a homeless shelter in Cardiff and another in Ladbroke Grove, a stones throw from Grenfell Tower.

Sali, who has written about her prior experiences of homelessness, has said decisions like whether to buy products like shower gel are ones that we, as a society, take for granted. For some, she says it can make a difference between “being clean and not being able to eat.”

Jo Jones said she thought of the idea to donate unwanted and surplus toiletries to food banks about six months ago after realising the huge demand for non-food items.

Donations parcelled up by Beauty Banks will be sent to each of the five locations supported by the Trussell Trust, which co-ordinates a nationwide network of food banks.

Head of operations, Samantha Stapley, said research conducted with the University of Oxford found more than half of people using centres could not afford toiletries. She told the BBC: “No one should be left struggling to wash their hair, brush their teeth or afford tampons because they’ve been hit by something unexpected like redundancy, sickness or delayed benefit payment. This is a dignity issue.”

Sali has asked that people do not donate money, but send in spare toiletries they have lying around, specifically products such as deodorant, tampons, toothbrushes and razors.

Email beautybanks@tcs-uk.net to find out more.

 

Kosovo dentist hits the slopes at Winter Olympics

Albin Tahiri, a recently graduated dentist, has just become the first athlete from Kosovo to compete in the Winter Olympics. 

Tahiri took part in the mens ski slalom, where many seasoned professionals crashed out, yet Albin Tahiri finished the course at 37th place.

He told Reuters: “It was really icy, so I had a lot of problems, but when I saw the other guys fall out, I decided just to finish it because it’s our first race and I wanted to finish my first competition at the Olympics. ”

Despite his dream to be in the Winter Olympics, Tahiri retains that dentistry – specifically oral surgery – is his passion. 

He trains in dentistry mostly in Austria, Italy and Slovenia, due to lack of facilities in Kosovo. 

Tahiri has been waiting to compete in the Winter Olympics due to Kosovo only being recognised across the International Olympic Committee four years ago. After taking part in five individual mens skiing events at the Olympics, he will head home and finish off his internship in a dental practice. 

He added: “During these years that I’ve been waiting for Kosovo to become an Olympic family, I just simply decided not to wait and to study instead – so I graduated in dentistry, which was my passion.

“I just graduated now, I have one more year of internship and then I‘m thinking about full-mouth reconstruction with implants and so on, something like that, a bit of oral surgery, a bit of prosthetics.

‘Maybe I’ll fix some things from the skiers… no, I’m just kidding.’

Woman receives £7,500 pay out after losing a tooth

The Grimsby Telegraph has reported that a woman from Grimsby has received a £7,500 payout after her dentist failed to diagnose a decaying tooth.

Michelle Willerton, 45, suffered such severe pain to the extent that she couldn’t eat on one side of her mouth, and the tooth became so badly infected that it had to be removed.

Michelle visited The Corner Dental Practice, the same one she had been attending since childhood, for a routine appointment in 2014. She said to the Grimsby Telegraph: “My dentist Dr Kokinov examined my teeth and took an x-ray. He said that I would need to come back in a month to have a filling placed on one of my teeth, but that everything else looked fine. I was not worried at all.”

Over the next year, Michelle says she began to experience severe pain in the left hand side of her mouth and a huge hole started to grow in her tooth.

Michelle said: “It was so painful. I couldn’t eat anything on the left hand side of my mouth and I completely lost my appetite because it was just too uncomfortable to eat. It made me feel really low.”

In March 2015, Michelle went to see another dentist at the practice who advised that she had a large hole in her tooth as a result of the infection, before prescribing her a course of antibiotics.

Wanting a second opinion, she decided to visit a dentist at another practice, who attempted root canal treatment as well as fillings, but the tooth ultimately had to be removed as it was so damaged.

Michelle added: “I was so upset, if Dr Kokinov had spotted the decay as he should have done in the first place then I never would have suffered all of that pain, only to lose my tooth anyway.”

Michelle decided to contact Dental Law Partnership, a solicitors in the dentistry sector, to speak to them about the incident, and after analyzing her dental records it was clear that her dentist had failed to spot the decay, resulting in severe pain, infection and the loss of her tooth.

She said: “the whole experience has completely knocked my confidence. Going to the dentist never bothered me before, but now I feel really anxious every time I have an appointment.”

Tyla Westhead, of the Dental Law Partnership told the Grimsby Telegraph: “What our client went through was completely unnecessary. If the dentist had diagnosed and treated the decay in the first place the pain and loss she suffered could have been avoided.

“We hope the compensation she receives goes some way towards paying for the additional treatment required.”

Poor oral health increases risk of frailty in older men, says Dr Nigel Carter, OBE, CEO Oral Health Foundation

Oral health problems such as gum disease and tooth loss have been linked to frailty in older British men, a new study has revealed.

Researchers observed more than 1,000 men over a three-year period and found those with poor oral health were more likely to suffer from weight loss, exhaustion, gripping ability, a reduction in walking speed and low physical activity.

The study showed that one in five (20%) people examined had no teeth, more than half (54%) had gum disease, nearly a third (29%) suffered from dry mouth and around one in ten (11%) had trouble eating.

Older adults are more likely to experience issues in the mouth and this can have a direct effect on their overall wellbeing. Oral health problems are more common among older adults with tooth loss, gum disease, tooth decay and dry mouth the most likely to occur.  These conditions not only influence the health of the mouth but also impacts on a person’s quality of life too.

We often see first-hand the difficulties that poorer oral health in the elderly can have, including making it harder to eat, swallow, speak, get adequate nutrition, and even smile. Elderly people who are suffering with poor oral health could also be in pain and discomfort and experience problems their mouth and jaw.

As well as a dental examination, the participants which were aged between 71 and 92, had their height, weight and waist measured, took timed walking tests and had their grip strength recorded.

The study, which featured men from 24 towns across the UK, highlighted the importance of oral health in the elderly and we at the Oral Health Foundation believe more could be done to identify and manage poor oral health of older adults.

Sensory impairments such as eye sight and hearing, poor physical function and a patient’s wider history of disease are often what is taken into consideration when identifying frailty and oral health is often ignored when assessing the care of older people.

Dental examinations and the health of a person’s mouth could become highly useful indicators of frailty and be added to general health screening assessments in older people. 

The government must begin to take a greater interest in identifying the needs of the elderly population at an earlier stage in order for healthcare providers to manage them quickly and correctly.

The UK is facing significant changes to its elderly population, with the number of people over 60 expected to increase by around seven million in the next 20 years.

Amongst challenges to the workforce, housing, education and public services, added healthcare needs continue to be a growing concern.

An urgent and preventive approach must be taken to the population’s oral health, in order to relieve future pressure on an already over-burdened health system.

A simple daily routine of brushing our teeth last thing at night and at one other time during the day with a fluoride toothpaste could vastly improve the health of our mouth moving into our later years.

Reducing the amount of sugar that we consume and visiting the dentist regularly, as often as they recommend, is also really important. By doing these things, there is no reason that we cannot keep our teeth for life and also reduce our risk of frailty as older adults. 

References

1. Ramsey S. (2017) ‘Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men,’ Journal of the American Geriatrics Society, available online at http://onlinelibrary.wiley.com/doi/10.1111/jgs.15175/full.

The caffeine culprits of tooth staining – Payman Langroudi

People with particularly dull teeth often seek to brighten their smile through non-invasive cosmetic procedures such as tooth whitening – the most effective systems give patients the freedom to eat and drink whatever they wish, without affecting the overall colour of their teeth before, during, and after treatment. However, although many people in the UK are particularly image conscious, they do not always stop to think how their favourite hot coffee beverages could affect their teeth.

The enamel of teeth behaves similarly to the way in which a piece of pottery ages, and often has fine cracks in its surface that become stained over time. Unknown to many are the factors that can cause extrinsic discolouration:

  • Chromogens are intensely pigmented molecules that quickly latch on to dental enamel
  • Tannins are plant-based compounds that make it easier for teeth to stain
  • Acids are a substance that erode and soften enamel

These three basic elements are the culprits to discoloured teeth, and they are found in much of what many people eat and drink on a regular basis. What some people may not realise is that these substances can still stain the teeth even after some whitening treatment – that’s why it’s essential to use only the very best whitening products.

Unfortunately for caffeine lovers everywhere, coffee and tea contain tannins and acidic properties that damage teeth, and can result in staining. If you have ever brewed a cup of extra strong black tea longer than recommended, you will have immediately noticed a bitter taste in the middle of your tongue from your first sip, and a dryness in the front of your mouth, indicative of tannins. Black tea, in particular, is incredibly tannin-rich, which makes it a more potent tooth staining substance than coffee. A good rule of thumb to follow is that food that would stain clothes will do the same thing to teeth. Nevertheless, people need not worry that they should give up their favourite coffee and teas, as long as they maintain a good oral health regime that includes brushing teeth regularly, and attending routine dental appointments.

Additionally, there are tooth whitening treatments that can eliminate stains entirely. These options include home-based products such as toothpastes, gels, and films, as well as in-practice based systems where products containing highly concentrated bleaching agents are applied under professional supervision.[i] The Enlighten Whitening system, for example, employs a combination of both in-practice whitening and at-home procedures to guarantee a Vita shade B1 for every patient. What’s more, this impressive result is achievable without any change in a patient’s diet during or after treatment.

We are now a nation of coffee addicts, but it is important that Britons enjoy their early morning drinks with moderation in mind. It is essential to do so in order to maintain a whiter smile for many years to come.

For more information, visit www.enlightensmiles.com, email at info@enlightensmiles.com or call the team on 0207 424 3270

 

 

 

[i] Carey, C. (2014) Tooth Whitening: What We Now Know. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058574/. [Last accessed: 13.12.2017].

The love/hate relationship – Arifa Sultana

A love/hate relationship can occur between two people that deep down have strong feelings for each other. Instead of expressing their emotions openly they may bicker or pretend they don’t care, but subconsciously, they are attracted to each other and seek the other’s approval. In Romeo and Juliet, Shakespeare expresses this contradiction of feelings by using phrases such as “O brawling love” and “O loving hate.” Sigmund Freud also borrowed the term ‘ambivalence’ to indicate the presence of both love and hate towards the same object.

Certainly, most people have experienced these conflicting feelings at some point in their lives, whether it is the fascination with something that is macabre or the relationship that often exists between siblings. In fact, recent research reveals that the emotions of love and hate can co-exist and, most interestingly, human intuition allows us to possess both positive and negative feelings even towards significant individuals such as a partner.[1]

It is possible to trust, admire, like or love a person but at times, that same individual can prompt feelings of fear, disrespect, dislike and even hate. This can be true of a lot of couples in a long-term relationship, as they may argue long and hard but within hours they are making up. No matter how much they may dislike each other at times, they stay together often inhibiting negative evaluations of their partners, accepting their behaviour and transforming their partner’s faults into virtues.[2]

Of course, there are certain things that should not be tolerated such as emotional, verbal or physical abuse as well as other undesirable tendencies, including jealousy, controlling behaviour or infidelity. Other things that people secretly hate about their partners include: flirting, swearing, vanity, lack of ambition, untidiness, taking too many selfies or constantly playing video games. However, there are some problems, which despite being very hard to live with, are often not addressed or dealt with properly by many couples. For example, a national poll of over 2000 UK adults reveals that a significant number of individuals refuse to seek professional help for medical issues, even though they have a negative impact on their relationships.[3]

Top of the list of issues is snoring. It has been suggested that as many as one in four people in England snore regularly[4] but 84% of sufferers have never sought help for the problem.3 The survey also revealed that 20 per cent of men in the UK have suffered from erectile dysfunction, but over half of sufferers ignore the condition. Over a quarter of British adults have smelly feet or bunions but a staggering 61 per cent leave these issues untreated. The figures are similar for the problem of flatulence, but most surprising is that a significant number of people suffer from unpleasant smelling breath yet 80 per cent of them do nothing about it.

Unfortunately, halitosis can put a strain on any relationship. It is a key factor at the start of a partnership and also in the maintenance of a long-term relationship. Equally, bringing up the subject of unpleasant breath, even with ones nearest and dearest, can be very difficult. It is frequently avoided until the condition becomes intolerable because halitosis can result in extreme embarrassment as well as avoidance, frustration, lack of intimacy, loss of self-esteem and also anger and depression.

Although common, waking up with smelly breath is not regarded as halitosis and most people experience some kind of transient unpleasant oral odour at some time. However, up to 50% of the general population have persistent or recurrent episodes of halitosis[5] and the source of 90 per cent of cases is the oral cavity.[6] Even in healthy individuals, the accumulation of food debris and the retention of dental bacterial plaque on the teeth and tongue can cause halitosis. Conditions such as tooth decay, periodontal disease, dry mouth, ill-fitting dental restorations or dentures can all contribute to oral malodour too. Yet, as dental professionals are well aware, they can all be exposed during a regular dental examination.

As well as identifying any contributory issues and planning treatment where appropriate, dental professionals can also help patients by educating and showing them how to carry out a thorough oral health routine. It is also a good idea to recommend CB12 mouthwash as an adjunct to brushing and interdental cleaning as it has been clinically proven to prevent unpleasant breath for up to 12 hours. [7] Its patented formula gets to the root cause of bad breath by targeting and neutralising the odorous volatile sulphur compounds (VSCs) that are mainly responsible for intra-oral halitosis5 and also by chemically binding to the tissues of the mouth CB12 provides long lasting effects and reassurance.

It seems that many people could be living in a love/hate relationship simply because they are too embarrassed to address a problem that can often be easily remedied. There really is no need for patients to live with an issue such as odorous breath or with their loved one’s frustration, negativity or intolerance. A good oral health routine and effective products can successfully address this common condition and make for a happier relationship too.

 

For more information about CB12 and how it could benefit your patients, please visit www.cb12.co.uk

 

 

 

 

[1] Zayas V et al. Love you? Hate you? Maybe it’s both: Evidence that significant others trigger bivalent-priming. Social Phychological and Personality Science 2015. 6(1) 56-64. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1026.4031&rep=rep1&type=pdf [Accessed 21st August 2017]

[2] Murray S et al. A Smart Unconscious? Procedural Origins of Automatic Partner Attitudes in Marriage. J Exp Soc Psychol. 2010. 46(4): 650–656. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879496/#R29 [Accessed 21st August 2017]

[3] British Journal of Family Medicine. News 7th June 2017. Brits too embarrassed to seek help about common problems survey finds. Research by PharmacyOutlet.co.uk https://www.bjfm.co.uk/brits-too-embarrassed-to-seek-help-about-common-problems-survey-finds [Accessed 21st August 2017]

[4] NHS Choices. Snoring. http://www.nhs.uk/Conditions/Snoring/Pages/Introduction.aspx [Accessed 21st August 2017]

[5] Porter S et al. Oral malodour (halitosis). BMJ. 2006; 333(7569): 632–635. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570844/ [Accessed 21st August 2017]

[6] Aylıkcı BU et al. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013; 4(1): 14–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/ [Accessed 21st August 2017]

[7] Seemann R et al. Duration of effect of the mouthwash CB12 for the treatment of intra-oral halitosis: a double-blind, randomised, controlled trial. J. Breath Res. 10 (2016) 036002 https://www.ncbi.nlm.nih.gov/pubmed/27328808 [Accessed 21st August 2017]

Mentoring in the Dental Profession – Alpesh Khetia

Mentoring is defined by the Oxford School of Coaching and Mentoring as “Supporting and encouraging people to manage their own learning in order that they may maximise their potential, develop their skills, improve their performance and become the person they want to be”. It is a productive relationship based on mutual trust and respect, and should be empowering and enriching for both parties involved.

It can be an effective way for an individual to develop and grow in their career and is a popular method in dentistry to complement other training and educational resources. Selecting and finding a suitable mentor can be challenging as experience, personality and accessibility are all important factors to consider. However, once the correct person is found it can lead to a career-long, positive experience.

Benefits to the mentor:

  • Someone new to bounce ideas off and offer completely fresh perspectives
  • Teaching a topic is known to broaden one’s own understanding
  • Mentoring will require an individual to develop new skills in communication, leadership and coaching
  • Expanded professional network, which may create new friendships or encourage increased referrals for complex cases in the near future
  • Provides credibility and improves reputation among the wider profession

Benefits to the mentee:

  • Improved confidence in practice knowing there is someone there for help and advice in every stage of a treatment from planning to long-term maintenance
  • Guidance from someone more experienced and more qualified ensures they deliver safe and effective treatment from the start
  • The opportunity to learn from someone else’s mistakes and to avoid encountering similar difficulties
  • More objective help for more accurate self-assessments, which can help to boost the rate of improvement

Becoming a mentor / mentee

The easier way to become a mentor or find a mentor is to build a network of professionals with similar interests to you. This provides instant access to various people who are either seeking advice or who are willing to share their own experience to help others progress. There may also be a ready-made network within your practice / corporate environment as well. Rodericks Dental, for example, prides itself on supporting and nurturing all members of staff through a comprehensive training and mentoring programme. With a network of experienced and knowledgeable dentists ready to help individuals’ progress in their chosen path, it is a company created by dentists for dentists.

 

For more information about careers with Rodericks, please visit www.rodericksdental.co.uk/careers, email opportunity@rodericksdental.co.uk or call 01604 602491 (option 1) and ask for Christina Regan in our Dental Recruitment Team.

 

Twitter @rodericksdental and LinkedIn

#wearerodericks

 

Achieve stability to achieve success – Kate Scheer

The role of stability in achieving successful osseointegration has been well documented in recent years. Only with this biological process can professionals ensure predictable and reliable implant loading and long-term success of dental implants for long-lasting, quality results.

There are two different stages of stability: primary and secondary. Primary stability refers to the mechanical engagement of an implant with the surrounding bone, while bone regeneration and remodelling determine the secondary – or biological – stability of the implant. There are a number of factors that are known to affect primary stability, including bone quantity and quality, surgical technique and implant geometry such as length, diameter and surface characteristics. Any negative outcomes at this stage may have a knock-on effect, as the secondary stability is ultimately determined by the results of the primary stability. For this reason, continuous monitoring and regular assessment of the primary stability are absolutely essential, whatever the circumstances of the case.

With that being said, there are some situations in which measuring the implant stability at different time-points is more pertinent to the overall outcome than others. For immediate loading, for instance, there has to be consistently high implant stability measurements in order for the treatment to be successful. Where there isn’t sufficient stability, any attempt to carry out immediate implant placement will be compromised.

Only with objective measurements can clinicians accurately determine the optimal time to load an implant and ensure the right decision is made with each and every case. This not only helps to improve the likelihood of long-term success for the patient, but also demonstrates to the patient that all possible treatment pathways have been evaluated using measurable values as opposed to subjective judgements. What’s more, should any problems occur later on down the line or if the implant subsequently fails, the evidence is there to support any action taken and could prove useful in locating the source of the issue. Likewise, being able to show patients implant stability measurements can be a great educational tool in helping them to understand the decision process behind their treatment. This is especially true in situations where a patient may be keen to undergo immediate placement before sufficient primary stability has been achieved.

There are a number of different methods in which clinicians can assess primary implant stability, some of which are considered by experts to be more destructive than others. One of the more invasive techniques is histomorphometric analysis, which is where calculations of peri-implant bone quantity and bone-implant contact is obtained through a dyed specimen of the implant and peri-implant bone. Tensional testing, push-out/pull-out testing and removal torque analysis are also defined as destructive, and as such their clinical usage is limited.[i]

Instead, methods that are regarded as non-invasive are preferred – though some more than others. Indeed, as has already been established relying on nothing more than perception is not always the most effective technique, as it’s difficult to provide evidence should a problem arise. What’s more, these calculations can only be made once the implant is inserted, not before loading the implant.i Still, an experienced clinician’s opinion and skill should always be taken into consideration.

Imaging techniques are widely used to assess quantity and quality of the jawbone, but research shows that there are limitations in making an accurate assessment of implant stability and assessing facial bone level. The same goes for cutting torque resistance analysis, which can be useful in determining an optimal healing period, but is sometimes unsuitable for providing information on bone quality until the osteotomy site is prepared. Other methods include modal analysis, reverse torque test and percussion test, though the two procedures that are typically employed in practice are periotest and resonance frequency analysis.i Periotest uses an electro-magnetically driven and electronically controlled tapping metallic rod in a handpiece to measure the reaction of the peri-implant tissues to a defined impact load. Some research indicates, however, that the reliability of this method is debatable due to poor sensitivity, lack of resolution and susceptibility to operator variables.[ii]

Out of all the methods available, resonance frequency analysis is perhaps one of the most widely used, and has been shown to be a reliable tool for identifying implant stability.[iii] It uses vibration and a principle of structural analysis to measure the resonance frequency of a transductor attached to the implant body, and has a display panel to show the implant stability quotient (a measurement of the firmness at the implant-tissue interface).

The Implantmed Sl-1023 with Osstell ISQ module by leading manufacturer, W&H, is now available to clinicians looking to enhance their implant workflow and improve primary stability outcomes. Having recently earned the prestigious Red Dot Design Award 2017, W&H’s Implantmed is an ideal solution for any practitioner looking to offer quality implant outcomes to patients.

Implant primary stability is integral to the overall result of any dental implant. To maximise your chances of success and to achieve safer, more reliable results, be sure to equip yourself with the best possible tools.

 

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

 

 

 

 

 

[i] Swami V, Vijayaraghavan V, Swami V. Current trends to measure implant stability. J Indian Prosthodont Soc. 2016; 16 (2): 124-130. Accessed online November 2017 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837777/

[ii] Salvi GE, Lang NP. Diagnostic parameters for monitoring peri-implant conditions. Int J Oral Maxillofac Implants. 2004; 19(SUPPL):116-27. Accessed online November 2017 at file:///Users/officeone/Downloads/Group4-article01.pdf

[iii] Sul YT, Johansson CB, Jeong Y, Wennerberg A, Albrektsson T. Resonance frequency and removal torque analysis of implants with turned and anodized surface oxides. Clin Oral Implants Res. 2002 Jun;13(3):252–259. Accessed online November 2017 at https://www.ncbi.nlm.nih.gov/pubmed/12010155

 

Bone or tissue level? Mr. Trevisan

The rehabilitation of partially and completely edentulous patients with dental implants has become a popular and routine method of treatment; however this therapy is not free from challenges.

Of the complications experienced, peri-implant infections represent one of the most common issues. Classified as peri-implant mucositis and peri-implantitis, these inflammatory reactions affect the implant surrounding tissues in the osseointegrated functional implant after normal bone remodelling. If left untreated, peri-implant mucositis could progress and lead to crestal bone resorption, which is considered the main characteristic of peri-implantitis.[1]

Identifying specific risk factors for peri-implantitis before the implant is even placed is therefore crucial to ensure a long-term successful result. Several systemic as well as behavioural and local factors have been identified as risk indicators of peri-implant diseases. Such factors may include genetic traits, diabetes mellitus, smoking, a history of periodontitis, irregular maintenance programmes, poor plaque control, inadequate widths of keratinised mucosa, and implant bioshape and surface.1

Furthermore, implants are often placed in patients with a history of poor oral hygiene and edentulism, where structures and surfaces differ from those with natural teeth. For successful treatment, an implant system that causes minimal marginal bone loss should be used. It is believed that alveolar crestal bone remodels and loses height due to the implant placement and prosthetic reconstruction. The maintenance of the crestal bone support around implants is considered one of the most important factors of long-term efficacy and success. However, the aetiology of the marginal bone loss around dental implants is poorly understood.[2] Several factors can influence the loss of surrounding bone, including the implant type (one-piece, two-piece), the type of connection between the implant and abutment (platform switch or matching platform), the location and stability of the implant-abutment junction in relation to the alveolar crest and the soft tissue.2

Many different implant systems with various surgical solutions are available that aim to improve biomechanical properties such as primary and secondary stability and to limit the extent of peri-implant bone loss. Among them are bone-level implants with the abutment junction at the level of the crestal bone and tissue-level solutions that have the implant-abutment junction above the crestal bone, at soft tissue level.2 Selection depends on the case. When treatment planning, it is important to consider the type and number of implants required to replace the missing teeth, appropriate positions for implantation, prosthesis design, cantilever length, proper diameter and length of implants, prosthetic materials and type of occlusion.[3]

Aesthetics is another important area that requires increasing consideration and treatment must address this along with optimal occlusal function. Establishing an adequate amount of gingiva that is firmly attached to the underlying periosteum and bone has been cited as one of the main goals in implant maintenance. In accordance with the phenomenon of biological width, an undercut distance of the alveolar crest to the implant-abutment connection will lead to unfavourable bone remodelling.

The traditional tissue-level implant with an implant-abutment connection at a 2–3mm distance to the alveolar bone crest does not conflict with the biologic width, and when using implants with biocompatible materials such as zirconia, a pleasing aesthetic result can be achieved. Indeed, when tissue heals around zirconia, the epithelial fibres that develop are perpendicular, unlike the more vertical fibres which tend to develop around titanium – this mimics natural gingival growth. In some specific cases, though, bone-level implants may offer a preferred solution.[4]

The concept of platform switching has been one of the most significant innovations in bone-level implant provision in recent years. It is based on the use of small-diameter abutments compared to the platform diameter of the implant, therefore creating a mismatch between both components at the level of the implant-abutment interphase. This allows the horizontal implant surface to move away the connective tissue inflammatory infiltrate from the bone crest and thus reduce the loading stress in the crestal portion of the bone.[5]

TBR implant systems from Dental Express (a trading division of Surgery Express LLP) provide a multitude of features to help optimise and simplify surgery. It’s bone-level implants offer platform switching and a real morse taper connection, which helps develop a gingival ring-shaped sleeve protecting the implant. TBR’s innovative tissue-level design has a unique zirconia collar, which helps maximise tissue healing due to being highly biocompatible, and reduces the risk of developing peri-implantitis. Practitioners who have been using the Z1 implant for more than a decade say they are placing it in 99% of clinical situations because it makes implantology more comfortable for the surgeon, for the technician and for the patient. It requires less chairtime and it leads to more aesthetic and more predictable long-term results.

Selecting the correct implant for the case depends on a number of factors that need to be taken into consideration during treatment planning. Bone- and tissue-level implants both offer different benefits and solutions. Dental professionals should ultimately choose an implant system that utilises the highest quality of materials and provides the most effective and safe solution to patients.

 

For more information visit Dental Express at www.dental-express.co.uk, call 0800 707 6212 or learn more about the Z1 implant at http://z1implants.co.uk/

 

[1] Rokn, A., et al. (2017). Prevalence of peri-implantitis in patients not participating in well-designed supportive periodontal treatments: a cross-sectional study. Clinical Oral Implants Research, 28 (3), 314-319.

[2] Hadzik, J., et al. (2017). Comparative evaluation of the effectiveness of the implantation in the lateral part of the mandible between soft tissue level (TE) and bone level (BL) implant systems. Annals of Anatomy – Anatomischer Anzeiger, 213, 78-82.

[3] Mosavar, A., Nili, M., Hashemi, S. R., & Kadkhodaei, M. (2015). A comparative analysis on two types of oral implants, bone-level and tissue-level, with different cantilever lengths of fixed prosthesis. Journal of Prosthodontics, 00, 1-7.

[4] Rieder, D., et al. (2016). Implant therapy outcomes, peri-implant biology aspects. Clinical Oral Implants Research, 27, 469.

[5] Molina, A., et al. (2016). The effect of one-time abutment placement on interproximal bone levels and peri-implant soft tissues: a prospective randomized clinical trial. Clinical Oral Implants Research, 1-10.