Dr Sunil Chudasama is the Principal Dentist at DentalKind, in Billericay, Essex. Having completed his training at King’s College Dental Institute in London and then undertaken further education in restorative dentistry at the Eastman Dental Institute, also in London, he now performs cosmetic, restorative and implant dentistry. Here, he presents a recent restorative case using BRILLIANT EverGlow^®composite and ONE COAT 7 UNIVERSALbonding agent, both from COLTENE.  

Initial presentation and examination

This young adult male patient presented to me concerned about his smile, in particular his spacing due to congenitally missing lateral incisors (see Figs 1,2 and 3).The patient actually works within the dental industry and as a result is extremely conscious of his dental appearance. I have known him for several years, but it took him a while to become motivated enough to take action and make a positive change to his smile. Medically, the patient was fit and well. The variability in spacing around the upper anterior teeth due to his congenitally missing lateral incisors created many challenges. We discussed management with either comprehensive orthodontics to idealise and localise the spacing, or restorative dentistry to close the spaces. I advised that the ‘gold standard’ option would be orthodontic treatment to open the lateral spaces and then consider dental implants or resin-bonded bridges to replace the missing lateral incisors. Restorative options included direct composite bonding or minimal preparation porcelain veneers. Given the age of the patient and health of the teeth we strongly advised a non-prep approach. To give the patient a very quick idea of what could be achieved with composite bonding we performed a fast intra-oral mock up of his UR2-UL2. The patient was ecstatic with the result as his aesthetic concerns had been instantly addressed and he was excited to get the actual composite restorations completed. The composite shade selected was a VITA shade B1, and he maintained this with home teeth whitening.

Fig: 1

Fig: 2

Fig: 3

Treatment pathway

Treatment was completed under rubber dam without the use of any local anaesthetic. The rubber dam was held in place with a Wedjets Stabilising Cord, from Hygienic, and floss ties were used to correctly position the dam around the anterior teeth, ensuring ideal placement around the gingival areas. The patient has some older bonding on the disto-incisal aspect of the canines, which was removed. The build-ups were completed one tooth as a time, completely freehand (no stent or wax up made prior to treatment). The protocol was to sandblast with aluminium oxide powder (50 Micron), then etch for 15 seconds (as per the guidelines), followed by an application of ONE COAT 7 UNIVERSAL (COLTENE)and incremental build up using shade B1/A1 BRILLIANT EverGlow^®, also from COLTENE. A mixture of curved posterior sectional bands and/or transparent Mylar Matrix strips were used to shape the proximal areas. The final curing was finished under glycerine. The shaping and polishing of the restorations was completed using DIATECHSwissFlex^®Polishing Discs and Strips and DIATECH ShapeGuard system, all available from COLTENE. DIATECH SwissFlex^®Discs and Strips are extremely thin for great precision and flexibility to correctly shape the anteriors. The polishing wheels are an excellent and efficient polishing system that quickly bring the BRILLIANTEverGlow^®composites to life.

Appraisal

ONE COAT 7 UNIVERSALbond (COLTENE) is extremely user friendly and it dries to leave a very thin layer ideal for anterior restorations. It can be used as self-etch and selective-etch if desired. It can also be used in a dual cure approach, which is ideal for post-hold preparations. The BRILLIANT EverGlow^®composite (COLTENE) is also lovely to use, handles well and the blend to the natural tooth is excellent. The polish and lustre of the final restorations separates it from other composites on the market, especially when combined with the DIATECHSwissFlex^®polishing system, also available from COLTENE. Personally, I find that the biggest benefit with this composite is its colour adaptation. This allows me to create beautiful seamless results without the need for any more time consuming multi-layered restorations. I strongly recommend this system for anyone performing a lot of anterior composite restorations.

The patient is very pleased with the outcome and is feeling more confident with his smile (see Figs 4, 5 and 6).He wishes to undergo more treatment because of the fantastic results already achieved with his front teeth and we are now planning freehand fiber-reinforced closure of the residual spaces left between the canines and first premolars. 

Fig: 4

Fig: 5

Fig: 6

To find out more visit www.coltene.com, email info.uk@coltene.comor call 01444 235486

Over the course of your career you will see all manner of patients, from run of the mill individuals who rarely need more than a scale and polish to those with more complex dental and health needs. One condition to be aware of that can pop up from time to time is epilepsy.

Epilepsy is a neurological condition where the electrical signals in the brain become scrambled, occasionally causing sudden bursts of electrical activity leading to seizures. The possible symptoms can vary, typically manifesting as either: impaired consciousness; abrupt loss of muscle tone and consciousness resulting in sudden collapse; jerking of arms and/or legs and impaired consciousness; and repetitive jerking, stiffening and loss of consciousness. The condition is thought to affect around 600,000 people in the UK, often for the entirety of their lives once diagnosed.[i]

Naturally the risk of a seizure occurring whilst in the dental chair is a consideration that you should give thought to with all epileptic patients, as there are a number of risk assessments and safety precautions that you will need to have in place. However, you should also consider how epilepsy can affect patients orally. Due to an increased risk of dental caries, periodontal disease, canker sores and lesions, delayed healing, gingival hyperplasia and xerostomia thanks to side effects of anti-seizure medications, it is likely that epileptic patients will need extra monitoring and possibly intervention. Six monthly check-ups and a personalised oral health programme are therefore essential to maintain the oral health of these patients, as is regular confirmation of medications and dosage levels.

Seizures can also have a devastating effect on the patient orally as there is a high risk of tongue laceration, trauma-induced tooth avulsion and temporomandibular disc location, as well as oral trauma such as chipped and broken teeth. One study found that 52.4% of subjects experienced oral trauma of some description during an epileptic seizure. Of those, 18% suffered from a cracked tooth and 17% from a tooth fracture.[ii]Another discovered that generalised tonic-clonic, generalised and non-classified seizures were strongly associated with trauma within the 159-strong control group. The most common injuries were fractures, tooth avulsion, tooth luxation and fracturing of prostheses in edentulous patients.[iii]

All of the above can be extremely painful for the patient and have a huge impact on their quality of life. As such it is important to intervene as quickly as possible. Of course, the treatment that you provide will all depend on the type of trauma that the patient has experienced. In some instances, it may be possible to treat the affected tooth or teeth restoratively depending on the extent of the damage and whether the pulp is involved and healthy. This pathway is generally much less invasive for the patient and offers a promising prognosis. In other cases it may be necessary to perform root canal therapy, or even possibly remove the tooth if it cannot be saved.

One possible scenario in which restorative treatment might be possible is if the trauma in question is a ‘fractured cusp’ – where the cusp is separated from the rest of the tooth either by a complete or incomplete fracture.Indeed, it is believed that as long as enough of the tooth structure remains and the pulp is unaffected it may be feasible to provide a direct restoration or an inlay, onlay or build-up and crown, depending on what the assessment reveals. Factors to take into consideration include: the amount of tooth and enamel available; whether or not it is possible to isolate the tooth; and if margin placement is likely to be a concern. The long-term implications of each pathway on surrounding teeth must also be taken into account as well as the material choice.

A restorative pathway may also be taken (if the pulp is healthy and intact) to prevent a ‘cracked tooth’ from worsening, as long as the restoration covers the entire crack and provides cuspal coverage and support. A cracked tooth is defined as being an incomplete fracture that starts from the crown and extends subgingivally. Thanks to new and improved materials and bonding techniques, it is possible to save more of the tooth and manage with bonded direct or indirect restorations. 

COLTENE is amongst those providing high-performance restorative materials with high abrasion resistance, high compressive strength, excellent handling and application, and more. With the addition of superb polishability, gloss retention and long-lasting aesthetics, materials such as BRILLIANT EverGlow^®, Fill-up!™and the BRILLIANT Crios CAD/CAM bloc can help to make optimal results achievable.

You may never come across a patient with epilepsy, but in the event that you do, be sure to take into consideration how the condition might affect their oral health, and treatments that could be provided to restore their dentition. With the right techniques and materials it may be possible to make the teeth and gingiva one less thing for them to worry about.

To find out more visit www.coltene.com, email info.uk@coltene.comor call 01444 235486

[i]Epilepsy Action: Epilepsy facts and terminology. Accessed online August 2018 athttps://www.epilepsy.org.uk/press/facts

[ii]Gawlak D, Luniewska J, Stojak W, Hovhannisyan A, Stróżyńska A, Mańka-Malara K, Adamiec M, Rysz A. The prevalence of orodental trauma during epileptic seizures in terms of dental treatment – Survey study. Neurol Neurochir Pol. 2017; 51 (5): 361-365. Accessed online August 2018 at https://www.ncbi.nlm.nih.gov/pubmed/28711375

[iii]Nonato ER, Borges MA. Oral and maxillofacial trauma in patients with epilepsy: prospective study based on an outpatient population. Arq Neuropsiquiatr. 2011; 69 (3): 491-5. Accessed online August 2018 at https://www.ncbi.nlm.nih.gov/pubmed/21755128

Cost is no longer a barrier to benefitting from advanced CAD/CAM and milling solutions with MyCrown.

The innovative solution offers a cost-effective way of fabricating crowns, veneers, inlays, onlays and small bridges in-practice, enabling patients to walk away from one appointment with a supreme-fitting restoration.

Complete with a sophisticated intraoral scanner, MyCrown can be used to capture both 2D and 3D digital impressions, which can then be used with the system’s simple 5-step guided software to design the ideal prosthesis in under 10 minutes.

Once approved, MyCrown’s sophisticated milling unit produces the restoration in as little as 12 minutes, enabling you to maximise valuable time in practice. 

For more information, visit www.my-crown.co.uk or call 03339 873007

Every dental practice has a unique feature that distinguishes it from competitors. You can become recognised among patients for the quality of your services by investing in the Vibrenté range of dental consumables from Denka.

Practitioners are able to customise their practices with squat cups, disposable bibs, nitrile gloves, saliva ejectors, tray liners, face masks and aspirator tips in an exciting array of colours that are sure to get you noticed.

These have been specifically designed to not only help complement the unique aesthetic of your practice, but also to enhance your overall brand image and inject a little colour into everyday dentistry.

For more information, visit www.denkauk.com, call on 0800 707 6212 or email support@denkauk.com

Recently, it was announced that the Unit of Orthodontic Activity (UOA) benchmark price is going to be decreased in the North to accommodate for the lower cost of living, wages and operating costs. However, after surveying the numbers, we found that it is not in fact cheaper to run a dental practice in the North, mainly due to staff expenses as a result of recruitment difficulties.

As such, if the UOA rate is reduced but the pay rate is kept the same, then practices could potentially be even more out of pocket. This shows just how competitive the market now is.

If you need help recruiting associates to your practice, or want to know how your practice might be affected, get in touch with the Dental Elite team.

 For more information on Dental Elite visit www.dentalelite.co.uk, email info@dentalelite.co.uk or call 01788 545 900

Using advanced HyperSphere technology with a full-swivel ball joint, the RXDC X-ray unit by MyRay can reach any position with ease. This naturally has a number of benefits for the dental practice, including better accessibility and increased comfort for the patient. Forget positioning the patient to suit the equipment – now the X-ray can go to them.  

The RXDC also features an automatic touch-sensitive device for efficient locking and release of the X-ray head tube, meaning it can be effortlessly repositioned between one exposure and the next.

The innovation doesn’t stop there either. There’s also a wireless remote controller that lets the user control the device remotely, as well as automatic parameter modulation that ensures exposure power and time are always selected according to the patient’s build and site of investigation.

For more information about the RXDC X-ray unit with advanced technology, contact leading equipment distributor, RPA Dental.

 RPA Dental Equipment Ltd.

Visit us at www.rpadental.net

London and Manchester Sales and Service Centres call 08000 933 975

For any dentists looking to introduce digital technologies but who wish to retain some of their traditional workflows, the CS 7200 imaging plate system from Carestream Dental offers an ideal balance between the two.

Combining the benefits of film and digital imaging, the compact system produces sharp images with a true resolution of 17 Ip/mm. Available in as little as eight seconds, images reproduce excellent detail and ensure optimal contrast for enhanced diagnostics.

Facilitating a simple, virtually error-proof workflow, the clinician need only take an X-ray, scan the plate and the image automatically displays on the computer screen.

Aside from bridging the gap between film and digital imaging, the CS 7200 is also a cost-effective solution for anyone not yet in a position to invest in fully digital technologies.

Find your ideal balance with the CS 7200 from Carestream Dental.

For more information please contact Carestream Dental on

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For all the latest news and updates, follow us on Twitter @CarestreamDentl and Facebook

The British Academy of Cosmetic Dentistry (BACD) recognises the need for dentists to stay up-to-date on the latest trends and research within the profession.

Recommended Meetings are just one of many educational opportunities that the BACD offers to help dental professionals enhance their knowledge and skills. Foundation dentist, Dr Yoshan Patel, is a relatively new member to the BACD and recently attended a session in Berkshire.

He says: “The venue for the meeting was fantastic, providing great facilities and a comfortable environment that facilitated the process of learning.

“The meeting itself really delivered on all of my expectations. Throughout the day, all the topics I intended to explore were discussed in detail with live, practical demonstrations. Both speakers brought a wealth of experience with them on the day, which clearly showed in the case scenarios they presented.

“I strongly believe that it is essential to feed your passions, and if cosmetic dentistry lies within that scope, then joining an association like the BACD would be of huge benefit. Recommended Meetings offer a great opportunity for practitioners to further their theoretical and practical knowledge of cosmetic and aesthetic dentistry.”

For further enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com

Finding an implant you can trust is important for every procedure in implantology.

Dr Amit Mistry of Amit Mistry Implants explains why Nobel Biocare products are his first choice:

“I started using Nobel Biocare implants around 7 years ago because their compatibility with concepts like immediate function and immediate loading appealed to me. I also like that the products have a lot of research behind them, as it means they can be trusted to provide predictable and consistent results.

“I currently use NobelParallel^TMConical Connection implants in most of my routine cases, because of the good conical connection. For more complex cases in the upper anterior region I use the NobelActive^®implants because they offer high primary stability and allow for immediate temporisation. I also use them in cases where soft bone is present, typically in the posterior maxilla. For cases using the All-on-4^®treatment concept I always use NobelSpeedy^®Groovy implants.

“The customer service provided by Nobel Biocare is great. The representatives always look after me and are really helpful with my clients. They are always on hand to offer help and support when needed and their in-house training has helped us improve the implant experience within our practice.”

For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com