Osteoporosis is a common condition where bone density and quality are reduced and weakened, greatly increasing the risk of the bone fracturing and breaking. At present, more than 3.5 million people in the UK are living with osteoporosis – approximately 7% of men and 22% of women over the age of 50 are currently suffering from the condition.[1]As the large “Baby Boomer” cohort is approaching old age, it is projected that by 2030 more than a fifth of the population will be over 65 years old, and by 2041 this will have risen to more than a quarter of the population.[2]An aging population will see the incidence of osteoporosis and other systemic conditions continue to increase over the coming years.

While the proportion of the population with edentulism has fallen substantially, there are still well in excess of 2 million edentulous people in the UK, and aging continues to increase the commonality of various oral health conditions (dental caries, periodontitis, xerostomia, oral cancer, etc.).[3]^,[4]An aging population will almost certainly give rise to a greater number of patients with partial edentulism, many of whom will seek dental implants, and a significant proportion of which will have osteoporosis. It is therefore important to understand this condition and any of its associated risks.

Bone mass acquisition is largely complete within the first two decades of life, though growth can continue into the late twenties. The apex of bone strengthening and density is known as peak bone mass. Generally speaking, women tend to mostly retain their bone mass from age 30 until the onset of menopause. The majority of women then go through a rapid loss of bone tissue, which slows following the resolution of menopause, but will continue for the rest of their lives.[5]Osteoporosis is significantly more common in postmenopausal women, due to the reduction in oestrogen levels. The reduction in oestrogen results in the increased formation and prolonged survival of bone-resorbing osteoclasts.[6]Using oral contraceptives that contain oestrogen is associated with greater bone density, which may have a protective effect later in life.[7]Other conditions and medications that alter hormone levels and function may also increase the risk of osteoporosis. For example, transwomen are at greater risk due to the long-term use of hormone blockers and/or surgical treatment.[8]

Osteoporosis is associated with numerous inflammatory diseases, including rheumatoid arthritis and periodontal disease.[9]^,[10]Both osteoporosis and periodontitis are characterised by reductions in bone mass and fragility. In addition to the direct effect on bone tissue, menopause can be accompanied by dry mouth and other symptoms that may further encourage the development of periodontal disease.[11]

Research suggests that receiving treatment for osteoporosis reduces the prevalence of severe periodontitis, relative to those going untreated.[12]Osteoporosis treatments for postmenopausal women include hormone replacement therapy (oestrogen, sometimes with progestin), bisphosphonates, selective oestrogen receptor modulators (SERMs), supplements (calcium and vitamin D), and in rare cases parathyroid hormones.[13]

Bisphosphonates are commonly prescribed for osteoporosis (as well as for Paget’s disease). Osteoporosis is characterised by the rate of bone resorption exceeding the rate of bone formation, resulting in net bone loss. Bisphosphonates counter this by reducing osteoclastic activity and suppressing bone remodelling and replacement.[14]Patients receiving bisphosphonates are at risk of developing medication-related osteonecrosis of the jaw (MRONJ), a painful and potentially debilitating condition. Despite being relatively rare, where it does occur it is a potentially serious complication, resulting in progressive destruction of the bone in the maxillofacial region. Though bisphosphonates have a short half-life (30-120 minutes), once they have been incorporated into bone tissue, they can remain there for over a decade. Periodontal infection, tooth extraction and cancer have been established as risk factors and potential triggers for MRONJ.[15]

Smoking, a lack of physical activity, and poor nutrition can all lead to relatively low bone density. If patients follow these habits before reaching peak bone density, their likelihood of developing osteoporosis may increase.[16]Engaging in exercise (though not excessively) and getting adequate calcium and vitamin D – particularly while the bones are still developing – will help strengthen them, encouraging a higher peak bone mass.[17]

We might assume that the reduced bone quality that characterises osteoporosis – and the association between it and various systemic conditions – could compromise osseointegration and, therefore, increase the risk of dental implant failure. However, the literature on this subject is uncertain. Failure rates for patients with osteoporosis appear to be in line with those without the condition.[18]^,[19],[20]Osteoporosis may however increase peri-implant bone loss.[21]This emphasises the importance of selecting a high quality implant solution. The innovative Z1^®system from TBR, for example, features a highly resilient titanium body and an intelligently designed zirconia collar, which helps to protect the crestal bone and gingiva from iatrogenic inflammation. Protecting the bone-implant interface from infection is critical to osseointegration and the long-term success of the implant.[22]

Whilst particular care must be taken with patients suffering from compromised health and frailty, osteoporosis on its own is not a contraindication to the provision of dental implants. However, if a patient is receiving bisphosphonates for the condition, it is important to properly educate them on the risk of osteonecrosis.[23]

For more information on the Z1^®implant, visit tbr.dental, email support@denkauk.comor call 0800 707 6212

REFERENCES

[1]International Osteoporosis Foundation. Broken bones, broken lives: a roadmap to solve the fragility facture crisis in the United Kingdom. International Osteoporosis Foundation. 2018. https://www.iofbonehealth.org/broken-bones-broken-livesJune 13, 2019.

[2]ONS. Living longer: how our population is changing and why it matters. Office for National Statistics. 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13June 13, 2019.

[3]Ramsay S., Whincup P., Watt R., Tsakos G., Papacosta A., Lennon L., Wannamethee S. Burden of poor oral health in older age: findings from a population-based study of older British men.BMJ Open. 2015; 5: e009476. https://bmjopen.bmj.com/content/5/12/e009476June 13, 2019. 

[4]Thomson W., Ma S. An ageing population poses dental challenges. Singapore Dental Journal. 2014; 35: 3-8. https://www.sciencedirect.com/science/article/pii/S0377529114200095June 13, 2019.

[5]National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: peak bone mass in women. National Institute of Health. 2018. https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-massJune 13, 2019.

[6]Steves C., Bird S., Williams F., Spector T. The microbiome and musculoskeletal conditions of again: a review of evidence for impact and potential therapeutics. Journal of Bone and Mineral Research. 2016; 31(2): 261-269. https://onlinelibrary.wiley.com/doi/full/10.1002/jbmr.2765June 13, 2019.

[7]National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: peak bone mass in women. National Institute of Health. 2018. https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-massJune 13, 2019.

[8]Sedlak C., Roller C., van Dulmen M., Alharbi H., Sanata J., Leifson M., Veney A., Alhawatmeh H., Doheny M. Transgender individuals and osteoporosis prevention. Orthopaedic Nursing. 2017; 36(4): 259-268. https://nursing.ceconnection.com/ovidfiles/00006416-201707000-00005.pdf

 June 13, 2019.

[9]Steves C., Bird S., Williams F., Spector T. The microbiome and musculoskeletal conditions of again: a review of evidence for impact and potential therapeutics. Journal of Bone and Mineral Research. 2016; 31(2): 261-269. https://onlinelibrary.wiley.com/doi/full/10.1002/jbmr.2765June 13, 2019.

[10]Koduganti R., Gorthi C., Sandeep N. Osteoporosis: a risk factor for periodontitis. Journal of Indian Society of Periodontology. 2009; 13(2): 90-96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847131/June 13, 2019.

[11]Gopinath V., Prabhu M., Suryawanshi H. Osteoporosis and periodontal disease – a review. International Journal of Innovations in Dental Sciences. 2016; 1(1): 27-37. https://pdfs.semanticscholar.org/51f0/ebefcade10fd8d72e6d23d964b22c6c4e7f1.pdfJune 13, 2019.

[12]Passos-Soares J., Vianna M., Gomes-Filho I., Cruz S., Barreto M, Adan L., Rösing C., Trinadade S., Cerqueira E., Scannapieco F. Association between osteoporosis treatment and severe periodontitis in postmenopausal women. Menopause. 2017; 24(7): 789-795. https://journals.lww.com/menopausejournal/Abstract/2017/07000/Association_between_osteoporosis_treatment_and.12.aspxJune 13, 2019.

[13]NHS. Treatment: osteoporosis. NHS. 2016. https://www.nhs.uk/conditions/osteoporosis/treatment/June 13, 2019.

[14]Venkatakrishnan C., Bhuminathan S., Chandran C., Poovannan S. Dental implants in patients with osteoporosis – a review. Biomedical & Pharmacology Journal. 2017; 10(3): 1415-1418. http://biomedpharmajournal.org/vol10no3/dental-implants-in-patients-with-osteoporosis-a-review/June 13, 2019.

[15]Di Fede O., Panzarella V., Mauceri R., Fusco V., Bedogni A., Lo Muzio L., SIPMO ONJ Board, Campisi G. The dental management of patients at risk of medication-related osteonecrosis of the jaw: new paradigm of primary prevention. BioMed Research International. 2018; 2018: 2684924. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164200/June 13, 2019.

[16]National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: peak bone mass in women. National Institute of Health. 2018. https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-massJune 13, 2019.

[17]National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis: peak bone mass in women. National Institute of Health. 2018. https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-massJune 13, 2019.

[18]Giro G., Chambrone L., Goldstein A., Rodrigues J., Zenóbio E., Feres M., Figueiredo L., Cassoni A., Shibli J. Impact of osteoporosis in dental implants: a systematic review. World Journal of Orthopedics. 2015; 6(2): 311-315. https://www.wjgnet.com/2218-5836/full/v6/i2/311.htmJune 13, 2019.

[19]Radi I., Ibrahim W., Iskandar S., AbdelNabi N. Prognosis of dental implants in patients with low bone density: a systematic review and meta-analysis. The Journal of Prosthetic Dentistry. 2018; 120(5): 668-677. https://www.thejpd.org/article/S0022-3913(18)30094-5/fulltextJune 13, 2019.

[20]De Medeiros F., Kudo G., Leme B., Saraiva P., Verri F., Honório H., Pellizzer E., Santiago Jr. F. Dental implants in patients with osteoporosis: a systematic review with meta-analysis.  International Journal of Oral & Maxillofacial Surgery. 2018; 47(4): 480-491. https://www.ijoms.com/article/S0901-5027(17)31484-4/fulltextJune 13, 2019.

[21]De Medeiros F., Kudo G., Leme B., Saraiva P., Verri F., Honório H., Pellizzer E., Santiago Jr. F. Dental implants in patients with osteoporosis: a systematic review with meta-analysis.  International Journal of Oral & Maxillofacial Surgery. 2018; 47(4): 480-491. https://www.ijoms.com/article/S0901-5027(17)31484-4/fulltextJune 13, 2019.

[22]Wang Y., Zhang Y., Miron R. Health, maintenance, and recovery of soft tissues around implants. Clinical Implant Dentistry and Related Research. 2015; 18(3): 618-634. https://onlinelibrary.wiley.com/doi/abs/10.1111/cid.12343June 13, 2019.

[23]Venkatakrishnan C., Bhuminathan S., Chandran C., Poovannan S. Dental implants in patients with osteoporosis – a review. Biomedical & Pharmacology Journal. 2017; 10(3): 1415-1418. http://biomedpharmajournal.org/vol10no3/dental-implants-in-patients-with-osteoporosis-a-review/June 13, 2019.

Of all the confectionery in the world, chocolate is arguably the most loved. As a nation of chocoholics, it is unsurprising that we Britons dedicate a whole week every year in October to indulging our sweet tooth and celebrating the wonder that is chocolate. Research by Mintel has revealed that nearly one in six Britons eat chocolate every day, while a similar number do so four to six times a week.[i]The UK is also top of the charts as the country that consumes the most chocolate of any other, but where exactly did our love affair with chocolate originate from?[ii]

From bean to bar

The practise of making chocolate dates back thousands of years. It is produced from the cacao beans of pods that grow from theTheobrama cacao– a tropical tree (whose scientific name translates to “food of the gods”) that is native to Central and South America, but is also now widely cultivated in West Africa. The Olmecs of ancient Latin America were almost certainly the first to turn the cacao bean into chocolate, although not as we know it today. They roasted and ground the beans into powder, which was mixed with fluids for use as a ceremonial drink and as medicine. Historians believe this knowledge was passed down to the Mayans, who praised chocolate as a gift from the gods. Cacao beans became so valuable that they were prized above gold and traded as currency among the Aztecs.[iii]

Reports differ but it is thought that the cacao bean was later discovered by Spanish explorers, who brought them back to Europe to create hot chocolate drinks. The rest, as they say, is history. The cacao bean is now commonly used for mass-producing highly refined chocolate and although it remains incredibly popular, chocolate has received a lot of bad press over the years for its potentially negative effects on general health. In fact, the excess consumption of chocolate with a high fat and sugar content has long been associated with weight gain, diabetes, coronary heart disease, and hypertension – among other conditions. Some chocolates can also contain high levels of cadmium and lead, which are toxic to the kidneys, bones, and other body tissues.[iv]

It’s not all bad news…

Despite the health risks posed by chocolate, researchers have begun to uncover new evidence that chocolate can also offer numerous health benefits. Cacao beans themselves are full of antioxidants, including tannins, flavanols and polyphenols that help to neutralise free radicals and prevent oxidative stress on the body. Cacao beans are also rich in minerals such as iron, copper, magnesium, zinc and phosphorous.[v]^,[vi]Experts speculate that these naturally-occurring substances could aid in the prevention and control of cardiometabolic diseases. Interestingly, a recent meta-analysis of chocolate’s effects on diabetes, stroke and coronary heart disease concluded that moderate chocolate consumption is associated with a reduced risk of developing these conditions.[vii]

Other research shows that chocolate could improve cognitive performance. According to one study, the taste and smell of chocolate may interact with neurotransmitters in the brain – including dopamine, endorphins and serotonin – that contribute to appetite, reward and mood regulation, which is why many people often feel good when eating chocolate.[viii]Another study found that chocolate consumption might even lower the risk of cognitive decline in older people. Researchers assessed nearly 400 Portuguese citizens over the age of 65 and discovered that those who ate a moderate amount of chocolate (an average of one chocolate snack per week) decreased their risk of cognitive decline by 40% over two years.[ix]

The dark tooth

Some studies suggest that dark chocolate could be effective at protecting the teeth and gums from disease. This is because dark chocolate often contains a higher cacao bean content than milk or white chocolate, equating to a greater number of antioxidants. In fact, some dark chocolates contain far more antioxidants than green tea and red wine.[x]These natural chemicals possess anti-microbial and anti-inflammatory properties that can neutralise bacteria – including those that can result in bad breath – and limit their growth, preventing them from adhering to the teeth and converting sugar into acids that can cause dental caries.[xi]Although compelling, these finding do not necessarily justify consuming larger quantities of chocolate, especially as most chocolates contain various ingredients that can be harmful to the body.

Consumers are still advised to select high quality chocolate products and, more importantly, to consume them in moderation. Chocolates that contain a cacao percentage of 70% or higher are recommended in order for consumers to maximise on their general and oral health benefits. To further limit the risk of dental disease, it also remains vitally important for patients to follow good oral hygiene practises using the most reliable products. Curaprox offers the Be You range of toothpastes, the ultra-soft CS 5460 manual toothbrush and CPS interdental brushes, which facilitate gentle but effective cleaning of teeth and gums.

Chocolate is the ultimate comfort food, so it’s no wonder that we love it so much. As we approach National Chocolate Week, it is important to remember that while it may be tempting to overindulge on chocolate, like any food, it should always be consumed in moderation. This is key to ensuring we can all enjoy the sweet treat without harming our long-term health and wellbeing.  

For more information please call 01480 862084, emailinfo@curaprox.co.ukor visit www.curaprox.co.uk

References

[i]Mintel. (2014) Nation of chocoholics: Eight million Brits eat chocolate every day. Link: https://www.mintel.com/press-centre/food-and-drink/nation-of-chocoholics-eight-million-brits-eat-chocolate-every-day. [Last accessed: 20.06.19].

[ii]Mintel. (2018) A feast of innovation: Global Easter chocolate launches up 23% on 2017. Link: https://www.mintel.com/press-centre/food-and-drink/a-feast-of-innovation-global-easter-chocolate-launches-up-23-on-2017. [Last accessed: 20.06.19].

[iii]History. (2018) History of Chocolate. Link: https://www.history.com/topics/ancient-americas/history-of-chocolate. [Last accessed: 20.06.19].

[iv]Nordqvist, J. (2018) Health benefits and risks of chocolate. Medical News Today. Link: https://www.medicalnewstoday.com/articles/270272.php. [Last accessed: 20.06.19].

[v]Eske, J. (2019) What are the health benefit of dark chocolate? Medical News Today. Link: https://www.medicalnewstoday.com/articles/324747.php. [Last accessed: 20.06.19].

[vi]Szalay, J. (2018) Chocolate Facts, Effects & History. Live Science. Link: https://www.livescience.com/61754-chocolate-facts.html. [Last accessed: 20.06.19].

[vii]Yuan, S., Li, X., Jin, Y. and Lu, J. (2017) Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies. Nutrients. 9(7); 688. Link: https://doi.org/10.3390/nu9070688. [Last accessed: 20.06.19].

[viii]Nehlig, A. (2013) The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. British Journal of Clinical Pharmacology. 75(3): 716–727. Link: https://doi.org/10.1111/j.1365-2125.2012.04378.x. [Last accessed: 20.06.19].

[ix]Moreira, A., Diógenes, M. J., De Mendonça, A., Lunet, N. and Barros, H. (2016) Chocolate Consumption is Associated with a Lower Risk of Cognitive Decline. Journal of Alzheimer’s Disease. 53: 85-93. Link: https://pdfs.semanticscholar.org/056a/83e3fb5e6a2a2b600205411270b84a10ef89.pdf. [Last accessed: 20.06.19].

[x]Lee, K. W., Kim, Y. J., Lee, H. J., and Lee, C. Y. (2003) Cocoa Has More Phenolic Phytochemicals and a Higher Antioxidant Capacity than Teas and Red Wine. Journal of Agricultural and Food Chemistry. 51(25): 7292–7295. doi: 10.1021/jf0344385.  

[xi]Lakshmi, A., Vishnurekha, C., and Baghkomeh, P. N. (2019) Effect of theobromine in antimicrobial activity: An in vitro study. Dental Research Journal. 16(2): 76–80. Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364351/. [Last accessed: 20.06.19].

“Combined with the EyeMag Light II, the EyeMag Pro provides a very clear, sharp image,” says Dr Laura Birch. “The lightweight frame of EyeMag Pro is sturdy and can be easily adjusted to my needs. I wouldn’t complete my working day without these loupes now, as they enable me to achieve even better treatment results.

“I would 100% recommend the EyeMag Pro loupes, as they are comfortable and provide a fantastic level of detail. Moreover, Nuview was a good company to work with. The team answered all my questions efficiently and helped me make the right decision for me.”

For more information please call Nuview on 01453 872266, email info@nuview-ltd.com, visit www.nuview.co or ‘like’ Nuview on Facebook.

In dentistry, the list of available restorative materials continues to grow exponentially. Inspired by the quest for better aesthetics or better strength and longevity, new materials are being explored through research all the time, and many of these work their way into day-to-day usage.

Zirconia has been on the market for some time, but is increasing in popularity for NHS restorations. But what are the benefits of this material and is it always the best choice for restorations?

The aesthetic edge

It’s no understatement to say that aesthetics in dentistry are now a primary focus for patients and practitioners alike. What were once considered passable outcomes are now considered aesthetic failures if they do not look natural, even if they perform function correctly and can achieve appropriate longevity. Of course, this is subjective. Aesthetics will inevitably matter more in the anterior region where teeth are more on show. However, some patients will demand better aesthetics in posterior regions as well, so it’s important to establish the expectations of those you treat, and live up to them.

In light of this, zirconia has an obvious benefit. Unlike metallic or porcelain-fused-to-metal crowns (PFM) zirconia can offer wonderfully natural looking aesthetics even in challenging conditions such as changing light. Due to its atomic make up, the material echoes the appearance of natural teeth in a number of ways. Furthermore, its naturally white hue means that with careful shading it can become virtually indistinguishable from natural teeth – making it the ideal choice for high pressure aesthetic areas.

It is important to remember that not all zirconia is equal, however. Whilst zirconia as a material undoubtedly provides better aesthetics than say resins or metals, there are different varieties of the material available on the market and some will be more lifelike than others. As such, it’s worth exploring to see what level of aesthetics your patient is expecting and adjusting the zirconia you use accordingly to balance outcome with cost.

A functional fit

Traditionally, more aesthetic restorations had some functional downfalls. Some of the earlier ceramic options simply couldn’t provide comparable strength to natural teeth and many of these options have a higher fracture rate than metals when faced with occlusal forces.[i]It is for this reason that PFM crowns were first invented, as they combine the aesthetics of ceramic with the strength of metal. However, these crowns are also prone to fracture and chipping on the ceramic layer despite being stronger than most fully ceramic alternatives.[ii]

Zirconia bucks this trend in a number of ways. Due to the crystalline formation of this ceramic, the mechanical strength of the material can be up to three times stronger than other ceramic materials. Furthermore, zirconia has been proven to offer good long-term wear and to not degrade substantially over time, meaning that it is an appropriate choice for permanent restorations.[iii]Despite these benefits, however, the strength of zirconia restorations can still come up short when compared to all-metal crowns, albeit only slightly. Though zirconia is very strong, it is still able to fracture under pressure and therefore all-metal crowns may be a better choice in posterior sites where aesthetics matter less. That being said, research has proven that zirconia crowns have a 99.2% success rate in posterior locations over a long-term (7.4 year) period, meaning that they are a viable choice for crown placement in these sites.[iv]

An option for every patient?

As you can see, zirconia can easily be considered the gold standard for restorations in a wide array of cases. The use of zirconia for NHS patients is relatively new as an option, having traditionally been reserved for private patients as it is a more costly material to produce compared to metals or even PFM. However, as the boom in popularity of the material has continued, the price of zirconia is decreasing, coupled with bulk purchase of the material, making it viable for NHS patients.

CosTech Dental Laboratory has recently started offering Monolith Full-Contour Zirconia, an aesthetic, high quality full zirconia crown that is available for NHS patients. Priced at just £29.95 per unit including free delivery to and from the laboratory, these crowns can be used on any crown prep design and are available in all VITA shades A-D.

Every patient is different

Although zirconia restorations have proven their benefits in terms of strength and aesthetics, it’s still important to evaluate each case and discuss different options with your patients. There will be some cases where zirconia will not be the best option, but with Monolith Full-Contour Zirconia from CosTech, you can now provide everyone on your patient list with the option of an aesthetic and reliable solution.

For more information and to register for your Marketing pack please visit www.costech.co.uk/monolith or call 01474 320076

[i]Zhang, Y., Sailer, I., Lawn, B. Fatigue of Dental Ceramics. J Dent. 2013 Dec; 41(12): 10.1016/j.jdent.2013.10.007.

[ii]Quinn, J., Quinn, G. Fracture Toughness of Veneering Ceramics for Fused to Metal (PFM) and Zirconia Dental Restorative Materials. J Res Natl Inst Stand Technol. 2010 Sep-Oct; 115(5): 343–352.

[iii]Daou, E. The Zirconia Ceramic: Strengths and Weaknesses. Open Dent J. 2014; 8: 33–42.

[iv]Ozer, F., Mante, F., Chiche, G., Saleh, N., Takeichi, T., Blatz, M. A Retrospective Survey on Long-term Survival of Posterior Zirconia and Porcelain-fused-to-metal Crowns in Private Practice. Quintessence Int. 2014 Jan;45(1):31-8. doi: 10.3290/j.qi.a30768.

Maximising patient comfort throughout orthodontic treatment can help to encourage patient satisfaction and compliance. Discover the Clarity ADVANCED ceramic brackets from 3M Oral Care to do just this.

The dome-shaped design[i] and the low profile of the brackets[ii] both help to enhance patient comfort.

The various bracket tooth shades also blend with the natural dentition[iii] and resist staining[iv] for optimal discretion during treatment.

To find out more about how you could deliver comfortable and effective orthodontic treatment, contact the friendly team at 3M Oral Care about Clarity ADVANCED ceramic brackets today.

For more information, call 0845 873 4066 or visit http://solutions.3m.co.uk/wps/portal/3M/en_GB/orthodontics_EU/Unitek/

END

3M and Clarity ADVANCED are trademarks of the 3M Company

[i] 3M Oral Care internal data. Clarity, dome shape, 2010. Claim no. S10477

[ii] 3M Oral Care Internal Data. Lower profile for comfort. Claim S10461 (2010).

[iii] 3M Oral Care internal data. Clarity, tooth shades, 2011. Claim no. S10552

[iv] 3M Oral Care internal data. Clarity, resistant to staining, 2011. Claim no. S10550

Delegates attending this year’s BACD Annual Conference are invited to join an exclusive Gala Dinner on Friday night. Taking place in the Conservatory at the Millennium Gloucester Hotel, this will be a lavish masquerade ball event.

Dress to impress, don your best-looking mask and join a pre-drinks gathering at 7pm, before enjoying an extravagant evening of fantastic food, entertainment and live music. This is the perfect opportunity to catch up with friends and colleagues, whilst networking with some of the industry’s leading lights.

Hurry! Last year’s Gala Dinner had a waiting list of over 35 people and tickets to this year’s event are limited with only 8 tickets left! Book now via the BACD website to avoid disappointment.

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

Do you use high performance ceramics like zirconia for your crown and bridge materials, but struggling to find instruments strong enough to work on them? Then you need COLTENE’s DIATECH Z-Rex diamond instruments.

Made with a unique synthetic diamond mixture and complete with Enhanced Resilient Alloy (ERA) bonding, the sharp and resilient instruments offer an exceptional combination of durability and efficiency for ultimate performance and reliability when working with ceramics.

They are available in two grits to suit your needs – medium to reduce the likelihood of micro-fractures, and course for even increased crown cutting efficiency – and come individually blister packed for ultimate convenience.

To facilitate the adjustment, trepanning and removal of ceramic restorations in your practice, contact COLTENE today about the powerful DIATECH Z-Rex diamond instruments.

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