As dental implantology continues to develop, practitioners have pioneered innovative techniques in order to enhance the predictability and longevity of treatment. In the fast-moving modern world of dental implantology it’s important for practitioners to keep up to date with these techniques to be able to provide informed, exceptional care.

One such method currently being discussed is the socket shield technique. Yusuf Alshafi, dental implant surgeon, discussed the evidence and literature surrounding the topic at the ADI Members’ National Forum in November. Here he offers a summary of what he covered:

Socket shield in a nutshell

Socket shield is a precise process that involves saving the outer part of the tooth when performing an extraction before dental implant placement. This is designed to prevent the resorption of the bone that begins to occur as soon as a tooth is extracted. The method is particularly interesting as the sliver of the tooth that is kept in situ indefinitely is used as a way to preserve the original shape of the extraction site and keep harmony between the soft and hard tissues of the area to enhance aesthetics.

Yusuf says:

“A socket shield is when we leave behind the buccal portion of the root when extracting a tooth, followed by implant placement. This type of partial extraction means that the periodontal fibres are maintained in this area, ensuring the blood supply is preserved to the buccal bone. This is particularly important if this bone is less than 1mm thick, meaning it’s made up entirely of bundle bone, which would otherwise completely resorb with a normal extraction.  If executed in the correct way, this process retains the profile of the surrounding bone and soft tissue, significantly reducing the post extraction changes usually seen.

“During this process, the removal of the apex is fundamental as well as the root canal contents. Also, the careful shaping of the fragment of tooth left behind ensures there is space for the dental implant and bone graft material, and importantly provides space or the restoration.

“Although this procedure is very technique sensitive, being able to reduce dimensional changes to the socket following an extraction and enhance the aesthetics is proving to be popular with my patients.” 

Different approaches

As with many ideas in dentistry, the creation of socket shields can be achieved in a number of different ways.

Yusuf explains:

“During my lecture at the ADI Members’ National Forum, I took the opportunity to explore some of the methods in the literature to create the shields and the way that these methods impact outcomes.

“When performing a socket shield procedure there are always options regarding how the shield should be created. One option is to section the tooth and remove the palatal portion, then prepare for the implant placement into the bone in the conventional way. Alternatively, the osteotomy can be prepared directly through the root, following this the root is modified to the desired shape prior to implant placement.  There are also different thoughts on whether to graft the ‘jump gap’ between the shield and the implant. 

There have been a number of studies looking at the different advantages of the final dimension and position of the shield in relation to the buccal bone. For example, reducing the shield height to a 1mm supra-osseous position is known to help maintain the supra-crestal fibres and prevent recession. However, it was found that the chances of complications were reduced by preparing it to the bone level, without any noticeable difference in the recession.”

Complications

Of course, as with all surgery there are potential complications that we need to be aware of.  

“The incidence of failures with socket shield treatments is shown to be comparable to that of immediate dental implant treatments,” explains Yusuf. “There have also been cases where the shield fails and needs removing, but the implant can be maintained – as well as vice-versa. 

A fairly common problem is when socket shield may become “exposed”, either on the labial aspect (externally) or within the sulcus (internally). Management of such cases is important and usually straightforward, and usually achieved by simply reducing the exposed root and allowing the soft tissue to regrow. It was found that properly shaping the shield at the initial surgery, creating the space required for the soft tissue, greatly reduces the incidence of these exposures.

“The main thing to remember is that this surgery is not an option if there is any tooth mobility, or movement of the shield during its preparation. In these situations, it is always best to fully extract the tooth and proceed with conventional implant treatment.”

Keep up to date

Yusuf Alshafi’s seminar on socket shield was just one of the many informative lectures that entertained and educated delegates at the ADI Members’ National Forum 2019. To keep up to date with dental implantology, become a member of the Association of Dental Implantology (ADI) today.

For information on the ADI and upcoming events, please visit www.adi.org.uk

It’s important for all members of the dental team to have access to high-quality education tailored to their specific roles. For dental hygienists and dental therapists, this involves developing knowledge and skills in a wide spectrum of topics in order to continue providing the highest standard of patient care.

The British Dental Conference and Dentistry Show 2020 will once again present the Hygienist & Therapist Symposium, with two days of lectures dedicated to those in this area of the profession. To ensure the relevance and diversity of the programme, both the British Society of Dental Hygiene and Therapy (BSDHT) and the British Association of Dental Therapists (BADT) will be supporting the Symposium.

Julie Deverick, President of the BSDHT, discusses why the Society was happy to be involved with the event for another year.

“The conference is a great platform for both members and non-members to come and chat to us and discuss any issues they are experiencing face-to-face,” she says. “Even if people feel like their query or concern isn’t big enough to call our office about, meeting in person often makes it easier to have a conversation so we can offer guidance or signpost them as appropriate. 

“The BSDHT will also be hosting the Hygienist & Therapist Symposium on Friday, for which we have gathered several well-known speakers. They will cover various interesting topics that are all pertinent to delegates’ working lives. We quality assure all the presentations to ensure that the messages being communicated are correct and that they match the proper GDC learning outcomes.” 

Indeed, the BSDHT is practised in the art of designing a relevant and world-class learning programme for dental hygienists and dental therapists, as is evident from its own Oral Health Conference each year. At this and all the other events the BSDHT gets involved with, the focus is always about helping colleagues advance their knowledge for the betterment of the profession and the benefit of their patients.

As such, the Hygienist & Therapist Symposium at the British Dental Conference and Dentistry Show will offer plenty of support for professionals looking to advance their careers. In addition, the event will offer the opportunity for dental hygienists and dental therapists to learn more about other areas that might be of interest to them, such as practice management. This provides a greater understanding of different roles in the practice and could help dental hygienists and dental therapists to better utilise their capabilities among the team. It also offers a chance for professionals to widen their scope.

“A lot of dental hygienists and dental therapists are looking to move into new areas like tooth whitening and facial aesthetics,” says Julie. ”I think this is great as it provides a small break from full-time hygiene and therapy services, which can be pretty stressful. I would, however, urge professionals to ensure they use only high-quality products from reputable suppliers. It’s important to choose quality over price and to make sure you get good advice and support from the supplier so you can deliver the best outcomes. Events like the OHC and the British Dental Conference and Dentistry Show are great for researching the solutions available.”

These events are also ideal for reflective learning, encouraging delegates to think about what they do in practice compared to what is being discussed with trade experts or during lectures. Julie adds:

“Dental hygienists and dental therapists have many opportunities to reflect on how they may want to change their protocols in practice in light of information they gain at events. Being among peers during the development process is invaluable, as you learn from their experiences and their questions as much as from those of the speakers and the representatives. The discussions that follow lectures build on the speaker’s presentation and offer added value. This kind of environment also enables people to share their own advice and help someone else overcome challenges.”

Ultimately, there are many benefits for dental hygienists and dental therapists attending the British Dental Conference and Dentistry Show 2020. Julie concludes:

“The NEC is a good venue that is easily accessible by road, rail and air. The exhibition hall is filled with all aspects of dentistry from consumables and prevention products through to dental equipment. It provides a chance for professionals to check out new products and ask advice from the representatives. There is also CPD available in all areas of dentistry, and the chance to see friends and colleagues.

“I would encourage everyone to come and have a chat with us on the BSHDT stand. Of course, we can give members an update on what we’re doing or give non-members the information they need, but it’s much more than that. It’s about having the conversation and finding out what you’re doing and what we can help you with. We would also like to hear about any of our members’ special interests, how they would like to expand on them and if they would consider mentoring others in the field. This is all part of the BSDHT’s focus for 2020.”

The British Dental Conference and Dentistry Show 2020 will be held on Friday 15^th and Saturday 16^th May at the Birmingham NEC, co-located with DTS.

For all the latest information, please visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com

Despite the growing demand for dental implants, not all clinicians are in a position to offer such treatment. Thankfully, there is a solution with Ten Dental+Facial. 

The multi award-winning clinic accepts dental implant referrals from practices across the country. Led by Drs Martin Wanendeya and Nikhil Sisodia, Ten Dental+Facial combines state-of-the-art facilitates with years of knowledge and experience to provide high quality treatment.

You can feel confident knowing that the expert team will work closely with you throughout the referral process, keeping you up-to-date as treatment progresses, before returning the patient to your care. 

Simply get in touch with Ten Dental+Facial to arrange a referral today.

For more information visit www.tendental.com or call on 020 33932623

Sleep apnoea is a widespread cause of interrupted sleep. As you can imagine, due to the negative effects this condition can cause on physical, mental and even oral health, people have searched for a solution to this problem for years. This has resulted in the creation of various alternative therapies to treat the condition alongside trusted techniques such as continuous positive airway pressure (CPAP) therapy and dental appliances.

But which of these actually work?

A common curse

Sleep apnoea is when the throat muscles relax during sleep, obstructing the airways and causing loud snoring, periods of being unable to breathe and, ultimately, very interrupted sleep.[i]

Although this condition is more typically experienced by those over the age of 30, people can develop it at any age. It is estimated that as many as 4 in every 100 middle aged men and 2 in every 100 middle aged women have sleep apnoea.[ii]

Sleep and health

 It’s surprising how much the amount of sleep we get each night effects our daily life. Without proper sleep our bodies cannot recharge, and this can quickly result in a number of unpleasant side effects.

Sleep and brain function are intrinsically linked. Without sleep it can be difficult to make rational decisions, learn new things or even function normally. This is because our brains use sleep time to work out how to process information gained throughout the day. If this process is interrupted, mental performance could suffer, and this can lead to headaches, mood swings and accidents when people make mistakes due to lack of concentration.[iii]

The effects of lack of sleep on physical health are also well known, and extended periods of reduced sleep can lead to the formation of potentially fatal conditions. These include higher rates of obesity, heart diseases and diabetes.[iv]

Alternative methods – do they work?

In an age of alternative medicine, it’s not uncommon for people to turn to unconventional treatments for illnesses and conditions. In the case of sleep apnoea, this is no different.

One solution that patients may have tried is the Buteyko technique. The Buteyko technique basically emphasises the importance of breathing through your nose instead of your mouth, and claims to help with sleep apnoea as well as asthma and other respiratory conditions. Those who practice the technique are told to sleep with tape over their mouths, forcing them to breathe through their nose. This is meant to stop sleep apnoea as it prevents people being able to snore.

Some establishments that offer Buteyko classes claim that this behaviour can improve sleep and the quality of life, as well as improve asthma and allergies etc. by up to 70%.[v]

However, it’s generally agreed among medical professionals that Buteyko is not an appropriate way to treat sleep apnoea, especially as the problem is caused by more than just mouth breathing. An Indonesian singer shocked the world when she recently revealed that her whole family practice the Buteyko technique, even her young children. This was widely regarded as very dangerous, as restricting a child’s airways during sleep could easily lead to suffocation should they suffer from a blocked nose or something similar.[vi]

Another alternative treatment for the condition is called Positional Therapy. In essence, this treatment centres around training people to sleep in positions which prevent sleep apnoea from occurring.[vii] Though this does work in some cases, for some patients who suffer from sleep apnoea this treatment makes no difference at all.

Dental devices to the rescue

As many alternative therapies for sleep apnoea do not fully solve the problem, the best thing to do as a dental professional is to offer your patients a mandibular repositioning device. These custom-made devices move the jaw forward, increasing the size of the upper airway and preventing it from closing.

Fabrication of these devices requires the acquisition of oral impressions, something which is made instantly easier by using a cutting-edge digital intraoral scanner such as the CS 3600 from Carestream Dental. The scanner has multiple functions tailored towards sleep medicine, including a multiple bite capture option, which aids the creation of a well-fitting, effective device.

Trust the science

Although there have been proven benefits to certain alternative therapies for sleep apnoea, none of these are as effective as having a dental device created by a professional. By investing in a reliable intraoral scanner and making sure your patients are aware of the benefits of mandibular repositioning devices, you can help improve their quality of sleep and quality of life.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

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

and Facebook

[i] Mayo Clinic. Sleep Apnea. Link: https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631 [Last accessed July 19].

[ii] Bupa. Obstructive Sleep Apnoea. Link: https://www.bupa.co.uk/health-information/lungs-breathing/obstructive-sleep-apnoea [Last accessed July 19].

[iii] National Heart, Lung and Blood Institute. Sleep Deprivation and Deficiency. Link: https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency [Last accessed July 19].

[iv] National Heart, Lung and Blood Institute. Sleep Deprivation and Deficiency. Link: https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency [Last accessed July 19].

[v] Butyeko Breathing Centre. Home page. Link: https://www.buteyko.co.uk/ [Last accessed July 19].

[vi] BBC News. Buteyko: Why Indonesian Singer Andien Sleeps With Tape on her Mouth. Link: https://www.bbc.co.uk/news/world-asia-48951583 [Last accessed July 19].

[vii] AAST. 5 Alternative Sleep Apnea Treatment Options. Link: https://www.aastweb.org/blog/5-alternative-sleep-apnea-treatment-options [Last accessed July 19].

Dental professionals are likely aware that periodontal bacteria and systemic health conditions are linked. But why do these links exist, and could treating periodontitis help to reduce rates of other conditions such as dementia?

At the Oral Health Conference 2019, hosted by the British Society of Dental Hygiene and Therapy (BSDHT), Dr Mark Ide gave a lecture on the topic. Entitled ‘Periodontitis, Diabetes, Hearts & Minds’ the seminar was a perfect opportunity for dental hygienists and dental therapists to look at the science behind some of these linked diseases and see what they could do in the future to help patients more. Below is an overview of what was covered.

An ageing population

One of the key points highlighted in the lecture was that we are now living in a fast-ageing population. Due to innovations in healthcare, changes in attitudes to tooth loss and an improvement in the standard of living, people are living longer and also keeping their dentition for a longer period of time. While this is positive news from a functional perspective, it does mean that more and more people are likely to be attending dental practices with ongoing periodontitis.

One of the key points that Dr Ide put forward in this lecture was that the rates of mild to moderate periodontitis may be going down, but the prevalence of severe disease is, again due to better diagnosis and a tendency to retain teeth, actually on the rise.  Even so, levels of disease of all forms are still high in the UK population and this presents a significant public health challenge given our current workforce.

So why is periodontitis such a concern?

 The reason that periodontitis remains a concern, beyond the immediate impact on oral health, function and quality of life, is because of evidence from studies showing oral bacteria such as Porphyromonas gingivalis (P. gingivalis) entering the bloodstream. When a patient has periodontitis, actions such as brushing teeth or even chewing gum can transfer these pathogens into the bloodstream through micro-ulcers in the damaged soft tissue.

Here is where the problems begin. As Dr Ide suggested in his session, blood samples taken from patients with severe periodontitis revealed that once these pathogens enter the bloodstream they are then circulated throughout the body. This, in turn, causes the body to produce an inflammatory response, leading to the production of a range of proinflammatory molecules such as C-reactive protein. First linked to oral infection in 1967, C-reactive protein form a part of a normal response to viral and bacterial infections as well as trauma and other causes of tissue damage, and are generally present at low levels in healthy adults, increasing slightly with age. When patients have periodontitis, the body reacts as if it has a constant infection, and therefore continually produces these proteins as a response.

Elevated levels of C-reactive protein have been identified as a risk marker for adverse cardiovascular events, and, according to one study quoted in the lecture, rank well alongside other more commonly known aspects such as cholesterol. Furthermore, periodontal therapy has been shown to have a direct positive impact on markers of blood vessel wall health elsewhere in the body.

Numbers of individuals with diabetes are skyrocketing worldwide, and it’s likely that most professionals will be aware that gum disease progression is much faster in those with the condition. This is because excess glucose sticks to molecules in the blood stream, which either forms fatty acids or C-reactive proteins in the liver, thus causing liver diseases.

Research presented by Dr Ide in the seminar revealed that even a 1% reduction in patients’ blood sugar levels led to a significant improvement in general health. He explained how analysis of research findings has now led NHS England to release Guidelines for Dental care for patients diagnosed with Diabetes (a link to these is available on the BSP website News section), which state that GPs should refer diabetic patients to dental professionals, as treating periodontitis has been shown to help improve metabolic health in patients with type II diabetes.

Periodontitis and cognitive function

One interesting angle raised by Dr Ide’s lecture was an exploration of research surrounding endotoxins and their role in cognitive decline. Dr Ide presented a number of studies that have not only proven that cognitive function can change as a result of an infection, but also that endotoxins, periodontal organisms and proteins produced by these have been found in the brains of Alzheimer’s disease patients. One piece of research that he particularly focused on suggested that when these ideas were tested on mice, exposure to pathogenic periodontal bacteria sped up the progression of Alzheimer’s disease in the affected animals. They also found that if inflammatory responses were suppressed, this slowed down the Alzheimer’s disease progression. Although it is unclear whether a similar improvement would be the case in humans, this still proposes an interesting link that could very well enable dental hygienists and dental therapists to have a huge beneficial impact on people suffering from cognitive disorders.

He ended his session by showing delegates a flow chart that reiterated how inflammation, periodontitis, diabetes, heart diseases and cognitive decline are all linked. This hammered home the point that the impact of oral bacteria may well be more important than anyone previously thought.

Mel Mead, a delegate who attended the lecture, said:

“I found the lecture very informative, and the links to heart disease and diabetes to be very real. This knowledge will help us inform patients in the future.”

Claire Churchett, another delegate in attendance, added:

“This lecture was very informative and very potentially exciting for the future. It is a great way of giving patients information as to how to improve their overall general health.”

More from the BSDHT

Dr Mark Ide’s session was just one of the fantastic lectures at this year’s OHC. If you missed out and want to find out more, please contact the BSDHT for more information today.

For more information about the BSDHT, please visit www.bsdht.org.uk

call 01788 575050 or email enquiries@bsdht.org.uk

We live in a world where appearance matters. So why not offer all of your patients the chance for a more natural-looking restorative option?

Monolith Full-Contour Zirconia from CosTech Dental Laboratory is a durable, aesthetic and versatile option designed specifically for NHS patients.

Available at just £29.95 per unit including delivery to and from the laboratory, this material is also available in all Vita shades from A-D, meaning that it can be used to treat a wide array of patients.

With smile aesthetics playing a key role in patients’ lives, it makes sense to be able to give them a beautiful, strong restoration that blends with their natural dentition.

Find out more today.

For more information about CosTech Dental Laboratory, please visit www.costech.co.uk or call 01474 320076

From COLTENE comes BRILLIANT Crios.

With dentists seeing more patients of all ages presenting with worn enamel and non-carious surface loss, they need restorative materials for broad daily use on all conventional indications, from inlays to veneers.

A reinforced composite bloc, BRILLIANT Crios is ideal for single tooth restorations and is particularly recommended for bruxism patients because of its shock absorbing effects.

BRILLIANT Crios can be used in the anterior and posterior regions. No separate firing process is needed and its mechanical properties are excellent.

COLTENE knows what dentists need and what patients want. Contact COLTENE today, to try BRILLIANT Crios for yourself.

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

Even though dental implant treatment is becoming more and more popular, one considerable risk still remains – the development of peri-implantitis. A serious bacterial infection, peri-implantitis is often cited as the main cause of dental implant failure.[i]

But how can professionals limit the chances of peri-implantitis taking hold?

Why does peri-implantitis cause implant failure?

Before you can effectively protect against a condition, it’s important to be able to know as much about it as possible. Although the term peri-implantitis gets thrown about a lot in lectures and clinical studies, very few of these really delve into what the disease is and why it causes dental implant failure.

Effectively, peri-implantitis is an infectious, site specific disease that causes inflammatory responses in soft tissue and bone loss in the affected area. As it targets both the soft and hard tissue, it can be very destructive and quickly cause considerable damage to the implant foundation, resulting in it becoming loose and eventually failing.

The disease is generally caused by two types of microbes – spirochetes and mobile forms of Gram-negative anaerobes.[ii]

As such, it’s important for practitioners to be aware of what allows these bacteria to colonise and to dispense appropriate advice and make the right choices before and after surgery.

Before implant treatment

Experienced dental implant surgeons will know that there are certain cases which are more likely to result in failure. For example, a lack of substantial bone at the site is likely to result in a weaker implant foundation, and this means that an implant may fail even without peri-implantitis occurring.

However, peri-implantitis is also more likely to manifest in certain individuals depending on their health and behaviours, and these include patients over the age of 65,[iii] those with poor oral hygiene, as well as those who partake in habits such as smoking.[iv]

As such, it’s necessary for professionals to explain to patients why they may be at a higher risk before implant surgery is agreed. Litigation against dentists is fast becoming a real threat, and the development of peri-implantitis post implant surgery is one of the more common reasons for this legal action to take place. Therefore, it’s always necessary to ensure that patients know the full extent of the risks, especially if they are in one of the higher risk groups for developing the disease. It’s also worth encouraging smokers, or individuals with poor oral hygiene to change their habits for a substantial time, to see if implants become a viable treatment for them.

Aftercare is essential

Though outside factors can affect peri-implantitis, one of the strongest links between the development of the disease and those who get it is how adherent they are to proper aftercare. On a surface point of view this makes sense – the disease is caused by bacterial build-up, so an excellent standard of health is essential.

However, it’s also important to stress the fact that a dental implant needs to be treated even better than regular teeth. This means regular hygienist appointments, a comprehensive home oral care routine and a detailed aftercare plan. It’s also worth encouraging them to invest in some products to help improve their oral hygiene regime at home, such as water flossers, as these are likely to be more effective at eliminating bacterial build up.

Implant choice matters!

Although proper patient assessment and aftercare are absolutely vital, it’s also a good idea to explore different implant options in order to see which ones are most likely to help prevent peri-implantitis occurring. 

There is a huge variety of dental implants available nowadays, and each of these will promise to have certain benefits regarding shape, material and surface topography. However, one thing to look out for is whether they have any bacteria-proofing capabilities, especially between the abutment and the implant itself as this is a common place for bacteria to colonise.

Just one of the many benefits of the new Myplant Two implants from myplant is their inner cone design. Not only does this innovative feature result in a virtually bacteria-proof connection between abutment and implant, but it also helps to ensure outstanding mechanical load capacity and a high fatigue strength. This means these implants are perfect for providing a long-term, reliable and predictable solution.

Give yourself the best chance of success

Peri-implantitis is still a somewhat mysterious disease that can affect everyone, even those without the increased risk factors. Nonetheless, it’s so important that professionals approach every case in a way which gives the best possible chance of avoiding the disease. By properly discussing the risks and making sure patients are aware of the necessity of exceptional aftercare as well as choosing implants that can help prevent bacterial build up, you can give all of your implant patients the best chance of success.

To find out more, visit www.myplant-dental.com, email order@myplant-dental.com or call 0800 779 7879

Author: Mark Croft Managing Director UK & Ireland MyPlant

[i] Madhura, K., Palaskar, S., Kapoor, K. Implant Failure: A Dentist’s Nightmare. Journal of Dental Implants. 2016; 6 (2): pages 51-56.

[ii] Prathapachandran, J., Suresh, N. Management of Peri-Implantitis. Dent Res J (Isfahan). 2012 Sep-Oct; 9(5): 516–521.

[iii] Poli, P., Beretta, M., Grossi, G., Maiorana, C. Risk Indicators Related to Peri-Implant Disease: An Observational Retrospective Cohort Study. J Periodontal Implant Sci. 2016 Aug; 46(4): 266–276.

[iv] Kasat, V., Ladda, R. Smoking and Dental Implants. J Int Soc Prev Community Dent. 2012 Jul-Dec; 2(2): 38–41.