Being a part of something bigger than yourself is hugely advantageous, especially when it comes with as many benefits as membership with the ADI.

Regardless of your experience with dental implants, your future ambitions or your role within the dental team, the ADI offers something for you. Among the many benefits afforded by joining the community are:

• Free Premium Membership with Dentinal Tubules
• Free webinars
• 50 free patient information leaflets
• ADI Members Only Facebook Group
• Free attendance at ADI Members’ National Forum and Study Clubs
• Discounted access to other events like ADI Team Congress, ADI Masterclasses and ADI Focus Meetings
• ADI Implant Logbook
• Clinical Oral Implants Research journal

Find out more today!

For more information, or to join, pleases visit www.adi.org.uk

Providing complex endodontic treatment isn’t easy, so it can be tempting to simply extract the tooth in question rather than attempt treatment.

But what if you could save the tooth with the help of the team at EndoCare?

EndoCare specialises in complex endodontic cases and has saved tens of thousands of teeth that would have otherwise needed extraction. Using only the most cutting-edge techniques and treatments, the team at EndoCare do everything in their power to achieve optimal results.

When you refer to EndoCare we always return patients to your care with comprehensive details of any treatment performed and our suggested next steps and aftercare.

So, if you are faced with a challenge and need some assistance, call EndoCare – we’re here to work together.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

The UK held its breath as the Chancellor of the Exchequer, Rishi Sunak, presented the 2021 Budget. By this point, it was clear that the focus would be on post-pandemic recovery plans – including an outline of the financial support available beyond April 2021 – and the potential cost of these proposals on the UK taxpayer. Given that the Chancellor’s announcement brings the government’s total spending since the start of the COVID-19 crisis to £407 billion, the warning of “huge challenges” to address record levels of borrowing was unsurprising.

Dental professionals may feel at least some relief that the highly anticipated changes to Capital Gains Tax (CGT) did not appear to come to fruition. The threshold at which to start paying CGT is remaining flat until April 2026, which will have very little impact on dental practice owners when they come to sell their business. There was also no mention of the Business Asset Disposal Relief scheme, so we can only assume this remains at £1 million as set in last year’s Budget. Likewise, the gains on the disposal of assets that are not linked to residential property remains at 20%. 

In addition, Mr Sunak has maintained the income tax Personal Allowance and higher rate threshold beyond April 2021. This is a tax increase by stealth – whilst taxes do not rise in cash terms, if we equate the real value of currency after inflation over time, taxes will effectively increase from next year. Beyond taxes, a new super-deduction scheme was introduced that will only apply to companies, excluding sole traders (albeit dull details of the scheme have yet to be released). The super-deduction would, in theory, allow for 130% relief on any investment in capital expenditure linked to machinery, which would cover dental chairs, OPG machines and the like.

Therefore, if practice owners are considering an upgrade and trading as a limited company at the moment, there is some additional relief available for the next two years against profits made. Still, the Chancellor has laid out plans to increase the rate of Corporation Tax (CT) in April 2021 to 25% for an estimated 10% of companies. There are some considerations to make in regards to this. Firstly, if your company generates less than £50,000 a year in profit before tax, the CT rate will remain at 19%. This may affect those that are working as dental associates and how they declare profits.

Secondly, there is a tapering period for anyone that makes a profit between £50,000 and £250,000 – again, at the time of writing, the details of this tapering period were yet to be released – but this could mean you pay between 19% and 25%. If this is anything like what the taper relief used to be, the nearer you are to £50,000, the nearer you will be to paying 19%, and vice versa. This won’t necessarily be linear, but there will be some sort of tapering between different levels of profitability. Many dental practices will certainly have a hike in CT to deal with.

Other elements of the 2021 Budget may also relate to the running of a dental practice. For instance, those who employ ancillary staff or junior team members with relatively low hourly rates will need to apply the higher national minimum wage of £8.91 from April for those aged 24 and over. The incentive to take on an apprentice has doubled from £1,500 to £3,000 – a scheme that will run until the end of September 2021. The Chancellor also extended the furlough scheme to the end of September, although employers will have to contribute 10% of wages in July, increasing to 20% in August and September.

Furthermore, a great deal of practice owners will be categorised as a small- or medium-sized employer. Under the Statutory Sick Pay (SSP) rebate scheme that was specifically introduced for COVID-19, this does mean that eligible practice owners will receive a full rebate under SSP for any employee that is self-isolating. This will likely end soon, but certainly not before the end of lockdown measures in June.

The launch of a new recovery loan scheme from 6^th April will be welcome news to dental professionals who are looking to borrow. Interestingly, you will have access to this as long as you meet the eligibility criteria, even if you have already utilised the Bounce Back Loan Scheme (BBLS) or the Coronavirus Business Interruption Loan Scheme (CBILS). There’s no personal guarantor required for up to £250,000 and your personal private residence cannot be taken by means of security. However, we are still waiting on details regarding interest rates.

It is also important to consider that you can only amortise these loans over six years in the same way that you may have done with a BBLS or CBILS loan, which means a short, sharp repayment period. Interest rates will be a commercial interest rate from the bank so the new recovery loan may not be as attractive as it initially seems. There is a six-year repayment period for recovery loans, but there are also loans under the new scheme available for overdrafts, which offer a three-year repayment period.

There is certainly a great deal from the 2021 Budget for dental professionals to mull over as we look towards a swift recovery from the COVID-19 pandemic. Should you need professional advice and guidance on how you and your dental practice might be affected, get in touch with the knowledgeable team at Dental Elite.

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

Author: Luke Moore is one of the Founders and Directors of Dental Elite and has overseen well in excess of 750 practice sales and valuations. With over 11 years working in the dental industry, Luke has extensive knowledge in both dental practice transfers and recruitment and understands the complexities of NHS and Private practices.

Dr Uchenna Okoye, Principal of London Smiling, is the dental expert on Channel 5’s TV programme, “10 Years Younger”. She talks about how her relationship with Knight Dental Design Laboratory enables her to treat participants to the best of her ability: 

“I am a dentist first, an expert on a TV show second. My job is to provide the best dentistry I possibly can for the individual, taking into account all their personal needs. It’s a big ask for a lab to get involved in something like this. That’s why I work with Knight Dental Design Laboratory in London.

“I have worked with Tony Knight and his team for over 19 years. I needed someone I could trust to just get on with the job and who didn’t need extra support and extensive explanations from me to provide the level of function and aesthetics I was looking for.

“I have developed a close working relationship with Tony and his whole team over the years. They provide the fast and efficient service I rely on for the TV show, while still achieving the exceptional aesthetics that ultimately create the ‘wow factor’ that producers and viewers enjoy. Any problems would be a disaster considering how many people rely on the lab work to be right in order to proceed. It would be tremendously difficult without Knight Dental Design!”

For more information, please visit www.knightdentaldesign.co.uk, email info@kdduk.net or call 0208 317 0979

A 54-year-old female patient, medically fit and well, was referred to me with a retained root in the upper left first premolar region (UL4). The root was infected and the pre-operative radiograph showed the apex of the root to be possibly involved with the sinus floor. The hopeless prognosis of the tooth meant that it required removal during that appointment.

Following extraction healing was uneventful. 

Reconstruction

The patient was seen again 6 weeks later, when a radiograph and CBCT (image of scan section available) were taken. ITI classification (SAC) confirmed this as a complex case for implant reconstruction.

All potential treatment options were discussed with the patient. These included no treatment, with common consequences of bone resorption and potential over eruption of the opposing tooth or drifting of the adjacent teeth. Other treatment solutions were restoration with a bridge or an implant-retained prosthetic – including sinus elevation and bone augmentation – and all the likely advantages, disadvantages and possible complications were deliberated. Following explanations of each procedure, informed consent was obtained from the patient, who elected to proceed with an implant placement with simultaneous open sinus lift.

The CBCT was crucial in planning the case. As well as determining adequate mesio-distal space for the planned implant, it allowed assessment of the sinus anatomy and therefore guided both where to prepare the lateral window, and the size of the window that was possible. It allowed measurement from lateral to medial wall within the sinus to further plan the procedure and ensure correct elevation of the membrane and placement of the graft material. This can be seen on the image from the CBCT. The scan also allows visualisation of any blood vessels in the sinus walls and assessment of the thickness of the Schneiderian membrane.

Implant placement

Approximately 3 months after the extraction, the patient returned to the practice for implant placement. 

Following local anaesthesia, the patient’s own bone was harvested from the allocated donor site using a bone scraper (Safescraper® Twist, Gietslich). A lateral window was prepared using a diamond bur in a straight surgical handpick with saline irrigation. This was marked with a pencil using measurements taken from the CBCT scan to ensure correct positioning in relation to the sinus floor. The membrane was lifted intact and extended through to the medial wall, again using measurements from the CBCT examination. It can be seen from the preparation that the root of the UL6 was exposed. This is always a potential issue with a sinus lift for a single missing tooth. The post-operative radiograph shows no alteration to the width of the medial root of the tooth, though it will be kept under close radiographic review. 

Once the membrane was fully lifted, it was protected during the implant site preparation. The site was prepared for a Straumann^® Bone Level Tapered (BLT) implant with Regular Crossfit^® (RC) connection and SLActive^® surface. The site was underprepared slightly to allow for better primary stability at placement. A tapered implant was selected to further maximise primary stability. The SLActive surface was chosen as clinical trials have suggested that healing periods before prosthetic loading can be reduced using implants with a chemically modified and hydrophilic micro-rough surface.

The harvested autogenous bone was mixed with Giestlich Bio-Oss^® granules (0.25mm-1mm) in a 1:4 ratio. Blood collected from the site was used to aid this process. This mix was then packed through the lateral window and condensed to ensure total packing of the lifted region. The Straumann^® BLT implant (4.1 x 8mm) was then placed at an initial torque of 30Ncm. A closure cap was placed on the implant to allow complete closure of the flap and protection of the implant and graft during healing.

This mixture of graft materials was used as osteoinductive molecules like bone morphogenetic protein (BMP) and osteogenic cells will enter the augmented site. Bone formation is therefore significantly accelerated as compared to using bone substitutes alone. This allows reduction of healing times, and restorative procedures can be started 3-4 months after the sinus elevation procedure.

The lateral window was checked and then covered with a double layer of Giestlich Bio-gide^®. The site was closed carefully with Vicryl 4.0 sutures (Ethicon), ensuring no tension in the soft tissues. The post-operative radiograph demonstrated a good position of the implant and there was good condensation of the graft material. 

Upon review 1 week later, the site was healing well and the patient was experiencing no pain or symptoms from the region. The patient was returned to the referring dentist for on-going and routine care with the recommendation that the Implant Stability Quotient (ISQ) is checked at second stage surgery prior to loading.

Taking on cases of this complexity

It is important for all surgeons (and dentists) to continue to follow a Personal Development Plan to allow them to further develop their skills in their chosen area of dentistry. Mentoring and further learning after completion of initial implant training is vital to allow us to recognise cases that may be beyond our current skillset. This is where the ITI SAC classification can play a crucial role in helping clinicians recognise cases that are suitable for their ability or that may need referral. I use the SAC classification in my assessment of every implant patient I see.

I would recommend the ITI to all implant surgeons and restorative dentists as an excellent resource of knowledge and current thinking in implant dentistry and its related fields.

I am a firm believer in continual education and continue to seek out courses that allow me to further develop my skills as a surgeon. Despite having been mentored on sinus elevation techniques and carrying out these procedures for a considerable time, in 2018 I attended The Campbell Academy’s 3-day sinus elevation course and would highly recommend this to anyone looking to carry out sinus elevations.

Images

Figure 1-Pre-operative radiograph

Figure 2-CBCT planning

Figure 3-Preparation of the lateral window

Figure 4-Placement of graft material through lateral window

Figure 5-Implant placement

Figure 6-Membrane placed over graft site

Figure 7-Post-operative radiograph

For more information, please visit www.straumann.com

Author:

Alex Jones is the Principal of Alex Jones Dentistry near Sheffield. He is a very experienced dental implant surgeon, having successfully placed over 2,000 implants. Alex is also currently a member of the ADI and the BACD, as well as a Study Club Director for the ITI.

As a dental hygienist or dental therapist, finding eCPD that has been specifically tailored to you can is easier said than done.

So why not join a Society which can offer you tailored eCPD through a number of exceptional educational resources?

The British Society of Dental Hygiene and Therapy (BSDHT) gives members multiple paths to take when earning their eCPD. From online sessions to attending exceptional events, all of the educational resources are specifically chosen to appeal to individuals within the profession and always cover the most pertinent topics of the moment.

Furthermore, members also receive subscription to Dental Health – the BSDHT’s well-respected clinical journal, helping professionals to keep abreast of all of the latest developments in the field.

Join the BSDHT today by contacting the team!

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

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

In order to support practices during these tricky times, 3M Oral Care is giving you the opportunity to set up  FREE virtual meetings on Microsoft Teams with 3M Clinical Specialist John Rafelt!

Topics for the meetings include a spotlight on time-saving products and procedures during the pandemic, an introduction to the revolutionary 3M RelyX Universal Resin Cement and 3M Scotchbond Universal Plus Adhesive and a discussion about why 3M was recently voted “Most Innovative Dental Company” in the 2021 Dental Advisor Awards.

Plus, you can also set up your own bespoke training session if you want to discuss something different. Designed as bite-size sessions that fit into your schedule, these meetings are a perfect opportunity to connect with 3M on another level.

You can request a virtual meeting here: http://go.3M.com/virtual-meeting

 For more information, call 08705 360036 or visit 3m.co.uk/dental

END

3M, Scotchbond and RelyX are trademarks of the 3M Company.

If dental technology wasn’t already vulnerable before the COVID-19 crisis, it certainly is now. At the time of writing, the UK was in the midst of a third national lockdown and although dental practices remained open – even in a limited capacity in some cases – many were not treating the same number of patients each day as they were pre-pandemic. There are numerous and varied reasons for this, including decreased workforce capabilities, the need to adhere to fallow time guidelines, and patient concerns in relation to contracting COVID-19, despite the stringent infection control measures that practices typically maintain.

Ultimately, a fall in the number of patients visiting the dental practice has subsequently reduced the volume of work that dental laboratories have received. This has been the case since the first national lockdown in March 2020, when restorative and prosthetic dental work virtually dried up overnight. Practices reverted to providing emergency treatments only, meaning dental labs had little to no income for several months. Even now, many labs across the country are operating at a fraction of their usual capacity, which is significantly impacting their profitability. The situation has only been exacerbated by the difficulties labs have faced in accessing appropriate financial support.

Indeed, many dental lab owners have received little, if any, income themselves and whilst wages for some lab staff continue to be covered by the Coronavirus Job Retention Scheme (CJRS), job losses have occurred and may still be inevitable given that the CJRS is coming to an end very soon. There is certainly a great deal of anxiety surrounding cash flow, generating business and managing staff requirements given the uncertainty in relation to the volume of lab work expected moving forward. Many dental technicians fear that they might be made redundant due to these factors, especially as labs are under increasing pressure to either make drastic workforce reductions or close permanently.

In a recent article published within BDJ In Practice, Steve Taylor – President of the British Association of Clinical Dental Technology (BACDT) – said: “It is anticipated that 85% of dental laboratories within the UK will be making staff redundant. This could easily equate to well over 1,500 dental technicians being lost to the profession. There were only 6,000 technicians registered with the GDC, so this loss would be an enormous percentage.”[1] The delivery of exceptional dental treatment would not be possible without the collaboration between dentist and dental technician, which is why it is alarming to think that many technicians who leave dentistry now may never return in the future.

This would be a significant loss of skills and knowledge, which are incredibly valuable to young dentists, who often rely on experienced dental technicians for support in completing complex and/or advanced cases. Many of these same dental technicians have invested heavily in the latest digital technology to facilitate the quick and cost-effective delivery of highly aesthetic and functional restorations. This cutting-edge technology comes with a hefty price tag, which means that a lack of income for dental labs can ultimately affect their ability to make outstanding payments on equipment purchased through finance plans. Many dental lab owners have had no option but to rely on personal savings or loans to keep their businesses afloat.

The current situation underscores the need for dental practices to support labs wherever possible, which starts with ensuring that the first bill paid at the beginning of the month is the one for any lab work provided. In this case, paying on time is an absolute must as any delays could tip some dental labs over the edge. However, early payments are ideal, considering a dental lab might owe for the cost of certain restorative components and materials. Some companies have increased prices for dental lab supplies due to the combined challenges of the pandemic and Brexit, further emphasising the degree to which labs are being squeezed from all angles.

That’s why it’s also important to ensure that there is effective communication and transfer of information between dentist and dental technician. Good quality impressions/scans and correct shade taking, for instance, are essential in order to reduce the need for costly and time-consuming remakes. Dental practices can go a step further in easing some of the pressure for dental technicians by collaborating with labs that are UK-based and avoiding those that outsource work overseas. The BACD has always advocated for stronger professional relationships between dentists and dental technicians, which is why it encourages members and non-members alike to take action now and secure a brighter future for everyone within the profession.  

Now, more than ever, collaboration is vital if dental practices and labs are to ensure a successful recovery from the COVID-19 pandemic. The risk of adopting the “every man for himself” approach is that many dental businesses might simply succumb, which could mean losing invaluable skills, knowledge and experience that would benefit the next generation of dental professionals and, in turn, patients. We are all riding different boats through the same storm, so it is to every dentist and dental technician’s advantage that they support each other if they are to see sunnier days ahead.

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

Authors: Mark Ambridge and Paul Abrahams

[1] Westgarth, D. (2020) Dental labs and technicians: The last ones to fall?. BDJ In Practice. DOI: 10.1038/s41404-020-0533-2.