Knowledge and understanding – the key to immediate implant success

Immediate implant protocols are growing in popularity among dental professionals globally. The potential benefits of quicker, one-surgery treatment, as well as reduced patient discomfort and increased workflow efficiency can be significant for both patient and practitioner. However, achieving the best outcomes depends on a variety of factors, including the clinical technique and products used. In some cases, biomaterials play an important role in encouraging good aesthetic and functional results.

Dr Kailesh Solanki is the Principal of Kiss Dental and a highly experienced implant dentist, having placed over 1,000 implants in his career so far. He comments on the use of biomaterials when combined with immediate protocols:

“Biomaterials are very useful for immediacy when placing implants into extraction sites or into defect areas. They help to ensure you can still provide the implant, and maybe a fixed prosthesis, on the day of extraction. They also help to manage aesthetic and functional concerns of the bone and tissue.

“Achieving primary stability when placing an implant is key for immediacy. Once placed, if there are bony or soft tissue defects around the implant, biomaterials provide a way to treat the defects simultaneously. Before biomaterials, I would have traditionally extracted, grafted, let it heal and then placed the implant in a second surgery. Biomaterials can reduce the number of surgical interventions, which is much more gentle on patient.”

Despite becoming more common in the dental surgery, there is still some discussion surrounding the benefits of biomaterials when providing immediate implants. Dr Solanki believes this is the result of dependability on traditional concepts, training available in the field and understanding of the indications for immediacy. He continues:

“I believe there is some debate in the profession about the usefulness and effectiveness of biomaterials due to a lack of knowledge regarding the techniques and success rates compared to traditional protocols. Perhaps fear of using a concept not personally performed before could factor in for some clinicians as well. I have seen this time and again among colleagues attending the immediacy course I teach twice a year. Some don’t yet understand how it works, what clinical outcome they can achieve or how to optimise immediate placement or loading protocols. Immediacy is not traditionally taught in implant dentistry courses, but a change in training approach will change the attitudes of individuals, helping them see the benefits of techniques that are now tried and tested, and that work very well in the right conditions. Of course, immediacy is not for every case, but fewer cases are unsuitable than some clinicians think.

“I also think it’s important to emphasise that a lot of cases utilising immediacy are full arch, for which you would rarely use biomaterials. The technique allows the clinician to plan implant positions where there is greater bone quality. In my experience, biomaterials are used more commonly alongside single immediate implant placement, as you are more limited regarding implant position and any bony defects need to be addressed. Again, it’s all about understanding the technique, training and knowing when to use these products to ensure that immediacy is done well for successful outcomes.”

With the right training and support, it is possible for many clinicians with experience in conventional implant placement to achieve exceptional outcomes with immediate protocols. The products used – including implant systems and biomaterials – will also influence success of treatment and should be utilised correctly. Dr Solanki adds:

“I’m a big advocate of the Neodent® implant system and Straumann Group biomaterials. The implant system is specifically designed for immediacy – it comes from Brazil, where they immediately load as many as 70-80% of all implants placed. I think it’s important that clinicians in the UK realise this when using the system. I use it for its intended purpose and I get great benefits from it.

“In terms of the biomaterials from the Straumann Group, they allow me to place the product in the right area and I know that they are going to stay there. With other products, you worry that they will move, wash out and almost disintegrate. I need something stable as a product, which is why I like those from the Straumann Group. The mucoderm® and Jason® membrane deliver this stability every time. They are also easy to handle, come in different sizes to minimise wastage and deliver good clinical outcomes.”

Immediate implant protocols and biomaterials clearly have a place in the modern world of implantology, but training and the right products remain key to success. As Dr Solanki has suggested, knowledge of the systems and materials is essential to help individuals really understand their strengths and maximise on the advantages during treatment.

For more information on the complete range of biomaterials, please visit www.straumann-uk.co/biomaterials

For more details on Neodent® solutions, please visit http://www.neodent-uk.co/boost-efficiency

Let EndoCare offer expert assistance

Endodontic cases can present a number of challenges, especially if a patient requires retreatment after a failed root canal procedure.

So, instead of stressing why don’t you refer to EndoCare?

Our team has decades of experience in treating complex endodontic cases – in fact, we’ve saved tens of thousands of teeth that would have otherwise needed extraction. Plus, through the use of cutting-edge techniques, we can guarantee that treatment is as pain-free as possible.

We always return patients to your care with full details of any treatment performed, aftercare instructions and our suggested next steps.

To refer to us, you can either call one of our practices or fill out our patient referral form HERE: https://endocare.v-forms.net/refer-a-patient/

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Book now – for January 2022 IAS Academy lingual Brace course

If you’re looking to advance your orthodontic skills and progress onto lingual appliances, IAS Academy offers the perfect course and support for you.

The carefully designed programme teaches the principles of lingual orthodontics, explores the cases to avoid and when to refer, as well as focusing on how to deliver dentistry that lasts. Topics include lingual mechanics, occlusal planning and retention, diagnosis, assessment and case selection, arch evaluation and space calculation, treatment sequencing and more.

Like all IAS Academy courses, training is complemented by life-long mentoring, clinical support and governance to ensure the safety and effectiveness of patient care provided.

The next cohort starts on 21^st January 2022. Book today to start your journey into lingual orthodontics!

For details or to book, please visit https://courses.iasortho.com/courses/gb/lingual

Colosseum Dental helps Kevin Sinfield towards his goal

Colosseum Dental UK is delighted to be supporting Kevin Sinfield as he goes the extra mile to raise money for those impacted by motor neurone disease (MND). Aiming to run 101 miles in just 24 hours, Kevin hopes to raise £100,000, which will be split between an appeal by Leeds Charity Hospital to build the Rob Burrow Centre for MND and the MND Association – an organisation that funds multi-disciplinary care delivered at centres across the country, as well as performing research into potential treatments for the disease.

As well as giving Kevin access to facilities at Firs Dental, which raised £65, Colosseum Dental UK is donating £250 to MND to help towards his goal too.

If you’d like to show your support for Kevin, you can donate to his fundraiser here: https://donate.giveasyoulive.com/fundraising/kevin-sinfields-the-extra-mile-challenge

For more information, please visit www.colosseumdental.co.uk

#WeCareMore

“Once I switched to HyFlex™ files, it was love at first sight!”

“COLTENE’s HyFlex™ CM files are without doubt the best rotary files I have used. The HyFlex™ CM NiTi alloy is an innovation in rotary file metallurgy. It makes the files more flexible and durable, allowing preparation of canals with extreme curvatures efficiently and the same time increasing their resistance to fracture, offering ultimate safety.

“The flexibility and durability of the files gives me the confidence to achieve the best result in preparing canals in extremely complex cases. No more fear and scepticism when encountering challenging curves! Once I switched to HyFlex™ CM files, it was love at first sight, and since then I never looked back”.

Andreas Louloudiadis is a dentist with a special interest in endodontics. He has a DMD from the University of Alabama at Birmingham, Dip DS in Endodontics from Aristotle University of Thessaloniki and is a member of the British Endodontic Society, Hellenic Society of Endodontology and a certified member of European Endodontic Society.
He works at Dene Lodge Dental in Guildford, Surrey.

For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.

GC symposium addresses the challenges of an ageing population

In September, the Continental European division of the International Association for Dental Research (CED-IADR), together with the association’s Scandinavian division (NOF), welcomed more than 500 participants from 47 countries all over the world to the 2021 hybrid CED-IADR/NOF Oral Health Research Congress in Brussels, Belgium. The event, held over two and a half days, offered a broad scientific programme consisting of state-of-the-art symposia, keynote lectures and presentations by researchers from Europe and beyond.

On the first day, GC Europe hosted a symposium focusing on the challenges of an ageing population with respect to cervical lesions. The symposium, chaired by Prof. Avijit Banerjee (King’s College London, UK), was opened by Prof. Jo Frencken (Radboud University, Netherlands) with consensus recommendations for the primary and secondary prevention of root caries lesions and their operative management.

Being a founding father of atraumatic restorative treatment (ART), he emphasised its ease of application and effectiveness of its use in modern caries management. According to Prof. Frencken, ART with high-viscosity glass ionomer cement has been proved to be a successful approach to managing root surface caries.

The next speaker was Prof. Falk Schwendicke (Charité—Universitätsmedizin Berlin, Germany), who pointed out the importance of cost assessment of treatment. The prevalence of non-carious cervical lesions increases with age. The first focus should always be on prevention and non-restorative treatment. However, when the treatment fails or symptoms arise, restorative treatment is unavoidable. In his clinical study on EQUIA Forte for Class V restorations, he demonstrated not only the good performance and advantages of glass hybrid restoratives but also their cost-effectiveness, being 20% less costly than composite over the three-year follow-up period.

The series of lectures was closed by Dr Gerry McKenna (Queen’s University Belfast, UK), who provided a broad overview on ways to optimise treatment for older adults. In addition to preventive care and preservation of natural teeth, he recommended that tooth replacement follows a functionally oriented approach. At the end of the day, Prof. Banerjee moderated a Q&A session during which the participants could resume the discussion on this trending topic.

Having attracted over 100 participants online and on-site, the symposium was considered to be a great success.

For further information contact GC UK on 01908 218999, email info.uk@gc.dental or visit www.gceurope.com

The Oral Health Foundation and Denplan launch Mouth Cancer Action Charter to Parliament

The Oral Health Foundation and Denplan launched their Mouth Cancer Action Charter at a face-to-face event in the Houses of Parliament earlier this week. Members of Parliament, ministers and dental and health professionals were invited along to sign the Charter and demonstrate their support for its policy recommendations.

The Mouth Cancer Charter has been created to coincide with November’s Mouth Cancer Action Month – the UK’s biggest charity campaign for mouth cancer awareness. The campaign calls for more people to be mouthaware by being able to recognise and act on any unusual changes to the mouth.

The Oral Health Foundation and Denplan are concerned that mouth cancer referrals have significantly fallen over the pandemic period, while awareness of the major signs and symptoms of mouth cancer is very low. According to results from a recent MP survey, only 27% of MPs felt they were as well informed of the causes and symptoms of mouth cancer as they are of other leading cancers.^[1]

Dr Catherine Rutland, Clinical Director at Denplan, part of Simplyhealth said: “We’ve worked together with the Oral Health Foundation for over 20 years on the Mouth Cancer Action Campaign, but we wanted to go one step further this year by spreading the mouth cancer awareness messages further and wider into the corridors of Westminster.”

“Mouth cancer referrals will have been significantly reduced due to the Covid pandemic restrictions last year and delays have been incurred by the dental backlog and access to NHS dentistry remaining difficult in certain areas. We urge the Government to consider these mouth cancer policy interventions. The longer the delay to implement these changes, the more lives could be lost to mouth cancer as possible cases go undetected. Top of the policy recommendation list is that we are calling on the Government to fund a public health awareness campaign on the signs and symptoms of mouth cancer.”

Recent research conducted by the Oral Health Foundation and Denplan shows that four-in-five UK adults have never been exposed to public health messaging around mouth cancer, leading to poor awareness of the early warning signs and risk factors^[2].

Dr Rutland said: “If people can easily recognise the risk factors and what to look out for in terms of changes in their mouth, health professionals will also be able to catch cases earlier. Late diagnosis of mouth cancer is becoming all too common and this will have a severe effect on a person’s quality of life and their chances of survival.”

The Charter proposes that GP’s, pharmacists, care home and nursing staff should all be given enhanced training or further information about how to look out for signs and symptoms of mouth cancer to further improve early detection. Spotting signs early can increase someone’s chances of survival from 50% to 90%.

Sir Paul Beresford and Dr Nigel Carter OBE

Commenting on the policy recommendations proposed in the Charter, Dr Nigel Carter, Chief Executive of the Oral Health Foundation said: “If these mouth cancer policy changes were put into action we could drive down case numbers and save the government a significant amount of money in oral cancer treatment costs. In England, the cost of head and neck cancer treatment was £309m in 2010-11^[3] and since then case numbers of mouth cancer have grown by around 67%.”

The Mouth Cancer Action Charter highlights the following policy areas for change:

Conduct a government funded public health awareness campaign of the signs and symptoms of mouth cancer.
Improve access to routine dentistry to detect mouth cancers earlier and save lives.
Enable enhanced training of GPs to identify suspected mouth cancers and change the NICE guidelines so that more cases can be referred to secondary care.
Improve training programmes for healthcare staff to look for signs of mouth cancer.
Introduce free dental check-ups and treatment for mouth cancer patients to end the unfair financial burden placed on them.
Support the development of better technology to diagnose mouth cancers.

One of the key points in the mouth cancer charter is about the development of better technology to diagnose mouth cancers. During the pandemic, it has become more evident that innovation, data and technology are helping to make dentistry safer, faster and more accessible.

The use of technology in diagnostics is also becoming more important. Denplan and the Oral Health Foundation are proposing that with the support from NHSX a mobile app could be developed that would enable patients to share photographs of their mouth lesions which would then be reviewed within a short space of time by a consultant.

In addition to politicians and ministers, the Oral Health Foundation and Denplan are also asking dental professionals and other healthcare professionals to show their support and sign the Charter at www.dentalhealth.org/mouth-cancer-action-charter. More information on mouth cancer can be found on the website and by following the campaign on social media via #MouthCancerAction.

References:

^[1] YouGov completed online interviews with a representative sample of 103 MPs. The survey was completed between 6th and 28th September 2021;

^[2] The research was carried out online by Research Without Barriers – RWB. All surveys were conducted between 6th October 2021 and 8th October 2021. The sample comprised 2,008 UK adults

^[3] https://pubmed.ncbi.nlm.nih.gov/28734109/

New Covid guidelines unlikely to bring ‘business as usual’ back to dentistry

The British Dental Association has said new standard operating procedures for dentists in England published yesterday are unlikely to represent a silver bullet for restoring patient access to services.

The new model places patients on two pathways, given the likelihood of them suffering from respiratory illness. It replaces restrictions that have been all but universal for most treatments and most patients since the first lockdown, which has radically reduced capacity across the service.

Those on the non-respiratory pathway can be managed in line with pre-Covidstandard infection control precautions. Any placed on the respiratory pathway will remain subject to enhanced precautions, including maintaining ‘fallow time’ gaps of up to an hour between treatments. Screening to determine the pathway will take place both before attendance and on arrival the practice.

Dentist leaders anticipate a relatively high proportion of the population may find themselves on the respiratory pathway as the country heads into winter, given traditional patterns with seasonal flu and the common cold, even setting aside any surge in Covid rates.

Over 35 million NHS dental appointments have been lost since the first lockdown, driven by ongoing restrictions. The service has not received a penny of additional investment from the Government’s multi-billion-pound NHS ‘catch up’ programme to help bring down these backlogs, despite pressure from Healthwatch England and a growing number of MPs.

Unlike their colleagues in other UK nations dentists in England have received no capital funding to invest in ventilation systems that can allow for increased patient volumes while keeping to Covid restrictions.

BDA Chair Eddie Crouch said: “We have long called for roadmap to ease Covid restrictions. This approach is progress but will not represent a silver bullet for the tens of millions left without access to dental care. We cannot realistically expect a return to ‘business as usual’ as we head into winter given surging rates of respiratory disease.

“These new guidelines may help increase patient volumes but will barely make a dent into the unprecedented backlogs we now face. Without needed support from government we will continue to struggle to deliver for the patients that need us.”

Simple but powerful solutions

Dr Jessica Wake presents a recent case to demonstrate the power of simple yet highly effective anterior alignment orthodontics, alongside the ABB (Align, Bleach and Bond) concept.

The patient is a regular attender at our practice and sees the Clinical Director for her regular dental care. She was referred internally to see me for some potential orthodontic treatment.

The patient had recently become more conscious of her upper and lower anterior teeth and had noticed they were starting to become crowded. She’d previously had orthodontic treatment as a teenager, but gave up wearing her night time retainers in her early 20s and since then her teeth had gradually relapsed. As this was beginning to bother her, she was interested in treatment to correct the position of her teeth once again.

Orthodontic assessment

A comprehensive orthodontic assessment was conducted (Table 1) to determine the patient’s suitability for removable orthodontic treatment.

Table 1:

Skeletal Pattern	Class II moderate
FMPA	Low
Lower Face Height	Average
Facial Asymmetry	Yes, nose very slightly to left
TMJ	NAD
Soft Tissues	Competent lips, obtuse nasolabial angle, slightly high lip line on smiling
Overjet	3mm
Overbite	20%
Crossbite	No
Displacement on closure	No
Incisor relationship	Class I
Molar relationship	Right: Class II full unit Left: Class II full unit
Canine relationship	Right: Class II ¼ unit Left: Class I
Teeth Present	876 4321	1234 678
	7654321	1234567
Centrelines	Lower centre line deviated to the right by 1mm

Treatment planning

A full set of clinical photographs, x-rays and intraoral impressions were taken. The Spacewize™+ programme was used to assess the degree of crowding and arch form, and all were uploaded to the forum for approval. The Archwize™ digital simulation software from the lab confirmed case suitability for the ClearSmile Aligner Light appliance. It estimated that 5 upper and 8 lower aligners would be required for alignment, alongside a total of 0.2mm upper and 1.1mm lower interproximal reduction (IPR) to create sufficient space for tooth movement. The Archwize™ results were posted to the IAS Academy support forum for confirmation of suitability, as well as clinical reassurance from the Academy mentors and the go ahead for treatment.

The entire treatment plan was communicated with the patient, who was more than happy to proceed and we went through the consent process. The importance of retention was emphasised and the patient understood her role in terms of wearing retainers for life to maintain the results achieved.

Orthodontic treatment

Treatment progressed as planned, with the patient wearing each aligner for 22 hours a day for 2 weeks before moving onto the next in the pre-determined sequence. Progress was checked and oral hygiene instructions reiterated during review appointments.

Anchors were placed on the UR2 and UL12 and the LL3 and LR2 during the first visit and the recommended IPR carried out at this visit. Usual protocols were followed in relation to our Covid policies using non aerosol generating procedures.

After the patient had been wearing aligner 5 for 2 weeks, a new lower impression was taken to ensure the case was tracking correctly. The lab was then able to make the next 2 aligners in the sequence.

Once alignment was complete and both I and the patient were satisfied with the results, upper and lower bonded retainers were fitted. Following the ABB (Align, Bleach and Bond) concept, tooth whitening was performed with two weeks of night-time Phillips Zoom Nite white 16% tooth whitening solution using the IAS Lab to make the whitening trays for the patient. Once the patient was happy with the whitened shade she had achieved, very slight composite edge bonding was completed on the upper left central incisor and the upper laterals to improve their shape and optimise the smile aesthetics. Finally, night time Essix retainers were provided to wear indefinitely in order to maintain the new position of the teeth.

The patient was very happy with her treatment and the outcome, as was I.

Discussion

The mentors from the forum recommended getting the IPR done early in the treatment to make the space required to allow the teeth to start moving. The IAS support forum is a great tool to have cases assessed and approved. Any advice the mentors provide is useful to ensure treatment is tracking correctly and this is appreciated.

The skills I have learnt from IAS Academy removable appliance, ABB and ortho-restorative courses have been put into action here to produce a very nice result.

My experience with IAS Academy training has been excellent. The background teaching regarding full orthodontic case assessment, diagnosis and treatment planning is covered in great detail, helping you to understand what you are doing and keeping you safe in the treatment process for consistent results. The hands-on training is thorough so you feel confident about transferring these skills into practice. I would recommend IAS Academy courses.

I have been very happy with the ClearSmile Aligners and the IAS Laboratory process is excellent. The aligners always fit well and cases are carefully planned in the Archwize™ planning department so you know the movements you are creating are safe and I get very consistent results.

For anyone wanting to treat similar cases, it’s important to ensure the patient is diligent in wearing the aligners and that IPR is done accurately accordingly to the treatment protocols. You will then feel confident treating patients with mild crowding – the results are lovely to see and you will have a very happy group of patients.

For more information on upcoming IAS Academy training courses, including those for the Inman Aligner, please visit www.iasortho.com or call 01932 336470 (Press 1)

Jessica graduated from Birmingham in 1989 with a degree in Dentistry and has been at St John’s Hill for 6 years now. She especially enjoys general family dentistry and cosmetic dentistry using minimally invasive techniques.Jessica’s special interests include tooth whitening, edge bonding and anterior alignment orthodontics using the ClearSmile Brace system, ClearSmile Aligners and the ClearSmile Inman Aligner. She has recently achieved her Fellowship award with IAS Academy, having completed Prof Ross Hobson’s Advanced 2-year orthodontic programme, which allows her to complete more complex orthodontic cases. She is working towards her accreditation in the IAS removable appliance system.

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