One common hurdle that professionals face is a patient refusing recommended treatment. Not only is this disheartening, but it may also lead to further problems and more invasive interventions for the patient further down the line. 

Breaking down barriers

There are several reasons why patients may not accept proposed care and understanding these is important if clinicians are to help them proceed with the dental care they need and improve or maintain their oral health.

One study that assessed why patients refuse orthodontic treatment, for example, identified fear of tooth extraction, the necessity of frequent practice visits and uncertainty surrounding possible outcomes as key.[i] In the case of dental implant therapy, barriers to treatment acceptance may also include apprehension about the procedure and socioeconomic status.[ii] Other reasons could be a lack of trust between dentist and patient, not fully appreciating the need for treatment and time constraints if a patient leads a busy lifestyle or has a deadline such as a wedding.

How clinicians overcome these barriers will depend on each individual patient, but there are some general approaches to adopt to help boost treatment acceptance.

For example, it can help considerably to build an emotional connection with patients as choosing to proceed with dental treatment will require an emotional investment from them. This will also help to strengthen rapport between you and the patient, encouraging their trust in your ability to help them achieve the results you both desire. An open and honest discussion about money can help as well. Some patients will be comforted to know if there are payment plans available to make the procedures more affordable for them. The same can be said when exploring treatment options – giving them all their choices and explaining each one will help them feel more in control.

Finally, reassuring them that the treatment experience is as efficient and positive as possible will give patients another reason to proceed. This is often where modern digital technologies such as intraoral scanners come into their own.

Embracing the benefits of digital impressions

Studies have suggested that digital impressions are preferred by most patients,[iii] which means that utilising scanners will enhance their treatment experience. Replacing the gloopy, gag-reflex-inducing traditional impressions with technology allows you to start the assessment and diagnostic process in a more pleasant way. The equipment can also help patients say yes to treatment with smile simulations created from the digital scans that show patients what their teeth may look like. This helps to reduce miscommunication and lets patients know exactly what to expect while motivating them to move forward.

Finding the right scanner for you is important to make the very most of all these benefits and more. As such, the Straumann Group offers a suite of solutions tailored to your specific needs.

The Virtuo Vivo™ is the ideal entry level digital scanner for clinicians looking to transition to a digital workflow. It features easy handling, an ergonomic design, unsurpassed scanning access and real-time digital results. The 3D scanning technology provides life-like colour matching for enhanced communication between dentist and patient, and dentist and dental technician.

For clinicians looking to upgrade their current digital capabilities, the Medit i500 scanner features a small tip for simpler manoeuvrability and improved patient comfort. It also ensures high resolution images that make it easy to locate margin lines and undercuts. The 3D-in-motion video technology enables video-based scans for a shorter scanning time.

If you already offer digital impressions and are looking to upgrade your dentistry for an even more exceptional patient experience and comprehensive digital workflow, the 3Shape Trios scanner may be for you. This state-of-the-art technology provides unrivalled image quality as well as connectivity to leading software solutions, ensuring a smooth experience for patient and clinician every time.

To find out more about any of these intraoral scanners and how they can enhance your treatment acceptance rates, contact the Straumann Group. 

Virtuo Vivo™

Medit i500

3Shape Trios

Accepting better oral health

For patients to improve their dental health, function and aesthetics, they often need professional intervention and support. Where they are unsure about going ahead with recommended treatment, helping to break down potential barriers and enabling them to make the best decision for them is crucial.

For more information, please visit http://www.straumanngroup-uk.co/my-ios

[i] Verma, S. Why Patient Refuses Orthodontic Treatment? Let’s Find Out The Reason. Sch. J. Dent. Sci., 2017; 4(10):424-42.

[ii] Bilski T. Conquering barriers to treatment acceptance in complex cases. Inside Dentistry. June 2020. 16 (6) https://www.aegisdentalnetwork.com/id/2020/06/conquering-barriers-to-treatment-acceptance-in-complex-cases [Accessed September 2022]

[iii] Sivaramakrishnan G, Alsobaiei M, Sridharan K. Patient preference and operating time for digital versus conventional impressions: a network meta-analysis. Aust Dent J. 2020 Mar;65(1):58-69. doi: 10.1111/adj.12737. Epub 2019 Dec 19. PMID: 31749234.

The Kuraray Noritake Dental Teethmate Desensitizer kit, available from J&S Davis, offers a real solution for tooth sensitivity.

Teethmate Desensitizer crystalises hydroxyapatite (Hap) to seal dentinal tubules and enamel cracks. Kuraray Noritake Dental’s technology makes it possible to build Hap when combined with the optimal calcium and phosphate ion ratio. This real solution for sensitivity is suitable for your patients with dentine exposed by toothbrush abrasion, gingival recession, periodontal disease, or acid erosion, as well as treating the dentine before or after professional cleaning, whitening, or restoration.

Consider using the Kuraray Noritake Dental Teethmate Desensitizer kit, available from J&S Davis, and offer your patients a smart, invisible and durable sensitivity treatment with hydroxyapatite.

For more information on the industry-leading products available from J&S Davis,

visit www.js-davis.co.uk, call 01438 747 344

or email jsdsales@js-davis.co.uk.

Initial Medical, a trading division of Rentokil Initial UK Limited, is dedicated to offering customers nothing but the best standard of service and support.

In light of this, we’re proud to announce that Rentokil Initial has recently been presented with the RoSPA Gold Medal Award for 2022.

This exclusive accolade is only given to companies that have achieved a very high level of performance, demonstrating well developed occupational health and safety management systems and culture, outstanding risk prevention and very low levels of error. To receive the Gold Award, companies have to maintain these exceptional standards for at least five years. 

To find out more, please contact the team at Initial Medical today.

To find out more, get in touch at 0870 850 4045 or visit the website today www.initial.co.uk/medical

-Ends-

About Initial Medical Waste 

Initial Medical set the standard in healthcare and infectious waste management in the UK, providing a reliable, effective and fully compliant service built around customer needs and delivered by our highly trained local teams.  We are ISO 9001:2015 accredited, with technology fully integrated into our operations, providing full traceability of service delivery, electronic waste documentation and the best customer experience possible. We also offer innovative healthcare waste management services and infection control products, to help break the chain of transmission and prevent cross contamination.  

Initial Medical are a company with a ‘World Class’ Health and Safety record, and ISO 45001:2018 accreditation. We are also accredited to ISO 14001:2015 environmental standards, and pride ourselves on our sustainable approach with a focus on delivering eco-friendly products and operational solutions.
 

For further information please visit www.initial.co.uk/medical or Tel: 0870 850 4045

Media enquiries:

For more information, please contact:

erica@ekcommunications.net

01227 265700

Complications which occur after dental implant placement are often attributed to the patient’s oral hygiene, or the dentist’s lack of education and/or experience. However, the professors and practitioners at the CleanImplant Foundation believe that contaminated dental implants could be the cause of peri-implantitis in more cases than many would expect.

The CleanImplant Foundation was established in Germany by Dr Dirk Duddeck, dentist and biologist, who explains more about the organisation, its aims and the importance of truly clean dental implants:

“At the CleanImplant Foundation we conduct a quality assessment of approx. 100 sterile-packaged dental implants from different brands every 2 to 3 years. Over the years we have analysed a total of more than 300 different dental implant types from 200 companies using the Scanning Electron Microscope. The astounding result: approximately one-third of all tested implant samples are contaminated with significant residue from the manufacturing process or contaminants attributable to the packaging process. The dental implant surface debris most frequently evidenced were different carbonaceous compounds identified, e.g. synthetic polymers, thermoplastic materials, Perfluoropolyether (PFPE) – all of them are known to exhibit toxic effects. Significant residues of Dodecylbenzene-sulfonic acid (DBSA) were also found on surfaces of sterile-packaged dental implants. Remnants of this aggressive and surface-active cleaning chemical are cell-toxic and classified as ‘hazardous’ according to the US Environmental Protection Agency (EPA).

“The clinical relevance of dental implant surface contaminants is no longer in dispute. Many peer-reviewed studies conclude that residue on the surface presents a significant concern for treatment success. Organic carbonaceous pollutants are shown to be associated with initial bone loss or peri-implantitis. Foreign particles of 0.2 to 7.2 µm are acknowledged to be highly pro-inflammatory. Should these particles detach from the surface during dental implant insertion, they can create an expanding zone of soft tissue degradation. The secretion of TNF-α, IL-1b, IL-6, and PGE2 from the inflammation zone can stimulate the differentiation of osteoclast precursors into mature osteoclasts. All contaminants mentioned above have been shown to disturb the patient-specific foreign body equilibrium, a major cause of peri-implant bone loss, as stated by Tomas Albrektsson.

“There are numerous dental implant brands available today and they all advertise their products to be clean, however, the data we have collected shows this is not always the case. In fact, there are many dental implants on the market of inferior quality.

“When we are faced with patients complaining about their care and losing trust in our treatment abilities, we must consider the causes very carefully – and it is not always the dentist’s skill, or the technique used. Colleagues should demand flawless quality when it comes to the surface cleanliness of a dental implant to prevent the product from being the problem.

“Unfortunately, it can be very difficult for dentists to know which products are clean. Even brand reputation, size and origin, CE labels or FDA clearance do not prove that products are clean. As a matter of fact, even some of the biggest companies don’t have full control over their production processes.”

The CleanImplant Foundation aims to help clinicians choose only truly clean implants to promote patient safety and improved treatment outcomes. Though not always a comfortable topic for some manufacturers, the CleanImplant Foundation strives to be completely transparent in everything that they do and find. Dr Duddeck continues:

“The CleanImplant Foundation is a non-profit organisation who guarantee total transparency and 100% unbiased analyses. Results are peer-reviewed by some of the most renowned scientists, including Professor Dr Tomas Albrektsson and Dr Michael R. Norton (Past President of the Academy of Osseointegration). In 2017, we developed the first consensus paper to establish a threshold of acceptable contamination, defining what makes a dental implant ‘clean’. The companies whose products meet our requirements understand the problem. They have invested money, time, effort and extensive human resources on improving their production processes and corresponding quality management as a result. The CleanImplant Trusted Quality Seal gives dentists the information and confidence they need to make informed decisions about the dental implants they use. Our objective is not to blame companies, but to raise awareness and enhance standards across the profession for the benefit of our patients.”

When asked about the impact of this non-profit initiative on the dental market, Dr Duddeck summarised:

“We now have more than 120k followers on social media, which we have accumulated in only 3 years. Respect is earned but we have made a very strong start, and I’m confident that we’re on the right track. To date more than 40 key opinion leaders share our passion and believe in what we’re trying to achieve. We offer a fantastic opportunity for dental implant suppliers and industry partners to apply for a Trusted Quality Seal to demonstrate their commitment to quality as well.

To cite Tomas Albrektsson, ‘We have to know, not believe, that a specific implant is without harm to our patients’.[i] This is our mantra. We are providing dental professionals with this knowledge.”

Dr Duddeck will be among the many highly esteemed speakers at the ADI Team Congress 2023. He tells us what he hopes colleagues will gain from his session:

“I hope delegates will ask their sales representatives if they have unbiased proof that their dental implant is as clean as they say. I will encourage colleagues to question the promised quality of the dental implants they purchase. If they are unknowingly using a product that is not as clean as they think, they could be looking in the wrong areas to determine why their patients experience peri-implantitis.

“I am very excited to speak for the ADI for the first time and look forward to sharing more of our findings with peers in the UK.”

The ADI Team Congress 2023 will be held on 4-6 May at the Birmingham ICC. Visit the website for details in due course. ADI members get significantly discounted rates for all ADI events.

www.adi.org.uk

[i] Albrektsson, Tomas, et al. “Survival of NobelDirect implants: an analysis of 550 consecutively placed implants at 18 different clinical centers.” Clinical implant dentistry and related research 9.2 (2007): 65-70.

Fig.1: Sterile does not necessarily means the same as clean. Avoidable organic, carbon-containing contaminants (sample above) are clinically relevant as they are linked to bone loss and/or peri-implantitis. (SEM Mapping image in BSE mode shows two different new dental implants in comparison)

Fig.2: SEM implant analysis under clean room conditions in the accredited testing laboratory

Dr Sagi Shavit graduated from dental school in 2009 in Bucharest and shortly afterwards developed a special interest in endodontics. He undertook a number of endodontic training courses, including microsurgical endodontics, in London and in 2015, he gained an MSc in Endodontics from the University of Chester. He now treats endodontic patients exclusively at Cleveland Terrace Dental Practice, Darlington.

Here he presents a case where complex anatomy meant challenges for the entire treatment sequence.

Background, presentation and diagnosis

A female patient in her late 20s was referred to our clinic regarding her lower premolar.

She complained of occasional constant painful episodes and pain upon mastication. A clinical examination revealed that the tooth was not restored or carious, but seemed slightly discoloured and was not responsive to cold tests. It was also tender to vertical pressure.

The patient had orthodontic treatment several years ago and there was no recollection of trauma.

Radiographic examination (see figure 1) shows a single premolar, normal bone levels and discrete widening of the apical periodontal space. Further careful examination of the preoperative radiograph shows that there is a single wide canal which abruptly disappears mid-root. This is an indication of a separation of this canal into two separate canals.

Based upon the clinical and radiographic findings, a diagnosis of chronic apical periodontitis was placed. The treatment options of endodontic treatment or extraction of the tooth were discussed, and the patient decided to have endodontic treatment.

Treatment pathway

The tooth was accessed under rubber dam and the canals were located with the aid of the dental operating microscope (see figure 2).

The access to the two canals was refined using the HyFlex™ EDM Orifice Opener (25/.12) from COLTENE, in order to allow better access into each canal.

The working length was determined using the CanalPro™ electronic Apex Locator, also available from COLTENE, and verified with a radiograph (see figure 3). This also allowed me to understand the exact anatomy of the root canal system, which was proved to be type II Weine.

A smooth glide path was achieved using manual 8 and 10 K files, and the 10/.05 GlidePath file from the HyFlex™ EDM system.

Mechanical instrumentation continued using the 20/04 in both canals and the HyFlex™ EDM OneFile in the buccal canal, which was the main canal. This was done to avoid over instrumentation of the canals, which may lead to iatrogenic accidents.

This was performed under copious irrigation of 5.25% sodium hypochlorite, and a final rise with 17% EDTA. Both irrigation solutions were activated ultrasonically using the cordless CanalPro™ Endo Ultra Irrigation Activator.

The gutta percha points were fitted inside the wet canals to verify ‘tug-back’ and another radiograph was acquired to confirm fit (see figure 4). The canals were then dried using matching paper points, and obturated using warm vertical compaction (see figure 5 and figure 6).

The access cavity was sealed with resin composite and the patient discharged back to their referring dentist. The postoperative radiograph (see figure 7) shows adequate three-dimensional obturation of the endodontic space.

Conclusions

Lower premolars with multiple canals pose a challenge throughout the entire endodontic treatment, from diagnosis and treatment planning, through access and instrumentation, to proper irrigation and obturation.

COLTENE provides a range of high-quality endodontic tools, materials and equipment that allow us, as clinicians, to provide the best treatments to our patients. HyFlex™ EDM files are super elastic, efficient and safe. These files will own any canal you’ll give them. The CanalPro™ Apex Locator provides crisp and accurate readings of the working length and is indispensable tool during endodontic treatment.

Irrigation, the most important part of the endodontic treatment, is much more efficient using ultrasonic devices, such as the CanalPro™ Endo Ultra. The matching HyFlex™ EDM paper points and gutta percha points allow safe and accurate obturation of the endodontic space.  

Figure 1. Pre-op radiograph

Figure 2. Access cavity and view of the two canals

Figure 3. Working length radiograph

Figure 4. Cone fit radiograph

Figure 5. View of both canals obturated

Figure 6. ‘Down-pack’ radiograph

Figure 7. Post operative radiograph

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

Diagnostic images are the foundation of excellent dentistry. But with every patient bringing unique challenges and different decisions to be made, you need to feel confident that the technology you use in practice can support you.

That’s why Carestream Dental offers a range of imaging systems that meet every need.

From the easy intro to 3D imaging with the CS 8100 3D CBCT system to the power of truly future-forward imaging with the CS 9600 CBCT system, Carestream Dental ensure that all of your needs are met.

Fast scans.

Innovative features.

Premium imaging technology for crystal clear results.

The next level of dental imaging is yours to discover today.

To find out more, please contact Carestream Dental.

For more information, contact Carestream Dental

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk

As a busy dental professional, having a reliable place to invest in solutions and systems is vital to avoid unnecessary stress. Alongside their fantastic learning programmes, IAS Academy also provides a range of high-quality solutions from the IAS Shop.

With products from a vast array of brands, such as NSK and 3M, the IAS Shop is the best place to go for orthodontic and restorative products. From tools and instruments to wires, brackets and kits, there is plenty of choice.

The IAS Shop provides dental professionals with convenience and peace of mind, as they know they can purchase a range of products from trusted suppliers. To find out more, get in touch with the team or visit the website today.

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