Implants are an excellent solution for many edentulous patients – providing a long-lasting replacement for lost teeth. However, it’s important to be aware of the potential complications of dental implant treatment and how these can be avoided. A key consideration in the treatment planning stage should be ensuring there is correct spacing between the implant you are placing, and any existing implants or natural dentition.[i] Usually, the minimum distance required between the implant and adjacent tooth is 1.5-2mm. Before placing the implant, it is preferable to correct any spacing issues, be it through tooth recontouring, the use of restorative materials, or orthodontics.ⁱ Both mesio-distal and buccolingual distances will impact the results,ⁱ so it is vital that these factors are considered prior to implant placement.

Potential complications of too little distance

When there is too little distance between the natural dentition and the implant placed, complications may occur. A lack of space between the tooth and implant will lead to a lack of blood supply, causing bone resorption.[ii] This interproximal bone loss can cause the implant to fail, potentially resulting in the loss of the implant and the neighbouring natural tooth. It may also be difficult to form an ideal emergence profile with the implant-retained prosthesis, due to the limited space between the natural crown and implant. Being unable to produce a proper emergence profile can lead to aesthetic, hygienic, and soft tissue complications – further increasing the risk of implant failure.ⁱⁱ

Not only this, but insufficient space surrounding the prosthesis leads to poor access for cleaning, making proper oral hygiene difficult or impossible. Inadequate cleaning of the prosthesis will lead to plaque build-up, and could potentially cause peri-implantitis. Peri-implantitis is an extremely damaging complication, resulting in the inflammation of the soft-tissue, and leading to bone resorption[iii] – ultimately sometimes resulting in the failure of the implant. In addition, the interproximal bone loss caused by the close proximity of the implant to the tooth may lead to reduced papilla height resulting in periodontal and aesthetic problems.ⁱⁱ

Problems with too much distance

Conversely, if there is too much space between an implant and the remaining natural teeth, complications can also occur, such as biomechanical issues and aesthetic complications. For example, the final prosthesis may require over-contouring to achieve a contact area with the tooth. The final prosthesis will be atypical – leading to difficulty with insertion procedures.ⁱⁱ

Placing an implant too far from the natural dentition can cause a biomechanical disadvantage as well, with damaging forces potentially resulting in bone loss. When miscalculated, the cantilever effect may amplify forces on the implant system, potentially resulting in the screw loosening, cement retention failure, or the failure of the implant. Alongside this, the forces exerted on over-contoured crowns can lead to screw loosening, screw fracture, or implant fracture.ⁱⁱ

Complications with incorrect spacing between implants

Clinicians can avoid placing implants too close together by following ideal spacing rules – the guidelines being approximately 3mm between implants and around 1.5-2mm away from natural dentition. Similar to the consequences of placing implants too close to natural dentition, insufficient space between implants can cause bone loss, due to the decreased blood supply, leading to the loss of inter-implant papilla.ⁱⁱ

Methods for preventing these issues may include the use of implant positioning devices which allow for ideal placement – minimising the likelihood of placing the implant too close or too far from the adjacent tooth. When selecting tools to assist in spacing implants, consider the LM Implant Misura MR instruments which are available from J&S Davis. LM Implant Misura MR instruments assist in positioning the first spiral drill at the correct distance from the existing implant or natural dentition – and take into account the patient’s anatomy. They help to ensure correct mesio-distal and bucco-lingual positioning minimising the risk of complications and helping to ensure a more aesthetic and functional outcome.

As with many issues which arise in dentistry, prevention is easier than treatment when it comes to complications associated with dental implants. Ensuring correct spacing at placement will encourage effective osseointegration and reduce the likelihood of problems. By optimising spacing between implant and existing dentition, you are able to provide your patients with a long-lasting solution to replace their missing teeth. Avoiding complications which could risk the survival of the implant and any remaining dentition is crucial and will help to ensure a long-lasting restoration.

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.

[i] Kheder, Waad M. Assessing The Position And Angulation Of Single Implants Restored In The Predoctoral Dentistry Program. University of Toronto (Canada), 2014. https://tspace.library.utoronto.ca/bitstream/1807/68598/1/KHEDER_WAAD_M_201411_MSc_thesis.pdf

[ii] Pocket Dentistry. Ideal Implant Positioning. (Date accessed: 07.09.22) https://pocketdentistry.com/ideal-implant-positioning/

[iii] Oral Health Group. Peri-implantitis and the risk factors. (Date accessed. 08.09.22) https://www.oralhealthgroup.com/features/peri-implantitis-risk-factors/

It’s important to have multipurpose, efficient infection control products readily available to help ensure that your business setting remains a safe space for everybody.

With Initial Medical’s Signature Hand and Surface Sanitiser, you benefit from two methods of infection control in one solution. The versatile formula can be used on both surfaces and hands, contains 70% alcohol, and destroys 99.99% of bacteria and viruses.

The formula is even effective against enveloped viruses such as Coronavirus,* and has no added fragrances of dyes so it’s kind to skin – making it ideal for repeated use.

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

-Ends-

 
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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.  

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Media enquiries:

For more information, please contact:

erica@ekcommunications.net

01227 265700

Howden is a specialist dental indemnity provider that you can switch to with confidence.

That’s because we offer 10-year run-off for work completed, so you won’t need to worry about gaps in your cover. It’s like a built-in safety net!

Move to Howden and have insurance that is fit for the modern world. Our polices offer strong, contractual cover, they can be tailored to the work you do. We are cost-competitive, and you can be reassured you are getting fantastic value as well as high-quality and broad cover.

Move to Howden and you will have the right people on your side, at a time when you need them most.

For a no-obligation free quote, call today.

For more information, please visit www.howdengroup.co.uk or call 020 3918 9127

Howden Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority in respect of general insurance business. Registered in England and Wales under company registration number 725875. Registered Office: One Creechurch Place, London, EC3A 5AF.

Dr Jonathan Dougherty, of Kilmarnock Dental Care in Ayrshire, Scotland, presents a case utilising Neodent^®EasyGuide to simplify his workflow.

A 54-year-old male patient presented to the practice with a failing UR2. He was aware that what was left of the tooth would likely need extraction and was interested in replacing it with a fixed solution.

Assessment

The patient had a clear medical history, was a non-smoker and didn’t drink alcohol. A comprehensive intra- and extra-oral examination was conducted, which demonstrated no abnormalities other that the failing UR2. This tooth had broken off and only the fractured root remained. The patient’s general oral hygiene was fair, though there was some gingival recession recorded, especially in the lower anterior teeth. Existing amalgam restorations were noted on the UR4, UL4 and LL6.

A CBCT scan was taken to assess the anatomy and ensure suitability of implant placement. Intraoral scans were also taken using the 3Shape Trios scanner.

Treatment planning

All possible treatment options were explained to the patient in detail. These included doing nothing, extracting the remaining UR2 tooth root and providing a removable denture or extraction with an implant-retained restoration. The patient expressed a preference for the fixed option for optimal confidence in his smile going forward. All the benefits, limitations and potential complications of each option were detailed and the patient had an opportunity to ask any questions. He provided informed consent to proceed.

The CBCT and intraoral scans were sent to Quoris 3D for the fabrication of a surgical guide. This meant that implant location, angle and depth could be planned precisely ahead of time to ensure the best functional and aesthetic outcome for the patient. The digital impression was also used to manufacture an essex retainer for post-operative retention. The importance of on-going oral hygiene was emphasised to the patient so that he understood his role in maintaining the results.

Treatment

On the day of treatment, the failing UR2 root was extracted as atraumatically as possible. A 3.75mm x 11.5mm Neodent^® Aqua implant was placed using the Neodent^® EasyGuide. This facilitates guided surgery by enabling one-handed procedures and making is simpler for the clinician to achieve accurate implant placement.

A synthetic bone grafting material was placed around the implant to optimise the bone level at the surgical site, and a healing abutment was fitted. The wound was closed tension-free using 5.0 vicryl sutures. The essex retainer was also fitted during this appointment to help make sure the implant crown remained in the desired position as it healed. 

The patient returned to the practice three months later for impressions and was then back again another two weeks later for the fit of the final prosthesis. He was delighted with the outcome.

Discussion

The Neodent^® EasyGuide is very easy to use and facilitates a simple workflow that is particularly great for immediate implant placement cases. The specially designed drills fit directly onto the sleeve of the surgical guide and don’t need a drill handle, which makes it easier for the clinician to operate. As with any guided surgical technique, this can be very useful for clinicians wishing to achieve excellent accuracy during treatment, but it is still important to understand the analogue process first. Once mastered, the Neodent^®EasyGuide makes guided surgery a simple, one-handed procedure.

Figure 1- pre treatment anterior view showing failing UR2

Figure 2 – Occlusal view fo the failing UR2

Figure 3 – Extracted UR2 tooth root

Figure 4 -Post extraction

Figure 5 – Neodent EasyGuide fitted

Figure 6 – Implant positioning checked through EasyGuide

Figure 7 – Neodent Aqua implant placed through EasyGuide

Figure 8 – EstOss sybthestic bone grafting material placed over implant

Figure 9 – Surgical site closed using 5.0 vicryl sutures

Figure 10 – retained fitted with temporary crown on UR2

Figure 11 – radiograph at implant placement

For more details about the Neodent^® EasyGuide, please visit www.straumann.com/neodent  

Author bio:

Jonathan Dougherty Bds, Mjdf Rcs Eng, Mfds Rcs Ed, Mfds Rcs Gla, Dip Rest Dent Rcs Eng, Dip Imp Dent Rsc Eng

Jonathan is one of the youngest dentists to hold joint awards from the Royal Colleague Of Surgeons in Glasgow and Edinburgh. He is also one of a few dentists in Scotland to hold the Prestigious Restorative Diploma from the Royal Colleague of Surgeons London. He has a particular interest in both implant dentistry and sedation, which led him to set up a referral centre in Kilmarnock for the management of anxious patients under IV sedation.

The Centre for Oral-Maxillofacial and Dental Implant Reconstruction accepts patient referrals for routine, advanced and complex treatments.

Professor Cemal Ucer, Specialist Oral Surgeon, and his team offers treatment for bone and tissue grafting, reconstructive surgery, nerve lateralisation/positioning and zygomatic implants. Professor Ucer and the team only ever utilise well-researched and scientifically-proven market leading systems for optimal treatment results, as well as advanced technologies and equipment in the clinic. They also provide training, education, mentoring and clinical support.

The team are always on-hand to answer queries from the clinician or their patient, and provide a full written report within seven days of the initial consultation. Clinicians can refer to the Centre with total peace of mind that their patients are in the most capable hands.

Get in touch with the team to find out more today.

Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co

01612 371842

www.ucer-clinic.dental

IAS Academy is offering clinicians the opportunity to learn the skills to overcome complex orthodontic challenges with the Advanced Diploma Course – a two-year programme that leads to The College of General Dentistry’s Diploma in Primary Care Orthodontics.

Clinicians on the course will learn how to utilise all appliance systems, including fixed functional, aligners, lingual and Inman, and covers all practical and theoretical of providing orthodontic care.

Over the course of the programme, clinicians will discuss cases and have access to webinars, participate in hands-on practical sessions and receive comprehensive mentoring, ensuring a complete educational experience.

Recommended for dentists who treat a minimum of ten orthodontic cases per year and who are already familiar with fixed appliances, this is an outstanding opportunity for clinicians who want to hone their orthodontic skills.

To find out more, contact IAS Academy today.

Clinisept+ Dental Mouthwash provides a clinically-proven alternative to chlorhexidine (CHX) mouth rinses. It delivers superior antimicrobial benefits with no staining or effect to taste.

A uniquely formulated, next generation hypochlorous solution, Clinisept+ is non-toxic, non-irritant, hypoallergenic and anti-inflammatory, as well as having a neutral pH and not being subject to antimicrobial resistance.

“Clinisept+ is fantastically effective. If you compare its antimicrobial capability with chlorhexidine, it’s far superior. Clinisept+, which is a next generation hypochlorous acid, is not just more effective against bacteria, it is far more effective than chlorhexidine at killing viruses, and also spores. So we now have a mouthwash that is more effective than chlorhexidine, but with none of the draw backs or safety concerns of chlorhexidine. The difference in improved treatment outcomes is quite remarkable in my view.”

– Neil Millington

To see the advantages for yourself, discover Clinisept+ today!

Find out more at www.cliniseptplus.com, or contact 01455 247797 or

info@cht-ltd.com

Dr Simon Chard speaks about stepping into the role of President at the British Academy of Cosmetic Dentistry (BACD), his goals for the future and why dentists should consider joining the Academy in 2023 

“One of my core goals as president of the BACD will be to continue the exceptional work of those that came before me. I didn’t take on the role to rewrite the rule book or anything like that. Instead, I want to keep supporting our members by enhancing the help we offer them and continuing to explore new, cutting-edge ways to provide the very best educational opportunities and events.

“Dentistry is a rapidly evolving industry and the BACD needs to evolve alongside it. I want to use my time to develop a unique approach to how we do this, giving our members tools they need to stay ahead of the game.”

As President, Simon is also hoping to open wider discussions on areas of the profession he’s passionate about.

“There are a few subjects I feel really strongly about and one of them is mental health. As you’re probably aware, dentistry is a profession that’s rife with mental illness – dentists are twice as likely to suffer from mental health conditions compared to people working in other professions, and this is something that needs to change. Suicide rates among dentists are also high, so I think it’s crucial that we start seeing dentistry as a community again – supporting each other through thick and thin and making sure that individuals always have somewhere to turn in times of need.

“I’m also very interested in how we can all work together to be more sustainable. In the modern day, a more eco-conscious approach is vital, so during my time as President I want to explore ways to make our conferences zero waste and to implement a generally greener way of operation. As dentists, we need to be aware of how providing top-drawer treatment impacts the environment and to think of ways that we can allow exceptional treatment and sustainability to work hand in hand. Together as a community we hold the solution, and I’m looking forward to discussing this with members of the BACD so that we can collectively ensure that the future of the Academy and dentistry as a profession is more environmentally responsible.”

With cosmetic dentistry featuring heavily in the news and articles focusing on poorly performed procedures such as “Turkey teeth”, the importance of ethically provided cosmetic dentistry cannot be understated. Simon shares his thoughts:

“In an age of social media and widespread news coverage, it can be difficult for patients and dentists alike to understand what real cosmetic dentistry looks like. Social media has transformed modern-day dentistry, and for all of the excellent perks these platforms bring, there are negatives too. That’s why it’s vital that the BACD remains ethical and relevant, not only giving professionals the knowledge they need to perform the highest quality treatment, but also ensuring that patients are educated so that they can make informed decisions. Now is the perfect time for dentists to join the BACD as the Academy is so passionate about imbuing individuals with top quality skills, taught by the best in the industry. It’s also a great place for networking and connecting with others who will take your career to the next level.

“I will also say that the BACD truly does have something for everyone. Regardless of whether you’re a newly qualified dentist or someone who has years of experience providing cosmetic care, the Academy opens the door to countless opportunities!”

As a long-time member of the BACD himself, Simon explains why the Academy is so important to him and his career:

“I’m so proud of the BACD today and the positive impact it has on members. The Academy was instrumental in guiding me to where I am today, and I’m forever grateful to those who have supported me at every step. This is what makes the BACD so special – it’s a place for everyone to learn from one another as well as to get that all-important support that can really elevate your career to new heights.

“It’s time for the BACD to reinstate real, high-quality cosmetic dentistry. I’m excited to see what the future will bring and to be President of an Academy that is committed to real excellence.”

The BACD welcomes all dental professionals with an interest in cosmetic dentistry. To find out more about becoming a member, please contact the team today.

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

A patient you’ve not seen for a while, or a new one who admits it’s been “years” since they visited the dentist, may give the reason as being embarrassed about the “state of their teeth”. Even if they’ve reached the point of no return where the pain is now unbearable, the destruction of the dentition is visible, or they’re worried by a lump that hasn’t gone away – they could still be terrified of feeling judged.

The number-one job of every practice team is to ensure all patients know they are their partner in a lifetime of oral health. Achieving this common goal can only be possible when there is understanding and empathy. Most of us have seen – and heard! – it all. The media bombards us with images of perfect teeth, and this can be inhibiting, but no matter the problem, we’re here to help. Taking care of people, so that they leave feeling good about themselves and motivated in better habits is a source of satisfaction for all DCPs.

There are lots of other reasons why patients feel awkward at the dentist, which can become a barrier to good relationships and partnerships. Cost is one, for example, if someone would love to go ahead with treatment, but doesn’t think they can afford it. Payment plans can give people the choice to access the care they want. Ensure everyone who could be asked about payment plans knows the details, or who to pass a query on to. Written information must be clear, concise, comprehensive and readily available. 

You may also have patients who are in good oral health, but have a cosmetic problem that annoys them. Perhaps they feel it’s too small to be bothering you with. Should they feel embarrassed about wanting dentistry for aesthetic reasons? Definitely not, because taking positive action to improve their smile could boost their confidence, sense of wellbeing and make them happier. The potential ongoing benefits to physical, social and emotional health from cosmetic dental treatments are money-can’t-buy and often life-changing. Also, after they’ve made the investment, they’ll be motivated to keep the result beautifully maintained, with your help.

A patient who dislikes their discoloured teeth may have bought a whitening kit online and, either because the results are underwhelming or they had a bad experience, they could be reluctant to tell you. When there is trust, they’ll feel more comfortable with full disclosure. In return, you’ll give them practical tips about how to improve the colour of the teeth without spending a lot of money and protect against further staining. Professional whitening treatment may not be as expensive as they think, though, especially if they spread the cost with a payment plan. For added value, they’ll get customised care, delivered safely.

“Is it going to hurt? Can I listen to music, or bring someone in with me?” – these can be awkward questions to ask. A survey has found that half the UK population are still fearful about visiting the dentist and, since Covid, there will be those nervous of close physical contact with strangers.[i] Anticipate these issues by talking about what you offer, to help people stay calm or distract them during treatment. Make it clear that they are in control, as sometimes feeling out of control is the root cause of anxiety. Go through your infection control protocols, too.

Patients may also have questions about something they have read online. The internet is full of many non-evidence-backed tips to improve oral health, also attention-grabbing headlines that do not reflect the complex research that inspired them. Self-diagnosis is another feature of the internet age, but with good relationships and conversations, you can put people’s minds at ease. If they’re worried, they should not delay a professional examination. You should let them know it’s OK to talk to you about something they’ve read – even from a dubious source ­– also about issues that affect their general as well as oral health, such as smoking cessation and nutrition.

They should feel comfortable admitting to not cleaning as well as they should. Patients can be liberal with the truth when it comes to flossing, but interdental brushing using a brush that is the right size for each space is effective, and easy to master compared to string floss. TANDEX do a range of interdental tools, including the WOODI made from sustainably-sourced birchwood, that you can demonstrate during your consultations.

There are various reasons people can feel embarrassed at the dentist, not just “bad” teeth. A patient feeling too intimidated to discuss a problem bothering them, or something they’ve seen online, or finances – these are barriers to oral health. Good relationships are always the solution, as the gateway to trust and to feeling comfortable enough to ask about anything.

For more information on Tandex’s range of products,
visit https://tandex.dk/ or visit the Facebook page: https://www.facebook.com/TandexUK

Our products are also available from CTS Dental Supplies https://www.cts-dental.com/ and DHB Oral Healthcare https://dhb.co.uk/

Author Kimberley Lloyd- Rees on behalf of Tandex

Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.

[i] Statistics from www.DentalPhobia.co.uk accessed September 2022.

Consider the LM Arte SOLO instrument duo available from J&S Davis for your anterior and posterior composite restorations. LM Arte SOLO offers dual ended tools especially designed for anterior and posterior restorations – enabling you to execute many cases with ease.

Complete excellent anterior restorations using the anterior instrument’s sharp tip to undertake precision modelling and limit marking and scratching, and its rounded tip for delicate delimitation and cervical contouring. The anterior tool also features a convex profile to enable you to create depressions, buccal profiles and access difficult areas.

The LM Arte SOLO posterior instrument features both a flat end and a sharp tip. Its design enables you to access deep cavities due to the angulation as well as execute precision modelling, micro modelling, flow distribution, and bubble elimination.

Try the LM Arte SOLO anterior and posterior instrument duo to create excellent functional and aesthetic restorations and transform your patients’ smiles.

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.