Month: February 2023

Purple Media partners with BDCDS

Have you registered for the British Dental Conference & Dentistry Show (BDCDS) 2023 yet? If not, you still have time to secure a free delegate pass, which is available to all dental professionals from the website. Don’t forget, BDCDS is the largest dental event of its kind, this year being held on 12-13 May at the NEC in Birmingham.

While it is the perfect event to gain Enhanced CPD and develop your skills, it will also be ideal for connecting with the wider profession and getting the very latest news in dentistry. As such, there will be various media outlets in attendance, including Purple Media Solutions – publisher and CPD training provider for the whole team.

Purple Media publishes several market-leading journals, including the UK’s oldest independent dental journal, The Probe. The organisation also offers Enhanced CPD content for thousands of clinicians and DCPs every year, as well as annually running the prestigious Dental Awards to celebrate the achievements of individuals and teams across the nation.

Purple Media will be a media partner for BDCDS 2023, which the team will be attending, connecting with professionals and covering the highlights in their own editorial. They will also be sharing copies of their publications and inviting anyone wanting to stay up-to-date with industry news to subscribe.

James Cooke, Editor of The Probe, comments: “We are thrilled to once again be partnered with the British Dental Conference & Dentistry Show. This is, without a doubt, the biggest and best British dentistry exhibition. No other event on the dental calendar attracts such a wide audience, which makes it the must-attend event for all dental professionals, as well as everyone within the wider dental sector.”

The British Dental Conference & Dentistry Show 2023 will be held on Friday 12 and Saturday 13 May, NEC Birmingham, co-located with DTS. 

For more information, visit birmingham.dentistryshow.co.uk or email dentistry@closerstillmedia.com 

Register today

 

GDC introduces further improvements to fitness to practise processes

The General Dental Council (GDC) has introduced some small but important changes to its fitness to practise processes. The changes aim to reduce the impacts on those subject to investigations, improve case progression, and make best use of limited resources in the absence of regulatory reform. It is now clear that full regulatory reform for the GDC is several years away following last week’s announcement by the Department of Health and Social Care (DHSC).

Fitness to practise can be a long and stressful experience for those involved. The latest improvements the GDC is making will reduce the impacts that long-standing or multiple investigations can have on those who are the subject to an investigation, and lead to improved performance.

The following changes have been made:

  • The GDC will close cases that mirror an investigation being carried out by another authority, for example the NHS or Medicines and Healthcare products Regulatory Agency (MHRA) at the Registrar’s direction. Cases involving an ongoing police inquiry, interim order, or where there are other open fitness to practise investigations will not be closed.
  • The GDC will not automatically open cases for matters referred from the NHS where the NHS is either investigating or managing the issues locally. Where there is a serious and immediate risk to public safety or confidence, the GDC will open an investigation (if, for example, the dental professional also practices privately) and, if appropriate, refer the matter to the Interim Orders Committee.
  • The GDC is reviewing and closing some older cases, those where there is no realistic prospect of establishing that a dental professional’s fitness to practise is impaired, following review and approval of the Registrar.

John Cullinane, Executive Director, Fitness to Practise, said: “We are looking to reduce uncertainty where we can for those who are subject to a fitness to practise investigation, because we know it can be a long and stressful position to be in. We are constrained by our legislation, but there are small changes we can make that together with other changes we’ve made will progress improvements in our performance and reduce the impact on those involved.”

The GDC will be tracking the impact of these changes, and other improvements it has been making, through an updated set of key performance indicators and timeliness measures that provide a more detailed picture of case progression at each stage of the fitness to practise process.

Head of Dental Nursing at Guy’s Hospital awarded MBE

BADN member and Head of Dental Nursing at Guy’s Hospital, Samantha Salaver,  was awarded an MBE for services to dental nursing in the New Year Honours List.

Samantha joined Guy’s and St Thomas’ NHS Foundation Trust in 2006 as a sister in the dental directorate, becoming a dental matron and then Head of Dental Nursing.  She set up the Dental Nursing Academy for apprentices at the Trust and is currently developing a specialist dental nursing degree.  She also set up and chaired the Association of Dental Hospitals’ dental nurses group, and has worked with NHS England to set up talent management for dental nurses.

Samantha is a member of BADN’s Panel of Representatives and also the BADN Education Committee.  She will be presenting a BADN Coffee CatchUp on the specialist dental nursing degree later in the year[1].

“I was overwhelmed and surprised to hear that I was to receive such an honour,” said Samantha. “I work with an amazing team and have been privileged to be supported by Guy’s and St Thomas’ – I am proud to be a dental nurse.”

Reference:

[1] To register for this or any other BADN Coffee CatchUps, sign up for to the BADN newsletters at www.badn.org.uk/newsletter

Hughes v Rattan one year on – what’s changed?

By Yvonne Shaw, Deputy Dental Director at Dental Protection

A year ago, the Court of Appeal handed down its highly anticipated judgment on the Hughes v Rattan case.

As a reminder, Mrs Hughes, represented by Dental Law Partnership (DLP), pursued a claim against Dr Rattan under both vicarious liability and non-delegable duty of care. Dr Rattan did not carry out any of the Claimant’s treatment, and the treating dentists had been identified at the outset and were willing to respond to the claim. DLP and their client refused to engage with them and instead pursued Dr Rattan as practice owner.

At the preliminary hearing in the High Court in June 2021, the judge ruled against Dr Rattan on both the vicarious liability and non-delegable duty of care elements of the claim and, with Dental Protection’s support, he appealed the decisions.

In February 2022, the Court of Appeal ruled that Dr Rattan was not vicariously liable for the actions of the associates concerned because of the freedoms they had in his practice. However, the judges agreed with the High Court that Mrs Hughes had been placed in Dr Rattan’s care as a patient of the practice and, as such, he had a positive non-delegable duty to protect her from harm.

The judges took into consideration the patient’s own perception and belief that she was a patient of the practice rather than the individual dentists who treated her. The personal dental treatment plan form used in England and Wales (FP17DC) was significant in relation to this point. The practice stamp named Dr Rattan as the ‘Provider’ and, although the ‘Performer’ number of the treating dentist is entered on the form, there is no field to record the Performer name. In the absence of any other documentation naming the individual treating dentists, it was therefore determined that the patients were ‘patients of the practice’.

At Dental Protection, we knew this case could have significant repercussions for the dental profession, and we were committed to challenging it as a matter of principle. One year on from the Court of Appeal decision, this commitment remains.

Enhanced protection for practice owners

Dental Protection has extended its benefits for eligible practice principal members to include additional protection against claims relating to treatment provided by self-employed, contracted dental practitioners. While eligible Dental Protection practice principal members can request assistance with vicarious liability and non-delegable duty of care claims where they are named as the defendant, we remain committed to fighting them on behalf of members and the wider profession.

Vicarious liability claims

The Court of Appeal ruled that Dr Rattan was not vicariously liable for the actions of the associates concerned because of the freedoms they had in his practice. While the decision was based on the facts specific to this case, meaning the judgment does not set a precedent for all other vicarious liability claims, it is benefitting other practice owners in England and Wales who are in a similar position to Dr Rattan.

Guidance to help stop claims being successful

At the time of the Court of Appeal judgment, we, at Dental Protection, said we would consider the Court’s findings carefully and provide further guidance to help reduce the chance of a vicarious liability and non-delegable duty of care claim being successful.

In July 2022, we set out some practical steps to enable practice owners to reinforce that a patient is under the care of the treating dentist, and to limit consideration that the associate relationship is akin to employment. This guidance can be viewed here and is a five-minute read. Some of the steps set out seem administrative but may just ensure a claim does not progress.

Who can make an offer of compensation

One of the most frustrating aspects of the Hughes v Rattan case was the fact that the treating dentists were willing to respond to the claim from the outset in 2016. They made offers directly to DLP to compensate Mrs Hughes, the first of which was made three years before the case was first heard in the High Court. DLP rejected all offers made by the treating dentists on the basis that the treating dentists were not party to the legal proceedings and decided to still pursue Dr Rattan as the practice owner at the time.

This added to the uncertainty, stress and complexity for Dr Rattan. It is also fair to question whether the resulting delays due to DLP’s approach served Mrs Hughes’ best interests.

As a result of DLP’s refusal to engage with the treating dentists, offers were then made by Dental Protection on behalf of Dr Rattan to compensate Mrs Hughes. DLP rejected these offers too which is why the case proceeded to a preliminary hearing in the High Court in June 2021.   

The recent case of Stephen Fletton v Petrie Tucker & Partners Ltd is helpful regarding who can make a valid compensation offer under Part 36 of the Civil Procedure Rules. DLP represented Mr Fletton in a claim alleging that the dental practice owed him a non-delegable duty of care and were vicariously liable for the three treating dentists who it was alleged failed to diagnose and treat periodontal disease.

The judge found that the compensation offer put forward by two of the treating dentists, via Dental Protection, was indeed a valid offer. While this judgment is a first instance decision, it does mean DLP can no longer reasonably refuse to negotiate directly with the treating dentists, even if a claim has been brought against the practice. This further strengthens our argument that there is no reason for a claim to be brought against the practice owner, where the treating dentists are cooperating and are prepared to settle the claim.

Corporate Protection

In January this year, Dental Protection introduced a new product, Company Protection, which allows incorporated companies to request assistance in the event they are alleged to be vicariously liable for the acts or omissions of a clinician working for the corporate and/or where the corporate is found to owe a non-delegable duty of care for the patients treated on its premises.

This product sits separately and in addition to any individual practice principal membership with Dental Protection. Any incorporated dental company with employees and a gross annual turnover of less than £1.7m can apply for Company Protection. Subscriptions are based on the individual circumstances of the company; for example, the number of dentists and dental care professionals working within the company, the number of Dental Protection members, and the period of retroactive protection required.

Many practice owners may not have considered that an incorporated practice is at risk of being the subject of a claim in its own right. Company Protection benefits include redirection and defence of vicarious liability and non-delegable duty of care claims. If these claims cannot be redirected or defended, Company Protection also will pay compensatory damages. It includes a claims indemnity limit of £1m for each claim and in the aggregate, and up to 10 years’ retroactive protection. The product also includes access to expert dentolegal and media advice and support. We hope it will offer some peace of mind for incorporated companies.

New hub

We understand that vicarious liability and non-delegable duty of care claims are complex and can be confusing. We have created a new hub to provide additional information, explain the different types of protection available, and help you decide which is right for you and your business. 

Webinars and podcasts

We have also been organising webinars and podcasts to help members understand the principles in vicarious liability and non-delegable duty of care cases.

On 28th March, we are hosting a Hughes v Rattan one year on webinar, where Dr Rattan will be joined by other Dental Protection colleagues to discuss these cases, understand the emotional burden of a claim and where to seek support. You can register for this webinar via Prism.

Dental Protection exists to protect the careers, reputations and financial security of our members. It is right that we take on important matters of principle like this, and we will continue to do everything we can mitigate the impact of vicarious liability and non-delegable duty of care claims for members.

My journey to making a crown in an hour genuinely possible

Alison Simpson talks about her journey to achieving highly aesthetic CEREC Tessera™ crowns in just one hour

 

Read the full article here, or listen to the audio version courtesy of The Probe Dental Podcast, also available on all major podcast platforms, including Apple Podcasts, Google Podcasts, Spotify:

Since opening my first squat clinic back in 2005 and subsequently moving on in 2015 to be principal of my private practice, Trinity Dental in Rothwell, I’ve always wanted to embrace the digital world of dentistry.

For over 30 years CAD/CAM technology and the CEREC® system have been at the forefront of digital dentistry, making same-day dentistry mainstream while simplifying every stage of the restorative journey from treatment planning, design and manufacture to final placement. I wanted to be a part of that journey, but I just needed the right support to get me on my way.

I talked to my colleagues about a move digital; some were very positive, a few less so, but I knew I had to start somewhere and I felt the time was right to get on board. I could see that a CEREC digital workflow would give myself and my associates the ability to take digital impressions, design, mill and place restorations within the practice in just one appointment. This was definitely the way forward in building a successful practice.

A validated workflow

Thanks to the innovation shown by Dentsply Sirona and the customer support they offered me to get the right equipment in place, we started offering CEREC same-day crowns in the practice in 2016 and haven’t looked back.

From my initial digital start-up with the CEREC® Omnicam, we now have our own in-house ceramic studio that centres on a combination of the latest state-of-the-art components – the CEREC® Primescan intraoral scanner, CEREC design software, the CEREC® Primemill and the CEREC® SpeedFire sintering furnace.

As well as same-day crowns, this validated digital workflow has enabled us to offer a range of restorative dental treatments including bridges, inlays, onlays and veneers to be easily completed in a single visit, as well as bringing faster clinical delivery of treatments such as dental implants and orthodontics.

Material choice

The  key to any successful restoration is in the choice of restorative material, not just for essential strength and aesthetics but also the compatibility with the milling and firing process for predictable treatment outcomes. The Primemill is compatible with a wide range of materials from validated manufacturers including feldspar, lithium disilicate and zirconia.

However, my material of choice now for almost every indication is Dentsply Sirona’s new CEREC Tessera block, an advanced lithium disilicate ceramic designed to accelerate the manufacturing process by significantly shortening the glaze firing time using the SpeedFire to just 4 minutes 30 seconds. Tessera also has significant material strength of >700 MPa and since I’ve started using it I’ve been really impressed with the overall aesthetics, especially the chameleon effect it brings, allowing the material to blend smoothly into the arch.

My associates have been so impressed with Tessera and the time it saves across the manufacturing process, that we have just procured a second SpeedFire. Instead of having to wait 15 minutes or more for conventional firing where it’s easy to get sidetracked onto other tasks, in the five minutes it takes with the CEREC SpeedFire we can bring the patient back into the chair, get them settled and get on with final placement.

This not only makes the treatment journey much easier for patients, it frees up more time for me to work on my business. It means you feel more in control, you have time to organise your business more efficiently and have more time to communicate with and educate your practice team.

Time-saving tips

In October 2021 as part of Dentsply Sirona’s ‘Let’s Talk LIVE Decoding Digital Dentistry’ event, I presented a live surgery demonstration of a single crown workflow with a real patient. This focused on the whole chairside process and how Primescan, Primemill and the SpeedFire together with Tessera CAD/CAM blocks all combine seamlessly to make a crown in an hour genuinely possible.

In the run-up to the event and with the advice of one of Dentsply Sirona’s digital specialists, I realised I could make further changes to my workflow which would make it possible to design, create and fit a Tessera crown in under an hour. Simple changes to the surgery layout combined with the speed of firing has resulted in an even more efficient workflow that has benefitted my entire team. I feel that Tessera has been the final step on my journey into same-day dentistry and my ability to deliver a crown in under an hour.

Changes for the better

Digital dentistry has come a long way in recent years. It isn’t something to be afraid of but something to challenge yourself with and there’s never been a better time to get involved.

The whole experience has given me a real hunger for more knowledge and what I like is knowing that this journey has not ended. With digital dentistry, it’s so good to know that every year you’re succeeding a bit more than last and that you’re growing not only as a person but as a clinician. But ultimately, what matters most is that we’re able to give our patients the best of experiences to make them feel a lot more comfortable about their treatment while giving them the best of oral health.

To find out more about Dentsply Sirona’s CEREC CAD/CAM solutions, please visit https://www.dentsplysirona.com/en-gb/categories/cerec.html 

To find out more about Dentsply Sirona’s CEREC Tessera CAD/CAM blocks, please visit https://www.dentsplysirona.com/en-gb/categories/restorative/cerec-tessera.html

You can visit the online Dentsply Sirona Academy for a wide range of education resources, video tutorials, courses and CPD webinars at dentsplysirona.com/ukeducation.

Earn DS Points Plus loyalty rewards on all your digital solutions at dentsplysirona.com – all the solutions you need under one roof.

Facebook: @dentsplysirona.uk
Twitter: @DENTSPLY_UK
Instagram: @dentsplysirona.uk

Alison Simpson BDS is Director and Principal at Trinity Dental

www.tridental.co.uk

Dental Technology Showcase 2023 – everyone is welcome, so don’t miss it!

Dental Technology Showcase (DTS) is returning to NEC Birmingham and is set to be better than ever before!

It has never been more important for the industry to come together, not just to celebrate its success and resilience, but to problem-solve the common challenges.

As a key part of the dental team, technicians are at the forefront of change, with more digital technology being used to elevate outcomes and make workflows more efficient.

DTS has always been for everyone, whatever your role. Being co-located with the British Dental Conference & Dentistry Show means there is a unique opportunity to see what dentists are doing, and the issues that are concerning them too.

With a trade exhibition featuring renowned brands and pioneering new start-ups, don’t miss your chance to attend. Register your interest today.

 

DTS 2023 will be held on Friday 12 and Saturday 13 May, NEC Birmingham,
co-located with the British Dental Conference & Dentistry Show. 

For more information, visit the-dts.co.uk or email dts@closerstillmedia.com

Dental Protection: Interim Orders Committee guidance must be clear and comprehensive to avoid unnecessary conditions

Dental Protection has welcomed proposed changes to the guidance used by the GDC’s Interim Orders Committee (IOC), but says refinements are needed to ensure the IOC has the most comprehensive information possible, when deciding on whether an interim order is necessary.

The IOC is a statutory committee of the GDC which considers whether it is necessary to make an interim order to restrict the individual’s practice pending final determination of the matter by the GDC. A decision can be made to impose an order if the IOC is satisfied that it is necessary for the protection of the public, or otherwise in the public interest, or in the interest of the individual concerned. The IOC can impose a suspension (up to 18 months with six monthly reviews), conditions (up to 18 months with six monthly reviews) or decide that no order is necessary. Having such an interim order imposed can have a very significant impact on dental professionals and it is therefore important that such orders are used appropriately and proportionately.

Responding to the GDC’s consultation on proposed revisions to its IOC guidance and Conditions Bank, Dental Protection said there was a need for the IOC to be provided with further and comprehensive details as to specific allegations against the dental professional, to help the IOC decide whether there is a risk to the public. It said this additional information would help to ensure the IOC assesses the risk to public safety consistently, proportionately and appropriately.

Dental Protection called for further refinements to allegations relating to clinical cases, lack of indemnity or insurance, failure to cooperate with an inquiry, sexual misconduct and violence, working beyond scope of practice, and concerns about the health of a dental professional.

The leading defence organisation also said further clarity was needed in the definitions used in the glossary of the IOC guidance, including in respect of the term ‘reviewer’, which is unclear and could refer to the registrant, supervisor or reporter. It said the glossary, guidance and the conditions bank provide important supporting literature and must be clear in order to facilitate appropriate decisions.

Dr Raj Rattan, Dental Director at Dental Protection, said: “We support dental professionals with IOC processes and hearings day in day out. We see the impact these hearings have on their careers and wellbeing and appreciate the opportunity to contribute to this important consultation.

“Dental Protection has strong teams of experts, with considerable experience of IOC processes, who have taken the time to review the proposed changes. While we broadly welcome the proposals, we have highlighted some key areas that require further refinement. The IOC must have comprehensive and clear guidance and supporting literature, in order to make appropriate decisions. Interim orders can have career changing implications for members, so we must get this right.

“While we welcome the proposed amendments to the IOC Guidance, we would also welcome the GDC reviewing the processes by which registrants are referred to the IOC in the first instance. We remain committed to working with the GDC on this matter.”

Dental Protection’s full response can be found here.

TMD and nutrition – the role diet plays in helping patients manage symptoms and maintain good health

Temporomandibular disorder (TMD), a set of conditions characterised by pain and discomfort in the temporomandibular joints (TMJs), can compromise nutritional status. A person with TMD may find it too sore to bite and chew, so will eliminate certain foods and instead eat a ‘soft’ diet, which although adequate initially, may not provide the range of nutrients needed to stay healthy in the long term. Particularly if they’re elderly, or rehabilitating from illness or surgery, poor nutrition can lead to other problems, exacerbate existing ones and impede recovery.

Mild or moderate TMD can come and go and is generally eased with simple strategies, such as taking over-the-counter pain relief or applying heat or cold to the area. Some conditions that fall under the TMD term, however, can significantly affect quality of life, such as trismus, when a person is unable to open their mouth wider than 35mm. This is one example of when TMD can make mastication painful, perhaps unbearably so. A patient’s enjoyment of eating will often be diminished, too; a key point because, even after their TMD has improved, a lack of pleasure in food may remain. This isn’t just a nutritional issue; socially, this can prevent someone living life to the full, impacting their emotional wellbeing.

After a diagnosis of TMD, treatment plans should assess what changes can be made to minimise eating-related discomfort, which also enable the individual to maintain good health. Their diet should incorporate foods from all the main groups, so soft dairy/dairy alternatives, soft fruit and vegetables without seeds or skin, which can be mashed, cooked and/or puréed or served as a smoothie or soup (rice could be added for bulk, if the patient can tolerate it). For protein, meat can be slow-cooked to tender and fish served unbreaded; vegetarian/vegan alternatives include mashed tofu, beans and pulses. For sweetness, there are plenty of options and, if gaining weight is a priority, smooth ice-cream, custard and milkshakes will add calories. Although weight loss is common for people with TMD, others may find they have gained, particularly if they are suffering from another systemic condition, like back pain, which has limited their mobility. Working with a dietician will help them stay well-nourished, while avoiding unwanted extra pounds. Even if a patient doesn’t need to gain or lose anything, while they’re managing TMD, they should eat plenty of nutrient-rich foods. Avocados, for example, are soft, high in healthy monosaturated fats, as well as being a source of folic acid, potassium and other important vitamins.

All healthcare professionals involved with a TMD care plan can support nutrition motivation. If the pain is severe and chronic, the thought of eating, let alone preparing a meal, can be exhausting. If someone has had to change their diet, and has eliminated high fibre foods that are often difficult to chew, they may have become constipated. Staying hydrated is important, and warm drinks can have a stimulant effect. Herbal infusions may be the most beneficial, as some TMD patients have reported that avoiding caffeine, which can “excite” the nerves, eased their symptoms.[i] To add fibre, seed and nut-free breads, particularly with a high bran content, can be soaked to in water or milk and finely-ground flax seeds are good when added to a drink or soup.

There are various therapies for TMD and a combination of several are often used in care and management plans, for example drugs and medication, psychotherapy and cognitive therapy (effective for bruxists and chronic nail-biters, pen chewers etc.). In more complex situations, speech therapy may be required, especially after surgery. Physical therapies include jaw exercises and learning how to adopt a correct posture to avoid straining the neck and shoulders. There are tools, too, that a patient can safely use at home. The OraStretch Press, distributed by Total TMJ, is a device that enables the user to maximise their range of motion, reduce pain and help the muscles around the jaw get stronger. Typically, it can add 1-2mm per week to how wide a person with TMD can open their mouth. For healthcare professionals, products like these provide an easy way to support people in dealing with this debilitating, often isolating condition.

The TMJs are among the most-used joints in the body. Because TMD can be caused by various things from overuse to injury, bad posture and stress, treatment tends to be multiagency, with the patient exploring ways to feel better, manage their TMD and improve long-term comfort, alongside a range of different professionals. Due to the potential for compromised nutrition with TMD, dietary advice will be part of care and management plans, in terms how food choices can ease masticatory pain, as well as promote good health.

For more details about Total TMJ and the products available, please email phil@totaltmj.co.uk or karen@totaltmj.co.uk

[i] King’s College Hospital. Patient Information Leaflets, Temporomandibular Dysfunction. Accessed at: https://www.kch.nhs.uk/patientsvisitors/patients/leaflets (September 2022).

Missing teeth? Easy, put in some implants

Dr Chris Leech, Scientific Director for the British Academy of Cosmetic Dentistry (BACD), presents an interesting case example that is often seen in general dentistry. He shows how comprehensive general dental skills– which are firmly advocated by the BACD among all members – are essential to providing a sufficient solution for the patient…

Implants are a fantastic tool we may utilise when restoring a patient’s dentition. However, as with all treatments they need proper planning and diagnostics in order to be successful. If a tooth has failed we must always start with “why”, and then ascertain how we can address the issue. The case below is all too familiar with what I routinely see. Seemingly it often happens in practices where an implantologist comes in and works on referral. They are tasked to “simply” replace missing teeth, often only surgically, and then the usual dentist pops some teeth on top, easy! The importance of managing the patient’s entire dental health can not be emphasised enough and I often find that patients ideally need pre restorative work to their remaining dentition before utilising implant therapy if we want to minimise risk and maximise longevity.

(Presenting Condition – Figures 1a-1c)

The patient had recently moved to the area and so was unable to visit her treating practice. She was having issues in that her implant teeth kept falling off. They had been re-cemented multiple times but the same thing kept happening. She claims she had been reassured this was normal. The radiographs (Figures 2a-2c) revealed severe bone loss around the implants. The patient was informed of our findings and was understandably not happy. At first, she was not entirely accepting of our diagnosis, especially when we explained that we felt the implants would need to be removed or in fact may simply fall out by themselves – most likely those around the lower left bridge. We explained how we felt there was complete occlusal failure occurring and that a full mouth rehabilitation was required.

The patient didn’t sign up to any care with ourselves but then returned around a month later with something in her hand. (Figure 3)

At this point the patient cited how we had informed her that this would likely happen and so now she wished to hear our proposal to restore her mouth to health. The patient also indicated that she would not accept any more implant treatment due to the cost and would prefer a denture.

The first thing we did was remove all the failing implants as well as embarking on some oral hygiene instruction and maintenance with our hygiene team. We also placed some simple composite restorations on the upper centrals to seal over the ominous fracture in the 11 and seal some of the exposed dentine on the palatial surfaces. Our diagnosis was one of an overclosed bite and a restricted envelope of function. The patient did not want a temporary healing denture.

Figures 4a-4c show the result after this initial stage and healing.

Now we had a healthy mouth we could begin to plan the patient’s new vertical dimension and occlusal scheme.

Thanks goes to Ashley Byrne and his team at Byrnes Dental Laboratory for their assistance with this case. Figures 5a-5b

The new vertical dimension and occlusal setup was designed as well as a wax try in for the missing teeth. Data from 3Shape Trios scans of the mouth were used to do this. Direct composite was used on the lower anterior teeth following the model’s proposed redesign using templates. The upper teeth as well as 46 were prepared for crowns with rest seats and guide plans for precision fit cobalt chrome dentures. These teeth were prepared and temporised with Protemp from the models at this stage. As figures 6a-6c below show, we had opened the vertical dimension and addressed the restricted envelope of function. This was “dialled in” directly in the patient’s mouth and we actually opened the vertical dimension more by adding composite to the palatal aspects of the upper centrals using the patient’s profile and passive lip position to guide us to the correct vertical position. A new Trios scan was then taken to communicate this adjustment to the lab.

The crowns were delivered with printed resin try ins of the framework design so that we could check for accuracy. The fit was perfect (it always is from Byrnes). Once this was confirmed the lab was given the go ahead to manufacture the final dentures. Figures 7a-7c

The lab work was returned – figures 8a-8b.

The fit and retention that can be achieved utilising precision preparation of the crowns is very impressive and the patient was delighted. Figures 9a-9c

Of course, the patient has been instructed of the importance of maintaining her oral hygiene and the need for ongoing professional maintenance. Overall, this case was interesting since the failure of the implants was likely not down solely to the implants themselves. The overall demise of the patient’s dentition and traumatic occlusion demonstrated by the amount of tooth wear as well as the repeated debonding of the indirect restorations was the key element to be managed here.

Dr Christopher Leech BDS MAGDS RCS (Ed)

MFDS RCPS (Glasg) Dip Imp Dent RCS (Ed)

After studying Dentistry at Newcastle University Chris also trained at Sheffield University where he discovered a love for dental implants. He has travelled Internationally training to the highest standards and is the Scientific Director for the British Academy of Cosmetic Dentistry. He is also the first dentist in the UK to pass the Membership for Advanced General Dental Surgery with the Royal College of Surgeons Edinburgh and is a member of the Dental Faculty for the Royal College of Physicians and Surgeons of Glasgow. Chris has also been awarded his Diploma in Implantology from the Royal College of Surgeons Edinburgh. He is an examiner for the Royal College and also a member of the Society for the Advancement of Anaesthesia in Dentistry.

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Maximise comfort for you and your patients

The Medit i700w intraoral scanner, from the Straumann Group, makes digital impression taking comfortable for you and your patients.

This model features a detachable cable, 245g lightweight design, 108º reversable tips, and remote-control mode to maximise manoeuvrability. 

But its fantastic features don’t end with the hardware. Gain full access to Medit Link, the software with intelligent features and specialised apps for your dental procedures. And, its regular software updates continually streamline your scanner experience and enhances performance. 

This software also improves communication between you and your patient, allowing patients to visualise the potential results of their dental procedure for increased treatment acceptance.

Consider the Medit i700 to improve both yours and your patients experience.

For more information about the Medit i700, please visit https://www.straumann.com/digital/en/home/equipment/io-scanners/medit-i700.html