Month: May 2023

How do you know when to change your file?

When carrying out endodontic treatment, it is important that you are able to make accurate judgements about the materials and instruments you are using. Endodontic files, for example, carry a degree of risk, should they fracture during a procedure. Because of this, the clinician should feel confident, at all stages of the treatment, that the instruments they use are suitable for the task. This means ensuring that they are sterile, strong, and able to function properly. If a file has been used a number of times, it is important that the clinician checks for signs of wear, and makes a decision as to whether it is better to discard the instrument, or use it during the procedure. This is an important decision, and one which can impact the outcome.

Reducing the risk to your patients

As with any dental procedure, endodontic treatment carries a number of risks. Should a file fracture during treatment, this could impact the result, as well as the patient’s confidence in your abilities. It is important to inform the patient if this happens, and recommend a course of action, which may be to remove the file, or to leave it in place if it is safer to do so.[i] By thoroughly checking your endodontic files, prior to treatment, you maximise the chances of a successful outcome, and minimise the risk of fracture. However, signs of wear may not be immediately obvious, so it’s important to understand how to properly check this, and what actions and signs may increase the risk of file separation.[ii]

How to judge if files should be discarded

Conventionally, NiTi endodontic files do not offer clear indications of wear, therefore it is hard for clinicians to predict their lifespan. This is evident when compared to files made of stainless steel which show a number of signs of increased risk of breakage, these may include unwinding flutes and shiny spots on the file. These both indicate that the file is a fracture risk, and that it should be discarded.ii Generally speaking, instruments which have experienced cyclic fatigue should be used carefully, or discarded to reduce any risk to the patient. Additionally, clinicians should discard the file if it appears to be deformed, or if they feel at all unsure about its functional ability.[iii]

Autoclaving – damaging or strengthening?

For any reusable instruments, autoclaving is essential. It is vital to ensure equipment is completely sterile prior to use, to reduce the risk of infection and cross contamination. This being said, research suggests that autoclaving instruments may either cause deterioration, have no effect on their function, or may actually improve the mechanical properties of the instrument. Understanding the ways in which autoclaving may affect your files can help you to predict the lifespan of the instrument, allowing you to judge when is best to discard, and when to reuse.[iv]

Research suggests that stainless steel instruments show no change to resistance to cyclic fatigue, whereas NiTi files made using electrical discharge machining (EDM) recover their original form after heat sterilisation, and actually display improved resistance to torsional fatigue. This improved efficiency is because EDM technology produces a harder surface than other file types, and other manufacturing processes, resulting in superior fracture resistance, and more efficient cutting.iv It is important to consider the effects that torsional fatigue can have on your endodontic procedures, because this could be a key reason for file fracture during endodontic treatment. For clinicians who sterilise their instruments directly before use, is it useful to be aware of the way autoclaving can affect their endodontic files, particularly if it has the potential to strengthen them, or deteriorate them.iv

HyFlex™ EDM endodontic files from COLTENE are the ideal solution for predictable and efficient root canal treatment. HyFlex™ EDM files offer clinicians a clear sign when they need to be discarded. Thanks to their controlled memory (CM) technology, when autoclaved, they rewind entirely, appearing good as new. If they do not rewind, they should be discarded. This regenerative capability is unique to the HyFlex™ range, and incredibly useful, as clinicians will know that the file is working properly, and should be used for treatment.iiHyFlex™ EDM files are also extremely flexible, offering excellent results and unmatched fracture resistance, including in extremely curved canals.

Being able to provide patients with predictable endodontic treatment is essential, so using instruments which facilitate reliable treatment processes is crucial for producing excellent outcomes. Even though it can be challenging to assess the lifespan of your dental instruments, using quality equipment will be beneficial to you, enabling you to provide more predictable treatment. However, if you are at all unsure about the structural integrity of the instrument, it is generally more sensible to discard it than to risk file fracture during the procedure.

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

Author: Mark Allen, General Manager at COLTENE

[i] Madarati, A., Watts, D. & Qualtrough, A. Factors contributing to the separation of endodontic files. Br Dent J 204, 241–245 (2008).https://doi.org/10.1038/bdj.2008.152 https://www.nature.com/articles/bdj.2008.152

[ii] Singh, H., and P. Kapoor. “Hyflex CM and EDM Files: Revolutionizing the art and science of Endodontics.” Journal of Dental Health, Oral Disorders & Therapy 5.7 (2016): 5-8. https://www.researchgate.net/profile/Harpreet-Singh/publication/312658413_Hyflex_CM_and_EDM_Files_Revolutionizing_the_Art_and_Science_of_Endodontics/links/5ae85609aca2725dabb39bb8/Hyflex-CM-and-EDM-Files-Revolutionizing-the-Art-and-Science-of-Endodontics.pdf

[iii] You, Sung-Yeop, et al. “Lifespan of one nickel-titanium rotary file with reciprocating motion in curved root canals.” Journal of Endodontics 36.12 (2010): 1991-1994. https://www.researchgate.net/profile/Kee-Yeon-Kum/publication/49624065_Lifespan_of_One_Nickel-Titanium_Rotary_File_with_Reciprocating_Motion_in_Curved_Root_Canals/links/602a152d4585158939a65eec/Lifespan-of-One-Nickel-Titanium-Rotary-File-with-Reciprocating-Motion-in-Curved-Root-Canals.pdf

[iv] Dioguardi, Mario, et al. “Effects of hot sterilization on torsional properties of endodontic instruments: systematic review with meta-analysis.” Materials 12.13 (2019): 2190. file:///Users/officeone/Downloads/materials-12-02190.pdf

 

Grow your practice with Smile in a Box™

Offering dental implant treatment is a great way to attract new patients and grow your practice. The treatment type has risen in popularity in recent years,[i] however, providing this advanced treatment type can require significant investments in hardware and software, which is not always realistic for many dental practices.

Smile in a Box™ allows clinicians to access the benefits of the Straumann® digital workflow, without investing in additional hardware or software. The service allows you to focus on providing high-quality care to your patients, improving their experiences and allowing you to improve efficiency in your practice.

Smile in a Box™ is able to accommodate all clinical situations ranging from single tooth to fully edentulous cases – giving you access to market-leading implant systems from the Straumann Group. Choose between solutions from Straumann®, Medentika®, Neodent®, and Anthogyr, enabling you to provide patients with restorations of the highest quality.

Get in touch with the Smile in a Box™ team for more information.

 

For more information on the StraumannÒ Smile in a Box™, visit https://www.straumann.com/digital/en/discover/smile-in-a-box.html

[i] Forbes. Dental implants: everything you need to know. Accessed March 23. https://www.forbes.com/health/body/dental-implants-guide/

Calibre implant training for dental nurses

If you are a dental nurse who wants to take their career to another level, The One to One Implant Education has an Implant Diploma just for you.

Expand your role and invest in a more fulfilling future. With implant therapies in high demand, the dental nurse is now a crucial part of every implant team.

The One to One Implant Education has become known for its quality learning, delivered by a high calibre team of educators and dentists, led by the renowned Dr Fazeela Khan-Osborne.

In stunning modern facilities in the heart of Harley Street you will broaden your skills and deepen your knowledge.

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To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000

 

London 2023 Save the date! The BACD Annual Conference 2023

Professionals with a passion for cosmetic dentistry should mark their calendars with the dates for the BACD 19th Annual Conference.

Taking place in London on the 9-11th November, the 19th Annual Conference is guaranteed to be a must-attend event for the whole team!

Past events have seen an excellent line-up of world-class speakers take to the stage to present leading research in the field. There are also countless networking and development opportunities – and, as ever, the chance to let your hair down and connect with colleagues from across the nation.

Make sure you put the dates in your diary so you don’t miss out!

 

For further enquiries about the British Academy of Cosmetic Dentistry,

visit www.bacd.com

One way to optimise implant aesthetics

Aesthetics are a priority for most patients seeking any kind of dental treatment. When it comes to more invasive procedures that require greater investment from the patient themselves, aesthetic expectations are often at their highest. As such, clinicians offering dental implant therapy must do everything in their power to encourage the best possible outcomes for their patients. This includes minimising the risk of infection in order to optimise the health and appearance of the soft tissue around the surgical site.

“We are drowning in information but starved for knowledge” – John Naisbitt

Across all areas of dentistry, patient expectations have grown in recent decades. This may be for a number of reasons. The general population has easier access to information than it ever has thanks to the internet. Patients need only search for 10 minutes to find a wealth of details about the various dental procedures available today. The same search will also produce no end of images that demonstrate the stunning smiles of people who have undergone procedures and achieved amazing results. Social media is particularly good for this, with thousands of accounts showcasing some truly inspiring aesthetic results following dental treatment.

The problem is that patients do not understand the many variables that contribute to such a result, and mistakenly believe that they too will get the same outcomes. They do not appreciate that their anatomy or their budget might not allow for the same aesthetic results as they see on someone else. Similarly, they might not realise that the photos they see took many months or years to achieve, including several different procedures. 

With regards to dental implants specifically – though the evidence remains weak and more research is needed – a systematic review[i] found that many patients had unrealistic expectations of what implant treatment could achieve, which could lead to dissatisfaction with the final results. This can have far-reaching consequences. Not only can this impact the patient-practitioner relationship and their future dental care, but this could also have negative repercussions for the practice and its reputation too. It is therefore very important for clinicians to manage patient expectations from the very beginning of the treatment process, especially in relation to aesthetics.

Soft and hard tissue considerations

There are several factors that can influence the aesthetic results of dental implant treatment, including soft tissue related complications. Some of the most common soft tissue concerns affecting aesthetics according to Wang et al[ii] are asymmetry of the peri-implant mucosa level, lack of papilla, unnatural gingival colour and volume deficiency/concavity.

Peri-implant disease is another issue that can impact the soft tissue post implant placement. Researchers have estimated that 30% of implants placed experience peri-implant mucositis, while 10% suffer from peri-implantitis.[iii] This can lead to gingival recession (and bone resorption), which both affect smile aesthetics. Of course, some soft tissue recession is expected with any implant placement – Small and Tarnow[iv] estimated the average to be around 0.75mm in the first three months, with a total of 1mm within the first year. In cases where patients were at greater risk of recession, some studies[v] recommend regenerative or augmentation techniques to minimise the impact and enhance the final aesthetic outcome.

Regarding the hard tissues, the volume of the underlying bone directly correlates with the volume, and therefore aesthetics, of the soft tissue. Tarnow et al[vi] showed this by linking the crestal bone height to the dental papilla. 

Optimising aesthetic outcomes

With so many aspects to consider when looking to minimise the risk of aesthetic complications during implant treatment, meticulous assessment and planning are crucial. So too is post-operative care and the on-going oral hygiene. One systematic review and meta-analysis[vii] demonstrated clear benefits of supportive peri-implant therapy to reduce rates of peri-implant disease and resulting marginal bone loss.

It is essential to educate the patient so that they understand the role they themselves play in implementing consistent oral hygiene routines and minimising the risk of post-operative infection. They also need access to high-quality products – like Clinisept+ Dental Mouthwash. Clinisept+ is a next generation hypochlorous solution that is clinically proven to deliver superior antimicrobial protection. It minimises the risk of infection before and after oral surgery without causing staining or any of the other negative side effects associated with products containing chlorhexidine. However, because Clinisept+ is also non-toxic, non-irritant, anti-inflammatory and hypoallergenic, it provides the optimum environment for tissues to recover. Dentists and patients report excellent post-surgical outcomes.

Aesthetics remain an important consideration for patients seeking implant therapy, alongside function and longevity. To optimise treatment results, clinicians and patients must work together. Only with carefully planned treatment, the right surgical techniques and meticulous oral hygiene maintenance can outcomes be truly optimised. 

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

info@cht-ltd.com

[i] Yao J, Tang H, Gao XL, McGrath C, Mattheos N. Patients’ expectations to dental implant: a systematic review of the literature. Health Qual Life Outcomes. 2014 Oct 29;12:153. doi: 10.1186/s12955-014-0153-9. PMID: 25358599; PMCID: PMC4221691.

[ii] Wang IC, Barootchi S, Tavelli L, Wang HL. The peri-implant phentotype and implant esthetic complications. Contemporary overview. J Esthet Restor Dent. 2021; 33:212-223

[iii] Lee CT, Huang YW, Zhu L, Weltman R. Prevalences of periimplantitis and peri-implant mucositis: systematic review and metaanalysis. J Dent. 2017;62:1-12.

[iv] Small PN, Tarnow DP. Gingival Recession Around Implants: A 1-Year Longitudinal Prospective Study. Int J Oral Maxillofac Implants. 2000; 15:527-532

[v] Wada M, Mameno T, Otsuki M, Kani M, Tsujioka Y, Ikebe K. Prevalence and risk indicators for peri-implant diseases: A literature review. Jpn Dent Sci Rev. 2021 Nov;57:78-84. doi: 10.1016/j.jdsr.2021.05.002. Epub 2021 Jun 8. PMID: 34158874; PMCID: PMC8203834.

[vi] Tarnow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63(12):995–6.

[vii] Atieh MA, AlAli F, Alsabeeha NHM. Outcome of supportive peri-implant therapy on the rates of peri-implant diseases and marginal bone loss: a systematic review and meta-analysis. Quintessence Int. 2021;52(2):122-131. doi: 10.3290/j.qi.a45428. PMID: 33433078.

 

Sara Hurley standing down as Chief Dental Officer for England

Sara Hurley, the Chief Dental Officer for England, is standing down after eight years in the job to focus on her new roles as a Non-Executive Director at Surrey Heartlands ICB and as an independent director at the University of Suffolk.

Sara will bring her professional knowledge and understanding of NHS dental care systems to her new roles, maintaining momentum in the transformation of NHS dental services at local level. She was appointed Chief Dental Officer for England in 2015, prior to which, she served as a clinician and as Chief Dental Officer for the Army.

Since her appointment, Sara has championed innovation and delivered on her pledge to “put the mouth back in the body”. This has included programmes such as Starting Well, a ministerial supported initiative which increased dental access for children in the most deprived communities with in-practice preventative treatments. From this initial programme and the broadening of access for ‘Dental Check By 1’, children’s oral health is now an established priority for the NHS Core20Plus5 strategy for children and young people.

More recently, Sara led the dental profession through the Covid-19 pandemic, developing guidance for the profession on the safe delivery of care and managing risk. Whilst the pandemic had a significant impact on dental access, we are now starting to see the signs of recovery. Last year the NHS and Government launched the first reforms to the dental contract in 16 years. Sara was instrumental in developing and launching these reforms, which built on her work to move the profession towards risk-based recall and prioritisation of care for patients with high needs.

Other key reforms included better use of the skill mix of the dental workforce and allowing dental hygienists and therapists to work to their full scope of practice when delivering NHS care. These were key recommendations arising out the Advancing Dental Care Review that Sara initiated.

Together with the suite of evidence-based clinical standards she has maintained a drive on the quality of care and shared decision making.

As head of the profession, Sara secured access for dentists to the NHS Clinical Entrepreneurs’ Scheme and founded the CDO Clinical Fellows scheme.

With Sara’s support and encouragement, alumni of the scheme took the lead on highlighting issues of equality and diversity across the dental profession. The resulting report ‘Equality, Diversity and Inclusion in Dentistry profession wide commitment’ was backed by over 30 organisations and the profession’s regulators.

Sara informed the National Medical Director at the end of last year of her intention to leave the role in 2023 and has recently agreed she will depart at the end of June.

NHS England will shortly be undertaking the process to appoint the next Chief Dental Officer for England and we will announce further details in due course.

Sara Hurley, Chief Dental Officer England, said: “It has been an honour to serve patients as England’s Chief Dental Officer and I am grateful for the support I have received from all my colleagues, across the NHS, from patients, academia, clinicians, industry, and policy makers.

When I started, I said it was time to “put the mouth back in the body” – and together we have achieved a great deal to do just that. Although challenges remain, we are well on our way to changing services for the better.

Delivering for patients always has and always will be my passion and that’s exactly what I will continue to do.”

Professor Sir Stephen Powis, NHS National Medical Director, said: “Throughout her eight years as Chief Dental Officer for England, Sara has demonstrated outstanding national leadership, providing huge support and commitment to dentistry and the dental profession. From building the clinical evidence base for reform, embedding dental clinical leadership across the NHS to leading the profession through the pandemic, Sara has taken on every challenge with a relentless determination to deliver for patients.

Dentistry is an important part of the NHS and I look forward to working with Sara’s successor to drive forward further reforms to improve the service for patients”.

Dr. Claire Fuller, Chief Executive of Surrey Heartlands ICS said: “Sara has a track record of working to address oral health inequality and, importantly, to integrate oral healthcare with other services – the kind of joined up thinking which Sara supported and underpinned last year’s Fuller Stocktake. ICBs have taken on responsibility for dental and other primary care commissioning, and the further integration of primary care will be key in how we tackle wider health inequalities and improve population health.

We are delighted to have Sara’s national experience in Surrey Heartlands as we seek to drive this agenda forward and make life-long changes for local people”.

Mr. Matthew Garrett, Dean, The Faculty of Dental Surgery at The Royal College of Surgeons of England said: “The Faculty want to extend our sincere congratulations to Sara Hurley. Over her eight years has Chief Dental Officer, she has led the sector through difficult times and has championed oral health to help thousands of people. We wish her the best and hope to continue working closely with her.”

Professor Chris Tredwin, Chair of the Dental Schools Council said: “Sara Hurley has demonstrated exceptional commitment to the dental profession. Dental Schools Council members extend their gratitude to Sara for her outstanding leadership, teamwork, and negotiation skills, notably during the Covid-19 pandemic. Her championing of the dental team in its entirety, and the education of all its members, has been sincerely appreciated”.

Neil Carmichael, Non-Executive Chair of The Association of Dental Groups said: “Putting the Mouth back into the Body” was Sara’s vision as Chief Dental Officer for England and the policy implications must be followed through. She was also a passionate advocate for all dental professionals and utilising the skills of the whole dental team to provide better patient care will be one of her legacies.  I have enjoyed working with Sara who never let the constraints of her office hold her back and remain grateful for her readiness to engage with stakeholders including the ADG”.

Professor Rich Withnall, Chief Executive of the Faculty of Medical Leadership and Management said: “We would like wish Sara the very best in her new leadership role and thank Sara for her commitment, advocacy and sponsorship of the Chief Dental Officer’s Clinical Fellow Scheme over the previous six years. 30+ dentists have graduated from the scheme since it was established in 2017, many of whom are now in senior leadership roles across the healthcare system, with the scheme continuing to provide opportunities for dentists to develop as leaders of the future.” 

Stefan Czerniawski, Executive Director Strategy of the General Dental Council said: “Sara has been a key figure in dental leadership over the past eight years and her commitment to improving oral healthcare and patient safety has been evident throughout. We share that commitment with the CDO and her team and look forward to working with her successor.”  

Simon Hearnshaw, Coordinator National Community Water Fluoridation Network and member of the British Fluoridation Society said: “Over Sara’s stewardship we have seen Community Water Fluoridation gradually move centre stage as a public health measure with the potential to have profound impact on improving oral health and reducing oral health inequalities”. 

Heidi Marshall, Chair of National Association of Specialist Dental Accountants and Lawyers said: “Sara has been a champion of the NASDAL DCby1 Practice of the Year award since its inception in 2018. Dental Check by One is such an important cause and her enthusiasm for it has been clear for all to see. We wish her the best in her future career.”

Edmund Proffitt, Chief Executive, British Dental Industry Association said: “The dental industry wishes Sara all the very best for the future. Over the last eight years she has shown a detailed understanding of the industry and its critical role in supporting the provision of dentistry. Her leadership, knowledge and relationships with industry were key in facilitating dental treatment during the pandemic and in the resumption of wider treatment thereafter. Sara’s dedication and vision have been a credit to the post of CDO”.

Miranda Steeples, The British Society of Dental Hygiene and Therapy: “The BSDHT thanks Sara Hurley for her initiative of ‘Dental Check By 1’. Instilling the concept of preventive care being a lifetime habit is key in maintaining oral health for life and embraces the care that can be offered by all members of the oral healthcare team. We thank Sara for her inclusive attitudes towards oral health and those who may deliver those messages and wish her every success for the future”.

Rob Middlefell, National Dental Adviser at The Care Quality Commission said: “It has been a pleasure working with Sara over the last few years as we have navigated one of the most difficult periods for the profession. CQC has enjoyed a positive working relationship with Sara and her Office; together we have enabled our regulatory processes to be relevant, proportionate, and appropriate. We wish Sara all the best for her future”.

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GDC publishes latest research on the public’s views and experiences of dentistry

The General Dental Council (GDC) has today published its latest round of research into the public’s views and experiences of dentistry, which encompasses views on a range of issues, including use of and access to services, affordability, and confidence in dentistry.

The research shows that in 2022 there was a significant increase in the number of people seeing a dental professional compared with our previous round of research in 2021, with most respondents saying they were satisfied with the care they received. However,  some people continued to experience issues in accessing dental care, particularly on the NHS, and our findings also show that the proportion of respondents accessing private dental services has risen since our last study.

The research shows that around a quarter of patients are making an active choice to reduce their dental care due to concerns over costs. Those who are struggling with the cost of living may be more likely to visit a dental professional when they are experiencing a problem or know they need treatment, rather than for check-ups and prevention.

In terms of public confidence, while two thirds of respondents said they were confident in the quality of dental services (should they need them), there was less confidence in being able to access dental services, with under two fifths confident of being able to access services when needed.

GDC Executive Director, Strategy, Stefan Czerniawski, said: “This research provides a rich and detailed picture of public experience of accessing and receiving dental care. Although more people report having had dental treatment than in previous years, the research highlights continuing difficulties in accessing dental services, and a lack of public confidence in getting appointments when they are needed. The issues highlighted by the research are not new or unexpected – but they do demonstrate the challenges still facing dentistry and the need to make progress in addressing them.”

Change the way you do dentistry

Clinicians who sign up to the Essential Shape on-demand virtual training course, created by 3M Oral Care and StyleItaliano, will receive what they need to change how they do dentistry.

Dr Jordi Manauta will help you achieve anterior restorations that are beautiful and long-lasting. He’ll guide you through both a demonstration and a hands-on exercise in layering a single mass and creating a perfect shape, in addition to showing you how single shade restorations can transform the way you work.

Included in the programme is a practice kit containing 3M Oral Care products. As such, you’ll have the very best resources at hand during your course, helping you learn actionable skills with tried and tested products.  

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“I use the wax mainly to build stock trays which allow me to create high-quality impressions. Similarly, I use the compound to fill out any spaces within the trays, and use the green sticks to build up the peripheries so that I can get as accurate an impression as possible, which is especially useful for denture work.

“I would rate the green sticks very highly and the wax and compound 10/10. They are fantastic products; I would absolutely recommend them to colleagues. As the practice principal, I order them for my team directly from Kemdent. I have also lent these products to colleagues in the past, and I have shared content about them on Instagram, recommending that colleagues visit the Kemdent website.

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For more information, contact the Kemdent team today.

 

For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256