The use of a rubber dam for endodontic treatment is crucial to effectively isolate the tooth, including the root canal, from bacteria, as well as protecting the patient’s airway.[i] Even though the rubber dam presents a range of benefits to the clinician and the patient, as well as improving surgical outcomes, many dentists choose not to use them after qualifying. Because of this, endodontic treatment may be performed without one.[ii] This decision brings with it a number of risks, so it is important that clinicians consider the regular use of rubber dams during endodontic treatment, and ensure that patients are informed of the benefits.

The risk of not using a rubber dam

Without the use of a rubber dam, the risk of a patient accidently swallowing or aspirating a dental instrument, irrigation fluid, or debris is significantly higher. This presents a number of issues for both the patient and the clinician. Injury can be caused to the patient, for example, if an instrument is swallowed and becomes lodged, or irrigation fluid (like NaOCl) is ingested, as it is an irritant. These risks can also present medicolegal challenges for clinicians.ⁱⁱ When a rubber dam is used, these potential problems are less likely, and therefore you are protected from any legal responsibility if accidents happen.ⁱⁱ

Cross contamination is another major risk when a rubber dam is not used during endodontic treatment. Because of this risk, the use of a rubber dam could be considered essential when carrying out endodontic treatment. A rubber dam creates a seal, separating the treatment area from the patient. This means that the patient will be unaffected by irrigating fluids and medicaments used during the procedure. Similarly, the treatment site is protected from any harmful bacteria present in the patient’s mouth. When this simple step is implemented, you protect yourself from litigation, and your patients from infection.ⁱ

Barriers to rubber dam use

Research shows that the majority of dental students expect that they will use rubber dams during treatment in practice, having used them as part of their education. However, the use of rubber dams appears to dramatically decrease post-graduation. In fact, endodontic treatment is generally performed without the use of a rubber dam.ⁱⁱ

Even though there are a multitude of benefits for both the patient and the practitioner, a number of reasons are given as to why rubber dams are not used during treatment. These include, lack of patient acceptance, more time needed for application, insufficient training/practice, difficult to use, as well as cost of materials and equipment.ⁱⁱ Even though these may be barriers in some cases, rubber dam placement is simple once the clinician has a good understanding of it. With proficient use of a rubber dam, clinicians will find application straightforward, and the process will become much faster.ⁱ

Those who use rubber dams frequently report that they face minimal patient resistance.ⁱⁱ A useful parallel to help patients understand the reasoning is that it isolates the operating site in the same way as a surgical drape, protecting the site from contamination. Once the reasoning behind the use of a rubber dam has been explained to patients, they are unlikely to reject it.ⁱ

Benefits of using a rubber dam

So, what are the benefits? In addition to protecting your patients from injury and infection, the use of a rubber dam results in significantly reduced microbial content of the aerosols produced during treatment.ⁱⁱ This is beneficial to the dental team as it reduces the risk of infection in the practice by up to 98.5%.ⁱ They also present the additional advantage of improved visibility and access to the treatment site as the rubber dam retracts the soft tissues, protecting them from injury, and making access to the field more straightforward. Visibility is also improved as they provide a dry field (which reduces mirror fogging) and creates a contrast.ⁱⁱ

The HySolate range of dental dams from COLTENE ensures complete isolation, crucial for providing effective and predictable dental treatment. Available in a range of colours and shades, including HySolate Black Edition, you can illuminate your site or create a clear contrast for excellent visibility. Plus, HySolate dental dams are available in a powder-free latex or a latex-free range to accommodate the needs of you and your patients.

Consider the use of a rubber dam for your endodontic treatment. They provide you with improved access to and visibility of the treatment site, helping to improve outcomes, while removing the risk of injury, contamination, and infection. This allows you to focus entirely on the treatment itself, rather than being concerned with protecting the patients’ airways and retracting the patients’ soft tissues.

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

Mark Allen

Author: Mark Allen, General Manager at COLTENE

[i] Carrotte, P. Endodontics: Part 6 Rubber dam and access cavities. Br Dent J 197, 527–534 (2004). https://doi.org/10.1038/sj.bdj.4811799 https://www.nature.com/articles/4811799

[ii] Ahmad, I. A. “Rubber dam usage for endodontic treatment: a review.” International endodontic journal 42.11 (2009): 963-972. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1365-2591.2009.01623.x

Dr Hazra Patel recently completed the Reveal: Confident Smile Makeover course from the IAS Academy. Hazra comments:

“I have been using the Invisalign aligner system for a number of years and wanted to offer additional options to my patients. When I heard that Dr Tif Qureshi was delivering the course, I confirmed my place. I have colleagues who have attended courses presented by Tif in the past and they have very much recommended them.

“I have been a dentist for 17 years and I felt I had a good grounding in most aspects of dentistry. This course encouraged me to look at my patients with a fresh pair of eyes, and I now regularly have conversations about intervention in order to prevent problems developing in the future. I also provide treatment which offers improvements in function, not just aesthetics, and practice more ethical dentistry.

“All of the information delivered on the course was useful and relevant to daily dentistry. The concepts we learnt could easily be applied the very next day in clinic and I have already adopted many of them. I have also been using the IAS Academy orthodontic assessment form, which ensures I correctly assess and plan my orthodontic treatment in a safe manner.

“I would definitely recommend this course to others. In fact, I have already done so! Any future orthodontic courses I take are likely to be with the IAS Academy, and I would like to take the Fixed Braces course next.”

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

For many patients, conventional dental implants are the ideal solution for their edentulism. However, there remains a cohort of patients whose severe disuse atrophy makes them unsuitable for regular implant treatment. With the ever-increasing popularity of implants as a solution, and an aging population with rising numbers of complicating factors, finding alternative treatment pathways is only going to become more important. Site specific implants including zygomatic implants, pterygoid, trans-sinus and nazalus implants, as well as patient specific 3D custom printed titanium implants, are now available as evidence-based, safe and reliable treatment options for the rehabilitation of the atrophic edentulous patient.

Dental implants fundamentally depend on osseointegration for their success. Many factors can impact the success of osseointegration, and potentially compromise it in the long-term. On a basic physical level, the dimensions of the implant hold influence over how load is distributed. The more implant surface area is in contact with surrounding bone, the less stress is proportionately transferred.[1] That said, larger implants are not always suitable and provided that the patient fits specific criteria, shorter modern implants are a promising treatment.[2]

All things being equal, osseointegration success in the maxilla is notably lower than in the mandible (though success rates overall remain very high). Fundamentally, the quality and quantity of maxillary bone, particularly in the posterior region, is generally inferior to mandibular bone for long-term implant success.[3] This deficit is the case even when the bone is in a healthy state, but can be further exacerbated due to illness and long-term complications, such as failing implants due to advanced peri-implant disease. Lower diameter implants placed in the posterior region can potentially cause excessive bone loss due to comparatively higher amounts of stress being transferred to them than to a broader implant.

Zygomatic implants are substantially longer and wider than the largest conventional dental implants, providing increased stability compared to traditional types. The zygomatic bone itself is sturdy and dense tissue, which can provide improved stability for dental implants. This is particularly important for patients who have suffered significant bone loss and need a solution that will provide a stable foundation for their new prosthesis.

In some cases, such as when severe resorption and remodelling has occurred, a bone graft may be called for in order to rebuild sufficient volume for conventional implants. While this can still be employed in conjunction with zygomatic implants (such as with the extended sinus elevation technique), under the right circumstances the structural strength of the zygoma can facilitate simpler, more streamlined treatment.[4]

Because zygomatic implants can compensate for insufficient bone without augmentation procedures, the approach is of special relevance to patients who have lost substantial tissue and function due to conditions such as oral pathology, disuse atrophy or peri-implant diseases.

Zygomatic implants are placed using 3D computer aided planning and guided surgical techniques and immediately loaded using provisional prostheses in a single surgical procedure, reducing treatment time. Unlike conventional dental implants, which often require several months of healing and osseointegration, zygomatic dental implants can be placed and loaded within a shorter timeframe. This can be particularly beneficial for patients who need to replace missing teeth urgently, and allows aesthetics to be restored faster with fewer appointments, which naturally tends to be appreciated by patients.

While zygomatic implants can provide a treatment pathway for patients who are unsuitable for conventional dental implants there are still contraindications, many of which overlap. These include on-going acute sinus infections and uncontrolled systemic diseases such as diabetes.[5]

Zygomatic procedures, and the type of cases that generally require them, need advanced training for the clinician. There are potential complications that can occur due to penetration of the sinus, or in rare instances invasion of the orbit. If you feel your patient would benefit from a zygomatic implant, but are currently not in a position to offer the treatment yourself, you might consider referring them to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction. The highly experienced team, based at the international ZAGA centre in Manchester, are led by Specialist Oral Surgeon Professor Cemal Ucer and utilise the renowned Zygoma Anatomy-Guided Approach (ZAGA). This technique has been developed to minimise complications and provide the best possible outcomes for patients by refining the technique according to individual anatomical differences. Particular care is taken to preserve sinus membrane integrity, perforation of which can result in sinus complications.[6]

In summary, zygomatic dental implants can provide a valuable alternative for patients who have suffered significant jawbone loss and do not have enough healthy jawbone for conventional dental implants. By offering a solution that can provide improved stability, a shorter treatment time, and a minimally invasive approach, zygomatic dental implants can help clinicians provide more of their patients with a functional and aesthetic solution for missing teeth.

Zygomatic, pterygoid and customised implant treatment training is available for beginners and experienced implant surgeons in this field of dental implantology at ICE Postgraduate Dental Institute.

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

01612 371842

www.ucer-clinic.dental

[1] Kowalski J., Lapinska B., Nissan J., Lukomska-Szymanska M. Factors influencing marginal bone loss around dental implants: a narrative review. Coatings. 2021; 11(7): 865. https://doi.org/10.3390/coatings11070865 February 13, 2023.

[2] Rameh S., Menhall A., Younes R. Key factors influencing short implant success. Oral and Maxillofacial Surgery. 2020; 24: 263-275. https://doi.org/10.1007/s10006-020-00841-y February 13, 2023.

[3] Ramalingam S., Al-Hindi M., Al-Eid R., Nooh N. Clinical evaluation of implant survival based on size and site of placement: a retrospective study of immediate implants at single rooted teeth sites. The Saudi Dental Journal. 2015; 38(2): 105-111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459117/ February 11, 2023.

[4] Hinze M., Vrielinck L., Thalmair T., Wachtel H., Bolz W. Zygomatic implant placement in conjunction with sinus bone grafting: the “extended sinus elevation technique.” a case-cohort study. The International Journal of Oral & Maxillofacial Implants. 2013; 28(6): 376-385. https://doi.org/10.11607/jomi.te18 February 15, 2023.

[5] Grecchi F., Bianchi A., Siervo S., Grecchi E., Lauritano D., Carinci F. A new surgical and technical approach in zygomatic implantology. Oral Implantology (Rome). 2017; 10(2): 197-208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965068/pdf/197-208.pdf February 15, 2023.

[6] Aparicio C., Polido W., Zarrinkelk H. The zygoma anatomy-guided approach for placement of zygomatic implants. https://doi.org/10.1016/j.cxom.2021.05.004 February 12, 2023.

Oral malodour occurs for many reasons, including diet. Foods rich in protein and sugar, in addition to acid, create the perfect environment for bad bacteria to thrive in the mouth. But your patients don’t have to suffer – recommend The Breath Co oral rinses for solutions that work.

With an alcohol-free and a pH-balancing formula, The Breath Co solutions are clinically shown to fight bad breath for 24 hours, when used every 12 hours after brushing and flossing.

When patients implement The Breath Co oral rinses into their oral hygiene routine, they can enjoy fresh breath while you rest assured that their oral health is well protected.

To find out more about The Breath Co oral rinses, visit the website today.

For more information about The Breath Co, please visit http://www.thebreathco.com/  

In today’s dentistry, it’s not only about what you’re offering, but how you’re offering it that often matters. With regards to restorative care, patients are all-too aware of what’s available; they know that they have plenty of options when it comes to choosing a dental provider.

Dentistry has an intense competitive edge, and if two practices have similar offerings, what sets them apart? For some dental practices, it may be a case of improving staff training and education surrounding certain treatments and procedures. For others, it may be investing in technology that can help combat simple inefficiencies that greatly impact treatment outcomes.

It’s no secret that digital dental technologies, since their conception in the 1980s, have accelerated development and innovation within dentistry, completely transforming how care is delivered. Standing out from your competitors isn’t easy in this day and age, but is digital technology the secret to staying at the cutting-edge of the profession, and ahead of the game?

A time-saver    

Time is always of the essence, but in the modern-day patients’ expectations have risen dramatically and many of them are seeking exceptional results swiftly. Lengthy waiting times have never been an attractive proposition for patients, and if they can receive quick treatment elsewhere, many of them may prefer that option.

Of all the benefits that digital dentistry presents, time-saving is arguably the most commended. Digital impressions, for instance, can reduce chair time through improved efficiency and accuracy when compared with conventional impression taking.[i] A study[ii] compared the time taken to take an impression with conventional and digital methods; it was found that scanning a single abutment and a full-arch prosthesis digitally took 5 minutes 57 seconds and 20 minutes and 55 seconds respectively. With the conventional impression-taking method, it took around 18 minutes 15 seconds for the single abutment, and between 21 minutes 25 seconds and 30 minutes 25 seconds for the full-arch prosthesis scan.

Even better, some technologies grant dental professionals the flexibility to fabricate prostheses in-house, which can then be placed the very same day. This is a fantastic way to demonstrate the best of what digital dentistry can do; patients will greatly appreciate the reduced number of clinic visits, and being able to go home with their restorations in place.  

Clear the mist  

A recent study[iii] found that the “unknown element” of dentistry was a common concern among patients. Dental professionals know dentistry like the back of their hand, but from a patient perspective it can be vast and complex, which may prompt patients to be more selective when choosing where to go for treatment. Digital dentistry can help to bridge the gap between patient understanding and what’s actually happening. There are numerous systems that help professionals to engage their patients more successfully, in the form of digital planning and pre-visualisation software, where patients can view the final result before the procedure has even commenced, creating intrigue and a “wow” factor. This also helps to facilitate treatment acceptance rates, as communication can be drastically improved; you can discuss treatment planning goals, alleviate confusion, enhance comfort and compliance.[iv]

Plus, with digital systems you can better manage patient expectations, ensuring that they receive beautiful results that are long-lasting as well as aesthetic. This is because digital technologies can be used to detect oral concerns, like cavities, that could have otherwise disrupted the treatment further down the line.

Make changes where they count  

Kitting out the dental practice with the latest digital advancements isn’t feasible for every business, but some form of technology is still essential. Assessing your existing systems can help you make more conscious investments should you choose to expand your digital capabilities. These advancements not only help to give you an edge over competitors, but also simplify processes for staff members, improving team communication, skillsets and confidence. In addition, you’re granted more flexibility with a digital workflow, as with some systems you can fabricate temporary prostheses in-house within a single appointment. The benefits of a system such as this are countless, but above all, it demonstrates to patients your practice’s professionalism and skill.

A wise investment

Clark Dental is proud to offer the Primescan and Primemill, with the latest CEREC software for the ultimate digital workflow. With Primescan, one of the most accurate intraoral scanners on the market,[v] you can process more than one million 3D points per second, for ultra-realistic and reliable data. The innovative Primemill unit allows you to produce outstanding chairside restorations, effortlessly. Together, the Primescan and Primemill facilitate a complete in-house restoration workflow, giving you more flexibility to choose when to refer to a dental laboratory. You’ll also save money on lab fees and the costs associated with multiple patient visits.

Digital dentistry is not the future, it’s already here. Adopting these technologies can facilitate an exceptional patient experience and help your business stand out from the crowd, boosting productivity, profitability and, above all, patient satisfaction.

STUART CLARK

MANAGING DIRECTOR CLARK DENTAL

For more information call Clark Dental on 01268 733 146, email info@clarkdental.co.uk or visit www.clarkdental.co.uk

[i] Lee, S.J., Jamjoom, F.Z., Le, T., Radics, A. and Gallucci, G.O. (2021). A clinical study comparing digital scanning and conventional impression making for implant-supported prostheses: A crossover clinical trial. The Journal of Prosthetic Dentistry. [online] Available at: https://www.sciencedirect.com/science/article/abs/pii/S0022391321000287 [Accessed 25 Jul. 2022].

[ii] Patzelt, S.B.M., Lamprinos, C., Stampf, S. and Att, W. (2014). The time efficiency of intraoral scanners. The Journal of the American Dental Association, [online] 145(6), pp.542–551. Available at: https://www.sciencedirect.com/science/article/pii/S0002817714601136 [Accessed 26 Jul. 2022].

[iii] Calladine, H., Currie, C.C. and Penlington, C. (2022). A survey of patients’ concerns about visiting the dentist and how dentists can help. Journal of Oral Rehabilitation, [online] 49(4), pp.414–421. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/joor.13305 [Accessed 26 Jul. 2022].

[iv] Jafri, Z., Ahmad, N., Sawai, M., Sultan, N. and Bhardwaj, A. (2020). Digital Smile Design-An innovative tool in aesthetic dentistry. Journal of Oral Biology and Craniofacial Research, [online] 10(2), pp.194–198. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193250/ [Accessed 26 Jul. 2022].

[v] Ender, A., Zimmermann, M. and Mehl, A. (2019). Accuracy of complete- and partial-arch impressions of actual intraoral scanning systems in vitro. International Journal of Computerized Dentistry, [online] 22(1), pp.11–19. Available at: https://pubmed.ncbi.nlm.nih.gov/30848250/ [Accessed 25 Jul. 2022].

Make the right choice with the 3M Oral Care Imprint 4 VPS impression material, winner of the best VPS impression material in the Dental Advisor Awards 2023!*

With this solution, you can achieve impressions with remarkable precision, due to its unique chemistry. Patients will appreciate the active self-warming technology, which causes the product to set swiftly in the mouth. As the Imprint 4 VPS impression material from 3M is hydrophilic, you can capture every little detail even in a moist environment.**

Get in touch to find out more.

For more information, call  08705 360 036 or visit www.3m.co.uk/dental 

Please scan for the:

• Latest news on education, webinars and events
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3M and Imprint are trademarks of the 3M Company. 

* Dental Advisor Awards 2023: https://www.dentaladvisor.com/evaluations/imprint-4-2022-award-winner/

A patient-led approach is defining modern dentistry. When dentists upskill and train to do more, it is with elevated patient outcomes in mind. The high demand for quality restorative treatments, from composite bonding to implant therapies, is a good example of this. People now want to repair and improve, rather than remove any healthy tissue, or the tooth itself. They want a naturally beautiful result, delivered in a minimally invasive way.

They also want convenience; appointments that fit into busy lives, which can be booked easily and are as short and as few in number as possible. They want value from their investment, and to know they are spending money at a practice that is efficiently run by a caring and knowledgeable team who enjoy their work. Modern patients also expect to see high-tech equipment that tells them this is a place with a competitive edge.

Perhaps most important of all to modern patients is predictability and stability. If they’re having a tooth restored, they want it to be done right, first time. They want the fit to be precise and aesthetics to be pleasing, meeting if not exceeding their expectations. Their role in ongoing maintenance must have been made clear, so they understand their responsibilities. However, they will expect the treatment to be correct and appropriate from day 1.

For dentists and their teams, it is about ensuring that every element of each task performed, is done to the highest possible standard. This includes giving the patient all the information they need to make informed decisions. Communication should be constant and followed up, with all the options explained in detail. Digital scans show more and give the full picture, and are a good aid for talking through the diagnosis, and what happens next. More dentists are using digital smile design technology in their restorative cases, to enable them and their patient to see what the new smile will look like.

Exceptional patient-led treatment also means choosing the best products. Modern product development has been driven by patients, with manufacturers responding to what clinicians tell them they need to upgrade their service delivery. Particularly in the last decade or so, truly game-changing products have been developed out of a conviction that a problem considered unsolvable could actually be fixed. This has meant that teeth previously regarded as unsavable, can be saved after all. Innovative materials, in the hands of skilled dentists who use good techniques, have helped to push back boundaries and give patients more choice.

One treatment segment in which we’ve seen incredible product development is dental implantology. New products have made these therapies more accessible, also more efficient, precise and stable. There are now implant systems that offer fantastic value too, without compromise to their durability or aesthetics. Patients who thought that dental implant treatment was way out of their price range are discovering that they can say ‘yes’.

For dentists, product development has not only allowed them to offer cost-competitive implants, but has given them flexibility. Pioneering manufacturers, using precision engineering, have created multi-platform components and abutments which are compatible with all major implant systems. Clinicians can select the most appropriate system for each case, to support a successful result that lasts for many years.

These manufacturers are also helping dentists to implement digital workflows, to support their implant treatments, should they wish to do so. Clinicians can now create a customised abutment, with or without a CAD-CAM system. Digital dentistry is set to dominate in the future but, for a while at least, will co-exist with conventional techniques. Because of this, true product pioneers offer a high-performance portfolio that can be used with conventional delivery methods too.

Product development for implant dentistry has incorporated state-of-the-art abutments, suitable for even the most aesthetically demanding or otherwise challenging restorations. With stronger bonding interfaces, several chimney heights and an optimised, slimmer emergence profile, dentists love using these products, for confidence of both patient and clinician satisfaction. Although an abutment seems like a small element of the dental implant workflow, it is crucial to ensure that every step of the treatment process has been delivered with excellence in mind. Medentika^®, a Straumann Group brand, supplies components and multi-platform abutments that are durable and fully compatible with all major implant systems at an affordable price, and can be used with digital or conventional workflows. It has been developing its range since 2005 and, by listening to feedback from dentists, its products have evolved from pioneering to state-of-the-art.

Patient-led dentistry means ensuring every single step of the treatment process is focused on giving patients the very best in terms of stability, beauty and comfort. As more people choose restorative options, to repair or replace a damaged or diseased tooth rather than remove it, ensure you choose all your products from manufacturers who have development and innovation at their heart.

For more information, please visit https://www.straumann.com/medentika/gb/en/professionals.html

Effective infection control is crucial in any dental practice, so why not streamline your approach?

When you use the Lyla steriliser from W&H you can expect reliable, sustainable, and streamlined sterilisation processes. Lyla features an automatic water filling option and facilitates fast everyday cycle times. Plus, Lyla offers the option to upgrade your system to suit the unique requirements of your practice.

Lyla offers unique upgrade flexibility utilising activation codes to add a B cycle, and to enhance traceability depending on the needs of your practice, as well as adding remote data storage. Lyla’s upgradeability makes the system truly unique, and excellent value.

For more information, contact the team at W&H today.

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com