Imaging has become crucial in many aspects of dentistry. Used to assist dentists in diagnosis and treatment planning, radiographs allow clinicians to gain a clearer view of the patient’s anatomy, and pick up on issues which may have otherwise gone unnoticed. 3D imaging, in particular, provides clinicians with precise information about patients’ conditions, making it an especially valuable tool in day-to-day dentistry. With more practices across the country implementing digital dental solutions, it is useful to understand where dental imaging technology began, and the many ways it can be used routinely in practice.

The introduction of 3D imaging to dentistry

When Wilhelm Röntgen discovered X-rays in 1895, he kickstarted the development of a valuable tool in the medical and dental professions. In the months and years after his discovery, technology was further explored by pioneers at the time, developing to make exposures of bone fractures and bullets in injured soldiers, in addition to early attempts at radiotherapy. Just two weeks after Röntgen’s discovery, the first dental radiograph was taken, and in 1896, the first dental X-ray laboratory was established.[i] Many further innovations have been made since then, leading to the development of the cone beam computed tomography (CBCT) scanner in the 1990s, which is now the conventional 3D dental imaging method.ⁱ

Benefits in day-to-day dentistry

CBCT is an incredibly useful imaging method in daily dentistry. This 3D imaging method allows clinicians to visualise and assess the patient’s bony anatomical structures and any pathologies with accuracy thanks to its high diagnostic precision.[ii] CBCT imaging is particularly useful when 2D imaging methods don’t provide enough information needed for accurate diagnosis and treatment planning, and should be used where clinically necessary, to acquire a clear picture of the patient’s anatomy.ⁱⁱ

When compared to other imaging methods, such as CT and MRI imaging, CBCT is preferred for diagnosing a number of conditions because of its low radiation capabilities, high-resolution images, wide ranging fields of view, and value for money.[iii] The use of 3D imaging should be considered when needed to achieve an accurate diagnosis, and when required for treatment planning. Another way that CBCT imaging is used as part of day-to-day workflows, is for follow-up examinations. For example, in many cases, clinical examinations and 2D radiographs are not sufficient to establish healing. Should this be the case, CBCT imaging could be appropriate to determine the patient’s condition with accuracy.ⁱⁱⁱ

Enhance communication

In addition to its benefits as a tool for diagnosis and treatment planning, CBCT imaging acts as a useful communication tool both amongst the dental team, and with patients. Because images obtained using CBCT produce comprehensive descriptions of the patient’s anatomy, they facilitate communication between clinicians, specialists, and dental technicians. This means that should a patient require a dental implant, for example, the dental team are able to work together to fabricate an ideal prosthesis based on surgical guides derived from CBCT images.[iv] By using CBCT images as a tool for treatment planning, the dental team can expect to produce more accurate results in all fields.

3D imaging is also particularly useful when communicating with patients. The comprehensive view of their dental anatomy makes it simpler for them to understand their diagnosis, as well as the reality of any treatment plans which you might suggest. With the implementation of digital treatment planning in many dental practices, the possibilities for communication expand further, as patients will be able to see a virtual model of their anatomy which includes their hard and soft tissues.[v] By providing patients with these additional communication tools, you are likely to see a boost in treatment acceptance and patient satisfaction, with patients feeling confident in your abilities, and experiencing a more in depth education about their own oral health.

The CS 8100 3D Evo Edition CBCT scanner from Carestream Dental is the ideal solution for any dental practice. With the ability to produce high-resolution 3D images with limited artifacts, the CS 8100 is trusted by thousands of general dentists and endodontists around the world. Plus, its award-winning design is able to fit into tight spaces, perfect even for smaller dental practices.

CBCT imaging is becoming more widely implemented into many practices’ digital workflows, with clinicians and patients enjoying the numerous benefits it brings. Imaging solutions are constantly being developed, with options suitable for smaller dental practices, making this incredibly useful technology more easily accessible for use in daily dentistry.

For more information on Carestream Dental visit www.carestreamdental.co.uk

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

Nimisha Nariapara

Bio

Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market. 

Kind regards

[i] Pauwels, R. “History of dental radiography: Evolution of 2D and 3D imaging modalities.” Med Phys Int 8.1 (2020): 235-77.

[ii] Hung, Kuofeng, et al. “Current applications, opportunities, and limitations of AI for 3D imaging in dental research and practice.” International Journal of Environmental Research and Public Health 17.12 (2020): 4424.

[iii] Cohenca, Nestor, and Adrian Silberman. “Contemporary imaging for the diagnosis and treatment of traumatic dental injuries: A review.” Dental Traumatology 33.5 (2017): 321-328.

[iv] Rios, Hector F., Wenche S. Borgnakke, and Erika Benavides. “The use of cone‐beam computed tomography in management of patients requiring dental implants: an American Academy of Periodontology best evidence review.” Journal of periodontology 88.10 (2017): 946-959.

[v] Swennen, Gwen RJ, Wouter Mollemans, and Filip Schutyser. “Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging.” Journal of oral and maxillofacial surgery 67.10 (2009): 2080-2092.

Whenever a patient thinks about improving their dental appearance, chances are they’ll think of braces to straighten their teeth. Sometimes called ‘train track’ braces by the general population, they’re a common presentation of dental treatment in popular culture.

Solutions have developed over time, but their presence in dentistry remains. Often reliable in achieving the best results for patients with moderate to complex malocclusions, fixed braces are renowned as an effective treatment.

 Children and the relationship with braces

Children are regularly open to fixed brace treatment, with aesthetics as a prevailing motivation – and concern.[i] Whilst children with braces can experience teasing and bullying, there is a perceived normalisation amongst young people to have fixed braces. They are likely to see friends and family with braces, and a higher presence in social experiences and influences within day-today life and media could increase openness to the treatment.[ii]

Orthodontic treatment at an early age is not only for aesthetic benefit, but is, of course, designed to prevent future dental problems.[iii] Evidence suggests that measures including fixed braces for young people improve their dental quality of life (QoL).[iv] Dependent on the diagnosis, fixed braces could prevent periodontic, speech, and confidence issues, as well as pain related to temporomandibular joint dysfunction (TMD) later in life.[v]

Braces for Adults

There has been an increase in adult patients seeking orthodontic care over the past few years.[vi] Many adults prioritise aesthetic and practical considerations for their treatment, though, meaning they tend to reach for clear aligners[vii] and lingual braces[viii] over the conventional fixed brace.

However, removeable aligner treatment is regularly only a viable option for simple to moderate malocclusions.[ix] Adults with a more serious issue will appreciate the level of impact a fixed brace can have compared to a clear aligner on their treatment outcomes and long-term oral health. A fixed brace is more effective and reliable when controlling occlusal contacts and producing a result that lasts.[x] Patients that have received fixed orthodontic treatment have significant increases in self-esteem following treatment,[xi] which is the target for anyone.

Discussing a patient’s motivations and intentions for outcomes is important in any case, and this may be easier with a figure they have already received care from. Adult patients will also prioritise receiving treatment from a figure they trust.[xii]

When is a fixed brace appropriate?

Dental crowding and spacing can affect patients throughout life, aesthetically and functionally. QoL is negatively impacted in adolescents who suffer issues of crowding,[xiii] and predictably the same applies for the QoL and self-esteem of adults with similar malocclusions.[xiv] Many adolescents are bullied and teased because of the aesthetic results of dental spacing,[xv] and a spaced dentition can have an effect on speech throughout life,[xvi] which can affect communication and confidence.

Speech complications are also prevalent in patients with issues such as an open bite, often finding the letter “s” difficult to pronounce. [xvii] The impact this has one a person’s social confidence, alongside other functional difficulties, can mean patients with malocclusions such as this face a negative impact to their QoL. [xviii]

All of these issues can be aided by fixed orthodontics, moving the teeth into more desirable positions.

Timing the introduction of fixed braces for children or adolescents should be judged on a case-by-case basis, but treatment is typically provided in the late mixed or early permanent dentitions.[xix] This takes full advantage of this period of extreme growth in a child’s jaw, and minimises issues as teeth continue to move over time. [xx] Adults can treat orthodontic issues when they immediately arise, or when it works best them, since timing treatment alongside growth is no longer an important factor.

Dentists should treat each case uniquely, understanding the effects fixed braces and other treatments can have on aesthetic and functional results. It is also important to recognise the value of referral in cases that need it to provide the appropriate care for a patient.

Clinicians who are looking to broaden their expertise on fixed braces should undertake appropriate training and qualifications. During the Fixed Braces course provided by the IAS Academy, clinicians who are beginners to fixed appliances can broaden their depth of knowledge from diagnosis and case evaluation, to fitting and retention. The experienced lecturers provide expansive training and you can receive case-by-case mentoring for life, allowing you to grow within a dependable support network.Fixed braces are a mainstay in orthodontic care. A reliable option for children, adolescents, and adults, they help dentists continue to provide brilliant smiles every day.

For more information on upcoming IAS Academy training courses,

please visit www.iasortho.com or call 01932 336470 (Press 1)

[i] Geoghegan, F., Birjandi, A. A., Machado Xavier, G., & DiBiase, A. T. (2019). Motivation, expectations and understanding of patients and their parents seeking orthodontic treatment in specialist practice. Journal of orthodontics, 46(1), 46-50.

[ii] Trulsson, U., Strandmark, M., Mohlin, B., & Berggren, U. (2002). A qualitative study of teenagers’ decisions to undergo orthodontic treatment with fixed appliance. Journal of orthodontics, 29(3), 197-204.

[iii] Williams, A. C., Shah, H., Sandy, J. R., & Travess, H. C. (2005). Patients’ motivations for treatment and their experiences of orthodontic preparation for orthognathic surgery. Journal of orthodontics, 32(3), 191-202.

[iv] Javidi, H., Vettore, M., & Benson, P. E. (2017). Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 151(4), 644-655.

[v] Agrawal, G. (2016). Deep bite its etiology, diagnosis and management: a review. Journal of Orthodontics, 2(4), 12.

[vi] BOS Admin, (2021, May 6). The ‘Zoom Boom’ BOS stats reveal a surge in demand for orthodontics during the pandemic. British Orthodontic Society. Available at: https://www.bos.org.uk/news-and-events/news [Accessed April 2023]

[vii] Saccomanno, S., Saran, S., Laganà, D., Mastrapasqua, R. F., & Grippaudo, C. (2022). Motivation, perception, and behavior of the adult orthodontic patient: a survey analysis. BioMed Research International, 2022.

[viii] Alansari, R. A., Faydhi, D. A., Ashour, B. S., Alsaggaf, D. H., Shuman, M. T., Ghoneim, S. H., … & Dause, R. R. (2019). Adult perceptions of different orthodontic appliances. Patient preference and adherence, 2119-2128.

[ix] Phan, X., & Ling, P. H. (2007). Clinical limitations of Invisalign. Journal of the Canadian Dental Association, 73(3).

[x] Ke, Y., Zhu, Y., & Zhu, M. (2019). A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health, 19(1), 1-10.

[xi] Johal, A., Alyaqoobi, I., Patel, R., & Cox, S. (2015). The impact of orthodontic treatment on quality of life and self-esteem in adult patients. European journal of orthodontics, 37(3), 233-237.

[xii] Fenton, G. D., Cazaly, M. H. M., Rolland, S. L., & Vernazza, C. R. (2022). Eliciting preferences for adult orthodontic treatment: a discrete choice experiment. JDR Clinical & Translational Research, 7(2), 118-126.

[xiii] O’Brien, C., Benson, P. E., & Marshman, Z. (2007). Evaluation of a quality of life measure for children with malocclusion. Journal of orthodontics, 34(3), 185-193.

[xiv] Jung, M. H. (2015). An evaluation of self-esteem and quality of life in orthodontic patients: Effects of crowding and protrusion. The Angle orthodontist, 85(5), 812-819.

[xv] Seehra, J., Fleming, P. S., Newton, T., & DiBiase, A. T. (2011). Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life. Journal of orthodontics, 38(4), 247-256.

[xvi] Kaya, D., & Taner, T. U. (2011). Management of an adult with spaced dentition, class III malocclusion and open-bite tendency. European journal of dentistry, 5(01), 121-129.

[xvii] Farronato, G., Giannini, L., Riva, R., Galbiati, G., & Maspero, C. (2012). Correlations between malocclusions and dyslalias. European Journal of Paediatric Dentistry, 13(1), 13-18.

[xviii] Feres, M. F. N., Abreu, L. G., Insabralde, N. M., Almeida, M. R. D., & Flores-Mir, C. (2016). Effectiveness of the open bite treatment in growing children and adolescents. A systematic review. European Journal of Orthodontics, 38(3), 237-250.

[xix] Fleming, P. S. (2017). Timing orthodontic treatment: early or late?. Australian dental journal, 62, 11-19.

[xx] de Oliveira, J. M. L., Dutra, A. L. T., Pereira, C. M., & de Toledo, O. A. (2011). Etiology and treatment of anterior open bite. Health Sci Inst J, 29, 92-95.

Digital adoption is becoming more widespread within dentistry, but it can be difficult knowing what options are best suited to you if you are new to the technology.

The Straumann Group offers clinicians the Virtuo Vivo^™ intraoral scanner, the ideal system for those looking to transition from analogue to digital workflows. It’s fast and easy-to-use, helping you treat patients comfortably (for them, and you!) with high precision and accuracy.

Guided workflows support you at every step, with access to services through integrated connectivity. The Virtuo Vivo^™ is also an open system, so you can export and share scan data with any dental labs for ultimate flexibility.

Looking to make the switch to digital? Get in touch the Straumann Group to find out more today.

For more information on intraoral scanners and digital solutions from the Straumann Group, visit: https://www.straumann.com/digital/en/home/equipment/io-scanners.html

Here at Dental Elite, we strive to find our candidates a vacancy that suits their unique job requirements.

Our expert team understands the needs of every dental professional and so we’re able to find you a role in a workplace that shares your values. We’ve got a variety of both clinical and non-clinical employment opportunities available!  

Regardless of whether you’re seeking a permanent or locum role, in an NHS, private or mixed practice, Dental Elite will identify exactly what you need and will shortlist any current job vacancies suitable for you. We also recruit for roles within ‘unique’ settings, such as the prison service.  

If you’re looking for a new opportunity, we’ve got you covered – get in touch with the team to find out more today!

For more information, visit www.dentalelite.co.uk, email info@dentalelite.co.uk or call 01788 545 900

The Perio Plus+ range of solutions, available from leading Swiss oral health specialist, Curaden, consists of mouth rinses, toothpaste and a gel. Each product is formulated with chlorhexidine and CITROX^® to deliver superior antimicrobial protection compared to solutions with chlorhexidine alone.

The portfolio consists:

• Perio Plus+ Balance mouth rinse
• Perio Plus+ Forte mouth rinse
• Perio Plus+ Regenerate mouth rinse
• Perio Plus+ Focus gel
• Perio Plus+ Support toothpaste

Whether your patient requires short-term support for acute dental problems or longer-term protection from pathogens, Perio Plus+ provides an answer. Find out more from the experts today.

For more details, please visit www.perioplus.com/uk

Looking for a new insurance provider can seem like a minefield – where to start? Has your scope of work changed? Have you become more anxious about patients making a claim against you? Although we are not as litigious in the UK than in other parts of the world, there are law firms that specialise in dental negligence cases, and who encourage people to pursue their matter on a no-win-no-fee basis.

At Howden, we offer indemnity that is fit for the modern world. We know insurance inside and out and have been working with dentists, practices and dental professionals for a long time. We know that the industry has changed, and we believe that discretionary policies, like those offered by Medical Defence Organisations (MDOs) can no longer offer the level of protection that you and your patients need.

What happens if an MDO chooses to exercise its discretion? 

This can and does happen.

In 2022, 81-year-old Clive Worthington was awarded £116,000 compensation for dental implant work that left him in agony.^[1] The case had taken 14 years to reach court, with Mr Worthington in constant pain and stress during this time. But he didn’t receive a penny, because the dentist who delivered his treatment was a member of a MDO, who exercised their discretion to not provide indemnity. An attempt to go after the dentist’s personal assets was unsuccessful.

Ask yourself, is discretionary indemnity appropriate for modern dentistry?

Cases like this have left many wondering if the lack of regulation can continue for MDOs.

At Howden, you will be in safe hands from the very first call you make to us – and so will your patients. All our policies are contract-backed, and we are regulated by the Financial Conduct Authority (FCA). This means that in line with our obligations, we are required to treat all clients fairly, and make a full recommendation as to the most appropriate cover based on the customer’s personal situation. This is a crucial point of difference from discretionary providers, and also means that policy holders are eligible for compensation via the Financial Services Compensation Scheme, should the insurer be unable to cover the cost of a claim.

With Howden policy, our safety net clause also gives an extra layer of certainty so if you were previously with a MDO, Howden can retroactively protect you for that period.

Do the job you love with your mind at ease! It is a fact of life that there will be patients who are unsatisfied, and who feel that the care they received didn’t meet their expectations. So, choose quality insurance and know you’ll have the right people by your side to support you, during what otherwise could be a stressful time.

The 3 Cs

Howden won’t let you down, and will offer you more.

Our approach is based on the 3Cs – Confidence of Cover that is Cost competitive.

A policy tailored to your work, with protection in a wide number of scenarios, you will feel reassured and free to enjoy your dentistry.

We believe that quality insurance should be accessible and affordable; in fact, many have saved money on their premiums when they moved to us!* Get added value with exceptional service, and extras like 24/7 access to a mental health helpline and medico-legal helpline. The claims process can be lengthy and stressful and may take its toll on not just you, but your colleagues as well as a wider network of family and friends.

For a no-obligation free quote from Howden, call our friendly team today.

For more information, please visit www.howdenmedicalindemnity.com or call 020 3918 9127

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

^[1] Man, 81, takes own life after botched dental work and the loophole that denied him compensation. ITV News, 31 January 2023. Link: https://www.itv.com/news/2023-01-30/man-81-takes-own-life-after-loophole-denied-him-pay-out-for-botched-dentistry (accessed February 2023).

*42 of 49 Dental Indemnity quotations delivered between May-August 2022 showed a saving against their existing terms.