Abstract:
This case report describes the successful management of a failing upper right 4567 bridge in a 67-year-old female using advanced digital dentistry techniques. The process involved virtual extraction, CBCT planning, guided surgery, and in-house milling of the final prosthesis.

Introduction:
The evolution of digital dentistry has revolutionized the way dental procedures are planned and executed. This case highlights the integration of various digital tools and techniques to achieve a predictable and satisfactory outcome.

Case Presentation:
Patient Profile:

• Age: 67 years
• Gender: Female
• Medical History: Fit and well with no known medical problems.

Initial Presentation:
The patient presented with a failing upper right 4567 bridge anchored on UR4 and UR7.

Methods:

• Virtual Extraction:
  • Tool Used: Medit Design
  • Procedure: The failing bridge was virtually extracted using a scan from the Medit i700.
• Implant Planning:
  • Tools Used: CBCT and Medit i700 scan
  • Software: SMOP guided surgery software by Swissmeda
  • Plan: A four-tooth bridge with Anthogyr Axiom X3 implants at the upper right first premolar and the upper right second molar.
• Surgical Guide Fabrication:
  • Printer: Asiga Max UV
  • Material: Keyguide resin
  • Post-Processing: After washing, Anthogyr integral sleeves were placed before the final post-processing cure.
• Implant Placement:
  • Kit Used: Anthogyr integral kit
  • Procedure: Immediate implant placement followed by the placement of healing abutments. The sockets were augmented using bovine xenograft.
• Restoration:
  • After an 8-week healing period, scan bodies were utilized.
  • Design: Custom gold anodised titanium abutments and a cement-retained lithium disilicate bridge using Kronos blocks.
  • Milling: Custom abutments were milled by Simeda. However, the surgical guide planning, CAD design, and final bridge were milled and completed in-house by Professor Adam Nulty.

Results:
The patient achieved a functional and esthetically pleasing result with the new bridge. The integration of advanced digital techniques ensured a predictable and satisfactory outcome.

Discussion:

The integration of digital dentistry into clinical practice has been a transformative evolution in the field. The case presented here underscores the importance of a comprehensive digital workflow in modern implant dentistry. The use of virtual planning, guided surgery, and in-house milling ensured precision and reduced the overall treatment time.

• Virtual Planning and Guided Surgery:
  The utilization of virtual planning tools, such as the Medit Design and SMOP guided surgery software by
  Swissmeda, allows for a more predictable surgical outcome. Mangano et al. (2017) highlighted that digital workflows, including virtual planning and guided surgery, improve the accuracy of implant placement, reduce surgical time, and minimize post-operative complications(1). This precision ensures that the implant is placed in the most optimal position, reducing the risk of complications and ensuring the longevity of the implant.
• Immediate Implant Placement:
  Immediate implant placement, as executed in this case, has its advantages. Chen and Buser (2009) emphasized the benefits of immediate implant placement, including reduced treatment time, preservation of soft and hard tissues, and improved esthetic outcomes(2). This method not only speeds up the treatment process but also results in better patient satisfaction due to the reduced number of visits and faster recovery.
• Digital Impressions and In-House Milling:
  The Medit i700 scanner was instrumental in obtaining accurate digital impressions. According to Nulty (2022), the trueness and precision of digital scanners, including the Medit i700, are remarkable, ensuring that the final prosthesis fits perfectly(3). Furthermore, in-house milling, as done by Professor Adam Nulty in this case, provides the clinician with greater control over the final prosthesis design and fit, leading to improved patient satisfaction(4).
• 3D Printing and Accuracy:
  The Asiga Max UV was used for printing the surgical guide. Nulty (2021) in his study compared the trueness and precision of various 3D printers, including the Asiga Max UV, and found them to be highly accurate. The Asiga Max UV was statistically superior to others with overall trueness under 35 μm, ensuring that the printed surgical guides fit precisely during surgery(5). The accuracy of such printers is crucial in ensuring that the surgical guide aligns perfectly with the patient’s anatomy, ensuring successful implant placement.
• Material Selection:
  The choice of bovine xenograft for socket augmentation is supported by studies that have shown its efficacy in preserving alveolar ridge dimensions post-extraction6. Additionally, the use of lithium disilicate for the final bridge, known for its excellent esthetic properties and durability, aligns with the current trend in restorative dentistry(7).
• Collaborative Approach:
  The collaboration between different digital tools, materials, and experts, as seen in this case, is a testament to the multidisciplinary nature of modern dentistry. Such an approach ensures that patients receive the best possible care, combining expertise from various domains.
• The Significance of Primary Stability and Implant Design:
  One of the critical aspects of successful dental implantation is achieving excellent primary stability. Primary stability refers to the mechanical stability of an implant immediately after placement, and it’s a crucial factor in determining the success of osseointegration and the overall outcome of the implant procedure. The Anthogyr Axiom x3, with its unique implant design, has been recognized for providing exceptional primary stability. Primary stability ensures that the implant securely anchors into the bone, reducing micromovements that can hinder the osseointegration process. This stability is not just beneficial for the immediate post-operative period but also plays a pivotal role in the long-term success of the implant.(8)

Conclusion:
Digital dentistry, when used comprehensively, can offer patients a swift and precise treatment plan, leading to predictable outcomes. This case serves as a testament to the advancements in the field and their practical applications.

In conclusion, the advancements in digital dentistry, as demonstrated in this case, offer a holistic approach to patient care. By integrating various digital tools and techniques, clinicians can achieve predictable, efficient, and esthetically pleasing outcomes.

References:

• 1) Mangano, F., Gandolfi, A., Luongo, G., & Logozzo, S. (2017). Intraoral scanners in dentistry: a review of the current literature. BMC Oral Health, 17(1), 149. ↩
• 2) Chen, S. T., & Buser, D. (2009). Clinical and esthetic outcomes of implants placed in postextraction sites. The International Journal of Oral & Maxillofacial Implants, 24(suppl), 186-217. ↩
• 3) Nulty, A. (2022). A comparison of trueness and precision of 12 3D printers used in dentistry. BDJ Open, 8(1), 14. ↩
• 4) Alghazzawi, T. F. (2016). Advancements in CAD/CAM technology: Options for practical implementation. Journal of Prosthodontic Research, 60(2), 72-84. ↩
• 5) Nulty, A. B. (2021). A Comparison of Full Arch Trueness and Precision of Nine Intra-Oral Digital Scanners and Four Lab Digital Scanners. Dent J (Basel), 9(7), 75. ↩
• 6) Araújo, M. G., & Lindhe, J. (2015). Ridge preservation with the use of Bio-Oss® collagen: A 6-month study in the dog. Clinical Oral Implants Research, 21(5), 574-580. ↩
• 7) Fabbri, G., Zarone, F., Dellificorelli, G., Cannistraro, G., De Lorenzi, M., Mosca, A., & Sorrentino, R. (2017). Clinical evaluation of 860 anterior and posterior lithium disilicate restorations: retrospective study with a mean follow-up of 3 years and a maximum observational period of 6 years. The International Journal of Periodontics & Restorative Dentistry, 37(1), 19-31. ↩
• 8) Tettamanti L, Andrisani C, Bassi MA, Vinci R, Silvestre-Rangil J, Tagliabue A. Immediate loading implants: review of the critical aspects. Oral Implantol (Rome). 2017 Sep 27;10(2):129-139. doi: 10.11138/orl/2017.10.2.129. PMID: 29876038; PMCID: PMC5965071.

Acknowledgments:
The team acknowledges the contributions of Professor Adam Nulty for his expertise and in-house work on this case.

Conflicts of Interest:

None to declare.

Convincing patients that dental treatment is worth spending money on is not a new problem for practices. When an option of ‘do nothing’ is given following a diagnosis, dentists accept that some will make this choice and that cost is often the reason why.

The increase in NHS dental charges – up by 8.5% from the end of April 2023 – plus inflation remaining high, has made things worse. If dentistry can be delayed, or avoided, why not? Another alternative is going abroad for more affordable care. Especially if they’re unable to access a dentist locally, this is a factor tempting patients to Europe and beyond.^[i]

What can be done to support patients, whom you want to take on the next stage of their treatment journey, but are considering something other than your recommendation, in order to save money? For example, if an infection is diagnosed, you may tell them that endodontic therapy would be the clinically preferable route forward. If they are able to manage any discomfort, they could decide to do nothing. But they must understand that this could lead to them needing more invasive, and expensive treatment further down the line.

Or, they may conclude an extraction would be more cost-effective than a root-canal, which is a technically demanding procedure and best performed by a highly-experienced dentist or endodontic specialist. The thought of instant relief, when the whole tooth is removed, can also be very appealing.

Reframing the concept of cost

If the cost of endodontic treatment is proving a barrier for acceptance, using the language of a consumer and words like ‘value’ and ‘investment’ can help. Root canal work, when delivered ethically using high-tech tools and quality materials can return the health, function and natural beauty of the patient’s smile, for many years to come, with correct maintenance. So, it offers excellent value for money.

There are often long-term benefits to wellbeing, too. Studies have found that the lasting emotional impact of an extraction was something that patients were unprepared for.^[ii] Although it may seem like the easier option, it will be hard to predict how they’ll feel about losing a tooth, once any initial relief at being pain free has passed. Unlike previous generations, modern patients have different expectations regarding tooth loss, which is no longer accepted as an inevitable part of the aging process. Practices are seeing individuals of all ages who want to keep their own teeth for as long as possible, for functional and aesthetic reasons. They don’t want to feel old, or incomplete. They don’t want others to think they neglect their oral health and hygiene. They don’t want to feel differently about themselves when they look in a mirror, or smile, or talk, or eat.

Build a case for cost-effective, quality care by telling patients that you have the technology in place to speed things up, and ensure their experience is as efficient as it is comfortable. This could include offering things like teledentistry or video calls for the initial consultations to discuss the process, so they can get all their questions answered at a time that suits them, without having to travel in to the practice. Also, utilise 3D imaging systems so they can see more, and understand the problem, which will also boost communication and build trust.

In fact, with endodontics, technology and innovation is often key to the ‘high-value’ message. If root canals have a bad reputation, for being painful and invasive, this belongs in the past. Now, there are high-tech tools, equipment and techniques to ensure it can go right, first time. Also, that any time they spend in the chair – which will be less than they think – will be comfortable. Endodontic therapy is fundamentally about restoring and repairing, returning the patient to health and saving their tooth. It’s ethical, it’s conservative and, thanks to the latest innovations, you are unlikely to need to retreat the tooth.

Ongoing return on your investment

Communicate the benefits of root canal therapy in a value-driven way, focusing on how investing now could save them money, as well as time and stress, in the future. Because you only use the best tools and equipment, efficient treatments mean costs can be kept down, without compromise to the outcome. Many preeminent endodontic dentists and specialists choose COLTENE’s endodontic range, including the HyFlex™ EDM file system, where only one or two files are needed for canal preparation. Also available is the CanalPro™ Jeni, for efficient digital autonomous navigation of the root canal. This is fast, safe, stable, high-value endodontics.

Quality dental care can be costly. Dentists must respect a patient’s right to choose, to say no or to go elsewhere, while giving them all the information they need to make the best decision for their long-term health. Endodontic therapy is not only more affordable than many might think, but the real cost of delaying or avoiding it, will be much higher.

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] ‘Impossible to get an appointment’: Britons forced abroad to seek dental treatment. Guardian, 9 August 2022. Link: https://www.theguardian.com/society/2022/aug/09/britons-forced-abroad-to-seek-dental-treatment (accessed April 2023).

^[ii] Okoje VN, Dosumu OO, Alonge TO, Onyeaso C. Tooth loss: are the patients prepared? Niger J Clin Pract. 2012 Apr-Jun;15(2):172-5. doi: 10.4103/1119-3077.97305. PMID: 22718167.

Tooth decay is very common in children, with an estimated 50% of children aged 6-8 having a cavity in at least one of their teeth. Additionally, over half of those aged 12-19 have cavities in permanent teeth. While there are a number of factors which may increase a patient’s chances of developing tooth decay, research suggests that children between 5-19 are over 2 times as likely to have the disease if they come from a low-income household.[i] This can create barriers for some patients when accessing dental care, education, and resources. Because of this, it is important to focus on the benefits of prevention from a young age to reduce the risk of developing tooth decay at any stage in life.

Importance of prevention in early years

Cavities can form for a number of reasons including bacterial biofilm, eating sugary snacks, consuming drinks with a high sugar content, and insufficient dental hygiene. In the short term, if decay is left untreated, the cavity is likely to grow larger, and begin to impact deeper layers of tooth structure. This can result in tooth sensitivity, mild or sharp pain, and staining.[ii] In the long term, if left untreated, patients can expect more serious consequences such as severe toothache, pulp necrosis, and sometimes tooth loss.[iii]

Lack of resources is a key reason for tooth decay in children, with lack of education, barriers to dental care access, and financial challenges all playing a role. However, these issues may intensify should a patient require more involved care for a more serious issue. Even though cavities are incredibly common in children, they can be very easily prevented by keeping up good oral hygiene, a balanced diet, and dental sealant application.

Dental sealants are able to help protect against the onset of decay for a number of years following application,[iv] if the patient’s oral hygiene is of a high standard. They are particularly helpful in maintaining the health of children’s molars as these are at an increased risk of cavities due to their complex fissure patterns and the role that they play.[v] One study found that, when a sealant is applied to the occlusal surfaces of the molars, it can prevent up to 80% of cavities.[vi] Sealants create a barrier to protect the enamel from plaque acids, preventing the demineralisation of the hard tissues.

While this is a fantastic option for troublesome areas, sealants must be used in conjunction with good oral hygiene. It is never too early to encourage children to look after their oral health. Good oral hygiene is key for maintaining oral health, and children should attend dental appointments regularly to ensure that teeth are examined soon after they erupt. This offers the opportunity for clinicians to assess a child’s risk of developing cavities.[vii]

Continuing this to adulthood

Insufficient oral hygiene is a key cause of cavities in patients of any age. Because of this, it is important to continue providing oral hygiene advice to all patients, including both adults and children, to help solidify the message, and give them the confidence to maintain high standards at home.[viii]

Some patients may think that, because they brush their teeth regularly, they will not have any problems. However, there are a number of places which ordinary tooth brushing cannot reach. As such, it is vital to recommend daily interdental cleaning to children over 12, to access the surfaces in between the teeth and remove any plaque and food debris. Interdental cleaning is an effective way of preventing tooth decay, and this is a good habit to get patients into once their permanent teeth are in place.[ix]

Tailoring oral hygiene advice to each patient is key for maintaining oral health. For children, recommend the Junior and Kids toothbrush ranges. These brushes feature slightly broader handles to make brushing easier, and SOFT bristles to deliver a high-quality clean while being gentle on the gums. For children over 12 and adult patients, the FLEXI range of interdental brushes from TANDEX is ideal for cleaning in between the teeth. The range is available in 11 different sizes, with flexible handles and when PREVENT GEL from TANDEX is applied with any FLEXI brush, patients gain the added benefit of its antibacterial effect and enamel strengthening properties, along with the pleasant taste of peppermint.

Even though tooth decay is incredibly common amongst children, it is important that it is not overlooked. There are a number of causes for the disease, and it is important to understand what measures patients should be taking at home to reduce the risks of cavity development, and protect their long-term oral health. With solutions such as dental sealants appropriate in some cases, there are many options to give your patients the best chances of preventing decay. However, at any age, oral hygiene is important, and encouraging patients to carry out interdental cleaning every day will drastically reduce the likelihood of decay.

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

Our products are also available from CTS Dental Supplies https://www.cts-dental.com/ and

DHB Oral Healthcare https://dhb.co.uk/

Author Kimberley Lloyd- Rees on behalf of Tandex

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

I[i] Beshers, Sarah. “An Evaluation of Eastman Institute for Oral Health’s Dental Sealant Program.” (2022).

[ii] Beshers, Sarah. “An Evaluation of Eastman Institute for Oral Health’s Dental Sealant Program.” (2022).

[iii] Beshers, Sarah. “An Evaluation of Eastman Institute for Oral Health’s Dental Sealant Program.” (2022).

[iv] Beshers, Sarah. “An Evaluation of Eastman Institute for Oral Health’s Dental Sealant Program.” (2022).

[v] https://mirchi.in/stories/lifestyle/5-health-benefits-of-dental-sealants-for-kids/101808436

[vi] Beshers, Sarah. “An Evaluation of Eastman Institute for Oral Health’s Dental Sealant Program.” (2022).

[vii] https://mirchi.in/stories/lifestyle/5-health-benefits-of-dental-sealants-for-kids/101808436

[viii] https://mirchi.in/stories/lifestyle/world-oral-health-day-why-brushing-isnt-enough/98766415

[ix] https://mirchi.in/stories/lifestyle/world-oral-health-day-why-brushing-isnt-enough/98766415

We can all agree that dentistry is in a constant state of evolution, with clinical techniques, materials and technologies continually being developed for the benefit of the profession and patients. Manufacturers and suppliers are always looking to create new solutions that will fill gaps in the market, cater to the challenges being faced by clinicians, simplify professional workflows and improve the quality of patient care delivered.

However, this is only a success if there are strong connections between industry and profession. Products must be designed and refined with the end users – the dentist and their patient – in mind. To be fit for purpose and improve the professional and/or patient experience, manufacturers must really understand the demands faced by everyone in the dental practice. This means they must communicate with those at the coalface of dentistry and ensure that the feedback received influences the design of their solutions. The concept of user experience steering product development is not new and, indeed, has been proven to work in various sectors.[i]

For professionals on the ground, this is an important consideration when it comes to choosing which technologies and services you wish to implement in your own practice. Take intraoral scanners as an example – not all offer the same advantages or are as effective as other impression methods in specific clinical situations, so you have to choose your equipment carefully for each case. Greater confidence is afforded by only utilising solutions you know have been designed and fabricated specifically for the dental profession. This is particularly useful when considering new digital products on the market – which are often implemented in practice with varying degrees of success.

Clinical input

It is vital that the developers truly understand dentistry and its unique nuances when creating technologies specifically for the profession. There is significant merit in working with suppliers who have direct insight into the clinical situations and challenges that the product is being designed to improve or overcome. That’s why you often see clinical advisors on company boards, or practitioners getting involved with prototype development

Many of the most effective innovations hitting the market today are driven by practising dentists, researchers or academics (or a combination of all three). This means that they have first-hand experience of the issues they are trying to solve and the benefits they are attempting to deliver for colleagues and/or patients. Such invaluable clinical input can be used to ensure that the very best products are manufactured, which enhance professional workflows, save the business time and money, and, ultimately, elevate the standard of patient care delivered.

A two-way conversation

There are many ways for companies to interact with the profession. For productive and practical product development, two-way communication is essential between the dental manufacturer and the dental team. Actively seeking feedback from the end user and listening to what they say is crucial for any manufacturer, but in a fast-paced and intricate profession like dentistry, it is even more important to implement positive change and improve experiences.

Beta testing is often one of the first key stages that puts a product in front of a professional and asks them to try it in a real-life setting. This provides an opportunity to identify problems or inefficiencies and smooth them out before a solution is mass-produced and made available on the market. However, this is not where the conversation should end.

By continually encouraging comments from professionals to steer the fine-tuning or progression of products over time, companies can ensure that technologies remain relevant and optimised for modern needs. There is also evidence that two organisations working together – i.e. dental manufacturer and dental practice – can initiate new market opportunities.[ii] In dentistry, this could create even greater advantages for the profession and for patients.

Long-term relationships

The relationship established between manufacturer and profession will also be indicative of an organisation’s future collaboration with customers. A company that prioritises user feedback from the start is far more likely to be responsive to requests and suggestions once the product is available. As the clinician, this means you can have greater confidence in the quality of customer service you will likely receive, improving your experience overall with any new digital solutions you introduce to your practice.

Choosing the right partners

Of course, there are many aspects to consider when choosing a new technology to integrate within the practice, but the manufacturer is an important one. Be sure to check the science behind the product, the testing it underwent and the clinical input utilised throughout its development before you invest. In an age when new innovations are constantly reaching the profession, it is vital to choose new products carefully in order to maximise professional efficiency, patient safety and quality of care.

Stephen Claffey Managing Director of Dental Pathway™ and the Independent Dental Advisory Board™

[i] Choi, Young. (2015). Utilizing end User Input in Early Product Development. Procedia Manufacturing. 3. 2244-2250. 10.1016/j.promfg.2015.07.368.

[ii] Mengoni M, Perna A, Bevilacqua M, Giraldi L. The role of business relationships in new product development. The case of Antrox-Nel Design. Procedia Manufacturing. 2017; 11; 1351-1357

Dr Heidi Foster completed the first and second Year Implant-Long Courses with The Campbell Academy – supported by Straumann – in the past couple of years. She reflects on what she has gained from the training:

“I had been looking for an implant course for a little while – I wanted an environment I felt comfortable in. I am maybe not a ’typical implant’ dentist and didn’t want to do a course where I would complete it and not feel confident to actually place implants.

“This course surpassed my expectations. The entire team at The Campbell Academy are brilliant; the lecturers are knowledgeable but approachable and the support staff are so helpful. It’s really well organised and the facilities are wonderful.

“The training started just pre-covid and was impacted a little, but we did online teaching where necessary and the slack support and zoom worked well enough. The highlights for me were the hands-on and clinical days.

“I had not used Straumann implants before but doubt I’ll ever place anything else. I am now placing implants regularly and am about to move to a practice which delivers a very high number of implants at all levels of complexity.

“I think the course has really helped my confidence in all aspects of dentistry and has re-ignited a passion for my work. Taking on board the workflow of the clinic and applying it daily has had a huge impact. I would recommend The Campbell Academy without hesitation; the ethics of what and how they teach and the support to the delegates is second to none.”

Discover all educational courses at www.straumanncourses.com

Interest rates have sustained their skyward trend, reaching highs not seen for over 15 years. The numbers have continued to climb in a bid to tackle inflation, taking mortgage rates with them into the financial stratosphere. The residential property market can be difficult to traverse for self-employed dentists, but it’s worth considering how the rises could affect your situations now, and in the future.

 The impact

For a substantial period over the past decade, interest rates have been somewhat stable. The Bank of England’s base rate has stayed under 1% since 2009, reaching a low of 0.1% during the pandemic. In January 2022 the rise began; the hike from 0.1% to 1% took six months, and six months after that it had trebled, breaking 5% in June 2023.[i] Mortgage rates have followed in trend, leaving the landscape for purchasing property a stressful environment.

It’s worth noting who this rise affects most. Those in fixed rate mortgage deals will not see this change their monthly payments – until their agreed term comes to an end.

Those on a variable rate will have witnessed an almost immediate effect, expenses surging skywards at a pace chosen by their lender. A tracker rate is an adaption of a variable rate, but it follows the Bank of England base rate at a consistent difference, for example, 1% above the base rate. Variable terms may have been beneficial over the past few years, but they now are at the mercy of the interest rate rises.

Dentists and mortgages

A majority of dentists may experience the residential mortgage difficulties associated with being self-employed. It is essential to find a lender who understands the financial differences between this career and other conventional self-employed, and salaried, roles. The right one will recognise the earning potential over a career. Some lenders have been reported to offer a mortgage value of 5 or 6 times an applicant’s annual income, but the onus is on the borrower to ensure they are a trustworthy source.

Many lenders will look at an individual’s average salary and dividends across the past three years, which for self-employed dentists could look irregular, especially if they operate between various practices. The additional scrutiny helps to protect the lender’s financial commitment, but it shouldn’t be an issue with records that display the consistent financial ability required to meet mortgage repayments.

Approaching the market

In order to swallow the expense increase, some people will need to adjust their monthly budgets and spending, where possible. There are, though, multiple ways to work with and around the increased rates.

It’s important to consider the value of remortgaging, with your current lender or another altogether. Professionals with a fixed rate mortgage should take advantage of any remaining period of lower rates, but it’s worth looking ahead for when the deal comes to an end. Entering a fixed rate mortgage scheme now is an option if you believe the rates are likely to increase further, and remain there for an extended period of time. In a similar vein, entering a variable agreement that is either independently relying on a lender’s standard variable rate, or is directly tracking the Bank of England’s base rate, could take advantage of any drop in the interest rate in the near future.

Reducing your monthly payments is also possible by readjusting the terms of your mortgage. Whilst it does not affect the interest rate, extending a residential mortgage from 25 years to 40, where possible, will reduce the amount you owe in each instalment. However, the interest will add up over time, and extending the term means you will pay more overall.

Commercial mortgages

Commercial mortgages will certainly feel the mortgage rate rise too, as they typically utilise variable rates – often higher than those for residential properties. The term length will likely be far shorter, and the ratio of loan to property value will be far lower than that of a residential mortgage, with a ceiling of 65%. Lenders will also request a business plan to see how high their risk is and probable it is that their financial investment will be returned.

Finding your best option

Making decisions about your mortgage in such a pivotal moment can be extremely stressful. By contacting money4dentists, you can gain the help of a respected and experienced team of independent financial advisors who intimately understand your needs and situation as a dentist. The team will find the best mortgage rates and terms for you, guiding you through the entire process from initial interest, to submitting an application, and receiving a mortgage in principle. money4dentists provide security for first time buyers, those looking to remortgage or move, and even others considering residential buy to lets.

As interest rates rise, consider your current situation and the possible economic turns ahead to judge the best route for you. Mortgages are an important investment, and having expert help surrounding the rising rates could save you time, money, and plenty of stress.

For more information, please call 0845 345 5060 or 0754DENTIST.

Email info@money4dentists.com or visit

www.money4dentists.com

Richard T Lishman

Managing Director of the 4dentists Group of companies

[i] Bank of England, (2023). Official Bank Rate history. Bank of England Database. (Online) Available at: https://www.bankofengland.co.uk/boeapps/database/Bank-Rate.asp [Accessed on July 6, 2023]

Orthodontic treatment is incredibly popular, with more that 200,000 people seeking treatment in England per year.[i] However, as focus on aesthetics gains more importance for patients in the UK, there is one very clear barrier for patients seeking treatment – traditional braces are considered unattractive.[ii] Because of this, it is important that patients are presented with a range of options to correct their malalignment – including conventional braces, clear aligner treatment, and lingual braces.

What are the options?

When patients hear the word braces, they are likely to conjure images of “train tracks” – or conventional fixed metal braces. For many patients, these are not the ideal option, as they draw attention to dental work in progress – which some would consider an unattractive option,ⁱⁱ creating a barrier for patients in need of orthodontic treatment.

For others, the rise in popularity of clear aligner treatment might mean that this is what many are seeking when they visit the practice. While this treatment type offers many benefits, including improved aesthetics and hygiene during treatment, they are not a suitable option for everyone. While they can be very effective at correcting relatively minor misalignments, they may not be appropriate for patients with more complex needs. Because of this, it is important to understand the reasons that patients are seeking this treatment type, and offer them an alternative solution to satisfy their desires in a safe and clinically effective way.

The best of both worlds

There is, however, another option. In many cases, lingual braces offer patients the best of both worlds. Lingual braces are fitted to the inside of patients’ teeth, meaning that they are not visible when they smile. This level of discretion is an attractive prospect, meaning that patients are able to receive the complex treatment types they need, without everyone around them knowing that they have braces. This is because lingual braces are able to tackle complex malocclusions, treating a wide range of cases effectively.[iii]

In addition to overcoming some of the biggest challenges of other orthodontic treatment types, lingual braces offer a number of additional benefits. The lingual surfaces of the teeth are not as uniform when compared to the buccal aspects, so the brackets must be custom made and positioned perfectly, to offer optimal control.ⁱⁱⁱBecause of this, clinicians are able to carry out complex movements, with accuracy, and the brackets can be made to fit the mouth comfortably – for an improved patient experience.ⁱⁱⁱ

Patients also gain the benefit of excellent aesthetics after treatment, as lingual braces carry no risk of damage to the buccal surfaces of the teeth. To minimise any lasting effects of treatment, patients should carry out excellent oral hygiene routines – regardless of the type of orthodontic treatment chosen. However, should any damage occur due to diet or oral hygiene, lingual braces will not leave any visible marks to the front of the teeth, and will therefore not impede the lasting aesthetics.ⁱⁱⁱ

Lingual braces offer one final benefit which can be an excellent motivator for patients undergoing orthodontic treatment – they are able to see the results of treatment as it progresses. By receiving lingual braces, patients can continuously show off their results, monitoring their progress and beginning to appreciate the aesthetics before treatment is complete. Additionally, clinicians are able to more easily evaluate the results as treatment reaches its final stages, making any necessary changes for the best result.ⁱⁱⁱ

Becoming a provider

The skills needed to provide lingual braces are different to conventional fixed braces, so it is important that clinicians have sufficient knowledge. Placing wires and brackets to the lingual surfaces can be more of a challenge when compared to traditional treatment, so clinicians should undertake the appropriate training to carry this out with confidence.

The Lingual Brace course from the IAS Academy offers clinicians a comprehensive blend of practical and theoretical teaching. It discusses the benefits of lingual braces, and when it is appropriate to provide them, as well as ensuring that clinicians are equipped with the skills needed to provide this treatment type back in their practice. This one-day course covers everything that professionals need to place lingual braces with confidence, and is followed by life-long mentorship so that clinicians have all of the support they need going forward.

For many patients, lingual braces offer the best of both worlds, with excellent aesthetics and the ability to tackle complex cases. It is important to do all you can to meet the needs of your patients, and this means removing the aesthetic barriers to orthodontic treatment by providing alternative solutions for treatment where appropriate.

For more information on upcoming IAS Academy training courses, please visit

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

[i] British Orthodontic Society. Why Orthodontics? Accessed July 2023.  https://www.bos.org.uk/patients/treatments/orthodontics-for-adults/why-orthodontics/

[ii] Healthline. Lingual Braces: the upside and downside of braces on the back side. Accessed July 2023. https://www.healthline.com/health/lingual-braces-2

[iii] British Lingual Orthodontic Society. The benefits of lingual braces. Accessed July 2023.  https://www.blos.co.uk/blog/the-benefits-of-lingual-braces/

RelyX Universal Resin Cement from 3M Oral Care is simple yet powerful.

Working either as a standalone, self-adhesive cement or as an adhesive cement when combined with Scotchbond Universal Plus Adhesive from 3M Oral Care, this solution is trusted by clinicians. In fact, it won the Universal Resin category in the Dental Advisor Awards 2023!

Judges liked the comfortable syringe design and unique mixing tip which helps to reduce waste by 80%**. One commented: “having one material to use for all cases is great”; while another praised the “excellent engineering”.

For a simplified workflow, choose the RelyX Universal Resin Cement from 3M. To find out more, get in touch today.

 For more information, call 08705 360 036 or visit www.go.3M.com/ocsdpr

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 3M, RelyX and Scotchbond are trademarks of the 3M Company. 

 * Dental Advisor awards 2023: https://www.dentaladvisor.com/evaluations/3m-relyx-universal-resin-cement/

** 3M Internal data

About 3M
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