Keeping implant patients motivated – it’s often harder than you think

Dental implants are now commonplace, as the desired alternative to removable dentures. Demand has increased, worldwide and in the UK, as patients love how they look, feel and function like natural teeth. More dentists are training to deliver implant therapy, to help more people and add a valuable revenue stream to the practices they work in. The inclusion of implant therapy on your list of services can be a good decision, from an oral health and from a business point of view.

Implants aren’t place and go, and all dental professionals must ensure that people are motivated to take ongoing care of them for long-term success. More implants mean more peri-implantitis, which affects the hard and soft tissue surrounding the site and can lead to implant failure. We are still learning about peri-implantitis and its risk factors, which need to be considered for earlier diagnosis, better prevention and improved management of the condition. Like a lot of dental disease, it can be pain-free, especially in the early stages – silently destructive and without any obvious symptoms that send a red flag for the patient to call the practice.

But how easy is it to motivate implant patients into an elevated oral hygiene routine? Despite the fact they would have made an often-substantial financial investment into their treatment and want it to last – and look good – for years, you will know from experience that compliance is sometimes harder than you think to achieve.

Patients acting like consumers, proactively choosing how and where to proceed, does mean that practices have had to raise their game and keep standards of care high. On one hand, this is a positive, but it is about balance, not a wholesale shift of power to patients. It is their willingness to trust you and adhere to your guidance and advice, in combination with your clinical knowledge, skills and experience, that will support a lifetime of good oral health. So, if we hear that modern patients are in the driving seat, this isn’t strictly true. They have decided to say “yes” to implant therapy, and they have chosen to have their treatment with you, but they must work alongside the dental team in an ongoing partnership if they want to continue heading in the right direction.

The importance of trust

Practices must commit to establishing trust with all their patients, but especially those interested in implants. A friendly, informed and knowledgeable manner at every point of contact is key, as is a schedule of pre-treatment consultations. If your implant patient is new to the practice, you won’t have had much time to develop a relationship with them. Pre-consultations, therefore, must be comprehensive, covering more than the mechanics of what will happen once they’re in the chair, and the practical things like timings and cost.

Is there anything that they can do before treatment starts to improve their oral hygiene, for example? And are they prepared to put the required effort in afterwards, practise elevated cleaning and attend regular maintenance appointments? Talk through the basics of oral hygiene, including things like smoking status, alcohol and nutrition, and all the risks for failure. Collaborate – there may be a great deal yet to learn about peri-implantitis and implant failure, but there is plenty that we do know. Make it a discussion, rather than a set of instructions. Patients should understand that follow-up appointments are necessary even if there is no pain, or other signs of a problem. These maintenance visits are useful for engaging patients with the importance of prevention generally, not just for getting their implants checked and cleaned, but for talking about other issues that could affect their oral health and all-round wellbeing. Constantly reinforcing messages in a positive way is the key to better outcomes.

This isn’t about a time-pressed patient adding multiple layers to their hygiene routine, rather making one or two hard-working alterations. Keep it simple, keep it good value, keep it effective and, hopefully, the changes will become habit. Go through adjuncts and the differences between them. A common home-care aid that all patients find easy to use is mouth rinse – just swirl and spit. The difference lies in the quality of the product. For use before and after implant therapy, Curasept ADS Implant mouth rinse, available from J&S Davis in the UK, contains ingredients to prevent infection and promote healing and repair, including PVP-VA and hyaluronic acid. The patented Anti Discolouration System (ADS) means the risk of staining and taste disturbance is minimised too, making it a convenient choice.

A patient who does not see you as a partner often leaves after their treatment is completed, not to return unless there is an obvious problem. This inhibits treatment success and goes against the essence of preventive dentistry. Keep your message straightforward and simple, engage with patients to establish good relationships and make elevated oral hygiene accessible. With small changes and quality products, plus a commitment to regular maintenance appointments, they will keep their implants stable, functional and looking wonderful for years.

 

For more information on the industry-leading products available from J&S Davis, visit www.js-davis.co.uk, call 01438 747 344 or email jsdsales@js-davis.co.uk

 

Author:

Steve Brown Director of Sales and Marketing J&S Davis Ltd

Shield your scope from contamination

Take advantage of the Nuview Scope-Shield and Scope-Cone to protect your dental microscopes from contamination. These innovative PPE solutions have been developed in conjunction with leading dental professionals to shield against spray and droplets generated during microscopically assisted dental procedures.

Available in packs of five, the Nuview Scope-Shield seals the gaps at the binocular/shield interface, whilst the Scope-Cone protects the microscope head, with its conical design enabling easy access to the microscope’s handles during operation.

Don’t let the risk of cross-infection keep you from utilising your microscope – protect your investment with the Nuview Scope-Shield and Scope-Cone. Call now to order.

 

For more information please call Nuview on 01453 872266, email info@nuview-ltd.com, visit www.nuview.co.uk or ‘like’ Nuview on Facebook.

A team you can trust

Looking for a team that can handle complex cases? Consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction.

Led by Professor Cemal Ucer – Specialist Oral Surgeon and renowned clinician – the practice is perfectly equipped to handle challenging cases, such as dental implant treatment in severely atrophic and medically compromised patients. It features cutting-edge facilities with a comprehensive digital workflow day-care surgery under the management of a medical team of consultant anaesthetists. The centre utilises evidence-based techniques, materials and technologies to optimise audited clinical outcomes.

The highly experienced team routinely carries out complex treatment planning and advanced surgical procedures, with a focus on ensuring utmost patient satisfaction and safety. Call today to discuss how they might help your patient.

 

Please contact Professor Ucer at ice@ucer.uk or Mel Hay at mel@mdic.co

01612 371842

Freedom from dental decay: a human right of all UK children?

Children suffering from the blight of dental decay caused by processed foods over-laden with sugar need protecting says Professor Amandine Garde, the founding director of the Law & Non-Communicable Diseases Research Unit at the University of Liverpool.

 A leading expert on the role that the law can have on promoting better health, Professor Garde is a speaker in the first session of BSPD’s Conference on 5 October when she will explain why she advocates for a child rights-based approach to the prevention of non-communicable diseases.

Also on the panel dedicated to discussing policies for reducing sugar consumption are Dr Emma Boyland, an Experimental Psychologist, based at the University of Liverpool, and Dr Alison Tedstone, Chief Nutritionist at Public Health England. The session will be chaired by Dr Clare Ledingham who also Chairs the conference hosted this year by BSPD’s Merseyside branch.

Professor Garde will promote a rights-based approach supporting population-wide, preventive measures as the most likely to ensure that the UK government and others around the world comply with their obligation to protect the right to the enjoyment of the highest attainable standard of health and related children’s rights.

In particular, she will argue that governments are legally accountable for their failure to protect children from the damage that excessive sugar consumption causes and will reflect on the regulatory tools that public health campaigners have at their disposal to increase the pressure on the government to promote better health, and therefore reduce health inequities and improve compliance with children’s rights She will frame the discussion in a post-Brexit context, highlighting that trade negotiations should bear in mind the imperative for governments to protect public health.

Professor Graham McGregor, Chairman of Action on Sugar, who with Professor Garde was at the 2018 Sugar Summit organised by the BDA, said a legal or regulatory approach was probably one of the most effective ways to bring about change.

Just recently there had been a flurry of promising new policies for improving the British diet, he said, but unless targets for sugar reduction were enforced there would be little improvement.  “The food manufacturers are completely in charge of what goes into their products and will not change unless mandatory targets for sugar reduction are imposed.”

Other speakers lined up for the virtual 2021 conference by Scientific Chair Laura Gartshore include:

  • Dr Charlotte Waite, the community dentist and Charlotte Waite, a social worker who will discuss: Advocating for Vulnerable Children and their Oral Health
  • Dr Aideen Naughton: Childhood adversity brain development and life course legacy.
  • Dr Hannah Barham Brown, a GP and disability campaigner: Issues with my tissues and contending with Ehlers Danlos Syndrome
  • Dr Lola Solebo, a Consultant Opthalmologist: Through the eyes of a child.
  • Professor Julian Pine: How parents influence their children’s language development
  • Dr Sally Hibbert on transitional care.

The two day conference on 5 and 6 October will be preceded by the BSPD Teachers Branch Study morning on 4 October.

BSPD 2021 Scientific Programme

GDC reforms must safeguard dentists with health concerns

John Makin, head of the DDU on why proposed regulatory reforms could penalise the most vulnerable dental professionals.

The extreme pressure placed on healthcare professionals by the pandemic has been well documented but is non the less shocking. A recent survey by charity the Laura Hyde foundation revealed the troubling findings that more than 300 healthcare professionals attempted to take their own lives during 2020 as they responded to the pandemic. The DDU’s own research has found that over three quarters of some 400 dental professionals surveyed feel stressed or anxious on a weekly basis.

As dental practitioners have worked so hard to deliver safe care to patients during the pandemic, it’s more important than ever that they can place their faith in their regulator if facing a GDC investigation.

Long awaited proposals have now been published by the Department of Health and Social care on regulating professionals and protecting the public. There is much to applaud in the suggestions aimed at modernising and streamlining procedures. For example, the consultation sets out proposals for reforming fitness to practise to allow for the “safe and quick conclusion of many cases without the need for expensive and lengthy panel hearings”.

However, one proposal has caused us concern. Removing health as a category of impairment in fitness to practise cases, we believe would be a retrograde step. The government motive for this, which we support, are that such concerns should usually be dealt with outside a fitness to practise process. However, there will inevitably be some cases where health concerns lead to a formal process. Such cases would instead be dealt with under the banner of ‘lack of competence’. The terminology will surely add to the distress for any dental professional who is struggling with their physical or mental health under the strain of an investigation. 

In recent years, the GDC has established measures for sensitively managing these concerns, such as ensuring details about a clinician’s health are separated from other publicly available content about fitness to practise matters.

Removing the health category for fitness to practise cases risks undoing these advances. The practical effect of this will be to penalise the most vulnerable doctors. We believe it is essential to retain separate procedures for dealing with dental professionals with health problems.

Dental professionals have waited a long time to see the GDC reformed and the pandemic has highlighted the need for that reform to be delivered at pace. Frustratingly, the GDC is not included in the first priority group for reform. The DDU strongly believes dental professional regulation must not be put to the back of the line. It’s vital the GDC is provided with the powers its needs to be a stronger and more flexible regulator without further delay.

See more about the DDU’s views on healthcare regulation on our websitewww.theddu.com.

Utilising a digital workflow to optimise the clear aligner patient journey

Dr Aran Maxwell-Cox presents a recent case study.

 

A 27-year-old male patient attended for a cosmetic consultation as he had been recommended my services from friends in the local community. His main concerns were lower crowding and the overall aesthetics of his smile. The patient was a prominent local business owner, speaking in front of people a lot, so he was conscious of his teeth every day. As work took up much of his time, he wanted a hassle-free treatment solution that would be straightforward yet yield the results he wanted.

When discussing his concerns, the patient expressed the desire for a white, straight, yet natural-looking smile and was happy to have orthodontic treatment as part of the plan to achieve this.

Assessment

A comprehensive intra-and extra-oral examination was performed. The patient had calculus present in in all quadrants and caries affecting the UR6. These issues were addressed first to ensure he was dentally-fit prior to cosmetic treatment. The patient had a composite restoration placed alongside intensive dental hygiene and advice before being suitable for treatment. At this point, the patient was happy with the position of his upper teeth but had lower crowding with the LR1 set back in the arch.

All possible treatment options were discussed with the patient in detail. He had already expressed a preference for removable orthodontics rather than a fixed solution. It was explained that a fully digital journey could be implemented, which would be more comfortable and convenient for the patient and allow for fewer in-practice appointments. The 3D treatment set-up for ClearCorrect® requires no upfront fee, so we proceeded to take the appropriate clinical photographs, radiographs and digital impressions scan using the 3Shape Trios® intraoral scanner.

While this case was ideal for treatment with clear aligners – given the mild crowding present ­– it was still important that the patient understood any potential compromises in the possible outcome with removable orthodontics. The 3Shape Trios Treatment Simulator creates a simulation of the predicted final result and it is then up to the patient whether they can accept this, or if they require different treatment to achieve a different outcome. This helps with consent and treatment acceptance.

In this case, the patient was very happy to proceed, so the clear aligners were ordered.

Treatment

Orthodontic treatment commenced in January 2020. The patient initially returned to the practice four weeks into treatment for review and to receive the next aligners in the sequence. At this time, attachments were placed to encourage tooth movement once the patient had become slightly more accustomed to wearing the aligners.

Interproximal reduction (IPR) was performed as and when necessary after that. The patient’s last appointment before lockdown was in March 2020.

Of course, face-to-face appointments were not possible at this point. The patient continued with the aligner sequence until IPR was required and then wore the last aligner he had as a retainer to prevent relapse. When practices were allowed to re-open in early July, we were able to trial Dental Monitoring via the Straumann Group, which I offered to the patient. He accepted, came in to collect the scan box and the next selection of clear aligners, and was able to continue treatment more remotely. The patient found the app easy and straightforward to use and was able to continue treatment with fewer appointments while I monitored his progress.

At the end of the initial course of treatment, we decided to do some slight refinement to perfect the tooth positioning. The patient completed this with 1-week changeovers and then attended for a review. To complete treatment, tooth whitening and composite edge bonding were performed. We then took final scans for retainers, placing fixed upper and lower retainers, as well as providing removable retainers for night-time wear.

Review

This was a fantastic ABB (Align, Bleach and Bond) case and both the patient and I were over the moon with the result. Whilst we had the initial frustration of lockdown delaying treatment, the patient was delighted that we were able to continue with remote monitoring, enhancing his experience and allowing for fewer practice visits.

For any clinicians starting out with ClearCorrect® or any other clear aligner system, case selection is really important. It’s vital to begin with simple cases to see what can be achieved and build from there. Over time, a growth in confidence and knowledge about orthodontics and clear aligners will allow for trickier cases to be considered and successfully completed.

By enabling remote treatment assessment and monitoring, Dental Monitoring was a brilliant addition to the case and the software enhances the digital workflow – patients who have used it have really warmed to it. When planning cases now, I aim to place attachments and IPR within fewer appointments and utilise this system to free-up surgery time and require fewer visits for patients. I would recommend Dental Monitoring and ClearCorrect® to all dentists who are wanting to progress in the field of clear aligner therapy, it really is a game-changer!

Images

 

For details about ClearCorrect®, please visit https://www.straumann.com/clearcorrect/en/home.html

 

Author:

Dr Aran Maxwell-Cox provide cosmetic dentistry and facial aesthetics to patients in Durham. He qualified with a Bachelor of Dental Surgery in 2014 from the University of Dundee and has since completed various postgraduate training courses to advance his skills.

Oral health in our coastal communities

Neil Carmichael, Chair of the ADG, has responded to the Chief Medical Officer’s annual report on Health in our Coastal Communities published this week.

“The Coastal Communities report confirms that coastal towns face many healthcare challenges, but it is important to remember that this includes dental public health. Our members have been telling us that the hardest parts of the country for recruiting dentists include many coastal communities such as Scarborough, Hull, Cornwall and the Isle of Wight.”

We welcome the report recommendation that “The current mismatch between health and social care worker deployment and disease prevalence in coastal areas needs to be addressed. This requires action by HEE and NHSE/I”, however this must include the dental workforce and consider incentives for training and working in coastal areas struggling with access to NHS dentistry.”

Dr Sandra White, ADG Clinical Director, added: “There are persistent inequalities in oral health across England1. In 2019 five-year-old children in half of the ten case study areas mentioned in the report had a higher number of decayed, filled and missing teeth than the English average2. Oral health must not be left behind in levelling up population health across the country.

“Dental decay is largely preventable. It is worth noting that two of the coastal areas used as case studies in the report benefit from fluoridated water supplies, with 5-year-old children in these areas having a lower than the national average experience of tooth decay. (Hartlepool and parts of Lincolnshire)”.

The case for ridge preservation

With so many ways of doing things in modern dentistry, it’s important for professionals to consider all the possibilities in order to deliver the best possible patient care. Different approaches and techniques can lead to varying treatment success, with a multitude of factors impacting the final result. By sharing top tips, discussing experiences and evaluating clinical concepts, dental professionals can improve their capabilities as a collective and, ultimately, enhance the care that they deliver to their patients.

In dental implantology, where new ideas are constantly emerging, it is crucial to assess and challenge techniques and products. Only with proper evaluation and careful development can dental implant treatment be optimised for different clinical situations, enabling more patients to benefit from effective solutions.

The ADI Team Congress 2022 will be the perfect place for dental professionals involved in the field to join the conversations. Entitled “The Great Debate: Current Dilemmas in Dental Implantology”, it will do exactly what it says on the tin, providing a platform for constructive discussion and the sharing of expertise from leading lights across the global profession.

Among the highly anticipated speakers will be Daniel Thoma, a Specialist in Reconstructive Dentistry and ITI Fellow from Switzerland, with particular interests in dental implantology and aesthetic dentistry. He will be presenting at the ADI Team Congress as part of the Plenary Programme, making the case for ridge preservation in a debate about possible treatment modalities for the failed central incisor.

Speaking about the main challenges of ridge preservation and the benefits available when delivered in the right cases and performed effectively, Daniel comments:

“The main challenges of ridge preservation techniques are associated with conducting a proper risk analysis and ensuring prosthetically-orientated treatment planning with the final outcome in mind. Depending on the specific case and the risks involved with that particular patient, there are often various therapeutic options that might be appropriate. The impact of different treatment strategies is documented in several situations, so the research should be used to support the planning and decision-making process in order to achieve the most pleasing outcome.

“In the right cases, the key benefits of ridge preservation are the ease of treatment and the reduced need for guided bone regeneration at dental implant placement. Clinically, this approach maintains the ridge profile of both the hard and soft tissue for enhanced aesthetics.”

During his session, Daniel will share his wealth of expertise to help delegates improve their knowledge regarding ridge preservation techniques. He will detail the clinical steps involved and offer practical advice that clinicians will likely find insightful.

“To ensure the success of treatment,” Daniel continues, “clinicians need a sound knowledge of all the available treatment options, including the advantages and disadvantages of each. If choosing to proceed with ridge preservation, the key is to apply the correct clinical sequence during therapy for optimal results.”

The ADI Team Congress 2022 will include sessions dedicated to dentists, dental nurses and practice managers, dental hygienists and therapists and dental technicians. There will be a combination of lectures, workshops and demonstrations on offer to provide an all-inclusive and diverse learning experience for delegates. A major trade exhibition will host an array of dental suppliers and manufacturers offering dental implant-related products and services. Plus, the legendary Congress Dinner on Saturday night will provide an opportunity to relax and enjoy time with friends and colleagues.

The entire event is designed to encourage discussion and debate among peers, enabling everyone to offer their perspectives and learn from others. Talking about the format of the event, Daniel adds:

“Clinicians will be challenged by different speakers focusing on specific treatment modalities. Attendees will be provided with an excellent overview on various treatment modalities. This is an interesting event design since the speakers will be challenged as well as delegates. They have to defend their option/therapy so delegates can make their treatment decisions based on the data/cases presented.”

If you are involved with the provision, restoration or maintenance of dental implants, this will be the perfect opportunity to update your knowledge and skills, while joining the conversation. To get your voice heard and to hear from industry-leading professionals, don’t miss the ADI Team Congress 2022.

ADI Team Congress 2022

“The Great Debate”

26-28 May 2022, Manchester Central

 

ADI members will be able to attend the ADI Team Congress for discounted rates. Join today.

www.adi.org.uk/congress22

Hear from the leading voices in dental technology

Don’t miss out on the opportunity for your lab to hear from the industry’s preeminent figures at the next Dental Technology Showcase (DTS).

Save the dates for what will be a flagship conference for the sector as over 50 world-renowned speakers present a programme developed by the industry’s most forward-thinking professionals.

The first-class series of sessions will be delivered over two days and hosted by experts from across the sector and beyond – covering key topics such as digital dentistry, the next generation of dental technicians, indoor air quality, financial infrastructure, and more.

Sign up today and join hundreds of other dental technicians as we reunite and rebuild in 2022.

 

DTS 2022 will be held on Friday 13th and Saturday 14th May, Birmingham NEC, co-located with the British Dental Conference and Dentistry Show.

For the latest information, please visit www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

Taking it tooth by tooth: benefits of minimally invasive dentistry

As we know, tooth surface loss (TSL) is a complex, multifaceted issue that can be challenging to manage in patients. When presented with a case it is vital that the underlying pathology is identified early and treated ahead of the symptoms, so as to avoid the problem arising in the future, and with increased severity.

Tooth wear seems to be a growing problem affecting all ages [i] with a notable increase in young patients presenting with moderate to severe erosive wear caused by intrinsic and extrinsic acids. i

Symptoms of TSL can range from mild sensitivity from an abrasion lesion, to gross destruction of the dentition. [ii] If left uncontrolled it can lead to not only poor aesthetics, but also dentine hypersensitivity and functional problems – ultimately resulting in a reduced quality of life for the patient. ii

Modern treatments for tooth surface loss

Depending on the severity of symptoms experienced from TSL, treatment can range from simple operative care, to full mouth reconstruction with crowns, veneers or complex dentures. There is always a balance to be had between too little or too much treatment – both of which can lead to tooth loss and patient dissatisfaction or complaint.

However, traditional treatment methods for moderate or advanced tooth wear, such as indirect restorations and crown lengthening surgery, are invasive and destructive of remaining tissues. This isn’t conducive to achieving the lifetime patient status modern dentists strive to accomplish. Below are examples of minimally invasive procedures which protect the natural tissues for the long term, and provide benefits for both patient and practitioner.

Localised minor axial tooth movement (the ‘Dahl’ approach)

There are a variety of methods that combine differential intrusion and eruption of teeth to create interocclusal space, as described by Dahl. [iii] The approach is a way of treating localised anterior tooth wear before posterior wear starts to open the vertical dimension of the occlusion.  

Originally consisting of a removable cobalt chromium platform worn in the upper arch, poor patient compliance required evolution of the Dahl approach to include cementation of the appliances to ensure full-time wear.

Recently, adhesive anterior direct composites have been used, especially when restoring anterior tooth wear in patients who have lost vertical dimension and are experiencing malocclusion due to attrition. The creation of inter-occlusal space significantly reduces the amount of tooth preparation required, particularly on a compromised palatal surface, enabling a less invasive technique and more progressive method to manage the issue.

Conventional orthodontics
Orthodontics can provide a controlled and predictable method of creating localised inter-occlusal clearance, and form part of a comprehensive treatment plan when used alongside the Dahl approach. Using orthodontics instead of crowns or veneers can improve the aesthetics of a smile or function of a bite, without causing excessive damage to the tooth tissue.

A treatment option could include using clear aligners to reposition the anterior teeth, in combination with interproximal reduction (IPR). The staggered execution of IPR would also mean that there is far less opportunity to over-strip and gouge the teeth, plus the contacts remain more anatomically correct and less likely to trap plaque.

With careful planning following a ‘tooth by tooth’ assessment, a combination of technologies may provide an extensive but conservative treatment plan that will benefit the patient across their lifetime.

Benefits of minimally invasive treatment

Minimally invasive restoration should be considered in the first instance to ensure each patient case, whether simple or complex, is treated appropriately and ethically to achieve biologically stable and aesthetically pleasing results.

The dual goals of prevention and preservation sit at the heart of minimally invasive dentistry, with the aim being to maintain as much of the natural tooth and tissue as possible. Improvements in composite materials and an increased appreciation of their applications have made these goals achievable through direct restoration, particularly concerning tooth wear of anterior teeth.

Offering minimally invasive treatments to patients as a first step benefits both patient and practitioner. While encouraging greater stability of the teeth, they require a limited healing period (unlike extractions), and speed up the overall orthodontic process, saving patients time and money.

While some dentists might feel more confident in performing conventional prosthodontic techniques, it is clear that minimally invasive treatments, such as the Dahl Principle, have significant benefits that are hard to ignore. 

Get the training you need

IAS Academy offers comprehensive training for those looking to establish and advance their skills in orthodontics and restorative dentistry – including the conservative treatments mentioned above. Subjects covered include creating beautiful smiles using alignment, bleaching and bonding (ABB), using the Dahl Principle to deliver better patient outcomes, and designing a life-long restorative plan that your patients can afford.

 

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

 

Author: Dr Tif Qureshi founder and a clinical director of IAS Academy

 

[i] Redman, C., Hemmings, K. & Good, J. The survival and clinical performance of resin–based composite restorations used to treat localised anterior tooth wear. Br Dent J 194, 566–572 (2003). https://doi.org/10.1038/sj.bdj.4810209

[ii] Tooth Wear Guidelines for the BSRD. Available at https://www.bsrd.org.uk/File.ashx?id=15192 [Last accessed 26.5.2021]

[iii] Dahl BL, Krogstad O, Karlsen K. An alternative treatment in cases with advanced localized attrition. J Oral Rehabil 1975; 2: 209−214.