Ten Dental+Facial is proud to offer a streamlined referral service for dental implant cases. Whether you seek to refer for partial or complete implant treatment, rest assured that the multi award-winning team can provide additional support.

Adhering to stringent infection control measures and social distancing guidelines, Ten Dental+Facial is highly experienced in treating both simple and advanced cases, including those where complications may be present.

The friendly team make it their mission to ensure patients benefit from the highest quality care. In turn, referring practitioners are provided regular updates as treatment progresses to ensure they remain integral to the process.

For more information visit www.tendental.com, email referrals@tendental.com or call on 020 8675 1798

The British Dental Conference and Dentistry Show will be supporting the Oral Health Foundation’s National Smile Month once again this year and encouraging everyone to get involved in any way that you can.

Among the activities taking place between May and June 2021 is the Great British Brushathon on 3^rd June, as well as the Smiley singalong. Other ways the practice and team can do their part in raising awareness including getting involved on social media by sharing a selfie or a poem about dental health. There will also be a focus on diet with the Sugar Swap Challenge – another topic that many dental professionals could expand upon during patient appointments and in general marketing.

Various resources are available through the website to assist your efforts, which you can find at https://www.dentalhealth.org/national-smile-month. At a time when self-care and dental hygiene are so important, let’s work together to help more people enjoy better dental health.

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

For more information, visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com

If you’re looking for a more flexible way to access digital solutions that don’t require a substantial investment of time and money, Straumann^® Smile in a Box is for you.

It offers a modular yet integrated treatment planning and manufacturing service, which can be tailored specifically to your needs. This means you can outsource key elements of the digital process, enabling you and your patients to benefit from all the advantages of digital dentistry, with none of the hassle.

Simple, convenient, flexible and highly cost-efficient, Straumann^® Smile in a Box is an excellent solution to encourage the growth of your business, while elevating the standard of patient care you deliver. Find out more today.

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

Dr Vikram Chugani, a principal dentist with a special interest in prosthodontics, endodontics and implant dentistry, has been thoroughly impressed by the OPMI Pico dental microscope he purchased from Nuview. 

“I just want everyone to know that after 7 years of use, I can confirm that my Zeiss microscope is worth every penny I spent on it and more,” he says. “I did, of course, look at a few microscopes before I decided to invest in this one. However, the OPMI Pico enabled me to establish the best ergonomic working position and provided the ability to upgrade parts in the future.

“The real deal clincher for this microscope is the excellent service I have received from Steve Clapman at Nuview. He has continued to help me years after my purchase as I have begun to use more and more of the microscope’s features. I have bought other equipment in the past where you never see the salesman again once you have parted with your money, but rest assured that this will never be the case with Steve.

“If you’re thinking of going down the greater magnification route, speak to Steve at Nuview. You will never regret your purchase.”

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 female, 37-year-old patient presented at Digital Dental Office in Ulaanbaatar, Mongolia, in September 2018. She did not like her crowded teeth and was seeking a smile correction.

Upon enquiry, the patient’s medical history was clear. The comprehensive intraoral evaluation (Table 1) identified weakened enamel and some teeth erosion. She was missing her lower right premolar, which she was conscious of. A full set of clinical photographs and an OPG were taken as part of the initial assessment.

Table 1: Assessment

All possible treatment options were discussed with the patient that might help her achieve her desired outcome. The recommended course of treatment was alignment with a fixed orthodontic appliance, due to the amount of movement that would be required. This process was explained in detail, with the importance of oral hygiene maintenance and retention emphasised. A Spacewize™+ calculation was created to determine the amount of space that would need to be created in order to align the teeth, which estimated 3.30mm in the upper arch and 0.3mm in the lower.   

Table 2: ideal vs. compromised treatment aims

A treatment planned was formed, involving the placement of ceramic braces 0.22 Roth, with fixed orthodontics appliances on the upper and lower 6-6. A wire sequence of 0.12, 0.16, 0.20×0.20 and 0.19×25 was proposed, as was a powerchain to encourage correct of the upper midline shift. Both fixed and removable clear retainers would be required upon completion of alignment to help maintain results for life.

The orthodontic assessment and treatment plan with initial Spacewise™+ digital measurements were posted on the IAS Academy’s ClearSmile Brace support forum. It was revied by the highly experienced instructors, who approved the case for treatment with the appliance, without any extractions.

Treatment

The patient commenced treatment in October 2018 using 3M Advanced Clarity fixed ceramic braces with 0.012 NiTi wire. A small amount of build-up composite was placed on the buccal aspect of the upper second molars to prevent the patient from biting on the occlusal surface of the upper second molars to prevent the patient from biting on the brackets of the lingually tipped premolars. Short ligatures were used on the rotated teeth. During the treatment period, the patient was advised to use MI Paste (GC) to help protect her demineralised enamel surfaces and prevent caries development. 

In December, we started sequential interproximal reduction (IPR), based on the Spacewise™ digital analysis for space creation. Approximately 0.96mm of IPR was performed on the mesio-distal aspect of the upper canines and centrals using diamond serrated strips (yellow 0.08mm-red 0.10mm-blue 0.12mm). More MI Paste was applied. Progressive proximal reduction (PPR) was also performed using Sof Lex dics (3M) on the distal edge of the upper canines.

In January 2019, the archwire was changed to 0.016 NiTi. The patient continued to visit the practice regularly for review.

The case was complete in October 2019. The ABB (Align, Bleach and Bond) concept was applied and the patient offered whitening and edge bonding. A course of home whitening – Opalescence 10% Ultradent worn at night for 2 weeks – was completed and some composite bonding was placed on the teeth that were affected by enamel erosion to enhance the overall aesthetics of the smile. Due to her enamel demineralization, the patient felt some mild sensitivity during home whitening and she was recommended to use UltraEZ gel as a desensetising agent when necessary.

Case appraisal

The IAS Academy ClearSmile Brace support forum was utilised throughout this case to ensure that the safest and most effective treatment was always being delivered. Guidance ranged from when and where to place different sized ligatures, to when it was suitable to move onto the next archwire in the sequence. IAS academy’s mentorship helps us to implement our orthodontic treatment in the right way and in the right sequence to make our patients happy and deliver treatment with confidence.

In hindsight, I would increase her maxillary transerse measurement and premaxilla area with three screwed, removable expanders before fitting the orthodontic appliance and help her maxilla grow forward to make more room for mandible movement. 

Images

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

Author:

Dr Bilgee Jigjid qualified in 1995 from the medical University of Mongolia. She went on to complete various postgraduate courses and qualifications in operative dentistry and periodontal therapy. She was initially introduced to IAS Academy in 2010 and has since taken an array of ortho-restorative courses with the Academy.

Dr Adnan Rehman, Principal of Inspired Dentistry in Southampton, discusses how the One to One Dental Education Implant Programme benefitted his dentistry and his career:

“I sought more knowledge to improve predictability of procedures. I wished to ensure a scientific, evidence-based approach to providing implant solutions. I met Fazeela at a lecture she was speaking at. She was quite impressive and very knowledgeable. This lead me to the One to One Dental Education Implant Programme.

“Fazeela’s knowledge and teaching style on the programme were ideal – her energy and passion were spot on. I also liked the formal and informal group discussions, quality of guest speakers, topics, research papers, handouts and practical sessions near exams.  

“There was also amazing and genuine support available. Fazeeela gave up her weekends and I felt looked after throughout the training. An added bonus was the amazing lunch during practicals – the best food on any course!

Since completing the training, I have experienced a massive boost in my confidence and feelings of fulfilments. I am also able to achieve greater predictability in my treatments, and have increased both my business gross and net profit.

“I cannot recommend this programme enough. Fazeela will always be someone I think of as a significant mentor in my dental career.”

To reserve your place or to find out more, please visit https://www.implantcourse.co.uk/our-courses/project-one-7kpfx

or call 020 7486 0000

If you have heard about the Waterpik^® Water Flosser, but want to know more about how it could elevate your patients’ oral hygiene, a Lunch & Learn is just want you need!

You can book a 1-hour slot with one of our Professional Educators, who will present all the scientific data supporting the Waterpik^® Water Flosser and demonstrate its key benefits. They will be able to answer any of your questions and offer advice on how to maximise the advantages available specifically for all your patients.

Your practice will even get a free Waterpik^® Water Flosser demo model when you sign up.

Now available virtually or in person – where is it safe to do so – Waterpik^® Lunch & Learns are the ideal way for you to get all the answers you need. Book yours today!

For more information on Waterpik^® products please visit www.waterpik.co.uk. Waterpik^® products are available from Amazon, Asda, Costco UK, Argos, Boots, Superdrug online and in stores across the UK and Ireland.

Book a Waterpik^® professional Lunch and Learn for 1 hour of verifiable CPD and a free Waterpik^® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/

Across the UK, dental practices are being challenged by new guidance to continue operating successfully, while adapting to the restrictions imposed by the pandemic and inevitably limiting how many patients can be seen per day.

The outcome of this is less availability for dental appointments, which has in turn likely contributed to a rise in calls to the NHS 111 service[i] and increased activity through NHS Online. NHS Digital[ii] reported 5,236 call triages and 5,773 online journeys on 18^th January 2021, which – although not at the peak of its usage – is still significantly higher than daily figures from before the pandemic. In dentistry, the GDC found[iii] that a third of people surveyed had a dental appointment cancelled or postponed during the first national lockdown when practices were forced to close. Perhaps even more worryingly, though the majority of people understood that emergency dental services were still available, over half of those who experienced pain or dental problems during lockdown chose to wait for the restrictions to end before seeking help. Many dentists are continuing to report last minute cancellations due to the coronavirus, with patients having to self-isolate or just not wanting to leave their houses at this uncertain time.

All of this demonstrates that careful supervision of the appointment diary is needed to ensure that your dental practice remains productive and that patients receive the care they need.

Waiting lists

To help decrease the burden on the wider NHS service and enable you to manage short-term cancellations efficiently, creating a waiting list is key. This provides a way of prioritising patient needs, while also boosting practice efficiency. For example, when a patient needs an appointment, you may not be able to see them as soon as they would like. Regardless of whether they make an appointment or not, you can enrol them onto a waiting list. This means that when a last-minute cancellation is made, you have a preprepared list of patients who need to visit the most. You can instantly view and connect with these people to deliver an exceptional service and ensure your practice remains as viable as possible.

SMS text reminders

Of course, the ultimate goal is to reduce the number of short-notice cancellations in the first place. Communicating regularly with patients, keeping them informed of changes in the practice and reassuring them of their safety are all vital. The use of SMS can be particularly helpful to keep them up-to-date with what is happening and to remind them of upcoming appointments. Many practices are also utilising SMS to prepare patients for their arrival at the practice, letting them know when they should enter the premises and what they can expect. It’s a convenient, unintrusive method of communication that the vast majority of patients today appreciate.

Emails

Given that so many patients continue to work from home at this time, email messaging can be just as effective. Most people are likely in the habit of checking their inbox for general correspondence with an array of organisations, individuals and services, plus they can access the information at the most convenient time for them. Why not email your database and provide them with confidence to keep appointments wherever possible? 

Remote forms

Keeping direct contact with patients to a minimum when they do visit the practice is important. The Department of Health and Social Care has confirmed that patients do not have to sign forms during a practice visit until at least 31 March 2021,[iv] helping to avoid cross contamination. Given the recent extension and development of various other restrictions, it is possible that this could be extended further too.

Despite signatures not needed, forms still need to be completed in the practice. Providing these forms to patients head of their appointment to complete at home has become the new standard.                             

Technical support

Of course, all of this will take time and resources to implement and manage on a daily basis within the practice. At a time when practice efficiency is so important, Carestream Dental’s CS R4+ and Sensei Cloud practice management software can make life easier for every team. Both systems offer waiting list functionality to optimise the diary in case of last-minute cancellations, as well as integrated SMS messaging and email capabilities. In addition, CS R4+ offers Remote Forms for COVID-19 screening, medical history and FP17 documentation, which are competed by patients at home and then automatically imported to their R4+ patient file. In Sensei Cloud, patient forms now enable the practice to send a link directly to patients to complete the forms prior to their appointments.

Optimising the diary

Optimising the practice diary is the foundation of a productive and profitable business, but it also enables maximum patients to receive the care they need. Utilising your practice management software to encourage patient attendance and minimise any wasted surgery time is more important right now than ever before.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Twitter @CarestreamDentl

and Facebook

Cheryl Hayes
Carestream Dental, DPMS Regional Product Manager
Europe, Middle East & Africa

[i] NHS 11 call volumes increase be a third due to coronavirus. March 2020. https://www.pulsetoday.co.uk/news/urgent-care/nhs-111-call-volumes-increase-by-a-third-due-to-coronavirus/ [Accessed January 2021]

[ii] NHS Pathways coronavirus triages. Daily data. https://digital.nhs.uk/dashboards/nhs-pathways [Accessed January 2021]

[iii] GDC. Access to dental services has been severely limited and will take time to recover. The impacts of COVID-19. https://www.gdc-uk.org/information-standards-guidance/covid-19/the-impacts-of-covid-19/limited-access-to-dental-services [Accessed January 2021]

[iv] Gov.uk. Suspension of patient signatures on prescription, dental and general ophthalmic services forms. Department of Health & Social Care. https://www.gov.uk/government/publications/temporary-approval-to-suspend-the-need-for-signatures-on-prescriptions-dental-and-ophthalmic-forms/suspension-of-patient-signatures-on-prescription-dental-and-general-ophthalmic-services-forms [Accessed January 2021]

The HyFlex™ REMOVER file removes gutta-percha mechanically, eliminating the need for an additional solvent which may be toxic for the patient. The surrounding tooth structure benefits from the intelligent, asymmetrical design: a non-cutting tip provides additional safety.

Here’s what clinicians say:

• “Makes gutta-percha removal easy and fast”
• “Respects complex root canal anatomies”
• “My ‘endodontic life’ is more convenient”
• “A single instrument for removing old gutta-percha? The REMOVER fulfils the dream!”

The REMOVER is available in several sizes and can be integrated into the HyFlex™ and MicroMega file systems for optimum results.

Fast, reliable, intuitive – the REMOVER from COLTENE will upgrade your dentistry.

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

A 54-year-old female patient presented to my colleague as a new patient to the practice looking for cosmetic dentistry. She was a regular attender with her previous dentist, was generally fit and well with an unremarkable medical history, and presented with no urgent concerns. The patient had been treated with a fixed appliance orthodontic treatment as a child, which she recalled as being painful.

The patient simply wished to improve the appearance of her teeth. She had a particular dislike of the shape and chipping of her upper incisors, and an anterior tooth that was out of alignment in her lower arch. The patient’s dental health was secured by my colleague, including routine periodontal treatment with our hygienist, before referral to myself for an orthodontic assessment.

Orthodontic assessment

Extraorally, the patient had an increased lower face height with no asymmetry. Her profile was mildly convex with an obtuse nasolabial angle and an increased FMPA angle.

Intraorally, she had a mild Class II Division I incisor relationship on a mild Class II skeletal base, with mild upper incisor crowding and moderate lower crowding. The patient’s upper centreline was coincident with her midline, while the lower centreline had a 3mm shift to the right. The canines had a Class I relationship, there were spaces in the upper premolar regions, and the molar relationships were Class II on both sides.  

All possible treatment options were presented to the patient, including fixed labial appliances and removable clear aligners. The patient preferred removable aligners since she remembered a lot of discomfort associated with the fixed braces she had as a child.

Treatment planning

Records were collected for submission to the ClearCorrect^® portal, including DSLR photographs, Trios (3Shape) intraoral scans and an OPG to review all the teeth and root lengths. During this process, the spaces present in the upper premolar areas were discussed with the patient, explaining that to close these completely would involve a significantly longer treatment plan. It could also possibly risk adverse effects on her profile with a reduction in lip support. The patient did not feel that closing these gaps was a priority and was happy to accept some residual spacing.

The ClearCorrect^® dental technician was instructed to create a treatment set-up that would aim to align the upper and lower incisors. I requested that we achieve this by relieving the upper incisal crowding with arch development and some utilisation of the existing premolar spaces. In the lower arch we would also use arch development, interproximal reduction (IPR) and some incisor proclination. After receiving the 3D digital treatment set-up, I was able to directly communicate with the technician through the ClearPilot portal and request some adjustments. The initial plan showed the aligned incisors displaying ‘black triangles’ at the end of the treatment, so we added additional IPR in these areas to improve the overall aesthetic outcome.

Once the final set-up was shared and approved with the patient, I explained the stages of the treatment using the interactive ClearPilot online tool. I showed the patient where interproximal adjustments would be carried out and engagers fitted. The treatment was scheduled to take place using 15 stages, changing aligner every 2 weeks over a total duration of about 8 months. The Unlimited ClearCorrect^® treatment option was selected, offering unlimited aligners and retainers over a five-year period and enabling me to control the lab fees no matter how many aligners were eventually required.

It was emphasised during this consultation that the set-up is only a guide and that there are occasions with aligner treatment when teeth do not move as expected. Personally, I routinely inform patients that we should allow an additional period of time in case it’s necessary to wear an aligner a little longer to allow complete movements or to refine the treatment set-up with a new scan. This helps to manage patient expectations. In this case, the patient was warned of the possible need for an additional 3 months of treatment time.

Treatment provision

Once the consent process was complete, the ClearCorrect^® aligners were manufactured and two weeks later treatment began. Initially, the IPR prescribed for the lower arch was performed and the aligners fitted. The patient was reminded to wear them for at least 22 hours per day and only removed to eat, drink (with the exception of plain water) and clean her teeth. The importance of maintaining meticulous oral hygiene was reinforced and she was advised to wear stage 1 for two weeks, before changing to stage 2, which was provided to take home.

Four weeks later, she attended for her first review appointment and fitting of the stage 2 aligner in-situ was checked to be satisfactory. Engagers were also placed as scheduled to aid the action of the aligner by enhancing the ‘grip’ on the tooth. This procedure is made very straightforward with the templates provided by ClearCorrect^®, allowing the precise placement of composite resin as required. Stage 3 was fitted and stage 4 provided to use after 2 weeks.

The review appointments continued every 4 weeks, ensuring that the teeth were tracking with the aligners and moving as planned. At stage 10, it became apparent that we were starting to lose tracking with a slight gap developing at the lower incisal edge.  I advised to step back to stage 9 and wear this for an additional week, reinforcing the use of chewies to ensure that the aligner was fully seated. This improved the fitting and we were able to continue to stage 10. With stage 11, there was a slight tendency for the gap to return, so I re-scanned her teeth and refined the treatment plan.

With the prompt turnaround by ClearCorrect^® following submission of the new scan, I was able to see the refined treatment set-up. I requested that some of the tooth movements be slowed down, extending the overall treatment to 19 stages. This was finalised, the aligners were fabricated and the patient resumed treatment less than two weeks later.

Following this sequence, we were pleased with the outcome of the upper teeth, but a little further buccal movement of the LR2 and some rotation of the LR3 was needed. A new scan was taken, but before this, with an eye on the final outcome, we decided that we would carry out some simple composite bonding and incisal edge contouring to improve the shape of the incisor teeth.

The new set-up was reviewed and 5 sets of aligners manufactured. Alignment was complete 3 months later.

The patient had a strong preference for fixed retainers, which I agreed was vital to secure the new position of the LR2. However, the patient was advised against a fixed retainer in her upper arch due to the limited space and increased risk of debonding, as well as the fact that a removable retainer would still be required to help maintain the relative positions of the canines and premolars.

Outcome

The patient was delighted with the final outcome, particularly with how natural her smile looked. Further aesthetic improvements were discussed, including tooth whitening and composite bonding to improve the tooth morphology, which she declined.

When I look back over this case, I feel we had a very successful overall outcome. The patient’s objectives were fulfilled by repositioning the LR2 and improving the overall alignment of her teeth. There was also a modest improvement with her lower centreline and we managed to reduce some of the spacing in the upper premolar regions.

The treatment involved a total of 24 stages, which includes the two necessary refinements, over a period of 14 months. Retrospectively, I feel that some of the tooth alignment would have benefited from slower movements that were staged slightly differently.

That said, the treatment time extension was not an issue. Since I had forewarned the patient of the possibility of treatment time extension, the overall treatment time remained acceptable to the patient’s expectations. The ClearCorrect^® Unlimited treatment option also meant that even though we required more aligners, the lab fees were unaffected and this provided security for me as the clinician.

The Trios scanner also played an important role by not only ensuring the most precise fit of aligners, but also enabling a quicker turnaround when refinements were required.  Cutting out the need for handling and posting impressions saves days and ensures active treatment can resume with minimal delay.

Images

For more information on ClearCorrect^®, visit: https://www.straumann.com/clearcorrect/en/home.html

Author: 

Sean Power graduated from Birmingham University in 1998 and has since worked at various practices in the UK and Australia. He has a specialist interest in orthodontics and endodontics, having used clear aligners since 2009 and ClearCorrect^® since it arrived in the UK in 2016. He currently works at Heath Dental and Smile Concepts in Solihull, West Midlands.