DT UK 2010

White Paper reshapes NHS / News / GDPUK round-up / Do you dream about success or have nightmares about failure? / Meeting face to face / IMPLANT TRIBUNE 3/2010 (part1) / IMPLANT TRIBUNE 3/2010 (part2) / IMPLANT TRIBUNE 3/2010 (part3) / IMPLANT TRIBUNE 3/2010 (part4) / When your job description takes an unexpected turn / Back to the Egg; Part II / Industry News / Helping at Crisis Christmas / Discovering the H Factor / Classified

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Table of contents

August 2-8, 2010

PUBLISHED IN LONDON
News in Brief
Hopital loses dental services
NHS Barnet has axed dental
services from Edgware Community Hospital in North London due to ‘financial pressures’.
More than 60 patients with
ongoing treatment have had
to find alternative treatment
after the closure of the Dental
Access Centre due to ‘financial pressures’ on NHS Barnet.
It claims the Dental Access
Centre has been closed because
there is spare capacity at the
71 other NHS surgeries in Barnet. A statement from the Trust
said: ‘In this time of economic
downturn, financial pressures
on the local NHS is increasing making it absolutely vital
in ensuring that we use all
our available resources fairly
and appropriately. These patients, along with all previous
patients who accessed dental
services at this site, have been
notified and arrangements
are being made for their treatment to continue at an alternative dental clinic nearby. In
and around the Edgware area
alone, there are 15 dental practices that provide NHS dental
services and are available for
the public to use.’
GDPs not ready
GDPs are not ready for registration with the Care Quality Commission, according
to recent research conducted
by Software of Excellence, a
practice management software company. With only six
months to go, 22 per cent of
those surveyed admitted to
being unprepared for registration, whilst a further 19 per
cent did not know what CQC
meant. The procedure for registration needs to allow time
for processing, meaning that
some practices will be given
a date for registration that
could be as early as October
this year. Greg Clay, sales and
marketing director at Software
of Excellence said it ‘is a cause
for concern’.
Sonicare For Kids
The Sonicare For Kids toothbrush has been accredited
by the British Dental Health
Foundation (BDHF). An independent panel of dental academics drawn together by the
BDHF assessed the basis for
claims made by Philips about
the Sonicare For Kids and approved them. These claims include ‘Sonicare For Kids removes
significantly more plaque than
a manual toothbrush’, ‘Sonicare For Kids is safe and gentle
on your childs’ gums and ‘children brush significantly longer with Sonicare For Kids than
with a manual toothbrush’
The BDHF accreditation logo
will soon be appearing on Sonicare For Kids packaging and
practice and patient literature.
www.dental-tribune.co.uk

News

Implant Tribune

Winner

VT wins 2010 prize for best case
presentation at local VT scheme

page 4

CAD/CAM possibilities

Case study looking at the use of
CAD/CAM in treatment

pages 19-22

VOL. 4 NO. 20
Clinical

Feature

Back to the Egg

Crisis Christmas

Kenneth Serota discusses dentine and endodontics

pages 24-26

One woman’s story of helping
the homless

page 29

White Paper reshapes NHS
PCTs and SHAs scrapped as GPs take over healthcare; dentistry
reverts to centralised control by NHS Commissioning Board

T

he Coalition Government
has set out its reforms for
the NHS in a White Paper
entitled Equity and Excellence:
Liberating the NHS.
In a radical shakeup of the
way the NHS is currently run,
the White Paper proposes that
most of the mainstream healthcare services currently looked
after by Primary Care Trusts will
become the responsibility of GP
Consortia, who will assess and
commission services.

we want to hear the views of
healthcare professionals on how
the new system should work.
The Way Forward
“The White Paper also reiterates the Coalition Government’s
commitment to introduce a new
dentistry contract following consultation and trials. This will be
designed in the context of the
new commissioning arrangements. I am having ongoing
meetings with key representatives of the profession to discuss
the way forward.”

Dentistry will not fall under
this remit however, as there will
be an independent NHS Commissioning Board who will be
responsible for services such as
pharmacy and ophthalmology
as well as dentistry. The will see
a return to centralised control
for dental services, as PCTs and
SHAs will fall by the wayside in
the proposed reforms.
Consistency
Commenting on the proposals,
Health Minister, Lord Howe said:
“The White Paper proposes that a
new NHS Commissioning Board
should take over from PCTs the
responsibility for commissioning
dentistry in order to improve the
quality of care for patients and
consistency of commissioning.
“The transition to the new
system will require careful management at every stage. This will
be a challenge, but I have every
confidence in the NHS’s ability to
manage this successfully.
“We recently published a
consultation seeking views on
commissioning for patients and
the implementation of the NHS
Commissioning Board and now

The NHS will see widespread reform if the
White Paper becomes reality

Dental associations gave
the White Paper a cautious welcome. General Dental Practice
Committee (GDPC) chair Dr
John Milne said: “The White
Paper does not address dental services in detail nor exactly what the implications of
the new framework will be,
but it is promising to see that
primary care dentistry will be
commissioned by a new NHS
Board. Safeguarding dental
services, whether provided
by family practices or the salaried and specialist services,
is paramount. It is reassuring
that the government has reiterated its pledge to pilot changes
to the dental contract and we
are urging the Minister to

continue developing the pilots
testing out the recommendations in the Steele report.”
“We look forward to more detailed proposals on how the government intends to implement
these changes.”
Impact
Peter Bateman, chair of the
British Dental Association’s Salaried Dentists Committee, commented on the potential impact

of the White Paper for salaried
dental services.
He said: “It is essential that
special care dentistry and other
salaried dental services are included in same dental commissioning arrangements as for
general practice otherwise there
is a risk that the budget for community services could be lost to
dentistry.” DT

[2] =>

2 News

United Kingdom Edition August 2-8, 2010

See what you
are missing...
Carl Zeiss
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Guidance is ‘confusing’ –
Dental Protection

T

he new local anaesthetic
guidance for hygienists
and therapists has been
criticised as ‘confusing’.

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Dental Protection claims that
the recent order to amend the
Medicines Act 1968 has failed to
create a situation that is universally applicable to dental hygienists and therapists (DCPs).

Carl Zeiss
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It said that instead it has had
the effect of ‘distinguishing between the method of payment
applicable to the treatment when
it comes to deciding how local
anaesthetic and high-content
fluoride products (the ‘items’)
should be delivered to a patient

during their course of treatment’.
The patient group directive
was primarily designed for use
in NHS settings and the Department of Health now advises that
they are not valid for treatment
that is provided privately.
Apart from being confusing
to the clinical team involved, the
situation seems somewhat ‘illogical’, said Dental Protection.
A spokesman for Dental Protection said: ‘‘It also flies in the
face of DH’s long-held view that
there should be no negative comparison drawn between NHS
treatment and private treatment.’’

Dental Protection’s spokesman added: ‘‘At best it is totally
confusing and may even act as
a barrier to patients receiving
treatment that they both need
and want.’’
Until the situation has been
resolved by a further amendment to the legislation Dental Protection is advising any
dental hygienist or therapist
wishing to supply these ‘items’
to a patient whilst working in
a private practices or seeing
an NHS patient privately, to
continue to use a patientspecific
directive
(written
prescription). DT

New guidelines for dental implants

N

three main mono-specialties
as
well
as
the
general
dental arena.”

ew guidelines for the
provision of dental implants and the care of
dental implant patients have
been drawn up by the Academy
of Osseointegration.

Carl Zeiss
EyeMag Pro
prismatic
loupes

While the document is based
largely on the recommendations established by the specialist boards based in the United
States, Dr Norton did his utmost
to ensure that UK and European
guidelines were equally well
represented.

Dr Michael Norton (pictured)
who runs the Norton Implants
surgery in Harley Street in London, was asked by the Academy
to form a task force to review
their 2008 guidelines.

Carl Zeiss
GTX

EverClear™
a triumph in clarity

The new guidelines have
been published in the International Journal of Oral and
Maxillofacial Implants.
Dr Norton, who runs the
Norton Implants surgery in Har-

ley Street in London, said: “The
need to represent all the specialties as well as the general dental practitioner was foremost
in my mind. To this end I set
out to establish a task force with
representation
from
the

The
document
includes
recommendations
made
by
European Union, The Royal
College of Surgeons (Edinburgh), The Faculty of General Dental Practitioners and
The
European
Association
of Dental Implantology. DT

Dentist comes fifth in beauty pageant

A
V2 LED
Illumination

young dentist has come
fifth in the Miss Professional beauty pageant.

Jennifer Bate (pictured), who
is sponsored by dental products
company, Schottlander, has
also just been awarded her
Diploma of Membership of
the Joint Dental Faculty of the

Royal College of
(MJDF) certification.

Surgeons

The 24-year-old, who works at
University Hospital in Coventry, has already won the title Miss Charity after raising
funds for the Variety Club and
Bridge2Aid.

Published by Dental Tribune UK Ltd
© 2010, Dental Tribune UK Ltd.
All rights reserved.

For details of Carl Zeiss and our wide range of other
dental products contact:
Nuview Ltd, Vine House, Selsley Road,
North Woodchester, Gloucestershire GL5 5NN
Tel: 01453 872266 Fax: 01453 872288
E-mail: info@nuview-ltd.com
Web: www.voroscopes.co.uk

Dental Tribune UK Ltd makes every
effort to report clinical information and
manufacturer’s product news accurately,
but cannot assume responsibility for
Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com

Now that she is a qualified
dentist she hopes to stay in the
Warwickshire area to practise.
Ms Bate said: “I am passionate about what I do. It is so rewarding to do this work, to be able
to free people from pain, and
give them a wonderful smile.” DT

the validity of product claims, or for
typographical errors. The publishers also
do not assume responsibility for product
names or claims, or statements made by
advertisers. Opinions expressed by authors
are their own and may not reflect those of
Dental Tribune International.

Features Editor
Ellie Pratt
Ellie.pratt@
dentaltribuneuk.com
Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.com

Sales Executive
Sam Volk
Tel: 020 7400 8964
Sam.volk@
dentaltribuneuk.com
Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com
Design & Production
Ellen Sawle
ellen@dentaltribuneuk.com

Dental Tribune UK Ltd
4th Floor, Treasure House, 19–21 Hatton Garden, London, EC1N 8BA

[3] =>

News 3

United Kingdom Edition August 2-8, 2010

15m steps Editorial comment
for cancer Here comes the summer!
charity

M

outh cancer charity the
Mouth Cancer Foundation is challenging
1,000 dentists to walk 15 million
steps between them to help combat mouth cancer.

Well, Dental Tribune is heading off for
its holidays as the
hot days keep coming and the kids get
off school. But never
fear, we will be busy
working behind the scenes to

bring you all the in-depth news
and views as we interview people such as Earl Howe, Minister for dentistry. We also have
great features in store for the Autumn including a look at a new
mouthguard technology and a
chat with a laboratory owner

about the future of dental labs
and the importance
of communication between labs and clinicians.
See you in September...

Do you have an opinion or something to say on any Dental Tribune
UK article? Or would you like to
write your own opinion for our
guest comment page?
If so don’t hesitate to write to:
The Editor,
Dental Tribune UK Ltd,
4th Floor, Treasure House,
19-21 Hatton Garden,
London, EC1 8BA
Or email:
lisa@dentaltribuneuk.com

Places are filling up fast for
the Mouth Cancer Foundation
that takes place on Saturday 18th
September 2010, in Kensington
Gardens, London. In 2009 in excess of £60k was raised which
goes to help patients and their
families, like mouth cancer survivor Michelle Morton.
Michelle, 26 from Hastings, East Sussex was only 22
when she was diagnosed with
Nasopharyngeal Carcinoma in
June 2006.
Michelle says: “I had a large
tumour that came from the Nasopharynx, down my left nostril.
I was treated by my GP for six
months for what was thought to
be a sinus infection. I was eventually referred to ENT at the local
hospital and diagnosed. By this
point the cancer had also spread
to a lymph gland in my neck. I
went through six cycles of high
dose chemotherapy (Cisplatin &
5FU), followed by six and a half
weeks of Radiotherapy.

‘To be honest there
were times I wanted
to go to sleep and
not wake up’
“During treatment I dropped
to 6stone 10lb and I vomited
every day for about three
months! It was really awful, really gruelling and to be honest
there were times I wanted to
go to sleep and not wake up!
The cure is far harder than
the disease! I’m feeling REALLY good now. I’m working full
time again and I love my life!
As far as they’re concerned I’m
cancer free”.
“I support the Mouth Cancer
Foundation as they helped me
so much during my battle with
cancer. I want to make younger
people more aware of the symptoms and risk factors of Mouth
Cancer. It happened to me and it
can happen to anyone. We aren’t
indestructible!” DT

The entire dental team can get involved in the 2010 campaign focusing on
‘Discover 3 Essentials for an Even Healthier Mouth’.
Practice packs contain educational materials, motivational stickers, patient
samples and materials to enable dental teams to create their own display to
drive awareness of the 3 Essentials for an Even Healthier Mouth.
The 2010 interactive CPD programme ‘Putting Prevention into Practice’
providing verifiable CPD will be available to download by visiting
www.colgateohm.co.uk from 1st September 2010.
If your practice has not previously been involved in Colgate Oral Health
Month, please call 0161 665 5881 to register by 20th August 2010.

[4] =>

4 News

United Kingdom Edition August 2-8, 2010
Tribune_june:Precision

New regulations for
Scottish NHS dentists

ew regulations have
come into force for NHS
dentists in Scotland.

The 2010 regulations consolidate the 1996 regulations and
various amending legislation introduced over the years.
It also extends the dental list
system to include, for the first
time, Dental Corporate Bodies
and those working as assistants
in general dental practice.
Traditionally, dental lists
only included dentists working as ‘principals’ in general
practice, whether as practice
owners or associates.

All dentists working for Dental Corporate Bodies will be
under a duty to join dental lists
but inclusion will be voluntary
for the Dental Corporate Bodies
themselves.

tended to protect patients. They
widen the existing differences in
the arrangements for NHS dentistry north and south of the border, and address some areas of
concern in England and Wales.’’

Hugh Harvie, head of dental services (Scotland) for Dental Protection, said: ‘‘The 2010
regulations provide a welcome
update to the law governing the
provision of general dental services in Scotland and are intended
to increase the protection of patients and NHS resources alike.

‘‘Members in Scotland can
be assured of Dental Protection’s
support and guidance in relation
to any difficulties in understanding and issues arising from the
implementation of the 2010 regulations.’’

‘‘As a caring profession, the
dental profession in Scotland can
only welcome any measures in-

The 2010 regulations also
give the Health Board power to
suspend a dentist or body corporate from the dental list in a limited range of circumstances. DT

14/6/10

14:49

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GSK, a Gold Sponsor at the
event, took the opportunity to
showcase new Sensodyne Rapid
Relief – a toothpaste designed to
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A spokeswoman for GSK
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In response, Sensodyne Rapid
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Whipps Cross VT Scheme Prize Winner

r Sabina Bidgol, Vocational Trainee based at
Chingford Mount Dental
Practice, has won the 2010 prize
for Best Case Presentation for the
Whipps Cross Vocational Training Group. The champagne and
Prize Certificate were presented
by Eloise Nutton of Denplan,
which sponsored the award

Dr Bidgol had selected a
complex restorative case for her
case study which involved multiple dental disciplines including
endodontics, periodontics, oral
surgery, prosthetics and bridge
work.
“I am delighted”, said Dr
Raj Gogna, Principal Dentist at

Dr Sabina Bidgol (1st Prize Winner), Dr Raj Rattan (Whipps Cross VT Scheme Organiser),
Dr Jonathan Brown (2nd Prize), Dr Raj Gogna (Principal, Chingford Mount
Dental Practice).

Chingford Mount Dental Practice,
“Sabina chose a very challenging
case and the extensive treatment
took several months. She was
able to deliver a high standard of
treatment and I am very pleased
that she managed to achieve such
a level of competance”.
“Yes, I’ve really had a fantastic
year.”, said Dr Bidgol, “My clinical
exposure has been extensive and
I’m pleased to have been part of
the Whipps Cross Scheme”.
Having completed her vocational year, Dr Bidgol leaves
Chingford Mount Dental to take
up a position as an SHO in Maxillofacial Surgery at The Eastman Dental Hospital. However,
she enjoyed working in a broadbased family practice and hopes
to return to private practice following her hospital post. DT

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[6] =>

6 GDPUK

United Kingdom Edition

GDPUK round-up

The GDPUK online community this month sees a flurry of
conversation on public spending, says Tony Jacobs

quieter month on the
political scene followed
the Newsnight watching
frenzy in April and early May.
The health ministry teams have
settled in and gradually news
has emerged of developments

between the Department
Health and the profession.

The Government has started
to lower expectations in terms
of the economy for the medium
term, while speculation regard-

ing where the axe would fall led
to forum members making some
suggestions on the types of savings that could be made.
Money matters
What do you think is the most

wasteful aspect of public spending in dentistry? Could local
practices provide dental access
services for a lower cost than the
politically inspired Dental Access
Centres? Should denture repairs
attract no patient charge? What

August 2-8, 2010

about patient charges for pregnant people? What about molar
endodontics? This is a zero UDA
treatment, so there is nothing to
be saved. However, despite our
musings, the decisions will be
made by politicians who wish to
be re-elected, and this certainly
makes them choose soft targets,
things that do not affect their constituents.
How about the tick-box culture? Still rife near you? Form
after form, from agency after
agency, are getting under the skin
of GDPUK members. As long as
you can prove you have filled in
every FP17DC form correctly
and ticked every box, somehow
it doesn’t seem to matter if the
treatment fails. And in a latest
self-assessment tool, silly questions are posed for which no one
will answer “no” to, for example, whether needles are used
only once. The same with Health
and Safety – no central or simple process proves this has been
done, so the clipboarders have to
visit again and again to see the
same documents.
Techno babble
Dentists on the forum like to have
the odd friendly disagreement on
topics other than dentistry, ie Apple versus Microsoft, so the pros
and cons of the latest iPhone 4
generated some chat. However,
like chatting in a sports club, or
pub, people’s differing perceptions of the same item or concept
can be illuminating.
There have been a number of
clinical cases discussed, one being interesting enough to be suggested for a scientific “write-up”.
An image of a radiograph was
posted showing a bifid lateral
incisor, with a dens invaginatus,
and the root was dilacerated too.
It was possible that one canal was
vital and one non vital. Very complex, and it was proposed that it
could be best solved using the
22nd element of the periodic table – namely titanium!
Latest events
The LDC Conference was held
in Harrogate in mid June, and on
the forum, there were discussions
about the validity and benefits
of the event before it occurred,
followed by reports during the
event, then dissection afterwards.
Overall the view was that Chair
Richard Emms’ speech was very
well received, and that speech
was published in full. DT

About the author
Tony Jacobs, 52, is
a GDP in the suburbs of Manchester, in practice with
partner Steve Lazarus at 406Dental.
Tony founded GDPUK in 1997 which
now has around
7,000 unique visitors per month, who
make 35,000 visits and generate more
than a million pages on the site. Tony
is sure GDPUK.com is the liveliest and
most topical UK dental website.

[7] =>

[8] =>

8 Feature

United Kingdom Edition

August 2-8, 2010

Do you dream about
success or have nightmares about failure?
asks Seema Sharma

re you feeling FAB?
Are you one of these
eternally positive people
who knows that as long as people
have teeth, you know you have
a product people need or want?
Even when you think about those
who don’t have teeth, you may
be upbeat if you are unique,
special and different and one of
your many niches is dentures
and implants! If you use a FAB
marketing campaign (less about
the Features, more about the
Advantages and Benefits of coming
to your practice) you are already
ahead of the game. If you have
to make some tweaks to prepare
for the changing environment,
perhaps you see this as simply
adding to your repertoire of benefits to promote to your patients.
Or are you feeling SAD?
Are you worrying about the
future of your practice? Is the
economic downturn starting
to bite? Are you fretting about
CQC? Does it feel like the PCT is
on a different page to you, your
team is on a different page to
you, your patients are on a
different page to you – worse
still all three? Does reading the
white paper make feel like you
will soon die of change fatigue?
Are you at the bare bones of
costs already, and struggling with
how else to cut spiralling costs?
Could you do with a PEP talk
or better still with pepping up
your practice? Soldiering on and
hoping it will all go away could
be a formula for failure whereas
a little forward thinking will
help formulate a straegy for success. Are you ready to step up
from managing your practice or
just practising?
Stylish Leadership
Great leaders inspire their teams,
are good communicators, brings
positive energy to the practice and avoid the use of words
like but, can’t, won’t. They are
problem solvers who continually review what works and what
doesn’t and do not do what they
have always done. They take
a flexible approach and build
relationships well. It is often
their personal qualities rather
than their management capability that attracts their followers and they build dream
teams from which members
emerge themselves as leaders!
There are many documented

styles of leadership but in my
experience the most successful
leaders balance a combination of
styles: Autocratic leaders make
the decisions, participative leaders make decisions after consultation with their teams. There is a
fine line between being autocratic
and over-controlling, just as there
is a fine line between being participative and losing control!
Vision without action is a daydream
In a nutshell, a leader defines the
vision for the practice, a manager puts the vision into action.
Vision is about knowing where
the practice is at the moment,
defining where it wants to be at

registration is just a few months
away, the lack of leadership will
show quickly in the plunging morale of the team. Authority and responsibility can be delegated but
never accountability. Action without vision is a nightmare.
Futureproof your practice.
Leadership is less about power
and more about empowerment,
and there is nothing more dynamic than an empowered team.
A good leader will put a full
repertoire of skills into action
by defining where the practice is
going (vision), advising the team
what is not working and why
a new strategy is required (autocratic), arranging a meeting for

‘Great leaders inspire their teams, are good
communicators, brings positive energy to
the practice and avoid the use of words like
but, can’t, won’t. ’
a point in the future, and planning
a number of strategies for how to
get there. One size does not fit
all, so flexibility is key. For your
practice to succeed in a changing environment, and in difficult
financial times, a number of strategies are a good idea but don’t
give in to indecision – the wait
and see approach will result in
no action. Vision without action
is a daydream.
Action without vision is a
nightmare
Clinicians in well run practices
are often able to give the practice manager freedom to run the
practice whilst they concentrate
on dentistry, self-development or
something else. (In my case my
charity and my practice management courses!). This is a huge
compliment to managers who
have the training, vision and leadership skills themselves to be able
to take on this responsibility.
What about the converse –
where the team do what they
think is best but have never understood the overarching vision?
When the diary is full of new
patients to meet an NHS access
driver but no slots were left free
for treatments, or when no clinical governance meetings have
been planned even though CQC

ideas (participative) and deciding who is going to take on which
tasks to implement the new
strategy (delegation).
Don’t sweat the small stuff.
There are 3 kinds of people in this
world – people who make things
happen, people who watch things
happen and people who wonder
what happened! Are you a leader,
a follower or an ostrich? The decision is yours.
Email me at seema.sharma@
dentabyte.co.uk to find out the
two outcomes that CQC expects
from leaders and managers, and
how Dentabyte can help. DT

About the author
Seema
Sharma
qualified as a dentist but gave up
clinical work after
10 years in practice
to go into full time
practice management. Today she
runs three practices, including one
which is a multi-disciplinary specialist
centre. Seema established Dentabyte
Ltd to provide affordable “real-world”
practice management programmes to
help practice managers and practice
owners keep pace with the changing
clinical and commercial environment
facing them today. Visit www.Dentabyte.co.uk to register for updates on
practice management or email Seema
at seema.sharma@dentabyte.co.uk to
find out more.

[9] =>

MSc Blog 9

United Kingdom Edition August 2-8, 2010

Meeting face to face
Elaine Halley continues her journey through the online MSc in Restorative and
Aesthetic dentistry from Smile-on and the University of Manchester

NEW

going to have lectures in the
practical techniques but at
this point I’m not sure. The current unit’s lectures are mostly
about communication,
legal
record-keeping etc – we have

SODY

RTISE

This nervousness was quickly overtaken by the realisation
that this is a clinical MSc – we
seem to have had it fairly easy
in the first unit which has consisted of lectures and assessments. Now, the dentistry is really going to be evaluated – we
have 26 clinical cases to submit for Units 2-3 of the course!
A lot of time was spent on
photography and being sure
that we could all take the
correct photos and are able to
upload them onto our learning plan and send them to be
evaluated. I am pleased to report
that after a slight panic about
how to attach my flash, my
photography came flooding
back to me – I managed fine although must book myself in for
a whitening after seeing my caffeine tinged lower incisors on
the big screen!

After photography, Chris Orr
covered treatment planning and
shade taking with an eye-cross-

ing exercise in matching values
on the computer. All of this with
Covent Garden beckoning outside and an ash cloud to disrupt
our homeward travel – the joys
of CPD. DT

CORSODYL MOUTHWASH
YEARS O

For many of us, learning
about the thesis was nervewracking but essential! We are
to start thinking about possible
topics for this research project
which will be a structured clinical review rather than a clinical or laboratory based project.
This is to fit in with the distancelearning nature of the course.
Fiona advised us that the thesis
comprises the last six months of
the course starting in May 2011
but we should start collecting
references and sources as we
come across them. We will be
assigned a tutor in due course
who will make suggestions
and offer guidance but this is a
major undertaking – there was
some nervousness about the unknown nature of this expressed
by participants.

two with Kevin Lewis coming
up on Thursday.

ALCOHOL FREE
C

The diversity of the student
group was evident – I met students from Kenya, India and Qatar, as well as the many different
nationalities working in the UK
– it made for fascinating lunchtime conversations! There is
also a real mix of age-groups
and experience, from young
NHS associates to the not-soyoung (myself included) private
practice owners.

The clinical cases so far
include six whitening cases,
simple orthodontics, restoration
of the endodontically treated
teeth and single tooth indirect
restorations. I think we are

he first residential for
the Msc was held at the
Strand Palace Hotel in
London in mid-May. The flight
down was an excellent opportunity for me to catch up on the
background reading so I arrived
feeling well prepared! The residential was compulsory for all
students and started with an
overview of the remainder of
the course by Fiona Clarke from
Manchester University.

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References: 1. Veihelmann S, Mangold S, Beck P, Lemkamp V, Schmid F-G, Schlagenhauf U. Hemmung des Plaquewiederbewuchses auf Zähnen durch die Chlorhexamed alkoholfrei Mundspüllösung [Inhibition
of plaque-regrowth on teeth by Chlorhexamed alkoholfrei mouthrinse]. Parodontologie 2008; 19 (3): 326. 2. GlaxoSmithKline data on file, Bacteria Kill Test, In Vitro, SGS 2007. 3. GlaxoSmithKline data on file,
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[11] =>

Implant Tribune
Implant Tribune

Implant Tribune

Treating Peri-implantitis

Vavalekas Michail discusses the topic of peri-implantitis and ways of treating it

pages 16-18

CAD/CAM possibilities

Case study looking at the use of CAD/CAM in
dental implant treatment

pages 19-22

A winning formula
Dental Tribune looks back at an enlightening
visit to implant manufacturer Euroteknika

T

he life of a dental editor
can be a pretty mundane
one. We don’t often get let
out, mostly for the safety of the
general public. But sometimes
an opportunity comes along for
us to pack our things and head
for foreign climes.
One such opportunity arrived
recently when I received an invitation to visit the offices of implant manufacturer Euroteknika,
located in a French village just
ten minutes from Chamonix, and
I wasn’t about to say no!
Euroteknika was established
in 1992 by implantologist Guy
Hervé. In 2004, the company was
acquired by French dental distributor GACD, which allowed
the company to develop five
ranges of implant systems and
maintain its service mission – to
offer high quality products with
professional service at the best
price. In 2010, the company now
boasts:
• A new facility of more than
3,000m2. This allows the whole
of the manufacturing process to
be done in-house
• The claim that it is the number
one French manufacturer purely

dedicated to implants
• A staff of 64, having grown from
a staff of six in 2004
• The establishment of Teknika
Training in 2009 to allow for various types of training and mentoring to allow first time dentists
to place implants and more experienced clinicians maintain their
skills
What does this have to do
with dentists in the UK? Well,
Euroteknika has developed an
exclusive partnership with D2D
Implants, the implant arm of
D2D Endo.
After an extremely early
start, my fellow colleagues from
the dental press and I met John
Laugher, head of Sales and Marketing at D2D at the airport for
our flight to Geneva where we
were met by our French hosts
Laurent Dereuddre, International Marketing and Sales director
and Benoit Fontaine, Sales advisor. Driving to the factory it was
hard to understand why everyone didn’t move their business
there! Nestled in a little part of
France that lies between the borders of Italy and Switzerland under the shadow of Mont Blanc,
the area is known for more

than just its outdoor pursuits of
climbing, parasailing and skiing
– it is also home to a thriving micromechanical manufacturing
industry, the origins of which lie
in clock making.
After a chance to have a coffee, it was time to get down to
why we were there; to find out
more about Euroteknika and
D2D Implants. Laurent gave
a series of presentations that
provided a background into the
company and its aims in the
development of five implant
systems. Then John Laugher
spoke about D2D Implants, the
importance of the relationship
between the two companies and
the benefits that it can bring to
UK dentists.
We then had the opportunity to tour the factory, seeing
the process from the storage of
the titanium bars through to the
manufacture of the implants;
the finishing and packaging of
the products as well as the R&D
suite and the order fulfilment
area, which uses an innovative
electronic system to try to reduce errors.
I am a big fan of getting
behind the scenes to see how
things are made, so this was
a very interesting experience.
The processes that the implants
must go through are so complex; and the attention to tracking the implants from the batch
number on the source bar of
titanium to the implant being
placed in a patient’s mouth was
mind-blowing.
Throughout the time we
were in France the Euroteknika
team, including managing di-

The heart of the operation: Euroteknika’s implant manufacturing facility

à DT page 13

[12] =>

[13] =>

Implant Tribune 13

United Kingdom Edition August 2-8, 2010

ß DT page 11

rector Alain Veillard, were on
hand to answer any question
about their implants. I also had
the opportunity to speak with
John about D2D and how they
came to work with Euroteknika.
“The company started as
D2D Endo three years ago after
the founders, Jason Bedord and
Charlie Nicholas, realised that
they were often recommending
products to delegates on their endodontic courses. They decided
to put together a range of equipment together that they were
happy with - no big sell, the guys
can just say ‘this is what we use,
it works for us and if you want to
buy it you can get it at this price’.

“In the beginning people are
used to placing what they have
been placing (ie Straumann, Astra, Nobel) because they are good
products, they have been on the
market a long time and they have
all the surgery equipment to do it.
So to change systems, well there
needs to be a good reason. Those
that have taken on board the Euroteknika product have honestly
not had one problem. All we have
had are plaudits on the ease of
how it works and the ability to

match the prostheses. So, the labs
like us – they like the prosthetics
– the dentists like us because the
products are of good quality at the
right price. They also like the fact
that if they have an issue they can
talk to Willie and he can answer
them clinician to clinician.”
Ninety per cent of the equipment that clinicians have to place
Straumann/Astra/Nobel implants
can be used with Euroteknika
implants. We also do promotions

such as once someone has placed
20 implants we give them a free
Euroteknika surgical kit. And
from what dentists tell me it is a
very good surgical kit !
John added: “The relationship
between Euroteknika and D2D
Implants is crucial as it is a long
term partnership. We have got the
ability to talk to them at every level right up to the MD about things
we’d like to change or things we
can get involved in - I think we’ve

Treat small
spaces with

“What’s fairly unique about
D2D is that it’s owned by dentists for dentists. Any clinician who has a query about a
product can pick up the phone
and talk to a fellow clinician
about it; this means they will get
relevant practical answers from
someone who truly understands
their needs.”
The formula seems to have
worked well for D2D Endo, and
late last year they teamed up with
implantologist Willie Jack to provide the same sort of service on
the implant side. “When the opportunity came along to go into
the implant side, with Willie Jack
(who has been placing implants
since 1992) the same sort of system worked. He saw that the
market was growing, that more
people were becoming aware of
implants and he thought ‘well I’m
an implantologist, I would like
people to have more of their implant work done in the UK by UK
dentists’. So, he looked for a system that was competitive in price
with the bigger dental implant
brands but still offered the same
quality and reliability as the well
established brands.
“There are so many people
selling cheap implant into the
UK because dentists want to be
able to deliver an implant system
at a low cost. The way we’ve approached it is we need to know
from a clinical perspective that
the products we are offering are
100 per cent reliable. The thing
with D2D is that the directors are
dentists, they do not want their
reputation to be tarnished by any
dentists saying ‘look this product
that you’ve sold us, it doesn’t do
what it’s supposed to do’. We’ve
gone with Euroteknika because
they represent quality. Also there
is about a 40-60 percent difference in price if you compare
Euroteknika to the established
brands, but as far as we can see
they are comparable especially
in terms of quality. Not only that
but the prosthetics can be up to
80 per cent of the cost of the big
brands so if you put all that together it’s a very powerful argument for D2D.

ticked all those boxes. I think
they are prepared to listen, I
think they are prepared to change
things and it seems to be their
aspiration to make us a part of
their business. So it really does
work, we will help them develop things on the clinical side as
Willie is highly qualified and experienced clinical implantologist,
and they are a very good manufacturing company – put the two
together and you have a winning
formula.” DT

confidence

Laser-Lok 3.0 placed in
aesthetic zone.

Radiograph shows proper
implant spacing in limited site.

Image courtesy of Michael Reddy, DDS

Image courtesy of Cary Shapoff, DDS

Introducing the Laser-Lok® 3.0 implant
Laser-Lok 3.0 is the first 3mm implant that incorporates Laser-Lok technology to create a biologic seal and maintain crestal bone
on the implant collar1. Designed specifically for limited spaces in the aesthetic zone, the Laser-Lok 3.0 comes with a broad array
of prosthetic options making it the perfect choice for high profile cases.

• Two-piece 3mm design offers restorative flexibility in narrow spaces.
• 3mm threadform shown to be effective when immediately loaded.2
• Laser-Lok microchannels create a physical connective tissue attachment (unlike Sharpey fibers).3

For more information, contact BioHorizons
Customer Care: +44 (0)1344 752560 or
visit us online at www.biohorizons.com

1. Radiographic Analysis of Crestal Bone Levels on Laser-Lok Collar Dental Implants.
CA Shapoff, B Lahey, PA Wasserlauf, DM Kim, IJPRD, Vol 30, No 2, 2010.
2. Initial clinical efficacy of 3-mm implants immediately placed into function in conditions of
limited spacing. Reddy MS, O’Neal SJ, Haigh S, Aponte-Wesson R, Geurs NC.
Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):281-288.
3. Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant.
M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim.
International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.
SPMP10109 REV B MAY 2010

[14] =>

14 Implant Tribune

United Kingdom Edition

August 2-8, 2010

Simply doing more
Dental implant manufacturer Straumann recently organised a day to allow the
dental press a chance to get a feel for the company. Dental Tribune was there

recently was able to add implantology to my ever growing list of dental skills after
a very insightful day at the UK
headquarters of Straumann,.
The day was entitled ‘An insight into the world’s leading

dental implant company’ and it
gave the dental press an chance
to get to know the team at Straumann, find out what the company does beyond its implant
offerings and hear about its association with the ITI (International Team for Implantology). It

also allowed us to have a chance
to place an implant for ourselves,
though fortunately our patients
were nothing more than a small
plastic disc.
The event began with a welcome from head of Marketing Va-

nessa Elwill. Following her was
managing director of Straumann
UK Stephen Booth. He gave a
background to the company, from
its beginnings as a family-owned
research institute in 1954,
through to the present where it
is claimed as a global leader in

replacement, restorative and regenerative dentistry.
Straumann UK has established itself at its offices in Crawley as not only a base for UK
operations but also a first-class
training facility for internal and
external clients. In the last year
there have been 75 courses at the
centre and 45 external courses,
with more than 1300 delegates.
Stephen also pointed out that
Straumann are more than just implants. The product portfolio covers solutions for preserving, restoring and replacing teeth, including: Emdogain – regeneration
product in perio; Bone Ceramic
– synthetic bone replacement;
CAD/CAM – in partnership with
Ivoclar Vivadent, this includes
the Cadent digital scanner; Digital implant systems and guided
surgery; Implant surface technology – Roxolid, SLA Active.

For a
free sample

Following Stephen was John
Aiken, Straumann CADCAM
Sales Manager. John gave further
insight into the benefits to labs
clinicians and patients of using
digital scanning and CAD/CAM
in the design and production
of appliances such as crowns,
bridges and onlays.

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Then it was the turn of Phil
Freiberger, clinician and Chairman UK & Ireland ITI Section. .
He explained who the ITI is as
a global association in implant
dentistry aiming to promote research, development and education in its field.
It currently boasts 7,500
members and 700 Fellows in its
ranks. Education and research is
key to the ITI, with study clubs,
courses such as the ones run at
Straumann and Scholarship programme at the Eastman.

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Research-wise it is critical,
with investment of CHF1.7m
in 2009 alone into 60 different
projects at 22 different institutes
worldwide. Since 1988 283 research projects have been funded to the tune of CHF32.2m.
After the presentation it was
time to play dentist! A few hardy
souls sat down under the watchful gaze of the Straumann team
and Phil. We were taken through
the process of drilling the implant socket, having to be careful
not to drill too far. My implant is
now pride of place on my desk in
the office.
Thanks to Straumann for a
wonderful and informative day
at their offices, I look forward to
the next time! DT

[15] =>

United Kingdom Edition August 2-8, 2010

Aesthetic challenge

Thorough examination and execution of treatment are key to carrying out immediate tooth
replacement Dr Riz Syed explains

In the aesthetic anterior zone,
we are often faced with an aesthetic challenge. Do we extract
a tooth and delay the placement
of an implant allowing the site to
heal before implant placement
and try to rebuild any bone and
soft tissue loss following the healing process?
Gingival support
The main reason for placing an
implant at the same time as extracting the tooth and possibly
placing a provisional restoration
is to support and maintain the
gingival architecture of the failing tooth.
In order for us to place implants in immediate extraction
sites, certain protocols have to be
followed to achieve a successful
outcome:
• Careful patient assessment
should be undertaken both clinically and radiographically
• No active underlying pathology
• Gingival form: look at the
whether the form is flat or scalloped and determine the marginal position relative the adjacent teeth. This is significant in
deciding the degree of marginal
discrepancy that may occur
• Gingival biotype: is the biotype thick or thin? We can often
determine the biotype by probing the buccal tissue and seeing
how much of the probe is visible
through the tissue. The thinner
the tissue, the higher the chances of soft-tissue recession.
Carrying out extraction
The tooth has to be extracted
carefully using peritomes in order to avoid unnecessary trauma
to the bone. The socket is then
cleaned thoroughly and probed
to determine the length of the
socket from the soft tissue or
bone margin. The ideal option
would be to place an implant just

About the author
Dr Riz Syed
qualified at the Royal London Hospital
in 1999 and runs
referral clinics in Islington and Waltonon-Thames. Regularly consulted
for complex treatment planning
cases, Dr Syed lectures internationally. To contact Dr Syed, visit
www.leadingdentalimplants.com.

a few millimetres longer than
the socket to engage in the apical
bone to achieve primary stability. Pressure should be avoided
on adjacent interdental bone to
maintain the papillae between
the implant and tooth.

©Nobel Biocare Services AG, 2010. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare.

n our clinics, we often have
to deal with patients who
require a single implant to
replace a failing tooth. Our aim
should always be aesthetically
driven, in that we should always
strive to achieve the most stable
aesthetic outcome.

For incisal teeth, the midpalatal socket is an ideal location for the initial twist drill. The
final implant should therefore
be placed in more palatal
position. The remaining gap between the implant and the buccal

Implant Tribune 15
plate, if it is less than 1mm, can
be filled in with bone. If, however, the gap is larger, bone material should be used to prevent the
collapse of the buccal bone and
soft tissue.
The ideal depth of the implant in the majority of cases is
three mm below the soft-tissue
margin to ensure the biological width is not encroached. In
areas where there is a bony
wall defect, implants can still be
placed at the same time as extraction and guided bone regenera-

tion can also be carried out the
same time. In V-shaped defects,
there is often minimal recession
compared to U-shaped defects.
Placing an immediate provisional without encroaching on
the tissue with a negative contour will help to support the tissues. Although immediate implant placements can result in a
successful outcome, there is
slightly higher risk of failure.
Thorough
examination
and
surgical execution are vital to ensure success. DT

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prosthesis.* Final solutions include both
fixed and removable prostheses such as
NobelProcera Implant Bridge Titanium
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posterior implants help avoid relevant
anatomical structures, can be anchored

in better quality anterior bone and offer
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by reducing cantilevers. They also help
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All-on-4 can be planned and performed
using the NobelGuide treatment concept,
ensuring accurate diagnostics, planning
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Nobel Biocare is the world leader in
innovative and evidence-based dental
solutions. For more information, call
+ 44 (0) 1895 430650 (UK),
1800 677306 (Ireland) or visit our
website.

www.nobelbiocare.com

Nobel Biocare UK LTD, Telephone: + 44 (0) 1895 430650. Fax: + 44 (0) 1895 430636
Ireland, Telephone: 1800 677306. Fax: 1800 677307
* If one-stage surgery with immediate loading is not indicated, cover screws are used for submerged healing.
Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NB All-on-four A4 UK.indd 1

10-05-05 15.25.54

[16] =>

16 Implant Tribune

United Kingdom Edition

August 2-8, 2010

A4 - Pdf Ripper.qxd:Text pasting Document.qxd 13/04/2010 11:26 Page 1

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Peri-implantitis:
definition, etiology
and treatment
By Vavalekas Michail of the Ashman Department
of Periodontology and Implant Dentistry at New
York University College of Dentistry

P

eri-implantitis is an inflammatory process affecting the soft and hard
tissues resulting in rapid loss of
supporting bone, often associated
with bleeding and suppuration.
The etiopathogenesis of periimplantitis is complex and is related to a variety of factors. The
peri-implant environment and
soft tissue-implant interface has a
major impact on the progression
of peri-implantitis.

Patient-related factors include: 1) systemic diseases (for
example, diabetes, osteoporosis),
2) social factors such as adequate
oral hygiene, smoking, drug
abuse, 3) parafunctional habits
(bruxism) 4) and previous dental
history of periodontitis. In addition to the above etiologies, iatrogenic factors can also play a significant role in the development
of peri-implantitis.
Although restorations of endosseous implants have demonstrated a very high survival rate
(1)
, one study suggested that over
a five-year period, 0 to 14.4 per
cent of dental implants demonstrated peri-implant inflammatory reactions associated with
crestal bone loss (2).

The treatment modalities
are: 1) administration of systemic antibiotics, 2) mechanical debridement with or without
chlorhexidine oral rinses or antibiotics 3) mechanical debridement combined with LASER decontamination, 4) debridement
combined with a flap access and
more recently, 5) debridement
was combined with guided bone
regeneration (GBR) for repairing
of osseous defects (6, 7, 8). GBR has
limited predictability (9) and some
case series have demonstrated
limited bone fill after GBR procedures (6). There is insufficient
evidence to support any one of
the aforementioned treatment
strategies for peri-implantitis (4,
5)
. Therefore, different treatment
modalities for peri-implantitis
will be compaired from previously published studies.
Points for discussion
One study (21) demonstrated the
importance of bacterial plaque
accumulation in the development
of inflammation around implants
(peri-implantitis) while another
(15)
showed that, if this condition
is left untreated and the surface is
not decontaminated, it will lead to
peri-implant pocketing, alveolar
bone loss, and eventually to im-

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Peri-implantitis is an inflammatory process affecting hard & soft tissues around an implant

The etiology of failure has
classically been be related to infection. Bleeding, suppuration,
pain, and plaque accumulation (5)
along with progressive bone loss
was defined as peri-implantitis
(3)
. It was initially thought that
peri-implantitis was caused by
bacteria, thus initial treatment
was focused on bacterial removal and surface decontamination
of implants. Currently, different
methods of implant decontamination have been proposed for
ailing implant surfaces (6, 10, 13).

plant failure. Because there are
biologic differences between teeth
and implants, the advancement of
infection around implants is also
different than natural teeth.
The inflammatory cell infiltrate around implants was reported to be larger and extend more
apical when compared to a corresponding lesion in the gingival
tissue around natural teeth (29). In
addition, the tissues around implants seem to be unable to resist
the plaque associated infection

and antibiotics may be necessary
for the treatment of peri-implantitis (29).
Bacteria on the implant surface are the target in treating infections around implants and traditional therapeutic approaches
have been directed towards implant surface decontamination.
Systemic administration of antibiotics were also used in the treatment of peri-implantitis with an
immediate reduction of inflammation, bone re-growth and gradual reduction of pocket depth, but
a three-month recurrence of periimplantitis was observed due to
bacterial re-colonisation of the
implant surface (14).
To date, there is no reliable
evidence that suggests which intervention (chemical agents, mechanical debridement, surgical
procedures, lasers or a combination of Guided Bone Regeneration (GBR) with the former techniques) is the most effective for
treating peri-implantitis (4, 22, 24).
Therefore, there is no gold standard approach for the treatment of
peri-implantitis.
Some of the treatment modalities suggested for peri-implantitis
are: 1) sub-mucosal mechanical
debridement and antimicrobial
minocycline spheres (Arestin), 2)
mechanical ultrasound debridement without antibiotics, 3) laser
ablation (Er:YAG) with mechanical debridement, chlorohexidine,
with and without open flap surgery, 4) antimicrobial therapy
with open flap debridement, 5)
access flap surgery and bone substitute or bone graft.
Furthermore, it was compared
the combination of oral hygiene
instructions, mechanical debridement and topical application of
minocycline microspheres (Arestin) in peri-implant lesions (with
bone loss corresponding to no
more than three implant threads)
to the combination of oral hygiene
instructions, mechanical debridement and one per cent chlorhexidine gel application.
The results obtained after a
follow-up period of 12 months on
sub-mucosal mechanical debridement and antimicrobial minocycline spheres showed that only a

[17] =>

Implant Tribune 17

United Kingdom Edition August 2-8, 2010

limited reduction in bleeding on
probing was achieved and that
the mean peri-implant probing
depth (PD) remained unchanged
(3.9mm) in the chlorhexidine
group. On the other hand, in the
minocycline group, the reduction of bleeding on probing was
statistically significantly greater
than that in the chlorhexidine
group, coupled with an improvement in mean peri-implant PD
(from 3.9mm to 3.6 mm). These
results suggested that the topical application of chlorhexidine
provides limited or no adjunctive clinical improvements when
treating shallow peri-implant
lesions as compared with using
mechanical debridement alone.

lesions and the main reason
for this result can be found
in the difficulty accessing the
apical portion of the defect in
those lesions. (30)
Treating advanced peri-implant lesions may include an attempt to regenerate as much as
possible of the lost bone structure. The efficacy of two bone
regenerative procedures for the
treatment of moderate intrabony peri-implantitis lesions

(33)

Habits, good or bad, started at a young age can last a
lifetime. As you know, many adults do not brush their teeth
for as long as they should – twice a day for 2 minutes.
At Aquafresh we understand good toothbrushing habits
can offer patients a lifetime of protection.

lky
i
M
0-3
yea
rs

sub-mucosal debridement alone
for the therapy of peri-implantitis utilising an ultrasonic device
versus hand instrumentation
with carbon fibre curettes. He
concluded that there was no statistically significant difference
reported for the implants treated
either by the ultrasonic device
or manually scalers between
baseline and three to six months
regarding reduction in bleeding
on probing and radiographical
bone loss. (34)

Several treatment modalities
have been suggested for treatment of peri-implantitis, however, it was demonstrated in the
case series that it was possible,
but not predictable, to maintain

implants using a treatment model consisting of surgical cleaning and a systemic antimicrobial treatment for five years (9).
Long-term treatment modalities
need to be assessed and there is
a need for randomised-controlled studies evaluating treatment
of non-surgical therapy of periimplantitis.
Conclusion
The management of implant
à DT page 18

That’s why we have developed a range of products to suit
children of all ages, from when milk teeth first appear
and to support your recommendations. With the help of
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activity and help children develop good oral hygiene habits.

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4yea6
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An interesting treatment modality can be the laser decontamination of the implant surface.
The use of Er:YAG laser was
used alone and compared to the
combination of mechanical debridement (using plastic curettes)
and antiseptic (0.2 per cent chlorhexidine digluconate) administration for the treatment of periimplantitis. In both studies the
results obtained at six months
after therapy suggested that the
treatment modalities were equally efficacious in significantly improving peri-implant probing
pocket depth (PPD) and clinical
attachment level (CAL).
However, at 12 months in
both groups, the mean values
of peri-implant PPD and CAL
was not statistically significantly
different from the corresponding values at baseline. Therefore, the efficacy of the Er:YAG
laser seems to be limited to a
six-month period, particularly
for advanced peri-implantitis

years the evaluation of the study
showed that application of the
combination of natural bone
mineral and collagen membrane seemed to correlate with
greater improvements in clinical
parameters (32).

Habits started at a young age
can last a lifetime

Moreover, in another study
was compared the efficacy of

‘The management
of implant infections should be
focused both on
infection control of
the lesion, detoxification of the implant surface, and
on regeneration
procedures’.

were also compaired. The defects
were randomly treated either
with a combination of access
flap surgery and the application
of nanocrystalline hydroxyapatite or with a combination of flap
surgery and the application of
a bovine-derived xenograft (BioOss, Geistlich, Wolhusen, Switzerland) and the placement of
a bioresorbable porcine-derived collagen membrane (BioGides,
Geistlich,
Wolhusen,
Switzerland) (31). After two

Aquafresh big teeth

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year

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mouthwash

To find out more about Aquafresh and the Nurdles, visit:

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AQUAFRESH, THE THREE STRIPED logo, BIG TEETH (stylised), LITTLE TEETH (stylised), MILK TEETH (stylised) and the NURDLE CHARACTERS are trade marks of the GlaxoSmithKline group of companies.

SM1813_8 Aquafresh Kids Dental Tribune.indd 1

21/6/10 12:17:09

[18] =>

18 Implant Tribune

United Kingdom Edition

August 2-8, 2010

REFERENCES
1. Albrektsson T, et al. Osseointegrated oral implants - A Swedish multicenter study of 8139 consecutively inserted Nobelpharma implants. J Periodontol 1988;59:287-296.2. Berglundh T, et al. A systematic review of the incidence of
biological and technical complications in implant dentistry reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29:197-212. 3. Rosenberg ES, et al. Microbial differences in 2 clinically distinct types of
failures of osseointegrated implants. Clin Oral Implants Res 1991;2:135-144. 4. Esposito M, et al. Differential diagnosis and treatment strategies for biologic complications and failing oral implants: a review of the literature. Int J Oral
Maxillofac Implants 1999;14:473-490. 5. Klinge B, et al. A systematic review of the effect of anti-infective therapy in the treatment of peri-implantitis. J Clin Periodontol 2002;29:213-0. 6. Grunder U, et al. Treatment of Ligature-lnduced
Periimplantitis Using Guided Tissue Regeneration: A Clinical and Histologic Study in the Beagle Dog. Int J Oral Maxillofac Implants 1993; 8:282-292. 7. Jovanovic S. The management of peri-implant breakdown around functioning
osseointegrated dental implants. J Periodontol 1993; 64:1176-1183. 8. Schupbach P, et al. Implant-tissue interfaces following treatment of periimplantitis using guided tissue regeneration: a light and electron microscopic study. Clin Oral
Implants Res 1994; 5:55-65. 9. Lang NP, et al. Clinical trials on therapies for peri-implant infections. Ann Periodontolgy 1997; 2:343-356. 10. Lehmann B, Bragger U, Hammerle CHF, Foumousis I, Lang NP. Treatment of an early implant
failure according to the principles of guided tissue regeneration (GTR). Clin Oral Implants Res 1992; 3:42-48. 11. Hammerle CHF, et al. Successful Bone Fill in Late Peri-Implant Defects Using Guided Tissue Regeneration. A Short Communication. J Periodontol 1995;66:303-308. 12. Zablotsky MH. Chemotherapeutics in Implant Dentistry. Implant Dent 1993;2:19-25. 13. Parham PL, Cobb CM, French A. Effect of an air-powder abrasive system on plasmasprayed titanium
implant surface: an in vitro evaluation. J Oral Implant 1989;15:78-86. 14. Mombelli A, Lang NP. Antimicrobial treatment of peri-implant infections. Clin Oral Implants Res 1992;3:162-168. 15. Mombelli A. Etiology, diagnosis, and treatment
considerations in periimplantitis. Current Opinion in Dentistry 1997;4:127-136. 16. Scheck G, et al. Controlled local delivery of tetracycline HCl in the treatment of periimplant mucosal hyperplasia and mucositis. Clin Oral Implants Res
1997;8:427-433. 17. Lindhe J, et al. Peri-implant diseases: Consensus report of the Sixth European Workshop on Periodontology. 2008 Sep;35(8 Suppl):282-5. 18. Esposito M, et al.The role of implant surface modifications, shape and material on the success of osseointegrated dental implants. A systematic review. Eur J Prosthodont Restor Dent. 2005 Mar; 13(1):15-31. 19. Esposito M, et al. Cochrane Database Syst Rev. 2006; 3:CD004970, Cochrane Database Syst Rev. 2008 Apr
16 ;( 2) Interventions for replacing missing teeth: treatment of peri-implantitis. Esposito M, et al. 20. Mombelli A et al.The diagnosis and treatment of peri-implantitis.Periodontology 2000 1998 Jun; 17:63-76 21. Pontoriero et al. Experimentally induced peri-implant mucositis. A clinical study in humans. Clin Oral Implants Res. 1994 Dec;5(4):254-9 22. Klinge b et al. Peri-implantitis.Dent Clin North Am. 2005 Jul; 49(3):661-76 23. Romanos Ge et al. Regenerative therapy
of deep peri-implant infrabony defects after CO2 laser implant surface decontamination. Int J Periodontics Restorative Dent. 2008 Jun; 28(3):245-55 24. Claffey N et al. Surgical treatment of peri-implantitis. J Clin Periodontol 2008; 35
(Suppl. 8): 316–332. 25. Deppe H et al .Convensional versus CO2 laser assisted treatment of peri implant defects with the concomitant use of pure phase beta tricalcium phosphate: a 5-year clinical report. Int J Oral Maxillofac Implants.
2007 Jan-Feb;22(1):79-86 26. Leonhardt A. Five-Year Clinical, Microbiological and Radiological Outcome Following Treatment of Peri-Implantitis in Man. J Periodontol 2003; 74:1415-1422 27. Mombelli A. Microbiology and antimicrobial
therapy of peri-implantitis Periodontol 2000, 2002; 13:127-132 28. De Araujo Nombre M, Non-surgical treatment of peri-implant pathology: Int J Dent Hyg, 2006 May; 4(2):84-90 29. Lindhe J et al.. Experimental breakdown of peri-implant
and periodontal tissues. Clin Oral Impalnts
Res 1992;3:9-16 30. Schwarz, F et al. (2006a)
.Nonsurgical treatment treatment of moderate and advanced periimplantitis lesions:
a controlled clinical study. Clinical Oral
™
Investigations 10, 279–288. 31. Schwarz, F et
al. (2006b) Healing of intrabony periimplantitis defects following application of a
nanocrystalline hydroxyapatite (Ostimt)
or a bovine-derived xenograft (Bio-Osst)
in combination with a collagen membrane
(Bio-Gidet). A case series. Journal of Clinical Periodontology 33, 491–499 32. Schwarz,
F et al. (2008) Two year clinical results following treatment of peri-implantitis lesions
using a nanocristalline hydroxyapatite or a
natural bone mineral in combination with
a collagen membrane. Journal of Clinical
Periodontology 35, 80–87. 33. Renvert S, Topical minocycline microspheres versus topical
chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant
infections: a randomized clinical trial. J
Clin Periodontol. 2006 May; 33 (5): 362-9. 34.
Karring Es, Treatment of peri-implantitis
by the vector system. Clin Oral Implants
Res. 2005 Jun; 16(3):288-93 35. Mombelli A.
Colonization of osseointegrated titanium
implants in edentulous patients. Early
results. Oral Microbiol Immunol. 1988
Sep;3(3):113-20. 36. Albrektsson, T et al. (1994)
Consensus report of session IV. In: Lang,
N. P. & Karring, T (eds) Proceedings of the
1st European Workshop on Periodontology,
pp. 365-369: London Quintessence Publishing
Co. Ltd.

7 YEARS

6.0 x 5.7mm

4.5 x 6.0mm

ß DT page 17

7 YEARS

5.0 x 6.0mm

infections should be focused
both on infection control of the
lesion, detoxification of the implant surface, and on regeneration procedures. Treatment
options can be surgical or nonsurgical. It was observed that nonsurgical treatment of periimplantitis was unpredictable,
while the use of chemical agents
such as chlorhexidine had
only limited effects on clinical
and microbiological parameters.

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Adjunctive local or systemic
antibiotics were shown to reduce
bleeding on probing and probing depths and some beneficial
effects of laser therapy on periimplantitis have been shown, but
this approach needs to be further
evaluated. Despite treatment and
re-treatment of lesions, establishing an adequate healthy environment was found to be difficult
since inflammation can be still
present in a significant number
of patients. DT

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About the author

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5/12/10 11:24 AM

Vavalekas Michail graduated from the
University “Gr. T. Popa” in 2001, and
continued with the advanced education in general dentistry from “Carol
Davila” from 2002 to 2005, before returning to Greece to work in a private
office. During the period 2008-2010 he
has been specialising in the department of Periodontics and Implant dentistry at New York University College
of Dentistry as a student and a clinical
assistant fellow where he got involved
in different clinical and research activities.

[19] =>

Implant Tribune 19

United Kingdom Edition August 2-8, 2010

Individual Anterior Esthetics

The Possibilities of Straumann® Cadcam in combination with a conventional technique

Initial findings and treatment plan
he 30-year old patient
had lost tooth 21 in an
accident about 15 years
previously. Tooth 11 underwent
root treatment (Fig. 1). As a result of fear of the dentist, the patient continuously delayed treatment of the two teeth and wore a
temporary denture for years. The
treatment plan envisaged an implant in position 21 and a crown
on 11. Since the incisive papilla
was directly in the implant region, cone beam tomography
was performed in order to clarify
the position of the incisive canal.
The width of the bony ridge at
position 21 was five mm measured in the sagittal plane (Fig 2).

Treatment
A mucoperiosteal flap was dissected for the implantation with
vertical relief distally at tooth
22. As expected, the incisive canal was only slightly palatal to
the ideal implant position. The
implant site was prepared with
the aid of a splint along the buccal boundary of the canal (Fig 3)
without perforating the canal. A
Straumann® Bone Level Implant
(4.1 mm, length 12 mm) could be
placed in correct prosthetic position without dehiscence (Figs
4, 5). Because of the thin buccal bone plate and the concavity
of the ridge, augmentation was
performed with a bone substitute and a collagen membrane,
fixed with resorbable pins (Fig
6). At tooth 11, 1mm of crown
lengthening was performed on
the buccal aspect. The flap was
mobilised and sutured over the
wound without tension (Fig
7). The sutures were removed
ten days later; the wound area
healed uneventfully.
After healing the soft tissue
over the implant did not yet have
the desired convex contour and
had a rather uneven structure
(Fig 8). Therefore, eight weeks
after implantation, a split flap
was dissected buccally in region
21 and a connective tissue graft
from the palate was inserted
(Figs 9-10); in addition, the mucosa was de-epithelialised with a
diamond bur in order to smooth
the surface. The connective tissue graft allowed volume to be
gained buccally (Fig 11). Eight
weeks after graft insertion a mini
rolled flap was formed over the
implant and folded in the buccal direction with a conical gingiva former (Fig 12). At the same
time, tooth 11 was prepared for
a crown and fitted with a direct
temporary. Two weeks later,
the impression for the indirect
temporaries was taken. In the
laboratory, a screw-retained
à DT page 20

Fig 1

Fig 2

Fig 3

Fig 4

[20] =>

20 Implant Tribune

United Kingdom Edition

Fig 5

Fig 6

Fig 7

Fig 9

Fig 10

Fig 13

Fig 8

Fig 12

August 2-8, 2010

Fig 13

Fig 14

Fig 15

Fig 16

ß DT page 19

temporary on the implant and
a temporary crown for 11 were
made using a temporary abutment. The temporaries were fitted (Fig 13); conditioning of the
soft tissue began one week later
with application of composite to
the cervical region of the implant
temporary. After conditioning
three times, the desired emergence profile was achieved (Figs
14-15). For the final impression,
an impression post was customized with composite so that it
corresponded to the emergence
profile of the temporary (Fig 16).
After taking an impression
with polyether a model was
made that reproduced the gingival conditions perfectly. The
patient, dental technician and
dentist had agreed to carry out
all-ceramic reconstruction with
the Straumann® CADCAM system. The “Wax Up Design” function of the CADCAM etkon™
visual software allows wax patterns to be scanned and zirconium oxide frameworks to be
produced that optimally support
the veneering porcelain. First, a
try-in wax-up was made from
resin and tried in the patient;
minor esthetic corrections were
made. Using a silicon index of
the wax-up, the frameworks
for crown 11 and the directly
screwed implant crown 21 were
formed from scannable wax (Fig
17). The modelled frameworks
were placed in the 3D scanner
and scanned (Fig 18). These data
were then sent via the Internet
to the milling center. Three days
later the frameworks arrived in
the laboratory and the accuracy
of fit was checked on the model.
à DT page 22

[21] =>

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Some products and indications may be pending regulatory approval and may therefore not be in compliance with local regulations.

[22] =>

22 Implant Tribune
Fig 24

Fig 18

United Kingdom Edition

August 2-8, 2010

Fig 17

ß DT page 20

W
E
N ed at

PracticeWorks

Oralinsights

ch
n
u
tal
a
n
L
e
D
A
T
BD wcase
Sho 09
20
intelligent oral cleaning
.05
J
d
Stan

After that, the frameworks were
veneered with porcelain and the
biscuit bake was tried, in the patient’s mouth. The crowns were
then completed and fitted (Fig
19). An opaque white composite
cement was used for the crown

Oralinsights is an interactive, personalised education system exclusive to PracticeWorks.
It is proven to motivate long lasting improvements in brushing behaviour and technique.
There are also equivalent improvements in plaque removal.

Fig 19

Fig 23

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on tooth 11 in order to prevent
the dark colour of the abutment
from showing through.
Treatment outcome and
conclusion
On follow-up two months after insertion, the esthetics were
satisfactory and the two crowns
harmonized well with the rest of
the dentition (Fig 20). The soft
tissue in region 21 was similar
to the rest of the gingiva in color
and texture, and the papillae
mesial and distal to 21 were almost completely filled up. In the
final radiograph the marginal
bone level seemed ideal (Fig 21).
The patient appeared highly satisfied with the restoration. DT

About the authors

Get it right for life with Oralinsights
Available exclusively from PracticeWorks
Revealed at BDTA Dental Showcase 2009, Stand J05
For further details or to place an order call 0800 169 9692
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MDT Andreas Graf
Master Dental Technician, Dental Technology Studio, Zurich/
Switzerland.
Dr. med. dent. Karin
Wolleb
Dental resident at the
Department of Fixed
and Removable Prosthodontics and Dental Material Sciences,
Center for Dental and
Oral Medicine, University of Zurich.
PD Dr. med. dent. Ronald E. Jung
Vice Chairman at the
Department of Fixed
and Removable Prosthodontics and Dental Material Sciences,
Center for Dental and
Oral Medicine, University of Zurich.

[23] =>

DCPs 23

United Kingdom Edition August 2-8, 2010

When your job description
takes an unexpected turn
Glenys Bridges looks at the upheaval of change

W

cause we can see they are also
meet their needs, the more willhen we were children
are logical and meaningful.
ingly we will make changes even
we were excited by
although at first they are insurprises because we
3D ING 15-07-2008 9:57 Pagina 1
convenient and demanding beThe accelerated pace of the
associated them with gifts and
the excitement of celebrations
such as a birthday or Christmas.
In adult life we come to realise
that not all surprises are created
to thrill and excite: some life
events that descend upon from
Gendex. Imaging Excellence.
a clear blue sky create the levels
of anxiety and stress which can
badly affect your emotional and
physical well-being none more
so than when your employer informs you that you are required
to learn a whole range of new
skills in order to keep up with
changes in the practice’s opertions

modern professional practice
rising to meet workplace demands can be tough at the best
of times. But with an economic
C

M

Y

CM

MY

CY CMY

K

Affordable
Cone Beam 3D.

Over recent years developments in the dental sector have
lead practices to review many
aspects of how they operate and
this had lead them to introduce
new working practices, which
has meant that dental team
members have needed to develop new skills and approaches
to their day-to -day work. The
very fact that patient’s demands
and expectations have changed
so much means that we need to
complete more openly than ever
before with the other providers
of goods or services who are
competing for the same disposable income that patients could
opt to spend on dental care. This
in turn places more demands
upon the dental team, not least
because patients are asking pertinent and stretching questions
about their treatment plans.

Gendex presents the GX-CB500, the latest in Cone Beam 3-D
Dental Imaging. Cleverly designed for use as a powerful
diagnostic and treatment-planning tool, it is perfect
for implant planning and small oral surgical procedures.
• Cylindrical Volume Reconstruction up to 14 cm in diameter
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• Scan time less than 9 sec
• Full 3-D reconstruction in less than 20 seconds
• Accurate volumetric rendering of critical anatomic structures
• Easy to use
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Gendex.
X-Ray solutions you can trust.

While it’s often impossible to prepare or change situations you have no control
over, you do have power over
how you respond to and handle these life events. And while
there may never be a satisfying answer to why bad things
happen to good people, coming to an understanding of the
situation and accepting what
you can and cannot change
can, at the very least help you to:
• Get over unexpected challenges and succeed on the job
• Take charge of your well-being
in good and bad times
We can get so wrapped up
in our own needs and the desire to have then them met,
that we miss opportunities to
connect with others. The irony is that the more we can see
the bigger picture and recognise
the needs of others and understand how any required changes

KaVo Dental Ltd.

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Tel: +44 1494 733000 • Fax: +44 1494 431168

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Colori compositi

crunch adding to the strain on
the bottom line and forcing many
employees to do more with less,
learning to catch, run with and
manage unexpected challenges
on the job is no longer an option—it’s a necessity.From learning to work with your manager,
to making the most out of newly
assigned job duties, you need
to learn to channel workplace
challenges into occupational
opportunities. DT

[24] =>

24 Clinical

United Kingdom Edition

August 2-8, 2010

Back to the Egg; Part II
Kenneth Serota continues his look at the Endodontic Implant Algorithm

D
The UK’s leading supplier of
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entin is the most abundant mineralised tissue
in the human tooth. In
spite of this importance, over half
a century of research has failed
to provide consistent values of
dentin’s mechanical properties.
In clinical dentistry, knowledge
of these properties is pivotal to
any number of variables ranging
from innovations in preparation
design to the choice of bonding
materials and methods.
The Young’s modulus (the
measure of the stiffness of an
isotropic elastic material) and
the shear modulus (modulus of
rigidity) are diminished by viscoelastic behaviour (time-dependent stress relaxation) at strain
rates of physiologic (functional)
relevance. The reported tensile
strength data suggests that failure initiates at flaws. These flaws
may be intrinsic, perhaps regions of altered mineralisation,

upon tooth strength as a function
of these altered forms of dentin is
not well understood.
The long-term predictability
of residual coronal tooth structure to function in a manner
commensurate with the demands of the orofacial ecosystem, may need to be reassessed
in light of observations that
sclerotic dentin, unlike normal
dentin, exhibits no yielding before failure and that the fatigue
lifetime is deleteriously affected
at high stress levels (20). Mechanisms for energy dissipation and
crack growth resistance present
in young dentin are not present
in old dentin. Restorative methods and techniques, particularly
as it relates to ferrule creation
for endodontically treated teeth,
may need to be amplified to address the fact that fatigue crack
growth resistance of dentin decreases with age (21) (Fig 3).

‘There are primary causes that predispose
teeth to fracture and secondary causes that
predispose fracture after a period of time ’

or extrinsic, caused by cavity or
post channel preparation, wear,
or damage. There have been few
studies of fracture toughness or
fatigue (18). Finally, little is known
about the biomechanical properties of altered forms of dentin
subsequent to decay, the influence of irrigants, chemicals and
the choice of curing techniques
used for bonded restorations (19).
Studies suggest that there are
at least two forms of transparent or sclerotic dentin; a form
associated with caries and a
form associated with age-related
changes in the root. The impact

Addressing clinical problems
Understanding the mechanical
properties of teeth is essential
in order to address the most
common clinical problem affecting all endodontically treated
teeth, fracturing, which in spite
of even minimal loss of tooth
structure may be severe enough
to necessitate removal (22-24).
The hypothesis that dentin brittleness increases with diminished moisture content has been
debunked;
conserving
bulk
dentin is the sine qua non of
fracture prevetion.
Kuttler et al reported that

dentin thickness correlates inversely to post space diameter
in the distal roots of mandibular
molars (25). A #4 Gates-Glidden
drill caused strip perforations
in 7.3 per cent of canals studied.
The authors recommend that
Gates-Glidden drills no larger
than a size #3 be used. After endodontic treatment, the furcation
side dentin thickness was less
than 1mm in 82 per cent of the
distal roots studied (Fig 4).
There are primary causes
that predispose teeth to fracture
and secondary causes that predispose fracture after a period
of time (Fig 5). Endodontics is
a component of an interdisciplinary process and a chain is only
as strong as its weakest link.
Subsequent to any endodontic procedure, intensity of stress
concentration and tensile stresses within an endodontically
treated tooth will depend upon
(1)
the material properties of the
crown, post, and core material
chosen, (2) the shape of the post,
(3)
the adhesive strength at the
crown–tooth, core–tooth, and
core– post, post–tooth interfaces,
(4)
the magnitude and direction
of occlusal loads, (5) the amount
of available tooth structure and
(6)
the anatomy of the tooth. Any
combination of vectored stress
concentration and high tensile
stresses will predispose these
teeth to fracture without an
adequately engineered restorative design.
Reengineering
Reengineering negative treatment outcomes is a significant
part of the contemporary endodontic oeuvre. The presence
of apical periodontitis may or
may not affect the outcome of
initial endodontic treatment (26);
however, there is a general consensus that apical periodontitis

For more information please
contact your dental retailer
www.septodont.co.uk
Anaesthetics • Endodontics
Restorative Dentistry • Dental Surgery
Prosthetic Dentistry • Disinfection & Hygiene

Fig 3. Two different retreated teeth; two different potential treatment outcomes. The root canal system of both teeth has been reengineered
in its anatomic entirety; however, the treatment outcome after restoration for both is unlikely to be the same. Regenerative technologies
incorporating mesenchymal stem cells derived from dental tissues may one day obviate the concern.

[25] =>

Clinical 25

United Kingdom Edition August 2-8, 2010

is the most important variable
influencing a positive outcome
with non-surgical and surgical
retreatment (27-29). Positive treatment outcomes may be more
likely in certain teeth with a
combination of both procedures
rather than with one or the other
alone (Fig 6).
The premise that non-surgical retreatment improves the
outcome of periapical surgery
has been supported by both his-

endodontic outcomes (34, 35).
Prior procedural errors (36),
occlusal considerations (37), material choice for the restoration
(38)
and design of the full coverage
component all suggest that success is a function of comprehensive treatment planning as much
as technical expertise. Evidence
based or controlled best evidence studies should conclude
that these are non-endodontic

Fig 4. A) Less porous, less hydrated and highly mineralised outer dentine. B) Pulp canal space. C) More
porous, more hydrated and less mineralised inner dentin.
D) Water in the dentinal tubules and pulp space is held in a
confined environment under hydrostatic pressure.

torical and current studies (30-32).
Apical surgical “correction” of
intracanal infections may isolate, but not eliminate, the residual microflora of the root canal space. It should therefore be
limited to situations where nonsurgical retreatment is judged
impractical.

causes of failure and that the
success of endodontic treatment
itself is high and predictable.
Kvist and Reit (39) have shown
that while surgical cases may
demonstrate higher healing rates
than non-surgical retreatment
cases initially, four years out
there was no difference between
the two modalities due to “late”
surgical failure. The failure rate
for surgical therapy appears to
be analogous to the failure rate

for retreatment as a function of
the size of the lesion treated (40).
Levels of apical resection
and the type of root end filling material make a difference
in surgical treatment outcome
success (42); however, the dentin
bonded composite technique and
the use of compomer materials
has not been widely reported.
As these techniques dome the
resected root face, sealing off the
cut tubuli, they may prove to be

the most effective retrograde surgical protocols of all. In regard to
periapical re-surgery, the literature is unclear.

(41)

Gagliani et al. (43) compared
periapical surgery and re-surgery over a five-year follow-up
period. Using magnification and
microsurgical root-end preparations, the positive outcome for
primary surgery was 86 per cent
and 59 per cent for resurgery.
While others have shown posi-

“Give me something that works fast
and I might be interested”
Patient, UK

With the range of sophisticated equipment and material
in the conventional endodontic
armamentarium, this is a remote
consideration at best. When the
etiology is independent of the
root canal system, surgery is the
most beneficial treatment (33).
Non-surgical retreatment may
still be indicated in these cases,
especially when intracanal infection cannot be ruled out. Time
constraints or financial pressures, should never be a factor
in making surgery the first treatment choice (Fig 7).
Other options
The variables associated with
non-surgical retreatment are
myriad and treatment outcome
studies in endodontics have been
egregiously abused by those
wishing to diminish the value
of re-engineering natural teeth.
Many studies have categorised
teeth with caries, fractures, periodontal involvement and poor
coronal restorations as negative

Sensodyne Rapid Relief – rapid* and long-lasting**
relief from the pain of dentine hypersensitivity1,2
The strontium acetate formulation of Sensodyne
Rapid Relief forms a deep occlusive plug within
the dentinal tubules3,4 providing:
• Clinically proven relief.1,2
Works in 60 seconds*1

The robust occlusion formed by Sensodyne Rapid
Relief is still maintained after an acid challenge4
Unoccluded
dentine

After treatment
and a 30 second
acid challenge

After treatment
and a 10 minute
acid challenge

• Proven long-lasting relief
with twice daily brushing2
• A deep, acid-resistant occlusion3,4
• Fluoride to strengthen tooth enamel

In vitro study of dentinal tubule patency following an acid challenge
(immersion in grapefruit juice, pH 3.3) applied after dabbing and massaging
for one minute with Sensodyne Rapid Relief. Adapted from4.

Recommend Sensodyne Rapid Relief for rapid relief
from the pain of dentine hypersensitivity
* when directly applied with finger tip for one minute
Fig 5. Primary causes of fracture include
excessive structure loss, loss of free
unbound water from the root canal
lumen and dentinal tubuli, age induced
changes in the dentin and restorations and
restorative procedures. Secondary causes
of fracture include the effects of endodontic
irrigants and medicaments on dentin, the
effects of bacterial interaction with dentin
substrate and bio-corrosion of metallic
post-cores.

** when used twice daily

SENSODYNE and THE RINGS DEVICE are registered trade marks of the GlaxoSmithKline group of companies.
References: 1. Mason S et al. J Clin Dent 2010; 21 [Spec Iss]: 42-48. 2. Hughes N et al. J Clin Dent 2010; 21
[Spec Iss]: 49-55. 3. Banfield N and Addy M. J Clin Periodontol 2004; 31: 325–335. 4. Parkinson C and Willson R.
J Clin Dent 2010. Accepted for publication.

SM1818_9 Rapid Relief Press Ad 2010 - Dental Tribune 2.indd 1

27/07/2010 15:16

[26] =>

26 Clinical

Flexibility is our Strength

United Kingdom Edition

tive outcomes for resurgery, the
decision remains highly case
specific. In spite of our best
efforts, negative endodontic
treatment outcomes occur and
orthobiologic replacement of
teeth and their surrounding anchoring structures is an integral
part of contemporary foundational treatment planning.
Engineering methods
A recent article by Assuncao et al
(44)
describes engineering methods used in dentistry to evaluate
the biomechanical behaviour
of osseo-integrated implants.
Photo-elasticity is used for determining stress concentration
factors in irregular geometries.
The application of strain-gauge
methodology on dental implants
provides both in vitro and vivo
measurement strains under
static and dynamic loads. Finite
element analysis can simulate
stress using a computer-created

model to calculate stress, strain,
and displacement. An analysis
of the impact of mechanical/
technical risk factors on implantsupported reconstructions is
beyond the scope of this publication; however, the replacement
of lost teeth by implants should,
without exemption, provide
a feeling of restitutio ad integrum. The means by which the
restoration of the original condition at the “crown/root” interface is idealised will be detailed.

August 2-8, 2010

Fig 7. The initial endodontic treatment procedure was inadequate and failing. Reengineering (inclusive of interim
calcium hydroxide therapy) ensured optimal eradication
of microflora from the root canal space and the obturation produced definitive closure of the apical termini.
Surgery was performed to redress persistent symptoms.

‘The structure and composition of teeth is perfectly adapted to the functional demands
of the mouth, and are superior
in comparison to any artificial material. So first of all, do
no harm…’ Anonymous
The final part of Kenneth
Serota’s paper will be published in a future issue of Dental
Tribune UK. DT

Fig 6. The image on the left is a flat field periapical
radiograph; the one on the right, a small focal field cone
beam volumetric tomograph (Kodak 90003D, Kodak Dental Systems, Woodbridge CT). The differential in visualization of periapical pathology from a 3 dimensional to a
2 dimensional image is as much as 2:1 (Estrela et al, 2009).

References
1. Torabinejad M, Anderson P, Bader J et al. Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed
partial dentures, and extraction without replacement: A systematic review. J Prosth Dent 2007;98(4):285-311 2. Ruskin JD, Morton D et
al. Clinical controversies in Oral and Maxillofacial Surgery: Part One. Failed root canals: The case for extraction and immediate implant
placement. J Oral Maxillofac Surg 2005;63:829-831 3. Moiseiwitsch J, Caplan D. A cost-benefit comparison between single tooth implants
and endodontics. J Endod 2001;27:235 4. Jokstad A, Braegger U, Brunski JB et al. Quality of dental implants. Int Dent J 2003;53:409-443
5. Berglundh T, Persson L, Klinge B. A systematic review of the incidence of biological and technical complications in implant dentistry
reported in prospective longitudinal studies of at least 5 years. J Clin Periodontol 2002;29 Suppl 3:197-212 6. Brånemark PI. On looking
back with Per-Ingvar Branemark. Interview. Int J Prosthodont 2004;17:395-396 7. Christensen GJ. Implant therapy versus endodontic
therapy. J Am Dent Assoc 2006;137:1440-3 8. Morris FM, Kirkpatrick TC et al. Comparison of nonsurgical root canal treatment and single tooth implants. J Endo Oct 2009;35(10):1325-1330 9. Torabinejad M, Kutsenko D et al. Levels of evidence for the outcome of nonsurgical endodontic treatment. J Endod 2005;31:637-46 10. Torabinejad M, Bahjri K. Essential elements of evidenced-based endodontics: steps
involved in conducting clinical research. J Endod 2005;31:563-9 11. Ricucci D, Grosso A. The compromised tooth: conservative treatment
or extraction. Endo Topics 2006;13:108-122 12. Friedman S, Mor C. The success of endodontic therapy: healing and functionality. J
Calif Dent Assoc 2004;32:493-503 13. Friedman S. Considerations and concepts of case selection in the management of post-treatment
endodontic disease (treatment failure). Endod Topics 2002;1:54-78 14. Foster KH, Harrison E. Effect of presentation bias on selection of
treatment option for failed endodontic therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:36-9 15. Tamse A, Fuss Z,
Lustig J, Kaplavi J. An evaluation of endodontically treated vertically fractured teeth. J Endod 1999;25:506-8 16. Aquilinio SA, Caplan
DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosth Dent 2002;87(3):256-263 17. Zadik
Y, DMD, Sandler V, Bechor R. Analysis of factors related to extraction of endodontically. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2008;106:31-35 17. Chugal N, Clive J, Spångberg L. A prognostic model for assessment of the outcome of endodontic treatment:
Effect of biologic and diagnostic variables. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics 2001;91(3)
342-352 18. Kinney JH, Marshall SJ, Marshall GW. The mechanical properties of human dentin: A critical review and re-evaluation of
the dental literature. Crit Rev Oral Biol Med 2003;14(1):13-29 19. Deliperi S, Bardwell DN, Carlo Coiana C. Reconstruction of devitalized
teeth using direct fiber-reinforced composite resins: A Case Report. Deliperi.fm Seite Freitag April 2005 9:50 09 20. Kinney JH, Nalla et al.
Age-related transparent root dentin: mineral concentration, crystallite size, and mechanical properties. Biomaterials June 2005;26(16):
3363-3376 21. Bajaj et al. Age, dehydration and fatigue crack growth in dentin. Biomaterials 2006;27:2507-2517 22. Gher ME Jr, Dunlap
RM, Anderson MH, Kuhl LV. Clinical survey of fractured teeth. J Am Dent Assoc 1987;114:174-177 23. Lagouvardos P, Sourai P, Douvitsas G. Coronal fractures in posterior teeth. Oper Dent 1989;14:28-32 24. Patel DK, Burke FJ. Fractures of posterior teeth: A review and
analysis of associated factors. Prim Dent Care 1995;2:6-10 25. Kuttler S et al. The impact of post space preparation with Gates-Glidden
drills on residual dentin thickness in distal roots of mandibular molars. J AmDent Assoc 2004;35(7):903-909 26. Sjogren U, Hagglund
B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod 1990;16:498-504 27. Hoskinson SE,
Yuan-Ling N et al. A retrospective comparison of the outcome of root canal treatment using two different protocols. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod 2002;93:705-715 28. Chugal NM, Clive JM, Spangberg LS. A prognostic model for assessment of the
outcome of endodontic treatment choices for surgical endodontics treatment: effect of biologic and diagnostic variables. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2001;91:342-352 29. Chugal NM, Clive JM, Spangberg LS. Endodontic infection: some biologic and
treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:81-90 30. Zuolo ML, Ferreira
MOF, Gutmann JL. Prognosis in periradicular surgery: A clinical prospective study. Int Endod J 2000;33:91-98 31. Rud J, Andreasen JO,
Jensen JE. Radiographic criteria for the assessment of healing after endodontic surgery. Int J Oral Surg 1972;1:195-214 32. Mattila K, Altonen M. A clinical and roentgenological study of apicoectomized teeth. Odontol Tidskr 1968;76:389-408 33. Nair PNR, Sjogren U et al.
Intra-radicular bacteria and fungi in root filled, asymptomatic human teeth with therapy-resistant periapical lesions: A long- term light
and electron microscopic follow-up study. J Endod 1990;16:580-588 34. Gorni FGM, Gagliani MM. The outcome of endodontic retreatment: a 2-yr follow-up. J Endod 2004;30:1-4 35. Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic analysis of teeth with failed
endodontic treatment and the outcome of conservative retreatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:86-93
36. Farzanah M, Abitbol S, Friedman S. Treatment outcome in endodontics: The Toronto study. Phases I and II: Orthograde retreatment.
J Endod 2004;30:627-633 37. Iqbal MK, Johansson AA, Akeel RF, Bergenholtz A, Omar R. A retrospective analysis of factors associated with the periapical status of restored, endodontically treated teeth. Int J Prosthodont 2003;16:31-38 38. Hansen EK, Asmussen E,
Christiansen NC. In-vivo fractures of endodontically treated posterior teeth restored with amalgam. Endod Dent Traumatol 1990;6:49-55
39. Kvist T, Reit C. Results of endodontic retreatment: A randomized clinical study comparing surgical and nonsurgical procedures. J
Endod 1999;25:814-817 40. Wang N, Knight K, Dao T, Friedman S. Treatment outcome in endodontics – the Toronto study. Phase I and
II: apical surgery. J Endod 2004;30:751-761 41. Kim S, Pecora G, Rubenstein RA. Osteotomy and apical root resection. In: Kim S, Pecora
G, Rubenstein RA, eds. Color atlas of Microsurgery in Endodontics. Philadelphia: WB Saunders, 2001:85-94 42. Baek S-H, Plenk H, Kim
S. Periapical tissue responses and cementum regeneration with amalgam, SuperEBA, and MTA as root-end filling materials. J Endod
2005;6:444-449 43. Gagliani MM, Gorni FGM, Strohmenger L. Periapical resurgery versus periapical surgery: A 5-year longitudinal comparison. Int Endo J 2005;38:320-327 44. Assunção WG, Barão VA, Tabata LF, Gomes EA, Delben JA, dos Santos PH. Biomechanics studies
in dentistry: bioengineering applied in oral implantology. J Craniofac Surg. 2009 Jul;20(4):1173-7

About the author
Kenneth S Serota, DDS, MMSc graduated from the University of Toronto, Faculty of Dentistry in 1973 and was
awarded the George W Switzer Memorial Key for excellence in Prosthodontics. He received his Certificate in
Endodontics and Master of Medical Sciences Degree from the Harvard-Forsyth Dental Center in Boston, MA. A
recipient of the recipient of the American Association of Endodontics Memorial Research Award for his work in
nuclear medicine screening procedures related to dental pathology, his passion is education and most recently
e-learning and rich media. Ken provided an interactive endodontic program for the Ontario Dental Association
from 1983 to 1997 and was awarded the ODA Award of Merit for his efforts in the provision of continuing education. He was selected for Fellowship in the Pierre Fauchard Academy and is a Fellow of the Academy of Dentistry
International. The author of over sixty publications, he has lectured on Endodontics internationally. He is on the editorial board of
Endodontic Practice, Endodontic Tribune and Implant Tribune. The founder of ROOTS – an online educational forum for dentists
from around the world who wish to learn cutting edge endodontic therapy, he recently launched IMPLANTS (www.rximplants.com)
and www.tdsonline.org in order to provide a clear understanding of the endodontic/implant algorithm in foundational dentistry. As
well, he lectures on the empowerment digital technologies provide to the sophistication of the dental team and the propagation of
comprehensive care.

[27] =>

United Kingdom Edition August 2-8, 2010

Digital Imaging in
Yorkshire moves into a
new dimension
360 Visualise was delighted to
announce today the opening
of its new 3D outpatient
imaging centre in Ilkley,
near Leeds. 360 Visualise’s
innovative scanning process
enables convenient and comprehensive imaging of the head and teeth in a
simple 15 minute visit, with no additional software required for referring dentists.
The new outpatient imaging centre boasts a Kodak 9500 CBCT scanner, the
first of its kind to be installed in the UK. The scanner produces high-quality,
anatomically accurate 3D images, whilst producing a significantly reduced
radiation dose compared to traditional CT scanners.
Ryan Roosekrans, General Manager at 360 Visualise offered his opinion on the
new centre,
‘Cone Beam CT scanning redefines 3-Dimensional cranio-maxillofacial imaging,
and we are proud to bring this technology to Ilkley.’ The images produced by
the Kodak 9500 CBCT scanner are invaluable in the planning of treatments for
impacted teeth, dental implants, extractions, TMJ disorders, orthodontics, and
facial reconstruction, to name but a few. This technology enables doctors to
provide more accurate diagnoses, improved treatment planning and ultimately,
more efficient patient care.

Increase Your Implantology Expectations with
the Chiropro L
Created with practitioners for practitioners the
Bien-Air Chiropro L ultra-efficient, extremely
versatile implantology system leaves nothing to
chance.
The Chiropro L has been designed with efficiency
and comfort in mind. The intuitive interface can
be managed by the control pedal. The patented
peristaltic pump with disposable irrigation lines
and insertion support ensures easy handling and
optimum infection control.
The Chiropro L System includes the MX-LED self-ventilating motor, which is
the most powerful on the market to offer LED lighting at equal intensity at
both high and low speeds. Incorporating 7 of the leading brands of implants
with their complete sequences the Chiropro L can also be customised to your
individual requirements.
With the world’s first internal irrigation system the 20:1 contra-angle handpiece
incorporates the smallest head on the market allowing access to the tightest of
areas. Fitted with an exclusive double optical glass rod system, the handpiece
provides uniform lighting of the operative field.
This user-friendly system has proved to meet the demands of implantologists
worldwide and more.

For further information please call 01943 601222 or email peted@360v.co.uk

For further information please contact Bien-Air on 01306 711 303 or visit
www.bienair.com

Digital Dental
The NEW Flex3D
As easy as 1 .. 2 .. 3D!
Digital Dental, the UK’s leading
independent
digital
imaging
company, offer the complete range of
digital imaging units from Vatech & E
Woo, the world’s no.1 Digital Dental
Radiography & CT manufacturer. This
includes the impressive new Flex3D.
The most adaptable and feature-rich
digital imaging unit available on the
market, the new Flex3D enables the practice to switch from conventional
panoramic to Cone Beam imaging as easily as 1…2…3D! This enables Practices
to select the most appropriate technology, in terms of image quality and
patient exposure, for every situation. It also offers an extremely cost effective
and simple way to upgrade from panoramic to Cone Beam when the time is
right!
In its Cone Beam format, the Flex3D offers a choice of two optimum fields of
view – 5cm x 5cm for single-site implants, complex endo, perio and surgical
applications; and 8cm x 5cm for guided implant surgery and larger procedures.
The new Ez3D 2009 3D viewer software offers a powerful yet easy to use
planning and diagnostic software interface and is compatible with various
surgical guidance software including Simplant and Procera.
For further information call Digital Dental on 0800 027 8393,
email sales@digitaldental.co.uk or visit www.digitaldental.co.uk.

Next BioHorizons
International
Symposium to be held in
Antalya, Turkey
BioHorizons is pleased to
announce Antalya, Turkey
as the next venue in the
International Symposium
Series on 24th – 25th September. Held at the spectacular Mardan Palace, the
two days will feature lectures on the latest trends in implantology and will
unveil groundbreaking new technology.
The BioHorizons 2010 Symposium in Turkey features an impressive line-up
of renowned international speakers including Marius Steigmann, Maurice
Salama, Jack Ricci, Ken Nicholson, Givi Ordzhonikidze and Abdelsalam Elaskary.
The tuition fee is €500 and includes the main programme of lectures, lunches
and refreshments every day and a Gala dinner on Saturday night to celebrate
and socialise with colleagues and the presenters.
BioHorizons core values of Science, Innovation and Service are a strong
competitive advantage that dentists can use to support their reconstructive
practices. The growing success of BioHorizons’ courses such as this first class
symposium is a testament of the company’s commitment to ongoing training
and excellence in implant dentistry.
Please register now to reserve your place at this outstanding educational
event. To register please contact your Product Support Specialist or
BioHorizons directly on 01344 752560, email: infouk@biohorizons.com or
visit our website at www.biohorizons.com

General Medical
OsteoBiol MP3
The perfect answer to Sinus Lift GBR
General Medical are UK Distributors for
the complete range of OsteoBiol bone
graft materials and membranes including
MP3, the perfect answer to Sinus Lift GBR.
Ideally suited to lateral access sinus lift
procedures, MP3 consists of prehydrated
OsteoBiol granules, in a choice of
either porcine or equine origin, in a
sterile syringe delivery presentation.
Consequently using MP3 facilitates easier
and more convenient handling with minimal waste compared with utilising
conventional granules which require hydration prior to placement.
Manufactured by an exclusive and patented process, the OsteoBiol range
also includes a choice of Genos granules for traditional bone regeneration
procedures; and Putty for post extraction alveolar regeneration and
periodontal defects. Both of which are also available in a choice of porcine or
equine derived options. The range also includes Evolution Membranes, in a
choice of thicknesses to suit different applications. Clinicians report that using
OsteoBiol products is easier and more convenient than using similar materials
made from other available products.
For further information telephone General Medical on 01380 734990, visit
www.generalmedical.co.uk or email info@generalmedical.co.uk

The Right Choice for Implant Surgery
NSK now brings dental professionals a
combination
of
powerful,
innovative
equipment designed specifically to meet the
everyday clinical demands of implant dentists.
The powerful surgical micromotor Surgic XT
Plus, ultrasonic surgical system VarioSurg
and the newly launched iSD900 cordless
prosthodontic implant screwdriver, each
deliver power and control that enables implant
dentists to tackle even the most complex cases
with confidence.
Developed and designed with advice from the
profession, the Surgic XT Plus brings a new
dimension of control through the innovative application of Advanced Torque
Calibration (ATC). ATC ensures that you are always working with the optimum
torque and speed settings for accurate, safe and smooth operation.
The new iSD900 cordless prosthodontic screwdriver also features NSK’s unique
Torque Calibration System (TCS) which ensures that the correct torque is
applied at all times. This helps the clinician to screw and unscrew abutments
reliably and without risk, eliminating tiring and strenuous manual procedures.
For more information on the NSK surgical product range contact Jane White at
NSK on 0800 6341909 or visit www.nsk-uk.com
*The iSD900 cordless prosthodontic screwdriver is available exclusively from
Straumann UK, phone 01293 651230 for more details.

General Medical
Physics Forceps
The predictable way to extract teeth

Implant 27
CEREC® 3D Systems
Why buy CEREC®
from Ceramic Systems?
Looking to improve your profitability, then you
need CEREC® from Ceramic Systems the UK
CEREC® Specialists! Only Ceramic Systems can
offaer you:• Dedicated Service and Support Engineers
• Countrywide Product Specialists for pre and
after sales support • Low cost finance arranged for
you • User meetings • Dedicated training facility
• Gold Club for software upgrades, service and
support • Courses by Ceramic Systems’ exclusive
Trainer Dr Simon Smyth – the UK’s Number 1 CEREC® Trainer
CEREC® enables Dentists to create high quality and durable chairside all-ceramic
restorations, including restorations for implant retained crowns and bridges,
in the most cost effective and efficient way. It is a computer-aided method for
creating precision fitting all-ceramic restorations; saving Laboratory costs it
enables Dentists to design and create all-ceramic inlays, onlays, partial crowns,
veneers and crowns for the anterior, premolar and molar regions in one visit.
Eliminating the need for impressions, CEREC® utilises a digital impression taking
technique to capture the data used to design the restoration which is then
milled in the milling unit.
For further information, contact Ceramic Systems Limited on 01932 582930,
e-mail j.colville@ceramicsystems.co.uk or visit www.ceramicsystems.co.uk

GC UK Ltd
GC Gradia is a high strength microhybrid composite system with
the brightness, translucency and
warmth in the oral environment,
making it remarkably life-like in
appearance providing fantastic
aesthetics combined with superb
physical properties. Gradia is the
material of choice for inlays, veneers and crowns and bridges.
As an adjunct to the Gradia system, GC developed a light cured composite for
the highly aesthetic reproduction of missing gingival tissue. GC Gradia Gum
is particularly indicated for implant superstructures and for other fixed or
removable prosthesis.
GC Gradia Gum allows you to reproduce unlimited natural gingival shades, as
the layering technique combined with a variety of modifiers provides endless
possibilities.
GC FitChecker II is the perfect material to check the fit of your crowns and
bridges, as well as dentures. This A-silicone has excellent flow characteristics
enabling minute surface detail to be recorded. You can easily identify even
subtle misfittings according to the tone and translucency of the set FitChecker
II, which has a film thickness of just 15 microns.
For further information please contact GC UK on 01908 218999 or
visit www.gceurope.com

General Medical
Piezosurgery 3 by Mectron
Accept no imitations

Physics Forceps, from General Medical, are a
revolutionary concept that enables Dentists
to extract teeth quicker, more efficiently,
more predictably and with less trauma for
the patient. A real Practice Builder, they
dramatically reduce the amount of time
required to extract teeth and make the whole
procedure much more comfortable and pleasant for both the operator and
patient.
Physics Forceps have a revolutionary “beak & bumper” design that enables
Dentists to extract teeth using wrist movement only – no more “reaching for
the apex”. Dramatically reducing the stress and strain experienced by patients
they also help preserve the buccal plate of bone, which is vital for the patient’s
long term dental health and success of future treatment options including
dentures, bridges and implants.
Significantly reducing both the surgeon’s and patient’s time and associated
stress they are a breakthrough in patient care. To all intents and purposes they
eliminate the need for surgical flaps, facilitate efficient extraction of practically
every tooth ( no matter what the condition ) and achieve virtually atraumatic
extractions in just a few minutes.
For further information telephone General Medical on 01380 734990,
visit www.generalmedical.co.uk or email info@generalmedical.co.uk

General
Medical
are
the
UK Distributors of the NEW
Piezosurgery 3 by Mectron. Like its
predecessors it features Mectron’s
unique ( patented ) dual wave
modulated frequency technology, which ensures optimised cutting efficiency
at a third of the power setting of the imitations which are piezosurgery units
in name only.

Sident Dental Systems
Looking for Sirona Equipment, get it
from Sident!
If you are looking for any Sirona
equipment, including specialist items
for implantology applications, get it
from Sident Dental Systems, the UK’s
only Specialist Supplier of Siemens /
Sirona equipment. Only Sident Dental
Systems can offer you:-• Comprehensive
bespoke Project Management Service for Surgery refurbishments • Factory Trained
Engineers • Product Specialists to advise on design, installation and on-site training
• Low cost finance packages for all products • Established 28 years
Sirona Specialists, Sident Dental Systems offer the choice from the complete range
of Sirona Treatment Centres, 2D and 3D digital and film based x-ray apparatus –
including the very latest Galileos 3D digital cone-beam equipment, their extensive
range of Sirona handpieces, and auxiliary items including SiroLaser, SIROEndo and
the DAC Universal sterilisation unit.
Wherever possible potential clients are invited to visit The Courtyard, Sident’s
state-of-the-art training and showroom facility, where they will be able see the
complete product range in action.
Finally Sident will undertake a complete Project Management Service, including
installation and post installation service support, to enable these dreams to
become reality.
For further information call Sident Dental Systems on 01932 582900 or email
j.colville@sident.co.uk

Sirona launches a new
database for GALILEOSImplant
At the beginning of March Sirona
launched a modified database
for its proven GALILEOSImplant
software. A key feature of the new
database is the realistic visualization
of Nobel Biocare implants. A total
of 228 Nobel Biocare models have
been included.

Using Piezosurgery 3 by Mectron is the safest way to cut bone and other
mineralised tissues without any risk to adjacent soft tissues. It has built in
programmes for bone surgery (Cortical, Spongious plus “Special”) together
with one-touch power settings for Perio, Endo and Implant inserts; variable
fluid control and an automated cleaning cycle.
Piezosurgery 3 by Mectron has the widest range of insert tips for all types of
bone cutting and harvesting including NEW Implant site preparation inserts. It
can be utilised for the widest range of indications including extractions, block
grafts, sinus lifts, crown lengthening, minor oral surgery and much more.
For further information telephone General Medical on 01380 734990,
visit www.generalmedical.co.uk or email info@generalmedical.co.uk

In addition, the implant data of seven other manufacturers has been
updated.
Alongside Nobel Biocare, a further 12 implant manufacturers have been
integrated into the database for the first time.
The GALILEOSImplant database now embraces 42 manufacturers and
3,860 realistically visualized implant models. This facilitates fast and
convenient implant planning.
GALILEOS users can download the database (size: 392 MB) free of charge
from www.sicat.com
For more information contact Sirona Dental Systems 0845 071 5040
info@sironadental.co.uk

[28] =>

28 Industry News
The world’s Number One
dental Implant provider Straumann
Long recognised as one of
the leading providers of
dental implants, Straumann has now officially been recognised as the world’s
number one provider of dental implant solutions in figures released earlier this
year.
Straumann’s success is built on the founding tripartite principles of reliability,
simplicity and versatility and these principles, backed by an unrivalled level
of over 20 years of clinical research have led to Straumann rightly claiming
to have “the most extensively documented, clinically validated and practiceproven implant system in the market.”
As the most practice-proven system on the market, the Straumann® Dental
Implant System provides a unique combination of reduced healing time,
long-term reliability, simplicity of use and a high degree of versatility. The
Straumann® Dental Implant System requires only one surgical procedure
and if appropriate, can be ‘immediately loaded’, to help practitioners achieve
predictable results in any clinical indication.
Now, Straumann’s pioneering approach encompasses not only dental
implants, but also tissue regeneration and digital solutions.

United Kingdom Edition August 2-8, 2010

FREE IMPLANTOLOGY BROCHURE
Perfect results effortlessly – Coltene
Whaledent
Coltene Whaledent would like to offer the
new Implantology Booklet which contains
information for the Dental professional on
relevant products for implantology. Including the
outstanding Affinis MonoBody the first singlephase impression material with an innovative
Affinis surface wetting system for perfect
impressions in a moist environment and G—Mask New Formula for accurate
reproduction of soft tissue structures plus many more. This informative
booklet gives concise description of Coltene Whaledent quality, precision
made, dental products and clinical images and application.
To obtain your fee copy calls free phone 1800 936028 exts 233/224.
www.coltenewhaledent.com

For more information contact Straumann on 01293 651230 or
visit www.straumann.com

How Clean is Your Surgery?
Can you guarantee that your surgery is
germ free? The Saniswiss biosanitizer
automate from Bambach will disinfect your
entire surgery overnight at just the press of
a button.
This surgery atomiser dispenses the
revolutionary
Saniswiss
biosanitizer
directly into your surgery. Being airborne Saniswiss biosanitizer will get to all
of those hard to reach areas efficiently and effectively. Saniswiss biosanitizer’s
innovative technology converts germs utilising a unique patented super
oxygenised water solution.
To take full advantage of a deeply cleaned surgery carry out your usual
disinfecting routine throughout the day; before you leave in the evening
activate the Saniswiss biosanitizer automate. A fine mist is dispensed from the
Saniswiss biosanitizer automate, which combines with the oxygen in the air to
give a 100% guarantee of a perfectly disinfected surgery.
Saniswiss biosanitizer automate provides you absolute peace of mind that
there are no longer any germs lurking in the surgery. This product has been
tested extensively in Europe’s leading laboratories and is proven to offer
outstanding efficacy (active in < 30 seconds).
To find out more please call 0800 581108, e-mail info@Saniswiss.co.uk or visit
www.Saniswiss.co.uk

Implants
Dress to Impress with Dental Sky!
Dental Sky are proud to be recognised as the sole
licensed distributors of Cherokee Uniforms to the
dental profession. Cherokee Authentic Scrubs
are modern and stylish but still hard wearing and
practical with durable easy care fabrics, styles built on
quality and a range of 23 vibrant colours that stand
up to fading. For many years Cherokee have been
established around the world as the main supplier
of uniforms to healthcare professionals and are
America’s most popular scrubs.

Dental Sky work very closely with Cherokee and Toffeln to ensure they offer
their customers the latest styles and colours and endeavour to support a wide
range of products from their UK warehouse.

DENTSPLY enjoys successful exhibit at ISDH
2010
Dental Health, the only global conference
specifically aimed at dental hygienists and dental
therapists, which was held in Glasgow in early
July.
Delegates responded extremely well to the
lecture delivered by Marie George and Cindy
Sensabaugh on myths surrounding insert
selection, with many clinicians using the handson session afterwards to try out some of the
DENTSPLY cutting-edge equipment mentioned in the talk. These included
the Cavitron™ ultrasonic scaler, which provides proven scaling efficacy, and is
available in a range of options to suit every budget.
Members of the DENTSPLY team were also on hand to inform delegates about
products such as the THINsert™, designed to support the Cavitron ultrasonic
scaler. 47% finer than any other slimline insert on the market, the THINsert™
offers superior access for improved biofilm removal.
DENTSPLY recognises the important role played by dental hygienists and
therapists in advancing preventative dentistry andlooks forward to another
successful event in 2011.

To see the full range of styles and colours available please visit
www.dentalsky.com or call 0800 294 4700 to request the new full product
brochure.

For more information please contact your local representative,
Freephone +44 0800 072 3313
Or visit www.dentsply.co.uk

Dental Sky are also working in partnership with Toffeln Footwear, a well
established family business based in the UK with a strong reputation for fresh
and innovative designs created with comfort and durability in mind. New to
the range are the Ultra Lite Elite™ sports styled comfort shoes combining all
the renowned Toffeln comfort and quality with the latest styling.

IIn a randomized,
controlled, observer blind,
parallel group six month
trial, Sharma et al concluded
that for patients with gingivitis who brush and floss routinely, the adjunctive
use of a mouthrinse containing essential oils (Listerine, Johnson & Johnson)
provides a clinically significant and meaningful benefit in reducing plaque
that can lead to gingivitis1.
Mechanical methods of dental plaque removal have for many decades been
based on the recommended twice daily toothbrushing and daily flossing, or
other means of interdental cleaning2. For many patients, this mechanical
routine does not appear to be entirely sufficient as supported by increasing
incidence and prevalence data3.
This long-term study demonstrates that the adjunctive use of an essential
oil containing mouthrinse twice daily provides a meaningful and clinically
significant incremental benefit to a recommended regimen of brushing
twice daily and flossing once daily1. Dental professionals should consider
recommending a brush, floss and rinse regimen to their patients when
brushing and flossing are not enough to maintain gingival health1.
For your copy of this scientific paper and for more information about the
Listerine range of mouthwashes, please contact Johnson & Johnson on 0800
328 0750.

Since Septodont was founded, we have
emerged as a company fully focused on a
single purpose: to provide dentists with
dental products of superior quality and value.
We at Septodont believe that staying ahead
of the competition requires more than just
supplying dental products. Septodont is
actively involved and contributes to many
events, conferences, trade shows and CPD
courses around the world, using this valuable time to pass on our technical
expertise. Septodont has also prided itself on being a highly creative business
with the example of improving on existing technology to bring the dental
world N’Durance®, Septodont’s low shrinkage, long lasting, low toxicity
composite for use in anterior and posterior teeth that is compatible with all
leading bonding systems, plus the launch of a revolutionary product soon into
the UK market, so keep watching our website for more information.
If you have yet to experience the benefits provided by all essential Septodont
products for yourself, please contact Septodont on 01622 695520 or call your
local Septodont Product Specialist.

Prestige Medical
announces launch of new
UltraClean II Under Bench
Washer Disinfector
We are pleased to announce the launch of the UltraClean II Standard Under
Bench Washer Disinfector Dryer.
Based on the popular UltraClean II bench top unit, the new under bench model
allows the dental practice to choose the decontamination solution best suited
to his requirements – all at a competitive price.
With all the same features and accessories as the bench top, including proven
performance and reliability but now in a floor standing unit specifically
designed for situating under bench, you need look no further for the best
washer disinfector for the dental market.
Supplied complete with a 12 month warranty, service is carried out by our
own team of Prestige Medical engineers and, of course, the UltraClean II Under
Bench comes complete with installation, commissioning and user training
completely free of charge as standard.
More information is available from Prestige Medical direct by calling 01254 844
103 or email to sales@prestigemedical.co.uk

Great PracticeSafe offer- Buy 12 boxes
and get 12 refills free.
PracticeSafe ready to use, tear-resistant,
moist wipes are designed for fast cleaning
and disinfection of non-sensitive surfaces
and objects. These Aldehyde and phenolfree, Practicesafe wipes are available in 100
piece packs of strong, extra large sheets.
PracticeSafe wipes are low odour, non-drip
and durable. They are gentle on the hands
but above all, very effective against harmful bacteria. HBV/HIV/HCV/BVDV,
vaccinia are deactivated within 30 seconds. Tubercolocidal and Hospitalism
prophylaxis within 60 seconds. Kemdent PracticeSafe wipes used correctly,
guarantee a safe inactivation of influenza A (H1N1)- viruses (pathogens of
swine flu).
Kemdent know their customers demand high quality, value for money
products. PracticeSafe wipes provide all dental professionals and their
patients with the highest possible level of protection. Unlike, paperbased
wipes, PracticeSafe synthetic wipes hold the disinfectant on the surface of the
wipe, enabling the user to clean all surfaces effectively and evenly without the
inconvenience of using a soggy wipe.
For further information on special offers or to place orders call Helen or Jackie
on 01793 770256 or visit our website www.kemdent.co.uk.

Great value - Diamond
Capsules
Now is the ideal time to try
Diamond GIC Capsules. Buy 3
packs of 20 Diamond Capsules
and get 3 more packs at half
price. A saving of £46.35!
Diamond
is
manufactured
by Kemdent in the UK. The long-term alliance between Kemdent, Exeter
University and Bristol University Dental School has brought about up-to-date
research and development projects into Diamond Glass Ionomer Cements.
Diamond GIC Capsules are used for Class 1 and 2 restorations together with
build up fillings and linings, core build up and retrograde root fillings. The
packable consistency of Diamond Capsules means that the restoration will
set quickly to a rock hard state. No light curing is required as the restoration
is chemically cured and rapid snap set into position. The restoration is
completely waterproof once the chemical snap set is complete.
For further information on special offers or to place orders call Helen or Jackie
on 01793 770256 or visit our website www.kemdent.co.uk.
Issued by Belinda Mayoh –Kemdent email belinda@kemdent.co.uk
Tel: 01793 770256, Fax: 01793 772256
Date:07062010 Ref: GIC07062010
Associated Dental Products Ltd. Kemdent Works Purton Swindon Wiltshire SN5
4HT ENGLAND

Badge of honour
- Sonicare For Kids
accredited by the British
Dental Health Foundation
Three pieces of good news
relating to Sonicare For
Kids have been released
today by Philips. It has just
been announced that Sonicare For Kids has been accredited by the British
Dental Health Association. An independent panel of dental academics drawn
together by the BDHF assessed the basis for a number of claims made by
Philips about the Sonicare For Kids and approved them. This allows dental
professionals to reinforce the benefits of using the pioneering sonic toothbrush
it designed especially for children, safe in the knowledge that they have been
independently verified:
• Sonicare For Kids removes significantly more plaque than a manual
toothbrush
• Sonicare For Kids is safe and gentle on your childs’ gums
• Sonicare For Kids helps establish healthy brushing habits early on
Practice makes perfect
Good news comes in threes and Philips has also announced that Paediatric
Dentist Cheryl Butz has taken custody of the Sonicare For Kids Lego toothbrush
which will now form an eye-catching feature in her dedicated paediatric
practice waiting room.
For more professional information about Sonicare For Kids
visit www.sonicare.co.uk.dp or call 0800 0567 222.

Get a feel for perfection.
It is a symbiosis of intelligent technology
and unequaled precision. A perfect match
between the Original Piezon LED handpieces
and the i.Piezon module for instrument
movements perfectly aligned with the tooth.
An incomparable fit when used with EMS Swiss
Instruments made of ultrafine biocompatible
surgical steel.
The result is a treatment which irritates neither teeth nor gingiva – and which
deliversextrasmooth tooth surfaces without abrading the oral epithelium.
Everyone benefits, all feel good – patient, practitioner, the whole practice.
For more information, please contact:
E.M.S. Electro Medical Systems S.A.
Chemin de la Vuarpillière 31
CH-1260 Nyon
Tel. +41 22 99 44 700
Fax +41 22 99 44 701
welcome@ems-ch.com
www.ems-dent.com

[29] =>

Feature 29

United Kingdom Edition August 2-8, 2010

Helping at Crisis Christmas

Bianca is a senior dental nurse who volunteered in the Dental
Service at Crisis Christmas for the first time in 2008

hen I first heard about
the Dental Service
at Crisis Christmas I
wanted to give it a go, as it sounded so rewarding. I signed up in
2008 and was thrilled to be given
three days of volunteer work!
I went to the induction meeting where a Crisis team explained how the week is run,
what to expect and they also
went into what it means to be
homeless and the reasons why
people are homeless.

The ‘guests’ were extremely polite and grateful

I had never worked with or
been in contact with homeless
people before. I was one of the
many people who offers a pound
here and there and the most I’d
ever done for a rough sleeper
was give them a cup of hot chocolate on a freezing night.
Admittedly, I was a little
daunted by the idea of coming face to face with these unfortunate people whom we see
every day across London, and
who seem ignored by our society.

Treatment was carried out in fully equipped vans

When I turned up on that first
chilly morning, I was immediately affected by the warmth of
the place. It was buzzing! There
were people everywhere – holding steaming cups of tea and
coffee, engrossed in wholesome
conversations and having a good
laugh. I couldn’t tell the difference between the guests and the
volunteers. Although the building had been set up only a couple of days before, it seemed that
this was an old meeting place for
good friends.
Our first patient was a young
man from Lithuania who was
extremely polite and grateful. I
wished all my patients to be like
him! Another patient was a young
professional man who had come
to London on a working holiday
and lost his job and couldn’t find
another. He soon became homeless. Another still, was a gipsy
who had great travel stories to
tell and made everybody laugh.

He had even been to a suburb I
used to live in in Melbourne!
The dentistry was carried out
in a couple of fully equipped vans
which weren’t much smaller

than some of the surgeries I’ve
worked in. We also had heating
and a steady supply of chocolate
to keep up our energy levels! We
were parked next to the makeshift
kennels, where guests’ dogs were

Projekt2_Anzeigen Stand DIN A4 27.07.10 12:20 Seite 1

having a Crisis Christmas of their
own. They were bathed, fed and
given a thorough workout and
barked their appreciation regularly. I went in to visit the dogs
several times – they were so cute!

We all worked hard but had
plenty of time to sit down and
have a chat with the guests and
other volunteers and share stories. It was a great opportunity
to meet new people. At the end of
the three days I wished that my
day to day work was as much fun
as this.
If you’re interested, don’t hesitate to give it a go! Go to www.crisis.org.uk/volunteering. We love
meeting new volunteers. DT

[30] =>

30 Events

United Kingdom Edition August 2-8, 2010

Discovering the H Factor
Dental Protection brings two events to Northern Ireland

F

ollowing the success of previous events Northern Ireland, Dental Protection is
pleased to be offering two further
events in Belfast and Derry.

H Factor’ events, which had been
a resounding success when they
were delivered at venues across
the Republic of Ireland earlier in
the year.

Brian Edlin will discuss the ‘H’
Factor – human nature – and will
explore why it may not be possible to keep all of our patients
happy all of the time.

Responding to feedback from
members, Dental Protection is
presenting two ‘Discovering the

The events will take place
during October 2010 when
speakers Hugh Harvie and

These team-focused evening
lectures are designed to help all
members of the practice identify

difficult patients in advance, in order to adopt techniques and practices to assist them in proactive,
as well as reactive, management.
The session will also explore the
ethical standards expected by the
GDC, and provide examples of
situations where litigation could
have been avoided.

Brian Edlin

Dates for your diary
Wednesday 13 October – City Hotel, Derry (Hugh Harvie presenting)
Thursday 14 October – Belfast
Waterfront, Belfast (Brian Edlin
presenting)

‘These evening lectures are designed
to identify difficult
patients in advance’
The lectures are open to all
members of the dental team and
cost £60 for DPL members, £50
for DPL Xtra members (practice programme) and £75 for
non-members.
Accompanying
staff members (dental nurses,
technicians, receptionists and
practice managers) can attend
free of charge.

Hugh Harvie

Including 1.75 hours verifiable CPD for all members of
the dental team who are GDCregistered, the evening will also
give delegates a chance to meet
some of the Dental Protection
advisory team face to face and to
familiarise themselves with the
wide range of benefits available
to members.
The H Factor joins a growing list of prestigious educational
events organised by Dental Protection that includes the teambased regional Horizons events,
the Premier Symposium organised in conjunction with Schülke
and the Young Dentist Conference in association with the BDA
and BDJ.
For more information, delegates can visit www.dentalprotection.org/newsnevents/events/
hfactor or contact events@dentalprotection.org. DT

[31] =>

Classified 31

United Kingdom Edition August 2-8, 2010

Something to
Smile about!...
SmileGuard is part of the OPRO Group, internationally renowned for revolutionising the
world of custom-fitting mouthguards. Our task is to support the dental professional with
the very latest and best oral protection and thermoformed products available today.

Custom-fitting Mouthguards* – the best protection for teeth
against sporting oro-facial injuries and concussion.
OPROshield – a self-fit guard enabling patients
to play sport whilst awaiting their custom–fit guard.
NightGuards – the most comfortable and effective way
to protect teeth from bruxism.
Bleaching Trays – the simplest and best method for
whitening teeth.
Snoreguards – snugly fitting appliances to
reduce or eradicate snoring.
OPROrefresh – mouthguard and tray
cleaning tablets.

In 2007, OPRO was granted the UK's most prestigious business award,
the Queen's Award in recognition of outstanding innovation.

www.smileguard.co.uk
email info@smileguard.co.uk or call 01707 251252

part of the oprogroup

* SmileGuard - the first to provide independent certification relating to
EC Directive 89/686/EEC and CE marking for mouthguards.

7320_09_3

Geoff Long
2010

FCA

Tax Planning Slate
Now Available!

mouthguard and tray
cleaning tablets

office@dentax.biz

info@medicsfinancialservices.com
www.medicsfinancialservices.com
+44 (0) 1403 780 770
Very competitive fixed rates - House and Practice
Finance
Surgery Finance - Bank of England Base
(from) + 1.00%
100% Mortgage Finance - House and Practice
Extremely Enhanced Income Multiples

Enhanced income
multiples, market
leading rates & highly
competitive
mortgage solutions

for Dentists

+44 (0) 1403 780 770

Your home may be repossessed if you do not keep up repayments on your mortgage. Medics Professional Mortgage Services is a trading style of Global Mortgages Ltd.,
which is an Appointed Representative of Home of Choice Ltd., which is authorised and regulated by the Financial Services Authority.

MPMS 95x50 Dentists.indd 1

11/12/2006 21:56:19

Call 01438 7222242

[32] =>

80% extra protection

against future acid erosion1

Studies show that the combination of Sensodyne Pronamel
daily toothpaste and Sensodyne Pronamel Daily Mouthwash
can provide up to 80% extra protection against future acid
erosion.*1 Sensodyne Pronamel Daily Mouthwash is an
alcohol free 450 ppm fluoride mouthwash with tri-hydra™
polymers, which help build more protection against acid
erosion than standard fluoride mouthwashes.2-4

* compared to brushing with Sensodyne Pronamel
daily toothpaste alone

For patient samples visit
www.gsk-dentalprofessionals.co.uk
References:
1. GlaxoSmithKline data on file Guibert et al 2010.
2. Fowler C et al. J Den Res 88 (Spec Iss A): 3377, 2009.
3. Gracia L et al. J Den Res 88 (Spec Iss A), 3376, 2009.
4. GlaxoSmithKline data on file Young and Willson 2008.
SENSODYNE and PRONAMEL are registered trade marks of the GlaxoSmithKline group of companies.

RECOMMEND PRONAMEL PROTECTION FOR YOUR PATIENTS

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[cover] => DT UK 2010

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Table of contents

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