Northern powerhouse welcomes 2017 British Orthodontic Congress / Technology, the ageing population, regulation: Pondering the future of orthodontics / Early orthodontic treatment and oral health-related quality of life / My complete conversion / Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report / 4th Orthocaps Symposium in Munich
Northern powerhouse welcomes 2017 British Orthodontic Congress
1 - 1 viewTechnology, the ageing population, regulation: Pondering the future of orthodontics
2 - 2 viewEarly orthodontic treatment and oral health-related quality of life
4 - 4 viewMy complete conversion
5 - 5 viewUse of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report
6 - 6 view4th Orthocaps Symposium in Munich
7 - 7 viewArray
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ORTHOTRIBUNE
The World’s Orthodontic Newspaper · United Kingdom Edition
www.dental-tribune.co.uk
Published in London
Vol. 11, No. 7
OPINION
TRENDS
CASE REPORT
Technology, the ageing population, regulation: Dental consultant Chris Barrow ponders the future of orthodontics.
London lingual orthodontics provider Dr Asif Chatoo describes his
navigation of digital technology.
Use of diode laser in the treatment of gingival enlargement
during orthodontic treatment.
” Page 18
” Page 21
” Page 22
Northern powerhouse
welcomes 2017 British Orthodontic Congress
Three-day conference being held in Manchester this month
By DTI
MANCHESTER, UK: After the congress of the British Dental Association in May, the city of Manchester
will see its second dental highlight
this year when the British Ortho-
Dr Richard Jones
dontic Conference opens for orthodontists and affiliated professionals on 14 September at the
Central Convention Complex in
the heart of the city. Being held for
only the second time in one of the
north’s most dynamic powerhouses during the last 30 years, it
promises to be a conference to remember, according to conference
chair Dr Richard Jones, who told
Dental Tribune that the organisation is expecting over 1,000 delegates for the event.
“Our first conference in Manchester in 2013 was already one of
the best-attended conferences we
ever had, and with the Central Convention Centre, we also have a very
modern and contemporary venue
that proved very popular among
the conference-goers four years
ago,” he said. “Manchester itself is
a great city. All the amenities and
attractions are very central. The
conference hotel, for example, is
© Shahid Khan/Shutterstock.com
located right next to the congress
venue and the nearby Gothic-inspired town hall will be a great
backdrop for our social events.”
Social is indeed the key, according to Jones, who said: “We
spent a lot on our social programme in 2016 in Brighton, and it
was very well received. Therefore,
we are continuing with that format this year.”
He also stated the conference
will be offering something for
everyone in the orthodontic team.
In addition to the annual conference of the Orthodontic Technicians Association, which will run
parallel to the main congress in the
same venue, there will be full-day
sessions for affiliate professionals
including practice support staff,
nurses and orthodontic therapists.
“We expect around a third of
attendees to be non-orthodontists, so we are offering three days
of parallel programmes and a
whole day of lectures on impor-
tant things like business development, management and other
non-clinical skills,” Jones said.
In addition to traditional topics in this year’s clinical programme, he said that there will be
emphasis on recent developments, such as lingual orthodontics, which will be the focus of this
year’s Northcroft memorial lecture. Also in the spotlight will be
digitalisation, the pros and cons of
which will be discussed in detail
during a special session on the second day of the conference.
“There are some questions
about some of the technologies in
terms of how they actually enhance the patient experience,” he
explained. “Some early adaptors of
digital technology argue that the
new workflow eliminates impressions and speeds up the manufacturing of appliances, offering
some advantage in the outcomes
of treatment. There are other people on the spectrum however who
argue that this trend is actually
driven mainly by the manufacturers, as they are making a lot more
money out of digitally designed
appliances than of traditional appliances.”
“There isn’t a lot of research
yet to support the assertion that
digital technologies actually enhance the patient experience or
improve results. That is why we
have structured the session as a
debate to have both sides of the
story,” Jones added.
Plans are in the making to use
the congress as a platform to raise
awareness among the general
public and dentists of the importance of retention. A nationwide
campaign is scheduled to be
launched in Manchester.
The Midland Hotel (left) and Town Hall (right) are close to the conference centre.
More information and news
from this year’s conference
are available at the official congress website, and www.dentaltribune.co.uk.
[2] =>
ORTHO OPINION
18
Ortho Tribune United Kingdom Edition | 7/2017
Technology, the ageing population, regulation:
Pondering the future of orthodontics
By Chris Barrow, UK
One of my blogging heroes, Seth
Godin, once commented “don’t
write about what you know, write
about what fascinates you”. Yet
many of the writing assignments
we are given request that we tackle
the former and let the readers know
how much we know about a given
subject. At this year’s British Orthodontic Society conference, I will be
speaking on marketing for the orthodontic practice, what works,
what does not and how to get the
best return on investment from
your marketing. It would be simple
enough to recreate that content
here so that those unable to attend
can obtain the knowledge—but I
have the devil in me this morning,
half way through a week of project
work at my desk, and want to do
something different. So, I have decided to write about what fascinates me in the world of orthodontics right now, observing from the
perspective of helping clients to
grow successful businesses and
maintain a decent balance between
their personal and professional
lives. Here are my Top 10 current
ponderings.
1. I wonder for how much longer
goodwill values will stay at
their historically high level.
The figures are astonishing
and only an institutional investor speculating on a fouryear turnaround or an insurance company looking to
cross-sell products and services can really swallow the
crazy multiples of earnings
now quoted.
2. I wonder how many principals
over the age of 50 are going to
stick around for much longer.
It is becoming more difficult to
run a dental business and it
takes more energy every year
to stay connected with all that
is happening in business and
in the profession. The juxtaposition of an ageing population
of owners and the aforementioned high goodwill values
creates an environment in
which now is a good time to go.
3. I wonder who is going to buy
the practices left to sell. Are the
institutions still prepared to
speculate given the macro-economic situation in the UK? Are
younger dentists (with or without family money) prepared to
take part in a gold rush that is
beginning to sound like history
and not current affairs? It was
the late Sir James Goldsmith
who said, “if you can see a bandwagon, it’s too late to get on it”.
4. I wonder when the regulatory
backlash will hit those general
dental practitioners and specialists who have been flogging
short-term orthodontics like
hot cakes. There are early signs
of patients whose expectations have been raised beyond
the capacity of a system or a
clinician to deliver—patients
who are disappointed, savvy
and motivated to litigate. Dentists should be cautioned by
this environment or by those
who are training them.
5. I wonder how many more systems will appear in the marketplace offering either “cheaper”
or “quicker” as their unique
selling proposition. To cite
Godin again, the greatest danger in a race to the bottom is
winning it. We have already
seen the spectacular demise of
some dental businesses offering orthodontics at deep discount (and I have been involved in belatedly rescuing
others who followed the same
fool’s gold).
6. I wonder for how much longer
orthodontic associates will be
able to make a decent living. As
the profit margins on dental
work erode and the number of
dental care professionals increases, ever more downward
pressure on associate remuneration is created. Is orthodontics still a viable career
choice?
7. I wonder how technology will
affect the delivery of dentistry
in the future, as well as the patient experience and business
systems. Digital dentistry has
become a buzz phrase in recent years. As Apple prepares
to launch iOS 11 and introduce
ARKit (augmented reality
built into iPhones and iPads),
the worlds of e-commerce and
social media are poised to undergo an augmented reality
revolution that will be as culturally influential as the industrial, technology and in-
formation revolutions that
heralded the last two centuries. Technology must affect
the clinical delivery of orthodontics, as well as the patient
experience.
8. I wonder what skill set will be
required of the practice/business manager in the next five
years. With the advent of responsibilities in financial analysis, branding, marketing, user
experience, treatment coordination, governance, compliance, operations and human
resources, will the future manager be of MBA standard?
9. I wonder how dental teams will
develop in orthodontics. Will
you still be able to hire telephonists, receptionists, nurses
and administrative staff at relatively low wages, on the basis
that support people are disposable and replaceable, or
will you have to take a different view that people are an asset on your balance sheet and
not an overhead on your profit
and loss statement? Will the
savvy principal realise that
customer service is how you
positively differentiate yourself from the corporate/retail
competition and from price
wars and that customer service requires a significant investment in your people?
10. Finally, I wonder what our patients will look like in five
years. We live in an age in
which not just augmented reality is about to change the
landscape. Say hello to wearable technology, to fibretronics,
to predictive (not preventative) health care. Our patients
are already living an average of
25 years longer than their
grandparents, a bonus 25 years
in which they are exploring
the world around them and
their inner selves. That bonus
period is going to extend.
Some predict that there are individuals in our current generation of children who will live
good lives until the age of 135.
Dental health and appearance
are a part of that extended
lifespan and the profession
will have to adapt and adopt
new techniques.
Is it not all just fascinating? I
cannot wait to see what happens,
who the winners will be and what
they do to win.
Chris Barrow
is the founder
of Coach Barrow consultancy
practice. An active consultant,
a trainer and
a coach to the
UK dental profession, he regularly
contributes to the dental press, social media and online. Chris Barrow
can be contacted at coachbarrow@
me.com.
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Dental Tribune International
ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com
[3] =>
[4] =>
ORTHO NEWS
Ortho Tribune United Kingdom Edition | 7/2017
Early orthodontic treatment and
oral health-related quality of life
Relationship confirmed by University of Sheffield’s School of Clinical Dentistry study
By DTI
SHEFFIELD, UK: In Western countries like the UK, between 10 and
20 per cent of adolescents undergo orthodontic measures in
some form. A recent meta-analysis
conducted by researchers at the
University of Sheffield’s School of
Clinical Dentistry has indicated
that treatment in those younger
years may have a measurable im-
© Nina Buday/Shutterstock.com
20
pact on a person’s oral health-related quality of life (OHRQoL). In
their review, they found that levels
of emotional and social well-being
AD
The study revealed first evidence that
orthodontic treatment in early age improves oral health-related quality of
life.
concerning OHRQoL improved
moderately in patients who were
treated orthodontically before
they were 18 years old. The findings are relevant, because, until
now, there has been little evidence
that treatment actually improves
OHRQoL.
The researchers included data
from over a dozen studies reporting outcomes before and after orthodontic treatment that were
conducted within the last ten years
in countries like Australia, Brazil,
Canada, China, Italy, the UK and
the US. Of these, four were finally
selected for using similar questionnaires to measure what young
people thought about their teeth
and how their dental appearance
affected their life, before and after
orthodontic treatment. All showed
measurable and moderately large
improvement in the areas of emotional and social well-being, according to the researchers.
“As practicing orthodontists
we are constantly being told by
our patients that they are pleased
they had their teeth straightened
and that they are no longer embarrassed to smile or to be photographed,” explained co-author
Prof. Philip Benson, who is also Director of Research at the British
Orthodontic Society. “We wanted
to find all the research that has
tried to measure this effect with
young people.”
While the findings are a first
step to establishing a platform for
exploring this issue further, Benson admitted that the number of
participants included in the studies was small and that higher-quality data is needed to
substantiate the conclusions. A
follow-up study investigating
OHRQoL in the under-18 age
group under the supervision of
co-author and student Hanieh
Javidi as part of her doctoral
research project is underway at
the School of Clinical Dentistry.
The study, titled “Does orthodontic treatment before the age of
18 years improve oral health-related quality of life? A systematic
review and meta-analysis,” was
published in the April issue of the
American Journal of Orthodontics
and Dentofacial Orthopedics.
[5] =>
Ortho Tribune United Kingdom Edition | 7/2017
ORTHO TRENDS
21
My complete conversion
London lingual orthodontics provider Dr Asif Chatoo describes his navigation of digital technology
By Dr Asif Chatoo
© dencg/Shutterstock.com
In order to convey how this approach differs from
other treatments on
offer, I compare it to
the difference between an off-the-peg
suit and going to a
tailor in Savile Row.
Many of the patients
I treat at my practice
are referred by leading dentists. Their
expectations
are
high. Sometimes orthodontic treatment
is just one part of an
i nt e rd i s c i p l i n a r y
treatment that in its
My professional journey has no end
or destination. If I ever felt satisfied
by one system and I applied it in the
same way without acquiring new
knowledge or discovering more advanced technologies and materials,
I would consider myself ready for
retirement, which I am certainly
not.
My voyage through digital
technology, however, has just
reached a natural conclusion. I realised recently that I had progressed through all aspects of
digital technology as it relates to
orthodontic treatment and I had
completed a circle (Fig. 1).
1
My journey started with photography some years ago, but the
process accelerated, and in recent
years, everything has gone digital,
including radiography, record-taking, treatment planning, and the
manufacture of brackets and
wires.
Over the course of my digital
conversion, I have tried several different systems, all of which have
delivered important benefits. The
system I have used most as I completed the digital circle over
the last two years is suresmile
(OraMetrix). It is a treatment management system and among its
benefits is that I am able to provide
a highly customised service in a
shorter space of time, saving on
average six months of treatment
time per patient.
I have had a digital scanner for
some time, but this month I acquired an updated 3Shape TRIOS
scanner. It is extremely fast and allows my team to take completely
accurate and detailed records of
patients’ upper and lower arches.
In the past, the process took half
will affect all the other teeth. This
will increase the chairside time.
The solution is the robotic wire
bending that is central to suresmile.
I aim to deliver several things
to my patients: an aesthetic result,
a functional occlusion and an occlusion that is comfortable at rest.
More than anything, I want them
to be wowed by their experience. I
believe suresmile delivers that
wow factor.
I have gone 360 degrees and
am now fully digital, but this is
only the first navigation of new
and evolving technology. My or-
“Being impression-free has brought more value to
the team than going paperless.”
an hour, but now it is immediate.
Adult patients are particularly
grateful not to have impressions
taken, and the orthodontic nurses
are delighted to avoid this most
trying aspect of record-taking.
It was invariably messy. Being
impression-free has brought more
value to the team than going paperless.
It goes without saying that a
key benefit of digital technology
is the integration of the orthodontic processes and records. For
instance, a scan of the patient’s
teeth can be superimposed on to
a photograph, which I can in turn
integrate with a grid. I can relate
the tooth positions to facial
planes and check that the dental
midline is centrally located. I can
show the patient his or her teeth
and bite and I can provide him or
her with a visual simulation of
the difference that treatment will
make. The patient can then ask
questions. My vision for the finished result may not be the patient’s vision and being able to
manipulate the outcome on
screen means one can be absolutely sure the patient understands the treatment planning.
The patient can influence the
treatment if he or she wishes, and
if he or she changes his or her
mind towards the end, the technology allows for last-minute nuancing.
entirety will cost in excess of
£ 20,000. Patients expect perfection—in so far as it is possible in an
ageing dentition—and they expect a high level of service. Suresmile allows me to deliver both.
Rightly for a West End practice,
many of the benefits of suresmile
relate to communication and the
care of patients with high expectations, but there are also personal
benefits for the clinician.
In my case, there is one that
surpasses all others. Bending archwires at the end of treatment is almost always inevitable and it is an
aspect I dread. Why am I so hung
up on this? The reason is that, if
one bends a wire on one tooth, one
thodontic journey continues and I
suspect a few more digital revolutions await.
Dr Asif Chatoo is a London-based orthodontist and a leading provider of
invisible lingual treatments. He can be
contacted at info@londonlingualbraces.com.
[6] =>
ORTHO TRENDS
22
Ortho Tribune United Kingdom Edition | 7/2017
Use of diode laser in the treatment
of gingival enlargement during
orthodontic treatment: Case report
Prof. Carlo Fornaini, Drs Aldo Oppici, Luigi Cella & Elisabetta Merigo, Italy
In recent decades, we have witnessed the substantial development and expansion of the use of
fixed orthodontic appliances.
While their application has many
advantages, several problems related to the health of the soft tissue may sometimes appear during
treatment. In fact, the use of fixed
orthodontic appliances may provoke labial desquamation,1 erythema multiforme,2 gingivitis3 and
gingival enlargement. 4
Gingival enlargement is a
very common complication during orthodontic treatment,5 but
fortunately, it seems to be transitory and generally resolves after
orthodontic therapy, even if
sometimes incompletely. Gingival overgrowth induced by orthodontic treatment shows a specific
fibrous and thickened gingival
appearance, different from fragile gingiva with marginal gingival
redness common in allergic or inflammatory gingival lesions.6
Several clinical studies suggest that orthodontic treatment
may be associated with a decrease in periodontal health,
causing a hypertrophic form of
gingivitis. However, the actual
pathogenesis of gingival enlargement is not yet completely understood, although probably involves increased production by fibroblasts of amorphous ground
substance with a high level of glycosaminoglycans. Increases in
mRNA expression of Type I collagen and upregulation of keratinocyte growth factor receptor
could play an important role in
excessive proliferation of epithelial cells and increased development of gingival enlargement, on
the basis of some studies, in cases
of poor oral hygiene status.7 However, there is no clear definition
on its aetiology, although it is
probably associated with the inflammatory response induced by
the corrosion of orthodontic appliances, particularly those of
nickel,8 linked to an inflammatory response considered a Type
IV hypersensitivity and manifested as nickel-induced allergic
contact stomatitis, even if its
aetiology has not yet clearly been
defined.9
The treatment of these conditions is surgical. Histological
and histochemical studies have
demonstrated that the removal
of the gingival papilla can promote the formation of normal
connective tissue.10 Because the
classic intervention performed
1
Prof. Carlo Fornaini is a lecturer at
the MICORALIS Laboratory of the Côte
d’Azur University in Nice, France, and a
dentist at the “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza,
Italy.
2
He can be contacted at:
carlo@fornainident.it
3
4
Dr Aldo Oppici is the Head of “Special
Needs and Maxillofacial Surgery Unit”
of the “Guglielmo da Saliceto” hospital
in Piacenza, Italy.
A.Oppici@ausl.pc.it
5
6
Fig. 1: Clinical view, showing gingival enlargement, just before the debonding procedure. – Fig. 2: Application of a topical
anaesthetic. – Fig. 3: Surgical laser-assisted treatment via laser gingivectomy. – Fig. 4: Clinical view just after surgery. –
Fig. 5: Healing five days after surgery. – Fig. 6: One month follow-up.
by scalpel has some disadvantages, mainly linked to the discomfort for the patient (e.g. anaesthesia by injection and sutures), there has been great interest in the utilisation of laser
technology.
Case report
A 14-year-old female patient
was referred to our department
by the orthodontics unit because,
at the end of fixed orthodontic
treatment, she had developed
gingival enlargement in the upper arch (Fig. 1), probably related
to the fast closure of the spaces
associated with very poor oral hygiene due to bleeding during
toothbrushing. Just after the removal of the appliance, a topical
anaesthetic (EMLA, AstraZeneca)
was applied to the gingivae (Fig. 2)
and a gingivectomy was performed using a diode laser (XD-2,
Fotona) according to the technique of removal of the interden-
tal papillae (Fig. 3). The parameters used were as follows: a wavelength of 808 nm, 3 W in continuous wave, a 320 µm fibre in
contact mode. The intervention
had a duration of 375 seconds,
and the patient did not feel any
pain (Fig. 4). After the intervention, the patient did not take any
kind of pain medication, and the
healing process was completed in
five days (Fig. 5).
Discussion
The first laser appliance was
built by Maiman in 1960, and
some years later, it was successfully employed in medicine and
in oral surgery with several advantages. It may provide excellent incision performance with
sealing of small blood and lymphatic vessels, resulting in haemostasis and reduced postoperative oedema. Furthermore, target
tissues are disinfected as a
result of local heating and pro-
duction of an eschar layer, which
results in a decreased amount of
scarring owing to decreased
post-operative tissue shrinkage,
allowing one to avoid the use of
sutures.
Diodes, the last generation
of laser used in dentistry, have
several advantages, such as reduced cost and size, and offer the
operator the possibility to work
both incontinuous and chopped
mode. Based on our experience,
we can confirm that this technology may represent a new approach to the resolution of gingival enlargement during orthodontic treatment, with better
comfort for the patient during
and after surgery.
Editorial note: A list of references
is available from the publisher.
This article was originally published in the Ortho magazine
No.2/2017
Dr Elisabetta Merigo is a lecturer at
the MICORALIS Laboratory of the Côte
d’Azur University in Nice, France, and a
dentist at the “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo
da Saliceto” hospital in Piacenza, Italy.
elisabetta.merigo@gmail.com
Dr Luigi Cella is a maxillofacial surgeon
at the “Special Needs and Maxillofacial
Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy.
L.CELLA@ausl.pc.it
[7] =>
ADVERTORIAL
Ortho Tribune United Kingdom Edition | 7/2017
23
th
4 Orthocaps Symposium in Munich
International user’s meeting addresses current innovations and gives an overview
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The Orthocaps Symposium is held
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The two days will bring together
Orthocaps system users from many
countries from all over the world.
The event will also feature a diverse
programme with renowned speakers from France, Spain, Italy, the UK
and Germany. The speakers will
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and its future prospects. The lecture
series will be opened on Friday by
Prof. Olivier Sorel of France. Sorel
will talk about the importance of
“Smile Design”. Dr Wajeeh Khan
(Germany), the founder of the sys-
© photo./Shutterstock.comua
Prof. Benedict Wilmes (Germany) will demonstrate skeletal
anchorage and how the aligner
therapy can be supplemented
with temporary anchorage devices (TADs), and Dr Wajeeh Khan
will highlight the advantages and
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Hybrid Aligner treatment (HAT).
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Lastly, the two-day event will end
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All lectures will be held in English, an optional French translation will also be available for international participants. Please contact us for further information
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International Magazines
ortho
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Vol. 1 • Issue 1/2016
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ortho
international magazine of
tem, will talk about different class II
treatment modalities with Orthocaps. Dr Achille Farina from Italy will
share the six key factors that he considers important for a successful
treatment with Orthocaps. The lecture on “Symbiosis and Uses of 3D
Techniques in Daily Practice” by Dr
Florian Boldt (Germany) will complete the programme on the first
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orthodontics
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Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the renewal date.
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1
2016
Name
Address
Zip Code, City
practice management
Short-term gains…
long-term problems?
Country
trends & applications
Vibration therapy in orthodontics:
Realising the benefits
E-mail
industry report
The programme on Saturday
will be no less interesting. Once
again, Prof. Dr Olivier Sorel will
open the programme—this time
with a lecture on the most important aspects in planning interproximal enamel reduction (stripping). Dr Enrique Fernandez
(Spain) will share with the participants, his personal experience
with the Orthocaps system that he
has been using since a long time.
From straightforward
to complex cases
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[8] =>
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The medical-therapeutic and pedagogically valuable
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)
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Table of contents
-
Northern powerhouse welcomes 2017 British Orthodontic Congress
1 - 1
view
-
Technology, the ageing population, regulation: Pondering the future of orthodontics
2 - 2
view
-
Early orthodontic treatment and oral health-related quality of life
4 - 4
view
-
My complete conversion
5 - 5
view
-
Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report
6 - 6
view
-
4th Orthocaps Symposium in Munich
7 - 7
view
[toc_titles] => Northern powerhouse welcomes 2017 British Orthodontic Congress
/ Technology, the ageing population, regulation: Pondering the future of orthodontics
/ Early orthodontic treatment and oral health-related quality of life
/ My complete conversion
/ Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report
/ 4th Orthocaps Symposium in Munich
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