DT UK & Ireland No. 1, 2024

Tooth wear and bruxism: Dentistry’s hidden struggle—Insights into managing an overlooked condition by Dr Paul Tipton, UK / Steven Bartlett announced as headline speaker at this year’s British Dental Conference & Dentistry Show / UK NEWS: Delivering health screening in dental practice; Team harmony as a key factor for the mental well-being of dental professionals; UK researchers develop effective new xerostomia solution; Benefits of water fluoridation may have peaked in rich countries / INTERNATIONAL NEWS: European Parliament bans dental amalgam; SmileDirectClub leaves patients in the lurch; / How to handle complex endodontic cases: An interview with ROOTS SUMMIT speaker Dr Ruth Pérez-Alfayate / Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series by Drs Gary M. Schwartz, David M. Harris & Gregori M. Kurtzman, US / INDUSTRY: Keeping dental staff healthy during the flu season; DirectEndodontics offers high-quality instruments for forward-thinking dentists / EVENTS: Highlights from the 2023 Digital Dentistry Conference and Exhibition; World Endodontic Congress 2024 to take place in autumn; British Orthodontic Conference 2024 set to take place in Birmingham in October

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The World‘s Dental Newspaper
Published in London

uk.dental-tribune.com

Vol. 14, No. 1

CASE SERIES

UK EVENTS

Endodontist Dr Ruth Pérez-Alfayate is
a speaker at this year’s ROOTS SUMMIT.
She discusses the challenges and
methodologies of complex endodontic
diagnostics.

A study presents the long-term effectiveness of LAPIP in treating peri-
implantitis, showing significant bone
regeneration and reduction of clinical
signs of disease.

Learn more about dental conferences in the UK, including the World
Endodontic Congress in Glasgow and
the British Orthodontic Conference
in Birmingham.

Page 7

© D K Grove/Shutterstock.com

INTERVIEW

Page 10–12

Page 14–15

Tooth wear and bruxism: Dentistry’s hidden struggle
Insights into managing an overlooked condition.

When it comes to tooth wear, there
are two primary aetiologies that I as
a practising dentist encounter most
frequently. The first, erosion, is often
linked to dietary habits. An excessive
intake of acidic beverages, including
fizzy drinks and alcohol, particularly
those with added citrus like lemon,
contributes significantly to dental
erosion. Additionally, the prevalence

of modern diets high in acidic fruits
further exacerbates this condition.
Medical issues such as bulimia and
gastro-oesophageal reflux disease also
play a role, as they introduce gastric
acids to the oral environment. The second major aetiology is attrition, largely
due to bruxism. This physical wear
is often a response to psychological
stress, which has become increasingly
common in our fast-paced society.

The prevalence
and consequences
of bruxism
Various reports suggest that
5%–30% of the population clench and

When teeth are already damaged,
restorative treatment becomes necessary. This can range from using com
posite materials for minor repairs to full
reconstructions using ceramics or gold,
the latter of which is particularly well
accepted by older patients. The choice of
material and technique must be tailored
to each patient’s specific needs and
circumstances. Restorative treatments
also need to take into consideration the
correct occlusal principles to ensure
longevity of the restorations and health
of the masticatory system.

© Agenturfotografin/Shutterstock.com

By Dr Paul Tipton, UK

grind their teeth to some degree, and
virtually everyone will brux at some
point.1, 2 It is, in fact, a more significant
issue than dental caries and periodontal
disease in terms of prevalence.
Bruxism-induced tooth wear gives
rise to occlusal disease. Occlusal disease encompasses problems arising
from abnormal or harmful contact
between the maxillary and mandibular
teeth. This includes joint and muscle
problems, breakdown of dental restorations, and broader implications for

overall health and well-being. The condition often affects one or possibly
two components of the masticatory
system, typically not all at once. If the
temporomandibular joints are affected,
it can lead to joint pain, difficulties in
chewing and joint sound phenomena.
Muscle involvement often results in
headaches, myofascial pain and retro-
orbital discomfort. Besides tooth wear,
fillings and other restorations can
break, and the periodontal ligaments
can become stressed, leading to tooth
mobility.

© thitinonjong/Shutterstock.com

It may have further repercussions,
depending on the way sufferers respond to these symptoms. For instance,
this condition often leads to heightened
tooth sensitivity, prompting a shift
towards softer food choices. Consequently, individuals tend to consume
foods rich in carbohydrates while avoiding tougher textures, like meats, which
are more challenging to chew. This dietary adjustment can result in a notable
reduction in protein and fibre intake,
thereby potentially affecting overall
body health. 3 Such changes in eating

patterns not only affect oral health but
can also have far-reaching implications
on the individual’s general well-being,
both physical and psychological.

Prevention
and treatment
Managing bruxism and occlusal
disease requires a multifaceted strategy, having the primary aim of alleviating
stress. In treatment terms, the first line
of defence in managing bruxism is the
use of occlusal splints. These devices,
when correctly designed and used, can
prevent further damage to the teeth
and jaw. However, their effectiveness
depends on factors like design, cost
and patient compliance.4, 5
Understanding the theory behind
splints is crucial, as some types can
worsen the condition. For example,
soft splints, which are generally the
only option available on the National
Health Service, can be helpful for some
but detrimental for others, whereas
hard acrylic, fully adjusted splints offer
more predictable results. 5

The role of
general dentists
General dentists can manage a significant proportion of cases involving
bruxism and occlusal disease. Continuing education and practical training are
crucial for dentists to diagnose, treat
and manage these conditions effectively.6 About 80%–90% of treatments
fall within the scope of general dental
practice, the remaining cases requiring
specialist referral.
It is not at all as daunting as you
might think when you consider that to
treat bruxism dentists need to understand just five principles:
1. E
 stablish temporomandibular joint
position: Our initial approach focuses
on aligning the temporomandibular
joints into their proper position, that
is, either centric relation or retruded
axis position. Despite the different
terminologies used in occlusion, both
terms signify the same position, aiming to align the condyles correctly.

 Page 2

© CC BY-SA 4.0

Steven Bartlett announced as headline
speaker at BDCDS
British podcaster to inspire clinicians to implement new strategies in their practices.
Steven Bartlett, entrepreneur, speaker,
investor, best-selling author and
the host of Europe’s No. 1 podcast
The Diary of a CEO, will be speaking
at this year’s British Dental Con
ference & Dentistry Show (BDCDS),
which is taking place alongside

 ental Technology Showcase at
D
the National Exhibition Centre
Birmingham. Bartlett is an accomplished investor in the health and
wellness space, having made
notable investments in Huel—the
UK e-commerce company that is

growing the fastest internationally—
and ZOE—a personalised nutrition
3c
programme
created by top scientists. His popular podcast has
become a hit as an unfiltered journey into the remarkable stories and
3c
untold dimensions of the world’s

most influential people, experts and
thinkers.
Bartlett’s session promises to
ignite new ideas and strategies

 Page 2

Steven Bartlett.

[2] =>

UK NEWS

2
© CloserStill Media

Dental Tribune United Kingdom Edition | 1/2024

 Page 1 “BDCDS”
among dental professionals and
will delve into the intersection of
entrepreneurship, technology and
healthcare, providing a unique
perspective that is both relevant
and forward-thinking. His insights
into the power of social media and
digital marketing are invaluable
for dental practices aiming to
modernise and expand their reach.
His passion and expertise when
it comes to team culture will be
especially pertinent for dental
practice owners, who often face

Dentistry in England:
A national disgrace?
DIY dentistry, dental deserts, staff shortages.
By Iveta Ramonaite,
Dental Tribune International

“The government keeps saying it
wants everyone to be able to access
NHS dentistry. But there’s no sign of a
credible plan to make that a reality, and
no willingness to break from the failed
contract,” the BDA said in a press release.
Unable to access dental care in
their own country, some UK nationals

The British government has recently
published the much-anticipated recovery plan for National Health Service (NHS) dentistry in a policy paper,
yet many dental professionals have
found it to be somewhat underwhelming. Primarily designed to enhance the
availability of dental services in the
country for those desperately seeking
dental care, the plan falls short of
meeting the government’s stated ambitions and fails to effectively address
the overwhelming backlog and to
resurrect dentistry in England.

the number of dentists providing care
in the state-funded NHS stands at
its lowest level in a decade. According
to data from the Organisation for
Economic Co-Operation and Development, the UK has a shocking 49 public
dentists per 100,000 inhabitants.

Seeking to ease the crisis, the UK government will now be offering financial
compensation ranging from £15 (€18)
to £50 to dentists who accept new
patients, in order to ease the staffing
shortage. The total government
funding for this step is £200 million.
Approximately 240 dentists will additionally be offered one-off payments
of up to £20,000 for working for at least
three years in underserved areas.
Other measurements include a
major focus on prevention and good
oral health in young children and the
launch of dental vans to help reach
isolated communities. Plans are also
in place to expand the NHS dental
workforce. This includes increasing
the number of dental undergraduate
training places and facilitating the
recruitment of overseas dentists.
“The health service will now introduce a wide range of practical measures to help make it easier for people
to see a dentist, from incentivising
dentists to take on new patients to
supporting dentists to be part of the
NHS in areas where access is chal
lenging,” NHS England CEO Amanda
Pritchard said.

NHS dentistry is on a slippery
slope. Just recently, the British Dental
Association (BDA) described it as a
national embarrassment, saying on
its website: “Ministers need to take
some responsibility. A wealthy twenty-
first-century nation is slipping back to
the Victorian era on their watch.”
The country is seeing a concerning incidence of dental caries and dental sepsis in toddlers, a DIY dentistry
epidemic, unattainable NHS targets
and the return of scurvy. Additionally,

are resorting to seeking it in Ukraine,
despite it currently being a war zone.
Worryingly, the statistics do not paint
an optimistic picture. According to
data published in The Economist, the
UK trails behind both Ukraine and
Rwanda when it comes to timely access to care—an especially sobering
fact in light of the last being a developing country.

Faster, simpler, fairer

Access to dental care is now promised to be faster, simpler and fairer.

IMPRINT
INTERNATIONAL HEADQUARTERS
Publisher and Chief Executive Officer:
Torsten OEMUS

However, many dental professionals have expressed doubt over
the new reform. Dr Shawn Charlwood,
chair of the BDA’s General Dental
Practice Committee, commented that
the recovery plan was not worthy of
the title. He noted: “It won’t halt the
exodus from the workforce or offer
hope to millions struggling to access
care.”
“Nothing here meets government’s stated ambitions, or makes
this service fit for the future,” he
concluded.
The policy paper, titled Faster,
Simpler and Fairer: Our Plan to Recover
and Reform NHS Dentistry, can be
accessed at www.gov.uk.

the challenge of instilling a cohesive ethos while also focusing
on their clinical role. This year’s
BDCDS, renowned for being a hub
of innovation and learning, takes
things a step further by inte
grating these critical aspects of
business growth and patient engagement.
The BDCDS, set to be held on
17 and 18 May, is the perfect stage
for this engaging session. Bartlett’s
fireside chat will be taking place
in the BDA Theatre on Saturday,
18 May, at 11:50 a.m.

 Page 1 “Tooth wear”
2. E nsure tooth contact: Once the temporomandibular joints have been
accurately positioned, it is crucial to
verify that all teeth make simultaneous contact. This uniform contact
across all teeth is essential for a comfortable occlusion.
nsure anterior guidance during
3. E
movement: In protrusive, retrusive
and lateral movement, it is important that the anterior teeth facilitate
the sliding motion while the posterior teeth disengage. This anterior
guidance is key to proper dental
function.
4. A
void posterior tooth interference:
During various movements, including bruxism, it is important to ensure
that the posterior teeth do not interfere with one other. This means
avoiding non-working side, or balancing side, interferences, which
create Class 2 leverage, to maintain
oral health.
5. E stablish posterior tooth stability:
The focus here is on ensuring that
the forces exerted on the posterior
teeth are directed down the long axis
of each tooth. This approach seeks to
ensure that every posterior tooth
has three points of contact to prevent tilting and maintain stability.
The key to managing these conditions lies in education. Understanding
the principles of occlusion, the mechanics of splint therapy and the nuances
of restorative treatments is
essential. Dentists must
be proactive in identif ying signs of
bruxism and occlusal disease
a n d s h o u l d
not hesitate
to implement
appropriate
interventions,
such as splints,
to prevent further damage.

Embracing a
holistic approach
As dental professionals, we must
integrate these insights into our
practice, ensuring comprehensive

Attendees can expect not only
to learn but also to be inspired to
implement new strategies in their
practices. This event marks a sig
nificant milestone in the show’s
history, symbolising a commitment
to embracing broader business
knowledge and innovative thinking.
Don’t miss this opportunity to witness
a fusion of dental expertise and
entrepreneurial brilliance, all under
one roof.
For more information and to
register, please visit birmingham.
dentistryshow.co.uk.

care for our patients. This approach
not only addresses immediate dental
concerns but also considers the
broader implications for the patient’s
overall health and quality of life.
Editorial note: Dental professionals who would
like to know more about this topic are invited
to attend Dr Tipton’s presentation titled “Treatment options for the bruxist and wear patient”,
which he will be delivering on 17 May at the
British Dental Conference & Dentistry Show in
Birmingham. More information can be found
at birmingham.dentistryshow.co.uk.

References
1. M
anfredini D, Winocur E, Guarda-Nardini L,
Paesani D, Lobbezoo F. Epidemiology of bruxism
in adults: a systematic review of the literature.
J Orofac Pain. 2013 Spring;27(2):99–110. doi:
10.11607/jop.921.
2. Maluly M, Andersen ML, Dal-Fabbro C, Garbuio S,
Bittencourt L, de Siqueira JT, Tufik S. Poly
somnographic study of the prevalence of sleep
bruxism in a population sample. J Dent Res.
2013 Jul;92(7 Suppl):97S–103S. doi: 10.1177/
0022034513484328.
3. Toyama N, Ekuni D, Fukuhara D, Sawada N,
Yamashita M, Komiyama M, Nagahama T,
Morita M. Nutrients associated with sleep bruxism. J
Clin Med. 2023 Mar 31;12(7):2623. doi: 10.3390/
jcm12072623.
4. Hardy RS, Bonsor SJ. The efficacy of occlusal
splints in the treatment of bruxism: a systematic review. J Dent. 2021 May;108:103621. doi:
10.1016/j.jdent.2021.103621.
5. A inoosah S, Farghal AE, Alzemei MS, Saini RS, Guru
murthy V, Quadri SA, Okshah A, Mosaddad SA,
Heboyan A. Comparative analysis of different types of
occlusal splints for the management of sleep bruxism:
a systematic review. BMC Oral Health. 2024 Jan 5;
24(1):29. doi: 10.1186/s12903-023-03782-6.
6. O
mmerborn MA, Taghavi J, Singh P, Handschel J,
Depprich RA, Raab WH. Therapies most frequently
used for the management of bruxism by a sample of
German dentists. J Prosthet Dent. 2011 Mar;105(3):
194–202. doi: 10.1016/s0022-3913(11)60029-2.

Dr Paul Tipton
is an internationally acclaimed
specialist in prosthodontics who
has worked in private practice
for over 30 years. He seeks
to share his experience and expertise
through the postgraduate and
continuing education of
dental profess i o n a l s . To
that end, he is
a visiting professor lecturing
in restorative and
cosmetic dentistry
at the City of London
Dental School in the UK
and founded Tipton Training,
one of the UK’s leading private
dental training academies. More
information can be found at
tiptontraining.co.uk.

Tel.: +49 341 4847 4302

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Fax: +49 341 4847 4173

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Dental Tribune International GmbH

that has been reprinted or translated and reprinted

written permission of Dental Tribune International

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Claudia Duschek

Holbeinstr. 29, 04229 Leipzig, Germany

in this issue is copyrighted by Dental Tribune Inter-

GmbH is expressly prohibited.

of Dental Tribune International GmbH.

[3] =>

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UK NEWS

Dental Tribune United Kingdom Edition | 1/2024

Delivering health screening in dental practice
Study emphasises role of dental professionals in screening patients for chronic disease.
© Olena Yakobchuk/Shutterstock.com

spanned from August 2020 to November 2021 at the first practice and from
February 2021 to January 2023 at the
second. At the NHS practice, 4.1% of
the 11,200 patients accepted the offer for
screening and 6.5% of the 871 patients
at the mixed practice.
The screenings included assessments of blood pressure, cholesterol,
blood glucose, body mass index (BMI)
and waist-to-height ratio—crucial for
detecting early signs of cardiovascular diseases and Type 2 diabetes in
healthy adults. The selection of these
specific screening tests was based
on their relevance to oral health and
shared risk factors for oral health
complications, such as diet and chronic
inflammation.

By Franziska Beier,
Dental Tribune International
The connection between oral health
and chronic disease has been increasingly supported by substantial evidence, revealing shared risk factors
and inflammatory processes. In light
of these findings, researchers from
the Royal Liverpool University Dental
Hospital and the University of Plymouth
have conducted a study that involved
the introduction of health screenings
during regular dental check-ups in
general dental practices. They found
that dental professionals could make
a positive difference to public health
by being trained to spot some of the
key markers of chronic disease.
According to the study authors,
reports show that in the UK alone
up to 11% of the adult population is

affected by impaired glucose regulation and nearly half of dental patients
aged 45 years and older are at risk
of developing diabetes within the
next decade. These numbers indicate
the potential benefits and positive
impact of implementing diabetes
screening in dental settings, particularly for early intervention in Type 2
diabetes.
The study aimed at evaluating the
service of health screening in dental
settings, including patient willingness
to accept such a service and recommendations for improvement. The
data was gathered from two dental
practices located in North West
England and the Welsh border region,
one a predominantly National Health
Service (NHS) practice and the other
offering a mix of NHS and private
dental services. The data collection

The findings showed that 78.4% of
the patients screened had blood
pressure readings above the normal
range, 55.8% had BMI values that fell
outside the healthy range and 16.7%
had cholesterol levels that deviated
from the healthy range. Elevated
blood glucose levels were observed in
just over 3% of the patients.
“We already place significant emphasis on training students to provide
holistic care for their patients. We also
promote the concept of oral health
being an integral part of general
health and well-being. While there are
resource challenges to consider in
NHS dentistry, this study shows there
are enormous opportunities for dental teams to support their patients and
work more closely with our medical
and healthcare colleagues to benefit
public health,” commented co-author

Dr Robert Witton, professor of community dentistry at the Peninsula
Dental School of the University of
Plymouth, in a press release.
The authors emphasised that clear
protocols and careful interpretation
of screening results are required to
avoid patient confusion and frustration. Findings should always be interpreted in relation to the context of the
dental setting; for example, patients
delaying their meal until after having
seen the dentist could account for
the high proportion of patients with
lower blood glucose levels. Additionally,
high blood pressure could just be a
sign of dental anxiety.

Closer collaboration
between dental and
medical care
Health screening in dental settings
may significantly reduce morbidity,
mortality and healthcare costs by preventing the acute onset of advanced
chronic diseases. Dental practices,
therefore, present a valuable opportunity for early screening, offering
personalised interventions and, where
necessary, serving as a referral point
for early diagnosis.
Lead author Dr Janine Doughty,
from the Royal Liverpool University
Dental Hospital, said: “A health check
at the dentist could provide reassurance for many patients, and a wake-up
call for others to become healthier.
We have someone already sitting in
the chair who visits the dentist every
six to 12 months yet who may not have
seen a GP for years. It is simple to give

them a few minutes of health checks
at the same time.”
In order to put the study findings
to use, greater alliances between
dental and general medical care will
be needed, the study authors rec
ommended. Strengthening partnerships between dentistry and other
NHS platforms could support the
NHS Long Term Workforce Plan’s goal
of fostering collaborative efforts for the
early detection of conditions linked to
cardiovascular disease. By involving
the entire dental health team in health
screening, dental professionals can
expand their practice scope and align
with NHS England’s objective to fully
utilise dental health teams’ potential.

Dental professionals
can make a
substantial difference
Health screenings conducted in
dental settings provide a new opportunity to identify a significant number
of patients who have risk factors
for chronic disease, concluded the
authors. They added: “Dental professionals can be successfully trained
to deliver the screening interventions
and are aptly placed for delivering
brief lifestyle advice and signposting
patients to general medical care or
other appropriate clinical services.”
The study, titled “Opportunistic
health screening for cardiovascular and
diabetes risk factors in primary care
dental practices: Experiences from a
service evaluation and a call to action”,
was published online on 10 November
2023 in the British Dental Journal.

Team harmony as a key factor for the
mental well-being of dental professionals
One third of UK dental professionals report disrespectful behaviour from colleagues.

A recent survey conducted by Dental
Protection—a leading protection organisation for doctors, dentists and
other healthcare professionals—has
found that dental professionals in
the UK recently experienced an increase in disrespectful behaviour from
colleagues compared with during the
height of the COVID-19 pandemic.
The organisation emphasises that such
an experience can impact the mental
well-being of dental professionals,
potentially leading to poorer patient
care or absenteeism from work. To
support its members, Dental Protection
provides a counselling service tailored
for those in the dental profession.
The survey was completed by
1,379 Dental Protection members
between 20 March and 17 April 2023.
The respondents reported that 30%
of them had observed or encountered an increase in disrespectful

ehaviour from colleagues, 35% having
b
witnessed or been subjected to such
behaviour in the last 12 months.
Among those who had experienced
or observed disrespectful behaviour
from colleagues, 65% reported that
it had had a significant or moderate
impact on their mental well-being.
Dr Raj Rattan, MBE, dental director
at Dental Protection, commented in
a press release that poor mental
well-being is concerning for the dental
professional and can have a negative
effect on the patient relationship and
patient care. It may result in absenteeism
for dental professionals, and those
severely affected might even consider
leaving the dental workforce to pursue
a career in a different field.
“During challenging times, the
need for civility and respect is even
greater. A difficult day can feel much
worse if interactions with colleagues
are strained, or if you feel you have

continuing: “Importantly, it also
reminds us that incivility encom
passes a range of behaviours such
as rudeness, verbal abuse and
bullying. We should also be mindful
of cyber-incivility which violates
our ethical duty to maintain mutual
respect within the team.”

By Dental Tribune International

been treated disrespectfully,” he
added.
“We know that for any team to
succeed, each member must feel
valued, respected and supported.
Maintaining team harmony in the
workplace is the key to organisational
success and dentistry is no exception,”
he emphasised.

Dr Rattan encourages dental
professionals to look into the C
ivility
Saves Lives campaign. “While, as
the name suggests, it is more aimed
at the medical community, its key
principles apply to all working in
healthcare—namely that when we
are in a team which values and
respects us, the benefits impact us
and our patients,” he explained,

In addition, he recommends
that Dental Protection members
facing mental well-being concerns
stemming from interactions in the
workplace use the organisation’s
counselling service and other
well-being support. “The service is
provided through a third-party
partner and is completely confi
dential,” he said.
More information about the
Civility Saves Lives campaign can be
found at www.civilitysaveslives.com.
More information about Dental
Protection’s services is available at
www.dentalprotection.org.

[5] =>

Dental Tribune United Kingdom Edition | 1/2024

UK researchers develop effective
new xerostomia solution

UK NEWS

Study paves way for new dry mouth therapy.
By Franziska Beier,
Dental Tribune International
Xerostomia is a prevalent condition
especially among older adults, cancer
patients and people taking multiple
medications. Researchers at the
University of Leeds have developed
a saliva substitute to alleviate the
discomfort of patients suffering from
dry mouth. The novel solution mimics
natural saliva in its ability to moisten
the mouth and serve as a lubricant
during food intake. It comes in a dairy
and a vegan formulation, and in vitro
experiments have found it to be more
effective than other commercially
available products.
According to a 2018 systematic
review, xerostomia affects roughly
22% of the global population and
can lead to severe complications.
The global rise in xerostomia cases in
recent years is attributed to increased
polypharmacy and use of cancer-
related radiation therapies and a
growing incidence of chronic, neurodegenerative and autoimmune diseases
like Sjögren’s syndrome, coupled with
the significant growth of the global
ageing population.
Although a broad range of saliva
substitutes are available, they do not

relieve xerostomia for a sufficient
period of time. Prof. Anwesha Sarkar,
who led the development of the saliva
substitute and is chair in colloids and
surfaces at the School of Food Science
and Nutrition at the university, commented in a press release: “The problem
with many of the existing commercial
products is they are only effective for
short periods because they do not
bind to the surface of the mouth, with
people having to frequently reapply
the substance, sometimes while they
are talking or as they eat. That affects
people’s quality of life.”
The newly developed saliva
substitute, a microgel-reinforced
hydrogel-based lubricant, was evaluated against eight existing commercial products, including well-known
brands such as Biotène from GSK,
Glandosane from Fresenius Kabi,
Saliveze from Wyvern Medical, and
Oralieve. The experiments were
conducted on an artificial tonguelike surface.
The study found that the saliva
substitute provided significantly enhanced boundary lubrication, being
41%–99% more effective against liquids and viscous substances compared
with current products. This result is
primarily due to its adsorption proper-

the production of the saliva substitute
are non-toxic and non-caloric.

Study limitations

Graphical representation of the structures of the dairy-based lubricant (left) and
the vegan version (right). The proteins of the hydrated microgel (dark blue and
dark green mesh-like structures) are partially coated by a hydrogel made from
a polysaccharide. (Image: © Anna Tanczos)

ties, which enable it to bind more
effectively to oral surfaces. In contrast
to the 23%–58% desorption rate observed with commercial alternatives,
the novel saliva substitute demonstrated a notably lower desorption rate
of 7%. In addition, the research team
observed that the dairy formulation
showed slightly better performance
than its vegan counterpart.
Lead author Dr Olivia Pabois, a
postdoctoral research fellow at the
university, said: “The test results provide a robust proof of concept that
our material is likely to be more effective under real-world conditions and

could offer relief up to five times
longer than the existing products
that are available.”
She added: “The results of the
benchmarking show favourable results in three key areas. Our microgel
provides high moisturisation, it binds
strongly with the surfaces of the
mouth and is an effective lubricant,
making it more comfortable for
people to eat and talk.”
The first formulation of the new
solution is based on a dairy protein
and the vegan version based on a
potato protein. The substances used in

While the study measured lubricity under conditions relevant to oral
use, it did not assess the long-term
hydration efficiency of the newly

developed lubricant compared with
competitive samples. Additionally, it
has to be taken into consideration that
the temperature of ingested products
could potentially affect the lubrication
properties of the saliva substitute.

Future applications
The study authors aim to transform
the novel saliva substitute into com
mercially available products, intending
to enhance the lives of individuals
suffering from challenging dry mouth
conditions. This extensive benchmarking
study thus sets the stage for the use of
these microgel-based aqueous lubricant
formulations as an innovative approach
to treating xerostomia.
The study, titled “Benchmarking
of a microgel-reinforced hydrogel-
based aqueous lubricant against
commercial saliva substitutes”, was
published online on 20 November 2023
in Scientific Reports.

Benefits of water fluoridation may have
peaked in rich countries
Have benefits of water fluoridation reached their limit?

Researchers from the University of
Manchester have conducted a pioneering study in the UK focusing on
the oral health and economic impacts
of water fluoridation on adults and
adolescents, considering populations
with widespread access to topical flu
oride. While the findings indicate that
water fluoridation remains beneficial,
the advantages are not substantial.
Therefore, in high-income countries,
the potential benefits of fluoride
treatment alone may have reached its
zenith and other measures—such as
fostering environments that support
healthier food choices—may be more
effective.
Initial research on the implementation of community water fluoridation to combat caries indicated a
reduction of up to two-thirds in the
average number of teeth affected.

“Fluoridation of drinking water is
justifiably recognised as one of the

twentieth century’s greatest public
health achievements,” said project lead
Dr Deborah Moore, a research asso
ciate at the University of Manchester,
in a press release.

Like with any public health intervention, continued monitoring is required, as the implementation context
evolves over time. “[As] fluoride toothpastes became available in the mid1970s—considered to be the key factor
in the dramatic decline in the prevalence and severity of dental decay—
the context of water fluoridation has
changed,” explained Dr Moore.
Even though the broader adoption of water fluoridation is considered an effective, cost-efficient public
health strategy for lifelong protection
against the gradual onset of caries,
there is limited published evidence on
its efficacy in adults. In high-income
countries, the nature of caries has
transformed from a fast-progressing
childhood disease leading to early
tooth loss to a more slowly advancing
condition, and adults now bear the
majority of its burden. Given the widespread use of fluoride toothpaste and
the increasing number of individuals
retaining their natural teeth into later
life, in this new study, the research
team sought to assess the dental
health benefits for adults.
The researchers used routinely
collected National Health Service (NHS)

dental treatment data submitted
between 2010 and 2020. The study

included individuals aged 12 years
and older who were receiving care
from NHS primary dental services in
England, totalling 17.8 million patients.
The analysis involved matching individuals with exposure to optimally
fluoridated drinking water to those
without, resulting in a sample of
6.4 million patients.
The findings showed that the average number of invasive NHS dental
treatments, such as restoration and
extraction, was 3% lower in the group
with optimal water fluoridation, compared with the control group. Additionally, the average number of decayed,
missing and filled teeth was 2% lower
in the group with optimal water fluoridation. There was no notable difference
in the average number of missing teeth
per individual, and the data did not
provide strong evidence that water

fluoridation significantly influenced
social disparities in dental health.

Implications for
health economics
Between 2010 and 2020, the estimated cost of optimal water fluoridation

in England was £10.30 per individual.
During this period, NHS dental treatment expenses for patients in areas
with optimal fluoridation were reduced by 5.5%, equating to a saving of
£22.26 per person.
“The patients who received optimal water fluoridation had very small
positive health effects. But as the costs
of NHS dentistry are much higher than
the costs of water fluoridation, the
relatively small observed reductions

in visits to the dentist still resulted in
a positive return for the public sector.
This return should be evaluated against
the projected costs and lifespan of
any proposed capital investment in
water fluoridation, including new programmes,” said Dr Moore.

Fluoride only mitigates
sugar intake
“There is no doubt that population-
level, mass preventive interventions
for tooth decay are still required.
Tooth decay remains almost universal
by adulthood, even in populations
that have had access to fluoride toothpastes and fluoridated water from birth.
However, in high-income countries,
we may be reaching the limit of what

can be achieved through fluorides
alone,” commented Dr Moore.
The researchers emphasised that
a dose–response relationship between dietary intake of free sugars
and caries is evident, and fluorides
merely mitigate this association.
“The relationship between sugar
consumption and tooth decay is very
clear: average consumption of sugars
in the UK is more than double the recommended level for adolescents and
is almost double for adults. Managing
sugar consumption is another area of
policy that needs to be investigated,”
highlighted Dr Moore.
The study authors concluded that
water fluoridation has made an unparalleled contribution to oral health
in the twentieth century; however,
for the twenty-first century, greater
impact may be achieved by advocating
healthy food intake.
The study, titled “How effective
and cost-effective is water fluoridation
for adults and adolescents? The LOTUS
10-year retrospective cohort study”,
was published on 8 January 2024 in
Community Dentistry and Oral Epidemiology, ahead of inclusion in an issue.

By Franziska Beier,
Dental Tribune International

[6] =>

INTERNATIONAL NEWS

Dental Tribune United Kingdom Edition | 1/2024

European Parliament bans dental amalgam
EU ban on amalgam may cause UK supply chain issues, impacting Northern Ireland the most.
© rarrarorro/Shutterstock.com

the Minamata Convention on Mercury,
which entered into force in 2017. Additionally, using the material for treating
pregnant or breastfeeding women, as
well as children under the age of 15, has
been banned in the EU since 1 July 2018.
Dentists in the Philippines have been
prohibited from using amalgam as a
restorative material since last year.

Growing disillusionment
of dental services
in the UK

By Iveta Ramonaite,
Dental Tribune International
Amalgam is the restorative material of
choice for many dentists. It is the gold
standard of dental care. However, its
popularity has been slowly declining
in recent years and so has its use, all
thanks to strict governmental regulations. Now, the European Parliament
has announced that it will completely
ban dental amalgam starting from
1 January 2025—news that came as

a shock to many dental professionals
and organisations, especially those
who have relied heavily on amalgam.
The use of dental amalgam, which
consists of approximately 50% mercury,
greatly contributes to mercury pollution
and poses an environmental threat to
ecosystems. Owing to rising health
concerns about the material, stringent
regulations have been imposed to phase
down amalgam use and to ensure safe
disposal in dental practices, in line with

The ban will greatly affect the
UK’s dental services, which have been
struggling to recruit and retain dental
professionals in recent years. According
to the British Dental Association (BDA),
amalgam is the material most commonly
used for permanent fillings by the
National Health Service (NHS). Additionally, the organisation stated that fillings
account for approximately a quarter of
all courses of NHS treatment delivered
in England and that amalgam is used in
around a third of all procedures.
Given its wide use, the EU ban
on amalgam is expected to result in

supply chain issues in the UK. Since it
has the most filled teeth proportionally, Northern Ireland will be the most
affected UK nation.
Although the BDA supports amalgam reduction, it has called the rapid
phase-out of amalgam in dental
practices unfeasible and unjustifiable.
It said: “Dental amalgam has been
in use and extensively studied for
150 years as a restorative material.
Its safety and durability are well
established, and it remains the most
appropriate material for a range of
clinical situations.”
Although alternatives exist, they
are significantly more costly and
take longer to place. BDA Chairman
Dr Eddie Crouch commented in a press
release: “When alternative materials
can’t compete, this will add new costs
and uncertainties to practices already
on the brink.” According to him, banning
amalgam would mean losing a key
weapon in the treatment of dental
caries, and he cautioned that this
could be “the straw that breaks the
back of NHS dentistry”.

Amalgam-free
restorative materials
Alternatives to amalgam include
glass hybrid materials and high-
viscosity glass ionomer cements.
Each alternative offers unique advantages and disadvantages, and the choice
often depends on the specific needs
of the patient, including aesthetic
considerations, durability requirements
and financial constraints.
Prof. Falk Schwendicke summarised this in his recent article published on the Dental Tribune website:
“There is not a single material that
fulfils all the requirements for an

amalgam replacement; instead, a range
of materials with different properties
are available, and dentists will need to
make informed choices about which
material suits which indication best.”
“The era of dental amalgam is
slowly coming to an end,” he concluded.
Breakthroughs in dental technology
may lead to new, more advanced
materials for dental restorations in
the future.

SmileDirectClub leaves patients
in the lurch
Company has announced that it no longer provides customer care.

The self-proclaimed democratiser of
orthodontic care, SmileDirectClub (SDC)
has abruptly shuttered its global business after less than ten years of oper
ations. The Tennessee clear aligner
company announced in December
that it had failed to secure a financial
lifeline in Chapter 11 bankruptcy proceedings and that it would consequently liquidate and end all services
with immediate effect. According to
media reports, the closure came as
a surprise to thousands of SDC customers who were in various stages of
orthodontic care and who must now
consult a local dentist to continue
their treatment.
Typically a patchwork of reviews,
endorsements and promises of easy
and cost-effective clear aligner therapy, SDC’s website on 8 December was
reduced to a landing page featuring a
short statement and a few brief FAQs.
The company had “made the incre
dibly difficult decision” to end its operations, the statement read, explaining
that customer care was no longer
available. Recent orders would not
be fulfilled, the company’s Lifetime
Smile Guarantee was now void and
any questions about ongoing treatment would need to be directed at
local dentists, the FAQs explained. For
those seeking a refund, the company
said that the ongoing bankruptcy process would determine the next steps.

In December, the UK’s Oral Health
Foundation voiced its concern about
the ongoing orthodontic care of
SDC patients. Dr Nigel Carter, OBE,
chief executive of the foundation, said:
“The closure of SmileDirectClub has
created an upsetting situation for many
patients who were undergoing dental
treatments. We are extremely worried
about what impact this will have on
the oral health and mental well-being
of thousands of people currently
undergoing treatment.”

By Jeremy Booth,
Dental Tribune International

“It all leaves a very bitter taste,”
Dr Carter said, adding: “Patients have
been left in the lurch and it will now no
doubt fall on orthodontists to rescue
the situation for those SmileDirectClub
customers who remain unhappy with
their smile.”
SDC filed for Chapter 11 bankruptcy
protection in the US on 29 September,
remaining in control of its business
operations while seeking capital re
organisation under the oversight of
the US Bankruptcy Court for the
Southern District of Texas. At the time
of the filing, SDC owed creditors nearly
US$900 million (₤716 million) and had
just US$5 million in cash, despite having
been valued at close to US$9 billion
when the company went public in 2019.
Lawyers acting for the company told
UK magazine Dentistry in October that
the bankruptcy filing only affected its
US business and that its UK and “other
international affiliated entities have not
sought any bankruptcy protection”.

Despite being laden with debt,
SDC continued to ship thousands of
clear aligner cases to customers in
Australia, Canada, Ireland, New Zealand, the US and the UK throughout
2023, and reports suggest that it continued to advertise and sell treatment
even into the final throes of its
global business. Public information
shows that the company shipped
106,419 unique clear aligner orders
in the first half of last year, and
The Guardian highlighted the plights
of US consumers who responded to
SDC promotions as late as November.
Kat Fernandez of Texas told the newspaper that she received an offer for
SDC aligners that was “too good to be true”

and paid in full for the treatment on
3 November. “It infuriates me to know
that they were aggressively pursuing
[customers] so close to when they were
going to pull out. I feel scammed and
conned,” Fernandez said.
Rebekka Reynolds of Oklahoma,
who paid in full for her treatment in
October, told the newspaper that
she received news about the closure
via social media and not from SDC.
“I found out because a bunch of my
TikTok followers started tagging me
in videos, asking me what I was going
to do. Then I looked it up and found
out. That kind of blows my mind,”
Reynolds said.

Founded in 2014, SDC was on
a strong upward trajectory in 2019
when it went public on the Nasdaq
stock exchange and installed 49 HP
Multi Jet Fusion 3D printers at a new
manufacturing facility. Running nonstop, the printers enabled SDC to
produce 20 million clear aligner trays
annually and made the company
the largest user of this 3D-printing
technology in the US. Prior to the
SARS-CoV-2 pandemic—which hit the
company particularly hard, owing to
its disproportionate financial impact
on its target market—SDC was a major
employer in Tennessee and other
US states and had a global headcount
of 6,300 staff.

[7] =>

INTERVIEW

7

Dental Tribune United Kingdom Edition | 1/2024

How to handle complex endodontic cases
An interview with ROOTS SUMMIT speaker Dr Ruth Pérez-Alfayate.
By Franziska Beier,
Dental Tribune International

to be identified in a patient presenting
with a low pain threshold.

 valuate the actual pulp status before
e
conducting treatment.

From 9 to 12 May, the ROOTS SUMMIT
2024 is scheduled to take place in
Athens in Greece. Registration for the
event is still open, and the organisers
would like to introduce some of the
great speakers and their lecture topics for this year’s event. One of them
is endodontist Dr Ruth Pérez-Alfayate
from Madrid in Spain. In this interview,
she introduces her lecture, titled
“Complex diagnosis in endodontics”,
and explains why she decided to
speak at the congress.

The balance, in my opinion, can
be found when we understand the
expectations of our patients in the
first instance. Patient safety, the concept of “do no harm” and minimally
invasive treatment should prevail
and must be a priority for us. All of
these concepts can still be applied
even when we need to use invasive
tests for diagnosis.

What will be the main learning objectives
of your lecture at ROOTS SUMMIT 2024?

In some cases, even after the use of
diagnostic tests, the dental professional can be left with a high level of
doubt. What is the reason for this?

I have attended this congress many
times, and I have to say it is one of
my favourites. Also, the organisers of
ROOTS SUMMIT are three people whom
I admire greatly, and when they ask you
to come to their congress, it is impossible
to say no—it is an immense privilege.

Dr Pérez-Alfayate, in some of the
more complex endodontic cases, dental professionals have to use invasive
tests in order to be able to make a clear
diagnosis. For which cases are these
invasive tests appropriate, and how do
dental professionals keep a balance
between invasive treatment measures
and the desire to keep the treatment
minimally invasive?
These tests might be appropriate
when there is doubt about a vertical
root fracture, when there is severe
pulpitis, when more than one tooth
is suspected of this pathology and is
radiated, or when pulp necrosis needs

I will describe a diagnostic protocol for endodontists to enable them
to understand which clinical situations
require a complex diagnosis, and I will
propose how they should act in these
specific situations.

What made you decide to participate in
the upcoming ROOTS SUMMIT?

The reality is that currently we do
not have any test that is 100% objective.
This means that one or two tests are
not sufficient. We need to find a diagnostic protocol that gives us as much
information as possible.

What are some of the endodontic
diagnostic tests for complex cases, and
why can they be challenging?
The diagnostic tests include
exploratory surgery, selective anaesthesia and cavity testing. Deciding
when or when not to use them is the
challenge.

I know I will learn a great deal from
the best and humblest endodontists in
the world. I am sure this will be a great
congress, and I hope to see as many
people as possible there. Do not miss it!
Dr Ruth Pérez-Alfayate, an associate professor at the Faculty of Biomedical and
Health Sciences at Universidad Europea in Madrid in Spain.

Are there any future developments
in endodontic diagnostics that you
can tell us about?

Some researchers are working on
various devices, such as pulse oximeters,
real-time ultrasound and ways to

Editorial note: The lecture by Dr Pérez-
Alfayate, titled “Complex diagnosis in
endodontics”, will be held on 10 May from
11:00 a.m. to 12:30 p.m. More information
on the programme and registration can
be found at www.roots-summit.com.

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[10] =>

STUDY

Dental Tribune United Kingdom Edition | 1/2024

Laser-assisted protocol for the treatment
of peri-implantitis:
A long-term retrospective case series
Drs Gary M. Schwarz, David M. Harris & Gregori M. Kurtzman, US
Introduction
Pulsed Nd:YAG dental lasers are
surgical tools used to obtain specific
surgical objectives as defined in the
LANAP (laser-assisted new attachment procedure) for periodontitis
and the LAPIP (laser-assisted peri-
implantitis procedure) for peri-
implantitis. The LANAP using the
PerioLase Nd:YAG laser (Millennium
Dental Technologies) was introduced in 1998 as Laser ENAP,1 and in
2004, the LANAP gained US Food
and Drug Administration 510(k)
clearance (No. K030290) for the
claim “laser assisted new attachment
procedure (cementum-mediated
periodontal ligament new attachment
to the root surface in the absence
of long junctional epithelium)”.
Subsequently, human histology

studies 2, 3 established that the
LANAP resulted in “periodontal
regeneration—true regeneration of
the attachment apparatus (new cementum, new periodontal ligament,
and new alveolar bone) on a previously
diseased root surface” (2016 510(k)
clearance No. K151763).
The LAPIP emerged from the
LANAP as a stand-alone procedure.4–7 The indication for the LANAP
is moderate to advanced periodon
titis,i whereas the LAPIP is indicated
for peri-implantitis treatment.ii The
basic steps in the two protocols are
the same and have adjustments for
the whole mouth versus a single
site, the responses to irradiation
of root cementum versus implant
titanium, and differences in surgical
objectives.
A recent review of published
studies of peri-implantitis laser
treatment concluded that laser
treatment enhances bone growth,
but a quantitative analysis of
bone-level changes is limited.9 The
authors called for greater relevance
and translation of the research
findings to the clinician. This report
addresses those concerns with
a
detailed analysis of the clinical
outcomes and a quantitative description of changes in radiographic
density two to five years after

undergoing a LAPIP in a private
practice setting.

iP
eriodontitis: “Inflammation of the
periodontal tissues resulting in clinical
attachment loss, alveolar bone loss,
and periodontal pocketing.”8
ii P
eri-implantitis: “An inflammatory
process around an implant which includes both soft tissue inflammation
and loss of supporting bone.”8 Clinical
signs include inflammation, bleeding
on probing and suppuration. It progresses from peri-implant mucositis,
which is confined to the soft tissue,
to include PD > 4 mm and evidence of
bone loss. Peri-implantitis often leads
to progressive loss of osseointegration
and eventual loss of the implant.

blood within the sulcus and again
passed around the implant, heating
and congealing the blood and forming a fibrin clot, constituting Pass 2
with the laser.11
Hence, real-time dosimetry is
based on these clinical conditions.
With a constant laser power (output), the time spent lasing within the
sulcus determines the total energy
delivered. In other words, a prescribed laser dose does not determine the treatment end point;
rather, achieving the surgical end
point determines the total joules.
The surgeon understands that clinical conditions determine the precise
laser parameters and the total energy delivered. However, exceeding
the recommended dosimetry increases the risk of possible adverse
effects.

1
Fig. 1: Proportion of dental implants in each clinical treatment outcome category.

Dr Schwarz completed training
in the LAPIP in September 2013.
A retrospective analysis of the
222 sequential patients with 437 failing dental implants that were
treated during the following three
years was performed.7 That study
was focused on the short-term efficacy of the LAPIP. A statistically
significant reduction of clinical signs
of erythema, bleeding and suppuration and reduced probing depth (PD)
at the first follow-up visit (median
period: 7.6 months; P < 0.001) was
noted. The survival rate, the percentage of intact implants, was 94%
over the longest follow-up period
(median: 13.1 months) among those
in the analysis.
Long-term clinical and radiographic data are presented from
the same group of 222 patients.
There was a continuum of responses, including long-term successes, partial responses with intact
implants and implants lost after two
years of maintenance with multiple
treatments, as well as cases of successful treatments that relapsed
after one to two years. Analysis of
radiographic data from a sample
of successfully treated implants
provided a time course for bone

regeneration.

Methods
Collection and analysis were
performed of retrospective data,
wherein patient records were sorted
to find all patients in the practice
who had undergone LAPIP treatment within the 37-month interval
from the first treatment (October
2013) until the date of institutional
review board approval (October
2016). A private institutional review
board (Quorum Review) granted

a waiver of informed consent and
approved the retrospective data collection and analysis protocol. Later,
the institutional review board approved the retrospective analysis of
the long-term follow-up data that is
included in this report. The original
study was conducted according
to standards established by the
Declaration of Helsinki and Good

Clinical Laboratory Practice Guidelines.
Research standards established in
the original study were maintained
in the current study.
The purpose of the original
study was a precise statistical analysis of the initial clinical outcome of
a single treatment, seeking to determine whether there was improvement or a lack of improvement at
the first follow-up visit. A review was
conducted of patients who received
the treatment in the three years
after the LAPIP training. All patients
were included to eliminate selection
bias. A staff member went through
the medical records of each LAPIP
patient and copied data into case
report forms. Any identifying information was excluded, and the case
report forms were sent electronically to the statistician for data
entry and analysis. Data captured
included laser settings, demographics,
medical history, implant information, adverse events, PD (mm; for
six pockets) and the presence of clinical signs (bleeding, erythema and/
or suppuration). Panoramic and/or
periapical radiographs were available for analysis. The statistician excluded patients with missing data
from the various analyses. The original group included 222 patients
with 437 implants. That study enrolment closed in October 2016. Exclusion of patients with incomplete
data resulted in 116 patients with

224 implants available for analysis,
including 47% men and 53% women
with a mean age of 65.8 years
(range: 23–98 years).
Two years later (September
2018), a second look at the original
group of patients was performed.
Several patients had follow-up visits
beyond the closing date of the original analysis. Case report forms of
additional follow-up visits were collected, uploaded and added to the
original data set. This resulted in
155 patients with 299 implants who
had sufficient baseline and follow-up
data to determine implant survival
and clinical outcomes.

Laser dosimetry

The dental laser was a 6
W
pulsed Nd:YAG laser (PerioLase MVP-7)
utilising an optical fibre that delivered high-energy pulses of light to
the tissue. For the LAPIP, the fibre
tip is inserted into the periodontal
pocket. Parameters that are set on
the control panel are energy per
pulse up to 300 mJ; pulse duration,
variable from 100 to 650 µs; and
pulse repetition rate from 10 to
100 Hz. The duration of exposure is
controlled with a foot switch.
The LAPIP details have been
published elsewhere 4–7 and are only
summarised as follows for the protocol specifying surgical end points.
Achieving those end points is what
determines the dosimetry. In Step 2
of the protocol, the distal fibre tip is
inserted into the periodontal pocket
and passed around the implant several times to initially open the sulcus
and then to remove the diseased
pocket epithelium and disinfect the
tissue, constituting Pass 1 with the
laser.10 In Step 4 of the protocol, the
fibre tip is inserted into the pooled

The hard copy printout of the
laser dose for Pass 1 and Pass 2 was
available for 138 implants, and the
mean total energy per implant was
285.8 J. This was divided between
the two laser steps. Pass 1 mean
total energy was 181.8 J , and Pass 2
mean total energy was 104.0
J.
Energy was delivered according to
the following formulas, and sizable
case-to-case variance was required
to achieve the surgical end points:
•P
ass 1 total joules delivered
=130 + (10 × aPD)
• Pass 2 total joules delivered
=85 + (4 × aPD)
These two formulas are not a
prescription; they merely define
the dosimetry used in this study. On
average, Pass 1 required an initial
130 J for all implants, and Pass 2 required an initial 85 J. The formula
specifies that the total joules per
pass is related to the average probing depth (aPD; the average of six
PD measurements). Consequently,
to estimate the total energy, add ten
times the aPD in joules to the initial
values for Pass 1 and four times the
aPD for Pass 2.

Radiographic analysis

Film radiographs were scanned
and digitised and then the digital
radiographs were rotated, cropped
and resized. Brightness and contrast were not adjusted. Images
were arranged in chronological
order to illustrate the sequential
changes in radiographic density for
each case. A technician skilled at
reading dental radiographs outlined the radiographic defect and
areas of change in subsequent images. The cross-sectional area of
the defect within the outlines was
measured using public domain software (ImageJ, National Institutes of
Health freeware). As the dimensions
of the implant were known, the

[11] =>

STUDY

11

Dental Tribune United Kingdom Edition | 1/2024

areas were calibrated in square millimetres so that comparisons could
be made over time and across cases.
The sum of the defect areas on both
sides of the implant is referred to
as the cross-sectional area. Cross-
sectional areas at follow-up visits of
successful cases were converted to
baseline percentage to estimate the
time course of bone regeneration.

Results
The clinical outcome categories
were defined as follows (Fig. 1):
• Long-term success: return to healthy
PD and an absence of clinical signs
• Short-term success: patients with
successful outcomes but without
follow-up data beyond 12 months
• Partial response: failure to meet
success criteria but the implant
was still intact and stable
• Relapse: initial success and then
return of clinical signs
• Failed: implant lost or removed.
The long-term responses to
treatment can thus be divided into
four general outcomes: successful
response (Group 1), partial response
(Group 2), spontaneous relapse
(Group 3) and lost implant (Group 4).
Summary statistics for each of the
four groups are presented in this
section, followed by one case from
each group.

Group 1:
Successful response
This was the most common
response, 204 implants (68%)
meeting the success criteria of post-
treatment PD  ≤  4  mm and no clinical
signs at follow-up visits. Most implants in this group (91%) achieved
success after a single treatment.
Others (7%) demonstrated a partial
response and then success after a
second treatment, and 2% achieved
success after three treatments.
The median follow-up period in this
group was 18.8 months, and one
implant was still successful at

63 months. At the time of the
latest analysis, 48% of all implants
still showed long-term success
(12–63 months). The remaining 20%
of successfully treated implants
had follow-up periods of less than
12 months, so their long-term outcomes could not be determined.
Most of these patients did not
return for their scheduled hygiene
visits.

Group 2:
Partial response
Partial responders are implants
that improved but still showed some
clinical signs, had a PD > 4 mm and
never achieved the success criteria.
There were 47 implants (16%) in
this category. Most were treated
a second time at six or 12 months
after the first treatment, and several received a third treatment. They
continued to exhibit clinical signs
and had a PD  >  4  mm. The median
follow-up period in this group was
22 months.
Case 2 is an example of a partial
response to treatment (Fig. 3). The
patient was a 58-year-old man with
Type 2 diabetes, hypertension and
hyperlipidaemia and had had an
implant (Nobel Biocare Tapered)

placed in position #46 in July 2014.
The patient presented in December
2014 with a PD of 9  mm around the
implant, bleeding and suppuration
and was treated with the LAPIP.
At four months, there was no bleeding, but the PD was still 9  mm, and a
second treatment was performed.
At 15 months, the clinical signs had
improved, and PD was reduced to
an aPD of 4.2  mm. At 33 months,
the implant was still intact; however,
the PD had increased to 5.3  mm,
and there was some bleeding on
probing. The PD and clinical signs
at follow-up visits did not allow this
implant to reach the success criteria.
Even though bone regeneration is
unlikely with a defect this wide, the
PD and clinical signs improved and
remained improved for almost three
years after the first LAPIP treatment, and the implant remained
in function at the time of last
follow-up.

Group 3:
Spontaneous relapse
There were 32 implants (11%)
with initially successful outcomes
that demonstrated relapse with the
return of inflammatory markers
along with deeper PD. The medium
time to relapse was 24 months
(range: 11–43 months).

Case 3 is an example of a successful single treatment that was
without clinical signs for over two
years and then presented with
signs of reinfection (Fig. 4). The
59-year-old female patient had had
an implant (Nobel Biocare Tapered;
3.5  ×  16.0  mm) immediately placed
Case 1 is an example from the
in position #11. She had no risk facgroup of successful treatments (Fig. 2).
tors for peri-implantitis, but four
The patient was an 87-year-old man
months later, at her first follow-up
with a cardiovascular condition
visit, the implant showed signs of
and had implants in positions #32
redness and bleeding from 4 mm
and 42 that supported a mandibular
pockets. Subgingival cement was
overdenture. He presented with
noted on the periapical radiographs
deep pockets (PD  =  5.7  mm) accomand was removed. The first LAPIP
panied by a large defect around
treatment was performed in Sepimplant #42. This had led to acute
tember 2015. At follow-up visits at
symptoms, including pain, erynine, 15 and 27 months after the
thema, bleeding, suppuration and
first treatment, all inflammatory
swelling of the vestibule. At the
markers were absent, and the PD
pretreatment visit, the labial plate
showed progressive improvement,
was mostly absent along the buccal
good bone fill being noted in the
aspect of the implant becoming
periapical radiographs. The apical
exposed. At six months post- radiolucency was absent, but a new

treatment, the clinical signs had
defect had appeared coronally at
resolved, the PD had reduced to

27 months. At 32 months, she
3.8  mm and the area of radiolucency
showed significant relapse with
had reduced too. At 30 months, the
redness and bleeding from pockets
PD was 2.8  mm, and there was a
that had deepened beyond the
complete absence of clinical signs.
pretreatment levels. Radiography


revealed that the new defect had
enlarged. The implant was subse
quently retreated.

Group 4: Lost or
removed implants
There were 16 implants (5%) that
failed during the follow-up period.
The median time to failure after
the initial LAPIP treatment was
five months (range: one week to
31 months). Four implants were lost
within the first month, six more
by the first follow-up visit (five
months), two at nine months, one at
18 months and three after two years
of maintenance. One of the last was
healthy but ordered extracted by
the patient’s physician.
Case 4 is among the lost implant
cases (Fig. 5). The patient was an
81-year-old immunocompromised
man with several medical conditions, including cardiovascular disease and a drug-resistant systemic
infection. An implant (Nobel Biocare
Tapered; 5  ×  13  mm) had been
placed in position #46, and he was
seen six months later with an aPD
of 6.8  mm, bleeding at four sites,
erythema and radiographic evidence
of bone loss. At the five-month follow-up visit, bleeding had resolved,
and the aPD was reduced to 5.5 mm,
but there was still redness and
suppuration. By the 18-month visit,
the condition had deteriorated. The
aPD had increased to 8 mm, and there
was bleeding and suppuration. At
that time, the patient received a second LAPIP treatment. At 30 months,
one PD was 11  mm and the rest were
12  mm, and there was an increase in
the radiographic size of the defect.
A third treatment was performed,
and the laser dose was increased
to 305  J at Pass 1 and 180  J at Pass 2
for that treatment. However, the implant was finally removed 31 months
after the first treatment.

Change in
radiographic density
Radiographs from all 299 implants were reviewed to identify
interproximal vertical defects at

baseline indicating bone loss. Many
patients had panoramic radiographs of low resolution, and most
bone loss was restricted to the buccal
plate, which is not visible in trans
mission (periapical and panoramic)
radiography. Only 21 cases were
identified, and of these, ten provided measurable baseline and
follow-up radiographs. Radiographic
data reflected a similar proportion
of outcomes to the PD and clinical
sign data. Out of the ten cases, one
was from Group 3 (lost implant),
two were from Group 2 (partial response) and seven were from Group 1
(successful cases). The cross-
sectional areas of the seven successful cases were converted to a
percentage of the baseline areas,
and those values were plotted at
their respective follow-up times
(Fig. 6). The data fitted well to a decaying exponential function, y  =  e –0.1x,
which suggested that regeneration
approached 98% by 36 months.

Discussion
The LAPIP utilises the advantages of laser sulcular debridement
(e.g. selective tissue removal, bacte-

2

3

4

5
Fig. 2: Example of a successful treatment (Case 1), showing changes in radiographic
defect (mm2), probing depth (PD; mm) and clinical signs from baseline to 30 months later.
Violet = cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD;
ML = mesiolingual PD; L = lingual PD; DL = distolingual PD; R = redness; B = bleeding;
P = suppuration; Tx1 = first treatment. Fig. 3: Example of a partial response to treatment
(Case 2), showing changes in radiographic defect (mm2), probing depth (PD; mm) and
clinical signs from baseline to 33 months later. Violet = cross-sectional area; MB =
mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual
PD; DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment;
Tx2 = second treatment. Fig. 4: Example of a successful single treatment that was without
clinical signs for over two years, and then the implant presented with signs of reinfection
(Case 3), showing changes in radiographic defect (mm2), probing depth (PD; mm)
and clinical signs from baseline to 32 months later. Violet = cross-sectional area; MB =
mesiobuccal PD; B = buccal PD; DB = distobuccal PD; ML = mesiolingual PD; L = lingual
PD; DL = distolingual PD; R = redness; B = bleeding; P = suppuration; Tx1 = first treatment.
Fig. 5: Example of a lost implant (Case 4), showing changes in radiographic defect (mm2),
probing depth (PD; mm) and clinical signs from baseline to 30 months later. Violet =
cross-sectional area; MB = mesiobuccal PD; B = buccal PD; DB = distobuccal PD;
ML = m
 esiolingual PD; L = lingual PD; DL = distolingual PD; R = redness; B = bleeding;
P = suppuration; Tx1 = first treatment; Tx2 = second treatment; Tx3 = third treatment.

[12] =>

STUDY

12

Dental Tribune United Kingdom Edition | 1/2024

rial reduction, haemostasis, minimally invasive method) and embeds
the laser components into a medically
sound protocol that also includes
implant debridement, occlusal adjustment, and detailed pretreatment
and post-treatment procedures.
Because of these additional therapeutic measures, the outcomes
reported here may not be directly
comparable with those of many
controlled laser studies.
PD and clinical signs were analysed. Analysis of the short-term data
from 116 patients with complete
baseline and follow-up data determined that there was a statistically
significant reduction in PD and clinical signs at the first follow-up visit
(median: 7.6 months) after a single
treatment. The aPD was reduced by
2.0  mm (5.4  mm reduced to 3.4  mm,
P  <  0.001), and clinical signs of erythema, bleeding and suppuration
were reduced by 78%–85% (P  <  0.001).
A recent prospective controlled trial
of ten patients who were treated with
the LAPIP found similar results: a
1.9  mm PD reduction and decreased
bleeding and suppuration.12
Several patients had follow-up
visits after the short-term study
had concluded. By the time of
this long-term analysis, there were
155 patients with 299 implants available to determine long-term survival
and response to therapy. The initial
survival rate was 94% at 13.1 months
(15 were lost out of the 264 implants).
AD

6
Fig. 6: Change in cross-sectional area of the defect as a percentage of the baseline
area for seven implants from Group 1. Black circles = success.

The long-term survival rate matched
and surpassed the previous results,
being 95% at 28.8 months (16 of the
299 implants were lost). In the long
term, PD remained ≤  4  mm, and clinical signs remained absent for 68%
of the 299 implants. An additional
11% were initially successful, but
then presented with a relapse at
about two years post-treatment.
Sixteen per cent of the 299 implants
never achieved success, but remained
intact at 22 months.

cases demonstrated that, on average, bone fill is expected to be
25% complete by three months,
70% complete at one year, 90% complete by two years and 98% complete
after three years. It is important
to note that this study only
sampled interproximal defects,
and the analysis may thus not accurately 
reflect changes to labial
bone.

The clinical healing curve indicated by the average rate of increase
in radiographic density for successful

One of the greatest challenges
has been fighting a losing battle
against peri-implantitis. The impact

Conclusion

of the LAPIP on treatment of
peri-implantitis has been significant. Using other methods over
30 years of practice in the case of
Dr Schwarz, achieving bone fill
and eliminating all signs of in
flammation have been challenging.
These results describe the final
stage of translation of an experimental protocol into clinical practice.
An attempt to present an unbiased
analysis of the real-world clinical
outcomes, successful or not, has
been accomplished. The results
demonstrated would be typical for
any clinician who has been properly
trained and follows the protocol.
Even a partial responder is a clinical
success if the implant remains
improved. Periodic retreatment of
the partial responders and the
relapses is a way to extend the
time of functionality for the patient.
The results of this study indicate
that the LAPIP offers a minimally
invasive, repeatable way to regenerate bone and eliminate clinical
signs of disease in most patients
and to effectively manage the
more difficult cases.

Editorial note: Please
scan this QR code for the
list of references.

Dr Gary M. Schwarz
Dr Gary M. Schwarz works in
private practice at Valley Oral
& Maxillofacial Surgery in
McAllen in Texas in the US.

Dr David M. Harris
works at the Department of
Periodontics of Rutgers School
of Dental Medicine in Newark
in New Jersey in the US.

Dr Gregori M. Kurtzman
works in private practice in Silver
Spring in Maryland in the US.

Acknowledgements

We would like to thank Veronica
Serna, Jennie Richie, Molly Tuttle
and Ray Guajardo for technical assistance and acknowledge Burkart
Associates, which assisted with
statistical analyses. We appreciate
the review by and suggestions of
John Sulewski, Ray Yukna, Jon Suzuki
and Dawn Gregg.

Contact
Dr Gregori M. Kurtzman
3801 International Dr Ste 102
Silver Spring MD 20906, US
drimplants@aol.com

[13] =>

INDUSTRY

Dental Tribune United Kingdom Edition | 1/2024

Keeping dental staff healthy during the flu season
Dental practitioners are one of the
most at-risk groups during viral pandemics or flu seasons. Luckily, regularly using the Perio plus+ regenerate
mouthwash from Curaden can help
keep staff safer.
Typically, viruses and bacteria
enter the body via the nose and
mouth, contaminating their mucosa.
The infection then progresses and
infects organs in different parts of
the body. Viral infections can happen
to anyone, but dental practitioners
are one of the most susceptible
groups. Daily close contact with
patients, regular exposure to bodily
fluids and the handling of sharp
instruments all greatly increase the
risk of infection, especially during
a viral pandemic or the yearly flu
season.
How to protect the dental p
ractice:
•U
se a proper handwashing technique.
• Wear personal protective equipment,
that is, gloves, gowns, masks and
eye protection.
•
Rinse the patient’s mouth before
a dental procedure.
• Use dental dam isolation when
possible.
• Employ anti-retraction handpieces.

•D
isinfect the clinic environment,
including surfaces.
• Manage medical waste properly.
Maintaining excellent hand hygiene,
wearing protective equipment and disinfecting the clinic environment are protective measures that help keep the dental
practice safe. However, there is one more
simple step that can help you decrease
the risk of infection, kill bacteria and inhibit the entry of viruses into the system.
According to a study by researchers at
the University of Lyon in France, using
Perio plus+ regenerate mouthwash before
dental procedures significantly reduced
the viral load of viral infection.1

Powerful combination
of ingredients that protects
against infection

The same properties that help
Perio plus+ regenerate fight infections
in the mouth and battle bacteria that
can damage enamel or threaten gingivae can also help protect against
the spread of viruses. Two ingredients
of Perio+ plus regenerate that help
protect against viral infection stand
out: chlorhexidine and Citrox.
Chlorhexidine digluconate (0.09%)
has been a gold standard in oral health
for over 70 years. As an antiseptic and
disinfectant, it is very efficient at elimi-

nating harmful bacteria, fungi and
viruses. Citrox is a novel ingredient based
on natural bioflavonoids derived from
bitter orange. Bioflavonoids have been
demonstrated to act against bacteria,
fungi and viruses. They bind to bacteria’s
receptor sites, blocking the passages
that bacteria need for feeding and
emptying. Unable to sustain these processes, the bacteria essentially drown
and are thus killed.

In Perio plus+ regenerate, Citrox is further combined with polylysine amino
acids to create the Citrox/P formula.
Combined, these two substances create
a protective layer on teeth, gingivae
and oral mucosa. This is an additional
way in which the mouthwash acts as
a protective measure to keep viral infection in the practice in check.

Reference
1. C arrouel F, Valette M, Gadea E, et al. Use of an

Various types of bioflavonoids,
such as hesperidin, naringin, caflanone
and Equivir, have been shown to
hamper the replication of viruses and
inhibit their entry into our system.

antiviral mouthwash as a barrier measure in the
SARS-CoV-2 transmission in adults with asymptomatic to mild COVID-19: a multicentre, randomized,
double-blind controlled trial. Clin Microbiol Infect.
2021;27(10):1494-1501. doi:10.1016/j.cmi.2021.05.028.

DirectEndodontics offers high-quality instruments
for forward-thinking dentists
When it comes to choosing endodontic systems, quality, cost and
access are major considerations.
DirectEndodontics was founded
to directly supply dental pro
fessionals based in Europe with
locally made high-quality reci

procating and rotary instruments.
The company told Dental Tribune
International (DTI) that its products are competitively priced and
that dentists can easily swap to
its instruments without having
to change the techniques they
currently use.
DirectEndodontics prides itself
on being at the forefront of dentists’ evolving needs. Founded to
form partnerships with the technology-based clinicians of today,
the company focuses on quality,
accessibility and keeping prices
low. Caroline Dort, head of operations at the company, told DTI:
“Today, dentists who do endo
dontic procedures want to use
high-quality products at a fair
price. They are looking for an
easy, flexible and fast service.
DirectEndodontics provides them
with a fast and very simple way to
order directly through the website.
Our files are made in Europe under
strict quality controls, ensuring
our products are safe and easy
to use.”
What makes DirectEndodontics
stand out from other manufac
turers is that the company supplies
endodontic files and products

high-quality product. Another favourite among our customers, which
is also a trendy product, is our
DirectBioceramic Sealer, which is a
sealer of a very high quality that we
sell at an affordable price.”
The feedback from clinicians has
been positive. “Our customers are
very satisfied with our products,
and we have received great feedback and very positive reviews. We
put our customers at the centre because we believe that having access
to high-quality products at compet
itive prices leads to better endo
dontic treatments and better care
for the patients,” Dort said.

directly to clinicians without distributors. “Our sales model yields
many advantages for customers,”
Dort explained. “The main advantage of ordering directly is the
competitive prices, as there is one
fewer channel that keeps a margin
of the sales price. Another advantage is the speed with which we
react to the needs of our customers.
We can directly connect with them.
And that is not all—we also offer
free shipping on all orders!”

Made in France and conforming to strict EU controls and standards for medical devices, the company’s instruments aim to ensure
the highest quality, consistency
and safety. They are designed to
be an alternative to leading reciprocating and gold taper and rotary
instruments, offering designs that
improve cutting efficiency and increase safety in order to provide
the ideal flexibility required for
perfect root canal therapy. Dort

explained: “At DirectEndodontics,
we focus on our customers. Our
systems do not require a change of
clinical techniques or a change of
motors. We want our customers to
continue to use the techniques that
they feel comfortable using.”
Dort explained that one product that is popular with clinicians
is Direct-R Gold. “This is a reci
procating file that we sell at a
very competitive price for a very

DirectEndodontics was founded
by endodontist Dr Charles J. Goodis,
whose background in mechanical
engineering helped him to found
EdgeEndo in the US in 2013. After
just ten years of company history,
EdgeEndo has become one of the
largest endodontic suppliers in the
US, serving endodontists and general dentists across the country.
Dr Goodis explained in company
information that his goal in founding DirectEndodontics was to bring
high-quality European-made endodontic instruments directly to
clinicians at a lower cost. “I want
DirectEndodontics to be a modern,
fresh, digital, millennial company
working with you, the modern
dentist,” he said.
More information can be found
at www.directendo.com.

[14] =>

EVENTS

14

Dental Tribune United Kingdom Edition | 1/2024

Embracing innovation
© Matej Kastelic/Shutterstock.com

Highlights from the 2023 Digital Dentistry Conference and Exhibition.

By Dr Ali Nankali, UK
The 3rd Digital Dentistry Conference
and Exhibition, organised by UKDental
Courses (UKDC), an online education
platform that offers continuing profes
sional development opportunities to
dentists worldwide, recently convened
in London. Held at Queen Mary Univer
sity of London (QMUL) in the Garrod
Building, the landmark event provided
a unique platform for dental profes
sionals to explore the evolving land
scape of digital dentistry.
The 2023 Digital Dentistry Con
ference and Exhibition, a cornerstone
event for UKDentalCourses, opened a
new chapter in the digital transformation

of dental care. On 10 November 2023,
the event welcomed an eclectic mix
of attendees, including ambitious
s tudents, experienced clinicians and
innovators in the dental field. The
Garrod Building, a venue steeped in
history, offered the perfect setting
for a day of engaging discussions and
groundbreaking presentations.
This year’s conference was char
acterised by its enhanced interactivity
and more inclusive atmosphere, at
tracting a larger and more diverse
group of professionals, both in
person and online. Spearheaded by
a dedicated team of Queen Mary
University dental students, who were
led by the UKDC representative at

QMUL Hamdan Baker in collaboration
with the UKDC group team leader
Karmen Lam, the event fostered a
unique learning environment.
The conference sought to broaden
the understanding of digital dentistry,
moving beyond its conventional asso
ciation with advanced systems. It
highlighted extensive applications of
digital technology in dentistry, includ
ing in integrated electronic records
and advanced digital methodologies.
Dr Ali Nankali’s opening presen
tation, titled “AI: The next frontier in
dental care”, described how artificial
intelligence is reshaping dental care
and set a thought-provoking tone for

the event. Among the highlights to
follow were Cathy Padmore’s session
on tissue regeneration in oral surgery
using plasma rich in growth factors,
Don Babs’s insights on permanent
restorations and Dr Preeti Jauhar’s
critical overview of digital orthodontic
technologies.

The event underscored the trans
formative impact of digital dentistry on
healthcare services. With a blend of clinical
insights, technological advancements and
hands-on demonstrations, it highlighted
the importance of integrating digital tech
nologies into dental practices for improved
patient care and greater efficiency.

The conference was not only an
academic endeavour but also a
holistic experience that combined

knowledge sharing with practical
application. It provided a comprehen
sive overview of the digital dentistry
landscape, offering insights into scan
ning, design and the practical applica
tions of digital technology in various
dental specialties.

The 2023 Digital Dentistry Conference
marked a significant milestone in the
journey of digital transformation within
the dental industry. It was a testament to
the growing importance of technology in
enhancing dental care and to the con
tinued evolution of the field. As the dental
community looks forward to the future,
such events play a crucial role in shaping
a technology-driven, efficient and patient-
focused approach to dental care.

The exhibition hall was a focal
point for the conference, featuring
numerous organisations showcasing
their latest technologies and
ser v ices.    Prominent
exhibitors    included
Awesome   Tech 
nology, BioMin
and BTI Biotech
nology Institute,
each bringing
their unique
contribution
to digital den
tistr y.    Other
notable partici
p a n t s     in c l u d e d
Haleon,    ProL ab3D
and Quality Endodontic
Distributors. These companies offered
attendees a comprehensive view
of the current and future state of
dental technology.

Dr Ali Nankali
is a clinical senior lec
turer at Barts and the
London School of
Medicine and
Dentistry at
Queen Mary
University of
London and
the president
of UKDental
Courses, an
online educa
tion platform
that offers continu
ing professional devel
opment opportunities to
dentists worldwide. More in
formation can be found at
https://www.ukdentalcourses.com.

World Endodontic Congress 2024
to take place in autumn
This year’s IFEA world congress will be held in Glasgow.
© KenSoftTH/Shutterstock.com

 pportunity to host this prestigious con
o
gress and aims to attract endodontists,
other dental specialists, general dental
practitioners and students from Europe
and around the world.” He continued:
“In delivering a contemporary programme
we aim to leave a legacy of endodontic
advancement going forwards.”

The International Federation of
Endodontic Associations’ 2024 World
Endodontic Congress will take place
in Glasgow from 11 to 14 September
at one of the UK’s largest integrated
meeting spaces, the Scottish Event
Campus. The congress is being organised
by the British Endodontic Society (BES),

and it expects 3,000 attendees. The
event, which is held biennially and is
marking its 14th anniversary this year,
encourages endodontic clinicians to
meet and discuss progress in the
field and presents an opportunity
for collaboration to find solutions and
inspire development.

Expert speakers from around
the world, including Dr Daniel Černý,
Prof. Elisabetta Cotti, Dr Adham
Abdel Azim, Dr Phil Tomson and
Prof. Paul Lambrechts, will present on
cutting-edge endodontic techniques.
The programme will also include pre-
congress workshops on topics such

as endodontic microsurgery, orofacial
pain and minimally invasive and pred
icable removal of broken files.
The 2024 Congress Chair Dr William
McLean, who is professor of endodon
tics at the University of Glasgow, said:
“The [BES] is very excited to have the

The organisers have also arranged
an engaging social programme for
the congress days. Attendees will be
greeted with a welcome reception at the
congress venue on Wednesday evening.
On Thursday night, a dinner featuring
traditional Scottish dancing—a ceilidh—
will take place at Merchant Square,
Glasgow’s historic dining and nightlife
hub. A formal dinner is scheduled for
Friday evening at the Kelvingrove Art
Gallery and Museum. For golf enthusiasts,
there is an opportunity to sign up for
pre-congress golf tours.
More information on the congress
and registration can be found at
ifea2024glasgow.com.

[15] =>

EVENTS

15

Dental Tribune United Kingdom Edition | 1/2024

Largest gathering of orthodontists in the UK
BOC 2024 set to take place in Birmingham in October.

This year, BOC promises an
 nriching experience with a pro
e
gramme meticulously designed to
cater to a broad spectrum of inter
ests within the orthodontic field.
Participants can look forward to an
amalgamation of scientific sessions
and practical workshops, each aimed
at enhancing professional knowledge
and skills. The inclusion of a com
prehensive exhibition alongside the
conference offers a unique platform
for attendees to interact with leading
suppliers, explore groundbreaking
innovations, and connect with industry
pioneers.
A notable addition to this year’s
conference is the Trade Theatre,
s trategically situated within the


but also opens doors for subse
quent client dinners. The festivities
culminate on Friday night with a
grand party, inviting delegates and
sponsors alike to mingle in a relaxed
atmosphere.

© D K Grove/Shutterstock.com

The British Orthodontic Conference
(BOC) 2024, scheduled to unfold in
at the International Convention
Centre in Birmingham from the
18 to the 19 October, stands as a
beacon for orthodontic profession
als across the UK. Renowned as the
largest annual assembly of ortho
dontists in the nation, and host to
the most extensive orthodontic
trade exhibition in the UK, BOC 2024
is a pivotal event in the orthodontic
community.

 xhibition hall. This innovative space
e
is set to host presentations during
conference breaks and trade drinks
sessions, ensuring that attendees
don’t miss out on the main programme.
Exhibitors have the opportunity to

purchase slots on Thursday and Friday,
providing a spotlight to showcase
their products and services.
Social engagements are a corner
stone of BOC 2024. The schedule

includes a welcome reception and
a gala dinner, with special arrange
ments for a drinks reception around
the exhibition stands on Thursday
evening. This social gathering not
only allows for informal interactions

Dr Guy Deeming, chair of the
BOC committee, highlights the con
ference’s significance in advancing
orthodontic practice. He noted:
“BOC 2024 will feature a world-class
lineup of speakers and a packed
social programme. We also continue
to offer a virtual conference com
ponent, which has been exceed
ingly popular in recent years,
allowing us to engage an even

wider audience of orthodontic pro
fessionals.”
BOC 2024 stands out as the UK’s
only conference solely dedicated to
the field of orthodontics. Over the
past decade, it has attracted more
than 15,000 visitors, solidifying its
position as the premier event for
those interested in orthodontics
in the UK. The event is being
organized by the British Orthodontic
 ociety.
S
More information can be found
at boc2024.co.uk.
AD

[16] =>

Register at

www.dds.berlin

Digital
Dentistry
Show

In collaboration with
Digital
Dentistry
Society

OF DENTISTRY

OF DENTISTRY
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E

DIGITAL
DENTISTRY
SHOW

D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E

28 & 29 JUNE 2024

) [page_count] => 16 [pdf_ping_data] => Array ( [page_count] => 16 [format] => PDF [width] => 846 [height] => 1187 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT UK & Ireland No. 1, 2024

[toc] => Array ( [0] => Array ( [title] => Tooth wear and bruxism: Dentistry’s hidden struggle—Insights into managing an overlooked condition by Dr Paul Tipton, UK [page] => 1 ) [1] => Array ( [title] => Steven Bartlett announced as headline speaker at this year’s British Dental Conference & Dentistry Show [page] => 1 ) [2] => Array ( [title] => UK NEWS: Delivering health screening in dental practice; Team harmony as a key factor for the mental well-being of dental professionals; UK researchers develop effective new xerostomia solution; Benefits of water fluoridation may have peaked in rich countries [page] => 4 ) [3] => Array ( [title] => INTERNATIONAL NEWS: European Parliament bans dental amalgam; SmileDirectClub leaves patients in the lurch; [page] => 6 ) [4] => Array ( [title] => How to handle complex endodontic cases: An interview with ROOTS SUMMIT speaker Dr Ruth Pérez-Alfayate [page] => 7 ) [5] => Array ( [title] => Laser-assisted protocol for the treatment of peri-implantitis: A long-term retrospective case series by Drs Gary M. Schwartz, David M. Harris & Gregori M. Kurtzman, US [page] => 10 ) [6] => Array ( [title] => INDUSTRY: Keeping dental staff healthy during the flu season; DirectEndodontics offers high-quality instruments for forward-thinking dentists [page] => 13 ) [7] => Array ( [title] => EVENTS: Highlights from the 2023 Digital Dentistry Conference and Exhibition; World Endodontic Congress 2024 to take place in autumn; British Orthodontic Conference 2024 set to take place in Birmingham in October [page] => 14 ) ) [toc_html] =>

Table of contents

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