DT UK 1310

Dentistry minister loses seat in General Election / News / News & Opinions / What keeps your patients coming back for more? / Touting your wares / Implant Tribune / Learning Curve / Protecting the profession / Industry News: BDA Show / Industry News: Implants / Events / Classified

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Table of contents

May 17-23, 2010

PUBLISHED IN LONDON
News in Brief
National Smile Month
National Smile Month was
launched in the House of Parliament on 13 May. Organised
by the British Dental Health
Foundation, this year’s National Smile Month tagline of
Teeth4Life aims to highlight
the importance of looking after your teeth and maintaining them for life. The official
launch was hosted by Parliamentary sponsor Sir Paul Beresford MP. The campaign itself runs between May 16 and
June 16 and encourages people of all ages to get involved
and talk about their teeth, in
the hope of being able to improve general standards of
dental health. Chief executive
Dr Nigel Carter said: “Getting
people to talk about their teeth
and dental habits is vital in
our goal of improving the state
of oral health in this country.
We have had a tremendous
response to the campaign, particularly in the last couple of
years, but we must work harder to ensure this year’s National Smile Month can build on
that success.”
Care Quality Commission
From April 2011, all dental
practices in England will have
to be registered with the Care
Quality Commission (CQC).
This represents a significant
change for private practices as
it will be the first time that they
will be formally regulated. The
CQC has stated that the aim of
the new registration system is
to make sure that people can
expect services to meet essential standards of quality and
safety that respect their dignity
and protect their rights.
Professor Nairn Wilson
Professor Nairn Wilson has
been appointed leader of the
Dental Clinical Academic
Group. Professor Wilson is
currently the dean and head
of the King’s College London
Dental Institute at Guy’s and
St Thomas’ and King’s College Hospitals, and deputy vice
principal (Health) at King’s
College London. King’s Health
Partners’ executive director,
Professor Robert Lechler, said:
“I am delighted that we have
made further appointments to
the positions of clinical academic group leader.”

News

Implant Tribune

Feature

Class of ‘59

Do you recognise this photo? If
so turn to page 6 now!

Keep them coming back
Seema Sharma gives some tips
to keep patients coming back
for more

page 6

VOL. 4 NO. 13

page 9

Implant Tribune

Algorithm

Nobel Active

Dr Tidu Mankoo presents an
interdisciplinary case study
using Nobel Active implants

Kenneth Serota looks at the
Endodontic Implant Algorithm

pages 12-15

page 18-22

Dentistry minister loses
seat in General Election
Ministerial Health team decimated by lost seats, lack of clear
outcome leaves both dentistry and country in limbo
The Conservatives needed
326 seats to win outright and now
the country faces the prospect of a
hung parliament.

Any takers? Cameron, Brown & Clegg in leadership battle

he minister in charge of
NHS dentistry, Ann Keen,
has lost her seat in the
General Election.
Dubbed Mrs Expenses for
her role in the MP expenses
scandal, Mrs Keen lost her
seat of Brentford and Isleworth to
the Conservatives.
She and her husband Alan
Keen, were investigated by the
parliamentary commissioner for
standards earlier this year, after
they combined second homes
allowances to buy an apartment in a development at Waterloo
in London.
The rest of the Labour health team also lost their seats, with
the exception of Secretary of State
Andy Burnham.

Research prize awarded
Dr Maria Retzepi, lecturer in
Periodontology of UCL Eastman Dental Institute was
awarded the André Schroeder
Research Prize at the World
Symposium of the International Team for Implantology (ITI)
in Geneva, Switzerland. Dr
Retzepi was commended for
her work on ‘The Effect of Experimental Diabetes on Guided
Bone Regeneration’.

The Conservative health team
all managed to win their seats,
which means Mike Penning, the
shadow minister currently in
charge of dentistry, could become
the new dentistry minister.
The Lib Dem health spokesman, Norman Lamb, also won
his seat of Norfolk North with
27,554 votes.

www.dental-tribune.co.uk

Sir Paul Beresford, a practising dentist who runs a private

surgery in London, managed to
keep his seat as Conservative
MP for Mole Valley in Surrey and
even increased his share of the
vote by 2.8 per cent.
He picked up 31,263 votes
out of the 54,324 total, a 57.5
per cent share and more than
double the number gained by his
nearest rival, Liberal Democrat
Alice Humphreys.
Sir Paul said he was ‘pleased
and relieved’ at the result. He
added: “It shows the support that
I have because of the time I have
spent working in Mole Valley.”
Labour’s Anas Sarwar comfortably beat the SNP’s (Scottish Nationalist Party) candidate
by almost 10,000 votes, in Glasgow Central. Mr Sarwar polled
15,908 votes, while Osama
Saeed, the SNP candidate, polled
5,357. The 27-year-old worked
for more than four years as an
NHS general practitioner in
Paisley before stepping down a
few months ago to concentrate
on campaigning.
The General Election with its
uncertain outcome has left the
country in turmoil with Conservative winning 306 seats, Labour
258 and Liberal Democrats 57.

The Dental Practitioners Association has branded the outcome of the election as an ‘unsatisfactory mess’. Derek Watson,
its chief executive claimed that
dentistry has been plunged into
uncertainty and called it a ‘very
unsatisfactory mess’.

Another poll carried out
by the Foundation before the
election found that Conservative leader David Cameron was
the leader with the best smile,
with 38 per cent of people preferring his smile to that of his election rivals.
Labour’s Gordon Brown
came in second with 33 per cent
while Liberal Democrat leader
Nick Clegg came in third with 29
per cent.

The British Dental Association refused to comment on the
result as it is apolitical.

The results of the survey seem to
be borne out by the election results.

The British Dental Health
Foundation (BDHF) claimed that
the race to become prime minister was very dependent on a good
smile. A national survey from the
BDHF found that almost 70 per
cent of us think that people who
smile have a greater chance of being successful.

As Dental Tribune went to
press, discussions were still being held between the Tories and
the Lib Dems over a power-sharing deal. The Lib Dem team has
also been meeting with senior
Labour officials to see what a Lib
Dem/Labour pact would mean
for the country. DT

[2] =>

2 News

If so don’t hesitate to write to:
The Editor,
Dental Tribune UK Ltd,
4th Floor, Treasure House,
19-21 Hatton Garden,
London, EC1 8BA
Or email:
lisa@dentaltribuneuk.com

Editorial comment
Lives in limbo

‘

Well,
the
good
news is I’m back
from a fantastic and
very humbling experience in Tanzania
with Bridge2Aid. The
bad news is, like the country
at present, I feel a bit in limbo!

The team that went to Bukumbi – Andrew, Andy, Jackie,
Cornelius, Julie, Nicola (all
from Schülke UK), Len (Henry Schein Minerva), Margaret
(NHS Manchester), Mark, Jo
(practice owners) and myself –
spent a very intense and emo-

tional two weeks renovating the
community block and turning
it from a dingy unsafe building to a clean, vibrant and usable space for all members of
the community to enjoy. It has
been hard to come back to the
UK and to a life of comparative
privilege and leave behind a
community spirit that is strong
in the face of poverty. All we experienced in Tanzania will live
long with us, and hopefully over
the next few issues I will be able

May 17-23, 2010

to share some of this experience
with you.
Big thanks to everyone who
supported me, especially Smileon, Practice Plan, Denplan,
friends and family and an extra
thank you to Mr Robert Naysmith
for his support and kind words.
It isn’t too late to support B2A’s
work, go to www.justgiving.
com/bukumbibound.
As I slowly come round to
all things dental, I hope you’re
geared up for National Smile
Month, which launched last
week and runs to June 16. Please
get in touch with your stories
and events you have run in your
practices – I’d love to hear about
them. Email me at Lisa@dentaltribuneuk.com.

‘

Do you have an opinion or something to say on any Dental Tribune
UK article? Or would you like to
write your own opinion for our
guest comment page?

United Kingdom Edition

And don’t forget to come over
to Stand A12 at the BDA this
week, say hello and
celebrate with Smileon and Dental Tribune
as Smile-on turns 10
years old. DT

Dentist
fraud

A

dentist who defrauded
a primary care trust of
£85,000, has been sentenced to two years in jail.

Daljit Singh Jabbal, of Liversedge in West Yorkshire,
pleaded guilty to defrauding
Bradford and Airedale Primary
Care Trust (APCT) of £85,000 and
paid back the full amount before
he was sentenced.
The 56-year-old took sick
leave at various times between
November 2006 and December
2007 and was still paid his full
contract allowance by the PCT
After discovering in 2008 that
the NHS Dental Services Division
were to carry out a routine check
of his Units of Dental Activity, he
confided to the chairman of his
Local Dental Committee that he
had submitted false UDA claims.
In summing up the Judge told
Jabbal: “It is sad that you have
let yourself down so badly, but I
consider the offending so serious,
and over a two-and-a-half-year
period, that I would be failing in
my public duty not to give you an
immediate custodial sentence.”
The NHS Counter Fraud Service (NHS CFS) was established
to tackle fraud and corruption
throughout the NHS and Department of Health.
In 2008-2009, the NHS CFS
successfully prosecuted 69 criminal cases with a 96 per cent success rate. DT

[3] =>

News 3

United Kingdom Edition May 17-23, 2010

NHS in Northern Ireland to charge for orthodontic treatment

he NHS in Northern Ireland is to start charging
for orthodontic treatment,
echoing the system currently in
place in England and Wales.
The move has been criticised
by Alex Easton (Democratic Unionist Party), a member of the
Stormont Health Committee, as a
‘tax on children’s smiles’.

undergo the necessary training
and patients can become familiar with the changes.
The BDA is also concerned
that dentists will now be put in
a difficult position as it will be
left to them to explain to patients
who are already in the system and
waiting for orthodontic treatment,
that the terms have changed.

A spokesman for the BDA’s
NI DPC said: “All parties to this
change, whether referring dentists, treating dentists, dental practices and patients and parents
require time to plan accordingly.
The proposed timescale of introducing the change in May 2010
does not enable the process to be
managed at practices and planned
for by parents. NI DPC would like

to see this move delayed to allow
time for proper planning on the
part of Department of Health, Social Services and Public Safety to
understand what the savings are
and how that saving can be reinvested in dental services for the
people of Northern Ireland.”

in Northern Ireland between April
2009 and March 2010, the NHS
fitted 19,405 orthodontic appliances, including fixed or removable appliances. DT

Figures from the Business
Services Organisation reveal that

Under the new guidelines,
nearly all cases will have to be
paid for privately as everyone
apart from the most severe cases
will have to pay for their care.

Brushing and flossing are
vital, but don’t always get the
attention they deserve.

Many children will be prevented from having orthodontic
treatment as their parents won’t
be able to afford treatment that
can cost more than £2,000, according to Mr Easton.
The new guidelines which
look set to become reality within
the next two months, will save
the NHS in Northern Ireland millions of pounds.
Under the guidelines, only
those with a reported Index of
Orthodontic Treatment Need
(IOTN) rating of 3.6 or above will
be paid for by the NHS in Northern Ireland.
The British Dental Association’s Northern Ireland Dental
Practice Committee (NI DPC)
called for the savings made as a
result of the change to be ‘reinvested in dental services’.
It also wants the timescale
of the change to be extended so
dentists and orthodontists can

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

Dental Tribune UK Ltd makes every
effort to report clinical information and
manufacturer’s product news accurately,
but cannot assume responsibility for
the validity of product claims, or for
typographical errors. The publishers also
do not assume responsibility for product
names or claims, or statements made by
advertisers. Opinions expressed by authors
are their own and may not reflect those of
Dental Tribune International.
Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Features Editor
Ellie Pratt
Ellie@dentaltribuneuk.com

Features Editor

Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.
com

If oral hygiene best practice
isn’t always possible, why
not recommend adding
Listerine? It kills bacteria
deep in the plaquebiofilm.1 And, added to
brushing and flossing,
provides up to 52%
extra plaque reduction.2

Sales Executive
Sam Volk
Tel: 020 7400 8964
Sam@dentaltribuneuk.com
Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com
Design & Production
Keem Chung
Keem@dentaltribuneuk.com

For a deeper clean
recommend Listerine

Dr Liviu Steier
Liviu Steier [lsteier@
gmail.com]

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

05414

02782_ocdlis_DentalTribune_man_WP_fa1.indd 1

References: 1. Data on file, McNeil-PPC Inc. 2. Sharma NC et al. J Am Dent Assoc 2004; 135: 496-504.

5/4/10 11:24:26 AM

[4] =>

Hatchard Medical Ltd, West Lancs,
Investment Centre, Skelmersdale WN8 9TG
Tel: 0844 873 1262 Email: sales@hatchardmedical.co.uk

LED Operative light
(Hands free operation)

Based in the NorthWest of England,
Hatchard Medical have been
specialists in dental and x-ray
equipment for over 25 years.

Nurses control

Agents for Eurodent, Metasys, Loran
Ewoo, Tridac, Satelec, Bien Air, HPA
and more. For the latest surgery
technology come along to stand
B86 to see the Eurodent Absolute,
complete with wireless Bluefoot, LED
Vision and Wayfinder. Our specialist 3D
planning software ensures the surgery
meets your every need.

Electric Mirco motor

Email: sales@hatchardmedical.co.uk
or Tel: 0844 873 1262

Modular d

We have a range of cabinetry including
Decontamination rooms. In both metal
and wood carcasses and a range of
work surfaces including Corian, Starion,
Glass and Laminate. Mobile cabinets
with a work surface, allowing freedom
to move your instruments, at the same
time offering extra work surfaces where
you need them.

Wireless foot control

Compressors, suction pumps,
amalgam separators and an
extensive range of cleaning
products for all your surgery needs.

[5] =>

Co
o
at n m
th Sta e a
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AC d d
C B8 see
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rp 10
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r & fibre optics as standard

design

If your suction is suffering from nasty whiffs, we have a range of easy to use suction cleaners, including a brush system suitable for spittoons with spittoon valves.
The modular design allows you to have the instruments you want, in the positions
that suit you and the way you work. If you add to or change the layout it can take
just a few minutes.
Hanging or Balanced arm hose delivery, Induction motor module with an option of
a saline pump, Camera module, electro-surgical module, Scaler module, Light cure
module, to mention just a few.
The touch free LED operating light stays cool and the ten LED’s last much longer
than Halogen bulbs, so no need to scrabble to find a spare bulb.
The Wireless foot control option allows you to control the chair instruments and
even the * headrest, without having to touch the chair with your hands. (*Only on
electric headrest option)
If you’re fed up with your
“Bleeping Aspiration system!”
Talk to us about the New
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is coupled to the ECO 2
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No Bells, No Whistles, and
No Bleeping - ‘just suction!’
Metasys also offer a range of
oil free compressors with or
without dryers and with an
option of quiet cabinets
if needed.

[6] =>

6 News

United Kingdom Edition May 17-23, 2010

Conference success
for CIC 2010
T

he Clinical Innovations
conference, held in conjunction with Smile-on,
the AOG and The Dental Directory, celebrated its seventh year
with a hugely successful event.
The Conference, held May 7-8
at the Royal College of Physicians
in London, attracted more than
300 people, with some sessions
seeing delegates standing to hear
about the latest developments
in the fields of whitening, medi-

cal emergencies, aesthetics and
many more.

The event was also celebrated
in style with a glitzy charity ball
at the London Marriot Hotel in
Grosvenor Square.
A spokesperson for the conference said: “This year’s Clinical Innovations Conference was
extremely well received. Both
delegate and speaker feedback
has been very positive, with some

delegates electing to stand to see
the latest innovations in aesthetic
and restorative techniques.
“A big thank you to all of our
sponsors, speakers and delegates
for making Clinical Innovations
Conference 2010 a great success!”
Look out in the next issue
of Dental Tribune for all the reaction news and reviews from
Clinical Innovations Conference
2010. DT

Class of 1959 WRAF hygienists. Back row (L-R): Edna Birch, name unknown, Brenda
O’Neill, Jan Corless, Sylvia McKie. Middle Row (L-R): Madge Oldham, Vera Hatzfeld,
Alison Halford, Fiona Fleming, Lucy Edwards. Front Row (L-R): Brenda Willis, name
unknown, name unknown, name unknown, Marian Magdaburg

1959 reunion call

A

re you or is someone
you know in this photo?
Brenda Eagles, (nee Willis) WRAF dental hygienist and
a member of this graduation
group from 1959, is trying to organise a reunion and is looking
to find members of the class and
their families.
Brenda commented: “We are

A full house listens to Julian Webber at Clinical Innovations Conference (CIC)

hoping to organise a reunion
event – even 70+ year old ladies
have not forgotten how to party!
“We’d love to hear from or
about any of the graduates or their
families. Please get in touch!”
To contact Brenda, telephone
01453 882216 or e-mail john@
johneagles.wanadoo.co.uk. DT

Dental students spread good oral healthcare message

D

ental students from Peninsula Dental School
have been spreading the
message of good oral healthcare
to children, through quizzes and
art competitions.

providing them with free books,
toothbrushes and toothpaste.

The students have been
working with children aged
between five and nine at the
Pembroke Youth Service at Mount Wise Neighbourhood Centre
in Plymouth.

Mandi Leaves, manager of
the Pembroke Youth Service,
said: “The dental students have
been taking the kids through
general well-being for teeth and
it has been great.”

The students have been giving advice on how to keep teeth
healthy, showing the children
how to look after their teeth, and

Bijal Sisodia, Year Two student and part of the team working with the children at Pembroke Youth Service, added: “We

They have done quizzes
with the children and held art
competitions.

have really enjoyed working
with the children and making a
difference to their dental health.
Getting the message out to the
community is an important part
of our training, so we are grateful
to Mandi and her colleagues for
the opportunity.”

in which we operate. I cannot
stress enough the importance
of this interaction to the development of our students and we
are hugely indebted to organisations such as Pembroke Youth
Service that allow us to work
with them.”

Dr Gill Jones, director of
Community Based Dentistry at
the Peninsula Dental School,
commented:
“Our
students
spend a lot of time on Special
Study Units in the community.
It is great experience for them
and also allows us to give something back to the communities

Dental students at Peninsula Dental School are involved
in a diverse range of community based projects such as a
homeless refuge, a project that
supports vulnerable teenage
parents, community anchor
organisations and the Public
Health Development Unit.

They have been working
on reducing mouth trauma in
partnership with Plymouth
Albion Rugby Club students
and have devised a project
which will result in players acting as ‘ambassadors’
to encourage young people to
wear mouth guards during
contact sports.
They have also carried out
a Fluoride Varnish Programme, working with a Children’s Centre where more than
30 children received treatment
with help, advice and support
for families. DT

[7] =>

News & Opinions 7

United Kingdom Edition May 17-23, 2010

Dentist admits trying to strangle wife

dentist has admitted trying to strangle his wife on
New Year’s Eve.

Dr Peter Fleming has admitted punching and trying to strangle his wife at their home in Wirral on New Year’s Eve.
Fleming, who runs the Castle Dental Care surgery in Birkenhead, appeared at Liverpool
Crown Court accompanied by
two mental health nurses.
The 39-year-old had been
charged with causing grievous

Software
developer
wins award

bodily harm with intent and
grievous bodily harm.
Fleming denied the two
charges and pleaded guilty to
the less serious alternative count
of assault occasioning actual
bodily harm.
The prosecution accepted the
plea, saying it matched the seri-

ousness of his wife’s injuries as
she had bruises and a cut
which needed stitches after the attack.
Fleming
was
initially remanded
in Walton prison,
but has been transferred to Rainhill’s
Scott Clinic.

to be completed. He remanded
Fleming to the hospital to await
sentencing on May 21.

A psychiatric report confirmed that he is fit to go on trial.
The hospital is to carry out
a full mental health report on
Fleming and the case
has been adjourned
until 21 May.
Judge
Bryn
Holloway
agreed to adjourn sentencing
for a full mental health report

Fleming graduated from
King’s College London in 1995.
He is a member of the Faculty of
Dental Surgery at the Royal College of Surgeons of England. He
is actively involved in postgraduate education, holds a teaching
certificate and has been involved
in the training of a number of
newly qualified dentists. DT

Dental Webinars
Be Wherever You Want
Let the Seminar Come to You...

dental software developer has won the Queen’s
Award for Enterprise in
the Innovation category for development of its dental restoration software.
The award was given to Delcam in recognition of the continuous development of its software
for the design and manufacture
of dental restorations.

Managing director, Clive Martell said: “Having identified the
need in the dental sector for efficient, easy-to-use CADCAM software, the response to our DentMILL and DentCAD products has
been extremely positive and this
award will further boost its reputation as the market-leading offering in the dental industry.”
Delcam’s involvement in the
dental area began several years
ago when companies in the industry started to use the company’s
PowerMILL CAM system for the
machining of restorations.

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The software gave immediate
benefits, both in the time in which
machining data could be generated, and in the speed and quality
of the machining operations.
However, this early experience
showed that it was difficult for
dental technicians with no previous experience in CADCAM to use
the system.
A dedicated piece of software
was needed for the dental industry and so Delcam developed
DentMILL, a highly-automated
knowledge-based program specifically designed to generate toolpaths to machine restorations.
Following early success with
DentMILL, Delcam began the introduction of the partner design
program, DentCAD. DT

To find out more go to
www.dentalwebinars.co.uk
or call
020 7400 8989
or email
info@smile-on.com

[8] =>

8 News & Opinions

United Kingdom Edition May 17-23, 2010

GDPUK round-up

The GDPUK online community this month likens the aviation
industry to dentistry. Tony Jacobs explains

ne of the most interesting points raised on the
forum at the time the
first lot of Icelandic volcanic
ash was hitting the headlines,
was made as almost a throwaway comment.

Forum members had been discussing the initial prolonged nofly period, with tales of colleagues
from the dental team stranded
around the globe, and the effect it
was having on the flying industry
by having air traffic controllers sup-

The comparison was made
with the pilot of the BA777 at
Heathrow who saved the lives of
passengers and people of Hounslow by lowering flaps in an unorthodox method, and dropping
the plane onto the grass verge of

ervising. It was concluded and agreed that NATS, in light of the situation, was making sure it was covered and that its jobs were safe in
the name of theoretical problems,
while test flights seemed to be
showing no effect on jet engines.

PracticeWorks
KODAK R4 Practice Management Software
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Heathrow. The moral drawn by
Chas Lister was: “If you let an
external agency make draconian
rules and let that agency employ
non-dentists to enforce them,
don’t complain when they act in
THEIR interest, not yours.”
For the airline industry, volcanic dust threatens life. For
dentistry, it’s HTM-0105. Our
profession will not be grounded
by this document though, but it
will be hamstrung by an unscientific political document, written at the Department of Health
by people who are covering theoretical possibilities. The cost of
implementing the changes along
with ongoing costs will be enormous, yet the profession cannot
regain control.
Volcanic ash and infection control aside, there have been so-me
more gripes from the forum. We
have accepted the fact there is “core CPD”, subjects we must visit
during each cycle of CPD. The
BDA makes a meal of this requirement as part of its Good Practice Scheme. However, in practice, this means we have to listen
to the same information time after time, and perhaps ignore other more interesting parts of the
educational world, subjects that
are more practical, and more
everyday (although cross-infection, resuscitation and radiography are important in daily life).
The same theme arose from
this discussion – our profession
(without being prompted) has
allowed the hurdles to be set by
other people, and this is what occurs. But the GDC has covered
its corporate self, and the good
guys go and sit through the boring repetitive re-education.

Another breakthrough from PracticeWorks
PEARL is the new iPhone or Blackberry application for R4.

About the author

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PracticeWorks

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The General Election has
received coverage on GDPUK,
as on all other forms of social
networking. A poll of colleagues
shows an unsurprising tendency
towards the Tories, and the televised debates raised a frisson of
excitement. Perhaps when you
read this we will all have an idea
of how our lives will be shaped
over the next few years, or maybe a balanced Parliament with
a period of hammered compromise will be the outcome. Have a
great month… DT

Tony Jacobs, 52 is a
GDP in the suburbs of
Manchester, in practice with partner Steve
Lazarus at 406Dental (www.406dental.
com). He has had
roles in his LDC, local
BDA and with the annual conference
of LDCs, and is a local dental adviser
for Dental Protection. Nowadays, he
concentrates on GDPUK, the web
group for UK dentists to discuss their
profession online, www.gdpuk.com.
Tony founded this group in 1997 which
now has around 7,000 unique visitors
per month, who make 35,000 visits and
generate more than a million pages on
the site per month. Tony is sure GDPUK.com is the liveliest and most topical UK dental website.

[9] =>

United Kingdom Edition May 17-23, 2010

What keeps your
patients coming back
for more?
Seema Sharma offers some advice

Keep patients coming back to your practice by taking time to get to know them

e all have been suffering and seen our
neighbours suffering
from the effects of the economic downturn, but what keeps
your patients coming back to you
for more treatment?

Invest in communication
training for the whole team
Many dentists concentrate on
the high-production dentistry –
smile rejuvenation, full-mouth
rehabilitation, implants and sinus lifts and so on, but what
about when the money dries
up and the patients drop off
the radar?
I have found it is often the
simple things that keep your patients coming back for more.
These are sometimes the
things that we forget about with
the day-to-day chaos of running a practice, but these are the
things that will stick in your patient’s minds and make the difference to whether they return to
you or not; in fact it is customer
service and the smiles and personal touches you display, that
will keep your patients coming
back to you for more.
Keys tips for patient
satisfaction
Don’t keep your
patients waiting
We all hate to be kept waiting.
Queues, call waiting, automated answering services – I can’t
think of one person who relishes
any of the above. Patient surveys
show that no more than 10 minutes waiting time is acceptable.
No excuses. Learn to manage

your time effectively and book
realistic appointment times.
Take time to get to know
your patients
Greeting someone by name, even
though you have not met them
before, remembering where
they went on holiday or what
their children’s names are in
age order, are all ways in which
you can build rapport and get to
know your patient. If you show
your patient you care not just
about their teeth, but them too, it
will inevitably lead to them coming back to you for more.
Don’t cancel or chop
and change your patients’
appointments
We all hate being mucked
around, especially at the last
minute. If you have to change
an appointment, make sure you
stick by your own rules and allow enough notice and try to
avoid at all costs.
Roll out the red carpet every
time a patient visits you
Ever been to a salon or hotel
where they have something so
cool and thoughtful on tap and
complimentary that it blew you
away? It could be something as
simple as having cool, fresh water available in an iced jug on a
hot day, a warm hot towel available to freshen up after a long
treatment or an unexpected call
the following day just to check
how you’re doing after your root
canal treatment.
These are all examples of
going that extra mile to make
your patients comfortable and

making them feel wanted and
needed. Don’t underestimate
these small touches; they go a
long, long, way.
Don’t fine your patients for
non-attendance
In my experience, fining patients for non-attendance alienates patients – you can bet your
bottom dollar they will not return quickly! Instead, create
value for the treatment they are
about to receive.
Create value!
Once you have created value,
you should have no problems
collecting deposits to secure
their next appointment. It is a
darn sight easier to retain a deposit than collect a fee for something the patient has not had
done yet.
CQC Tip: Outcome 1 of a
long list of care quality outcomes
is that dental teams will have to
demonstrate how they respect
and involve the people who use
their services, ie patients! DT

About the author
Seema
Sharma
is the founder of
Dentabyte.co.uk,
which
provides
practice management and core CPD
courses for all dentists and practice
managers, in private or NHS practice.
She has also established a philanthropic charity, The Sharma Foundation.
For practice management and CQC
support, email info@dentabyte.co.uk
or visit Website: Dentabyte.co.uk
If you would like to know more about
her humanitarian efforts, email info@
seemasharma.co.uk.

Feature 9

[10] =>

See what you
are missing...

United Kingdom Edition May 17-23, 2010

Touting your wares

Carl Zeiss
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Sheila Scott, business consultant to dentists and
their teams, discusses the power and focus of
dental practice promotions

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How much are you spending
on promotions?
A significant number of practices are spending a lot of money
on marketing promotions at
the moment – particularly to
attract those interested in cosmetic treatments. A quick web
search in your region for whitening, invisible braces, veneers
and other cosmetic treatments
including facial aesthetics, will
throw up countless practices
chasing the cosmetic holy grail
– the new patient who needs a
makeover. And there are offers
galore: benefits and discounts
on advertisements, articles, flyers, web offers, special days and
open sessions.
Sustainable marketing
expenditure
Now, the practices that are
spending on marketing are undoubtedly building profile and
attracting new patients. But I
do wonder about the long-term
benefit of this expenditure when
it is totally concerned with cosmetic opportunities. What if a
number of these new cosmetic
patients accepted a course

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of
treatment
and then disappear? If
you’re not also working hard
to encourage them to become
regular attendees, that do attend
regularly, you could be finding
yourself spending on marketing
just to keep next month’s figures
afloat and no more.
Promotion can become a
vicious cycle that makes existing patients a little uneasy as
their practice’s focus begins to
change from traditional dental
care to a more glitzy, glamorous
emphasis. And from a practice’s
perspective, a reliance on high
margin cosmetic work to stay
afloat is a dangerous strategy,
especially if the big-ticket opportunities begin to dry up as
seems to be the case recently.
Building stability
In my opinion, it is far better to
build your practice on a stable
platform that focuses on what’s
really important to patients –
for example, dental health. This
keeps existing patients coming
back regularly which inevitably
results in reduced costs for you,

‘It doesn’t take a huge amount of
in-practice organisation to put a dental
health approach, promotion or
campaign together.’
a wider audience to appeal to
and the ability to rejuvenate existing patients’ recommending
behaviour thus creating a pool
of additional patients.
Think for a moment about
a formerly reluctant patient
walking past your practice, or
browsing your website. If your
window or website is full of only
cosmetic offers and makeover
statements, how does that patient feel about walking in? Do
they see a practice dedicated to
‘looking after me’ dentistry, that
might give them a ‘clean bill
of health’ (what they are hoping for!). Or will they fear being ‘sold’ these treatments that
are advertised? Is your market
positioning keeping some
patients away?
A health focus
Why can’t we design
more promotions targeted at showing how the
practice helps patients
to achieve strong
and healthy
teeth
and
gums? Instead
of smile makeovers, can we provide
health assessments, risk
reduction plans or dental fitness profiles? Shouldn’t we
be telling the public about the
skills and habits they and their
children need to adopt to avoid
dental fillings for life? Can we
please let the public know that
the practice believes that dental
health is more important than
a makeover? And that if makeovers are requested, they will
only be provided once dental
health is secure?
It doesn’t take a huge
amount of in-practice organisation to put a dental health approach, promotion or campaign
together. And a dental health
campaign does far more for the
apparent trustworthiness of the
practice than another whitening
offer out of this context. However, you must be careful to be delivering just what you promise.
For most practices that means
re-examining the language and
explanations used in day-to-day
patient contact, and a change
in focus to the positive drive for
dental health.

It means encouraging every
single patient that attends, to
return to the practice exactly as
recommended – not two, three
or ten months after the recall
period stated or reminded. It
means very positive communications about why these return
visits are necessary.
It means encouraging the
vast majority of patients to attend their hygiene visits as recommended – not when they
feel they can find the time or
when they can afford them.
This means practices have to be
exceptional at explaining why
these visits are necessary and of
benefit to each patient.
Encouraging referral
If you’re already doing all of this,
can you please now think about
giving your patients some ‘free’
dental health advice to tell their
friends about, or to pass onto
other friends who might be interested? Can you please dedicate most of the space on your
website to telling patients how
you can help them to keep strong
and healthy, and help keep problems at bay?
And if you must produce
some promotions, can you think
of ways to prove your attention
to the most important things that
patients want from practices…
1. To trust their dentist and
2. To receive care and treatments that improve the health
of teeth and gums
Once you’ve set the scene as
a totally health-focused practice
worthy of the patients’ trust, you
should find that occasional promotions for cosmetic treatments,
promoted as an adjunct to the
health-based care you offer, attracts more new patients and
interest from existing patients
without causing that little bit
of unease in those who already
think you’re wonderful. DT

About the author
Sheila Scott has dedicated the last 20 years to
helping dentists and their
teams grow and prosper.
See her website www.
sheila-scott.co.uk for more details, or
contact her on 01343 862930.

[11] =>

Implant Tribune
Tribune_apr10:Precision

Implant Tribune

16/4/10

15:12

Page 1

Implant Tribune

Excellent Quality
Excellent Value
Active implant

Dr Tidu Mankoo presents an
interdisciplinary case

page 12-15

Screw vs cement

Prof Steier looks at the comparison
of using screw or cement retained
techniques

... Why compromise

Gordian knot

Kenneth Serota discusses the
Endodontic Implant Algorithm

page 16-17

page 18-22

A-Silicone Fast Set Putty

A light at the end of
the tunnel?
Professor Liviu Steier asks if there’s a future for bacteriafree dental devices such as implants

hy should a dentist be worried about bacterial contamination or even worse
bioflims? And by this, I don’t just mean
plaque. Let us have a look on the definition of “biofilm” by the University of
Montana under the chairmanship of Dr
David Costertone.
It says: ‘‘Biofilm forms when bacteria
adhere to surfaces in aqueous environments and begin to excrete a slimy, gluelike substance that can anchor them to
all kinds of material – such as metals,
plastics, soil particles, medical implant
materials, and tissue. A biofilm can be
formed by a single bacterial species, but
more often biofilms consist of many species of bacteria, as well as fungi, algae,
protozoa, debris and corrosion products.
Essentially, biofilm may form on any
surface exposed to bacteria and some
amount of water. Once anchored to a
surface, biofilm microorganisms carry
out a variety of detrimental or beneficial
reactions (by human standards), depending on the surrounding environmental
conditions.’’ (http://www.erc.montana.
edu/CBEssentials-SW/bf-basics-99/
bbasics-01.htm).
A dentist’s concern?
Now, why and how should this concern the dental practitioner? A prosthesis, an implant, or any device added to
the oral cavity could be surrounded by
biofilm once exposed to saliva. Virulence factors of bacteria surviving in
biofilm differ heavily from planctonic
ones. Infective processes can be induced, leading to as much as rejection
of the incorporated device. Researchers
at the Max Planck Institute in Mainz,
Germany, started to research developing a surface coating to reduce or even
prevent biofilm from forming on devic-

es, prosthesis and implants. Dr Renate
Förch, the spokeswoman of the research
group, has outlined the future achievements on polymertechnology and the
use of plasmatechnology (http://www.
mpip-mainz.mpg.de/www/pages/aktuelles/pressemitteilungen/?year=2
010#kap_72).Involved in this project,
are research institutes from Spain, the
UK, Switzerland and of course Germany, covered by a grant of the European
Community. The biological attachment
process of bacteria and the formation of
biofilm are its main focus.
Daily practice
We deal with monomers and polymers
in our daily practice. We use materials such as composites for restorations
or veneering and help turn monomers
into polymers. Polymers are chains of
monomers, which offer new and unique
properties. But do you remember what
plasma is? Brian Kross, chief engineer
at Jefferson Lab explains:

‘Plasma is the fourth state of
matter… there are three states of
matter; solid, liquid and gas, but
there are actually four. The fourth
is plasma. To put it very simply, a
plasma is an ionized gas, a gas into
which sufficient energy is provided
to free electrons from atoms or molecules and to allow both species,
ions and electrons, to coexist. The
funny thing about that is, that as far
as we know, plasmas are the most
common state of matter in the universe. They are even common here
on earth. A plasma is a gas that has
been energised to the point that some
of the electrons break free from, but
travel with, their nucleus. Gases can
become plasmas in several ways, but

all include pumping the gas
with energy. A spark in a gas
will create a plasma. A hot
gas passing through a big
spark will turn the gas stream
into a plasma that can be useful. Plasma torches like that
are used in industry to cut
metals. The biggest chunk of
plasma you will see is that
dear friend to all of us, the
sun. The sun’s enormous heat
rips electrons off the hydrogen and helium molecules
that make up the sun. Essentially, the sun, like most stars,
is a great big ball of plasma.’
(http://education.jlab.org/
qa/plasma_01.html)
Results are to be expected
within the next five years. ‘Many
patients will be benefit and have
fewer problems after surgery relating to implant infections und
healing delays,’ says Profesor
Katharina Landfester, director
at the Max-Planck-Institute for
Polymertechnology. DT

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About the author
Dr Liviu Steier (PhD)
is Spezialist fuer Prothetik (www.dgzmk.de) and
specialist in Eendodontics (GDC-UK). He is an
honorary clinical associate professor at Warwick
Medical School and course director of
the MSc in Endodontics (www.warwick.ac.uk/go/dentistry). He is a member of the Scientific Advisory Board for
the Journal of Endodontics (AAE) and
maintains a private referral practice
for endodontics, implantology, etc at
20 Wimpole Street, W1G 8GF London
(www.msdentistry.co.uk).

www.precisiondental.co.uk
Tel: 020 8236 0606 5 020 8236 0070
All trade marks acknowledged. Offers subject to availability not valid with any other offers, price
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Terms and conditions apply. E. & O.E.

[12] =>

12 Implant Tribune

United Kingdom Edition May 17-23, 2010

The Nobel Active implant
Dr Tidu Mankoo demonstrates the interdisciplinary restoration of six maxillary
anterior teeth and a single Nobel Active implant
Abstract
This case illustrates the use of the Nobel Active (Nobel Biocare) implant for restoration of a failed maxillary central incisor, as part of the
wider interdisciplinary restoration of the maxillary anterior teeth, in a 35-year-old female patient with a history of extensive treatment
including previous crowns, multiple endodontic treatments and post cores.
There are a number of key factors in achieving inconspicuous aesthetic integration of an implant restoration, particularly in the case
where a failed maxillary central incisor has led to considerable damage to the alveolar bone and compromised soft tissue volume.

6.0 x 5.7mm

THE BICON DESIGN is driven by simplicity. A cornerstone of
its simplicity is short implants. When the Bicon system was first
introduced in 1985, its 8.0mm length implants were considered
quite short—most other implants were at least 12–14mm and
sometimes 18–20mm long! Since then, the natural progression
of Bicon’s design philosophy has resulted in 5.0mm, 5.7mm, and

4.5 x 6.0mm

6.0mm short implants, all with proven clinical success.

5.0 x 6.0mm

3 Avoid the Inferior Alveolar Canal:

4 Years Post Op

4 Years Post Op

7 Years Post Op

5 Years Post Op

4 Years Post Op

12 Years Post Op

These new concepts for component designs generally aim to
create a transmucosal “undercontour” which logically, in turn,
increases the available volume
of peri-implant soft tissue and in
effect thickens the soft tissue cuff
around the implant-abutment
complex 14-22.

7 Years Post Op

Since 1985 » Simple. Predictable. Profitable.
Contact Andrea Kiddell UK Manager ■ Bicon Marketing Limited
8 Hadleigh Business Park, Pond Hall Road, Hadleigh, Suffolk IP7 5PW
TEL: 01473 829299 ■ EMAIL: noscrews@bicon.co.uk ■ www.bicon.co.uk

Bicon SI-NI Outsert UK 1109 2a.indd 1

A number of factors have
been proposed as playing a role
in this process 2-16 and in recent
years, new implant designs have
been suggested as being potentially helpful to reduce the impact of the remodelling process
on the marginal bone; therefore
creating enhanced stability of the
marginal soft peri-implant soft
tissues. While it is clear that the
components alone are not the
whole story, nevertheless most
of the new designs serve to enhance the thickness of the soft
tissue cuff around the neck of the
implant restoration and create a
narrower transmucosal contour
often combined with an element
of “platform-switching”.
Of course, the clinical management of implant restorations
in the aesthetic zone has involved
anticipation of the consequences
of this remodelling and strategies
that reduce or negate the impact
of possible soft tissue and bone
changes. It is increasingly evident
that the volume of bone and the
tissue quality, tissue thickness
and tissue biotype around our implants in the aesthetic zone play
a key part in maintaining longterm aesthetic outcomes 9,17-18.

3 Avoid the Maxillary Sinus:

6 Years Post Op

T

he goal of any implant
therapy in the aesthetic
zone is to produce a restoration of the tooth (or teeth) that
blends inconspicuously into the
patient’s smile and maintains stable soft-tissue form over time. It
is understood that bone and soft
tissue remodelling occurs around
all dental implant restorations
and while this remodelling has
been attributed to a number of
factors, it is now commonly accepted that it is probably due to
the establishment of a “biologic
seal”, commonly described as a
“biologic width” between the free
gingival margin to the crest of the
peri-implant alveolar bone 1-3.

11/17/09 4:34 PM

The Clinical Case
In this example, a 35-year-old
female patient with a history of
extensive dental treatment required revision of her previously
restored maxillary anterior teeth
(canine to canine), as well as additional treatment in the posterior
regions, which are not relevant to
the article. The teeth had been
previously crowned in a piece-

[13] =>

Implant Tribune 13

United Kingdom Edition May 17-23, 2010

meal approach over some years,
and the most of the teeth in question were root treated and restored with post crowns.
The overall aesthetic situation was compromised by the appearance of short clinical crowns,
giving the teeth (particularly the
central incisors) a rather ‘short
and broad’ appearance (Fig 1). In
addition, there were pre-existing
endodontic treatments and post
crowns in a number of the teeth
and residual apical radiolucencies evident on some of the teeth
(Fig 2).

same time, crown lengthening of
the maxillary anterior teeth was
carried out, by recontouring both
the gingival margins and labial
alveolar bone around the anterior
teeth. Figure 6 shows the damage
to the labial bone plate in the area
of the tooth extraction and loss of
labial contours in that area.

Fig 1.

An additional point to note is
that the presence of metallic post
and cores and dark-root substrate
makes ideal colour of the gingival
margins tissue difficult to achieve
and has to be managed carefully
when being restored with all-ceramic restorations to avoid affecting the value of the crowns.
The maxillary left central incisor needed surgical endodontic
treatment, but had to be removed
shortly after due to root fracture
(Fig 3), and it was not possible
to place an implant immediately
due to the infection and damage
to the labial bone.
Soft-tissue healing
A provisional metal-acrylic fixedpartial denture was fabricated
and fitted at the time of tooth extraction and soft-tissue healing
allowed to occur (Fig 4, 5). After
approximately six weeks surgical treatment was performed to
place the implant and augment
the bone and soft tissues in the
implant site. A wide mucoperiosteal flap was raised across the
anterior maxilla using sulcular
incisions with no vertical releasing incisions necessary. At the

Fig 1. Case 1 at presentation.
Note the short and broad looking
crowns. Provisional crowns had
already been fabricated for the central incisors. Fig 2. Pre-treatment
radiograph with presence of apical
radiolucencies. Most of these are
healed scars, but maxillary left central incisor is failing. Fig 3. View of
extracted tooth with root fractures
and extrusion of root filling.
Fig 4. Provisional bridge in place
and tissue healing at six weeks
post extraction. Fig 5. Radiograph
at six weeks post extraction prior
to implant surgery. Fig 6. View of
surgical site after raising the flap.
Note the extent of the defect and the
missing labial bone.

Fig 3.

Fig 5.
Fig 4.

Fig 6.

Positioning the implant
The correct three-dimensional
à DT page 15

aesthetics

These were asymptomatic
(except for the failing left central
incisor); the right lateral incisor
and canine had been apicected
and retrograde root filled a couple of years prior, the right central
incisor had been previously root
treated and contained a fibre post
and composite core although the
root filling was difficult to assess
radiographically. However, as the
tooth was stable and symptom
free it was decided to accept the
situation as re-treatment would
be difficult, and lastly the radiolucency on the left lateral incisor
had been symptomless and stable
for a number of years and may
have been a scar.
Nevertheless, it was clear
that the prognosis of some of
these teeth was uncertain and
that further surgical endodontic
treatment may be required in the
future for the left lateral and possibly the right central incisor. The
patient was made aware of this
and the risk of possible future
root fractures, particularly in the
left lateral incisor where there
was a large metallic post.

Fig 2.

enhanced by

technology

Laser-Lok® dental implant at 8 years
post-restoration showing superior
crestal bone & tissue maintenance.

Laser-Lok®

Case courtesy of Cary A. Shapoff, DDS (Surgical); Jeffrey A. Babushkin, DDS (Restorative)

microchannels

BioHorizons is known for using science and innovation to create unique implants with proven surgical and aesthetic
results. Laser-Lok microchannels exemplify our dedication to evidence-based research and development.
The effectiveness of Laser-Lok has been proven with over 15 years of in vitro, animal, and human studies at leading
universities.† This patented precision laser surface treatment is unique within the industry as the only surface treatment
shown to inhibit epithelial downgrowth, attract a true, physical connective tissue attachment to a predetermined zone
on the implant and preserve the coronal level of bone; long term.‡
Laser-Lok is currently available on Tapered Internal, Single-stage, and Internal Implants.

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

Clinical References available. ‡Human Histologic Evidence of a Connective Tissue
Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim.
The International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.
†

SPMP10032 REV A FEB 2010

[14] =>

Project1

6/5/10

16:29

Page 1

United Kingdom Edition May 17-23, 2010

Fig 7.

Fig 9.

Fig 8.

Fig 10.

Fig 11.

Fig 12.

Fig 13.

Fig 15.

Fig 16.

Fig 17.

Fig 18.

Fig 19.

Fig 14.

Fig 7. Verification of biologic width during osseous
recontouring for crown
lengthening. Fig 8. Ideal
positioning of the implant,
3mm apical and 2mm
palatal to the desired final
gingival margin.
Fig 9. Anorganic bone mineral grafted to augment the
labial bone contours.
Fig 10. Resorbable membrane in place. Note good
labial contours.
Fig 11. Good primary
closure achieved and meticulous suturing of the flap
using 6-0 mono-filament
polypropylene sutures. Note
the recontoured gingival
margins. Fig 12. Provisional
crowns and bridge after
healing and maturation
of soft tissue, and tooth
preparation and relining.
Fig 13. Radiograph of the
implant with provisional
bridge in place. Fig 14. The
case just before final impressions with retraction cord in
situ. Fig 15. Occlusal view of
healing abutment showing
excellent labial contours
and tissue thickness.
Fig 16. Close-up occlusal
view with the healing abutment removed to show the
thick labial.
Fig 17. An example of a
custom zirconia abutment
as was used in this case
showing the correct design
with a scalloped margin to
facilitate cementation of the
crown. The implant abutment connection lends itself
to creation of a natural
transmucosal under-contour
which enhances the tissue
thickness in this critical
area. Fig 18. Final result
at two month follow up.
Note improved crown proportions and good restoration of soft tissue
contours around the
implant restoration.
Fig 19. Final radiograph.
Fig 20. Close up view of the
final result.

Fig 20.

References
1. Bengazi F, Wennström JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study.
Clin. Oral Impl. Res. 1996; 7: 303-310. 2. Saadoun AP, LeGall M, Touati B. Selection and ideal tridimensional implant position for soft
tissue aesthetics. Pract Periodontal Aesthet Dent 1999;11(9):1063-1072. 3. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-toimplant relationship on esthetics. Int J Periodontics Restorative Dent. 2005 Apr;25(2):113-9. 4. Abrahamsson I, Berglundh T, Glantz PO,
Lindhe J. The mucosal attachment at different abutments. An experimental study in dogs. J Clin Periodontol. 1998 Sep; 25(9):721-7.
5. Abrahamsson I, Berglundh T, Lindhe J. The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. J
Clin Periodontol. 1997 Aug;24(8):568-72. 6. Hermann JS, Buser D, Schenk RK, Higginbottom FL, Cochran DL. Biologic width around
titanium implants. A physiologically formed and stable dimension over time. Clin Oral Implants Res. 2000 Feb;11(1):1-11. 7. Hermann JS,
Buser D, Schenk RK, Schoolfield JD, Cochran DL. Biologic Width around one- and two-piece titanium implants. Clin Oral Implants Res.
2001 Dec;12(6):559-71. 8. Grunder U. Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results.
Int J Periodontics Restorative Dent. 2000 Feb;20(1):11-7. 9. Kan JYK, Rungcharassaeng K, Klyotaka U, Kols JC. Dimensions of Peri-Implant Mucosa: An Evaluation of Maxillary Anterior Single Implants in Humans. J Periodontol 2003; 74: 557-562. 10. Degidi M, Artese
L, Scarano A, Perrotti V, Gehrke P, Piattelli A.J Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular
endothelial growth factor expression, and proliferative activity in peri-implant soft tissues around titanium and zirconium oxide healing
caps. Periodontol. 2006 Jan;77(1):73-80. 11. Rimondini L, Cerroni L, Carrassi A, Torricelli P. Bacterial colonization of zirconia ceramic
surfaces: an in vitro and in vivo study. Int J Oral Maxillofac Implants. 2002 Nov-Dec;17(6):793-8. 12. Welander M, Abrahamsson I, Berglundh T. The mucosal barrier at implant abutments of different materials. Clin. Oral Impl. Res. 19, 2008; 635–641. 13. Baumgarten H,
Cocchetto R, Testori T, Meltzer A, Porter S. A new implant design for crestal bone preservation: initial observations and case report. Pract
Proced Aesthet Dent. 2005 Nov-Dec;17(10):735-40. 14. Lazzara RJ, Porter SS. Platform switching: a new concept in implant dentistry for
controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent. 2006 Feb;26(1):9-17. 15. Shin YK, Han CH, Heo SJ, Kim
S, Chun HJ. Radiographic evaluation of marginal bone level around implants with different neck designs after 1 year. Int J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):789-94. 16. Nowzari et al. Immunology, microbiology, and virology following placement of NobelPerfect scalloped dental implants: analysis of a case series. Clinical implant dentistry and related research (2008) vol. 10 (3) pp. 157-65. 17.
Bianchi AE, Sanfilippo F. Single-tooth replacement by immediate implant and connective tissue graft: a 1-9-year clinical evaluation.Clin
Oral Implants Res. 2004 Jun;15(3):269-77. 18. Kan JY, Rungcharassaeng K, Lozada JL. Bilaminar subepithelial connective tissue grafts
for immediate implant placement and provisionalization in the esthetic zone. J Calif Dent Assoc. 2005 Nov;33(11):865-71. 19. Wohrle PS.
Nobel Perfect esthetic scalloped implant: rationale for a new design. Clin Implant Dent Relat Res. 2003;5 Suppl 1:64-73. 20. Chou CT,
Morris HF, Ochi S, Walker L, DesRosiers D. AICRG, Part II: Crestal bone loss associated with the Ankylos implant: loading to 36 months.
J Oral Implantol. 2004;30(3):134-43. 21. Norton MR. Multiple single-tooth implant restorations in the posterior jaws: maintenance of
marginal bone levels with reference to the implant-abutment microgap. Int J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):777-84.
22. Rompen E, Raepsaet N, Domken O, Touati B, Van Dooren E. Soft tissue stability at the facial aspect of gingivally converging abutments in the esthetic zone: a pilot clinical study. The Journal of prosthetic dentistry (2007) vol. 97 (6 Suppl) pp. S119-25. 23. Mankoo T.
Single tooth implant restorations in the aesthetic zone – Contemporary concepts for optimization and maintenance of soft tissue esthetics
in replacement of failing teeth in compromised sites. Eur J Esthet Dent 2007;2:274-295.

[15] =>

United Kingdom Edition May 17-23, 2010

positioning of the implant is of
critical importance in helping to
achieve a lasting aesthetic result
and here it is important to place
the implant correctly, ie, three
mm apical and two mm palatal to
the final gingival margin desired
on the implant restoration. In this
case the teeth were to be crown
lengthened, so it was necessary to
recontour the osseous architecture and establish the correct biologic width on the teeth (Figs 7,
8) prior to positioning the implant
so that the final gingival margins
will harmonise.
In effect, this meant that the
implant was placed deeper than
would have been in a case where
no crown lengthening was required and facilitated a good
housing of bone for the implant.
Despite this, it was still necessary
to augment the labial osseous and
soft tissue contours for the purposes of achieving the correct soft
tissue aesthetics.
A Nobel Active 4.3 x 13mm
implant was placed after preparation of the osteotomy, achieving
excellent primary stability, and
bone augmentation was carried
using the principles described in
the previous publications by the
author 23 using an organic bovine bone mineral (Nu-Oss, Ace
Surgical Co, Brockton, USA) and
covered with resorbable collagen
membrane (Bio-Gide, Geistlich
AG) (Figs 9, 10).
A narrow healing abutment
was placed, the bone augmentation carried out and the tissue on
the crest of the ridge was deepitheliased and rolled under itself
to the labial to create an increase
of the soft tissue volume on the labial of the implant healing abutment and the flap sutured using
6-0 mono filament polypropylene
sutures (Fig 11). This could be
further enhanced with a connective tissue graft if necessary, but
in this case, the roll flap created
sufficient thickness. The bridge
was re-cemented after adjustment of the pontic to fit passively
against the augmented ridge and
healing abutment, and to allow
for a slight tissue excess in the
area of the implant.
The healing process begins
After three months of healing,
the remaining crowns and provisionals were removed and the
teeth re-prepared to the new gingival margins. The bridge retainers were relined and provisional
crowns made and cemented
provisionally to allow for tissue
maturation to occur (Figs 12, 13).
After six months, final refinement of the tooth preparations
(Fig 14) and the achievement of
good soft-tissue contours can be
seen particularly on the labial aspect of the implant, where a thick
collar of labial tissue is evident

(Figs 15, 16). The final impressions of the preparations and a
transfer impression of the implant were made and subsequent
steps to try-in the abutment and
bisque bake of crowns were carried out. After all necessary adjustments were made the final
Procera alumina crowns were
finished and final cementation
performed with a glass ionomer
cement (Fuji 1, GC) over a period of a few weeks. It is essential
that retraction cord is used when

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

à DT page 13

cementing the crown (whether
provisional or final) on the implant abutment to ensure that
no cement excess travels into the
sub-mucosal area as this can lead
to peri-implantitis and therefore
compromise the result.
A Procera Zirconia abutment
was fabricated and Fig 17 shows
an example of this, demonstrating the ideal contours of the abutment with the scalloped margins
resembling a tooth preparation.

Implant Tribune 15
This enables crown margins to
be ideally placed for cementation.
The design of the Nobel Active
implant components lend themselves naturally to the creation of
the transmucosal under-contour
that facilitates a thicker transmucosal tissue cuff and therefore
greater stability.
Figs 18, 20 show the final
crowns at two-month follow up. It
is interesting to note the difficulty
in achieving ideal soft-tissue col-

our at the gingival marginal area
of the teeth restored with metallic
post crowns, but good colour is
achieved around the implant. DT

About the author
Dr Tidu Mankoo is
in Private & Referral
Practice in Windsor,
UK, treating Implant,
Restorative and Aesthetic cases, particularly complex cases.
He is the current
President of the European Academy of
Esthetic Dentistry.

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All-on-4 was developed to provide
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or Implant Bar Overdenture. The tilted
posterior implants help avoid relevant
anatomical structures, can be anchored

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by reducing cantilevers. They also help
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All-on-4 can be planned and performed
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Nobel Biocare UK LTD, Telephone: + 44 (0) 1895 430650. Fax: + 44 (0) 1895 430636
Ireland, Telephone: 1800 677306. Fax: 1800 677307
* If one-stage surgery with immediate loading is not indicated, cover screws are used for submerged healing.
Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.

NB All-on-four A4 UK.indd 1

10-05-05 15.25.54

[16] =>

16 Implant Tribune

United Kingdom Edition May 17-23, 2010

Screw versus cement-retained, implant-supported prosthetic restorations

Professor Liviu Steier discusses passive-fit, cemention hydraulics/overhangs and retrievability
of
implant-supported
prosthetics
Jxx-05-10BA
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t was the year 1999 when
Kim et al. stated that: ‘The use
of cement-retained implant
prosthesis is increasing because
of improved occlusal anatomy,
esthetics, and simplified labora-

tory procedures. Little is known
about the biomechanics of cement
retained implant prosthesis compared with that of screw retained
implant prosthesis.’
While comparing, ‘cement
retained versus screw retained
implant restoration’, Michalakis
et al. reviewed the literature in
2003. His research emphasised
the following factors:

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Weber et al. (2007) could not
find enough evidence to prove
any significant difference among
restoration design and treatment
outcome and Chee et al. (British
Dental Journal 2006; 201: 501507) summarised the differences
they have identified:
• Screw-retained restorations
are more easily retrieved and
maintained
• Cemented restorations can
accommodate more implant
positions
• Screw-retained restorations
are easier to manage when immediately loading implants.
Screw loosening is among the
biggest post-loading problems.
Cavazos et al. (1996) summarise reasons for screw loosening:
‘Screw stretch, less than ideal
implant position, inappropriate occlusal scheme or crown
anatomy, variations in hex dimension coupled with equal
variations in the abutment
counterparts, slight differences
in fit and accuracy, tension on
abutment and cylinder from illfitting restorations.’
Several approaches have
been researched and suggested
to avoid screw loosening, from
silicon to resin sealing, from
screw material innovation to
coating techniques.
Fit variation
As early as 1961, Kurosu and
Ide demonstrated that marginal
fit of cemented restorations varies between 20 and 90 microns.
Wilson et al. proved in 1990 the
deformation of restorations with
the cementation procedure. Kim
et al. (1999) measured the deflection of prosthesis at loading time:
‘In the single-crown situation,
the provisional cement-retained
implant crown transferred less
stress to the implant fixture
and supporting structure than
the screw-retained and the
permanent-cement-retained

[17] =>

Implant Tribune 17

United Kingdom Edition May 17-23, 2010

implant crown when a vertical
force was applied.’
Researching the literature,
only one paper by Schwedhelm
et al. (2003) has been identified addressing the cementation
problem in implant-supported
crowns. He suggested a lateral
crown venting to allow elimination of cement excess and reduce
deflection/deformation of the
prosthetic part as well nocive
forces to the implant.
A clinical case study

Missing tooth 46 was replaced
by an implant: Internal Implant
RBT, Laser-Lok 4.0 x 12mm,
4.5 Platform (Biohorizons UK,
17 Wellington Business Park,
Dukes Ride, Crowthorne, Berkshire RG45 6LS). After adequate
osseointegration time (three
months after insertion), the
second-stage surgery has been
performed and the gum sculpted
with a provisional.

the impression as well as to be
used as definitive abutment. The
preparation of the abutment is
performed by the technician. It
is important to make sure that a
nice prep margin is defined. This
will ease the removal of the cement at the crown margins.
The author prefers a technique of cementation with coronal venting. The presented crown
design addresses the following
technology shortcomings:
• Cementation will easier pardon framework discrepancies.
• Coronal access will facilitate
and allow screw retightening
at any needed time.
• Coronal access will facilitate
excess cement evacuation and
clearly facilitate a better fitting.

The postoperative x-ray demonstrates the
perfect fit of the abutment – restoration
margin.

(2010). The tape will easily facilitate future screw access and
findings proved a less bacterial
contamination manifested by
bad smell.

The abutment seated in vivo using the transfer key.

The laboratory delivered the
prepped abutment mounted into
the transfer key. The PFM crown
(high precious metal) guarantees
a coronal access to the screw.

The crown will be seated
using a luting cement, producing a very thin cement film. I
favour active cemenatation using vibrating approach to ease
excess cement evacuation and
avoid misfit and/or defelection
or restoration.
Conclusion
Adequate fit of the prosthetic
restoration can be guaranteed
only by understanding prosthetic biomechanic shortcomings.
Researching the literature helps
finding solutions. I successfully
managed to elaborate and demonstrate a simple solution for a
difficult, mostly ignored problem: perfect marginal fit and retrievability of implant retained
fixed prosthetics. DT

The prepped abutment mounted into the
transfer key.

About the author

Clinical picture demonstrating a good emergence profile, nice and healthy gum coloration
(as no nocive forces applied), and an excellent esthetic integration in the remaining tooth
arcade. The occlusal access was closed using composite resins.
Intraoral picture illustrating the established gum architecture.

A correctly seated implant
allows the use of the primary
attached titanium abutment for

The PFM crown with coronal access to the
abutment screw.

The abutment will be tightened according to the indications of the manufacturer using a torque control device. The
abutment access is closed using

polytetrafluoroethylene (PTFE)
tape (plumber tape) to seal the
screw access channel to protect
the screw head of the abutment
as described by Moráguez et al.

Dr Liviu Steier (PhD)
is Spezialist fuer Prothetik (www.dgzmk.de) and
specialist in Eendodontics (GDC-UK). He is an
honorary clinical associate professor at Warwick
Medical School and course director of
the MSc in Endodontics (www.warwick.ac.uk/go/dentistry). He is a member of the Scientific Advisory Board for
the Journal of Endodontics (AAE) and
maintains a private referral practice
for endodontics, implantology, etc at
20 Wimpole Street, W1G 8GF London
(www.msdentistry.co.uk).

References
1. Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999;81:537-52. 2. Chee W, Felton DA, Johnson PF, Sullivan DY. Cemented versus screw retained implant prostheses:
which is better? Int J Oral Maxillofac Implants 1999;14:137-41. 3. Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent
1997;77:28-35. 4. Michalakis KX, Hirayama H, Garefis PD. Cement-retained versus screwretained implant restorations: a critical review. Int J Oral Maxillofac Implants 2003;18:719-28. 5. Breeding LC, Dixon DL, Bogacki MT, Tietge
JD. Use of luting agents with an implant system: part I. J Prosthet Dent 1992;68:737-41. 6. Rodriguez AM, Orenstein IH, Morris HF, Ochi S. Survival of various implant-supported prosthesis designs following 36 months of clinical function. Ann Periodontol 2000;5:101-8. 7. Cavazos E, Bell FA. Preventing loosening of implant abutment screws. J Prosthet Dent 1996;75:566-9. 8. Doerr J. Simplified technique for retrieving cemented implant restorations. J
Prosthet Dent 2002;88:352-3. 9. Okamoto M, Minagi S. Technique for removing a cemented superstructure from an implant abutment. J Prosthet Dent 2002;87:241-2. 10. Chee WW, Torbati A, Albouy JP. Retrievable cemented implant
restorations. J Prosthodont 1998;7:120-5. 11. Clausen GF. The lingual locking screw for implant-retained restorations – aesthetics and irretrievability. Aust Prosthodont J 1995;9:17-20. 12. Valbao FP Jr, Perez EG, Breda M. Alternative
method for retention and removal of cement-retained implant prosthesis. J Prosthet Dent 2001;86: 181-3. 13. Pow EH, Wat PY, Chow TW. Retrievable cement-retained implant-toothsupported prosthesis: a new technique. Implant Dent
2000;9:346-50.

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[18] =>

18 Implant Tribune

United Kingdom Edition May 17-23, 2010

Untying the Gordian Knot; Part I
Kenneth Serota discusses the Endodontic Implant Algorithm, which provides
highlights in the assessment and identification of determinant factors leading to
endodontic failures, in order to help in the decision-making process whether or
not it is adequate to implement a new endodontic approach vs. extraction and
replacement with dental implants

ver the years, endodontics has diminished itself by enabling the presumption that it is comprised of
a narrowly defined service mix;
root canal therapy purportedly
begins at the apex and ends at
the orifice. Nothing could be further from the truth. It is the catalyst and precursor of a multivariate continuum, potentially the
foundational pillar of all phases
of any rehabilitation (Fig 1a, 1b,
1c). Early diagnosis of teeth requiring endodontic treatment,
prior to the development of periradicular disease, is critical for
a successful treatment outcome
(1)
. Esthetics, function, structure,
biologics and morphology are

the variables in the equation of
optimal oral health. Interventional or interceptive endodontics, restorative endodontics, the
re-engineering of failing therapy, transitional endodontics and
surgical endodontics encompass
a vast scope of therapeutic considerations prior to any decision/tipping point to replace a
natural tooth. Everything we do
as dentists is “transitional”, with
the exception of extractions.
No result is everlasting, none
are permanent; thus our treatment plans must reflect this reality. Artifice versus a natural
state is not a panacea for successful treatment outcomes (Fig
2a, 2b, 2c, 2d).

In 1992, funding from the
Cochrane Collaboration was obtained for a UK Cochrane Centre based in Oxford to facilitate
the preparation of systematic
reviews of randomised trials of
healthcare (2). The Cochrane Systematic Review is a process that
involves locating, appraising, and
synthesising evidence from scientific studies in order to provide
informative empirical answers to
scientific research questions. In
1952, the enterprising son of an
inventor named Ron Popeil created infomercials using 30 to 120
second television spots to sell his
inexpensive array of useful products, including the Pocket Fisherman and the Veg-O-Matic food

Figs 1a, 1b – Previous endodontic therapy on tooth #2.6 (14) had failed; the clinician chose
to correct the problem with a microsurgical procedure on the MB root. This procedure
failed over time as well (sinus tract). Radiographic and clinical evidence demonstrate the
developing apical lesion. The root canal system was re-accessed, the untreated canal identified, the entire system debrided, disinfected and after interim calcium hydroxide therapy,
obturated. One year later, the lesion has healed. While the retrograde amalgam remained
in the root end, its presumed ability to effectively seal a complex apical terminal configuration was ill-considered. Everything leaks in time; retreatment is always the first choice for
resolution of an unsuccessful endodontic procedure where possible.

slicer. The singular goal of an
infomercial was to get the viewer
to a phone immediately and have
them place their order. No waiting weeks, months or even years
for the lofty marketing goals of
branding to pay off. Somewhere
along the way, dentistry morphed
the two concepts. Nowhere is this
becoming more apparent than in
the debate on the endodontic implant algorithm.
New treatment modalities
Scientific doctrine is the cornerstone of Endodontic therapeutics.
However, of late, anecdotal testimony has become the default setting for new paradigms to justify
endodontic treatment modalities
and an encomium to technologic
advances. The strength of the
arch of this or any specialty’s integrity and relevance must rely
on a keystone of randomised
clinical trials and evidence-based
treatment outcomes. Expert opinions reflected through the looking
glass of business models or global
tours cannot replace stringently
controlled clinical assessments
distilled from exacting independent investigations. Science cannot
be applied through a McLuhanistic rearview mirror of technology.
The two must symbiotically occupy the same space regardless
of whether that is antithetical to
the Pauli Exclusion Principle, one
of the most accepted laws of physics; no two objects can simultaneously occupy the same space.
In December 2004, Salehrabi
and Rotstein (3) published an epidemiological study on endodontic treatment outcomes in a large
patient population. The outcomes
of initial endodontic treatment
done by general practitioners and
endodontists participating in the
Delta Dental Insurance plan on
1,462,936 teeth of 1,126,288 patients from 50 states across the

Fig 1c – “Listening to both sides of a story
will convince you that there is more to a
story than both sides [Frank Tyger]”. The
endodontic implant algorithm ensures
that philosophy does not obscure pragmatism and expediency does not denigrate
adaptive capacity.

USA were assessed in an eight
year timeline. Ninety seven per
cent of teeth were retained in the
oral cavity subsequent to nonsurgical endodontic treatment over
this period. The combined incidence of untoward events such
as retreatments, apical surgeries,
and extractions was three per cent
and occurred primarily within
three years from the completion
of treatment. Analysis of the extracted teeth revealed that 85 per
cent had no full coronal coverage.
A statistically significant difference was found between covered
and uncovered teeth for all tooth
groups tested which is consistent
with the findings from numerous
investigations (4, 5, 6).
The purpose of this publication is to evaluate current trends
and perceptions pertaining to the
standard of care in endodontics
and provide an evidence-based
consensus on their relevance and
application. Part II will address
the algorithm by which sacrifice
of natural structures for orthobiologic replacements can be validated and the engineering principles and designs that best mimic
clinical dictates.
Evolutionary paradigm shifts
Three surveys have been conducted with the membership of
the American Association of En-

[19] =>

United Kingdom Edition May 17-23, 2010

Matrix

Figs 2a, 2b – Tooth #1.5 (4) was determined to be non-salvageable. It was removed, the socket stimulated to regenerate and in four month’s
time an ANKYLOS® implant inserted, a sulcus former placed and the tissue closed over the site to allow for osseo-integration to occur.

Inserts like a
wedge

Form Contact
Point

Tight cervical marginal
adaptation prevents
overhangs

Flexible wing exerts
pressure for maintained
separation and cervical
adaption

Figs 2c, 2d – The choice of a natural tooth versus an orthobiologic replacement will increasingly be a powerful force in dental treatment
plans. The temptation to choose one or the other based on expediency versus complexity, on marketing versus science is going to be the
sine qua non of the standard of comprehensive care.

Fig 3 – The degree of complexity of the root
canal system has been understood for most
of the past century. The failure to negotiate
the labyrinthine ramifications of the root
canal system has purportedly been a function of technical limitation rather than
comprehension and yet, it took until the
mid 70’s to appreciate that thermolabile
condensation of an obturating material
could demonstrate a greater occlusive degree of the system than any other modality.

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Fig 4b - Vertucci FJ – 1984.Two thousand four hundred human permanent teeth were
decalcified, injected with dye, and cleared in order to determine the number of root canals
and their different morphology, the ramifications of the main root canals, the location of
apical foramena and transverse anastomoses, and the frequency of apical deltas.

paramount importance (Fig 3).
The primary patho-physiologic
vectors of pulpal disease and the
myriad complexity of the root canal system had always been understood; as the century closed,
clinicians were provided with
new tools and technology to expand the boundaries and limitations of endodontic treatment
procedures (Fig 4a, 4b).
Root canal infections are polymicrobic, characterised predominantly by both facultative
and obligate anaerobic bacteria
(9)
. The necrotic pulp becomes
a reservoir of pathogens, toxic
consequences and their resultant infection is isolated from
the patient’s immune response.

Fig 4a – Panel of anatomic preparations
from the classic work by Professor Walter
Hess of Zurich – The Anatomy of the root
canals of teeth of the permanent dentition,
London, 1925, John Bale, Sons & Danielsson.

Eventually, the microflora and
their by-products will produce
a periradicular inflammatory
response. With microbial invasion of the periradicular tissues,
an abscess and cellulitis may
develop. The resultant inflammatory response will initiate either a protective and/or immunà DT page 20

dodontists since the late 1970s.
The first reflected what is now an
anachronistic view of emergency
procedures and the standard of
care defining non-surgical therapy during that period (7); the second, done prior to the technologic
advances of the last decade of the
20th century, was hallmarked by
a dramatic decrease in leaving
pulpless teeth open in emergency
situations and a significant decline in the use of culturing prior
to obturation (8). The report indicated that the concept of “debridement and disinfection” versus
“cleaning and shaping” was now
the focus of the biologic therapeutic imperative and the need
for expansive microbial strategies was recognised as being of

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[20] =>

20 Implant Tribune

Figs 5a, 5b – Flat field sensors provide a sense of the extent of osseous pathology; however, the periapical
radiographic image corresponds to a two-dimensional aspect of a three dimensional structure. Periapical lesions confined within the cancellous bone are usually not detected. Thus a lesion of a certain size
can be detected in a region covered by a thin cortex, whereas the same size lesion cannot be detected in
a region covered by thicker cortex.

United Kingdom Edition May 17-23, 2010

Fig 6 – All cone beam tomography units provide correlated
axial, coronal and sagittal multiplanar volume reformations.
Basic enhancements include zoom or magnification and visual
adjustments to narrow the range of grey-scale, in addition to the
capability to add annotation and cursor-driven measurement.

Fig 7 – Strategic extension of the access perimeter is too often undervalued in terms of successful endodontic treatment
outcomes. The shape of the chamber must be regressed to its
native state to ensure that axial interference is negated as an
instrument traverses the length of the root canal space.

à DT page 19

opathogenic effect; additionally,
it may destroy surrounding tissue
resulting in the five classic signs
and symptoms of inflammation;
calor, dolor, rubor, tumor and penuria. Patient evaluation and the
appropriate diagnosis/treatment
of the source of an infection are of
utmost importance.
Patients demonstrating signs
and symptoms associated with
severe endodontic infection (Table I) should have the root canal
system filled with calcium hydroxide and the access sealed.
In the event of copious drainage,
the access can be left open for no
longer than 24 hours, the tooth
then isolated with rubber dam,
the canals irrigated and dried
and calcium hydroxide inserted
into the root canal space and
the access sealed (10). The antibiotic of choice for periradicular
abscess remains Penicillin VK;
however, recent studies have reported that amoxicillin in combination with clavulinate (1gm
loading dose with 500mg q8h for
seven days) was a more effective
therapeutic regimen (11).
Systemic antibiotic administration should be considered if
there is a spreading infection that
signals failure of local host responses in abating the dispersion
of bacterial irritants, or if the patient’s medical history indicates
conditions or diseases known to
reduce the host defense mechanisms or expose the patient to
higher systemic risks. Antibiotic
treatment is generally not recommended for healthy patients with
irreversible pulpitis or localised
endodontic infections (Table II).
Numerous studies with welldefined diagnosis and inclusion
criteria failed to demonstrate enhanced pain resolution beyond
the placebo effect (12, 13).

Untitled-14 1

3/12/09 10:23:32

The sophistication of endodontic equipment, materials and
techniques has been steadily iterated and innovated since the
second survey. The microscope
first introduced to otolaryngology
around 1950, then to neurosurgery in the 1960s, is now standard of care for the voyage into the
microcosmic world of the root
canal system. Recursions in the
micro-processing technologies of
electronic foramenal locators begat unprecedented accuracy lev-

[21] =>

United Kingdom Edition May 17-23, 2010

els, improved digital radiographic
sensors and software enhanced
diagnostic acumen, and ultrasonic units with a variety of tips designed specifically for use when
performing both nonsurgical and
surgical endodontic procedures
minimised damage to coronal
and radicular tooth structure in
the effort to locate the pathways of
the pulp. The treatment outcome
of non-surgical root canal therapy at this point in time is far more
predictable than at any other period in our history.
Diagnosis
Of all the technologic innovations
embraced by endodontics, digital
radiography should have generated the greatest impact; however,
its value remains limited in diagnosis, treatment planning, intraoperative control and outcome
assessment. Flat field sensors still
require three to four parallax images of the area of interest to establish better perception of depth
and spatial orientation of osseous
or dental pathology. These threedimensional information deficits, geometric distortion and the
masking of areas of interest by
overlying anatomy or anatomic
noise are of strategic relevance
to treatment planning in general
and in endodontics specifically
(14)
, (Fig 5a, 5b).
Cone beam computed tomography (cbCT) produces up to
580 individual projection images with isotropic submillimeter
spatial resolution enhanced by
advanced image receptor sensors; it is ideally suited for dedicated dento-maxillofacial CT
scanning. When combined with
application-specific
software
tools, cone beam computed tomography can provide a complete
solution for performing specific
diagnostic and surgical tasks.
The images can be resliced at
any angle, producing a new set
of reconstructed orthogonal images and studies have shown that
the scans accurately reflect the
volume of anatomic defects. The
limited volume cbCT scanners
best suited for endodontics require an effective radiation dose
comparable to two or three conventional periapical radiographs
and as such are set to revolutionise endodontics (15, 16) (Fig 6).
Three dimensional pre-surgical assessment of the approximation of root apices to the inferior
dental canal, mental foramen and
maxillary sinus are essential to
treatment planning. The ability
of cbCT to diagnose and manage
dento-alveolar trauma using multiplanar views, the determination
of the root canal anatomy and the
number of canals, the detection
of the true nature and exact location of resorptive lesions and the
discovery of the existence of vertical and horisontal fractures outweigh concerns about the degree
of ionising radiation and the risks
posed (17). Provided cbCT is used

in situations where the information from conventional imaging
systems is inadequate, the benefits are essential for optimisation
of the standard of care.
Patel reported that periapical
disease can be detected sooner
and more accurately using cbCT
compared with traditional periapical views and that the true
sise, extent, nature and position
of periapical and resorptive lesions can be accurately assessed

. Using a new periapical index
based on cone beam computed
tomography for identification of
apical periodontitis, periapical lesions were identified in 39.5 per
cent by radiography and 60.9 per
cent of cases by cbCT respectively
(P < .01). Simon et al compared
the differential diagnosis of large
periapical lesions with traditional biopsy. The results suggested
that cbCT might provide a faster
method to differentially diagnose
a solid from a fluid-filled lesion or

(18)

Implant Tribune 21
cavity, without invasive surgery
(19, 20)
. In spite of the presence of
artifacts, the learning curve related to image manipulation and the
cost, cone beam tomography will
invariably be the accepted standard of diagnostic care and treatment planning in endodontics in
the very near future.
Access
An improperly designed access
cavity will hamper facilitation of
optimal root canal therapy. If the

orientation, extension, angulations and depth are inaccurate,
retention of the native anatomy
of the root canal space becomes
precarious. The requirements
of access cavity design can be
achieved by conceptual and
technical regression of the existing configuration to that which
one would logically expect to
have seen prior to the insults of
restoration, function and aging.
à DT page 22

[22] =>

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Fig 8a – Dystrophic calcification confounds even the most experienced clinician. The key
to identification of the orifices is to regress the inner space using the continuum, cusp
tip, pulp horn, canal orifice. In lieu of an ultrasonic tip which tends to chop the stone
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Fig 9 – Micro-etching ensures the removal of oils and debris as well as eliminating the
residue in fusion lines and fissures. Routine dentin bonding is then performed. The composite chosen in this instance is Permaflo® Purple (UPI, South Jordan, UT) which enables
differentiation of restoration and tooth structure should re-entry be necessary.

à DT page 21

If tertiary dentin were perceived
of as “irritational dentin” or dystrophic calcification considered
“decay”, the chamber outline
could be used to blueprint an inlay configuration for the access
design that literally replicates
the “virgin” tooth (Fig 7).
Removal of the existing restoration in its entirety and/or
preliminary preparation of the
coronal tooth structure for the
subsequent full coverage restoration will identify decay, fractures,
unsupported tooth structure and
expose the anatomy of the underlying root trunk periphery which
assists in discovery of the spatial
orientation and morphology of
the roots. The pulp chamber ceiling and pulp stones can be peeled
away with a football diamond bur
to grossly identify the primary
orifices. Micro-etching (Danville

Materials, San Ramon CA) the
floor of the chamber, perhaps
the most underused of all access
tools, is invaluable in the exposure of fusion lines and grooves
in order to identify accessory orifices. Troughing with ultrasonic
tips of any design is used solely to
trace fusion lines, not effect gross
removal. The use of ultrasonics to
“jackhammer” pulp stones is simply too risky as one approaches
the floor of the chamber, particularly if there are no water ports
on the tips. Orifice lengthening
and widening enables straight
line glide path to the apical third.
The strategic objective is not to
impede the file, stainless steel or
nickel-titanium rotary along the
axial walls with minimal dentin
removal (Fig 8a, 8b).
It is equally as important to
produce a high quality coronal
restoration at the time of sealing the root canal system (21, 22).

Despite research supporting the
effectiveness of coronal barriers
and the need for their immediate
placement as a component of the
completion phase of root canal
treatment, a universally accepted
protocol does not exist. Schwarts
and Fransman have described
a clinical strategy for coronal
sealing of the endodontic access
preparation that lists the following considerations in the protocol; use bonded materials (4th
generation (three step) resin
adhesive systems are preferred
because they provide a better
bond than the adhesives that require fewer steps), the “etch and
rinse” adhesives are preferred to
“self etching” adhesive systems
if a eugenol containing sealer or
temporary material is used, “self
etching” adhesives should not be
used with self-cure or dual-cure
restorative composites, when
restoring access cavities, the
best esthetics and highest initial
strength are obtained with an
incremental fill technique with
composite resin, a more efficient technique which provides
acceptable esthetics is to bulk
fill with a glass ionomer material to within two mm to three
mm of the cavo-surface margin, followed by two increments
of light-cure composite and if
retention of a crown or bridge
abutment is a concern after root
canal treatment, post placement
increases retention to greater
than the original state (23) (Fig 9).
Irrigation
The complex anatomy of the root
canal space presents a daunting
challenge to the clinician who
must debride and disinfect the
corridors of sepsis with absoluteness to achieve a successful
treatment outcome (see Fig 10).
In addition, the absence of a cellmediated defense (phagocytosis,
a functional host response) in
necrotic teeth means the microorganisms residual in tubuli,
cul de sacs and arborisations
are mainly affected by the redox
potential (reduction potential
reflects the oxidation-reduction
state of the environment – aerobic microflora can only be active
at a positive Eh, whereas strict
anaerobes can only be active at
negative Eh values) and availability of nutrients in the various
parts of the root canal (24). While
our knowledge of persistent
bacteria, disinfecting agents
and the chemical milieu of the
necrotic root canal has greatly
increased, there is no doubt that
more innovative basic and clinical research is needed to optimise the use of existing methods
and materials and develop new
ones in order to prevent and/or
treat apical periodontitis.
Varying degrees of sterility of
the root canal space are achieved
by mechanistic removal, the
chemical reactivity and fluid
dynamics of irrigants and their
introduction to the canal space;

[23] =>

United Kingdom Edition May 17-23, 2010

Implant Tribune 23

Table I and II – derived from Antibiotics and the Treatment of Endodontic Infections –
Summer 2006 – American Association of Endodontics – Colleagues for Excellence

Fig 10 – A vast array of equipment exists in the marketplace to optimize irrigation protocols. Radical change may well be in the offing,
however, R&D on bio-active obturating materials may prove to be the defining variable in total asepsis.

Fig 11 – Numerous investigators have shown that the concept of keeping the apical foramen foramen as small as practical does not mean
a size 20 or 25 file. This Schilderian concept should read as small as the apical morphology permits in order to ensure that the free flow of
irrigant to the apical terminus enables more definitive cleaning of the apical segment of the root canal space.

however, the protocols used today cannot predictably provide
sterile canals. As none of the
elements of endodontic therapy
(host defense system, systemic
antibiotic therapy, instrumentation and irrigation, interappointment medicaments, permanent root filling, and coronal restoration) can alone guarantee complete disinfection,
it is of utmost importance to
aim at the highest possible quality at every phase of the treatment. In the classic study by
Sjogren et al, 55 single-rooted
teeth with apical periodontitis
were instrumented and irrigated
with sodium hypochlorite and
root filled. Periapical healing

was followed-up for five years.
Complete periapical healing
occurred in 94 per cent of cases
that yielded a negative culture. Where the samples were
positive prior to root filling, the
success rate of treatment was
just 68 per cent – a statistically
significant difference. These
findings emphasise the importance of completely eliminating bacteria from the root canal
system prior to obturation. This
objective cannot be reliably
achieved in a one-visit treatment
of necrotic pulps because it is not
possible to eradicate all infection
from the root canal without the
support of an inter-appointment
antimicrobial dressing (25).

NaOCl is the most widely
used irrigating solution. It is a
potent antimicrobial agent and
lubricant, which effectively dissolves pulpal remnants and organic components of dentin thus
preventing packing infected hard
and soft tissue into the apical confines. Hypochlorous acid (HClO)
is the active moiety responsible
for bacterial inactivation. NaOCl
is used in concentrations varying from 0.5 per centto 5.25 per
cent; the in vitro and in vivo studies differ significantly in terms
of the effectiveness of the range
of concentrations as the in vitro
experiments provide direct access to microbes, higher volumes
are used and the chemical milieu

complexity of the natural canal
space are absent than in the in
vivo experimentation. A study by
Siqueira et al (26) showed no difference (in vitro) between one
per cent, 2.5 per cent and give per
cent NaOCl solutions in reducing
the number of bacteria during
instrumentation. What has been
shown is that the tissue dissolving effects are directly related to
the concentration used (27).
Perhaps the most misunderstood aspect of NaOCl irrigation
is the need for the quantities of
irrigation required due to the
morphologic and anatomic variations in the volumetric sise of
the root canal anatomy. Siqueira
showed that regular exchange
and the use of large amounts
of irrigant should maintain the
antibacterial effectiveness of the
NaOCl solution, compensating
for the effects of concentration
(28)
. Numerous devices have appeared in the endodontic armamentarium to address this situation; EndoVac (Discus Dental)
– a negative pressure differential device designed to deliver
high volumes of irr-igation solution while using apical negative pressure through the office
high volume evacuation system,
Negative Pressure Safety Irrigator (Vista Dental, Racine WI)
– device is similar to EndoVac,
Rinsendo (Air Techniques, Corona CA) uses pressure suction
technology; 65ml of irrigant are
automatically drawn from the
attached syringe and aspirated
into the canal (pressure created
is lower than manual irrigation),
VIbringe (Bisco Canada, Richmond BC) – sonic flow technology facilitates enhanced irrigation
through the myriad complexities
of the root canal system (Fig 11).
NaOCl cannot dissolve inorganic dentin particles and
thus prevent smear layer formation during instrumentation
(29)
. Chelators such as EDTA and
citric acid are recommended
as adjuvants in root canal therapy. It is probable that biofilms
are detached with the use of chelators; however, they have little if any antibacterial activity.
Several studies have shown that
citric acid in concentrations
ranging as high as 50 per cent
was more effective at solubili-

sation of inorganic smear layer
components and powdered dentin than EDTA. In addition, citric
acid has demonstrated antibacterial effectiveness.
Technology and innovation
will not negate the need for optimal preparation (debridement
and disinfection) to eliminate
microbial content and its impact
on a necrotic root canal system.
We as a discipline need to be better; however, by the same token,
endodontics has shown its commitment to endless reinvention.
In time, that will restructure the
role of natural teeth in foundational dentistry, currently diminished by the market forces
of implant driven dentistry. Orthobiologic replacement is not
a panacea as random clinical
trials increasingly show; the severity of peri-implantitis lesions
demonstrates significant variability and as such no treatment
modality has shown superiority.
The pendulum will continue to
swing as the endodontic implant
algorithm becomes increasingly
multivariate. DT
Part 2 in next issue, including
references

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

[24] =>

24 Education

United Kingdom Edition May 17-23, 2010

With more than 4,500 new
cases opened every year, there
is a wealth of experience
within Dental Protection from
which all of us can learn

n a well-balanced life, the
pressures of practicing dentistry are usually offset with

sufficient recreational time to redress the balance. However, this
in turn creates an additional need
to ensure that adequate cover is

provided for patients in the absence of their usual provider.
Sometimes there are colleagues
in-house who can provide this

The ‘How
to

service, but single-handed practitioners must seek the support of
a colleague from a near-by practice. Either way, it is important to

make a

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Consider the case of a patient who visited his local dental practice complaining of sore
gums. His regular dentist was
away from the practice that day
and so the receptionist informed
the senior partner of the problem. The partner did not bother
to examine the patient, but noticed from the record card that
he had suffered from periodontal
disease for a long time and told
him that his problem was likely
to be a recurrence of the same
problem. He gave the patient a
prescription of Metronidazole.

‘It’s important to
see “occasional” patients in person and
examine them fully
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Unfortunately, the patient’s
medical history was not checked
and in fact he was on long-term
high-dose Warfarin therapy. The
antibiotic potentiated the action
of the Warfarin and resulted in
the patient being hospitalised
two days later, needing an emergency transfusion.
The partner sought advice
from his indemnity provider
and it was agreed that he would
arrange to see the patient for
a review and explain the problems that could result from a
prescription of this type of antibiotic despite it being a drug
commonly used to treat periodontal disease. The patient took no
further action.
This case illustrates the importance of a clinical examination, to confirm that the prescription was a justified treatment
and also the need for careful
consideration of the patient’s
medical history for possible
drug interactions.
Watch out for another Learning Curve from Dental Protection
in future editions of Dental Tribune UK. DT

[25] =>

United Kingdom Edition May 17-23, 2010

Protecting the profession
If the reputation of NHS dentists is not
maintained, can we really expect the public to
trust us? Neel Kothari ponders the question

any dentists working
within the NHS face
a daily battle of trying
to provide a high level of care
in a system that is determined
to provide mass produce. As
working professionals, many
dentists feel monetary reward is
only a small part of job satisfaction – from my friends and colleagues all too frequently I hear
the common complaint: “I wish I
could practice the dentistry I was
trained to provide.”
Access all areas
We all know, that irrespective of
how much money is force-fed
into NHS dentistry, the prime
objective is access. While rhetoric of quality, prevention and
patient choice is plastered over
Department of Health literature,
I can’t think of the last Government policy that wasn’t to do
with increasing more bums on
the seat, rather than providing
patients with a better standard
of healthcare. With numbers of
root fillings as well as complex
restorative work having taken
a severe hammering since the
introduction of the dental contract, it seems more and more
dentists are not providing the
type of dentistry they were
trained to provide.
So what does this do to our
professionalism? Are the newspapers right when they publish
headlines like this one: ‘greedy
dentist profiteering over the
system’? Or how about patient
groups angry that the new contract has reduced quality?
A damning report
The most thorough review into
the success and failures of the
system must surely come from
the Health Select Committee,
whose verdict, as described by
Susie Sanderson from the BDA,
is ‘damning’. While the BDA acts
as our official trade union to help
protect those within dentistry,
essentially it is the General Dental Council (GDC), which ultimately regulates dentists making
us ‘professionals’. This concept
of self-regulation where a body
of peers regulates the profession
not only applies to dentists, but
also to other professions such as
medicine, veterinary surgeons
and lawyers.
The General Medical Council has the slogan ‘Regulating
doctors, ensuring good medical
practice’, the Royal College of
Veterinary Surgeons has the slogan ‘Promoting and sustaining
confidence in veterinary medi-

cine’ and the Law Society slogan
announces that it is ‘Supporting
lawyers’. All positive and reassuring statements – after all, if I
needed to call upon the services
of a doctor, a vet or a lawyer,
I’d like to think that they are all
adequately trained, supported
and able to provide a good level
of care. The GDC’s slogan exclaims: ‘Protecting patients, regulating the dental team’.

‘Should we really
be expecting more
and more patients
to go abroad for
their treatment?’
The fear factor
Dentistry as a profession already
instils fear into many of our patients, so if we announce that
we’re ‘protecting patients’, do we
really need to suggest to them
that they are in need of protection? Of course regulating the
dental team is important, but
where are the positive messages
of ‘ensuring good dental practice’
or ‘supporting dentists’? It seems
as a profession, this organisation which we all pay money
into can offer little or no support to encourage good clinical
practice, other than to chastise
those who are found breaking
its rules. While punishing bad
practice is an importance part
of any regulatory body, could
the GDC do more to encourage
good practice? And do they consider the confines of the current
dental contract conducive to
good dental practice?
While the GDC may claim
to protect patients, presumably
from dentists, who is there to
protect the profession? Ultimately, good standards are far more
than just punishing the bad apples, so surely good standards
come from good training and
from there allowing dentists to
practice the type of dentistry they
were trained to provide. While
this is unfortunate for dentists,
it’s the patients who really suffer,
with recent research showing
that in Britain, 260,000 people a
year go abroad to get their teeth
fixed. Between 2004 and 2008,
around 1.3 million people had
dental work done overseas and
nearly 70 per cent of those were
under the age of 34.
Much of this work was at the
higher end of dentistry involving
complex restorations as well as
implants, which currently in the

UK is often hard to find within
the NHS. When researching the
availability of implants under the
NHS, I was told where ‘clinically appropriate’ this is available
in the hospital sector. I subsequently found out that for cases
of hypodontia, a minimum of six
missing teeth were needed before funding could be granted.
Money matters
Although I accept the NHS will
always have budgeting, when
these matters arise, it should be
made clear to the public that this
is an issue of finance and that to
fund one patient with a dental
implant would mean less treatment for many others. In my
opinion it is wholly inappropriate to suggest that a patient with
five or fewer missing teeth due
to hypodontia, or anything else
for that matter, should not qualify for implant treatment because
it is not ‘clinically appropriate’. This not only misleads the
public, it also decays the profession by taking clinical decision making out of the hands of
the professionals.
The professional status endowed upon dentists is more
than a method of regulation – it’s
a privilege. This privilege tells
the public that we can be trusted,
we are trained to a higher level
than others and that we are qualified to provide them with dental
care; ultimately it helps patients
put their trust in us. If this status
is not protected, can we really
expect patients to put their trust
in us? Or should we really expect
more and more patients to go
abroad for their treatment? And
can we honestly say that within
the NHS the treatment options
we are providing them are the
most clinically appropriate within our professional opinion? DT

About the author
Neel Kothari qualified as a dentist
from Bristol University
Dental
School in 2005, and
currently works in
Cambridge as an
associate
within
the NHS. He has
completed a yearlong postgraduate
certificate in implantology at UCL’s Eastman Dental
Institute, and regularly attends postgraduate courses to keep up-to-date
with current best practice. Immediately post graduation, he was able to
work in the older NHS system and see
the changes brought about through
the introduction of the new NHS system. Like many other dentists, he has
concerns for what the future holds
within the NHS and as an NHS dentist,
appreciates some of the difficulties in
providing dental healthcare within this
widely criticised system.

[26] =>

26 BDA Show

United Kingdom Edition May 17-23, 2010

SMARTSEAL TO REVEAL EXCITING
NEW DEVELOPMENT
AT BDA CONFERENCE
Smartseal, the creator of innovative
endodontic systems, is set to reveal
an exciting new development to smartpoints at the BDA’s British Dental
Conference and Exhibition in Liverpool in May.

BDA Exhibition & Conference May 2010
Zhermack Stand no. B103
Zhermack’s range of impression materials and a new disinfection range are
designed to make your life easier and achieve superior results. Take advantage
of a free sample of Hydrogum5, the 5 day stability alginate with a fruity berry
flavour. Mix the new extra soft sweet mint flavoured Hydrorise putty with its
hyper-hydrophilic wash. Try new Hydrosystem, the pre-impression surface
enhancer for reducing impression voids by 50%. Or Elite Glass the clear
silicone for making a clear matrix, to enable light-curing of temporary veneers
in the mouth. And finally Zeta 6 Dry Gel, a new hand gel that does not dry out
your hands.
UK Mobile 07870 690811 uk@zhermack.com
www.zhermack.com Contact - Graham Brown

Visit The Dental Directory Stand
A125 at BDA, Liverpool
Visitors to the Dental Directory’s
Stand A125 at this year’s BDA
Conference in Liverpool won’t be
disappointed!
You will be able to review the
company’s
expanding
facial
aesthetic range. Experts will be
present to demonstrate the various skincare ranges and answer any questions
regarding facial rejuvenation, aesthetics and training.
The company’s experienced Digital Division will also be on hand to discuss the
latest innovations and answer any questions relating to digital imaging. Their
experience combined with their impartiality puts them in an ideal position
to review the various options available and help you decide on the most
appropriate solution for your practice.

After considerable effort, the team at smartseal has created a fully radioopaque hydrophilic polymer point called propoint. This product has been
developed following feedback from practitioners who said they found
smartpoints easier and quicker to use but requested the point be more radioopaque so as to be more consistent with other products.
Propoint will be demonstrated by representatives at smartseal’s stand A192 at
the city’s Arena and Conference Centre on May 20 - 22.
It is the latest product to be launched by smartseal, which revealed its
biocompatible root canal sealer, smartpaste bio, to thousands of clinicians at
the BDTA’s Dental Showcase in Birmingham in 2007.

Sample ‘new’ Klin-Up-Ultra on Stand
Alkapharm will be exhibiting there wide
range of professional hygiene products at the
BDA Conference & Exhibition in Liverpool.
A comprehensive range of products to aid the
dental team in the control of cross infection will be on display and visitors will
be able to ‘take-away’ free samples from Alkapharm’s new ‘Alcohol-Free’ range
of products which now includes the brand new Klin-Up-Ultra foaming instant
hand sanitiser.
Be sure to stop by at Stand A112 where our expert friendly staff will be on
hand to offer professional advice on your practise hygiene / disinfection
requirements.
We very much look forward to seeing you.
www.alkapharm.co.uk

For further information on The Dental Directory call 0800 585 586 or visit www.
dental-directory.co.uk

Come and visit us at stand B59 at the 2010 BDA Conference. If you are unable
to join us FreeCall 0500 321111, email enquiries@evident.co.uk or visit www.
evident.co.uk

It is time for the BDA conference and
Septodont are happy to announce
our attendance. Septodont is actively
involved and contributes to many events,
conferences and trade shows around the
world, using this valuable time to pass on
our technical expertise.
We expect the Septodont stand to be a hive
of activity as we showcase key products
including the various anaesthetics range
such as Lignospan Special, Septanest and
Scandonest, as well as several ranges of needles including the unique antineedle stick injection system, Ultra Safety Plus® now available as a completely
disposable syringe system with the introduction of the USP Single White
Handle.
Most noteworthy will be the continued interest in N’Durance, the revolutionary
Dimer Acid based, low shrinkage, universal application composite that is
taking the UK market by storm.
Many Dentists have come to rely on our well trained and knowledgeable
product specialists to deliver the latest information and product expertise to
add value to the delegate experience.
So come along to stand B124 and see for yourself why dentists in the know
use Septodont.

3D digital dental radiography is a hot topic so it’s no surprise that as the UK’s
premier independent imaging specialists Digital Dental offer the widest range
of 3D Cone Beam CT systems. We will be showcasing a new 3 in 1 extraoral
imaging concept that should make 3D imaging affordable for most practices.
To celebrate our 10th anniversary we will have some unbeatable show offers.
For further information call Digital Dental on 0800 027 8393, visit stand
A26 at the BDA Conference, email sales@digitaldental.co.uk or visit www.
digitaldental.co.uk.

Jerry Watson, Chief Executive of smartseal, says, “We are very excited to be
revealing propoint to leading dental professionals in May, as this is exactly
what they have been asking us for. We look forward to welcoming clinicians to
our stand to find out more.”

So make sure you come and visit The Dental Directory Stand A125 at this year’s
BDA Conference in Liverpool.

Evident..it’s all about quality
At this year’s BDA annual conference
Evident will be showing their
beautifully designed loupes and
lights. Evident’s dedicated and
experienced team of consultants,
including dispensing opticians, will be busy demonstrating the custom-made
loupes by leading supplier ExamVision™. Considering their superior design
and craftsmanship it’s clear to see why these ExamVision™ loupes are proving
to be so popular.
ExamVision™ loupes and lights offer dentists a considerable choice in
versions, colours and magnifications including ExamVision’s newly developed
short barrel 4.2x magnification loupe, the lightest and most balanced high
magnification loupe on the market today.
Evident will also be demonstrating their highly desirable consumable
products, most of which are from leading US dental company Danville.
Danville developed their range of “Adhesive Dentistry” products with the help
of leading aesthetic dentist Dr. Raymond Bertolotti. These include Prelude;
the ONLY system you need for dentine and enamel bonding, Accolade SRO; a
super radiopaque, flowable composite and the Accolade PV veneer placement
system.

Digital Dental
Enter the Third Dimension at the
BDA Conference, Stand A26
Don’t get confused by all this new
technology. Visitors to the Digital
Dental Stand A26 can compare the
best digital x-ray and intraoral camera
systems and receive unbiased advice
from one of our imaging specialists.
View the latest advances from Schick,
Durr, Digora, Satalec and Vatech.

Be individual…
Practice Plan will be making
its mark at this year’s annual
BDA
Conference
and
Exhibition, by revealing all
the unique components
that makes us the leading custom branded dental plan provider.
From our innovative in-house marketing agency and dedicated regional
support managers, to our educational workshops and invaluable consultancy
services, everything that we offer has evolved to ensure you can run your
practice the way you want to, with the support you need.
We’re firm believers in individuality and that your practice should belong to
you. That is why we make it our priority to help you develop a plan that fits into
your own unique brand and personality, and runs alongside your individual
practice’s ethos, image and goals.
You may just need to make a few tweaks, or perhaps you want to completely
transform your image? Whatever the case, our range of support services can
help you leave your own distinctive mark.
Visit us on stand A68, we’ll even have some of our customers at hand, so you
can hear straight from the horse’s mouth how we can help.
Contact details:
T: 01691 684135 F: 01691 684149
E: info@practiceplan.co.uk W: www.practiceplan.co.uk

Plotting your route to
successful practice
Following the launch of
our University of Chester
accredited programme
for practice managers,
we are delighted to
bring our practitioner
colleagues a Level 7
Postgraduate Certificate
for dentists accredited
by FGDP. These new
courses are available in
addition to our 5 day
modular
programme
BITE and 2 BITE-SIZED
1-day seminars for those
wanting to start a new practice, and those who want to make the most of their
existing practices. Naturally, we continue to work successfully with a range
of clients, helping prepare tender applications, acquire practices and solve
practice management issues for NHS and private practices. To find out more
visit us on stand A121 or call The Dentistry Business on 0161 928 5995 or email
at info@thedentistrybusiness.com

Experience A-dec Solutions at Liverpool
BDA Conference 20th-22nd May 2010
As one of the world’s leading dental
equipment manufacturers, A-dec designs,
builds, and markets much of what you see
in the dental treatment room. Our range
includes chairs, stools, delivery systems,
dental lights, cabinets and infection control
units along with a full line of accessory
options.
A-dec will be exhibiting at the 2010 BDA
Conference at the Liverpool Arena and
Conference Centre and look forward to the
opportunity of welcoming you to Stand
A74 to experience a selection of equipment packages including A-dec 300
and A-dec 500 ranges. We will also be demonstrating our range of innovative
cabinetry solutions as well as our latest integrated options.
We look forward to welcoming you to our stand and sharing with you the latest
A-dec solutions for the betterment of dentistry.
For further information about the A-dec range, contact us today:
Tel: 0800 233285 (freephone) or 02476 350901
Email: info@a-dec.co.uk

Astra Tech Launches New OsseoSpeed™ TX
implant – Find out more at the BDA Exhibition
Stand No. B121
Practice Plan will be making its mark at this
year’s annual BDA Conference and Exhibition, by
revealing all the unique components that makes us
the leading custom branded dental plan provider.
From our innovative in-house marketing agency and dedicated regional
support managers, to our educational workshops and invaluable consultancy
services, everything that we offer has evolved to ensure you can run your
practice the way you want to, with the support you need.
We’re firm believers in individuality and that your practice should belong to
you. That is why we make it our priority to help you develop a plan that fits into
your own unique brand and personality, and runs alongside your individual
practice’s ethos, image and goals.
You may just need to make a few tweaks, or perhaps you want to completely
transform your image? Whatever the case, our range of support services can
help you leave your own distinctive mark.
Visit us on stand A68, we’ll even have some of our customers at hand, so you
can hear straight from the horse’s mouth how we can help.
Contact details:
T: 01691 684135 F: 01691 684149
E: info@practiceplan.co.uk W: www.practiceplan.co.uk

Patient Plan Direct offer a simple and effective way to administer practice
branded dental plans. We offer one straightforward product bundle which
includes direct debit collection, enhanced dental accident insurance and a
secure administration system to view, create and service patient accounts.
Patient Plan Direct is expert in direct debit solutions and fully managed
payment schemes. Our business is founded on first class service and support
and we invest heavily in new technology.
Our product is very user friendly, it’s simple to administer and importantly, it
gives your dental practice more of the revenue generated from your patients.
Whether you have an existing plan and want to be aware of all your options or
you are considering implementing a new plan, Patient Plan Direct may have
the solution you are looking for.
Visit us on Stand A6 or visit our website; www.patientplandirect.co.uk for
more information.

[27] =>

BDA Show 27

United Kingdom Edition May 17-23, 2010

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

20% discount on the Diamond range of
Glass Ionomer Cements at the British Dental
Conference
Visit Kemdent stand A96 to take advantage of
the 20% discount on all Kemdent products,
including the Diamond GIC range.
Extensive research has helped Kemdent
develop a range of Glass Ionomer Cements
which allow dentists to perform various styles of
chairside treatments. Diamond Carve is available
in capsules and hand mix.
The firm, packable consistency of the Diamond
GIC range allows easy placement of the
materials.
This packable consistency of Diamond means that the restoration will set
quickly to a rock hard state. No light curing is required as the restoration is
chemically cured and rapid snap set into position. The restoration is completely
waterproof once the chemical snap set is complete.
Diamond Capsules are available in 3 shades and Diamond Carve/90 is
available in seven shades. Diamond GICs release fluoride to nurture a healthy
environment for the mouth at all times.
For further information on Kemdent products contact Helenor Jackie on 01793
770256 visit our website
www.kemdent.co.uk.

CEREC® 3D Systems
Why buy CEREC® from Ceramic Systems?
Looking to improve your profitability, then you
need CEREC® from Ceramic Systems the UK CEREC®
Specialists! Only Ceramic Systems can offer you:• Dedicated Service and Support Engineers
• Countrywide Product Specialists for pre and after sales support • Low cost
finance arranged for you • User meetings • Dedicated training facility
CEREC® enables Dentists to create high quality and durable chairside allceramic restorations in the most cost effective and efficient way. It is a
computer-aided method for creating precision fitting all-ceramic restorations;
saving Laboratory costs it enables Dentists to design and create all-ceramic
inlays, onlays, partial crowns, veneers and crowns for the anterior, premolar
and molar regions in one visit. The milling unit can be situated anywhere that is
convenient within the Practice, even as a fascinating eye-catcher in the waiting
room.
Combined with adhesive bonding techniques, CEREC® creates biocompatible,
non-metallic, natural-looking restorations from durable high-quality ceramic
materials in a single treatment session - without the need for provisional
restorations.
For further information, contact Ceramic Systems Limited on 01932 582930,
e-mail j.colville@ceramicsystems.co.uk or visit www.ceramicsystems.co.uk

Gain a Clearview of
Successful Orthodontic
Treatment with Clearstep
The team from Clearstep
will be at the BDA Annual
Conference 2010 to showcase the innovative orthodontic system that allows
clinicians to offer their patients an aesthetic solution to malocclusions.
Visitors to Stand A060 can learn more about the ‘invisible’ solution. Developed
by an expert orthodontist, the Clearstep System incorporates five key elements
that are combined into a treatment plan individualised for each patient.
Delegates will also have the opportunity to see the latest diagnostic support
tool provided by Clearstep.
Clearview is a computer-generated visualisation created from accurate 3D
scanning of the impression of the patient’s actual teeth. Clearview shows
how the predicted outcome will be achieved once treatment is successfully
completed.
Clearview is a simple way to create greater patient acceptance of the
treatment plan and represents another way Clearstep supports clinicians in
giving patients their perfect smile.
The BDA Annual Conference takes place in Liverpool’s ACC on 20-22nd May
2010.
For more information call the OPT Laboratory & Diagnostic Facility
On 01342 337910 or email info@clearstep.co.uk
www.clearstep.co.uk

Digital Imaging, laser dentistry, hi-tech
equipment and much more. . .
This year’s BDA Conference and Exhibition
gives Henry Schein Minerva the perfect
opportunity to showcase their range of surgery equipment as well as their new
specialist digital and laser division; Dental Innovations.
Hi-tech dentistry has a vital role to play in driving the profession forward to meet
the ever increasing demands of patients and the importance of embracing this
technology has never been more apparent than at the moment.
The launch of Dental Innovations demonstrates Henry Schein Minerva’s
commitment to understanding and reacting to the specific needs of high
tech dentists. The specialist division brings together advisors, engineers and
trainers, all with experience and in-depth knowledge of products ranging from
digital imaging solutions to state-of-the-art CADCAM technology.
You will also be able to obtain information about the full programme of
education courses being organised for 2010, designed to help you maximise
the potential of your practice.

Coltène Whaledent –
Stand A53
Coltène Whaledent is a
global leader in dental
consumables and small
equipment
covering
the
whole
dental
treatment process. A
leading developer and manufacturer of high-precision impression materials
and innovative, aesthetically-pleasing filling materials. Coltène Whaledent
has brought polymer chemistry-based impression and filling materials, a
broad range of high-precision mechanical instruments, dental pins and posts,
carbide and diamond burs, as well as the areas of hygiene and patient safety,
to a truly advanced level.
Actively involved in Post Graduate sponsorship, supporting Dental Student
education, Coltène Whaledent is held in high esteem by universities in the UK
and throughout the world with long-term commitment and close relationships
with the institutions and lecturers that provide dental education.
Visit the Coltene Whaledent stand for up to date offers and see our brand new
products. www.coltenewhaledent.com

Visit Stand B90 for more information on how Henry Schein Minerva can help
you develop your practice. Alternatively you can call 08700 10 20 41 or visit
www.henryschein.co.uk

Implants
BioHorizons go Gold at the
2010 EAO meeting
Leading implant company,
BioHorizons, are pleased to
announce their gold sponsorship at this year’s European Association for
Osseointegration (EAO) conference in Glasgow on 6th-9th October. Held at
the Scottish Exhibition Conference Centre, this year’s annual event is focussed
on Clinical Controversies in Implant Dentistry and involves a diverse four day
lecture and workshop programme.
With multiple parallel sessions, master classes, short oral communications,
basic and clinical research and poster competitions, together with a series of
pre-congress ‘step-by-step’ courses, there really is something for everyone.
Topics include Aesthetics: Clinical Guidelines, CAD-CAM in Implant Dentistry,
Possibilities for Conventional Dental Treatment and Sinus Surgery.
BioHorizons is one of the fastest growing oral reconstructive device
companies in the world as a result of their commitment to providing the most
comprehensive line of evidence-based, scientifically-proven dental implants
and tissue regeneration solutions.
BioHorizons customers attending the EAO can register for a special drinks
reception on Thursday 7th October. For more information please contact
Heather Wagstaff on 01344 752560 or infouk@biohorizons.com or visit www.
biohorizons.com.

How Clean is Your Surgery?
Can you guarantee that your surgery is germ free?
The Saniswiss biosanitizer automate from Bambach
will disinfect your entire surgery overnight at just
the press of a button.
This surgery atomiser dispenses the revolutionary
Saniswiss biosanitizer directly into your surgery.
Being airborne Saniswiss biosanitizer will get to all
of those hard to reach areas efficiently and effectively.
To take full advantage of a deeply cleaned surgery carry out your usual
disinfecting routine throughout the day; before you leave in the evening
activate the Saniswiss biosanitizer automate. A fine mist is dispensed from the
Saniswiss biosanitizer automate, which combines with the oxygen in the air to
give a 100% guarantee of a perfectly disinfected surgery.
From as little as 60p a day put your mind at rest with Saniswiss biosanitizer
automate from Bambach and see how clean your surgery really is. Bambach
are offering a 5 day free trial complete with a petri dish kit so that you can see
the effectiveness for yourself before and after use.
To find out more please call 0800 581108, e-mail info@Saniswiss.co.uk or visit
www.Saniswiss.co.uk

Surgical Success from NSK
Market leaders in high-quality
turbines, handpieces and
small equipment, NSK’s range
of micromotors and ultrasonic
systems meet the primary
requirements
for
today’s
surgical procedures.
NSK’s surgical micromotor,
Surgic XT Plus, incorporates the unique Advanced Torque Calibration (ATC)
which effectively calibrates the micromotor to the rotational resistance of
the individual handpiece, offering optimum torque and speed settings and
ensuring accurate, safe and smooth operations.
NSK’s powerful VarioSurg is the first choice for ultrasonic surgery as it’s versatile
enough to be used in bone surgery and sinus lifts. Strong, precise cutting
power is enhanced with the TiN (Titanium Nitride) coated bone cutting tips,
leaving a surface that aids bone formation and helps control exacting surgical
procedures.
For more information call Jane White at NSK on 0800 6341909 or 01438
310670, or visit www.nsk-uk.com

All-on-4: Combining predictable treatment
results with affordability
The rehabilitation of the edentulous maxilla and the
mandible always presents a challenge for dental
professionals, however, the All-on-4 system from
Nobel Biocare helps provide predictable results for
even the most challenging case.
The revolutionary All-on-4 procedure is based on
placing two straight anterior implants and two angulated posterior implants to
avoid the sinus nerve but at the same time reduce the cantilever.
Unlike more traditional procedures that may necessitate the complete
rehabilitation of the upper and lower jaw, the fast and efficient All-on-4 system
allows practitioners to provide patients with a faster, less traumatic procedures
and a speedy recovery.
Benefits of the system include:
• No complicated bone grafting procedures required • No sinus lifts required
• No nerve repositioning required • Limited/shorter cantilevers on posterior
implants
Additionally, All-on-4 also offers a significant financial advantage to both
patients and professionals. Ideally suited to be offered as a practice’s second
system, All-on-4 provides a wider range of patients a brilliant solution to
traditional implant treatment, at an affordable price.
For more information on All-on-4, contact Nobel Biocare on 01895 452 912, or
visit www.nobelbiocare.com

Straumann - delivering
value for money and peace
of mind!
Over the past 30 years
Straumann have developed their implant dentistry portfolio on a scientific
foundation and continuously increase treatment safety, while suppliers of
cheap implants are exclusively sales-oriented organisations with a short-term
outlook.
It is not uncommon for low-price players to promote their products with price
differences by comparing their products against the most expensive, highend premium solutions. For instance, one cheap manufacturer may compare
the price of its undocumented, second-generation surface with the price of
Straumann’s third-generation hydrophilic SLActive® surface.
Without clinical substantiation, low price implants simply have no claim to
equivalence. Even when it comes to simple design features and finish, the
claim that a cheap implant is an equivalent alternative must be based on
comparative long-term data to support it, which often is not the case.
Straumann offers great flexibility, for example in terms of prosthetic range
and planning – with simple handling and workflow. These are just two of many
elements of their value proposition, which, together with Straumann’s lasting
quality and service, explains why Straumann is a premium implant solution.
For more information about the Straumann Dental Implant System visit www.
straumann.com

Referrals that you can rely on
The highly skilled team at the
Kent Implant Studio, located
on Northumberland Road in
Maidstone, understand the importance of a reliable referral practice, and are
dedicated to providing the very best service to both you and your patients.
Lead by principal dentist Dr Shushil Dattani BDS, MFGDP(UK), DipImpDent
RCS (Eng), the team understands that as a busy professional you need to be
confident in your referral practice, and as such will do all they can to ensure
that you are well informed about all aspects of your patients treatment.
Treatment can be carried out either at the Kent Implant Studio, or if you and
your patient prefer, at your own practice. Keen to work as an extension of you
team, Dr Dattani is happy to carry out as much or as little of the treatment as
necessary.
The Kent Implant Studio relies on the support of referring practitioners, and
does all it can to ensure that referring practitioners are happy with the service
that both they and their patients receive.
For further information on the Kent Implant Studio or to
obtain a referral pack please call 01622 671 265,
or visit www.kentimplantstudio.com

[28] =>

28 Implants
Dr. Carl E. Misch
brings Implant
Course to London
with BioHorizons
This October will
see the first of a
four session implant programme in London with Dr. Carl E. Misch. Held at the
Hilton London Metropole, this hugely popular twelve-day programme covers
all aspects of surgery and includes hands-on workshops.
Chris Netherclift, General Manager of BioHorizons UK on this highly anticipated
course:
“We are delighted to be sponsoring such an important event in UK Implant
Dentistry. Dr Carl Misch is world renowned as one of the most influential
Implantologists of our era and we are excited that London will be hosting this
first European edition of the course. For anyone placing implants or looking
to get into this highly specialised area of dentistry this really is a course not to
be missed.”
Completion of the twelve day course includes a Certificate of completion from
the Misch International Implant Institute® and a copy of Dr. Carl Misch’s book
‘Contemporary Implant Dentistry, 3rd Edition’.
This highly anticipated course will sell out quickly so to register your interest
or to book now please contact BioHorizons, the courses sponsor, on Tel: +44
(0)1344 780380 or email Cindy Matejic at cmatejic@biohorizons.com.

United Kingdom Edition May 17-23, 2010

Looking at Cone Beam Technology!
Digital Dental have the range to suit every
requirement and budget.
Digital Dental offers a complete range of cone
beam digital imaging systems.
The entry-level Uni-3D is a combined panoramic
and small FOV cone beam CT system which can be
upgraded with a one shot Ceph for orthodontic
applications. It has been designed for the multidisciplinary practice which carries out implant
dentistry.
Top-of-the-range, the Reve 3D is the first system
to offer Free FOV ranging from 5cm x 5cm to
15cm x 15cm. This further extends the range of
diagnostic capabilities and includes various default values for greater operator
convenience.
All of the systems automatically switch between the panoramic and CT sensor
and can replace your existing OPG – enabling you to scan every type of image
without the need to purchase more than one device.
The 3D images are viewed with the powerful EZ3D software. They deliver all
the anatomical information for single up to full arch implant placement, and
are ideal for precise endodontic, orthodontic and periodontal diagnoses.

Groundbreaking new
technology unveiled at
BioHorizons Symposium
Continuing
their
2010
International Symposium series, BioHorizons are pleased to announce Antalya,
Turkey on 24th – 25th September as the next venue. Held at the spectacular
The Mardan Palace, the two days promise to be of great interest to all dentists
interested in implantology. Tuition costs €500 which not only includes the main
programme of lectures but also lunches and a Gala dinner on the Saturday
night to socialize with your colleagues and the presenters. Preferential room
rates for attendees have been negotiated with the hotel.
BioHorizons 2010 Symposium in Turkey features an impressive line-up of
renowned international speakers addressing current trends in implant
dentistry and unveiling groundbreaking new technology. Speakers include
Marius Steigmann, Maurice Salama, Jack Ricci, Givi Ordzhonikidze and
Abdelsalam Elaskary.
By balancing the core values of Science, Innovation, and Service, BioHorizons
delivers a strong competitive advantage that supports dental reconstructive
practices.

For further information call Digital Dental on 0800 027 8393, email sales@
digitaldental.co.uk or visit www.digitaldental.co.uk.

Please register now to reserve your place at this outstanding educational event.
To register please contact your Product Support Specialist or BioHorizons
directly on 01344 752560, email: infouk@biohorizons.com or visit our website
at www.biohorizons.com

Nusonic NAC for effective instrument
decontamination
Blackwell Supplies understands the central role
decontamination plays in today’s dental practice
and offers Nusonics, an advanced cleaning solution.
Nusonic is a general purpose, non-ammoniated
cleaning solution designed for use in ultrasonic
cleaners. The advanced formulation provides
dental practitioners with an efficient method of not only cleaning instruments
effectively, but also brightening and degreasing.
Nusonic comes complete with an in-built rust inhibitor, to ensure the
longevity of instruments whilst decontaminating effectively.
Available in both 1 and 5-litre amounts, the concentrate is designed to be
diluted to meet specific cleaning needs, for convenient and economical
provision of the highest standards of infection control.
As one of the country’s leading suppliers of specialist products to the dental
profession, Blackwell offers Nusonics as the solution to effective instrument
decontamination.
For more information please call John Jesshop of Blackwell Supplies
On 020 7224 1457, fax 020 7224 1694
Or email john.jesshop@blackwellsupplies.co.uk

Celebrate with Smile-on at the BDA’s
Annual Conference 2010
Join Smile-on in celebrating 10 years of
innovation at the BDA Annual Conference on stand A12.
For the last ten years, Smile-on has continued to help dental professionals
meet their CPD obligations, providing courses that are flexible, involving and
inspirational. Busy practitioners can log on to the company’s website which is
specially focused on users’ core CPD.
Smile-on will be on hand to talk to delegates interested in the MSc in
Restorative and Aesthetic Dentistry which is in conjunction with the University
of Manchester, CORE CPD - the latest learning platform that looks after all
your core subject needs and DNNET II which is designed to help dental
nurses studying for the National Certificate or the NVQ level 3 in Oral Health
Care Dental Nursing, but also serves as a great refresher course for more
experienced nurses.
The company’s key values of partnership, imagination, innovation, creativity
and potential have helped evolve the products from simple training courses
into the multi-media learning platforms of today and helped Smile-on become
the source for cutting edge software and training resources. Happy birthday
Smile-on!
For more information call 020 7400 8989 or visit www.smile-on.com

Listerine Total Care helps your
patients
to improve their oral health
Listerine Total Care mouthwash
offers six proven oral health
benefits. Not only is it clinically proven to reduce plaque by up to 56 per cent
compared to brushing alone1, it helps maintain healthy gingivae, strengthens
teeth against decay, helps to reduce calculus, kills bacteria and freshens breath.
Listerine Total Care contains a fixed combination of four essential oils – thymol,
eucalyptol, methyl salicylate and menthol – which provide anti-microbial
action proven to reduce plaque development1. Listerine quickly penetrates
the plaque biofilm resulting in bactericidal activity helping to protect against
recolonisation of dental surfaces2.
As the average brushing time in adults is only 46 seconds3, and only 20
per cent of the population perform acceptable flossing4, it is increasingly
important for patients to use a mouthwash as part of their daily oral care
routine, to enhance the mechanical removal of plaque, especially in hard-toreach areas.
For more information on helping your patients with Listerine Total Care, for
samples and a copy of a Patient Information Leaflet, please contact Johnson &
Johnson on 0800 328 0750.

Quicksleeper
2010 Hands On Training Sessions Now Taking
Bookings
General Medical are UK Distributors for Quicksleeper, the
computer controlled local anaesthetic system that delivers
profound anaesthesia quickly, easily and painlessly. They
will be running Hands On Training Sessions in Glasgow
( Friday 18th June ), Edinburgh ( Saturday 19th June ),
Southampton ( Friday 17th September), Bath
( Friday 24th September), Hornchurch ( Friday 1st October), Birmingham (
Friday 15th October ), Manchester ( Friday 19th November) and Barnsley (
Friday 26th
November ).
Quicksleeper enables Dentists to perform Osteocentral Anaesthesia whereby
a small amount of conventional local anaesthetic is placed in the spongy
bone in between teeth. Eliminating the need for painful infiltration, block and
palatal injections it delivers a profound anaesthesia almost instantaneously; a
real Practice Builder, especially when treating children and other potentially
nervous patients.
Using Quicksleeper it is possible to anaesthetize between 2 and 8 teeth with
just one injection without the need for additional palatal or buccal injections –
enabling more treatment to be performed per session.
Places are strictly limited so to book your place contact General Medical on
01380 734990, visit www.generalmedical.co.uk or email info@generalmedical.
co.uk

Vitablocs®-the bedrock of
Cerec© success for over
20 years.
Cerec© milled Vitablocs
Mark II restorations have
it all: Strength, durability
and beautiful aesthetics.16
Millions restorations over 20
years, Gold Standard survival
rate of 90 % after 10 years,
and 84.4% after 18 years for
inlays, Vitablocs Mark II are
a success story all round.
Patient and Dentist satisfaction are guaranteed. Easy to work with, time saving,
and with reduced wear on grinding tools, Vitablocs® Mark II can be just simply
polished or stained and glazed, if customisation is required. If you are using
Cerec or you are looking at using Cerec, think Vitablocs®!

Improving Periodontal
Health with Colgate Total
Toothpaste
Maintaining an effective
level of plaque control is a
challenge for most individuals.
The published consensus on
evidence-based advice for
improving periodontal health

General

NEW! Vita Triluxe Forte the several layers coloured feldspathic ceramic block
from Vita.
For more information and a FREE Sample of Vitablocs® MARK II or Triluxe Forte
block, call Panadent 01689 88 17 88 or visit www.vitablocs.com

Hogies Galilean and Prismatic
operating loupes for superior
magnification
Blackwell Supplies is proud to offer
dental practitioners the Hogies range
of operating loupes.

Just Dental Supplies is a UK supplier of dental products who aim to offer
Quality, Value and Choice. Just Dental Supplies are now the official distributors
of DentKist, a leading Korean manufacturer of quality dental materials.
The range offers quality restoratives including CharmFil® Plus a light curing
Nano Microhybrid Composite which is highly polishable, easy to work with
and has very low shrinkage. CharmFil® Flow also available is a highly flowable
composite resin. Its hardness and elasticity make it ideal for small cavity fillings.
In addition to DentKist composites, Just Dental Supplies also supply the
popular CharmFlex® Addition Cured Silicones suitable for crowns, bridges,
inlays and dentures. CharmFlex® is available in cartridges, tubes and jars and
like all Just Dental products, offers value for money.
Current offers include a free syringe of CharmFil® Flow, with a purchase of
the CharmFil® Plus Composite Kit, consisting of: 4 x 4g Nano Microhybrid
Composite Syringes, 1 Etch, 1 Bond, Microbrushes and accessories all for just
£49.95.
To purchase this exciting range of dental materials visit: www.
JustDentalSupplies.com or call 0845 199 9931

Hogies Galilean operating loupes provide 2.5X magnification with a working
distance of up to 500mm with the added advantage of being ‘flip-up’ for
efficient clinical workflow.
A convenient and versatile operating loupe, the Galilean is ideal for general
practice use. Popular for endodontic procedures is the Prismatic operating
loupe, available with either 3.5X or 4.5X magnification.
Both Galilean and Prismatic operating loupes utilise Hogies patented
magnetic technology provides for fully integrated and adjustable:
• Prescription lenses • Eye protection • Extreme declination angles • All
interpupillary distances • Height of presentation of loupes to the eye
Hogies has an established reputation for delivering high quality magnification
equipment, and Blackwell Supplies is one of the UK’s leading providers of
products to the dental profession.
For more information please call John Jesshop of Blackwell Supplies
On 020 7224 1457 or fax 020 7224 1694

focuses on the key role of daily oral hygiene.1
‘Delivering Better Oral Health – An evidence-based toolkit for prevention’1
guidance is supported by varying levels of evidence, from level 1 which is
‘strong evidence from at least one systematic review of multiple, well designed
randomised control trials’, to level 5 evidence that is the consensus opinion of
a group of experts.
Colgate Total toothpaste is for everyday use. It contains a unique combination
of triclosan, an antibacterial agent, along with a copolymer.
In addition to patient samples, Colgate have a number of resources to support
patient recommendation of Colgate Total toothpaste, these include a waiting
room poster for your practice to encourage your patients to seek advice from
you on how to improve their gingival health, along with a patient information
leaflet entitled ‘Helpful tips to keep your gums healthy’ to help you in your
patient education.
For further information or to request patient samples, please call the Colgate
Customer Care Team on 01483 401 901.

BACD Belfast Study Club
Dental professionals in Northern
Ireland and the Republic of Ireland
have a unique opportunity to gain
valuable guidance from one of
the UK’s leading dental business
consultants.
’10 Top Tips to Survive and Prosper
in the Next 10 Years’ is the title of the
BACD Belfast Study Club event to be held on Wednesday 27th October 2010.
Chris Barrow in a consultant, trainer and coach for with a wealth of experience
in helping dental professionals succeed in their lives and businesses.
During the evening event, Chris aims to:
• Look forward over the next 10 years of dentistry
• Identify likely winners and losers in the professions
• Suggest business models that will survive and prosper
Open to both members and non-members of the BACD, attendees will gain
an insight into the current market for dentistry and current trends in dental
products and services.
The BACD is committed to excellence and this event will help motivate dental
professionals in achieving their potential.
For more information or a booking form please contact Suzy Rowlands on
0208 241 8526 or email suzy@bacd.com.

[29] =>

Events 29

United Kingdom Edition May 17-23, 2010

A break from the norm

If you want the opportunity to get out of your comfort zone, why
not try a Bridge2Aid fundraising challenge?

B

ridge2Aid is on the lookout for adventurous supporters to make a real
difference this year and next; so
whether you want to volunteer
your time on the Dental Volunteer Programme, or fancy living
a ‘life less ordinary’ by jumping
from a perfectly good plane in a
tandem skydive – there is something for you!
“There are so many great opportunities available now,” said
CEO Mark Topley. “Whatever
the financial trends bring, we
have a commitment to working
with the poor and marginalised
in Tanzanian society, and we
want to continue making a difference. To achieve this, we need
the continued support from individuals, companies and practices in the UK, and we want them
to have as much fun as possible
along the way!”
How can you help?
Well, the following challenges exist for the adventurous out there:
Tandem skydive (12 June),
Nightrider cycle around London
(19 June), It’s a Knockout (3 July),
London 10k (11 July), Climb Kilimanjaro (1-11 October).
In other practical ways,
Bridge2Aid can benefit if you:
1. Recycle your ink cartridges,
toners and mobile phones with
The Recycling Factory (www.
therecyclingfactory.com)
2. Host a dinner party and raise
money with Dinner4Good
(www.dinner4good.com)
3. Purchase goods online by
first visiting www.buy.at/
bridge2aid
4. Change your internet search
engine to Everyclick (www.
everyclick.com)
If you would like to support
Bridge2Aid and find out more
about any of these opportunities, please contact fundraising
co-ordinator Kerry Dutton on
07881 912060, or email kerry@
bridge2aid.org. For other ways to
support Bridge2Aid, please visit
www.bridge2aid.org
About the charity
Bridge2Aid (B2A) is a dental and
community development charity
working in the Mwanza region of
North West Tanzania. We started
full scale operations in 2004 and
work closely with the Tanzanian
Government to deliver aspects of
their dental strategy. We operate
a not-for-profit dental clinic in
the city of Mwanza (Hope Dental
Centre), and have a community
development programme for the

disabled community based at Bukumbi Care Centre.

long-term. The four key aspects
of Bridge2Aid’s vision are:

• To provide primary dental
Our focus is sustainability –
msc_ad_source_uk.pdf
15:21:59
care and
oral health education
empowering
local people to1 im-03/08/2009
to communities in Tanzania
prove their own lives over the

• To train local health personnel
to provide emergency dentistry
to rural communities
• To care for and empower the
poor and marginalised in Tanzanian society

skydive for charity with Bridge2Aid

• To provide opportunities for
UK dental professionals and
others to use their skills to
serve Tanzania, as locums or
participants on the Dental Volunteer Programme (DVP) DT

[30] =>

30 Events

United Kingdom Edition

May 17-23, 2010

On tour Down Under
UK orthodontists journey to Australia in a bid to
promote London as host to the 8th International
Orthodontic Congress in 2015

F

rom February 6-9 2010,
orthodontists from more
than 100 countries and
100 internationally renowned

speakers gathered in Sydney,
Australia, for the 7th International
Orthodontic
Congress (IOC). A contingent of

around 150 British orthodontists was among those who
travelled Down Under and one
of the largest international

Countdown to the London 2015 International Orthodontic Congress

groups represented at the conference. Spearheading the British delegation was the Organising Committee of the 8th IOC,

which is charged with bringing
the next World Congress to London in 2015.
Starting the countdown
The Committee from the British
Orthodontic Society was there to
start the countdown and promote
London ahead of 2015. As part of
the flag-waving initiative, the Society hosted a BOS Village Day at
the Congress during which four
international and eight leading
UK speakers took to the rostrum
in front of a full auditorium. The
Society also hosted a buoyant and
exuberant cocktail party, which
was graced by the majority of UK
delegates and a number of distinguished invited guests from the
world orthodontics.
The BOS encouraged delegates to visit its ‘patriotic’ exhibition stand from which it gave
out branded red London bus key
rings featuring a newly created
London 2015 logo and the URL
of a new website – www.wfo201-5london.org – which went
live on the final day of the convention. Such was the popularity of
the key rings, 4,000 were snapped
up in two days and were seen dangling from practically every conference rucksack.

Perfect Bleach
1HƂEG

THE EFFECTIVE CHAIRSIDE
WHITENING GEL
r QuickMix syringe for easy, automatic mixing without waste
r Visible whitening results after only approximately 10 minutes
r A genuine concentration of 27 % hydrogen peroxide even after mixing
r Special tips for precise application for all endo bleaching treatments

NEW LAUNCH

During his presentation at the
conference, Dr Jonathan Sandler,
the Chairman of the 8th IOC, explained that there couldn’t be a
better time to visit London: “After
staging the 2012 Olympics, London will have the infrastructure
and stature to put it on a world
footing. 2015 also looks like being a bumper year for London. It
is hosting the Rugby World Cup
at the same time as the World
Orthodontic Congress, so if you
are a fan of the game, there could
be no better time to be in London – in fact you might consider
combining your professional and
sporting interests.”
For more information, visit
www.wfo2015london.org. DT

VOCO GmbH · P.O. Box 767 · 27457 Cuxhaven · Germany · Tel. +49 (0) 4721 719-0 · Fax +49 (0) 4721 719-140 · www.voco.com

VOCO_DTI-UK_1410_PerfectBleachOffice_210x297
29
97..indd
in
nd 1
nd

Home from home
The stand became a home from
home for the British delegation,
which turned up to take tea, and
refuge on the Union Jack bedecked sofas. On a large plasma
screen, the BOS showed a specially recorded interview with London Mayor Boris Johnson who
encouraged delegates to visit London and explore the many benefits of the UK capital. Every day
there was also a chance for delegates to win a digital photograph
frame, featuring scrolling pictures
of London.

03.05.2010
03.05
3.05
1

[31] =>

Classified 31

United Kingdom Edition May 17-23, 2010

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

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

for Dentists

+44 (0) 1403 780 770

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

MPMS 95x50 Dentists.indd 1

11/12/2006 21:56:19

To advertise here please contact Sam Volk on

0207 400 8964

[32] =>

PE

F

GU

E

X

YEARS O

RTISE

C

SODY

L

OR

M CARE

DUAL CARE FOR
GUMS AND TEETH

CORSODYL DAILY GUM & TOOTH PASTE IS DIFFERENT
FROM REGULAR DENTIFRICES
The only formulation to contain
sodium bicarbonate, 1400 ppm
fluoride and six natural plant
extracts

Over 67% of the ingredients are
for the care of gingiva and teeth
– compared to 25% in many
other regular dentifrices

Free from sodium lauryl
sulfate – suitable for patients
using 0.2% chlorhexidine
digluconate mouthwash

Corsodyl Daily Gum & Tooth Paste is a clinically proven dentifrice,
which can kill bacteria that can cause gum disease1.
With regular brushing, it helps maintain firm and tight gums and a low gingival index2.

Recommend Corsodyl Daily Gum & Tooth Paste
because teeth need gum care too
References: 1. Arweiler N, Auschill T, Reich E , Netuschil L. Substantivity of toothpaste slurries and their effect on re-establishment of the dental
biofilm. J Clin Perio 2002, 29, 615-621. 2. Yankell SL, Emling RC. Two month evaluation of Parodontax dentifrice. J Clin Dent 1988 Suppl A, A41-3.

CORSODYL is a registered trade mark of the GlaxoSmithKline group of companies.

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[cover] => DT UK 1310

[toc] => Array ( [0] => Array ( [title] => Dentistry minister loses seat in General Election [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => News & Opinions [page] => 07 ) [3] => Array ( [title] => What keeps your patients coming back for more? [page] => 09 ) [4] => Array ( [title] => Touting your wares [page] => 10 ) [5] => Array ( [title] => Implant Tribune [page] => 11 ) [6] => Array ( [title] => Learning Curve [page] => 24 ) [7] => Array ( [title] => Protecting the profession [page] => 25 ) [8] => Array ( [title] => Industry News: BDA Show [page] => 26 ) [9] => Array ( [title] => Industry News: Implants [page] => 28 ) [10] => Array ( [title] => Events [page] => 29 ) [11] => Array ( [title] => Classified [page] => 31 ) ) [toc_html] =>

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