DT UK No. 4, 2011

The only constant is unforeseen change / News / Wear one short sleeve and one long / ‘We are all worms. But I believe that I am a glow-worm’ / Implant Tribune / It is not all about mouths you know / SEM evaluation of morphological changes / Implants / ADI Team Congress - Manchester / Classified

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February 14-20, 2011

PUBLISHED IN LONDON
News in Brief
Dentist of Facebook
Mark Zuckerberg’s father Dr
Edward Zuckerberg, a dentist, said in a recent radio
interview that an early exposure to computers inspired
his son’s interest in technology. Edward Zuckerberg said
he computerised his offices
in 1985 and his son Mark
Zuckerberg, cofounder of
Facebook, was born in 1984
and was raised in the house
where his father’s dental offices are located. The dentist majored in biology in
college and said he has “always been technologically
oriented in the office” and
“always had the latest hightech toys,” including an early
Atari 800. “It came with a
disk for programming,” he
said. “I thought Mark might
be interested and I imparted
that knowledge to him. From
there it took off.” Zuckerberg
said he uses Facebook to promote his dental practice and
spends about an hour a day
on the site. He also still does
Mark’s “routine dental care.”
Civil war dentistry
A full civil-war dental surgeon’s kit is currently on
display at the Rosenburg Library Museum. Historians
are of the opinion that the kit
was owned by a Confederate
soldier and contained more
than 50 items, including dental elevators, picks and some
rather grisly looking forceps,
all contained in a handmade
rosewood box. It was manufactured in New York by John
D. Chevalier, a dental supply
house with a history stretching back to 1833. It is unusual
to have such a complete and
well-preserved dental kit and
historians have discovered a
surprising amount of information about mid-19th century dental care and it has
allowed an insight into the
nation’s health of the 19th
century. The dental surgeons
kit in question was donated by
Clark Hazlitt in 1949, Hazlitt
had bought the kit from the
estate of W.T. Armstrong.
Armstrong (1864-1949) was
an attorney and dean of the
Galveston Bar was a board
member of the library from
1905 to his death in 1949.
IDH, ADP in merger deal
Private equity company Carlyle has bought Integrated
Dental Holdings (IDH) for
£450m from the buy-out division of Bank of America Merrill Lynch and is planning
to merge it with Associated
Dental Practices (ADP).The
deal will create the biggest
dental group in the UK, with
control of around 450 private dental practices, treating more than 3.5m patients.
www.dental-tribune.co.uk

News

Practice Management

Cheap treatment

Dental Tribune reports on
dental tourism

page 4

“I am a glow worm’’

Sharon Holmes on knowing the
MDD

VOL. 5 NO. 4
Implant Tribune

Clinical

Morphological changes

Form and function

Michael Sonick details a case of
aesthetic management

page 8

Georgi Tomov discusses hard
dental tissues

pages 11-12

pages 25-27

The only constant is
unforeseen change

Minister for dentistry looks to the future in keynote speech

T

he minister responsible
for dentistry took to the
stage to urge dentists to
embrace change in a keynote address to Foundation Dentists and
trainers.
Earl Howe (pictured), Parliamentary Under-Secretary of State
for Health and, made the speech
at the Career Opportunities for
UK Dentists Conference, held in
London earlier this month.
Addressing a packed auditorium, Earl Howe gave a rallying
call for dentists to be involved in
the political process surrounding the latest wave of changes in
dentistry: “You are the future of
the dental profession and all of
you need to understand and be
engaged in the development of
policy in the area for which you
have been trained.
“I am aware that there has been
lots of change in dentistry in the
last few years, and I’m sure many
of you must be wondering what
sort of opportunities there are
for you once you had graduated
from your dental schools. Looking around the room I see a few
more mature heads scattered
about, and I’m sure that they will
tell you that paradoxically one of
the few constants in life is un-

foreseen change. It is how you
respond to those changes that it
is crucial - some people see it as
an opportunity, others see it as a
threat – but it a constant feature
in the world of medicine and
dentistry as it is throughout the
world of work.”

cially for the first times outcomes
for primary care dental services.
We are very grateful for the cooperation we have been receiving from the dental associations
and clinicians from all fields
in dentistry in developing high
quality indicators.

Discussing the proposed
reforms to the current dental
contract Earl Howe said: “As
dentists you will be dealing with
dental conditions that are varied,
changing in nature and changing in prevalence. The way you
provide services and patient
management has to constantly
evolve to align with changes in
people’s health and improvements in methods of treatment
and technology.

“It’s complex and challenging
work but I’m sure that there will
be a need for indicators to evolve
with experience. It’s vital to the

“We know that the currency
of any contract has significant
impact on the nature of services
delivered. Historically, dentists
pay was based on an item of service methodology. At a time when
we know that the prevalence of
active dental caries is decreasing
most reasonable people would
agree that it would be perverse to
continue to relate remuneration
to activity. But it’s vital that not
only do patients get the most appropriate treatment and dentists
are appropriately rewarded; but
also that taxpayers get value for
money for their investment.
“The coalition government is
committed to introducing a new
dental contract based on the three
elements of registration, capitation and quality. We are keen to
develop quality indicators for use
in monitoring services and cru-

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morale of the profession and the
satisfaction of your careers that
we get them right and we keep
their roles under review.”
Earl Howe added: “The world
you are entering is now significantly changing – and changing
for the better. As minister I am
committed to both sustaining that
change and making sure that the
direction of that change is correct
and positive.” DT

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[2] =>

2 News

United Kingdom Edition February 14-20, 2011

Free toothpaste for families, experts say

ental health experts are
calling for radical plans
to be implemented to
halt rising rates of child tooth
decay. Dr Gill Davies and Dr
Colette Bridgman, dental public health specialists who work
for Manchester’s NHS primary
care trust, want a new approach
to tackle the growing number
of children, some as young
as three, who have to undergo
painful extractions.
Writing in the British Dental
Journal, they demanded that parents play the key role in getting
their offspring into good dental
hygiene habits from soon after
they are born by not giving them
high-sugar foods and drinks, ensuring they have regular checkups and cleaning their teeth
regularly.
They also want schools to
stop rewarding students who do
well with chocolate; child-mind-

ers and nursery staff to ensure
that toddlers brush their teeth
twice a day; and a big increase in
the number of children receiving
fluoride varnish.
To halt the rising rates of
child tooth decay, dentists are
saying that not only should families receive free toothpaste and
toothbrushes and parents told
not to sweeten babies’ feeding
bottles, but pupils should also be
banned from sharing birthday
cakes with friends at school.
“It is the parents who have
influence over food and diet
choices, purchasing and use of
toothpaste and the making of appointments for dental care,” they
write. “How many children are
likely to insist that no more biscuits or sugary drinks be bought
for a household?”
Given that only 10 per cent of
the UK has fluoridated water, the

authors want other steps taken,
such as:
• Children using family fluoride
toothpaste, not children’s toothpaste, which is low in fluoride
• Schools and nurseries to stop
giving children fruit squash at
snack times
• Every schoolchild to have fluoride varnish painted on their
teeth at least twice a year. Currently less than 15 per cent do so
• “Meet the dentist” sessions at
primary schools
• An end to the practice of sharing birthday cakes at schools
Their recommendations draw
on the success of the Manchester Smiles dental health campaign which began last year.
Under it, 6,000 pupils at 80 primary schools have supervised
brushing sessions twice daily
and dental practices are “buddied” with schools. Under a different scheme, 200,000 families
in Manchester have received

free toothpaste and toothbrushes
since 1999, a plan that Davies
and Bridgman believe should be
extended nationally.
The Department of Health
said: “The government has
wasted no time in setting out

its plans to improve dental services. At their heart is improving preventative care for children. They need a service that
helps them maintain good oral
health and prevents decay, rather than one that is based solely
on treatment.” DT

Experts want birthday cakes to be banned in schools

Dentist removed after diagnosis concerns

he chairman of the Assembly’s health committee has said Health
Minister Michael McGimpsey
will face “difficult questions”
after the removal of a senior dental consultant from his
job at Belfast’s Royal School
of Dentistry.

After a review of senior dental consultant Professor Philip
Lamey’s work, the Belfast Trust
has recalled 117 people as a “a
precautionary measure” following concern about the late

diagnosis of cancer found in
some patients.
Four patients have since
died; however the Belfast Trust
will not confirm whether a late
cancer diagnosis may have contributed to their deaths.
Health Minister Michael
McGimpsey is expected to make
a statement to the Assembly in
relation to the dentist’s work
and he is also due to meet with
the chair of the health committee, Jim Wells.

Mr Wells said the 117 patients involved “deserve serious
answers from the Belfast Trust.”
“This simply isn’t good
enough. The committee will be
asking very searching and difficult questions,” he said.

ation
was
affecting
him.
Reports said that the patient,
who remains anonymous, said
it was “very worrying”.

Dr Lamey is due before a
hearing of the General Dental
Council in London on 9 July.

“Until Monday morning
when I go to my appointment
and the follow-up, I’ll not know
for sure. This condition hasn’t
gone away, it’s very upsetting
not only for me but for my family,” reports stated him saying.

One of the patients recalled by the trust told BBC
reporters
how
the
situ-

According to reports, Trust
Medical Director Dr Tony Stevens said problems with the

care administered by the dentist came to light in late 2009;
however he was not removed
from his post until the end of
last year. Even though he is no
longer treating patients he is
still employed by the trust. Dr
Stevens said anyone who needs
to be contacted has already
been sent a letter.
The trust is also providing a helpline, which received
between 40 and 50 calls at
the weekend. The telephone
number is 028 9063 6330. DT

Training centre opens at Portsmouth University

new £9 million purpose-designed facility to
train dental care professionals and final-year undergraduate dentists was officially
opened by Health Minister, Earl

Published by Dental Tribune UK Ltd
© 2011, 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
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.com

Howe at the University of Portsmouth’s Dental Academy.
Supervised by tutors, dental
students will work with hygiene
therapists and dental nurs-

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.

Sales Executive
Sam Volk
Tel: 020 7400 8964
Sam.volk@
dentaltribuneuk.com
Editorial Assistant
Laura Hatton
Laura.hatton@dentaltribuneuk.com

Design & Production
Ellen Sawle
ellen@dentaltribuneuk.com
Clinical Editor
Livui Steier

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

ing students, as they would in
practice and provide free treatment for 2,000 local people every year.
The new centre has 20
additional dental chairs, radiography facilities, a state-of-theart instrument decontamination centre as well as seminar
rooms.
Each year, 80 final year
students from King’s College
London Dental Institute will be
trained alongside dental nursing students from Portsmouth.
Development of the new
building has been enabled by
capital funding support from
the Department of Health, the
local NHS and the Higher Education Funding Council for
England (HEFCE).
Earl Howe, who is the Min-

ister with lead responsibility for
Dentistry, said: “I was delighted
to see the high quality hands-on
training provided at Portsmouth
Dental Academy today.
“As set out in the NHS White
Paper, we are committed to
improving oral health for adults
and children as well as increasing access to NHS dental
services across the country. The
University of Portsmouth Dental Academy has an important
role to play in delivering on
this agenda. They are providing
first-class training and education for our future dentists and
dental care professionals and
excellent services to patients in
the area.”
Director of the Dental Academy, Sara Holmes MBE, said:
“Today marks the culmination
of over two years of planning
and represents a unique part-

nership between the University
and the NHS. The entire staff
and student body are thrilled to
be working and studying, alongside colleagues from Kings,
in such a dynamic and progressive institution right the heart
of Portsmouth.”
Nairn Wilson, Dean and
head of KCLDI, said: “King’s
College London Dental Institute is delighted to have joined
forces with the University of
Portsmouth to create the Dental Academy, with a focus on
innovation in the education
of the dental team and the student experience.
The event was attended by
over a hundred members of
the local dental community,
representatives from the local
NHS and from KCLDI who was
joined by University Chancellor, actor Sheila Hancock. DT

[3] =>

News 3

United Kingdom Edition February 14-20, 2011

Editorial comment

ere at Dental
Tribune we
are committed to providing our
readers with insightful articles, practical
help from specialists
in their fields and a
mix of news and opinion which helps to keep all members of the dental team up to date.

• cosmetic dentistry: covering the
most significant developments in
the world of cosmetic and restorative dentistry
• implants: delivering the latest
thinking in implant therapy
• roots: presenting up to date information in the field of endodontics
These
presented

quarterly
titles,
in a glossy, high

quality format, will deliver superior articles from both international
and UK clinicians focusing on a
wide range of issues surrounding
each particular topic. We do not
want these magazines to be all
things to all readers. We want
highly focused titles related
to your interests.
To celebrate the launch of

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?

roots, implants, and cosmetic dentistry, we are currently making
these titles available at very special
prices for a year’s subscription.

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

Call
my
colleague Joe Aspis on
02074008969 or email
him
joe@dentaltribuneuk.com to get
the latest. DT

Or email:
lisa@dentaltribuneuk.com

As part of this commitment
we have been looking to see how
we can provide more to UK dental professionals with regards to
specialised material related to a
particular interest.

Now, to the point – in March
we are bringing to the UK three
titles of international renown tailored to the UK dental profession
- roots, implants, and cosmetic dentistry. Although the international
versions are published by our
colleagues at Dental Tribune International, the UK versions will
be published by the same team
that brings you Dental Tribune
UK. The three titles cover the following issues:

TREATMENT PROGRAMME

All under
one roof

hirty members of the
dental press gathered at
London’s World famous
department store for this year’s
Showcase press launch.

The dental press were also
informed that the Dental Lab @
Showcase would be returning
by popular demand in 2011.
A programme of lectures and
seminars would also take place
at the event supported by other
learning opportunities in the
Show Guide and in the exhibition hall.
BDTA Dental Showcase
2011 takes place at the NEC,
Birmingham
from
20-22
October 2011. For further
information, visit www.dentalshowcase.com DT

The results are revolutionary

BEFORE1

Instant relief achieved with direct application
of toothpaste massaged on sensitive tooth for
one minute and continued relief with subsequent
twice-daily brushing3

AFTER1

3
In Vitro SEM photograph of untreated
dentine surface.

In Vitro SEM photograph of dentine
surface after application.

The tubules that lead to
sensitivity are open

The tubules are occluded
for instant, lasting relief

With Pro-Argin™ Technology, you can finally provide instant*
and lasting relief from dentine hypersensitivity using the
Colgate® Sensitive Pro-Relief™ Treatment Programme:
• In-surgery desensitising paste
• At-home everyday toothpaste
Pro-Argin™ Technology works through a natural process of
dentine tubule occlusion that attracts arginine and calcium
carbonate to the dentine surface to form a protective seal
that provides instant relief.2
*Instant relief is achieved with direct application of toothpaste massaged on
sensitive tooth for 1 minute.
References: 1. Petrou I et al. J Clin Dent. 2009;20(Spec Iss):23-31. 2. Cummins D et al. J Clin Dent. 2009;
20(Spec Iss):1-9. 3. Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.

Colgate Customer Care Team: 01483 401 901

60 %

70%

improvement

Sensitivity relief

BDTA Dental Showcase
provides members of the dental team with the chance to
see, hear, learn and buy everything they need to do their job,
all under one roof. From the
latest products and most
appealing special offers to
the highest quality services,
Showcase is really ‘Your one
stop dental shop!’

A breakthrough: Pro-ArginTM Technology

Air blast sensitivity score

The launch was held in Harrods’s Georgian Restaurant and
gave the gathering of dental
editors and reporters the opportunity to hear what’s in
store at this year’s event.

Finally, instant* sensitivity relief
patients can take home.

Baseline

Immediate

When applied directly
to the sensitive tooth
with a fingertip and
gently massaged for
1 minute, Colgate®
Sensitive Pro-Relief™
Toothpaste provides
instant sensitivity
relief compared to the
positive and negative
controls. The relief was
maintained after 3 days
of twice-daily brushing.

3-day

Colgate® Sensitive Pro-Relief™ Toothpaste
Positive control:
Toothpaste with 2% potassium ion

Negative control:
Toothpaste with
1450 ppm
fluoride only

Visit www.colgateprofessional.co.uk to learn more
about how instant relief from dentine hypersensitivity
can benefit your patients.

www.colgateprofessional.co.uk

[4] =>

4 News

United Kingdom Edition February 14-20, 2011

The price of dental tourism
T

hroughout the UK, Europe and America, people are heading abroad
to receive dental care, having
been lured by the cheap prices of dental treatments and
cosmetic
dentistry.
Dental
tourism is rapidly becoming a
very attractive option for those
people who need cosmetic dentistry procedures, restorative
dental care, and routine dental
treatment but believe the treatments carried out in the UK are
too expensive.
However, the current trend
is giving patients more problems than it is solving and there
are more and more high profile
cases of treatments going wrong
overseas. Recently, Sherree
Rolf, 49, travelled to Hungary
and had a full set of crowns,
veneers and bridgework done
for half the cost of UK dental
work at just £5,765. However,
she claims the Hungarian company Dentart-Klinik left her
jaw broken halfway through the
five days of treatment in Gyor.

Thousands of Britons travel
abroad every year for cheap
dental work and many issues can begin as soon
the patients return home.
Once
Sherree
was
back
in the UK she visited her dentist, who upon inspection found
that her jaw was broken. They
also found that two veneers
were also cracked.
Commenting on the issue, a
spokesman for Dental Protection said: “Prevention is better
than cure. Patients travelling
abroad for dental treatment
should enquire what arrangements are in place and what
costs might be involved if the
treatment is unsatisfactory. Patients should also ensure that
the dentist providing the treatment is properly indemnified
against claims in negligence,
and that the dentist and patient
can communicate effectively
when seeking and giving consent for treatment.”
With regards to where the

blame would lie if the treatment fails in spite of additional work carried out by
a UK dentist, the spokesman
added: “It is standard practice for dentists to examine
all new and existing patients
carefully, particularly noting
any changes that might have
occurred since the patient was
last examined. It is important
where treatment has been carried out in another practice
(or indeed another country)
that a new baseline chart is
documented. It is also critical
that any concerns identified
are described to the patient,
without bias and in a factual
way, noting the conversation in
the records and any specific
issues that the patient wanted
to discuss.
“These records are very important if concerns are later
raised by the patient in the light
of any remedial treatment undertaken in the UK or with regard to the original work done
outside the UK. All the con-

temporaneous dental records,
radiographs, photographs etc
are invaluable sources of evidence if a claim in negligence
is made.”
Deputy head of the DDU,
Bryan Harvey said: “All procedures carry a degree of risk,
wherever they are carried out.
“We believe it is important
that patients themselves ask
questions before signing on the

dotted line for dental treatment
overseas. For example, does the
dentist speak English, do they
know what follow-up there will
be from the dentist carrying out
the procedure and what will
happen if they return to the UK
and something goes wrong? Is
there a complaints procedure?
And most importantly, if the
dentist acts negligently and the
patient is harmed as a result,
will it be possible to obtain
compensation?” DT

Patients need to know the risks of getting dental treatment abroad

BDA calls for piloting overdue NI contracts

P

iloting of new contractual
dental arrangements for
Northern Ireland is overdue and must begin promptly,
the British Dental Association
(BDA) argued.
Submitting its response to the
Health and Social Care Board’s
consultation on piloting new dental contracts, the BDA said that it
believed the proposed personal
dental services scheme would
meet the objective of testing the
proposed arrangements for den-

tistry and pressed for progress.
The BDA response also
stresses the importance of pilots being allowed to produce a
clear picture of both positive and
negative implications of the
new arrangements against a
difficult financial position, and
emphasises theneed to understand the effect of elements of the
contract including payments for
patient care, quality and items
of service. BDA also welcomes
the Health and Social Care

Board’s acknowledgement that
it will be important to pilot
revised patient charges prior to
the implementation of the definitive new contracts.

training and skills to deliver
treatments that might otherwise
be unavailable to patients in
certain areas is particularly important, the BDA argues.

Whilst the BDA response
also signals its agreement with
the proposal to have separate
contracts for primary dental
care, orthodontics and oral
surgery, it highlights that changes in one area of dentistry will
impact on another. The ability
of practitioners with enhanced

Peter Crooks, Chair of the
BDA’s Northern Ireland Dental Practice Committee, said:
“It’s nearly five years since
reform was touted. Progress
is well overdue. These pilots will take place against a
backdrop of financial pressures and will need to take ac-

count of the difficult circumstances facing practitioners.
“Nonetheless, Northern Ireland
Dental Practice Committee endorses the proposed scheme and
looks forward to continuing
constructive and meaningful
engagement as pilots progress. It
is important that these pilots
are given the time and resources they need so that
their effects can be properly
understood and a better future
delivered for health service dentistry in Northern Ireland.” DT

Time running out for ‘early bird’ discount

A

OG and Smile-On, in conjunction with the Dental
Directory and the Faculty
of General Dental Practice (UK),
will again be hosting the 2011
Clinical Innovations Conference
(CIC). Now in its eighth year, the
CIC promises to be bigger and
better than ever, with a wealth of
top speakers, including the AOG’s
President, Pomi Datta, who said:
“Last year’s conference and the
dinner brought together innovators and thinkers of this millennium. We are going to build on that
with our partners and friends. We
want to make this the most exciting annual event in Europe.”
Taking place on the 6th and
7th of May 2011 in the iconic setting of the Royal College of Physicians, (pictured), situated in the
heart of London, the CIC promises to offer all members of the

dental team some unmissable
learning opportunities and the
chance to gain up to 14 hours of
verifiable CPD.
With innovation once again
the main theme, dental professionals can expect to learn more
about the latest developments
within the field of endodontics
from the likes of Julian Webber,
occlusion from Raj Rayan OBE
and an opportunity to discover
the benefits of practising minimally invasive orthodontics with
speakers such as Tif Qureshi and
James Russell.
Confirmed speakers include:
The internationally acclaimed
Nasser Barghi, Joe Omar, Peet
van der Vyver, Eddie Lynch, Bob
McLelland and Wyman Chan,
amongst many others. On the
Friday, attendees will also have

the opportunity of attending the
Conference Charity Ball, which
will be held at the fashionable
Millennium Mayfair Hotel. Last
year’s proceeds went to the AOGsponsored project in Chitrakoot
to repair cleft lips and palates and
provide dental treatment for 500
villages in one of the most rural
parts of India.
Secretary of the AOG, Dr Nishan Dixit, is thrilled to once again
be involved with this dynamic
gathering: “As one of the UK’s
fastest-growing dental organisations, we are a body that not only
values professional standards but
also understands the need for innovation within dentistry, as well
as the vital role that continuing
education plays within the profession. We also hope that CIC
delegates will join us in striving towards ‘the greater good’,

our organisation’s motto, at the
Conference Charity Ball, which
promises to be a really fun and
glamorous occasion, all in aid of
a good cause.”
Given the record attendance
rates at the 2010 event, delegates
are advised to book early to avoid
disappointment. The deadline
for early bird registration, which
entitles those who book before
7th March 2011 to a 15 per cent
concession, is fast approaching!
Members and clients of affiliated
sponsors and co-organisers may
also be entitled to special rates, so
get in touch with the organisers
to find out more.
Why not use this opportunity
to keep in touch with innovations
in this dynamic and fast-growing area of dentistry and help
your practice reach its most

profitable potential?
For more information, visit
www.aoguk.org - For early bird
offers, or to book, please visit:
http://www.clinicalinnovations.
co.uk/ or call 0207 400 8956 DT

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[6] =>

6 News

United Kingdom Edition February 14-20, 2011

BDTA surveys
raise B2A cash
T

he British Dental Trade
Association (BDTA) is
pleased
to
announce
the donation of nearly £1000 to
Bridge2Aid following the submission of completed membership
questionnaires and technology
surveys sent out last year.

Executive Director of the
BDTA, Tony Reed, stated; “It is
important for us to understand
the needs of our members in order to continue to serve them effectively and introduce new ben-

I

f you are interested in implantology then the Osseointegrated Implantology
Courses, which are being held
on Sunday 27th March – Friday 1st April 2011 could be the
right choice.
Delivering 36 hours of CPD
accreditation, the fee for the
course is £2,200 and is ideal for
delegates who wish to participate in a course over six consecutive days.

In order to assess how well the
Association is meeting the needs
of its members, questionnaires
were sent out to each member
company, and the BDTA offered
to donate £5 to the Bridge2Aid
charity for every questionnaire
returned. 47 member surveys
were filled in and submitted
which represented an exceptionally high response rate.
The BDTA also conducted research amongst dentists to investigate their attitudes towards new
technologies and training courses.
Again, an excellent response
rate was received and £2.50 was
donated to Bridge2Aid for
each of the 285 surveys completed and returned.

Osseointegrated
Implantology Courses

efits. It is vital for our members
to understand how members of
the dental team respond to new
technologies and the mix of training preferred. We were extremely pleased with the response
achieved from the questionnaires
and to be able to donate funds to
Bridge2Aid made the research
worthwhile on a number of levels. Thank you to all those who
participated.”
Mark Topley, Chief Executive
at Bridge2Aid, commented: “The
BDTA has been a great support
to us over the past six years and

helped us to achieve so much –
restoring tens of thousands of
smiles and changing many lives
in Tanzania. This donation will
go a long way to helping us relieve the pain of thousands more
people in the coming year and
extend our work to new areas
desperate for basic dental services and training. Our thanks go
to the BDTA for thinking of us
in this way, and to all the members of the dental industry for
completing their questionnaires.”
For further information on the
BDTA visit www.bdta.org.uk DT

Topics covered include:
• examination and treatment
planning • dealing with the patient within the practice • anatomy, physiology. • biomaterials
• sterility • surgical templates •
surgical techniques (to include
bone augmentation and advanced surgical techniques) •
implant impression techniques
• jaw registration • articulation
• periodontal consideration (to
include maintenance protocol
and guided tissue regeneration)
• connecting teeth to implants •
detailed literature review.

ning”
• Mr Keith Rowe on “Laboratory
Techniques”
There will also be handson session on the surgical,
prosthetic
and
laboratory
phases and delegates will attend a CT scan appointment
with one of the patients on
the course.
This course is suitable for
the application of all different
osseointegrated implant systems
and delegates who complete
the course are eligible for the
ICOI Fellowship, without further examination.
For more details or to
book your place please call
020 7584 9833 / 020 7584
7740 or email reception@walpolestreetdental.co.uk. DT

There will be guest speakers
on the following subjects:
• Dr Joe Omar on “Medical
Emergencies”
• Dr Alan Cohen on “Medico –
Legal Aspects”
• Mr Sean Goldner on “CT Scan-

Eddie Scher - course director

V+B scheme‘to
be scrapped’

The clear choice for straighter teeth!

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children is to be scrapped.
Set up by the Independent
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the original Vetting and Barring
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prosecution for breaches. Approximately nine million adults who
came into contact with children
once a week or more had been
subject to checks.

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Home Secretary Theresa May
suspended it last June so a review
could be held. A Home Office
spokesman said an official announcement - which affects England, Wales and Northern Ireland
- would be made shortly.
It has also been reported that
the government will also announce that criminal record
checks are to be sent to individuals first to allow them to challenge
any mistakes. DT

[7] =>

GDPUK 7

United Kingdom Edition February 14-20, 2011

Wear one short sleeve and one long
Tony Jacobs highlights the hot topics of debates in the world of GDPUK

s you read this, GDPUK
forum members will
have been discussing the
new Health Bill, as well as proposals from the GDC for revalidation, the next bête noir.
A major topic was when a
colleague asked for opinions
from others about a request
from a patient with chronic
leukemia to have her amalgam
fillings removed and replaced
with composit. The reaction
of many dentists is to immediately worry that the patient will
not recover, and health will not
improve if this is done. On the
other hand, if the same patient
had attended and asked for replacement of the same silver fillings with tooth-coloured ones
for aesthetic reasons, how many
of us would hesitate?

Two notes of caution, regarding emergency drug kits, one
report that buccal midozalam
is now £274 for a 5ml bottle.
Will you be stocking it? Plus
a practice inspector was perturbed that a practice’s emergency drugs kit was visible to the

public. The principals explained
the box had to be easily accessible by the team in an emergency, the inspector insisted it must
be locked. A solution was found
using a tamper-evident displaying plastic tag, as used on fire
extinguishers.

On the same vein, one PCT
wrote to dentists insisting that
their infection control advice,
due to aerosols generated,
was that dentists and teams
must now wear long sleeves in
surgeries. If implemented, this
would mean removing cloth-

ing too, between patients. This
is contrary to advice in HTM
0105. Advice from the forum – ask the PCT which
regulation should be ignored,
HTM or theirs, or ... wear one
short sleeve and one long! DT

Approximately 6,000 people in the UK annually are
diagnosed with oral cancer - with an estimated
2,000 deaths every year
(Source: British Dental Health Foundation, www.mouthcancer.org)

This led to a heated debate
with more than 50 replies. Does
the metal in her mouth have an
effect on her disease? There are
tests which can investigate these
matters. Another writer asked
us to consider whether changing the fillings would give the
patient a positive mental lift.
And so the debate swung on
from “don’t touch with a bargepole” to treat like an aesthetic
request. Concepts of professionalism were brought in, aspects
of “do no harm”. Another poster
suggested making the change
slowly to see if there was any
benefit to her health.
Modern amalgam alloys have
more copper in them and latest
research links exposure to copper as a factor in chronic leukemia. Another turn and there was
a mention of seriously ill patients
clinging onto illogical hopes
and being willing to undergo
unproven medical treatments,
in the hope of success. If a dentist is investigated by the GDC
for this type of claim to treat
other diseases, the dentist loses
the case and their career. This
poster says we must ensure we
do not give patients any false
hope, and ensure there are no
more high profile cases showing
lack of professionalism by dental colleagues.

Oral Cancer – prevention, examination, referral has been designed to support all health professionals
by updating their knowledge, highlighting the importance of oral cancer screening, and providing
practical tools for communicating with patients and colleagues

The programme comprises four topics:
1: The facts - Providing a background into the incidence, causes and development of oral cancer
2: Team Approach - Looking at all aspects of communication both within the team and with patients
3: Screening Examination - Practical advice on improving the opportunistic screening procedure in practice
4: Case Studies - Providing first hand experiences of examining, making referrals and living with oral cancer

About the author
Tony Jacobs, 52, is
a GDP in the suburbs of Manchester, in practice with
partner Steve Lazarus at 406Dental
(www.4 0 6dental.
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.co.uk.

For more information call us on 020 7400 8989 or log on to www.smile-on.com

[8] =>

8 Practice Management

United Kingdom Edition February 14-20, 2011

‘We are all worms. But I believe
that I am a glow-worm’
Sharon Holmes provides some advice on understanding the Medical Device Directive

I

am sure there are many
dental practices and laboratories out there scratch-

ing their heads in wonderment
with regards to the Medical Device Directives, which has been

a legal requirement for dentists
since March 2010, and covers a
vast amount of dental and med-

ical materials used on patients.
A statement of manufacture

Healthy plaque
management

Barrage of questions
Our group dental arts studio is
made up of six practices and we
use many different laboratories
so when this task was set before
me I knew it would take some
organisation, however I was
unprepared for the barrage of
questions that came flowing in
from many of the labs.

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gingivitis and prevent periodontitis.

Due to my frustration at
what should have been a simple
task I did some research and

DECAPINOL® creates an invisible barrier
that prevents bacteria from adhering
to the tooth surfaces.
■

■

■

is a prescription of the device
that has been prescribed, who
it was prescribed by, and what
the product is. It informs the
patient of the manufacturer and
the materials used. It also states
standard after care advice of
how to care for the device that
has been prescribed and issued.

‘What I understood
was that it was the
dentist’s responsibility to liaise with
their lab with regards to the statement of manufacture, which must be
supplied with all
laboratory work
that gets placed
into our patient’s
mouths’

Clinically effective in prevention against
plaque and gingivitis as shown in
multiple clinical studies
Unlike other dental products
DECAPINOL® gently and safely protects
against gingivitis
Preventative against periodontitis

made a couple of phone calls to
find out that I was not the only
person who was struggling to
make some sense of the Medical Device Directive.
As this is a legal requirement it concerned me, and I
wanted to implement it as soon
as possible to avoid any future
repercussions. What I understood was that it was the dentist’s responsibility to liaise
with their lab with regards
to the statement of manufacture, which must be supplied
with all laboratory work that
gets placed into our patient’s
mouths. Changes have been
made to this Medical Device
Directive 93/42/EC to improve
the standard of appliances provided to patients to ensure good
and ongoing patient care.

DECAPINOL® promotes a healthy
long-term plaque management.

■

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■

All dentists were notified
about the directive requirement and made aware of their
à DT page 10

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Science: Materials in Medicine 2002; 13(6):557−565. 4. Clark AE et al. Journal of Dental Research 2002; 81 (Special Issue A): 2182. 5. GlaxoSmithKline data on file SF/EU/05/10 Earl J, 2010. 6. Du MQ et al. American
Journal of Dentistry 2008; 21(4): 210−214. 7. Pradeep AR & Sharma A. Journal of Periodontology 2010; 81(8):1167−1173. 8. Salian S et al. Journal of Clinical Dentistry 2010; 21 (Special Issue): 82–87.
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[10] =>

10 Practice Management

United Kingdom Edition February 14-20, 2011

ß DT page 8

risk we take if we do not comply.

work manufactured.

responsibilities to comply with
the directive.

The process
In our practice procedure I
have outlined to the whole dental team as to what the process
should be from the prescribing
of the appliance to dispatching thereof. The outline of our
practice procedure is as such:

• As and when the lab work is
delivered to the practice, the
dentist and the nurse should
make sure that a copy is available for the patient.

I created and implemented a group policy as well as a
practice procedure as to what
is required to fulfil our legal
obligations to our patients. I
am currently creating tool box
talks during training sessions
to talk about it further and what
it means to the patient and the

• All laboratories are to supply
each patient with a statement of
manufacture for all laboratory

• If a statement of manufacture is not accompanied by
the laboratory work, then the
nurse must inform the practice
manager who in turn must call
the laboratory and request a

faxed copy with immediate effect. A lab doc that states it is
compliant is not a statement of
manufacture.
• The dentists and the practice managers are responsible
for liaising with the laboratories and on guiding those
on the necessary requirements
as the Department of Health
have made it the responsibility of the treating dentist to
inform their labs of the

statement of manufacture.
• If the patient declines to take a
copy away with them then this
should be noted in the patient’s
medical notes and the practice
must file it away for safe keeping for the life-span of the appliance should the patient request a copy later on.
• If the patient chooses to take
the statement of manufacture
then, a copy must be made and

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the patient must be asked to
sign the copy and it must be
dated and placed on file. This is
in the event that the patient forgets that they received a copy
or possibility of misplacement.
Good Practice
To assist the labs I instructed
my practice managers to direct
the dental labs and technicians
to the article in the Summer
2010 GDC magazine written
by David Smith, who is a dental technician as well as a GDC
member. We also shared good
practice from elsewhere. The
process, though stressful during the implementation phase,
helped us build stronger working relationships with our labs.
To protect the practice
as well as the patients it is
vitally important that you
cover all bases when dealing with implementing new
policies or procedures into
the practice. Only when the
whole
team
understands
what is being asked of them
will they be able to comply.
As Winston Churchill once
said: ‘‘We are all worms. But I believe that I am a glow-worm.’’ DT

About the author
Originally from
South Africa, Sharon Holmes has
worked in the field
of dental practice
management since
1992. In 2003, she
moved to London
City Dental Practice where after 18
months, was responsible for managing four practices
in the group. The
London City Dental Practice is now
part of a mini co-operative group called
the Dental Arts Studio, of which she
has been instrumental in its creation.

[11] =>

Implant Tribune
Implant Tribune

A case of FPD

Implant Tribune

The ultimate challenge

Nawrocki and Almog provide implant information

Richard Brookshaw discusses anterior
implants

pages 13-15

pages 16-19

Implant Tribune

Aesthetic managment

A second case study presented by Dr
Michael Sonick

pages 20-22

Aesthetic management of
a single dental implant

Dr Michael Sonick details a case involving both
form and function in the aesthetic zone

medically and periodontally stable 37-year-old man
presented with coronally
fractured tooth #9, which had a
history of endodontic treatment
(Fig 1). The tooth was deemed restoratively hopeless.
Treatment Plan
1. Extraction of tooth #9 and socket preservation
2. Three-month healing period
3. Placement of implant #9 and
connective tissue graft
4. Three-month healing period
5. Implant #9 exposure, placement
of healing abutment and connective tissue graft
6. Three-month healing period
7. Final implant #9 crown
restoration
Extraction and Socket Preservation of Tooth #9
After oral sedation with 0.25mg triazolam one hour prior to surgery
and local anaesthetic induction
using two per cent lidocaine with
1:100,000 epinephrine and 0.5 per
cent bupivacaine with 1:200,000
epinephrine, a sulcular incision was made circumferentially
around tooth #9. The remaining
root was extracted atraumatically
using a piezoelectric periotome
device (Fig 2). Thorough degranulation of the extraction site with a
pear-shaped carbide finishing bur
and Prichard curette proceeded.
No dehiscence or fenestration
was detected. Freeze-dried bone
allograft (FDBA) was used to obliterate the extraction socket. A bioabsorbable collagen plug (CollaPlug®, Zimmer Dental, Carlsbad,
CA) was used to cover the graft.
The area was secured using 4-0
expanded polytetrafluoroethylene
(ePTFE) suture (Fig 3). The restorative dentist temporised space
#9 with an interim removable
partial denture.
After three months of uneventful
healing (Fig 4), Stage 1 implant
placement was initiated.

#9 Fixture Placement and
Connective Tissue Graft
After oral sedation with 0.25mg
triazolam and local anesthetic induction using two per cent lidocaine with 1:100,000 epinephrine
and 0.5 per cent bupivacaine with
1:200,000 epinephrine, a flap was
created using a trapezoidal papilla-sparing incision design that involved a palatally-oriented crestal
incision over the #9 site with two
vertical releasing incisions made
on the buccal, both avoiding the
mesial and distal papillae. A fullthickness flap was raised past
the mucogingival junction. Degranulation of the site with a pearshaped carbide finishing bur and
Neumeyer bur revealed adequate
apico-coronal,
bucco-lingual
and mesio-distal dimensions for
implant placement. After osteotomy preparation, a rough-surfaced,
internal hex 4mm (diameter) x
13mm (length) implant was
placed into the filled site (NanoTite® Parallel Walled Certain®
Implant, Biomet 3i, Palm Beach
Gardens, FL) (Fig 5). Primary stability was achieved, and a cover
screw was placed.
In order to form an aesthetic
soft tissue profile by expanding
mucosal dimensions, a connective
tissue graft was harvested from the
palate and placed on the buccal
aspect of the ridge overlying the
implant. The graft was stabilised
using 5-0 chromic gut sutures
(Fig 6). After periosteal release
via lateral scalpel incisions, the
flap was primarily closed with 4-0
ePTFE sutures in an interrupted
and horizontal mattress fashion
(Fig 7). The area was re-temporised with a resin-bonded fixed
partial denture.
Implant Exposure with Connective Tissue Graft
The #9 site healed well and
without incident after three
months (Fig 8). After using a
tissue punch technique to remove

the mucosa immediately coronal
to the fixture (Fig 9), a one-piece
4.1mm (platform) x 5mm (emergence profile) x 4mm (height)
healing abutment (Certain® EP®
Healing Abutment, Biomet 3i, Palm
Beach Gardens, FL) was placed
on the #9 implant. To further
augment the buccal ridge dimension, another connective tissue
graft was harvested from the palate. A pouch-like envelope flap
was raised over the labial ridge
aspect into which the connective tissue was transplanted and
fixed using 5-0 chromic gut suture
(Fig 10). The healing abutment
remained exposed. A periapical
radiograph revealed sufficient
bone height around the fixture
(Fig 11). The resin-bonded fixed
partial denture was replaced.
Final Prosthetics
Final restoration of the #9 implant
was performed three months
post-exposure (Fig 12). The
marginal height and contour of
the #9 implant crown matched
that of adjacent tooth #8, and a
periapical radiograph showed
suitable peri-implant bone height
(Fig 13). The patient was satisfied
with the functional and esthetic
result (Fig 14).
Post-Operative Instructions
After each surgical procedure, the patient was instructed to take ibuprofen 600mg
every 4-6 hours, hydrocodone
7.5mg/acetaminophen 750 mg
every 4-6 hours as needed for
pain, and doxycycline 100 mg
every day for 10 days. The patient was instructed not to
brush at or near the surgical site
but instead to rinse with 0.12 per
cent chlorhexidine or warm saline
twice daily. The patient was also
directed not to chew in the affected
area for at least two weeks. Suture
removal occurred at 10-14 days
post-surgery. DT
à DT page 12

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Dentists in the
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Prosthetic Dentistry • Disinfection & Hygiene

[12] =>

12 Implant Tribune

United Kingdom Edition February 14-20, 2011

ß DT page 11

TISSUE
Management

1a: Hopelessly fractured tooth #9

1b: Periapical radiograph of endodontically-treated tooth #9

3b: Occlusal view of socket preservation
site

4: Healing three months post-extraction and
socket preservation

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™

2: Atraumatically
extracted #9 tooth

3a: Buccal view of socket preservation site

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cord dispensing!

5a: Occlusal view of implant placement.
Note palatal placement of fixture

e

7: Primary closure of grafted implant site

5b: Buccal view of implant placement.
Note papilla-sparing flap design

6: Connective tissue graft secured in place over
the buccal ridge

8: Healing three months post-implant
placement. Note the favourable position
of the mucosal margin

10a: Soft tissue graft inserted into the buccal pouch

9: Exposure of the #9 implant using a tissue
punch technique

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10b: Placement of the healing abutment
on the #9 implant

12: View of final restoration

10c: Buccal view of site with graft in place

12c: View of final restoration

12b: View of final restoration

11: Periapical radiograph of fixture at time of
exposure. Note the favourable bone height

The same amount of cord (1cm)
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Practical built-in cutter, no need
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13c: Final implant-supported crown in #9 site

14a: Patient smile prior to treatment

13a: Tooth #9 prior to treatment

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DUX_ShortCut_ad_DT_EN_1-2p.indd 1

13b: Periapical radiograph of tooth #9
prior to treatment
12-01-2011 12:35:29

13d: Periapical radiograph of final #9 implant

14b: Patient smile post-treatment

[13] =>

United Kingdom Edition February 14-20, 2011

Implant Tribune 13

Screw-retained implant-supported
fixed partial denture (FPD)
Michael Nawrocki and Dov M Almog provide implant information and a case report

T

he choice between cement and screw-retained
implant-supported prosthesis may be a matter of clinicians’ preference or dictated
by particular clinical situations.
This case report presents a clinical situation and the guidelines
that led to the ultimate prosthetic treatment decision based
on implant angulations, interocclusal relationship and arch
position. The clinical considerations are presented to aid the
clinicians in determining the
most appropriate method of
retention for a screw-retained
implant-supported fixed partial
denture (FPD).
A screw-retained implantsupported fixed partial denture (FPD) has certain physical
advantages. However, according to several studies they
require
precise
positioning
of the implant for optimal location of the screw access
hole. Also, obtaining passivity
of frameworks that are screwretained is difficult due to dimensional discrepancies inherent in the fabrication process.
Anchorage of prosthetic
fixed partial dentures to implants can be achieved in two
ways: some clinicians cement-

‘Screw-retained
implant restorations
have an advantage
of predictable retention and retrievability, and the lack of
potentially retained
excessive sub-gingival cement’

ing the prosthetic construction to implant abutment,
while others suggest that
screw retention is preferable.
Screw-retained
implant
restorations have an advantage of predictable retention
and retrievability, and the lack
of potentially retained excessive sub-gingival cement. On
the other hand few disadvantages exist: obtaining passivity of screw-retained framework that is difficult due to
dimensional discrepancies inherent in the fabrication process. Screw-retained units gener-

ally have screw access openings,
which can compromise aesthetics, weaken the porcelain
around the openings and at cusp
tips, and establish unstable oc-

clusal contacts.
Cementation of implant restorations eliminates unaesthetic
screw access holes. Cemented

restorations also have the potential to compensate for any
minor dimensional discrepancies in the fit of restorations
to abutments, which can con-

tribute to lack of passivity. It
has the potential to reduce
stress to splinted implants, since
à DT page 14

[14] =>

United Kingdom Edition February 14-20, 2011

ß DT page 13

the effects of minor misfit of
the framework are not transferred directly to the implants,
as is the case with prosthesis-retaining screws. In addition, the exposure of screw access holes in esthetic areas of
the mouth can be avoided. On
the other hand, any excess
retained
cement
extruding
from the prosthesis/abutment
interface, especially when located sub-gingivally, can cause
inflammation, infection, and
periodontal complications.
As more and more dental practitioners are focusing
on implant-supported fixed
partial dentures (FPD) restoring dentists need to understand
the restorative options they
may have to deal with. Many
dental practitioners and labs
will persistently use a screw-re-

CT and technologies and 3-D
derived virtual planning software solutions altered the manner in which we pull together diagnostic data, plan and execute
both simple and complex implant
cases. As a result, more and more
implant trajectories are consistent with the planned prosthetic
trajectories. Yet, some cases are
still driven by the residual bone
trajectories and are left to the restoring dentists’ decision as far
as the final restorative option. In
other words, when the implant
trajectories are inconsistent
with the planned prosthetic trajectories, the screw-retained
implant-supported fixed partial denture systems offer an
opportunity to minimise any
controversy between the surgeons, restorative dentists and
labortories, creating greater understanding, appreciation and
professional camaraderie.

‘As more dental practitioners are focusing
on implant-supported fixed partial
dentures restoring dentists need to understand the restorative options they
may have to deal with’
tained implant-supported fixed
partial denture, and thereby
promote the utmost choices of
serviceability, cosmetic result
and maintenance of optimised
bite possible.
At the same time, in recent
years the utilisation of adjunctive state of the art Cone Beam

International,
Hatfield,
Pa)
and revealed reasonable alveolar
dimensions,
both
vertical
and
horizontal.
However, by utilising ImplantMaster ™ software (iDent Imaging,
Inc., Foster City, CA, 944041294), it was discovered that
the residual bone trajectory
(RBT) and the planned prosthetic trajectory (PPT) were
in conflict, that is, projecting a
compromised restorative trajectory lingually in implant site
#9 and buccally in implant site
#11 (Fig 1). Nevertheless, following a treatment planning
conference, rather than considering bone grafting, a decision was made to proceed with
these angulations and a 3-D
reconstruction of a patient’s
anatomy was attained and
a virtual surgical guidance
template was designed and
computer manufactured with
precise drilling holes’ distribution and trajectory for implants
#9 and 11.
The palatal trajectory of the
implant in tooth position #9,
the patient’s deep bite which resulted in severely limited space
for prosthetic components, dictated a screw-retained prosthetic FPD construction solution for
the case.

Case Report
Patient presented for implant
supported FPD after having
teeth #8, 9, 10 extracted with
socket preservation.
A CBCT study was performed with the iCAT CBCT
machine (Imaging Sciences

The extremely buccal angulation of the implant replacing tooth #11 resulted in
a buccaly located screw access
opening, which compromised
aesthetics,
and
potentially
weakened the porcelain around
the screw opening in the pro-

Figures 1a & 1b: Figure 1: CBCT
study was performed with the iCAT
CBCT machine (Imaging Sciences
International, Hatfield, Pa). By utilising ImplantMaster ™ software (iDent
Imaging, Inc., Foster City, CA, it was
noted in the 3DVR (a) and Virtual
surgical template (b) that the residual bone trajectory and the planned
prosthetic trajectory were in conflict,
projecting compromised restorative
trajectory lingually in implant site
#9 and buccally in implant site #11.

posed screw-retained three
units FPD. The aesthetic dilemma could be solved by either
gold plating of the metal portion
of the screw chamber, which
can reduce the need for opaque
composite material, or by
metal cut back to hide the nonaesthetic metal. We chose to
overcome this aesthetic and
structural obstacle by using
a separate telescoic crown
design to cover the metal sub-

[15] =>

United Kingdom Edition February 14-20, 2011

Implant Tribune 15
Figures 2a, 2b & 2c: Figure 2: The screwretained restoration was made by CQC a
DTI Dental lab in Rochester, NY. Different
views of final screw-retained restoration
emphasise the extreme lingual trajectory of
implant #9 (a) and extreme buccal trajectory of implant #11 (b). Note telescopic
design crown on #11 (b & c).

About the author
Michael Nawrocki, DMD, MD, MS,
Prosthodontist, VA New Jersey Health
Care System (VANJHCS).
Dov M. Almog, DMD, Prosthodontist,
Chief of the Dental Service, VA New
Jersey Health Care System (VANJHCS).

INNOVATION

Simplicity is The
Key to Success

Figures 3a & 3b: Figure 3: Intraoral views
of the screw-retained restoration. Note the
implants’ prosthetic platforms (a) emphasizing the actual trajectories of implants
#9 & 11 in the patient’s maxillary ridge.
Note telescopic design crown on #11 (b).

structure of the screw-retained
in #11 location.
Conclusions
As more and more dental practitioners are focusing on implant-supported fixed restorations, restoring dentists need
to understand the restorative
options they may have to deal
with. Dental practitioners and
dental labs need to be prepared to use a screw-retained
implant-supported fixed partial denture, and thereby promote the utmost choices of
serviceability, cosmetic result
and maintenance of optimised
bite possible. DT

The MIS SEVEN implant has a highly advanced
surface with a high rate of successful
osseointegration (98%), which was validated by
extensive worldwide research and clinical studies
in cooperation with world-class universities and
scientiﬁc research institutes. Its unique geometrical
design gives the SEVEN implant the important
features of simple, quick and safe insertion, high
primary stability, and compatibility in the most
complex cases in every area of the jaw.

Innovation Movement by MIS...

References
1) Winston Chee, David A. Felton, Peter
F. Johnson, Daniel V. Sullivan. Cemented
versus screw-retained implant prostheses:
Which is better? Int J Oral Maxillofac
Implants 1999; 14(1):137-41. 2) Hebel KS,
Gajjar RC. Cement-retained versus screwretained implant restorations: achieving
optimal occlusion and esthetics in implant
dentistry. J Prosthet Dent. 1997; 77(1):28-35.
3) Guichet DL. Load transfer in screwand cement-retained implant fixed partial
denture design [abstract]. J Prosthet Dent
1994; 72:631. Guichet DL, Caputo AA, Choi
H, Sorensen JA. 4) Passivity of fit and
marginal opening in screw or cementretained implant fixed partial designs. Int
J Oral Maxillofac Implants. 2000; 15:239-46.
5) Implant Bridge Mounting Choices:
Cemented vs Screw Mount. http://www.
dental--implants.com/fixed_bridge_implants.html (last viewed 10-8-10)

The MIS SEVEN implant is the only implant system in the world that comes with a specially
designed and sterilized ﬁnal drill, allowing a short and safe drilling procedure.
© MIS Corporation. All Rights Reserved.

MIS makes it simple with SEVEN implant. The only
implant in the world that comes with a specially
designed and sterilized, single use, ﬁnal drill, allowing
a short and safe drilling procedure. To learn more
about MIS visit our website: www.mis-implants.com

or call us: 01255 424624

M a k e

i t

S i m p l e

[16] =>

16 Implant Tribune

United Kingdom Edition February 14-20, 2011

Single tooth anterior implant,
the ultimate aesthetic challenge
Dr Richard Brookshaw discusses an interesting case presentation, placing a single
tooth anterior implant in a young female patient

derstandably she did not want
he patient, a 36-year-old fea conventional bridge as she
male office worker, was in‘At the time of the trauma, the patient
was afraid of “cutting down” the
itially referred for implant
had asked her dentist if she was able to
adjacent healthy teeth. The
therapy (via one of my implant
rest of her dentition was largely
course delegates) for replacement
have a dental implant, but was told that
un-restored.
of the missing upper right central
there wwas insufficient bone and that such
incisor. The upper central incisor
treatment was impossible’
At the time of the trauma, the
had been lost following accidenpatient had asked her dentist if she
tal trauma when she was 17 years
was able to have a dental implant,
old; the resultant space had been
but was told 11:22
that there wasPage
insufinitially restored with a removable
199598_BDJ_Biocare
22/4/10
1 Intra orally, the patient had UR1 with retainer wings UR2
UL1. There was Class 1 occlusigns of widespread gingival reficient bone and that such treatdenture, but more recently with
sion with general overcrowdcession, oral hygiene was excelment was impossible.
an adhesive bridge.
ing, no interferences and calent, with no deposits and BPE
nine guidance.
codes healthy in all sextants.
On examination the paThe patient was strongly
tient was fit and well, a reguopposed to keeping her denture
Radiographic assessment of
The patient presented with a
lar attender, non-smoker with
having tolerated it for almost
UR2, UL2, revealed absence of
composite occlusal restoration
low alcohol consumption. Extra
20 years; and afraid that the adperiapical pathology, non-con(UL6, LL6) and an adhesive
oral examination found nothing
hesive bridge would fall out, she
vergence of roots in adjacent
“Maryland” bridge restoring
abnormal.
now wanted a fixed solution. Unteeth with good bone height.
The missing upper right central incisor had healthy adjacent teeth and a healthy, bony
site. The edentulous area had
reduced volume with respect to
soft and hard tissue.
Following a formal discussion of her treatment options
and advantages / disadvantages of each, a treatment plan
was formalised in a detailed
written patient report and verbal and written consent to treat-

www.thenobelbiocareyearcourse.com

London May 2011 - 2012
tel: 0845 604 6448

ment was obtained.
Treatment Plan
1. Two stage implant surgery
was planned: Under LA, full
flap elevation, implant placement (16mm NP NobelReplace
tapered groovy) with hard and
possibly soft tissue augmentation either simultaneously or at
second stage surgery.
2. Second stage surgery; uncovering of implant +/- soft tissue
augmentation and attachment
of under contoured modified
healing abutment.
3. Fixture head impression for
lab construction of ideal design
screw retained composite prototype crown.
4. Fit prototype implant crown
with negatively contoured subgingival emergence profile
5. Pick up impression using
modified impression coping
6. Fit definitive under contoured
zirconium abutment and all ceramic procera crown
7. Maintenance of implant restoration and remaining dentition by GDP. Including continued hygienist support.
The treatment was carried out over a period of seven

Fig 2: Preop photograph

www.theimplantcourse.com
Fig 1: Preop periapical radiograph

TR199598

Fig 4: Narrow platfrom replace select
16mm implant with buccal dehiscence and
concavity

free implant ipod rrp £2000 for each delegate

Fig 6: Autogenous bone collection in
titanium dish

Fig 3: Remote flap design distal to UR2
and tunneling to UL1 distal retraction
Pritchard’s

Fig 5: Bone scraper utilised on nasal spine
for autogenous bone augmentation

Fig 7: Placement of autogenous bone collection over implant surface with biooss
sandwich layer to buccal deficiency.
biogide resorbable membrane stabilised
using palatal mucosa prior to covering
bone graft

[17] =>

United Kingdom Edition February 14-20, 2011

Implant Tribune 17

months with visits.
Reflection
The patient had an optimal
result at the end of treatment,
which she was extremely
delighted with. Her management
throughout
was
planned and executed with
the utmost detail to attempt
to deliver the most comfortable
experience
possible
considering the nature of
the treatment involved. She
was offered a denture, which
she had endured for the past
20 years and refused; a conventional bridge, which would
have been destructive to
the adjacent virgin teeth; or
an adhesive bridge which she
preferred to her denture but
did not instil her with confidence.
The
patient
was
determined
to
undergo
implant
therapy
if
possible, and she had sought
advice as to the feasibility 10
years ago but was dissuaded.
She was willing to undergo
any necessary treatment to
augment the site ready for optimal implant therapy and was
consented for the potential
treatment
sequence
which
may even involve block bone
grafting and repeated soft tissue procedures.
As it was, she responded extremely well to treatment and
her treatment was more simplified than expected. The utilisation of a laboratory made
prototype restoration was a good
policy which greatly improved
the final result, although the
patient’s finances were limited and it was carried out free
of charge. The under contoured
adjustment of the standard healing abutment at the minimally
invasive second stage procedure encouraged more soft
tissue growth, which also helped
the final result. The patient
was very amenable to the
philosophy employed and never complained about the extra
visits involved. Her focus was
trying to gain the best possible
final outcome. Translation of
all of the information worked
so hard to achieve in the prototype was also communicated to
the laboratory in as accurate a
way as possible, which helped
ensure the final result.
The use of a narrow
platform implant (3.5mm diameter) helped to keep the hard
and soft tissue dimensions to
a maximum and therefore
perhaps allow greater longterm aesthetic success, which
is why these implants are often
utilised in the aesthetic zone.
Lengthy discussion was also
had regarding root coverage
procedures on the other recessions, which the patient is now
considering following the good
result achieved with the adjacent UR 2. DT

Fig 8: Advancement and closure of flap with 4/0 vicryl suture.
simple interrupted sutures after periosteal release. Root coverage ur2 evident

Fig 9: Healed site prior to second stage surgery

à DT page 18

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EMS Swiss Instruments Surgery
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coNtrol savEs
Effective instrument control fosters
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(membranes, nerves, blood vessels, etc.).
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[18] =>

18 Implant Tribune

United Kingdom Edition February 14-20, 2011

ß DT page 17

Estetica A4 SELECTED:Layout 1

25/2/09

13:42

Page 1

Fig 10: Undercontoured healing abutment to encourage further soft tissue growth and
mucosal thickening

Fig 11: Undercontoured healing abutment shows excellent volume and quality of soft tissue

KaVo – Dental Excellence
Fig 12: Healed postoperative periapical radiograph at four months showing excellent
bone levels above microthreads

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Fig 14: Prototype crown showing excellent
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Fig 15: Indexing idealised prototype crown
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Figure 17: Customised impression coping in situ to copy soft

[19] =>

United Kingdom Edition February 14-20, 2011

Implant Tribune 19

Fig 16: Pickup impression coping screwed
to implant analogue and composite
flowline injected and cured to customise
impression coping

Fig 20: Procera crown fit UR 1 showing optimal aesthetics

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Fig 18: Undercontoured zirconium abutment and procera all ceramic crown

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About the author
Dr Richard
Brookshaw
BDS
MMedSci
(Oral Surgery) Dip
Imp Dent RCSEd
qualified in 1996
from the University
of Dundee. In 1999
he gained a MMedSci in Oral Surgery
from the University
of Sheffield, and
further extended his
clinical
qualification in 2001 by completing an 18
month Implant Training Programme,
also at the University of Sheffield,
Richard is both nationally and internationally respected as a lecturer
and mentor in Implant Dentistry
and Nobelguide CT scan, In 2008
Bob McLelland and Richard Brookshaw launched CADE (Centre for
advanced
dental
education)
in
order to pass on their knowledge and
experience to fellow Clinicians. The
ground-breaking method of theoretical and practical training is both
highly informative and inspiring.

t tissue architecture more accurately for lab

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Fig 19: Fit of zirconium abutment and screw access seal with provisional after torquing
screw to 30 Ncm showing excellent soft tissue

[20] =>

20 Implant Tribune

United Kingdom Edition February 14-20, 2011

Aesthetic management of
adjacent maxillary central incisors
Extraction, immediate placement and immediate provisionalisation - a case presented by Dr Michael Sonick

medically
and
periodontally stable 50-year
old woman presented

history of failing root-canal
therapy
and
apicoectomy
(Fig 1).

with failing #8 and #9 teeth
that exhibit asymmetry, lack
of interdental papilla and a

Treatment Plan
1. Extraction of teeth #8 and #9,
immediate implantation of #8 and

aesthetics

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: 01344 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.

†

SPMP09074 REV A MAR 2009

#9 and immediate non-functional
provisionalisation of #8 and #9
2. Three-month healing period
3. Gingivectomy to create mucosal symmetry
4. Six-month healing period, during which contour adjustments
to interim restoration will be
made to manipulate papillary
regeneration
5. Placement of final single PFM
crowns on implants #8 and #9
Treatment Plan Rationale
Implant rehabilitation for sites
#8 and #9 boosts long-term
prosthetic success, which diminishes future costs and permits
more future restorability options.
The patient is an ideal candidate
for immediate implant placement and temporisation due to
her thick biotype, which resists
recession, as well as the inherent coronal positioning of the
gingival drape around #8 and
#9 compared to the adjacent
teeth, which allows any minor
recession post-treatment to remain within aesthetically-pleasing bounds.
Extraction of Teeth #8 and
#9, Immediate Placement of
Implants #8 and #9, and Immediate Non-Functional Provisionalisation of Implants #8
and #9
After oral sedation with 0.25mg
triazolam and local anaesthetic
induction using two percent lidocaine with 1:100,000 epinephrine
and 0.5 per cent bupivacaine with
1:200,000 epinephrine, sulcular
incisions were made circumferentially around teeth #8 and
#9. To create room for extraction instructions, the crowns on
teeth #8 and #9 were reduced
(Fig 2a). Teeth #8 and #9 were
extracted atraumatically using
a piezosurgical insert and serrated universal maxillary forceps
(Figs 2b-2c). Degranulation of
the sockets was performed using a carbide finishing bur and
Neumeyer bur. A surgical guide
was used to prepare the implant
osteotomies, and proper positioning was attained (Fig 3). After finalisation of the osteotomy sites,
rough-surfaced, internal hex 4
mm (diameter) x 13mm (length)
implants were placed into the #8
and #9 sites (NanoTite® Tapered
Certain® Implant, BIOMET 3i,
Palm Beach Gardens, Fla.) (Fig 4).
Healing abutments were placed
on the implants to prevent soft
tissue and bony collapse during
the period that extraoral fabrication of the temporary prostheses
occurred (Fig 5a). The orientation of the implants was ideal,

[21] =>

United Kingdom Edition February 14-20, 2011

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1b. Smile view. Lack of papillae between 8
and 9 is evident. Patient also reveals gingival asymmetry, inflammation and excess
gingiva around teeth 8 and 9

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1d. Left lateral initial smile view. Teeth 8
and 9 appear to be on a different occlusal
plane. Attention is drawn to them

1e. Initial radiograph. Teeth #8 and #9
are failing endodontically

2a. Contact points are broken and the
crowns are removed. Trauma to the bone
and adjacent teeth is to be avoided

2c. Utilizing beaked serrated forceps and
rotational apical pressure tooth #8 is removed
without any destruction to the alveolar plate

4. Occlusal view following placement of two
4 mm-diameter dental implants. Note the
palatal position and the thickness of the buc- 5a.Temporary healing abutments in place.
cal plate. A gap is present between the labial They prevent soft tissue and bony collapse
while the provisional restoration is being
aspect of the implant and the facial plate.
fabricated extra-orally
This will be grafted

Temporary cylinders (PreFormance® Temporary Cylinder,
Certain® Internal Connection, 4.1
mm platform, hexed) were placed
on the implants to check the restorative position (Fig 6). These
were removed, and an implantlevel pick-up impression was
taken. After chair side creation
of a cast with implant analogs,
the hexed temporary cylinders
were connected to the analogs
and acrylic resin interim crowns
were fabricated using a vacuumformed template made over ideally-shaped central incisors. The
resin interim crowns were seated
and screwed onto the implants us-

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3b. Occlusal view of the surgical guide in
3a. A surgical guide is used to ensure correct place. Note that the osteotomy is located at
orientation during osteotomy preparation. the cingulum position, the preferred site for a
screw-retained restoration. Notice to the occluA buccal view of the guide in place with
sal wings on the guide that stabilise its position
orientation pins is shown
on adjacent teeth during surgical preparation

and the fixtures exited from the
sockets at the cingulum positions
(Fig 5a). Primary stability was
achieved. Radiographic review
of the implants revealed a peak
of bone between the fixtures, an
inter-implant distance of greater
than 4mm and an implant-tooth
distance of 2mm (Fig 5b). To
bridge the circumferential gap between the socket walls and the implant surfaces, freeze-dried bone
allograft (FDBA) was used as graft
material (LifeNet Health, Virginia
Beach, Va.).

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ing hexed titanium screws with
20Ncm torque. Cotton pellets were
placed over the screw heads, and
the access holes were sealed with
composite resin. Occlusal adjustment prevented functional contact
upon excursions. The interim
restorations did not fill the papillary space between #8 and #9 (Fig
7). A radiograph taken following
completion of provisionalisation
demonstrated satisfactory positioning and seating (Fig 8).
Gingivectomy Over Implants
Healing of the implant sites proceeded without incident. At one
week post-surgery, the buccal marginal tissue remained
coronally-oriented and encroachment of the papilla into the unfilled interdental space began
(Fig 9). Three months after
initial surgery, further coronal displacement and papilla
fill occurred (Fig 10). Minor
gingivectomy was performed
to create mucosal symmetry
between the maxillary central
incisors. The contact point and
contour of the interim crowns
were also adjused to create a~
fuller papilla.

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3c. Initial osteotomy orientation confirmed by
radiograph

Final restoration of Implants
Six months after gingivectomy
and provisional contour modification, the implants were ready for
final prostheses (Fig 11). Single
final PFM crowns were placed on
implants #8 and #9. Clinical analysis demonstrated resolution of
inflammation, idealisation of the
soft tissue drape and papillary regeneration (Fig 12). A radiograph
illustrated preservation of interproximal and peri-implant bone
(Fig 13). The patient was satisfied
with the functional and aesthetic
results (Fig 14).
Post-Operative Instructions
After each surgical procedure, the
patient was instructed to take ibuprofen 600mg every 4-6 hours, hydrocodone 7.5mg/acetaminophen
750mg every 4-6 hours prn pain and
doxycycline 100mg as required
for every day for 10 days. The patient was instructed not to brush
at or near the surgical site but instead to rinse with 0.12 per cent
chlorhexidine or warm saline
twice daily. The patient was also
directed not to chew in the affected area for at least two weeks. DT
à DT page 22

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[22] =>

22 Implant Tribune

United Kingdom Edition February 14-20, 2011

ß DT page 21

5b.Radiograph of implants in place with
temporary healing abutments. Note peak of
bone between the implants

7. Provisional restoration immediately
following reline and placement. Papilla is
not present

6b. Facial view of temporary cylinders

8. Radiograph the day of implant placement

10. Provisional restoration three months
post-implantation

ADI Dental Tribune A5 Advert Jan 11

1/2/11

16:48

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6a. Occlusal view of temporary cylinders. Note ideal positioning for both function and
esthetics. Occlusal forces are directed along the long axis of the implants. Implants are also
positioned palatally which will allow for ideal sculpting of the tissue with the provisional

ADI 2011 TEAM CONGRESS
14-15 APRIL 2011

MANCHESTER CENTRAL CONVENTION COMPLEX

The ADI Team Congress has now become the leading dental implant meeting
in the United Kingdom and one of the foremost in Europe, with the unique
combination of a plenary programme with internationally renowned
speakers, parallel sessions for all dental care professionals, an exhibition and
a fantastic party.

9. Provisional restoration one week postimplantation. Very good soft tissue healing
and minimal recession

Association of Dental Implantology UK

Team Congress
14-15 April 2011
Manchester

what we know, what we think we know and what
we think we don't know about implant dentistry

11. Provisional restoration at 6 months
following gingivectomy and adjustment of
interim crown contours

Dental implantology is a team speciality and the 2011 Congress programme
continues to uphold and endorse this ethos. The team programme includes
sessions for dental nurses, dental hygienists/therapists and practice
managers, with the dental technicians being included in the plenary
programme where two world-class technicians will be speaking.

www.adi.org.uk/congress2011

Thursday 14 April

£555 for member Clinicians

PLENARY PROGRAMME FOR CLINICIANS AND TECHNICIANS
Professor Tomas Albrektsson, Sweden
Professor Mauricio Araújo, Brazil
Dr Stephen L Wheeler, USA

Mr Michel Magne, USA
Professor Clark M Stanford, USA

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12b. Close up view of final restoration

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Ms Anita H Daniels, USA

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About the author

DENTAL IMPLANT TEAM PROGRAMME - (Afternoon)
Hygienists' & Therapists' Programme
The role of the dental hygienists in implant treatment
Ms Anita H Daniels, USA
Practice Managers' Programme
Ringing the changes: turn every patient enquiry into an appointment
Mr Ashley Latter, UK

12c. Right lateral final view

Nurses’ Programme
Asepsis for dental implants; Effective communication with patients; Advanced surgical
techniques, instruments & preparation; Medical emergencies in implant surgery; HTM0105
and implant dentistry; Sinus lifts
Miss Helen McVicker, UK
Miss Louise Fletcher, UK
Miss Helen Batty, UK
Dr David Speechley, UK
Miss Helen Frost, UK
Miss Amy Miller, UK
Dr Simon Wright, UK
Miss Kara Moody, UK

12d. Left lateral final view

Friday 15 April
PLENARY PROGRAMME OPEN TO THE WHOLE TEAM
Professor Joseph Kan, USA
Dr Stephen S Wallace, USA
Professor Torsten Jemt, Sweden

Mr Oliver Brix, Germany
Associate Professor Tara Aghaloo, USA

Congress Exhibition - Thursday 14 & Friday 15 April
Opportunities to view and discuss the latest innovations face to face with the industry experts

Optional Congress Social Event - Thursday 14 April
“A Hard Day's Night” at Lancashire County Cricket Club: The Point
Entertainment provided by the Bootleg Beatles

Book your place now ONLINE at www.adi.org.uk/congress2011
For more information and a Congress brochure call the ADI
on +44 (0) 20 8487 5555 or email info@adi.org.uk

12a. Final #8 and #9 implant restorationsn

13. Radiograph of
final restoration.
There is preservation
of interproximal and
14. Final facial view
peri-implant bone

Dr Michael Sonick
is a full-time practicing periodontist
and implant surgeon in Fairfield CT.
A renowned educator, author, and
clinical researcher,
he is a Guest Lecturer for the International Dental
Program at New
York
University
School of Dentistry,
a former Clinical
Assistant Professor in the Department
of Surgery at Yale University School of
Medicine and University of Connecticut School of Dental Medicine, and a
frequent lecturer on periodontics, dental implants and practice management
for educational programs around the
world. Locally, he is the founder and
director of the Fairfield County Dental
Club, an advanced continuing education organisation that provides courses
on the latest development in dentistry
to clinicians and their staff. Dr Sonick
is also founder and director of Sonick
Seminars, LLC, a multidisciplinary
teaching institute located in his clinical
office and teaching center. Courses are
given on all surgical aspects of periodontics and implant dentistry. Unique
to this program is the three part continuum: dentists to observe live surgery participate during the Hand’s-On
portion and attend lectures. Interested
participants can contact Carole at 203
254-2006 or visit the website at www.
sonickdmd.com.

[23] =>

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[24] =>

United Kingdom Edition February14-20, 2011
CAD/CAM SYSTEMS | INSTRUMENTS | HYGIENE SYSTEMS
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It is not all about
mouths you know
Mhari Coxon discusses a new perspective to
consider on the business of dentistry

have always attended CPD
courses ever since I qualified
as a hygienist. I often worked
as the only hygienist in a team
and enjoyed the interaction with
my peers initially, using it as a
reunion with my college buddies.
Clinically I felt it refreshed my
basic skills, added new thinking
and research into my work ethos
and allowed me to attempt to
keep my patient care at a consistently good standard. Recently, I
have been looking at trying to
improve my customer care and
business sense to help with my
practice life and my role as director at CPD for DCPs.
I have just attended my first
totally non-clinical dental conference. Run by the uniquely named
Marketing Pirates of Dentistry; I
was privileged enough to be one
of their guest speakers. This was
with the promise, by me, of not
going all clinical. That was a lot
tougher than I thought.
To name but a few there was
a blend of speakers; the brilliant
and “not vanilla” Tony Gedge on
the marketing strategy used in
dental practice; Paul Howe on
selling, which was extremely
useful, and a superb motivational speaker called Clive Gott. I
was sad to miss hearing Nadim
Majid talking on website development for the dental practice.
But, being technically minded, he
has recorded it so I can watch it at
my leisure.

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From this event, I have a full
mind that keeps throwing up
ideas, about 12 pages of notes to
write up, and a very new perspective on the business of dentistry. I
am still mainly a clinician in my
job, and was trained to do just
that. I then spent a lot of years attending lectures and courses on
how to develop and hone those
clinical skills. Now I can see the
importance of the team understanding the business of dentistry, understanding the forecasts
and targets and knowing what a
HNW patient is and how to recognise one. (High Net Worth, it
is like our abbreviations, they
wouldn’t know what a BPE was
so don’t worry).
Most of my customer service
skills come from being a waitress
when I was at school back home
in Troon a few years ago now!
By working in different environments I have tried to learn from
the things that work and also the

things that don’t. Being self-employed I am used to having to justify costs and am coming to terms
with ROI and its importance.
(That is return on investment and
it is ok if you didn’t know that).
What impressed me most was
the number of teams that were
attending this event. There were
only two principals that had attended on their own. I can understand how they feel. As principal and sole owner, they feel
the running of the business is
down to them. And in a way it
is. It is how I felt for a long time
about my little training business. But if the team can’t see
what your vision is how can they
begin to implement the changes
you want? Also, after attending

experience has shown me, you
can take the horse to the water but they have to be thirsty.
There is no doubt in my mind
that this will give the best result. In this situation the principal is instigating the change and
development in the team and
therefore you are part of something ready to action change.
Route two is you feel that you
would like more business training
and your principal may not be seeing the value just at this moment.
There are many courses you can
attend independently and perhaps
your principal will see the benefit of a work based qualification,
such as an NVQ. If you grow
your skills independently, without the support of your principal

‘Now I can see the importance of the team
understanding the business of dentistry, understanding the forecasts and targets
and knowing what a HNW patient is and
how to recognise one’
a busy one or two-day event do
you feel you can pass on the information in a suitable way to
your team? Could you have taught
someone to drive after one driving lesson?
I remember saying in a
column last January that we
needed to work together to keep
our businesses fresh at the beginning of 2010. Well 2011 will
be another year of finding
solutions and building service to
keep your businesses improving
and succeeding.
It could be really beneficial
for teams to define their roles, do
a swot analysis and make a training plan purely based on their
business skills. Once you have
decided who needs to improve
what then you can implement a
training programme with a definite “done by” date.
There are two routes you
could go down that I can see, or
use a blend of the two perhaps.
Route one is to take the team
through coaching and support
of a well known and proven business advisor in dentistry, such
as Chris Barrow, Kevin Rose and
of course Tony Gedge and his
pirates. The really important bit
of this is that the principal is the
leader and instigator of this; as

then this is commendable.This
will also almost certainly lead to
you moving on if the circumstances do not change. I am learning
slowly that work satisfaction has
to be a team experience. So get out
there and develop your skills.
A great toe in the water solution would be to sign up to
the dentistry show in Birmingham on March 4th and 5th. They
have two whole days of business
speakers that the whole team
can attend. And, best of all, it
is free to attend most speakers
sessions. To register you and your
team visit www.thedentistryshow.co.uk
I look forward to seeing all
those with their finger on the
pulse of modern dentistry there;
I will be the one in the front row
making notes furiously. DT

About the author
Mhari Coxon is
a dental hygienist
practising in Central London. She
is chairman of the
London British Society of Dental Hygiene and Therapy
(BSDHT) regional
group and is on the
publications committee of its journal, Dental Health.
She is also clinical director of CPDforDCP, which provides CPD courses
for all DCPs. To contact her, email
mhari.coxon@cpdfordcp.co.uk

[25] =>

Clinical 25

United Kingdom Edition February 14-20, 2011

SEM evaluation of morphological changes
Georgi Tomov discusses tissues prepared by Er:YAG laser and rotary instruments

T

he main categories of
techniques for microinvasive preparation (MIP)
include
chemo-mechanical
cleaning with Carisolv gel, air
abrasion and dental lasers. 1, 2
The trends for the replacement
of the conventional method of
preparation led to focus the attention of researchers on the
impact of alternative techniques for MIP on hard dental
tissues and underlying dental
pulp. MIP techniques claim for
controlled removal of infected
and softened dentin while preserve healthy hard dental tissues
and do it with minimal discomfort for the patient. However,
currently available data provide
contradictory the impact of
alternative techniques of MIP
on hard dental tissues compared
to conventional preparation.
Possible reasons for this are
the variety of experimental studies and difficulties to standardise
the results of clinical researches.
It is striking that researchers who
give the most positive evaluation
of alternative methods of preparation are using mainly clinical
criteria for evaluation (perception and tolerance of the patient,
noise, atraumatic work, colour
and texture of the dentine
when probing etc) which are
some subjective.
Opposite, the SEM and histologic evaluations are not
unanimous for its benefits
and advantages. On the dental
market new improved versions of alternative systems for
preparation are available claiming for clinical efficiency, but
scientific data are still scarce
(these are generally the multi-frequency high-energy lasers and air abrasion devices).
For that reason periodic updates
of researches in this rapidly
developing
and
promising
field of dentistry are needed. The
purpose of this in vitro
study was to evaluate by
SEM the ultrastructural changes
in the hard dental tissues treated
with Er: YAG laser (LiteTouch)
and conventional preparation
with diamond burs/air turbine
and steel burs/micromotor.
Methods
Experimental design: the study
used 30 human teeth freshly
extracted due to advanced periodontal disease. The preparation
involved natural carious lesions
on tooth surface.
According to the preparation technique the teeth were
divided into three groups of 10
teeth (n=10):
Group 1: Laser preparation by
Er: YAG laser (LiteTouch, Syn-

eron, Israel) (Fig 1 a, b)
Group 2: Mechanical rotary
preparation by diamond burs/air
turbine)
Group 3: Mechanical rotary preparation by steel burs/micromotor
Preparations are made strict-

ly according to manufacturer’s
instructions for service.
The removal of caries is
proved by clinical methods –
observation and probing. After
preparation the teeth are immersed for one hour in four per

cent buffered fixative solution
of glutaraldehyde (0.075 M, pH
7.3). Then rinsed with distilled
water and placed for 90min in
cold buffer solution of sodium
kakodilate (0.02M, pH 7.2, 660
mOsm) for fixation of organic
matter. Subsequent dehydra-

tion is carried out in ethanol in
ascending series of 30, 50, 70,
80, 95 and 100 per cent in one
hour in each series, such as drying of the teeth is based on CPD
(Critical Point Drier) method in
à DT page 26

[26] =>

26 Clinical
ß DT page 25

a dessicator. Dried specimens
are fixed on metal stand and
covered with gold layer (200250nm) by cathode atomisation under vacuum. Scanning
microscopy is performed with the
electron microscope of Philips
(Holland) 515 model SEM with
accelerating voltage of 25kV in
secondary emission mode. On
each specimen were made respectively five pictures with the
same magnification (x2000) of
randomly chosen areas and different numbers of photos with
other magnification.
On SEM photos are rated,
described and compared morphological findings and differences in enamel and dentin
tissues after treating with alternative methods for caries removal and cavity preparation.
Results
Cavity forms prepared with
Er:YAG laser (Group 1) are
characterised by a lack of definite and precise geometric configuration and outlined cavity elements. There is rough
and irregular surface without presence of smear layer
(Fig 2 a). Dentinal tubules orifices are clearly exposed. Intertubul
dentin is ablated more than
peritubular dentin and that
made dentinal tubules appearance more prominent (Fig 3 b).
Laser ablation changes enamel
and the surfaces appeared strong
retentive (Fig 2 c).
In Group 2 (preparation with
diamond burs, air turbine and
water cooling) a thin, smooth

United Kingdom Edition February 14-20, 2011

and in some places missing
smear layer was observed (Fig
3 a). In the area of water turbulence marked dentinal tubules
orifices can be seen, but without
having a clear outline of both
tubules lumens and peri-and intertubular dentin (Fig 3 b). The
boundary between enamel and
dentin is unclear and the cavity

surface suitable for adhesive
bonding.1 Antibacterial effects
of the alternative preparation
techniques must not be lower
than those of standard necrotomy with rotary instruments and
even to excel them.1
Nowadays the laser devices
available for clinical use are ca-

‘Nowadays the laser devices available for
clinical use are capable for effective and
controlled ablation of hard dental tissues’
forms heve smooth contours.
When analysing the SEM
photomicrographies
of
the
specimens examined, it is found
that the conventional method of cavity preparation with
steel burs and micromotor at
low speed without water cooling (Group 3) leaves contaminated surface covered with
smear layer of dentin debris
without visible dentinal tubules
orifices. (Fig 4 a, b). Thick smear
layer covers all treated surfaces.
The walls of the cavities are
smooth and rounded and the
border between enamel and dentin is not perceptible.
Discussion
The philosophy of minimally
invasive cavity preparation approach is based on several main
principles – to remove only irreversibly damaged dental tissues
and to avoid macroretention
preparation in healthy tissues.1
Additionally these techniques
should protect the underlying
pulp and to leave the treated

pable for effective and controlled
ablation of hard dental tissues;2
however, not all researchers
agree with these conclusions.
Therefore, such studies should
be periodically updated due
to constant introduction of
new technologies.
The experimental results of
the presented study revealed
significant differences in the
surface morphology of the
studied samples, which would
affect the ability to perform effective adhesive bonding. These
morphological differences are
highly dependent on the mechanism of action of the used preparation systems.
Laser devices use a variety of physical media as sources
for generating different wavelength that is absorbed and interact with specific molecules in
human tissues. The explanation for the hard tissue ablation
is the water content that evaporates when exposed on laser

1a

Figs 1 a, b: Laser preparation with Er: YAG laser LiteTouch (Syneron, Israel) “Hard tissue mode” (400mJ/20Hz; 8.00W)

radiation creating high internal
pressure and subsequent microexplosions. In this interaction of laser radiation with tissue if inadequate water cooling
occurred, that will lead to undesirable thermal effects.3 Depending on parameters such
as pulse energy and frequency
CO2 lasers, Nd: YAG and Er: YAG
lasers cause changes in enamel
and dentin as roughing, craters, cracking, slicing, carbonification, melting and recrystallisation described in many
previous studies.4, 5, 6 These
changes depend on the laser type,
mode of operation, system
for water cooling and proper
operation.3 Additionally, the
opportunities to ablate carious dentin and enamel strongly vary according to different
experimental studies. 4, 5, 6 For
argon-fluoride laser (ARF) and
the excimer laser there are
data on their ability to remove
dental caries, which is not of sufficient efficiency.5 Krypton fluoride excimer laser emitting in ultraviolet range has been shown
to remove dentin, but enamel
resists the attempt for ablation.5
Used in this experimental
study, LiteTouch Er:YAG laser
incorporates special software,
which allows for the broadest
range of energy and frequency
settings. The unique LiteTouch
optical system incorporated in
the ergonomic hand piece prevents loss of energy and along
with the precision control over
pulse duration, pulse energy
and repetition rate optimise, allows for a wide range of hard
tissues procedures. Another
characteristic of this laser is the

1b

wavelength (2940nm) which is
absorbed mostly by the water
and also sapphire tips, showing stability in providing focused energy of laser radiation.8
The mechanism of LiteTouch
action is based on interaction between laser radiation and hard
tissues incorporated water that
results in microexplosions. It is
believed that this process is the
mechanism of ablating particles
from dental tissues without overheating, and without smear layer
formation.7 This combination allows precise microinvasive cavity preparation with minimal
heating and optimal rate of radiation absorption by the hydroxylapatite incorporated water.7
The program “hard tissue
mode” removes enamel, dentin
and dental caries effectively and
without visible carbonisation or
disturbance of the dental microstructure. Evaluated under SEM
the dental tissues treated with
Er: YAG laser showed rough and
irregular surface without presence of smear layer, open dentinal tubules orifeces were found
as well. Intertubular dentin is
ablated more than peritubular
giving a characteristic appearance of the dentinal surface with
mild prominent dentinal tubules.
Enamel shows preserved prismatic structure, but also strong
retentions due to microexplosions on its surface. Overall the
cavity form is irregular, devoid
of strict geometry and dotted
with microretentions, but without presence of contaminants
or smear layer. The observed
changes correspond to changes
in hard dental tissues reported by
other authors in previous studies

[27] =>

Clinical 27

United Kingdom Edition February 14-20, 2011

on Er: YAG lasers 9, 10, but without thermic degenerated surfaces, areas of extensive recrystallisation, melted surfaces or cracks
in the dentin, as described in
some in vitro studies.3,4,5 It is also
reported for better opportunities
for adhesive bonding,11 faster
ablation of enamel and dentin
compared with rotating burs 12
and an increase in dentinal microhardness after treatment with
Er: YAG pulsed lasers. 13 The latter statement is not confirmed
by other studies. The marked
surface irregularities and lack
of smear layer observed in the
recent study, noted also in other
researches 14, 15 provide a solid
evidence for the physical mechanism of bonding with composite
materials after laser treatment.11
This fact is not yet fully explored
as a possible opportunity to eliminate acid etching of hard dental
tissues and its related adverse
effects on the underlying dentin
and pulp.

layer, and opened dentinal tubules. Intertubul dentin is
ablated more than peritubular dentin and that made the
dentinal tubules appearance
more prominent. Er:YAG laser
ablated enamel effectively and
remained
exposed
enamel
prisms without debris. The surfaces are very retentive.
The author declares not having any financial interest in
a company (or its competitor)
that makes a product discussed in
the article or any conflicts
of interest. DT

References:
1. Banerjee, A. Watson TF, Kidd EA. Dentine caries excavation: a review of current clinical techniques. Br Dent J 2000;188(9):476-82. 2.
Yazici, A.R. Ozgunaltay, G. Dayangac, B. A scanning electron microscopic study of different caries removal techniques on human dentin.
Operative Dentistry 2002;27:360–6. 3. Stefanovic, M. Skenirasch electronically - mikroskopski analysis Efektim from vzdeystvieto on Er:
YAG laser and konventsionalniya method vrhu dentin. KFOR and the NUS 2005; 4(1): 153 – 156 4. McCormack, S.M. et al. Scanning
electron microscope observations of CO2 laser effects on dental enamel. J Dent Res 1995;74:1702–8 5. Palamara, J. et al. The effect on the
ultrastructure of dental enamel of excimerdye, argonion and CO2 lasers. Scanning Microsc 1992; 6:1061–71 6. Li, Z.Z. Code, J.E. Van De
Merwe, W.P. Er:YAG laser ablation of enamel and dentin of human teeth: determination of ablation rates at various fluences and pulse
repetition rates. Lasers Surg Med 1992;12:625–30 7. Park, N.S. Changes in Intrapulpal Temperature After Er:YAG Laser Irradiation.
Photomedicine and Laser Surgery. 2007, 25:229-232 8. Eguro, T. et al. Energy output reduction and surface alteration of quartz and
sapphire tips following Er:YAG laser contact irradiation for tooth enamel ablation. Lasers in Surgery and Medicine. 2009; 41:595-604
9. Eberhard, J. et al. Cavity size difference after caries removal by a fluorescence-controlled Er:YAG laser and by conventional bur treatment. Clin Oral Investig 2008;12(4):311-8. 10. Matsumoto, M. et al. Morphological and Compositional Changes of Human Dentin after
Er:YAG Laser Irradiation. J Oral Laser Applications 2003; 3:12 – 20 11. Ceballos, L. et al. Bonding to Er-YAG-laser-treated dentin. J Dent
Res 2002;81(2):119-22. 12. Baraba, A. et al. Ablative Potential of the Erbium–Doped Yttrium Aluminium Garnet Laser and Conventional
Handpieces: A Comparative Study. Photomedicine and Laser Surgery. 2009, 11:465-504 13. Chinelatti, MA. et al. Effect of erbium:yttrium–
aluminum–garnet laser energies on superficial and deep dentin microhardness. Lasers Med Sci. 2008, 34:135-140 14. Raucci-Neto, W.
Chinelatti, MA. Palma-Dibb, R.G. Ablation Rate and Morphology of Superficial and Deep Dentin Irradiated with Different Er:YAG Laser
Energy Levels. Photomedicine and Laser Surgery. 2008, 26:523-529 15. Kinoshita, J. Kimura, Y. Matsumoto, K.Comparative study of carious dentin removal by Er,Cr:YSGG laser and Carisolv. J Clin Laser Med Surg. 2003 21:307-15. 16. Banerjee, A. Kidd, E.A.M. Watson, T.F.
Scanning electron microscopic observations of human dentine after mechanical caries excavation. Journal of Dentistry 2000;28:179–86.

The results of some contemporary studies showed that despite of the differences between
individual authors, generally
the amount of smear layer after
treatment with Er: YAG laser in
all cases is less than that after
conventional rotating instruments, and surface changes are
characterised by markedly rugged topography.2, 3, 12, 15
The
morphological
features of hard dental tissues observed in our study suggested us
to generalise that cavity preparation with Er: YAG laser
is consistent with the principles
of minimally invasive preparation, leaving clean surfaces and
strong microretentions suitable for adhesive restorations.
These assumptions about the
benefits of alternative techniques
for minimally invasive preparation of dental tissues for adhesive restorations should be confirmed in future clinical studies.
Conclusion
SEM analysis of hard dental tissues treated with steel and diamond burs showed surfaces covered with a thick layer of debris,
which could compromise the adhesion of filling materials. Dental tubules orifices are obturated
with debris, with exception the
areas under water turbulence
where the debris is partially removed. All laser-treated samples
showed no evidence of thermal
damage or signs of carbonification
and melting. The SEM examination revealed characteristic
micro-irregularities of the lased
dentin surface without smear

Figs 2 a, b: Laser treated dentin. The surface is clean and free from debris, all dentinal tubules were found open. The surface is irregular, rough, which creates strong retentions. At
greater magnification more effective removal of intertubular dentin is seen, and that makes dentinal tubules orifices to appear convex (Magnification x 500, 2000).

Fig 2 c: Enamel treated with Er: YAG laser revealed characteristic surface which is very
retentive and free from contaminants and smear layer (Magnification x 2000).

About the author
Georgi Tomov, Department of Operative dentistry and endodontic, Faculty
of Dental Medicine, Medical University, Plovdiv, Bulgaria. Assist. Prof. Dr.
Georgi Tomov, Faculty of Dental Medicine, Department of Operative dentistry and endodontic, 3 Hristo Botev str,
4000 Plovdiv, Bulgaria e-mail: stomatolog79@ abv.bg

Figs 4 a, b: SEM photomicrographies of tooth surfaces prepared with steel burs. The surface is covered with a layer of debris, dentinal tubules orifices are not visible. (Magnification x 500, 2000)

Figs 3 a, b: Smooth and thin smear layer covers tooth surfaces prepared with diamond
burs and air turbine. In the area of water turbulence partially removed contaminants and
single dentinal tubules lumena were observed. (Magnification x 500, 2000).

[28] =>

28 Implants
BioHorizons join forces
with Dr Paul A Tipton for
One Year Implant Course
BioHorizons is pleased to
be partnering with one of
the most influential dentists and teachers in the UK, Dr Paul A Tipton in 2011
for his One Year Implant Dentistry Course. Commencing February 2011 in
Manchester/ Leeds and April in London, this course is designed for dentists
who want to learn how to place and perform post-surgical prosthodontic
techniques.
The course, running for 13 days over the year, will cover implants occlusion,
facebows and articulators, aesthetics in implantology, implant placing
techniques and impression taking, as well as sinus lifts, overdentures and
advice on how to market your practice. Dr Tipton will also discuss pricing
options and treatment options, teaching you to place implants quickly and
easily to increase your income, secure a better job and improve the quality
of your work.

United Kingdom Edition February 14-20, 2011

Kent Implant Studio: The
best service for patients
and practitioners
The Kent Implant Studio
team, under the direction
of Dr Shushil Dattani, is dedicated to first class patient care and this is
achieved through excellent service and a commitment to establishing strong
relationships with all referring clinicians.
A brand new practice with state of the art technology allows the Kent Implant
Studio team to attend to the needs of clients and referring practitioners
with efficiency and professionalism. With a practice perfectly situated to
treat patients throughout London and the South East, you can be sure that
Dr Dattani will be on hand to offer help and advice to you and your patients
throughout every stage of their treatment.
Dr Dattani welcomes referrals for all types of cases including complex
procedures, surgery only prosthesis assistance and a full implant service.
Referring clinicians are kept fully up to date at every stage of the treatment
and are invited to attend the clinic with their patients at any time.

Arizona plays host to the
2011 Global Symposium
for BioHorizons
Held at the Arizona Biltmore
Hotel in Phoenix, Arizona on
28th April- 1st May 2011, BioHorizons Global Symposium will address a range
of implant dentistry challenges, including immediate loading, aesthetics,
tissue regeneration and implant complications.
Providing the perfect opportunity to stay current on the latest treatment options,
techniques and products, the four day programme includes pre-and postsymposium courses as well as dedicated educational tracks for auxiliary staff.
Lectures from world leading clinicians, including Marius Steigmann,
Carl Misch, and Jay Malmquist, and a welcome from R. Steven Boggan,
BioHorizons, the symposium will include the latest implant innovations,
feature clinician-moderated panel discussions and audience participation.
This Global Symposium will provide invaluable insight into existing and future
implant techniques for UK Dentists placing BioHorizons implants or for those
looking to use BioHorizons’ products in the future. Tuition for the Symposium
includes daily lectures, continental breakfast, lunch and coffee breaks for the
attendee as well as admission to the highly anticipated Saturday Gala for the
attendee and one guest. As always, attendance will be limited to maintain
an environment conducive to learning so please visit www.biohorizons.
com now for more information or contact the UK office on 01344 752560 or
infouk@biohorizons.com to register.

The course is charged at £399 + VAT per day in Manchester/ Leeds and £499
+ VAT per day in London and includes reading material and training. Each
day provides 6 hours of verifiable CPD and can lead to a Diploma in Implant
Dentistry from the British Academy of Implant Dentistry.

A referral to Dr Dattani ensures a professional, experienced service and
treatment of the highest quality. With Kent Implant Studio, your patients are
in safe hands.

For more information or book your place contact Tipton Training on 0161 602
3128 on at enquiries@tiptontraining.co.uk

For further information on the Kent Implant Studio or to obtain a referral pack
please call: 01622 671 265 www.kentimplantstudio.com

NobelActive™ from Nobel Biocare
NobelActive™ from Nobel Biocare is an advanced,
next-generation dental implant featuring a unique,
innovative body design and prosthetic connection.
Suitable for all indications, NobelActive™ offers
outstanding primary stability even in complex bone
situations. Particularly suited for use in the esthetic
zone, NobelActive™ has the ability to redirect
during insertion, whilst providing clinicians with
maximum placement flexibility. NobelActive™ boasts
a comprehensive prosthetic range of restorative
options, whilst being designed to work in harmony
with the system’s versatile set of components. When
combined with NobelProcera™ CAD/CAM crowns, bridges, implant bridges
and overdentures, NobelActive™ provides the best-in-class aesthetics. The
standardized prosthetic assortment for NobelActive™ provides restorative
clinicians with a comprehensive selection of components and abutments,
facilitating all restorative treatments.
As the world leader in innovative restorative and aesthetic solutions, Nobel
Biocare prides itself on providing dental professionals with advanced sciencebased tooth-to-root solutions. With a highly motivated, professional and
dedicated team available for training and support, Nobel Biocare is always on
hand to offer the support and advice needed by dentists.

Offer your patients a greater choice than ever
before with Nobel Biocare’s NobelProcera™
Thanks to developments in material design,
dental implants are no longer an option that most
patients can only dream about. With a wide range
of material options including titanium, zirconia and
alumina, Nobel Biocare enables practitioners to
offer more flexible pricing plans, helping to attract
more patients. NobelProcera™ from Nobel Biocare
encompasses several advanced technologies
such as conoscopic holography and the latest
3D prosthetic software, along with a seamless,
automated industrialised manufacturing process. The NobelProcera™ system
uses cutting-edge computer aided design (CAD) software, allowing clinicians
to create accurate and aesthetically pleasing restorations. Every practice
needs to look for new ways to increase their client base, and with the ability to
provide patients with such high quality and bespoke restorations, dentists will
enjoy increased patient interest and greater financial rewards.
As a world leader in developing innovative restorative and aesthetic solutions,
Nobel Biocare prides itself on providing dental professionals with advanced,
science-based solutions from tooth to root.
Dedicated representatives from Nobel Biocare are always available to clinicians
to offer support and advice wherever needed.

For further information, call Nobel Biocare on: 020 875 633 00
www.nobelbiocare.com

For further information, call Nobel Biocare on: 020 875 633 00 www.
nobelbiocare.com

For more information visit www.septodont.co.uk or call 01622 695520.

DentalAir.com relocates to
new premises
Dedicated
specialist
compressed air suppliers to
dental practices, DentalAir.
com has relocated to new premises in Lancashire.
DentalAir.com can now be contacted at:
DentalAir Services (UK) Ltd, The Mill House, Harp Business Centre, Queensway,
Rochdale, Lancashire, OL11 2QQ
DentalAir.com’s team can be easily contacted on 0800 975 7530, by fax on 0800
048 1616 or by email at info@dentalair.com
Using the best possible equipment available, DentalAir.com air compressors
offer maximum reliability and minimum noise levels. All of the company’s
machines are oil free for increased safety.
DentalAir.com also offers a low-cost lease rental package, which includes full
servicing and support.
Recently certified to ISO 9001 quality management standards, Dental Air will
provide expert non-obligation advice and full on-site surveys and maintenance
anywhere on the UK mainland. Its team of specialists are sensitive to the needs
of each individual practice, offering advice on anything from equipment care
to the supply of the latest oil-free piston and scroll compressors. DentalAir.
com’s team of experienced technicians also offer ‘Lunch & Learn’ sessions
on their range of clean air equipment at your dental practice at a time that
suits you.
For more information on DentalAir.com’s range of packages for every practice
please contact the team on 0800 975 7530.

Decapinol®: A Modern Approach to the
Control of Gingivitis and Prevention of
Periodontitis
The Decapinol® system successfully manages the
effects of gingivitis and assists in the prevention
of periodontitis.
Decapinol®
Toothpaste
has
clinically
demonstrated its ability prevent periodontal
diseases and has shown that it can reduce
gingivitis by up to 57 per cent. Extensive supporting data comprising 12 major
clinical studies in over 1,500 patients confirm that using Decapinol® Toothpaste
and Mouthwash every day is an ideal way of helping to prevent periodontitis.
The act of regular brushing and flossing combined with the innovative antiplaque formula of Decapinol® guarantees:
• Effective prevention of new plaque build-up
• Easy removal of plaque deposits
• No unpleasant taste or aftertaste
• No semi-permanent staining of the teeth
Decapinol® achieves this due its triple action against gingivitis:
• Forming an invisible anti-plaque barrier over teeth and gums to reduce the
attachment of plaque bacteria
• Interacts with the polysaccharides in the plaque to make it easier to remove
• Keeps the mouth flora in balance to protect from pathogenic invaders
A breakthrough in modern dental technology, Decapinol® is the helpful
solution for both the long and short-term management of gingivitis.
For more information call 01483 410 600 or visit www.decapinol.com

The Dental Plan: The Complete Practice
Solution
Created and run by dentists, The Dental
Plan understands what it takes to make a
dental practice successful. It offers principals
and staff a range of additional benefits,
including CPD training, help with regulation
compliance, complete Quality Management
Systems, as well as strategic business advice.
Dr Philip Bown of Nith Place Dental Practice
in Dumfries explains why he joined The
Dental Plan: “We recently transferred to The
Dental Plan, mainly because of their knowledge of the private dental market,
which is invaluable really, for advice, backup and business help. We were very
keen to move our practice forward and The Dental Plan’s help with producing
a very professional-looking newsletter with various offers to patients helped
us to generate a huge amount of business and new referrals to the practice – a
great success.
We are also in the process of expanding our practice, and here the financial
and business advice from the team at The Dental Plan has also proved to be
invaluable.”
Why not find out what The Dental Plan can do to expand and develop your
practice?
For a FREE initial practice analysis or for more information, please contact The
Dental Plan on 0845 604 28 61 or email: info@thedentalplan.co.uk
www.thedentalplan.co.uk

DentalAir.com offers new Lunch and Learn
sessions
Dental compressed air compliancy is the subject
of National Health guidelines and C.O.S.H.H.
legislation, so it has never been so important
for your practice’s oil free compressors, dryers,
filtration and pipework to be in full working
order.

Gingival preparation procedures are easier
and more comfortable with RaceGel®
A global pioneer in cutting-edge dentistry
and the UK’s number one supplier of dental
anaesthetics, Septodont is committed to
continually developing and bringing to market
new and dynamic products which revolutionise
the way in which modern dentistry is done, the
latest of which is, RaceGel®.
RaceGel® is a brand new gel specifically designed to make gingival preparation
procedures easier and more comfortable for patients, while ensuring the
quality and precision of impressions.
With thermo-setting properties, the product is liquid at room temperature
(T: 20°C) and turns into a firm gel when placed in contact with oral tissues (T:
35°C). This effectively creates a space in the gingival sulcus without applying
any pressure, keeping the gingiva passive and the patient comfortable.
The gel is easy to place, won’t run or drip and its distinctive orange colour
makes it easy to visualise during placement and rinsing. It also has a raspberry
aroma which makes it more pleasant for the patient than other products.
RaceGel® is orange to help visualise during placement and rinsing and comes
in a thin syringe with pre-bent tips to better control the placement of the gel.

Industry News
NEW Dash 30 per cent HP Whitening System
Exclusively Available from The Dental Directory!
The new Chairside whitening system from Discus
Dental, Dash is now available exclusively at The
Dental Directory!
Dash was developed with the clinician in mind as it
includes everything you need in one all-inclusive
kit. The unique 30 per cent hydrogen peroxide
whitening gel requires no syringe to syringe mixing
or refrigeration making it easy to use and store at
your practice.
Plus the kit includes easy to follow step-by-step
directions which will help you to make isolation and
application clear, quick and easy. Included in the pack
also to ensure your patients comfort, is a syringe of relief ACP that combines
chemical sensitivity relief (KN03) and long term relief of ACP and fluoride.
Dash is available from The Dental Directory for £45.00 per kit*, simply quote
product code PGD 060 when ordering.
For more information or to order speak to your local Dental Directory
Representative, call 0800 585 586 or visit www.dental-directory.co.uk
Price valid until 30th April 2011

Kemdent’s New Diamond
Micro Luting Cement
Capsules
Kemdent are pleased to
announce the launch of
their new Diamond Micro
Luting Cement Capsules,
the latest addition to the
popular Diamond range of
GIC restoratives. Kemdent customers can benefit from a special introductory
offer of 25 per cent discount on this product if they buy a 20 capsule pack
during January - March 2011!
Diamond Micro is a resin-reinforced, chemically-curing, glass ionomer cement
for permanent cementation of orthodontic appliances, crowns manufactured
from alumina-only or Zirconia-only cores, posts, metal inlays, onlays, crowns,
bridges, porcelain-fused to metal crowns, bridges on hard dental tissue and
cores rebuilt with amalgam, composite or glass ionomer cements.
With a working time of two - four minutes at room temperature and a sets-inthe-mouth time of three - five minutes, these capsules are easy to handle, have
a low solubility in the mouth and high adhesion. They also have an excellent
potential for luting Zirconium Oxide Crowns.
They are available in boxes of 20 x 0.25g capsules and value packs of 60 x 0.25g
capsules, and customers can contact Kemdent to request a free sample.
For more information call Helen or Jackie on 01793 770090 or visit our website,
www.kemdent.co.uk and follow us on twitter @Kemdent.

To help ensure your team is up-to-date with
the latest legislation, DentalAir.com, a leading
provider of compressed air to dental surgeries, now offers ‘Lunch and Learn’
sessions for the whole dental team, held either during the lunch break or at the
end of the working day at the dental practice.
Each talk lasts approximately one hour and attendees will learn about the risks
involved with compressed air and vacuum systems within the dental practice.
By the end of the session, delegates will understand the implications regarding
health and safety and the NHS relating to the use of compressed air in the
workplace.
The cost for the Lunch and Learn talk is just £295 including VAT – a small price
to pay for patient safety and your peace of mind.
For more information on Lunch and Learn or DentalAir.com’s range of packages
for every practice please contact the team on 0800 975 7530.

[29] =>

IntroducIng
’s biggest
innovation In 60 years
With 15 years of research behind it, our newest innovation protects all the key areas you check most:

3 PLaQUe 3 gUM PRobLeMs 3 sensitivitY 3 CaRies 3 enaMeL eRosion 3 staining 3 taRtaR 3 HaLitosis

Coming soon
Visit us at oralb.co.uk/professional

© 2010 P&g

PgW-4030

Continuing the Care That Starts in Your Chair

[30] =>

30 Events

United Kingdom Edition February 14-20, 2011

ADI Team Congress - Manchester
T

he Association of Dental Implantology Team
Congress is taking place
at the Manchester Central Convention Complex on the 14 & 15
April 2011.

ADI President Stephen Jacobs
along with Michael Norton, the
ADI’s Scientific Chairman, have

put together a two-day programme that should appeal to
all members of the dental implant team. To quote Stephen:
“The congress has now become the leading dental implant
meeting in the United Kingdom
and one of the foremost in Europe, with the unique combination of a plenary programme

with internationally renowned
speakers, parallel sessions for
all dental care professionals, a
large technical exhibition and a
fantastic party.”

The plenary session, for both
Clinicians and Technicians,
takes place over the two days,
with speakers such as:
Mr

Michel Magne (USA) “Aesthetic
dentistry today – a distinctive
approach to nature”, Professor
Maurício Araújo (Brazil) “Management of the alveolar socket”,
Dr Stephen S Wallace (USA)
“Latest strategies and techniques for maxillary sinus augmentation”, Associate Professor Tara Aghaloo (USA) “Bone

grafts for site development – the
past, the present and the future”.
A combined team programme,
followed by dedicated sessions
for Nurses, Hygienists/Therapists and Practice Managers is
offered on Thursday 14 April.
Anita Daniels will be speaking
in the morning on “The team
approach to implant dentistry: a
blueprint for success”. In the afternoon she will continue with
the Hygienists/Therapists on:
“The role of the dental hygienist
in implant treatment”.
Ashley Latter will take to the podium to speak to Practice Managers on “Ringing the changes:
turn every patient enquiry into
an appointment”.
The dedicated Nurses programme sees ADI Nurse members take to the podium to
present papers, and offers a
choice of three optional interactive workshops. Topics to be
covered include: “Asepsis for
dental implants: the theory &
the practical”, “Effective communication with patients”, “Advanced surgical techniques, instruments & preparation”,
“Medical emergencies in implant surgery”, “HTM0105 and
implant dentistry” and “Sinus
lifts”
Congress Exhibition
Open to all delegates is the congress exhibition.
Confirmed
exhibitors to date include: Astra Tech, BioHorizons, Biomet
3i, Gestlich Biomaterials, Nobel
Biocare, Straumann and many
more. For a full list of exhibitors
or to book a stand please visit
www.adi.org.uk/congress2011/
exhibition
Congress Social Event – A Hard
Days’ Night
Thursday 14 April 2011
Lancashire County Cricket Club
– The Point
1930 – 0100
Entertainment on the evening
will be provided by the world
famous Bootleg Beatles. Dress
code is ‘black tie, no tie’, and included in the price of the ticket
is all food, ½ bottle of wine, welcome drink and entertainment
(£75 per ticket). Also available
on the night will be a cocktail
bar offering a selection of aptly
named drinks!
Book online at www.adi.org.uk/
congress2011 or contact the ADI
office directly.
Association of Dental Implantology UK: 98 South Worple Way,
London, SW14 8ND: Tel 020
8487 5555: Fax 020 8487 5566:
www.adi.org.uk

[31] =>

Classified 31

United Kingdom Edition February 14-20, 2011

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

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

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

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

part of the oprogroup

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

7320_09_3

“I need an independent

review of my income protection”

mouthguard and tray
cleaning tablets

THE YEAR CERTIFICATE COURSE IN
NO
AESTHETIC DENTISTRY
W
4T I N I T
HY
FRIDAY 8th APRIL - FRIDAY 2nd DECEMBER 2011 (9 DAYS)
EA ' S
R

CENTRAL LONDON

Topics covered include:
‣ Smile Design & Management of the Aesthetic Case
‣ Digital Dental photography
‣ Porcelain Veneers, including no-prep & minimal-prep veneers
‣ Computerised Cosmetic Imaging
‣ Multilayered Anterior Composites
‣ Tooth Whitening tips and tricks
‣ Aesthetic Crowns, Onlays & Inlays
‣ Excellence in Posterior Composites
‣ Medicolegal aspects of Cosmetic treatment
‣ Restoration of the root Þlled tooth
‣ Marketing of Cosmetic services
‣ Management of toothwear including the ÒDahlÓ concept
‣ TMJ, Occlusion & Articulators
‣ Multidisciplinary treatment planning, e.g. Periodontics & Orthodontics

9 days of state-of-the-art dentistry

Hands-on sessions

Courses are run by Dr Ian Cline and Dr Joe Oliver, as seen on Channel 4Õs 10 years younger. The course
will consist of lectures, structured tutorials, demonstrations, videos, evaluation of scientiÞc papers, and
hands-on sessions. Fees are £540 per day, fully inclusive. Please visit the website or call the number
below for full details, including numerous testimonials and an application form.

Friendly, relaxed, informal teaching
WEBSITE www.cosmeticdentalseminars.org | EMAIL cdseminars@mac.com| TEL 0207 252 4210 | POST 7 Bury Place London WC1A 2LA

To advertise here please contact Sam Volk
on 0207 400 8964

‘Make sure you are covered by arranging an
income protection review with one of PFM’s
experienced Independent Financial Advisers’.

[32] =>

40% of denture patients are
1
concerned about denture odour
Yet many denture wearers fail to keep their
dentures clean2.
That’s because brushing dentures with ordinary toothpaste can scratch
denture surfaces3. And scratched surfaces can lead to bacterial growth4
leading to denture odour.

Scanning electron microscope (SEM)
images at 240 minutes confirm a significantly
higher build up of Streptococcus oralis on
denture materials previously cleaned with
ordinary toothpaste vs. a non abrasive solution5

Poligrip denture cleansing tablets effectively
remove plaque and tough stains6 without
scratching3, to leave dentures clean and fresh.
Poligrip Total Care denture cleansing tablets
also kill 99.9% of odour causing bacteria.

Recommend Poligrip denture
cleansing tablets to help your
patients control denture odour
References: 1. GlaxoSmithKline data on file, 2010. 2. Dikbas I et al, Int J Prosthodont 2006; 19: 294-8.
3. GlaxoSmithKline data on file Study L2630368 2006. 4. Charman KM et al. Lett Appl Microbiol. 2009;
48(4):472-477. 5. GlaxoSmithKline data on file Study NPD/EU/062/07 2008. 6. GlaxoSmithKline data on
file Study USNPD 016 and CS5244.

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

SPEAK, EAT AND SMILE
WITH CONFIDENCE

) [page_count] => 32 [pdf_ping_data] => Array ( [page_count] => 32 [format] => PDF [width] => 842 [height] => 1191 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT UK No. 4, 2011

[toc] => Array ( [0] => Array ( [title] => The only constant is unforeseen change [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Wear one short sleeve and one long [page] => 07 ) [3] => Array ( [title] => ‘We are all worms. But I believe that I am a glow-worm’ [page] => 08 ) [4] => Array ( [title] => Implant Tribune [page] => 11 ) [5] => Array ( [title] => It is not all about mouths you know [page] => 24 ) [6] => Array ( [title] => SEM evaluation of morphological changes [page] => 25 ) [7] => Array ( [title] => Implants [page] => 28 ) [8] => Array ( [title] => ADI Team Congress - Manchester [page] => 30 ) [9] => Array ( [title] => Classified [page] => 31 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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