News for November 2012

British Society for Restorative Dentistry Spring Scientific Meeting Manchester 2013

The spring scientific meeting in 2013 will take place in  Manchester on the 10th and 11th of May. The title is  New Technologies, New Deliveries And New Acquaintances.

Speakers are: 

  • Phil Ower, Specialist in Periodontics, Newbury
  • Joerd van der Meer Researcher, University Medical Centre of Groningen, the Netherlands
  • Ric van Noort Professor of Dental Materials Science, University of Sheffield
  • Jennifer Kirkham, Head of Oral Biology, Leeds Dental Institute
  • Brenda Murray Consultant Dental & Maxillofacial Radiologist, Leeds Dental Institute
  • Andrew Keeling Lecturer in Restorative Dentistry, Leeds Dental Institute

There is a Morning Masterclass on Friday 10th May:  Surgical techniques for Restorative Dentistry (Numbers limited to 24).

Click here for a PDF of the flyer.

19 November 2012

Assessment in education and ethical aesthetics

This yearly two day lecture plan was held at the RCS London.  Each day having a different focus reflecting the society’s endeavors to support education and clinical management in dentistry.  Up to 130 delegates attended the event with as always opportunities for people to see like minded collogues and make new connections. The event was kindly sponsored by……… who’s support is always invaluable.
    Day one looked at improving assessment in education with support of BATCD:
    Dr Chamberlain a assessment specialist from the GMC/GDC started the day and spoke on how to construct MCQ’s and assessment questions to best reflect the knowledge of students. Opened eye’s as to how to question without unnecessary ambiguity and started the days debate of assessment off by sparking peoples interest and  posing interesting questions on improvement of assessments.
    Professor Val Wass as the chair of the Medical School Council Assessment Alliance as Head of Keele Medical school, talked about the medical schools council assessment and alliance partnership and how university’s can work together and that there should be consideration of national question banks meaning better standardization of exams.
    Professor Youngson Head of Liverpool Dental School, talked about dental school collaboration and consideration of one standard looking at the problems and benefits.
    Dr Bennett  as director of undergraduate dental studies at Peninsula, talked about new methods of ongoing progress testing.  The benefits of which can help to show step wise growth in student developments. Results can provide more personalized individual feedback to help students focus on areas which need further learning and development.  The ongoing tests can also be used to assess how well the new programme is working.  
    Dr Chamberlain assessment specialist from the GMC/GDC looked at the do’s and don’ts of psychometric analysis.  This focused on reliability validity and quality of designs and delivering of assessments.  Also considering the use of appropriate questions, marking reliability and consistency of testers.
    Day two had a more clinical focus on ethical aesthetics:
    Mr Miznahi from The Eastman, started off the day by looking further into the aesthetic use of  and evidence base behind ceramic restorations and what results can be achieved.  He talked about his own clinical experience and his methods of cementation and isolation to aid long term aesthetic success.  Showing case studies to demonstrate the high quality outcomes that he has achieved while highlighting potential problems that can occur which where the reason for many of the replacement restorations which he had placed.

Mr Northeast from the University of Sheffield then approached aesthetics from a more conservative point of view and discussed the use of composite resin restorations.  He look at the scope of these materials, the different types of material and techniques to gain the best results.  Importantly he also looked into the limitations of such restorations with evidence base on deterioration and longevity. Concluding that more encouragement into the use of these materials to aid development of techniques and research.

Professor Saulean came all the way from the department of Periodontology in Bern to talk about periodontal aesthetics in terms of the possibilities and limits of treatment on single and multiple rescissions around natural teeth and dental implants. Breaking up the treatment in terms of tooth/implant, soft tissue and bone. He suggested limited success on Class III defects and showed case studies on each recession class highlighting the dramatic improvements which can be achieve which were maintain at 5yr review.

Mr Kelleher from Kings College London then gave a vehement summery of the ethical principles in dental bleaching.  Considering the legality of its clinical use and its effectiveness for improvement of dental discolouration.  How the use of dental bleaching is a clinical and moral decision as to the potential positive outcome which can be reached in controlled treatments and educated patients.

Mr Ahmad as a GDP from the Ridgeway Dental Surgery, talked on the used of aesthetic posterior materials.  He focused on to bulk fill vs incremental fill techniques. This beautifully presented talked took us through the evidence base behind bulk or incremental filling.  It looked at techniques for placement and new materials and applications methods available.  Compare and contrasting between different these techniques with clinical examples and videos of application methods.

Mr Ayliffe a Maxillofacial surgeon from Great Ormand Street then talked though many rare cases of facial deformity.  He showed the new options available with distraction to change and improve appearance and provide bone for dental restoration.  He discussed the close work he does with orthodontist and this eye opening talked allowed some insight into such complex cases from a surgeons perspective.

Professor Tredwin from Peninsula then closed the day looking at training and how to teach undergraduates. He discussed the core knowledge skills needed and how scientific knowledge is a important supportive aspect to that learning.  The main restorative skills which we would expect where highlighted.  Individual diagnosis, prognosis for different areas of the specialty were explored. This talk candidly reminded us all of the importance of passing on valuable knowledge to the new generations.

This year saw a new opportunity for postgraduates to present their experiences in our Scientific presentations:

3 presentation were accepted for presentation;

    Linda Greenwall, BDS MSc MGDS RCS MRD RCS FFGDP
In the aesthetic driven society that we live in a beautiful smile is an essential asset. There has been an exponential  demand for patients requesting smile improvement. Whilst the previous model of mass veneer placement has cause mass destruction of healthy teeth which was unethical, there more ethical simple ways to improve smiles for patients with severe discolouration. The current trend is towards minimally invasive aesthetic dentistry and the presentation will discuss options for treatment and the treatment planning protocols that need to be in place in order for to accomplish this minimally invasive modality for patients with severe discolouration ( eg Fluorosis, white spots, tetracycline discolouration). Furthermore the legislation concerning tooth whitening is changing on 31st October. This affects the way these techniques can be undertaken and as such all dentists providing whitening should know the new legislation and implications for practice.

The presentation will include tooth whitening techniques, microabrasion, use of Ikon Infiltration Resin to treat white lesions after bleaching  and combinations of treatment.  The presentation will show many before and after cases demonstrating this minimally invasive approach. New whitening treatment techniques will focus on minimally invasive aesthetic dentistry.

To provide the delegates with a knowledge of  how to introduce a minimally invasive approach to make aesthetic improvements for patients and how to undertake treatment planning to make this happen.

To provide delegates with an understanding of tooth whitening, for smile improvements
To learn about  the  process and indications for Microabrasion after tooth whitening .
To learn about the use of Amorphous calcium phosphate for soothing and fading white marks on teeth.

 At the end of the presentation delegates should be able to understand:
1.    Tooth whitening techniques
2.    Classification of tooth whitening into basic, intermediate and advanced.
3.    Treatment planning and staging of whitening  treatment  
4.    Ethical whitening treatment
    Najam Iman BDS MJDF
Consultant knows best? – A case study in ethically delivering aesthetics within the NHS

Background: A generally fit and healthy 79 year old male attended in general practice with an extensive restorative consultant-prescribed treatment plan involving 10 primary/replacement cast restorations and 5 primary/re-root canal treatments.

He had already been ‘passed around’ several NHS practitioners unwilling to undertake his treatment. The patient felt his current treatment plan would increase his restorative burden significantly and requested only elimination of pain and re-establishment of his basic functional and aesthetic needs with minimal intervention.

History/Examination: His main complaint from his partial dentition was constant tenderness from his UL5 and LR3 and no posterior support on his right side. He also presented with retained roots on his UR2 and UL3 and carious lesions on his LL2 LR3. Porcelain bonded crowns were present on his LL456 and UL2 and a fixed-fixed bridge spanning UR456, which were all asymptomatic. His anterior teeth exhibited moderate erosion-attrition tooth wear.  

Radiographically, he had several root canal obturations which were either short or contained voids. However, many of these were over 20 years old and all were asymptomatic.

Treatment: Obtaining a ‘perfect’ outcome by performing extensive primary and re-treatments would have almost certainly resulted in an extensive and potentially problematic treatment course. Therefore, a more minimally invasive aesthetic approach was considered.  

His initial pain relief phase involved extirpation of his UL5 and LR3 and extraction of his retained roots on UR2 and UL3. Study models were also mounted on a semi-adjustable articulator and a diagnostic wax-up produced using a reorganized approach.

Stabilisation involved oral hygiene instructions, restoration of his carious lesions on his LL2 and LR3 and completion of the root canal treatments on his UL5 and LR3. Tooth wear was addressed by composite build-ups on the affected teeth.

Once stabilized and extraction sites matured, upper acrylic and lower cobalt-chrome partial dentures were construction at the new vertical dimension, as was one porcelain-bonded crown on the UL5.

Discussion: Aesthetic dentistry needs to be placed in the context of the patient’s age, wishes and financial situation to be truly ethical. The urge to provide complex restorative treatment needs to be tempered with what the patient truly needs. The ivory towers of dental hospitals and private practices may be doing an injustice to the majority of patients who cannot get access to the extensive restorative care they require.  

Although a consultant’s opinion should be heavily considered, their treatment plan should be achievable by the average NHS practitioner. This patient’s treatment shows how treatment plans can, and indeed should be modified to the patient’s needs in order to provide an ethically considered aesthetic resolution.
    Roshni Karia BSD MJDF
Ethical aesthetics in a moderately-severely worn young male dentition: A case report.

This case highlights the clinical presentation and subsequent management of a 25 year old gentleman who presented to the Restorative department at Kings College Dental Institute for moderate-severe tooth surface loss localised to his upper anterior teeth.
Managing worn dentitions using biologically conservative and minimally invasive techniques is a vital part of overall treatment planning. Whilst there is an aim to establish an aesthetic result, what must be borne is mind is that clinicians are often presented with little enamel and dentine as a result of the preceding pathological process and this tooth tissue must be preserved.  
Case report
A patient studying Psychology, visited his GDP to have his aesthetic concerns (of his upper anterior teeth) addressed and this prompted a referral to the secondary care environment.
A localised pattern of moderate-severe incisal and palatal wear was noted from the UR3-UL3. In addition, a banded pattern of brown demineralisation was detected along the cervical margins of these teeth as well a ‘notched’ appearance of the incisal edge at the UL1.  A previous history of a high intake of Cider along with diluted squash and carbonated soft drinks helped to ascertain the aetiology of the pattern of tooth surface loss, which was primarily erosive in presentation.
Treatment options could have included direct composite build ups, indirect composite build ups or indirect ceramic based restorations, with or without metal understructure.  Whilst, these options could have been used to execute the final result independently, the patient was dissatisfied with the colour of his existing natural dentition. Therefore, night guard vital bleaching was prescribed to the patient following suitable assessment to help favour a more aesthetic result. This technique has been well reported, even in the use of full coverage restorations to help improve the aesthetic outcome.1,2
Direct Composite resin restorations were the elected treatment modality to restore this young adult upper anterior dentition, which is well reported in dental literature1, 2, 3.  Chair side ‘mock ups’ on un- etched and dry teeth were used to demonstrate to the patient the intended result. Following this the above treatment was carried out.  

Application of these minimally invasive treatment methods using direct composite and night guard vital bleaching resulted in restoration of an ethically aesthetic and biologically acceptable outcome, which has indirectly extended the life cycle of these teeth and has not meant further loss of tooth tissue to accommodate restorative material. Tooth surface loss, though a progressive phenomenon need not lead to an accelerated restorative spiral by clinicians themselves. The importance of taking into account the patient’s age wants and needs are paramount in overall treatment planning. However, more importantly are the steps taken to ensure tooth survival long term.

All cases where presented to all delegates a panel of 3 judges selected a winner. This years winner was Roshni Karia was awarded £250 and a certificate, this was presented by Josephine Pollock and in memory of the late Gary Pollock this award is to be know as; the Gary Pollock Postgraduate prize.

17 November 2012


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