journal of specialist dentistry developing dental ... · pdf filespecial interest include...

Editorial Board

www.chiswellgreendental.co.uk Issue 7- April 2017 1

ContentsRetention in Orthodontics

- Dr Luisa Lucchesi 2-3

Bar retained ISOD to manage maxillary

hard and soft tissue deficiency.

- Dr Zulaikha Burki 4-5

Systems for Dentists

Dental Practice Management Software

- Gary Ingram 6-7

CPD courses / Lunch & Learn sessions 8

Dr Claudio PeruSpecialistEndodontist

Dr Luisa LucchesiSpecialistOrthodontist

Dr Rajiv PatelSpecialistPeriodontist

Dr Kostas IoannidisSpecialistEndodontist

Dr Zulaikha BurkiSpecialistProsthodontist

Dr Poonam KalsiSpecialistProsthodontist

Journal of Specialist DentistryDeveloping Dental Expertise

www.chiswellgreendental.co.uk

Journal of Specialist Dentistry

Editorial Board

Welcome to the JSDEditor, Dr Massimo Peru, BDS, MSc Endo

Following the success of the first edition, we are delighted to present two cutting edge clinical cases performed by two specialist dentists, andmembers of the JSD editorial panel, Dr Luisa Lucchesi and Dr ZulaikhaBurki.

We are also pleased to introduce our new sponsor, Wright Cottrell,leading suppliers of dental materials.

If you are interested in developing your knowledge and practical skills,details of the next CPD seminar events organised by our partners atChiswell Green Dental Centre can be found at page 4. The seminars arefree of charge and valid for two CPD hours.

Best wishes,Dr Massimo Peru

Contents

Dr Claudio PeruSpecialist Endodontist

Developing Dental Expertise

Dr Luisa LucchesiSpecialist Orthodontist

Dr Rajiv PatelSpecialist Periodontist

Dr Aneesha ShahSpecialist Oral Surgeon

Dr Kostas IoannidisSpecialist Endodontist

Dr Zulaikha BurkiSpecialist Prosthodontist

Dr. Zulaikha Burki20, Rennie Court,11 Upper Ground,London, SE1 9LP

Mob: 077890-72059Email: [email protected]

Nationality: BritishGDC no: 84508

OBJECTIVE:

I qualified as a dentist in 2002. After working in General Practice for 5 years, I successfully completed Masters in Clinical Dentistry in Prosthodontics with Distinction from Kings College London 2009-2013 based at Guys Hospital. I hold the Membership in Restorative Dentistry (MRD) from Royal College of Surgeons Edinburgh. I am a GDC registered Specialist in Fixed and Removable Prosthodontics. I am also a fully trained and certified provider for Inman Aligner orthodontic system.

I am looking to work in a progressive practice where I can offer high quality and ethical dentistry.

EXPERIENCE:

Currently working as a Specialist Prosthodontist in the Department of Restorative Dentistry at Guys and St. Thomas Foundation Trust. I am responsible for treatment planning and management of patients with complex restorative needs and those needing extensive implant treatment. Most of my patients suffer from Severe Hypodontia and the restorative phase of management involves reorganising occlusion, a combination of conservative adhesive dentistry, onlays, veneers and multiple implant restorations. I am actively involved in clinical research and postgraduate teaching at Guys Hospital.

Prosthodontist in private practice; Sterling House Dental Centre till Nov 2014. Treating patients referred from in-house and local general dental practices that require restorative management and implant treatment.

General Practice

Worked as a General Dental Practitioner in mixed practice for 5 years (2005-2009), treating cases from all dental disciplines. Working closely with patients to develop a comprehensive treatment plan, managing patients expectations and providing treatment to the highest standard.

• St. James Road Dental Practice194a, Southwark Park Road, London

• Ooi Dental Practice 36, Brunel Road, London

Issue No2 - December 2015

Dr Simon MooreSpecialist Oral Surgeon

Page 2:Loss of a LowerIncisor in an adult. Case report Dr LuisaLucchesi

Chiswell Green Specialist Dental Centre

Page 3:MultidisciplinaryManagement OfSevere Hypodontia.Case report Dr Zulaikha Burki

Page 4:CPD courses/Lunch& Learn sessions/howto refer

Page

Welcome to the JSDEditor, Dr Massimo Peru BDS, MSc EndoWe are pleased to introduce a new addition to our team of Specialist dentists, Dr Kostas Karagiannopoulos specialist prosthodontist. Kostas qualified at the Royal London Hospital in 2001 and subsequently completed specialist training at Guy’s Hospital in Prosthodontics. He regularly attends courses and conferences both in the UK and internationally as part of his commitment to continuing professional education. His areas of special interest include replacement of missing teeth, bite problems, and aesthetic dentistry. He is a member of the American Academy of Fixed Prosthodontics and the American Prosthodontic Society and he annually attends their meetings in Chicago. Recently he became a faculty member of Spear Education, the leading educational institute in the U.S.

Since 2008 Kostas has been teaching undergraduate and postgraduate dental students at King’s College (Guy’s Hospital).

We are happy to present two clinical cases performed by two of our specialist dentists, Dr Luisa Lucchesi and Dr Zulaikha Burki. Also from SfD (Systems for Dentists) an article about their dental practice management software system.

If you are interested in developing your knowledge and practical skills, details of the new CPD seminar events organised by our partners at Chiswell Green Dental Centre can be found at page 8. The seminars are free of charge and valid for two CPD hours. Spaces are limited so please book early as it is on a first come first served basis.

Best wishes, Dr Massimo Peru, Chief Editor

Dr Dhru ShahSpecialist Periodontist

Dr Vittorio FrancoSpecialistEndodontist



Retention in OrthodonticsDr Luisa Lucchesi, Specialist Orthodontist

Retention in OrthodonticsRelapse, defined as the return, following correction, of the original malocclusion, is one of the commonest risk factors in orthodontics. Retention is necessary following treatment to try and prevent relapse of the final occlusal outcome. Careful planning of the retention phase of orthodontic treatment is an essential part of the treatment planning process and allows the patient to make an informed decision prior to the commencement of active treatment.Why is retention necessary?• To allow for periodontal and gingival reorganisation• To minimise changes from growth• To permit neuromuscular adaptation to the corrected tooth position• To maintain stable tooth positions but also unstable tooth positions if such are required for reasons of compromise or aesthetics.

TYPES OF RETAINERSRetainers are appliances designed to maintain the position of the teeth following orthodontic treatment. They can either be fixed or removable.

REMOVABLE RETAINERSThese retainers can be taken out of the mouth and therefore rely on good patient compliance. They are easy to maintain and importantly, do not compromise oral hygiene. The most commonly used are vacuum-formed retainers and removable retainers with a wire labial bow (Hawley and Begg type retainers).

VACUUM-FORMED RETAINERSThese are produced from a thermoplastic material and can be quickly fabricated so that there is minimal wait from appliance removal to start of retention. They are discreet and well accepted by patients from an aesthetic and comfort perspective. They also provide better control of incisor alignment than Hawley type retainers. These types of retainers however should not be worn when eating or drinking as they can act as a reservoir for fluids, increasing the risk of decalcification in the presence of a cariogenic diet.

These retainers are simple, robust and retentive. The Hawley retainer utilises clasps on the posterior teeth and a labial bow around the incisors. The labial bow can be fitted or acrylated to improve the retention and rotational control of the incisors. They also allow for occlusal settling and will maintain overbite reduction with the addition of a bite plane.

Vacuum-formed retainers

Removable acrylic retainers – Hawley or Begg





DURATION OF RETENTIONA patient’s individual retention regime should be based on an assessment of the specific factors which are known to be more likely to relapse. In particular, the decision to recommend prolonged or indefinite retention is based on consideration of some of these presenting factors:• Severe rotations• Midline diastema and spacing• Periodontally compromised teeth with bone loss• Proclination of the lower labial segment• Expansion of lower intercanine width• Correction of anterior open bite by extrusion of the incisors• Correction of an overjet with lip incompetence at the end of treatment.To conclude, the general dental practitioner has an important role to play in reinforcing the importance of good retainer wear for patients who have completed a course of orthodontic treatment. By supporting the advice given by the orthodontist, the GDP can help ensure that their patients achieve maximum gain from their treatment.

FIXED RETAINERSThese types of retainers consist of a multistrand stainless steel wire bonded to the teeth that the patient cannot remove. They are used when long term or permanent retention is required. They are commonly used in the lower incisor region, extending from canine to canine but can also be used in the upper arch to prevent a midline diastema from reopening. Upper fixed retainers have a higher failure rate, particularly in deep bite cases. However, their advantages are that they do not interfere with speech, are less reliant upon compliance, they are well tolerated and aesthetic. They do require regular attention as calculus can build up around them, particularly in the lower incisor region.

Issue 7- April 2017 3



Business Bite Back

JFH LAW LLP 7B Bayham Street London NW1 0EY

Tel: 020 7388 1658 Email: [email protected]

Need to change staff contracts? Here’s how

During the life of your practice, staff requirements will fluctuate and the needs of your business will change. For example, practice hours may change to meet the needs of your patients.

First and foremost, if you are seeking to change an employee’s terms and conditions of employment, such as their hours of work, making unilateral changes may risk the employee resigning and claiming constructive dismissal against you. We therefore recommend the following approach. Seek Agreement Hold a meeting with any employee affected by the proposed change. Explain what the changes will be and why they are needed. Give the employees a chance to ask questions. Following this up in writing; give the employee the choice of accepting the change or having an individual consultation meeting.

If the change is agreed make sure you have this in writing and then you can amend the contract. Termination – Some Other Substantial Reason (SOSR) If an employee refuses to accept the change then you can look to terminate on grounds of SOSR dismissal. This is a catch all phrase to cover ‘some other substantial reason of a kind as to justify the dismissal.’ You should hold an individual consultation meeting with the employee and find out why they do not agree to the change. You should consider if you can adjust the change in any way to avoid dismissal. If you are able to make changes then you should look to do so. Blindly steaming ahead with the changes is unlikely to be seen as a reason to justify dismissal. If not, then at the end of the process you can terminate the contract. If you need any assistance and advice with changing employment contracts, please contact us on the number below.



INTRODUCTION:It is well documented that implant supported overdentures (ISOD) are a successful treatment modality. Cases originally planned for fixed implant bridges and later restored with overdentures present higher failure rates, especially in the maxilla. In such cases, the overdenture is a rescue or an emergency treatment (Krennmair 2007). It is important understand the case selection and planning of an ISOD and the types of attachments suitable for denture retention.CASE REPORT:A 25 year old edentulous patient presented with severe gagging. Dental clearance was carried out due to rampant caries and severe tooth wear caused by excessive vomiting during treatment of Leukemia. Patient had two sets of conventional complete dentures made but was unable to tolerate due to prominent gag reflex. The bone and soft tissue deficiencies in the maxilla could not be compensated for without extensive bone augmentation. Fixed implant supported restoration would not be able to provide sufficient replacement of resorbed hard and soft tissue in maxilla to produce acceptable facial aesthetics. Patient was not keen on undergoing advanced bone grafting procedure. A significant labial flange (gumwork) could be added to the fixed restoration but this would compromise aesthetics and make hygiene maintenance complex.The majority of patients in a within subject cross over trial had significantly higher general satisfaction with maxillary implant bar retained overdentures and scored removable option higher for speech function and ease of cleaning than fixed prostheses (Heydecke et al. 2003).The initial diagnosis based on the diagnostic tooth set up, demonstrated the lack of lip and cheek support due to significant maxillary hard and soft tissue defect. This was

definitively verified with a CBCT scan. This case was very carefully planned and patient’s enhanced gag reflex was managed during clinical procedures with distraction techniques. The initial plan was to place four implants in the maxilla and two implants in the mandible. Apart from the reduced volume of bone in the maxilla, the bone quality (Type 4) was extremely poor. The decision was taken to place six implants instead of four. It was planned to construct a milled titanium Hader® bar retained by Uni-abutments in the maxilla which would allow the implants to be splinted and a single path of insertion for the denture. Although there is no difference in implant survival rates between splinted and unsplinted design but the bar-clip implant supported overdenture has been shown to be a more successful prosthesis with significantly less prosthetic complications and higher patient satisfaction regarding prosthesis retention (Stoumpis and Kohal, 2011).Anatomical features can lead to a divergence in the implant axis especially when multiple implants are placed. This hinders the vertical insertion path for the prosthesis if connected to multiple single ball anchors or Locators®. A well-designed bar, which follows the anterior arch curvature may solve the problem (Mericske-Stern 2008). This type of overdenture has appropriate implant support, imitating a rigid fixed prosthesis with regard to biomechanical aspects. CAD-CAM technology allows the fabrication of titanium bars which reduces the fracture problem, even with cantilevers.The final restoration was upper Hader® bar and lower Locator® retained ISODs. Patient was very happy with the treatment outcome regarding aesthetics and function. He found them very comfortable and there was no incidence of gagging.

Bar retained ISOD to manage maxillary hard and soft tissue deficiencyDr Zulaikha Burki, Specialist Prosthodontist


CONCLUSIONS:Although there is a tendency to offer fixed prostheses to our patients, overdentures may offer many advantages – number of implants, costs, ease of handling and

hygiene maintenance. Careful planning, case selection and thorough diagnostic stage is very important for a successful outcome.

�

��

��

�

��

��

�

��

��

��

��

Pre-op and maxillary stage 1 surgery

Healing abutments in situ

Designing CAD-CAM milled bar and bar in situ

Denture in situ with upper bar clips and lower Locator® inserts.



Systems for Dentists Ltd Was Founded In 1987 And Has Continued To Provide Quality Dental Practice Management Software Ever Since, Working To Promote And Deploy Our Systems To Dental Practices Primarily In The United Kingdom And The Republic Of Ireland.

We strive to offer the best in dental practice management software, focusing not only on clinical practice but involving the entire practice team in the planning, running and management of the dental business. It is our belief that by working closely with every team member involved in the dental practice, we are able to ensure that systems are designed appropriately for each department. We endeavour to maximise the efficiency and communication between each team member regardless of their job role.Systems for Dentists believe that every practice has the right to run their business in a manner most appropriate to themselves; we have worked hard to develop our software to enable flexibility while retaining enough structure to ensure quality.From the conception of the company 30 years ago we have developed the software internally and we pride ourselves on building strong, long-term relationships with our clients who have direct access to programmers who not only understand the language of dentistry but are also very experienced in application development and computer systems from the most basic setup to corporate infrastructures.Our clients are actively encouraged to make feature requests and propose ideas that they would like to see included in the systems future versions. Our UK based programmers ensure these suggestions are integrated and developed to give the best possible dental practice management software for all practices with regular updates - unlike some of our competitors.Features include :Support• Calls answered within the first 2 rings• Calls completed there and then, not left for endless call backs• Kept informed if there is a further issue

Reception• Ease of adding a new patient - Just one button to click on• Ease of filling out the rest of the info• Can use the WSP to add new patient and update record• Medical on WSP - no loosing bits of paper• FP17 PR signed and exemption done on WSP Tablets

Surgery• Treatment items can be configured easier• “Draw your own filling” - unique to SfD no one else has this• Treatment can be added by tooth • WSP - send treatment plans/FP17 DC to pad so patient can sign there and then, rather than printing copies• Treatment completion screen for x-rays to grade, and diagnosis notes• You can set up “quick plans” to add staged items, or treatment items for exam, x-rays, oral health checkManagerial• Real time reports• Reports most needed are written in reports section• Ad Hoc patient reports can be created in the Patients Reports• Luminosity - overview “live”

General• Innovation - we listen to what our customers’ requirements are• Customer service calls throughout the year• SMS - this is run by SfD and not an external company - cheaper and able to see if there is a problem• Online Backup - run by us, data warehoused securely, we can see when backups have been run

Dental Practice Management SoftwareGary Ingram, Sales Manager

Issue 3 - March 2016 7Issue 7- April 2017 7

• WSP Tablet- better than paper, better than writing medicals on a small pad stuck to reception • WSP Tablet - better than iPad. We store a more biometric signature including the separate strokes and the pressure. iPads do not have pressure sensitivity

For more information please do not hesitate to contact us via email [email protected] or call our friendly sales team on 0845 643 2828.Visit our website and download a free Demo www.sfd.co

CPD QuestionsAll questions relate to articles in this issue of the JSD by completing the answers you can earn I hour verifiable CPD.

1). Which of the following relates to Vacuum-formed retainers A. They require regular attention as calculus can build up around them B. They are produced from a thermoplastic material C. They utilise clasps on the posterior teeth and a labial bow around the incisors2). Fixed retainers have a higher failure rate on the: A. Lower B. Upper C. Neither3). What does ISOD stand for? A. Implant Supported Overdentures B. Implant Stabilisation Overdentures C. Invisible Supported Overdentures4). In Dr Burki’s report, how was the following verified? – “The initial diagnosis based on the diagnostic tooth set up, demonstrated the lack of lip and cheek support due to significant maxillary hard and soft tissue defect”. A. Periapical radiograph B. CBCT Scan C. DPTPlease email your answers to: [email protected] o your name o GDC number o Email addressWe will then email your certificate



Upcoming CPD EventsAs part of Chiswell Green Dental Centre‘s committal to dental excellence we periodically organise eveningseminars on different dental related subjects. These seminars are free of charge and valid for two CPD hours. To register for your place please contact our reception team on 01727 800 372 or email [email protected] Registration with refreshments starts at 6.00pm and the course begins at 7pm.

The next available seminars will be:

Lunch & LearnBook a “Lunch & Learn” session. We can visit you or you are welcome to bring your team to us. Let us show you the practice and give you a quick overview of the different treatment options available to your patients. We will provide a light lunch with refreshments. Just let us know how many members of your team will attend and each person will receive training worth 1 CPD hour. A certificate will be issued.

If you would like to participate in these sessions please email [email protected] or call us on 01727 800 372 for more information.


25th April 2017- Dr Dhru Shah - Periodontics

17th May 2017 - Dr Claudio Peru - Endodontics

21st June 2017- Dr Zulaikha Burki - Prosthodontics

14th July 2017 - Dr Kostas Ioannidis - Endodontics

17th August 2017 - Dr Poonam Kalsi - Prosthodontics

20th September 2017 - Dr Luisa Lucchesi - Orthodontics

17th October 2017 - Dr Jashme Patel – Oral Surgery

14th November 2017 - Dr Dhru Shah - Periodontics

TBC December 2017 - Showcase

Private referral formPractice and referring dentist detailsReferring practice ............................................................ Referring dentist details:Practice address ............................................................................................................................................................................................................................................Patient detailsPatient’s name ................................................................. Male/female ..................................................Patient’s address .............................................................. Date of birth .................................................Town/City....................................Post code: ................... Home telephone ................................................................................................................................. Mobile ..........................................................

Treatment required:Orthodontics Endodontics BiopsyImplants + Restorations Endodontics + Crown Crown LengtheningImplants placement only Prosthodontics Opinion onlyPeriodontics Oral Surgery Other Treatment (please specify below)

Reason for referral/provisional diagnosis ..........................................................................................................Treatment carried out to date .........................................................................................................................Medical and dental history .............................................................................................................................................

.....................................................................................................................................................................................

journal of specialist dentistry developing dental ... · pdf filespecial interest include...

Documents