An introduction to dental implants.

The use of implants to replace missing teeth is now commonplace and practised by clinicians worldwide in both general and specialist practice. There is an abundance of evidence on the general success of implant treatment. As well as reviewing the history of dental implants, this narrative review will discuss the merits and successful placement of tissue-level verses bone-level implants. Furthermore, the article will evaluate the concept and benefits of platform switching for implant treatment. Finally, with the increased placement of implants, this narrative paper will review how different titanium surfaces impact on the risk of peri-implantitis.

The provision of dental implants: current practice among university and hospital specialists in restorative dentistry within the UK and Ireland.

Objectives To establish current implant practice among university and hospital restorative dental specialists in the United Kingdom (UK) and Ireland and their opinions relating to criteria for implant treatment.Materials and methods An online questionnaire was distributed to 150 university and hospital restorative dental specialists in the UK and Ireland.Results The response rate was 27%. Twenty-nine (70%) respondents provided implant treatment, of which 76% and 100% placed and restored implants respectively. In addition, 79% worked with oral surgeons or oral and maxillofacial surgeons as part of the implant team. Hypodontia and malignancy were cited as the main groups that qualified for NHS dental implant treatment. Irradiation, smoking and bisphosphonates were considered the most important medical factors in patient selection for implant placement, while untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important dental factors.Conclusions The majority of responding university and hospital restorative dental specialists within the UK and Ireland provide dental implant treatment and undertake a multidisciplinary approach where necessary. There is variation in the number of patients treated with implants by each respondent annually. The main patient groups that receive priority for NHS dental implant treatment are malignancy and hypodontia. Otherwise, there is general agreement about the factors considered important when selecting patients for implant treatment on the NHS and this aligns to the Royal College of Surgeons guidelines on selecting patients for the provision of dental implants.

Maintaining peri-implant health: an evaluation of understanding among dental hygienists and therapists in Wales.

Objectives To describe the approach taken by dental hygienists and therapists (DH/Ts) in Wales regarding dental implant maintenance. To gather their opinions about the current level of implant education.Materials and methods Online questionnaires were distributed to 257 DH/Ts within Wales.Results The response rate was 35%. Dental implant care was within the remit of service for 92% of respondents. All respondents that provided implant care stated that they performed oral hygiene instruction, while 98% performed supragingival debridement, 85% subgingival debridement, and 64% clinical assessment of peri-implant health. A high proportion of DH/Ts in Wales did not feel entirely confident in carrying out procedures relating to peri-implant maintenance and only 27% felt confident in clinically assessing dental implants. The majority (83%) felt that postgraduate training in peri-implant maintenance should be obligatory. 'No available courses' was the main reason for not attending further postgraduate training in implantology.Conclusions A high proportion of responding DH/Ts practising in Wales do not feel entirely confident in carrying out procedures relating to peri-implant maintenance. Postgraduate training may be useful in addressing this issue and undergraduate training programmes may need to consider increasing trainees' exposure to dental implant maintenance.

Teaching of implant dentistry in dental hygiene and therapy schools in the UK and Ireland.

Objective The aim of this study was to assess the current status of implant teaching within dental hygiene and therapy schools in the UK and Ireland.Methods An online questionnaire relating to current and future possible trends in dental implantology education was developed and distributed to programme directors in each of the 23 dental hygiene and therapy schools in the UK and Ireland.Results All responding schools (response rate of 60%) provided implant training for their students. The teaching is mainly delivered in lecture-based or phantom head room settings. The majority of schools provided direct clinical experience in procedures relating to peri-implant maintenance, although in some schools it was stated that not every student was guaranteed to receive such experience. In 86% of schools, students gained experience in oral hygiene and scaling, while 71% and 64% provided experience of non-surgical management of patients with peri-implant mucositis and peri-implantitis, respectively. The main barrier to developing the implant programme was an insufficient number of suitable cases.Conclusions Although all responding schools provide implant training, the overall findings show that further development and improvement of implant teaching in dental hygiene and therapy schools within the UK and Ireland is required, particularly with respect to direct clinical experience. This will ensure that newly qualified dental hygienists and therapists are sufficiently prepared for managing implant patients in their clinical practice.

The Use of 3D Metal Printing (Direct Metal Laser Sintering) in Removable Prosthodontics.

The use of 3D printing is expanding and it is envisaged that it will have an increasing presence within dentistry. Having an appreciation and understanding of such technology is therefore paramount. It is currently used to produce a variety of dental objects/prostheses. This paper briefly looks at 3D printing in dentistry and specifically describes the use of the direct metal laser sintering 3D printing technique in the production of cobalt chromium removable prosthesis frameworks. Clinical relevance: Understanding the different technologies that can and are being used within the dental field is important, particularly as it is a rapidly changing field. Having an understanding of such technologies will allow practitioners to utilize such technologies appropriately in the management of their patients.

Summary of: dental practitioners and a digital future: an initial exploration of barriers and incentives to adopting digital technologies.

BACKGROUND: Digital technologies are proliferating into dental practices. While their technical attributes have often been studied, it remains unclear why some dentists adopt and use these technologies more than others. AIM To explore the incentives for and barriers against accepting and using digital dental technologies. METHOD: Eleven semi-structured qualitative interviews were conducted with experts in dentistry, dental technology and dental education in the Netherlands. RESULTS: Dentists' acceptance and use of digital technologies are to varying degrees driven by the perceived advantages over analogue methods, perceived influence on treatment quality, dentists' personal and professional orientation, and social influence from peers and external groups. These effects are complemented by personal and dental-practice characteristics. CONCLUSIONS: The findings suggest that there are large differences in motivation to adopt and use digital technologies between early adopters, late adopters and non-adopters, which should be examined in greater detail. We recommend that educators, dentists, and representatives of the dental industry who deal with the diffusion of these technologies take account of dentists' widely different attitudes to digitalisation.

Gagging during impression making: techniques for reduction.

UNLABELLED: In everyday dental practice one encounters patients who either believe themselves, or subsequently prove themselves, to be gaggers. Gagging is most frequently experienced during impression making, but is also reported during the taking of radiographs, in the placement of restorations in posterior teeth and, in some individuals, the insertion of a finger for examination purposes. This paper describes some techniques that can easily be mastered by clinicians that may help both operator and patient avoid this unpleasant occurrence. Techniques such as acupressure, the adaptation of trays, or even the use of alternative impression materials and breathing techniques all have their place, and clinicians may have to try several of these, perhaps in conjunction, in order to assist their patients. CLINICAL RELEVANCE: A significant number of patients attend for dental treatment that require impressions, and for those with gagging problems it can be a horrendous experience. Being able to make the procedure less of an ordeal is better for all involved.

Placement of posterior composite restorations in United Kingdom dental practices: techniques, problems, and attitudes.

OBJECTIVE: To investigate the range of techniques used by U.K. general dental practitioners when placing posterior composites, their attitudes and opinions and problems encountered. METHODS: A pre-piloted questionnaire was distributed to 500 UK GDPs selected at random from the U.K. Dentists Register requesting specific information on attitudes, use and problems encountered in relation to posterior composite placement. RESULTS: 254 useable replies were returned (response rate= 51%). Over 95% of respondents would consider placing posterior composites, but only 33% (n=84) would regularly or often place composite in the occlusal surface of a molar tooth. 62% of respondents (n=157) are influenced by articles in peer-reviewed journals when deciding to place a posterior composite, while 95% (n=241) reported that they are not influenced by advertising. Techniques for managing operatively exposed dentine vary, and are related to the depth of the dentine cavity: 79% (n=201) use a 'dentine-bonding' technique (i.e., no base/liner) approach for shallow cavities, while only 9% (n=23) would consider this approach for a deep dentine cavity. Only 10% of respondents (n=25) use a sectional metal matrix system for restoring occlusoproximal cavities, while 29% (n=74) use transparent matrix systems, and 61% (n=155) use a circumferential metal matrix system. More than one-half (52%, n=132) of practitioners reported they experienced problems with food packing in more than one in four posterior composites placed. CONCLUSIONS: Despite having been previously discouraged by financial guidelines and with probable limited exposure to posterior composite instruction at dental school, U.K. GDPs are placing posterior composites with reasonable reference to current best available evidence. Diverse opinions exist on the management of certain clinical scenarios, such as of operatively exposed dentine.

Orthodontic extrusion: an interdisciplinary approach to patient management.

UNLABELLED: Root fractures that occur at the cervical margin do not always heal predictably, even following a period of splinting. This often leaves margins either sub-gingival or sub-crestal. This provides an unsatisfactory situation for restoring the remaining root as restorations will impinge on the biological width. Provided a root is long enough to support a post crown, then orthodontic extrusion to provide sufficient supra-gingival tooth tissue is a useful treatment option to consider. A review of the literature on orthodontic extrusion is considered in conjunction with a case report of the management of a young male who fractured a canine and lateral incisor whilst playing cricket. CLINICAL RELEVANCE: Trauma to upper anterior teeth is frequently seen in practice. One treatment option in the management of sub-crestal cervical root fractures is orthodontic extrusion, rather than removal of the tooth.

'Double-veneers'--a novel approach to treating macrodontia.

UNLABELLED: Macrodontia is a relatively rare but cosmetically challenging dental anomaly with different aetiologies. Where surgical interventions are inappropriate, minimal restorative interventions may be indicated. A case is described of a teenager with macrodontic central incisors who was treated with indirect composite 'double veneers'. The aesthetic outcome was excellent without unnecessary loss of teeth. CLINICAL RELEVANCE: Knowledge of the use of indirect composite veneers provides another treatment option for aesthetic problems in the management of tooth anomalies, including macrodontia.

Crown and bridge disassembly--when, why and how.

UNLABELLED: Crown and bridgework has a finite life span and fails for a number of reasons. Removal is often by destructive means. There are a number of clinical circumstances, however, in which a conservative disassembly would aid the practitioner in completing restorative/endodontic procedures. The aims of this paper are to provide a classification for crown and bridge removal systems; describe how a number of such systems work; and when and why they might be considered. CLINICAL RELEVANCE: Crown and bridge removal is a frequent occurrence for dentists. There are many situations in which salvaging extracoronal restorations may be more helpful than their destruction.

Modern restorative management of patients with congenitally missing teeth: 4. The role of implants.

UNLABELLED: In this fourth and final paper on the management of patients with congenitally missing teeth, the use of dental implants is considered. This group of patients often provides unique challenges when implant reconstruction is considered. Often a multidisciplinary approach is required involving orthodontists, oral surgeons and restorative dentists. The use of dental implant systems is a rapidly developing area of dentistry and its implications on hypodontia are discussed. This paper identifies the problems associated with a congenital absence of teeth and addresses their management in relation to the use of implants. CLINICAL RELEVANCE: The use of dental implants in hypodontia patients should always be considered as a treatment option. These groups of patients, however, require careful planning, often of a multidisciplinary nature, so that the timing of the various treatment modalities is seamless.

Modern restorative management of patients with congenitally missing teeth: 3. Conventional restorative options and considerations.

Restoration of spaces in hypodontia patients needs to take into account many factors including, the number of missing teeth, the distribution of space, the size of the teeth, and the age of the patient. This paper considers adhesive and conventional bridgework, as well as removal alternatives for the restoration of spaces. The various merits of each are discussed, together with treatment planning considerations for such cases.

Is amelogenesis imperfecta an indication for renal examination?

BACKGROUND: The term 'amelogenesis imperfecta' (AI) describes a diverse group of hereditary conditions primarily affecting the quality and/or quantity of dental enamel. CASE REPORT: This paper describes a case in which hypoplastic AI with delayed/failure of eruption of the permanent teeth was shown to be associated with renal calcification. CONCLUSION: Given the importance of the renal involvement, the authors suggest that paediatric dentists consider referring all children with this dental phenotype for renal ultrasound examination.

Modern restorative management of patients with congenitally missing teeth: 1. Introduction, terminology and epidemiology.

The management of patients with congenitally missing teeth can be a challenge and, in many cases, requires multidisciplinary care. In this four-part series, a contemporary approach to managing this group of patients is discussed. This first paper examines the terminology, epidemiology and restorative challenges that such patients can exhibit.

Dental implant treatment for patients with psychiatric disorders.

The literature with respect to whether or not psychiatric disorders represent a contraindication to dental implant treatment is sparse and contradictory. This paper describes three cases in which patients with psychiatric disorders were provided with dental implant retained prostheses. It is concluded that mental health disorders are not necessarily a contraindication to dental implant treatment and dental implant treatment can provide valuable psychological support. If any doubt exists about the effect of a psychiatric disorder on the prognosis of implant treatment the opinion of a psychiatrist should be obtained. The development of liaison psychiatry for dental hospitals should be seen as an ideal.

Modern restorative management of patients with congenitally missing teeth: 2. Orthodontic and restorative considerations.

Managing edentulous spaces in patients with congenitally missing teeth demands careful planning and, often, a multidisciplinary approach. Orthodontic tooth movement can be considered to close spaces as well as improve the distribution of available teeth. In this second paper, the advantages of a collaborative approach are discussed.

Incisor toothwear caused by a dietary habit involving chillies-a case report.

Toothwear cases can vary dramatically in their presentation, with some displaying quite peculiar patterns. This case report outlines a patient's unusual eating habit that had led to a localized pattern of toothwear affecting his maxillary and mandibular central incisors. The patient had a habit of eating fresh chillies between his incisors after most evening meals; this was followed by immediate toothbrushing, which he had done for many years. This case illustrates that, not only is diet analysis important in identifying aetiological factors in toothwear cases, but also dietary habits.

A closer look at diagnosis in clinical dental practice: part 6. Emerging technologies for detection and diagnosis of noncaries dental problems.

The final article of this series examines some recent innovations in diagnostic procedures for noncaries dental problems and assesses the potential for new endodontic and periodontal methods to become everyday tools of the dental clinician.