Survey of consultants in restorative dentistry in the UK regarding ongoing care of patients provided with dental implants.

Background Funding for implant-based treatment within secondary care is limited, and acceptance criteria are determined locally according to funding agreements with NHS England. Indefinite review of all patients in secondary care is unlikely to be feasible due to limitations on departmental capacity. The increasing number of patients provided with implant-based treatment in secondary care has resulted in a growing maintenance burden, raising the question of who should provide this care. Management of some complications within primary care would facilitate patients' access to treatment, although no specific provision for maintenance of implant-retained prostheses is made within the NHS Dental Charges Regulations.Materials and methods An online survey was carried out to review services provided within restorative dentistry departments across the UK, investigating departmental protocols for review and maintenance of patients provided with dental implants.Results There was no consensus view on review protocols, discharge or provision of maintenance following implant placement. Fifty-seven percent would indefinitely carry out remake of implant-retained overdentures when clinically indicated, replace worn inserts, housings or abutments. Sixty-one percent would manage loose/lost screw- or cement-retained restorations and 68% would manage fractured restorations. Re-referral for peri-implant disease would be accepted by 64% of respondents. The lack of clear NHS funding for the management of complications was of concern to respondents in this survey.

Gingival overgrowth: Part 2: management strategies.

The effective and predictable management of gingival overgrowth requires correct diagnosis and consideration of aetiological factors, as discussed in Part 1 (BDJ 2017; 222: 85-91). Initial management should involve cause-related therapy, which may resolve or reduce the lesion. If functional, aesthetic and maintenance complications persist following this phase; further treatment may be required in the form of surgery. This paper discusses management strategies, including management of aetiological factors and surgical techniques.

Gingival overgrowth: Part 1: aetiology and clinical diagnosis.

Most commonly, gingival overgrowth is a plaque-induced inflammatory process, which can be modified by systemic disease or medications. However, rare genetic conditions can result in gingival overgrowth with non-plaque-induced aetiology. It is also important to appreciate the potential differential diagnoses of other presentations of enlarged gingival tissues; some may be secondary to localised trauma or non-plaque-induced inflammation and, albeit rarely, others may be manifestations of more sinister diseases or lesions. A definitive diagnosis will then enable an appropriate management strategy. This paper aims to discuss clinical features and diagnoses for conditions presenting with gingival overgrowth and other enlargements of gingival tissues.

The restorative management of the deep overbite.

A deep overbite is where the vertical overlap of the upper and lower incisors exceeds half of the lower incisal tooth height. Problems associated with the deep overbite can include soft tissue trauma, lack of inter-occlusal space and tooth wear, all of which can present significant challenges for the restorative dentist. While management options very much depend on the nature of the situation and patient's symptoms, options may range from provision of a simple removable appliance or splint and non-surgical periodontal therapy, to multidisciplinary care involving orthodontics, orthognathic surgery and restorative dentistry. Restorative management may involve an increase in the occlusal vertical dimension with fixed restorations or removable prostheses, and careful assessment and treatment planning is essential. This article discusses the aetiology and restorative management strategies for deep and traumatic overbites.

The management of severe hypodontia. Part 2: bone augmentation and the provision of implant supported prostheses.

The first part of this series on severe hypodontia discussed the assessment of patients and factors to consider when treatment planning for the provision of conventional restorative solutions. This article discusses the provision of implant supported prostheses in the severe hypodontia patient who typically presents with inadequate bone volume and other associated dental and craniofacial anomalies. The role of bone augmentation to facilitate implant placement is discussed, in addition to prosthesis design and long-term maintenance. With careful case selection and planning most patients with severe hypodontia can be rehabilitated effectively, both functionally and aesthetically, with implant supported prostheses. In complex cases the involvement of a multidisciplinary team is needed to improve outcome. It should be highlighted that these patients will require ongoing follow up, maintenance and retreatment procedures over their lifetimes.

The management of severe hypodontia. Part 1: Considerations and conventional restorative options.

Severe hypodontia is the absence of six or more permanent teeth and is relatively uncommon (estimated prevalence of 0.1-0.2%). This condition may have considerable functional, aesthetic and psychological implications for the patient, as well as presenting a significant challenge for the restorative dentist. There are a number of additional dental and craniofacial features that are seen frequently in patients with severe hypodontia that may complicate the provision of restorative treatment. These patients typically present at a young age and are likely to require lifelong support from the dental team. Initially this may be limited to oral health education and delivery of effective preventative regimes in childhood. Where required, missing teeth may be replaced using conventional removable and fixed prosthodontics as well as implant retained restorations. This article, part one of a two-part series, deals with the assessment of patients and factors to consider when treatment planning for the provision of conventional restorative solutions in severe hypodontia.

Provision of an appliance to correct mandibular deviation secondary to temporomandibular joint replacement.

This report outlines the provision of an appliance of novel design to correct mandibular deviation secondary to temporomandibular joint replacement. The aim of the appliance was to reduce the deviation of the mandible by guiding its path during function, thus reducing the symptoms of facial pain. A significant improvement in symptoms was noted as a result of wearing the appliance which was still evident at the 12 month review. In a patient with high levels of chronic pain associated with TMJ dysfunction, reversible minimally invasive treatment has definite advantages, particular if there is a wish to avoid further surgical intervention.

Provision of a swing lock denture for a patient with Gorlin Goltz syndrome.

Swinglock dentures are used relatively infrequently but in cases of compromised anatomy or where the pattern of tooth loss is unfavourable, they provide a useful removable partial denture design option. The aim of this article is to provide a clear summary of the clinical and technical considerations necessary when providing a Swinglock denture.

Resin bonded bridges: techniques for success.

Resin bonded bridges are a minimally invasive option for replacing missing teeth. Although they were first described over 30 years ago, evidence regarding their longevity remains limited and these restorations have developed an undeserved reputation for failure. This article provides a brief review of the literature regarding bridge success and continues to highlight aspects of case selection, bridge design and clinical procedure which may improve outcome.

Decisions about restorative dental treatment among dentists attending a postgraduate continuing professional development course.

Continuing professional development (CPD) courses seek to inform, educate and develop practitioners' patterns of prescribing in line with the evidence base. When devising such courses it would be useful for organisers to have some idea of what current practice is and the decision-making process as this would inform the development of appropriate continuing education courses. A questionnaire comprising ten questions was given to 90 dentists at the start of a day's lecture course run under Section 63 regulations. The dentists were then shown a series of pictures and asked how they would manage each of the cases presented. Eighty-nine dentists completed the questionnaire and the results were tabulated and fed back to the group at the end of their day's course. Results showed varied and inconsistent application of advances in restorative techniques among the respondents. Despite a definite interest in more modern treatment options, many practitioners continued to support the use of traditional techniques that could be considered outdated. Further investigation of the practices of GDPs and their decision-making processes would be useful in targeting postgraduate education programmes to encourage the uptake of evidence-based practice.

Dental assessment prior to stem cell transplant: treatment need and barriers to care.

OBJECTIVE: To assess the treatment needs of patients undergoing pre-haematopoietic stem cell transplant (HSCT) dental assessment, to collate the examination findings and treatment provided and to define the management issues impacting on care. DESIGN: Single centre retrospective analysis. SETTING: Salaried Primary Care Dental Service, Western General Hospital, Edinburgh, UK. SUBJECTS AND METHODS: One hundred and sixteen available charts of patients who attended for pre-transplant dental assessment during April 2004-June 2007 were examined. RESULTS: Ninety-four patients, 52 men (55.3%) and 42 women (43.6%), were included. Patients were referred a mean of 31.5 (SD 18.82) days before admission for transplant. Dental assessment occurred, on average, 7.88 days (SD 6.78) following referral. Eighty-eight (93.6%) patients were dentate, while six (6.3%) were edentulous. Eighty-eight (93.6%) patients presented with oral disease; 89 (94.7%) patients received dental care. Issues impacting on care were medical (n = 88, 93.6%), time constraints (n = 73, 77.7%), no GDP (n = 25, 26.7%), dental complexity (n = 5, 5.3%) and anxiety management (n = 1, 1.1%). CONCLUSION: The majority of patients required dental care, most of which, for healthy adults, would normally be completed within a primary care setting. However, the issues surrounding the care of patients destined for HSCT indicate that there is a place for a dedicated dental service as part of the multidisciplinary team.