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.

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.

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.

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.

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.