Health – Page 15 – Thoughts on Life and Dentistry

EAO 22nd Scientific Meeting Dublin

October 25, 2013Broadway Dental CareLeave a comment

The European Association for Osseointegration meeting opened on Wednesday evening in Dublin, Ireland . The conference theme being ‘Preparing for the Future of Implant Dentistry’.

Famine Ship - Jeanie Johnston Dublin — Famine Ship – Jeanie Johnston Dublin

On the Thursday morning we started with a presentation about the importance of maintaining the bone supporting the teeth and gums after extraction. In a normal extraction we lose 50% of the supporting bone within 4 months. This volume of bone loss can make it difficult to restore the missing tooth later both functionally and aesthetically. Bone loss can however be reduced to about 20% with the immediate use of bone substitutes placed in the extraction socket at the time of extraction making speeding up healing and future restoration of the space more predictable.

The afternoons title was ‘Treatment planning for success-how to get in right.’ and was presented by Dr Mark Pinsky a dentist who is also a commercial airline pilot. The theme revolved around the adoption of airline style checklists to reduce errors in surgery. As a side note we have been using these checklists in the practice for the past two years already and find them extremely useful as treatments and patients medical histories get more complex.

Friday morning we discussed the increasing problem of infection round dental implants and whether it was an infection or just the body trying to reject the implant, the conclusion was that more research needed to be done into this area but both factors were to a degree responsable.

The afternoon covered treating patients with long-term loss of upper back teeth from a quite minimalist approach to major surgery for cancer patients.

By far the most interesting series of lectures was on saturday morning titled ‘Implants in the Aging population’. In a lot of Western countries there are more over 65 year olds than 5 year olds and we discussed the problem of how to manage dental health in the age group 80-100. In fact the population of 100 year olds will increased by 400% in the next 25 years. The biggest problems were dental health, retaining unhealthy teeth into old age and long-term chronic illness. Though this subject is not a political vote winner we do need to acknowledge its existence and positively take charge of the challenges it presents. One strategy was the use of a single implant to stabilise a lower denture which over 10 years has dramatically improved patients quality of life at a significantly reduced cost and level of intervention.I have always found the Saturday morning lectures to be the most thought-provoking and applicable to the real world of dental health.

Trinity College Library - Dublin — Trinity College Library – Dublin

2nd Ziess Dental Symposium London

October 5, 2013October 5, 2013Broadway Dental CareLeave a comment

Yesterday I attended the second dental symposium on surgical microscopy hosted by Zeiss. I think these symposia are great as they bring together some of the most skilled dental surgeons in the world to talk on the advances in micro-surgery. Its quite simple, the better you can see what you are doing the better you can do the surgery.

The first speaker was Prof. Krejci on the ‘Geneva Concept’. In summary decay and gum disease is a highly infectious incurable chronic disease and we acquire the bacteria responsible for it at birth. Therefore since we can’t cure it we need to focus on prevention and conservation of damaged tissues. To quote “There is no such thing as a permanent restoration, they are all temporary until the last one”. The easiest and most cost-effective treatment is early intervention and the use of adhesive materials such as resins and composites. With the use of microscopy we can preserve tooth tissue because it’s so much easier to see small defects and cavities in the teeth and precisely repair them.

Dr Rino Burkhardt’s subject was ‘Minimally invasive periodontal surgery and its effects on wound healing’. In essence success depends on maintaining the microscopic blood supply to promote rapid healing and was best achieved by adopting the skills from the other surgical disciplines such as eye and microvascular surgery.

Dr Domenico Massironi (one of my personal heroes) gave a beautiful presentation on the use of surgical microscopes in aesthetic dentistry. Only with improved vision can we truly assess the quality of our work and achieve the precision that our patients deserve. Check out his video (its only in Italian but that does not matter watch it anyway)

In the afternoon followed three excellent lectures by Prof. Gilberto Debelian, Dr Tony Struttman and Dr Tomas Lang on root fillings, retreating failed root fillings and micro-invasive dentistry. If a tooth can be reasonably saved there are huge advantages to the patient than losing it and hoping that an implant will perform any where as well.This may not have been so 15 years ago but microscopy now allows us to literally look down the root of a tooth which was impossible before then. It’s hard to out engineer nature.

The final presentation was from Oscar von Stetten on using the microscope to document our treatment and communicate what we see down the microscope to colleagues and patients. If our patients truly understand what we as clinicians are trying to achieve the better the treatment outcomes. Below is a picture of a cracked back tooth which helped the patient understand why it hurt every time they bit on it.

Better Choices

September 24, 2013September 24, 2013Broadway Dental CareLeave a comment

Compared to twenty years ago one of the major changes in healthcare in the dramatic increase in choice. Choice can be good and it can also be bad so how do we both as dentists and patients choose the best treatments.Here is a short list that may help.
There is no perfect treatment,all have various pros and cons that need to be carefully considered. A treatment that most suits a person in their twenties may be totally unsuitable for a person in their eighties.
The only way to know if a treatment is reliable or not is to see how it stands the test of time. Most anything can be deemed successful over 18 months but what is the success rates at 5 and 10 years later. We therefore need to be a little wary of ‘the newest or latest’ therapies if there is no medium to long term reliable research backing up the claims.
When making a choice it is always best initially to look at all your options impartially as though time and money do not exist and then carefully strike out the unsuitable choices. You may be surprised once you know all your practical choices and how successful each of them is over time that selecting the right treatment becomes very simple.
Our practice philosophy is to try and tailor the best treatment to each patients personal needs both in the short, medium, long term and budget.
Using special equipment and techniques like digital imaging and surgical microscopy we have been able to dramatically improve long term success when it comes to saving teeth. The ability to prolong the health of your own teeth has many advantages over implants for example, both in terms of aesthetics, function and reducing the need for surgery. That is not to say that in some cases implants are not the best treatment but I think all other practical solutions need to be carefully considered before making that choice.