Forum A - Saturday 7 November
We studied trephine core samples taken from 252 sites where implants were to be placed in a series of 35 patients; all material was obtained with patient consent and local ethical committee approval. The sites were both native cores where implants were placed at the first operation and grafted sites, where a sinus lift procedure had been performed approximately six months before the second operation to place the implant. Samples were embedded in PMMA and blocks were finished to produce polished longitudinal sections through the cores which were studied by (a) quantitative backscattered electron (BSE) SEM; (b) X-ray microtomography (XMT) using the QMUL MuCAT scanner to make direct correlations between the current block face imaged with qBSE SEM and rendered XMT data; and (c) after iodine staining for BSE SEM to read soft tissue and cellular histology. The combination of methods gives important new information.
Alan Boyde is a founding member and an Honorary Member (1987) of the Association of Dental Implantology. His current position is Professor of Mineralised Tissue Biology in the Dental Physical Sciences Section of the Department of Oral Growth and Development of the Dental Institute of Barts’ and The London School of Medicine and Dentistry, Queen Mary University of London. His current research is aimed at understanding bone and cartilage development, structure and function and responses to hormonal and drug challenges, impact exercise, aging, osteomalacia, osteoporosis, osteoarthritis, traumatic osteochondrosis, fatigue fracture, iatrogenic bone wounding (including dental and skeletal implants) and tumour metastases, and skeletal changes in genetically modified mice. It uses a wide range of imaging modalities from naked eye to sub-micron resolution. Dental hard tissue structure, development, disease and iatrogenic damage are also studied.
Qualifications: PhD BDS LDSRCS MDhc FRMS FAS
Over the past two years at my practice we have integrated a system of simultaneous sinus grafting and implant placement allowing us to restore many implants following six weeks of healing. Conventionally, healing in sinus grafted sites has taken a considerable period of time and people have assessed sinus grafting sites on residual alveolar height alone. During this presentation I hope to demonstrate that residual height is less significant in the ability to achieve primary stability, and measuring this during simultaneous implant placement will increase the scope to place more implants earlier and to restore even earlier again. The common pathway in my practice for sinus grafted situations is simultaneous placement and loading at six weeks. I will demonstrate a significant audit of hundreds of implants in hundreds of sinus grafts and the practical aspects of providing this treatment.
Colin Campbell is a Specialist in Oral Surgery who qualified from the University of Glasgow in 1994 and gained his Fellowship in Dental Surgery from Edinburgh in 1999.
He worked as a junior in Oral and Maxillofacial Surgery in Glasgow, Nottingham and Derby before entering practice as a Primary Care Oral Surgeon where he stayed for over fifteen years.
Colin began practising Implant Dentistry in 1998 and began lecturing in 2000. He became a Fellow of the International Team for Implantology in 2006 and was the Communications Officer for the ITI UK & Ireland Section from 2011 – 2014.
Colin’s practice is limited to Implant Surgery (and a little bit of Oral Surgery) He has placed over 4000 dental implants and provides all aspects of bone grafting in Implant Dentistry.
He is the Clinical Director of The Campbell Clinic in Nottingham, a multi-disciplinary Specialist Practice and is a Partner and Director in The Campbell Academy.
Qualifications: BDS FDS RCS
This audit project formed part of my MSc for Warwick Implant course. Current national guidance on implant maintenance appointments and the criteria by which we should be assessing the health of implants/implant patients are highlighted. A literature search revealed the evidence behind this national guidance and I then created a template to use to audit my own clinical notes in primary care. The audit of clinical records looks at notes from around two hundred maintenance appointments of patients who had previously received dental implants and shows some shocking results - we are poor at assessing ALL the criteria we should at each appointment and the criteria assessed can be inconsistent even by the same clinician at different appointments. A maintenance protocol note template is created and then a prospective second cycle audit completed showing great improvement in record keeping. ADI members will benefit from understanding the guidance and considering self-audit.
William Carter graduated from Newcastle Dental School in 2004. Whilst there he was awarded the J N Procter prize for restorative dentistry and won a scholarship to study dentistry in Helsinki, Finland in 2003.
After completing his general professional training at Newcastle Dental Hospital in 2006, Will continued his post graduate study, undertaking his Diploma in Conscious Sedation from Newcastle University after carrying out research into a new type of electronic intravenous cannula.
In 2013 he was awarded a Master of Science with a merit in clinical restorative cosmetic dentistry from the University of Central Lancashire. Following this Will passed the Diploma of Membership of the Joint Dental Faculties (MJDF) examinations at the Royal College of Surgeons England, and gained his Diploma in Implant Dentistry from Warwick which will be progressed into an MSc.
In November he graduated as an alumni from the Kois Centre in Seattle.
Will is a partner at Queensway Dental Clinic Billingham.
Qualifications: BDS Diploma Conscious Sedation MJDF (RCS Eng) MSc Restorative Dentistry Diploma Implantology (Kois graduate)
Tooth extraction causes resorption of the alveolar buccal wall/socket, in both maxilla and mandible. Loss of the buccal wall degrades the visual aesthetics of the prosthetic rehabilitation. Additionally, the harmony of hard and soft tissue morphology can be impaired during surgery. Tissue augmentation can be carried out consecutively with an extraction/immediate implant placement or following bony resorption in the delayed scenario. The subepithelial connective graft (SCTG) is used to mask inadequate tissue volume and suboptimal aesthetic morphology. I have described the predictable fixation of the SCTG to implant sites ensuring the non-extrusion of the graft. Now, one needs to address the demand of the extreme high profile site: the anterior maxilla, producing the invisible result. For this, I have developed the Labial Glove Flap with fixed Underlay Graft of the SCTG. This ‘step-by-step’ presentation is illustrated by (at least) 20 cases with follow-ups ranging from 12 - 72 months.
Shane McCrea graduated from The Royal Dental Hospital in 1979 with BDS, and LDSRCS (Eng). In 2005 he completed an MSc in Dental and Maxillofacial Radiology at KCL – his dissertation ‘Selection criteria for imaging prospective implant sites – a critical review’ being published in the BDJ in 2008. Since then he has had 24 publications in peer-reviewed journals. In July 2010 he concluded his Master of Medical Science Degree in Dental Implantology, from the University of Sheffield. In October 2014, Shane was awarded his third Masters degree: Stem Cells and Tissue Regeneration from the University of Bristol.
These postgraduate degrees have provided him with a sound understanding of bone and soft tissue physiology and the actual cell activity involved in recognition of trauma, activation and differentiation that allows stabilisation, repair, regeneration and modification. This information gives justification for his innovatory surgical techniques resulting in his prolificacy in investigation and scientific writings.
Qualifications: MMedSci (Dental Implantology) MSc (Dental and Maxillofacial Radiology) MSc (Stem Cells and Tissue Regeneration) BDS, LDSRCS, MFGDP
The recapture of both soft and hard tissue loss can be corrected to varying degrees with various methods. The resulting morbidity can often be significant for our patients. Thus the scope of this presentation is to demonstrate the use of osmotic tissue expanders (balloons) to facilitate repair of tissue defects, and to show how plasma rich in growth factors can be of benefit in differing conditions. Both of these applications reduce patient morbidity in the more challenging cases. This paper will present: (1) a brief literature review of balloons; (2) a brief literature review of plasma rich in growth factors; (3) clinical case examples of the use of both balloons and growth factors; (4) a case report involving reconstruction of part of a mandible using a combination of techniques to achieve a functional outcome. There will also be some commentary about the speaker's experience with balloons and their complications.
Shiraz Gulamali qualified in 1980 at Guy’s Dental Hospital and returned there to complete his Masters in Periodontology. This was completed in 1985, and following this he gained his Fellowship in Dental Surgery from the Royal College of Physicians and Surgeons in Glasgow. His recognition as a Specialist in Periodontology was granted by the GDC in 1999. He currently has a practice exclusive to periodontics and implantology, and has also been involved extensively in the past with both undergraduate and postgraduate teaching. He has now introduced plasma rich in-growth factors to his course material in sinus augmentation procedures, and has presented numerous papers to professional bodies, both locally and internationally. He is currently on the ADI Register of Mentors.
Qualifications: BDS LDSRCS MSc FDSRCPS
I will be presenting a series of case presentations detailing how as a hygienist/therapist I have tailored implant maintenance programmes for each patient in order to prevent the risk of implant failure. I will explain how I assess, treat and advise patients before, during and after implant surgery in order for them to be best equipped and educated to take care of their implants. I aim to inform members of the dental implant team about the importance of implementing an implant maintenance protocol and how this can benefit implant patients.
After Emma McCormack completed her degree in Biomedical Science in 2010, she decided that she wanted to utilise her knowledge of the human body within a clinical setting and be at the front of patient care. Emma completed the Diploma in Higher Education in Dental Hygiene & Therapy at the University of Sheffield in June 2013.
Emma currently works full-time as both a Dental Hygienist and Therapist across four different practices throughout the Midlands. One of the practices Emma has worked at since qualifying in 2013 is the Campbell Clinic, where Emma is primarily involved in implementing implant maintenance programmes for patients.
Emma is currently Chairperson for the BSDHT Midlands Committee and last year volunteered with the charity Dental Hygienists for India, providing dental treatment to 600 underprivileged children in South India.
Qualifications: BSc DipHE Dental Hygiene & Therapy Sheffield
Peri-implantitis and periodontitis are bacterial infections with chronic inflammation characteristics. The pO2 value in areas of peri-implantitis is significantly lower than in healthy tissue. Moreover, pO2 value correlates with pocket depth; the deeper the pocket, the lower the pO2 value. These lower oxygen levels reduce the body’s resistance to bacteria and healing potential. Wound healing requires a variety of cells to increase their metabolic activity and this results in a high oxygen demand. Oxygen at the wound site has been shown to promote wound healing. Often, local or systemic antimicrobials are used to support peri-implantitis treatment. These products are known to have beneficial effects, but also have limitations, disadvantages and side effects. We have been using a protocol to apply topical active oxygen therapy in peri-implantitis cases. The results are showing some promise in the successful treatment of peri-implantitis cases.
Nik Pandya is a Specialist in Periodontics and an Implant Surgeon. He qualified from University of Newcastle upon Tyne in 1983. Following hospital appointments, and general practice, completed a postgraduate programme in Periodontology at Queen Mary, University of London in 1992.
He is lead clinician of a busy referral practice in Colchester, a part time Postgraduate Clinical Tutor/Lecturer in Periodontology at Barts & The London Queen Mary School of Dentistry, and a Visiting Professor and programme lead for Master of Clinical Dentistry (Periodontology) at BPP University. He is also a visiting academic at University of Essex, School of Human Sciences. He is a member of ADI, AAP, ICOI and he sits on the education committee of the BSP.
As an implant surgeon he works with other local specialists in prosthodontics for carrying out advanced restorative treatments. Together with an orthodontist and a prosthodontist colleague Nik completes the team delivering much needed care at the Hypodontia Clinic in Colchester.
He has a passion for teaching and is involved in many local and national courses. His research interest lies in Guided Bone and Tissue Regeneration, Lasers and Local Antimicrobial Delivery/Therapy.
Qualifications: BDS MSc DGDP(UK)
This lecture will outline the current position regarding the growing issue of peri-implantitis. It will aim to explore the legal, ethical and practical issues surrounding the selection of patients for implants and issues around placement and management of the peri-implant site both post operatively and for the implant lifetime. It will outline the peri-implant care protocols that should be in place to ensure the best possible future for implants placed, and explore the products and aids that can be utilised both professionally and as home care by the patients themselves.
Donna Schembri is a hygienist with over twenty years’ experience, working clinically between two practices in Yorkshire and Lancashire which both place implants.
Trained as a professional Dental Mentor and one of only a few DCPs to hold the PgCert in Mentoring in Dentistry from the FGDP (RCS), Donna is trained to offer support and coaching to dental professionals at any stage in their careers.
Donna is a DCP board member for the FGDP Yorkshire division, an Editorial Advisory Board member for the DH&T journal and a judge for the Dental Hygiene & Therapy awards. A Key Opinion Leader on professional care for various companies, she lectures on hygiene and therapy related topics including implant care, clinical techniques, team working and personal development, and has recently spoken at both the Dentistry Show and Europerio8.
Overload? Foreign body reaction?, or infection? How does one treat a disease where there is so much confusion and speculation on aetiology? Confusingly, the literature describes a “scatter gun” approach to treatment from antibiotics, to ultrasonic debridement, with and without polymer coated tips, to blasting implant surfaces with powders, to scrubbing the implant surface with NiTi brushes, to implantoplasty, all with non-surgical and surgical approaches, sometimes with combination therapies. Given that recent studies suggest that prevalence of peri-implant disease may be as high as 50%, and consumer trend reports predict a rapid rise in uptake of implants, the UK is braced with a burgeoning epidemic of peri-implantitis. With this in mind, implant practitioners need to consider the prospect of treating this disease themselves. This presentation considers the emerging evidence in the use of lasers to assist management of peri-implant infection.
Raj Wadhwani maintains a private referral practice in Cambridge with a focus on prosthodontics and implantology, after having completed his Masters studies at GKT and Warwick Medical School. He has been using a Diode and an ErCrYSGG laser for 15 years for various aspects of his implant practice which covers single tooth to full mouth reconstruction across several different implant platforms.
He has recently re-commenced further studies and research in Genoa, Italy under Professor Stefano Benedicenti and Professor Steven Parker to study laser interaction with dental implant surfaces, with a view to identifying the true decontamination potential and ability of lasers.
Raj runs several dental practices in the Cambridge area, known as the Antwerp Dental Group. Within this nucleus of practices, he has created the brand Antwerp Implant Dentistry.
Qualifications: BDS LDSRCS(ENG) DGDPRCS(ENG) MFDSRCS(ENG) MClinDent (Prosth) MSc (Imp) ILM
The fact that there are so many different ways of treating full-arches with implants is testament to the fact that there is no one best way of doing so, each method having its pros and cons. Even that best way of attaching the full-arch bridge to the implants is debated, with some wanting to cement their bridges and others preferring them to be screw-retained. In this talk the conometric technique will be presented, which allows a full-arch implant bridge of any material to be securely attached to the implants without the need for screws or cement. It has the advantages of each technique and the disadvantages of neither. I have cemented a reasonable number of full-arch implant bridges. I have screw-retained well over 70 full-arch implant bridges. Now the full-arch implant bridges that I do are all conometric.
Bill Schaeffer is qualified in dentistry and medicine, has post-graduate qualifications in both dental and general surgery and is recognised as a specialist Oral Surgeon. He has been placing dental implants since 1996 and is experienced in a number of different implant systems. He is co-owner of two implant centres in Sussex, which focus purely on dental implant treatments. Bill has been a past South East England Committee representative and was Director of Education for the Association of Dental Implantology (2009-2011).
Qualifications: BDS MBBS FDS RCS (Eng) MRCS (Eng)
The challenge of full arch restoration has been the aesthetic and functional rehabilitation, which is often compromised by post-extraction resorption. This talk briefly compares and contrasts the approaches to fixed full arch restorations and looks at how technological developments with implant prosthetic component design can allow for a potentially simpler more cost effective solution for full arch fixed restorations in conjunction with CAD milled superstructures.
Anthony Bendkowski is a specialist in oral surgery in practice limited to implant reconstructive surgery in London and the South East of England. He qualified from University College Hospital Dental School, London in 1982 and subsequently gained extensive experience in both hospital and practice-based oral surgery. He has over 25 years’ experience in both the surgical and restorative management of implant cases. He has a keen interest in all aspects of dental education and has lectured on and run bone augmentation and implant training courses, as well as lecturing on business skills for successful implant practice for a number of years. He is a Past President of the Association of Dental Implantology and an examiner for the Edinburgh Diploma in Implant Dentistry as well as for Membership in Oral Surgery for the Royal College of Surgeons, England.
Clinically he undertakes all aspects of bone grafting, immediate load full arch surgery and restoration and has a particular interest in synthetic bone regeneration substitutes.
Qualifications: BDS LDSRCS MFGDP DipDSed DPDS MSurg Dent
For over 30 years the standard to replace all the teeth in an arch has been the hybrid bridge, originally cast gold and acrylic and more recently titanium and acrylic. Despite advances in denture teeth and acrylics, problems continue to occur with debonding of teeth, discolouration and fracture of acrylic being frequent. Implant companies have built their own CAD/CAM milling facilities and many third party milling facilities are appearing, offering a wide variety of solutions from milled cobalt chrome to one piece all zirconia bridges. This presentation looks at the advances in the production of one piece screw retained frameworks and will provide practical advice based on the experience we have gained using, almost exclusively, all-zirconia and ceramic based frameworks for the last 5 years.
Kevin Lochhead is a Specialist in Prosthodontics and clinical lead at Edinburgh Dental Specialists, a referral only multidisciplinary specialist practice that he started 23 years ago.
He is a strong proponent of "evidence based dentistry" and the "team" approach to dental implant treatment: multidisciplinary treatment planning (prosthodontically driven), implant placement by oral and maxillofacial surgeons and restoration fabrication by an onsite dedicated implant laboratory.
Having a laboratory and team of technologists on site has allowed the careful assessment of new technology as it has become available.
Qualifications: BDS DGDP