Central and North West London NHS Foundation Trust, UK
On Wednesday 31st January 2018, at a cow ranch in the city of Bhanvad, India, a health camp took place. Implemented by the charitable organisation, Shree Bhanvad Mahajan Panjrapol Gaushala, free healthcare services: ophthalmology, physiotherapy and dentistry were made available to hundreds of underprivileged persons.
The dental team consisted of a UK based dentist (the author) and a chief dentist based in India. The author participated in this event by interacting with guests, answering dentally-related questions and providing oral hygiene and preventative advice. Emergency dental care, including exodontia and temporary restorations and impressions for the provision of dentures were performed by the chief dentist.
Dozens of dental extractions including teeth and retained roots were performed; however, not via traditional approaches. Combining Ayurveda and yoga, which are ancient scientific practices of Hinduism, a unique extraction method was employed, using Jalandhara Bandha Yoga. This technique involves the locking or blocking of the nerve plexus, arteries and veins around the neck, thus restricting blood flow and pain pathways involving the head and neck. This appears to facilitate painless tooth extractions without the need for local anaesthesia or prior analgesia.
The author is fascinated by the quick, efficient and cost-effective nature of this extraction method. Although this does not have a global presence in todayʼs modern era, it appears to be very productive in the rural, charitable health camp setting within India. It is also growing in popularity amongst dentists based in India that have a special interest in Ayurveda and yoga.
Biography:
After qualifying as a dentist in 2012 from Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth in the Southwest of England, UK, Dr. Bhaven Modha has had both a varied and unique mix of experience in dentistry. From gaining worthwhile skills and experience from several general dental practices, Bhavenʼs journey in dentistry has also included dentist positions in secure units to include prisons and immigration removal centres; special care community clinics, university and educational establishments and as a senior dentist overseas.
1São Leopoldo Mandic College, Brazil
2UNISUL, Brazil
An insufficient amount of keratinized mucosa around the implants can often cause increased sensitivity to brushing and become uncomfortable to patients just as the absence of it can favor plaque accumulation and make oral hygiene uncomfortable for the patient. The aim of this case report was in the second surgical stage to use the technique of free gingival graft to increase the range of keratinized mucosa in the region of implants 46 and 47. The treatment consisted of preparation of the receptor bed through a split flap with apical displacement, fixing it with simple sutures and installing the healers. To demarcatise the size of the graft tissue to be collected, a template was performed. The donor area chosen was the hard palate on the right side of the canine region to the first molar, the initial incisions were made using custom template and the graft was removed with connective tissue and epithelium. The graft was firmly stabilized in the recipient area through simple and suspender sutures and in the donor region sutures were also performed to contain the clot and reduce postoperative bleeding. The present case was monitored for 30, 60, 90 days and after 18 months. The case report showed a considerable increase in the range of keratinized mucosa at the site of dental implants. Based on vast existing literature, it was possible to verify in this case report that free gingival graft surgery promoted an increase in the local keratinized mucosa, benefiting the perimplant health of the patient.
Biography:
Helton Panisson is a dentist graduated from the Federal University of Parana since 2001. He is a Specialist in Implantology and Periodontics and works in his own practice. Resident in the Master of Oral Implantology at São Leopoldo Mandic College, Curitiba – PR Unit Brazil.
1São Leopoldo Mandic College/ Curitiba PRUnit, Brazil
2UNISUL/ Campus Grande Florianópolis, Brazil
The immediate installation of dental implants in the aesthetic area of the smile is an increasingly common practice in dental clinics. The lack of information about the anatomy of this region can bring unsatisfactory aesthetic results. The aim of this study was to analyze the anatomy of the alveolar bone ridges in the anterior region of the maxilla regarding the thickness of the bone around the natural teeth.
Methods: This study analyzed 314 cone beam computed tomography (CBCT) exams performed at a Radiology and Private Dental Imaging Clinic in the city of Curitiba, State of Paraná - Brazil in the year 2018. Of these, 211 exams were of the maxilla 155 exams were eliminated according to the exclusion criteria. The samples included 36 women between 10 and 84 years old and 20 men between 12 and 66 years old. A total of 201 teeth analyzed, including central incisors, lateral incisors and upper canines. Chi-square tests of linear trend and paired T test were performed. The level of statistical significance was 5% (p <0.05).
Results: The largest thickness of the buccal bone plate was found in teeth 12 and 22 to 2 mm from the alveolar bone crest and in teeth 13 and 22 to 4 mm from the bone crest and the same locations for the palatal wall the highest averages were for teeth 11 and 21. The greatest average distance from the apex of the roots to the floor of the nasal fossa was teeth 12 and 22. The greatest distances between the cemento-enamel junction and the vestibular alveolar crest were in teeth 22 and 23, while for the palate teeth 23 and 11. According to the root positioning in the alveolar process, it was observed that in class I (Kan et al., 2011) the proportions of the vestibular bone plate were <1mm, 85.2% to 2mm of the alveolar crest and 95% at 4mm.
Conclusion: This study showed that the prevalence of tooth root positioning in Cl I in the alveolar process was significantly predominant and that the thickness of the buccal alveolar bone plate is less than 1 mm in all anterior region of the maxilla.
Biography:
Flavio Gameiro de Souza graduated from the Faculty of Dentistry of Lins in 1996. He has a degree in Dentistry from the University of Lisbon in 2000. Specialist in Implantology from CEPEO-Curitiba; Specialist in Periodontics and Radiology and Dental Imaging and Resident in the Master of Oral Implantology at São Leopoldo Mandic College-Pr. Unit, Brazil. He works in a private practice in the city of Curitiba - Brazil.
São Paulo State University, Brazil
Currently, it is possible to achieve digital flow through laboratory scanners, however, due to a large number of commercial brands, there are limited evidence that address the accuracy among the commercial models available. Thus, the impression accuracy of three laboratory systems in prosthetic rehabilitation on parallel and angled implants was evaluated, in vitro and three-dimensionally. A metal model of a toothless jaw with four implants was scanned by a contact scanner (MDX-40-Roland, control, n=10) and compared to three laboratory scanners (n=10): Amanngirrbach, Shining and 3Shape. The images (STL) were exported to Bio-CAD software, where the overlapping and comparison of the positioning, in 3D, of the digital models with the digital master model was performed. The three-dimensional analysis on the X, Y and Z axes were guided by a pyramid, present in the digital master model. The Kruskal-Wallis and Anova Two-Way tests were applied to verify the commercial brands and implant position variables, respectively, with a level of significance at 5%. There was no difference between the scanners regarding their accuracy (p=0.0806). When the implants (A, B, C and D) were analyzed, an interaction (p<0.001) was observed between the implant (p = 0.001) and commercial brands (p=0.262) variables. Only the D implant showed a statistical difference in the scanning accuracy when the Amanngirrbach model was compared to Shining (p<0.001) and 3Shape (p=0.002). Thus, there is precision in all laboratory systems evaluated but angled implants can provide deviations during the digital impression.
Biography:
Graduation in Dentistry by UniFACID Wyden; Master in Oral Rehabilitation, Prosthesis area, at School of Dentistry, Araraquara (UNESP-FOAr); Researcher with the Total Prosthesis / CNPq research group (UNESP-FOAr); Worked in research projects in the lines tooth bank, roughness between acrylic and bisacrylic resin and biofilms of Candida albicans. Currently is a PhD student in Oral Rehabilitation, Prosthesis area, at School of Dentistry, Araraquara (UNESP-FOAr), working in the research line prosthetic treatment in odontogeriatrics.
Arrowe Park Hospital, UK
Coronectomy is a surgical technique used to minimise the risk of damage to the inferior alveolar nerve (IAN) and is performed in many Oral & Maxillofacial Surgery (OMFS) units. The third molar is decoronated, leaving the roots in situ and theoretically minimising the risk of damage to the IAN. Damage to the IAN can result in significant morbidity and affect a patientʼs quality of life. There is risk of damage to the inferior alveolar nerve (IAN) following extraction of mandibular third molars, which are increased inso-called “high-risk” teeth.
A retrospective review was carried out, reviewing case notes of patients who underwent coronectomies in the OMFS unit at Arrowe Park Hospital in the UK from March 2019 to March 2020. Of the patients in the study, three had post-operative complications. Two had significant pain in the weeks following the procedure, which had subsided on further review. The third patient developed a post-operative infection requiring oral antibiotics, their symptoms subsequently subsided. No patients in the sample required procedures to remove the remaining roots and no patients had symptoms of IAN damage.
This review found a 79% success rate of coronectomies. This is similar to the success rate of previous studies. Coronectomies have a reduced risk of damage to the IAN when compared with extraction of mandibular third molars and should be considered as an alternative to extraction when indicated.
Biography:
Sandeep Acharya is currently a DCT2 working at Liverpool University Dental Hospital. He has worked at Oral and Maxillofacial Surgery units across numerous hospitals in the United Kingdom. He has a keen interest in Oral Medicine and Surgery and wants to pursue further training and research in these fields.
University of Liverpool Dental Hospital, UK
Introduction: The dental patients that are seen at SRFT services often have a high caries risk due to many different reasons such as an inability to brush properly through either a disability or living circumstances. In 2007 Public Health England published a tool kit for dentists with guidance of preventative aids to help reduce tooth decay which includes appropriate fluoride intervention for patients.
Aims and Objectives: The aims of this retrospective study and audit was to find out if SRFT dental services are following fluoride intervention guidelines for every patient or whether more can be done to ensure we are helping our patients to prevent tooth decay.
Methodology: 120 child and adult examination notes were assessed at random from 6 different dentists (20 from each). The criteria used to assess the notes was whether patientʼs oral hygiene status was documented, whether the patient had been caries risk assessed and if high caries risk was fluoride varnish or a fluoride prescription provided.
Results: 83% of notes at the patientʼs oral hygiene status documented, 82% of notes had been caries risk assessed and 49% of high caries risk patients had the appropriate fluoride intervention.
Conclusion: Improvements across all categories are required including what is documented in patient notes and following fluoride prevention guidelines to provide excellent care to our patients and help to reduce caries risk.
Biography:
Maria Jackson graduated from University of Liverpool in 2017 in Bachelor of Dental Surgery. She has since worked in a general dental practice, community dental service centre, 2 different dental hospitals and 3 different general hospitals. She is looking to specialise in Special care dentistry and is currently undertaking a DCT 3 year at Liverpool Dental Hospital.
Wirral University Teaching Hospital, UK
Retained roots are commonly seen as an incidental finding, with many being asymptomatic. A general dental practioner (GDP) may notice this incidental finding in practice following radiographic examination. Over time they may have the ability to migrate, develop pathological change and become symptomatic for the patient. In this circumstance, they may be referred to an oral and maxillofacial department for further investigation. This paper uses an interesting clinical case to demonstrate where these roots can migrate to, how they can present and the surgical techniques required in their removal. In this particular case, the retained root of a lower right second molar migrated to below the right side of the inferior alveolar nerve.
Biography:
Melissa Loh is currently undertaking her second year as a Dental Core Trainee in an Oral and Maxillofacial Unit at Arrowe Park Hospital in the Wirral, Merseyside. She has enjoyed the challenges and various clinical exposures in relation to managing patients in a secondary care setting. She hopes that the skills that she has acquired during her time as a Dental Core Trainee will be transpired into my career in the Dental Profession.
Liverpool Dental Hospital, UK
An 8 year old male patient presented with failure of eruption of permanent teeth. This patient is fit and well with no family history of this. All deciduous teeth were still present and radiographic examination showed all permanent teeth (apart from third molars) were unerupted and of sound anatomy.
No cause for this patientʼs delayed eruption has been found. The patient has attended genetic specialists and multiple dental specialists to diagnose. The working diagnose currently is primary failure of eruption with no genetic or anatomical cause.
At age 9 the patient underwent surgery to expose upper central incisors and all permanent first molars. Initially this appeared to have been successful, however, at a review 10 months after, only one cusp tip from the Lower left molar and part of the labial surfaces of upper incisors was erupted.
Following a multidisciplinary meeting, a complete upper overdenture and a lower partial denture was made for the patient. These will need to be replaced every 18 months roughly until the patient has fully grown. Considerations for the future will be to reattempt exposure of permanent teeth although unsuccessful before or providing implant retained prosthesis.
Biography:
Maria Jackson graduated from University of Liverpool in 2017 in Bachelor of Dental Surgery. She has since worked in a general dental practice, community dental service centre, 2 different dental hospitals and 3 different general hospitals. She is looking to specialise in Special care dentistry and is currently undertaking a DCT 3 year at Liverpool Dental Hospital.
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