Dr Andrew Farr talks to The Revu about his recent experience of undertaking the ITI Foundation in Implant Dentistry (FID) course and why, along with the guidance of his mentor, he is now more than ready to place his first implants.

What first motivated you to attend the FID course?

We were already offering implant treatment at our practice, but I was keen to learn for myself how to place and restore implants. I qualified over 10 years ago and received no implant training at all at undergraduate level, so it was a question of looking at the introductory courses out there that could get me confidently started in implant dentistry and the FID course was definitely the one that suited me best.

How did you find the course content?

Because it’s a Foundation course it’s designed to give you a solid theoretical understanding of how and when to use implants and to guide you in implant selection. I believe that the theory is very important when you are starting out in implant dentistry and the FID course definitely gets you off on the right foot.

I was very impressed at the quality of the teaching from some of the most experienced implant dentists in the UK, including Dr Shakeel Shahdad, Prof Nikos Donos and Dr Nikos Mardas. Between them they have a vast amount of experience, and I found them to be very open and honest about real life situations in practice, both good, and occasionally not so good. It would be easy for the experts to just say how good they are at placing implants, but that’s not what the delegates need, nor what they did. It’s just as important to learn about the things that can go wrong as well as the vast majority of cases with highly successful outcomes.

The FID modular course is spread over six months and you successfully completed the course in September. What has been happening in that time?

The most significant thing I’ve done is to partner with my mentor, Michael Betteridge. Michael is a specialist oral surgeon who is very experienced in providing not just oral surgery care in the primary care environment, but also a highly-regarded dental implant service, and is therefore ideally suited to being a mentor.

Are you looking to now move on to an MSc course or similar in implant dentistry or is mentoring giving you everything you currently need?

For the time being, with the help of Michael, my plan is to first get the basics right in practice before considering moving onto further education and I’m already in the process of planning my first implant cases. It can be a bit daunting when you first start out, but it’s probably more a fear of the unknown and that’s why a mentor is such a good idea to guide you over those first hurdles until you find your feet.

How have you found the support from Straumann - do you plan to place Straumann implants?

Yes, that’s my plan. Straumann are market leaders and when you are starting out you want to place the implant that offers the best chance of long-term success and is backed by a huge amount of research.

The support they offer is terrific and our local Straumann representative Hayley has been a great help in terms of my surgery set-up and making sure I have everything I need to get me started. Everyone at Straumann really knows what they are doing and if I have any problems I know they are there to help. It’s about the whole support package - not just the implant.

What are your plans now going forward?

I want to be doing a lot more than just placing the occasional implant. My aim is to eventually place something in the region of 100 implants a year and be in a position to accept referrals from local colleagues.

Finally, would you recommend the FID course to other GDPs?

Yes, I would definitely recommend this course - it’s ideal for any clinician looking to get the best start in a career in implant dentistry.

In association with Straumann, the next ITI Foundation in Implant Dentistry course begins in February 2018. For further information or to reserve your place, please call the Straumann Education Department on +44 (0) 1293 651270 or visit iti.org/uk

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Broad Street Dental Surgery, Broadway House, 32-35 Broad Street, Hereford HR4 9AR

Andrew Farr BDS(Hons), MJDF RCS Eng 

Andrew joined Broad Street Dental Surgery, Hereford in October 2014. Born and raised in Caerphilly, South Wales he studied dentistry at the University of Cardiff, graduating with honours. He completed his vocational training in Plymouth, then spent a year as a Maxillofacial Senior House Officer at Derriford Hospital where his duties included emergencies in A&E, head and neck surgery and wisdom tooth removal. He has developed an interest in orthodontics and is qualified to offer Quick Straight Teeth short-term orthodontics.

Small, strong and enduring, and completing the Straumann portfolio for narrow space indications, the Ø 2.9mm implant brings all the Bone Level Tapered (BLT) advantages to narrow interdental spaces.

The Straumann Bone Level Tapered (BLT) Ø 2.9mm implant is the implant solution for narrow interdental spaces or ridges. The smallest in the Bone Level Tapered range, it completes the portfolio for narrow space indications and integrates seamlessly with the reliable Straumann® Dental Implant System.

Benefitting from the clinically-proven BLT design, it has a parallel body with full-depth thread and three cutting notches for self-cutting in underprepared sites. Its apically tapered design delivers excellent primary stability in soft bone and fresh extraction sockets as it adequately compresses the underprepared osteotomy and allows the clinician to effectively master the patient’s anatomy, even when limited, and protects the anatomical structure with its round tip.

As well as the tapered implant body, all Straumann BLT implants possess the powerful combination of Roxolid®, SLActive®, Bone Control Design™, CrossFit® connection and prosthetic diversity.

Roxolid®

Roxolid has enabled Straumann to create smaller implants than ever before, thus reducing invasiveness, by preserving bone and minimising the amount of bone grafting required. Roxolid is a high performance alloy, specifically designed to offer higher strength than pure titanium, making these smaller implants possible. Smaller implants increase the range of treatment options available to the clinician and patient acceptance will be higher when less invasive treatment options are offered.

SLActive®

The SLActive surface allows fast and predictable osseointegration, enabling safer and faster treatment and higher treatment predictability in challenging protocols. Clinically proven to provide safer and faster treatment in 3-4 weeks for all indications, it increases safety during the early healing phase and leads to a superior structural and functional connection between the implant and vital bone.

Bone Control Design™ and CrossFit® connections

Bone Control Design optimises crestal bone preservation while the CrossFit connections simplify handling and increase confidence in component positioning, ensuring precision against rotation and long-term flexibility.

Prosthetic diversity is ensured by compatibility with the full range of Straumann prosthetic components, including the unique oval design for optimal soft tissue management in smaller spaces.

The BLT Ø 2.9mm implant is indicated for single-tooth restorations of the central and lateral incisors in the mandible, and lateral incisors in the maxilla.

And coming soon… single use instruments will allow you to place the BLT Ø 2.9mm implant with sterile, disposable burs, drills, taps and profilers, ensuring your instruments are always sharp and minimising the cost and inconvenience of sterilisation.

For more information on the range of Straumann® Bone Level Tapered Implant solutions, please contact Straumann on 01293 651230 or visit straumann.co.uk.

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Dr Neel Patel and Dr Vinit Gohil, both Specialists in Prosthodontics, explain the benefits of guided surgery, why they use it routinely and how anyone involved in implant dentistry can incorporate guided surgery and its benefits into their everyday practice.

The increase in predictability and accuracy that digital dentistry enables is now well-documented, and we have been taking advantage of this for some time at our practice in Oxford with the use of guided surgery and implant placement. Although until now we have been incorporating conventional impressions and study casts in the planning stages of the guided surgery workflow, the development of intraoral scanners facilitate an entirely ‘digital’ workflow. In addition to investing in an intraoral scanner for digital impressions, we hope to also incorporate a 3D printer into our practice, thus completing the entire workflow digitally.

Why guided surgery?

Although it might seem obvious, the key to successful implant-supported restorations is the correct placement of implants with respect to the supported restoration. It is well-documented that both biological and hardware complications are commonplace in implant dentistry, and unfavourable implant positioning will greatly contribute to this. Optimal plaque control and maintenance of the peri-implant tissues is critical, and the transition between the implant, abutment and restoration need to be ideal in order to facilitate this.

Where possible, we plan for screw-retained restorations and prostheses, as not only does this help facilitate maintenance of our patients’ implants and restorations, but can also help minimise complications as access to both the peri-implant tissues and abutment screws is always possible.

Optimal implant positioning also avoids the need for complex custom abutments, suprastructures and angled screw systems, thus relatively simplifying the restorative phase and can also reduce the overall cost.

The majority of our dental implants are placed with a guided surgical template where possible, even straightforward ones, as the guided surgical template ensures that the implant is placed in, or very close to, the position it was planned to be in. Many of us who have placed dental implants will be able to relate to the occasional difficulties in getting the dental implant to be placed exactly within the prepared osteotomy. Using a guided surgical template can reduce the margin of error significantly when compared to ‘freehand’ or non-guided placement.

Restoration-guided implant placement

The ideal workflow involves being able to visualise the proposed definitive tooth position, shape and form. This can be either a conventional diagnostic wax/tooth set up, that has been scanned and formatted into a surface scan (.STL file) or even a digital wax/tooth set up. Both of these can be imported into many of the available implant planning software together with the patient’s 3D CBCT images. The surface scans (.STL files) and CBCT images are aligned together through a process of segmentation (partitioning of the digital images into multiple objects) and merging (superimposing identical surfaces together). Although it may sound complicated, both these processes are easily done with a few clicks of the mouse in coDiagnostiX and other planning software.

The dental implants can be precisely planned with reference to the proposed restoration/tooth position, and the software can be easily manipulated to not only change the implant position, but also visualise potential abutment designs and relationship of proposed implant positions to vital structures.

Designing the guided surgical template is also straightforward in most cases. However, at this stage, all the information a laboratory would require to design and print it can also be transferred across to them with the press of a button.

The next step is to trial the surgical template in the patient’s mouth to make sure it fits correctly, and although uncommon (provided the planning is accurate), it can be easily adjusted and modified if required to obtain a stable and precise fit. The surgical procedure involves using the guided surgical template at every step of the osteotomy preparation sequence, followed by placing the implant through the guided surgical template.

We feel it is important to use the guided surgical template for every part of the osteotomy preparation including placement of the dental implant (where available), and not just for the pilot drill, as advocated by other guided surgery systems. As we have mentioned already, getting the dental implant to be placed exactly within the prepared osteotomy can be challenging, especially in softer bone and sites with difficult access. The guided surgical template will ensure that your implant is guided into the same place as the osteotomy and more often than not, if planned appropriately, the angulation does not need to be constantly checked (especially with adjacent implants).

We believe restoration-guided implant placement with guided surgical templates will become commonplace in implant dentistry and form an integral part of the patient treatment workflow.  Nearly all implant practitioners utilise 3D CBCT imaging to help aid assessment of implant sites, adjacent anatomical vital structures and to plan proposed implant positioning. It is now even routine to incorporate the proposed restoration/tooth positon with a radiographic template and in the absence of one, even easier to import the required information through ‘segmentation’ (data separation) and ‘merging’. With all this information already present, all it takes is a couple of small steps to transfer this vital information into a guided surgical template which, when planned appropriately, will allow the implant to be placed precisely where it was planned to.

Straumann Restoration-Guided Implant Placement Course

Through our postgraduate teaching and lecturing experience, it has become apparent to us that many clinicians are nervous about taking the next step that would allow them to incorporate guided surgical templates into their practices and implant workflow. As such we have  teamed up with Straumann ITI to provide a two-day course on Restoration-Guided Implant Placement including the use of coDiagnostiX planning software, guided surgical templates and the Straumann Guided Surgery system.

The course is aimed at clinicians who are competent in implant dentistry and would like to incorporate guided implant placement into their everyday practice, and those clinicians that are just getting into implant dentistry and would like to incorporate the concept of Restoration Guided Implant Placement for their patients. Most of the course will be dedicated to live demonstrations and hands-on experience of the coDiagnostiX planning and guide design software. On the second day, each participant will complete the entire coDiagnostiX planning and guided surgical template design process, prior to learning about the Straumann Guided Surgery system and using it to place implants with a guided surgical template.

We appreciate there is a learning curve in using guided surgical templates, and although they are by no means a substitute for surgical experience, we feel they can greatly enhance the overall treatment outcome. For us, one of the main advantages of restoration driven implant placement with guided surgical templates, is the ability to plan for screw-retained restorations and prostheses with optimal implant positioning. This ensures that our patients’ implant restorations and prostheses are ‘retrievable’, facilitating future maintenance and hopefully minimising the risk of subsequent complications.

We usually only have one opportunity  to get it right with implant placement, and it is important we do so as it is well-documented that the implant position will influence numerous factors that will ultimately determine the success and longevity of our patients’ implant treatment in the long-term.

The Straumann ITI Restoration-guided Implant Placement course takes place on 3^rd November 2017. For more information or to book your place, contact Straumann on 01293 651230 or visit http://www.cvent.com/d/ctqnvx

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BDS MFDS MClinDent MPros

Neel is a registered Specialist in Prosthodontics, and after graduating from the University of Bristol in 2002, he worked both in the Community Dental Service and General Dental Practice, and also held hospital posts in Oral & Maxillofacial Surgery. He subsequently completed 4 additional years of specialist training in Fixed and Removable Prosthodontics at the UCL Eastman Dental Institute during which he obtained the MClinDent in Fixed and Removable Prosthodontics, with Distinction, and the Membership in Prosthodontics from the Royal College of Surgeons Edinburgh.

Neel received a scholarship from the International Team for Implantology (ITI) to undertaken a 2 year full time Fellowship in Implant Dentistry at the Center for Implant Dentistry at the University of Florida, Gainesville, USA. He has gained extensive experience in all aspects of restorative, aesthetic and implant dentistry including complex treatments and managing the failing dentition. His special interests include the use of digital technology in dentistry, in particular with guided implant placement and 3D planning, and the management of complications with dental implants.

In addition to his private and referral practice limited to restorative and implant dentistry, he is also involved in post-graduate dental education and lectures both locally and nationally on topics related to implant dentistry and fixed and removable prosthodontics. Neel is a registered speaker and mentor for the UK & Ireland Section of the International Team for Implantology (ITI) and part of the Straumann Clinical Mentoring Programme for other dentists starting out in implant dentistry.  He is co-director of the Oxford ITI Study Club and is part of the UK & Ireland Young ITI Committee.

Vinit Gohil

BDS MFDS MClinDent MPros

Vinit is recognised as a specialist in Fixed and Removable Prosthodontics by the General Dental Council. He graduated with honours from the Guy’s, King’s & St Thomas’ Dental Institute, King’s College London. Following graduation he undertook 3 years of hospital-based further training in Oral and Maxillofacial Surgery, Paediatric and Restorative Dentistry. Vinit also gained experience in sedation and special care treating anxious and medically compromised patients.

He subsequently completed 4 years of specialist training in Fixed and Removable Prosthodontics at the UCL Eastman Dental Institute, during which he obtained the MClinDent in Fixed and Removable Prosthodontics, with Distinction, and the Membership in Prosthodontics from the Royal College of Surgeons Edinburgh. During his training he gained extensive experience in all aspects of restorative and implant dentistry including complex rehabilitations and managing the failing dentition.

He now principally works in private practice in Oxford and his clinical practice is limited to implant and restorative dentistry. His main clinical interests include management of failing crown and bridgework, rehabilitation of patients with dental implants utilising digital technology, removable dentures and dental implant complications.

In addition to his private practice, he is also involved in post-graduate dental education and lectures both locally and nationally on topics related to implant dentistry and fixed and removable prosthodontics. Vinit is a visiting lecturer at the UCL Eastman Dental Institute where he is involved in teaching post-graduate dentists and is an examiner for the UCL Diploma in Implant Dentistry. Vinit is also involved in teaching on the MSc in Dental Implantology at the University of Bristol. Vinit is also a registered speaker for the UK & Ireland Section of the International Team for Implantology (ITI) and co-director of the ITI Study Club in Oxford.

The Straumann® Bone Level Tapered Implant features the Straumann® Bone Control Design™ and the CrossFit® connection together with its corresponding prosthetic CrossFit® components from the Bone Level product portfolio.

The implant has an apically tapered and self-cutting design which, when combined with our Roxolid material and SLActive surface, make it particularly suitable for anatomically and clinically challenging situations like those involving soft bone or fresh extraction sockets where higher initial stability is required.

The Straumann® Bone Level Tapered Implant now includes a surgical protocol using single use drills, profile drills and taps designed for flexibility and efficiency. Single patient drills always comes sterile, sharp, ready to use. After the surgery, simply dispose of the single patient instruments and save your clinic the time for reprocessing and space for storage.

For more information on our range of Straumann® Bone Level Tapered Implant solutions, including the new single use instruments, please contact Straumann on 01293 651230 or visit straumann.co.uk.

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Building on over six decades of experience, Straumann® have developed a new, unique, proprietary, glass-ceramic material called n!ce™, which is coming to the market as fully crystallised milling blocks that can be polished and seated straight after milling with no additional crystallisation firing.

Glass-ceramic has become an increasingly popular material for restorations over the past few years as results are durable, aesthetically pleasing and relatively cost-effective for clinicians. Straumann say their product brings new qualities to glass-ceramic single-tooth restorations which deliver additional benefits to both clinician and patient:

• The high-strength material, made of lithium aluminosilicate ceramic and reinforced with lithium disilicate, is indicated for all single-tooth restorations, even hybrid abutment crowns where walls need to be as thin as 1.0mm.
• Smooth margin lines facilitate robust adhesion to the tooth.
• Both clinician and patient save valuable time as no additional crystallisation firing is required after milling, making same-day single crown restorations a real possibility.  
• Use of n!ce fits seamlessly into standard CADCAM workflows as it is compatible with the vast majority of commercially-available milling machines including Dentsply Sirona’s CEREC.
• The biocompatible, aesthetic material can be polished to obtain a smooth, glossy life-like appearance or stained and glazed if needed.
•  Available in two levels of translucency, and six shades for each translucency, restorations can perfectly match the VITA tooth shade guide.

For more information on n!ce fully-crystallised, glass-ceramic milling blocks, call 01293 651230 or visit www.straumann.co.uk.

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Dentistry is moving into a new digital age and clinicians across the UK are seeking training and support to adopt these technological advances.

Straumann and Implants Centres of Excellence (ICE) recognise this demand and have collaborated to provide a valuable opportunity to see the full range of digital workflow solutions and educational opportunities currently available.

Straumann CARES® Digital Solutions combines interconnected software platforms and open, fully-validated workflows, alongside a wide variety of materials to deliver an unrivalled digital solution. On the 17^th and 18^th July, they will be bringing all this technology to the Old Trafford home of Manchester United on their massive 16-metre long Digital Performance Roadshow juggernaut which houses a full digital workflow.

Nearby at the ICE headquarters and hospital, the Straumann CARES® Digital Solutions portfolio will also be on display, including leading chairside scanning and milling technology and 3D printing, in the impressive ICE facilities which include training surgeries, an operating theatre, a laboratory and lecture facilities.

For a fully immersive experience, attendees can dive into a virtual reality experience, showcasing Straumann’s impressive digital portfolio and centralised manufacturing facilities. The Straumann and ICE team will also be on hand to advise and give a full overview of different product solutions.

Stephen Booth, Country Manager, Straumann UK comments, “We are delighted to be working closely with ICE as this underpins our commitment to facilitating a successful educational pathway for clinicians, whilst delivering the latest innovations and ultimately improving the patients’ quality of life’.”

For the perfect opportunity to gain direct experience of the latest digital products and an insight into the latest training available, book a free place today at straumanndigitalperformance.co.uk

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•       OUTSOURCED PRODUCTION – The Straumann® CARES® Centralised Milling facility operates as an extension of the modern laboratory, with state-of-the art equipment and validated workflows. There is a comprehensive range of products to choose from, including one-step restorations, customised abutments, screw-retained bridges and bars, copings, bridge frameworks as well as full contour crowns and bridges. Alongside this, Straumann offer a variety of materials including multiple glass ceramics, zirconia available in numerous shades and translucencies, cobalt chrome, titanium and polymers.

By adding an all-encompassing digital dimension to their portfolio Straumann have added a completely new vibe to their offering – they’re more than a dental implant company, they’re your digital solutions partner.

TOUR DATES

Audiences will be driven wild by the great product deals, insightful presentations and hands-on demonstrations on offer at the Straumann Digital Performance Tour. Plus, with exclusive backstage access to the live music and entertainment on offer, and after parties scheduled at selected locations, the Straumann Digital Performance Tour promises to be a must-attend event for any technician, CDT or clinician looking to enhance their digital offering in 2017 and beyond.

Don’t miss the opportunity to see these fantastic innovations at the Straumann Digital Performance Tour. FREE to attend places are limited - to book your place visit straumanndigitalperformance.co.uk, or visit Straumann at TDS / DTS on Stand B10 or call 01293 651230.

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