Dental Tribune UK Edition, September 20-26, 2010, Vol. 4 No. 22

Technology such as CAD/CAM design and digital impressions are aiding treatment plans for better aesthetics 17EducationSeptember 20-26, 2010United Kingdom Edition O ver the past five years or so I have noticed a grad- ual move from piece- meal dentistry (the product of the National Health Service) to a more holistic, full-mouth ap- proach and the increasing in- volvement of other disciplines, such as facial aesthetics. The use of CAD/CAM technology, both to manufacture dental restorations and in the plan- ning and execution of surgical procedures has also grown; the adoption of magnification and illumination by more and more clinicians has also risen. Interestingly, we have seen a gradual, but distinct consensus across the disciplines, so that the procedures we are carrying out are backed up with stronger evidence. We seem to have de- veloped a much better under- standing and agreement of the treatments we carry out for our patients. Of course, there are still gaps, but we are all heading in the right direction. Behind the scenes I have great admiration for the unseen supporters of our profes- sion that are continually striving to create better materials and more efficient equipment. This requires an intricate knowledge of chemistry, biology, electron- ics and material science. Although it may sometimes seem overwhelming, the huge choice of materials and equip- ment available to us is a minor miracle and underpins the suc- cess of what we do in our prac- tices. Not enough recognition is given to such people by our profession. The John McLean Memorial symposium, which was organised by Dr David Winkler just before the Eu- ropean Academy of Aesthetic Dentistry meeting, took place on May 26 in London and of- fered a tribute to one such man, who gave us glass ionomers and dental ceramics. While the materials we have now are excellent, I’m sure somewhere there is al- ways a team of people who feel they can do better! How- ever, although we are con- tinually provided with better materials, the techniques adopt- ed by practitioners must be skilful and consistent enough to utilise the optimum properties of these materials: If you take clinical shortcuts, no material will save you for very long! The greatest advances I would have to say though that the greatest advances have been seen in postgraduate educa- tion. There is a proliferation of courses, conferences, symposia, mentoring and publications. My personal feeling is that people are talking to each other more freely than they did before; they show more willingness to share their experiences and their fail- ures, discussing the black holes in our knowledge that people use to shy away from in the past. As far as one particular item is concerned, the profession has put a lot of faith in zirconia and especially CAD/CAM manufac- tured zirconia restorations. The material itself is pretty tough and easily the most durable ce- ramic we have at our disposal; however, the problems experi- enced with adhesion of veneer- ing porcelain and cement to this material – as well as its degra- dation over time when exposed to the punishing oral environ- ment – is still a subject for in- tensive debate. I hope that the problems are ironed out and we can keep zir- conia. However, some very ex- perienced practitioners around the world are finding a greater cumulative failure rate of zir- conia-based restorations as years go by, so this might be one technology where I would rec- ommend not putting all of your eggs in one basket just yet. How patients benefit One would hope that through better knowledge and acquisi- tion of more advanced skills, more of us are in a position to assist our patients with the problems they face. The use of stronger aesthetic materials that bond better to teeth will hope- fully mean less frequent revi- sion being necessary during the patient’s lifetime and greater re- liability of our treatment. How- ever, again it must be stressed that this will only occur if the clinical techniques and control with which these materials are used is of a high standard. As for the future, who knows? I would like to see a drive to- wards better 3-D documenta- tion, such as digital impressions and digital studies of dynamic mandibular movement to assess occlusal function and balance in larger restorative cases. I would also like to see an improvement of communica- tion and workflow between cli- nicians and laboratory techni- cians and to hopefully see an increase in the compactness of some of the equipment we use such as curing lights, implant motors, piezosurgery devices, x-ray sensors and apex locators, for example, which take up such a huge amount of room in our surgeries. Of course we all await the advances in genetic engineer- ing that will allow the growth of new teeth. Maybe not during the next five years...although you never know. DT The bigger picture Dr Koray Feran looks at how restorative dentistry has progressed in the past few years and compares some of the materials on the market About the author Dr Koray Feran qualified in 1989 from Guy’s Dental Hospital, winning the Final Year Prize for overall excellence and the SJ Kaye Prize in Oral Medicine and Pathology. He remained at Guy’s for two separate House Surgeon ap- pointments in Prosthetic Dentistry and then Oral and Maxillofacial surgery till 1991 when he went into general practice in North London. After com- pleting the Master of Science degree in Periodontology from Guy’s Hospital, he obtained a (Restorative Dentistry) Fellowship in Dental Surgery from the Royal College of Surgeons of England. He has since been in practice dedicated to quality dental care, having a special interest in multi-disciplinary cases that require detailed planning and co-ordi- nation of several specialist branches of dentistry. For more information or to refer to Koray, contact The London Centre for Implant and Aesthetic Den- tistry on 020 7224 1488, koray@koray- feran.co.uk or by visiting www.koray- feran.co.uk. ‘Although it may sometimes seem overwhelming, the huge choice of materials and equipment available to us is a minor miracle and underpins the success of what we do’

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