Saturday, 28 February 2015

It's Time for War: Laser Tag

Last week my DF1 scheme spent a thouroughly enjoyable afternoon running about in the dark shrieking (guys as well as girls!). 



Having been paint-balling before and regretting it (no one likes being shot in the ear!), when my fellow young dentists suggested a social activity I was definitely more keen for the less painful option of laser tag.

Luckily, there's a laser tag centre pretty close to central London based in Greenwich right by the Thames Barrier. It was relatively easy to get to although finding the actual entrance was a bit challenging as it's located in an old industrial building and was made out to look like an old cold war bunker.

Despite being a bit late due to having trouble finding the place, we still managed to get kitted up and ready and have our full hour of yelling, ducking, diving and hiding (it seemed to go on for much longer!). 

Since there were 21 of us, it proved to be a really fun and exciting game - my particular favourite was when we broke up into smaller coloured teams against each other, but that might just be because the team I was in won! 

We had 5 games in total in the end over 2 different arenas. Once you got used to the 'atmospheric' smell it was easy to forget that it was light outside! You didn't have to be great at it either, it was still really fun to run about chasing each other. It was a bit grubby too so I'd definitely recommend wearing comfortable trainers and taking the overalls they offer!

We also got a bit of money off as it was half-term, and it was surprisingly quiet too - we had all the arenas to ourselves bar from the first game we played. 

To find out more please see the Bunker 51 website


Have you been to laser tag before? Did you have fun? Please leave your comments in the section below!


Thursday, 26 February 2015

Are you being Pulled out of Orbit? The NHS/Private Interface

I have also discussed this talk on the 2020dentistry blog page.

This post is based on a talk by Raj Rattan at the Young Dentist Conference 2015



Raj Rattan raised important issues and asked “What treatment should be provided on the NHS?” this is what he said:

All treatments that are proper and necessary to secure and maintain oral health should be provided under the National Health Service.
Most NHS dentists will hold General Dental Service contracts, but additional services can be provided if the dentist has been contracted to carry them out. These include:
  • Dental Public Health services
  • Sedation services
  • Domiciliary services
  • Orthodontic services
  • Advanced Mandatory services.
What are Advanced Mandatory services?

A service which provides a high level of expertise and facilities where general practitioners can refer their patients for specialist periodontal or endodontic treatments.

There are several guidelines available that assess the complexity of the treatment required for a patient, which can be used to determine whether a referral to an advanced mandatory service is indicated, and include guidelines from:

  • American Association of Endodontics
  • British Society of Periodontics
  • NHS Restorative Dentistry: Index of Treatment Need Complexity Assessment

The most common treatments that are ‘pushed privately’ by dentists who violate the terms of their NHS contract and do not follow the GDC Standards of Care are:

  1. Cobalt Chrome Dentures
  2. Periodontal treatment and referrals to hygienists
  3. Bridgework
  4. Endodontic treatment
As professionals, we are trained as clinicians, and not business managers, and this brings me to the issues of: time, quality and money, and how well equipped are we to deliver.

Ideally, we all would like to perform highly in all of the above, but unfortunately this is often not possible. It has been estimated that around £72 million was inappropriately claimed by gaming dentists; 50% of this were treatments claimed which the patient didn't actually receive. This is not in the interest of the profession or the patients.



Dentists are also under pressure to be transparent in their pricing by the Office of Fair Trading, more recently by Which? and to be CQC compliant. The profession therefore need to have a conversation on how best to use their clinical skills and the settings to deliver dental care.



To see another post about a talk about NHS Rules and Regulations by Raj Rattan and Len D'Cruz click here.



See my new post about a talk by Reena Wadia at the Young Dentist Conference, How to survive as a young dentist?




Do you have trouble understanding what treatments you can provide your patients on the NHS? Or have views on the proposed new contact? Please leave your comments in the section below!



Tuesday, 24 February 2015

#Tubuleslive Event: CBCT - Current Concepts in Dental 3D Imaging



This week's #Tubuleslive was with Andrew Legg about the use of Cone Beam Computerised Tomography (CBCT) in practice.

Despite a few technical glitches, Andrew delivered a highly topical and interesting talk and here I shall summarise the main points of his talk:
  • CBCT can be used in both implant dentistry and oral surgery to help both with diagnosis and treatment planning
  • 2D images such as DPTs can be misleading sometimes as it only gives a flattened view of a 3D object
  • You can use CBCT to scan patients as well as prostheses to treatment plan cases - placing gutta percha in points in the denture can help locate the prosthesis. 
  • Ideally you need around 4-5mm of sound bone to place an implant - CBCT can help you determine the amount and quality of the bone present
  • If you don't have enough bone to place an implant, you can consider angled implants, zygomatic implants or extensive bone grafts or sinus lifts
  • The UK guidelines of CBCT are containing in the HA-CREC-010 document
  • When considering performing or referring for these images, you need to adhere to the IRR (99) and the IRMER (2000) guidelines 
  • Usually in order to be a CBCT practitioner, you will need at least 11 hours of training 
  • When taking a CBCT you must justify the reason why you need to take one and specify which area you need to see
  • Record the justification and the report on the image fully in your notes. Dictated notes have been deemed contemporaneous
  • You must also perform a quality assessment if you take CBCT. At least 95% need to be of an acceptable standard. 
  • Unlike conventional dental radiographs, the quality assessment is only broken down into acceptable and unacceptable (< 5%), due to the scattering effect of metallic restorations
  • A small Field of Vision (FOV) CBCT usually amounts to around 2-4 times a DPT, whereas a large FOV amounts to 6-7 times. 
  • Doses keep decreasing with the newer machines 
  • Typical background radiations is 7-8 mSv a day, so a CBCT usually amounts to a couple of days worth of background radiation, although not all machines are the same
  • Uses of CBCT in oral surgery include: assessment of ID nerve position in impacted wisdom tooth extractions, position of impacted teeth in relation to adjacent teeth to assess potential to damage, assessment of periapical pathology prior to surgical endodontics
  • Uses of CBCT in implant dentistry include: assessment of bone volume and quality, proximity to vital structures e.g. ID nerve, mental foramen, sinuses, sinus assessment e.g. spicules, membrane thickness
  • The software you can use with your CBCT scan can be integrated e.g. Galaxis, Carestream, Icat Vision, or a third party software e.g. Nobel Clinician, Simplant, Osirix
  • You can use CBCT with digitial scanning system e.g. CEREC (please see the previous #Tubuleslive post to read about this) in order to plan the ideal position of the implants and create a drilling guide
  • With proper planning you can avoid complications such as a sublingual artery bleed as a result of lingual wall perforation
Together with the previous talk from Colin Campbell, these talks have given me a better understanding of the use of 3D imaging and scanning to plan and treat patients who require implants.


The next #Tubuleslive event will be next week the 26th of March: Principles of bone augmentation for implant dentistry with Dr Koray Feran.

Why not attend the live audience where you can get FREE CPD! 

To see my other posts about previous #TubulesLive events see here

Do you use CBCT in practice? Please share your experiences in the comments section below!



Sunday, 22 February 2015

Why do People Complain?

This post can also be found at theyoungdentist.com

This blog post is based on a talk by Jane Merivale of Dental Protection who I saw talk at the FGDP Open Day


I have realised in the few months that I have been practising out in the big wide world that dentistry isn't just about clinical skill: people skills and effective communication are key when treating patients. 

Dentistry is unique as a health profession, not only should you provide excellent health care to your patients, but it is also a business and in some ways your patients are actually your customers. Therefore it is vital that your patients are satisfied with your care and the service they receive. 

Often, complaints arise as a result of a misunderstanding or as a result of poor communication and it's hard not to take a complaint to heart. Whilst nobody likes receiving a complaint, it is important to respond to them constructively and professionally to improve the care we provide.

Satisfaction and Dissatisfaction


As consumers, things that we buy in life tend to be either products or services. Sometimes in dentistry, the care we provide is an overlap of both these things such as the provision of a denture or crown. 

There is a spectrum of dissatisfaction ranging from those you are satisfied enough to present you with a gift, to those who are dissatisfied enough to complain or sue. The majority of patients fall into being either 'silently satisfied' or 'silently dissatisfied'

The problem with this is that we don't receive feedback on how well we are doing as dentists and those who are silently dissatisfied disappear off the radar and go see someone else. This is reason why we should welcome complaints so we can reflect on how well we are doing in order to improve our skills. 


Why do some people complain and others don't?


Many different factors influence whether a person complains. These can include:
  • The person's personality and assertiveness
  • If the patient is busy as it takes time and effort to complain
  • If it is easy for them to complain and whether they are obstacles in their way
  • If they have the view that it won't make a difference
  • Some people prefer to tell people they know rather than complain
  • It can depend on what went wrong and what factors are at work
Happy, satisfied and appreciative patients are less likely to complain and are less likely to sue, even when mistakes occur!



What people are looking for when they complain?


1. OUTLET - letting off steam, feeling respected and being taken seriously

2. APOLOGY - this doesn't have to be an admission of fault. You can say sorry in different ways as long as it is sincere

3. EXPLANATION - but only if this is what the patient wants. Lots of explanations may sound like excuses!

4. REMEDY - only the patient knows what will put things right in their eyes, so ask!

5. REDRESS - compensation does not always have to be monetary

6. RETRIBUTION - settling the scores


What makes some people want to take things further?

The best place to resolve issues is in practice but some patients, less than 3%, want to escalate things either to the GDC or to submit a negligence claim with their lawyers. 

Whether they will do this could depend on:
  • How much they like you
  • Whether they think you like them
  • Whether or not they think you care about them
  • Whether they trust you
  • How important or valued you make them feel
If you are unwilling to listen, appear rushed, are disinterested or lack concern you are more likely to be sued. 


Danger signs



According to a study by Dental Protection there are 6 danger factors that either alone or in combination seemed to be the strongest drivers behind a complaint:
  1. Pain
  2. Money - 'why should I pay, it's all your fault!'
  3. A sense of violation - 'I trusted you and you let me down'
  4. Interpersonal problems - falling out of some sort
  5. Dignity - dentist perceived to be arrogant or dismissive
  6. Consequences - 'I had a wedding to attend'


Ingredients of an effective in-house complaints system

Organisational culture and leadership

Issues should be addressed and problems sorted out before other parties become involved e.g. lawyers, GDC, Health Ombudsman, Dental Complaint Service. 
We can learn valuable lessons from complaints and identify problems in our practice. Ultimately we can rebuild stronger relationships with our patients. 

Management, systems and processes

Complaints need to be well designed and operated by the right people with the correct skills although this doesn't necessarily mean the most senior person in the practice. 
The system needs to be accessible, fair, simple, non-threatening, confidential, speedy, flexible and promotes improvement. 

Top Tips for Complaints Handlers

1. Keep your cool

Stay calm and professional, demonstrate your concern, give the patient choices and follow up after a resolution has been achieved.

2. Use the 'Sad but Glad' technique

e.g. I am sorry you are unhappy but I am glad that you told me. 

3. Don't be afraid to ask what you can do to put things right!

The sooner you find this out, the sooner you can resolve the situation. Even if you don't think you can give them what you want, you can at least start thinking about what you can offer them in order to move towards a solution. 

DO NOT:

  • Blame the patient - this will escalate the patient's dissatisfaction
  • Pick a fight - resolving a complaint is not the same as winning an argument
  • Ignore complaints - they will not go away and patients will view this as a sign of disrespect


As I have discussed in my previous post, 'How to avoid being sued before the time you hit 30...', litigation is exceptionally high in this country so it is essential to have an effective in-house complaints procedure and make sure that patients are aware of them. It is a GDC standard to make sure patients have a clear way to complain. If patients are unaware your complaints procedure, the next thing they'll do is turn to Google and the GDC - something we would all like to steer clear of!


Are you aware of your own practice's complaints procedure? Have you received a complaint? Please leave you experiences in the comments section below!


Thursday, 19 February 2015

Nina Conti: In Your Face

Time for a light-hearted review: 

Unusual for a school night, last week I went to see Nina Conti perform at the Tricycle Theate in Kilburn. 


My boyfriend and I had spent one evening some time last year watching compilations of her performances on Youtube having seen her perform on Live at the Apollo on TV.

Nina has been doing performances quite a bit throughout London recently - Kilburn was a bit more a trek than usual but the Tricycle Theatre is a really intimate and quirky location for stand-up. We had really good seats too!

She was really confident and charismatic, she wasn't phased even by the most awkward or uncooperative of audience members! The act was only around an hour long but it felt much longer and was probably of a good length as it didn't drag at all - perhaps if it went on for longer we would've gotten a bit bored.

Unlike traditional ventriloquists, Nina doesn't just work with a hand puppet - she asks audience members to come up on stage and gets them to wear a face mask with a movable mouth so that she speaks for them. This did lead to a bit of an awkward situation where a particularly boisterous member of the audience suddenly decided he wasn't going to cooperate on stage, but Nina handled it well and we were still in fits of laughter!

I have a feeling that 'Monk' her monkey puppet, is the voice in her head which announces the elephant in the room...like acknowledging that he doesn't exist or that he can't talk without her! Her act may not be to everyone's taste but I still think it's downright funny and also pretty clever!

To see when she's next performing take a look at her website

Have you seen Nina Conti perform? What do you think of her act? Leave your comments in the section below!



Tuesday, 17 February 2015

FGDP Open Day 2015

It's been a busy past week! I had a great opportunity not only for some dental learning, but also to catch up with some old friends at the FGDP's Foundation Dentist Open Day at the Royal College of Surgeons.

The Royal College of Surgeons in London


The various talks throughout the day covered the popular topics that come up again and again in Dentistry nowadays and gave us an insight into where a career in Dentistry may be heading for us in the next 30 or 40 years.

Whilst nothing will beat being there on the day, here I shall summarise some of the main points from the talks that were held throughout the day. 


What kind of Dentist would you like to be?


A very important question - but most young dentists I ask find it difficult to come up with an answer. 

Lawrence Mudford spoke about how important is not to get complacent during your career and fall into the trap of just coasting along. 

Patients are changing - gone are the days of full clearances as wedding gifts. People are retaining their natural teeth for longer, so gradually older patients are requiring more care - especially in terms of periodontal disease and also more recently, peri-implantitis. 

As a profession we have to adjust to this change in patient needs. Complete denture construction may soon be a specialist treatment and there must be provisions to allow for domiciliary care for the elderly. 

As long as we are ready to adapt and continue our life-long learning we can not only survive, but thrive in this new era of dentistry. 


Aesthetics in Dentistry


So what's the difference between aesthetic and cosmetic dentistry?

So there is a general view that aesthetics are concerned with beauty but implies restoring teeth to their natural appearance, whereas cosmetic is improving their colour, shape or arrangement to look better in the eyes of a patient. 
However, according to Mike Mulachy and the Royal College of Surgeons, there is no difference between aesthetic and cosmetic. 

There has been an increase in interest in aesthetic dentistry recently and especially in the provision of Botox and dermal fillers in light of the Keough Report which investigated the PIP breast implant scandal. 

Currently, injectable fillers can be provided not only by Doctors, Dentists and Nurses, but also by Beauty Therapists as long as they have appropriate training. Botox and Fillers are Prescription Only Medicines (POM), although there can be lots of different types of filler and some may be unregulated. 

Beauty therapists however are not trained to deal with anaphylaxis and cannot stock Epipens in their salons as they are also POMs. This could lead to some issues in the future. 

There is also the issue as to whether these treatments should be available under the NHS. There has been outrage recently with news breaking of some women who have had breast implants on the NHS - this is clearly a sensitive issue with some people, especially with the austerity measures going on with government at the moment. 

Harry Singh is holding a webinar in the next few weeks speaking about Botox in Dentistry - keep an eye out for a blog post summarising the talk.


Oral Surgery


A big source of fear for some young dentists, especially FDs new to practice life. Richard Moore spoke of how many inappropriate referrals he receives as an oral surgeon and helped us to understand what kind of cases we should be able to manage ourselves.

80% of patients who require oral surgery of some form or the other can receive their treatment in primary care. There are specialists out in practice with NHS contracts to provide treatment, so it isn't always necessary to refer patients to a hospital setting.

So what sort of things should I be referring to an oral surgeon?

That can depend on your experience! Some common reasons to refer include symptomatic wisdom teeth, cysts, complicated medical histories, anxious patients and bariatric patients. 

Other reasons for referrals can happen as a result of complications during surgery in primary care, such as failed extractions, OAC/OAF, tuberosity fracture, displacement of fragments into the antrum. 

To see more about oral surgery see one of my previous posts here


Minimally Invasive Restorative Dentistry


There is a shift in the way we manage disease in dentistry: from the Drill and Fill era, to the Minimally Invasive approach.

I spoke about a talk about MI dentistry led by Professor Banerjee here - but MI dentistry isn't exclusively driven by caries management. 

With the popularity and uses of adhesive dentistry, namely composite (see a previous post about composites here) exploding in the past few years, the provision of destructive aesthetic solutions such as porcelain veneers or crowns is becoming frowned upon by some dentists like Nicholas Lewis who spoke to us about restorative dentistry. 

Materials such as Mineral Trioxide Aggregate (MTA) and Biodentine have the potential to revolutionise pulp therapy, and the introduction of high fluoride products and compounds such as ACP are now routinely prescribed to help prevent and manage disease.

So whilst the implant industrious is booming, there is still no replacement for a healthy natural tooth. It has been shown that 15-20% of implants will suffer from peri-implantitis within 10 years. 


Complaints


I saved the best til last - and if you are a regular reader of my blog, you will know I have recently written the memorably named 'How to Avoid being Sued before you hit 30'

The main message that I've taken from both of these talks by Dental Protection representatives (here it was Jane Merivale) is that complaints can arise from simple misunderstandings and poor communication therefore it is imperative that dentists learn not only how to handle a complaint, but to minimise their risk of complaints by working on their communication skills and identifying 'red flag' encounters early! 
See my summary of Jane's talk here





FGDP also hold lots of postgraduate courses to help you make the most out of your career in dentistry. I think it's really important to look into some form of postgraduate qualification, not only due to the today's competitive job market, but dentistry is developing and changing so much even in the few years since I first went to Dental School so it's really important to keep up-to-date with what's going on!

Thanks to FGDP, the Royal College of Surgeons and to all the speakers for such an informative day!

To have a look at what courses FGDP provide, take a look at their website


Did you attend the open day? Which talk did you like the best? Please leave your comments below!




Thursday, 12 February 2015

How to Avoid Being Sued Before you hit 30...

Newly qualified Dentists like myself are facing some shocking statistsics nowadays: in a recent talk by Raj Rattan we were told that we will be faced with litigation a mere 8 times on average! That's around once every 5 years throughout our career!

The UK now has the second highest litigation against Dentists, overtaking America and only just being beaten by Iran! 

Recently, I attended a day of workshops run by Dental Protection in managing risk and minimising the likelihood of being sued. They run a series of 4 workshops which focus on:
  1. Mastering Risk
  2. Mastering Adverse Outcomes
  3. Mastering Difficult Interactions
  4. Mastering Consent 
Here is a brief summary of some of the ways to help minimise your risk of litigation. See another post about 'Why people complain.'


What makes an interaction difficult?


Difficult situations may arise from interactions of the following 3 factors:
  1. Patients e.g. demanding, unrealistic expectations, anxiety, language barriers, financial situations, medical history etc.
  2. Environmental e.g. time pressures, lack of or faulty equipment, NHS dentistry? 
  3. The Dental team e.g. poor communication between members of the team, lack of skill, poor teamwork, personal problems
We then can alter the way we communicate if we perceive a situation to be difficult such as in non-verbal signals and greetings.

How can I deal with difficult interactions?


Choose an emotionally intelligent response!
  1. Recognise and diagnose the difficulty of the situation - 'We're having difficulty agreeing on what course of treatment to take aren't we?'
  2. Support the patient e.g. active listening and empathy, as well as using tension skills e.g. acknowledging the problem and stating your boundaries
  3. AID model  
Acknowledge the patient's position
Inform them about your position
Discuss a way forward


What if things don't get resolved?


Sometimes when you are unable to come to an immediate solution with a patient. In these cases:
  • Ensure expectations are realistic
  • Talk to trusted colleagues 
  • Time a time out
  • Identify, develop and use support systems e.g. Indemnity provider

Why do you need consent?


Consent in dentistry is essential but can be a bit of a grey area. Consent is defined as:

 'permission for something to happen or agreement to do something'.

In order for consent to be valid, a patient must have:
  1. Autonomy i.e. make the decision for themselves
  2. Capacity i.e. understand and assimilate information in order to make a decision which they can communicate
  3. Adequate information i.e. risks, benefits, costs of treatments as well as the consequences of doing nothing
If you do not obtain valid consent, any treatment you provide may be seen as battery and you could be deemed negligent by the General Dental Council if they get wind of it!


What is Shared Decision Making?


I briefly mentioned this before in my EBD post, but coming to a decision and involving the patient in this process helps establish trust, you can also check patient understanding as well as learning about their values. 

70% of litigation is related to poor communication from the dentist and patients often prefer a collaborative role, so by using a shared decision making approach you can increase patient satisfaction and reduce the risk of litigation. 

But what would you do?

A lot of patients ask this and it may seem that your shared decision making approach has failed but a lot of patients are overwhelmed with the treatment options you give them and so reiterating the choices or rephrasing the way you answer can facilitate their own choice for example:

'It sounds like you really don't like the idea of having a tooth taken out, so if I were you, with your values and feelings, I might choose to have a root canal treatment over an extraction.'

If they really don't state a preference and want to go with your recommendation, then always document this on their notes!

The set up for the workshop

Sorry that the title of this post is rather pessimistic, I'm not usually one for propagating the negativity that is spreading through our profession like the plague, but figures don't lie and gone are the days where there was only a 1 in 3 chance of getting sued!

Minimising the risk of complaints is a vital skill we all need to acquire as well as learning how to handle complaints locally if they arise so things don't escalate any further!

Thanks to Dental Protection and Daniel Shaffer for running these educational workshops - I would highly recommend them to all dentists, but especially to Foundation Dentists like me!


Have you attended one of these workshops by Dental Protection? Please leave any comments or thoughts below! 


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Sources:

'Mastering Consent and Shared Decision Making' Medical Protection Society and Dental Protection Limited 2013

'Mastering Difficult Interactions' Medical Protection Society and Dental Protection Limited 2012

Monday, 9 February 2015

London Theatre Guide: Miss Saigon

It's been a while since I last wrote a London Living post - so let's have a little break from dentistry!



Last weekend my mum came down to visit as I had promised her tickets to see the musical Miss Saigon for her Christmas present.

We saw this musical about 10 years ago when it was on tour in Nottingham but I have found that touring companies are slightly less polished than when a play or musical is performed in a more permanent venue. 

I swear theatre tickets used to be cheaper than they are nowadays and it has been a while since I went to the theatre, certainly in London (I think it must have been the Curious Incident of the Dog in the Night time back in 2013). But I found out a way I could get discounted tickets.

Some theatres have day tickets or stand-by tickets which you can only buy on the day of the performance and they only usually have a limited number available. I managed to get to the theatre half an hour before the box office opened in the morning but there was already a substantial queue outside! Luckily I was able to get two very good tickets at the bargain price of £20 each - the downside being we couldn't sit directly next to each other. 

You'd probably have to get to the theatre pretty early in the morning on a Saturday to get tickets sitting together!

The view of the stage from where I was sitting

The story is set during the Vietnam war and tells of a love story between a Vietnamese bargirl called Kim and an American GI called Chris whose relationship is torn apart by the American withdrawal from Vietnam during the fall of Saigon in 1975.

We were not disappointed with the London performance. The opening brothel scene is one of my favourites and is really effective, making you feel awkward and uncomfortable with the exploitation of the young women of Vietnam during the war. 

The scene both me and mum were really looking forward to was the helicopter scene - having been disappointed with the flat projection of the helicopter 10 years ago we were blown away when the back wall opened up and real-life helicopter pod emerged! 

I would definitely recommend Miss Saigon if you're looking for an exciting, thought-provoking and sometimes emotional west end show to see in London! Let's just say mum was in tears when I found her after the curtain went down!

To find out more see the Miss Saigon website.


Have you seen Miss Saigon? Would you recommend it? What are your thoughts about the show? Please leave your comments in the section below!



Saturday, 7 February 2015

#Tubuleslive Event: CEREC Integration in Practice

This week's #Tubuleslive event was hosted by yours truely, and was led by Colin Campbell, a really inspirational figure in the profession. 
His talk was on how he integrated CEREC into one of his practices and here I shall summarise his main points. 

A CEREC designed and milled Emax crown on the lower first molar.

Colin Campbell is a specialist oral surgeon who is mainly interesting in implant dentistry. He has introduced the CEREC system into one of his practice and integrated it with his CBCT system (Sirona) which has resulted in more predictable outcomes for patients and ultimately benefited the team and practice as a result of improving patient care and also patient satisfaction.

  • CAD/CAM has many applications in patient care: from CBCT scanning to the production of surgical guides and provisional restorations as well the final definitive restoration
  • CEREC can be used conventionally to manufacture restorative extra-coronal restorations such as inlays, onlays and full coverage crowns. 
  • These restorations are made on the same day, which means that there is no need for a provisional restoration and there is only one visit for the patient - this often increases patient satisfaction as they can watch the milling of their restoration sitting in the waiting room
  • CEREC alongside CBCT scanning can be used in the diagnosis and planning of treatments and can be useful to help explain to patients their situation as a 3D image of their teeth and their surrounding anatomy can be generated.
  • This 3D image gives a better diagnosis than conventional 2D imaging as you can accurately diagnose fractures, qualities of root fillings, periapical areas, the amount and quality of the surrounding bone and proximity to vital structures e.g. ID canal
  • All the team can be involved in the diagnosis and planning stages of a patient's visit - appropriately qualified nurses and technicians can take the scans and place implants in the correct place on the scan. This can lead to more efficient use of a clinician's time
  • Provisional restorations can be milled from composite blocks based on these planning stages to help plan the emergence profile of the restorations, shape the soft tissues as well as help the patient understand what the final restoration may look like
  • CEREC can then be used to scan preps or the implant (either at the same stage as the surgery or delayed) so there is no need for impression taking
  • Definite materials for implant crowns include Zirconia and Emax. Emax crowns can be milled in 12-13 minutes!
  • If there are any issues with the provisional or definitive restorations, data has been stored electronically so re-milling is easy and there is no loss of information which can happen with an analogue system. 
  • In order to introduce a CEREC or CBCT system into practice, you will have to invest quite a lot of money both in the equipment but also in yourself in terms of training. 
  • These systems, despite the high initial outlay can help increase your turnover as you are not only providing a better quality of care for your patients, you can actually save a lot of clinical time so you can ultimately see more patients!
I hope this short summary has enthused some of you to learn more about CEREC and CAD/CAM which will probably be the future of dentistry. Thanks to Colin for a great talk and making my first hosting for #TubulesLive such an enjoyable experience!


The next #Tubuleslive event will be next week the 19th of February: CBCT in practice with Andrew Legg

Why not attend the live audience where you can get FREE CPD! Register online and if you're wondering how #Tubuleslive is set up, check out this timelapse from the set up at this event.




Do you use CEREC in practice? Or are you considering doing so? Please comment in the section below!

To see my other posts about previous #TubulesLive events see here 



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