On Friday 3rd March 2017, I attended the ADI Team Congress Event at the ExCel London. It was a really great day!

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There was a special programme for dental students at the amazingly low price of Β£25 – which proved to be incredible value for money.

Before I write any more, let me clarify:

ADI = Association of Dental Implantology

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So as an undergraduate dental student in the UK, we unfortunately have very limited teaching on dental implantology within the BDS curriculum. It is a shame, because dental implants are a rapidly growing scope of practice for dental surgeons yet we graduate after five years of training with minimal knowledge of implants: how to place them, how to maintain them, how to restore onto them, when to suggest them as the best treatment option etc.

I can’t say that I know exactly what kind of dentistry I want to be practicing when I qualify in 2020, but I definitely have a good idea of how I’d like my professional career to progress and being able to place dental implants for my patients is certainly something I want to be able to offer!

The ADI is a fantastic non-profit dental association we have here in the UK. If you, like me are very interested in learning about dental implants then you need to download this (see blow) FREE 40 page document they have created and share online. It is a beautiful e-booklet about implants.

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Download this from their website

I’ll be more specific about my dream dental career in a future post! Watch this space πŸ™‚

The dental undergraduate education programme varies all over the world – so I must stress that I am writing from my own experience as a dental student training in the UK. If you’re a dental student in the United States for example, I am aware that you have more teaching on dental implants and based on what I know from my US dental student friends from Instagram, I know that some undergraduates actually place implants!!

Having said all that, dentistry is evolving rapidly with the advent of the the digital age which is creeping more and more into how we do dentistry. It’s a very exciting time to be a trainee dentist and I am certain that in the not to distant future, the dental undergraduate programmes here in the UK will invest more time into teaching about dental implants!

I hear this all the time:

A lot of dentistry today will be out-dated in 5/10 years time!

Dentistry is evolving and we as dental care professionals will always need to keep up with the most recent advancements in order to do best by our patients.

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I don’t want to write too much about Dental Implants as such in this post, I will leave that for another post I am planning to write in the near future. This feature post is intended for me to share my experiences from the ADI Student Congress Day so I can tell you all what I learnt and what I got to do in the hands-on sessions! πŸ™‚

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So let me tell you about the day…

As I mentioned before, it cost me Β£25 in total. And when you read about what I learnt, what I got to do in the hands-on practicals and how well they fed me – you’ll understand that I got one hell of a good deal!

The event took place at the ExCel Arena in London, which is located right next to London City Airport.

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The Student Congress day was on a Friday, and luckily for me I had the day off.

How did I find out about the event?

A while ago, I decided to make the most of the perks on offer for dental STUDENTS and signed up to be a member for all sorts of different national dental communities, one of which was the ADI which offers FREE STUDENT MEMBERSHIP – it’s really a no-brainer, if you are a dorky dental student like me – you simply have to take advantage and do the same.

As a member of the ADI, I get a regular newsletter emailed to me with updates about their events. I noticed that they were advertising this day which had a specific programme tailored for students, and I immediately was drawn in. So I went to their website and saw the programme breakdown – it look great! But…tickets were Β£100. That for me was a bit too expensive, so initially I didn’t book on, but then a few weeks later I got another email from the ADI saying they had slashed the ticket price to Β£25 if you use a certain code when ‘checking out’ – I booked on that same day.

When I booked on, I did it solo (#billynomates). I knew that most of my pals wouldn’t be interested in spending money to use their day off to learn about dentistry – not everyone is as keen as me! Especially since I’m still only a second year! But fortunately, I wasn’t the only attendee there from my dental school. In total I’d say there were roughly 45 attending dental students, 8 of whom were also from Barts and The London (6 fourth years, 2 third years and me).

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The Full Conference Brochure – a hefty 60 page booklet!

The Student Congress day was one part of the three-day programme which made up the full ADI Congress, which was a sort of international conference attracting dental professionals (mainly those who place implants). So basically our Student event was a small part of the bigger conference. I really liked it how they made an effort to organise a specific programme for undergraduates – well played ADI πŸ™‚

I got a copy of the full conference brochure, which had a breakdown of all the speakers on all three days – looking through it, it was really nice to see that it wasn’t just dentists giving talks. They also had a dedicated list of speakers who were: Radiologists (talking about CBCT), Technicians, Nurses and Practice Managers, Hygienists and Therapists. It’s great to see an appreciation for the wider team, instead of focussing solely on what the dentists have to say!

As part of the conference, they had a huge trade fayre populated by stalls for various dental companies, mainly those that offer services/products specifically used with dental implants.

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The Trade Fayre from above

I arrived at the ExCel at 9am, and the Student Congress wasn’t due to start till 9:30am – so I had half an hour to explore the trade fayre.

As soon as I collected my conference pass, they gave me a complimentary ADI branded black backpack – a great freebie which I used throughout the day to store all the other freebies I amassed!

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Does anyone want a free backpack? I appreciated having this on the day but there’s no chance you’ll see me cruising through London carrying this

The trade fayre was huge so I didn’t get to go all the way around in the morning, especially since I got distracted by the free breakfast they were offering! If only I had known there’d be loads of complimentary food – I wouldn’t have had porridge at home…

Anyway, whilst walking through the trade fayre, I stumbled across a stall that was showcasing their own dental implants kit and invited me over to come and try it all out. Their assumption was that I was a dentist but as I approached, they saw my badge and realised I was still just a baby student…Nonetheless, they patiently showed me how to place an implant using their handpiece and even explained how it all works. That was the first implant I’ve ever placed…in bovine tibia bone, which is cow bone!! (see pictures below)

The early bird catches the worm

I was their first visitor of the day so I was the first person to screw an implant into that bone πŸ™‚

 

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So after grabbing myself a few breakfast flapjacks I went up to the theatre space where the morning talks were happening.

The programme for the morning was a series of back-to-back talks, all delivered by UK based dentists who have placed so many implants lets just call them well-established ‘implantologists’.

Here’s a list of the speakers for the Student Programme and their talk topics:

  • Aly Virani – BDS (Hons) MJDF RCS (Eng)
    • Implant Dentistry: How Did We Get Here and Why Do We Keep Going?
  • Pynadath George – BDS MFDS RCPS DRDP MSc Rest Dent PGDip MSc Imp Dent
    • Dental Implant Training: Where, How, Diploma/Msc and the GDC
  • Samantha Pugh BDS (Hons) MFDS RCS MSC (Hons)
    • An Overview Of Implant Planning: From Consultation to Placement
  • Nilesh Parmar BDS (Lond) MSc (Prosth Dent) MSc (Imp Dent) MBA
    • Impressions and Implant Restoration
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The introduction speech before the morning talks started

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Here are some randomly ordered notes I made whilst listening to Dr Aly Virani…

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Dr Virani placed his first implants during his VT training year under the close supervision and mentorship of his trainer – this is very rare as usually a dentist needs at least a few years of experience after graduating before they would be competent and comfortable in placing an implant!

His talk was very much focussed around the modern age of dental implantology…

He mentioned the power of social media within dentistry for educational purposes, specifically mentioning the Dental Roots: Connecting Dentists and Dental Students Facebook Page. It might not provide Evidence Based Dentistry but through social media there is a lot of potential to learn more about various aspects of dentistry and offers different people’s opinions.

One thing he discussed which I really liked hearing was how when it comes to dental implants he doesn’t like to use the word “fail”, instead he prefers to say there were “complications”.

He referred to Professor Branemark who is considered “The Father of Modern Dental Implantology” who worked on researching the osseointergration of implants in the alveolar bone.

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Prof Per-Ingvar Branemark: Look at that bow tie!

Modern dental implants have many kinds of surface modifications that offer numbers benefits, such as:

  • Helping to accelerate the osseointegration process
  • Allowing for shorter implants to be used (due to the implants being made to have a bigger surface area for osseointegration)
  • Tooth restorations can now be added ~6 weeks post implant placement

With regards to abutments, there is now the possibility of using custom abutments (as well as stock abutments). The final result in terms of the restorations is no longer limited by a properly aligned implant, since we can use angled abutments and angled screwed implants used specifically to avoid the sinus.

Another thing that really amazes me is how dental implantology has benefitted from advancements in Digital Dentistry as we can now create surgical stents to help us with guided implant placements.

In the past, dental implants used to be quite unsightly but composite can now be used to fill the screw hole of an implant retained crown.

A DR VIRANI TOP TIP: make sure you work with a good dental lab, they are so important for helping you to ensure the final result is great for the patient.

With digital cases, it is so important to start from the end point (think about the final result) and then work backwards. So this would mean planning the crown before you even place the implant!

He asked a few rhetorical questions to us in the audience (FYI we were all young students!):

  • How many of you would want to have healthy teeth prepared down for a bridge?
  • How many of you would wear a denture?

 

Advice for examining a patient with implants: when probing around the implants, worry about bleeding, don’t worry so much about the specific probing depth.

Peri-Implantitis: bone loss around the implant

Peri-Mucositis: soft tissue inflammation around the implant

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Here are some randomly ordered notes I made whilst listening to Dr Pynadath George (PG)…

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Dr PG talked a lot about the importance of having a good mentor when starting your own ‘implants journey’.

The ADI’s definition of a MENTOR =

  • Someone with at least 5 years of experience with placing implants
  • Someone who has placed at least 250 implants
  • Someone with a postgraduate qualification or >70 hours of CPD related to implants

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PG referred to Miller’s Prism of Clinical Competence

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He spent some time addressing a question on many people’s mind:

Which dental specialty would implants be most appropriately categorised under?

Dental implants are associated with all the dental specialties and so would most accurately be attached with all of them: periodontology, restorative, prosthodontics, oral surgery and also endodontics!

If you ask a periodontist, they’d probably tell you that implants should be thought of under the perio umbrella; ask an oral surgeon the same question and they’d say implants ought to be thought of as part of their surgical specialty etc etc.

But if we think about which dental professionals are the most likely clinicians to be placing implants, it would be General Dental Practitioners (GDPs).

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Here are some randomly ordered notes I made whilst listening to Dr Sam Pugh…

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Dr Pugh talked through the “basics” – she went through the treatment planning process you would take (as with any dental procedure) but throughout made specific reference to areas of significance with regards to dental implant planning.

It is important to establish the GINGIVAL BIOTYPE the patient has – especially if planning to place an implant in the aesthetic zone (replacing a lost anterior tooth).

Patient’s can have either a THICK or a THIN gingival biotype.

A thick gingival biotype versus a thin gingival biotype is determined by:

  • More keratinised tissue
  • Thicker alveolar bone
  • Shorter papilla (thin biotype has long scalloped papilla)
  • More resistant to inflammation

A nice simple way to decide on a patient’s biotype is to place a blunt-ended probe (BPE/Williams) into a pocket and if you can easily see the silver probe through the gingiva then the patient most likely has a thin biotype.

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We must always remember that unlike a tooth, implants DO NOT HAVE A PERIODONTAL LIGAMENT (PDL) and therefore the forces applied onto an implant restoration are very important to consider – so we must always thoroughly check the occlusion.

The CROWN:IMPLANT ratio is very important.

SIZE DIMENSIONS:Β When placing the implant in a gap, there are ideal size dimensions that should be aimed for

  • The ideal bucco-lingual/bucco-palatal width of alveolar bone should be 7mm.
  • The ideal mesio-distal width around the implant should be 7mm.
  • There needs to be a minimum of 1.5mm around the implant.

We must always aim to spare the dental papilla when making a surgical incision, this is hugely important when thinking about the aesthetics of the final restoration – so the first incision must be made paracrestally.

Pathway when placing an implant is as follows:

  • Pilot Drill
  • Directional Indicator used repeatedly
  • Radiographs taken continuously to monitor the depth of the implant and its location with regards to other adjacent anatomies
  • Progressively wider drills are used

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Here are some randomly ordered notes I made whilst listening to Dr Nilesh Parmar…

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Dr Nilesh gave the final talk of the morning session and his topic was to discuss the impressions that can be taken when restoring implants.

There are two kinds of impressions that can be taken: open or closed. The general consensus as I understood was that it doesn’t make much of a difference as to which type you choose to take…

It is so important to take a good impression in order to ensure that the lab is able to create a crown which will fit properly and complete the restoration. You also need to remember to take an alginate impression of the opposing arch so that the lab can match the restoration to the patient’s occlusion.

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Dr Parmar made some interesting additional points aside from his presentation title which struck a cord with me:

  • Of the ~45,000 practicing dentists in the UK, only a small proportion of these individuals actually place implants (~8,000 dentists).
  • Despite what studies suggest is the average longevity of a dental implant once placed, there are many examples of patients who have had implants retained successfully for 15-20 years (and counting)

He also really beautiful put into perspective how amazing dental implants are. When we think about modern medicine, there are various parts of the human anatomy that can now be replaced by prostheses. If we think about limbs for example: a person missing a limb, lets say a leg, can have a prosthetic leg attached, but the current prostheses available do not completely mimic the anatomy of an actual leg! Whereas if we consider dental implants, they are the most accurately ‘biomimetic’ form of a medical prosthetic we have available today. You can place an implant to replace a central incisor and if done properly, it can look exactly like the adjacent natural incisor making it almost impossible to identify to a third person!!! When you think about dental implants like this, they are truly amazing and game changing with regards to modern dentistry.

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So…those are all the random notes I made from the day! If you managed to survive reading through it all then I guess you know how much I learnt – it was a great morning jam-packed full of information directed at undergraduate dental students.

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After the morning talks, we went down to the main trade fayre room where lunch was served. It was a buffet service and the food was amazing. Definitely value for money (Β£25 for everything).

I had another look around all the stalls at the trade fayre at this stage and checked out some of the implant kits on offer.

One exhibitor didn’t seem to understand that I was just a student, he kept trying to sell me one of his implant kits and was insisting it was brilliant value for money at the “low” price of Β£1800… #facepalm

I was really impressed by one stall in particular, who got me to put on a pair of VR goggles (VR = virtual reality). As soon as you put the VR goggles on, I was transported into an oral surgery clinic stood right beside a dentist as he was placing an implant! The exhibitor told me that he believes in the not-too-distant future we will be teaching/learning oral surgery techniques such as implant placement by giving students VR scenarios to watch.

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Once I’d filled my belly – it was back up to start the afternoon hands-on sessions.

There were two hands-on rotations; we got to do both of them. It was great that the speakers from the morning were there leading the sessions, and since the groups were split out we had small-group teaching with them essentially.

hands-on session #1

The first session was led by Dr Nilesh Parmar and Dr Sam Pugh

We used study models to take both open and closed tray impressions for implants using putty and wash.

We then got to place a couple of implants into the study models.

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It was awesome – how many second year dental students can say they’ve had such early exposure to using the technology to place dental implants?!

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hands-on session #2

The second session was led by Dr Pynadath George.

In this workshop, we had a pig’s jaw and used it to do some Guided Bone Regeneration (GBR). We used a bur to make a hole in the pig’s jaw, and then used bovine bone chips to fill the hole.

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We had to mix the bone chips with a saline solution, and then used a mini syringe to pack the particles into the hole. In reality, this is done in implant surgery when there is insufficient alveolar bone levels where the implant will be placed. Once the bone particles were packed, we were shown how to suture the ‘wound’, specifically using a simple interrupted technique – again that for me was a first!

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The Simple Interrupted Suture Technique

So anyway, that was it – apologies for the random stop-start flow to this post. I hope you enjoyed reading through this post and perhaps you learnt something?

If you’re a UK based dental student and are also interested in learning more about dental implants then I would highly recommend you go along to the ADI Young Dentist day in September 2017.

They are selling tickets online already for Β£45 – definitely worth it!

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Especially since there will be two extra speakers who weren’t there at the Student Congress Day I went to – I wish I would have been able to have the talk that Dr Zaki Kanaan will be delivering!

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Here’s the line up of speakers:

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The cheeky marketing team for the ADI took a photo of me and are using it to promote this day!

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That’s me pictured top right

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Thanks for reading – please let me know what you thought of this car-crash post!

FINAL THOUGHTSΒ 

I would like to finish off with one important message to bear in mind – especially for those prospective/current students or junior dentists:

While it is great to have early learning and exposure to dental implantology. It is very much a complex dental realm and there is a reason why undergraduate dental students have limited experience with them.

If like me you are a dental student, you’ve got to always stay grounded and “not try to run before you can walk”. Advice from dentists (including many YOUNG dentists who now place implants) is that before beginning to take steps to incorporate dental implants into your scope of practice, you must first master the ‘basics’.

What do I mean by ‘mastering the basics’? Essentially this means, being really confident with going through the process of screening a patient through to planning their treatment and executing a successful care plan for them. Master how to manage even the simple perio problems (eg. plaque-induced gingivitis), master how to give oral hygiene advice, master how to extract problem wisdom teeth and give the proper after care, master how to do surgical extractions, master how to restore a tooth to bring back balance to the patient’s smile whilst harmonising the restoration with their existing occlusion. Don’t try to run, before you can walk damn well.

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I sometimes lose track of my own advice and get ahead of myself, so we need constant reminders to go through the dental journey step-by-step. I’m only a second year student!!! I haven’t even extracted a single tooth yet, I haven’t even filled one cavity on a real patient yet!!!

But that doesn’t mean I can’t dip my toes in the dental implants lake and see what the water temperature is like right?! πŸ˜‰

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