The Fall Scientific Seminar
Friday November 13th 2015
For a synopsis of the lectures click the link, or scroll down.
Dr. Effie Habsha, DDS, Dip, Prosth
Dr. Michael R. Norton, BDS, FCS, RCS
THE PRESIDENTS ADDRESS
Let me welcome you all to our Fall Scientific Meeting. We’ve had a great morning and I’m sure the afternoon will be equally engaging. I’d like to take this opportunity to bring our membership up to speed on recent changes with our organization.
Of particular note, we have established a new web site, which is informative and user friendly to both our membership and visitors. This new site will also give us a strong social media presence, provide timely meeting updates, and allow for on-line registration and dues payments. Special thanks goes to Dr David Gardner , Steve Pigliacelli, and Justin Hayes, who worked tirelessly to get the new site on-line for our Fall meeting.
In keeping pace with evolving technologies, our membership will now be receiving their JPD issues via email and PDF. This will give us greater control over escalating costs and give you access to information in a more efficient format. Thanks goes to Carol Bensky for facilitating this transition.
The question I would like to pose today is, how do you keep excited about your job?
The practice of dentistry is a marathon, not a sprint. And while we all get out of the gate strong, what keeps you going and maintains your drive? Three “C’s” sum it up for me: Contributing, Connecting, and Collaborating.
Contributing to a greater mission: Every effort we make in our professional lives improves the lives of not only our patients, but those of our co-workers, employees, and their families- as well as our own. Don’t loose sight of this fact- you each have a tremendous impact on the people that surround you. It’s a powerful position of responsibility, that should give you great satisfaction.
Connecting with colleagues: Conferences and meetings, especially regional ones, like the NGS, will give you a great opportunity to get excited about new ideas, materials, and methods. Not only be exposed to them, but to share your thoughts with peers and get unbiased answers from other dental colleagues.
Finally, Collaboration: joining with fellow professionals, whether it’s as a faculty member shaping young minds or as an NGS board member, shaping the future of our organization. Getting involved will get you excited.
I hope that today’s program will recharge your professional passions and that you all come away with a sense of value for the NGS and the efforts of so many to make a day like this possible.
Thank you.
-Dr. Eric Gordon
SYNOPSIS OF THE DAYS EVENTS
“Sleep Bruxism and Putative Association to TMD and Sleep Apnea”
Speaker: Gilles Lavigne, DMD, PhD
As dental providers, our role in sleep medicine is to diagnose and manage patients with sleep bruxism. It is imperative that we, as clinicians, are able to assess and properly refer patients with sleep disorders and sleep-related breathing disorders to the appropriate dental and medical specialists. If the disorders are left untreated, these patients are at a risk for metabolic syndromes, increased upper airway collapsibility and possible mortality. Some criteria mentioned by Dr. Lavigne when screening patients with sleep bruxism are: “(1) Does the patient have a recent history of tooth grinding sounds that occur at least 3-5 nights per week? (2) Is there a presence of tooth wear?” If the answer to these questions are yes and a patient has sleep disordered breathing, appliances such as a CPAP or a mandibular advancement appliance can be fabricated and utilized.
Dr. Lavigne’s presentation was both informative and evidence-based. With a fundamental understanding of how to diagnose and treat or refer sleep bruxism and sleep disordered breathing, we have the ability to provide optimal care for our patients.
Synopsis written by Rebecca Sternberger, D.D.S., M.A., M.B.A.
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“The Implant Supported Overdenture – Going the Way of the Dinosaur???”
Speaker: Effie Habsha, DDS, Dip. Prostho MSc
Dr. Habsha presented the evolution of different treatment options for a fully edentulous patient,she summarized the indications and contraindications for implant-supported overdentures, and she reviewed the different attachment types.
Scientific data has proven that mastication efficiency and patient satisfaction has increased inimplant-supported overdentures compared to complete dentures. The main advantages of theoverdenture compared to a full-arch fixed implant-supported restoration is the additional lipsupport, easier access to clean the prosthesis, and decreased costs.
The design and use of different attachments is dictated by the amount, location and angulationof the implants, need for retention, patients’ manual dexterity, bone quality and quantity and theinterocclusal space available.
Overall Dr. Habsha has reminded us that implant-supported overdentures are still a viableoption for fully edentulous patients.
Synopsis written by Michèle Landolt, DMD, Prosthodontist
“Immediate Placement of Adjacent Implants in the Esthetic Zone”
Speaker: Michael R. Norton, BDS, FDS, RCS
Dr. Norton began his presentation by discussing that all implants are not created equally. He spent the first few minutes reviewing and apologetically debunking Dr. Tarnow’s classic literature on adjacent implants and the ‘3mm rule’ which states that adjacent implant must have a minimum of 3mm of space between them to prevent bone loss. He then followed with a brief discussion on ‘platform switching’ and why it is important to utilize an implant system that preserves crestal bone, eliminating the 3mm spacing requirement. The quandary which he then presented was why can you maintain crestal bone, or even bone above the heads of the adjacent implants, but still have inadequate soft tissue in the papilla area?
This lead to his statement ‘maintain don’t regain’ in terms of soft tissue around adjacent implants. Dr. Norton’s protocol for soft tissue preservation begins at the time of extraction of the tooth. It calls for staging the process – extract one tooth and place the immediate implant and provisional. He then allows 6-9 months for full soft tissue maturation and then extracts the adjacent tooth and places the immediate implant and provisional. He did note that in his own current research of the technique, he is still trying to ascertain what the most effective time frame in between surgical interventions is.
The protocol calls for the utilization of the extracted tooth, whenever possible, as the provisional to maintain the root form subgingivally. When creating the final custom abutment for the definitive restoration, a concave subgingival profile is necessary to enhance vascularity and allow for greater tissue volume.
Dr. Norton’s technique is a straightforward thought process which is clearly valid when taking into consideration the peer reviewed literature that was interspersed throughout his presentation.
Synopsis written byJason K. Sauer, D.D.S.
“Prosthetic Digital Advancement from Smile Design to Delivery”
Speaker: Lars Hansson, CDT
There were two central themes to the presentation. First, there was an exploration of modern materials and workflow protocols used in fabrication of dental restorations with particular emphasis on monolithic zirconium. Second, the importance of communication between the dentist and the laboratory and the use of advanced communications technologies were discussed.
Monolithic zirconium is a fairly new material used in restorative dentistry. The presenter compared this material to conventional materials such as acrylic, hybrid, and conus dentures used to create fixed and removable prostheses. Failures of dental materials are often attributed to poor communication between the dentist and the laboratory, and mishandling that takes place during clinical and laboratory protocols. Taking correct impressions and bite registration records also become even more crucial. Otherwise, mistakes become very costly for the clinicians and for the technician.
To minimize remakes, communication is the key. Current digital technologies allow the dentist and the laboratory for more frequent and detailed collaboration on cases. For example, patient photographs, videos, dental smile designs, Pano’s, and CT’s can be easily shared electronically. Using these records, the laboratory is in a better position to design and fabricate dental prostheses with proper tooth position and functions not available from simply mounting the models on the articulator. Ultimately, advanced communication options create better smiles, lasting restorations, and satisfied patients.
Based on my laboratory experiences and the knowledge of the Prosthodontic/ Dental Technology peer reviewed literature, the information presented in Lars Hansson’s lecture “Monolithic Zirconium: Restorative Workflow, Materials and Prosthetic Options” is valid.
Synopsis written by Renata Budny, MBA, MDT, CDT, FNGS
“Surgical versus Prosthetic Options to Achieve Ideal Tooth and Soft Tissue Form”
Speaker: Tal Morr, DMD, MSD
Dr. Morr presented a detailed review of concepts pertaining to the achievement of ideal soft tissue form. A systematic approach to pretreatment evaluation of a patient’s condition was discussed in order to develop a proper diagnosis and treatment modality within the appropriate biological, surgical, and prosthetic reality.
A review of the important factors that will lead to reaching patients’’ esthetic expectations such as adjacent teeth, biotype, residual ridge were presented. A realistic discussion of the limitations of surgical intervention as it relates to implants in the anterior region followed by a step-by-step sequence for the management of single and multiple missing teeth in the esthetic zone. A review of several soft tissue manipulation and maintenance procedures was illustrated. Finally a review of prosthetic options in lieu of surgical intervention was given in order to achieve acceptable soft tissue form.
Synopsis written by David M Gardner DDS
