Our case of the month for March 2022 is a true smile transformation in every sense of the word. In this case, we successfully corrected a complete reverse overjet or underbite using Invisalign Full. We then enhanced the overall aesthetics using a home whitening kit (Philips ZOOM) and bonding.
 

Article written by Beata Knysak for dentists, dental hygienists and therapists.

Periodontal disease is a major public health concern due to its high prevalence. According to the data severe periodontitis is the sixth-most prevalent condition in the world [1]. In the United Kingdom, 62% of adults under 40 years of age are affected by moderate periodontal disease [2] and throughout the Covid-19 pandemic we have seen an immense increase in the number of patients with periodontal tissue breakdown and tooth loss.

While there is an increase in life expectancy and a significant decrease in tooth loss, periodontal disease puts a burden on the national healthcare systems across the globe.

Although bacteria arising from plaque is the main aetiological factor of periodontal disease, the host’s immune inflammatory response is accountable for the majority of the destructive changes seen in periodontal tissues. Even in healthy periodontium, host immune cells are continuously present, supporting the balance between microbial plaque and the host [6]. Any interactions between the host and oral microbiota will either support the homeostasis or results in dysbiosis within the community of pathogenic microorganisms [7].

Periodontal health-associated commensals are vital in protecting this equilibrium by for example inhibiting the growth of periopathogenic microorganisms. However, quantitative and qualitative changes within subgingival plaque biofilm may lead to disturbed homeostasis, which subsequently leads to the onset of the periodontal disease with various degrees of periodontal tissue breakdown.

This is not a continuous process but alternates between a period of inactivity and aggravation and it can be affected by local and systemic factors [3&4]:

• Microbial plaque-biofilm burden
• Patient’s age, ethnicity, genetic predisposition and patient’s immune response
• Systemic diseases i.e., Diabetes Mellitus, Osteoporosis
• Tooth morphological factor: i.e., defective restoration, malocclusion, bulbous crowns and dental bridge that unbales the patient to perform an adequate oral hygiene routine
• Patient’s socio-economic factors i.e., education and access to dental care
• Life-style choices i.e., smoking, obesity, poor diet, stress, sleeping pattern,
• Deficiencies in patient’s oral hygiene routine.

If not treated, periodontal disease leads to connective tissue destruction and alveolar bone resorption that eventually results in tooth loss [5]. It negatively affects patient’s chewing function and aesthetics, it is a source of social inequality, and significantly impairs their quality of life.

The main objectives of non-surgical periodontal therapy (NSPT) are to provide the least invasive treatment that gives the patient the best and most predictable outcomes through the promotion of periodontal tissue regeneration and restoration of tooth function. After successful treatment, periodontal ligament (PDL) cells (fibroblasts) migrate and attach to the microorganism free root surface. They proliferate, differentiate and synthesise extracellular matrix proteins to form collagen fibres. It is crucial to obtain newly formed PDL to prevent apical migration of junctional epithelium and to allow regeneration of PDL, cementum and alveolar bone; therefore, the application of laser irradiation has been proposed to allow for the compatibility of root surfaces with regenerative processes.

An increasing number of studies have demonstrated the benefits of adjunctive laser therapy in conventional NSPT due to its reported ability to significantly reduce pathogens, promote healing and to suppress the inflammatory cytokine cascade through to surgical ablation of diseased tissues [8]. As a result of its deeper penetration, diode laser has not only had bactericidal effects but also bio-stimulatory effects on periodontal ligament stem cells, osteoblasts and fibroblasts [9]. The Erbium Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser, however, allows selective subgingival biofilm and calculus ablation without causing any thermal side effects (carbonisation) or morphologic changes to the root surface to allow the attachment of these cells [10]. Also, when compared with conventional hand instrumentation, Er,Cr:YSGG laser therapy was not only found to promote PDL fibroblast cell migration and attachment, but it also increased the number of cells that differentiate in periodontal regeneration [11,12,13].

Although in the treatment of periodontal disease, surgical interventions (with the use of osseous graft material, barrier membranes or application of a biologically active material) deem to have more predictable outcomes than conventional NSPT, they may however, possess multiple shortfalls including high cost, painful healing and post-operative complications. Also, with regard to the application of local or systemic antibiotic there are multiple side-effects including antibiotic resistance, gastrointestinal complications or drug interactions.
 

Article written by Dr Nissit Patel BDS MClinDent (Pros) 

I am often asked about various different dental treatments and one of them involves porcelain onlays. Most of my patients know about porcelain veneers but in general, porcelain onlays are not well known. I will attempt to explain the treatment in simple detail, with explanation on the procedure, what to expect, why they are beneficial and the fee scales involved.
 

Mouth cancer is on the rise in the UK with over 2,700 people dying from the disease last year. This is an increase of almost 50% compared to 10 years ago which is a huge increase. One of the main issues is that over 45% of all mouth cancers are diagnosed in the late stages which means that the survival rate is much lower than early diagnosis. Not only this, but treatment is often far less invasive when caught early on leading to a far higher quality of life. During each dental examination at Progressive Dentistry, we undertake a thorough analysis of mouth cancer but with check ups usually every 6 months, we are encouraging our patients to check their mouth once a month for signs of the dreadful disease.
 

After fitting your orthodontic appliance (brace), it is important to follow some simple but important instructions. We have also provided some useful information and advice regarding after care.
 

Our case of the month for February 2022 is one involving 2 dental implants to replace 3 missing back teeth. Dental implants are considered the gold standard to replace missing teeth but what are dental implants? Well, essentially implants are the replacements for the roots of the missing teeth. They provide the foundation to allow us to place new teeth on top. Simple? Not really! Dental implant treatment is complicated and requires a huge amount of training, experience and ongoing education. Of course, some cases are more complex than others but in general, here is our workflow from missing tooth to replacement:

1. Full case assessment and records including x rays and CBCT scans.

2. Diagnostic planning on digital software.

3. Manufacture of surgical stent.

4. Surgery - placing the dental implant(s) using the surgical stent.

5. Allow healing of 12 weeks.

6. Take new records.

7. Place implant tooth/ teeth ( try in stage needed for several teeth).

Our case had lost several teeth over many years which meant she was unable to eat on the right side of her mouth. By using 2 dental implants, we were able to provide 3 teeth by 'bridging' the gap. A lovely end result and the ability to chew again! Life changing? Maybe not but certainly life enhancing.
 

Thankfully January is over! Longer days are on the horizon and Spring time not too far away. Our case of the month for January involved quite a complex one to replace a missing front tooth using a dental implant. Unfortunately, our patient had an accident causing severe trauma to his front tooth. The tooth could not be saved and required removal. This is a nightmare scenario for most of us but thankfully we have the technology and options available to replace the tooth with a long term solution- a dental implant. In the past, we the option of a bridge was the main method of replacing teeth. This is where the adjacent teeth are cut down to size to literally 'bridge' the gap. However, this is extremely destructive and removes almost all of the supporting structures of the tooth which will almost certainly lead to issues in the future. Of course, there is also the option of a removable partial denture! Realistically, this is not a long term option especially for a young adult.
 

Our case of the month for December was a stunning one involving the replacement of old porcelain veneers and a dental implant crown for a front tooth.
 

Our case of the month for November 2021 was a classic tooth bonding case involving severe tooth wear. Tooth wear is an increasing problem with grinding at night becoming an ever increasing problem coupled with acid in the diet. The combination of these two factors can lead to the softening and dissolving enamel leading to thin edges, chipping, fractures and exposure of the underlying dentine which can be very sensitive. 

The beauty of cosmetic bonding is that we can treat the wear, protect the teeth and improve the aesthetics in one visit. We do not need to cut the teeth down at all, there is no need for any needle, the procedure is pain free and easy to maintain.