Member Newsletter

BSSPD Annual Conference 15th/16th March 2018

Photograph: Dr. Alejandro Umanzor at Unidad de Prostodoncia Dental Pensando a future.

The British Society of Newsletter, Volume 24, February 2018 President’s Editorial Phil Smith

I’m delighted to welcome you to the latest edition of the newsletter of the British Society of Prosthodontics. I am pleased to report that the Society has been active on several fronts over the past year. One of our functions is the delivery of suitable platform to allow Council education and CPD opportunities in Discussions to take place online without Prosthodontics and related disciplines. the need for face to face meetings. This is One way we fulfil this important gaining more importance as in recent commitment is through our annual series times it has become difficult and of Webinars. We are fortunate to have increasingly expensive for Council to take been able to assemble an impressive line- time away from clinics. We have had a up of presenters who provided our series of ‘screen tests’ and have found a members with invaluable learning updates platform that suits our needs and hopefully in a wide range of contemporary this will allow Council to become better Prosthodontic and related topics. The connected when we need to work on your Webinars attract many participants but behalf. there are some members who have yet to experience them and I would encourage BSSPD current and future Presidents have you all to sample some of them. You will also been involved in initial discussions to need to sign up to join our live Webinars, explore how we can work closer with RD- but all members are able to access our UK and BSRD on areas of mutual benefit. impressive Webinar archive and obtain It is envisaged that these will most likely verified CPD for each one you complete relate to areas where ‘political’ statements so you might want to take a look at these. are requested by other bodies, and I encourage all participants, both regular around conference provision. You will be and new, to spread the word to others, kept informed of any outcomes and rest and perhaps attract some new members assured there are no plans for BSSPD to too! be involved in a merger of the societies, we made it clear that we wish to maintain Behind the scenes your Council Members our autonomy and continue to follow our have been working on your behalf to founding principles that support ensure the interests of the Society have excellence in research, education and been well looked after. Much effort has clinical prosthodontics. been devoted to identify and adopt a

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Undoubtedly the highlight of the year for conference delegates on contemporary me, and many members, is the Annual research and clinical matters, and also Scientific Conference. This year it is being enter for the Schottlander Poster Award held in Liverpool on March 15th and 16th should they wish. in the magnificent setting of St Georges Hall, conveniently located close to Lime The second day is designed to start with Street Station for those travelling by train. current research and clinical The conference theme is contemporary prosthodontics as oral presentations in practice and is divided into two distinct contention for the prestigious Schottlander days, and each day will, I think, offer Oral Award. This will be followed by a truly delegates a thought provoking insight into impressive series of presentations by patient management. internationally recognised colleagues intended to stimulate interest and update The first day is devoted to managing cleft delegates on aspects of contemporary lip and palate and we have been fortunate endodontics, periodontics, , and to assemble an array of speakers at the of course fixed and removable pinnacle of the various specialties involved prosthodontics. in managing this most deserving of patient groups. The day will allow us to appreciate I really think that this year’s conference will the background work that led to the be stimulating and have something for current approach to managing CLP from everyone, and as well as enjoying the birth into adulthood. It will showcase conference don’t forget to take the contemporary surgery, , opportunity to experience Liverpool, it’s a speech therapy and prosthodontics. vibrant city with lots to see. I hope to see Interspersed with this are poster as many of you there as possible. presentations allowing members to inform

3 Conference Programme

‘Achieving Favourable Outcomes: Contemporary Practice’

Thursday 15th to Friday 16th March 2018, St George’s Hall. Please note that this programme may be subject to minor changes.

Thursday 15th March 08:30-09:30 Registration & coffee/trade show 09:30-09:45 Welcome and opening of conference by Sir Munir Pirmohammed 09:45-10:15 Overview CLP 'Why we are where we are. And where are we going?' by Bill Shaw 10:15-11:00 Surgery in CLP: Achieving favourable outcomes - challenges and solutions by Simon Van Eeden 11:00-11:30 Coffee and trade 11:30-12:15 Contemporary cleft orthodontics by Susana Dominguez-Gonzalez 12:15-13:00 Psychology in CLP patients by Zoe Edwards 13:00-14:30 Lunch, trade and Schottlander poster viewing 14:30-15:15 Fixed and removable prosthodontics in CLP by Andrew Barber 15:15-16:00 Speech appliances and speech therapy in CLP by Sandip Popat and Ginette Phippen 16:00-16:15 Tea and trade 16:15-16:45 Cases and Panel discussion 17:00-17:30 BSSPD AGM 19:00 Conference mixer drinks and finger buffet, St George's Hall Dress Code: Smart casual (email [email protected] if you wish to attend)

Friday 16th March 08:30-09:30 Registration and coffee/trade show 09:30-11:00 Contemporary prosthodontic research: Schottlander Oral Presentations 11:00-11:30 Coffee and trade. 11:30-12:30 Contemporary periodontics by Ian Needleman 12:30-13:30 Lunch and trade 13:30-14:15 Trouble shooting failed restorations by Peter Briggs 14:15-15:00 Contemporary endodontics by Mark Hunter 15:00-15:45 Contemporary removable prosthodontics by Craig Barclay 15:45-16:30 Contemporary toothwear management by Alex Milosevic 16:30 Prize announcements by Tony Preston 16:35 Handover to new president Phil Taylor 16:40 Close

Conference bookings can be made online via the BSSPD website: http://www.bsspd.org Alternatively you can contact the sales administrator [email protected]

4 Prosthodontic Perspectives Harold Preiskel

I am honoured by the BSSPD Gold Medal award of 2017 that has closed a personal circle of prosthodontic endeavors of more than half a century. The BSSPD was the first prosthodontic organisation I joined and the first I addressed more than 50 years ago. I am fortunate that my prosthodontic journey has brought me in contact with some of the greatest names in the field throughout the world, but I made an unfortunate start. As a newly appointed lecturer in a hurry to reach my first BSSPD the knowledge there is a warm welcome meeting in Cambridge I overtook the there. senior London professor with such a speed differential that his car was blown Working in numerous countries brought off the road by my slipstream-fortunately me in contact with outstanding individuals without damage. Later we were to remain some of whom were unaware of similar friends for life. This was typical of the work in progress elsewhere. An amazing BSSPD where misdemeanors were quickly London committee supported me in my forgiven and one could disagree without endeavors to bring together prosthodontic being disagreeable. Heated discussions in leaders throughout the world to London to the lecture hall were usually resolved over work with their UK counterparts. Members a pint (or two) of beer later on. of the BSSPD joined the symposium in 1982 that was opened by Princess I have been lucky to liaise with marvelous Margaret and proved an outstanding colleagues in the academic, hospital and success. The Proceedings served a practice environments together with a generation of post graduate students. The wonderful team with which to work. So International College of Prosthodontists many have contributed. I can only offer a was born at this meeting and now combined ‘Thank You”. Of course represents more than 80 nations crossing recognition is particularly sweet on home both national and political borders. I am territory, while the achievements of former honoured to have served as its founding students provides paternal satisfaction. It Chairman and later its first President. I am is gratifying to travel to many countries in also happy to have assisted the Continued >

5 ...continued from page 5 > foundation of the International Journal of first time a life enhancing prosthodontic Prosthodontics serving as its first co-editor therapy became a possibility. Furthermore, and later Chairman of the Editorial Board. an entire new range of answers became I’ve been fortunate to receive numerous available for the partially dentate patient awards but one of the more gratifying was and those with maxillo-facial defects. to be appointed the first non-American President of the American Prosthodontic Osseointegration was originally surgically Society. In later years I was to receive their driven often producing irregularities of the Golden Medallion award. This augmented occlusal plane, unusual tooth position, the pleasure of having chaired questionable aesthetics and unknown distinguished UK organisations and effects upon the supporting ridge of an profited from interaction with my opposing complete denture. Nevertheless colleagues here. few complained; most were overjoyed. The breakthrough had been made and the My interest in mandibular movements and door opened to prosthodontic innovations. related structures has been lifelong. It continues to this day. Returning from the This surgically driven approach produced American articulator wars with a newly greater complications in the maxillae minted degree I was surprised to find that where the pattern of bone resorbtion often chewing cycles, and masticatory resulted in implant placement well palatal movements received relatively scant to the optimal position for the artificial attention. While my research in the field teeth. In these early days reduced lip appears to have raised more questions support, excessively proclined artificial than it answered, exposing unknown teeth or large gaps between issues is an important part of investigation. and mucosa were not uncommon. The restoration of the partially dentate Nevertheless, the security and confidence mouth led to my in interest in precision felt by patients usually outweighed the attachments that made possible improved drawbacks despite the occasional equine overdentures and a plethora of solutions in appearance. prosthodontic fields. Several retention systems developed for roots work well on Before long the versatility offered by the implants. Differential support from overdenture became apparent. The mucosa and periodontal ligament raised Brussels overdenture conference in 1989 issues still pertinent today with implant concentrated on the number of supporting supported overdentures. implants required, the possible need to connect them, together with retention For generations the nemesis of many a units. However, the undercurrent was prosthodontist was the restoration of the more important. No longer was it resorbed edentulous mandible for a acceptable to place implants in convenient maladaptive patient. The advent of bony sites at odd angles then add on the osseointegration added a new dimension teeth as an afterthought. At long last it was to therapeutic possibilities. The appreciated that the main purpose of the edentulous mandible became eminently therapy was the replacement of missing restorable with a fixed prosthesis as for the teeth: the surgery should be planned with

Continued > 6 ...continued from page 6 > the desired prosthodontic result in mind. occur. The science of Metrology, With this in mind the implant supported understanding surface chemistry together overdenture became a useful addition to with an appreciation of implant/ host the prosthodontic armamentarium. response are but a few aspects of ensuring predictable long term results. The anatomical challenges of providing Digital technology has yet to make its full posterior occlusal support were met by impact on prosthodontics. Already pioneering surgical and prosthodontic imaging and diagnostics have been protocols with the result that for a fit revolutionised while CAD/CAM is changing patient, there were few situations that everyday practice. It’s a privilege to be defied implant placement. The realization part of this evolution. I’m confident there is that the area of interfacial osseogenisis did far more to come and surprisingly quickly! not have to match that of the lost Nevertheless, I perceive the siren call of periodontium led to a reduction in technology worship that tempts so many supporting implants placed for fixed to forget that today’s wonderful gadgets prostheses. Site preparation including are tools, not icons, with which to treat our ridge augmentation, regenerative patients. No articulator in the past treated techniques, and sophisticated grafting a patient; no digital device is likely to do approaches have resulted in better looking so soon. functional prostheses while digital protocols expedite and simplify planning The BSSPD laudably embraced the future and execution. The edentulous patient with its last Annual Meeting devoted to the need not now be a dental cripple. impact of digital technology. I was proud to have been asked to open the The implant is not a universal panacea. programme and wish the organisation Peri-implant complications can and do success in the years to come.

Membership

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7 Specialist Training: Is it worth it? Tameeza Tejani & Christos Theocharides

Over the last few years, in the differentiate yourself from the rest. For UK has been transforming significantly. example, those on the prosthodontic Currently, with political uncertainty of specialist list tend to make up only 1.1% of the future of the NHS and a rise in the all registered dentists. High-end practices cost of living, patient’s spending worldwide constantly seek to employ UK decisions with regards to both private qualified specialists as their level of and NHS dentistry have changed. training is considered equivalent or higher Furthermore, young dentists who have than other countries. Personally, we have not had the opportunity to develop their both found our employment prospects to skill sets are facing higher litigious risk be greatly improved by specialising as for lower financial rewards. Society and practices seem to prefer specialists over the rise in social media has encouraged general dentists due to the limited number litigation and patient’s aesthetic of specialists on the UK list. This allows expectations. the practices to market their specialist and their practice with a unique selling point. Therefore, more and more young dentists are at crossroads, needing to plan for their future by skilling up and undertaking some level of postgraduate training. This can vary from attending conferences and practical hands-on sessions to diplomas, Masters in Sciences (MSc’s), Masters or Doctorates in Clinical Dentistry (MClinDent and DClinDent programmes) and even PhDs.

With the current political / social situation, Table 1: Registrants by Speciality is it worth considering different career (Registrant report - April 2017 GDC 2017) opportunities? We would argue against this and say “YES, it is worth specialising” 2. By Specialising, your mind set for the following reasons: changes

1. By specialising, you make yourself a Specialist training is not only a commodity qualification that would mean an additional post nominals after your title, it From GDC registrant data taken in April is a structured training that teaches you to 2017, there are 40,205 currently registered change your mind set; whether it be dentists and 69,226 Dental care understanding of the materials and professionals registered (1). Table 1 lists techniques or embracing up-to-date the number of specialists on each of the technology. Additionally, you learn how to 13 specialist lists. By specialising, you interpret research and how to implement

Continued > 8 ...continued from page 8 > this evidence based dentistry into your Specialty Training in the UK (i.e. the dental daily practice. gold guide (2) is a very useful publication in explaining the role of the GDC, the role Specialist training widens career options of the Joint Committee for Postgraduate for dentists. It allows dentists to learn how Training in Dentistry (JCPTD) (who work to plan and treat complex cases both in through the Royal Colleges) and the role hospital and practice environments and of the training providers (i.e. the teaches them how to provide high level Universities, NHS boards and trust/health care within a multi-disciplinary team. A few boards). The GDC’s role is particularly training programmes include some degree important in setting standards for specialty of teaching where the postgraduate training (3) and awarding “Certificates of trainees are involved in teaching and Completion of Specialist Training” clinical supervision of undergraduate {CCSTs} which allows entry to the dental students. This can highlight the specialist list. Furthermore, certain trainees desire to teach or undertake publications written by restorative research posts that can lead to becoming consultants may be useful (4). clinical lecturers, mono-specialty consultants or even professors (once a The GDC requirements for entry include (3): PhD is achieved). • Registration with the General Dental 3. By Specialising, you get trained by Council prior to commencement of experts in the field training.

Dentistry is a practical subject and • A minimum requirement for entry to practical tips learnt from these experts can specialty training is 2 years of post- increase your clinical work to a higher graduate foundation training (or level, increase your time efficiency and equivalent) which may include vocational reduce stress levels. Furthermore, working training (VT) and may also include under consultants, allows you to establish secondary care in an appropriate good relationships with within the dental specialist environment. Markers of community. Moreover, during training, as completion of a 2-year foundation training the trainee’s practical work is assessed by period may include MJDF (Membership of experts, there is a journey of self- Joint Dental Faculties RCS England) or awareness and in turn self-confidence as MFDS (Membership of the Faculty of their clinical work reaches the anticipated RCSEd and RCPS Glasg) higher level. or MFD (Membership of the faculty of Dentistry RCSI). So I have decided to apply for a mono- speciality programme (Prosthodontics, • The essential and desirable criteria for Periodontics, Endodontics), how can I specialty trainees will be included in the maximise my chances of getting in? person specification for training posts in the specialty. Evidence of excellence (in Before considering an application to any terms of attributes such as motivation, mono-speciality programme, one should career commitment etc) would be read specific guidance to that speciality. A expected. Reference Guide for Postgraduate Dental Continued >

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It would be desirable to have research and qualified specialist in the field. publications. These are thought to be a useful mannerism to present Trainees will be involved in pre and post organisational skills, knowledge and treatment case discussions. Pre-treatment motivation4. case discussions can be used to facilitate development of evidence based decision What is expected during a three-year making and planning of the treatment Prosthodontics mono-speciality execution. Post-treatment case programme? discussions can be used to reflect on what went well, what could be improved or what The usual training period is a total of 4500 alternative treatment options could have hours over a full-time three-year period or been considered. agreed equivalent within the framework of a less than full-time training programme. Generally, training programmes are The programme content should be closely monitored by the local deaneries. approximately 15% research, 25% For the three postgraduate institutes in academic and 60% clinical. The research London (Queen Mary University, Eastman component can be in the form of a Dental Institute and Kings College) the laboratory based study, or a clinical based London Deanery monitors the training research that may need ethical approval progress and requires trainees to log their prior to commencing or may be in the cases but also complete certain form of conducting a systematic review. A assessments within each year of their 25,000 to 40,000-word thesis is required to training. These are entered and submitted be submitted at the end depending if the electronically through an intercollegiate programme of study is an MClinDent or surgical curriculum programme (ISCP). DClinDent and the trainee has to Each year the trainee has to submit a undertake a viva (oral) examination where certain number of Cased Based they would be expected to present and Discussions (CBDs), Clinical Evaluations defend their study. The academic (CEXs), Direct Observations of Clinical component includes a series of seminars, Skills (DOPS), Procedural Based laboratory practice sessions, self-directed Assessments (PBAs), Multi Source learning, tutorials and case presentations. Feedbacks (MSFs), Assessment of Audits The clinical component involves (AoAs) and Observations of Teaching restorative and implant consultation clinics (OoT). Specialist trainees are also and supervised treatment clinics. expected to keep clinical logs of all patients treated and procedures carried In the early stages of training, trainees will out. All these procedures are assessed be greatly assessed and guided in order and graded by clinical lecturers and to determine their competence base. As consultants involved in their training. the trainees demonstrate clear development of competence, the level of Furthermore, each year the trainee has to supervision may be decreased. Towards attend an Annual Review (ARCP) set by the end of their training, trainees should the deanery which will assess that the be confident to act in a more independent trainee is on track and will sign off way and demonstrate qualities of a newly completion of that year of training and

Continued > 10 ...continued from page 10 > allow the trainee to progress to the next consultants and the deanery. In the long one. The final review meeting is usually run, it is advantageous and highly carried out after the speciality membership recommended to work part-time during examination. This is considered to be the any postgraduate qualification as you get final sign off for the trainee to be entered to practice your knowledge and skills into on the specialist register. real primary care setting.

Throughout this training there are several Organisation: examinations involved. Each institution has a certain number of examinations In order to have a fairly smooth three-year including case presentations, viva’s and training, a high level of organisation is written exams which are required in order expected. This can be in the form of to complete the course and be awarded keeping organised notes but also planning the Masters degree. Upon completion of and executing appointment times and the training the postgraduate if eligible can treatments in order to maximise clinical submit a selection of clinical cases and scientific knowledge. Trainees will be demonstrating excellent skill sets and recommended to read a vast number of understanding of their field of speciality papers and books which ideally should be and all other restorative disciplines and reading them throughout the course and take the Membership Examination of the in a systematic way, instead of leaving Royal College of Surgeons (eg. MPros for them towards the end of each year prior to Prosthodontics). exams. They should create good summary notes which they can read again closer to What were the main Challenges? the exams and be able to quote the fundamental papers. Long-hours, commitment and stress: The appointment and treatments provided During these three years of intensive should be carefully planned as well, in training, a trainee will be faced with a few order to maximise the number of challenges and high and low moments. procedures carried out but also to the The initial challenge will be getting your anticipated quality. We recommend that mind set back into long hours of studying trainees plan their diaries themselves, in as you will be entering from a working order to control the above parameters. It is environment. Irrespective, of undertaking a always advised to have read and be well part-time and full-time programme there prepared prior to any upcoming clinical will be a noticeable drop in income and a procedure and knowing what equipment financial burden due to the hours and cost will be needed in order to avoid wasting of these training programmes. In our case, time during the clinical treatment session our programme was full-time and we had trying to figure what they would need and to work over the weekend to be able to how they would use it. fund this. This was very stressful and tiring considering that within the week we had Conclusion: long days of clinics and long hours of There are disadvantages and challenges studying. However, we had good support during specialist training. One of the major networks with other trainees, our disadvantage of specialist training is the

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11 ...continued from page 11 > financial burden. Despite this, we would would recommend specialising in any field still advise that the training benefits of restorative dentistry, without a doubt our outway the disadvantages. So, when response is always yes. asked by dental students or dentists if we

References: 1. Registrant report - April 2017. General Dental Council (2017) https://www.gdc-uk.org/about/who we-are/facts-and-figures

2. COPDEND. The dental gold guide. Online article available http://www.copdend.org/

3. The GDC Curriculum for the chosen specialty. For example, for prosthodontics: Curriculum for specialist training in Prosthodontics June 2010 https://www.gdc-uk.org/api/files/Prosthodontics%20Curriculum%2006%2010.pdf

4. Critchlow S & Nanayakkara L. A guide to entry into specialist training. British Dental Journal 2012; 212, 35 – 40.

Future BSSPD Webinars

Each webinar will start at 7.30pm and will provide up to 2 hours of CPD. The webinars will remain free to our members (£10 per webinar for non-members). More details and booking via our website.

• Wednesday 7th March 2018 by Professor Nic Martin “Impressions that are fit for purpose”

• Wednesday 4th April 2018 by Professor Paul Hyde “Does the quality of our impressions matter for our patient’s quality of life”?

• Monday 30th April 2018 by Dr Tony Preston “Gerodontics for the 21st Century”

12 Treatment outcomes of maxillary and mandibular removable partial - a retrospective study Dr Ali Nankali & Dr Maria Kalou

Introduction and Background 18 years of age. Patients that were Several treatment options are available for undergoing or treated with RPDs for first multiple tooth loss. Although patients time or those that were under 18 years of prefer fixed treatment options, the age were excluded from this study. The removable partial dentures (RPDs) are still population size was between 900 and a choice of partially edentulous patients as 1000, while the sample size was 130 RPDs. it is conservative, less time consuming and The data were analysed using Microsoft more affordable (Shaghaghian et al., 2014). Excel programme. A general dental practitioner using criteria drawn from the An acceptable RPD should fulfil the dental existing bibliography examined dental requirements and provide the patient with records. The formatted Excel sheet had a a satisfactory solution, preventing further personal data section, followed by damage to oral structures and improving information relating to the RPDs such as function, without any complications (Frank the type of RPD, involved teeth and et al., 2000, Removable prosthodontics: reasons for failing the treatment. The table Indications for removable partial dentures: was formatted in such a way, to illustrate a literature review, 2006). However, when the issues related to factors such as complications or failures are present, it is abutment teeth, dentures, acceptance from important to identify the causes by the the patient, possible oral hygienic examination of particular criteria. problems of the participants, further treatment needed and the longevity of Aims and Objectives each individual denture. The aim of this clinical audit was to evaluate the treatment outcomes of Results maxillary and mandibular removable partial One hundred and thirty (130) RPDs were dentures (RPDs), identify causes of failures examined (60 maxillary, 70 mandibular) of the dentures and improve quality of care from patients with an average age of 64 through suggestions based on the results. years and was demonstrated, as it is shown in Figure 1, that 49% of the patients Materials and Methods had periodontal problems on their This audit was based on documentary abutment teeth, 41% presented with caries, analysis of data obtained, with approval, almost 32% had fracture, wear or loss, 20% from the existing dental files of Barts and needed root canal treatment and 16% The London Dental Hospital. Inclusion presented with mobility. In addition, it was criteria included patients undergoing detected that on dentures; 60% had treatment or being treated with RPDs, retention and stability problems, 34% had between 2013 and 2015, in Barts and The fractures, 26% had problem with the acrylic London Dental Hospital and were above base, 19% had problems with clasps, 15% Continued >

13 ...continued from page 13 > had loosened or loss of artificial tooth, as it Discussion is presented in Figure 2. The main reasons of failures of the RPDs based on dental criteria concern the In terms of patient experience, 40% of abutment teeth and the dentures. On the patients expressed pain or discomfort, abutment teeth was observed the 38% had difficulty in mastication and 27% presence of periodontal disease (49%) and of patients had rejected their dentures dental caries (41%). The RPDs eliminate (Figure 3). the ability of self-cleaning in the junction between clasps and tooth surface and this Regarding the hygienic issues about 55% favors the accumulation of microbes. This were diagnosed with oral hygienic can result to the above diseases, as well as problems. The average longevity of the the need for root canal treatment (20%), RPDs was also audited, as it is displayed in mobility (16%) and loss of the abutments Figure 4 and the calculations showed a (32%). It should be noted that there is gap figure of 4 years. in the literature for further analysis of the

Figure 1: Chart showing the percentages of dental caries, endodontic treatments, mobility, periodontal problems, fracture, wear and loss of the abutment teeth.

Figure 2: Percentages of unsuccessful RPDs with the associated causes based on the dentures. Complications included problems with the metal framework, the clasps, the artificial teeth, the acrylic base and retention and stability problems.

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Figure 3: The percentages of the RPDs that were rejected by the patient, difficult or not used for mastication, causing pain or discomfort.

Figure 4: The longevity of the RPDs at different time intervals, ranging between months to 30 years. progression of periodontal disease due to planes should be transferred from the removable prosthesis. Another surveyor with accuracy in the oral cavity in complication was fracture and wear of the order to protect the abutment teeth from abutment teeth, on approximately 32% of displacement and fracture caused by the participants. In the section of the data lateral and horizontal forces. collection with the supplementary notes, it was found that many of the participants On the dentures the main findings were had parafunctional habits with generalized problems with retention and stability (60%), wear of their natural teeth and decreased fractures on different parts of the RPDs occlusal vertical dimension. Further studies (34%), problems with the acrylic base in the relation of the RPDs with (26%) or with clasps (19%) and loosened malocclusion leading to fracture or wear of or loss of the artificial tooth (15%). The the abutment teeth should be considered. main causes related to the above failures Moreover, it should be noted that the were problems with the design, fabrication reduction of occlusal stresses can be and surveying during the construction of provided by correct preparation of the the dentures, presence of malocclusion or abutment teeth and the appropriate parafunctional habits and misuse of the position of the clasps. Parallel guiding Continued >

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RPDs from the patients (path of insertion People older than 65-year of age have and accidental falls). It is known that with impaired neuromuscular control and time the bone where teeth are lost and poorer adaptation to dentures. In addition, extracted becomes gradually more and material bulkiness, occlusal instability and more resorbed and atrophic. Moreover, support can result to discomfort and another cause could be the poor fitting of rejection of the RPDs by the patients. the denture as it can harmfully affect the retention and the stability of RPDs. Conclusion The findings from this clinical audit The third section was focused on patient’s demonstrated that treatment outcomes of criteria. The main complaints were RPDs mainly depend on factors such as presence of discomfort (40%), RPDs that design, surveying and fabrication of the were not functional during mastication dentures as well as the oral hygiene habits (38%) and others that were totally rejected of the patients. The main suggestions for from the patients (27%). The main causes improvement are the development of official of these complaints were the inappropriate guidelines for etiology and management of surveying, design and fabrication of both failures of RPDs, the need of dentists' dentures and abutment teeth preparation. further training in design and fabrication of If the cause of failure was from patients’ RPDs and providing information to the view it was mainly because of the inability patients for the importance of oral hygiene to adapt to the change of a new denture. and recall system.

References Frank R, Brudvik J, Leroux B, Milgrom P and Hawkins N. Relationship between the standards of removable partial denture construction, clinical acceptability, and patient satisfaction. The Journal of Prosthetic Dentistry 2000; 83 , 521-527.

Shaghaghian S, Taghva M, Abduo J and Bagheri R. Oral health-related quality of life of removable partial denture wearers and related factors. J Oral Rehabil2014; 42 , 40-48.

Removable prosthodontics: Indications for removable partial dentures: a literature review. British Dental Journal 2006; 200 , 23-23.

Kaula Maria, 2016; Treatment outcomes of Maxilary and mandibular removable partial denture – Dissertation, Barts and the London Dental Institute, Centre for Oral Immunobiology and Regenerative Medicine, dissertation.

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16 Expert Witness Bias Simon Thackeray

Expert witnesses play an important role in judicial systems of all types. It is vital that 1 Types of Bias they present their opinion evidence in a 1.1 Affective Bias neutral and impartial manner, and not be Examples of affective bias include biases subject to bias when presenting evidence. such as racism, sexual orientation, or a There are many types of bias that can strongly held moral standpoint. This is a exist within expert opinion, some of it more personal bias based on inherent personal overt that others, and it is important that views and beliefs held by an individual. steps are taken to identify and neutralize these biases in order that justice is served 1.2 Cognitive Bias appropriately and correctly. Cognitive biases are the inherent unconscious errors in the way humans Many types of bias are unconscious and think, and as such are not necessarily cognitive in nature but lead to the risk of subject to control by the individual unless amplification of bias if other biases also they are made aware of them. It is co-exist, either within an individual, or therefore important to consider that amongst a group experts that are of experts. Other influenced by such biases may be cognitive biases more overt and will be likely to be due to the values of the opinion that and beliefs of the they are acting in a individual. They neutral manner, may also be applying what they present due to a consider to be an lack of objective and understanding of impartial thought an expert’s process, and overriding duty to therefore be the court. Again unjustifiably these may lead to confident in their bias amplification conclusions and opinion as a result, when when co-existing with other biases, either this may not actually be the case at all. individually, or across multiple persons. When an expert receives instruction from one side or the other the process of some Methods to identify and neutralise bias bias forming may begin, since it is likely within expert opinion exist and have that there may be some difference of potentially been further enhanced with opinion or a contentious issue being recent reforms. Some of these methods present by virtue of instructions being may prove to be more successful than issued. others in neutralising expert bias.

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entrenched as to be inflexible in its 1.2.1 Confirmational & application. However, it is a bias Hindsight/Outcome Bias This could be described as ‘I knew it all nonetheless and there is a fine line along’ or the ‘No Smoke without fire’ type between such honestly held opinion of bias. Hindsight bias is a confirmation of based on accepted ideology and a one’s own preconceptions. One of the dogmatic belief in a concept to the examples of type of bias is when an expert exclusion of all other explanations. tests hypotheses to only confirm the evidence presented, rather than testing for 1.4 Financial conflicting hypotheses that may well be A direct financial interest in the outcome of equally supported. a case is one of the most obvious biases that could exist. For this reason, the use of Conditional Fee Agreements by expert 1.3 Structural Bias This is an ideological bias. Essentially this witnesses is not recommended in the UK . is the bias that gives the expert his or her opinion and is 1.5 Other based on the Aspects experience in a It is possible that field of practice. personality of an An expert by their expert may cause very nature is a bias that affects therefore going to jurors (and to a have structural lesser extent bias since they judges). A more may prefer one confident witness opinion to another may appear a due to it working more plausible more effectively in witness and may their hands. consequently influence the decisions of a jury. 1.3.1 Dogma A dogmatic belief in one’s opinion to The civil courts the exclusion of have mechanisms others is likely to whereby evidence create bias. If the can be limited or reasons for an experts belief is based on even ruled inadmissible. At the pre-trial flawed data (in the cases involving Roy stage of proceedings it is possible that the Meadow) and/or an inflexibility to accept identification of potentially biased expert other views (as with the cases involving testimony can be identified and then dealt Squier) then the outcome of a case will be with accordingly. It may be that a bias is affected if weight is given to the expert identified that is so great the evidence evidence. It may be that this dogmatic cannot be seen to be reliable, and opinion is honestly held; but it may be so therefore this allows a mechanism

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18 ...continued from page 18 > whereby it is not admitted as it may have 2.3 Regulation of Experts an adverse effect on the outcome of the Regulatory bodies have the power to case. discipline their registrants, with the ultimate sanction of removing them from 2 Solutions the register, effectively ending their career. The unconsciously held biases discussed However, there is no such mechanism for previously may present a court with non-regulated occupations to be problems in their identification. More disciplined in the same manner. An obviously held biases would be simpler to inequality therefore exists, which advances reveal in cross-examination. the argument for the separate registration of expert witnesses. 2.1 Single Joint expert The use of a Single Joint expert (SJE) can 2.3.1 Training of experts remove the individual biases of multiple An awareness of the rules of court is the experts in civil cases. absolute basic requirement of expert training. It would also highly beneficial that There is a lack of utilization of the SJE, there should be included training in the which may be because of an acceptance various types of bias. within some fields that there are often vast ranges of opinions that exist, and therefore 3 Conclusions multiple experts can present a broader Due to the nature and foibles of human range of opinion from which a choice can behaviours, it will remain an imperfect be made. situation, which court rules need to make the best of to avoid the more obvious 2.2 Concurrent Evidence or biases, and reliance on robust training to ‘Hot-tubbing’ create an awareness of the effect of bias. This process involves the presentation of In the pseudo-adversarial world of the expert evidence simultaneously before regulatory discipline, such as found within the court, with the opportunity for the the GDC FTP process, it is important that judge to direct the proceedings the expert witness does not align appropriately as the true issues where themselves with one side or another and opinion differ in the case are more likely to remains truly impartial when presenting surface, and more swiftly. testimony.

Keep in touch! Remember to regularly visit the Society’s website to keep informed about planned events and to update your membership details. Share your success with us! BSSPD would like to share the success stories of its members with the world! Send your news items to [email protected]

19 In-Training Award 2017 – Boston University John Krezel

In September 2017 I was fortunate to be with the final prosthesis never fabricated able to spend time at Boston University until all functional and aesthetics Goldman School of Dental Medicine requirements have been met with the department of Prosthodontics, observing provisional. All indirect restorations are both residents and temporarily faculty. The three cemented and year postgraduate IOPA taken to programme in check the margins Prosthodontics is prior to permanent the largest in the cementation. US and has 8 (predominately Removable overseas) Prosthodontics residents per year made up the large and is led by Dr majority of the Hiroshi Hirayama. work undertaken by the residents The department with treatment had a slightly more protocols closely destructive With Dr Hirayama: following my treatment Director of the Advanced Specialty teaching in the UK. philosophy than in Education Program in Prosthodontics As at the Royal the UK with full London they have coverage crowns recently started being primarily using laser used instead of more conservative onlay sintered Cobalt Chrome frameworks with or composite restorations to restore worn good success. teeth. The dahl principle is not utilised, with likely litigation if it were to be used. The residents are provided a similar Although destructive, the quality of the amount of implant experience as in the UK work produced was excellent, and I was with the focus on treatment planning and present at a 47 year follow up of a full- restoring, with approximately 10 surgical mouth reconstruction that still looked placements. I learnt a new technique for perfect. accurately capturing the soft tissues of an implant restoration. An impression of the There is a great emphasis on the need for provisional in situ is taken, this is then high quality provisional restorations and I removed and placed into the impression was able to attend an excellent lecture by and an analog placed. This is then cast Dr Gurkan Goktug on this topic. whilst the patient is waiting and provides an accurate representation of the soft Impressions for indirect restorations are tissues around the provisional restoration. never taken on the day of the preparation, Residents complete a similar amount of

Continued > 20 ...continued from page 20 > lab work as at Queen Mary’s. They are being $1000. Treatment plans had to be responsible for their own mounting and tailored to patient budgets with some diagnostic wax ups and are encouraged to patients simply not able to afford complete as much treatment. of their own clinical work as is feasible. Overall, the programme and Unlike in the UK a teaching is very research much aligned to component is not that I am receiving incorporated into at present. Some the 3 year treatment plans programme, were more residents have an destructive than option to pursue would be research by completed here, completing an however the additional 1 year of execution was study for a Masters excellent with a or 2 years for a likely good long- Doctorate. Only a term prognosis. minority of the residents intended to pursue this research option and wanted to I would like to thank the BSSPD for this have academic careers. excellent opportunity to experience Prosthodontics in the US and to the A big difference was that unlike the UK, Department of Prosthodontics at Boston patients at US dental schools pay for their University for being so welcoming to me treatment with the price for a single during my visit.

Save the Date...

We may only be just into 2018 but preparations for our 2019 annual conference are well under way. It will be held on Friday 15th – Saturday 16th March 2019 at the Royal College of Physicians in the beautiful surroundings of Regents Park, London under the presidency of Professor Phil Taylor. The theme will be 'managing the heavily restored dentition'.

21 Obituary Professor Robin Michael Basker OBE, DDS, BDS, FDSRCS Edin, MGDSRCS Eng, LDSRCS Eng, 1936 – 2017

Robin died on the 4th November at the committees and enormously helpful to age of 80 years after a short illness and a others. His quiet strength and long battle with Parkinson’s disease. determination shone through, but he was not demonstrative. He was On graduating in 1961 a GDC visitor to numerous Robin had a spell in dental schools and general practice before undertook a visitation of taking up a lectureship South African dental in Dental Prosthetics at schools in the late 1990s. Birmingham under He was also a member of Professor John the Nuffield Enquiry into Osborne. He was Dental Education. Robin awarded a DDS in 1969 was very popular amongst for his research into GDC staff and was seen as dental amalgam and a true gentleman. In 2001 became a Senior he was awarded an OBE Lecturer in 1978. He was for services to dental then appointed education. Professor in Dental Prosthetics at Leeds After joining the British where he strengthened Society for the Study of the course by increasing Prosthetic Dentistry (now its clinical relevance spurred on by his the British Society of Prosthodontics) in career-long interest in prosthodontics in 1964 Robin became a frequent contributor general practice, effective communication and was President in 1988-9. He was a co- between dentist and technician, and author of several successful textbooks. dental teamwork. Effective communication One, ‘The Prosthetic Treatment of the was one of Robin’s many strengths, but Edentulous Patient’, was first published in regrettably not via his hand writing which 1975, has had several international was notoriously difficult to decipher, editions, and is still going strong with its seriously challenging even his most 5th UK edition appearing in 2011. A 6th committed of colleagues. He was Dean at edition is currently being considered. Leeds from 1985 – 90. Robin was active in the British Dental Robin became the Leeds University’s Association, both locally and nationally, representative on the General Dental and was a Scientific Advisor to the British Council from 1986 – 2000 where he served Dental Journal. He had a long involvement on a number of committees including the with the British Standards Institution and Education Committee of which he was acted as Convenor of the International Chairman for several years. He was very Standards Organisation Committee on diligent in his preparation for chairing resilient lining materials. When there were

Continued > 22 ...continued from page 22 > differences of opinion amongst Committee Chairman of the Society and again members he kept things calm and civil, demonstrated his charm and tact at handling matters with tact, diplomacy and Society meetings. These were often held humour. He made good I.S.O. friends both at his home sitting around his fine at home and abroad. The extensive Mouseman dining table beneath which travelling associated with his post lurked his two Schnauzer dogs who made provided opportunities for some certain that everybody left when business adventurous overseas holidays. These was completed! On retirement, and while opportunities cropped up frequently still living in Harrogate, Robin became a enough for some on the Committee to popular guide at Fountains Abbey and claim that I.S.O. stood for ‘International very much enjoyed the overseas trips to Sightseeing Organisation’. He was European historic sites with the other awarded the BSI’s Distinguished Service guides. About five years ago Robin and Certificate in 2002. Jacquie moved south to Shalbourne, Wiltshire, to be closer to the rest of their Robin was very musical and was a great family. fan of West End shows. He had a fine singing voice and used to be a talented Robin is survived by his wife Jacquie, his pianist. He and his then wife-to-be, daughters Sally and Katie, and his Jacquie, first met while they were granddaughters Robyn and Laura. members of the London Hospital Choral Society. He joined the Harrogate Choral Society in 1978 and was a member, with John Davenport (with contributions from Jacquie, for 35 years. In 2005 he became colleagues, family and friends).

Goodbye to...

We were also saddened by the recent deaths of three of our honorary members and past presidents:

David Berry (president 1967-68), Roy Storer (president 1968-69) and Roy MacGregor (president 1971-72).

Our thoughts and condolences to their families and loved ones.

23 Who’s Who

Council Officers Council Members Dr Philip Smith (President) Miss Jennifer Jalili (2015-2018) [email protected] [email protected]

Dr Phil Taylor (President Elect) Mrs Lorna McCaul (2015-2018) [email protected] [email protected]

Prof Mike Fenlon Miss Pamela Yule (2016-2019) (Immediate Past President) [email protected] [email protected] Dr Guy Lambourn (2016-2019) Mrs Claire Field (Hon. Secretary) [email protected] [email protected] Dr Shiyana Eliyas (2017-2020) Neil Poyser (Hon. Treasurer) [email protected] [email protected] Miss Hannah Beddis (2017-2020) Dr Tony Preston [email protected] (Hon. Curator & Awards Administrator) [email protected] Mr Callum Cowan (StR representative) [email protected]

Co-opted Members & Representatives Dr Rob McAndrew (Conference Organiser) SAC representative [email protected] Prof Mike Fenlon [email protected] Mr James Field (Webmaster) [email protected] RD-UK representative Mr Peter Briggs Kushal Gadhia [email protected] (Early Practitioners Group Chair) [email protected] Specialist Advisory Board in Restorative Dentistry Royal College of Surgeons of Kirstin Berridge (Administrator & Data Edinburgh Protection Officer) Mr Dean Barker [email protected] [email protected]

Mr Suresh Nayar (International representative) [email protected]

Honorary Members (since 2008) 2008 Peter Likeman 2014 Peter Farrelly, Peter Frost, 2009 Jocelyne Feine Richard Welfare, Paul Wright 2010 Robert Clark 2016 Frauke Müller, Johan Wolfaardt 2011 Tomas Albrektsson