Dental Implant’s- A New Begining

At the end of 2017 I had completed the FDI Certificate in Implant Dentistry and was looking forward to this new and exciting chapter of Dentistry. I just needed the right patient.

The key to starting anything new is to know your limits and when dealing with dental Implants you really need to start with a simple single tooth case, ideally in the upper premolar region. This reduces the aesthetic risk and there is little anatomy of concern (ideally no Maxillary antrum sneaking forward!)

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For you first Implant you need a good team  – At Broad Street Dental surgery we are very fortunate to have dental nurses with over 20 years of Dental Implant experience. A mentor is also key and is recommended by the GDC when starting out in dental implants. A good mentor will help guide you through the treatment planning phase, placement and restoration of cases.

In this case a single Straumann SLActive implant was placed in the upper right first pre-molar area. There was sufficient bone and no bone grafting was needed. The implant was restored with a Zirconia screw retained implant. The new implant has provided improved function and aesthetics for the patient who was very happy with the results.

Maintenance is now the key to long term success and the patient has regular hygiene appointments at least every 6months.

Dental implants are now being provided regularly at the practice

If you are interested in dental implants or any other information please contact Broad Street Dental Surgery

or 01432 266899

Dentist Andrew Farr BDS(Hons)

 

 

 

 

Straight Teeth – Amazing Aesthetics

At Broad Street Dental Surgery we ONLY use 3M brackets. These have a proven track-record worldwide for their performance, beautiful aesthetics, and are nearly invisible in the mouth. We also use tooth-coloured wires making our braces the most aesthetic when compared to similar systems.

QST is used to correct mild misalignment of the front 6 to 8 teeth, to give you a beautiful smile. Because we only move the front teeth, the force required is minimal. The wires exert mild pressure to move the teeth, without the need for severe tightening which can cause the discomfort noted in conventional orthodontic treatment.

Have you ever wondered how to straighten teeth without using any fixed braces?

At Broad Street Dental Surgery we use the QuickStraightTeeth™ which has a clear “teeth straightening” system that has been developed to be a quick, discreet and very cost effective alternative for patients not wanting traditional braces.

For more information please contact Dr. Andrew Farr

01432 266899

http://www.broadstreetdentalsurgery.com

Dentist Andrew Farr BDS(Hons) MJDF
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A Traumatic Fall – By Andrew Farr

This patient presented a few weeks following a fall where all four Maxillary incisors were damaged. The delay in presentation was due to her upper lip being extremely swollen and painful that she did not want any sort of examination of her dentition.

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Traumatic fractures

As shown above the maxillary left central incisor has a complex dentine-enamel fracture and has devitalised. The Maxillary right central incisor also has a complex dentine-enamel fracture. Both lateral incisors have dentine enamel fracture with no pulp exposure and were extremely sensitive to air.

Both central incisors were root treated and due to the discolouration a crown was recommended. To improve the aesthetic outcome it was decided to crown both central incisors as a pair. The lateral incisors were treated with Filtek Supreme composite and Synergy enamel shades.

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Final restorations

The patient was very happy with the final restoration.

Andrew Farr BDS(Hons), MJDF Associate Dentist at Broad Street Dental Surgery

@DentistHereford

Adult Orthodontics – Upper and Lower Crowding. By Andrew Farr

Mrs K. presented complaining of upper and lower arch crowding. She had orthodontics completed in her adolescents and this has now relapsed due to a lack of retention following treatment.

Mrs K. had 4mm crowding in the upper arch with the Maxillary right first molar buccally placed. The lower arch had mild crowding of around 3mm as shown above. Treatment options were discussed and it was decided that fixed upper and lower arch short term orthodontics followed by fixed retention in the form of a bonded retainer would provide an acceptable outcome.

The treatment was provided at Broad Street Dental Surgery using the QST (Quick Straight Teeth) system and took approximately 6 months to complete. Excellent result were achieved and the patient was provided with fixed upper and lower retainers along with Essix retainers to wear at night.

If you are interested or know of anyone interested in short term orthodontics then please visit Broad Street Dental Surgery in Hereford.

Dr Andrew Farr (Dentist) BDS(Hons), MJDF

@DentistHereford

 

 

The ITI Foundation in Implant Dentistry is the ideal way to get the best start in a career in implant dentistry

Dr Andrew Farr talks to The Revu about his recent experience of undertaking the ITI Foundation in Implant Dentistry (FID) course and why, along with the guidance of his mentor, he is now more than ready to place his first implants.

 What first motivated you to attend the FID course?

We were already offering implant treatment at our practice, but I was keen to learn for myself how to place and restore implants. I qualified over 10 years ago and received no implant training at all at undergraduate level, so it was a question of looking at the introductory courses out there that could get me confidently started in implant dentistry and the FID course was definitely the one that suited me best.

How did you find the course content?

Because it’s a Foundation course it’s designed to give you a solid theoretical understanding of how and when to use implants and to guide you in implant selection. I believe that the theory is very important when you are starting out in implant dentistry and the FID course definitely gets you off on the right foot.

I was very impressed at the quality of the teaching from some of the most experienced implant dentists in the UK, including Dr Shakeel Shahdad, Prof Nikos Donos and Dr Nikos Mardas. Between them they have a vast amount of experience, and I found them to be very open and honest about real life situations in practice, both good, and occasionally not so good. It would be easy for the experts to just say how good they are at placing implants, but that’s not what the delegates need, nor what they did. It’s just as important to learn about the things that can go wrong as well as the vast majority of cases with highly successful outcomes.

The FID modular course is spread over six months and you successfully completed the course in September. What has been happening in that time?

The most significant thing I’ve done is to partner with my mentor, Michael Betteridge. Michael is a specialist oral surgeon who is very experienced in providing not just oral surgery care in the primary care environment, but also a highly-regarded dental implant service, and is therefore ideally suited to being a mentor.

Are you looking to now move on to an MSc course or similar in implant dentistry or is mentoring giving you everything you currently need?

For the time being, with the help of Michael, my plan is to first get the basics right in practice before considering moving onto further education and I’m already in the process of planning my first implant cases. It can be a bit daunting when you first start out, but it’s probably more a fear of the unknown and that’s why a mentor is such a good idea to guide you over those first hurdles until you find your feet.

How have you found the support from Straumann – do you plan to place Straumann implants?

Yes, that’s my plan. Straumann are market leaders and when you are starting out you want to place the implant that offers the best chance of long-term success and is backed by a huge amount of research.

The support they offer is terrific and our local Straumann representative Hayley has been a great help in terms of my surgery set-up and making sure I have everything I need to get me started. Everyone at Straumann really knows what they are doing and if I have any problems I know they are there to help. It’s about the whole support package – not just the implant.

What are your plans now going forward?

I want to be doing a lot more than just placing the occasional implant. My aim is to eventually place something in the region of 100 implants a year and be in a position to accept referrals from local colleagues.

Finally, would you recommend the FID course to other GDPs?

Yes, I would definitely recommend this course – it’s ideal for any clinician looking to get the best start in a career in implant dentistry.

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In association with Straumann, the next ITI Foundation in Implant Dentistry course begins in February 2018. For further information or to reserve your place, please call the Straumann Education Department on +44 (0) 1293 651270 or visit iti.org/uk

Facebook: Straumann UK

Twitter: @StraumannUK

broadstreetdentalsurgery.com

Broad Street Dental Surgery, Broadway House, 32-35 Broad Street, Hereford HR4 9AR

Andrew Farr BDS(Hons), MJDF RCS Eng 

Andrew joined Broad Street Dental Surgery, Hereford in October 2014. Born and raised in Caerphilly, South Wales he studied dentistry at the University of Cardiff, graduating with honours. He completed his vocational training in Plymouth, then spent a year as a Maxillofacial Senior House Officer at Derriford Hospital where his duties included emergencies in A&E, head and neck surgery and wisdom tooth removal. He has developed an interest in orthodontics and is qualified to offer Quick Straight Teeth short-term orthodontics.

@DentistHereford

 

Dental Tips to Start the School Year with a Smile

With the new school year fast approaching the following back-to-school dental tips for parents are sure to help your child start the school year with a healthy smile, and keep it that way all year long.

Preventing decay starts at home, so the more child-friendly your dental supplies, the more your child will love keeping up with their oral hygiene routine.

Establish a Back-to-School Dental Routine (and Make it Fun!)

Children (and adults!) should brush their teeth twice a day for two minutes to maintain good oral hygiene. Children under the age of 8 should have their toothbrushing supervised. Children under the age of 8 lack fine motor skills needed to brush their teeth effectively, so it’s important for parents to help. Establish a fun morning and evening routine that allows you to help your younger child. It is recommended that children over the age of 3years, use toothpaste containing between 1,350-1,500 ppm fluoride and to not rinse after brushing.

Pack Healthy Lunches (and a Water Bottle)

As you pack your child’s lunch, remember that sugar is added to many food products. Check food labels for added sugar and by swapping sugary foods with healthy, whole foods like crunchy vegetables, pieces of fruit and hard cheeses you can reduce the risk of decay developing in your children’s teeth. You will also want to skip crackers and chips since these foods contain simple starches that break down and get sticky, which can also cause decay. Replacing juices, sports drinks and fizzy drinks with plain water will reduce the risk of decay further and also the risk of erosion (which is a form of tooth wear caused by acid in the diet) which is dramatically on the increase in children.

 

Schedule a Back-to-School Dental Exam at Broad Street Dental Practice

Are you ready to start the school year with a smile? Our experienced dentists at Broad Street Dental Practice are experienced in paediatric dentistry, friendly, and welcoming to kids. contact us today to request back-to-school-dental exams for your toddler, child or teen.

Hereford

Broad Street Dental Surgery

 

Implant Surgical Guide

A surgical guide as the name suggests serves as a guide to place implants accurately in 3 dimensions i.e. bucco-lingual, messiah-distal and apiece-coronal.

Here I am showing a simple surgical guide that has been produced from an initial wax up (there are more accurate guides available). It is constructed of hard acrylic and can also has barium sulphate incorporated into it so it can double as a radiographic stent.

With the guide in place, the long axis of the teeth are marked a small pilot hole is made in the centre of the tooth and old implant drills can then be used to enlarge the guide window. A window can also be made in the buccal aspect of the guide to aid vision and insertion of the drills in the mouth.

This can be worn by a pt during a CBCT to confirm the correct angulation and position of the final restoration.

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http://www.broadstreetdentalsurgery.com

Andrew Farr

FDI – Implant Retained Dentures

Managing the edentulous patient can be at times, very difficult. Following extraction of the dentition bone is remodelled and resorbed, muscles and ligament insertions become closer to residual ridges. This can in turn lead to an unstable and unretentive denture due to a lack of bony support.

When treatment planning for the edentulous patient, it is useful to classify the edentulous ridge. Ridge classification can aid both the dentist and patient in communicating any difficulties and the likelihood of a successful outcome.

3b. Adaption of Cawood & Howell classification with explanation (1).compressed

The optimum conventional dentures should be both aesthetic and functional with good fit and stability. The McGill consensus statement 2002 and York Consensus statement 2009 say that the “Minimum standard of care” in the edentulous mandible is two implant retained dentures. Working in both the private sector and primary care/community sector I find the both statement of little use. From my experience the patients who can afford two implants tend to be well educated and well informed regarding diet, oral hygiene and are regular dental attendees – they are less likely to be edentulous. Those in need are less likely to be able to afford two implants and the prosthesis.

For a mandibular implant retained denture – a minimum of two implants should be placed and four in the maxilla. The ideal position in the mandible would be the canine region and in the maxilla it would be the canine and second premolar region allowing for adequate bone and other anatomical features.

Locators, bars and milled bars can be used to improve retention, stability and support. These are a good option if an optimally made denture is still unretentive or is lacking support.

At Broad Street Dental Surgery we can provide dental implants to aid and improve the support of dentures as well as replacing single and multiple spaces.

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Tissue level implants with locator attachments in situ

Dentist Andrew Farr 

Broad Street Dental Surgery

 

Simple Composite Makes a Huge Difference

This is a nice little case that I wanted to share. It shows that sometimes the simple treatment plans and simple minimally invasive techniques can have a profound effect on a patient.

Mrs A. a 68 year old grandmother was concerned regarding the appearance of her central incisor, which her granddaughter had said looked “dirty.”

The UL1 (12) composite had leaking margins and a stained buccal enamel crack. The composite was removed and the enamel crack was cleaned with air abrasion. The UL1 (12) was then restored with A2 and enamel shade Synergy composite. The patient was very happy and so was her granddaughter!

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Dentist Andrew Farr

Broad Street Dental Surgery

Hereford Tooth Decay Worse in The West Midlands

Dental decay amongst five year old children is more prevalent in Herefordshire than any other county in the West Midlands. The Dental public Health Epidemiology Programme for England published in May 2016, show that 41.3% of five year old children in Herefordshire have had experience of or currently have dental decay. Compare that to our closest neighbours Worcester (27.3%) or Malvern Hills (17.7%) Shropshire (21.5%) then it is clear that Herefordshire is failing in the dental health of it’s children.

 

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Tooth decay damages your teeth and leads to fillings or even extractions. Decay happens when sugar reacts with the bacteria in plaque. This forms the acids that attack the teeth and destroy the enamel. After this happens many times, the tooth enamel may break down, forming a hole or ‘cavity’ into the dentine.

Every time you eat or drink anything containing sugars, these acids attack the teeth and start to soften and dissolve the enamel. The attacks can last for an hour after eating or drinking, before the natural salts in your saliva cause the enamel to ‘remineralise’ and harden again. It’s not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids. (These are the ‘fermentable’ carbohydrates: for example ‘hidden sugars’ in processed food, natural sugars like those in fruit, and cooked starches.) Always check the ingredients.

Having sugary or acidic snacks and drinks between meals can increase the risk of decay, because your teeth come under constant attack and do not have time to recover. It is therefore important not to keep having sugary snacks or sipping sugary drinks throughout the day.

Children – at the age of 5 lack the manual dexterity to brush their teeth correctly and need supervised brushing. The Delivering Better Oral Health 2014 Toolkit recommends that all children between 3-6 years should brush using toothpaste containing more than 1,000ppm of fluoride. Children at a higher risk of developing decay should use a “pea size amount” of toothpaste containing between 1,350ppm – 1,450ppm fluoride.

Children at the age of 5 also lack the required funds to purchase sweets, fizzy drink, fruit shoot drink and other high products containing high levels of sugar. Parents therefore must take on the responsibility of caring for their child’s dental health with regular dental check – ups, good diet and good oral hygiene.

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Bring your child as early as possible to visit the dentist. We need to reduce the incidence of decay amongst 5 year old children in Herefordshire to at least the level of our neighbours before we become the shame of the West Midlands.

Andrew Farr BDS(Hons) MJDF

Broad Street Dental Surgery

 

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