The 2016 Annual Conference took place in Manchester on Friday 18th & Saturday 19th March at the iconic Bridgewater Hall. The theme for the conference was ‘Progress & Precision in Prosthodontics’, showing how advances in technology and a greater understanding of disease processes mirror a background and history of precision work. Last year’s conference in London (under the Presidency of Peter Briggs) was held on a Friday and Saturday for the first time – this popular choice was continued for this year, and was also beneficial as the Friday matched the usual study day for the region’s foundation dentists. The venue was booked to capacity with a broad range of delegates ranging from foundation dentists, general dentists, postgraduate and specialty trainees as well as established specialists and consultants.
The conference was formally opened by Mr Nicholas Taylor, local Postgraduate Dental Dean and Chairman of COPDEND. Mr Peter Briggs chaired the morning session, inviting our first speaker to commence the scientific programme. Dr Chris Orr, one of the most prominent cosmetic dentists and educators in the UK, gave a talk entitled ‘Aesthetics and function: can we have our cake and eat it?’ Chris presented a broad overview, encouraging a ‘balanced’ approach to treatment planning in aesthetic cases. He gave a brief but thorough overview of smile design and options for improving appearance – stressing the role of conservative direct options as well as more destructive indirect options, showing several cases of direct build-up with fantastic end results. He discussed the need to consider and plan changes to vertical dimension carefully, and also recapped functional considerations and the need in many cases to consider occlusal relationships and schemes as part of an aesthetic plan.
Dr Rupert Austin, Clinical Lecturer and Specialist in Prosthodontics at King’s College London Dental Institute, was our next speaker, with an exciting and modern topic ‘Restoration of teeth: digital scanning and milling’. Rupert took the audience back in time when digital dentistry was in its infancy and beautifully demonstrated what challenges the inventors of such technologies faced and overcame as digital impressions and milling techniques evolved with time. Rupert gave the audience a clear grasp of how digital dentistry compared to conventional techniques of impression taking, creating casts and fabricating prostheses throughout its life story of evolution and explained how the users of these modern techniques benefitted, and occasionally suffered, from its many advantages and occasional shortfalls. He then explained how digital techniques are growing to become faster, more precise and more user-friendly and in many cases more economically justifiable. He ended his presentation with a systematic comparison of the current market leaders, their superiorities and deficiencies.
Professor Julian Satterthwaite, BSSPD president, then introduced the first of the afternoon speakers, Dr Anil Shrestha, Specialist Prosthodontist and owner of Lister House ICED. Anil has a wealth of experience in both general and specialist practice and took a wonderfully refreshing approach to his talk on ‘Removable prosthodontics: an alternative to implants’ reflecting on lessons he had learned (sometimes the ‘hard way’) as well as providing an evidence base for the often complex cases discussed. He gave a fascinating presentation where he showcased over two decades of his precision attachment work. His honest and pragmatic style of presentation took the audience on a journey of his professional life, treating patients successfully when dental implants were not an option and learning from errors, discussing what alternative treatment options could have been pursued with clear explanation of their pros and cons. The audience were mesmerized by the variety and diversity of the techniques used, many of them easily adoptable in any setting. He also clearly demonstrated the importance of a systematic approach in managing such cases, accurate treatment planning and precision dentistry, not only in preparation of the mouth but also in quality assuring every stage of the work and finally producing a high quality end result.
The afternoon session was completed by Dr Nigel Rosenbaum, Specialist Prosthodontist working in Sheffield and Derbyshire. Nigel’s lecture was ‘When all is lost, what can we do?’ His presentation focused on the management of the completely edentulous patient utilizing conventional removable prosthesis. He initially highlighted theneed for accurate diagnosis of the existing denture problems to help determine the suitable treatment plan for the new denture. Nigel asked the audience by a show of hands, what materials were used for various stages during the denture making process, suggesting that the audience should question their conventional techniques in view of the characteristics of more modern materials. Nigel discussed how he had asked himself the very same questions and in looking for the answers found the ‘Biofunctional Prosthetic System (BPS)’ by Ivoclar Vivadent. The clinical stages of this technique were discussed in depth and the rationale behind the differences to a ‘conventional technique’ outlined. Of particular note was the absence of a wax rim, instead relying on a Gothic Arch tracing followed by tooth set-up based purely on biometric and anatomical guides. Nigel’s lecture was complemented on the Saturday morning by a live patient demonstration run as a parallel session to the main programme. Each of the BPS clinical stages was carried out and the rationale behind using a dual phase alginate for the primary impressions, a concept that had raised eyebrows during the previous days lecture, became clear when you see the variety of anatomically detailed stock trays that the system offers in contrast to the few that the majority of us are used to. The steps of preliminary jaw registration, recording of functional impressions and Gothic arch tracing to (carried out using interchangeable components that are added on top of the special trays) were shown and discussed. It is fair to say that even for those not a convert to the BPS system there are certainly aspects of the clinical techniques involved that could be very useful adjuncts for the treatment of the edentulous patient.
The conference dinner was held on Friday evening at Manchester Town Hall, just a short stroll from the conference venue. The Town Hall is one of the most iconic landmarks in the city. Situated on Albert Square, the Town Hall is definitely one of the hidden jewels in Manchester’s crown – it was opened in 1877 and radiates the history of the city. Following the pre-drinks reception we were fascinated by magician Jay Rollins before the traditional President’s speech of thanks and toast to our Guests: Julian Satterthwaite thanked the conference sponsors, all those on council for their input and work through the year, particularly Shiyana Eliyas who was completing her term as Honorary Secretary and also Rob McAndrew (conference organizer) and Kirstin Berridge (administrator) for their conference work. Phil Smith (Awards Administrator) announced the recipients of the Society’s awards: The Heraus-Kulzer Award winner was Danny Watts, an undergraduate student at UCLan Dental School in Preston for ‘The factors affecting the decision to support fixed partial dentures with teeth and/or implants’; the BSSPD In-Practice Award was made to Mark-Steven Howe to help support his practice based research project ‘A Restorative Dental Risk Index – The use of evidence based heuristics in clinical risk assessment/communication’; and the BSSPD In-Training award was made to Ash Gopakumar (Liverpool University Dental Hospital) to support her visit to Dept of Oral Restorative Sciences at the Westmead Centre for Oral Health, Sydney, Australia. Our after dinner speaker was Dr Paul Redmond, an employment and generations guru who knows everything that needs to be known about generations X, Y and Z, and gave a tremendously entertaining talk on behavior and behavioral differences that truly entertained all present. Each year during our annual conference dinner we raise funds for a charity - this year’s conference charity was Help for Heroes, founded in 2007 to provide direct, practical support for wounded, injured and sick Veterans, Servicemen and women and their loved ones.
The second parallel workshop on Saturday morning was a treatment planning workshop specifically targeted at early career dentists. This was given by Kushal Gadhia (Consultant in Restorative Dentistry and Chair of the BSSPD Early Practitioners Group) along with Carly Taylor (Lecturer in Restorative Dentistry at the University of Manchester). Attendees were mainly dental core trainees and postgraduate students who were given cases to treatment plan in groups, which were then discussed. Treatment planning is often the least understood and poorly performed part of clinical practice, despite the central nature of this process to all that we do. The opportunity to explore decision making in a small group and supportive environment was appreciated by all present. Some interesting discussions ensued around how to plan and deliver multidisciplinary treatment plans including some of the evidence base upon which we base our treatment decisions.
Whilst the parallel sessions were running, the main programme on Saturday morning commenced with the Schottlander Oral Presentations, once again ably chaired by Phil Smith (BSSPD Awards Administrator). All speakers demonstrated their knowledge within their field of work, with wide-ranging topics being presented. As in previous years, the quality of presentations was high and questions were fielded from the audience. In deciding upon a prize-winner, the judging panel had a difficult task, but selected Dr Victoria Hannah ‘Death by dirty dentures?’ to receive this year’s prize. The Poster display area received a large amount of attention during the two days and the Society once again demonstrated the supportive and encouraging environment for clinicians and researchers to showcase their work – the Schottlander Poster Prize was awarded to Dr James Ban (Specialty Registrar in Restorative Dentistry at Bristol) for his poster on ‘3D printing in the construction of resin-retained bridge framework’.
‘Hosting duties’ were then picked up by Neil Poyser before lunch, and he introduced Mr Steve Campbell of Nexus Dental Laboratory who spoke on ‘Implant superstructures: digital scanning and milling’. Steve gave a fascinating lecture, picking up on the ‘digital dentistry’ and precision theme of previous speakers. The work presented by Steve was, unsurprisingly for those familiar with his work, of exceptional quality. Steve also demonstrated an intimate and thorough understanding of the whole concept of a digital workflow and as well as presenting what is technically possible, gave an insight into how advances in technology can revolutionise working patterns and practices whilst simultaneously improving quality of outcome.
After lunch, Dr Rutger Schepers, Maxillofacial surgeon at the University Medical Center Groningen, gave an inspiring presentation on the reconstruction and rehabilitation of large craniofacial defects utilising composite free flaps and implant supported restorations. He demonstrated how such treatment can be planned and executed using digital technology, which allows tumour resection and final reconstruction to occur at the same procedure with a high degree of accuracy. This involved digital planning with MRI and CT scans to allow cutting guides and implant drilling guides to be constructed for implant placement prior to harvesting of the flap. Through a series of case reports, he discussed the initial introduction of the technique at his clinics and his teams development and progression, presenting lessons learned and plans for future.
Julian Yates, Professor of Oral and Maxillofacial Surgery at the University of Manchester gave the last presentation of the conference. His lecture continued on the theme of computer aided design and manufacture, but with a focus on prostheses to replace soft tissue. This fascinating talk focussed on potential materials and 3D manufacture of facial prostheses using rapid prototyping technologies and novel materials, highlighting the significant benefits it can bring to patients and clinicians. Such techniques can allow for rapid replacement of facial prostheses, which is advantageous given their limited life span in addition to significantly reducing chair time.
The final business of the conference was to hand over the Presidential chain of office to Professor Mike Fenlon, President of BSSPD for 2016-17, who provided an insight into next year’s conference ‘Prosthodontics; the future is digital’ to be held on Thursday 6th - Friday 7th April 2017, at 155 Bishopsgate, London.