Consultants In Restorative Dentistry Research Articles

Developing procedural metrics for training in class II posterior composite resin restorations: Outcomes from an international Delphi panel

ObjectiveThe objective of this study was to develop and operationally define procedural performance metrics for the Class II posterior composite resin restoration procedure and to obtain face and content validity through a consensus meeting. MethodsA Metrics Group consisting of 4 experienced Consultants in Restorative Dentistry, an experienced member of staff from the Restorative Dentistry department in CUDSH and a senior behavioural scientist and education/training expert deconstructed the performance of the Class II posterior composite resin restoration and defined performance metrics. At a modified Delphi meeting, 20 experts in the field of Restorative Dentistry from 11 different Dental Institutions critiqued these metrics and their operational definitions before reaching consensus. ResultsInitially performance metrics consisting of 15 Phases, 45 steps, 42 errors and 34 critical errors were identified that characterize the performance of the Class II posterior resin composite procedure. During the Delphi panel these were modified and consensus was reached on 15 Phases (with a change to the initial sequence) with 46 Steps (1 added, 13 modified), 37 Errors (2 added, 1 deleted, 6 reclassified as Critical Error), and 43 Critical Errors (9 added). Consensus on the resulting metrics was obtained and face and content validity verified. ConclusionsIt is possible to develop and objectively define performance metrics that comprehensively characterize a Class II posterior composite resin restoration. It is also possible to achieve consensus on the metrics from a Delphi panel of experts and to confirm the face and content validity of those procedure metrics.

Conventional and implant-based mandibular oral rehabilitation for patients with head and neck cancer.

Surgical treatment of head and neck cancer can cause loss of teeth, loss of hard and soft tissues and result in significantly altered anatomy. Prosthodontic rehabilitation for such patients can be challenging, requiring pre-surgical planning at a time-sensitive point in the patient's cancer pathway. Rehabilitative outcomes are optimised by early and collaborative planning at the multidisciplinary team discussion, involving surgeons, oncologists and consultants in restorative dentistry. Conventional and implant-based prosthodontics contribute to the armamentarium of rehabilitative approaches used in this patient cohort. In order to achieve the best possible outcomes for patients, collaborative planning and teamworking between head and neck surgeons and restorative dental consultants is required from the outset. Each plan is bespoke, considering the patient's needs and wishes within the context of their holistic and cancer-specific care and their general and dental health.

Oral prehabilitation for patients with head and neck cancer: getting it right - the Restorative Dentistry-UK consensus on a multidisciplinary approach to oral and dental assessment and planning prior to cancer treatment

Historically, oral and dental issues for head and neck cancer patients were often not considered until after cancer treatment was complete. As a result, outcomes for oral rehabilitation were sometimes suboptimal. Inconsistencies in service delivery models and qualification, training and experience of staff delivering dental care often compounded this problem, making research and audit almost impossible. Collaborative working by consultants in restorative dentistry from all over the UK as part of a Restorative Dentistry-UK (RD UK) subgroup, renamed more recently as the RD-UK Head and Neck Cancer Clinical Excellence Network (CEN), has re-emphasised the importance of specialist restorative dentistry intervention at the outset of the head and neck cancer pathway to optimise outcomes of patient care. The CEN has driven several initiatives, reflecting Getting It Right First Time (GIRFT) principles aimed at reducing unwarranted variation. This improved consistency in approach and optimised collaborative working of the team now presents a better environment for multicentre audit and research. Ultimately, this should result in a continued improvement in patient and carer experience.

Pre-radiotherapy dental extractions in patients with head and neck cancer: a Delphi study

ObjectivesTo gain a consensus from consultants in restorative dentistry about the types of teeth that should be extracted from head and neck cancer patients (HNC) pre-radiotherapy. MaterialsLiterature- and clinician-informed questionnaires were emailed to an ‘expert panel’ of consultants (n = 24/28; 86%) in the United Kingdom (UK) and Ireland on three consecutive occasions (Delphi rounds). The results of Round 1 were used to revise the questionnaire that was distributed in Round 2, and this procedure was repeated for Round 3. During Rounds 2 and 3, participants were asked to indicate, on a 5-point Likert scale, their level of agreement with a series of statements on the types of teeth that should be extracted pre-radiotherapy. The target level of consensus for each statement was 70%. ResultsIn Round 2, there was consensus-agreement for 69 of 102 statements (i.e. ≥ 70% of participants rated ‘agree’ or ‘strongly agree’ to the relevant statement). Consensus agreement was also achieved for 20 of 28 statements in Round 3. Therefore, a total of 89 consensus statements are presented that illuminate the decision-making process for the pre-radiotherapy extraction of molar, premolar, and anterior teeth with periodontal pocketing, furcation disease, mobility, caries, tooth-wear, apical disease, or other pathology. ConclusionThe statements represent the consensus professional views of participated consultants in restorative dentistry in the UK and Ireland regarding the types of teeth that should be extracted from HNC patients pre-radiotherapy. The results provide a platform for the development of future guidelines. Clinical SignificancePre-radiotherapy dental assessments for head and neck cancer patients are considered mandatory. This study presents different criteria that should be considered for the treatment planning of these patients in relation to pre-radiotherapy extractions, according to the collective consensus opinion of participated consultants in restorative dentistry in the UK and Ireland.

The role of the consultant in restorative dentistry.

The role of a hospital consultant has changed extensively over the past decade as the National Health Service has progressed through a series of challenges including an ageing population and rising costs of clinical care. The traditional concept of a consultant has changed with different and increased expectations of the role as the pressures to deliver high quality patient care, education and advice continue to rise in a difficult financial climate. In addition, consultants in restorative dentistry are faced with the challenge of a poor general awareness of the scope of their speciality and their role. This paper provides an update on how the role of the consultant in restorative dentistry has evolved in the last decade and how it differs from that of other dental specialists and general dental practice.

Survey of consultants in restorative dentistry in the UK regarding ongoing care of patients provided with dental implants.

Background Funding for implant-based treatment within secondary care is limited, and acceptance criteria are determined locally according to funding agreements with NHS England. Indefinite review of all patients in secondary care is unlikely to be feasible due to limitations on departmental capacity. The increasing number of patients provided with implant-based treatment in secondary care has resulted in a growing maintenance burden, raising the question of who should provide this care. Management of some complications within primary care would facilitate patients' access to treatment, although no specific provision for maintenance of implant-retained prostheses is made within the NHS Dental Charges Regulations.Materials and methods An online survey was carried out to review services provided within restorative dentistry departments across the UK, investigating departmental protocols for review and maintenance of patients provided with dental implants.Results There was no consensus view on review protocols, discharge or provision of maintenance following implant placement. Fifty-seven percent would indefinitely carry out remake of implant-retained overdentures when clinically indicated, replace worn inserts, housings or abutments. Sixty-one percent would manage loose/lost screw- or cement-retained restorations and 68% would manage fractured restorations. Re-referral for peri-implant disease would be accepted by 64% of respondents. The lack of clear NHS funding for the management of complications was of concern to respondents in this survey.

A national survey of restorative consultants' treatment provision for head and neck oncology patients.

To investigate current UK practices in the treatment of head and neck oncology patients by consultants in restorative dentistry. A postal questionnaire requesting details of surgical and restorative head and neck oncology care from diagnosis to oral rehabilitation was circulated to all 315 consultants in restorative dentistry in the UK. If a reply was not received within 12 weeks a follow up was sent. One hundred and thirty-two (43%) completed questionnaires were returned. On average 46% of respondents treated head and neck oncology patients, this varied with geographical location. Sixty percent of consultants' weekly workload was less than 25% oncology related, while 13% indicated more than 75%. Of the cohort providing oncology care only 12% thought there was always time for dental screening pre-radiotherapy, furthermore 67% had difficulty liaising with primary care. Within the UK great variety existed between attendance at multidisciplinary team meetings, dental care professional support, and provision of dental implant reconstruction including timing, manufacturer, operator, and funding. Significant variation in dental input into head and neck oncology patients' pathways exists, most notably with pre-radiotherapy screening. This study highlights a change in trend for patient rehabilitation with dental implants, and an increase to 52% of restorative dentistry consultants' attendance during a multidisciplinary team meeting.

A national survey of consultants, specialists and specialist registrars in restorative dentistry for the assessment and treatment planning of oral cancer patients.

To investigate the approach of restorative dentists towards the assessment and treatment planning of oral cancer patients in the UK. The survey was conducted at the annual meeting of the Association of Consultants in Restorative Dentistry (ACSRD) and Specialist Registrar in Restorative Dentistry group (SRRDG) in September 2011. Delegates were requested to fill in a two-section questionnaire; the first section included 16 questions, evaluating cancer service provision in their units, and the second included five questions based on a clinical scenario evaluating dental management of a patient undergoing pre-radiotherapy treatment. Ninety-four questionnaires were distributed; 65 (69.1%) were returned. Thirty (46.1%) respondents were consultants, 27 (41.5%) were specialist registrars and the remaining 8 (12.3%) were either specialist practitioners or trust grade dentists working in the speciality of restorative dentistry. Forty-eight (73%) of the respondents worked in NHS posts and the remaining 17 (27%) worked in academic posts. A total of 50 (77%) respondents carried out clinical work which regularly included the dental assessment or treatment of head and neck (H&N) oncology patients, before or post radiotherapy. Among the respondents who were involved in the dental assessment of oncology patients, 32% of them did not have a protocol for review appointments in their units. Ninety-one percent of respondents said that they used dental implants for rehabilitation post cancer surgery and 80% also used implants either always or sometimes in irradiated bone. Answers to scenario questions highlighted that all the respondents would extract very poorly prognostic tooth (that is, root stumps) before radiotherapy, irrespective of it being at the side of the planned radiotherapy field. Fifty-eight percent of respondents preferred to extract a non-functional, heavily restored, non-carious, distal maxillary molar tooth which was not in the area of radiotherapy beam and the majority (84%) chose to carry out root canal treatment (RCT) of a functional premolar tooth if considered non vital. This study highlights the variability in the approach of clinicians in dental and oral rehabilitation of patients undergoing radiotherapy treatment for oral cancer patients.

Conscious sedation training received by specialist registrars in restorative dentistry in the UK: a survey

To investigate conscious sedation training received by Specialist Registrars in Restorative Dentistry (SpRs) during their training programme. Postal questionnaire survey in the UK. Setting SpRs and recently certificated Consultants in Restorative Dentistry (CRDs). A questionnaire was sent to 81 current SpRs in Restorative Dentistry and CRDs who had been awarded a Certificate of Completion of Specialist Training within the previous three years. One follow-up letter was sent to non-responders. The completed questionnaire was returned by 67 (83%) SpRs and CRDs. Analysis revealed that 44 (69%) respondents had received conscious sedation training during their specialist training programme and that 50 (78%) respondents carried out restorative dental treatment under sedation during their programme. Thirteen (20%) respondents had not received conscious sedation training in their programmes but eight (13%) SpRs indicated that sedation training was planned. Training experiences differed throughout the UK: 29 (66%) respondents gained experience in inhalational and single agent intravenous sedation techniques under the supervision of an experienced colleague. Fourteen (32%) respondents who performed sedation had not been on a resuscitation course in the previous year. These included nine (21%) current SpRs. Sixteen (53%) current SpRs intended to offer restorative dental treatment under sedation after specialist training. Fifty-nine (92%) respondents thought that all SpRs in Restorative Dentistry should receive sedation training and 42 (71%) thought that a structured core course would be the most appropriate format. Although the majority of SpRs and recently certificated CRDs considered that all SpRs should receive training in conscious sedation via a core course during the restorative dentistry training programme, a small number had not received or planned to undertake such training. Conscious sedation training experiences differed throughout the UK and SpRs treated a wide range of deserving patient categories under sedation. It is encouraging that many SpRs hope to continue employing sedation techniques after their restorative dentistry training has finished. The results of this survey should inform all those involved with restorative dentistry training programmes.

Quality of Written Reports Provided by Consultants in Restorative Dentistry to Referring General Dental Practitioners in the West Midlands

The primary objective of this study was to assess the views of general dental practitioners (GDPs) on the content, style, and readability of written reports provided by restorative consultants at a dental hospital in response to referral letters from the GDPs. The secondary objective was to determine the style of the written consultant report preferred by GDPs. Referral letters received and replied to by four consultants in the restorative department at Birmingham Dental Hospital. The quality of written reports sent by the four consultants to 100 referring GDPs in the West Midlands area was evaluated using a postal questionnaire, which assessed 100 GDPs' satisfaction with the content, style, and readability of the reports. To assess which format they favoured a second questionnaire was subsequently sent to the same GDPs with three versions of the original report in: (a) a standard format, (b) a summary format, and (c) a bullet point format. The results of the initial questionnaire revealed that 79 (96%) of practitioners were satisfied with the existing style of the reports. Following a second questionnaire in which GDPs were asked to choose which format they preferred, 61 (81%) expressed a preference for a bullet point or summary style report. The GDPs who responded to the questionnaires felt that a bullet point format or summary style report from the consultants concerned would summarise cases more clearly and concisely than the conventional standard format letters which they had previously received. Opportunities may exist for improving the quality of consultant reply letters through the use of structured templates and/or a summary or bullet point format.

Conscious sedation services provided in secondary care for restorative dentistry

Objectives To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. Design Postal questionnaire survey in the UK. Setting Consultants in restorative dentistry. Results There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held substantive posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. Conclusions Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey

To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. Postal questionnaire survey in the UK. Consultants in restorative dentistry. There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.

Why undertake outreach into general dental practice?

There are many reasons why patients are referred to consultants in restorative dentistry and these range from general practitioners requiring treatment planning advice, to the desire for the consultant to undertake the treatment. The consultation process should be seen as an opportunity to educate the patient about the nature of their dental problem, to make them aware of the various treatment alternatives as well as to inform them of their role in the prevention of further disease. The nature of the hospital-based consultation means that the general dental practitioner is to a large extent a passive onlooker. The educational value for the practitioner will be dependent upon the nature of the written report (or other forms of communication) sent to the general dental practitioner following the consultation. In some cases this may be very limited, so when the practitioner is faced with a similar case, because they have not been actively involved with the previous examination and consultation, they will have no alternative but to also refer the new case for treatment planning advice.

A survey on the provision of implants in the NHS Dental service

Objective To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. Design/Setting Anonymous postal questionnaire in the United Kingdom. Subjects Consultants in restorative dentistry. Results Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2–150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. Conclusions There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.

The provision of dental implants in the National Health Service Hospital dental services--a national questionnaire.

To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. Anonymous postal questionnaire in the United Kingdom. Consultants in restorative dentistry. Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2-150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.

A survey on the provision of implants in the NHS Dental service

This article: Objective To assess the activity of consultants in restorative dentistry in the United Kingdom in the provision of osseointegrated dental implants within the National Health Service Hospital service and to evaluate their attitudes concerning the relevant medical and oral factors considered in patient selection for implant treatment. Design/Setting Anonymous postal questionnaire in the United Kingdom. Subjects Consultants in restorative dentistry. Results Out of the sample of 145, 109 consultants (75%) completed the questionnaire in 1999. 54 of the 109 consultants (49.5%) are involved in the provision of osseointegrated implant treatment, treating an average of 29 cases/year (range 2–150). However, over one third of the respondents treated 10 or less cases/year. 89% worked with oral surgeons as an implant team. 68% used Branemark (Nobel Biocare) implants as their main system. The majority of consultants felt that smoking, psychoses and previous irradiation were the most important medical factors that contra-indicated implant retained restorations whilst untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important oral contra-indications. Many centres were experiencing significant problems with the funding of implant treatment with one centre receiving no funding. The implications for patient care and specialist training are discussed. Conclusions There is a marked variation in the number of patients treated with endosseous dental implants within the United Kingdom National Health Service hospitals. Many consultants treat 10 or fewer patients each year. In the main, there is agreement about the factors that contra-indicate implant treatment; these are in line with national guidelines.

Shortened dental arch therapy: views of consultants in restorative dentistry in the United Kingdom.

This paper reports the results of a study on the attitudes of the consultants in restorative dentistry (CRD) in the UK towards shortened dental arch therapy (SDAT). Data were collected by means of questionnaire, with a response of 67% achieved. The results indicate that 95% (n = 87) of the 91 participants in the study were of the opinion that SDA has a place in contemporary clinical practice. Eighty (88%) of the participants reported having prescribed SDA therapy during the last 5 years, the number of these patients requiring > 5 units of crown and bridgework being typically less than 25%. Forty-one (45%) of the participants reported patients being considered for SDAT expressing reservations about the outcome of their treatment, although around 75 (82%) of the participants indicated that SDAT was satisfactory in terms of oral function, comfort and well being. Experience of having to extend shortened dental arches following SDAT was limited to 34 (37%) of the participants. It is concluded that SDA is widely accepted but not widely practiced by CRDs in the UK and that, in patients satisfying existing criteria, the outcome of SDAT may be found to be acceptable in approximately 82% of cases.

Letter: Consultants in restorative dentistry.

Letter: Consultants in restorative dentistry.