Craig Barclay

Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK and provides recommendations on the pre-treatment oral and dental assessment, during and after treatment and oral rehabilitation. Restorative dentists are core members of the multidisciplinary team treating head and neck cancer patients, involved from the treatment planning phase through to long-term rehabilitation. Recommendations • Preventative oral care must be delivered to patients whose cancer treatment will affect the oral cavity, jaws, salivary glands and oral accessibility. (G) • Close working and communication between the surgeons, oncologists and restorative dental specialists is important in ensuring optimal oral health outcomes. (G) • Intensity-modulated radiotherapy has been shown to reduce long-term xerostomia and should be offered to all appropriate patients. (R) • If patients are deemed at risk of trismus they should be warned and its progressive and potentially irreversible nature explained. (G) • Where it is known that adjuvant radiotherapy will be given, extractions should take place at primary surgery to maximise the time for healing and minimise the number of surgical events for patients. (G) • Osseointegrated implants should be considered for all patients having resection for head and neck cancer. (G)

A new clinical training scheme for overseas dentists under Tier 5

Since the introduction of the Points Based Immigration System to the UK the opportunities for overseas trained dentists to train in the UK have been limited. This paper describes a new opportunity which has resulted from the Tier 5 Medical Training Initiative.

Sagittal Condylar Angle and Gender Differences

PURPOSE The purpose of this study was to measure sagittal condylar inclination (SCI) in male and female participants and to assess differences between the two groups. This measurement has a clinical value in setting the articulator SCI before fabrication of indirect restorations. MATERIALS AND METHODS The study included 32 dental students, 16 men and 16 women (aged 18 to 40 years). The participants had no signs of muscular or articular pain. SCI was recorded for participants using a CADIAX® compact 2 electronic axiograph. RESULTS The mean SCI in both men and women varied between 26.1° and 61.8°, with a mean of 41.9° (SD 7.8). The mean right SCI was 42.0° (SD 8.5), and the mean left SCI was 41.9° (SD 9.2). The mean SCI for men was 40.3° (SD 7.9), and the mean for women was 43.6° (SD 7.7). No statistically significant difference in SCI values was found between the right and left side (p = 0.995), or between the male and female groups (p = 0.133). Also, no correlation could be found between SCI and the age of the participants (r(2) = 0.016, p = 0.489). CONCLUSIONS The mean value of SCI was within the range reported in previous studies. SCI is highly variable, but this variability does not seem to be attributed to condylar asymmetry, gender, or age of the adult participants. This high variability suggests that independent condylar measurements should be conducted for each patient instead of relying on reported average values.

The use of dental implants, cast bars and sleeve overdentures in oral cancer patients.

Surgical resection of an oral tumour (and the associated free flap reconstruction) can significantly alter the oral anatomy. The lack of sulcus depth, alveolar ridge, presence of a mobile flap and limited tongue movement can make it impossible for patients to control a removable prosthesis. To help this cohort of patients, dental implants can be invaluable. The Oral Rehabilitation Team at Central Manchester University Dental Hospital have used dental implants to rehabilitate oral cancer patients for over thirty years. After their resective surgery, a number of patients were dentally rehabilitated with a laboratory-made, precious metal-alloy bar supported by at least four dental implants. A metal-alloy under-sleeve retained overdenture was then provided to fit over the milled bar. The majority of the 50 patients in this case series had tumours in the anterior floor of the mouth. It was noted that 76% of the patients received a rim resection and were reconstructed with a fasciocutaneous, soft tissue free flap. Six percent of patients received a segmental resection and were reconstructed with either a fibular or deep circumflex iliac artery free flap. The dental implants and sleeve overdentures had a survival rate of 100%. None of the dentures lost retention, implying that the frictional grip between the overcasting and the milled bar was sufficient to appease the retention demands of this cohort. However, 10% of patients encountered complications. This would suggest a success (or complication free) rate of 90% for this cohort of 50 oncology patients. This would still imply that milled bars/sleeve overdentures carry a relatively low maintenance burden and may be a useful treatment option for oral cancer patients.