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-DEFENCE


tooth is vital or not is a crucial factor in its care. While a vitality test is not 100 per cent accurate, it offers a guide as to the state of the pulp. Performing and recording this simple test, especially prior to more advanced restorative procedures, supports your diagnosis and restorative treatment options.


Lesson 7 – BPE Failure to diagnose and treat periodontal disease has become, I believe, the biggest cost to indemnity providers and ultimately dentists. I still come across failure to perform regular basic periodontal examinations (BPEs) indicating periodontal disease or health, the foundation of any restorative care. Recent guidance states that a BPE should be carried out


at every routine examination, and scores of three or four should lead to further examination, active treatment and resolution before proceeding with any restorative option.


Lesson 8 – Educate yourself in CAD/CAM With the growth of CAD/CAM dentistry (of which I am an advocate) there is a risk that you may start to look at every case and think of it as the “only option” rather than just “one option”. Education to utilise the benefits of CAD/CAM dentistry is


not as developed as the technology itself and there can be confusion as to what can be achieved. Some may see these as low quality destructive crown machines when in reality they can produce minimally invasive restorations, the quality of which matches the gold standard. The world of adhesive dentistry is rapidly evolving with new materials constantly appearing but it remains unforgiving in terms of basic technique. Staying abreast of new developments is just as important as focusing on the basics. The pitfall is to invest only in the technology and not in


the education required to utilise the benefits. All of the above lessons apply just as much, if not more, to evolving techniques over traditional dentistry. Your treatment options may have to be justified not only to a critical patient but also possibly to an ‘expert’ witness who, ironically, may have limited experience in this field. The pitfalls of restorative care are more than just hard


“ Many complaints arise when patients’ expectations have not been managed and are unrealistically high”


clinical technique. Acquiring and applying ‘softer skills’ has the mutual benefit of improved risk management and ultimately better patient care.


Gordon Boyle is a dentist in Glasgow and Scottish practice adviser for Denplan, with an interest in restorative CAD/CAM dentistry. He also works as an expert witness in GDC proceedings and litigation cases


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