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The crisis in NHS dentistry in the UK has been widely reported. Despite an increase in dentist registrants with the General Dental Council (GDC) over the past decade, data from NHS England and Wales shows that over 2500 dentists (8%) stopped treating NHS patients in 2021.1 The ‘GDC Public Survey 2022’ also highlighted a significant shift towards private dental care since 2019/2020.2 In 2020/2021, the UK dental market was valued at £8.3 billion, with the NHS component accounting for only £3.8 billion.3 This growth in private dentistry is likely to lead to more complex treatment plans and care items not typically available under the standard NHS General Dental Services contract.
Concurrent with the rising tide in private dentistry in the UK is the practice of defensive dentistry, an approach often driven by perceived fears of litigation and dental regulation. As part of this, dentists commonly take extra precautions, frequently recommending more conservative treatments. This trend is likely to be associated with a significant increase in the prescription of minimally invasive dental treatments aimed at enhancing the smile zone, including (but not limited to) clear aligner treatments and composite bonding, which are often perceived as lower-risk options. This is highlighted by the projected growth in the global market for clear aligners, estimated to rise from US$6.7 billion in 2023 to US$29.9 billion by 2030.4
However, it is imperative for dentists to understand that failing to provide good-quality care and to meet the professional standards reasonably expected from a dental professional can have severe consequences, even when delivering minimally invasive dental care.
The relevance of the previous discussion on defensive dentistry and minimally invasive treatments ties directly into the broader context of aesthetic dentistry. As outlined in the Aesthetic Update editorial in August 2024,5 aesthetic dentistry encompasses biological considerations and measures to improve form, function and appearance. This approach aims to enhance the long-term performance and longevity of the dentition, along with other oral health benefits that improve the patient's overall wellbeing. Aesthetic Update aims to provide content that aligns with the principles of aesthetic dentistry, supporting the growth of private and advanced dental care both in the UK and internationally. It emphasizes the importance of upholding professional and ethical standards, ensuring that patients receive high-quality care that meets their expectations.
The journal will feature a variety of article types to showcase and support the provision of high-quality dental care, with an evidence-based approach. Key areas of focus will include:
The articles will emphasize the importance of conducting thorough assessments and evaluations to achieve an accurate diagnosis and support logical treatment planning. This process enables dental practitioners to discuss relevant treatment options and obtain valid informed consent. This ‘patient-centred’ approach contrasts with a ‘system-led’ approach, where the clinician follows a predetermined protocol to meet the patient's needs, rather than discussing all relevant options based on the diagnosis in a clear, accurate and balanced manner. A patient-centred approach not only enhances the quality of care but also fosters trust and transparency between the dentist and the patient.
In this issue of Aesthetic Update, we have included content that captures the areas of focus mentioned above. These range from conventional prosthodontic approaches for the predictable rehabilitation of the anterior dentition, to interdisciplinary collaboration involving pre-restorative orthodontics followed by an additive approach for the rehabilitation of a worn dentition. We also explore contemporary computer-aided techniques for the accurate placement of pterygoid implants for the rehabilitation of a severely atrophic maxilla.
Additionally, this issue features our second Top Tips article, which eloquently describes the use of a digital workflow for constructing a Tanner appliance. This includes using a leaf gauge to determine the necessary level of inter-occlusal clearance and the innovative use of bilateral direct composite jigs to record the desired occlusal relationship prior to scanning. This facilitates the virtual mounting of casts onto a digital semi-adjustable articulator using a digitally mounted facebow transfer. We have also included a further Top Tips article that is a largely pictorial-style case-based report, documenting the use of an immediate adhesive bridge to create the desired emergence profile prior to implant placement. Subir Banerji and I have discussed our views on the importance of using correct nomenclature in dentistry and the risks of not doing so, especially with terms such as biomimetics and bio-emulation.
This issue also features the third in a three-part series on the art of shade matching, focusing on indirect restorative materials, written by Stephen Bonsor, Dipesh Parmar and the late Louis Mackenzie. As many of you know, Louis was a highly respected dental professional known for his prolific contributions to dental education and practice, with a remarkable ability to convey complex concepts in an accessible manner. Louis was also instrumental in the development of Aesthetic Update. This article is one of several of Louis' posthumous articles for Aesthetic Update. I am highly confident that this piece, along with his numerous contributions, will leave a lasting impact and continue to inspire others, ensuring his legacy lives on. On a personal note, and on behalf of our team at Aesthetic Update, I am forever grateful for Louis' contributions, and we will always cherish his memory.