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A2 ◊Page A1 to implant related infections and contaminations.” Funding for this project was received from the EPSRC CASE Studentship and the Guy’s and St Thomas’ NHS Foundation Trust. Notes The SafeRoot project was chosen by the Design Council to participate in their 2016 Spark Programme, a funding and support programme designed to help entrepreneurs turn their bright ideas into commercially successful products. Over the course of 16 weeks, the research group were ENDO TRIBUNE Dental Tribune Middle East & Africa Edition | 3/2017 provided with specialist expertise and one-to-one mentoring. The SafeRoot project has been a col- laboration between the Biophoton- ics Research group in the Dental Institute and clinical specialist endo- dontists in Guy’s and St Thomas’. •Dr. Frederic Festy: Senior Lecturer in Biophotonics •Prof. Francesco Mannocci: Professor of Endodontics •Dr Neveen Hosney: Research Asso- ciate •Dylan Herzog: PhD student •Prof. Tim Watson: Professor of Bio- materials & Restorative Dentistry •Dr. Federico Foschi: Consultant En- dodontist •Dr. Garrit Koller: Research Associate •Dr. Richard Cook: Reader in Oral Medicine Papers mentioned in this news article ‘Rapid Bacterial Detection During Endodontic Treatment’ by Dylan B. Herzog, Neveen A. Hosny, Sadia A. Niazi, Garrit Koller, Richard J. Cook, Federico Foschi, Timothy F. Watson, Francesco Mannocci, Frederic Festy is published in the Journal of Dental Research at 00.01 GMT on Wednes- day 08 March 2017. Engineering and Physical Sciences Research Council (EPSRC) As the main funding agency for engineering and physical sciences research, our vision is for the UK to be the best place in the world to Re- search, Discover and Innovate. By investing £800 million a year in re- search and postgraduate training, we are building the knowledge and skills base needed to address the scientific and technological challenges facing the nation. Our portfolio covers a vast range of fields from healthcare technologies to structural engineer- ing, manufacturing to mathematics, advanced materials to chemistry. The research we fund has impact across all sectors. It provides a plat- form for future economic develop- ment in the UK and improvements for everyone’s health, lifestyle and culture. We work collectively with our partners and other Research Councils on issues of common con- cern via Research Councils UK. Rediscovering operative dentistry By Aws Alani, UK The first thing to come to mind among the majority of the public when dentistry is mentioned is the delivery of fillings or the need for crowns, the management of the bite or the improvement of colour or shape of teeth. This is our core busi- ness and is the basis upon which the public is likely to measure the skill of the clinician. Indeed, many a dentist may cower behind the X ray machine if he or she overhears a patient com- plaining in the waiting room that “the filling fell out an hour later”. Nothing humbles us more than this sort of dissatisfaction. Operative dentistry appears to be a lost art among a contract that does not reward and more lucrative cos- metic sidelines outside of dentistry. Indeed, fillings or crowns or meth- ods of achieving maximal benefit from minimal intervention are not marketed as “sexy” in the same way as Botox or aligners are. Despite what the dental spin doctors want one to believe, restoring teeth optimally and properly will forever remain our utmost and required skill set. Con- serving tooth tissue and protecting the pulp or preserving remaining tooth tissue after root canal treat- ment is invaluable where implants are less successful than we thought and veneers are more invasive than we would ideally like to provide. Selling health as opposed to selling a product is the successful business model shared across all professions. Indeed, the value of health is price- less for a patient. The minimally invasive movement is rifein more acute and life threatening situa- tions than dentistry ever was and could be in the future. How many of us would truly prefer open heart surgery through the slow splitting expansion of a ribcage, like a cook- ing oyster, as opposed to a stent fed through the femoral vein with the wound the size of a plaster? Destruc- tive dentistry sells because there are those among us who prefer to let Photograph: marionbrun/PixaBay our technical (or more talented?) col- leagues do the creative work while they vaporise teeth to oblivion. Like many paradoxical things in life, ignorance is bliss. Ask yourselves what your patients would choose if they understood the difference be- tween destroying tooth tissue and conserving it and the associated biological costs. They would gladly pay more for a procedure that will guarantee less pain and likely pro- long the longevity of the tooth as op- posed to the restoration. We have to be wary of the root canal treatment crisis at the current time. Secondary care units are oversubscribed with referrals, and primary care is remu- nerated poorly for a procedure that is cost- and technique-prohibitive, but essential. Saving teeth and pre- venting pulp necrosis is where the profession should be, but not neces- sarily can be, in the current climate. In addition to the threat of bacte- ria, patients are overworking their muscles and destroying their teeth in the process. Parafunction is rife. From the stressed to the hypomo- bile, temporomandibular dysfunc- tion is highly prevalent. (Indeed, the Brexit caused me some bruxing recently.) Owing to the intricacies of the joint, patients can present with a multitude of symptoms and its association with mental well-being means there is a high possibility of psychosocial factors to boot. As such, diagnosis is one conundrum, but treatment options can vary, depend- ing on whom the patient sees and the skill set at the clinician’s disposal. From advice and exercises to arthro- scopic procedures, the spectrum is wide and vacuous. Personally, I have found the tried-and-tested sta- bilisation splint (otherwise known as Michigan splint) a sensible op- tion when advice on changing life- style and self-administered physi- otherapy fails. Those patients who “Ask yourselves what your patients would choose if they understood the difference between destroying tooth tissue and conserving it and the associated biological costs.” to do things correctly. When teeth are lost despite our best efforts, tooth replacement can seem a straight choice between an implant and a denture, as any con- ventional bridgework will need- lessly destroy the abutments. I still feel conventional bridgework has its place in operative dentistry, but it has been eclipsed by the emergence of resin-bonded bridges. These res- torations have had a mixed recep- tion historically, but I can now say that they are the most predictable method of replacing a single tooth. Good longevity without any tooth preparation whatsoever is money for old rope and any solicitor sniffing is tempered by the lack of any harm to teeth or the patient. The recipe as always is being aware of the indica- tions and sticking to the rules. As we become progressively en- grossed in the digital age, patients are increasingly requesting aesthetic improvements. That bad, bad word (starts with a ‘v’) can still be advo- cated, but there are easier, kinder and more predictable techniques we can provide for our patients. Whit- ening and bonding may not always have the same gloss finish as veneers (sorry!), but in the majority of cases, patients are entirely satisfied with a well-planned and executed case. Where residual spacing is closed, the colour is improved and the incisal edges are uniform and straight, the flaws are difficult to find. The kudos attached to operative dentistry will slowly experience a rebirth as the undoubted need for these skills rises among our patients. One would hope the powers that be have the foresight to realise that an optimally restored and cared for tooth actually prevents the future need and cost for a crown, molar root canal treatment, molar root canal re- treatment, apicectomy, a complicat- ed surgical extraction or a prosthesis. Editorial note: The article was origi- nally published in Rooth Internation- al Magazine 01.2017 Aws Alani is a Consultant in Restorative Dentistry at Kings College Hospital in London, UK, and a lead clinician for the management of congenital abnormalities. He can be contacted at: awsalani@ hotmail.com. have succeeded at abating their symptoms with these devices can- not live without and swear by them. Once again, the minimally invasive prevails over the “occlusionists” (il- lusionists?) who aim for the perfect patient occlusion among the poten- tially most imperfect of mindsets. Take heed and beware of the patient who wants his or her bite fixed so that the jaw does not click. Patients want to retain their teeth however heavily restored. Root ca- nal treated or not, we are all wired to crown teeth to protect remaining tooth tissue. Against a background of widespread parafunction and ever- increasing cracking teeth, the need for crowns is higher than ever. Prepa- ration of a tooth for a crown takes a great deal of skill and awareness of trajectories and angles while provid- ing a preparation that is retentive to achieve a final shape that is conserv- ative of tooth tissue. Those core skills of cutting are important and need not be abused. Capturing the preparation in its entirety with the aim of providing technical colleagues with enough physical and written information to deliver an optimal restoration is fairly challenging too. Alas, the best crown preparation is only as good as the crown cemented to it. In a num- ber of cases, many a dentist’s head has been scratched when the crown fits the model perfectly, yet looks alien to the patient’s mouth. Un- derstanding why things have gone wrong is of as much importance in operative dentistry as knowing how