Please find below downloaded course material and lecture summaries to accompany recent courses & presentations to aid teaching. These will be removed generally 8-12 weeks after the course. Please note that the content is most suitable and appropriate for the education of dentists and dental professionals. In addition summaries (with reading material) are also available of the 2015 / 2016 Specialist Registrar and Post Graduate MClinDent Seminars that Peter is involved with at The Royal London Hospital /QMUL and Health Education England.
We hope that you find these resources helpful.
Friday 21st July 2017 – 123 Gray’s Inn Road, London
Peter was delighted to meet the UCL Endo Diploma group.
PDF of Endodontics in the changing NHS environment:
Wednesday 12th July 2017 – QMUL Dental School, Whitechapel
Peter was asked to provide an evidence- based and balanced view around the ‘hot topic’ in Restorative Dentistry, Endodontics, Periodontics and Prosthodontics. He was delighted to meet members of the SRRDG and hopes that they enjoyed the session and that it will stimulate them find out more about this important subject.
Friday March 10th March 2017 – Edinburgh, Scotland
Peter has been invited by the Royal-Chirurgical Society of Scotland to celebrate their 150 anniversary as part of their 150 year anniversary study day – he been asked to discuss ‘Replacement of Teeth’. Peter will be looking back and forward with particular emphasis on the challenge that the increase in the proportion of elderly patients will have on the maintenance of complex prosthodontics.
PDF of Peter’s presentation:
Friday 3rd March 2017 – East of England – Newmarket
Peter and Phil provided a day of discussion, case examples, clinical demonstrations and philosophical discussion on this important and growing area of dentistry. Discussions took place on what to do with carious lesions in the frail elderly and those patients who go one to develop mental capacity issues e.g. dementia. Many of these patients will have many natural teeth – many of which will be heavily restored. The group discussed the issues of implant and over-denture maintenance.
Friday 24th November 2016 – Dental Practical Skills Laboratory St. George’s University Hospital, London SW17
PDFs for courses:
Course Programme Friday 25th November 2017 SGH
Introduction Posterior Tooth Preparation SL DF 2016
Lecture – Performance of Conventional bridges 2016
Score Sheet for Cast Metal Full posterior Crown SWL DFs 2016
Friday 4th November 2016 – Dental Practical Skills Laboratory St. George’s University Hospital, London SW17
PDFs for courses:
This is second year has helped Sana introduce DFs to Clinical Research / Audit and the importance of EBD. The hope is that we will not repeat what we all learnt as undergraduates.
The DFs will be encouraged to think about what Audits they can do to develop their practice in the next 9 months. All will undertake an antimicrobial Audit as part of HEE commitment to reducing unwanted prescription of antibiotics to patients. The Audits will be presented later in the year.
We hope the day will stimulate some to consider a potential career in academic or clinical dentistry and others to prepare for life long learning. The day will start with assessment and critical analysis of three papers that give quite a different picture about the outcome and predictability of Resin Bonded Bridges.
PDFs of Lecture Presentation:
EBD DFs Most important Dental papers Oct 2016
EBD DFs Project suggestion Oct 2016
This is the first time Peter has visited the postgraduate training centre in Lincoln. This visit has been facilitated by Stephen Dixon – Associate Dean for CPD – Health Education England East of England. I am looking forward to meeting delegates over the two days. The evening lecture will be an evidence-based update on contemporary Prosthodontics to take in some of the newer understanding of occlusion and TMJ management.
With the aid of evidence, clinical experience and clinical examples Peter will cover them.
PDFs of Peter’s Lecture Presentation:
Sumitha and Donovan 2015 – Evaluation of Contemporary Ceramic Materials
WPFM Maxillary Canine Preparation Scoring sheet 2015 PB & RD
Emax Layered ceramic crown performance assessment scoring sheet 2015
WPFM Maxillary Canine Preparation Scoring sheet 2015 PB & RD
Peter and Janice, with support from Simon Best, provided a full day simulation course that covered the principles of restoring root treated teeth. The course covered Nayyar Cores, Preparing roots safely for direct or indirect posts. It also included optimal cementation of posts and at the end the group prepared the core restored teeth to accept crowns.
The trainees were also given the opportunity to try-out reciprocation files and fill root canals with warm vertical condensation. They then learned to safely cut back GP to allow preparation for an appropriate length post.
PDFs of Peter’s Presentations and background reading:
RCT Reciproc Nayyar Post Practical 2016
Practical 3 restoration of RCT’d tooth
Sorensen & Martinioff 1984 – Intracoronal and cuspal coverage restorations in endo
Sorensen & Martinioff 1984 – Dowel design
WPFM Maxillary Canine Preparation Scoring sheet 2015 PB & RD
Intro and WPFM 2015
The training team of Mital Patel, George Bourne, Raj Dubal and Peter deliver a day of didactic and practical simulation in the LonDEC dental simulation facility. The trainees are Dental Core 1 and 2. They will receive training and clinical instruction in modern endodontic preparation and irrigation strategies.
PDFs of Peter’s Presentations:
Peter was asked by the Early Years Practitioner Group of the British Society of Prosthodontics (BSSPD) to chair the panel discussion session on Thursday 26th May 2016. The photograph below shows the panel discussing the outcome of direct composite restorations used to manage tooth wear. The session used real time voting, via the BDA app, from of the audience. This could be compared to the views of the panel.
Find PDF below of the first patient that was discussed by the panel with details of the votes made by the seven panel members.
PDF of the first patient discussed by the Panel Discussion Group at the 2016 BDA Conference – BDA Case 1
Accompanying Papers:
Saunders 2014 endo-implant Sorensen & Martinioff 1984 – Intracoronal and cuspal coverage restorations in endo
Sorensen & Martinioff 1984 – Dowel design
Sorensen & Martinioff 1984 – Intracoronal and cuspal coverage restorations in endo
Peter will outline some new important clinical evidence that should drive our planning and decision-making in general, enhanced and specialist practice. He will discuss some of the other non-clinical skills things that are important for the modern dentist – such as resilience, leadership, communication. He will also discuss talent – and how we nurture and expand our own talent and the value of benchmarking against others more talented than us. He will also discuss some problem clinical examples – where things have lead to litigation and why. Please also find evaluation results of the evening presentation from those who attended.
Peter and Phil hope to provide sensible and practical day full of help and advice to course delegates on the management strategies of compromised teeth and the elderly patient.
Following on from the successful seminar on Occlusion given by Phil and Peter to a full house at the BDA headquarters in London at the end of 2015 – they have been asked by the BDA to provide present three more to other parts of the UK.
Please go to the BDA events webpage for further details. We hope that we can meet you for a fact and fun filled day on an honest appraisal of where Occlusion fits in Dentistry in 2016. Please find PDF of Peter’s presentations. Peter and Phil will also discuss their case examples
PDFs of presentations:
Peter has been asked by the British Society of Prosthodontics (bsspd.org) to chair two interactive panel treatment planning sessions in the main auditorium during the 2016 BDA conference. The panel discussion will include several well known dentists from primary and secondary care. The audience will be able to interact with Peter and the Panel via the BDA Conference App (smart phone – compliant). Like last year the bsspd team will be present throughout the conference and provide presentations across a broad Prosthodontics (to include Implants, removable and fixed tooth replacement, aesthetic dentistry, interface with endodontics and periodontics). Please keep an eye on both bsspd.org and https://www.bda.org/Conference/Pages/Home.aspx websites for further details.
I look forward to seeing you in Manchester in May 2016
A day on EBD may not be every DFs idea of fun. Hopefully Peter & Sana will provide a different approach and encourage all to think about what they can Audit in their DF year in London. Should be fun and remember DFs that the seminal / essential reading is a good place to start.
Lovely to see everyone. I really enjoyed the day and it was nice to meet so many committed people. Thanks to Kevin, Suzie and the rest of the team for the very kind hospitality.
PDFs of presentations:
It was great to meet up with all the DFs and the DF trainers in the Oxford and Thames Valley HEE Scheme. I really enjoyed the day and also the beautiful venue at Lake Vyrnyi in Wales.
It was good to meet up with you all and I wish everyone the very best for the next 11 months. Remember that you all need to be prepared to work hard, look in the mirror and reflect on your performance and be prepared to take criticism on the chin – in order to improve – it is the only way to go!
As promised please find PDFs of all my presentations and remember that most of the papers, which as I mentioned, can be found either within course downloads or essential reading – which are both with the education & training section on hodsollhousedental.co.uk. Please Enjoy!…..
PDFs of the presentations given by Peter Briggs on Tuesday 29th September 2015:
See you all again soon, Thx Peter
Peter and Raj will run a hands-on refresher course for the SW London DF scheme. The day will involve knowledge-based update, practical skills training and reflective learning with all attempting to objectivise their performance. The day will cover the following practical tasks:
PDFs to accompany all day practical course:
The hope is at the end of the day that the Foundation Trainees will have gained confidence and competence in anterior tooth preparation particularly in the following domains: taper, match preparation design to restoration choice, margin choice and execution, planes of labial reduction and appropriate inter-occlusal space creation.
Course Leaders: Peter Briggs & Sumair Khan It is nice to meet up with a group of the new London DF in their induction week. Starting off with a introduction and re-cap on Diagnosis and management of dental and other head and neck pains. Lots of cases to allow individual and small group interactive discussion. Handout to accompany study day (PDF): Differential diagnosis of Pain 3rd Sept 2015
Peter and Graeme will lead a clinically-based simulation training session on the use of Reciproc files and obturation for both De-novo and Re-treatment in 2015. Current literature will be discussed and clinical use practised in a simulation setting. The group will also discuss the issue of cost effectiveness within NHS Restorative (and other NHS environments) of such techniques. We look forward to lively session and we present the supporting evidence together with summary of the evidence provided by Graeme. We also thank QED for supporting this course and QMUL for providing the use of the excellent facilities. Supporting Evidence:
Peter and Ken will outline current concepts in Restorative Dentistry that are relevant to Dental Foundation trainees and trainers . Peter will attend the meal after the study day at the Royal College of Physicians
David Rule Df Craft 2015 David Rule DF Risk 2015 David Rule Restorability 2015
Peter and team will provide practical and knowledge-based education for Dental Core Trainees working in South London with the goal of improving practical skills, understanding more about conventional indirect restoration outcome and helping advise how to reduce risk and better explain and record the issues around risk and benefits of treatment
Peter will provide an update in endodontic techniques to include instrumentation, diagnosis, outcome, restorative Endodontic interface, learning new skills and advice on how to avoid mishaps and dento-legal complaints
Peter spoke at the 2015 BDA Conference in Manchester – his presentation focused on how team working can and will improve clinical outcome and reduce clinical risk. This is the third time Peter has spoken to the annual BDA conference. Peter was at the conference manning with colleagues the British Society of Prosthodontics and was delighted to meet so many young and year dentists who signed up to join the society. Please look up the society on: bsspd.org.
Venue: Dental Simulation Department of Northwick Park Hospital, Watford This hands-on course will focus on the restoration of RCT’d teeth to include Nayyar Cores (amalgam & composite), Reciproc RCT, safe cut back of GP to allow post preparation for indirect and direct (carbon fiber) posts together with direct composite core build up. The learning points will be to learn how to assess the best way of restoring endodontically treated teeth – and being able to clinically apply the term restorability. Reduce the risk of post deviation and perforation. PDFs & Course Handouts:
Update on ceramic use in 2011 and beyond: Daniel Edelhoff from Munich presented a couple of fantastic presentations on use of modern day ceramics, CAD/CAM technology and modern management of Tooth Wear. Enjoy one of his PDFs: Edelhoff-Brix JADA 2011
A hands on course for GDPs in the Norwich, Cambridge and Suffolk area on modern endodontic techniques. Learning aims included: Correct/ appropriate access (in extracted teeth), coronal, mid and apical preparation with ProTaper and Reciproc, apical gauging, apical verification of final GP point and 3D vertical GP obturation and warm back fill with hot tip and hot shot. Goal of course was to introduce new techniques that may need further practice within simulation and out-of-mouth environments before general clinical use. Course leaders included: Peter Briggs, Tracy Watford and Ahmed Al-Khayatt Course PDF Handouts:
A hands on course for GDPs in the Norwich, Cambridge and Suffolk area on modern tooth preparation for traditional and modern indirect restorations within dental simulation laboratory. The preps covered included: winged PFM, Dentine bonded crown (DBC) and E-max layered and monolith. Finally the full gold crown preparation, which with minimal modifications is similar to a E-max monolith. Course leaders included: Peter Briggs, Tracy Watford and Ahmed Al-Khayatt
Title: Hands-on management of Worn dentition in the 21st Century Thursday 12th Feb 2015 at LonDEC, Waterloo, London The course for South London DCTs provides experience of building-up worn teeth in a high tech simulation environment with knowledge of the aetiology of tooth wear (particularly erosion). The different options of restoration were also covered allowing for balanced messages and treatment strategies. Course leaders included: Dr Igor Blum, Raj Dubal, Sara Tabiot-Pour, Peter Briggs & Ahmed Al-Khayatt
Lecture 3 TSL adhesive and cases LonDEC May 2015
BDA Symposium South West Presidential Meeting Location: Bristol Title: Problems and Solutions for the Older Patients Date: Tuesday 25th November 2014 PDF Handout: Bristol and Bath 2014 Peter Briggs Tunbridge Wells Dental Study Group Title: Restoration and Re-restoration of Posterior Natural Teeth – is it all Worthwhile? Date: Thursday 13th November 2014, Location: Pembury Handout: Tunbridge Wells Posterior Teeth final BDA Seminar Huddersfield, UK Title: Presentation Title: Repair, Re-treat, Restore or Replace?
Peter is presenting a joint day with Phil Taylor (from Barts Health Trust Dental School) in Huddersfield as part of the 2014 BDA Seminars series. They will discuss clinical decision-making, the dismantling and removal of failed or failing restorations and working out the best strategy for patients of all ages. Please find below links to PDFs of Peter’s presentation. Accompanying PDFs:
British Society of Restorative Dentistry – Spring Conference – May 2014 Venue: Mandela Lecture Theatre Oxford University, Oxford Lecture title: Endodontics or Implant? Find full length (40 minutes) HD recording by Dentinal tubules at: https://www.youtube.com/watch?v=nYmvyh2atZs
Please find below examples of papers, healthcare management scenarios and clinical case examples that are discussed at our weekly Registrar seminars in 2014. Clinical Cases -Friday 21st Feb 2014
Health Care Management Scenarios and Clinical Case Friday 28th Feb 2014
Apical Surgery – Clinical Papers – Friday 7th March 2015
Health Care Management presentation at the Faculty of Dental Surgery RCS(Eng) by Peter Briggs on Friday 14th March 2014
Decision-making in terms of natural tooth preservation and restoration versus extraction and placement of implant. Does experience and exposure to implant training affect decision-making in this area? Friday 21st March 2014 paper
Friday 4th April 2014 St George’s Seminar – recent paper on Peri-Implantitis What is the best way to manage peri-implantitis? This 2014 paper tries to answer what a Cochrane review cannot. The problem is lots of bias, lots of different methods, no direct comparison with non-surgical techniques with surgery. A good suggestion of a structured clinical protocol for patients with such problems at end of paper. Hope you enjoy it.
Friday 25th April 2014 St. George’s Seminar – Karoussis et al 2003 – 10 year ITI Implant outcome paper Our group discussed this paper in terms of its strengths and weaknesses. It is commonly used as a reference to support the risk of smoking with perio and the comparison of non-smoking and periodontal susceptibility with implants. It is also use to support the value for money when implants placed to restore teeth lost from caries, trauma or agenesis (hypdontia). Have a careful look in terms of how ‘prospective’ the study actually was and how well matched the sample groups of A and B were. In addition the observational unit is something that may cause concern. Finally I want you to think in an ideal world how you would better design and carry out such a study to answer the research questions it asks? Enjoy
Friday 2nd May 2014 St George’s Seminar – Saunders (2014) I am in Oxford lecturing to the British Society of Restorative Dentistry (BSRD) on the subject of: Endodontics or Implants? Unfortunately the lecture is being recorded and contracted to Dentinal tubules for a 6 week period. In the meantime I post up a good recent article on the subject written by Bill Saunders from Dundee in the BDJ. It is a good, thorough and well balanced critique of the issues involved with good evidence base. See what you think and I promise that I will post the full recording of my BSRD lecture on this my site in 6 weeks time.
Friday 13th June 2014 St George’s Hospital Seminar – TMJ therapies – What is best? Systematic review of three groups of clinical TMJ patients with evaluation of single (dentist) or multi-modal treatment strategies for the different problems described. Interesting conclusions and hopefully useful to all dealing with the TMJ problems.
Friday June 27th June 2014 – Orthododontics Healthcare management & HNC outcome One Canadian study and another study that attempts to stratify the associated confounding factors to allow assessment of dental risks to include: oral heath, gingival bleeding, care from dentists, denture wearing and the risk of alcohol containing mouth rinses. See what you think
Healthcare Management Examples: Long cases (20 mins): Q1)32 year old clinic that needs a refurbishment – discuss how you would put together a business plan. Issues to cover in discussion: Identification of the stakeholders involved, what is involved in the business plan, risk to reward assessment, managing service patients during refurbishment, what equipment would you need what are the purchase options? Q2) 14 year old girl has been referred to NPC via orthodontics for extractions. Mum calls to say she didn’t come home last night and it has happened a few times and wants you to call when she gets to your clinic. How would you manage this? Issues to cover in discussion: Mother / Child relationship / healthcare professional’s duty of care. Who you would contact before the appt, who you would contact if the child did come, who would you contact if they didn’t turn up? If apt was for Rx would you go ahead without parents? What stage would do you call the police? How would you refer to safeguarding team? CAF-what it is and where it goes once you send it off and what happens because of it. Short case scenaros (10 mins): Q1) Out of date prescription issued, dad notices and doesn’t give it to the child – What would you do? Discussion to include: How would you deal with complaint? How would you prevent this? How is severity of incident graded? What is a never – never event? Q2) Nurse flags up that you have used out of date local anaesthesia – What would you do? Discussion to include: Information that you would give to patient and parent / Reporting of incident / Fact finding and Root Cause Analysis of the failure to check and know that drug was out of date. Are others likely to be doing the same? – How would you respond to complaint from patient? What is risk to patient of this incident / Role of WHO pre-op protocol / future strategy – place LA label in the notes. Audit of practice, identify responsibility and implement policy for future safe practice. Q3) A Paed Dent DCT sends out a letter requesting incorrect extractions (permanent teeth instead of deciduous). GDP writes into the Consultant. What would you do? Discussion to include: Nature of fact finding, assessment of DCT capability. Role of Ed Sup, appraisals, WBAs How would you support them? What you would do to rectify the mistake? Can you alter the medical records? 5th September 2014 – Clinical Seminar (separated endodontic instruments / should we remove existing cores and crowns prior to endodontic and re endodontic treatment and if so why?) This seminar concentrated on clinical strategies for to do with an endodontic file separation. A recent BDJ article was assessed with understanding more of the correct balance between risk and reward with regard to removing or accepting the presence of the instrument.
The second paper PV Abbott (2004) is a fascinating paper that assesses teeth that are referred to the Australian author for endodontic therapies. He assesses the pre-operative staus of the tooth and compares this to what is found with the restoration tripped from the tooth. Interesting stuff and big differences between amalgam and composite in terms of pulpal status and restoration longevity prior to problems.
Happy New Year to all . These two papers provide a very different ‘take’ on the two options. One outlines the biological and gingival performance of immediately plced implants – with favourable soft tissue results. The other highlights the risk of losing labial bone if implants are paced early in the ‘osteoclastic-stage’ compared to waiting 6-8 weeks after extraction within the osteoblastic-stage of socket change. Read both, try both clinically and make up your own mind. It will be many years before clinical studies tell us the answer.
The team from the Chapel Hill Team, USA and headed by the popular Terry Donovan (who I lectured with in Oxford in May 2014) – have brought together an excellent and far-reaching scientific review of dentistry to include caries, materials, perio, endo and prostho. This paper is a must for anyone wanting to underpin their knowledge of current evidence from a peer review perspective. I warn you there is a lot to take in and digest so I would suggest you do it in parts and subjects. It will be worth it I promise! Enjoy
Two UK outcome studies on the performance of Resin Bonded Bridges. One a retrospective study at the Eastman Dental Hospital in London (Djemal et al 1999) and the more recent (King et al 2015) a prospective study of RBBs provided at Bristol Dental School. Interestingly Paul King is an author on both papers. As a prospective study the more recent is more scientifically valid and has interesting conclusions including 20% failure in first 5 years which then stabilises for the mature restorations (with little drop off). Factors of statistical note for the Bristol study were: include coverage, bridge design and operator. Rubber dam use does not help survival and the double-winged butterfly bridge to replace missing maxillary lateral incisors performs well. The number of abutments, rather than the number of pontics, was more important for the outcome of multi-winged bridges. Enjoy and see if your view on the long-term predictability of RBBs is changed. Take a look at the statistical method and see what you think about the conclusions. Should we cement with rubber dam? Should we prepare abutments? Is the cantilever design the best? Should we be using double abutment butterfly design to replace missing lateral incisors (hyopodontia patients)? Also compare with Pjetursson’s (2007) systematic review of RBBs – there is a big difference in stated survival probability between this and the King et al (2015) paper.
There is much controversy about TMD. The evidence is constantly on the change and this seminar focussed on a hard look at the best evidence we have on the subject. The areas covered are summarized in my PDF summary of the discussions. I also enclose the evidence that we discussed. Please see what you think and see if you can relate what you personally do for patients with this problem. Does your approach, whether working in primary or secondary care, fit in with this evidence? My summary of discussion areas: TMJ Evidence:
Some ISFE Healthcare Management Questions to be to be considered by the StRs for tomorrow following on from the TMD Seminar: 1. Outline how you would go about setting-up a TMD / Facial pain clinic within a Trust on appointment as Consultant in Restorative Dentistry? 2. Where do you think the responsibility lies for Restorative Dentistry in terms of TMD referrals? 3. In terms of evidence based dentistry and efficient management of NHS resources – what is the most relevant patient pathway for TMD referrals and how might they be managed within the proposed commissioned pathways? 4. What should the London Local Professional Network be doing in terms of setting up the planning for managed clinical networks for TMD and Facial pain and how might this impact on Restorative Dentistry? PDF of useful supporting information:
Course Title: Periodontal / Endodontic / Prosthodontic / Implant interface – to include periodontal / endo infections implants performance in perio disease. The Seminar will look at the things that we need to consider within our area of mono interest when making decisions about treatment planning. Such as when should we crown lengthen? How long should we wait after crown lengthening before placing restorations? The Endo/ Perio defect – how do we decide what is the best thing to do and whether we do the endo or the perio first? You will see another PV Abbot (2009) paper creeps in -like much of his work worth a read. Supportive evidence:
I have also include a PDF on the recent discussions we have had on the clinics on Tooth Restorability – enjoy
A seminal paper from Lindhe that produced experimental periodontitis and plaque to show that within the study limitations that poor plaque control and experimental tooth jiggling can accelerate periodontitis. This is only one of the series of experiments in Sweden that used Beagle dogs. Polson was using Squirrel monkeys in the USA and looked at similar factors. This coincided with the view that occlusal overload may be an important factor in the progression of periodontitis and that there may be a therapeutic role for occlusal adjustment to manage this problem. Then followed randomised study (Burgett et al 1992) to look at the ‘effect’ of occlusal adjustment of patients treated for periodontal disease in Michigan – enjoy and discuss the pros and cons – why are we no longer suggesting this treatment philosophy?
A quick update on the principals of taking accurate static jaw registrations for patients. The seminars focus not on the materials used but more on the understanding of when and when not a jaw registration is necessary. Also the concept of taking registrations and common pitfalls. I enclose two PDFs that I used to accompany the seminars – please try and read some of the references.
Peter qualified from King’s College Hospital in 1983, and completed a Cons MSc at the Eastman in 1988. He has worked as a Consultant in Restorative Dentistry and a Specialist Referral Practitioner since 1995.
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