LCIAD Academy Private Practice Course Module 8: Finalisation

• Do you find it challenging to establish perfect tissue health and gingival stability around dental and implant restorations prior to final impressions?
• Do you have trouble taking full arch impressions or for multiple restorations?
• Do you routinely use custom impression trays?
• Are you pushed for time when carrying out impressions and bite relationship records for full arch cases?
• Define you lose control of the occlusion when transitioning from provisionals to final restorations?
• Do you have a protocol for checking all of the lab work well in advance of it being fitted?
• Do you have a protocol for cementation and bonding of final restorations including booking your laboratory to be on standby for any modifications?
• Do you every have implant restorations that do not fit passively?
• Do you have issues with residual cement?
• Do you have an end of treatment protocol for documenting the final baseline situation?

he objective of this course is to prepare colleagues for successful private practice.

Whether coming into private practice for the first time as an associate, transitioning from the NHS, setting up a partnership or becoming a principal in your own practice for the first time, planning and organising your first practice and the rest of your career can seem a daunting task. Or maybe it seems simple until you start and the reality is very different from what you envisaged.

This course aims to prepare and educate our colleagues on the scope of modern private practice ownership and cover multiple salient topics that are often overlooked or poorly understood with open discussion, advice, and contributions from well-known guest speakers with extensive experience in assisting colleagues achieve their ideal practice environment.

Finalisation of the case is the culmination of many hours of careful work in preparing the patient to render them healthy and dentally stable and comfortable.

The final quality of definitive restorations and their longevity is directly related to the quality of preparations, quality of impressions, quality of the laboratory being used in the maintenance of tissue health and occlusal stability around restorations.

It is important to maintain a sound protocol for preparation of tooth surfaces for bonding and cementation such that every restoration is placed in the optimal environment for longevity and predictability.

This module is run on consecutive days with Module 9 which is a one day module on Maintenance and Management of Complications.

The Big Picture

Introduction to the course, aims and objectives.
Being able to maintain dental and tissue health throughout impression taking, refitting of provisionals and fitting of final restorations.
Whether using analogue or digital impressions, ensuring the ability of your laboratory to produce good quality working models and restorations that fit with a high degree of accuracy with excellent inter-dental contacts and occlusal stability.
Ensuring that the way restorations are fitted optimises their final longevity and ensures comfort, lack of food trapping, good cleansibility and no residual cement or voids that may cause future gum irritation or commencement of new leakage and caries.
Establishing a protocol to ensure that patients are happy with the final work before it is fitted and to make provision for its alteration if this is required.
It is necessary to ensure that the patient is aware of when treatment is completed and what their responsibilities and your responsibilities are from that point forward to look after the work that has been fitted.
Establishing an excellent dental hygiene program following fitting and having a protocol for monitoring future occlusal functional stability, marginal integrity, and control of caries and periodontal or peri-implant disease around the restorations that have been placed.

The Objectives – what steps are required for excellence in finalisation of restorative work

Understanding the ideal bonding cementation materials for the restorative materials being used.
Optimising the tooth surfaces to be bonded or cemented to and the cleanliness of the implants where final implant restorations are being placed.
Having a protocol for closely inspecting and photographing laboratory work when it returns from the lab and allowing sufficient time for any revisions or modifications before the patient attends if this is necessary.
Establishing a protocol for laboratory work to be fitted being biologically clean.
Understanding cementation and bonding protocols and following them to the letter.
Understanding the importance of allowing patients to use occlusal forces to seat restorations which are superior to digital pressure by the dentist.
The use of retraction cord where required during cementation.
Timing of cement removal – the Goldilocks period.
The end of treatment review appointment for baseline reference records and commencement of guarantees in the first week after fitting and its importance.
Decision-making on the requirement for long-term occlusal protection or protection of temporomandibular joints in patients with deranged joint anatomy at the end of treatment.

The Preparation – how do you prepare for finalisation and fitting of laboratory work?

Training your team as to how to set up for restorative fitting of multidisciplinary work such as overlays, veneers, crowns or implant restorations in combined cases.
Understanding how to thoroughly clean all residual deposits of teeth to be bonded or cemented to without irritating the gingival margin.
Understanding how to ensure the laboratory work is of high quality and photographic recording of laboratory work to be fitted at least 2 to 3 days before the patient is due to allow time for any minor modifications if necessary.
Establishing the order of fitting and ensuring that this is adhered to during the appointment.
Allowing adequate time for trying in and allowing the patient to approve the restorative work. Informing them in advance that due to their being anaesthetised during fitting it may be difficult for them to evaluate their smile but to reassure them that their dental restorations have been made to conform with the provisionals that they have already approved.
The importance of a dry run and making sure that restorations fit passively and smoothly before cementation.
When can multiple restorations be fitted at once and when should they be carried out individually?
Assessing the necessity for application of retraction cord before cementation.
Protocols for screw retained and cemented implant restorations – perfect screw hole restorations versus perfect cement removal.

The Method – how to go about making perfect provisional restorations

Having a suitable tray that arranges the laboratory work in the order in which it is going to be fitted so that individual restorations are not mixed up.
Inspecting surfaces of restorations and teeth after trying in and ensuring that services are biologically clean.
Protocols for cementation of crowns
Protocols for bonding of overlays and veneers
Protocols for fitting of individual implant abutments and crowns and the importance of new screw componentry.
Protocols for fitting screw retained individual implant abutments and crown assemblies.
Protocols for fitting full arch implant restorations.
Protocols for end of treatment review appointment and taking of detailed baseline records from which all future measurements and guarantees will be taken.
Revisiting the terms and conditions of guarantee and ensuring that adequate hygiene and examination appointments are arranged following fitting and final review appointment.

Course structure, timetable and content detail

08:30 Registration

9:00 Lecture 1: Dr Koray Feran: Critically assessing final laboratory work preparing for final fit. Order of fit, biological cleanliness and surface integrity.

10:15 Coffee break

10:45 Lecture 2: Dr Koray Feran: Removal of provisional restorations and preparation of tooth surfaces and gingivae for final restoration fitting. Protocols for bonding of veneers, overlays, cementation of crowns on teeth

12:30 Lunch

13:30 Lecture 3: Dr Koray Feran – Protocols for fitting of implant restorations

14:45 Coffee break

15:15 Lecture 4: Dr Koray Feran: the end of treatment review appointment and baseline records

17:00: Questions

17:30 End

One day of structured didactic teaching by Dr Koray Feran who has 3 decades of experience running a high-end referral practice in London’s W1

This two-day course will provide information and experience of providing

Password-protected PDF presentations will be shared with all delegates the day before the course.

Course Days:

Day 1 – The Royal Society of Medicine (RSM), 1 Wimpole Street, London W1G 0AE

Google maps location:

Accommodation near LCIAD map:

When booking The Marylebone Hotel please quote The LCIAD Academy to receive a preferential rate.

You do not need to bring anything for this module apart from your laptop.

In the interests of reducing large amounts of printing for environmental reasons and to keep the costs of the course as low as possible, your presentations will be sent to you as a restricted sharing and password-protected PDF document the evening before the course for you to be able to make digital notes as we go.

We strongly advised that you also have a personal subscription to Adobe Acrobat Pro for maximum flexibility with how you interact with your PDF course notes, though in the first instance Adobe Reader which is free of charge will allow access with more limited functionality.

Type of CPD (A,B,C or D) based on GDP Enhanced CPD development outcome requirements

7 hours of CPD

Development outcomes in bold

A
Effective communication with patients, the dental team and others across dentistry, including when obtaining consent, dealing with complaints, and raising concerns when patients are at risk.

B
Effective management of self and effective management of others or effective work with others in the dental team, in the interests of patients, providing constructive leadership where appropriate.

C
Maintenance and development of knowledge and skill within your field(s) of practice.

D
Maintenance of skills, behaviours and attitudes which maintain patient confidence in you and the dental profession and put patients’ interests first.

Brand new course from 2027

Course fees are charged at £795  for dental surgeons.

The course is restricted to 20 dental surgeons.

Lunch and teas / coffees will be served each day and your dietary requirements can be indicated on the accompanying booking form.