Impt spring summer newsletter 2015

IMPT newsletter S P R I N G / S U M M E R

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Welcome Welcome to the winter edition of the IMPT newsletter.

INSIDE THIS ISSUE:

IMPT Scientific Congress 2015—a look back

2

A lab with a view— continued

4

Free Verifiable CPD—Possible?

6

Intra-oral work and obturation—Where do we stand?

IMPT Congress Award Winners

8

11

Heidi Silk looks back of our recent congress onboard HMS Belfast in London and shares the feedback received. Having been part of team arranging the lectures, I can say that we had an abundance of lectures that we sadly could not accommodate. Given this, I strongly advise those wishing to lecture at the next congress, to submit in plenty of time.

Intra-oral work has been a bit of a hot topic recently with our profession edging towards statutory registration. We ask where the extent of our practise lies with particular reference to the fitting of obturators. This is a subject that will stimulate discussion on all sides. I am happy to share different opinions in future editions

Carmen Orbaneja from St. Georges hospital has written an article about CPD and gives numerous avenues to obtain it for free.

We also have a collection of views from laboratories around the country. I would love to feature as many as possible (good and bad) in future newsletters so get in touch As with every edition, I welcome contributions from every member to highlight instances of professional and personal achievement, opinions, stories and comments.

Finally, as this edition should reach you just before Christmas, I wish you a happy and healthy Christmas and a prosperous and successful new year. And for those of you who are on-call, the rest of us will raise a glass (and a smile) and be glad it’s not us!!!! akearns@nhs.net

IMPT Scientific Congress 2017 The next IMPT congress will be held in Glasgow. We last visited Glasgow in 2003 and we are all looking forward to be another excellent event.

More details will be included in future newsletters and impt.co.uk As the congress in 2015 was over-subscribed for delegates and presentations, we strongly advise making as many preparations as you can in advance of the application and call for papers announcements.

IMPT Congress—London 2015—a look back

The venue of the 27th Biennial congress was easily spotted as I walked over the impressive Tower Bridge, early on the first morning. Not only was the view amazing, the weather was lovely and was promising for the whole duration. On board HMS Belfast, it was quickly realised that we were in for a treat of exploration, history and navigation!! Proceedings started promptly with the inauguration of our new president Kavin Andi, his opening lecture was one of inspiration and awe. His knowledge of digital technology and 3D data manipulation was stunning, giving us a glimpse of what is coming in the future with vascular analysis and augmented reality, merging the virtual world with the real world. We are extremely fortunate to have his support and guidance over the next two years.

The morning progressed with the first free paper session, invited speakers Professor Lucy DiSilvio and Professor Mike Fenlon gave interesting and informative presentations on Tissue engineering and Obturation, showing how near the reality of in-situ tissue engineering is and the realisation of obturation as a treatment option and life style for the patients. They were followed with the BAOMS Lecture from Niall Kirkpatrick. His lecture, “Facing the world” was outstanding, showing challenging and complex cases from his charity work with children from all over the world. He demonstrated the significance of the development and use of CAD/CAM in preoperative planning and how it has advanced the success of these cases. All in all, an amazing start to the congress.

There was great support from the trade stands that were attended at refreshment breaks and the poster presentations were viewed whilst enjoying lunch. The different venues for these allowed us to explore the historical areas and displays around the ship; there was always a surprise around the corner!!

Lunch was followed by session 2, the topics being on; the pathways for registration as Clinical Scientists, equivalence to do so and the forthcoming Higher Specialist Scientific Training (HSST) in Reconstructive Science. There was interesting debate on why and when equivalence will be needed, along with concerns for the future provision due to low applicant numbers and lack of host units for the potential students.

Session 3 concluded with presenters showing research results, modification of surgical planning with CAD/CAM and an overview of case studies, with all speakers showing expertise in their fields.

After a full-on first day it was over the bridge for a quick freshen up then back over the bridge again to meet in the Horniman Pub, a former tea warehouse. I must admit, this wasn’t the highlight of my time in London, however, the good company, atmosphere and chatting the night away soon took us on to thinking about having to get up and do it all again the next day.

Free paper session 4 on the Friday morning was not to disappoint, overseas presenters on ocular prosthetics showed how their skills give the patients acceptance into their communities and another presentation showing how overseas collaboration using digital technologies could be used to provide prostheses to patients remotely. Emma Worrell showed an innovative technique that can be easily and cheaply introduced into units to reduce the weight of ocular prosthetics, and lastly, a presentation of difficult and complex cases that would have been fascinating…….. with a little more preparation.

After the coffee break it was time for the STP session. All lined up and ready to go, they all gave terrific presentations; two case studies and five proposals for their forthcoming research projects. This was a great feature for the congress and shows the high level of attainment that these future Reconstructive Scientists have already achieved.

The final session of the congress concluded with presenters sharing knowledge of all aspects of maxillofacial prosthetics/reconstructive science – 3D orthognathic planning, prosthetics and surgical reconstruction of the nose, ocular prosthetics, research and finishing with the surgical and prosthetic rehabilitation of possible palliation cases. After a short IMPT business meeting, it was back over that magnificent bridge again to get our glad rags on for a night of entertainment.

All aboard the transformed HMS Belfast we were entertained with music and some mystical ladies of the sea. This was followed by a very enjoyable meal, very entertaining after-dinner speeches and the prize giving ceremony. The evening ended with live music, drinking and dancing on the deck with the mermaids and two nautical contortionists. There was much laughter and entertainment for all, a fantastic finish to the congress.

It was with much sadness that Chris Maryan announced this would be his last congress. As one of the most significant contributors to maxillofacial prosthetics over the decades, it really is the end of an era.

His enthusiasm, frivolity, knowledge, ability and skills politically and practically leaves congress with a sizeable hole to fill. Thank you Chris, you are a legend!

HMS Belfast was a unique and quirky venue for the congress, after finding our feet on board and getting our bearings, the two days of full-on lectures left me feeling inspired and motivated for my return to work!!

Heidi Silk

A lab with a view…………..

We all know the value of natural light when mixing silicone, having a nice view from our treatment rooms and laboratories is an added bonus. Below are a small collection of views from laboratories around the country.

Left is the view from Chris Maryan’s Lab during his time at Fulwood Hospital in Sheffield.

Below is the view from the lab at Salford Royal. In spring, wagtails are frequent visitors (to the trees, not the lab).

These images are from the lab at the Queen Victoria Hospital in East Grinstead. As you can see, the church bell is 6 feet from the lab window and its weekly ringing led Adrian Kearns to wrap the clapper in bubble wrap on his last day working there. The bellringer was not impressed!

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This striking image is from Guys Hospital in London. The unmistakable view takes in the Shard, Tower Bridge, Canary Wharf and those with good eyesight will make out the HMS Belfast.

Two contrasting views from labs in the South-West. The picture on the right is the spectacular view from Salisbury which has to be one of the best. The one on the left is from Poole which lets say is ‘industrial’.

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Free Verifiable CPD: Possible?

As registered dental care professionals (DCPs), keeping skills and knowledge up to date throughout the career is a duty to maintain. Continuing Professional Development (CPD) is the scheme DCPs must take part in by law to maintain and update knowledge and behaviour therefore delivering good quality care throughout their working life.

The General Dental Council recommends CPD topics for DCPs to do as part of the minimum verifiable CPD requirement, which are:

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Medical Emergencies: at least 10 hours in every CPD 5 year cycle.

Disinfection and Decontamination: at least five hours in every CPD 5 year cycle.

Materials and equipment: at least five in every CPD 5 year cycle.

Other topics recommended by the GDC are:

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Legal and ethical issues Complaints handling Oral Cancer: Early detection Safeguarding children and young people Safeguarding vulnerable adults

As DCPs, Maxillofacial Prosthetists must comply with a minimum of 150 hours of CPD every five years; at least 50 of these hours should be verifiable CPD. Requirements for CPD to be verifiable: “Submission of first grade photocopies of verifiable CPD certificates from the provider or organiser, often in the form of a certificate of attendance or other written document. It should show the number of hours spent on the activity, what the activity was, the date the activity took place and the professional’s name”.

Also, they will not be counted courses which took place over a whole day or a number of days as 7 hours per day. If certificates do not state the time spent on them, the GDC will require a program curriculum, showing hours or time”.

Materials and Methods There are various ways in which to obtain free verifiable CPD at every professional’s convenience, these are:

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Induction courses In-house e-learning Presentations held in the unit by commercial organisations to promote their service.

Exhibitions and Roadshows: One example is the "Dental Showcase", which is organised annually by the British Dental Trade Association (BDTA).

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Also, Tri-Tech 3D offers the latest technology in 3D printing and scanning roadshow around the UK.

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Visits: They can be arranged with other Maxillofacial Prosthetics Units, a company related to the field (silicone, 3D models, spectrometry, cad-cam design, implants…), or any place which will provide additional valuable knowledge to improve practice.

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Evening lectures provided by The School of Clinical Dentistry: The University of Sheffield . It is required to book online

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Isopharm Online verifiable CPD is provided in the form of various courses from 30 minutes to 1 hour.

Once each course is finished, a printable PDF certificate will be stored in each personal account.New courses available every month.

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ProDental CPD E-learning course as a CPD trial. Assessment within the module and again at the end will be carried out. Once passed, a CPD certificate is saved in each CPD log.

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4everlearning 1 hour verifiable CPD by watching an online course and then successfully passing a test. A certificate is then sent to each personal e-mail account.

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Dentsply This website provides plenty of webinars which last from 1 to 2 hours, at the end of which a test is taken in order to obtain a certificate. (11) Carmen Orbaneja MIMPT Maxillofacial Prosthetics Service Saint George’s Hospital, London Carmen.Orbaneja@stgeorges.nhs.uk

Many thanks for Carmen for this interesting article. I am sure this will give everyone an avenue to boost areas where their individual CPD is lacking.

If anyone has any suggestions for further CPD opportunities, please let me know.

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Intra-oral work/obturation—where do we stand?

Our profession is now recognised as an independent specialism within the family of healthcare science with post-graduate entry into the Scientist Training Programme (STP). Successful completion of the work -based training and the associated Master’s degree programme leading to the award of a Certificate of Attainment from the Academy for Healthcare Science enables graduates to register with the Health and Care Professions Council as a Clinical Scientist.

This standardisation of education, along with the Assessment Interview Board, ensures those holding MIMPT are in the best possible position to offer exemplary patient care. Coupled with lifelong-learning; practices are challenged, improved and developed. We continue to ensure that the practice we undertake and the devices we make have the patient at their core, knowing what to do, what not to do, when to treat, and when to refer on as part of patient care.

“...at no point has the fitting of dentures with obturators ever been part of our education, training or

We also register with the General Dental Council (GDC) as Dental Technicians in order to undertake the dental aspects of our role; this has legal and ethical implications. As we know, the taking of intra-oral impressions, occlusal registrations and facebows are additional skills registered dental technicians can undertake, however much of our practise is outside the scope of our GDC registration.

Prior to registration in 2008, a joint statement issued by the Department of Health in conjunction with the GDC and IMPT stated “…maxillofacial prosthetists can continue to practise dental intra oral work…” This would appear that in the case of obturators, an MfP can construct, manufacture and fit these devices if they also have GDC registration. However we must be aware of the correct definitions in discussing this. An obturator is the bung that fills the hole; it may or not be attached to a denture or other intra-oral device. The denture or dental device may have a different legal status.

practise.”

However the statement continues “Relevant expertise will be sought where extra oral work is in issue and the GDC would expect the standards of such work, and education and training relevant to it, to be achieved to appropriate relevant professional standards, for example, IMPT standards.” This would indicate that obturation undertaken by an extra-oral approach associated with a facial prosthesis is subject to a standard being achieved through education and training, which it has been in the past, and is being significantly enhanced via the STP and HSST. The GDC statement is now over seven years old and since then; we now have a new GDC curricula and Scope of Practice documents. This raises further questions.

It would appear that the GDC approved our intra-oral work such as obturators provided we have the training and education to evidence all stages of this work. The crux however is that at no point has the fitting of dentures with obturators ever been part of our formal education or training. It would appear that some units have assumed this role over the years for whatever reasons, their skills developed in-house and not formally assessed. The new STP and HSST curriculum does not include fitting in any section.

The theory of clinical stages of denture and obturator construction were covered to give background in these aspects but the log for the Diploma in Professional Studies only had ‘observe’ relating to impression, occlusal registration, try-in, fitting and review relating to obturation. We did however have training and education in the construction of prostheses for mid face defects approaching through the face.

Nice guidelines stipulate the presence of a consultant restorative dentist at all regional Head and Neck MDT’s, with the MfP being part of the team, their presence not mandatory, but to be available when their input is required. The new Higher Specialist Scientific Training curriculum defines the role of our scope in relation to our abilities and expertise with regard to facial prosthetics and rehabilitation, however the role of Reconstructive Scientists (RS) MfPs or any other healthcare scientist are not mentioned anywhere within the NICE guidelines. Failure to recognise this surely falls short of the potential benefit of a MDT an issue for another newsletter. However as a restorative dentist is a required part of the MDT, it is implied their presence is to take the ‘team lead’ in aspects of care in the case of prosthetic obturation.

Another question raised is whether an obturator is a surgical or dental device. It can be argued that a device inserted/reviewed/adjusted in theatre could come under the role of an MFP if classed as a surgical device. If classed as a dental device it may require direct dental supervision. This raises the questions.

When is an obturator an obturator?

The glossary of prosthodontic terms refers to an obturator as “that component of a prosthesis which fits into and closes a defect within the oral cavity or other body defect”. So for two-part obturators, this relates to the (mainly) silicone section that seals off the nasal and oral cavities. We all know that in order for this to function, the connecting section (generally with teeth) is required to engage to provide a fully functioning device. Does this mean the silicone component is the obturator and the connecting component is a denture? What about one-part obturators? Are they obturators or dentures?

We have never been formally trained or assessed in the clinical aspects of providing a dental device, dentists and clinical dental technicians (CDT) are, but CDT’s can only deal with edentulous cases.

The Dentists Act 1984 Section 37 states the following.

Definition of practice of dentistry.

(1) For the purposes of this Act, the practice of dentistry shall be deemed to include the performance of any such operation and the giving of any such treatment, advice or attendance as is usually performed or given by dentists; and any person who performs any operation or gives any treatment, advice or attendance on or to any person as preparatory to or for the purpose of or in connection with the fitting, insertion or fixing of dentures, artificial teeth or other dental appliances shall be deemed to have practised dentistry within the meaning of this Act. (2) Dental work shall not treated for the purposes of this Act as amounting to the practice of dentistry if it is undertaken under the direct personal supervision of a registered dentist As the majority of obturators have teeth, it would appear that fitting dentures with obturators is an act of dentistry, but the obturator alone may not be. To counter that we can always refer to the 2008 statement that states the GDC will not interfere with the intra-oral work undertaken by MfPs. This can be countered still by the question that if the GDC were aware that our practice, education and training has never included the fitting of obturators, if this were tested in the courts, would we be deemed to be acting outside our scope of practise?

If the fitting of obturators is mentioned or implied within a MfPs job description, could it be suggested that the hospital is complicit, or has been misled by the author? Again, if challenged in the courts, would we be deemed to be acting outside our scope of practise?

Whatever your views are, it would appear that the argument of having done something for years and nothing has gone wrong, would be difficult to justify when it can be argued for other more suitably qualified lead care providers. MfPs however have extensive knowledge as our training and curriculum proves. This means that we are still an integral member of the clinical and surgical team when it comes to aspects of obturator and patient care.

Continued on next page

The IMPT Professional and Ethical Code states: Recognise limits of competence. If required, liaise with colleagues in the patient’s best interest.

You must acknowledge the bounds of your skills and knowledge and, if necessary, be willing to confer with or seek guidance from colleagues.

Should we continue to fit obturators as we have not been challenged or taken to court? Or should we continually evaluate our practise, change and adapt our role in line with current guidelines?

The NHS continually evolves and every profession within it must re-evaluate its role and the service it provides with the patient’s best interest paramount.

If you have a point you wish to share, I am happy to continue the discussion. akearns@nhs.net

Steps towards registration Congratulations to Jason Watson from Nottingham as he becomes the first member of the IMPT to complete AHCS equivalence assessment and is now eligible to register as a Clinical Scientist with the HCPC. Jason in his role as IMPT Education Officer is working with council to offer guidance for IMPT members for their applications. Keep a look out for announcements on the website.

Education courses for all.

Following the recent Council meeting, the possibility of introducing structured education/study sessions was discussed. We are looking for input from the membership with the view of Introducing the idea at the spring/autumn seminars. This may be in the form of workshops, demonstrations or round table discussions. We are welcoming any topic or format ideas that you think would be of benefit. Please send any ideas to Heidi.silk@poole.nhs.uk and the feedback will be discussed at the next council meeting on Wed 9 th march. We look forward to hearing from you.

IMPT Congress Award Winners—2015 The Wim de Ruiter Delft Plate Awarded for significant research contribution. Mr Wim de Ruiter from Ridderkirk near Rotterdam provided a maxillofacial prosthetic service for the Rotterdam area and donated this award in 1985.

Awarded to Taranjit Malhotra.

The Mount Vernon Award Awarded for outstanding clinical or technical practice. Designed and fabricated by Chief Maxillofacial Prosthetist Mr John Hayward at Mount Vernon Hospital, this award was first presented at the 1981 IMPT Congress held at Brunel University, London.

Awarded to Joern Brom and Dr Philipe Federspil

The Presidents Award Awarded for the best poster display. This award was inaugurated in 1983 at the IMPT Congress; held at the Royal College of Surgeons, London.

Awarded to Dr Andreas Artopolous

The Kidd Award Awarded for innovation. This award was donated by Mr Norman Kidd, who began making subperiosteal implants in 1956 and upon his retirement, instigated the Kidd Award plaque in 1997.

Awarded to Kavin Andi

The Ian MacLeod Alumno Award Awarded to the most outstanding contribution from a student or junior/associate IMPT member. This award has been dedicated by the IMPT in honour of Ian MacLeod; a member of the IMPT who had a positive influence on many young MfP’s.

Awarded to Sabah Zaulifqar

Technovent Award for the best first time lecturer Awarded to the best first time lecture delivered at congress Awarded to Amy Davey

Materialise Award for the best Journal article This award goes to the individual with the best journal article chosen from the Journal of Maxillofacial Prosthetics and Technology Awarded to Muhanad Hatamleh

The IMPT Travel Fellowship £1,000 is awarded to the successful applicant to provide the means for study and research. This award is assessed and awarded by the Fellows of the IMPT. It must be applied for prior to the IMPT Congress by contacting the Chairman.

Awarded to Dr Neeraj Chandraker The Brian Conroy Award Awarded for outstanding services to maxillofacial prosthetics. Donated by Mr Brian Conroy MBE FIMPT (Hon) in 1969, the award was commissioned- “For those who have given significant service for advancement in technology, prosthetics, surgery and other activities that relate to maxillofacial prosthetics and technology”.

Awarded to Richard Eggleton

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Congratulations

Nipple areola prosthetics course

Congratulations to the following people who have successfully completed their AIB and are now full members of the IMPT.

Calling all STP and MSc students.

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Naomi Pearson

One place has become available on the Nipple Prosthesis Training Day on Friday 26th February 2016. Please contact Heidi Silk on Heidi.silk@poole.nhs.uk if you are interested.

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Holly Turner

Congratulations Congratulations to James Dimond from Coventry and Holly Turner from Birmingham on their recent marriage. As they cement their role as the ‘Posh and Becks’ of the MfP world, we wish them all the best for a long and happy future ahead

Merry Christmas The IMPT Council wishes all of its members, associates, fellows and colleagues in the UK and around the world, a very merry Christmas and a happy and healthy new year

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