Australasian Dental Practice May/Jun 2022 by dentalcommunity

dentevents presents...

Infection Control

UPDATE 2022 5hr FACE-TO-FACE LECTURE + 1hr VIDEO

SYDNEY | SEPTEMBER 3, 2022 Presented by Emeritus Professor Laurence Walsh AO

BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FFDT (RCS Edin)

This course will discuss recent developments in infection control and their practical implementation in dental practice. The course is presented face-to-face with some video materials as required content to be watched prior to the session. The video material covers recent changes in the regulatory space in terms of the Dental Board of Australia (July 2022) and the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021).

HOURS CPD

TOPICS for the face-face session include: Topics for the face-to-face session include: n

Applying the chain of infection and risk assessment to special situations - including pandemics of coronaviruses and influenza viruses.

Best practices for PPE, Hand hygiene and Environmental cleaning.

Preventing the spread of contamination using high volume evacuation and pre-procedural rinses and dental dam

Applying quality assurance measures to instrument cleaning and sterilizing, including performance tests for washer disinfectorsand ultrasonic cleaners

Common errors in instrument reprocessing and how to prevent them

Low temperature sterilization technologies

Enhancements in dental clinic design, including airflow

Managing water quality for dental practice

A Vital Update on recent changes...

Dental Board of Australia (Jul 2022) ADA Guidelines (Aug 2021) COVID-19 (Oct 2021)

FULL UPDATE! All the changes to Infection Control Guidelines in 2022

Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. Laurie has been teaching and researching in the areas of infection control and clinical microbiology for over 25 years and was chief examiner in microbiology for the RACDS for 21 years. His recent research work includes multiple elements of infection control, such as mapping splatter and aerosols, COVID vaccines and novel antiviral and antibacterial agents. Laurie has been a member of the ADA Infection Control Committee since 1998 and has served as its chair for a total of 8 years, across 2 terms. He has contributed to various protocols, guidelines and checklists for infection control used in Australia and represented dentistry on 4 committees of Standards Australia and on panels of the Communicable Diseases Network of Australia and of the Australian Commission on Safety and Quality in Health Care.

REGISTRATION FEES

Dentists

$660 inc gst

Others

$330 inc gst

DATE AND TIME

Sydney

Saturday, 3 September 2022

Starts 8.30am | Ends 2.30pm | Rego opens 8am See the website for venue details

Infection Contol Update 2022 is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Infection Contol Update 2022™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2022 Main Street Publishing Pty Ltd

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VOLUME 33 | NUMBER 3 MAY/JUNE 2022

contents | REGULARS

On the cover... With Simplicity by Kerr, three trusted brands are being highlighted as one effective solution for simplifying your restoration workflow and inventory management.

management

8 10 12 14 16 66 68 70 146

briefs

76 Huge financial changes to impact dentists If your staff don’t highly value your services, 80 then treatment plans won’t be sold Why are they selling? Why good business 82 owners sell strong businesses to prosperity: A dentist’s guide to 84 Pathway wealth creation - Part 2 Your biggest investment in your practice 86 should be this

one man’s opinion in my practice mouth wide shut spectrum CPD centre

marketing

abstracts

scary words that are costing your 88 The practice big time

the cutting edge

finance

new products

facebook.com/dentalpracticenow

Do “Finfluencers” have a place in the Australian advice landscape?

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www.dentalpractice.com.au Publisher & Editor: Joseph Allbeury Clinical Editor: Dr David Roessler Technology Editor: Prof. Laurence J. Walsh Infection Control Editor: Prof. Laurence J. Walsh Senior Contributing Editor: Dr Christopher CK Ho Columnists: Dr Georges Fast, Dr Jesse Green, Garry Pammer, Phillip Win, Dr David Moffet, Graham Middleton, Simon Palmer, Julie Parker, Jayne Bandy, Angus Pryor Design & Production: Jasper Communications Australasian Dental Practice™ ISSN 1445-5269 is printed in Australia and published six times per year by Main Street Publishing Pty Limited ABN 74 065 490 655 PO Box 586, Cammeray NSW 2062 Tel: (02) 9929-1900 Fax: (02) 9929-1999 Email: info@dentist.com.au

© 2022 All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

Subscriptions: Australia and NZ: A$99.00 per year includes OralHygiene™ and eLABORATE™ magazines; Overseas Airmail: A$220.00 per year.

May/June 2022

Australasian Dental Practice

contents | FEATURES

VOLUME 33 | NUMBER 3 MAY/JUNE 2022

infection control

clinical excellence 92

102

Case report: Same day restoration of an upper lateral incisor

102

control: Facts versus 92 Infection fallacies in the post-June 2022 world 98 Preventing needle stick injury

READ ME FOR

CPD

110

Applying digital dentistry to an aesthetic restorative case

READ ME FOR

CPD

READ ME FOR

CPD

110

surgery design 134

How to talk about pedo crowns

116 with your paediatric patients

READ ME FOR

CPD

134 Class 1 Orthodontics opens West Perth Luna 2: The versatile dental restorative 120 for every dentist Canberra Dental Specialists practice is born 140 Case report: Sinus filling for 122 implant placement Case report: Step by step - Three-unit bridge 124 in the posterior area with Straumann BLX implants and immediate prosthesis

May/June 2022

Australasian Dental Practice

briefs | NEWS Party like its 2019...

t almost seemed like we’d never had a pandemic as Digital Dentistry & Dental Technology 2022 opened on June 3. For all intents and By Joseph Allbeury purposes, the event unfolded exactly the same as the last staging in 2019. A huge crowd attended to hear a first class 2-day lecture and workshop programme delivered by our amazing line up of 43 speakers, enjoying breaks amongst a healthy trade display. It was bustling, noisy and energetic. It felt right. It felt familiar. And it was fun. But of course it was by no means a fait accompli that it would be like this. Some of the other dental events I’ve been to this year felt a bit “off”. And I don’t mean that in the obvious transitioning-from-a-pandemic sort of way. And then there were a number of worst case scenarios we planned for - like speakers being unable to attend - that also never happened. And the icing on the cake was that there were no reports of the event being a COVID super-spreader, as had occurred with a dental event earlier in the year, so it ticked every box in every way. So thank you very much to everyone who came together to help with the staging of one of the largest educational events in Australia... from speakers, to sponsors, to trade exhibitors and everyone who helped... and most especially to the almost 500 delegates who attended. Thank you. For everyone who did attend and for those who were unable to make it, we’re planning a few spin-off events throughout the rest of the year. And what I mean by that is we’re running some full day programs with some of the speakers from Digital Dentistry & Dental Technology 2022 that will provide greater detail and insight into hot topics. The first of these is a full day event with Sam Dias on intraoral scanning and digital dentures on September 10 in Sydney. Sam’s sessions at DDDT22 were packed and he is keen to present a more detailed presentation based on how he delivers dentures digitally every day through the four dental practices he owns in Sydney and regional New South Wales. This is a dose of reality from first hand experience so if you’re interested in creating dentures digitally, register now at www.ios.events. We’re also looking at another full day programme on 3D printing with a selection of speakers from DDDT22 presenting a masterclass - so stay tuned for more details. A raft of changes have occurred to infection control regulations in Australia from the Dental Board of Australia (July 2022), the new edition of the Australian Dental Association Guidelines and also regarding COVID-19. On September 3, Emer. Prof. Laurie Walsh AO, the doyen of infection control in Australia, will present a one day update of all these changes and more. Register at www.icupdate.au. Finally, we’re looking for readers to start contributing videos to Dentevents.TV and each month we’re offering a prize for the best video! See page 16 for details. Stay safe! Joseph Allbeury, Editor and Publisher

8 Australasian Dental Practice

Biodentine tops 1000 scientific publications

eptodont’s Biodentine “bioactive” dentine substitute now has more than 1000 scientific publications on Pubmed supporting the major benefits it brings in restorative, endodontic and paediatric procedures. This increase in the number of publications is indicative of a strong scientific community endorsing Biodentine and researchers’ interest on all the benefits of this product. Biodentine is a tricalcium silicate-based material designed to be a permanent dentin substitute. It is bioactive and biocompatible and was developed using the purist form of calcium silicate cement. The Septodont research team persevered in combining their efforts in creating the patented Active Biosilicate Technology (ABS) with the completed formulation surpassing Portland Cement.

IDEM Singapore coming up on October 7-9

DEM Singapore 2022 is coming up on 7-9 October 2022 and it’s timed to coincide with School Holidays in all states except Queensland and Victoria, making it the ideal event to combine business and pleasure. IDEM Singapore 2022 is also moving to a new home at the Sands Expo and Convention Center, making the iconic Marina Bay Sands hotel next door with its 150m rooftop infinity pool the perfect place to stay... and to top it all off, the event starts a few days after the Singapore F1 Grand Prix. Tick. Tick. Tick. As the leading exhibition and conference for the dental industry in the Asia-Pacific, the aim of IDEM is to provide a comprehensive experience and bring together exhibitors and attendees from all over the world. IDEM Singapore is the leading dental exhibition and conference in the Asia-Pacific region. Participants at IDEM 2022 can look forward to a series of programmes that cater to the dental community including a Trade Exhibition with 400 local and international exhibitors; Scientific Conference - with the theme of Building Resilience in Dentistry with over 30 conference sessions and workshops; and IDEM 360 - a supplementary digital platform. Registration is now open. Register before 2 August and use PROMO CODE IDEMADPMCR9B to SAVE 10%. To register, visit www.idem-singapore.com for more information.

May/June 2022

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spectrum | NEWS Online Resources for the Dental Profession...

One man’s opinion...

By Georges Fast

www.dentalcommunity.com.au • • • • • • • • •

Update your personal details Update your practice on dentist.com.au Manage your subscriptions Read 13,500 articles from past magazines Log your CPD points Answer CPD Questionnaires Run your own dental events Create online discussions And more...

www.dentevents.com

• Dental education calendar • Register for all popular dental events

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• Find-a-dentist in New Zealand

www.dentalpractice.com.au • Australasian Dental Practice™ online

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www.elaborate.com.au

• eLABORATE™ magazine online

“The interesting thing is that many corporate dentists are being paid an hourly rate that is significantly lower that that which I pay to my dental assistants!”

rying to keep up with the latest developments in dentistry, both clinical and administrative, is reminiscent of the fifth labour of Hercules when he was tasked with cleaning out the stables of King Augeas. That alone is hard enough, yet dentists appear to want to complicate things further by allowing themselves to be the whipping boys of the health funds and insurance companies. I happened upon an article in “The New Dentist” by Dr Travis Campbell. In his opening paragraph he says that: “The most cited complaint within a dental office stems from stresses generated when dealing with dental insurance. Stressors can range from simple irritation about response times and misinformation, to declining reimbursement trends, increasing incidence of claim denials, disallows or audits”. He then finishes with: “Why then do we deal with dental insurance at all?” He continues by providing statistics based on the American experience where the uptake of dental insurance is significantly higher than in Australia, resulting in a higher proportion of patients not availing themselves of dental treatment in any one year despite having insurance cover, as this is often an automatic part of their salary package. In Australia, where most extras cover (including dental) is paid for by the patient, usage amongst those insured appears to be proportionately higher. A simple mathematical calculation would easily prove that because of this, rebates have to be lower. The legislation that proposed to make it illegal for health funds to pay different rebates to patients attending preferred providers lapsed with the calling of the 2019 Federal election. There is now a financial incentive for the funds to redirect patients to preferred providers (who are contracted to charge lower fees per service) and also to health fund owned clinics. There are increasing reports from patients that have attended corporate owned or heath fund owned clinics that they were treated by the next available dentist and not necessarily the one who examined them in the first place. Having spoken to (admittedly disgruntled) dentists who have worked in a corporate environment, it appears that they had KPI’s (Key Performance Indicators) and were expected to produce an average hourly dollar return for the practice. The interesting thing is that many of these dentists were being paid an hourly rate that is significantly lower that that which I pay to my dental assistants! I worked in such an environment when I was employed as a locum in a couple of large NHS clinics whilst doing some studies in the U.K. half a century ago. The volume of work that was required and the resultant quality was something that I will never forget. In one practice, I was expected to see 60 patients in a six-hour day and no low speed handpieces were provided - all work was to be performed with an air rotor and a manual excavator. The owner drove a Rolls Royce! It is in the interest of the health funds and the corporate practices to convince the public and the government that dentistry is a product and not a service. If we want dentistry to survive as a health profession and to keep our self-respect, we must fight this tooth and nail. The alternative is a fragmented profession where high quality professional service and clinical excellence is the guiding principle for treatment will become the province of the wealthy and the well-educated. So much for an egalitarian society!

May/June 2022

2 ndGeistlich Symposium Sydney

The Future of Regeneration is Here! 21-22 October, 2022

Scientific Presentations by: • Prof. Lisa Heitz-Mayfield • Prof. Sašo Ivanovski • A/Prof. Stephen Chen • A/Prof. Tino Mercado • Dr Mike Danesh-Meyer • Dr Wendy Gill • Dr Ryan Lee • Dr Lydia Lim

Clinical Case Reports by: • Clin. A/Prof. Mehdi Valizadeh • Dr Jamil Alayan • Dr Mahnaz Syed Hands-On

International Keynote Speaker

Prof. Matteo Chiapasco Keynote Lectures:

• Peri-implant soft tissue thickening using Geistlich Fibro-Gide®: indications and medium to long-term outcomes • Protected bone regeneration of large defects with Yxoss: medium to long-term experience and handling of complications Hands-On workshop: Saturday afternoon – Dedicated to hard and soft tissue regeneration with a variety of practical exercises – limited numbers available. Register now!

Advances

in Oral Regeneration

online

International Speaker

Prof. Mariano Sanz

Need for keratinised mucosa around implants. Modern approaches to periimplant soft tissue augmentation

Joining Live from Madrid!

Venue: Park Hyatt, Sydney TO TOSCAN REGISTER REGISTER NOW!

CLICK HERE

or register at dentevents.com

For more information please contact our customer service team on 1800 776 326.

spectrum | NEWS

In my practice... By Christopher Ho

“Anycheck is a device that measures the time of contact between the impacting rod and the healing abutment. It strikes the healing abutment six times over three seconds and converts the time into the implant stability test (IST) values... but does not require the removal of the upper component of the fixture...”

his issue we look into some products and equipment that I use in practice. We look at some recently released new products and elaborate on how their use can be applied in practice. Investing in the right armamentarium allows clinical practice to be simpler and more enjoyable for the wet-fingered dentist and hopefully, this column provides the reader with some of the latest “tools of the trade”.

protect the implant. Use of the Osstell ISQ requires removal of the upper component of the fixture (cover screw or healing abutment) and connection of the smart-peg when measuring implant stability which has additional costs and can be inconvenient, while the Anycheck can be used directly on the healing abutment. This is much simpler with no need for separate purchase of Smartpegs used for Ostell device.

Trollfoil Blue articulating paper

Kerr Trimming & Finishing Carbides hen layering a restoration, it is advisable to build-up in a manner so that finishing is minimal as there is often an inherent damage to the restoration:tooth interface with the finishing procedures. Enhancing the marginal integrity and finish is fundamental to a long term stable interface. The Kerr Trimming & Finishing Carbides are designed to provide a smooth finish on composite, amalgam or crown and bridge restorations. The egg and needle shapes are an ideal fit for interproximal, buccal, lingual and occlusal areas. One of the advantages of these is that they are designed to remove composite with minimal damage to natural tooth structures and thus recommended when finishing a restoration. The only downside is that they do blunt relatively easily and hence need replacement regularly to ensure efficient cutting.

Anycheck (Neobiotech)

he stability of a dental implant is used to predict the prognosis of the implant. This stability is defined as the ability of an implant to resist vertical, horizontal and rotational forces and is employed as an indirect index of osseointegration and successful healing. There are several methods to measure primary stability and some techniques involve non-invasive quantitative analysis, such as resonance frequency analysis (RFA) (e.g. Ostell) and damping capacity analysis (DCA) e.g. Anycheck, Periotest. Anycheck is a device that measures the time of contact between the impacting rod and the healing abutment. It strikes the healing abutment six times over three seconds and converts the time into the implant stability test (IST) values. This device strikes the healing abutment with less force compared to the Periotest and has a function to stop automatically when the stability is low to

12 Australasian Dental Practice

nalysing occlusion can sometimes be frustrating with some paper being too thick, or sometimes not marking consistently. One of my favourite articulating films is the TrollFoil Premium Articulating Paper. It can be used under a wide variety of clinical situations including wet or dry teeth and on metal and non-metallic restorations. This double-sided Premium Articulating Paper is only 8 microns thick and it has no problem marking wet surfaces, dry surfaces or highly polished surfaces such as cast gold or zirconia. It comes packaged with a handle and conveniently with an outer barrier protecting the film from fingers for a clean environment.

About the author Dr Christopher Ho is a Specialist Prosthodontist in Sydney. He is Head of School of Australasian College of Dental Practitioners, Visiting Lecturer at Kings College London, Adjunct A/Prof at University of Puthisastra and Editor of the WileyBlackwell textbook “Practical Procedures in Aesthetic Dentistry” and “Practical Procedures in Implant Dentistry”.

May/June 2022

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spectrum | NEWS

Getting your ducks in a row

By David Moffet

“We heard a call at a dental office where the caller was inquiring about a consultation to discuss ALL ON 4™ treatment and was told no appointment was available for some two months. Meanwhile, at the same practice, we heard a caller with a toothache being given an appointment the next day...”

e hear some crazy stuff being said on dental office phones. And it’s not just crazy stuff being said by callers who can’t speak dental lingo... its real crazy stuff being said by the dental office team members. It’s stuff that makes me wonder what the heck these people are doing answering the dental office phone? After all, you wouldn’t want to go to a dentist who wasn’t educated and trained and registered in the necessary skills required to perform dental procedures on paying patients? Would you? And you wouldn’t want an unskilled person pretending to be a radiographer and dialling up the incorrect amount of radiation? Would you? Then why would you allow someone unskilled and untrained in the art of phone communication to answer your phone? And if the telephone is the lifeblood of every business, supplying a never ending supply of new business enquiry calls, why would any business not employ the best and most highly skilled and trained people to answer those calls? And why would those business owners not keep those employees accountable for their performances and have them coached and trained by highly skilled coaches? It just makes no sense not to do that... From what we hear... We listen to incoming calls at the businesses we coach. And let me tell you this... there are a lot of times during those calls where employees answering those calls DROP THE BALL and deviate from the ideal phone call structure and turn off new customers making genuine enquiries. And the worst part about this is that because the employees are not focused on the results they should be achieving and are not focused on solving the callers’ problems, they are oblivious to how poorly they are performing. And they are oblivious to the fact that their poor performance is dramatically affecting the income that their employer’s business should be making. In dental... We often hear employees answering the phone who are so focussed on being SLOT FILLERS in an appointment book that they fail to remember that their role is to be a PROBLEM SOLVER for the caller first and foremost. And they treat the appointment as being a time and day thing only. They fail to remember that the appointment is for treatment of disease and pathology for that person. There is a REASON for every appointment... You can’t make this stuff up... Recently we heard a call at a dental office where the caller was inquiring about a consultation appointment they needed to make to discuss ALL ON 4™ treatment and was told no appointment was available for some two months or more.

14 Australasian Dental Practice

Meanwhile, at the same practice, we heard a caller with a toothache being given an appointment the next day! Now, both of these types of appointments would have run 30 minutes, but the ongoing treatment from each of these initial appointments would have been significantly different. The consultation for the ALL ON 4 treatment could have resulted in an ongoing treatment plan of significant investment for that patient. And just to be clear, a caller enquiring about ALL ON 4 treatment is usually at a point where treatment is imperative and there are no other options, including delaying. So for that caller to be told that they couldn’t have been seen at this practice for two months, well that’s certainly a MOOD KILLER... the caller would most likely just hang up, jump on the web and Google another practice... There’s nothing surer. In this case, on this phone call, the caller wasn’t even offered any “hope” by the dental employee who took the call. And fortunately for this practice, we heard the call and were able to talk with the employee, the team and the owner of the practice about the call and about making sure that this sort of gaffe did not happen again. But in most practices that don’t record their calls and don’t have coaches, this sort of stuff just goes on and on and on... undetected... forever. One ALL ON 4 case not scheduled each week is equal to over $1.5 million annually of treatment not being done in your practice but being done elsewhere... And think about all the unscheduled restorative and orthodontic work that’s also leaking out of your dental office phones... Nobody wakes up one morning... Nobody EVER wakes up one morning and jumps on the piano for the first time in their life and plays Beethoven’s Fifth. Nobody EVER wakes up one morning and picks up a Taylor Made Driver and wacks out a 300-yard drive. These skills need to be learned... And perfected... By teaching and coaching. And they can be learned! Just like how to answer the office phone well can be learned. A well answered phone is a joy to listen to, just like a wellplayed piano. A poorly answered phone is painful to the ears... because it’s opportunity wasted...

About the author Dr David Moffet is a dentist and a #1 Amazon Bestselling author. He is the inventor of The Ultimate Patient Experience™, a simple to implement patient retention system he used to build and subsequently sell (for several million dollars) his successful dental practice [of 28 years] located in Parramatta in working class western Sydney. He can be contacted at david@theUPE.com or visit www.theUltimatePatientExperience.com.

May/June 2022

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spectrum | NEWS

Bring simplicity to your restoration and inventory needs

ith Simplicity by Kerr, three trusted brands are being highlighted as one effective solution for simplifying your restoration workflow and inventory management. Simplicity combines everything you need for easier restorations whilst providing zero compromise.

“By simplifying the shade selection right down to 3 choices, there is far less guess work and less time wasted. Reducing the inventory/stock is also a major advantage and a big cost saver...” Dr Aodhan Docherty

SimpliShade™

Simplify your workflow with just three shades Only three shades (LIGHT, MEDIUM, DARK) needed to match all 16 VITA® classic shades. Adaptive Responsive Technology (ART) ensures lifelike restorations with exceptional strength and aesthetics. Spend less time and money reordering parts, weeding out expired products, and managing inventory.

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16 Australasian Dental Practice

May/June 2022

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dentevents presents...

Intraoral scanning for Digital Dentures Practical workflows for fabricating dentures digitally

SYDNEY | SEPTEMBER 10, 2022 Presented by Sam Dias, Dental Prosthetist This event is both a lecture documenting why you should choose digital dentures today as the optimal solution for your dental practice or denture clinic together with a LIVE systematic run-through of the process for fabricating digital dentures. You will be able to follow Sam Dias as he explains the step-by-step process he uses in his four clinics across Sydney every day. A demonstration of accurate intraoral scanning and prostehtic design ensures that the outcome won’t be compromised while saving time and money for you and your patient. The session will conclude with a Q&A session discussing options leading to self-design or aided design as well as the finishing and polishing process. This course will cover the following...

HOURS CPD

1. Impression vs Scanning

5. Digital denture teeth setups

A discussion and slide presentation comparing intraoral

Digital denture teeth setup tips and tricks for faster and

scanning and traditional impressions including a live scan of

more effortless setups will be detailed.

dentures will be shown. The scanning process will be shown

6. Denture base design

step-by-step and the many different impression techniques

Key principles to bear in mind when designing your denture

currently used will be reviewed and details of how these can

bases plus a guide to troubleshooting.

be carried on to the digital world shown.

7. 3D printing

2. Adding mesh and articulator adjustment

3D printing techniques plus a guide to material selection

Combining multiple scans and adjusting the setup of the

and achieving better outcomes.

virtual articulator will be shown.

8. Carded denture teeth

3. Wizard and model analysis

Step-by-step bonding technique with tips and tricks.

Wizards and model analysis tools will be explained.

9. Staining technique

4. Digital denture teeth selection

Techniques for staining and filling in the gaps.

How to select the correct digital denture teeth library will

10. Finishing and polishing

be discussed as well as the use of the measure tool plus

Tips to achieve a great final outcome.

patient notes and extra scans. Denture teeth library options and applications will be discussed.

Discussion + Q&A Session

REGISTRATION FEES

DATE AND TIME

Registration $660 inc gst

SYDNEY Saturday, 10 September 2022

Earlybird

$550 inc gst

Starts 9.00am | Ends 5.00pm | Rego opens 8.30am

Before 10 Aug 2022

See the website for venue details

Intraoral Scanning for Digital Dentures is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Tel: (02) 9929 1900 • Fax: (02) 9929 1999 • Intraoral Scanning for Digital Dentures™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2022 Main Street Publishing Pty Ltd

spectrum | NEWS

Almost 500 delegates attend Digital Dentistry & Dental Technology 2022

he third annual Digital Dentistry and Dental Technology conference has been another outstanding success, attracting some 500 delegates to the Novotel Sydney Brighton Beach over two days on June 3 and 4, 2022. “As the organiser of the event, it was fantastic to see one of the largest dental conferences in Australia play out seamlessly and without a hitch,” said Dentevents’ Joseph Allbeury. “It was like the pandemic had never happened with an enthusiast audience of close to 500, together with 43 stellar local and international speakers and an array of dental industry representatives all enjoying the event. “Digital Dentistry and Dental Technology is an intimate affair in a hotel setting and it generates a real buzz. You can feel the energy, both in the sessions and during the breaks. “With COVID-19 now a part of life in Australia, we of course planned for multiple scenarios that could have occurred due to this but as it happened, every speaker attended, every session was delivered and there were no reports post-event of participants becoming ill. It was a fantastic outcome. “The feedback on all levels was resoundingly positive and we can see exactly where we need to steer the event for 2023 and beyond in order to attract an even larger audience and continue to be at the cutting edge of dental education.” Digital Dentistry and Dental Technology 2022 presented delegates with a choice of over 90 education sessions - 84 hours of content - in 7 concurrent streams presented by 43 speakers. Topics covered included 3D printing, intraoral scanning, milling CAD and CAM software, materials, smile design, digital dentures, implantology, CBCT, restorative, aligners, orthodontics and more.

20 Australasian Dental Practice

“The success of Digital Dentistry and Dental Technology 2022 is thanks to a lot of help and support from everyone involved,” Mr Allbeury said. “The event simply could not take place without our sponsors - Ivoclar, Innovatio Dental Supplies and Fabdent. Each of these companies presented an education stream packed with outstanding content and delivered by an amazing group of speakers, several of whom made the journey from overseas. “The talent on show throughout the entire event in all streams was simply outstanding and included some of Australia and the world’s most sought after speakers. “As the organiser, I am always trying to ensure the program is relevant and compelling and nothing says that more than a lecture room that is standing room only with still more delegates bulging out the door. This was certainly the case on a number of occasions throughout the event. So thank you to all the speakers who presented throughout the two days of the event. “Thank you also goes to the dental industry and the 40 companies that participated. And I would also like to thank the NSW Government who supported the event with a Business Events Grant. “Thank you to Dani, Angus, Michael and Frank who hosted lecture rooms and thank you to my family who I steal time from every year to organise and run the event. “And finally, thank you to everyone who attended the event as a delegate, many for the third time. Without you, all our hard work would be for nothing. “So we hope to see you again in 2023.” Registration for Digital Dentistry and Dental Technology 2023 will open soon. Visit www.dentaltechnology.com.au for updates.

May/June 2022

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©herein Institut Straumann AG, 2022. 2022. All rights rights reserved. reserved. Straumann® and/or other trademarks trademarks and logos from from Straumann® Straumann® mentioned mentioned herein areStraumann the trademarks trademarks or registered registered trademarks of Straumann Straumann Holding AG and/or and/orand its affiliates. affiliates. © Institut AG, All Straumann® and/or other logos are the or trademarks of Holding AG its © Institut Straumann AG, 2022. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are are the the trademarks trademarks or or registered registered trademarks trademarks of of Straumann Straumann Holding Holding AG AG and/or and/or its its affiliates. affiliates. herein © Institut Straumann AG,or 2022. All rights reserved.of Straumann® trademarks and logos from Straumann® mentioned herein are the trademarks registered trademarks Straumann and/or Holdingother AG and/or its affiliates.

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spectrum | NEWS

Proven 3-Step water treatment protocol

ith increased emphasis on infection control in the current pandemic environment, there is a new focus on ensuring dental unit waterline quality is adequately maintained. A-dec Product Manager, Shal Hafiz says that together with daily waterline maintenance with a proven solution like A-dec ICX tablets, it’s important to monitor water quality and periodically shock the lines. New A-dec ICX Renew – launched in Australia in May – is the perfect complement to self-contained waterline units to ensure the highest quality water is delivered to patients. ICX Renew is a shock treatment and part of the “A-dec 360 Maintenance” approach which includes regular waterline maintenance; waterline quality monitoring; and periodic shock treatment. ICX Renew clears deposits and contamination which can build up over time, without harming plastic tubing or corroding dental unit components, unlike some harsh treatments. “Contaminated water lines can cause odour and foul-tasting water that can also present a potential health risk,” Mr Hafiz said. The latest ADA Infection Control Guidelines suggest a shock treatment if CFU (colony forming units) reach 200 CFU/mL.

22 Australasian Dental Practice

“These shock treatments are required periodically to clean dental unit waterlines and more often if dental units have been left unused for any period, such as over a holiday break,” Mr Hafiz said. He said A-dec dealers now offer a waterline testing service using a highly accurate high tech Lumitester device. This water testing service could easily be incorporated in clinics as part of routine equipment servicing. “It’s good practice to test microbial levels in water lines regularly – at least every six months, as this is a good protocol to ensure dental unit waterline quality is not forgotten,” Mr Hafiz said. “In keeping with ADA Guidelines, A-dec recommends a three-step: ‘Maintain, Monitor, and Shock’ approach to keeping water lines clean. “Monitoring requirements will depend on your water quality and the clinic’s individual requirements,” Mr Hafiz said. “Initially, test water once a month. If the results pass your specified action level for three successive months (i.e. 200 CFU/mL), reduce the testing protocol to quarterly.” Mr Hafix said the A-dec 360 Maintenance system took the uncertainty out of waterline maintenance, ensuring water quality and patient safety was maintained and that equipment was protected. “Some testing systems are inaccurate and take up to 72 hours to produce a result,

which could mean you are using contaminated water on patients while awaiting your test results. “A-dec’s 2-minute Lumitester system produces an accurate result in just two minutes, without the need for cumbersome and potentially inaccurate manual counts. If your test triggers an action level, treat your dental units with ICX Renew. Best results are achieved by adding the ICX Renew Tablets to the dental unit waterline and letting it sit overnight.” ICX Renew turns the dental unit waterline water blue, indicating the shock treatment is at work in the waterline. The next day the lines are flushed until they are clear and are then ready to be refilled with clean water and a regular ICX tablet matching the size of the self-contained water bottle. Mr Hafiz said both ICX and ICX Renew were completely safe to use in dental units and did not cause corrosion of metals or damage to soft components. “Some other shock treatments use harsh nappy sanitiser chemicals which can harm dental tubing, diaphragms and ‘O’ rings.” A-dec ICX, ICX Renew and the 2-minute Lumitester dental unit waterline test are all available from your local A-dec dealer. Contact A-dec on 1800-225-010 or visit: australia.a-dec.com to find your nearest authorised A-dec dealer or representative.

May/June 2022

Unwanted guests in your waterlines?

When you SHOCK, let ICX RENEW. Unwanted visitors like bacteria love to colonise in your dental unit waterlines. A daily waterline maintenance protocol with A-dec ICX® waterline treatment tablets, along with periodic ICX Renew™ shock treatments, will help reduce these nasty microorganisms. For complete trademark information, visit a-dec.com/legal/trademarks.

To find out more, visit australia.a-dec.com

spectrum | NEWS

Clear Aligner Excellence helps you increase profits by $270K p.a.

lear aligner therapy continues to be one of the fastest growing and potentially most profitable areas of general dentistry, yet many practices still do not offer treatment to their patients or dabble with just a handful of cases a year. Specialist orthodontist Geoff Hall, well known as a clinical educator through the The OrthoED Institute and Dr Jesse Green, a general dentist who trains dentists in practice management skills under the Savvy Dentist brand, have now teamed up to help dentists who want to offer aligner treatment take it to the next level. Their new venture, Clear Aligner Excellence, offers general dentists all the support they need together with significant discounts from leading aligner manufacturers. We caught up with Geoff and Jesse to hear how it all works. Clear Aligner Excellence is a service to help dentists treat more patients with clear aligners? How does it work?

ADP

Clear aligners represent a massive opportunity for the dental practice on a couple of different levels. This includes helping the dentist do work that’s interesting and stimulating and creates beautiful smiles for patients. But it also represents a commercial opportunity for the practice as well. And we know from various research, the aligner market is going to grow 29% over the next six years. It’s already a big market, so an extra 30% - give or take - is going to be a big uplift. What we also know is that in spite of the current and the projected opportunity, there are three big hurdles for dentists to overcome in order to embrace aligner therapy and to successfully integrate it into their practice. The first hurdle is that dentists have to feel confident and competent in their ability to be able to identify appropriate clear aligner cases, treatment plan those cases and deliver the treatment to a really high standard so that they’re doing great work.

24 Australasian Dental Practice

The second big hurdle that dentists encounter is how do I do this in a commercially successful way? If they do a case here and there, they never really make the commercial case work well. The economics just don’t work. The final hurdle that stops dentists from fully integrating clear aligners into their practice is the cost of the aligners themselves. The lab fees from the aligner companies are very steep which erodes profit margins and thus erodes people’s willingness to do these cases. What Clear Aligner Excellence is designed to do is to provide an end-toend solution to help dentists overcome all three hurdles with a turnkey operation for aligner therapy in their practice. We do that by giving them the clinical expertise and the clinical confidence. Geoff is Australia’s leading trainer of orthodontic services for general dentists in the country and is incredibly well respected as an innovator in clear aligner orthodon-

tics. We have tapped into his expertise to create the Aligner Education Program to help people understand aligners, how to treatment plan and how to deliver care to a really high standard. Next, we help dentists integrate aligners into their practice commercially using my knowledge from the practice management space to launch the Aligner Business Program. This system will focus on best practices in marketing, case presentation and workflow optimisation so that we can drastically increase case presentations and case acceptance and in turn, increase new case starts. And the best part is that the techniques in this program can be applied to almost any elective procedure – not just clear aligners. Finally, we have created an Exclusive Buying Group that offers tremendous discounts with the seven major aligner companies that includes Invisalign, SureSmile, Spark, SmileStyler, AngelAlign, ClearCorrect and Trio. Depending

May/June 2022

spectrum | NEWS

on the aligner company being used, our Network Providers can enjoy discounts of as much as $900 per case on their lab fees. Plus, we also have discounts from ancillary dental companies to include Dental Monitoring, Geoff’s treatment planning service, whitening products and many others. The way it works is that the practice becomes a Clear Aligner Excellence Network Provider for which they pay a nominal subscription fee. If the practice is already doing one case a month, which is a very low bar, their savings on the lab fees alone cover that subscription. Then they also gain access to all the clinical and business education. We have really tried to make this a true turnkey solution that is a total no brainer. Just to go one step further from what Jesse said, we’re also partnering with other companies that will help them in their conversion and increase their clear aligner growth. For example, we’re partnering with Openpay, so rather than patients having to pay the traditional 25% deposit, there will be 10% deposit as well as no-deposit options and the doctor can get their money up front as well, with lower transaction fees. What we’ve attempted to do with Clear Aligner Excellence is to take away every possible hurdle for doctors not to convert patients. The average general dentist is currently starting about one new aligner case a month - if they’re doing aligners at

May/June 2022

all. We want to take them from that one case a month to four cases a month. And that will give them an immediate saving of over $3,000 a month just off the aligner lab fees. And these extra cases that they’re going to feel more confident in doing, they will find these in their own backyard, they just don’t know how to sell the case or how to market it to their existing patients. We believe that and we’ve done trials on this showing that the average general dentist could increase his or her profit by over $270,000 per year. The other part to it is that it’s a very scalable because the bulk of the ongoing treatment can be delegated to an hygienist or an oral health therapist. The key to great aligner outcomes is getting the diagnosis and treatment plan right the first time. After that, the clinical part of it is absolutely minimal - it’s just bonding a bit of composite on, doing a little bit of IPR and making sure the aligner is set each visit. That’s it. It’s a no-brainer clinically. It’s the upfront diagnosis that takes the most skill and experience which develops over time. The Aligner Education Program provides our Network Providers with the training needed for those great outcomes and if the doctor wants, we also have a treatment planning service in the background where I can do the treatment plan for them with the end result being the same as if the patient came to my specialist orthodontic practice.

Clear Aligner Excellence is really designed to be a wholly integrated end-to-end solution for the general dentist. We want to help them go from one case a month to one case a week. Or in other words, four cases a month. We find a lot of people dabble in clear aligner treatment but never really master it so what we’ve created here is a turnkey process to address this.

What are the mechanics of how it works from the perspective of a dentist if I’m doing one case a month and I want to do more. What happens?

ADP

First, our Network Providers will go through an onboarding and welcome process. Then they will have access to our 8-week Aligner Education Program which includes Geoff’s clinical training and the Aligner Business Program which includes my business training. After that point, there will be ongoing clinical and practice development education available from our international faculty of experts. Some of the biggest names in aligner therapy from around the world - the people who are on the cutting edge of aligner therapy - are on our clinical faculty. We’re also going to be connecting Network Providers with the aligner companies so that they can start accessing their discounts immediately. I will also add them to our directory of Clear Aligner Experience Continued on page 28 88

Australasian Dental Practice

spectrum | NEWS

Openpay announces partnership with Clear Aligner Excellence

igital payment solution Openpay has announced a partnership with exclusive dental network Clear Aligner Excellence, that serves to remove the financial barriers many Australians face when it comes to receiving dental and orthodontic treatment. Openpay will now be the preferred buy-now-pay-later (BNPL) provider for the growing number of certified Network Partners within the Clear Aligner Excellence network. This new partnership allows eligible patients receiving treatment from a practice within the Clear Aligner Excellence network to spread the cost over 2-18 months, for treatment costs up to $15,000 without paying interest. With greater choice and payment flexibility, these payment plans which extend beyond the traditional “pay-infour” model are therefore well suited to helping Australians access the orthodontic treatment they need, without the stress of managing unexpected or large lump sum bills. In turn, practices benefit from receiving upfront payment from patients, while offering flexible payment plans that can improve efficiencies, increase average transaction value and cashflow.

Data suggests that Openpay dental patients generally spend $378 across a 2-month plan, with this rising to $2,579 for 6 months and $7,112 for 12-month plans*. This highlights how patients utilise flexible, longer-term plans to access more expensive dental treatments. One of Australia’s most exclusive networks of dentists and a pioneer of modern-day orthodontic education, the Clear Aligner Excellence membership base is expected to grow significantly

over the next two years with more than one thousand providers anticipated to join the network by 2024. Clear Aligner Excellence supports dental practices to unlock the untapped clear aligner opportunity in both their practice and in their community. It does so by helping members: • Attract new patients - on average quadrupling the number of new patients; • Maximise outcomes - by increasing clinical confidence and reducing treatment times; • Reduce overheads - by an average of 30%; and • Add $270K in annual revenue growth.

In this sense offering Openpay to its members will help increase the uptake of clear aligner and orthodontic treatments by reducing the financial barriers to entry. Declan Harrington, Head of Healthcare at Openpay, said: “At Openpay, we’re committed to offering longer more flexible plans which are suited to helping Aussies be more proactive about and investing in their health, something many Australians feel priced out of. In the case of the Clear Aligner market, we’re proud to partner with market-leading providers to help offer alternative payment solutions for dental treatment, ensuring Aussies don’t have to choose between their orthodontic and financial health.” Dr Geoff Hall and Dr Jesse Green, Directors at Clear Aligner Excellence, said: “Having flexible finance options available is key to improving case acceptance as the cost of orthodontic treatment as a lump sum can be overwhelming for patients. We are delighted to work with Openpay as one of our preferred suppliers of flexible patient finance. Through this relationship, Clear Aligner Excellence practices are set to enjoy a higher number of new case starts, enabling them to treat more patients and increase revenue”. * Data provided is an average of Openpay dental plans from the last 12 months (June 21-June 22).

88Continued from page 27 accredited doctors which will be used for doing outbound marketing to drive patients - and cases - to their practices. Although, as Geoff rightly pointed out, most dentists already have a million diamonds in their own backyard - they just need to bend down and pick them up. That’s why most of the cases a dentist will treat are already in their patient database. What we’re going to be doing is making sure that, as they go through their experience with us, our customer success team are going to be partnering with each Network Provider to set them up for success by directing them to resources

26 Australasian Dental Practice

and training and helping them get what they need done. Because what we find is, it’s all well and good to give people access to training, systems and discounts, our job, our goal is to hold their hand and help them integrate all of these into their practices. The other important consideration is that dentists have to realise they can use any aligner system they want. And like Jesse said we have the seven biggest aligner companies who have all come on board because they want to increase this aligner pie. We are

agnostic with regards to what system they want to use and our Network Providers are not stuck with one particular system. What we’ve tried to do is put everything that a general dentist would need to successfully integrate aligner therapy into their practice in one place. It an end-to-end solution that perfectly responds to the hurdles general dentists face when trying to introduce and grow clear aligner therapy in their practices.

For more information on Clear Aligner Excellence, visit www.clearex.com.au

May/June 2022

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TO LEARN MORE: 1 300 002 239 CLEAREX.COM.AU

spectrum | NEWS

Waterpik® Water Flosser: Significantly more effective than string floss for removing plaque Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use Goyal CR, Lyle DM, Qaqish JG, Schuller R. J Clin Dent 2013;24(2):3742. Study conducted at BioSci Research Canada, Ltd., 3.

Objective o compare the plaque removal efficacy of the Waterpik Water Flosser to string floss combined with a manual toothbrush.

Methodology eventy subjects participated in this randomised, single use, single blind, parallel clinical study. Subjects abstained from any oral hygiene for twenty three to twenty five hours prior to their appointment. Subjects were screened and assigned to one of two groups: Waterpik Water Flosser plus a manual toothbrush, or waxed string floss plus a manual toothbrush. Instructions were provided for each product used. Each participant brushed for two-minutes using the Bass method. Group One used the Water Flosser with 500 ml of warm water and Group Two used waxed string floss cleaning all areas between the teeth. Subjects were observed to make sure they covered all areas and followed instructions. Scores were recorded for whole mouth, marginal, approximal, facial and lingual regions for each subject using the Rustogi Modification Navy Plaque Index.

Bleeding on Pocket Probing 17%

he Waterpik Water Flosser was 29% more effective than string floss for overall plaque removal, 29% for approximal surfaces and 33% for marginal surfaces.

28 Australasian Dental Practice

40%

30%

15%

14%

15.1%

Waterpik® WaterFlosser

Interdental Brush

Significant difference, p=0.030

Conclusion he Waterpik Water Flosser is significantly more effective than string floss in removing plaque for all tooth surfaces.

% Reduction

16.6%

Results

Bleeding on Marginal Probing

(4-week results for all sites)

(4-week results for all sites) 34.1%

20%

21%

10%

Waterpik® WaterFlosser

Interdental Brush

Significant difference, p=0.003

Want more information? For more information or to book a free Waterpik Lunch and Learn, email profesisonalAU@ waterpik.com

May/June 2022

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Clinically Proven Results Untreated

Treated

Removes up to 99.9% of plaque from treated areas2

Up to 50% more effective for improving gum health vs floss2

Up to 2X as effective for improving gum health around implants vs string floss2

Up to 3X as effective for removing plaque around braces vs strong floss2

*Dependent upon location of practice. Sessions via face to face or Zoom. 1. Terms & Conditions apply. Please visit Waterpik.com.au/shop for more information. 2. Independent clinical studies. Go to Waterpik.com.au for details.

Visit www.waterpik.com.au for more information or email professionalau@waterpik.com

spectrum | NEWS

Upload your videos to Dentevents.TV now and win a smartphone gimbal

entevents.TV has launched a brand new feature to allow anyone working in dentistry to upload and share videos that’s easier than ever. Simply login at www.dentevents.tv and click “Upload Video” to get started. Whether you have a webinar recording, a product hack, a clinical technique, a product review or unboxing, a diatribe on difficult patients or some wisdom or humour about dentistry, you’re invited to share your video with your peers through the site. Plus, the author of the video that receives the most votes before August 31 will receive a DJI OM 5 Smartphone Gimbal Stabiliser (Phone not included) to help you make even better videos in the future. “Dentevents.TV has continued to grow in popularity following its launch during the first COVID lockdown, but moving forward, we need to attract more con-

30 Australasian Dental Practice

tent to take it to the next level,” said Dentevents.TV publisher Joseph Allbeury. “We have a great catalogue of dental videos available free and on demand 24/7 from a variety of sources already, but now we’re looking for more content created by members of the dental community. “Many people working in dentistry are already prolific content creators and we want to engage with these people and encourage them to use dentevents.tv as an additional way to share their videos with their peers. “Part of this is making it far easier to load videos and part of this is incentivising videos creators to share their content.” Up until now, the only way to post videos on Dentevents.TV was by logging in to the www.dentalcommunity.com.au website,

clicking Manage Your Videos and then uploading your video. However, now you can upload videos directly through the Dentevents.TV website. The latest videos all appear under “Recently Added” and a new “VOTE” button has been added to enable anyone to vote for the videos they like. “You have to login to Dentevents.TV to watch the videos and vote,” Mr Allbeury said. “Each person can only vote once for a video, but they can also vote for multiple videos. So if you load a video onto the site, then it’s in your interests to encourage your friends to login as well and vote for it. The VOTE button activates after you have watched the video.” For more info, visit Dentevents.TV. It’s free to login and watch any of the videos 24/7.

May/June 2022

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spectrum | NEWS

“Same day crown” made from Zolid zirconia - so fast, so beautiful, so safe The Ceramill Therm DRS high-speed sintering furnace from Amann Girrbach allows users to sinter zirconia restorations in just 20 minutes

ith the Ceramill Therm DRS highspeed sintering furnace and the specifically developed Zolid DRS zirconia or the popular Zolid Gen-X universal zirconia, Amann Girrbach offers the perfect basis for the ultra-fast fabrication of highly aesthetic zirconia restorations. The restorations can be sintered in just 20 minutes and offer maximum efficiency with a natural appearance. The focus of the development was clearly on the issue of safety, as only durable restorations are of benefit to the laboratory, the clinician and the patient. For this reason, numerous studies were

32 Australasian Dental Practice

conducted by renowned external institutes. The results were conclusive: the rapid sintering cycle has no negative effects on the material properties. The Zolid DRS zirconia was developed specifically for the high-speed sintering furnace and offers maximum safety due to the perfectly matched 16 Vita shades with integrated colour and translucency gradient and a flexural strength of >800 MPa. With the approval of the Zolid Gen-X universal zirconia for high-speed sintering, laboratories now become even more flexible. The integrated colour and translucency gradient and the >1,000 MPa flexural strength well exceed any indication constraints. Only the shades

may show minimal deviations - they can appear slightly brighter. The darker the original shade of the blank, the more pronounced the effect. Both laboratories and dental practices benefit from this innovative high-speed sintering process enabling them to add the so-called “Same Day Crown” to their service offering. Due to the extremely shortened sintering process, single-tooth crowns and three-unit bridges can be realised in just one day, from preparation to final insertion. What’s more, the fabrication of other indications can also be shortened considerably, for example, an implant restoration consisting of a zirconia abutment and a crown.

May/June 2022

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Neoss® Group celebrates 20-year anniversary at Neoss Integrate 2022

ver 600 dental professionals came together to Integrate, Educate, Celebrate from June 9th to June 11th at Neoss Integrate 2022 in Gothenburg, Sweden. The participants were treated to three days of social activities, multiple integration opportunities and a scientific program with 40 speakers, who for the first time ever in the dental industry presented on a 4K wall and floor screen. “I am overwhelmed with the positive feedback we have received from the participants and our speakers alike,” said Dr Robert Gottlander, CEO and President of Neoss Group. “Really pleased with how we at Neoss have managed to take dental events to a new level with the implementation of new technology never seen before in the industry. The future is bright for Neoss.”

34 Australasian Dental Practice

This milestone celebration marked 20 years since the first Neoss implant was placed and that initial patient was present on stage to commemorate the event. This was also the first time the latest 10-year data on the Neoss implants was presented along with a significant amount of positive clinical research. “Wow, this has been 3 amazing days of education and celebration. I think all speakers did an outstanding job and that has also shown in the extremely positive response that we have received!” said Prof. Christer Dahlin, Scientific Chairman. Neoss launched multiple new products at the meeting. The most notable was the Neoss branded intraoral scanner, NeoScan 1000™. An easy to use, fast, light weight intraoral scanner that fits perfectly into any practice’s digital workflow. Other notable launches were a new surgical tray, new surgical tools, SLM implant bridges and more.

About Neoss eoss offers intelligent solutions that are intuitively easy to use. Its products allow dental professionals to provide reliable and cost-effective treatments to their patients with predictable long-term results. Leading the market with ingenuity and integrity, Neoss strive to set new standards. In developing smart treatment solutions and working closely with each practice, Neoss makes the complex less complicated. They call this Intelligent Simplicity. Headquartered in Harrogate in the United Kingdom and with research and development based in Gothenburg, Sweden, the company has established a global footprint with a long-standing presence in key markets.

For more info, visit www.neoss.com

May/June 2022

THE AORALSCAN 3 IOS THE AORALSCAN 3 AI INSIDE EVERY SCAN THE AORALSCAN 3 IOS IOS AI INSIDE EVERY SCAN AI INSIDE EVERY SCAN

With unprecedented scan speeds allowing you to scan a quadrant in 25 seconds, full arch in 1 minute, and With unprecedented scanaspeeds allowing you to scan With unprecedented allowing you to scan anquadrant entire ortho inscan 3 minutes, the 3 a in 25case seconds, aspeeds full arch inAORALSCAN 1 minute, and a quadrant in faster 25case seconds, a full arch 1 minute, and3 IOS promises appointment times and a more an entire ortho in 3 minutes, theinAORALSCAN an entire ortho caseappointment in 3 minutes, times the AORALSCAN comfortable patient experience. IOS promises faster and a more3 IOS promises faster appointment times and a more comfortable patient experience. comfortable experience. When you’re patient done scanning, its hassle-free exporting of STL and full-colour PLY scans,its along with theexporting license-free When you’re done scanning, hassle-free of When you’re doneyou scanning, its hassle-free exporting of operation, means send to aswith many or as few labs STL and full-colour PLYcan scans, along the license-free STL and full-colour PLYcan scans, along the as you like. operation, means you send to aswith many orlicense-free as few labs operation, as you like.means you can send to as many or as few labs as youscanner like. Every package comes pre-installed with a suite of intuitive, doctor-friendly software, including: Every scanner package comes pre-installed with a suite Every scanner package comes pre-installed with a suite of intuitive, doctor-friendly software, including: of intuitive, doctor-friendly software, including: Scan software - Intraoral scanning Scan - Intraoral scanning Orthosoftware simulator - Chairside orthodontic simulation Scan software Intraoral scanning Ortho simulator Chairside orthodontic Healthcheck - Intraoral scaner camera + intraoralsimulation Ortho simulator Chairside orthodontic simulation Healthcheck Intraoral scaner intraoral camera + Lab cloud - Seamlessly send scans your lab Healthcheck Intraoral scaner intraoral camera + Lab cloud - Seamlessly scans your Model builder - Base andsend export models tolab a chairside printer Lab cloud - Seamlessly scans your Model builder - Base andsend export models tolab a chairside printer Model - Base and export to a chairside printer Unlike builder many other scanners onmodels the market, there are no ongoing fees, and on updates are free andare Unlike manylicense other scanners the market, there Unlike manyensuring other scanners on market, there automated, youand enjoy the latest features as no ongoing license fees, updates are free andare no ongoing license fees, and updates are free and they’re released. automated, ensuring you enjoy the latest features as automated, ensuring you enjoy the latest features as they’re released. they’re released. When you buy the AORALSCAN 3 IOS from Osseo Group, you’ll receive the scanner, PC, trolley, ongoing When you buy the AORALSCAN 3 IOSand from Osseo Group, When you the AORALSCAN IOSand from Osseo Group, clinical andbuy technical support for3one low price. you’ll receive the scanner, PC, trolley, ongoing you’ll receive the scanner, PC, trolley, clinical and technical support for oneand low ongoing price. clinical and technical support for one low price.

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spectrum | NEWS

Figure 1. Zirkonzahn’s wide range of implant prosthetic components is available for more than 140 implant systems.

Up to 30-year warranty for all Zirkonzahn implant abutments!

s one of the world’s largest manufacturers of implant prostethic components, Zirkonzahn uses high-quality medical titanium alloy (Ti-6Al-4V ELI according to ASTM F136 and DIN EN ISO 5832-3) to meet the strictest quality criteria (ISO 13485 MDSAP; Medical Device Directive 93/42/EEC; EU Regulation 2017/745 on medical devices). All components are conceived and manufactured at its production sites in South Tyrol, Italy. Zirkonzahn believes in what we do and we assume the responsibility for our products granting voluntarily - in addition to the legally prescribed warranty obligation - up to 30 years warranty on all Zirkonzahn implant abutments used (titanium bases, Multi Unit Abutments, Multi Unit Abutments Angled, Raw-Abutments® as well as the corresponding screws). Within the current Zirkonzahn warranty regulation, we explicitly include also implants from other manufacturers used with Zirkonzahn implant abutments. Have a look at our renewed range of components at www.zirkonzahn.com and check if they are compatible with your implant system!

Zirkonzahn implant prosthetic components or more than 140 implant systems and produced entirely in South Tyrol (Italy), Zirkonzahn Portfolio consists of a great range of products: regular titanium bases, Scanmarkers, White Scanmarkers, ScanAnalogs (our laboratory analogues used as scanmarkers), impression copings, laboratory analogues, Multi Unit Abutments, Raw-Abutments®, healing caps. The product line has been recently expanded with innovations, such as all new titanium bases with adaptable length or with an angled screw channel, White Metal Scanmarkers, Zirkonzahn Titanium Posts and LOC-

36 Australasian Dental Practice

Connectors. Zirkonzahn implant prosthetics components are 100% integrated into the workflow via corresponding libraries. exocad® and 3Shape users may also download and implement Zirkonzahn components for free in their design software through a dedicated portal (Zirkonzahn Library Download Center).

Multi Unit Abutment (MUA) 17° ulti Unit Abutments (MUA) exist in different heights and are especially suited for multi-unit restorations. The connections to the secondary structure are unified so that the latter can be screwed directly – or with additional titanium bases – on different implants. Thanks to the standardised connection, also other components such as titanium bases, Scanmarkers, etc., are reduced to one connection to compensate for divergences. Multi Unit Abutments exist in two different versions: straight and angled. • Straight MUAs are characterised by a non-hex connection without anti-rotation feature to simplify multi-unit restorations. Their application is extremely easy, because all types of implants have been adapted on a standard platform. Available in five gingival heights for flexible treatment options, Zirkonzahn Multi Unit Abutments are used in combination with conical cemented titanium bases. • The new Multi Unit Abutments Angled are currently available with a 17° angle and two differently angled hex implant connections to compensate for implant inclination. Indicated for single and multi- unit restorations, a sterilisable screw-in aid (PEEK) is included for proper positioning. The abutments are screwed onto the implant with a specific Ratched Wrench and MUA Screwdriver. Special MUA screws are available for this purpose. 88

May/June 2022

COMPONENTS FOR MORE THAN 140 IMPLANT SYSTEMS. SCAN THE140 CODE TO KNOW MORE! COMPONENTS FOR MORE THAN IMPLANT SYSTEMS. SCAN THE CODE TO KNOW MORE!

IMPLANT IMPLANT PROSTHETICS PROSTHETICS COMPONENTS COMPONENTS Everything from a single source: all components are designed and manufactured in our homeland, South Tyrol, Everything from a single source: all components are designed and manufactured in our homeland, South Tyrol, at our Molaris I and Molaris II production sites, and they are available for more than 140 implant systems. at our Molaris I and Molaris II production sites, and they are available for more than 140 implant systems. LABORATORY ANALOGUES LABORATORY ANALOGUES

HEALING CAPS HEALING CAPS

SCANANALOGS SCANANALOGS

SCANMARKERS SCANMARKERS

WHITE SCANMARKERS WHITE SCANMARKERS

WHITE METAL SCANMARKERS WHITE METAL SCANMARKERS

IMPRESSION COPINGS IMPRESSION COPINGS

CONICAL TITANIUM BASES CONICAL NON HEX TITANIUM BASES NON HEX

PARALLEL TITANIUM BASES PARALLEL TITANIUM BASES HEX HEX

NARROW TITANIUM BASES NARROW NON HEX TITANIUM BASES NON HEX

NARROW TITANIUM BASES NARROW TITANIUM BASES HEX HEX

TITANIUM BASES NON TITANIUM BASES NON HEX K80 ANGLED SCREW HEX K80 ANGLED CHANNEL (ASC) SCREW CHANNEL (ASC)

TITANIUM BASES HEX K80 TITANIUM BASESCHANNEL HEX K80 ANGLED SCREW ANGLED (ASC) SCREW CHANNEL (ASC)

CONICAL TITANIUM BASES CONICAL BASES NON HEX TITANIUM K85 NON HEX K85

PARALLEL TITANIUM BASES PARALLEL HEX K85 TITANIUM BASES HEX K85

ABUTMENT SCREWS ABUTMENT SCREWS METAL METAL

ABUTMENT SCREWS ABUTMENT ZIRCONIA SCREWS ZIRCONIA

ZIRKONZAHN MULTI UNIT ZIRKONZAHN MULTI UNIT ABUTMENTS NON HEX ABUTMENTS NON HEX

ZIRKONZAHN MULTI UNIT ZIRKONZAHN MULTI UNIT ABUTMENTS 17° ABUTMENTS 17°

LOC-CONNECTORS LOC-CONNECTORS

RAW-ABUTMENT® HEX RAW-ABUTMENT® HEX

TOOLS TOOLS

UP TO A UP TO A 30-YEAR 30-YEAR WARRANTY WARRANTY

Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

spectrum | NEWS

Figures 2-3. Multi Unit Abutments straight and angled (17°) are excellent for complicated full arches where the screw channels are strongly divergent. They can be utilised for all types of works, from bars and Prettau® Bridges to even small bridges or single crowns with uncomfortable implant positions.

MUAs are incorporated to correct the insertion direction of structures retained by divergent implants. A variety of platforms is offered: (hexagonal, square, triangular and octagonal): each geometry is available in two different typologies (1 and 2), effectively doubling the connection possibilities.

Titanium bases K85 and K80 Angled Screw Channel (ASC) s with all Zirkonzahn implant prosthetic components, our titanium bases are manufactured with high-quality medical titanium alloy. Our portfolio of titanium bases recently expanded with the addition of new innovations for flexible and patient-specific restorative design: • Titanium Bases K85 can be individually shortened for optimal adaptation to the respective tooth length. Available in conical or parallel shafts, the Titanium Bases K85 can be integrated with or without an anti- rotation device according to the restorative indication. • Titanium Bases K80 Angled Screw Channel (ASC) combine the advantages of adjustable abutment height with adjustable screw channel angulation. Angled screw channels compensate for sub-optimal implant positioning by tilting the access hole between 0°-30°. Available in conical or parallel shafts, the Titanium Bases K80 Angled Screw Channel (ASC) can be integrated with or without an anti-rotation device according to the restorative indication. A Ball Head screwdriver, special torque wrench (Ratched Wrench) and adapter are required for insertion.

Originally published in Labline Magazine.

38 Australasian Dental Practice

Figure 4. MUAs can be used for indications requiring different divergence degrees. Indeed, they can be purchased with different connections (hexagonal, square, triangular and octagonal): each connection is available in two different typologies (1 and 2), so that the number of connection possibilities is doubled.

Figure 5. Titanium bases K85 can be individually shortened for optimal adaptation to the respective tooth length.

Figure 6. Titanium bases K80 Angled Screw Channel (ASC) with an access channel which can be tilted from 0-30°.

May/June 2022

ZIRKONZAHN SHADE GUIDES WWW.ZIRKONZAHN.COM

Prettau® Bridge made of polychromatic Prettau® 3 Dispersive® zirconia on andosided titanium bar

ZIRCONIA FROM THE DOLOMITES PRETTAU ® – THE MOST EXPENSIVE. FOR THE PATIENTS YOU VALUE. New! Prettau® 3 Dispersive® zirconia with Gradual-Triplex-Technology: the high-quality zirconia is already provided with colour, translucency and flexural strenght gradients during the production process.

FOR THE PATIEN

TS YOU VALUE.

THE MOST EXPEN

SIVE.

OPTIMAL MATERIAL AND COLOUR SELECTION WITH THE NEW ZIRKONZAHN SHADE GUIDE Monolithic Prettau® Dispersive® zirconia shade guides in the shape of a premolar as well as lower and upper incisor (also customisable), identical to the ﬁnal restoration. (2)

(3)

Monolithic sample teeth available in the shape of:

(1) (4)

Upper incisor

Upper incisor with minimal cutback for further characterisation with incisal materials

Lower incisor

Premolar

Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

spectrum | NEWS

Intraoral cameras build patient trust

ental practitioners around Australia are embracing the proven benefits of intraoral cameras in improving diagnosis, supporting treatment decisions and increasing case acceptance by their patients. The ergonomic and powerful Sopro 717 intraoral camera is known for its diagnostic benefits, with a powerful macro lense that extends way beyond the limitations of the human eye, giving a magnified view of up to 115 times. This enables close examination of the external tooth structure and gum health, helping identify suspect cracks, pits and fissures for further investigation, often without the need for X-rays. The Sopro 717 is also very easy to use, with pre-set “SOPROTOUCH” auto focus and an ergonomic grip and narrow neck, allowing it to be manoeuvred easily in the oral cavity. The Sopro 717 can be integrated into the A-dec delivery system, enabling a visual insight to be easily shared on a patient monitor to help involve and engage patients in the diagnosis and treatment planning process.

Build trust t takes considerable trust and belief from the patient side to accept when the dentist tells them that they might not only need fillings but may require an expensive crown or other complex treatment. Suddenly they face a bill of couple of thousand dollars if they accept the proposed treatment plan. It sometimes makes it hard for the patient to completely trust the diagnosis if they haven’t experienced pain or sensitivity - or if the issue was not picked up on a previous visit, perhaps to another dentist. One such dentist reported that a Sopro camera saved his reputation when a second dentist challenged his diagnosis. However, when he was able to show the patient live on the video monitor what he was seeing tooth-by-tooth with his Sopro intraoral camera, it was simply a case of “seeing is believing” for the patient. After showing the images to the patient and then letting them decide what they want to do, he finds 99% want to fix whatever they see. In his words: “a single photo leaves a better impression than a thousand words could ever do.” Sopro cameras also give the dentist or specialist the ability to view the tooth close-up in macro mode and from a different (indirect) angulation to locate a problem that is not visible when viewing the same tooth from above with the naked eye or even using loupes. Taking diagnosis a step further is the SoproLIFE diagnostic intraoral camera which uses fluorescence to detect caries within the tooth that is often not visible to the naked eye or even on X-rays – and also the SoproCARE which provides a deeper insight into periodontal health and plaque accumulation on the tooth surface, without using messy disclosing solutions. All Sopro cameras can be easily integrated into modern A-dec delivery systems to display on a chair mounted patient monitor or can be connected via USB onto any attached monitor such as laptop computer.

Contact A-dec on 1800-225-010 or visit: australia.a-dec.com to find your nearest authorised A-dec dealer or representative.

40 Australasian Dental Practice

May/June 2022

! P U R E V O C Geistlich Mucograft® Seal Additional Size for Posterior Placement NEW SIZE 12mm

For more information please contact your local Geistlich Product Specialist or call 1800 776 326.

spectrum | NEWS

Zolid zirconia - as successful as ever In 2022, Amann Girrbach will be celebrating two anniversaries at once: 15 years of zirconia production at the Austrian site and 10 years of Zolid

mann Girrbach, one of the leading manufacturers in the field of zirconia, is celebrating two important anniversaries this year: 15 years ago, the company produced zirconia blocks for the fabrication of dentures for the first time and exactly ten years ago, the globally successful Zolid brand was launched. Customers will therefore receive a tenyear warranty on all Zolid materials as of now. At the same time, Amann Girrbach will be hosting various webinars on zirconia throughout the year under the hashtag #nosurprisezirconia. Amann Girrbach was one of the first companies to start manufacturing zirconia for dentures 15 years ago. Due to the rising demand for increasingly aesthetic zirconias and the desire for more cost-effectiveness

42 Australasian Dental Practice

and process reliability, Amann Girrbach introduced the Zolid brand five years later. With Zolid, CAD/CAM blanks that achieved high aesthetics without requiring complex veneering processes were available to users for the first time. Since then, the company has been continuously developing the corresponding materials and processing methods: meanwhile, blanks such as the Zolid Gen-X allow for lifelike restorations with integrated colour gradients in 16 Vita shades. In addition to the excellent aesthetic properties and outstanding mechanical values, they prove convincing due to their diversity of indications and their clinical long-term success. In the context of quality assurance, only the best raw materials are processed here using the strictest test methods and certified processes. To give an example, Amann Girrbach is one of the first dental companies to be certi-

fied in accordance with the new Medical Device Regulation, thus supporting users in complying with MDR obligations. “This year we are celebrating two special anniversaries that once again demonstrate that we at Amann Girrbach are constantly driving the boundaries of technical possibilities forwards,” said a delighted Melanie Röschmann, Director Global Business Unit - Consumables at Amann Girrbach. “At the same time, we are taking this opportunity to underline our quality promise with a 10-year warranty on all Zolid materials. We view ourselves as an holistic system provider and support our customers along the entire customer journey. With this in mind, we will also be focusing more on training and education in the coming years with regard to zirconia. This year, we will be kicking off with a series of webinars on the subject of working with zirconia.”

May/June 2022

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spectrum | NEWS Celebrating 10 years of Amann Girrbach Zolid Zirconia

44 Australasian Dental Practice

Material: Made by: Milestones:

Zolid White Amann Girrbach First Zolid blank

Caption:

Bridge 13-16 infiltrated, 13 reduced frame, 14, 15 reduced vestibularly, 16 monolithic, coloured

Material: Made by: Milestones:

Zolid Preshade Amann Girrbach First pre-shaded Zolid blank

Caption:

Crowns 34-37 34 reduced, fully veneered 35 vestibularly veneered 36 circularly veneered 37 monolithic, coloured

Material: Made by: Milestones:

Zolid FX White Amann Girrbach First monolithic anterior restorations

Caption:

Veneers 33-43 monolithic, infiltrated and coloured

Material: Made by:

Zolid FX Preshade Amann Girrbach

Caption:

Bridge 35-37 monolithic, coloured

Material: Made by: Milestones:

Zolid FX Multilayer CDT Lucas Lammott, M31 Dental Studio, Gloucester MA, USA First blank with integrated colour and translucency gradients

Caption:

Crowns 13-23 monolithic, glazed

May/June 2022

spectrum | NEWS Celebrating 10 years of Amann Girrbach Zolid Zirconia

May/June 2022

Material: Made by: Milestones:

Zolid HT+ White CDT Alexander Wünsche, Zahntechnique, Miami FL, USA First blank for monolithic, wide-span bridges

Caption:

REAX bridge, monolithic, coloured and glazed

Material: Made by:

Combination work Zolid HT+ White & Zolid FX ML MDT Benni Votteler, Dentaltechnik Votteler, Pfullingen Germany

Caption:

Implant bridge 16-26 (Zolid HT+ White) vestibular and gingiva cutback, rest monolithic. Molar crowns 16,17,27 (Zolid FX ML) monolithic, coloured & glazed

Material: Made by:

Zolid HT+ Preshade DT Luís Manuel Rocha Saraiva, Clarity Lab, Porto Portugal

Caption:

REAX bridge, 13-23 vestibular and gingiva cutback, rest monolithic

Material: Made by: Milestones:

Zolid Gen-X CDT Atsushi Hasegawa, Organ Dental Lab, Chigasaki-City, Japan Just one material for all indications - due to excellent material properties

Caption:

Crowns 13-23 monolithic, coloured and glazed

Material: Made by: Milestones:

Zolid DRS MDT Benni Votteler, Dentaltechnik Votteler, Pfullingen Germany High-speed sintering of crowns in 20 minutes

Caption:

Crown 36 monolithic, colored and glazed 16 monolithic, coloured

Australasian Dental Practice

spectrum | NEWS

Neo Edition of CS 8200 3D Family makes CBCT even more intuitive

arestream Dental is introducing more dentists to CBCT imaging— and giving current CS 8200 3D users more options—by launching the Neo Edition of the CS 8200 3D Family. The Neo Edition is an evolution of the CS 8200 3D and optional Scan Ceph module, that improves ease of use, contributes to a better clinical experience and leads to more successful outcomes for patients. “The benefits CBCT can bring to diagnosis and treatment are well recognised, but barriers like perceived cost, concerns around the potential learning curve and even lack of education from manufacturers keep doctors from taking that next step,” said Stéphane Varlet, Product Line Manager, Carestream Dental. “The Neo Edition of the CS 8200 3D Family makes our most popular 3D systems even more user friendly with features and benefits designed with new CBCT users in mind. Plus, practitioners already using the CS 8200 3D can easily upgrade to the Neo Edition to take advantage of all the new features.” As with the original CS 8200 3D Family, the Neo Edition includes 2D panoramic imaging, CBCT imaging, 3D object scanning and optional cephalometric imaging. Up to nine selectable fields of view (FOV), from 4 cm x 4 cm to 12 cm x 10 cm, cover both daily clinical applications and more advanced treatments. In order to reassure doctors they’re seeing the full picture and to reduce dose for full arch scans on smaller patients, the Neo Edition features additional FOV including 10 cm x 5 cm and 10 cm x 10 cm. For endodontists focusing on even the smallest details of root and canal morphology, the EndoHD mode delivers extremely highresolution scans (75 µm); the system can even capture full arch images at the highest resolution for endodontic scans, making it ideal for cases involving multiple quadrants and teeth.

46 Australasian Dental Practice

Doctors who introduce CBCT to their practices are often looking to expand their treatment capabilities, like placing implants or designing surgical guides. So, the new 5 cm x 8 cm FOV of the CS 8200 3D enables doctors to easily capture opposing teeth to better manage occlusion for implant cases. Optional add-on software, and modules like Prosthetic-Driven Implant Planning and Swissmeda, integrate seamlessly

with the CS Imaging software suite to help doctors create more comprehensive implant treatment plans or design and order surgical guides. But all treatment, no matter how advanced, starts with a scan and a highly accurate one. To facilitate proper patient positioning, a low-dose scout image lets users control the imaging area prior to the examination to reduce the need for retakes. Follow-up exams are also faster and easier to compare over time since the unit memorises the scanning parameters used for each. Plus, the system’s new user interface makes it easier, faster and more intuitive to set up the unit for

exams—meaning fewer clicks and more confidence. And since panoramic images remain the foundation of most treatment plans, the system comes with a new low dose panoramic program, reducing dose to 50% without compromising image quality. Once CBCT is adopted into their practice, doctors will want to ensure they’re gaining the most from their investment. The optional CS UpStream, a 24/7 advanced equipment monitoring service, leads to faster, more responsive service while reducing equipment downtime through automated diagnostic feedback to Carestream Dental. CS UpStream is available as an add-on to the CS Advantage program. The Neo Edition of the CS 8200 3D Family follows the same award-winning compact footprint of the CS 8100 3D; recognized for its slim profile, user-friendly features and ease of installation. With more than 15,000 CS 8100 3D and CS 8200 3D systems installed worldwide, these systems are Carestream Dental’s most successful CBCT units. The Neo Edition CS 8200 3D system joins Carestream Dental’s expansive portfolio of extraoral imaging technology solutions. No matter a practice’s size or specialty, Carestream Dental offers an imaging solution that can meet their unique needs. To learn more about the Neo Edition of the CS 8200 3D or the CS 8200 3D with Scan Ceph module, or any of Carestream Dental’s innovative solutions, visit carestreamdental.com/en-au or Freecall on 1800-223-603 or email anz-enquiries@csdental.com.

May/June 2022

Seeing Seeingthe thedifference difference makes makesaadifference difference

CSCS 8200 8200 3D3D NEO NEO EDITION EDITION

Extended Extendedcapabilities capabilities for fornew newopportunities opportunities See See CBCT CBCT in ainnew a new light light with with CSCS 8200 8200 3D3D NEO NEO EDITION. EDITION. It isIt the is the versatile versatile 4-in-1 4-in-1 imaging imaging system system that that creates creates new new possibilities possibilities with with capabilities capabilities such such as as an an intuitive intuitive user user interface, interface, 9 fields 9 fields of of view view and and low-dose low-dose panoramic panoramic imaging. imaging.

carestreamdental.com/8200 carestreamdental.com/8200 anz-enquiries@csdental.com anz-enquiries@csdental.com 1800 1800 223 223 603 603

ULTRA SAFETY PLUS TWIST safe & easy > Protects you and your staff from needle stick injuries > Complies with latest regulations > Intuitive device > Available with either sterile single use or sterilisable handle

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table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Pulpitis Pulpitis discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Irreversible Pulpitis Irreversible Pulpitis n it comes to the perfect fit, Hu-Friedy is just right. MANAGING Pulpitis Irreversible Pulpitis n it comes to the perfect fit, Hu-Friedy is just right.Irreversible MANAGING Pediatrics Endodontics MANAGING Irreversible Pulpitis ™ Biodentine saves pulps EVEN with signs and symptoms As world leader in Pain Management, Septodont TS LOVE OUR STAINLESS STEEL Pediatrics PEDO CROWNS: Endodontics MANAGING ™ Biodentine saves pulps EVEN with signs and symptoms ™ of world irreversible pulpitis* Ultra Safety with the new Twist Lock ™Plus As leader in Pain Management, Septodont Biodentine saves pulps EVEN with signs and symptoms TS OUR STAINLESS STEEL PEDO CROWNS: provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms ableLOVE outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. As leader in Pain Management, Septodont ™ of world irreversible pulpitis* ™ pulps Biodentine saves EVEN with signs and symptoms of irreversible pulpitis* provides you products and services to help you As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with and symptoms eight and width patented design your safety device oflittlest irreversible pulpitis* able outcomes for your with Hu-Friedy Stainless Steel Pedo Crowns. administer experience, amongst those : As world leader inmakes Pain Management, Septodont iscover whymesio-distal dentists favor our patients impeccable fit. Perfect for your patients. Easy forsigns you. ™painfree provides you products and services to help you ofbiocompatible Biodentine ™ ™brings one-of-a-kind benefits for the treatment of irreversible pulpitis* ™ dentin wherever As the first all-in-one andMANAGING bioactive dentin substitute, fully replaces it’s damaged. Biodentine Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : For vital pulp therapy, bulk-fi lling the cavity with Biodentine iscover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. it comes the perfect fit, Hu-Friedy isproducts just right. ™placement provides you and services to help you even easier to use. administer painfree experience, amongst those mmed andtopre-crimped for simple brings one-of-a-kind benefi ts for the treatment of Biodentine ™ 85%** ™ : up to of irreversible pulpitis cases: MANAGING ™ ™ PRACTICE fully replaces dentin wherever it’s damaged. Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier and faster: it comes the perfect fit, Hu-Friedy is justfirst right.experience, Septanest :of the choice of tsdentists with over administer painfree amongst those mmed andtopre-crimped for simple placement ™ 85%** ™ : up to irreversible pulpitis cases: world leader inone-of-a-kind Pain Management, Septodont ™CROWNS: helps of dentin, preserves the pulp brings one-of-a-kind benefi for the treatment of the Biodentine to As 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OURup STAINLESS STEEL PEDO occlusal anatomy that matches the natural tooth brings benefi ts Biodentine for the treatment of remineralization PRACTICE Biodentine makes your procedure better, easier and faster: up to 85%** of irreversible pulpitis cases: PRACTICE Septanest : the first choice of dentists with over Available with either sterile single-use or ™ bioactivity 150 million injections per year, provides you high • Pulp healing promotion: proven biocompatibility and As world leader in Pain Management, Septodont ™ helps the remineralization of dentin, dentin preserves pulp Biodentine vitality and promotes pulp healing. It replaces withthe similar Septanest : the first choice of dentists with over up to 85%** of irreversible pulpitis cases: provides you products and services you • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OUR•anatomy STAINLESS STEEL PEDO CROWNS: occlusal that matches the natural tooth brings one-of-a-kind benefi tsto forhelp the treatment of up tomillion 85%** ofallowing irreversible pulpitis cases: PRACTICE Vital Pulp Therapy complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •Biodentine Vital Pulp Therapy allowing complete dentin bridge formation ght and mesio-distal width 150 injections per year, provides you high • Pulp healing promotion: proven biocompatibility and bioactivity sterilisable handles quality you can trust vitality and promotes pulp healing. 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Innovative nature Innovative byby nature safe Plus, Withpatients Ultra Safety needle stick To injuries enjoy clinical benefitsforofBiodentine the first and. only dentin in a capsule, ask your the dental distributor Innovative by nature Innovative by nature Innovative by nature ask your dental distributor for Biodentine . Innovative by nature decreased fromby an average of 11.8 to 0 injuries per Innovative nature Innovative by nature Exclusively available Exclusively available (1) in New Zealand fromhours worked in Australia from Innovative by nature Exclusively available Exclusively available 1,000,000 ™

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Please visit our website for more information Call 0508 486 252 our website website for more information information Please visit our for more www.septodont.com Please visit our website for more information Please our website for more information Call 0508 486 252 J.M Zakrzewska et 486 al. visit Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J65 200188 ; 190;22 88-92. 08 855 (1) www.henryschein.co.nz Orders 1300 www.henryschein.com.au www.ivoclarvivadent.co.nz Call 0508 252 www.ivoclar.com Please visit our website for more information www.septodont.com www.septodont.com Please visit ourvisit website for morefor information www.septodont.com *If haemostasis cannot be achieved after full pulpotomy, a pulpectomy and a RCT should65 be carried out, www.henryschein.com.au provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) Please our website more information Learn more with 08 855 www.henryschein.co.nz Orders 1300 88 22 www.ivoclarvivadent.co.nz www.septodont.com

08 855 www.septodont.com www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au ** Taha et al., 2018 www.septodont.com *If haemostasis cannot be achieved after full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) the Biodentine™ brochure

spectrum | NEWS

Venus Bulk Flow ONE: Kulzer introduces first flowable, single-colour bulk-fill without additional capping layer

ith Venus Bulk Flow ONE, Kulzer responds to dentists’ demand for one layer of bulk filling composite without additional capping, making it the universal solution for everyday restorations in the posterior region. Due to its excellent shade matching properties, a restoration with the new Venus Bulk Flow ONE fits seamlessly by blending into any surrounding dentition. The composite also ensures improved mechanical properties, thus expanding the successful Venus Diamond/Venus Pearl ONE portfolio. “The flowable bulk-fill composite is a consistent evolution of our ONE Shade product, with which we are responding directly to the needs of our customers,” said Dr Andreas Utterodt, Senior Scientist at Kulzer. “After the successful introduction of Venus Diamond/Pearl ONE Shade, there was the wish for a flowable bulk-fill material with universal colour matching - the result is a modern composite that is suitable for the majority of filling therapies.” To achieve this, Venus Bulk Flow ONE combines the self-levelling effect of a flowable material with a high curing depth and good stability after application. This allows dentists to place increments of up to 4mm and as an additional capping layer is not mandatory with this solution, dentists benefit from a reduced treatment time. However, dentists still can place an additional layer on top, if desired, to imitate the occlusal tooth morphology more naturally. An efficient restoration procedure is also possible due to its wide range of indications: Venus Bulk Flow ONE simplifies direct restorations of Class I, II, III and V cavities (according to G. V. Black). As the bulk filling reduces the chair time for the patients, it is ideal for the restoration of primary teeth.

50 Australasian Dental Practice

Moreover, it can be used for cavity lining and bulk base in Class I and II cavities and is suitable for splinting of teeth loosened by trauma or periodontal disease

as well as for repairs of temporary and permanent indirect and direct restorations. By using Venus Bulk Flow ONE, dentists always select the right shade. In fact, the Kulzer composite determines the shade of the restoration by absorbing

the light waves that are reflected by the surrounding tooth shade and thus blend seamlessly into the surrounding dentition. Thanks to these shade matching properties, Venus Bulk Flow ONE saves time as no shade selection is needed. It represents the first flowable one-shade bulk-filling composite in the dental market that adapts to any tooth shade from A1 to D4. “The daily practice routine and the patient situation do not always allow time-consuming restorations and shade selections,” said Dr Andreas Utterodt, “so a simpler solution with less time expenditure and a nevertheless convincing aesthetic result fits perfectly into every practice. This is a win-win situation for users and patients.” Venus Bulk Flow ONE fulfils manifold requirements for successful composite restorations, thus dentists obtain durable restorations due to low shrinkage stress, high flexural strength and wear resistance. The innovative Venus formula promises long-lasting pleasing and reliable restorations with a permanent, natural lustre. Venus Bulk Flow ONE additionally convinces through efficient handling properties and easy polishability, while its high radiopacity of more than 250% AL ensures reliable diagnosis.

May/June 2022

4 3 2 1 0

NEW Venus BULK Flow ONE.

The first flowable one-shade bulk-filling composite for everyday cases. ■

■

Always grab the right shade: With the incredible shade-matching properties of Venus Bulk Flow ONE the restoration becomes invisible by blending into the surrounding dentition. Efficient handling: Cavities are filled quickly and easily with increments of up to 4 mm without the need for an additional capping layer. Long-lasting restorations: Low shrinkage stress, high flexural strength and high wear resistance ensure durable restorations that withstand the high mastication load in the posterior region.

2227 15/06/22

Try it for yourself.

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Infection Control

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26 VIDEOS - 6+ HOURS OF EDUCATION INTERACTIVE Q&A SUPPORT WEBINARS Presented by Professor Laurence J. Walsh AO Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

HOURS CPD

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions. Hand hygiene and hand care practices. n n Addressing common errors in personal protective equipment. n n

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Requirements for record keeping for instrument reprocessing. n n Correct use of chemical and biological indicators. n n

FULL UPDATE! All the changes to Infection Control Guidelines in 2020

Professor Laurence Walsh AO is a clinically active specialist in special needs dentistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgraduate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equipment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care. Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

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Infection Infection Contol Contol Boot Boot Camp Camp is is presented presented by by Dentevents, Dentevents, aa division division of of Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd ABN ABN 74 74 065 065 490 490 655 655 •• www.dentevents.com www.dentevents.com •• info@dentist.com.au info@dentist.com.au ™ ™ Tel: (02) (02) 9929 Tel: 9929 1900 1900 •• Fax: Fax: (02) (02) 9929 9929 1999 1999 •• Infection Infection Contol Contol Boot Boot Camp Camp™ and and Dentevents Dentevents™ are are trademarks trademarks of of Main Main Street Street Publishing Publishing P/L P/L © © 2020 2020 Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd

spectrum | NEWS

Significant growth for the Ivoclar Group

Figure 1. Headquartered in Liechtenstein, the Ivoclar Group has recently undergone a rebranding.

voclar Group, the Liechtenstein-based dental and medical technology company, experienced strong growth in the 2021 fiscal year, achieving a turnover of more than 840 million Swiss francs. The following factors all contributed to the gain in market share of the Ivoclar Group and the achievement of the highest sales turnover in the company’s history: the introduction of a series of successful new products, expansion into new geographical areas, rebranding and an increased demand from customers. Over the past year, following the industry-wide slump in the challenging 2020 fiscal year, the Ivoclar Group managed not only to achieve considerable gains, but also surpass its previous turnover record which was set in 2019. The overall sales volume of the Group in 2021 was more than 840 million Swiss francs currency adjusted: 31.2 per cent over 2020 and 7.8 per cent over 2019. While in 2020, many dental offices and laboratories had to close temporarily or work only on an emergency basis, the world economy had to deal with supply

54 Australasian Dental Practice

bottlenecks due to a shortage of raw materials and cargo capacities in 2021. Nevertheless, the Group was only minimally affected by these challenges as a result of a foresighted procurement policy, careful logistics planning and highly motivated employees. As a result, the Group was able to supply products from all its categories throughout the world.

Successful products for the workflows of dental offices and laboratories he Ivoclar Group manufactures medical and medical technology products and supports the work of dentists, dental technicians and dental hygienists by offering integrated solutions. The focus in the development of the relevant products is to enhance efficiency, aesthetics and quality. This approach helped the family-owned business to grow its sales of integrated solutions for dental offices as well as laboratories in the 2021 fiscal year. The dentist business grew by 39.2 per cent compared with the previous year. Direct restoratives were primarily respon-

sible for this excellent result due to a high demand for filling materials. Accompanying products that are used in the restorative treatment process also saw an increase in sales: for example, the Adhese Universal bonding agent, which has been available in a new user-friendly pen-like design since 2021 and OptraGate, which offers a proven solution for heightening the comfort of patients and the efficiency of the operator. An increase in turnover was also registered for prosthetic products. The company is a leading supplier of millable ceramic blanks including the furnaces needed for the corresponding workflow. These efficient machines further reduce the process time in the fabrication of restorations. A new furnace, the Programat CS6, was introduced in 2021. The laboratory business grew by +23.1 per cent, primarily due to digital solutions. Ivoclar manufactures the zirconia discs, such as IPS e.max ZirCAD Prime Esthetic launched in 2021. Specialised equipment for the digital workflow of this target group, for example, the new PrograScan PS3 and PS5 scanners, optimise the manufacturing process in the laboratory.

May/June 2022

spectrum | NEWS Growing faster than the market n 2021, sales of the Ivoclar Group increased in all its business regions: +61.3 per cent in Latin America, +36 per cent in North America, +31 per cent in EMEA (Europe, Near East and Africa) and +17.2 per cent in Asia Pacific. In all four regions, the Group grew faster than the market, enabling it to acquire new market shares. The growing markets within these regions also contributed to this development – in particular India (+89.6 per cent), Brazil (+72.2 per cent), Mexico (+46.8 per cent) and China (+16 per cent). Over the past two years, the Ivoclar Group has been unable to participate in trade shows or conduct face-to-face training courses at its 71 training centres around the world. “Nonetheless, we were able to provide optimum service to our customers in all areas during these challenging times by developing creative solutions,” said Diego Gabathuler, CEO of the Group. For example, the company offered extensive remote learning opportunities through its new Ivoclar Academy online knowledge platform. Furthermore, an international event series “The Live Experience Tour” created a safe environment in which people could meet, interact, inspire, learn and network.

Outlook 2022 s a result of the current uncertain geopolitical situation, the Ivoclar Group is cautiously optimistic about the future, despite very positive sales figures in the

About the Ivoclar Group he Ivoclar Group’s success is based on a comprehensive portfolio of products, systems and services, strong research and development capabilities and a clear

Figure 2. CEO Diego Gabathuler attributes the success of the company to the strong commitment of its employees.

Investing in the success factor of people r Gabathuler is convinced that the success of the 2021 fiscal year must be largely attributed to the exceptional expertise and commitment of the company’s employees throughout the world, because they were able to satisfy the high demand of the customers and realise the company’s forward-looking projects. At the end of December 2021, the Ivoclar Group had a global staff complement of 3,548 employees. After only a few selected positions were filled in 2020, more than 200 jobs were created in the 2021 fiscal year. About 100 of these positions are still being advertised throughout the world. The company heavily invests in modern working conditions and infrastructure at all its facilities worldwide. The new global distribution centre which started operating in Ellwangen (Germany) in 2021 is a case in point. From there, around 17,000 products are sent to more than 130 countries.

May/June 2022

Figure 3. The Ivoclar Group hosted the exciting “Live Experience Tour” for its customers. This innovative series of events allowed the company to physically interact with its customers even during the pandemic. The tour events offered information, inspiration and in-person exchanges. It is scheduled to resume in 2022. first three months of the new fiscal year. Further new products will be launched in 2022, which will highlight the innovative spirit of the company. The corresponding product, training and service offerings are already being developed.

commitment to training and further education. More information about the Ivoclar Group is available at ivoclar.com. AU: 1300-486-252 orders.au@ivoclar.com NZ: 0508 486 252 orders.nz@ivoclar.com

Australasian Dental Practice

spectrum | NEWS

Straumann Group SmileAward contest 2022 - don’t miss it!

very day across the globe, thousands of dental professionals use Straumann products to give patients the confidence to smile again... to laugh with friends... to eat the foods they love. They use Straumann solutions to rebuild the quality of life of untold numbers of patients every year. With the SmileAward contest, Straumann wants to capture the life changing impact of dentistry and invites you to show how you’re changing the lives of your patients. You can enter the contest with either full-arch treatments (Straumann SmileAward) or clear aligner treatments (ClearCorrect SmileAward). A jury composed of world-renowned thought leaders in the field of dentistry will select the final winners who will be awarded their prizes during the EAO Congress in Geneva (Sep 29-Oct 1, 2022). Participate now and don’t miss the opportunity to showcase the way you’re impacting your patients’ lives every day!

solutions focusing on the patient story and how the treatment changed her/ his life. Final restoration is mandatory to participate to the award. The full-arch cases must be treated with Straumann solutions and products using the loading protocol of choice, respecting the Instructions For Use (IFU) and clinical indications.

Contest timeline • Phase 1: 14 Jan - 20 Jul Submission of the video cases • Phase 2: 1 Aug - 29 Aug Public voting - The top 25 will be submitted to the Evaluation Jury • Phase 3: 1 Sep - 14 Sep The Evaluation Jury selects the 8 winners out of the top 25 • Phase 4: 29 Sep - 1 Oct Announcement of the winners during EAO Congress in Geneva The Straumann SmileAward2022 contest is open to dentists from all over the world; submit a case report (or however many cases you like) covering full-arch implant treatment procedures (all clinical on-label indications are accepted), including dental implants and prosthetic

56 Australasian Dental Practice

As Straumann clearly recommends and promotes use and combination of original Straumann products, SmileAward2022 only accepts cases in which only Straumann products or products recommended by Straumann were used throughout the treatment. Case documentation should include all relevant diagnostics and appropriate step-by-step illustrations. The submission will consist of a video case (maximum 5 minutes duration) and must be a combination of clinical images in high definition describing the case including a testimonial from the patient.

The videos can be submitted from January 14th to July 20th 2022 in an electronic format. All video cases will be posted on the SmileAward public voting section where everyone is invited to vote for their favourite case. The jury will receive the 25 most voted cases and will select the final 8 winners who will receive their respective prizes during the EAO Congress. The objective scoring by the jury looks at the following in each of the three areas: 1. Patient story: Reflection of a patient centred approach to dental care. 2. Case documentation with photos/ videos and radiographic imaging covering planning, clinical procedures and follow-up. 3. Presentation: Relevance and clarity of information, quality of photos/video and radiographic material and absence of use of self-promotion. Show the world how YOU are changing the lives of your fully edentulous patients and how dentistry can give back confidence and improve the overall well-being of individuals. Create and submit your best patient story, together with the clinical procedure and the patient’s testimonial by July 20th, 2022. All cases fulfilling the criteria will be submitted for public voting.

Find out more at www.straumann.com/group/en/discover/smileaward-2022.html

May/June 2022

coDiagnostiX®

Implant Planning Software.

PREDICTABILITY

VISUALISATION

ADDED VALUE

Comprehensive planning for successful digital implant placement.

Better patient communication thanks to sophisticated visualisation features.

Support for digital drill guide design and fabrication directly through your local laboratory.

Contact your local Straumann Specialist now or visit www.straumann.com.au/codiagnostix

Straumann Group Pty Ltd | Straumann New Zealand Limited 93 Cook Street, Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 Email customerservice.au@straumann.com www.straumann.com.au | www.straumann.co.nz

Digital Solutions

spectrum | NEWS

Reclaim your time with Dentally

n recent months within the world of dentistry, it has become even more invaluable for efficient time management; as practitioners have had to deal with the challenge of juggling an endless to do list in the day-to-day running of a busy dental practice; whilst navigating the impact of a global pandemic and staff shortages. Choosing the right dental practice management software for your dental practice can be transformative in simplifying all aspects in your workflow and helping you use your time efficiently - and it can really improve the way you manage your patients and help you keep staff happy and morale high. Dental practice management software platform Dentally is focused on making dental practitioners lives easier - whether that is reducing the time staff need on certain every day tasks, ensuring workflows are simple, removing the admin burden and allowing your practice to thrive and grow - Dentally helps you reclaim your time so you can focus on delivering exceptional care to your patients.

Software that supports you loud technology has changed the way many dental practitioners work, allowing them to triage patients, work remotely and deliver a safe patient experience while dealing with an increase in patient demand and a backlog of treatments. It also helps to restore work life balance something we all desire but few are able to achieve with the tools they have in place. Dentally is completely cloud-based and is feature rich, so your team can securely work remotely whenever they need to, taking care of admin, writing up treatment notes or dealing with telephone triage appointments.

Improve efficiency sing automation to optimise your practice efficiency is an essential tool, keeping everything running smoothly in your practice, taking care of day-to-day admin and ensuring patient communication is consistent.

58 Australasian Dental Practice

Automating patient communications means that you will never forget to create an invoice or message to a patient again! Automated Patient Communications in Dentally is simple to set up, allowing messages to be sent to patients by scheduling around certain events such as appointments, creation of invoices or estimates. There are many different scenarios when

“Automating recalls helps keep the appointment book filled, so conversations are easier and delivered via a patient’s preferred contact method...” this tool can really help a dental practice, from online medical history, appointment reminders and much more! Automating recalls also helps keep the practice appointment book filled, so conversations are easier and delivered via a patient’s preferred contact method in a timely manner. Automated recalls in Dentally means that recall messaging workflows can be created within the software, which automate the process to send the patient an email, SMS or letter on the appropriate day and time.

Stay on track o once the practice workflows are running more effectively and automation tools are in hand, how can you see if the practice is really working as it should without spending hours ploughing through reports and data analytics? With Dentally there is no need to wait to run reports - they are done instantly and in real time, whether you need a quick snapshot or are looking for more valuable in-depth insights into areas of the practice. The powerful reporting tools in Dentally can help you manage your finances, understand your patient demographics, explore appointment trends and track treatment completion and practitioner activity. All critical elements in ensuring your dental practice can thrive and grow are available to be customised to your needs so you can make informed decisions.

Talk to Dentally today entally from Henry Schein One is the market leading cloud enabled practice management software, reclaim your time by getting in touch today. Visit www.dentally.com.au or email hello@dentally.com.au

May/June 2022

Software designed to take the stress out of daily practice life. Transform your business with our cloud-based software, putting patients and simplicity at the heart of your practice.

Save money and stay secure, without the need for hardware or servers - all your data is stored securely on the cloud.

Our contactless reception keep things safe and simple, from online medical history to self-check-in and payment links.

Giving your patients a safe and simple experience, whilst ensuring your practice runs smoothly and securely. Visit dentally.com.au to find out more.

Save time with our task list feature and manage your practice from any location, using automation and Dentally chat.

Stay connected with patients direct from their records and through automated communications.

62% of your patients 62% of your 62% of your patients patients want straighter teeth. want straighter teeth. want straighter want straighter teeth. teeth. Are you sitting on Are you sitting Are you sitting on on a goldmine? a a goldmine? goldmine?

Despite a slowdown in household disposable Despite a slowdown in household disposable Despite a slowdown in household disposable Despite a slowdown in household disposable Despite a slowdown in household disposable incomes and fewer people with private health incomes and fewer people with private health Despite a slowdown in household disposable incomes and fewer people with private health incomes and fewer people with private health incomes and fewer people with private health insurance, Australian dentists are sitting on a insurance, Australian dentists are sitting on a incomes and fewer people with private health insurance, Australian dentists are sitting on a insurance, Australian dentists are sitting on a insurance, Australian dentists are sitting on a goldmine. goldmine. insurance, Australian dentists are sitting on a goldmine. goldmine. goldmine. goldmine. Research by Orthodontics Australia shows that Research by Orthodontics Australia shows that Research by Orthodontics Australia shows that Research by Orthodontics Australia shows that Research by Orthodontics Australia shows that approximately 55% of Australians are selfapproximately 55% of Australians are selfResearch by Orthodontics Australia shows that approximately 55% of Australians are selfapproximately 55% of Australians are selfapproximately 55% of smile Australians are are self-willing conscious about their and 62% conscious about their smile and 62% are willing approximately 55% of smile Australians are are self-willing conscious about their conscious about their smile and 62% conscious about their smile and and 62% 62% are are willing willing to have their teeth straightened. to have their teeth straightened. conscious about their smile and 62% are willing to have their teeth straightened. to have their teeth straightened. to have their teeth straightened. to have their teeth straightened. Which explains why the Australian clear aligner Which explains why the Australian clear aligner Which explains why the Australian clear aligner Which explains why the Australian clear aligner Which explains why the Australian clear aligner market is expected to grow at a CAGR of market is expected to grow at a CAGR of Which explains why the Australian clear aligner market is expected to grow at a CAGR of market is expected to grow at a CAGR of market is expected to grow atUSD a CAGR ofmillion 28.7%; reaching a whopping 534.3 28.7%; reaching a whopping 534.3 market is expected to grow atUSD a CAGR ofmillion 28.7%; reaching 28.7%; reaching a whopping USD 534.3 million 28.7%; reaching a a whopping whopping USD USD 534.3 534.3 million million by 2028 by 2028 28.7%; reaching a whopping USD 534.3 million by 2028 by 2028 by 2028 by 2028 Affordable, discreet and effective; clear Affordable, discreet and effective; clear Affordable, discreet and effective; clear Affordable, discreet and effective; clear Affordable, discreet and effective; clear aligners are here to stay. aligners are here to stay. Affordable, discreet and effective; clear aligners are here to stay. aligners are here to stay. aligners are here to stay. aligners are here to stay. Whether you’ve been holding off, dabbling Whether you’ve been holding off, dabbling Whether you’ve been holding off, dabbling Whether you’ve been holding off, dabbling Whether you’ve been holding off, dabbling in cases, or you’re looking to take on more in cases, or you’re looking to take on more Whether you’ve been holding off, dabbling in cases, or you’re looking to take on more in cases, or you’re looking to take on more in cases, or you’re looking to take on more complex cases, now is the time to level up your complex cases, now is the time to level up your in cases, or you’re looking to take on more complex cases, now is the time to level up your complex cases, now is the time to level up your complex cases, now is the time to level up your skills and tap into this growing demand. skills and tap into this growing demand. complex cases, now is the time to level up your skills and tap into this growing demand. skills and tap into this growing demand. skills and tap into this growing demand. skills and tap into this growing demand.

DIY clear aligners do not “cut out” dentists. Without a dental expert overseeing cases, DIY aligners can be a risky business. The diagnostic process is going to suffer. Patients might not be ready for aligners. Impressions made by the aligner company may not be accurate. Plus, the patient has no idea whether things are going well or not. Therefore, dentists with strong aligner skills are in demand. The OrthoED Institute helps dentists gain confidence and competence to take on aligner cases with a principle-based approach and hands on support.

Ready to find out more? Book a free 30 minute consultation with OrthoED to discuss your current aligner experience, requirements and to help choose the right orthodontic learning path for you.

Call 1300 073 427 to book your complimentary no obligation call or visit OrthoED.com.au to find out more

Want to learn orthodontics the Want to learn orthodontics the Want to learn orthodontics the Want to learn orthodontics the Want to learn orthodontics the easy and predictable way? Want to learn orthodontics the easy and predictable way? easy and predictable way? easy and predictable way? easy easy and and predictable predictable way? way? Many GPs want to learn Many GPs want to learn Many GPs want to learn Many GPs want to learn orthodontics but are Many GPs want toare learn orthodontics but Many GPs want to learn orthodontics but are orthodontics but are worried about cases orthodontics but are worried about cases orthodontics but are worried about cases worried about cases going wrong, or having worried about cases going wrong, having worried aboutor cases going wrong, or having going wrong, or having to refer patients to an going wrong, or having to refer patients to an going wrong, or having to refer patients to an to refer patients to an orthodontic expert and to refer patients to and an orthodontic expert to refer patients to and an orthodontic expert orthodontic expert and coming under fire from orthodontic expert and coming under fire from orthodontic expert and coming under fire from coming under fire from AHPRA. coming under fire from AHPRA. coming AHPRA. AHPRA. under fire from AHPRA. AHPRA. With OrthoED’s MiniMasters a fully accredited 2-year With OrthoED’s MiniMasters - a fully accredited 2-year orthodontics orthodontics

With MiniMasters -- a accredited 2-year orthodontics course with optional post-graduate diploma -- GPs are learning how to With OrthoED’s OrthoED’s MiniMasters a fully fully accredited 2-year orthodontics course with optional post-graduate diploma GPs are learning how to With OrthoED’s MiniMasters - a fully accredited 2-year orthodontics course with optional post-graduate diploma GPs are learning how to successfully complete cases faster, more efficiently, confidently and course with optional post-graduate diploma GPs are learning how to With OrthoED’s MiniMasters a fully accredited 2-year orthodontics successfully complete cases faster, more efficiently, confidently and course with optional post-graduate diploma - GPs areconfidently learning how to successfully complete cases faster, more efficiently, and with predictable outcomes every successfully complete cases faster, more efficiently, and course with optional post-graduate diploma - GPstime. areconfidently learning how to with predictable outcomes every time. successfully complete cases faster, more efficiently, confidently and with predictable outcomes every time. with predictable outcomes every time. successfully complete cases faster, more efficiently, confidently and with predictable outcomes every time. with predictable outcomes every time. With state of the art tools and comprehensive and sound principle-based training, GPs learn to think for

NOW YOU CAN TAKE ON ALIGNER NOW YOU CAN TAKE ON ALIGNER CASES WITH CONFIDENCE CASES WITH CONFIDENCE

With state of the art tools and comprehensive and sound principle-based training, GPs learn to think for With state of the art tools and comprehensive andand sound principle-based training, learn to think for themselves, treat a range of cases foresee problems before theyGPs arise. With state of the art tools and comprehensive andand sound principle-based training, learn to think for themselves, treat a range of cases foresee problems before theyGPs arise. themselves, treat a range of cases and foresee problems before theyGPs arise. With state of the art tools and comprehensive and sound principle-based training, learn to think for themselves, treat a range of cases and foresee problems before they arise. With also statereceive of the art tools case and comprehensive andand sound principle-based training, GPs learn to think for GP’s ongoing support from myth-busting orthodontist, Dr Geoffrey Hall so they always themselves, treat a range of cases foresee problems before they arise. GP’s also receive ongoing case support from myth-busting orthodontist, Dr Geoffrey Hall so they always themselves, treat a range of cases andto foresee problems before they arise. GP’s also receive ongoing case support from myth-busting orthodontist, Dr Geoffrey Hall so they always have someone to turn if they need help. GP’s also receive ongoing case have support from myth-busting orthodontist, someone to turn to if they need help. Dr Geoffrey Hall so they always someone to turn to if they need help. Dr Geoffrey Hall so they always GP’s also receive ongoing case have support from myth-busting orthodontist, have someone to turn to if they need help. GP’s also receive ongoing case have support from myth-busting orthodontist, someone to turn to if they need help. Dr Geoffrey Hall so they always have someone to turn to if they need help.

Enjoy clinically successful aligner cases, with profitable and As part of the course, you’ll enjoy modules on As part of the course, you’ll enjoy modules on As part of the course, you’ll enjoy modules on Asoutcomes, part of the course, you’ll enjoy modules on and Enjoy clinically successful aligner cases, with profitable predictable if it’s your first time. Diagnosis, treatment planning, riskeven Clear Aligner therapy As part of the enjoy modules on Diagnosis, treatment planning, risk course, you’ll Clear Aligner therapy As part the course, you’ll enjoy modules on Diagnosis, treatment planning, riskeven Clear Aligner management, and the art ofof excellent predictable outcomes, if it’s your first therapy time. Diagnosis, treatment planning, risk Clear Aligner therapy management, and the art of excellent

Thepresentation OrthoED Institute’s programs allow you to orthodontics, TMJ management, and the artconvenient of excellent Aesthetic andtherapy accelerated case Diagnosis, treatment risk Clear Aligner training Clear Aligner management, and theplanning, art of excellent Aesthetic andtherapy accelerated orthodontics, TMJ case presentation Diagnosis, treatment planning, risk Clear Aligner Aesthetic and TMJ case and sleep apnoea develop the confidence and skills toClear offerAligner exceptional ofaccelerated Orthodontic management, and the artconvenient of excellent Thepresentation OrthoED Institute’s training programs allow you to orthodontics, Aesthetic and accelerated orthodontics, TMJ case presentation andstandards sleep apnoea Orthodontic brackets, wires, auxiliaries, management, and the art of excellent and sleep apnoea Aesthetic and accelerated orthodontics, TMJ case presentation Orthodontic wires, auxiliaries, treatments, regardless ofand your previous experience. and sleep apnoea develop thebrackets, confidence skills to offer exceptional standards ofaccelerated Orthodontic orthodontics, TMJ Orthodontic brackets, wires, auxiliaries, Aesthetic and bracket placement and Indirect bonding case presentation Advanced biomechanics and sleep apnoea Orthodontic brackets, auxiliaries, bracket placement andwires, Indirect bonding biomechanics bracket placement andwires, Indirect bondingexperience.Advanced treatments, regardless of your previous and sleep apnoea and Biomechanics Orthodontic brackets, auxiliaries, Advanced biomechanics bracket placement and Indirect bonding Provide and Biomechanics Tap into a rapidly growing market your patients with better Advanced biomechanics Orthodontic brackets, wires, auxiliaries, and Biomechanics bracket placement and Indirect bonding Advanced biomechanics and Biomechanics Management of severe skeletal and dental Orthodontic bracket prescriptions, Risk clinical outcomes bracket placement and Indirect bonding Management ofwith severe skeletal and dental Advanced biomechanics Tap into a rapidly growing market Provide your patients better and Biomechanics Orthodontic bracket prescriptions, Risk Learn principles that apply to all Management of severe skeletal and dental discrepancies Orthodontic bracket prescriptions, Risk analysis, Orthodontic mechanics forRisk and Biomechanics Management of severe skeletal and dental discrepancies Orthodontic bracket prescriptions, clinical outcomes analysis, Orthodontic mechanics for aligners and a variety of cases discrepancies Management of severe skeletal and dental analysis, Orthodontic mechanics forRisk Improve Nonextraction and Extraction cases Orthodontic bracket prescriptions, principles that apply to all Learn patient experience discrepancies analysis, Orthodontic mechanics forRisk Nonextraction and Extraction cases Management of severeofskeletal dental IDT and management difficultand orthodontic Orthodontic bracket prescriptions, discrepancies Nonextraction and Extraction cases analysis, Orthodontic mechanics for IDT and management of difficult orthodontic aligners and a cases variety of cases Nonextraction and Extraction cases Take on more with IDT and management of difficult orthodontic discrepancies Improve patient experience problems and malocclusions, Digital Smile analysis, Orthodontic mechanics for Early orthodontic and referrals management of difficult orthodontic Nonextraction andtreatment, Extractionincluding cases problems and malocclusions, Digital Smile BoostIDT Earlyconfidence, orthodontic treatment, including patient and practice no matter how problems and malocclusions, Digital Smile Design (DSD) IDT and management of difficult orthodontic Early orthodontic treatment, including Nonextraction and Extraction cases facial growth and dental development Take on more cases with problems and malocclusions, Digital Smile Design (DSD) Early orthodontic including facialcomplicated growth and treatment, dental development IDT and management of difficult orthodontic profits Design (DSD) problems and malocclusions, Digital Smile facialconfidence, growth andnotreatment, dental development Boost patient referrals and practice Early orthodontic including matter how Design (DSD) facial growth and treatment, dental development problems and malocclusions, Digital Smile Early orthodontic including profitsDesign (DSD) facialcomplicated growth and dental development Increase Design (DSD) Stand facial growth job andsatisfaction dentalEnrol development out 2023 from the competition in OrthoED’s Mini Masters program today. Enrol in OrthoED’s Mini Masters 2023 program today. Enrol in OrthoED’s Mini Masters 2023 program today. Increase job satisfaction Stand Enrol in OrthoED’s Mini Masters program today. out 2023 from the competition orMini call 1300 0732023 427 secure one of the limited spots Email geoff@orthoed.com.au Enrol in OrthoED’s Masters program today. 073 427 secure one of the limited spots Email geoff@orthoed.com.au or call 1300 Enrol in available OrthoED’s Mini Masters 2023 program today. call to 1300 427 learning. secure one of the limited spots Email geoff@orthoed.com.au fororface face 073 or online call to 1300 427 learning. secure one of the limited spots Email geoff@orthoed.com.au available fororface face 073 or online available for face to face or online learning. For more information visit www.orthotraining.com.au orabout geoff@orthoed.com.au call to 1300 427 secure one of the limited Emailwww.orthotraining.com.au/testimonials available fororface face 073 orand online Visit hearlearning. what other students say spots geoff@orthoed.com.au call to 1300 427 secure one of the limited Emailwww.orthotraining.com.au/testimonials Visit hearlearning. what other students say spots about available fororface face 073 orand online Visit information www.orthotraining.com.au/testimonials and hear other students OrthoED program and why they all give 5 starwhat reviews every time say For more www.orthotraining.com.au orabout call 1300 073the 427 foravailable avisit free 30 minute consultation. for face face online learning. Visit www.orthotraining.com.au/testimonials and hear what other students about the OrthoED program and whyto they allor give 5 star reviews every time say the OrthoED program and why they all give 5 star reviews every time Visit www.orthotraining.com.au/testimonials and hear other students the OrthoED program and why they all give 5 starwhat reviews every time say about

spectrum | NEWS

A-dec joins ADHF International Update In the genes - risk factors for severe COVID as supporting sponsor

evere COVID-19 results from immune-mediated inflammatory lung injury. Critically-ill COVID-19 patients are more likely to have the primary disease process - hypoxaemic respiratory failure - and that this group of patients have a divergent response to immunosuppressive therapy compared to other hospitalised patients. Host genetic variation influences the development of illness requiring critical care or hospitalisation following SARS-CoV-2 infection. The GenOMICC (Genetics of Mortality in Critical Care) database was used for comparing the genomes from critically-ill COVID-19 cases with population controls in order to find underlying disease mechanisms. This study used whole genome sequencing in 7,491 critically-ill COVID-19 cases compared with 48,400 controls. There were 23 gene loci that significantly predispose to severe Covid-19, with 16 new independent associations, including variants within genes involved in interferon signalling (IL10RB, PLSCR1), leucocyte differentiation (BCL11A) and blood type antigen secretor status (FUT2). Using transcriptome-wide association and co-localisation to infer the effect of gene expression on disease severity, there was evidence implicating multiple genes, including reduced expression of a membrane flippase (ATP11A) and increased mucin expression (MUC1), in critical disease. There was evidence from Mendelian analysis for causal roles for myeloid cell adhesion molecules (SELE, ICAM5, CD209) and coagulation factor F8. These adhesion molecules have known roles in inflammatory cell recruitment to sites of inflammation, including E-selectin (SELE), intercellular adhesion molecule 5 (ICAM5) and dendritic cell-specific intercellular adhesion molecule-3-Grabbing non-integrin (DC-SIGN, CD209). Mendelian randomisation results were consistent with a direct link between plasma levels of a closelyrelated cytokine receptor subunit, IL3ra and critical COVID-19. Mendelian randomisation revealed the genetic evidence in support of a causal role for coagulation factors (F8) and platelet activation (PDGFRL) in critical COVID-19. Overall, these findings are also broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. A key implication is that genetic factors are important in susceptibility and that adhesion molecules could be targets for drug therapy.

S A-dec Australia General Manager, Patrick Jones and Director International Sales, Craig Young.

-dec is pleased to announce that it has joined the Australian Dental Health Foundation (ADHF) as a supporting sponsor, to help the organisation deliver the operation of charitable dental programs to assist disadvantaged Australians. The 3-year sponsorship agreement of $40,000 per year, will run until July 2024. The funding will help support the ADHF coordinate the delivery of pro bono dental treatment and oral healthcare education to disadvantaged members of the community. A-dec Director International Sales, Craig Young, said, “Over its 57 years in business as a family-owned company, A-dec has at its core a strong belief in helping the communities in which it operates all over the world. “We are very proud to have been invited to support the ADHF programs to provide pro-bono dentistry to disadvantaged members of the Australian community. We look forward to working closely with the ADHF team to assist wherever possible.” A-dec Australia General Manager, Patrick Jones, said he sees this partnership “as a great opportunity to assist in the provision of quality dental care to all Australians regardless of their financial, geographical or social situation.” The foundation accepts referrals to the Volunteer Dental programs for clients who are being supported by a registered charity or not for profit organisation. The dental volunteers provide their time, expertise and practice facilities at no cost to eligible patients. The ADHF also funds programs that encourage better oral health outcomes and reduce the inequality of access to education within the community through its Community Service Grants, Indigenous Study Grants and Oral Health Projects. For further information on the ADHF visit adhf.org.au

62 Australasian Dental Practice

Kousathanas A et al. Whole genome sequencing reveals host factors underlying critical Covid-19. Nature 2022 March 7, doi: 10.1038/s41586-022-04576-6.

May/June 2022

E E Y R F TR EN

27- 29 October 2022 Highlights include: • Opening Breakfast • Free childcare • Free business growth seminars • Latest technology & innovations

• Women in Dentistry Breakfast • Australian Dental Association Queensland professional CPD program

Brisbane Convention & Exhibition Centre @ausdental

See you at

#ADXexpo #ADXBrisbane

/ ADXexpo @adxexpo

AUSTRALIA’S PREMIER DENTAL EVENT

Organising a dental event, l spectrum | NEWS congress, trade show or we New Express Listings for dentevents.com

entevents.com, the dental from that for webinar organisers, and A link will be emailed to you that can profession’s go-to source indeed all event organisers, is that more be used to edit the event if required, again of upcoming post-gradand more dental professionals will check without the need to login. uate dental education and Dentevents.com when looking to find out “Express Listings are not designed to events, has added a new replace Standand and Premium listings,” EXPRESS Listing option Mr Allbeury said. “Express Listings that can be used to rapidly add events to include less information than traditional the calendar without the need to login with Dentevents listings and do not include links a username and password. to the organiser, venue and speaker infor“Overall, we’ve added the new Express mation pages. Express listings also cannot Listing facility to Dentevents.com to accept registrations and payments for increase the number of events being listed events. The Express listings are designed on the calendar by making it a quick to rapidly add events to the calendar if 2-minute process,” said Dentevents.com you do not have a login. For everything publisher, Joseph Allbeury. “And more else, the traditional pathway applies.” specifically, we’re targeting webinar Mr Allbeury said the new Express Listevents with the Express Listing because ings were part of the ongoing evolution of the cycle of these events is far more rapid about upcoming events because the inforDentevents.com to provide a platform to than traditional face-to-face events. mation available is so comprehensive.” help event organisers reach greater audi“We’re seeing webinars promoted a To use the Express Listing, simply ences for their events as well as providing few days to a few weeks ahead of broadvisit www.dentevents.com, select Adding tools to accept registrations and payments, cast and so by facilitating rapid listing Events and then Express Listing. A form manage delegates and allocate CPD. onto Dentevents.com, we will see more then displayed and once completed, dental education, event or If you’reis organising any kind of post-graduate webinars being added. The outcome your eventyour will event be reviewed and posted. For more information, see dent.events webinar, listing on the dentevents.com continuing education

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64 Australasian Dental Practice

May/June 2022

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ONLINE CPD CENTRE infection | CONTROL

infection | CONTROL

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Infection control: Facts versus fallacies in the post-June 2022 world

Preventing needle stick injury

By Emeritus Professor Laurence J. Walsh AO

t is important that all dental practices are aware of some significant changes which are occurring from June 29, 2022 and are not misled by those who would seek to profit from the confusion that these changes may create. Hence this article is themed around “an audit of the auditors”.

The DBA change

here is a significant change in the position being taken by the Dental Board of Australia (DBA), with the move away from its 2010 policy, towards the use of a structured comprehensive self-reflection tool. This move does not in any way denigrate the importance of the existing national standards and guidelines, nor does it lower the expectations

90 Australasian Dental Practice

By Dr Greg Mahoney, BDSc, PhD, MSc (Dent), GradDipClinDent, FADI, FPFA

for dental practices in terms of infection control. The Board has made these two points abundantly clear in its communications to registrants about these changes. The key point from the DBA change is that a greater emphasis is being placed on practitioners being aware of the regulatory environment for infection control and staying up-to-date with changes as they occur. The DBA self-reflection tool is designed to prompt serious consideration by individual clinicians around how well-informed they are now and how they plan to remain wellinformed going into the future. As one of the individuals involved in testing the draft of the tool, I can say from first-hand experience that when done properly, it will take some time (e.g. around 1.5 to 2 hours) to complete in a thorough manner. This is not a quick “tick and flick“ document.

harps injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s. An Australian study found 27.7% of dentists had experienced at least one sharps injury in the previous 12 months and 16.1% of these involved a contaminated instrument that had been previously used on a patient. Furthermore, the most common devices to cause sharps injury in the previous 12 months were needles (14.4%).1 Hollow-bore needle injuries are of particular concern, since they are likely to contain residual blood and are associated

with an increased risk for blood-borne virus transmission. Of the 57 documented cases of occupational HIV transmission to healthcare personnel reported to CDC from June 1995 to December 2002, 50 (88%) involved percutaneous exposure. Of these, 45 (90%) were caused by hollow-bore needles and half of these needles were used in a vein or an artery.2

The risk lood-borne viruses that could potentially be transmitted by a sharps injury include hepatitis B and C, as well as HIV. The risk of transmission following a skin puncture injury is dependent on:

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• Whether the person who previously used the object had an infection; • The level of virus in their blood; • The amount of blood involved; • The type of needle or syringe in question; • The time that has elapsed since it was used; and • The nature of the injury. So in dentistry, the most likely source of a blood-borne virus transmission is the local anaesthetic needle, being hollow and injected into a vascular rich area. It is estimated that up to 14% of inferior dental nerve blocks result in an intravascular injection and with an infiltration may too puncture a blood vessel.3

May/June 2022

Question 1. A significant change in the position being taken by the Dental Board of Australia in relation to infection control:

Question 6. How effective is post-exposure prophylaxis in preventing HIV from needle stick injuries?

a. Denigrates the importance of the existing standards and guidelines. b. Lowers the expectations for dental practices. c. Places greater emphasis on practitioners being aware of the regulatory environment and staying up-to-date with changes. d. All of the above.

a. 20% b. 40% c. 60% d. 80%

Question 2. In regard to infection control, the Dental Board of Australia has moved towards the use of a structured comprehensive self-reflection tool that can be completed:

a. Ultra Safety Plus Snap b. Ultra Safety Plus Twist c. Ultra Safety Plus Pro d. Ultra Safety Plus Lock

a. Quickly with a tick and flick. b. In 15-20 minutes. c. In anout an hour. d. In 90 minutes to 2 hours. e. In 4-6 hours. Question 3. The ADA guidelines for infection prevention and control and the Risk Management Principles for COVID were prepared in consultation with: a. The Dental Board of Australia. b. DHAA and ADOTHA c. DAA d. ADPA e. All of the above. Question 4. ADA guidelines are: a. Only guidelines so you can ignore them. b. Are a key reference document that parallels NHMRC guidelines. c. Designed for infection control auditors as a cheat sheet. d. Out of date and need to be updated. Question 5. Australian standards automatically overrule all guidelines: a. True b. False

Question 7. The new version of the Ultra Safety Plus is called the...

Question 8. The risk of transmission following a skin puncture injury is dependent on: a. The level of virus in their blood. b. The amount of blood involved. c. The type of needle or syringe in question. d. The time that has elapsed since the needle was used. e. All of the above. Question 9. The risks of acquiring HIV from a contaminated needle are: a. 0.23% b. 0.56% c. 1.8% d. 6-30% Question 10. Following the implementation of Ultra Safety Plus, a study found that the number of avoidable needle stick injuries reduced to an average of: a. 14.8 per 1 million hours worked. b. 8.3 per 1 million hours worked. c. 11.8 per 1 million hours worked. d. 7.3 per 1 million hours worked. e. 0 per 1 million hours worked.

INSTRUCTIONS: Australasian Dental Practice™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, log in to the Dental Community website at www.dentalcommunity.com.au (call (02) 9929-1900 if you do not have a login) and click on the CPD Questionnaires link; select the Australasian Dental Practice May/Jun 2022 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD clinical | EXCELLENCE

clinical | EXCELLENCE

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Applying digital dentistry to an aesthetic restorative case

How to talk about pedo crowns with your paediatric patients Explaining the benefits of pedo crowns

Communication and digital tools combine to assist in meeting higher patient expectations

pplied to permanent molars, sealants can reduce the risk of cavities by 80%. But, what about deciduous teeth... and the caries that can sometimes show up? When it does happen, it’s common for parents to be upset and worried. And that anxiety can easily pass along to the child.

By Julie Driscoll, DMD and Mike Roberts

So, how can you help both parents and their children have a positive dental experience, even when the dentist finds a cavity?

Postoperative full-face view demonstrates the symmetry and harmony of the patient’s new smile that is presented in this case report.

n dentistry, communication is a three-way information exchange between the patient, dentist and laboratory, all focused on a single goal—successfully meeting the patient’s expectations. In theory, the more information each party imparts to the next, the more certain and optimal the outcome, especially in highly aesthetic cases. In an analogue information exchange, the patient verbally expresses his or her concerns and desires to the dentist. The dentist listens intently to the patient’s concerns and expectations, envisions what the outcome of the case should look like and then writes a prescription, or may even call the laboratory,

The key is to approach those conversations as an opportunity for learning.

detailing the case and expected outcome. It’s up to the laboratory to interpret all the collected information and fabricate a restoration that it believes meets the expectations of both the dentist and patient, often without ever seeing the patient. It is not until the seating appointment that the three parties—patient, dentist and laboratory—discover whether or not the information exchange and envisioned outcome has resulted in the restorative reality the patient expected. This fragile hundreds-year-old information exchange can be upended by any number of missteps in the communication process, from a bad impression and inaccurate shade interpretation to the selection of restorative materials and subjective decision-making.

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Let parents know that they’re not alone - tooth decay is the most common chronic disease in children and more than 40% of children will have dental caries by the time they reach kindergarten. Parents may not know that decay spreads quickly between deciduous teeth because that enamel is thinner than on permanent teeth. Follow up with the good news. They have an excellent option for treatment when significant tooth loss has occurred as a result of rampant or very advanced caries: pedo crowns.

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Question 11. In dentistry, communication must be clearly exchanged between: a. The laboratory, dentist and computer technician. b. The dentist, prosthodontist and periodontist. c. The patient, dentist and laboratory. d. The milling centre, dentist and ceramist. Question 12. The central restorations placed in the article were milled from:

May/June 2022

Question 16. In the BOIT system, the “I” stands for: a. Incisal b. Insidious c. Inside d. Intensive Question 17. Removing deciduous teeth too early is a problem because:

a. Lithium disilicate b. Zirconia c. Feldspathic ceramic d. Leucite-reinforced glass-ceramic

a. It creates space for neighbouring teeth to move into. b. It can interfere with how permanent teeth come through. c. It makes it harder for the child to chew some foods. d. It is very unaesthetic. e. All of the above.

Question 13. The white spots on the patients teeth were corrected using:

Question 18. According to the article, what percentage of children will have dental caries by the time they reach kindergarten?

a. Crowns b. Veneers c. Composite resin d. An infiltration agent

a. 10% b. 25% c. 40% d. 55% e. 70%

Question 14. The lab technician created a virtual case design by combining: a. 2D full-face digital photograph of the patient. b. 3D intraoral scan of the patient. c. CBCT scan of the patient. d. a and b. e. All of the above. Question 15. Restoring single centrals that blend seamlessly with adjacent teeth, while taking into consideration lip dynamics, is one of the most difficult challenges in dentistry: a. True b. False

To retrieve your FREE Dental Community Login:

Call (02) 9929 1900 or Email info@dentist.com.au

Question 19. In the BOIT system, the “T” stands for: a. Teeth b. Tonsils c. Tongue d. Tip Question 20. Hu-Friedy pre-trimmed, crimped and contoured crowns are made from: a. Nickel b. Titanium c. Stainless Steel d. Zirconia

abstracts | 2022

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

The spread of irrigant fluid versus saliva during periodontal procedures

ental procedures generate particles that are a mixture of saliva, blood, water coolant, plaque, gingival crevicular fluid, tooth hard tissue debris, calculus and dental restorative materials. The extent and spread pattern of common dental aerosol-generating procedures (AGPs) need to be identified before applying mitigating strategies. This study evaluated particle spread associated with various common periodontal AGPs in a simulated setting and in a periodontal clinic. The simulation study visualised the aerosols, droplets and splatter spread with and without highvolume suction (HVS, 325 L/min, Cattani Aspi-Jet 6) during common dental AGPs, namely ultrasonic scaling, air flow prophylaxis and implant drilling after fluorescein dye was added to the water irrigant as a tracer. Each procedure was repeated 10 times. These experiments were carried out in a 25m2 room which had 7 air changes per hour. The air flow device produced the highest amount of splatter, while the ultrasonic scaler generated the most aerosol and droplet particles at 1.2 m away from the source. HVS significantly reduced the spread of splatter, droplets and aerosols for ultrasonic scaler and air polisher, with reductions up to 96% for splatter generation for all three dental AGPs and 93% for aerosols. HVS did not alter the median size of splatter particles. The clinical study measured the spread of contaminated particles within the dental operatory and quantified airborne protein dispersion following 10 mins of ultrasonic supragingival scaling of 19 participants during routine periodontal treatment. The closed operatories used were each 15 m2 and had 7 air changes per hour, with delivery air outlets and return air collection on the ceiling of the operatory. All patients used hydrogen peroxide pre-procedural rinses. Bioaerosol contamination at each location for each patient was estimated based upon the protein quantity at that location and the protein concentration of the patients’ original whole saliva sample. Higher protein levels above background levels following ultrasonic supragingival scaling were detected in fewer than 20% of patients, indicating minimal particle spread. Fluids recovered at large distances from the oral cavity are comprised of coolant water rather than material from the patient’s mouth. While three common periodontal AGPs produce aerosols and droplet particles up to at least 1.2 m from the source, the use of HVS is of significant benefit. Routine ultrasonic supragingival scaling produced few detectable traces of salivary protein at various sites throughout a 10-min treatment. The likelihood of aerosol spread to distant sites during common periodontal AGPs is greatly reduced by high-volume suction. Clinically, limited evidence of protein contaminants was found following routine ultrasonic scaling, with the majority of fluid being irrigant rather than organic matter from the oral cavity.

Pulich A et al. Simulated and clinical aerosol spread in common periodontal aerosol-generating procedures. Clinical Oral Investigations 2022 May 17;1-12. doi: 10.1007/s00784-022-04532-8.

68 Australasian Dental Practice

Huff and puff in the gym aerosol generation during exercise

hysical activity and recreational and competitive sports not only are an important part of our culture and leisure activities but also prevent many diseases. Exercise is also an effective treatment for at least 26 major diseases. However, indoor group exercise in small, poorly ventilated rooms promotes infection with SARS-CoV-2 via aerosol transmission. During exercise, pulmonary ventilation can increase over 10-fold and therefore, exercisers will exhale a greater volume of aerosol-containing air. However, until now it is not known how exercise affects the concentration of aerosol particles in exhaled air and the overall emission of aerosol particles. This study used a new method to measure in parallel the concentration of aerosol particles in expired air, pulmonary ventilation and aerosol particle emission at rest and during a graded exercise test to exhaustion, for 8 women and 8 men. The aerosol particle concentration in expired air increased significantly from 56 particles/litre at rest to 633 particles/litre at maximal intensity. Aerosol particle emission per subject increased by a factor of 132 from 580 particle/ min at rest to 76,200 particles/min during maximal exercise. There were no gender differences in aerosol particle emission, but endurance-training subjects emitted significantly more aerosol particles during maximal exercise than untrained subjects. The concentration of aerosol particles during exercise was greater than the increase reported for loud speech (that was 320 particles/ litre). Deeper inspiration and expiration during exercise increases the particle concentration in expired gas. During intensive exercise, this is exacerbated by increases of ventilation by a factor of 10 or more. These data partly explain superspreader events especially during high-intensity group exercise indoors and suggest that strong infection prevention measures are needed especially during intense exercise.

Mutsch B et al. Aerosol particle emission increases exponentially above moderate exercise intensity resulting in superemission during maximal exercise. PNAS 2022;119(22): e2202521119 doi: 10.1073/pnas.2202521119

May/June 2022

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the cutting | EDGE

Defects in impressions: More than meets the eye By Emeritus Professor Laurence J. Walsh AO

o begin with, the most basic point, an impression, is required to render an accurate threedimensional representation of the surfaces of interest in the mouth, so that the dental lab has the information needed to manufacture the appropriate restoration or prosthesis. This is where the similarity with an intraoral scan is most apparent in terms of the final purpose. As a set of threedimensional data points, a representation which has high fidelity to the source increases the likelihood of the final prosthesis for restoration fitting the preparation for which it was designed with the chosen degree of tolerance.

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When looking at defects in impressions and trying to work out what caused them and what to do about it, the process is not as simple as it would seem at first sight (pun intended). The first issue is that the clinician, their clinical supervisor if relevant and the laboratory technician must be able to look at the impression and, in their mind’s eye, inverted so that the defects can be identified in the first place. This is not a skill that everyone has and arguably it is not a skill that can be learnt if one lacks the capability entirely. For those who do have the skill to be able to invert the information in three dimensions to identify the flaws, there is then the challenge of understanding the various problems that can lead to defects in impressions, such as phase separation, velocity compounding and shear thinning.

May/June 2022

the cutting | EDGE Returning now to the main theme, despite a significant literature in the area of viscosity and fluid dynamics, much of the information provided to clinicians and to dental technicians by the companies that manufacture impression materials is questionable in terms of its quality. It may be technically incorrect, lacking in detail and far too simplistic in trying to explain what is actually a complex series of interactions between the impression material and the surfaces of teeth and oral soft tissues. This article, as the latest in a series of articles on properties of fluids that relate to dentistry, seeks to explore these topics. It could well make for some readers uncomfortable reading. In addition to the points of a purely technical nature that are discussed in this article, there must be a willingness on the part of the clinician to engage in a discussion with others about the impression. This can be challenging when there is an unwritten and unspoken agreement (a contract of sorts) that the topic of impression quality will not be mentioned or discussed at all between the various parties. Recognising that this barrier might exist and seeking to overcome it, is an essential part of the challenge, if one wants to improve quality. This subject will be addressed in depth in a later article in this series, so that it gets the scholarly attention which it deserves.

Fit and finish he engineering concept of “fit and finish” is highly relevant here. Components which are manufactured to a high degree of precision fit in a reproducible way into other components. Misinformation and distortions in the three-dimensional dataset will lead to a compromise in whether that fit can be achieved. An inherent challenge in a clinical impression is that the prosthesis or restoration which will be manufactured based on it will not come into existence for some time (hours, days or weeks), so the fit cannot be tested immediately, to gain feedback on it. Adding to this, the stability of dental impression materials over time is itself fraught with a series of problems, which vary according to the nature of the material and how it responds to the external environment (including humidity and exposure to detergents and disinfectants) and how the material responds to

May/June 2022

the stresses that are generated when the impression material is withdrawn from areas with undercuts.

Assessing outcomes common expression is that dentistry combines both art and science, but neither of those provides a reason in itself for a lack of precision in the task of recording an impression. What is needed are people that have the skills to be able to assess their work, in the same way as that of a bricklayer, who when laying a line of bricks refers to a streamlined process to provide a discrete outcome around the three-dimensional placement of the brick. What we need for clinical dental practice is a clearly designed set of parameters and guidelines around what constitutes an impression that is adequate and fit for the task. The extent of advice provided on this aspect by major manufacturers of impression materials is sadly lacking.

Spatial perception o be able to read the surface of an impression, the fundamental skills at work are around spatial perception and sensory processing. Such aspects are well-known to differ between individuals (a phenomenon described as neurodiversity) within the one gender and between genders. To use an everyday situation which is illuminating, consider the task of reversing a car into a parking space. Some drivers have in their mind a clear perception of where the rear of the vehicle is and are able to park their vehicle into a space without anxiety and with precision. Other people, aware that they have limited skills in this area, will become very anxious when tasked with reversing their car into a parking space. This leads to the important question, should there be some efforts made to develop standardised ways to assess whether, during their training, studying for a career in clinical dentistry (including in oral health therapy, dental hygiene and dental prosthetics) as well as students studying to become dental technicians, should be screened for their visual perceptive skills. A number of simple methods have been developed to identify issues around hand and eye coordination, as well as depth perception. It seems likely that reliable methods could be developed

to identify from the outset those who lack the visual processing ability that is required in order to read and understand what is happening on the surface of a dental impression.

Sensory processing dding to this, one must bear in mind that the personality type distribution in dentists is not the same as in the everyday population and that personality types could be related to sensory processing capabilities. Sensory processing refers to the way that each individual can sense, perceive and respond to the sensory stimuli that are present in their environment. It includes how incoming information is detected, as well as how it is processed and integrated in the brain, as well as how the insuing response or behaviour is modulated. As one example, if an individual is on the spectrum for autistic spectrum disorders, despite being high functioning and having a high IQ, they can still be affected by sensory processing issues and may tend to develop strategies such as camouflage when faced with situations where these skills are put to the test.1 Attempting to trivialise the situation or being flippant about it could be an example of a camouflage strategy. Differences in sensory processing between individuals can be magnified by their culture and upbringing and by the hobbies undertaken during childhood, which can enhance considerably aspects such as hand-eye coordination and the ability to interpret three-dimensional space. Sculpture is an obvious example, as is building complex models from very small generic parts. In covering the topic of sensory processing, one must also recognise that there is a literature on gender-based differences in ability. It is well-known that, on average, males have reduced verbal ability compared to females, but have superior visuospatial skills. On average, an adult male is more likely to be better at visualising what happens when a threedimensional shape is rotated in space and at correctly determining angles from the horizontal. Such gender-based differences have been measured even at very young ages and can be identified even in two and three-month-old infants, where infant girls are more interested in faces, while infant boys are more interested in objects.

Australasian Dental Practice

the cutting | EDGE It must be emphasised that within any gender there will be a distribution of capabilities across these domains and that those who are at the lower extremes of the normal distribution in both genders could struggle with the three-dimensional interpretations needed to assess the surface of an impression. It is important to avoid rigid gender-based stereotypes and to recognise the variation that will occur within the one gender and to factor this into an overall understanding of what can influence performance in the analysis of impressions.

Response to stimuli esting this aspect in students using impressions with certain types of defects versus those without such defects could be done by measuring the time taken to respond. Those who are unable to mount a response within a realistic timeframe could then be identified as those who are unable to distinguish the nature of the stimulus. Within those who do respond, one would need to account for a range of the confounders that influence the way that students respond to a particular stimulus, including as well as their gender, their age, their personality type and whether they are mostly sedentary in their life outside university or are exercising regularly. There is evidence that medical students who exercise regularly have faster reaction times to stimuli compared to those with sedentary lifestyles.2 Ignoring all the obvious reasons why regular exercise is good for general health, this could lead to the suggestion that those who do possess the visual processing skills themselves should be encouraged to exercise regularly in order to maintain and indeed improve their efficiency levels. When considering the nature of the individual personality factors that could be at work, there is evidence going back to the mid-1990s that the way that extroverts and introverts, when faced with a novel stimulus, process information is fundamentally different - ranging from exploration (being bold) to quiet vigilance (being timid). These differences result from biochemical differences in neurotransmitters and to the way that information is processed by introverts more in the right hemisphere. These factors also vary according to the intake of caffeine as well as the time of day. Overall, introverts

72 Australasian Dental Practice

tend to be more reflective and more stringent in determining what they respond to then extroverts.3 Unfortunately, when put on the spot under pressure, their high arousability can lead to disorganisation, which then interferes with their sensory processing abilities. Said another way, if the individual dentist or dental technician is an introvert and another person makes a point of demanding whether or not they can see the errors in the impression, their ability to process the information is compromised by the stress of the attention placed on them in that moment. Something that they might be able to do when relaxed, they now are less capable of doing.

“It is important for clinicians to understand the differences in behaviour between Newtonian fluids (like local anaesthetic solutions) and non-Newtonian fluids (such as impression materials)...”

simplest explanation is how these materials flow and deform. Understanding the influence of applied force on impression materials is fundamental and these aspects have been discussed in previous articles in this series. It is important for clinicians to understand the difference between Newtonian fluids (like local anaesthetic solutions) and non-Newtonian fluids such as impression materials. In the latter, the viscosity varies as a result of the applied shear stress and effects such as shear thinning or pseudoplastic flow occur because of micro-structural rearrangements within the impression material. When clinicians apply very high pressure to an impression tray, dispersed elements such as fillers jam together and form networks and less viscous components can separate out. This leads to variations in the composition of the impression material between regions around a tooth as well as across the surface of the impression tray. These alterations lead to variations in the elastic behaviour of the impression as it responds to the process of withdrawal and the subsequent relaxation back to a low energy state. Even without having formally studied fluid dynamics, some people may be able to understand them as a physical phenomenon - but whether or not that happens depends on variables such as their familiarity with the events occurring within the impression that they are now trying to understand.4 Do they fundamentally understand what is happening or do they hold misconceptions?

Education and training Before leaving the extroversion and introversion discussion, one must mention that an extrovert who lacks the necessary visual processing skill might simply exercise some bravado or showmanship to try to avoid being pinned on their specific shortcomings. This aspect can be seen in some online videos which purport to show the clinical techniques involved in taking an impression.

Rheology basics ast of all, even when armed with the visual processing skills and able to put aside the issues of the stress of the moment and its inherent anxiety, there is a need to understand the basic rheological properties of impression materials, which in its

ffective teaching by those who do understand what is happening can extend a student’s current state of knowledge, bringing them up to speed with the necessary information so that their concepts are accurate. Children can understand basic concepts such as containment and flow and often use these when playing with materials such as plasticine or putty. Arguably, taking people back to their childhood days and developing training exercises that use materials of differing viscosity to show how they respond to applied pressure, could be a worthwhile component for education. Learners will perform better when presented with concrete and familiar versions of the same event that they are trying to study.

May/June 2022

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the cutting | EDGE Conclusions and implications n summary, multiple variables influence the capability of an individual clinician to be able to look at the impression they have just taken and be able to identify what has been happening to the impression material. It is not simply a case of telling a clinician to look up a short guide on troubleshooting common impression problems and figure it out for themselves. Before that happens, the clinician has to identify that they have a problem in the first place, by applying their particular visual processing skills for this task (if they possess them). They must also have a logical framework to understand how

the quality of their impressions. Is it that they cannot see these in the first place or that they can see and do not know - and do not understand - what can be done better? There is a challenge to educators to explore the visual processing capabilities of their students in a robust way and for supervisors of clinicians and dental technicians to understand that there is variability in sensory processing skills and that the skills of any one person may be compromised when they are put under intense pressure and their anxiety levels are raised. When faced with the challenge of working out what has gone wrong when an impression has defects, is it a matter of

Table 1. Stepwise requirements for analysing impressions Requirement

Influencing factors

Visual processing skills

Innate (yes or no)

Gender Hobbies Personality type Response to the stimulus

Time of day Caffeine

Gender Exercise routine Analysis of the information

Dental materials knowledge Understanding of fluid dynamics

Introversion vs extraversion Pressure of the moment Anxiety level

Willingness to have the conversation

the material is behaving and a sound theoretical basis drawn from fluid mechanics to know reason how to prevent the same problem recurring. The conclusions from this discussion article are relevant to clinicians as well as to dental laboratories (Table 1). A primary complaint that dental technicians voice is that the impression they receive on a daily basis contains flaws such as voids and drags) and lack adequate marginal detail. It is simply not enough to discount these complaints. An impression with defects is, after all, a dataset with errors and an object that does not comply with the “fit and finish” philosophy. It is not surprising that some clinicians develop significant anxiety when asked about

74 Australasian Dental Practice

“Do you see what I see?”. In a larger clinic or lab, where more staff members are present, the normal variations that occur in the level of skill might lead to one or more individuals who have (regardless of their gender) somewhat better visual processing abilities than their colleagues and who may be better able to assess impressions and recognise the types of problems that might be occurring when they cast their eyes over impressions. This is not to disempower in any way those who have - for whatever reason - less skill in this area, but rather to suggest that others could use those with better visual processing skills as a resource and also learn from them, to enhance their own skills and understanding.

Knowing what is an acceptable outcome is essential. The end goal is to improve the quality of information flowing to those in the lab who are tasked with manufacturing a restoration or prosthesis. Dealing with the associated anxieties around performance is important, as is being prepared to have a conversation about it in the first place, while at the same time the physics of the fluid behaviour cannot be ignored either.

References 1. Osorio JMA et al. Sex differences in sensory processing in children with autism spectrum disorder. Autism Research 2021; 14: 2412-2423. 2. Jain A et al. A comparative study of visual and auditory reaction times on the basis of gender and physical activity levels of medical first year students. International Journal of Applied and Basic Medical Research 2015; 5(2): 124-129. 3. Aron EN and Aron A. Sensory processing sensitivity and its relation to introversion and emotionality. Journal of Personality and Social Psychology 1997; 73(2): 345-368. 4. Vicovaro M. Intuitive physics and cognitive algebra: a review. European Review of Applied Psychology 2021; 71: 100610. 5. Kaiser MK at al. Intuitive reasoning about abstract and familiar physics problems. Memory & Cognition 1986; 14: 308–312.

About the author Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

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practice | MANAGEMENT

Huge financial changes to impact dentists By Graham Middleton

“Dentists with long memories will remember Paul Keating’s self-styled ‘Recession we had to have’... Manufacturing jobs vanished as non-competitive industries closed in Australia and were rebirthed in China...”

entists with long memories will remember then-Labor Treasurer Paul Keating’s self-styled “Recession we had to have” of the early 1990’s. It was designed by Treasury and Reserve bank officials to crush high inflation. It accompanied a restructuring of the Australian economy through floating our dollar and deregulatory measures. A host of formerly protected businesses were crushed as Australia converted from a significant manufacturing economy to a service economy. In retrospect, Treasury officials admitted that they had not realised the seriousness of the recession in their cosseted world of Canberra, with its high household income and multitudes of job protected government employees. I remember a client, an engineer, whose last task for his employer was to photograph, number and pack the manufacturing plant into containers to be shipped to China. He subsequently carried out similar tasks for another business specialising in packing up manufacturing plants and freighting them to China! Manufacturing jobs vanished as non-competitive industries closed in Australia and were rebirthed in China.

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Not all bad conomics teaches us that the world is better off when every country concentrates on producing the goods and services where it has a natural advantage. Australia’s natural advantages have long been in mining and agriculture, but technology has displaced many of the jobs in those sectors. Modern miners use huge machines which have long since displaced large numbers of humans toiling with picks and shovels while agriculture has seen huge aggregations of farms. As such, Australia had to develop jobs in service industries including tourism and education. Many students studied in Australia for the purpose of gaining residency. Tourism benefitted from having alternate seasons to the Northern Hemisphere. Both were successful until COVID shut Australia off from the world.

Is there a coming recession? ach major financial event starts differently but there is always an impact. The Keating recession had the deepest and longest impact of any economic event since the Great Depression of the 1930s which preceded World War 2.

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practice | MANAGEMENT Other events such as the Asian economic crisis, 9/11 terrorist attacks on the United States, the Global Financial Crisis (GFC) and the initial impact of COVID were of shorter duration. Australia was lucky to have worked its federal budget into surplus and paid down government debt and was therefore able to cope with the GFC, albeit that it recreated government debt and deficits. Measures to assist employers deal with COVID and other government spending has increased government deficits and further expanded debt at a time when interest rates are rising. It is as yet unclear whether a combination of rising interest rates and much higher fuel costs for industry will drive Australia into recession but certainly there will be significant impact.

Don’t fight the Fed! he US Federal Reserve (the Fed) sets interest rates and monetary policy in the United States and this has global impact. Money flows to the countries with better interest rates and investing conditions. The Reserve Bank of Australia makes policy setting to keep the money flow positive for Australia. If the Commonwealth Government was able to limit its spending (fiscal policy), the RBA would have less need to toughen monetary policy but history demonstrates that politicians tend to overspend rather than save. American financial wisdom is that it is foolish for investors to make decisions which are contrary to the direction of monetary policy, hence the wisdom is “don’t fight the Fed”. The Fed has made it clear that its direction of interest rate settings is upward, but may be slightly slower than previously thought due to the outbreak of the Ukraine war. Australia’s Reserve Bank has indicated that interest rate increases are underway. This may tip Australia into recession.

If the Fed is increasing interest rates expect share markets to fall s a long-term effect as interest rates increase, share prices fall. With the Fed forecasting a series of interest rate increases and our Reserve Bank indicating that a series of monthly increases are also likely, expect the share market to

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weaken - meaning that most superannuation funds if heavily invested in shares as well as managed funds invested in shares are likely to fall over the coming year. My family superannuation fund now has well over half of its assets held in interest bearing deposits and bank hybrid securities despite their low yield. There will come a time when the interest rate cycle stabilises and it will be time to shift to greater equity weighting.

Managed funds fail to beat the share market indexes any advisers erroneously recommended managed funds over direct equities despite there being overwhelming evidence that the vast majority of managed funds underperform the share market over both short and long term. Many active fund managers claim to be able to

“Many advisers erroneously recommended managed funds over direct equities despite there being overwhelming evidence that the vast majority of managed funds underperform the share market over both short and long term. Many active fund managers claim to be able to beat the market, but few do and then generally only temporarily...” beat the market, but few do and then generally only temporarily. To be better than share market indices, they have to beat the market by more than their own fee structure which the vast majority fail to do and if they do so it is invariably for a limited time. If you do not want to invest directly in the share market, then exchange traded funds have much lower Management Expense Ratios (MERs) than managed funds. It is important to wait until the worst of the increases in the interest rate cycle have occurred before investing heavily in either the share market or into ETFs based on equities. Patience is a

virtue as evidenced by the Warren Buffet led company Berkshire Hathaway sitting on vast amounts of cash as stock markets underwent a huge growth in prices. Warren rarely gets the long-term strategy wrong and has been very successful over many years. His recent yearly letters to shareholders are required reading by those trying to make sense of financial markets. They are on the internet.

The lesson he lesson is that dentists need to avoid advisers advocating managed funds, particularly “active managers with high fee structures”. Always check the MERs of funds and compare them with the MERs of Exchange Traded Funds. If the MER is hidden or unclear, avoid. Naturally my advice is subject to the caveat of seeking alternate professional advice but be sure that the adviser concerned is not simply directing you to a costly solution involving high fees for them/their organisation. There is no substitute for being personally familiar with the operation of financial markets. Check on financial advisers pitching for your business by asking them questions to which you already know the answers.

Higher interest rates = Lower house prices he competition by bank lenders to swell their assets (loans to customers) on their balance sheets together with historically low interest rates to borrowers and zero or near zero rates for depositors resulted in home buyers attending auctions with high loan pre-approvals. This bid-up house prices to record levels by late 2021. From early 2022 indications of rising interest rates and directions by bank regulators to increase stress testing before approving loans to borrowers has begun the wind back of maximum loan approvals. In turn, those seeking to buy have had to reduce the amount that they are prepared to pay and house prices have begun to weaken. The Reserve Bank of Australia has to follow the upward direction of interest rates led by the Fed. If housing interest rates double from 2 percent to 4 percent, the impact on recent borrower’s personal cash flows is huge. A monthly repayment on a 30-year home

Australasian Dental Practice

practice | MANAGEMENT loan increases from $3691 to $4,759 or an additional $12,861 per year. If the home interest rates grow to 5 percent, which is likely in 2023, the monthly repayment is $5346 or an extra $19,860 per annum. In practice the banks will limit new home loans to what they judge the borrower can afford to pay. The result will be falling house prices over the next 18 months as interest rates increase. Those who purchased recently with maximum loans during the house price boom are the hardest hit. They face much higher payments while the value of their house is likely to fall. Those who bought with the intention of upgrading in a few years may be trapped in their current home for much longer by higher repayments and reduced home equity. I have vivid memories of the stress experienced by clients during the Keating recession of about 30 years ago, faced with huge interest rates of 13.5 percent on regulated home loans, 17 percent on new home loans and business overdraft rates of 22 percent coupled with falling home and other asset values. Each generation forgets the lessons of the past. The housing boom culminating in late 2021 was based on a widespread misbelief fueled by the real estate industry that houses continually rise in value. History teaches us that there are significant periods when house prices fall or when the real estate industry stagnates. After a few good years much of the population forgets the tough times. As interest rates have fallen, those who bought or upgraded homes 5 or 6 years ago experienced a big lift in their net equity but those who bought recently will suffer. Over many years, I bid at Melbourne House auctions on behalf of long-term clients. Bidding tactics varied according to the state of the market and I always advised the client to give me sensible limits. I have witnessed some bizarre outcomes and many bidders who were unable to read the auction. Selling by auction is favoured in strong markets but falls away when markets are negative.

The home loan lesson compared to business debt ome loans on which the interest is not tax deductible should be reduced as quickly as possible. At a marginal tax and Medicare rate of 47 cents per marginal

78 Australasian Dental Practice

dollar, the interest on a tax-deductible business borrowing is almost halved after tax. Hence a housing loan at 5 percent, as is likely during 2023, is equivalent to a loan on practice premises of 9.44 percent. The lesson is clear when borrowing to buy dental premises arrange with the bank to pay interest only on the business loan while agreeing to accelerate repayments of the home loan. If housing interest rates rise beyond 5 percent, the advantage of this strategy increases. Some bank lenders will readily agree, usually limiting the interest only period on the business loan for three years. Dentists who demonstrate that they have run profitable practices usually have little difficulty in persuading their bank or a competitor to continue interest only

“In some states, particularly Victoria, legislation which greatly favours the rights of tenants over owners makes rental housing an undesirable investment. As interest rates increase, more rental properties will be thrown back onto the market as owners sell to reduce their home mortgages or take financial pressure off their businesses...” business loans after the initial period. Safe secured loans enhance bank balance sheets.

Residential rental property: Avoid, if possible, particularly in Victoria esidential rental properties seemed satisfactory to some during a period of rising real estate prices but rising interest rates and accompanying falling prices will expose their extremely poor net income yield. In some states, particularly Victoria, legislation which greatly favours the rights of tenants over owners makes rental housing an undesirable investment. As interest rates increase, more rental

properties will be thrown back onto the market as owners sell to reduce their home mortgages or take financial pressure off their businesses. We experienced this in the late 1980s and early 1990s.

If you want to help your children buy houses! t is now the time to encourage children to be patient as interest rate increases and the expectation of increases to come reduce house prices. Those who think that house prices always increase are mistaken. The best time to buy is when interest rates are at their zenith and hence likely to reduce. When interest rates begin reducing the value of houses purchased at the peak of the interest rate cycle increase.

When upgrading your home obody upgrading a home in the current market of rising interest rates should buy before they have a sale on their existing home as there is a risk of failure to sell or having to accept a much lower price in a falling market. If interest rates rise by more than expected, home buyers disappear. The opposite was the case when rates were falling and likely to fall further the housing market was growing and we could afford to buy with bridging finance confident of a quick sale of our existing homes. It is all about the direction of the interest rate cycle.

The share market, Bitcoin and superannuation rypto currencies have multiplied in number but have no intrinsic value other than speculating in other crypto currencies and making those who successfully promoted them wealthy. Recently crypto currencies numbered in the thousands, some domiciled in tax havens. Apart from being havens for money laundering and used for criminal activity, they are an unregulated maelstrom which at early signs of substantial global economic slowdowns shed value. I am reminded of the Dutch Tulip Bulb and English South Sea Bubble implosions and a variety of other historic failures. Inflation particularly in the price of basic necessities and rising interest cost snuffs out speculative bubbles. Crypto currencies are difficult to

May/June 2022

practice | MANAGEMENT regulate because they exist in cyber space and their domicile can change quickly. Their value can collapse quickly.

Financial markets and history lessons arren Buffet, arguably the world’s greatest investor, observed in 2002 that it is only when the tide goes out that we see who has been swimming naked. Warren was referring to the result of rampant speculation when investors paid inflated prices for assets with too little income to service their debts. The greatest period of this, in my lifetime, was the era of the 1980’s Australian Entrepreneurs who bought companies and other assets with huge amounts of borrowed money and shamelessly exploited their small shareholders with management agreements which took away their income. The October 1987 global share market collapse followed a couple of years later by strongly increasing interest rates and falling company profits exposed these entrepreneurs as swimming naked with insufficient means to service their debts and unable to sell assets except at huge losses. They were unable to continue refinancing by shuffling asset ownership. The period saw huge liquidations, forced by bank lenders and collapses of companies. Some entrepreneurs fled from Australian legal retribution to foreign exile, several went to jail and lots were destroyed financially. That period saw Alan Bond jailed, Christopher Skase in exile in Spain, Abe Goldberg in exile in Poland, Laurie Connell dying in jail and a host of other bad endings.

Success in dentistry: The dental quad verwhelmingly, successful dentists concentrate on owning four assets which are: 1. Their family home with accelerated repayment of mortgage; 2. Their dental practice debt financed; 3. Their dental premises also debt financed with possible exceptions for some country practices with very low rents; and 4. Their superannuation fund, which dependent on cash flow, they fund with a combination of concessional and nonconcessional contributions.

May/June 2022

Practice ownership is vastly more lucrative long term for most than being a corporate dentist. It provides the opportunity to employ spouses, superannuate both and benefit from growing practice goodwill value and the value of practice premises. Corporate claims to the contrary do not stand up to examination. There are a plethora of advisers clamoring to do business with dentists but simple truths need to be restated: • The key to practice profitability is the fees generated by the practice owner personally, since they do not have to pay another dentist a substantial amount to do that work. Practice owners are generally the best dentists in their prac-

“The key to practice profitability is the fees generated by the practice owner personally, since they do not have to pay another dentist a substantial amount to do that work. Practice owners are generally the best dentists in their practice with the most patient relationships. And the best privately-owned practices are more profitable per dollar of fees than corporate practices...” tice with the most patient relationships; • The best privately-owned practices are more profitable per dollar of fees than corporate practices; • Don’t let assistant dentists spread their appointments over more sessions than the work requires. An assistant dentist with 2.5 days of appointments spread over 4 days costs 1.5 days extra chairside assistant time. Keep practice support staffing to a minimum; and Measure the number of follow-up appointments generated by assistant dentists and their number of personal referrals. Some assistant dentists are practice builders, others are not. Best wishes to all dentists and specialists.

General Advice Warning The information contained in this article is unsolicited general information only, without regard to the reader’s individual financial objectives, financial situation or needs. The information contained on this article is general in nature and you should consider whether the information is appropriate to your needs, and where appropriate, seek professional advice from an accountant or financial adviser. It is not specific advice for any particular individual and is not intended to be relied upon by any person. Before making any decision about the information provided, you should consider the appropriateness of the information in this article, having regard to your objectives, financial situation and needs and consult your professional adviser. Any indicative information and assumptions used here are summarised, are not a product illustration or quote and also may change without notice to you, particularly if based on past performance. This notice must not be removed from this article.

About the Author Graham Middleton disposed of his interest in Synstrat group on 30 June 2020 and won’t be starting another business. He spent the later 33 years of his working life advising health professionals on business and financial matters. Dentists were the most numerous of his clients. He is the author of the recently published Financial Success for Dentists. Dentists may obtain a copy by making a donation of a minimum of $60 to the Delany Foundation, a registered charity which assists schools in Ghana, Kenya and Papua New Guinea, then email Graham at graham. george.middleton@gmail.com. A copy will be sent to you. All proceeds go to the Delany Foundation for its good work. Graham has paid for the printing and mail costs personally.

Australasian Dental Practice

practice | MANAGEMENT

If your staff don’t highly value your services, then treatment plans won’t be sold By Julie Parker

our team deals with the issue of the price of dentistry daily. You develop systems to manage this aspect of treating patients, such as payment plans, issuing verbal and written quotations and structuring a portion of your discussions with patients around the topic. It is appropriate to contemplate how your team members navigate the issue of the cost of dental treatment and the impact on dental patients. All consumers weigh up the benefits and drawbacks of making any purchase: What are the benefits the purchase will deliver to us against the drawbacks of the amount of money that will be removed from our bank account? The larger the perceived benefit and/or the lower the perceived price makes these decisions easier for the consumer. The price range of dental services is higher than many purchases, so deeper consideration is often thought to be required by patients. Here’s a crucial insight for your consideration: When one or more of your team members feel that: • The patient cannot afford the treatment; • The price of the treatment is too high; or • They would not personally spend that amount on their own dental health... Then the message of “too expensive” can be subconsciously delivered to patients. The issue of “price” versus “value” is one that I encourage all dental teams to discuss openly. Team members know the price of every service down to the last cent but often do not understand and appreciate the value delivered to their patients by those treatments. The price of any service your practice provides is relevant only up to the point of payment. After your patient has paid for

80 Australasian Dental Practice

their treatment, the value they experience is over the days and years to come. And this is what your team members need to understand and appreciate to effectively communicate with your patients during treatment plan discussions. If you handle this issue well, it can make a wonderful positive difference to the energy within your practice and the feelings that your patients experience with every interaction. After your patients have paid for their treatment, the value they experience will be enjoyed over the days and years to come. And this is what your team members need to understand and appreciate to effectively communicate with your patients during treatment plan discussions and to assist them to make excellent decisions. Therefore, gaining a deeper understanding of what is important to each patient is crucial. Your patients don’t want a filling or a cleaning or an implant. What they do want is what the filling, the cleaning or the implant DOES FOR THEM. The VALUE that you need to communicate to your patients is the OUTCOMES they experience after receiving your treatment. There is a distinction between what are good outcomes for your dental team and what are good outcomes for your patient. For example, one of the good outcomes when saving a tooth for your team is maintaining bone height of the jaw bone. However, your patient does not care about this outcome because he or she has not studied dentistry and therefore cannot appreciate these benefits. What he or she does see as a valuable outcome is enjoying a youthful appearance for as long as possible by maintaining their facial structure. To be able to speak in “patient outcome” terms, consider how the different services you offer:

• • • •

Help your patients look better. Help patient’s mouths function better. Help your patient feel better. Help your patient have peace-of-mind. These are the outcomes of dental treatment that are valuable and meaningful to your patients. These are the outcomes they understand. Missing this crucial step in your treatment plan discussion with your patients is not only a disservice to you and your practice, but also denies your patients the information they need in order to make informed decisions about their oral care. I urge you to work with your team to involve them in identifying the comprehensive list of patient outcomes for key treatments offered by your practice. This will have the following substantial and beneficial impact on the discussions conducted with your patients: 1. Team members will clearly understand the value each treatment can deliver; 2. The mindset of team members will be one based on the positive outcomes patients will experience rather than the price; 3. There will be consistency in the message the patients receive when speaking to the dentist, the nurse, the receptionist or other team member about their treatment options; and 4. There will be an important flip in the team’s purpose, from “‘trying to get patients to accept expensive treatment” to “helping patients look, function and feel better”.

About the author Julie Parker Practice Success provides dental teams with coaching and training so they can work together and achieve successful outcomes for their dental practice. For info, contact Julie on 0407-657-729 or julie@julieparkerpracticesuccess.com.au

May/June 2022

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practice | MANAGEMENT

Why are they selling? Why good business owners sell strong businesses By Simon Palmer

ne of the first questions that a buyer will ask when a business is for sale is Why are they selling? When the business is strong and the vendors seem young and healthy, buyers will often show some incredulity and/or suspicion about why it is for sale. There seems to be a misconception out there that a successful business owner will only ever buy, grow and accumulate businesses. That when they decide to sell one, it could only be if they were retiring, sick or if there was something wrong with the business that the buyer cannot see yet... This is an incredibly narrow and pessimistic view of what it is to be a successful business owner. Successful businesspeople sell their businesses for many reasons that have nothing to do with the underlying prospects of the actual business being sold. Any successful business owner should consider selling any business when they realise that one of the following has occurred:

82 Australasian Dental Practice

1. If they realise that their time and/or resources is better spent elsewhere

2. If they realise that the business is worth more to someone else than it is to them

ne of the things that makes a person or company successful in business is that they seem to understand the inherent opportunity cost of their time and resources. Every business owner has limited/finite time and resources and needs to decide where to allocate them. Not every business opportunity operates at the same ratio of time/effort to profit/return. Some businesses are more time hungry and require more effort than others. When a successful business owner is selling a business, it is often because they could allocate those resources to another business that they already own (that needs more attention or investment) or to another business that they wish to buy. This doesn’t mean that the business they are selling is not good. The business may be an excellent business, but just isn’t a good fit for their circumstances and their business holdings/portfolio at the time.

a. A dental practice that is turning over $700,000 per annum with 0% profit can still be a good job for a dentist who is the owner-operator (taking home 40% of the $700,000 (less lab fees)), but without any profit, it may not be a good business for a third-party owner (who still needs to pay a dentist the 40% of the $700,000 (less labfees) to do the work). That is to say, some practices are worth far more to an owner-operator to run and work in, than to a third-party business owner. b. Some businesses are full of opportunity that the current owner simply lacks the skill, time or inclination to realise. To give an extreme example, a dental practice with a $1 million turnover that is referring out all crown and bridgework or implant cases or simple orthodontics is worth far more to another owner who can offer these treatments, than to its current one.

May/June 2022

SBANE June

practice | MANAGEMENT 3. If they realise that they’ve extended beyond their ceiling of complexity

Their relationships with their family and friends; or n Their mental health. If someone is good at juggling and you hand them one more ball than they’re used to, they don’t just drop the extra ball…they drop them all. If the owners in this category cannot raise their ceiling of complexity, they’re better off selling the additional n

usiness owners that become successful often feel they now can replicate the formula with a second location or business, then a third. Many (most) will grow until they hit their ceiling of complexity.

If a business owner starts to see a decline in the turnover and profit of a business that they own and don’t have a plan or inclination to reinvest time and energy into it, it would make sense to sell now, before the value decreases further. If they want to continue to work, they should do so as an employee/contractor in their old business.

5. If they only bought the business to build it up and sell

here are three main ways to make money out of business ownership:

a. Salary. For a dentist practice owner, this means their 40% commission; b. Profit. What the business makes after all expenses are paid, including the principal’s salary; and c. Capital growth realisation. Buy low, build up and sell. A good example of this business model is with property developers.

For many, their ceiling of complexity will be their ability and capacity to delegate, manage, hire, inspire and keep good staff. Their initial business did well because it had 100% of the owner’s attention and time. Once they reach their ceiling of complexity, each additional business they own: • Has diminishing returns because the owner’s attention and time will be diluted and there is no one onsite with an ownership mentality; AND/OR • Starts to diminish: n The performance of the original business/es;

SYDNEY BRISBANE 22 24 October June

May/June 2022

MELBOURNE SYDNEY 2922 October October

business, consolidating their holdings to a point they are comfortable with.

4. If they realise that their business would be worth less in the future under their ownership business owner’s final years are usually less productive than the years that preceded them. These business owners tend to prioritise lifestyle (as they should) and work less hours per week, weeks per year (and dentist business owners offer lower clinical range).

Some practice owners fall into this third category. They have no interest in buying a business and running it for the rest of their careers. They want to buy something cheap, with potential, fix it up, show buyers that the growth is sustainable and sell it for a profit.

About the author Simon Palmer is the Managing Director of Practice Sale Search, Australia’s largest dental practice brokerage. If you’d like more info on practice sales or want to have a confidential discussion about your practice’s circumstances, email Simon at info@practicesalesearch.com.au or call 1300-282-042.

MELBOURNE 29 October

Australasian Dental Practice

practice | MANAGEMENT

Pathway to prosperity: A dentist’s guide to wealth creation Part 2 By Dr Jesse Green In this second in his article series, dentist coach Dr Jesse Green shifts gears and invites practice owners to consider the pathway to prosperity using their practice as the vehicle for the journey. With practical tips for dental business owners wanting to create real wealth, Dr Green takes you through the Savvy Dentist Value Model and the key elements needed to move beyond a profitability focus for your practice to a wealth creation mindset that underpins enduring prosperity.

here’s a certain predictable, reproducible growth journey every practice takes if the owner wants to achieve the pinnacle of the Savvy Dentist Value Model - wealth creation and freedom. But how do we get there when there is so much conflicting advice and we’re flat out running a practice. In the Savvy Dentist Academy, we coach literally hundreds of dentists that the practice owner’s journey to prosperity starts with a business vision and working through the Savvy Dentist Value Model, one level at a time, so let’s cover that first.

Step 1 on the pathway to prosperity: A profitable business he first layer of the model is focused on creating a profitable practice and cash flow. The currency at this level is money and all efforts are directed at creating a repeatable, sustainable flow of cash into the business. When your practice operates at this level, efforts are focused on systems that generate revenue and manage

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cashflow. The key question: How do we ensure we’re addressing all the financial aspects of the business? Why? Well, cash flow is the oxygen that keeps the business alive. If cash flow is poor, things aren’t right and need to change. A profitable business is a good thing, but at this level, a practice owner exerts

“A profitable business is a good thing, but at this level, a practice owner exerts enormous effort, yet has very little leverage. You’ll know if you’re here because you’ve basically created a job for yourself. Now, many practice owners stay at this level. They are comfortable with being the main source of revenue...” enormous effort, yet has very little leverage. You’ll know if you’re here because you’ve basically created a job for yourself. Now, many practice owners stay at this level. They are comfortable with being the main source of revenue for their business and aren’t interested in moving up the value model. That’s okay, so long as you understand the limitations. For business owners interested in a pathway to prosperity, however, there is more to be done if less personal involvement and more leverage is what you’re after.

Step 2 on the pathway to prosperity: A scalable business scalable business requires that we cross the leverage line and start implementing systems, developing a selfmanaging team and shift our mindset from owner-operator to now leading a business. When you achieve leverage through systems and a high performing team, your currency is time. Instead of choosing between money and time as you do in a profitable business, you enjoy the benefits of money and time. But as a scalable business, we’re only part way along the pathway to prosperity. As we progress up the model, we cross another leverage line into new territory again. It’s where we can truly enjoy the return on our efforts and investment as our business becomes a valuable asset.

Step 3 on the pathway to prosperity: A valuable business he third level in the Savvy Dentist Value Model involves creating a valuable business, an asset that has value. In that type of practice, we’re no longer thinking like an operator or owner. Instead, we’re thinking and acting like an investor. Getting to valuable means crossing another line; one I call the enterprise line. This means understanding the drivers of value in a dental practice. One challenge I see for practice owners is not having embedded and consolidated the elements needed at the profitable level. Unfortunately, there isn’t a fast track that leapfrogs you from start up to super star.

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practice | MANAGEMENT In fact, it’s best you don’t miss the steps. I’ve found the pathway to prosperity will be a challenging road to hoe unless a practice articulates through each level. It could be my navy background, but I liken the process to earning your stripes. You need to work through each level. Not only will your business be more solid in its systems and people, there’s a better chance your business will maintain this level of operation too; a key factor in achieving genuine wealth. I’ve reminded more than one client not to despise the profitable level because it really is the foundation of your business.

Are you making these wealth creation mistakes? ight up front in this article, I touched on the challenges facing dental business owners committed to creating wealth. If we think of the practice as the pathway to prosperity, then we’d better have some solid strategies in place for optimising our position, but knowing where to start is a challenge. Financial information overload is real and leaves even the most diligent researcher overwhelmed. Another common mistake I see high earning practice owners make is “investing” in lifestyle, rather than assets. This is shortsighted and reduces the capacity to build another revenue source with the potential to accelerate the pathway to prosperity. And of course, there’s the “hit an miss” approach; in effect, trying many things, hoping they’ll work, but not making any meaningful headway. You don’t need to be a financial advisor to know that hoping isn’t a wealth creation strategy, nor is the pathway to prosperity. An unlucky turn of the dice can leave you high, dry and in a financially vulnerable position. Thankfully, there is a better way and it starts with a key ingredient.

Desire: The key ingredient to wealth creation (and a handful of practical tips) o what’s the way forward? It starts with desire. In his seminal book, Think and Grow Rich, author Napoleon Hill researched the habits of over 500 of the wealthiest people on the planet over a period of 25 years. After studying these people and how they created their significant wealth, he concluded the first step

May/June 2022

on the pathway to prosperity is desire. Although published in the first half of last century, Hill’s words ring as true today as they did in 1937. Desire is the starting point on the pathway to prosperity and must be closely backed by a clear plan consistently implemented. With a clear desire and a plan, you’ll be well positioned to implement these 3 tips: • Invest regularly - An effective approach to wealth creation means investing regularly by putting money aside at consistent intervals (e.g. weekly or monthly), to allow funds to grow in value over time. Avoid the temptation of putting your hard-earned cash into lifestyle assets that depreciate quickly and aren’t income generating;

“Another common mistake I see high earning practice owners make is ‘investing’ in lifestyle, rather than assets. This is shortsighted and reduces the capacity to build another revenue source with the potential to accelerate the pathway to prosperity...” • Look for predictable outcomes - In so far as possible, we want to be sure we’re investing in assets that produce predictable returns. Of course, there are no guarantees, but prudent investment that generates a foreseeable return over time will keep you on the pathway to prosperity; and • Stay focused on freedom - Savvy Dentist clients know we talk about the different types of freedom: Financial, time and choice. These freedoms come once we’ve mastered the levels of the Savvy Dentist Value model and implement the steps that move us further along the trajectory to enduring prosperity. It’s this final point that resonates most deeply with me and the clients who subscribe to the Savvy Dentist mission, which has at its heart an objective to help dentists transform their practice to create multigenerational wealth for their family and have a massive impact in the communities they serve.

The wrap up n this article we’ve talked about profitability, scaling and leverage, with a handful of practical tips too, but as dentists, most of us are inspired by helping our patients enjoy better health and by enriching our families personally and financially. Both these goals are imminently possible when we understand the pathway to prosperity and have a clear plan for getting there.

About the author Dr Jesse Green is a leading business coach for dentists, author of Retention, a sought after speaker, and founder of the Savvy Dentist Academy. Jesse shares his knowledge, skills and experience as a practice owner through the Savvy Dentist Academy, a digital hub of training, events, courses and resources for dental practice owners who want to earn more and work less. Learn more when you book a Practice Growth call on 1300-668-384 with the Savvy Dentist team or visit savvydentist.com

Australasian Dental Practice

practice | MANAGEMENT

Your biggest investment in your practice should be this By Jayne Bandy

oes it seem like your team are just not getting their job done and under-performing? Are they doing something completely different to what you want them to do? Does something sound not quite right, when you catch yourself listening to the team on their phone calls? The reason why this is happening in your Dental Office is because your team don’t know what you expect and have never been shown what to do. It is so important right from the start that your team are clear about their role at the practice, what you expect and the steps to follow. Jumping to the conclusion that your team are lazy and incompetent is often what happens and people with great potential leave. I believe that there are four main reasons why front office teams fail to perform well.

1. They have NO job description job description clearly states what the team’s daily tasks are and the role that each person has in the functioning of your business. If YOUR team have no job descriptions, they don’t know what they are doing and only know bits and pieces of their job.

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“The reason why this is happening in your Dental Office is because your team don’t know what you expect and have never been shown what to do...”

2. They have had NO training roper training is essential for the whole team. You want to make sure your team know how to do their job properly and meet your expectations. Very often dentists believe in hiring people with previous experience. Previous experience can be great, but it is not always lined up with how you want to run your dental business. I also see dentists who rely heavily on existing team members to train new people even though the existing team barely know their own jobs due to a lack of training.

I went into the business of training teams because I experienced first-hand the frustrations team members have when they have not been trained and I know how this has a negative effect on your business and retaining staff.

3. Your team has NO support our team need a go-to person at work to advise and guide them, especially when they first start. Having support helps people keep on track and provides reassurance and accountability for them. No one wants team members making things up as they go.

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practice | MANAGEMENT 4. You have the wrong team

About the author

hen you are clear about your expectations, your team are trained and you offer great support, a team member can still struggle with their job. There is a time when a person you hire is just not suitable for the job. The match is wrong. This is why it is so important to monitor and check on team members at the practice all the time. Have a good look at your team today. Decide if you have the right team and they are competent at their job. It’s time to ask yourself the following questions: • Are you offering correct training? • Do you have a clear job description for your team to follow? and • Are you offering your team enough support? You know your team are there to help you grow your business and help your patients. Your team are your biggest investment and asset so do everything you can to nurture them.

Jayne began her career as an educator. After spending several years teaching, she made the jump to practice management, serving as a Practice Manager for a renowned dentist in Sydney for more than 25 years, giving her first-hand experience at what works when it comes to building and maintaining patient relationships, how to convert leads over the phone and most importantly - what it takes to reach your practice goals. As the CEO and Founder of Dental Phone Excellence, Jayne helps practices convert more calls into appointments, reduce cancellations and nurture effective patient communication that will result in increased profitability. Her past experience as an educator combined with her passion for practice management gives her a unique set of skills that allows your team to fully understand and take advantage of the tools she presents.

The Dental Phone Excellence Online Master Class dentalphoneexcellencemasterclass.com I listened to you and finally my Master Class is here ONLINE just for YOU! Your team do not need a day off work to attend this Master Class. YOUR TEAM can complete the Dental Phone Excellence Master Class right there in your practice at their own pace. The BEST part of my Master Class is that you have it FOREVER!

For more information on what to say and ask your patients, call 1300-378-044 or email jayne@thedpe.com

dentalphoneexcellencemasterclass.com

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You can either e-mail dental@synstat.com.au with your request for the book together with your postal address or go to www.synstrat.com.au, navigate to the Synstrat Publications area and fill in the form. You will then be forwarded the book.

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May/June 2022

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marketing | INSIGHTS

The scary words that are costing your practice big time By Angus Pryor, MBA (Marketing)

ome words can be scary, can’t they? It’s strange that mere words can create such a strong emotional reaction... yet they can. In this article, I’m going to unpack some of the scarier words in dentistry and reveal the benefits of overcoming them.

What are you scared of?

hen I was about five, I was really scared of letting out the plug from the bath. No joke.

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When you first let out the plug, it’s okay. But after a while, an ear-piercing squeal starts to emerge from the plug hole - quiet at first, but ever louder as each moment passes. As a five-year-old, I really hated this sound and would do anything to avoid being in the room during the squealing. It got to the point where I would make sure I was 100% ready to leave the bathroom, then at the last second, pull out the plug and run to my bedroom. Anything to avoid the horrible sound! Fortunately, as an adult, I no longer have a fear of that sound I now know it’s just a product of water going down the drain as air is trying to come up.

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marketing | INSIGHTS At age 7, a family member of mine was fearful about monsters under her bed. When she needed to get off her (rather tall) bed, she would look underneath to check for monsters, then literally leap off and ran to the door so she could avoid them. Given no monsters were ever found, this family member no longer has this fear either - and there’s a theme here. While we could easily brush off these examples as misconceptions of a child, it wouldn’t be true to say we don’t have fears as an adult. Like the examples above, it’s possible with further knowledge to overcome the fears and live unaffected by them.

Fears in dentistry ll of the above leads me to this. At dental practices, there is one fear that I see holding back growth - big time. There are significant implications for patients, practice staff and practice owners alike. So, what’s the fear? It’s the fear of selling and sales. Without me even saying another word, I wonder what your reaction was to the last sentence. I’ll say it again now - check your reaction. Most dental practices are scared of selling and sales? How about you? Before we unpack the fear a little further - lest you think this doesn’t apply to you - let’s talk about sales at its most fundamental. If your practice stops selling any service, you’re out of business and everyone is out of a job. I think we can all agree that “selling” at this level is fine. Yet, I’m certain, even though we agree that some level of selling in dentistry is essential, there is a fear in most practices of the most basic sales components - and it happens every single day. In particular, the fear of selling in healthcare relates to not telling your patients about the services that you offer. This seems so simple and hard to believe it’s real, but I can assure you it’s alive and well in dental land. As a case in point, among the 10+ dentists that I’ve been to in my life (I’ve lived all over the world), I have never had a single dentist ask me about my interest in any form of cosmetic service including orthodontics and whitening. This is even though I have some obvious crowding of my teeth (fixable with braces) and I have stained teeth from drinking tea, coffee, wine, etc (fixable with whitening).

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Not one dentist ever mentioned anything about a fix for my dental problems. This non-asking is not the exception in dentistry, it’s the norm.

But I hate selling! o overcome our fear of sales and selling, we need to understand what type of “sales” I’m talking about. Let me say upfront, I have NO interest in you being “salesy”. None, zero, nil. The main problem with salespeople being salesy is that they are pushing their agenda instead of yours. They’re not listening to what you want and are only pushing what they want. Curiously, if a salesperson does their job properly - i.e. help you clarify your needs and find what you want - you won’t feel like you’re being sold to at all.

“The main problem with salespeople being salesy is that they are pushing their agenda instead of yours. They’re not listening to what you want...” Perhaps this example will help: You want to buy a new car. You walk into a car lot and interact with the salesperson. You discuss a petrol model and an electric model. You express reservations about 100% reliance on electricity, but you’re also alarmed by increasing petrol prices. He just nods and smiles. You leave the car lot and you don’t buy. What if I told you that that company also had a hybrid car, but the salesperson didn’t mention it to you because he was worried about being “salesy”. That would be madness and worse, unhelpful. Yet what I have just described is what happens in practices daily. There is often no discussion with patients about their options for a range of services that are available - that they might actually want. If zero out of 10 is doing no selling at all and 10 out of 10 is being overly salesy, I would say most practices sit at a 1 or a 2. But I’m not asking you to be a 10 out of 10; just make it easier for people to get the services they want from you - a 4 or 5 out of 10 on this scale would be fine. You are not serving anyone by not telling people about their options.

A conversation between neighbours onsider the following discussion between two neighbours in a suburb near you. Alison: “Hi Mary, how are you?” Mary: “Hi Alison, haven’t seen you in a while, how are you doing? You look great by the way; I love what you’ve done with your smile.” Alison: “Thanks! The dentist that I’ve been going to told me about a few different treatment options that could really give my smile a boost. I took the plunge and I have to say I love it; I can’t stop smiling.” Mary: “That’s great! Which dentist do you go to?” Alison: “ZZZ Dental, why do you ask?” Mary: “ZZZ Dental? Really?! I can’t believe it! They never told me about those options...” As you can see in the example above, your existing patients could get annoyed if they find out that you didn’t tell them about the range of services that you offer. To avoid this situation, a simple question to ask is something like “I’ve noticed that you’ve got [problem], would you like to hear about the options?” This kind of questioning is non-salesy and totally appropriate. Patients come to you for professional advice and here is your chance to give it.

Summary eing scared of sales or selling helps no one at your practice. The irony is, the very thing you’re trying to avoid (patients feeling unhappy - from too much selling) can lead to another form of patient unhappiness... when they discover you had services available that you never told them about. No one wants you to adopt a “salesy” approach, however, there is a price to pay for simply not telling patients about the services that you offer. The choice is yours.

About the author Winner of the ADIA 2020 Marketing Award and Australia’s number one Google-ranked dental marketer, Angus Pryor is a #1 Amazon bestselling author, marketer and international speaker. For help with any of the issues discussed in this article, visit www.AngusPryor.com and book a free call.

Australasian Dental Practice

finance | INVESTMENT

Do “Finfluencers” have a place in the Australian advice landscape? By Andrew Squires

y now, you may have come across the emerging social genre of the “influencer’. This is someone with a particular insight or perspective who has the means to broadcast their message through various forms of social media. Well, a Finfluencer does the same with a focus on all things finance. After rising popularity in the U.S., a wave of Finfluencers is now active in Australia and their followers are not the only ones listening in. Lately, ASIC is interested, referencing existing financial licensing regulations and reminding these new players that a Finfluencer must not provide financial product advice or

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participate in arranging a financial product without an Australian Financial Services licence. The ever-growing complexity of the Australian Financial Services law has brought the Finfluencer to the community. Complex compliance measures may be a regular part of business life for your finance professional, but it is the Finfluencer’s first rodeo and their wake-up call has just been announced. According to a recent article by the ABC, 28% of young people followed at least one Finfluencer on a social media platform. Given the age we live in, it is no wonder young people are turning to their beloved social media for financial influence: the cost of financial advice is ever-growing and often unaffordable for consumers

with less complex needs, let alone young people starting on their wealth journey. The Finfluencers can be seen to present topical issues that their target market can relate to, while the consumer chooses who they “follow” or who they are influenced by. There is no doubt that quenching the educational thirst of our youth is a good thing and it could even be bridging the gap in being financially literate. Young people are making money decisions, building behaviours, and forming pathways that can be difficult to move away from once they become embedded in early lifestyle choices. Simply taking an interest can help to build a healthy money mindset and can lay the foundations for a generation that makes educated financial decisions.

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finance | INVESTMENT ASIC (the financial services regulator) recently held a closed-door meeting with around 30 popular Finfluencers with the intention to resolve unanswered questions and discuss a recently released Information Sheet (INFO 269). While praising the delivery of financial education on one hand, ASIC relentlessly leans on existing law on the other, somewhat blindsiding the average Finfluencer with the apparent crackdown. The vast majority of Finfluencers do not have a financial services licence or begin to meet the extensive education standards required by your Financial Adviser. Finfluencers are running into problems where an audience is influenced to make a financial product decision. ASIC provides a regulation guide (RG36) which states that financial product advice is given when it is intended to influence a person into making a decision about a financial product. Further, some Finfluencers provide affiliate links to sponsors which could indicate the arranging of a financial deal and arranging a financial deal is only permitted with a financial services licence.

The recent direction seems to be a stern warning to Finfluencers with the looming threat of both civil and criminal prosecution. The Finfluencer may have little choice but to reconsider their subject matter; to become licenced is an unattractive and time-consuming solution. ASIC leaves the Finfluencer with nowhere to hide but within the bounds of the law. As such, little may be left on the table for the young and impressionable cohort looking to increase their personal finance game. While the Finfluencer is not yet dead and buried, we can certainly add them to the Australian Financial Services Law focus list with due cause.

About the author Andrew Squires is a Financial Adviser at Profile Financial Services Pty Ltd (AFSL 226238), a privately owned and self-licensed fee-based financial planning firm that specialises in working with dental professionals. Profile focus on implementing strategic advice and have a solid understanding and working knowledge of dentists’ structures and investment issues. Andrew can be contacted on (02) 9683-6422, andrew.squires@profileservices.com.au or see www.profileservices.com.au

General advice warning This communication is issued by Profile Financial Services Pty Ltd. (ABN 32 090 146 802), holder of Australian Financial Services Licence and Australian Credit Licence No. 226238. It contains information and general advice only and does not take into account any investor’s individual objectives, financial situation or needs. It should not be relied on by any individual. Before making any decision about the information provided, investors should consider its appropriateness having regards to their personal objectives, situation and needs, and consult their adviser. Any indicative information and assumptions used here are summarised, are not a product illustration or quote, and may change without notice to you, particularly if based on past performance.

SAFety FirSt even fOr yOur

FinAnciAl AFFAirS Whether you’ve just started working, own your own practice or are considering retirement, Profile Financial Services can help you plan and secure your financial future. Just like good dentistry, in investing, prevention is better than cure! A sound financial plan can help anticipate and avoid risks before they damage your portfolio.

How safe are your investments? To find out, contact Profile now to book an obligation-free initial meeting: (02) 9683 6422 Or visit our website www.profileservices.com.au

BUilDinG WeAltH SecUrity AFSl 226 238

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May/June 2022

FOr OVer 30 yeArS

Wealth managers for the dental industry

18/03/11 2:04 PM

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infection | CONTROL

READ ME FOR

CPD

Infection control: Facts versus fallacies in the post-June 2022 world By Emeritus Professor Laurence J. Walsh AO

The DBA change

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May/June 2022

infection | CONTROL

Figure 1. The regulatory environment for infection prevention and control, showing major inputs that clinicians should be considering. The upper right box groups together those linked to national health approaches, such as the National hand Hygiene Initiative and the Immunise Australia program.

Consensus and uniformity he regulatory environment for infection control has been through significant recent changes, with the publication in 2021 of the fourth edition of the ADA guidelines for infection prevention and control and the Risk Management Principles for COVID, which replaced the previous restriction levels framework. It is important to appreciate that both of these ADA documents went through extensive consultation, involving not just consultation within ADA branches, but also with external stakeholders including professional peak bodies (ADOHTA, DHAA, ADPA, DAA) and the Dental Board of Australia, all of whom supported these two key documents. This broad base of support is important when considering what would be used by a regulator, such as a public health unit in a particular jurisdiction, or the DBA, in terms of expectations on what practitioners should be following. Likewise, it is also important to note that the ADA guidelines are one of the key reference documents that inform the development of the NHMRC infection control guidelines and

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in a reciprocal way, changes in the NHMRC infection control guidelines are reflected in the ADA guidelines and other ADA publications and advice. While this is not difficult to understand, it is very frustrating that some individuals who are involved in auditing dental practices completely misunderstand this point and as a result, they give misleading advice, such as “they are only guidelines so you can ignore them”.

Context is important t is up to each practice to apply the guidelines to the situation of their own clinical environment and this is explained clearly in the opening sections of the ADA document. Likewise, the introduction to the NHMRC guidelines state that these have been written with an emphasis on an acute care hospital environment and that they need to be interpreted for other contexts to determine which components are relevant and appropriate. The ADA guidelines are this interpretation and they follow the same principles of evidence as the NHMRC use when compiling their guidelines.

Australasian Dental Practice

infection | CONTROL One reason why some auditors might get such a fundamental point completely wrong is because those individuals are not actually registrants. They do not understand the regulatory environment around AHPRA, nor the existence of co-regulatory jurisdictions and how they function. Typically, they have no appreciation of the activity of public health units and their significant powers under the various jurisdictional public health acts and regulations. Through the COVID-19 pandemic, the general awareness of the powers that sit under public health acts have reached greater prominence, so there is no excuse today for not recognising that registrants need to meet the requirements of their registration body, as well as the public health regulator in their particular jurisdiction. As a specific example of this local flavour, registrants in Queensland are required to have compiled an infection control management plan (ICMP), which details the nature of the risks, the approach to their management, how the control strategies are implemented and monitored, who was responsible for implementing them and how often the plan is updated. Such requirements are enshrined in Queensland legislation. Figure 1 gives a summary of the regulatory environment.

It is more than one thing espite such points being abundantly clear, one will sometimes hear of auditors who say “you only need to comply with this particular Australian standard and you can ignore everything else”, which clearly is incorrect. Likewise, they will make statements such as “after our audit, you will never be able to get in trouble for infection control in the future”. This is a promise which is impossible to keep, since having a practice audit or going through practice accreditation is no insurance for future errors that may occur. Both of these will build greater awareness within the staff about potential issues that could occur and so some preventive actions can be put into place. Hence, there is a lower risk, but not zero risk for the future. A major area where those in the audit space can often be incorrect relates to the application of Australian standards. They often have no idea that the standards

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undergo periodic major revision as well as occasional amendments and so maybe quoting standards that are out of date. Even worse, they may not be aware that each standard has a very carefully worded section on its scope and that there is no application or relevance of a standard outside the scope. To give a particular example, the standards on instrument reprocessing are not relevant to matters such as personal protective equipment that is worn in the operatory, but they do discuss appropriate personal protective equipment for those undertaking tasks in instrument reprocessing, working within the sterilising room environment.

Changes in standards ver the past two decades, there have been significant developments in the scientific basis of methods used to evaluate methods for sterilisation using steam or other technologies. This point is highly relevant when considering what is in the 2006 instrument reprocessing standard (AS/NZS 4815) versus what is in more recent standards such as the 2014 standard (AS/NZS 4187) and what has been released in the public draft of the new reprocessing standard (DR AS 5369: 2021) which when completed will replace both of these earlier documents. Looking at the advertising materials for some who are involved in practice auditing, they have no understanding of the impending changes with the 5369 standard. Moreover, they make irrational and incorrect statements such as “Australian standards overrule all guidelines”. It is clear they are not aware that standards do not hold regulatory force until cited in a regulatory instrument, or that those who write the standards and those who write the guidelines are often the same people and are drawing on the same expert knowledge.

Conflicts and competence particular concern is when a company which is involved in infection control auditing is also involved in selling products, made by themselves or others. I recently came across an example where a particular company advertised that a 30-minute audit would cost almost $3000 and that the company was then advising as a predetermined outcome of the audit that they would be advising that their

own products would then be used in the practice. Even worse, they claimed that some of these products would eliminate the need for biological indicators (spore testing) and other parts of validation. They went on to give advice which was directly contradictory to the advice in the two reprocessing standards, regarding the use and interpretation of chemical indicators. This prompted me to think, as well as the obvious commercial conflict of interest, was there a degree of conspiracy or was this simply incompetence? Further investigation including checking on social media posts revealed that some claims around the expertise of the auditors could not be substantiated. The point of this anecdote is that there are some individuals who will seek to prey upon dental practices in the period of uncertainty which will occur as a result of the change in the Dental Board policy.

It’s not conflicting or complex n an attempt to generate business, some in the audit space make statements such as “it’s all too complex” when in fact this is not the case at all. They also claim that “there is conflicting information” when in fact there is very close alignment between all the major reference documents produced at the national level, from ADA, from NHMRC and from the Australian Commission for Safety and Quality in Health Care. There are extensive resources provided by the ADA, with the fourth edition guidelines being effectively an implementation guide to a vast array of reference documents from multiple government bodies.

Cut-and-paste problems ractitioners need to be conscious that they might be paying for protocols and procedures which have simply been lifted verbatim from existing freely available resources. In addition to the obvious moral and legal issues around copyright infringement, a cut-and-paste signifies lack of expertise on the part of the auditor and a failure to deliver what has been promised. I have been involved in several situations where clinicians were subject to regulatory actions because the protocols or manuals which they had purchased from an auditor were grossly deficient and out of date.

May/June 2022

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infection | CONTROL Red flags summary of common issues that have been encountered with practice auditing or advising services is presented in Table 1. While there are some in the auditing space who are providing a valuable service at a high level, there are also some rogues, who hold poorly formed opinions - and those opinions then masquerade as facts. This creates a problem when an incident occurs in the practice and a regulator becomes involved. The liability for substandard, outdated and incomplete procedures and documentation then falls back on the registrant, who discovers to their horror that those doing the audit actually had no formal relevant training, relevant qualifications or expertise.

Audit the auditor or an auditor, a clue to their knowledge in the field will be the nature of the statements which they make and whether they have relevant sources for those that will stand scrutiny. A good example will be claims around the efficacy of particular products used for environmental surface management, such as for cleaning and disinfection. Claims around disinfection are regulated by the TGA and are based on evidence. If a disinfectant is placed within a certain class, then claims cannot be made about it being in a superior class, or being the “best of the bunch” within a certain class. This is simply hyperbole and exaggeration and a sign of a lack of integrity on the part of the individual making that claim. For those who are considering using an auditing service, think about whether the auditors actually have a track record of working within dental practices and are familiar with what actually happens in a dental practice. It is not the same as an audit for food hygiene in a restaurant, or a health audit for a nursing home. Consider whether the qualifications and experience of the auditor are relevant for dentistry. Look carefully at the way the auditor presents themselves on social media. This will often give insight into whether the individuals involved are making outrageous statements that run counter to mainstream requirements that are well-articulated in the national guidelines. Of course, Australian consumer law requirements around integrity and advertising apply equally well to social media as they do to

Table 1. Aspects to be alert for when advice on infection prevention and control seems dubious n n

n n

96 Australasian Dental Practice

Commercial conflict of interest No first hand knowledge of committee processes that generate guidelines and standards (within Standards Australia, NHMRC, ADA, etc) Auditors are not registrants with AHPRA; Lack understanding of regulatory frameworks for registrants (from DBA, public health regulators, role of the TGA, etc) Gaps in the basic knowledge including microbiology Misinterpreting existing guidelines and how they apply to the dental practice context References to documents are out of date; no awareness of impending changes Advice on risk management does not follow the hierarchy of controls

traditional websites, so one expects to see information in social media posts which is accurate and verifiable. Claiming false qualifications, using honorific titles (such as Dr) when these are not appropriate and the like, are all signs that the individuals involved are not trustworthy.

Future risk ast of all, advice which is inaccurate is not just a waste of time and money, but creates an issue for staff who will have adopted suboptimal practices based on the advice which has been given. This generates downstream risks for the practice, including risks of regulatory action for the clinicians and damage to the reputation of the practice should an incident attract attention in the local press or in online fora. With the change in emphasis from 30 June 2022, more effort is needed on the part of registrants to make sure that they are working in line with current requirements. The onus of responsibility sits with each registrant to keep up-to-date and to understand the totality of the regulatory space around infection control in which they work. This is the whole point of the new self-reflective tool - to enhance that awareness and help clinicians recognise and define their learning goals and how

they can stay in touch with this field as developments occur.

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Biodentine saves pulps EVEN with signs and symptoms provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms e outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. As world leader in Pain Management, Septodont ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms ht and width of irreversible pulpitis* painfree experience, amongst those : over whymesio-distal dentistsadminister favor our impeccable fit. Perfect for your patients. Easy for you. ™ provides you products and services to help you brings one-of-a-kind benefi ts for the treatment of Biodentine ™ ™ dentin wherever it’s damaged. fully replaces Biodentine of irreversible pulpitis* For vital pulp bulk-filling the cavity with Biodentine comes the perfect fit, Hu-Friedy istherapy, just right.experience, administer painfree amongst those : med andtopre-crimped for ™ simple placement

up to 85%** irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier faster: Septanest :brings the in first choice of dentists with over ™ As world leader Pain Management, Septodont ™ helps Biodentine up to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation OVE OUR anatomy STAINLESS STEEL PEDO CROWNS: occlusal that matches the natural tooth pulpitis benefi brings one-of-a-kind ts for the treatmentthe of remineralization of dentin, preserves the pulp Biodentine up to 85%** of irreversible cases: 150 million injections per year, provides youand high •upPulp healing promotion: proven biocompatibility and bioactivity vitality promotes pulp healing. It replaces dentin with similar Septanest : the first choice of dentists with over provides you products and services to help you to Therapy 85%** ofallowing irreversible pulpitis cases: • Vital width complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •Pulp Vital Pulp Therapy allowing complete dentin bridge formation t and mesio-distal quality you can trust • Reduced risk of failure: strong sealing properties biological and mechanical properties. 150 million injections per year, provides you high administer painfree experience, amongst thoseformation : Vital Pulp Therapy allowing complete dentin bridge • Minimally Invasive treatment preserving the tooth structure •forOnly Immediate Pain relief for your patients’ comfort d and pre-crimped simple placement Minimally Invasive treatment preserving the tooth structure • one material to fi ll the cavity from the pulp to the top quality you can trust ™ cclusal anatomy that matches the natural tooth Improving on Biodentine Minimally treatment preserving the tooth structure • Immediate Pain relief for your comfort Bio-Bulk fiInvasive lling procedure foras an easier protocole •• Similar mechanical behavior natural dentin: ideal for bulk fillingclinical implementation, you can now bond Immediate relief forpatients’ your patients’ comfort Septanest : Pain the first choice of dentists with over onto Biodentine™ in the same visit and perform the the composite • Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole • Immediate Bio-Bulk filling for an The fifinal restoration will beeasier placedprotocole within 6high months. 150 million injections per year, provides you full restoration in a single session. INE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk fi lling procedure for an easier protocole quality you can trust

PRACTICE

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To enjoy the clinical benefits of the first and only dentin in a capsule, ask your dental distributor for Biodentine™.

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Please visit our website for more information Call 0508 486 252 Please visit our website more information www.septodont.com Please visit our website for morefor information Please visit our website for more information 855 www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au www.ivoclarvivadent.co.nz Call 0508 486 252 www.ivoclar.com www.septodont.com www.septodont.com *If haemostasis be achieved full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) Please visitwithcannot our website forafter more information Learn more www.septodont.com

8 855 www.henryschein.co.nz ** Taha et al., 2018 the Biodentine™ brochure

www.septodont.com

Orders 1300 65 88 22 www.henryschein.com.au

*If haemostasis cannot be cannot achieved full pulpotomy, a pulpectomy and a RCTand should be carried out,carried provided tooth isthe restorable (ESE Position Paper,Duncan et al. 2017)et al. 2017) *If haemostasis beafter achieved after full pulpotomy, a pulpectomy a RCT should be out,the provided tooth is restorable (ESE Position Paper,Duncan ** Taha et al., 2018et al., 2018 ** Taha

infection | CONTROL

READ ME FOR

CPD

Preventing needle stick injury By Dr Greg Mahoney, BDSc, PhD, MSc (Dent), GradDipClinDent, FADI, FPFA

98 Australasian Dental Practice

May/June 2022

ULTRA SAFETY PLUS TWIST

A LONG-PROVEN infection | CONTROL EFFICACY A study demonstrated that when introduced in a dental school, Ultra Safety Plus was a the key success factor for avoiding needle stick injuries.

fe & easy

otects you and your fromUltra needle stickPlus injuries Figure 1. staff The new Safety Twist from Septodont. mplies with latest regulations uitive device ailable with either sterile single use or sterilisable handle

FREQUENCY OF NEEDLE STICK INJURIES ULTRA SAFETY PLUS INTRODUCTION

sive or active aspiration:

ity for the patient

sparent barrel:

ation is clearly visible

ng protective sheath:

ction from needle stick injuries

YEAR 1 Two different positions:

first Holding Position (reversible) final Locking Position (irreversible)

Figure 2. The Ultra Safety Plus from Septodont.

YEAR 2

YEAR 3

YEAR 4

YEAR 5

Figure 3. Zakrzewska thatstick the number With Ultra Safety Plus,found needle injuries of avoidable needle decreased an average 11.8 to11.8 0 injuries per stick injuriesfrom reduced from anofaverage per 1,000,000 hours (1) 1,000,000 hours worked worked to zero in UK dental schools. Consequently it has been adopted by most dental school across the UK.8-10 (1) J.M Zakrzewska et al. Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J 2001 ; 190; 88-92.

The risks of acquiring other bloodborne viruses from a contaminated needle are considerably higher than the 0.23% for HIV with 6-30% for hepatitis B and 1.8% for hepatitis C.4 Acquired hepatitis B and C cases have been reported in Australia.5,6 Following known exposure to blood borne virus, post-exposure prophylaxis (PEP) should be considered. PEP is known to be over 80% effective in preventing HIV from needle stick injuries and while oral health care workers are vaccinated against hepatitis B, there is no vaccination for Hepatitis C. Post exposure prophylaxis protocols are an essential part of everyday practice although are an expensive and time consuming process with a considerable emotional toll.7 It makes eminent sense for all dental operatories to adopt effective needle stick injury prevention protocols and safety equipment. The criteria for local anaesthetic delivery should be:

May/June 2022

• Compatible with the existing local anaesthetic cartridge; • Able to be used for all techniques for local anaesthesia; • Single use or autoclavable; • Proven to be effective in reducing or eliminating needle stick injury; and • Cost effective.

Prevention review of the availability of safety systems, including needleless systems, found that one system met the above criteria - the Ultra Safety Plus from Septodont. The Ultra Safety Plus™ and now the new Ultra Safety Plus Twist (also from Septodont) system – which does not require the re-sheathing or removal of a needle from its syringe – has been in my private practice for over 10 years and in that time there has been no cases of local anaesthetic needle stick injury.

Evaluating the system against the desirable criteria Compatibility: The system uses the existing 2.2ml cartridges. Technique: The system comes with preloaded a 27 or 30 gauge needle in short and extra short and looks, feels and acts like the traditional dental injection. Autoclavable: It comes in single use and if desired, an autoclavable plunger. Effectiveness at reducing needle stick injury: Zakrzewska found that the number of avoidable needle stick injuries reduced from an average 11.8 per 1,000,000 hours worked to zero in UK dental schools (Figure 3). Consequently it has been adopted by most dental school across the UK.8-10 Cost effectiveness. The University of Queensland found the cost of safety syringes was comparable to non-disposable syringes, however the reduction in the cost of managing sharps injuries was substantial.11

Australasian Dental Practice

infection | CONTROL

“The system works by sliding down a captive rigid lock sheath over the needle when loading up a new cartridge, exposing the needle and cap. After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the of 100 sterile needles end1 box the handle injection, the sheath 1 box of 50 sterile need +of 1 STERILISABLE is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries 1 box of 50 sterile SINGLE-USE handles 1 sterilisable handl during changeover between patients...”

ULTRA SAFETY PLUSA secure ULTRA SAFETY PLUS TWIST TWIST

A INTUITIVE NEW PATENDED DESIGN Only 2 easy steps are needed for a secure assembly

A secure lock

Introduce the pins of the handle in the notches 1. of the barrel Introduce the pins of the handle in the notches of the barrel

length

Twist the finger grip to lock it

gauge

x short - 10 mm short - 25 mm short - 25 mm long - 35 mm long - 35 mm

Twist the finger grip to lock it

color code

30 g 30 g 27 g 27 g 25 g

Please visit our website for more information: www.septodont.com

P w

Find the relevant details in the instructions manual

BROCHURE 3 volets SEPTODONT v16 GAMME XL OK 23/09.indd 1-3

The system works by sliding down a captive rigid sheath over the needle when up a v16 new cartridge, exposing BROCHUREloading 3 volets SEPTODONT GAMME XL OK 23/09.indd 1-3 the needle and cap. After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the end of the injection, the sheath is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries during changeover between patients. Adopting sharp safe methods is essential in all dental practices. The Ultra Safety Plus and Ultra Safety Plus Twist provides the dental team with the necessary tool to provide safe practice. If sharp safe habits are not expected of each team member, the risk of a sharp injury increases.

100 Australasian Dental Practice

References 1. Leggat PA, Smith DR. Prevalence of percutaneous exposure incidents amongst dentists in Queensland. Aust Dent J. 2006;51(2):158-61. 2. CDC. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program 14 Dec 2019]. Available from: https://www.cdc.gov/ sharpssafety/part1TEXTONLY.htm. 3. Taghavi Zenouz A, Ebrahimi H, Mahdipour M, Pourshahidi S, Amini P, Vatankhah M. The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection. J Dent Res Dent Clin Dent Prospects. 2008;2(1):38-41. 4. CDC. Exposure to Blood :s What healthcare personnel need to know. National Center for Infectious Diseases Divison of Healthcare Quality Promotion and Division of Viral Hepatiti. 2003. 5. Haber PS, Young MM, Dorrington L, Jones A, Kaldor J, De Kanzow S, et al. Transmission of hepatitis C virus by needle-stick injury in community settings. J Gastroenterol Hepatol. 2007;22(11):1882-5.

6. Res S, Bowden FJ. Acute hepatitis B infection following a community-acquired needlestick injury. J Infect. 2011;62(6):487-9. 7. McAllister J. Literature review for the national guidelines for post-exposure prophylaxis after nonoccupational and occupational exposure to HIV (revised). National PEP Guidelines Expert Reference Group 2016;Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. 8. Zakrzewska JM GIaJJ. Introducing safety syringes into a UK dental school – a controlled study. BrDent J 2001(190):188-92. 9. Zakrzewska JM BE. Use of dental safety syringes in British and Irishdental schools. . Br Dent J. 2003(195):207-9. 10. Oliver G, David DA, Bell C, Robb N. An Investigation into Dental Local Anaesthesia Teaching in United Kingdom Dental Schools. SAAD Dig. 2016;32:7-13. 11. Walsh L. Sharps injuries during patient changeover: Are you getting the point. Australasian Dental Practice January/February 2018:64-6.

May/June 2022

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Reverse the Reverse the Reverse the TRUST Reverse the TRUST Irreversible! SATISFACTION Irreversible! Irreversible! SATISFACTION TRUST Irreversible! “First ever

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IS EVERYTHING Biological REPUTATION the right one with Hu-Friedy SEPTANEST Bulk Fill” SEPTANEST Irreversible Pulpitis IS EVERYTHING Irreversible Pulpitis Irreversible Pulpitis SEPTANEST Irreversible Pulpitis he right one with Hu-Friedy Restorative PAIN FOR

table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. n it comes to the perfect fit, Hu-Friedy is just right.

Pediatrics ™

Biodentine saves pulpsManagement, EVEN with signs and symptoms As world in Pain Septodont TS LOVE OUR STAINLESS STEELleader PEDO CROWNS: of irreversible pulpitis* ™

MANAGING Endodontics MANAGING

PAIN FOR YOUR MANAGING YOUR PRACTICE PAIN FOR PRACTICE YOUR

Biodentine saves pulps EVEN with signs and symptoms provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms able outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. As world leader in Pain Management, Septodont ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : iscover why dentistsprovides favor our impeccable fit. Perfect for your patients. Easy for you. ™ you products and services you brings one-of-a-kind benefi tsto forhelp the treatment of ™ dentin wherever it’s damaged. Biodentine ™ fully replaces Biodentine of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine it comes the perfect fit, Hu-Friedy is just right.experience, amongst those : administer painfree mmed andtopre-crimped for ™ simple placement ™

up to 85%** irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier faster: Septanest :brings the in first choice of dentists with over ™ As world leader Pain Management, Septodont ™ helps the to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OURup STAINLESS STEEL PEDO CROWNS: occlusal anatomy that matches the natural tooth pulpitis brings one-of-a-kind benefi ts Biodentine for the treatment of remineralization of dentin, preserves the pulp Biodentine up to 85%** of irreversible cases: 150 million injections per year, provides you high • Pulp healing promotion: proven biocompatibility and bioactivity vitality and promotes pulp healing. It replaces dentin with similar Septanest : the first choice of dentists with over you products and services to you up to Therapy 85%** ofallowing irreversible pulpitis cases: • Vitalprovides complete dentin bridge formation •Pulp Minimally Invasive treatment preserving thehelp tooth structure • Vital Pulp Therapy allowing complete dentin bridge formation ght and mesio-distal width quality you can trust • Reduced risk of failure: strong sealing properties biological and mechanical properties. 150 million injections per year, provides you high administer painfree experience, amongst those : Vital Pulp Therapy allowing complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •forOnly Immediate Pain relief for your patients’ comfort med and pre-crimped simple placement Minimally Invasive treatment preserving the tooth structure • one material to fi ll the cavity from the pulp to the top quality you can trust ™ e occlusal anatomy that matches the natural tooth Improving on Biodentine Minimally treatment preserving the tooth structure • Immediate Pain relief for your comfort Bio-Bulk fiInvasive lling procedure foras an easier protocole •• Similar mechanical behavior natural dentin: ideal for bulk fillingclinical implementation, you can now bond Immediate relief forpatients’ your patients’ comfort Septanest : Pain the first choice of dentists with over the composite onto Biodentine™ in the same visit and perform the • Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole • Immediate Bio-Bulk filling for an The fifinal restoration will beeasier placedprotocole within 6high months. 150 million injections per year, provides you full restoration in a single session. NLINE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk fi lling procedure for an easier protocole quality you can trust

PRACTICE

Innovativebyby nature Innovative nature

g.LINE Co., LLC.AT All HU-FRIEDY.COM/PerfectFit rights reserved.

Innovative by nature Innovative by nature Innovative by nature

Exclusively available in New Zealand from

To enjoy the clinical benefits of the first and only dentin in a capsule, ask your dental distributor for Biodentine™.

Exclusively available in Australia from

Please visit our website for more information Call 0508 486 252 Please visit our website more information www.septodont.com Please visit our website for morefor information Please visit our website for more information 08 855 www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au www.ivoclarvivadent.co.nz Call 0508 486 252 www.ivoclar.com www.septodont.com www.septodont.com *If haemostasis be achieved full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) Please visitwithcannot our website forafter more information Learn more www.septodont.com

08 855 www.henryschein.co.nz ** Taha et al., 2018 the Biodentine™ brochure

Orders 1300 65 88 22 www.henryschein.com.au

clinical | EXCELLENCE

case report

Same day restoration of an upper lateral incisor By Andre Schertel, BDS, Grad.Dip.Clin.Dent (Oral Implants) (Melb)

Figures 1-2. Initial presentation.

Figure 3a. Deep bite - close up.

female patient in her late 70s, healthy, presented for an urgent appointment due to a broken anterior tooth. Our assessment found tooth 22 to be missing the entire mesial incisal edge. The tooth was heavily restored with multiple pinned composites. Radiographs showed that these pins were placed quite deep into the tooth, however it was still vital and responsive to CO2 testing.

102 Australasian Dental Practice

Figure 3b. Build-up. The patient has a Class 2 Div 2 dentition with a very deep bite and traumatic occlusion. Her remaining upper anterior teeth have advanced palatal wear and chipping of the anterior edges. The patient wears a lower partial denture which was recently replaced. The patient was leaving on the very next day on a caravan trip around Australia and at this stage, was not interested in an extensive treatment plan for her teeth.

May/June 2022

clinical | EXCELLENCE We discussed treatment options including: 1. A simple composite restoration repair of the fractured portion of her tooth; 2. The replacement of all the existing pinned restorations with a single composite build-up; 3. A lithium disilicate (Ivoclar IPS e.max) milled crown, to be completed in a single visit/single day using our TRIOS/ Roland workflow; or 4. A porcelain fused-to-metal crown with a metal palatal surface, completed over two visits. The patient chose to proceed with the IPS e.max milled crown due to time constraints and her need for a stronger restoration. She agreed to consider a comprehensive treatment approach upon her return.

Figure 4. Preliminary check of prep clearance.

Treatment Plan s the fractured tooth was already extensively restored and worn down, the additional preparation required for the crown had to be taken into consideration. The deep bite was a concern and sufficient thickness had to be achieved in the palatal surface of the crown to avoid a fracture. The existing restorations were failing and had to be replaced prior to the crown prep. The existing dentine pins were left in place during the preparation due to their depth and the concern about propagating dentine cracks if their removal was attempted. Finally, the milled IPS e.max crown would be bonded with an adhesive cement system to assist with retention. A strong restoration that would last until the patient’s return and give her an opportunity to consider a comprehensive long-term treatment plan for her entire dentition. The entire case was completed in a single day, once the patient gave us consent to proceed with treatment. After pre-op photos were taken, the patient was anaesthetised and we completed the removal of the failing restorations and caries and placed a new composite core build-up on the tooth. An OptraGate dam (Ivoclar) was used to help retract and protect the lips and ensure adequate access while scanning with the TRIOS scanner. Preliminary

May/June 2022

Figure 5. First scan with two cords.

Figure 6. High definition scan. TRIOS scans of both arches and the bite were immediately completed, making the most of our limited time. Due to the limited tooth structure and the patient’s deep bite, the crown preparation margins were placed equi-gingival

and retraction of the gingival tissue was achieved with a double-cord technique, using a piece of Ultradent’s #00 retraction cord soaked into haemostatic agent followed by a piece of size #0 or #1 retraction cord.

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clinical | EXCELLENCE The final preparation scan was completed using a two-step technique. We find this makes the scanning process very predictable and easy. The preparation is first scanned with both cords in place, using the preliminary scan taken at the start of the procedure as a guide. Marking the tooth on the software opens up the next step of the process which gives us the option to review the path of insertion, the occlusal clearance achieved for the new crown and the shade of the prepared tooth and the adjacent teeth. This feature is particularly useful when we are dealing with cases such as this one with a deep bite. It is the perfect opportunity to go back, re-prepare the tooth if required and re-scan. This takes little to no time at all and can save a lot of fit issues and adjustments later on. The TRIOS software allows us to easily trim the scan as required, and we proceed to digitally remove the retraction cord and the entire margin of the preparation, which at this stage does not look very sharp on the scan. Leaving behind the bulk of the prepared tooth helps the software stitch the images together and quickly capture new images in the following step. Once we are satisfied with the preparation, the top retraction cord is removed. We then quickly proceed with a second scan, this time using the TRIOS HD/Zoom feature which allows us to see the margins quite clearly. We also take a couple of HD photos to assist with selecting the preparation margins later on. After a quick inspection of the final scan, the second cord is removed, and we allow the patient to have a break while the new crown is manufactured.

Figure 7. Crown margin detailed.

Figure 8. Crown margin detailed II.

Crown design with 3Shape TRIOS Design Studio esigning the crown is a simple process using the chairside TRIOS package. After the scan is processed by the software, it is pushed seamlessly into Design Studio. During our assessment, we noticed that teeth 22 and 12 were quite different in shape and length. We warned the patient that an attempt would be made to design the new crown so that it looks as similar as possible to the contralateral tooth.

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Figure 9. Insertion path. The first step of the design process is to mark the margin line. This is where all the care taken during the scan process pays off. A well-defined margin is quickly picked up by the software and further adjustments can be made using the HD photos taken during the scan.

The software then suggests the ideal occlusion plane and path of insertion for the crown, which can be adjusted along with other parameters such as thickness of the cement layer. The path of insertion is calculated based on the undercuts and very rarely requires manual tweaking.

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Figure 10. Copy tooth over preliminary scan.

Designing the crown comes next. TRIOS Design Studio will at first automatically suggest a tooth design, which we find works very well, with little to no input needed, allowing us to move through the design process very quickly. The software also comes with multiple “tooth libraries” installed, for both anterior and posterior teeth and we can simply pick one that we feel suits the smile. In this particular case, our intent was to design the crown to make it look similar to the contralateral tooth 12, to try and achieve an even “look”. This can be easily done using the aptly named “Copy Tooth” feature. It is as simple as pointing to the tooth we want to make a copy of. TRIOS will then identify its shape and features and once we are happy it correctly marked the tooth, Design Studio will mirror the image automatically and this becomes our new crown. The crown can be adjusted using the transform, morph and wax knife tools until we are satisfied with its shape, prior to a final check of the occlusion and contact points using the virtual articulator. In this case, some modifications were required due to the patient’s deep bite.

Figure 11a. Copy tooth feature.

Figure 11b. Copy feature II.

Figure 12. Crown adjustment.

Figure 13. Occlusal contacts.

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clinical | EXCELLENCE The only step left to complete is to send the crown to our Roland DGSHAPE DWX-4 mill, which is fully integrated into the workflow. This can usually be done with two clicks after we pick the material block size and mill quality. The software automatically places the crown within the block to optimise the milling process. In this case, however, the sprue that connects the crown to the block rested on the thin palatal surface of the crown. A particularly useful feature of the software allows us to accurately “see” the scan and the crown blended together and carefully place the crown and sprue within the block, avoiding these thinner areas of the crown and making the finishing process a lot easier once the crown is milled.

Figure 14. Crown in block sowing sprue.

“The software automatically places the crown within the block to optimise the milling process. A particularly useful feature of the software allows us to accurately ‘see’ the scan and the crown blended together and carefully place the crown and sprue within the block...” After milling using the DGSHAPE DWX-4, the only thing left to do is to process the milled crown. In this IPS e.max case, that means polishing off the sprue, mounting the crown into a firing pin and tray, staining and glazing as required and then crystalising the crown with the Ivoclar Programat furnace. The patient was brought back in for a try-in. No adjustments were required and she was quite pleased with the appearance of the new crown, telling us that she was never happy with the look of the old tooth to start with. The crown and the tooth were prepared and finally bonded together with an adhesive cement system. Our patient was quite thankful that we could help her in such a short period of time, and asked if we could eventually do the same to her adjacent teeth!

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Figure 15. Sprue on the palatal.

Figure 16. Moving sprue to distal for finishing.

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Figure 17. After image.

Figure 19. Before and after comparison.

Solutions featured 3Shape TRIOS intraoral scanner 3Shape TRIOS Design Studio

Figure 18. After image close up.

Benefits to the patient according to Dr Schertal

Comments e present the case of a single broken upper lateral incisor, in a patient with advanced tooth wear and a deep bite. Time was an issue, as our patient was due to go on extended travel the very next day. Using the TRIOS scanner and the TRIOS Design Studio chairside package, we were able to quickly design and mill an IPS e.max crown to restore this tooth in a single visit.

Benefits of the digital workflow according to Dr Schertal aving TRIOS and TRIOS Design Studio gives me more treatment options to offer our patients. We were able to build a stronger restoration for our patient in a very short timeframe. We have control over the entire process and flexibility to adjust the design as we see fit. We also particularly like the TRIOS feature that allows us to immediately inspect the preparation details, giving us the opportunity to “go back” and adjust the work as required. In the past, this would require a set of impressions, pouring up models and waiting for a phone call from the lab, telling us that the preparation was not sufficient, or the impression had bubbles! We were able to complete the entire process in less than two hours, including the time it took to mill and process the crown, which happened in the background while we continued to see other patients on a busy day.

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he patient appreciated the option to choose a longer lasting restoration, which gave her peace of mind during her extended trip. She was also very happy with the final result and appearance of the new crown.

Conclusion key challenge in this case was the patient’s difficult deep bite and worn tooth surfaces. The instant “feedback” of a TRIOS scan allowed us to change and adapt the preparation on the fly and then design the crown knowing exactly where it needed to be reinforced. This helps ensure a longer lasting restoration.

About Dr Andre Schertel After completing post-graduate studies in restorative and cosmetic dentistry, Andre permanently relocated to Australia, where he undertook a post-graduate degree in Clinical Dentistry (Oral Implants) at the University of Melbourne in 2011. Andre is passionate about continuing education and the use of technology in dentistry, in particular CAD/CAM applications and 3D printing in the dental practice. He currently works full-time in a busy four-chair private practice in Mt Eliza, Victoria on the beautiful Mornington Peninsula.

May/June 2022

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Applying digital dentistry to an aesthetic restorative case Communication and digital tools combine to assist in meeting higher patient expectations By Julie Driscoll, DMD and Mike Roberts

Postoperative full-face view demonstrates the symmetry and harmony of the patient’s new smile that is presented in this case report.

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As today’s patients become more informed, discerning and demanding, ever greater pressure is being placed on the dental team to meet their restorative objectives. Fortunately, digital dentistry has emerged to provide tools that not only reduce the subjective human element in the communication process and peopledriven workflows, but that also empower the patient in the critical aesthetic decision-making process. From intraoral scanners and CAD/ CAM production to powerful software that allows the patient to preview and approve the proposed final case outcome, the digital approach to the information exchange, workflow and final outcome offers the patient, dentist and laboratory a more predictable, accurate and efficient pathway to meet their envisioned expectations.

Figure 1. Preoperative view of retracted anterior arch. The patient did not like the appearance of the 10-year-old all-ceramic crown on tooth 11 and the white spots on teeth 12, 13, 22 and 23. There was also a chipped incisal edge on tooth 21, as well as cervical concavities on the mesial and distal aspects of the tooth.

Case report healthy female in her mid-20s presented to the practice concerned about the shade and shape of a crown that had been placed 10 years earlier on tooth 11, the cervical contours of tooth No. 21 and white discolorations on teeth Nos. 12, 13, 11 and 23, which made her self-conscious about her smile (Figure 1 and Figure 2). She was studying for her law bar exam and before venturing into the workplace, she wanted to improve the aesthetics of her smile. At the consultation appointment, the clinician also noted the cervical concavities causing a black triangle between teeth 11 and 21, as well as the gingival height discrepancy between the teeth. Tooth 21 also exhibited a chip on the incisal edge. Although the patient wanted to restore all six teeth, the clinician advised that the white spots noted on the four teeth could be treated without destroying any tooth structure and recommended restorations for teeth 11 and 21, along with crown lengthening for tooth 11. The patient agreed and was scheduled for a recordstaking appointment.

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Figure 2. Preoperative retracted left view demonstrates the high chroma on the cervical third of the natural teeth and moderate translucency on the incisal third. Restoring single centrals that blend seamlessly with adjacent teeth, while taking into consideration lip dynamics, is one of the most difficult challenges in dentistry and requires the dentist and laboratory to have a shared vision for the final case outcome. At the next appointment, x-rays were taken, along with a series of photographs, following the protocol set by the laboratory for highly aesthetic cases. The upper arch was scanned using an intraoral scanner (iTero, Align Technologies), capturing the length and width of the natural teeth and the occlusal surfaces of both arches for communication with the laboratory. The intraoral scans and the series of photographs were uploaded to the laboratory for a case design proposal. An online TeamViewer meeting was scheduled for the dentist and technician to discuss the case and view the proposed shared vision of the case design.

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Figure 3. Intraoral scan and full-face photo are overlaid in CAD software to determine proper midline position and length of designed restorations.

Virtual case design communication protocol rior to the TeamViewer meeting, the lab technician imported the straighton 2D full-face digital photograph of the patient and the 3D intraoral scan into CAD software (3Shape Dental System, 3Shape), aligning them to create the perfect midline and incisal edge position for generating a design of the case (Figure 3). The virtual case design was shared with the dentist for 3D analysis (Figure 4), including virtual simulation of chewing motions, a cross-sectional analysis of the proposed design for determination of final material thickness and preparation design and the inclusion of a wing-tipped pontic at the gingival interface to close the black triangle between teeth 11 and 21. Once the design had been approved by the dentist, the digital case design file was shared via video conference with the patient for her input and approval.

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Figure 4. Virtual collaboration between the practice and laboratory allows detailed review and tweaking of the final design. With approval from the patient, the laboratory 3D printed a model with tooth surface texture of the designed teeth 11 and 21 and created a silicone putty matrix to send to the dentist for preparing the teeth and fabricating temporary restorations to precisely replicate the approved design of the crowns for teeth 11 and 21.

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Figure 5. A digital photo of the preparation design with shade tabs for preparation shade analysis and final shade selection.

Figure 6. Full contour zirconia crowns for teeth 11 and 21 are CAM milled.

Figure 7. Green state zirconia crowns are milled with surface texture.

Figure 8. Internal stains are applied to the green state restorations to mimic the translucency of the patient’s natural teeth.

Figure 9. Stained and glazed crowns are placed on the model to check for fit.

Figure 10. Final restorations on black background show translucency and colour gradients.

Preparation, temporisation and final delivery t the preparation appointment, teeth 11 and 21 were prepared for crowns, an infiltration agent (Icon Resin Infiltration, DMG) was applied and light cured to remove the white spots on teeth 12, 13, 22 and 23 and crown lengthening of tooth 11 completed. A photo was taken with shade tabs next to the natural teeth to ensure the final restorations would blend seamlessly with adjacent dentition, as well as to communicate the darker preparation shade of tooth 11, which would impact restorative material selection for the case (Figure 5). The photo of the preparations with shade tabs was uploaded to the laboratory for restorative material consideration and fabrication. The dentist used the laboratoryfabricated silicone putty matrix to create provisional restorations (Luxatemp, DMG). Multiple photos and an intraoral scan of the

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patient with seated temporaries were uploaded to the laboratory for finalising the design and fabricating the final restorations. Because of the darker preparation shade of tooth 11 and the high translucency on the incisal edge of the patient’s natural teeth, it was important that the final crowns were fabricated with a zirconia material that was highly aesthetic yet would mimic translucency on the incisal edges and blend seamlessly with the natural teeth once seated (IPS e.max ZirCAD Prime Esthetic, Ivoclar). The final full-contour restorations were milled (ProgaMill PM7, Ivoclar) (Figure 6 and Figure 7). Prior to sintering, the surface anatomy of the restorations was finalised and internal stains (IPS e.max ZirCAD Coloring Liquid, Ivoclar) added to further mimic incisal translucency (Figure 8). Once sintered, the final crowns were stain and glazed (IPS Ivocolor, Ivoclar), final fired and delivered to the practice (Figure 9 and Figure 10).

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Figure 11. Delivery of the final restorations using a rubber dam for tissue retraction and absolute isolation.

Figure 12. Postoperative retracted view of the six anterior teeth. The final restorations match the gradient of adjacent teeth and the white spot lesions have been removed using a resin infiltration technique.

Figure 13. Postoperative view of the new restorations with the lips in repose.

Figure 14. Postoperative left view of smile showing the contours and texture of the final restorations.

Final restorations and seating he patient returned to the practice for the seating appointment. The clinician removed the temporaries and air abraded the preparations (PrepStart, Danville Materials) to remove any remaining particles of cement or debris prior to try-in of the final restorations. The preparations were rinsed and dried and the crowns tried in using a water-soluble try-in paste (Variolink Esthetic Neutral, Ivoclar) for patient approval of the final restorations. The aesthetics of the restorations were analysed by the patient and dentist in natural light for final approval. For final cementation, a rubber dam was clamped in place (Nic Tone, MDC Dental) for moisture control and to ensure complete isolation (Figure 11). Each crown was rinsed and a cleaning agent (Ivoclean, Ivoclar) applied into each restoration for 20 seconds, rinsed and dried. A primer was applied to each preparation (Monobond Plus, Ivoclar) and a cement applied to each crown (IPS e.max ZirCAD, Ivoclar), the crowns seated and light cured. The patient was thrilled with her new smile (Figures 12 through 14) and

returned 2 weeks later for a follow-up appointment to check the bite, assess healing of the gingival architecture and confirm appropriate occlusal function.

Conclusion igital workflow in dentistry enhances the communication pathway for the patient, dentist and laboratory to deliver prosthetic solutions that are highly aesthetic and more accurate and predictable in order to meet increasing patient demands and expectations.

About the authors Dr Julie Driscoll is in private practice in South Carolina. Mike Roberts is a ceramist at CMR Dental Laboratory in Idaho. For more info, contact Ivoclar in Australia on 1300-IVOCLAR or in New Zealand, call 0508-IVOCLAR or visit www.ivoclar.com

Originally published in Inside Dental Technology June 2022. Reprinted with permission.

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How to talk about pedo crowns with your paediatric patients Explaining the benefits of pedo crowns

So, how can you help both parents and their children have a positive dental experience, even when the dentist finds a cavity? The key is to approach those conversations as an opportunity for learning. Let parents know that they’re not alone - tooth decay is the most common chronic disease in children and more than 40% of children will have dental caries by the time they reach kindergarten. Parents may not know that decay spreads quickly between deciduous teeth because that enamel is thinner than on permanent teeth. Follow up with the good news. They have an excellent option for treatment when significant tooth loss has occurred as a result of rampant or very advanced caries: pedo crowns.

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Asofdentistry’s ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. innovator of the cassette-based instrument management system, Hu-Friedy is proud bring ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. Allinstrume rights rese 1) Compared to other leading scaler designs. Data on file. Available upon re • Color-coded silicone rail system that significantly reduces instrument contact • and Color-coded allows silicone rail system that significantly you the modern design and functionality of the Infinity Series Cassettes which include: Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. 1) Compared to other leading scaler designs. Data on file. Available upon request. ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 • Color-coded silicone rail system that significantly reduces you•discover the modern design and functionality of Mfg. the Infinity Series Cassettes which include: yououtcomes the modern design and functionality of the Infinity Series Cassettes which i innovator of the cassette-based instrument management system, Hu-Friedy is proud to significantly bring ©2020 Hu-Friedy Co., LLC. All rights reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights rese ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 You’ll quickly why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Color-coded silicone rail system that significantly reduces instrument contact • and Color-coded allows silicone rail system that • Color-coded silicone rail system that significantly reduces instrument contact and allows Ensure predictable for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 •dentists Color-coded silicone rail that significantly reduces instrume you the modern design and functionality the Infinity Series Cassettes which include: You’ll quickly discover why dentists favor our impeccable fit. Perfect forofyour patients. Easy you. You’ll quickly discover why favor our impeccable fit.system Perfect for your patients. Easy for you.instrum for more water flow while protecting the instruments during reprocessing WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS LOVE STAINLESS STEEL PEDO CROWNS: ©2020 Hu-Friedy Mfg. Co., LLC. All for rights reserved. HFL-482AUS/1220 WHY DENTISTS LOVE OUR STAINLESS STEEL PEDOCassettes CROWNS: WHY LOVE OUR STAINLESS STEEL PEDO CROWNS: •hole Color-coded silicone rail system that significantly reduces instrument contact and allows you modern design and functionality of OUR the Infinity Series which include: for more water flow while protecting the instruments during reproc for more water flow while protecting the instruments during reprocessing for more water flow while protecting the You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy you. All OUR company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, itsfor affiliates orthe related companies, unless otherwise noted. ••when An pattern that promotes water flow throughout the cassette WHY DENTISTS DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS LOVE STAINLESS STEEL PEDO CROWNS: You’ll quickly discover dentists favor ourotherwise impeccable fit.STAINLESS Perfect for your patients. Easy for you. WHY DENTISTS LOVE STEEL PEDO CROWNS: All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related All OUR company noted. and product are trademarks ofinstruments Hu-Friedy Mfg. LLC, its affiliates for more water flow while protecting the during reproco Because itopen comes tofor the perfect fit, Hu-Friedy is just right. for more water flow while protecting the instruments during reprocessing for more water flow while protecting the instrum more water flow while protecting the instruments during reprocessing Anit open hole pattern that promotes water flow throughout the cassette •when Anwhy open hole pattern that promotes water flow throughout theCo., cassette Because when comes to the perfect fit, Hu-Friedy is just right. Because itcompanies, tounless perfect fit, Hu-Friedy isnames right. WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: All to company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates orcomes related companies, unless otherwise noted. 1) Compared other leading scaler designs. Data on file. Available upon All the company and names are trademarks ofjust Hu-Friedy Mfg. 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All company product names trademarks of Hu-Friedy Mfg.oneCo., LLC ©2020 Hu-Friedy Mfg. Co., LLC. All rights rights reserved. HFL-482AUS/1220 Ideal height andsilicone mesio-distal width • Ideal height and width Color-coded rail system that significantly reduces instrument contact and allows •Color-coded Easy-to-use, ergonomic latch that allows for one-handed opening • Easy-to-use, ergonomic latch allows for All company product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. ••• ••Ideal height and mesio-distal width • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening ©2020 Hu-Friedy Mfg. Co., LLC. All reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220 silicone rail system that significantly reduces instrument contact • Co., and Color-coded allows silicone rail system that significantly reduces instrument contac All company and product names are trademarks of Hu-Friedy LLC, its affiliates or companies, otherwise All company noted. and product names are trademar All company and product names aredesigns. trademarks ofon Hu-Friedy Mfg. Co., Hu-Friedy Mfg. Co.,and LLC. Allmesio-distal rightsunless reserved. HFL-482AUS/1220 •Mfg. Color-coded silicone rail system that significantly reduces instrument contact and allows Ideal and mesio-distal width •©2020 Ideal height • height Easy-to-use, ergonomic latch that allows for one-handed opening •related Easy-to-use, ergonomic latch that allows for one•• Ideal height and mesio-distal width All company and product names are trademarks of Hu-Friedy Mfg. 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Performing at your best means having confidence in what you Exp for more flow while protecting the instruments during reprocessing ™companies, • Ideal height and mesio-distal width •water Easy-to-use, ergonomic latch that allows for one-handed opening WHY LOVE OUR STAINLESS STEEL CROWNS: WHY LOVE STAINLESS STEEL PEDO CROWNS: Pre-trimmed and pre-crimped for simple WHY DENTISTS OUR STAINLESS STEEL PEDO CROWNS: 1) Compared to other leading scaler designs. Data onHFL-482AUS/1220 file. Available upon reD 1)PEDO Compared to other leading scaler designs. Data on file. file. Available upon request. 1) Mfg. Compared torights otherreserved. leading scaler designs. •flow Pre-trimmed and pre-crimped for simple placement forLOVE more water while protecting the instruments during reprocessing for more flow while protecting the instruments during reprocessing for more water flow while protecting the instruments during reprocessing ©2020 Hu-Friedy Co.,confidence LLC. All Cassettes, and improve Performing at your best means having confidence in what you do. Experience Infinity Series ™ All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. • Pre-trimmed and pre-crimped for simple placement 1) Compared to other leading scaler designs. Data on file. Available upon request. Performing at your best means having in what you do. Exp •••• WHY Pre-trimmed and pre-crimped for simple placement DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: ™ Pre-trimmed and pre-crimped for simple placement Cassettes, and improve Performing atwater your best means having in what you Experience Infinity Performing Series at your best means having confidence in for and more flow protecting the instruments during reprocessing 1)while Compared tosimple other leading scaler designs. Data onHFL-482AUS/1220 file. Available request. 1)natural Compared toprotect otherreserved. leading scaler designs. 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HFL-482AUS/1220 • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening • Accurate occlusal anatomy that matches the natural tooth the efficiency of your practice, while helping protect your patients, you •• Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening ™ • Pre-trimmed and pre-crimped for simple placement • Accurate occlusal anatomy that matches the natural tooth the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. All company and product names are that trademarks of Hu-Friedy Mfg.one-handed Co., LLC, its affiliates or related companies, unless otherwise no ©2020 Hu-Friedy Mfg. Co., LLC. rights reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights rese height and mesio-distal width • HFL-482AUS/1220 Ideal height andstaff mesio-distal width Easy-to-use, ergonomic latch that allows fortrademarks one-handed opening Easy-to-use, ergonomic latch allows for opening ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. All company company and product names are trademarks ofAll Hu-Friedy Mfg. Co., LLC, LLC, its affiliates or•related related companies, unless otherwise noted. Performing at your best means having confidence in what you do. Experience Infinity Series Cassettes, and improve •unless Accurate occlusal anatomy that matches natural tooth the ofData your practice, while helping protec •Ideal occlusal anatomy that matches the natural tooth All and product names are of Hu-Friedy Mfg. Co., its affiliates or companies, otherwise Allefficiency company noted. anddesigns. product names are trademarks ofthe Hu-Friedy Mfg. 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To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit To learn more about how IMS can enhance US ONLINE ATHu-Friedy.com/Infinity HU-FRIEDY.COM/PerfectFit yourVISIT practice visit ©2016 Hu-Fried y Mfg. Co., LLC. All is rights now reserved. Hu-Friedy a your practice visit Hu-Friedy.com/Infinity To learn about how IMSy Mfg. can To learn more about IMS can ©2016 Hu-Fried Co.,enhance LLC. All is rights now reserved. VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit Hu-Friedy Mfg. Co., LLC, 1666 how E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com Hu-Friedy a proud proud member member of of

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©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | Hu-Friedy.com practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Co., LLC. All member rights reserved. of Hu-Fried y Mfg. Co., LLC. All is rights reserved. Mfg. All company andLLC, product names are trademarks of Hu-Friedy Mfg. Co., LLC, your©2016 Hu-Friedy now a proud To learn more about how IMS can enhance Hu-Friedy Mfg. Co., 1666 E. Touhy Ave., Desenhance Plaines, of IL 60018 | Hu-Friedy.com All company and product names are trademarks Hu-Friedy Mfg. Co., LLC, ©2017 VISIT US ONLINE AT To learn more about how can ToHu-Friedy learn how IMS can enhance ©2016 Hu-Fried y Mfg. Co., LLC.HU-FRIEDY.COM/PerfectFit All rightsIMS reserved. Mfg.more Co., LLC. All about rights reserved. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. its affiliates or related companies, unless otherwise noted. To learn more about how IMS can enhance ©2016 and Hu-Fried y US Mfg. Co., LLC. Allare rights reserved. All company product names trademarks of Hu-Friedy noted. Mfg. Co., LLC, VISIT ONLINE AT HU-FRIEDY.COM/PerfectFit ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. its affiliates or related companies, unless otherwise ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All Hu-Friedy.com/Infinity rights reserved. your practice visit your©2016 practice visit ©2017 Hu-Friedy Mfg. Co., All rights reserved. ©2021 Hu-Friedy Mfg. Co., LLC. rights reserved. ©2016 Hu-Fried y Mfg. Co., LLC.All All rights reserved. ©2016 Hu-Fried y Mfg. Co., LLC. AllLLC. rights reserved. Hu-Fried y Mfg. Co., LLC.Hu-Friedy All Hu-Friedy.com/Infinity rights reserved. its affiliates or related companies, unless otherwise noted. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 Mfg. Co., LLC. All rights reserved. your practice visit Hu-Friedy.com/Infinity ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 Hu-Friedy Mfg.Hu-Friedy Co., LLC. AllMfg. rightsCo., reserved. ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved. ©2017 LLC. All rights reserved.

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clinical | EXCELLENCE You may get some pushback: “Why put a crown on a tooth that’s going to fall out anyway?” You know the reasons why, but young patients and their parents probably don’t, or they haven’t thought about them. As you may need to explain the benefits of this treatment, here’s how to highlight the benefits of pedo crowns.

Why pedo crowns are better than extraction his is where hygienists can be the voice of education and comfort for paediatric patients and their parents.

Baby teeth are worth saving (and not just for the tooth fairy) rowns are also a great alternative to extracting teeth. Removing deciduous teeth too early creates space for neighbouring teeth to move in, making it nearly impossible for permanent teeth to come through the way they should. Another unwanted result from extraction is that the resulting gap makes it hard for the child to chew. Parents work hard enough to get their kids to eat fruits and vegetables, most of which are crunchy in texture. If chewing is painful or uncomfortable, that hard work becomes even more difficult.

Pedo crowns are different to adult crowns hen adults think of crowns, they think of their own crowns (or those of another adult they know) and assume it will be the same experience for their children. But children typically struggle to sit still for long stretches and very quickly become scared. Their tolerance for even the slightest discomfort is low. So, crowns made specifically for children were designed to alleviate these issues as much as possible. HuFriedyGroup Pedo Crowns were specifically created for pediatric situations, making procedures faster and more efficient. They’re also made from stainless steel that is pre-trimmed, crimped and contoured, which minimises the need for adjustments during placement.

118 Australasian Dental Practice

Help parents prevent more cavities hile talking with the child and caregivers about paediatric crowns, don’t miss out on the opportunity to promote good oral health care practices. We all know good dental hygiene starts at home. But, knowing and doing are two different things.

“Removing deciduous teeth too early creates space for neighbouring teeth to move win, making it nearly impossible for permanent teeth to come through the way they should....” Many parents want to develop healthy oral care in their children, but they’re not sure how to do it right. A great recommendation from hygienist Debbi Viger is to demonstrate the “BOIT” system using a soft brush and a rice-sized bit of toothpaste. BOIT brushing involves three circular passes starting in the upper-right side of the mouth: • “Bumpy” - Brush the biting surface. • “Outside” - Brush the parts of teeth you see when the child smiles. • “Inside” - Brush the tooth surfaces near the tongue. • “Tongue” - Finish with a quick brushing of the tongue.

Also, take this opportunity to remind parents that sugary drinks, sticky sweets, fruit juice and over-sweetened yogurt can damage young teeth.

Relief for anxious kids o matter how much you try to make children feel comfortable at the dental office, many of them will still have a lot of anxiety. Nitrous oxide/oxygen sedation can calm anxiety and make a child’s experience much less stressful. While both reusable and disposable nasal masks are available, the pandemic-induced trend toward disposable does go a long way in preventing infection. ClearView™ Nasal Masks are designed to match a child’s flow of breathing and the soft inner mask creates a better seal. As the mask is clear, there’s no guessing whether a child is breathing through their nose - you can see for yourself. What kids really like about the ClearView Nasal Masks is how many colours and scents (like bubblegum and strawberry) are available. By letting young patients make some choices, they will feel more in control and comfortable during procedures and cleanings. Hygienists play an important role in helping paediatric patients and their parents practice healthy oral care habits. By supporting the dentist when young patients need paedo crowns and conscious sedation, children can feel more comfortable at the dental office.

May/June 2022

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Co., LLC, its affiliates or•related companies, unless otherwise All company noted. promotes and product names are flow trademar • An open hole pattern that promotes water throughout the cassette An open hole pattern that water th Because •when it comes to the perfect fit, Hu-Friedy is right. Because it to the perfect fit, Hu-Friedy is just right. All company andjust product names arereduces trademarks of Hu-Friedy Mfg. Co., LLC, its when affiliates orcomes related companies, unless otherwise noted. All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC Color-coded silicone rail system that significantly instrument contact and allows • An open hole pattern that promotes water flow throughout the cassette • An open hole pattern that promotes water flow throughout the cass Compared to other leading scaler designs. Data on file. Available upon request. 1) Compared to other leading scaler designs. D Because when it comes to 1)the perfect fit, Hu-Friedy is just right. 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To learn more about how IMS can enhance VISIT USCo., ONLINE AT HU-FRIEDY.COM/PerfectFit Hu-Friedy Mfg. LLC, 1666 how E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com To learn more about IMS your practice visit Hu-Friedy.com/Infinity VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit To learn more about howcan IMS can enhance ©2016 Hu-Fried y Mfg. Co., LLC. All rights All company and product namesreserved. are of Hu-Friedy Mfg. Co., LLC, VISIT US ONLINE ATtrademarks HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co.,companies, LLC. All rights reserved. its affiliates or related unless otherwise noted.member of ©2017 Hu-Friedy Mfg. Co., LLC. Allis rights reserved. Hu-Friedy now a proud your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All is rights now reserved. Hu-Friedy a proud member of ©2021 Hu-Friedy Co.,AllLLC. rights reserved. ©2017 Hu-Friedy Mfg.Mfg. Co., LLC. rightsAll reserved.

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clinical | EXCELLENCE

Luna 2: The versatile dental restorative for every dentist

estorative dentistry is a blend of art and science. One of the most important choices for a dentist is their choice of preferred restorative. Apart from being easy to use, the restorative must look fantastic under a critical patient eye - and stoically stand the test of time for years to come. Your choice of universal composite is critical to the health and endorsement of your patients. Both in the short term and the long term. A new innovative universal composite from Australia has the potential to fulfill all your clinical requirements. Luna 2 (SDI Limited) is a new BPA free universal composite - which is a significant advantage for health-conscious patients. Bisphenol A (BPA) is an organic compound used in materials utilised in several industrial and health fields, including many dental composites. An increased release of BPA can lead to the absorption into oral and gastrointestinal mucosa with high risks of local and systemic toxicity.1 Luna 2 comes as the solution to this problem. But being BPA free is just one benefit. Over 100 dentists worldwide have already used Luna 2 clinically through a special pre-release conducted by SDI. These clinicians have lauded the handling, shade matching and polishability of Luna 2, confirming that Luna 2 will have a strong future. Feedback received from these professionals showed that

120 Australasian Dental Practice

Figure 1a. SEM of Luna 2 restoration Figure 1b. SEM of Luna 2 restoration before finishing and polishing. after finishing and polishing. Source: Independently tested by Unité de Recherches Biomatériaux Innovants et Interfaces (URB2i-EA 4462 Paris Descartes). Chairman: Dr Jean-Pierre Attal

Figure 2. Translucency in different thicknesses of Luna 2 shade A2. the composite delivers ease of sculpting, non-sticky consistency, excellent polish, very high radiopacity and reliable mechanical properties. Luna 2 also makes shade matching effortless. Attaining an accurate shade match can be a complex process. It is also the greatest source of frustration for clinicians and patients.2 A poor shade selection is usually linked to a poor value (the

colour lightness) selection.3,4 To improve shade selection accuracy, Luna 2 includes Logical Shade Matching Technology and the Chameleon Effect. In developing Luna 2, the SDI scientists prioritised shade value and arranged pigments in a logically increasing way. This approach streamlined the shade development for a simpler and faster match to the Vita Classical Shade Guide®.

May/June 2022

clinical | EXCELLENCE

Figure 3. Luna 2 veneers. Images courtesy of Dr Jiovanne Neri, Brazil.

LUNA 2 RADIOPACITY 250% Al

LUNA FLOW RADIOPACITY 265% Al DENTINE RADIOPACITY 100% Al The Luna 2 formulation also mimics lifelike translucency, opalescence and fluorescence. This means that Luna 2 gives you consistently predictable and more accurate aesthetic results.

But what about mechanical properties? una 2 does not disappoint, offering a high compressive strength of 360 MPa to support robust masticatory forces and a very high flexural strength of 130 MPa to reduce failure risk in areas of high stress, by mitigating tensions of compressive forces.5

Luna 2 also provides excellent radiopacity of 250% Aluminium, allowing clear differentiation for easy and precise visualisation for diagnosis assistance. Luna 2 is available in syringes and complets (single dose) in 12 shades, including one incisal, two opaques and two extra bleach shades. As if that wasn’t enough, Luna 2 harmoniously blends with Luna Flow, the new SDI universal flowable composite.

References 1. An integrative review on the toxicity of Bisphenol A (BPA) released from resin composites used in dentistry. Lígia Lopes-Rocha,Lara Ribeiro-Gonçalves,Bruno Henriques,Mutlu Özcan,Maria Elizabeth Tiritan,Júlio C. M. Souza. Pub: 8/4/21. https://www.researchgate.net/publication/350755430_An_integrative_review_on_the_ toxicity_of_Bisphenol_A_BPA_released_from_resin_composites_used_in_dentistry 2. Color and Shade Matching. S. Monala; S. Narayanaswamy. https://www.researchgate.net/publication/347993804_Color_and_Shade_Matching 3. Analysis of variables that can interfere with tooth colour. Masters dissertation. Bernadete Rodrigues do Amaral & Edson Dias da Costa Junior. University of Brasilia, Brazil, 2006. 4. Achieving the predictable composite resin restoration: the nature of colour. David Klaff. International Dentistry SA VOL. 12, NO. 2 5. The Evaluation of Flexural Strength of Composite Resin Materials with and without Fibre. Mustafa Gundogdu et al (2014), Dentistry Vol 4 Issue 9 1000259.

Figure 5. Luna 2 restorations. Images courtesy of Dr Bill Gergis, Australia.

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clinical | EXCELLENCE case report

Sinus filling for implant placement By Dr Bruno Salsou - Toulon

Figure 1. Pre-operative examination: Radiographic examination showing large sinus volume.

Figure 2. Opening of bone flap with piezosurgery.

Figure 3. Placement of 1-2 mm diameter granules of R.T.R./MBCP® Technology filling material using the delivery syringe.

Figure 4. Sinus filling completed.

Figure 5. Repositioning the flap to close off the site tightly. Suturing the area. End of operation.

Figure 6. Immediate post-operative check: Panoramic x-ray examination showing the bone gain obtained following the sinus-lift in sector 1.

s a result of caries problems, a 25-year-old patient lost teeth 15 and 16. A retroalveolar radiographic examination showed large sinus volume, which in such condition would prevent the placement of implants to replace the missing teeth.

122 Australasian Dental Practice

Figure 7. 6 month follow-up: Placed implants 4.1mm in diameter and 10mm in length.

Treatment decision

he decision was therefore made to perform a sinus lift.

Operating procedure Surgical procedure shown in Figures 2-5.

Conclusion • The highly granular consistency of the material permits easier placement and prevents the dispersion of the R.T.R. / MBCP® Technology granules. • The stability of the material also optimises bone healing.

May/June 2022

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clinical | EXCELLENCE

case report

Step by step: Three-unit bridge in the posterior area with Straumann® BLX implants and immediate prosthesis By Sergio Piano, DMD, Italy

ncorporating digital workflows into our treatments can provide numerous benefits, including increased precision and quality of results. Nevertheless, selecting the correct quality and design of materials for our treatments is just as crucial as performing a comprehensive decision-making process to define our clinical strategy and workflow. The following case report describes a smile makeover in a woman with high aesthetic aspirations, including a digitised process, implant placement and immediate implant loading. We met the patient’s needs by using an efficient treatment protocol for implant placement and providing an aesthetic provisional and final restoration design using the Straumann® BLX implant made of Roxolid® and coated with a surface of SLActive® in combination with the digital workflow. The 58-year-old healthy female patient presented to our office with the chief complaint of reduced masticatory function on the left side and the desire to improve her smile. Moreover, the patient expressed her wish to avoid removable rehabilitations during any of the treatment phases and wanted to be treated with a minimally invasive procedure, as she has had previous unpleasant experiences with dental treatments. The extraoral evaluation revealed a medium smile line with a dark area on the second quadrant due to the absence of premolars and molars (Figure 1). The intraoral assessment showed a partially edentulous maxilla, with missing teeth 17, 14, 24, 25, 26 and 27 and black triangles on the second sextant (Figure 2). The occlusal view of the upper jaw showed a Kennedy Class II Applegate modification I with slightly misaligned teeth (Figure 3). The lateral photo showed a possible good amount of available bone in terms of height (Figure 4). The view of the left side of the mouth in occlusion showed the extrusion of teeth 34 and 36 (Figure 5). A CBCT scan visualised with the software coDiagnostiX® was recorded to assess the quality and quantity of bone available for implant placement (Figure 6). In the region 24-26, the assessment revealed adequate vertical and horizontal bone availability.

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Figure 1.

Treatment planning Considering the patient’s requests, the aims of the treatment were: • To evaluate the placement of two implants in positions #24 and #26 to be restored with a fixed three-unit bridge. • To consider the possibility of placing an immediate prosthesis on the implants, if satisfactory primary stability is obtained: in this way, a pleasant esthetic appearance is guaranteed from the beginning of the treatment. • To consider the option of placing the implants with computer-guided surgery and a flapless approach to reduce the invasiveness and to simplify the prosthetic workflow. Taking the above aims into consideration, the following treatment options were presented and discussed with the patient:

May/June 2022

clinical | EXCELLENCE

Figure 2.

Figure 3.

Figure 4.

Figure 5.

1. Implant placement in positions 24 and 26 with no provisional restoration during the healing time. After implant osseointegration, final restoration with a three-unit implant-supported bridge in positions 24-26. 2. Implant placement in positions 24 and 26 and, if the implant stability is optimal, an immediate provisional implant-supported bridge. After implant osseointegration, final restoration with a three-unit implant-supported bridge in positions 24-26. 3. Implant placement in positions 24 and 26 with a guided surgery approach and, if the implant stability is adequate, an immediate provisional implantsupported bridge. After implant osseointegration, final restoration with a three-unit implant-supported bridge in positions 24-26. The SAC v2.0 Assessment Tool (based on ITI SAC Classification) was used to identify the degree of complexity and the potential risk involved in the planned case (Figure 7).

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Figure 6.

Figure 7.

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Figure 8. In order to make the final decision on treatment planning, the pros and cons were evaluated, taking into account the choice of computer-guided implant positioning with an immediate prosthesis (three-unit bridge) for the replacement of teeth 24, 25 and 26. It was decided to choose option number 3 after discussing the risks, benefits and treatment options and considering the patient’s age, medical conditions and expectations. Thus, it was planned to treat the patient with Straumann BLX implants in sites 24 and 26 with immediate prostheses (three-unit bridge) using computerguided planning and surgery. The rationale for the treatment was as follows: • The choice of a fixed implant-supported rehabilitation satisfied the patient’s request to avoid a removable prosthetic solution. • The patient can be provided, as requested, with a fixed provisional bridge assuring a pleasing aesthetic appearance from the beginning of the treatment. • Thanks to their specific shape, the use of BLX implants guarantees the high stability needed for the immediate prosthesis. • The computer-guided planning and implant placement assure a surgical approach with reduced invasiveness and simplify the prosthetic procedures. • The appropriate amount of keratinised gingiva allows for a flapless approach, thus minimising the surgical impact. • Favourable site anatomy, suitable bone availability and a convenient amount of keratinised gingiva reduce the risk of aesthetic complications.

Figure 9.

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Treatment workflow included: 1. Preliminary data acquisition: Intra- and extraoral photos, impressions, creation of the diagnostic guide and CBCT scan with the diagnostic guide in position (already collected). 2. Scanning of the cast model and the diagnostic guide seated on the model; creation of the corresponding STL files and the STL file related to the digital wax-up of the missing teeth. 3. Processing of Dicom (CBCT scan) and STL (upper model, upper model with guide and digital wax-up) data in coDiagnostiX planning software to carefully plan the implant placement. 4. Production of printed surgical guide and resin models via the coDiagnostiX plan. 5. Fabrication of the provisional bridge by the dental lab based on digital wax-up (on resin printed models). 6. Surgical phase: implant placement and provisional bridge positioning. 7. After the healing, final rehabilitation with a screw-retained bridge on the implants.

Surgical procedure he patient was instructed to rinse her mouth with 0.12% chlorhexidine gluconate on the day of surgery. Anesthetic infiltration was done with 2% lidocaine and 1:100,000 epinephrine in the area corresponding to the premolar/ molar apexes and in the surrounding gingiva (Figure 8). A dedicated set of surgical instruments for the BLX implant guided surgery was used (Figures 9 and 10). The guide was placed in the mouth and the stability and precision were verified through the windows created in the guide at specific teeth positions (Figure 11). The lateral view of the guide shows the sleeve dedicated to the pin fixation, which was essential to guarantee the perfect stability of the guide during the drilling procedures (Figure 12). From the occlusal view of the guide, the areas of keratinised gingiva visible through the sleeves assured the possibility of performing flapless implant surgery (Figure 13). A tissue punch, directed by the guide, was used with the purpose of removing the soft tissue layer. During this phase there was no need to fix the guide with the fixation pin (Figure 14). Then the guide was removed and it was easy to see the circular cut of the tissue punch (Figure 15). The soft tissue disks were then peeled away (Figure 16). The guide was kept in its precise position and, using the dedicated bur, the drilling procedure through the sleeve was then performed (Figures 17 and 18).

Figure 10.

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clinical | EXCELLENCE

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

Figure 17.

Figure 18.

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Figure 19.

Figure 20.

Figure 21.

Figure 22.

The fixation pin, placed in the dedicated sleeve, allows the guide to remain in its stable position and the drilling procedure can be carried out in a precise way. After the guide placement (Figure 19), the milling cutter bur was used with the purpose of creating a flat surface for the precise work of the following drills. The specific handle reduced the dimension of the sleeve to that of the selected drill. This bur is the only one without a stop (Figure 20). The ø 2.2 mm pilot drill was used (Figure 21), followed by the ø 2.8 mm drill (Figure 22) and finally the ø 3.5 mm drill (Figure 23). Each drill was cooled with copious amounts of sterile water and the tip was moved back and forth to minimise overheating. In accordance with the choices made during coDiagnostiX planning, a BLX implant 4.5 mm in diameter and 12 mm long was used in position 24 (Figure 24). The pin placed in the apical part of the implant was gently broken according to the manufacturer’s instructions (Figure 25).

Figure 23.

Figure 24.

Figure 25.

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clinical | EXCELLENCE

Figure 26.

Figure 27.

Figure 28.

Figure 29.

Figure 30.

Figure 31.

The implant was then ready to be engaged into the sleeve for the perfect guidance in the prepared bone site (Figure 26). The dedicated BLX transfer piece drives the implant in the correct position. The procedure ends as soon as the black line is in contact with the edge of the sleeve (Figure 27). The molar site was prepared following the procedure for the premolar. Because the quality of the bone was not excellent in this site, the ø 2.8 mm drill was the last one used. As seen in the procedure for the premolar, the implant was chosen in accordance

with the coDiagnostiX planning (BLX 4.5 mm in diameter and 8 mm long). After placing the implant, the insertion torque obtained was evaluated. The high values reached allowed us to proceed with the immediate provisional bridge (Figures 28 and 29). In the occlusal view of the implants after placement, we observed an optimal 3D position (Figure 30). The temporary abutments, customised by our dental lab, were screwed onto the implants (Figure 31).

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Figure 32.

Figure 33.

Figure 34.

Figure 35.

Figure 36.

Figure 37.

The temporary bridge was then checked in the patient’s mouth in order to evaluate its precise seating on top of the temporary abutments (Figure 32). The seating of the temporary bridge was very precise thanks to the accurate planning and execution of implant placement, perfectly in line with the prosthetic design (Figure 33). Prior to connecting the bridge and the abutments with resin, the field was isolated by means of two pieces of dental dam. This procedure is very useful especially when a flap is raised and it is not easy to obtain the ideal wet conditions for resin polymerisation (Figure 34). Next, a thin layer of resin was applied to the temporary bridge (Figure 35).

We can observe the temporary bridge in position, after the removal of the resin sheet that has allowed the precise placement of the bridge (Figure 36). After the temporary bridge was unscrewed from the mouth, it was filled with resin in the spaces between bridge and abutments and this was followed by the refinement procedures (Figure 37). The refinement procedure for the temporary bridge was performed first with the tungsten carbide bur, then with a rubber pre-polisher and finally, with a polishing buff. It is important to create an ideal emergence profile of the bridge units and to have a completely smooth surface in contact with soft tissues (Figure 38). A reverse angle view of the temporary bridge showed the

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clinical | EXCELLENCE

Figure 38.

Figure 39.

Figure 40.

Figure 41.

Figure 42.

Figure 43.

correctness of the emergence profiles: in this way the bridge started the precise conditioning of soft tissues from the beginning of the implant healing (Figure 39). The temporary bridge was screwed onto the implants (Figures 40 and 41). The chimneys were closed and the smile line looked harmonious with the prosthesis well integrated into the patient’s mouth (Figure 42). The temporary bridge was intentionally not in full occlusal contact in order to reduce the risk of excessive loading on implants (Figure 43). The patient’s smile immediately after the surgery (Figure 44). The treatment at this point already met the patient’s expectations, delivering the expected aesthetic and functional benefits.

Figure 44.

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clinical | EXCELLENCE “When indicated, immediate treatments can reduce the chair time and cost, maintain the gingival tissues and increase the comfort of our patients...” Figure 45.

Figure 46.

Figure 47.

Figure 48.

Figure 50.

Figure 49.

Figure 51.

Prosthetic procedures

Acknowledgements

he patient reported no mechanical or biological issues at the 3-month follow-up visit. Moreover, the clinical examination showed that the emergence profiles created by the provisional bridge were harmonious and natural. To prepare the final restoration, the temporary bridge was removed and the soft tissues were evaluated. The tissues around the implants were healthy and with an optimal emergence profile (Figure 45). Afterwards, a conventional impression was taken (Figure 46). The final restorations were screwed onto implants 24 and 26 and the occlusal plane was corrected by making new restorations in the opposite jaw (Figures 47 and 48). The final x-ray image showed the perfect integration of the implants and the precision of the prosthetic work (Figure 49).

I would like to express my gratitude to Dr Elisa Oneto for her great contribution to the prosthetic procedures and to Alessandro Giacometti for his excellent lab work.

Treatment outcomes he treatment outcome met the patient’s aesthetic and functional expectations. The patient reported an improvement in her quality of life. She was involved in a maintenance program with yearly follow-up visits. Two years later, the patient is still very satisfied with the treatment outcome and the peri-implant tissues appear in excellent condition (Figures 50 and 51).

132 Australasian Dental Practice

About the author Sergio Piano graduated in Dental Medicine from the University of Genoa, Italy. Visiting Assistant at Geneva University, Switzerland in 1991-92 (Departments of Prosthodontics, Prof. Belser, and Implantology, Prof. Bernard). Lecturer on the Postgraduate Program at Federico II Naples University, Italy (Master’s in Implantology), Marconi Rome University, Italy (Master’s in Computer-guided Surgery) and Brescia University, Italy (Master’s in Digital Dentistry). Director of the Dr. Sergio Piano private dental clinic in Genoa, Italy. Regular national and international lecturer in more than 30 countries. Author of several scientific papers in the fields of implantology and esthetics. Active member of IAO (Italian Academy of Osteointegration) and IAED (Italian Academy of Esthetic Dentistry). Affiliate member of EAED (European Academy of Esthetic Dentistry), ITI Fellow and member of the Lead Team of the Italian Section with the role of Education Delegate.

May/June 2022

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surgery | DESIGN

Class 1 Orthodontics opens West Perth

r Chris Orloff is the owner and principle of Class 1 Orthodontics, one of Perth’s leading orthodontic providers. Class 1 now comprises seven practices in Western Australia with the latest, a beautifully executed design and fitout adjacent to WA’s parliament building. For the design and fitout of each of his practices, Chris has returned to Medifit Design & Construct, a company that regular readers of this publication will recognise.

134 Australasian Dental Practice

“Since I completed my first practice at Rockingham in 2008, Medifit have been rock solid and always deliver an excellent result,” Dr Orloff said. “They understand what I want and need from each of my practices and they know how to make it happen. I’ve been a happy customer for many years. I trust the Medifit team to get it right and the results speak for themselves.” Chris’s vision for Class 1 Orthodontics has always been a suite of practices that offer a consistent, high quality experience to patients and their families in an

environment that encourages interaction and enjoyment. Patients make many visits to the practice over the course of their orthodontic treatment and a familiar and welcoming environment for patients and their families helps to foster positive interactions with the practice. The design of the new West Perth practice echoes the distinctive timber theme developed for other Class 1 practices, giving the new practice a contemporary look with timber features and curves throughout lending the space a natural feel.

May/June 2022

The practice covers approximately 250m2. A beautiful courtyard garden leads patients to a generous waiting area. Custom circular entry and exit pods take the place of a traditional reception counter and facilitate the smooth flow of patients through the waiting room. The new sixchair practice consists of two private consulting rooms with an open treatment area containing four chairs arranged for both open and semi private treatments. The open treatment area is also home to the steri, allowing for quick and easy access to equipment and a brush station for patients to refresh and recover post treatment. A small standing consult room lies adjacent to the waiting area for brief consultations and checkups. The practice also houses a lab, staff room, plant room, IT nook and ample storage for additional equipment and supplies.

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surgery | DESIGN

Class 1 West Perth is located adjacent to an occupied residential apartment complex and this posed significant restrictions on construction activity. Demolition, concrete cutting and all noisy works were limited to a small window of time between 5 and 7pm on weekdays and further restricted on the weekends, so efficient scheduling and coordination of trades was essential for successful delivery of the project. With a fitout period of just 10 weeks, the practice was completed on time and on budget. “The site was challenging due to the complications relating to fire and emergency egress that were previously shared with other

136 Australasian Dental Practice

tenants without authority,” Dr Orloff said. “Medifit took it upon themselves to fully resolve these issues even though it was outside of their scopes of work. The final resolution was outstanding and we were very thankful for their assistance in resolving the matter fully and garnering back square meters that rightfully belong to us. “I don’t expect that there is another company that can design and deliver a project on time and on budget in the way that Medifit does. The attention paid to our needs and desires was beyond reproach, and I feel that their approach to their customers aligns with our own.”

May/June 2022

surgery | DESIGN

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Summary The Practice The Practice

Class 1 Orthodontics

Principal

Dr Chris Orloff

Type of Practice

Specialist Orthodontic

Location

West Perth, Perth, Western Australia

Size

250 square metres

No of chairs

The Team Architecture

Medifit Design & Construct

Interior Design

Medifit Design & Construct

Construction

Medifit Design & Construct

Equipment

“As always Medifit were able to deliver a quality product matching our design brief and philosophy within an unbelievable 10 week period despite the ravages of COVID impacting three different trade teams and major supply chain issues. On time and on budget is not just a throw away line by Medifit, its embedded as part of their DNA,” Dr Orloff said.

138 Australasian Dental Practice

Dental Units

Dexta MK5CE

Autoclaves

Melag

OPG

Carestream

Compressor

Bambi VT200D

“The project is a testament to Medifit’s construction management and quality but also their ability to design a fantastic outcome that fully utilises every m2 of the building. Yet another fantastic result by the Medifit design team. Testament to our relationship and trust that we put in Medifit, Class 1 has now completed our sixth project with Medifit over the last 15 years and I hope that it is not the last. “We highly recommend Medifit to anyone who is looking for a professional, creative, ethical, honest and attention to detail company. A big thank you goes to Sam, Mark, Rob and all the guys on site. You once again exceeded our expectations.” Medifit’s Sam Koranis added “I’ve known Chris for 15 years now and have always respected his business acumen and vision for Class 1. We share common values regarding quality outcomes and operating with the utmost honesty and transparency and it has been a pleasure working with Chris for the 6th time. The Medifit team are proud to have played a part in helping Chris grow Class 1 into one of Perth’s leading ortho practices.”

May/June 2022

Practices that work with you Since 2002, Dentists and Dental Specialists all around Australia have trusted Medifit to create state of the art practices with individual interior designs that boost productivity and enhance levels of care. Whether it’s your first practice or your latest, we’ll help you create a dental practice that reflects your personal style and complements the way you work - and we do it with a friendly, no fuss approach using proven best practices. Contact Medifit today for a no obligation consultation and experience our award winning service. • SITE ASSESSMENTS • LEASE NEGOTIATION • FEASIBILITY STUDIES • COUNCIL SUBMISSIONS • ARCHITECTURAL DESIGN

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surgery | DESIGN

Canberra Dental Specialists practice is born

highly credentialled young Canberra endodontist has set up her own practice after starting her career working in public health, academia and other

private practices. Dr Arpana Devi has established Canberra Dental Specialists in a mini “hub” of specialist medical practitioners in the Belconnen district of the ACT. After winning two scholarships and training in Western Australia under the renowned Prof. Paul Abbott AO and at the University of Otago NZ, Dr Devi has spent several years building up her skills in public health, teaching dentistry and working in private practice.

140 Australasian Dental Practice

She is now a highly skilled endodontist as well as serving five years as a member of the ACT Dental Group, including as both President and Secretary. Dr Devis said there was an unmet need in the ACT for endodontists and that there was good collaboration among specialists such as periodontists and paediatric dentists to provide referrals to one another, resulting in more holistic care for patients. Her motivation is providing care to patients who want to keep their teeth. Unlike in some public health settings where she had worked (where extractions are the norm over root canal therapy and implants), Dr Devi said being in private practice gave her the “independence to do what she wanted as a clinician to give her patients the best experience they could have in a dental setting”.

By David Petrikas

She was able to fulfill her dream of establishing her own practice by taking on a commercial space in the predominantly family-oriented residential suburb of Florey. The upstairs space has large rooms which are now her clinical rooms and a large reception area, so patients feel comfortable, without the clinical feel. Dr Devi said she wanted a small practice, so patients are not so overwhelmed by the clinical nature of the setting. “Being part of a small practice feels like a ‘family’ and when you spend time with people and work as a close team, you end up with happier patients. “I’ve also added some personal touches and décor, so it does not look like a ‘hospital’ setting and is not daunting, which is important as most patients are anxious about their treatments.”

May/June 2022

The reception area has an assortment of comfortable chairs and the reception desk has geometric ribbed timber batons, matching the timber feature wall behind, plus attractive black and chrome pendant lighting adjacent to the distinctive blue practice logo. Instead of solid room dividers, Dr Devi chose black framed glass walls to introduce more light throughout the practice. Internally, the surgery layout has been designed to allow enough room for her and the dental assistant to easily move around in the surgery. The theme of the colour palette is “Hamptons”, with white walls, black architraves and skirtings and black handles on the built-in white cabinetry. A great deal of warmth is introduced by the timber grain flooring in the reception area and central hallway which contrasts with the white walls throughout.

May/June 2022

Another notable feature is a generous, carpeted staff kitchen and meals area to give staff “time out” when required. The space is also furnished with a large table and whiteboard which enables training sessions and caters for meetings and CPD sessions. Dr Devi was referred to NSW and ACT A-dec dealer, Presidental and visited the A-dec showroom in Sydney to see the range of equipment that would best suit her needs. She chose A-dec chairs because they were modern and comfortable and opted for the Continental delivery system in her own surgery for its ergonomic and practical benefits. “I’ve worked on both Continental and traditional systems and I find I can place the A-dec 500 Continental delivery head closer to the patient, allowing better access to the oral cavity and ensuring better ergonomics for endodontists.

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“It’s easy to replace an instrument on the Continental system as it goes back to its own position without having to look up from the patient, which is especially useful when using the Leica microscope.” (A second surgery is equipped with an A-dec 400 chair, but with the more common traditional delivery system and is intended for use by a visiting specialist in the future). Because patient comfort was very important to her, Dr Devi chose the sewn upholstery on the sturdy and stable A-dec 500 patient chair which is ideal for root canal procedures.

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“Because I do longer procedures, if the patient is uncomfortable, even the slightest movement is a big movement when working with a microscope,” she said. She added that the thin and flexible backrest of the A-dec 500 does not feel “heavy” on her lap and gave her good access to the patient. Another feature of the A-dec chair which Dr Devi said really stood out was the double articulated “gliding” headrest which made it very quick and easy to adjust the headrest for an optimum view and access to the oral cavity.

May/June 2022

A-d ec 300 00 4 c A-de

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THERE’S AN A-DEC FOR EVERYONE Every dental practice is unique. That’s why A-dec offers a full line of dental chairs, with a wide variety of options and price points, all designed for comfort, performance, and reliability. From the entry-level A-dec 200, the stylish A-dec 300, to the classic A-dec 400 and the premium A-dec 500, there’s an A-dec chair to fit your practice, your personal style, and your budget.

To see our award-winning family of A-dec dental chairs – scan the QR code and find the one that’s right for you.

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Summary The Practice The Practice

Canberra Dental Specialists

The Principal

Dr Arpana Devi

Practice Type

Specialist endodontic

Location

Florey, Australian Capital Territory

Size

100 square metres

No of chairs

2+1

The Team Installer

Presidental

Equipment

The A-dec 500 delivery system also has a handy clip-in tray system which provides a perfect place for not only dental consumables, but also an Apex locator when required. Dr Devi said the A-dec 500 chair has also proven to be good for the reputation of her practice among patients and prospective patients. “The A-dec chairs with their quilted black upholstery also convey a ‘modern’ look and one of my patients said: ‘Now I know why they send me to a specialist – a general practice looks like economy, and this is like flying First Class’.”

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Dental Units

A-dec 500 Continental and A-dec 400 Traditional with A-dec NLZ and A-dec EA53 electric motors and Satelec scalers A-dec 500 ceiling mounted lights

Sterilisation

Lisa VA-B steriliser

X-ray

PSPIX phosphor plate scanner X-mind Unity & X-mind DC

Compressor

Cattani AC300

Suction

Cattani Turbo SMART A

Software

Core Practice

Another commented: “I’m not normally one to do reviews, but I’ll definitely do one for you!” Dr Devi said some patients might prefer a “lady’s touch” as she is the only female endodontist practising in Canberra. “I make sure the patients are comfortable in the chair before embarking on a long procedure such as root canal therapy and I know some patients have referred me onto others on that basis and DVA (Department of Veterans’ Affairs Canberra) patients who have been referred by others are asking for me by name, due to this particular caring approach in our practice.” When it came to choosing the equipment, Dr Devi said she was aided greatly by Luke Williams from Presidental to equip the entire practice. “He was amazing and travelled down from Newcastle to show me what was available and he has so much knowledge about the equipment. “He also gave me options for the best equipment available for what I needed - and some more economical solutions to fit my budget. He never pushed anything on me and unlike other salespeople who are always on your back, he just said: ‘I’ll let the equipment speak for itself’.” The practice includes Acteon X-Mind X-ray units in each surgery, a central steri room area with W&H sterilisation equipment, ultrasonic bath, multi-handpiece cleaner and compact Acteon PSPIX phosphor image plate scanner.

May/June 2022

new | PRODUCTS Information contained in this section is provided by the manufacturers or distributors. Australasian Dental Practice does not assume responsibility for the accuracy of the data.

MDP2 (Mobile Dental Photography 2)

The Smile Lite MDP2 Mobile Dental Photography by Prof. Louis Hardan - the ultimate evolution in mobile dental photography – is here. It’s equipped with three groups of next generation “SunLike“ LEDs and each group can be lit up individually. A dimmer function gives you the possibility to set four different illumination levels. The increased light power is perfect

for posterior shots and the new integrated ergonomic handle provides stable support. The back of the Smile Lite MDP2 is equipped with a universal adapter that is adjustable and fits any smartphone with a width between 55-85mm.

SDI launches new Luna Flow composite SDI has launched new Luna Flow, an extra strong light-cured flowable composite. With a blend of fillers in different ultrafine sizes to optimize handling, mechanical and optical properties, Luna Flow offers high radiopacity, control over application, easy shade matching, excellent strength and wear resistance. Luna Flow is a reliable and easy universal option for liners, bases, provisionals, restoration and provisionals repairs, Class V and conservative Classes I to IV. Luna Flow was designed in two viscosities to suit all clinical needs. The regular viscosity offers superior handling and maximum control during application. This beautiful composite flows on demand, holds its shape and does not string. The low viscosity (Luna Flow LV) offers more flow, making it perfect for liners and bases. Luna Flow is available in 12 shades, including one incisal, two opaques and two extra bleach shades. Luna Flow is an Australian innovation. Available: SDI Limited Tel: 1800-337-003 www.sdi.com.au

Available: Alphabond Dental Tel: (02) 9417-6660 info@alphabond.com.au www. alphabond.com.au

Cention Forte from Ivoclar Vivadent

Colgate Optic White Light Up

Ivoclar Vivadent has launched Cention Forte and Cention Primer, a mercury-free system for filling dental cavities suitable for the placement of permanent Class I and II fillings. The bioactive powder-liquid filling material is characterised by exceptional durability, high flexural strength, true-to-nature aesthetics and bioactive ion release. Cention Forte clearly stands out from commercial glass ionomer cements and delivers exceptional performance due to its high flexural

Colgate has launched a DentistExclusive Optic White Light Up Pen and matching LED device in a take-home whitening kit that will make your teeth “up to 7 shades whiter in 5 days” if used as directed. The precision applicator pen supplied in the kit contains a patented 6% hydrogen peroxide (HP) whitening serum that is applied to the tooth surface. The unique chemistry

strength values of over 100 MPa in the load-bearing posterior region. Cention Forte blends in seamlessly with the natural tooth structure: The material is tooth-coloured and has a high translucency of around 11%. The matching selfetching, self-curing Cention Primer completes the system. Available: Ivoclar AU Tel: 1300-IVOCLAR NZ Tel: 0508-IVOCLAR www.ivoclar.com

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of the serum, when paired with the powerful indigo LED device, delivers enriched whitening and optimum results. The kit includes the LED teeth whitening device and charging case, a USB-A charging cord and the whitening pen. Available: Henry Schein Tel: 1300-658-822 www.henryschein.com.au

May/June 2022

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Australasian Dental Practice May/Jun 2022

Articles inside

Pathway to prosperity: A dentist’s guide to wealth creation - Part 2

Why are they selling? Why good business owners sell strong businesses

If your staff don’t highly value your services, then treatment plans won’t be sold

Huge financial changes to impact dentists

Your biggest investment in your practice should be this

The scary words that are costing your practice big time