Australasian Dental Practice Sep/Oct 2023 by dentalcommunity

Australasian

DENTAL PRACTICE THE BUSINESS MAGAZINE FOR DENTISTS

Vol. 34 No. 4

SEPTEMBER/OCTOBER 2023

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VOLUME 34 | NUMBER 4 SEPTEMBER/OCTOBER 2023

contents | REGULARS

On the cover... Kerr launches matching gutta percha points for their ZenFlex™ NiTi rotary shaping files - High cutting efficiency and minimally invasive design

management

8 briefs 10 one man’s opinion 12 in my practice 14 commentary 18 spectrum 74 CPD centre 76 abstracts 78 the cutting edge 146 new products

184 Risky advice sources for dental practices The power of words: Choosing truth over 188 meaning for personal growth and progress to hold ‘em and when to fold ‘em: 190 When What poker can teach us about exit planning 192 3 important parts of every call dental practice owners can buy back 194 How their time marketing

READ ME FOR

CPD

questions about your team you may not 198 Two want to answer

finance does the recent review of the 100 What Reserve Bank of Australia mean for you?

facebook.com/dentalpracticenow

twitter.com/adpmagazine

instagram.com/dentevents

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

© 2023 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.

September/October 2023

Australasian Dental Practice 5

contents | FEATURES

VOLUME 34 | NUMBER 4 SEPTEMBER/OCTOBER 2023

infection control

clinical excellence 106

112

Surface matters: How to maximise monolithic zirconia restorations

READ ME FOR

CPD

READ ME FOR

CPD

112

120 The rarely spotted pulpotomy 106

Sustainability in dentistry: Part 2 - Life cycle analysis: A primer

120

READ ME FOR

CPD

surgery design 134 Correct shade determination with

124 monolithic zirconia shade guides identical to the final restoration

124 Ellenbrook Smiles - A Medifit

134 Design & Construct collaboration 140 A Gold Coast practice to smile about! 128 September/October 2023

Differential diagnosis of resorption: Diagnosis and management Australasian Dental Practice 7

briefs | NEWS Don’t miss out...

10th Anniversary of Ceramill Sintron

f you love quality education and you also love a bargain, then register immediately for our two digital dentistry events in 2024. Early bird By Joseph Allbeury rates now apply for both 3D Printing in Dentistry 2024 on February 9-10 plus the fifth instalment of Digital Dentistry and Dental Technology 2024 on May 24-25. Both of these two-day events feature a stellar line-up of expert speakers that are not to be missed. Planning is well underway for 3D Printing in Dentistry 2024 on February 9-10 at the ParkRoyal Sydney Darling Harbour. This event is a single stream conference with multiple speakers and this year, as well as looking at new tech and new materials, we’ll have a particular focus on the next evolution of printers approaching more autonomous operation. There are solutions already available in Australia, some serious, some novel, that are introducing automation at various levels. We’ll also be looking at the importance of validated workflows to ensure consistency in printed objects. The event at the beginning of 2023 highlighted the complexity of the 3D printing process and the need to ensure that every step of the printing, washing and curing process is consistent and inline with manufacturer’s guidelines. To that end, the Therapeutic Goods Administration have also confirmed they will be providing a speaker and we’re working with them to ensure their presentation answers the key questions users of 3D printing are asking that will impact the future of the use of this technology. We’ll also be covering the applications of Artificial Intelligence in the design process, clinical and technical case studies and a range of other topics of interest... plus plenty of interaction and debate delivered by the best speakers from Australia and New Zealand. Then, for the fifth time, we will be staging Digital Dentistry & Dental Technology 2024 on May 24-25. This event attracts some 500 delegates and if you register now, you’ll save 75% off the full price (paying just $220 until November 24). Our signature event brings together dentists, prosthetists and technicians in a multi-stream programme that covers every area of digital technology and its applications in the clinic and the lab. Apart from 3D printing, topics covered include intraoral scanning, 3D facial scanning, milling, CAD and CAM software, materials, smile design, digital dentures, implantology, CBCT, restorative, aligners, orthodontics and more. Digital dentistry continues to define the clinic and the lab and offers tremendous gains in efficiency, time and labour saving that is delivering a revolution in the profession. Both of these events offer clinicians and technicians unprecedented access to expert information to help navigate the transition to digital dentistry and how to take its use to the next level and beyond. So register now and SAVE. Enjoy the edition... Joseph Allbeury, Editor and Publisher

8 Australasian Dental Practice

n 2013, Amann Girrbach launched the CoCr sintering metal Ceramill Sintron, which has since enjoyed great popularity worldwide. The Ceramill Sintron CoCr sintering metal is distinguished by innovative supremacy. The non-precious metal revolutionises the manufacturing process, as Ceramill Sintron blanks can be dry milled effortlessly on in-house desktop machines such as the Ceramill Motion 3 due to their wax-like nature. During the subsequent sintering process under inert gas flooding, the frames achieve their final state - a non-precious metal unit with a very homogeneous material structure, precise, without cavities and machinable with any common metal veneer ceramic within the CTE range. A revolution in the fabrication of CoCr restorations, with a manufacturing process that involves only a few steps. According to the data available from now ten years of market surveillance, Ceramill Sintron has proven itself to be an established and clinically proven material. Developed together with the Fraunho-fer IFAM Dresden and validated by independent universities and accredited test laboratories, the material and the matched workflow assure maximum safety for the user and the patient. For more information, visit to www.amanngirrbach.com

New Amann Girrbach Zolid Bion zirconia mann Girrbach brings a new material to market following 15 years of zirconia development work. Zolid Bion is the name of the new high-performance zirconia, which optimises the aesthetics and natural appearance of restorations without compromising on safety. Thanks to the innovative design of the Therm DRS sintering furnace, extremely fast sintering cycles are now possible. Crowns made of Zolid Bion can thus be sintered in just 45 minutes – and without any sacrifice in terms of aesthetics or safety. Zolid Bion is the first material in its class to achieve such speeds and thanks to the raw materials used by Amann Girrbach, a strength of over 1,100/± 150 MPa can also be guaranteed over the entire cross-section of the blank. For more information, visit to www.amanngirrbach.com

September/October 2023

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spectrum | NEWS

One man’s opinion...

H By Georges Fast

“One aspect that immediately became obvious when speaking with European colleagues was the amount of clinical freedom that they enjoy without being micromanaged by the regulatory authorities. They don’t appear to have to constantly look over their shoulders to ensure that they comply...”

aving just returned from Europe where I was fortunate to attend a meeting of the Italian Dental Association in Sardinia, I started thinking about the difference between the way dentistry has evolved in Australia as opposed to Italy and the rest of Europe. One aspect that immediately became obvious when speaking with European colleagues was the amount of clinical freedom that they enjoy within their own practices without being micromanaged by the regulatory authorities. They don’t appear to have to constantly look over their shoulders to ensure that they comply with all sorts of regulations, both with respect to instruments and materials as well as workplace industrial laws. When I told some of them about how dental surgeries in Victoria must be made “body protected areas” with respect to electrical circuitry as soon as a new piece of equipment is installed, the cost involved and the rigid requirement to have a “cleaner’s power point” in the actual operatory, they just shook their heads! There was a piece of equipment at the trade show that I would love to have access to. It was a pair of goggles with green lenses that filtered certain wavelengths and which, in combination with a normal composite curing light, had the potential to detect potentially malignant lesions in the mouth. The way this works in Italy is that, in combination with a filter that fits over the lens of a mobile telephone camera, one can send the photo to a specialist and if they are suspicious they call the patient in for further investigation. The distributor didn’t believe the size of the fine that our TGA could impose on me if I imported one of these and used it to look at a patient. I explained that if I wanted one, I would have to apply for a licence to sponsor one into the country and that the cost of obtaining such a permit was more than 5 times the cost of the item. Somewhere along the way in the pursuit of absolute safety, we have managed to stifle innovation! In the 1990s, it was the USA who were a few years behind the rest of the world in adopting new technology, especially if it was developed outside the US. Their FDA was largely to blame and in those days, I was never sure whether this was in pursuit of safety or to give American firms time to catch up. At the first World Implant Congress held in Paris in October 1972, I heard a statement that I will never forget made by Leonard Linkow who was one of the fathers of modern implantology: “Behold the turtle, he only makes progress when he sticks his neck out”. The world has moved on from those times and nobody is suggesting that we should be allowed to experiment on our patients. But we, as educated and trained clinicians, should be afforded

10 Australasian Dental Practice

some clinical freedom to perhaps vary certain processes without exposing ourselves to huge fines and sanctions, if we think that it would benefit the patient. We are cursed with layer upon layer of people whose main aim in life is to keep themselves employed by generating regulations for every aspect of our lives. Our infection control rules are micromanaged and constantly expanding without any demonstrable improvement in safety. Our equipment must be repaired by qualified technicians who have been certified by these same bureaucrats (not that many of them would have any idea about how to actually fix the equipment). The rules that govern our everyday lives in our practices must “articulate” with other rules about everyday lives made up by the same cabal of bureaucrats. Over my practising life, I have owned, either by myself or in partnership with other dentists, 11 practices across 13 locations. I have been paying for X-ray licences for over 50 years and in those 50 years, we have had one premises inspected! Coincidentally, it happened to be the practice closest to the offices of the radiation safety people! Interestingly, I got a call late last year that they would like to come and check the licence at my current practice. The day they suggested was one that coincided with me being interstate. I had a chat with the inspector and said how much I welcomed the inspection, mentioning that I was a member of the working party that produced the current NH&MRC Guidelines for Radiation Protection in Dentistry. The person that I spoke to had no idea about radiation and said that they would get back to me about arranging a suitable date. Maybe they’ll call next week! In the meantime, our overheads keep escalating and the administrative burden keeps growing. Interestingly, one of the large corporates, who over the years have acquired in excess of 200 practices in Australia, have put the whole lot on the market. Perhaps they have realised how little profit there is in dentistry when they have pay people to do the everyday things such as draining compressors, cleaning air-conditioning filters, maintaining stock control and doing minor repairs to equipment that we as private practitioners do as a matter of course in our own practices. Our own professional association has of necessity grown from a group of dedicated senior practitioners who volunteered their time to assist those following behind and to represent our interests, into a large bureaucracy so as not to be left behind. To put it succinctly, we need “our” bureaucrats so that they can deal with “their” bureaucrats. I have a framed cartoon in my office with a picture of one person digging a ditch with 7 or 8 onlookers representing various inspectors, safety officers, traffic management people and Union representatives drawing a wage for being present. In the meantime, the average person has trouble affording dental treatment.

September/October 2023

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spectrum | NEWS

Fast track to a rusty old garden chair... “Have you ever heard someone say they’ll do something when they win the lottery? Would it surprise you that a large percentage of people who want to win the lottery don’t even buy a lottery ticket? I’d reckon that it would be 100% certain that it will be impossible for these people to ever win a lottery...”

W By David Moffet

e need to realise that there are numbers and there are lessons. And usually the numbers are the lessons. I learnt at a very early age that in life, the statistical fact that when people reach the age of 65, only 1% are truly wealthy and only 4% are well off. What that means is that 95% of people reaching the age of 65 are either dead or broke, or financially dependent on others. That’s a terrible result for most people after a lifetime of work. In another statistic, interestingly, when looking at the population, only 3% have made written plans and goals for their future. Do you think there’s a correlation between these statistics? Some people like to tell you what they’ll do when they win the lottery... Have you ever heard someone say they’ll do something when they win the lottery? Would it surprise you that a large percentage of people who want to win the lottery don’t even buy a lottery ticket? I’d reckon that it would be 100% certain that it will be impossible for these people to ever win a lottery if they don’t buy a ticket. One of my mentors, Jim Rohn, said this: “All of the books that we will ever need to make us as rich, as healthy, as happy, as powerful, as sophisticated and as successful as we want to be, have already been written. All of the insights that we might ever need have already been captured by others in books. The important question is this: In the last 90 days, with this treasure of information that could change our lives, our fortunes, our relationships, our health, our children and our careers for the better, how many books have we read?” For me, the interesting thing about a book is that it is available information, but it’s not the same as receiving tuition and coaching. I can buy a book about golf written by Tiger Woods and I can read it, but if I had lessons from Tiger Woods, or any golf professional, that looked at how I was hitting the golf ball and gave me advice and tuition about WHAT THEY SEE I COULD DO BETTER, then my golf game would definitely be better because of the tuition and the 1:1 accountability created, than it would be from me reading a book. If self-help books worked, then we wouldn’t need self-help books, because by definition, we could work out the answers by ourselves. Years ago... I asked the guy who mowed my next door neighbour’s lawn how much it would cost for me to have him mow my front lawn while I was away overseas? [I was mowing my own lawn at that time]. He told me it would cost me $20 each time for him to do that. And I then immediately asked him how much would it cost for me to have him mow my front lawn while I was at home?

12 Australasian Dental Practice

You see, for $20 a time, I was able to secure the services of a professional person who knew what he was doing and who was able to do a great job for me in a quicker time than I could, while I could be doing something else... A professional coach sees things from above and outside of your own little silo and brings that breadth of knowledge and experience to the table in bite-sized consumable pieces designed for you to achieve maximum sustainable growth. Sure, you can buy a full set of Brian Tracy books and delve through them at your own pace... and see how far you get doing trial and error along the way... or you can use a coach to help you and prevent you from making those mistakes in the first place... A coach will give you... 1. A proven game plan that works and has worked for others; 2. A realistic time frame for achieving your goals; and 3. Much needed accountability to keep you on the road to success and prevent you from deviation and distraction. 95% of people will choose not to have a coach They will choose: 1. No coach. Work it out for themselves. The trial and error method is long and extensive and usually expensive when you add up the costs of the errors and the costs of the wasted time. 2. Ask their friends. See results for “No coach” above. 3. Read books and Google: Results in confusion. And results are expensive. Because of time wasted. Statistics will tell you... You’ll probably find that the 95% of business owners who don’t choose to work with a coach pretty well matches up with the 95% who end up dead, or dead broke, by age 65... As Mike Michalowicz says: “You don’t want to be that guy who one day ends up in a rusty old garden chair regretting a life of toil...” Where we sit today is a direct result of the actions and commitments we have made over the past five years. Where you sit in five years time will be a direct result of the actions and commitments you make in the next five years.

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 very successful dental practice [of 28 years] located in Parramatta in working class western Sydney. David recently retired from wet-fingered dentistry and now spends his time lecturing and coaching private dental clients in the USA, Canada, Great Britain, Europe and Australia and New Zealand on how to improve their practices. David can be contacted at david@theUPE.com or visit www.theUltimatePatientExperience.com.

September/October 2023

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spectrum | NEWS

People-managing the “social media generation”

By Kia Pajouhesh

“By its very nature, social media trains users to make rapid, almost instantaneous decisions. In an instant, the individual decides whether they “like” or “dislike” a post. Apps demand that a definitive decision be made instantly, without thought or consideration of extenuating factors...”

hroughout the developed world, employee longevity and workplace loyalty have critically and irrevocably changed over the past decade. Data from the social media giant LinkedIn shows that the average tenure is now reduced to just under two years. Even more alarming, a sizeable subgroup of the population - mostly members of Gen Z and young Millennials - spend only months in each employment role before moving on to seemingly greener pastures. This leaves people management teams, including those in the health industry, needing to contend with an ever-widening generation gap - between the above groups and the rest of their workforce. But what is behind such a seismic shift? At its core is a single disruptive influence: the internet, and in particular, social media. Workplaces are increasingly being populated by a new generation of employees wholly nurtured and raised in an internet-obsessed world. As a resource, the internet has an abundance of positives, with rapid access to information, online services and, more recently, powerful AI. However, as is now freely recognised, the world of social media reflects a darker side of the net. Gen Z and young Millennials have spent their entire lives immersed in the alternative reality of this ever-evolving space with apps such as TikTok, Instagram and Snapchat. A number of well-documented behavioural patterns are now being attributed to prolonged exposure to social media. Multiple studies have demonstrated a strong link with anxiety, depression, shortened attention span, self-absorption and the overwhelming urge of FOMO (the fear of missing out) - all of which pose significant challenges to keeping employees happy in their workplaces. I believe, however, that there are four additional ways in which social media affects the day-to-day behaviour of the younger generations, which in turn represents a unique and immediate challenge for business management.

1. Speed

(“It takes a second to judge and a lifetime to understand.” Kia P.) y its very nature, social media trains users to make rapid, almost instantaneous decisions. In an instant, the individual decides whether they “like” or “dislike” a post. Apps demand that a definitive decision be made instantly, without thought or consideration of extenuating factors or information. Concerningly, this is also often done without consequence or remorse. In the workplace, these quick, unequivocal decisions can be both detrimental to the business and a barrier to the individual growth and development of the employee. A split-second, kneejerk response to a situation or information may have negative outcomes. For example, a junior staff member in the health industry may well form an immediate negative opinion of a

14 Australasian Dental Practice

cranky client over the phone without taking the time to think about factors that might have led to that behaviour, such as anxiety, or fear of treatment based on a previous negative experience. Making a split-second decision to judge rather than understand fails to treat the patient with the humility and patience required to better understand their needs and expectations. It also disengages the team member from the pathway to developing more compassion and empathy in their social interactions at work.

2. Ignoring the big picture (Decisions made on a single detail) recently observed my 15-year-old daughter’s Instagram habits. She scrolled through posts at a blindingly rapid rate, pausing for a moment on approximately one in three images to “like” a post. The posts she liked had a number of elements that would have taken me, at my age, some time to properly take in and comprehend. I suggested she cease scrolling for a moment while I asked what inspired her to like one particular photo. She replied, without pause or doubt, that it was the influencer’s shoes in the picture. Our ensuing discussion revealed that her decision was made without consideration of the subject person, their demeanour, other products in the image, background or actions within the photo. This learned behaviour has caused whole reputations on social media to be built on small details, irrespective of the larger picture. It seems the growth of social media is seeing the degradation of analysis of the whole picture in favour of single-detail focus. In a work environment, such a process means that the greater tapestry of context is often being ignored in favour of a simple decision based on one factor. “Cancel culture”, whereby an individual can be boycotted without warning on the basis of one action or belief system, is a reflection of this rudimentary decision making. When focus is on the part rather than the whole, decisions may lack sound judgement. To this end, an individual may become disenchanted in a great role based on just one detail. Furthermore, rumours and mistruths can take a new lease on life with this tendency to judge the whole based on one detail. Without persistence to seek facts and the truth about the bigger picture comes a lazy acceptance of misinformation and misunderstanding. Repairing such thought processes can be time-intensive - or, in some circumstances, not even possible. Further still, such a mindset can even prevent a potential candidate from engaging with the business in the first place.

3. Polarisation

(“All the colours of life exist within the shades of grey between black and white.” - Kia P.)

ocial media can serve to proliferate dichotomous thinking. People, images, stories and narratives are polarised - either

September/October 2023

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spectrum | NEWS liked or disliked, swiped left or right, where the “all or nothing” mindset of the user works to their detriment. Also, social media profiles are optimised, providing a curated feed designed to appeal to a specific individual and thus reinforcing a limited narrative. Very quickly, an individual becomes an extension of their social media feed, attracting similarly minded individuals, thinking and ideals. This in turn limits the user’s capacity to be challenged about their ideas and perspective. Losing the capability to question and analyse leads to a simplistic view of the world in which only the polarised black and white exist, not the nuanced shades of grey in between. In the workplace, this type of thinking gives rise to two tendencies: a resistance to being challenged and a predilection for focussing only on what one likes or dislikes. An employee can lose sight of the bigger picture, exaggerating what they don’t like at the expense of the unseen positives in any given situation. It can be quite destructive when an employee who has developed a negative mindset attracts other likeminded people, shunning positive-minded colleagues who may challenge them with an alternative perspective that benefits the organisation. The resulting toxic workplace culture can spread amongst staff, more unencumbered and more virulent than ever before.

4. Apathy

(Avoidance of conflict and confrontation at all costs) nother trend amongst a large proportion of young social media users is a reluctance to engage and enquire, meaning that concerns and questions often go unheard. By way of example, while a TikTok video may attract, say, 20,000 likes, only 20 to 200 (0.1-1.0%) or so might engage by commenting - reflecting a reluctance to actively interact. It is also common for the same small group to engage over and over with a particular post, while the majority of users remain largely silent and passive. In most circles of social media, questions are frowned upon and labelled as trolling behaviour and are, therefore, avoided at all costs by the silent majority fearing the risk of backlash and condemnation. Due to this aversion to healthy active engagement, in what is often incorrectly dubbed conflict and confrontation, internalising negative thoughts has become the norm for so many. In a work environment, such behaviours can manifest as a reluctance to raise concerns or queries, at its worst leading to abrupt and unexpected departure from your organisation of socalled “sleeper” employees. Younger employees often keep their burning concerns to themselves, quitting before having an honest discussion with their managers and without an appreciation as to why things are done in a certain way in the work environment. Furthermore, when issues are addressed, many younger employees shut down and refuse engagement. In the health industry, business decisions are based on patient care, employee happiness, the science of health and basic business viability. At first blush, the reasoning behind decisions and processes may not be immediately clear to all employees. This combination breeds a challenging situation - by not raising questions in the aim of avoiding and fearing confrontation, younger employees can harbour misinformation without benefiting from an alternative viewpoint.

16 Australasian Dental Practice

What is the solution? s a business owner in the health industry, I believe it is crucial to perpetually adapt to emerging employee trends. Right now, management styles need to be flexible enough to understand and respond to the social context in which our younger employees have grown up. Firstly, both managers and team members must become aware of the above emerging trends in young people’s behaviour. Secondly, younger employees need to be provided with the tools to appreciate the pitfalls of those trends. Otherwise, our youth risk drifting from workplace to workplace, never experiencing high job satisfaction or the joy of being in a multi-generational team that genuinely thrives as a cohesive group. Furthermore, managers need to spend more energy on nurturing their staff, imparting the wisdom that it’s important to speak up early when problems arise; that positive dialogue and engagement in a workplace are not to be confused with conflict or confrontation; that job satisfaction requires focus on the whole rather than the part; that real issues versus idealised perceptions should be investigated; and that understanding, not judgement, builds a great workplace culture. It’s also up to managers to ensure that new challenges, role variations and clear progression pathways are made available and that pursuit of those is encouraged. Ongoing communication with, and careful monitoring of, team members is more important than ever. This could start with simple changes such as more frequent meetings, one-on-one or in smaller groups to procure greater engagement; provision of consistent evidence-based feedback; and a dedication to offering transparent information. Last but not least, clear and open messaging explaining business decisions should address the key purposes of the business.

Conclusion (“My single best investment has been my investment in people.” Kia P.)

ducation about the advantages of benefits, security and growth that can accompany long-term employment in a great workplace is critical to retaining staff. As someone who has invested so much of myself in staff retention, I have made it a personal mission to keep the “social-media generation” of employees more engaged and content in my dental practices. There has never been a more important time to listen, adapt and overhaul traditional methods of people management so that long-term employment relationships can be nurtured; and, in turn, our businesses and our people can grow and prosper.

About the author Dr Kia Pajouhesh, a University of Melbourne graduate, established Smile Solutions in 1993. Situated in the heart of Melbourne’s CBD and incorporating the Collins Street Specialist Centre, Smile Solutions is the largest singly located dental practice in Australia engaging over 80 clinicians, including 20 board registered specialists. Together with his Core Dental chain of practices, he controls over 100 chairs across Melbourne, with a combined patient base of 350,000.

September/October 2023

Restorative Solution Journey

info.australia@kulzer-dental.com

Kulzer.com/australia

spectrum | NEWS

Kerr launches matching gutta percha points for their ZenFlex™ NiTi rotary shaping files - High cutting efficiency and minimally invasive design In initial comparison tests, ZenFlex exhibits exceptional performance across a range of metrics including torsional strength and resistance to cyclic fatigue

eading innovator of endodontics technology, Kerr Dental, has announced the launch of the matching gutta percha points for their ZenFlex™ NiTi Rotary Shaping File. ZenFlex features high cutting efficiency, an ideal balance of strength and flexibility and a minimally invasive design. Initial comparative studies against other leading files on the market indicate that ZenFlex delivers exceptional resistance to torsional stress and cyclic fatigue, while offering the flexibility and controlled memory to accommodate even the most complex canal anatomies.

18 Australasian Dental Practice

“ZenFlex has been designed to balance strength with flexibility, as well as achieve high cutting efficiency, all while being minimally invasive,” said Monique Bambagiotti, Marketing Manager at Kerr Dental. “These are made possible due to the proprietary variable heat treatment technology used in ZenFlex. Now with the matching gutta percha points, our system is complete.” Through this heat treat process, ZenFlex provides the strength and flexibility to accommodate up to 90-degree curves. ZenFlex additionally has exceptional controlled memory to maintain its pre-curved shape to better follow even than most challenging canal anatomies.

September/October 2023

NEW! ZenFlex™ Gutta Percha Points

Designed to Work Seamlessly with ZenFlex NiTi Shaping Files

Gutta Percha Points Use your ZenFlex confidently and precisely. ZenFlex Gutta Percha Points match canals shaped by ZenFlex NiTi Files. Choose the corresponding size, taper and length to meet the needs of each root canal procedure. Points designed to match canals shaped by ZenFlex NiTi Shaping Files Zero natural rubber latex Flexible matches to a wide range of canal depths Reliable fill and seal with a seamless glide path

Scan with your camera to learn more

Australia: 1800 643 603 New Zealand: 0800 167 626 orders.anz@kerrdental.com

spectrum | NEWS “ZenFlex shaping instruments have variablepitch flute angles that prevent them from threading into canals, provide them with enormous chip space between flutes, and help prevent tip breakage. These sophisticated instruments deliver single-file shapes without transporting canals due to their variable-heat treatment. Customizing heat treatment for each file size produces smaller files with more shape memory to prevent unwinding and larger files with remarkable ductility. It also has a 1mm maximum flute diameter in order to better maintain the structural integrity of teeth after RCT, and Kerr’s AutoFit gutta percha points fit well to the ends of canal shapes cut by ZenFlex Files.” - Dr. Stephen Buchanan

In recent comparative tests, ZenFlex delivered greater resistance to cyclic fatigue than other files, resulting in a longer time to failure. Additional tests showed that ZenFlex is as resistant or more resistant to torsional stresses despite having a smaller maximum flute diameter and smaller mass. “In tests conducted by leading endodontist Dr Stephen L. Buchanan, against other recognized files on the market, ZenFlex did a better job reaching the full working length of severely curved canals,” explained Brian Ho, Kerr Dental Global Product Manager. ZenFlex offers endodontists a minimally invasive shaping file option, with a 1mm maximum flute diameter and its non-cutting tip. Combined, these features help increase control during the root canal procedure and preserve the tooth’s structural integrity. “With its high cutting efficiency, balance of strength and flexibility and minimally invasive design features, ZenFlex is the shaping file endodontists have been waiting for,” Mr Ho said. “We are excited to launch this next-generation product and look forward to hearing feedback from doctors and practices around the country.” ZenFlex NiTi Rotary Shaping Files and matching Gutta Percha are now available to order though your authorised Kerr dealer. Visit Go.Kerrdental.com/ZenFlex.

20 Australasian Dental Practice

Leading endodontist Dr Stephen Buchanan found that ZenFlex is able to shape severely curved canals and maintain more tooth structure after RCT, due to its 1mm maximum flute diameter.

Average Time to Failure in Seconds

Compared to other brands, ZenFlex delivers greater resistance to cyclic fatigue. This results in longer time to failure and shorter time to reach the working length while minimizing the risk of breakage and transportation.

Resistance to Breakage (gcm)

ZenFlex is designed to be as resistant or more resistant to torsional stresses relative to major rotary file competitors despite having a 20% smaller maximum flute diameter and smaller mass.

ZenFlex™ NiTi Rotary Shaping File System Maximum Strength. Minimally Invasive. Featuring an ideal balance of strength and flexibility, ZenFlex lets you reach the full working length with reduced risk of breakage while preserving more tooth integrity. High Cutting Efficiency Designed with triangular cross section with proprietary heat treatment, ZenFlex exhibits high cutting efficiency that lets you reach the full working length of even complex root geometries. Minimally Invasive A maximum flute diameter of 1mm and a non-cutting tip work together to minimize transportation and preserve the tooth’s structural integrity. Exceptional Strength Resists torsional stress and cyclic fatigue resulting in minimal breakage and reduced transportation. Excellent Flexibility Proprietary heat-treatment design delivers excellent controlled memory and flexibility for up to 90˚ curves. Corresponding ZenFlex Gutta Percha Points Choose the corresponding size and taper to meet the needs of each root canal procedure.

September/October 2023

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spectrum | NEWS

Mocom launches new solutions to streamline handpiece maintenance By Joseph Allbeury

OCOM Australia is well-known as a leader in the supply of specialised infection control equipment for dental practices and now the company is introducing another unique solution. We spoke with MOCOM Australia’s Jim Owen to hear all the details. Hi Jim, I hear that MOCOM Aus-

JA tralia is backing up its leading

position in the steriliser and washer disinfector market with a new solution for handpiece maintenance. Tell us more. Australia is launching JO MOCOM two solutions for automated

handpiece maintenance under the brand name THALYA.

22 Australasian Dental Practice

There’s an entry level unit, which lubricates four handpieces in just under a minute and then there’s the THALYA+, which can clean, disinfect, lubricate, purge excess oil and then dry four handpieces in 12 minutes. Both units have couplings available for all the major handpiece brands including KaVo, Dentsply Sirona, W&H, Bien-Air and NSK and there is also a Midwest connection. And both work with any brand of lubricating oil, so if you use a certain brand of handpiece, you can continue to use the matching oil if you wish, except for KaVo QUATTROcare Plus oil, as the can size and shape is not compatible. MOCOM Australia also has its own brand of oil available as a further option.

when you buy a THALYA or JA So THALYA+, you specify which

handpiece connectors you want?

Exactly. So whatever brand of

JO high speed handpieces you’re

using, we configure the unit according to your needs. Slow speed handpieces are generic, so there is also a slow speed coupling available. The launch package for THALYA and THALYA+ includes four couplings of your choice. The THALYA+ package also includes the cleaning chemical. You just need to add the oil of your choice. what does the base model JA So THALYA do?

September/October 2023

spectrum | NEWS

“We can really see a need for THALYA+ because handpieces are either not being cleaned internally or not being cleaned after every use... THALYA+ performs this function in 12 minutes...”

It’s pretty straightforward and

JO easy-to-use. It purges the hand-

piece, lubricates it and then purges excess oil. It will complete 4 handpieces in 55 seconds. Handpieces last longer if lubricated continually and correctly and THALYA makes this a simple process. And what does the THALYA+

JA do differently?

The THALYA+ is unique to the

JO Australian market in terms of its

capability. It flushes a chemical through the handpiece internally and also externally to clean and disinfect it. It then lubricates, purges excess oil and dries the handpiece. There is no other product that does what this unit does.

And then you would still sterilise the handpiece? Yes. So it doesn’t replace sterili-

JO sation, but it does mechanically

clean the handpiece. And I think that’s a major point to highlight because I don’t know that many practices are actually cleaning handpieces internally. When a handpiece slows down after use, it creates

September/October 2023

a back-siphoning effect, where it can draw bioburden and liquids back inside the handpiece. And that needs to be cleaned out. It’s just like anything else that’s sterilised - if it’s not cleaned first, if that bioburden’s not removed, then it can’t be sterilised effectively. So the THALYA+ ensures handpieces are both cleaned and lubricated ready for sterilisation as part of a repeatable, mechanised process. do practices clean handJA How pieces internally now? a good question. In my JO That’s experience, it’s most often not

being done. If you have a washer disinfector unit, you can use a coupling to allow handpieces to be washed internally and then you still need to lubricate. You can also manually spray a chemical through the handpiece. But again, if you’re doing it manually, how can you gauge its effectiveness? You can’t see what’s inside a handpiece, so automating the process using a proven method is ensuring consistent and effective cleaning every time. how often should you interJA And nally clean a handpiece?

You should be doing it after every

JO use of the handpiece, just like you

sterilise it after every procedure. Clean, lubricate and sterilise. We can really see a need for THALYA+ because handpieces are either not being cleaned internally or not being cleaned after every use and when they are, it’s a time-consuming, labour-intensive and technique-sensitive task that slows down the reprocessing cycle. So the THALYA+ performs this function in 12 minutes in a set-and-forget process. It allows this important step to be easily incorporated into the reprocessing cycle every time. do manufacturers recomJA And mend this? manufacturers recommend JO All that their handpieces are cleaned

and lubricated and both of these functions prolong handpiece life.

the THALYA+ just be used JA Can to lubricate the handpieces

without cleaning?

There are four different JO Yes. cycles you can choose from with

Australasian Dental Practice 23

spectrum | NEWS “You can tilt the couplings 45 degrees forward for easier access attaching the handpieces onto the couplings...”

can do that. When you’re processing the scaler handpieces, it’s just cleaning and disinfecting - you don’t need to lubricate. And which scalers does the

JA THALYA+ accommodate?

It will clean EMS, Satelec, Stern

JO Weber and Anthos scalers.

this is quite a game changer JA So for speeding up instrument

reprocessing?

as the THALYA+ JO Especially allows you to easily and auto-

matically clean inside a handpiece. I’ve spoken to various handpiece technicians, who obviously open handpieces when they’re repairing them and the feedback is that most are in an horrendous condition. So the fact that we’re able to address this problem in an automated manner in order to make sure that you achieve sterilisation is vitally important. So yes, I believe it is a real game changer. The THALYA+ takes all the hard work out of handpiece maintenance with the same proven, effective process performed every time. The correct amount of oil is delivered - the same measured dose of cleaning chemical is used. You’re not over- or under oiling and you’re not leaving dirt or bioburden inside.

JA Thank you for your time. the Thalya+. Cycle 1 does everything clean, disinfect, lubrication, air purge. Cycle 2 is just clean and purge if you want to clean without the lubrication. Cycle 3 is lubrication and air purge. And Cycle 4 is an additional air purge. So if you need to remove excess oil from a handpiece, you can use Cycle 4. there any other points to JA Are highlight? There are a couple of other unique

JO points. The first is that when you

place the handpieces into the chamber, you can tilt the couplings 45 degrees forward for easier access attaching the handpieces onto the couplings. Another feature is that the THALYA+ can also process scaler handpieces. There’s nothing else on the market that

24 Australasian Dental Practice

September/October 2023

Total Handpiece Maintenance.

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Advanced Training for Dental Assistants Digital Photography - Digital Smile Mock Up Digital Impression - Digital Crown Design SYDNEY • FRI 3 - SAT 4 NOVEMBER, 2023 Presented by Massimiliano Zuppardi, MDT SUPERCHARGE YOUR SUPPORT TEAM AT THIS HANDS-ON WORKSHOP This hands on course offers several technical exercises, allowing dental assistants to improve their current skill set in assisting the high end cosmetic dentist with Digital Workflows. This course will include Digital Smile Mock Ups, Digital Photography as well as Staining and Glazing. This unique hands on course will help the dentist save valuable time by leveraging their trained dental assistants to conduct multiple specialised procedures in the dental practice. This includes training on how to take shades, digital inrtaoral scanning on single quadrant, full upper and lower jaws, ceramic restorations using CAD/CAM, lab communication using keynote software as well as Digital Smile Mock Ups and more. This course will enhance the organisational skills of dental assistants. After completing this course, dental assistants will not only be proficient in a number of technical dental skills but also will be more organised in the clinical setting, be more efficient as well as be able to fully support the dentist during and after the dental procedure.

HANDS-ON COMPONENT

The aim of this workshop is to train dental assistants to be highly proficient in dental techniques that would otherwise be done by the dentist. By doing this course, dental assistants will be able to further assist dentists to simplify technical protocols in the daily workflow, optimising clinical time and enhancing outcomes. The workshop covers: Camera set up lens, flashes and accessories Shade guide selection and shade taking n Ideal portrait photo protocols n Ideal intraoral photo protocols n Digital impressions using an intraoral scanner n Digital Smile Mock-Ups for patient motivation n Guide for ideal crown design using digital workflows n CAD/CAM block selection based on restoration needs n Furnace program and stain choice selected through the helps of photos n Mastering the stain and glaze technique n Polishing techniques - Rubbers, Diamond Paste and the final touch n n

Re g i s t e r No w a t w w w. z up p a rd i . e ve n t s

Massimiliano Zuppardi

This advanced course is ideal for dental assistants working in practices offering full cosmetic dentistry and smile makeovers. You will be working on Video/Photography, Digital Smile Mock Ups, Digital Intraoral Scanning, Digital crown design and staining and glazing. The course is being presented by a Master Dental Technician in order to demonstrate the technical procedures from a practical skill level that only a Master Technician is able to do. This is a course for Dental Assistants wanting to go to the next level in their mind set working in cosmetic and digital dentistry. Ideally, participants should bring their own instruments, camera* and laptop*.

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Re g i s t e r No w a t w w w. z up p a rd i . e ve n t s

spectrum | NEWS

Connect to “what’s next” with A-dec Pro! By David Petrikas

-dec has launched its breakthrough new “A-dec Pro” delivery system amid excitement from A-dec equipment dealers and the dental buying public. The new A-dec 500 Pro and A-dec 300 Pro delivery systems were publicly released in Australia to coincide with the FDI World Dental Congress (FDIWDC23) at the International Convention Centre in Sydney, from 24-27 September 2023. It was the first time the A-dec Pro system had been seen outside the US home market. The new generation A-dec Pro delivery systems - built to fit on the proven latest generation A-dec 500 and A-dec 300 patient chairs - are now being rolled out through A-dec dealers across the country. A-dec Pro heralds the new area of “Connectivity” in delivery systems, bringing touchscreen technology and intelligent control on an all-new software-based platform. This brings the latest technology right into the dental surgery, supporting both the operator and the entire dental team in caring for patients, now and in the future. The “tablet” style A-dec Pro touchscreen is immediately intuitive to use, providing easy to navigate controls with visual

28 Australasian Dental Practice

diagrams and icons allowing users to interact with their equipment in a way they’re used to with connected devices - just like using a “smartphone”. Everything is at the user’s fingertips from controlling all chair, handpiece and ancillary equipment functions to looking up maintenance schedules chairside. A-dec Pro is seen as the launching pad of future options and upgrades and already incorporates useful day-to-day features like the time of day, a timer function (for administering local anaesthetic), alarms and even buzzers to help manage procedures and communicate with the wider dental team. The A-dec 500 Pro’s new, larger 7” moveable screen (with both side-to-side and tilt adjustment) has a wide viewing angle of almost 180 degrees, enabling it to be positioned at the perfect angle for both the dentist and assistants to see and access. A new larger, assistant’s touchpad also provides improved, intuitive control of chair and light functions. The “home screen” shows a graphic of the chair position as a visual reference, making it straightforward to position the chair to its intended position at the touch of the screen icon – recline, rinse, or entry/exit (also with built-in auto “light on” and “off” functionality). Continued 88

September/October 2023

A-dec 500 Pro: Experience a new level of connection. Everything you’ve come to appreciate about the A-dec 500 dental chair, is now available with a new delivery. Enabled with A-dec+ and an updatable software platform, the A-dec 500 Pro delivery system supports your dental team with a new level of connection.

australia.a- dec.com

Swipe the screen and a new page of menu options is displayed to further explore chair configurations and individual settings for control and customisation as required. Pick up a handpiece or scaler and the settings and adjustments are automatically displayed - and can be programmed to display either motor speed - or bur speed, for precise control. This feature is especially useful when using speed-increasing or speedreducing handpieces. When using an Acteon Satelec scaler, the colour coded tip intensity is automatically displayed on the screen, giving added visual support to the operator. The new delivery system can also be configured to accommodate other popular scaler models. Another highly useful feature is the “vaporiser” function which provides a blast of air to remove droplets from the turbine handpiece as it stops. This prevents contaminants entering the head of the turbine and also avoids droplets falling on the patient when the handpiece is removed from the mouth. The entire system can be linked to the new “A-dec+” app which enables all equipment to communicate via ethernet for stable, fast and reliable connectivity. It can also connect to the app wirelessly. The system allows the user to see system analytics like software version number and equipment diagnostics, enabling the operator to customise and control the chair and attached equipment directly via the chair touchpad. It will also allow remote diagnostics of equipment in the future to aid chair servicing and maintenance. Once configured, the A-dec Pro system “knows” what equipment is attached to the delivery system and instantly recognises a handpiece or scaler as soon as it is picked up, allowing seamless control without the need for the user to manually enter the settings. Memory functions for up to three operators can set chair heights and instrument settings tailored to each user’s preferences for all prophylactic and restorative work, including control of electric motors and endodontic handpieces to be done via the touchpad.

30 Australasian Dental Practice

Despite the advanced electronics, the time proven reliability of the A-dec delivery system has been maintained and actually improved. The capacitive touch screens have been designed for a 20+ year life and have no moving parts, unlike membrane or button style controllers. The touch-activated inbuilt capacitive switch unlocks the delivery arm when you grip the handle and automatically locks the delivery head securely in position without drifting when released.

The more compact A-dec 300 delivery system features a new 5” colour screen touchpad and a completely redesigned continental delivery arm option for superior flexibility, ergonomics and focus, allowing handpieces to be retrieved and replaced on the delivery head without taking your eyes off the patient. The new generation A-dec Pro delivery systems - built to fit on the proven latest generation A-dec 500 and A-dec 300 patient chairs - are now being rolled out through A-dec dealers across the country. Contact your local A-dec dealer to explore this exciting new leap into the future with A-dec Pro 500 an A-dec Pro 300 delivery systems. For more information, call A-dec on 1800-225-010.

September/October 2023

briefs | NEWS Can a notification be defamation #2?

ractitioners need to be aware that in making notifications about other practitioners whether mandatory or otherwise, they need to seriously consider the basis for the notification. If a notification is not made in good faith, then there can understandably be serious consequences for the notifier for their own registration. In the recent case of Health Ombudsman v Ling [2023] QCAT 92, the Tribunal found that Dr Ling provided a false and misleading notification in the absence of good faith about a second practitioner, a Dr X who had level 1 supervision imposed in 2014 - which

made him practically unemployable - and then had Level 2 conditions imposed after filing an appeal to the tribunal after 2015. The Tribunal found that it appeared Dr Ling had also coordinated another notification by another person. Tellingly at [4] the Tribunal noted... “...but on the morning of the third day, after the respondent had been crossexamined for most of the second day, I was told that the parties would be providing joint submissions, in which the respondent would concede that the statements relied on by the applicant as false had been made recklessly and not in good faith. In view of this, the respondent was not cross-examined further and the hearing was adjourned.”

BRAD WRIGHT Dr Ling was also the subject of an investigation as to his records and practice. At [11] “Under cross-examination the respondent admitted that he had spoken to this (hospital) official before he made his notification and it appears that the notifications were coordinated... On 29 May 2017 the Queensland Notifications Committee of the Medical Board of Australia decided to take no further action on any of the three notifications. In substance, Dr X was exonerated.” The Tribunal notes the lack of protection as to privilege. Perhaps the Dr X referred to will have a civil claim against Dr Ling. The sanction is yet to be determined. More at www.bwbarrister.com.au

New concierge service for clear aligner treatments

mileStories is bringing a concierge service for Clear Aligner Treatments to Australia, in partnership with ClearCorrect, a Straumann Group Brand. For the first time in A/NZ, select clinicians will be able to avail of SmileStories, the premier concierge service which matches patients to the best clinicians for clear aligner treatment. SmileStories offers patients a personalised experience to find the right clinician for their clear aligner treatment, removing the element of guesswork for the patient and providing a steady income stream to clinicians. This concept, pioneered in Europe, has been launched in ANZ with Clear Correct - a Straumann Group brand – aligners. “We’re excited to launch SmileStories and partner with ClearCorrect to offer

32 Australasian Dental Practice

patients a new level of convenience and quality for clear aligner treatments,” said SmileStories Country Manager, Christian Claussen “We know that finding the right clinician can be a daunting process and we’re here to make it easy by providing personalised guidance and support every step of the way.” ClearCorrect is a leader in the clear aligner industry, offering state-of-the-art technology and exceptional service. Their partnership with SmileStories further strengthens their commitment to providing the highest level of patient care. Markus Kaufman, Country Manager Straumann ANZ, said: “Clear Correct offers a complete solution including clinical excellence, education and practice growth opportunities. With SmileStories, we cement our commitment to offering patients a more personalised experience when seeking a clear aligner clinician.

“We are confident that this will lead to better outcomes and more confident smiles for patients.” For the patient, Smile Stories offer streamlined process to find the right clinician for their clear aligner treatment. The partnership with ClearCorrect ensures access to the latest technology and a network of highly qualified clinicians. By utilising an online service like SmileStories in conjunction with a qualified dental clinic, patients can have peace of mind knowing that they are receiving the best possible care and achieving the beautiful, healthy smile they deserve. SmileStories is a concierge service that matches patients with the best clinicians for clear aligner treatments. Founded in 2022, SmileStories is headquartered in Melbourne, Australia and serves patients across the country.

September/October 2023

“

Communication and service has always been exceptional, and I have no hesitation in recommending Credabl across the board. Dr Andrea King, Dentist

Getting more from my finance partner, means my patients get more from me. Professional and personal finance solutions, tailored for you and turned around fast. When you partner with Credabl, you can expect all that and more. With a team of experienced finance specialists, we understand the medical sector so you can look forward to finance solutions that help you get on with business and looking after your patients.

You always get more with Credabl. 1300 27 33 22 credabl.com.au

Practice Purchase • Commercial Property • Goodwill Loans • Overdraft Facilities • Home Loans • Car Loans • Equipment & Fitout Finance • SMSF Lending The issuer and credit provider of these products and services is Credabl Pty Ltd (ACN 615 968 100) Australian Credit Licence No. (ACL) 499547.

spectrum | NEWS

3D Printing in Dentistry 2024 focuses on Automation, Validation, Replication

he 2nd annual 3D Printing in Dentistry conference is again being staged at the ParkRoyal Darling Harbour, Sydney on Friday and Saturday, February 9 and 10, 2024. The theme of the event is Automation, Validation, Replication. “From the feedback we received, the inaugural 3D Printing in Dentistry event this year was a highly productive, interactive learning experience for delegates,” said Dentevents’ Joseph Allbeury, the organiser of the event and publisher of this magazine. “The lectures included a mix of clinicians and technicians detailing the use of 3D printing in their daily routines, presentations from material scientists and manufacturers as well as technical information on setting up, using and maintaining 3D printers. “When we craft multi-speaker events like this, we’re really trying to present the right information for delegates at the right time, presented by the best real world educators available. It gives delegates high level access to information in a concentrated form that will allow them to make better decisions, solve problems and grow their use and understanding of these burgeoning, gamechanging technologies.”

34 Australasian Dental Practice

Mr Allbeury said that the event included a high level of interaction between the audience and presenters, enhancing the learning experience and highlighting the commonality of issues faced in implementing 3D printing technologies into clinics and labs. “Many delegates came with questions and the format of the event allowed these to be answered, either directly through the presentations or via lively exchanges and Q&A’s with the presenters.” Mr Allbeury said that the event highlighted the level of complexity involved in the 3D printing process and the need for quality education focussed on establishing replicable processes, procedures and workflows to ensure optimal results. “For the 2024 event, we will again cover a broad range of topics covering hardware, software, materials and solutions, plus we’re adding sessions that focus on a couple of aspects of 3D printing that are driving future directions,” Mr Allbeury said. “One of these areas is automation, whereby many printer manufacturers are now looking at what happens beyond the build, working towards more autonomous operation. This is similar to the evolution we saw in milling machines with the addition of automated tool and material changing that allows mills to work

unattended, in some cases 24/7. 3D printers are evolving the same way, though through very different means. “Another area is the validated workflow. Particularly in 3D printing, where the finished product is the result of an essentially complex chemical process, the creation and validation of workflows that ensure 3D printed objects are accurately replicated time and again through printing, washing and curing to guarantee patient safety will only grow in importance to the point where government may well be involved in oversight.” Mr Allbeury said that they are currently engaging with key players in the 3D printing landscape in Australia and New Zealand to devise a programme that is representative of the current needs of local clinicians and dental technicians. “3D printing is clearly a game changer in dentistry and we are once again aiming to deliver a programme that will empower delegates to either take up the technology or take their current investment to an entirely new level. I hope that everyone interested in 3D printing in dentistry will join us in February for another fun, interactive and informative two days.” For more information or to register visit www.3dpd.events

September/October 2023

AUTOMATION • VALIDATION • REPLICATION

WHITTY

KLIJNSMA

ELSEY

TGA

VISIT THE WEBSITE FOR UPDATES ON MORE SPEAKERS

Join Australia’s leading experts on dental 3D printing at this two day event exploring the applications of 3D printing in both the clinic and the laboratory. Visit the website for information and additional speakers. BOTH DAYS ARE DESIGNED FOR DENTISTS, SPECIALISTS, DENTAL PROSTHETISTS & TECHNICIANS PLUS A SPECIAL PRESENTATION BY THE THERAPEUTIC GOODS ADMINISTRATION

DAY ONE - FEB 9 - CLINICAL n Importance of validated workflows n In-house clear aligner production

n Full and partial digital denture workflows n Printed crowns - an update

n Applications of 3D printing in cosmetic dentistry n Printing Class IIa appliances in-house

n The advantages of outsourcing design n And more...

DAY TWO - FEB 10 - TECHNICAL n Latest advances in 3D printer materials n Autonomous printing solutions

n Automated post-processing solutions

n Artifical intelligence and design automation n Digital denture production n Debugging print failures

n Workflows for optimising 3D printed results n And more...

REGISTRATION FEES

DATE AND TIME

One Day

$660 inc gst

SYDNEY 9-10 February 2024

Two Days

$990 inc gst

Starts 8.30am | Ends 5.00pm | Rego opens 8.00am

sAVE $330 BEforE 9 octoBEr 2023

ParkRoyal Sydney Darling

3D Printing in Dentistry 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 • 3D Printing in Dentistry™ and Dentevents™ are trademarks of Main Street Publishing P/L © 2023 Main Street Publishing Pty Ltd

spectrum | NEWS

New Panasonic Oral Irrigators harness ultrasonic technology for optimal outcomes

aintaining excellent oral hygiene is crucial for overall health and as dental professionals, it’s our responsibility to provide our patients with the best tools for achieving optimal oral care. One such tool that has been garnering attention in the industry is the new Panasonic range of Oral Irrigators. With cutting-edge ultrasonic technology and a track record of delivering remarkable results, they are helping change the game in the realm of oral hygiene. In this article, we will explore why offering Panasonic Oral Irrigators to your patients can revolutionise their oral care routines.

36 Australasian Dental Practice

The power of ultrasonic technology n the pursuit of comprehensive oral care, traditional methods such as brushing and flossing have long been staples. However, with the introduction of ultrasonic technology, Panasonic Oral Irrigators have taken dental hygiene to the next level. Ultrasonic technology utilises high-frequency sound waves to create tiny bubbles in the mouthwash or water used in the device. These bubbles effectively clean and remove plaque, bacteria and food particles from hard-to-reach areas, such as gum pockets and between teeth. The ultrasonic technology employed by Panasonic Oral Irrigators ensures a deeper and more thorough cleaning, enhancing the overall oral health of patients. 88

September/October 2023

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spectrum | NEWS Enhanced patient experience major advantage of Panasonic Oral Irrigators lies in their ability to provide a gentle and comfortable oral care experience. Traditional flossing can often be uncomfortable, leading to patients neglecting essential interdental cleaning. With Panasonic Oral Irrigators, however, patients can experience a non-invasive and soothing way to remove debris and maintain oral health. The adjustable water pressure settings allow for a customised experience, catering to each patient’s unique needs.

Convenience and efficiency n our fast-paced world, convenience plays a significant role in our daily routines. Panasonic Oral Irrigators recognise this and offer a solution that seamlessly integrates into patients’ busy lives. With their compact design and easy-to-use functionality, these devices allow for fast, hassle-free oral care both at home and on the go. The efficient cleaning process saves time while providing remarkable results.

“I’m seeing the Panasonic water flossers produce really excellent clinical results. I’m strongly recommending this oral hygiene aid to my patients to aid in maintaining ideal hygiene around implantsupported restorations, particularly for large or fullarch restorations where palatal access is challenging.” Dr Nicholas Hocking, BDS

Excellent clinical results r Nicholas Hocking (BDS (Adel), MSc (Lond), M.Clin.Dent (Pros) (Lond), FICD, FPFA), a dental surgeon and clinical lecturer with vast experience in the field of dental implants, has seen positive results from his patient’s use of Panasonic Oral Irrigators as a means to enhance their oral hygiene. He stated, “I’m seeing the Panasonic water flossers produce really excellent clinical results. I’m strongly recommending this oral hygiene aid to my patients to aid in maintaining ideal hygiene around implant-supported restorations, particularly for large or fullarch restorations where palatal access is challenging.”

Supporting your practice o support dental practices, Panasonic have recently appointed MKS Health Technologies, a local Australian business specialising in solutions for the health and well-being sectors to supply their Oral Care range in the Australian market. Matthew Shepherd, Managing

38 Australasian Dental Practice

Director of MKS Health Technologies said, “We’re delighted to be adding the Panasonic Oral Care range to our product offering. With their advanced ultrasonic technology, easy-to-use designs and exceptional cleaning power, these devices offer a comprehensive solution for healthy teeth and gums.” Dental practitioners looking to provide their patients with the Panasonic range should contact MKS Health Technologies for professional pricing and special introductory offers for their dental practice.

Summary ncorporating Panasonic Oral Irrigators into your dental practice not only demonstrates your commitment to offering the latest advancements in oral care but also provides your patients with an alternative, effective and enjoyable means of achieving optimal oral hygiene. With the remarkable benefits of ultrasonic technology and support from MKS Health Technologies, Panasonic Oral Irrigators are poised to revolutionise the oral care routines of your patients.

For more information, call 1300-202-264, visit www.mkshealthtech.com.au or email info@mkshealhtech.com.au

September/October 2023

spectrum | NEWS

Digital imaging essentials for your practice By David Petrikas

igital imaging technology has gone from a “nice to have” to a “must have” in contemporary dental practice. Since the changeover from wet film to digital imaging, there has been significant growth in both the quality and the range of tools to carry out oral examinations. Yet despite this, some dentists still overly rely on a visual oral examination with a dental mirror. This method may miss identifying trouble spots and can result in inaccurate diagnosis and missed early intervention opportunities.

Intraoral cameras far more reliable and consistent approach to the early and accurate diagnosis of problems is the use of a quality intraoral camera, such as the slimline Sopro 617 and Sopro 717 intraoral cameras - or the more advanced SoproLIFE and SoproCARE intraoral cameras with built-in caries detector function. Thanks to their high magnification, these cameras can easily detect problem areas not visible to the naked eye for further examination and additional diagnosis as required. They are also invaluable “practice builders” by involving the patient directly in the problem identification and treatment planning. Images acquired with the simple swipe of a button can be captured for display on a video monitor and also saved to the patient file as a medico-legal record and to allow monitoring of the tooth over time.

ACTEON SoproLIFE intraoral cameras use fluorescence to visually help identify caries, demineralisation, plaque and gum disease.

Digital X-rays igital X-ray is the next step in the diagnosis of advanced caries, deeper endodontic and periodontic problems such as root canal issues, calcified roots, abscesses, periodontal pockets and bone regression. Image acquisition devices used in conjunction with X-ray generators include digital sensors such as the Acteon Sopix2 and new U-SENSE sensors or a phosphor image plate scanner such as the compact PSPIX2 “desktop” scanner.

Caries detectors n the case of the SoproLIFE and SoproCARE intraoral devices, caries and gingival inflammation can be detected early thanks to the use of fluorescent light. In “diagnostic” mode, the reflected image is displayed on a video monitor and clearly identifies demineralised dentine and the early stages of caries. During “treatment mode” a tooth can be examined again under fluorescence on high magnification during excavation to determine the extent of caries and differentiate between “affected” and “infected” dentine. This can assist the practitioner in performing minimally invasive dentistry with minimal excavation and reduced use of restorative materials to help preserve the integrity of the existing tooth structure and allow the surrounding tissue to heal. The SoproCARE, favoured by oral health therapists and hygienists, also flags the early onset of gingivitis and biofilm accumulation without the need for messy disclosing solutions. It is clean, quick and effective.

40 Australasian Dental Practice

Digital sensors he newly-released Acteon U-SENSE sensors - and Sopix2 digital sensors are invaluable in delicate root canal and implant procedures, giving the dentist or specialist a virtually “real time” view of vital structures and for positioning of instruments or appliances such as endodontic drills, implants or posts.

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spectrum | NEWS

ACTEON PSPIX2 phosphor plate scanner. Acteon’s imaging plates are thin and flexible and available in five sizes to suit any patient morphology, including children and infants and adults with smaller oral cavities. These are a useful alternative to those patients who struggle with a larger digital sensor. The fine detail captured by the PSPIX2 image plate, together with optimum image contrast, highlights with precision the different anatomic structures of the tooth, enabling you to clearly identify details such as hidden or interproximal caries, pulpotomy, gum structure, calcified root canals or apical lesions.

Digital workflow

These sensors can be incorporated with the “Red Dot” award winning X-mind Unity X-ray generator - with its easy-to-position head, ergonomic handle and its small focal spot, which provides enhanced image quality and reduced radiation. Using its CMOS technology, once the Sopix2 or U-SENSE sensor receives adequate exposure, it automatically switches off the Acteon X-Mind X-ray unit, adjusting X-ray dosage to patient morphology. In practice, this means lower dosage for juvenile or elderly patients with lower bone mass - and the added benefit of no more over-exposed images!

he built-in digital imaging workflow couldn’t be simpler. Simply drop the image plate into the scanner and it begins processing it immediately, displaying a thumbnail image on the in-built display when completed. The images are also available for viewing in fine detail on any networked display, so you can view the information on a surgery monitor or share it with your patients. Bringing it all together is Acteon Imaging Suite - a simple, yet powerful imaging software solution that uses an open platform “TWAIN” system that enables images to be stored on the Sopro open-source database or exported to patient management software as a medico-legal record. Acteon Imaging Suite also links with other Acteon devices such as Acteon’s X-Mind Trium and X-Mind Prime OPG and CBCT units and also external resources such as implant databases. This provides all the benefits of a fully integrated digital workflow, including Sopro Imaging’s powerful imaging tools to perform detailed surgical planning and enabling images to be saved for record keeping and monitoring patient progress.

Phosphor plates

More information

T ACTEON X-Mind X-ray generator.

n general practice, the most efficient, affordable and practical image acquisition device is a phosphor plate image scanner. The Acteon PSPIX2 is the fastest and most compact phosphor plate scanner, processing an image in just seconds. The scanner is small enough to fit on any benchtop within the surgery - or can be shared and networked to up to ten PCs.

42 Australasian Dental Practice

cteon Sopro intraoral cameras, X-Mind X-ray generators, PSPIX2 phosphor plate units and U-SENSE and Sopix2 sensors are available in Australia from A-dec and backed by a comprehensive manufacturer’s warranty and local support.

Call A-dec on 1800-225-010 or visit Acteongroup.com for details.

September/October 2023

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spectrum | NEWS

Catching up with Dr Isabella Rocchietta ahead of her Australian workshop tour By Joseph Allbeury

talian Periodontist, Dr Isabella Rocchietta, was one of the presenters at Osteology Barcelona in April and is also the latest addition to the board of Osteology. We caught up with Dr Rocchietta there to congratulate her on this achievement and for a preview of what to expect when she delivers two workshops in Australia this October. you very much for your time and congratulations JA Thank on becoming the latest member of the Osteology Board.

IR Thank you. JA What do you hope to achieve as a board member? Well, first of all, I’m extremely honoured and grateful.

IR I’ve always looked up at the Osteology Foundation as

being one of the most challenging and in a way, enthusiastic groups of individuals who promote education and knowledge in our field. Being part of this means contributing to increasing the education around which I care very much about.

JA So when I see you in a few years’ time... We will hopefully have found even more ways to edu-

IR cate professionals with the sole outcome of improving

patient care.

do you think it’s really important for more women JA And to take up these leadership roles in education like this?

IR Absolutely. JA

And is it exciting? Is it fulfilling? Is it a new level to your career? It’s very fulfilling for me personally. I think it goes down

IR to having the passion to educate and disseminate knowl-

edge. And you know this from the very beginning, from when perhaps you’re doing this with your small local study groups or at University. I’ve always known. So I assume this is something that you have from the very beginning and then whether you grow it or not, it’s down to your personal ambition and the lifestyle you want to lead.

46 Australasian Dental Practice

have you found any problems or barriers as a JA And woman to doing this? I don’t think I ever received any discrimination because

IR I was a woman in the last decade. What I found dif-

ficult was at the very beginning of my career, when I didn’t have any literature that backed me up nor any experience, the attitude of peers and superiors was different between myself and a male fellow colleague. Because I had to work harder to gain respect and reputation within the community in order to establish myself. That’s good to hear that times are changing. And I also

JA hear you have some interesting research you’ve been

presenting here at Osteology Barcelona?

September/October 2023

spectrum | NEWS Yes. We’ve just published a very meticulous and in-depth

IR review that I’ve been showing here. It’s a randomised

control trial where we’re looking at every detail of vertical augmentation procedures, especially focusing on the human factor - the capability of the surgeon - in relation to the percentage of complications and success rates.

JA And what have you found? We’ve found that it’s obviously correlated. The more experience you have, the less complications you acquire. And this does not mean that you don’t have complications, it means that you have a significantly lower number. And it confirms the fact that these surgeries are down to a series of factors which include the personal ability to perform. So training, training, training and more training mitigates complications to a great extent. Repetition, repetition, repetition... and applying a strict protocol to what you do is a key factor in lowering complications.

JA And are you using Geistlich products and a lot? IR Yes, I do. I mainly use the bone substitutes. JA Which Geistlich products do you use? I use the Geistlich Bio-Gide® membranes and Geistlich

IR Bio-Oss bone substitutes. Connective tissue grafts are ®

still the gold standard for soft tissue because for the time being, the connective tissue graft still outperforms the substitutes.

JA And you’re coming to Australia in October? IR Yes, I’m looking forward to it. So, what can people expect to hear? What will you be

JA talking about?

Was there a sweet spot in terms of where the number

JA of complications reduced dramatically once a surgeon

has performed a procedure a certain number of times?

We have looked statistically at these numbers; how-

IR ever, I still think we should not rely on numbers alone

because it’s too dangerous. I can give you the average number that we have found, which is 200 procedures, but what does that mean? Which kind of procedures? When and how long have you been performing these procedures? So, there are too many factors involved. So simply concluding that if you’ve done 200 procedures, you can call yourself an expert in vertical augmentation is a little risky. However, from a literature standpoint, it’s a good starting point to start assessing all of what we do from a clinician’s point of view. Because there is a high risk that the randomised control trials are scientifically at the highest level of evidence when it comes to reliability, but it takes away the human factor, which, from a clinical perspective, is at the highest level. So funnily enough, you’re dealing with one compared to the opposite of the other. So, for the first time, we have basically tried to merge the two. interesting. And clinically, what are you doing JA Very that’s exciting?

I’ll be lecturing on how to treat moderate to severe bone

IR atrophic cases. It will be an A to Z of what you need

to know with tips and tricks on how to manage complications and how to avoid them. I’ll cover everything including hands-on procedures for performing a horizontal augmentation as well as getting into the nitty-gritty of all the details. sounds like that will be very popular amongst JA ItAustralian clinicians. Thank you for your time and I

look forward to your lecture in October.

IR Thank you and see you in Australia.

Treating patients every day! I must say that the most

IR exciting aspect for me is to try to be as conservative as

possible whilst we’re doing these big surgeries. So, trying to really minimise the flap designs to reduce trauma to the soft tissues. And we have seen tremendous improvements when it comes to doing this. The other really great step forward is all the diagnostics before treatment commences. There is so much planning and digital diagnostics that you can do pre-operatively. So, you arrive in the operating theatre with an overall reduction in surgical time, a less invasive treatment and this decreases the patients’ post operative morbidity which is always very much appreciated.

September/October 2023

ard and soft tissue reconstruction of alveolar defects using Guided Bone Regeneration is the title of two full day workshop programmes in Melbourne and Sydney this October, presented by Italian Periodontist Dr Isabella Rocchietta and sponsored by Geistlich Biomaterials. Scan the QR code or visit https://tin yurl.com/457v6wds for info.

Australasian Dental Practice 47

spectrum | NEWS

Dr Daniel Thoma and his research on 5 years of Geistlich Fibro-Gide® By Joseph Allbeury

wiss Prosthodontist, Dr Daniel Thoma, was one of the presenters at Osteology Barcelona in April. We caught up with Dr Thoma there after his workshop on Modern soft-tissue management with autologous tissues and substitutes to hear about his latest research with Geistlich Fibro-Gide®. Thank you very much for your time, Daniel. Can

JA you please tell me about the importance of soft tissue

grafting in terms of establishing horizontal width and can you share with us your research in this area?

Perhaps in 95% of all cases, you would probably end up

DT using the 3mm thickness, which means with the tradi-

tional thickness of 6mm, you would have to trim it by 50%, which is not that simple. It takes a little more time. It’s ideal to have something that has a thickness already of 3mm, which is probably the best thickness for the majority of the cases. I understand you’ve published some research on JA And Geistlich Fibro-Gide recently based on five year’s of ®

usage. Could you share details about that please?

Yes, absolutely. I think predominantly when we deal

DT with dental implants, we understood in the past that there

is mainly one main priority in the aesthetic zone, which is that we want sufficient volume and contour. And part of it is obviously the horizontal contour. So, in the past, we have been using autogenous grafts. Now, based on research in collaboration with many different universities, we’re able to also use soft tissues substitutes. This is quite important for achieving aesthetic perfection. how important is a product like Geistlich FibroJA And Gide to that? ®

Sure. I think the first oral surgery we ever did using

DT Geistlich Fibro-Gide was in single implant sites where

I think it’s highly important for two main reasons. I think it’s important for clinicians because it opens up the field for these surgical techniques to a larger population of clinicians because in my mind, I think it’s easier to handle compared to a traditional connective tissue graft, which are kind of difficult to harvest from the palate. On the other hand, the most important benefits overall are that you can reduce patient morbidity compared to connective tissue grafting. So, I consider it to be a highly important development.

we augmented the soft tissues in a horizontal way so it’s an RCT with the comparison of using an autogenous graft. So, once crowns were delivered, we’re following up our patients over five years and that’s quite important. I think no one believes in a product if you don’t share some longer-term data and one of the benchmarks is obviously five years. In this case, the outcomes are the same compared to using an autogenous graft, which means it’s a clinical success in the long run.

is this something being up taken by the specialist JA And community as well as general dentists?

JA Geistlich Fibro-Gide for clinicians?

I think it heavily depends on the region. Being a spe-

DT cialist and if you look around the world at specialists, we

have been trained to use specific techniques for harvesting autogenous grafts for many years. It takes quite a lot to convince us to do something else and if you have a specific product, you have to charge for it and it might be a reason not to use it. So maybe this is why it is used less by specialists. However, I clearly see it is being used by many general practitioners. Great. And I understand that Geistlich Fibro-Gide® is now available in a 3mm thickness. How’s that affecting your work?

48 Australasian Dental Practice

Excellent. So what is the clinical relevance of using ®

Well, the clinical relevance is that it’s a matter of indications. I think I mentioned in the beginning, I really see it indicated as for aesthetic reasons. On the other hand, we have also understood in the past, based on some studies that have been done in the mid-nineties, that it’s quite important also to establish a certain vertical thickness in the posterior cell. And here I see another indication for using Geistlich Fibro-Gide®.

JA Excellent. Thank you very much. DT You’re welcome. September/October 2023

Making the bone harvesting a handy procedure Micross: a minimally invasive disposable device indicated for cortical bone harvesting. The excellent cutting performance, due to its outstanding micro-blade, allows for an easy collection of autologous bone, even in narrow and hard-toreach areas. This harvesting technique warrants the best preservation of cell vitality of the cortical tissue, a fundamental characteristic for the best graft integration.

The only instrument for the Tunnel harvesting technique Micross is the only bone harvesting device specifically studied for tunnel surgical techniques that minimise postoperation discomfort. The external diameter of the cannula is 5mm and due to its particular shape the instrument can be inserted in tissue tunnels in Advantages of the disposable semicircular the intraoral area as the external oblique line, blade the cortical palatine and the zygomatic process. • Maximum cutting efficiency • Collects cortical bone shavings of appropriate size and thickness for the graft integration • Excellent control during the harvesting procedure • Effective on any bone surface (plane, concave, convex) • No contamination due to the wear of the device By using Micross the bone tissue is directly collected in the chamber inside the cannula and it gets an excellent biological plasticity, because of the presence of coagulated blood. The volumising effect, due to the curly morphology of the collection reduces the quantity of bone needed to fill the defect and as a consequence it minimises invasiveness for the patient.

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spectrum | NEWS

Dr Martina Stefanini talks up Geistlich Fibro-Gide® over connective tissue grafts By Joseph Allbeury

talian Periodontist and researcher, Dr Martina Stefanini, was one of the presenters at Osteology Barcelona in April. We caught up with Dr Stefanini there after her workshop on Recession coverage around teeth and implants to hear about her latest research with Geistlich Fibro-Gide®. Thank you for talking to us today. I wanted to talk

JA about coverage of soft tissue recession in periodon-

tology and I understand that you’re using Geistlich Fibro-Gide® for this rather than, say, a connective tissue graft. Why is that?

Yes. I’m working a lot with connective tissue substitutes

MS because I can reduce the pain and the discomfort for my

it. Would you say that all your procedures now JA Got include Geistlich Fibro-Gide or are you still using ®

connective tissue grafts occasionally?

In some indications, we still need to use connective

MS tissue grafts, especially, for example, in the treatment of

gingival recession in lower incisors or when we raise a flap where there is no keratinised tissue remaining apical to the gingival recession. In this indication, the CTG is still the gold standard, but in all other cases, Geistlich Fibro-Gide® is very predictable and safe as an alternative.

patients. I think that Geistlich Fibro-Gide® is a very good alternative, especially when you need to increase soft tissue thickness around both teeth and implants. The most important thing is that you have enough keratinised tissue remaining apical to the gingival recession, so your flap will remain stable in the coronal position. And thanks to the adjunctive use of Geistlich Fibro-Gide®, we’re able to increase the soft tissue thickness.

JA Do you see this as a notable shift in periodontology? Yes, because you can reduce the time taken for your sur-

MS gical procedure. You reduce the pain for your patient.

You have only one surgical site instead of two as you do when you perform the harvesting procedure. There is no doubt that introduction of this new biomaterial is a game-changer in periodontology.

JA Is it a hundred percent successful? Let’s say a hundred percent success in dentistry and in

MS medicine is almost impossible. But we’ve published

some results in the literature that show that the procedure is safe and predictable, with a percentage of root coverage that is similar to the percentage of root coverage that you can obtain with a connective tissue graft.

And can you explain the extent of the research you’ve been doing?

I’m doing research using collagen matrixes in conjunction with hyaluronic acid that can be incorporated in the collagen matrix that will shorten the healing time and improve the quality of the healing. So, this is a further step into the periodontic surgical procedure that combines the collagen matrix with this new biomaterial to obtain some more successful results.

JA That’s exciting. It is but the data will be published soon so I cannot give

MS you a spoiler about my research! 50 Australasian Dental Practice

And you’re seeing great results with this with your

JA patients?

Yes, my patients are very happy because the surgical

MS procedure is very short, with no post-op pain and a very

successful result. So this is not only from a clinical point of view, but also from a patient perspective, which is of paramount importance. And obviously the aesthetics is always great because with the connective tissue graft, in some cases, you can have exposure of the graft or an excessive growth of the connective tissue graft, which is not ideal aesthetically. But with Geistlich Fibro-Gide®, success from an aesthetic point of view is highly predictable. is this a shift across periodontology in regard to JA And moving to products like Geistlich Fibro-Gide ? Are all ®

specialists getting on board with this?

Yes, definitely. Because if you don’t have to use a con-

MS nective tissue graft, then the surgical procedure is easier.

Clinicians who are not familiar with periodontal surgery can also start to learn these surgical procedures thanks to this material that allows us to perform far easier surgical procedures.

JA Excellent. Thank you very much for your time. MS Thank you for inviting me. September/October 2023

The gold standard in intraoral bone harvesting Safescraper TWIST provides an easy method to obtain autologous cortical bone with a minimally invasive technique. The outstanding cutting performance of the blade allows for cortical shavings to be collected, while preserving maximum cell vitality, which is essential for graft integration. The collected bone is already combined with blood and ready to be positioned to the defect, or mixed with Geistlich Bio-Oss®. It can also be temporarily maintained in aseptic conditions in the transparent chamber.

Properties of the cortical graft High cells vitality The manual harvesting technique preserves the cellular component of the graft. The cortical shavings obtained bythe Safescraper TWIST blade contain living and well-preserved bone cells, particularly osteocytes (mean vitality: 45-72%), but also osteoblasts, osteoclasts and osteoprogenitor cells. Ideal morphology The cortical bone obtained with Safescraper TWIST looks like a elongated and convoluted shaving of a mean length of 1.3 mm and thickness ranging between 150 and 250 μm.

Geistlich Select

Advantages of the disposable semicircular blade • Maximum cutting efficiency • Accelerates the harvesting time • Collects cortical bone shavings of appropriate size and thickness for the graft integration • Excellent control during the harvesting procedure (plane, concave, convex) • No contamination due to the wear of the device • 160° cutting area range

Sterile 3 pack: $319 AUD (inc. GST) Product Code: MET-3987

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

spectrum | NEWS

Dr Ronald Jung guiding communications and education... plus 25 years of GBR By Joseph Allbeury

rained in prosthodontics, implant therapy and oral surgery, Prof. Dr Ronald “Rony” Jung, one of the presenters at Osteology Barcelona in April, is now taking on the role of helping the Osteology Foundation communicate with members and the dental profession at large as well as working on the new Geistlich learning platform.

communicate, as there are so many. We need to see which of these we want to emphasize more on than others. And I think that’s a process which we need to do as an entire Board to see where our strengths are and then which types of communication we would want to invest in more and others which need a little less investment than we did in the past. I’m sure that it will be an interesting and important

JA journey. And I understand you’ve also been working

on the new learning platform for Geistlich as well?

Yes. So, as I mentioned, there are so many more oppor-

RJ tunities to communicate with clinicians today. So

just as Osteology needs to look at new ways to communicate, Geistlich also needs to have different formats for the education in its portfolio. And one of these for Geistlich is a new platform for providing very specific product information. What we focus on at Osteology is more about the science and evidence whereas Geistlich is filling the gap between patient indications and its products.

Hi, Rony. Thank you for your time today. I understand

JA you’re heading up the new Osteology Foundation’s

Communications Committee?

Hi, Joseph. Thank you very much for taking the time

RJ here with us to discuss this. I’m actually very excited

about taking on this role. Osteology is trying to strategically reorientate itself for the future and we’ve seen how important it is to place emphasis on how we communicate. We have Research and Education committees and there was once a Communications committee in the past. So now with the importance of communication today, it was a strategic decision by the Board to reopen that position again and I’m very happy and thankful to be able to take it on.

JA And what will be your first order of business? The first thing is to strategically orientate ourselves and set out the major strategies we want to communicate. I think that today, the problem is no longer having enough opportunities. The problem is really finding the right ways to

52 Australasian Dental Practice

So is it correct that the Geistlich education platform

JA will be about how to use Geistlich products?

Yes. The whole setup is based on patient indications.

RJ Clinician will be learning therapeutic approaches that

are specific to a patient with a problem that is based on a specific indication. The learning platform will educate the user on treatment pathways that include the relevant Geistlich products.

September/October 2023

spectrum | NEWS

makes sense. And what do you think has come out JA That as the best way for people to learn what are essentially

quite complex procedures?

I think today we have a much better understanding of

RJ how we learn. During the pandemic, the importance

of the practical part and the importance of having this practical interaction became clear. I just came out of a workshop which I did for Osteology and I think that this is the most ideal format in order to transition the textbook knowledge into applied knowledge. This format can really teach not just the science behind it, but how you apply these principles. And for me, the workshop is one of the most efficient ways to bring this information to the dentist. And also, there is the emotionalising of the teaching process that people are very excited and happy about which also helps in order to really bring this knowledge into dental practices. what is the biggest thing that people are missing JA And out on using online learning? Online learning received a dramatic boost during the

RJ pandemic, but we can clearly see its limitations. And

again, when we talk about the different types of learning, textbook knowledge today can be transferred online where there is traditionally no interaction with the dentist. But again, when it comes to the part where you want to apply this information, then you need to have this practical part and this can never be replaced by any kind of online format. On top of that comes the social part. You need to benchmark with your peers and that’s also kind of one of the beauties we have with the congress. At the end of the day, what we have learned from the pandemic is that we just need to play the right instrument for the right situation and one size doesn’t fit all. The online format has its place, the congress format has its place and also this type of practical workshop has its place. certainly very exciting to see thousands of cliniJA It’s cians back in Barcelona for Osteology and that all of

the workshops are full.

September/October 2023

We could get some idea how it would be RJ Absolutely. based on last year with the first congresses that were held

again in a normal format since the pandemic. And I think everybody clearly sees the benefit. I think people really appreciate being together with each other again and having this exchange, which never takes place on the same level in online education. Online education is still important, but it’s only one part of the overall structure of an education program. And I think Osteology is really trying to incorporate this into one format where we really try to play all the instruments in the right order to make nice music. Well said. And I understand you’ve been recently pub-

JA lished some research on 25 years of GBR techniques?

Can you tell us about that please?

Of course. This is a study which has been conducted

RJ over 25 years in the University of Zurich, which began

before I was there in a faculty position. And we took great effort to get all these patients back to the clinic. And what made it really very special is that we could get a cone-beam CT of every patient. And therefore, the study is actually the only study on the one hand which shows what happens on the buccal aspect, where bone augmenting has taken place. What is also special for that study is that it’s a study where you have a comparison between two types of membrane, a collagen membrane and resorbed membrane compared to implants which have been placed in sufficient native bone without the use of GBR. So this is the only study comparing GBR procedures with implants where there was no need for a GBR procedure. And the outcomes were very important for us because I think that’s the study which is most important for our patients where we have the same behaviour of the implants, which have been regenerated with our methods of GBR compared to implants which have been placed without the need for GBR. This has been a very important outcome when it comes to safety and predictability of the treatment we do on a daily basis.

JA Thank you very much for your time. RJ Thank you. Australasian Dental Practice 53

spectrum | NEWS

Hygoclave to the rescue! By David Petrikas

The decision to purchase a new steriliser took on an extra sense of urgency when one practice’s old steriliser completely broke down in Melbourne recently. Being unable to see any patients because his steriliser was down, Dr Martin Levy was genuinely excited when the team from A-dec and Alldent arrived with a brand new Dürr Dental Hygoclave 40 ready for installation. A-dec Victorian Territory Manager Scott Williams said Dr Levy was right in there with the team of technicians watching everything and working his way through the manuals provided “like a kid with a new toy” kind of excitement. The Alldent techs responsible for the installation and validation (some who had not yet trained on this model at that time) had the machine up and running in no time at all, demonstrating how intuitive the Hygoclave and attached barcode printer is to operate. Scott, who was conducting the handover, said the machines ship without the door seal installed, so it is necessary to first install the seal and then lock the door to help seat the seal. Once the door was closed, then opened, the seal was checked and then the door closed again and the Hygoclave passed its vacuum test perfectly. During the handover training, Scott demonstrated how to transfer cycle data files via the USB. Although the Hygoclave is sold widely in Europe, it has only recently been released in Australia thanks to a partnership with Dürr Dental following extensive pre-release trials in local dental practices. The Hygoclave 40 at Dr Levy’s practice is connected to a Dürr Hygodem demineraliser to allow automated water filling of the steriliser. As a standard feature, Hygoclave’s inbuilt water quality tester monitors water quality and issues an alert if it drops below the required standard. Scott said that incredibly, Dr Levy himself will be the primary user. Dr Levy operates his practice quite uniquely, being the dentist, practice manager and the primary reprocessing manager which makes him a good candidate for offering feedback! Congratulations to Dr Levy on his purchase and to Scott and the Alldent team for a job well done.

Alldent’s Lucas Brundell, Mike Noye and Will Stanton (Above) installing the new Hygoclave 40. Dr Levy (Below) watches on as the vacuum test is performed.

For more info, call A-dec on 1800-225-010.

54 Australasian Dental Practice

September/October 2023

Hygiene is in our DNA. The new Hygoclave 50.

5“ high-resolution colour touch display for intuitive navigation

3-fold flexible fresh water supply with integrated quality control

High-performance sterilization- and drying system

Integrated dust protection filter

With Hygoclave 50, Dürr Dental and A-dec offers dental practices a professional Class B solution that combines impressive performance with a well thought-out operating concept – for maximum efficiency and exceptional user friendliness designed to cope effortlessly with tough day-to-day working environments. Available with a volume of 17 or 22 litres. More information under www.duerrdental.com

Scan the QR code or call 1800 225 010 to contact your local A-dec dealer

All in view and documented thanks to connection to the practice network

dentevents presents...

Natural Morphology for Dentists SYDNEY • FRI 16 - SAT 17 FEBRUARY 2024 Presented by Massimiliano Zuppardi, MDT This 2-day program is designed for dentists who want to improve their knowledge of dental morphology and learn step-by-step protocols for achieving natural aesthetic restorations with improved techniques in wax up, ceramic and stain management and teeth reconstruction. The techniques could be applied to composite as well as digital design and manufacture.

LECTURE - Friday, 16 February

Morphology of anterior and posterior teeth n Natural teeth morphology transfer n Importance of morphology n Shape differentials between males and females n Margin creation and ideal emergence profiles n Preparations for Lithium Disilicate n Occlusal Plane alignment using DSD n Embrasure management n Shade map for cosmetic composite/ceramic reconstructions n Morphology shape map for the buccal and occlusal surface n The importance of the marginal crest n Cameras, lenses, flashes, soft boxes, additional light for portrait and intraoral photo/video workflow. n

Case presentations

HANDS-ON - Saturday, 17 February

How to achieve natural morphology every step of the way with a simplified protocol, applicable on multiple materials. This program takes place on a real cases - Bring Your Own! Learn powerful step-by-step techniques including: DSD settings, photos and software selection Choosing the right wax and tools n Working with loupes n Step-by-step tooth morphology reconstruction protocols n Crest and cuspid alignment to create the ideal relationship between uppers and lowers n How to select the right ingot for the milling protocol n Furnace set-up to optimise firing n Bur selection for refining and polishing n Defining shape, texture design and line angle n Staining technique and minimal build up to camouflage artefacts and to achieve smooth integration in situ n Hand and mechanical polishing for a perfect lustre n n

Participants will progress through all exercises including photo/video taking and digital smile design.

Re g i s t e r No w a t w w w. z up p a rd i . e ve n t s

Massimiliano Zuppardi

Master Dental Technician/Ceramist Since the 80’s, Massimiliano “Max” Zuppardi has been working with his father, Maestro Giuseppe Zuppardi, the first Oral Design Member as his partner and Mentor. In 1993, he established his own laboratory in Naples and became an Oral Design Member. Max specialises in complex implant cases and full mouth restorations, with a core focus on precision, bite, morphology and aesthetics. He has studied the most innovative materials and technology for dental restorations aiming to achieve the most lasting and natural looking prosthesis.

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Having experience working in many countries, he has now established his business in Sydney, Australia, where he opened Zuppardi Dental Studio “Oral Design Down Under”. Mentored from master technicians such as Willi Geller, M.H.Poltz, P.Adar, D.Shultz M Magne and many more, Max has lectured internationally and the author of several publications on featured in the most important Dental Journals.

DATES AND TIMES Friday, 16 February 2024 to

Dentists

$2350 inc gst

Early Bird

$1950 inc gst

save $400 - register by January 3

Saturday, 17 February 2024 Starts 8.30am | Ends 5.30pm Rego opens 8.00am Venue: Oral Design Australia, Mosman, Sydney

Natural Morphology for Dentists is presented by Dentevents, a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au Telephone: (02) 9929 1900 • Facsimile: (02) 9929 1999 • Dentevents™ is a trademarks of Main Street Publishing P/L © 2023 Main Street Publishing Pty Ltd

Re g i s t e r No w a t w w w. z up p a rd i . e ve n t s

spectrum | NEWS

Take your dental skills to the next level Learn from orthodontic experts with interactive face-to-face or live stream courses... Powered by OrthoEd Mini Masters

Aligner Essentials

he OrthoED Mini Masters is a proven, fully accredited 2-year course that will allow you to deliver predictable, efficient, high quality and profitable orthodontic treatments for your patients. The 2023 face-to-face course is now SOLD OUT. The live-streamed course (which is available) is fully backed with full case support and mentorship to give you the confidence to take on more cases and provide predictable outcomes, every time. Learn how to: • Build a solid foundation in all areas of orthodontics; • Properly diagnose and deliver orthodontic treatment plans; • Save time and money on every orthodontic case; and • Complete cases quickly and successfully, allowing you to take on more cases and grow your bottom line. To learn more about this program visit: orthotraining.com.au/orthoed-mini-masters or scan the QR code below:

n the OrthoED Aligner Essentials module over 3 days, you’ll learn how to provide Clear Aligner treatments confidently, profitably and successfully, even if you have no experience with orthodontics or have struggled with treating patients with aligners in the past. The OrthoED Institute teaches you all of the principles of clear aligner treatment, allowing you to take on cases with confidence. Attend a face-to-face course or learn from the comfort of your home or office through a live streamed event. Through Aligner Essentials, learn how to: • Increase your practice profits; • Provide a better service to your patients; • Provide improved restorative treatments; • Increase your scope of practice; • Reduce referrals to specialists; and • Gain a strong competitive advantage. To learn more about his program visit: https://orthotraining.com.au/aligners or or scan the QR code below:

Advanced Aligner Module earn advanced aligner skills with this 2-day Advanced Aligner module. Learn from industry experts either through a face-to-face course or via the comfort of your home or office through a live streamed event. • Understand when, why and how to combine fixed appliances with clear aligners; • Learn how to manage difficult tooth movements using auxiliary tools and advanced biomechanics; • Learn how to handle early treatment cases for children and teens; a rapidly growing market; • Develop a deeper understanding of the pros and cons of DIY aligner treatments to advise and educate patients accordingly; and • Learn how to take on more complex, challenging cases without having to refer them to specialists. To learn more about this program visit: orthotraining.com.au/advanced-aligner-course or scan the QR code below:

Postgraduate Certificate in Clear Aligner Therapy et the ultimate certificate of acknowledgement in clear aligner treatment that will gain patients’ trust, improve your skills and drive more patients to your practice. The OrthoED’s Postgraduate Certificate in Clear Aligner Therapy is a reputable certification granted by EduQual, a globally-recognised awarding body in the UK. Only current students and graduates of the OrthoED’s Aligner Essentials and Advanced Aligners modules are eligible for this extra qualification. By becoming accredited, you and your practice will receive many invaluable benefits.

58 Australasian Dental Practice

• Gain credibility and win the trust of your patients; • Prove your commitment to learning and excellence; and • Demonstrate your understanding of the principles and techniques of aligner therapy through assessments and treatment planning cases; • Gain a competitive advantage in your local area. To learn more about this program visit: https://orthotraining.com.au/clear-aligner-therapy Visit www.orthotraining.com.au for more information on all of the OrthoED courses or call (03) 9108-0475.

September/October 2023

TAKE YOUR

DENTAL SKILLS TO THE NEXT LEVEL IN 2023

Learn from orthodontic experts with our interactive Face to Face or live stream courses Powered by

MINI MASTERS

ALIGNER ESSENTIALS

The OrthoED Mini Masters is a proven, fully accredited 2 year course that will allow you to deliver predictable, efficient, high quality and profitable orthodontic treatments for your patients.

In the OrthoED Aligner Essentials module over 3 days, you’ll learn how to provide Clear Aligner treatments confidently, profitably and successfully, even if you have no experience or have struggled with aligner cases in the past.

Our 2023 Face to Face course is SOLD OUT. The live streamed course (which is available) is fully backed with full case support and mentorship to give you the confidence to take on more cases and provide predictable outcomes, every time. • Build a solid foundation in all areas of orthodontics • Properly diagnose and deliver treatment plans • Save time and money on every orthodontic case • Complete cases quickly and successfully, allowing you to take on more cases and grow your bottom line

The OrthoED Institute teaches you the principles of aligner treatment, allowing you to take on cases with confidence. Attend a Face to Face course or learn from the comfort of your home or office through a live streamed event. • Increase your practice profits • Provide a better service to your patients • Provide improved restorative treatments • Increase your scope of practice • Reduce referrals to specialists • Gain a strong competitive advantage

To learn more about this program visit:

https://orthotraining.com.au/orthoed-mini-masters/ To learn more about this program visit:

https://orthotraining.com.au/aligners/

ADVANCED ALIGNER MODULE Learn advanced aligner skills with this 2 day Advanced Aligner module. Learn from industry experts either through a Face to Face course or via the comfort of your home or office through a live streamed event. • Understand when, why and how to combine fixed appliances with clear aligners • Learn how to manage difficult tooth movements using auxiliary tools and advanced biomechanics • Learn how to handle early treatment cases for children and teens; a rapidly growing market • Develop a deeper understanding of the pros and cons of DIY aligner treatments to advise and educate patients accordingly • Learn how to take on more complex, challenging cases without having to refer them to specialists

To learn more about this program visit:

https://orthotraining.com.au/advanced-alignercourse/

POSTGRADUATE CERTIFICATE IN CLEAR ALIGNER THERAPY Get the ultimate certificate of acknowledgement in clear aligner treatment that will gain patient’s trust, improve your skills, and drive more patients to your practice. Only current students and graduates of the OrthoED’s Aligner Essentials and Advanced Aligners modules are eligible for this extra qualification. • Gain credibility and win the trust of your patients • Prove your commitment to learning and excellence • Demonstrate your understanding of the principles and techniques of aligner therapy through assessments and treatment planning cases

To learn more about this program visit:

https://orthotraining.com.au/clear-aligner-therapy/

Visit orthotraining.com.au for more information on our OrthoED courses Or Call +613 91080475

spectrum | NEWS

Transform your practice with cloud technology

sing cloud technology has become the norm for many people, whether that is through Netflix™ and Amazon Prime™ to catch up on the latest shows, or by sharing content online with family and friends via Facebook™ or Instagram™. Industries worldwide have leveraged the power of the cloud to enhance and grow their businesses and Dentally from Henry Schein One is no different. With the Health Care and Social Assistance industry projected to grow by over 15% in the next five years, making it one of the four fastest-growing industries in Australia*, there has never been a better time to start thinking about what the future looks like for your dental practice. Dentally’s complete cloud enabled practice management software uses the latest cutting-edge technology to help you adapt to the challenges you face in dentistry every day and help you grow and plan for the future. With Dentally, all patient information is stored securely in the cloud, accessible from anywhere with a secure internet connection. Simply Chrome and go!

Getting technical entally is one of a few, true cloudbased solutions, (SaaS - Software as a Service) using a network of multiple remote servers hosted online to store, manage and process data. In dentistry, the utilisation of cloud has enabled practices across the globe to overcome the challenges of the past few years from keeping patients in the loop with Dentally Portal’s contactless journey, to overcoming staff shortages with flexible working capabilities.

60 Australasian Dental Practice

Why choose cloud? hen searching for ways to improve and grow your dental practice, today’s market can be confusing and crowded with the number of solutions available and finding the right one is a task in itself. Dentally know how crucial it can be to not only find something that will work best for you now, but to find something that is future proof! You can be certain that with Dentally your software will scale with you as your practice grows.

User security entally keeps everything in one place, eliminating the need for multiple software to run each aspect of the surgery. As a complete cloud solution, you will no longer need any onsite data storage as your data will be stored safely and securely, so you don’t have to. Dentally automatically backs up and syncs any changes straight to the cloud. Not only does this save you money on server maintenance and expensive IT, it gives you the assurance that you are working and reporting in real time.

Not just a software entally’s services go beyond futureproofing your business through practice management software. Their dedicated support team are always available on a live chat to help you get the best out of the software.

You will also have access to the customer success programme, Dentally Elevate. Spend one to one time with a trained team where you can get advice and new perspectives on growing and thriving as a business with the use of Dentally’s easy to use tools, such as: • Fast reporting - No more time wasted on loading screens; with Dentally’s live reporting tools, you get up-to-date results instantly. • Intuitive automation features - Dentally’s automatic communications work in the background to remind and recall patients, freeing up time in surgery to continue to deliver exceptional patient care. • Dentally Portal - Enhance your patient’s journey from beginning to end through online booking, payments and forms giving them convenient ways to keep on top of their own oral health. • Live Dashboards - Dentally’s home screen has an overview of the practice data including white space, cancellations, revenue, etc. This snapshot of information is great for setting daily goals for your team.

The future is cloud entally is committed to giving users an intuitive, easy-touse practice management solution and with the use of built-in features, you can keep everything running smoothly whilst saving time and resources in the process. Dentally takes the stress out of running your practice.

Speak with the Dentally team today for a software demo and find out how it can help you thrive both now and in the future. Visit Dentally.com, call 1300-889-668 or email help@dentally.com.au. * https://labourmarketinsights.gov.au/our-research/ employment-projections

September/October 2023

Welcome to the future in practice Faster, simpler practice management

Accessible from any location giving better work-life balance

Visit dentally.com to see how we can help.

Dentally from Henry Schein One, oﬀers a complete cloud solution to help you run your practice more eﬀectively. Spend more time on patient care and developing your practice, and less time on admin.

Clinical excellence with everything at your ﬁngertips

Patient-centric features to deliver the experience people demand

Grow your practice with Elevate, our exclusive customer success programme

spectrum | NEWS

AALD 2024 set for Fraser Island

he Australasian Association of Laser Dentistry is once again planning another compelling conference from March 8-10, 2024 on picturesque Fraser Island, also known as K’gari. The event will be held at the Kingfisher Bay Resort on the World Heritage Listed island

Photons for the Future he theme for the 2024 Conference is “Photons for the Future” with lectures covering the State of the Art in Laser Restorative Dentistry; Hygiene/Periodontal related laser therapy; Laser surgical case selection and outcomes; and New Research Frontiers in Laser Dentistry as well as other topics. On Saturday afternoon, delegates have the option to participate in the Ultradent Amazing Race, Laser hands-on workshop or an afternoon of 3D printing.

62 Australasian Dental Practice

Speakers at the event include: • Emeritus Professor Laurence Walsh; • Professor Roy George; • Dr Mohammed Meer; • Dr Victor Lagunov; • Dr Lan Tran; • Dr David Cox; and • Dr Sachin Kulkarni.

Meeting Participants are invited to attend all lectures with lunch included Saturday and Sunday as well as the Ultradent Amazing Race on Saturday (Teambuilding) or the option of a handson session on Saturday afternoon. All Participants have included in their packages Breakfast Saturday and Sunday, Dinner Friday and Saturday night, one of which is a seafood buffet, drinks during dinner, Bush Tucker Taste & Talk Friday night with “Sunset by Septodont” dinner and Return boat transfers. Discounted rates have been applied for accommodation and these can be extended for 2 days either side of the Conference. Hotel rooms and Villas are available there may be some other options for larger families, but these need to be confirmed with the resort. For more information on the event, visit www.asnaald.com.au/copy-of-register

September/October 2023

AALD Conference 2024 at Kingfisher Bay Resort - K’gari (Fraser Island)

AALD Conference 2024 at K’gari (Fraser Island )Kingfisher Bay

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spectrum | NEWS

IDEM 2024 announces its return to April with dates confirmed for 19-21 April 2024

oelnmesse Pte Ltd and the Singapore Dental Association (SDA) have launched the 13th International Dental Exhibition and Meeting, IDEM 2024, which will return to its April dates from 19-21 April 2024 at the Marina Bay Sands. IDEM is the leading dental exhibition and conference in the Asia-Pacific region, attracting exhibitors and attendees from around the region. With the expansion of the exhibition space, the event is expected to host around 500 exhibitors and welcome more than 8000 attendees from 70 countries. Mathias Kuepper, Managing Director and Vice President Asia-Pacific, Koelnmesse Pte Ltd said, “We are excited to be working with our longstanding partners the Singapore Dental Association once again to bring IDEM 2024 to the dental community. After IDEM’s overwhelming success as an in-person event last year, we look forward to growing the show even more and providing international companies the ideal launchpad into the Asia-Pacific Market.”

64 Australasian Dental Practice

Dr Lawrence Yong, President of Singapore Dental Association, stated, “IDEM is a platform that provides dental professionals a unique opportunity to interact with the industry’s leading minds and leading companies. The IDEM 2024 conference theme combines expertise from both research and practice under the theme of ‘Exceptional Dentistry: Techniques, Technologies and Trends’ and will provide a platform for dental professionals to explore new advancements and innovations in the field that they can take back to their dental clinic.” The IDEM 2024 exhibition will fully maximise close to 17,000 square metres of floor space on a single level, moving all 3 conference tracks up to be consolidated on the first floor. The exhibition will also expand the number of meeting spaces, such as the business matching lounge, meeting pods and recharge points. The trade exhibition will feature over 500 exhibitors showcasing a wide range of products and services, including dental equipment, instruments, materials and software. In addition to the exhibition, IDEM 2024 will also feature

a comprehensive scientific conference programme running 3 parallel tracks and hands-on workshops. Major national pavilions such as Germany, Italy, USA, Switzerland and Brazil have already committed to expanding their presence at IDEM 2024, demonstrating the event’s increasing popularity and relevance in the dental community. “Without a doubt, the feedback from the France Pavilion exhibitors has been overwhelmingly positive regarding IDEM 2022. We are delighted to hear that they are satisfied with the event’s organisation, and we are proud to have provided them with a platform to showcase their products and services to a global audience. In fact, we are thrilled to announce that many of our pavilion exhibitors have already expressed their interest in returning for IDEM 2024, which is a testament to the value they see in this event.” Lae Douangpraseuth, Head of Business Development, The French Chamber of Commerce in Singapore said. For more information, visit the official website at www.idem-singapore.com.

September/October 2023

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spectrum | NEWS

Carestream Dental IO Scanner Link gives practitioners more choice and easier access to intraoral scans

n today’s digitally connected practice, it’s all about choice,” said Philippe Maillet, general manager, imaging equipment, Carestream Dental. “The choice to connect your existing technology with a multitude of partners or devices to create the workflow that’s right for your practice.” Carestream Dental is now making a seamlessly connected digital practice a reality with IO Scanner Link, its latest innovation that allows CS Imaging version 8 software to directly connect to third-party intraoral scanners’ acquisition software not developed by Carestream Dental. IO Scanner Link is more than a manual file import/export option. It leverages CS Imaging 8—the imaging hub that centralises and displays all of a user’s Carestream Dental imaging data—as the core practice platform to drive efficiency and connectivity. By aggregating, storing and managing all images through a single software and patient database, a practitioner can optimise and simplify the workflow in their digital dental practice. Within CS Imaging 8, an integrated button allows intraoral scans from supported third-party scanners, along with all the necessary patient data, to be launched with just one click. When the scan is complete, the intraoral scan is automatically imported back into CS Imaging 8 to be used for implant planning through Carestream Dental’s Prosthetic-driven Implant Planning (PDIP) module; surgical guide design with Smop software; sharing with labs; or exporting to other third-party software. “Making it easy for practitioners to use the intraoral scanner of their choice and giving them unrestricted access to their preferred clinical solutions aids them in optimising their daily treatments through an efficient workflow,” Mr Maillet said. Medit is the latest intraoral scanner manufacturer to integrate with CS Imaging 8 through IO Scanner Link. This will allow

66 Australasian Dental Practice

users of Carestream Dental imaging equipment and Medit intraoral scanners to integrate their favourite devices with a single click of a button. CS Imaging 8 also connects with Dexis intraoral scanners. In coming months, Carestream Dental intends to expand the number of integrations for even more choice. CS Imaging 8 is one of the most widely used dental imaging software platforms on the market, thanks to its extremely userfriendly, modern interface. To learn more about CS Imaging 8, IO Scanner Link or any of Carestream Dental’s innovative solutions, visit carestreamdental.com. CS Imaging version 8 software connects to multiple intraoral scanner acquisition programs not developed by Carestream Dental and permits the delivery of intraoral scans from third-party software to CS Imaging.

About Carestream Dental arestream Dental is committed to transforming dentistry, simplifying technology and changing lives. In this pursuit, we focus on providing cloud solutions and technology for practice and clinical management for dental practices, groups, DSOs and partners. For more info, visit carestreamdental.com.

About Medit edit is a global provider of 3D intraoral scanners and an all-in-one digital dentistry platform, based on its own patented state-of-the-art technology. The company also develops innovative software for digital dentistry, supporting collaborative workflows between dental clinics and labs. For info, visit medit.com.

September/October 2023

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spectrum | NEWS

International Update Piksters named Best-Rated Dental Teledentistry is useful for caries assessment D Floss & Picks 2023

iksters has won a Canstar Blue Award for “Most Satisfied Customers” for the “Dental Floss & Picks” category, coming in above big name multi-national players such as Oral-B, Sensodyne and Colgate. “Piksters was the favourite pick of shoppers in Canstar Blue’s dental floss and pick ratings, winning 5-star reviews for ease of use, effectiveness, packaging convenience, taste and overall satisfaction,” read the Canstar Blue citation. Earning a Canstar Blue Award is a tribute to Piksters’ commitment to their customers which echoes Megan Doyle’s (Canstar Blue CEO) statement - “When you see the Canstar Blue Award logo, know that you’ve got a dedicated team and brand behind you every step of the way.” “The gap between your teeth is where most big dental problems start. We have been working on easier and better ways to clean that gap for 30 years and it’s nice to see we’re having some success,” said Dr Craig Erskine-Smith BDS, CEO of Erskine Oral Care (parent company of Piksters). The Piksters “Dental Floss & Picks” range includes: • Piksters Interdental Brushes • Piksters Interpik • Piksters Pikstix • Piksters HydroPik Water Flosser • Piksters Eco Charcoal Floss Picks • Piksters SupaGRIP Floss Picks • Piksters Gorilla Floss Piksters is known for their leading interdental brush widely distributed throughout dental, grocery and pharmacy channels. Oral care is their specialty. Piksters’ products span across categories such as floss, toothbrushes, toothpaste and teeth whitening. The company strives to bring innovative, new and improved products to the market that represent high quality and value to dental professionals and consumers. Learn more at the consumer website www.piksters.com and for dental professionals www.pikstersdental.com

68 Australasian Dental Practice

ental caries is a common dental health problem affecting all age groups across the globe. Accurate detection and assessment of dental caries are crucial for effective treatment and preventive measures. Teledentistry (TD), which involves remote dental assessment using digital technologies, has shown promise as a potential tool for caries screening. TD has recently emerged as a promising method for overcoming the difficulties involved with conventional dental examinations, including for patients living in remote areas and those who are hospitalised or residents of nursing homes. It allows dental professionals to interact with patients, diagnose oral health issues, provide consultations and offer treatment recommendations, all without the need for an in-person visit. TD allows for the evaluation, diagnosis and management of oral health conditions, including dental caries, without the need for in-person visits. This systematic review was undertaken to answer the research question: “What is the difference in diagnostic accuracy between teledentistry and conventional assessment methods for the detection of dental caries?”. Literature searches were conducted across databases such as PubMed, Embase, the Cochrane Library, Scopus, the Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO by using predefined search terms and inclusion criteria. Eight studies met the inclusion criteria and were included in the review. The Newcastle-Ottawa scale (NOS) grading indicated that the studies were of good quality. The key findings were that TD assessments (based on intraoral photographs captured using smartphones or intraoral cameras) demonstrated comparable accuracy to traditional clinical examinations in detecting and assessing dental caries. Among the four studies that were quantitatively analysed, no significant difference was noted at p = 0.09. A mean difference of 0.64 (95% confidence interval (CI): -0.10 to 1.38) suggested that clinical examination and teledentistry-based checkup were on par with each other for the detection of dental caries. Hence, TD may be an effective approach for identifying and evaluating dental caries. However, further research is required to substantiate the findings of this review. Priyank H, et al. Comparative evaluation of dental caries score between teledentistry examination and clinical examination: a systematic review and meta-analysis. Cureus 2023; 15(7): e42414. (July 25, 2023) DOI 10.7759/cureus.42414

September/October 2023

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Please visit our website for more information Call 0508 486 252 Please our website more information www.septodont.com Please visit ourvisit 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 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

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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. 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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

ONLINE CPD CENTRE the cutting | EDGE

infection | CONTROL

READ ME FOR

CPD

The optical science of colour correction: how it works

Sustainability in dentistry: Part 2 - Life cycle analysis: A primer

By Emeritus Professor Laurence J. Walsh AO

nderstanding what determines the colour of teeth is fundamental to the proper use of a range of techniques in dentistry (Table 1). This article focusses on why teeth are fundamentally yellow and how that attribute can be altered in a dramatic but temporary way using colour corrector products.

Time marches on ooth shade varies across a continuum, in terms of brightness (luminosity) and colour (hue, chroma and value). A progressive increase in yellow with age is a normal age-related change.1,2 Studying cross-sections of permanent maxillary incisor teeth (Figure 1) reveals obvious reasons for such changes over the years. In young adults,

76 Australasian Dental Practice

the dentine has patent tubules. Light bends as it passed through both enamel and dentine, following the direction of prisms and tubules, respectively.3 This property makes teeth in young adults anisotropic, which means that the light does not travel in a straight line (Figure 2). By middle age, some sclerosis of the dentine is occurring, making the dentine become a more homogenous solid and thus more isotropic. In older adults, the dentine is more sclerosed and can become completely translucent in parts, while the enamel is more translucent and also thinner. As a result, the underlying yellow shade of the dentine shows through more.2 Adding to this, progressive deposition of secondary dentine as an aged-related change makes the pulp chamber smaller. There can also be tertiary or reparative dentine laid down locally, as a response to having a restoration placed or an exposed root surface.

By Emeritus Professor Laurence J. Walsh AO

his instalment of the series on sustainability considerations in infection control deals with life cycle analysis (LCA), also known as environmental Life Cycle Assessment. This approach can inform dental clinics when weighing up alternatives, including when staff make environmentally conscious decisions around single use items versus those that can be reprocessed. As well as decisions around purchasing, LCA also helps to unpack product claims around whether or not a product is “greener” than its competitors.

In the World Dental Federation (FDI) Vision 2030 document, all oral health care providers have an ethical and moral responsibility to manage the impact of our activities on the environment and ensure that we do this in a sustainable manner. Adding to the moral obligations around sustainable dental practice, which are now considered core competency requirements for all types of registered dental practitioners, it is important to remember the Australian Government Department of Agriculture, Water and the Environment’s National Plastics Plan 2021, where a range of bans on single-use plastics have been rolling out across the country.

106 Australasian Dental Practice

September/October 2023

Question 1. Absorption of violet and blue light makes teeth appear...

Question 6. A Life Cycle Assessment can...

a. Grey b. White c. Yellow d. Brown

a. Help staff make environmentally conscious decisions. b. Help staff make decisions around purchasing. c. Unpack product claims around whether or not a product is “greener” than its competitors. d. All of the above.

Question 2. Toothpaste ingredient CI 74160 is... a. Titanium dioxide for slower release of fluorides over time. b. Blue covarine dye to make teeth look brighter and less yellow. c. Used to create special red stripes. d. Used to create special green stripes. Question 3. V34 colour corrector serum contains... a. Red dye b. Blue dye c. Red and blue dye d. Red and green dye Question 4. When natural teeth that are yellow are exposed to sunlight, the reflected light spectrum shows... a. A reduction in visible violet b. An increase in yellow light c. A reduction in blue light d. An increase in red light e. All of the above Question 5. A surface that colour correcting dyes can bind to is... a. Natural teeth b. Pellicle c. Restorative materials d. All of the above

Question 7. All oral health care providers have an ethical and moral responsibility to manage the impact of their activities on the environment according to the... a. ADA b. AHPRA c. FDI d. HCCC Question 8. Carbon dioxide emissions for oral health care principally come from... a. The supply chain. b. Waste generated by the clinic. c. Travel by patients and staff. d. All of the above. Question 9. Greenwashing is... a. Chemically breaking down plastics to a biodegradable compound. b. Treating plastics in preparation for recycling. c. Misleading product labelling to make it seem “greener”. d. Using biodegradable detergents in a washing machine. Question 10. The “3 Rs” represent... a. Recycle, recycle, recycle b. Reduce, reuse and recycle c. Recycle, reduce, reconstruct d. Replace, reduce, refine

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 Sep/Oct 2023 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

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Differential diagnosis of resorption: Diagnosis and management By Dr Shaurya Srivastava, M.Endo (London), RCSEd, Specialist Endodontist

The rarely spotted pulpotomy

his case focuses on the diagnosis and management of internal inflammatory resorption (IIR), using Biodentine™ as a bulk fill due to its enhanced physical and chemical properties, as well as its ability to cease clastic activity. Resorption in permanent teeth is undesirable, since it is of a pathologic origin, driven by clastic cells leading to the destruction of mineralised cementum or dentine.1 It can be classified based on histology, aetiology or its origin in literature.2-6 In adults, root resorption is caused by osteoclast like multi and/or mononucleated cells called odontoclasts. This process is usually initiated when there is damage to the unmineralised organic cementoid and predentin, which protects the root from external and internal root resorption respectively. This is due to the inability of clastic cells to adhere to unmineralised surfaces.6,7

By Dr Peter Raftery, Endodontist, Hampshire Endodontics

n his Hampshire practice in the UK, endodontist Dr Peter Raftery frequently saves patients (and himself) time and money by offering Biodentine™ (Septodont) pulpotomy as an alternative to root canal treatment, much to their delight. However, he often finds that general dentists can be hesitant to follow suit, with pulpotomy a vastly overlooked option. Here, Dr Raftery makes the case for why Biodentine pulpotomies are more beneficial, more lucrative and easier to perform than you think.

Does Vital Pulp Therapy have an image problem? es. I think that Vital Pulp Therapy (VPT) in permanent teeth has an image problem - literally. In terms of eye-catching Instagram updates, Biodentine pulpotomy post-ops just don’t compete with a sealer-filled apical delta. And so, outside of a textbook, you probably haven’t seen any pulpotomy cases in years. Which in turn means you probably aren’t aware of how incredibly useful a treatment option it is.

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Question 11. Current evidence shows pulpotomies are predictable, with high success rates for pulpotomies in adult teeth with signs and symptoms indicative of irreversible pulpitis... a. True b. False Question 12. In their 2022 Pulp Therapy Evidence Guidelines, the British Endodontic Society describes Biodentine as the single best pulp therapy material because... a. Calcium hydroxide induces a poorer, less predictable pulpal response. b. The bismuth oxide in MTA irreversibly discolours teeth. c. I t can be used as an enamel restoration material for up to 6 months. d. All of the above. Question 13. According to the British Endodontic Society paper on pulpotomy, maintaining pulp vitality... a. Preserves the tooth’s circulatory defence system. b. Maintains the full proprioceptive function of the tooth. c. Means the tooth will be less mechanically weakened and hence less prone to fracture. d. All of the above. Question 14. Teeth suitable for consideration for pulpotomy include: a. Vital teeth with caries extending into the pulp with or without pulpitis symptoms (reversible or irreversible). b. Caries not extending into the pulp of teeth with no symptoms or with symptoms of reversible pulpitis. c. Non-vital teeth and teeth with apical areas of rarefaction. d. All of the above.

Resorption can be classified as internal and external and further classified as internal inflammatory resorption; internal replacement resorption; external inflammatory resorption; external cervical resorption; external replacement resorption; surface resorption; and transient apical breakdown, which are categorised under external resorption. The process of resorption occurs over three stages: initiation, resorption and repair.8 It is understood to be a self-limiting process and can go undetected clinically. After its initiation, if the resorptive surface is sustained by infection/or pressure, the destruction of hard dental tissue will continue leading to the tooth becoming unsalvageable over time. Resorption is poorly understood and often misdiagnosed. The use of CBCTs in endodontics has significantly improved the detection of internal and external resorption and provides a 3D representation of the lesion size, location, extent and proximity to the pulp.9-17

September/October 2023

Question 16. Resorption... a. Is pathologic in origin. b. Is a self-limiting process. c. Can go undetected clinically. d. All of the above. Question 17. Biodentine is the only resin-free tricalcium Silicate-based material which has high mechanical properties similar to dentine? a. True b. False Question 18. Biodentine sets upon... a. Light curing b. Hydration c. After 5 minutes d. Any of the above Question 19. IIR stands for... a. Internal Inflammatory Response b. Internal Infection Resorption c. Internal Inflammatory Resorption d. Inferior Inflammatory Response Question 20. The compressive strength of Biodentine is... a. 100MPa b. 200MPa c. 300MPa d. 400MPa

Question 15. Pulpotomy is a more technically demanding treatment to perform than full root canal treatment and takes significantly more chair time. a. True b. False

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abstracts | 2023

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

Mental stress in dentists during COVID

he dental profession endured unprecedented disruption amid the 3.5 years of the COVID-19 pandemic. Novel stressors have included the risk of occupational exposure to COVID-19 from close interactions with patients and from aerosol-generating procedures, financial losses from lockdowns and the cessation of clinical operations and stricter infection prevention and control requirements. This study investigated the longitudinal impact of the pandemic on the stress and anxiety levels of a cohort of 222 Canadian dentists between September 2020 and October 2021. Salivary cortisol was used as a biomarker of mental stress and 10 sets of monthly saliva samples (2,131 in total) were self-collected, sent to the laboratory in prepaid courier envelopes and analysed by enzyme-linked immunosorbent assay. To assess anxiety, 9 monthly online questionnaires were administered, comprising a general COVID-19 anxiety instrument and 3 items regarding the impact of dentistry-related factors. Statistical mixed effect models were used to estimate the longitudinal trajectory of salivary cortisol levels and their association with the disease burden of COVID-19 in Canada over the study period. After accounting for the confounding factors of age, gender, COVID vaccination status and the normal diurnal rhythm of cortisol secretion, there was a modest positive association between salivary cortisol levels in dentists and the number of COVID-19 cases in Canada. The self-reported impact of dentistry-related factors, such as fear of getting COVID-19 from a patient or a coworker, was greatest during peaks of COVID-19 waves in Canada. Dentists experienced a greater degree of mental stress when the state of the pandemic was more severe. These findings strongly suggest a link between self-reported and biochemical measurements of stress and anxiety in Canadian dentists during the COVID-19 pandemic. Outside of their professional lives, however, dentists appeared to be adapting to the pandemic. Importantly, general anxiety about COVID-19 decreased consistently throughout the study period. Overall, participants reported relatively low rates of psychological distress symptoms. Hence, dentists remained mindful about COVID-19 in their working lives but were adapting to it outside of dentistry. These results should be reassuring for the dental community.

Kolbe RJ, et al. Salivary cortisol and anxiety in Canadian dentists over 1 Year of COVID-19. J Dent Res. 2023;102(10): 1114-1121. DOI: 10.1177/00220345231178726

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COVID news on TV affected hand hygiene

espite its recognised importance, hand hygiene is still not well-practised and has continued to be a challenge, including to people in the community who are not health care workers (NHCW). This study tracked changes in hand hygiene among NHCW who were visiting a university hospital in Osaka, Japan from before the pandemic (December 2019) over 148 days covering the onset of the pandemic and up to March 2022. During this time, the amount of coverage time dedicated to COVID-19 related news on the local public television channel was measured, as well as the number of confirmed cases and deaths reported. Hand hygiene compliance in 111,071 visitors to the hospital was monitored. The baseline compliance in December 2019 was only 5.3% (213 of 4,026), however hand hygiene compliance rose from late January 2020 when the pandemic was declared, to reach almost 70% in August 2020. It then remained at a level of 70%-75% until October 2021, after which it declined slowly declined to the mid-60% range. Thus, although compliance was initially very high compared to the baseline study period, the trend changed later. It is likely that people may have become complacent after constantly hearing about the disease and stopped paying attention to important advice. There was a statistically significant association between the on-air time of COVID-19-related news and compliance. It was estimated that one additional hour of news coverage at 50% compliance would increase the compliance the next day by approximately 1%. The instructive words of experts and government officials were intended not only to educate the general public and encourage them to act rationally, but also to create conforming pressure in relation to hand hygiene. Hand hygiene was reinforced by Japanese authorities and the media repeated the same advice. People may have become more interested in cleanliness in response to the news coverage of the outbreak or public health announcements and also wanting to conform to greater expectations about hand hygiene practices as a preventive measure against spreading the infection. Further investigations are needed to determine whether high compliance with hand hygiene becomes a customary practice in daily life over time.

Morii DM, et al. The impact of television on-air time on hand hygiene compliance behaviors during COVID-19 outbreak. Am J Infect Control 2023;51:975-979. DOI: 10.1016/j.ajic.2023.03.001

September/October 2023

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The optical science of colour correction: how it works By Emeritus Professor Laurence J. Walsh AO

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the cutting | EDGE

Figure 1. Typical hard tissue cross sections of maxillary central incisors showing changes in the dentine.

Table 1. Dental concepts based on altering light reflections from teeth Vital bleaching: Oxidation of coloured molecules in dentine and enamel reduces absorption of blue/ violet light, making teeth appear less yellow.22 Polishing teeth: Enhances specular (mirror-like) reflections from the enamel surface, making teeth appear brighter.5,6 Tooth lightening: Enhanced mineralisation of the outermost enamel layer using CPP-ACP boosts reflection of blue light, making teeth appear less yellow.23 Tints on enamel and on composite and ceramic restorations: Dyes used in shade modifying kits enhance the reflection of blue and violet light, giving a permanent colour change.24 Colour correction: One or more dyes bind to the tooth/restoration surface and to pellicle to enhance the reflection of blue and violet light, making teeth appear less yellow for a temporary colour change.10-21

September/October 2023

Figure 2. Dominant light paths through maxillary incisor teeth based on directions of enamel prisms and dentine tubules, as shown on a cross section of the tooth. At the surface, some reflection occurs. Through refraction, light enters the enamel. Further refraction occurs as light enters the dentine at the DEJ. The SEM image is courtesy of Dr Frederic Meyer.

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Figure 3. Reflectance spectroscopy for direct sunlight. The upper panel shows light reflected from a natural tooth (A3 shade), while the lower panel shows the spectrum of the illuminating light. Vertical units are intensity. For the reflected light from the enamel surface, the tooth shows a 50% reduction in blue (at 450 nm) and a 2-fold increase in yellow (at 600 nm). Spectra collected using an Oceans Optics USB 2000 high resolution spectrometer.

Figure 5. Colour wheel showing the opposite nature (reciprocity) for violet-blue and yellow-orange and the wavelength ranges for particular colours of visible light.

Why teeth are yellow he apparent colour of teeth is based on which visible light wavelengths (400-700 nm) are absorbed and which are reflected.4 Absorption of violet and blue

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Figure 4. Reflectance spectoscopy using white LED illumination. The lowest panel shows the illuminating source, which uses a 450 nm blue LEF to excite a phosphor to generate broad spectrum light that resembles daylight. A white paediatric zirconia crown gives an even reflection of all the light wavelengths, while in the natural teeth, there is a marked reduction in reflection of blue light (the line at 450 nm) and a relative increase in the reflection of yellow light (the line at 575 nm). There is a distinct orange-red colour shift for the root.

light makes teeth appear yellow. This is aptly shown by reflectance spectroscopy, using direct sunlight (Figure 3) or artificial lights of known characteristics (Figure 4). When natural teeth or restorations that

are yellow are exposed to sunlight, or to artificial light, the reflected light spectrum shows a reduction in visible violet and blue light and an increase in yellow and red light.

September/October 2023

the cutting | EDGE Table 2. Published evidence for colouring correcting dyes Patents granted & patent applications Tarver JG. 2000.10 Tarver JG, et al. 2006.11 Tarver JG, et al. 2007.12 Joiner A, et al. 2016.13

Published studies using blue covarine Joiner A, et al. 2008A.14 Ashcroft AT, et al. 2008.15 Joiner A, et al. 2008B.16 Joiner A. 2009.17 Joiner A. 2010.18 Tao D, et al. 2017A.19 Tao D, et al. 2017B.20 Philpotts CJ, et al. 2017.21

Refer to the reference list for full citation details for each source. Applying the concept of the colour wheel with its complementary colours (Figure 5), if violet or blue materials are applied to the surface of teeth, these will absorb yellow light and reflect violet and blue light, making the teeth appear less yellow. As mentioned earlier, many of the aesthetic techniques used in dentistry apply the optical principles of selective absorption and reflection of light (Table 1) and colour correction is one of these. When teeth are polished and surface irregularities are reduced, more backscattered specular (mirror-like) reflections occur.5,6 The scatter process occurs more for those wavelengths that are shorter (violet and blue from 400-450 nm) than for yellow and red (600-700 nm). The way that wavelengths of blue light are scattered from enamel is very important in terms of influencing tooth colour.4,7,8 Teeth of normal shades reflect far less violet and blue light than they reflect yellow and red light, with as little as 3.5% for violet and 7.9% for blue of the incoming light being reflected.9 Based on these considerations, applying a tint or dye onto the tooth surface that reflects violet and blue light but absorbs yellow light will make a tooth appear less yellow.

Applying dyes to the tooth surface istorically, based on the patent literature, this idea of a dye that is applied to achieve a temporary effect can be credited to Jeanna Gail Tarver, a

September/October 2023

Figure 6. Dyes used in colour correction. A: blue covarine. B: erythrosine. C: brilliant blue FCF. D: D&C red 33. The original Tarver formula used B+C, while Hismile V34 uses C+D. Oral-B and Colgate toothpastes use A. Panel E shows the absorption spectrum for Hismile V34, indicating the peak absorption for the red and blue dyes at 575 nm and at 625 nm. There is minimal absorption in the violet-blue region 380-475 nm as highlighted in the box. Panel F shows the application of V34 on a toothbrush, and panel G shows the product at a high dilution rate to reveal its violet colour

Blue covarine beautician from Lehi in Utah, who added a commercial food dye to regular toothpaste, to enhance the colour of teeth. The food dye was a mixture of red 3 (erythrosine) and blue 1 (brilliant blue FCF) (Figure 6 panels B and C) and because of colour mixing effects, the dye had a violet colour.10 The concept was granted a US patent,10-12 but was not commercialised. The original patent subsequently expired in 2018.

ater work by Unilever conducted at their Port Sunlight research laboratories in Liverpool, led by Andrew Joiner, used a dye known as blue covarine (CI 74160) (Figure 6 panel A). This was added to toothpaste to enhance the appearance of the teeth, making them look brighter and less yellow.10 As a result of many successful laboratory and clinical studies (Table 2),13-21 blue covarine dye is now included in several toothpastes.

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the cutting | EDGE These include toothpastses from Oral-B and more recently the same dye has been included in a Colgate toothpaste (Figure 7). As an ingredient in toothpastes, blue covarine dye is present at a very low level and hence when checking the ingredient list on the packaging, it will be listed near the end, as CI 74160. It is important to note that in ordinary toothpastes, one or more colouring agents are normally present, such as the white pigment titanium dioxide and the colouring agents used to create special red or green stripes. These enhance the colour of the toothpaste, but do not alter the colour of the teeth. From a pharmaceutical chemistry point of view, one of the problems with using blue covarine as a dye for colour correction is that it is poorly soluble in water, but very soluble in oil. When added into toothpastes, where there is a hydrophilic vehicle of water and glycerin, the dye forms clumps and aggregates, as phase separation occurs into water-rich and oil-rich regions (Figure 7 panel C). The poor water solubility of blue covarine also influences its dilution by saliva and how it interacts with pellicle and biofilms on the surface of teeth. While an obvious solution would be to choose violet dyes to replace blue covarine, this is not feasible as many alternatives are also water insoluble and their colours are unstable and change according to the pH. Moreover, alternative violet dyes are toxic and unsuitable for inclusion into an oral care product.

Hismile V34 colour corrector serum his product is a viscous hydrophilic glycerin-based liquid containing high concentrations of a red dye (D&C red 33) and a blue dye (brilliant blue FCF) (Figure 6 panels B and C). Both are highly water-soluble non-toxic widely used food colouring dyes and are colour stable in terms of pH. This is important since intraoral pH can vary widely and pH-responsive dyes would have an unpredictable colouring effect. The colour mixing effect created by using two dyes gives a very intense violet colour. Diluting the product shows the violet colour more clearly (Figure 6 panel G). Measuring the absorption of light by

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Figure 7. Panel A shows three toothpastes with blue covarine dye and Hismile V34 colour corrector serum, with some product expressed from the containers. Panel B shows colour channel changes for typodont resin teeth after a single treatment (2 min brushing with toothpastes, or a 20 sec application for V34). Values for blue and for luminosity have increased for V34 in both experimental runs conducted one week apart, indicating a less yellow and brighter appearance. Panel C is a close up view of Oral B and Colgate toothpastes, showing clumping of the blue covarine dye. this dye combination using a laboratory spectrophotometer shows two very distinct peaks at 575 and 625 nm, which correspond to the red and the blue dyes, respectively. There is very little absorption of violet and blue light, so these visible wavelengths will instead be reflected when the dye mixture binds to pellicle on the tooth surface (Figure 6 panel E). The product is brushed onto the teeth for 20 seconds (Figure 6 panel F). It causes an

instant intense reduction in yellow and an overall boost in brightness (luminosity) for natural unrestored teeth (both enamel and root surfaces), but with no change in the appearance of the soft tissue (Figure 8). The colour boosting effect is temporary and lasts for as long as the two dyes remain bound to pellicle (several hours). The effect is reproducible and occurs to the same extent when the product is used again (e.g. 1 week later).

September/October 2023

the cutting | EDGE

Figure 8. Clinical assessments of Hismile V34, showing two before and after series (A and B; and C and D). The after images are taken immediately after expectoring the dye and traces of dye can be seen interdentally because of capillary action. Changes in luminosity (E and F) and in blue pixel channel data (G and H) for the maxillary incisor tooth enamel explain why the treated teeth appear brighter and less yellow. With both parameters, the distribution narrows and shifts to the right (higher values). In the example shown in panel A of Figure 8, the teeth have a baseline shade of A3 and no restorations are present. Performing image analysis using RGB colour channel data for the labial enamel surfaces (excluding all specular reflections) shows a boost in luminosity (Figure 8 panels E and F) and an enhancement of reflections for blue (Figure 8 panels G and H), both of which are due to changes in spectral reflectance caused by the dyes bound to the tooth surface. Measuring the delta E value (which is on a scale of 0-100) provides a robust way of determining if the changes will be visibly obvious or not to an untrained observer (delta E of above 6), or could only be seen

September/October 2023

by a trained dental professional (delta E between 3 and 6), or are below the level of discrimination (delta E below 3). In the example shown in Figure 8 panels A and B, the patient is in their early 60’s. For the upper and lower teeth, the delta E values are 11 and 14, respectively. Hence, such changes will be very obvious. Similar beneficial changes are seen when the same product is used in a patient in their mid 30s, whose teeth are a lighter shade. The boost in luminosity makes the teeth appear brighter (Figure 8 panels C and D). The dyes in V34 also bind to tooth coloured restorations, even when no salivary pellicle is present. This can be shown using typodont resin teeth. Colour channel anal-

ysis allows a comparison of the changes caused by one application of V34, with one 2-minute brushing cycle using 3 toothpastes containing blue covarine (2 Oral-B and one Colgate). In this study (Figure 7 panel B), the V34 part of the experiment was repeated after 1 week to assess reproducibility. In both experimental runs, V34 enhanced the blue channel value and the luminosity to the same extent and thus the effect was consistent across both runs. The one brushing cycle using toothpastes with blue covarine did not improve the reflection of blue light and the brightness of the teeth, but instead there was a small darkening effect with the Colgate toothpaste and this was more pronounced for both of the Oral-B toothpastes.

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the cutting | EDGE Conclusions here are several key take-home messages on the colour correction concept that can be distilled from the literature and from the experiments described above.

1. Colour correcting exploits well-known principles of linear optics and leverages the selective reflection of blue and violet light to overcome the natural tendency of tooth structure to absorb these wavelengths of light; 2. The patterns of reflection of light from teeth can be demonstrated using various forms of reflectance spectroscopy and image analysis; 3. The science of colour correction using dyes has advanced considerably over the past 25 years, since the original concept was proposed; 4. Colour correcting effects of dyes are documented in the patent literature and in multiple journal papers; 5. Colour correcting effects are visibly obvious to untrained observers, as shown by the delta E values exceeding the thresholds for meaningful change in colour; 6. Using V34 gives reproducible effects on colour; 7. The direction and magnitude of colour correcting effects vary according to the single dye or dye mixture which is used. This is because of issues such as light reflection and absorption, binding properties and interactions with water, saliva and pellicle; and 8. Colour correcting effects occur on surfaces and substrates that dyes can bind to, including the surfaces of natural teeth and pellicle, as well as restorative materials. Based on this short duration but deep dive into the science of colour correcting technology, clinicians can now hopefully better appreciate how and why this technology is used in instant effect products such as V34 and also in some toothpastes.

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References 1. Joiner A. Tooth colour: a review of the literature. J Dent. 2004; 32: 3-12. 2. Alkhatib MN, et al. Age and perception of dental appearance and tooth colour. Gerodontol. 2005; 22: 32-36. 3. Spitzer D, Ten Bosch JJ. The absorption and scattering of light in bovine and human dental enamel. Calcif Tiss Res. 1975; 17: 129-137. 4. Ten Bosch JJ, Coops JC. Tooth colour and reflectance as related to light scattering & enamel hardness. J Dent Res, 1995; 74(1): 374-380. 5. Altschuler G. Human tooth in low and high intensive light fields. Proc SPIE Medical Applications of Lasers III 1995: 2623: 68-87. 6. Patil HA, et al. Effect of various finishing procedures on the reflectivity (shine) of tooth enamel - an in-vitro study. J Clin Diagn Res. 2016; 10(8): 22-27. 7. Yu B, et al. Measurement of translucency of tooth enamel and dentin. Acta Odontol Scand. 2009; 67: 57-64. 8. Lee YK. Translucency of human teeth and dental restorative materials and its clinical relevance. J Biomed Opt. 2015; 20(4): 045002. 9. Poljak-Guberina R, et al. Prilog poznavanju utjecaja refleksije svjetlosti na boju zuba (A contribution to the knowledge on the effect of light reflection on the color of teeth). Acta Stomatol Croatica 1984; 18(4): 263-268. 10. Tarver JG, et al. Tooth whitening compositions and methods for using the same. US patent application 2006/0104922, 2006. 11. Tarver JG, et al. Tooth whitening compositions and methods for using the same. US patent application 2006/0104922, 2006. 12. Tarver JG, et al. Systems and methods for enhancing the appearance of teeth. US patent application 2007/0086960, 2007. 13. Joiner A, et al. Oral care compositions comprising a polymeric dye. European patent EP 2334479, 2016.

14. Joiner A, et al. A novel optical approach to achieving tooth whitening. J Dent. 2008; 36 (Suppl 1): S8-S14. 15. Ashcroft AT, et al. Evaluation of a new silica whitening toothpaste containing blue covarine on the colour of anterior restoration materials in vitro. J Dent. 2008; 36 (Suppl 1): S26-S31. 16. Joiner A, et al. In vitro cleaning, abrasion and fluoride efficacy of a new silica based whitening toothpaste containing blue covarine. J Dent. 2008; 36 (Suppl 1): S32-S37. 17. Joiner A. A silica toothpaste containing blue covarine: a new technological breakthrough in whitening. Int Dent J. 2009; 59(5): 284-288. 18. Joiner A. Whitening toothpastes: a review of the literature. J Dent. 2010; 38 Suppl 2: e17-24. 19. Tao D, et al. Tooth whitening evaluation of blue covarine containing toothpastes. J Dent. 2017; 67 Suppl: S20-S24. 20. Tao D, et al. In vitro and clinical evaluation of optical tooth whitening toothpastes. J Dent. 2017; 67 Suppl: S25-S28. 21. Philpotts CJ, et al. In vitro evaluation of a silica whitening toothpaste containing blue covarine on the colour of teeth containing anterior restoration materials. J Dent. 2017; 67 Suppl: S29-S33. 22. Markovic L, et al. Effects of bleaching agents on human enamel light reflectance. Operative Dent. 2010; 35(4): 405-411. 23. Walsh LJ. Tooth lightening: maximizing surface esthetics. RDH Magazine 2008: 76-82. 24. Grundler A, et al. Method and color kit for color correction of replacement teeth or natural teeth. US patent application 2005/0123880, 2005.

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 390 journal papers, with a citation count of over 18,300 citations in the literature. Laurie holds patents in 8 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.

September/October 2023

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practice | MANAGEMENT

Risky advice sources for dental practices By Graham Middleton

“A dentist who passes up an opportunity to buy a good practice... will suffer a reduced income for 30 to 35 years...”

ommonly, dental practice owners and buyers of practices take advice from a variety of sources but accountants, solicitors, marketing consultants and financial planners are common to most. However, many give ill-informed advice which often has lifelong consequences. A dentist who passes up an opportunity to buy a good practice which ticks a lot of boxes and who subsequently buys a much inferior one will suffer a reduced income for 30 to 35 years. Dentists who gets poor financial structuring advice from an accountant reinforced by a financial planner with no experience of giving overall strategic advice to a practice-owning health professional can find themselves millions of dollars (2023 value) worse off at retirement. A dentist who swallows the wrong type of “snake oil” from an ill-informed marketing

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consultant can similarly end up far worse off. Usually, these accountants, financial advisers and marketing consultants lack an holistic knowledge of dental practice performance, structuring or what makes some dentists much better off than similarly experienced dental peers.

Lifetime cost of bad accounting advice im, an assistant dentist, is looking to buy a relatively busy two-chair practice off his employer, practice owner Lee. Overall fees are about $1.1 million with Lee doing $580,000 in a 3.5-day clinical week and Tim bringing in $520,000. Tim works one day per week at another practice beyond the catchment area. Rent on the premises owned by Lee’s family trust is $44,000 per annum which is close to the average percentage of fees across the dental profession.

September/October 2023

practice | MANAGEMENT The practice, located in a middleincome suburb, is a long-established non-provider to health funds. A long-term lease is available to Tim if he buys the practice. There is space for a third surgery but it is unplumbed. Dental Earnings Before Depreciation Interest expense and Tax (DEBDIT) is a sound 58 percent. Lee’s accountant searches around for valuation advice and ends up asking $850,000. There is a tiny bit of fat in the value as equivalent practices in similar locations have recently sold for around $770,000 and Lee has figured that he will ask a bit above market and be prepared to reduce the price a bit during negotiations. Up until now, Tim has had the simplest of tax returns. He notes that an accounting practice owned by the Numbers Brothers has signage proclaiming that “We provide business advice” and makes an appointment. What is not apparent is that Numbers Brothers’ main client base are a mixture of landscape gardeners and pizza shops. Billy Numbers is not about to disclose his total lack of knowledge of the health professions and figures he can bluff his way into Tim’s confidence. He looks at Lee’s offer and proclaims it to be way above the market, which is untrue. He suggests that “you would be better off starting your own practice”. In actual fact, he has zero knowledge of the dental market nor of the costs and risks involved in establishing a dental practice. Tim’s confidence in the genuineness of Lee’s offer is shattered. He advises Lee that he will look elsewhere. In due course, he rents retail space in a shopping strip but is astonished at the fit-out cost. Meanwhile Lee has sought more informed advice. He hires a replacement assistant dentist, Sandy and has an interior decorator redo the décor of his practice. There is no mention of Tim on the practice website and existing patients making appointments are either booked to Lee or to Sandy. Very few seek out Tim and he finds that he has very few patients and struggles for years to build up a sound practice as the area surrounding his practice is serviced by established practices with loyal patient lists. Their patients refer their friends to these established practices. Tim learns a bitter lesson.

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A smarter adviser than Billy Numbers would have opened up negotiations with Lee and Lee’s advisers by asking for a joint meeting and exploring whether a compromise on purchase price could be achieved. They would also have negotiated other issues including for how long Lee would be prepared to work for Tim on a gradually reducing number of sessions per week. This would likely result in an amicable deal, making Tim much better off financially over both the short and long term. By unwittingly choosing an accountant with no knowledge of dental practice, Tim causes huge damage to his dental career

“If somebody tells you that a practice is overvalued, demand market evidence of a comparable practice and price. Accountants have a habit of telling prospective clients what they want to hear; often this is not in their best long-term interest...”

and ends up millions of dollars worse off over his dental career. Billy Numbers who gave him such poor advice suffers no financial penalty.

Poor accounting advice in a multi-chair practice arry, a long-term dental friend, employed three long term dental assistants - the “Three Amigos”. They had long been interested in buying the practice as he was approaching retirement age. The practice was housed in good premises with four equipped surgeries and the premises were available for purchase or lease at valuation. It was a long-established, non-preferred provider practice in a middle-income suburb.

Garry offered to sell the practice to the Three Amigos at a fair price. Although modestly priced, the deal was refused, based on the low-ball valuation of a person who held himself out to have expertise in dental valuations. The Three Amigos then fitted out a startup practice with three surgeries adjacent to a nearby shopping strip. Based on the cost of dental fit outs, they would have spent far more than the accountant’s advice as to the value of the practice that they passed up and in which they enjoyed existing banks of patients. Meanwhile, there was a delay in set up. Since patients have a strong tendency to make appointments with their existing dental practice, there was negligible change in the number of patients attending Garry’s practice. Garry’s website made no mention of the Three Amigos and the practice telephone number remained unchanged. Subsequent requests for dental records indicated that very few patients followed the Three Amigos to their start up or even heard of it as they continued to make appointments to Garry’s practice and were efficiently booked to Garry or his new assistant dentists. Garry subsequently sold the practice and agreed to work for the new owners for a reasonable handover period. The Three Amigos had to contemplate the continued success of the practice that they passed up based on poor advice. Like Lee’s practice, the long-term cost of having to equip, fit out and build up a practice from a near zero patient base leaves each of them vastly worse off financially in the long term. They are saddled with an expensive start up in an area dominated by a number of long-established successful practices with loyal patient followings. Those loyal patients continue to refer their friends and hence they do not use the Three Amigos’ practice. The accountant who gave them poor advice will never be held financially accountable for the huge lost opportunity cost of the decision that he advised.

The lesson f somebody tells you that a practice is overvalued, demand market evidence of a comparable practice and price. Accountants have a habit of telling prospective clients what they want to hear; often this is not in their best long-term interest.

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practice | MANAGEMENT Incompetent solicitor and accountant create costly delays and result in the offer being withdrawn three-chair specialist practice is offered to one of the employed specialists, Jamahl, who is contracted full time for significantly less than the fit out and equipping cost of three surgeries on the basis that there will be continuity of practice. Samantha, the vendor, makes the price attractive to the buyer as she wishes to have an orderly path to retirement after working for the new owner on a gradually declining availability basis. The premises are offered for rent at fair market rental or for sale at valuation. The proposed contract of sale is drawn up by an experienced solicitor who has long specialised in advising dental clients. The potential buyer consults an accountant with insignificant knowledge of dental/dental specialist matters who introduces a solicitor who also lacks relevant experience. Her work mainly consists of conveyancing and drawing up wills. The solicitor and accountant keep making irrational changes which have to be put right causing significant extra legal and accounting expense to the vendor. Eventually, Samantha says she is going to terminate the deal and sell the premises, a converted house, located in an area with hot demand. The premises are converted back to a home and sold for a handsome price. Jamahl moves on but he cannot find a career option as good as the one that his inept solicitor and accountant killed off. Jamahl also finds that while bankers were happy to finance an existing practice with a reliable income, they are reluctant to finance a start-up and charge a higher interest rate with tougher conditions. The inept accountant and solicitor have cost Jamahl a valuable business opportunity through their lack of knowledge and incompetent advice. He will eventually start up a referral practice elsewhere and approach referring dentists to reconnect with him but many of them have begun referring elsewhere. This will take considerable time and expense. His long-term loss is incalculable. Those who poorly advised him suffer no financial pain.

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The lesson mong the myriad of accountants, there are only a small proportion of competent business advisers and only a very few of those are competent to advise dental practice owners. Most simply complete annual tax accounting financials. Only a small proportion of lawyers are competent business advisers; relatively few lawyers or accountants are competent negotiators.

Fast talking marketing consultant misadvises dentist enry had been an assistant dentist in George’s upmarket practice for several years and had been mentored by him.

“Among the myriad of accountants, there are only a small proportion of competent business advisers and only a very few of those are competent to advise dental practice owners. Most simply complete annual tax accounting financials...”

His skill level, although lagging behind that of George, had grown appreciably by the time her was offered the opportunity of purchasing a dental associateship. This consisted of the patient list treated by him and in addition, George was prepared to ensure that Henry would receive a substantial majority of new patients for the next three years consisting both of Henry’s own referrals and any new patients not specifically requesting to be treated by George. The rent on the premises was set by an arms-length appraisal. It appeared to go well for a time, but George noticed that Henry’s patient conversion rate remained well below his own and he was feeding off patients connected to his own patients but who had not specifically requested George. George suggested ways in which Henry could improve his

conversion rate and his personal referral rate, but Henry appeared uninterested. After his three-year obligation ceased, George reclaimed half of unreferred patients and his own personal referrals. Henry’s referral rate remained poor and his patient conversion rate remained well below George’s. Henry’s income plummeted and he blamed George, but failed to recognize that it was his own shortcomings causing his poor results. Henry’s wife introduced a friend’s friend, Mr Smooth - a marketing consultant. Smooth was very convincing and persuaded Henry that he could have all the patients he needed if he engaged Smooth’s service to construct his own marketing plan. It is doubtful that Smooth had advised any self-employed health professionals and his marketing plan involving lots of internet web-based marketing more suitable for businesses not dependent on close personal loyalties. Despite Smooth’s expensive efforts, Henry’s fees remained far below George’s and his fees were very costly. The practice receptionist noticed that there were negligible new patients from Smooth’s marketing plan whereas George’s patients continued to have high treatment conversion rates and consistently referred their friends. Eventually, Henry realized his costly mistake and listened carefully to George. He sought assistance to improve his chairside skills and ended his experiment with Smooth. The interlude was hugely expensive in the loss of income.

A key lesson here are relatively few marketing consultants who understand that successful dentists overwhelmingly achieve success through their chairside interpersonal skills and the presentation of their practice plus steady improvement in their clinical skills.

The two dental practice town or a number of years, I viewed the financials of two dental practice owners in a medium size town about 3-4 hours drive from a major city. I will call them Leo and Phineas. Leo had purchased his practice from another client of mine and followed advice to be communityminded, give good treatment and earn the trust of the town. He employed the pre-

September/October 2023

practice | MANAGEMENT vious owner for several years part time. He painted his premises, was seen to support the local football team and had a standing instruction with his receptionist that if the local kids’ netball or footy team walked in seeking to sell raffle tickets to support the team, she was to buy $5 worth out of petty cash. Leo wasn’t interested in the prize, he just knew that it was wise to be a responsible member of the community. He and his two assistant dentists (one part time) respected their patients and Leo was confident that patients would return and, having won their confidence, would accept necessarily more expensive treatments over time. Phineas, who had a similar size practice, was addicted to expensive practice development plans. Although his practice showed little benefit from a one-year plan, he signed for the three-year Bonanza version complete with annual get-together seminars with other dentists in an exotic location and kept extending the arrangement. Year after year I observed that Leo, who concentrated on good patient relationships and was not interested in marketing schemes, significantly outperformed Phineas who was distracted by practice development/marketing schemes. He forgot lesson number one in a country town, which is to be community-minded and concentrate on friendly relations with the locals. The town population accepted Leo but were unsure about Phineas. Leo’s practice thrived while Phineas’ practice stagnated. Country people are community-minded and quick to assess outsiders practising in their town.

The lessons any consultants make extravagant claims but lack a financial means of measuring practice financial performance including the growth in the net worth of their clients. They often give advice which is not cost-effective. In many cases, their advice is financially damaging. Dental success lies in the presentation of a practice and chairside communication skills overlaying clinical ability.

Overall lessons entists who buy practices based on sound advice, structure their practice correctly, own suitable premises and present themselves and their practice cor-

September/October 2023

rectly end up millions of dollars better off over their full career than do dentists who spend their careers as dental contractors. The most common reasons for failure to achieve optimum benefits arise from inept advice from accountants misleading them by pretending that they have significant knowledge of dentist practices and their expected outcome. Relatively few accountants and advisers have a sufficiently deep knowledge of dental practices and of how dentists grow their wealth. Back to business and financial basics 33 years of advising dental and veterinary practice owners on a full range of business and financial matters demonstrated conclusively that overwhelmingly the successful ones had concentrated on ownership of four core assets. These were:

“Many consultants make extravagant claims but lack a financial means of measuring practice financial performance including the growth in the net worth of their clients. They often give advice which is not cost-effective. In many cases, their advice is financially damaging...”

1. Their long-term family home; 2. Their practice; 3. Their practice premises; and 4. Their family superannuation fund. There is a huge difference in the financial outcomes of dental practice owners, often dependent on the relative knowledge of their advisers. Over many years of being consulted for the first time by dentists I observed that invariably they were in a much inferior financial condition than those long-term dental clients who had got their key financial structures and practice settings right in the beginning. Further valuable advice Please read my book “Financial success for dentists”. See my website at grahamgeorgemiddleton.com for further details and valuable information. Payment for the book is via donation to the Delany

Foundation, a registered charity. All costs of printing and mailing are met by me personally.

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 in 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 of Financial Success for Dentists by making a donation of minimum $60 to the Delany Foundation, a registered charity which assists schools in Ghana, Kenya and Papua New Guinea. Donations can be made at delaneyfoundation.org.au, then email 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.

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The power of words: Choosing truth over meaning for personal growth and progress By Julie Parker

have a friend who recently shared her frustration when someone routinely turned up late to meetings. My friend stated, “This means that this person doesn’t respect me”. I immediately thought of something I hear Charles say: “Be precise with your words, because their meaning has an impact”. The words we use to describe an event are not always accurate. In fact, they usually aren’t. The “knowledge” we formulate in our minds from an event is typically the MEANING we have elected to create from it. As such, this interpretation is highly subjective, assumptive and biased. Here are some examples... Situation: A mother doesn’t pick her child up from school at the correct time. Child’s meaning: “Mum doesn’t care about me”. Truth: “Mum did not arrive on time and I do not have enough information to determine the cause”. Situation: A friend cancels plans at the last minute. Created meaning: “My friend doesn’t value our friendship”. Truth: “My friend cancelled our plans abruptly, but I don’t know the exact reason behind it”. Situation: A co-worker misses a deadline. Created meaning: “My co-worker is irresponsible and unreliable”.

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Truth: “My co-worker did not meet the deadline and I am unsure about the reasons for the failure.” When we create for ourselves a meaning over truth, our thoughts, feelings, responses and beliefs are generated from that created meaning. The danger is, we start managing our personal lives,

“Mistakes and failure are how we learn and grow. Flip the meaning you attach to your ‘failings’ and embrace your growth journey. You are getting better and stronger all the time. You get stronger every time you fall and get back up. This is LIFE. This is how you learnt to walk and run. This is how you master your life...” relationships and experiences based on the created meaning or stories that we tell ourselves, not the truth, not the reality. There are a range of created stories that we tell ourselves that can actually sabotage our lives and our careers in very big ways. For example... “When I get more money/opportunity/ health, then my life will be great.” “I would achieve more/do more/have goals, but I don’t have the time to take action.”

“This aspect of my life is not working for me, but I am unable to change because of the size of my mortgage.” If we have the ability to be “precise with our words”, why do we create fake stories or meaning instead? Sometimes, it’s to feel better about our failings. For example, “I didn’t place well in the race because others had a greater advantage over me” or “I am overweight because of my slow metabolism”. Another reason we create stories over truth is cognitive dissonance. That is, the way I am behaving is incongruent with the identity I have of myself, so I am going to make up a story because the truth doesn’t match my identity. But, I suggest that the biggest reason why we believe our created stories over the truth is to avoid taking responsibility in our lives. We dislike feelings of discomfort, disempowering thoughts, ramifications of our behaviours and poor results that we have caused so we create more tolerable meanings. Even though it feels way more comfortable to avoid taking responsibility, there is one hell of a drawback: you lose control over your own life. When you create and believe your stories, you are telling yourself that you are at the mercy of all the things around you: people, events and bad luck. You are telling yourself that you are a victim. Thus, you cannot have control if you have already given it away through your created meaning and stories. So, what can be done to immediately take responsibility in your life?

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practice | MANAGEMENT Understand your strength e often defer responsibility because we fear we cannot cope with our own failures and mistakes. Remind yourself that this is just not true. Mistakes and failure are how we learn and grow. Flip the meaning you attach to your “failings” and embrace your growth journey. You are getting better and stronger all the time. You get stronger every time you fall and get back up. This is LIFE. This is how you learnt to walk and run. This is how you master your life.

Be mindful and contemplative ake the time to truthfully and accurately contemplate your thoughts, actions and results. If the results are undesirable, identify what you could have done if you had your time over to achieve a more positive outcome. This awareness will serve your future in a powerful way. Journaling can be a great method for accurate and effective contemplation.

without making mistakes. A negative response to mistakes usually comes from a conscious or even subconscious belief. Start repeating a mantra to yourself when you would normally feel regretful or ashamed of your mistake, such as “despite not being perfect, I still completely love and accept myself”. Embrace your humanness and the need for mistakes on the journey of growth and progress. By being precise with our words, embracing our mistakes, practising selfawareness and taking full responsibility for our actions, we can regain control over our lives and embrace the real challenges of our journey of personal growth.

Practice makes better o one learns to ride a unicycle on their first try. It takes practice and lots of it. And life is more complicated than learning to ride a unicycle, so give yourself many opportunities to practice and get better at the game of life.

Stop saying “because” he moment we say “because”, we’re providing an excuse or reason why we are not fully responsible for an outcome. “I am late because of the traffic”.” “I forgot our anniversary because I’ve been so busy with work”. Remove the word “because” and take full responsibility: “I apologise that I am late”.

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 more information, please contact Julie on 0407-657-729 or julie@julieparkerpracticesuccess.com.au

Embrace your humanness o err is human. To forgive, divine. Forgive yourself every time you fail or make a mistake. Mistakes are how you learn and grow. You cannot get better

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September/October 2023

Australasian Dental Practice 89

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When to hold ‘em and when to fold ‘em: What poker can teach us about exit planning By Simon Palmer

o play poker, a player needs to put money in at the beginning of each hand in order to get dealt their cards. The player then needs to choose to invest further with every additional round of cards that are drawn. With each round of cards that are dealt, the probability of

success changes. A good poker player will be keeping note of the cards that are dealt and continually re-assessing their odds of winning.

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When the odds are in their favour, a good poker player will continue to bet - and when they aren’t, they will quit (or “fold”). Poker is unlike almost any other game, in that being successful is not just a measure of how you play the cards that you’re dealt... being successful is also a measure of the cards that you choose NOT to play. A professional poker player will play only a mere 15-25% of the starting cards that they are dealt (an amateur will choose to play over 50%). The measure of a good poker player lies in their ability to navigate the sunk-cost fallacy.

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practice | MANAGEMENT The sunk-cost fallacy is a strong cognitive bias that exists in most people, in which there will be a strong urge to continue to invest resources (such as time, money or effort) into an activity that is unlikely to yield a positive return, simply because they have already invested so much in it. A poor poker player will fall victim to the sunk-cost fallacy if they continue to invest in a hand they have a low chance of winning. Their emotional attachment to the chips they have already put in makes them believe that they can somehow “turn it around”. Great business owners are similar to good poker players, in that they are also characterised not just by how well they run their businesses, but also by the timing of when they decide to sell and retire. They often have so much invested in their businesses (in time, effort, money, identity) that they hold onto their businesses and careers past the point when all the evidence around them seems to indicate that it is in decline, time to sell, or not the best use of their resources. In this regard, the measure of a good business owner also lies in their ability to navigate the sunk-cost fallacy. So... as a business owner, how do you avoid falling victim to the sunk cost fallacy?

1. Being able to read the signs n business - and in poker - you need to be keeping a close eye on “the cards you are dealt” so that you can notice when the odds of success change. In business, this means keeping an eye on KPIs like revenue, expenses, profit, competition, new patient flow, etc.

2. Being able to recognise your emotions n business - and in poker - it’s important to make important decisions rationally and unemotionally. If you are deciding to stay, is it because you have read the signs and rationally assessed the positive prospects of the future? Or is there an irrational/emotional anchor keeping you from moving forward?

3. Make decisions based upon the facts on the ground nce you’ve read the signs and kept your emotions in check, you simply need to make logical decisions based on the facts.

In poker - and in business - the sunkcost fallacy makes a person’s rational analysis of the likely future returns diffi-

cult to assess, because they are blinded by their past investment. When this happens, it’s impossible to know when it is the right time to move on. In business ownership - and in poker winning is not about each transaction, it’s all about the long game - and winning the long game is not just about playing well, it’s about knowing when to stop. Knowing “when to hold ‘em and when to fold ‘em” so that you are ahead after the total amount of time and hands played.

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

Lisa Singh National Account Manager

September/October 2023

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3 important parts of every call By Jayne Bandy

hen you answer the phone in a dental practice, it’s very easy to lose sight of “WHY” the person has called in the first place. To avoid this happening, all you need to start doing is these three things: 1. Ask the right questions; 2. Listen carefully; and 3. Schedule the appointment. It’s this simple. Or is it? This is how the call goes most of the time. The person calling your practice starts the conversation with a question. The team member answering the calls believes they are doing the right thing and immediately answers the question. Some of the questions asked, include: • How much does it cost for a filling? • Do you have parking? • Do you have an appointment today? • How much will I get back with my Health Insurance? At this point in the conversation, you have not asked for the caller’s name, you don’t know if they are a new patient or existing patient, you have not asked questions to find out exactly what the caller needs and how you can help them. Answering a caller’s first question too soon is not good. Imagine this scenario... The caller wants to know if you have an appointment today. You say no, then the caller thanks you and hangs up. Is this a missed opportunity? Yes, it is a MISSED OPPORTUNITY! What you need to do is FLIP the conversation so you can start to ask questions. But how do you do this without sounding rude and the caller feeling like you are just ignoring their first question. It’s very easy once you get into the habit of doing it. First, ask who you are speaking with. “Who am I speaking with?” Then you ask this question. “John, so I can help you with that, do you mind if I ask you a few questions first?”

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You have asked for permission to start asking questions. The caller is OK with you leap frogging over their initial question because you have framed it up that you are still going to answer their question after you ask your questions. This is a very easy way to now gain control of the call, build value on the call and help the caller eventually schedule an appointment.

Call Tracking Excellence is not a product IT’S A RESULT! With Call Tracking Excellence your team will learn the SAME exact processes Jayne used to: 1. Dramatically improve new patient call-in conversions to booked appointments. 2. Retain existing patient appointments and... 3. Prevent ongoing losses from appointment cancellations. Visit the website to find out how to get started. It’s that easy! www.calltrackingexcellence.com

Using this communication strategy will turn more calls into appointments, especially if your team are struggling when asked questions at the start of the call. Asking the caller questions and gathering information is much better than answering the caller’s questions and being an information giver. You end up providing the caller with more relevant information by asking questions to find out exactly what the caller needs to know. It does take practice and time to develop the skill of asking great questions. Once you start asking questions, you are now listening to the caller which is much better than doing all the talking while the caller listens to you.

You find out so much more. Be an active listener. Pay attention. Ensure your next question flows on from your previous question and is relevant to the caller’s last answer. Taking notes helps to keep you on track so you are in control of the call. Everyone calling your practice wants to have the opportunity to speak and be listened to, so ask questions to give the caller this opportunity. You want to find out more, then find out even more. Asking questions is the only way to do this. Have you ever had a person ask you all the right questions and you felt like they knew what they were doing and you trusted them? This is what happens when your team start asking questions on phone calls. And MORE calls will become APPOINTMENTS. To find out how I can teach your team to know what to say and ask your patients, to help them make more kept appointments and prevent cancellations, call me on 1300-378-044 or email jayne@thedpe.com

About the author 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.

September/October 2023

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practice | MANAGEMENT

How dental practice owners can buy back their time By Dr Jesse Green

ime. It may be cliche, but it’s our most precious resource and the relationship between time and money has always been a delicate balancing act at best. In my early days as a dental practice owner, my goal was clear: make more money. But as I began to see success in my business and started navigating the complex world of running a dental practice, another goal soon emerged: the luxury of personal time. Just like a hierarchy of human needs, there’s a hierarchy in business. Initially, it’s all about cash flow, the vital fuel that keeps a business alive. But once you’ve reached a particular financial milestone,

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a craving for more time to enjoy life and find personal satisfaction becomes more pressing, creating an intriguing paradox, a constant tug-of-war between increasing income and the longing to reclaim personal time. The challenge lies in striking the perfect balance between professional gain and personal freedom. I’m sure many of you know the struggle I’m talking about here, especially when success leads to what feels like golden handcuffs. I’ve been on both sides of that struggle. Today, I want to share my experiences and insights into buying back your time and guide you through reengineering your business to align with your true desires and avoid the mistake of creating a business you don’t love.

September/October 2023

practice | MANAGEMENT Lessons from my own life y journey to becoming a dentist started with excitement and high hopes. I had run successful businesses before, where I learned about sales, marketing and being a leader, so I was sure I could build a successful business. But when I started my dental practice, I put all that experience aside and followed traditional practice management teachings. While the finances were stable, I soon found myself desperately unhappy. If I wasn’t there, I wasn’t earning; if I wasn’t earning, the business was going backwards. Days filled with dentistry and nights with admin activities left me drained. I spent my evenings and weekends catching up and it took a toll on my family life and personal health. My kids, my health and happiness had to take a back seat and I felt like I was missing out on what was most important. Successful people don’t fail because their businesses aren’t profitable; they fail because they create a company they don’t love and I was no exception. This constant stress and guilt eventually caught up with me and I felt forced to sell the business, a decision I recognise as probably one of my biggest financial mistakes. After selling my practice, I reflected and realised I had made a mistake. But it wasn’t the business that was the problem; it was how I had designed it. I started other companies outside of dentistry and began to see that it was possible to create a business that I loved. If you’re feeling burned out like I was, I encourage you to avoid making the same mistake I made. Instead of feeling like you must choose between a great business or a great life, think about reengineering your business to create something you love. Optimise it for the money you want to make and the time you want to have for yourself, your family and your life. The idea is simple but important: You can redesign your business to maximise money and personal time. That is, as long as you understand the proper steps you need to take.

the collective strengths of a team, aiming to maximise efficiency and productivity. For business owners, the relentless deluge of responsibilities often threatens to overwhelm them, making the need for a systematic approach to task management crucial. But in this vast sea of duties, how do you discern the tasks to keep and those to distribute? I’ve found that three factors best guide this pivotal decision.

The three pillars of delegation decision-making 1. Monetary value he “effective hourly rate”, which is effectively your earnings divided by the number of hours you put into your practice, allows you to determine which tasks you could delegate quickly. In contrast to a high clinical billing rate, delegation becomes a realistic alternative if a task can be entrusted to someone at a lower hourly rate than your effective rate. After all, organisations are not supposed to thrive on chores that sap their financial effectiveness.

2. Energy dynamics ot all tasks align with an individual’s interests or strengths and this misalignment can be energy-draining. Energy is an underrated currency in business. If a task isn’t your forte or passion, delegate it. Surprisingly, there’s likely someone who finds pleasure in the very task you dread. It’s all about aligning passions and strengths, making the business environment energetic and vibrant.

3. Impact assessment Using the 80/20 rule

The power of delegation

he essence here is to pinpoint tasks that genuinely impact business growth. While many jobs might seem essential, only a select few truly “move the needle”. Adhering to the 80/20 rule, prioritise the 20% of tasks that generate 80% of the results, delegating trivial ones that don’t substantially impact the business.

he first step before doing anything else is learning how to delegate effectively. In the complex business world, delegation stands as a beacon of efficiency. It is the art of skilfully allocating tasks to harness

By embracing the three pillars of delegation, determining what to delegate becomes refreshingly straightforward. Monetary considerations ensure fiscal prudence; energy dynamics lead to role-

September/October 2023

passion alignment; and impact assessment zeros in on pivotal tasks. These factors combine to make delegation choices almost automatic, streamlining the process with finesse and precision.

The importance of trust t’s important to understand that delegating tasks isn’t just a matter of offloading work; it’s an intricate dance that requires strategic thought. When done right, it can be transformative. The success of delegation lies in effectively preparing the person you’re entrusting with the job. This means providing thorough training to understand the task’s nuances and ensuring they have the necessary resources, tools, time or additional manpower. Monitoring is equally critical - not in the sense of micromanagement, but to ensure there’s ongoing support. This monitoring helps in pre-empting challenges and ensuring smooth task progression. Further, establishing clear communication channels ensures that those delegated jobs can raise concerns, ask questions and provide updates. This mutual exchange of feedback ensures that tasks are on track and standards are met consistently. Lastly, remember that the act of delegation is a sign of trust. It frees up your valuable time and empowers others, nurturing their growth within the company. This means that proper delegation doesn’t just enhance efficiency; it builds more robust, more confident teams.

Training: The underestimated powerhouse n sports, athletes prioritise training over competition; they train for hours but compete for just a fraction of that time. I’ve always found it odd how the business world often flips this model, focusing on competition at the expense of training. This distinction is particularly evident in dental practices, where training usually takes a back seat, even though it’s vital. Nearly every dental practice undergoes training, but many still overlook its potential. While external training courses are valuable, they do not substitute robust internal training. Efficient integration of new team members, competency benchmarks and effective knowledge transfer can transform a practice, offering a strategic advantage.

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practice | MANAGEMENT The resources must be tailored to allow for active learning, not just passive absorption, whether it be with videos, documentation or audio. Assessing and confirming competency ensures a steady improvement in skills, not a slow deterioration. The transformational power of training is seen in practices that excel at taking inexperienced individuals and turning them into pros in a short span. This metamorphosis from rookie to pro is a significant competitive advantage that can’t be overlooked.

Elevate with education aintaining a training edge requires consistent, systematic and prioritised training. Regular mentoring ensures that competencies are supported and guards against losing valuable insights when a skilled person leaves. The dental practice must become a training institution, capturing what “great” looks like and decoding it into an actionable process. Sadly, when business heats up, training is often the first sacrifice. This short-term thinking must be replaced by a long-term vision, where you see training as an investment in the future, not just an immediate need. Recognising training as a powerhouse ensures that it builds efficiency and fosters growth, skill development and a competitive edge in the industry.

Elevating dentistry with strategic hiring he journey of establishing and running a successful dental practice involves evolving, adapting and making significant decisions about allocating time and resources. A pivotal moment for many dental practices is transitioning from primarily focusing on clinical work to fostering a business growth mindset. This shift is life-saving for those who feel trapped in the cycle of 9-to-5 dentistry.

Mindset matters he first challenge lies in the mindset shift. Understand that stepping back from direct clinical work isn’t a lost opportunity but an invaluable chance to

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invest in your practice’s broader growth and well-being. By allocating time to nurture your team and put solid standard operating procedures in place, you can set the stage for an infrastructure that grants you more freedom and flexibility. However, you’ll need to delegate some clinical responsibilities to navigate this transition smoothly. Whether you hire an associate dentist, dental hygienist or oral health therapist is up to you and can be tailored to your practice’s unique needs. Initially, you might lean towards offloading fundamental tasks, such as dental hygiene or routine adult treatments. But as your practice expands and demands grow, you might see the merit in bringing on board more specialised roles. For instance, a treatment coordinator can focus on presenting and selling treatment plans, ensuring consistent revenue generation. This step ensures that the principal dentist isn’t the sole revenue-generator and that there’s no drop in revenue when they reduce their clinical time.

Streamlining administration fter you’ve built a solid clinical and sales team, your next step is to alleviate administrative pressures. Consider hiring a personal or executive assistant. This can free up your time to focus on higher-level strategy and growth. They can manage your calendar, emails and individual tasks. Depending on your practice’s specific needs, this role can be full-time, part-time or even virtual. As your practice grows, you might need higher-level strategic oversight. This is where roles like General Managers or Operations Managers become essential. These individuals focus on the broader business strategy and leadership for you. It’s vital to differentiate between traditional practice managers who might excel in administrative tasks but need more leadership capabilities and general managers who bring in-depth strategy and leadership skills. Your hiring roadmap can look like this: 1. Offloading clinical work; 2. Ensuring consistent sales and revenue; 3. Streamlining administrative tasks; and 4. Concentrating on higher-level strategic and leadership roles.

Always ensure your hiring sequence aligns with your practice’s specific friction points and needs. This strategic sequence of hiring, combined with effective delegation, in-house training and nurturing internal capabilities, is your path towards a thriving dental practice and personal freedom. Your ultimate goal is to enjoy the benefits of your hard work and lead a fulfilling life beyond your clinic’s walls.

Breaking the golden handcuffs our journey as a dental practice owner isn’t solely about earning an income; it’s about ensuring that your revenue doesn’t sacrifice your freedom. The key to finding balance is evaluating your business trajectory, pinpointing friction points and making strategic hiring decisions. Embracing the idea of progressing up the organisational chart and nurturing a mindset of delegation, mentorship and in-house training is crucial for you. These actions ensure you can effectively replace yourself in different roles over time and grant you the luxury of enjoying the results of your hard work without being consumed by daily responsibilities. The vision is clear yet profound: build a dental practice that isn’t just about revenue but also affords you the time and freedom to experience life’s broader landscapes. You must challenge the status quo to break those golden handcuffs, creating a harmonious blend of business achievement and personal satisfaction. With these insights and strategies, you are better positioned to steer your path, ensuring professional growth and a life you cherish. As the saying goes, it’s not just about the destination but the journey and you deserve a lucrative and enriching one.

About the author Dr Jesse Green is a leading business coach for dentists, author of Retention and a sought-after speaker. 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 practice owners who want to earn more and work less. Get your personalised plan to grow and scale your practice by booking a Practice Growth Call. To book, call the Savvy Dentist team on 1300-668-384 or visit https://savvydentist.com/growthcall

September/October 2023

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marketing | INSIGHTS

Two questions about your team you may not want to answer By Angus Pryor, MBA (Marketing)

recently read a book about growing your business above $2 million a year. It turns out that in Australia, this is quite a significant threshold - businesses that are above or below $2m - only 7% of businesses make the leap. The reason why this leap is significant is because there is a different skillset required for the $2m+ business. And a key focus of that skillset involves how you build your team. I’m aware that I’m the marketing guy and that’s what you’d usually expect me to write about. However, it’s fair to say that there’s a strong link between growth and marketing (otherwise why market?) and if you don’t get your team working well, your growth plans will be thwarted. In this article, we’ll look at two questions about your team you may not want to answer.

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Why do you want to grow your business? confess, growth is seriously my thing. Personality tests have shown that I’m on this planet to grow people and grow business. Do you find growth exciting? Growth in your business, growth in your capabilities, growth in your team? However, amid the growth-related dopamine hit, it’s worth examining why you want to grow. Is it about more personal income, creating something of significance, or impacting more people? Truthfully, growth is not for everyone - you may be happy with a good income and a well-balanced life without feeling the need to shoot for the stars in your practice. However, if growth is what you’re after, then brace yourself for some uncomfortable (but important) questions about your team. Here goes...

September/October 2023

marketing | INSIGHTS Question one s noted above, there is a different skillset required to achieve a business that is doing more than $2m in revenue. A key part is the business owner trusting capable others to do the things that the business owner can hand over. Put it this way, you cannot expect to be a control freak and assume you will grow your business past $2m. You cannot expect to be closely involved in every part of the business for it to grow. You’ll become a bottle neck and inadvertently block your own growth aspirations. So, assuming that you must release some control to competent team members, you’re going to need competent team members, aren’t you? And in a business that’s been in place for some time, you may find you have team members who are on board basically for historic reasons, rather than because of their superior competence. For example, the skills that the employee had that served the smaller version of your business might not be the skills you need in the bigger version of your business. So, here’s the first question you might not want to answer:

“If you sacked everyone in your company right now, who would/wouldn’t you re-employ?” I can say from personal experience, there have been many times in my business career where the answer to this question about certain existing team members would have been “no”. It’s an uncomfortable question to consider, but it’s essential to do so to achieve your growth aspirations.

Question two n spite of the challenging nature of question one, it is still relatively straightforward to think about. Typically, it means you need someone to do that role, but possibly not the person that’s currently in the role. It requires some mental energy to figure out a way forward, but with sufficient will, it’s do-able. Question two, however, is a bit harder and goes like this: “If you didn’t have a specific role for that person, would you still have them in the business somewhere?”

September/October 2023

This is a much harder question because it means creating a part of your business that doesn’t currently exist. That’s much harder than simply hiring a new employee to fill a gap left by another employee. More on that below.

What do I do with people I wouldn’t rehire? lright, I’ve laid on you some heavy questions, but you’re still here, so let’s talk about what’s next? For question one (about whether you’d rehire someone), you have some decisions to make about team members in the “no” category. The challenge with this group is that they may not be that bad. If they were really bad, you’d have got rid of them some time ago. Yet, there’s obviously some shortfall, since you wouldn’t be prepared to rehire them. It is said that “the enemy of a great life is a good life” and I’d say that’s probably the issue you’re facing here. You’ve got a good employee, but not a great one. Before we explore your options from here, let me tell you something I’ve learnt after several decades of management/ leadership roles:

If you pay less, it will be easier on your budget, but you’ll probably find that things grow slower because you’re dealing with a less competent individual (not always true, but usually this is how it rolls). On the other hand, if you’re prepared to pay more to get someone great, it’s tougher on your budget, but you can expect better performance and faster company growth.

I’ve never once regretted moving someone on whose performance was less than great. In fact, my only regret (and it’s been a frequent one) is that I didn’t move them on earlier! Further, I’ve discussed this with many other managers who have all said the same thing. So, what to do now? If you find yourself thinking that you’re worried you might not get anyone better, there are two possibilities. The first may be a mindset issue. Do you believe that you don’t deserve better employees? Do you actually think there aren’t better employees out there? In my experience, it really is a case of “seek and you shall find”. Once you start looking for someone better (and do the necessary recruiting), they’ll usually turn up. The second issue may be more about the dollars and cents. A mentor of mine said something very interesting about hiring staff, noting you typically have a choice between how much you pay them and how fast they help you grow.

What if I don’t have a role for them now? f you have an employee who you’d want to keep even if you don’t have a role for them, this suggests you value their abilities highly. Fortunately, this is a good problem to have. If you’re aiming to breach the $2m threshold, then you’re going to need to delegate more and hand responsibilities to competent others. In the context of that growth environment, having this person on your team is probably just what you need. Bring them along for the journey and let them help shape what your $2m+ company looks like.

Conclusion friend of mine notes that success in life is in direct proportion to the number of uncomfortable conversations you have. In this article, I’ve posed two uncomfortable questions for you. While they can be hard to consider, they are nevertheless an essential part of what’s required for your practice to grow past the $2m mark. For you from here, the choices are simple (though not always easy). Ask yourself the two questions I’ve posed, then contemplate your next steps.

About the author Multi-award-winning Practice Growth Specialist, Angus Pryor, is an author, marketer and international speaker. He is the #1 Google-ranked dental marketer in Australia. In 2023, Angus’ team at Dental Marketing Solutions received the ADIA’s marketing award. More details are at www.DentalMarketingSolutions.com.au. For a smarter, cheaper solution to finding great team members doing particular tasks, there is a solution. To find out how to unlock the gold in your practice from incomplete treatment plans, reactivations and more (and to access free sources), visit www.DentalStars.com.au.

Australasian Dental Practice 99

finance | INVESTMENT

What does the recent review of the Reserve Bank of Australia mean for you? Findings and recommendations of an historic independent review of the Reserve Bank of Australia (RBA) have been released, providing a comprehensive look under the hood of Australia’s central bank, as well as the bank’s own internal governance and processes. By Lena Ridley, CEO, Profile Financial Services and Heidi Liling, Associate Director, Investments, Willis Towers Watson

n the 20th of April, the findings and recommendations of an historic independent review of the Reserve Bank of Australia (RBA) were released. This was a comprehensive look under the hood of Australia’s central bank, turning the spotlight on performance of the monetary policy decision-making processes and framework over the last

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decade, as well as the bank’s own internal governance and processes. The review makes 51 recommendations focused for the most part on improving on the inputs used in cash rate decision making and ensuring greater clarity for the public around the rationale of rate decisions. The governmental response is initially supportive and all recommendations have been agreed with in principle by Australian Treasurer, Jim Chalmers.

“The review makes 51 recommendations focused for the most part on improving on the inputs used in cash rate decision making and ensuring greater clarity for the public....”

September/October 2023

finance | INVESTMENT THE KEY RECOMMENDATIONS Leadership structure • The review recommends an overhaul of the leadership structure of the bank; • Most significantly, the review panel recommended the abolishment of the current board and the subsequent establishment of two separate boards; n

One monetary board with the sole purpose of setting monetary policy (cash rate decisions); and Another board responsible for overseeing the bank’s day-to-day management and governance.

• It has been conceded that the current setup falls far below contemporary best practice standards and this move would align the Reserve Bank of Australia with other central bank peers including the Bank of England and the United States’ Federal Reserve.

Monetary board meetings • The review recommends revising the frequency of the monetary board meetings from 11 times to eight times a year. • It also emphasises the need for greater transparency from the board around its decision making, with the following recommendations: n A press conference should follow each monetary policy meeting as well as a written statement; n Unattributed votes on decisions be published; and n The bank should release more of the research and data that form the basis of interest rate decisions.

Board composition • Shortcomings were found within the composition of the current board, noting specifically the limited challenge the board was able to provide to the RBA executive’s view and that the skill set of members was misaligned to that of the

complex environment in which monetary policy will likely sit going forwards. • The review recommends appointing an “expert” monetary policy board with a majority of external members with diverse perspectives and knowledge who individually have expertise directly applicable to the challenges of rate setting to create a meaningful counterbalance to internal bank member influence.

Objectives of monetary policy and the inflation target • The review recommended that the RBA have dual monetary policy objectives of price stability and full employment, with equal consideration given to each. • The review also recommended that the current third objective of monetary policy - the economic prosperity and welfare of Australians now and in the future - should be reframed as an overall purpose for the RBA, rather than an explicit objective of monetary policy.

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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

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Australasian Dental Practice 101

finance | INVESTMENT • The review recommends retaining the flexible 2-3% inflation target, noting that this framework has typically worked well over the last three decades and is well understood in Australia. • The review does take exception with the current wording of the inflation target, that is that inflation should be between 2 and 3 percent “on average, over time” noting that this wording makes it difficult to evaluate whether the target is being met.

• The review also stated that the bank should empower its people by improving transparency and feedback around career progression and opportunities.

Profiles’ assessment e support the view of our asset consultants, Willis Towers Watson, in their belief that these changes will not have a material impact on financial markets - with the review broadly endorsing

press conferences and speeches by Board members, is a noble attempt at repairing public confidence in the RBA following the harsh criticism of Governor Lowe’s approach to providing forward guidance on monetary policy in recent years. It is therefore unlikely that the changes will foster direct portfolio implications for Profile. As always though, please discuss any thoughts you have with your Financial Adviser. Interested in a deeper dive? You can access the full report “An RBA fit for the future” at www.rbareview.gov.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.

About the author • The review pushes for improved clarity around how the bank uses this flexibility and recommends that the RBA explain how quickly it expects to return inflation to around the midpoint of the target, its assessment of full employment and how any financial vulnerabilities it identifies have impacted its decision.

Culture • A cultural overhaul was recommended to create an environment where staff can constructively debate and challenge leaders’ views on the basis that fostering an environment supportive of diverse perspectives and views will ultimately lead to better outcomes and decisions.

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the RBA’s existing inflation targeting approach and its current 2-3% target inflation range. This view aligns with the lack of any real reaction to the release of the report from local bond and equities markets. We are encouraged by the push to promote a more robust and transparent decision-making framework with respect to monetary policy. The creation of a separate and larger Monetary Policy Board is a sensible way of encouraging greater debate and a broader contribution of views - though we would caution against expectations that this will generate meaningfully different policy settings than the current approach does. And the push to provide greater public reporting of the Board’s decisionmaking process and voting records, coupled with an increase in the number of regular

Lena Ridley is the CEO of 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. Lena can be contacted on (02) 9683-6422, lena.ridley@profileservices.com.au or see www.profileservices.com.au. Profile is an independently owned boutique financial planning firm with offices in the Sydney CBD and North Parramatta. They have operated for over 25 years and specialise in serving the wealth creation and protection needs of professionals and small business owners. Many of their clients are dental professionals. Profile focus on implementing strategic advice and have a solid understanding and working knowledge of dentist’s structures and investment issues.

September/October 2023

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Learn from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control including from the Dental Board of Australia (July 2022), the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021)), the new guidelines

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COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2022 including: n Risk-based precautions. n Hand hygiene and hand care practices. n Addressing common errors in personal protective equipment. n Biofilm reduction strategies. n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n Correct operation of mechanical cleaners and steam sterilisers. n Wrapping and batch control identification. n Requirements for record keeping for instrument reprocessing. n Correct use of chemical and biological indicators.

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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.

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infection | CONTROL

READ ME FOR

CPD

Sustainability in dentistry: Part 2 - Life cycle analysis: A primer By Emeritus Professor Laurence J. Walsh AO

106 Australasian Dental Practice

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infection | CONTROL Table 1. HVE large diameter suction tip Parameter

Reusable stainless steel metal tip

Cost

Once-off cost to develop inventory. Staff time for reprocessing

Single use plastic tip Recurring cost - one item per patient. Nominal cost for storage of bulk supplies. No staff time considerations

Performance

No difference

Social element

Positioning around re-use could help in practice branding

Normal standard of care (i.e. no benefit)

Use of resources - raw material

Iron ore from the ground used in steel production

Crude oil from the ground used in plastic production

Production aspects

Electrical energy and coal used in steel production

Electrical energy used in plastic production

Releases to air, water and land

Re-use involves cleaning (water and detergent releases)

Not applicable

Transport

Once off transport to clinic

Recurring transport to restock supplies

Re-use considerations Steam sterilisation uses electricity and water

Not applicable as single use and the plastic is not recyclable

End of life considerations Indefinite use life

Plastic may not be biodegradable. Landfill or incineration have adverse impacts

Components of a formal LCA he requirements for a formal LCA are detailed in ISO 14040:2006 Environmental management - Life cycle assessment - Principles and framework (including its 2020 amendment). That ISO standard defines life cycle as “consecutive and interlinked stages, from raw material acquisition or generation from natural resources to final disposal”. ISO 14040 describes how to work through the four phases of an LCA (goal and scope definition; inventory analysis; impact assessment; and interpretation), to assess the impact on the environment at all phases of existence of a product, from manufacture, to use, to recycling or end-of-life/disposal. It considers aspects such as the energy used in producing the item, fuel used in transport and costs of recycling or re-use. Based on these considerations, a formal LCA is a major task and is generally done by a manufacturer or supplier, rather than by an end user/consumer. As well, a formal LCA does not include the economic or social aspects of a product, which are important. Hence, at the dental

September/October 2023

clinic level, it is best to take elements from the LCA concept and add to those the economic and social aspects. For those who want a comprehensive LCA, the free software tool OpenLCA is a good starting place. It can create databases of life cycle processes and users can build their own life cycle models and perform calculations and analyses. You can also import LCA databases and many are available from the openLCA Nexus online repository which has free LCA databases as well as databases for purchase. There are 14 dental components in the database covering dental clinics and dental labs.

Components of a real-world LCA that a clinic can do in-house everal worked examples of LCA prepared by the author are shown in Tables 1 and 2, with supporting data on costs in Table 3. The same analysis as shown in Table 1 also applies for stainless steel patient cups versus single use polypropylene disposable plastic cups. One can readily adapt the LCA by adding more columns to cover wax-coated paper

cups, plastic-free eco-cups, PLA-coated commercially compostable biodegradable Bagasse paper cups and cellulose-based bioplastic cups. The components of an LCA are readily adaptable to decisions that dental clinics can make. By looking at components of environmental impact, it also alerts staff to “greenwashing” in advertising, where a supplier or manufacturer claims that their products are the superior “green” alternative. As an example, an advertisement for a hand drier may state “they’re more environmentally friendly than paper towels, so you can save paper clutter and help reduce your carbon footprint” but this does not stack up when an LCA is undertaken. When putting together an LCA, bear in mind that carbon dioxide emissions for oral health care come from 3 principal sources: manufacturing, distribution and procurement of materials and equipment along the supply chain; waste generated by the clinic (especially single-use plastics (SUPs)) and the management of that waste; and travel by patients and staff. The first two of these three components will feature strongly in an LCA.

Australasian Dental Practice 107

infection | CONTROL Table 2. Hand drying in patient and staff toilets Parameter

Electrical hand drier

Paper towel from dispenser

Cost

Once-off cost to install. Periodic repair, servicing and maintenance. Cost of electricity (consumption 1000-2500 W). Replacement of HEPA filter (if included)

Recurring cost - one or more paper towels item per use. Nominal cost for storage of bulk supplies of paper towel. Staff time to check and refill dispenser

Performance

Similar, but generates considerable noise (over 60 dB) and disperses skin bacteria into the air

Quiet. Quality of hand drying varies with brand and type of paper towel used

Social element

Normal standard of care in large facilities Can be made from recycled paper (i.e. no benefit, unless electricity is from solar).

Use of resources - raw material

Iron ore, copper ore from the ground used in steel and copper production in the motor in the hand drier

Paper produced from trees as a renewable resource

Production aspects

Electrical energy used in steel and copper production for the motor

Water used in paper production

Releases to air, water and land

CO2 emissions if electricity to run the drier is from coal or gas

Not applicable

Transport

Once off transport to clinic

Recurring transport to replenish supplies

Re-use considerations

Energy use

Not applicable as single use

End of life considerations

Long use life, then disposal to recover metals through recycling

Paper is placed in domestic waste stream and is not recycled. It ends up in landfill where it is biodegradable

Making the evidence from an LCA apply to decisions ach clinic should have or develop a policy position around sustainable procurement, which is where the clinic meets its needs for appropriate consumables in a way that meets the needs of oral health care and achieves value for money, whilst at the same time minimising adverse impacts on the environment. Armed with such a policy position, those involved in decisions around procurement can then “practice what they preach”. The information from a short-from LCA, such as shown in the examples, should be used to inform staff discussions around purchasing consumables. The components of an LCA help to increase awareness amongst staff members of the parameters that are important. Discussions can then be had around simple actions that are achievable and impactful. The mindset is to be part of the solution and not a continuing part of the problem. The practice can find sustainable solutions that can create cost savings, as well as give environmental benefits.

108 Australasian Dental Practice

September/October 2023

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infection | CONTROL Table 3. Examples of cost calculations Paper towels

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Hand drier

Commercial-grade hand dryers, stainless steel case with automatic infrared sensor. No hygienic sensor. Purchase cost $500-650. Installation cost up to $250. Dyson Airblade V Hand Dryer V HU02 with HEPA filter purchase cost $1900. Installation cost up to $250.

Metal suction tip for HVE

Stainless steel suction tips. Cost $35 each (e.g. Hager).

Disposable suction tips 11 mm

Plastic suction tips 11mm diameter, $16 per pack of 25 single use (64¢ each).

Autoclavable plastic suction tips 11 mm

Multiple brands (e.g. Pelotte HW254024, Cattani No. 17 C-T21000, DMS) which are reusable for 100 sterilisation cycles. From as much as $70 per pack of 10 ($7.00 each) down to $17 per pack of 10 ($1.70 each).

Steel cups

600 mL stainless steel cups, $30-48 for a set of 6.

Plastic cups

600 mL disposable single use polypropylene plastic cups (10¢ each). Alternatives include wax-coated paper cups, plastic-free eco-cups (6¢ each), PLA-coated commercially compostable biodegradable Bagasse paper cups (20¢ each), BioPak cellulose-based bioplastic cups (16¢ each).

When considering consumables, the “3 Rs” of reduce, reuse and recycle are relevant, as each can help cut down the volume of waste that is produced from the clinic. As an example, using stainless steel HVE suction tips and patient cups will reduce waste volume and landfill demands, whilst also at the same time conserving natural resources. Changing from polypropylene patient cups to Bagasse paper cups made from sugar cane processing waste gives a biodegradable end product whilst not requiring crude oil as the starting material for the synthesis of plastics. As shown in Table 3, the direct

cost impacts to the clinic of changing between single use plastics and ecofriendly versions of cups are very small. Due to the National Plastics Plan, dental patients are increasingly aware of single use plastics in their everyday world, including in healthcare settings. Aligning decisions to achieve reduced use of single use plastics to conform to community expectations could be considered “low handing fruit” in terms of the clinic’s owners/operators having the power to decide such matters. In later parts of this series, the issues of sustainability applied to clinic design and operation will be explored.

References and key online resources for LCA 1. ISO 14040:2006 http://pqm-online.com/assets/files/lib/std/iso_14040-2006.pdf

2. 2020 amendment to the definitions section of ISO 14040 https://cdn.standards.iteh.ai/samples/76121/262b9 77639614967b6084a9534967efd/ISO-14040-2006-Amd-1-2020.pdf 3. OpenLCA software (free) https://www.openlca.org/download/

4. Open LCA user manual https://www.openlca.org/wp-content/uploads/2019/07/openLCA-1-9_User-Manual.pdf 5. openLCA Nexus online repository for free LCA databases https://nexus.openlca.org

6. Duane B et al. Environmental sustainability and procurement: purchasing products for the dental setting. Bit Dent J. 2019; 226:453-458. 7. Richardson J, et al. What’s in a bin: a case study of dental clinical waste composition and potential greenhouse gas emission savings. Brit Dent J. 2016: 220:61-66.

8. Borglin L, et al. The life cycle analysis of a dental examination: quantifying the environmental burden of an examination in a hypothetical dental practice. Community Dent Oral Epidemiol. 2021; 49:581-593.

110 Australasian Dental Practice

September/October 2023

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clinical | EXCELLENCE

Figure 1. Surface textures (left) are contoured by hand to impart a natural appearance to the restoration.

Surface matters: How to maximise monolithic zirconia restorations By Aiham Farah

odern zirconia materials incorporate a wide range of lightoptical properties that impart an inherent natural appearance to restorations. In spite of these highperforming material characteristics, it is in the hands of the technician to use these materials to their best advantage. Results that are virtually indistinguishable from the original, the beautiful natural dentition can be achieved by creating suitable textural and morphological features and, in some cases, by adding external shade effects. Here, the author uses a monolithic anterior restoration to introduce his technique to create beautiful zirconia restorations. A state-of-the-art zirconia (IPS e.max ZirCAD Prime, Ivoclar), skilled craftsmanship and a well-rounded range of stains and glazes (IPS Ivocolor, Ivoclar) help him achieve highly aesthetic restorations.

112 Australasian Dental Practice

Nature’s perfection is reflected in intricate details, such as the pattern of incident light on the surfaces of natural teeth. The typical appearance of “naturalness” arises from their richly faceted surfaces on which even the smallest rays of light create specific patterns. However, nature does not produce perfectly straight lines, while CAD/CAM milling machines do. So is the CAD/CAM fabrication of monolithic restorations incompatible with natural aesthetics? No, this is not the case, because there is a remedy: If CAD/CAM technology and monolithic materials are used to generate as perfect a copy of the natural tooth as possible, the resulting restoration should be finalised by hand. This gives the dental technician an opportunity to refine the secondary anatomy with craftsmanship and skill. Think surface texture! Morphological details can be created with the aid of fine diamonds that have a geometrical configuration that is amenable to surface contouring. And while the morphological details are being created, the tooth is gradually “springing to life” (Figure 1).

September/October 2023

clinical | EXCELLENCE Figure 2. IPS e.max ZirCAD features a continuous and smooth progression of shade and translucency. The material combines two zirconia raw materials (5Y-TZP and 3Y-TZP) in one product.

Monolithic CAD/CAM zirconia restorations can be given an additional touch of individuality and natural beauty by applying external shade effects to refine the surface texture (secondary anatomy). When the staining technique was introduced in the 1980s, it revolutionised the manufacture of ceramic restorations. Its success was based on its user-friendly technique and reliability. In recent years, the layering technique has experienced a revival in response to the increase in aesthetic expectations. At the same time, polychromatic ceramic materials have begun to compete successfully with conventional layering methods due to their efficiency. Innovative restorative materials have outperformed the layering ceramics in a number of areas. So, what could be more tempting than creating monolithic restorations and customizing them with the staining technique? Ivoclar is a company that has been aware of this change in expectations from an early stage. The company’s product developers realised that a skilful combination of framework material with a matching staining system had the potential to achieve enhanced results in terms of aesthetics, reliability and economic efficiency. Today, this combination of materials is available to dental laboratories: it consists of the high-strength IPS e.max ZirCAD Prime and the versatile IPS Ivocolor range of stains and glazes.

Looking at the materials science of a contemporary innovative zirconia material he zirconia material IPS e.max ZirCAD Prime is based on a unique manufacturing technology which, among other things, produces discs that offer a seamless internal progression of shade and translucency (Figure 2). Unlike conventional blocks that are built up in multiple layers, this zirconia features a continuous

September/October 2023

seamless progression of shade and translucency and combines two zirconia raw materials into one product: In the dentine zone, the high-strength zirconia 3Y-TZP (flexural strength of around 1,200 MPa) endows the material with stability. This attribute enables the fabrication of restorations with a reduced wall thickness and a minimally invasive preparation technique. Given its high strength, IPS e.max ZirCAD Prime is suitable for bridges with up to 14 units. In the incisal area, the disc contains the highly translucent zirconia 5Y-TZP. This zirconia compound features a lower flexural strength, which has no limiting effect in the incisal area and in areas away from the connectors. Its high translucency is a major advantage, as it is optimally coordinated with the incisal area. The excellent optical properties give monolithic restorations a naturally vibrant appearance, even without additional characterisation work. IPS e.max ZirCAD Prime delivers an accurate shade match. And yet, it leaves all options open. If desired, the restorations can be customised using the infiltration, staining or layering technique. This is especially advantageous in the anterior region, where the already high potential can be maxed out.

Processing the restoration after CAD/CAM milling and sintering his report focuses on the process to finalise monolithic zirconia restorations, create the restoration’s secondary anatomy and apply external shade effects. Full-contour anterior crowns milled from IPS e.max ZirCAD Prime are used to demonstrate a proven approach. Once the crowns are sintered, fitted on the working model and their contact points adjusted, the attention is turned to the restoration’s surface texture.

Australasian Dental Practice 113

clinical | EXCELLENCE

Figure 3. Grinding over the entire surface with a long diamond bur.

Figure 4. Polychromic zirconia with subtle progression of shade and translucency.

Figure 5. Contouring the surface using a diamond rubber.

Figure 6. Creating natural textural features using stone burs.

Applying secondary anatomical features to the monolithic framework n the first step, a long diamond bur (usually coded with a red ring) is used to grind over the entire restoration lightly, without applying pressure (Figure 3). By slightly roughening the surface, the actual shade of the zirconia material can be seen more accurately. After sintering, zirconia surfaces tend to have a mirror-like reflective appearance. Because of this, their shade tends to be slightly distorted. By removing the reflective layer, the proper shade comes to the fore. If this step is performed correctly, the real base shade of the zirconia is revealed. Additionally, the subtle natural progression of shade and translucency incorporated into IPS e.max ZirCAD Prime can be observed, without having to illuminate the restoration with a light source from any particular angle (Figure 4). In the next step, the tooth shape is checked to make sure that the milling machine has faithfully translated all the details of the technician’s design to the restoration. A diamond rubber is a good choice for applying any necessary corrections and for surface contouring (Figure 5). When fine-tuning the shape of anterior crowns, it is essential to bear in mind that the gradation in translucency (from cervical to incisal) is more visible if there is a vestibular curvature. This makes the translucency of the incisal third appear more clearly.

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In the third step, the transition lines are accentuated and then the surfaces are checked to see if they are symmetrical. This check can be carried out with the help of a pencil or a direct light source. Attention is now turned to creating the macrotexture. This step is essential to reproduce the 3-dimensional features typical of natural teeth. Eroded green stone burs, applied at low rpm, have been shown to provide good results here. The natural texture of the teeth can be emulated in a targeted fashion using the tip of the stone (Figure 6). Now the vertical microstructure is applied. Diamond burs are again very useful here. In the case shown here, a bur that looks a bit like an American football (Figure 7) produces a delicate texture without leaving aggressive grooves. The tip of the bur creates a fine pattern of micro grooves that gradually and softly open out, resembling very closely the natural tooth structure. A direct light source is ideal for visualising these fine details. In the absence of an adequate light source, the intensity of the texture can be visualised with an auxiliary method, such as dusting the surface with silver powder or passing over the surface with articulating paper. Visualising the textures assists in observing the differences between highly reflective zones (e.g. prominent areas such as angle lines or strong contours) and shaded zones (e.g. depressions or fine grooves).

September/October 2023

clinical | EXCELLENCE

Figure 7. Applying vertical microtextures using a diamond bur with a tip in the shape of an American Football.

Figure 8. Creating the horizontal microtexture.

Figures 9a-b. Comparison of various differently textured teeth. Note: The more texture, the more reflection.

Figures 10a-c. The shade match is assessed after the shade tabs (shade guide) have been given a matte finish (by sandblasting) and both the restorations and shade tabs have been moistened with glaze paste. Lens- or ball-shaped diamond burs are used for creating the horizontal microtexture (Figure 8). Important rule for creating a natural surface texture: when creating perikymata and grooves, make sure that vertical lines run parallel to the long axis of the tooth and horizontal lines run perpendicular to the long axis. After that, any sharp angles created while texturing the surface are softened using a rubber wheel (small diameter). Excessively textured areas are slightly smoothed over. Subsequently, the restoration is blasted with aluminium oxide (50 µm, 1.5 bar) to remove any contamination or deposits left by the diamond-coated burs or rubber wheels. Ideally, the incisal third of the crown is not too heavily textured. This is because the more textured the surface, the more reflective it is. Figure 9 shows a selection of differently textured surfaces next to each other. To take the picture, the restorations were illuminated from behind to better visualise their textures.

September/October 2023

One set of crowns have been textured as described in the procedure above, the others have not been. Clearly noticeable: The more pronounced the texture, the more light is reflected. This has also an effect on translucency. For this reason, surface textures should be kept light; especially in the incisal third, where a high degree of translucency is essential for the monolithic crown to look natural. The shade is checked one more time before proceeding to applying the external shade effects. However, there is a problem when evaluating the shade using a conventional shade guide and this problem needs addressing: To start with, shade guides and zirconia restorations are made from different materials with a different surface behaviour (light reflection, etc.). What is more, the tabs of the shade guide have a high gloss finish while the zirconia crowns have a matte finish after having been blasted. To create a level playing field, the shade guide is first sandblasted and then, together with the crowns, moistened with glazing material (Figure 10).

Australasian Dental Practice 115

clinical | EXCELLENCE

Figure 11a. Characterizing the incisal area using IPS Ivocolor Shade Incisal.

Figure 11b. Applying a thin veneering layer using the materials of the IPS e.max Ceram range.

Figure 12. Optimally coordinated opacity of monolithic CAD/CAM crowns.

This enables an accurate evaluation of the shade match. In the clinical case shown here, the shade of the crowns (IPS e.max ZirCAD Prime) harmonises beautifully with the target shade on the shade guide (BL2 Bleach). Additional shade adaptations are not a must. In principle, the crowns could now be simply glazed and finished. In the mouth, their shade would look beautiful and natural. However, additional customisations – such as a youthful opalescence and mamelons – can be created at this stage by applying external shade effects using the staining technique.

External shading and characterisation using IPS Ivocolor and IPS e.max Ceram for 3D effects he middle area of the monolithic crowns shows a shade that matches the IPS Ivocolor Shade Incisal 2 (SI2). In principle, this would be the shade that is used to create the desired translucency according to the shade guide to achieve a progression of shade. However, the crowns have been made from a polychromatic material, with the translucency incorporated into the incisal edge. So, there is no need for painting a translucent effect onto the restoration and the focus can be placed straight away on creating the opalescent effect. For this purpose, Shade Incisal 3 (SI3) is used. The bluish hue of this ceramic material provides incredibly

116 Australasian Dental Practice

natural-looking illusions of opalescence, which can hardly be attained with other stains, especially not in Bleach areas. The mesial and incisal edges are characterised using SI3. The technician should not be shy to move the brush slightly down (toward the dentine) to achieve a soft transition. After that, a small line of interrupted dashes is applied horizontally under the incisal edge with the tip of the brush using Shade Incisal 1 (SI1). The shades applied to the restoration are now fired at a low temperature (e.g. 700°C) to fix them in place (Figure 11a). Subsequently, the mamelon and halo effects can be applied. Mamelon effects can be produced by applying one of the light-reflecting bright stains of the Essence kit. To create an additional “true-to-life”, three-dimensional effect, the shade is mixed with 10% layering material, such as IPS e.max Ceram Opal Effect 4 (OE4). As a Bleach shade is used in the case shown here, this “thin veneering layer” is applied. The blend consists of IPS e.max Ceram OE4 and IPS Ivocolor Essence white, mixed together with IPS e.max ZirCAD Zirliner liquid. In my opinion, the IPS e.max ZirCAD Zirliner features a better consistency for mixing the materials than the Build-up Liquid. When applied to the surface, the mixture stays in place and can be placed exactly where wanted (Figure 11b).

September/October 2023

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clinical | EXCELLENCE

Figure 13. Completed zirconia restorations on the model.

Figures 14a-b. Inserted restorations offering natural-looking shade effects and a natural surface texture.

The opacity of the monolithic crown is optimally coordinated, especially in the cervical third and makes for an impressive result (Figure 12). In spite of the dark shade of the preparation, the restoration accurately matches the shade of the BL2 shade guide. Finally, glaze material is applied to smooth out any uneven areas created between the layered 3D mamelon structures. This is done with a fluorescent glaze material (IPS Ivocolor Glaze FLUO). Fluorescent glazes are generally recommended for monolithic zirconia surfaces. The restoration is fired using the standard glaze firing program. After that, the entire surface is coated with a second, extremely thin layer of fluorescent glaze material. This time, the material is applied in a slightly thinner consistency to make sure that the textural features are retained (Figure 13).

Conclusion onolithic zirconia restorations can be “brought to life” by manually creating surface textures and, as an option, by applying external shade effects. To do so successfully, the skilled craftsmanship and creativity of the dental technician are required in addition to a coordinated range of materials. The procedure presented in this report involves clearly less work than the conventional layering method; the result, however, comes very close to the high benchmark set by layered restorations. When using IPS Ivocolor, it is possible to create monolithic restorations with brilliant aesthetics that are a near perfect representation of the natural tooth – even in the anterior region. (Figure 14a and b).

About the author Aiham Farah is a certified dental technician with his work focused on aesthetic dentistry. In 2003-2006 and 2009-2012 he specialised in the field of aesthetic restorative dentistry. From 2010-2011, he was a teacher lecturer at the Department of Dental Technology at the University of Kalamoon. Since 2009, he has been a materials consultant for Ivoclar in the Near East and Orient. He is a member of the National Association of Dental Laboratories (NADL) and an ICDE Ivoclar (Switzerland) certified Master Trainer. Thank you to Dr Gordon Chee DDS for the excellent teamwork.

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clinical | EXCELLENCE

READ ME FOR

CPD

The rarely spotted pulpotomy By Dr Peter Raftery, Endodontist, Hampshire Endodontics

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clinical | EXCELLENCE In fact, in their 2022 paper on the evidence concerning pulp therapy, the British Endodontic Society (BES) suggests that this procedure might represent “a paradigm shift in how we manage pulpal disease”.1 Now that is attention-grabbing.

Biodentine pulpotomy - the win-win treatment approach hen patients are referred to me, they arrive already knowing our root canal treatment fee. If, following consultation, I am then able to recommend a pulpotomy (which I charge at two thirds of the full fee), patients are delighted with the prospective financial saving. And the savings don’t end there. We all know that molars typically get crowns after root canal treatment. Most of my work is on molar teeth and so, if we’re avoiding a root canal treatment via Biodentine pulpotomy, it seems reasonable that there is a chance of avoiding a crown, too. Having done many now, I am confident enough in the predictability of the procedure. I reassure patients that, in the unlikely event the pulpotomy doesn’t work, I’ll complete the root treatment for the remaining third of the fee. As such, patients perceive that there is no financial penalty preventing them from trying pulpotomy. Patients soon start to love the idea of Biodentine pulpotomy. Still, some might question whether this novel pulpotomy is as “tried and tested” as a full root canal treatment and ask: “Would it not be better to spend a little more time and money for a more certain outcome?”. Forget the Dycal pulp caps you did at school; current evidence shows pulpotomies are predictable, with high success rates for pulpotomies in adult teeth with signs and symptoms indicative of irreversible pulpitis.2 Further, these success rates are no lower than those of more invasive and costly conventional endodontic treatments.3 There are plenty of reasons for the operator to love this approach, too. Pulpotomy is a less technically demanding treatment to perform than full root canal treatment, avoiding most of the headlinegrabbing risks (e.g. irrigant extrusion) and taking significantly less chair time. I find pulpotomy to be the most enjoyable treatment to perform and, when I consider the fee structure mentioned, probably the most lucrative, too. Pulpotomies, I feel, are the win-win treatment modality.

September/October 2023

The rationale for Biodentine pulpotomy t used to be the case that if the pulp of a permanent tooth became exposed by caries (or by caries removal), root canal treatment was indicated. Direct pulp caps with materials like Dycal were as unreliable as they were unpredictable. The development and uptake of modern materials like Biodentine in 2010, alongside a better understanding of pulp biology, means that VPT of inflamed mature teeth is now approaching the routine. With the increased acceptance of Minimal Intervention (MI) principles, I would suggest all conservative-minded dentists ought to be offering Biodentine pulpotomies.

Patients instantly grasp the rationale. They instinctively understand that if, say, a diabetic patient develops irreversible foot complications, surgeons would best address the problem by amputating at the ankle, rather than cutting off the whole leg. By that token, if their dental problem comprises toothache or an extensively carious but vital tooth, they will understand the rationale behind removing that unviable portion of pulp and leaving behind the healthy, unaffected tissue. To quote the BES paper on pulpotomy: “Maintaining pulp vitality preserves the tooth’s circulatory defence system, the full proprioceptive function of the tooth is maintained and the tooth will be less mechanically weakened and hence less prone to fracture”.1

Case selection eeth that are suitable for consideration for pulpotomy include: • Vital teeth with no caries but symptoms of irreversible pulpitis; and • Vital teeth with caries extending into the pulp with or without pulpitis symptoms (reversible or irreversible). Cases not suitable for consideration include: • Caries not extending into the pulp of teeth with no symptoms or with symptoms of reversible pulpitis. These teeth should be restored conventionally; and • Non-vital teeth and teeth with apical areas of rarefaction. These pulps are dead and the pulp space is infected.

With necrotic pulps, there is no tissue to preserve and root canal treatment (mature apices) or revascularisation (immature apices) are the endodontic options of choice. Case selection does not hinge entirely on the irreversible/reversible pulpitis categorisation. Despite improvements in the understanding of pulp biology, pulp histology still correlates poorly with clinical symptoms. If symptoms can correlate poorly with the true condition of the pulp, then patients must be cautioned that “the goalposts may move” during the pulpotomy procedure. If no viable pulpal tissue is found intra-operatively, then there is nothing to preserve and a fuller clean-out of the pulp space is necessary.

Australasian Dental Practice 121

clinical | EXCELLENCE Patients need to be quoted (and appointment times need to allow) for pulpotomy or root treatment. For a proposed pulpotomy to remain an option intra-operatively, I say: “I need to see red stuff on the inside of the tooth”. I will always take an image to justify doing (red stuff) or not doing (no red stuff and/ or a smell) the pulp therapy and for this reason, I think that intraoral imaging is a medicolegal must-have. The European Society of Endodontology (ESE) says that: “The colour and intensity of pulp bleeding on exposure intra-op may provide a surrogate marker of inflammation and capacity to recover after treatment”.4

I will clean out the pulp chamber with a cotton pledget or small piece of sponge soaked in sodium hypochlorite. I will apply some pressure to the cut pulp through the pledget for a minute. Pressure will help stop the bleeding from a healthy pulp stump and the hypochlorite will kill bacteria and gently dissolve any necrotic pulp. Upon removal, I have a clean, vital, non-bleeding pulp directly onto which I will pack some Biodentine (not MTA). In their 2022 Pulp Therapy Evidence Guidelines, the BES describes Biodentine as the single best pulp therapy material. Calcium hydroxide induces a poorer, less predictable pulpal response and the bismuth

In successful cases, I request the General Dental Practitioner (GDP) resurface the Biodentine, ideally cutting back the outer 2mm of Biodentine and flowing something harder-wearing and aesthetically suitable on top. I can accept that some cases still need a casting (crowns or onlays) despite a successful pulpotomy. Failures are rare, characterised by clinical and/or radiographic signs of infection. I also deem as failures those very rare cases where the patient cannot wait until six months due to worsening pain symptoms. A common concern from dentists is how to complete a root filling when you’ve packed Biodentine down. Having progressed a few of my own pulpotomies into root fillings, I can say that it is not as hard as one might think to visually discern between white Biodentine and yellow dentine when drilling. Nor is it hard to discern between the two from a tactile perspective when drilling with a Goose Neck bur.

Conclusion ulpotomies are soon to be routine. I find the most disgruntled patients at my endodontic practice are those who experience an agonising Bank Holiday weekend after a “deep filling” at their dentist (such as a deep amalgam or composite in a deep cavity close to the pulp). I would argue that placing a deep filling in a carious molar and hoping for the best is asking for trouble (and complaints). I would argue that being slightly more proactive with deeply carious cavities, excising the inflamed pulp and placing a Biodentine restoration onto uninflamed pulp will be the proverbial “stitch in time, saving nine”.

Only with injectable anaesthetics do I feel I have a hope of getting inflamed pulps numb. Rubber dam use is necessary because bacterial contamination of the pulp space spells certain failure. After clearing caries, I will deroof the pulp. It is necessary to remove the vital pulp with a diamond bur. A slow handpiece will entangle and rip out the very pulp you’re trying to preserve. Drilling away pulp is a skill to be learned on the job. A light touch (and good vision) is needed to discern the “feel” of pulp and to avoid gouging out the pulp chamber dentine. Once I’ve drilled away the coronal pulp down to orifice level, I will take a photo for the record. I need to see red circles (not pus, not empty orifices and not a gushing, hyperaemic pulp).

122 Australasian Dental Practice

oxide in MTA irreversibly discolours teeth.1 Septodont’s procedure allows me to fill the entire cavity with one Biodentine capsule (the Bio Bulk-Fill procedure). Septodont advise that Biodentine can be used as an enamel restoration material for up to six months. I don’t see any argument for taking a post-pulpotomy x-ray.

Post-op management aving manipulated the densely innervated tissue, I supply the patient with two days of oral steroids as a potent antiinflammatory. After six months, I review the case. To determine success clinically, I use an absence of swelling or draining sinus. Radiographically, I require an absence of apical rarefaction.

References 1. British Endodontic Society (BES). https://britishendodonticsociety.org.uk/_userfiles/pages/files/ a4_bes_guidelines_2022_hyperlinked_final.pdf 2. Asgary & Eghbal 2013, Asgary et al. 2015, 2017, 2018, Galani et al. 2017, Linsuwanont et al 3. Ng Y-L, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature – Part 1. Effects of study characteristics on probability of success. International Endodontic Journal, 40, 921–939, 2007. 4. European Society of Endodontology (ESE) https:// britishendodonticsociety.org.uk/_userfiles/pages/files/ duncan_et_al2019international_endodontic_journal.pdf

September/October 2023

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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

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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 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

Correct shade determination with monolithic zirconia shade guides identical to the final restoration

Figures 1-2. Colour theory shows that shape and surface structure considerably influence the colour effect. For this reason, Zirkonzahn Shade Guides are available in all respective Prettau® Dispersive® zirconia materials, not only in the shape of upper and lower incisor, but also in the shape of a premolar.

Figures 3-4. The shade guide is made of the same material and colour as of the final restoration. This guarantees that the colour of the final restoration will be 100% identical to the shade guide used. On request, the front side of the shade guides can be personalised with the name of the dental practice and the back with the name of the dental laboratory (at extra charge).

ith the new Zirkonzahn Shade Guides, the patient’s individual tooth colour can now be determined by selecting the matching zirconia typology, for a final restoration that corresponds 1:1 with the patient’s natural shade. The teeth are a mirror of a person’s life and individual lifestyle. They differ from person to person and lived years, nutrition and habits shape a unique appearance of wear patterns, degrees of translucency and colouring. The colour of a tooth is formed by the combination of dentine and enamel. In youth, the dentine has a uniform colour. With increasing age, discolouration occurs, which usually manifests itself as darker areas in the dentine area. The overlying enamel, which is firmly bonded to the dentine, is characterised by varying degrees of opacity depending on the

124 Australasian Dental Practice

respective area - from whitish opaque to almost transparent. Overall, the tooth tends to have a single shade, with a higher translucency level towards the incisal edge. The reproduction of the natural tooth colour is therefore a very complex process, especially nowadays, where pre-coloured dental materials are making their way in the production of dental restorations. To achieve the best possible result, many factors must be considered - from tooth structure and translucency to light reflection and material selection - and an exact determination of the natural basic tooth colour is fundamental. Based on this, the specialist literature* recommends to always use the shade guide of the material that will be used for the restoration. In this context, Zirkonzahn Shade Guides (developed by the South Tyrolean company Zirkonzahn) represent an important step forward for colour-precise final zirconia restorations.

September/October 2023

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clinical | EXCELLENCE

Figure 5. Zirkonzahn Shade Guides in the shape of an upper incisor are available also with sintered, minimally reduced sample teeth (minimal cutback) for individual characterisation with incisal materials.

Figure 6. The colour spectrum is inspired by the VITA classic range and includes 19 colours (A1-D4, including 3 Bleach shades).

Figure 7. The transparent, metal-free sample bars made of temperature-resistant plastic avoid interference caused by translucent metal (metal sample bars would shine through the zirconia material). Zirkonzahn Shade Guides are composed of monolithic sample teeth made of polychromatic Prettau® zirconia and reproduce both the colour and translucency gradient of the human teeth. Inspired by the VITA classic range, they include 16 dentine colours (A1D4) and 3 Bleach shades and are available not only in the shape of upper and lower incisors but also in the shape of a premolar. If the material of the shade guide is identical to the material of the zirconia crown, it is ensured that the colour of the zirconia restoration corresponds 1:1 with the natural tooth colour of the patient. For individualists, the shade guides in the shape of an upper incisor are also available with minimally reduced, sintered sample teeth (minimal cutback), which can be further characterised by the application of different incisal materials. This results in truly unique shade guides that exactly reflect the individual approach and own aesthetic demands. For an easier determination of a patient’s tooth shade, Zirkonzahn Shade Guide Prettau® Line has been developed specially for the dental practice.

126 Australasian Dental Practice

How to avoid possible disturbing influences when using Zirkonzahn shade guides • Colour determination should be carried out under natural daylight conditions or in a room illuminated with standardised daylight lamps; avoid direct, bright light (approx. 2000 lux, a well-lit dental chair already has approx. 8000 lux). • Carry out colour determination quickly (no longer than 5-7 secs). The human eye tires quickly when looking at something with concentration. This also affects the colour perception. • Perform shade matching in a neutral colour environment, on a patient without make-up who is wearing neutral-coloured clothes. Intense colours influence the perception of colours that are observed immediately afterwards (simultaneous contrast). For more information, visit www.zirkonzahn.com or contact the sales team at +39-0474-066-663 (Italian time zone).

September/October 2023

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clinical | EXCELLENCE

READ ME FOR

CPD

Differential diagnosis of resorption: Diagnosis and management By Dr Shaurya Srivastava, M.Endo (London), RCSEd, Specialist Endodontist

128 Australasian Dental Practice

September/October 2023

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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

Innovativebyby nature Innovative nature

o., rights reserved. NELLC.ATAll HU-FRIEDY.COM/PerfectFit

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 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

clinical | EXCELLENCE

Figure 1. Pre-operative periapical radiograph of the #47. The red circle encapsulates the diffuse radiolucency, which is suggestive of resorption.

Figure 2. Sagittal slice; Red arrow shows the extent of the resorption in a buccolingual plane.

Figure 4. Obturation.

Figure 5. Post-operative radiograph.

Internal inflammatory resorption (IIR) usually occurs when there is damage to the predentin, either by trauma due to physical/chemical irritation and/or by bacterial infection in pulpal inflammation. Typically, in IIR lesions, the pulp tissue coronal to the resorptive site will be necrotic, while the apical portion remains vital, providing nutrients to the odontoclasts for the progression of the resorption. The resorption ceases when the pulp in the entire canal is necrotic/loses vitality.1,4,5 IIR lesions are granulomatous in nature and profuse bleeding on probing can be observed, which will cease after the removal of the pulp and the granulomatous tissue. In vital teeth, IIR is usually diagnosed when a patient exhibits symptoms of reversible or irreversible pulpitis, whereas

in cases where the tissue is completely necrotic, IIR is diagnosed radiographically when the patient presents with signs and/or symptoms of apical periodontitis. The literature has described these lesions as a radiolucent symmetrical round or oval ballooning of the root canal wall, but in reality, the radiographic appearance of these lesions might not adhere to its rigid presentations.18 Although parallax radiographs might help determine the position of the lesion, periapical radiographs have their limitations in differentiating external cervical resorption from internal resorption. The full extent of the lesion cannot be determined and often can lead to misdiagnosis, especially in multi-rooted teeth, due to the superimposition of the unaffected tooth over the affected root.

130 Australasian Dental Practice

Figure 3. Axial slice; The red arrow shows the resorption perforating the PRRS and extending into the distal aspect of the coronal pulp.

During the management of IIR, a small field of view (FOV), high-resolution CBCT is recommended to determine the exact nature, location and extent of the IIR and whether it has perforated the root.4,17 All these factors affect the outcome of the treatment. Due to the irregularities within these defects, energized irrigation,19 interappointment medication,17,20 followed by obturation using thermoplasticised guttapercha is recommended. In very rare cases external cervical resorption, can occur internally, initiating itself within the tooth prior to perforating the PRRS (Protective Resorptive Root Sheath). Keeping this in mind as a differential diagnosis, Biodentine is an ideal material to use to cease any potential clastic activity.

September/October 2023

clinical | EXCELLENCE

Figure 6. Post-operative view of the mesial canals in the coronal slice. Figure 7. Post-operative view of the distal canal in the coronal slice. Figure 8. Post-operative view of the resorptive defect condensed with Biodentine (Red Arrow).

Figure 9. Coronal plane; Healing of the periapical lesion associated with the mesial root.

Figure 10. Coronal Plane; Healing of the periapical lesion associated with the distal root.

Figure 11. Axial Plane: Resorptive defect condensed with Biodentine (Red Arrow), has remained unchanged (Yellow Arrow) at 6 months.

The #47 did not respond to Endofrost. The tooth was tender to percussion and tender to palpation. The #45 was unrestored, with no obvious signs of caries, although there was a crack along the buccal aspect of the tooth. The probing depths were within normal limits, even along the buccal crack. The periapical radiograph of the #47 revealed a diffuse radiolucency (Figure 1) adjacent to the distal pulp horn, a pulp stone in the coronal third of the distal canal and a periapical pathology associated with the mesial and distal roots. A small FOV (5x5cm) CBCT was taken to further assess the diffuse radiolucency. The CBCT scan confirmed the presence of internal resorption in the coronal third of the pulp chamber, encapsulating

the distal pulp horn (Figures 2 and 3). A diagnosis of Chronic Apical Periodontitis associated with a necrotic pulp and Internal Inflammatory Resorption was reached for the #47. After discussing the various treatment options, the decision to perform a root canal treatment and internal repair of the resorptive defect was made, subject to restorability. The #47 was isolated with a rubber dam. The operating field was disinfected using 5.25% Sodium Hypochlorite21 and accessed in a conservative fashion. The pulp chamber was cleaned and refined with ultrasonics. The pulp stone in the distal canal was detached and removed with the help of ET25 ultrasonic tips (Acteon).

Clinical case 39-year-old male was referred to a specialist private practice for the endodontic assessment of pain associated with the lower right quadrant (LRQ). The patient complained of an intermittent dull ache during mastication and occasional radiating pain along the LRQ region without any stimuli. The #46 was extracted 3 years ago and was replaced with an implant. The patient has a history of parafunction but does not wear a nightguard. The patient was medically fit and well. Clinical examination revealed good oral hygiene, a minimally restored dentition and BPE (Basic Periodontal Examination) scores of 112/121. The #45 was unrestored and responded within normal limits to Endofrost (Coltène/Whaledent).

September/October 2023

Australasian Dental Practice 131

clinical | EXCELLENCE The canals were coronally flared using ProTaper Gold SX files (Dentsply Sirona) and a glide path was achieved using a #10 flex-o K file, and patency was confirmed using an apex locator (Eighteeth). Chemo-mechanical preparation was completed using ProTaper Next (Dentsply Sirona) up to X2 (25/06), 0.5mm short of the ‘0’ reading. 5.25% sodium hypochlorite was used as an irrigant after every file sequence.

“Biodentine is the only resin-free tricalcium Silicate-based material which has high mechanical properties, after a short setting time, which are similar to dentine. The compressive strength of Biodentine (300MPa) is comparable to that of natural dentine (297 MPa)...” Following the chemo-mechanical preparation, the canals were irrigated with 17% EDTA and the liquid was activated using an Endoactivator (Dentsply Sirona). The canals were then rinsed with 5.25% Sodium Hypochlorite and dried with paper points. Since BioRoot™ RCS (Septodont) was being used a sealer in the mesial canals, they were washed gently with saline and aspirated to provide moisture for the setting reaction of the calcium silicate sealers. The canals were obturated with a single cone technique (X2 gutta percha) using BioRoot RCS with hydraulic condensation. After completion of the root canal treatment, the resorptive defect was debrided using rose head burs and disinfected with cotton pellets soaked with 5.25% Sodium Hypochlorite. Biodentine (Septodont) was mixed as per manufacturer’s recommended instructions and the entire pulp chamber was restored with the calcium silicate cement up till the coronal most extension of the resorptive defect. Following the initial setting time of 12 minutes, a composite core (Herculite XRV Unidose; Kerr) was placed in the #47. The tooth surfaces and Biodentine

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was etched with 37% phosphoric acid, followed by the application of a bonding agent (OptiBond Solo Plus; KerrHawe). A post-operative CBCT was taken in this case (Figures 6-8) to ensure the resorptive defect was well-filled and the lesion could be monitored in 3 dimensions over time. The patient was reviewed at 6 months to assess healing of the lesions, as well as the ceasing of the progression of the resorption prior to cuspal coverage. The review shows healing of the lesions associated with the mesial and distal roots and no further progression of the resorption (Figures 9-11).

Discussion he objective of treatment with regards to resorption is, to cease clastic activity to prevent further loss of mineralised tooth structure. Internal inflammatory resorption ceases once the tooth has lost its vitality. The position of the IIR in this case could also mimic a very rare External Cervical Resorption (ECR), which can initiate within the tooth, without an external portal of entry and spread around the protective resorptive root sheath (PRRS) prior to perforating it, which could lead to inflammation of the pulp and cause pulp necrosis. The diagnosis of IIR was made based on the presenting spread of the resorption. After the tooth was accessed, the entire coronal pulp, as well as the radicular pulp in the mesial canals, were completely necrotic. The distal canal was partially necrotic and there were areas of irreversibly inflamed hyperemic tissue, either granulomatous or fibro-vascular in nature, in the resorptive defect above the distal pulp horn, which could be the contributing factor for the clastic activity and eliciting symptoms of pulpitis. Non-Surgical Root Canal Treatment was completed with a single cone technique using BioRoot RCS with hydraulic condensation, which has demonstrated high success rates in endodontic treatments.22,23 Biodentine sets upon hydration, a process which leads to ion/molecule release. These so-called by-products inhibit bacterial growth and interact with surrounding tissues, leading to the dampening of inflammatory reactions and inducing

healing in the form of repair and regeneration. The sustained release of calcium hydroxide aids in ceasing any clastic activity by alkalinization of these lesions, making it an ideal material to be used to restore the resorptive defect in this case. Biodentine’s interaction with dentine is a combination of micromechanical as well as chemical interaction between the two substrates. Tag-like structures can form within the dentinal tubules which may reflect a micromechanical retentive mechanism to hold the cement in place.23,24 This explains the improved shear bond strength with dentine over time and has a similar bond strength to glass ionomer cement to dentine.25,26 Biodentine is the only resin-free tricalcium Silicate-based material which has high mechanical properties, after a short setting time, which are similar to dentine. The compressive strength of Biodentine (300MPa) is comparable to that of natural dentine (297 MPa),27 which is an important property to withstand masticatory

“While Biodentine shares comparable physical and chemical properties with calcium silicate cements, this material has significantly higher mechanical properties and has the advantage of shorter setting time allowing its use as a therapeutic coronal restorative material....” forces. This property allows the material to be used as a bulk fill and as a dentine substitute. It also acts a liner to seal the pulpal floor preventing any leakage via inter-radicular or sub-pulpal floor canals. Additionally, the 12-minute initial set of the material allows it to be bonded with different types of adhesives, finishing off the final restoration with composite in a single visit. The cuspal coverage restoration was delayed until the 6-month review to ensure healing of the peri-apical lesion

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clinical | EXCELLENCE and no further progression of the resorption, as the latter could not have been monitored with a definitive restoration using a CBCT.

Conclusion iodentine is bio-interactive with surrounding environment and tissues through ion-rich pore solution enriched with calcium hydroxyl ions. This solution is responsible for the alkaline etching of dentine as well as the production of apatite minerals and calcium carbonate in the presence of body fluids. Such interactivity may grant an improved seal for the cement dentine interface combined with the biological and antimicrobial effects of released ions. While Biodentine shares comparable physical and chemical properties with calcium silicate cements, this material has significantly higher mechanical properties and has the advantage of shorter setting time allowing its use as a therapeutic coronal restorative material besides its uses in endodontics. Biodentine is an invaluable component and should be a stalwart material in a practioner’s armamentarium, bridging restorative and endodontic applications.

About the author Dr Shaurya Srivastava is a Specialist Endodontist from King’s College London (MClinDent Endodontology), a Member in Endodontics (M. Endo RCSEd) at the Royal College of Surgeons, Edinburgh, and the youngest Keynote Speaker for Septodont in India for Biodentine and BioRoot RCS. He specialises in failures of endodontic treatments; complex diagnosis and multidisciplinary treatment planning using CBCTs; apical microsurgery; intentional replantations; vital pulp therapies; dental trauma and restorations of endodontically treated teeth. Shaurya currently works in referral practice in Mumbai and speaks nationally as well as internationally on topics that have an impact on endodontic outcomes, such as diagnosis and use of CBCTs in endodontics and evidence-based treatments and outcomes using calcium silicate materials. All treatments provided are using the latest peer-reviewed evidence and in accordance with the European Society of Endodontology.

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References 1. Patel S, Ford TP. Is the resorption external or internal? Dent Update. 2007;34(4):218-20, 22, 24-6, 29. 2. Heithersay GS. Management of tooth resorption. Aust Dent J. 2007;52(1 Suppl):S105-21. 3. Patel S, Kanagasingam S, Pitt Ford T. External cervical resorption: a review. J Endod. 2009;35(5):616-25. 4. Patel S, Ricucci D, Durak C, Tay F. Internal root resorption: a review. J Endod. 2010;36(7):1107-21. 5. Tronstad L. Root resorption--etiology, terminology and clinical manifestations. Endod Dent Traumatol. 1988;4(6):241-52. 6. Trope M. Root Resorption due to Dental Trauma. Endodontic Topics. 2002;1:79-100. 7. Wedenberg C, Lindskog S. Evidence for a resorption inhibitor in dentin. Scand J Dent Res. 1987;95(3):205-11. 8. Mavridou AM, Hauben E, Wevers M, Schepers E, Bergmans L, Lambrechts P. Understanding External Cervical Resorption in Vital Teeth. J Endod. 2016;42(12):1737-51. 9. Patel S, Horner K. The use of cone beam computed tomography in endodontics. Int Endod J. 2009;42(9):755-6. 10. Patel S, Foschi F, Mannocci F, Patel K. External cervical resorption: a threedimensional classification. Int Endod J. 2018;51(2):206-14. 11. Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J. 2015;48(1):3-15. 12. Patel S, Dawood A, Wilson R, Horner K, Mannocci F. The detection and management of root resorption lesions using intraoral radiography and cone beam computed tomography - an in vivo investigation. Int Endod J. 2009;42(9):831-8. 13. Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems. Int Endod J. 2009;42(6):447-62. 14. Patel S, Dawood A. The use of cone beam computed tomography in the management of external cervical resorption lesions. Int Endod J. 2007;40(9):730-7. 15. Patel S, Brown J, Semper M, Abella F, Mannocci F. European Society of Endodontology position statement: Use of cone beam computed tomography in Endodontics: European Society of Endodontology (ESE) developed by. Int Endod J. 2019;52(12):1675-8.

16. Patel K, Mannocci F, Patel S. The Assessment and Management of External Cervical Resorption with Periapical Radiographs and Cone-beam Computed Tomography: A Clinical Study. J Endod. 2016;42(10):1435-40. 17. Bhuva B, Barnes JJ, Patel S. The use of limited cone beam computed tomography in the diagnosis and management of a case of perforating internal root resorption. Int Endod J. 2011;44(8):777-86. 18. Hargreaves KMBLH. Cohen’s pathways of the pulp2016. 19. Topçuoğlu HS, Düzgün S, Ceyhanlı KT, Aktı A, Pala K, Kesim B. Efficacy of different irrigation techniques in the removal of calcium hydroxide from a simulated internal root resorption cavity. Int Endod J. 2015;48(4):309-16. 20. Burleson A, Nusstein J, Reader A, Beck M. The in vivo evaluation of hand/ rotary/ultrasound instrumentation in necrotic, human mandibular molars. J Endod. 2007;33(7):782-7. 21. Ng YL, Spratt D, Sriskantharajah S, Gulabivala K. Evaluation of protocols for field decontamination before bacterial sampling of root canals for contemporary microbiology techniques. J Endod. 2003;29(5):317-20. 22. Zavattini A, Knight A, Foschi F, Mannocci F. Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial. J Clin Med. 2020;9(3). 23. Han L, Okiji T. Uptake of calcium and silicon released from calcium silicatebased endodontic materials into root canal dentine. Int Endod J. 2011;44(12):1081-7. 24. Atmeh A, Chong E, Richard G, Festy F, Watson T. Dentin-cement Interfacial Interaction: Calcium Silicates and Polyalkenoates. Journal of dental research. 2012;91:454-9. 25. Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-out bond strength of biod Biodentine™ entine and conventional root perforation repair materials. J Endod. 2013;39(3):380-4. 26. Dawood AE, Manton DJ, Parashos P, Wong R, Palamara J, Stanton DP, et al. The physical properties and ion release of CPP-ACP-modified calcium silicate-based cements. Aust Dent J. 2015;60(4):434-44. 27. Grech L, Mallia B, Camilleri J. Investigation of the physical properties of tricalcium silicate cement-based root-end filling materials. Dent Mater. 2013;29(2):e20-8.

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surgery | DESIGN

Ellenbrook Smiles - A Medifit Design & Construct collaboration

llenbrook Smiles, a beacon of dental care excellence nestled in Ellenbrook, Western Australia, stands as a testament to the partnership between Dr Tejas Patel and Medifit Design & Construct. This collaboration has brought forth an environment that seamlessly merges tranquility with professional dental services.

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Ellenbrook, a burgeoning suburb in northeastern Perth, has experienced a surge in population growth. Its demographic diversity, encompassing families, professionals, and retirees, underscores the need for premium healthcare services. Ellenbrook Smiles serves to address this need, offering state-of-the-art dental care. Dr Patel approached Medifit late in 2021 with a view to establishing a new practice. From the moment he engaged with Medifit’s Sam Koranis, he felt

assured that Medifit were the right team to help make his vision for practice into a reality. Sam was able to draw upon his significant experience to assist with the lease negotiation and ensure that conditions were optimal for the new practice. Dr Patel writes “Sam Koranis’ assistance throughout the entire journey was invaluable. Sam voluntarily offered to be a part of the Lease negotiations with the Landlord free of charge and added considerable value to the final outcome”.

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Australasian Dental Practice 135

Sam said “We were delighted to have been chosen to help Tejas establish Ellenbrook Smiles. I personally find it very rewarding to be able to value add throughout the entire project life cycle and to make sure that Medifit clients are positioned for practice success”. At Ellenbrook Smiles, Medifit has skillfully designed a practice that matches beauty with functionality. Entering the practice, pristine white aesthetics are interwoven with the inviting warmth of timber flooring. This union of elements creates an atmosphere that captures the essence of professionalism with a warm, natural touch. This design philosophy elevates Ellenbrook Smiles beyond conventional clinical spaces, ensuring that every patient interac-

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tion is characterised by tranquility. Curved bulkheads and privacy screens throughout waiting and reception help to make the areas distinct and offer subtle visual cues to guide patients within the practice. Ellenbrook Smiles spans a generous 145 square meters, incorporating four well-planned treatment rooms, two of which are fully equipped with chairs at handover with services including plumbing and electrical running to the remaining treatment rooms. This strategic layout caters to immediate patient needs whilst accommodating future growth. The treatment rooms are a fusion of practicality and contemporary design with bespoke joinery and chair position guaranteeing optimal patient care and practitioner comfort.

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Medifit has masterfully curated a waiting area designed to envelop patients in comfort and anticipation. Careful consideration has been given to the lighting, seating and decor to create an ambiance of serene expectation. As with all successful practices, the reception area sets the tone for the care that follows. Recognising the pivotal role of efficient administration, the practice manager’s office is seamlessly integrated into the layout. This functional enclave serves as the administrative nerve centre, facilitating seamless operations and allowing Ellenbrook Smiles to concentrate on elevating patient experiences. Upholding stringent standards of hygiene is pivotal in dentistry and the centralised steri and lab exemplify this commitment with the layout designed for ease of access from all treatment areas.

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Australasian Dental Practice 137

Summary The Practice The Practice

Ellenbrook Smiles

Principals

Dr Tejas Patel

Type of Practice

General

Location

Ellenbrook, Perth, Western Australia

Size

145 square metres

No of chairs

2+2

The Team Design

Medifit Design & Construct

Construction

Medifit Design & Construct

Equipment

Ellenbrook Smiles emerges as a state of the art dental practice today and as a catalyst for growth with the provision for two additional treatment rooms aligning with Dr Patel’s aspiration for future expansion. The collaborative synergy between Dr Patel and Medifit Design & Construct has created a haven of dental care excellence. This collaboration reflects an unwavering commitment to harmonise aesthetics with function and serenity with professionalism. Ellenbrook Smiles goes beyond a mere practice; it symbolises a shared commitment to elevate dental standards. Dr Patel said “Medifit have produced an outstanding, high quality outcome for our new practice. They managed to complete the fitout on time and on budget as per their contract. Ivan [PM] and the trades were great to deal with and were readily available to answer any queries that we had. We wish to thank the entire Medifit team for delivering an outstanding final result. We highly recommend Medifit to anyone that is looking at undertaking a similar project”.

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Dental Units

A-dec 400

Autoclaves

MOCOM B Futura

Imaging

Kavo Focus intra oral x-ray Planmeca ProMax 3D Classic CBCT

Compressor

Dürr Duo Tandem

Suction

Dürr VS1200

Sam Koranis added “We would like to thank Tejas for choosing Medifit as a partner on his dental practice journey and wish him every success. Our team

is proud of what we have been able to achieve for Tejas at Ellenbrook Smiles and look forward to witnessing the practice’s undoubted growth.”

September/October 2023

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

A Gold Coast practice to smile about! By David Petrikas

Gold Coast dentist who has earned a reputation for his caring, focused general dentistry along with his complex restorative and aesthetic outcomes has created a new high-quality practice setting from the ground up to better service his patients. Their mission statement incorporates “dignity, kindness and quality” as the overarching practice theme. Dr Mark Taylor operates Taylor Dental Implants & Aesthetics - co-located at his practice, Robina Quays Dental Care. The

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practice has become known as “a one stop smile solution” thanks to his in-demand implant work and cosmetic procedures. The UK-trained dentist completed his undergraduate training at the Royal London Hospital Dental School and one-year of postgraduate training at the prestigious Kings College, London. He has also completed a Masters of Dental Implants at nearby Griffith University the first University in Australia to offer a Master of Clinical Dentistry post-graduate course which has earned strong recognition among peers. Dr Taylor came to Australia many years ago as a sponsored dentist and operated

a country practice in the NSW Riverina town of Temora for a time, before moving to Newcastle and then onto the Gold Coast. He has spent a couple of decades owning and partnering in a large leading Gold Coast group practice before selling to a corporate group, then deciding to set up his own new practice to focus on providing quality services to his local patients. Being a popular family, education and retirement location and of course close to the bustling commercial centre of the Gold Coast and residential developments around nearby Robina, has seen Dr Taylor’s services in strong demand.

September/October 2023

So much so that he says he has struggled to find enough dentists to help with general dental treatments. Prior to the COVID-19 pandemic, Dr Taylor and his practice manager partner, Jaya, embarked on creating a new look and logo for their practice, including a fresh, modern interior design with neutral colours. They briefed an architect and surgery design company, Dentafit, to do a complete ground up design, to create a relaxing place to welcome patients. This included calming off-white walls and timber grain furniture and flooring, a wide central hallway, generous sized surgeries and a comfortable carpeted patient lounge area.

September/October 2023

Not surprisingly, given the brief to provide a tranquil setting, peace lilies abound in bespoke woodgrain planter boxes which separate the waiting area from the nearby reception area. It in turn features potted palms, miniature orchids and ferns around the reception desk area. The blue backlit neon-look signage behind the reception desk adds a professional touch, also boasting the practice’s wellearned motto: “Naturally Beautiful Smiles.” Vertical woodgrain slats help screen the waiting area from the clinical areas. The waiting room includes upholstered chairs, a refreshment table with water cooler and wall-mounted television screen. Blue botanical inspired artworks reflect the logo colours.

Australasian Dental Practice 141

Despite the quality of the makeover, an even more important part of improving the patient experience was upgrading the dental equipment, notably the dental units, to be better suited to longer procedures such as implants and full smile makeovers. Having worked at a previous Gold Coast practice on another brand of chairs which were far less comfortable for patients, Dr Taylor sought the advice of dental equipment specialist, Jane Miller from Dental Medical Solutions in Brisbane, to find something more suitable for his needs. After looking at other brands, Dr Taylor said he really felt that the A-dec 500 was very high tech and functional, plus A-dec was known for its reliability. “Like a lot of American equipment - they also make very good tools - it is good quality.”

142 Australasian Dental Practice

September/October 2023

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Summary The Practice The Practice

Robina Quays Dental Care

The Principal

Dr Mark Taylor

Practice Type

General

Location

Robina, Gold Coast, Queensland

Size

170 square metres

No of chairs

The Team Installer

Medical Dental Solutions, Brisbane

Equipment

He said the A-dec 500 was more “patient focussed” with soft, comfortable chair cushions and was also very user-friendly for the dentist. “The sewn upholstery is much more comfortable and feels like a good armchair. I also like the gliding headrest as it’s so easy to adjust. The first thing you do is get the headrest right, so the patient feels comfortable straight away. “The wide backrest also means the patient feels really supported and when you recline them. It can go back a long way and they still feel comfortable in the chair. “I can recline the patient right back and see the upper arch which makes working easier and sometimes enables me to see directly into the oral cavity, which makes it even easier when placing implants. “If the patient is comfortable, it takes their mind off the treatment and half the battle is won and you can make it a positive experience for them. It’s hard enough to come to the dentist as it is, but to also have your mouth open for a long period is not that easy.” Dr Taylor said another useful feature was that the A-dec 500 chair is also ambidextrous, so both left and right-handed dentists can work on it. “Jane Miller recommended the continental delivery system and I went to the dental show in Brisbane to look at it. Unlike the

144 Australasian Dental Practice

Dental Units

A-dec 500 Continental A-dec 500 LED operatory lights

Sterilisation

W&H Lisa

Imaging

Acteon X-Mind Unity X-Ray Vatech Green 16 CBCT PSPIX phosphor plate scanner

Intraoral Scanner

3Shape TRIOS

Compressor

Cattani AC300

Suction

Cattani TurboSMART

Software

Dental4windows

old-style continental which felt like it ‘pulled back’, this new A-dec system is nice and easy to use. “I don’t like the handpiece tubing dragging on the ground and with other (traditional delivery) chairs you are twisting and turning all the time and constantly looking down to pick up a handpiece. With this new A-dec continental system, you can just reach out in front of you and pick up the handpiece without even having to look up. It is smarter and far more ergonomic way of working because of the flexibility of the whip arms. “You can actually hold a handpiece with just a light finger touch as the continental system is much more supportive and it’s all in front of you, so you don’t have to reach around all the time. “The touchpad is also very intuitive and easy to program and controls the speeds of the handpieces and other attached equipment, including a Sopro 717 intraoral camera and a Satalec Piezo scaler.” Dr Taylor has set up his practice with a full suite of digital X-ray equipment including low radiation Acteon X-Mind Unity X-ray unit and Acteon PSPIX phosphor plate scanner for routine imaging, plus a CBCT machine to get a full view of occlusal dentition, airways and the temporal mandibular joints. A 3Shape TRIOS intraoral scanner complements the digital planning. This enables him to view, diagnose and plan full arch restorative cases and implant surgeries - and additionally can help to diagnose and treat patients with underlying TMJ issues.

September/October 2023

A-d ec 300 00 4 c A-de

Ade c5 00

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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.

Perfit ZR partially sintered zirconia

Perfit FS fully sintered Zirconia blocks

VATECH Perfit ZR is the simplest way to have to acheive perfect aesthetics. Perfit ZR are partially sintered zirconia discs that feature VATECH’s Uniform Compaction Firing (UCF) technology to optimixe machinability, isotropic shrinkage and physical properties including flexural strength, translucency and shades. Perfit ZR features include perfect

VATECH Perfit FS is the World’s first fully sintered machinable zirconia block. Perfit FS is the most naturallooking zirconia with a flexural strength of 500 MPa. It does not need to be fired, so you can save time and concentrate on your patients. Perfit FS features include saving time, as no firing is required; seamless 3-layered structure; high level of crack resistance; and high

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3Shape E8 dual laboratory scanner

ASIGA UltraGLOSS a game changer

Engineered for efficient dual model scanning workflows requiring minimal scanner interaction, the 3Shape F8 enables you to do more, in less time and with fewer steps. Placement of models is intuitive and fast thanks to the open scanner design and magnetic place-and-scan system. And auto-start ensures scanning begins as soon as your models

The new UltraGLOSS tray by Asiga allows you to 3D print clear parts directly with a glossy / pre-polished surface removing the need for manual post-polishing. No special post processing steps are required. Simply 3D print your parts using Asiga’s new UltraGLOSS™ material trays and then wash and cure as normal following the material

are in place. This scanner goes far beyond the crown and bridge or implant bar. From upper/ lower, die-in-model, articulator and impressions, what you can achieve is virtually limitless. Available: 3Shape Dealers Tel: (02) 8310-7020 3shape.com/en/scanners/f8

146 Australasian Dental Practice

manufacturer’s guidelines. The result – a pre-polished finish direct from the 3D printer. UltraGLOSS™ is compatible with the Asiga MAX UV, MAX X and PRO 4K. Available: ASIGA Dealers Tel: (02) 9417-6660 info@asiga.com www.asiga.com/australia

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