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SYDNEY 2-3 JUNE 2023
NOVOTEL SYDNEY BRIGHTON BEACH
TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL TECHNICIANS AND DENTAL PROSTHETISTS
TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL TECHNICIANS AND DENTAL PROSTHETISTS
TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL TECHNICIANS AND DENTAL PROSTHETISTS
TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL AND DENTAL
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management
82 Dental associateship conflicts
86 Where is your level of customer service?
88 Dental premises council zoning FAQs
90 Artificial intelligence 101
94 The time when you must call your patient marketing
96 A trip to India... the link between learning new skills and boosting your business finance
98 Quality of Advice Review: What does it mean for the profession and most importantly, for you?
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102 Instrument reprocessing without the “black box” or “magic window”
132 All smiles in Stirling
138 Mini makeover, maximum impact
106 Tooth surface protectionfrom concept to clinic
102 112
132
112 The 3D printed permanent crown - Are we there yet?
142 Second time around another success
118 A new approach in managing soft tissue volume deficiencies using Geistlich Fibro-Gide®
120 Facial scanning and new wireless intraoral scanning
120
126 Implant rehabilitation of an unrestorable maxillary lateral incisor incorporating Guided Bone Regeneration
128 Pulpotomy procedures using Biodentine™ in an immature permanent tooth and in a deciduous tooth
If you build it... will they come? In the 100-year history of the International Dental Show celebrated in March, the answer has always been a resounding yes. But in the immediately post-COVID world of trade exhibitions and events the world over, nothing is any longer a given.
By Joseph AllbeuryCertainly there was no shortage of dental companies to exhibit - in fact, 1,788 companies exhibited from 60 countries - but would the traditionally huge number of visitors once again return?
Travel restrictions were still in place for countries like China, air travel remains hellishly expensive, many people are still worried about getting sick while others are taking a wait a little longer and see approach.
For me, my personal mental health rehabilitation journey is always buoyed by repeating experiences I enjoyed preCOVID in the post-COVID world. Hence, when I booked my ticket, I had a lot riding on IDS returning as a tour de force - after all, this event is the greatest dental show on earth, right?
Fortunately, I was relieved, elated in fact, to see that the IDS experience has returned as amazing as ever!
The party we always throw on the night before IDS begins for anyone from Australia and New Zealand to attend went off without a hitch. The beer hall we always use as the venue was even staffed by the same surly waiters from four years prior. And we pulled a respectable crowd of our own.
Nothing like the main event, however.
In 2023, IDS succeeded in attracting 120,000 visitors from 162 countries to the Cologne fair grounds to see the latest and greatest that dentistry has to offer. It was packed! Covering 180,000 square metres, the 40th edition of the event in its 100th year didn’t disappoint. The last full size event in 2019 pulled an additional 40,000 people, but for all intents and purposes apart from that, it was bigger [10,000 square metres bigger] and better than ever... with wider aisles and the brand new Hall 1 with high ceilings similar to what we see at exhibition halls in Australia.
And all the halls were packed with everything dental has on offer - the best, the worst, the latest, the greatest. Home!
By the end of it, I didn’t even mind overpaying by around 400% for a very average hotel room. After all, that’s all part of the IDS experience.
Face-to-face, live and in person conferences and trade shows have survived COVID and returned in force as one of the most loved components of the dental world where you can meet up with friends and network with colleagues, learn and share experiences across the profession.
Our own Digital Dentistry & Dental Technology 2023 event is being staged in Sydney on June 2-3 and is a great way to see the latest tech from IDS and to catch up with your friends and colleagues for some fun while enjoying a first class education program. I hope to see you there!
Joseph Allbeury, Editor and Publisher
INLINE Systems, a leading dental imaging solutions provider, has announced a strategic partnership with EPIC-X and EVERX, sister businesses with common values of delivering excellent customer care with passion. This partnership will expand INLINE’s product portfolio and market reach, enabling the company to improve operations and provide enhanced customer support under new management. INLINE Systems founder, Mike Harman, will retire but continue to support the business as a consultant. EPIC-X is one of the fastest-growing suppliers of medical imaging products and services in Australia and New Zealand, while EVERX is the largest business in the APAC region providing pre-owned medical imaging equipment globally with offices in Sydney, Tokyo and San Diego. The partnership with EPIC-X and EVERX will enable INLINE Systems to provide a wider range of highquality products and services to its customers, taking the company to the level of growth!
Practice Sale Search has appointed
Michael Brivulis as its new National Account Manager. Michael joins the Practice Sale Search team after working in dental practice acquisitions and practice builds for two major Australian dental corporate aggregators. Before this, he worked in the financial services sector for more than 15 years. Michael’s experience gives him a unique insight and knowledge into how buyers (both private and corporate) value and assess practices for purchase. Through his involvement in hundreds of practice purchases, he has seen many vendors miss opportunities to get the best terms and price for their practice, either by being poorly represented during negotiations or not understanding the true value that their business holds for a buyer. As a CFA charterholder, he has an acute understanding of the financials of a dental practice and how to maximise profit. His background means he is perfectly positioned to appraise and value dental practices, a service that will greatly benefit Practice Sale Search’s clients. Michael brings a wealth of business development and client relationship experience to his role at Practice Sale Search and will be an invaluable asset to the company and its clients.
Anew Directories feature has been added to the www.dentalcommunity.com.au website as part of the trial of our new Dental Products and Services directory that will offer dental professionals in Australia, New Zealand and elsewhere a comprehensive resource to source information. Both software development and information collection are underway, with the first segment available providing a comprehensive list of autoclaves - Scan the QR code to view these and compare.
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A confocal micrograph of a gap-free Stela-dentine interface. Note the penetration depth of Stela Primer (yellow) within the dentine tubules.
More than 50 years ago during a course in restorative dentistry at the Eastman Institute in London, one of the instructors said something that had a profound impact on my dental career. He said that the primary aim of dental treatment should be to ensure that the patient retains a functioning dentition for life - it is not to enrich the dentist! Recently, there has been a lot of commotion in the profession regarding a push to allow pharmacists in Queensland to examine young patients and apply fluoride varnish. Clearly this is not an ideal situation, but it is one that has a lower potential for harm than the mail order orthodontics that are promoted through some of the pharmacy chains, or for that matter, the “Bleaching Boutiques” that are springing up in various shopping centres.
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The rot started when dentists no longer felt it necessary to ensure that their name was the primary identifier on their practice and, for reasons that escape me, have followed a trend to call their practices by names invented by advertising people. In most cases, it is now impossible to find the name of the actual dentist on the outside of their practice (or even anywhere on their website!). What this has done is to commodify dental treatment into a generic product. To quote Sean Connery from the movie The Untouchables, “look, he’s brought a knife to a gunfight”. And so it is with us - we are competing with large pharmaceutical retailers for market share instead of promoting the provision of a professional service.
The Corporates and the Health Funds could well be following the same tactic in their pursuit of profit (camouflaged as providing better access to “affordable” dental treatment!) as that used by the progressive left to deny their opponents the moral authority to speak.
The origins of that manoeuvre as quoted in a recent newsletter from The Menzies Institute were originally outlined by Saul Alinski half a century ago in the best-selling activist handbook ”Rules for Radicals” - Pick the target, freeze it, personalise and polarise it.
Dentists are the target. People would prefer to avoid a visit if possible; it is never really pleasant and always costly. Now if you can promote dental treatment away from dentists and include cost saving in the equation without mentioning the risks involved, you have a marketable product.
To a large extent, we are primarily to blame for our own predicament. It began when members of our profession started large advertising campaigns to promote aspects of dental treatment to the public at large, often for treatment that had more to do with financial returns to the practice than what was best for the patient. Protecting themselves by establishing relationships with other professionals so as to comply with the letter of the law and yet possibly not its intent, we left ourselves vulnerable to exploitation by commercial organisations that aren’t even hampered by a Code of Ethics - no matter how ineffective that appears to be.
It’s a race to the bottom in pursuit of monetary gain and we, as a once proud profession, are the poorer for it.
By Georges Fast
“One of the instructors said the primary aim of dental treatment should be to ensure that the patient retains a functioning dentition for life - it is not to enrich the dentist!”
“The rot started when dentists no longer felt it necessary to ensure that their name was the primary identifier on their practice and have followed a trend to call their practices by names invented by advertising people....”
This issue we look into some products and equip ment that I use in practice. We look at some recently released new products and elaborate on how their use can be applied in practice. Investing in the right armamentarium allows clinical prac tice to be simpler and more enjoyable for the wet-fingered dentist and hopefully, this column provides the reader with some of the latest “tools of the trade”
Finally, a dental company has improved on current rubber dam offerings with the addition of a pre-printed rubber dam. This is a powder free latex rubber dam that is black in colour. HySolate Black Edition from Coltene was created to allow for higher contrast and, thus, improved visibility during procedures. The black colour is also a non-reflective surface so there is no glare to contend with. The higher contrast and zero-glare allow one to also take higher-quality photographs. The material consistency is medium in strength, allowing excellent retraction of the tissues. The addition of the pre-printing has marked the template with the positions of the teeth ensuring holes are punched in the correct positions on the dam. Historically, one would have to mark the dam with a rubber stamp, which sometimes would rub off and make a mess, but this saving in time and convenience is a welcome addition.
With the widespread adoption of dental implantology, there is often the need to temporise during the osseointegration phase and a concern is always the inadvertent loading that could occur with provisional removable prostheses in the mouth. It is often necessary to adjust the prosthesis to ensure that these are relieved but it can come at the price of lost retention and discomfort, especially as healing takes place with
is the primary concern, while the medium version is used for higher durability. One of the other advantages is that the material comes in an easy auto-dispensing system so there is no need to mix the materials and it comes in a pink colour matching gingival aesthetics better.
Iam asked about my recommendations for sutures for surgical closure and one I really recommend is Monocryl from Ethicon. It is an absorbable, monofilament suture comprised of a synthetic material called Poliglecaprone. This suture has a medium tensile strength and comes both dyed (violet) and undyed (clear). Monocryl has a low tissue reactivity, maintains high tensile strength and has a half-life of 7 to 14 days. At 1 week, its in vivo tensile strength is at 50-60% undyed (60–70% dyed); 20-30% undyed (30-40% dyed) at two weeks; and essentially completely hydrolysed by 91-119 days. It is slippery, making it easier to pass than a braided suture with a consistency close to nylon which makes it easy to use intraorally. Due to being absorbable, it should not be used where extended approximation of tissue is under stress, but for the majority of surgical procedures it is my preferred suture material. I normally use a 3/8 reverse cutting needle 5/0 size.
Dr Christopher Ho is a Specialist Prosthodontist based in Sydney, Australia. He is Head of School of the Australasian College of Dental Practitioners, Visiting Lecturer at Kings College London, Adjunct A/Prof at University of Puthisastra and Editor of the Wiley-Blackwell textbook “Practical Procedures in Aesthetic Dentistry” and “Practical Procedures in Implant Dentistry”.
MRC’s 2023 International Summit is an excellent opportunity for both experienced and new practitioners to meet and network with like minded industry professionals and learn from globally recognised experts in the field of myofunctional orthodontics, dental sleep medicine, integrated airway and TMJ treatment, as well as other related topics!
Key and Guest Lecturers:*
*May be subject to change.
Dr Chris Farrell
Additional Lecturers Include: Dr Madeeha Khan - Dr
Scan the QR code to redeem a 20% discount on the summit registration fee.
“The patients’ mouths are under-diagnosed. The patients don’t have comprehensive treatment presented to them. The patients do not experience and receive total care and total oral health. In most cases, these patients receive treatment for symptomatic reasons only...”
II meet a lot of dentists. I meet some dentists and I wonder what they were ever thinking in becoming dental practice owners. Yes, really.
Because the way these dentists run their dental practices, there are no winners.
Their patients do not win.
Their staff and employees do not win.
Their practice owners and shareholders [including themselves] do not win.
In these practices, in most cases...
In most cases, the patients of these practices do not have their oral health treated with respect.
The patients’ mouths are under-diagnosed. The patients don’t have comprehensive treatment presented to them. The patients do not experience and receive total care and total oral health.
In most cases, these patients receive treatment for symptomatic reasons only. A lot of their diagnosed treatment is “watched”, or the patient is told: “we’ll see how it is next time”
In most cases...
Staff are considered an expense rather than an investment for these dental practices. Staff are often followers and reactors and are rarely delegated roles of support and leadership.
Team are rarely incentivised nor rewarded on practice performances and results. And yet in these practices, results are expected to simply just “naturally occur”?
In most cases..
In most cases, these dental businesses simply trundle along in second gear. In most cases, the results these businesses achieve are discussed retrospectively. At the end of the financial year. After each quarter. At the end of each week and each month.
In most cases, profit is minimal and is not maximised.
In most cases, the owners receive a financial benefit of only slightly more than a paid job and not nearly as much as they could be, and should be, receiving.
It seems pointless...
It seems pointless to be the owner of an underutilised and underperforming facility for the sake of only a few dollars more return than having a job, that has no risks, no headaches and shorter hours than are involved in owning a dental practice.
It’s like owning a Mustang, but only ever driving it at 30kph to the corner shop three times a week.
A well-run practice should allow the patients of that practice to have and enjoy a truly 100% healthy dental environment.
A well-run practice should be a breeding ground for team members to develop a love for a career in dentistry and all of the options and pathways that a career in dentistry has to offer.
A well-run dental practice should be a solid investment providing a healthy return to the owners for their capital investment and for the investment of their time and toil into their facility.
ability to do so...
All that dental business owners simply need to have is a helping hand as guidance to truly get the best out of the asset that they have right there in the palm of their hand.
Because when these owners fail to truly realise that asset?
That’s the real tragedy of dental practice ownership.
It’s a tragedy for the owners [as shareholders].
It’s a tragedy for the lost opportunities of employment advancement for the team members that work there.
And it’s a tragedy because the patients of these practices do not receive the opportunities of having complete comprehensive dental treatment presented to them as being in their best interests for their own health and well-being.
Is the system failing the profession?
Dental students are graduating with clinical skills, but not with any business skills sufficient to run and survive for 40 years.
Dental school is not preparing their graduates with the necessary skills and a blueprint moving forward for successful business ownership.
Have you noticed that leadership, people management and front office phone training are not taught in dental school?
Successful dental practices have: Great systems and protocols; Great leadership; Good people management; Their dental office phones are managed exceptionally; World class customer service systems; and Great time management.
These subjects are not taught at dental school.
Graduates leave university extemely underprepared for the different phases of their 40 forty years as dental practice owners.
It’s no wonder that 95% of them slip into the land of mediocrity when running their dental practices. And that’s a tragedy.
It’s a tragedy for the dentists, it’s a tragedy for the staff employed in those underperforming practices and it’s a tragedy for the people who become patients of those dental practices...
The good news is...
The good news is that the missing pieces of dental business ownership can be sourced after graduation, by engaging with qualified coaches and consultants who have “been there and done that” and owned and run successful dental practices and have successfully taught others how to own and run their own successful dental practices. Good help is around.
Dr David Moffet is a dentist and a #1 Amazon Bestselling author. He is the inventor of The Ultimate Patient Experience™, a simple to implement patient retention system he used to build and subsequently sell (for several million dollars) his successful dental practice [of 28 years] located in Parramatta in working class western Sydney. He can be contacted at david@theUPE.com or visit www.theUltimatePatientExperience.com.
“A social network is like an onion. Close to the centre, there are a few tightly wrapped, cohesive layers. These are intimate, personal contacts of the person at the centre of the onion. But they are small in number...”
In my article in Australasian Dental Practice in the July/August 2022 edition, we took a look at some different customer acquisition strategies using Peter as an example: (1) selling to Peter as an individual; (2) selling to Peter’s friends and network; and (3) selling to market segments. Each has a different impact on the “sales funnel” and therefore a different expected ROI (return on investment) for your advertising dollars. Furthermore, each requires a substantially different approach and different data to be a success. Figures 1-3 show a quick refresher of how the sales funnel for each looks.
In this edition, I want to expand on the psychology behind “stratified network leads” to help your better understand how to design a social media campaign that results in new customers and new revenue. For anyone who has dabbled in Facebook advertising before, you will know this is not an easy thing to do unless your aim is to be bombarded with advertisements from other dental practices in your socials feed, in which case it’s a piece of cake.
A social network is like an onion. Close to the centre, there are a few tightly wrapped, cohesive layers. These are intimate, personal contacts of the person at the centre of the onion. For Peter, this might be his immediate nuclear family and closest friends. They are people who are very likely to heed Peter’s advice that you’re a great dentist. But they are small in number. If we can get Peter to recommend our practice to these patients, then they are likely to switch, particularly if you can provide Peter with a competitive edge with which to plug your services (more on this in future editions).
If we move out a few layers, the onion rings are more numerous in number, further from the centre, thicker and less closely packed together. But they are closer to the centre and more penetrable than the hard outer rings of the onion. These are middle ground contacts; people with regular personal contact with Peter but a much looser social connection where social norms rather than personal trust dominate. A good example is another parent that Peter runs into every weekend at the playground while there with his own children. They exchange social niceties bound by social norms but are not bound by personal trust. These are people who might take Peter’s advice that you are a great dentist. Taking up this recommendation largely depends on two things: (1) not having advice from a looser social connection and (2) whether the connection evoked the search by asking Peter if he knows a great dentist rather than Peter volunteering unsolicited recommendations. The consequence for social media is obvious: a direct appeal initiated by Peter to his network will have limited success precisely because it emanates from Peter without solicitation. It is certainly better than a complete cold advertisement, but certainly not going to hit a home run for new patient bookings.
On the very outside of the onion, we have tough layers who encapsulate the softer inner layers and form a physical barrier between the inner layers and the outside world. These are the people that exist at the very periphery of Peter’s network. It is his large extended virtual network that exists solely in the world of social media. These leads are plentiful. But they also operate on herd mentality rather than personal or social norms. This is where most social media campaigns like Facebook fall down – they reach a huge network of people that result in little to no bookings and conversions. The few conversions that do arise capitalise on the fact that there is safety in numbers when it comes to choosing an unknown (like a new dentist).
So how do we go about making a social media campaign that gets results? Here’s one algorithm:
post and cause them to share with their own networks, thereby going viral.
Here’s an example...
1. Avoid: Avoid unsolicited recommendations by avoiding posting about your business to your existing customers;
2. Mobilise: Target the inner core of the onion by mobilising your existing customers who have real experience of your business and services to post on your behalf; and
3. Emote: Tap into emotions to create a ripple effect by providing a reason for the post to go viral and penetrate core upon core upon core outside your existing customer base.
On first glance, it might seem impossible to mobilise our inner networks while avoiding solicitation to do so. But we can achieve this by getting our patients to post on our behalf. But any post will not do, it has to be a post that can elicit emotions sufficiently strong to get repeated shares. Which means we must understand the psychological factors that would make a patient want to post about our businesses in the first place and understand what makes readers of posts go on to share to their own networks and make posts go viral and both must be positive reflections on our business.
I could write pages on the psychology of these points, but in short, humans are attracted to anything that stimulates the primal regions of the brain as opposed to higher centres. This is why we pay more attention to negative events than positive events and why we pay more attention to things that stimulate negative emotions like jealousy or feeling unappreciated than our happy moments which are quickly forgotten.
If you need more convincing, just think of what happens during a break-up. We fixate on every little hurt and insult but find it hard to ruminate, let alone recall all the good moments which must have outweighed the bad for the relationship to survive its infancy. So we want a positive post from an existing customer that will evoke primal emotions in those who see the
Peter has been coming to your practice regularly for the last 10 years and has an excellent relationship with you and your staff. You know Peter is saving for the upcoming wedding of his eldest daughter. When Peter comes to see you for his crown, you waive not only the fee for the crown but refuse to even take a health-fund rebate. Instead, you simply say consider it a contribution to the wedding and a thanks for all the years you’ve been coming to see us. Peter is going to feel great! And although he isn’t a big user of Facebook, his daughter certainly is. He tells his daughter what happened and passes on your well-wishes for the wedding. Peter’s daughter loves to post anything about her wedding and shares this event on her socials. Her close contacts who are vested deeply in Peter’s daughter are also deeply touched. But they are also a little jealous because their dentist at most has only ever sent them a birthday card each year and has certainly never given such a grand gesture of appreciation. So they feel a little disgruntled with their own dentist (with whom they previously felt no such sense of entitlement) and at the same time compelled via social norms to share his daughter’s post with their own network. The same psychology that compels people to share this story also compels people to chase positive feelings in their own dental relationships; resulting in new patients searching for this difference. Your post reaches the core of many social networks and it cost you the lab fees for one crown and an hour’s chair time. The same principle with different application applies to taking advantage of social norms in the middle ground contacts.
“When Peter comes to see you for his crown, you waive not only the fee for the crown but refuse to even take a health-fund rebate. Instead, you simply say consider it a contribution to the wedding...
And although he isn’t a big user of Facebook, his daughter certainly is...”
I have used these principles successfully in my own business and hope you can find a way to do likewise in yours.
Why not start by trying to work out how to take advantage of middle ground contacts using the information you’ve learned in this article?
Lani Guy is a University of Queensland trained General Dentist working in private practice. In a prior life, Lani was a management consultant. She has a Bachelors, Masters and Doctorate in business along with a Bachelors in psychology and has spoken globally on the topic of digital disruption and IR4.0. She has a special interest in evidence-based improvement techniques and disruptive innovation... as well as healthcare.
“Any post will not do, it has to be a post that can elicit emotions sufficiently strong to get repeated shares... We must understand the psychological factors that would make a patient want to post about our businesses and what makes readers go on to share to their own networks and make posts go viral...”
In the wake of the first wave of the COVID-19 pandemic, a phenomena dubbed the “Great Resignation”, where employees have voluntarily resigned from their jobs en masse, began to be seen in hospitality, healthcare, education and elsewhere Many health-sector employees, taking advantage of the widescale skills shortages that followed an unprecedented increase in consumer demand, negotiated better work conditions and salaries with their employers. Alternatively some employees, per the trend, chose to switch jobs altogether, many more than once. Here are 7 pitfalls to consider before you make the switch...
Your overtime hours may be disregarded in your new workplace. There may be expectations on you to start early, finish late and work through part of your lunch breaks, almost always unpaid. An expectation to work an additional 15 minutes at either end of the day and 15 mins into your lunch break will erode over 11% off your hourly rate on a standard 38-hour-per-week roster. Some businesses may also avoid paying overtime rates for weekend work and long shifts.
The health care practices offering pay well above market rates may be offering you “danger money”. Some practices struggle to retain staff for a variety of reasons, so are forced to pay above-market sums simply to attract staff. Reasons may include poor HR practices, infection control and workplace culture, to name but a few. As a guide, look for other long-serving current employees of the business in similar roles.
“Practices paying danger money to simply secure your services may struggle to offer another pay rise for a very long time. Apart from negotiating your new pay rate, also negotiate your next pay rise date and the approximate quantum of that rise if you meet reasonable expectations...” 1
You may sign off on a job description you’re comfortable with, only to discover the new role comes with a series of tasks and expectations that are not worth the hours of unsupported physical and mental stress that comes with the pay increase. Be very clear on your proposed job description - not only in what it “includes” but also in what it excludes.
The practices paying danger money to simply secure your services may struggle to offer another pay rise for a very long time. Apart from negotiating your new pay rate, also negotiate your next pay rise date and the approximate quantum of that rise if you meet the reasonable expectations set down for you in your new role.
Some practice owners and managers securing your services on danger money may “begrudge” the money they are paying you. Set to plague your relationship may be never-ending unrealistic and shifting expectations on performance, hours of work and duties.
5 2 6 3 7 4
Whilst your minimum weekly hours are safe in good economic conditions, any downturn in business revenue or gaps in the appointment books may lead to a reduction of your weekly hours. Unwanted obligatory late starts and early finishes can eat heavily into your pay packet.
Some roles within the health sector are a stepping stone to more learning and career development; others are dead-end roles with no career pathways. Carefully consider the pros and cons of choosing near-term financial upsides over career progression within your business and industry as a whole.
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.
Patient well-being, dental staff comfort and cutting-edge performance all come together in the new S380TRC.
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As Europe’s number one dental unit manufacturer, Cefla Medical Equipment implements synergies from the design phase right up to industrialisation in order to ensure premium product quality standards are respected.
Stern Weber, one of the trademark brands of Cefla stands for excellence backed by distinct values and a unique history.
“Steve had a great life and was no more than 55 when a blood clot in his brain tore it apart, leaving him a shell of his former, confident self. Steve suffered from sleep apnoea... the suffering and frustration became too much for him and he pulled the ejection lever for the last time...”
As I strode up the ramp of the dilapidated PCYC on Monaco street, the scent of sweat and the distant rumblings of 80s rock music greeted me as I approached the door. It was my first day on the job as a freshly minted Exercise Physiologist and I was filled with a sense of trepidation and accomplishment. Finally, I’d arrived at the point where I could treat my first patient!
I met Steve (not his real name) at 7:00am on a Monday morning, sometime back in 2008. He had suffered a stroke 12 months prior and was left with almost complete paralysis on his right side, as well as aphasia affecting his speech. Our first encounter was brief and awkward, with a shaky handshake between my right and his left hand, followed by my briefing him on how we would begin. I’m sure he was thinking, “Who the f*%k is this Kid who’s meant to be rehabbing me?”
Over the next six months, Steve and I trained together every week, sometimes twice a week. We eventually hit it off and I won’t lie, he was my favourite patient and probably the best I’ve had to this day. I learned a lot from him about his two beautiful daughters, his 30 years as an airline pilot (which he missed dearly) and most impressively, his time as a Navy pilot, during which he was invited to what is essentially the “Top Gun” program in the United States.
Steve had a great life and was no more than 55 when a blood clot in his brain tore it apart, leaving him a shell of his former, confident self. Steve suffered from sleep apnoea and six months after I had finished his structured rehabilitation program, the suffering and frustration became too much for him and he pulled the ejection lever for the last time.
It wasn’t until years later, when I underwent training in the field of sleep disordered breathing, that I thought back on Steve. For years, he had received regular check-ups, dental visits and screenings by GPs and specialists as part of his job. What was passed off as sustained, almost untreatable hypertension was likely caused by something as simple as sleep apnoea, which he was only diagnosed with after his stroke.
Steve’s story is one of the saddest I’ve personally dealt with in my time working in healthcare but by no means is it unusual.
With one in every four men suspected of having sleep apnoea and only 20% of patients having received a formal diagnosis, there are plenty of Steve’s walking in our clinics each day. The question that haunts me the most is where does our obligation start and where does it end? Is it the patients responsibility to recognise warning signs and risks or are we as health professionals able to identify and lead a patient on the path to diagnosis and eventual treatment. Knowing that treating a patient with sleep apnoea results in a 30% reduction in 5-year mortality by drastically reducing cardiovascular risk, how can you not act?
Thankfully, over the last 15 years, the sleep disordered breathing space has innovated and grown in leaps and bounds. We now have access to dozens of home sleep testing options, some as small as a ring on your finger. With the integration of wearables, cloud computing and artificial intelligence, we’re able to more accurately diagnose in the home in a way that is comfortable and accommodating of normal sleep (more so than the “wired for sound” devices of the past).
However, even with the gold standard treatment of obstructive sleep apnoea (OSA) being positive airway pressure (PAP), many patients stop using their devices within the first two years of treatment (60% or more). This highlights the need for alternative treatments, such as oral appliances, which have a compliance rate of close to 90% after two years of use and are becoming more prevalent in the field.
As more research and development is focused on monitoring patients and interpreting data to improve therapy, we are witnessing a new era of OSA treatment emerging as a potential market leader in the field.
Devices for the treatment of sleep disordered breathing have greatly improved over the years due to advancements in 3D printing technology, stronger biocompatible materials and a better understanding of airway and TMJ biomechanics. As a result, these devices now provide better efficacy and comfort compared to older designs. For dentists, there are now hundreds of courses and programs available worldwide, providing easy access to education in dental sleep medicine. Physicians are also favouring oral appliance therapy over PAP, leading to a 300% growth in oral appliance sales compared to PAP systems.
Dentists, who have a unique understanding of the mouth and upper airway, are perfectly positioned to identify patients at risk of sleep disorders and to provide them with appropriate treatment. With access to education in dental sleep medicine, dentists can upskill and become part of one of the fastest-growing fields in healthcare, while also giving their patients the opportunity to improve their quality of life.
Ultimately, the obligation of dentists is to their patients and upskilling in dental sleep medicine is one way to ensure that they are providing the best possible care. By identifying and treating sleep disorders, dentists can help their patients live longer, healthier lives, giving them the opportunity to enjoy time with their loved ones and engage in the activities that bring them joy. We look forward to having you join the field.
Joel is one of the founding directors of Good Sleep Co. He has over 12 years experience in the sleep apnoea and snoring treatment market to the development of Good Sleep Co products. Contact Joel via email for info - joel@goodsleepco.health
More than 64 percent of dental professionals suffer from general musculoskeletal pain. The new HDL Ergo loupes from Orascoptic fight work-related neck discomfort, improve your posture and prolong your career.
Ergo loupes, also referred to as deflection loupes, employ an innovative optical prism element that deflects light at a steep angle. This allows the clinician to look straight ahead, keeping their chin up and neck straight, while viewing the operating site below.
The use of prismatic loupes may significantly reduce the risk of developing musculoskeletal disorders (MSDs), including neck and shoulder pain and decrease perceived muscular exertion during the performance of dental work.
Designed for performance, the HDL Ergo optics deliver a crisp image with edge-to-edge clarity that enables precise movements. Each loupe is custom crafted to your desired working distance and features a field size of almost 90mm.
The telescopes can be mounted on six different frame models, including the new Dragonfly powered loupe that features a built-in headlight.
Dragonfly by Orascoptic is a loupe with fully integrated battery power and circuitry to operate a built-in headlight.
A true triumph of optical engineering, Dragonfly seamlessly combines Orascoptic’s industry-leading optics and award-winning headlight into a single, lightweight product.
All electronics and batteries are completely contained within the custom-built frame, so there are no visible wires or cables. An innovative counter-balance design provides all-day comfort by minimising pressure on the wearer’s nose bridge. Dragonfly offers...
n Untethered freedom of movement.
n Magnification and illumination working in harmony.
n Balanced ergonomic comfort. Reduce the weight on your nose by as much as 30% compared to traditional loupes.
With HDL Ergo and Dragonfly, you get the best of both worlds - enhanced ergonomics together with outstanding illumination, all with the exceptional quality you know and love from Orascoptic.
Schedule a free no-obligation demo by calling 1800-643-600.
Introducing Dragonfly: a new species of loupes that seamlessly integrates a built-in headlight.
The better your equipment, the better your work. But there’s something to be said about how your equipment makes you feel. Sleek. Agile. On top of your game.
You have never owned a loupe like this because there has never been a loupe like this. Empower yourself with the vision and freedom to perform at your peak.
To schedule your free demo call 1800 643 600
The era of the powered loupe has arrived.
By Joseph Allbeury
Stoma Instruments are proving popular with dentists and specialists in Australia following Geistlich commencing distribution of the range. We caught up with Markus Braun, Vice President International Sales & Business Development at Stoma, during the recent ADX dental exhibition in Melbourne to hear about the secrets to their success.
JA Welcome to Australia Markus. Tell us about Stoma instruments - where are they made, where’s it based?
MB Yes, absolutely. We’re very much engaged with our end customers. Our direct sales approach allows us to maintain close contact with dentists across various specialties such as prophylaxis, perio, perio surgery, surgery, implantology and more. We have a wide range of products that cater to these specialised areas. Building strong
screws for bone augmentation, known as osteosynthesis. Our expertise in these specialised areas has earned us a reputation as a specialist in dental instruments, covering a wide field of dental applications.
What are some of your key achievements in instrument development?
MB
Joseph, I greatly appreciate your warm welcome. It’s a pleasure to be here in Australia. Stoma / Storz am Mark is a German-based company with its headquarters and factory located in Germany. We take pride in manufacturing approximately 1,700 diverse products at our facility. Storz am Mark produces and sells them worldwide under the brand name stoma®. All our products are made in Germany.
JA
And what was the genesis of the business? How did it start?
MB The journey of our company began 104 years ago with its founder, Mr Walter Storz. He was a highly innovative individual who started inventing dental instruments for dentists from his own home. He would then ride his bicycle to the dentists’ offices, showcasing his products and asking for feedback. This same pioneering spirit and customer-centric approach still define our company’s DNA today. The family business is now run in the third generation by the granddaughter of the founder, Tina Storz-Mazzeo.
relationships with our customers is at the core of our company’s DNA. Through this engagement, we are able to generate new ideas and develop innovative products in collaboration with our customers.
MB We hold numerous patents for our products, with a history dating back to the 1930s and 1940s. Many of the current instruments used in dentistry were actually pioneered by Stoma / Storz am Mark, making us the inventor or leader in these products. For example, we have patented bone applicators and micro screws, which are used as bone screws. We also have a cutting-edge product called VST (Vestibular Socket Therapy), which is a highly innovative instrument set with unique features. We have also developed two new noble handle designs for our micro instruments, hy-light® and dark line. These instruments make the user’s work easier due to 25% less weight and less reflections under the microscope. Our commitment to developing new and innovative solutions for dentists is evident through our continuous development of new products
What would you say are your strengths and which areas of dentistry are you particularly focused on?
JA Is there anything unique about your manufacturing process?
MB
And how does that work? You’re working with clinicians to develop new instruments?
JA
We have a clear focus on various key areas, including prophylaxis which is a crucial part of periodontology, perio surgery including microsurgery, as well as a wide range of surgical instruments and implantology. Additionally, we also manufacture bone
Oh yes. As a company, we are not large-scale, so our production process involves a combination of automation and manual work, especially for precise instruments used in microsurgery. Our team consists of skilled individuals with specific expertise in manufacturing such instruments and our 103 years of experience in the field adds
to our proficiency. The production process involves various aspects, including the use of high-quality stainless steel sourced from either the US or Germany, stringent quality management practices and validation of processes to ensure compliance.
Additionally, customer engagement is a vital part of our approach as we strive to maintain a high level of quality in our products. It’s the collective combination of these factors that form the DNA of our company and the quality that our customers recognise in our products.
JA Are there well-known dentists you’re working with?
MB We collaborate with renowned dentists such as Professor Anton Sculean and Professor Giovanni Zucchelli, who are internationally recognised experts in periodontology. They choose to work with Stoma because we not only provide innovative products, but also reliable, precise and safe instruments for their clinical needs. Our commitment to delivering high-quality products that meet the
expectations of these influential experts is what makes Stoma a trusted and valuable partner in the field of periodontology.
JA So do these clinicians help develop new instruments?
MB Indeed. The process of product development at Stoma is not an overnight process. It involves close collaboration with our Member of the Executive Board and Product Designer, Martin Mazzeo, who is the driving force behind our innovative products. Martin initiates contact with Key Opinion Leaders (KOLs) in the field and together they exchange ideas and insights. Martin has a unique ability to visualise the product in his mind, which leads to the creation of a prototype. This prototype is then sent to KOLs for clinical use and their feedback is taken into consideration for further modifications and improvements. However, the challenge lies in the regulatory aspects, especially with the current MDRs [(Medical Device Regulations), which have made the process more complex, but we strive to
meet all regulatory requirements to bring our innovative products to the market.
JA Finally, why Stoma and Geistlich?
I appreciate the collaboration between Stoma and Geistlich because we share the same philosophy and mentality. Both companies are considered top-notch in their respective fields, offering high-end products to the best dentists. This collaboration is not just about finding a specific market, but there is potential for much more. It’s about delivering the best products and solutions to meet the needs of dental professionals and that speaks volumes about the value of this partnership. Together, we strive to be at the forefront of innovation and excellence in the dental industry. So there is a lot of potential for growth and expansion in our collaboration with Geistlich.
JA Thank you for your time, Markus.
With passion for per fection
We are proud to offer stoma®, a traditional manufacturer of precise dental instruments made with passion for perfection. Strict manufacturing processes and rigorous testing ensure that all Geistlich products exceed expectations and meet established regulatory requirements.
We are proud to offer stoma®, a traditional manufacturer of precise dental instruments made with passion for perfection. Strict manufacturing processes and rigorous testing ensure that all Geistlich products exceed expectations and meet established regulatory requirements.
Periosteal elevator Buser, 17 cm
Periosteal elevator Buser, 17 cm
Goldman-Fox Scissors, 13cm, curved, toothed
Periosteal elevator, Prichard, straight
cm, curved, toothed 22, 2-4-6-8-10-12)
Periodontal probe (PCPN22, 2-4-6-8-10-12)
Hy-grip handle, dia. 8mm x2
mm, toothed, DE
Bone curette, Lucas, 2.5mm, toothed, DE
Scalpel blade holder, straight
Scalpel blade holder, straight
Forceps, advanced, surgical 1:2 teeth, 1.3 mm, straight
Forceps, advanced, surgical 1:2 teeth, 1.3 mm, straight
Forceps, advanced, anatomic TC, 1.3 mm, straight
Forceps, advanced, anatomic TC, 1.3 mm, straight
Micro needle holder, Barraquer, TC, 1.2 mm, straight, 18cm
Micro needle holder, Barraquer, TC, 1.2 mm, straight, 18cm
MEGA "Rhodium Front Surface" Mouth Mirror, size 4, dia. 22mm plane (12PK)
MEGA "Rhodium Front Surface" Mouth Mirror, size 4, dia. 22mm plane (12PK)
Optional:
Optional:
Gingevectomy knife, Orban O 1-2, contra-angled
Gingevectomy knife, Orban O 1-2, contra-angled
P.i.c tray with 2 racks for 7 instruments, 1 rack for tweezers, 2 holding bolts and cover
STO-19924.00
STO-19924.00
Images are not to scale.
Images are not to scale.
P.i.c tray with 2 racks for 7 instruments, 1 rack for tweezers, 2 holding bolts and cover made in germany
please contact your local Geistlich Product Sales Specialists or our customer service team on 1800 776
ocial media has become an important tool for practices to reach out to their target audience and connect with potential customers. Instagram is one of the most popular social media platforms and it can be a powerful marketing tool for dentists who want to increase their online presence and attract new patients.
Here are five ways dentists can best use Instagram...
Share high-quality photos and videos. Instagram is a visual medium, so it’s crucial to share highquality photos and videos that showcase your practice and services. Take pictures of your office, staff and patients to create a personal connection with your followers. You can also post before-and-after photos of dental procedures to demonstrate your expertise - as the saying goes, a picture paints a thousand words.
with
Use relevant hashtags. Hashtags are an excellent way to increase your reach and attract new followers. Use relevant hashtags such as #dentist, #dentalhealth, #smilemakeover and
on your followers’ posts. You can also ask your followers to tag your practice in their posts or share their photos on your account.
Show your personality. Instagram is a social platform, so it’s essential to show your personality and let your followers get to know you. Share behindthe-scenes photos and videos, post stories about your hobbies, social events and interests and showcase your staff’s personalities.
#teethwhitening to reach people who are interested in dental health and procedures. Engage with your followers. Engagement is crucial on Instagram. Respond to comments and messages promptly and make sure to like and comment
Promote specials and promotions. Use Instagram to promote specials and promotions to your followers. You can create custom graphics and posts that highlight your offers and encourage people to book appointments or visit your practice. Rather than offering discounts, consider bundling items such as free whitening with braces.
More at dentalmarketingsolutions.com.au
Bring your practice up to the latest scientific compliance for infection control. Pass ALL current and future accreditations. We do all the work and offer a Turn Key Solution. We undertake a complete run through of your practice and...
s Custom write all practice operation manuals and procedures for infection control
s Custom write all WHS/HR policies and procedures
s Train and certify all staff members to ASNZ 4815:2006
s Certify your practice to ASNZ 4815:2006
s Provide ongoing service and support
The manuals and documents have no expiration date and encompass all the current scientific methods utilised in international infection control.
Total Infection Control (TIC) takes your practice into the 21st Century. Utilising the latest international scientific standards, these short videos provide a complete course for dental infection control, complete with CPD certificates upon completion.
n Individual login for each staff member
n Access to all areas of infection control
n Easy to understand - Next generation of training
n Comical and entertaining
n Easy to use
n Multiple choice quiz
Your staff will become competent and confident in their knowledge of infection control in dentistry, holding strong scientific knowledge, without the need of expensive classroom style training.
The uniquely designed PENTAX deflection prism allows the surgeon to view the surgical site with the greatest depth of field and enhanced vision, whilst maintaining the best possible working posture.
To learn more and book an in-office demo, scan the QR code or visit osseogroup.com.au/pentax
In the last three years, there has been an increase - notwithstanding the increased incidence of Service and Facility Agreements as opposed to employment arrangements - in assertions by patients, and in some cases dentists, that the person or entity responsible for treatment-related complaints including personal injuries liability is not the dentist who provided the treatment, but rather the owner of the facility. This follows some unusual lower court precedent in the UK to some degree. Typically, the practice name rather than the dentist is all over the consent forms
and bills for the services. Whether the claims will be successful or not as decided by a Court or Tribunal is not clear as it is very messy and fact dependent.
However, responding to these claims should of course be done properly and carefully, addressing both issues of contract and regulatory law.
It may be that prudent practitioners - if they determine patients or dentists to be high risk in this regard - such as practitioners who perform orthodontics, implant surgery or complex alternative treatments - seek indemnities and waivers in this regard from dentists who use their
BRAD WRIGHTfacilities and also have patients execute such agreements before treatment is commenced.
At the very least, Medical History and Consent forms can include information for patients about this aspect. In some cases, specific clauses should be inserted into agreements as to responsibility and liability for treatment.
It does start to seem a lot of work, but perhaps not compared to the stresses practitioners face when these claims are made and have to be defended.
More at www.bwbarrister.com.au
Specialist medical lender, Credabl, is thrilled to reveal the five recipients of the 2022 Credabl Helping Hand Grants, after receiving over 440 heartfelt applications and nominations from medical, dental and vet practices and the healthcare community.
The judging panel comprised of Dr Garnett Hall (Veterinary Surgeon, Founder and CEO at VetChip and President of AVA WA), Dr Geoff Toogood (Cardiologist and Founder of Crazy Socks 4 Docs), Dr Kristina Cain (Dentist and Business Owner of SmileChix), Stafford Hamilton (CEO at Credabl), Glen Stewart (Chief Risk Officer at Credabl) and Kelly Gall (Finance Specialist at Credabl).
Applications were judged based on their 150-word submission answering how a Helping Hand Grant could help their practice.
Stafford Hamilton, Credabl CEO and co-founder, says it was incredibly hard for the judging panel to select only five recipients. The applications shared heartfelt stories of hardship and loss and ongoing challenges from drought, bushfires, floods and the pandemic. But amongst the mix, there were also ambitious growth plans, as well as the need to acknowledge amazing teams and dedicated staff.
“Medical, dental and veterinary practices continue to be hard-working, regardless of what’s going on in the world so we must ensure we shine a light on the amazing work that they do for us and our communities,” Mr Hamilton said.
“Congratulations to all the winners and thank you again to everyone who applied or nominated a deserving practice. We look forward to sharing the stories of our grant recipients with the broader community in the coming months.”
The 2022 Grant recipients are:
• Dr Sara Lassemillante, Edge Dental Care, NSW;
• Dr Sam Schneider and Dr Carla Schneider, Monocle Optometry, WA;
• Dr John Hammond, Riverland Veterinary Practice, SA;
• David McIntosh, ENT Specialists, QLD; and
• Dr Brad Viljoen, Main Street Veterinary Clinic, VIC.
The 2022 Helping Hand Grants kicked off on 1 September and were designed to support practice growth, showcasing the amazing contributions occurring in local communities and to help drive patient numbers and engagement. The grants are valued over $10,000 and awarded to up to five medical practices around Australia across the medical, dental and veterinary professions.
Each grant includes a cash incentive, practice growth and management coaching from industry partners including Health Business Network, Prime Practice and Vettr, a Delonghi Nespresso coffee machine, 50,000 Qantas Points* for their business and a digital guidebook filled with great tips to help boost patient numbers.
Credabl is a team of finance specialists providing tailored solutions for medical, dental, veterinary and accounting professionals. Through simplified, customised and digitised solutions, Credabl ensures that medical professionals receive the financial attention they deserve in both their personal and professional lives. With niche finance knowledge and specialist industry skills, Credabl is your partner on call.
Prime Practice is a global dental practice management and consultancy company that provides training and business solutions to the dental community across Australia, New Zealand, South East Asia, China, North America and Europe.
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
me.
“Communication and service has always been exceptional, and I have no hesitation in recommending Credabl across the board.
“
Dr Andrea King, Dentist
Almost 6000 people and around 140 exhibitors attended ADX23 in Melbourne in the event’s long-awaited return in the buzz of activity in Victoria following COVID.
According to Australian Dental Industry Association (ADIA) policy and communications manager Stephanie Wells, this was a return to pre-COVID levels, indicating a desire for the dental profession to engage with key industry suppliers.
More than 75% of visitors at the event were from Victoria. Ms Wells said the expanded ADX series (Sydney, Melbourne, and Brisbane events) has reached its goal of bringing world-class products and services to a local audience.
The busy trade show and accompanying comprehensive continuing professional development (CPD) program were so popular that some CPD sessions were totally booked out.
Popular events included the Opening Breakfast featuring entrepreneur and philanthropist, Simon Griffiths, CEO and co-founder of Who Gives a Crap, whose
energetic and humorous presentation inspired attendees to think outside the box with new exciting ways to have their company stand out and succeed.
Another popular session was the Women in Dentistry Breakfast on Saturday where speaker, Lucy Bloom, delivered the key message of “Don’t let fear trick you into a boring life”.
Ms Wells from the ADIA said ADX exhibitor feedback was very positive with a number of suppliers lauding the opportunity to exchange ideas, communicate, get feedback on products and meet and greet and catch-up.
One of the event sponsors said: “the opportunity to mingle with the industry really made them feel a much closer-knit part of this amazing community”. 88
Another highlight of ADX was the awarding of the very generous lucky door prize of a brand new MG3 Excite which was won by oral health therapist Brooke Walter. Visitors who attended ADX needed to be present at the time of the draw if their number was drawn. As the event was held at the same time as the Melbourne Formula 1 Grand Prix, there were also daily Formula 1 ticket giveaways.
ADX included the annual ADIA industry awards dinner where ADIA President Ryan Green bestowed A-dec’s Simon Taggart with ADIA Life Membership for his continued service to industry, including as former ADIA events chairman.
Mr Green also presented Meritorious Awards to Tanya McRae of equipment supplier, Dental Installations, Sydney; along with fellow Meritorious Award recipient, Craig Young of A-dec.
A-dec was once again one of the major exhibitors with its “Formula 1” inspired stand theme. It used the opportunity to launch the advanced new European Hygoclave autoclave range which it is selling on behalf of industry partner, Dürr Dental.
Senior representatives from Dürr Dental travelled from Germany to attend the Melbourne exhibition for the Australian Hygoclave launch and assist dentists in understanding the advanced technology, simplicity of operation and ease of service of these breakthrough autoclaves.
The Hygoclave can process dental instruments in as little as 30 minutes, including drying using the ‘B’ Flash cycle with minimal water and power use.
A-dec Australia has thrown its full support behind the Dürr Hygoclave range, with the recent appointment of Dr Wee Teo as Dürr product manager to provide technical and clinical support to external customers for the Dürr Hygoclave range
– as well as supporting Acteon’s quality digital imaging solutions available through A-dec.
A-dec’s marketing manager, Simon Taggart said the Melbourne event saw a lot of activity on the A-dec stand which featured five of the company’s range of advanced dental units and delivery systems, together with most of the key ancillary equipment needed to set up a surgery.
He said the imminent winding up of the ATO’s Instant Asset Write-off incentive for new equipment also generated a lot of activity on the individual A-dec dealer stands of Alldent and Presidental, together with Henry Schein which also supplies A-dec equipment in Australia.
The next ADX event is ADX Sydney –held in conjunction with SIDCON on 20-23 March 2024. Dental professionals in NSW are urged to “save the date” with the ADX Sydney website due to be live later in the year.
5“ high-resolution colour touch display for intuitive navigation
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
3-fold flexible fresh water supply with integrated quality control
All in view and documented thanks to connection to the practice network
High-performance sterilization- and drying systemPresented by Dr Sarkis Nalbandian, specialist prosthodontist
Specialist Prosthodontist Dr Sarkis Nalbandian is one of Australia’s leading cosmetic dentists. In this one day program, he offers a specialist’s perspective on the MINI SMILE MAKEOVER concept to enable you to offer patients options
for aesthetic enhancements commensurate with their individual needs and budget. Treatment options to address discolourations, fluorosis, white spot lesions, diastemas and more will be detailed encompassing a range of solutions including composite and porcelain veneers. Equip yourself with a range of solutions to address common aesthetic issues cost-effectively and minimally invasively.
TOPICS include Diagnosis | Critical thinking in patient assessment | Case selection | Indications and contraindications for composite and porcelain veneers
Smile Design | Non-invasive treatments
Dr Sarkis Nalbandian is a specialist prosthodontist. His special interests include non-invasive treatments of white spot lesions, the application of composites and porcelain technology for treating complex functional and aesthetic problems, along with the application of piezosurgery in implantology, accelerated orthodontics (PAOO) and bonding to zirconia.
Dr Nalbandian is a founder and course director for the International College of Dental Practitioners (ICODP.COM) and has a specialist
private referral practice in Sydney focusing on Aesthetics, Prosthodontics, Implant surgery, TMD & Facial Pain.
Dr Nalbandian has lectured both locally and internationally on Aesthetics, Dental Implants and Complex Prosthodontics.
He is a contributor and consultant to postgraduate master’s degree programs in Restorative Dentistry and Prosthodontics at King’s College, University of London and doctorate program at University of Sydney.
TShow, IDS 2023, in March in Cologne, Germany, the replication of solutions was apparent at every turn. Implants, intraoral scanners, 3D printers, CBCT systems, benchtop mills and the like all enjoyed the rarefied pedestal of innovation drivers at various points in history but alas are now commonplace with myriad choices available at every level.
At the IDS, we are looking for different. New. And the question is always what is the next big thing? What will drive the next technological change in dentistry? What will give us leverage and allow us to stand out from the crowd?
At IDS 2023, that stand out product was clearly RayFace. Whereas 3D facial scanning is not brand new per se, through RayFace, Ray has defined the category, established the benchmark and attributed purpose to what otherwise could be dismissed as novelty.
RayFace is a desktop 3D facial scanner that captures a highly accurate extraoral scan of your patient in 1-2 seconds. This scan then integrates with intraoral scans and CBCT data to form an invaluable aid in treating cosmetic and full arch cases, digital dentures and more.
By using this advanced digital technology from diagnosis to treatment, the new genre of “Face Driven Dentistry” has been created by considering the patient’s overall facial features - beyond the smile alone - enabling dentists to achieve a high level of accuracy in diagnosis and treatment planning for better, more predictable and aesthetic outcomes.
At IDS 2023, Ray showcased all of its cutting-edge made in Korea digital imaging solutions - RayScan CBCT, intraoral scanners, 3D printers and CAD/CAM software, which are highly innovative and can be tailored to the specific needs of each dental practice. However, RayFace took centre stage, occupying the majority of the expansive exhibition space.
Presentations on the technology by well-known dentists and prosthetists throughout the IDS saw the aisles around the stand regularly blocked with dentists and experts from different parts of the world including Australia and New Zealand impressed by this digital dental solution that will enable them to improve their workflow and enhance the patient experience... because apart from being a clinical tool, RayFace will add a 100% WOW factor to your practice and get your patients spreading the word.
Ray’s large presence at IDS 2023 highlighted the company’s commitment to advancing the field of digital dentistry and facial scanning in particular and Ray’s innovative solutions are likely to play a key role in shaping the future of dental practice globally including Australia and New Zealand, one face at a time.
For more information, contact Ray Australia on 1300-813-050 or visit the website www.rayaustralia.com.au
As one of the world’s leading providers of integrated solutions for high-quality dental applications with a comprehensive portfolio of products and systems for dentists and dental technicians, Ivoclar is proud to offer the IPS e.max ZirCAD product range, an innovative and versatile zirconia that is distinguished by outstanding quality and aesthetics that deliver optimum patient treatment.
For dentists, zirconia is the material of choice when strength and stability, thinner walls and natural aesthetics are of primary importance. In addition to the proven IPS e.max ZirCAD product portfolio, the IPS e.max range of zirconia products also includes IPS e.max ZirCAD Prime and IPS e.max ZirCAD Prime Esthetic, which was launched in 2021.
As a material, zirconia ceramic is designed with the future in mind and is an achievement that has proven its worth when it comes to facilitating sustainable restorations. IPS e.max ZirCAD is a highlyaesthetic, high-strength all-ceramic material that is incredibly similar to the natural tooth structure in terms of function and aesthetics, without the need for any metal at all. Aesthetics adapted to each individual patient - that’s what makes zirconia restorations so special. By glazing, staining or veneering the restoration, the tooth shade as well as the transition between the teeth and gums can be adapted to the patient’s specific requirements. This zirconia ceramic is reliable, clinically proven over many years and based on Ivoclar’s solid expertise in ceramic material science. IPS e.max ZirCAD is designed to remain extremely stable and to retain its high strength even in longspan restorations - and it delivers impressive aesthetic results too.
However, no two zirconia materials are alike, and the differences in quality are not always immediately obvious. IPS e.max ZirCAD offers superior stability with flexural strength of up to 1200 MPa, ensuring excellent longevity.
The database of clinical studies continues to grow and demonstrates an outstanding survival rate for IPS e.max ZirCAD of 96% after 5 years. In addition, the restorations offer shade sta bility and translucency, are resistant to wear and to fractures and provide superb tissue compatibility so that, ulti mately, both patient and dentist can smile with confidence.
However, IPS e.max ZirCAD doesn’t just offer out standing material properties and superior aesthetics – it also covers a wide variety of applica tions. In addition to anterior and posterior restorations, crowns and full-contour (long-span) bridges, it can also be used for two-part implant abutments. Thanks to the high sta bility of the zirconia, the wall thickness can be significantly reduced in the various application scenarios so that natural-looking restorations can be created that preserve as much tooth structure as possible.
The respective restoration can be cemented either adhesively, self-adhesively or conventionally.
In recent years, the requirements that dental practices must meet have become considerably more complex. Patient expectations have grown too. On the one hand, dental products should
be more sustainable, long-lasting and versatile, yet at the same time, the pressure in the daily practice routine to offer improved productivity, efficiency and reliability has never been greater. All these requirements are combined in the IPS e.max portfolio from Ivoclar, both for proven lithium disilicate glass-ceramics as well as for zirconia: The materials are proven in the daily clinical routine to offer the longevity for which they have been engineered and provide complete flexibility across the range of applications. Minimum wall thickness ensures maximum preservation of tooth structure and natural aesthetics. IPS e.max restorations are free from metal, offer a high level of biocompatibility and provide for restorations that are longlasting, true to the motto: Making . With IPS e.max, trust is rewarded right away –and dentists and patients are
he Ivoclar Group, headquartered in Schaan, Liechtenstein, is one of the world’s leading manufacturers of integrated solutions for high-quality dental applications. In 2023, the company proudly celebrates its 100-year anniversary under the theme of “A Century of Innovation”. The company’s success is based on a comprehensive portfolio of products, systems and services, strong research and development capabilities and a clear commitment to training and further education. The group of companies, which sells its products to around 130 countries, has 47 subsidiaries and branch offices and employs roughly 3,500 people worldwide.
More info about the Ivoclar Group is available at www.ivoclar.com. In Australia, call 1300-486-252 or email orders.au@ivoclar.com. In New Zealand call 0508-486-252 or orders.nz@ivoclar.com.
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.
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:
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 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:
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; 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:
Get 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.
• 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
Learn from orthodontic experts with our interactive Face to Face or live stream courses
Powered by
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.
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
To learn more about this program visit: https://orthotraining.com.au/orthoed-mini-masters/
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/
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.
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/aligners/
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/
Using 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 lever aged 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 Assis tance 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!
Dentally 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.
When 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.
Dentally keeps everything in one place, eliminating the need for multiple software to run each aspect of the surgery. As a complete cloud solution, you no longer need any onsite data storage as your data will be stored safely and securely, so you don’t have to.
Dentally auto matically 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.
Dentally’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 pro gramme, 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
Dentally 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
Welcome to the future in practice
Faster, simpler practice management
Accessible from any location giving better work-life balance
Clinical excellence with everything at your fingertips
Grow your practice with Elevate, our exclusive customer success programme
Artificial Intelligence (AI) and Automation will be the future of dental technology and this will be no more prevalent than in 3D printing. In a joint collaboration between Fabdent Digital Dental Technology and HeyGears 3D Printing, Australia’s first 3D printing system capable of 24-hour non-stop autonomous operation was commissioned in Fabdent’s Sydney dental laboratory in April.
“We’ve been working closely with Heygears for about 18 months and were originally planning to install the previous model of this printer,” said Yahah Karim, Fabdent’s technical production manager. “We waited patiently and after we were notified the A3D Ultracraft printer would be available in the near future, we decided to invest in this latest technology. We’ve been using 3D printing for the past 15 years so we’re not new to the technology and we have many brands of printers that we are happy with as all of them do their job very well.
“However, we can already see the trend in AI and automation is going to make a big difference to the way we work. Currently about 80% of our work is coming in from intraoral scans, so having the ability to print 24 hours a day unattended is going to make a massive difference. The software from Heygears is nothing short of amazing and we can ‘remote in’ from any computer anywhere in the world and compile jobs and have them printed, even when we’re not physically in the laboratory.”
Realistically, the printer needs to be attended to once a day but this a far cry from the constant attendance of conventional printers that need attending to hourly. The printer can print any type of polymer-based dental model, appliance or restoration and has some very high tech features not found on any other dental printer.
“I can see this will be the start of something big for Fabdent and of huge benefit to our customers. We’re looking forward to ramping it up and seeing what this printer can really do.”
Fabdent is both a full service digital dental laboratory with multiple 3D printers and milling machines and also the home to the Truline brand of Australian-made clear aligners. For more information, visit www.fabdent.com.au or call 1300-878-336.
The Heygears 3D printing system now operating at Fabdent in Sydney was one of the standouts at IDS 2023, attracting significant interest. If you want to see what all the fuss is about, scan the QR code or visit dentevents.tv (short cut - https://tinyurl.com/2bxejrpe), login using your Dental Community login and watch the short video interview between Fabdent founder, Terry Whitty and HeyGears’ Hiro Takahashi that includes a demo of how the machine works.
Workflows for fabricating Full and Partial dentures digitally
SYDNEY - JUL 22 |
MELBOURNE - AUG 5
This event is both a lecture documenting why you should choose digital dentures today as the optimal solution for your dental practice or denture clinic together with a LIVE systematic run-through of the process for fabricating both full and partial digital dentures. You will be able to follow Sam Dias as he explains the step-by-step process he uses in his four clinics across Sydney every day.
A demonstration of accurate intraoral scanning and prosthetic design ensures that the outcome won’t be compromised while saving time and money for you and your patient.
The session will conclude with a Q&A session discussing options leading to self-design or aided design as well as the finishing and polishing process. This course will cover the following...
1. Impression vs Scanning
A discussion and slide presentation comparing intraoral scanning and traditional impressions including a live scan of dentures will be shown. The scanning process will be shown step-by-step and the many different impression techniques currently used will be reviewed and details of how these can be carried on to the digital world shown.
2. Adding mesh and articulator adjustment
Combining multiple scans and adjusting the setup of the virtual articulator will be shown.
3. Wizard and model analysis
Wizards and model analysis tools will be explained.
4. Digital denture teeth selection
How to select the correct digital denture teeth library will be discussed as well as the use of the measure tool plus patient notes and extra scans. Denture teeth library options and applications will be discussed.
5. Digital denture teeth setups
6 HOURS CPD
Digital denture teeth setup tips and tricks for faster and more effortless setups will be detailed.
6. Denture base design
Key principles to bear in mind when designing your denture bases plus a guide to troubleshooting.
7. 3D printing
3D printing techniques plus a guide to material selection and achieving better outcomes.
8. Carded denture teeth
Step-by-step bonding technique with tips and tricks.
9. Staining technique
Techniques for staining and filling in the gaps.
10. Finishing and polishing
Tips to achieve a great final outcome.
Discussion + Q&A Session
IDS 2023 in Cologne, Germany in March was a resounding success with a return to exhibitor and visitor numbers approaching the last pre-COVID show in 2019. Amongst the 1788 exhibitors, Australia was again well-represented with seven companies showcasing their products on the world stage.
Well-established global businesses like SDI Limited, Myofunctional Research Co and ASIGA were joined by return exhibitor Ozdent with endodontic products Ledermix and Calmix, as well as newcomers Blenderfordental with CAD software, Partmaker with CAM services and Biominiatures with a range of miniature implants.
Global sensation, Sydney-based 3D printer manufacturer Asiga has been a fixture at IDS for many years and again returned to Cologne to launch an exciting new development.
“IDS2023 was once again incredibly busy at the Asiga booth and there was a palpable buzz around our new UltraGLOSS™ 3D printing technique,” said Asiga’s Global Operations Manager, Graham Turner. “UltraGLOSS allows Asiga customers to 3D print parts with a polished surface finish direct from the printer. No more manual polishing. UltraGLOSS saves production time, removes the risk of accidental adjustment due to over-polishing and produces true-to-CAD patient fit. This is a revolutionary development and compatible with all our MAX and PRO 4K systems.”
Asiga also showed its full range of market leading MAX, MAX X, PRO 4K and PRO 4K XL 3D printers and TGA listed materials for 3D printing that are designed, developed and manufactured in Sydney, Australia with 95% exported globally. Asiga printers are used extensively in dentistry, jewellery and industry.
Australia’s oldest and most-successful dental products manufacturer, SDI Limited, which has its European headquarters in Cologne, again celebrated its 50th year in style with a cocktail reception at the elegant Excelsior Hotel. A number of new products were launched to its global distribution network at the event that were heralded as genuine innovation.
“SDI had a very successful IDS,” reported CEO Samantha Cheetham. “Seeing dentists and key distributors from all over the world, many for the first time since the pandemic, was one highlight. SDI sells products to over 100 countries on all continents so IDS is an ideal way to showcase SDI, our Australian research, Australia product development and Australian manufacturing.
“The launch of two key products, Riva Cem Automix, a resin modified glass ionomer cement and Stela, a bulk fill self-cure flowable composite, both of which were well received, was the other highlight. We developed Stela in conjunction with researchers at the universities of Sydney, NSW and Woollongong as an innovative high performance self-cure composite which can be used for Class I, II, III, V, core build ups, base or liner and sealing endodontic cavities where light cannot access. Stela only has two steps: prime and place restoration. It has unlimited depth of cure and extremely high bond and compressive strength.
“Riva Cem Automix is a resin modified glass ionomer cement for crowns, bridges, inlays, onlays, orthodontic appliances and posts. It contains SDI’s Ionglass™ technology, with sustained fluoride release and BPA free and the high flexural strength and superior bond strength ensure it has the best long term aesthetics for most cement requirements.”
Myofunctional Research Co released its new breathing and myofunctional integration techniques for orthodontics, TMJ and sleep disorders.
“The growing demand for aligner and early intervention orthodontics, integrated airway and TMJ treatment, myofunctional therapy and dental sleep medicine is reaching unprecedented levels in 2023 and a modern solution is needed for practitioners looking to expand their scope of practice,” said Founder and CEO Dr Chris Farrell.
“Myofunctional Research Co. (MRC) has been committed to producing revolutionary treatment systems for more than three decades and we proudly unveiled our latest developments at IDS.”
The showcase included MRC’s new TLJ for Braces (TLJB) appliance designed to strengthen and tone the tongue, lip, jaw and throat muscles while using braces, an expanded Myobrace® Class III appliance group with three stages for the permanent dentition, a new two-stage appliance group for paediatric patients (Myosa® for Kids) aimed at establishing a functional airway for nasal breathing and correct myofunctional habits as well as the new Myosa Consultation and Activities programs.
“I was impressed with the level of interest and engagement shown by attendees,” Dr Farrell said. “We found that delegates at IDS were very interested in our new developments and we were eager to share our latest technologies and enhancements with them.
“Our innovative treatment systems continue to cater for the growing demands of practitioners around the global and empower healthcare professionals to find simple and effective solutions for implementing these techniques into their clinics.” 88
Furthermore, MRC added a new advanced course to its online learning platform that focuses on the treatment of TMJ and breathing disorders using the Myosa® TMJBDS® appliance protocol. Practitioners are encouraged to visit myoresearch.com to learn about implementing MRC’s wide variety of treatment systems in little to no time.
“Most of the interest in our products was to do with the small batch production of parts that some dental labs had identified as missing from the catalogues of the primary suppliers. Our flagship product, our screwdriver set, was received as an interesting promotional product for medium sized labs, primarily in Eastern Europe and even the Middle East where the implant markets are still early in development and product ranges are limited.
“One of the amazing opportunities in sneaking in a few field trips around the halls was to network with some of our suppliers and even our own customers, to see where the market is trending in digital dentistry. There are some interesting new materials coming out in the 3D printer area, while there were quite a few software companies addressing the bridge between printing and milling.
“Arriving in Koln to the Australasian Dental Practice partya sausage-and-beer-fest - was a wonderful way to warm up for what would be a long week,” Dr Hart said. “Whilst our stand would have won a few awards - Fastest Bump in, Most Hidden, Lowest Eco emissions and most efficient use of floor space - we enjoyed a really great range of visitors to our stand.
“From a few friendly existing customers visiting for some socialising and support, to the international guests who thought they had just found the hidden gem of IDS 2023, we think we saw it all.
“There seemed to be less happening in the world of scanning, but a few new players in the CAD design market, including Australia’s Blenderfordental. The digital CAD software options are certainly prepared for integrating new components and workflows which we are expecting in the area of full arch implant prosthetic and surgical design. We estimated that out of the 120,000 attendees, around 5,000 passed our stand, with 80 to 100 taking time to stop and explore PartMaker’s solutions. With the skeleton crew of three and coffee, snack and toilet breaks allowed for, we really did work hard most days.”
Sydney-based BioMiniatures Pty Ltd proudly exhibited its ground-breaking Miniature Implant system at IDS. The company’s stand created a buzz among the international implant companies, as Miniature Implant systems stood out as the newest implant development in the market.
“The innovative design and advanced features of our Miniature Implants received widespread acclaim from dental professionals and distributors worldwide,” said creator
Dr Omid Allan.” Our products were well-received, with many expressing awe at the precision and feasibility offered by the unique design of the implants. Our commitment to pushing the boundaries of dental implant technology is evident and we earned accolades for this pioneering approach to full and partial arch rehabilitation solutions.”
BioMiniatures’ participation at IDS 2023 was a significant milestone for the company, showcasing its leadership in the dental implant industry and its dedication to innovation. The event provided a platform for BioMiniatures to engage with professionals
and distributors from around the world, generating interest and demand for its unique Miniature Implant system.
As a result of its successful participation at IDS 2023, BioMiniatures Pty Ltd solidified its position as a trusted name in the dental implant market, with its Miniature Implant system gaining recognition as one of the newest and most cutting-edge developments in the field.
“This was our first official international launch at the IDS,” Dr Allan said. “It felt very special to have a stand as an Australian company in the biggest and best dental exhibition in the world.
The biggest and best event in dentistry is over for another two years and if you missed it, don’t despair... because we’ve got it covered!
Rather than simply writing about what’s new at IDS 2023 in Cologne, Germany, we asked eLABORATE ’s technical editor, Terry Whitty and our favourite prosthetist, Sam Dias, to document the best of what they saw on video. All the videos are available now at www.dentevents.tv/channel/ids2023 or scan the QR code below:
You can sign up for free through the website or simply use your existing Dental Community login to sign in and watch them all at your leisure.
“This was eLABORATE’s first foray into video reporting and we learnt a lot during the process,” said Joseph Allbeury, publisher of eLABORATE and this magazine. “We mostly need to get better at sound!
“Overall, the videos give a unique perspective on what two Australians found interesting at the IDS in March and have presented it in a more indepth way than a magazine can alone.”
Apart from these videos recorded at IDS, Dentevents.tv features hundreds of videos related to dentistry with more being continually added.
“Dentevents.TV is a dedicated video streaming service for the dental profession that we built during the first COVID-19 lockdown,” Mr Allbeury said. “We encourage you to watch the videos but also to add your own videos based around dentistry. The more the merrier!”
IDS 2025 is next on again in Cologne, Germany from March 25-29, 2025. Visit www.ids-cologne.de for more details.
Watch all the IDS videos 24/7 at www.dentevents.tv/channel/ids2023
In 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
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.
Carestream 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.
Medit 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.
A dental practice is usually one of the most valuable assets in a dentist’s life. When it comes time to sell, many will do so with little understanding of the value of what they are selling and how to present it effectively to a buyer. Others delay putting their practice on the market at an optimal time, fearful of what to do next and afraid of a loss of their identity. This course explains:
6 HOURS CPD
• How to prepare your practice for sale to optimise the price, terms and compatibility with a purchaser
• Which exit strategy is right for your practice and why
• When is an optimal time to maximise the return for your asset
• Pitfalls owners fall into that devalue their practice in the final years of ownership
• Steps owners can take to improve the outcome in the final years of ownership
With more than 20 years’ experience in dental practice sales, Simon Palmer has extensive knowledge of and insight into the complexities and sensitivities involved in buying and selling dental practices. Simon’s business - Practice Sale Search - sells more than 100 practices per year. He is a regular writer/contributor to dental publications and journals, and is regarded as an expert on dental practice purchases and sales in Australia and New Zealand.
n Exit planning: how do you get your practice ready to sell?
n What are the pros and cons of the exit options/ strategies available to you?
n Succession Planning: What do you need to do now to prepare?
n What is the likely profile of the buyer for your practice and what will they be looking for?
n Valuing Dental Practices: What/ where is the value in your practice?
n How do you handle staff discretion, confidentiality and disclosure?
n Legal agreements
n Effective strategies for transferring patients effectively from seller to buyer
n What to do next post sale: post-sale strategies
n Tax implications and strategies when selling
n Expert finance, legal, accounting speakers
Technical research and development are in continuous evolution, constantly providing new techniques for the realisation of dental restorations. In the heart of the Italian Alps, with the fundamental values of discipline, innovation, trust and responsibility, the family-run company Zirkonzahn provides dentists and dental technicians with dedicated, simplified instruments for a smooth and reliable workflow, from the implant planning procedure to the final restoration. Based on the accurate recording of a patient’s data, Zirkonzahn’s workflow can be carried out 100% digitally starting from the acquisition of the patient’s physiognomy through the innovative Face Hunter 3D facial scanner. In this way, the user can transfer the facial scan data, together with the models, in the virtual articulator in relation to the axis.
With a single click it is possible to scan the patient’s face in a few seconds only. The scanner can also be used out of the dental laboratory, just using a laptop. A flash system for perfect lighting is included in the equipment. Upon request, a light stand may also be provided.
3D facial scan data can bring many advantages not only to the dental technician but also to dentist and patient. Thanks to the use of the patient’s real physiognomy, the dental technician can obtain a result that is much more precise, providing dentists and patients with a near-photorealistic preview of the final restoration during the consultation phase.
Facial scans can be perfectly combined with the PlaneSystem® (MDT Udo Plaster): an innovative approach for capturing patient-specific information which can be then transferred 1:1 into the virtual world, allowing for precise planning security and a more achievable function and aesthetics design in the restorations.
The PlaneSystem® is composed of the PlaneFinder®, to detect the patient’s Natural Head Position (NHP) as well as his occlusal plane angle; the PS1 physical articulator; and the PlanePositioner®, a platform used to place the maxillary cast in the PS1 articulator and to reproduce the occlusal plane.
The PlaneSystem® is also enriched with the PlaneAnalyser II: an analysis and recording device for digital acquisition of a patient’s mandibular movements. 88
Recording patient-specifi c information with the PlaneSystem ® and the Face Hunter 3D facial scanner improves diagnostic planning, reduces chair time and increases patient satisfaction. Individual position of the maxilla, occlusal plane and 3D face scans are accurately transferred 1:1 into the Zirkonzahn software and combined without loss in information. The 3D virtual patient provides the restorative team in the clinic and lab with the ideal planning tools for high quality functional and aesthetic dental splints and rehabilitations.
Regardless of the approach to capturing the patient’s planes and physiognomy, the patient information gathered has to be transferred to the Zirkonzahn.Scan software in order to proceed with the design phase. Transferring the patient’s data into the software is a very simple task: the articulated models can be easily digitised in less than three minutes with a Zirkonzahn scanner
In the design software Zirkonzahn.Modellier, the Virtual Articulator software module allows the technician to work on the articulated models exactly as if they were in a physical articulator. This module enables the simulation of the mandibular joints, since all movements are recreated virtually. The dental technician can also carry out the tooth set-up based on the patient’s natural teeth or, alternatively, use the available virtual tooth libraries. In addition, the dental technician can apply different tooth sizes, display the teeth in true colour and incorporate different reference lines in the 2D images for better tooth alignment (e.g., the smile line).
using the PS1 physical articulator. The Zirkonzahn.Software can work best with the PlaneSystem components, however, any physical articulator can be used and registered into the Zirkonzahn. Software, so that the articulated models can be displayed directly in the correct position in the registered articulator. Once the models have been transferred 1:1 into the Zirkonzahn.Scan software and integrated with other possible digital data, the Zirkonzahn.Modellier software comes into the picture.
With a workflow permitting seamless transition between digital and analog, Zirkonzahn offers a flexible and complete solution for the production of exceptional dental restorations. By producing almost everything at its manufacturing sites - never surrendering control to others - the family-run company perfectly combines each component to one another: Zirkonzahn’s first aim is to provide laboratories with innovative hardware, software, restorative materials and implant prosthetic components. This ensures a 100% smooth workflow for technicians and clinicians - from patient data acquisition, articulation, virtual design and milling to restoration placement in the patient’s mouth.
For info, visit www.zirkonzahn.com or call +39-0474-066-663 (in the Italian time zone).
COMPONENTS FOR MORE THAN 140 IMPLANT SYSTEMS
In our production halls Zirkonzahn Molaris I and II we have a versatile professional CNC machinery with turning, grinding and coating systems. Here, highly accurate techniques are used to produce our milling tools, titanium bases, Raw-Abutments® and machine parts.
We provide up to 30 years of warranty on all Zirkonzahn implant abutments used, as well as on implants of other manufacturers used with Zirkonzahn components.
All implant prosthetics components are designed and manufactured in our production sites in South Tyrol.
Adjusting each components to one another is particularly important especially in case of implantsupported restorations. For this reason, we provide a wide range of implant prosthetics components.
In the manufacture of our components, we meet the strictest quality criteria (ISO 13485 MDSAP; Medical Device Directive 93/42/EEC; EU Regulation 2017/745 on medical devices).
All components are produced according to the high standards we set for our production process. In order to meet our search for precision and perfection, we use the latest manufacturing technologies.
All components are fully integrated in our Zirkonzahn.Software. In addition, with the Zirkonzahn Library Download Center, also 3Shape and exocad® users can implement the libraries into their design software.
Our components are available for more than 140 implant systems and our libraries are constantly expanded.
No limitations! All our implant prosthetics components are TGA approved.
SDI Limited has launched Stela, a new bulk fill flowable self-cure composite that is widely lauded as an amalgam replacement and the future of composites. This innovative restorative is the result of a partnership between SDI scientists and engineers from three leading Australian universities: the University of New South Wales; the University of Sydney; and the University of Wollongong.
As a self-curing bulk fill composite, Stela offers an unlimited depth of cure with low polymerisation stress. Stela is applied in a simplified two-step process; primer and composite. This efficient 15 second process reduces your in-chair time by eliminating traditional preparation steps such as etch, bonding systems and light curing.
Stela Primer contains a catalyst that initiates the curing process at the restoration interface and not from the occlusal surface like traditional light curing processes. This polymerisation sequence mitigates stress to enable a gap-free interface, reducing post-operative sensitivity and the risk of premature failure.
The Stela initiator system starts a snap set fast cure to convert monomers into polymer chains. Simultaneously, these chains become rapidly and densely cross-linked to each other, forming a complex network. This network reliably binds fillers, resulting in impressive mechanical properties. With very high compressive and flexural strengths, Stela is the ultimate highperformance composite and the ideal amalgam replacement for Classes I, II, III and V.
Both Stela Primer and Stela composite contain the 10-MDP monomer to ensure high bond strength to dentine and enamel, providing long lasting restorations with a flawless marginal seal. Stela also offers outstanding radiopacity of 308% Al to aid diagnosis. The formulation contains fluoride, calcium and strontium and is also BPA and HEMA free.
Stela is available in either capsule or syringe delivery systems in one universal shade with chameleon effect for excellent aesthetic results.
Stela is an Australian innovation, developed and manufactured in Australia and distributed to over 100 countries.
For more information, contact SDI at www.sdi.com.au.
Soon after the outbreak of the COVID-19 pandemic, preprocedural mouthwashes were recommended in Australia, Europe and the USA for temporarily reducing the intraoral viral load and infectivity of individuals potentially infected with SARS-CoV-2 in order to protect staff. Several mouthrinses have shown virucidal effects against SARS-CoV-2 in vitro. This randomised controlled clinical trial investigated the efficacy of commercially available mouthwashes containing cetylpyridinium chloride (CPC) and chlorhexidine digluconate (CHX) at 0.05% each, compared to a placebo mouthwash (0.9% NaCl) in 61 SARS-CoV-2-positive patients who had onset of symptoms within the last 72 hours. Oropharyngeal samples were taken at baseline and then patients gargled for 60 seconds with 20 mL of the test or placebo mouthwash. After 30 mins, further oropharyngeal samples were collected. Viral loads were analysed by quantitative reverse transcriptase polymerase chain reaction and infectivity of oropharyngeal specimens was analysed by cell culture and quantified as tissue culture infectious doses 50% (TCID50). Viral load significantly decreased upon gargling in the test groups (P = 0.0435) but not in the placebo group. Viral infectivity as measured by TCID50 also significantly decreased in the test groups (P = 0.0313). Furthermore, it was found that the samples from patients who had received a vaccine booster exhibited significantly lower infectivity at baseline as compared to those without a vaccine booster (P = 0.0231). Overall, this study indicates that preprocedural mouthwashes containing CPC and CHX can significantly reduce the viral load and infectivity in SARS-CoV-2–positive patients. Further studies are needed to investigate whether the observed reductions in viral load and infectivity translate into clinically useful effects in reducing COVID-19 transmission in the dental workplace.
Bonn EL, et al. Efficacy of a mouthwash containing CHX and CPC in SARS-CoV-2–positive patients: a randomized controlled clinical trial.
J Dent Res. 2023;0(0). doi:10.1177/00220345231156415
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By Dr Ahmad Al-Hassiny
Transitioning a traditional dental practice to a digital workflow offers a unique set of challenges for practitioners steeped in the conventional analog treatment process. Indeed, that was true in our situation in Wellington, New Zealand, where our independently operated clinics would need to transition. As one could imagine, the first challenge was the expense of outfitting each of our clinics with CEREC (Dentsply Sirona) CAD/CAM systems, let alone all the other intraoral scanners, milling machines and 3D printers we have purchased over the years. This undertaking was an incredibly significant investment, not to mention the inventory of materials each clinic would require. The second major hurdle and probably the most critical challenge, was the learning curve for our associates and us. However, we all agreed that the expense would be justified and the initiative profitable if we could perfect an efficient digital workflow that maximised clinical processes and was streamlined effectively enough to minimise patient chair time.
As we undertook our transition, digital technologies matured, as did the millable materials. Modern intraoral scanners are now much faster and more accurate; milling technologies more precise; CAD software more intuitive and user-friendly; and materials much stronger, more predictable, and more aesthetic. Most importantly, our associates and I worked very hard to master and streamline our workflow processes, which directly impacted the profitability of our practices.
Today, our standard workflow from prep to design and mill for a single crown can be accomplished within 45 minutes or less and the final crown is seated in an hour to an hour and a half on average. After we prep the tooth, we routinely use a retraction cord (Figure 1) to displace the gingiva and ensure an accurate scan of the margins and a dry field of operation to avoid contamination from blood, saliva or crevicular fluid. We take an intraoral scan using CEREC Primescan™ for our same-day dentistry and design using CAD software. Our dental assistants are fully trained to be proficient in using the CAD software (Figure 2) and do all of our CAD designs with clinician oversight and approval of the final design, which is then sent to the milling machine (Figure 3). Our nurses are also trained in all post-processing steps, from the crystallisation firing process to staining and glazing the final restoration (Figure 4). In the meantime, the retraction cord stays in place so that during the seating of the final crown, the fit at the margin is clearly visible and once cemented, excess cement is removed as the cord is removed. Most critical to this process and the profitability of our practices is that while the design, milling and postprocessing is taking place, our clinicians are busy seeing and treating other patients. Singlevisit dentistry can be immensely profitable if done well. Now 95% of the work is completed in-house that was once sent to the laboratory. This effectively slashed our lab bill by more than 70%.
My advice to colleagues considering entering this space is to be confident in the cost, learning curve, and new workflow processes. We hire new associates steeped in the analog process, and within about two months or less, they are proficient with the CAD/CAM process and workflow. Even if you are doing sameday dentistry already, the key to that transition or perfecting your workflow is immersing yourself in online and in-person learning from those who have mastered the CAD/CAM equipment and digital workflow process. Our Institute of Digital Dentistry (instituteofdigitaldentistry.com) welcomes professionals worldwide who want to learn and perfect the efficiencies possible with this workflow process to help them gain the knowledge and confidence they need.
Also, choose a restorative material that offers the confidence of predictability, flexibility, strength and aesthetics in all areas of the mouth. We need a material that research has shown to have all these characteristics and a fracture rate of less than 1-2%. That’s why we choose IPS e.max® (Ivoclar). Millions of these restorations have been placed globally and the research on this material is extensive.
Tooth preparation is vital to success when using CAD/CAM processes. Above all things, this matters the most. If you under prep or
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Many of my colleagues and I thought we were masters of tooth preparation until we transitioned to CAD/CAM and could see our preparations on the computer screen. With the ability to examine all aspects of your preparation in 3D, you can see any flaws and make corrections while the patient is in the chair. Using intraoral scanners makes you a better dentist due to the instant feedback you receive about the quality of your preparation.
A critical area that requires attention during tooth preparation for the CAD/CAM process is adequate occlusal reduction. The primary reason for the failure of all-ceramic restorations is inadequate tooth reduction. Depending on the restorative material being used, you need at least 1mm of occlusal reduction to ensure the integrity and durability of that restoration. If you don’t reduce the occlusal to that degree, the software will compensate and you will either end up with a poorly designed restoration invading minimal thickness or a high spot on the finished crown that risks fracture from occlusal forces.
Undoubtedly, the CAD/CAM process is extraordinarily accurate and can be used for a wide range of chairside single-visit cases (Figures 5-8). However, the output is only as good as the input
In Part III of this series, I will share some clinical cases from a single crown to full quadrant dentistry that we have completed using our same-day dentistry workflow and processes.
Dr Ahmad Al-Hassiny is a global leader in digital dentistry and intraoral scanners, carrying out lectures as a KOL for many companies and industry. He is one of the few in the world who owns and has tested all mainstream scanners and CAD/CAM systems in his clinic. Dr Ahmad is also the Director of The Institute of Digital Dentistry (iDD), a world-leading digital dentistry education provider. iDD offers live courses, masterclasses and an online training platform, with a mission to ensure dentists globally have easy and affordable access to the best digital dentistry training possible.
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Question 1. A common contributor to external stains on teeth are:
a. Tannins and polyphenols from beverages such as tea, coffee and red wine.
b. Coloured molecules from beverages such as cola drinks.
c. Pigments from foods such as berries and soy sauce.
d. Mouth rinses like chlorhexidine and quaternary ammonium compounds.
e. All of the above.
Question 2. The most widely used abrasive particle in toothpastes has an RDA rating of:
a. Low
b. Medium
c. Highly
d. Harmful
Question 3. A short term improvement in the optical properties of teeth can be achieved with the toothpaste ingredient...
a. CPP-ACP
b. Sodium hexametaphosphate
c. Copper phthalocyanine
d. PAP+ and nano hydroxyapatite
Question 4. A highly abrasive ingredient in toothpaste is:
a. Sodium bicarbonate
b. Brushite
c. Perlite
d. Hydrated silica
e. Calcium pyrophosphate
Question 5. Shade reversion agents remove extrinsic stains and provide a permanent brightening effect:
a. True
b. False
Question 6. Correct and proper instrument reprocessing is the responsibility of the:
a. The chairside nurse.
b. The sterilisation area nurse.
c. The treating clinician.
d. The practice manager.
Question 7. When using cassettes in an optimal workflow, instruments are removed from the cassette:
a. Chairside.
b. On entering the sterilistion area.
c. Prior to ultrasonic cleaning or automated washing.
d. Prior to sterilisation.
e. All of the above.
Question 8. Using cassettes:
a. Keeps instruments organised in sets.
b. Mitigates the risks of sharps injury due to reduced instrument handling.
c. Eliminates manual instrument cleaning and sorting.
d. All of the above.
Question 9. The “magic window” is a reference to:
a. Large internal windows into the sterilising room to give patients an opportunity to view reprocessing.
b. The dispensary at dental school where students collected their instruments.
c. The limited understanding of students about how instruments are reprocessed.
d. All of the above.
Question 10. Patients are more impressed by instruments in a cassette than a scary pile of instruments on a tray:
a. True
b. False
Question 11. A zone of demineralisation develops at the edge of resin-based sealants:
a. Due to the difficulty of reliably bonding.
b. As the most superficial layers of enamel are aprismatic.
c. As a cariogenic dental plaque biofilm is present.
d. All of the above.
Question 12. Fluoride containing glass ionomer cements are “recharged” when exposed to:
a. Fluoride containing toothpaste.
b. Fluoride gel.
c. Fluoride mouth rinse.
d. All of the above.
Question 13. Fuji VII EP contains:
a. Hydroxyapatite.
b. Fluorapatite.
c. CPP-ACP
d. All of the above.
Question 14. A fundamental limitation of the concept of chemical synthesis of enamel is that it lacks the organic matrix structure which guides the formation of enamel by ameloblasts:
a. True
b. False
Question 15. Pellicle acts as a semipermeable ionic membrane protecting teeth from strong erosive challenges:
a. True
b. False
DQuestion 16. The main drawback for printed zirconia at this time is...
a. The crowns look lifeless.
b. Long post-processing times.
c. The printed and cured binder material is toxic.
d. The printers can only print resin.
Question 17. Printing Lithium Disilicate is promising but at this time the machinery is...
a. Not able to print veneers.
b. Only able to print veneers.
c. Expensive for the average user.
d. Only available in 110 volts.
Question 18. Most quality printers available in dentistry today...
a. Will not be able to print hybrid ceramic crowns.
b. Can only print bridges.
c. Will be able to print hybrid ceramic crowns.
d. Are too expensive.
Question 19. Hybrid ceramic crowns are currently monolithic however..
a. Can be stained and glazed to characterise them.
b. They can be layered with porcelain.
c. They will never look like a tooth.
d. This will never change in the future.
Question 20. For shades, some companies are experimenting with...
a. Laser-based resins.
b. Changing resins at different times of the print cycle to get polychromatic restorations.
c. Not worrying about shade at all.
d. None of the above.
As the COVIID-19 pandemic has proceeded, ventilation has been recognised increasingly as an important tool in infection control in health workplaces with poor air management. Many hospitals in Ireland and the UK do not have mechanical ventilation systems such as airconditioning and instead depend on natural ventilation. Poorly ventilated spaces harbouring infectious persons, such as hospital wards, can pose a considerable threat to both patients and healthcare workers, with nosocomial COVID-19 outbreaks reported in the literature. The effectiveness of natural ventilation varies with atmospheric conditions and building design. In a challenge test of a legacy design ward, portable high-efficiency particulate air (HEPA) filtration units were used. Such units have previously been shown to remove SARS-CoV-2 RNA from air samples taken in COVID-19-surge hospital units. This study reports the effects of a portable air filtration unit (AFU) in clearing a common hospital air pollutant (nebulized Ventolin (salbutamol)) from a ward bay under renovation. Such fugitive drug aerosols of respirable size are common in hospitals and are useful proxies for persistence and circulation of infectious particles of respiratory origin. There was no heating, ventilation or air conditioning system for air handling in the ward. Laser light scattering was used to measure the concentration (μg/m3) of nebulised airborne particles in the size range of 0.3–2.5 μm. Mean peak particle count over background was lowest in the “windows open, AFU on” condition and particle clearance was fastest. The “windows alone” condition was unable to reduce concentrations back to baseline levels without aid of the AFU. Overall, the portable AFU successfully augmented natural ventilation in airborne particle clearance from a legacy design hospital ward by increasing the clearance rate of particles. The combination of AFU and natural ventilation may be synergistic, possibly because secondary air movement from the AFU increases currents through the windows.
Fennelly M, et al. Portable HEPA filtration successfully augments natural-ventilation-mediated airborne particle clearance in a legacy design hospital ward. J Hosp Infect. 2023;131:54-57
SARS-CoV-2, the causative agent of COVID-19, is mainly transmitted by first infecting nasal and lung epithelial cells. Host cell entry by SARS-CoV-2 is mediated by the binding of the spike protein, a transmembrane class I fusion protein that is exposed on the viral surface, with the angiotensin converting enzyme 2 (ACE2) receptor on the host cell. In addition to ACE2, other host cell factors including transmembrane serine protease 2 (TMPRSS2) and Furin are required for viral entry, however alternative receptors including CD147 have been proposed. The mouth is also believed to be a viral portal site since certain types of oral epithelial cells were shown to express the ACE2 receptor. The oral cavity structures, keratinized and non-keratinized mucosa and salivary glands’ epithelia express SARS-CoV-2 entry and transmission factors, especially ACE2 and TMPRSS2. However, it is unclear whether oral epithelial cells are directly infected by SARS-CoV-2. In this study, we examined epithelial cells of oral gingiva. We found that KRT5+ and KRT18+ gingival epithelial cells do not express ACE2, but highly express TMPRSS2 and Furin as well as CD147, which was proposed to be an alternative receptor for SARS-CoV-2. However, using SARS-CoV-2 pseudoviruses containing the spike protein, it was observed that gingival epithelial cells were not susceptible to infection due to their lack of ACE2 expression and the inability of CD147 to mediate viral entry. These results strongly suggest that epithelial cells from the gingiva are not susceptible to SARS-CoV-2 and CD147 is not a receptor for the SARS-CoV-2 virus. The susceptibility of oral cells from other oral structures under healthy and pathological conditions still needs to be confirmed to better understand the role of the oral cavity in COVID-19 infection and transmission. In this study, we found that previously detected ACE2 RNA expressed in gingival epithelial cells did not equate to expression of the ACE2 receptor on cell-surface. The use of cell-surface staining and in vitro/in vivo infection models with SARS-CoV-2 pseudovirus or live virus is needed to confirm ACE2 expression and infection susceptibility of epithelial and non-epithelial cells in various oral tissues. An important question remains as to the source of virus found in the saliva of people infected with COVID-19 if the virus in saliva did not originate from oral epithelial cells. It can be argued that in such cases the infected lung and nasal epithelial cells are the source of virus in the saliva. More studies are still needed to confirm the susceptibility of different cell types found in various oral tissues and susceptibility to SARSCoV-2 and the many variants under healthy and pathologic conditions to better understand the role of the oral cavity in COVID-19 infection and transmission.
Improving the appearance of teeth is a common request from patients. Intrinsic tooth colour varies between individuals and changes over the lifespan, with greater saturation in the yellow range in the later years of life.1-3 Yellow teeth are considered less popular because a yellow tooth colour adds to a perception of advanced age and reduced vitality.4
Common contributors to external stains are tannins and polyphenols from beverages (such as tea, coffee and red wine), coloured molecules from beverages (such as cola drinks) and pigments from foods (such as berries and soy sauce). Mouth rinses that contain active ingredients which are positively charged (chlorhexidine and quaternary ammonium compounds) will also bind to the negatively charged enamel surface and pellicle, causing discolouration.5,6
This article describes seven methods which can create variations in tooth colour to reduce the fundamental progression towards yellowing, other than traditional in office or at home bleaching methods, or the use of veneers.
The stain removal capabilities of conventional toothpastes depends on their abrasiveness, as measured by their relative dentine abrasivity (RDA) value.7
If one rates various abrasives used in toothpastes according to their abrasivity, sodium bicarbonate and dicalcium phosphate dihydrate (also known as brushite) are considered soft; hydrated silica and
calcium pyrophosphate are medium; and alumina and perlite are hard. The most widely used abrasive particle in toothpastes is particulate hydrated silica. Typically, the particles of hydrated silica are roughly polyhedral with sharp edges.8
There are international regulatory restrictions on the maximum abrasion levels permitted in a toothpaste and hence there are limits to how far the idea of using abrasive technologies alone to improve the appearance of teeth can be pushed.9-11
In micropolishing toothpastes, the abrasive particles are reduced in size by processes such as micronising or ball milling. These methods can be used with all common abrasive particles found in toothpastes including silica, calcium carbonate and naturally occurring minerals. Using smaller particles is more effective
for removing extrinsic stains, provided that the bristles of the tooth brush can reach the area to properly apply the micronised particles in a slurry. In practical terms, this means that micropolishing toothpastes are very effective for removing stain on labial surfaces, but not interdentally. For patients who have a regular daily intake of tea and coffee, such toothpastes can be particularly good for reducing the buildup of tannins and polyphenols.12-14
For patients whose lifestyle does not contain foods or drinks that cause extrinsic staining, there is no value in using micropolishing toothpastes on a regular basis. On the other hand, for patients who are regular drinkers of tea or coffee, micronised particles can reduce the inevitable accumulation of external stains on their labial tooth surfaces.
One particular agent which is attracting current interest is nano hydroxyapatite. These nanoparticles are considered to have medium abrasivity.15 The enormous surface area of these nanoparticles means that there is sufficient saturation of apatite species into the water phase that they can contribute to remineralisation.16,17 While traditional abrasive particles used in commercial toothpastes are designed to help remove plaque and stains while causing only negligible levels of damage to tooth surfaces or gingival tissues, from a chemical perspective, most abrasive particle types other than nano hydroxyapatite are unable to contribute to remineralisation.18,19
Recent analyses indicate that regular use of oral care products containing nano hydroxyapatite exerts a whitening action on teeth.20 There are multiple reasons for this. Since hydroxyapatite nanoparticles are white and opaque, if they are deposited onto the surface of teeth they can mask the yellow appearance of teeth, as well as acting as an abrasive to remove extrinsic stains.21,22 There is some suggestion that a layer of white particles not only masks the underlying yellow colour of teeth, but may also block reflection of light from the dentine core of the tooth, not allowing this to pass through the tooth and back to any observers.23 Lastly, the nanoparticles may also fill in microcracks and defects in the enamel surface and enhance its reflectivity.24 As could be predicted, there is a dose-response relationship between the concentration of nano hydroxyapatite in toothpastes and its whitening effects on teeth.25,26
In this approach, the extrinsic stains which accumulate remain on the tooth surface, but are chemically altered by oxidation, so that they no longer absorb light and make the tooth surface appear dull. By its very nature, such an approach must be used periodically to “touch up” the appearance of the surface. Several methods that can be used to decolourise surface stains including an oxidising agent (such as hydrogen peroxide) in a regular toothpaste;27 adding an oxidising agent (such as a powder containing PAP+ and nano hydroxyapatite) to an existing
toothpaste; using a low concentration (0.5%) hydrogen peroxide mouthwash; applying whitening strips; applying paint-on gels; and using peroxide and non-peroxide whitening strips.
Hydrogen peroxide-containing polyethylene strips have been used for many years, with the concept being that the adhesive provides a sustained exposure of the tooth surface to the hydrogen peroxide bleaching agent.28-30 Bleaching strips are also available that use alternative oxidants such as PAP. This has the advantage of avoiding gingival soft tissue irritation, which will otherwise cause sensitivity (Figure 1).
If a paint-on material is being used, removing saliva from the surfaces of the teeth to be treated will improve the results that are obtained, because saliva contains lactoperoxidase and catalase that will inactivate hydrogen peroxide by converting it into water and oxygen.
Sodium hexametaphosphate is an ingredient found in some toothpastes (such as in the Oral-B Pro-Health series). This has the ability to bind strongly to pellicle and enamel because of the strong charge of the polyphosphate component.
As a result, when the polyphosphate has bound to pellicle on a freshly brushed tooth, the coating prevents the accumulation of stains from the diet. A second effect is that the existing stains do not bind as strongly to pellicle as the hexametaphosphate and so they will be dislodged and displaced.31
Numerous randomised controlled trials of stain removal and the rate of deposition of stains by sodium hexametaphosphate have been undertaken, testing the effects on external stains in patients with diverse backgrounds and lifestyles. Reductions in external stain of up to 90% have been seen with regular use of such toothpastes twice-daily over six weeks.32,33
Prophylaxis using a rubber cup or an abrasive particle beam device is a highly efficient way of removing external stains from all aspects of teeth. Methods that rely upon the patient will inevitably fail to reach interdental areas,34 whereas professional prophylaxis deals with all erupted surfaces of teeth. As well as removing extrinsic stains, calculus and dental plaque, depending on the type of abrasive that is used in the prophylaxis paste, a micro polishing effect of the tooth surface can also be achieved. Likewise, graded abrasive disks can rapidly polish a tooth surface (Figure 2). Normal enamel is not microscopically smooth. Small irregularities on the enamel surface at the micron scale readily scatter light, particularly light of the shorter wavelengths in the visible spectrum. When such small irregularities are removed by polishing, more specular mirrorlike reflections occur from labial surfaces, making these appear brighter.
In this approach, a remineralising treatment is undertaken using optimal conditions to ensure that a surface layer of regularly formed perfectly crystalline fluorapatite is formed on the tooth surface.35,36 To achieve this, enamel micro abrasion is performed (using phosphoric acid and pumice) and the patient then uses a topical crème containing CPP-ACP (GC Tooth Mousse™) or CPP-ACP and 900 ppm fluoride (GC Tooth Mousse Plus™) over the following four weeks, each night before retiring (Figure 3). The timing of night time use is designed to ensure that there is optimal availability of the rate-limiting ingredient of calcium ions during the overnight period when the resting salivary flow and intraoral pH will drop. Such products are able to drive remineralisation reactions under acidic pH conditions (down to pH 4 in the case of Tooth Mousse Plus). This is possible because of the release of stabilised calcium and phosphate and fluoride at the ideal atomic stoichiometric ratios to form fluorapatite. The perfectly formed mineral crystals on the surface are better able to reflect short wavelengths of visible light, particularly those in the blue and violet range, making the tooth appear less yellow. The yellow to blue tooth colour shift that is achieved produces an overall improvement in the perception of tooth shade and the effect is permanent.
T his concept relies on the application of a single dye, such as blue covarine, or a mixture of dyes, onto the tooth surface (Figure 4). The dyes can be applied as part of a toothpaste, or
Figure 3. Tooth lightening. A: 10% CPP-ACP topical crème with 900 ppm fluoride. B: Baseline appearance. The incisal edges were smoothed with a disk and then enamel microabrasion undertaken. C: Appearance after 4 weeks of daily use of GC Tooth Mousse Plus™. Note the reduction in yellow.
Figure 4. Relevant chemical structures. A: Typical tannins from tea that cause extrinsic staining. B: CI 74160/ copper phthalocyanine/ blue covarine dye used in Oral-B toothpastes. C: CI17200/ D&C Red No. 33 (upper) and CI42090/FD&C Blue No.1 (lower) used in HiSmile V34 colour corrector foam and serum.
applied directly in a mixture that contains a binding agent, so that they are retained on the tooth surface for several hours. These light blue and purple dyes reflect violet and blue light, making the tooth appear less yellow for as long as there is a sufficient amount of retained dye on the surface of the tooth.
Blue covarine dye (also known as copper phthalocyanine or CI 74160) is used in several Oral-B toothpastes for the specific purpose of changing the optical properties of the teeth to gain a short-term improvement in their appearance.37-40 There are other violet dye mixtures available on the
market for gaining an improvement in the shade of the teeth for several hours, e.g. HiSmile™ V34 colour corrector foam or serum, which uses CI 17200/D&C Red No. 33, and CI 42090/FD&C Blue No.1. These types of products are brushed on to the teeth and left in place.
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.
1. Joiner A. Tooth colour: a review of the literature. J Dent. 2004;32 (Suppl 1):3-12.
2. Joiner A, et al. A review of tooth color and whiteness. J Dent. 2008;36(Suppl 1):2-7.
3. Gómez Polo C, et al. Correlation of natural tooth colour with aging in the Spanish population. Int Dent J. 2015;65:227-234.
4. Newton JT, et al. The impact of tooth colour on the perceptions of age and social judgements. J Dent. 2021;112:103771.
5. Walsh LJ. Cosmetic dentistry – the discoloured tooth. Brisbane: Knowledge Books and Software, 2002. ISBN: 1875219994.
6. Walsh LJ. Tooth stain removal: a critical appraisal. ADAQ News 2017;637:13-14.
7. González-Cabezas C, et al. Abrasivity testing of dentifrices - Challenges and current state of the art. Monogr Oral Sci. 2013;23:100-107.
8. Joiner A. Whitening toothpastes: A review of the literature. J Dent. 2010;38:e17-e24.
9. International Standards Organisation ISO 11609, Dentistry-Toothpastes. Requirements, Test Methods and Marking, 1995.
10. Goldberg M, et al. Undesirable and adverse effects of tooth-whitening products: A review. Clin Oral Investig. 2010;14:1-10.
11. Wiegand A, Schlueter N. The role of oral hygiene: Does toothbrushing harm? Monogr Oral Sci. 2014;25:215-219.
12. Raoufi S, Birkhed D. Effect of whitening toothpastes on tooth staining using two different colour-measuring devices - a 12-week clinical trial. Int Dent J. 2010; 60:419-423.
13. Schemehorn BR, et al. Abrasion, polishing, and stain removal characteristics of various commercial dentifrices in vitro. J Clin Dent. 2011;22:11-18.
14. Casado BGS, et al. Efficacy of dental bleaching with whitening dentifrices: A systematic review. Int J Dent. 2018;2018:7868531.
15. Epple M, et al. A critical review of modern concepts for teeth whitening. Dent J. 2019;7:79.
16. Chen L, et al. Hydroxyapatite in oral care products - a review. Materials 2021;14:4865.
17. O’Hagan-Wong K, et al. The use of hydroxyapatite toothpaste to prevent dental caries. Odontology 2022;110:223-230.
18. Sarembe S, et al. In vitro whitening effect of a hydroxyapatite-based oral care gel. Eur J Dent. 2020;14:335-341.
19. Limeback H, et al. Biomimetic hydroxyapatite and caries prevention: A systematic review and metaanalysis. Can J Dent Hyg. 2021;55:148-159.
20. Limeback H, et al. Tooth whitening with hydroxyapatite: a systematic review. Dent J. 2023;11:50.
21. Niwa M, et al. Polishing and whitening properties of toothpaste containing hydroxyapatite. J. Mater. Sci. Mater. Med. 2001;12:277-281.
22. Dabanoglu A, et al. Whitening effect and morphological evaluation of hydroxyapatite materials. Am J Dent. 2009;22:23-29.
23. Steinert S, et al. Daily application of a toothpaste with biomimetic hydroxyapatite and its subjective impact on dentin hypersensitivity, tooth smoothness, tooth whitening, gum bleeding, and feeling of freshness. Biomimetics 2020;5:17.
24. Fabritius-Vilpoux K, et al. Quantitative affinity parameters of synthetic hydroxyapatite and enamel surfaces in vitro. Bioinspired Biomim Nanobiomater. 2019;8:141-153.
25. Kim BI, et al. Tooth whitening effect of toothpastes containing nanohydroxyapatite. Key Eng Mater. 2006;309:541-544.
26. Shang R, et al. Tooth whitening with an experimental toothpaste containing hydroxyapatite nanoparticles. BMC Oral Health 2022;22:331.
27. Kleber CJ, et al. In vitro tooth whitening by a sodium bicarbonate/peroxide dentifrice. J Clin Dent. 1998;9:16-21.
28. Gerlach RW, et al. A randomized clinical trial comparing a novel 5.3% hydrogen peroxide bleaching strip to 10%, 15% and 20% carbamide peroxide tray-
An important point is that shade reversion agents do not remove extrinsic stains, but provide a temporary brightening effect that reduces the yellow appearance of the teeth. It is good practice to always combine shade reversion agents with a method that removes extrinsic stains.
Each of the seven strategies discussed above can be used in various combinations to achieve worthwhile outcomes. Key considerations are the extent of effort that the patient is prepared to make in using products as part of their selfperformed oral care, versus relying on professional interventions undertaken in the dental clinic. It is important to understand the patients’ demands and to have a realistic approach to meeting these, that takes into account practicability as well as cost.
based bleaching systems. Compend Contin Educ Dent. 2000;21:S22-S28.
29. Gerlach RW, et al. Objective and subjective whitening response of two self-directed bleaching systems. Am J Dent. 2002;15:7A-12A.
30. Walsh LJ. New Oral-B 3D White Whitestrips provide a useful adjunct to in-office or at home bleaching treatments. Australas Dent Pract. 2014; 25(1):12-14.
31. Park YD, et al. Research about changes of abrasiveness and whiteness of each dentifrice including nano-hydroxyapatite, sodium metaphosphate. Key Eng Mater. 2006;309:545-548.
32. Gerlach RW, et al. Removal of extrinsic stain using a 7.0% sodium hexametaphosphate dentifrice: a randomized clinical trial. J Clin Dent. 2002;13(1):6-9.
33. Gerlach RW, et al. Extrinsic stain removal with a sodium hexametaphosphate-containing dentifrice: comparisons to marketed controls. J Clin Dent. 2002;13(1):10-14.
34. Walsh LJ. Interdental cleaning – the final frontier for mechanical plaque control. Auxiliary 2016;26(3):18-19.
35. Walsh LJ Tooth lightening: a new concept of maximizing surface aesthetics. Australas Dent Pract. 2008;19(2):48-50.
36. Walsh LJ. Molecular and pharmaceutical aspects of novel methods and materials for the prevention of tooth structure loss. Curr Pharm Biotechnol. 2017;18(1):45-51.
37. Joiner A et al. A novel optical approach to achieving tooth whitening, J Dent. 2008;36:s8-s14.
38. Collins LZ, et al. Instant tooth whitening from a silica toothpaste containing blue covarine. J Dent. 2008;36:s21-s25.
39. Joiner A. A silica toothpaste containing blue covarine: a new technological breakthrough in whitening. Int Dent J. 2009;59(5): 284-288.
40. Tao D, et al. Tooth whitening evaluation of blue covarine containing toothpastes. J Dent. 2017;67: S20-S24.
Question: What is a dental associateship?
The term “associate” has different meanings in each of the veterinary profession, the legal profession and in the dental profession.
A dental associateship is an arrangement whereby dental equity participants, known as associates, each retain the benefits of the fees that they generate while sharing in the ownership of practice identity including the practice name, practice business name, practice telephone number and practice website. A dental associateship has aspects of personal ownership melded with co-ownership of practice identity assets.
Associates share common expenses but routinely are responsible for their own laboratory costs and for costly items such as implant components. In some practices, associates each own the equipment
in their own surgeries and directly employ their own chairside assistants, but all other equipment is commonly owned and other staff are jointly employed. In others, all equipment is commonly owned and all staff commonly employed by a joint service entity—these days via a non-profit partnership. Any tax planning structures such as partnerships or trusts should be located within each associate’s entity.
Why have a dental associateship rather than a conventional partnership?
Dentists have differing ability and willingness to treat patients. This includes differing skillsets, such as special interests in various specialties with few dentists being exactly alike, albeit having substantial skillset overlaps. The dexterity of dentists, or what are commonly referred to as “dental hands”, varies considerably in many practices with some able to produce significantly more quality dental treatment than their associates. A dentist producing much larger fees is unwilling to share profit equally with a dentist producing significantly less which is the main reason behind dental associateship structures.
“A dentist producing much larger fees is unwilling to share profit equally with a dentist producing significantly less which is the main reason behind associateship structures...”
Some dentists with finely tuned chairside communication skills will generate a greater proportion of follow up appointments and a greater volume of personal referrals than another associate. It is the responsibility of each associate to develop their individual skillset and their chairside communication skills. It is the joint responsibility of all associates to maintain the good name of their practice, the presentation of their website, practice telephone number, the appearance of their premises and the skills of support staff, particularly practice receptionist(s). This is implicit in the shared ownership of these common assets and is a reason why associates must not take actions which devalue these shared assets.
Where legal conflict involves a court or legal arbitration hearing, it is normal for the court to rely heavily on the evidence of industry experts. I personally have been engaged as an expert witness in a variety of legal processes involving dentists and veterinary practice owners. Overwhelmingly, I encouraged the protagonists to avoid introducing lawyers which inevitably leads to substantial cost and diminishes personal trust. My business model was not reliant on fees from being an expert witness.
Lawyers come in quads; each party’s solicitor and each party’s barrister creating a circle of demands for information with questions, answers and supplementary questions establishing an indeterminate cycle of activity which inevitably extend and magnify disputes. This process is accompanied by regular legal bills plus bills from legal support experts. My experience is that the expense, including the cost of industry expert advisers assisting each party’s lawyers to understand the intricacies and conventions of practice structures and respond to opposing demands for information, leaves both parties much worse off financially and emotionally.
I regard it as a challenge to get the antagonists to settle their differences without lawyer’s involvement. Overwhelmingly lawyers do not understand the practice financials or the conventions
underpinning dental associateships. Lawyers seek to gain an edge for their client by interpreting agreements to suit their client and making demands on the other party(s). Soon both parties’ lawyers are exchanging demands and accusations which perpetuates and widens conflict.
In 33 years of advising the dental profession, I never saw an associate’s dispute solved by lawyers. On a few occasions I was able to tell lawyers to withdraw on the basis that what they were doing was not helping their clients but rather magnifying and prolonging a dispute.
Associates’ disputes hardly ever go to court because the quantum of legal and legal support costs is so great as to dwarf the benefit of a possible financial settlement. Even winners in court end up financial losers. Top performing dental practices are tiny compared to big business and their associates cannot afford the cost of legal conflict which are not apparent at the outset.
Where a dentist purchasing a dental associateship has been employed in the practice for several years, they have the comfort of already having substantial patient relationships. On purchase, they own the goodwill of the patients who they have treated (their list) who provide them with referrals and the convention is that they receive a pro-rata share of new patients not specifically referred to either associate. The continuing associate retains their own patient list plus a pro rata share of non-specifically referred new patients. Practice receptionists identify who the new patient is allocated to by the affiliation of the patient who referred them. Where there are more patients than can be treated by an associate, they are allocated to assistant dentists who are usually jointly employed.
The new associate is expected to increase their patient list, thus creating additional fees and profit. The new associate is expected to meet the challenge of generating follow-up appointments and increasing personal referrals. The continuing associate may be expected to mentor the new younger associate but usually this is not mandated.
Surveys of dental audiences at a variety of locations and times across Australia plus the experience of a large personal client list of dentists advised over many years revealed that almost universally, practices grew and sustained their patient numbers by personal referral from their existing patients of friends, relatives and work mates.
The dominant influences were the quality of their chairside relationship with patients including their relationship with their chairside assistant, the quality of the treatment, the appearance of the practice premises and professionalism of the practice receptionist.
It is vital that a practice presents a unified image regardless of containing two or more associated dentists.
Where the appearance of dental premises deteriorates, existing long-term patients tend to continue to make appointments but become reluctant to refer their friends as they fear negative reactions. Once premises are renovated, referral patterns are re-established.
Surveys revealed that most money spent on external marketing consultants had little impact on patient numbers compared to personal referrals and was largely wasted! Time and money expended on improving communication skills, particularly at chairside, is money well spent. If contemplating using a business consultant, it is vital that the consultant has a strong record of advising dentists and can provide dental references. Dentists can also evaluate business consultants claiming to be able to work magic for them by asking them questions of which they already know the answers. I am aware of circumstances where dentists spent huge sums of money on business coaches and marketing consultants for negligible fee growth. Many would achieve far better results by having an interior design expert redo the décor of their waiting room and by working on their chairside communication skill.
Legal mediations do not have the power to arbitrate solutions. I have long advised dentists to write a different approach to potential conflict resolution into associate agreements—refer to my book Financial Success for Dentists. Sometimes solicitors finalising associate agreements have slipped in a legal mediation clause despite advice to the contrary. Mediations bring the parties together briefly then separate them together with their legal and expert advisers. The mediator then moves between the rooms hoping to get a conversation started about settlement. Then the mediator can carry responses backwards and forwards. I have only met one really good mediator out of a significant number having been to a number of mediation proceedings as an expert. The mediations of his that I attended as an expert/client adviser were not dental related. He is now long retired. The outcomes of mediations are, at best, mixed. They are usually very costly with barristers, solicitors and attendant experts billing for attendance and time spent in preparation plus the mediator’s fees. The parties are not bound to accept recommendations from a mediator. Mediators are usually, but not exclusively, lawyers.
Grant has a very upmarket dental practice and has an overflow of patients normally treated by his assistant dentist. Grant’s fees amount to 3 to 4 times those of the assistant dentist and he is well connected socially. He has exceptional dentist to patient communication skills. The assistant dentist is replaced by an associate, Maria, on the basis that she will own the pool of patients who have been treated by the previous assistant dentist. Grant’s continuing referrals lead to him having a continuing high proportion of patients requiring extensive treatment plans. His patients tend to be referred by people with similar financial resources and similar needs.
There is a formula for sharing expenses of a common nature with recognition that particular resources are utilised more heavily by Grant. Friction develops between the two associates and Maria
engages a lawyer who fires off demands but is ineffectual in resolving the conflict. Nor does the lawyer display more than a superficial understanding of dental practice. Grant continues to provide excellent treatment to his patients and produces vastly greater fees than Maria. Maria’s lawyer suggests legal mediation. Grant does not agree. A mediator is not an arbitrator and has no power to order an outcome. Eventually Maria tires of the dispute and Grant repurchases her associateship for a similar amount as her buy in figure. Maria moves on and Grant hires an assistant dentist.
Several dentists practice as associates with a couple of jointly employed assistant dentists. They have an agreement drawn up many years ago which has been ignored as all decisions between associates have been reached by a series of informal discussions. The relationship has been one of harmony but one of them has a daughter, Gillian, who recently qualified as a dentist to whom he sells his associateship. After a handover period, the father departs. She does not fit in with the other associates and her aggressive nature becomes a cause of friction with staff. The other associates, who are not combative by nature, tire of trying to persuade her to adapt to the overall practice. One by one they find her too difficult to relate to and she becomes isolated. One day, Gillian announces that she intends to set up in separate premises nearby. The others are advised that their best course is to stand back while she arranges her move. She demands a significant pay out but as she has already committed to leasing and fitting out her new premises, these golden financial chains are extracting her from her present location. Eventually, the others agree that she take with her the equipment from her own surgery and a quarter of the hand instruments and a quarter of the consumable stock. She can communicate with patients on her/her father’s list. The continuing associates refuse to alter practice name, signage or telephone number. Rather than try and value the hand instruments, they are all brought to a central location and lots are drawn for order of picking. The associates each take turns in picking items until the pile is exhausted. Consumable items are treated similarly.
Having painted herself into a corner, Gillian departs and henceforth the practice returns to a pleasant working environment. Some patients follow Gillian but over time, others of her original list make appointments with the continuing associates.
Golden extractor chains two
Silas and Greg are associates with a 4-chair practice. One each for them and two occupied by jointly contracted assistant dentists. Silas decides to move upmarket and demands that his associate, Greg, pay him for his portion of the fit out when he vacates the existing premises in which they have practised in association. Their lease is approaching renewal but if he renews, Greg will be paying full rent rather than half. He cannot fill the two surgeries to be vacated. Silas claims that Greg must buy his interest in the practice fit-out based on a biased interpretation of an old agreement but this is an impost Greg had not sought. He takes advice and is told to not respond until Silas is committed to his move. Greg learns that Silas has signed a lease on new premises and is committed to an expensive fit out. The golden financial chains are pulling Silas toward his new location and he has lost bargaining power. He takes the equipment from two rooms and half the small instruments and half the stock on hand. Greg has arranged a new lease with the landlord. He refuses to buy Silas’s fit out because he only has sufficient patient base for himself and one assistant dentist and because he has been left with the impost of double the rent. Silas’s solicitor weighs in but Greg’s adviser tells him that there is nothing he can achieve by making vague legal noises.
Silas moves. Greg changes the locks.
Over time Silas’s move toward expensive upmarket dentistry is less successful than he had anticipated and his costs have blown out due to payments on a very expensive fit out and high rent.
Two orthodontists in conflict.
Iceman and Excitable are two orthodontists practising in associateship. They originally practised together but some years later acquired a second practice remote from the first. There are also a couple of monthly one day visits to country dental practices where they treat
referred orthodontic cases from those practices. The two separate practice locations are approximately equal.
Iceman wants to separate their associateship but Excitable is not sure what he wants. There are a few crossover patients but in number they are insignificant. They ask for guidance and in our initial meeting it is apparent that Excitable has difficulty controlling himself while Iceman knows exactly how to push his buttons. It is obvious that each needs to take one arm of the practice and end their association. Excitable raises various minor issues, but these are easily batted away. We receive an email from a solicitor stating that he is acting on Excitable’s behalf. Our reply is: “There is nothing that you can do to enhance the outcome except to delay it and cause more expense!” The solicitor crawls back into his burrow.
Excitable raises possible difference in value of hand instruments and stock on hand. Our solution is to agree on a weekend on which all of the instruments in both locations are to be tabled. You toss a coin for first pick and take alternate picks until the pile has been separated and do the same with the stock. You then travel to the other location and do likewise. While ending up with half of each practice location’s instruments and stock each seems messy, it overcomes Excitable’s concern that there might be a significant differential between locations. The patient base attached to each location is closely matched. Inevitably, Excitable raises minor issues which Iceman treats with an occasional cynical comment. We point out that the alternative to our straight forward separation process are expensive and pointless legal processes which almost certainly will never reach court. The two orthodontists need to get on with their separate lives. They part and have no further relationship.
Gene works for a practice owned by Harry. Gene has about six years practice experience. Harry is possibly about five years from retirement from dentistry but this is uncertain as many experienced dentists don’t know when they want to retire until the date is imminent. Harry is a competent and popular dentist with a strong patient list. He likes his work and
produces much greater fees than Gene. Harry offers Gene the chance to buy part of the practice and work in association. This will also put Gene in a position to buy the remainder of the practice from Harry in due course using the same valuation formula. Somebody gets into Gene’s ear and asks him, “Why pay for goodwill when you can set up your own practice nearby?”
Unfortunately for Gene, he swallows the Kool-Aid and starts looking for premises to rent.
Gene leases premises then finds that practice fit out and minimum equipment will cost a great deal more than he had realised. Whereas banks were prepared to finance his purchase into an existing established practice offering reliable income from day one, they are not prepared to lend to him unless they have substantial security. Gene’s parents reluctantly agree to guarantee his borrowings and assist him to establish a practice. On hearing that Gene is establishing his own practice, Harry dismisses him and locks him out of the practice computer system and changes the door locks.
Gene finds that practice growth is agonisingly slow. Very few patients follow him from Harry’s, but on ringing that practice for an appointment are quietly booked for an appointment with Harry or his new assistant dentist. It is over two years before Gene can meet his expenses—let alone make a personal income—yet other practices nearby have large patient lists who refer new patients to them. Gene now regrets his rejection of Harry’s offer. His debt has grown and exposed the financial risk to his parental guarantors.
Gene survives but it takes a couple more years to create as much profit in a year as he had earned working as an assistant dentist for Harry and certainly significantly less than he would have earned as an associate. He realises that he made a huge mistake not buying an associateship with Harry. In due course he learns that Harry had sold an associateship to his successor as an assistant dentist, then a couple of years later that Harry has sold her the remainder of his practice and agreed to work part time on a declining time basis to complete a goodwill transfer. Their practice has expanded to a successful busy three dentist practice. Gene has achieved the income of a single assistant dentist and deeply regrets his strategic mistake.
Enjoying a reliable income immediately on purchase of an associateship is a huge advantage over the expensive risky task of building a practice from a zeropatient base. It is the reason most dental practices have substantial goodwill value.
All names and some details in the above examples have been altered to avoid disclosing those involved.
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.
Graham Middleton disposed of his interest in Synstrat group on 30 June 2020 and won’t be starting another business; he spent the later 33 years of his working life advising health professionals on business and financial matters. Dentists were the most numerous of his clients. He is the author of the recently published Financial Success for Dentists. Dentists may obtain a copy by making a donation of minimum $60 to the Delany Foundation a registered charity which assists schools in Ghana, Kenya and Papua New Guinea then email Graham at graham. george.middleton@gmail.com. A copy will be sent to you. All proceeds go to the Delany Foundation for its good work. Graham has paid for the printing and mail costs personally.
hen it comes to customer service, dental practices have always been way ahead of medical (in my opinion). How often do you enter a medical practice and either:
a. Stand in a queue and wait to be served;
b. Be the first in line but the two or three receptionists behind the desk take their time to acknowledge you; or
c. Find everyone too busy to address you so you take a seat, only to then notice the signs displayed everywhere instructing you to “report to reception before taking a seat!”.
Patients certainly receive a more immediate and friendly welcome when they visit their dentist!
This has certainly been the case in my experience over my 35 years in the industry. However, with the introduction of social media, specialised marketing and increased competition for dental practices, it is probably a good time to take a fresh look at the customer service we offer to our dental patients.
I suggest to my clients that there are four levels of customer service; identifying the level of service that you want to deliver to your patients is crucial if you want to move together as a team to create a unique experience for your patients.
The first level of customer service is unacceptable. We have all, unfortunately, experienced unacceptable customer service. We know how it makes us feel. Unacceptable customer service is when you are treated so shabbily that you leave, promising to jump online and leave the company a bad Google review.
WOr, you call the manager or owner and make a complaint. You certainly advise anyone who will listen to avoid the company and promise never to use their products or services again.
In terms of a dental practice, witnessing unacceptable customer service delivery by a team member will have the owner or
“Despite MANY practices professing to deliver ‘optimum’, ‘ideal’, ‘premium’ and ‘first-class’ customer service, most are providing anticipated customer service. There is nothing wrong with that. Anticipated customer service is professional, courteous and helpful and contributes to a good reputation for your practice. Everyone is satisfied with anticipated customer service...”
manager set up a meeting with that team member to swiftly manage this underperforming employee.
The second level of customer service is basic. Basic customer service is when the employee exhibits little-to-no interest in the customer and just scrapes by in achieving a task or responsibility to serve them. Customers get the assistance they required - just - and leave wondering how this person manages to keep their job.
The third level of customer service is anticipated. Anticipated is just that; this is the level of customer service that we expect and are satisfied with. We receive the assistance we require from a friendly and professional employee. Customers of practices that deliver anticipated customer service can become regulars and develop good relationships with team members. If it is requested of them, customers will leave a positive Google review but are unlikely to spontaneously do so themselves.
The fourth level of customer service is unanticipated. Unanticipated customer service is something special. This level of service is delivered by employees who are willing - eager, in fact - to go above and beyond to make a customer happy. They are upbeat, energetic, happy, passionate and obviously love their job. Customers who experience unanticipated customer service are so surprised and delighted that they will voluntarily leave a great Google review or provide feedback to the manager or owner on how impressed they are with the service of the practice. They will share such a terrific experience with family and friends, urging them “you HAVE to go there!”
Figure 1. shows some examples of how the levels of customer service are displayed in a dental practice so you can easily identify the differences. Despite MANY practices professing to deliver “optimum”, “ideal”, “premium” and “first-class” customer service, most are providing anticipated customer service. There is nothing wrong with that. Anticipated customer service is professional, courteous and helpful and contributes to a good reputation for your dental practice.
Patient requires more time for treatments and is very anxious
UNACCEPTABLE Employee
BASIC No interest in patient
ANTICIPATED Interest
“Dental surgery”
“Good morning, Dental Practice, Julie speaking. How can help you? (Tone is flat and sounds automatic)
UNANTICIPATED
High interest and high energy
“Good morning, Dental Practice, Julie speaking. How can I help you? (Tone and modulation is excited!)
Often make mistakes in booking appointment due to lack of mindfulness and concern
“That’s not my job/It was not our fault/You misunderstood/ We don’t offer that here”
Books correct time
Books correct time, ensures patient has a card or entered into smartphone
Books correct time, gives card, clarifies with patient what will be done on the day, the cost, if the patient has to prepare in any way and provides quote
“I’ll get the manager”
“I will speak to the manager about what has happened and get back to you”
“I apologise that there is a concern. Let’s sit down together and talk so I can listen to what has happened and get a solution for you”
“I don’t know”
“We are ready now” (no acknowledgement of name and bolt up the hall)
Fail to announce what is happening, fast and painful injection, no concern for patient
Answers the query. Does not ensure patient is satisfied or understands whether there are further questions
Answers the query and asks “Is there anything else I can help you with?”
“Are you Bill? Come through.” (Wait for patient then walk)
Announce LA is coming but no comfort for patient
“Bill? You can come through now. How are you?”
(Politely walk with patient)
Announce LA, administer gently, DA comforts patient
Answers the query in a conversational manner so there is back and fourth with the patient. Draws diagrams, uses display models, offers brochures, etc - whatever is needed so the patient gains a complete understanding
“Bill. How delightful to see you! Come on through. Tell me, how was your Christmas?”
Dentapen™ to administer/warmed LA, gentle, comforting. Speaking softly and reassuring
“You need a crown. Just book in for one when you’re ready”
“You are not letting us work. We can’t do the treatment” (Send patient away)
“You need a crown. Here is a brochure explaining what a crown is. Reception can book you in”
Pushing patient through to set time regardless of anxiety
Everyone is satisfied with anticipated customer servicecustomers and practice-owners alike.
However, it is through the delivery of unanticipated customer service that your practice can grow rapidly via existing patients actively recommending your services to their personal networks and anyone who will listen. Your patients are so impressed and delighted with their experience at your practice that they would never go anywhere else and remain loyal for the long term. Your dental practice becomes known as THE BEST practice in the area. Your patients feel lucky to have found you.
“You have 3 options”
(Options explained) (Book for chosen option)
Lengthen appointment, treat patient with more care
“This is your condition and treatment options to resolve it”. (Explanation with aids, printed quotation, time for patient questions, payment options, use doc folder)
“We know you’re anxious and we are here to help. This is what we are going to do” (Meds, lights down, meditation, hypnotherapy, etc)
If you would like our downloadable lesson and guide to assist your team improve the level of customer service delivered in your dental practice, simply email Julie at julie@julieparkerpracticesuccess.com.au and we will be delighted to forward it directly to you.
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
There are a lot of misconceptions out there among dentists who are buying practices, in regard to the council zoning required for a dental practice. Can you put a dental chair in a retail shop and start practising? Can a dental practice operate in an area that is zoned “commercial”, or does it need Special Purpose zoning? If a practice has been in the area for a long time... is council approval assumed? Are all approvals for dental practice use the same? What happens if your practice is operating under the wrong permit?
To provide some clarity in this regard, we thought we would answer some dental practice zoning FAQs.
ACouncils divide land into different areas, or “zones”. The zoning of a piece of land determines how you can use it. An area zoned “residential” might only allow houses to be built on the land, while an area zoned “commercial” might allow retail stores and other businesses to be built there.
Permitted uses for these zones can be found online in each council’s planning
scheme. Dental practices will usually fall under a medical centre or health consulting room definition within the local council planning schemes.
Q. Can a dental practice operate in any area that is zoned “commercial”?
AGenerally speaking, the answer is “No”; a dental practice usually requires Special Purpose zoning. To operate a dental practice, you need two approvals - the first being a permitted use approval and the second being an approval for the build.
If the premises is located in a retail or office building, you may also need the permission of the body corporate. There are many buildings that do not allow dental or medical services to operate within the building, even though the zoning may permit it.
Q. How can I work out what zoning/usage approvals have been granted on my premises?
ATo find out the zoning and approvals, you can:
• Call your local council and ask if there are any approvals on record for the establishment of the practice;
• Ask the landlord/property or business vendor for copies of the approvals; and
• Explore the DA Search component of your local government website.
Q. What are existing use rights?
ASometimes, a dental practice will predate the zoning ordinances of the council. When this happens, the practice will usually have an exemption from any newer zoning restrictions or compliance requirements.
Q. If the zoning allows for a dental practice, can I operate the dental practice however I want?
AA Council zoning approval doesn’t just dictate the type of business that can be established on the site. It can also dictate:
• The hours of operation (it can say no trading in late evenings or weekends, for example);
• The number of concurrent clinicians allowed to be working there at one time; and
• There are some zoning permits that dictate that a percentage of the premises has to be used for residential purposes.
Q. How can the incorrect council zoning usage influence my practice sale?
AA large part of a practice’s goodwill is often tied to its ability to trade in its current location into the future.
A buyer’s lawyer is there to mitigate the buyer’s risk. As part of this risk mitigation, a buyer’s lawyer should check the council zoning to ensure that the practice can continue to trade as it has into the future.
If it is discovered that the practice is operating in a way that is in contravention to the zoning permit, the lawyer will often advise their client to either adjust the terms (reduce the price) of the deal, or not to proceed with the purchase until the zoning is fixed.
Examples of sales where we have seen this happen include:
• A practice that is operating in a residential conversion building that has approval for commercial use, but not medical/dental;
• A practice for sale on premises that has zoning approval for medical/dental, however, it also prohibits Saturday trading... and 20% of the practice’s billings were being done on a Saturday; and
• A practice for sale on premises that has zoning approval for medical/dental, however, it is an old approval that only allows for 1 clinician to be operating at a time... and the practice regularly has 3 dentists working at the same time.
Q. What happens if my practice is operating in a way that isn’t allowed for within the original approval?
(i.e., the zoning permit only allows for 1 clinician at a time and we have several, or the zoning permit doesn’t allow Saturday trading and we offer Saturday appointments)?
AOften, this can occur innocently enough, simply by the organic growth of a practice over time. In our experience, this can often be fixed in a few months by an application to the council. You may need advice from a town planner. This is another reason why you may want to exit plan well in advance of when you wish to sell your practice.
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.
Tal Eloss is the Founder and Director of 1Group Property Advisory. Tal and 1Group Property Advisory have extensive experience assisting and representing dental and medical professionals with their property and practice premisesrelated acquisitions.
If you’ve managed to access the internet and/or social media in the past six months and not heard about the rise of AI and ChatGPT - then you surely deserve some kind of award.
Once the stuff of science fiction and doomsday predictions, Artificial Intelligence is here... and it’s here to stay.
The pursuit of AI can be traced back to as early as 1950 when Alan Turing published his trailblazing paper Computing Machinery and Intelligence (Turing, A. M. (1950). Computing machinery and intelligence. Mind, 59, 433–460).
Since then, mathematicians and software engineers have worked to answer the million-dollar question – can machines think?
The past decade in particular has seen formidable progress in the development of AI and human-like technologies. We were given auto-correct, Siri, Google Maps, driverless cars, smart-homes and chatbots that infuriated us on Telstra’s website.
But up until recently, AI and predictive technologies were mostly the realm of entrepreneurs, Silicone Valley start-ups, futurists and the particularly tech-savvy.
Today, AI technologies (and Chat GPT in particular) have exploded as a tool for business owners, marketers, freelancers and anyone concerned with running a business on a budget.
But this of course begs the question, what opportunities does AI present? And what risks might be lurking below the shiny new surface?
Encyclopaedia Britannica defines AI as “the ability of a digital computer or computer-controlled robot to perform tasks commonly associated with intelligent beings. The term is frequently applied to the project of developing systems endowed with the intellectual processes characteristic of humans, such as the ability to reason, discover meaning, generalise or learn from past experience”.
This definition might conjure up images of self-aware machines or robots with feelings (think Wall-E or Blade Runner), but AI is far less dramatic and far more pervasive than that.
Predictive text when you use Google Search? That’s AI.
Face ID to unlock your phone? That too.
Social media algorithms, Grammarly, Amazon recommendations, even Netflix –all examples of how we already use AI on a daily basis.
In fact, according to Grandview Research, the global artificial intelligence market was valued at USD 136.55 billion in 2022.
An article from TechJury also showed that AI adoption is growing steadily and now sits at 35% (a four-point increase from 2021), whilst IBM reports that 77% of surveyed business are already using or plan to use AI in 2023.
So, if AI has been around for years, then what’s all the recent hype about?
A culmination of many things (it’s more topical in the wake of Bitcoin and the Metaverse), but there is one recent invention on everyone’s lips...
ChatGPT is a new technology that’s making waves for its ability to generate particularly versatile and reasonably specific text.
It was developed by a company called OpenAI (a Silicon Valley start-up Elon Musk is involved with) and was first made available November 2022.
Since launching, ChatGPT has been used over 30 million times and gets approximately 5 million visits each day, according to the New York Times
It has been able to:
• Pass an MBA exam;
• Write and debug computer code; and
• Conduct makeshift therapy sessions.
It’s clearly an impressive technology but has been met with its fair share of controversy for both the opportunities and threats it poses.
One of the key benefits of Chat GPT is that it’s able to create text on virtually any topic and in any specified tone.
It has been built with limitations around graphic, violent or highly offensive content – but beyond that it can generate more or less anything.
Business owners and marketers have been quick to put the technology to work creating blog posts, emails and social media posts.
This is particularly exciting for smaller operations who don’t have the resources to hire professional writers or a large marketing team.
As you’ll see, Chat GPT also allows you to refresh the content multiple times until it hits the nail on the head.
ChatGPT sounds like a wonder machine – so why would there be any downsides?
Well, no machine is infallible.
In fact, I asked ChatGPT itself to explain its own shortcomings.
It responded...
As an AI language model, Chat GPT has been subject to various criticisms and risks. Some of the most common ones include:
Bias: Language models like Chat GPT are trained on large amounts of text data and if that data is biased, the model may also exhibit biases in its responses. This can result in the model producing inappropriate or offensive responses, particularly on sensitive topics like race, gender and sexuality.
Lack of understanding: While Chat GPT can generate text that is coherent and grammatically correct, it may not always understand the context or meaning of what it is generating. This can result in the model producing irrelevant or nonsensical responses.
Misinformation: Chat GPT can generate responses that are factually incorrect or misleading if it is trained on inaccurate or biased data.
Overreliance: There is a risk that people may become too reliant on Chat GPT or other language models for generating text, which could lead to a decline in critical thinking skills and the ability to write effectively.
Security: Language models like Chat GPT can also be vulnerable to security threats such as adversarial attacks or data breaches. For example, a malicious actor could train a language model to generate spam or phishing messages.
Lack of transparency: Some have criticized the lack of transparency in how language models like Chat GPT are trained and the algorithms they use. This can make it difficult to understand how the model is generating its responses and can contribute to concerns around bias and misinformation.
Privacy: There are concerns about the privacy implications of language models like Chat GPT, particularly if they are
used to generate text based on sensitive user data. This could potentially lead to the exposure of personal information or other privacy violations.
Overall, while Chat GPT and other language models have shown great promise in generating human-like text, they also come with a number of risks and criticisms that need to be carefully considered and addressed.
And while this is an impressive list straight from the horses’ mouth, there have been additional issues flagged by users.
Plagiarism is set to be one of the biggest apprehensions around ChatGPT. Schools and larger workplaces are already implementing systems that can detect AI-generated text and flag it as plagiarism.
who are vehemently against ChatGPT will now have the tools to identify and block the content if they so choose, much like an Ad Blocker works.
And one of the more significant concerns includes cyber security. ChatGPT itself has flagged it as an issue, but cyber security remains a growing concern for individuals and businesses worldwide. Like any technology we use, a data breach could see your data compromised and subject to cyber threats.
The most obvious solution is to review, review, review the content.
Contrary to popular belief, machines aren’t infallible and are all but bound to make mistakes from time to time.
Inaccuracy is another key concern. We all know the internet is rife with misinformation and opinions - which ChatGPT might not be able to accurately detect. When the AI scans the internet for information to inform its content, there’s always the risk that it’s drawing from an inaccurate source.
To combat the hesitations around plagiarism and inaccuracy, software is already adapting to respond to AI generated content. Google have advised that publishers should disclose the use of AI in creating content, along with Who, How, and Why. At this stage, it is not overtly penalising AI generated writing, but if it’s thought to be created with the intent of manipulating rankings, then it will be penalised by Google.
Software engineers have also rolled out a series of web pages and Chrome Extensions that are able to detect whether writing has been generated by AI. Those
It also makes sense that if your text is going to be read and consumed by humans, it needs to be proofed, edited and approved by a human.
You’ll know the context of your content far better than any machine, including the context, audience, potential sensitivities and the platforms it will be promoted on.
Chat GPT and AI technologies can create a solid foundation, but they still need a human touch at this stage.
A great example is Canva and the way we as business owners use their technologies. They provide the templates and the tools and then we jump in and tweak it so that it makes sense for our brand and our audience.
Another important user tip is to give ChatGPT plenty of direction. The more vague you are, the more waffling and scanning the internet it’s bound to do. Add links or examples of previous work that you want to emulate, so that it can pick up on specific information and tone of voice.
So, is ChatGPT going to replace the need for writers?
It’s probably not going to make writers completely obsolete (which is good news for the estates of Hemmingway and Shakespeare).
But there’s no denying it’s an excellent tool that can be incorporated into your business, replace some human labour and create a great jumping-off point.
There are absolutely times when a professional such as a copywriter, lawyer or author are necessary, but overall, don’t be afraid of ChatGPT.
Businesses the world over are embracing AI chatbots as a must-have technology and a handy tool in their marketing arsenal.
If you haven’t already, it’s highly worth giving it a go for yourself and your practice. The opportunities are endless and I must admit - it’s a lot of fun!
I also wanted to take a moment to let you know about the ultimate practice productivity hack, one that’s a little less cutting edge than AI technology, but a lot more effective...
It’s called the Productive Dentist Workshop; a day of training where you can bring your Associate Dentist along to learn how to apply intelligent business techniques and workflows to everyday practice life.
It’s a win for you, a win for your Associate and a win for the practice.
Specifically designed for associate dentists as well as practice owners, this is a world-class workshop that will show you exactly how to:
1. Attract your ideal patient;
2. Present treatment with ease and NO “yucky” sales tactics; and
3. Deliver with excellence - so your great patients keep coming back!
The workshop is jam packed with tools and tips I’ve developed over the years to create multi-7-figure success in my own practices. We’ve brought it back by popular demand because our previous sessions were so powerful and we wanted you to be one of the first to know!
You can secure your spot by visiting https://tinyurl.com/58bhdxwu or scanning the QR code. See you there.
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
Synstrat has spent many years collecting data on dental practices. We provide you with the best available knowledge on the performance of your practice relative to others. Our proven service has assisted many dentists Australia wide to create significant wealth. We are able to provide you with business accounting, practice valuation and financial advice services tailored to the dental profession.
•Do you need us to value the practice?
•What rent can it afford?
• How do you structure to meet tax planning requirements?
• What changes should you make to the practice business plan?
Ioften get asked how to word certain emails to patients. Getting the words right when you’re sending emails is so important. You want to ensure that your message is correct and you get the outcome you’re wanting.
But before I dive in and give advice on how to send a good email, my question is always this:
“Is an email the best way to deliver your message and will it give you the best outcome?”
Often you send an email because it’s easy and quick and you get to avoid any confrontations with patients if you’re delivering the not so good news.
For example... You contact your patient to reschedule their appointment because your dentist is away sick, or your dentist has left the practice suddenly.
I know many of you have had this happen and no one likes contacting patients for this reason. But this is the one time when an email just doesn’t cut it. When you need to reschedule your patient’s confirmed appointments, it can be a bit sticky, especially when you’re on the phone and the patient becomes upset. Even so, this is when it is best to call your patient rather than email. You want to know the response of your patient and be able to listen to them and offer a solution.
An email, at the best of times, can feel generic and impersonal and if you’re emailing your patient asking them to call your office to reschedule their appointment, then why not simply call them first.
If you call your patient and cannot get a hold of them, then leave a message but avoid going into details. The aim of your message is to tell your patient just enough, so they’re driven to call you back to find out what it’s all about.
Once you get hold of your patient, the very first words from your mouth must be an apology, even if the circumstances are through no fault of yours. It is the highest level of professionalism to take responsibility for anything that happens in your business.
Lately I have personally seen a lack of accountability for customer satisfaction in many businesses. I’m not sure why this seems to be so hard for many people but the impact you have on your customers when you take the fall, even if you did nothing wrong, is a positive one and customers respect you for it.
The next thing you should do after you have called your patient to change their appointment and apologise, is to direct your patient immediately to a new
By Jayne BandyThere are no winners when the phone call becomes one of conflict between you and the patient, so coming off the call reduces this immediately. There is always the opportunity to have another team member call the patient back, so you remove yourself from more conflict with the patient, but always have a solution ready.
Even the most unreasonable patients will be more reasonable when you try to meet them half-way.
So, even though it seems easier and quicker to send out an email to reschedule your patient’s appointment, the phone call gives you an opportunity to personally apologise, redirect the patient smoothly to a new appointment and if needed offer solutions for patients who are not happy.
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
time. By the way, always presume your patient will be ready to accept the new appointment time so be ready with it.
Most of the time rescheduling your patient’s appointments will be easy and fast but there may be patients who are disappointed and respond a bit differently, not wanting to change their appointment. For these few patients you must stay calm and understand how they are feeling and try to offer another solution. If you see the phone call starting to turn a bit nasty, then the best advice I have is to come off the phone by offering to see what you can do to fix the problem and call them back.
The outcome is a much more satisfied patient who feels they are important enough for you to take the time and make a call to them.
Jayne began her career as an educator. After spending several years teaching, she made the jump to practice management, serving as a Practice Manager for a renowned dentist in Sydney for more than 25 years, giving her first-hand experience at what works when it comes to building and maintaining patient relationships, how to convert leads over the phone and most importantly - what it takes to reach your practice goals. As the CEO and Founder of Dental Phone Excellence, Jayne helps practices convert more calls into appointments, reduce cancellations and nurture effective patient communication that will result in increased profitability. Her past experience as an educator combined with her passion for practice management gives her a unique set of skills that allows your team to fully understand and take advantage of the tools she presents.
For more information on what to say and ask your patients, call 1300-378-044 or email jayne@thedpe.com
By Angus Pryor, MBA (Marketing)
Recently, I travelled to India with a bunch of dentists who were seeking to further their skills through an intensive, surgical hands-on course.
As a marketer, what made me curious about the course (I was there to produce a video) is the capacity to create business growth through additional services.
In this article, we look at the link between learning new skills and boosting your business and how sometimes, one does not lead to the other.
One of the trends I’ve noticed in dentistry over my approximately 10 years in the field, is the increasing number of services offered by general dentists. Whereas services such as implants, crowns and orthodontics were historically only offered by specialists, increasingly they are being offered by “generalists”.
In this context, I travelled to Chennai in India with a team of dentists organised by the Australian Dentistry Institute, headed by Specialist Prosthodontist, Dr Yohan Thomas.
The basic premise is as follows:
1. Do lots of cases in a very short space of time to quickly boost your skills (during my visit, delegates placed implants or undertook extractions);
2. Have cases pre-screened so that each case is the right level of complexity to optimise the learning process;
3. Work with a mentor for instant guidance/feedback on how to best treat your cases; and
4. Undertake cases on live patients, who benefit from the free treatment offered.
I interviewed the course participants about their experience during the course and they were confident about their ability to implement these newfound skills in their practice. One group placed 10 implants in five days; the other group completed 12 extractions over the same period.
You may be wondering why I’m talking about learning additional skills as a business-growing pursuit. Let’s go back to basics. In reality, for every dental practice, there are really only three ways to grow:
1. Increase patient numbers;
2. Get them visiting more often; and/or
3. Have them spend more on each visit.
If you acquire the skills to be able to place an implant, do more complex extractions, or start simple orthodontic treatment, etc, your ability to impact points two and three above can be quite significant.
Some treatments, particularly ortho, automatically cause an increase in visits. Similarly, services such as placing implants and extractions are higher yielding (spend more on each visit) than most other general dentistry services.
On top of that, there is an obvious patient benefit of offering additional services. Most patients would prefer to deal with the same dentist and if you are able to perform more services for them without having to refer them out of the practice, usually the patients appreciate this.
This has the potential to increase patient loyalty and referrals.
Just because there is a business benefit in offering additional services, in my view, that’s not reason enough to go and learn skills. Let me ask you this:
How many times in your career have you done a course to learn a new skill and not actually implemented it at your practice?
The answer for most dentists I know is plenty.
Basically, you’ve invested time and money for no net benefit (unless there are other drivers for you getting you out of the practice). I’m a very practical person and I hate the idea of you going and doing a course that you are never going to implement.
It’s part of the reason why intensive courses like those offered by Dr Thomas are so good. Every student that I interviewed was confident that they could go and implement it straight away because they had done so many cases in such a short time.
One of the key factors you need to ask yourself is what is your level of interest in this additional service? If you hate the idea of doing more Endo, for example, then why in the world would you go and do an Endo course?
In my mind, the low hanging fruit in this area are:
• Clear aligners*
• Implants; and
• Extractions.
* Caution: I’ve spoken to many dentists that have done a course on clear aligners that was basically just instructions on how to use the manufacturer’s software. This meant they didn’t implement what they’d learned. Courses, such as those offered by OrthoED, provide sound orthodontic principles meaning you’re much more likely to implement what you’ve learned.
Ihave already mentioned my preference for intensive courses, because if you’re only partly confident about the new skill, you’re probably not going to implement it. However, there is another factor. There’s no point in having these extra skills added to your tool belt if you never tell your patients about it.
In this regard, I recommend internal marketing to boost the return from your investment in acquiring new skills. The simplest internal marketing you can do is an email or newsletter to your existing patient database letting them know that you now offer this service.
Important: While you’re talking about the extra service that you now offer, don’t fall into the trap of getting too heavy on the technical details. It’s nice for patients to know that you offer that service, but just be aware what they’re buying is a result, not a process.
The truth is most patients don’t really care how you achieve the outcome, just that you give them the outcome that they’re looking for... a better looking smile, better functionality, less pain, etc.
In your email or practice newsletter, tell them about the service, the benefits of the new process (and who it’s for) and invite them to book in an appointment to discuss.
Another internal marketing option is getting posters or pull up banners done for your reception area announcing that you offer the new service and what it means for your patients. To take it a step further, include appropriate before and after photos and text along the lines of “actual cases performed by Dr Bloggs at this practice”.
Adding additional services to your practice can be a great way to grow your business. It may also give you a fresh lease of life in your dental journey and your patients should appreciate the fact that they don’t need to be referred out for a particular service.
However, choose carefully which additional services you want to offer and make sure that the course you’re doing gives you sufficient confidence so you can actually implement the services in your practice. Unfortunately, I’ve seen many dentists go and do additional courses that have never been implemented.
Finally, consider how are you going to market these additional services to your patients. There are a range of internal marketing options to get the word out.
Angus and his team are winners of the 2022 Australian Business Awards for Marketing Excellence and Australia’s number one Google-ranked dental marketers. Angus is a #1 Amazon bestselling author, marketer and international speaker. For more information, visit www.DentalMarketingSolutions.com.au.
By Spiros Christoforatos and Yue Leng
The former government announced a review of the Financial Advice profession in early 2022, answering calls from the public and the industry to simplify the framework around the provision of financial advice so more Australians could access quality and affordable advice. The then government appointed Ms Michelle Levy, a leading superannuation lawyer and adviser to banks and wealth managers, as the independent reviewer.
The review considered the law and rules that govern the provision of financial advice and the roles of financial planners, licensees and professional associations in ensuring financial advice meets the needs of clients.
The key to this review, as mentioned above, is the affordability and accessibility of quality financial advice for everyday Australians.
The review commenced in March 2022 with the findings and recommendations presented to the government in December 2022 and made public a few weeks ago.
In summary, the review aimed to identify areas where improvements could be made to improve the quality of advice being provided to people. The review identified several broad areas where improvements could be made, including greater emphasis on the importance of professional qualifications, improved disclosure of fees and advice costs, better information about the performance of advice services and improved processes for assessing and managing conflicts of interest.
For the financial advice profession, the review is a positive development as it provides a clear and comprehensive framework for improving the quality of advice provided to clients. The review also provides a framework for the profession to improve their practices and processes to better meet the needs of their clients.
For clients, the review provides assurance that their financial advisers are taking the necessary steps to provide quality advice that meets their needs. The review also provides clarity on what clients should expect from their financial advisers and how they can assess the quality of advice they receive.
All in all, both consumer groups and the profession welcomed the recommendations now it is up to the government to decide if all or some of the recommendations will be implemented.
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
tion or quote, and may change without notice to you, particularly if based on past performance.
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 illustra-
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
Spiros Christoforatos is Head of Adviser and Client Growth and Yue Leng is an Associate Financial Adviser at Profile Financial Services Pty Ltd (AFSL 226238). 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. To book an obligation-free meeting with a Profile planner, call Spiros Christoforatos on (02) 9683-6422 or email spiros.christoforatos@profileservices.com.au or visit www.profileservices.com.au
“For clients, the review provides assurance that their financial advisers are taking the necessary steps to provide quality advice that meets their needs...”
BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FFDT (RCS Edin)
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 from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course provides a summary of how those changes interlink with one another and also covers practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening.
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.
8 HOURS CPD
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.
When students are undergoing clinical training at dental school and there is a lot to learn, their attention is focussed on patient care, rather than on all of the “back of house” support functions that keep the clinic running, like the sterilising room. Instrument reprocessing is not handled by students, who will drop off used dirty instruments to the sterilising room and collect sterilised instruments from a dispensary, often without thinking very much about the “Black Box” of instrument reprocessing, or all the hard work that has gone on behind the “Magic Window” of the dispensary to make the instruments fit and safe for re-use.
Students need to understand what happens behind the “Magic Window”, since the responsibility for proper instrument reprocessing sits on the clinicians who are using the instruments in patient care. Dental clinicians need to understand the scope and importance of proper reprocessing and how it impacts the entire practice. It is more than just prevention cross contamination, since the processes must also be right from both a safety and compliance standpoint. There are several regulators that oversee infection prevention and control in dentistry - including the Dental Board of Australia and the public health units in states and territories.
The most sophisticated solution for instrument management
The most sophisticated solution for instrument management
The
The most sophisticated solution for instrument management
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Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.
That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:
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The
That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:
That’s right, you deserve it. You deserve the peace of mind and confidence that you are employing the most contemporary method of processing instruments. innovator of the cassette-based instrument management system, Hu-Friedy
• An open hole pattern that promotes water flow throughout the cassette
• An open hole pattern that promotes water flow throughout the cassette
Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.
• An open hole pattern that promotes water flow throughout the cassette
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing
Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing
• Ideal height and mesio-distal width
• Easy-to-use, ergonomic latch that allows for one-handed opening
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Ideal height and mesio-distal width
•
• Ideal height and mesio-distal width
• Easy-to-use, ergonomic latch that allows for one-handed opening
• Pre-trimmed and pre-crimped for simple placement
• Ideal height and mesio-distal width
• Accurate occlusal anatomy that matches the natural tooth
• Pre-trimmed and pre-crimped for simple placement
Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.
• Pre-trimmed and pre-crimped for simple placement
• Accurate occlusal anatomy that matches the natural tooth
• Accurate occlusal anatomy that matches the natural tooth
• Pre-trimmed and pre-crimped for simple placement
Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.
• Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.
©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.
©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.
©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.
• Accurate occlusal anatomy that matches the natural tooth
Younger clinicians often don’t realise that while they might assign the instrument reprocessing tasks to their staff, they are ultimately responsible for ensuring their practice is meeting all required standards. These clinicians need to have a good understanding of the steps in reprocessing. This aspect is also important when bringing on a new staff member.
So, to both inform and refresh, here are three key insights about instrument reprocessing:
Proper PPE must always be worn when reprocessing contaminated patient equipment. This includes using gloves when handling instruments and cassettes following patient treatment and utility gloves in the sterilising room when loading cassettes into ultrasonic cleaners or into instrument washers. Utility gloves should not be bulky and should enable tactical sensitivity. Contaminated utility gloves should only be worn on the dirty side of the sterilisation area and should be disinfected according to the manufacturer’s instructions.
More than ever, patients are looking for reassurance that dental practices are emphasising infection prevention and control and instrument reprocessing can be a good aspect of the practice to showcase.
Instrument reprocessing takes time and handling contaminated instruments is a safety risk for staff. Instrument Management Systems like the IMS™ Cassette from Hu-Friedy address those challenges because they are designed to keep instruments organized and intact throughout the entire process, from cleaning to chairside. Many dental schools already use cassettes for this reason, so some students will already be familiar with the concept.
IMS cassettes eliminate time-consuming tasks like manual instrument cleaning and sorting, while making it easy to standardise procedural set-ups and to train new staff. Those small time-savings throughout the day add-up and lead to more time spent with patients in the chair.
Cassettes provide safety benefits because the handling of contaminated sharp items is minimised. The instruments stay secured throughout the entire reprocessing cycle, reducing the risk of injury or exposure to bloodborne pathogens.
Instrument Management Systems provide better efficiency and improved safety, which is ultimately a win-win for all involved in instrument reprocessing.
As an example, some practices feature a glass wall or large internal windows into the sterilising room to give patients an opportunity to view reprocessing and see the steps being performed. Additionally, the practice website can give patients a virtual tour of the sterilising room so they can see for themselves how much effort the practice puts into cleanliness, organisation and safety.
If your practice uses IMS Cassettes, you can open the cassette in front of the patient as a demonstration. A well-organised and nicely presented cassette can make a world of difference when compared to a tray of loosely arranged instruments.
“Some practices feature a large window into the sterilising room to give patients an opportunity to view instrument reprocessing...”
The most sophisticated solution for instrument management
The most sophisticated solution for instrument management
That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:
That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:
Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy
Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.
• An open hole pattern that promotes water flow throughout the cassette
• An open hole pattern that promotes water flow throughout the cassette
when it comes to the perfect fit, Hu-Friedy is just right.
• An open hole pattern that promotes water flow throughout
Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
©2016
•
• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing
WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:
• Ideal height and mesio-distal width
• Easy-to-use, ergonomic latch that allows for one-handed opening
• Ideal height and mesio-distal
• Easy-to-use, ergonomic latch that allows for one-handed opening
•
• Ideal height and mesio-distal width
• Pre-trimmed and pre-crimped for simple placement
• Accurate occlusal anatomy that matches the natural tooth
Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.
Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.
• Pre-trimmed and pre-crimped for simple placement
• Accurate occlusal anatomy that matches the natural tooth
©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.
The concept of protecting enamel and root surface from dental caries is a very old idea. Going back into the writings of GV Black, he proposed placing margins for class II cavities into a zone that he had identified histologically as not being affected by the caries process. Unfortunately, using the histology methods available at his time, which precluded sectioning of teeth with associated soft tissues, he did not realise that this zone, which was spared from demineralisation, was unfortunately in fact the zone where the junctional epithelial cells attached. Despite this false start, much work has been done to develop the concept of tooth surface protection into its most modern forms.
In the 1960s, the work of Richard Simonsen on resin-based fissure sealants was instrumental in establishing the concept of protecting pits and fissures by covering the enamel with an unfilled resin.1,2
Later studies of fissure sealants applied to erupted permanent molar teeth showed high effectiveness for the areas where the sealant materials remained over time.3-5 The principle that arises from this is that resins are an inert material which covered the surface to prevent acid produced by dental plaque biofilms coming into contact with the enamel. Later work done in my lab by Jason Yap6 showed that modern fissure sealant materials and nano filled resins protect enamel from acid attack in the same way as the early materials of the 1960s. At the edge of the resin material, where a cariogenic dental plaque biofilm is present, a zone of demineralisation develops. Hence, with such materials, it is important to cover the area that you want to protect.
This then leads onto the major problem with resin-based materials, which was the difficulty of reliably bonding a resin to partially erupted teeth where crevicular fluid, dental plaque and saliva were likely to be present. All of these local factors can impede the adhesion of resin to etched enamel. Adding to this, on erupting teeth, the most superficial layers of the enamel are aprismatic and as a result, do not etch particularly well.
“The whole concept of pellicle being inert turned out to be incorrect, since pellicle is now known to be inherently helpful as a means of protecting the enamel from the outside world...”
Areas of enamel may be present on newly erupted teeth that are not fully mineralised.7 To address these concerns, the concept of using glass ionomer cement as a less technique-sensitive and more reliable fissure sealant approach for erupting teeth emerged.8,9 The GIC forms a transition zone with the enamel, creating a region of greatly increased resistance to acid dissolution. This acid-resistant zone remains even when gross fracture of the overlying cement occurs because of high occlusal stresses.
The next logical development from studying the impact of glass ionomer cements used in the early 1990s in field trials of atraumatic restorative dentistry was the concept of deliberately placing high fluoride releasing glass ionomer cements onto partially erupted teeth, as a form of tooth surface protection.10 The underlying principle here is that materials such as GC Fuji VII not only display extremely high fluoride release, but also impressive recharging abilities when the material is subsequently exposed to a fluoride containing toothpaste, a fluoride gel or another fluoride product.11 When present in thin layers, fluoride ions will move through the material from the oral environment to become incorporated into the enamel. In this way, the overlying Fuji VII helps to not only protect the enamel of the tooth, but also to encourage its greater mineralisation. Laboratory studies of Fuji VII reveal that the material provides a wide zone of protection beyond its borders, defending the enamel even from strong carious attacks from organic acids.6,12 Repeated attacks by strong mineral acids will of course eventually cause the Fuji VII to dissolve away, sacrificing itself to protect the underlying tooth.12 This can be likened to a sacrificial anode effect, drawing a parallel to the electrochemistry behind a modern domestic electrical hot water system.
Having found this approach using GIC highly successful on erupting permanent teeth, the concept was then extended to root surfaces. Certain sites in the mouth are known to be highly prone to root surface caries, most notably the buccal furcation area of mandibular molar teeth
and the buccal surfaces of the mandibular premolar teeth. These surfaces show the highest attack rates for root surface caries. In a patient with a high caries risk, for example due to salivary gland hypofunction from polypharmacy, Fuji VII can be painted in a thin layer onto the root surface.10 The fluoride released alters the metabolic behaviour of the overlying dental plaque biofilm, reducing its acid production. The later development of Fuji VII EP, which contains CPP-ACP, added further to the concept because the release of CPP from this material causes prebiotic effects,13,14 encouraging the growth of health associated bacteria which naturally inhibit the growth of acid tolerant and acid producing cariogenic bacteria.15,16
The idea of altering the chemical structure of teeth using intense light goes back to the 1980s. It was driven very much by dental scientists who had an interest in the physical chemistry of enamel mineral. 17 By using wavelengths of light that were absorbed strongly into enamel, superficial heating could be achieved.18 As a result, the chemical composition of the enamel could be altered, as well as its porosity.19-21 Sufficient amounts of applied heat could even create a liquefied form of tooth mineral, which could flow over the tooth surface to reshape existing pits and fissures, removing their deep recesses.18 A similar approach could also be used to sinter synthetic hydroxyapatite particles onto the surfaces of teeth.22
A key consideration for pulpal safety was that the carbon dioxide laser radiation had to be delivered in a pulsed manner, to prevent inadvertent thermal stress.23
Much of the early work used the carbon dioxide laser and the Er:YAG laser, since the far and middle infrared wavelengths of light produced by these lasers (e.g. 2.94 and 9.3 to 10.6 µm) were all strongly absorbed in enamel and were also able to vaporise any unbound water in the enamel. The idea of deliberately lasing surfaces transition from the laboratory, to in situ studies using enamel slabs in removable appliances, through to clinical assessments. Numerous narrative and systematic reviews of the positive effects of infrared laser energy on enamel have been published in recent years.24-27,38
More recently, there have been clinical trials undertaken of 9.3 µm carbon dioxide laser treatments for caries prevention at the University of Southern California in San Francisco, where Drs John Featherstone and Peter Rechmann have been pioneers of the concept of using far infrared laser energy to enhance enamel resistance to carious attack (Figure 1).39-41
The next conceptual development was to explore the interaction of topical fluoride gels with applied laser energy.28-35 This was tested by applying fluoride gel followed by the laser, or in the reverse sequence, assessing parameters such as fluoride uptake, chemical conversions within the enamel, surface microhardness, surface loss and resistance to standardised challenges that replicate dental caries or dental erosion, such as lactic acid solutions or hydrochloric acid solutions, respectively. Studies of fluoride uptake showed that a threefold improvement could be obtained over simply applying the fluoride gel onto the tooth surface alone.
This work extended through to in situ studies and then into the clinical setting. In special needs clinical practice, this method was quite useful for patients with severe salivary gland hypofunction (e.g. Sjogren’s syndrome or post head and neck radiotherapy), as it made treated surfaces less likely to decay and break down over time.36
From a photobiological perspective, when using a light-based therapy, it is important to determine its action spectrum, which is the region or regions of
light that are responsible for the effect and which are most effective for therapeutic use. As an example of the action spectrum effect, one can use various standardised photobiological light sources to simulate solar radiation and then determine which parts of the ultraviolet, visible and infrared spectrum are responsible for effects such as photo-ageing, cataract formation and erythema (sunburn). During my training as a photo biologist, I determined the action spectrum for sunburn using sensitive measures of invisible inflammatory changes that pre-seed the visible appearance of redness in the skin.37
Applying the same thinking to the light and fluoride interaction, a series of studies at UQ were undertaken to map out the action spectrum of the effect, testing wavelengths through the visible spectrum and well into the infrared.28,29 While we and others were able to demonstrate that all the wavelengths tested were effective to some degree, we noticed a particularly high efficacy for wavelengths in the visible blue-green regions. It is perhaps no coincidence that the same wavelengths have the greatest penetration through water.
Part of the journey of exploration was to test such effects using light emitting diodes. This leverages the recent transition of dental curing lights away from halogen lamps and plasma arc lamps to LEDs. When one converts the exposure parameters for blue and green lasers (488, 515 and 532 nm) to the 460-470 nm wavelength range of a traditional dental curing light, the required
15 J/cm2 equates to one 20 second curing cycle for an LED light with a 6-8mm diameter tip and optical power of 1000-1500 mW (Figure 2). This is a fortunate convenience since it makes the clinical application of the concept quite straightforward.
In recent years, work has shown that a range of hard tissue laser wavelengths in the middle infrared range are also effective for enhancing fluoride uptake and improving resistance to acid attack. There have been published systematic reviews of the laboratory studies, as well as of the multiple clinical trials which have been conducted of light enhanced fluoride therapy.24,25,27 Of note, the definition used in the current edition of the ADA Schedule and Glossary for item 121 mentions the activation of the remineralising agent, which is a contracted version of the initial longer description dating back to 2008 which explicitly mentioned lasers and fluoride used together.
When considering what situations might suit the application of a lightenhanced fluoride approach, one must consider carefully the underlying chemistry of what is happening. There are over six different physical and chemical processes involved, with a major one being the conversion of surface hydroxyapatite into fluorapatite.30 This is responsible for an increase in surface microhardness and greater resistance to attack by both organic and mineral acids. This effect requires the availability of fluoride ions in an aqueous phase on
tooth surface.
Knowing this, there is no known value or benefit in using a curing light when one is applying a fluoride varnish, including a fluoride varnish containing CPP-ACP, or Tooth Mousse Plus. In the case of the varnishes, there is rapid precipitation of calcium fluoride granules, which form a layer several microns thick over the enamel surface. This layer can take up to a week to dissolve. The light does not interact with the calcium fluoride. In the case of Tooth Mousse Plus, the fluoride is initially bound to the peptide and then when released forms part of the neutral ion species which interacts with and penetrates deeply into the tooth surface. The stoichiometry of the product is such that there is not a gross excess of free fluoride ions.
One situation where there could be significant amounts of free fluoride ions is immediately following the application of stannous fluoride or silver fluoride. The issue here is the susceptibility to oxidation and light sensitivity of the stannous and silver ions respectively. When products such as SDI Riva Star or Riva Aqua are used in combination with potassium iodide, one has to remember that silver iodide will be formed and this will be very light-sensitive. All halide compounds of silver are exceptionally light sensitive and even metallic silver itself is unusually sensitive to certain wavelengths of violet light (around 420 nm), which cause a phenomenon known as plasmon resonance. One must also remember that a darkened tooth surface becomes a broad-spectrum absorber of light and so any intense light applied to the tooth can cause thermal stress to the dental pulp as heat is conducted through the dentine.
Key recommendations for the use of various tooth surface protection measures are given in Table 1.
In the laboratory, there are well-known methods for chemical synthesis of hydroxyapatite and fluorapatite. These can produce the materials in microscopic aggregates or as nanoparticles, depending on the method of synthesis. The challenge has always been, can such methods be applied on the surface of teeth to recreate enamel that has been lost? Over 40 years of work on the concept of chemical synthesis of enamel has been done and the most that has been achieved by any
research group has been to generate layers that are up to 0.5 µm in thickness. To give a sense of scale, this is approximately the thickness of a single bacterial cell and more than 25 times less than the amount of enamel that would be lost as a result of drinking a single can of black cola soft drink. A fundamental limitation of the concept of chemical synthesis of enamel is that it lacks the organic matrix structure which guides the formation of enamel by ameloblasts. Further, through the enamel there are various complex arrangements of enamel prisms to create structural support systems (such as the Rainey ridge in molar teeth), which are difficult if not impossible to recreate.
Sintering studies using synthetic apatites have been conducted and these can generate sizeable portions of tooth-like structure using additive manufacturing laser sintering methods. As a point of history, the first successful work of this type was done in the early 1990s.22 The major limitations encountered with this approach include the fact that it is a benchtop rather than intraoral method, as well as the predictable challenges working with very small apatite particles because of electrostatic effects that cause clumping and aggregation. The sintering process itself alters the chemistry of the apatite, leading
to conversion to beta tricalcium phosphate. This makes the resultant material inferior from a structural point of view (lower compressive strength), unsuitable for bonding and highly opaque in appearance and thus aesthetically unacceptable.
In the mid-1980s, I recall attending a symposium held as part of the International Association of Dental Research general meeting in North America. One of the major topics of discussion was what would be the design characteristics for a material that could be coated onto enamel to protect it. A range of people working in the field contributed their opinions and shared their experiences on what they had tried and found to be lacking in one way or another. The discussion shifted to then explore what the inherent usefulness was of pellicle, the saliva glycoproteins that adsorb onto the surface of exposed enamel. Up to this point, there had been a generally held view that pellicle was fundamentally either useless or harmful.
The latter concept grew from the recognition that several primary colonisers of teeth had adhesin molecules that bound to pellicle, allowing them to form a stable anchorage.
This whole concept of pellicle being inert turned out to be incorrect, since pellicle is now known to be inherently helpful as a means of protecting the enamel from the
outside world. Studies of dental erosion and its site specificity clearly show an association with the salivary film, while enamel sites where pellicle has been destroyed (e.g.
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.
1. Simonsen RJ. Preventive resin restorations and sealants in light of current evidence. Dent Clin North Am. 2005;49(4):815-823.
2. Walsh LJ. Pit and fissure sealants: current evidence and concepts. Australas Dent Pract. 2006;17(6):122-124.
3. Charbeneau GT, et al. A filled pit and fissure sealant: 18-month results. J Am Dent Assoc. 1977;95(2):299-306.
4. Mejare I, et al. Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand. 2003;61(6):321-330.
5. Ahovuo-Saloranta A, et al. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev. 2004;(3):CD001830.
6. Yap J, et al. Evaluation of a novel approach in the prevention of white spot lesions around orthodontic brackets. Aust Dent J. 2014;59:1-11.
7. Dennison JB, et al. Evaluating tooth eruption on sealant efficacy. J Am Dent Assoc. 1990;121(5):610-614.
8. Yip HK, Smales RJ. Glass ionomer cements used as fissure sealants with the atraumatic restorative treatment (ART) approach: review of literature. Int Dent J. 2002;52(2):67-70.
9. Frencken JE, et al. ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years. Community Dent Oral Epidemiol. 1998;26(6):372-381.
10. Walsh LJ. Tooth surface protection – well beyond just fissure sealing. Auxiliary 2014;24(4):22-24.
11. Arbabzadeh-Zavareh F, et al. Recharge pattern of contemporary glass ionomer restoratives. Dent Res J. 2012;9(2):139-145.
12. Perera D, et al. Acid resistance of glass ionomer cement restorative materials. Bioengineering 2020;7(4):150.
13. Mazzaoui SA, et al. Incorporation of casein phosphopeptide-amorphous calcium phosphate into a glass-ionomer cement. J Dent Res. 2003;82(11):914-8.
14. Mao B, et al. Casein phosphopeptide-amorphous calcium phosphate modified glass ionomer cement attenuates demineralization and modulates biofilm composition in dental caries. Dent Mater J. 2021;40(1):84-93.
15. Philip N et al. Randomized controlled study to evaluate microbial ecological effects of CPP-ACP and cranberry on dental plaque. JDR Clin Trans Res. 2020;5(2):118-126.
16. Walsh LJ. Contemporary uses of CPP-ACP technologies in 2021. Part 2. Prebiotic actions. Australas Dent Pract. 2021;32(3):64-68.
17. Walsh LJ. Applications of infrared lasers in preventive dentistry. Dent Today 1990;6:1-4.
18. Walsh LJ, Perham SJ. Enamel fusion using a carbon dioxide laser: a technique for sealing pits and fissures. Clin Prev Dent. 1991;13(3):16-20.
19. Aminzadeh A, et al. Raman spectroscopic studies of CO2 laser-irradiated human dental enamel. Spectrochimica Acta. 1999;55:1303-1308.
20. Rodríguez-Vilchis LE, et al. Morphological and structural changes on human dental enamel after Er:YAG laser irradiation: AFM, SEM, and EDS evaluation. Photomed Laser Surg. 2011;29: 493–500.
21. Shahabi S, et al. FT-Raman spectroscopic characterization of enamel surfaces irradiated with Nd:YAG and Er:YAG lasers. J Dent Res Dent Clin Dent Prospects. 2016;10:207-212.
22. Walsh LJ. Burgeoning technology: future directions in oral health. In: Dental Perspectives. An overview of clinical issues facing community dentistry. 1998;2:6-8.
23. Sandford MA, Walsh LJ. Differential thermal effects of pulsed vs. continuous CO2 laser radiation on human molar teeth. J Clin Laser Med Surg. 1994;12:139-142.
24. Ramalho KM, et al. Erbium lasers for the prevention of enamel and dentin demineralization: a literature review. Photomed Laser Surg. 2015; 33:301-319.
25. Lombardo G, et al. Sub-ablative laser irradiation to prevent acid demineralisation of dental enamel. A systematic review of literature reporting in vitro studies. Eur J Paediatr Dent. 2019;20:295-301.
26. Al-Maliky MA, et al. Laser-assisted prevention of enamel caries: a 10-year review of the literature. Lasers Med Sci. 2020;35:13-30.
27. Pagano S, et al. Lasers to prevent dental caries: a systematic review. BMJ Open. 2020;10:e038638.
28. Vlacic J, et al. Laser-activated fluoride treatment of enamel against an artificial caries challenge: comparison of five wavelengths. Aust Dent J. 2007;52(2):101-105.
by acid proteolysis) show greatly enhanced dental erosion. This explains the characteristic pattern of damage in patients with uncontrolled gastric reflux, where there is frequent regurgitation of gastric contents. The hydrochloric acid protein releases the pellicle, making the enamel completely bare and exposed, which then leads to its rapid dissolution. When pellicle is present, since it acts as a semipermeable ionic membrane, teeth are more protected from strong erosive challenges. Fortunately, manufacturers of toothpastes now understand the value of pellicle and make toothpastes with low levels of abrasivity, which means that they do not remove all traces of pellicle from the tooth surface during ordinary brushing, even for periods of up to 2 minutes. This invisible layer continues to protect us, even though we may not be aware of it.
29. Vlacic J, et al. Laser-activated fluoride treatment of enamel as prevention against erosion. Aust Dent J. 2007;52(3):175-180.
30. Vlacic J, et al. Photonic conversion of hydroxyapatite to fluorapatite: a possible mechanism for laser-activated fluoride therapy. J Oral Laser Appl. 2008;8(2):95-102.
31. Bevilácqua FM, et al. Fluoride uptake and acid resistance of enamel irradiated with Er:YAG laser. Lasers Med Sci. 2008;23:141-147.
32. Rios D, et al. In vitro evaluation of enamel erosion after Nd:YAG laser irradiation and fluoride application. Photomed Laser Surg. 2009;27:743-747.
33. Hossain M, et al. Effect of pulsed Nd:YAG laser irradiation on acid demineralization of enamel and dentin. J Clin Laser Med Surg. 2001;19:105–108.
34. Mei ML, et al. Prevention of dentine caries using silver diamine fluoride application followed by Er:YAG laser irradiation: an in vitro study. Lasers Med Sci. 2014;29:1785–1791.
35. Fekrazad R, Ebrahimpour L. Evaluation of acquired acid resistance of enamel surrounding orthodontic brackets irradiated by laser and fluoride application. Lasers Med Sci. 2014;29:1793–1798.
36. Walsh LJ. Clinical evaluation of dental hard tissue applications of carbon dioxide lasers. J Clin Laser Med Surg. 1994;12:11-15.
37. Walsh LJ. Ultraviolet B irradiation induces mast cell degranulation and release of tumour necrosis factor-alpha. Immunol Cell Biol. 73,226-233. 1995.
38. Xue VW, et al. Combined effects of topical fluorides and semiconductor lasers on prevention of enamel caries: a systematic review and meta-analysis. Photobiomodul Photomed Laser Surg. 2022;40(6):378-386.
39. Rechmann P, et al. Caries inhibition with a CO2 9.3 μm laser: An in vitro study. Lasers Surg Med. 2016;48(5):546-554.
40. Rechmann P, et al. In vitro CO2 9.3-μm shortpulsed laser caries prevention-effects of a newly developed laser irradiation pattern. Lasers Med Sci. 2020;35(4):979-989.
41. Badreddine AH, et al. Demineralization inhibition by high-speed scanning of 9.3 µm CO2 single laser pulses over enamel. Lasers Surg Med. 2021;53(5):703-712.
Dentistry as a profession is well-known for adopting new technologies and often well ahead of the curve when it comes to Star Trek-like advancements. Intraoral scanning, CAD/CAM manufacturing, CBCT and digital x-ray just to name a few... and of course the latest and greatest craze, 3D printing.
Although 3D printing has been around since the 1980s, in the last 5 years or so it has really come into its own as the next big thing in manufacturing. The 3D printing option has changed dramatically as newer, progressively lower cost machines have come to market that are physically smaller, more user friendly and designed for dental.
The latest new wave of “additive manufacturing” or desktop 3D printing has the whole of dentistry whipped into a frenzy of amazing expectation. The
truth is, 3D printing is a great technology and can be adapted well for some dental applications. However, as with all marketing, it tends to gloss the results and instead of trying to polish a wet cigar, they defiantly roll it in glitter which actually can give people false expectations.
Certainly 3D printing works well for models, surgical guides, splints, sleep appliances, orthodontic aligner manufacturing, dentures and lots of other polymer-based appliances, but what about directly printing crowns and bridges?
To answer that, we would have to ask many questions. What is the case proposed?; What material do we want to use?; Where will we print it (chairside or lab side)?; How long is post-processing and is the resultant crown viable aesthetically?; Are the physical properties up to the level we would expect for a long-term restoration?; and is it economically viable? Phew!
Firstly, let’s look at dentally-focused materials that can currently be 3D-printed.
Lithium Disilicate is a well-known and loved material. It grew to fame via the e.max brand from Ivoclar. It’s a glass ceramic and aesthetically, some say it cannot be beaten as a monolithic restoration. It has a flexural strength of about 400 MPa and a flexural modulus of approximately 70,000 MPa!
One company of note, LITHOZ from Austria, is investing heavily into creating lithium disilicate 3D printed restorations and are making a big noise about it. The printing of lithium disilicate opens up great possibilities, especially with restorations such as veneers which traditionally can be time consuming and technique and ability dependent, however it could possibly be used for all areas where lithium disilicate is used currently.
LITHOZ called their printing technology LCM, or Lithography Ceramic Manufacturing and it’s definitely something to watch in the future. However, the current technology to print lithium disilicate comes with a hefty price tag so to get an affordable chairside solution may still be a long way off.
Zirconia is in a similar situation. There are a few companies dabbling in printable zirconia technology and yes, there are printers that can print zirconia. However, the post processing time required currently leaves this technology in a similar bag as lithium disilicate. It’s currently not possible to have a patient sit down, do a quick scan and print an all-ceramic crown in a few minutes; however this will change in the future.
For all/glass ceramics, 3D printing materials is the main reason you won’t see a chairside solution for some time as printing and post processing is very time consuming as mentioned before. The ceramic is in a liquified form with a binder holding the ceramic particles together and this “mix” is laid down layer-by-layer.
Once the part is printed, the binder needs to be removed, usually by heat over time and the glass ceramic or ceramic also needs to be crystalised or sintered to create the restoration ready for finishing.
At present, this is a fairly long process so it’s not viable to be used chairside. Dental labs are experimenting with this technology and while it’s in its infancy, there may possibly be some advantages to the process. Traditional milling or pressing (which can involve 3D printed models) of ceramics will remain the most viable process for some time yet. In fact, many companies are trying to make chairside milling even more viable.
Probably no material group is as polarising as hybrid composites to create a definitive 3D printed crown. Some people will think it’s a great idea whilst others find themselves running in the opposite direction. Let’s be clear here, we’re talking about a crown at the moment; we’re not including any bridgework here as that will open up a completely different can of worms.
The materials used for 3D printing hybrid composites vary widely from one company to the next, however all are starting to show great promise as a restorative material. Most are nanofilled ceramic composites. Seremco, for example, have a product called Crowntec that has a flexural strength of 135 MPa and an elastic modulus of 4000 MPa which seems to be one of the category leaders. They suggest this product is for permanent crowns, inlays, onlays and temporary bridges. The elastic modulus is key here, notice it is 4000 Mpa.
Formlabs describes their permanent crown material as “a toothcoloured, ceramic-filled resin for 3D printing permanent single crowns, inlays, onlays and veneers. Permanent Crown Resin produces high strength, long term restorations with an accurate and precise fit, available in four VITA Classical* shades. Low water
absorption and a smooth finish ensure restorations made from Permanent Crown Resin have a low tendency to age, discolour or accumulate plaque”. They state the flexural strength is 116 MPa and a Flexural modulus of 4090 MPa.
SprintRay describes their new material in partnership with Bego as “a new hybrid nanoceramic, FDA-cleared Class II resin for 3D printed definitive full crowns, partial crowns, and veneers. Ceramic Crown is a ceramic dominant material, with over 50% inorganic ceramic content, for high strength and resistance to wear making SprintRay Ceramic Crown a go-to material for definitive 3D crowns”. Flexural strength of 136 MPa and a Flexural modulus of 7600 MPa.
I think you can see a pattern here regarding the flexural strength and flexural modulus. Remembering a higher flexural modulus indicates a material is more resistant to bending, while a lower flexural modulus indicates a material has a higher tendency to bend when a given amount of bending stress is applied.
Does all this mean the crown will have the mechanical properties to be suitable for long term use? This will no doubt be a point of debate for many, but in the correct circumstances, it could well be the case.
So what about the aesthetics of these materials? Unfortunately all of these materials are monochromatic as they are usually printed from one shade of resin, for example A2, A3 etc. However, after curing, they can be stained and manipulated in many ways to characterise them, so this is an option. For highly aesthetically demanding cases, however, they may not be suitable.
There are companies working on techniques to improve the printing. Of note is the company DWS with their technique called Photoshade Adaptive Gradient Technology which gives the restoration the appearance of having multiple areas of the shade at differing levels.
This is done with some clever resin changing technology as it will print lighter areas then change or mix the resin and continue to the darker areas. This is in its infancy, but it’s heading in the right direction.
The 3D printed permanent crown in its current state is not so much a replacement for a traditional ceramic restoration but as a new option of treatment. If the case selection is carefully evaluated and the expectation of the aesthetics is not highly demanding, then it’s quite possible the 3D-printed permanent crown is arguably a treatment option today.
Terence Whitty is a well-known dental technology key opinion leader and lectures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental laboratory in Sydney specialising in high tech manufacturing. Using the latest advances in intra- and extra-oral scanning, CAD/ CAM, milling, grinding and 3D printing, most specialties are covered including ortho, fixed and removable prosthetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.
Aim: Horizontal ridge deficiencies in the anterior maxilla can have a negative impact on aesthetics and the long-term maintenance and health of peri-implant tissues. Such a deficiency is usually caused by both hard and soft tissue components. If the existing horizontal bone width allows for the correct prosthetically-driven placement of an implant (with sufficient surrounding crestal bone thickness), then the regenerative focus should be on the soft tissues. The aim of this procedure is to augment the soft tissue volume on the labial aspect of the upper left lateral incisor (#22) implant site using a novel xenogeneic collagen matrix.
view of the pre-operative situation (site 22) just prior to soft tissue augmentation. The loss of labial ridge contour is commonly observed at extraction sites in which an alveolar ridge preservation procedure was not performed at the time of extraction with appropriate biomaterials.
Figure 4. Geistlich Fibro-Gide®, a novel porcine-derived, porous, volume-stable, collagen matrix was used to augment the soft tissues. It was customised to match the approximate dimensions of the defect, taking into account the volume expansion of the material once hydrated (up to 25% increase in volume). The margins are bevelled to help reduce tension on the flap margins when sutured.
Figure 5. In this situation, the Geistlich Fibro-Gide® material was placed directly on the bone since a full thickness flap was raised for placing the implant. Adequate periosteal release is required to allow for sufficient coronal advancement of the flap to achieve tension-free water tight primary closure. The biomaterial must not be left exposed.
Figure 7. Incisal view of the primary wound closure. The flap has been coronally advanced to fully cover the Geistlich FibroGide®. Wound closure of the relieving incisons has been achieved and the flap has been tightly adapted to the healing abutment.
Conclusion: The gold standard for managing soft tissue volume deficiencies is grafting with a subepithelial connective tissue graft (SCTG). However, a disadvantage of this therapy is the need to harvest donor tissue from the palate. There is a finite limit to the quantity of tissue that can be harvested which may also be of variable quality. Geistlich Fibro-Gide® now offers a convenient alternative that can result in a clinical outcome not too dissimilar to the SCTG, without the need for donor site surgery.1 Geistlich Fibro-Gide® can be used prior to implant therapy (i.e., site preparation), at the time of implant placement, or at implant uncovery.
References: Soft tissue augmentation with a volume-stable collagen matrix or an autogenous connective tissue graft at implant sites: Five-year results of a randomised controlled trial post implant loading. Thoma D.S., Gasser T.J.W., Hammerle C.H.F., Strauss F.J., and Jung R.E. Journal of Periodontology. 2023; 94(2):230-243.
By Terence Whitty
Two new products recently released at IDS 2023 in Cologne had sparked so much interest it was hard to even get near the booth to see them in action, however perseverance prevailed.
The new MetiSmile facial scanner from Shining 3D Dental is a revolutionary 3D scanner that takes a 3-dimensional facial scan of the entire face all in about 10 seconds. This is a very compact unit weighing in at only 800 grams, a size of only 215 x 50 x 75 mm and can be mounted on the supplied stand or handheld, so it’s portable and easy to move between surgeries whether it be next door or a branch practice.
The technology of the MetiSmile uses an Infrared Vertical Cavity Surface Emitting Laser (VCSEL), not unlike that used on the iPhone for facial recognition and an array of cameras including 1.3 Megapixel and 5.0 Megapixel cameras to
SYDNEY 2-3 JUNE 2023
capture the data and the texture information of the patient’s face of an accuracy of 50 microns–quite impressive for a tiny unit. With the high fidelity texture scanning, the MetiSmile scanner can accurately record and display facial colour so it appears as realistic and true to the patient.
The software behind MetiSmile is where all the real magic happens; it’s intuitive and incredibly easy to use. The patient is positioned in front of the scanner with their face positioned in the area displayed on the screen of the computer. Once this is done, a small countdown begins and image capturing starts. The patient will then be instructed to turn their head to the left and then to the right. This is all done in about 10 seconds and after a small amount of processing time, the 3D image will appear on the screen. It’s really impressive to actually see the face on a screen in colour in a 3D rendering. The detail is quite astounding and the colour is very realistic.
Now comes the fun part. If you also take an intraoral scan, the software provided will automatically merge the facial scan with the intraoral scan which is where it really becomes useful. Imagine being able to see the teeth in relation to the face as if the patient was present for treatment planning, diagnosis and communication. In effect, it creates a virtual patient!
The supplied software that enables this also comes with some nifty features such as a suite of facial feature measurement and comparison tools and an Ortho Simulator.
With the right external software, the MetiSmile data has the potential to digitise and replace conventional extraoral records, occlusal analysis and diagnostic wax-ups. You can also merge a CBCT and see it all as an amazing 3D virtual patient and this can easily be done with a program such as exocad.
Speaking of intraoral scanners, Shining 3D also introduced their Aoralscan 3 Wireless intraoral scanner at IDS 2023 and you really have to hold and use one of these amazing scanners to appreciate it. For a start, it’s built on WiFi 6 technology. In a nutshell, this is a new breed of WiFi that has new features that make the data transmission faster and more reliable. It has a huge 5 metre range so computers can be placed where you need them rather than directly in front of the scanner (of course a monitor within sight is mandatory). Don’t
worry, the scanner is not interested in your own WiFi to work; it’s only a connection between the scanner itself and the computer you choose to use... and yes that’s right you can use a laptop or a desktop... or even an Apple laptop/desktop or an iPAD... the choice is yours as long as it’s up to spec.
In addition, it has 3 batteries supplied with it that are all rechargeable and each of them provides two hours of scanning time. That’s 6 hours of scanning from just the batteries. And if you really messed up and forgot to charge all 3 batteries, just plug the Aoralscan 3 Wireless power adaptor into the back of the scanner and scan away as per normal.
On the scanner itself, a new “one button does everything” approach has been added and this will activate all the functions including all the motion function gestures. So what this means is all interaction with the software is commanded from
the actual scanner itself–no need to use a mouse at all. It has two sizes of ergonomic tips, large and small, the small being great to reach those difficult to reach areas or for smaller mouths. They are self-heating and can be autoclaved up to 100 times each.
There is an accurate battery indicator and the scanner itself is lightweight at 330 grams, is well-balanced and very easy to use without feeling like its a vacuum cleaner head as some scanners do.
The new software that comes with the Aoralscan 3 Wireless is incredibly refined and intuitive and packed with features only seen on scanners costing 3 times the price. It’s just very easy to use with a wizard type interface at your fingertips, making the whole process a breeze. As a bonus, the scanning software can directly integrate with the exocad suite of CAD software, making it a very powerful system indeed.
For scanning, just setup the type of job you would like to do and the software will automatically prompt you and tell you exactly what action is needed to be executed. For example if I wish to scan a case for two anterior implant sites, the software will tell you when to scan the tissue, the implant scan abutments (scan flags), the opposing and of course the bite registration.
In fact, one of the most impressive actions is the taking of the bite registration where a small scan is taken of the registration area and the alignment is performed automatically–it’s most impressive. Remember, you could take a bite in CR or CO or in a specific bite such as a construction bite for a splint or a sleep device. Just use your normal bite technique with wax or bite registration material and scan away, making sure there is not too much overhang and you will nail it.
The software offers more features such as undercut detection - valuable when trying to get preps parallel, margin line detection, occlusion maps and a new interesting feature called an Oral Health Report. After scanning, the software will generate a report which includes information such as existing dental caries, missing teeth, dental calculus, pigment, etc. The idea here is to give patients a visual report to help relay a better understanding of their oral health, a novel idea.
Also, an orthodontic simulation module is included allowing a virtual setup and a visual treatment plan for the patient. This is primarily aimed at clear aligner cases but can be adapted to traditional
fixed appliances as well. Of course, we all know orthodontic simulation is a big deal these days so no scanner is really complete without one! The software will move the teeth automatically for you and instantly give you different scenarios, for example extraction vs non extraction and you can even tweak the teeth if you so desire. It will then generate a QR code you
exocad. They call this the Dynamic Bite. This really has to be seen to be appreciated and as mentioned, this can be incorporated with the facial scan from the MetiSmile. There are many other features in the software but one of note is an added program that allows you to edit your scans and turn them into models ready to print, including adding labels and hollowing if necessary.
Shining 3D Dental has really come up with a great pair of new products that work well together and allow the practitioner to go beyond what is possible now. The combination of facial scanning and intraoral scanning will become the new norm as it’s necessary, practical and now even more affordable than ever.
can have the patient scan and it will download the simulation to their phone - a great communication tool.
As an added bonus a new Dynamic Bite function is included. The new Aoralscan 3 Wireless intraoral scanner has added the function to be able to precisely capture and record the patient’s individual jaw movements and then transfer these movements to CAD software, namely
Terence Whitty is a well-known dental technology key opinion leader and lectures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental laboratory in Sydney specialising in high tech manufacturing. Using the latest advances in intra- and extra-oral scanning, CAD/ CAM, milling, grinding and 3D printing, most specialties are covered including ortho, fixed and removable prosthetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.
By Dr Oleg Pushkarev and Dr Michael Barber
Aim: The patient presented with an endodontically-treated left maxillary lateral incisor (tooth #22) with a subgingival crown fracture. The tooth was judged to be unrestorable. The patient had a deep overbite; managing the situation with a resin-bonded bridge or removable partial denture would be challenging. The neighbouring teeth were minimally restored and generally sound. The patient’s preference was an implant-supported and retained restoration. An immediate implant placement treatment plan was agreed upon.
flap raised. Atraumatic extraction of tooth #22 (assisted with scalpel and periotomes). The socket was curetted to ensure all soft tissue remnants were removed. An implant osteotomy with palatal positioning created. Note small labial fenestration.
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Conclusion: The predictable use of Geistlich Bio-Oss® and Geistlich Bio-Gide® for filling the gap and managing fenestration defects is welldocumented.1 In this clinical case, excellent bone height and width has been achieved after 6 months of loading without the need for harvesting autogenous bone. Geistlich Bio-Oss® is a material with a low substitution rate and volume-preservation behaviour.
References:
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Clinical and radiographical performance of implants placed with simultaneous guided bone regeneration using resorbable and nonresorbable membranes after 22-24 years, a prospective, controlled clinical trial. Clin. Oral Implants Res. (2021). 32(12);1455-1465.
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alcium silicate-based cements have demonstrated remarkable clinical outcomes and, among other products, Biodentine ™ (Septodont, France) may be considered a valid option in the treatment of primary and permanent teeth and a promising material to be applied in different area of endodontics.
Two cases of vital pulp therapy in a deciduous and an immature permanent tooth are reported here. Pulpotomy procedures were performed using Biodentine as pulp dressing material in both cases. Clinical and radiographical follow-up were performed until 1-year post-treatment.
Biodentine demonstrated a 100% success rate in both reported cases showing to be more than suitable as pulpotomy material. Specifically, in case of immature permanent tooth, apexogenesis was appreciated.
Biodentine demonstrated a great induction of new hard tissue formation and hence may be considered a valid choice in vital pulp therapy.
Calcium silicate-based cements have demonstrated remarkable outcomes, mainly in endodontics and have resulted in predictable, safe and successful therapies.1-3
These cements are considered as unique ceramic compounds capable to react with water forming a solid mass.4 Among others, Biodentine demonstrates a greater resistance to compression and flexion than other tricalcium silicate-based cements as well as sealing properties, bonding strength and a great release of calcium ions.5-7
In addition, Biodentine shows better results when compared to MTA in terms of handling, reduced setting time and colour stability, caused by the absence of bismuth oxide.8
Due to these reasons, Biodentine can be considered a valid option in the treatment of primary and permanent teeth and a promising material that can be applied in different areas of endodontics.9
Among others, vital pulp therapy provides favourable clinical survival results over time, allowing maintenance of vitality of primary teeth until their natural exfoliation as well as apexogenesis in immature permanent ones.10
Adeep carious lesion involving the mandibular first molar was observed in a female patient aged 6 years, as previously reported by Bossù et al.1
The dental element presented immature root formation and reversible pulpitis. Vital pulp therapy was carried out to allow apexogenesis.
Briefly, after local anesthesia and rubber dam isolation, the caries were removed and the pulp tissue was exposed. Coronal
pulp was amputated by high-speed diamond bur under abundant irrigation. Haemostasis was achieved using sterile cotton pellets moisturised with saline solution within 5 minutes.
Then, Biodentine was prepared according to the manufacturer’s instructions and placed on radicular pulp stumps with a thickness of 2-4 mm.
Definitive restoration with resin composite was performed after 3 days, once the cement hardening was clinically appreciated by a dental probe.
Periapical radiographs were obtained immediately after pulpotomy procedures (baseline) (Figure 1a), then the element was clinically and radiographically evaluated after one (Figure 1b), three (Figure 1c) and 12 months (Figure 1d).
Clinical evaluation revealed an absence of pain, discomfort, swelling or inflammation at every time point, reporting a success rate of 100%.
The absence of pulp reaction was further confirmed by the radiographic assessment, as demonstrated by the progressive formation of the dental roots, closure of the apical foramina as well as the increase of root walls thickness.
Adeep carious lesion involving the mandibular second deciduous molar was observed in a male patient aged 5 years.
The dental element presented reversible pulpitis, therefore vital pulp therapy was carried out.
Briefly, after local anesthesia and rubber dam isolation, the caries were removed and the pulp tissue was exposed. Coronal pulp was amputated by highspeed diamond bur under abundant irrigation. Haemostasis was achieved using sterile cotton pellets moisturised with saline solution within 5 minutes.
Then, Biodentine was prepared according to the manufacturer’s instructions and placed on radicular pulp stumps with a thickness of 2-4 mm.
“Biodentine demonstrated a 100% success rate in both reported cases showing to be more than suitable as pulpotomy material. Specifically, in case of immature permanent tooth, apexogenesis was appreciated...”
Definitive restoration with resin composite was performed after 3 days, once the cement hardening was clinically appreciated by a dental probe.
Periapical radiographs were obtained immediately after pulpotomy procedures (baseline) (Figure 2a), then the element was clinically and radiographically evaluated after one (Figure 2b), six (Figure 2c) and 12 months (Figure 2d). Clinical evaluation revealed absence of pain, discomfort, swelling or inflammation at every time point. Radiographically, absence of periapical reactions was appreciated.
The overall success rate at 12-month follow-up was 100%.
The reported clinical cases showed that Biodentine yielded successful clinical and radiographical outcomes when applied in vital pulp therapy of immature permanent tooth and primary tooth, respectively.
After 1 year of follow-up, it might be speculated that apexogenesis, as the continued physiologic development
Maurizio Bossù, DDS, PhD is an Associate Professor of Pediatric Dentistry at the Department of Oral and Maxillofacial Science, “Sapienza” University of Rome, Rome, Italy and Dentist at the Unit of Pediatric Dentistry of Policlinico Umberto I Hospital in Rome. Professor Bossù is Director of Post-graduate Specialization in Pediatric Dentistry and Director of Master in “Odontostomatology in the age of development” at “Sapienza” University of Rome. He took PhD in “Odontostomatological Diseases” in 2005 and the Specialty Board of Oral Surgery in 2007 at “Sapienza” University of Rome. He attended post-graduate courses in paediatric dentistry, restorative dentistry and endodontics. Prof. Bossù is a consultant for the Italian Ministry of Health and since 2010 Trainer at ICDAS - “McGill” University of Canada. He is Professor at the School of Dentistry of “Sapienza” University of Rome and Lecturer at several Master and post-graduate courses, mainly in paediatric dentistry and endodontics. He is a founder of Accademia Internazionale Ricerca in Odontoiatria Pediatrica e di Comunità (AIROPeC), Academic Member of Italian Society of Endodontics (SIE) and accounts auditor of Società Italiana di Odontostomatologia e MaxilloFacciale (SIOCMF). Prof. Bossù has coauthored more than 50 papers published in national and international peer-reviewed journals in the field of preventive dentistry, paediatric dentistry, endodontics and dental materials. He attended more than 100 National and International Congresses as an invited lecturer.
and formation of the root’s apex, 11 was obtained. The present report clinically confirmed the excellent features of Biodentine as good biocompatibility and promotion of mineralized dentinal tissue deposition.1
Biodentine demonstrated a great induction of new hard tissue formation and may be considered a valid choice in vital pulp therapy of primary as well as immature permanent teeth.
1. Bossù M, Mancini P, Bruni E, Uccelletti D, Preziosi A, Rulli M, Relucenti M, Donfrancesco O, Iaculli F, Di Giorgio G, Matassa R, Salucci A, Polimeni A. Biocompatibility and antibiofilm properties of calcium silicate-based cements: an in vitro evaluation and report of two clinical cases. Biology (Basel) 2021;10:470.
2. Dawood AE, Parashos P, Wong RHK, Reynolds EC, Manton DJ. Calcium silicate-based cements: composition, properties, and clinical applications. J Investig Clin Dent 2017;8(2).
3. Bossù M, Iaculli F, di Giorgio G, Salucci A, Polimeni A, di Carlo S. Different pulp dressing materials for the pulpotomy of primary teeth: A systematic review of the literature. J Clin Med 2020;9, 838.
4. Primus CM, Tay FR, Niu LN. Bioactive tri/dicalcium silicate cements for treatment of pulpal and periapical tissues. Acta Biomater. 2019 Sep 15;96:35-54.
5. Rajasekharan S, Martens LC, Cauwels RGEC, Anthonappa RP, Verbeeck RMH. Biodentine material characteristics and clinical applications: A 3 year literature review and update. Eur Arch Paediatr Dent 2018;19:1–22.
6. Malkondu Ö, Kazandag MK, Kazazoglu, E. A review on Biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:160951.
7. Camilleri J. Investigation of biodentine as dentine replacement material. J Dent 2013;41:600–610.
8. Çelik BN, Mutluay MS, Arıkan V, Sarı Ş. The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth. Clin Oral Investig 2019;23:661-666.
9. Rajasekharan S, Martens LC, Cauwels RGEC, Anthonappa RP. Biodentine material characteristics and clinical applications: a 3 year literature review and update. Eur Arch Paediatr Dent 2018;19:1-22.
10. Bossù M, Iaculli F, Di Giorgio G, Salucci A, Polimeni A, Di Carlo S. Different Pulp Dressing Materials for the Pulpotomy of Primary Teeth: A Systematic Review of the Literature. J Clin Med 2020;9:838.
11. American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. Pediatr Dent 2017;39:325–333.
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In the bustling Perth suburb of Stirling in Western Australia, a dental practice has recently opened that exemplifies luxury and efficiency. Stirling Smiles Dental, designed and built by Medifit Design & Construct, is a modern, architecturally inspired oasis for both patients and staff. This is the second project that Medifit has completed for practice owner, Dr Quincy Leung and it’s evident that their partnership has resulted in an incredible space that pushes the boundaries of dental practice design.
The design and construction of Quincy’s first practice in Perth was such a positive experience that he had no hesitation approaching Medifit again to establish Stirling Smiles Dental.
Quincy and his business partners, Dr Anne Lee and Dr Amy Lee, met with Medifit Managing Director Sam Koranis and his experience and knowledge of the dental space assured them that they had made the correct decision. The three dentists, all seasoned clinicans with a keen eye for design, desired a space that would not only provide patients with an unparalleled dental experience but also create a sense of
serenity and relaxation. With this in mind, the team at Medifit Design & Construct set out to create an environment that would perfectly blend form and function, resulting in a visually stunning practice that also delivers top-notch dental care.
Stirling Smiles Dental exudes a modern, architecturally inspired aesthetic that incorporates French-washed paint textures and parquetry throughout the interior. This choice of materials brings an air of sophistication and luxury to the space, inviting patients into a world where dental care is not only a necessity but a pleasure.
The harmonious blend of textures creates a visual feast for the eyes and the attention to detail is evident in every corner.
Upon entering Stirling Smiles Dental, patients are greeted by a welcoming reception desk with clean lines and an understated elegance that sets the tone for the rest of the practice. The waiting area features comfortable seating, ambient lighting and a curated selection of reading materials, ensuring patients feel at ease while they wait for their appointments. A curved curtain wall and circular floor features help soften the space, whilst curved bulkheads and arches provide an architectural focus.
The walls are textured with a light grey marble wash that complements the overall design aesthetic, while large windows allow natural light to flood the space, creating a bright and airy atmosphere. The use of plants and greenery throughout the waiting area further enhances the sense of serenity and calm, providing patients with a much-needed respite from their busy lives.
The three treatment rooms at Stirling Smiles Dental have been thoughtfully designed to maximize patient comfort and ensure the highest level of care. Each suite features state-of-theart dental equipment and technology, with bespoke joinery and ergonomic dental chairs that allow practitioners to work efficiently and effectively.
The light grey walls extend into the dental suites, providing a sense of continuity and cohesion throughout the practice. Large windows in each suite allow for natural light and views of the outside, helping to reduce patient anxiety and create a more soothing environment.
The sterilization and storage areas have been designed with efficiency in mind, ensuring that all necessary supplies and equipment are readily accessible for dental practitioners. This attention to detail not only benefits the staff but also contributes to a seamless and efficient patient experience.
Stirling Smiles Dental’s design also incorporates environmentally conscious features that reduce the practice’s ecological footprint. Energy-efficient LED lighting is used throughout the practice and the incorporation of natural light reduces the need for artificial lighting during the day.
Stirling Smiles Dental is a testament to the power of innovative design in transforming the dental care experience. By prioritising patient comfort and staff functionality, Medifit Design & Construct, in partnership with Dr Quincy Leung, has created a truly exceptional space that raises the bar for dental practice design.
The combination of modern architectural elements, luxurious textures and environmentally conscious features demonstrates the team’s commitment to delivering a dental practice that not only meets the needs of its patients and staff but also makes a positive impact on the environment.
Stirling Smiles Dental serves as a shining example of how design can play a crucial role in enhancing the overall dental experience. By crafting an inviting and relaxing environment, patients are more likely to feel at ease during their appointments, which in turn can lead to better oral health outcomes.
In summary, Stirling Smiles Dental is a remarkable showcase of what can be achieved when design and function come together to create a space that pushes the boundaries of conventional dental practice design. It stands as a testament to the vision of Quincy Leung and the expertise of Medifit Design & Construct, who have together crafted a dental practice that sets a new standard in dental care and the overall patient experience.
Quincy is delighted with the new practice. “As always, Medifit completed the project to an extremely high standard and exceeded expectations. They completed the project on time and on budget. Our sincere thanks go out to the entire Medifit team”.
Medifit’s Sam Koranis adds “We were delighted to have been chosen again by Quincy, Anne and Amy for the design and fitout of their new practice. Helping successful dentists realise their practice dreams is a privilege that we do not take for granted. Quincy has now become one of 50+ clients that
The Practice Stirling Smiles Dental
Principal Dr Quincy Leung, Dr Anne Lee and Dr Amy Lee
Type of Practice General
Location Stirling, Perth, Western Australia
Size 138 square metres
No of chairs 3
The Team
Design Medifit Design & Construct
Construction Medifit Design & Construct
Equipment
Dental Units A-dec 500 and A-dec 400
Autoclaves W&H Lisa
Imaging Kavo Focus intra oral x-ray Planmeca ProOne OPG
Compressor Dürr Trio
Suction Dürr VS900
Software Dental4windows
have utilised the services of Medifit between 2 to 8 times. I would like to personally thank Quincy, Anne and Amy for their trust and confidence in Medifit to deliver another worthy practice.
all the best for Stirling Smiles Dental.”
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.
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Amini makeover, together with brand new equipment, has added a whole new dimension to a popular outer suburban Melbourne dental practice.
Atlihan Dental Surgery in the Melbourne suburb of Dallas offers both family dental and additional treatments for local patients without them needing to travel into the city.
Dallas is adjacent to Broadmeadows and is one of the first areas settled in the colony of Victoria. The area had one of Victoria’s first ever large-scale public housing projects which began soon after World War II in 1949 on former dairy and farmland. Before that, Broadmeadows was the site of an Australian Infantry Forces (AIF) WWI training camp.
It is also not far from the site of Ford’s Broadmeadows manufacturing plant at Campbellfield which employed over 2000 workers until it ceased operations in 2016.
Nearby Dallas underwent a major expansion between 1960 and 1970 with a major public housing project and further industrial development which transformed the area and attracted many new settlers. This history has strongly shaped the demographic of the local community.
As a result, Dallas has a very rich cultural history with a strong Middle Eastern population and is known for the Broadmeadows Mosque and other places of worship and restaurants and shops catering to the local Middle Eastern and Indian communities.
A proud Melbournian, practice owner Dr Cihad Atlihan is a charismatic character
who is proud of the area’s history and has attracted a strong personal following. As well as offering quality and affordable general family dentistry, he has a particular interest and experience in dental implants, TMD disorders and botox as well as general orthodontics.
Dr Atlihan used the downtime during COVID to rejuvenate the practice, including refurbishing the reception area, two of the three surgeries and the sterilisation room with new stone benchtops and cabinetry. He also purchased new equipment.
The reception refresh features a richly marbled reception desk under a curved bulkhead which frames a bold purple logo and signage behind. Glass tiles provide additional light to the multiple recessed LED downlights above reception and the waiting room.
Ample cabinetry and generous sized rooms provide an abundance of above and below bench storage throughout the practice, which includes an expansive steri room with a dedicated area for lab equipment and also a separate OPG room.
The range of treatments available at the practice cover everything from preventative and restorative dental to more involved procedures such as endodontics and implants.
This required re-equipping the practice with new dental units to provide a sturdy and comfortable platform to treat patients, especially during longer procedures.
Dr Atlihan said the equipment was all-important in achieving his clinical goals and above all caring for patients’ needs and comfort. The choice of A-dec was “pretty easy as it was by far the most recommended,” he said. “Everyone I talked to that has A-dec equipment didn’t have any complaints. A-dec has earned the reputation that it’s going to be reliable,” he said. “I knew with A-dec I wouldn’t have to worry about it.”
Dr Atlihan was also confident that if he ever needed help with something that he could depend on A-dec’s very experienced local dealer, Alldent in Port Melbourne for support.
“I wanted a Continental delivery system after talking to senior dental equipment technician, Bill Stoney from Alldent who convinced me it was more ergonomic and better than traditional delivery systems.
“The Continental has no cables for patients or staff to catch or trip on and the handpieces aren’t low or where you are likely to reach across with your hand, so there is not much risk of needle-
stick or bur injuries. Also because the Continental arms support the tubing you cannot drop an expensive handpiece or camera on the floor. I also find the Continental is less intimidating for the patient as it swings out of the way when they get in the chair and they don’t really see it during procedures.”
The new A-dec 500 delivery arm has a capacitive (touchactivated) brake switch built into the grab handle which unlocks the pivoting arm when the handle is grabbed and automatically applies the brake when the hand is released.
“The delivery arm is really easy to glide into position and once you release the grip and hear the hiss, it is set and it doesn’t drift once locked in place,” Dr Atlihan said.
The newest model A-dec 500 features completely redesigned flexible rubber support arms which allow total freedom of movement fore and aft and side to side and gently support the handpiece without the “pulling” of some Continental systems. This reduces the weight of the instrument in the hand and allows the operator to concentrate on the oral cavity as the handpieces are easily returned and retrieved from the control head without looking up.
The delivery system includes an electronic touchpad with full control of turbines, electric motors and scalers and also has a built-in endodontic function for controlling rotary instruments.
The icon-based touchpad features memory settings for different operators and pre-sets for different handpieces - which it recognises automatically and displays the programmed settings on the LCD display as they are picked up.
Air and water for each handpiece can be adjusted by rotary dials on the side of the control head which illuminate to show which handpiece is in use.
The patient chair features an orthopaedically pressure-mapped backrest design and shoulder support for patient comfort but has a slim side profile and flexible backrest material to allow better operator access.
Dr Atlihan said the thin, flexible backrest was extremely comfortable for patients and he has had patients fall asleep in the chair during procedures.
The Practice
The Practice Atlihan Dental Surgery
The Principal Dr Cihad Atlihan
Practice Type General
Location Dallas, Melbourne, Victoria
Size 130 square metres
No of chairs 3
The Team
Colour & Design Dr Cihad Atlihan
Construction Alkin Painting Pty Ltd
Project Manager Ali Keles
Installer Alldent, Melbourne
Equipment
Dental Units A-dec 500 Continental
Sterilisation Sirona DAC Professional
Imaging Sirona Heliodent Plus Morita Veraview X800 CBCT with lateral ceph arm
Compressor MES 2-chair compressor
Suction Dürr VS600
Software Dentally
He also finds it ergonomically superior to his old chair which had a wide and solid backrest and was difficult to work around without leaning across the patient and arching his back and neck to properly access the oral cavity.
“I can actually get much closer to the patients with the A-dec 500 and can get my legs under the chair backrest and work close in a good, seated position without having to strain my body and lean across the patient.”
To take full advantage of the ergonomic benefits offered by the A-dec system, Dr Atlihan invested in matching A-dec 500 Doctor’s Stools and A-dec 500 Assistant’s Stools which have a superior base design that provides zoned support to maintain healthy and comfortable posture without restricting blood flow to the legs.
The sturdy assistants’ stools have a wide range of height adjustment supporting four-handed dentistry and a swivelling torso rest to support the assistant when working chairside.
Dr Altihan said his assistant Enise (Atlihan) and other dentist, Dr Ezra Oz also enjoyed working with the new equipment and that patients had often commented on the comfort of the patient chair.
The team are justly proud of their revamped practice and modern equipment which helps them offer quality and comprehensive dental care to their local community.
Every dental practice is unique. That’s why A-dec offers a full line of dental chairs, with a wide variety of options and price points, all designed for comfort, performance, and reliability.
From the entry-level A-dec 200, the stylish A-dec 300, to the classic A-dec 400 and the premium A-dec 500, there’s an A-dec chair to fit your practice, your personal style, and your budget.
To see our award-winning family of A-dec dental chairs – scan the QR code and find the one that’s right for you.
When Sydney born and raised dentist
Dr Katrina Zhao decided to open a second practice, she knew exactly where to go to get the job done.
Buoyed by the success of her first practice, “Midas Dental” at Macquarie Park, North Ryde in Sydney’s Northwest (Australasian Dental Practice, Sep/Oct 2019), she decided to stick to a proven formula.
After finding out that the brand-new Park Sydney shopping centre at Erskineville was looking for a dentist as a foundation tenant, Dr Zhao decided to act. The inner-city vibe and cosmopolitan Erskineville community beckoned for something out of the ordinary, so she immediately knew who to call.
Dr Zhao had so much confidence in the design and build process managed and performed by Commodore Dental and Medical Fitouts on her first surgery that she engaged them in earnest.
Not only that, but she gave their chosen designer an “open creative licence” to produce a design and matching décor to suit her space and setting.
The design aspects key in perfectly with the modern vibe of the surrounding developments and urban demographic, including many young people moving into their first homes and starting families.
The brief was totally broad ranging, with a brand-new building to occupy and a generous 125 square metre floor area. The only challenge was an engineering one, with a 150mm drop from the door opening to the floor.
But rather than a setback, Commodore’s project manager and principal, Craig Exley found this was an ideal way of running services throughout the occupancy without disturbing the residential strata units above. He installed a false floor to plumb the water, power and air lines and installed the compressor and suction remotely to save space and provide access to the equipment.
The overlay of richly textured grey and white carpet over the false floor, off-white soft furnishings, matching feature wallpaper in icy whites and greys pick up the marble tones of the reception desk, giving a truly embracing feel in this rarefied space.
The wintery whites and greys contrast brilliantly with the “dark chocolate” feature wall and gold signage behind the reception desk, along with the dark timber
stemmed pendant lights above and the contrasting light toned timber inlay panels set into the front of the marble reception desk.
The finishes and variety of textures inside are both vibrant, yet cohesive and soak up the daylight in the waiting room and reception area, providing an enticing atmosphere. Passers-by are treated to a “peek-a-boo” effect inside through a rectangular cut-out in the dark chocolate exterior glass signage overlay.
The light toned and grey theme continues into the surgeries and back-office areas, again punctuated by random splashes of warm woodgrain units set among the otherwise white cabinetry.
Practical touches included roll-out procedure cabinets which can be wheeled from under the benchtop and placed chairside during treatment.
The kitchen has the same cabinetry design flourishes with contrasting light woodgrain and a dedicated microwave shelf providing a streamlined and usable space.
Dr Zhao said the unmistakeable “designer” styling of the interior decor feels “premium and elegant”. “It is a very nice workplace for all of us and there’s lots of glazing to let in the light and provide a view into the front of the practice.”
This has proven a real bonus with the exposure to the high level of foot traffic, including locals going about their daily business, walking their dogs or on their way to take in the outdoors or exercising at the popular 40ha Sydney Park wetlands and ponds nearby.
“People walking up and down the street see the practice and I think this has had an effect,” Dr Zhao said. “Patients who come in are also really wowed by the surroundings and also the modern technology. We haven’t even had a chance to promote ourselves yet, but the bookings are already coming in online.”
So much so, that Dr Zhao has three other dentists working with her and has had to recruit new dental assistants and reception staff to cater for the demand. She said the staff also love working in the practice which is an added advantage in a competitive market for skilled dental staff.
In addition to the design elements, Dr Zhao said the practice was also very practical with a cohesive “donut” shaped interior layout around a central hub. Sliding connecting doors and corridors provide easy access in and out of the back-office areas without having to walk long distances.
The Practice
The Practice Midas Dental
The Principal Dr Katrina Zhao
Practice Type General
Location Erskineville, Sydney, New South Wales
Size 125 square metres
No of chairs 3
The Team
Colour & Design Antony Poate
Construction Commodore Medical & Dental Fitouts
Project Manager Craig Exley
Installer Dentsply Sirona
Equipment
Dental Units Intego Teneo
Sterilisation Melag Vacuklav 43B+
Imaging Sirona Orthophos XG CBCT Sirona Heliodent Plus with Dürr VistaScan Mini
Compressor Cattani KAC2000 AC200
Suction Cattani Turbo SMART
Software D4W Cloud
Sidexis Imaging
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.
With the Hygoclave 50, Dürr Dental offers dental practices a professional Class B steriliser 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. With the intuitive operation of its graphical interface, the high-resolution
125mm touch screen delivers comfortable standalone operation of all functions. Colour-coded icons on the home screen make for incredibly easy navigation and offer fast access to key functions and the integrated user management system. There, the most recently executed sterilisation and test cycles can be conveniently started via quick access or program starts can be freely programmed Stainless steel and plastic are used across the board in the sterilisation process to prevent the the risk of highly corrosive demineralised water dissolving ions from the materials.
Available: A-dec Dealers
Tel: 1800-225-010
www.duerrdental.com/en/AU
Ultradent Products, Inc. has launched the newest edition of its multi-award-winning VALO™ curing light - the completely redesigned VALO™ X broadband LED curing light. As Ultradent’s most innovative curing light yet, the VALO X offers the ultimate in engineering and design when it comes to every aspect of the light—including durability, power, accessibility and versatility. Thanks to its larger 12.5 mm lens and new powerful custom LED chip, the VALO X curing light offers a more complete cure than ever before. Its superior features allow clinicians to cure with
confidence and not have to question the capabilities of their light. This includes improved curing depth, beam collimation and thermal management. The VALO X comes equipped with two power modes (Standard Power and Xtra Power), two diagnostic light modes (black light and white light), as well as the ability to work corded or cordless. VALO X is milled from a single bar of aerospacegrade aluminum.
Available: Dentavision
Tel: 1800-806-640
Available: Henry Schein
Tel: 1300-658-822
www.ultradent.com
SDI has launched Riva Cem Automix, a new resin modi fied glass ionomer cement. It is a self-curing, radiopaque, fluoride releasing paste/ paste resin modified glassionomer luting cement.
SDI Limited has launched Stela, a new bulk fill flowable self-cure composite that is widely lauded as an amalgam replacement and the future of composites. As a self-curing bulk fill composite, Stela offers an unlimited depth of cure with low polymerisation stress. Stela is applied in a simplified two-step process; primer and composite. This efficient 15 second process reduces your in-chair time by eliminating traditional preparation steps such as etch, bonding systems and light curing. Stela Primer contains a catalyst that initiates
the curing process at the restoration interface and not from the occlusal surface like traditional light curing processes. This polymerisation sequence mitigates stress to enable a gap-free interface, reducing post-operative sensitivity and the risk of premature failure.
Stela is the ultimate high-performance composite and the ideal amalgam replacement for Classes I, II, III and V.
Available: SDI Limited
Tel: 1800-337-003
info@sdi.com.au
www.sdi.com.au
Riva Cem Automix is indicated for the perma nent cementation of metal and ceramic restorations such as zirconia, porcelain and orthodontic bands. Riva Cem Automix fea tures SDIs revolutionary ionglass™ technology. This unique blend of different sized reactive glass particles harnesses ion-release to cross-link polycarboxylic acid chains. This focused ion release gives Riva Cem Automix a clinically higher bond strength, improved strength and more stable aesthetic properties. A 2022 study showed that Riva
Cem Automix has a superior enamel/dentine bond strength combination compared to leading cements. Riva Cem Automix also has a superior flexural strength. The same 2022 study also confirmed that Riva Cem Automix has the bestin-class colour stability, ensuring restorations do not deviate from their original shade. Get more. Waste less. Riva Cem Automix offers more tips than any other leading cement – and has 25-50% less tip wastage than other cements. Riva Cem Automix is an Australian innovation.
Available: SDI Limited Tel: 1800-337-003
info@sdi.com.au www.sdi.com.au
TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.
TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.
TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.
TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.
Another Quality Product From
Another Quality Product From
Another Quality Product From
Another Quality Product From
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