Australasian Dental Practice May/Jun 2021

Australasian

DENTAL PRACTICE THE BUSINESS MAGAZINE FOR DENTISTS

Vol. 32 No. 3

MAY/JUNE 2021

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VOLUME 32 | NUMBER 3 MAY/JUNE 2021

contents | REGULARS

On the cover...

Whether feminine, classic or urban, KaVo’s new Design Series inspired by Japanese culture combines harmoniously with a variety of furnishing styles and gives your dental practice even more personality.

management

70 practices retire millions of dollars better off than dentists who are corporate careerists Why dentists who build successful

briefs 8 10 one man’s opinion 12 in my practice 14 mouth wide shut 16 spectrum 60 CPD centre 62 abstracts 64 the cutting edge 154 new products

72 ensure your next hire is a great decision!

74 Protecting yourself from a bad valuation 76 My top 8 phrases not to say to patients A 6-step recruitment process to help

marketing

78 of time?

Are Google reviews a complete waste

finance

READ ME FOR

CPD

asset write-offs vs temporary full 80 Instant expensing: Semantics or can I still claim an immediate tax deduction?

84 The humble SMSF

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

© 2021 All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

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

May/June 2021

Australasian Dental Practice

5

contents | FEATURES

VOLUME 32 | NUMBER 3 MAY/JUNE 2021

infection control

clinical excellence 88

104

Using VITA SMART.FIRE® to create a fast and aesthetic same-day, chairside restoration

Ozone in water: Let the

88 recent evidence speak Four changes to infection prevention 96 and control that made a difference Face mask performance: 100 Are you protected?

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CPD

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104 Selective-etch adhesive bonding of 110 an IPS e.max CAD partial crown Diastemata - A viable correction 112 method using an aesthetic composite ®

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CPD

surgery design 148

118 Are all arch development techniques

118 created equal?

Immediate extraction and implantation of 122 lateral incisor in combination with the

140 Heritage makeover in a class of its own

148 All the vital elements!

May/June 2021

CS 3600 by Carestream Dental, MGUIDE

by MIS-Implants and exocad software

Plastic periodontal surgery combining mucoderm® and Emdogain®

130 Conservative treatment for a symptomatic 136 irreversible pulpitis using Tricalcium Silicate Australasian Dental Practice

7

briefs | NEWS Slowly but surely...

S

lowly but surely I’m thinking is a good way to categorise Australia’s COVID-19 vaccine rollout.

Ahead of the Olympics,

By Joseph Allbeury Japan is vaccinating a million people a day and the US something like 4 million. In Australia, we’re almost at 7 million people total with at least one dose; it’s taking sooooo long. Every vaccination mitigates the risk of COVID-19 interrupting life once again and we’re all over that. Our saving grace ultimately will be our relatively small population, but the sooner we have a critical mass, the sooner COVID will no longer be the barometer of life.

And slowly but surely, Digital Dentistry and Dental Technology 2021 on September 10-11, 2021 at the Novotel Sydney Brighton Beach is coming together as another great event too. Creating a COVID-safe face-to-face event has been an interesting experience and not without its challenges. Even though the vaccine rollout will have extended to well over half the population by September, events are planned using the rules that apply today rather than the rules that may apply in the future.

And apart from that aspect, access to international speakers is also restricted. Fortunately, we have no shortage of exceptional talent in Australia and New Zealand. Digital Dentistry and Dental Technology has always been about providing an accurate portrayal of digital dentistry here and now and that is what the program delivers.

With this next instalment, the program is evolving to a more mature level to cater to more experienced users with advanced sessions on 3D printing, large span implant prosthetics, digital dentures, orthodontics and more.

Some of the session choices include Dr Fadi Yassmin discussing Digital Smile Design and the use of preparation guides in porcelain veneers; Dr Anthony Mak will look at Advanced Digital workflows for implant and fixed Prosthodontics; Dr Derek Mahony will explore Artificial intelligence, consumer behaviour and its impact on orthodontics; while Dr Ahmad H Al-Hassiny will tell you Everything You Need to Know Before Investing in an Intraoral scanner.

Grass roots sessions for delegates in the analogue to digital transition phase will remain, as will the popular handson workshops introduced in 2021. The latter includes the Intraoral Scanner Test Drive Workshops where you can test every brand of intraoral scanner in one place in a 45 minute session with experts on hand to answer all of your questions.

A host of talented clinicians and technicians will provide insight into every available digital dentistry solution on the market today and detail their experiences in getting the best from the technology, efficiently and economically.

This event remains the only forum that brings together clinicians and technicians to exchange ideas, debate solutions, network and have fun! We hope to see you at Digital Dentistry and Dental Technology 2021 on September 10-11, 2021 at the Novotel Sydney Brighton Beach.

Joseph Allbeury, Editor and Publisher

8 Australasian Dental Practice

ITI 2022 André Schroeder Research Prizes

he International Team for Implantology (ITI) invites all researchers who have demonstrated new findings in implant dentistry to apply for the 2022 André Schroeder Research Prize for Preclinical Research or the André Schroeder Research Prize for Clinical Research. Submissions for the awards, which are presented annually by the ITI, will be accepted until September 15, 2021. The award winners will each receive CHF 10,000 as well as a gold medallion. In addition to this, the ITI will provide a flight to the official award ceremony, hotel accommodation as well as a free congress ticket. The award ceremony will be held during the ITI Congress Italy in Rome in April 2022.

The André Schroeder Research Prize has been awarded to independent researchers for 30 years with the aim of promoting new scientific findings in implant dentistry. The awards are presented in honor of Professor André Schroeder, the founding ITI president, who pioneered implant dentistry and whose lifework contributed significantly to modern dentistry. More information as well as the terms and conditions of participation and the application form are available at http://www.iti.org/Andre-Schroeder-Research-Prize

T

Plan to end HIV transmission in 2025

ustralia can end HIV transmission within four short years, averting over 6,000 infections by 2030 and saving $1.4 billion in health costs, according to a costed plan presented to parliament. Agenda 2025: Ending HIV Transmission in Australia is a consensus statement that draws on the expertise of the nation’s top HIV clinicians, researchers and community leaders, including the Australian Federation of AIDS Organisations, the Kirby Institute, the Doherty Institute and many others.

It finds that with annual additional investment of $53 million and fresh policy settings, transmission of human immunodeficiency viruses could be ended within the next term of parliament (by 2025). The statement calls for investment in prevention, testing and treatment, along with a renewed campaign against the stigma associated with HIV. Taken together, this would provide a path to a 90% reduction in HIV infections, compared to 2010.

This requires 95% of people at risk of HIV using one or more forms of effective prevention; 95% of people with HIV diagnosed and treated; and 98% achieving undetectable viral load. “This month we entered the fifth decade of the HIV epidemic. If parliamentarians adopt this plan, we can avoid entering a sixth,” said Darryl O’Donnell, chief executive of the Australian Federation of AIDS Organisations. “The previously unthinkable achievement of ending HIV transmission is entirely within reach, but only with new policy settings and additional investment. In the last few years science and technology have outpaced regulation. We need a fresh approach that expedites approval and funding of new innovations such as self and rapid testing so that they can reach those who need it. We must take the learnings from COVID-19 and establish a new public health track so tests and medicines needed in the public interest get to consumers safely and quickly.” The Kirby Institute’s Professor Andrew Grulich said the plan came at a timely moment in Australia’s HIV response.

A

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spectrum | NEWS

One man’s opinion...

“The corporates, health funds and insurance companies can take advantage of any oversupply of doctors and dentists to force prices down and therefore increase their profits. With the acquiescence of naïve or unconscionable politicians, they get away with underpaying their professional employees...”

W

By Georges Fast

e all need a jolt of reality at various times in our lives. We are currently being bombarded by prophets of doom - “Climate change is going to bring us all undone”, “Nobody is building things properly”, “There won’t be enough food to feed the world’s population”, “Doctors and dentists are no longer being trained properly”, “Oil is going to run out (popular during the Middle East Oil Crisis)”, “The next generation won’t be able to afford housing”, “We can’t afford to educate our kids”...

Let’s stop, regroup and give some thought to the following: “The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs and tyrannize their teachers.”

This quote, which would not be out of place today, is from Socrates who lived between 470 and 399 B.C.E. Have we learnt much in the intervening 2500 years and assimilated it into our knowledge bank, or does human nature, being what it is, allow optimism and pessimism to always triumph over experience and reality?

This morning’s papers were full of news about dodgy builders using substandard materials, employing untrained staff and taking short cuts. If there was no demand for cheaper housing that still had all the so-called luxury features promoted by lifestyle programmes and magazines, the situation would not have arisen - the purchasers were conditioned to believe that they were getting a bargain (otherwise known as “fantastic value”) when, in fact, they got exactly what they paid for.

We read in the press about global warming and this may well be currently true, but the world has been cyclically warming and cooling since the beginning of time and will continue to do so. On the one hand, we read reports about a volcanic eruption that released more carbon dioxide than the whole industrialised world could in one year; yet on the other hand, activists want us to destroy our industries and lower our standard of living knowing full well that it won’t affect our climate, just so that they can feel important.

It may well be true that some doctors and dentists are not being trained properly - but most are. The problems that have arisen have a lot in common with the revelations in this mornings’ paper about poor quality housing construction. We appear to be in the middle of a “perfect storm” - our politicians have

10 Australasian Dental Practice

woken up to the fact that training dentists and doctors is a very expensive undertaking. It takes many years and considerable infrastructure. Simple accounting will show that not only is it cheaper to qualify someone already trained overseas but by charging them an examination and registration fee, it becomes a profitable exercise. To politicians, it’s a win-win situation and the pressure on examiners to get these people through must be considerable.

The corporates, health funds and insurance companies who treat health as just another profit centre can take advantage of any oversupply of doctors and dentists to force prices down and therefore increase their profits. With the acquiescence of naïve

“The reality is that standards of living are rising, people are living longer, there is more leisure time, medical knowledge has expanded exponentially and for most people, medical care is better. There is enough food (although not always in the right locations), people are generally better educated and have adequate shelter. And if we use our common sense, remember the values that have served us well in the past and always stop to think about what we are doing, we won’t fall prey to the “snake oil” salesmen...” or unconscionable politicians, they get away with underpaying their professional employees and forcing their preferred providers to accept fees that preclude them from doing their best for the patient.

Any patient who believes that they can get the same quality of care for less than half the price that they would have paid in a private practice, volunteers for the consequences they will suffer. To quote that great philosopher: Zorba the Greek - “If God hadn’t wanted them to be shorn, he wouldn’t have made them sheep”.

The reality is that standards of living are rising, people are living longer, there is more leisure time, medical knowledge has expanded exponentially and for most people, medical care is better. There is enough food (although not always in the right locations), people are generally better educated and have adequate shelter. And if we use our common sense, remember the values that have served us well in the past and always stop to think about what we are doing, we won’t fall prey to the “snake oil” salesmen.

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spectrum | NEWS

In my practice...

By Christopher Ho

T

“The unique drilling protocol and trioval neck of the implant has been designed to benefit biologically with less trauma to the bone and the unique prosthetic connection enhancing the internal connection of the implant for excellent seal and rigidity...”

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

SDR Flow+ (Denstply Sirona)

Nobel Biocare N1 t’s been over 10 years since the introduction of Surefil SDR that changed posterior resin dentistry with this bulk fill composite. There has been controversy over the use of bulk fill materials which went against the conventional protocols of incremental layering to minimise polymerisation shrinkage.

It was always thought that to minimise the C factor, the solution was minimising bonding to many walls, hence layering was utilised in an effort to minimise shrinkage and sensitivity, micro-leakage and consequently premature failure. The long clinical use and literature, however, suggest that the material has the same success rate as conventional composite. Bulk fill materials improve efficiency and minimise application steps.

The adaptation and seamless flow of the material allows excellent integration into a cavity outline. The use of conventional paste composite may at times introduce voids and gaps leading to secondary caries formation or sensitivity. SDR+ possesses low shrinkage stress minimising the chance of microleakage, however it is still used with an overlying capping material of universal composite for adequate strength and aesthetics. One of the unique advantages is the self-levelling properties of the material and being able to have a depth of cure of 4mm. The newer SDR Flow+ has multiple shades and comes with a unique delivery tip which allows direct placement into a cavity box and gives reassurance that your first initial placement will adapt seamlessly and not be concerned about voids in a most crucial area such as a proximal box in a Class II restoration.

I

fter many years of development, Nobel Biocare has released an innovative new implant called the N1, which simplifies placement with a three step process coined “Direct/Shape/Place”. The first “Direct” step utilises the Osseodirector drill, similar to a 2mm twist drill, which also allows change in direction due to its tapered body. However, the unique second step is the “Shape” process using an Osseoshaper which is used at 50 rpm, a very low speed with no irrigation, with the torque measured during the shaping guiding the surgical procedure. The third step is to place the implant and this has been engineered with a trioval implant neck which has been designed to reduce stress on the cortical bone and along with the TiUltra surface, promote fast integration. The unique drilling protocol and trioval neck of the implant has been designed to benefit biologically with less trauma to the bone and the unique prosthetic connection enhancing the internal connection of the implant for excellent seal and rigidity. We are always looking to achieve the best results for our patients with optimal crestal bone maintenance and minimise any problems, so it will be interesting to utilise these new innovative designs in practice and enhance our outcomes for our patients.

A

12 Australasian Dental Practice

About the author Dr Christopher Ho is a Specialist Prosthodontist in Sydney.

He graduated with First Class Honours from the University of Sydney and has completed postgraduate qualifications in Oral Implants as well as a Masters of Clinical Dentistry in Prosthodontics from the University of London. He completed his Doctorate in Clinical Dentistry in Prosthodontics at the University of Sydney. He is a Faculty member of GIDE, a Visiting Lecturer at Kings College London and the editor of the Wiley-Blackwell textbook “Practical Procedures in Aesthetic Dentistry”.

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spectrum | NEWS

Are you devaluing your true worth?

D

By David Moffet

“Dr Omer Reed said 95% of dentists reaching the age of 65 cannot afford to retire because they haven’t been able to put away enough money along the way to fund their own retirement. They simply haven’t looked at the efficiencies of better time management and better time utilisation...”

o you know your hourly rate as a dentist?

What is an hour of clinical dentistry worth to you?

The calculation is simple: Work out how much dentistry you produced personally in a certain time frame [usually three or six months], then divide that dollar amount by the number of days you worked and there’s your daily rate.

Divide your daily rate by the number of hours you work each day to calculate your hourly rate.

Knowing your hourly rate is very powerful: When you know your hourly rate for being a dentist in your dental practice, you can soon be able to work out those tasks in your practice that you SHOULD NOT BE DOING and should be delegating to someone employed or hired on a lower hourly rate.

You can also work out those tasks that you could hire someone to do in your office instead of you so that you as a dentist could concentrate on working and generating more income for your dental practice by doing more dentistry.

Here are some tasks in the dental office that you can pay someone a lower hourly rate to do: • Fill out lab sheets; • Type up clinical notes; and • Mix plaster and pour up models.

Here are some tasks in the dental office that you can pay an expert a lower hourly rate than you earn, to do: • Bookkeeping; • Dental hygiene; • Front office phone skills training; and • Customer service training for your team.

Here are some tasks you do at home that you can pay someone a lower hourly rate than you earn, to do: • Mow your lawns; • Wash your cars; • Clean your house; and • Trim your hedges.

Dr Omer Reed said that in the USA, 95% of dentists reaching the age of 65 cannot afford to retire because they haven’t been able to put away enough money along the way to fund their own retirement.

They simply haven’t looked at the efficiencies of better time management and better time utilisation in their dental practice.

14 Australasian Dental Practice

There’s no point employing a dental assistant and then putting your own matrix bands together, while the dental assistant sits there beside you twiddling her thumbs.

Similarly, why not employ an extra dental assistant to transfer the completed patient to and who then transfers that completed patient and hands them over to the front office team, while you the dentist move into the next treatment room and begin doing dentistry immediately on the next patient.

You don’t see Lewis Hamilton filling up his own Formula 1 race car?

He’s paid a lot of money to drive that car.

Mercedes can pay other people a lot less to fill the tank of Hamilton’s F1 racer.

Similarly, I bet you don’t see Hamilton teaching the pit crew how to change tyres... I’ll bet that Mercedes hire specialists to do that sort of training.

The other thing about Mercedes is that when they hire someone to help their pit crew improve performance, they really make sure that they are getting the best available.

They do their research.

What they don’t do is train their pit crew on what they the owners THINK needs doing.

They hire someone with a proven track record.

And it’s still a lot less expensive than training the pit crew themselves.

And it’s far more sensible than NEVER TRAINING their pit crew.

How’s things in your dental practice?

How are things in your dental practice?

Are you doing a lot of lower paid tasks in your practice yourself, instead of performing the dentistry?

And do you have dental office team members performing crucial roles in your business who have never been trained on those roles?

About the author Dr David Moffet is a dentist and a #1 Amazon Bestselling author.

He is the inventor of The Ultimate Patient Experience™, a simple to implement patient retention system he used to build and subsequently sell (for several million dollars) his very successful dental practice [of 28 years] located in Parramatta in working class western Sydney. David recently retired from wet-fingered dentistry and now spends his time lecturing and coaching private dental clients in the USA, Canada, Great Britain, Europe and Australia and New Zealand on how to improve their practices. David can be contacted at david@theUPE.com or visit www.theUltimatePatientExperience.com.

May/June 2021

Are you maximising Are you maximising your patients’ your patients’ healing capabilities? healing capabilities?

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98.2 % 98.2 %

100 % 100 %

Randomised controlled multicenter study Randomised controlled (96 patients, 127 implants) multicenter study (96 patients, 127 implants)

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spectrum | NEWS

Colourful and diverse: KaVo launches new Design Series inspired by Japan

J

APAN, the island nation in the Pacific, with densely populated metropolises, pulsating pop culture, deeply rooted traditions, mountainous national parks and subtropical beaches, full of contrasts and diversity, is the inspiration for developing KaVo’s new colourful and diverse Design Series. Whether feminine, classic or urban, the designs combine harmoniously with a variety of furnishing styles and give your dental practice even more personality.

The new Design Series is now available in the KaVo ESTETICA E70/E80 Vision; KaVo ESTETICA E50 Life; and KaVo Primus 1058 Life dental units centred around three themes.

16 Australasian Dental Practice

Cherry Blossom he Cherry Blossom is the embodiment of beauty and is considered the emblem of a new beginning. The motif and the bountifulness of colours are captivating through gentle strength and elegant playfulness. Depending on the combination of colours and materials, one aspect or another is emphasized. Enchanting, classic or strong in character.

T

Bamboo ubtle elegance characterises the Bamboo design. The colour green is said to have a balancing, soothing and yet refreshing quality. The gently flowing leaf shapes are reminiscent of the awakening of nature in spring. So it is not surprising that bamboo is also a symbol of purity in Japan. Delicate and at the same time so strong and striking.

S

Fujisan owerful and shining, the highest mountain in Japan rises above the clouds in its perfectly symmetrical shape. Dipped in sunny yellow, the motif feels light-hearted and cheerful. Yellow stands for happiness and well-being; combined with gray tones and concrete, the radiance is even stronger.

P

May/June 2021

Individuality is

NOW Make your practice even more individual: Enjoy the highest quality, certified ergonomics and the individual style of the new KaVo Design Edition “Cherry Blossom“.

KaVo Dental. Level 4, 7 Eden Park Drive, Macquarie Park NSW, Australia. www.kavo.com/en-au

Freecall 1800 643 603 kavokerr.queries@kavokerr.com

Learn more.

spectrum | NEWS

KaVo: Engineered for ergonomics

D

entists complete around 80,000 treatments throughout their careers, so it’s no wonder that many suffer from back and neck pain.

Each KaVo product is specifically designed to answer the needs of each clinician to work in a relaxed manner.

The KaVo ESTETICA E70/E80 Vision treatment units and the PHYSIO Evo dentist’s chair have been awarded the ergonomic seal of approval from the “Campaign for Healthier Backs” association (AGR). This is the first time, and to date, the only time that the coveted title has been awarded to dental practice equipment.

The greatest ergonomics - regardless of height he extremely low position of 350 mm enables natural posture for patients in a sitting or lying position - even for shorter practitioners. The maximum position of 900 mm (KaVo ESTETICA E70/E80 Vision) or 830 mm (KaVo Primus 1058 Life, KaVo ESTETICA ESQ Life) also enables dentists who are taller than 1.80 metres to work in an ergonomic position.

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80%

of all dentists suffer from back pain at least once in their career.1

Double duty ergonomics ll doctor and assistant elements can be swivelled and adjusted in height and can be positioned to ergonomic perfection regardless of whether treatment is performed while standing or sitting. The optional swing arm version with a low table height of 45 cm and balanced swing arms offers optimum ergonomics.

A

Trendelenburg means treating in total relaxation n order to achieve the Trendelenburg patient position, the footrest tilts and lifts automatically to match the tilt of the backrest.

The lying position remains ergonomic, preventing the patient’s back from being compressed or stretched when the backrest is positioned. With the KaVo ESTETICA ES0 Vision’s motorised seat lift, patients of different sizes, children and even patients with health restrictions such as hunched back or hollow back are always in the best possible position. Some KaVo treatment units are available as right-handed or left-handed versions. In addition, many have an integrated endo and surgery function as standard or optional, saving you additional avenues and investments.

I “I’ve been using KaVo equipment for the past 12 years.

The reliability and superior quality of KaVo’s Equipment has been integral to the growth of my practice.

KaVo’s unique design offers world class ergonomics and maximum comfort which my patients love...”

Dr Anthony Mak, W Dental, Woollahra, Sydney

Suspension chair concept he unique suspension chair concept is KaVo’s answer to neck and back pain: the free space under the KaVo ESTETICA E70/E80 Vision patient chair enables you and your assistant to maintain healthy, relaxed leg and body positions while being close enough to the patient.

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18 Australasian Dental Practice

Obviously ergonomic he natural white light of the KaVoLUX 540 LED enables optimum visibility. The COMPOsave mode, which prevents fillings from hardening prematurely, keeps the dentist from being rushed. The KaVoLUX 540 LED is automatically switched on and off in accordance with the automatic positions of the treatment centre. The user can also control the most important functions such as dimming and switching on and off without contact.

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1. Source: www.the-dentist.co.uk/content/news/back-for-the-future (Retrieval date: 6.11.2020)

May/June 2021

Individuality is

NOW KaVo Dental. Level 4, 7 Eden Park Drive, Macquarie Park

Make your practice even more individual:

NSW, Australia. www.kavo.com/en-au

Freecall 1800 643 603 kavokerr.queries@kavokerr.com

Enjoy the highest quality, certified ergonomics and the individual style of the new KaVo Design Edition “Fujisan“.

Learn more.

spectrum | NEWS

Posture and exercise can impact your career Correct posture combined with an in-office exercise routine can prolong your working life

Correct basic posture n Place

your feet on the floor with a sufficiently wide angle at the knee. n Raise the chair enough so that the feet stay on the floor and the thighs are clearly inclined. n Support your pelvis by sliding your buttocks backwards and pulling the backrest forward until your back is supported. n Now tilt the seat forwards in order to avoid pressure on the edge of the thigh and to support it over the entire surface.

End position n The

pelvis is supported and tilted forward. n The physiological oscillation of the spine (double S-shape) is ensured. n Shoulder girdle is in balance. n Head is perpendicular.

Dynamic seating position

Dynamic standing position

Hanging posture

Mobilisation and relief of the back

Provides relief to the intervertebral disc

Stretches the muscles, mobilises the spine

Starting position

Starting position

Starting position

n Start

in the basic sitting position, the 12 o’clock position. n Your movements should be carried out slowly and consciously one after the other.

Execution n Rock

your pelvis back and forth. n Let your shoulders circle back and forth. n Arch your spine sideways to the right, then the left, alternating back and forth. n Rotate your shoulders/ upper spine from right to left, alternating back and forth.

20 Australasian Dental Practice

n Pelvis

is stable. angle 90 degrees. n Feet are positioned firmly and to the front. n Knees are relaxed. n Pull the belly button slightly inwards. n Pull your shoulders down. n Head remains extended. n Arm

Execution n Shoulders

and pelvis can be easily moved while treating the patient.

n Sitting

on the dentist’s chair. n For a break during the treatment phase.

Execution n Slowly

roll your head forward. n First bend the upper part of the spine, then the middle and lower parts. n Let yourself hang loosely and breathe into your back. n Swing your arms and upper body slightly back and forth. n Slowly straighten up again.

May/June 2021

spectrum | NEWS

Brought to you by...

The weightlifter

Arms flutter

The shoulder twist

The flank stretch

Trains all muscles in the body

Trains the deep muscles, stabilises the spine

Stretches the shoulder muscles, mobilises the cervical spine

Stretches the pelvis and the upper and lower spine

Starting position

Starting position

Starting position

Starting position Skier’s crouch n Bend

your knees, push back your bottom, stretch your arms forward and straighten your back. n Flex your thigh, glute and back muscles.

Execution n Hold

the starting position for a while. n Then slowly lift your body back again, lowering your arms. n Exhale and go back into the skier’s crouch. n Repeat the exercise around 10 times.

May/June 2021

n Bend

your knees slightly. your arms out in front of you. n Pull your belly button inwards. n Stabilise your pelvis - this is particularly important during this exercise to avoid hollow back.. n Stretch

Execution n Flutter

your arms up and down vigorously in a scissor motion, slowly lifting your arms. n Slowly lower your arms again, continue breathing normally. n Repeat the exercise around 10 times.

n Extend

your arms out to the sides. n Turn one palm up on the side where you are looking; the other palm faces down.

n Place

one ankle behind the other, grab your wrist on that same side, pull your arm over your head up as far as possible. n Keep breathing normally.

Execution n Slowly

Execution

turn your head to the other side while turning your palms in the opposite direction. n Perform the exercise 10 times in a slow, relaxed manner with the rhythm of your breathing.

n Hold

the starting position for approx. 10 seconds, stretch your arm as far as you can. n Place the other ankle behind, switch the wrist you are holding and now stretch this side as well.

Australasian Dental Practice

21

spectrum | NEWS

The two that can do it all!

A truly universal two-component system for all direct and indirect bonding applications

“Dream Team: 3M Scotchbond Universal Plus Adhesive and 3M RelyX Universal Resin Cement in the self-sealing syringe, plus 3M RelyX Universal Micro Mixing Tip and the thin, long and flexible elongation tip for easy cement application into the root canal...”

W

hat if two components were all you needed to cover virtually every self-adhesive and adhesive dual-cure resin cement indication as well as all direct adhesive cases? This wish comes true with the launch of 3M™ RelyX™ Universal Resin Cement and 3M Scotchbond™ Universal Plus Adhesive.

When used alone, RelyX Universal Resin Cement works as a self-adhesive resin cement with outstanding bond strength, reliably solving routine cases with maximised efficiency.

Scotchbond Universal Plus Adhesive is the first radiopaque, all-in-one universal adhesive. It serves as a universal primer for all materials including glass ceramics and further boosts bond strength of RelyX Universal Resin Cement for demanding adhesive resin cement cases. As a fully aligned system, the adhesive is initiated and cured by RelyX Universal Resin Cement thus saving the light-cure step.

These features reduce procedure steps and the number of required components to 2, eliminating the hassle and confusion associated with the use of different resin cements, adhesives and primers, reducing stock and saving you and your practice time, space and money.

The new universal resin cement comes in a game-changing 3M RelyX Universal Automix Syringe. Due to its proprietary self-

sealing design, it can be cleaned easily and stored without the used Micro Mixing Tip for better hygiene. Being smaller than currently available standard automix systems, the ergonomic syringe delivers the usual number of applications with half the plastic waste. The unique mixing tip design is responsible for an 80 percent reduction of cement waste per application compared to the standard mixing tips.1 Other benefits of RelyX Universal Resin Cement relate to its innovative initiator system and filler architecture. Thanks to the initiator system, excess outflow can be easily removed after tack curing. Moreover, it ensures that a high bond strength is developed independent of the selected curing mode (self-cure or light-cure). The new fillers offer a radiopacity higher than that of enamel, which facilitates identification of the cement layer and possible excess material on X-rays.

RelyX Universal Resin Cement is available in four colourstable, fluorescent shades for highly aesthetic outcomes and produces virtually no post-operative sensitivity.2 3M RelyX Universal Resin Cement and 3M Scotchbond Universal Plus Adhesive are available now from all 3M authorised distributors.

For more information in Australia, visit go.3M.com/RelyXUau or in New Zealand visit go.3M.com/RelyXUnz. 1. Source: M. Cowen, J.M. Powers, Dental Advisor, Biomaterials Research Report, Number of Automix Applications and Mixing Efficiency, No. 134 June 23, 2020.

2. Source: Field Evaluation EU/USA conducted by 3M.

Always follow the Instructions for Use (IFU) and refer to IFU for full indications, precautions and warnings.

22 Australasian Dental Practice

May/June 2021

3M™ RelyX™ Universal Resin Cement

Goodbye complexity.

The two that can do it all: Instead of multiple resin cements, primers and adhesives, get two products that reduce hassle and confusion – saving you space, time and money.

FLAME_3M5950 12/20

With outstanding self-adhesion, 3M™ RelyX™ Universal Resin Cement reliably and efficiently treats routine cases. Used with 3M™ Scotchbond™ Universal Plus Adhesive, it provides extra bond strength for demanding indications. Benefit from easy excess clean-up and a unique, ergonomic, low-waste automix syringe with a self-sealing design for hygienic storage.

3M Australia Pty Limited Building A, 1 Rivett Rd North Ryde, NSW 2113 1300 363 454 go.3M.com/RelyXUau

3M New Zealand Limited 94 Apollo Drive Rosedale, Auckland 0632 0800 808 182 go.3M.com/RelyXUnz

Scan to request a demo.

3M, “3M Science. Applied to Life.”, RelyX and Scotchbond are trademarks of 3M. © 3M 2020. All rights reserved.

spectrum | NEWS

American Eagle and Dr Anthony Mak team up to create new instrument range

A

merican Eagle Instruments Inc. has teamed up with Sydney dentist Dr Anthony Mak to create a new range of instruments perfectly suited to placing composite resin restorations. American Eagle is a leading global manufacturer of dental hand instruments and related supplies based in Missoula, Montana, USA. “American Eagle approached me to come on board as their key opinion leader during IDS in 2019,” Dr Mak said. “I knew American Eagle as a great company with great instruments, so I said I would love to be involved. They were particularly interested in working together on the development side of things.

“American Eagle have always been well-known for their perio instruments and now they’re looking to build up their restorative product portfolio.

So they offered me the opportunity to develop a set of restorative instruments designed for general dental practices.

“I said that if I was going to do that, I wanted to develop something that was simple, rather than a huge range of lots of different instruments designed for a really fine niche. My idea was to develop a set of instruments that was going to cover 90% of the composite restorative needs of the general practitioner.

“And they loved that idea.”

Dr Mak then set about reviewing American Eagle’s existing range of restorative instruments and seeing what needed to be done in order to meet his goal of developing 5 instruments for 90% of indications.

24 Australasian Dental Practice

“Together with American Eagle, we looked at their current portfolio. The range was already very good and we just needed to tweak some of the blades and the tips and package them together so that it would fit within five instruments,” Dr Mak said. “We selected some of the instruments we felt would be the most useful or similar to what we’d been using in the past and really liked.

“Obviously, each instrument has two ends, so some existing instruments had one really useful end while the other end wasn’t so useful.

The new range of instruments designed

by Dr Mak is titled the American Eagle M5 Restorative Series amd comprises the M5-Sculpt, M5-Anterior, M5-Pack, M5-Carve and M5-Mini.

“Finally, we were able to use one of American Eagle’s stainless steel cassettes to package and protect the instrument set.

The cassettes are really low profile so you can fit multiple cassettes in the autoclave easily. The idea was that every time a dentist would be doing any sort of restorations

WATCH THE VIDEO

“We were then able to modify some of the ends how we wanted and then we selected handles. We liked a wider handle because of the weight and the balance of it and we wanted to use stainless steel because we want these instruments to be really long lasting.

“And finally we wanted all the instruments coated with American Eagle’s amazing patented XP® Sharpen-Free technology that is designed to eliminate the need to re-sharpen instruments.

“We ended up with five instruments which we felt would indeed cover the majority of the requirements for placing anterior and posterior composites in dayto-day general practice.”

in composite, they would just use this kit together with an exam kit and you would have everything you need.”

Dr Mak road-tested all of the instrument designs in his practice to ensure their efficacy before giving the final green light.

“This was a great opportunitity to get involved in product development and this year-long project resulted in a very useful outcome. Hopefully I can do more of this in the future and share what I’ve experienced to develop products for dentists in Australia and globally so that we can improve dentistry together.”

The American Eagle M5 Restorative Series are now being launched globally and are available in Australia through Dentavision. For more information or to order, call 1800-806-640.

May/June 2021

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1800 806 640 | dentavision.com.au

1800 806 640 | dentavision.com.au

spectrum | NEWS

$90,000 Ultimate Practice Makeover on offer to one lucky dentist - Apply now!

A

perfect day for a great many dentists is to arrive at work, have their appointment book full of the work they love to do and have an infrastructure around them running like a well-oiled machine.

You’re working as hard as you want to and the financial rewards are rolling in, funding a nice home, regular holidays, private schools for your kids and money in the bank besides.

For some dentists, however, that dream is proving elusive. You studied hard at dental school and have attended all the right post-graduate clinical programs supporting your particular areas of interest.

But somewhere in the mire of transition from simply being a great dentist to a great dental practice owner, the wheels fell off.

But take heart! Great dentists are not necessarily great at business. The key to owning a successful dental practice is actually not so much about becoming great at business as recognising that you need help to do so.

There are a plethora of service organisations in Australia today that have sprouted up in support of the skills dentists now need to bring to bear to run a successful practice.

So the real question is how do you know what you need to do and who the best people are to help you take your practice from good to great?

If you’re a practice owner that feels your potential is far from being at its fullest, then we invite you to apply for a firstof-its-kind experiment on the cause and effect of all of these services being brought to bear on your practice over an intensive 6-month period. Enter the Ultimate Practice Makeover competition now and it could help give your practice the kick start it needs for you to realise your dream.

Accepting the challenge ustralia’s Number 1 Google ranked dental marketer, Angus Pryor, together with a host of renowned consultants, trainers and industry experts, have joined forces to accept a challenge.

“As the publisher of Australasian Dental Practice, I’ve known Angus for a number of years now; I’ve read his articles, watched his video presentations and heard him speak at events on several occasions,” said Joseph Allbeury. “But like many dentists, I’m always curious

A

Entering the competition o enter the competition to win the Ultimate Practice Makeover, you need to either make a two-minute video or a 250-word entry. Full details of what to include can be found on the website. If you win, be prepared for an amazing adventure as Angus and the Makeover Crew descend on your practice and enact a plan to take it to new heights. And remember, every step of your journey will be videoed and streamed on Dentevents.TV, so if you’re shy, think twice before you apply!

T

IN!TheUltimate...

W Practice Makeover WIN a complete public image update valued at over $90,000! as to how much of a difference dental marketing, and indeed many of the other services that often fill the pages of this magazine, actually makes.

“So with a view to finding out once and for all, I issued Angus with a challenge!

Find a dental practice in need of some TLC and fix it! To his credit, Angus accepted the challenge with fervour and the Ultimate Practice Makeover was born!

“Angus has recruited a formidable team to help with the Makeover as well as a range of products and services that will ensure the practice chosen will, as he put it, go from wallflower to sunflower.

“My final stipulation to Angus was that every second of this unique experiment must be filmed for our new Dentevents.TV dental video streaming website so every dentist can see the results as they unfold.”

The makeover he Ultimate Practice Makeover is currently valued at over $90,000 and includes everything required to completely reinvent your public image.

Angus and the Makeover Crew will create an individual road map for your future success and tailor the contents of the prize around your exact needs.

Part of this will include working on your brand identify and ensuring you have the right name for your practice, logo, colour scheme and website address.

The most tangible component of the Makeover is an update of the reception and waiting area of your practice valued at $40,000, courtesy of leading surgery design and construction company, Medifit.

This will ensure your practice has a fresh,

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www.ultimatepracticemakeover.com.au 28 Australasian Dental Practice

May/June 2021

dentevents.tv

Entries Close 31st May

IN!TheUltimate...

W Practice Makeover ORIGINAL productions

WIN a complete public image update valued at over $90,000!

If you love being a dentist but recognise that your practice is not where it needs to be, then take heart!

For the first time ever, you could win the “Ultimate Practice Makeover” valued at over $90,000! This package of products and services will completely update the public image of your dental practice and get you and your staff trained and on track for business success over a 6-month journey.

The prize, valued at over $90,000, includes a new website, new branding, new uniforms, coaching for you, training for the whole team, an update of your reception area, signage and more (check the website for the growing list).

To enter, you need to make a video on your smartphone or other device and make it fun!

Tell us why you want to change! The video should also include: To be eligible to enter, all you need is a dental • Information on you, your practice and team practice and a smartphone or camera to video your show us the team at work entry!

• Where your practice is located Plus, if you win, you’ll need to be ready for a fun • Why you think you need help adventure as your practice is transformed from • Any stories of how you’ve tried to grow the wallflower to sunflower. practice in the past and what the result was Your practice’s journey will be documented on • What you’re really like - don’t be afraid to inject video and your results published for other practices your personality into your video as we want to to see - and follow along - so be prepared for some see the real you! fun in the spirit of reality television as your practice • Do not include anything in your video you do not is tuned for maximum patients orErskine competitors to will see provide as the patient contemporary and invitingsuccess. look and feel You personally will want receiveyour one-on-one Oral Care mayestabbe published Dentevents.TV orwill proin keeping with new brand, ready for marketer, coaching with Dr Jessevideos Green, who welcomeon packs whilst SpeedPix Australia’s #1 your Google ranked dental elsewhere. all the new patients who will be beating a lished Savvy Dentist to support dentists to vide software and a tablet computer to Angus Pryor, will manage your makeover, roping in path to your door once your new marketing develop financial intelligence, have more make chairside patient education easy. a range of experts to help along the way. Together, Once selected as the winner by the expert judging regime is in place. time and work less, create highthe performance premium listing on dentist.com.au they’ll bring the public image of your practice panel, “experiment”Your begins!

Legendary While is creatingand yourensure marketing teamsare and master thedental art of patient flow. Angus combined with acomprehensive into theAngus 21st century that you marketer Pryor (and team of otherSearch maximising your opportunities for success. plan, Jayne Bandy from Dental Phone Channel D will beconsultants) installed on a will TV in Optimisation ensure workEngine with you over thewill next 6 patients Excellence and Call Tracking Excellence your waiting area to prompt patients to are flocking to your brand new website. months to transform your practice.

By the end of the journey, your practice will look will train your team in how to ensure start conversations about treatment.

So if your practice needs help to get better and function better and your new patient now! every caller ends up in your dental chair Centaur SoftwareApply numbers and turnover will grow. And you will have will provide you with to the next level and you’re looking for a for treatment.

And you and your team will Dental4Windows practice management fun adventure, enter the Ultimate Practice a plan to maintain your success for the future. also receive stylish new uniforms.

software or $5,000 of services.

Makeover before 31 July, 2021.

Sponsored by... ™

www.ultimatepracticemakeover.com.au May/June 2021

Australasian Dental Practice

29

dentevents.tv

Entries Close 31st July

IN!TheUltimate...

W Practice Makeover ORIGINAL productions

WIN a complete public image update valued at over $90,000!

If you love being a dentist but recognise that your practice is not where it needs to be, then take heart!

For the first time ever, you could win the “Ultimate Practice Makeover” valued at over $90,000! This package of products and services will completely update the public image of your dental practice and get you and your staff trained and on track for business success over a 6-month journey.

To be eligible to enter, all you need is a dental practice in Australia and some details (via video or text) to support your entry.

The prize, valued at over $90,000, includes a new website, new branding, new uniforms, coaching for you, training for the whole team, an update of your reception area, signage and more (check the website for the growing list).

To be eligible to enter, all you need is a dental practice in Australia and either (i) 250 words describing why you should win, or (ii) a short video to support your entry!

Tell us why you want to change! You can include details such as: • Information on you, your practice and team show us the team at work Plus, if you win, you’ll need to be ready for a fun • Where your practice is located adventure as your practice is transformed from wallflower to sunflower.

• Why you think you need help • Any stories of how you’ve tried to grow the Your practice’s journey will be documented on practice in the past and what the result was video and your results published for other practices to see - and follow along - so be prepared for some • What you’re really like - don’t be afraid to inject fun in the spirit of reality television as your practice your personality as we want to see the real you! is tuned for maximum success.

• Do not include anything in your entry you do not want your patients or competitors to see as the Australia’s #1 Google ranked dental marketer, content may be published on Dentevents.TV or Angus Pryor, will manage your makeover, roping in elsewhere. a range of experts to help along the way. Together, they’ll bring the public image of your practice Once selected as the winner by the expert judging into the 21st century and ensure that you are panel, the “experiment” begins! Legendary maximising your opportunities for success. dental marketer Angus Pryor (and a team of other consultants) will work with you over the next 6 By the end of the journey, your practice will look months to transform your practice. better and function better and your new patient numbers and turnover will grow. And you will have Apply now! a plan to maintain your success for the future.

Sponsored by... ™

PRIZE INCLUDES… •

Refresh of your waiting area and signage valued at up to $40,000

•

New website and SEO package ($12,000 value)

•

New practice management software (if required) ($5000 value)

•

Marketing consultancy for 6 months to help you “stay on plan” ($10,000 value)

•

Telephone answering training ($3500 value)

•

New uniforms, patient welcome packs and more... ($2500 value)

•

A full marketing review of your practice with a “SWOT” style analysis ($3500 value)

•

Online marketing including dentist.com.au premium upgrade ($2000 value)

•

Training for you and your team ($2000 value)

•

Treatment presentation coaching ($2000 value)

•

Development of a marketing strategy for six months ($2000 value)

•

Full branding package - logo, colours, style guide and more... ($1000 value)

•

A clear roadmap for your future success Priceless!

•

And more…

Reception and waiting area update Your marketing must match the look and feel of your practice when patients arrive so as part of the prize, Medifit, Australia’s oldest and most accomplished dental surgery design and construction company will makeover the public face of your practice to ensure your patients are WOW’d every single time.

The team from Medifit will work with you to enhance the reception and waiting area of your practice to ensure it delivers on patient expectations. Every practice is different and Medifit will craft a bespoke solution based on your individual situation that could include upgrading your shopfront and signage, new waiting room furniture, reception desk and lighting, an updated colour scheme and more up to the value of $40,000.

Medifit will consult with you and the practice makeover marketing team, providing you with 3D renderings of how your practice will look right through to delivering the upgrade, working around your schedule to ensure minimal disruption. Your reception and waiting area and public image will shine once Medifit have worked their magic. The entire experience will be filmed for broadcast on Dentevents.tv and elsewhere, as well as featured in magazines so everyone in the profession can understand the advantage of working with an experienced, professional dental practice design and construction company like Medifit.

See www.UltimatePracticeMakeover.com.au for full details Terms & Conditions • • • • • •

Entry is open to all privately owned dental practices in Australia.

All entries must be made by the owner of the practice or an authorised representative of the owner.

The only valid method of entry is by completing the entry form on www.UltimatePracticeMakeover.com.au including either a video or up to 250 words of text.

All content provided can be used for promoting the competition. All entries may be displayed on Dentevents.TV for public viewing.

The content provided becomes the property of and may be displayed on dentevents.tv and other websites.

The content provided must not contain material that is considered to be offensive to any gender, cultural group, race, etc and should not contain nudity or profanity.

• If you choose to supply a video, it should be no more than 2 minutes in length.

• The prize incorporates a bespoke, interactive consulting process (and supporting products) tailored to the winning practice. By entering, you agree to participate in this consulting process which will be filmed and appear on Dentevents.TV and elsewhere, and as part of written articles that include photographs published in Australasian Dental Practice magazine, Oral Hygiene magazine and elsewhere both in print and online.

• As part of the consulting process, you agree to disclose information related to various metrics of your practice at the beginning and the end of the “makeover” for the purposes of publishing the results as a quantifiable outcome. For example, the show may disclose that the turnover of the practice increased by $100,000, or new patient numbers increased from 20 to 40 per month.

• FULL TERMS AND CONDITIONS ARE ON THE WEBSITE

spectrum | NEWS

Kulzer Australia launches Venus Diamond and Pearl ONE Shade

O

ne for the basics.

All for the details.

With this message, Kulzer launches a one-shade composite solution for the majority of everyday cases: Venus Diamond ONE Shade and Venus Pearl ONE Shade. Due to its incredible shade matching properties, a restoration with the new ONE Shade becomes invisible by blending into any surrounding dentition. ONE Shade saves time as no shade selection is needed. Based on the Kulzer experience and know-how in modern composites, Venus Diamond and Venus Pearl ONE Shade come with the huge advantage of being integrated into a family of composites that have been scientifically evaluated and documented in numerous clinical cases for more than 10 years. Venus Diamond and Venus Pearl are appreciated by dentists worldwide for their efficient handling, strength and aesthetic possibilities.

Figure 1a-b. Tooth 26 before and after Class I restoration with Venus Diamond ONE.

Figure 2a-b. Tooth 45 before and after class II restoration with Venus Pearl ONE.

ONE for the basics enus Diamond and Venus Pearl ONE Shade are used for basic restorations, e.g. in the posterior region. ALL for the details: All known Venus Diamond and Venus Pearl shades cover the more complex and aesthetically challenging cases, e. g. in the anterior. Altogether, they stand for one efficient and reliable solution independent of one-shading or aesthetic layering demands.

Venus Diamond and Venus Pearl ONE Shade blend seamlessly into the surrounding dentition, independent of the tooth shade, enabling restorations to simply disappear. Dentists not only meet the same easy and convenient handling as with Venus Diamond and Venus Pearl that has been confirmed by numerous awards, from Reality or The Dental Advisor.

They can also expect the same enhanced mechanical properties of Venus Diamond and Venus Pearl that have been confirmed successfully in various scientific studies

V

32 Australasian Dental Practice

worldwide. The confirmed resistance to chippings and fractures allows the filling of even large cavities with confidence to satisfy patient demands. The combination of these underlying prerequisites makes the composite so ideal for everyday cases.

The unique TCD-matrix and the optimised nano-hybrid filler system lead to exceptional flexural strength, minimal shrinkage stress and high wear resistance preventing chippings and fractures. The innovative Venus formula thus promises long-lasting, pleasing and reliable restorations with a permanent, natural lustre. Both composites also have high radiopacity, ensuring a reliable diagnosis.

Dentists do not have to change their handling habits while getting a reliable all-in-one composite. With Venus Diamond and Venus Pearl, they can choose the composite consistency according to their preference and indication: Venus Diamond ONE Shade for a firm consistency and Venus Pearl ONE Shade for a creamy consistency. Both composites are stable and equipped with very low stickiness and offer an extended working time.

Their non-slump qualities provide for easy carving and sculpting. Both provide one shading and unlimited possibilities for the aesthetic zone. There is no need for a second line of composite.

Truly universal ONE shade composites enus Diamond and Venus Pearl ONE Shade are truly universalshade composites for everyday cases with enhanced mechanical properties.

With Venus Diamond and Venus Pearl ONE Shade dentists can confidently skip the step of colour selection and still expect highly aesthetic and longlasting results.

V

May/June 2021

kulzer.com/one-shade

ONE FOR THE BASICS

NEW

Scan to learn how Adaptative Light Matching works

Venus Pearl ONE Shade.

Your one shade solution for everyday cases.

Always grab the right shade: With the incredible shade-matching properties of ONE shade the restoration becomes invisible by blending into any surrounding dentition.

Efficient handling: Non-slump qualities for easy carving and sculpting with a creamy, low-stick consistency.

Long-lasting restorations: Exceptional strength to resist chipping and fracture, with over 8 years proven clinical experience.

Try it out for yourself – with our Venus Pearl ONE Shade-Kit kulzer.com/try-one.

Everyday cases with Venus Diamond ONE Shade for a firm consistency and Venus Pearl ONE Shade for a creamy consistency.

For further information, please contact your local Kulzer Restorative Supplier TODAY!

Source: Dr. Edoardo Fossati, Turin, Italy

Source: Prof. Dr. Claus-Peter Ernst, Mainz, Germany

Kulzer Australia P/L E: info.australia@kulzer-dental.com Kulzer.com/australia © 2021 Kulzer GmbH. All Rights Reserved.

spectrum | NEWS

Streaming now on www.dentevents.tv

D

entevents.tv is a brand new website for the dental profession that offers a broad range of video-based content focussed on all aspects of dentistry - from clinical, to technology, to management, marketing and more. Sign in for FREE and watch hundreds of on-demand videos, with more being added every day. Some videos even offer CPD! A selection of videos that will interest dentists and specialists appear below - or browse the website for many many more.

Managing Patient Expectations Presented by Dr Brett L Taylor and Matt Race Duration 0:33:52 AVAILABLE ON DEMAND CPD 0.5 Hours Dr Brett Taylor will discuss exactly what you need to say to patients to manage their expectations, so they remain happy with you (and your treatment), when something goes wrong.

Analysis, Set-up Principles and Patient Satisfaction for Class III Bi-Lateral Crossbite Dentures Presented by Marc Wagenseil Duration 1:50:02 AVAILABLE ON DEMAND CPD 2.0 Hours

DenTechKnow - Digital Dentures Presented by Terence Whitty Duration 0:17:41 AVAILABLE ON DEMAND In this episode of DenTechKnow, Terry Whitty explores the state-of-the-art of digital dentures. This hot topic has been the focus of digital dentistry for the past few years with hardware, software and materials companies collaborating to try and provide a fully digital solution. Terry investigates what is possible at this point in time when it comes to producing dentures using the various solutions on offer and what we can expect in the future.

Infection Control Boot Camp Presented by Prof. Laurence Walsh Duration 7:08:14 AVAILABLE ON DEMAND CPD 6.0 Hours Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months. This paid online learning program spans 27 video modules watched on-demand over more than 7 hours.

Watch hundreds of videos on-demand for FREE at www.dentevents.tv

34 Australasian Dental Practice

May/June 2021

STREAMING NOW ON-DEMAND

Dentevents.TV is a brand new dental video streaming service Watch a growing list of hundreds of videos related to dentistry all in one place

www.dentevents.tv

spectrum | NEWS

8 great websites for dental professionals

www.dentalpractice.com.au Magazine

www.oralhygiene.com.au Magazine

www.elaborate.com.au Magazine

www.dentalcommunity.com.au Professional Portal

www.dentevents.tv Dental Video Streaming

www.dentevents.com Events Calendar

www.dentist.com.au FInd-a-dentist - Australia

www.dentist.co.nz Find-a-dentist - New Zealand

8

websites catering to all the needs of the dental profession have now been updated to optimise their performance across all devices.

Brand new websites have also been created for Australasian Dental Practice, Oral Hygiene and eLABORATE magazines.

36 Australasian Dental Practice

“8 websites may seem like a lot but each fulfils a role in the dental profession,” said Joseph Allbeury, publisher of this magazine and all of the websites. “Whether you are looking for news, product info, events to attend, videos to stream and more, we have it covered. We even help dental practices attract patients through dentist.com.au and dentist.co.nz.”

May/June 2021

RIVA STAR AQUA RIVA STAR AQUA TOOTH DESENSITISING AGENT TOOTH DESENSITISING AGENT

THE NEXT THE NEXT GENERATION GENERATION SDF SYSTEM SDF SYSTEM SDF (Silver Diamine Fluoride) has a proven clinical history of arresting and Fluoride) treating dentine SDF (Silvercaries Diamine hypersensitivity for over 50 years. has a proven clinical history of arresting caries and treating dentine Riva Star Aqua isfor theover latest hypersensitivity 50 innovation years. to the SDF treatment category. The patented waterisbased silverinnovation fluoride Riva Star Aqua the latest solution is not only antimicrobial, to the SDF treatment category. The it is also awater bio film eliminator and patented based silver fluoride asolution powerful desensitiser. is not only antimicrobial, it is also a bio film eliminator and a powerful desensitiser.

NEW NEW

INDICATIONS: BRAZIL / LATIN AMERICA: Desensitising cervical tooth hypersensitivity, arresting caries, detecting caries.

AUSTRALIA / EUROPE: Desensitising cervical tooth hypersensitivity. USA: Treatment of dentinal hypersensitivity, for use in adults over the age of 21.

Each product kit contains Instructions For Use to ensure correct use as indicated.

INDICATIONS: BRAZIL / LATIN AMERICA: Desensitising cervical tooth hypersensitivity, arresting caries, detecting caries.

AUSTRALIA / EUROPE: Desensitising cervical tooth hypersensitivity. USA: Treatment of dentinal hypersensitivity, for use in adults over the age of 21.

Each product kit contains Instructions For Use to ensure correct use as indicated.

COMPOSITES | GLASS IONOMERS | TOOTH WHITENING SDF RIVA STAR | CEMENTS | ADHESIVES | ETCHANTS SEALANTS | AMALGAMS | ACCESSORIES COMPOSITES | GLASS IONOMERS | TOOTH| EQUIPMENT WHITENING SDF RIVA STAR | CEMENTS | ADHESIVES | ETCHANTS SEALANTS | AMALGAMS | ACCESSORIES | EQUIPMENT

orders phone 1300 65 88 22 | orders fax 1300 65 88 10

YOUR OUR SMILE. VISION. YOUR OUR Call 1800 337 003 SMILE. VISION. www.sdi.com.au Call 1800 337 003

dentevents presents...

Infection Control

BOOT CAMP 2020 BOOT CAMP ON DEMAND ONLINE LEARNING PROGRAMME

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

6

HOURS CPD

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

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions. n n Hand

hygiene and hand care practices. n n Addressing common errors in personal protective equipment. n n Biofilm

reduction strategies. n n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n n Correct

operation of mechanical cleaners and steam sterilisers. n n Wrapping and batch control identification. n n Requirements

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

Register Now: www.boosterinjection.com.au

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

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

Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

REGISTRATION FEES

REGISTRATION INCLUDES n n

Dentists Others

$660 inc inc gst gst $330 inc inc gst gst

n n n n n n

dentevents.tv

n n

On-Demand access to 26 Online Learning Videos (Over 6 hours of education).

Online Learning Companion Booklet.

Suggested Reading Material Booklet.

Access to regular Q&A Webinar(s).

Online Questionnaire to earn 6 Hours of CPD.

Infection Infection Contol Contol Boot Boot Camp Camp is is presented presented by

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

Register Now: www.boosterinjection.com.au

spectrum | NEWS

AG.Live CON highlights the key trends of transformation in the dental industry

D

igitisation in the dental industry is unstoppable. It heralds change and at the same time offers enormous potential. The fact that many dental technicians and dentists want to seize these opportunities is evidenced by the large number of participants at AG.Live CON. 38 international speakers presented the blueprints for a new dimension of unified dentistry in numerous live presentations and discussions. All contributions are still available free of charge at http://show.aglivecon.digital.

The benefits of digitisation are clear, as Prof. Dr. med. dent. Daniel Edelhoff explained in the panel discussion: “In more and more clinical work processes, analog steps are being replaced by digital technology, which brings about enormous advantages: the simplification of process steps, reproducibility and a high degree of predictability.” However, the communication gap between dental technicians and dentists emerged as a key issue in the panel. “Laboratories have invested heavily over the past few decades and digitised in the field of CAD/CAM. However, digitisation currently stops at the interface with the dentist,” said master dental technician Andreas Kunz during the panel discussion. The experts unanimously agreed that the greatest deficit currently lies in combining all available patient data in a meaningful manner and then using these data to provide patient-specific treatment.

More than the sum of its parts hat is important is teamwork for the benefit of the patient. “For a complex restoration, you need a highly competent partner in the laboratory and a highly competent clinician. Then their combined expertise is more than the sum of the individual parts,” emphasized Prof.

Dr. med. dent. Florian Beuer. The objective must be for the two to join forces in the best possible manner. This is precisely the mission that Amann Girrbach has set itself and, after five years of development work, has

W

40 Australasian Dental Practice

launched AG.Live, the largest digitisation offensive in the company’s history. This web-based portal for collaboration between laboratories and dentists offers perfect digital services at all levels. To give an example, AG.Live as a central tool for digital case management, a networking, infrastructure and material management, support and knowledge database will gradually replace the previous C3 customer portal.

tion Kit, consisting of the Ceramill Map DRS intraoral scanner, the appropriate scanning software as well as the connection to the AG.Live platform, serves as the entry-level variant. Any order data including all the required information can therefore be shared seamlessly and in real time, as the practice is linked fully digitally to the laboratory via AG.Live. This permits same-day dentistry for simple res-

On the one hand, the platform networks machines and materials in the laboratory, thereby simplifying processes and increasing quality and reproducibility. The biggest advance, however, is providing the link in a growing global network of digitally operating dental professionals. This bridges the interdisciplinary gap between dentists and dental technicians and facilitates future-oriented cooperation. In this network of optimised and new partnerships, the participants can focus on their strengths and better position themselves on the market.

torations, also with zirconia by using the Ceramill DRS High-Speed Zirconia Kit. This is supplemented by the Ceramill DRS Production Kit, which allows fabrication to be performed directly in the practice by the dentist. Here, the laboratory can assist the practice in terms of design, know-how, service and advice.

This results in 3 Ceramill Team Workflows, which can be used depending on the kit equipment and team constellation. Due to the modular design, it is possible to start on a “small scale” with the Ceramill DRS Connection Kit and upgrade to the Ceramill DRS Production Kit at a later stage.

AG.Live and DRS as well as all digitization solutions from Amann Girrbach support practices and laboratories on the journey that Prof. Dr. med. dent.

Jan-Frederik Güth describes in his summary of the panel discussion as follows: “Patient-oriented, focused, personalized, team-oriented, simplified and digital that’s where the journey is headed.”

Extending Ceramill CAD/CAM workflow to the dentist G.Live also forms the basis and interface for the Ceramill Direct Restoration System (DRS), with which Amann Girrbach extends the digital Ceramill CAD/CAM workflow to the dentist. The Ceramill DRS Connec-

A

May/June 2021

DISCOVER THE NEW DIMENSION OF UNIFIED DENTISTRY #dentistryunified

DIGITAL DENTAL CONFERENCE + EXPO 20-24 APRIL 2021

With AG.Live CON, Amann Girrbach has presented the status quo of digitization, innovative trends and new technologies in dentistry.

True to the motto „Own the digital transformation,“ experts from all over the world provided exclusive insights and top-class expertise on the topics of digitization and interdisciplinary workflows.

Charité University Clinic of Berlin, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders

University Clinic of Dentistry Vienna, Managing Director, Medical Director, Head of the Clinic

PRESENTATION HIGHLIGHTS

Amann Girrbach AG Tel +43 5523 62333-105 www.amanngirrbach.com

DISCO

CE

CREDITS TA L D E N TIS

Y

LMU University Clinic of Munich, Polyclinic for Dental Prosthetics / Director

& RN

TR

PROF. DDR. ANDREAS MORITZ

I

The presentations are available online. Register for free today!

UNIV.-PROF. DR. MED. DENT. FLORIAN BEUER MME

DIG

show.aglivecon.digital 3

PROF. DR. MED. DENT. DANIEL EDELHOFF

R VE

MISSED THE START? NO PROBLEM AT ALL!

LE A

All the presentations and contents continue to be available free of charge after the event at show.aglivecon.digital

spectrum | NEWS

New and improved flexible service agreement for 3Shape TRIOS scanners

3

Shape has introduced a new and improved flexible service agreement for its award-winning TRIOS intraoral scanner. The new TRIOS Care, improved and flexible service agreement, adds exceptional benefits for TRIOS users. Benefits include a 5-year warranty; 24-48 hours replacement service for faulty systems; unlimited technical support and 3Shape Academy training points for 1:1 3Shape Academy sessions.1 Importantly, full-service coverage, as outlined above, is now free with the first year of TRIOS ownership.

“When you dive into something new, like dentists are doing with intraoral scanners, we want them to be 100% certain that they are making the right choice and their investment is secure,” said 3Shape CEO Jakob Just-Bomholt. “TRIOS Care makes a doctor’s decision so much simpler. Our awardwining scanner comes with complete and comprehensive coverage and support. For doctors, it means reaching your digital potential stress-free.”

3Shape research has found that 66%2 of dental practices are preparing to invest in a digital impression system. 3Shape TRIOS Care provides professionals with complete peace-of-mind assurance when they purchase a 3Shape TRIOS scanner.

With the TRIOS Care service agreement, doctors can focus on providing great treatments and succeeding in their digital journey from day one. Any worries about getting started with digital dentistry workflows, having technical support, or mishaps with the scanner, are now covered by TRIOS Care.

TRIOS Care - gateway to new flexible choice fter the first year of TRIOS Care expires, professionals can continue to enjoy the complete peace-of-mind benefits of the service agreement with monthly or yearly installments. Professionals can also switch to TRIOS Only - a basic scan-ready service agreement with limited benefits and no monthly costs.

A

Comparison of TRIOS Care service agreement with no cost TRIOS Only

TRIOS Care

TRIOS Only

3 3 3 3 3

3

Software updates New features

Technical Support

Express replacement

3Shape Academy points Discounts

Pay per case

25% on add. TRIOS Care Trade up offers

1st year of TRIOS Care included for all new customers.

Present 3Shape TRIOS CliniCare customers RIOS Care and TRIOS Only will be available to 3Shape TRIOS CliniCare customers on expiration of their active CliniCare agreements from early 2022.

T

1. Terms of the agreement can vary by country. Contact your reseller for details. 2. Buying intent, 3Shape Market Survey, 2020 - data on file.

42 Australasian Dental Practice

May/June 2021

A BIT MORE… A BIT MORE… OTHER BRANDS

SEPTOJECT

Every Every practitioner practitioner can can experience experience diffi difficulties culties with with the the penetration penetration and and trajectory trajectory of of aa dental dental needle, needle, which which is often directly related to the pain felt by the patient, both at the time of application and afterwards.

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(1) Microscopic evaluation of dental needles.

Diego Espinosa Sanchez ans Roberto Espinosa Fernandez. University center of Health Sciences. Guadalajara Mexica. The dental surgeon of “Best Product 2010”.

France N°1206 du 07 avril 2005.

Orders 0800 808 8

20:17 Orders08/12/2016 0800 808 08/12/2016 20:17

(2) Assessing dental needles. Diego Espinosa Sanchez and Roberto Espinosa Fernandez .University center of Health Sciences, Guadalajara, Mexico. The DENTIST January 2007.66-68.

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A BIT MORE… Biodentine Biodentine Biodentine

SEPTOJECT SEPTOJECT XLX ™

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T SEPTOJECT XL S XL NEW E NEW NEW Septoject XL The first and only dentin in aStandard capsule NEW Needle Needle

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Septoject Standard XL Preferred Septoject XL Products in the Anesthetics, Inje Imp Needle Needle Needle

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le outcomes for (triple your littlest patientsand with siliconized Hu-Friedy Stainlesscannula) Steel Pedo Crowns. bevel cover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Pulpitis choices. Selected voluntary clinicians cond Pulpitis Irreversible PulpitisSte Sterilized by gamma-Ray comes to the perfect fit, Hu-Friedy is just right.Irreversible in their private practice and then report

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2010, Septoject XL was evaluated by 11 U Endodontics The clinicians involved rated Septoject XL

Biodentine saves pulps EVEN with signs and symptoms Biodentine saves pulps EVEN with signs and symptoms outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. ™ of irreversible pulpitis* first all-in-one biocompatible and bioactive substitute, Biodentine saves pulps EVEN with signs and symptoms htverand mesio-distal width “Best Productdentin 2010”. of irreversible pulpitis* why dentists favor our impeccable fit.

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Biodentine of irreversible pulpitis* For vital pulpistherapy, comes the perfect fit, Hu-Friedy just right. bulk-filling the cavity with Biodentine ed andtopre-crimped for ™ simple placement

up to 85%** irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier faster: ™ ™ helps Biodentine up to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation OVE OUR anatomy STAINLESS STEEL PEDO CROWNS: cclusal that the tooth pulpitis benefi brings one-of-a-kind of remineralization of dentin, preserves the pulp Biodentine up tomatches 85%** of natural irreversible cases:ts for the treatmentthe •upPulp healing promotion: proven biocompatibility and bioactivity vitality and promotes pulp healing. It replaces dentin with similar to Therapy 85%** ofallowing irreversible pulpitis cases:bridge • Vital width complete dentin formation •Pulp Minimally Invasive treatment preserving the tooth structure Vital Pulp risk Therapy allowing complete bridge formation and mesio-distal •• Reduced of failure: strong sealing dentin properties biological and mechanical properties.

Vital Pulp Therapy allowing complete dentin bridge formation • Minimally Invasive treatment the tooth structure d and pre-crimped simple placement Immediate Pain relief your patients’ comfort Minimally Invasive treatment preserving thepulp tooth ••forOnly one material to fifor llpreserving the cavity from the to structure the top ™ clusal anatomy that matches the natural tooth Improving on Biodentine Minimally Invasive treatment preserving the tooth structure • Immediate Pain relief for your patients’ comfort Bio-Bulk fi lling procedure for an easier protocole •• Similar mechanical behavior as natural dentin: ideal for bulk fillingclinical implementation, you can now bond Immediate Pain relief for your patients’ comfort ™ in the same visit and perform the the composite onto Biodentine •• Immediate Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole Bio-Bulk filling for The fifinal restoration willan beeasier placedprotocole within 6 months. full restoration in a single session.

INE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk filling procedure for an easier protocole

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Please visit our website for more information Call 0508 486 252 Please our website more information www.septodont.com Please visit ourvisit website for morefor information Please visit our website for more information 855 www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au www.ivoclarvivadent.co.nz www.septodont.com www.septodont.com *If haemostasis cannot be achieved after full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) Please visit our website for information Learn more with www.septodont.com more

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

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

spectrum | NEWS

NeossONE™ - One Platform, Smart Prosthetics, three implant ranges

N

eossONE is a solution unique to the Neoss® Implant System - one prosthetic platform, across three implant ranges, including ALL implant diameters and abutments. Simply put, the same prosthetic components fit every implant.1 ONE Prosthetic Platform, ONE Impression Coping, ONE Kit! One prosthetic platform, across three implant ranges, means one impression coping, one implant replica and one abutment interface, facilitating treatments that are adaptable and versatile.

With fewer components in the system, complexity is reduced and time-efficiency is improved. All of which results in a truly cost-effective solution and predicable outcome.

Why choose the NeossONE Platform? n a market where simplicity is commonly claimed, Neoss has redefined its meaning. In contrast to traditional implant systems necessitating up to a thousand components, Neoss uses a minimum number of components to achieve the highest level of flexibility and functionality, without compromise. Utilising NeossONE, with its proven long-term clinical performance, enables integration of innovations in surgery and prosthetic rehabilitation, providing unique benefits for the whole dental team.

I

What does NeossONE™ provide for dental team? or clinicians, it means predictable aesthetics, soft tissue integration and prosthetic precision. The ingenuity lies not only in the NeossONE solution, but in the patented Neoss implant design that optimises stability in all bone qualities and conditions and eliminates the need for separate one- or two-stage designs. The benefits of both are clear: a predictable solution with shorter chair time2 and optimised inventory control.

“The NeossONE concept of a single restorative platform across an entire implant range is a huge benefit for our entire dental team. It offers elegant and comprehensive treatment solutions to achieve predictable long term results, whilst maintaining the simplicity of a reduced inventory,” said Dr Kavit N Shah, BDS, MFDS.RCS (Eng), M.Clin.Dent, MRD.RCS (Eng) from The London Centre for Prosthodontics.

For dental technicians, the NeossONE solution offers an intelligent and simple solution with less inventory of components, digital workflows supporting local production or central production for patient-specific solutions. This requires less effort and time to implement, gives maximum flexibility and strengthens relationships with the clinician’s team.

“I am probably one of the first customers of Neoss in the US (2006). I saw the ingenuity and technical advantages from the start; one prosthetic platform reduces inventory, eases communication and saves time,” said Steven Pigliacelli, CDT, MDT from Marotta Dental Studio Inc.

F

46 Australasian Dental Practice

The benefits are clear: reducing patient treatment time, optimising inventory control and patient outcomes.

About Neoss® ounded in 2000, by a professor of prosthodontists and a specialist engineer, Neoss offers intelligent dental solutions that are intuitively simple to use. The company’s products are designed to allow dental professionals to provide reliable and cost-effective treatments to their patients with excellent longterm results. Leading with innovation and integrity, Neoss develops smart treatment solutions and works closely with each practice to drive Intelligent Simplicity, making the complex less complicated. Headquartered in Harrogate, UK, with research and development based in Gothenburg, Sweden, the company has established a global footprint with long-standing presence in key markets.

F

To find out more information about the NeossONE solution, visit www.neoss.com/en/products-solutions/neossone

References 1. Narrow diameter implant range excluded.

2. Customer feedback from the Neoss ProActive® Edge implant ambassador programme.

May/June 2021

A new angle on treatment setups.

2.0

Faster, smarter, and more mobile than ever— your treatment setups are about to take flight.

P R O U D LY P R E S E N T I N G N E W F E AT U R E S Mobile view: Need to approve a case on the go? No problem. Mobile view keeps it simple so that you can take care of business any time, anywhere.

Multiview: view upper and lower arches in occlusion and independently all at the same time.

Occlusal heat map: Need to check on any heavy occlusal contacts? We’ve got just the tool for you.

Scan the QR or visit dr.clearcorrect.com to become a provider today!

To learn more, call Osseo Group at 1300 029 383 AUS or 09 973 5342 NZ

dentevents presents...

Exiting Your Dental Practice and Maximising Your Outcome How to get the right result when selling one of your greatest assets MELBOURNE* : JUL 24 | SYDNEY* : SEP 11 | BRISBANE : SEP 25

*organised

in conjunction with the australian dental association

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.

6

HOURS CPD

This course explains: • 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

Register Now: www.exitacademy.com.au

VITAL

INFORMATION for anyone within 5 years of EXITING

Presented by Simon Palmer With more than 15 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.

TOPICS INCLUDE 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

Guest expert finance, legal, accounting speakers

Register Now: www.exitacademy.com.au Dentevents is a division of Main Street Publishing Pty Ltd ABN 74 065 490 655 • www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

spectrum | NEWS

MySmileSim.Dental helps you mine the gold in your goodwill

M

ySmileSim.Dental is a new App and website that can both help dentists attract more new patients and also stimulate greater interest in treatment from existing patients.

MySmileSim.Dental allows patients to take a “selfie” of their smile and receive a custom-designed simulation of how their smile could look after treatment.

Seeing their simulated self is a powerful motivator for considering treatment.

MySmileSim.Dental is already being used by patients to create smile simulations and then being connected with participating dentists for treatment.

“Selfies” received by MySmileSim.Dental are “allocated” to participating dentists based on geographical proximity.

Participating dentists can also place their unique link to MySmileSim.Dental on their website to attract new patients using this innovative, interactive feature.

Each participating dentist can use theirunique link to connect with patients who are predisposed to treatment.

Goodwill mining ne of the most powerful ways to use MySmileSim.Dental, however, is to email a link to your entire patient database as a way of stimulating interest in treatment. From the comfort of their own home, your patients can take a selfie and receive a custom simulation of how their new smile could look after treatment from their already trusted dentist.

MySmileSim.Dental unlocks a new, modern digital patient experience in the convenience of the patient’s home without having to visit the dentist.

The MySmileSim.Dental App is a game-changer and will ignite new growth in your practice - bridging the gap between case acceptance, treatment planning and delivery of a predictable result.

MySmileSim.Dental includes ready to use Digital Smile Simulation software and presents a compelling digital treatment

O

50 Australasian Dental Practice

option to patients, encouraging them to make appointments, accept your treatment plans and return to your practice.

MySmileSim.Dental software allows you to easily design the perfect smile for your patients, allowing for efficient communication, fast treatment planning and more appointments booked.

When the expectations and plans have been carefully reviewed and discussed with the patient, the end result will more likely meet the expectations of the patient.

Exceptional communication ySmileSim.Dental is an exceptional tool for communication. It allows dentists to communicate remotely with the patient via their mobile, tablet or computer, ensuring that more appointment bookings are made by the patient, especially the patients that you are not seeing on a regular basis.

M

Designs can be securely shared via the MySmileSim.Dental App provided free of charge to the patient.

MySmileSim.Dental software provides easy to use tools for designing beautiful, natural and harmonious smiles and does not require any additional equipment or software to function. Participating dentists can create their own simulations or MySmileSim.Dental will complete the simulations and provide options for the dentist to choose to send to the patuent.

MySmileSim.Dental revolutionises a dentists’ ability to communicate with patients who do not visit the dentist regularly, resulting in a higher rate of case acceptance and more appointments booked due to the improved realisation of created designs.

For more info, visit MySmileSim.Dental or email info@mysmilesim.dental or call 1300-489-878.

May/June 2021

“

IF YOU DON’T HAVE CHANNEL D, I THINK YOU’RE NUTS...

Almost every day, a patient says to me....

“I love your videos” . Then they tell me something that they never knew before, or ask me a question.

That’s how the conversation starts, and those conversations inevitably lead to more work.

It’s like having a dental guru sitting next to each and every patient in reception, whispering ideas and planting questions in their head. They walk into the operatory interested in the right topics.

Without these conversations, we wouldn’t be doing half the treatments we do.

Look at the maths. I have 2-3 extra relevant conversations per day. That’s 10-15 per week.

40-60 per month. 480-720 per year. This all adds up to a ton of work and many personal referrals. The patients all think I created the content and I get compliments about it because it’s so personal.

This is nothing like boring dental videos showing scary procedures.

It’s a significant business builder and the cost is peanuts. Speaking of peanuts, that leads me back to my original statement, “if you don’t have Channel D, I think you’re nuts”.

Dr Brett Taylor, Sydney General dentist and super happy Channel D user

Try ChannelD for FREE and see the difference it can make to your practice... Sign up at ChannelD.com and use Promo Code AM58

www.channeld.com

The

to working with only high-quality patients Do you feel like you are on an endless hamster wheel, just trying to keep your practice growing in the face of increasing competition?

You provide an amazing service, but despite your all your efforts and good intentions, your day is a constant struggle to find high-quality patients, set yourself apart from the competition, and boost your production.

As if that weren’t enough, you’re competing against corporates and dealing with patients who seem to care about only one thing…

PRICE. A day in dentistry should be enjoyed not endured - yet, if you don’t learn these secrets, that’s exactly what you can expect more and more of . . . enduring your days away.

Imagine a day where every patient you see:

 regards you as a highly valued healthcare

professional, rather than just an expensive hassle

 is willing and open to accept your

recommendations for ethical treatment plans

 is a walking billboard for your practice, inviting friends and colleagues to become patients.

In this game changing masterclass, you will walk away with a complete understanding of where you have been going wrong, and the three instantly implementable strategies to turn it all around.

What you get Drawing from over 10,000 hours of consulting dentists all over Australia and internationally, multi-award-winning Practice Growth Specialist, Angus Pryor reveals his tried and tested high-quality patient blueprint.

This is his signature A-Z system, proven to propel even the most unprofitable dental practice into unstoppable momentum and growth. You will leave this LIVE event feeling a renewed excitement for your practice – but most important, with a reliable plan of success based on three simple steps: In this action-packed LIVE event, you’ll discover:

 what you are inadvertently doing to attract terrible clients  how your practice is failing the dental equivalent of dressing for success  why even if you could flick the switch, you’re not ready for great patients (yet).

BONUS: attend the live event and receive a FREE 6-pack of social media posts to promote you as a high quality practice Enjoy drinks and canapes from 6.30pm onwards. The presentation starts at 7pm.

Event details

Who is this for?

This LIVE event is perfect for dental practice owners, dental associates and practice managers not happy with the status quo but looking for the fast-track to a steady flow of high quality patients.

�

Mon 19 Jul 21, 6.30pm-9.00pm, central location (details TBC)

�

Key takeaways

 discover your pool of motivated, high-quality patients

Sydney Wed 21 Jul 21, 6.30pm-9.00pm, central location (details TBC)

 finally differentiate yourself and put an end to competing on price  understand why you can’t (and shouldn’t be) everything to everyone

Melbourne

�

 achieve a new outlook on attracting patients to your practice

Brisbane Mon 26 Jul 21, 6.30pm-9.00pm, central location (details TBC)

About Angus Australia’s number one Google-ranked dental marketer recipient of the 2020 marketing award from the Australian Dental Industry Association

number one Amazon ranked author international speaker

REGISTER NOW Visit www.HighQualityPatients.com.au to secure your spot.

Tickets are free but places are limited. Register now!

spectrum | NEWS

Workflow combines analogue and digital

Z

irkonzahn’s workflow has been conceived to let the technoclinical team combine analogue and digital working steps. Each analogue working step can be transferred and reproduced 1:1 in the software and the digital design can be in turn converted back to digital at any time, allowing the user to benefit from the advantages of both working methods and to plan his/her job in a complete individual manner.

As a first step, it is necessary to gather all of the patient’s specific information through the intraoral scanner (Figures 1 and 8). Through the PlaneFinder® (a component of the PlaneSystem®, developed by MDT Udo Plaster in collaboration with Zirkonzahn), the dentist can identify the patient’s Natural Head Position and occlusal plane, transfer the data in the software with no loss of information and then match them with the face scans acquired via the Face Hunter 3D facial scanner (Figures 2 and 9). Furthermore, the movements of the mandible can be recorded by means of the new PlaneAnalyser II (Figures 3 and 10).

In this way, it is possible to obtain a 3D virtual reproduction of the patient’s physiognomy and oral situation, which allows for a better achievable function and aesthetic design of restorations in the digital world (Figues 4 and 11). In order to have also a physical model of the patient’s situation, the new CAD/CAM Model Maker software module is available to the dental technician. Once the model of the initial situation made through the Model Maker software module has been milled (Figures 5 and 12), the workflow allows the user to check the virtual data for correctness in the physical world using the resin block JawPositioner.

Indeed, in the JawPositioner, it is possible to mill quickly a positioning pattern for the mandibular model, which is then fixed into the PS1 physical articulator using the PlanePositioner® (Figures 6 and 13), a positioning platform that can be tilted according to the reference planes previously registered with the PlaneSystem.

In the PS1 physical articulator it is now possible to perform checks on the inclination of the jaw, for the subsequent design and milling of the restoration (Figures 7 and 14). Any possible change implemented during the check phase can be immediately digitalised and transferred back to the virtual situation through one of the Zirkonzahn’s scanners.

54 Australasian Dental Practice

May/June 2021

Screw-retained complete rehabilitation in Prettau® 2 zirconia on anodised titanium bases Based on 3D virtual reproduction of patient’s physiognomy and oral situation, captured with the PlaneSystem® and Face Hunter 3D facial scanner

ZIRKONZAHN’S WORKFLOW – FROM DIGITAL PATIENT ANALYSIS TO THE FINAL RESTORATION, EVERYTHING FROM A SINGLE SOURCE!

PLANESYSTEM ®

FACE HUNTER

SCANNERS

SOFTWARE

MILLING UNITS

MATERIALS

Alphabond Dental Pty Ltd – T +61 2 9417 6660 – stan@alphabond.com.au – www.alphabond.com.au Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

FURNACES

Organising a dental event, l show or we New Expresscongress, Listings fortrade dentevents.com

spectrum | NEWS

D

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

For more information, see dent.events webinar, listing on the dentevents.com continuing education

GO EXPRESS»»»»» calendar is now easier than ever.

New “easy add” for dentist.com.au

I

No username, no password and no need to login - add your event by simply visiting dentevents.com, clicking on Adding Events and then selecting Express Listing.

t’s now easier than ever to add Complete all the details on the form and click SUBMIT. or update your dental practice on Australia’s #1 find-a-dentist webAn email containing a link to edit or update the event will be sent to you site - www.dentist.com.au. A new that also allows you to track the approval status. option allows you to add all your information using a simple form After the event is checked, it will be posted to dentevents.com. with your practice being added or updated within 24 hours of submission.

“If you have a login to the Dental ComAdvanced functionality munity website, then adding and updating For event organisers who already use Dentevents to manage their events practices has always been easy,” said through www.dentalcommunity.com.au and use the registration, payment Joseph Allbeury, publisher of this magaand ticketing tools, this system should continue to be used as normal. zine and dentist.com.au. “However, if you’re checking out your information on Tools will for directly event result organisers in more patients in your Every dental professional in Australia the web and end up on dentist.com.au, Dentevents.com offers event organisers a full suite of marketing, ticketing, dental chair. and New Zealand is entitled to a free login then how to add or update your details was payment, registration and event management tools cost-effectively and “Dentist.com.au is such a success to www.dentalcommunity.com.au where less straighforward. because it lists every dental practice and you are able to control your presence on “By adding this form, it alleviates on-demand. the every dental practitioner in Australia [and dentist.com.au (and dentist.co.nz). need to email or call us and it captures all Full information is available at the newly updated Dentevents.com website.

New Zealand on dentist.co.nz],” Mr Allthe information that we need.” beury said. “There is no charge to be listed To obtain a free login, click the Sign In Around a million searches a year are and our goal is to list every private pracbutton on www.dentalcommunity.com.au made on dentist.com.au by the public tice, corporate practice, health fund clinic, or to use the “easy add” function, visit looking for a dentist. Ensuring your pracpublic dental clinic and denture clinic.” dentist.com.au/information-for-dentists tice is listed and the information is correct

Visit www.dentevents.c

56 Australasian Dental Practice

Published by Main Street Publishing Pty Ltd • PO Box 586 Cammeray NSW 2062 • C May/June 2021

Organising a dental event, lecture, congress, trade show or webinar?

GO EXPRESS»»»»» If you’re organising any kind of post-graduate dental education, event or webinar, listing your event on the dentevents.com continuing education calendar is now easier than ever.

No username, no password and no need to login - add your event by simply visiting dentevents.com, clicking on Adding Events and then selecting Express Listing.

Complete all the details on the form and click SUBMIT. An email containing a link to edit or update the event will be sent to you that also allows you to track the approval status.

After the event is checked, it will be posted to dentevents.com.

Advanced functionality For event organisers who already use Dentevents to manage their events through www.dentalcommunity.com.au and use the registration, payment and ticketing tools, this system should continue to be used as normal.

Tools for event organisers Dentevents.com offers event organisers a full suite of marketing, ticketing, payment, registration and event management tools cost-effectively and on-demand.

Full information is available at the newly updated Dentevents.com website.

Visit www.dentevents.com Published by Main Street Publishing Pty Ltd • PO Box 586 Cammeray NSW 2062 • Call (02) 9929 1900

spectrum | NEWS

International Update New Pola Rapid: Super fast in-office whitening treatment

Researchers led by the University of Michigan School of Dentistry developed a machine learning algorithm to assess an individual patient’s risk of regenerative outcomes after surgical treatments of peri-implantitis. The algorithm, called FARDEEP, was used to analyse tissue samples from a group of patients with peri-implantitis who were receiving reconstructive therapy. Patients who were at low risk for periodontal disease showed more immune cells that were highly adept at controlling bacterial infections, said Yu Leo Lei, senior author and assistant professor of dentistry. The team was surprised that the types of cells associated with better outcomes for implant patients challenge conventional thinking. “Surgical management can reduce bacterial burdens across all patients, however, only the patients with more immune cell subtypes for bacterial control can suppress the recolonisation of pathogenic bacteria and show better regenerative outcomes,” Dr Lei said. “In the future, it may be possible to predict the risk of peri-implantitis before a dental implant is placed.” More human clinical trials are required before FARDEEP is ready to be used widely by clinicians.

S

DI Limited is proud to announce the launch of Pola Rapid, a new in-office whitening treatment that safely whitens teeth in a super fast 24-minute application time - significantly faster than other alternative whitening options.

The specially formulated high viscosity 38% hydrogen peroxide gel enables a superior handling process with a faster application and removal time due to its non-stick attributes. Furthermore, Pola Rapid uses a vivid blue colour for ease of visibility and application.

Pola Rapid does not need an additional pre-desensitiser step. Instead, Pola Rapid uses a unique potassium nitrate and high water content ratio to maximise patient comfort and reduce treatment time. In addition, Pola Rapid contains fluoride to further strengthen teeth and protect against sensitivity.

No mixing required. The dual barrel syringe system automatically self-mixes as the whitening gel is applied directly to the tooth.

The supplied brush tip is sculpted to deliver a smooth and more precise application.

Pola Rapid delivers super fast results and is specially formulated to reduce sensitivity. The Pola tooth whitening range has successfully improved the smiles of millions of patients across over 100 countries. SDI has an ongoing commitment to providing better tooth whitening solutions that are safe, simple and effective. Pola Rapid is an Australian innovation and is available through all major dental distributors.

Pola Rapid is available in 1 or 3 patient kits.

For more information, visit www.sdi.com.au

58 Australasian Dental Practice

Researchers from Penn Dental Medicine say they have made new discoveries in the search for disrupting a biofilm that can lead to early childhood tooth decay. The findings build on previous research that discovered that a dental plaque that gives rise to ECC is composed of both a bacterial species and a fungus. In an attempt to eliminate the plaque, researchers applied three different mannan-degrading enzymes to a biofilm growing on a tooth-like surface in a human saliva medium, leaving it for five minutes.

Following the treatment, the overall biofilm volume and thickness were reduced along with the bacteria-yeast interactions. The researchers kept the application time relatively short at five minutes though they hope to see activity in the two minutes recommended for tooth brushing. They also said a non-alcohol-based mouthwash with these enzymes added could potentially be used as a preventive measure against ECC. Under a new state mandate in New Mexico, public school students who recently relocated to the state or are transferring to a new district or charter school are required to have had a dental exam within the past year to enroll. Effective July 1, the rule applies to new students at all grade levels. The dental exam requirement was passed in 2019 as part of a larger dental health bill intended to expand access to oral health care in the state. However, no money was appropriated for districts to enforce the mandate or to offer aid to students who are unable to meet the requirement. The Santa Fe school board recently approved a policy to ensure compliance with the rule, despite concerns that without financial aid, the rule will lead to inconsistencies in dental health care for low-income students. Seeking required exams could result in children getting teeth pulled rather than receiving tooth-saving treatments such as fillings and root canals, since the cost of a root canal can be twice that of a tooth extraction. Under the district’s policy, students will not be denied enrollment at a school due to lack of dental insurance or inability to pay for an exam, however, parents or guardians are required to sign a waiver indicating they understand “the risks associated when a student does not undergo a dental examination prior to school enrollment.”

May/June 2021

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Contemporary uses of CPP-ACP technologies in 2021 Part 2. Prebiotic actions

By Emeritus Professor Laurence J. Walsh AO

T

his article, the second in the series, discusses current concepts for the use of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) technologies in their role as a prebiotic agent that can modulate the behaviour of dental plaque biofilms.

Beyond mutans streptococci he concept of beneficial influences of topical CPP-ACP on dental plaque volume, composition and metabolism has been building steadily over the past decade,1,2 however the foundations for this area of research were laid over 20 years ago in work around effects on the binding of bacteria to dental hard tissues and to salivary pellicle. Today it is recognized that such effects contribute to caries prevention in settings such as patients with fixed orthodontic appliances. When topical forms of CPP-ACP, such as GC Tooth Mousse™ (TM) and Tooth Mousse Plus™ (TMP) are used, plaque levels around brackets are reduced.3 By 2013, it had become apparent that daily use of TM in infants and young children could drive a dramatic reduction in their levels of mutans streptococci.4,5 This provided a further rationale for topical use of CPP-ACP beyond its well known roles in remineralisation.6-8 This concept has matured to now incorporate the concept of CPP-ACP being a prebiotic agent, that supports the growth of those health-associated commensal bacteria that constrain the growth of cariogenic microorganisms.9-11

T

The concept of balance he concept of using prebiotic agents to support healthy commensals and thus achieve and maintain balance in the microbiome is well-established for the gut and is a tenet of modern gastroenterology.

The oral cavity is the start of the GI tract.

While it contains quite different organisms, the concepts of balance are equally relevant. Gut dysbiosis is known to lead to

T

“Using prebiotics to support health-associated microorganisms provides a diverse microbiome that, because of its diversity, is more resistant to external influences, such as changes in diet and the use of broad-spectrum antibiotics...” overgrowth of particular pathogenic bacteria or fungi. Using prebiotics to support health-associated microorganisms provides a diverse microbiome that, because of its diversity, is more resistant to external influences, such as changes in diet and the use of broad-spectrum antibiotics. The two classic examples of this are the antibiotic clindamycin creating a risk of overgrowth of Clostridium difficile, causing an enterocolitis and broad spectrum antibiotics causing a florid oral fungal overgrowth of Candida albicans. The latter organism is

important for dental caries and the literature for the past decade has documented its role in dental caries. Having high oral levels of Candida species elevates the risk for caries by around two-fold.

In modern clinical practice, we do not need a microbiology laboratory to detect or diagnose dysbiosis in the dental plaque biofilm. We can identify that problem in real time using a clinical tool to assess dental plaque fermentation, namely GC TriPlaque ID Gel™. Thin young plaque binds only to the Rose Bengal red dye, while mature plaque binds and traps the dark blue dye. When the plaque biofilm generates acid by fermenting carbohydrate substrates, the red dye becomes clear and the dark blue dye changes colour to light blue/aquamarine. It provides a visual Stephan curve of the pH within the biofilm.

This method can easily be used to track changes in individual patients over time, when areas are stained at follow-up visits.

Such clinical tools can reveal how much the use of CPP-ACP in various delivery systems is changing the volume and metabolism of the dental plaque biofilm.

Use of this particular tool is addressed under ADA item code 048.

Ozone in water: Let the recent evidence speak

By Emeritus Professor Laurence J. Walsh AO

I

n recent articles, I’ve discussed the use of novel oxidant-based technologies in infection prevention and control. This article explores the recent literature on ozonated water, drawing particularly on high level evidence from systematic reviews, meta-analyses and clinical trials that are cited in the PUBMED database.

Ozone is a well-known and potent oxidant which is a powerful antimicrobial agent in its aqueous form, as it dissolves readily into cold water. Effects of ozone will depend on the concentration and the application time.

As well as common pathogenic oral bacteria (such as Streptococcus mutans and Porphyromonas

Laboratory biofilm models o test prebiotic effects that support the growth of health-associated bacteria, it is necessary to use multispecies biofilm models. The first study of this type was conducted at the University of Queensland and published in 2019.12 Saliva-derived polymicrobial biofilms were grown for 96 hours in a cariogenic environment and

T

64 Australasian Dental Practice

88 Australasian Dental Practice

May/June 2021

Question 1. Having high oral levels of Candida species elevates the risk for caries by around:

gingivalis) and fungi (such as Candida albicans), ozone is known to be effective against both enveloped and non-enveloped viruses and amoeba, even at sub-ppm levels such as 0.1-0.4 ppm.1-6 In terms of delivery systems, ozone can be delivered as the gas dissolved in water or in oil, or used in its natural gaseous form, which is the most unstable. Most research has examined the use of ozonated water, since this can be produced on demand to give consistent ozone levels and is suitable for common applications such as irrigation, mouth rinsing and dental unit waterline treatment. Hence, the emphasis in this article will be on ozonated water. The special situation of oils is discussed at the end of the article.

May/June 2021

Question 6. Ozone is effective at killing:

a. Two-fold. b. Three-fold. c. Four-fold. d. No change.

a. Streptococcus mutans b. Porphyromonas gingivalis c. Candida albicans d. Viruses e. All of the above

Question 2. With GC TriPlaque ID Gel™, thin young plaque appears:

Question 7. Ozone dissolved in water can be used:

a. Dark blue b. Light blue/aquamarine c. Red d. Green

a. As an antimicrobial agent. b. To modulate pain and inflammation. c. To improve healing of the oral mucosa. d. All of the above.

Question 3. The combination of SnF2 and CPP-ACP inhibits enamel demineralisation by:

Question 8. When used in dental unit waterlines, ozonated water can eliminate:

a. 22% b. 57% c. 66% d. 72% e. 81%

a. Amoeba b. Fungal spores c. Fungal cysts d. Biofilms e. All of the above

Question 4. CPP-ACP alters the composition of biofilm by suppressing levels of:

Question 9. An ozonated water rinse yielded better outcomes than chlorhexidine in the management of gingivitis in orthodontic patients.

a. Streptococcus sanguinis b. Streptococcus mitis c. Streptococcus salivarius d. Scardovia wiggsiae e. All of the above

a. True b. False

Question 5. CPP-ACP has been incorporated into: a. Fluoride Varnishes. b. Glass Ionomer Cements. c. Chewing Gum. d. Toothpaste. e. All of the above.

Question 10. Ozonated oils have antimicrobial actions because they contain: a. Free ozone b. Formaldehyde c. Free radicals d. All of the above

INSTRUCTIONS: Australasian Dental Practice™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, log in to the Dental Community website at www.dentalcommunity.com.au (call (02) 9929-1900 if you do not have a login) and click on the CPD Questionnaires link; select the Australasian Dental Practice May/Jun 2021 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

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

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Face mask performance: Are you protected?

Four changes to infection prevention and control that made a difference

By John A. Molinari, PhD and Peri Nelson, BS

M

ask resistance to bacterial penetration was studied using an enclosed, specially fabricated 1.2m x 1m x 0.9m chamber around a dental chair (Figure 1). A mannequin head was mounted on a rod and fitted with a test mask before each experiment. One investigator held the mannequin head in the chamber in front of a “patient” mannequin head (Dexter) with full dentition during testing. The indicator bacterial species used was Serratia marcescens.

This is a Gram-negative bacillus that occurs naturally in soil and water and produces a red pigment at room temperature. It is associated with urinary and respiratory infections, endocarditis, osteomyelitis, septicaemia, wound infections, eye infections, and meningitis. A mixture of water-soluble red dye and S. marcescens was placed in the mannequin’s oral cavity. This fluid served as an analogue for the “patient’s saliva”.

The second mannequin head fitted with the worn face mask was mounted approximately 30 cm in front of the mouth of the “patient”. This masked head represented a dental clinician using a high-speed handpiece during treatment.

The mannequins were exposed to aerosolised preparations of the red dye/ bacteria mixture for periods of either 5, 15 or 30 minutes. To accomplish this, a dental water-driven high speed handpiece was run by an investigator in the mouth of the patient mannequin, touching teeth and creating aerosolised spatter. The masked mannequin was positioned as a clinician would be during treatment, in order that airborne droplet spatter from the

A

t this time last year, we were all collectively reeling from the onset of the COVID-19 pandemic and dealing with the challenges of managing a new virus. And, in the midst of an unprecedented shutdown that nearly ground dentistry to a complete halt for a month, practices pivoted on the fly to implement the Australian Dental Association’s advice on infection prevention and control transmission based precautions that would enable practices to work safely at different levels of restriction.

The past year has not been easy, to say the least. But the good news is that the Herculean effort that dental professionals put in to improve infection prevention and control has paid off. In a recent study conducted by the American Dental Association (AmDA) and the American Dental Hygienist Association (ADHA), researchers found that only 3.1% of surveyed dental hygienists had ever tested positive or been diagnosed with COVID-19 as of October 2020, despite being a high-risk group.

Additionally, the development and distribution of effective vaccines has already had a positive impact on the industry, with Australian dental professionals receiving vaccinations at high rates.

As infection rates among dentists and hygienists remain low and vaccination rates continue to rise, we may be turning a corner with the virus. But, if there is one lasting lesson from the last year, it’s that the risk of new infections is ever-present and infection prevention and control will remain a critical issue indefinitely.

96 Australasian Dental Practice

a. The first line of defence for protecting staff. b. Ranks higher than implementing social distancing measures. c. More important than telephone screening of patients. d. The last line of defence for protecting staff.

Question 12. Improved aerosol management practices include: a. The universal use of antimicrobial mouthrinses prior to procedures. b. Proper use of high volume suction. c. Use of rubber dam. d. All of the above.

Question 13. A recent survey in the US found that: a. 1.7% of surveyed dentists had tested positive to COVID-19. b. No respondents had tested positive to COVID-19. c. 3.1% of surveyed dental hygienists had tested positive to COVID-19. d. 55% of responde had been vaccinated.

Question 14. HuFriedy Harmony™ Ergonomic Scalers and Curettes minimise strain, fatigue and risk of injury to clinicians by reducing the pinch force in clinicians’ hands and pressure needed on the tooth: a. True b. False Question 15. Aerosols can be reduced by: a. Using hand instrumentation. b. Using less water spray on ultrasonic scalers. c. Reducing water spray on air turbine drills. d. All of the above.

in tryptic soy broth were also used to culture the outside and inside surfaces of the masks. Aerobic S. marcescens microbial growth was evaluated by culturing collected specimens onto tryptic soy agar plates at room temperature for 48-72 hours. Bacterial growth patterns were then observed for the experimental exposure intervals with each mask type tested.

The objectives of this study were to:

Assess how extended use of different levels of fluid-resistant mask affects microbial penetration;

u v

Evaluate the penetration resistance of Medicom Safe+ face masks during specific intervals to aerosolised “red” spatter (fluid resistance) and resistance to aerosolised mixtures of water-soluble red dye mixed with a representative bacterial species (bacterial filtration); and

Compare the penetration effectiveness of the Medicom Safe+ masks to masks from other manufacturers with level 1, 2 or 3 fluid resistance (as per AS 4381) and to non-medical (domestic) disposable masks with no rating for resistance to fluid penetration.

w

Figure 1.

100 Australasian Dental Practice

May/June 2021

Question 11. In the Hierarchy of Controls, PPE is:

“patient’s mouth” would contact the test masks as per clinical procedures. Handpieces were run for 30-second intervals until total exposure times were reached.

Masks were subsequently removed from the mannequin heads and visually inspected for detection of red spatter on the outside and inside portions of the mask. Sterile cotton swabs moistened

May/June 2021

Question 16. What colour pigment does Serratia marcescens produce at room temperature? a. Green b. Blue-Green c. Red d. Yellow Question 17. In the study, ASTM performance level 3 masks could resist fluid splatter for a maximum of at least: a. 5 minutes b. 15 minutes c. 30 minutes d. 45 minutes e. Indefinitely Question 18. In the study, ASTM performance level 2 masks could resist fluid splatter for a maximum of at least: a. 5 minutes b. 10 minutes c. 15 minutes d. 30 minutes Question 19. Masks used in dentistry should be certified to comply with Australian Standard: a. AS 4187:2014 b. AS 4381:2015 c. AS 4381:2002 d. AS 4031-1992 Question 20. A Level 3 mask provides protection again fluid pressure of up to: a. 80 mm Hg b. 120 mm Hg c. 140 mm Hg d. 160 mm Hg e. 180 mm Hg

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abstracts | 2021

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

COVID-19 transmission reduces with better air quality management

n recent months, more attention has been paid to airborne transmission of SARS-CoV-2 and methods to reduce that.

Studies of COVID-19 transmission in US schools have provided insight into how well various control measures work.

To meet the educational, physical, social, and emotional needs of children, many US schools opened for in-person learning during September 2020 by implementing strategies to prevent transmission of COVID-19. The number of new cases of COVID-19 was 37% lower in schools that required teachers and staff members to use masks and 39% lower in schools that improved ventilation. Ventilation strategies that were beneficial included dilution methods such as opening door and windows and using fans (35% lower incidence) or using HEPA filters with or without using UV light (48% lower incidence). Mask requirements for teachers and staff members and improved ventilation are important strategies in addition to vaccination of teachers and staff members that schools could implement as part of a multicomponent approach to provide safer, in-person learning environments. Many of these principles will be relevant to other settings.

I

Gettings J et al. Mask use and ventilation Improvements to reduce COVID-19 incidence in elementary schools - Georgia, November 16 - December 11, 2020. Morbidity and Mortality Weekly Report 2021; 70: May 21

Are periodontal pockets a potential reservoir for SARS-CoV-2?

any recent studies have explored interactions between periodontal health and COVID-19. Since the mid-1990s, viruses have been detected at higher levels in periodontitis sites than health sites, such as Epstein-Barr virus type 1 (43% vs 18%); while Herpes simplex virus and cytomegalovirus have been found in periodontal pockets (26-78% and 42-58%, respectively). Shot-gun DNA sequencing studies of subgingival plaque collected from periodontal disease patients have showed over 95% contained viruses. The initial viral infection of periodontal tissues could start either from direct infection coming from the mouth via saliva or from infected immune cells. The continuous inflammatory response present in affected sites of periodontal disease could bring mononuclear cells infected with the virus.

ACE2, the main receptor for SARS-CoV2 entry into human cells, is present not only in the airway and lungs, but also in oral epithelial cells, nasopharyngeal mucosa and salivary glands. This results in high viral load in the oral cavity (in saliva and crevicular fluid), which reinforces the need in dental practices to use antimicrobial preprocedural rinses.

M

Bertolini M et al. Periodontal disease in the COVID-19 era: potential reservoir and increased risk for SARS–CoV-2. Pesquisa Brasileira em Odontopediatria e Clínica Integrada 2020; 20(supp1):e0134.

62 Australasian Dental Practice

Gender and genetic background factors in COVID-19

here is an urgent need to understand the molecular determinants of SARS-CoV-2 infection, factors associated with COVID-19 heterogeneity and severity and therapeutic options for infected patients. The angiotensin converting enzyme 2 (ACE2) is a key host factor for viral entry, through binding of the viral spike protein, which permits viral entry, while proteolytic cleavage by host proteases, such as plasma membrane-associated type II transmembrane serine protease (TMPRSS2), mediates membrane fusion and release of the viral RNA into human cells.

TMPRSS2 is essential for the establishment of airway infection. Patterns of ACE2 expression correlate with susceptibility to infection. Lower nasal epithelial ACE2 expression reported in children has been suggested to explain the milder disease observed in this population. In the lungs, surfactant-producing alveolar type 2 (AT2) cells are targeted by the virus. These AT2 cells may thus represent a potential viral reservoir for replication, or alternatively undergo viral-induced cell death to initiate lung barrier damage and inflammation. ACE2 may be linked with oestrogen receptor responses. There is stronger overall ACE2 and TMPRSS2 lung expression in males than females, which links with more severe COVID-19 disease at presentation, higher intensive care unit admission rates and higher case fatality rates.

High ACE2 and TMPRSS2 levels in the elderly may contribute to increased viral infection rates. Human variants of ACE2 could alter the protein interface with the SARS-CoV-2 spike protein.

Other important host factors involved in viral–host interactions, viral protein processing and immune function also contribute to severity. Understanding how regulation of host factor genes varies in physiological and pathological states might explain the heterogeneity observed in SARS-CoV-2 infection, help identify pathways for therapeutic development and identify patients most likely to progress to severe COVID-19.

T

Ong SYQ et al. From bedside to bench: regulation of host factors in SARS-CoV-2 infection. Exp Mol Med. 2021 Apr;53(4):483-494.

May/June 2021

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Contemporary uses of CPP-ACP technologies in 2021 Part 2. Prebiotic actions

By Emeritus Professor Laurence J. Walsh AO

T

his article, the second in the series, discusses current concepts for the use of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) technologies in their role as a prebiotic agent that can modulate the behaviour of dental plaque biofilms.

Beyond mutans streptococci he concept of beneficial influences of topical CPP-ACP on dental plaque volume, composition and metabolism has been building steadily over the past decade,1,2 however the foundations for this area of research were laid over 20 years ago in work around effects on the binding of bacteria to dental hard tissues and to salivary pellicle. Today it is recognized that such effects contribute to caries prevention in settings such as patients with fixed orthodontic appliances. When topical forms of CPP-ACP, such as GC Tooth Mousse™ (TM) and Tooth Mousse Plus™ (TMP) are used, plaque levels around brackets are reduced.3 By 2013, it had become apparent that daily use of TM in infants and young children could drive a dramatic reduction in their levels of mutans streptococci.4,5 This provided a further rationale for topical use of CPP-ACP beyond its well known roles in remineralisation.6-8 This concept has matured to now incorporate the concept of CPP-ACP being a prebiotic agent, that supports the growth of those health-associated commensal bacteria that constrain the growth of cariogenic microorganisms.9-11

T

64 Australasian Dental Practice

The concept of balance he concept of using prebiotic agents to support healthy commensals and thus achieve and maintain balance in the microbiome is well-established for the gut and is a tenet of modern gastroenterology.

The oral cavity is the start of the GI tract.

While it contains quite different organisms, the concepts of balance are equally relevant. Gut dysbiosis is known to lead to

T

“Using prebiotics to support health-associated microorganisms provides a diverse microbiome that, because of its diversity, is more resistant to external influences, such as changes in diet and the use of broad-spectrum antibiotics...” overgrowth of particular pathogenic bacteria or fungi. Using prebiotics to support health-associated microorganisms provides a diverse microbiome that, because of its diversity, is more resistant to external influences, such as changes in diet and the use of broad-spectrum antibiotics. The two classic examples of this are the antibiotic clindamycin creating a risk of overgrowth of Clostridium difficile, causing an enterocolitis and broad spectrum antibiotics causing a florid oral fungal overgrowth of Candida albicans. The latter organism is

important for dental caries and the literature for the past decade has documented its role in dental caries. Having high oral levels of Candida species elevates the risk for caries by around two-fold.

In modern clinical practice, we do not need a microbiology laboratory to detect or diagnose dysbiosis in the dental plaque biofilm. We can identify that problem in real time using a clinical tool to assess dental plaque fermentation, namely GC TriPlaque ID Gel™. Thin young plaque binds only to the Rose Bengal red dye, while mature plaque binds and traps the dark blue dye. When the plaque biofilm generates acid by fermenting carbohydrate substrates, the red dye becomes clear and the dark blue dye changes colour to light blue/aquamarine. It provides a visual Stephan curve of the pH within the biofilm.

This method can easily be used to track changes in individual patients over time, when areas are stained at follow-up visits.

Such clinical tools can reveal how much the use of CPP-ACP in various delivery systems is changing the volume and metabolism of the dental plaque biofilm.

Use of this particular tool is addressed under ADA item code 048.

Laboratory biofilm models o test prebiotic effects that support the growth of health-associated bacteria, it is necessary to use multispecies biofilm models. The first study of this type was conducted at the University of Queensland and published in 2019.12 Saliva-derived polymicrobial biofilms were grown for 96 hours in a cariogenic environment and

T

May/June 2021

the cutting | EDGE

Figure 1. GC Tooth Mousse. treated every 12 hours with 2% CPP-ACP or vehicle control. Microbial ecological effects of CPP-ACP were assessed based on the relative abundance of 14 specific caries- and health-associated -bacterial species. In this complex biofilm model, CPP-ACP reduced the biofilm virulence (its disease-causing ability) as well as its bio-volume. When the biofilm was exposed to sucrose, lactic acid production was reduced. CPP-ACP altered the composition of the biofilm. It suppressed levels of mutans streptococci and other cariogenic bacteria such as Scardovia wiggsiae. CPPACP enriched health-associated bacteria.

There were higher bacterial loads of commensals such as Streptococcus sanguinis (fold change 30.22), S. mitis (fold change 9.66), and S. salivarius (fold change 89.35).12 The elevation in levels of healthassociated Streptococci is critical as these bacteria are involved in regulating the pH of the plaque biofilm, particularly through the arginine deaminase system (ADS).

This metabolises arginine and produces ammonia, which elevates the pH to keep it around neutral. This neutral pH discourages the growth of acid tolerant (aciduric) bacteria and fungi. By these pathways, CPP-ACP attenuates the virulence of the biofilm and promotes a beneficial microbial ecological change in the plaque biofilm.

A subsequent study at the University of Melbourne, also published in 2019, showed using a polymicrobial biofilm model that CPP-ACP could modify plaque composition.13 This followed on from earlier work published by the same team in 201614 which showed that CPPACP impaired biofilm formation by S.

May/June 2021

mutans on glass ionomer cement and moreover that it disrupted established biofilms of S. mutans. The 2019 study used a biofilm model of caries with 6 bacterial species that were grown on sound human enamel. The biofilm was exposed to sucrose 4 times each day to provide a cariogenic challenge. Twice-daily addition of either CPP-ACP or stannous fluoride (SnF2) reduced demineralisation by 50%.

While SnF2 had only a slight effect on the

composition of the polymicrobial biofilm, CPP-ACP had strong prebiotic actions, suppressing the levels of Actinomyces naeslundii and Lactobacillus casei and increasing the level of S. sanguinis in the biofilm. The combination of SnF2 and CPP-ACP resulted in a greater suppression of the acidogenic and aciduric bacteria and an impressive 72% inhibition of enamel demineralisation. When used together, the SnF2 and CPP-ACP interact with one another to form a nanofilament coating on the tooth surface. By cross-linking the CPP-ACP, the stannous ion helps to stabilise the nanocomplexes. This improves their binding to the tooth surface and the delivery of ions for remineralisation.15

Clinical trials of self-administered products 2019 clinical trial conducted at the University of Melbourne tested the prebiotic actions of CPP-ACP delivered using a sugar-free chewing gum.16 A total of 19 participants were involved in a three-leg cross-over, randomised, controlled clinical trial. Subjects chewed a

A

Figure 2. GC TriPlaque ID Gel assesses dental plaque fermentation. sugar-free gum with or without added CPP-ACP six times daily for 20 minutes over two weeks. Supragingival plaque was collected and analysed for bacterial composition. As was seen in the two biofilm studies in the laboratory in this clinical trial, CPP-ACP elevated levels of S. sanguinis and S. mitis when compared with the no gum intervention. All the species that were enhanced by CPPACP treatment possessed either arginine deiminase, which was discussed earlier, or nitrate reductase, which is another alkaliproducing enzyme system.

Australasian Dental Practice

65

the cutting | EDGE Overall, this clinical study revealed strong prebiotic effects from the CPPACP when it was delivered using a chewing gum, with increased proportions of health-associated bacterial species in the supragingival dental plaque biofilm.

Another randomised controlled clinical trial was conducted at the University of Queensland during 2018 and this was published in 2020.17 This study used CPPACP delivered in a fluoride toothpaste.

The bacterial loads of 14 key bacterial species (8 caries associated and 6 health associated) in the dental plaque of participants were measured using real-time quantitative polymerase chain reaction (PCR) analysis. It showed beneficial microbial ecological effects over 6 weeks of product use, compared with a toothpaste that was identical but lacked the CPP-ACP ingredient. Compared to the fluoride control dentifrice, the CPP-ACP dentifrice demonstrated suppression of S. mutans and elevation of S. sanguinis.

Taken together, these two clinical trials show that common delivery methods (i.e. chewing gum and fluoride toothpaste) are suitable for delivering CPP-ACP. These can drive species-level shifts in the ecology of the microbiome, resulting in a biofilm microbial community that is associated with health, rather than with dental caries.

Additional recent evidence for changes in microbial composition can be seen in studies of high caries risk children that were conducted in Jordan. GC Tooth Mousse was used as a toothpaste, or in conjunction with a 500 ppm fluoride toothpaste, versus the fluoride toothpaste alone. Paediatric dentists supervised all the school-based brushing sessions. The subjects were 4-5 year old children and all had at least one WSL or cavity on their primary anterior teeth. Changes in lesions were tracked using quantitative light fluorescence, comparing the baseline to the situation after 3 and 6 months of treatment. There was mineral gain and a reduction in lesion size in all three groups, for baseline versus 3 months or 6 months.

Using TM alone was just as effective as using the F dentifrice.18 When levels of S. mutans in the saliva were assessed, the greatest reduction in S. mutans levels occurred in the children using CPP-ACP, either with TM alone or when TM was combined with the fluoride toothpaste.19 These results reinforce earlier findings

66 Australasian Dental Practice

that CPP-ACP when used on a daily basis in the form of TM drives a reduction in the load of S. mutans in plaque in children and in teenage orthodontic patients.5,20 Ideally, for daily use, a properly designed dentifrice (toothpaste) should be used. A CPP-ACP dentifrice has been developed with the same level of CPP-ACP (10% w/w) as TM and TMP and this product (MI Paste One™) is available in North America. As well as delivering exactly the same calcium and phosphate ions as TM, this dentifrice has unusually high fluoride bioavailability. A 2021 study of bioavailable fluoride in 6 commercial F toothpastes containing different types of calcium and fluoride revealed that those

“Over the past 20 years, a cohesive story has emerged that CPP-ACP is an effective prebiotic agent. These beneficial effects have been seen with many delivery systems and the effects are similar, regardless of the delivery system that has been used. The choice of delivery system relates to the patient’s clinical need and their likely compliance with selfperformed measures...” with calcium carbonate generated poorly soluble fluoride phases and so had lower levels of available F (27% to 61%). In contrast, the CPP-ACP toothpaste had 97% of the fluoride in a bioavailable form.21 This reflects the ability of the CPP component to stabilise fluoride and calcium.

Reducing the need for compliance: Clinical trials of varnish and GIC n terms of compliance, using a varnish to deliver CPP-ACP removes the need for patients to use a particular chewing gum, crème or toothpaste every day. There is now evidence that frequent applications of CPP-ACP in a fluoride varnish (GC MI Varnish™) also provides prebiotic actions.

A recent study conducted in Indonesia

I

tracked changes in the plaque microbiome in children with caries who received CPPACP/F varnish weekly for 4 weeks. The treatment modulated the dysbiotic cariogenic microbiome, moving this towards a healthier community with more healthassociated protective species. 22 This finding adds to the results of other recent studies that show that the same protocol applying the CPP-ACP/F varnish weekly for 4 weeks gives a useful reduction in levels of S. mutans in most individuals (average reduction of 172 fold, which is a log reduction of 2.237).23 This beneficial effect adds to the ability of this same CPPACP/F varnish to exert useful chemical actions, including the ability to recharge ion-leaching restorative materials and thus add to their reservoir for re-release of ions such as fluoride.24 Another method for sustained delivery of CPP-ACP which resolves compliance issues is to incorporate the CPP-ACP into a glass ionomer. Fuji VII-EP™ (also known in some markets as Fuji TriageEP™ has CPP-ACP (5% w/w) distributed through the GIC matrix, providing release of calcium and phosphate ions as well as fluoride ions.25 The released calcium and fluoride ions reduce acid production by the biofilm. As well as causing a useful (39%) reduction in bacterial biofilm volume, the inclusion of CPP-ACP into GIC also lowers the cariogenicity of the plaque biofilm on the GIC restoration surface and around its margins, driving lower levels of S. mutans, and higher levels of S. gordonii, a key health-associated bacterial species.26

Conclusions ver the past 20 years, a cohesive story has emerged that CPP-ACP is an effective prebiotic agent. These beneficial effects have been seen with many delivery systems (topical crème, toothpaste, chewing gum and GIC) and the effects are similar, regardless of the delivery system that has been used. The choice of delivery system relates to the patient’s clinical need and their likely compliance with self-performed measures. For patients with compliance concerns, varnishes and GIC are suitable sustained delivery systems. These differ in that varnishes are a short-term measure, while a GIC is a permanent restoration and its CPPACP loading can be recharged by topical application of CPP-ACP.

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May/June 2021

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the cutting | EDGE Since CPP-ACP fosters a health-associated oral microbiome, CPP-ACP provides a valuable long term strategy for maintaining a healthy oral biofilm. Fostering healthassociated bacteria exploits the point that these bacteria are the natural antagonists of cariogenic aciduric microorganisms. It is highly desirable to have elevated levels of health-associated bacteria, including S. sanguinis and S. gordonii and to maintain that situation across the lifespan.

Adding to this, it is clear that the long term use of CPP-ACP can influence dental patient’s awareness of their oral health.

Qualitative research work has shown that long term at-home use of a topical CPPACP product such as TMP is more complex than a dental patient simply being compliant with advice they have received from a dental professional. For adhering to a new oral hygiene routine that included daily self applications of TMP, patients were found to take on an active and independent role in their oral health care. They understood the significance of applying TMP daily. Hence, rather than being passive recipients of advice, they took control of their oral hygiene care and this gave them positive outcomes as they began to experience the results, with a more comfortable mouth and teeth that were now less vulnerable to destruction. In other words, the positive changes in oral health experienced by patients that were driven by the chemical and microbial effects of the TMP were accompanied by empowerment.27 This creates a virtuous feedback loop, encouraging sustained changes in oral care behaviours over time, to maintain oral health.

A final point of reflection is that, when considered over the long term, the biological effects of CPP-ACP (as a prebiotic) may well be equally as important as its chemical effects (through remineralisation). Combining both actions explains why, in high risk situations such as fixed orthodontic appliance therapy, daily use of CPP-ACP can both prevent caries occurring and help reverse its actions on the enamel.3 Fortunately, we are now in the position of having both the diagnostic tools to identify, track and monitor the problem of biofilm dysbiosis and an effective solution, in the form of CPP-ACP as a prebiotic, plus changes to diet and lifestyle. The challenge for clinicians is to choose from the available approaches that which matches the patient’s clinical need and then to titrate the interventions as required.

68 Australasian Dental Practice

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

References 1. Walsh LJ. Topical CPP-ACP crèmes: beyond caries prevention. Internat Dent. 2014;9(4):48-58.

2. 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.

3. Mounir Bakdach WM & Hadad R. Effectiveness of different adjunctive interventions in the management of orthodontically induced white spot lesions: A systematic review of systematic reviews and meta-analyses. Review Dent Med Probl.

2020;57(3):305-325.

4. Plonka K et al. A randomized controlled clinical trial comparing a remineralizing paste with an antibacterial gel to prevent early childhood caries. Pediatr Dent. 2013;35(1):8-12.

5. Pukallus ML et al. A randomized controlled trial of a 10 percent CPP-ACP cream to reduce mutans streptococci colonization. Pediatr Dent. 2013; 35(7): 550-555.

6. Walsh LJ. Altering dental plaque biofilm ecology using CPP-ACP. Auxiliary 2014; 24(5):22-24.

7. Walsh LJ. Expanding applications for CPP-ACP technology: lessons from across the globe. Australas Dent Pract. 2014; 25(5):62-66.

8. Philip N. State of the art enamel remineralization systems: the next frontier in caries management.

Caries Res. 2019;53(3):284-295.

9. Philip N et al. Ecological approaches to dental caries prevention: paradigm shift or shibboleth? Caries Res. 2018;52:153-165.

10. Philip N, Walsh LJ. Beyond Streptococcus mutans: Clinical implications of the evolving dental caries aetiological paradigms and its associated microbiome. Brit Dent J. 2018. 224(4):219-225.

11. Philip NV, Walsh LJ. The potential ecological effects of casein phosphopeptide-amorphous calcium phosphate in dental caries prevention. Aust Dent J. 2019;64(1):66-71.

12. Philip N et al. Casein phosphopeptide-amorphous calcium phosphate attenuates virulence and modulates microbial ecology of saliva-derived polymicrobial biofilms. Caries Res. 2019;53(6):643-649.

13. Dashper SG et al. CPP-ACP promotes SnF2 efficacy in a polymicrobial caries model. J Dent Res. 2019;98(2):218-224.

14. Dashper SG et al. Casein phosphopeptide-amorphous calcium phosphate reduces Streptococcus mutans biofilm development on glass ionomer cement and disrupts established biofilms. PLoS One. 2016;11(9):e0162322.

15. Fernando JR et al. Self-assembly of dental surface nanofilaments and remineralisation by SnF 2 and CPP-ACP nanocomplexes. Sci Rep. 2019;9(1):1285.

16. Fernando JR et al. The prebiotic effect of CPP-ACP sugar-free chewing gum. J Dent. 2019;91:103225.

17. 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.

18. Al-Batayneh OB et al. Assessment of the effects of a fluoride dentifrice and GC Tooth Mousse on early caries lesions in primary anterior teeth using quantitative light-induced fluorescence: a randomised clinical trial. Eur Arch Paediatr Dent. 2020;21(1):85-93.

19. Al-Batayneh OB et al. Effect of CPP-ACP on Streptococcus mutans in saliva of high caries-risk preschool children: a randomized clinical trial. Randomized Controlled Trial Eur Arch Paediatr Dent.

2020;21(3):339-346.

20. Shen P, et al. Bioavailable fluoride in calciumcontaining dentifrices. Sci Rep. 2021;11(1):146.

21. Sharda S et al. Remineralization potential and caries preventive efficacy of CPP-ACP/Xylitol/ Ozone/Bioactive glass and topical fluoride combined therapy versus fluoride mono-therapy - a systematic review and meta-analysis. Acta Odontol Scand. 2021.

Jan 16;1-16.

22. Widyarman AS et al. Casein phosphopeptideamorphous calcium phosphate fluoride treatment enriches the symbiotic dental plaque microbiome in children. J Dent. 2021;106:103582.

23. Apriani A et al. Caries activity and ph level changes after fluoride varnish and casein phosphopeptides-amorphous calcium phosphate application on children’s saliva. Contemp Clin Dent. 2020;11(2): 126-130.

24. Ruengrungsom C et al. Evaluation of F, Ca, and P release and microhardness of eleven ion-leaching restorative materials and the recharge efficacy using a new Ca/P containing fluoride varnish. J Dent. 2020; 102:103474.

25. Mazzaoui SA et al. Incorporation of casein phosphopeptide-amorphous calcium phosphate into a glass-ionomer cement. J Dent Res. 2003;82(11):914-8.

26. 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.

27. Sbaraini A et al. Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus®. BMC Oral Health 2021;21:14.

May/June 2021

AALD Australian Association For Laser Dentistry Dental Conference 2021 Tangalooma Island Resort Queensland 10th-12th September 2021 Proudly Sponsored By:

For information on the conference, venue, speakers and scientific program please visit www.aald.asn.au

practice | MANAGEMENT

Why dentists who build successful practices retire millions of dollars better off than dentists who are corporate careerists

By Graham Middleton

“Talented and ambitious dentists have a strong tendency to seek to own their own practice within about eight years of registration but after several years of clinical experience, preferably in privately owned practices...”

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on preferred provider practices out-perform. Practice purchases versus start-ups.

Corporate hype overblow.

When assessing value current practice performance is far more important than financials from three years ago.

Successful practices are defined as efficiently conducted 2 or 3 chair practices located in established suburbs of cities or in major regional centres and substantial towns and which are not preferred providers to health funds.

There are many successful dental practices across Australia. Over a multitude of years of benchmarking dental practice performance for dentists and valuing dental practices for buyers, sellers or for legal support reasons, it was abundantly clear dental practice performance varied widely. There are practices with extremes of excellence and at the other end of the scale some which struggle to keep operating. No practice which is a preferred provider to private health funds has ever stood out as being as near as successful as the top echelon of practices which have avoided becoming preferred providers.

70 Australasian Dental Practice

Talented and ambitious dentists have a strong tendency to seek to own their own practice, desirably within about eight years of registration but after several years of clinical experience, preferably in privately owned practices.

Ownership of a practice carries additional responsibility but the financial outcomes are rewarding for competent dentists with good interpersonal skills.

The financial facts are clear. The dental practice owner has the opportunity to build their practice, adding to its goodwill value whereas the corporate employee has no goodwill ownership despite the legal fiction that they are contracting the use of corporate facilities to treat their own patients!

Sharing income with spouse he dentist who purchases their own practice and includes their spouse in the purchase can within Tax Office guidelines include them in tax planning and is particularly true of practices with two or three chairs employing multiple clinical staff.

Many successful dentists and their spouses accelerate their home mortgage repayments and upgrade to their forever home much earlier than can a dentist contracting to a dental corporate.

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May/June 2021

practice | MANAGEMENT Practice owners prerogative he dental practice owner enjoys the ability to fill their own surgery by controlling the allocation of non-referred patients to other clinical staff and to a significant degree to choose the mixture of treatments that they attend to as opposed to those allocated to employed clinical staff.

In stringent times, ownership of a two or three chair practice enables the owner to maintain a full book at the expense of employed/contracted staff. The lion’s share of profit is generated in the owner’s surgery, typically 80 to 85 percent since they are not paying someone else the contracted percentage and have the best book of patients. Successful practice owners have the ability to generate far more profit for themselves than do dentists contracted to corporates.

The successful dental practice owner has the opportunity to superannuate their spouse. Earning greater income than better performed corporate contracted dentists they are able to achieve much greater joint superannuation fund balances. These often exceed their individual pension account limits well before retirement age whereupon they continue to make concessional contributions ($27,500 each per year from 1 July 2021).

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Active business asset capital gains tax concessions ost successful dental practice owners purchase their premises which, like their practice, are classified as active business assets. If much of their assets are included in their long-term family home and in their superannuation fund, both of which are exempt from the relevant assets test, with careful planning many successful dentists access the small business capital gains tax concessions on sale of practice and dental premises.

Corporate dental contractors don’t have the ability to build significant capital growth behind this shield.

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Relative fee base entists who are able to purchase non preferred provider practices and who maintain and grow the practice patient base consistently produce significantly more profit than do preferred provide practices. As health funds make a gross margin on extras insurance premiums, typically in the order of 30 percent, by rationing benefits to patients and by placing sig-

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“The barrier facing corporates is that unlike large supermarket chains which have replaced check out staff with automation, there is no way that capital investment can enable a dentist to treat multiple patients simultaneously.

Dentistry remains labour intensive. Nor do corporates have better equipment than leading privately-owned practices. The only way for corporates to outperform is to bear down on the contractual fee percentage paid to contractor dentists...” nificant restrictions on dentists preferred provider practices are inevitably disadvantaged. Since dental corporates seek to have contractual agreements with private health fund providers, the contractual percentage of fees received by corporate dentists is a percentage of a lower fee base. A multitude of successful practices not only refuse to become preferred providers but quietly educate their patient base as to the economic shortcomings of ancillary (extras) health insurance.

Treat corporate hype with care orporates, whether dental, medical or veterinary related have had a significant incidence of failure and mediocre performance. The recent example of Smiles Inclusive’s descent into insolvency administration and sale of the remnants of its business destroyed investors wealth and ruined the residual value of dental joint venture arrangements. For virtually the entire time of existence it continued to make lofty announcements to support additional capital raisings in desperate attempts to remain solvent. It is likely that the next dental practice offering to the share market will be treated with a great deal of caution.

The barrier facing corporates is that unlike large supermarket chains which have replaced check out staff with automation there is no way that capital investment can enable a dentist to treat multiple patients simultaneously. Dentistry remains labour intensive. Nor do corporates have better equipment than leading privately-owned practices. The only way for corporates to outperform is to bear down on the contractual fee percentage paid to contractor dentists and tie their fortunes to health fund preferred provider schemes with their limitations. Dental Partners sold out to New Zealand’s Abano group but shareholders objected to more Australian practice purchases because they were not proving to be earnings accretive. In due course, Abano sold to North American buyers. New owners may be challenged to improve individual practice profitability or improve the outcomes of contracted dentists.

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About the author Graham Middleton disposed of his interest in Synstrat group on 30 June 2020 and won’t be starting another business; he retains many friends in the dental profession. He spent the last 33 years of his working life advising health professionals on business and financial matters. Dentists were the most numerous of his clients. He can be contacted at graham.george.middleton@gmail.com.

GENERAL ADVICE WARNING: The information contained in this article is unsolicited general information only, without regard to any investor’s individual objectives, financial situation or needs. It is not specific advice for any particular investor and is not intended to be relied upon by any person. Before making any decision about the information provided, an investor should consider the appropriateness of the information in this article, having regard to their objectives, financial situation and needs and consult their adviser. Any indicative information and assumptions used here are summarized, 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 document.

May/June 2021

Australasian Dental Practice

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practice | MANAGEMENT

A 6-step recruitment process to help ensure your next hire is a great decision!

By Julie Parker

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inding and hiring great people is a challenge that every dental practice faces. Some face it every few months and some, every few years.

But, everyone is looking for that next perfect hire routinely over the life of their practice.

Hire slow and fire fast is sound advice that, in reality, is often reversed. An easy trap to fall into is to hire quickly to fill a gap in your team. The equally easy trap to fall into is to fire slow, dragging out the process, hoping the team member will eventually work out.

The more time you take to fire a team member who is not a good fit, the longer that person has a detrimental impact on your team and business.

Designing and crafting your recruitment process to filter out those who are not suited to your practice and to help you more clearly identify the perfect candidate is a prudent and valuable system to implement.

Each step in your recruitment process is an additional step in discovering more about each candidate. If your current process involves assessment of resumes, interviews, then making your selection, you are simply not giving yourself adequate opportunities to gather the evidence you need to select an appropriate candidate.

The following is a 6-Step Recruitment Process that you will find useful the next time you have an important hiring decision to make.

This 6-Step Recruitment Process is designed to progressively discover real evidence that applicants possess the skills and characteristics that your practice has determined to be important for the position you are looking to fill.

72 Australasian Dental Practice

As your practice moves through the funnel, less-than-ideal candidates are filtered out so that by the time you reach the end of the process, you are left with someone whom you can have great confidence will be the best person for the job.

1. Resume lthough resumes can be biased and shed only a positive light on the candidate, they do essentially provide effective, basic information.

Look for the obvious - years of experience in their field in the industry, loyalty at previous workplaces and skills they have developed.

In addition to this basic information, look for evidence of any charity work. It is a positive character trait to spend time working for a benefit other than money.

Being involved in a sporting or recreational club is a good indicator that this person is happy being part of a team. If they have taken a leadership role in any group or organisation, this is also a positive. If their prime hobbies are reading and bushwalking, you should be wary!

An important inclusion in candidates’ resumes is the availability to access references. These will be useful later on in your recruitment process.

Candidates who pass through this first filter then progress to a telephone interview.

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2. Telephone interview ou can get a strong feel as to whether a candidate is favourable or not during a simple telephone conversation.

Ask the candidate to tell you about their career so far. Tell them a short history of your practice. This discussion will reveal

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evidence as to whether this candidate can build rapport, have a friendly nature, is well-spoken and a good listener: a person’s communication style will reveal the level of self-confidence and ability to explain details and be understood.

Another key element that I advise you raise at this point in your recruitment process is money. Finding out early whether both sides are in the same arena financially is appropriate. At this early stage, you will not know what you are prepared to pay the person who fills the position because it will depend upon the degree to which the new employee possesses all the attributes you are seeking. Ask yourself the question, “What is the least you would like to pay and the most you are willing to pay, for the right person?” Ask your candidates, “In terms of a wage, what is the least you are willing to accept and what is the most you are hoping to achieve?” You will then be able to determine whether there is a cross-over in ranges.

Explain your hiring process to candidates so they understand and have clarity.

Let them know that you will be moving through a series of steps over the coming days gathering evidence as to what degrees candidates possess the skills and attributes required for the role. With this evidence, you will be in a position to determine the right wages and conditions to offer to a candidate. This will be in the form of a formal letter-of-offer at the completion of the process to the successful candidate.

This telephone call is a highly effective filter in your recruitment process. You can identify those who are not a good fit at this early stage and helps you avoid time-wasting (for them and for you) with an in-person interview. Those who pass through this filter move on to the next step.

May/June 2021

practice | MANAGEMENT 3. Personality profile ersonality profiles are becoming more common in many industries. Once you have identified the characteristics ideal for the role you are filling - for example, thoughtful, patient and supportive are a few of the traits desirable for a dental assistant role - you can ask applicants to complete an online personality profile to help you seek further evidence of this candidate’s suitability.

There are many personality profiles available to choose from, each one offering slightly different insights into a person’s personality. Many have free online tests that take only a few minutes to complete. For a higher-level hire, you can engage an external expert, who will not be costly.

Candidates who indicate they fulfill many of the qualities you are seeking are then moved through to the next step.

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4. In-person interview he in-person interview is your first opportunity to see how well a candidate presents themselves.

You are looking for someone who dresses professionally and is wellgroomed. The candidate should exhibit self-confidence, positivity and effectively build rapport.

Ask the candidate questions that you can later cross-check with supplied references, such as, “How punctual were you at your last workplace? How often did you run late for work?” and “Tell me about a time when someone criticised your work.

What was your response and assessment of the situation?” Cross-checking this information will provide an indication as to the candidate’s honesty in answering direct questions.

The following is a series of questions that are designed to reveal specific characteristics of candidates that will definitely assist you in determining whether they filter through to the next stage of the 6-Step Recruitment Process.

Why does this position appeal to you?

What was the reason you left your last workplace?

What additional skills did you learn at your last workplace?

What do you like most about your role?

What do you like least about your role?

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Thinking about your previous workplaces, which was the best in terms of team harmony? What worked well?

Thinking about your previous workplaces, think of one that had a problem with team harmony. What didn’t work well?

How do you think a conflict could be resolved between two team members?

If you were to tell a trainee DA that she is leaving debris behind on instruments and needs to improve in this area, how would you go about it?

If a patient complained about the service, how would you manage it?

Describe any career goals that you have for your future.

What benefits are you hoping to enjoy with this new role?

What drawbacks would you like to avoid by leaving your last practice?

Candidates whose responses are aligned with the character of someone that would fit in well with your team and culture move onto the next step in the process.

5. Reference checks t’s not unusual for a reference-check telephone call to last just a few short minutes. However, speaking with people who have actually worked with a candidate is a unique opportunity to gather alot of valuable information.

Check the details of their employment for accuracy, for example, their longevity in the position and their responsibilities.

This can be an indicator of honesty in the candidate’s resume.

Ask the cross-check questions of: How punctual was this candidate? How often did they arrive late to work?

How did the candidate respond to feedback about performance?

Here are some more excellent questions to gather as much useful data as possible: What was it like to work with this candidate?

Did the candidate get along well with team members?

Was the candidate an effective communicator and relationship-builder with patients?

Could you delegate tasks and have them competed successfully?

Were they open to learning new things?

Were they a slow or quick learner?”

Were they caring and empathic with patients and co-workers?

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If you had a position open, would you hire this person again?

After moving through the previous five steps of the 6-Step Recruitment Process, you will likely have a clear idea of which candidate you have selected. As a final check, move this candidate through to the final stage.

6. Final interview his final interview does not need to be lengthy. Just 10 to 30 minutes.

However, the goal is clear: to check for consistency of character. I have often found a positive applicant to appear quite differently at a subsequent interview. Use this meeting to also clarify the expectations of the practice and answer any questions the candidate has considered.

If you and any colleagues who are involved with the final interview are happy with this candidate and agree to offer the position, craft and send your letter of offer. This letter can include, or be the Employment Agreement or Contract. It will include the wage you are offering, whether or not this is starting at a base rate that will then increase based on performance in the role and the specific hours and days of work.

Finding and hiring the right person is just the beginning. The next step is to onboard your new team member in a manner that gives every chance to deliver best performance and success.

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The hiring process and the onboarding of new staff are both topics that have been discussed at length on the JPPS Lunch ‘n Learn’s - episodes 61 and 62, part of The Club membership. These episodes also include the JPPS Staff Hire Guide and our Onboarding Process downloads that you will find most helpful. Go to the following link and discover how this great Club can assist your practice in so many ways: julieparkerpracticesuccess.com/the-club

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

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practice | MANAGEMENT

Protecting yourself from a bad valuation

By Simon Palmer

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practice or real estate sale is usually a high-stakes transaction involving hundreds of thousands even millions - of dollars changing hands. Quite often, the buyer and seller will base the price paid for a practice on an appraisal or valuation that has been done by an accountant.

And yet, if real estate or a business is put to market with competitive bids, it is quite common for the price paid to vary from the valuation price. Why is this? And what are the ways that you can minimise your risk when relying on a valuation?

74 Australasian Dental Practice

1. Poor or incomplete info provided to the valuer valuer is only as good as the information that has been provided and is accessible to them.

If relevant information has been withheld or made unavailable, they cannot be expected to be accurate.

CHECK: If you are getting a valuation done, make sure that the valuers have all the necessary relevant and accurate information. The valuation should list the reference documents that the valuer assessed to come to their appraisal.

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2. Timing he appraised value of a business may be accurate at the time that it is created, but may change significantly over a relatively short period if: a. The fortunes of the practice change due to key clinicians leaving, physical damage to the premises (fire, flood, etc.), its reputation is damaged, etc. b. There is a perceived or real change in global or local economic conditions. Examples of this may be interest rate changes, GFC, pandemic causing panic.

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May/June 2021

practice | MANAGEMENT c. There are new announced changes in the local area. Examples of this may include key employers investing or divesting in the area, or if there is a development or new infrastructure announced in the area.

CHECK: If you’re basing a transaction decision on a valuation, make sure that the valuation has occurred within the last 6 months. If the valuation was done earlier, you should be asking for it to be reviewed by the valuer.

3. Poor choice of valuer ome people will just go to their trusted family accountant to appraise a dental practice. While your accountant is probably very experienced and trustworthy, a dental practice valuation is not just the application of accounting principles. To value a business effectively, the valuer needs to have an understanding of the industry norms of the business they are valuing and have access to information about comparative practice transactions/sales.

If your accountant doesn’t have this experience and exposure to comparative financials, they are likely to miss vital pieces of information or apply an incorrect/inappropriate multiple to their appraisal. An inexperienced valuer would value the practice using the same methodology and formula that they would use for a coffee shop or travel agency (we see this regularly).

CHECK: If you are basing a transaction decision on a valuation, make sure that the valuation was done by a valuer who is experienced in the industry being valued. In our opinion, there are only 3 or 4 valuers in the dental industry in Australia with enough industry knowledge to be accurate on a consistent basis.

Ask specialist lenders/financiers in the

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profession - if they haven’t heard of the valuer, it may not be the correct one to be basing your transaction on.

4. Terms here is no price without terms. Price is often a function of risk and much of the risk protection is in the terms of the deal. For example, corporates have been known to offer higher valuations for practices, but these higher prices come with more onerous post-sale conditions (years of post-sale commitment, revenue and profit targets, etc.).

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“Make sure that the valuation was done by a valuer who is experienced in the industry... There are only 3 or 4 valuers in the dental industry in Australia with enough industry knowledge to be accurate on a consistent basis...”

CHECK: If you are basing a transaction decision on a valuation, make sure that the valuation specifies the basic terms that the valuation is predicated upon (i.e., post-sale commitment, premises lease terms, etc.).

5. Lack of comparable transactions usiness valuations are only accurate to the extent that the valuer has a thorough knowledge of the market for the business being valued.

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The more unique a business is (if it is highly specialised or located in an extremely remote location), the less likely it is that there are comparable transactions for a valuer to use in their assessment. This can affect the ability of the valuer to predict the demand and appetite for this business.

6. Fact vs emotion valuation is usually an objective assessment of the available relevant facts. However, people often do not act objectively in the marketplace.

For example: • A buyer may fall in love with a business or property and offer more than market rate because of how convenient the location is (close to their home, their children’s school, etc.).

• They may offer more due to “fear of missing out” (FOMO), social proof (e.g., seeing lots of interest at an auction) and search fatigue.

It is extremely difficult for a valuer to factor these external emotional components into an appraisal.

CHECK: No one can take the possibility of a ridiculous offer into account when valuing a practice but, at the same time, a valuation that gives you a reasonable range rather than a single value is more likely to have taken into consideration the emotion factor.

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About the author Simon Palmer is the 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 info@practicesalesearch.com.au or call Simon Palmer at 1300-282-042.

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practice | MANAGEMENT

My top 8 phrases not to say to patients

By Jayne Bandy

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here is such a focus on what to say on the phone with your patients but are you thinking about what you should not be saying to your patients?

Here are a few phrases that are being said on the phone calls and should NOT.

“That’s OK” f patients call to cancel their appointment, we often say it’s OK. Our patient hears, “It’s alright to cancel an appointment.”

We know it is never a good thing when your patient calls to cancel or change their appointment. I know there are times when patients have a valid reason why they need to cancel. It is much better to say: “Is everything OK?” (Now it’s OK to say OK!).

Once you get to the bottom of it and ask the patient the reason for the cancellation, you can now see if you can offer a solution and try to keep the patient coming in for their appointment.

You can ask these questions: “Is there anything I can do to help you keep your appointment?”

“Is there any way you can change a few things so you can still keep your appointment?”

“Your treatment for ______________ is very important.” (Build urgency for the type of treatment and care they need).

Take control of the call and help your patient keep the appointment or make another appointment immediately.

Always avoid your patient cancelling with no next step and no appointment.

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“Would you like to make an appointment?” o why do we ask if they would like an appointment. The patient now has a choice and they can say no!

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It is much better to say: “Let me make you an appointment for_____________. Would you prefer morning or afternoon?”

Answer the caller’s 1st question

he first question is important but it is usually not the only important thing a caller wants to know. Find out what else is important to the caller.

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Start asking questions!

You’re now helping the caller to stay more focused on their dental problem and concern. You can then come back to the original question and answer it. You’re now more likely to make and confirm an appointment at the end of the call.

“No, I don’t have that time available”

lways let the caller know what appointment times you do have, not what you do not have. This maintains a positive call, guiding the patient to the available appointment that suits them and your appointment book. Often a caller will ask for a specific time but never ever presume this is the only time they can come in.

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“We have no parking available his is another “NO” response we should avoid saying. Why not let the caller know what you do have available rather than what you do not. After working in a city practice with little on site-parking, I soon discovered that the city had plenty of parking. Let the caller know where other patients find parking and even send a parking map to make it easy for them. See how much better this is than saying “NO”.

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“Dr Jones is away for 2 weeks”

ake the appointment for two weekstime. No patient likes to hear their dentist is away on holiday. All the patient needs to know is that Dr Jones has an appointment available for them in two weeks-time. If it is an emergency and treatment cannot be delayed, then have a contingency plan to see a trusted colleague.

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We’re not a preferred provider

lways ask other questions first and then once you’ve built some rapport and found out what their dental problem and concern is, then you can address the preferred provider question.

If you’re not a preferred provider then why not let the caller know that many of your patients are with their same insurer and choose to come to your practice for the best care and advice you offer. After all, there must have been something else that attracted them to you!

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practice | MANAGEMENT ”There is a cancellation fee”

About the author

his is the best way to turn a patient off. The message you send is I know you will cancel and so to stop you, I will threaten you with an extra charge and scare you into not cancelling. Your patient then cancels their appointment, never pays the fee and goes to another dentist.

Set up the appointment so the caller is committed and serious about the appointment that has been reserved and confirmed at the time they made the appointment.

Jayne began her career as an educator.

After spending several years teaching, she made the jump to dental practice management. Jayne served as a Practice Manager for a renowned dentist in Sydney for more than 25 years, having the opportunity to learn first-hand 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 strives to help practices convert more calls into appointments, reduce cancellations and help 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.

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Can you see how important it is to carefully choose your words, when you speak to your patients? Have a think about what you say to your patients. It might be time to change a few phrases.

To find out how I can teach your team to know what to say and ask your patients, to help them make more kept appointments and prevent cancellations, call me on 1300-378-044 or email jayne@thedpe.com

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 www.calltrackingexcellence.com

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May/June 2021

Australasian Dental Practice

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marketing | INSIGHTS

Are Google reviews a complete waste of time?

By Angus Pryor, MBA (Marketing)

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was recently talking to a dental practice about Google® reviews and they expressed a view that I’ve heard several times before. The comment was that Google reviews are a waste of time and not worth chasing. In this article, I will discuss the pros and cons of Google reviews for dental practices.

“One challenge about dentistry is that for the common person, they really have no other way of telling whether a dentist is good or not and this is where Google reviews bridge that gap....”

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The case against...

he arguments that I’ve heard against Google reviews are usually one of the following.

Google reviews can be manipulated and cannot be trusted he gist of this argument is that dental practices (and other businesses) can kind of ‘hack’ the system by asking their friends and family to complete favourable (and non-genuine) reviews. The inference from this is that Google reviews cannot be trusted.

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It is certainly true that not every Google review for a dental practice is a legitimate, arm’s-length, assessment of the merits of a practice. To support this view, there is research published every year that talks about the minimum number of Google reviews that people need to see before they trust the average rating of the reviews.

According to BrightLocal.com, in 2018 the minimum number of reviews required for someone to trust the average rating was 40. In 2019, this number had increased to 48 reviews, suggesting scepticism is growing over time. This does not mean, however, that attracting multiple Google reviews is a waste of time; simply that if you are going to build Google reviews, you need a good body of them for people to believe the average rating.

I don’t currently have any Google reviews and if I start, I won’t be able to control what people say f your practice has zero Google reviews, you may somehow believe that your Google review profile has “slipped below the radar” and as a result, no one will think to leave you a review, as though the thought never occurred to them.

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marketing | INSIGHTS This is flawed thinking. From a zero base a few years ago, the number of reviews being left online grows every year. And in that space, Google has the fastest growing reviews program on the planet.

Younger generations, in particular, have grown up where the norm is to able to leave online reviews (and by the way, they regularly do so) i.e. this generation has never known anything else. As further evidence of this, Bright Local notes that 18-34 years olds leave twice as many reviews as people aged over 55.

The second problem with this thinking is it ignores the fact that Google reviews provide offensive and defensive benefits.

From an offensive point of view, as we have seen in the data above, having a good body of Google reviews builds trust (as long as there are enough of them).

From a defensive point of view, however, having a number of positives Google reviews is essential and here is why. It stands to reason that as the number of reviews grows, so does the number of one-star reviews.

As a dental marketer, I have been contacted about more one-star reviews in recent times than ever before. There are, I believe, two reasons for this. The first reason, as alluded to above, is that consumers more than ever are used to expressing their views about a business by leaving an online review (particularly on Google).

The second reason is, unfortunately, a rise in vexatious or false Google reviews.

Let’s face it, if more and more people recognise that having a strong Google review profile is helpful for a business, there is always the risk of someone trying to sabotage your positive review profile.

I’d like to tell you that this never happens, but my experience is that these types of false reviews probably account for more than half of the one-star reviews I see.

And here is the problem... getting rid of, or otherwise handling, a one-star review is no easy task.

For dental practices, getting a one-star review removed is very difficult and anecdotally, may take as long as a year to do so. Even for my agency, which is a certified Google partner (and theoretically has better access to Google), it may still take months to get a one-star review removed, if it can be removed at all.

May/June 2021

The above data points to the fact that potential patients want to see a lot of reviews before they trust the average star rating. If you have no Google reviews, or just a few, then a one-star review can destroy your average star rating. And in a world where people are increasingly relying on Google reviews, a substandard average star rating is disastrous for a business.

Additionally, as I have written in another article in Australasian Dental Practice, Google reviews are actually trumping word-of-mouth referrals. This means that even after getting a positive word of mouth referral, potential patients are still likely to check your Google reviews and may, in fact, decide not to become clients on the basis of the latter, even in spite of the initial recommendation.

The case for... s noted above, the number of Google reviews being written every year is increasing more and more. Further, younger generations are relying on them more than more. Here are a couple of reasons in support of boosting Google reviews.

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Easier decision-making for consumers y (millennial) daughter-in-law told me recently about her decisionmaking process in choosing a new dental practice to provide orthodontic treatment for her (an $8000 expenditure).

She said that if a practice didn’t have a good Google review profile (lots of reviews and recent reviews), she simply wouldn’t even look at them. In the end, she chose a new practice that was some distance away from where she lived (i.e. she was prepared to travel out of her area) because it had the best Google review profile.

The increasing reliance on Google review profiles in dentistry actually makes sense. One challenge about dentistry is that for the common person, they really have no other way of telling whether a dentist is good or not and this is where Google reviews bridge that gap.

Of particular relevance for dentistry, Bright Local found that in 2020, health care was the third most likely industry for consumers to read reviews, after restaurants and hotels.

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Flow-on benefits ne of the other benefits of a strong Google reviews profile, is a positive impact on a practice’s overall presence in Google. Many sources point to the fact that Google reviews improve a practice’s listings on the Google Map and search results.

I should emphasise that the reviews help, but don’t guarantee, the precise location of a practice in search results. A quick Google search in your local area will show that the top three practices on the map are not listed in order of Google reviews from highest to lowest. However, SEO gurus are unanimous in their view that Google reviews definitely do help.

My final point here is that a strong Google review profile, believe it or not, becomes part of the assets of a business when it is time to sell. As you may have experienced, building a strong Google review profile is not easy (otherwise everyone would be doing it) and therefore a strong review profile is of real value.

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Conclusion hile there will still be naysayers about the positive impact of Google reviews, this does not mean Google reviews are not worth pursuing.

On the contrary, actively pursuing Google reviews for your practice is definitely worth doing.

The data shows that more and more people are leaving Google reviews, reading Google reviews and relying on them to make an informed decision about the merits of one practice versus another - particularly in the health care space. Thinking that this issue will go away (or is not important) is a head in the sand approach. For any forward-thinking dental practice, actively growing your Google review campaign is a sound return on effort.

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About the author Winner of the ADIA 2020 Marketing Award, Practice Growth Specialist Angus Pryor is a #1 Amazon bestselling author, marketer and international speaker.

For help with attracting higher-quality patients, visit www.AngusPryor.com and book an obligation-free call to talk to Angus or take advantage of free video training at www.AngusPryor.com/HQ.

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finance | INVESTMENT

Instant asset write-offs vs temporary full expensing: Semantics or can I still claim an immediate tax deduction?

By Garry Pammer, BEc, LLB, CA, DIP.FS (FP)

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id I have to order my Cone Beam CT scanner by 31 December 2020 last year or can still I claim 100% depreciation for it because I have just now purchased and installed it before 30 June 2021 this year? Was the cost threshold $30,000 or $150,000? What does my turnover have to do with anything?

Confused? Of course you are!

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There have been so many significant changes in the tax treatment of depreciating assets for practice’s since March 2020 but how do you determine what part of your current investment plans for your practice can be claimed as a deduction and when deductions should be claimed?

Instant asset write-off rules he “instant asset write-off” is a feature of the simplified depreciation provisions in Subdivision 328-D of the Income Tax Assessment Act 1997 (ITAA 1997) which small business entities can choose to apply.

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finance | INVESTMENT The rules have been determined with reference to turnovers, timelines as to contract purchase dates as well as installation and use by dates together with differing limits to cost thresholds.

It’s laborious to work through but Table 1 is a line-by-line summary of all the turnover thresholds, date ranges and cost limits that apply.

So having worked through line-by-line, have you missed out on claiming 100% of the equipment you invested in for the new practice fit out that you had been trying to finalise before 30 June 2021?

The bad news is that if you did not sign off on your purchase contract before 31 December 2020, then you have no basis for which to claim an “instant asset write off” in the 30 June 2021 year.

The good news is that you may still be able to claim an immediate deduction under the “temporary full expensing rules” in the 30 June 2021 and subsequent years. So read on!

Temporary full expensing rules t a very high level, you may still be able to claim an immediate deduction for the cost of assets that start to be held and are first used or installed ready for use between the 2020 Budget (7.30pm ACT time on 6 October 2020) and 30 June 2022.

In fact, the Government announced that in the 2021-22 Federal Budget, these rules would be extended for a further 12 months to apply up to 30 June 2023.

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The fine print here are some slight differences in claiming an immediate deduction under the temporary full expensing rules depending on whether you are classified as a small business entity (SBE) or not.

Let us, however, assume your aggregated annual turnover is less than $10 million. That aggregation is across all your practice and trading entities - sole trader, service trust, practice company, etc. Think of it as grouping all the entities which you control.

Then, in order for your SBE to access the temporary full expensing rules under simplified depreciation, the following conditions generally need to be satisfied:

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• The asset must start to be held at or after 7.30pm ACT time on 6 October 2020; • The asset must start to be held on or before 30 June 2023; and • The entity must start to use the asset or have it installed ready for use for a taxable purpose on or before 30 June 2023.

If the above-mentioned conditions are met, then the entity would claim a deduction for the full cost of the depreciating asset in the year that it is first used or installed ready for use for a taxable purpose.

The stand out of course is that, unlike the instant asset write off rules, there is absolutely no limit to the cost of the asset when it comes to claiming an immediate deduction.

From 1 July 2021 the upper car limit claimable is $60,733.

Assets which do not qualify he temporary full expensing rules do not generally apply unless “normal” depreciation deductions would be available in relation to the asset in question.

This means that the rules will not generally apply to the following assets: • Capital works; • Eligible work related items (e.g. laptops obtained by an employee under a salary sacrifice arrangement); and • Assets allocated to a low value pool.

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Table 1. Summary of Instant Tax Write-Off Rules Aggregated turnover threshold < $500 million

Date range for when the asset must first be used or installed ready for use

Asset Cost threshold*

12 March 2020 to 30 June 2021

$150,000

as lon as the asset is purchased by 31 December 2020

< $50 million

2 April 2019 to 11 March 2020

$30,000

< $10 million

29 January 2019 to 2 April 2019

$25,000

< $10 million

1 July 2016 to 28 January 2019

$20,000

< $2 million

12 May 2015 to 30 June 2016

$20,000

< $2 million

1 January 2014 to 12 May 2015

$1,000

< $2 million

1 July 2012 to 31 December 2013

$6,500

< $2 million

1 July 2011 to 30 June 2012

$1,000

However, note that some adjustments will generally be required if the asset is a luxury car or where the asset is not used 100% for a taxable purpose.

Luxury cars he luxury car limit in section 40-230 applies for tax depreciation purposes which includes temporary full expensing.

Therefore, while the temporary full expensing rules do not have a cost limit, it is still necessary to consider the possible application of the rules dealing with luxury cars.

As such, there is an upper limit on the cost you use to work out the immediate deduction for the business use of your car or station wagon, including four-wheel drives (and SUVs).

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Capital works his is the big-ticket exclusion item. As noted above, the new temporary full expensing rules cannot apply to expenditure that falls within the scope of capital works.

While it is not always easy to distinguish between capital works and depreciating assets, be sure to get your builder or quantity surveyor to identify and split out what is depreciable plant and equipment in your practice fit out or renovations.

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Assets subject to a depreciating asset lease eware that you will not be able to make the immediate deduction if you have financed the purchase under a depreciating asset lease.

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finance | INVESTMENT A depreciating asset lease is an agreement (including a renewal of an agreement) under which the financier actually owns or holds the depreciating asset and grants a right to use the asset to you. A finance lease is an example of this.

What you need is a chattel mortgage or a hire purchase agreement or a short-term hire agreement. Check with your financier.

Conclusion es, there are different parameters between the instant asset write off and temporary full expensing rules but an immediate tax deductible write-off continues to be available until June 2023.

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As such, certainly continue to take it into account in your plans to invest in your practice as the tax benefit is tangible. Just remember that the tax benefit manifests on lodgement of your tax return some 11 months after the financial year in which you have outlaid the capital expenditure.

In commercial terms, any decision regarding a capital outlay should be made after assessing the pay back period of the outlay. Namely, how long before you recoup the cost having regard to future increased patient fees as well as the eventual tax benefit? In nominal terms, a two-year pay back period is a good rule of thumb.

The tax benefit of an immediate deduction is an opportunity not to be

overlooked but in the end, it is only one factor in the equation. Do not give it more weighting in your decision making than warranted.

About the author Garry Pammer is a Director of Specialist Accounting & Business Advisory, specialising in providing advice to dentists.

Advice not only in respect of taxation and accounting but also planning for your financial wellbeing, superannuation, practice management and the buying and selling of dental practices. For a free assessment of your position and to see how you can achieve your goals, please do not hesitate to call Garry on 1300-221-486.

General advice warning This information might contain unsolicited general information only, without regard to any investor’s individual objectives, financial situation or needs. It is not specific advice for any investor and is not intended to be relied upon by any person. Before making any decision about the information provided, an investor should consider the appropriateness of the information in this article, having regard to their objectives, financial situation and needs and consult their adviser. Any indicative information and assumptions used here are summarised, are not a product illustration or quote and may change without notice to you, particularly if based on past performance. This notice must not be removed from this article.

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finance | INVESTMENT

The humble SMSF

By Andrew Squires, Associate Financial Adviser

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he humble Self-Managed Super Fund, or SMSF, has wavered in popularity since the original legislation passed the House of Representatives back in 1999. There are features that a Self-Managed Super Fund offers that make it stand apart from an APRA-regulated superannuation fund and this article is going to look at some of the reasons you would look at commencing an SMSF, what’s involved in running one and some of the limitations you may face.

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When can an SMSF be a good idea?

Larger balances he Australian Securities Investment Commission (ASIC) report* that on average, SMSFs with balances below $500,000 have lower returns after expenses and tax than funds regulated by the Australian Prudential Regulation Authority (APRA). This mainly has to do with the fees and expenses related to operating an SMSF - the lower the balance, the higher the overall percentage of fees. If you are considering taking on some of the administration tasks yourself, starting an SMSF with a balance below $500,000 may still be cost-effective.

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May/June 2021

finance | INVESTMENT Those seeking diversification into direct property

Business owners with commercial property needs

nvesting into direct property is allowed within superannuation by using a SelfManaged Super Fund structure. The Trustees can borrow through a “limited recourse borrowing agreement”, which is effectively a mortgage for the SelfManaged Super Fund.

n SMSF Trustee can rent commercial property to their own business subject to certain conditions... A well-run Self-Managed Super Fund featuring commercial property can help with business cash flow and overheads while benefiting the Trustee with lower tax rates that apply to the superannuation environment. Furthermore, a Self-Managed Super Fund can provide a level of asset protection from future claims or liabilities resulting from business operations.

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Limitations include higher interest rates and deposits (to reflect the higher risk to the lender). A valuable feature of a SelfManaged Super Fund is that it can be used to borrow and invest in residential and commercial property. Then, the Trustee can benefit from rental income taxed at superannuation tax rates of 15% and capital gains at just 10% (if the asset is held for greater than 12 months).

Notably, with residential property, you cannot rent the property to a fund member or any person associated with a fund member such as a relative.

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Pooling your investment assets n SMSF is currently allowed four members and this is expected to increase to six once the recent Treasury Laws Amendment is passed. The members can pool their assets and effectively increase their purchasing power, which can be useful when looking at a large asset such as property.

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What does it take to run an SMSF? You must establish the fund o open an SMSF there are administration responsibilities that comes with costs. To establish the fund, you will need a Trust Deed. If you’re using a corporate trustee structure, you will need to establish the company as well.

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Ongoing fees and costs ost of the costs involve engaging an industry professional to assist in meeting your obligations. You (or an outsourced professional) will be required to prepare annual asset valuations, regular reviews of your investment strategy and lodgement of your annual tax return. As a Trustee, you will also be responsible to keep an up-to-date Trust Deed and pay the ATO supervisory levy and audit costs. Other costs can include a corporate trustee fee as well as actuarial costs to determine eligible member pension payments (if applicable).

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Australasian Dental Practice

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finance | INVESTMENT

Responsibility s a Trustee, you’re responsible for running the fund. You’re bound by the Superannuation Industry (Supervision) Act 1993 (Cth) and you must understand your compliance obligations. The ATO regulates SMSFs and non-compliance can lead to penalties. You cannot outsource your responsibility as a Trustee to a third party such as your accountant or financial adviser, however, they can be useful for guidance.

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What do you need to look out for?

Considerations with direct property any SMSFs have been established so the members can invest in direct property. The diversification implications of this can be a double-edged sword; larger balances can benefit from the additional assets class of direct property, but smaller balances may find that all your eggs are in one basket, providing the opposite effect.

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Aligning the investments with the member’s interests f the fund is made up of a lumpy asset such as property, they may need to be sold down to allow a member to begin drawing their share say in pension phase.

The fund will need to provide sufficient liquidity which could be difficult if it’s

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not a good time to sell the property. By forward-thinking and strategic planning, this can be mitigated but it takes active management and typically professional planning to achieve. Getting the right advice is important.

“Many SMSFs have been established so the members can invest in direct property.

This can be a double-edged sword; larger balances can benefit from the additional assets class of direct property, but smaller balances may find that all your eggs are in one basket...”

Limitations on your SMSF investments n Borrowing restrictions - A property loan

must be undertaken through a Limited Recourse Borrowing Agreement (LRBA).

These loans warrant higher interest rates, stricter terms and larger deposits. n Investments must be at arm’s length - the investments must be made and maintained on a strictly commercial basis. For example, you cannot purchase a commercial premise with the SMSF and rent it out to your business at below-market rates.

n Sole

purpose test - The fund must be maintained for the sole purpose of providing retirement assets to the members. n You must create, maintain and always adhere to a written investment strategy.

This should consider the risk appetite of the members and explain how the investments will meet each member’s retirement objectives.

An SMSF does not provide a one-sizefits-all approach to building a retirement nest egg; what’s good for the goose may not be good for the gander. There are many considerations in establishing, maintaining and even winding up a SelfManaged Super Fund structure and like all financial decisions, they should be made carefully.

About the author Andrew Squires is an Associate Financial Adviser at Profile Financial Services, a privately owned and self-licensed feebased financial planning firm, with offices in the Sydney CBD, Parramatta and Mudgee. Profile has operated for over 30 years and specialises in serving the wealth creation and protection needs of professionals and small business owners. Many of Profile’s clients are dentists and they run regular education seminars on financial planning topics. To find out about upcoming seminars, or to book an obligation-free meeting, call (02) 9683-6422.

General advice warning This article is issued by Profile Financial Services Pty Ltd (ABN 32 090 146 802), holder of Australian Financial Services License No 226238.

This information might contain unsolicited general information only, without regard to any investor’s individual objectives, financial situation or needs. It is not specific advice for any investor and is not intended to be relied upon by any person. Before making any decision about the information provided, an investor should consider the appropriateness of the information in this article, having regard to their objectives, financial situation and needs and consult their adviser. Any indicative information and assumptions used here are summarised, are not a product illustration or quote and may change without notice to you, particularly if based on past performance. This notice must not be removed from this article.

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infection | CONTROL

READ ME FOR

CPD

Ozone in water: Let the recent evidence speak

By Emeritus Professor Laurence J. Walsh AO

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n recent articles, I’ve discussed the use of novel oxidant-based technologies in infection prevention and control. This article explores the recent literature on ozonated water, drawing particularly on high level evidence from systematic reviews, meta-analyses and clinical trials that are cited in the PUBMED database.

Ozone is a well-known and potent oxidant which is a powerful antimicrobial agent in its aqueous form, as it dissolves readily into cold water. Effects of ozone will depend on the concentration and the application time.

As well as common pathogenic oral bacteria (such as Streptococcus mutans and Porphyromonas

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gingivalis) and fungi (such as Candida albicans), ozone is known to be effective against both enveloped and non-enveloped viruses and amoeba, even at sub-ppm levels such as 0.1-0.4 ppm.1-6 In terms of delivery systems, ozone can be delivered as the gas dissolved in water or in oil, or used in its natural gaseous form, which is the most unstable. Most research has examined the use of ozonated water, since this can be produced on demand to give consistent ozone levels and is suitable for common applications such as irrigation, mouth rinsing and dental unit waterline treatment. Hence, the emphasis in this article will be on ozonated water. The special situation of oils is discussed at the end of the article.

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infection | CONTROL Ozonated water in the COVID-19 pandemic n industry, ozone dissolved in water is used extensively in wastewater treatment and in water recycling, where its powerful oxidizing actions and disinfecting properties can render water free of organic contaminants and microorganisms.

These same features have made it attractive in the COVID-19 pandemic as an antiviral agent for use in pre-procedural rinsing, as recommended in the advice issued in 2020 by the ADA Infection Control Committee for transmissionbased precautions. Comparative clinical studies of ozonated water versus chlorhexidine and povidone iodine in terms of their effects on microorganisms in dental aerosols generated by scaling have shown similar effects in terms of reducing both aerobic and anaerobic bacterial colony forming units (CFU). Moreover, ozonated water can be generated by a purpose-built unit and delivered through a tap, making it easy to collect water for mouth rinsing, to perform hand hygiene and to rinse impressions or items of equipment. For the latter, an example is decontamination of the chamber of the ultrasonic cleaner at the end of the working day. Ozonated water is highly effective for this purpose.7 A built-in water ozonating system can deliver water directly into the waterlines of dental units, so that the cup fill and coolants delivered into the mouth also can provide some antimicrobial actions. The available ozone level as the water exits the dental chair will depend on the temperature, pH and other parameters that influence the half-life of ozone in water, as well as the flow rate and the tubing volume of the dental chair.8 It is well known that sub-ppm levels of dissolved ozone in water exert powerful effects on oral microorganisms, including bacteria and fungi as well as viruses. This is why rinsing the oral cavity with ozonatedwater (e.g. 0.1-0.4 ppm) will suppress microbial growth and slow biofilm formation and will also disrupt existing biofilms because of microbial cell lysis.9 When used at levels up to 10 ppm, ozone in water does not adversely affect the bonding of adhesive restorative materials or orthodontic brackets to tooth structure.10,11 The broad-spectrum actions of ozonated water make it useful for applications where

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inactivation of viruses is the objective.

To this end, ozonated water has been used for the disinfection of contaminated dental casts. It causes less surface changes in micro-roughness than diluted sodium hypochlorite.12 Likewise, it has been used for disinfection of silicone and alginate impressions, causing less microscopic changes to the impression surface than sodium hypochlorite.13,14

Dental unit waterline biofilm control ontamination of dental unit waterlines (DUWL) with heterotrophic bacteria is an important issue in infection prevention and control in dental practice. Bacteria and other microorganisms in waterline biofilms can cause health problems in elderly and immune compromised patients.

Many dental practices now use ozonated water with low levels of ozone to address this issue. Ozone treatment inactivates microbes present in reticulated tap water, making the water entering the chair sterile and hence unable to serve as an inoculum for further biofilm development within the waterlines. Moreover, as freshly ozonated water enters the waterlines, any biofilm remnants will be attacked and broken done.

DUWL biofilms can contain not only bacteria, but also fungi and amoeba. Ozonated water is highly effective against both fungi and amoeba when they are present in DUWL, including when in the forms of fungal spores or cysts, which represent the most difficult and resilient forms of these organisms.15 Given these microbial challenges, chemical treatments of water entering dental units are commonplace. Consequently, ozone has been used to treat DUWL for more than 30 years.16,17 Recent studies provide strong support for using ozonated water for overcoming problems associated with DUWL. A 2019 study of the effects of low concentration (0.4 ppm) ozonated water as a means to limit biofilm growth measured bacteria in DUWL exit water and also examined dental unit components to assess if any harmful chemical effects occurred. Ozonated water was found to be highly effective against heterotrophic bacterial biofilms. Moreover, it was not harmful to dental chair internal components. This confirms its value for preventing DUWL contamination over the longer term.18

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Useful clinical effects on pain and inflammation s well as being a potent antimicrobial agent, ozone dissolved in water exerts additional actions, including the modulation of pain and inflammation, which make it of interest to dentistry for a wide range of clinical applications where antimicrobial actions and anti-inflammatory or immune modulating effects are desirable.19,20 A noteworthy example of this is limiting postoperative pain after extractions. Ozonated water used postoperatively as an irrigant over 1 week is superior to both ordinary saline and to povidone iodine in terms of reducing pain and preventing alveolar osteitis (dry socket).21,22 Ozone in a gel has been shown in another study to reduce postoperative pain, swelling and trismus and hence patients had lower requirements for analgesics.23 In medication-induced osteonecrosis of the jaw due to bisphosphonates, ozone combined with debridement using piezosurgery has been shown to give an overall success rate of 64%, with healing of the lesion when multiple applications of ozone were undertaken over 10 weeks.24,25 Similar positive results have been seen for cases of MRONJ caused by denosumab or bevacizumab.26,27 Likewise, topical ozone therapy has been shown to improve healing of the oral mucosa healing in cases of chemotherapyinduced ulcerations and mucositis. This has been attributed to the combination of its antimicrobial and anti-inflammatory actions, which prevent supra-infections and promote healing, respectively.28 The benefits of using ozonated water rinses for reducing the bacterial counts and encouraging the healing of chemotherapy-induced oral ulcers has been demonstrated conclusively in animal models of chemotherapy-induced oral mucositis stomatitis.29 One contributing mechanism to the positive effect of ozone on wound healing is its strong induction of vascular endothelial growth factor (VEGF), which is elevated for 7 days after a single topical application.30

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Safety for human tissues ll the applications of interest to dentistry involve the use of very low levels of ozone - in the low ppm range for topical use or even in the sub-ppm

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infection | CONTROL range for water treatment. These low levels avoid issues with toxicity. Healthy human cells contain antioxidant systems such as those based on vitamins C and E, which protect cells against harmful effects of oxidation.31-34 In cell culture studies, ozone has good biocompatibility with periodontal cells and gingival fibroblasts. In keeping with this, clinical trials have not documented any adverse effects on oral soft tissues.

This includes studies in children. A recent study of 10-12 year old children who used ozonated water or chlorhexidine as a mouthrinse for 15 days did not find any issues with tolerance of the ozonated water. The authors concluded that ozonated water was preferred for use in children over chlorhexidine, as it was free of adverse effects such as staining and taste alterations.35 This finding validated earlier research from 2017 which compared ozonated water to chlorhexidine when used daily over 14 days in patients with high caries rates. Ozonated water was superior to chlorhexidine for suppressing salivary levels of S. mutans.36 Similar positive conclusions regarding ozonated water as an alternative to chlorhexidine were reached in clinical trials that compared plaque and gingival parameters in orthodontic patients. An ozonated water rinse yielded better outcomes than chlorhexidine in the management of gingivitis in these orthodontic patients.37

Ozone in periodontal therapy Periodontal debridement sing ozonated water rather than regular water as the coolant for ultrasonic scaling is a simple substitution to make. Studies show that this gives an enhanced reduction in bacterial load and can be of benefit in non-surgical periodontal treatment cases with moderate to severe chronic periodontitis.38 Similar benefits have been seen in the recent clinical studies when conventional periodontal debridement (full-mouth scaling and root planning using hand instruments) is combined with ozonated water irrigation using a 22-gauge needle.

Ozonated water irrigation improves the clinical outcomes of mechanical debridement.39,40 A similar study published in 2020 showed that ozonated water used as

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the coolant for an ultrasonic scaler for the initial therapy of patients with moderate to severe chronic periodontitis eradicated the key periodontal pathogens T. forsythia and T. denticola.41 A 2020 meta-analysis that included data from six studies concluded that ozone therapy was an effective adjunct to scaling and root planing in the treatment of periodontitis.42 Of note, prior studies up to 2019 have shown more mixed results, with no difference when scaling and root planing plus sulcus irrigation with ozonated water were used, when compared to scaling and root planning plus irrigation with 2% chlorhexidine gluconate. Issues with 12 studies published between 2010 and 2019 on the adjunctive clinical effect of ozone therapy on nonsurgical periodontal treatment include heterogeneity across the studies, confounding factors and short followup periods. Hence, additional work is needed to give definitive clinical protocols for the optimal clinical outcomes.43,44

Ozonated water and implant dentistry Implant production sing ozonated water during production can be useful for decontaminating the implant surface, as it removes oils and other organic contaminants. 45 The same approach of using ozonated water for removal of organic surface deposits has been used with screw- and cement-retained prostheses, to eliminate contamination that has occurred during their fabrication in the dental laboratory.46 In the later stages of the production of dental implants, ozonated water containing 20 ppm ozone and 100 mM calcium chloride may be a useful approach for modifying the surface of roughened titanium, since using this approach calcium is deposited on the implant surface and cell attachment is enhanced, while adhesion of bacteria is reduced.47

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Implant placement zonated water has been used to irrigate implant osteotomy sites as an alternative to saline. A recent study published in April 2021 used ozonated water at 25 µg/mL concentration, with 30 patients in each group. Patients were assessed by evaluating pain, wound

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healing and levels of C-reactive protein (CRP). Overall, the study demonstrated that using ozonated water decreased pain and inflammation and accelerated wound healing. Pain levels were lower at 2 days and 7 days post-operatively, while soft tissue healing indices were significantly higher at both 7 and 14 days post-operatively, compared to saline. CRP levels were 84% lower. The ozonated water did not cause any side effects.48

Treatment of biofilms on implant surfaces zonated saline solution has been considered as a possible irrigant for helping to destroy biofilms on titanium implant surfaces. In a recent study published in November 2020, ozonated saline was used to treat both single and multi-species biofilms of Porphyromonas gingivalis that had been grown on titanium for 5 days under anaerobic conditions.

Biofilms were treated with an ozonated saline solution at different concentrations for 1 minute. The effect was compared to 0.12% chlorhexidine and to conventional saline solution (0.89% NaCl) without added ozone. The ozonated saline solution containing 80 μg/NmL ozone exerted antibiofilm activity when used for 30 seconds, reducing P. gingivalis viability, with 2.78 and 1.7 log reductions in CFU for single and multi-species biofilms, respectively, over ordinary saline. Its effects were far superior to chlorhexidine, which gave log reductions of only 1.4 and 1.2 under the same laboratory conditions.49 In light of its antibiofilm activity, ozonated saline is a promising candidate therapy for the treatment of peri-implant diseases. In more severe cases of periimplantitis where implant surface decontamination procedures are combined with reconstructive surgical treatment (RST), decontamination of the implant surface by irrigation with ozonated water has been suggested. A recent study compared this approach to decontamination of the implant surface using sterile saline. Following surgery, the ozonated water treatment led to significantly higher clinical attachment levels and better radiographic bone fill of the defects at 6 months. Using ozonated water for implant surface decontamination also gave a notable reduction in inflammation.50

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infection | CONTROL Endodontics Endodontic irrigation for vital pulp therapy zonated water (2-4 ppm) may be a suitable irrigant in regenerative endodontics and vital pulp therapy because of its potent antimicrobial actions as well as its favourable effects on vital dental pulp cells and its low cytotoxicity.51,52

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Irrigation or conventional anterograde endodontics, useful effects have been documented for ozonated water as an irrigant when activated by laser pulses or by ultrasonics, including on biofilms of Enterococcus faecalis in the root canal system.53,54 There have not as yet been sufficient detailed clinical trials of ozonated water as an irrigant to make valid assessments of its adjunctive use as a terminal disinfection step.55 A systematic review of 8 studies comparing ozone with sodium hypochlorite concluded that ozonated water should not be used to replace conventional sodium hypochlorite irrigants.56

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Oral mucosal disease Oral lichen planus zonated water has been used in the treatment of erosive oral lichen planus (OLP), as an adjunct to traditional topical therapy (such as rinsing with betamethasone). Clinical trials have shown that patients treated with betamethasone and ozonated water as a combined therapy experienced significantly greater improvement in symptoms of pain and had a higher rate of overall improvement than those using the steroid rinse only.57,58 A systematic review of 55 trials of treatments for erosive OLP published in March 2021 summarised the benefits of adding ozonated water on to topical corticosteroids. This improved pain resolution compared to placebo from 3.18 for topical corticosteroids to 9.9 fold for topical corticosteroids plus ozonated water. Likewise, rates of clinical resolution versus placebo also improved, from 13.6 fold for topical corticosteroids, to 52 fold for topical corticosteroids plus ozonated water. The authors of this systematic review concluded that topical corticosteroids should be the

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first-line method for treating oral lichen planus and commented that adding on ozonated water had a very useful benefit.

Using ozonated water was free of adverse effects, which distinguishes it from other alternatives such as topical cyclosporine.59

Fungal diseases andida albicans is a major cause of oral fungal infections. Candida-associated denture stomatitis is common among denture wearers. Ozonated water exerts anti-fungal actions and also disrupts fungal biofilms. Based on these actions, ozonated water is a useful strategy to include in denture stomatitis management.60,61

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Ozonated oil live oil can be dosed with ozone.

Other oils have also been used, including sunflower, castor and almond oil. An important caveat is that the antimicrobial and therapeutic actions of such ozonated oils are not due to ozone. Rather, they are due to products formed by the ozonation of mineral oils, such as formaldehyde and not to the ozone itself, which has a very short half-life. Contact with ozone breaks double bonds between carbon atoms of lipid oil molecules, resulting in unsaturated molecules including formaldehyde and other end products.

A study of ozonated oils found that none contained any free ozone, when tested using the sensitive indigo trisulfonic dye test. However, all the oils were found to contain formaldehyde. The presence of this compound explains why ozonated oils can exert antimicrobial actions, despite having been manufactured several months earlier. Hence, one cannot compare directly the effects of ozonated oils with those of ozonated water, where there is only dissolved ozone gas and ozone radicals as active agents - both of which convert to normal di-atomic oxygen.62 Several commercial ozonated olive oil products have been developed for the European market, including Ialozon Blu and Ialozon Rose mouthwash (Gemavip, Cagliari, Italy). As would be expected from their formaldehyde content, these oils exert antimicrobial actions against oral bacteria, including Streptococcus mutans, at dilution factors up to 1:32.63 Likewise, ozonated olive oil also exerts antifungal effects against Candida albicans.64

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The use of an ozonated olive oil-based mouthrinse over 3 months by patients with periodontitis has been shown to improve the results of non-surgical periodontal treatment, with lowered levels of salivary matrix metalloproteinase-8 and reduced bleeding on probing and probing pocket depths when used after periodontal debridement, compared with treatment using debridement alone.65 Studies of ozonated oils have given variable outcomes. One study which compared ozonated olive oil as an adjunctive subgingival irrigant to chlorhexidine in the non-surgical treatment of patients with chronic periodontitis found that both had similar effectiveness, with improvements in clinical indices as well as reductions in subgingival levels of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.66 Given concerns regarding the safety of formaldehyde, long term use of such oils as topically applied oral care products cannot be supported by this author.

Practical applications of ozonated water and current technology he first major application of ozonated water is point-of-care treatment systems built into the joinery of the dental practice with the ozonated water delivered via a tap. The treated water has multiple applications, including use as a pre-procedural mouthrinse, hand washing (for both staff and patients), feed water for a dental chair with a bottled water system, irrigation for stand-alone devices such as ultrasonic scalers, rinsing instruments, rinsing of S traps and suction systems, decontamination of impressions and environmental cleaning. Mint Devices Australia introduced the Kona Infection Control tap™ (KIC tap) system and this has been installed in many dental clinics as well as in residential aged care facilities. This system has a patented electrically powered ozone gas generator and valve system and a Venturi mixing tube, in a fully contained enclosed under-bench unit that is activated by a sensor to provide treated water on demand. KIC taps give a standardised level of ozone in water. From a regulatory perspective, as a disinfectant treatment, KIC taps are TGA approved (ARTG 315409).

For installation in Australia they also are WaterMark™ approved, which means that

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May/June 2021

?

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infection | CONTROL they comply with Australian certification requirements for plumbing products (AS/ NZS 3718:2005 Water supply - tap ware) and can be connected into normal plumbing as a permanent installation. The rapid viral and bacterial inactivation caused by the treated water (10 seconds) makes this a very practicable approach in dental clinic settings, for enhancing infection prevention and control. These units will produce up to 10,000 continuous hours of ozonated water (0.8 - 1.4 ppm) before the treatment cartridge needs to be replaced.

electrical current, supplied by a lithium ion 7.4 volt 1.8 Amp-hr rechargeable battery. The water is broken down by electrolysis. The resulting oxygen is then converted to ozone. The ozonated water (containing 0.5 - 2 ppm ozone) then exits through the spray nozzle. The overall sequence can best be described as “charge the battery, fill the water reservoir, spray the ozonated water, then wipe”. The unit is able to dispense at least 10 full reservoirs (a total of 3785 mL) of ozonated water for each charge cycle of the recharge-

Conclusions here is a strong evidence base drawn from clinical trials and high-level systematic reviews and meta-analyses to support the safe and effective use of ozonated water for specific applications in modern clinical practice. The most common applications for treatment of dental unit waterlines leverage an extensive literature and decades of experience with this approach in industrial settings and in drinking water treatment and wastewater management. In a similar way, the use of ozonated water as a mouthrinse during the COVID-19 pandemic is built on the known antiviral actions of this agent and its potent actions as an oxidizer.

Clinical applications that exploit the ability of ozonated water to influence cell healing are now attracting considerable interest. Clinical challenges where wound healing is impaired, such as MRONJ or mucositis, or is particularly complex, such as in peri-implantitis, have shown positive results. Further work on these topics will lead to a better understanding of the molecular pathways by which wound healing processes are modulated by sub-ppm levels of ozone delivered in water.

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About the author

Figure 1-2. The Kona Infection Control (KIC) Tap and the EnozoPro spray bottle ozonate tap water on an on-demand basis. Both are available from Mint Devices.

A second major way for generating ozonated water is using the Active Diamond Electrolytic Process Technology (ADEPT). The EnozoPro ™ system was introduced by Mint Devices Australia. This is an on-demand ozonated water-producing spray bottle device for environmental sanitizing based on ADEPT, with the system built into the top of the spray bottle with a patented ozone genator. Ordinary tap water is added into a 400 mL reservoir in the spray bottle.

When the trigger is pressed, a batterypowered micro-pump draws water from this reservoir into a chamber. Here the water comes in contact with a solid diamond plate in the presence of a direct

94 Australasian Dental Practice

able battery; and 5000 refills across the life of the battery. The whole device is only slightly larger than a normal spray bottle and so can be taken from room-toroom as needed. The EnozoPro system is Green Seal® certified (under GS standard 37 Cleaning Products for Industrial and Institutional use and GS standard 53 Specialty Cleaning Products for Industrial and Institutional Use), which means, amongst other things, that the undiluted spray is not toxic for humans and that the dissolved ozone is fully biodegradable and leaves no residues. The ozone exposure levels emitted when the water is sprayed onto surfaces are below the allowed peak and short-term exposure limits.

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

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infection | CONTROL References 1. Broadwater WT et al. Sensitivity of three selected bacterial species to ozone. Appl Microbiol. 1973; 26(3): 391-393.

2. Restaino L et al. Efficacy of ozonated water against various food-related microorganisms. Appl Environ Microbiol. 1995; 61(9): 3471-3475.

3. Lezcano I et al. Ozone inactivation of Pseudomonas aeruginosa, Escherichia coli, Shigella sonnei and Salmonella typhimurium in water. Ozone Sci Eng. 1999; 21: 293-300.

4. Lezcano I et al. Ozone inactivation of microorganisms in water. Gram positive Bacteria and yeast. Ozone Sci Eng. 2001; 23: 183-187.

5. Nagayoshi M et al. Efficacy of ozone on survival and permeability of oral microorganisms. Oral Microbiol Immunol. 2004; 19(4): 240-246.

6. Johansson E et al. Antibacterial effect of ozone on cariogenic bacterial species. J Dent. 2009; 37(6): 449-453.

7. Estrela C et al. Antimicrobial potential of ozone in an ultrasonic cleaning system against Staphylococcus aureus. Braz Dent J. 2006; 17(2): 134-138.

8. Bardellini E et al. Coronavirus disease-2019 and dental practice: A project on the use of ozonized water in the water circuit of the dental armchair. Stomatologija 2020: 22(2): 35-38.

9. Razak FA et al. Oxidizing effect of ozonated-water on microbial balance in the oral ecosystem. J Coll Physicians Surg Pak. 2019; 29(4): 387-389.

10. Akturk E et al. Do ozonated water and boric acid affect the bond strength to dentin in different adhesive systems? Niger J Clin Pract. 2019; 22(12): 1758-1764.

11. Alkan O et al. Effects of ozone and prophylactic antimicrobial applications on shear bond strength of ortho brackets. Turk J Orthod. 2017; 30(4): 101-105.

12. Nishikiori R et al. Effect of ozonated water on the surface roughness of dental stone casts. Dent Mater J. 2018; 37(5): 740-745.

13. Abinaya K et al. Evaluation of surface quality of silicone impression materials after disinfection with ozone water: an in vitro study. Contemp Clin Dent.

2018; 9(1): 60-64.

14. Savabi O et al. Prevention of cross-contamination risk by disinfection of irreversible hydrocolloid impression materials with ozonated water. Int J Prev Med. 2018; 9:37.

15. Hikal W et al. Evaluation of ozone application in dental unit water lines contaminated with pathogenic Acanthamoeba. Iran J Parasitol. 2015; 10(3):410-419.

16. Filippi A. Water disinfection of dental units using ozone - Microbiological results after 11 years and technical problems. Ozone Sci Eng. 2002; 24: 479-483.

17. Walker JT et al. Microbiological evaluation of a range of disinfectant products to control mixed-species biofilm contamination in a laboratory model of a dental unit water system. Appl Env Microbiol. 2003; 69(6): 3227-3332.

18. Okubo K et al. Effectiveness and safety of lowconcentrated ozonized water for the reduction of contamination in dental unit water lines. Heliyon 2019; 5(8): e02306.

19. Bocci VA et al. The ozone paradox: Ozone is a strong oxidant as well as a medical drug. Med Res Rev. 2009;29(4):646-682.

20. Tricario G et al. A critical evaluation of the use of ozone and its derivatives in dentistry. Eur Rev Med Pharmacol Sci 2020; 24(17): 9071.

21. Ahmedi J et al. Efficiency of gaseous ozone in reducing the development of dry socket following surgical third molar extraction. Eur J Dent. 2016: 10(3): 381-385.

22. Ghosh D et al. Comparison of efficacy of ozonated water, normal saline, and povidone iodine after surgical removal of impacted mandibular third molars: A crosssectional study. J Family Med Prim Care 2020; 9(8): 4139-4144.

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23. Sivalingam VP et al. Does topical ozone therapy improve patient comfort after surgical removal of impacted mandibular third molars? A randomized controlled trial. J Oral Maxillofac Surg. 2017; 75(1):51.e1.

24. Ferreira LH et al. Bisphosphonate-associated osteonecrosis of the jaw: systematic review. Minerva Stomatol. 2020 Sept 22.

25. Goker F et al. Treatment of BRONJ with ozone/ oxygen therapy and debridement with piezoelectric surgery. Eur Rev Med Pharmacol Sci 2020; 24(17):9094.

26. Raimondi A et al. Rechallenge of denosumab in jaw osteonecrosis of patients with unresectable giant cell tumour of bone: a case series analysis and literature review. EMSO Open 2020; 5(4): e000663.

27. Maluf G et al. A rare case of bevacizumab-related osteonecrosis of the jaw associated with dental implants. Int J Implant Dent. 2019; 5(1):34.

28. Oldoini G et al. Ozone therapy for oral palatal ulcer in a leukaemic patient, Eur J case Rep Intern Med. 2020; 7(2):001406.

29. Hayashi K et al. Effects of ozone nano-bubble water on mucositis induced by cancer chemotherapy.

Biochem Biophys Rep. 2019; 20: 100697.

30. Eroglu ZT et al. Effect of topical ozone therapy on gingival wound healing in pigs: histological and immuno-histochemical analysis. J Appl Oral Sci. 2018; 27: e20180015.

31. Bocci V. Is it true that ozone is always toxic? The end of a dogma. Toxicol Appl Pharma. 2006; 16: 493-504.

32. Suh Y et al. Clinical utility of ozone therapy in dental and oral medicine. Med Gas Res. 2019; 9(3): 163-167.

33. Sen S, Sen S. Ozone therapy - a new vista in dentistry: integrated review. Med Gas Res. 2020; 10(4):189-192.

34. Swanson TJ et al. Ozone toxicity. Treasure Island (FL): StatPearls Publishing; 2021 Jan 17.

35. Mon J et al. Effect of herbal water, ozonated water, water, and chlorhexidine mouthrinses on oral health status of children: a randomized controlled trial. Int J Clin Pediatr Dent. 2019: 12(6): 514-519.

36. Anumula L et al. Antibacterial activity of freshly prepared ozonated water and chlorhexidine on Mutans Streptococcus when used as an oral rinse - a randomised clinical study. J Clin Diagn Res. 2017; 11(7): ZC05-ZC08.

37. Jose P et al. Assessment of the effect of ozonated water irrigation on gingival inflammation in patients undergoing fixed orthodontic treatment. J Indian Soc Periodontol. 2017; 21(6): 484-488.

38. Moreo G et al. Efficacy of ozone therapy in reducing oral infection of periodontal disease: a randomized clinical trial. J Biol Regul Homeost Agents 2020; 24(4 Suppl 1):31-36.

39. Ameyaroy DK et al. Comparative evaluation of the effect of ozone therapy and photodynamic therapy in non-surgical management of chronic periodontitis: A split mouth longitudinal study. J Indian Soc Periodontol. 2020; 24(5):447-453.

40. Vasthavi C et al. Evaluation of ozone as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A randomized clinico-microbial study. J Indian Coc Periodntol. 2020; 24(1): 42-46.

41. Piva A et al. The use of ozone therapy for treatment of periodontal disease: a split mouth, randomized, controlled clinical trial. J Biol Regul Homeost Agents 2020; 34 (3 Suppl 1):91-98.

42. Deepthi R, Bilichodmath S. Ozone therapy in periodontics: a meta-analysis. Contemp Clin Dent. 2020; 11(2): 108115.

43. Moraschini V et al. Ineffectiveness of ozone therapy in nonsurgical periodontal treatment: a systematic review and meta-analysis of randomized clinical trials.

Clin Oral Investig. 2020; 24(6): 1877-1888.

44. Lio F et al. The effectiveness of subgingival irrigant ozone-based as adjuvant for nonsurgical periodontal

therapy in treatment of chronic periodontitis: a review.

J Biol Regul Homeost Agents 2020; 34 (3 Suppl 1):27-34.

45. Lubojanski A et al. Application of selected nanomaterials and ozone in modern clinical dentistry.

Nanomaterials 2021 Jan20;11(2):259.

46. Yin L et al. Evaluating the efficiency of three methods to clean and disinfect screwand cementretained prostheses. J Prosthet Dent. 2021 Jan 13.

47. Takechi M et al. In vitro investigation of the cell compatibility and antibacterial properties of titanium treated with calcium and ozone. Dental Mater J. 2021 Jan 30.

48. Shekhar A et al. An evaluation of the effect of ozone therapy on tissues surrounding dental implants.

Int Immunopharmacol. 2021 Apr1;96:107588. DOI: 10.1016/j.intimp.2021.107588.

49. Tonon CT et al. Anti-biofilm effect of ozonized physiological saline solution on periimplant-related biofilm. J Periodontol. 2020 Nov 24.

50. Isler SC et al. The effects of decontamination methods of dental implant surface on cytokine expression analysis in the reconstructive surgical treatment of peri-implantitis. Odontology 2021; 19(1):103-113.

51. Agarwal S et al. Comparison of antimicrobial efficacy of aqueous ozone, green tea, and normal saline as irrigants in pulpectomy procedures of primary teeth.

J Indian Soc Pedod Prev Dent. 2020; 38(2): 164-170.

52. Küçük F et al. Cytotoxicity assessment of different doses of ozonated water on dental pulp cells. BMC Oral Health 2021 Jan 16;1-16.

53. Hmud R et al. Cavitational effects in aqueous endodontic irrigants generated by near-infrared lasers. J Endod. 2010; 36(2): 275-278.

54. Case PD et al. Treatment of root canal biofilms of Enterococcus faecalis with ozone gas and passive ultrasound activation. J Endod. 2012;38(4): 523-526.

55. Brignardello-Petersen R. Insufficient evidence regarding the effects of ozone when used as a disinfectant in RCT. J Am Dent Assoc. 2020; 151(5): e43.

56. Silva EJ et al. The effect of ozone therapy in root canal disinfection: a systematic review. Int Endod J. 2020; 53(3): 317-332.

57. Mostafa B, Zackaria M. Evaluation of combined topical ozone and steroid therapy in management of oral lichen planus. Open Access Maced J Med Sci. 2018; 6(5): 879-884.

58. Veneri F et al. Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study. Med Oral Patol Cir Bucal 2020; 25(5):e675-e682.

59. Sridharan K, Sivaramakrishnan G. Interventions for oral lichen planus: A systematic review and meta-analysis of randomized clinical trials. Aust Dent J. 2021 Mar 8.

60. Murakami H et al. Disinfection of removable dentures using ozone. Dent Mater J. 1996; 15(2): 220-225.

61. Mirmortazavi A et al. Kinetics of antifungal activity of home-generated ozonated water on Candida albicans. Curr Med Mycol. 2018; 4(2): 27-31.

62. Guinesi AS et al. Ozonized oils: a qualitative and quantitative analysis. Braz Dent J. 2011; 22(1): 37-40.

63. Nardi GM et al. Mouthwash based on ozonated olive oil in caries prevention: a preliminary in-vitro study. Int J Environ Res Public Health 2020; 17(23):8106.

64. Zakrzewski W et al. The influence of ozonated olive oil-loaded and copper-doped nanohydroxyapatites on planktonic forms of microorganisms. Nanomaterials 2020; 10(10):1997.

65. Nardi NM et al. Evaluation of salivary matrix metalloproteinase (MMP-8) in periodontal patients undergoing non-surgical periodontal therapy and mouthwash based on ozonated olive oil: a randomized clinical trial. Int J Environ Res Public Health 2020; 14(18):6619.

66. Gandhi KK et al. Effectiveness of the adjunctive use of ozone and chlorhexidine in patients with chronic periodontitis. BDJ Open 2019 Nov 28;5:17.

Australasian Dental Practice

95

infection | CONTROL

READ ME FOR

CPD

Four changes to infection prevention and control that made a difference

A

t this time last year, we were all collectively reeling from the onset of the COVID-19 pandemic and dealing with the challenges of managing a new virus. And, in the midst of an unprecedented shutdown that nearly ground dentistry to a complete halt for a month, practices pivoted on the fly to implement the Australian Dental Association’s advice on infection prevention and control transmission based precautions that would enable practices to work safely at different levels of restriction.

The past year has not been easy, to say the least. But the good news is that the Herculean effort that dental professionals put in to improve infection prevention and control has paid off. In a recent study conducted by the American Dental Association (AmDA) and the American Dental Hygienist Association (ADHA), researchers found that only 3.1% of surveyed dental hygienists had ever tested positive or been diagnosed with COVID-19 as of October 2020, despite being a high-risk group.

Additionally, the development and distribution of effective vaccines has already had a positive impact on the industry, with Australian dental professionals receiving vaccinations at high rates.

As infection rates among dentists and hygienists remain low and vaccination rates continue to rise, we may be turning a corner with the virus. But, if there is one lasting lesson from the last year, it’s that the risk of new infections is ever-present and infection prevention and control will remain a critical issue indefinitely.

96 Australasian Dental Practice

May/June 2021

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infection | CONTROL Dental professionals have gone above-and-beyond to address infection risks and keep their practices safe. Here are four critical changes that practices made (and should continue to make) in order to keep up the good work:

3. Better engineering and administrative controls n the Hierarchy of Controls, PPE is actually the last line of defence for protecting staff. Before PPE comes engineering and administrative controls (in addition to elimination and substitution strategies), which dental professionals successfully implemented in their practice. This included actions like re-arranging the waiting room to ensure the ability to physical distance patients and removing unnecessary and high touch items like magazines.

Practices have also successfully implemented new check-in procedures to limit the number of patients in the waiting room at any given time. Additionally, pre-appointment telephone screening and triage protocols, as described by the Australian Dental Association, have helped ensure that potentially unwell or infected patients could be identified and asked to reschedule prior to their appointments, while teledentistry provided new options for supporting patients.

I

“HuFriedy Harmony™ Ergonomic Scalers and Curettes minimise strain, fatigue and risk of injury to clinicians...”

1. Stringent Personal Protective Equipment (PPE) use hile PPE has always been a major part of the dental experience, the pandemic necessitated closer attention to the proper wearing of masks and other items of PPE, such as N95 respirators when there was moderate to substantial community spread. Dental staff have greater awareness of the risks associated with aerosol generating procedures.

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2. Improved aerosol management practices uring 2020 we learned more about the coronavirus and how it spreads through aerosol and droplets. This was the basis for restrictions on aerosol-generating equipment, and for the universal use of antimicrobial mouthrinses prior to procedures. Proper use of high volume suction and dental dam adds further control to aerosols. These measures have continued under level 1 restrictions even when patients show no signs of coronavirus infection.

Using less water spray on ultrasonic scalers and reducing water spray on air turbine drills are additional measures that equipment manufacturers have promoted. These help clinicians continue to practice safely.

Additionally, many practitioners began using hand instrumentation more often, to avoid generating aerosols in the first place.

New instrumentation like the HuFriedy Harmony™ Ergonomic Scalers and Curettes minimise strain, fatigue and risk of injury to clinicians by reducing the pinch force in clinicians’ hands and pressure needed on the tooth, which may alleviate conditions caused by repetitive motions.

D

98 Australasian Dental Practice

4. Enhanced preparedness lthough the last year has been challenging, dental professionals (and patients) are now far more aware of infection prevention and control best practices than ever before. Dental professionals rose to the challenge of the pandemic and now are more prepared than ever to deal with the next challenge that comes their way.

Whether its instrument reprocessing and sterilization, waterline maintenance, hand hygiene, clinical techniques, or any other element of daily practice, infection prevention and control is a constant topic that requires attention.

Through the crucible of the pandemic, dental professionals have persevered to prioritise their safety and their patients’ safety. Ultimately, that preparedness and attention to detail will only serve as a benefit in the long run.

A

May/June 2021

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HFL-482AUS/1220 • Color-coded silicone rail system that reduces instrument contact and allows WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: forLOVE more water flow while the instruments WHY DENTISTS STAINLESS STEELprotecting PEDO CROWNS: WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS STAINLESS STEEL PEDOwhile CROWNS: forLOVE more water flow while protecting the instruments during reproce moreOUR water flowSTAINLESS while protecting the instruments during during reprocessing reprocessing forOUR more water flow protecting the instrume WHYfor DENTISTS STEELprotecting PEDO CROWNS: forLOVE moreOUR water flow while the instruments during reprocessing • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening •• Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening All company and product names are that trademarks of Hu-Friedy Mfg.one-h Co., LLC Ideal and mesio-distal width • Ideal height and mesio-distal width • height Easy-to-use, ergonomic latch that allows for one-handed opening • Easy-to-use, ergonomic latch allows for All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

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To learn learn more about how IMS can enhance Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit To more about how IMS VISIT USVISIT ONLINE AT about HU-FRIEDY.COM/PerfectFit To learn more howcan IMS can enhance All company and product names are of Hu-Friedy Mfg. Co., LLC, USLLC.ONLINE ATtrademarks HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., All Hu-Friedy.com/Infinity rights reserved. your practice visit ©2016 Hu-Fried y Mfg. Co.,companies, LLC. All rights reserved. its affiliates or related unless otherwise noted. your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved. ©2017 Mfg. Co., rights reserved. ©2021 Hu-Friedy Co.,All rights reserved. ©2017 Hu-Friedy Hu-Friedy Mfg.Mfg. Co., LLC. LLC. AllLLC. rightsAll reserved.

Hu-Friedy is is now now a a proud proud member member of of Hu-Friedy Hu-Friedy is now a proud member of ©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All is rights now reserved.

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©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

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infection | CONTROL

READ ME FOR

CPD

Face mask performance: Are you protected?

By John A. Molinari, PhD and Peri Nelson, BS

M

ask resistance to bacterial penetration was studied using an enclosed, specially fabricated 1.2m x 1m x 0.9m chamber around a dental chair (Figure 1). A mannequin head was mounted on a rod and fitted with a test mask before each experiment. One investigator held the mannequin head in the chamber in front of a “patient” mannequin head (Dexter) with full dentition during testing. The indicator bacterial species used was Serratia marcescens.

This is a Gram-negative bacillus that occurs naturally in soil and water and produces a red pigment at room temperature. It is associated with urinary and respiratory infections, endocarditis, osteomyelitis, septicaemia, wound infections, eye infections, and meningitis. A mixture of water-soluble red dye and S. marcescens was placed in the mannequin’s oral cavity. This fluid served as an analogue for the “patient’s saliva”.

The second mannequin head fitted with the worn face mask was mounted approximately 30 cm in front of the mouth of the “patient”. This masked head represented a dental clinician using a high-speed handpiece during treatment.

The mannequins were exposed to aerosolised preparations of the red dye/ bacteria mixture for periods of either 5, 15 or 30 minutes. To accomplish this, a dental water-driven high speed handpiece was run by an investigator in the mouth of the patient mannequin, touching teeth and creating aerosolised spatter. The masked mannequin was positioned as a clinician would be during treatment, in order that airborne droplet spatter from the

100 Australasian Dental Practice

“patient’s mouth” would contact the test masks as per clinical procedures. Handpieces were run for 30-second intervals until total exposure times were reached.

Masks were subsequently removed from the mannequin heads and visually inspected for detection of red spatter on the outside and inside portions of the mask. Sterile cotton swabs moistened

in tryptic soy broth were also used to culture the outside and inside surfaces of the masks. Aerobic S. marcescens microbial growth was evaluated by culturing collected specimens onto tryptic soy agar plates at room temperature for 48-72 hours. Bacterial growth patterns were then observed for the experimental exposure intervals with each mask type tested.

The objectives of this study were to:

Assess how extended use of different levels of fluid-resistant mask affects microbial penetration;

u v

Evaluate the penetration resistance of Medicom Safe+ face masks during specific intervals to aerosolised “red” spatter (fluid resistance) and resistance to aerosolised mixtures of water-soluble red dye mixed with a representative bacterial species (bacterial filtration); and

Compare the penetration effectiveness of the Medicom Safe+ masks to masks from other manufacturers with level 1, 2 or 3 fluid resistance (as per AS 4381) and to non-medical (domestic) disposable masks with no rating for resistance to fluid penetration.

w

Figure 1.

May/June 2021

infection | CONTROL After 5 minutes of splatter/aerosol exposure Non-ASTM performance

Figure 2. Non-rated mask performance.

ASTM performance level 1

Figure 3. Fluid resistance level 1. The rated masks provides superior protection over a non-rated masks.

After 15 minutes of splatter/aerosol exposure ASTM performance level 1

Figure 4. Fluid resistance level 1. Note the presence of dye after 15 minutes of aerosol exposure.

ASTM performance level 2

Figure 5. Fluid resistance level 2. Note absence of dye penetration. Level 2 provides superior protection compared to level 1.

After 30 minutes of splatter/aerosol exposure ASTM performance level 3 Results: Red Dye Penetration Studies bservation of exposed masks showed that, in general, the higher fluid resistance (Level 3) Medicom Premier Elite Mask was able to resist red dye penetration better than Level 1 and Level 2 masks after 15-minute exposure times. Red dye was seen on the inside surfaces of both low level performance masks by the end of the 15-minute intervals. Most of the Level 1 and Level 2 masks showed evidence of dye penetration by the 15-minute test interval. However, the inside portion of the Level 2 Medicom Premier Plus Mask demonstrated little, if any, red colour after treatment.

O

May/June 2021

Figure 6. Fluid resistance level 3. Even after 30 minutes, only a single spot of dye on the inside was noted. Medicom level 3 masks were superior to level 1 masks for procedures with high splatter/aerosol exposure.

Australasian Dental Practice

101

www.medicom-australia.com

infection | CONTROL

www.medicom-australia.com Bacterial Challenge Studies

A summary of the bacterial challenge results is shown inwww.medicom-australia.com Table 1.

www.medicom-australia.com Table 1. Bacterial Penetration Results Following Mask Challenge with S. marscescens* Mask

Fluid resistance 5 minutes 15 minutes

Moulded Face Mask, Alt. brand 1 —

Fail Fail

Procedure Mask, Alt. brand 2 —

Fail Fail

Procedure Mask, Alt. brand 3 1

Fail Fail

Procedure Mask, Alt. brand 4

1

Pass Fail

Procedure Mask, Alt. brand 5

2

Pass Fail*

Premier Mask, Medicom

1

Pass Fail

Premier Plus Mask, Medicom

2

Pass Fail

Premier Elite Mask, Medicom

3

Pass Pass

*Pass = no bacterial growth, failed = bacterial growth

30 YEARS OF PRIDE EMPOWERING

failed the 15-minute bacterial challenges.

The Medicom Premier Plus and an alternative brand Level 2 masks demonstrated Bacterial Penetration Studies more resistance to microbial penetration, as only a few Serratia colonies were acterial cultures from the outer surdetected on the mask inside surfaces. faces of all of the masks tested were In contrast, the only masks shown to found to be heavily contaminated with S. completely resist S. marscescens penmarscescens after 5-, 15-, and 30-minute etration at 15-minutes was the Level 3 aerosol generating procedures. When Medicom Premier Elite Mask. It should be the inside mask material was sampled, noted here that a 30-minute bacterial chalresultant bacterial cultures showed that Medicom arenon-rated manufactured state-of-the-art lenge also on no bacterial growth on the inner face surfacesmasks of the two Medicom is dedicated to revealed designing and the inside surface ofdesigns this Level 3 mask. mask typesin(Molded Facefactories.

Mask and Our machinery ourproducing own innovative a wide range of personal and Mask) and the Level 1 fluid resistant mask premium materials ensure that Medicom masks provide protection equipment to face foster a safe, Conclusions demonstrated bacterial penetration after comfortable and efficient environment for and reliable protection, as well as exceptional breathability the 5-minute exposure intervals. None of dental professionals to perform their his investigation the feel ability of the other masks study showed comfort, evenused forin this those with sensitive skin orstudied who everydaypenetration work. Your different patients trustfacethe available masks to prered-pigmented Serratia claustrophobic in ordinary masks. Produced to the highest professional, and so can ventyou. penetration by a water-soluble red at that interval. standard complying with AS4381:2015 and registered with dye and aerosolised suspensions of bacAs expected, the inside surface cultures teria.

Airborne from all of Mediicom the Level 1 masks tested to alsokeep TGA. Trust masks you safe.challenges to test masks

Results:

were conducted using a high-speed handpiece for 5-, 15- and 30-minute intervals.

The findings demonstrated that each of the non-rated masks and Level 1 masks failed both the red dye bacterial penetration test much more quickly than masks with Level 2 or level 3 splash resistance. While the two Level 2 masks were shown to allow only small numbers of red-pigmented S.marscesens through to the inside of the mask after 15-minutes exposure, the Free samples available.

Medicom Premier Elite masks (Level 3) Simply scan code Free samples available. were able to prevent all detectable bacteriaand let us know what scan code you and let us to penetrate for up to Simply 30-minute challenge are penetration interested know what youin. are intervals. Both the dye and bacterial penetrationinterested tests demonstrate in. that AS 4381 rated masks are significantly more protective than non-rated masks.

Furthermore, level 3 masks outperform level 1 or level 2 when exposed for 15-30 minutes.

THE PROFESSIONALS WITHTRUST PRODUCING MASKS YOU CAN B THE PROFESSIONAL PRODUCTS

T

Safe+Mask® Premier Plus Earloop Masks 203515

SafeBasics™ Easy Fit Latex Powder Free Gloves 1188

SafeSeal® | Quattro Sterilisation Pouches 88000

*1175 SafeTouch Slim Blue Nitrile PF Glove

*1266 Dental Dam

contact us at email: cs@medicom-australia.com Ph: 1300 818 168 or visit www.medicom-australia.com

Contact us at email: cs@medicom-australia.com | Phone: 1300 818 168 or visit www.medicom-australia.com

102 Australasian Dental Practice

May/June 2021

www.medicom-australia.com www.medicom-australia.com

www.medicom-australia.com www.medicom-australia.com

30 YEARS OF PRIDE EMPOWERING THE PROFESSIONALS WITHTRUST PRODUCING MASKS YOU CAN THE PROFESSIONAL PRODUCTS

Medicom face masks are manufactured on state-of-the-art Medicom is dedicated to designing and machinery in ourproducing own factories.

Our range innovative designs and a wide of personal premium materials ensure that Medicom provide protection equipment to face fostermasks a safe, comfortable andexceptional efficient environment for and reliable protection, as well as breathability dental professionals to perform their comfort, even for those with sensitive skin or who feel everyday work. Your patients trust the claustrophobic in ordinary masks. Produced to the highest professional, and so can you. standard complying with AS4381:2015 and registered with TGA. Trust Medicom masks to keep you safe.

Safe+Mask® Premier Plus Earloop Masks 203515

SafeBasics™ Easy Fit Latex Powder Free Gloves 1188

SafeSeal® | Quattro Sterilisation Pouches 88000

Scan the QR code to

receive a FREE BOX Free samples available. of AS4381:2015 Simply scan code and let us Level 2 Mask know what you are interested in.

*1175 SafeTouch Slim Blue Nitrile PF Glove

*1266 Dental Dam

contact us at email: cs@medicom-australia.com Ph: 1300 818 168 or visit www.medicom-australia.com

Contact us at email: cs@medicom-australia.com | Phone: 1300 818 168 or visit www.medicom-australia.com 28052021-DN-AD-009-MAU V1

clinical | EXCELLENCE

Using VITA SMART.FIRE® to create a fast and aesthetic same-day, chairside restoration

By Daniel Vasquez, DDS, Dr Vasquez & Associate Dentists, Oceanside, California, USA

A

s an experienced advanced cosmetic and general dentist, I rely on materials and equipment that allow me to practice smart, same-day dentistry. I use a variety of CAD/CAM blocks to complete my chairside restoration cases, but can use the VITA SMART.FIRE® to crystallise, stain and glaze all of them. I have been using the VITA SMART.FIRE furnace since its inception three years ago. It’s compact, good-looking and crystallises all the glass ceramics I work with. I can also stain and glaze with it. The easy and efficient setup allows me to have all the materials I work with on one screen, accessible with a simple touch of a button. The patient case in this article is an example of how the right materials and the right equipment, when used together, produce a successful, fast and aesthetic same-day cosmetic restoration.

Case report 49-year-old female patient presented in the office with severe pain when biting down. She also experienced sensitivity to hold and cold. After a detailed examination, x-rays and clinical evaluation, the diagnosis was an inflamed nerve and irreversible pulpitis (Figure 1). The determination was made to perform a root canal and replace the crown using same-day dentistry. The challenge was to find a suitable restorative material that was strong enough to last and would also look aesthetically pleasing. In this case, IPS e.max (Ivoclar Vivadent) was the chosen material. The VITA SMART.FIRE furnace (VITA Zahnfabrik) was selected to crystallise the material. VITA SMART.FIRE can crystallise IPS e.max in just 10 minutes and 12 seconds, faster than any other furnace on the market and the fastest commercially

A

104 Australasian Dental Practice

validated cycle for IPS e.max. The goal was to create a durable tooth restoration with a natural appearance and pleasing aesthetics in one appointment.

Equipment he VITA SMART.FIRE is an efficient, compact firing unit that has been specifically designed for chairside restorations, including the crystallisation, glaze, stain and corrective firing of all common chairside materials. I use VITA SMART.FIRE to crystalize VITA SUPRINITY® PC (VITA Zahnfabrik), as well as IPS e.max (Ivoclar Vivadent). I also use the furnace to stain and glaze VITABLOCS® VITA Mark II and VITABLOCS TriLuxe forte and glass ceramic VITA SUPRINITY PC (VITA Zahnfabrik), Katana (Kuraray Noritake), Celtra Duo (Dentsply Sirona) and IPS Empress (Ivoclar Vivadent) (Figure 2). Materials can be selected and the program started in one simple step using the intuitive touch control unit with a high resolution 10-inch display. Patient images can also be uploaded for easy reference. The setup offers additional convenience features, like the ability to add materials and photographs, view adjacent teeth and match another colour by working off the uploaded pictures on the screen. Customised, material-specific programs are already pre-installed for simple firing. The fully automatic temperature calibration produces reliable results and a software-based assistance function is also available for supported, step-by-step firing.

The convenient, compact size means VITA SMART.FIRE can also be set up quickly and simply and is mobile for use in any treatment room. Most materials take just 10 minutes to stain or glaze in the furnace. VITA SMART.FIRE can crystallise IPS e.max in just 10 minutes and 12 seconds on the speed crystallisation setting, faster than any other furnace on the market and the fastest commercially validated cycle for IPS e.max.

T

May/June 2021

clinical | EXCELLENCE

Figure 1. X-ray of a 49-year-old female patient who presented with pain when biting down and sensitivity to hot and cold.

Figure 2. The VITA SMART.FIRE screen with all my most widely used materials.

Figure 3. Access for the root canal was done through the existing crown.

Figure 4. The buccal view from the existing crown with a view of the open margin.

Figure 5. The crown is removed and the tooth is cleaned.

Figure 6. Final x-ray for the root canal.

Preparation o access the root canal, we went in through the existing crown (Figure 3). During that process we discovered that there was decay under the crown and an open margin on the buccal was visible (Figure 4).

Replacement of the crown was thus necessary. For aesthetic purposes, the patient also decided to replace the composite filling on the adjacent back molar (tooth #31). We removed the existing crown and cleaned the tooth (Figure 5). A final x-ray was taken (Figure 6) and the rubber dam was placed for isolation (Figure 7).

Next, we completed a build up of the restoration to create a ferrule effect using Clearfil Universal Bond Quick adhesive and Clearfil DC Core Plus resin (Kuraray Noritake).

T

May/June 2021

Figure 7. A rubber dam is placed for isolation and a build-up of the restoration is completed for the ferrule effect.

Australasian Dental Practice

105

clinical | EXCELLENCE

Figures 8-9. Impressions are taken using CEREC Primescan.

Figure 10. The restoration is designed using CEREC 5.1.3 software.

Figure 11. The IPS e.max block is milled in the Dentsply Sirona CEREC Primemill.

Treatment plan o begin the treatment plan, we took digital impressions using the CEREC Primescan (Dentsply Sirona), which is fast, efficient and produces exceptional images (Figures 7-8). Impressions were taken with the rubber dam on, allowing us to view all four well-defined margins, which were clean and dry. We designed the restoration using the CEREC 5.1.3 software, adding the material selected, which was IPS e.max (Ivoclar Vivadent) (Figure 10).

T

Milling ext, the restoration was milled in the CEREC Primemill (Dentsply Sirona) (Figure 11). The sprue was removed and the IPS e.max restoration was placed in the VITA SMART.FIRE furnace for the final crystallisation using the speed crystallisation setting (Figure 12). The crystallisation was completed in just 10 minutes and 12 seconds (Figures 13-14).

N Figure 12. The sprue is removed and the restoration is placed in the VITA SMART.FIRE furnace.

Figure 13. Crystallisation of the IPS e.max block using the speed crystallisation setting. Total time is 10:12.

106 Australasian Dental Practice

Figure 14. The cycle and the temperatures used to crystallise the IPS e.max on the speed crystallisation setting.

May/June 2021

Biodentine Biodentine Biodentine

™ ™™ ™ ™

NEW NEW NEW

*

SATISFACTION

PRACTICE PRACTICE EFFICIENCY EFFICIENCY REPUTATION PRACTICE REPUTATION EFFICIENCY •••

••••••

* * *

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Reverse the Reverse the Reverse the TRUST Reverse the TRUST Irreversible!

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Irreversible!

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“First ever

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The first and only dentin in a capsule NEW

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

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

Pediatrics ™

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

MANAGING Endodontics MANAGING

PAIN FOR YOUR MANAGING YOUR PRACTICE PAIN FOR PRACTICE YOUR

Biodentine saves pulps EVEN with signs and symptoms provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms able outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns.

As world leader in Pain Management, Septodont ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : iscover why dentistsprovides favor our impeccable fit.

Perfect for your patients.

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clinical | EXCELLENCE

Bonding efore bonding, the rubber dam was placed to protect the tissue (Figure 15). The crown was fit and the contacts were cleaned.

The restoration was bonded using Panavia V5 cement (Kuraray Noritake) (Figures 16-17).

B Figure 15. Preparing the final restoration for bonding using the rubber dam.software.

Figures 16-17. Bonding the final restoration.

Figure 18. The completed restoration.

Figure 19. Final x-ray of the completed restoration.

Conclusion he final restoration and x-ray show a beautiful, well-fitted restoration with excellent margins (Figures 18-19). The patient no longer has pain when biting, or sensitivity to hot and cold and is pleased with the look and feel of her new restoration. The combination of using IPS e.max and the VITA SMART.FIRE allowed for a fast, but durable and aesthetic restoration that was completed in one appointment, in keeping with my practice of smart, sameday dentistry. The VITA SMART.FIRE is simple, efficient and fast and allows me to be consistent on the finish and the delivery of my restorations, regardless of the product (Figure 20).

T

Figure 20. VITA SMART.FIRE furnace.

About the author Dr Daniel Vasquez is a world-renowned advanced cosmetic and general dentist in San Diego with his practice, Daniel Vasquez & Associates. He offers a variety of dental services from one-day visit CEREC crowns, veneers, same day smile makeovers, and more.

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clinical | EXCELLENCE case report

Selective-etch adhesive bonding of an IPS e.max® CAD partial crown

By Dr Gunnar Reich, Germany Initial situation

A

Final situation

52-year-old female patient presented with a large composite filling and a fractured cusp on the endotontically treated tooth 27. The tooth was restored with a lithium disilicate glass ceramic partial crown cemented with 3M™ RelyX™ Universal Resin Cement and 3M Scotchbond™ Universal Plus Adhesive in the selective-etch adhesive technique.

Figure 1. Initial situation and preparation.

Figure 2. HF etching of bonding surface and priming with 3M Scotchbond Universal Plus Adhesive as silane.

Always follow the Instructions for Use (IFU) and refer to IFU for full indications, precautions and warnings. 3M Science. Applied to Life.”, RelyX and Scotchbond are trademarks of 3M. All other trademarks are owned by other companies © 3M 2021. All rights reserved.

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Figures 3a-b. Selective enamel etch with 3M Scotchbond Universal Etchant and application of 3M Scotchbond Universal Plus Adhesive.

Figure 4. Application of 3M RelyX Universal Resin Cement.

Figure 5. Seated partial crown with cement excess.

Figure 6. Tack-cure of cement excess.

Figure 7. Excess clean-up with scaler.

Figure 8. Final situation.

Figure 9. Final situation buccal view.

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clinical | EXCELLENCE

Diastemata - A viable correction method using an aesthetic composite

By Alexandra Papanikolaou, DDS

T

he Greek term Diastemata describes spaces or gaps between the anterior teeth, not caused by tooth loss.

Beauty is perceived differently across the world

n Ghana, Namibia and Nigeria, a diastema between the two front teeth is considered attractive and a sign of fertility. In fact, some people even try to actively create a gap with cosmetic dentistry. However, in other regions of the world, including Greece, diastemata are seen as less favourable and a gappy smile is a leading cause of discontent. Numerous patients have already visited our clinic in search of an aesthetic solution to this perceived imperfection.

Diastema closure is a challenge for both the dental technician and the dentist. Even the fabrication of direct veneers requires cooperation on both sides to achieve an aesthetic end result. It starts with the wax-up and ends with the dentist’s meticulous task of inserting the restorations into the mouth.

I

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clinical | EXCELLENCE

Figure 2. Smile before treatment.

Figure 3a. Starting situation.

Figure 1. Photo before treatment.

Figure 3b. Starting occlusal situation.

The clinical case his is the interesting case of 20-year-old Melina, who was treated in our clinic. The case was documented extensively. As a professional model, Melina was concerned about her appearance when she smiled and the way her natural diastemata affected the overall aesthetics of her face. When she came to our clinic, she was looking for a quick solution to the problem (Figure 1).

The clinical examination showed the following aesthetic deviations:

T

Starting situation • Gummy smile; • Old, deficient composite restorations on teeth 21 and 11; • Diastemata between the teeth 24-23-22-2111-12-13-14; and • Overjet and overbite (Figure 2).

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Treatment plan t the first appointment, we tried to identify all aspects and discuss the possible solutions with the patient. Initially, we took a series of digital photos so that we could examine the situation carefully (Figures 1, 2, 3a and 3b). Next, we took impressions and made study models. Once the treatment plan had been established and the patient was in agreement, we sent the models to the technician for the wax-up.

At the very beginning, we contemplated taking an orthodontic approach with orthognathic surgery or the extraction of the first premolars. However, this plan was quickly disregarded due to the lengthy treatment measures and invasive nature of these procedures. In addition, in our opinion, the patient had a functional occlusion and a very harmonious face shape and any change in her facial proportions would have been too risky.

The clinical examination revealed another aesthetic problem - the gummy smile. Due to her high smile line, the patient showed a disproportionate amount of gingiva. However, the fact that her gums were visible when she laughed did not bother her. We proposed surgical crown lengthening procedure, but the patient rejected this.

The selected treatment plan was as follows: 1. Teeth bleaching; and 2. Direct composite veneers on teeth 13-12-11-21-22-23.

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Procedure he bleaching procedure took four weeks with the use of 16% carbamide peroxide on custom-made mouthguards overnight. After that, a break of two weeks is required to allow the teeth to rehydrate.

This step is important for two reasons.

Firstly, it will prevent detachment of the restorations from the bleached surfaces and secondly, it will allow the correct shade for the restoration to be selected.

After the wax-up appointment, the shapes and proportions of the restorations were determined. At a later appointment, we started working on the veneers.

T Figure 4. Shade selection.

Step-by-step Shade selection

Figure 5. Isolation.

irst, we removed the old restorations with an electric handpiece and magnification using a minimally invasive procedure to preserve as much tooth structure as possible, in order to achieve a natural-looking result.

We used “composite buttons” to select the correct shade for the restoration. Small amounts of composite in different shades were strategically placed onto the incisors.

Usually, the dentine shades are applied in the cervical region and the incisal material is placed at the incisal edge (preferably with a black contrastor, in order to check the translucency) (Figure 4). This step is carried out before the rubber dam is placed, so that the shade can be checked before dehydration of the teeth. In this case, the dentine shades A1 and A2 and the incisal shades BL-L and B1 were tested from IPS Empress Direct. Finally, the dentine shade A2 and incisal shade BL-L were selected.

F

Figure 6. Silicone key.

Figure 7. The first incisal layer.

Isolation eeth 14-24 were isolated and the gingiva was retracted using a heavy rubber dam and double ligatures on each tooth (Figure 5).

T

Applying the composite

Figure 8. Proximal walls.

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sing the wax-up, a palatal silicone key was fabricated in an extra hard, addition-cross-linked silicone material.

U

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clinical | EXCELLENCE

The silicone key was cut precisely at the incisal edges of the 6 upper anterior teeth.

Teeth 13 to 23 were sandblasted with 50µm aluminium oxide.

Then, the selective etching technique using TOTAL ETCH (37% phosphoric acid) was performed for 30 seconds.

Adhese Universal (Ivoclar Vivadent) was then applied to the surfaces to be restored.

The composite IPS Empress Direct (Ivoclar Vivadent) in the shade BL-L was applied to the silicone key, then inserted into the mouth and light-cured. This is how the incisal veneers were made. It helped us to define the length, width and shape of the restorations on the teeth 13-23.

We used the instrument OptraSculpt Pad (Ivoclar Vivadent), which enabled us to fabricate the composite successfully and effectively (Figure 6).

After this step, any excess composite was removed from the veneers with a no.12 scalpel. This step is very important, in order to prevent a bond between the individual composite parts (Figure 7).

After the first composite layer, the cervical-incisal dimensions were designed.

Pre-formed metal matrices were placed between the incisal veneers so that the mesio-distal areas could be fabricated.

The matrices were originally made for the posterior tooth segments. The proximal walls were built up using the incisal material shade BL-L from IPS Empress Direct again. OptraSculpt with the slanted cylinder attachment (Figure 8) was used.

Here, a small “enamel box” was created to define the limits of our “work”. In other words, it created the framework for our canvas.

Next, IPS Empress Direct in dentin shade A2 was applied to the teeth 22-1112-21 within the “frame”. An OptraSculpt instrument was used to create different mamelons. To do so, the pointed end of the OptraSculpt was used. The easy flowing IPS Empress Direct Effect Trans Opal was then applied between the mamelons to achieve an opalescent effect and visually separate the mamelons from one another (Figure 9).

For the last composite layer, the incisal material BL-L from IPS Empress Direct was used again. Little “amorphous” (shapeless) heaps of composite were prepared for the build-up (Figure 10).

May/June 2021

Figure 9. “Enamel box”.

Figure 10. “Amorphous” veneers.

Figure 11. After the final adjustments and the polish.

Figure 12. A new smile.

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Figures 13a-b. Photos after treatment.

Finishing and polishing he restorations were contoured and finished with a pointed bur, rotating at a low speed in a handpiece, following the transition areas previously marked in pencil. Particular attention was given to the individualisation of the surface micromorphology and growth grooves, to ensure the restoration was appropriate for the age of the patient. The rough scratches caused by the bur were polished smooth with Politip F (Ivoclar Vivadent). The final polish was achieved with Politip P (Ivoclar Vivadent) (Figure 11). The patient was discharged from the practice and an appointment for final corrections was scheduled for a few days later. The direct veneers integrated harmoniously into the patient’s smile and complemented her natural beauty perfectly (Figures 11, 12 and 13a-b).

T

Conclusion ood communication between dentist, dental technician and patient, together with careful planning, can lead to a pleasing and satisfactory result.

Minimally invasive treatments are beneficial for the preservation of the hard tooth substance and allow the cosmetic changes of a new smile to be integrated harmoniously into the natural beauty of the face. It is important to remember that there is no fundamental physical constant in aesthetics. Instead, it is the shape, shade and dynamic design that determine the aesthetic end result.

G

About the author Alexandra Papanikolaou received her D.D.S from the National and Kapodistrian University of Athens with grade “Very Good” on 2011. She continued her education in the postgraduate program of gIDE/UCLA receiving the title “Master Clinician in Aesthetic Dentistry “ with top honours. Since 2013 she has her own private clinic in Athens, Greece focused mainly on restorative and aesthetic dentistry. She s founding member of Academy Of Clinical Dentistry (ΑΚΟ) of Greece and lecturer on topics in her expertise field.

For more information, contact Ivoclar Vivadent Pty Ltd in Australia on 1300-486-252 or orders.au@ivoclarvivadent.com

For more information, contact Ivoclar Vivadent Ltd in New Zealand on 0508-486-252 or orders.nz@ivoclarvivadent.com

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clinical | EXCELLENCE

Figure 1. The Farrell Bent Wire System™ - a simple and effective expansion approach combined with the Myobrace® System.

Are all arch development techniques created equal?

By Dr Emad Ahangari, BOH Dent Sc (Griffith), GDipDent (Griffith)

T

he debate between the fixed and removable or rapid and semi-rapid expansion camps has been raging for decades. Regardless of the type of arch development technique, the aim is more or less the same: turn a screw and expand the mid-palatal suture. Very few question this dogma, but is this the best approach to arch development?

Donald Enlow is widely considered as one of the greatest researchers in craniofacial growth. In fact, you would be hard pressed to find an orthodontic school who does not teach his concepts. Although many clinicians have read his highly influential book Essentials of Facial Growth, few take notice of this paragraph: “Historically, the process of expanding the maxilla by ‘splitting’ the mid-palatal suture has been thought of as a ‘biologic’ procedure. Such is not the case. The

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mid-palatal suture probably plays a small role, if any, in the displacement of the maxillary shelf laterally.”1 According to Enlow, the techniques employed to separate the mid-palatal suture have no basis in the normal process of growth and development. Furthermore, such a traumatic procedure, although widely employed, has been previously reported to have serious side effects in some patients and may be affecting others in ways we haven’t anticipated.2,3 Many readers will be asking themselves, if splitting the mid-palatal suture is not the right way, then what is? Before we can answer this question, we must first understand how the arches develop.

The theories of Enlow, Moss and others, are commonly known in orthodontics.4 These authors proposed that although the genes play a guiding role in facial growth, the function and growth of the soft tissues are the primary drivers. Nasal breathing

in combination with the correct tongue to palate contact and correct function of the peri-oral muscles is crucial in driving the correct development of the upper jaw and dentition.5 From this knowledge, it follows that the re-establishment of correct breathing and oral muscle habits, from as early as possible in growing patients, is an essential endeavour if we are to give patients the best chance of developing correctly.

The issue that we face currently is that virtually all expansion appliances occupy space across the palate, which worsens the patient’s tongue position and will invariably affect swallowing patterns and breathing, particularly during sleep.

These atypical habits that are caused or worsened by expansion techniques which occupy space across the palate will logically deteriorate patient function. Perhaps this may also explain poor stability in expansion cases.6

May/June 2021

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Figure 2. This 9-year-old female patient is still in treatment, but shows the power of the BWS and Myobrace® combination in creating arch development.

Since they work on the suture, almost all expansion appliances develop mainly in the transverse dimension. Although research has shown that this opens the nasal cavity and decreases resistance to airflow, a good portion of the change may be due to the sagittal development of the maxillary structures which occurs as a side effect of expansion and not only lateral development of the nasal cavity. Forward displacement of the upper jaw results in increasing nasopharyngeal dimensions and perhaps more crucially, the translation of the lower jaw and tongue anteriorly, improving muscle tone around the velopharynx and base of the tongue, factors commonly implicated in sleep breathing disorders.7 If we are also to create more room for the tongue to move upwards and forwards out of the airway and rest against the palate, expansion should be performed in the transverse and sagittal dimensions together. As the structures are being developed, all efforts should be directed at simultaneously correcting the patient’s breathing and oral muscle habits so that optimum natural development is achieved in addition to the mechanical expansion. Thinking of these issues as only structural, as opposed to a combination of structural and functional components, is highly flawed and unidimensional thinking. Since function and structure reciprocally affect one another, expansion and habit correction should be done together and not staggered one after the other. As a bonus, three-dimensional expansion invariably creates more space for the teeth, as opposed to expansion that only occurs in two dimensions.

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We now understand the shortcomings of mainstream expansion techniques and how we should be thinking about approaching arch development. Unfortunately, for many decades, the profession lacked any solution which could develop the arches in three dimensions, avoid trauma to the mid-palatal suture, while simultaneously improving patient function.

The Farrell Bent Wire System™ (BWS) from Myofunctional Research Co. (MRC) was developed precisely to meet this demand. The BWS is a lightwire arch expansion technique, which develops the arches in three dimensions while avoiding any traumatisation to the mid-palatal suture and interference with patient function. It must be combined with specially designed Myobrace® appliances which simultaneously improve patient function, while the BWS develops the arches.

In addition to these biological benefits, there are practical benefits too. The BWS can be made in-house by trained auxiliaries in less than 10 minutes, while costing a few dollars per appliance. It doesn’t interfere with patient speech and is invisible to outside viewers, which makes it well accepted by patients. The BWS is adjusted every 4 weeks, harnessing the superiority of intermittent forces over continuous ones, while the adjustment appointment itself is extremely simple, taking less than 2 minutes to complete.

The power of the BWS is illustrated in Figure 1. This 9-year-old female patient attended MRC’s clinics with the complaint of severe crowding and mouth breathing. In combination with the Myo-

brace T1BWS, the BWS appliance was used, demonstrating the impressive expansion achieved. The patient’s function is completely resolved and she is habitually nasal breathing while awake and asleep.

This case is still in treatment and used for illustrative purposes, yet it shows that the BWS and Myobrace combination can correct some of the more severe cases of arch restriction.

Practitioners who would like to learn about the aforementioned techniques can do so by visiting www.myoresearch. com and completing the online training courses. Recently, the release of the Farrell Bent Wire System™ course allows practitioners to gain an end to end understanding of the BWS, including how to fabricate, fit and adjust the appliance.

Visit the website to get started today!

References 1. Enlow, D. Essentials of Facial Growth. Chapter 1.

W B Saunders. August 1996.

2. Romeo et al. Headache and Diplopia after Rapid Maxillary Expansion: A Clue to Underdiagnosed Pseudotumor Cerebri Syndrome? Journal of pediatric neurology: JPN. July 2015; 13(01):031-034.

3. Baysal et al. Evaluation of alveolar bone loss following rapid maxillary expansion using cone-beam computed tomography. 2013 Apr; 43(2): 83–95.

4. Proffit, W. Contemporary Orthodontics. 4th Ed. Chapter 2. Elsevier Health Sciences. January 1994.

5. Peltomäki. The effect of mode of breathing on craniofacial growth–revisited. Eur J Orthod 2007;29(5):426–429.

6. Gurel et al. Long-term effects of rapid maxillary expansion followed by fixed appliances. Angle Orthod. 2010 Jan;80(1):5-9.

7. Sánchez-Súcar et al. Effect of rapid maxillary expansion on sleep apnea-hypopnea syndrome in growing patients. A meta-analysis. J Clin Exp Dent.

2019 Aug; 11(8): e759–e767.

May/June 2021

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clinical | EXCELLENCE

case report

Immediate extraction and implantation of lateral incisor in combination with the CS 3600 by Carestream Dental, MGUIDE

by MIS-Implants and exocad software

By Mithridade Davarpanah

A

middle-aged male patient presented with a long-term fracture to his lateral right maxillary incisor and was seeking a permanent restoration. The crown of the tooth had been stabilised years ago with a temporary mesh bonding, which had deteriorated over time. Diagnostic records were taken, including vestibular and lingual views of the maxillary arch, showing deterioration of the temporary stabilisation

and a PA radiograph of the lateral incisor clearly showed the high root fracture.

A complete digital approach was taken to planning the treatment for this case. An optical scan of the patient’s dentition was obtained using the CS 3600 by Carestream Dental and CBCT images were acquired.

An initial ISQ reading of over 68 was obtained using the Ostell machine. The customised preformed milled healing abutment was placed, which allowed for the contouring of the gingival tissues at the time of implant placement.

Next, the CS 3600 digital impression and CBCT datasets were imported into MIS MSoft CAD software for planning of the implant placement, size and position.

Due to the narrowness of the site, an MIS V3 Ø3.3 x 16 mm implant was selected.

The surgical guide was then designed based on the position and size of the implant and was sent to be manufactured.

Next, the crown of the lateral incisor was extracted and the MGUIDE surgical guide template was placed to verify that seating and stability were correct.

Figures 1-5. Initial situation on left, post-whitening shown on right.

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clinical | EXCELLENCE

Figures 6-8. Patient was scanned with CS 3600.

Figures 9-10. CBCT + CS 3600 Digital Impression imported into MIS MSOFT Planning software.

Figures 11-14. The printed surgical guide template and resin support were manufactured.

Figures 15-18. Crown of the lateral incisor was extracted.

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Figures 19-20. The MGUIDE surgical guide template was placed to verify that seating and stability were correct.

Next, the appropriate MGUIDE Conical Connection pilot drill kit was selected based on the implant and sleeve size for the guide. The pilot drills were selected from the MGUIDE pilot kit in the appropriate drilling sequence, beginning with the starter drill, and then proceeding with the guided pilot and conical drills.

Figures 21. MGUIDE pilot drill kit.

Figures 22-23. Starter drill left; guided pilot drill right.

Figures 24-25. Conical drill.

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clinical | EXCELLENCE

Figures 26-30. Implant placement.

Once the drilling sequence was complete, the implant was inserted using a ratchet tool and the placement verfied by seating the guide.

The abutment was placed and a soft tissue graft was performed.

The graft tissue was harvested from the posterior region of the patient’s palate. A postoperative radiograph was taken to verify the implant placement with the healing abutment.

Figure 31. Placement verfication with guide template.

Figure 32-35. Abutment placement.

About the author Dr Mithridade Davarpanah is a medical doctor, stomatologist certified in periodontology, diplomat of the American Board of Periodontology and member of the French Academy of Surgery. He was successively Associate Professor at the Southern California University of Los Angeles and Paris VI. He has extensive experience with bone grafts and is the author of numerous articles published in international journals as well as several books. His Manual of Clinical Implantology, translated into a dozen languages, was very well received and has entered a Second Edition. He is a much sought after speaker in Europe and the US.

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Figures 36-38. Harvesting of graft tissue.

Figures 39-41. Healing abutment with graft placed.

Figure 42. Optical impression of scanbody.

The appropriate scanbody was selected and placed and an X-ray was taken to verify that the scanbody was seated correctly. The patient was re-scanned with the CS 3600 to obtain a digital impression to be used for restoration planning. As a timesaving measure, the previously scanned dataset was used and only the lateral incisor with the scanbody was re-scanned.

The STL file was imported into exocad software to plan the restoration design.

The correct 3 mm Ti-base implant and scanbody were selected in the software.

The new restorative crown was designed in exocad software based on the placement of the patient’s implant.

Figure 43-45. Restorative planning in Exocad software.

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clinical | EXCELLENCE

Figures 46-47. The patient’s initial situation shown on left, and current situation shown on the right

Figures 48-49. Restorative design in Exocad software.

Figure 50. CAD design of the crown.

Figure 51. Screw-retained crown.

The crown with its Ti-base abutment, which was selected from the prosthetic pillars library of the MIS V3 implant system, we designed in the CAD software. The temporary crown was manufactured with a short pillar of 0.5mm and was adjusted prior to placement.

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Figures 52-56. Final adjusted temporary crown.

Figures 57-58. 1-week post-operative follow-up.

The temporary crown was placed, and a control radiograph was taken to confirm the placement and installation. Intraoral photos were taken showing the final adjusted temporary crown.

The patient was seen at both 1-week and 3-month post-operative intervals. A radiographic control image was taken at the 3-month post-operative appointment to verify success of placement and installation.

Figure 59. 3-month post-operative follow-up.

128 Australasian Dental Practice

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clinical | EXCELLENCE

case report

Plastic periodontal surgery combining mucoderm® and Emdogain®

By Dr. med. dent. Dávid Botond Hangyási, Hungary

Figure 1.

T

his case report describes the predictable coverage of multiple adjacent maxillary gingival recessions using the modified coronally advanced flap (MCAF) technique and modified coronally using the advanced tunnel technique (MCAT) in conjunction with an acellular porcine-derived collagen matrix (mucoderm®) combined with enamel matrix derivative (Straumann® Emdogain®). The author states: “In my opinion, this case can be viewed as satisfactory both for the patient and the operator, effectively demonstrating the benefits of the combination of mucoderm and Emdogain as regards time and pain.”

130 Australasian Dental Practice

Figure 2.

Figure 3.

Initial situation 30-year old female patient in good general health presented with Miller Class I gingival recessions in the upper jaw affecting teeth #12, #13 and #14 and teeth #22, #23 and #24 (Figures 1-3). She was referred to our office by an orthodontist colleague (Dr Enikő Szívos, DMD, orthodontist).

The patient sought a minimally invasive approach to improve ther aesthetic appearance and to facilitate brushing.

A

Treatment planning

T

o achieve a satisfactory aesthetic result with, at the same time, minimal

traumatisation of the soft tissues, a minimally invasive approach was chosen to cover the exposed roots. Professional oral hygiene was implemented prior to the scheduling of regenerative therapy with mucoderm and Emdogain. We decided to perform the coverage before the orthodontic therapy, and we also decided to use different surgical procedures and biomaterials depending on the local clinical situation.

As we wanted to improve the quality of attachment, we decided to use PrefGel®/ Emdogain. In some places the thickness of keratinised gingiva was not adequate. To thicken the gingival tissues and produce more keratinised gingiva, we planned to apply mucoderm.

May/June 2021

clinical | EXCELLENCE

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Surgical procedure he old cervical fillings were removed.

The exposed root surfaces were cleaned with curettes, under local anesthesia, in the region #12 to #14, and split thickness oblique papillary incisions were made according to the modified coronally advanced flap (MCAF) technique (Zucchelli & DeSanctis J Periodontol 2000), thereby creating a new “surgical

T

May/June 2021

papilla” and a connective tissue bed (Figures 4 and 5). The anatomical papillae were de-epithelialised to extend the connective tissue bed. Root conditioning was performed with Straumann PrefGel for 2 minutes; Straumann Emdogain was applied all over the clean, blood-free root surfaces (Figure 6). mucoderm was trimmed to the desired size and rehydrated for ten minutes in sterile saline solution.

Next, the collagen matrix was placed over

those exposed root surfaces exhibiting the most prominent recessions (teeth #12 and #13) and immobilised at the level of the cementoenamel junction with palatal sling sutures (Figure 7). A periosteal releasing incision was made to allow for coronal positioning and suturing of the elevated flap. Finally, buccal sling sutures and modified sling sutures were used to fix the flap and achieve primary wound closure (Figure 8).

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clinical | EXCELLENCE

Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Suturing was performed according to the double-sling technique with 6/0 non-resorbable monofilament suture material. To treat the recessions in the region #22 to #24, the modified coronally advanced tunnel (MCAT) approach (Azzi & Etienne, 1998) was chosen. Before the tunnel was prepared, the exposed root surfaces were mechanically cleaned, Straumann PrefGel, followed by Straumann Emdogain, were applied all over

132 Australasian Dental Practice

the root surfaces (Figure 9). The tunnel was then prepared using tunneling knives and the collagen matrix was rehydrated for 10-20 minutes. Next, the collagen matrix was pulled into the tunnel with the help of vertical mattress sutures (Figures 10 and 11). The graft and tunnel were positioned by double-sling suturing (6/0 non-resorbable monofilament sutures), the graft being about 2 mm apically from the CEJ. The flap was moved in a coronal

direction to cover the mucoderm matrix completely and primary wound closure was achieved (Figures 12-15). Post-operatively, the patient was instructed to rinse with chlorhexidine solution twice a day for 2 weeks, but no other medication was prescribed. The patient refrained from mechanical tooth brushing for the first two post-operative weeks to avoid traumatising the treated area. The sutures were removed two weeks after the surgery.

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clinical | EXCELLENCE

Figure 16.

Figure 17.

Figure 18.

Final result ost-surgical healing was uneventful.

At 20 months following regenerative therapy with mucoderm and Emdogain, the clinical situation appeared stable (Figures 16 and 17). Previously exposed tooth roots were covered in a satisfactory manner and significant thickening of the marginal gingiva was visible. This stable clinical outcome was maintained in the long term, as demonstrated at 27 months after the surgery (Figure 18). The patient expressed a high level of satisfaction, specifically with respect to the healing process and the aesthetic appearance of the treated teeth.

P

Conclusion he case presented here illustrates the successful coverage of exposed tooth roots with simultaneous thickening of

T

134 Australasian Dental Practice

the marginal tissue using a less invasive approach by applying the collagen matrix mucoderm in combination with Emdogain.

The post-operative follow-up revealed complication-free healing and a stable clinical situation two years after the surgical intervention. This approach is characterised by a high level of acceptance by the patient, since harvesting of an autologous soft tissue graft is avoided and a satisfactory aesthetic result is achieved. Thus, to cover Miller class I and II multiple recession cases, if a satisfactory amount of keratinised gingiva is available apically to the recession, then MCAF and MCAT represent predictable procedures if used with the combination of mucoderm and Emdogain.

In my opinion, this case can be viewed as satisfactory both for the patient and the operator, effectively demonstrating the benefits of the combination of mucoderm and Emdogain as regards time and pain.

About the author Dr Dávid Botond Hangyási received his Doctorate of Dental Medicine in 2007 at the University of Szeged, Faculty of Dentistry, Hungary. He completed his postgraduate training and graduated as a Specialist in Periodontology.

He runs a private practice in Hungary (Hódmezővásárhely) and is a part-time lecturer at the Department of Periodontology at the University of Szeged, since 2007.

Since 2015 he is an Academic Contributor at the Department and a board member of the Hungarian Association of Periodontology. Dr Hangyási is a key opinion leader for Botiss Medical AG and is providing international and national lectures and courses in the field of periodontology and implant dentistry. His fields of interest are non-surgical periodontal therapy, periodontal plastic surgery and hard- and soft tissue management in implantology.

May/June 2021

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clinical | EXCELLENCE

Conservative treatment for a symptomatic irreversible pulpitis using Tricalcium Silicate

By Prof. Dr Maximiliano Casa Herzmann

“The choice of Biodentine is underpinned by its excellent biocompatibility, low induction of inflammation and bioactivity...”

I

would like to share an interesting and challenging situation for today’s dentist.

For decades we have been taught that, for a symptomatic irreversible pulpitis, we always had to perform a complete biopulpectomy because it was not possible to clinically and clearly identify the extent of the inflammation contained inside the neurovascular bundle.

The objective of the treatment after exposing the pulp is to encourage the healing of the pulp tissue and facilitate the formation of restorative dentin to maintain the vitality and health of the pulp (Abarajithan M, Velmurugan N, Kandaswamy D, 2010).

Sensitivity tests guide the professional tentatively in interpreting the condition of the pulp, whether it is healthy, reversibly inflamed, or so inflamed that the only treatment option is to remove it completely.

Currently, thanks to histopathological understanding and to advances in biomaterials such as those based on tricalcium silicate like Bioden-

136 Australasian Dental Practice

tine™ (Septodont, France), used in regenerative treatments where the resulting response of the dentine-pulp tissue is evidently better, the doors have been opened to attempt to go beyond the paradigms established in this respect.

The choice of Biodentine is underpinned by its excellent biological properties such as biocompatibility (Kettering J.D., Torabinejad M.1995), (Osorio R.M., Hefti A., Vertucci F.J., Shawley A.L, 1998), (Septodont, 2013); low induction of inflammation, bioactivity, good interaction with different tissues such as periodontal ligament and pulp (Lee S.J., Monsef M., Torabinejad M, 1993), (Abedi H.R., Ingle J.I. 1995), antibacterial capacity, (Torabinejad M., Hong C.U., McDonald F., Pitt Ford T.R, 1995); (Torabinejad M., Hong C.U., Pitt Ford T.R., Kettering J.D, 1995), but specifically in cases of repairing interradicular furcation perforations, as well as its great compressive and flexural strength, similar to dentine, capable of withstanding mastication forces without fracturing (Septodont. Biodentine Active Biosilicate Technology Scientific File, 2013).

May/June 2021

clinical | EXCELLENCE

Figure 1. Clinical examination of the carious lesion.

Figure 2. Radiographic examination of the extent of the lesion.

Figure 3. Inhibiting haemorrhage while cutting.

Figure 4. Macroscopic examination of the remaining pulp.

It is precisely in this respect that these things may not be so accurate: where these precepts rooted deep in our consciousness begin to fall apart and where we understand that interpreting the symptoms a patient expresses, to which we attribute a histological meaning to then prescribe a treatment. This leaves the professional in a delicate position of having to establish some preparatory steps, which we can indicate as progressive development, before the indicated treatment. Cases have been published (Qudeimat et al 2017, Taha et al 2017) which showed successful results in teeth with partial irreversible pulpitis and apical periodontitis, respectively.

May/June 2021

The presence of apical radiolucency has been assumed to be a contraindication to performing therapy on the vital pulp in permanent teeth. However, a retrospective study showed a high percentage of success, including in teeth that underwent pulpectomy using MTA (mineral trioxide aggregate) (Linsuwanont et al. 2017).

In so doing, jumping to conclusions and indicating an irreversible treatment for a symptom is not recommended. It is recommended to move forward gradually while observing those macroscopic clinical signs that provide us with some missing data in order to determine the appropriate treatment.

Clinical case 9-year-old male patient presenting at the Autonomous University of Chile, comprehensive paediatric chair II, with a pulp diagnosis of symptomatic irreversible pulpitis due to the progression of a carious lesion that was evidenced clinically by occlusion of tooth 46 (Figure 1) and radiographically by the large cavity near the pulp chamber (Figure 2). Following the pattern of confronting the previously outlined conservative treatments, it was decided to move forward gradually while removing the unsupported enamel - the dentine was completely decayed -

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clinical | EXCELLENCE

Figure 5. Biodentine protecting the remaining pulp. exposing a pulp that was seen to be clinically inflamed. Spontaneous haemorrhage then occurred after removing 2mm of pulp. At this point, it was decided to remove the pulp completely from the pulp chamber (Figure 3), thus containing the haemorrhage, using a sterile gauze moistened in saline solution for two minutes, to assess possible inflammation of the radicular pulp. Gratifyingly, there was no spontaneous bleeding of the remaining pulp, thus suggesting a tissue without irreversible inflammation from a macroscopic point of view (Figure 4).

Thanks to the excellent qualities of bioceramics such as Biodentine, pulp remnants are protected (Figure 5) and benefit from its biocompatibility, bioactivity and excellent mechanical properties that provide it with a suitable and conducive medium to begin the healing process, also benefiting from its mineral tissueinducing property.

The patient had a follow-up examination at 7 months, at which the tooth was asymptomatic, functional in so far as there was no radiographic sign of apical pathology (Figure 6) and responding positively to sensitivity tests.

Discussion t is essential to reassess the position of the professional when interpreting the signs and symptoms presented by the patient. It is important to understand that the histology will not always be accu-

I

138 Australasian Dental Practice

Figure 6. Radiographic control examination at 7 months.

rately reflected clinically; knowledge of this fact should be enough to consider the possibility of the tooth undergoing conservative treatment, regardless of the initial symptomatology.

It is recommended to move forward gradually while observing those macroscopic clinical signs that provide potential missing data in order to determine the appropriate treatment.

“Thanks to the excellent qualities of bioceramics such as Biodentine, pulp remnants are protected and benefit from its biocompatibility, bioactivity and excellent mechanical properties...”

Biodentine iodentine can be used wherever dentin is damaged, both in the crown and in the root: • In the crown: temporary enamel restoration, permanent dentine restoration, deep or large carious lesions, deep cervical or radicular lesions, pulp capping, pulpotomy (reversible and irreversible pulpitis).

• In the root: root and furcation perforations, internal/external resorptions, apexification, retrograde surgical filling.

B

About the author Prof. Dr Maximiliano Casa Herzmann graduated from the National University of La Plata, Buenos Aires, Argentina in 1996. He has been a Professor at the Faculty of Dentistry in the Endodontics Chair of the National University of La Plata, Buenos Aires, Argentina; at the University of Chile; at the Andrés Bello University, Santiago, Chile and at the Autonomous University of Chile working within the areas of endodontics and paediatric dentistry in the degrees leading to professional degrees (dentist and dental surgeon) and in the Specialties of Endodontics. He is the author of clinical guides in the area of endodontics and paediatric dentistry. He has run two of his own clinics since 1996 and has worked in the clinics of (P.E.C.I.F.A) Civilian Personnel of the Armed Forces, Sanitary Unions, various public, private dental clinics and more.

He is co-author of the book “Clinical guide and endodontic text”, currently in the process of being published in the Spanish Academic Editorial. He serves as Coordinator of the area of Conservative Treatments in Young Permanent Teeth at the Autonomous University of Chile. Collaborator from Endodontics in Specialties such as Rehabilitation, Implantology and Pediatric Dentistry in this and other national and international universities. He is currently appointed Director of the Specialty in Endodontics at the Autonomous University of Chile.

May/June 2021

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surgery | DESIGN

Heritage makeover in a class of its own

A

ustralia’s oldest continuously operating dental practice has undergone a transformation.

The building, on the corner of Carron Street and Sydney Road, Coburg was built in 1906 and originally operated as physicians’ rooms. The building was designed in a distinctive style, a cross between Neo Tudor and Federation and has been a landmark in Coburg since it was first built.

In 1922, Coburg dentist Vic French Snr bought the property and it has been operated as a dental surgery ever since.

In 1946, Ron French and his brother Vic took over the practice from their father.

140 Australasian Dental Practice

The French family are Victoria’s (and possibly Australia’s) oldest established dental family with a long line of dentists and specialists that spans several generations. The building was extended in 1948 and again in the early 60’s to accommodate the growing practice. After 43 years as a dentist, Ron retired in 1989 and the practice was sold to current owner Dr Jeffrey Kestenberg.

It is hard to imagine the numbers of patients that have walked through the doors in the century since Coburg Dental opened the doors. Families in the local community have visited the practice over multiple generations for their dental care and preserving this legacy would be key to the success of this transformation project.

Fittingly, as Australia’s oldest national health care design and construction provider, Medifit were the natural choice for this project. The Medifit team were able to utilise their experience with heritage renovations to deliver a state-of-the-art dental practice whilst delicately preserving the heritage aspect and history of the building.

The story of the transformation is best told by Dr Jeffery Kestenberg himself...

•••••• t was on my mind for quite a long time.

I knew I had to modernise the practice and I could not decide if I should relocate to a newer, nearby location or renovate our existing location which has been the home to Coburg Dental Group for over 90 years.

I

May/June 2021

I owned the property, loved the location and everyone in Coburg and its surrounds knew this distinctive building as “the dentist”. It’s situated right on a pedestrian crossing and tram stop and is just a short walk from the train station and the bus.

Street parking was readily available most of the time but foot traffic was poor. I suppose you can’t tick every single box. I looked at local properties which could accommodate us but there was nothing that was suitable for rent or purchase. Local real estate agents couldn’t assist my search successfully and time was ticking by as the search continued (Timing is everything because the COVID epidemic has resulted in several businesses closing and there are several good properties which are vacant now).

Frustrated by the lack of result from my property search, I decided to stay at our current location.

I decided to speak to our equipment supplier to see who they would recommend as Designers and Builders for a new renovation and fit out of our premises. After all, these equipment guys would be working all the time with all the fental fitout specialists so they would know who was good and who to avoid. I also spoke to a few dental finance brokers to ask the same questions.

Amongst all the names which were suggested, one name stuck out as the obvious choice. They all highly recommended Medifit and that I speak to Sam Koranis, who is the Managing Director.

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surgery | DESIGN

I met Sam at an ADIA conference about 11 years ago for an informal chat and we agreed to meet to discuss various ideas and options. Do I develop the whole property? Do I tear down the existing building and redevelop from scratch? Do I renovate and extend? Sam also has a qualification in accounting (CPA) so he could help me to crunch the numbers and work out a business plan for the project. This turned out to be very helpful later when I was negotiating with the Banks. Sam was a great spokesman for the project and the financiers have immense respect for Sam and his experienced team. He seems to know everyone!

At the same time, I still investigated other “dental fit out” companies and builders. I asked many colleagues who had renovated and closely followed social media. I wanted to really make sure that I made the right decision. This was going to be too big a project and such an important business decision, so my due diligence had to be right. Medifit again was clearly the stand-out candidate to handle my project.

After several planning meetings I decided that we would build apartments on top of a state-of-the-art dental surgery. We experienced the most frustrating period of my professional career in dealing with the most indecisive and obstructionist local council (Which I call the People’s Republic of Moreland), the banks including a change of bank manager, financiers and town planners. I had an arborist write a report for the council so that I could

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May/June 2021

surgery | DESIGN

have a dead tree removed, the elders of the First Nation to get their permission to develop their land, the local historical society, the neighbours and so on. We explored several different ideas which all had immense potential.

After several years, many headaches, a lot of stress and considerable expense I gave up on those plans. However, the team at Medifit were terrific through the whole planning process in helping me to try to achieve my desired end result. Finally, we decided to renovate our existing premises. This was now a renovation project and it was going to be big, totally gutting out the entire building and creating an extension to the rear with the same heritage aspects just leaving 3 outside walls and the key structural internal walls. A completely new fit out was undertaken and all the new equipment was going to make Coburg Dental Group a wonderful state of the art facility to work in.

Medifit was intimately involved in all the planning, design, tendering process, building supervision and fit out of the renovated premises. We also decided to vacate our building as this was to be more cost-effective, cleaner, quicker and easier than having the renovations done while we were still occupying part of the building. We found temporary premises nearby and Medifit helped us with the temporary fit out and relocation.

Each stage of the project was undertaken with expertise, professionalism and minimal fuss.

May/June 2021

Whilst the building is situated on a double block, it also has a council imposed historical overlay. This isn’t as stringent as a heritage listing when it comes to conforming to rules and regulations, however conditions still apply.

Renovating any building which is 110 years old is never easy.

There are unknown treasures and many surprises when you tear down a wall or rip down a ceiling.

All types of flora and fauna, a major rotting wooden beam, a collapsing wall and a history of layers of floor coverings were found, just to name a few of our surprises.

Medifit acted as my eyes and years on site and supervised the structural elements of the build to ensure any problems were promptly resolved with no time lost. As a result of their expertise, I had no headaches, no stress and could focus on my main job, that of a dentist treating patients, albeit in our temporary premises.

Medifit also looked after all the daily hassles, no matter how small.

Despite the COVID-19 epidemic, the lockdowns, supply issues and the usual issues with trades, the building renovation finished exactly on time as planned. The fit-out finished exactly on time and the equipment installation by Anthos was undertaken exactly as planned. That was truly amazing!

My staff, family, patients and I are so happy with the final result. It is well and truly far beyond our wildest dreams and it has rejuvenated our desire to come to work.

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surgery | DESIGN

Sam Koranis and each member of the Medifit team have been wonderful. Most importantly, their communication with us has been exemplary. I have received over 500 emails from them over the last few years. I was told they sent over 5,000 emails to everyone concerned with the project. Absolutely, everything has been documented.

Most importantly, my accountant and bank is also extremely happy too, especially with the fact that no variations were made considering the complexity of the project.

There are many people who I would like to thank for the success of our project.

My wife Ruth who has always supported all of my professional dreams and aspirations and is simply the best. She encourages, supports and facilitates everything I do.

My family in general who put up with a lot, particularly during the few stressful times. I love each and every one of you.

My Practice Manager, Rachael, who I am blessed to have as the leader of our Coburg Dental Group team. She has been my “right hand person” for over 25 years and without her, nothing would ever get done. She is an amazing woman who has sacrificed so much to ensure the success of the Coburg Dental Group business. She works after hours, weekends, on her days off and even when she’s on holidays. Her family has also been amazing in supporting her when needed.

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May/June 2021

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Summary The Practice The Practice

Coburg Dental Group

Principals

Dr Jeffrey Kestenberg

Type of Practice

General

Location

Coburg, Melbourne, Victoria

Size

305 square metres

No of chairs

6

The Team Design

Medifit Design & Construct

Construction

Medifit Design & Construct

Installer

Anthos In Australia

Equipment

My staff have all been wonderful. Thank you for all of your help each and every day.

Yes, you all get paid to work but your loyalty, dedication and willingness to work extra when required, to help with our shifting to the temporary premises on the weekend, reorganizing the practice, putting up with all the inconveniences and stresses and then moving back to the newly renovated premises over Easter and your days off has been terrific. Thank you for a job well done.

Thank you, Sam Koranis, the Managing Director of Medifit, who I have now known for 11 years. His knowledge of the dental industry, his support and accountability are second to none.

Also, a huge thank you to all the Medifit team who were involved in our project, including Mark, Gerry, Sow-Yoong and Lynda together with the onsite project management team of Michael, Rob and Jackie.

You were all great people to work with.

Craig Spiegel and his team from Credabl finance have been wonderful too. I have known Craig for over 20 years and have done many deals with him over this period.

Purchasing our state-of-the-art equipment and fit-outs were made so easy. I could

146 Australasian Dental Practice

Dental Units

Anthos L9, Anthos R7, Anthos A9

Autoclaves

MELAG Vacuklav 40B+ Evolution MELAG MelaTherm wsher disinfector

X-ray

MyRay Hypersphere with MyRay Sensors integrated in Anthos Units

CBCT

MyRay Hyperion X9 PRO 3D CBCT Ceph

Compressor

Cattani AC 400

Suction

Cattani Tandem Turbo Smart never find a better deal than the deals Craig offered and believe me, I tried!

Thank you to the team at Anthos in Australia headed by CEO Phil Pagliuso, general manager Bobby Trenkovski, together with Frank and Ray, the ever-dependable installers and technicians. I have used Anthos equipment for most of my career and cannot recommend it highly enough.

I highly recommend the entire team that worked on the project as true professionals in their selective fields. Thank you all.

•••••• Medifit’s Sam Koranis added “We knew we’d been entrusted with something special at Coburg. A dental legacy that stretched back for a century requires a special combination of skills and experience and I was always confident that our team would deliver. Having known Dr Kestenberg and shared this journey with him and his staff over many years, we are proud of what we have been able to achieve together. Myself, along with the entire team at Medifit thank Jeff, Rachel and everybody at Coburg Dental Group for the opportunity to be involved in such an iconic makeover project and wish them well in their new practice.

May/June 2021

Pioneers

IN!TheUltimate...

W Practice Makeover WIN a complete public image update valued at over $90,000!

www.ultimatepracticemakeover.com.au

Medifit have set the standard for excellence in dental practice design and construction since inception in 2002. Dentists and Dental Specialists around Australia trust us to create state of the art practices with individual interior designs that boost productivity and enhance levels of care.

Whether it’s a brand new space, a redesign of an existing practice, or a heritage makeover - we’ll help you create a practice that reflects your personal style and complements the way you work. and we do it with a friendly, no fuss approach.

BEFORE

AFTER

BEFORE

AFTER

Contact Medifit today for a no obligation consultation and experience our award winning service.

• SITE ASSESSMENTS • LEASE NEGOTIATION • FEASIBILITY STUDIES • COUNCIL SUBMISSIONS • ARCHITECTURAL DESIGN

• INTERIOR DESIGN • BUILDING CONSTRUCTION • PRACTICE FIT-OUTS • RENOVATIONS / REFRESHES • BRANDING & MARKETING

MULTI AWARD WINNING HEALTHCARE DESIGN & CONSTRUCTION • 2017/18 ASOFIA Best Medical Fitout • 2017/18 ASOFIA Best Use of Sponsors Product • 2017/18 & 2018/19 ASOFIA Best Design - Professional Suites

1300 728 133 www.medifit.com.au

surgery | DESIGN

All the vital elements!

By David Petrikas

N

ewly established general dental practice, Vital Dental, really lives up to its name, showing that getting the vital elements right is the recipe for

practice success.

Managing director, Andreas Schilling - who is not a dentist, but has 10 years’ experience in running medical, dental and radiology clinics - understands that by asking the right questions and bringing the right people together, it’s possible to create outstanding practices.

First and foremost was the location of Vital Dental which occupies a doublelet retail space in a busy high traffic area of Royal Randwick Shopping Centre in Sydney’s eastern suburbs.

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Not only is the practice highly visible and easily accessible - coupled with ample free parking and proximity to public transport - but the centre is close to nearby teaching hospitals and high-level dental expertise.

Mr Schilling said his aim was to build and equip a dental facility where patients would want to come and staff would want to work. A simple philosophy, but one that requires great thought to the details to make it happen.

For Mr Schilling, there was never a doubt that the new dental clinic would be a success, considering the convenientlylocated bright and modern practice makes it appealing to “walk-in” patients. There was also the element of COVID which stopped people travelling outside the local area for treatment.

Given his previous experience in building and operating medical and dental practices, Mr Schilling knew the first step once the site was identified was to create the optimal layout of rooms, steri, lab and other areas within the practice. Once he had the basic design and requirements in mind, he then looked for the best partner for the final details and fit-out.

To make the dream into a reality, Mr Schilling then called in the expertise of Craig Exley, principal of surgery design and fit-out company, Commodore Dental & Medical Fitouts.

“Craig was amazing with coming up with the right size rooms and layout and his cabinetry is very thoughtfully designed to avoid someone having to reach into a bottom drawer ‘24 times a day’ while working,” Mr Schilling said.

May/June 2021

surgery | DESIGN

“He understands the space and how it all fits. The quality of his joinery is second to none and he came in on-time and on-budget.”

Some of the practical considerations included an efficient steri room with enough room for two people to work in and surgery layouts and cabinetry which supported the dental team.

The front of house has been designed to provide a balance of being bright and welcoming and also providing some privacy to patients and family members in the waiting area.

A thoughtful touch is a “fenced off” children’s play area in easy view of the waiting room and reception desk. Although the shopping centre has cafes, takeaway options and clean public restrooms nearby, Mr Schilling also wanted a large staff meals area and private toilet inside the practice.

“I think it’s important in building a team to give them time to talk together instead of just working hard all day and then having to go out to find lunch and eat alone and then coming back again to go straight back to work.”

May/June 2021

The other vital consideration is the type of equipment used in the practice and how it works for patients and also appeals to the dentists and assistants.

After asking lots of questions of the dentists now working in the practice - some who are highly experienced and also hold lecturing positions nearby - A-dec came out as the clear winner.

Mr Schilling said this was a combination of A-dec’s reputation for reliability, functionality and ergonomics for both patient and dentist. Another vital consideration was the availability of local back-up support which is provided by local A-dec dealer, Dental Installations in Miranda.

“One of our local dentists from Coogee is a huge A-dec fan and I wanted to hear the feedback from our dentists before making a decision,” Mr Schilling said.

“They have likened them to BMWs and I think the investment in a quality product is worth it as we want to use the chairs for years to come.”

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Continuing the theme of attracting and looking after the clinical team while on the job was the provision of ergonomic A-dec 500 dentist’s and assistant’s stools.

Mr Schilling said the additional expense of the top-of-the-line A-dec dental stools was a wise investment in the long-term occupational health and productivity of the dental team.

The A-dec 500 dentist’s and assistant’s stools have been quite literally redesigned from the “bottom up”. A specially shaped armature and built-in performance zones mould to the operator and special padding doesn’t restrict blood flow to the thighs. The seat base is also designed to tilt forward to transfer some of the operator’s weight on the legs while seated, to avoid putting pressure on the lumbar area which is a major cause of musculoskeletal injury when working in a seated position for long periods.

“The A-dec stool really makes a difference - which is important as they sit on them all day, so it is important to get that aspect right,” Mr Schilling said.

When it came to choosing dental units, Mr Schilling opted for A-dec 300 patient chairs with traditional delivery systems to provide a balance of ergonomics, features and price.

150 Australasian Dental Practice

May/June 2021

A-d ec 300 00 4 c A-de

Ade c5 00

THERE’S AN A-DEC FOR EVERYONE Every dental practice is unique. That’s why A-dec offers a full line of dental chairs, with a wide variety of options and price points, all designed for comfort, performance, and reliability.

From the entry-level A-dec 200, the stylish A-dec 300, to the classic A-dec 400 and the premium A-dec 500, there’s an A-dec chair to fit your practice, your personal style, and your budget.

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

V99299

Contact your A-dec dealer today visit australia.a-dec.com/find-a-dealer

Summary The Practice The Practice

Vital Dental

Practice Type

General

The Principal Location Size

No of chairs

Andreas Schilling Randwick, Sydney, New South Wales 220 square metres 3+3

The Team Design

Commodore Dental & Medical Fitouts

Construction & Joinery

Commodore Dental & Medical Fitouts

Installer

Dental Installations

Project Manager

Craig Exley, Commodore Dental & Medical Fitouts

Equipment Dental Units

A-dec 300

X-ray

Acteon X-Mind DC with Acteon PSPIX image plate scanner

Sterilisation

OPG

Compressor Suction

W&H Lisa

Acteon X-Mind Prime Cattani AC300

Cattani Turbo SMART A

Software Dental4windows “The A-dec chairs are very comfortable and easy to use and have a wide range of adjustability which is important as our staff here range from very small and petite to a giant of a dentist,” he said.

“We also look after disabled children and with the A-dec chair we can flip the headrest and treat patients in their wheelchairs while still supporting them properly and in relative comfort.

“Some patients might have four or five fillings done or multiple crowns, which might take a few hours. When I asked one of them how it went, he said ‘great’ - I watched Michael Jordan (on the entertainment monitor in the ceiling above the chair).

“Clearly the combination of the chair comfort and the patient entertainment is working!

“The other thing I like about A-dec is they are easy to convert to left- or right-handed and while we don’t have any left-handed dentists at the moment, moving forward we want to be able to accommodate them if needed.”

Mr Schilling said the combination of the stylish new practice and state-of-the-art equipment has paid off in establishing the practice – even during the challenge of COVID. “Dentists walk in here and want to work here.

I don’t have to sell it to them, it sells itself and attracts the right calibre of dental staff (There are currently five dentists and a visiting implant dentist working in the practice).

152 Australasian Dental Practice

“I also wanted to create a patient perception of a ‘clean and professional’ clinic which was not ‘over the top’ so that patients would have no hesitation in having a procedure done in the practice without constantly thinking about their wallet.”

And even with the month-long COVID lockdown which occurred the first day after the practice was completed and temporary restrictions since then, patient bookings are rapidly building - indicating the strategy is working, thanks to the selection of the right team and right equipment when establishing the practice.

May/June 2021

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C O M M O D O R E Dental & Medical Fitouts

DENTAL AND MEDICAL WORKSPACE SPECIALISTS DENTAL AND MEDICAL WORKSPACE SPECIALISTS

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166 Arcadia Road, Arcadia NSW 2159 Ph 9655 1919 • Fax 9655 1818 • admin@commodorefitouts.com.au 166www.commodorefitouts.com.au Arcadia Road, Arcadia NSW 2159 Ph 9655 1919 • Fax 9655 1818 • admin@commodorefitouts.com.au www.commodorefitouts.com.au

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new | PRODUCTS Information contained in this section is provided by the manufacturers or distributors.

Australasian Dental Practice does not assume responsibility for the accuracy of the data.

Ark Health partners with Kimberly-Clark Pola Rapid 38% hydrogen peroxide

Ark Health has partnered with Kimberly-Clark Professional™ (KCP) to add KCP’s range of Kleenex® and Scott® brand paper products to its infection control range. The range, which includes KCP’s most popular paper product Kleenex Compact Hand Towel, as well as other Kleenex and Scott brand hand towels, facial

tissues, wipers and absorbent pads, adds to Ark Health’s already comprehensive selection of infection control products. “With infection prevention and control front of mind for dental practices around the country, we are very excited to now offer Kimberly-Clark Professional’s high-quality products to our customers,” said Noah Shroot, Managing Director, Ark Health.

Available: Ark Health www.arkhealth.com.au Tel: 1800-422-227

New Pola Rapid in-office whitening treatment safely whitens teeth in a super fast 24-minute application time significantly faster than other alternative whitening options.

The specially formulated high viscosity gel enables a superior handling process with a faster application and removal time

due to its non-stick attributes.

Furthermore, Pola Rapid uses a vivid blue colour for ease of visibility and application and does not need an additional pre-desensitiser step.

Available: SDI Limited www.sdi.com.au

New Colgate recyclable Trial Bags

Easy activation capsule technology

Colgate Professional Oral Care has introduced new environmentally-friendly recyclable Trial Bags that are ideal for dental practices to use in their oral health promotion. The Trial Bags are supplied complimentary with a minimum order of 144 product “sets” comprising Colgate Plax Mouthwash 60mL; a Colgate toothbrush; Colgate Total fluoride toothpaste 40g; and Colgate Total Dental Floss travel size. Practices can also

Drawing on 50 years of dental research innovation, SDI is proud to announce the launch of Easy Activation Technology.

This innovation makes it 70% easier to press down and activate Riva glass ionomer capsules, making restoration preparation easier than ever. The Easy Activation technology is now available in all Riva Self Cure and Riva Light Cure product ranges. In addition to easier activation, the Easy Activation technology delivers improved extrusion control. Easy activation capsules are 70% easier to extrude than glass hybrid and

opt to customise the products included in the pack based on their individual requirements.

Once the patient no longer has a use for the Trial Bag, they can help the environment by placing it in their kerbside recycling bin.

Available: Henry Schein AU Tel: 1300-658-822 www.henryschein.com.au NZ Tel: 0800-808-855 www.henryschein.co.nz

154 Australasian Dental Practice

glass ionomer capsules from other manufacturers. This innovation minimises hand tremors and muscle stress, giving you more stability and control when placing restorations. Riva Self Cure and Riva Light Cure have restored the smiles of over 85 million people across 100 countries. Easy Activation Technology is an SDI Australian innovation that will make your restoration faster and easier than ever before.

Available: SDI Limited www.sdi.com.au

May/June 2021

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Preventive Regenerative Solutions for Your Patients!

New To

for D ol a Prac ily tice

What is Preventive Regeneration?

Preventive regenerative treatments can help you minimise invasive surgeries and save time and money in your daily dental practice.

Introducing the First Two of many Preventive Solutions...

• The information hub “New Daily Practice” offers easy orientation in a broad field of treatments.

Interactive and animated infographics, decision trees, and literature overviews give a quick outline of the values and benefits of different options.

• An interactive section about presenting treatment solutions to patients invites professionals to share their expertise related to patient information in the field of preventive regenerative dentistry.

Be part of the experience!

Learn more about New Daily Practice

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