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Aoralscan Elite

SHINING 3D has introduced a groundbreaking innovation, lntraoral Photogrammetry revolutionizing precision and efficiency in dental implantology. This unique photogrammetric scanning directly into intraoral procedures, enhancing the edentulous implants, particularly in All-on-X procedures. IPG simplifies workflow outcomes by seamlessly combining intraoral scanning with advanced photogrammetry standard in dental care.

IPG

lntraoral

SHINING 3D has introduced a groundbreaking innovation, lntraoral Photogrammetry Technology (IPG}, revolutionizing precision and efficiency in dental implantology. This unique technology from SHINING 3D integrates photogrammetric scanning directly into intraoral procedures, enhancing the precision and efficiency of full-mouth edentulous implants, particularly in All-on-X procedures. IPG simplifies workflow and promises to elevate treatment outcomes by seamlessly combining intraoral scanning with advanced photogrammetry techniques, setting a standard in dental care.

SHINING 3D has introduced a groundbreaking innovation, lntraoral revolutionizing precision and efficiency in dental implantology. This photogrammetric scanning directly into intraoral procedures, enhancing edentulous implants, particularly in All-on-X procedures. IPG simplifies outcomes by seamlessly combining intraoral scanning with advanced standard in dental care.

next level dentistry hacks, workflows & out-of-the-box solutions in aesthetic restorative dentistry

Presented by Dr Angelo Lazaris

SYDNEY | AUSTRALIA • NOVEMBER 1-2, 2024

Dr Angelo Lazaris is one of Australia’s most accomplished aesthetic restorative dentists and has built his brand on consistently delivering exceptional outcomes in aesthetic restorative dentistry. Despite keeping a low profile on the lecture circuit, his reputation precedes him and he’s ready to talk. In this two-day course, Dr Lazaris will present his unique aesthetically-driven protocols and digital workflows as a unified system developed specifically to enhance clinical efficiency and predictability and eliminating any margin for error. Structured in a modular sequence, each topic is delivered as a step in a methodical, reverse-engineering process that maps out a logical path to achieving superior treatment outcomes with precision and confidence. Honed through comprehensive critical analysis and evolution, these protocols are universally applicable to every dentist, every patient and every case.

n Treatment philosophy

n Digital clinical records

n Smile architecture and frames of reference

n 2D aesthetic digital analysis and treatment planning

n 3D digital design. Reverse engineering through virtual previsualization

n Digital communication

n Pre-restorative considerations

n Preparation geometry

n Digital shade analysis and lab communication

n Optical and biomechanical properties of natural teeth and restorative materials and why it matters

n Restoration design and preparation geometry

n Digital shade analysis and lab communication

n Fitting and delivery of indirect adhesive restorations

n Verification of treatment sequences and outcome validation

n Breaking down complex cases with novel solutions to restorative dilemmas

n Practical clinical applications and case studies

Dr Angelo Lazaris

BDS (Hons) (Syd), MSc (Aes) (Kings College)

Angelo has developed his own complete digital protocols from inception and design through to delivery and integrated these with biomimetic adhesive dentistry and contemporary restorative materials to create a complete clinical workflow that is equally applicable to single restorations, through to complex full mouth rehabilitations, culminating in outstanding clinical outcomes in a real-world commercial environment.

His innovative approach to clinical dentistry is to start at the desired endpoint, deconstruct complex treatments and develop solutions have made him

a sought after KOL, educator and mentor. With appointments including honorary senior lecturer for kings college london and the university of sydney, Angelo has recently been assigned as course director for a post graduate diploma and masters degree in digital dentistry; a testament to his expertise and the influence of this discipline in dental practice.

On the cover...

The Shining 3D Aoralscan Elite is the world’s first device to integrate both intraoral scanning and photogrammetry into a single

special report

88 Is the gap between orthodontics and myofunctional orthodontics closing?

management

92 If you have agreed to purchase a dental practice, what are your key decisions from this point?

96 Unearth the hidden treasures in your dental practice: The parable of acres of diamonds

98 I’d like the staff without the entitlements

100 VITA Easyshade LITE: Precise tooth shade determination is just a click away marketing

102 Interactive content: The secret to transforming your marketing

facebook.com/dentalpracticenow twitter.com/adpmagazine instagram.com/dentevents

www.dentalpractice.com.au

Publisher & Editor: Joseph Allbeury Clinical Editor: Dr David Roessler Technology Editor: Prof. Laurence J. Walsh Infection Control Editor: Prof. Laurence J. Walsh Senior Contributing Editor: Dr Christopher CK Ho Columnists: Dr Georges Fast, Dr Jesse Green, Garry Pammer, Phillip Win, Dr David Moffet, Graham Middleton, Simon Palmer, Julie Parker, Jayne Bandy, Angus Pryor Design & Production: Jasper Communications Australasian Dental Practice™ ISSN 1445-5269 is printed in Australia and published six times per year by Main Street Publishing Pty Limited ABN 74 065 490 655 PO Box 586, Cammeray NSW 2062 Tel: (02) 9929-1900 Fax: (02) 9929-1999 Email: info@dentist.com.au © 2024 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.

infection control

106 The relevance of endotoxin in instrument reprocessing - An odyssey

surgery design

134 818 Dental - An elegant expansion 140 Smile Society elevates patient experience

Enter the Matrix - Part 1

118 The Programat CS6 in clinical practice

122 BloodSTOP iX absorbable, adhesive wound dressing for the gum

126 The iceberg effect: How CBCT allows the GP to see “under the surface”, treatment plan and prepare patients for surgical interventiont

130 Bio-Bulk fill treatment of deep caries

By Joseph Allbeury

The next 9 months...

Congratulations to our esteemed author, Dr Georges Fast, who has received an A ward for Distinguished Service from the ADA VB for his many contributions to the profession. Dr Fast started writing for us back in 1998 and has since penned close to 140 articles, including one in this edition. Read all about the Award on page 22.

The front cover of this edition is launching the latest innovation in intraoral scanning that incorporates photogrammetry technology normally only found in standalone extraoral devices at a high price point. With the Aoralscan Elite, Shining 3D has endeavoured to cost-effectively deliver a solution to the missing link - the scanning of the edentulous arch, particularly in support of All-on-X workflows. For more info, visit dentevents.tv/channel/shining3d

We’re also launching 5 new courses/events that we hope will tempt you to upskill in the next nine months (Remember: the current CPD cycle concludes at the end of 2025).

First up, following his amazing presentation at DDDT24, we’ve worked with Dr Angelo Lazaris to create the 2-day “next level dentistry - hacks, workflows & out-of-the-box solutions in aesthetic restorative dentistry” on Nov 1-2. If you’re an aspiring cosmetic dentist and digitally focussed, then this program is for you. Register at smilenow.com.au

Next, we’ve teamed up Prof. Axel Spahr, another recruit from DDDT24 with Dr Tom Giblin from DDDT22 to deliver a 2-day “Tips, Tricks and Pitfalls in Implant Dentistry - The specialist perspective on common surgical and restorative quandaries” on November 29-30 Register now for this advanced program covering implant surgery and prosthetics at www.smileacademy.com.au

And finally this year on November 23, Dr Omid Allan is again presenting his popular “Miniature Implants: A unique system for minimally invasive treatment” program. Register for this one at www.implanteducation.au.

3D Printing in Dentistry is back on February 21-22, 2025. This two day program looks at the latest developments in 3D printing divided into clinical and technical days. The last event held in February this year generated lively debate and saw the best clinicians, technicians and industry experts present on a range of topics. Hot early bird rates apply so please register sooner rather than later at www.3dpd.com.au

Last but not least, Digital Dentistry & Dental Technology 2025 is scheduled for May 29-30, 2025. Expect lots of new innovations on show following IDS in Cologne, plus we’re keeping the Digital Denture Day and introducing a Full Arch Innovations Day. The multi-stream, multi-speaker format remains and again, super hot early bird rates apply so please register now at www.dentaltechnology.com.au.

And finally, the word COVID only appears once in this entire magazine. See if you can find it!

Enjoy the edition...

Joseph Allbeury, Editor and Publisher

Red Dot Design Award for ASIGA Ultra

The brand new ASIGA Ultra 3D printer launched at 3D Printing in Dentistry in Sydney last February has been awarded a 2024 Red Dot Award for Product Design. The Red Dot Award is the world’s most prestigious design award celebrating good design. The Ultra, designed and manufactured in Sydney, Australia has positioned itself as arguably the most advanced dental 3D printer ever. Housing the latest 4K DLP imaging technology alongside the full suite of Asiga’s robust layer monitoring technologies, the Ultra delivers manufacturing certainty but with a new focus for the sector – design. It is clear that Asiga has taken note and listened to their customers to bring to market a product where the end-user is front and centre. You cannot help being drawn to the Ultra. It all starts with their new and beautifully designed user interface which feels like something straight from a market leading tablet/phone manufacturer. Menu navigation, infographics and the responsiveness of the user interface screen all have a high quality feel and draw you in for more. A feature that will most definitely have you hooked is their new touchless entry, an engineering marvel in itself. Asiga surely had a lot of fun with this and with a simple hand-wave gesture, the hood opens effortlessly and is so silent that it leaves you helplessly opening and closing the hood. Once you have satisfied your desire to play with the hood, it is clear that the attention to detail and build quality of the Ultra is nothing short of exceptional. A magnetic build platform, simple material tray clamping, internal lighting and wide range of connectivity options all help in the presentation of a cleverly refined 3D printer for both the dental laboratory and dental clinic. Another key feature to the Ultra is a new infrared heating system which warms materials to 70°C. This opens doors to new polymer technologies where high impact and hardness are key material properties. This is an exciting time for 3D printing and dentistry in general and this new product from Asiga will certainly be turning heads.

For more information on Asiga and these new 3D printers, visit www.asiga.com.

By Georges Fast

IOne man’s opinion...

“When inexperienced people, who aren’t intelligent enough to visualise the consequences of their latest bright idea get into positions of power and are driven by an almost fanatical obsession to comply with the latest ‘Group Think’, it can only end in tears...”

n the late 1950s and during the 1960s, my father and a number of partners developed blocks of apartments around various suburbs in Melbourne. These were generally of solid brick construction and reflected the standards of the time. The apartment blocks were built on 3 levels - Ground floor and 2 floors above. They generally consisted of nine 2 bedroom apartments and three 3 bedroom apartments. Each had a full family bathroom and the 3 bedroom apartments had a powder room as well. All had balconies. All of them still exist today.

When looking back at those times, two things stand out. The first is that the time interval from setting out on the cleared and levelled block until the granting of occupancy permits was 3 months. The second thing that stands out is that it was mandatory to provide two car parking spaces on the site for each 3 bedroom apartment and one space for each 2 bedroom apartment.

I started thinking about this when it took my daughter two and a half years to build a family home in Perth. It was originally meant to take 14 months which at the time I thought was excessive, but it was explained to me then, that this was a worst case scenario allowing for delays in materials and a shortage of labour.

Going back to those apartment blocks. There was little if any union interference (there was no scaffolding required to be erected for any work performed more than 2 metres above ground level). Once plans were approved and granted by the Council, there were regular inspections by the building inspectors, the Board of Works checked that the plumbing was done properly, the wiring was checked before they connected the power and the Gas and Fuel Corporation did likewise with the gas.

The projects were built by relatively small sub-contractors who had plenty of work, were well paid and cooperated with each other. There was always a party and BBQ when a project was finished and there was always another job in the pipeline.

The people working on the projects seemed to drive nice cars, live in nice houses and often had a beach shack and often a boat.

What has changed? And why does it take at least four times as long to build a house and why can’t normal working people afford one without serious sacrifice and often help from family?

Having been privy to some of the problems that arose during the building of my daughter’s house, I see remarkable parallels with what is happening in our profession.

After the permit was granted, some paper-pusher at the Council realised that the levels on the plan did not match historical levels for the area - this despite the fact that the new house was planned on the same levels as the recently demolished one and in fact, the road outside did not match the historical levels either! This caused a significant delay in the commencement date and in the end, someone decided that they would leave the road where it was! There was constant interference from bureaucrats at the council, most of whom knew nothing about

construction but had to make sure that all the forms complied with other forms that needed to be filled out. The nett result of all this was that costs blew out, rent had to be paid for a year more than was budgeted and a lot of the fun and anticipation of moving into a new house had evaporated. There really were no winners, except for the Council employees who had no skin in the game except having to justify their employment.

When inexperienced people, who aren’t intelligent enough to visualise the consequences of their latest bright idea get into positions of power and are driven by an almost fanatical obsession to comply with the latest “Group Think”, it can only end in tears. Melbourne is experiencing horrendous traffic problems; the congestion in the inner suburbs makes travelling by car a nightmare. Public transport is inefficient, dirty and not very safe. Cars idle in traffic which adds to pollution and yet so called “green” councillors who are generally public servants (often working from home for most of the week) have managed to pass laws in some inner Melbourne municipalities that restrict the number of car spaces that are permitted on any new site to 30% of the apartments built on that site. This results in most residents parking in the street or in shopping centre car parks. Apart from the inconvenience, it restricts access to restaurants and retail outlets and is causing shopping strips to wither and die.

Why am I writing this in a magazine aimed at dentists? At the end of the financial year, whilst tidying up my files, curiosity got the better of me and I thumbed through a folder that has all my fee schedules going back to 1973. Dentistry was always seen as being expensive but when compared to what I was paying my senior nurse, whose wages have gone up by a factor of 36, my fees have gone up by an average factor of 69! In that same period, my overheads have gone up to nearly 70% of turnover (compared to 22-25%). Who benefits? Will we see a return to a situation comparable to that which existed in Australia in the 1940s and early 50s when it was common for 18 year old girls to have a full upper clearance and a denture fitted to reduce future dental costs and thus improve their marriage prospects?

When cost of living pressures are forcing people to make a choice between eating and heating, when statistics show that average wage earners are being forced to limit spending to absolute essentials, when the press reports that people are cancelling insurance policies, foregoing regular car servicing, delaying visits to their doctors and reducing health insurance cover and when restaurants and small businesses are closing because of declining patronage and rentals are becoming unaffordable, surely we must ask whether this is the right time to impose a further cost burden on private practices and their patients, especially as the public system lacks the capacity to deal with existing patient loads let alone being able to deal with a huge influx of patients who can no longer afford private dentistry!

Mad Max - here we come!

By David Moffet

IThe front desk

“It’s time to throw out the lazy and the careless and the pointless that has crept into our dental office vernacular. It’s time to give the people who work in our front office a title fitting of what they do and fitting about the important role they play, rather than calling them by a piece of furniture....”

have to agree one hundred percent with Dr Howard Farran who said that it is absolutely ridiculous to name a dental practice employee after a piece of furniture.

That employee’s title, used worldwide is:

“The Front Desk”

And it’s not just used only in dental...

Do you use that title in your dental office?

Do you or your team members say:

“You’ll have to ask the front desk.”

“I’ll get the front desk to organise that for you.”

“Did the front desk give you your next appointment?”

Who in their right mind ever thought that this was a good job title?

Really!!

The person’s duty is being named after an inanimate object.

Just think about it for a minute...

Q: Where does the person called the front desk sit?

A: The “Front Desk” sits at the front desk.

That’s right... the person who sits at the front desk is called the “Front Desk”...

It’s so stupid it’s laughable.

Thank goodness...

Thank goodness that the person who sits on a horse is not called the “horse” but is rather called the jockey.

Kids Play

POSSIBLE GATE?

And the person who sits behind the steering wheel of a car is not called the “car”... rather, they are called the driver... It’s time for a change...

It’s time to right the wrongs.

It’s time to throw out the lazy and the careless and the pointless that has crept into our dental office vernacular.

It’s time to give the people who work in our front office a title fitting of what they do and fitting about the important role they play, rather than calling them by a piece of furniture.

Aren’t they really:

Front office co-ordinators?

Or Front office managers?

Or Dental front office receptionists?

They’re not a piece of furniture.

They are not “desks”, or “front desks”.

They are people...

Let’s get serious about who they really are.

And give them and the important role they play, the respect that they truly deserve...

And nothing less...

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 practice [of 28 years] in working class western Sydney. David has now retired from wet-fingered dentistry and 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.

Source: Dr Salvatore

Photos courtesy of Prof Dr Rocio Lazo (Peru)

Photo

SHINING 3D unveils Aoralscan Elite with revolutionary IPG technology

SHINING 3D has unveiled a groundbreaking advancement in dental technology with the launch of the Aoralscan Elite, featuring revolutionary Intraoral Photogrammetry Technology (IPG). This innovative solution sets a new benchmark for accuracy and efficiency in dental implant procedures, especially for full-mouth edentulous cases and All-on-X treatments.

Aoralscan Elite: A game-changer in scanning

The Aoralscan Elite is the first device in the world to integrate intraoral scanning and photogrammetry into a single unit. As an advanced intraoral scanner (IOS), it captures detailed images of dentulous cases, including teeth and oral structures. Additionally, it functions as a photogrammetry system, precisely recording the placement of dental implants in edentulous cases. This dual functionality streamlines both traditional dental work and complex implant procedures, enhancing versatility and efficiency.

What is IPG technology?

Intraoral Photogrammetry Technology (IPG) is a cutting-edge dental solution that merges structured light 3D reconstruction with photogrammetry. Developed by SHINING 3D, a leader in high-precision 3D vision technology, IPG technology is based on advanced photogrammetry techniques originally used in industrial metrology.

• Enhanced efficiency: IPG technology simplifies multi-angle intraoral scanning and captures precise data from minimum perspectives using panoramic photogrammetry. This innovation also reduces the need for multiple devices and complex workflows, enabling the Aoralscan Elite to handle full-mouth implant cases with ease.

• Increased success rate: By providing accurate design and placement for large-span multi-unit implant restorations, IPG technology reduces the likelihood of rework caused by traditional trial and error, compatibility issues and gum deformation, thereby improving treatment success rates.

• Comfort and speed: Patients benefit from faster, more reliable diagnoses and treatments. The Aoralscan Elite’s precision reduces anxiety and uncertainty by providing accurate results quickly, enhancing patient comfort throughout the diagnostic and treatment process.

SThis technology has been innovatively adapted for dental applications, particularly in scanning full-mouth edentulous implants, delivering exceptional accuracy.

Key advantages of IPG technology

• Exceptional accuracy: The Aoralscan Elite utilises advanced image processing algorithms and real-time tracking to ensure high accuracy. Encoded patterns on the supplied scanbodies serve as accuracy control points, optimising recognition and pose calculation for consistent results. The large IPG scan tip minimises the impact of soft tissue changes, further enhancing implant positioning accuracy.

Seamless scanning for edentulous cases

The Aoralscan Elite’s IPG tip, larger than standard, ensures wider and faster captures of edentulous oral geometries. High-resolution data enables dentists to accurately assess soft tissue contours and identify abnormalities, leading to superior results in edentulous cases.

Comprehensive digital dental solutions

HINING 3D offers a complete suite of advanced dental products, including intraoral scanners, face scanners, lab scanners, 3D printers, washing and curing systems and a Dental Cloud platform. With integrated design and communication tools, SHINING 3D provides an end-to-end digital dental solution, ensuring a seamlessly integrated workflow for all dental applications.

For more information on the Aoralscan Elite and SHINING 3D’s full range of dental solutions, visit www.shining3ddental.com.

About SHINING 3D

S HINING 3D is a global leader in 3D vision technology, dedicated to advancing digital dental solutions through innovation and precision. With over 20 years of expertise, SHINING 3D continues to set new standards in the dental industry.

The New ELITE IntraOral Scanner from Shining 3D uses patented IntraOral Photogrammetry Technology to be the most accurate scanner available.

• Small form factor

• Lightweight 124 grams!

• Ultra fast scanning

• Dual mode IPG scanner

• Complete software suite

• Scan All On X Cases accurately

• Suitable for all IntraOral Scanning

• 3-year Warranty

NEW Shining 3D Elite: The super intraoral scanner with photogrammetry

By Terry Whitty

In the world of modern dentistry, intraoral scanners have become indispensable tools, streamlining the process of capturing digital impressions with unprecedented precision and patient comfort. These devices are redefining workflows, enhancing diagnostic accuracy and improving overall patient experiences by eliminating the need for traditional, messy impressions.

There have been many milestones and just as many failures in the history of intraoral scanning over the years. One of the first intraoral scanners was the photo-based CEREC, first commercialised in 1987 as part of the CERamic REConstruction system from Siemens. The original CEREC as well as CEREC 2 were all-in-one units combining scanning and milling. CEREC has evolved through several generations and today, their brand new Primescan 2 remains a high-end, premium scanning solution.

Itero was originally from Israel from the company CADENT. Dentists would scan with an iTero and then the company would mill dental models based on the scans and deliver them to your laboratory for use in traditional analogue laboratory manufacturing. iTero has also gone through many design incarnations, both before and since its acquisition by Align Technology. Apart from being the manufacturer of Invisalign, Align more recently acquired CAD software developer exocad.

E4D, a South African developed American backed scanning and milling solution aimed squarely at taking on CEREC, arrived in 2008. Whilst the name is rarely heard nowadays, Planmeca invested heavily in E4D and the technology has now evolved to the Planmeca Emerald, Ivoclar PrograScan One, AmannGirrbach Ceramill Map DRS and others.

TRIOS from 3Shape has been incredibly successful and was launched in 2011. Apart from being a powerful and versatile scanning platform, 3Shape produces a great suite of software that sets the standard for dental CAD. Medit scanners from Korea have also been very successful in recent times, putting a value-packed scanner and software solutions into dentists’ hands. And there are of course others. Carestream Dental sold its scanner business which are now sold under the DEXIS brand.

SEnter: Shining 3D

hining 3D is a name that people are starting to prick up their ears about and with good reason. The company was founded in 2004 and in the early years, it primarily concentrated on providing 3D scanning technology for industry which included handheld and desktop scanners. These scanners were used for a wide range of applications, such as quality control, reverse engineering and prototyping in a variety of industries including automative and aerospace.

In 2010, Shining 3D branched out to develop 3D printing systems as well and upgraded their scanning technologies with the debut of their Einscan series of scanners in 2015. They have since become market leaders in affordable handheld scanning with user-friendly software solutions.

In 2016, Shining 3D began exploring applications of its 3D scanning and printing technology in the healthcare sector. The company developed specialised solutions for dental and medical applications, including intraoral scanners and 3D printing solutions for prosthetics, orthodontics and surgery.

This has become one of the fastest-growing segments of Shining 3D’s business, releasing the Aoralscan 2 IntraOral Scanner in 2020 and the Aoralscan 3 in 2021. The Aoralscan wireless scanner followed in 2022. All of these scanners are well-designed, well thought-out and follow a lot of what all the other manufacturers are doing and perform on par or better than their more expensive counterparts (based on independently published data).

Aoralscan Elite: Changing the game!

Improvements in the accuracy, quality, features and benefits in new intraoral scanners have become stepwise at best. An evolution rather than a revolution.

Now, Shining 3D has launched arguably the greatest leap forward in intraoral scanning systems. The launch of the Aoralscan Elite brings with it, myriad “firsts” inlcuding photogrammetry and other design elements that clearly differentiate it from everything else on the market, yet at a price any clinician can afford.

Figures 1-2. Shining 3D Aoralscan Elite IntraOral Scanner with intraoral photogrammetry weighs in at 124 grams.

The Aoralscan Elite has a one piece seamless aluminium alloy body with a special medical grade coating resulting in the smallest, lightest intraoral scanner of its kind ever, lighter by a hundred grams over its closest competitor. It weighs in at just 124 grams and the 245 x 30 x 26 mm sizing makes it small and ergonomic. The Elite is easy to manipulate and its size and weight eliminate fatigue. The Elite scanner features simple one-button operation and has a built in LED light on the button that changes colour to indicate the status of the scanner. It also uses an advanced motion sensing technology so the scanner can be used seamlessly to acti vate menus on-screen to proceed to the next step, view the scan and move it for inspection without touching a monitor, keyboard or mouse if desired.

It’s also amazingly fast. This next generation scanner has some high-tech hardware under the bonnet not seen before and very advanced software that lends itself to some of the fastest scan ning imaginable. But there is more to this scanner than just raw speed. It comes with a selection of tip sizes - paediatric for small children or hard to access mouths; a regular tip suitable for most people situations; and then something new - a special edentulous tip for fully edentulous arch scanning plus some other functions that we will elaborate on later. The tips can be autoclaved up to 100 times each or as a semi-critical item, can be disinfected in the appropriate way which may lead to longer life. The replacement tips are inexpensive.

The software is not only a crucial part of the scanning process with a lot of AI functionality, but it can also be deactivted if you wish if your scanning preference calls for it. It’s very flexible as you can also customise your scanning sequence as well, so if you always want to scan the upper jaw first, you can do so and you are not locked into someone else’s ideal scanning sequence (i.e. create your own). There are also some really good features available for editing scans and adding extra scans as well that just work so well. The workflow is just so very easy.

Software features include high definition scanning (say if you want a higher resolution scan in a particular area such as a margin), Ortho Simulation (this feature is now very well advanced and allows a lot automation as well as manual input if desired

have a new, patented IntraOral Photogrammetry Mode. In the past, the only way to accurately digitally record multiple implant positions across an arch has been with highly expensive extraoral photogrammetry systems such as the Pic Camera or the iMetric iCAM 4. These are great devices, but the price for providing this single function has been cost prohibitive for most clinicians, not to mention cumbersome to operate.

Figure 3. Three tip sizes are included.

Figure 4. Figure 8. Scan body kit.

Now, with the Shining 3D Aoralscan Elite, this capability is accessible to everyone. Using the special high definition IPG mode and the included high definition coded scan markers, the Aoralscan Elite scanner can accurately scan the position of implants in All On X cases and more.

With advanced image processing algorithms and real-time dynamic tracking technology, the scanner uses the coded patterns on the scan bodies as accuracy control points. IPG technology ensures global consistency and accuracy by combining algorithm optimisation, fast recognition and accurate calculation of implant position. The large IPG scanning head specially designed for the Aoralscan Elite intraoral scanner effectively decreases the impact of soft tissue changes on the scanning results, further improving the accuracy of implant positioning.

So what does it all mean? You will get a cross arch accuracy of implant position of less than 5 microns and that’s about as accurate as it gets!

In addition, you do not need to scan any more scan markers as the software will automatically position the ones of your choice from the included library virtually and ready to be

exported to CAD software such as exocad or 3Shape. This is a huge time saver as a whole step is now cut out of the process but the result is still the same. In the next article, the complete photogrammetry workflow will be explained in detail. Currently it is available for 30 leading brand implant systems with more to come.

As far as computers go , currently the software runs on a Windows PC and of course the faster your PC, the better it will run, i7 - 8700 series or better, 16 Gb RAM and the minimum graphics card is an NVIDIA RTX 2060 6Gig. Soon there will be a version for Mac as well and this will work on an M3 Chip or better.

The Shining 3D Aoralscan Elite intraoral scanner is an amazing piece of technology, a lightweight, accurate scanner like no other that boasts a ton of features as well as groundbreaking photogrammetry that it puts this hardware above all others. And it’s available now.

Terry Whitty is a director of Fabdent. For more information on the Shining 3D Aoralscan Elite, visit www.fabdent.com.au or call Terry on 1300-878-336.

Figures 5-6. Edentulous scans.

Figure 7. Close-up of scan body.

Figures 9-10. Using the IPG mode scanning.

Figure 8. Using the IPG mode scanning.

A One-Day Intensive Event to Help You Grow Your Implant Skills and Stop Referring Out Too Many Cases

6 CPD Points

Date and Time: Friday, November 1, 2024

6 CPD Points

Date and Time: Friday, November 1, 2024

Location: Sydney CBD

9:30 AM - 4:00 PM

Date and Time: Friday, November 1, 2024

9:30 AM - 4:00 PM

Date and Time: Friday, November 1, 2024

9:30 AM - 4:00 PM

Why Attend Implantopia?

If you’re a dentist looking to grow your implant skills, take on more complex cases, and keep more implant work in-house Implantopia is the event you’ve been waiting for.

This one-day, high-impact event is designed to provide you with the practical knowledge and techniques you need to confidently manage more implant cases from start to finish.

What You’ll Learn:

Location: Sydney CBD

Sydney CBD

Our expert speakers will guide you through the 5 Ps of Implant Success: What You’ll Learn:

Our expert speakers will guide you through the 5 Ps of Implant Success:

Our expert speakers will guide you through the 5 Ps of Implant Success: What You’ll Learn:

Planning:

How to create a detailed, predictable treatment plan for implant cases.

Placement:

How to create a detailed, predictable treatment plan for implant cases.

Placement:

Techniques for precise implant placement and minimising complications.

Printing:

Techniques for precise implant placement and minimising complications.

Printing:

The latest in 3D printing for implant prosthetics and workflow integration.

Prostheses:

Techniques for precise implant placement and minimising complications.

Prostheses:

Strategies for selecting, designing, and delivering implant-supported restorations.

The latest in 3D printing for implant prosthetics and workflow integration.

Patients:

The latest in 3D printing for implant prosthetics and workflow integration.

Patients:

Printing: You’ve got the skills, now discover how to fill your books with implants patients.

You’ve got the skills, now discover how to fill your books with implants patients.

Printing: You’ve got the skills, now discover how to fill your books with implants patients.

You’ve got the skills, now discover how to fill your books with implants patients.

Meet the Speakers:

Dr Yohan Thomas

Specialist Prosthodontist

Dr Yohan Thomas Specialist Prosthodontist

The ‘Prosthodontic Mentor’, renowned for his practical, step-by-step approach to implant restorations.

Dr Angie Papas

Dr Andrew Ip

Testimonials:

Laser Dentistry Guru

Dr Andrew Ip

Dr Angie Papas

Digital Dentistry Expert

Dr Andrew Ip

Dr Andrew Ip Digital Dentistry Expert

Digital Dentistry Expert

From design to 3D printing, discover how to enhance your digital workflow.

Dr Angie Papas Laser Dentistry Guru

Dr Angie Papas

Laser Dentistry Guru

Cutting-edge techniques for using soft-tissue/hard-tissue lasers in implantology.

Mr Terry Whitty

Mr Angus Pryor Practice Growth Specialist

Dental Industry Legend

Mr Terry Whitty

Dental Industry Legend

Mr Terry Whitty Dental Industry Legend

Mr Terry Whitty

Dental Industry Legend

Learn from an expert in intra-oral scanning for patients requiring implants.

Testimonials:

Andrew covered everything from the fundamentals of dental 3D printing to creating restorations – an amazing deep dive into implants!

– Dr Andarsyn, WA

Angie is an extremely passionate speaker – lots of knowledge. Loved the little tips, very practical approach. Amazing versatility of use of lasers. Loved it.

– Dr Ankur Sachdeva, TAS

Angie is an extremely passionate speaker – lots of knowledge. Loved the little tips, very practical approach. Amazing versatility of use of lasers. Loved it.

– Dr Andarsyn, WA

– Dr Ankur Sachdeva, TAS

Secure Your Spot: Limited Seats Available!

Ticket Price: $330 per person

Mr Angus Pryor

Mr Angus Pryor Practice Growth Specialist

Practice Growth Specialist

Proven strategies to fill your books with more implants patients faster.

Dr Yohan shares practical, actionable information that demystifies the implant restoration process. For a structured, step-bystep approach, I highly recommend attending.

– Dr Kerin Jacobs, SA

Dr Yohan shares practical, actionable information that demystifies the implant restoration process. For a structured, step-bystep approach, I highly recommend attending.

– Dr Kerin Jacobs, SA

Angus is an amazing and extremely passionate about what he does. His presentation made me re-evaluate everything in my practice.

Angus is an amazing orator and extremely passionate about what he does. His presentation made me re-evaluate everything in my practice.

– Dr Judy Liu, NSW

– Dr Judy Liu, NSW Secure Your Spot: Limited Seats Available!

– Dr Judy Liu, NSW

Early Bird Special: Just $165 per person (Save 50%)

Includes all meals and refreshments.

ADA VB honours Dr Georges Fast with Award for Distinguished Service

The Council and members of the Australian Dental Association Victorian Branch Inc. have presented to Dr Georges Fast, BDSc, LDS the Award for Distinguished Service in recognition of his outstanding service to dentistry.

The citation for the award reads...

Dr Fast graduated as a dentist from the University of Melbourne in 1969 and served as an oral surgery clinical assistant and senior clinical demonstrator at the Royal Dental Hospital.

His active association with the Branch began in 1984 when he first served on the Practice Administration Committee which he subsequently Chaired. He was elected as a Branch Councillor in 1988 and served on that body for 6 years to 1994.

Dr Fast has been enormously generous to the Branch with his expertise and time. In addition to Branch Council and Practice Administration Committee membership, between 1988 and 2023, he has been a member of numerous committees including Dental Schemes, Dental Education, Dental Nurses Evaluation Committee, Sports and Social, Graduate Education, Public Relations, Legislation and most recently the Quality Assurance Panel and Third Party Committees.

Dr Fast has authored articles and given numerous lectures locally and internationally including those on practice administration, setting fees, marketing and new technologies.

He has contributed at the national level as a member of the ADA Inc’s Practice Committee and as a long-term member of the DIME equipment subcommittee.

In 1994, Dr Fast was elected as the inaugural chairman of the Private Dental Surgeries Association of Victoria and served in that role until 2004. He was representative for eight years on a government Working Group for the revision of Practice for Radiation Safety in Dentistry.

He is a fellow of the Pierre Fauchard Academy, International College of Dentists and Academy of Dentistry International.

Also, Dr Fast is a long-time columnist, writing “One Man’s Opinion” for the Australasian Dental Practice Journal from 1999 until the present. He also served as the honorary dentist to the Victorian contingent for the Moscow Olympics and to the Fitzroy Football Club.

It is fitting with such outstanding service that Dr Georges Fast is a recipient of the Branch’s Award for Distinguished Service.

The world’s smallest, lightest and only intraoral photogrammetry scanner.

Aoralscan Elite IOS/IPG

$27,990+GST Includes High-Accuracy Coded Scan Kit

Philips appoints Dentavision as preferred oral healthcare distribution partner in Australia

Philips has announced it’s changing supply arrangements for the Philips Zoom! professional teeth whitening range and Philips Sonicare oral care products in Australia, appointing Dentavision as its preferred and only dental professional distribution partner.

The appointment of Dentavision, who will be the only distributor of Philips Zoom! in the market, will provide dental practices across the country with easier access to Philips’ market leading range of oral healthcare solutions.

“Dentavision is the perfect partner for Philips in Australia, with its marketleading position and extensive industry expertise,” said Simon Amor, Country Lead, Personal Health, Philips Australia. “Dentavision’s ethos also reflects Philips purpose, with patient-centric priorities of improving people’s health and well-being. Our partnership will expand access in Australia to Philips Zoom!, the #1 patientrequested professional whitening brand,1 as well as Philips Sonicare power toothbrushes and power interdental products.”

“Dentavision are thrilled to announce our collaboration with Philips to deliver cutting-edge products to dental professionals in Australia,” said David Macnaughtan, Managing Director, Dentavision. “Philips’ industry leading range, coupled with Dentavision’s unparalleled sales and service team and product portfolio make us perfect partners for the journey ahead. Dentavision has a nationwide sales team that has extensive experience in training, education, marketing and supply of products and solutions for dental practices.”

The products

Philips’ flagship Zoom! WhiteSpeed in-chair system utilises advanced blue LED light-technology to accelerate the whitening process. In 45 minutes, teeth can be up to 8 shades whiter,2 reversing stains from food and drinks, ageing and even discolouration from some medications. Philips Zoom! DayWhite and NiteWhite complete the range with take home options in 6%, 9.5% and 14% hydrogen peroxide and 10%, 16% and 22% carbamide peroxide respectively.

Philips Sonicare range of electric toothbrushes pulse fluid between the teeth and along the gum line while 62,000 brush strokes per minute gently and effectively remove plaque. The Sonicare range includes the Sonicare 9900 Prestige, Sonicare DiamondClean 9000, ExpertClean 7300, ProtectiveClean, Sonicare 3100 Series, Sonicare 2100 Series and Philips Sonicare For Kids.

Complementing these, the Sonicare Power Flosser range features a unique X-shaped nozzle that creates 4 streams for up to 99.9% plaque removal.3 The Quad Stream covers more area and requires less technique than a single stream nozzle, for fast and effective flossing.

1. Surveyed among 50 dentists in Australia.

2. Excludes preparation time. Research conducted in the US using 25% HP Zoom! Kit.

3. In an in-vitro study, actual results may vary.

For info visit www.philips.com.au/zoom

Dental practices can place orders for Philips products with Dentavision immediately. Call 1800-806-640 or visit www.dentavision.com.au

Oral Health Care

patient-requested whitening brand*

Taking it to the people

The Australian Dental Foundation is the largest dental charity in Australia

It didn’t hurt at all!”

That’s from Charlie, 5, as he emerges triumphant from the mobile dental clinic named “Shirley” with his friend Heidi.

He’s just had his first visit to a dentist and he’s proudly waving his report card around, filled in by Dr Ramya Krishna at his school. He’s collected his free toothbrush and he’s back off to class.

“Shirley” is part of the Australian Dental Foundation’s fleet of mobile dental clinics visiting schools across South Australia and Victoria, complemented by more than a dozen teams working with portable equipment in schools, childcare, residential aged care, homelessness shelters and disability centres across the country.

The decade-old foundation has well-established operations in South Australia, where it is headquartered, as well as Victoria, New South Wales and Tasmania and this year has become truly national after signing service agreements with large aged care providers to work in Queensland, Western Australia and the Northern Territory.

ADFi is the largest dental charity in Australia and provides care to more elderly patients (in residential care) nationally than any other entity, government or private.

Its mission as a not-for-profit charity is to bring dental services and education to those who rely on others for their care, such as children, the elderly and those living with homelessness or disability.

ADFi has so far provided $20 million of dentistry to more than 100,000 patients.

Dr Ramya has been a dentist with ADFi for the past three years and says she enjoys the work because the Foundation manages the administration and equipment and she can focus on patient care.

“And the way in which we organise the work means we can see more people. There is so much demand, especially in aged care and the families are always grateful,” she said.

Dr Ramya is a favourite with residential aged care facilities for her gentle and reassuring presence.

Oral Health Therapist Han Nguyen enjoys her work at schools and wears bright socks every day.

“It’s just a little thing that helps the kids to relax and gives us something to talk about and break the ice,” Han says. “It works in aged care, too!”

ADFi is funded by a combination of sources, including Medicare’s Child Dental Benefits Schedule for students from low-income families.

Unlike many private providers of services to schools, ADFi will see all children at no out-of-pocket cost, regardless of their CDBS eligibility, financial or residency status which is something not available even in some State government services!

In aged care, ADFi works on a cost-recovery basis, setting its fees lower than the average private service and relying on economies of scale to fund its equipment and transport.

Other work relies on clinicians donating their time, grant funding, partnerships, donations and sponsorships.

ADFi is QIP-accredited and over many years has developed customised and approved protocols for operational matters and infection control.

Central and Western Australia Operations Manager Abbey Greenhalgh says the biggest issue for ADFi is its operational costs, particularly consumables and the cost of replacing and repairing equipment.

“We need to build our network of financial support so we can keep doing what we do. Donating to our charity is a great way for the dental industry to give back.

“While you’re busy running your clinic and managing your staff, you can support us financially to do essential work in the community for those who face barriers to accessing dental treatment,” she said.

Dr Jaldi Bendaj, Operations Manager for the Eastern States agrees. “Increasingly we see that the big aged care groups are coming to us because they see that our mission aligns with their goals and there is a growing understanding of the need for more attention to oral health in aged care.

“But many clinics cannot work in aged care because they don’t have the portable equipment or it’s just not practical when you’re running a fixed clinic.

“As a mobile dental service, our clinical teams are trained accordingly. Operationally it is run differently from a fixed clinic. We understand in detail the needs in aged care and schools because we do this daily and for many years,” Dr Jaldi said.

The patchy coverage of government dental services across the country means ADFi is always in demand, especially in aged care.

And in schools, ADFi is giving kids a great start in oral health through treatment and education and helping to avoid GP visits and hospital admissions.

How can you support ADFi?

• Stock ADFi’s toothbrushes and toothpaste in your clinic - all proceeds fund their charity work. Available at Gunz Dental now. See https://www.gunz.com.au/brand/australian-dental-foundation

• Make a tax-deductible donation to help the charity purchase portable equip ment at https://www.dentalfoundation.org.au/donate

• Volunteer at one of ADFi’s events to promote oral health education. Contact ADFi Director of Engagement - Shauna Black - shauna@dentalfoundation.org.au

• Work for the Foundation. There are a number of opportunities nationwide. https://www.dentalfoundation.org.au/work-with-us

Partners with heart

Charities like ADFi rely on partnerships with businesses that share the same values and can contribute their knowledge and IP to supporting their mission.

Gunz Dental is a good example. Many people in the industry know of Gunz and now the company is re-born and re-invigorated and supporting ADFi by donating a portion of every sale and, most importantly, stocking the Foundation’s own range of toothbrushes and toothpastes for dental clinics to buy.

Gunz has recently engaged Luke Vassallo as Pacific Sales Manager. He is heading a team to deal directly with the long list of loyal Gunz customers – and has just been joined by his previous fellow co-worker in Michael Lasscock as General Manager. Luke And Michael come from a strong background of dental industry knowledge and experience and are passionate supporters of the work done by ADFi.

“When you hear stories from the individuals helped by the foundation, you come to understand how it is that accessible dental services can change people’s lives,” Luke said.

ADFi is also supported by other dental industry affiliates in Medetec and ATi Implants.

ADFi has a unique position to leverage from these partners to reach even more vulnerable populations.

A very special project

Jacinta, the nurse at River Nile School in Melbourne, contacted ADFi to seek help for her students - young refugee and migrant women aged 16 to 22. She said 80% of them had either never visited a dentist or had not seen one for a decade.

These young women had no access to Medicare and could not afford private dental care. Too many of them were turning up at emergency departments and having teeth extracted which could have been saved with timely treatment.

ADFi partnered with the Australian Refugee Taskforce to provide free dentistry to the students and the school, changing lives along the way.

Jacinta said: “I just wanted to... say a massive thank you to everyone from the Australian Dental Foundation who helped support the very first dental clinic at the River Nile School.

“Our students were all really keen to see the dentist, especially at school... [they] commented on how friendly the dentists and assistants were too. We really appreciated the kindness and trauma-informed way your team worked with our students.

“One of our really vulnerable students who had black stained teeth was seen by one of your beautiful dentists and the stains were removed. You couldn’t wipe the smile off her face!”

As a bonus, one of the students’ sisters - Mona - has joined ADFi as a dental assistant after having previous experience in Iran and now being permitted to work under her bridging visa.

Brush for good

It’s an enormous undertaking to launch a retail product in Australia, particularly when you are going up against some very well-known international brands!

ADFi understands that the big brands have been part of Australian dental clinics for decades but they are asking dentists and consumers to reconsider.

The Foundation’s products are the only ones on local shelves that have been designed by Australian dentists to meet Australian health guidelines and created after long consultation with consumer trial groups here.

So the shape and colour of the brushes, plus the tastes of the toothpastes, have been designed with Australian consumer input. Plus the retail price is deliberately affordable and is assisting the Foundation’s goal to distribute 1 million toothbrushes by 2025!

But the biggest reason to buy them is that proceeds fund the Foundation’s work. We all know brushing IS good but now you can also brush FOR good.

You can order from Gunz Dental and read more about the products at https://www.dentalfoundation.org.au/programs/products

ONLY $440 FOR 2 DAYS OF EDUCATION (12 HOURS OF CPD) IF YOU REGISTER BEFORE 24 JANUARY 2024 (SAVE 50%) Full details of the speakers and presentations online

Join us again or for the first time at Digital Dentistry & Dental Technology No 6 for a fun, exciting and fully immersive learning experience with the best of the best in the new age of dentistry. This year’s program will again cover Digital Smile Design • Digital orthodontics • Intraoral scanning • 3D Facial Scanning • Digital implantology • Digital full arch restorations and full mouth rehabilitations • Digital Dentures • 3D Printing • Milling • CBCT • Materials and applications • Software and more with MORE Hands-on Sessions • MORE Advanced Sessions • MORE New Products • NEW Masterclasses... and more!

Join us again or for the first time at Digital Dentistry & Dental Technology No 5 for a fun, exciting and fully immersive learning experience with the best of the best in the new age of dentistry. This year’s program will again cover Digital Smile Design • Digital orthodontics • Intraoral scanning • 3D Facial Scanning • Digital implantology • Digital full arch restorations and full mouth rehabilitations • Digital Dentures • 3D Printing • Milling • CBCT • Materials and applications • Software and more with MORE Hands-on Sessions • MORE Advanced Sessions • MORE New Products • NEW Masterclasses... and more!

REGISTRATION FEES

$880 inc gst

EARLY BIRD PRICING

$440

Registration

price increases $110 on the 30th of every month INCLUSIONS

PROGRAMME DETAILS

DETAILS

FRIDAY 30 MAY 2025 9.00am - 5.00pm - education 5.00pm - 7.00pm - happy hour

12 HOURS CPD

TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITAL DENTISTRY FOR DENTISTS, SPECIALISTS, DENTAL TECHNICIANS AND PROSTHETISTS The current AHPRA CPD Cycle concludes on 30 Nov 2025

BIRD PRICING

$220 before 30 nov 2024

FRIDAY 24 MAY 2024 9.00am - 5.00pm - education 5.00pm - 7.00pm - happy hour SATURDAY 25 MAY 2024 9.00am - 5.00pm - education 12 HOURS CPD

SATURDAY 31 MAY 2025 9.00am - 5.00pm - education

Together towards the future: Ivoclar and 3D printing expert SprintRay launch collaborative partnership

The Ivoclar Group, one of the world’s leading manufacturers of integrated solutions for high-quality dental applications with an extensive product and systems portfolio for dentists, dental technicians and dental hygienists announces its partnership with the US-American technology company SprintRay. As one of the leading manufacturers in the dental industry worldwide, the Liechtensteinbased Ivoclar Group is now setting new standards in the field of 3D printing with this cooperation.

Digital technologies and processes are constantly driving changes in the dental industry and are having a major impact on the way dental professionals work. To enhance its customer support, the Ivoclar Group has entered into a partnership with SprintRay. The US-American technology company develops end-to-end 3D printing solutions for dental practices and laboratories. During SprintRay’s recent 3DNext event in Miami, USA, Ivoclar’s CEO Markus Heinz and SprintRay’s CEO Dr Amir Mansouri shared their joint vision with the dental sector.

Synergies smartly used

Ivoclar is one of the world’s leading material manufacturers in the dental industry and has been providing solutions for high-quality fixed and removable prosthetics for more than a century. For about 20 years, Ivoclar has been inspiring with efficient and aesthetic solutions that set new standards for CAD/CAM workflows in dental practices and laboratories. SprintRay stands for a coordinated and thought-through product portfolio that meets the needs of customers purposefully and in the long term. With this partnership, the synergies and expertise of

“Our aim is to really understand the problems and needs of our customers in order to provide optimally coordinated solutions...”

both companies will be aligned allowing their customers to ideally combine stateof-the-art solutions for 3D printing with high-quality materials.

Together for the next generation

With the announcement of their partnership, Ivoclar and SprintRay also reveal that further innovations can be expected as early as this spring.

“We are very pleased to partner with SprintRay - an equal partner with whom we want to set new standards together. The philosophies of our companies complement each other perfectly and we are striving to provide our customers with the best possible support in their daily work”, said Markus Heinz, CEO of Ivoclar Group.

Dr Amir Mansouri added, “Ivoclar and SprintRay both have extensive internal dental expertise. Our aim is to really understand the problems and needs of our customers in order to provide optimally coordinated solutions. With Ivoclar, we are delighted to have one of the dental industry’s leading material manufacturers at our side.”

For more information, contact Ivoclar AU: 1300 486 252 orders.au@ivoclar.com NZ: 0508 486 252 orders.nz@ivoclar.com or visit ivoclar.com

A-dec celebrates major milestones

By David Petrikas

Another milestone has passed during A-dec’s 60th anniversary year, with 2024 also marking 40 years of A-dec’s operations in Australia.

A-dec Australia officially began operations from Balmain on 1 May 1984, with Keith Mentiplay, long time Territory Manager in the region, at the helm (later becoming General Manager Australia). The company is currently headed up in Australia by Craig Young.

After establishing a local presence, A-dec soon grew and moved to Camperdown and then Alexandria before moving into the current Australian A-dec headquarters at 5-9 Ricketty Street Mascot in July 2007.

The headquarters is 2400 square metres and includes a large warehouse, offices, training facilities, showroom and in-house technical service facilities.

A-dec Australia is a distribution company owned by A-dec International that imports and markets A-dec manufactured and other products from its key supply partners through dealers in Australia and New Zealand.

A-dec’s presence in Australia, backed by one of the largest networks of experienced territory managers and dealers in the Australian dental equipment industry, provides unrivalled support to dentists around the country.

A-dec is one of the leading markets for A-dec outside of the USA where A-dec is the top selling and most-respected brand as evidenced by 21 years of consecutive “Townie” awards for dental operatory equipment.

A-dec is also well known for its contribution to the local dental industry on many levels, including through the Australian Dental Industry Association (ADIA) and

its partnerships with teaching universities and of course its lasting relationships with dental customers throughout Australia.

A-dec’s presence in Australia provides customers with local logistics and warehousing, millions of dollars in spare parts and product inventory to provide outstanding customer service with immediacy.

A-dec also markets, distributes and supports select equipment from other major brands, such as infection control and digital imaging solutions from Europe’s highly respected dental equipment supplier, Dürr Dental.

Fun Fact: The total years of service of A-dec Staff is a combined 329 years, indicating the length of service and experience of one of Australia’s most trusted dental equipment companies.

For info, visit https://australia.a-dec.com

AESTHETIC MONOLITHIC ZIRCONIA

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Dentistry

The specialist perspective on common surgical and restorative quandaries

SYDNEY • NOVEMBER 29-30, 2024

Presented by Specialists Prof. Axel Spahr and Dr Tom Giblin

Professor Axel Spahr

Specialist Periodontist in Private Practice and Head of the Discipline of Periodontics and Program Director of the Doctor of Clinical DentistryPeriodontics post-graduate program at The University of Sydney Dental School.

Doctor Thomas Giblin

Specialist Prosthodontist in Private Practice

President, International Congress of Oral Implantologists, Diplomate ICOI, Board Member of Australian Society of Implant Dentistry (ASID), Member of ADA, ACP, IAG, AARD.

This advanced course is tailored for dentists with prior experience in implant surgery, aiming to further refine their expertise and clinical proficiency. The program is designed to deepen participants’ understanding and enhance their skills in both the surgical and restorative aspects of implant procedures. It emphasizes essential clinical topics to optimise outcomes and success rates, including practical insights into common challenges and solutions.

DAY ONE - FRIDAY NOVEMBER 29

Surgical Considerations

n Patient selection and comprehensive treatment planning.

n The effects of systemic diseases and medications on surgical outcomes, healing and implant success.

n Risk assessment (SAC), and the influence of implant type, material, surface characteristics and implant/abutment connections.

n The use of short and reduced-diameter implants.

n Guidelines for implant planning, key parameters and management of peri-implant tissues.

n Immediate, early and late implant placement strategies.

n One-stage versus two-stage implant surgery techniques.

n Surgical instruments, materials, and common complications.

n Freehand versus guided implant placement methods.

n Implant maintenance to avoid problems.

DAY TWO - SATURDAY NOVEMBER 30

Prosthetic Considerations

n Evaluating the digital workflow in implant dentistry: practical benefits versus technological novelty.

n Digital shade analysis and lab communication.

n Prosthetic design single / bridge /full arch / removable.

n Restorative materials.

n Impressions vs scanning.

n Optical and biomechanical properties of natural teeth and restorative materials and why it matters.

n Restoration design and preparation geometry.

n Fitting and delivery of indirect adhesive restorations.

n Verification of treatment sequences and outcome validation.

n Breaking down complex cases with novel solutions to restorative dilemmas.

n Practical clinical applications and case studies.

The secret power of short-form videos...

Want to give your social media a serious boost?

Let’s talk about short-form videos.

Platforms like TikTok, Instagram Reels and YouTube Shorts are all the rage and they’re fantastic for grabbing attention fast. Here’s how you can jump on this trend and make it work for you...

Know your audience: Dive into your analytics and figure out what your followers love. Tailor your short videos to fit their interests - the more targeted, the better your engagement.

Create catchy content: You’ve got seconds to hook people, so make them count! Start with something eyecatching and keep it fun and to the point. Whether it’s a quick tip, a peek behind the scenes or a quirky challenge, make sure it’s entertaining and informative.

Be consistent: Keep those videos coming! Regular posts keep your audience engaged and can boost your visibility. A content calendar can help you stay on track and ensure you’re always posting fresh content.

Jump on trends and hashtags: Stay in the loop with what’s trending and use popular hashtags. This makes your content more discoverable. Joining in on viral challenges or using trending sounds can also give your reach a nice bump.

Engage with your viewers: Social media is all about interaction. Reply to comments, ask questions and encourage your followers to engage with the videos you are creating. Adding interactive elements like polls or Question & Answer sessions can take your engagement to the next level.

Cross-promote: Share your short-form videos across different platforms to reach a wider audience. Each platform has its unique crowd and cross-promotion helps you tap into various user bases.

Analyse and adapt: Keep an eye on your video performance. Look at metrics like views, likes, shares and comments to see what’s hitting the mark. Use these insights to tweak your strategy and keep improving.

By focusing on short-form videos, you can seriously boost your social media game in 2024. These quick, engaging videos are perfect for capturing attention and building a stronger online presence. Give it a go and see how your engagement soars!

For more info on mastering social media, visit dentalmarketingsolutions.com.au

ACCOUNTING & FINANCIAL SERVICES FOR DENTISTS

DON’T RISK SECOND BEST

Synstrat has spent many years

We provide you with the best available knowledge on the performance of your practice relative to others. Our proven service has assisted many dentists Australia wide to create significant wealth. We are able to provide you with business accounting, practice valuation and financial advice services tailored to the dental profession.

Buying A Practice?

•Do you need us to value the practice? •What rent can it afford?

How

World leading Dürr Dental VistaSystem offers key benefits

A-dec and Dürr Dental have teamed up to offer dental professionals an exceptional new option in the competitive world of dental imaging solutions. Dürr Dental’s high-quality intra- and extra-oral imaging solutions cover the full spectrum, from a range of diagnostic intraoral cameras, image plate scanners and X-ray units, all the way up to top-tier CBCT, OPG and Cephalometric imaging systems.

Seamless communication and collaboration

The Dürr Dental VistaSystem is unified by the cutting-edge yet user-friendly VistaSoft software.

This innovative integration simplifies the use of digital imaging devices and streamlines image management for dental practices.

With VistaSoft Cloud View, dentists can effortlessly share data and communicate with labs, dental specialists and patients, transforming digital workflows.

This advancement marks a significant leap forward in patient education and case acceptance, setting a new standard in dental care.

Advanced treatment planning

VistaSoft offers advanced implant plan ning tools and implant databases using Implant and Guide software, or for CEREC users, Sicat Implant. The intuitive VistaSoft Trace enables quick cephalometric anal ysis in seconds, automatically identifying orthodontic reference points such as vital structures and soft tissue silhouettes and plotting them directly on the X-ray image for accurate analysis and planning.

AI-supported workflows

T he VistaScan Mini View 2.0 image plate scanner comes equipped with advanced AI features, including auto matic tooth detection, image rotation and automated image plate quality checks, sim plifying and enhancing operator outcomes.

Benefit from the automatic marking of the mandibular nerve canal on Dürr

VistaScan Mini View 2.0

Advanced features include:

• Brilliant HD image quality;

• Stepless autofocus from macro to extraoral (portrait) images;

• Diagnostic aid for detection of proximal caries without X-rays (Proxi head); and

• Software evaluation of carious lesions and visual display of plaque (Proof head).

VistaIntra DC X-ray

Dürr Dental’s VistaIntra DC is an easy-to-use, compact X-ray generator that pairs perfectly with Dürr Dental’s exceptional VistaScan IQ image plate technology to produce unparalleled intraoral images.

Key features include:

• Simple operation and accurate ergonomic positioning;

• Versatile arm lengths to suit any surgery;

• Reliable with a long service life;

• Adjustable mA and kV for fine-tuning images; and

• 0.4mm focal spot for ultra-fine detail.

The widely used VistaScan Mini, known for its unparalleled image quality, now boasts a crisp new design and AI image processing, helping streamline intraoral X-ray processing and reduce errors through automatic tooth detection and image rotation. VistaScan IQ image plates feature RFID technology, which helps drive the power-packed AI workflow. With 100% image coverage, the IQ plates deliver 22LP/mm effective resolution, the gold standard in image plate technology.

VistaPano S 2.0

The VistaPano S 2.0 sets a new standard in extraoral image resolution. Featuring an innovative 8” glass touch display, it incorporates state-of-the-art CSI sensor technology for enhanced picture quality and S-Pan technology for pinpoint-sharp panoramic images. The OPG images are captured in just seven seconds and with the optional Cephalometric addition, images are produced in two seconds, helping to minimise radiation exposure.

VVistaVox S

istaVox S is the top-of-the-range imaging unit, handling all advanced imaging procedures as a 3-in-1 CBCT, Panoramic and Cephalometric unit. It features automatic AI mandibular nerve mapping and implant visualisation, enhancing safety and efficiency for implant and third molar treatment planning. The special feature of VistaVox S is that its imaging volume is based on the human anatomy, representing precisely the area you need for diagnostics in the dental region. Other features include:

• Reduced radiation dose thanks to the anatomically adapted field of view;

• Exceptional image quality in 2D and 3D; and

• VistaSoft integration options for implant planning, guided surgery and Cephalometric tracing.

Learn more about these premium digital imaging options from your local A-dec dealer. To locate your nearest Dürr Dental authorised dealer, call A-dec on 1800-225-010.

High-performance sterilization- and drying system

5“ high-resolution colour touch display for intuitive navigation

3-fold flexible fresh water supply with integrated quality control

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

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

Integrated dust protection filter Scan the QR

Miniature Implants: A unique system for minimally invasive treatment

SYDNEY ON NOV 23, 2024

Presented by Dr Omid Allan

This is an exclusive training course on the BioMiniatures

Miniature Implant system, offering an opportunity to be the first to learn about this innovative system. The course includes hands-on education on the use of Miniature Implants for full and partial arch rehabilitation using a minimally invasive approach. Miniature Implants are narrow diameter implants with a unique self-drilling and self-advancing design which allows placing implants in very narrow alveolar ridges without needing complex and risky bone augmentation procedures.

The course will enable you to restore dentitions in severely atrophic ridges with simplicity and confidence. This will include both surgical and prosthetic procedures.

Dr Omid Allan

DDS, ADC, MFGDP, MSc (Aesthetic Dentistry) (King’s College London), MSc Oral Implantology (Goethe Frankfurt), FICOI

Dr Omid Allan holds a Masters degree in Oral Implantology from Geothe University of Frankfurt and also a Masters degree in Aesthetic Dentistry from King’s College of London. He is the inventor of the miniature implant system and founder of BioMiniatures with extensive knowledge and experience in implant dentistry.

Growth through education

Leveraging education as a tool for growth can be a powerful strategy for businesses, including dental practices. Here are ways in which a dental practice can foster growth through education:

1. Patient education

• Preventive care workshops: Host workshops or seminars on preventive oral care, covering topics such as proper brushing techniques, flossing and the importance of regular dental check-ups.

• Online resources: Develop and share educational content on your website or through social media platforms to inform patients about various dental procedures, oral health tips and the importance of specific treatments.

2. Continuing education for staff

• Skill development programs: Invest in ongoing training and education for your dental team to keep them updated on the latest advancements in dentistry.

• Specialised training: Encourage staff members to pursue specialised training or certifications in areas such as cosmetic dentistry, orthodontics or implantology to expand the range of services your practice can offer.

3. Community outreach programs

• School partnerships: Establish partnerships with local schools to provide oral health education programs for students. This can include presentations,

dental screenings and the distribution of educational materials.

• Community workshops: Host educational workshops in the community, covering topics like oral hygiene, nutrition for oral health and the importance of early dental care for children.

4. Tele-dentistry for education

• Webinars and online courses: Offer webinars or online courses on oral health topics. This not only educates your existing patient base but can also attract new patients who are interested in learning more about dental health.

• Virtual consultations: Provide virtual consultations for educational purposes, allowing patients to discuss their concerns and learn about potential treatment options from the comfort of their homes.

5. Collaboration with educational institutions:

• Internship programs: Collaborate with dental schools to offer internship programs for dental students. This provides hands-on experience for students and introduces them to your practice.

• Guest lectures: Invite dental professionals or educators to conduct guest lectures at your practice, creating a learning environment for both staff and patients.

6. Educational events

• Health fairs: Participate in or organise health fairs where your practice can provide information about oral health, offer screenings and engage with the community.

• Open houses: Host open houses at your practice to showcase the latest technologies, discuss treatment options and educate the community about the importance of dental care.

7. Patient engagement programs

• Support groups: Establish support groups for patients with specific dental concerns or undergoing similar treatments. This can facilitate peer support and education.

position itself as a trusted resource, fostering patient loyalty and attracting new clients. Education-driven growth creates a positive impact, both in terms of patient outcomes and the overall reputation of the practice. The OrthoED Institute offers a range of course options, from a 1-day introduction to Orthodontics called

“By prioritising education, a dental practice can not only contribute to the well-being of its community but also position itself as a trusted resource, fostering patient loyalty and attracting new clients...”

• Interactive workshops: Conduct interactive workshops on topics such as managing dental anxiety, post-operative care and maintaining oral health during different life stages.

By prioritising education, a dental practice can not only contribute to the well-being of its community but also

Orthodontic Fundamentals, a certificate in clear aligner therapy (5 days) and the flagship 2-year Mini Masters course that includes the aligner modules and the opportunity to gain a diploma in Orthodontics.

For more info, visit www.orthoed.com.au, email info@orthoed.com.au or call (03) 9108-0475.

ALL MATERIALS

Create full dentures, Titanium frames and abutments, CoCr frames and copings, Zirconia, PMMA, glass ceramics, PEEK, HPP, and hybrid composite restorations with ease and precision.

The Waterpik™ Water Flosser: Significantly more effective than interdental brushes for removing plaque

Comparison of water flosser and interdental brush on plaque removal:

A single-use pilot study

Objective

To determine the efficacy of a Waterpik™ Water Flosser vs interdental brushes for plaque removal.

Methodology

Twenty-eight subjects completed this one-time use study. Subjects were randomly assigned to one of two groups: Waterpik™ Water Flosser (WF) plus manual tooth brushing or interdental brushes (IDB) plus manual tooth brushing. Plaque scores were obtained using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects were instructed on the use of their interdental product. Post-cleaning scores were obtained after a supervised brushing and use of the interdental device. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject.

Results

The Waterpik™ Water Flosser group was significantly more effective than the IDB group for removing plaque from all areas measured.

Specifically, the WF was 18% more effective for whole mouth and marginal areas, 20% for approximal areas, 11% for facial areas, and 29% for lingual areas.

Conclusion

The Waterpik™ Water Flosser and manual toothbrush removes significantly more plaque from tooth surfaces than interdental brushes and a manual toothbrush after a single use.

What more information? Book your free Professional Education session today by visiting waterpikshop.com.au/lunch

New Zirkonzahn facility in Sydney opens its doors!

After the openings in Toronto and London, the Italian company lands in the southern hemisphere

We’re almost there! In the north of Sydney, Zirkonzahn will open soon a brand-new facility: Zirkonzahn Australia – the company’s 14th location worldwide, following the last openings in Toronto and London. Only a few minutes from the city centre in St Leonards, the facility will host educational training on Zirkonzahn’s products and devices for all dentists and dental technicians who wish to know more about the company’s workflow and work philosophy.

The training courses offered on-site are part of the Zirkonzahn School - the wide, well-structured and targeted educational programme developed by the Italian company with the aim of teaching the use of its equipment and materials with no knowledge gaps.

But that’s not all – Zirkonzahn Australia will also feature a logistics department for supplying materials without delivery delays. Moreover, the on-the-ground experts DT Rian Barnard and Hanna Kukula will support clients and potential customers in the creation of their workflow with Zirkonzahn products, explaining and showing the different components as well as answering to all technical questions.

Zirkonzahn Australia is the company’s 14th location worldwide.

From a one-person business to more than 350 employees all over the world, Zirkonzahn is now a global revolution.

NEW! DETECTION EYE

INTRAORAL SCANNER OPTIMALLY INTEGRATED INTO ZIRKONZAHN’S DATA MANAGEMENT SYSTEM

- High scanning accuracy

- High scanning speed: jaw digitisation in less than 60 seconds

- Real-time scan with realistic colours and clear preparation borders

- Powder-free scanning for a simpliﬁed process

- Non-contact scanner with structured light; lightweight, compact and ergonomic

- Autoclavable and reusable tips available in two different sizes

- Through a QR code the clinician can share with patients 3D scans and recommendations for a better understanding of the treatment plan

- Open output formats: export as STL, OBJ and PLY

ZIRKONZAHN SUPPORT

With our products we offer a complete solution to produce high-quality dental restorations.

With the new opening, Zirkonzahn customers and potential clients from Australia can now see first-hand all of the company’s innovations and solutions without flying to Italy, which is, however, always worth a visit: Zirkonzahn doors are always open to dentists and dental technicians wishing to discover where all products are manufactured and enjoy the typical South Tyrolean culture that has shaped Zirkonzahn since the beginning.

Dental technology 100% made in Italy

In the heart of the Italian Alps, with the core values of discipline, innovation, trust and responsibility, the family-run company Zirkonzahn has been providing solutions and approaches for the dental sector since its foundation in 2003. The know-how and skills developed during the years are inherited from father to son, both Master Dental Technicians, ensuring continuity to clients and building with customers last relationships based on mutual trust.

From patient diagnostics to the final restoration, Zirkonzahn’s main goal is to optimise the collaboration and communication between dentists and dental technicians, providing clinics and laboratories with dedicated instruments forming an optimum match in the complete workflow. Under the motto “Everything under one roof”, all milling units, dental materials, hardware equipment, software, tools and implant prosthetic components are conceived and developed in-house to guarantee constant controls over the production process and thereby comply with the highest quality standards. Only in this way, all products can be perfectly coordinated with each other.

From Zirkonzahn, customers don’t just buy “a product”. They buy a whole work philosophy that includes the conception of a seamless and well-coordinated dental workflow - with the possibility of switching from digital to analogue and vice versaa complete package of services and reliable support.

Zirkonzahn is open

Always developing innovative technologies and searching for smart, unconventional solutions, all company’s hardware components and software modules generate open data formats (e.g. STL, OBJ) which are therefore compatible with all open CAD systems, milling units or 3D printers. Of course, also open data (scans or design files) from other manufacturers can be processed with Zirkonzahn wide range of products. In this way, customers can benefit from a complete system which can be personalised und upgraded according to different combination possibilities to meet all one’s requirements. Moreover, the CAD/ CAM system design can be customised on request in all colours and different styles, expressing every attitude.

Zirkonzahn Australia Pty Ltd is located at Unit 57, 6-8 Herbert Street, 2065 St Leonards, NSW 2065. Tel: +61 432446682 Fax: +45 7022 7158 info.australia@zirkonzahn.com For more information, visit www.zirkonzahn.com

100 % AESTHETICS THANKS TO INTELLIGENT SOLUTIONS

K80 ANGLED SCREW CHANNEL TITANIUM BASES

CONICAL TITANIUM BASES NON HEX

- With or without anti-rotation connection, but with anti-rotation device on the chimney as well as cut-off marks for adjusting the height

- Available also gold-plated, to increase biocompatibility and reduce the grey value of the restoration

- Side opening to tilt the screw access channel from 0° to 30° and compensate for divergent implant positions

- Chimney height can be ajusted to tooth length; also available in different gingival heights

CONICAL TITANIUM BASES NON HEX K80 ANGLED SCREW CHANNEL

Figure 1. VITABLOCS TriLuxe forte makes efficient CAD/CAM restorations possible with impressive results.

VITABLOCS TriLuxe forte: Premium aesthetics with even more options

VITA Zahnfabrik offers highly aesthetic solutions for prosthetics. The same applies to the proven VITABLOCS TriLuxe forte CAD/CAM blocks. Just in time for the 100th anniversary, the blocks are now available in five new VITA classical A1-D4 shades.

Aesthetics and proven high quality

With its integrated shade gradient, VITABLOCS TriLuxe forte is especially suitable for CAD/CAM fabrication of crowns and veneers in the smile zone. The four intensity layers guarantee

a natural interplay of colour and light –as close to the aesthetics of natural teeth as possible.

Proven feldspar ceramic – for over 35 years

This material has a special fine structure, which is proven to make it exceptionally easy to polish, as well as resistant to abrasion. Numerous clinical studies confirm the long-term durability of restorations using VITABLOCS.

Simple and efficient to use

VITABLOCS TriLuxe forte will also be available in the shades B1, B2,

B3, C2 and C3, in addition to the VITA classical shades A1, A2, A3 and A3.5 that have already been available. This gives users even more options for quickly and easily creating restorations with matching shades.

VITABLOCS TriLuxe forte also saves time and makes the workflow more efficient. A chairside treatment in just one session at a dental practice is easily possible using VITABLOCS.

Patients not only benefit from the fast treatment, but also from the highly aesthetic results.

For More info on VITABLOCS TriLuxe forte see www.vita-zahnfabrik.com/ vitablocs_TP6_Multicolor.html

Diagnostic excellence with Meyer CBCT: Dr Lena Qiu’s experience at Meili Dental

Over my 14 years blending roles as an oral health therapist and dentist, I’ve always looked for ways to improve our practice. Bringing in the Meyer CBCT from Osseo Group was a big step forward for us, showing our commitment to getting better and bringing in top-notch technology. I’m keen to share the good it’s done for us and our patients.

We’ve aimed to mix high-tech dental care with the feel of a boutique clinic, making visits as warm and welcoming as seeing close friends. This led us to choose the Meyer CBCT, thanks to the trust we’ve built over the years with Osseo Group and especially with Cat Trinidad, their account manager. Our past work together, like on clear aligners and intraoral scanners, meant I trusted her recommendation completely and knowing I would have the in-person technical support.

From purchase and installation, to using the machine, everything has gone smoothly, really showing off the Meyer CBCT’s dependability and quality. It fits our needs perfectly, especially for looking at wisdom teeth, helping with root canal work and planning for implants. The images are so clear and free from metallic artefacts–they make our diagnoses and treatment plans much better.

Adding the Meyer CBCT to our practice has made a huge difference. It’s made our workflow smoother and our treatment planning for implants, wisdom teeth and root canals more accurate. This hasn’t just improved things for our team; our patients are happier and getting better results, as we can perform our imaging in-house instead of sending patients elsewhere, delaying their treatment, increasing their costs and time away from work and commitments.

What’s great about the Meyer CBCT is how doctor-friendly it is to use, making it a breeze to add to our practice. The support from Osseo Group and Meyer has been excellent, giving us the help, training and resources we need. This means we’re

never on our own trying to get the most out of this technology.

Looking back, I’m really pleased with our decision. The Meyer CBCT has gone beyond our expectations, showing the value of our investment and its key role in raising the standard of care we offer.

Adopting in-house imaging technology like the Meyer CBCT has been a game changer, letting us offer more precise, efficient and patient-focused services without the need to refer them away for diagnostics and increasing our treatment plan acceptance.

Dr Lena Qiu is the principal of Meili Dental Care in Hurstville, Sydney, NSW.

For more info on Meyer CBCT, contact Osseo Group on 1300-029-383 or visit www.osseogroup.com.au

VITA expands VITA VIONIC Solutions portfolio opening even more possibilities

VITA Zahnfabrik is bringing more new products to market for its VITA VIONIC Solutions portfolio and offering users even more freedom of choice in the future for workflow and materials. Regardless of the hardware and software systems used, this means completely new possibilities in terms of quality, aesthetics and efficiency.

In addition to the products already available, users can choose from a wider range and completely new components in the series including:

VITA VIONIC® DENT DISC multiColor

With thsi new disc, users can mill teeth for partial and full dentures themselves via CAD/CAM. Within the VITA VIONIC Solutions portfolio, you

can now choose between prefabricated or individually created teeth. Thanks to the high-quality composite (inorganically filled PMMA), the new disc is significantly more abrasion-resistant than comparable products. VITA is offering its usual high quality of analog VITA premium teeth for digitally created dentures as well. The integrated shade gradient also makes the VITA VIONIC DENT DISC multiColor unique on the dental market.

VITA VIONIC® BASE DISC HI

The disc for milling the denture base via CAD/CAM comes onto the market with an improved material that is impact-resistant and more durable than its predecessor. In addition, the BASE DISC HI is available in three lively gingiva shades (with a fourth coming) which appear even more natural for full and partial dentures.

VITA VIONIC® DIGITAL VIGO Denture Library

VITA is also reorganising its dental database. Users are able to digitally design try-in dentures, denture bases and teeth and then 3D print or mill them. The database is available for the denture modules of 3Shape and soon, exocad. Users can choose from a total of seven predefined setup concepts for partial and full dentures - including cross-bite and the recently added setup concepts for straight setup lingualised, straight setup buccalised and Dutch lingualised occlusion. This means that the VITA VIONIC DIGITAL VIGO denture tooth database enables simple and time-saving digital design and manufacture using all common open CAM and 3D print systems. The denture tooth library for 3Shape is available now and will be available soon for exocad.

More info at vita-zahnfabrik.com/vionic

When choosing Ampac Dental, your getting More Than Equipment. Your gaining a dependable partner that provides genuine, personalised support, and collaboration in the success of your practice.

IDS 2025: The biggest trade fair of the dental industry continues to grow

Seven months before opening, the International Dental Show (IDS) 2025 has recorded a strong rise in the number of exhibitors and is thus underlining its position as the leading trade fair for the global dental industry. Almost all relevant key players have already confirmed their participation at the 41st IDS, which is being staged in Cologne from 25 to 29 March 2025. The current list of participants already includes over 1,100 companies from 54 countries, so there are high expectations for a convincing end result.

A current list of exhibitors containing all companies that have registered so far is available online under the “Provisional list of exhibitors” for IDS Cologne 2025. https://www.ids-cologne.de/ids-cologneaussteller/ausstellerverzeichnis

The Society for the Promotion of the Dental Industry (GFDI), the commercial enterprise of the Association of German Dental Manufacturers (VDDI) and Koelnmesse said in a joint statement: “In 2025, IDS will once again be welcoming the who’s who of the entire dental industry in Cologne. The excellent number of registrations clearly shows that IDS is recognised as the leading international event and that it offers the best forum for innovations and market trends. It is impressive to see how many companies use IDS as a platform for their business development.”

the Olympic Games that were held in Paris this summer, IDS stands for excellence, fairness and global cohesion. “IDS is a unique product show for the entire dental industry. We create fair competition conditions for a sportingly ambitious and collective comparison of performance in line with the Olympic principle,” Mark Stephen Pace, Chairman of the Association of German Dental Manufacturers (VDDI), emphasised.

About IDS

The organisers’ priority lies on the sustainable business success of all stakeholders involved and has always been shaped by the Olympic principles. Like

T he IDS (International Dental Show) takes place in Cologne, Germany every two years and is staged by Koelnmesse GmbH, Cologne. For more information, visit www.ids-cologne.de

American Express® expands partnership with HICAPS

Coinciding with the roll-out of HICAPS’ new best-in-class Trinity Payment Terminals, American Express has expanded its partnership with the leading healthcare claiming solution. This enables tens of thousands of healthcare providers across Australia to accept American Express and gives American Express Card Members the ability to earn Membership Rewards® points when visiting a HICAPS provider.

The new Trinity Terminals, currently being rolled out, will see 90,000 HICAPS providers set up to accept American Express payments including dentists, chiropractors, physiotherapists, general practices and more. The rollout is expected to be complete by the end of 2024.

The HICAPS Trinity Terminals are designed to streamline the patient payment experience with fast claim processing among 100% of private health insurers in Australia. For practices, this

reduces the need to manually input claims, transactions and quoting - cutting down on administration.

Robert Tedesco, Vice President & General Manager of Global Merchant Services at American Express said: “Digitisation and automation is a priority for many businesses wanting to simplify the payments process, both for customers and themselves. This announcement bolsters our commitment to supporting healthcare providers by removing friction at the checkout, while allowing our Card Members to earn reward points for essential health services.

“71% of American Express Card Members say they are more likely to return to a business that accepts American Express*. With that, we hope healthcare providers will see increased customer loyalty and repeat business with American Express automatically enabled in their payment process.”

Simon Terry, Executive for HICAPS said: “One of the most common pain

points for both practices and patients when it comes to paying a health bill is speed and flexibility. HICAPS is dedicated to delivering ease, speed and reliability and since 2014, we’ve achieved this in partnership with American Express.

“We’re proud to support more than 90,000 healthcare providers across Australia and today’s announcement will help further reduce administration and complexity for practices, while offering more choice to patients.”

For more info, visit www.hicaps.com.au

* American Express commissioned internet panel survey conducted in April -May 2022 based on purchases made in the 6 months prior to the survey. Definition of American Express Card Members: Respondents who reported that they have an American Express Card and that they used that card to make purchases in the prior 6 months.

Luna 2 is the next generation Luna universal composite.

Luna 2 is the next generation Luna universal

Luna 2 is BPA free and has a unique blend of fillers to deliver enhanced handling and polishing.

» Handling is fantastic - much improved. It is SDI’s best handling composite yet. «

Dr Michael Chan - Australia

Images courtesy of Prof Dr Marco Aurélio Chaves da Silva (BRAZIL)

Images courtesy of Dr Mohamed Saad [ALGERIA]

New packaging designs for VITA CAD/CAM and DISC products

In order to provide even better protection for VITA products and use sustainable packaging materials, the packaging for VITA CAD/ CAM blocks and DISC products have been optimised.

CAD/CAM packaging

Starting in April 2024, the VITA CAD/ CAM blocks will be gradually supplied in standardised folding boxes. This optimisation will reduce the number of packaging variants from 12 to 6. The products will now be differentiated by their unique labeling. The exceptions will be the VITA YZ products over 55 mm, as well as VITA CAD-Waxx and VITA CAD-Temp over 65 mm in height, which will continue to be available in special packaging.

The new block packaging will no longer use foam inserts and will rely instead on a cardboard cavity that offers the prod-

ucts optimised protection. Instructions for use can be accessed digitally via QR codes on the packaging, which will reduce paper consumption.

DISC packaging

Significant improvements have also been made to the DISC packaging. Plastic foils and foam inserts have been replaced by environmentally friendly cardboard and cellulose half-shells, which will result in a significant reduction in waste. In addition, QR codes on the outer packaging will promote the digital availability of instructions for use, which will further reduce paper consumption.

The design of the new slipcases, which are now constructed as closed boxes with a fold-out base, has also been updated and adapted to match the design of the block packaging. The products will also be differentiated via labels, which will reduce the amount of packaging to a minimum.

VAbout VITA Zahnfabrik

ITA Zahnfabrik H. Rauter GmbH & Co. KG is a fourth-generation family business based in Bad Säckingen, Germany. For 100 years, VITA has been developing, producing and distributing innovative, high-quality products and solutions for dental technology and dentistry. Worldwide, more than 600 employees work for VITA Zahnfabrik, with the objective of being closer to users and customers than anyone else. Areas of expertise range from analog and digital shade determination, denture teeth and veneering materials, press ceramics and CAD/CAM materials and furnaces and dental materials. The needs of the user are also the focus of the new development of innovative system solutions for the functional and aesthetic reproduction of tooth structure.

More info at vita-zahnfabrik.com

Figure 1. The packaging for VITA CAD/CAM blocks and DISC products have been optimised.

• Any Design

• HD PMMA Milled

• Flexion Milled

• POM Resin Milled

• 3D Print Option

• Perfect Fit

• Upper or Lower

• All scans accepted

Molaris I & II - The heavy metal side of Zirkonzahn: Production of metal blanks, machine parts, milling burs and more than 6,000 implant prosthetics components

Zirkonzahn’s Molaris I and II production sites, located near to the company’s headquarters in the Aurina Valley in South Tyrol, Italy, host the high tech equipment necessary to produce all burs, machine parts, implant prosthetic components and metal blanks. The company’s values of rigor, precision and quality are clearly reflected in this location. By means of the latest turning, milling and grinding techniques, the company’s range of manufactured implant prosthetic components achieves a particularly high accuracy, using a high-quality medical titanium alloy (Ti 6Al 4V ELI according to ASTM F136 and ISO 58323). The range, which includes Scanmarkers, White Scanmarkers, White Metal Scanmarkers, impression copings, laboratory analogues, Multi Unit Abutments and Raw-Abutments® currently comprises more than 6,000 components and has recently been expanded with new products:

A1. Zirkonzahn LOC-Connector

snap attachment system for implants and bars to fix removable dental prostheses on the implant.

2. Multi Unit Abutments 17°

M UA characterised by a 17° angle to compensate for any implant inclinations and with two different anti - rotation connection types which allow intermediate positions.

3. Titanium Bases K85

Titanium Bases with the chimney height adjustable to the individual tooth length and available in different gingival heights

Figure 1. All components are available for more than 140 implant.

Monolithic full arches made of Prettau® 2 Dispersive® Bleach zirconia on anodised titanium bases, veneered only in the gingival area.

DT Janka Gregorics – Zirkonzahn Education Center Brunico, South Tyrol, Italy

PRETTAU® 2 DISPERSIVE® BLEACH

NATURAL REPRODUCTION OF WHITE AND BRIGHT TEETH

- Pre-shaded zirconia with natural colour gradient, optimal ﬂexural strength and particularly high translucency

- No limitations! Ideal for monolithic full arches, but also for single crowns, inlays, onlays, veneers, bars and multi-unit bridges (reduced or monolithic)

- No ceramic chipping (thanks to monolithic design), no abrasion of the antagonist

- Can be characterised individually for each patient with Colour Liquid Prettau® 2 Aquarell Intensive, ICE Ceramics, Fresco Ceramics, ICE Stains Prettau® and ICE Stains 3D by Enrico Steger

- Also available in three Bleach shades

4. Titanium Bases K80 Angled Screw Channel

Titanium Bases K80 Angled Screw Channel with a chimney height adjustable to the tooth length and the possibility to tilt the screw access channel from 0° to 30°; also available in different gingival heights.

5. White Metal Scanmarkers

Reusable scanbodies to acquire the implant position and orientation during intraoral and model scans.

All components are available for more than 140 implant systems and are fully integrated in Zirkonzahn.Software. Fabricated to meet the strictest quality criteria, the company assumes the responsibility by granting voluntarily up to a 30-year warranty on all Zirkonzahn implant abutments used and the corresponding screws. The warranty also includes implants from other manufacturers used in combination with Zirkonzahn’s implant abutments.

In Molaris I and II, the company also manufactures all milling and grinding tools for their milling systems with no involvement from third parties, creating any tool geometry and making quick and flexible adjustments in close collaboration with the in-house R&D department. Surface coating, electroplating and diamond coating procedures are also performed in this facility, along with the production of the company’s range of 200 milling burs - with different geometries and shank diameters (3 and 6 mm) - milling unit parts and colouring liquids.

The company’s blanks of Sinternit, the firm’s sinter metal, are also produced in this location, where moulding machines are used to inject more than 10 different types of resins into discs, providing them with different colours or colour gradients. Finally, to ensure safety and prevent breakdowns, the same task is performed by two machines and measurement equipment as well as technical testing (e.g. optical and tactile 3D measuring, hardness and roughness measuring, microscopic analysis, etc.) are used to guarantee quality and precision.

For more info, visit www.zirkonzahn.com

Figure 2. Sinternit blanks, the company’s sinter metal.

Figure 3. Measurement equipment guarantees quality and precision.

Figure 4. One of the company’s 3 production halls dedicated to implant components.

Dr. med. dent. Holger P. Meiser – Holger Dental Group, Minnetonka, USA

PRETTAU® 3 DISPERSIVE®

COMPLETE RESTORATION MADE OF ZIRCONIA SINGLE CROWNS

- Digital articulation; virtual tooth set-up using RHEIA and AIDA tooth sets from the Heroes Collection library

- Digital design of a gingival guide in the Zirkonzahn.Modiﬁer software for the gingivectomy

- Minimally invasive preparation of the natural teeth

- Production of the ﬁ nal, minimally reduced single crowns in Prettau® 3 Dispersive® zirconia; characterisation with ICE Stains 3D by Enrico Steger and minimal veneering with Fresco Ceramics

- Cementation of the zirconia crowns in the patient’s mouth

r.zirkonzahn.com/vjd

DT Alexander Lichtmannegger – Zirkonzahn Education Center Brunico, South Tyrol, Italy

Red Dot Award for ASIGA Ultra

The brand new ASIGA Ultra 3D printer has been awarded a 2024 Red Dot Award for Product Design. The Red Dot Award is the world’s most prestigious design award celebrating good design. The Ultra, designed and manufactured in Sydney, Australia has positioned itself as arguably the most advanced dental 3D printer ever. Housing the latest 4K DLP imaging technology alongside the full suite of Asiga’s robust layer monitoring technologies, the Ultra delivers manufacturing certainty but with a new focus for the sector – design. It is clear that Asiga has taken note and listened to their customers to bring to market a product where the end-user is front and centre. It all starts with their new and beautifully designed user interface which feels like something straight from a market leading tablet/ phone manufacturer. Menu navigation, infographics and the responsiveness of the user interface screen all have a high quality feel and draw you in for more. A feature that will most definitely have you hooked is their new touchless entry, an engineering marvel in itself. Asiga surely had a lot of fun with this and with a simple hand-wave gesture, the hood opens effortlessly and is so silent that it leaves you helplessly opening and closing the hood. A magnetic build platform, simple material tray clamping, internal lighting and wide range of connectivity options all help in the presentation of a cleverly refined 3D printer for both the dental laboratory and dental clinic. Another key feature to the Ultra is a new infrared heating system which warms materials to 70°C. This opens doors to new polymer technologies.

For more information on Asiga and these new 3D printers, visit www.asiga.com.

Suction is effective for reducing splatter from airflow devices and ultrasonic scalers

The oral cavity contains numerous microorganisms, including antimicrobial-resistant bacteria. These microorganisms can be transmitted via respiratory particles from patients to healthcare providers and vice versa during dental care. To track the spread of particles, we used Staphylococcus aureus bacteria in irrigation solutions during standardized dental procedures using different scaling devices and rinsing solutions during dental biofilm removal (guided biofilm therapy), using an EMS Airflow-1 with erythritol powder, or an EMS ultrasonic scaler on a typodont model in a phantom simulation head. A Staphylococcus aureus bacteria suspension was injected into the mouth of the model to mimic saliva. Different suction devices (a conventional saliva ejector or a prototype suction device) and rinsing solutions (water or 0.1% chlorhexidine) were used. To assess contamination with S. aureus, an air-sampling device was placed near the oral cavity of the phantom head and samples of surface areas were collected. S. aureus was detected by air sampling when the airflow was used with a conventional saliva ejector. Compared to the conventional saliva ejector, suction collects splatters in a more efficient way. No indicator bacteria were found when the airflow was used with high volume suction. with airflow was used. No growth was observed during treatments with the ultrasonic piezo instrument or the prototype suction device. Notably, a rinsing solution of chlorhexidine digluconate decreased the level of bacteria compared to water. Although our findings indicate the potential for airborne bacterial transmission during routine prophylactic procedures with an airflow device, this risk can be lowered by CHX rinsing and by using high volume suction, as both appear to reduce air contamination.

Franz J, et al. Bacterial contamination of air and surfaces during dental procedures - An experimental pilot study using Staphylococcus aureus. Infection Control & Hospital Epidemiology. 2024;45(5):658-663.

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Question 1. The extent of abrasion cause by toothbrushing is influenced by the...

a. Amount of abrasive particles in the toothpaste.

b. Force applied during brushing.

c. Hardness of the toothbrush bristles.

d. Length of brushing at any particular site.

e. All of the above.

Question 2. High-level evidence indicates that using toothpaste...

a. Doubles the amount of plaque removed.

b. Completely removes all plaque.

c. Does very little to the extent of plaque removal.

d. Removes plaque only after brushing for more than 2 minutes.

Question 3. Entangled fibre networks enhance cleaning because...

a. Its mesh-like structure creates a large amount of shear stress to detach biofilm.

b. They are propelled by the action of the toothbrush bristles and fluid movements in the mouth.

c. The special particles can reach places that may not be accessed by the ends of toothbrush bristles.

d. All of the above.

Question 4. Compared to regular toothpaste, toothpastes using micro-fibrillated cellulose are...

a. 3-4 times more effective in whole-mouth plaque reduction.

b. 5 times more effective on approximal surfaces.

c. 7 times more effective on lingual surfaces.

d. All of the above.

Question 5. Incorporating MFC technology into a toothpaste...

a. Can enhance performance whilst reducing abrasivity.

b. Does not require changes to toothbrush design or method of use.

c. Opens the prospect of “liquid cleaning” without a toothbrush.

d. All of the above

INSTRUCTIONS:

Question 6. Endotoxin (ET) is also known as...

a. Polynucleotide

b. Phospholipid

c. Lipopolysaccharide

d. Glycosaminoglycan

e. Liposome

Question 7. One of the largest concerns with ET is when it...

a. Is present in drinking water.

b. Gains access to systemic circulation.

c. Is present on dental instruments.

d. Is present in the gastrointestinal tract.

Question 8. The TGA Medical Device Standards Order (Endotoxin Requirements for Medical Devices) sets the exposure limit for endotoxins at...

a. 1 ng per device

b. 2 ng per device

c. 3 ng per device

d. 4 ng per device

Question 9. Endotoxins that dry onto instrument surfaces do not remain biologically active after normal steam sterilisation...

a. True

b. False

Question 10. Endotoxin is a fundamental component of the cell wall of...

a. Gram-negative bacteria

b. Gram-positive bacteria

c. Mycobacteria

d. Corynebacteria.

Question 11. When fixing a restoration to a Matrix implant, it does not require...

a. Cementation

b. Ti Base

c. MUA

d. Any of the above

Question 12. As the restoration is torqued down on a Matrix implant, the longevity of the crown is ensured as the ceramic is only placed...

a. In compression.

b. Under tension.

c. Under sheer forces.

Question 13. In full arch restorations on Matrix implants, a very wide path of insertion between fixtures is possible up to...

a. 45 degrees

b. 60 degrees

c. 75 degrees

d. 100 degrees

Question 14. Tri-matrix implants feature an abutment that is built directly into the implant itself, eliminating the need for a separate abutment...

a. True

b. False

Question 15. Matrix SmartBolts are available for...

a. Metal

b. Zirconia

c. PMMA

d. All of the above

Question 16. BloodSTOP iX is primarily used as...

a. An oral bandage.

b. Membrane.

c. Haemostatic dressing.

d. Wound dressing.

Question 17. BloodSTOP iX...

a. Stops bleeding.

b. Seals oral wounds.

c. Initiates the clotting cascade.

d. Promotes wound healing.

e. All of the above.

Question 18. BloodSTOP iX is suitable...

a. Only for topical use.

b. Only for internal use.

c. Both.

Question 19. BloodSTOP iX is...

a. Water soluble

b. Wholly resorbable with minimal expansion.

c. pH neutral.

d. Safe in contact with any tissue including nerves.

e. All of the above.

Question 20. BloodSTOP iX is vegan friendly...

a. True

b. False

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

Alcohol wipes for disinfecting smartphones

Smartphones in healthcare settings pose infection risks due to harbouring pathogenic bacteria. The microbiota found on smartphones resembles that observed on the hands of healthcare workers and between 9% and 25% of smartphones are contaminated with pathogenic bacteria. The inanimate surfaces of the phone serve as reservoirs for pathogenic microorganisms. This is an issue because smartphones have become a fundamental tool in our daily lives and clinical practice and their touch screens require repeated finger contact. This study assessed the effectiveness duration of two sanitization methods, 70% isopropyl alcohol wipes and ultraviolet-C (UVC) boxes, assessing the reduction in total bacterial load 3 hours post-sanitization. A randomised trial with two intervention arms (IPA wipes and UVC boxes) was designed. As participants, 71 healthcare workers from a university hospital were recruited, stratified by ward and block randomised within each ward to control confounders (62% nurses, equally from Neonatal Intensive Care, Geriatrics, and Intensive Care departments; physicians 21% and medical residents 17%). Initial bacterial load reduction was significant with both disinfection techniques and no different between the 2 options. However, when assessed again 3 hours after sanitizing, levels of bacteria had begun to return, approaching baseline levels in the UVC group. Bacterial levels were lower after using the IPA wipes, indicating some residual efficacy. This study highlights the necessity for guidelines on smartphone sanitisation methods in healthcare and reinforces the need for educational initiatives for both healthcare workers and patients who use smartphones, tablets and other devices. The use of 70% isopropyl alcoholimpregnated was more intuitive and practical than using UVC boxes, making it easier to sanitise the phone surface repeatedly throughout the work shift. Further work is needed to determine optimal sanitisation intervals.

Lontano A, et al. Pilot randomized experimental study evaluating isopropyl alcohol and ultraviolet-C radiation in the disinfection of healthcare workers’ smartphones. Journal of Hospital Infection 2024; 148: 105-111.

Quats in wipes not the cause of degradation

Surface cleaning and disinfection is a key part of breaking the chain of transmission and reducing the risk of healthcare associated infections (HAIs). However, if cleaning and disinfectant formulations are incompatible with surface materials, frequent application can cause premature failure of plastics due to Environmental Stress Cracking (ESC). Material compatibility should be considered when selecting cleaning and disinfecting products. Wipe formulations are comprised of active (biocides) and inactive (co-formulants) chemicals. A single formulation may contain multiple potential ESC agents at varying concentrations, influencing the overall ESC risk. Moreover, interactions amongst these ingredients can fur ther alter the ESC potential. Hence, predicting ESC solely based on individual ingredient tests is challenging. This study evaluated the ten dency of 2-in-1 wet wipes to cause ESC in commonly found healthcare plastics. These disinfectant and detergent products (2-in-1) contain a range of ingredients which make up their formulation. A total of 8 ready-to-use 2-in-1 wet wipes were evaluated for their ability to cause ESC in 13 plastic surfaces. Polymers were exposed to fluid extracted from wipes at a fixed strain of 0.5% for 7 days and assessed for cracking, crazing and tensile strength. The severity of ESC caused by wipes varied. Products with higher pH (>8.0) were responsible for 74% of failures, with 22 of the 39 tested plastics visibly cracking. All wipes tested contained quaternary ammonium com pounds (QACs), such as benzalkonium chloride, and didecyldimethylammonium chloride, as active ingredients. These were combined with co-formulants such as solvents, preservatives, biocide potentiators, stabilisers and pH buffering agents. Each of these other ingredients have the potential to act as ESC agents, with differing severity based upon their molecular structure, concentration and conditions such as pH, humidity and temperature. Factors such as pH levels, coformulants and the specific type and grade of plastic are crucial determinants of material compatibility. The results indicate that the QACs were not the primary cause of ESC, rather the small/ medium amines or alcohols that were included in the products, as these gave a greater propensity for plastic cracking. Overall, each disinfectant wipe formulation exhibited a unique spectrum of microbial efficacy and had a unique potential to cause surface damage to plastics. This damage may result in device failures that could compromise patient and staff safety.

Jennings J, et al. Chemical resistance testing of plastics – Material compatibility of detergent and disinfectant products. Journal of Hospital Infection 2024 DOI: 10.1016/j.jhin.2024.04.023.

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A new concept for toothpastes: the use of micro-fibrillated cellulose

By Emeritus Professor Laurence J. Walsh AO

Over the past 70 years, the fundamental design of toothpastes has been based on the concept that abrasives should be included, to remove external stains from the surfaces of teeth and improve the disruption of dental plaque biofilm.1-3

Over the past 20 years, different toothpastes have been developed that specifically target patients with cervical dentine hypersensitivity. As well as including agents with desensitising actions, these toothpastes have much lower abrasivity.

In the past 5 years, an opposite trend has also occurred with some recent toothpastes including higher levels of abrasive particles, including charcoal, in an attempt to increase the removal of extrinsic stains. This poses a risk for abrasive wear of teeth.4-7 The fundamental challenge here is that when a toothpaste has greater abrasivity, the impacts of this will be seen much more on exposed dentine and root surfaces than on the enamel. This has been a major challenge in toothpaste design since the 1940s.8-10 The extent of abrasion which occurs will be influenced by factors such as the force applied during brushing, the hardness of the toothbrush bristles that are used and the length of brushing at any particular site.

the cutting | EDGE

Figure 1. A. Scanning electron microscope view of the micro-fibrillated cellulose fiber network that was incorporated into toothpaste. B. V-shaped brushing machine used to test toothpaste performance. C. Samples with external stains from a tea and coffee mixture prior to brushing. D. The same samples after brushing, showing reduction in external stains. E. Sample preparation for standardised laboratory assessments of toothpaste performance. Image A is courtesy of NovaFlux Inc, Princteton, New Jersey, USA. Images B-E are courtesy of Therametric Technologies Inc., Noblesville, Indiana, USA. This lab did the PCR tests described in reference 28.

With the advent of nanotechnologies, there is an opportunity to break the long-held paradigm of toothpaste design and to reimagine the design of toothpastes, so that they can achieve enhanced cleaning of dental plaque biofilm, as well as better removal of extrinsic stains, but without necessarily posing a great risk for abrasion.

The challenge of lubricants and dilution

To understand how this could be achieved, one has to enter the world of engineering tribology, which is the field of science that focuses on the wear of objects. One of the key concepts in tribology is that the presence of lubricants lowers the effectiveness of abrasive particles.

In the case of conventional toothbrushing, viscosity modifiers (such as glycerin) and surfactants can alter the way that individual abrasive particles in the toothpaste come into contact with the tooth surface that is being cleaned.

In addition, during brushing, the physical brushing action and the stimulation caused by the flavours in the toothpaste cause a profound stimulation of saliva production. The stimulated saliva then dilutes the toothpaste and the salivary mucins also act as lubricating agents. These lubricating effects reduce the opportunity for abrasive particles to be trapped between the end of the bristles and the tooth surface while the bristle end is moving during a brushing stroke. These issues have all been described in the tribology literature,11-14 however they are rarely mentioned in dental publications.

Against this background, when one considers the literature on the effectiveness of toothbrushing, it is perhaps now less surprising that routinely used toothbrushing methods and conventional toothpastes typically leave dental plaque biofilm remaining in many areas of the mouth after brushing. In fact, several clinical studies15-18 and the most high-level evidence of the effectiveness of brushing, from systematic reviews,19 indicates that the addition of toothpaste to a brushing routine adds very little to the extent of plaque removal.

Entangled fibre networks for enhanced cleaning

One way to better remove dental plaque is to employ special particles with a mesh-like structure that can create a large amount of shear stress as they move across a surface, creating a type of nano scrubbing action. For toothbrushing, these particles can be propelled by the action of the toothbrush bristles, as well as by the fluid movements that occur in the mouth. This means the special particles can reach places that may not be accessed by the ends of toothbrush bristles.20,21

Mesh-like particles can be made from wood pulp, which can be treated to create microscopic fibrils of varying dimensions. Because of entanglement, the clusters of microscopic fibrils do not separate into their constituent fibrils during brushing. An example of this type of technology is NanoClean™, a form of micro-fibrillated cellulose (MFC) (Figure 1A). This material is insoluble in water and is classified as a “generally recognised as safe” (GRAS) ingredient by the US FDA.

the cutting | EDGE

The special mesh-like particles themselves can have powerful cleaning actions, depending on the speed at which they move across a particular surface. This can occur because of the fibers making direct contact with stacks of bacteria within the dental plaque biofilm and the stacks becoming entangled with the fibers, causing the stacks to be detached from the surface. This entanglement concept is also the basis of technologies used to remove body fluids and biofilms from the narrow channels of medical devices such as endoscopes.22,23

One can take this concept even further and trap within the meshwork of MFC particular abrasive particles that are designed for optimal cleaning and removal of external stain, such as high polishing silica. The silica particles are then dragged over the tooth surface as the MFC clusters move across the tooth surface.20,21

Removal of extrinsic stains

In conventional toothpastes, various insoluble abrasive particles from the toothpaste may be pushed along the tooth surface by the toothbrush bristles and some particles may theoretically even be sandwiched between the bristle end and the tooth surface, causing them to be pushed into the surface. The likelihood of such interactions occurring is reduced because of the dilution and lubrication events described above.

The standardised test for removal of extrinsic stains is the pellicle cleaning ratio (PCR) test. This compares the removal of a mixture of external stains from the enamel surface (Figure 1 B-D). The stain mixture applied to the teeth includes tea and coffee. The PCR results are highly predictive for clinical performance for extrinsic stain removal.24-27

When a very small amount of silica is loaded into MFC, impressive removal of extrinsic stains from tooth services can be achieved. This was shown in a recent laboratory study which used a novel fluoride toothpaste (Protegera™) containing 7% by weight high cleaning silica entangled into MFC. The PCR results were comparable (not significantly different) to several commercial toothpastes marketed specifically for whitening actions caused by removal of extrinsic stains (Figure 2).28

The cleaning efficiency index (CEI) calculations factor in both stain removal properties and dentine abrasion. The MFC toothpaste was found to be superior to six well-known commercial toothpastes that are marketed for their effects on appearance (Figure 3). When dentine abrasion was tested using standard methods, 7,29-31 the MFC toothpaste had far lower dentine abrasivity than toothpastes that are marketed with whitening claims (Figure 4).28

Clinical performance for dental plaque removal

Arecent clinical study compared dental plaque removal using the novel MFC fluoride toothpaste to a commonly used fluoride toothpaste (Crest Cavity Protection™), assessing supervised use as well as unsupervised at-home use over a period of one week, in 82 adults with moderate plaque deposits (a mean plaque score greater than or equal to 2.0 at baseline).32

Figure 2. Pellicle cleaning ratio results for 6 toothpastes. Protegera (black bar) is the brand containing microfibrillated cellulose. There is no significant difference between the PCR values for the first 4 toothpastes. Based on data from reference 28.

Figure 3. Cleaning efficiency index results for the same 6 toothpastes shown in Figure 2. The highest CEI value is found for Protegera. Based on data from reference 28.

Figure 4. Data for dentine abrasion. Note the low value for Protegera (black bar), the brand containing microfibrillated cellulose. Based on data from reference 28.

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the cutting | EDGE

Figure 5. Percent whole mouth plaque reduction was greater for Protegera (black bars) than for Crest Cavity Protection (blue bars) by 3 to 4 fold, at each of the points of comparison in a one week randomised clinical trial. Based on data from reference 32.

Overall, when compared to the conventional toothpastes, the MFC toothpaste was at least three times and up to four times more effective in whole-mouth plaque reductions (Figure 5), 5 times more effective on approximal surfaces (Figure 6) and 7 times more effective on lingual surfaces.32 This benefit was gained without the subjects changing their toothbrush or their toothbrushing method. The latter two findings are important, since approximal and lingual surfaces are typically the most difficult to clean. The explanation for these effects is that the MFC fibre networks with their entrapped silica abrasive particles are moving within the slurry of toothpaste diluted with saliva. The particles are cleaning those tooth services without needing direct contact between the bristles of the tooth brush and that tooth surface. The safety assessment conducted as part of the clinical trial showed no adverse soft tissue or hard tissue effects from the MFC

Figure 6. The percent plaque reduction on approximal surfaces in a 7 day clinical trial was greater for Protegera (black bars) than for Crest Cavity Protection (blue bars) by 3 to 5 fold, at each of the measurement sites. Based on data from reference 32.

toothpaste.28 Overall, the novel toothpaste had a similar mouth feel to a conventional toothpaste.

Advantages of a cleaner tooth surface

With greater removal of dental plaque biofilm and external stains, one would expect to see that the fluoride component of the MFC toothpaste would be highly efficacious. Standardised laboratory tests have revealed that there is greater efficacy than for a toothpaste with the same fluoride ingredient and concentration, giving a statistically greater reduction in enamel solubility for an acid challenge.28 It was effective at delivering fluoride for remineralisation of enamel lesions, causing fluoride uptake into those lesions and increased surface microhardness.

the cutting | EDGE

Conclusions

Incorporating MFC technology into a toothpaste can enhance multiple aspects of its performance, whilst at the same time reducing its abrasivity. This technology approach is disruptive because it challenges the long-held view that powerful stain removal requires large amounts of abrasives. Without changing the design of a toothbrush or the method of its use, worthwhile gains in performance can be achieved by this change to the toothpaste. As well, this technology approach opens the prospect of “liquid cleaning” applications where a toothbrush is not used and where the normal fluid motions of saliva can propel the MFC clusters around the mouth.

“This technology approach is disruptive because it challenges the long-held view that powerful stain removal requires large amounts of abrasives. Without changing the design of a toothbrush or the method of its use, worthwhile gains can be achieved by this change to the toothpaste...”

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 400 journal papers, with a citation count of over 20,000 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

1. Forward GC. Role of toothpastes in the cleaning of teeth. Int. Dent. J. 1991; 41: 164-170.

2. Ashley P. Toothbrushing: Why, when and how? Dent. Update 2001; 28: 36-40.

3. Lippert F. An introduction to toothpaste - its purpose, history and ingredients, Monogr. Oral Sci. 2013; 23: 1-14.

4. Hunter ML, Addy M, Pickles MJ, Joiner A. The role of toothpastes and toothbrushes in the aetiology of tooth wear. Int. Dent. J. 2002; 52 (Suppl. S5): 399-405.

5. Lewis R, Dwyer-Joyce RS. Wear of human teeth: A tribological perspective. Proc. Inst. Mech. Engin. Part J. J. Engin. Tribol. 2005; 219: 1-18.

6. Addy M, Hunter ML. Can tooth brushing damage your health? Effects on oral and dental tissues. Int. Dent. J. 2003; 53 (Suppl. S3): 177-186.

7. Schemehorn BR, Moore MH, Putt MS. Abrasion, polishing, and stain removal characteristics of various commercial dentifrices in vitro. J. Clin. Dent. 2011; 22: 11-18.

8. Manly RS. The abrasion of cementum and dentin by modern dentifrices, J. Dent. Res. 1941; 20: 583-595.

9. Epstein S, Tainter ML. Abrasion of teeth by commercial dentifrices, J. Am. Dent. Assn. 1943; 30: 1036-1045.

10. Kitchin PC, Robinson HB. How abrasive need a dentifrice be? J. Dent. Res. 1948; 27: 501-506.

11. Lewis R, Dwyer-Joyce RS, Pickles MJ. Interaction between toothbrushes and toothpaste abrasive particles in simulated tooth cleaning. Wear 2004; 257: 368-376.

12. Lewis R, Dwyer-Joyce RS. Interactions between toothbrush and toothpaste particles during simulated abrasive cleaning. Proc. Inst. Mech. Eng. Part J. J. Eng. Tribol. 2006; 220: 755-765.

13. Lewis R, Barber SC, Dwyer-Joyce RS. Particle motion and stain removal during simulated abrasive tooth cleaning. Wear 2007; 263: 188-197.

14. Bongaerts JHH, Rossetti D, Stokes JR. The lubricating properties of human whole saliva. Tribol. Lett. 2007; 27: 277-287.

15. Parizotto SP, Rodrigues CRMD, Singer JDM, Sef HC. Effectiveness of low cost toothbrushes with or without dentifrice, in the removal of plaque in deciduous teeth. Pesqui Odont. Bras. 1993; 17: 17-23.

16. Paraskevas S, Timmerman MF, van der Velden U, van der Weijden GA. The additional effect of dentifrices on the instant efficacy of toothbrushing. J. Periodontol. 2006; 77: 1522-1527.

17. Paraskevas S, Rosema NA, Versteeg P, Timmerman MF, van der Velden U, van der Weijden GA. The additional effect of a dentifrice on the instant efficacy of toothbrushing: A crossover study. J. Periodontol. 2007; 78: 1011-1016.

18. Zanatta FB, Antoniazzi RP, Pinto TM, Rösing CK. Supragingival plaque removal with and without dentifrice: A randomized controlled clinical trial. Braz. Dent. J. 2012; 23: 235-240.

19. Valkenburg C, Slot DE, Bakker EWP, Van der Weijden FA. Does dentifrice use help to remove plaque? A systematic review. J. Clin. Periodontol. 2016; 43: 1050-1058.

20. Labib ME, Perazzo A. Oral cavity cleaning composition method and apparatus. U.S. Patent 20210121386, 29 April 2021.

21. Labib ME, Perazzo A, Winston AE, Tabani Y, Manganaro JL, Franz LL, Sohn SY, Kuchar C. Oral cavity cleaning composition, method and apparatus U.S. Patent 202100330557, 28 October 2021.

22. Labib ME, Duhkin SS, Tabani Y, Lai CY, Manganaro JL, Materna P, Roberston JC. Compositions for Cleaning and Decontamination. U.S. Patent 10,266,793, 23 April 2019.

23. Labib ME, Duhkin SS, Tabani Y, Lai CY, Manganaro JL, Materna P, Roberston JC, Sohn SY. Cleaning Composition with Superabsorbent Polymer. U.S. Patent 11,345,878, 31 May 2022.

24. Stookey GK, Muhler JC. Laboratory studies concerning the enamel and dentin abrasion properties of common dentifrice polishing agents. J Dent Res. 1968 Jul-Aug;47(4):524-32. doi: 10.1177/00220345680470040301.

25. Stookey GK, Burkhard TA, Schemehorn BR. In vitro removal of stain with dentifrices. J. Dent. Res. 1982; 61: 1236-1239.

26. Pontefract H, Courtney M, Smith S, Newcombe RG, Addy M. Development of methods to enhance extrinsic tooth discoloration for comparison of toothpastes. 1. Studies in vitro, J. Clin. Periodontol. 2004; 31: 1-6.

27. Pontefract H, Courtney M, Smith S, Newcombe RG, Addy M. Development of methods to enhance extrinsic tooth discoloration for comparison of toothpastes. 2. Two-product clinical study, J. Clin. Periodontol. 2004; 31: 7-11.

28. Labib M, Perazzo A, Manganaro JL, Tabani Y, Durham CJ, Schemehorn BR, McClure HC, Walsh LJ. Stain removal, abrasion and anticaries properties of a novel low abrasion dentifrice containing micro-fibrillated cellulose: in vitro assessments. J. Dent. 2024; 2024. Doi: 10.1016/j.jdent.2024.105038

29. Grabenstetter RJ, Broge RW, Jackson FL, Radike AW. The measurement of the abrasion of human teeth by dentifrice abrasives: a test utilizing radioactive teeth. J. Dent. Res. 1958; 37: 1060-1068.

30. Bull WH, Callender RM, Pugh BR, Wood GD. The abrasion and cleaning properties of dentifrices. Brit. Dent. J. 1968; 125: 331-337.

31. Joiner A, Pickles MJ, Matheson JT, Weader E, Noblet L, Huntington E. Whitening toothpastes: effects on tooth stain and enamel, Int. Dent. J. 2002; 52 (Suppl 5): 424-430.

32. Labib ME, Perazzo A, Manganaro J, Tabani Y, Milleman KR, Milleman JL, Walsh LJ. Clinical assessment of plaque removal using a novel dentifrice containing cellulose microfibrils. Dent. J. 2024; 12: 7.

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Is the gap between orthodontics and myofunctional orthodontics closing?

For decades, the disparity between orthodontics and myofunctional orthodontics had been obvious. The traditional approach to orthodontics usually involved delaying treatment until the developing permanent dentition and creating space through extractions to align the teeth into an arbitrary Class I with permanent retention added at the end.

Conversely, myofunctional orthodontics has always encouraged early screening, diagnosis and treatment of paediatric patients as well as recognising breathing and myofunctional habits as aetiological factors of malocclusion. Myofunctional Research Co. (MRC) CEO Dr Chris Farrell established the modern practice of myofunctional orthodontics in 1989 when he founded MRC on the following principal - mouth breathing and incorrect myofunctional habits are the primary cause of malocclusion and TMJ disorder.

The distinction between the two treatment philosophies was clear for decades and deviation from either faction of the profession looked unlikely. However, recent evidence suggests the gap may be closing and a uniform approach to paediatric orthodontic treatment appears to be forming.

In January 2023, the American Association of Orthodontists (AAO) updated their website to include a page focused on “Child Orthodontics” that encourages orthodontists to screen and diagnose mouth breathing as a sign that the child may need orthodontic care. “Mouth Breathing - Although orthodontists cannot correct mouth breathing, there are orthodontic problems that can develop as a result of the pattern of breathing which can be addressed and corrected by an orthodontist” (Figure 1).1

Figure 1. In January 2023, an American Association of Orthodontists (AAO) website update recognised mouth breathing as a sign that a child may need orthodontic care.1

Figure 2. In August 2024, the American Association of Orthodontists (AAO) altered its position on mouth breathing by recognising that “many orthodontic problems develop as a result of mouth breathing”2 and removing the absolute statement that “orthodontists cannot correct mouth breathing”.1

Although this stance from the AAO is a significant step towards homogenous paediatric treatment philosophies within all divisions of the orthodontic profession, the webpage was updated in August 2024 to include a more vague view on mouth breathing, its effects within orthodontics and whether an orthodontist can correct it. “Mouth Breathing – Many orthodontic problems can develop as a result of mouth breathing. Your child’s orthodontist can address and correct these issues” (Figure 2).2

Figures 3-4. Edward H. Angle (left), author of Treatment of Malocclusion of the Teeth (1907), recognised “of all the various causes of malocclusion, mouth breathing as the most potent, constant and varied in its results”2 and included photographs of mouth breathing children he had observed (right).

Ironically, the Father of Modern Orthodontics, Dr Edward Angle, expressed similar views on the causative factors of malocclusion over 100 years ago. “Of all the various causes of malocclusion, mouth breathing is the most potent, constant and varied in its results”, wrote Angle.3 He also expressed his belief that the positions of the teeth were heavily influenced by “muscular pressure –the tongue acting upon the inside and the lips and cheeks upon the outside, of the arches”.4

This may be a case of modern orthodontics reconnecting with its myofunctional roots and the next step towards unification of paediatric orthodontic treatment philosophies is altering the dogma to recognise that orthodontists can treat the causative factors of malocclusion, such as mouth breathing and acknowledgment of treatment modalities that allow practitioners to achieve these treatment goals.

Backed by over 35 years of research and experience, The Myobrace® System by Myofunctional Research Co. (MRC) is a preventive pre-orthodontic treatment modality that focuses on intercepting a malocclusion before it develops by treating the underlying breathing and myofunctional causes of the issue, which will encourage sufficient jaw growth for the erupting teeth and address breathing disorders that may be affecting sleep.

MRC’s biological approach to paediatric orthodontic treatment of underlying airway and myofunctional issues with appliances that use light intermittent forces also has the benefit of indirectly producing natural tooth alignment with significantly reduced root resorption when compared to conventional orthodontics.5

Although Myobrace® treatment simultaneously works to improve multiple targeted areas of concern throughout the duration of treatment, the four stages of priority are:

• Stage 1. Habit correction - The first stage of Myobrace® treatment focuses on habit correction and involves teaching the patient to breathe through the nose instead of the mouth, retraining the tongue to rest in the maxilla, swallow the right way and maintaining lip seal when not eating or speaking. Focusing on correcting these breathing and myofunctional habits that are causing the malocclusion and poor jaw growth allows the child’s jaws to grow to their full genetic potential and creates sufficient space for the teeth to come in straight.

• Stage 2. Arch development - Along with habit correction, additional arch development may be required to widen the upper jaw to allow sufficient space for the teeth and tongue. Depending on the severity of the underdeveloped jaws, a patient may be recommended arch development techniques such as The Farrell Bent Wire System™ (BWS) to achieve additional arch development during Myobrace® treatment.

• Stage 3. Dental alignment - When the patient is reaching the stage of the last permanent teeth erupting, the Myobrace® for Teens is used and it includes an appliance specifically designed to align the teeth into their natural position.

• Stage 4. Retention - The final stage of Myobrace® treatment is retention and it aims to ensure the corrected breathing and myofunctional habits are maintained, which can often prevent the need to wear a permanent retainer or wire for an extended period. With good compliance and habit correction maintenance, Myobrace® treatment allows for more stable orthodontic results and overall health. The goal of Myobrace® treatment is to obtain natural development of the teeth and jaws, without the need for braces. The Myobrace® System provides practitioners with the flexibility of either intercepting a malocclusion before it develops or offering a better approach to orthodontic treatment altogether by treating the underlying breathing and myofunctional causes of the issue, not just the symptoms. Utilising myofunctional orthodontic treatment modalities like The Myobrace® System is the next step in unifying orthodontics and myofunctional orthodontics into a uniform approach to paediatric orthodontic treatment. The AAO’s recent recommendation of screening and diagnosing causative factors of malocclusion, such as mouth breathing, is a significant step forward for all persuasions of the orthodontic profession.

Figure 5. Treatment using the Myobrace® for Teens series includes multiple stages - Habit Correction, Arch Development, Dental Alignment and Retention.

Figures 6-7. Case Study - Left: This 11-year-old patient presented with crowding, a narrow upper arch, a deep overbite and a large overjet prior to treatment. Right: The patient has significantly improved in all aforementioned areas after 11 months of only Myobrace® treatment encompassing correction of mouth breathing and incorrect tongue and lip function. No fixed retainers required.

Getting started

Practitioners who are interested in learning more about myofunctional orthodontic treatment modalities and are looking to get started can do so by visiting www.myoresearch.com and completing the free online training courses provided by MRC or by contacting one of MRC’s qualified educators through the myoresearch website.

References

1. American Association of Orthodontists (2023), Orthodontics for children: Developing A Healthy Smile. https://aaoinfo.org/child-orthodontics/ (Accessed 8 August 2024).

2. American Association of Orthodontists (2024), Orthodontics for children: Developing A Healthy Smile. https://aaoinfo.org/child-orthodontics/ (Accessed 21 August 2024).

3. Angle, E.H, The Treatment of Malocclusion of the Teeth. 7th Edition. 1907. SS White Dental Manufacturing. Philadelphia p. 111.

4. Angle, E.H, The Treatment of Malocclusion of the Teeth. 7th Edition. 1907. SS White Dental Manufacturing. Philadelphia p. 26.

5. Ozkalayci et al. Effect of continuous versus intermittent orthodontic forces on root resorption: A microcomputed tomography study. Angle Orthod. 2018 Nov; 88(6): 733-739.

The Myobrace® System by MRC is the world’s leading myofunctional orthodontic treatment solution. The system differs from other orthodontic techniques by first treating mouth breathing and aberrant oral habits, followed by arch development, dental alignment, and retention. This approach creates a state of balance within the oral musculature and optimises stability, often without the need for braces.

If you have agreed to purchase a dental practice, what are your key decisions from this point?

How critical initial decision making for about to become practice owners can fall foul of incompetent accounting advice

By Graham Middleton

“Many dentists have made bad decisions at time of practice purchase which resulted in them being substantially worse off by the time of their retirement...”

Many dentists have made bad decisions at time of practice purchase which resulted in them being substantially worse off by the time of their retirement. Some received advice from an accountant who wrongfully claimed to have expertise in providing business advice but had no or few dental clients and who wrongly assumed that all businesses are alike. Dental practices have characteristics which set them apart from the majority of other businesses.

How most tax accountants spend their time

Many accountants spend their days processing last year’s financial statements and are so invested in looking backwards that they are not aligned with the direction of their client’s businesses as opposed to where they have been. Many are unsuited to being business advisers.

DDanny’s practice purchase

anny graduated with the ambition of owning his own practice. Former practice owners pointed out to him that over a career he should be much better off owning a practice rather than working for a corporate. He therefore chose to work in a privately run practice after graduation. His first practice employer did not live up to his expectations but he persevered and eventually found a good match when he contracted to a practice owned by Charlie, a successful dentist, with a strong patient list.

He understood that Charlie expected to practice for about a further five or six years but was aware that older dentists tend to be vague about retirement plans. The practice had three chairs, one operated by Charlie and one allocated to Danny who was replacing a dentist who had bought their own practice. The two part-time assistants, Maxi and Georgie occupied the third surgery plus a spare day in Charlie’s. It was apparent to Danny that the two three-day assistants each had an amount of spare surgery time, but he did not comment.

Charlie made it clear that he was keeping his long-term options open and had dropped a comment that suggested that he might consider selling to a dental corporate. He had long since moved to a productive 4 clinical day week, was considering reducing by another half day and in due course to three clinical days. The practice was located in an established middle-income suburb and was not a preferred provider to health funds.

Winning and maintaining the owner’s confidence

Danny wanted to buy the practice but was not quite ready, being only in his fourth year of practice, nor was Charlie yet ready to contemplate retirement. Danny engaged in a process of personal improvement and was careful to be supportive of Charlie. He knew that a practice owner had the power to consider selling to him at a future date or freeze him out. He was careful to thank the receptionist for her efforts in filling his book, took care to improve his chairside and clinical skills and worked on little improvements in the interactions with his chairside assistant. He set out to build his fee base. He kept a personal tally of his best fee tally per day, per week and per month. Each time he reached a better result, it became his personal goal to better. Over the next two years, he came to be regarded as being the best dentist to work with. He was prepared to stretch to fit in an emergency patient which assisted the receptionist and was able to enlist her support in arranging his patient book to greatest advantage. With the receptionist’s help, he calculated his rate of successful follow up appointments. His personal referrals took time to build, but over a couple of years, were showing a promising trend. At all times he remained respectful of Charlie and discussed professional happenings with him.

Becoming the practice lead dentist

When Charlie went on holidays, Danny was careful to brief him on his return concerning anything eventful with respect to his long-term patients who were referred back to Charlie for follow on treatment. After three years, he had overtaken Charlie as the practice’s leading fee

practice | MANAGEMENT

producer but continued to be deferential to him as principal and to engage in professional discussion with him in spare moments. Charlie became increasingly reliant on him.

Negotiating to buy the practice

As Charlie wound down his clinical time to three days per week with a couple of long holiday breaks during the year, his thoughts focused on whether to dispose of the practice. He had been approached by dental corporates but on testing the sale options, it became apparent that purchasers identified that Danny was the practice lynchpin. Charlie was too old and winding down. They would only buy the practice and pay the higher corporate price if Danny was prepared to sign a long-term contract as lead dentist. Danny produced significantly more fees than the two part-time assistant dentists combined and by now significantly more than Charlie. Danny was patient and careful to be diplomatic but he explained to Charlie that as he wished to buy a practice, he was unwilling to be contracted to a corporate. By doing so, he would give up his chance to buy. Corporates paid premium prices provided that the key dentist(s) were contracted but Charlie, who had reduced to three clinical days plus taking long holiday breaks, was too close to retirement to fulfill their need. Danny explained diplomatically that he would pay a fair price based on a dentistto-dentist sale. He would not pay a price which amounted to a corporate premium for having him as its contracted lead dentist. Charlie took time to consider his position but observed that Danny had become the lynch pin on which the practice depended. Danny hid his frustration and remained friendly to Charlie. After consulting his advisers and much thought, Charlie realized that he had forfeited the option of a corporate sale as he had aged and reduced his clinical availability. Danny was patient and eventually his fair offer was accepted. Charlie agreed to work for him on a further reducing time basis of two days per week as he moved toward retirement. They agreed not to make an announcement about the sale but to simply further reduce Charlie’s appointments with the receptionist gently redistributing his excess patients.

What did financials and practice records tell Danny?

The financials revealed that Charlie’s proportion of advanced treatments was in decline and his average patient fee was declining. He had backed away from some advance treatments so there was potentially significantly more advanced treatment that could be offered his patients. They also revealed that neither of the two part-time assistant dentists were working more than a realistic two full day patient load with both enjoying “lifestyle” working conditions with comfortable gaps between appointments. Their early finishes were encouraged by their chairside assistants. They had too few follow-up appointments and compared to Danny, too few patient referrals. They were using more practice resources per dollar of fees produced than was Danny. Danny identified the obvious economy to be achieved.

Review of fees

Danny wanted to upgrade the appearance of the practice and needed to estimate whether improved output could pay for the improvements. He selected a significant sample of Charlie and the two assistant dentist’s patients and Google searched the estimated value of their homes giving him a guide as to the dentistry that they could afford. He planned to adjust practice fees by affordable amounts and take steps to identify shortcomings in patient treatment plans. He would ensure that they were provided with better treatment alternatives. He indicated to staff that the fee adjustments would pay for practice improvements.

Initial business structureSpouse as co-purchaser!

D anny’s wife Suzi was an allied health professional but had reduced her clinical hours to look after their two young children. She was prepared to deal with practice administration but with minimal physical presence within the practice. She quickly became competent at dealing with dental suppliers, tradespeople and made a point of regularly asking the receptionist for advice. Both she and Danny recognized that a spouse involvement in the practice needed to be kept low key with respect to staff.

Danny’s dental study group network was able to introduce them to a bookkeeper who would visit the practice on a fortnightly cycle, updating financial records, arranging staff pay and presenting Danny with a list of bill payments for his approval. They dismissed recommendations about engaging a full-time practice manager as being likely to absorb profit rather than create it.

Danny had searched for an accountant but was disillusioned by several. He had evaluated them by asking questions relevant to dental practice operation and structure to which he already knew the answers. Several flunked his test. He settled on the principal of a relatively small practice who had several dental clients and was across most dental issues.

He asked several successful dentists about their business structure and sourced the practice management articles in Australasian Dental Practice. He decided to buy the practice goodwill in partnership with Suzi and then license the operation of the practice to a company thereby keeping goodwill ownership outside of the company. This was critical to dealing with their future capital gains tax outcomes on retirement sale. The fact that the practice had several other dentists contracted to it enabled Suzi to participate in its ownership and profit sharing.

Why Danny chose not to own the practice via a trust

Danny had learned that a trust must distribute all of its income in the year it was earned but a company with multiple clinical staff could retain part of its income.

In order to not be levied with charges for borrowing from the company, they planned to pay franked dividends at the beginning of each July, once they had begun paying company tax, to eradicate prior years drawings but an excess of profit could be held in the company. There was a timing issue involved. Danny had worked as a contractor to Charlie for 7 months of the financial year and had therefore booked significant taxable income for the year. Once purchased, their company accumulated profit for the 5 months to 30 June, their accountant completed the company return quickly and had company tax assessed. They were now in a position to pay the initial franked dividend and for the company to pay tax instalments.

Superannuation was paid privately and deducted on their individual tax returns.

Premises rent and buy agreement. Increased home loan repayments with interest only business loan

Danny and Suzi had purchased a home in his fourth year as a dentist and had increased their mortgage repayments to build home equity. Their significantly increasing home equity allied with the fact that they were purchasing a practice with a good income stream in which Danny was already the leading dentist meant that they were able to secure finance. They asked for an interest only business loan on the basis that they would continue accelerated

Taking over the practice

Danny advised Maxie and Georgie that he was tightening up their roster to make more economical use of chairside staff. They would be expected to work effectively with tighter patient schedules meaning that their existing workload could be accommodated in two clinical days each. They would still earn as much and indeed more because he was about to adjust fees. Maxie accepted the new working arrangement but Georgie departed to work in a “lifestyle” practice.

“A trust must distribute all of its income in the year it was earned but a company with multiple clinical staff can retain part of its income...”

Danny was now able to employ another full-time dentist. He had heard of a competent dentist who was disenchanted with his current employer, Henry Speed, known to friends as “Speedy”. Speedy was able to take up the patient list vacated by Georgie as well as those shed by Charlie as he reduced his clinical presence. He had an engaging manner and looked for opportunity to offer patients better treatment alternatives. The chairside assistants were now busy and the practice significantly more profitable than it had been under Charlie’s ownership.

Danny and Suzy were able to persuade the bank to lend them sufficient money to pay for an immediate refreshing of the décor of the practice, particularly the waiting room and the three surgeries and toilets. There was an agreeable response from long term patients and a noticeable lift in patient referrals. They kept the practice website simple, advising new patients of practice dentists, location, on-site parking and how to make appointments.

home loan repayments. The bank was initially only prepared to keep the business loan interest only for an initial three years but would change position as their practice profits increased and it became keen to finance the purchase of premises. Banks make their profits by lending to profitable customers. Danny indicated their plans to buy the premises after some shortcomings in the practice had been rectified. The bank viewed them as customers with a great deal of future financing potential.

The premises were leased from Charlie on an initial four-year lease with two further lease extension options and with a right to purchase within four years. The practice purchase contract and the premises lease with purchase option were signed simultaneously with each dependent on the other.

Note: Countless dental financials examined by the author have indicated that refreshing practice presentation achieves better results than large sums spent on marketing consultants. Where new client’s financials have indicated large expenditure on advertising/marketing they have been asked to confirm what proportion of new patients have come as a result of personal referral by existing patients. The results indicated that most dental marketing spending is wasted. Overwhelmingly, established practices get the vast majority of new patients by personal referral by patients of friends, work colleagues and family.

Charlie was still present working two clinical days but patients requiring advanced treatment plans were internally referred to either Danny (4.5 clinical

days) or to Speedy who was working four busy days. Maxie was working two busy days but had been advised by Danny that if he passed expected production goals, he could increase back to 2.5 days.

The practice was significantly busier than at the time of change of ownership and coupled with modest fee adjustments as well as providing patients with greater treatment options, the practice gross fees and profits were up 20 percent over the first year of new ownership.

They have no intention of adding a fourth surgery since a three-chair practice is considered optimum for a single dental owner operator. It is intended that they bring on another dentist when Charlie finally retires when there will be an availability of surgeries for four days per week. The likely surgery usage will then be Danny 4.5 days, Speedy 4 days, Maxie 2.5 days and new dentist 4 days.

The future.

Danny and Suzi will make important decisions to purchase the premises and to upgrade their home. Their premises will be purchased in partnership for simplicity. They will negotiate to pay down their home loan at an accelerated rate providing that the bank agrees to the premises loan being kept on an interest only basis like their practice goodwill loan.

They will avoid being talked into making their premises purchase inside a superannuation fund with more expensive limited recourse borrowings and longterm complications.

Superannuation will likely form a cornerstone of their long-term plan. They may start a self-managed superannuation fund once they have a realistic amount of joint superannuation balances (say $400,000 plus) and importantly the ability to make reliable ongoing substantial contributions.

Financial Planning advice; Is it worth the expense?

Danny and Suzi’s cornerstone investments are their home, their practice, in due course their practice premises and their superannuation fund. Providing that they stick to the fundamentals, they can forego having a financial planner since so much of their emerging wealth will be related to their upgraded home, practice

and premises. Few financial planners are able to advise them on practice decisions which is where they hope to generate most of their wealth.

If they stick to top Australian dividend paying stocks plus an international shares exchange traded fund with a low management expense ratio such as the S&P 500 ETF, code IVV invested in the top 500 shares listed on the New York Stock Exchange and NASDAQ many of which are globally significant stocks, they are likely to do no worse than following the recommendations of a financial planner and save on significant expense. Over long periods, the ASX 200 index has outperformed interest bearing securities. Financial markets fluctuate and long-term investing is necessary to achieve market

“They will avoid being talked into making their premises purchase inside a superannuation fund with more expensive limited recourse borrowings and long-term. complications...”

returns. A heavy weighting of shares is more suitable for younger investors with many years to likely retirement. Investors need to study the financials of companies of interest to them. A good start is to comb the ASX 200 for stocks which have proved to be long term performers then check their annual and half yearly reports dividend payments and extent of franking of dividends.

There is no easy substitute for careful personal research.

This article should be read in conjunction with two previous articles on buying and selling dental practices, part one and part two, in the last two editions of Australasian Dental Practice. Readers wishing to dig deeper should purchase my book “Financial Success for Dentists” by making the

appropriate donation to the charity I support, see below. You can also visit grahammiddleton.com and read dental articles on a variety of subjects relevant to dentists.

General Advice Warning

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

About the Author

Graham Middleton disposed of his interest in Synstrat group on 30 June 2020 and won’t be starting another business; he spent the later 33 years of his working life advising health professionals on business and financial matters. Dentists were the most numerous of his clients. He is the author of the recently published Financial Success for Dentists.

Dentists may obtain a copy by making a donation of minimum $60 to the Delany Foundation a registered charity which assists schools in Ghana, Kenya and Papua New Guinea then email Graham at graham. george.middleton@ gmail.com. A copy will be sent to you. All proceeds go to the Delany Foundation for its good work. Graham has paid for the printing and mail costs personally.

Unearth the hidden treasures in your dental practice: The parable of acres of diamonds

By Julie Parker

In the heart of Africa, there lived a farmer who dreamt of becoming an overnight millionaire. Tales of fellow farmers striking it rich by discovering diamond mines had ignited a spark of hope within him. With visions of wealth and success, he sold his cherished farm, filled with fertile soil and endless potential, to embark on a quest for diamonds.

However, destiny had other plans for him. The farmer’s relentless pursuit of these elusive diamonds led him on a lifelong journey across the vast African continent, only to end in despair and tragedy.

Consumed by frustration and sorrow, he tragically drowned himself in a river.

Unbeknownst to him, the new owner of his farm stumbled upon a radiant glimmer at the bottom of a stream on the property. He retrieved a dazzling stone that he placed on his mantel as an ornament. Little did he know that he held in his hands one of the largest diamonds ever discovered.

This story beautifully illustrates a profound lesson—often, we overlook the incredible riches that lie hidden right beneath our feet. As dental practice owners and team members, you possess “Acres of Diamonds” within your reach. Instead of ceaselessly searching for new patients and pouring resources into advertising, take a moment to reflect on your OWN “acres of diamonds”.

I consider there are three main layers of these “diamonds”.

The patient in the chair

The patient in the chair represents your most valuable asset. Are you conducting comprehensive examinations and offering personalised care to help patients understand and be aware of their oral health, or are you unintentionally observing a decline in their oral well-being during their visits? Review the following checklist for a comprehensive dental examination and assess if there are any additional elements that could be included in the assessment of your patients:

1. Medical and dental history; 2. Chief complaint; 3. Visual inspection; 4. Intraoral examination; 5. Periodontal assessment; 6. Dental charting; 7. X-rays; 8. Occlusion; 9. Oral cancer screening; 10. TMJ and jaw function; 11. Salivary gland evaluation; 12. Soft tissue examination; 13. Functional analysis; 14. Comprehensive treatment plan; 15. Oral hygiene and home care; 16. Airway assessment; 17. Evaluation for sleep-related issues; 18. Cosmetic/aesthetic assessment; 19. Assessment of the condition of existing dental restorations; and 20. Diet considerations.

Existing active patient base

Your active patients are the foundation upon which your practice can prosper. Are you nurturing this group effectively? Ensure that recalls and incomplete treatments are managed well. By doing so, you can maximise the value of your existing patients and maintain their loyalty. Here are elements of proper management for existing active patients:

1. Recall strategy

Assess the current recall strategy’s success rate in bringing patients back for check-ups. As a team, brainstorm ideas that can help you achieve stronger results.

2. Treatment plan acceptance

Identify each practitioner’s treatment plan acceptance rate. Analyse if there are areas for improvement in patient engagement and communication. Consider role-playing exercises with team members to practice presenting treatment plans effectively and addressing patient concerns.

3. Managing incomplete treatment

Explore ways to improve patient communication and follow-up, ensuring patients understand the importance of completing recommended treatment.

4. Patient nurturing

Create a patient nurturing program to maintain a strong patient-practice relationship. Consider sending regular newsletters with dental tips, practice updates and educational content. Send anniversary cards to celebrate patient loyalty and acknowledge milestones. Send birthday cards to show appreciation and personalise the patient experience. Patient surveys are also a powerful way to ensure patients realise that their satisfaction is important.

5. Education

Teach patients how to describe your practice within their own connections, to increase the chances of referrals. Most patients have little idea on how to uniquely share what is special about your practice.

Inactive patient base

Often forgotten, the inactive patient base holds significant untapped potential in established practices. Develop systems to re-engage them, offering compelling reasons to return and become active patients again. A simple, thoughtful outreach can transform these deeply hidden diamonds into valuable assets. Here are actions your practice can take:

1. Reactivation project

C reate a reactivation project targeting inactive patients who haven’t visited the practice in a specified period.

2. Share your news

Share practice news and improvements, emphasising any issues that may have been resolved (e.g., team member concerns or appointment flexibility).

3. Offer incentives

Offer incentives or promotions to entice return, such as discounts or bonuses on dental services or free oral health screenings for returning patients.

Oral health education

Remind inactive patients of the importance of maintaining good oral health and its impact on overall well-being.

5. Share educational content

hare educational newsletters and content that highlights the significance of regular dental check-ups. Include pictures of new team members, interesting aspects of their lives and in particular, their pets!

6. Information seminars

Host information sessions or webinars on various dental topics. Invite inactive patients to attend, providing an opportunity for them to reconnect.

7. Feedback survey

S end a feedback survey to inactive patients to understand the reasons for their absence. Ask for their input on what would encourage them to return. Use survey responses to address specific concerns and enhance the patient experience.

8. Generate referrals

Ask this group to consider referring your practice within their networks and connections.

The parable of Acres of Diamonds serves as a powerful reminder to practice owners and team members. In your relentless pursuit of success, don’t overlook the wealth that already surrounds you. Your practice is teeming with untapped potential. By focusing on comprehensive care, patient retention and re-engagement strategies, you can unlock the true riches of your practice without the need for endless searching and external investments. Your Acres of Diamonds are right where you are, just waiting to be unearthed.

About the author

Julie Parker is a Dental Practice Management Consultant and Team Educator. At the age of 33, Julie became the first non-dentist to own a dental practice in Australia. Julie is Co-Founder of Julie Parker Practice Success and CoFounder of Dental Business Mastery. Visit julieparkerpracticesuccess.com.au and dentalbusinessmastery.com.au to find how Julie can help your dental practice be more successful. You will find information about consulting programs, online courses, podcasts, free downloads and more.

I’d like the staff without the entitlements

By Simon Palmer and Harry Nicolaidis

When purchasers put forward offers to buy a practice, they will sometimes make a request along the lines of the following with their offer:

“At completion of the sale, I’d like the Vendor to terminate all of the staff contracts and pay out all of their employee entitlements, so that I may hire them ‘clean’.”

Is it legally possible to structure a deal like this?

To answer this question, we need to break down what is being requested here into smaller questions.

1. What happens to employees upon the sale of a business?

Abusiness sale usually doesn’t involve a buyer buying the ABN of the seller.

Usually (to reduce potential liability), a buyer will actually start a new ABN and buy the assets of the old business.

If the purchaser wants to keep the employees in the business post sale, the vendor actually needs to terminate their employment with the previous ABN and then the purchaser needs to offer them employment in the new ABN.

For this reason, when a business owner is thinking of selling their business, they need to keep in mind that there may be legislated “termination” notice periods that need to be given to the employees.

Generally speaking, for the vendor to avoid paying out redundancy payments to the terminating employees, the purchaser must offer employment to the employees on terms that must be “substantially similar to and overall no less favourable” than the terms of employment with the vendor.

2. How are leave entitlements

“usually” dealt with upon the sale of a business?

The standard position under most industry business sale contracts is that the purchaser takes on and recognises the accrued entitlements of those employees which it hires from the date of completion of the business sale. So, if a transferring employee has accrued 30 hours of annual leave with the Vendor, the Purchaser must recognise that leave entitlement when the employee starts working for the Purchaser. In exchange for recognising this leave, the seller needs to provide some financial compensation to the buyer. The way this adjustment is generally dealt with is slightly different for each category of leave entitlement (annual leave, personal/ carer’s leave, long-service leave, etc).

In exchange for recognising annual leave and long-service leave, the business sale contract usually provides that the vendor reduces the price paid for the business by an amount commensurate to the value of the leave entitlements transferred.

The financial adjustment that occurs for recognising personal/carer’s leave has much more variance in the industry norm and negotiation, depending upon the state that you are in, the size of the liability and

the perceived stability of the employee. If the employees are not offered employment by the purchaser or do not accept the purchaser’s offer of employment, the vendor will need to pay out their

7 September 14 September

annual and long service leave entitlements (but not personal carer’s leave).

3. What happens if the purchaser wants to hire the employees “clean”, without any entitlements (as per the premise for this article)?

This is possible for some of the employee entitlements and not for others.

It is an option and possibility for the annual leave and long service leave to be paid out and the employee to be hired “clean”, with respect to these entitlements. However, it is not an option for personal/

carer’s leave, parental leave and long service leave below the pro-rata payment threshold (usually 5 or 7-years’ service, depending on the state). These entitlements cannot be paid out and the purchaser will have to recognise the employees’ previous service with the vendor, if the purchaser wants to keep them on.

About the authors

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 Simon Palmer at info@practicesalesearch.com.au or call 1300-282-042.

This is a challenge in many practices. How to fix it post-haste

By Jayne Bandy

Lately there has been a lot of chat about what to do when multiple phone calls are coming into a dental office. Ultimately the goal is to answer and offer solutions to all of our callers but in a busy practice this can be a challenge.

The best solution is...

“If you haven’t got enough people to answer the calls coming into your business then you need more people.”

Iknow it does seem like a sensible and straight forward solution to what is a problem for many.

Is this a problem in your business?

When you start tracking the calls coming into your office, you soon work out how your team are handling the volume of calls.

The next step

The next step is to see how many callers are placed on hold and how the calls are being answered.

Are these calls being managed well?

Are the calls being answered by the second or third ring?

Does the person answering the calls have enough time for each caller, or are they being rushed?

Does the person answering your calls know how to handle multiple calls?

I have noticed that the skill of handling multiple calls coming into a dental office is a challenge for many people.

Answering multiple calls is not the easiest thing to do, especially if no one has shown you how.

As soon as you have multiple lines, at some point in the day more than one or two lines will ring at the same time.

I know that is a good thing. You do want this to happen. It means that your dental office is in demand.

Placing someone on hold is all about the timing.

You need to ask yourself this question: “How long will I be on the other line?”

Never pick up the second call and immediately tell the caller you are placing them on hold.

“Thank you for calling Active Dental. This is Julie. Please hold.”

Think about those times when this has happened to you on the phone.

You must know where you are up to on each call.

If a second call comes in and you have just started speaking to the first caller then you need to ask the second caller’s name, explain you are on another call and ask permission to call them back with a time frame for the call.

Keep in mind that there is a risk when you call a person back that they may have gone ahead and made another appointment at another dental office while they waited for you to call back, so never delay the return call.

When you pick up a second call always ask permission from the first caller if you can place them on hold for a moment.

You feel unimportant and you have no idea how long you will be on hold.

You now run the risk that the person on hold will hang up.

The rule...

Make it a rule never to do this! I listen to many callers while they are on hold and hear them say out loud how annoyed they are, having to wait so long.

Always ask the caller’s name and explain you are on another call and do they mind being on hold for a moment.

The other rule is to make sure you have something for your on-hold caller to listen to while they wait for you.

practice | MANAGEMENT

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.

3. Prevent ongoing losses from appointment cancellations. Visit the website to find out how to get started. It’s that easy! www.calltrackingexcellence.com

Many offices have music. The problem with music is it will not be music to the ears of everyone listening. If a caller does not like your choice of music, it can be irritating to the caller and inevitably, they hang up the phone before you get to them.

A better choice

Abetter choice than music is recorded information about your practice and how you help your patients. The message should be all about the caller and the patient experience they will expect at your practice.

A great message can even start the person on hold thinking about something they hadn’t even considered.

So have a good look at how your phones are answered and how the caller is placed on hold.

Most dental practices I speak with have no idea what their caller’s listen to when they are placed on hold.

I always recommend that you call your own office and be placed on hold so you can listen to what the caller is listening to. See what you think. If it’s awful, then change it straight away!

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

About the author

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

SAFety FirSt

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

How safe are your investments?

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

Interactive content: The secret to transforming your marketing

By Angus Pryor, MBA (Marketing)

Chances are, you’ve probably heard of interactive content. Well, it’s not just a buzzword—it’s a powerful tool that can transform your engagement rates, user experience, and social sharing. Here’s how you can make the most of it in your marketing strategy.

IWhy interactive content rocks

nteractive content is a total game-changer for marketers. It boosts engagement, improves user experience, and increases social sharing by inviting participation and making complex information enjoyable. Plus, it gives you valuable insights into your audience’s preferences and behaviours. Pretty cool, right?

marketing | INSIGHTS

Steps to effectively utilise interactive content in marketing

1. Define your goals

First things first—what do you want to achieve with your marketing efforts? Are you aiming to increase user engagement, collect data, or boost social sharing? Knowing your goals will shape the type of interactive content you create and how you measure its success.

2. Understand your audience

Next up, get to know your audience. Dive into your existing data to understand their interests and preferences. Tailor your interactive content to meet their needs. For instance, if your audience loves visual aids, think about creating interactive infographics that simplify your marketing messages.

3. Choose the right tools

Two of the best tools for creating engaging interactive content for your marketing campaigns are Typeform and Outgrow. Typeform is perfect for making beautiful, user-friendly polls, quizzes, and surveys. Its conversational style makes users feel more connected and engaged, making it great for gathering marketing insights.

On the other hand, Outgrow is ideal for a wide range of interactive content, including calculators, quizzes, and chatbots. Outgrow’s analytics provide deep insights into user interactions, helping you optimise your marketing strategy effectively.

4. Create compelling content

Time to get creative! Use your chosen tools to design interactive content that aligns with your brand voice and marketing goals. Consider creating quick and easy polls to gauge audience opinions on various topics related to your products or services. Fun and engaging quizzes can educate your audience about your offerings while collecting valuable data. Additionally, visually appealing interactive infographics can simplify complex information about your industry or products, keeping users engaged and informed.

5. Promote your content

Your awesome content is ready— now it’s time to share it. Promote it across your marketing channels by embedding interactive polls or quizzes on your homepage or blog to increase visitor engagement. Share interactive infographics or quiz links on social

rience, and gather valuable insights in your marketing efforts. By defining your goals, understanding your audience, choosing the right tools, creating compelling content, promoting it effectively, and analysing its performance, you’ll be well on your way to transforming your marketing strategy.

media to encourage participation and drive traffic to your site. Additionally, include engaging surveys or polls in your email campaigns to boost open and clickthrough rates.

6. Analyse and optimise

After launching your interactive content, keep an eye on its performance using the analytics tools provided. Track key metrics like engagement rates, completion rates, and data collected. Use these insights to refine your marketing strategy and improve future interactive content. Interactive content is a fantastic way to boost engagement, enhance user expe-

About the author

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

dentevents presents...

Infection Control BOOT CAMP

29 VIDEOS - 8+ HOURS OF EDUCATION

Presented by Emeritus Professor Laurence Walsh AO BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FFDT (RCS Edin)

Learn from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control including from the Dental Board of Australia (July 2022), the ADA (4th edition guidelines August 2021 and the ADA Risk management principles for dentistry during the COVID-19 pandemic (October 2021)), the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course provides a summary of how those changes interlink with one another and also covers practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening.

COURSE TOPICS

This one day course will cover changes in regulations and guidelines from 2018 to 2022 including:

n Risk-based precautions.

n Hand hygiene and hand care practices.

n Addressing common errors in personal protective equipment.

n Biofilm reduction strategies.

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

n Correct operation of mechanical cleaners and steam sterilisers.

n Wrapping and batch control identification.

n Requirements for record keeping for instrument reprocessing.

n Correct use of chemical and biological indicators.

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

REGISTRATION

n On-Demand access to 29 Online Learning Videos (Over 8 hours of education).

n Watch and re-watch at your leisure 24/7

n Digital Online Learning Companion.

n Digital Suggested Reading Material.

n Online Questionnaire to earn 8 Hours of CPD.

The relevance of endotoxin in instrument reprocessing - An odyssey

By Emeritus Professor Laurence J. Walsh AO

Clinicians need to have a working knowledge of endotoxin in order to assess its impact on their clinic practice and ensure that the methods used for reprocessing instruments ensure positive clinical outcomes. Endotoxin (ET) is also known as lipopolysaccharide (LPS) and is composed of lipid A, the core polysaccharide and the O-antigen polysaccharide. This article provides an overview of the key issues to inform how risks from endotoxin are assessed.

The famous ancient epic Greek poem the Odyssey is a suitable model for the discussion since

it captures the sense of journey and wandering. A relevant example of this wandering is endotoxin (ET) being displaced off the surface of surgical instruments and then causing local inflammation and in a worst-case scenario, adverse systemic effects such as fever.

Where ET comes from

ET is a fundamental component of the cell wall of Gram-negative bacteria.1 Because of the widespread presence of such bacteria in water, soil and other environments, there are well-developed mechanisms for tolerating ET in drinking water and on foods.2 The human body contains considerable

amounts of ET within the gastrointestinal tract because of the large load of both viable and non-viable Gram-negative bacteria found in the gut. This high local concentration of ET explains why the allowed limits for final rinsing of medical endoscopes in an automated endoscope reprocessor (AER) in ISO 15883 Part 4 and in AS 5369:2023 are set at 3 ng/mL (30 endotoxin units (EU)/mL). By way of context, this level is approximately 3-fold higher than the normal range found in reticulated water.

This raises the interesting issue of dental instruments that are being used for non-surgical procedures in the oral cavity, an environment where there are, like the gut, large numbers of Gram-negative bacteria and the ubiquitous presence of ET. This means that the level of ET on instruments is insignificant from an exposure perspective compared to ET already present in the mouth.

Endotoxins in the oral cavity

ET derived from oral bacteria is far more potent than its counterpart found on bacteria from the gut, even within the same genus of bacteria (e.g. Fusobacteria). One of my studies in the late 1980s documented this unusually high potency of ET from oral bacteria versus gut bacteria, in terms of the ability to stimulate the production of inflammatory cytokines such as interleukin-1.3

ET from oral bacteria plays a significant role in maintaining the chronicity of gingivitis insights where mature plaque biofilms are present. ET stimulates local immune cells and drives the expression of markers such as Class II major histocompatibility complex antigens and adhesion molecules, which increase the functionality of immune cells and stimulate their trafficking through the gingival tissues, respectively.4-7 ET is a major driver of local inflammatory responses to periodontal bacteria, especially when they have been killed, since this releases large amounts of ET into the local environment.8 Most individuals produce antibodies to the ET released by periodontal pathogens.9

Systemic effects of endotoxin

One of the largest concerns with ET is when it gains access to the systemic circulation. This can occur in certain med-

infection | CONTROL

ical procedures, as shown by case reports of ET on medical devices causing issues. Each of these medical contexts has significant differences from dental procedures:

• Joint (hip/knee) replacement surgeryvery large instruments and devices are used, which can carry large amounts on their surface. Prolonged procedure;

• Interventional cardiology proceduresdevices are located within the circulation;

• Renal dialysis - there is prolonged contact (over hours) with the circulation; and

• Cataract surgery - the extremely small volume of the anterior chamber of the eye and compromised local defences make inflammation very problematic.

in animal models of inflammation. 11,12 This is why, around the world, pharmaceutical manufacturers are required to produce medicines, sterile saline and sterile distilled water that have very low levels of ET (below 0.25 EU/mL) (Table 1).

Impact of ET on instrument surfaces

The classic paper on how much endotoxin dose is needed for specific adverse effects is a 2002 review by Anderson et al.13 It defines the “No Observed Effect Level” (NOEL), which

Table 1. Key reference standards for endotoxin

WHO Decontamination and reprocessing of medical devices for health-care facilities 2016.

Washer-disinfectors: ISO 15883-1:2018 for WDs - Water for the preparation of sterilization and disinfection products - Part 1: Quality of water. An ET limit of 0.25 EU/ mL in ISO 15883, for medical devices that are intended to come into contact with the bloodstream or other normally sterile areas of the body. Also found in the UK Health Technical Memorandum 01-01: Management and decontamination of surgical instruments (medical devices) used in acute care Part D: Washer-disinfectors.

Automated endoscope reprocessors: 30 EU/mL in in AS 5359:2023. Also in UK HTM 01-06 Part B.

Intravenous fluids (including medicines): 0.25 EU/mL. TGA Medical Device Standards Order (Endotoxin Requirements for Medical Devices) 2018. Also in the US, UK and other pharmacopeias for pharmaceutical requirements, and in the European Union Guidelines to Good Manufacturing Practice (EU Guidelines to GMP) 2021.

Final rinse water: 10 EU/mL in USA AAMI TIR 34:2014; Replaced in 2023 by ANSI/ AAMI ST108:2023 - Water for the Processing of Medical Devices. ANSI/AAMI ST108 is designed for all healthcare facilities in the United States, including hospitals, clinics, ambulatory surgery centers, endoscopy centers, and offsite reprocessing facilities.

Most stringent final rinsing water: 0.25 EU/mL (25 pg/mL) in AS 5359:2023.

Exposure to ET can also occur when patients receive intravenous medicines or intravenous biological agents and when they undergo treatments that are extra-corporeal, where blood is taken from the body and then returned to it (e.g. extracorporeal photochemotherapy and harvesting haematopoietic stem cells for transplantation. 10 Likewise, it is a major issue with recombinant cytokines and biological agents. Many of these are prepared using coliform bacteria such as E. coli and so considerable effort must be put into removing ET contaminants. I had to deal with similar issues when I was isolating and purifying cytokine antagonists and using these for intravenous therapy

is the threshold level below which ET elicits no adverse health effects, such as fever. The NOEL concept has been used widely in ET research and informs national requirements, such as the 2018 TGA Medical Device Standards Order (Endotoxin Requirements for Medical Devices).14 This sets the exposure limit at 2 ng per device, or for fluids, at 0.25 EU/ mL. An amount of 2 ng per person in contact with the bloodstream will cause fever. This limit of 2 ng per device is also the limit used in the USA by the Center for Devices and Radiological Health (CDRH) for products that directly or indirectly contact the cardiovascular system and lymphatic system (Table 1).15

infection | CONTROL

The US Centers for Disease Control and Prevention (CDC) Guideline for Disinfection and Sterilization in Healthcare Facilities 2008, which was last updated in 2019, makes the point that “Users of ultrasonic cleaners should be aware that the cleaning fluid could result in endotoxin contamination of surgical instruments, which could cause severe inflammatory reactions”.

In Appendix A.7.2.3.1 of AS 5369:2023, a risk-based approach has been taken in terms of the maximum endotoxin levels for final rinse water that are given in Table 7.2 for surgical instruments that are used in sterile body cavities. This was designed to cover the highest possible medical settings where the risks of ET contamination are well-known, namely orthopaedic surgery, interventional cardiology, renal dialysis, ophthalmic surgery and so on. These same informative appendix also discuss how for untreated reticulated tap water the facility should undertake risk assessment on the issue of water quality. That same risk assessment should also guide decisions around the frequency of monitoring of ET levels in water.

A key point in this informative appendix is that the standard discusses how a particular clinic should conduct a risk assessment to determine whether tap water as supplied is of suitable quality, based on the findings of the local risk assessment. When undertaking that risk assessment, each clinic must consider that the context of the threshold level given in Table 7.2 refers to instruments that are used in sterile body cavities and is based on high-risk medical settings. The mouth is not a sterile body cavity and the standard does not give any advice regarding rinse water for non-surgical instruments that would be used in dental practice. It is also important to note that surgical instruments used in dentistry are not dosing endotoxin continuously into a patient’s circulation over prolonged periods of time.

Practical considerations

For items that have been through the ultrasonic cleaner, thorough rinsing with tap water is required to remove traces of the ultrasonic cleaning fluid, prior to a brief final rinse. For surgical instruments, the purpose of that brief final rinse is to ensure that the traces of water

that remain on the item are relatively free of contaminants, such as ET and viable bacteria. Hence, as those instruments then dry off before being packaged, as the water evaporates very little, ET dries onto the instrument surfaces. Any ET which remains on the surface will remain biologically active after normal steam sterilisation, because of the heat resistant nature of ET.

For the length of final rinsing (which will be in seconds), the first place to go

Some clinics that do large amounts of implant placement, sinus lifts, third molar removal and other invasive surgical procedures where bone is accessed and mucoperiosteal flaps are raised have tackled the issue of ET in rinse water by performing the final rinse using water from a reverse osmosis (RO) system. As an example, a typical small RO system is the Melag MELAdem 47. This produces around 3-5 litres of treated water (permeate) per hour. This rate varies because

Table 2. Endotoxin exposure limits

In fluids (e.g. medicines, saline) given intravenously...

• 2 ng (20 EU) per adult intravenously (20 EU)

• 25 pg/mL (0.25 EU/mL) for infusions

• 0.5 ng (5 EU) per kg of body weight per hour or 10 ng (100 EU) per m2 of body surface area per hour

Ingested from water or food...

• Greater than 500-4500 mg/kg body weight

Implantable medical devices...

• 2 ng (20 EU) per device

On instruments...

• 2 ng (20 EU) per device

Intraperitoneal administration...

• Lethal dose (LD50) is 27 mg/kg body weight

Inhaled...

• 500 ng per exposure (e.g. during a shower)

• 1 ng/m3 of air for gradual onset of fever

• 9 ng/m3 of air for rapid onset asthmatic effects

Based on refs 13, 16 and 17

is always the manufacturer’s instructions. It will vary depending on the complexity, size and shape of the item and whether or not items are in cassettes, etc.

The volume of rinse water that remains on dental instruments is very small due to the small size of the instruments. Careful measurements reveal that 50-150 microlitres is the applicable range. At typical tap water ET levels, on a single instrument, this would not give the threshold amount to meet the NOEL threshold (2 ng per instrument) (Table 2). This is why local risk assessments need to consider factors that modulate the risk, such as the number of instruments used in sterile sites and the duration of surgical procedures.

of 1) the local mains water pressure - which must be 2-6 bars; 2) the water temperature – (less output when the climate is very cold); and 3) the life of the mixed-bed resin cartridge and other cartridges. It has a maximum storage of 10.5 litres of treated water (permeate) in a pressurised tank. The RO process runs until the pressure tank is full and then it shuts off. This system has a production efficiency of 20-25%, so for each 1 litre of permeate produced, around 4 litres of waste water will be sent down the drain. The RO system pressure tank then connects to steam sterilisers and to an outlet tap via 6 mm hoses. In this case, the water outlet pressure is 4 bar, which is more than sufficient for the short final rinse.

A further key point is that surgical cutting instruments which are reused will pose the greatest risk. Bone cutting burs can be identified as posing a particularly high risk of transferring material. Using single use burs eliminates the possibility of such transfer events occurring, whilst at the same time ensuring optimal cutting performance and minimal thermal injury to the bone. A similar logic can be applied to situations such as pulpotomy, where there are methods that involve

“Surgical cutting instruments which are reused will pose the greatest risk. Bone cutting burs can be identified as posing a particularly high risk of transferring material. Using single use burs eliminates the possibility of such transfer events occurring, whilst at the same time ensuring optimal cutting performance and minimal thermal injury to the bone. A similar logic can be applied to situations such as pulpotomy, where there are methods that involve single use burs and single use laser tips...”

single use burs and single use laser tips. Alternatively, multi-use implant burs and other higher risk items could have their final rinse undertaken with purchased sterile water.

Measuring levels of ET in water

The Limulus Amebocyte Lysate (LAL) assay is the most widely used technology for measuring ET in water. The assay involves an enzyme cascade that is triggered in response to endotoxin. Different versions of the LAL assay exist, including the traditional gel clot form as well as assays where the readout is based

on turbidity or colour change. There are also alternative methods or variants of the LAL testing technology that use recombinant proteins in bio assays, as well as technologies for electrochemical measurement. There are also miniaturised versions of the test technology which suit on-site measurement using handheld devices, with a read-out time of around 15 minutes. The most widely used device of this type is the Endosafe® nexgen-PTS™, which is a hand-held spectrophotometer

were typically 10 to 12.5 ng/mL (100 to 125 EU/mL). In Australian studies conducted by Dr Joanne O’Toole from the Monash University School of Public Health and Preventive Medicine and the Cooperative Research Centre for Water Quality and Treatment, similar levels were reported, up to 12 ng/mL (120 EU/mL).

Based on these results, a typical level of 10 ng/mL could be expected in most parts of Australia.

with specialised single use cartridges into which the sample is introduced for on-site measurement. AS 5369:2023 discusses commercial laboratory testing of water samples and mentions that such laboratories would be accredited, e.g. by the National Association of Testing Authorities (NATA) and/or to meet international standards for testing laboratories, namely AS ISO/IEC 17025.

Natural variations

Reported levels of ET in municipal tap water vary by season and by location. For the USA east coast, tap water ET levels in the Anderson et al. review, 13

A cold water tap has a typical flow rate of 100 mL/second, which means that approximately 1000 ng per second of ET would be delivered. A single visible water drop is 5 microliters (1/200th of a milliliter). At an ET concentration of 10 ng/mL, one visible water drop of 5 microliters will contain 0.05 ng of ET (50 pg). Since the endotoxin threshold per item is 2 ng (2000 pg), a total of 40 visible water drops containing 10 ng/mL (100 EU/mL) would be needed to dry onto the surface of one item to leave 2 ng behind. As already mentioned, that will not be readily achievable with dental instruments because of their small size and small surface area.

infection | CONTROL

This explains why, to date, there are no reports in the literature of dental instruments being responsible for systemic ET exposures causing fevers and other adverse systemic outcomes.

Levels of ET in municipal water supply can vary due to water system factors (e.g. water trunk line repairs and other maintenance work carried out on water supply infrastructure), seasons and climatic variations (which changes the use of desalination and water recycling) and major adverse weather events (cyclones and floods). One can now consider that when the ET level rises, the number of drops of water needed to transfer 2 ng of ET onto a given instrument reduces. For example, at 50 ng/mL (500 EU/mL), only 8 drops will suffice, while at 100 ng/mL (1000 EU/mL), only 4 drops will suffice. This highlights how the potential risk of ET on surgical instruments can increase dramatically when the quality of the municipal water is compromised and when many instruments are used to enter sterile sites.

In settings such as immediately after a cyclone or flood, when a “boil water” alert is issued by the local government, this will mean higher than expected levels of coliforms (such as E. coli) and other Gram-negative bacteria and also ET, since it is derived from Gram-negative bacteria. In this situation, when a dental clinic reopens during a “boil water alert”, using small volumes of sterile water (not sterile saline, which contains ions) for final rinsing would be prudent. Likewise, mobile dental services should consider stocking supplies of sterile water during times of the year when floods can be expected to occur.

The LAL assay has an intrinsic method variability of factor 2. Sample properties (e.g. protein concentration, pH, etc.) may cause inhibition or enhancement of the LAL assay, which impacts the limit of quantification (LOQ) achievable for that specific sample. Given this and the need to identify suitable ET action limits, in the pharmaceutical industry, this action limit has been set as 6 times the threshold. For example, at a threshold of 0.25 EU/mL, the action limit would be 1.5 EU/mL. If a water test shows levels at or above that, the clinic would consider issues such as whether there was proper sample collection and storage and if the analysis checked for interfering and enhancing substances in the sample (including those released from the sample containers).

Conclusions

Following this risk-based approach is fundamental to managing the risk that is posed for the surfaces of instruments that have been contaminated with ET coming into contact with bone or soft tissue during surgical procedures. Each clinic needs to conduct their own risk assessment regarding the suitability of water for final rinsing. This needs to

consider the types of procedures that the clinic is undertaking. Where a clinic has introduced a water treatment system to improve the quality of final rinse water, it is essential that staff are aware of the maintenance requirements for that system, since there will inevitably be requirements for servicing and replacement of particular components such as cartridges depending on the extent of use and the quality of the feedwater that is entering the system.

References

1. Walsh LJ. Microbiology Essentials. 8th edition. RACDS: Sydney. 2018.

2. Ziegler-Heitbrock HW. Molecular mechanism in tolerance to lipopolysaccharide. J Inflamm. 1995;45(1):13-26.

3. Walsh LJ, Stritzel F, Yamazaki K, Bird PS, Gemmell E, Seymour GJ. Interleukin-1 and interleukin-1 inhibitor production by human adherent cells stimulated with periodontopathic bacteria. Arch Oral Biol. 1989;34(9):679-83.

4. Walsh LJ, Seymour GJ, Bird PS, Powell RN. Modulation of HLA-DR antigens in the gingival epithelium in vitro by heat-killed Fusobacterium nucleatum and E. coli lipopolysaccharide. J Oral Pathol. 1985;14(10):833-43.

5. Walsh LJ, Seymour GJ, Powell RN. Differential expression of Class II (DR & DQ) antigens by human gingival Langerhans’ cells and keratinocytes in vitro. J Oral Pathol. 1987;16(1):27-30.

6. Walsh LJ, Seymour GJ, Powell RN. The regulation of Langerhans cell T6, DR and DQ antigen expression: an hypothesis. J Oral Pathol. 1988;17(1):43-6.

7. Gemmell E, Walsh LJ, Savage NW, Seymour GJ. Adhesion molecule expression in chronic inflammatory periodontal disease tissue. J Period Res. 1993;29:46-53.

8. Gemmell E, Bird PS, Bowman J, Xu LJ, Polak B, Walsh LJ, Seymour GJ. Immunohistological study of lesions induced by Porphyromonas gingivalis in a murine model. Oral Microbiol Immunol. 1997; 12:288-297.

9. Pietrzak ER, Polak B, Walsh LJ, Savage NW, Seymour GJ. Characterization of serum antibodies to Porphyromonas gingivalis in individuals with and without periodontitis. Oral Microbiol Immunol. 1998;13:65-75.

10. Vowels BR, Cassin M, Boufal MH, Walsh LJ, Rook AH. Extracorporeal photophoresis induces the production of tumor necrosis factor-alpha: implications for the treatment of cutaneous T cell lymphoma and systemic sclerosis. J Invest Derm. 1992;98:686-692.

11. Walsh LJ, Lander PE, Seymour GJ, Powell RN. Isolation and purification of ILS, an Interleukin-1 inhibitor produced by human gingival epithelial cells. Clin Exp Immunol. 1987;68:366-374.

12. Walsh LJ, Au TW, Seymour GJ. Inhibition of the induction of contact hypersensitivity by an epithelial cell-derived Interleukin-1 inhibitor. Aust J Dermatol. 1989;30;48-52.

13. Anderson WB, Slawson RM, Mayfield CI. A review of drinking-water-associated endotoxin, including potential routes of human exposure. Canad J Microbiol. 2002; 48(7):567-587.

14. Medical Device Standards Order (Endotoxin Requirements for Medical Devices) 2018. URL https://www.legislation.gov.au/F2018L01280/ latest/text

15. US FDA Guidance for Industry: Pyrogen and Endotoxins Testing: Questions and Answers. URL https://www.fda.gov/regulatory-information/ search-fda-guidance-documents/guidance-industrypyrogen-and-endotoxins-testing-questionsand-answers

16. Elin RJ, Wolff SM, McAdam KPWJ, Chedid L, Audibert F, Bernard C, Oberling F. Properties of reference Eschericia coli endotoxin and its phthalylated derivative in humans. J lnfect Dis. 1981;144(4): 329-336.

17. Suffredini AF, Fromm RE, Parker MM, Brenner M, Kovacs JA, Wesley RA, Parrillo JE. The cardiovascular response of normal humans to the administration of endotoxin. New Engl J Med. 1989;321(5):280-287.

About the author

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Enter the Matrix - Part 1

The TRI-Matrix implant represents the biggest step forward in implant interface design since implants were first launched and fully embracing digital restoration manufacture

By Dr Thomas Giblin, BSc (Syd), BDent (Hons) (Syd), Cert.Pros (Texas)

1-2. Matrix multilevel implant gives excellent tissue response with radiograph confirming excellent fit and bone response around the restoration.

Over the last 20 years, there have been many incremental advances in dental implantology- surfaces, connections, platform switching to name a few. But the overall format of an implant, with an abutment-supported restoration, has been the basic formula for the restorative side of implantology the entire time. Whilst materials have changed, the basic configuration has not.

For a time, we tried zirconia abutments to make things more effective, but material science came

back to bite us as we were treating a ceramic as a metal. That set us up for failure when exposing these materials to high shearing and tensile forces that metal tolerates well, but consistently leads to fractures in ceramics.

From there, we moved to using stock metal interfaces with Ti Bases - it solved the material problem with the connection, but often there are problems with debonding and poor fit. The main issue with Ti-bases is you often lose all control of your emergence profile as they often dictate a wide, overbulked emergence profile that is not in harmony with the surrounding bone and soft tissues, leading to peri-implant bone loss and remodelling.

Figures

Materials Indications Angulations

Figure 3 (Above). The many options and indications of the Matrix connection.

Figure 4 (Below). Engineers designed the connection so the large screw places the restoration in compression, avoiding fractures. Figure 5 (Below right). The connection simplifies the restoration of single units, bridges and full arch restorations.

MMulti Unit Abutments

ore recently, we have seen a trend of skipping the Ti-base on full arch restorations and milling or printing Zirconia or resin directly to a Multi Unit Abutment (MUA). This is potentially risky as we are again asking ceramics and resins to perform like metals and we regularly see chipping and fractures at the interface in these restorations. These types of restorations do offer advantages in simplicity and cost and as we do not need to make space for a Ti-base or abutment, mean there is increased bulk of material over the MUA. However, the risk of misfit and slop in a

multi-unit connection designed for metal is significant and is likely to result in breakages or breakdown of the connection. Zirconia is much harder than Titanium and so if not milled to very high tolerances, it will rapidly wear the implant interface.

With this in mind and seeing the rapid evolution of both materials and CAD/ CAM manufacturing technologies, the team of engineers at TRI Dental Implants in Switzerland developed a new concept which embraces these trends, applying Swiss engineering and precision to develop the Matrix connection.

Matrix connection

The Matrix is the 3rd connection on TRI’s proven SLA-surfaced implant. The traditional Zimmer-compatible internal hex and Straumann compatible tissue level implants have over 12 years of service with excellent results around the world. An advantage to this approach is that you use the same surgical kit across the 3 types of implant in the range.

The Matrix connection resembles a trumpet shape going into the implant, with a flat outer bevel transitioning into a conical internal connection. As all parts are custom-milled or printed, there is no

Figure 6. The design of the platform allows large divergence between implants without the use of a multiunit, while the advanced milling strategies allow correction of the screw channel up to 30 degrees.

need for the hex or octagon usually needed for stock parts and so there is a single locating lug. The way the crown interface works is that if it is a single unit, the conical is milled at full depth to provide lateral stability, but when milling full arch restorations, only the outer bevel is engaged, allowing a very wide path of insertion of up to 100 degrees between fixtures and simplified milling. The depth of the connection is determined by the case type in the software.

The design of the Matrix connection is done with modern CAD/CAM materials in mind and knowing most ceramics and resins perform well in compression, but less so in tension or shear forces. As such, as the restoration is torqued down, the ceramic is only placed in compression, ensuring longevity of the crown. Another unique feature is the oversized screw that takes a lot of the load and torques the crown down to a full 35 ncm-1. The system is also unique in that is has screws that are uniquely matched to the material used with screws for metal, ceramic and resin with different sizes and interface profiles. This again is selected in the design software.

A further advantage of this interface over a traditional MUA is the bulk of ceramic or resin over the dental implant.

While most load goes through a restoration at the implant site, by the time you have created a screw channel and space for the MUA or the Ti-base, there is minimal thickness at the site, making it prone to fracture at the screw site.

With the Matrix, the crown penetrates into the implant connection, meaning there is added bulk of the material at the implant site, increasing strength.

Another feature in this regard is the option of two screw heights - regular or long. Selecting the long screw will mill the restoration with a screw seat that is much more occlusal in the crown, ensuring increased thickness of ceramic at the implant site, ensuring its durability. TRI has done a lot of research into this connection and studies at the University of Zurich and University of Munich have found it to be equal or superior to traditional Ti-Base implant restorations in terms of cyclic fracture resistance. This new Matrix connection from TRI is a real innovation in implantology, driven by the incredible changes in materials and CAD/CAM developments in dentistry. It took TRI a lot of effort to simplify the restoration of implants and it could pave the way for how we restore implants in future, especially in full arch applications, which will be discussed in future articles.

Part 2 of this article will look at how TRI-Matrix makes full arch treatment simpler.

About the author

Dr Giblin graduated Dentistry from Sydney University with Honours in 2004. In 2007, he was accepted into a 3-year Advanced Prosthodontics Residency at the University Of Texas Health Science Centre in San Antonio, regarded as the top program in the USA. In his time there, Dr Giblin gained a broad education in all aspects of dentistry, including implant, fixed and removable prosthodontics as well as sleep dentistry, occlusion and TMD. He is a Clinical Director of TRI ANZ

The world’s ﬁrst implant approved for full digital restorations without abutment

The matrix® is the ﬁrst-ever dental implant connection that has been speciﬁcally designed for the new digital manufacturing technologies such as CAD/CAM milling or 3D printing. The implant concept allows to plan the restoration directly on the implant without the use of the abutment and without manual cementation. NO

The world’s ﬁrst implant approved for full digital restorations without abutment

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The Programat CS6 in clinical practice

By Dr med. dent. Sven Holtorf, MSc (Oral Implantology)

The use of highly aesthetic zirconia is gaining in popularity in chairside dentistry. Monolithic one-appointment restorations have become a benchmark in dental care as a result of these dependable high-strength materials. IPS e.max ZirCAD has become a firm favourite within our materials portfolio due its outstanding clinical properties. Together with the proven lithium disilicate IPS e.max CAD, it offers dental practitioners a wide spectrum of solutions for both their tooth-supported and implant-supported restorations.

In the past, the firing of zirconia represented a “bottleneck” in the overall restoration fabrication process. The “speed” programs of Programat CS2 and Programat CS3 furnaces are well-known for having reduced the firing time of IPS e.max CAD. However, zirconia materials are more demanding in this respect because they have to undergo a sintering process, which requires more time.

The Programat CS6 from Ivoclar offers users* a versatile machine, which raises the bar in terms of quality and time in both the firing of lithium disilicate and the sintering of zirconia materials.

Accurate programs for firing IPS e.max CAD and sintering IPS e.max ZirCAD are pre-installed. The furnace significantly reduces the process time in both cases, which considerably speeds up the overall treatment time.

Furthermore, the Programat CS6 is the only machine that allows us to sinter zirconia resto-rations and crystallise and finalise lithium disilicate restorations with the assistance of vacuum. This greatly enhances the translucency and surface quality of the restorations.

The furnace has firmly established itself in our clinical practice because it allows us to efficiently process both zirconia and lithium disilicate. The main aim is to offer patients* permanent single-tooth restorations in one appointment or at least on the same day (chairside or semi-chairside). As a result, we are highly dependent on using machines that produce fast and reliable results and fulfil utmost aesthetic standards.

In chairside fabrication procedures, the Programat CS6 is capable of crystallising and glazing IPS e.max CAD restorations within 11 minutes and 10 seconds. In other words, if milling takes an estimated 8 minutes, it takes a total time of approx. 20 minutes to produce a restoration. The furnace time in the Programat CS6 increases to only 24 minutes and 40 seconds when firing four single-tooth restorations or a three-unit bridge.

The IPS e.max ZirCAD LT zirconia material can be sintered in only 22 minutes (up to three restorations or one three-unit bridge at a time) and the IPS e.max ZirCAD MT Multi material in a total of 55 mins and 20 secs.

The furnace features two somewhat longer sintering programs, which allow you to increase the level of translucency in only slightly extended sintering times.

The furnace user, therefore, has the option of sintering their restoration at a higher speed and compromising a little on its translucency, or sintering at a nominally lower speed and thereby enhancing the aesthetic appearance (translucency) of the restoration. This is an important factor that needs to be considered when selecting the right treatment for your patients.

The furnace allows additional programs to be freely added for all thirdparty materials available on the market.

The possibility of using vacuum during the firing cycle represents an important furnace feature for us, since in some cases, we like to customise our restorations with add-on materials in the cervical and vestibular areas in our professional on-site dental laboratory.

The Programat CS6 offers us the high-speed capabilities we require in the fabrication of in-office restorations, but also fulfils our needs in terms of producing layered ceramic restorations.

Programat CS6 features and benefits

• First sintering furnace with vacuum and oxygenation processes

• Crystallisation of lithium disilicate in “speed” and “super-speed” cycles

• Sintering of zirconia

• Up to four single tooth restorations or one threeunit bridge can be fabricated at a time

• Firing chamber of 55-mm diameter accommodates large restorations

• Stain and glaze firing cycles

• Unlimited programming for wide variety of materials

• New crystallisation tray

• Open system for all CAD/CAM systems

• Pre-installed programs for all Ivoclar blocks

• Built-in digital shade analysis (DSA)

• Object plate and tweezer tips made of zirconia for optimum handling

• Pre-drying cycle for wet milling

• Only furnace in which the restoration descends into the firing chamber for improved control of drying and cooling

• High-tech design that blends in seamlessly with state-of-the-art practice surroundings

clinical | EXCELLENCE

TCase studies

wo case studies illustrate how the Programat CS6 is capable of firing zirconia restorations in a very short time and achieving excellent and reproducible results.

Single-tooth crown

Material: IPS e.max ZirCAD LT

Milling time (dry): Approx. 17 minutes

Sintering time: 22 minutes

Self-adhesive placement

About the author

Three-unit bridge

Material: IPS e.max ZirCAD MT Multi

Milling time (dry): Approx. 31 minutes

Sintering time: 69 minutes

Conventional cementation

Dr Sven Holtorf has worked in private practice in Bad Segeberg, Germany since 1992. He has been a CEREC user since 2003 and graduated with a Masters (MSc) in Oral Implantology in 2008. He has been an ISCD certified trainer since 2014. Dr Holtorf is a CEREC mentor and an international CEREC advocate, lecturing and training extensively in Germany and internationally.

IS EVERYTHING the right one with Hu-Friedy

predictable 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. when it comes to the perfect fit, Hu-Friedy is just right. DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

EVERYTHING

right one with Hu-Friedy

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BloodSTOP iX absorbable, adhesive wound dressing for the gum

By Dr Thomas Giblin, BSc (Syd), BDent (Hons) (Syd), Cert.Pros (Texas)

Haemostatic dressings developed for emergency medicine, surgical and battlefield applications can equally find a home in the dental surgery. Blood-STOP iX, well known in medicine as an emergency trauma dressing, offers dental surgeons the two-fold benefits of haemostasis and wound sealing.

From a practical perspective, BloodSTOP iX is cut to size like a traditional membrane or oral dressing and placed over any intraoral wound, implant, extraction or graft site, etc. It adheres to wet/bleeding surfaces with an almost suction-like effect.

BloodSTOP iX provides fast acting bleeding control and actively initiates the clotting cascade. At the same time, it creates a physiological environment for proliferation of tissue growth and wound healing. BloodSTOP iX is a biocompatible, water soluble, oxidized-etherified regenerated nanocellulose made from a tightly woven matrix of plant fibres (It contains no animal derived products) and has neutral pH (~7.2).

When wetted, the nanocellulose transforms into a sticky translucent gel that adheres to and seals the wound to form a

protective layer, both preventing contamination and enabling easy monitoring of the wound without disrupting blood clotting.

BloodSTOP iX is odourless and tasteless and can be easily removed by irrigation. It can be used both topically or internally and is effective in patients using anticoagulants.

BloodSTOP iX is easy to use, cut, fold or layer and is costeffective (around $16 per dressing). The sterile, single use packages have a 5-year shelf-life.

BloodSTOP iX is suitable for use with any intraoral wound; extraction/ridge preservation sites; sutures/flap margins; donor and recipient sites of gingiva/connective tissue grafts; mouth ulcers/aphthous ulcerations; periodontal, oral, implant surgery and any other procedures causing bleeding. It’s especially useful in covering donor sites of connective tissue grafts on the palate.

In the following case, BloodSTOP iX is used to cover a surgical site in an immediate implant placement and temporisation.

Dr Giblin is a Sydney-based specialist prosthodontist in private practice. He is a clinical director of TRI Implants, the dental distributor of Bloodstop in ANZ.

Figures 1-2. Initial situation - Tooth 21 has internal resorption with a hopeless prognosis.

Figure 4. Crown fractured off due to resorption.

Figure 5. Atraumatic extraction preserving bone- sectioned mesio-distal and elevated with flat plastic.

Figure 3. Previous RCT due to trauma.

Figure 6. Immediate TRI-Matrix bone level implant (TRI Dental ANZ) placed.

Figure 7. Jump Gap grafted with Mineross XP (BioHorizons).

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Biodentine™ saves pulps EVEN with signs and symptoms of irreversible pulpitis*

saves pulps EVEN with signs and symptoms

Biodentine™ brings one-of-a-kind benefits for the treatment of up to 85%** of irreversible pulpitis cases:

Bone Grafting

For vital pulp therapy, bulk- lling the cavity with Biodentine™ makes your procedure better, easier and faster:

Biodentine™ brings one-of-a-kind benefits for the treatment of up to 85%** of irreversible pulpitis cases:

tooth

Biodentine™ brings one-of-a-kind benefits for the treatment of up to 85%** of irreversible pulpitis cases:

As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine™ fully replaces dentin wherever it’s damaged.

• Vital Pulp Therapy allowing complete dentin bridge formation

brings one-of-a-kind benefits for the treatment of

• Vital Pulp Therapy allowing complete dentin bridge formation

brings one-of-a-kind benefits for the treatment of up to 85%** of irreversible pulpitis cases:

Pulp healing promotion: proven biocompatibility and bioactivity

• Minimally Invasive treatment preserving the tooth structure

Reduced risk of failure: strong sealing properties

• Vital Pulp Therapy allowing complete dentin bridge formation

• Minimally Invasive treatment preserving the tooth structure

• Immediate Pain relief for your patients’ comfort

Vital Pulp Therapy allowing complete dentin bridge formation

Only one material to fill the cavity from the pulp to the top

• Immediate Pain relief for your patients’ comfort • Bio-Bulk filling procedure for an easier protocole

• Minimally Invasive treatment preserving the tooth structure

• Bio-Bulk filling procedure for an easier protocole

• Immediate Pain relief for your patients’ comfort

New Biphasic Formulations allowing you to manage the pace of your bone grafting procedures:

Similar mechanical behavior as natural dentin: ideal for bulk filling

Minimally Invasive treatment preserving the tooth structure

Immediate Pain relief for your patients’ comfort

Biodentine™ helps the remineralization of dentin, preserves the pulp vitality and promotes pulp healing. It replaces dentin with similar biological and mechanical properties.

• Bio-Bulk filling procedure for an easier protocole

(80% ß-TCP / 20% Hydroxyapatite)

The final enamel restoration will be placed within 6 months.

Improving on Biodentine the composite onto Biodentine full restoration in a single session

Bio-Bulk filling procedure for an easier protocole

40/60 (40% ß-TCP / 60% Hydroxyapatite)

Innovative by nature

Please visit our

Please visit our website for more information

www.septodont.com

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

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

Figure 8-9. Gelatamp (Roeko) placed over graft material to contain graft prior to suturing with 5-0 Dyloc Sutures (Dynek Australia).

Figure 10. Bloodstop (TRI Dental ANZ) folded and trimmed to size.

Figure 11. Bloodstop (TRI Dental ANZ) placed on wet wound.

Figure 12. Bloodstop (TRI Dental ANZ) adheres to tissues creating a clear barrier.

Figure 13. Clear barrier allows easy monitoring of the wound.

Figure 14. “Spiderweb” technique used to build up direct temp pontic directly on the smooth Bloodstop surface.

Figure 15. Immediate Matrix Bone level implant (TRI Dental ANZ) and Mineross XP graft placed to fill the jump gap.

Figures 16-17. Nice final result preserving soft tissue, protecting the site and providing an aesthetic result.

ADVANCED HEMOSTAT WITH WOUNDHEAL®

WITH WOUNDHEAL

For topical applications and internal surgical use. Effective in patients using anticoagulants.

• Water soluble, oxidized-etherified regenerated nanocellulose.

• Biocompatible & pH neutral (~7.2).

• Non expanding hemostat, forming sealing clot & reducing pain.

• Tightly woven matrix of plant fibres.

• No animal derived products.

• 100% absorbable without any residue.

• Easy to use, cut, fold or layer and cost effective.

• Sterile, single use packaging. Minimum 3 years expiry.

How BloodSTOP iX Works:

• Adheres to wet/bleeding surfaces.

• Fast acting bleeding control. Actively initiates clotting cascade.

• Creates physiological environment for proliferation of tissue growth and wound healing.

• Transforms into a sticky translucent gel that adheres to and seals the wound.

50mm x 50mm RRP $16 inc gst per dressing* *Price current at time of publishing (August 2024). Only available in boxes of 24 dressings. Check the

• Odourless & tasteless. Can be easily removed by irrigation.

• Forms protective layer, preventing contamination.

• Enables easy monitoring of the wound.

The iceberg effect: How

CBCT allows the GP to see “under the surface”, treatment plan and prepare patients for surgical intervention

Diagnosis performed with support of the Neo Edition of the CS 8200 3D with Scan Ceph Module allows doctor to mitigate patient’s pain; avoids extra consultations and wait time

By Dr Ian Lowell

part

A76-year-old male patient presented at the office with pain on tooth #46. The patient— who splits his time between two states—had had 2D X-rays taken at his out-ofstate general practitioner’s office four months prior and had been informed a root canal on #46 would most likely be needed.

At the time, the patient’s other GP recommended he see an endodontist. However, the patient did not follow up with a specialist and was now experiencing pain and discomfort.

PAs and bitewing were taken as part of a basic exam (Figures 1-2), which revealed infection.

To understand the extent of the infection, a CBCT scan was captured with the Neo Edition of the CS 8200 3D with Scan Ceph Module (Figures 3-4). The 3D scan confirmed and showed significant infection up into the furcation and covering the distal of #46. Due to the extent of the infection, the question became not how to save the tooth but rather which options to consider for extraction.

Options for treatment included 1) extraction with no bone graft or replacement; 2) extraction with bone graft and a future implant; and 3) extraction, bone graft and a future bridge.

Figures 1-2. Initial PA and bitewing radiographs taken as

of the basic exam revealed infection.

Figure 3. 3D scan confirmed and showed significant infection up into the furcation and covering the distal of #46.

Figure 4. 3D scan confirmed and showed significant infection up into the furcation and covering the distal of #46.

The patient preferred a prosthesis but did not want to drill on the healthy teeth on either side of #46 for a bridge; instead, he was willing to wait for a future implant so elected for the second treatment option. Since the tooth was a molar, this would help to replace his overall chewing capacity on the right side.

Treatment

On the day of surgery, the patient was sedated and Dr Reece Cochran, the periodontist for the office, extracted tooth #46; significant granulation tissue was also removed. Then, both mechanical and chemical debridement were used to clean the socket and ensure it was healthy. Next, guided bone regeneration (GBR) was performed using a combination of Bio-Oss ® (Geistlich) and mineralised bone (Salvin) to provide structural support and osseous graft. Tenting screws were not necessary in this case.

Following GBR, the surgeon completed platelet-rich fibrin (PRF) and used the patient’s own blood cells for optimal healing; a membrane, along with the PRF, to provide for optimal healing were then placed.

TOutcome

he patient had full primary closure and was healing well after two weeks so the post-op sutures were removed. The patient was scheduled to return for an implant in six months.

Conclusion

There was a time—prior to owning my own in-office CBCT system—when I would have made the same recommendation as this patient’s out-of-state dentist: Take a 2D X-ray and refer him to the endodontist. Now however, 3D imaging gives me greater insight into what’s truly going on in any clinical situation.

In this case, not only did my CS 8200 3D system help me immediately identify the full extent of the infection, but I was also able to plan the full treatment from every stage. Though I’m not always the doctor performing the procedure, my periodontist was then able to effectively and immediately perform surgery with confidence. I was easily able to confirm that there was no nerve involvement and Dr Cochran knew exactly how far to go down to clean up infection and decay to provide the patient with a better long-term outcome.

In-office 3D imaging also has unique benefits to the patient. I was able to clearly show him the extreme spread of the infection to help the patient understand exactly why we couldn’t save the tooth; the patient was able to make an informed decision regarding next steps and treatment.

Also, through CBCT, I have been able to develop a relationship with my periodontist. This relationship has allowed Dr Cochran to trust my treatment planning judgment, so that when he comes into the office monthly, he does not have to waste precious time educating the patient before surgery. Instead, he can begin surgery immediately and save the patient an additional consultation appointment and fee and an extra month or more of waiting to be seen by a different specialist.

About Dr Ian Lowell

Dr Ian Lowell received his bachelor’s degree in exercise science with a minor in chemistry from Fort Lewis College before attending the Anschutz Medical Campus, School of Dental Medicine for his graduate dental degree. As a student at the School of Dental Medicine, Dr Lowell accelerated in the technological aspects of dentistry. He graduated in 2018 as a general dentist. Dr Lowell spent his initial years in dentistry developing a strong digital component to his dental practice. He utilises the newest, and most cutting-edge tools available to provide unparalleled care. He continues his training and strives to provide a fun, safe, ethical and compassionate practice to achieve each patient’s specific needs.

For more information on Carestream Dental products, call 1800-223-603 or anz-enquiries@csdental.com or see carestreamdental.com.

Envision your future practice

With the new Carestream Dental

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With the new Carestream Dental

CS 8200 3D Family

With the new Carestream Dental

CS 8200 3D Family

State-of-the-art CBCT imaging is now within reach and without compromise. Explore our family of solutions including the new CS 8200 3D Access and the CS 8200 3D Neo Edition.

Discover more confident diagnosis, broader treatment options and better patient engagement with advanced imaging technology that boosts in-office procedures and provides the chance to expand your business.

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Bio-Bulk fill treatment of deep caries

By Michal Ganowicz, DDS, PhD

Avital pulp produces dentine, nourishes the hard tissues, conducts stimuli and participates in the immune response. A tooth with a vital pulp is always better than a non-vital one. Therefore, practising dentists should spare the hard tissues of the tooth and the pulp at all costs and use materials and methods that minimise the need for intervention.

Introduction

The current method of choice for treating tooth decay is to prepare the cavity and fill it with composite material. Properly performed, composite fillings effectively restore tooth function and their effectiveness has been proven in millions of cases. However, this treatment is essen-

tially prosthetic. Every filling, even the smallest, is a prosthetic. At the same time, we know that healthy enamel, dentine and pulp are precious.

Case report

Clinical signs and

symptoms

The patient presented with hypersensitivity of tooth 16. The tooth had been treated two months previously for a deep MOD cavity with a zinc oxide-eugenol paste. Due to the poor mechanical properties of such a temporary filling, parts of the dentine were exposed, hence the hypersensitivity symptoms. Tap test was negative. The response to cold stimuli was normal.

Diagnosis

Deep caries, uncomplicated!

AProcedure and treatment

fter anaesthesia and application of a rubber dam, the cavity was prepared. The dentine was left demineralised on pulp chamber walls of the cavity. A minimum of 2 mm of hard tooth tissue was left fully prepared and hard around the cavity margin to ensure tightness of the future restoration.

The proximal walls were restored with A3 universal composite after etching and using a universal bonding system at the cavity margin. The rest of the cavity was filled with Biodentine™ (Septodont) up to the occlusal surface.

After 12 minutes of initial setting of the Biodentine, the rubber dam was removed and the patient was sent home. The next appointment was scheduled for two weeks.

Between visits, the patient had no toothache and the sensitivity diminished. The sensitivity to cold was still normal. Therefore, a rubber dam was placed and 1.5 mm of the outer layer of Biodentine was removed. In this case, it was not necessary to anaesthetise the tooth. After selective enamel etching with a universal bonding system, the cavity was filled with one layer of A3 universal composite, prepared and polished.

Follow up

One year after the last visit, the patient has no sensitivity and the tooth responds correctly to stimuli.

Discussion

Untreated caries eventually leads to destruction of the hard tissues of the tooth, inflammation and even pulp necrosis. Therefore, the methods of choice should be those that can postpone the need for root canal treatment and preserve tooth structure and pulp vitality. Indirect pulp capping with Biodentine fulfils these criteria, as Biodentine has a posi-

tive effect on the condition of the pulp, promotes remineralisation and dentine restoration and acts as a restorative material. In addition, according to the author’s clinical experience and the observa -

Dr Ganowicz on Biodentine...

How long have you been using Biodentine?

I’ve been using Biodentine for the past 5 years.

Why do you use the Bio-Bulk Fill procedure with Biodentine? What are the main advantages for you?

tions of other authors, Biodentine works well in direct pulp capping in cases of irreversible pulpitis.

After filling the entire cavity with Biodentine and waiting 12 minutes, we can send the patient home. Unfortunately, Biodentine is not suitable as a permanent filling due to its abrasiveness and colour.

According to the manufacturer’s recommendations, it can be used as a long-term temporary filling for up to six months. However, if we use the Bio-Bulk Fill method and cover Biodentine with a 1.5-2

The most important thing is the positive effect of Biodentine on pulp healing. For me, it’s a tool to prevent root canal treatment.

When do you use the Bio-Bulk Fill procedure?

I use the Bio-Bulk Fill procedure with Biodentine most often for direct and indirect pulp capping. Occasionally, I also use it to treat cementum caries and to seal perforations in root canals.

mm layer of composite, we eliminate the problem of abrasion and the aesthetics of the filling, while retaining the positive properties of the bioactive cement. In this case, the Biodentine acts as a dentine substitute and the composite as an enamel substitute. Together they can function as a permanent restoration for many years.

Figure 1. Tooth 16 with MOD cavity and deep caries. Two months after treatment using zinc oxide with eugenol.

Figure 4. Filling of the rest of the cavity with Biodentine.

Figure 2. Tooth after preparation.

Figure 5. Temporary long-term restoration with Biodentine.

Figure 3. Restoration of the proximal walls with composite material.

Figure 6. Tooth after two weeks. A rubber dam was fitted.

In theory, we can cover Biodentine with composite 12 minutes after application. However, it is better to wait at least two weeks for the material to fully cure if possible. After this time, it will have a microhardness like natural dentine. After this time, a stronger bond between the bonding system and its surface is also achieved.

Another consideration is the ability to control the vitality of the pulp over time. This will be particularly important in the case of direct pulp capping in a state of irreversible pulpitis.

Conclusion

The Bio-Bulk Fill method with Biodentine works well in the treatment of deep caries. The application of bioactive cement to demineralised dentine preserves as much hard tissue as possible and significantly reduces the risk of pulp necrosis. Biodentine as a dentine substitute, combined with an outer layer of universal composite, works perfectly as an aesthetic permanent filling.

ISummary

n a tooth treated with zinc oxide with eugenol for deep caries, a Bio-Bulk Fill filling was placed using Biodentine as a dentine substitute and composite. The final filling, which was carried out in two stages, fulfilled its purpose as a method of preventing pulp necrosis while also acting as a permanent filling.

Discussion

The methods of choice should be those that can postpone the need for root canal treatment and preserve tooth structure and pulp vitality. Indirect pulp capping with Biodentine fulfils these criteria, as Biodentine has a positive effect on the condition of the pulp, promotes remineralisation and dentine restoration and acts as a restorative material. Biodentine, covered with a 1.5-2 mm layer of composite, eliminates the problem of abrasion and the aesthetics of the filling, while retaining the positive properties of the bioactive cement. The best option is

to treat the tooth in two stages: at the first visit, fill the entire cavity with Biodentine; at the second visit, after two weeks, cover the Biodentine with composite.

The Bio-Bulk Fill method with Biodentine works well in the treatment of deep caries. Biodentine as a dentine substitute, combined with an outer layer of universal composite, works perfectly as an aesthetic permanent filling.

About the author

Dr Ganowicz is a specialist in conservative dentistry and endodontics with 20 years of experience working in Warsaw, Poland. His daily practice involves treating complex issues such as occlusion and temporomandibular joint disorders and he is am particularly passionate about using composite materials and employing biological treatment methods. Dr Ganowicz fully endorses the power of adhesion and the regenerative abilities of the pulp. He advocates for simplified treatment procedures as he believes they are the optimal choice for both dentists and patients alike.

Figure 7. Tooth after removal of 1.5 mm Biodentine.

Figure 10. Tooth after application of a single layer of A3B universal composite.

Figure 11. Glycerine-mediated polymerisation of a composite.

Figure 12. Filling after initial preparation and polishing.

Figure 13. Bio-Bulk Fill.

Figure 8. Selective enamel etching.

Figure 9. Tooth after application of the universal bonding system.

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818 Dental - An elegant expansion

Dr Lloyd Saville, a dedicated dentist with a passion for dentistry ignited in childhood, has devoted over 30 years to a profession he loves. His inspiration came from an unexpected source—his father’s second job cleaning dental surgeries.

As a young boy, Lloyd would accompany his father and became fascinated by the dental tools and operatories. This early exposure set him on a path to a fulfilling career in dentistry. He pursued his studies at the University of Melbourne, graduating in 1992 and has since built a

reputation as a trusted and skilled dentist in Armadale, Victoria.

Lloyd owns and operates 818 Dental, a boutique, customer-focused dental practice in Melbourne, where both patients and the dental team expect nothing short of excellence.

His journey to creating the perfect dental practice has been one of learning and evolution. Lloyd’s first practice, established in 2003, was marred by the challenges of working with a builder unfamiliar with the intricacies of dental construction. However, lessons learned from this experience laid the foundation for future success.

By 2010, the practice had grown, necessitating an expansion. With the purchase of the mirror image property adjacent to 818 High Street, Dr Saville aimed to expand the practice with minimal impact on the street front’s appearance. The challenge was to merge the two buildings seamlessly while maintaining the aesthetic appeal.

This time, Lloyd chose Medifit, a specialist in healthcare interior design and fit-out. The result was a seamless project delivered on time, with minimal disruption to the practice’s operations. Medifit’s ability to integrate the new building with the existing one over a long weekend exemplified their expertise and efficiency.

Medifit’s innovative solution involved retaining each title independently through the creation of an unimposing glass atrium structure that merged the two buildings. This approach preserved the heritage overlay and maximised the value of the properties in this affluent area. The council approved this resolution, which maintained the heritage look with minimal impact.

The design philosophy for the interior was to create a modern, boutique feel, catering to the patient demographic. The initial Medifit project required the creation of four surgeries, two hygienists’ rooms, sterilisation, OPG, practice manager’s office, staff room, reception and waiting area. The existing toilets within the building complex provided easy access for staff and clients.

The finishes and colour palette, chosen by Dr Saville’s wife Anne, included a mix of whites, wenge, light timber and a subtle green tinge. The reception area features a sleek counter finished in wenge laminate with contrasting white colour back glass. The adjacent spacious waiting room offers comfortable earthy-coloured chairs and a custom-built coffee table, along with a kids’ play area with ottoman seating.

The surgeries, located along the external walls, benefit from maximum natural light. Where external windows were not available, internal glazing allows light from the atrium to penetrate the rooms. The new atrium walkway, designed with exposed beams, clear finished ply and glass, provides a striking interior design feature while maintaining a minimal street front impact.

The latest expansion, complicated by COVID-19 restrictions, presented the greatest challenge yet. The practice had again outgrown its space, prompting the purchase of a third building to accommodate three additional surgeries and a photographic studio. Once again, Medifit rose to the occasion, delivering a stateof-the-art facility that met all of Lloyd and Anne’s objectives.

The primary objective for the new project was to expand the practice in a seamless and cohesive way to elevate the level of service for cosmetic patients and streamline workflows. The expanded space and modern design have not only met but exceeded these goals with a refresh of the existing practice waiting and reception areas blending the old and new spaces. The new facilities have enhanced the patient experience and improved operational efficiency.

The result is a spacious, modern practice that delights both patients and staff. The stylish interiors and advanced operatories are a testament to Medifit’s design and construction prowess. The addition of a photographic studio further enhances the practice’s capabilities, allowing for comprehensive cosmetic consultations and treatments.

Reflecting on his experience with Medifit, Lloyd highlights their excellent communication and problem-solving skills. Unlike previous builders who presented problems without solutions, Medifit approached challenges proactively, working collaboratively to achieve the best outcomes. Their commitment to high standards and understanding of the complexities of modern dental practice have made them an invaluable partner.

Lloyd first encountered Medifit at a trade show in 2002 and has since completed several successful projects with them. His experience throughout has been overwhelmingly positive, characterised by mutual respect and a shared vision for excellence.

Summary

The Practice

The Practice 818 Dental

Principal Dr Lloyd Saville

Type of Practice General

Location Armadale, Melbourne , Victoria

Size 147 square metres (Addition) 357 square metres (Total)

No of chairs 8

The Team

Design

Construction

Equipment

Medifit Design & Construct

Dental Units Planmeca Compact i5

Autoclaves Mocom Futura B22

Melag Vacuklav 43B+

Imaging Kavo Intraoral X-rays

Soredex Cranex D OPG

Compressor Cattani

Suction Cattani

Practice Software Exact

“Our experience with Medifit has been an enjoyable one. We get along well and have built two amazing buildings together. They deliver on their promises. They build to the highest standards and they fully understand the intricacies associated with modern dental practice,” he said.

Medifit’s Sam Koranis added “When I first met Lloyd all those years ago, it was clear that we shared a similar philosophy on quality and professionalism. Medifit is privileged to be a part of Lloyd’s journey as a dentist over the past 22 years as ‘818’ has grown from strength to strength. I would like to personally wish him and Annie every success with the new space and thank him for the opportunity to assist once again.”

Lloyd’s journey to a seasoned professional running a cuttingedge dental practice is a story of passion, perseverance and partnership. His collaboration with Medifit has been instrumental in realising his vision for a practice that not only meets but exceeds the expectations of patients and staff alike. The transformation of 818 Dental in Armadale, Victoria, stands as a testament to what can be achieved when expertise and dedication come together.

Practices that work with you

Since 2002, Dentists and Dental Specialists all around Australia have trusted Medifit to create state of the art practices with individual interior designs that boost productivity and enhance levels of care.

Whether it’s your first practice or your latest, we’ll help you create a dental practice that reflects your personal style and complements the way you work - and we do it with a friendly, no fuss approach using proven best practices.

Contact Medifit today for a no obligation consultation and experience our award winning service.

• SITE ASSESSMENTS

• LEASE NEGOTIATION

• FEASIBILITY STUDIES

• COUNCIL SUBMISSIONS

• ARCHITECTURAL DESIGN

• INTERIOR DESIGN

• BUILDING CONSTRUCTION

• PRACTICE FIT-OUTS

• RENOVATIONS / REFRESHES

• BRANDING & MARKETING

Smile Society elevates patient experience

By David Petrikas

The cosmopolitan suburb of Norwood, just outside the Adelaide CBD, is the home of a stylish modern dental practice, Smile Society Dental, operated by Dr Delia Yeak. Norwood is known for its early Italian culture and more recent Asian influence, expressed through various eateries, together with its iconic colonial architecture seen in grand public buildings, hotels and the Odeon Theatre.

Smile Society is a general dental practice with a focus on aesthetic treatments,

especially veneers and other smile enhancement procedures ranging from whitening and restorative treatments to mulit-unit implants.

The newly fitted out practice is ideally located in the Norwood Mall complex with its supermarket, cafes and retail stores, coupled with ample convenient parking right outside.

After working in various other Adelaide dental practices, Dr Yeak sought the advice and assistance of experienced Adelaide dental fit-out company and equipment supplier, Dental Concepts, to help her achieve her dream practice.

Dental Concepts in turn engaged Cheesman Architects to come up with an interior design solution to put the dream into reality. Their designer, Liliana Ramirez followed the brief provided by Dr Yeak, including the basic “donut shaped” layout and a series of photos of interiors which Dr Yeak had researched online to provide a general design direction. With the aid of showing some sample colours, materials and finishes for Dr Yeak to choose from, the designer came up with a modern twist on a classic deco vibe, which probably exceeded the vision in terms of execution thanks to the high-end finishes.

The feeling in the first-floor practice, with its sunny outlook, is “understated luxe”. The mood is created by restrained colours and a “deco” style exuded by shell backed lounge chairs and extensive use of curves throughout the space.

It is immediately apparent from entering the practice that it is going to be an out of the norm experience. Smile Society’s motto: “Experience what it’s like to truly come first” is put into practice by Dr Yeak’s bubbly personality and her attentive staff’s genuine concern for people, together with the use of the latest dental equipment, products and techniques.

Dr Yeak said she wanted the feeling to be more like a nice home than a dental practice. It is more like stepping into a wellness oasis than a dental clinic.

The reception area, with its comfortable tub lounge chairs in bone and contrasting on-trend blue, takes advantage of fulllength glazing and light tones to be an inviting and airy space.

The large, curved reception desk features a recessed ceiling with curved edges and inbuilt lighting, illuminating a terrazzo benchtop and Venetian style plaster feature wall.

The practice has sheer curtains for a balance of privacy and filtering out the sunny aspect from the full glazing at the front and sides of the building.

Illuminated shelving with a curved top housing sculptural items and consumer products is set into the wall to the left of the reception desk. Next to this is a section of arched deco style wall panels with curved inbuilt seating which serves as a children’s play area.

The main surgeries are located on the far side of reception behind twin private consult/payments areas located discretely behind heavy curtains and away from the waiting room.

surgery | DESIGN

A central galley-style sterilisation room with contrasting charcoal cabinets and bright task lighting connects the two hallways looping through the building, giving ease of access.

At the rear of the building in a suntrap on the northeast side is a fully equipment staff kitchen and meals area with bold rust coloured cabinetry. The space includes

refrigerator, microwave and a table with seating for six and doubles as a training room when needed.

The surgeries are individually numbered behind solid sliding doors. Each feature extensive above- and below-bench built-in cabinetry and are equipped with comfortable A-dec 400 dental units with black sewn upholstery.

Dr Yeak said the use of the latest equipment and treatment processes enabled her to deliver the very best for her patients. She specifically chose the A-dec dental units for their reliability and said she opted for the A-dec 400 in particular for patient comfort.

“Some treatments like veneers and implants take a long time and so it’s important that the patient is supported and comfortable during the procedure,” she said.

An added benefit is that Dental Concepts is a local company and offers full support, including staff training and servicing of the equipment that it supplies and installs.

Dr Yeak said the A-dec equipment had lived up to its dependable reputation and was much more stylish, comfortable and reliable than other dental units she had used in the past.

She said some patients have even commented on the comfort of the chairs which feel as comfortable as they look, thanks to the plush, sewn upholstery.

Another feature is the option of an inbuilt ceramic cuspidor for patient rinsing, which Dr Yeak says is far easier for the patients to use than a cup or suction system.

Word of mouth from existing patients has seen the practice flourish and it is likely that it will soon be expanded from the two currently equipped surgeries to a further two surgeries which have services already installed to cater for future expansion.

Summary

The Practice

The Practice Smile Society Dental

The Principal Dr Delia Yeak

Practice Type General

Location Norwood, Adelaide, South Australia

Size 175 square metres

No of chairs 2+2

The Team

Design Liliana Ramirez, Cheesman Architects and Dental Concepts

Builder Leske Homes

Project Manager Jason Puiatti, Dental Concepts

Installer Dental Concepts Adelaide

Equipment

Dental Units A-dec 411B Dental Chair with A-dec 572 Chair Mount LED

Sterilisation W&H Lisa 22VA Autoclave W&H Assistina Twin

Surgical W&H Set 4 Implantmed

Imaging Vatech A9 CBCT

Vatech EzRay Air wall x-ray Vatech EzSensor

Compressor Cattani AC300

Suction Cattani Turbo SMART A Cube

Software Zavy 360 and EZDent (Imaging)

A-dec 500 Pro: Experience a new level of connection.

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

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.

BEGO VarseoSmile TriniQ

Introducing VarseoSmile® TriniQ® by CM MEDICAL, the latest advancement in dental 3D printing materials. Designed for versatility, it supports permanent crowns and bridges, extensive temporaries and denture teeth with exceptional stability and aesthetic quality. Offering 10 VITA® shades, outstanding polishability and superior translucency, it ensures seamless integration into natural dentition. VarseoSmile TriniQ boasts an efficient 3D printing workflow, high bond strength and excellent biocompatibility. Enhance your dental practice or lab with this revolutionary material, providing superior patient care and expanding your treatment capabilities.

Available: CM Medical Tel: 1300-466-588 info@cm-medical.com.au www.cm-medical.com.au

Shining 3D Aoralscan Elite

The Aoralscan Elite is the world’s first device to integrate both intraoral scanning and photogrammetry into a single unit. The device functions as a standard intraoral scanner (IOS) for capturing images of dentulous cases, allowing for detailed scans of teeth and oral structures. Additionally, it serves as a photogrammetry system, which is used to accurately record the position of dental implants in edentulous cases. This dual

functionality makes it versatile for both traditional dental work and advanced implant procedures. This groundbreaking innovation allows for comprehensive dental imaging and precise implant positioning, setting a new standard in dental technology.

Available: Fabdent Tel: 1300-878-336 www.fabdent.com.au

BloodSTOP iX haemostatic dressing

BloodSTOP iX with WoundHeal adheres to wet/bleeding surfaces to form a protective layer to prevent contamination. It is highly adhesive and fast acting while controlling bleeding and accelerating the clotting cascade. It transforms into a sticky translucent gel that adheres to and seals the wound. BloodSTOP iX creates a physiological environment, encouraging the proliferation of tissue growth and wound healing. It is odourless and tasteless and can be easily removed by irrigation. It is designed for any oral surgery

or dental procedures causing bleeding. BloodSTOP iX is biocompatible and 100% absorbable without any residue.

Available: TRI Dental Implants ANZ Tel: (02) 8355-2200 info@tri-implants.com.au www.tri-implants.com.au

Cure up to 2.5 mm in 1 second!

The handheld Monet Laser is the first of its kind curing light. The collimated beam and consistent power of the Monet Laser create superior bond strength and a faster, deeper, more reliable cure. Cure up to 2.5 mm in 1-second! Each click of the Monet is a 1-second cure up to 2.5mm with an 8mm curing depth capacity. It cures composites, luting cements, adhesives and sealants and has been tested on over 50 brands of dental materials. Monet reduces shrinkage and debonding, reduces the potential for “soft bottoms” and features a consistent dispersion for a deep cure - Bulk fills in just 3 seconds! The compact laser includes optics for a parallel beam within the form-factor and an unrestricted rotatable head mechanism. Monet is covered by a two year warranty.