Australasian Dental Practice Mar/Apr 2022 by dentalcommunity

Australasian

DENTAL PRACTICE THE BUSINESS MAGAZINE FOR DENTISTS

Vol. 33 No. 2

MARCH/APRIL 2022

The new face of digital dentistry

dexis.com/en-au

$99.00 p.a.

dentevents presents...

Digital Dentistry & Dental Technology SYDNEY 3-4 JUNE 2022 NOVOTEL SYDNEY BRIGHTON BEACH TWO DAYS OF LECTURES AND WORKSHOPS ON

TWO DAYS OF LECTURES AND WORKSHOPS ON DIGITALDENTISTRY DENTISTRY FOR FOR DENTISTS, DIGITAL DENTISTS, SPECIALISTS, SPECIALISTS, DENTALTECHNICIANS TECHNICIANS AND AND DENTAL DENTAL DENTALPROSTHETISTS PROSTHETISTS 2019 RECAP: 476 DELEGATES • 8 STREAMS • 110 SESSIONS • 52 SPEAKERS

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TWO DAYS • 7 CONCURRENT EDUCATION STREAMS Join us again or for the first time at Digital Dentistry & Dental Technology 2021 for a fun, 40+ TOP SPEAKERS • with 95+ EDUCATION exciting and fully immersive learning experience the best of the best in the newSESSIONS age of dentistry. This year’s program will cover Digital Smile Design • Digital orthodontics • 3D PRINTING • INTRAORAL SCANNING • MILLING Intraoral scanning • Digital implantology • Digital full arch restorations and full mouth rehabilitations • Digital Dentures • 3D printing • Milling • CBCT • Material and applications DIGITAL DENTURES • IMPLANTS • ORTHO & MORE • Software and more with MORE Hands-on Sessions • MORE Advanced Sessions • MORE New Products • NEW Masterclasses and more!

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REGISTRATION FEES INCLUSIONS DETAILS Registration fee includes PROGRAMME FRIDAY 3 JUNE 2022 fee includesin TWO full days participation inc gst Registration FRIDAY 28 MAY 2021 9.00am - 5.00pm - education participation TWO full days inc gst of in education (12 CPD hours), 9.00aM - 5.00pM - education of education (12 CPD and hours), all catering Friday drinks. 5.00pm - 7.00pm - happy hour all catering and Friday drinks. EARLY BIRD PRICING 5.00pM - 7.00pM - happy hour Multiple lectures and workshops Multiple lectures and run workshops $660 before 28 Mar are being concurrently to allow SATURDAY 4 JUNE 2022 are being run concurrently to allow SATURDAY 29 MAY 2021 you to build your own program to price increases $110 on you to build your own program to 9.00 am - 5.00pm - education suit your specific interests.9.00 PriceaM - 5.00 pM - education suit your specific interests. Price the 28th of every Month is all inclusive. is all inclusive.

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Organised by Dentevents™ a division™of Main Street Publishing Pty Ltd ABN 74 065 490 655

Organised by Dentevents

a division of Main Street Publishing Pty Ltd ABN 74 065 490 655

www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

www.dentaltechnology.com.au www.dentaltechnology.com.au

VOLUME 33 | NUMBER 2 MARCH/APRIL 2022

contents | REGULARS

On the cover... DEXIS is the new company name and overarching brand for a suite of trusted digital imaging products previously sold under the KaVo Kerr and KaVo Imaging brands.

management

8 10 12 14 16 18 68 72 74 76 152

and awkward 82 Disputes professional relationships you seeing your team’s performance 86 Areaccurately, or do you have blinders on? Dental practice MoneyBall: How to uncover 88 undervalued dental practices profit and cashflow: What every 90 Revenue, practice owner needs to know - Part 1 How many people call your office and do not 92 schedule an appointment?

briefs one man’s opinion in my practice mouth wide shut outside in spectrum

marketing

product review

changes to dental marketing in 2022 94 Three you can’t afford to ignore...

CPD centre

finance

abstracts the cutting edge

Commonplace Trust Strategies:

196 Not “ordinary” just because “everyone else

READ ME FOR

CPD

does it” says the ATO

new products

facebook.com/dentalpracticenow

100 Urgent Action: New Director ID requirements 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 Paul Coceancig, Gary Pammer, Phillip Win, Dr David Moffet, Graham Middleton, Simon Palmer, Julie Parker, Jayne Bandy, Angus Pryor Design & Production: Jasper Communications Australasian Dental Practice™ ISSN 1445-5269 is printed in Australia and published six times per year by Main Street Publishing Pty Limited ABN 74 065 490 655 PO Box 586, Cammeray NSW 2062 Tel: (02) 9929-1900 Fax: (02) 9929-1999 Email: info@dentist.com.au

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

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

March/April 2022

Australasian Dental Practice

contents | FEATURES

VOLUME 33 | NUMBER 2 MARCH/APRIL 2022

infection control

clinical excellence 90

108

Six upper and four lower ceramic veneers restoration using smile design and digital workflow

114

Clinical case report using the Aoralscan 3 intraoral scanner from Shining 3D Technology

108

102 Unravelling the mystery of long COVID

READ ME FOR

CPD

surgery design 146

118

Increasing patient comfort with advanced technology

122

CPD The tooth colour, a complex matter: Correct shade determination with the very first monolithic zirconia shade guides identical to the final restoration

READ ME FOR

CPD

READ ME FOR

122

142 St John expands WA dental network 146 Capital Smiles Orthodontic delivers in style

126 Aesthetic parameters of digital planning Post-extraction bone filling before 132 implant placement Maxillary molar replacement using 134 a Straumann TLX implant and an ®

immediate restoration

March/April 2022

Australasian Dental Practice

briefs | NEWS It’s finally here...

inally, after two and a half years of delays, Digital Dentistry & Dental Technology 2022 is taking place By Joseph Allbeury again on June 3 and 4. And let me start by saying that it’s going to be a great event once again - so if you haven’t registered, stop reading and do it immediately! The normally annual event was last staged in September 2019, so personally, I can’t wait for it to run again. When we created this event, it was meant to provide a comprehensive window into how digital technology is affecting the clinical and laboratory sides of dentistry. It was meant to be a fun event where delegates are offered the choice of multiple education sessions throughout the two days that allows each individual to craft a program that suits their individual requirements. Digital Dentistry & Dental Technology was also meant to celebrate the symbiotic relationship between clinic and laboratory and bring together great minds in one place to discuss the here and now as well as the future. And I must say, time and again, Digital Dentistry & Dental Technology delivers all this and more. If you haven’t attended in the past, here’s how it works. The event this year offers you seven concurrent education streams to choose from. Six of the streams are lectures, either 45 or 90 minutes in length and the other stream offers hands-on sessions. You don’t need to commit to any stream and you can move freely between the sessions - all the rooms are close together so it’s simple to move around. There is no need to prebook any of the lectures, however, when you arrive, please visit the workshop desk and sign up for any workshops you want to do as these take limited numbers. Everything is included in the registration price as is morning tea, lunch and afternoon tea on both days and drinks on Friday evening. Visit www.dentaltechnology.com.au and download the program before the event and plan which sessions you want to attend - or play it by ear on the day. Whatever works for you. You will also receive a hard copy of the programme in your conference satchel. It’s taken a huge amount of work to organise this event and I cannot thank everyone enough who has worked with us to make it possible. We have a world class line-up of local and international speakers delivering sessions that cover every hot topic in the digital space from scanning, 3D printing, milling, software, aligners and orthodontics, to implant prosthetics, digital dentures, restorative dentistry and much more. All we need now is for you to come along, relax and enjoy the program. Thank you too to our sponsors, exhibitors and everyone else who has helped, plus everyone who has registered already, especially those who have been patiently waiting a long time for this event to occur. So if you haven’t already, register now and see you in June! Joseph Allbeury, Editor and Publisher

8 Australasian Dental Practice

William Green expands management team

illiam Green has appointed Mr Mark Howe to the role of National Sales & Marketing Manager responsible for the company’s extensive range of dental equipment that it both manufactures in Sydney and also distributes on behalf of several leading intternational brands. An accomplished contemporary Manager trained with a Sales and Operations Planning (S&OP) background within commercial manufactured products (FF&E), Mr Howe brings a unique perspective to the third-generation family-owned William Green that was established in 1946. Mr Howe heas commercial and retail product development and sales experience in various industries, most recently with Roca, a Spanish producer of bathroom furniture products with presence in more than 135 countries. Mark can be contacted at William Gree Pty Ltd on 1300-363-830.

IDEM Singapore postponed to October

riginally slated for 8-10 April, IDEM 2022 will now take place between 7-9 October 2022 instead. The organisers of IDEM, Koelnmesse and the Singapore Dental Association, made the decision to postpone the event in light of current travel and safety restrictions in the Asia-Pacific region. As the leading exhibition and conference for the dental industry in the Asia-Pacific, the aim of IDEM is to provide a comprehensive experience and bring together exhibitors and attendees from all over the world. With this in mind, the 12th edition of IDEM will take place between 7-9 October 2022 at Sands Expo and Convention Center; Marina Bay Sands. Participants at IDEM 2022 can look forward to a series of programmes that cater to the dental community: • Trade Exhibition - the exhibition will feature close to 400 local and international exhibitors; • Scientific Conference - with the theme of Building Resilience in Dentistry, participants can look forward to over 30 conference sessions and workshops by industry-leading speakers around the world; and • IDEM 360 - a supplementary digital platform.

Online registration is ongoing. Quote the PROMO CODE IDEMADPMCR9B before 2 August 2022 for a 10% discount. Visit www.idem-singapore.com for more information.

March/April 2022

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START START DATE START DATE DATE SYDNEY SYDNEY SYDNEY #24 #24 #24

VIA ZOOM VIA ZOOM VIA ZOOM

19-2219-22 August 19-22 August 2022 August 2022 2022 (Sem (Sem #1/out (Sem #1/out of 12x #1/out ofSeminars) 12xofSeminars) 12x Seminars)

2nd June 2nd 2022 June 2nd (Thu, 2022 June 5pm (Thu, 2022–5pm (Thu, 8pm) –5pm 8pm) – 8pm)

MELBOURNE MELBOURNE MELBOURNE #23 #23 #23

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18th 18th June 2022 18th June (Sat, 2022 June8am (Sat, 2022–8am (Sat, 11am) –8am 11am) – 11am)

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Card Card # Card # # Expiration Expiration Expiration Date Date Date

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www.posortho.com www.posortho.com www.posortho.com

spectrum | NEWS

One man’s opinion...

A By Georges Fast

“It is a tragedy that Health Funds have convinced many of our politicians that they are more efficient at delivering health outcomes in more cost-effective ways than the State - making sure that they don’t reveal that the only way it is possible to do this is by lowering the standard of care!”

s we read the daily papers and listen to the nightly news, a common theme is becoming obvious; and that is that we are systematically replacing that which works with that which sounds good. A related issue is an education system that once rewarded hard work, conscientious study and excellence is now slanted towards inclusion and ensuring that nobody is made to feel inferior when their results don’t come up to expectations, regardless of whether this is the result of lack of ability or lack of application. It appears to me that this is the first time in the history of the human race that there is a danger of reversing the process of evolution. In the educational field, we have a university in Melbourne that is giving a credit of one year in its Psychology degree to anyone with a trade diploma. The example being promoted is if you’re a qualified hairdresser, you’re exempted from doing first year (I presume that this is to fill empty places caused by the lack of foreign students). We have schools that are promoting students who are functionally illiterate and innumerate to the next level so as not to separate them from their friends. The fact that this leads to tertiary students who need remedial classes in reading and writing on admission to university appears not to bother our education bureaucrats. In the United States, the country that in my youth was looked up to as the example to follow in terms of modernity and standard of living, we have for the first time in a modern society a decreasing life expectancy. To an educated observer there are two obvious reasons for this. One relates to a health system that is largely run by insurance companies whose main objective is to return a profit for their investors. The public system is largely non-existent and successive State and Federal Governments have absolved themselves of the responsibility to care for their most vulnerable citizens. If you aren’t insured either through your employment or privately, the cost of any treatment that requires a hospital visit will most likely lead you to losing your house. The other issue that is impacting on the health of Americans is their diet and lack of physical activity. A few years ago, we were waiting for a flight out of Las Vegas and seated opposite us was a family that ate “junk food” for the whole time that we were there. They had a son who was 10 or 11 years old and who I estimate weighed at least 120 Kilos. In the time we were waiting, he ate 3 hamburgers, a large tub of potato chips and drank a container of Coca Cola the size of an old fashioned milk shake container. When he finished that, he got a container the same size full of soft-serve ice-cream that he demolished before the flight. The rest of his family were proportionately the same size as him.

10 Australasian Dental Practice

In Canada, where life expectancy is not going up but appears not to be decreasing, we were staying at a resort and ordered 2 cocktails on the terrace. We were expecting a few nuts to go with them. We not only got the cocktails, but we were served a helping of potato crisps and avocado dip that would have fed a small African village - had we eaten it we would not have been able to eat dinner. On our way into the dining room, we saw a woman eating an entrée that consisted of a large bowl of chips covered with melted cheese and coated with lashings of gravy. Well, at least their health system works better than that of the U.S. Australia could fall into the same pattern. The pandemic means that kids have been denied the opportunity to exercise and become even more dependent on their devices. Parents who both need to work to maintain a decent standard of living and pay for education can be easily tempted by the convenience of readily available pre-processed meals that contain far too much sugar and salt. At a time when we most need a robust health system, it is a tragedy that Health Funds have convinced many of our politicians that they are more efficient at delivering health outcomes in more cost-effective ways than the State - making sure that they don’t reveal that the only way it is possible to do this is by lowering the standard of care! The first step is to reverse the downward spiral of our education system and also make competitive sport fashionable, rewarding success ahead of inclusion. That way kids will look up to sports stars and want to emulate them instead of copying “media influencers”. The easiest way to keep kids quiet and occupied is to let them play with their devices, but the price that our society is likely to pay for this will be far too high. The second step is to ensure that decent health care does nor become the province of the rich. I am finishing this column with a quote from Joel Weldon: “Don’t wish it was easier, wish you were better”. POSTSCRIPT: Following my last column, I requested that American Express escalate my issue with the underwriter. I was pleasantly surprised that it was Chubb Insurance, a company that has insured my Home and Contents for well over 20 years and who I’ve always found to act in a fair and ethical manner. They contacted me and appeared to understand why I wasn’t happy in my dealings with American Express. They reassessed the claim and, as a gesture of goodwill, paid it. Thus, ensuring themselves of a loyal client for years to come. The Lake House managed to resell 2 nights and the New Year’s eve function to a couple on their waiting list and refunded us for that part of our cost (I thought that they would even though the booking was non-cancellable). It is a place where everything is always done properly and correctly - we did not ask them for a refund! Chubb refunded us the balance - again, and I know that it is an oxymoron but they are a very good insurance company.

March/April 2022

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Australian Australian medical medical device device manufacturer manufacturer backed backed by an byAustralian an support support teamteam that that specialises specialises in rapid in rapid diagnostic diagnostic technologies. technologies. Australian medical device manufacturer backed byAustralian an Australian support team that specialises in rapid diagnostic technologies. *must *must be used be used byused relevant by relevant practitioners, practitioners, or persons or persons under under their supervision, supervision, trained trained in the in correct the use use and and interpretation interpretation oftechnologies. test of test results results *must be by relevant practitioners, or persons under their supervision, trained in correct the correct use and interpretation of test results Australian Australian Australian medical medical medical device device manufacturer device manufacturer manufacturer backed backed by backed an byAustralian an bytheir Australian an Australian support support support team team that team that specialises that specialises specialises in rapid in rapid in diagnostic rapid diagnostic diagnostic technologies. technologies. *negative *negative results results not exclude not exclude infection infection with with SARS-CoV-2 SARS-CoV-2 (COVID-19) (COVID-19) *negative results not exclude with SARS-CoV-2 (COVID-19) *must *must be *must used be used be bydoes used relevant bydoes relevant bydoes relevant practitioners, practitioners, practitioners, orinfection persons or persons or persons under under their under their supervision, their supervision, supervision, trained trained in trained the in correct the in correct the use correct use anduse and interpretation and interpretation interpretation of test of test results of test results results *negative *negative *negative results results does results does notdoes exclude not exclude not exclude infection infection infection withwith SARS-CoV-2 with SARS-CoV-2 SARS-CoV-2 (COVID-19) (COVID-19) (COVID-19)

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In my practice... By Christopher Ho

“After using several generations of 3D printers, I can report that this Asiga printer has been remarkable in the quality of printing, speed and the ability to use different materials. Some other manufacturers lock users to specific resins, however Asiga provide access to over 500 different resin materials...”

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

Ultradent® Porcelain Etch

modelling brush or an instrument to prevent stickiness of a composite material when applying intraorally. The application of the last layer using a brush moistened in GC Modeling Liquid allows you to smooth it effectively and to obtain a very beautiful surface. It should only be used sparingly and although slightly yellow during application, it will become transparent after light curing, guaranteeing an aesthetic result. It can also be used when repairing composite so if there is a bubble or you need to add to the resin when there is no oxygen-inhibited layer, the modelling liquid can be used to wet the resin and allow simpler application.

Asiga PRO 4K80 UV ith the explosion of digital dentistry and intraoral scanning has come the need for 3D printing. After using several generations of printers, I can report that this Asiga printer has been remarkable in the quality of printing, speed and the ability to use different materials, being an open system. Some other manufacturers lock users to specific resins, however Asiga provide access to over 500 different resin materials from many of the world’s leading material manufacturers. The PRO 4K80 UV offers a large build plate for high throughput with a uniform accuracy thanks to their patented platform positioning technologies and automatic projector adjustment. The Asiga dental model resins are used to produce excellent models and the resolution and accuracy of the models are optimal, meeting those of the milled models in the past.

W ltradent Porcelain Etch is a buffered hydrofluoric acid used to etch porcelains used in veneers, crowns, bridges, inlays, onlays and fractured dental porcelain. The etchant creates a micromechanical roughness within porcelain that allows adhesive bonding. Studies have demonstrated that etching with hydrofluoric acid and using silane with a quality bonding resin yields the highest bond strength to porcelain. This Ultradent Porcelain Etch is a viscous, buffered 9% hydrofluoric acid which is easy to control and place. Being slightly thicker in viscosity, the acid does not easily run off, allowing more accurate placement. It can be used extra- and intra-orally, however extreme care should be used to prevent the inadvertent spillage onto any facial or intraoral soft tissues and hence rubber dam isolation is advocated if using in the mouth. The normal time that 9% Hydrofluoric acid is used is 60s for all porcelains such as feldspathic porcelain, leucite ceramics e.g. Empress (Ivoclar), Polymer infiltrated ceramic network (PICN) e.g. Enamic (Vita), however lithium disilicate e.g. e.max (Ivoclar), LiSi (GC) restorations are etched only for 20 seconds only.

GC Modeling Liquid his modelling resin liquid from GC can be used to shape and smooth composite resin restorations. The modelling resin can moisten a

12 Australasian Dental Practice

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

March/April 2022

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Zero risk: Having logical systems and processes in place for those times when things might go awry “How well do you believe your practice is known for being ZERO RISK... where if something does not go to plan and fails to live up to a patient’s expectations, your practice will go ABOVE AND BEYOND to make things right...”

O By David Moffet

ne of the key factors or accelerators for your business to unleash its maximum potential is for your organisation to be known for being ZERO RISK to do business with. ZERO RISK is an ideology that your business lives by that if ever anything could possibly go wrong or awry during a customer’s visit to your business, that the customer can rest assured that this error will be rectified, as quickly as possible, no matter what it takes for your business to make this happen.

And that’s the point lthough your customer may be disappointed with how your business has failed to meet their expectation, they will be in AWE at the way your business SEAMLESSLY swings into its SERVICE RECOVERY MODE to make things right for the customer, no matter what. And so a business that operates like a well-oiled machine will have a complex blueprint of logical systems and processes that cover exactly what needs to be done, whenever, during every step or stage of the customer’s visit to that business, as well as covering exactly what needs to be done TO MAKE THINGS RIGHT whenever anything sometimes does not go exactly to plan. And a great business will know what each of those possible service defects are... A well-oiled machine following logical processes will always operate more smoothly than a business that flies by the seat of its pants with only a few and sometimes no processes at all. Having all of the logical systems in place to be ready to swing into Service Recovery Mode without having to “check with the boss” when something needs to be MADE RIGHT quickly and immediately helps that business to be known for being to do business with. And ultimately that helps the business to maintain its “goodwill” in the community and helps the business to keep operating profitably at a successful level. As hard as a business tries to be error proof, there will occasionally be errors. And knowing what each of those errors are and can be, and knowing how to rectify each one of those errors quickly and surely and WITHOUT BLAME, is what sets the truly World Class and Five Star businesses apart from the rest of the pack. Good customers understand that errors and defects can happen from time to time. The best customers will understand and appreciate a great business’s efforts to seamlessly rectify any service defects quickly and efficiently.

14 Australasian Dental Practice

World Class businesses will have thoroughly analysed each and every stage of their customer’s journey through their practice and will be au fait with all and everything that could possibly go awry and will be alert to the need to enact any necessary Service Recovery Processes should those needs arise. This is because these businesses have established complex blueprints of clear and logical systems and processes for their day-to-day operations, for when things go right and for whenever any small thing could possibly go wrong. So with that in mind, may I ask you a question... On a scale from one to ten, how well do you believe that your dental practice is known for being ZERO RISK to do business with in your community, where if something does not go to plan and fails to live up to your patient’s expectations, your practice will go to ABOVE AND BEYOND levels to make things right for the customer, no matter what? On this scale, a score of one is where you don’t believe your practice has any form of logical systematised SERVICE RECOVERY and a score of ten is a position where you and your team believe unconditionally that no matter what can happen in your dental practice, there is always a ZERO RISK PROCESS that can seamlessly swing into place to make things right for the patient, no matter what. Where do you believe that your dental practice is on that scale from one to ten? Our signature program, The Ultimate Patient Experience, helps our clients create and deliver the necessary processes to create all of the logical Service Recovery systems they need for their practice that helps each of our clients to improve how smoothly their practices are able to operate. A dental practice that operates as smoothly as a well-oiled machine does so because of its logical systems and Service Recovery processes that it is able to deliver consistently. And those systems and standards determine the strength of the dental practice’s BLUEPRINT. Creating that complete list of Zero Risk Service Recovery systems in your practice is one of the three accelerators we apply to the lever that transforms your dental office into that well-oiled machine, helping your dental business on its way to unleashing its maximum potential.

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

March/April 2022

NEODENT® CREATING NEW SMILES EVERYDAY

Neodent Acqua hydrophilic surface demonstrates successful outcomes in a 2 year retrospective study.

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of implants in the study were immediately loaded1

1. Thomé G, Cartelli CA, Vianna CP, Trojan LC. Retrospective Clinical Study of 453 Novel Tapered Implants Placed in All Bone Types: Survival Rate Analysis Up to 2 Years of Follow-Up. Int J Oral Maxillofac Implants. 2020;35(4):757-761. (https://pubmed.ncbi.nlm.nih.gov/32724928/) NEO025 09/21

Straumann Pty Ltd/Straumann New Zealand Limited 93 Cook Street , Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 Email customerservice.au@straumann.com www.straumann.com.au www.straumann.co.nz © Institut Straumann AG, 2021. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates.

Contact your Straumann Group Specialist for information.

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Can I nudge you to nudge more?

By Lani Guy

“Nudging attempts to redirect decisions to behaviours that benefit people by altering their choice architecture; without forbidding any options or changing their economic incentives. Putting healthy food at eye level alters choice architecture without banning or removing unhealthy foods altogether...”

n the last few issues of Australasian Dental Practice, I’ve questioned some of the terms we use, or don’t use, in the dental industry. In this issue, I continue with the theme of asking you to think a little differently about the business body of knowledge and what it has to offer the dental industry... this time we take a look at Behavioural Economics. When we think about the business body of knowledge, we think about how it can affect our bottom line - attract more customers, improve profit margins, reduce costs. But the business body of knowledge can also help us with one of our most challenging aspects as dental practitioners - improving health outcomes and introducing lasting positive change to the health behaviours of our patients. Traditional dental education tackles behavioural change borrowing mostly from psychology - motivational interviewing being the leading form of behavioural change interventions in terms of effectiveness. With outstanding personal communication skills and positive patient relationships being a necessary prerequisite. But any practitioner who has ever tried motivational interviewing can tell you that it is extremely time heavy and therefore not practicable or economically feasible for most general practitioners. As such, motivational interviewing is only usually found in the toolbox of periodontists who can build time into their fees. This is where Behavioural Economics shines - in practicable and economically feasible approaches to positive behavioural change that will not only affect your bottom line but improve patient health outcomes. So what is Behavioural Economics? Put simply, Behavioural Economics is an applied cross-disciplinary blend of business, psychology and neuroscience which answers the question “why do people behave in the way they do in the real-world and not what they should do when looked at rationally”. For example, why do people fail to exercise 30 minutes a day when they know it would benefit them and why do gamblers risk more after both winning and losing even though the odds remain the same? Behavioural Economics breaks down the decisions people make and the choice architecture (the cues in their environment) they use when making these decisions. And if we understand a person’s choice architecture, we have the opportunity to alter their choices. Enter nudging; an applied form of behavioural economics. Nudging attempts to redirect decisions to behaviours that benefit people by altering their choice architecture; without forbidding any options or significantly changing their economic incentives. For example, putting healthy food at eye level alters choice architecture (a nudge) without banning or removing unhealthy foods altogether (a smack). Nudging works because 80% of day-to-day decision making is automatic; with people responding to cues in their environment (their choice architecture). Nudging has been shown to be incredibly effective in all sorts of applications;

16 Australasian Dental Practice

like attracting police recruits, improving doctor compliance with antibiotic stewardship, increasing retirement and pension savings and improving compliance with hand hygiene measures. What’s more, nudging has been shown to be more effective on a cost-adjusted basis than traditional approaches. And unlike many approaches, nudges can be easily tested with randomised control trials to confirm whether they work in practice. Nudging works in many ways but is particularly effective for overcoming inertia (or the tendency for inaction) which most dentists would agree is a powerful enemy of positive health behaviours. Let’s take a look at a few examples...

Organ donation esearch shows most people favour organ donation. Despite this, organ donation registration remains low and default opt in plans are highly controversial. An intervention in Illinois, asking drivers during their renewal process if they wished to optin, almost doubled their donor registration rates from 38% to 60%.

Recycling cling any countries including Sweden, Denmark and Norway have been experimenting with green footprints leading to bins in an attempt to increase recycling and reduce littering. In experiments run over a three month period, the average reduction in litter on the ground was 16% with some councils seeing reductions as great as 42%. So, can we use this in the dental industry? Well, I put to you that most of us are already nudging... in the form of recalls. Yes, while we don’t think of them as such, recalls are a form of nudging and they do work - there is empirical evidence to show recalls are an effective tool to prompt bookings. Many practitioners aim for informative recall campaigns; at the same time educating patients about why preventative healthcare is important and the health benefits of doing so. But does this work? If you look to the empirical evidence, no it doesn’t. Informationladen recalls are no more effective than content-free recalls; it’s the nudge itself that matters. So now we know what nudging is and how it works, I challenge you to think about how else you might apply nudging to the benefit of you and your patients. Nudge nudge

Lani Guy is a University of Queensland trained General Dentist working in private practice. In a prior life, Lani was a management consultant. She has a Bachelors, Masters and Doctorate in business along with a Bachelors in psychology and has spoken globally on the topic of digital disruption and IR4.0. She has a special interest in evidence-based improvement techniques and disruptive innovation... as well as healthcare.

March/April 2022

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The new face of The new face of digital dentistry digital dentistry

DEXIS™ digital solutions transform practices and patient smiles

EXIS is the new company name and overarching brand for a suite of trusted digital imaging products previously sold under the KaVo Kerr and KaVo Imaging brands. With the recent sale of KaVo treatment units and handpieces, together with the acquisition of Carestream Dental’s intraoral scanner portfolio, the time was right to relaunch the comprehensive portfolio of products under the DEXIS brand. The range is built on over 200 years of dental imaging expertise, combining leading brands such as i-CAT™, Gendex™, Instrumentarium™, SOREDEX™ and NOMAD™. Today, over 150,000 DEXIS dental imaging devices can be found in practices around the world. From the groundbreaking i-CAT and OP 3D built on pioneering Cone Beam CT advancements, to the handheld NOMAD Pro 2 X-ray system, to the ruggedly intelligent DEXIS IXS™ sensors - these solutions transform practices and patient smiles.

18 Australasian Dental Practice

Along with the move to a new, unified brand, the products are being brought together in one complete integrated digital workflow. With DEXIS as your trusted, experienced partner, you’ll have a simplified roadmap for your digital practice, backed by the dedicated support of experts.

Your complete diagnostic workflow EXIS combines the industry’s most comprehensive selection of diagnostic imaging solutions, intelligently designed to deliver a complete workflow. With leading products for X-ray generation, intraoral digital radiography, intraoral scanning, panoramic and cephalometric imaging and 3D CBCT imaging from one reliable and experienced partner, DEXIS offers everything you need for efficient, effective and accurate digital diagnosis and treatment planning.

March/April 2022

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Digital workflow experts available on demand

Future-ready innovation hile delivering enhanced workflow efficiencies today, DEXIS also prepares your practice for the treatments of tomorrow. Through its partnership with X-NAV technologies, DEXIS is also introducing X-Guide, the cutting-edge 3D Navigation system for implant placement.

More solutions mean more flexibility ith DEXIS’s expansive portfolio of industry-leading products, practices also have more options and flexibility to meet patient needs and practice preferences. Choose DEXIS Titanium’s single-size intraoral sensor or go with the DEXIS IXS Size 1 and Size 2 sensors to accommodate different anatomies. Select the DEXIS OP 3D with multiple fields of view or go large with the i-CAT FLX V17. Use DEXIS Imaging Suite for 2D workflows or intraoral scanning for any modality.

March/April 2022

EXIS solutions are known for their innovation and future-proof advancements. But behind these pioneering technologies are over 1,000 of the industry’s most experienced, committed and responsive experts around the world. When you choose DEXIS, you also have access to a dedicated team who’s ready to support your success at any point in your journey. Digital workflow experts help you create a customised roadmap for your digital workflow and practice. Once your DEXIS solutions are in place, training is provided and educational resources available including webinars and in-person continuing education to maximise your team’s comfort levels and proficiencies.

For more info on DEXIS products, visit www.dexis.com/en-au

Australasian Dental Practice

Scan eXam™

IXS™

NOMAD™ 3800™ 3700™ 3600™

Digital Intraoral Sensor

Handheld X-Ray System

Intraoral Scanning

PANORAMIC

OP 3D, 2D upgradable pan OP 3D, 2D upgradable pan/ceph

OP 3D™

Digital Imaging Plate System

OP 3D (4 configurations) OP 3D Pro

™

i-CAT FLX V8 i-CAT FLX V10 i-CAT FLX V17

X-Guide®

3D Guided Surgery

™

Best-In-Class workflow All-In-One Software

DEXIS solutions transform practices and patient smiles

DEXIS now includes a full portfolio of award-winning digital solutions from sensors to CBCT, intraoral scanning to implant planning, and NOMAD handheld X-Ray to navigated surgery. Now, over 150,000 DEXIS dental imaging devices can be found in practices around the world — Discover what DEXIS can deliver for you, visit dexis.com/en-au

The new face of digital dentistry

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Full steam ahead for Australia’s best digital dentistry event June 3-6, 2022

igital Dentistry and Dental Technology 2022 is a month away and registrations continue to grow for the 2-day face-to-face conference. The event is being held on Friday, June 3 and Saturday, June 4 at the Novotel Sydney Brighton Beach and if you haven’t registered already, then don’t miss this great experience (and early bird rates still apply). Digital Dentistry and Dental Technology 2022 brings dentists and specialists, technicians and prosthetists together in a single program, as it should be. Digital Dentistry and Dental Technology 2022 offers every delegate access to more than 80 session choices over two days that allows you to build your own program based on your needs. There is no need to register for any session, you can choose your program ahead of time, on the day or minute-by-minute.

Access to real knowledge he interactive nature of Digital Dentistry and Dental Technology 2022 means that you have unprecedented access to real knowledge and experience from over 40 speakers who are immersed in the digital workflow every day and the hundreds of delegates who share the same challenges you do.

22 Australasian Dental Practice

Stellar line-up of speakers his year, we welcome a stellar and still growing line-up of speaking talent, both favourites from past editions as well as many new faces with knowledge and experience to share. From clinicians and technicians, inventors, product and software developers, don’t miss this unique all access educational opportunity. This year, we’re also continuing with the workshop stream including the opportunity to try scanning with all the latest intraoral scanners, all in one room, plus other workshops teaching, for example, stain and glaze techniques for monolithic restorations. Whether you’re a dentist, prosthetist or technician, whether your interests are in products like intraoral scanners, 3D printers, mills or solutions for digital dentures, orthodontics, implants or endo, this program will give you the opportunity to learn and explore. Digital Dentistry and Dental Technology 2022 is designed to be a fun learning experience. Located adjacent to the Sydney domestic airport, the Novotel Sydney Brighton Beach is an ideal venue - easy to fly-in or easy to park. Accommodation is available and full catering is provided.

To view the growing programme of education sessions or to register, visit at www.dentaltechnology.com.au.

March/April 2022

Say goodbye to neck and back pain!

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To learn more and book an in-office demo, scan the QR code or visit osseogroup.com.au/pentax

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Dental Economics 2022 designed to help you grow your dental practice

ental Economics is a brand new major event for 2022 that is designed to help you and your private dental practice GROW. The event is perfect for principal dentists, employed dentists, new graduates, senior clinicians, practice managers, dental hygienists, oral health therapists and clinical and business support team members. After two years of uncertainty, 2022 and beyond is the time to start getting back on track - growing your practice, starting a new practice, building your revenue, honing your systems, adding more chairs or opening in new locations. Whatever your plan, Dental Economics 2022 will provide you with the tools, ideas and inspiration from the absolute best in the business to go to the next level. Dental Economics 2022 is a 2-day multi-stream event that allows you to create your own program - on the fly. The event is staged at the Novotel Sydney Brighton Beach - close to Sydney Airport with ample parking and easy access. Throughout the two days, you can choose from over 50 different lectures, workshops and forums to tailor a program to meet your exact requirements (or bring your entire team to cover all the bases). Dental Economics 2022 offers a total of 12 hours of CPD organised into six concurrent education streams under the topics of:

Leadership n this interactive forum, hear Australian dentists who are running large private dental practices over multiple locations, large group practices or practices with a range of unique business models, franchises and concepts be interviewed on stage, give insight into the future trends of private dental practice and answer your questions. Gain first hand insight into how large successful dental practices have overcome challenges to grow, evolve and prosper that you can apply and adapt to your own situation.

Practice Management articipate in lectures, workshops and forums with the best dental management consultants in Australia who will offer advice and insight from decades of experience working with private dental practices in Australia.

Finance nderstand how to navigate the unique financial and legal requirements of dental practices from legal, accounting and financial advisers who create dental practice structures for large group and corporate practices. Sessions on trusts, insurances, superannuation, buying and selling practices, starting up a brand new practice, securing premises and more will be featured.

Attention entrepreneurial dentists, practice managers and owners ental Economics 2022 is looking for entrepreneurial dentists, practice managers and business owners who want to share their stories of success with their colleagues as part of an interactive forum. If you have a large practice or group of practices or an interesting idea or business model and would like to participate, then please contact Joseph Allbeury at joseph@dentist.com.au to start a conversation about presenting at Dental Economic 2022.

24 Australasian Dental Practice

Marketing arketing your dental practice successfully is a key driver for growth. Hear from clinicians, business owners and consultants about what works and what doesn’t. Sessions on websites, social media, video marketing, advertising and more will all be incorporated into a range of fun and interactive educational sessions.

Hygiene Department or the first time in Australia, this program for dental hygienists, oral health therapists and hygiene coordinators will present a range of sessions from inspiring clinicians and consultants that will change the way you view your career and your clinical practice. From looking at concepts for growing hygiene revenue and clinical engagement, to the exploration of the dental spa concept to mobile dentistry and domicillary care models, a broad range of topics will be covered designed to help dental hygienists and oral health therapists rethink their role in the practice and their overall dental career.

Communications ommunication is the key to starting and growing a practice. This stream will offer insight, tips and advice on a range of techniques and technologies that can help your practice grow, increase your efficiency and reduce your overheads.

Brought to you by Dentevents, Dental Economics 2022 will deliver unprecedented access to the most knowledgeable and entrepreneurial clinicians, business owners and consultants in Australia today. Dental Economics 2022 will feature over 60 education sessions in six concurent streams and the program is updated and evolving on a continual basis at www.dentaleconomics.com.au. Full price registration is $880 per person. Register before March 5 and pay only $330 per person. Price increases $110 per month.

March/April 2022

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

GO EXPRESS»»»»» If you’re organising any kind of post-graduate dental education, event or webinar, listing your event on the dentevents.com continuing education calendar is now easier than ever. No username, no password and no need to login - add your event by simply visiting dentevents.com, clicking on Adding Events and then selecting Express Listing. Complete all the details on the form and click SUBMIT. An email containing a link to edit or update the event will be sent to you that also allows you to track the approval status. After the event is checked, it will be posted to dentevents.com. Advanced functionality For event organisers who already use Dentevents to manage their events through www.dentalcommunity.com.au and use the registration, payment and ticketing tools, this system should continue to be used as normal. Tools for event organisers Dentevents.com offers event organisers a full suite of marketing, ticketing, payment, registration and event management tools cost-effectively and on-demand. Full information is available at the newly updated Dentevents.com website.

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

DENTAL dentevents presents...

ECONOMICS SYDNEY 5-6 AUGUST 2022 NOVOTEL SYDNEY BRIGHTON BEACH REGISTER NOW and SAVE 50% Dental Economics is a brand new event for 2022 created to help dental practices GROW. Whether you own a practice or want to own a practice, whether you’re a clinician or part of the team, whether you’re new to the profession or a seasoned veteran, Dental Economics is a festival of ideas and information that will empower you to revisit how you think and work in dentistry today. The multi-stream, multi-session format allows participants to create their own program, with presentations, forums, workshops and round tables delivered by leading Australian dentists operating large practices over multiple locations; experienced experts in corporate structures, employment, finance and taxation; practice management gurus; marketing and social media consultants; internet and defamation lawyers; and much more.

Grow your private practice and Grow your team at Dental Economics 2022

www.dentaleconomics.com.au

TWO DAYS • 6 CONCURRENT EDUCATION STREAMS 40+ TOP SPEAKERS • 60+ EDUCATION SESSIONS

Session details updated daily online Dental Economics 2022 - Everything you need to know to GROW! REGISTRATION FEES

$880 inc gst

EARLY BIRD PRICING $440 before 5 APr Price increAses $110 on the 5th of every month

INCLUSIONS

PROGRAMME DETAILS

Registration fee includes participation in TWO full days of education (12 CPD hours), all catering and Friday drinks.

FRIDAY 5 AUGUST 9.00Am - 5.00Pm - educAtion 5.00Pm - 7.00Pm - hAPPy hour

Multiple lectures and workshops are being run concurrently to allow you to build your own program to suit your specific interests. Price is all inclusive.

HOURS CPD

SATURDAY 6 AUGUST 9.00Am - 5.00Pm - educAtion

VENUE DETAILS Novotel Sydney Brighton Beach - The Grand Parade, Brighton-Le-Sands NSW 2216 - Close to Sydney Domestic and International Airports Check the website for details of discounted accommodation rates for the conference • Ample parking available at the hotel

Organised by Dentevents™ a division of Main Street Publishing Pty Ltd ABN 74 065 490 655

www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

www.dentaleconomics.com.au

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ADX22 exhibition a success

rganisers and exhibitors were extremely pleased with this year’s ADX22 dental exhibition held at Sydney’s International Convention Centre from Thursday to Saturday, March 17–19. Chief Executive Officer of the Australian Dental Industry Association, Kym De Britt said with almost 200 exhibitors (193 total) and a significant increase in the number of custom booths, stand activation programs and mascots, feedback from visitors attending ADX22 Sydney was “exceptional”. “The feedback has been fantastic – everyone I’ve spoken to said it was great and that the people they spoke to on the stands ‘were at ADX to buy’. Many told me that they broke all sales records for ADX events at this year’s ADX22 and we’ve had interest in the Brisbane exhibition already,” Mr De Britt said. The trade exhibition, held in conjunction with the ADA’s SIDCON dental convention, held over the preceding Wednesday and continuing into Thursday (March 16-17), provided an excellent blend of professional development sessions and displays of the latest equipment, technology and services for the dental sector.

28 Australasian Dental Practice

By David Petrikas

With 7,485 confirmed visitors through the door - approximately three quarters of which came from New South Wales, there was also good interest from interstate with Victoria and Queensland the most represented interstate visitors. Mr De Britt said the total visitor numbers exceeded the ADIA forecast of attendance. “This shows an engaged community of dental professionals that continues to enjoy the value of ADX. The 2,200 registered exhibitor staff captured 12,984 leads, indicating strong interest in the products and services on offer at the exhibition.” The event had its own combined mobile app where attendees could choose their Learning Lab and ADA CPD sessions, read up on speakers, find their way around and navigate to their favourite ADX exhibitors. “A lot of effort went into where to place cafes and amenities to allow visitors more time on the floor and we came up with a floor plan to make sure we didn’t have dead areas. The event also had a much more interactive response from visitors for the People’s Choice awards and activations of competitions on member stands.

March/April 2022

spectrum | NEWS

“At ADX 2020 there were only three mascots and only three companies did activations on their stand. In Melbourne there were six mascots, and 20 companies did activations. “In Sydney this year we had 10 mascots and 40 exhibitors did activations on their stands ranging from mini putt putt; spin the wheel to win a prize; smoothie-making exercise bikes and GSK’s Sensodyne and the MiniMax stands (who each provided ice creams to visitors) - all designed to encourage visitors to vote for their stands.” The Women in Dentistry breakfast hosted 390 attendees, while the free creche also proved extremely popular with 295 children enrolled, compared to just 92 at ADX 2020 and 134 at the previous Melbourne event. Mr De Britt attributed the increased interest and activity at ADX22 to the revised format and layout of the event, in conjunction with the timing of the ADA SIDCON conference. “We put the CPD lecture rooms in the exhibition instead of a separate conference building. Conference goers also gained access to the show floor with the opportunity to visit exhibitors as they made their way to and from each session. “Within the lecture rooms all of the people attending the lesson had earphones and each lecturer has a microphone on

March/April 2022

their own channel so that people in stands outside can’t hear the lecturers and those in the lecture don’t get noise from the stands outside.” Mr De Britt said the NSW ADA reported that every CPD session was full. With over 2,200 people attending each day on Thursday and Friday and well over 3,000 on the Saturday, exhibitor feedback was that the Exhibition was an outstanding success. Mr De Britt also congratulated the People’s Choice Award Winners at ADX Sydney: • Best mascot - SDI Ltd • Best activation - MiniMax • Best small booth - Primary Dental • Best medium booth - Curaprox • Best large booth - SDI Ltd The next ADIA event is ADX Brisbane from Thursday 27 to Saturday 29 October at the Brisbane Convention & Exhibition Centre. The event will be held in conjunction with ADA Queensland which will convene an expert CPD program to coincide with the event. Registrations are now open on the ADX Brisbane website at www.adxbrisbane.org.au

Australasian Dental Practice

spectrum | NEWS

SDI celebrates 50 years at ADX

022 marks 50 years of SDI, Australia’s largest manufacturer of dental products. It’s very rare and certainly unique in Australia for a dental company to record a 50-year milestone, yet SDI Limited, continues to go from strength to strength. To coincide with ADX Sydney, the company, headquartered in Melbourne, kicked off a year of celebrations with a cocktail reception at the Sydney Opera House. We caught up with CEO, Managing Director and daughter of the founder, Samantha Cheetham for a chat. “SDI has survived because our founder and Chairman, Jeffery Cheetham, never gives up,” Ms Cheetham said. “He has the determination and can-do attitude that means no challenge is impossible. Our products have gotten better and

30 Australasian Dental Practice

better and now deliver brilliant results with universities and evaluators globally. Our Riva glass ionomers, Luna and Aura composites and Pola tooth whitening products are recognised by many as the best in the world.” Ms Cheetham said that the key to the company’s success was the early realisation that the world was their oyster. “To expand, we had to start exporting,” she said. “From Australia, that has not always been easy. We now export to over 100 countries on all continents. We’re very fortunate to have long standing partnerships with many of our distributors. “One of our first distributors, for example, was in Greece and they’re still our exclusive distributor. That’s a 45-year relationship. We’re loyal to our customers and our teams. We have many long standing employees, several who have worked with us for over 40 years and

many who have worked for more than 10, 20 and 30+ years. We value teamwork, respect, accountability, passion and innovation with all our stakeholders. “We have 50 years of innovation, particularly with research and development of our products. Very few dental manufacturers have achieved this. We are passionate about researching and developing our own products and we’re proud to say that all of our research team is in Australia and most of the manufacturing is also completed at our Melbourne HQ. “Achieving all of this has only come with a team that is passionate about global success and proud that we are Australian.” Further celebrations will continue throughout 2022 and culminate at IDS 2023 in Cologne, Germany, where SDI is a long standing exhibitor. Visit sdi.com.au for more info.

March/April 2022

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spectrum | NEWS

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

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

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

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

32 Australasian Dental Practice

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

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

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

March/April 2022

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spectrum | NEWS

3Shape launches 3Shape Unite platform Connecting dental professionals, technology and services to create digital dentistry workflows that just flow!

Shape has launched 3Shape Unite – a new open platform that brings world-leading dental companies, solutions and labs together, enabling dentists to manage all their cases with choice and ease - from 3Shape TRIOS scan to treatment completion. Included free with every TRIOS®, the Unite platform allows practitioners to enjoy the freedom to effortlessly manage and expand their digital dentistry via an ever-growing Unite Store app library.

“Fully integrated with the multiple award-winning TRIOS intraoral scanner, the Unite platform includes best in class workflow between the dental practice and over 1000 labs; and 50+ clear aligner providers...” Fully integrated with the multiple award-winning TRIOS intraoral scanner, the Unite platform and apps deliver an intuitive user interface including a simplified lab order form with built-in chat and best in class workflow between the dental practice and over 1000 labs; integrations with 50 plus clear aligner providers and patient management systems and easy-access to patient images - making digital dentistry more straight-forward and accessible than ever. “3Shape Unite is a tremendous launch for 3Shape! It brings to life our historic vision of giving dentists freedom and open options. It is digital dentistry united under one platform. From labs and treatment solution partners to managing patient care, 3Shape Unite creates workflows that just flow,” says Jakob Just-Bomholt, 3Shape CEO. “For dentists, 3Shape Unite simply and openly connects them to the right dental partners and makes digital dentistry easy, end-to-end.”

34 Australasian Dental Practice

In the true spirit of unity and openness, industry leaders Henry Schein, Ivoclar and the Straumann Group, have teamed up with 3Shape as Unite founding partners to launch the platform. The partnership enables 3Shape Unite users to directly access with optimised integrations Henry Schein’s multiple Practice Management Software solutions, clear orthodontic aligners, implants and restorative solutions; Ivoclar’s dental applications for both dentists and dental

technicians; and the Straumann Group’s clear aligner, implant, prosthetic solutions and services. For dental laboratories, 3Shape Unite provides a platform and directory for them to become more visible to dental practices, market their services with a profile they create and take advantage of an optimised order workflow with practices. Professionals can access the 3Shape Unite platform from their laptop and TRIOS MOVE via a software update.

March/April 2022

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Enter the Ultimate Practice Makeover

E Q A

ntries are now open for the Ultimate Practice Makeover 2022 and we talk to host and co-producer, Angus Pryor, about the upcoming dental reality TV show called.

Hi Angus, so what exactly is the Ultimate Practice Makeover?

It’s basically everything we could think of that would maximise the chance for a practice to dramatically grow in the shortest possible time rolled up as a prize for the winner. This means a really broad range of just about every kind of help we could give. We have a very generous group of sponsors donating their wares and time and the total package is unbelievable - totalling over $90,000. There’s a full suite of marketing help, software, training, coaching, uniforms, patient communication tools and a $40,000 fit out of the reception area to take a practice from good to great in the shortest possible time.

Q A

How does it work?

Practices enter the competition. Once the winner has been selected, we start the makeover process on 1 July 2022. The winner will receive a large range of help to take their practice to the next level. In the process, we record the journey of the practice to turn it into a reality TV show available on Dentevents.TV. This will allow viewers to learn from the makeover experience and to think about how they can apply those elements to their own practice. Apart from that, our overwhelming desire is to create what will be compelling viewing. As far as I know, this has never been done before!

Q A

Who should enter the Ultimate Practice Makeover?

There are a few elements to this. It’s open to privately owned dental practices in Australia. People can apply if their practice would benefit from a $40,000 reception area fitout - generously provided by Medifit. Secondly, we want an open-

36 Australasian Dental Practice

ness to work with the various coaches and trainers to not just transform the look of the practice but also the behaviour of the practice, so we can get the maximum return. Bottom line, if the practice needs a bit of a pick-me-up and the owners are open to learning new things and implementing them, they should definitely apply.

Why are you doing the Ultimate Practice Makeover?

Q A

Any excuse to get in front of a camera [laughs]! No, it just sounded like a fun project. As far as I know, no one has ever done a reality style TV show in the dental industry like this. The beauty of UPM is

For my company, Dental Marketing Solutions, we’re basically throwing the kitchen sink at it - a new website, SEO, social media, branding, logos, consulting and so on. With all these sponsors on board, won’t the TV show just be like one giant infomercial? No way! My number one goal is for it to be fun and educational. The reality is that all of the sponsors involved really just wanted to help and weren’t even too worried about what kind of recognition they get for their involvement. The project only works if the final product (a reality TV show) is great viewing.

IN!TheUltimate... W Practice Makeover

WIN a complete image update at that overit$90,000! that we can take viewers onpublic the journey Myvalued hope is becomes a series as a practice goes through the makeover that is binge-watched for years to come process, while the practice gets the benefit because of the compelling mix of the draof a $90,000 makeover. matic practice transformation with a good dose of storytelling. We’re hoping to do Who is involved in delivering this every year although it’s pretty full on the makeover? producing the show - I might need to wine and dine my wife [laughs]. We’re very lucky. Because I’ve been What is the criteria to determine in the dental industry for quite a long who wins? time, I’ve been able to lean on a bunch of other businesses to come and join the proIt’s a combination of the answers that ject. The typical reaction has been one of we get from the entrants, plus the great enthusiasm. practice that we think we can generate the As I said earlier, I really can’t think of best results for within a six-month period. what else we could do to grow a practice For example, if someone had a brand-new, faster in a shorter time... unless maybe we immaculate practice, that would restrict get Justin Beiber to do a concert out the our options from the fit-out point of view. front of the practice [laughs]. How can someone enter the We have Medifit doing the fit-out, Ultimate Practice Makeover? Dental4windows providing software, Jesse Green helping with consulting, It’s quite simple, just head to Jayne Bandy helping with phone skills ultimatepracticemakeover.com.au and Simon Palmer helping guide the proand enter your details. From there, if you cess in terms of building the value of the make it through to the next round, you practice. Channel D is being installed will receive an email asking for some and there’s some neat tools from Erskine more information. If you make it to the Dental. Then there’s an upgrade on next round, there will be a zoom interview www.dentist.com.au. before the successful practice is selected.

Q A

Q A Q A

March/April 2022

HEY

PODCAST LISTENER

HERE’S SOMETHING

JUST FOR YOU ! A BRAND-NEW PODCAST

PRACTICE GROWTH HQ

is your home for all things practice growth. IN THIS WEEKLY PODCAST

You’ll enjoy learning from thought-leaders, industry experts, best-selling authors, and thriving practice owners as they reveal their very best tips, tools, and strategies to help you grow your practice faster.

YOUR MULTI AWARD WINNING HOST

ANGUS PRYOR is an Amazon-best-selling author

PRACTICE GROWTH HQ DROPS EVERY WEDNESDAY With great content on

International speaker and

MARKETING Tactics

TEAM Building

Australia’s no.1 Googleranked dental marketer.

BUSINESS Strategies

PERSONAL Development

IN EPISODE 1

IN EPISODE 2

you’ll hear from Dr Mark Costes who has built nothing short of a dental empire. Yet, for a man of great achievement, Mark is a man of great humility and willingness to share what he has learnt along the way.

You’ll hear from Pete Williams from Deakin University in Melbourne. He’s a serial entrepreneur, (part time academic) and best-selling author of ‘Cadence: a tale of fast business growth’,where he reveals7 key levers to growing faster.

IN EPISODE 3 clinical psychologist, Kasey Compton, talks about her new book ‘Fix This Next for Healthcare Providers’. She discusses the simple system that shows you exactly what to fix next in your quest for practice growth.

Practice Growth HQ is available now on all popular podcast channels visit www.PracticeGrowthHQ.com

WIN! TheUltimate...

Practice Makeover 2022 WIN a complete public image update valued at over $90,000! If you love being a dentist but recognise that your practice is not where it needs to be, then take heart! For the first time ever, you could win the “Ultimate Practice Makeover” valued at over $90,000! This package of products and services will completely update the public image of your dental practice and get you and your staff trained and on track for business success over a 6-month journey.

Hurry! Entries close on 31 May 2022.

ENTRY REQUIREMENTS To be eligible to enter, all you need is a dental practice in Australia. Visit www.ultimatepracticemakeover.com.au (takes 2 minutes to apply) and look out for an email from us with the next steps. Plus, if you win, you’ll need to be ready for a fun adventure as your practice is transformed from wallflower to sunflower. Your practice’s journey will be documented on video and your results published for other practices to see – and follow along – so be prepared for some fun in the spirit of reality television as your practice is tuned for maximum success.

Visit www.ultimatepracticemakeover.com.au and apply now!

PRIZE PRIZEINCLUDES… INCLUDES… Refresh Refreshofofyour yourwaiting waitingarea areaand andsignage signage PRIZE INCLUDES… valued at up to $40,000 valued at up to $40,000 A review practice Refresh of your waiting area and signage Afull fullmarketing marketing reviewof ofyour your practice with valued at up to style $40,000 withaa“SWOT” “SWOT” styleanalysis analysis($3500 ($3500value value AA12 Channel DDplus full marketing review oftoto your practice 12month monthsubscription subscription Channel plus a your area with “SWOT” style analysis ($3500 value aTV TVafor for yourreception reception area($3100 ($3100value) value) Development ofofaamarketing strategy ADevelopment 12 month subscription to Channel D for plus marketing strategy for July 2021 ($2000 value) aJuly TVto for your reception ($3100 value) toDecember December 2021area ($2000 value) Full - -logo, colours, style Development of a marketing Fullbranding brandingpackage package logo,strategy colours,for style guide value) July toand December 2021 ($2000 guide andmore... more...($1000 ($1000 value)value) New website Full branding package logo, colours, style New websiteand andSEO SEO-package package ($12,000 guide andvalue) more... ($1000 value) ($12,000 value) Refresh ofofyour waiting area New website and SEO package Refresh your waiting areaand andsignage signage valued up ($12,000 valuedatatvalue) uptoto$40,000 $40,000 Online including Refresh of your waiting areadentist.com.au and signage Onlinemarketing marketing including dentist.com.au premium ($2000 valued at upgrade up to $40,000 premium upgrade ($2000value) value) New patient welcome packs Online marketing including dentist.com.au Newuniforms, uniforms, patient welcome packsand and more... value) premium upgrade ($2000 value) more...($2500 ($2500 value) Tablet with loaded New uniforms, patient welcome packs and Tablet withSpeedPixTM SpeedPixTM loadedfor forbetter better case conversion ($1500 value) more... ($2500 value) case conversion ($1500 value) Marketing 66months toto Tablet withconsultancy SpeedPixTM loaded for better Marketing consultancyfor for months help you “stay on plan” ($10,000 value) case ($1500 helpconversion you “stay on plan” value) ($10,000 value) Training you Marketing consultancy forteam 6 months to Trainingfor for youand andyour your team ($2000 value) help you value) “stay on plan” ($10,000 value) ($2000 Telephone training Training foranswering you and your team Telephone answering training ($3500 value) ($2000 ($3500 value) Treatment coaching Telephone answering training Treatmentpresentation presentation coaching ($2000 ($3500 ($2000value) value) New management software Treatment presentation coaching Newpractice practice management software (if ($5000 ($2000 value) (ifrequired) required) ($5000value) value) A roadmap for success New practice management software Aclear clear roadmap foryour yourfuture future success- Priceless! (ifPriceless! required) ($5000 value) A clear roadmap for your future success Priceless! SPONSORED BY... SPONSORED BY...

Reception Receptionand andwaiting waitingarea areaupdate update You Younever neverget getaasecond second chance to make a chance to make agood good Reception and waiting area update first firstimpression. impression. You never get a second Marketing might chance to make goodpatients Marketing mightabring bring patientstotoyour yourfront front door, but how do they feel when they first impression. door, but how do they feel when theywalk walk through throughit? it?As Aspart partofofthe theprize, prize,Medifit, Medifit, Australia’s oldest and most dental Marketing bring to your front Australia’smight oldest and patients mostaccomplished accomplished dental surgery design and construction company door, but design how doand theyconstruction feel when they walk will surgery company will makeover reception and through it?your As part of the prize, Medifit,area makeover your reception andwaiting waiting areatoto make your makes the first Australia’s and most accomplished dental makesure sureoldest yourpractice practice makes theperfect perfect first impression. surgery design and construction company will impression. makeover your reception and waiting area to Every practice different and will make yourisis practice makes the perfect first Everysure practice different andMedifit Medifit willcraft craft a impression. abespoke bespokesolution solutionbased basedon onyour yourindividual individual situation situationthat thatcould couldinclude includenew newwaiting waitingroom room furniture, reception desk an Every practice is different andlighting, Medifit furniture, reception deskand lighting,will ancraft updated colour scheme and aupdated bespoke solution based onmore your individual colour scheme and moreup uptotothe the value situation that could include new waiting room valueofof$40,000. $40,000. furniture, reception desk and lighting, an Medifit work with and the updated colour scheme and more up to the Medifitwill will work withyou you and thepractice practice makeover marketing value of $40,000. makeover marketingteam teamtotodeliver deliveraastunning stunning reception receptionand andwaiting waitingarea, area,from from3D 3Drenderings renderings of practice through Medifit will work withwill you and the practice ofhow howyour your practice willlook lookright right throughtoto delivering working around your makeover marketing team to deliver a stunning deliveringthe theupgrade, upgrade, working around your schedule minimal disruption. Your reception and waiting area, from 3D renderings scheduleto toensure ensure minimal disruption. Your reception and waiting area and public image ofreception how your practice will look right through to and waiting area and public image will shine once Medifit have worked their delivering upgrade, around your will shine the once Medifit working have worked their magic. will schedule toentire ensure minimal disruption. Yourfor magic.The The entireexperience experience willbe befilmed filmed for broadcast on Dentevents.tv and elsewhere, reception area and public imageas broadcastand on waiting Dentevents.tv and elsewhere, as well as ininmagazines so will shine once Medifit have worked their inin well asfeatured featured magazines soeveryone everyone the can understand the magic. The entire experience will beadvantage filmed for theprofession profession can understand the advantage of with an professional broadcast Dentevents.tv and elsewhere, as ofworking workingon with anexperienced, experienced, professional dental and well aspractice featured in magazines so everyone in dental practicedesign design andconstruction construction company like the profession can understand the advantage company likeMedifit. Medifit. of working with an experienced, professional dental practice design and construction company like Medifit.

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dentevents.tv

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Dentapen: Painless, effortless, cordless dental anaesthesia is back!

entapen is back and now available from William Green Pty Ltd. The next generation of electronic syringe took Australia by storm when it was launched in March 2020 but following a global distribution change, became unavailable locally in recent times.

Performing the right injection is the first step toward a pain-free patient experience naesthesia is a first and essential step for most dental procedures. But dentists face a variety of issues when using a traditional syringe such as adhering to the recommended injection time (i.e. 1 millilitre in 1 minute); variations in pressure, which can damage tissue and cause discomfort to the patient; and keeping the quality of injections consistent throughout the day. With the Dentapen, these challenges are greatly reduced.

Dentapen: a new generation of electronic syringe to perform pain-free injections ike most electronic syringes, the Dentapen injection is monitored with a constant flow, at the right pace. This gives the dentist the opportunity to focus more on needle insertion, leading to better control of the injection

40 Australasian Dental Practice

and a reduction in pain for the patient. For instance, during a study done on 50 dentists who received a palatal injection, 96% of them preferred injections from an electronic syringe versus a manual syringe and their pain perception was reduced by a factor of two. What makes the Dentapen different is that it is a selfcontained, cordless, intuitive device that matches the dentists’ habits. There is no console, no foot pads, no tubing or proprietary disposables. It can be held in two different ways - by the wings, like a manual syringe, or pen-like, for a precise injection during special procedures. And dentists can use ANY local anaesthetic cartridge and their FAVOURITE dental needle. Patients find the small, modern look to be less threatening and more reassuring, helping them to relax.

Made in Switzerland entapen continues to be manufactured by Juvaplus, a company founded by Bernard-Pierre Legrand in 2011. Specialising in the design and production of compact and wireless motorised devices, Juvaplus quickly imposed itself as a leading innovative company in the medicine market. Juvaplus develops products that combine research, design and technology at the service of medicine and is based in Fleurier, Switzerland.

For info, call William Green on 1300-363-830 or visit williamgreen.com.au/products/by-brand/7/dentapen-pro

March/April 2022

E E Y R F TR EN

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

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

Brisbane Convention & Exhibition Centre @ausdental

See you at

#ADXexpo #ADXBrisbane

/ ADXexpo @adxexpo

AUSTRALIA’S PREMIER DENTAL EVENT

Better Quality of Life for Your Patients Interview with PD Dr. Daniel Thoma (University of Zurich, Switzerland) What do you like about Geistlich Fibro-Gide®? What I like most about Geistlich Fibro-Gide® is its unlimited availability and its standardised quality. In contrast to subepithelial connective tissue grafts, Geistlich Fibro-Gide® does not give a reason to worry about limitations in terms of quantity and quality. Moreover, avoiding a second surgical site reduces patient morbidity as well as my surgical time. . Do you see any risks in the use of Geistlich Fibro-Gide®? Every surgical intervention is associated with certain risks. Thus, in the case of Geistlich Fibro-Gide®, incomplete wound healing might occur with exposure of the material to the oral cavity. Based on our own experience, such complications do not result in any local infection, and the material does not have to be removed. As such, I would even expect less risk than with the use of a subepithelial connective tissue graft. When patients need a soft-tissue augmentation procedure, what do you tell them?

one is the use of a subepithelial connective tissue graft. This procedure is well-documented in the literature with long-term outcomes and considered the gold standard. As an alternative, the use of Geistlich Fibro-Gide® is suggested, which offers benefits in terms of reduced patient morbidity, surgical time and unlimited availability. My patients are informed that the use of Geistlich Fibro-Gide® is less documented, but in pre-clinical and clinical research performed over a ten year period, the outcomes were non-inferior to the gold standard.3,18 How do your patients benefit, and how do you benefit from using Geistlich Fibro-Gide®? Advantages for me are the unlimited availability and standardised quality, as well as the ease of use and faster surgeries. My patients benefit from shorter treatments, less swelling and less morbidity since no second surgery is needed. Larger areas and more sites can be treated at the same time.

I usually offer my patients two options when a soft tissue grafting procedure is indicated. Option

“Avoiding a second surgical site reduces patient morbidity as well as my surgical time.” PD Dr. Daniel Thoma

Register your interest for our educational Fibro-Gide® hands-on courses and live surgery events at the ADX Geistlich booth #81.

Geistlich Fibro-Gide®

The alternative to connective tissue grafts

Geistlich’s Collagen Expertise

The first volumestable collagen matrix designed for gaining soft-tissue thickness.1,2 1 European Patent Specification – EP 3 055 000 B1. 2 Data on file. Geistlich Pharma AG, Wolhusen, Switzerland.

For more information please contact your local Geistlich Product Specialist or call 1800 776 326 or NZ 0800 500 043.

dental | UNITS

New Diplomat “Connected” dental chair

he Diplomat Dental Chair is a revolutionary product that continues to be an integral part of dental spaces globally. It’s no ordinary dental chair – it’s designed to be your assistant while serving your patients. It’s your best shot to turn dentistry from ordinary to extraordinary. Diplomat Dental is an holistic package deal of advanced ergonomic features, convertibility, stability and compatibility.

connect the chair and Voila! You can now make a preventive appointment, convert the configuration, or change the inclination of the seat and backrest, all from your tablet. Even odd jobs like bowl rotation, cup filling and bowl rinsing can be easily managed through the device. The cherry on the cake is it also notifies you of potential errors. These errors can be automated for your technician to resolve in no time.

All comfort, no effort

he Diplomat Dental chair is designed for occupant comfort. But diving a little deeper, the dental chair has very compact dimensions, which makes it a perfect fit for smaller operatories. The robust body is layered with UV resistant paint. It has an articulate and foldable armrest, multi-functional and programmable foot controller and a 3-D headrest with manual and pneumatic adjustment. The dental unit is equipped with a movable bowl that provides an ideal rotation up to 120 degrees to the patient and out.

ometimes calming your nervous patients can be taxing. Acknowledging this fact, Diplomat Dental’s dental chair is designed to provide maximum comfort to your patients. The seat offers customisable positions and instrument parameters for every occupant. How? With a gentle touch of your finger, you can control all the inclination settings, both for seat and backrest from your tablet. It’s that easy!

Advanced automated controls o wonder, medicine and technology go hand in hand and Diplomat Dental is the perfect example. You can literally operate the dental chair with your tablet. All you need to do is download the Diplomat Connect app on your tablet,

44 Australasian Dental Practice

Designed to perfection

Left-hand friendly inding the ideal equipment set for a left-handed person can feel like an ordeal. With the Diplomat Dental Chair, you can say goodbye forever to all these clumsy and confounding chores.

You can switch the configuration, instrument panels and trays to the likes of your dominant hand - effectively the whole structure of the chair - in just a matter of a few seconds.

Butter-smooth workflow very operation, every dentist and every surgery are different and so are their requirements. No matter what your requirements are, you can count on the Diplomat Dental Unit to adapt.

Installation and servicing by William Green smooth installation by expert service technicians from Authorised Australian Distributor William Green Pty Ltd backed up by ongoing customer-focused service is part of the Diplomat Dental experience. Avoid unnecessary service call out fees with remote diagnostics making it possible to fix the issue remotely or if that’s not possible, a technician will arrive to solve the pre-diagnosed problem, saving you precious chair time. You focus on the dentistry and William Green will worry about the chair - Upgrade your chair and downgrade your stress!

For info or a showroom demo, contact William Green on (02) 8865-0300 email sales@williamgreen.com.au or visit www.williamgreen.com.au

March/April 2022

The only Dental Unit controlled with a single click

1300 363 830 sales@williamgreen.com.au www.williamgreen.com.au

spectrum | NEWS

New “plug and play” U-SENSE sensors

cteon Australia has launched two new sensors designed to improve digital workflow in dental practices: The affordable U-SENSE and U-SENSE HD. Both the U-SENSE and U-SENSE HD sensors provide the benefits of outstanding picture quality, enhanced digital imaging workflow and high levels of patient comfort. A-dec Australia product manager, Angie Wong, said Acteon’s Fiber2pixel technologyw means users won’t miss any details in their clinical images. “Thanks to the CMOS sensor’s HD multi-layer technology, the U-SENSE produces low noise and high contrast images, displaying the region of interest with outstanding sharpness,” she said. “All the anatomical structures are represented with great precision, allowing a faster and safer diagnosis. With an image resolution of up to 25-line pairs per millimetre (25lp/mm), the U-SENSE HD sensors provide very high-quality images for accurate and reliable dental diagnostics every time.” The Acteon U-SENSE and U-SENSE HD sensors are available in two different sizes - 200 x 300 mm - corresponding to size 1 and suitable for paediatric patients, periapical and endodontic images and the 260 x 340 mm sensor - corresponding to a size 2 film and ideal for occlusal and bitewing examinations. Practitioners can choose the size that best suits their patients and the focus of their typical clinical examinations. Designed to be as practical as they are powerful, Mrs Wong said the rounded corners of the intra-oral sensors had been designed to make the examination more comfortable for patients. “Comfort in the mouth is a key element for reliable and accurate imaging and reducing patient anxiety,” Mrs Wong said.

46 Australasian Dental Practice

Quick imaging a real time saver he Acteon Group has focused U-SENSE and U-SENSE HD on ease of use and simplification of the dental process to achieve the best results in record time. “With an acquisition time of only three seconds, you can view your clinical images almost instantly during patient diagnosis,” Mrs Wong said. “Simply connect the USB cable from the sensor directly to your computer to benefit from the clinical shots and share them with your patients.” Because of the 3-metre-long cable, practitioners can easily adapt the fully portable sensors to any sized surgery. A shock absorption area has been integrated into the structure of the sensors to improve durability during day-to-day use. These new sensors, which were launched at ADX22, are a more affordable alternative to the high-end Sopix2

premium sensor, also available from Acteon through A-dec dealers. The new U-SENSE sensors are also compatible with the powerful Acteon Imaging Suite imaging software which allows the practitioner to easily and accurately monitor patient abnormalities.

“With an image resolution of up to 25-line pairs per mm, the U-SENSE HD provides very high-quality images for accurate and reliable diagnostics every time...” The open architecture of Acteon Imaging Suite makes it possible to export images to patient management software and to also import information such as dental implant databases. Contact A-dec on 1800-225-010 or visit acteongroup.com for more information.

March/April 2022

IT’S TIME FOR PLUG & PLAY

A new high-tech intraoral sensor providing versatility, reliability in image quality and ease of use in the daily workflow

FOR MORE INFORMATION, CONTACT YOUR LOCAL AUTHORISED DISTRIBUTOR

Class II with type A applied parts Medical device according to 93/42/CEE -CE0051 (IMQ) - Manufacturer: De Götzen Distributor: de Götzen

Dental Installations Miranda (02) 9526 3500 Pegasus Dental Services South Hurstville (02) 9585 1100 Presidental Warners Bay 1800 773 743 Silverwater 1800 773 743 Southern Dental Tech Services Engadine 0438 702 151

Tristan’s Dental Equipment Service Campbelltown (02) 9820 8086

QLD

Dental Depot Windsor (07) 3857 0011 Medical Dental Solutions NQ Currajong (07) 4728 2055 Loganholme (07) 3801 5797 Presidental Mansﬁeld 1800 773 743

Leading Dental Murarrie (07) 3139 1549 QDS Noosa Heads 1300 770 977

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Alldent Port Melbourne (03) 9646 3939 Medi-Dent Braeside 1300 886 674 Presidental Clayton 1800 773 743

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Dental Intelligence Osborne Park (08) 9244 8888 West Coast Dental Depot Belmont (08) 9479 3244 JAD2200004

NSW/ACT Chairs Delivery Systems Lights Monitor Mounts Cabinets Maintenance Imaging

spectrum | NEWS

Pola For Aligners : Advanced take home tooth whitening optimised for aligners

DI Limited has launched Pola For Aligners, an advanced tooth whitening system that combines Pola’s award-winning whitening formula with the growing use of clear orthodontic aligners. With the clear aligner market forecasted to grow 25% in the next 5 years, more patients are looking to combine tooth whitening with their orthodontic journey. Pola For Aligners can easily be used as a take home kit, ensuring a great patient experience by providing whiter, brighter smiles with no additional wear time. Pola For Aligners combines the same benefits of the award-winning Pola whitening formula. The neutral pH gel ensures the greatest patient comfort in a whitening kit and the high-water content gel contains potassium nitrate and fluoride to reduce sensitivity and increase patient compliance. The high viscosity gel ensures it can be easily and securely placed into the aligner tray, staying in place. The pleasantly flavoured spearmint gel is both fresh and long lasting. The Pola For Aligners system is available in Pola Night 10% carbamide peroxide gel that has been carefully selected as the ideal whitening agent to suit any aligner system. It enables patients to customise use between meals for just a couple of hours a day, to the convenience of overnight wear. Pola Night 10% can be used from 1-2 hours per day to overnight. Usually patients will notice whiter teeth after one or two days of treatment. Clinical research has identified 10% carbamide peroxide as the Gold standard in teeth whitening, providing optimal whitening results whilst maintaining maximum patient safety and comfort.1 Not only does Pola For Aligners whiten teeth but it will also assist in maintaining oral hygiene of patients with the active ingredient, Carbamide Peroxide, a well-researched antimicrobial agent.2 Additional benefits of using 10% carbamide peroxide in the clear aligner tray may

48 Australasian Dental Practice

“Not only does Pola For Aligners whiten teeth but it will also assist in maintaining oral hygiene of patients with the active ingredient, Carbamide Peroxide, a well-researched antimicrobial agent...” be improved oral hygiene and reduction of caries. Studies show that 10% carbamide peroxide has shown an improvement in gingival indices during treatment.3 The Pola For Aligners premium packaging is crafted to elevate the appeal of Pola whitening gels above other less effective pharmacy and online options. This gives clinicians the confidence and support to introduce whitening to their orthodontic patients. Pola For Aligners can be easily combined with a premium aligner system of choice and is available as a professional only product to clinically qualified dental professionals. Pola for Aligners can be prescribed as a once off treatment during the orthodontic treatment and can be customised for extended periods of use, in order to achieve an optimal whitening result. The Pola tooth whitening range has success-

fully whitened the teeth of millions of people worldwide. SDI has an ongoing commitment to providing better tooth whitening solutions that are safe, simple and effective. Pola tooth whitening is an Australian innovation and Pola For Aligners is available through all major distributors. For more info, visit www.sdi.com.au

References 1. Efficacy of Pola Night on tooth whitening. 24 months post treatment on Japanese 2006 - Tsubura Shuichi. Clinical evaluation of new bleaching product “Pola Night” on Japanese population 2005 – S Tsubura, R. Yamaguchi 2. Whitening, therapeutic aesthetics and oral health improvement: The future - Dr. Linda Greenwall 2013. 3. Teeth Bleaching Efficacy During Clear Aligner Orthodontic Treatment - Rhoda J. Sword, DMD; and Van B. Haywood, DMD.

March/April 2022

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NOW YOUR PATIENTS CAN ENJOY A BRIGHTER, MORE CONFIDENT SMILE IN 5 DAYS. • Fast acting, delivering whiter teeth in as little as 5 days • Formulated to safely remove long term stains • Fully rechargeable for future tooth whitening treatments • Remineralisation to strengthen the teeth • Extra hydration to minimise sensitivity • No custom tray required • Available in 6% and 9.5% hydrogen peroxide

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

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table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Pulpitis Pulpitis discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Irreversible Pulpitis Irreversible Pulpitis n it comes to the perfect fit, Hu-Friedy is just right. MANAGING Pulpitis Irreversible Pulpitis n it comes to the perfect fit, Hu-Friedy is just right.Irreversible MANAGING Pediatrics Endodontics MANAGING Irreversible Pulpitis ™ Biodentine saves pulps EVEN with signs and symptoms As world leader in Pain Management, Septodont TS LOVE OUR STAINLESS STEEL Pediatrics PEDO CROWNS: Endodontics MANAGING ™ Biodentine saves pulps EVEN with signs and symptoms ™ of world irreversible pulpitis* Ultra Safety with the new Twist Lock ™Plus As leader in Pain Management, Septodont Biodentine saves pulps EVEN with signs and symptoms TS OUR STAINLESS STEEL PEDO CROWNS: provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms ableLOVE outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. As leader in Pain Management, Septodont ™ of world irreversible pulpitis* ™ pulps Biodentine saves EVEN with signs and symptoms of irreversible pulpitis* provides you products and services to help you As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with and symptoms eight and width patented design your safety device oflittlest irreversible pulpitis* able outcomes for your with Hu-Friedy Stainless Steel Pedo Crowns. administer experience, amongst those : As world leader inmakes Pain Management, Septodont iscover whymesio-distal dentists favor our patients impeccable fit. Perfect for your patients. Easy forsigns you. ™painfree provides you products and services to help you ofbiocompatible Biodentine ™ ™brings one-of-a-kind benefits for the treatment of irreversible pulpitis* ™ dentin wherever As the first all-in-one andMANAGING bioactive dentin substitute, fully replaces it’s damaged. Biodentine Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : For vital pulp therapy, bulk-fi lling the cavity with Biodentine iscover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. it comes the perfect fit, Hu-Friedy isproducts just right. ™placement provides you and services to help you even easier to use. administer painfree experience, amongst those mmed andtopre-crimped for simple brings one-of-a-kind benefi ts for the treatment of Biodentine ™ 85%** ™ : up to of irreversible pulpitis cases: MANAGING ™ ™ PRACTICE fully replaces dentin wherever it’s damaged. Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier and faster: it comes the perfect fit, Hu-Friedy is justfirst right.experience, Septanest :of the choice of tsdentists with over administer painfree amongst those mmed andtopre-crimped for simple placement ™ 85%** ™ : up to irreversible pulpitis cases: world leader inone-of-a-kind Pain Management, Septodont ™CROWNS: helps of dentin, preserves the pulp brings one-of-a-kind benefi for the treatment of the Biodentine to As 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OURup STAINLESS STEEL PEDO occlusal anatomy that matches the natural tooth brings benefi ts Biodentine for the treatment of remineralization PRACTICE Biodentine makes your procedure better, easier and faster: up to 85%** of irreversible pulpitis cases: PRACTICE Septanest : the first choice of dentists with over Available with either sterile single-use or ™ bioactivity 150 million injections per year, provides you high • Pulp healing promotion: proven biocompatibility and As world leader in Pain Management, Septodont ™ helps the remineralization of dentin, dentin preserves pulp Biodentine vitality and promotes pulp healing. It replaces withthe similar Septanest : the first choice of dentists with over up to 85%** of irreversible pulpitis cases: provides you products and services you • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OUR•anatomy STAINLESS STEEL PEDO CROWNS: occlusal that matches the natural tooth brings one-of-a-kind benefi tsto forhelp the treatment of up tomillion 85%** ofallowing irreversible pulpitis cases: PRACTICE Vital Pulp Therapy complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •Biodentine Vital Pulp Therapy allowing complete dentin bridge formation ght and mesio-distal width 150 injections per year, provides you high • Pulp healing promotion: proven biocompatibility and bioactivity sterilisable handles quality you can trust vitality and promotes pulp healing. It replaces dentin with similar Reduced risk of failure: strong sealing properties Septanest : the first choice of dentists with over biological and mechanical properties. provides you products and services to help you injections perpulpitis year,dentin provides you high: administer experience, amongst those up tomillion 85%**painfree ofallowing irreversible cases: • Vital150 Pulp Therapy complete bridge formation

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Innovative nature Innovative byby nature safe Plus, Withpatients Ultra Safety needle stick To injuries enjoy clinical benefitsforofBiodentine the first and. only dentin in a capsule, ask your the dental distributor Innovative by nature Innovative by nature Innovative by nature ask your dental distributor for Biodentine . Innovative by nature decreased fromby an average of 11.8 to 0 injuries per Innovative nature Innovative by nature Exclusively available Exclusively available (1) in New Zealand fromhours worked in Australia from Innovative by nature Exclusively available Exclusively available 1,000,000 ™

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

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

spectrum | NEWS

Next March marks 100 years of IDS

DS, the leading global trade fair of the dental industry is celebrating a double anniversary next year: Not only will the 40th edition of the International Dental Show be staged from 14 to 18 March 2023 in Cologne, Germany, IDS is also looking forward to its 100th birthday. The success story of the dental world is inseparably linked with IDS, because the leading trade fair is based on a system of values that makes it unique. 100 years of IDS stands for the depiction of the industry in its entirety, for innovations and market trends, for a consistent and open comparison of performance in the sense of the Olympic principle and last, but not least, for a leadership claim as the largest international industry platform that has been repeatedly confirmed for decades. When the online applications kicked off in February, the centenary edition of the world’s largest trade fair for dentistry

52 Australasian Dental Practice

and dental technology received numerous inquiries for exhibition space from myriad companies. The first planning phase is now underway. The success story and the anniversary of IDS are also an outstanding result for Cologne-based organiser Koelnmesse, because the International Dental Show has now been staged at the trade fair location in Cologne for over 30 years. At the time, the Association of German Dental Manufacturers (VDDI), decided to provide IDS with a permanent home in Cologne from 1992 onwards and to entrust Koelnmesse with organising the trade fair. Before this, the IDS was staged in different locations by different organisers. Cologne (Köln) is the largest city on the Rhine River and the fourth most populous city in Germany. The city’s medieval Catholic Cathedral (Kölner Dom), is a globally recognised landmark. Visit www.ids-cologne.de for more information.

March/April 2022

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dentevents presents...

Infection Control

BOOT CAMP 2020 BOOT CAMP ON DEMAND ONLINE LEARNING PROGRAMME

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

HOURS CPD

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

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

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

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

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

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

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

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Keeping your details up-to-date on dentist.com.au just became far easier

ustralia’s number one find-a-dentist website www.dentist.com.au has introduced a new option that allows you to quickly request your practice to be listed or changes made to your existing listing. “Our goal continues to be to publish the most up-to-date and comprehensive list of practices and practitioners in both Australia and New Zealand to allow the general public to easily locate a dentist of their choice,” said Joseph Allbeury, publisher of dentist.com.au, dentist.co.nz and this magazine. “In order to facilitate that even further, we have introduced a new option to make the process of adding or updating your information far easier. “Simply click on the For Dentists link on the website and follow the instructions to display the update form. Once you’ve completed the form with all your details, your practice will be added or updated within a day or two.” Mr Allbeury said that the more information you include and the clearer you make the requested changes, the faster your information will be updated. “Please spell out if there is a change in circumstances, like a new owner at the practice or a name change or if you’ve moved. We process every request manually and if we have to do a lot of detective work, it delays the process,” he said. “We typically align all our information with the information on your website, so spell it out if your website doesn’t reflect the changes you’re requesting. We read it all! “Equally, if you don’t have a website at all, then let us know things like your opening hours for example.” All dental practices listed on the website must also have at least one dentist linked to the practice. If there is no dentist, or in the case of a denture clinic, no prosthetist, then the software blocks the listing from being displayed.

“Every practice on the website needs to have at least one dentist linked to it,” Mr Allbeury said. “And before we add a dentist to our system we check that the dentist - and indeed all practitioners in the system - are registered with AHPRA. If we cannot verify your registration record, then we don’t list you on dentist.com.au.” Mr Allbeury said that all practitioners are recorded in the system under the name they are registered under with AHPRA. However, practitioners can choose to have their information displayed using an alternative first name [preferred name]. “We ask that you list all the practitioners working at your practice on the form and it’s very helpful if you list the name you’re registered under too. Then you can also list your preferred name. We have lots of dentists called Robert who like to be known as Bob, for example. Or dentists using their middle name or a nickname or a Western name. It’s no problem, we just need to be able to verify you’re registered.” Mr Allbeury said that whilst using the form is quick and easy, using your Dental Community login to directly update your information remains the preferred option for managing your online presence.

“The best way to maintain your information remains logging in to the Dental Community website,” he said. “This gives you direct access to your own information and so many more options. “If you own a practice, it gives you full control over who works there and the information that is displayed, plus you can see live Google Analytics of who is looking at your information. “If you don’t own a practice, you can log in and link to the practices where you do work or remove yourself when you leave a practice. “You can sign up by visiting the website at www.dentalcommunity.com.au and start managing your own information. It’s simple and it’s free. “Either way, we encourage everyone to visit www.dentist.com.au and work with us to ensure your info is correct.” www.dentist.com.au processes over a million searches per annum from members of the public searching for a dentist. Whether you have a website, or particularly if you do not have a website, ensuring your details are accurately listed will help patients connect with you and your practice.

Add or update your details at www.dentist.com.au/information-for-dentists

56 Australasian Dental Practice

March/April 2022

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spectrum | NEWS

Load your videos on Dentevents.TV

ideos on anything to do with dentistry can now be loaded by anyone through the Dental Comminity portal for streaming on Dentevents.TV. “Since we launched Dentevents.TV last year in response to the first of the COVID-19 lockdowns, we’ve painstakingly loaded hundreds of videos onto the platform on behalf of others,” said Joseph Allbeury, publisher of this magazine and Dentevents.TV. “Now we’ve released new functionality within www.dentalcommunity.com.au to allow anyone to DIY. You simply login, click Manage Your Videos and then Add Video to begin the upload process. “With this next natural evolution of Dentevents.TV, we’re hoping to attract a more diverse range of content for the platform and in doing so, attract an even larger and more diverse audience.

New Dentevents.TV features include... n

n n

“To date, the content is largely based on recorded webinars and information relating to dental products,” Mr Allbeury said. “And we have also started producing our own content series as well, but we need much more. By allowing anyone to upload videos, we hope to be able to help content creators build their profiles.

Ability to upload your own videos for streaming on www.dentevents.tv Content can be anything dental! Engage with your viewers like never before Allocate CPD for watching your videos with or without a CPD quiz Create your own channel and build an audience Create your own private education platform Monetise your videos to earn $$$

“Educational content creators will have a platform to stream videos, issue CPD certificates to viewers or ask CPD quizzes. Content can also be monetised on a payper-view or subscription basis if desired.”

Organising a dental event, l show or we New Expresscongress, Listings fortrade dentevents.com Sign in to www.dentalcommunity.com.au and you can start adding videos today!

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

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

2022 58 Australasian Dental PracticeNo username, no password and no need to login - add yourMarch/April event

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spectrum | NEWS

A new look and feel for the future: Ivoclar Group updates visual identity

or the Ivoclar Group, one of the world’s leading providers of integrated solutions for high-quality dental applications with a comprehensive product and system portfolio for dentists and dental technicians, values, convictions and a progressive, customeroriented corporate culture are the basis of its strong brand. For almost 100 years, the company, headquartered in Schaan, Liechtenstein, has been shaping the dental market with its name, product innovations and industry-leading pioneering achievements. Working with dental professionals to give people around the world a healthy and beautiful smile is the company’s stated mission. Already started in 2021, Ivoclar set new accents with targeted activities that are even more strongly focused on the needs of the customer. In order to visually underline the new departure into a customer-oriented, modern and innovative age, Ivoclar is starting the new year with a fresh appearance and an adapted logo. The most important change: the “Vivadent” in the brand name and logo has been dropped, as have some additional visual elements, so that in future, the company’s clear focus on the essentials will also be reflected in the logo.

The brand as a guiding principle ith its focus on putting people, partners and customers at the center of its activities, Ivoclar underpins its claim to make the workflows in the daily work of dental technicians and dentists easier and more efficient and likewise to make the patient experience as pleasant and personal as possible. The brand image is and remains a first point of contact with the company. This is precisely why it is so important that the brand’s appearance also serves the function of a mission statement and reflects the innovative strength that is lived out. At Ivoclar, the external understanding of the brand rests on three supporting pillars:

60 Australasian Dental Practice

1. Partnership and customer eople, partners and customers are the focus of the daily actions and activities. The brand stands out with a straightforward design and consistent communication to the customer.

2. Innovation and technology voclar stands for progress through technological innovation. This carries the company’s mission: “Making People Smile”. Innovation, progress and continuous research and development, based on the needs of customers, ensure the success of tomorrow in the long term. With inno-

vative products and services, Ivoclar not only makes dental technicians’ and dentists’ workflows easier and more efficient, but also makes the patient experience shine positively.

3. Family and friends he Ivoclar Group is a family-owned company with heart and soul: reliability, transparency and communication at eye level are the basis of a good partnership - whether towards customers, employees or patients, who are all considered together as part of the Ivoclar family.

Focus on the essentials - the new look voclar already demonstrated a modern, fresh design approach last year with its new website, the appearance at its “The Live Experience Tour 2021” and in other communication areas. The reduction to the essentials, a lifestyle-oriented, emotional visual language that puts people in the foreground and, last but

not least, the development and use of modern marketing tools pay directly into the mission “Making People Smile”. It is only logical that the logo has now also been redesigned. The most striking feature is the reduction of the brand name to its essential component: “Ivoclar Vivadent” becomes “Ivoclar”. And even here, the consistent orientation towards the customer is evident, because many of Ivoclar’s business partners have long since dispensed with the suffix “Vivadent” in their daily usage. “With our long-standing tradition, our pioneering achievements and our constant innovation, we can rely on a strong corporate brand as a foundation”, explains Diego

Gabathuler, CEO of the Ivoclar Group. “Nevertheless, I am convinced that there is still a lot of unused potential for us here, which we want to fully exploit in the future. A clearly structured positioning, which is also expressed in the visual appearance, is particularly important with regard to a future-oriented alignment of the company, which leads to the innovation that places our customers and their patients at the centre of our actions and activities. For us, this is not just a matter of giving our logo some tweaks. Rather, the new corporate identity with its clear, reduced and focused visual language represents everything that our brand understanding stands for.” The new Ivoclar logo and corporate design will be used globally in all communication channels from now on - where this has not yet been incorporated - and will also be gradually applied to brochures and other printed collateral. For more information, contact Ivoclar in Australia on 1300-IVOCLAR or in New Zealand, call 0508-IVOCLAR or visit www.ivoclar.com

March/April 2022

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spectrum | NEWS

“Ivoclar Vivadent presents Cention Forte, the new, high-strength alternative to amalgam...”

Ivoclar Vivadent launches new Cention® Forte, a pioneering filling material featuring bioactive ion release

voclar Vivadent has launched Cention Forte and Cention Primer, a mercury-free system for filling dental cavities. The new bioactive basic filling material is superior to its traditional amalgam counterparts in almost every respect. It is suitable for the placement of permanent Class I and II fillings. The bioactive powder-liquid filling material is a truly innovative alternative to conventional amalgam filling materials. It is characterised by exceptional durability, high flexural strength, true-to-nature aesthetics and bioactive ion release.

Making people smile: Long-lasting aesthetic results igh flexural strength is an important factor for long-lasting restorations. In this respect, Cention Forte clearly

62 Australasian Dental Practice

stands out from commercial glass ionomer cements and delivers exceptional performance due to its high flexural strength values of over 100 MPa in the load-bearing posterior region. Cention Forte blends in seamlessly with the natural tooth structure: The material is tooth-coloured and has a high translucency of around 11%.

Highly sophisticated: Release of bioactive ions as required ention Forte helps to prevent demineralisation and promote remineralisation. This special filling material contains a sophisticated ion-releasing mechanism. If the pH drops due to the growth of cariogenic bacteria, Cention Forte will release hydroxide ions as required and therefore help to restore the pH balance and prevent the demineralisation of tooth structure. At the same time, the fluoride and calcium ions released

from Cention Forte can assist in the remineralisation of the tooth structure and the prevention of secondary caries.

A fully coordinated system: Cention Forte & Cention Primer voclar Vivadent additionally supplies a matching primer, therefore providing a fully coordinated system made up of Cention Forte and Cention Primer for the placement of basic dental fillings. The two-component Cention Primer has been specially developed for use with Cention Forte. The self-etching and self-curing primer provides the best possible foundation for filling procedures. Both products used together enable quick and efficient minimally invasive treatment.

For more information, visit Ivoclar.com or call 1300-IVOCLAR in Australia or in New Zealand, call 0508-IVOCLAR.

March/April 2022

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ivoclarvivadent.com | 1300 486 252

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

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

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

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

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

NOW YOU CAN CAN TAKE TAKE ON ON ALIGNER ALIGNER NOW YOU CAN TAKE ON ALIGNER CASES CASES WITH WITH CONFIDENCE CONFIDENCE CASES WITH CONFIDENCE Enjoy clinically successful aligner cases, with profitable and Enjoy clinically successful aligner cases, with profitable and predictable outcomes, evenaligner if it’s your first time. Enjoy clinically successful cases, with profitable and predictable outcomes, even if it’s your first time. The OrthoED Institute’s convenient even Clear Aligner training allow you to predictable outcomes, if it’s yourprograms first time.

The OrthoED Institute’s convenient Clear Aligner training programs allow you to develop the confidence and skills to offer exceptional standards of Orthodontic develop the confidence and skills toClear offerAligner exceptional standards of Orthodontic The OrthoED Institute’sofconvenient training programs allow you to treatments, regardless your previous experience. treatments, regardless of your previous experience. develop the confidence and skills to offer exceptional standards of Orthodontic Provide your patients with better Tap into aregardless rapidly growing market treatments, of your previous experience. Tap into a rapidly growing market Provide your patients with better clinical outcomes Learn principles that apply to all clinical Tap into a rapidlythat growing market Provideoutcomes your patients with better Learn principles apply to all aligners and a variety of cases Improve patient experience clinical outcomes aligners and a variety of cases Learn principles that apply to all Improve patient experience Take on more cases with aligners and a cases variety of cases confidence, Take on more patient referrals and practice Improve patient experience Boost no matterwith how Boost patient referrals and practice confidence, nocases matter how profits complicated Take on more with profits complicated Boost patient referrals and practice confidence, no matter how Increase job satisfaction Stand profitsout from the competition complicated Increase job satisfaction Stand out from the competition Increase job satisfaction Stand out from the competition

For more information visit www.orthotraining.com.au or For more information visit www.orthotraining.com.au or call 1300 073 427 for a free 30 minute consultation. For more call 1300 information 073 427 for avisit freewww.orthotraining.com.au 30 minute consultation. or

spectrum | NEWS

Luna Flow. Perfect flow. Perfect stay.

DI is proud to launch Luna Flow, the new extra strong light-cured flowable composite. With a blend of fillers in different ultrafine sizes to optimize handling, mechanical and optical properties, Luna Flow offers high radiopacity, control over application, easy shade matching, excellent strength, and wear resistance. Luna Flow a reliable and easy universal option for liners, bases, provisionals, restoration and provisionals repairs, Class V, and conservative Classes I to IV. Luna Flow was designed in two viscosities to suit all clinical needs. The regular viscosity offers superior handling and maximum control during application. This beautiful composite flows on demand, holds its shape and does not string. The low viscosity (Luna Flow LV) offers more flow, making it perfect for liners and bases. Using the Logical Shade Matching Technology with chameleon effect, Luna Flow shades were developed prioritising value (lightness), while pigments were arranged in a logically increasing way. The result is a simpler and faster match to the Vita Classical Shade Guide®, with lifelike translucency, opalescence, and fluorescence in every restoration. The Luna Flow filler formulation is primed for excellent polishing results, wear resistance and longevity. Luna Flow innovative formulation also offers exceptionally high compressive strength of 421 MPa to support the occlusal loads; very high flexural strength of 128 MPa for where flexibility is important to ensure restoration longevity; and outstanding radiopacity of 265% Al, providing a significant contrast to natural dentine/enamel (100%/170%) to aid faster and more precise diagnosis. Luna Flow is available in 12 shades, including one incisal, two opaques and two extra bleach shades. Luna Flow harmoniously blends with Luna 2 – the SDI BPA free universal composite. Luna Flow is an Australian innovation from SDI. For more information, please contact SDI at www.sdi.com.au.

66 Australasian Dental Practice

International Update Current infection prevention and control measures reduce transmission of SARS-CoV-2 in the dental clinical setting

his study examined the risk of SARS-CoV-2 transmission among dentists and their team members by sampling 2784 participants across Germany, using questionnaires and blood samples, to detect IgG antibodies against SARS-CoV-2. The staff used dental dam and surgical respirators during treatment when performing AGPs and patients used pre-procedural mouthwashes. The continuous high use of PPE, mouthwash and ventilation procedures during the wave of cases occurred because teams were very well prepared and appropriate supplies were available in sufficient quantities and knowledge was widely disseminated on how to mitigate SARS-CoV-2 exposure. The questionnaires were analysed to investigate demographic data and working conditions during the pandemic. There were 146 participants with positive SARSCoV-2 IgG antibodies (5.2%) and 30 subjects with a borderline finding (1.1%). Some 74 out of the 146 participants with SARSCoV-2 IgG antibodies did not report a positive SARS-CoV-2 PCR test (50.7%), while 27 participants without SARS-CoV-2 IgG antibodies reported a positive SARS-CoV-2 PCR test (1.1%). Combining the laboratory and self-reported information, the number of participants with a SARS-CoV-2 infection was 179 (6.5%). The risk of SARS-CoV-2 transmission was not higher among the dental team compared to the general population of Germany. The findings contrast with those of a study with over 1500 dental team members which was performed in May 2020 in the UK during the first wave, when PPE shortages existed and other control measures were not used. The UK infection rate was twice as high for dental staff as for the general population (16.3% vs 6-7%). Hence, these results show that following hygienic regulations and infection control measures ensures the safety of the dental team and their patients and provides confidence that dentists and their team members are not at higher risk for patient-dentist transmission of SARS-CoV-2.

Mksoud M et al. Prevalence of SARS‑CoV‑2 IgG antibodies among dental teams in Germany. Clinical Oral Investigations 2022 https://doi.org/10.1007/s00784-021-04363-z

3Shape and Envista partnership in A/NZ

Shape Oceania is extending its global partnership with Envista, one of the largest global dental product companies in the world, in 2022. In January 2020, 3Shape and Envista became global strategic partners and from March 16, 2022, Envista will honour this partnership by distributing TRIOS and related software packages in Australia and New Zealand through Nobel Biocare and Implant Direct. Envista represents more than 125 years of dental industry excellence with brands including Nobel Biocare, Ormco, Spark, Implant Direct, Orascoptic, Kerr and Dexis.

March/April 2022

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Source: Dr. Edoardo Fossati, Turin, Italy

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

product | REVIEW review

New Colgate Optic White Light Up By Emeritus Professor Laurence J. Walsh AO

oday there are quite a few different options available in the at-home tooth whitening space. Using carbamide peroxide or hydrogen peroxide gels in custom-made vacuum formed trays has been the norm in dental practice since the 1980s. Every so often, something comes along which represents a significant improvement in that overall approach. Colgate, who revolutionised the consumer tooth whitening market with the first paint on product (Simply White) have now come up with a clever way to extend the concept of a paint on product and combine it with an LED array to boost the overall effect.

Visible light can improve the results of bleaching through a range of different mechanisms including photochemical and photothermal processes. I did notice that the colour of the light produced by the LED array in the Colgate unit was different from that of other LED oral lamps that I have seen. The wavelength was shorter (more towards the indigo end of the spectrum, rather than towards the light blue region). Shorter wavelengths of light carry more energy and are better for activating photochemical processes. In the normal use protocol, after the LED illuminator is removed, the dried layer of whitening serum is left on the teeth overnight. As it doesn’t dissolve in water, you can still have a

Click and go licking the Optic White pen twice gives enough serum to do up to 4 teeth. After using the pen, a simple wipe of the bristles using a dry tissue is sufficient to keep them in shape before replacing the cap on the pen. To make sure there is no saliva on the teeth to be bleached, immediately after brushing, I used tissue paper to blot dry both the enamel and the labial gingiva. After one or two clicks from the pen, the serum appeared as a droplet that was trapped in the fine bristles at the end. I then just simply painted the serum directly onto the enamel surface of the teeth. As the solvent evaporates, which takes around 10 to 15 seconds, I could see a thin clear coating was left behind. The binding agents in the serum localise the hydrogen peroxide against the tooth surface and also protect it from inactivation and dilution by saliva. This is quite an important technical improvement over the early paint on products. Painting the serum on allows selective treatment of different teeth to be done. Some patients will have uneven shades of their teeth and may only want to paint the serum onto certain teeth that have darker shades in order to bring them to a shade that is more consistent with the other teeth. I found that it was easy to control the serum as it comes out from the bristles of the pen because it is moderately viscous in nature and binds well to the dried tooth surface.

Let there be light nce the serum had dried, it was then time to use the next component from the system, which is the LED illuminator. This LED array gives an even distribution of light around the anterior teeth because of the diffuser that it uses. When using the LED light, I did not experience any heat sensations on my gingival soft tissues or in my teeth. After use, the LED device is simply rinsed off in running tap water and left to dry, ready for a recharge or for its next use.

68 Australasian Dental Practice

drink of water before you go to sleep. The dried serum comes off easily when the teeth are brushed the next morning. Leaving the whitening serum to sit on the teeth overnight improves the overall outcome because it gains exposure time, which allows the radicals from the peroxide to penetrate into the enamel.

Reflections overall n using this new system for some time, I found it very easy to use and quite convenient. As there is no vacuum form tray involved, the overall approach is very simple, as there are no impression or laboratory fabrication steps. This system seems to breach the principle of “no pain, no gain” which has often been the case with tooth whitening products in the past. Freedom from sensitivity is something that all patients will value. I did not notice any discomfort from the teeth or the soft tissues during the treatment. There were no unpleasant tastes from the tooth whitening serum. The total package seems to be a very nice way of achieving effectiveness and safety with minimum hassle, with only a few minutes work involved. It certainly deserves a big thumbs up to the design team who were responsible for this product.

March/April 2022

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Scans accepted from all open intraoral scanner systems, Scans accepted from all3Shape open intraoral or directly connect with TRIOS. scanner systems, Scans accepted from all3Shape open intraoral or directly connect with TRIOS. scanner systems, Scans accepted from all open intraoral or directly connect with 3Shape TRIOS. scanner systems, Scans accepted from all3Shape open intraoral or directly connect with TRIOS. scanner systems, or directly connect with 3Shape TRIOS. CyberConnect – complete the 100% online prescription CyberConnect – complete the 100% online form and upload scans directly to the case.prescription CyberConnect – complete the 100% online form and upload scans directly to the case.prescription CyberConnect – complete the 100% online form and upload scans directly to the case.prescription CyberConnect – complete the 100% online form and upload scans directly to the case.prescription form and upload scans directly to the case. No additional fees for digital cases. We don’t think you No additional fees forfor digital cases. We don’t think you should be penalised being progressive! No additional fees forfor digital cases. We don’t think you should be penalised being progressive! No additional fees for digital cases. We don’t think you should be penalised for being progressive! No additional fees forfor digital cases. We don’t think you should be penalised being progressive! should be penalised for being progressive!

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1/4/2022 10:43 am 1/4/2022 10:43 am

ADP Digital Partner CD.indd 1

1/4/2022 10:43 am

ADP Digital Partner CD.indd 1

1/4/2022 10:43 am

ADP Digital Partner CD.indd 1

1/4/2022 10:43 am

dentevents presents...

Exiting Your Dental Practice and Maximising Your Outcome How to get the right result when selling one of your greatest assets SYDNEY* : MAY 14 | BRISBANE : JUNE 24 | SYDNEY* : OCTOBER 22

*organised

in conjunction with the australian dental association

A dental practice is usually one of the most valuable assets in a dentist’s life. When it comes time to sell, many will do so with little understanding of the value of what they are selling and how to present it effectively to a buyer. Others delay putting their practice on the market at an optimal time, fearful of what to do next and afraid of a loss of their identity.

HOURS CPD

This course explains: • How to prepare your practice for sale to optimise the price, terms and compatibility with a purchaser • Which exit strategy is right for your practice and why • When is an optimal time to maximise the return for your asset • Pitfalls owners fall into that devalue their practice in the final years of ownership • Steps owners can take to improve the outcome in the final years of ownership

Visit the website for more dates & locations

VITAL

INFORMATION for anyone within 5 years of EXITING

Presented by Simon Palmer With more than 20 years’ experience in dental practice sales, Simon Palmer has extensive knowledge of and insight into the complexities and sensitivities involved in buying and selling dental practices. Simon’s business - Practice Sale Search - sells more than 100 practices per year. He is a regular writer/contributor to dental publications and journals, and is regarded as an expert on dental practice purchases and sales in Australia and New Zealand.

TOPICS INCLUDE n

Exit planning: how do you get your practice ready to sell?

What are the pros and cons of the exit options/ strategies available to you?

Succession Planning: What do you need to do now to prepare?

What is the likely profile of the buyer for your practice and what will they be looking for?

Valuing Dental Practices: What/ where is the value in your practice?

How do you handle staff discretion, confidentiality and disclosure?

Legal agreements

Effective strategies for transferring patients effectively from seller to buyer

What to do next post sale: post-sale strategies

Tax implications and strategies when selling

Expert finance, legal, accounting speakers

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

ONLINE CPD CENTRE the cutting | EDGE

infection | CONTROL

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CPD

Collective efficacy in eliminating drags in alginate impressions: The Smart 7

Unravelling the mystery of long COVID By Emeritus Professor Laurence J. Walsh AO

his article explores some of the implications for patients who develop “long COVID”, also known as “long haul COVID”, which refers to new health problems that develop 3 or more months after infection. The information presented below has been put together from reading through some 265 papers on long COVID and is designed to highlight key points of relevance for dental professionals.

By Emeritus Professor Laurence J. Walsh AO

ontinuing the theme of exploring how dental materials flow and behave when force is applied, this article explores the seven simple things that people often forget to do with alginate impressions, which then create problems later on. Predictable alginate impressions can be made by adhering to a protocol that considers how the material is behaving as it is being mixed; as it is starting to set; once its initial set has occurred; as it is being removed; and as it is stored temporarily before being poured up.

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Information transfer hy is it important to get a good alginate impression? Because the whole purpose of an impression is to accurately record the 3D shape of the oral tissues. This information is needed to manufacture appliances and prostheses, either on-site in the practice or off-site at a dental production facility. Alginate impressions are also used to generate study models to plan treatment strategies and for performing diagnostic wax-ups. In oral rehabilitation cases, the initial impression records the baseline situation of the patient’s dentition, in terms of both their hard and soft oral tissues.

Disease trajectory fter becoming infected with SARS-CoV-2, around 40% of people will have an asymptomatic infection, while another 40% will have a mild infection and will convalesce at home. In most cases with asymptomatic or mild infections,

the person will clear the virus as they recover and inflammation will subside, with little or no persisting effects over the following months - and hence there is only a low probability of long COVID (6% or less). Around 20% of people have a more severe acute illness and of those, around 1 in 4 will need to be hospitalised. More severe acute illness means there has been a larger disturbance to the host immune system and more inflammation and together these factors elevate the likelihood of having long COVID, with health issues extending from 3 months after the acute infection and not seeing a return to good health. Those patients who are in ICU and the subset who are ventilated experience a range of issues, known as post-ICU syndrome and ventilator withdrawal, respectively. These follow after the acute infection and after those subside, long COVID is then likely to follow.

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Question 1. Poor quality alginate impressions can result from:

Question 6. People with long COVID may experience:

a. Water too hot during mixing b. Water used for mixing is too hard c. Incorporation of air during mixing d. Uneven mixing e. All of the above

a. Fatigue and shortness of breath b. Fever c. Pneumonia and acute respiratory failure d. Delirium e. All of the above

Question 2. Alginate is superior to reversible hydrocolloid impression materials:

Question 7. Reductions in smell and taste are common with which variant of COVID:

a. True b. False

a. Only Alpha b. Only Delta c. Only Omicron d. Alpha and Delta e. Delta and Omicron

Question 3. After setting, an alginate impression should be removed after: a. Immediately b. 30 seconds c. 1 minute d. 3 minutes e. 5 minutes Question 4. Alginate impressions should be poured up: a. At any time as alginate is dimensionally stable. b. As soon as possible after decontamination. c. At any time as long as the impression is stored in water. d. Within 24 hours. Question 5. Teeth should be dried immediately before inserting the tray with the material into the mouth: a. True b. False

Question 8. The symptoms associated with long COVID number more than: a. 10 b. 25 c. 50 d. 75 e. 100 Question 9. How many research papers did the author read to formulate the content of the article: a. 45 b. 96 c. 145 d. 265 e. 317 Question 10. Long COVID is more likely to affect women than men: a. True b. False

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

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

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CPD

Increasing patient comfort with advanced technology

READ ME FOR CPD

The tooth colour, a complex matter: Correct shade determination with the very first monolithic zirconia shade guides identical to the final restoration

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

How to deliver the best care while keeping your patients relaxed

n any health care environment, patient comfort is incredibly important. While dental practitioners are highly trained with this in mind, technology can make it even easier to ensure your patients are relaxed when in the chair. In fact, when dental practices stay up-to-date on the latest technological advancements, it assures patients they’re getting the highest level of care and comfort. It also leads to better outcomes for those patients, who are more likely to return for care and to have lifelong and multigenerational relationships with your dental practice. One excellent use for today’s dental technology has to do with a cause near and dear to all our hearts: relieving patient anxiety safely.

clinical | EXCELLENCE

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

No matter how much you try to make patients feel at ease, some of them will still have tremendous anxiety about dental care. You can focus on how comfortable the chair and neck support are, give them sunglasses to block out the harsh lighting and even create ambience with

118 Australasian Dental Practice

lighting and music, but they’re still tense and uncomfortable. And the tenser your patients are, the more likely they will jolt and jump during the procedure, which makes it hard to work with instruments, drills and other equipment. This is a real concern.

March/April 2022

Question 11. Nasal masks are beneficial to patients in the age of COVID because: a. Everyone is stressed and likes to relax at the dentist. b. Nitrous oxide gas kills any COVID virus in your nose. c. Patients have to breathe through their nose which lessens their exposure to respiratory droplets. d. Sedated patients can be treated faster. Question 12. Five minutes of 100% oxygen eliminates nitrous oxide from the bloodstream: a. True b. False Question 13. According to the article, the best way to relieve tension in a patient is to: a. Ensure they are comfortable in the chair and have neck support. b. Give them sunglasses to block out harsh lighting. c. Create ambience with lighting and music. d. Administer nitrous oxide sedation. Question 14. Using nitrous oxide is beneficial for your practice because: a. More cooperative and relaxed patients create a less stressful environment for clinicians. b. Higher patient satisfaction can lead to more referrals. c. Higher patient satisfaction can lead to better Google reviews. d. All of the above. Question 15. Features of the ClearView Nasal Mask include: a. Mask-in-mask design reduces ambient N2O. b. Clear outer mask that shows the patient “breathing through nose”. c. Low profile provides easier access to the patient’s mouth. d. All of the above.

To retrieve your FREE Dental Community Login:

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

ith the new Zirkonzahn Shade Guides, the patient’s individual tooth colour can now be determined by selecting the matching zirconia typology, for a final restoration that corresponds 1:1 with the patient’s natural shade. The teeth are a mirror of a person’s life and individual lifestyle. They differ from person to person and lived years, nutrition and habits shape a unique appearance of wear patterns, degrees of

translucency and colouring. The colour of a tooth is formed by the combination of dentine and enamel. In youth and when the person is in healthy growth, the dentine has a uniform colour. With increasing age, discolouration occurs, which usually manifests itself as darker areas in the dentine area. The overlying enamel, which is firmly bonded to the dentine, is characterised by varying degrees of opacity depending on the respective area - from whitish opaque to almost transparent. Overall, the tooth tends to have a single shade, with a higher translucency level towards the incisal edge.

122 Australasian Dental Practice

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Question 16. The colour of the tooth is formed by the combination of: a. Zirconia and enamel b. The shade guide and the dentine matching. c. The dentine and enamel of the tooth. d. None of the above. Question 17. It’s always best to use a shade guide... a. Made from PMMA b. Made from composite c. Made from 3D printed resin d. Made from the exact material that will be used for the restoration Question 18. One big advantage of the Prettau Shade Guides is... a. They are made in shapes of upper and lower incisors and premolars as well b. They only are made in posterior shapes c. They are only made in anterior shapes d. They are made from PMMA Question 19. For best results, shades should be taken... a. In a darkened room b. Under UV light c. In natural daylight conditions or daylight lamps d. With an Incandescent light bulb Question 20. It’s best to carry out shade determination quickly in no more than... a. 40-50 seconds b. 1 Minute c. 3 minutes d. 5-7 seconds

abstracts | 2022

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

Preprocedural rinsing and suction attenuate risk for symptomatic COVID-19 cases

his study at the Ohio State University College of Dentistry tracked the origins of microbiota in aerosol generating procedures (AGPs): osteotomies for dental implants, tooth preparation for restorations and scaling and root planing using ultrasonic scalers. All treatment was delivered in two enclosed dental operatories measuring 10.5 × 10 × 12 feet each, with a ventilation system that allowed 6 air exchanges per hour. Subjects were recruited from the outpatient population seeking dental care and not from a COVID-19 ward. Five operators and assistants carried out the clinical procedures and at any given time, no more than 3 individuals occupied the room. Operators and assistants wore N95 masks with single-use face shields and high-volume intraoral evacuators (HVE) were used during AGP. Patients used 1% hydrogen peroxide pre-procedural rinses, in line with current CDC/AmDA guidelines. Viruses and bacteria in aerosols were quantified by combining reverse transcriptase quantitative polymerase chain reaction (to identify and quantify SARS-CoV-2) and 16S sequencing (to characterise the entire microbiome) with fine-scale enumeration and source tracking. Linear discriminant analysis revealed significant class separation between the salivary microbiome and aerosol microbiota deposited on the operator, patient, assistant or the environment. Some 78% of the microbiota in condensate could be traced to the dental irrigant, while saliva contributed to a median of 0% of aerosol microbiota. They also identified low copy numbers of SARS-CoV-2 virus in the saliva of several asymptomatic patients but none in aerosols generated from these patients. Undetectable viral levels in the aerosol were most likely due to low salivary loads, coupled with dilution of the saliva by the irrigant and at-source aerosol mitigation with a high-volume suction device. Together, the bacterial and viral data encourage us to conclude that when infection control measures (pre-procedural rinsing and high volume evacuation) are used, such as preoperative mouth rinses and intraoral highvolume evacuation, dental treatment is not a factor in increasing the risk for transmission of SARS-CoV-2 in asymptomatic patients and that infection control practices are sufficiently capable of protecting personnel and patients from exposure to potential pathogens.

Meethill AP et al. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. Journal of Dental Research 2021, 100(8): 817-823.

74 Australasian Dental Practice

A trusted source of accurate advice for infection prevention and control

ike other frontline healthcare workers, a major challenge faced by dentists was having to adjust their services and workflows to ensure patient safety and minimise risk of transmission during the COVID pandemic. Unfortunately, a “disinfodemic” of poor quality or inaccurate advice driven by social media has plagued health advice to the public and to professionals, causing problems for clinicians seeking quality and timely advice. This study examined dentists’ knowledge, preparedness and experiences of managing COVID-19 in Australia. A crosssectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. Practising dentists holding a current ADA membership were invited to participate. At the time the study was conducted, ADA had 11,173 registered practising dentists. Participation was voluntary. An online survey was developed on the Research Electronic Data Capture (REDcap) platform. The survey questions were developed by a panel of experts from dentistry and infection prevention and disease control. COVID-19 had a significant impact in oral healthcare in Australia. Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. The ADA COVID microsite and its resources were used heavily as an authoritative source of information to inform procedures and protocols for clinical practice. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n = 98/339) feeling more stressed than usual and having heavier workloads. Overall, dentistry in Australia has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines, especially those provided by the ADA’s national Infection Control Committee, were fundamental for successful patient management during the COVID-19 outbreak. Australian dentists reported constructive, beneficial and productive experiential learnings and changes amid the pandemic and gained benefit from multiple modes of support for the current pandemic.

Castillo CS et al. Australian dentists’ knowledge, preparedness and experiences during the COVID-19 pandemic. Infection, Disease and Health. 2021;27(1):49-57.

Note: A qualitative analysis of the experiences of dentists from the previous study has also been published as a separate article: Nahidi S et al: “We will have to learn to live with it”: Australian dentists’ experiences during the COVID-19 pandemic. Infection, Disease & Health 2021 https://doi.org/10.1016/j.idh.2021.11.001

March/April 2022

Subscribe Today! Earn 2 CPD Hours every edition Only $99 per year or $165 for 2 years Click Subscribe at...

www.dentalpractice.com.au Paid subscribers can access all past editions of Australasian Dental Practice and complete any of the CPD questionnaires by logging in at www.dentalcommunity.com.au

the cutting | EDGE

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CPD

Collective efficacy in eliminating drags in alginate impressions: The Smart 7 By Emeritus Professor Laurence J. Walsh AO

76 Australasian Dental Practice

March/April 2022

the cutting | EDGE Like all dental records, an impression must be accurate. If it is inaccurate, this will affect people who are “downstream” working from that impression or the resulting scan of the impression or the model, because they are now working from incorrect and inadequate information. A poor quality impression is like sending in a blurry or distorted photo for a photo ID badge or a passport, or trying to read an inadequately exposed and scratched X-ray film to score dental caries or bone loss. One can draw the same parallel to illegible writing on a drug prescription, or on a production lab work order card, or in a hard copy treatment record. The person working downstream, be that a pharmacist, a dental technician, or another clinician, respectively, lacks the information that they need to be able to work safely and effectively. Known impression problems with alginates include bubbles (due to incorporation of air during mixing and interactions with fluids such as saliva on the teeth), voids (due to insufficient material) and drags (due to voids from entrapped air). Fluid flow has an effect as flow separation can also occur as discussed below. This results in impressions that have missing or defective information.

Figure 1. Examples of common defects in alginate impressions.

Table 1. Steps where issues can arise with alginate impressions

Considering each step nderstanding what goes wrong at each step is the beginning of wisdom in terms of making sure that we address those things up front, to ensure that the impression meets the objective of accurate transfer of 3D information - and that this goal can be met consistently, day in and day out. Factors that affect the quality can operate at many different steps of the process (Tables 1 and 2) and solutions to these issues have been reported in the literature (Table 3). Examples of defects are shown in Figure 1.

Alginate versus reversible hydrocolloid t has been known for more than 40 years that reversible hydrocolloid (RH) is superior as an impression material to alginate (irreversible hydrocolloid) and this is why it is used for duplicating in a dental production laboratory. RH becomes more intimately involved with the tooth surface. This is why it adheres better and thus appears to be more “sticky”.

March/April 2022

• • • • • • • • • • •

Selection of the impression tray Mixing the impression material ** Loading the tray Preparing the mouth Inserting the impression Stabilising the impression while it sets ** Waiting for set to occur ** Removal of the impression ** Inspection of the impression Decontamination Storage before being poured **

** Asterisks indicate the steps that this article discusses.

RH lacks the filler particles which cause many of the issues with alginate that will be discussed below. As one example, alginate contains a large amount of diatomaceous earth filler (typically 60% by weight). When force is applied, the water separates from the filler component, leading to drags in the impression. This problem of flow separation does not occur with RH.

Table 2. Commonly missed factors leading to poor quality alginate impressions During mixing • Water too hot • Water too hard • Hand mixing • Incorporation of air • Uneven mix

In the mouth • Excessive force applied to the tray • Movement during setting

During removal • No waiting 3 mins after gelation • Action of removal too slow

After removal • Loss of moisture from evaporation • Water gain by imbibition if immersed • Distortion of posterior parts beyond the tray

Australasian Dental Practice

the cutting | EDGE The setting reaction he setting process of an alginate impression is a chemical reaction involving the formation of a calcium alginate gel from alginate and calcium ions. Water is the solvent that allows those ions to form and thus react together. The calcium comes from calcium sulphate dihydrate (gypsum), which constitutes 16% by weight of the alginate power. The alginate represents typically 15% by weight of the impression powder. Once the powder is mixed with water, the setting reaction begins and a gel starts to form, with the material progressing from a soft solid to a more rigid mass as time passes.

“Mechanical mixing is consistent and helps us achieve the objective of having a mix that is smooth and free of bubbles, every time. This is more important than other benefits such as less time and less mess, but all these considerations explain why it is superior. A properly mixed alginate can be identified using a ‘slump test’. The unset alginate behaves as a soft solid (akin to a thick custard) and it will not drip off the sides of the spatula that is being used to load the impression tray...” 1. Water characteristics he water should not be warm or hot or the material will set too quickly. Warm water from the tap can be an issue in warmer seasons when the ambient temperature increases. The resulting problems when the alginate sets too fast are as follows. As the operator applies force to the material through the tray, the more rigid material will now start to displace the oral tissues. The deformable

78 Australasian Dental Practice

oral soft tissues are going to be displaced. As well, within the impression, there will be separation of the liquid parts from the rigid elements, i.e. flow separation. The effect is the same as that which occurs when walking on damp sand. As force is applied, the water separates away from the sand particles. The water must not be too hard. Hard water contains more calcium ions, as well as other metal ions such as magnesium. More calcium ions drive a faster setting reaction. The hardness of reticulated water varies by location. Tap water in Brisbane, for example, is rated as being moderately hard. When changing from one location to another, changes in water hardness will affect the setting time of

Table 3. Key good practice actions • Use room temperature water1 • Mechanical mixing2 • Compressed air to remove saliva from teeth3,4 • Wait 2-3 mins after setting before removal1,5 • Pour up within 10-12 mins5 1. Harris WT. Water temperature and accuracy of alginate impressions. J Prosthet Dent. 1969; 21: 613-617. 2. Patel RD et al. An in vitro investigation into the physical properties of irreversi-ble hydrocolloid alternatives. J Prosthet Dent. 2010; 104: 325-332. 3. Arora N et al. Clinical evaluation of different preimpression preparation proce-dures of dental arch. J Int Oral Health. 2015; 7: 80. 4. Al Qahtani MA et al. Evaluation of pre-alginate impression preparation methods in the surface accuracy of dental cast. Saudi Dent J. 2019; 31: 451-456. 5. Donovan TE & Chee WW. A review of contemporary impression materials and techniques. Dent. Clin. North Am. 2004; 48: 445-470.

alginate. One way to avoid that variability is to use deionised water, rather than tap water. Using deionised water that is at room temperature ensures a consistent setting process for the alginate impression material all year round.

2. Mechanical mixing powered alginate mixer is superior to mixing by hand and consistently gives a smooth mix in less time. There are 3 fundamental issues with hand mixing.

Firstly, during hand mixing, air is incorporated into the mix in an irregular way. The air as bubbles is distributed randomly, so is located in many different places in three dimensions throughout the mix. Some of these air bubbles might end up being on margins or on occlusal surfaces, while many will be inside the body of the set material. As the material undergoes dimensional changes, the air bubbles will not behave the same as the set alginate and this leads to distortion during recovery after removal from the mouth. Secondly, during hand mixing, there is often incomplete wetting of the powder. This is because of the process of flow separation during mixing as force is applied as the water and the powder are added. This is driven by the very large amount of filler that is present in the powder. Thirdly, during hand mixing, the action used in the bowl causes separation of the denser components of the powder from the lighter components. The dense filler particles are pushed together and clump into aggregates as force is applied with the mixing spatula. Mechanical mixing is consistent and helps us achieve the objective of having a mix that is smooth and free of bubbles, every time. This is more important than other benefits such as less time and less mess, but all these considerations explain why it is superior. A properly mixed alginate can be identified using a “slump test”. The unset alginate behaves as a soft solid (akin to a thick custard) and it will not drip off the sides of the spatula that is being used to load the impression tray.

3. Compressed air common omission is forgetting to dry the teeth immediately before inserting the tray with the material into the mouth. This is critical for 5 reasons. Firstly, the mucin in the salivary film on the teeth and oral soft tissues will act both as a lubricant and as a separator and lubricant. It will allow the impression material to slip at the tooth to impression interface, creating errors in reproducing the fine details of the teeth and soft tissues. Instead of engaging with the surface and reproducing the fine details in 3 dimensions, it will “slip and slide” over the surface.

March/April 2022

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the cutting | EDGE Secondly, saliva on oral surfaces will cause an effect known as shear thinning. As force is applied, the less viscous (more runny) components like saliva and blood will move faster than the more viscous impression material. The effect can be likened to squeezing a sponge, with the least viscous component (the water) being expressed from the matrix of the sponge. The higher presence of water from the saliva near the tooth surface - and its rapid movement under displacement - lead to irregular setting of the material closest to the surface and hence distortion, as some areas are now richer in water than others. The third problem caused by saliva is that it dilutes the gel that is forming on the surface of the impression material against the teeth, reducing its tear strength. The fourth problem is that water from the saliva is taken up into the gel (water imbibition) causes dimensional change. Many of these issues with saliva are well known with other materials that set using the formation of a gel, such as glass ionomer cement. Hence, for dentate cases, compressed air must be used to remove saliva from the teeth, just before the tray with the alginate is inserted. Finally, if saliva is present, air/saliva bubbles will form at the interface of the impression material and the occlusal surfaces of posterior teeth. These bubbles will cause positive defects (nodules or blebs) on the occlusal surface of the teeth on the cast. These blebs will cause occlusal inaccuracies and will interfere with the proper articulation of maxillary and mandibular casts.

4. Holding the tray nce the tray is in its proper final position, high levels of applied force must be avoided. A strong force is not necessary to overcome the effects of gravity or to hold the tray in a steady position. Only a light force is needed to hold the tray in place. Once the tray is centered in position in the mouth, it is best to release any strong force used when seating and then apply only a light force to keep it in place. The rationale for this relates to the way the material sets. The teeth and oral soft tissues will be at a temperature of 35-36oC. This is much warmer than the material in the tray when it is inserted (nominally 22-24oC). As a result, the material starts setting from the oral surfaces. If a strong

80 Australasian Dental Practice

force is being applied as it begins to set, then the material will set under strain. When the impression is removed from the mouth, those strains will be released, causing distortion. For the same reasons, the impression tray must not be moved around (rocked, twisted or rotated) during the gelation setting reaction as that will also incorporate strains from shear forces.

5. The 3 minute wait ost operators are impatient and will wait only until the material seems somewhat firm and will then immediately remove the impression from the mouth. It is much better to wait for 3 minutes after the material has reached its firm (gelation) stage before attempting to remove it from

“The tear strength of alginate increases with the rate at which a stress is applied - hence the impression needs to be removed in a rapid action and not by a slow rocking or twisting movement. If the removal action is slow, the time during which the set material is being distorted increases...” the mouth. One reason is that the compressive strength of the alginate nearly doubles in the first 3 minutes after it appears to have set. Of greater importance, the ability of the material to recover in an elastic manner, improves with time. Thus, the extra three minutes minimise the distortion that could occur as the set material is pulled out of undercuts and over the coronal bulges of teeth. With this additional period of time, it can recover from being stretched during removal without distortion. This means that the recording of undercuts and other negative features will be accurate.

6. Remove the impression quickly he tear strength of alginate increases with the rate at which a stress is applied - hence the impression needs to

be removed in a rapid action - and not by a slow rocking or twisting movement. If the removal action is slow, the time during which the set material is being distorted increases.

7. Pour it up quickly nce decontaminated, pour up the impression as soon as possible. Alginate impressions are dimensionally unstable. If left exposed to ordinary room air, syneresis occurs and fluid evaporates. On the other hand, if submerged under water, imbibition occurs, causing swelling. Hence, if there is a short delay, keep the impression at 100% relative humidity.

Finally, don’t leave an impression with a large amount of excess material in the posterior region beyond the tray sitting flat, as the weight of the excess material plus the impression can cause distortion. Instead, cut off posterior excess (e.g. using a scalpel) to avoid these weight effects. Hopefully armed with these practical points based on the fluid mechanics of the material, dental staff can now take consistent high quality alginate impressions.

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

March/April 2022

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practice | MANAGEMENT

Disputes and awkward professional relationships By Graham Middleton

“It’s important when buying a dental practice to consider long term impacts of structure. I’ve seen many examples of poor business structure because an accountant advised it...”

ver 33 years, I came across a multitude of disputes involving partnerships, associateships and part practice sales to corporates involving dentists, veterinarians and other professionals. There were a variety of outcomes and a variety of causes among which jealousy, greed and unfair carrying of the burden of building and administering practices were prominent. Names and some details have been altered to preserve the identity of those involved.

The incompatible veterinary partners, circa 1990 eorge was a competent veterinary surgeon but had a hair trigger temper while Ike was naturally diplomatic. Their practice was very profitable with several employed vets and about six support staff. George regularly snapped at staff if the slightest matter upset him. Ike quietly patched matters up and provided a safety valve for staff. The

82 Australasian Dental Practice

practice remained profitable but one day, Ike was diagnosed with a terminal illness and was forced to retire. Rather than have a new partner, George purchased Ike’s partnership share of the practice and premises. It proved to be a disaster, with regular turnover of staff. Such was George’s reputation in his profession, no staff member had to explain to a prospective veterinary employer why they had left his practice. Eventually George decided to retire after his practice had been badly run down. It took several years but the new owners rebuilt it into a vibrant practice and several former staff members became employees.

The controlling dental associate ames and Joe were associates in an established dental practice. James was controlling and many of his actions offended Joe who was naturally cooperative. James burnt off some good staff, while Joe was protective of those who supported him. James produced the higher fees but had a lifestyle which required more income. Joe’s lifestyle was modest and although he earned less, his financial position was much stronger.

March/April 2022

practice | MANAGEMENT Everybody in James’ life appeared to be expendable. He changed accountants and advisers regularly—his personal life was messy. A series of James’ chairside assistants departed for other practices as did a receptionist. Joe had a long-term chairside assistant who did not want to work for James. Two assistant dentists learned to avoid James as far as possible but got on well with Joe. One of them bought a one third associateship off James and Joe. A year or so afterwards, Joe decided to retire at a relatively early age and sold his remaining one third to the other associate. The two newest associates were each capable of producing significantly more. One day, James announced that he was taking sick leave and was able to claim on his insurance policy. He failed to make adequate arrangements and lots of his patients drifted to other practices nearby while some transferred their allegiance to the younger associates. When several years later James decided to sell, his goodwill had vanished and the other associates were only prepared to offer a token payment for the remnant of his associateship.

The controlling accountant who destroyed the financial potential of a dental practice om, Dick, Jo and Harriet were associates in a dental practice spread over four locations. Long ago the practice had been owned by Jo’s father who had had a long relationship with an accountant. Over many years the original city central practice (Central) had progressively spread to three suburban locations and Jo’s Dad had sold associateships to Jo and the other three but the practice had maintained a highly centralized structure and had a practice manager (Boadicea) who had taken on two assistants and who was close to the accountant. Boadicea and the accountant, known as “Stick in the Mud” or “Stick” for short had run the group centrally with the practice manager located at Central, but each of the associates spent most of their work time at the suburban locations. Parking and access had become progressively more difficult at Central and it was mainly staffed by employed assistant dentists. Two of the associates worked there for one and two days per week respectively. Stick counselled against change but had too little direct contact with the associated owners.

March/April 2022

It suited Stick and Boadicea for most contact to occur through her. The practice ground along but its relative efficiency or DEBDIT percentage was a long way below the average of a vast number of sound practices. Stick had negligible knowledge of dental practice outcomes as his client base was a variety of unrelated small businesses. If Boadicea was questioned about practice outcomes she referred to advice from Stick. It was a classic case of the blind leading the blind. The associates became frustrated that they were struggling to earn more than they would have received as contractors producing their respective amounts of fees if working for other practices. They were getting little or no benefit from ownership. The myopic Stick did not see the problem and Boadicea was motivated to preserve the status quo which supported her team. If costs had been broken down and distributed it would have become apparent that Central was no longer viable and the group were carrying unnecessary baggage. Eventually, many years after it became necessary, the group closed Central after having as many patients as possible referred on to whichever suburban location was nearest via a telephone redirection system and website. The remaining three practices were separated with Jo and Dick each owning one of the two smaller practices while Tom and Harriet formed a simple associateship at the larger of the three. The three separated practices engaged their own accountants, had a simple bookkeeping arrangement and the services of Boadicea and her two assistants were dispensed with. There were also other staff economies and Central’s premises were sold. Subsequently each of the practice owners enjoyed far more personal control while their profits were much improved. Stick had exerted far too much negative influence over many years and had collectively cost each of the owners a great deal of profit.

The lessons 1. A great many accountants claim to be good at giving business advice but too many have scant knowledge of dental practices and what makes them efficient and profitable; they make up their advice without having a basis for it. 2. Many practice managers are profit destroyers.

The financial adviser who lost the plot rancis, better known as “Frankie”, discovered that he had a gift with words as a teenager and initially made a significant living as a life assurance salesman but was quicker than most to recognise the potential of the changes to superannuation contributions which came into effect on 30 June 1983. These changes permitted much greater tax-deductible contributions if paid by an employer. It turned out to be a catalyst for the incorporation of practices or service entities. A pretax salary could be cocktailed into a substantial amount of superannuation and a lesser amount of salary by a formula. Initially and for several years, most accountants did not understand the formula. For those in the know like Frankie, there were easy pickings because for the first five years after the change, superannuation contributions were not subject to any tax nor were superannuation fund earnings subject to taxation. Additionally, for several years, Australia had a punitive marginal tax rate on middle to higher incomes. Frankie talked in mysterious riddles to potential clients and had developed an impressive white board presentation covering everything from treasury notes through various forms of property and taxation rates including tax of insurance bonds and superannuation preceding and following the changes of 30 June 1988. His presentations were loaded with powerful phrases and he knew when to stop and look into the eyes of the recipients. For most hearing Frankie’s presentation for the first time, he appeared as the only person they had ever met who had a 100% view of Australian investment and taxation facts. Whereas others were catching on fast and a financial advisory industry had been born, very few advisers could come close to matching Frankie’s presentation. A significant proportion of well-off clients hearing it for the first time were mesmerised and were prepared to do whatever Frankie suggested. Those with wider business experience recognised a carefully crafted and endlessly rehearsed sales pitch aimed at people’s emotions. Frankie invariably identified a few weaknesses in his targets’ financials which suggested that their accountants had not been active in advising them.

Australasian Dental Practice

practice | MANAGEMENT Quite a few unethical accountants of the period had directed their clients into deeply flawed timber plantation investment schemes, investment in rubbish films and had been mislead into buying keyman insurance products despite being essentially self-employed. Many of these paid huge commissions to outwardly respectable chartered accountants and certified practicing accountants. Events were to prove Frankie right but he had his own internally geared integrated property schemes which in a rising property market in the mid 1980’s propelled by then high inflation and very high marginal tax rates before the Hawke/Keating reforms appeared to be an easy way to make money for his clients. Frankie negotiated a slice of the deals as reward for putting investment syndicates together. For several years these syndicates flourished and Frankie attracted clients who wanted to be included in a new syndicate or two.

Impact of the October 1987 Stock Market Crash he October 1987 global stock markets crash not only changed the fortunes of Australia’s corporate entrepreneurs dramatically with a large number of them destined to collapse over the several succeeding years, but it also led to a reappraisal of Commonwealth Treasury and Reserve Bank of Australia senior bureaucrats together with various regulatory agencies. They took several years to identify problems and solutions but eventually advised the government that the financial excesses typical of the 1980’s had to be eliminated. Increasing interest rates were their primary weapon of choice and these also reduced inflation, but at a cost of very high unemployment. A number of the 1980’s entrepreneurs were convicted of offences and jailed, found their way into exile, were bankrupted or saw their corporate empires liquidated by banks. Treasurer Keating later explained the impact of huge increases in interest of 1991 as “The recession Australia had to have”. A related impact was the destruction of a number of the internally geared property syndicates that Frankie had put together. Many tenants went broke or were enticed to move to far more attractive accommodation in recently built office towers

84 Australasian Dental Practice

with concessional rent periods of several years and other inducements. The rental income of Frankie’s property syndicates collapsed and was insufficient to cope with the rising internal interest burden. A number of syndicates became worthless as the gearing effect worked in reverse. By this time, many in Frankie’s business had realised that he lacked fundamental economic knowledge and the group fragmented.

Frankie reinvents himself ver the master salesman, Frankie was able to regroup, bring in new advisers, administrators and accountants and embarked on new vertically integrated investment structures syndicating vineyards and other rural schemes. These too were flawed and ultimately other partners dispensed with Frankie’s services. His once influential organisation had become worthless.

The lessons 1. Internal gearing works best when there is high inflation increasing asset values coupled with high marginal tax rates to give maximum tax benefit; 2. Even attractive property assets can fall sharply in value during a recession. Recession also puts the businesses of tenants at risk; and 3. Recently the placing of Dixon Advisory into administration has focused attention on the weaknesses of internal vertically integrated structures.

Carrying a non-performing veterinary partner indsay and Melinda bought a veterinary practice in partnership but it quickly transpired that Lindsay was a practice builder who had developed a substantial range of veterinary skills. Melinda simply did not contribute to the practice as a partner should, referring out to specialists matters that most competent vets treated inhouse. To make matters worse, many of the clients whose pets she referred to specialists never returned to the practice. Lindsay was able to treat most patients inhouse referring very little out and built up a strong personal following. Eventually, Lindsay demanded that Melinda perform or sell. Melinda’s

spouse had a significant income and she decided that she did not want the stress of continuing as a partner if it meant working as hard as Lindsay and sold her partnership in the practice and premises to Lindsay. Subsequently the practice grew strongly. A visiting specialist did the small number of complex surgeries that Lindsay could not do and the clients were retained by the practice. Quite a few years later, Lindsay was able to sell the practice for an impressive amount and proceed to retirement with a nice home, a substantial superannuation fund and substantial additional assets.

Carrying other dental associates ames, a South African dental immigrant, had an impressive range of dental skills and was able to purchase an associateship in a capital city practice. James quickly outperformed the other associates and routinely provided treatments that the others were used to referring outwards. His own patient list grew and soon there was a spillover of new patient referrals to the other associates. The other associates were less efficient than James but refused to adjust the allocation of administrative overheads to reflect the relative costs and benefits. Eventually, James sold his associateship to the others and bought a practice a long way distant where he could build his own patient list confident in being able to keep the reward.

The impact of controlling accountant mark 2 recall being approached by a dentist concerning the frustrations of a practice with four owners with a weird structure presided over by the group accountant. Although the four owners had widely varying productivity, the structure worked against the most efficient dentists and subsidised the least busy. All associates in the practice plus a couple of assistant dentists were allocated 40% of their fees minus associated laboratory costs. The remaining profit after expenses was then split evenly four ways. In reality, the dentist with the greatest productivity was a great deal more efficient in his use of resources including his chairside assistant compared to the least efficient who were content to work at a

March/April 2022

practice | MANAGEMENT much slower pace producing less fees. A proper allocation of costs would have recognised the greater efficiency and profit per dollar of fees as well as the aggregate outcomes of the most efficient compared to the less efficient. The group accountant had little experience of other dentists and staunchly defended the structure he had designed many years earlier even though it was inevitably destined to tear the group apart.

Poor set-up advice by accountants t is important when buying a dental practice to consider long term impacts of structure. I have seen many examples of poor business structure because an accountant, or occasionally a solicitor, advised it. Ownership via a company had attractions in the 1980’s because of the superannuation rules. Subsequent introduction of the small business capital gains tax concessions in 2001 indicates that practices should not be bought inside companies but rather goodwill should be owned personally. Once income is sufficient, consideration is given to licensing a company to conduct the practice. Goodwill ownership remains with the dentist. It is necessary to retain the long-term potential to reduce capital gains tax through the 50% advantage on sale of assets owned for more than one year personally and also to gain access to the small business capital gains tax concessions. The other weakness of most accountants is that they simply do not understand the key factors which make some dental practices much more lucrative than others despite being owned by dentists of similar skill. The truth is that while a multitude of accounting practices have signage proclaiming that they provide business advice, the majority spend almost all their time providing annual financials and tax returns and understand little about their client’s businesses and practices. I regularly came across dental practices which had been structured wrongly, but their owners were unable to explain why. Sometimes bad advice at the purchase time leads to long term outcomes which leave a dentist millions of dollars worse off at retirement. By that time, the accountant concerned has long since ceased practice.

March/April 2022

Tips for choosing an accountant

General Advice Warning

1. When interviewing a prospective accountant, test them with searching questions about dental practices of which you already know the answers; 2. Don’t assume that because an accounting practice has a foothold in the dental profession that all of its accounting partners and staff have the same skills and give consistent advice; 3. Big is not beautiful. The most financially successful single owner practices have no more than two chairs occupied by other dentists, OHTs or hygienists. Dual owner practices are the most efficient if they have no more than two chairs occupied by others in addition to those utilised by the owners. In the overwhelming proportion of practices, at least 85% of the profit is earned in the owner’s surgery(s). The owners are usually the most productive dentists and they are not paying a substantial share of fees to an assistant dentist for the fees they generate personally. Many accountants lack this understanding; 4. Size of accounting practices does not necessarily indicate better advice; 5. An efficient dental practice with a hardworking owner who has good personal communication skills earns more profit for the owner than can be achieved by a collection of small practices staffed by contractors. Be wary of accountants advising you to add several more surgeries or buy satellite practices; 6. If you’re so busy as to be unable to attend to all practice administration, use a part time bookkeeper who visits the practice for a few hours per fortnight, updates financials, arranges staff salaries and bill payments for your approval and provides a bank reconciliation; 7. Some accountants have only one or two dentists on their books but make the mistake of judging outcomes by comparison with dissimilar small businesses. It is essential that you ask the accountant how many dental practices he/she completes accounts for as distinct from the firm overall; and 8. Dentists considering buying a practice need to read “What dentists buying practices need to know” in Australasian Dental Practice September/October 2021 and obtain the book “Financial Success for Dentists” - See below. Best wishes to all dentists and specialists.

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

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

Australasian Dental Practice

practice | MANAGEMENT

Are you seeing your team’s performance accurately, or do you have blinders on? By Julie Parker

have recently surrendered on an issue and it feels oh, so good! A dental receptionist I’ve been working with for many years, let’s call her Robyn, was tracking her Incomplete Treatment follow-up in a way that she found worked well for her. However, it was not the system I had encouraged her to use, as it meant entering information in an area of the dental software that is normally used for something else. Robyn does not come from a dental background, so part of my coaching of her includes how to use the dental software effectively. Despite my reasoning and numerous explanations, Robyn could not see how my way was better than the process she developed. Time and again, I would come across Robyn’s Incomplete Treatment follow-up messages and I felt my frustration rise. “This is not the area to enter these messages!” For those readers who know me, you know that I’m passionate about allowing team member autonomy. You will also know that I used to be a micro-manager and I’m always wary of its influence over my management of teams. Because of this, I tried to manage Robyn in a fair and empowering way. But, why wasn’t Robyn taking my advice? Why was she questioning my knowledge of the dental software and doing the opposite to what I was suggesting? After some months, I contemplated the situation and decided to take a different approach. I asked myself: “What is the cost to the practice if Robyn continued managing Incomplete Treatment patients her way?”

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NOTHING. “Are the patients with Incomplete Treatment being followed up?” YES. “What is the potential negative impact on Robyn if I keep pushing my agenda?” HIGH - making her adhere to a process that made no logical sense to her would likely make her performance suffer. So, I decided my best path of management was to SURRENDER!

“Our perception of team members and their performance can easily become unfairly biased to the negative. We become blind to their positive attributes and work from a short fuse...” The next time I had the chance, I told Robyn of my decision and she should feel relaxed about continuing in the manner that she found efficient, straightforward and productive. She was relieved. What I discovered over subsequent sessions with Robyn was how surrendering my attachment to that one area opened my eyes to how effectively she managed other aspects of her work. My low-level frustration had actually been affecting the way I perceived Robyn’s overall performance and I hadn’t been aware of it. Our perception of team members and their performance can easily become unfairly biased to the negative. We become blind to their positive attributes and work from a short fuse when assessing areas that could be improved.

My attachment to one aspect of Robyn’s performance was out of proportion to the ultimate impact it would have. What surprised me was how much it affected my assessment of everything else she did. It brings to mind a powerful insight that I heard from American developmental biologist and epigeneticist, Dr Bruce Lipton. “The meaning we attach to reality is far more powerful than the reality itself.” Despite Robyn providing evidence by way of her performance and behaviour that she was achieving great success in many areas of her role (reality), the meaning I attached to her for this period of time was that she was not coming up to par (my subjective reality). My subjective response to Robyn belied the objective evidence in front of me that I could not see. So much of what we do, as practice owners and managers, has a profound impact on each team member’s self-confidence. We can compromise our team’s achievement of success because we become too focused on “a thing” on which we have decided to place a particular meaning. Our awareness of this, and insightful response to it, will allow us to take our self-imposed blinders off and see - and enjoy - the many wonderful attributes of those with whom we work.

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

March/April 2022

Did you know... Google Reviews now trump word of mouth recommendations? How a patient chooses a dentist is completely different to when you ﬁrst opened your practice? The worst thing you can do in marketing . . . is nothing?

Fact:

Every year, there are more dentists practicing in Australia than ever before … and this rate of growth is much faster than the growth of the Australian population.

Fact:

Potential patients have more choices for a dentist (and more ways to choose) than ever before

Fact:

If you don’t adapt your marketing to keep up with changes in consumer behaviour, you will get left behind with only fewer patients and declining proﬁts to look forward to

It’s time

to take control and stand out from your competitors!

practice | MANAGEMENT

Dental practice MoneyBall: How to uncover undervalued dental practices By Simon Palmer

“Most dental practice buyers are using the same metrics as other buyers to judge quality practices. These metrics take far too narrow a view of the available data and have blind spots and biases that let quality dental practices slip right past them...”

n 2002, Billy Beane, the general manager of the Oakland A’s baseball team, was faced with the departure of star players and a limited budget to replace them. He realised that if he was going to look for players using the same metrics as all the other teams, he was going to find the same players as every other team and be outbid every time. His solution was to find and use new metrics (aka Sabermetrics), in order to find underappreciated and affordable players and create a winning team from them. Using these new metrics, the Oakland A’s were able to recruit a team that brought them to the playoffs in 2002 and 2003, with a third of the budget of their competitors. If the story of how Billy Beane revolutionised how baseball players were

88 Australasian Dental Practice

valued seems familiar, it’s because it was made into a book and a movie (starring Brad Pitt in 2011), called “Moneyball”. A nice story... A good movie... But what does all this have to do with buying dental practices? The central premise of Moneyball is that the metrics of baseball, used by insiders to rate players, missed some fundamental value that allowed great players to slip through and go unnoticed by recruiters. In my experience, many dental practice buyers are making a similar mistake with how they are assessing practices. Most dental practice buyers are using the same metrics as other buyers to judge quality practices. These metrics take far too narrow a view of the available data and have blind spots and biases that let quality dental practices slip right past them.

Buyer blind spots n order to assess the future financial prospects of a practice, most buyers will focus primarily on its historical performance. While this is extremely important... it is only important in so far as it informs future profit and revenue. If I launched the two practices shown in the table for sale at the same time, “Practice A” would get more enquiries and higher bids from buyers every time, as most buyers’ analysis will focus purely on historical trading and only use the first three rows of the table as inputs. I believe this buyer preference and method of assessment highlights some rather large blind spots in dental buyers’ views of practices:

March/April 2022

ELAIDE pril

practice | MANAGEMENT Practice A

Practice B

1. $820,000 gross

$800,000 gross

2. $120,000 profit

$100,000 profit

3. Modern equipment facility

Older tired equipment facility

4. Expensive website and high advertising spend

No website or advertising, poor signage

5. High rent

Reasonable rent

6. Normal consumables spend as a % of revenue

High consumables spend as a % of revenue

7. Clinical range includes: Some implants plus Invisalign

Clinical range includes: few crowns, no ortho or implants

8. Practice open 5.5 days per week

Practice open 4 days per week

9. Principal working 5 days per week, including one evening - 48 per year

Principal working 4 days per week, 9am – 5:30pm, 46 weeks per year

10. High fee levels when benchmarked against other practices in the area

Low fee levels when benchmarked against other practices in the area

1. Dentist buyers tend to ignore or undervalue opportunity f, as a buyer, you look at Practices A and B with a view to trying to assess future income and profit, I think there is a very high probability that practice B has a brighter future for several reasons: • Practice A already has a wide clinical range, is open 5.5 days a week, has high fee levels, a good website and is spending significant money on advertising. Its revenue doesn’t have many obvious avenues of opportunity to explore; • On the other hand, if Practice B is able to produce $800k revenue and $100k profit without a website or advertising, with poor clinical range and poor patient availability and with far lower fees than other practices in the area... imagine what would be possible if someone bought this practice who was able to change these things. There is huge opportunity in what the practice isn’t doing!; and

SYDNEY ADELAIDE 14 9 April May

March/April 2022

BRISBANE SYDNEY 2414 June May

• Not all expenses should be assessed equally. For example, most general dental practice consumable spend can be benchmarked as between 5 and 7% (dental consumable spend as a % of revenue). If a practice is spending considerably more than this, it can usually be fixed post purchase by shopping around. Rent as an expense is usually locked in via a lease at the current rate with mandated annual increases and is not usually negotiable at all.

2. Dentist buyers tend to ignore or undervalue the opportunity cost of time and effort n the example in the table, the owner of Practice A is achieving its results working 1 more day per week and 2 more weeks per year than Practice B. If you add this up, the owner of Practice A is working 56 more days per year. Surely this needs to be considered and factored into the desirability of Practice B?

3. Buyers have a bias towards high socio-economic areas f we have two identical practices for sale, one in a higher and one in a lower socio-economic area, the one in the higher socio-economic area would get twice the interest from buyers. There are many often ill-founded reasons for this that you can read about here - practicesalesearch. com.au/dental/blue-collar-article

4. Dentists have a suburban bias (as opposed to rural and CBD) here are many advantages of rural and CBD practices that are overlooked by buyers. You can read about them here: practicesalesearch.com.au/dental/cbd-article practicesalesearch.com.au/dental/rural-article

Conclusion any buyers will express frustration at the amount of competition that exists for quality practices. If buyers can slightly adjust their views to incorporate some new metrics, they would be able to recognise value that is invisible when using their current assessment of practices. They would be able to find quality practices that are overlooked or under appreciated by the market. and be able to buy them at a reasonable price.

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

BRISBANE 24 June

Australasian Dental Practice

practice | MANAGEMENT

Revenue, profit and cashflow: What every practice owner needs to know - Part 1 By Dr Jesse Green

reality of life for almost every dental practice owner is that beyond education and training received at university and even as a practising associate, there’s a need to very quickly upskill on all aspects of business management. Financials, human resources, marketing and productivity and that’s all after a long day of seeing patients. The challenge for most of us is we gain our business education “on the job”, learning as we go. Consequently, many practice owners make costly avoidable mistakes, often through a lack of experience and knowledge and failing to analyse information that is readily available to them in the financial statements of the business. In this first of a six-part series on how to work less and earn more, we’ll cover exactly what a dental practice owner must understand about three vitally important aspects of their business: Revenue, profit and cashflow. Importantly, we’ll also learn practical, actionable steps to optimise these in a dental business.

90 Australasian Dental Practice

Revenue (and how to accelerate it) regularly meet many dentists who equate business success with meeting revenue targets. Of course, there is merit in higher turnover, but I remind clients

“I regularly meet many dentists who equate business success with meeting revenue targets. Of course, there is merit in higher turnover, but I remind clients that revenue is vanity, profit is sanity and cash flow is king...” that revenue is vanity, profit is sanity and cash flow is king. If our current business strategy is focused on accelerating revenue, then as far as possible, we want to do so without increasing overheads.

Increasing revenue means working the “levers” at our disposal and in my experience, there are just three that can be manoeuvred. The first of these is the number of patients seen at the practice. The more patients we see, the more revenue is generated. We can attract more patients to the practice via marketing, retention of existing patients and reactivation. Lever number two is to see the patients more frequently, a measure that’s achieved by ensuring your recall system is in place and that patients are returning for planned treatment. The third lever is to increase the size of transactions. This could involve examining your case presentation and diagnosing comprehensively. It could also involve a review of fee structures and ensuring correct use of item numbers or your auxiliary. In any discussion around levers, I use the analogy that small hinges swing big doors, so in terms of these three levers, we need to remember they compound each other. For example, making a 10 percent increase across all three levers will result in a 33 percent increase in revenue

March/April 2022

practice | MANAGEMENT overall because there’s a compounding effect. Remember though the key is realising the benefits of any acceleration in revenue without impacting overall costs. When robust systems are in place, this is achievable.

Profitability (and how to increase it) mentioned before that profit is sanity. It follows that for dental business owners, it makes total sense to look for ways to increase profitability. The challenge of focusing only on one lever, that is, hitting the accelerator pedal and driving revenue up, is we miss the opportunity to review expenses and identify opportunities to reduce costs. Contrary to what you may think, reviewing expenses is the best place to start if you’re interested in improving profitability. Doing this boils down to a simple question: Where are we spending money we don’t need to? Let me walk through an example that explains what I mean. Practice A and Practice B both have a hundred dollars revenue for the month. They both also have $90 of expenses and $10 profit. Not surprisingly, both practices want to increase profitability by 30 percent to $13. Practice A decides they will only focus on increasing revenue, that is, grow current revenue to the necessary $130. Practice A reaches their revenue and profit target, but also increases expenses to $117 meaning their expense ratio has not changed at all. Practice B takes a different approach. They leave revenue exactly as it is and take time to review their profit and loss statement. In doing so, they reduce expenses by just $3, so expenses are now $87 and they achieve $13 in profit. This simple example shows it is easier initially to address expenses if we’re looking to increase profitability. Chances are if you haven’t looked at your expenses in a while, you’ll definitely discover opportunities to reduce costs in your business. And while we like to have all the latest gear and gadgets, do we really need them all now? A good hard look at wants versus needs through the lens of profitability can be very revealing and it’s why I always recommend starting with this kind of analysis before taking other steps to change practice operations.

March/April 2022

Cash flow (and how to improve it) fan of metaphors, I’m going to use another one here that keeps things real. Not only is cash flow king, Cash flow is like oxygen for a business. It really is, because without cash flow, a business goes broke. Our job as business owners is simple (but not necessarily easy): To maximise cash flow. Cash flow is created when we use assets, for example our physical assets - our building, chairs and equipment, patient database, our team and intellectual property assets - to generate cash flow. When it comes to maximising cash flow, however, there are really only five levers we can move. Understanding what these are means taking a good look at our prac-

“We need to structure payment terms and financial arrangements so we receive the bulk of the money at the time of transactions, not weeks or months later. When our practice time and resources are spent chasing payments, we inflict a double cost onto the business...” tice profit and loss statement and balance sheet. We’ve already touched on revenue and expenses above (you’ll find them in the profit and loss statement), so let’s shift gears to the balance sheet. Now looking at your balance sheet might not be quite as exciting as checking out the latest piece of dental kit, but time spent analysing the balance sheet reveals a lot about the cash flow of your practice. To start with, let’s dive into accounts receivable. Moving this lever to improve cash flow means doing what you can to bring money in, rather than having money outstanding through payment plans or third party providers for treatment, bad debts or slow payments. To make this lever work, we need to structure payment terms and financial arrangements so we receive the bulk of the money at the time of transactions, not weeks or months later. When our practice time and resources are spent

chasing payments, we inflict a double cost onto the business, which is why it makes good sense to reduce outstanding payments to a minimum. A second lever we can use to move cash flow is reducing inventory days. What this means is minimising the stock held in the practice. I’ve visited many practices and discovered an excess of stock that is either slow moving or infrequently used. The bottom line is if we’re holding stock, we’re impacting cash flow. Just like our levers to increase profitability, together these levers can have a compounding effect, only in this case it’s negative. For example, let’s say you only place an implant once a month and the patient’s payment plan is nine months, this has a negative impact on cash flow. For positive cash flow purposes, it would be better to receive the money upfront and order the implant system in as required. The final lever we can use to improve cash flow is by increasing accounts payable. While we need to pay our bills in a timely fashion we can use the terms available to us, whether they are seven, 14 or 30 days. By doing that we keep cash in our bank account as long as possible before we pay it out, remembering that it’s the oxygen that keeps our business alive.

The wrap up ny practice owner interested in earning more and working less really needs to start with these financial fundamentals. Becoming educated in what’s required to accelerate revenue, increase profitability and improve cashflow creates a solid foundation for dental business that is not only profitable, but scalable too.

About the author Dr Jesse Green is a leading business coach for dentists, author of Retention, a sought after speaker and founder of the Savvy Dentist Academy. Jesse shares his knowledge, skills and experience as a practice owner through the Savvy Dentist Academy, a digital hub of training, events, courses and resources for dental practice owners who want to earn more and work less. To learn more, book a Practice Growth Call by visiting http://SavvyDentist.com/Practice-Growth or by calling the Savvy Dentist team on 1300-668-384.

Australasian Dental Practice

practice | MANAGEMENT

How many people call your office and do not schedule an appointment? By Jayne Bandy

veryone who calls your dental office has already partly chosen you as their dentist. Something influenced the caller to call you in the first place. It was either your fabulous website and SEO or a friend referred them after telling them how wonderful you are, or they’ve decided you were so convenient to their home or work. Whatever the reason was, they chose you. The next step is for the caller to finally choose to schedule an appointment with you.

It seems so straight forward, so why are so many dental offices failing to make those appointments? o you know how many people call your office every day and fail to make an appointment? I am sure if I asked you what your new patients numbers are, you would know this number straight away. It’s so easy to bring a New Patient Report up on your dental software program. But a lot of dentists have no idea how many actual calls come into their practice each day. The good news it is easy to work out. I know you’re probably wondering why you should know the number of calls received each day. Once you know the number of New Patient calls you received each day you

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can soon work out how many calls did not make appointments. Yes, the number of callers who did not make an appointment. The number of non-converted calls. You can now compare the new patient calls received to the number of new patient appointments you made. Why do you need to know the number of people who called your office and did not make appointments?

“Everyone who calls your office are potential patients who have a dental problem and/or concern that needs solving. And so, you need to keep an eye on the callers who are not making appointments and get to the bottom of why...” Because this is what you have missed out on. This is how many people you have missed out on who did not become your patient.

So why do people call your office and some make appointments and some do not make an appointments? oesn’t everyone who calls your office have a dental problem or concern? Yes!

Everyone who calls your office, other than your labs, dental supply companies and the like, are potential patients who have a dental problem and/or concern that needs solving. And so, you need to keep an eye on the callers who are not making appointments and get to the bottom of why.

The only way to know for sure how many callers are not making appointments, is to track the calls and analyse what is being said on each of the calls his is how you get to the bottom of your missed opportunities when it comes to unconverted callers. You may have no idea that your team are struggling to make appointments with the calls coming in because you don’t track this number. Your team could be struggling to make new patient appointments and they have no idea this is happening. I have seen a huge turn around in practice production and growth once calls are analysed and something is done to fix the problems. Once you analyse the calls, you know for sure what is happening and why you are not converting calls to appointments. You now have an opportunity to change what is being said on the phone, so more calls are converted to appointments. The problem I see happening for many dentists and business owners who finally find out they have a big problem with

March/April 2022

practice | MANAGEMENT calls not being converted to appointments, is they don’t know what to do to fix the problem and nothing gets done and nothing gets improved. Teams need to be continually working on their patient communication skills to improve and increase the conversion of calls to appointments. You don’t want to be that dental office that receives FIVE calls and only ONE makes an appointment.

Tracking the calls coming into your business is one of the easiest ways to immediately grow your businesss eep in mind that you have already paid for every call that comes into your practice through your marketing, so it just makes sense to ensure all or most of your calls turn into appointments not just some of them!

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:

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

1. Dramatically improve new patient call-in conversions to booked appointments. 2. Retain existing patient appointments and... 3. Prevent ongoing losses from appointment cancellations. Visit the website to find out how to get started. It’s that easy!

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

www.calltrackingexcellence.com

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March/April 2022

Australasian Dental Practice

marketing | INSIGHTS

Three changes to dental marketing in 2022 you can’t afford to ignore... By Angus Pryor, MBA (Marketing)

ecently, I was doing a Google search on my own business and stumbled across an ad from a competitor, linked to my business name. In some ways, this ad is a form of flattery, but it did get me to thinking about the constant changes in the marketing environment. In this article, we discuss three important changes to dental marketing in 2022 that you cannot afford to ignore.

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1. The end of .com.au? he regulatory body that controls the release of domain names (e.g. yourbusiness.com, yourbusiness.com. au, yourbusiness.net.au etc) has been under pressure to release more domain names because so many have already been taken. There are now over 1 billion websites on the Internet! I’ve seen this situation from working with dental practices who are setting up for the first time. In many cases, the name they want for their practice has already been taken. The impact of that is typically longer or more obscure names for the practice. But this situation is soon to change.

March/April 2022

marketing | INSIGHTS As of 24 March 2022, the relevant authority (auda.org.au in Australia) will offer the owners of every .com.au and .net.au website the opportunity to claim the ‘.au’ version - the ‘.com’ will no longer be required. For example, if your website is www.myawesomedentist.com. au, you will be given the opportunity to register www.myawesomedentist.au. Under these arrangements, the current owners of the.com.au or .net.au versions will have six months to claim the .au version before the .au version is thrown open to the general marketplace. If both .com. au and .net.au versions of a domain name are owned, priority will be given to the first one to originally register their domain (probably the .com.au). This situation provides an opportunity for some dental practices and a risk for most. For your existing .com.au/.net.au website, I would strongly advise registering the .au version of your name ASAP, particularly when it’s relatively inexpensive (less than $100 a year) to do so. The main reason to do this is to shut out competitors, a bit like my example at the beginning of this article where competitors were advertising against my business name. Once you’ve registered the .au version of your own website, there are two ways you can go. You can either choose to migrate your website and email addresses to the .au version or simply register the .au version and then place an automatic redirect to the .com.au/.net.au version of your website. This is very simple for your web developer or hosting company to do. If your practice domain name is not optimal, then I recommend you write down this date on your calendar: 21 September 2022. This is the date from which all unclaimed .au websites will be open slather. It might provide a great opportunity for you to get a much better, shorter domain name for your practice, with a simple .au suffix.

2. The main emphasis for dentists in Google will change o make sense of the above headline, bear with me for a moment as I explain how Google works. One of the most common misunderstandings about Google is that it is one system. It is not. While search results from Google all appear on one page, what you are looking at is actually three separate systems:

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• Usually at the top (and bottom) of the page is one or more Google ads (system one); • After that, assuming you are searching for a business, the next thing you see is the Google map (system two); and • After that, is the so-called “organic” listings from Google with the top 10 listings for a given search term. So what’s changed? From our experience working with many dentists all over Australia, we expect that for virtually every dentist, they will get more new patients in 2022 from their presence on the Google map than on the organic listings. The great benefit of the Google map is that it is the highest search result in Google that is NOT an ad. While Google ads can be a helpful addition to your

“This situation provides an opportunity for some dental practices and a risk for most. For your existing .com.au or .net.au website, I would strongly advise registering the .au version of your name ASAP, particularly when it’s relatively inexpensive to do so...” marketing efforts, there is an inherent mistrust by some users that the ad is just that: an ad. As a result, many people claim to skip over or ignore Google ads. Being on the Google map means it’s really only you and two others for users to compare. This is much better than the organic listings which, while still very helpful, list 10 practices not 3 – i.e. more practices for you to compete against.

3. There will be more changes to Google hen Google started, there was only the organic listings in the form of the top 10 search results. The introduction of the Google map and Google ads came much later. Interestingly, the founders of Google did not know how they were going to monetise Google when they built it originally. Google ads were introduced

more than two years after Google was launched and it now generate billions of dollars for Google every year. To better understand the incessant changes to Google, we need to look at the incredible effort that Google puts into their algorithm. This proprietary piece of technology has caused Google to become one of the most valuable companies on the planet. Appearing before the US Senate, the CEO of Google said that the company has 1000 staff working on the Google algorithm. As you can imagine, this is an extraordinary intellectual weight applied to this all-important formula. The upshot of that is that there can be minor changes to the Google algorithm every single day with more major changes occurring a few times a year. That means a haphazard approach to maximising your Google presence is highly risky. To illustrate, the department with the highest rate of legislative change in Australia is the Australian Tax Office - i.e. no government department makes more changes to the law than the ATO. For that reason, most business people don’t try to do their own tax - it’s just too hard to keep up with all the changes. The same is true with Google. The real skill of a good company boosting your Google presence (using a technique called search engine optimisation or SEO) is, in fact, constantly adapting to the changes in Google to stay on top. Using techniques that worked a few years ago won’t keep you at the top of Google in 2022.

Summary taying on top of your dental marketing really is a must. Every year many more dentists join the Australian marketplace. In this article, we have talked about the importance of keeping up-to-date with Google and the upcoming introduction of .au websites. If you need help managing either issue, feel free to get in touch.

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

Australasian Dental Practice

finance | INVESTMENT

Commonplace Trust Strategies: Not “ordinary” just because “everyone else does it” says the ATO By Garry Pammer, BEc, LLB, CAANZ, Dip.FS (FP)

n a previous article published in the March/April 2021 edition of Australasian Dental Practice entitled Income-splitting and the ATO traffic light set: Are you red, green or amber?, we set out new ATO guidance on income-splitting practices. Those income-splitting guidelines were specifically concerned with practices that operate through trusts and partnerships of discretionary trusts and how the profits from these practices are being taxed. In late February, the ATO released a draft ruling, TR 2022/D1, which set out new guidance material that directly targets how trusts distribute their income. The ATO is basically very much focussed on what, until now, has been considered common tax planning strategies that involve distributions to companies, family members and other family group entities. To do so, the ATO is seeking to invoke an integrity rule contained in the tax legislation, Section 100A. The latest guidance suggests that the ATO will be looking to apply section 100A to some trust income distribution arrangements with a view to drawing a tighter boundary on what they find acceptable. What this means is that you will need to urgently reconsider how you are using your service or investment trusts to distribute income or profit.

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Section 100A ection 100A was originally inserted into the tax legislation upon the introduction of a uniform income tax by the Commonwealth in 1942 which ensured a rebate for gifts to public hospitals. That version of Section 100A was repealed in 1950 when deductions replaced rebates.

“The ATO is basically very much focussed on what, until now, has been considered common tax planning strategies that involve distributions to companies, family members and other family group entities. What this means is that you will need to urgently reconsider how you are using your service or investment trusts to distribute income or profit...” Section 100A was then reinserted in 1979, now applying to arrangements where trust income is paid to or applied on behalf of a beneficiary designed to enable trading profits and other income derived by trusts to escape taxation.

Key points of S 100A in its current announced application by the ATO are: • Where income of a trust is appointed in favour of a beneficiary, commonly, your young adult children or grandparents, but the economic benefit of the distribution is enjoyed by you or another family member or family group entity; • Section 100A is only concerned with tax avoidance arrangements. This is apparent by section 100A(8) which effectively excludes from the scope of section 100A, any agreement that was not entered into or carried out for the purpose of reducing a person’s income tax liability in respect of an income year; and • Where trust distributions are caught by section 100A, then this generally results in the trustee being taxed at the highest marginal tax penalty rates rather than the beneficiary being taxed at their own lower marginal tax rates.

So when will your trust distributions be valid? epending on the individual arrangements, there is potentially a significant level of risk where you distribute to adult children, corporate beneficiaries and family group entities with losses. Last year the ATO used red-green -amber “traffic light” classifications in its Income-Splitting guidelines. In

March/April 2022

finance | INVESTMENT February this year, the ATO sets out four “risk zones” - white, green, blue and red. These “zones” allow you to self-assess the ATO’s expected response to your fact situation.

White zone he ATO will not look at pre-1 July 2014 arrangements unless it is part of an ongoing investigation or where the trust and beneficiaries failed to lodge tax returns by 1 July 2017.

Green zone reen zone are low risk scenarios and, assuming that arrangements are documented, are unlikely to be reviewed by the ATO. For example, when trust income is distributed to a spouse but the funds are paid into a joint bank account of both spouses. For example, in a one-off arrangement, the trust distribution is to an adult child and used to pay for the deposit on the adult child’s mortgage.

March/April 2022

Blue zone lue zone arrangements may be reviewed by the ATO. This is essentially the ATO’s default zone. It covers arrangements that do not fall within one of the other risk zones. For example, a distribution of income is minuted but the funds are retained by the trustee. This gives rise to an unpaid present entitlement of the beneficiary. Remember, section 100A only applies in the case of anti-avoidance. The existence of an unpaid present entitlement, does not of itself, automatically mean there is an issue. It just means that the ATO will need to satisfy itself that the arrangement does not involve other aspects of potential anti-avoidance.

Red zone ed zone arrangements will be reviewed in detail. Arrangements in the red zone are suspected to be designed to deliberately reduce tax otherwise payable, or where an individual or entity, other than the

beneficiary, is deriving the actual economic benefit of the trust distribution. For example, if the trust is distributing to adult children at university and earning no other income. They have the full benefit of each tier of the marginal tax rates. Trust distributions in the amount of say, $180,000, may generate tax savings of around $30,000. Parents may avoid physically distributing $180,000 into their teenager’s bank account or the funds from that distribution actually end up back in their parent’s bank account. Contrast the preceding example to where an adult child lives on site at university and receives a $40,000 trust distribution from their parents’ family trust. The child forwards that distribution to their parents to repay residential college fees and car running costs, etc that their parents had originally outlaid during the year. This may withstand scrutiny under 100A. For example, an adult child’s entitlement to trust income is paid to a parent or other caregiver to reimburse them for expenses, such as private school fees, incurred before the adult child turned 18.

Australasian Dental Practice

finance | INVESTMENT

For example, a loan is provided by the trust to an adult child for expenses incurred before they turned 18 and the subsequent trust distribution is offset against or used to pay off that pre-existing loan. Contrast the preceding example to where an adult child lives at home with their parents. They receive a $15,000 trust distribution from their parents’ family trust and the child on-pays that distribution to their parents to cover board and car running costs, etc covered by their parent’s in the preceding year. Distributions from a trust to an entity with losses could also fall within the red zone unless it is clear that the economic benefit associated with the income is provided to a family group entity with the losses which shelter the income from tax. If the economic benefit associated with the income (i.e. the cash) that has been appointed to the entity with losses, is instead withheld and utilised by the trust or another entity, then section 100A could apply. This presumably also contemplates scenarios where present trust entitlements remain unpaid or forgiven or the loss entity on-lends to other entities or members of the family group. A difficult onus of proof for you to discharge and shift back to the ATO who are seeking to make out tax avoidance under section 100A.

Corporate beneficiaries he section 100A draft ruling was released in conjunction with a draft determination dealing specifically with unpaid trust distributions owed by trusts to corporate beneficiaries. An unpaid entitlement owed by the trust can be seen to be financial assistance and therefore also be deemed to be a company loan. That company loan can potentially fall within the scope of another integrity

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provision in the tax law, Division 7A. The worst case scenario here (unless a loan agreement within strict statutory requirements is put in place) is that the full amount of that unpaid company loan could be deemed to be an unfranked dividend received by the trust! I propose that the issues raised by this new Division 7A draft ruling be covered in a separate article in a subsequent edition of this magazine. Not every family group uses corporate beneficiaries. Furthermore it is a complex area of tax law. To illustrate, Division 7A’s provisions have been changed by 23 different pieces of legislation - that’s almost one change a year, every year - since its introduction in 1997. That is not to mention 23 taxation rulings, practice statements and practical compliance guidelines.

So how should I be using my trust? hilst the ATO’s views have been released in draft form, parts of their view are intended to apply retrospectively. As such, if you have a service or investment trust, distributing to several family members or family group entities, you should be considering the issues outlined in this article and address them before finalising and lodging your 2021 accounts and tax returns (assuming a May 2022 lodgment date) as well as part of your annual 30 June 2022 tax planning. Remember, section 100A is a tax anti-avoidance provision. Not all trust distribution arrangements attract high levels of risk because not all are driven by tax considerations. Many clearly rest within the gambit of “ordinary family or commercial dealings”. Therefore ensure you put appropriate documentation in place which demonstrates the reasoning for your actions and

how funds relating to trust distributions are physically being used or applied for the benefit of specific beneficiaries. Service and investment trusts should continue to be effective practice structures as well as for managing family wealth. However, the tax planning aspect has just become more complex in light of the ATO’s latest guidance and your past practices will need to be checked and future practices tailored. Remember, documentation and detailed reasoning for your trust’s actions will be crucial in any argument that the “ordinary family or commercial dealings” exemption to section 100A should apply.

About the author Garry Pammer is a Director of Specialist Accounting & Business Advisory, specialising in providing advice to dentists. Advice not only in respect of taxation and accounting but also planning for your financial wellbeing, superannuation, practice management and the buying and selling of dental practices. For a free assessment of your position and to see how you can achieve your goals, please do not hesitate to call Garry on 1300-221-486.

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

March/April 2022

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finance | INVESTMENT URGENT ACTION:

New Director ID requirements By Kelly Lindsell

f you’re the director of a company, this article is a must read. Why? Because failure to comply with the new Director ID requirements may result in both civil and criminal penalties.1 Whilst some of you may have this new requirement well under control, for others, what you are about to read may be completely new to you and if that is the case, we urge you to act immediately. The Treasury Laws Amendment (Registries Modernisation and Other Measures) Bill 2019 introduced a new Commonwealth Modernising of Business Registers (MBR) regime under which all Directors need to be issued with unique a Director identification number (Director ID). One of the primary reasons that this legislation is being implemented is to try to help curb repeated illegal phoenixing activity. Phoenixing occurs when companies deliberately avoid paying liabilities by shutting down an indebted company and transferring assets to another company, hurting the creditors of that company, the employees and the public by way of lost taxes. The intention is that the Director ID will be kept permanently and will provide traceability of a director’s profile and their relationships across companies over their career. As a result, regulators should be able to better track directors of failed companies and those who may use fictitious identities to get away with fraud. For most of us, phoenix activities are something we only read about in the news. Our decisions to be directors often are necessary because of how we run our businesses, our Self-Managed Super Funds, our trust structures and maybe even involvement in other organisations. Nevertheless, we all fall under this new requirement. This article is intended to highlight your new obligations as a director of a company structure and provide the appropriate information to ensure your ongoing compliance with your director obligations.

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What is a Director ID? Director ID is a unique (15-digit) identifier that you will keep forever, even if you cease being a director. All directors of existing companies and new companies are required to apply for a Director Identification Number (DIN) and the most efficient way to do this is to apply electronically. You will need to personally apply for a Director ID if you are an appointed company director, where you are a director of a company acting as a trustee, such as the corporate trustee of your SMSF, family trust or other trust structure.2

When do you need to apply for a Director ID? hen you must apply for a Director ID, depends on the date you became a director, or intend to become a director, as outlined below: • New directors appointed for the first time between 1 November 2021 and 4 April 2022 must apply within 28 days of their appointment. • From 5 April 2022, intending new directors must apply before being appointed. • Directors appointed before 1 November 2021 have until 30 November 2022 to apply.

How do you apply for a Director ID? ach individual director must apply for their own Director ID directly to verify their identity via the ABRS website (abrs.gov.au).3 You simply click on the heading “Apply for your Director ID” and follow the requirements discussed below. Now, for most directors, the three-step registration process can be done online and provided you have all the required documentation it can take less than ten minutes.

The three-step registration process comprises the following steps:

Step 1: Set-up a myGovID et-up a myGovID with a standard or strong identity strength. If you already have one go to step 2. A myGovID is different from other myGov numbers and is obtained by downloading and applying via the myGovID app on your smart device. To set up a myGovID you will need to have on hand two Australian identity documents on which your name matches, for example, your driver’s licence or learner’s permit, passport, birth certificate, visa (using foreign passport providing still in Australia), citizenship certificate, ImmiCard or Medicare card.

Step 2: Gather your documents o apply for your Director ID, you will need to have access to additional information the ATO knows about you, such as your tax file number (TFN) and the residential address linked to your ATO’s records. You will also require information from two documents to verify your identity such as your bank account details, an ATO notice of assessment, your super account details, a dividend statement, a Centrelink payment summary or a PAYG payment summary (if applicable).

Step 3: Complete your application nce you have a myGovID with a standard or strong identity strength and information to verify your identity at hand, you can log in and apply for your Director ID. At this point in the process, your myGovID details and ATO details should be prefilled and all you need to do is enter your place of birth, postal address, mobile number and any former names before completing the declaration.

March/April 2022

finance | INVESTMENT Please note that if you cannot get a myGovID (with a standard or strong identify strength), there are alternative mechanisms to obtain a Director ID via the phone or a paper form. The phone number is 13-62-50 for directors in Australia and for directors calling from overseas, the number is (02) 6216-3440. If you can’t apply online or over the phone, you can still apply using a downloadable form “Application for a director identification number” (NAT 75329), although note this will be a slower process and you will also need to provide certified copies of your verification documents.

What do I do with my Director ID once I have successfully obtained it? nce you have obtained your Director ID, you will need to pass it onto the record-holder of any companies for which you are a director, for example, the company secretary, another director, a contact person, or an authorised agent of the company.

You should also retain the number for your own records as this will be your lifetime Director ID and required for any additional director appointments you have, or will accept. No additional steps need to be taken to record your Director ID with ASIC or the ATO.

About the author Kelly Lindsell is a Senior Financial Adviser at Profile Financial Services Pty Ltd (AFSL 226238) a privately owned and self-licensed fee-based financial planning firm that specialises in working with dental professionals. Profile focus on implementing strategic advice and have a solid understanding and working knowledge of dentist’s structures and investment issues. Kelly can be contacted on (02) 96836422, kelly.lindsell@profileservices.com. au or see www.profileservices.com.au

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

1. https://asic.gov.au/for-business/running-a-company/company-officeholder-duties/director-identification-number 2. https://www.ato.gov.au/Super/Sup/Preparing-for-your-director-ID 3. https://www.abrs.gov.au/director-identification-number

SAFety FirSt even fOr yOur

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

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

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March/April 2022

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Wealth managers for the dental industry

18/03/11 2:04 PM

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infection | CONTROL

READ ME FOR

CPD

Unravelling the mystery of long COVID By Emeritus Professor Laurence J. Walsh AO

102 Australasian Dental Practice

March/April 2022

infection | CONTROL Table 1. Risk factors for Long COVID

Female gender

Table 2. Common symptoms during long COVID

Central nervous system

Older age (being elderly)

Fatigue

Acute infection

“Brain fog” (comprehension and memory issues)

More severe initial symptoms

Dizziness

More symptoms

Low energy levels

Hospitalisation

Headache

Elevated C-reactive protein

Loss of smell

Elevated IL-6

Loss of taste

Pre-existing disease

Loss of hearing

Obesity

Ear pain

Diabetes mellitus

Orofacial pain

Hypertension

Sleep problems

Ischaemic heart disease

Anxiety

Chronic obstructive pulmonary disease

PTSD

Chronic kidney disease

Depression

Psychiatric illness

Respiratory system Shortness of breath Change in voice

Post-ICU hen someone has been in deep sedation in the ICU, they will experience a range of impairments that relates to the medicines used (especially those for paralysis and sedation) and their lack of mobility. Memory loss, problems with maintaining attention and reduced executive function are common issues after being in deep sedation for several weeks. Likewise, due to being immobile, reduced joint mobility, muscle weakness and muscle wasting occur. Changes in a person’s cognitive status and physical status from their time in intensive care ripple on over time, despite the fact the person has now been discharged back home. Other issues include the fear of infecting others and of being reinfected. These may be a significant mental burden that continues for some months. Lack of appetite can arise because the person has not had an oral intake for a prolonged period. This can be associated with some atrophy of the masticatory muscles due to reduced oral activity.

Risk factors for long COVID hile hospitalisation for the acute infection is a major risk factor for having long COVID, raising the probability to around 30%, it is not clear how it effects the duration of long COVID and information about the longevity of long COVID is limited (less than 2 years of follow-up to date). The risk of developing long Covid is enhanced when certain risk factors are present (Table 1).

March/April 2022

Lower voice volume GIT Nausea Diarrhoea Gut flora dysbiosis Lack of appetite Acid reflux Abdominal pain Musculoskeletal Weakness Joint pain Skin and appendages Skin hypo- or hyper-pigmentation Nail abnormalities Hair loss Telogen effluvium Androgenic alopecia Alopecia areata

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Image courtesy British Medical Journal

The risk factors that related to preexisting disease also make the initial infection more severe and more likely to lead to hospitalisation, with an accompanying sustained and intense “cytokine storm”. Of note, males will typically get worse acute COVID than females, but males are less likely to develop long COVID.

Aetiology of long COVID he basic cause of what is going wrong in patients with long COVID is lingering disease and persisting inflammation. There may be hidden reservoirs of virus, as well as secondary effects of acute infection with SARS-CoV-2 on the gut microbiome and this then influences other body systems. There is certainly

104 Australasian Dental Practice

good evidence for significance immune and inflammatory perturbations in long COVID, with dysfunction and dysregulation of normal endocrine systems such as the pituitary-adrenal axis and the thyroid. In a similar way, within the lungs, areas where the virus has not been cleared may go on to become isolated foci of fibrosis, with neutrophil extracellular traps. There is dysregulation of immune responses, with autoimmunity and excessive inflammation within the central nervous system. The heightened inflammation can be thought of as a less severe version of the cytokine storm from the acute illness. Any persisting virus will drive an associated host immune response against the pathogen. The presence of the spike protein in the brain and associated

inflammation could be responsible for chronic inflammation, that then manifests clinically as fatigue and “brain fog”.

Common symptoms during long COVID here are over 100 documented symptoms that can develop in long COVID and most people (80%) with the condition will have 2 or more symptoms that require attention. These symptoms affect multiple systems of the body and are not contained purely to the respiratory tract. They also vary according to which strain of the virus caused the infection. Reductions in smell and taste are very common with Alpha and Delta variants, but not with Omicron variants.

March/April 2022

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infection | CONTROL Differences in symptoms: Acute COVID vs long COVID ypically, people with long COVID suffer from fatigue and shortness of breath, but they usually do not show fever which is a classic sign seen during the acute infection. In acute COVID, pneumonia and acute respiratory failure occur, while in long COVID a persist shortness of breath may be caused by progressive fibrosis of the lungs. In long COVID, people can suffer from a range of heart problems including myocarditis, cardiomyopathy and arrhythmias and they can experience chest pain due to cardiac issues. They can develop joint pain and stiffness, which do not occur in acute COVID. In terms of mental health issues, in acute COVID the infection can trigger delirium, while in long COVID people experience disturbed sleep, depression, anxiety and PTSD. There are many other ways in which the anomalies seen differ between acute COVID and long COVID. Hence, long COVID is not merely an attenuation or persistence of the acute phase of the infection.

Long COVID and dental care epending on the pattern of symptoms, a range of modifications to care may be needed. Those with fatigue will be less able to withstand treatment, so the length of the appointment and also the timing will need to be adjusted. A patient with joint pain or muscle weakness will struggle getting into and out of the chair (or hoist), so we will need to take additional care with the patient’s ingress and egress procedures. Patients with long COVID often develop postural orthostatic tachycardia and this can be exacerbated when there are rapid changes in their body position, so any changes in the position of the dental chair need to be made slowly to make sure the patient is comfortable. Likewise, in patients with arthralgia or chronic pain, we need to be aware of what they can tolerate and ensure that are kept in a comfortable position during their appointment. If the patient has had significant coagulopathy during their COVID illness, they may taking antiplatelet and anticoagulant medicines and hence excessive bleeding needs to be prevented using local measures. Those with shortness of breath will be less mobile and may struggle using stairs.

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Using a pulse oximeter to monitor the oxygen saturation would be prudent and would inform decisions about whether the patient needs supplemental oxygen support. If a patient with long COVID reports chest pain, that could reflect a range of underlying problems, including heart disease which has been worsened by their COVID illness. Patients with long COVID can develop new psychiatric illnesses, particularly those related to anxiety and this may lead to them being medicated with antianxiety and anti-depressive medicines and in turn to salivary gland hypofunction. This problem has been noted to occur in about 25% of individuals with long COVID in over 6 studies. More aggressive prevention will be needed because of the resulting increased risks for dental caries and non-carious loss of tooth structure and the use of home care products will need to be adjusted to maximise oral comfort. When patients are experiencing brain fog and have major issues with memory, their ability to make decisions and reduced executive power, we need to consider whether they still have capacity to consent. If they lack capacity, we will then need to then involve other decisionmakers for the patient.

Long term health care hose with long COVID will need closer monitoring for health issues. Often, new health issues will require surveillance at the community general medical practice level (in person and through telemedicine visits) and those with more severe disease patterns will be seeing additional medical specialists and also attending hospitals. Hence, it is essential to make sure the medical history information for these patients is updated at each visit. Those who have developed coronary damage, lung fibrosis or diabetes are particularly likely to need specialist medical care for the foreseeable future and this could be a significant burden in their life going forward. As time passes, more will be known about the various presentations of long COVID and it is likely that the list of the more than 100 persistent symptoms of long COVID that have been documented in the literature will continue to grow. Hence, these patients need to be watched closely for new oral health problems, since some conditions may develop that are yet to be documented. At the same

time, we need to maintain a watching brief for these patients and recognise the need to refer them for urgent care if they develop symptoms that are life-threatening.

Recommended reading 1. Crook H et al. Long covid- mechanisms, risk factors and management. BMJ 2021;374:n1648. doi: 10.1136/bmj.n1648. 2. Garg M et al. The conundrum of ‘Long-COVID-19’: a narrative review. Int J Gen Med 2021;14:2491-2506. doi: 10.2147/ IJGM.S316708. 3. Hayes LD et al. More Than 100 persistent symptoms of SARS-CoV-2 (Long COVID): a scoping review. Front Med 2021;8:750378. doi: 10.3389/fmed.2021.750378. 4. Iqbal FM et al. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and metaanalysis. doi: 10.1016/j.eclinm.2021.100899 5. Marchesan JT et al. The “oral” history of COVID-19: Primary infection, salivary transmission, and post-acute implications. J Periodontol 2021;92(10):1357-1367. doi: 10.1002/JPER.21-0277. 6. Minblit D et al. Legacy of COVID-19 infection in children: long-COVID will have a lifelong health/economic impact. Arch Dis Child 2021 doi: 10.1136/archdischild-2021-321882. 7. Pavli A et al. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res 2021;52(6):575-581. doi: 10.1016/j.arcmed.2021.03.010. 8. Renaud-Charest O et al. Onset and frequency of depression in post-COVID-19 syndrome: A systematic review. J Psychiatr Res 2021;144:129-137. doi: 10.1016/j.jpsychires.2021.09.054. 9. Yan Z et al. Long COVID-19 syndrome: a comprehensive review of Its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines 2021;9(8):966. doi: 10.3390/biomedicines9080966. 10. Yong S, Liu S. Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies. Rev Med Virol 2021 DOI: 10.1002/rmv.2315.

March/April 2022

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Biodentine saves pulps EVEN with signs and symptoms Biodentine saves pulps EVEN with signs and symptoms e outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms ht and width of irreversible pulpitis* over whymesio-distal dentists favor our impeccable fit. Perfect for your patients. Easy for you. ™ brings one-of-a-kind benefits Biodentine for the treatment of ™ dentin wherever it’s damaged. Biodentine ™ fully replaces of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine comes to the perfect fit, Hu-Friedy is just right. med and pre-crimped for ™ simple placement

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

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

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

clinical | EXCELLENCE

Six upper and four lower ceramic veneers restoration using smile design and digital workflow By Dr Chee Chang

Figure 1. Original smile.

39-year-old male presented with no remarkable medical history or condition. The patient looked to achieve specific aesthetic goals with the restorations, in terms of shape and shade of the teeth. He had previously had composite restorations on his teeth that he was not satisfied with. He wanted a better and longer lasting outcome.

108 Australasian Dental Practice

Figure 2. Smile simulation with 3Shape Smile Design.

Treatment plan he treatment plan was to firstly carry out a comprehensive analysis of his smile and to show the patient what the expected outcome would be. We would then carry out bleaching of his teeth, followed by six upper ceramic veneers and four lower ceramic veneers.

March/April 2022

clinical | EXCELLENCE

Figure 3. Original oral situation.

Figure 4. Pre-existing tooth library forms customised to suit the clinical situation.

Figure 5. Photo-realistic rendering of the lower incisors to show the patient what could be achieved.

Figure 6. 3D printed model of the digital wax-up, based off the smile design.

Figure 7. Lower teeth prepared and retracted.

Figure 8. Upper teeth prepared and retracted ready for scanning.

Initial consultation t the initial consultation, photos and pre-operative intraoral scans with 3Shape TRIOS were taken. After a discussion with the patient, the photos were imported into the 3Shape Smile Design module and a smile design was carried out (Figures 1-3). Teeth were selected from the smile library and modified to suit the desired outcome. The photo-realistic rendering was used to show the patient what the final result would look like. This included a simulation of the lower teeth as well, which was invaluable as the patient was also wanting to address the minor shape and rotation issues with his lower incisors. Once the patient approved the smile design, this was transferred into 3D using CAD software and a 3D printed model for the patient’s final approval (Figures 4-6). The patient then had bleach trays fabricated and began bleaching his teeth using carbamide peroxide gel for 2 weeks. The teeth were then left for a further 2 weeks to settle and to ensure that the resin-enamel bond strengths would return to normal.

March/April 2022

Figure 9. Intraoral scan of preparations. Tooth preparations were carried out on the upper six anterior teeth and four lower incisors and intraoral scanned. Good retraction and a dry working field is essential for an accurate intraoral scan (Figures 7-9) .

Australasian Dental Practice

109

clinical | EXCELLENCE

Figure 11. Patient approved temporaries scanned and imported into 3Shape Dental System.

Figure 12. Upper veneers on 3D-printed model.

Figure 10. Provisional veneers were made from the diagnostic model.

Solutions featured

Figure 13. Lower veneers on 3D-printed model.

3Shape TRIOS intraoral scanner 3Shape Smile Design 3Shape Dental System Provisional restorations were made using the 3D-printed model and a putty key. The provisional restorations were finalised and adjusted clinically and then scanned again and sent to the lab to act as the final tooth position guide for the definitive restorations. The lab technician, Mr Sho Kurashige, designed the ceramic veneers in 3Shape Design System and lithium disilicate veneers milled and finally finished by hand on 3D printed master models (Figures 10-13). The lithium disilicate veneers were then tried in and bonded using a resin cement. The accuracy of the 3Shape intraoral scanner and the precision of the technical work ensured a perfect fit of the restorations. The result was near-identical to the initial smile design, so what was initially planned was able to be delivered to the patient with no surprises or compromises (Figures 14-16).

110 Australasian Dental Practice

Summary he Smile Design module was able to help the patient and dentist get an accurate representation of the final aesthetic outcome of the planned anterior veneers. This was beneficial with ensuring the dentist understood what the patient’s aesthetic goals were and to demonstrate to the patient what could be achieved. Using the digital workflow, the entire process was streamlined and efficient and the patient’s expectations were able to be met. The benefits of the digital workflow include: • The Smile Design module is quick and intuitive, allowing for the patient to already see “results” at the very first consultation. This was beneficial with case acceptance; • The most recent version of the Smile Design module now allows for smile design to be carried out on the lower teeth; • The digital workflow enabled multiple scans to be sent to the technician easily and quickly, including the pre-operative situation, the patient approved temporaries and the actual tooth preparations themselves;

March/April 2022

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

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

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

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Innovative by nature Innovative by nature Innovative by nature

Exclusively available in New Zealand from

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

Exclusively available in Australia from

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

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

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

clinical | EXCELLENCE

Figure 14. Veneers in situ.

Figure 15. View of lower veneers, showing a very close match to the initial simulation.

Figure 16. Final smile.

About the author • The digital images of the smile design and the digital models are all able to be virtually super-imposed and cross-arch mounted, which enables the technician to accurately design the final restorations to the dentist’s prescription; and • The accuracy of the TRIOS ensured a perfect fit of the restorations, with no or minimal adjustments during delivery.

Discussion he digital workflow has significant advantages over the traditional analogue workflow, in that many processes are now quick and efficient. The ability to show the patient a photorealistic rendering of the proposed final outcome at the very first consultation is invaluable for case acceptance. Being able to import the smile design simulation into the CAD design software also ensures that the initial design can be accurately copied. The entire case is then able to be completed with a clearly defined endpoint, leading to no surprises for the dentist or the patient.

112 Australasian Dental Practice

Dr Chee Chang trained at the University of Otago, New Zealand, graduating in 1999. He then joined Wellington Hospital and worked as a dental house surgeon where he further developed his skills in oral surgery and management of complex medically compromised patients. Following this, Dr Chang commenced work in private practice in Auckland and would later relocate to the UK where he worked in Somerset county and in London. He completed a postgraduate diploma from the Royal College of Surgeons (UK) in 2006 in advanced general dentistry and later returned to New Zealand to undertake specialist training in prosthodontics, finishing in 2009. During this time, Dr Chang completed his research thesis on dental ceramics and was published in the Journal of Prosthodontics. He has maintained teaching positions at both the University of Sydney and Melbourne University. Dr Chang lectures regularly to dental students, dentists and other dental specialists on all aspects related to prosthodontics and implant dentistry. He is a frequently invited speaker at conferences, both in Australia and overseas and is a key opinion leader for a number of dental companies.

March/April 2022

Digital dentistry, simply united!

Introducing 3Shape Unite. An open platform that brings together world-leading dental companies, solutions and labs. Manage all your cases with choice and ease, from TRIOS scan to treatment completion.

Simply connect to the right partners with app-based efficiency and make digital dentistry easier than ever with 3Shape Unite. 3Shape.com/Unite

clinical | EXCELLENCE

Clinical case report using the Aoralscan 3 intraoral scanner from Shining 3D Technology Inc By Dr Ona Erdt, DMD, CDA, MSHS St. Johns, Michigan

he Aoralscan 3 (Shining 3D Technolygy, Inc.) is a scanning system that can be used for orthodontic and restorative procedures. It is capable of ortho simulation as well as creating an oral health report (Figures 14-16). It connects to a computer or laptop and is now available with an optional cart for portability. This system possesses a host of features such as A.I. technology to automatically identify and filter out unnecessary soft tissue data, motion sensing to advance to the next scan with minimal contact with the computer, and most importantly, fast and accurate scans.

114 Australasian Dental Practice

Figure 1. Tooth #16 pre-op.

Figure 2. Tooth #16 crown preparation.

Figure 3. Aoralscan 3 has the option of two sizes of scan tips. Figure 4. The author scanning.

March/April 2022

clinical | EXCELLENCE

Figure 5. Final prescription before going to the lab.

Figures 6 and 7. Final scans.

Figure 8. Imported scan.

Figure 9. Maxillary and mandibular arches in design phase.

Figure 10. Final crown design prior to milling.

Figure 11. Occlusal view of final restoration on 3D-printed model.

Figure 12. Final zirconia restoration.

Figure 13. Sleekness of Aoralscan 3 (bottom) compared to competitor scanner.

coding and large visuals. A monolithic zirconia crown was chosen as the substrate. The tooth was prepared for a full coverage restoration. Tissue management was performed utilising a single cord technique with Ginga-Plain (GINGI-PAK) that

(Figure 4). The Aoralscan tip and handle already have a slim profile, is very sleek and is compact compared to other scanners on the market. The smaller head was a wonderful option for cases such as this or for paediatric scanning. In addition, the tooth was scanned utilising the A.I. mode for optimal margin recognition of the deep mesial margin. The scanning time was incredibly fast and with the motion sensing function, it was easy to move from each scan by waving the scanner wand without having to touch the mouse or screen. The scan was sent to the laboratory. The Aoralscan 3 is open-source and cloud-based, so after the scan was sent to the lab, the case was able to be accessed from the Shining 3D cloud.

Clinical Case he patient presented with a symptomatic tooth #16 (Figure 1) with a large existing composite restoration. The patient had been experiencing biting sensitivity for several weeks along with transient cold sensitivity and it was determined that a full coverage crown was indicated. The mesial portion of the existing restoration was sub-gingival and exposing tooth structure for the crown margin would result in a deep margin. In addition to the deep margin on the mesial of the tooth, another challenge to scanning this case was access, as it was a wisdom tooth and the patient had limited opening.

Procedure naesthetic was administered and while it was taking effect, the laboratory prescription was completed. The interface was very user friendly as it featured a simplistic design with colour

March/April 2022

had been soaked in Hemodent (Premier Dental). The cord was removed and the tooth scanned, followed by the opposing arch and a bite (Figure 2). The Aoralscan features the option of a smaller head scan tip (Figure 3). This tip was chosen for this scan for better access due to the patient’s limited opening

Laboratory milling ase data was submitted (Figure 5) electronically using the Shining 3D online portal. The scan data was downloaded and imported into the CAD

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clinical | EXCELLENCE

Figure 14. Model Builder.

Figure 15. Ortho Simulator.

Figure 16. Oral Health Report.

Restoration seating software for processing. The scan data was sufficiently clear to accurately determine margin position, contact points and alignment to the opposing arch. The identification of the margins was aided by the crisp resolution of the colour texture provided by the scanner. The crown was designed and a model was created digitally using the CAD software. The crown was then milled and the model was 3D printed. After sintering, the crown was checked for fit on the 3D printed model and characterised with stain and glaze.

he provisional crown was removed and the permanent restoration tried in with the marginal fit, interproximal contacts and occlusion evaluated. The permanent restoration fit perfectly with no adjustments required. The intaglio surface of the crown was cleaned with Ivoclean (Ivoclar) restoration cleaner and the tooth was cleaned, dried, and isolated. RelyX Universal (3M) was applied using the self-adhesive technique. Excess cement was removed and a final light curing was completed.

Conclusion hat sets the Aoralscan 3 apart (Figure 13) are its extremely fast, realistic scans coupled with motion sensing technology for easy, hands-free screen advancement and improved infection control. This scanner has a long, sleek wand with two head size options that make scanning comfortable for patients and improves the maneuverability, making scanning even faster. The completely adjustmentfree fit of the final restoration with a deep margin demonstrates the accuracy of the Aoralscan 3 and its software.

Originally published in Dental Advisor, Number 49, February 2022. Reprinted with permission.

116 Australasian Dental Practice

March/April 2022

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

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118 Australasian Dental Practice

March/April 2022

YOU REQUIRE REQUIRE MAXIMUM MAXIMUM EFFICIENCY. EFFICIENCY. YOU YOU REQUIRE MAXIMUM EFFIC YOU REQUIRE MAXIMUM EFFICIENCY. YOU DEMAND DEMAND COMPLETE COMPLETE ORGANIZATION. ORGANIZATION. YOU YOU DEMAND COMPLETE YOU DEMAND COMPLETE ORGANIZATION. YOU NEED NEED ENSURED SAFETY. INTRODUCES HUFRIEDYGROUP HUFRIEDYG HUFRIEDYGROUP YOU ENSURED SAFETY. YOU NEED ENSURED S YOU NEED ENSURED SAFETY. INTRODUCES YOU DESERVE DESERVE INFINITE INFINITE CONFIDENCE. CONFIDENCE. ™™ YOU YOU DESERVE YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYGROUP INTRODUCES HUFRIEDYG HUFRIEDYGROUP INTRODUCES

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clinical | EXCELLENCE In those situations, one way to deliver treatment safely is to use nitrous oxide/oxygen sedation (relative analgesia), which can make the patient experience much less stressful. It keeps them calm throughout the procedure, while actually helping them feel as if the time has passed faster. This happens with minimal side effects - just five minutes of 100% oxygen eliminates nitrous oxide from the bloodstream.

Using nitrous oxide is also beneficial for the practice. More cooperative and relaxed patients create a less stressful environment for clinicians. Higher patient satisfaction can then also lead to more referrals and better reviews for the practice. Nitrous oxide and oxygen delivery is easily adjustable so you can provide the right mix for each patient. While analogue and digital technology accomplish the same job, the Accutron™ Digital Ultra™ Flowmeter actually has more safety features than other models. Plus, its completely flat surface allows for easy disinfection or barrier protection.

“There’s no doubt that patient comfort is among the top priorities amongst dental practices today. Combining best practices with technology is the most effective way to ensure patient comfort while providing a superior patient experience...”

Best practice for using nitrous oxide dictates that practices use a single-use nasal mask and tubing that is sterilised per the manufacturer’s recommendations. Nasal masks are beneficial to patients in the age of COVID in that they require patients to breathe through their nose and lessen their exposure to respiratory droplets. The ClearView™ Nasal Mask uses a patient demand system for administering gas, which is designed to match the patient’s flow of breathing. And the soft inner mask creates a better seal against the patient’s face for better administration of gas. Features of the ClearView Nasal Mask include: • Mask-in-mask design to reduce ambient N2O; • Clear outer mask that shows the patient “breathing through nose”; and • Low profile that provides easier access to the patient’s mouth. The Axess™ Low Profile Nasal Mask is a single-use mask that works with positive flow systems. Its low profile offers better visibility and better access to a patient’s mouth. The nasal mask fits comfortably and snug and its lightweight circuit tubing makes it easier for patients to move without displacing the mask. To help make patients even more comfortable and relaxed, both the ClearView and the Axess Nasal Masks come in scents and colous that appeal to patients. There’s no doubt that patient comfort is among the top priorities amongst dental practices today. Combining best practices with technology is the most effective way to ensure patient comfort while providing a superior patient experience.

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YOUYOU REQUIRE MAXIMUM EFFICIENCY. YOU REQUIRE MAXIMUM EFFIC REQUIRE MAXIMUM EFFICIENCY. YOUYOU DEMAND COMPLETE ORGANIZATION. YOU DEMAND COMPLETE DEMAND COMPLETE ORGANIZATION. HUFRIEDYGROUP INTRODUCES HUFRIEDYG YOUYOU NEED ENSURED SAFETY. HUFRIEDYGROUP YOU NEED ENSURED S NEED ENSURED SAFETY. INTRODUCES ™ ™ YOU DESERVE INFINITE CONFIDENCE. YOU DESERVE HUFRIEDYGROUP INTRODUCES YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYG HUFRIEDYGROUP INTRODUCES

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

To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All rights reserved. Hu-Friedy is now a proud member o

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clinical | EXCELLENCE

READ ME FOR CPD

The tooth colour, a complex matter: Correct shade determination with the very first monolithic zirconia shade guides identical to the final restoration

122 Australasian Dental Practice

March/April 2022

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

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

Figure 7. The transparent, metal-free sample bars made of temperature-resistant plastic avoid interference caused by translucent metal (metal sample bars would shine through under the zirconia material).

The reproduction of the natural tooth colour is therefore a very complex process, especially nowadays, where pre-coloured dental materials are making their way in the production of dental restorations. To achieve the best possible result, many factors have to be considered - from tooth structure and translucency to light reflection and material selection - and an exact determination of the natural basic tooth colour is fundamental. Based on this, the specialist literature1 recommends to always use the shade guide of the material that will be used for the restoration. In this context, Zirkonzahn Shade Guides (developed by the South Tyrolean company Zirkonzahn) represent an important step forward for colour-precise final zirconia restorations. Zirkonzahn Shade Guides are composed of monolithic sample teeth made of polychromatic Prettau® zirconia and reproduce both the colour and translucency gradient of the human teeth. Inspired by the VITA classic range, they include 16 dentine colours (A1D4) and 3 Bleach shades and are available not only in the shape of upper and lower incisors but also in the shape of a premolar. If the material of the shade guide and the material of the zirconia crown are identical, it is ensured that the colour of the zirconia restoration corresponds 1:1 with the natural tooth colour of the patient. For individualists, the shade guides in the shape of an upper incisor are also available with minimally reduced, sintered sample teeth (minimal cutback), which can be further characterised by the application of different incisal materials. This results in truly unique shade guides that exactly reflect the individual approach

124 Australasian Dental Practice

and own aesthetic demands. For an easier determination of tooth shades on the patients, Zirkonzahn Shade Guide Prettau Line has been developed specially for the dental practice.

How to avoid possible disturbing influences when using Zirkonzahn Shade Guides • Colour determination should be carried out under natural daylight conditions or in a room illuminated with standardised daylight lamps; avoid direct, bright light (approx. 2000 lux, a well-lit dental chair already has approx. 8000 lux). • Carry out colour determination quickly in no longer than 5-7 seconds. The human eye tires quickly when looking at something with concentration. This also affects the colour perception. • Perform shade matching in a neutral colour environment, on a patient without make-up who is wearing neutral-coloured clothes. Intense colours influence the perception of colours that are observed immediately afterwards (simultaneous contrast). • Participation in a colour matching course - When determining the patient’s tooth colour, the exclusion of sources of interference and the individual experience level are of considerable importance. Participation in a special training course can be very helpful.

Reference 1. 2011: Strub, Jörg R. / Kern, Matthias / Türp, Jens Christoph / Witkowski, Siegbert / Heydecke, Guido / Wolfart, Stefan; 37 Curriculum Prosthetics, Volume II, 4th revised and expanded edition, Quintessenz Verlags-GmbH).

March/April 2022

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(3)

Monolithic sample teeth available in the shape of:

(1) (4)

Upper incisor

Upper incisor with minimal cutback for further characterisation with incisal materials

Lower incisor

Premolar

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

clinical | EXCELLENCE

Aesthetic parameters of digital planning “Since I have my new smile, I am much happier,” says patient. by Dr Henriette Lerner

healthy 31-year-old patient who was missing her laterals was having aesthetic concerns. Photos and videos were taken to evaluate these aesthetic concerns (Figure 1). An orthodontic consultation was conducted. The profile was convex with exposure of the gingiva with the smile. The patient was missing teeth #12 and #22, though teeth #53 and #63 were present. A multidisciplinary treatment approach was

126 Australasian Dental Practice

chosen. Orthodontic treatment started with extraction of teeth #18 and #48. The patient then underwent a ceramic bracket treatment (Figure 2). The orthodontic treatment continued with extraction of the deciduous teeth and creating space for implants on teeth #12 and #22. After two years of treatment, the conditions were created for bone grafting and implant placement (Figure 3). Smile design was done with Keynote software (Figure 4). Gingival contouring and veneers with minimally invasive preparation techniques would be needed in order to reestablish the aesthetic teeth proportions.

March/April 2022

clinical | EXCELLENCE

Figure 1.

Figure 2.

Figure 3.

Figure 4.

March/April 2022

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clinical | EXCELLENCE

Figure 5.

Figure 6.

Figure 7.

128 Australasian Dental Practice

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clinical | EXCELLENCE

Figure 8.

Figure 9.

Following the missing laterals and the orthodontic treatment, the bone in the region to be replaced with implants needed to be grafted. In order to avoid mistakes in the aesthetic zone, minimally invasive incision techniques were used (Figure 5). An intrasulcular incision (surgical incision) would cause recession at the neighboring teeth. A papilla sparing incision would leave scars due to the vertical releasing incisions (left in Figure 5). A “hybrid” incision (middle in Figure 5) was chosen in order to take the best from both worlds and avoid aesthetic complications. After four months of healing, the patient was ready for implants (Figure 6).

March/April 2022

The next step was the digital planning of the implants with the Swissmeda SMOP software. This was done by superimposing the digital wax up from the Carestream Dental CS 3600 intraoral scan with the DICOM data from the Carestream Dental CS 9600 CBCT system in order to see the amount of grafted bone necessary to place a 3.0 mm diameter implant (Figure 7). The parameters of implant placement were a minimum 4 mm insertion depth - the distance from the free gingival margin (STL file/green line) - and a minimum 4 mm from the collar of the implant to the buccal contour (green line) (Figures 8-9). The surgical guide would be planned in the same software.

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clinical | EXCELLENCE

Figure 10.

The tooth supported surgical guide was printed and used for the placement of the implants (Figures 10-11). An aesthetic healing abutment and a PRF (fibrin) membrane were used to close the implant site. After one year, a new intraoral scan was taken to manage the aesthetic success of the case (Figure 12). A Pink Esthetic Score (PES) of 9 was reported. A re-matching of the intraoral scan data with a CBCT scan one year after treatment showed lack of volume loss, maintaining the buccal parameter of 4 mm; 4 mm seems to be a predictable distance for maintenance of the per-implant structure stability (Figure 13). For more info about digital workflows, contact Carestream Dental on 1800-223-603 or email anz-enquiries@csdental.com.

Figure 11.

Figure 12.

About the Author Dr Henriette Lerner is the founder and director of HL Dentclinic and Academy in Baden-Baden, Germany, an academic, clinical, teaching and research facility of the Johann Wolfgang Goethe University in Frankfurt, Germany. Dr Lerner is a board member and expert for the DGOI (German Society of Oral Implantology) and board member and past president of the Digital Dentistry Society (DDS). She is an editorial advisor for four scientific journals and the author of a numerous scientific papers and book chapters which detail aesthetics in implantology, grafting procedures, biomaterials science and digital technologies. Her expertise spans research, advanced techniques in digital technologies, complex implant cases, soft and hard tissue augmentation biomaterials research, implant aesthetics and occlusion in complete oral rehabilitation.

Figure 13.

130 Australasian Dental Practice

March/April 2022

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clinical | EXCELLENCE case report

Post-extraction bone filling before implant placement

By Dr Bruno Salsou - Toulon

Figure 1. Furcation defect in tooth 36.

Figure 2. Clinical presentation.

Figure 3. Fractured tooth extracted.

Figure 4. Post-extraction alveolus.

Figure 5. Syringe with R.T.R.+/MBCP® Technology filling material, 0.5-1mm diameter granules.

Figure 6. R.T.R.+/MBCP Technology filling material saturated with blood.

Figure 7. Alveolus 36 filled with R.T.R.+/ MBCP Technology.

Figure 8. Protection of the graft with PRF membranes.

Figure 9. Repositioning of flap and suture with 3-0 silk.

so as to permit implant placement. Figures 2-9 detail the surgical procedure.

55-year-old patient presented with significant mobility in tooth 36. A retro-alveolar radiographic examination showed a level 3 furcation defect preventing the preservation of the tooth (Figure 1).

Figure 10. 6 month follow-up: Radiography shows significant bone gain. Implant placement can now be considered under optimal conditions.

132 Australasian Dental Practice

Treatment decision he decision was made to extract the tooth and perform bone “filling” using R.T.R.+/MBCP® Technology (Septodont)

Conclusion he packaging of R.T.R.+/MBCP Technology in pre-filled syringes facilitates the handling and placement of the material. The conglomerate formed with clotted blood helps to ensure the retention of the material within the alveolus, an essential element for good bone healing.

March/April 2022

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Biodentine saves pulps EVEN with signs and symptoms Biodentine saves pulps EVEN with signs and symptoms e outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms ht and width of irreversible pulpitis* over whymesio-distal dentists favor our impeccable fit. Perfect for your patients. Easy for you. ™ brings one-of-a-kind benefits Biodentine for the treatment of ™ dentin wherever it’s damaged. Biodentine ™ fully replaces of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine comes the perfect fit, Hu-Friedy is just right. med andtopre-crimped for ™ simple placement

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up to 85%** irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier faster: ™ ™ helps the Biodentine up to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation OVE OUR anatomy STAINLESS STEEL PEDO CROWNS: occlusal that the tooth pulpitis brings one-of-a-kind benefi ts for the treatment of remineralization of dentin, preserves the pulp Biodentine up tomatches 85%** of natural irreversible cases: •upPulp healing promotion: proven biocompatibility and bioactivity vitality and promotes pulp healing. It replaces dentin with similar to Therapy 85%** ofallowing irreversible pulpitis cases:bridge • Vital width complete dentin formation •Pulp Minimally Invasive treatment preserving the tooth structure Vital Pulp risk Therapy allowing complete bridge formation t and mesio-distal •• Reduced of failure: strong sealing dentin properties biological and mechanical properties. Vital Pulp Therapy allowing complete dentin bridge formation • Minimally Invasive treatment the tooth structure •forOnly Immediate Pain relief your patients’ comfort d and pre-crimped simple placement Biphasic Formulations allowing to Minimally Invasive treatment preserving theyou tooth structure •New one material to fifor llpreserving the cavity from the pulp to manage the top ™ cclusal anatomy that matches the natural tooth Improving on Biodentine Minimally Invasive treatment preserving the tooth structure pace of your bone grafting procedures: • Immediate Pain relief for your patients’ comfort Bio-Bulk fi lling procedure for an easier protocole •the Similar mechanical behavior as natural dentin: ideal for bulk fillingclinical implementation, you can now bond • Immediate Pain relief for your patients’ comfort ™ the composite onto Biodentine in the same visit and perform the • Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole • Immediate Bio-Bulk filling for easier protocole The fifinal restoration willan placed within 6 months. 80/20 (80% ß-TCP /be 20% Hydroxyapatite) full restoration in a single session. INE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk filling procedure for an easier protocole 40/60 (40% ß-TCP / 60% Hydroxyapatite) To enjoy the clinical benefits of the first and only dentin in a capsule,

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

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case report

Maxillary molar replacement using a Straumann® TLX implant and an immediate restoration By Dr Leandro Nunes

Figure 1.

Figure 2.

he introduction of dental implants for the replacement of missing teeth disrupted the era of dental prosthetic dentistry by providing the possibility of replacing a missing tooth with a fixed restoration without the need for the support of the adjacent teeth. During the beginning of the era of implant dentistry, two-stage procedures were followed by a waiting period of three to six months from the day of the surgery to the loading.1

Attempts to provide a better patient experience have led to the development of improved manufacturing technology, innovative techniques and a better understanding of the biological aspects through clinical and pre-clinical studies. The immediate loading of implants has now become a reality and these treatments are frequently used in the anterior maxillary area. However, the insertion of dental implants simultaneously with a provisional restoration can also provide benefits in the posterior areas, with a shorter time to the recovery of the masticatory function.1

134 Australasian Dental Practice

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clinical | EXCELLENCE

Figure 3. To this end, the estimation of the risk of the treatment result and effective treatment planning are crucial. It is essential to perform an analysis of the patient’s medical condition, bone availability, soft tissues and desired tooth shape and take into consideration our patient’s needs and expectations. The following case report describes the replacement of a single upper molar with the new Straumann TLX implant in a fully healed site (Type 4, ITI implant placement) and the immediate rehabilitation with a provisional restoration.

Initial situation healthy, 40-year-old female non-smoker presented at our clinic with a missing maxillary molar. Her primary wish was to recover her masticatory function as soon as possible, because her condition prevented her from eating properly and was affecting her quality of life. Her dental history revealed that the tooth had been lost due to a vertical fracture a couple of months before. Since this incident happened during the COVID-19 lockdown, she had not been able to receive the complete treatment of the site.

March/April 2022

The intraoral examination showed the missing upper right first molar. The patient’s periodontal condition was healthy and her oral hygiene was classified as good (Figures 1, 2). The pre-operative CBCT revealed sufficient vertical and horizontal availability for an implant placement at site #16 and no risk of damage to the surrounding anatomic structures (Figure 3).

Treatment planning rosthetic-driven planning was considered and close communication ensued between the patient, the prosthodontist (Dr Cristiane Juchem) and the dental technician (Lisiane Merlin). After the various treatment options were discussed with the patient, she opted for implant placement and provisional restoration at position #16. The clinical and radiographic evaluation showed adequate conditions for implant placement at the healed site. Furthermore, the CBCT for diagnosis revealed no need for a bone augmentation procedure. Therefore, a Straumann TLX RT SP (Standard Plus) Roxolid® 3.75 x 10 mm with immediate provisionalisation was planned only if the desired primary stability was achieved. The Straumann TLX Implant System offers fully tapered tissue level implants (TLX) that are designed for high primary stability and immediate treatment procedures.

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clinical | EXCELLENCE

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Surgical procedure ocal anaesthesia was infiltrated using articaine (4%) with epinephrine. Mid-crestal and intrasulcular incisions were performed without a vertical release. The flap was raised to expose the bone in the area of tooth #16 (Figure 4). Following the manufacturer’s surgical protocol, a Straumann TLX RT SP (Standard Plus) Roxolid 3.75 x 10 mm was placed in a prosthetically driven position. A minimum gap of 1.5 mm from

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the implant shoulder to the adjacent tooth was taken into consideration. Due to the self-cutting properties of the TLX Implant, the implant bed was lightly underprepared. The drill bits were rotated clockwise and an intermittent drilling technique with pre-cooled (5°C) sterile saline solution w as employed. The 1.6 mm diameter needle drill was used first to mark the implant site, followed by the pilot drill (ø 2.2 mm), which was drilled down to the full implant length (10 mm) (Figure 5).

March/April 2022

clinical | EXCELLENCE

Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

Figure 17.

Figure 18.

The bone density was then determined by drilling a pilot hole with drill # 2 (ø 2.8 mm) (Figure 6). Next, an alignment pin was placed to check the 3D position of the osteotomy and preparation depth (Figures 7, 8). Additionally, since the placement of the implant was planned to be deeper than the shoulder mark on the mesial site, the corresponding profile drill was used (Figure 9). The Straumann TLX implant was placed with a surgical ratchet with a torque setting >35 Ncm and optimal primary stability was achieved (Figures 10-12).

March/April 2022

Prosthetic procedure ince optimal primary stability was achieved, we were able to proceed with the preparation of the provisional restoration as requested initially by the patient. For the provisionalisation, a straight provisional titanium abutment and a pre-selected tooth based on the stone cast were used (Figures 13-18). The provisional titanium abutment was reduced with a carborundum disc to avoid occlusal contact with the antagonist. The pre-selected tooth was prepared to be adapted to the abutment and bonded with flow composite. The final contouring and polishing were done chairside by Dr Cristiane Juchem.

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clinical | EXCELLENCE

Figure 19.

Figure 20.

Figure 21.

Figure 22.

Single nylon 5-0 sutures were placed around the implant. Analgesics were prescribed post-operatively and a follow-up check and suture removal was planned one week later. The follow-up appointments were scheduled for 30 and 60 days post-surgery (Figures 19, 20). After two months of healing, a monotype scan body was screwed into the implant and a digital impression was recorded using the Straumann Virtuo Vivo™ Intraoral Scanner (Figures 21, 22). The coDiagnostiX® software was used for CAD processing and a metal-free restoration (zirconia) was cemented (Relyx™ U200, 3M) on top of the Variobase® (RT Variobase, ø 5 mm, AH 6 mm) for screw-retained rehabilitation. The height of the abutment was adjusted accordingly (Figures 23, 24).

138 Australasian Dental Practice

Figure 23.

Figure 24.

Figure 25.

Figure 26.

March/April 2022

IMPLANTOLOGY CONFIDENCE

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STRA151 02/22

Contact your Straumann Solutions Specialist for more information

clinical | EXCELLENCE

Figure 27.

Figure 28.

Figure 29.

“My short-term experience with TLX has been amazing. I’m a big fan of tissue level implants for the posterior region given all the benefits of this renowned design and the absence of the bone level connection, as also reported in the scientific literature. Allied to these advantages of the tissue level, we can now achieve better primary stability and greater confidence in immediate protocols with the new TLX. Therefore, I believe that the new body design and the predictability of the connection on the tissue level will be groundbreaking...”

In accordance with the implant manufacturer’s recommendations, the restoration was screwed in with a torque of 35 Ncm (Figures 27, 28). And finally, the screw access hole was sealed with composite material (Figure 29).

Treatment outcomes eplacing one tooth in the posterior zone and loading it immediately can pose many challenges. Since the key is to identify who is eligible for this type of treatment, the patient selection is crucial. In this case, we obtained good and predictable results in a short period of time as requested by the patient. The Straumann TLX allows the implant to be loaded immediately, which in our case proved highly satisfactory in terms of health, aesthetics and function.

References 1. Davarpanah, Mithridade, Szmukler-Moncler, Serge. Immediate loading of dental implants: Theory and clinical practice.1st Ed. Paris: Quintessence Int’l, 2008

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Dr Leandro Nunes

About the author Dr Leandro Soeiro Nunes graduated from the Federal University of Rio Grande do Sul and became a specialist in Oral and Maxillofacial Surgery in 2006 at ULBRA-RS. During his Masters (Bauru-SP), he evaluated the behaviour of biomaterials in Sinus Lift procedures and during his doctorate (PUC-RS) he compared the biological behaviour of different implant surfaces. In 2010, he moved to Bern (Switzerland) to join the ITI Scholarship program at the University of Bern with Prof. Daniel Buser. He is currently an ITI Fellow, ITI Study Club Director in Porto Alegre and Professor of Implantology at the Brazilian Dentistry Association and also maintains his private practice focused on oral surgery, implant therapies and bone reconstructions.

March/April 2022

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©Institut Straumann AG, 2021. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates.

EFFICIENCY

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Straumann® BLX

surgery | DESIGN

St John expands WA dental network

he highly respected St John organisation, perhaps best known for the St John Ambulance Service and its GP and Urgent Care centres, is expanding its dental service to provide quality, affordable dental care to key centres in Western Australia. St John opened two new dental clinics during 2021, one in Midland and another in Cannington in Perth’s populous growth corridors, with two more planned. This brings the current total to five dental clinics co-located with its medical centres in and around Perth, furthering St John’s

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By David Petrikas aim of supporting the wellbeing of local communities with holistic health care. The expanded dental service includes the state-of-the-art dental clinics and medical centres which became part of St John when it bought the former Apollo Health services. The dental clinics are all co-located with St John Urgent Care Centres and General Practice clinics, delivering wrap-around primary care for Western Australians. The new dental clinics at Cannington and Midland join existing facilities in Joondalup, Armadale and Cockburn, creating a city-wide network of centres strategically located in regions with high need.

The recent fit-outs at Midland and Cannington have similar floor plans and were successfully transformed into dental clinics by local medical and dental fitout specialist, Bill Elsegood of Dental Intelligence, Perth. The transition from Apollo Health to St John Dental was made seamless, when Apollo Health’s Principal Dentist, Dr Lawrence Chan, stayed on at the Armadale facility and joined St John Dental. Dr Chan was also able to provide useful advice in setting up the new Cannington and Midland dental centres, having previously worked closely with A-dec and Dental Intelligence in the establishment of the impressive Apollo Dental Centre at Armadale.

March/April 2022

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surgery | DESIGN

St John Head of Dentistry, Dr Mark Brazier, who has a background as a naval Dental Officer, said the aim was to provide consistency and uniformity across all of St John’s dental surgeries. This included the choice of equipment, with the reliability of A-dec chairs being a particularly strong point and supporting Dr Brazier’s 25 years working with the brand, including in challenging and remote locations such as on Royal Australian Navy ships.

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He said the new generation A-dec chairs in the new and recently acquired clinics had advanced in terms of comfort, features and more modern delivery systems which had been well accepted by staff and patients alike. “We certainly haven’t had patients complain and our staff are really happy using A-dec. The upholstery on the chairs has a soft and quality feel. Ergonomically they are well designed and easy to set up and program, enabling the A-dec touchpad’s instrument and chair positioning settings to be saved.”

March/April 2022

surgery | DESIGN

The new clinics feature A-dec 500 chairs with “Continental” style delivery systems which were recommended by A-dec’s WA Territory manager, Joe Minervini, based on their ergonomic benefits to the dental team. Mr Minervini has also helped establish dental facilities in other WA institutions, including the new Perth Children’s Hospital and specialist teaching and public health clinics in the Oral Health Centre of Western Australia at the University of Western Australia.

March/April 2022

Dr Brazier said providing excellent quality staff, quality equipment and facilities would help support St John’s philosophy of supporting local communities with access to the best holistic health care. “One thing that is really important to us is ethical dentistry and putting patients first. Our dental philosophy is the same as that of St John Urgent Care Centres and GP clinics. The St John brand is highly regarded and its important to us that we maintain that reputation across our dental facilities as well,” Dr Brazier said.

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surgery | DESIGN

Capital Smiles Orthodontic delivers in style

anberra has a new specialist orthodontic practice with one of the country’s most highly credentialled orthodontic practitioners, located in the Deakin. Dr Jasprit Nirmal Singh from Capital Smiles obtained her initial orthodontic qualifications in London, then completed her Masters of Lingual Orthodontics at one of a few universities in the world offering such a master’s program the prestigious Hannover Medical School, Germany. Lingual orthodontics is very popular with teenagers and a very effective and virtually invisible option for adults. Dr Nirmal Singh is the only orthodontist in Australia with a Masters in Lingual

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Orthodontics, under the tutelage of lingual orthodontics pioneer and Professor in Orthodontics at Hannover, Dr Dirk Wiechmann. After working in corporate practices in Sydney and Canberra, Dr Nirmal Singh understandably grew tired of the commute and decided to set up her own practice where she could apply her specialist skills as well as filling a market niche in Canberra. She was determined to provide not only clinical excellence, but a caring and comforting environment for patients, many of whom are children. After looking for a lease premises for a year, a property came up for sale in the highly sought-after Deakin medical precinct which contains lots of specialist medical and dental practices.

By David Petrikas The location, close to oral surgeons, a paediatric dentist and a prosthodontist and near Calvary John James Hospital, suited her needs perfectly. Dr Nirmal Singh said she wanted a view from within the practice and to create a “warm” feel for patients. She also wanted something a little different and not a stereotypical blue and white “dental practice” look. “Sometimes practices that are clean and modern can feel a bit clinical and I wanted a more welcoming feel,” she said. “I wanted to create a relaxing theme more like a lounge.” This has been achieved with a specious reception “lounge” complete with a coffee station with coffee machine, tropical fish tank, large flat screen TV, ornate pendant lighting and sculptured ceiling above the waiting room.

March/April 2022

The practice logo is also contemporary and unique, featuring a maroon and grey palette and smart stylised diamond-shaped tooth design. Design flourishes include contemporary textured carpet inserts and ottomans and an inbuilt magazine rack. The waiting room area also opens onto a covered terrace. The materials and finishes include woodgrain and terrazzo, light wall colours and terracotta and copper toned accents such as the splashbacks in the surgeries. A separate room with television screen, still in view of parents and behind reception, has been created for younger children wanting to watch cartoons or play video games. The nursery nook has dark ottomans and a “sunrise” effect mural with a low height bench.

March/April 2022

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The building’s aspect and abundance of glazing takes full advantage of the sunny vistas from each of the surgeries across colourful deciduous street plantings of Robinias and out to the Brindabellas (mountain range) and National Arboretum. Back of house includes adjoining private and administration offices behind reception and a discrete rear entrance and corridor which accesses the steri room, OPG room and laboratory. At the end of the wide central corridor down the spine of the building is a northerly facing staff meals area and principal’s private office.

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The wide hallway adorned with contemporary artworks, enables easy access and affords a view from the corridor all the way back to reception so staff can keep an eye on things while entering and exiting the surgeries, back of house areas or meal room. Matching the modern look is a whole suite of new equipment designed to deliver comprehensive in-house patient care. Even the stylish A-dec dental chairs with their streamlined slate grey upholstery underpin the contemporary décor and “high-end” feel of the practice.

March/April 2022

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Summary The Practice The Practice

Capital Smiles Orthodontics

The Principal

Dr Jasprit Nirmal Singh

Practice Type

Specialist orthodontic

Location

Deakin, Australian Capital Territory

Size

196 square metres

No of chairs

2+1

The Team Installer

Presidental

Equipment Dental Units

A-dec 400 traditional delivery

Sterilisation

W&H VA-B steriliser

X-ray

Vatech OPG & Ceph

I/O Scanner

MEDIT

Compressor

Cattani AC300Q

Suction

Cattani Turbo SMART A Cube

Software

Dolphin MEDIT Link

Because of her speciality, Dr Nirmal Singh said she needed a chair with a fully adjustable headrest to allow her to access the upper arch all the way up and back into the oral cavity. “Most chairs have very limited headrest movement, but after talking to friends and colleagues and using other A-dec chairs, I decided on the A-dec 400 for its comfort, support and superior access for the orthodontist,” Dr Nirmal Singh said. “Patients love the chairs and say they’re really comfy. The staff like the matching A-dec 400 stools as well.” Dr Nirmal Singh was assisted in her equipment selection by Presidental’s equipment specialist, Luke Williams, who recommended the key dental and ancillary equipment for the surgeries, steri room and plant room. Each of the dental units is equipped with a full set of doctor’s and assistant’s instruments and a cuspidor to allow patient rinsing. Dr Nirmal Singh chose A-dec’s lightweight and powerful EA-53 electric motor which allows any dynamic procedures to be performed quietly and efficiently. An A-dec daylight matched LED operatory light provides soft and even illumination of the oral cavity as required and includes a “cure safe” function to assist when working with light cured composites and bonding materials. Dr Nirmal Singh is hoping that her specialist qualifications, together with the convenient location, caring environment and the practice’s modern equipment will be of assistance to referring dentists in the Australian Capital Territory and surrounding areas.

150 Australasian Dental Practice

March/April 2022

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

NaviTip Tips 29 ga with Single Sideport Opalescence™ Quick PF 45% CP

Ultradent NaviTip™ delivery tips are available in four lengths (17mm, 21mm, 25mm and 27mm) and two gauges to easily deliver endodontic sealers, irrigants and other medicaments of varying viscosities just short of the apex. The cannula of each NaviTip tip is slightly rigid through the base and centre, but flexible at the tip to allow for easy navigation of curved canals. The NaviTip 29g Single Sideport Tip is designed to direct

the flow of chemistry through the sideport of the tip before flowing down into the area of the apex, thus reducing the risk of product extrusion. The 29 ga delivers paste materials including MTAFlow™ Repair Cement, EndoREZ ™ Canal Sealer and UltraCal™ XS Calcium Hydroxide Paste. Available: Dentavision 1800-806-640 Gunz Dental 1800-025-300 Henry Schein 1300-658-822

Now part of the Opalescence PF whitening family, Ultradent’s Opalescence Quick PF is the fastest take-home whitener used in a custom tray. The 45% Carbamide Peroxide formulation is available in a Mint flavour with a wear time of only 15 to 30 minutes a day. Opalescence tooth whitening gel contains PF (potassium nitrate and fluo-

ride) and the water-based gel helps prevent dehydration and shade relapse. The sticky, viscous gel also won’t migrate to soft tissues and ensures tray stays securely in place. Available: Dentavision 1800-806-640 Gunz Dental 1800-025-300 Henry Schein 1300-658-822

Umbrella lip, cheek & tongue retractor

Jiffy™ composite finishing system

Offering beautiful access and practical isolation in a comfortable way, Ultradent’s Umbrella soft tissue retractor provides clear access to all areas of the mouth while prioritising patient comfort. Rather than pulling or stretching the lips, it gently and naturally keeps a patient’s mouth open thanks to its durable, yet flexible, springlike design. Its innovative tongue guard allows the tongue to comfortably remain out of the way, prevents triggering the gag reflex for most patients,

Ultradent’s Jiffy composite finishing line provides a complete, quality solution to easily achieve a beautiful finish. The Jiffy Natural composite finishing and polishing systems consist of malleable spiralshaped wheels that effectively polish all tooth surfaces. Jiffy Natural easily re-creates the lustre of natural enamel and the efficient 2-step polishing process saves you chair time. The Ultradent diamond grit gives a beautiful finish on any composite material. The Jiffy Original composite finishing and polishing system is excel-

all while channelling saliva for efficient evacuation. It is easy to place and features anatomically positioned bumpers to rest a hand without causing pain to the patient. These benefits combine to make the procedure easier and provide a better overall experience for both clinician and patient. Available: Dentavision 1800-806-640 Gunz Dental 1800-025-300 Henry Schein 1300-658-822

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lent for contouring, finishing and polishing any composite material. Polishing cups feature a flared, flexible and thin wall design ideal for polishing near gingiva, labial surfaces and easily covers all tooth surfaces. The Jiffy Original system features unique polishing brushes that facilitate unsurpassed polishing and the Jiffy grit gives a beautiful finish on any composite material. Available: Dentavision 1800-806-640 Gunz Dental 1800-025-300 Henry Schein 1300-658-822

March/April 2022

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

SDI launches Pola For Aligners

New Pola For Aligners from SDI utilises Pola Night 10% carbamide peroxide gel that has been carefully selected as the ideal whitening agent to suit any aligner system. The neutral pH gel ensures the greatest patient comfort in a whitening kit and the high-water content gel contains potassium nitrate

and fluoride to reduce sensitivity and increase patient compliance. The pleasantly flavoured spearmint gel is both fresh and long lasting.

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

Available: SDI Limited Tel: 1800-337-003 www.sdi.com.au

Cention Forte from Ivoclar Vivadent

Colgate Optic White Light Up

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

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

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

154 Australasian Dental Practice

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

March/April 2022

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TGA TGA TGA NOTES NOTES TGA NOTES :NOTES We : We : have We have : have We always always have always worked always worked worked within worked within within the the within guidelines the guidelines guidelines the guidelines ofofthe of theTGA the TGA ofTGA the and and TGA and now now now and now with with with the the with new the new new the regulation regulation new regulation regulation wewecontinue we continue continue we continue totodo to doso. do so. toIfso. do you If you Ifso. you have have If have you any any have any concerns concerns concerns any concerns please please please please don’t don’t don’t hesitate hesitate don’t hesitate to hesitate tocontact to contact contact to us contact usfor us formore for more usmore for information. information. more information. information. Another Another Another Quality Quality Another Quality Product Product Quality Product From From Product From From

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Australasian Dental Practice Mar/Apr 2022

Articles inside

How many people call your office and do not schedule an appointment?

Dental practice MoneyBall: How to uncover undervalued dental practices

Disputes and awkward professional relationships

Are you seeing your team’s performance accurately, or do you have blinders on?

Revenue, profit and cashflow: What every practice owner needs to know - Part 1