Australasian Dental Practice Sep/Dec 2022

On the cover... Admetec ergo loupes foster healthy posture for a long lasting career, preventing and relieving neck and back pain.

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

By Joseph Allbeury

Everyone’s doing it...

Last school holidays, we joined pretty much every other Australian (or so it seemed) and jumped on a plane to take an overseas trip.

A buddy of mine who runs a travel agency tells me that every month in the latter half of 2022 has set a new financial record, exceeding anything he’d ever seen in his long career - everyone just can’t wait to get on a plane! And that’s despite domestic and international airfares equally being at all time highs.

For us, our destination was Singapore, timed for attending the kick off for the first IDEM meeting post COVID. We visited Singapore, Malaysia and Indonesia on the trip and all COVID protocols are now pretty much gone. It was literally like COVID had never happened - mostly anyway - and that was comforting to see. I think we’ve all looked forward to everything getting back to normal and that new normal looks pretty much the same as the old one.

IDEM Singapore 2022 was also same-same but different. Mostly on account of the move from the Suntec conference centre to the Sands Expo & Convention Centre at the Marina Bay Sands hotel complex. There were lots of exhibitors, lots of conference sessions with great speakers - like our own Dr Chris Ho and Dr Anthony Mak - and lots of Australians visiting the event.

The face-to-face event scene post-COVID has roared back to life this year... particularly in Australia as the 3-year CPD cycle, which essentially spanned the pandemic, comes to an end. And lets face it, the only reason anyone in dentistry wants to hear the word Zoom is when a patient wants whiter teeth!

And things are looking great for 2023 as well. Over 100 people have already registered for Digital Dentistry & Dental Technology 2023, coming up on June 2-3 in Sydney. This will be the fourth edition of this enormously popular event that each year sees around 500 delegates participate in the 2-day multi-stream, multi-session, multi-speaker programme. You can register before January 2 for just $330 at www.dentaltechnology.com.au which is excellent value.

Next year, we also have a brand new 3D Printing for Dentistry (3DPD) event over two days from February 10-11 in Sydney. Day 1 covers the clinical aspects of 3D printing while Day 2 looks at the technical side. You can choose to do either day or both days and if you’re interested in this burgeoning area, you will find value in coming for the entire event. All the speakers and sessions can be found at www.3dpd.events.

Finally, we’re still looking for readers to start contributing videos to Dentevents.TV and each month we’re offering a prize for the video that receives the most votes from viewers! Visit www.dentevents.tv to sign in and begin uploading.

With the holiday season upon us, I hope all our readers, contributors and advertisers have a very Merry Christmas and a Happy New Year. Stay safe and see you in 2023!

Joseph Allbeury, Editor and Publisher

Angus Pryor wins national marketing award

Long-time dental industry stalwart, Angus Pryor and his team recently won a national marketing award for their work in the dental industry. In 2022, Dental Marketing Solutions were recognised as the ABA100 Winner of The Australian Business Award for Marketing Excellence. “It was a real honour to win this award for our work in the dental industry and a nice surprise,” Angus said. “We were up against marketing firms from all over the country in a range of different industries. It’s great to see the recognition for the quality of work being done in the dental industry. Many of our team worked on the project that caught the judge’s attention, so it was a real team effort.” The judging process involved an assessment of a marketing project against a range of criteria and an interview with the client, Dr Geoff Hall of OrthoED, for whom the marketing work was completed.

3Shape Unite integrates with EXACT

Henry Schein One’s Dental Practice Management Software, EXACT, automates many of the essential management tasks that determine the financial success of a dental practice. Now, 3Shape’s TRIOS Intraoral scanner platform, Unite, is integrated with EXACT, allowing for a more streamlined workflow. This lets patient information pass from EXACT to 3Shape Unite without requiring double entry of patient data - patient information is automatically populated in 3Shape Unite, ready for a 3D TRIOS intraoral scan. 3Shape Australia’s Regional Leader, Sara Lowy, said “We’re thrilled about the integration with EXACT as it allows for time savings and easier patient flow for dentists and their teams. It’s one of many ways in which 3Shape, along with its partners, strives to ‘change dentistry together”. Mark Van Zuylekom, General Manager for Henry Schein One Australia and New Zealand, is equally excited about the integration and said, “We’re committed to delivering a seamless customer experience and this partnership helps us deliver on that. 3Shape’s TRIOS Intraoral scanner platform’s (Unite) integration with EXACT dental software is a wonderful outcome for our customers, a huge thank you to both teams for making this happen.”

By Georges Fast

One man’s opinion...

is probably some lawyer searching for a client, or some journalist searching for a story who could beat this up until it made the news on a “slow news” day. Someone’s reputation would suffer and the cost of professional indemnity would rise...”

It is often said that those who control the present control the past and when you control the past, you can control the future.

Australia is about to emerge from what has been the greatest restriction of our liberties since World War II. These restrictions were imposed on us by various State Governments, apparently on the advice of unelected health bureaucrats appointed by these Governments and who, one suspects, were politically allied to their masters. The different regulations that applied in the various States had more to do with which political party was in power than with the science on which they were based.

Once again one would have to be naïve to believe that the current easing of restrictions is the result of some medical epiphany, rather than the outcome of political polling that has determined that the public is no longer prepared to be bullied into submission and will likely punish their political masters at the next election.

Some 20 years ago, Australia’s then wealthiest man was asked for the reasons behind his success; his answer was: “only do what makes sense, if it doesn’t make sense to you, don’t do it regardless of what pressure may be applied to you” and he also said that everyone is allowed to make a mistake, but they are not allowed to make the same mistake twice.

It is indeed a pity that our governments don’t follow that advice. Here in Victoria, we have a situation similar to that which occurred 30 years ago where the State was effectively bankrupt, services had been allowed to run down, huge numbers of public servants were employed in non-productive tasks and red tape was delaying progress. It appears that we have learned nothing and once again projects that can be promoted on social media as building a better future take precedence over Health and Education. We have a real health crisis and unless you’re wealthy and well-connected to the medical establishment, your chances of obtaining proper and timely health care are not very good.

The difference between 1992 and now is that the press was concerned with the then current political situation and reported the news, keeping us informed of what our governments were doing and how they were falling short. Now it appears that the press is obsessed with trying to grab headlines based on unsubstantiated complaints from often anonymous “victims” about their treatment sometime in the past. If these stories are considered to be interesting enough to generate confected outrage, they will find their way into the popular media which is trying to compete with social media for impact.

An example is the current obsession with a few disaffected (unnamed!) footballers, the implication being that we need to judge their experiences a decade ago by the standards that apply today. Interestingly none of the footballers who were successful in playing the game professionally have complained about their treatment, it was only those who were rejected or couldn’t reach the required standard who complained. It made a good headline, doing immediate damage to respected individuals and football clubs without these people being approached for their input or given the chance to defend themselves before the headline was published. Even if they are fully vindicated, a certain stain will always remain.

“Here in Victoria, we have a situation similar to that which occurred 30 years ago where the State was effectively bankrupt, services had been allowed to run down, huge numbers of public servants were employed in non-productive tasks and red tape was delaying progress. It appears that we have learned nothing and once again projects that can be promoted on social media as building a better future take precedence over Health and Education...”

Imagine if these standards were applied to dentistry. What if we as dentists were held liable for using materials that are no longer currently approved. What if we were sued for every pulp that was killed because we didn’t use sufficient cooling, every TMJ problem that occurred because we didn’t fully balance every occlusion, every tooth that was extracted for orthodontic reasons that resulted in a flat profile, every RCT that was performed with a sealant that was later found to be problematic. There are any number of procedures that we performed 20 years ago in a manner that is not considered appropriate today. The science has advanced but does our treatment needs to be judged by the standards that applied at that time?

Emergency response times have blown out to the extent that people have died waiting for an ambulance. Waiting times for elective surgery, which appears to mean surgery for any condition that is not immediately life threatening, have been pushed out into the “never never”.

There is probably some lawyer searching for a client, or some journalist searching for a story who could beat this up until it made the news on a “slow news” day. Someone’s reputation would suffer and the cost of professional indemnity would rise.

The only way one can be assured of not getting into trouble is to do nothing.

“There

simply.TRIOS

5

Intraoral scanning that simply makes sense

Hygienic by design for minimal risk of cross-contamination. Smaller and lighter than ever for next-level ergonomics. And a ScanAssist engine with intelligent-alignment technology that makes precision scanning effortless, every time.

The six things every dentist needs to do to grow their dental practice

By David Moffet

Irecently heard about a practice that was having [a current] difficulty with its front office staff, who needed phone training.

[Actually, all dental practice front office staff need phone training.]

The interesting thing about this particular practice was that a couple of years ago, I spoke with the owner about organising coaching for the practice, including front office training, but the dentist did not want to go ahead because some staff were “concerned” about having their dental practice phone calls recorded.

The interesting thing is that I can guarantee that if this dentist had begun coaching two years ago, he would now be two years closer to his financial and career goals.

Whereas because the dentist bowed to his staff request, his practice is definitely not as suc cessful as it should be and is more than likely in a WORSE PLACE because it has done nothing at all.

The reason the dentist reached out to me two years ago was because eve rything that his practice had done in the past before that time had led his practice to a place of SERIAL UNDER-PERFORMANCE.

And seriously, you’ve really got to ask yourself who was employing whom in that practice, when the staff who took on the position of dental receptionist did not want to have their phone conversations with patients recorded?

I once heard Kerri-Anne Kennelly tell Ray Hadley, when talking about golf:

“No matter how bad you play, you can always play worse.”

And when it comes to dental office phones, I say: “No matter how bad you think they are, they’re always worse.”

And I add:

“No matter how good you think they are, they’re always worse.”

And this is what we find when we listen to actual dental practice phone call recordings – no matter how “experienced” the dental receptionists actually are.

The interesting thing with this dentist that I just mentioned and his practice, is that this dentist needs more than just front office training.

This dentist needs coaching for himself to improve his ability to manage people and his ability to be a good leader.

Have you noticed that those three things [leadership, people management and front office phone training] are not taught in dental school?

Successful dental practices have:

• Great systems and protocols;

• Great leadership;

• Good people management;

• Their dental office phones are managed exceptionally;

• World class customer service systems; and

• Great time management.

Have you noticed that those six things are not taught in dental school?

Those are six things that I teach my coaching clients...

When my coaching clients implement those six things that I teach them, they experience significant practice growth along with significant personal growth as well.

When I coach dentists who don’t follow my advice and behave their way off the sure fire path to success, guess what happens?

They lose their way and they fail to achieve their full potential. And then they blame their coach.

They blame their coach because they failed to follow a system.

And most commonly, their practices under-achieve because their practices are short on systems and discipline and accountability.

Funny that.

A University education teaches dentists clinical dentistry. Not business.

If you own a private practice, you owe it to yourself to learn the business.

Not make stuff up as you go along... That’s just dumb...

Having a dental business coach is not dumb, it’s common sense.

I’d call that a WIN-WIN relationship...

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.

“A couple of years ago, I spoke with the owner about organising coaching for the practice, but the dentist did not want to go ahead because some staff were ‘concerned’ about having their dental practice phone calls recorded...”

SENSODYNE REPAIR & PROTECT DEEP REPAIR*

Helps provide deep repair* and long-lasting protection against dentine hypersensitivity** 1-4

NO.1 BRAND FOR SENSITIVE TEETH5

Builds a strong hydroxyapatite-like layer deep within the tubules of exposed dentine for deep repair* and protection** 1,3,6-9

Reparative* hydroxyapatite layer is harder than underlying dentine and resistant to dietary acid and physical brushing 2,4,7,10

Advanced Science. Deep Repair*.

Proven for effective relief and long-lasting protection against dentine hypersensitivity** 11-13

*Forms a protective layer over the sensitive parts of the teeth. Brush twice a day for lasting sensitivity protection **With twice-daily brushing. Always read label and follow the directions for use.

References: 1. Greenspan DC. J Clin Dent 2010; 21:61–65. 2. Burwell A et al. J Clin Dent 2010; 21:66–71. 3. LaTorre G, Greenspan DC. J Clin Dent 2010; 21:72–76. 4. Earl JS et al. J Clin Dent 2011; 22:68–73. 5. GSK Consumer Healthcare calculation based in part on data reported by NielsenIQ and IQVIA through the IQVIA™ & NielsenIQ© RMS Sell Out] Service for the Oral Health Database, Sensitive Segment for the 52 week period ending 17/08/2021 for the Australia Grocery Pharmacy market according to the client defined product hierarchy. 6. Earl et al; J Clin Dent 2011; 22(3): 62-67(A). 7. Parkinson C et al. J Clin Dent 2011; 22(3): 74-81. 8. GSK Data on File; In vitro study number ML880; G7215/018; 2018. 9. GSK Data on File, Addendum to in vitro report ML880; 2021. 10. Wang Z et al. J Dent 2010; 38: 400-410. 11. Hall C et al; J Dent 2017; 60: 36–43. 12. GSK Data on File; Clinical Study number RH01748, 2013. 13. Hall, C et al; J Dent Res, 2017; 96 B:062 BSODR. Trade marks are owned by or licensed to the GSK group of companies. © 2022 GSK group of companies or its licensor. GlaxoSmithKline Consumer Healthcare Pty Ltd, Sydney, Australia. PM-AU-SENO-22-00121.

By Lani Guy

Give them the pickle!

“Most offers and promotions feel like a take rather than a give because you must give to get. These fail to address the underlying problem; the disgruntled customer who genuinely does not want to come back will not be incentivised but rather aggravated by such placations...”

IIn this edition of Australasian Dental Practice, I want to share with you some of the ways that I see business and innovation coming together with dentistry in a way that’s practical. And when I say practical, I mean in a way that adds value to your bottom line and isn’t just something that sounds good on paper. In the last edition, we explored “sales funnels” and being smarter about where we put our time and money for lead generation. In this article, we will take a look at dealing with everyday customer interactions that can yield big results by generating useful social media traffic. Specifically, we look at a technique called “give them the pickle!”

Give them the pickle is a business term used within customer service which refers to doing whatever a customer wants or needs to feel satisfied. The phrase was coined by Bob Farrell, founder of Farrell’s Ice Cream Parlor and Restaurant, after interactions with a disappointed long-term customer. This patron, after over 3 years of loyalty to the then-young business, had been refused his usual complementary pickle by a recently hired staff member.

The patron wrote to management to express his displeasure in no uncertain terms “I’m not coming back to your restaurant if that’s the way you’re going to run it”. After much assurance that this wasn’t the case, Bob sent him a coupon for a free chocolate sundae and invited him back to visit them. Bob Farrell has since credited much of his following success to this one encounter and history was made.

in return? Such offers are free of the taint that comes with give to get offers; they are purely get. When done right, they not only create huge customer satisfaction but, when combined with staff autonomy, can help make you an employer of choice and raise staff satisfaction when staff can choose whom to give the pickle. Pickles also have the ability to go viral on social media and get you not only new customers, but new staff who value the values you espouse as a business.

Before taking a look at a dental example, let’s take a look at a real world example. In 2019, a single mother in a university tutorial took her infant to the tutorial because she was unable to find childcare. Rather than reprimanding the mother or asking her to leave the tutorial (something which has happened to me for doing the same during my tertiary studies), the tutor asked to hold the infant so the mother could use her laptop and take notes. A classmate took a photograph of the tutor holding the infant and posted it to Linkedin. The post went viral with over 10,000 comments and was a major feature news story on the prominent CNN channel.

“A single mother in a university tutorial took her infant to the tutorial because she was unable to find childcare. Rather than reprimanding the mother or asking her to leave the tutorial, the tutor asked to hold the infant so the mother could use her laptop and take notes. A classmate took a photograph of the tutor holding the infant and posted it to Linkedin. The post went viral with over 10,000 comments and was a major feature news story on the prominent CNN channel...”

Give them the pickle has been widely used in business customer service training and taught at business schools to much success. However, along the way Bob’s original message has been distorted and the original intention lost. Specifically, most offers and promotions feel like a take rather than a give because you must give to get. In restaurants, this might look like a $15 voucher toward your next burger purchase or free delivery on your next order. These fail to address the underlying problem; the disgruntled customer who genuinely does not want to come back will not be incentivised but rather aggravated by such placations.

But what would happen if we gave them the pickle without a problem? Without a complaint? Without asking for something

This one act brought immeasurable positive media coverage to the university involved through the kind actions of one tutor and an unsolicited social media response by a student. In short, the tutor gave his student the pickle and it paid in a way that paid media could never achieve.

Contrast it to the unfavourable media attention that could have eventuated had a classmate similarly captured my tutor asking me to leave the tutorial for “being an irresponsible mother” when faced with the identical situation of being a single mother with a mandatory tutorial and no other option. Best case scenario, this would attract a lot of bad press and worst case scenario would result in legal proceedings; all of which the astute business wants to avoid.

So how might we use the pickle in dentistry to create positive social media attention and attract new customers? Let’s go back to Peter, our imaginary customer from last edition. Peter is a loyal customer that has never been dissatisfied with your service. Peter and his wife and their kids all attend regular care. Peter’s kids are now grown up but still return for treatment. Conventional marketing wisdom would say there is no value in investing cost-based incentives into retaining Peter. 88

LUNA FLOW

UNIVERSAL FLOWABLE COMPOSITE

PERFECT

» Shade matching and handling of Luna Flow are outstanding. Restorations are seamless. « DR FERNANDA ZEVIANI - AUSTRALIA

Call 1800 337 003 www.sdi.com.au

Call 1800 337 003 www.sdi.com.au

Why? Because promotional offers are not needed to retain Peter as a customer or assure his positive word of mouth.

But imagine you reward Peter without conditions (a condition would be an offer such as incentives for referring a friend) for his loyalty.

This might be unexpectantly announcing at the end of Peter’s restorative appointment that because you value his patronage and loyalty and you know his son has a wedding coming up, that you are waiving today’s fee and tell Peter to put the money toward his son’s wedding.

Peter feels pleased, valued and genuinely surprised by your generosity. Peter tells everyone he knows about it and brags about his unexpected boon on his social media account.

Mary, a friend of Peter, sees Peter’s post. Mary has spent over $30,000 at her dentist whom she has been very happy with to date. However, upon seeing Peter’s post, Mary realises that the most she ever got was a birthday card and begins to feel disgruntled.

The psychology behind Mary’s negative emotive response is simple - humans measure happiness and value relatively and not absolutely and the relative judgement Mary makes is one of being undervalued.

Like Peter, she wants to feel valued and makes the decision to switch to your practice. Moreover, Peter, who was already a loyal customer, will certainly never leave your practice and will be forgiving for any future trespasses that might occur. If you select the right patient and the right pickle, pickles have the ability to go viral with little to no cost - in this case the cost of one filling.

The savvy reader might ask if we could improve the economics of our pickles if the ask was not a financial cost to the customer?

For example, subtly suggesting that Peter could express his gratitude by tweeting it if he so felt like doing.

This is not only prohibited ethically but imposes a feeling of obligation and thereby negates the norm of reciprocity which entices Peter to talk well about you to others and brag about his experience.

Similarly, you could swipe through the treatment as no-gap. This also costs Peter nothing but is not as powerful as waiving the fee altogether and is unlikely to go viral.

Why?

You are still profiting from the transaction; Peter will not feel as special, Mary will not feel jealous, it will not invoke the norm of reciprocity through gratitude and it will not inspire others when they hear the story.

The bottom line from all of this – if you’re going to give them the pickle, give them the pickle!

About the author

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.

Sham contracting in dentistry…

“If a person calls a duck a rooster, it’s still a duck. If 20 people gather by the pond, nod in agreement and call the duck a rooster, it remains a duck... UNLESS the duck and the duck farmer agree that the duck is for the purposes of the farm, a rooster...”

[Modified High Court Aphorism]

Alot of nonsense is spoken about sham contracts. It is claimed all the time that independent contractor agreements are shams - but “shamminess” is in the eye of the beholder. Maybe BOTH parties wanted to avoid an employment contract?

According to the High Court in ZG Operations & Anor v Jamsek & Ors [2022] HCA 2, if one is engaged as an independent contractor by way of a written agreement specifying that it is an

independent arrangement and not one of employment, as a general rule, that will be decisive as to whether there are any employee entitlements available – subject to the arrangement being a sham.

A sham contracting arrangement exists when a principal attempts to disguise an employment relationship as a contractor relationship. They may do this to avoid their responsibility for employee entitlements - unknowingly, or recklessly. They may do it for another reason.

The evidentiary threshold is not easily met. It would be difficult to see that arrangement as between dentists and dental practices as generally there has to be some entitlements not met, such as an award - often in the case of vulnerable workers [Some dentists consider themselves vulnerable, but compared to whom?].

That does not mean that a dentist might not necessarily be entitled to superannuation even if not an employee for the purposes of the Fair Work Act.

Refractive loupes - an ergonomic and wellness perspective

By Dr Anikó Ball, BDSc (Melb), Dip.Clin.Hypnosis, Adv.Dip. Alexander Studies Founder Optimum Dental Posture

Refractive loupes have been in the market for several years. After a conservative acceptance of this new technology, they are gradually becoming the benchmark for dentists to sit in a correct posture that may very well increase career longevity in the dental profession (though more research is needed to test this hypothesis).

Most dentists wear magnification loupes, which greatly assist us in diagnosis and treatment. Unfortunately, there has been little or no education on how to use loupes correctly or the criteria for selecting them.

I have been investigating loupes for several years after finding that most dentists attending my “Ergonomics & Wellness in Dentistry” Workshops were using TTL (through the lens) loupes with inadequate declination angles, forcing harmful bending of the spine.

Biomechanical design principles every dentist needs to know

The head is connected to the spine at the atlanto-occipital or nodding joint (at the height of the ears). An imaginary rod through the ears is the axis of rotation for the head. This joint is designed to look up and down.

NOTE: There is only a 10˚ freedom of movement for the head to look down at the top of the spine! Any more tilting of the head involves other cervical joints.

The next joint is the atlanto-axial joint, C1 and C2, designed for head rotation to the left and right. All the intervertebral joints below C2 are gliding or plane joints, which are not designed for bending or

twisting, especially for prolonged periods as we do in dentistry.

Bending and twisting spinal joints in a manner contrary to biomechanical design increases the risk of musculoskeletal disorders and occupational chronic pain.

Why I recommend refractive loupes

Refractive loupes are great! They enable dentists to sit upright, look ahead and see into patients’ mouths without harmful neck bending. 88

Figure 1. Refractive loupes and wireless light by Admetec.

the “ideal” head-neck relationship. This results in chronic contraction of the neck muscles and spinal compression.

The head is designed to sit on top of the spine at the atlanto-occipital joint with a very slight forward rotation because the front of the head is heavier than the back; its centre of mass being anterior to its base of support.

This results in the activation of stretch receptors in the deep postural muscles at the back of the neck, which in turn activate the antigravity muscular support system.

Leaning to the side

If you’re considering a purchase, or have already purchased refractive loupes, it’s very important to be aware of a few potential issues related to your posture and work procedures, so that you can make the best use of your loupes while maintaining a healthy posture and avoiding long term damage to your body in general and specifically, to your spine. I’ve been

working with some of these companies to assist them in providing basic ergonomic advice to dentists purchasing these loupes.

Chin-up head posture

I‘ve seen dentists use refractive loupes (the same using microscopes) with a slight upward chin tilt, believing it is

S

ome dentists are still leaning to the side instead of asking their patients to turn their head to the side or move their stool around the chair. The spine is not designed for prolonged or repetitive side bending.

Long working distance

f the Working Distance is too long, the patient chair is positioned too low, resulting in dentists’ legs locked in. I’ve seen some dentists forced to sit on the front half of their dental stool trying to get their legs in under the chair!

I

Being locked into such a position encourages leaning to the side.

Summary

o summarise, refractive loupes can be a game changer to every dental or medical surgeon who is concerned consciously about their posture and wishes to prevent long term musculoskeletal damage. Like every technology, it needs to be used wisely.

T

Take care of yourself, you are your most precious instrument!

NOTE: I have no financial involvement with any dental company. I am an advocate for the wellness of my colleagues.

For more information, visit the website www.optimumdentalposture.com

La tes t de velopm en ts in reg e n erati ve the ra pie s

Li ve su rgerie s Hands-on wor ksho ps Cas e sessio n

Morning with master clinici an s Clini cal round ta ble s

Post er exhibitio n

Res ea rch net working day

Join t sessions with AAP an d SE PA

SCIENTIFIC CHAIRS

SC IE NTI FI C CHAI R

K. McClain

SC IE NTI FI C PR OGR AMME

CO MMI TT EE

WilliamV Giannobile, USA

Pamela K. McClain, USA

Franck Renouard, France

Frank Schwarz, Germany

Anton Sculean, Switzerland

Istvan Urban, Hungary

Free symposium registration & invitation to research networking day

Pamela

Is tvan Urban

SATURDAY, 29 APRIL 2023

SATURDAY, 29 APRIL 2023

Blood products for tissue augmentation

Moderator: Anton Sculean

FORUM 3

FORUM 3

Blood products for tissue augmentation

Blood products for tissue augmentation

Speakers: Reinhard Gruber / Shahram Ghanaati / Andy Temmermann

Moderator: Anton Sculean

Moderator: Anton Sculean

Case Session

Moderators: Fabio Vignoletti / Nele Van Assche

Speakers: Reinhard Gruber / Shahram Ghanaati / Andy Temmermann

Speakers: Reinhard Gruber / Shahram Ghanaati / Andy Temmermann

Case Session

Case Session

The six best cases will be selected for presentation and the best case presentation will be awarded a prize.

Moderators: Fabio Vignoletti / Nele Van Assche

Moderators: Fabio Vignoletti / Nele Van Assche

Proceedings from the Osteology / DGI / SEPA Consensus Workshop

The six best cases will be selected for presentation and the best case presentation will be awarded a prize.

The six best cases will be selected for presentation and the best case presentation will be awarded a prize.

Proceedings from the Osteology / DGI / SEPA Consensus Workshop

Proceedings from the Osteology / DGI / SEPA Consensus Workshop

FORUM 1

Battle of concepts: the treatment of intact and compromised extraction sockets

FORUM 1

Moderators: Pamela K. McClain & Nikolaos Donos

Battle of concepts: the treatment of intact and compromised extraction sockets

Battle of concepts: the treatment of intact and compromised extraction sockets

Speakers: Jose Carlos Da Rosa / Melle Vroom / Joseph Kan / Maurício Araújo

Moderators: Pamela K. McClain & Nikolaos Donos

Moderators: Pamela K. McClain & Nikolaos Donos

Peri-implant disease

Speakers: Jose Carlos Da Rosa / Melle Vroom / Joseph Kan / Maurício Araújo

Speakers: Jose Carlos Da Rosa / Melle Vroom / Joseph Kan / Maurício Araújo

Peri-implant disease

Peri-implant disease

Moderators: Frank Schwarz & Lisa Heitz-Mayfield Speakers: Purnima Kumar / Jan Derks / Ausra Ramanauskaite / Alberto Monje

FORUM 2

Moderator: Jose Nart Speakers: Eduardo Montero & Ausra Ramanauskaite Stefan Bienz & Cristina Vallès Vegas Ignacio Sanz-Martin & Maren Soetebeer

Moderators: Frank Schwarz & Lisa Heitz-Mayfield Speakers: Purnima Kumar / Jan Derks / Ausra Ramanauskaite / Alberto Monje

Moderators: Frank Schwarz & Lisa Heitz-Mayfield Speakers: Purnima Kumar / Jan Derks / Ausra Ramanauskaite / Alberto Monje

SEPA Session

FORUM 2

FORUM 2

Moderator: Jose Nart

FORUM 4

Moderator: Jose Nart Speakers: Eduardo Montero & Ausra Ramanauskaite Stefan Bienz & Cristina Vallès Vegas Ignacio Sanz-Martin & Maren Soetebeer

Speakers: Eduardo Montero & Ausra Ramanauskaite Stefan Bienz & Cristina Vallès Vegas Ignacio Sanz-Martin & Maren Soetebeer

Innovative technologies for tissue augmentation

Moderator: William V. Giannobile

FORUM 4

FORUM 4

A special programme will be set up by the Sociedad Española de Periodoncia y Osteointegración (SEPA).

SEPA Session

SEPA Session

AAP Session

A special programme will be set up by the Sociedad Española de Periodoncia y Osteointegración (SEPA).

A special programme will be set up by the Sociedad Española de Periodoncia y Osteointegración (SEPA).

A special programme will be set up by the American Academy of Periodontology (AAP).

AAP Session

AAP Session

Speakers: Darnell Kaigler / Saso Ivanovski / Jae Kook Cha / Atsushi Saito

Innovative technologies for tissue augmentation

Innovative technologies for tissue augmentation

Moderator: William V. Giannobile

Moderator: William V. Giannobile

Regenerative approaches in interdisciplinary dentistry

Speakers: Darnell Kaigler / Saso Ivanovski / Jae Kook Cha / Atsushi Saito

Speakers: Darnell Kaigler / Saso Ivanovski / Jae Kook Cha / Atsushi Saito

Regenerative approaches in interdisciplinary dentistry

Regenerative approaches in interdisciplinary dentistry

Moderator: Diego Velasquez Speakers: Karin Jepsen / Robert Sader / Irena Sailer / Mahmoud Torabinejad

Moderator: Diego Velasquez

Moderator: Diego Velasquez

Oral regeneration in a nutshell

Moderators: Bo Chen & Brenda Mertens

Speakers: Karin Jepsen / Robert Sader / Irena Sailer / Mahmoud Torabinejad

Speakers: Karin Jepsen / Robert Sader / Irena Sailer / Mahmoud Torabinejad

Oral regeneration in a nutshell

Oral regeneration in a nutshell

Moderators: Bo Chen & Brenda Mertens

Moderators: Bo Chen & Brenda Mertens

Speakers: Man Yi / France Lambert / Balint Molnar / Eik Schiegnitz / Vitor Marques Sapata / Jia-Hui Fu / Andre Vajgel

Speakers: Man Yi / France Lambert / Balint Molnar / Eik Schiegnitz / Vitor Marques Sapata / Jia-Hui Fu / Andre Vajgel

CLINICAL ROUND TABLES

Speakers: Man Yi / France Lambert / Balint Molnar / Eik Schiegnitz / Vitor Marques Sapata / Jia-Hui Fu / Andre Vajgel

Soft-tissue augmentation in focus

CLINICAL ROUND TABLES

CLINICAL ROUND TABLES

Speakers: Filippo Graziani / Luca Gobbato / Todd Scheyer

Soft-tissue augmentation in focus

Soft-tissue augmentation in focus

Speakers: Filippo Graziani / Luca Gobbato / Todd Scheyer

Bone augmentation in focus Speakers: Bilal Al-Nawas / Christoph Hämmerle / Gustavo Avila-Ortiz

Speakers: Filippo Graziani / Luca Gobbato / Todd Scheyer

Bone augmentation in focus

Bone augmentation in focus

Speakers: Bilal Al-Nawas / Christoph Hämmerle / Gustavo Avila-Ortiz

Speakers: Bilal Al-Nawas / Christoph Hämmerle / Gustavo Avila-Ortiz

A special programme will be set up by the American Academy of Periodontology (AAP).

A special programme will be set up by the American Academy of Periodontology (AAP).

LIVE SURGERY | SOFT–TISSUE REGENERATION

Moderator: Mario Roccuzzo Surgeon: Sofia Aroca

LIVE SURGERY | SOFT–TISSUE REGENERATION

LIVE SURGERY | SOFT–TISSUE REGENERATION

Moderator: Mario Roccuzzo Surgeon: Sofia Aroca

Moderator: Mario Roccuzzo Surgeon: Sofia Aroca

MICHAEL SERNIK

Welcome to Happy Smiles Dental Spa where gentle service is our priority. My name is Nikki. How may I help you today?”

Don’t use any script that has any potential to annoy the caller. This script is long. Some people might roll their eyes and be annoyed at having to wait while you rattle it off. As long as you use your name, speak clearly, are not rushed and sound very friendly, you won’t offend anyone. Something like: “Hello, this is Happy Smiles Dental, Nikki speaking” is inoffensive.

Avoid saying anything negative like “Sorry, we can’t quote unless we see you”. If they ask something like “How much for an implant”, your first response is to say something positive, like “Sure, I can definitely help you with that”.

Try and avoid firm quotes. If your fee is not lower than the last price they heard, they might just say thanks and ring someone else. It’s better to respond with “Sometimes there isn’t enough bone or the bone density is unsuitable. Do you know if there is an ideal amount of

bone support? There are several types of implants. I’d love to quote you accurately, because I know our fees are very competitive. Do you have a copy of a recent Xray of the area?”.

After answering a question, always add your own question. Never be silent after answering a question. For example, if you just quoted a fee and then said nothing, the patient will often not commit. They aren’t sure what to do so they say “Thanks. I’ll let you know”.

You can control the conversation with questions like this:

n Which tooth is it?

n Is it bothering you at the moment?

n Is this for you or for someone else?

n Is this something that you’d like done soon or are you just curious and not in any rush?

n Do you have health insurance?

n May I ask if we were recommended by one of our patients?

n Do you know if your mouth has any chronic gum condition, because if an implant is placed in any area with chronic infection, it has a chance of failing. Have you had the bacteria checked? (Only say things like with prior approval from your clinician).

Guide them to an appointment. “I’m just wondering (pause)... If I reserve a complimentary time for you so you can get a fixed quote... would that be of any help for you... do you think?

If they didn’t offer their name, get it. Say something like “By the way, my name is Nikki. May I have your name?” Then use their name when appropriate.

Dealing with phone shoppers is a game of wits. Scripts are not ideal because they can block you from being “in the moment”. You always want to try and start a relationship, so wherever possible, try and engage the patient into a deeper conversation and guide them to share more details.

More at www.sernik.com

TERRY WHITTY

IMPRESSIONS

NO matter

who told you otherwise, digital impressions are now statistically better and more accurate than conventional impressions, period. Check any study and you’ll find this to be true. Forget impression material, forget trays, forget gagging patients and forget plaster and stone. If you’ve not embraced digital impressions for the majority of your dental laboratory work and records, you’re falling way behind and wasting money. Digital impressions pave the way to more reliable and better fitting restorations and appliances. Your patient, your lab and your bank account will thank you!

3D PRINTING

Get a 3D printer. If you have an intraoral scanner, unless you totally outsource, you will also need a 3D printer. This will convert your scans to physical models when you need them. Also, you’ll be able to manipulate your scan data using simple CAD programs and print the results - Great for simple smile design mock-ups, clear aligners, splints, surgical guides, temps, etc. Compact 3D printers are inexpensive and are now “do all” machines. Your dental laboratory will still be able to design and construct the more complex cases for you, otherwise you’ll turn into your own lab and that may not be ideal!

OUTSOURCE

Consider the option of outsourcing your computer-aided designs. Let’s face it, creating designs using CAD design software is not for everyone. If you don’t have a human resource in-house who is a design whiz, there are now great design service laboratories (like fabdent.com.au) that will design most dental things for you at a cost-effective price. They are experienced and will save you a ton of time, money and stress on your next case. You can then decide how you’ll manufacture, be it in-house milling or printing, outsourced elsewhere... or even by sending it to your local dental laboratory.

“Dealing with phone shoppers is a game of wits... Try and engage the patient into a deeper conversation and guide them to share more details...”

tips for organic posting on Facebook...

Ever wondered why on your business Facebook page, you get little to no interaction on your posts - even though posts on your personal Facebook page get a lot more interaction?

Did you know on average your organic posts on your business Facebook page only reach 3-5% of your fans. In some cases, it’s less. This makes it a lot harder to get more interaction with your organic (unpaid) posts without paying Facebook to get more reach. Here are three secret tips to help you get more engagement on your posts.

Tip One

Agood way to get quick, viral engagement is to post up a meme. Now keep in mind this is a short-term solution only to get your engagement up. I would recommend posting up a meme once a

What Google wants...

What does Google want you to do on your website for it to give you a preferential position in search results... without paying for ads (often referred to as appearing on page one of the organic search)? Google uses a continually changing set of complex calculations, referred to as its algorithm, to determine who is more deserving of ranking higher. Google uses many factors in its decision making and you can “Google” what “experts” believe these to be (it’s a closely guarded secret like the 11 herbs and spices in KFC). The “art” of the process of making your website Google friendly is called Search Engine Optimisation - or SEO. A key factor that is often missed in SEO, however, is that Google favours websites that are continually updated with new content. A website is not a brochure; it should be a living, breathing, real time reflection of your practice. This is the reason SEO gurus tell you to “blog” without telling you why. Google doesn’t “read” your blog; all it sees is fresh new content. And fresh new content continually added is gold!

week or once every fortnight. Make it funny; humour is the best-selling emotion on social media. The key is to only run this type of post for a few months, just until your engagement is up.

Tip Two

There is a problem with posting up the same type of content (i.e., product posts). After a while, Facebook sees it as spam and reduces your reach. A good way around this is to create a schedule of different posts such as product posts, memes, industry-related posts, customer review posts, talkie posts (asking your fans a question). This will help you get more interaction on your posts, whilst keeping the Facebook algorithm happy.

Tip Three

To maximise the results of your posts, schedule your posts when your fans

are online. You can check this by going into your insights and seeing what time the majority of your fans are online. Then add your posts at a peak time. This will help you in getting more engagement and a better return on your effort.

More at dentalmarketingsolutions.com.au

Do you ever Google your practice? Because your potential new patients do. There are of course other search engines, but in Australia, Google has around an 86% market share. In times gone by, the Yellow Pages was the place to be and missing out on being in that annually printed tome coined the famous advertising slogan “Not happy, Jan!”. Nowadays, if a new patient cannot Google you, then you will be missing out on calls from new patients. Even if you don’t have a website, Google should still be able to find something out about you thanks to “aggregator” websites. Whereas Google can only “index” data from sources it finds online, aggregators (i.e. online directories) typically gather information from other offline sources too. The king of this is Your Dentist™ - located at www.dentist.com.au - which receives more than a million searches a year and is published by the publishers of this magazine. This site is continually updated based on interactions with the dental profession. The Yellow Pages and White Pages - once printed telephone books - are also both online directories and use data from telephone accounts. The Federal Goverment’s Health Direct website similarly uses offline means for data collection. Google “indexes” all the information from these aggregator websites and uses this in formulating its search results. Google also “indexes” Facebook™ pages and... pretty much anything else it can find about you. So Google your practice and see what you find. If there is absolutely no information showing about your practice at all... then you have a major problem (whether you have a website or not). Online directories - the aggregators - typically welcome your interaction to add or correct your information. For Your Dentist, visit www.dentist.com.au/information-for-dentists to add or update your information. This step alone will put you on the radar. If you don’t have a website, or your website hasn’t changed for years, then it’s really in your best interests to invest in a new website. Websites do not need to be expensive, but ultimately if you don’t have one, it’s costing you in missed opportunities.

The Dental Community website offers members of the dental profession a range of tools to make your life easier and more prosperous. Here are 3... Marketing! Login to list your practice - or update your details - on the hugely popular www.dentist.com.au website used by the public to find dentists. Not only can you manage your personal and practice details on the site, you can also view Google Analytics

data about how your listing is performing on the website.

Track your CPD: With a new CPD cycle beginning, now is the perfect time to start logging the CPD you complete as you do it so in 3 years time, you will know exactly where you stand. Not only can you do this in the Dental Community, the website does some of it for you automatically. Any course you register to attend through Dentevents.com

(such as with Ivoclar, Geistlich, GC, etc), your CPD is automatically recorded (and you can download the CPD certificate and your receipt any time).

Promote your own events. If you run courses or events for the dental profession, then you can list them on Dentevents.com and even accept registrations and payments and manage your delegates through the Dental Community. The powerful Event Manager caters to everything from a simple lecture to a full congress with multiple days, streams, sessions, speakers and registration options.

Practice Growth HQ Podcast

Angus Pryor 48 episodes

Practice Growth HQ is your home for all things practice growth for healthcare professionals such as dentists, doctors, physios, etc. In this weekly podcast, you’ll enjoy learning from thought-leaders, industry experts, and thriving practice owners as they reveal their very best tips, tools, and strategies to help grow your healthcare practice faster.

Dentistry Uncensored with Howard Farran Podcast

Dr Howard Farran

1716 episodes

Uncomplicate your dental life with Dr. Howard Farran as he interviews your fellow townies and leaders in dentistry! Dentists and dental professionals share their wisdom to make your dentistry faster, easier, higher in quality and lower in cost. Episodes released every week day.

The Dentalpreneur Podcast with Dr Mark Costes Dr Mark Costes

1585 episodes

This podcast assembles the greatest minds of the dental profession to pass on their most valuable and succinct lessons in order to help you to achieve your full potential. Dentistry can be a frustrating and isolating profession... but you don’t have to be an island anymore. It’s possible to become more profitable, less stressed and more fulfilled in your career and it’s our mission is to help.

Send your favourite podcast info to joseph@dentist.com.au so we can feature it in an upcoming edition

Restorative

Another day, another data breach: How NOT to become the next Medibank Private…

JAMES BORG

I’ve been spending a big chunk of my time over the last few weeks talking to practices who are scared to death of the potential risks from cyber attacks and rightfully so, considering these days it’s not a matter of if, but when.

Some of the classic responses I get when talking about security with clients range from a complete understanding of what they need to do to achieve their goals down to a completely opposite nonchalant attitude of “she’ll be right”...

Hackers aren’t interested in our little practice…

BUT THEY ARE!

It’s easier to compromise 1000 smaller businesses then it is to hit one big one; if only 10% of those pay a ransom of $10,000 then that’s a million dollars right there. Securing our network is too expensive...

It’s not too expensive. In the current landscape, especially with the Optus and Medibank Private breaches recently, we’re going to see government agencies start to really come down on businesses that are compromised and have been negligent in securing their networks.

I don’t need all this security mumbo jumbo!

You absolutely need this security mumbo jumbo.

I have good backups, I’ll be fine... That’s great, however do you want to be fined if you do have a data breach?

But let’s look at it from a different angle because a fine is only money.

How do you recover from the reputational damage that is caused when you have to tell all your patients that their personal and medical data has been breached and possibly out on the dark web to be sold to the highest bidder?

Cost is a big factor in a lot of the decisions that are made in regards to protection but considering the reputational damage that can be caused by a breach and losses due to downtime, it shouldn’t be, provided you’re investing in the right security “stack” to minimise your exposure in line with your goals.

So what should an ideal security stack look like?

Managed services

Managed services are the cornerstone of any good solution. They will usually include some form of support, anti-virus and “patch” management along with a proactive approach to looking at your hardware to minimise downtime.

HOWEVER, not all managed service plans are created equally; an ideal plan will include more than just antivirus and patch management; ideally they will be working to get your practice to an “Essential Eight” maturity level and include things like ransomware protection, persistent foothold protection and a good quality cloud backup solution.

We often put our security stack on to the networks of new clients only to find them riddled with viruses, malware and RATs.

Next-Gen firewalls

Your firewall is the equivalent of building a massive brick wall on the internet connection to your practice. Now as effective as a brick wall is at stopping things, we come across the problem of also needing to let things through it.

So we decide to put a door in the brick wall. This allows things to go through it, but now we have the problem where things are coming through it unchecked, so like a nightclub, we need a bouncer.

Although I think most of us have had a good night ruined by a bouncer at a nightclub at some point, a good one will only let in people that aren’t there to ruin the party and keep out the riff-raff.

A good Next-Gen firewall will have a bouncer that checks what is going through it using live cloud databases and also study the behaviour of what that traffic is trying to do.

We recently had a discussion with a practice who pulled out one of the cheapest modems on the market and pointed to the part where it said “firewall”.

Yes, it has a firewall function included, but it is only a basic brick wall with a door in it and no bouncer–basically completely ineffective and this is what we come

across every day. If you have a modem provided by your internet provider, it is ineffective to protect you against pretty much everything.

At Teamwork, we recommend Cisco Meraki firewalls as they’re fully cloud managed and provide one of the best levels of security for your network.

In addition to this, they will actually alert you if something is not right, for example if your internet goes down or if you have a device on your network that is doing something odd.

Spam protection

pam is one of the key vectors of attack for any business, not just dental. By stopping the majority of spam from hitting your network, you not only increase productivity but also plug one of the biggest security holes for your practice.

S

Spam protection is quite inexpensive these days and using a third party such as Mailguard will not just give you industry leading protection but insights in to how much junk mail you’re actually receiving, just by looking at their daily reports.

So what does it all cost to protect a five computer practice at this level?

Realistically, upfront, a good network firewall is around $2000-$3000 installed with a three year licence with all the bells and whistles.

As for the ongoing costs for the managed services and spam protection, the industry average should be around $500-$700 a month depending on the IT provider you use and the overall level of security and value they provide.

Whilst this may not be the be all and end all of your security stack, they definitely give you a great foundation to elevate the security of your network and significantly reduce your attack surface.

We believe practices should learn and understand what security they require and how it works for them.

Call Teamwork Technology on 1300-456-901 to learn more about network security tailored to you.

Say goodbye to neck and back pain!

The uniquely designed PENTAX deflection prism allows the surgeon to view the surgical site with the greatest depth of field and enhanced vision, whilst maintaining the best possible working posture.

ADX exhibition returns to Brisbane

There was a welcome return of visitors to ADX Brisbane from October 27–29, signalling a return of the Queensland event to the dental calendar.

ADX is a great opportunity for dental professionals to network, attend industry sessions, top-up their CPD points and to see the latest products, services and innovations from members of the Australian dental industry.

ADX Brisbane was kicked off with the ADX Breakfast, opened by MC Tanya McRae who is Australian Dental Industry Association President and Director of Dental Installations (Australia).

The three days of seminars and presentations were co-located with the impressive trade show exhibition supported by the dental equipment and services industry.

Major equipment supplier, A-dec Australia, had one of the larger displays which

attracted a high proportion of ADX visitors who took the opportunity to view the company’s range of award-winning products.

A-dec Australia marketing manager, Simon Taggart, said the availability of some special bundled package deals for A-dec equipment helped pique interest in their popular dental units.

“We had considerable interest in our special offers, which currently include a $10,000 saving on the flagship A-dec 500 chair package and the choice of a $7,000 saving – or a free Acteon intraoral camera – with our A-dec 300; and a free Acteon intraoral camera with the premium midmarket A-dec 400 packages.”

With the ATO’s Temporary Full Expensing measure due to finish on 30 June 2023, Mr Taggart said now was a great time to start buying to ensure plenty of time for equipment delivery and installation to be completed, so dental practices can claim the benefit.

Seen for the first time in Brisbane was the A-dec 360™ Maintenance infection control system and end-to-end protocol for dental unit waterlines.

The A-dec 360 Maintenance display was fronted by A-dec’s new Product Manager, Dr Wee Teo, who has a background in clinical trials and medical device product management.

The A-dec 360 Maintenance approach involves A-dec’s proven ICX tablets for self-contained dental waterline reservoirs, together with a recently introduced digital water testing service and a new shock treatment, ICX Renew, developed for periodic dental unit waterline maintenance.

The new water testing service is available through authorised A-dec service dealers and ensures the effective operation of dental unit waterlines and elimination of contamination risks and potential spread of infection and odours from dental unit waterlines and aerosols. 88

ICX tablets are widely acknowledged as a convenient, affordable and effective way of ensuring dental unit waterlines are kept free from contamination, while the new ICX Renew shock treatment is recommended when the water quality test results exceed the water quality action level.

The Australian Dental Association (ADA) advises that water from the dental unit waterlines should contain less than 200 colony forming units/ml (CFU/

ml), with ADA infection control guidelines recommending water testing every six months.

Mr Taggart said the water testing service should be introduced as part of the scheduled servicing of dental equipment in conjunction with other routine service calls such as steriliser validations.

“In addition to A-dec’s focus on productivity, reliability and ergonomics, infection control is an area where we want to support dental professionals by offering

a simple but comprehensive system for ensuring the health and safety of dental staff and their patients,” Mr Taggart said.

Interstate dental professionals will have another opportunity to see the latest equipment and services at ADX Melbourne which will be held next March 30 to 1 April 2023.

ADX Sydney 2024 will be held at the International Convention Centre, Sydney Thursday 21-Saturday 23 March 2024.

Unwanted guests in your waterlines?

When you SHOCK, let ICX RENEW.

Unwanted visitors like bacteria love to colonise in your dental unit waterlines. A daily waterline maintenance protocol with A-dec ICX® waterline treatment tablets, along with periodic ICX Renew™ shock treatments, will help reduce these nasty microorganisms.

For complete trademark information, visit a-dec.com/legal/trademarks.

To find out more, visit australia.a-dec.com

Intraoral scanning for Digital Dentures

Workflows for fabricating Full and Partial dentures digitally SYDNEY | FEBRUARY 25, 2023

Presented by Sam Dias, Dental Prosthetist

This event is both a lecture documenting why you should choose digital dentures today as the optimal solution for your dental practice or denture clinic together with a LIVE systematic run-through of the process for fabricating both full and partial digital dentures. You will be able to follow Sam Dias as he explains the step-by-step process he uses in his four clinics across Sydney every day.

A demonstration of accurate intraoral scanning and prosthetic design ensures that the outcome won’t be compromised while saving time and money for you and your patient.

The session will conclude with a Q&A session discussing options leading to self-design or aided design as well as the finishing and polishing process. This course will cover the following...

1. Impression vs Scanning

A discussion and slide presentation comparing intraoral scanning and traditional impressions including a live scan of dentures will be shown. The scanning process will be shown step-by-step and the many different impression techniques currently used will be reviewed and details of how these can be carried on to the digital world shown.

2. Adding mesh and articulator adjustment

Combining multiple scans and adjusting the setup of the virtual articulator will be shown.

3. Wizard and model analysis

Wizards and model analysis tools will be explained.

4. Digital denture teeth selection

How to select the correct digital denture teeth library will be discussed as well as the use of the measure tool plus patient notes and extra scans. Denture teeth library options and applications will be discussed.

5. Digital denture teeth setups

Digital denture teeth setup tips and tricks for faster and more effortless setups will be detailed.

6. Denture base design

Key principles to bear in mind when designing your denture bases plus a guide to troubleshooting.

7. 3D printing

3D printing techniques plus a guide to material selection and achieving better outcomes.

8.

Carded denture teeth

Step-by-step bonding technique with tips and tricks.

9.

Staining technique

Techniques for staining and filling in the gaps.

10. Finishing and polishing

Tips to achieve a great final outcome.

Discussion + Q&A Session

100% From the dolomites: Everything for your workflow

Technical research and development are in continuous evolution, constantly providing new techniques for the realisation of dental restorations. In the heart of the Italian Alps, with the fundamental values of discipline, innovation, trust and responsibility, the family-run company Zirkonzahn provides dentists and dental technicians with dedicated, simplified instruments for a smooth and reliable workflow, from the implant planning procedures to the final restoration. Based on the accurate recording of patient data, Zirkonzahn workflows can be carried out 100% digitally starting from the acquisition of the patient’s physiognomy through the innovative Face Hunter 3D facial scanner. In this way, the user can transfer the facial scan data, together with the models in the virtual articulator in relation to the axis.

Advantages for technicians, dentists and patients

With a single click, it’s possible to scan the patient’s face in only a few seconds. The scanner can also be used at the dental laboratory, just using a laptop. A flash system for perfect lighting is included in the equipment. Upon request, a light stand may also be provided.

3D facial scan data can bring many advantages not only to the dental technician but also to dentist and patient. Thanks to the use of the patient’s real physiognomy, the dental technician can obtain a result that is much more precise, providing dentists and patients with a near-photorealistic preview of the final restoration during the consultation phase.

Concrete and realistic

The facial scan data are imported into the design software Zirkonzahn. Modellier, where the dental technician can carry out the tooth set-up based on the patient’s natural teeth. Alternatively, the virtual tooth libraries available in the soft-

ware can be used. In addition, the dental technician can apply different tooth sizes, display the teeth in true colour and incorporate different reference lines in the 2D images for better tooth alignment (e.g., the smile line).

The PlaneSystem®For precise planning

Facial scans can be combined with the PlaneSystem ® (MDT Udo Plaster, in collaboration with Zirkonzahn). The PlaneSystem is an innovative approach for capturing patient-specific information,

which can then be transferred 1:1 into the virtual world, allowing for precise planning security and more achievable functional and aesthetic design of the restorations.

The PlaneSystem is composed of the PlaneFinder® to detect the patient’s Natural Head Position (NHP) as well as their occlusal plane angle; the PS1 physical articulator; and the PlanePositioner®, a platform used to place the maxillary cast in the PS1 articulator and to reproduce the occlusal plane. The PlaneSystem is also enriched with the PlaneAnalyser II: an analysis and recording device for digital acquisition of patient’s mandibular movements.

The 3D virtual patient using the Face Hunter 3D facial scanner and the PlaneSystem®.

Monolithic, zirconia restoration made 100% with Zirkonzahn digital workflow.

REVOLUTIONARY PATIENT ANALYSIS

FOR HIGH QUALITY DIAGNOSTIC PLANNING AND PATIENT SATISFACTION

Digital patient analysis with the PlaneSystem® and the Face Hunter Fig. 2 Fig. 3

www.zirkonzahn.com

Jain R, Chaturvedi R, Pandit N, Grover V, Lyle DM, Jain A. J Indian Soc Periodontol 2020; 24(4):348-353. Study conducted at Institute of Dental Services, Panjab University, Chandigarh, India.

Objective

To evaluate the efficacy of a water flosser and toothbrush using 0.06% chlorhexidine (CHX) with Pik Pocket® tip compared to 0.12% rinse and toothbrush in moderate-to-severe chronic periodontitis patients who postponed or declined surgical intervention.

Methodology

Forty subjects (40) were enrolled in this 3-month, randomised controlled clinical trial.

Subjects were assigned to one of two groups: Group A was instructed to irrigate with 0.06% CHX twice a day after brushing and Group B was instructed to rinse with 15 ml of 0.12% CHX twice a day after brushing.

All subjects received Phase I therapy consisting of scaling, root planing and oral hygiene instructions specific to their device and a standard manual toothbrush and toothpaste.

Gingival index (GI), oral hygiene index simplified (OHIS) and bleeding on probing (BOP) scores were recorded at baseline, 2 weeks, 4 weeks and 12 weeks post Phase I therapy.

Pocket depth (PD) and clinical attachment level (CAL) were recorded on 6 sites per tooth. The modification of Lobene stain index was used to assess intensity and area for each subject to monitor the staining by CHX.

Results

Thirty-six (36) subjects completed the study. Both groups showed a significant difference from baseline to 12 weeks for GI, OHIS and BOP. There were no differences between the groups. Group A, irrigation with 0.06% CHX, was more effective than Group B, rinsing with 0.12% CHX, for reducing PD and CAL.

Group A had significantly less staining on the lingual surface than Group B (p=0.014).

Conclusion

IDEM Singapore 2022 celebrates another great milestone achieved

The 12th edition of the International Dental Exhibition and Meeting (IDEM), held from 7-9 October, has successfully concluded. Coorganised by Koelnmesse and the Singapore Dental Association, the first physical IDEM after the pandemic hosted 6,530 attendees from 67 countries, exceeding the record number of attendee countries. This edition featured a total of 46 scientific conference sessions and workshops, covering all the latest trends and innovations. The exhibition floor hosted a total of 540 exhibiting brands from 37 countries of which 90% were returning exhibitors and 10% were exhibiting for the first time.

“Words cannot fully express my heartfelt gratitude to our sponsors, speakers, exhibitors, and delegates,” said Mathias Kuepper, Managing Director of Koelnmesse Pte Ltd. “This year, IDEM welcomed a strong number of quality dental traders and distributors from the region. In addition to the elevated interaction from an in-person setting, the number of quality leads that our exhibitors have secured is also testament to the success of IDEM 2022. With the support of our stakeholders, we continue to strive towards excellence at the next IDEM event.”

“Nothing compares to in-person conversations with like-minded dental professionals and the brightest minds in the industry. IDEM 2022 in person gave Envista the opportunity to showcase and share about our new products to the fullest, meet old and new connections, and explore new business opportunities. We look forward to the next IDEM edition in 2024,” said Keni Kubo, Country Manager of Envista Holdings.

Adrian Tan, Dentist at Dent1st Limited from New Zealand added, “IDEM 2022 was an opportunity for us to conveniently meet all the major manufacturers and suppliers in the world in one place. The scientific conference was led by quality speakers who presented niche and relevant topics that practitioners can immediately apply as well.”

Dr Jerry Lim, one of the speakers at IDEM 2022, presented on the topic: Comprehensive Aesthetic Rehabilitation: A Multidisciplinary Approach to a Complex Problem. More than 750 delegates attended to learn about the process of treatment planning for complex aesthetics rehabilitation. The conference aimed to expose participants to Digital Smile Design and Neuromuscular Occlusion concepts and to appreciate digital integration in comprehensive aesthetic rehabilitation.

The digital community platform, IDEM360+, specially created to supplement the in-person event, recorded close to 4,500 new connections. Of the new users onboarded, half of these users connected with a fellow delegate, speaker or exhibitor and about 40% engaged in online discussions via the IDEM360+ app.

The platform continues to run postshow, with 32 of the scientific sessions made available on-demand.

“IDEM continues to propel and invigorate the dental industry with not only the in-person event but also the IDEM360+ mobile application which continues to run after today,” said Prof Patrick Tseng, Scientific Chairperson of IDEM 2022. “Continual learning is key for our industry and we look forward to the next edition of IDEM as we aim to reach a wider audience and create a more insightful event for our participants.”

The next edition of IDEM will take place on 19-21 April 2024 at Marina Bay Sands Singapore. Attendees will be able to look forward to the latest developments in dental research and practice with more intensive educational sessions, interactive presentations, engaging meetings, and the latest advancements in dentistry. For more info, visit www.idem-singapore.com

40th IDS: 100-year success story set to continue with 1600+ exhibitors so far

IDS 2023 is not only celebrating its 40th edition, as the leading trade fair; the International Dental Show has also now been shaping the future of the global dental industry for 100 years. And the success story continues in 2023: So far, over 1600 exhibitors from 60 countries, including 14 group stands from 12 countries, have registered for the world’s largest trade fair for the dental industry, dental medicine and dental technology, which is being staged from 14 to 18 March 2023. And the online platform IDSconnect will allow all of the industry players to network, physically and digitally.

In addition to the largest participation from Germany, the strongest international exhibitor participants currently come from Italy, the Republic of Korea, France, Switzerland, Spain, Turkey and the USA. Beyond this, group stands from Argentina, Brazil, Bulgaria, China, Israel, Italy, Japan, Hong Kong, Korea, Singapore, Turkey and the USA are represented in Cologne. IDS 2023 will be staged in Halls 1 [new], 2, 3, 4, 5, 10 and 11 of the Cologne fair grounds in Germany on exhibition space spanning around 180,000 m2

IDSconnect

In addition to the physical exhibition, the digital platform IDSconnect, provides information on products and system solutions as well as enabling the streaming of webinars, press conferences, events and one-to-one interaction with industry decision-makers. This means consistent international reach combined with a successful in-person trade fair experience. Trade visitors of IDS can go live any time or call up content precisely when they have the time.

Furthermore, IDSconnect provides a range of digital offers that enrich the trade fair visit: from learning sessions, to online seminars, through to corporate and product presentations.

IDSconnect is very easy and intuitive for everyone to use - even without previous digital experience - bringing the world’s largest dental show directly to your screen for an authentic trade fair experience. All functions are presented as video tutorials on the IDS website - from the navigation through to networking at https://www.english.ids-cologne.de/ trade-fair/idsconnect/

IDS Ticket Shop is available from mid-December

All tickets for IDS 2023 can be booked exclusively online.

Free use of public transport in the Cologne region and the entire Ruhr region is included with your IDS ticket. That means that trade fair participants who travel from the metropolitan areas of Düsseldorf, Duisburg, Essen, Gelsenkirchen, Mülheim and Dortmund, who have booked accommodations there or who fly to Düsseldorf, can travel to the trade fair in Cologne with an Interregio train and other local public transport options free of charge.

About IDS

I DS (International Dental Show) takes place in Cologne every two years and is organised by the GFDI Gesellschaft zur Förderung der Dental-Industrie mbH, the commercial enterprise of the Association of German Dental Manufacturers (VDDI) and is staged by Koelnmesse GmbH, Cologne. For more information, visit www.ids-cologne.de

FAR UVC

222 nanometre lighting

SHEDDING NEW LIGHT ON BEATING AIRBORNE DISEASES

SHEDDING NEW LIGHT ON BEATING AIRBORNE DISEASES

Coronaviruses

Influenza

Rhinoviruses

Far-UVC lighting is an autonomous and continuous sanitation system that is safe for humans and animals – using 222-nanometer wavelength, and is also maintenance free.

Far-UVC lighting is an autonomous and continuous sanitation system that is safe for humans and animals – using 222-nanometer wavelength, and is also maintenance free.

Far-UVC lighting is an autonomous and continuous sanitation system that is safe for humans and animals – using 222-nanometer wavelength and is also maintenance free.

Together with the two primary methods for minimising exposure to airborne diseases (including COVID-19) – wearing a mask and social distancing, far-UVC has been proven to effectively sanitise the indoor air around us.

Together with the two primary methods for minimising exposure to airborne diseases (including COVID-19) – wearing a mask and social distancing, far-UVC has been proven to effectively sanitise the indoor air around us.

Together with the two primary methods for minimising exposure to airborne diseases (including COVID-19) – wearing a mask and social distancing, far-UVC has been proven to effectively sanitise the indoor air around us.

Far-UVC can be widely applied to safeguard populated spaces such as shopping centres, hospitals, schools, offices, public transport systems and gyms.

Far-UVC can be widely applied to safeguard populated spaces such as shopping centres, hospitals, schools, offices, public transport systems, gyms... and dental surgeries.

Far-UVC can be widely applied to safeguard populated spaces such as shopping centres, hospitals, schools, offices, public transport systems and gyms.

For more information on FAR UVC AFRICA and this immediately available and highly cost-effective solution, please visit www.faruvcafrica.com or contact: 082 578 3755

Available in Australia from Medisupply Pty Ltd Unit 33/110 Inspiration Drive, Wangara WA 6065 www.medisupply.net.au | info@medisupply.net.au

For more information on FAR UVC AFRICA and this immediately available and highly cost-effective solution, please visit

UVC 222nm lights for infection control

Safe for humans • Destroys viruses and bacteria in the air and on surfaces

FAR UVC light at 222nm destroys viruses and bacteria and is the only product that offers REAL TIME air and surface sanitation.

UVC light at 222nm is effective against viruses including SARS-CoV-2 (COVID) and Influenza together with multi-drug resistant bacteria in the air, on living human tissue and on surfaces.

Unlike UVA and UVB light, UVC does not penetrate the stratum corneum of the skin nor the cell membrane of a human cell.

The placement of fixed or mobile UVC lighting units in dental treatment rooms including during invasive, implant and oral surgical proceduces can add a further line of defence to your infection control protocols.

FAR-UVC lighting is the first safe, effective, autonomous and continuous disinfection system for occupied spaces.

Visit www.medisupply.net.au for product and technical information, scientific research and studies, recent installations and more...

High-speed sintering in just 20 minutes

Amann Girrbach’s HighSpeed Zirconia Kit allows users to sinter zirconia restorations in only 20 minutes. Consisting of the HighSpeed Ceramill Therm DRS sintering furnace and the specifically developed Zolid DRS zirconia, the High-Speed Zirconia Kit provides the perfect basis for the ultra-fast fabrication of highly aesthetic zirconia restorations. The restorations can be sintered in just 20 minutes and offer maximum efficiency with a natural appearance due to the perfectly coordinated 16 Vita shades with integrated shade and translucency gradient.

The focus of the development was clearly on the issue of safety, as only durable restorations are of benefit to the

laboratory, the clinician and the patient. For this reason, numerous studies were already conducted by renowned external institutes during the development phase. The result was conclusive: the fast sintering cycle has no relevant influence on optical or mechanical properties. In addition, the high flexural strength of > 800 MPa and the associated classification as a Class 5 zirconia provides an additional safety cushion.

Both laboratories and dental practices benefit from this innovative high-speed sintering process enabling them to add the so-called “Same Day Crown” to their service offering. Due to the extremely shortened sintering process, single-tooth crowns and three-pontic bridges can be realized in just one day, from preparation to final insertion.

What’s more, the fabrication of other indications can also be shortened considerably, for example, an implant restoration consisting of a zirconia abutment and a crown. Whereas previously at least two days had to be allowed for in planning this type of restoration, it can now be fabricated easily in less than 24 hours with the High-Speed Zirconia Kit.

The High-Speed Zirconia Kit offers every user an efficient and profitable process extension for the fabrication of zirconia in everyday routines - while at the same time maintaining natural aesthetics and maximum safety.

For more information, contact Innovatio Dental Supplies on Tel (02) 8575-8675, sales@innovatiodentalsupplies.com.au or see www.innovatiodentalsupplies.com.au

All Zirkonzahn implant abutments include a warranty for up to 30-years

As one of the world’s largest manufacturers of implant prostethic components, Zirkonzahn use a high-quality medical titanium alloy (Ti-6Al-4V ELI according to ASTM F136 and ISO 5832-3) and meet the strictest quality criteria (ISO 13485 MDSAP; Medical Device Directive 93/42/EEC; EU Regulation 2017/745 on medical devices). All components are conceived and manufactured at Zirkonzahn production sites in South Tyrol, Italy and in addition to the legally prescribed warranty obligation - the company offers up to 30 years warranty on all Zirkonzahn implant abutments used (titanium bases, Multi Unit Abutments, Multi Unit Abutments Angled and Raw-Abutments® as well as the corresponding screws). Within the current Zirkonzahn warranty regulation, they explicitly also include implants from other manufacturers used with Zirkonzahn implant abutments.

Zirkonzahn Implant Prosthetic Components

For more than 140 implant systems, the Zirkonzahn Portfolio consists of a great range of TGA approved products: regular titanium bases, Scanmarkers, White Scanmarkers, ScanAnalogs (laboratory analogues used as Scanmarkers), impression copings, laboratory analogues, Multi Unit Abutments, Raw-Abutments and healing caps. All implant prosthetic components are 100% integrated into the Zirkonzahn workflow via corresponding libraries. Exocad® and 3Shape® users are also able to download and implement Zirkonzahn components for free in their design software through a dedicated portal (Zirkonzahn Library Download Center). The product line has been recently expanded with new innovations and new products (See Table 1).

Table 1. New products and innovations

n Zirkonzahn LOC-Connector, a snap attachment system for implants and bars to fix removable dental prostheses on the implant.

n Multi Unit Abutment 17°, characterised by a 17° angle and two different anti-rotation connection types to compensate for any implant inclinations.

n Titanium Base K85, with the chimney height adjustable to the individual tooth length.

n Titanium Base K80 Angled Screw Channel, with a chimney height adjustable to the tooth length and the possibility to tilt the screw access channel from 0° to 30°.

n White Metal Scanmarkers, reusable Scanmarkers to acquire the implant position and orientation during intraoral and model scans.

All components are developed and produced at the Zirkonzahn Molaris I and II production sites in South Tyrol, Italy. Here, highly accurate techniques and versatile pro CNC machinery with turning, grinding and coating systems are used to produce milling tools, implant abutments and machine parts.

To exlore the renewed range of prosthetic components from Zirkonzahn, visit www.zirkonzahn.com and check if they are compatible with your implant system!

Figure 1. Zirkonzahn’s wide range of TGA approved implant prosthetic components available for more than 140 implant systems.

A-dec’s new Technical Specialist

A-dec has announced the appointment of Dominic Connolly as Technical Specialist with the company, based at its Australian Head Office in Sydney. Dominic (“Dom”) is well-respected in the dental community as a long-serving dental equipment technician and has extensive experience working on both A-dec dental units and a wide range of other dental equipment. He has a background as an equipment technician with a Sydney-based A-dec dealer before operating his own dental equipment servicing business for a number of years. His experience bolsters A-dec’s strong network of authorised A-dec dealers and A-dec Territory Managers and while his position is largely an advisory role, he is able to “get on the tools” when required. Mr Connolly recently helped with the setup of A-dec’s large trade display at the ADX Brisbane dental exhibition and is a great resource for A-dec and all of its Australian customers and equipment dealers. He can be contacted by calling the A-dec Sydney head office on (02) 8332-4000 or via email at dominic.connolly@a-dec.com

Formlabs appoints Dental Channel Sales Manager for

ANZ

3D Printing giant Formlabs has appointed Louis Manera as its Dental Channel Sales Manager for Australia and New Zealand. Mr Manera is well known in the dental industry, having previously held roles as a Dental Equipment Specialist for KaVo and Dürr at Ivoclar and most recently in his founding role as Country Manager (ANZ) for Dürr Dental SE over the last 15 years. “I am very excited to be joining a passionate, technology-driven organisation that has already had successes globally in cutting edge engineering applications including aerospace [NASA], automotive [Audi, BMW and Bosch], aircraft [Boeing] and healthcare (prosthetics).” Formlabs is based in Somerville, Massachusett and was founded in September 2011 by three MIT Media Lab students. Mr Manera is fully focused on growth within the dental space with Formlabs 3D printing solutions already being prominent in dental and orthodontic clinics as well as many dental laboratories. He can be contacted via email on louis.manera@formlabs.com or call 0412-959-525.

W&H appoints National Business Development Manager

Dürr Dental has appointed Mr Mina Farag to the newly created role of Product and Hygiene Specialist for Australia and New Zealand. Mr Farag is a registered Oral Health Therapist who graduated from Victoria’s La Trobe University in 2012. He has worked as an Oral Health Therapist for the past 10 years in both private practice and public community clinics, including the Periodontal Department at the Royal Dental Hospital of Melbourne. He was also an associate lecturer and the co-ordinator of second-year Bachelor of Oral Health Science at La Trobe University before transitioning to Dürr Dental. Mr Farag will be responsible for the hygiene, suction and compressor line of products, with a particular focus on the new Lunos premium prophylaxis system from Dürr Dental, which the company is excited to introduce to the Australian market! While working closely with its distributors, Mr Farag will also be available to clients to help with their needs and answer any questions they may have about Dürr products. He can be contact on 0437-799-323 or email Mina.Farag@duerrdental.com

W&H has appointed dental industry stalwart, Lindsay Forrest, to the role of National Business Development Manager. A Scot, Lindsay commenced his career in the UK before emigrating to Australia. He was one of the founders of Dentavision and it’s first Managing Director, however, spent the bulk of his career with Morita, managing both Australia, New Zealand and South East Asia. This was followed by nearly 5 years with Kulzer, initially in A/NZ as Operations Manager and later as General Manager, South East Asia. “I was enticed to join W&H based on its well-respected leadership and outstanding product range,” Mr Forrest said. “W&H is a company who I’ve held in high regard throughout my career and Martin Rolfe is a highly ethical and driven leader who I’m convinced will take W&H onwards and upwards in the Asia Pacific. My new role as National Business Development Manager is a perfect fit for my skill set and W&H is an ideal home.” Mr Forrest can be contacted on 0412-371-812 or lindsay.forrest@wh.com

Dürr Dental appoints Product and Hygiene Specialist for Australia and New Zealand

Implant Planning Module from Carestream Dental now accepts open files from intraoral scanners

Carestream Dental’s Prosthetic-Driven Implant Planning (PDIP) module now accepts scans from intraoral scanners that generate STL/PLY files, giving clinicians greater flexibility when planning and placing implants. The PDIP module is the implant planning solution that supports more confident diagnoses, improves treatment predictability, reduces the number of visits and leads to better patient communication and enhanced collaboration.

“Opening up the module to accept STL/ PLY files offers more options and helps you make better decisions about optimal crown and implant position, which leads to more control over the final clinical and aesthetic outcomes,” Stephane Varlet, global product line manager for extraoral imaging, Carestream Dental, said.

The PDIP module, which is an option available with CS 3D Imaging, makes it easy for doctors to ensure implants are positioned according to the ideal future restoration by letting them virtually plan a crown and implant on the same screen. The module automatically aligns the STL/PLY files from an intraoral scanner and DICOM file from either the CS 8100 3D, CS 8200 3D or CS 9600 CBCT systems to create a virtual set-up with little to no manipulation from the doctor.

Users then add a crown to the combined scanner/CBCT datasets and place the implant from a library featuring more than 90 manufacturers. They can also add abutments, create their own implants and manage their own library. Practitioners can also generate an implant report to order the components required for surgery and to share with their treatment network.

Because the PDIP module produces files in an open format, implant planning output can be easily exported with a single click into third-party software including Swissmeda or BlueSky Bio for the creation of surgical guides.

For more information about the PDIP module, CS 3D Imaging software or any of Carestream Dental’s innovative products, register your interest at https://bit.ly/3QEgACK

About Carestream Dental

C

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

Seeing the difference makes a difference

See CBCT in a new light with CS 8200 3D NEO EDITION. It is the versatile 4-in-1 imaging system that creates new possibilities with capabilities such as an intuitive user interface, 9 fields of view and low-dose panoramic imaging. carestreamdental.com/8200 anz-enquiries@csdental.com

New MyLunos air polishing handpiece

Dürr Dental has launched its portable powder handpiece in Australia. MyLunos, which has been available overseas since 2017, offers simple, powerful and ergonomic assistance when you need to remove discolouration, deposits and biofilms. Depending on the nozzle, it is ready for either supra- or subgingival applications.

The MyLunos handpiece sits comfortably in your hand due to its ergonomic design and interchangeable powder chambers, eliminating the need to refill in the middle of treatment. It also has the added benefits of allowing you to change from supra- to subgingival cleaning with a quick change of the nozzle.

In terms of reprocessing, all components are autoclavable and can be placed in the ultrasonic bath, reducing risk of clogging and ease of maintenance.

The primary benefits of subgingival air polishing are its gentler application and shorter treatment time in comparison to hand and ultrasonic instrumentation.

One of the low-abrasive powder materials, a non-cariogenic disaccharide, trehalose, has demonstrated equivalent outcomes to ultrasonic scaling over 12 months in terms of reducing periodontal pockets and bleeding on probing in patients with pocket depths of 5-9mm.

This was conducted using the new sterile perio tip designed by Dürr Dental, which has a small flexible diameter, allowing easy entry into the periodontal pocket, providing a much more comfortable experience for the patient compared to ultrasonic scaling. In contrast to an apical streaming tip, the single opening on the lateral surface of the tip enables optimal redirection of the compressed air towards the root surface, lowering the risk of emphysema.

Trehalose, which is substantially less abrasive than glycine and sodium bicarbonate, has also demonstrated the best efficacy for supragingival stain and biofilm removal.

The MyLunos supra nozzle allows easy removal of plaque and stains using trehalose that can be integrated into routine hygiene visits, cleaning around orthodontic brackets or preparing for fissure sealants.

There are three flavours of the trehalose-containing Gentle Clean powder for supragingival application: orange, spearmint and neutral. Additionally, a neutral-flavoured Perio Combi powder

is offered as a one-for-all powder for both supragingival and subgingival treatments. Patients no longer need to feel the unpleasant grittiness commonly associated with air polishing due to trehalose’s exceptional water solubility, along with a pleasant tasting experience.

1. Morawietz, M.; Sarembe, S.; Kiesow, A.; Hänel, K.; Hartl, J.: Air-Polishing: Investigation of Cleaning Performance and Abrasiveness of Different Powders; Poster 2020 IADR/AADR/ CADR (Washington, D.C., USA); 2020; Presentation ID 2984.

2. Kruse, A.B., Wölki, B.J., Woelber, J.P. et al. Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial. BMC Oral Health 22, 70 (2022). https:// doi.org/10.1186/s12903-022-02109-1.

MyLunos Perio Tip.

Morawietz, M, 2020, Cleaning performance in comparison to surface roughness. BEFORE AFTER

LUNOS® PROPHY POWDER PERIO COMBI (TREHALOSE) –BENEFICIAL FOR WOUND HEALING

in terms of cell response and in contrast to Glycine-based prophylaxis powder.

Lunos® Prophy Powder Perio Combi, based on trehalose, can be used for supra- and subgingival air-polishing in prophylaxis as well as to support periodontal or periimplantitis therapy. ▪ effective ▪ highly soluble ▪ pleasant taste for patients ▪ low abrasive

LUNOS® PERIO COMBIFORBENEFICIAL(TREHALOSE) HEALINGWOUND

A recent in-vitro study (Weusmann et al. 2021) has shown that trehalose has no pro-inflammatory and no pro-apoptotic effects on human gingival fibroblasts. Wound healing of gingival tissue is, in contrast to glycine, not negatively influenced (Fig. 1).

Wound closure (%)

Time (h) 0 0 10 20 30 40 50 60 70 6 12 24 36 48

Control

Trehalose

Glycine

Fig. 1: Wound closure of human gingival fibroblasts (HGF) in the presence of glycine and trehalose over 48 h. *significant difference from all groups °significant difference to control Derived from (Weusmann et al. 2021).

Thus, the authors suggest that in terms of cell response, trehalose-based air-polishing powder might be more beneficial than glycine- based powder for air-polishing.

Weusmann, Jens; Deschner, James; Imber, Jean-Claude; Damanaki, Anna; Leguizamón, Natalia D. P.; Nogueira, Andressa V. B. (2021): Cellular effects of glycine and trehalose air-polishing powders on human gingival fibroblasts in vitro. In: Clinical oral investigations. DOI: 10.1007/s00784-021-04130-0.

Future proof your practice with Dentally

The day to day running of any dental practice is hectic, there are always a million and one things on your “to do” list and not to mention trying to balance your working life with your home commitments. We all crave a little more time in our lives, so have you ever thought about how your practice management software could help your reclaim some time and make things a little easier?

Dentally’s cloud-enabled dental software will streamline your processes, reduce your practice admin, deliver great patient care and help you manage your team. It is easy to use, secure and allows your team to work effectively to deliver the best possible care to your patients. Our team use the latest tech to innovate and develop our software to ensure you have the best tools at your fingertips. We listen to our customers and are always striving to make their lives easier.

n Save time - manage your team and your practice admin seamlessly (whether staff are onsite or working remotely) with features such as task lists, automated communications, effective automated recalls and Dentally chat.

n Stay connected - keep patient communications open with Dentally to keep your practice running smoothly and develop better relationships with your patients. Communications are clear, concise and automated meaning you always have complete visibility and a detailed correspondence history for each patient.

n Effortless Patient journey - provide a seamless (contactless) patient journey from start to finish with tools such as Dental Portal including online appointment booking, customisable medical history, self check in and payments, plus straightforward clinical records, easy to use charting and patient treatment plans.

n Powerful real time reporting - Dentally sifts through your data quickly to produce clear, easy to interpret and analyse reports, so you can make informed decisions.

When you’re in the business of dentistry, patient care comes first and the daily demands of practice admin can seem endless, but that is where Dentally’s cloud enabled practice management software can help.

Dentally from Henry Schein One, is designed to make your day-to-day practice management simple - and sometimes just finding a short moment in your busy day to take a closer look at something new is worth every second invested!

Patient management is all about ease with Dentally, saving you time and resources by taking care of all your admin, tracking tasks, automating your patient communications, managing finances and all aspects of your day-to-day processes.

n Save money - There’s no need for expensive hardware and servers. All data is stored securely on the cloud, to keep your practice running smoothly and cost-effectively. All you need is to Chrome and go! It is stable and high performing, updates automatically - and will never slow you down!

n Easy onboarding - simple to switch, we will convert all your data from your existing system, so you have all the patient information you need backed by comprehensive training for your team.

n Elevate - a customer success programme designed to support you in sustaining and growing your dental practice, that you won’t find anywhere else!

Dentally understand that running your dental practice is so much more than appointments, charting and financial. Visit their website to find out more at dentally.com.au - and remember not all dental practice management software in Australia is the same!

Software designed to take the stress out of daily practice life.

Transform your business with our cloud-based software, putting patients and simplicity at the heart of your practice.

Save money and stay secure, without the need for hardware or servers - all your data is stored securely on the cloud.

Our contactless reception keep things safe and simple, from online medical history to self-check-in and payment links.

Giving your patients a safe and simple experience, whilst ensuring your practice runs smoothly and securely.

Visit dentally.com.au to find out more.

Save time with our task list feature and manage your practice from any location, using automation and Dentally chat.

Stay connected with patients direct from their records and through automated communications.

IDEC returns after 4 years for its 3rd Edition in 2023

Indonesia Dental Exhibition & Conference (IDEC) 2023 is back physically for the first time since the onset of the pandemic. It will return across three days from 15-17 September 2023 at the Jakarta Convention Center as an in-person event, expecting over 250 exhibitors and 20 international group pavilions with an expected 5000 local and international visitors spanning 2500 square metres of exhibition space. IDEC 2023 will also offer over 18 seminars conducted by over 20 speakers over the 3 days.

“We’re excited to bring back IDEC after the postponement in 2021. Participants will be able to connect with each other once again and meet key stakeholders of the dental industry in Indonesia to learn and discover the latest dental health developments,” said Mathias Kuepper, Managing Director of Koelnmesse Pte Ltd. “The continued collaboration between Koelnmesse, Traya and Indonesia Dental Association (PDGI) is an encouragement to bring IDEC to greater heights over future editions.”

“Indonesia’s trade fairs are roaring back to life and we are eager to bring together the local and international dental industry with IDEC,” said Andy Wismarsyah, Director of PT Traya Eksibisi Internasional. “We look forward to welcoming attendees back in person and bringing attendees an improved and refreshed IDEC 2023.”

“IDEC returns with the theme The Transformation of Dental Health Resiliency, with the vision of providing a platform for participants to pick up new skills and knowledge and continuously future-proof their skillsets,” said Dr Usman Sumantri, President of the Indonesian Dental Association.

IDEC is now open for exhibition space reservation. Trade visitor registration will open in March 2023.

IDEC will return in 2023 with the latest updates in the industry. For more information, please visit the IDEC 2023 website at www.indonesiadentalexpo.com.

International Update

Stuck on you: Survival of SARS-CoV-2 on PPE

Personal protective equipment (PPE) worn by healthcare providers is exposed to SARS-CoV-2 while caring for infectious patients, in turn increasing the chances of fomite transmission of the virus during PPE doffing or reuse without prior disinfection. We carried out a pilot study to model the stability of SARS-CoV-2 on common PPE worn in hospitals to simulate a moderate-dose SARS-CoV-2 transmission event that might occur during a highrisk airway procedure on a COVID-19 patient. The objective of this study is to relate SARS-CoV-2 concentrations on surfaces to predict the exposure of a single healthcare worker over an 8-hour shift and estimate the effects of doffing mistakes and number of care episodes per shift on inoculated dose per shift. We modelled the stability of SARS-CoV-2 on PPE commonly worn in hospitals when carrying out high-risk airway procedures. Evaluated PPE included the visors and hoods of two brands of commercially available powered air purifying respirators, a disposable face shield and Tyvek coveralls. Samples were collected at 4, 8, 24, 48 and 72 hours postexposure. A 72-hour time frame was selected as it coincides with a common work schedule observed by many intensive care unit personnel (e.g., nurses) in the United States (three 12-hour shifts worked over three consecutive days of the week) who may need to reuse PPE day after day because of PPE shortages. SARS-CoV-2 displayed prolonged stability on those PPE materials evaluated in this study, all of which had infectious SARS-CoV-2 present at least 72 hours postexposure. Following an exposure to 4.3 log10 plaque-forming units (PFUs) of SARS-CoV-2, all materials displayed a reduction in titre of > 4.2 log10 by 72 hours postexposure, with detectable titres at 72 hours varying by material (1.1-2.3 log10 PFU/mL). Although we found the predicted half-life of SARS-CoV-2 on PPE ranged from 6.74 to 10.05 hours (depending on the PPE material), it is important to note that between 1.9 and 2.3 log10 PFU/mL of infectious virus remained on those PPE evaluated in this study at 72 hours postexposure. This is in contrast to SARS-CoV-2 viability on cloth fabric (i.e., 50/50 nylon/cotton ripstop fabric), which decreased rapidly and was not recoverable at 24 hours postexposure. Our results highlight the need for proper doffing and disinfection of PPE, or disposal, to reduce the risk of SARS-CoV-2 contact or fomite transmission.

Haddow AD, et al. Modelling the stability of SARS-CoV-2 on Personal Protective Equipment (PPE). Am J Trop Med Hyg. 2020;104 (2): 549-551

Superior integration. A superior partnership.

Superior integration. A

Superior integration. A superior partnership.

Superior integration.

A superior partnership.

Superior integration. A superior partnership.

Seamless integration, a simplified workflow, and higher case acceptance—made possible by a powerful partnership: 3Shape, the Straumann Group—and you.

case acceptance—made possible by a powerful partnership: 3Shape, the Straumann Group—and you.

Seamless integration, a simplified workflow, and higher case acceptance—made possible by a powerful partnership: 3Shape, the Straumann Group—and you.

Your ClearCorrect experience—made better with TRIOS.

Your ClearCorrect experience—made better with TRIOS.

Your ClearCorrect experience—made better with TRIOS.

Your ClearCorrect experience—made better with TRIOS.

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

Pair your TRIOS scanner with your ClearCorrect account. Select any of your recent TRIOS scans and upload them to your patient’s case page straight from the ClearCorrect doctor portal.*

3Shape TRIOS Treatment Simulator

3Shape TRIOS Treatment Simulator

3Shape TRIOS Treatment Simulator

3Shape TRIOS Treatment Simulator

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back.

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back.

3Shape TRIOS Treatment Simulator

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back.

3Shape TRIOS Treatment Simulator

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back.

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back.

Contact

Contact your Straumann Group Specialist today to learn more or visit clearcorrect.com.au

Contact your Straumann Group Specialist today to learn more or visit clearcorrect.com.au

Contact your Straumann Group Specialist today to learn more or visit clearcorrect.com.au

Contact your Straumann Group Specialist today to learn more or visit clearcorrect.com.au

Contact your Straumann Group Specialist today to learn more or visit clearcorrect.com.au

This feature (now with ClearCorrect branding!) simulates the results of ClearCorrect treatment compared to the patient’s current dentition, and allows you to move individual teeth in real time, or even simulate whitening treatment. TRIOS Treatment Simulator can boost case acceptance by up to 40%**—once you try it, you won’t look back. *

Straumann Pty Ltd/Straumann New Zealand Limited

* Please allow 2–3 days for new scans to populate on Doctor Portal

** Dr. Pedro Goncalves | https://youtu.be/-cDebkYLH6A

* Please allow 2–3 days for new scans to populate on Doctor Portal ** Dr. Pedro Goncalves | https://youtu.be/-cDebkYLH6A

93 Cook Street. Port Melbourne VIC 3207, Australia

* Please allow 2–3 days for new scans to populate on Doctor Portal

** Dr. Pedro Goncalves | https://youtu.be/-cDebkYLH6A

AU Toll Free 1800 660 330 | NZ Toll Free 0800

Straumann Pty Ltd/Straumann New Zealand Limited

Straumann Pty Ltd/Straumann New Zealand Limited 93 Cook Street. Port Melbourne VIC 3207, Australia

93 Cook Street. Port Melbourne VIC 3207, Australia

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

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

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®

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.

Single-visit workflow using Medit + exocad to produce e.max crowns in-house

By Dr Ahmad Al-Hassiny

Transitioning from a traditional dental workflow to a digital workflow offers a unique set of challenges for practitioners steeped in conventional analog techniques.

As we undertook our evolution to a completely digital clinic many years ago, we have seen how the entire market has changed and digital technologies have matured.

Modern intraoral scanners such as the Medit i700 are now much faster, more accurate and more affordable than what we ever had access to over 15 years ago.

In addition to scanners, milling technology has also advanced significantly. Nowadays, the technology is much more precise, intuitive and user friendly than ever before.

Most importantly, my associates and I worked very hard to master and streamline our workflow processes, which directly impacted the profitability of our practices. Digital dentistry has completely revolutionised our practice and has resulted in much better patient outcomes.

One example of this is same-day crowns, something that in my opinion is an excellent service to patients and a great practice builder.

Today, our standard workflow from prep to design and mill for a single crown is all done in a single visit and can be accomplished within 2 hours or less.

Single visit dentistry provides endless advantages for the dentist and moving production in-house opens a world of opportunity and treatment possibilitiesmost significantly, return on investment.

In our clinic, 95 percent of the work that was once sent to the laboratory is now completed in- house. This effectively slashed our lab bill by more than 70%. Not only that, but we no longer deal with the frustrating issues that come with temporary crowns.

In this article I have outlined a standard example of the sorts of cases we do every day in our practice. In this example, the patient had two crowns completed within a single visit. The patient had been having issues with food packing around the first molar crown due to open contacts and it was decided we would replace the crown for this tooth and crown the heavily filled second molar too (Figure 1).

Two crowns in a single visit using digital dentistry

To begin, we start by prepping the teeth. With digital dentistry and modern ceramics we can be more conservative with tooth structure, keeping margins supragingival for instance. This effectively means it is also easier to scan the preparation correctly.

After I prep the teeth, I routinely use a retraction cord to displace the gingiva and ensure an accurate scan of the margins and a dry field of operation to avoid contamination from blood, saliva or crevicular fluid (Figure 2).

The preparation and tissue management part of the workflow is critical.

Scanners are optical devices and if there is any gingiva or fluids such as blood on the tooth margins, this will result in subpar scanning images. Incorrect use of scanners is the most common reason for a digital impression to have errors.

Using Medit i700 Wireless to take an intraoral scan

Following the preparation stage, I use the Medit i700 Wireless scanner to take an intraoral scan (Figure 3). The Medit i700 is an extremely fast scanner and I have personally used Medit scanners used for many years.

Figure 1. Preoperative view.

Figure 3. Intraoral scan taken using the Medit i700 Wireless.

Figure 4. Non-HD (top) and HD (bottom) scans were taken of the same preparation with the Medit i700 Wireless to illustrate the difference when using this mode. As you can see, the HD scan mode clearly results in a higher definition scan.

Figure 2. Completed tooth preparations for two IPS e.max ceramic crowns.

When used correctly and with correct retraction, this scanner can easily achieve a full arch scan within 45 seconds. The new Wireless model of the i700 adds an extra layer of comfort as you do not have to worry about wires. It makes the scanning process more comfortable for the dentist.

Medit intraoral scanners: HD Mode vs Non-HD Mode

Having the option of an HD mode in the Medit intraoral scanners is quite beneficial. Although not absolutely mandatory to use, it is a simple click on the software to switch to HD mode and as you can see in Figure 4, it results in margins that are clearer and more defined. Clearer margins and an accurate scan will mean the entire CAD/CAM workflow is more efficient and easier to carry out.

Designing the crowns with exocad CAD software

Back to our workflow... Once the scans are completed, this scan data is then exported to be used in our CAD software, in this case, exocad (Figure 5). Our dental assistants are fully trained to be proficient with using CAD software and do all of our CAD designs with clinician oversight. Medit software is also very easy to use and enables simple exporting of STL and also OBJ or PLY (colour files) if required.

As you can see in Figure 5, the PLY scan file is imported into exocad. The Medit scanner has produced a very clear digital impression for us. The next steps of the workflow involve margin line placement and CAD design (Figure 6).

Margin line placement and CAD design

The final CAD design is completed (Figure 6) and is ready to be produced. This is a process that has a learning curve much like using an intraoral scanning device but once you learn it, it’s easy.

This is why we provide digital dentistry courses online via our website to help teach dentists how to perform this efficiently in their practice. The design is then nested in the CAM software (Figure 7) and sent to our milling machine.

Figure 6. The final CAD design of two ceramic crowns using exocad.

Figure 7. Nesting the CAD design in the CAM software for manufacturing.

Figure 5. PLY scans exported from the Medit i700 Wireless and imported into exocad software for CAD designing.

Here our material of choice is IPS e.max from Ivoclar. This is an excellent ceramic for any single unit restoration in the mouth. It is backed by over 15 years of research and high success rates over 95%.

After milling is completed (Figure 8), the final part of the workflow is carried out with material post processing and finishing, which is another aspect we cover in our online training courses.

Post processing the crowns

The the final crowns are completed after polishing off the sprue and carrying out characterisation and glazing (Figure 9). This is another part of the workflow that our dental nurses are trained to do. So by this point everything is done by the team and I am free to see other patients.

Choosing the right material for your milling machine

Figure 8. IPS e.max CAD/CAM blocks are loaded in the milling machine and are then milled into the CAD design we have produced.

Figure 9. IPS e.max crowns before and after post-processing including ceramic characterisation, glazing and firing.

“Our dental assistants are fully trained to be proficient with using CAD software and do all of our CAD designs with clinician oversight... everything is done by the team and I am free to see other patients...”

Using Medit Link apps in the digital dentistry workflow

One excellent aspect of the Medit Link software is the free apps included. As you see in Figure 9, the crowns are fitted on a 3D printed model. While the crowns are milling, we can use the Medit Model Builder App to create a 3D printable model with dies to check the fit of the crowns (Figure 10).

This is not a required step in the workflow and we often do single visit crowns completely model-less, but this is a good illustration of how you can use Medit Link apps in day to day practice.

Bonding the crowns with resin cement

During this entire production workflow, the retraction cord stays in place so that during the seating of the final crowns, the fit at the margin is clearly visible and once cemented, excess cement is removed as the cord is removed.

The most critical part to this workflow and the profitability of our practices is that while the design, milling of the restorations and post-processing is taking place, our clinicians are busy seeing and treating other patients. The final ceramic restorations are bonded using resin cement (Figure 11).

Putting it all together - perfecting your digital dentistry workflow

Perfecting a digital workflow that is efficient, predictable and increases profitability requires practice and understanding of all aspects of the workflow. The first step is an intraoral scanner and

the Medit i700 or the more affordable i600 are an excellent first step in this world of digital dentistry.

Restorations fabricated using CAD/ CAM in-house have revolutionised dentistry. Digital is the future of the profession and provides endless benefits to both dentists and patients.

Need some guidance in digital dentistry?

IDD membership unlocks a catalogue of helpful videos that can take you from digital dentistry novice to a knowledgeable expert. It’s affordable and you can cancel anytime.

Scan the QR code to view membership offers perfect for dentists of every skill level, or as a great way to train your team to lessen your workload. Start a free 7 day trial of IDD membership here: https://instituteofdigitaldentistry.com/ online-membership

About the author

Figure

Anyone not adopting digital techniques is falling behind. By choosing the right equipment, suitable materials and executing the treatment properly, you will have peace of mind in the longterm outcome of the result. Whether you are interested in CAD/CAM in-house or simply scanning and sending to a lab, there are many benefits for both you and the patient.

The time to go digital is now!

Dr Ahmad Al-Hassiny is a global leader in digital dentistry and intraoral scanners, carrying out lectures as a KOL for many leading brands. He is one of the few in the world who owns and has tested all mainstream scanners and CAD/CAM systems in his clinic. Dr Ahmad Al-Hassiny is also the Director of The Institute of Digital Dentistry (iDD), a world-leading digital dentistry education provider. iDD offers live courses, masterclasses and an online training platform with a mission to ensure dentists globally have easy and affordable access to the best digital dentistry training possible.

Dr Al-Hassiny is in private practice in New Zealand.

Scan the QR code to read IDD’s Medit i700 scanner review or visit https://instituteofdigitaldentistry.com/ios-reviews/medit-i700-review

Figure 10. Medit Model Builder App used to design printable models from the intraoral scans. This was then printed using the NextDent 5100.

11. Post-operative photograph. The final ceramic crown restorations are bonded using resin cement.

THE AORALSCAN 3 IOS

AI INSIDE EVERY SCAN

With unprecedented scan speeds allowing you to scan a quadrant in 25 seconds, a full arch in 1 minute, and an entire ortho case in 3 minutes, the AORALSCAN 3 IOS promises faster appointment times and a more comfortable patient experience.

When you’re done scanning, its hassle-free exporting of STL and full-colour PLY scans, along with the license-free operation, means you can send to as many or as few labs as you like.

Every scanner package comes pre-installed with a suite of intuitive, doctor-friendly software, including:

Scan software - Intraoral scanning

Ortho simulator - Chairside orthodontic simulation

Healthcheck - Intraoral scaner + intraoral camera

Lab cloud - Seamlessly send scans your lab

Model builder - Base and export models to a chairside printer

Unlike many other scanners on the market, there are no ongoing license fees, and updates are free and automated, ensuring you enjoy the latest features as they’re released.

When you buy the AORALSCAN 3 IOS from Osseo Group, you’ll receive the scanner, PC, trolley, and ongoing clinical and technical support for one low price.

Visit osseogroup.com.au/aoralscan or scan the QR to learn more.

Visit osseogroup.com.au/demo or scan the QR to arrange an in-office demo.

Lessons from watching white spot lesions

Question 1. What percentage of the buccolingual width of a tooth must be affected by mineral loss for it to appear on a biteway x-ray?

a. 10% b. 17% c. 23% d. 33% e. 50%

Question 2. Once detected, white spot lesions should be monitored to determine if they are:

a. Progressing towards cavitation b. Undergoing arrest c. Regressing d. All of the above

Question 3. The application of a high concentration fluoride product can cause a white spot lesion to: a. Progress towards cavitation b. Undergo arrest c. Regress d. Become “frozen in time” e. All of the above

Question 4. Subsurface regeneration of white spot lesions, leading to their visible reversal, can be achieved using:

a. A high concentration fluoride product. b. CPP-ACP via various delivery systems. c. Fluoride varnish. d. Silver fluoride.

Question 5. An active white spot is covered by:

a. Saliva b. A cariogenic dental plaque biofilm c. An invisible layer of benign plaque d. Oral mucosal transudate

INSTRUCTIONS:

Masks and respirators: The inside story

By Emeritus Professor Laurence J. Walsh AO

The COVID-19 pandemic has brought much greater attention to the risk factors that operate in the dental clinical setting because of droplets and aerosols and thus the importance of respiratory protection as one of the layers of defence for dental staff.1,2 Masks and respirators perform multiple functions. This article will explore each of these functions and then go on to discuss some new antimicrobial technologies used in masks and respirators.

Containment Firstly, masks and respirators contain the secretions of the wearer and reduce the generation of droplets and aerosols into the immediate environment. This principle explains the use of these during pandemics to contain these on the face of the user, rather than having them dispersed into the

environment where they can infect others. Over the last three years, research in aerobiology has shown clearly that infectious aerosols are generated by the act of breathing, with an increased load of viruses produced during speaking, shouting, singing, coughing and sneezing, in increasing orders of magnitude. For this first purpose of containment, it is essential that the mask or respirator is adapted closely to the face so that expired air does not leak in large amounts from the periphery. Due to variations in facial shape, some individuals are unable to be properly fit tested with a surgical respirator and achieve a fully airtight fit for their respirator. An example of proper adaptation is shown in Figure 1. Surgical masks are not designed to be airtight, but rather to be adapted closely against the skin of the face. Not folding the mask out fully and not adapting the insert that covers the bridge of the nose are two common errors that result in air being directed away from the face of the wearer and into the general environment.

Question 6. The largest amounts of both splatter and aerosol are generated by:

a. Air polishing and ultrasonic scaling b. Triplex syringe c. High-speed handpieces d. Low-speed handpieces

Question 7. Level 3 fluid resistance is... a. 60 mm Hg b. 120 mm Hg c. 180 mm Hg d. 240 mm Hg

Question 8. The antimicrobial properties of some masks is achieved by incorporating antimicrobial metals into their manufacture including: a. Selenium b. Silver or Gold c. Zinc d. Copper e. All of the above

Question 9. The outermost and innermost layers of modern masks and respirators are produced using: a. Injection moulding b. 3D printing c. Electrospinning d. Thermoforming

Question 10. To be rated as P2/N95, a surgical respirator must be able to filter particles of 0.2 µm in size by over: a. 90% b. 93% c. 95% d. 97%

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

infection CONTROL

Figure 1. An example of proper adaptation of a respirator against the side of the face (Survivon P2 surgical respirator ARTG 384806).

Get organised and be efficient with Signature Series Procedure Tubs

Antimicrobial Product Protection

Microban protection is integrated into the tub and tub components during the manufacturing process. Microban technology works by interrupting key cell functions that allow the microorganisms to function, grow and reproduce. Microban protection begins to work as soon as the microorganism comes into contact with the product surface and works continuously to inhibit the growth of microbes that can cause stain, odours and product degradation for the lifetime of the product.

Standardises material set-up for every type of procedure

The Hu-Friedy IMS and Tub System increases efficiency of materials management and eliminates time-consuming tray preparation for every procedure. Tubs may be configured to meet your practice needs or are available as a complete tub. Procedure tub colours match Hu-Friedy IMS cassette rail colours...

Increasing practice organisation and workflow efficiency. Allowing for quick identification of consumable products. Providing aesthetic integration with IMS cassettes.

Locking covers...

Protect items from airborne materials during transportation to the operratory and storage.

Adhere to infection control standards Microban® Antimicrobial Product Protection.

Microban inhibits the growth of microorganisms that can cause stains, odours and product degradation. Allow for storage in central sterilisation or each operatory.

Tubs can be transported to the operatory prior to each procedure, eliminating inventory management of materials in each operatory.

For more information, visit www.hufriedygroup.com

Question 11. Signature Series Tubs are designed to store:

a. All the instruments required for a procedure type.

b. All the materials required for a procedure type. c. Both the instruments and materials required for a procedure type.

Question 12. Microban technology interrupts key cell functions that allow microorganisms to function, grow and reproduce:

a. True b. False

Question 13. Signature Series procedure tubs are available in:

a. Primary and secondary colours only.

b. Custom colours to match your practice. c. ISO standard colours for dental procedures. d. Colours that match IMS cassette rails.

Question 14. Signature Series procedure tubs are designed to:

a. Increase practice organisation. b. Increase workflow efficiency. c. Save on procedure set-up times. d. Safely store materials. e. All of the above.

Question 15. Locking lids protect tub contents from airborne materials during transportation to the operatory and during storage:

a. True b. False

By

Successful procedural outcomes depend on effective pain management; it is especially relevant when providing treatment to children. Pain is the response to nociceptive stimuli. The response to a stimulus varies greatly from one child to another child. The delivery of quality dental treatment relies heavily on the ability to prevent and RELIEVE pain. Controlling pain is critical to successful dental treatment. It was not too long ago that many in the dental and medical community doubted that children were susceptible to pain. Paediatric patients may not be able to provide a very detailed description of the pain, including the intensity. Fortunately, there are several pain scales that can be used with children to estimate the intensity and severity of the pain. Different options to help with pain are available to the dentist who provides care to children. These include: Behavioural management; Use of local anaesthetics (like articaine); Nitrous oxide; Analgesics; and Bioactive materials like Biodentine™.

Behavioural management, local anaesthetic and Nitrous

The use of behaviour management techniques when treating young patients is the key to pain control in the dental office. “Tell-Show-Do” is the core to this approach. The correct use of LA is also a fundamental component in the algorithm to control pain in children. A good understanding of the pharmacology and the specific techniques for children are critical in the successful use of the anaesthetic. Along with the basic behaviour management techniques and the use of LA, is the correct use of nitrous oxide. Without any question, the key to successful use of nitrous is patient selection. The ideal paediatric patient is slightly anxious and old enough to wear the nasal hood.

Treatment with biomaterials

The use of biomaterials is a recent and highly effective strategy to decrease pain, especially in the post-op phase. Biodentine™ is a calcium-silicate based material that became commercially available in 2009. The material is specifically designed as a “dentine substitute”.

The spectrum of applications of Biodentine is wide and includes endodontic repair, indirect pulp cap, direct pulp cap, liner and dentine replacement in restorative dentistry. The composition of Biodentine consists of a powder (tricalcium silicate, dicalcium silicate, calcium carbonate, oxide filler, iron oxide shade and zirconia) and a liquid (calcium chloride and hydrosoluble polymer).

One of the main advantages of Biodentine is the setting time, which is around 9-12 minutes. There is a significant difference in the setting time compared with other similar cements (like MTA). The compression strength of Biodentine is similar to dentine. The use of etch over Biodentine does not affect the compressive strength of the material. A critical factor of Biodentine is the porosity. Because of the low content of water of Biodentine, the porosity of the material is lower compared with other materials. This is a significant benefit when a perfect seal is mandatory, like in direct pulp cap treatment. The radiopacity of Biodentine, thanks to the zirconia, is ideal and allows the practitioner to visualise the material on radiographs. The antibacterial property of Biodentine is attributed to the high pH of the material. The high alkalinity has inhibitory effect on the growth of microorganisms.

The biocompatibility of Biodentine is outstanding and has been probed in multiple studies when the material is placed with fibroblasts from the pulp. According to the American Association of Endodontics, full pulpotomy involves the removal of the coronal portion of the vital pulp as a means of preserving the vitality of the remaining radicular portion. It may be performed as an emergency procedure

for temporary relief of pain and this is a critical advantage of Biodentine in front of other materials that can be placed in direct contact with the pulp. The presence of spontaneous or severe pre-operative pain does not always indicate that the pulp is not capable to repair.

Vital pulp therapy

Several recent clinical studies reported a successful medium to long term outcome of vital pulp therapy in teeth with PAIN, particularly young or immature teeth. The mechanisms of interaction of Biodentine with the dental hard tissues explain, at least in part, post-operatory pain control with Biodentine. The material provides micro-mechanical retention by infiltrating the dentine tubules. Furthermore, Biodentine induces the formation of tertiary dentine synthesis which provides protection to the pulp. These two combined effects might be responsible for the ABSENCE of pain and hypersensitivity.

Reducing inflammation and post-operative pain

Another critical report found that the application of Biodentine reduces both TRPA1 pain receptor expression and function. More importantly, when applied on odontoblast-like cells, Biodentine decreases pro-inflammatory TNFsecretion. This indicates that in addition to the roles of Biodentine mentioned in the first paragraph, its application onto the dentine-pulp reduces the inflammation and consequently the post-operative pain.

References

1. Malkondu O, Kazandag M, Kazazoglu E. A review on Biodentine, contemporary dentin replacement and repair material. Biomed Research International 2014. 2. Kaur M, et al. MTA vs. Biodentine: Review of literature with comparative analysis. Clin Diagn Res 2017; 11(8): 01-05. 3. Imad A. Biodentine: from biochemical and bioactive properties to clinical applications. Giornale Italiano di Endodinzia 2016; 30: 81-88.

Question 16. An option to help with pain in children is:

a. Bioactive materials like Biodentine b. Use of local anaesthetic c. Nitrous oxide d. Analgesics e. All of the above

Question 17. A behaviour management techniques when treating young patients is: a. Show-Tell-Do b. Do-Tell-Show c. Tell-Show-Do d. Do-Show-Tell

Question 18. The use of etch over Biodentine affects the compressive strength of the material: a. True b. False

Question 19. Biodentine sets in around: a. 1-3 minutes b. 3-6 minutes c. 6-9 minutes d. 9-12 minutes

Question 20. The biocompatibility of Biodentine is outstanding and has been probed in multiple studies when the material is placed with fibroblasts from the pulp: a. True b. False

How to deal with pain in young patients?

Juan F. Yepes DDS, MD, MPH, MS, DrPH, FDS RCS (Ed)

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

Air age in dental operatories

Dental professionals are at high risk of exposure to communicable diseases during clinical practice, but many dental clinics provide clinical care in closed spaces. Therefore, it is essential to develop efficient ventilation methods in dental clinics that do not rely on natural ventilation. Although some reports have described the evaluation of contaminant dilution in naturally ventilated dental clinics, dental clinics usually have air conditioners running at all times to ensure the comfort of the staff and patients. To maximise the effectiveness of air conditioners and to avoid the interference caused by sunlight and wind, staff and patients spend long hours with the windows and curtains closed, necessitating an efficient ventilation method that does not rely on natural

Particles in the air from PPE doffing

ventilation. In this study, to clarify the factors that cause air retention in dental offices, computational flow dynamics simulations were conducted focusing on (1) the flow path from the entrance to the exhaust port and (2) the presence of partitions. A threedimensional model of a dental clinic with three dental chairs was created and simulations were conducted for scenarios with and without partitions with different entrance and exhaust port positions. Evaluation of these simulations on the basis of the age of air, an indicator of ventilation efficiency, showed that the value of the air age near the partition was locally high in the scenarios with partitions. In the scenarios where the exhaust port was located close to the entrance, the air age near the exhaust port was high, regardless of the presence of a partition. In addition to wearing protective clothing and sterilising instruments, it is important to consider air quality improvement as a countermeasure against airborne and droplet infections, such as virus infections, in dental clinics. Since the location of the entrance and exit points has been shown to affect the concentration of indoor air pollutants, appropriate positioning of the exhaust port may be important in dental offices. However, since changes in the positioning of the exhaust vent cannot be easily performed in an existing dental office, it is necessary to examine whether increasing or decreasing the ventilation volume can improve air quality.

Nambu E, et al. Numerical simulation of air age in dental offices. Sci Rep. 2022; 12: 14120.

Self-contamination during doffing of personal protective equipment (PPE) is a concern for healthcare workers (HCW) following SARS-CoV-2-positive patient care. Staff may subconsciously become contaminated through improper glove removal; so, quantifying this exposure is critical for safe working procedures. HCW surface contact sequences on a respiratory ward were modelled using a discrete-time Markov chain for: IV-drip care, blood pressure monitoring and doctors’ rounds. Accretion of viral RNA on gloves during care was modelled using a stochastic recurrence relation. In the simulation, the HCW then doffed PPE and contaminated themselves in a fraction of cases based on increasing caseload. A parametric study was conducted to analyse the effect of: (1a) increasing patient numbers on the ward; (1b) the proportion of COVID-19 cases; (2) the length of a shift; and (3) the probability of touching contaminated PPE. The driving factors for the exposure were surface contamination and the number of surface contacts. The results simulate generally low viral exposures in most of the scenarios considered including on 100% COVID-19 positive wards, although this is where the highest self-inoculated dose is likely to occur with median 0.0305 viruses (95% CI = 0-0.6 viruses). Dose correlated highly with surface contamination, showing that this can be a determining factor for the exposure. The infection risk resulting from the exposure is challenging to estimate, as it will be influenced by the factors such as virus variant and vaccination rates. Regardless of the number of COVID-19-positive patients on a ward, notable decreases in predicted infection risk were associated with less self-contamination during doffing. For example, for scenarios involving all COVID-19 patients, the mean infection risk for 10% probability of self-contamination while doffing was 0.4%, while the mean infection risk for an 80% probability of self-contamination while doffing was more than a 420% increase at 2.1%. This emphasises the importance of adequate training for PPE use. The practical implications are that the infection risk from self-contamination during doffing PPE is an important concern in healthcare settings, especially on a COVID-19 ward. Fatigue during high workload shifts may result in an increased frequency of mistakes and hence the risk of exposure. Length of staff shift and a number of COVID-19 patients on a ward correlate positively with the risk to staff through self-contamination after doffing. Cleaning of far-patient surfaces is equally important as cleaning traditional “high-touch surfaces”, given that there is an additional risk from bioaerosol deposition outside the patient zone.

King MF, et al. Modelling fomite-mediated SARS-CoV-2 exposure through personal protective equipment doffing in a hospital environment. Indoor Air. 2022; 32(1): e12938

The

The

back

OrthoED’s MiniMasters is a fully accredited 2-year orthodontics course with an optional post-graduate diploma. Using state-of-the-art tools and comprehensive and sound principle-based training, GP’s will learn to think for themselves, treat a range of cases, and foresee problems before they arise.

OrthoED’s MiniMasters is a fully accredited 2-year orthodontics course with an optional post-graduate diploma. Using state-of-the-art tools and comprehensive and sound principle-based training, GP’s will learn to think for themselves, treat a range of cases, and foresee problems before they arise.

GP’s will also receive ongoing case support from our myth-busting orthodontist, Dr Geoffrey Hall. So at the end of the course, they will be fully equipped to complete cases more efficiently, confidently, and with predictable outcomes every time.

OrthoED’s MiniMasters is a fully accredited 2-year orthodontics course with an optional post-graduate diploma. Using state-of-the-art tools and comprehensive and sound principle-based training, GP’s will learn to think for themselves, treat a range of cases, and foresee problems before they arise. GP’s will also receive ongoing case support from our myth-busting orthodontist, Dr Geoffrey Hall. So at the end of the course, they will be fully equipped to complete cases more efficiently, confidently, and with

GP’s will also receive ongoing case support from our myth-busting orthodontist, Dr Geoffrey Hall. So at the end of the course, they will be fully equipped to complete cases more efficiently, confidently, and with predictable outcomes every time.

OrthoED’s MiniMasters is a fully accredited 2-year orthodontics course with an optional post-graduate diploma. Using state-of-the-art tools and comprehensive and sound principle-based training, GP’s will learn to think for themselves, treat a range of cases, and foresee problems before they arise. GP’s will also receive ongoing case support from our myth-busting orthodontist, Dr Geoffrey Hall. So at the end of the course, they will be fully equipped to complete cases more efficiently, confidently, and with predictable outcomes every time.

As part of the course, you’ll enjoy modules on

As part of the course, you’ll enjoy modules on

As part of the course, you’ll enjoy modules on

Diagnosis, treatment planning, risk management, and the art of excellent case presentation

Diagnosis,

Orthodontic

ever! Enrol in OrthoED’s Mini Masters 2023 program today. Email geoff@orthoed.com.au or call 1300 073 427 secure one of the limited spots available for face to face or online learning. Visit www.orthotraining.com.au/testimonials and hear what other students say about the OrthoED program and why they all give 5 star reviews every time

Enrol in OrthoED’s Mini Masters 2023 program today. Email geoff@orthoed.com.au or call 1300 073 427 secure one of the limited spots available for face to face or online learning. Visit www.orthotraining.com.au/testimonials and hear what other students say about the OrthoED program and why they all give 5 star reviews every time

ME FOR CPD

Figure 1. Characteristic appearance of enamel white spot lesions on the cervical aspect of maxillary incisors. This site has low resting salivary flow and poor access to stimulated saliva. The image has been taken 2 weeks after an intensive oral hygiene regimen has been introduced. This explains why the following 3 features can be seen: (1) there are no visible deposits of dental plaque; (2) there is no gingivitis; and (3) a small rim of healthy enamel is seen at the cervical aspect of the white spot lesions, apical to the lower margin of the white spot lesions.

Lessons from watching white spot lesions

By Emeritus Professor Laurence J. Walsh AO

In clinical dental practice, one of the most common things that we do is to detect white spot lesions and monitor their progress to determine if they are progressing towards cavitation, undergoing arrest, or regressing. This article summarises, from the perspective of the author, some of the main lessons about watching white spot lesions and provides a number of clinical hints in interpreting what is happening in these lesions.

Hidden beneath

An active white spot lesion will each day be undergoing numerous cycles of mineral loss followed by remineralisation.1-4 Because an active white spot is covered by a cariogenic dental plaque biofilm that is producing multiple organic acids, the fluid in direct contact with the surface is not the saliva of the patients mouth but rather the plaque fluid. If using technologies that can detect acid production by dental plaque, such as GC TriPlaque ID gel, active white spot lesions will be found beneath the plaque which is producing the highest amounts of acid following a challenge with sucrose or another suitable substrate.4,5

Hence, it is essential to assess what is happening in the dental plaque biofilm before removing it to assess the surface. Practically, this means undertaking dental plaque assessment and disclosing should come before scoring the teeth for white spot lesions.

El Nino or La Nina?

Developmental defects of enamel

Mild fluorosis Moderate fluorosis

W

hen white spot lesions are viewed under wet conditions, only those lesions with large percentages of subsurface mineral loss will be visible. On the other hand, when enamel surfaces are clean and any saliva or water on the surface is removed with compressed air, it

“The reason why compressed air makes white spot lesions much more visible is that the compressed air causes desiccation (drying) of the surface and also of the more superficial parts of the white spot lesion. This removal of water changes the refractive index and hence the way that light passes through or reflects from the surface...”

is much easier to detect the full extent of white spot lesions that are present.7 This principle is the basis behind the ICDAS/ ICMS category 1 white spot lesion diagnosis - a lesion which can only be seen when the teeth are clean and dry, but is not evident when the tooth surface is wet.

The reason why compressed air makes white spot lesions much more visible is that the compressed air causes desiccation (drying) of the surface and also of the more superficial parts of the white spot lesion. This removal of water changes the refractive index and hence the way that light passes through or reflects from the surface. The greater scanner coefficient for visible light from the surface of the dry white spot lesion explains why the surface appears white.

Systemic factors

Local factors

Figure 2. Proper diagnosis of enamel lesions that can appear white is essential for their proper management. This plate shows typical examples of common conditions other than dental caries that can manifest with opacities in the enamel, as well as other changes in the surface topography. With mild fluorosis (upper left), changes are subtle and become more evident when teeth are dried. As fluorosis becomes more severe (upper right), surface pitting may be present and the uptake of exogenous stains can make the affected areas dark. When systemic factors affect enamel development (lower left), the location of affected sites vary according to the chronology of tooth development. A common local factor that drives localised changes such as enamel opacity of permanent incisor teeth (lower right) is pulpal infection of deciduous incisors because of advanced caries.

Upstairs downstairs

When comparing anterior teeth, there is a large difference in the relative risk of labial surfaces of incisor and canine teeth for white spot lesions. The risk is much greater for the maxillary anterior teeth than for the corresponding mandibular anterior teeth.5 This difference is one of the reasons for the effectiveness of the “lift the lip” approach.

The reasons for the differences relate to the more hostile environment for the maxillary anterior teeth, which have little contact with stimulated saliva and which are covered by a saliva refill that is slowmoving and has relatively low buffer capacity when compared to its counterpart in the lower arch.8,9 As a result of the environmental influence of saliva, studies of plaque fermentation always show that plaque pH is lower for maxillary anterior teeth than for their mandibular tooth counterparts when one compares the same tooth surface on the labial aspect.5

Location, location, location

The three laws of real estate apply strongly to the distribution of white spot lesions within the one arch. In the maxillary arch, it will be very rare to find white spot lesions on the buccal surfaces of first and second molar teeth, because of their proximity to the parotid salivary duct. This information is not new. In 1966, Otto Backer-Dirks reported a study in which 184 buccal surfaces of maxillary first molars were examined at age 7 and every second year for eight years until age 15. Areas diagnosed originally as white spot lesions in a number of cases subsequently appeared normal.10

Maxillary molar buccal tooth surfaces show an exceptional ability for mineral to be deposited, typically by mineralisation of the dental plaque biofilm to form supragingival calculus - and likewise, for remineralisation to occur. Hence, one would only see white spot lesions in such a location if there had been a particularly strong local caries risk factor, such as a molar orthodontic band making oral hygiene difficult and allowing plaque to stagnate, or a patient developing saliva gland hypofunction.

In the mandibular arch, it would be very uncommon to see white spot lesions on the lingual or labial surfaces of the incisor

teeth, since these would normally have exposure to saliva that pools on the floor of the mouth at rest.1,11 Hence, when white spot lesions are seen in these locations, there is a strong suspicion of depressed production of saliva at rest.

The hidden story

The iceberg concept of dental caries diagnosis is that when one sees a single visible white spot lesion, there will be more lesions present at a less advanced stage. Conversely, the number of visible cavitations of the enamel is typically less than the number of white spot lesions that are present.7,12

“One has to consider whether a white spot lesion that has formed on an approximal enamel surface that is evident on a bitewing radiograph has actually cavitated, or not. If it has not, then strategies for remineralisation that can stabilise the surface and arrest the progression of the lesion can be deployed. However, once the enamel surface collapses and a cavity forms, restorative intervention is required...”

The major implication that flows from this is that when assessing a patient’s caries history, if one only tracks cavities and past restorations, it is likely that the total caries experience of the patient will be underestimated. In populations of children, scoring white spot lesions on primary teeth as well as cavities and filled surfaces will elevate the DMFT approximately threefold, providing a rather more alarming total score.13,14 Similar principles apply in adults. An individual could have a low DMFT if one defines a decayed surface as having a frank cavitation in the enamel, but still have a very large number of active white spot lesions.

The inside story

When a patient has numerous visible white spot lesions on the buccal tooth surfaces, one should immediately be suspicious of what is happening interdentally and check the patient for caries on the aproximal enamel surfaces. Typically, this is done using bitewing radiographs or digital imaging fiber optic transillumination (e.g. using the KaVo DiagnoCAM).15

A key point when assessing bitewing radiographs is to recall that approximately one third of the buccolingual width of the tooth must be affected by mineral loss for the change in mineral density to be reliably detected by radiographic examination. Practically speaking, this means that white spot lesions on a proximal enamel surfaces are much easier to detect on teeth where the contact points are narrow (e.g. incisors and premolars) rather than on teeth where contact points are wide, such as molars. An important point of dental anatomy is that contact points are wide on molar teeth but are placed further buccally as one goes more posterior in the mouth.

Furthermore, one has to consider whether a white spot lesion that has formed on an approximal enamel surface that is evident on a bitewing radiograph has actually cavitated, or not. If it has not, then strategies for remineralisation that can stabilise the surface and arrest the progression of the lesion can be deployed. However, once the enamel surface collapses and a cavity forms, restorative intervention is required, since the dental plaque biofilm within the cavity will now be in a protected space.7

The question is, are arrested enamel lesions on approximal enamel surfaces stable? Back to the studies of Otto Backer-Dirks in 1966 in the Netherlands. In a group of 45 male and 45 female children, mesial surfaces of upper and lower first molars on bitewing radiographs were tracked over 8 years. Some 26% of enamel lesions diagnosed at age 7 had not progressed after 8 years. This was in a non-fluoridated community and was prior to the advent of topical fluorides or modern remineralising therapies.10 So, the answer to the question of stability is yes.

Another aspect of the inside story of white spot lesions relates to the presence of bacterial products in the outermost poorest layers of the white spot lesion that make up its visible surface.

Current fluorescence technology based on the Diagnodent is sufficiently sensitive to be able to detect and measure such bacterial products in white spot lesions on tooth surfaces that have just undergone professional prophylaxis to remove all deposits of plaque. Tracking fluorescence scores over time on individual white spot lesions can provide clues as to their trajectory. If the fluorescence scores remain stable, it is highly likely that the lesion has stabilised, whereas when fluorescence scores are increasing, this indicates that more bacterial products from the overlying dental plaque have penetrated through the surface and into the body of the lesion. Increasing fluorescence scores over time correlate with cavitation occurring at a subsequent time point.13,14

Frozen in time

An important consideration when assessing white spot lesions is whether the lesion is active or not. A range of parameters provide information to inform such a decision.7 An active white spot lesion will have a rough irregular surface that will look under magnification like white sand. The lesion will typically be beneath a mature dental plaque biofilm with high levels of acid production. Because of the dental plaque biofilm, the configuration of the lesion will reflect the patient’s oral hygiene in that location and there will be corresponding inflammatory changes in the adjacent gingiva. Typically, the lesion will be close to the gingival margin and there will be visible signs of gingivitis present.

On the other hand, an arrested white spot lesion will have a surface that is macroscopically smooth and shiny or polished in appearance. The lesion location is typically supragingival, rather than equi-gingival and on a surface that is free of dental plaque. The adjacent gingival soft tissues may be quite healthy. Lesions which have undergone arrest can trap pigmented substances within them, that originate from coloured foods and drinks in the diet.

Regression or reversal?

It is important to have clear treatment goals for white spot lesions. If the intent is to cause these to arrest, making them “frozen in time” for the remainder

of the patient’s life, then the application of a high concentration fluoride product, particularly a fluoride varnish, can cause surface porosities to be blocked through the deposition of calcium fluoride. 16 In this author’s view, such a strategy should only be considered when the lesion is not in an area of aesthetic importance.

Regeneration or resin?

Where white spot lesions are present in areas that are aesthetically important, particularly maxillary anterior teeth, the treatment goal should be to return the enamel to a completely normal appearance. Use of CPP-ACP through

treatments carry a high risk of patients developing white spot lesions, so it is important to consider ways to prevent these lesions occurring during treatment, as well as to mitigate the impact of them at the end of treatment. A number of studies have shown that GC Tooth Mousse Plus used during orthodontic treatment lowers the risk of white spot lesion development, through both chemical as well as biological actions...”

various delivery systems has been shown to be highly effective for causing subsurface regeneration of white spot lesions, leading to their visible reversal.17-20 This happens progressively over time, as neutral ion species penetrate into the lesion. The enamel which forms has a high degree of resistance to acid dissolution, as well as an optimal appearance. Most commonly, such regeneration approaches involve repeated application of a topical crème such as GC Tooth Mousse Plus each day over a period of multiple weeks.

An important consequence of following this strategy is that the regenerated enamel has desirable aesthetic and chemical

characteristics and is contiguous with the previous unaffected enamel. As a result, should the teeth subsequently undergo dental bleaching, the result will be consistent across the surface of the tooth. Hence, the strategy of regeneration is preferred in situations where multiple white spot lesions are noted to be present when brackets are removed at the end of fixed orthodontic treatment, or at the end of a program of sequential plastic aligners.

Orthodontic treatments carry a high risk of patients developing white spot lesions,21,22 so it is important to consider ways to prevent these lesions occurring during treatment, as well as to mitigate the impact of them at the end of treatment. A number of studies have shown that GC Tooth Mousse Plus used during orthodontic treatment lowers the risk of white spot lesion development, through both chemical actions (including the release of optimal ratios of calcium, phosphate and fluoride ions) as well as biological actions (such as prebiotic effects).4,23

At the end of orthodontic treatment, if resin impregnation is used to treat white spot lesions that developed around brackets, some long-term issues could arise that must be considered. Historically, resin impregnation was developed for posterior teeth and its use on anterior teeth was not advised. Part of the thinking behind this was that any micro-scale or nano-scale leakage of fluid around the resin over time could be problematic. Moreover, later attempts to treat the tooth using in-office or at-home bleaching could result in irregular outcomes, since the presence of the resin would greatly affect the ability of reactive oxygen species to penetrate through the enamel. As well, long-term colour stability of the resin that had been infiltrated into the tooth could be an issue. Finally, from a purely structural point of view, having a tooth with an intact enamel surface with ideal mineral characteristics (true regeneration) is preferable to having weakened areas infiltrated with resin. This is because of the distribution of stress within the tooth and its concentration at interfaces and boundaries.

The roots of the problem

ome of the concepts described above can be adapted for the situation of the early or incipient root surface carious lesion.

S

“Orthodontic

In terms of location, the site with the greatest propensity for root surface caries to develop is the buccal surface of mandibular molar teeth, especially in the furcation region. On the other hand, the most protected sites in the mouth are the lingual surfaces of mandibular incisor teeth, since these normally sit in continuous contact with resting saliva.24 When root surfaces of mandibular incisor teeth are exposed because of periodontal attachment loss or gingival recession, these lingual surfaces should be the last ones in the mouth to develop dental caries. This is why the presence of dental caries in this site is highly suggestive of prolonged and severe saliva gland hypofunction, which removes the protection of the saliva at rest.1

Applying the iceberg concept, when cavitated root surfaces are found, one must always consider what is happening on the interdental root surfaces.25,26 Taking bitewing or periapical radiographs will often reveal lesions of root surface caries in locations that may not be readily accessible to probing. This results in the advice to always suspect that as many lesions of root surface caries may be present radiographically as may be present clinically.

In lesions of root surface caries, destruction of the surface occurs by multiple processes, including proteolysis of collagen as well as dissolution of mineral by organic acids. The combination of these two processes explains why lesions develop over a broad front beneath a cariogenic biofilm and why surface softening occurs a long time before physical breakdown of the surface.

Fluorescence can be tracked in incipient root surface lesions using the DIAGNOdent, and repeated applications of topical CPP-ACP have been shown to cause caries arrest.27 When this occurs, the fluorescence scores will stabilise or decline. The lesions may or may not change colour. When colour change does occur, it reflects a change in the metabolic state of key bacterial species that generate pigments, especially Acyinomyces odontolyticus. A colour change such as darkening may occur when a root surface lesion is treated, as the bacteria within the outermost regions of the dentine change their metabolic state. Unfortunately, such a colour change does not mean that the lesion has stabilised for an indefinite period of time.

Lastly, agents that may be used to arrest incipient or cavitated lesions of root surface caries can themselves cause discolouration of the tooth, with the classic example being silver diamine fluoride preparations. In this case, the colour change is caused by the silver component and it will mask any changes due to bacterial pigment production.

About the authors

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 390 journal papers, with a citation count of over 18,300 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

1. Walsh LJ. A system for total environmental management (STEM) of the oral cavity, and its application to dental caries control. International Dentistry SA Australasian Edition 2008;3 (1):34-48.

2. Walsh LJ, Brostek AM. Minimal intervention dentistry principles and objectives. Australian Dental Journal 2013; 58 (1 Suppl): 3-16.

3. Brostek AM, Walsh LJ. Minimal intervention dentistry in general practice. Oral Health and Dental Management 2014;13(2):285-294. PMID.

4. Walsh LJ, Healey D. Prevention and caries risk assessment and management in teenage and orthodontic patients. Australian Dental Journal 2019 (Special Issue) Jun; 64 Suppl 1:S37-S45.

5. Walsh LJ, Tsang AKL. Chairside testing for cariogenic bacteria: current concepts and clinical strategies. International Dentistry 2008;10(2):50-65.

6. Walsh LJ. Caries diagnosis aided by fluorescence. In: Arkanslan Z (Ed) Dental Caries - Diagnosis and Management. Croatia: InTech Publishers, 2018. Chapter 7, pp. 97-115.

7. Walsh LJ. Maximum interception: things to try before you drill. Australasian Dental Practice 2007;18(5):90-98.

8. Walsh LJ. Preventive dentistry for the general dental practitioner. Australian Dental Journal 2000; 45(2): 76-82.

9. Walsh LJ. Clinical aspects of salivary biology for the dental clinician. International Dentistry 2007;9(4):22-41.

10. Backer Dirks O. Posteruptive changes in enamel. Journal of Dental Research 1966; 45(3): 503-511.

11. Walsh LJ. Minimal intervention management of the older patient. British Dental Journal. 2017; 223(3):151-161.

12. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dentistry and Oral Epidemiology 2007;35(3):170-178.

13. Walsh LJ, Clifford H. Changes in Diagnodent scores in smooth surface enamel carious lesions in primary teeth: a longitudinal clinical study. Journal of Oral Laser Applications 2008;8(3):157-164.

14. Walsh LJ, Groeneveld G, Hoppe V, Keles F, van Uum W, Clifford H. Longitudinal assessment of changes in enamel mineral in vivo using laser fluorescence. Australian Dental Journal 2006;51(4):S26.

15. Walsh LJ. Shining infrared light through teeth – Laser transillumination and the DIAGNOcam. Australasian Dental Practice 2014; 24(2):76-78.

16. Walsh LJ. In-clinic fluoride products: current concepts for maximal effectiveness. New Zealand Dental Therapists’ Association Journal; April 2008; 15:7-8.

17. Walsh LJ. White spots, GC Asia Dental, Singapore, 2007.

18. Walsh LJ. Strategies for remineralization. In: Limeback H (ed) Comprehensive Preventive Dentistry, Ames Iowa: Blackwell Publishing 2012, Chapter 17. Pp. 298-312.

19. Fontana M, Walsh LJ, Amaechi BT, Ngo HC. Aids to remineralization. In: Mount GJ, Hume WR, Ngo HC, Wolff MS (eds). Preservation and Restoration of Tooth Structure, 3rd edn. 2016. Chichester, West Sussex, UK: John Wiley. pp. 67-80.

20. Tran C, Walsh LJ. Assessment of mineral gain in white spot lesions using CPP-ACP and CPP-ACFP in different clinical protocols: A proof of concept study. Recent Progress in Materials. 2021, 3(4): 18.

21. Chang HS, Walsh LJ, Freer TJ. Effect of orthodontic treatment on salivary flow, pH, buffer capacity, and levels of mutans streptococci and lactobacilli. Australian Orthodontic Journal. 15(4), 229-234, 1999.

22. Chang HS, Walsh LJ, Freer TJ. Enamel decalcification during orthodontic treatment - aetiology and prevention. Australian Dental Journal1997; 42: 322-327.

23. Philip N, Leishman SJ, Bandara HMHN, Healey DL, WALSH LJ. Randomized controlled study to evaluate microbial ecological Effects of CPP-ACP and cranberry on dental plaque. JDR Clinical and Translational Research. 2020;5(2):118-126.

24. Walsh LJ. Root caries – The emerging challenge in dental caries management. Annals of the Royal Australasian College of Dental Surgeons 2014; 22: 60-63.

25. Walsh LJ, Gan A. Proximal root surface caries in an Australian periodontal population. Periodontology 1991; 12: 33-36.

26. Walsh LJ. The problems of furcations: what lies beneath. Auxiliary 2008;18(2):26-28.

27. Vlacic J, Meyers IA, Walsh LJ. Combined CPPACP and photoactivated disinfection (PAD) therapy in arresting root surface caries: a case report. British Dental Journal. 2007;203(8):457-459.

Available 24/7

Available 24/7

Cyberdent

Volume discounts

Volume discounts

Available 24/7

We’re supporting Australian dental professionals by being available 24/7.

We’re supporting Australian dental professionals by being available 24/7.

We’re supporting Australian dental professionals by being available 24/7.

Submit, communicate, and manage your lab work anywhere, anytime with CyberConnect.

Submit, communicate, and manage your lab work anywhere, anytime with CyberConnect.

Submit, communicate, and manage your lab work anywhere, anytime with CyberConnect.

Your partner in digital dentistry

Your partner in digital dentistry

It’s as easy as 1,2,3...

Your partner in digital dentistry

It’s as easy as 1,2,3...

1– scan the patient, 2– complete the online prescription form, 3– upload the scans or send via your scanner.

1– scan the patient, 2– complete the online prescription form, 3– upload the scans or send via your scanner.

It’s as easy as 1,2,3...

1– scan the patient, 2– complete the online prescription form, 3– upload the scans or send via your scanner.

Visit cyberdent.com.au or scan the QR to learn more

Visit cyberdent.com.au or scan the QR to learn more

Visit cyberdent.com.au or scan the QR to learn more

Save up to 20% on all cases with Cyberdent volume discounts.

Save up to 20% on all cases with Cyberdent volume discounts.

Volume discounts

Whether you’re sending digital scans or physical records, it all contirbutes towards your volume discounts.

Save up to 20% on all cases with Cyberdent volume discounts.

Whether you’re sending digital scans or physical records, it all contirbutes towards your volume discounts.

Whether you’re sending digital scans or physical records, it all contirbutes towards your volume discounts.

$

$

$

No additional fees

No additional fees

Free pickup and delivery on all cases.

No additional fees

Free pickup and delivery on all cases.

No additional fees for model printing on cases, we don’t think you should be punished for being progressive!

No additional fees for model printing on cases, we don’t think you should be punished for being progressive!

Free pickup and delivery on all cases.

No additional fees for model printing on cases, we don’t think you should be punished for being progressive!

the dental laboratory with a difference. Cyberdent

the dental laboratory with a difference. Cyberdent

the dental laboratory with a difference.

Ballooning interest rates, falling house prices and likely global recession will impact dentists: Strategy for the times

By Graham Middleton

The signs have multiplied that we will be unable to avoid a substantial economic slowdown, probably classified as a recession. Already the bulk of the housing market is in significant decline. As this accelerates, more builders and developers will fail or suffer big losses.

Evidence suggests that not only does China have substantial economic problems, but that its rulers are content to see its housing bubble decline at a massive cost to millions of citizens. Because of the losses to Chinese local governments who have relied heavily on income from land sales to property developers, spending on Chinese infrastructure is in rapid decline. This spells a substantial reduction in demand for Australian iron ore both in quantity and price. Iron ore sales, along with coal and gas, are critical pillars providing massive revenue to federal and state governments through royalties, company tax, the tax paid by contractors and the PAYG tax paid by employees. Hopefully, Australian coal and gas exports will remain at record prices boosted by the flow-on demands created by the Russia/Ukraine war, but an overall slowing of the Australian

economy is occurring and the impact will be sustained. Dentists with CBD practices badly affected by lock downs have already suffered; those in the suburbs less so. As homeowners on low interest limited term loans progressively face conversion to loans at much higher rates, their spending power on other goods and services will be severely affected. Those whose homes are paid for or who have substantially paid down loans are in a much better position. Rising interest rates to counter still rising inflation will eventually see a hopefully small increase in unemployment.

Four key building blocks

Concentrate on the key building blocks for long term practice and financial success. The four key building blocks of dental financial development are:

1. Your home;

2. Your dental practice;

3. For most dentists, your practice premises (some smaller country centres excepted); and

4. Your family superannuation fund, usually with dentist and spouse the only members.

“Be empathetic toward patients who are struggling with much higher mortgage payments by offering them affordable alternatives...”

Dealing with patient impact

The first lesson is to keep your nerve. If you have a dental practice that has been profitable in the past, it is necessary to run the practice in such a way as the existing patient base is maintained. Dentists are in the relationship business to an even greater extent than medical GPs. The patient base is the unique asset which must be retained and from which most new patients are referred. Be empathetic toward patients who are suffering because of slow downs in their business or having to struggle with much higher mortgage payments by offering them affordable alternatives. Many will return for advanced treatment when the economy turns in their favour. Practices in well-established suburbs with older average residents will have many patients who have long owned houses and who have little or no mortgages. They are the premium practices to buy.

Attending to your own finances - Things financial advisers may not tell you

As variable home loan interest rates have increased from about 2 percent to about 5 percent—and are at risk of increasing further—the benefit of a higher income earner reducing their mortgage has jumped. At a home loan rate of 5 percent and a marginal tax rate of 47 percent (including Medicare levy) it is necessary to earn 9.43 percent on a safe pre-tax investment to achieve the same net post tax benefit as reducing a home loan. At a home loan rate of 6 percent and the same tax rate it is necessary to earn 11.32 percent!

By contrast, those dentists able to repay their home loans while maintaining interest tax deductible loans on practice premises, who have marginal tax rates of 47 percent including Medicare levy, are effectively only paying 3.18 percent after tax on a loan at 6 percent interest!

Dentists with good equity in their homes are able to secure finance on practice and premises by using their home as security because the bank regulator— APRA—gives special weighting to home loans when setting banks capital adequacy ratios. Banks with a large proportion of home loans on their balance sheet are able to lend a great deal more and will be prepared to be more generous lenders when a home is part of the lending package.

Keeping superannuation fees cost effective - Beware of multi-level hidden charges

Now that a period of high stock market returns is a couple of years in the past, it is time to take stock of your super fund to ensure that a high proportion of actual income is not being eaten up in fees. In a period of economic slow-down, market returns are likely to be low. It is easy to fall into one of the hidden high fee traps.

Beware of structures which bury significant fees inside a fund over and beyond those declared such as an adviser/fund administrator packaging a number of managed funds, which have high internal management expense ratios, as recommended investments within a fund or within an individually managed superannuation account or similar structure.

Paying too much for a lazy adviser!

Beware of changes which cost more including buried fees—the underlying purpose of these are to make an adviser’s job easier while preserving maximum income by their organisation. If advised of a change to investments from individually selected investments toward a wrap account or a process which significantly lessens the contact with your adviser in favour of some periodical computer- generated investment change recommendation, it is likely that your adviser is setting out to gain a continuing substantial fee with significantly less personal involvement. Very quickly the adviser is likely to become distant from having an intimate knowledge of your overall finances. In this event, be prepared to look elsewhere or demand a significant reduction in fees.

Prior to about 2020, the majority of advisers were wedded to managed funds because they were dependent on trail fees or arrangements whereby the managed funds collected their fees on their behalf.

Most did not have a deep knowledge of the share market except for a small number of stocks taken from their organisation’s “approved list” and to the extent that they included some shares in a client’s fund, the process was dumbed down for them. The proportion of advisers who had developed a deeper knowledge of the share market

was small and those advisers tended to avoid managed funds. Following regulatory change, the ease with which advisers could continue to earn trail fees on managed fund investments was removed but the years in which they had been wedded to managed funds meant that a great many were unable to cope in a new environment. Bank and AMP restructuring saw a vast number of financial planners displaced, some because they could not pass the required exam.

Personal declaration

n passing, I passed the required exam to continue to be a financial adviser about a year before my retirement, albeit that I found much of the study guide unrelated to much of what I actually did for my clients.

I

Regardless as to how you are advised, a key safety precaution is to acquire a significant understanding of investments within your fund. If your adviser is recommending changes, their reasoning should be clearly understood. With respect to shares, it is critical that you get used to dialing up a share market index and examining annual and half yearly reports. Examine whether these reports give a clear picture of profitability and of business strategy over time. Do not simply follow sharebroker recommendations, which are noted for their quantity rather than their quality.

Those who understand financial markets realise that the top twenty or so shares on the Australian stock market by capitalisation represent a huge proportion of the total value of the market. Most serious investors have a large proportion of their fund invested in top 20 stocks. Those seeking to gain more international exposure will choose to own one of the world’s biggest exchange traded funds, either the Vanguard Standard and Poor’s top 500 fund, ASX code IVV owning the top 500 stocks listed on the New York Stock Exchange and Nasdaq or Blackstone’s US Total Markets fund, ASX code VTS. Many stocks in these funds are global in their operation, thus giving international exposure and, very importantly, have very low Management Expense Ratios (MERs) of about 0.12 percent which is vastly lower than an array of managed funds and some listed investment companies (LICs).

Measuring the capability of your financial adviser

Measure your financial adviser by asking questions to which you already know the answers. My personal experience forged over 33 years of advising dentists and other health professionals was that a foundation to advice was a thorough understanding of a client’s practice development, practice financial performance, debt structuring and other financial assets. That was fundamental to their overall development and invariably meetings or telephone conferences quickly passed from a recent review report of their super funds to other pressing issues of most interest to the client. Being able to advise on the wisdom or otherwise of extending practice premises to add additional surgery(s), or discuss the productivity and remuneration of assistant dentists is going to have a long-term impact—either increasing profit and practice value, or detrimental to it. A financial planner worthy of the title must understand their dental clients’ practice financial performance and the strategic decisions which accompany it; in most instances (except for older dentists who have acquired substantial investment/ superannuation assets), dentist’s practice related income dwarfs their non-practice income, so advisers without the ability to measure/benchmark practice performance and identify recommended improvements do not deserve to call themselves financial planners.

Beware accountants without substantial dental client experience

Accountants often have signs proclaiming that they provide business advice, but most simply do tax returns which indicate how much taxable profit a dentist had last year. The vast majority have no idea as to how their one or perhaps a few dental clients actually perform compared to their peer group and often endorse faulty strategies as a result. I have come across many dentists who have suffered long term detrimental impact from having received poor advice from their accountants during their initial years as practice owners. It is best to do considerable personal research including discussion with trusted dental colleagues and measure the

competence of your accountant by asking questions to which you know the answers.

Holding cash and near cash

A t times of deteriorating economic conditions, it is prudent to hold a proportion of funds in cash or near cash; I hold an array of bank hybrid securities issued by our largest four banks plus Macquarie Group in addition to cash. They are not guaranteed but are regarded as being very low risk. They pay a margin above the rate at which banks price their transactions with each other, the bank bills exchange rate. As this rate fluctuates with other interest rates and I am being

able to advise on the wisdom or otherwise of extending practice premises or discuss the productivity and remuneration of assistant dentists is going to have a long-term impact. A financial planner worthy of the title must understand their dental clients’ practice financial performance and the strategic decisions which accompany it...”

paid a margin above, it is a conservative investment choice. I lower the risk by holding a number of hybrid securities of differing maturity dates issued by each of the major banks. Be aware that global stock markets will be early to predict an improvement in economies while markets for government bonds/treasury notes or what are known as gilts in the UK are early predictors of the direction and magnitude of interest rate increases (note when interest rates increase the value of these securities fall. I am making small investment shifts away from cash to shares. We will only know what the actual lowest share market point in the cycle was when we can look back after many further months.

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.

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.

“Being

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.

Australia’s no.1 Googleranked dental marketer.

PERSONAL Development

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.

clinical psychologist, Kasey Compton, talks about her new book ‘Fix This Next for Healthcare Providers’. She discusses the simple system that shows

exactly what to fix next in your quest for practice growth.

Are dental practice managers overwhelmed?

By Julie Parker

The role of practice manager in Australian dental practices is not one that can be easily nailed down. In some practices, the practice manager is also the full-time receptionist and has a handful of additional duties, such as team management and accounts payable. In other practices, the practice manager is a full-time role and their rostered duties do not spill over into other roles. This practice manager is responsible for team management, human resources, marketing, financial reporting, setting budgets, tracking key performance indicators and forecasting, payroll... the list goes on.

I recently conducted a survey of 53 dental practice managers. I wanted to get a feel for the type of person filling this role. I was interested in their level of training, the responsibilities they were charged with and how they experience the role.

Unsurprisingly, the role of practice manager is filled overwhelmingly with women, with 98% of respondents being female. This makes sense with dentistry only recently seeking men to fill auxiliary roles. Traditionally, dental practice managers are team members who have moved through the other roles in the practice, such as dental assistant, receptionist and patient or treatment coordinator. This is the case with 88% of the survey respondents who started off their careers in one of those roles.

The pay rates per hour were all within the range of $32 - $49 per hour. Six of the 53 respondents received bonuses in addition to their hourly rates.

Another result of the survey was the number of practice managers who seem to be finding their role overwhelming.

With the question of how well respondents felt they coped with the workloads and stresses of their roles, 35% indicated they were struggling.

I found this surprising feedback, so I did a little research. According to Lifeworks’ latest Mental Health Index, one-in-four Australians are experiencing burnout at work. At 35 per cent, it could be said that dental practice managers are in need of greater support in their working environments than they are currently receiving. Indeed, in my recent podcast episode where I interviewed Carmel Brown and Belinda Fyffe of the human resources services company, The Proven Group, providing proper support and a mentally healthy working environment is actually now an enforceable legal responsibility of employers.

“Workplace health and safety legislation requires workplaces to be, as far as is reasonably practicable, physically and mentally safe and healthy for all employees. This means steps must be taken to ensure that the working environment does not harm mental health or worsen an existing condition.”

Given the current challenges Australian dental practices are facing with low and seemingly dwindling numbers in the recruitment “pool”, I find it concerning that over one-third of practice managers are finding their roles stressful most of the time. If the industry hopes to retain and attract dental team members to auxiliary positions, we need to create work environments in which our people are keen to remain.

There are several reasons that I have discovered through speaking with students of the Dental Business Mastery - Dental Practice Management Program that are contributing to increased stress for practice managers.

1. Higher than normal rates of absent staff due to COVID isolation means often it is the practice manager who steps in to fill the role. This can be stressful as it may not be their favourite type of work, they must put off the management work they had planned to do, they are often

still responsible for their usual duties while trying to fill the role of dental assistant or receptionist for the day and this all comes after the initial mad scramble of trying to get temp staff or other team members to help out.

2. Continual interruptions. This is a tricky one. Most people are more productive and efficient when they can concentrate and be focused. However, an important aspect of the role of the practice manager is to be there for team members, patients and practice owners when required. Team members are most often committed to the clinical area and do

I am sure there are more reasons that could be added to my list.

Recognising, as a practice owner, what your responsibility is in terms of providing a mentally safe working environment is one thing. However, like many things in life, it’s a 50-50 deal. Employees also have a responsibility to develop effective coping skills, build resilience and do their part to contribute to a happy, caring and supportive environment for everyone.

Everyone wins when a dental practice prioritises the mental health of their team members:

• Productivity goes up;

• Team member happiness is boosted;

• Patients enjoy their visits;

• Team members are more engaged in their work;

• Absenteeism drops;

• Staff loyalty increases;

• Stronger relationships are forged;

• A caring and supportive team culture drives IMPOROVED team behaviours;

• Levels of motivation are higher;

• Stress is substantially reduced;

• Personal well-being improves; and

• Financial turnover increases.

not have the affordability of time and opportunity to arrange proper meetings with the practice manager. However, I certainly see that interruptions often result in increased stress.

3. Lack of authority with the team is another reason for increased stress for some practice managers. Depending upon the length of time in the role and specific characteristics, building authority and respect with others can be difficult.

4. Lack of adequate training. My survey revealed that only 20% of the practice managers who took the survey had formal, external education and training for the role. Without proper resources, education and support, the role of practice manager can quickly become overwhelming and self-confidence can suffer.

After assessing the results of the practice manager’s survey, there does appear to be a need to take action. The degree of action for any particular practice depends upon the systems currently in place to foster a low-stress, high-happiness workplace. To assist dental practices with helpful actions they can take - and also helpful actions employees can take to decrease their stress and increase their happiness - Charles and I have designed practical resources for you. The cost of doing nothing is too high. The benefits of doing something can be even greater! Head over to the website to discover new and insightful ways that your practice can act right now to ensure a mentally healthy workplace.

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

“Given the current challenges Australian dental practices are facing with low and seemingly dwindling numbers in the recruitment ‘pool’, I find it concerning that over one-third of practice managers are finding their roles stressful most of the time...”

The fog of raw dental financials

By Simon Palmer

For those of you unfamiliar with dental practice financials, you may be forgiven for thinking that if you’ve seen one, you’ve seen them all. That they all follow a similar structure or template and that the practice’s income and expenses will always be labelled somewhat consistently from practice to practice. The truth of it is that the structure and quality of dental practice financials vary enormously.

• Dental practice structures sometimes utilise service entities or engage with dentists using Service and Facility agreements (SFA or FASA), which change how the financials should be interpreted;

• Expenses that buyers/banks often want to see separately (like lab and consumables or clinical and staff wages) are often lumped together;

• Expenses are sometimes put into non-specific/ non-descript expense categories, like “consultants” or “professional services”, which are a shorthand that makes sense to the person doing it, but not to outsiders (like prospective purchasers or their financial advisers);

• Personal expenses may be mixed into the financials, diluting the profit of the practice (personal insurances mixed in with practice insurances, personal mobile phone and travel mixed in with those of the business);**

• Many non-recurring expenses may be mixed into the financials, diluting the profit (one-off repairs, signage, website creation, etc.);**

• The owner may not be paying themselves market-rate rent, or a market-rate salary (@40% of (collections less lab)); and

• Sometimes, other financial interests may be going through the same financial entity (investment property, other practices or businesses run out of the same ABN).

When we are involved as dental brokers, it is our job to work with the vendors and their accountants to provide clear financial statements to a prospective purchaser that best represent the practice and facilitate the sale. But how can you navigate a practice’s financials when this isn’t the case?

As a potential buyer

If you’re assessing practice financials that are not clear, it’s almost always a mistake to become suspicious or upset. The seller has almost certainly not deliberately created a “fog” to misrepresent the practice. Realise that:

1. When an owner shows a buyer their financials, it’s often the first time they have shown them to anyone outside their innermost circle. There are feelings of exposure, sensitivity and sometimes embarrassment that come with this exposure. Be sensitive to this and don’t criticise the quality of the information provided;

2. Sometimes, it’s the inexperience of the buyer’s accountant with dental practice accounting that is causing the issue (for example, we often get questions about the financials when dentists are working on SFA/FASA agreements, because

under this structure the dentist’s salary can then be missing from a Profit and Loss report);

3. A dentist practice owner sometimes puts their head down to focus on practice operations and delegates and/or abdicates responsibility for the financial documents to the bookkeeper/ accountant, who is allocating expenses, with little oversight and direction; and

• How they name expenses and structure their financials is not how everyone does it;

• A Profit and Loss report often shows a lack of profit for tax purposes and this can lead an inexperienced buyer to believe there is a lack of profit, where profit actually exists in abundance;

• A lack of clarity can lead to a lack of confidence; and

• Sometimes, a buyer will be too embarrassed to ask questions when they don’t understand financials and will just give up.

4. It’s not uncommon for raw practice financials to need clarification and expense add-backs**, in order to be able to see the true profit. While some owners are intimately aware of all of their practice’s figures, don’t put them on the spot with questions when you meet them, point to an expense line on a Profit and Loss that seems strange and expect them to have answers. Politely email any questions or necessary clarifications afterwards.

As a practice owner

Often, for the sake of expediency, a practice owner will send out their raw financials to a prospective buyer to progress a deal, without realising that:

Before you put your practice on the market, make sure that you take the time to ensure that your financials are up to date, clear and that you can account for all add backs. If you aren’t sure, send them to a practice broker or valuer for their opinion. While spending this time and expense may be frustrating and might slow things down initially, it will be worth it when your buyers are able to see the true value of what you have built.

(**For more information about personal and non-recurring add backs see this article: https://practicesalesearch.com.au/ dental/articles/when-profit-isn-t-profithow-to-boost-your-practice-valuation-byunderstanding-add-backs)

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.

Lisa Singh National Account Manager

“Before you put your practice on the market, make sure that you take the time to ensure that your financials are up to date, clear and that you can account for all add backs. If you aren’t sure, send them to a practice broker or valuer for their opinion...”

The 5 elements of scaling your dental practice - Part 4

By Dr Jesse Green

hen it comes to scaling a dental practice, it can be a bit confusing knowing where to start. You obviously want to grow as a business and see more patients, more cases and more profits... But this is virtually impossible without having the fundamentals in place to ensure your business is built on strong foundations.

And of course, in the process of growing, you want to make sure that you’re actually working towards goals that feel fulfilling to you. After all, what’s the point of a much bigger practice if it doesn’t ultimately provide you with more time, more money and more meaning?

So if you’re looking to scale your dental practice, it’s crucial to do some pre-scaling planning and ensure you have these five key elements in place. They’ll help ensure your growth is sustainable and that you scale into a practice and a life you love.

1. A winning strategy

To take your practice from profitable through to scalable, you need a strategy that sets you up for success.

You want a strategy that allows you to be the chess player, rather than the queen or king on the chess board. It’s not about having all the moves; it’s about making sure you can utilise all the pieces on the board for best effect.

That means instead of getting caught up in the minutiae or stuck on the details of daily practice life, you take a step back and look at the big picture. You want to take a bird’s-eye view of your business, your goals and the assets at your disposal and then make decisions from there.

WA rock-solid strategy should always include:

• Long term outcomes with a clear end goal;

• Measurable results that you can use to stay accountable; and

• A SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis and regular risk analysis and mitigation.

If you don’t have those, then you don’t have a strategy.

2. Be building assets

If you’re encountering bottlenecks and roadblocks in your practice, it’s almost certainly due to a lack or inefficiency of assets.

Every headache, frustration, pain in the neck, pain in the backside, burr in the saddle, pebble in the shoe (or whatever you want to call it) can be traced back somewhere to a deficiency of assets.

Assets can come in the form of physical assets such as your fit out, plant and equipment, chairs, etc. You can also have database assets, so patient bases, or if you’re a specialist, referral bases. Or even intellectual property assets, team assets, financial assets.

Long story short, there are numerous different types of assets you’ll require in your practice.

In order to keep the practice running smoothly, you want to constantly be building and growing assets.

But as the practice owner, your ultimate responsibility is to turn those assets into cash flow. This is really the best measure of business efficiency and effectiveness.

Once we’ve got that net cash flow, there are a few things that we can do with it. Keep it, pass out a dividend, reduce debt, buy more assets... What’s important is that you have the option and the freedom to do so.

3. Self-managing team

very dental practice owner dreams of a self-managing team. A team that knows what to do in their role, that doesn’t need to be micromanaged, that comes with “batteries included”.

E

You want to be recruiting and retaining people who are very clear about what tasks they need to complete, how to do them and they go ahead and do them well. Without the right people, you’ll continue to struggle with key person risk, taking time away from the practice and increasing your capacity.

One of the greatest sources of leverage you’ll have in your practice is a team who is really engaged, onboard, knows what to do, are a culture fit, can do what they need to be able to do and they’re clear on what success looks like in their role.

And honestly - I am yet to meet the person who comes in to work knowingly, willingly, trying to do a poor job.

Most people are internally wired to want to do their job successfully and want to do it well. But the fact is, sometimes they just fall short. When this happens, you need to run diagnostics on where things have gone awry. Is there a miscommunication in the priorities and expectations of the business? Have you failed to onboard and equip them adequately? Or are they simply not capable of delivering what you need them to?

Once you have clarity on this, you’ll find yourself much closer to having a selfmanaging team.

4. Data driven decisions

n dentistry, we’re trained to look at the evidence before making an educated and informed decision. We look at the data, we diagnose the issue, we compare

I

different courses of action - we measure twice and cut once. But why don’t we apply that same intellectual rigor when it comes to our dental practice?

Most dental practice owners will lean towards gut feel and intuition over datadriven decisions. Of course, there’s a time and a place for going with your gut (especially when it comes to your values, workplace culture and the people you work with). But it’s always worth your while verifying your intuition with facts and figures.

Now, there’s no one size fits all definition of the data that you should be keeping, but you should consider what’s right for you and your practice. It might be profit per chair, EBOC (Earnings Before Owner Compensation) per chair, EBOC per employee, case acceptance rates, marketing ROI, etc.

What’s important is that you identify the KPI’s that align best with your strategic goals, identify the data that will help you make informed decisions, track your metrics regularly and then USE IT.

Remember - you can’t manage what you don’t measure!

5. Effective implementation

The most common thing that stops us from implementing plans is simply having too much stuff to do.

We all know what it’s like when you have an endless to-do list, a dozen different projects in the works and way too much mental clutter bouncing around your head. The key here is to do less, but do it better. You need to accept the fact that there are lots of things you could and maybe even should be doing - but you can’t always do it all.

Sometimes you have to let some of the fires burn, because other issues are simply more strategically important and actually require your time and attention much more. And that can be really hard.

It does go against our nature, especially amongst dentists who are typically perfectionists and hate giving up that control. But once you master it, it will ultimately set you free.

If you can’t learn to let things go, you will constantly be playing whack-a-mole with an endless stream of tasks and jobs.

So, you see why those five elements are key to scaling your dental practice as effectively as possible. If you can:

1. Develop a winning strategy;

2. Build the right assets;

3. Cultivate a self-managing team;

4. Make data-driven decisions; and

5. And implement effectively.

...then you’re miles ahead of the competition! This ensures that you’re scaling sustainably, profitably and mess-free.

About the author

Dr Jesse Green is a leading business coach for dentists, author of Retention and a sought-after speaker. Jesse shares his knowledge, skills and experience as a practice owner through the Savvy Dentist Academy, a digital hub of training, events, courses and resources for practice owners who want to earn more and work less. Get your personalised plan to grow and scale your practice by booking a Practice Growth Call. To book, call the Savvy Dentist team on 1300-668-384 or visit https://savvydentist.com/growthcall

Correct appointment scheduling makes all the difference

By Jayne Bandy

During any challenging times, you’ve had to be able to adapt and make changes both small and big. The worst thing you can ever do is sit still and do nothing.

Making changes along the way is something the entire team must be onboard with.

The appointment book or schedule is a big part of the running of the practice. I always say to teams, “if there are no appointments booked, then there are no patients coming in”.

We’ve had a good or bad two years seeing such challenges with our appointment books. Patients not turning up due to fear, illness, enforced dental restriction levels, lockdowns, isolation and even those patients that started to use COVID as a good excuse to not turn up for their appointments.

The issues we have experienced still linger for many practices trying to get back on their feet.

Through it all, I kept saying to dentists and their teams, “keep developing excellent communication skills. Communication is going to play a big role in the survival of your business”.

And I was right.

Teams who are highly skilled in being able to communicate effectively, schedule appointments correctly and get RESULTS for you!

Correct appointment scheduling involves...

• Converting calls into appointments;

• Scheduling the appointments so the needs of the practice are being met and matched to the needs of the patient; and

• Avoiding making appointments without any regard to the structure of the appointment book. You never want to see an appointment as just the next available time that fits in with the patient. You want to be helpful when you’re booking a patient’s appointment and give them a time that is suitable, but you also need to create an appointment book that will ensure the success of your dental business.

You can help your patients find a suitable appointment as well as making sure the needs of the practice are met.

Here’s how...

For your Appointment Book to meet the needs of your practice, I would recommend the following:

1. A balance of long and short appointments

Scheduling an Appointment for a patient is so much easier with a planned appointment book schedule to follow.

A good mixture of long and short appointments gives everyone in the practice a steady flow of patients with time between patients to complete administrative duties, sterilisation and other daily routines that need to be completed.

2. Meet a daily production requirement and target

Longer appointments are usually highproduction and the practice needs these to financially survive. It is crucial that the appointment book always takes production into account as well as achievable goals that have been set.

3. Emergency and new patient appointment times available each day

Leaving available time each day to see a new patient or a patient with an emergency is also very important. These two types of patients have a high level of urgency and it is excellent customer service to be able to meet their needs. No one wants a new patient or an existing patient emergency going to another practice because you were unable to get them in soon enough. That patient probably won’t give you a second chance!

4. A healthy priority standby list

have written before about the importance of building a healthy patient standby list. It’s always better when an appointment has not been filled or becomes available to call patients who have given you permission to call them to move their appointment. A healthy priority standby list ensures that at the end of the day, the next day’s appointment schedule is complete and looking great!

I

5. Confirm appointments

When appointments are made for patients, the appointment should be confirmed at the time of making the appointment. Use the phrase, “I have now confirmed your appointment and reserved that time for you”.

You will of course still contact your patient prior to their appointment but you want to set it up from the outset so the patient is aware the appointment is firm and the idea of cancelling the appointment is not on their mind.

Instread, look at the confirmation call/ message simply as a courtesy to let your patient know you are looking forward to seeing/meeting them.

The difference between a practice with a well-designed, planned and implemented appointment schedule and one without is huge. When you have a wellplanned schedule, the production goals are met, the flow of the day is smooth and on time and the needs of the patients and the practice are both met.

The Dental Phone Excellence Online Master Class

About the author

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

For more information on what to say and ask your patients, call 1300-378-044 or email jayne@thedpe.com

Where should I open my new practice?

By Angus Pryor, MBA (Marketing)

Recently, I took part in a speaking tour around Australia that allowed me to meet up with literally hundreds of dentists. Among the various audiences were multiple dentists wanting to open up a new practice.

Yet, what concerned me was how many dentists had already committed to opening a practice in a particular location, apparently without considering the pros and cons of doing so. In this article, we’re going to look at key considerations for opening a new practice. But first, a story...

The practice that struggled

As a long-time consultant to the dental industry (more than 10,000 hours so far), I’m not easily surprised - but with one client, I definitely was.

This was a multi-chair practice in a busy capital city, but not in the CBD.

As we began to work together, I implemented the first steps of our proprietary 20-point Practice Maximus system. From experience, I’ve learned what works best so that consulting clients get a good return at the start of our time together.

However, with this client, I couldn’t understand why all my best “tricks” weren’t working. These are road-tested, practice-building techniques that I’d seen work effectively in lots of other practices.

Finally, in desperation, I asked the practice owner to complete an audit of other dental practices in the area. I gave them a sheet of paper which had columns for the names of their competitors, the distance from the practice, the number of Google reviews their competitors had and so on.

The competitor audit form had rows to list up to 16 competitors within 1500 metres of the practice. Imagine my surprise when the audit sheet came

back filled in on both sides of the page for a total of 25 dentists in a 1500 metre area! And remember, this was a practice NOT in a CBD.

No wonder we were having to work so hard to get traction! There was so much choice for consumers, so many alternatives, that boosting this practice was going to be an uphill task, requiring sustained effort over an extended period. That was what it looked like for a practice located among lots of competitors.

The practice that coasted

Contrast the hyper-competitive scenario above with other new practices we’ve worked with, where they’ve been far less influenced by competing practices. Rather than the uphill slog caused by all that competition, these practices have experienced a smooth, downhill run that felt almost effortless.

One of our clients went from zero patients to almost 1,000 patients within 12 months of opening! And, in case you’re wondering, none of the dentists at the new practice had worked in the area or were able to bring any significant number of new patients with them. What they did have going for them was a relative lack of competition in the area.

The contrast between these two could not have been more stark and this is my point... choose where your practice is going to be located (particularly in relation to other practices) very, very carefully.

Fortunately, there’s software available that will allow you to check the number of dentists per head of population in different areas. In this regard, the Australian Dental Industry Association (ADIA) has developed a geospatial dental market analysis tool and if you know a member (you’re in luck – see below), they’ll let you go in eyes wide open.

Or, simply visit www.dentist.com.au – or www.dentist.co.nz if you’re in New Zealand – and type in your suburb name and search. This site lists every practice in the country – private, corporate, health fund and government. When you search, it will show you all the practices located in the suburb you searched on and, if there are less than 20 found in that suburb, it will search out to a radius of 50 km until 20 practices are found and show you the distances in kilometres to the nearest ones. It’s gold.

Physical location

Apart from your new practice’s proximity to other practices in the area, it’s also worth looking at which types of locations are best. All locations have pros and cons but there are two main parameters for setting up a practice (in an area that allows dental practices):

• The proximity to other places where potential patients might go (e.g. other businesses); and

• The price.

The first decision about physical location relates to whether the practice will be relatively stand alone, or co-located with other businesses. To be clear, dentistry is not an “impulse buy” kind of business. It’s not like potential patients drop into the shops to pick up a hamburger or buy a bottle of wine and then get an implant on impulse.

However, there is a clear benefit in having people be aware of you - and regular visitors to somewhere nearby allows you to “capture those eyeballs” so that when they think of a dentist, you’ll be top of mind.

On the flip side, since dental practices are a “destination”, you could set up anywhere you can be approved to run a practice and know that if you’re well marketed, you could do well.

From a price point-of-view, typically practices that are co-located with other business or in high foot traffic areas tend to be more expensive to buy or rent. In fact, in many shopping centres, only renting is possible and that means you can be susceptible to sharp price increases.

In a perfect world, I would aim for somewhere nearby a high traffic site (e.g. A supermarket), which has moderate rental (or even better, the capacity to buy in).

I’m not fond of setting up a practice in a busy shopping centre (e.g. Westfield etc) simply because the rents are crippling (often uncapped) and there’s no chance of buying in. Put another way, the upside benefit of all that extra foot traffic, usually doesn’t offset the downside of the much higher rent.

Existing or new practice?

Recently on my podcast (to listen, visit www.dentalpracticehq.com.au), I interviewed fellow Australasian Dental

Practice columnist, Graham Middleton, who has worked with lots of dentists in his capacity running an accounting firm, among other things.

There were two things I took from the interview that are relevant to this article. The first was his comment that typically buying an existing practice is a better financial decision than opening up a new practice.

This mainly relates to having a patient base from day one and the many hidden costs in building which in Graham’s experience, dentists usually way underestimate. But I appreciate this is not always possible.

The second point from the interview was Graham’s comment about the importance of making good decisions in your practice - decisions that can literally lead to $2-$3 million dollars of difference in net worth at the end of a career. Ouch!

This is why I’m so surprised when I hear from dentists who have, from what I can tell, done so little checking before deciding to open up (or buy) a new practice. Don’t let that be you!

Summary

cannot overstate how important it is to choose wisely when deciding where to open your new practice. It’s a bit like wading waist deep into a fastmoving river.

I

Get this right and the tide will move in the same direction as you and everything will feel relatively easy. Get this wrong and you’ll feel like the tide is constantly moving against you and that makes for hard work and a poorer business overall.

About the author

Winner of the 2022 Australian Business Awards for Marketing Excellence and Australia’s number one Google-ranked dental marketer, Angus Pryor is a #1 Amazon bestselling author, marketer and international speaker. If you’re thinking of opening a new practice, book a free consult with Angus to look at the geospatial dental market analysis tool from the ADIA. In a few minutes, you’ll have a very clear map (literally) of areas to avoid and areas that are ripe for a new dental practice in your local area. Visit www.AngusPryor.com today and book a free call.

First homeowner government incentives

By Kelly Lindsell

Buying your first home is not just a huge step for most, it’s now more like a giant leap.

According to the September 2022 Domain House Price Report, the median price for a house in Sydney is now $1,464,371 and for a unit, it’s $754,812. Whilst both measures saw a drop of 5.2% and 3.1% respectively over the quarter, the numbers are still quite frightening if you’re considering the purchase of your first home. This is even more so if you’re buying a regional property, where prices have continued to lift and significantly so over the past year.

If you are interested in finding out a little more about the median prices across the country and in understanding how the property market has been impacted by recent interest rate hikes and strong inflation, scan the QR code below and read Domain’s report.

Of course, these are the median prices and more cost-effective properties are available, but getting a deposit together in this environment at any level, let alone worrying about interest rates rising, is certainly a challenge.

With all of this in mind the Governments, both Federal and State, are keen to assist more Australians to own their home and in doing so, help with the longstanding affordability crisis.

There are several government grants and schemes available for First Home Buyers and we are pleased to provide you with a list of the major announcements as of June 2022.

Four major national government schemes are now available for first-home buyers or will be available within calendar year 2022:

n Help to Buy Scheme; n The First Home Guarantee (previously the First Home Loan Deposit Scheme); n The Family Home Guarantee; and n The Regional First Home Buyer Support Scheme.

Table 1 shows a summary explaining a little about each of these four schemes. In addition to these four schemes, is also the First Home Super Saver Scheme.

The First Home Super Saver Scheme

The First Home Super Saver Scheme allows first-home buyers to save a deposit for their first home inside their super account, to take advantage of the

concessional tax treatment. You can do this by making voluntary contributions to your super.

You can then apply to have a maximum of $15,000 of your voluntary contributions from any one financial year included in your eligible contributions to be released under the scheme, up to a total of $50,000

You can use this scheme if you’re a first home buyer and...

n You will occupy the premises you buy or intend to as soon as practicable; AND

n You intend to occupy the property for at least 6 months within the first 12 months you own it, after it is practical to move in.

Other assistance in NSW

It is also important to note that First Home Buyers in NSW may be eligible for a:

n $10,000 First Homeowners Grant for a new home that no one has lived in before.

contributions across all years. You will also receive an amount of earnings that relate to those contributions.

To be eligible, you can not have previously had funds released from your superannuation under this scheme and it is only your voluntary contributions that can be accessed, not any of the contributions made on your behalf by your employer under the Superannuation Guarantee requirements.

n Full transfer (stamp) duty concession for both new and established properties valued up to $650,000, and partial concession for homes valued between $650,000 and $800,000.

n No stamp duty for vacant land valued at less than $350,000. And for land valued between $350,000 and $450,000, you’ll receive a concessional rate.

For more information, please visit the NSW Revenue Office’s website.

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

BUilDinG WeAltH SecUrity

“Four major national government schemes are now available for first-home buyers within calendar year 2022...”

finance

INVESTMENT

Table 1. Help to buy

First Home Guarantee Family Home Guarantee Regional First Home Buyer Support

What it is?

A shared equity scheme in which the Government Contributes 40% of the cost of a new home or 30% for an existing home

A guarantor scheme in which the government guarantees loans, so borrowers avoid LMI

It is a guarantor scheme where the government guarantees loans so borrowers avoid LMI

It is a guarantor scheme where the government guarantees loans so borrowers avoid LMI

Who is it for?

Low to middle-income earners who currently own no property First Home Buyers

Single parents with at least one dependant child who do not currently own a home

Only first home buyers who have lived in a regional area for the past 12 months and who purchase a property in their current or adjacent regional area

How many places are available? 10,000 each year 35,000 each year 5,000 each year 10,000 each year

What is the maximum deposit required? 2% 5% 2% 5%

What is the income cap?

$90,000 for singles and $120,000 for couples

$125,000 for singles and $200,000 for couples $125,000 $125,000 for singles and $200,000 for couples

When is it available? 1 July 2023 Available Now Available Now 1 January 2023

LMI refers to Lenders Mortgage Insurance, which can amount to tens of thousands of dollars for the borrower.

The need for advice

With this level of complexity, you should speak to your adviser before making any property transactions, especially if it is likely that you will be eligible for one or more of these schemes.

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) 9683-6422, 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.

Masks and respirators: The inside story

By Emeritus Professor Laurence J. Walsh AO

The COVID-19 pandemic has brought much greater attention to the risk factors that operate in the dental clinical setting because of droplets and aerosols and thus the importance of respiratory protection as one of the layers of defence for dental staff.1,2 Masks and respirators perform multiple functions. This article will explore each of these functions and then go on to discuss some new antimicrobial technologies used in masks and respirators.

Containment

Firstly, masks and respirators contain the secretions of the wearer and reduce the generation of droplets and aerosols into the immediate environment. This principle explains the use of these during pandemics to contain these on the face of the user, rather than having them dispersed into the

environment where they can infect others. Over the last three years, research in aerobiology has shown clearly that infectious aerosols are generated by the act of breathing, with an increased load of viruses produced during speaking, shouting, singing, coughing and sneezing, in increasing orders of magnitude. For this first purpose of containment, it is essential that the mask or respirator is adapted closely to the face so that expired air does not leak in large amounts from the periphery. Due to variations in facial shape, some individuals are unable to be properly fit tested with a surgical respirator and achieve a fully airtight fit for their respirator. An example of proper adaptation is shown in Figure 1. Surgical masks are not designed to be airtight, but rather to be adapted closely against the skin of the face. Not folding the mask out fully and not adapting the insert that covers the bridge of the nose are two common errors that result in air being directed away from the face of the wearer and into the general environment.

Figure 1. An example of proper adaptation of a respirator against the side of the face (Survivon P2 surgical respirator ARTG 384806).

ing. Panels A-C are 42X magnification images of the outer, middle and inner layers, respectively. The 3D printed nature of the outer and inner surfaces is evident. Panels D and E are 520X magnification images of the outer, middle layers, respectively. Note the differences in size and arrangement between the outer fibres, which are 3D printed, and the inner fibres, which are electrospun. Several small particles which appear white can be seen at hearing to the fibres.

Skin surface protection

Asecond feature of masks and respirators is that they are a disposable surface that covers the face and the upper neck. This is important when one is being exposed to fluid splashes, as frequently occurs in dental practice. Several studies have explored the extent of contamination and the most recent evidence shows clearly that dental assistants during their normal work receive greater splashes to the face and upper chest region then do dental clinicians. The nature of the equipment being used also has a powerful influence, with air polishing and ultrasonic scaling producing the largest amounts of both splatter and aerosol, followed by the triplex syringe and high-speed and low-speed handpieces, respectively.1,2 Knowing the outer surface of the mask or respirator becomes highly contaminated during a clinical procedure underpins the importance of removing this in a way that does not lead to contamination of the fingertips.

For use in a clinical setting, masks and respirators require resistance to splashes of fluid. Synthetic blood is the test liquid used to assess resistance to fluid penetration through the mask and resistance to penetration is expressed in terms of pressure in millimetres of mercury, so that it corresponds to blood pressure. Requirements for these are specified in AS 4381:2015 and the test protocol for fluid resistance is in ISO 22609. Level I fluid resistance is 60 mm Hg and this suits environments where little or no exposure to fluid is expected, because the triplex syringe or powered instruments are not being used at any stage of the procedure. Level 2 fluid resistance is 120 mm Hg and is more than sufficient for all routine surgical and nonsurgical dental procedures. Level 3 fluid resistance is 180 mm Hg. This is designed to cover situations of extreme exposure to arterial squirting during surgical procedures (such as orthopaedic or cardiac surgery and limb amputations). It is very rare for arterial squirting to occur in oral surgery procedures undertaken in an office-based setting.

Filtration

The third feature is that of filtration of particles. This occurs in two directions, trapping expired particles as they leave the mouth and the nose and also trapping particles from the external environment as the wearer is breathing in. The outer most and innermost layers of modern masks and respirators are produced using 3D printing, with dense aggregates of fibres and linking regions that provide strength and support. Typical examples of this structure are shown in Figure 2. Surgical masks and respirators have one or two central layers of very fine electrospun fibres that are designed for filtration of small particles. The filtration occurs both through straining out of larger particles that are intercepted as they attempt to pass through the forest of fine fibres, as well as attraction of smaller particles through electrostatic interactions with the fibres themselves. To achieve this second mechanism, the polypropylene fibres are treated with a high voltage as a final stage of manufacturing the mask.

Understanding these two filtration approaches is important for assessing the quality of a surgical mask. Filtration of larger particles of 2 µm in size (i.e. bacteria) is expected to be a minimum bacterial filtration efficiency (BFE) of either 95% or 98% for surgical masks under AS 4381. Filtration of small particles is not a requirement under this particular standard. High-quality surgical masks, such as those with four layers, can achieve significant filtration of small particles and in this case they will be labelled with their particle filtration efficiency (PFE). For surgical respirators, under AS 1716, filtration of particles of 0.2 µm in size (i.e. viruses causing respiratory infections) must exceed 95% for the mask to be rated as a P2/N95.

Antimicrobial actions

n addition to serving as a passive filter, in recent years several technologies have been developed so that masks can have active antimicrobial effects against bacteria and viruses. This is typically achieved by using one of the antimicrobial metals, or their compounds, such as those based on selenium, silver, gold, zinc or copper.3-10 Nanoparticles of the metal can be incorporated into the melt so that during 3D printing or electro spinning, the particles are integrated into the polypropylene,

I

Figure 2. Scanning electron microscope images taken by the author using a Phenom G2 Pro SEM of the various layers of masks and respirators after five minutes of wear

Figure 3. Testing of the surfaces of a Survivon™ Copatac mask with copper coating against a clinical isolate of SARS-CoV-2 by the Doherty Institute at Melbourne (conducted on March 4, 2021). Details of the mask are at https://www.survivon.com/copper-masks. The graphs compare the tested surfaces with a control and the percentage reduction is shown in the tables for the three time points of 5, 15 and 30 minutes. Each 10 mm X 10 mm sample was exposed to 50µL of SARS-CoV-2 to simulate large droplet contamination of material. After 5, 15 and 30 mins incubation at room temperature, exposed samples were washed 8 times with media, then the eluate collected and assayed for infectious viral load via performing a tissue culture infectious dose (TCID50) assay. The infectious titre was then determined 3 days later upon examination of virus induced cytopathic effects. The samples exhibited significant viricidal activity within 5 mins as a lower SARS-CoV-2 infectious titre (TCID50/mL) was measured. The average percent reduction in infectious titre was more than 97% at 5 min post-exposure. By 15 minutes post-exposure, the eluate had non-detectable infectious SARS-CoV-2 present and achieved an average of a 99.95% reduction in infectious titre. At 30 minutes post-exposure, the samples had non-detectable infectious SARS-CoV-2, reducing the infectious titre by 99.99%.

with some of these being on the outside of the fibres, where they can come into direct contact with bacteria or viruses. Alternative approaches are to use various vapour deposition processes to deposit at the nanoscale the relevant antimicrobial metal onto the surface of the fibres, or to spray on a polyurethane coating that has the metal nanoparticles within it. Regardless of the method, including such metals can change the appearance of the mask, giving it an unusual or distinctive colour.

One particularly popular strategy has been to use copper metal or copper compounds such as copper iodide. Copper exerts drawn antimicrobial, antifungal and antiviral actions and readily inactivates SARS-CoV-2 and human influenza viruses. The Survivon™ Copatac brand is an example of Australian-made masks and respirators that incorporate this type of copper technology. An example of test results for inactivation of SARS-CoV-2 is shown in Figure 3. The inactivation process occurs within a short time frame. The same type of concept using antimicrobial metals can also be applied to various textiles and this has been an active area of investigation in recent years as attempts have been made to develop personal protective equipment with active protection mechanisms.

About the author

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 390 journal papers, with a citation count of over 18,300 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

1. Han P, et al. Splatters and aerosols contamination in dental aerosol generating procedures. Appl Sci. 2021; 11 (4): 1914.

2. Pulich A, et al. Simulated and clinical aerosol spread in common periodontal aerosol-generating procedures. Clinical Oral Investigations 2022; ;26(9): 5751-5762.

3. Borkow G, et al. A novel anti-influenza copper oxide containing respiratory face mask. PLoS ONE 2010; 5(6): e11295.

4. Fujimori Y, et al. Novel antiviral characteristics of nanosized copper(I) iodide particles showing inactivation activity against 2009 pandemic H1N1 influenza virus. Appl Env Microbiol. 2012; 78(4): 951-955.

5. Takeda Y, et al. Application of copper iodide nanoparticle-doped film and fabric to inactivate SARS-CoV-2 via the virucidal activity of cuprous ions (Cu1). Appl Environ Microbiol 2021; 87: e01824-21.

6. Jung S, et al. Copper-coated polypropylene filter face mask with SARS-CoV-2 antiviral ability. Polymers 2021; 13: 1367.

7. Foffa I, et al. A copper nanoparticles-based polymeric spray coating: Nanoshield against SarsCov-2. J Appl Biomater Funct Mater. 2022; 20: 22808000221076326.

8. Jung S, et al. Sustainable antibacterial and antiviral high-performance copper-coated filter produced via ion beam treatment. Polymers 2022; 14: 1007.

9. Wang WB, Clapper JC. Antibacterial activity of electrospun polyacrylonitrile copper nanoparticle nanofibers on antibiotic resistant pathogens and methicillin resistant Staphylococcus aureus (MRSA). Nanomaterials 2022; 12: 2139.

10. Purniawan A. Synthesis and assessment of copper-based nanoparticles as a surface coating agent for antiviral properties against SARS-CoV-2. Sci Rep. 2022; 12(1): 4835.

IS EVERYTHING the right one with Hu-Friedy

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

IS EVERYTHING the right one with Hu-Friedy

DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

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

DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

Septanest : the first choice of dentists with over 150 million injections per year, provides you high quality you can trust

Get organised and be efficient with Signature Series Procedure Tubs

Signature Series Tubs are designed to match Hu-Friedy IMS instrument cassette rail colours and feature antimicrobial product protection. Together, procedure tubs and cassettes create the most efficient and organised system for managing instruments and consumable products. The time savings achieved by using IMS (Instrument Management System) cassettes and procedure tubs allow staff to spend time on more value-added activities in the dental practice.

IMS and Tub System

Procedure tubs can be used as portable operatory drawers to store, organise and transport consumable materials to and from the storage/sterilisation area and the operatory. All of the materials needed for a specific procedure can be stored in the tub. A different tub and colour can be used for each different procedure type (e.g. crown & bridge, composite, etc). The Signature Series procedure tubs are available in colours that match IMS cassette rails, which allow the staff to match the tubs and cassettes by procedure.

An example of how it works:

Blue cassette rails and a blue tub may represent a composite procedure. All of the consumable materials for composite procedures can be stored and organised in the blue tub and instrumentation stored in the cassette with blue rails, allowing for quick identification.

Microban® Antimicrobial Product Protection

Microban protection is integrated into the tub and tub components during the manufacturing process. Microban technology works by interrupting key cell functions that allow the microorganisms to function, grow and reproduce.

Microban protection begins to work as soon as the microorganism comes into contact with the product surface and works continuously to inhibit the growth of microbes that can cause stain, odours and product degradation - for the lifetime of the product.

Standardises material set-up for every type of procedure

The Hu-Friedy IMS and Tub System increases efficiency of materials management and eliminates time-consuming tray preparation for every procedure. Tubs may be configured to meet your practice needs or are available as a complete tub.

Procedure tub colours match Hu-Friedy IMS cassette rail colours...

• Increasing practice organisation and workflow efficiency.

• Allowing for quick identification of consumable products.

• Providing aesthetic integration with IMS cassettes.

Locking covers...

• Protect items from airborne materials during transportation to the operatory and storage.

• Adhere to infection control standards Microban® Antimicrobial Product Protection.

• Microban inhibits the growth of microorganisms that can cause stains, odours and product degradation.

• Allow for storage in central sterilisation or each operatory.

• Tubs can be transported to the operatory prior to each procedure, eliminating inventory management of materials in each operatory.

For more information, visit www.hufriedygroup.com

INFINITY

SERIES™ CASSETTES

INFINITY SERIES™ CASSETTES

INFINITY SERIES™ CASSETTES

INFINITY SERIES™ CASSETTES

The most sophisticated solution for instrument management

The most sophisticated solution for instrument management

The most sophisticated solution for instrument management

The most sophisticated solution for instrument

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. Because when it comes to the perfect fit, Hu-Friedy is just right.

That’s right, you deserve it. You deserve the peace that you are employing the most contemporary

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our impeccable fit.

• An open hole pattern that promotes water flow throughout the cassette

That’s right, you deserve it. You deserve the peace of mind and confidence of knowing that you are employing the most contemporary method of processing instruments. As dentistry’s innovator of the cassette-based instrument management system, Hu-Friedy is proud to bring you the modern design and functionality of the Infinity Series Cassettes which include:

Ensure predictable outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. You’ll quickly discover why dentists favor our

• An open hole pattern that promotes water flow throughout the cassette

WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS:

file. Available upon request.

• An open hole pattern that promotes water flow throughout the cassette

designs. Data on file. Available upon request.

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220

• Ideal height and mesio-distal width

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

• Color-coded silicone rail system that significantly reduces instrument contact and allows for more water flow while protecting the instruments during reprocessing

©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220

• Pre-trimmed and pre-crimped for simple placement

• Easy-to-use, ergonomic latch that allows for one-handed opening

All

• Accurate occlusal anatomy that matches the natural tooth

• Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment.

©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-482AUS/1220

To learn more about how IMS can enhance your practice visit Hu-Friedy.com/Infinity

VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit

Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | Hu-Friedy.com

• Easy-to-use, ergonomic latch that allows for one-handed opening Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

Performing at your best means having confidence in what you do. Experience Infinity Series™ Cassettes, and improve the efficiency of your practice, while helping protect your patients, your staff and your instrument investment. VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit

All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted.

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

©2021 Hu-Friedy Mfg. Co., LLC. All rights reserved.

Chu’s Aesthetic Gauges: The start to a perfect finish

By Dr Stephen Chu, DMD, MSD, CDT, MDT

Chu’s Aesthetic Gauges (Hu-Friedy) are used for quick, accurate measurements during a crown lengthening procedure. Predictable and swift diagnosis and correction can be accomplished with a minimum amount of stress and a maximum amount of patient gratification.

Chu’s Proportion Gauge

With colour-coded measurements having a predetermined ratio of about 78%, Chu’s Proportion Gauge is the easiest, fastest, and most precise instrument for diagnosing tooth size and proportion discrepancies.

Case Synopsis

A24-year-old African-American female presented with excessive spacing [diastema] between the maxillary anterior dentition and buccal flaring with distal inclination of the canine teeth (Figure 1).

The question was whether a tooth size, arch size or combination discrepancy existed for this patient.

Upon clinical examination, it was clear that the maxillary lateral incisors were developmentally deformed [peg size/shape] which led to the diastema; however, it was uncertain whether the central incisors were within normal limits of individual tooth size and proportion.

Figure 1. Initial situation.

Figure 2. Final result.

Using Chu’s Aesthetic Gauges, which define ranges of individual tooth size using predefined measurements, tooth and arch size discrepancies can be quickly and easily diagnosed.

In this case, the maxillary central incisors for this patient were found to be slightly deficient in width.

The aesthetic restorative therapy treatment entailed correction of tooth dimensions of all the maxillary anterior teeth using the gauges as a guide for reconstruction of size and shape with ceramic laminate veneers.

The centrals were corrected first, then the canines for occlusion and finally the lateral incisors.

With Chu’s Aesthetic Gauges, predictable and swift diagnosis and correction can be accomplished with a minimum amount of stress and a maximum amount of patient gratification.

The Proportion Gauge

• Precise colour-coded measurements.

• Provides quick, accurate diagnosis of tooth proportion.

• Provides accurate results and reduces chairside adjustment time.

• Easy to read - reduces visual fatigue.

• Common reference guide between clinicians and dental laboratories. This results in more effective communication to reduce the incidence of errors, and repeated adjustments.

• Compatible with the Hu-Friedy IMS® Instrument Management System cassettes and can be easily sterilised along with other instruments, thus reducing the incidence of cross-infection.

T-Bar Tip

The T-bar tip has a vertical and a horizontal arm. This measures length and width at the same time.

Inline Tip

The Inline tip has a short and long vertical arm.

This helps to measure the length and width, independently, in cases of crowding where the use of the T-bar tip may be difficult.

The Crown Lengthening Gauge

• Precise colour-coded measurements.

• Provides quick, accurate measurements and better results,

• Easy to read - reduces visual fatigue.

• Compatible with IMS cassettes and can be easily sterilised along with other instruments. Reduces incidence of cross-infection.

BLPG

The BLPG tip has predefined measurements to help achieve the proper mid-facial clinical crown and biologic crown length during a crown lengthening procedure.

Papilla Tip

The Papilla tip has predefined measurements to help establish the correct aesthetic position of the interdental papilla from the incisal edge before the flap is closed and sutured.

The Sounding Gauge

• The Sounding Gauge makes bone sounding simple and quick.

• Sounding tip curvature and sharpness allows easy manipulation and access into deeper areas to analyse the level of the bone crest.

Sounding Tip

The Sounding tip helps determine the sulcus depth, mid-facial osseous crest location and inter-proximal osseous crest location.

Dr Chu maintains a private practice with Dr Dennis Tarnow in New York City in aesthetic and implant dentistry.

case report

Crown-lay

By Dr Kasen Somana, Signature Dentistry

The patient, a male, age 43, is a long-standing patient at the practice. He has full dentition with several crowns present on molar teeth. There is a history of bruxism, clenching and cracking teeth with the patient not a very complaint occlusal splint wearer.

Tender tooth 46 has a deteriorating large MOD composite resin filling with a lingual crack visible under high magnification. Tooth tests positive for a crack associated with the ML cusp.

The patient was given two options for treatment:

• Replace filling with a larger resin filling that eliminates the ML crack; or

• Remove resin filling and undermined cusp and restore with a porcelain crown/onlay.

Upon assessment of the clinical presentation, functional habits, patient history, treatment plan and intended outcome, a decision was made for a crown-lay preparation and fabrication of lithium disilicate restoration.

1a.

Figure 1b.

Treatment goal

The treatment goal was to create an aesthetic crown that met all clinical requirements and accommodated the patient’s parafunction and intermittent occlusal splint usage.

Treatment

The time spent on each procedure throughout the case was documented by Dr Somana.

• Lower full arch and model set pre-prep using a 3Shape TRIOS intraoral scanner - 7 minutes (Figures 1a-b and 2).

• Tooth preparation under 12x magnification - 30-40 minutes (Figures 3-5).

• Prep Arch Scan -30 seconds (Figure 6).

Figure

Figure 5. Scan of prepared tooth.

• Occlusal plane defined (Figure 7).

• Restorative anatomy design proposed by TRIOS Design Studio (Figures 8-9).

• Restoration’s occlusal fit checked with 3Shape Patient Specific Motion and adjusted (Figures 10-11).

• Final restoration (Figure 12).

• Occlusion checked in virtual articulator (Figure 13).

• Original tooth used as a guide to design the crown to minimal thickness stipulated by the material of choice and to aid in matching the existing occlusal splint (Figures 14-15).

• Restoration placed in CAD block for milling (Figures 16-17).

• Final restoration seated (Figures 18-19).

Bonding Protocol: Crown prepared as per manufacturer’s recommendations (Ivoclar). Bonded with Panavia F 2.0 (Kuraray) as per manufacturer’s instructions.

Figure 2. Model pre-prep.

Figure 4. Scan of prepared tooth.

3. Prepared tooth.

Figure

Lower arch scan using 3Shape TRIOS.

Full arch TRIOS scan.

Figure 6. Prep Arch Scan.

Figure 7. Occlusal plane defined.

Figures 10-11. Restoration’s occlusal fit checked with 3Shape Patient Specific Motion and adjusted

Figure 12. Final restoration.

Remarks from Dr Somana

U sing TRIOS Design Studio, the designed crown inserted with no occlusal adjustment post cementation. The entire procedure was completed within a total of 75 clinical minutes.

A decision, however, was made to complete this case over two appointments. This was due to limited clinical time available on the preparation day and time not being critical to the patient.

Figure 13. Occlusion checked in virtual articulator.

During treatment, the biggest challenge for us was to create an aesthetic crown that met all the clinical requirements and that would accommodate the patient’s parafunction and intermittent occlusal splint usage.

For us, the ability to use the original tooth as a guide for designing the crown to minimal thickness stipulated by the material of choice and to aid in matching the existing occlusal splint was invaluable.

Figures 8-9. Restorative anatomy design proposed by TRIOS Design Studio.

simply.TRIOS

5

Intraoral scanning that simply makes sense

Hygienic by design for minimal risk of cross-contamination. Smaller and lighter than ever for next-level ergonomics. And a ScanAssist engine with intelligent-alignment technology that makes precision scanning effortless, every time.

Figures 14-15. Original tooth used as a guide to design the crown to minimal thickness stipulated by the material of choice and to aid in matching the existing occlusal splint.

Figures 16-17. Restoration placed in CAD block for milling.

Figures 18-19. Final restoration seated.

This function along with the ability to record a patient’s specific motion in TRIOS Design Studio significantly improves crown design from a functional and an aesthetic/anatomic perspective. These combined functions allow for a more predictable outcome. According to Dr Somana, the clinical benefits of TRIOS Design Studio include:

• Fast and accurate scans from the 3Shape TRIOS scanner;

• Simplicity and efficiency of crown design;

• Excellent marginal fit and therefore seal;

• Rapid turnaround time that, if needed, can be achieved in a single appointment;

• Zero occlusal adjustment required post bonding of the crown;

• Minimal adjustment to existing occlusal splint;

• The ability to design the crown by using the original tooth as a guide in the pre-preparation scan;

• The ability to design, adjust and adapt the crown to the patient’s own specific excursive movement OR with a traditional semi adjustable virtual articulator; and

• Absolute confidence in the quality of the restoration produced with the TRIOS Design Studio workflow.

Benefits of the digital chairside workflow for my patients include a simplified workflow; a far more comfortable experience; turnaround times suited to the patient and clinician’s requirements; and excellent results.

About the author

Dr Somana has been in private practice for over 15 years and has been interested in digital practice for over a decade. He is globally 1 of only 15 clinicians endorsed by and in collaboration with 3Shape to help develop TRIOS Design Studio. With knowledge backed by literature and hands-on experience, he spent 18 months testing and trialing different digital workflows in order to formulate a methodology for successful digital integration and practice productivity. His aim is to help every practitioner to successfully embrace digital dentistry and be the best they can be through quality education and training. In addition to being the clinical director of CADD, Dr Somana is the principal dentist of Signature Dentistry in Toorak, Australia.

Dynamic Bite Capture using the Aoralscan 3 intraoral scanner

By Terry Whitty

In any restorative, orthodontic or therapeutic dental modality, one of the major challenges is how to simulate the jaw movement of the patient outside the oral cavity, either in the real world or the digital world. Pre-adjusting the restoration, appliance or therapy so as to get the optimal result avoids often time-consuming chairside adjustment or worse, sending the device back to the lab for adjustments or remakes. For years, there have been expensive, fully-adjustable

articulators, face bows and even elaborate electronic systems that help to achieve this. However, nothing has really hit the mark in an exact way or become wide spread in use and probably more importantly, cost-effectively to routinely use.

With the rapid uptake of intraoral scanning, the manufacturers of these systems are battling for marketshare and are now finding more novel applications to seperate one from another, other than merely taking a static scan of the teeth and surrounding tissues, which most scanners now do very well.

Figures 1-4. Various devices to capture jaw motion.

Figure 5. Shining 3D AORALSCAN 3 intraoral scanner.

Figure 6. Taking a static bite with the Aoralscan 3 Intra Oral Scanner.

Figure 7. When capturing the dynamic bite, have the patient move into excursions; the area of the static bite and dynamic bite should overlap.

Figure 8. Dynamic bite is captured and recorded.

With the introduction of its Version 3 software, the new Aoralscan 3 intraoral scanner has added a new function to enable the precise capture and recording of a patient’s individual jaw movements and then transfer these movements to CAD software (exocad). They call this the Dynamic Bite.

The process is extremely simple and is part of the scanning workflow–just scan upper and lower jaws and the static bite is captured and recorded. You are then prompted to click a button and this enables the dynamic bite capture. Ask the patient to go into excursive movements while the scanner is in position and this movement is captured by the scanner. The results are instantly available on screen to view and if necessary, can be recaptured immediately if you’re not satisfied with the result.

Once the jaw motion is captured, this record can be directly imported into exocad CAD software and used as a replacement for an arbitrary digital articulator. However, it’s more accurate and true to the individual patient. You can then go ahead and design the restoration or appliance using these jaw movements as a reference.

Scan the QR code to see a demonstration of the Dynamic bite.

Figures 9-11. Dynamic bite can be played back and viewed.

Figures 13-15. XSnap Articulator module can be 3D printed to any model or scan.

This technology really opens up a plethora of applications from simple and complex CAD restorations and splint therapy to TMJ disorder diagnosis and any other modality that needs this type of individually recorded jaw movement.

Obviously, this technology is in its infancy and as software develops, the concept will evolve.

To give an example of what we may see in the near future, let’s also have a look at a new product called the xSNAP.

There is a plug-in module for exocad allowing the user to add an articulator directly to the virtual model to be 3D printed. Up until now, 3D-printed jaw models were only available with a clipfold articulator that allowed users to check the static occlusion.

In contrast, the natural jaw movements could only be performed using a conventional articulator.

With xSNAP, the 3D articulated system with spherical head is simply printed with the models of the upper and lower jaw to precisely simulate physiological mandibular movements (protrusion, mediotrusion and laterotrusion). The device is available with different standard condylar angles at present, but is still a very useful device.

Imagine if you will, this device drawing the data directly from the dynamic bite captured from the Shining 3D Aoralscan intraoral scanner and applying it to the xSNAP articulator. You would then potentially have physical models that could simulate the exact jaw motion of the individual patient. It’s not here yet, but definitely in the new future this type of device will be perfected.

There is no doubt the new Dynamic Bite from Shining 3D is a fantastic step forward and will have many uses. It will be interesting to see the evolution of

this type of technology as it will greatly assist us and demonstrates, in my opinion, that digital dentistry is really only just getting started.

About the author

Terence Whitty is a well-known dental technology key opinion leader and lectures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental laboratory in Sydney specialising in high tech manufacturing. Using the latest advances in intra- and extra-oral scanning, CAD/ CAM, milling, grinding and 3D printing, most specialties are covered including ortho, fixed and removable prosthetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.

How to deal with pain in young patients?

By Juan F. Yepes DDS, MD, MPH, MS, DrPH, FDS RCS (Ed)

Successful procedural outcomes depend on effective pain management; it is especially relevant when providing treatment to children. Pain is the response to nociceptive stimuli. The response to a stimulus varies greatly from one child to another child. The delivery of quality dental treatment relies heavily on the ability to prevent and RELIEVE pain. Controlling pain is critical to successful dental treatment. It was not too long ago that many in the dental and medical community doubted that children were susceptible to pain. Paediatric patients may not be able to provide a very detailed description of the pain, including the intensity. Fortunately, there are several pain scales that can be used with children to estimate the intensity and severity of the pain. Different options to help with pain are available to the dentist who provides care to children. These include:

• Behavioural management;

• Use of local anaesthetics (like articaine);

• Nitrous oxide;

• Analgesics; and

• Bioactive materials like Biodentine™.

Behavioural management, local anaesthetic and Nitrous

The use of behaviour management techniques when treating young patients is the key to pain control in the dental office. “Tell-Show-Do” is the core to this approach. The correct use of LA is also a fundamental component in the algorithm to control pain in children. A good understanding of the pharmacology and the specific techniques for children are critical in the successful use of the anaesthetic. Along with the basic behaviour management techniques and the use of LA, is the correct use of nitrous oxide. Without any question, the key to successful use of nitrous is patient selection. The ideal paediatric patient is slightly anxious and old enough to wear the nasal hood.

Treatment with biomaterials

The use of biomaterials is a recent and highly effective strategy to decrease pain, especially in the post-op phase. Biodentine™ is a calcium-silicate based material that became commercially available in 2009. The material is specifically designed as a “dentine substitute”. The spectrum of applications of Biodentine is wide and includes endodontic repair, indirect pulp cap, direct pulp cap, liner and dentine replacement in restorative dentistry. The composition of Biodentine consists of a powder (tricalcium silicate, dicalcium silicate, calcium carbonate, oxide filler, iron oxide shade and zirconia) and a liquid (calcium chloride and hydrosoluble polymer). One of the main advantages of Biodentine is the setting time, which is around 9-12 minutes. There is a significant difference in the setting time compared with other similar cements (like MTA). The compression strength of Biodentine is similar to dentine. The use of etch over Biodentine does not affect the compressive strength of the material. A critical factor of Biodentine is the porosity. Because of the low content of water of Biodentine, the porosity of the material is lower compared with other materials. This is a significant benefit when a perfect seal is mandatory, like in direct pulp cap treatment. The radiopacity of Biodentine, thanks to the zirconia, is ideal and allows the practitioner to visualise the material on radiographs. The antibacterial property of Biodentine is attributed to the high pH of the material. The high alkalinity has inhibitory effect on the growth of microorganisms.

The biocompatibility of Biodentine is outstanding and has been probed in multiple studies when the material is placed with fibroblasts from the pulp. According to the American Association of Endodontics, full pulpotomy involves the removal of the coronal portion of the vital pulp as a means of preserving the vitality of the remaining radicular portion. It may be performed as an emergency procedure

for temporary relief of pain and this is a critical advantage of Biodentine in front of other materials that can be placed in direct contact with the pulp. The presence of spontaneous or severe pre-operative pain does not always indicate that the pulp is not capable to repair.

Vital pulp therapy

everal recent clinical studies reported a successful medium to long term outcome of vital pulp therapy in teeth with PAIN, particularly young or immature teeth. The mechanisms of interaction of Biodentine with the dental hard tissues explain, at least in part, post-operatory pain control with Biodentine. The material provides micro-mechanical retention by infiltrating the dentine tubules. Furthermore, Biodentine induces the formation of tertiary dentine synthesis which provides protection to the pulp. These two combined effects might be responsible for the ABSENCE of pain and hypersensitivity.

S

Reducing inflammation and post-operative pain

Another critical report found that the application of Biodentine reduces both TRPA1 pain receptor expression and function. More importantly, when applied on odontoblast-like cells, Biodentine decreases pro-inflammatory TNF-a secretion. This indicates that in addition to the roles of Biodentine mentioned in the first paragraph, its application onto the dentine-pulp reduces the inflammation and consequently the post-operative pain.

References

1. Malkondu O, Kazandag M, Kazazoglu E. A review on Biodentine, a contemporary dentin replacement and repair material. Biomed Research International 2014.

2. Kaur M, et al. MTA vs. Biodentine: Review of literature with a comparative analysis. J Clin Diagn Res 2017; 11(8): 01-05.

3. Imad A. Biodentine: from biochemical and bioactive properties to clinical applications. Giornale Italiano di Endodinzia 2016; 30: 81-88.

IS EVERYTHING the right one with Hu-Friedy

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

IS EVERYTHING the right one with Hu-Friedy

LOVE OUR STAINLESS STEEL PEDO CROWNS:

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

LOVE OUR STAINLESS STEEL PEDO CROWNS:

ONLINE AT Co., LLC. All rights reserved.

ONLINE AT Co., LLC. All rights reserved.

ONLINE AT LLC. All rights reserved.

IS EVERYTHING the right one with Hu-Friedy 855 ww

Septanest : the first choice of dentists with over 150 million injections per year, provides you high quality you can trust Call 0508 486 252 www.ivoclar.com

Miniature implants: A revolutionary implant system for a minimally invasive treatment

By Dr Omid Allen

Replacing missing teeth with dental implants requires considerable volume of alveolar bone to host a conventional wide implant. In most situations, patients with edentulism exhibit some degree of resorption and deficiency in the residual ridge, particularly at the buccolingual width. This condition is a common obstacle for the application of conventional diameter implants above 3.3mm; these implants are impossible to use in such situations because of the limited bone width unless additional bone splitting or augmentation is considered.

Introduction of mini implants in 1998 by Victor Sendax opened a new chapter in implant dentistry. The IMTEC/3M mini implants allow a simple implant placement to help in stabilising lower dentures. Many dentists went beyond the initial recommendation for the use of mini implants and used narrow diameter implants for fixed restorations, despite their limited restorative options. However, the design of mini implants precluded the option of screw retention of fixed restorations and their small restorative head, unclear restorative margins and cement retention often lead to failure of the restorations or the implants due to a higher chance of peri-implantitis.

Figures 1-2. Pre-operative situation.

Miniature implants

The new patented Miniature Implant presented by the Australian owned company “BioMiniatures” offers a simple solution with a significantly less invasive approach for a wide range of implant treatments. These include replacing incisor teeth, multiple teeth missing, partial edentulism, full arch restoration and full mouth rehabilitation.

Miniature Implants can also be used in combination with other conventional implants if necessary. For example, in upper edentulous cases, it is common to face a narrow ridge in the anterior segment of the alveolar bone and sinus expansion in the posterior

region. A combination of short standard implants (with or without sinus augmentation) and Miniature Implants in the anterior region can facilitate a full arch rehabilitation. This would be an alternative to extensive procedures such as using zygoma implants.

Miniature Implants are offered in three narrow diameters of 2mm, 2.4mm and 2.8mm with length ranges of 8 to 14mm. They have a self-cutting, self-advancing form which requires no or minimal bone drilling for their insertion. The self-advancing feature allows implant insertion with some degree of bone expansion. This feature differentiates them from standard narrow implants which are supplied by some implant manufacturers in about 3 mm diameter, which still require bone drilling to the full length of the implant.

Figures 4-5. Following minature implant placement.

Figure 3. Post-op panoramic radiograph.

There are several design advantages to these new implants apart from their narrow diameter, which not only distinguish them in design but also make them a reliable alternative to conventional implants. These include:

1. One-piece form which eliminates the microgap and micropumping effect between the implant and abutment. This reduces the risk of marginal bone loss and peri-implantitis compared to conventional implants.

2. Tissue level design of the implants that suggests more stable bone and soft tissue health in the long term.

3. Multi-unit implant head that allows significant flexibility for the prosthetic options; and

4. External hex of the implant’s top that is favoured for its compatibility with other implant systems and long-term response. The implant insertion can be performed with or without raising a tissue flap or simply by using a tissue punch. The implants can be placed in the alveolar ridges as thin as 3 mm. In most situations, the insertion only requires a pilot drill to mark the insertion location and no full-length drilling is required. The full-length drilling is only recommended when facing a very hard bone of type D1. However, the drilling is done by using a standard pilot drill. The implants are usually drawn into the softer cancellous bone during their insertion.

The implants are delivered with an assembled insertion socket which plays multiple rolls in the prosthetic process. They can be used as the pickup cylinders, open tray impression copings, temporary abutments and Ti-base for the final restoration.

Case report

The patient was an edentulous 60-year-old male with a single remaining lower left canine with a hopeless prognosis (Figures 1-2). The patient was a non-smoker with no relevant medical conditions. Several treatment options were discussed with the patient including dentures, overdentures, full arch fixed and removable implant-supported prosthesis.

The patient was interested in fixed implant supported restorations. The radiographic examination revealed adequate bone volume for implant placement in both arches, however the patient opted to use Miniature Implants for their minimally invasive surgical approach and minimal morbidity.

The implant surgery was performed in a single surgical session to extract tooth 43 and insert six Miniature implants in each arch. The site preparation was performed using a tissue punch or small sectional pocket flaps to preserve the keratinised tissues where is proved necessary.

Figures 6-7. Nexus plus bridges made by Osteon Medical.

Figures 8-9. Nexus plus bridges in situ.

Figure 10. Nexus plus bridges in situ.

Figure 11. Bone level after fitting of the prosthesis.

The implant placement started with manual insertion using the cover lid of the implant which is designed as a hand wrench. When resistance is felt to further insertion with fingers, the plastic cap is removed and the procedure continues using a hand torque wrench or handpiece.

Excessive insertion torque is avoided to prevent implant fracture. The implant can be reverse torqued and the site may require preparation, using a pilot drill to the full length with irrigation before trying to insert the implant again. In most cases, the Miniature Implants reach a high primary stability.

The dentist should ensure that the entire rough surface of the implant is fully inserted in the bone (Although it’s recommended that the advancement of the implant continues until 1 to 2mm of the machined surface of the implant is also pushed into the bone. This can compensate for any future loss of the marginal bone and prevent risk of peri-implantitis) (Figures 3-5).

The insertion socket is detached and removed after implant insertion and the healing caps are then fitted on.

A set of provisional dentures are then made and relined with a soft-liner PVS material to help the patient adapt during the healing period.

A healing period of 12 weeks was allowed during which the patient was able to use his provisional dentures. No implants failed during the 12-week healing period.

The prosthetic process started with taking open tray impressions using PVS impression material using impression copings specific to the implants. The implants were joined together using flowable composite and metal bars. This ensures high accuracy for the implant position recording. Intraoral scanning can be an alternative option using scan gauges for multi-unit abutments such as the Osteon IOS scan gauges.

The final prosthesis are hybrid PMMA restorations on titanium bars known as a Nexus Bridge (Osteon Medical) (Figures 6-10). The misalignment of the implants are compensated for by their multi-unit head, although using Bi-Axial screws help by ensuring the access holes are configured in desired positions.

Regular six month follow up visits were scheduled to review the implants and prosthesis for their health and likely complications (Figures 11-13). A significant tendency for calculus buildup was observed, specially in the lingual aspect of the lower prosthesis. However, the marginal bone level of the implants presented a stable condition with no considerable loss or changes.

Figure 12. Bone level 12 months after treatment completion.

Conclusion

Miniature Implants are taking the lead in implant dentistry with their minimally invasive treatment option which assist dentists to provide a much safer and less traumatic treatment to their patients. Rehabilitation of full arch edentulous patients with fixed implant supported restoration can be a challenging exercise for dentists and a traumatic experience for patients. Sequential bone drilling to prepare the site for placing standard implants is contributing to most of the complications associated with implant surgery.

Using Miniature Implants can minimise the risk of the surgery for both the clinician and patient. Their minimally invasive placement, successful performance and marginal bone level stability offers a new alternative for easier and safer full arch rehabilitation.

About the Author

Dr Omid Allan is the founder of BioMiniature and inventor of Miniature Implants. He has been practising dentistry for over 25 years. Dr Allan holds an MSc degree in Aesthetics Dentistry from King’s College of London and MSc degree in Oral Implantology from Goethe University of Frankfurt.

Figure 14. Satisfied patient.

Figure 13. Panoramic radiograph at 18-month follow-up.

The original national healthcare design and construction company turns 20 in 2022

Medifit has built hundreds of dental practices and redefined the dental design and construction landscape in the two decades since their humble beginnings in 2002. Here we celebrate Medifit’s success over the past 20 years and look forward to continued growth and improvement over the next 20

2022 marks the 20th year in business for Medifit Design & Construct. Growing a business from the kernel of an idea to an established industry leader takes a lot of hard work and dedication. Medifit’s Sam Koranis has been at the helm of Medifit since its inception in 2002 and recently spoke with Australasian Dental Practice about the company’s history and the changes the industry has seen over the past two decades.

“Being able to help health care professionals realise their dream practices is a privilege,” Mr Koranis said. “For most of our clients, setting up their own practice is a defining moment in their career. It’s a leap of faith and we respect the trust that they put in us.

“From day one, we have been committed to operate with honesty and integrity and never compromise on quality. This formula has been the foundation of our success.”

Where it all began

In 2002, whilst researching applications for solid surfaces in the healthcare sector, Founding Director Sam Koranis discovered that at the time, there was no business in Australia offering a comprehensive, national turnkey practice design and construction service.

Medifit’s directors - John Gullotto, Geoff Raphael and Sam Koranis.

Dr Michael Lucas 2004

Dr Jayson McNaughton 2007

Dr Ervan Seeto 2007

Dr Ali Essfahani 2009

Establishing a practice typically meant that a busy dentist or specialist would contact an architect or interior designer and work through the design process. Once design was completed, a host of suppliers and generalist construction subcontractors would be engaged to complete the building and interior fitout.

“Good design is far more than making things look aesthetically pleasing,” he said. “From day one, we aimed to deliver solutions that not only looked great but also improved the day to day productivity of every practice we design.”

Medifit was founded on three guiding principles: honesty, transparency and a commitment to mutually beneficial outcomes for its clients. The business model delivers on these principles.

“In the last 20 years, the health care construction market has been saturated with companies trying to emulate Medifit’s success. We welcome the competition, comfortable in the knowledge that we offer what we believe is the best available health care design and construction solution in Australia,” Mr Koranis said.

“Our experience in the space helps us to cost your project realistically and offer fixed sum contracts for peace of mind. This honesty can be confronting in a market where low upfront pricing and contract variations are the norm.

Unaware of the specialist requirements of health care disciplines, mistakes were often made and stories of costly retrofitting and remediation were common. Unlucky health care practitioners found themselves caught up in a “blame game” with third party contractors refusing to take responsibility for errors and omissions.

Medifit was established to change this paradigm.

By offering a complete design and construction service under a single roof, they were able to maximise efficiencies and deliver a superior result, whilst reducing the mental load for clients.

Founding Director John Gullotto had a long and established history of award winning cabinetry and interior fitout services based primarily in the retail sector. A certified fabricator for all major solid surface materials, John was a natural fit as Medifit Construction Director.

“Over the years, we had fielded enquiries from the health care sector and had seen first hand the gaps in the services provided,” he said. “Successful health care fitout requires a combination of specialist design and construction working in tandem and this is where the idea for Medifit was formed.”

The third Founding Director, Geoff Raphael, brought acclaimed interior design skills to Medifit and completed the service offer. With a family history in dentistry, Geoff had valuable insight into how dental surgeries operated and the design intelligence to create solutions that deliver functionality and aesthetics.

“We’re not for everyone and we are ok with that.

“Our processes are fully transparent and we stand behind each and every practice we create. As testament to this, we have over 50 satisfied clients who have returned to Medifit to design and fit out their second, third, fourth and in one case sixth practices.”

Form and function

Medifit-designed practices are as productive as they are beautiful. Designed at every level to optimise patient flows and create efficiencies in the day to day running, Medifit practices share a common goal - to make working life better.

“Our designs and space planning processes have been recognised with a host of national industry awards over the years,” Mr Koranis said.

Recent Medifit Awards

Dr Lloyd Saville 2010

Dr George Connell 2013

From inception, Medifit embraced the concept of building local and employed state-based Project Managers to manage practice construction and fitout in their respective states, with quality standards and procedures handed down from head office. This approach resulted in an agility that has stood the test of time.

Being Perth-based has also provided a surprising benefit. Practitioners busy caring for patients in the Eastern States are able to take advantage of the time differences and contact the Medifit

team at the end of their working day via phone call or video conferencing. The model has been so successful that relationships with the original state project managers endure to this day.

Over the years, Medifit has built an enviable reputation among suppliers, trades and the dental community as a premier provider of high quality practices. The loyalty they have shown to their staff, trades and customers around the country is reciprocated and has resulted in steady growth since their inception.

Drs Polly & Phalika Hing 2015

Dr Frank Furfaro 2015

Dr Chris Orloff

2019

Dr Andrew Wang 2018

Dr Howard Holmes 2018

Dr Naomi Hollander 2018

Medifit takes an holistic approach to practice design. Taking the time to understand every client’s particular needs and desires ensures that Medifit clients get the practices they want.

“The first part of our design process is to compile your thoughts and wishes and those of your key staff and stakeholders into a comprehensive design brief that fully captures the intent of your new practice,” Mr Koranis said. “These initial discussions give us an opportunity to learn how you work. Most importantly, we get to know and understand your personality and values and bring these to the final design.

“Our designers are expert space planners, specialising in designing working space with optimum patient flows and in full compliance with the statutory requirements for your particular discipline.”

The Medifit design process is synonymous with quality outcomes. Proven over hundreds of successful projects across the healthcare spectrum. They will create a design solution that complements the way you work, helping you to deliver better care.

Dr Geoff Hall 2020

Dr Andrew Wang 2020

Dr David Hurst 2020

Dr Vivian Wang 2020

Medifit has entered select projects into various industry awards including The Australian Shop and Office Fitout Industry Association (ASOFIA) Awards and the Master Builders Excellence in Construction Awards. These award programmes are judged by industry peers and are fiercely contested in the design and construction industry and their work has been recognised with many award wins.

Medifit’s Sam Koranis has the final word. “I believe in the wisdom of the ancient Chinese proverb which states, ‘the journey is the reward’.

“As Medifit’s journey heads into its third decade, the team of dedicated staff, industry connections, suppliers, trades and the countless clients we now call friends has been a reward greater than we could have imagined.”

Dr Jeffrey Kestenberg 2021

Dr Jeffrey Kestenberg 2021

Dr Fabiana Petrykowski 2021

Dr Brian James 2021

Dr Spiro Agopitas 2021

Brisbane practice is a Hamptons haven

By David Petrikas

Despite the challenges of COVID over the past couple of years, Brisbane dentist Anna Song has successfully established a brand new practice during that time.

Although the timing has hardly been ideal for kicking off a new business, the result is a practice which puts its individual stamp on the suburb of Sherwood, providing an attractive new option for local patients to catch up on their oral health needs.

Dr Song, who has been involved in another suburban practice for some years, decided it was time to spread her wings and design and build a brand new practice of her own.

She also wanted an atmosphere which would be both attractive to patients and staff, making Sherwood Smiles a place people would be happy to be in.

With the fit-out now complete, the dream has transformed into reality and patients and staff alike - Dr Song included - are revelling in the huge new space and all its inclusions.

Dr Song said she wanted a “toned down” Hamptons style to fit with the old character of the building which features double-hung colonial bar windows on the surgeries and deep verandah over the footpath at the front.

The aim was for a reception area and waiting room which felt more like a living room to make the practice seem more “homely” than the traditional clinical feel of many dental practices.

The fit-out produced by Elite brings together classic Hamptons elements such as warm timber floors, classic light fittings and contrasting white walls to give it a light, open feel.

The first thing you are struck by on entering through the front door is the feeling of space. At over 180 square metres, it’s a large practice and Dr Song wanted to devote a generous chunk of it to the reception area.

When the building was renovated, some of the old walls were removed which means the waiting and reception area can benefit from the natural light coming through the generous expanse of glazing at the front and side of the building.

The waiting room has a custom-made upholstered window seat, individual seating and fabric ottomans facing a large

marble topped reception desk and walls adorned with Sherwood Smiles signage and slogan - “Your smile is our passion” - reassuring patients.

There is also a small glass-door refreshment fridge for patients, bookcase style cabinetry with consumables displays and a large screen television monitor.

Off to the side, opposite reception, is a semi-private consultation nook to go over treatment plans and options with patients. In practice, however, Dr Song says much of the consultation takes place in the dental chair.

The waiting room leads to a long hallway with surgeries and other rooms off to each side, stepping down to “his” and “hers” bathrooms and a private entrance at the far end of the building.

Although it is a general dental practice catering to families, Dr Song has an interest in implants and more complex procedures and needed equipment to support her in doing this, including comfortable patient chairs and good quality digital imaging equipment.

This was behind her thinking to buy the most comfortable chairs within her setup budget along with high quality handpieces.

Dr Song is a long term A-dec user after completing her dental studies at the then newly established Griffith University which was fitted out with A-dec 500 chairs.

“I am left handed, so I also needed an ambidextrous chair. As I used A-dec at university and have worked on A-dec chairs for another 12 years since, it was natural to continue to work with what you are comfortable with,” she said.

“I did look at some other dental chairs, but they were either too big and complex or had thin, hard upholstery and didn’t appeal to me on either looks or comfort.

“The advantage of the A-dec delivery system is it is an easy left-to-right conversion so that if I bring in an additional dentist, we can both use the chairs in a way that best suits us.”

After speaking to A-dec specialist Jane Miller of Medical Dental Solutions, who was able to provide both the brand of dental units and digital imaging equipment she was looking for, Dr Song opted for the A-dec 400 because of its comfortable “plush” sewn upholstery and its small overall footprint.

She said the A-dec chairs she has used for some years in the other practice had proven very durable and that the upholstery still looked good even after many years of use, so she opted for premium black sewn upholstery in her new surgeries as well.

“The new A-dec 400 chairs have great lumbar support for patients and many of my patients have said, ‘oh, it’s so comfortable!’ when they sit in the chair,” she said.

For the same reason, Dr Song opted for A-dec 400 dentist and assistant stools for correct ergonomic support for the dental team.

A-dec400

THERE’S AN A-DEC FOR EVERYONE

A-dec500

Every dental practice is unique. That’s why A-dec offers a full line of dental chairs, with a wide variety of options and price points, all designed for comfort, performance, and reliability.

From the entry-level A-dec 200, the stylish A-dec 300, to the classic A-dec 400 and the premium A-dec 500, there’s an A-dec chair to fit your practice, your personal style, and your budget.

To see our award-winning family of A-dec dental chairs – scan the QR code and find the one that’s right for you.

Summary

The Practice

The Practice Sherwood Smiles

The Principal Dr Anna Song

Practice Type General

Location Sherwood, Brisbane, Queensland Size 182 square metres

No of chairs 2+1

The Team

Design & Construction Elite

Chief Designer Damien Fuller

Project Manager Philip Boston

Installer Medical Dental Solutions Brisbane Equipment

Dental Units A-dec 400 x 2

Sterilisation W&H Lisa Automatic steriliser

CBCT Vatech Green 16 with ceph arm

X-ray Acteon PSPIX phosphor plate scanner

Compressor Cattani AC300E

Suction Cattani Turbo SMART A

Software Exact

The dental units also have the compact A-dec 300 traditional delivery system which Dr Song is familiar with from the other practice where she has been working.

In addition to conventional turbines, the delivery systems include A-dec’s compact NLZ electric micromotor and W&H handpieces which can be used for anything from heavy crown reductions to delicate endodontic procedures using the A-dec Deluxe touchpad.

Each of the two currently equipped surgeries have bespoke built in cabinetry as well as wall-mounted X-ray units. For patient comfort and convenience, Dr Song uses a compact Acteon PSPIX phosphor plate scanner which produces an image in a few seconds.

She also has a dedicated CBCT machine in a separate room for full arch scans and for implant planning.

Next to the CBCT room and opposite the surgeries is a large U-shaped sterilisation room with built-in cabinetry and shelving. Red and blue task lighting beneath the cabinets delineate clean from contaminated work areas.

Next to the steri room is a large staff kitchen and meals area. The room opposite is already plumbed ready for a surgery or complementary medicine practitioner as needs evolve in the future.

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 new Luna Flow composite

The Smile Lite MDP2 Mobile Dental Photography by Prof. Louis Hardan - the ultimate evolution in mobile dental photography – is here. It’s equipped with three groups of next generation “SunLike“ LEDs and each group can be lit up individually. A dimmer function gives you the possibility to set four different illumination levels. The increased light power is perfect

for posterior shots and the new integrated ergonomic handle provides stable support. The back of the Smile Lite MDP2 is equipped with a universal adapter that is adjustable and fits any smartphone with a width between 55-85mm.

Available: Alphabond Dental Tel: (02) 9417-6660 info@alphabond.com.au www. alphabond.com.au

Cention Forte from Ivoclar Vivadent

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

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

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

AU Tel: 1300-IVOCLAR NZ Tel: 0508-IVOCLAR www.ivoclar.com

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

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

TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.

TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.

TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.

TGA NOTES : We have always worked within the guidelines of the TGA and now with the new regulation we continue to do so. If you have any concerns please don’t hesitate to contact us for more information.

Another Quality Product From

Another Quality Product From trulinedental.com.au

Another Quality Product From trulinedental.com.au

Another Quality Product From

FLEX MINI ONE

A la carte Bite sized Fun-sized

For revisions and recent relapse cases. Pay for the exact amount of treatment you need—no more, no less.

For very mild cases, up to 12 sets of aligners, including one revision.

For mild cases, up to 24 sets of aligners, including one revision and one set of retainers.

TWO

Double the fun

For moderate cases, up to 48 sets of aligners, including two revisions and two sets of retainers.

THREE UNLIMITED

The triple play

For moderate to severe cases, up to 72 sets of aligners, including three revisions and three sets of retainers.

All you can eat

For severe cases, as many aligners as you need for five full years, including replacements, revisions, and retainers.

An assortment of treatment options

Tailored to your taste

OsseoGroup

Scan the QR code or visit clearcorrect.osseogroup.com.au to become a ClearCorrect provider.