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June 2020 | volume 7 | issue 2
articulate
the quarterly e-newsletter of the dental technologists association Dental Laboratory Crisis Management Pack
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oronavirus is having a significant impact on dental laboratories, and in addition to the immediate advice on how to safeguard your business, the DTA has produced a Dental Laboratory Crisis Management Pack to help you prepare your
business to operate once again when it is safe to do so. These documents should form part of your regular business documentation and they might already be in place; however, they will need to be reviewed and updated before you reopen.
It’s important to review and update them on a regular basis. The pack can be utilised for any crisis impacting your business in the future, not just coronavirus. ● Download it here.
Coronavirus news ● Please check the DTA News Page, which is regularly being updated with new information.
Articulate News
DTA elections 2020 The successful nominees of the May 2020 DTA Council elections are Tony Griffin, Delroy Reeves and Joanne Stevenson.
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he nominees have accepted their positions on Council, and we thank Delroy Reeves and Tony Griffin as returning Council members for their dedication and support with moving the association forward. We are delighted to welcome new Council member, Joanne Stevenson, to the DTA Management Team.
Joanne has been a prosthetics technician for 30 years and has been a member of the DTA since she was a student. Joanne recently wrote an article for the DTA ‘Benefits of the duplicate denture technique’ that was published in the May edition of The Technologist. The DTA Council welcomes Joanne’s active involvement moving forward.
This issue contains 45 minutes of CPD for DTA members Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
Joanne Stevenson
Our address is: PO Box 1318, Cheltenham GL50 9EA Telephone: 01242 461 931
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ARTICULATE NEWS (CONTINUED...)
TAKE PART IN EUROPEAN DENTAL TECHNICIANS DAY FRIDAY 5 JUNE Now, more than ever, it’s important to stand up and stand together to raise awareness of dental technology...
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or all dental technologists throughout the UK, the DTA is taking part in the third European Dental Technicians Day (EDTD), which is taking place on Friday 5 June 2020 and we encourage you to join our digital campaign to raise awareness of the work that dental technicians do. The ultimate goal is to showcase dental technology as a profession and the services that are provided. Until now, most dental patients were unaware that it is the dental technician who provides their custom-made dental device.
Get involved! On Friday 5 June: ● Share posts on social media including: – information about dental technology and what you enjoy most about your job – photos and videos illustrating the manufacturing of dental devices, both traditional and digital processes ● Make sure you tag us: @DentalTechnologistsAssociation on Facebook or @The_DTA on Twitter and we will share your post to spread the word and reach more people.
● Support online campaigns through social media. ● Share information about dental technology wherever possible to educate the public on what dental technicians do. ● Send us an article to promote via a future DTA publication or on the DTA website.
We are supporting National Smile Month
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ational Smile Month runs between 18 May and 18 June and aims to engage the general public and make them aware of the benefits of good oral health. The campaign aspires to raise awareness of these important facts (and many more) …
8337
new cases of mouth cancer a year
1 in 7 adults suffer from extreme dental anxiety
39% of adults do not attend a dentist regularly
3.5 million people live with oral pain
74%
of all adults have had a tooth extracted
Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation said: ‘Traditionally, National Smile Month is all about community, whether it’s championing oral health in schools, workplaces, high streets or shopping centres. National Smile Month has given us a chance to connect with some of the most in-need and vulnerable people in the UK. With safety and good health being of the upmost importance, we have decided to make some changes to how we are approaching this year’s National Smile Month.’ In 2020, National Smile Month will be an entirely digital charity campaign and the organisers will share some great ideas on what digital activities and events you can run to help spread these important messages.
Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
Download your supporter badge at: Smilemonth.org Shout about it on social media: @SmileMonth on Twitter and @NationalSmileMonth on Facebook
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ARTICULATE NEWS (CONTINUED...)
Ten virtual time case photographs required Twiddling your thumbs while waiting to get back to work? Could you use some of this time to sort out all those dental technology case photographs you have and potentially submit your best to DTA?
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eview your own photographic archive and find up to ten high quality photographs of dental appliance cases that you would be happy to submit.
● Add a short outline of what they show and send them to Rebecca Kinahan at Rebecca@dta-uk.org 1 They must be of a single case. 2 Your brief explanation should aim to spark some peer interest. 3 They must be your photographs and your submission gives the DTA the right to publish or not.
4 They must cover work that is addressed by the GDC’s relevant scope of practice for your registration.
DTS 2020 – working together for better dentistry Whether you are a dental technician, clinical dental technician, orthodontic technician or lab owner, DTS 2020 has you covered.
Don’t miss out! ● DTS 2020 – Friday 11 & Saturday 12 September – Hall 5, Birmingham NEC, co-located with the British Dental Conference and Dentistry Show. Register for free online.
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here will be two days of education tailored to each area of the profession. A particular focus will be placed on digital technologies in order to help delegates enhance their workflows. There will even be bespoke payment plans available through show partner MediFinance, making it easier for lab owners to invest in the solutions they need to drive their businesses forward. What’s more, there will be thousands of professionals in attendance, from fellow lab colleagues to dentists and trade representatives, encouraging improved collaboration and stronger professional relationships. After all, we work better together.
Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
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June 2020 | volume 7 | issue 2
Equipoise partial denture system and beyond By Tony Griffin P Standards for Dental Professionals
Aim:
● to reflect on the Equipoise partial denture system
CPD Outcomes: ● to provide an overview of the fundamentals of the Equipoise system ● to explain the basics of the Equipoise system ● to encourage interaction with the support materials provided ● to be aware of a proposed clasp modification
Development Outcome: C
Partial denture design and manufacturing has always been a fundamentally essential part of the dental technologist educational programme. The development of digital, additive manufacturing and flexible polymeric materials has, for some, revitalised the Equipoise partial denture system, but it requires the combined efforts of the oral healthcare team to achieve the necessary precision to satisfy the partial denture needs of patients.
MOTION
LOAD
FULCRUM Figure 1: Class 1 Lever
LOAD
MOTION
FULCRUM
artial dentures can be regarded as ‘trickier’ due to their inherent instability, which is why oral healthcare teams continually innovate designs, discuss techniques and implement new approaches. The desire to gain enhanced retention for removable partial dentures (RPD) has led to the development of complex designs using implants and/or precision attachments to provide further stability. Not all patients want or can afford extensive crown and bridge, or complex and timeconsuming invasive implant restorations. A simpler and less invasive approach that provides stability and aesthetics may need to be sought in order to meet the patients’ needs. Those who choose an RPD often want a stable and retentive prosthesis whilst not showing clasp arms and not being reliant on the complex advanced engineering associated with precision attachments. The Equipoise partial denture system aims to control and utilise masticatory forces in a novel and supportive manner. Rather than creating a Class 1 type lever effect, where the free end saddle (effort or load) rotates around the occlusal rest (fulcrum), and then applies a lift or crow bar effect (motion) via the clasp arm to the natural tooth (Fig. 1), the Equipoise design aims to use a Class 2 lever effect (Fig. 2).
Since 1946, when dentist Herman Goodman first proposed the idea of an Equipoise partial denture design, the fundamentals of the system have been developed and are still proposed by the Goodman family as appropriate today for RPD.1 A simple definition of the term ‘Equipoise’ is given as ‘an equal distribution of weight; even balance; equilibrium’.2 There are four particular partial denture designs that are proposed and are based on the following principles: ... continued on next page ...
Figure 2: Class 2 Lever
Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
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Equipoise partial denture system and beyond continued... a) providing guiding planes by creating flat proximal areas adjacent to saddle areas by removing around 0.5 mm of natural tooth surface in alignment to the path of insertion of the planned RPD b) creating occlusal support opposite the edentulous areas and also using anterior cingulum rests within sound tooth structure c) making space for proximal support between standing teeth for accurately fitting sections of the denture framework d) creating single arm clasps to engage the proximal undercuts adjacent to the saddle areas, such that the clasps are not visible on the labial aspects of the natural retained teeth. These are called ‘Equipoise’ or ‘E’ clasps by the authorities. The system attempts to create a very stable partial denture framework retained by clasps that are not visible and utilises rests in positions that create a Class 2 lever (Fig. 2). Therefore, the principle aims of the Equipoise Removable Partial Denture are to: 1. place the minimum strain on the abutment dentition 2. create more retention 3. provide improved aesthetics3 We present here what is freely available on the internet via YouTube as an overview into the Equipoise partial denture system. It provides members with an insight and reminder of the proposed methods used to
gain such extra partial denture stability and retention using a Class 2 lever. ● https://www.youtube.com/ watch?v=Bhiyv0DFc04 There are also various articles and books available on the internet on Equipoise denture design. Here is one article printed in Dentistry Today4 ● https://www.dentistrytoday.com/ prosthodontics/prosthetics/1724--sp586305325 There has also been a recent publication within the journal Decisions in Dentistry. This article looks at the use of rests and distal clasps on upper anteriors, which then creates a far more labial aesthetic view. This information was previously reported in the Journal of Prosthetic Dentistry in November 2009.5 These clasps use guiding planes and round-rest, distal depression (RRDD and thus being termed as R2D2) clasp design. Reciprocal support is provided by the mesial rest arm and retention by the clasp tip into the distal round formed depression (Figs 3a and b). The development of partial dentures with such R2D2 clasps are proposed as being: (i) relatively simple to design (ii) retentive and stable (iii) aesthetic
Figure 3a
Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
(iv) assistant in preserving the natural dentition (v) provided at a relatively low cost Along with the Equipoise principles, these R2D2 clasps should be worthy of consideration and can be incorporated into existing dental laboratory manufacturing methods and translate to digital manufacturing with their inherent higher degree of accuracy of final fit. ● https://decisionsindentistry.com/article/ alternative-esthetic-clasp-for-removablepartial-dentures-on-maxillary-incisors-orcanines/. 6 If you have found similar interesting design suggestions for RPDs, then please do make contact with the DTA and share your findings.
References 1 Equipoise Consulting – https://www.equipoisedental.com/about.html/. 2 Web-based dictionary – https://www.dictionary.com/browse/equipoise/. 3 Based on the web-based site – http://www.dentures.com.ph/equipoise-removablepartial-denture/. 4 Dentistry Today – Predictable Removable Partial Dentures Using Proper Design and Rest Preparations 2007, https://www.dentistrytoday.com/ prosthodontics/prosthetics/1724--sp-586305325/. 5 Journal of Prosthetic Dentistry 2009 – https://www.ncbi.nlm.nih.gov/pubmed/19853169/. 6 Decisions in Dentistry, April 2020 – https://decisionsindentistry.com/article/alternative-esthetic-claspfor-removable-partial-dentures-on-maxillaryincisors-or-canines/.
Figure 3b
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June 2020 | volume 7 | issue 2
Equipoise partial denture system and beyond – Development Outcome C – 45 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 The Equipoise denture system aims to create a Class 2 lever loading, that is:
Q2 The Equipoise system plans to ensure that the occlusal masticatory forces are:
a) b) c) d)
a) b) c) d)
Effort/Motion – Fulcrum – Load Load/Fulcrum - Effort/Motion Load – Effort/Motion – Fulcrum Fulcrum – Load – Effort/Motion
Distributed to the minor connectors Taken to loading along the long axis of the abutment tooth Transferred via the anterior occlusal rest to the adjacent teeth Taken by the alveolar areas of the saddles
Q3 There are four main designs for Equipoise partial denture designs and the third design for a tooth-borne case is:
Q4 A clasp tip in the Equipoise system engages the undercut on the:
a) One bounded posterior saddle with free end tips facing away from each other b) Two free end saddles with two anterior clasps c) One anterior saddle and one free end saddle d) One or two bounded saddles with free end tips facing each other
a) b) c) d)
Q5 Which one of the following is NOT true for the Equipoise system?
Q6 One other version of a novel clasping method called R2D2 uses:
a) Providing guiding planes by creating flat proximal areas adjacent to saddle areas by removing around 0.5 mm of natural tooth surface in alignment to the path of insertion of the planned RPD b) Creating occlusal support adjacent to the edentulous areas and also using anterior incisal rests within sound tooth structure c) Making space for proximal support between standing teeth for accurately fitting sections of the denture framework d) Creating single arm clasps to engage the proximal undercuts adjacent to the saddle areas, such that the clasps are not visible on the labial aspects of the natural retained teeth
a) b) c) d)
Mesial or distal of the natural tooth Palatal or lingual aspects of the natural tooth Available undercut under the prepared spoon rest seat area Buccal undercut of 20 thousands of an inch
Guiding planes Round-rest Distal depression All the above
IN YOUR NEXT 40-PAGE EDITION OF THE TECHNOLOGIST ...
● Digital feature ● Master ceramist feature ● Denture adhesives ● COVID and cleanliness ● And lots more … KEEP IN TOUCH WITH DTA
@DentalTechnologists Association
Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA call: 01242 461 931 email: info@dta-uk.org web: www.dta-uk.org
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