TT February 2017 by Dental Technologists Association

volume 10 issue 1 february 2017

issn 1757-4625

the

technologist the official journal of the dental technologists association

Happy New Year! In this issue: Getting to grips with MHRA Enter the digital technology world The use of removable devices

HOURS OF VERIFIED CPD PLUS 1 HOUR OF UNVERIFIED CPD IN THIS ISSUE!

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technologist in this issue Editor: Vikki Harper t: 01949 851 723 m: 07932 402 561 e: vikki@goodasmyword.com Advertising: Sue Adams t: 01452 886 366 e: sueadams@dta-uk.org

DTA administration: Sue Adams Chief Executive F13a Kestrel Court Waterwells Drive Waterwells Business Park Gloucester GL2 2AQ t: 01452 886 366 e: sueadams@dta-uk.org DTA Council: James Green President Delroy Reeves Deputy President Tony Griffin Treasurer Gregg Clutton Andrea Johnson Mike McGlynn John Stacey Gerrard Starnes Marta Wisniewska

Editorial team: James Green Tony Griffin Andrea Johnson Mike McGlynn

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dta column

hr facts: raising concerns

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business planning for 2017

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all change for dental devices regulation

the digital dental world: part one 11

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the use of removable appliances in place of fixed appliance therapy to treat an amateur boxer 13

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starting your own lab

dental technology showcase 2017 20 continuing professional development

Design & production: Kavita Graphics t: 01843 583 084 e: dennis@kavitagraphics.co.uk

Published by: Stephen Hancocks w: www.stephenhancocks.com

The Technologist is published by the Dental Technologists Association and is provided to members as part of a comprehensive membership package. For details about how to join, please visit: www.dta-uk.org or call 01452 886 366 ISSN: 1757-4625

Find out the 11 reasons to join DTA by visiting:

www.dta-uk.org the

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Views and opinions expressed in the publication are not necessarily those of the Dental Technologists Association.

Cost effective professional indemnity insurance for dental technicians and laboratories

Tel: 01634 662 916

2 february 2017

news&information ■ NATIONAL LIVING WAGE AND NATIONAL MINIMUM WAGE INCREASES From April 2017 the National Living Wage (NLW) for those aged 25 and over will increase from £7.20 per hour to £7.50 per hour. The National Minimum Wage (NMW) will also increase from April 2017 as follows: ■ for 21 to 24 year olds – from £6.95 per hour to £7.05 ■ for 18 to 20 year olds – from £5.55 per hour to £5.60 ■ for 16 to 17 year olds – from £4.00 per hour to £4.05 ■ for apprentices – from £3.40 per hour to £3.50 The government announced that £4.3 million is to be spent on helping small businesses to understand the rules and cracking down on employers who are breaking the law by not paying the minimum wage.

■ WINNER OF OUR CHRISTMAS TEASER We hope you enjoyed the teaser quiz in our December edition of TT. The lucky winner who receives DTA membership FREE for 2017 is Nick Tyler.

DTA’s John Stacey attends the All Party Parliamentary Group Reception at the Houses of Parliament. Image courtesy of BDA.

■ DENTAL LEADERS JOIN FORCES

TO KEEP ANTIBIOTICS WORKING

Organisations from across dentistry and other health sectors have come together to ask oral health professionals to support European Antibiotic Awareness Day and World Antibiotic Awareness Week by joining their social media ‘Thunderclap’.

he Faculty of General Dental Practice (UK), the British Dental Association and the Association of Clinical Oral Microbiologists, supported by Public Health England, the British Society for Antimicrobial Chemotherapy and the Antibiotic Action initiative, are asking their members to sign up at the Antibiotic Prescribing Pledge webpage and commit to help keep antibiotics working by auditing their management of oral and dental infections. The site will then post a message of support on their Facebook, Twitter or Tumblr profiles to help raise awareness among fellow professionals and the general public. Antimicrobial resistance is a global problem that leads to antibiotics no longer being effective in treating even simple infections, with serious consequences for everyone, but particularly those undergoing major surgery, chemotherapy, organ or stem cell transplants. Every year 25,000 people

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across Europe and 700,000 worldwide die from antibiotic-resistant infections, and the government predicts the annual global toll could be 10 million by 2050 – more than all deaths from cancer. In the UK dentists account for 9% of antibiotics prescribed in community healthcare. Auditing the management of dental infections can help reduce the number of antibiotics prescribed inappropriately – such as in response to patient demand, or in the absence of systemic signs of infection – and the FGDP(UK) publishes free online guidance to help dentists decide when they are required. A new audit tool for general dental practitioners, developed with Public Health England, will also soon be available on the FGDP(UK) and BDA websites. The organisations say that dentists can help their patients understand that for dental pain, dental care is usually a more effective treatment than antibiotics, and that when antibiotics are prescribed, taking and disposing of them responsibly can help fight the rise in antibioticresistant infections.

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■ WHEN WAS THE LAST TIME YOU VISITED YOUR SYSTEMS BACKUP? How robust is your business data? Have you considered the daily dangers that could put you and your business in jeopardy: encryption ransomware, data corruption, hardware failure, fire, flood, and other disasters, just to name a few. The causes of data loss are numerous and rarely considered until the unthinkable happens and it disappears.

ne of the most common reasons to restore from a backup is encryption ransomware. This malicious software typically infects a workstation through an email attachment and encrypts all of the data it can find on your local system and across your network, including servers.

no recourse but to throw her computer away and buy a new one. Thankfully we had all our data in Dropbox and a backup of all files, so once she had replaced her computer, we went back to a point before she had opened that innocent-looking email and repopulated her files with the lost data. Had we not had proper backup in place, everything would have been lost. So what can you do to ensure your backup procedures are robust? ■ Use multiple backup drives in daily rotation, plus monthly and annual backups. By having multiple time points from which you can restore data, it helps ensure data protection in case of disaster or corruption that goes unnoticed. ■ Always store the most recent backup drive offsite in case of environmental disaster, such as a fire or flood. ■ Add an offsite or cloud backup solution as a backup to the onsite backup. ■ Have at least three copies of your data: the original (your server), a local copy stored on a hard drive or other storage device, and an online storage service. ■ Check your backup software logs frequently to ensure they are running successfully.

DENTAL REGULATORS BACKS UK POSITION ON TOOTH WHITENING The organisation that brings together all European dental regulators has put out a statement backing the United Kingdom’s legal position on tooth whitening and endorsing its approach as the one to be used across Europe.

EDCAR – the Federation of European Dental Competent Authorities and Regulators – published a statement in November 2016 that stated that ‘in the interests of high standards of oral healthcare, and irrespective of the chemical products used, tooth whitening should only be provided under the supervision of a dental practitioner’. This statement goes some way to supporting the legal position in the UK, established in the High Court case of GDC v Jamous 2013, that tooth whitening is the practice of dentistry and therefore can only be performed by registered dental care professionals. The General Dental Council (GDC) has successfully prosecuted a number of illegal tooth whiteners since the High Court decision. The FEDCAR statement creates a European position on the issue – which it is hoped will improve patient safety across Europe. Victoria Sheppard-Jones, Interim Head of Illegal Practice at the GDC said: ‘This is great news for the dental profession and patients. It endorses the UK legal position that tooth whitening is a complicated and potentially risky procedure and as such can only be undertaken by a qualified dental professional.

Once encrypted, it is impossible to decrypt the files without purchasing the encryption key. Your only options are to restore from backup or pay the ransom. This exact scenario happened to a colleague recently. She opened an email that she thought was from me but was in fact a virus that spread immediately across her whole computer and all her files. There was nothing she could do but watch with despair as her screen was taken over by alien characters. She had

■ FEDERATION OF EUROPEAN

‘As always, we encourage anybody who is considering tooth whitening to check the register to ensure that the individual is legally allowed to do so before proceeding.’ the

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■ THE DTA COLUMN

Password for the DTA website changed on 1 February Look out for the new password on your 2017 membership certiﬁcate, mailed to you towards the end of January. Please be aware that any members who haven’t paid their subscription by the end of January will no longer have access to the members’ area of the website.

DTA Charity for 2017

Right Touch regulation

Thank you to everyone who voted in January to determine our charity for 2017. The overwhelming choice was Crisis www.crisis.org.uk.

Look out for the Department of Health consultation on Right Touch regulations. As soon as it’s available, we will post a link on the DTA website.

■ If you would like to undertake some fundraising for the charity or have suggestions on how DTA can support them, please get in touch with Sue Adams on 01452 886 366 or sueadams@dta-uk.org .

■ To ﬁnd out a little more in advance of the consultation, go to: http://www.profess ionalstandards.org.uk/what-we-do/ improving-regulation/right-touch -regulation .

Dental Professionals recognised in New Year Honours Congratulations to Professor Liz Kay who was awarded an MBE for services to dental education; Sarah Murray who was awarded an MBE for services to oral health; and Peter Heasman who was awarded a BEM.

Donate a £1 to Dentaid

letterstotheeditor From: J Gailes CPD Questions: A facial prosthetics case (materials & equipment) Comments: Fantastic article. From: S Grey CPD Questions: Case planning and guided surgery – it’s not the scan, it’s the plan (materials & equipment) Comments: I felt I had to comment on the other possible answers. They were poorly worded and didn’t represent appropriate answers in my humble opinion. From: S Carslake CPD Questions: Business planning and budgeting (verifiable non core) Comments: It is good to have a good cash ﬂow plan to make sure you have enough money coming in to pay money out.

Thank you to members who have chosen to donate £1 to Dentaid when paying their renewal fee. It’s too early to confirm the amount raised but we will be able to do so in the April edition of TT. A cheque will be presented to Dentaid at the DTS event in May.

Articulate e-journal Are you receiving Articulate by email? If not, let us know your current email address and we can add you to the mailing list. Alternatively, you can review each issue on the DTA website in the publications section. Each issue contains at least 30 minutes of CPD.

■COUNCIL OBSERVERS Do you have a passion for your profession? Would you like to get involved in the management of the DTA, but are not sure how?

If you have answered yes to these questions then why not come along to the next DTA Council meeting and meet the team, participate in the meeting and generally get to know what we do and how. ■ The next Council meeting will take place on Saturday 11 March 2017 in Gloucester. DTA will cover your expenses to the meeting (travel and hotel). Contact Sue Adams on 01452 886 366 for further details. the

technologist Keep in touch with DTA on Facebook and Twitter:

@DentalTechnologistsAssociation

@The_DTA

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hrfacts

■ Raising Concerns Standards for the Dental Team: Standard 8 Raise concerns about patients who are at risk ■ Educational aim: – to be aware of the GDC’s guidelines for whistleblowing as laid out in its Standards for the Dental Team ■ CPD outcomes: – to have an understanding of what the standard states with regard to whistleblowing – to be aware of your own rights with regard to being a whistleblower – to understand what is required with regard to implementing a whistleblowing policy in your lab and ensuring all team members are aware of what to do

In this article Richard Mander looks at whistleblowing within the context of professional registrants working within the dental industry. From the employee perspective he outlines your responsibilities as a dental professional and the protection offered to you when you report wrongdoing within the workplace. And, finally, as an employer, how can you ensure that you comply with current legislation in this important area?

Whistleblowing and the GDC

rincipal 8 of the GDC’s ‘Standards for the Dental Team’ is to ‘Raise concerns if patients are at risk’ and there is an expectation that all dental professionals will raise concerns or ‘whistle blow’ if patients or colleagues are at risk and will take measures to protect them. This applies to all dental professionals regardless of what role you have in the dental team.

Protection covered by law Whilst whistleblowing legislation emerged with high profile stories in the banking and care sectors, every employer has a legal responsibility to ensure that employees can make a ‘protected disclosure’ without fear of reprisal.

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The Public Interest Disclosure Act 1998 (PIDA) covers nearly all workers and employees in Great Britain. Designed to ensure that employees could raise concerns of serious wrongdoing whilst being protected from being treated badly or being dismissed, the Act was bolstered and broadened in 2013 with other supporting legislation.

What kind of things do I need to report? … generally, any wrongdoing relating to legal and ethical standards that comes to an individual’s attention through their work. Typically the concerns will relate to a danger or illegality or risk to another party. It’s not designed for handling relationship or personal problems within the workplace that should be managed via your grievance procedure if significant. From 25 June 2013 the Government introduced a public interest test and from this date only concerns that meet this test will give the whistleblower legal protection. ■ Further details can be found at www.gov.uk/whistleblowing .

Develop a policy As an employer or lab owner, it makes sense to have a policy in place to ensure that you deal with whistleblowing in the right way. It goes hand in hand with running an open and effective business to make all of your staff aware that you have such a policy in place and how they should use it. [A sample policy can be found on the DTA website in the members area.]

Practical guidance The best policies consist of a simple stepby-step guide to what your employees should do if they come across malpractice in the workplace. It’s helpful to include a few examples of the type of issues that might be included and a statement that they are unacceptable. Most issues can be resolved informally by telling someone with the authority to do something about it, so it’s important that people know who to speak to in the first instance. Generally this will be the supervisor or manager, but this can be a problem if they are the source of the concern, which is sometimes the case. Here, you should try to identify an the

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hrfacts independent resource that you can rely upon to investigate the matter that may well be yourself as lab owner or director. You need to make it clear within the policy that employees will not be penalised and make sure that this happens in practice. Finally, it’s really important to state that the issue will be managed in confidence.

Making it happen … so the policy will ensure that people know how to raise a concern, but you also need to make sure that if raised, concerns are dealt with effectively. Encouraging an open culture will ensure that the right kind of things get raised. A thorough investigation by an ‘independent’ person who ensures that they keep the whistleblower updated and informed of outcomes is also key.

Further advice and guidance ■ The General Dental Council has produced a detailed set of guidance on the subject of ‘raising concerns’, which can be found on their website at www.gdc-uk.org/Dental professionals/Fitnesstopractise/ Documents/Advice Also see http://standards.gdc-uk.org/ pages/principle8/scenarios/ scenario1.aspx

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Richard Mander Richard Mander is a freelance HR consultant with over 20 years’ experience. If you would like to ﬁnd out more about this topic or advice on other HR matters, you can contact him at www.manderhr.com 07715 326 568.

■ Business planning for Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to be aware of the statutory and other business deadlines in 2017 and to understand the beneﬁts of thinking and planning for the business year ahead ■ CPD outcomes: – to be aware of the statutory deadlines ahead in 2017 – to consider how to tax plan for the year ahead – to understand the beneﬁts and approach to planning for the business year ahead

As we welcome in 2017, it reminds us how important it is to plan for the business year ahead. This can be a combination of goal-setting, forecasting and meeting statutory deadlines. Adequate planning can contribute towards a fulfilling and successful year ahead. It offers an opportunity to stop and take a look around at where exactly you and your business are at the moment and where you would like to get to!

Statutory deadlines Tax return Whether you are self-employed or a director of a limited company, you need to ensure that your personal self-assessment return is filed with HM Revenue and Customs by 31 January 2017. Failure to do so will lead to an automatic penalty whether you owe any tax or not. If your return is still outstanding then make sure you are in a position to complete it yourself or give the information to your accountant as soon as possible.

PAYE If you have a PAYE scheme in place for your employees or yourself as a director of your own company, then the year end forms P60 will need to be given to all employees no later than 31 May 2017. The company summary form P35 needs to be filed with HMRC no later than the

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19 May 2017. If you or any of your employees receive any benefits in kind, such as company cars, private medical treatment, etc., then the forms P11D needs to be filed by 6 July 2017. Please ensure either you (if you deal with the payroll scheme) or your accountant has all the information required in good time to meet these deadlines.

Limited company accounts The year end dates for limited companies vary, so there is no one deadline that fits all, but please be aware of the following: ■ Companies House Your limited company accounts must be filed with Companies House within 9 months of your company year end date, so please make sure that you have all the information ready for your accountant in good time so they can get the accounts prepared in plenty of time. Failure to do so will lead to an initial penalty of £150 and increasing the later you are! ■ HM Revenue & Customs The company corporation tax return must be filed with HMRC within 12 months of the year end date and any corporation tax due should be paid within 9 months and 1 day of the year end date before it starts to incur interest.

Goals and targets The New Year provides an ideal opportunity to look around and assess where you currently are and where you would like to be in a year’s time and beyond. To remind you when you set goals, they should be SMART: ■ ■ ■ ■ ■

specific measurable achievable realistic time-oriented

What do you want to achieve this year? Get 5 more customers? Establish a better

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customers to ensure your margins remain healthy and competitive. 4. SWOT analysis – It is always useful to carry out a SWOT analysis, which stands for strengths, weaknesses, opportunities and threats. 5. The goals you raised earlier would also be included in your business plan and also your financial forecasts for the year ahead.

Adequate forecasting bus in will help you & bess pla udg nn plan spending etin ing g and borrowing for the year ahead and if you feel ill-equipped to do it yourself, then enlist the help of your accountant.

Tax planning Forecasts for the year ahead

online presence? Whatever it is, you need to make a note of your goals and what steps you need to take to make them happen and then review your progress on a regular basis.

Review and update your business plan If you have prepared a business plan before then this is an ideal time to review it to see where you are now in relation to where you had hoped to be. If the plan needs changing or updating in light of knowledge you may be aware of now but weren’t when the plan was prepared, then do it now and adjust your business strategy accordingly. If you haven’t prepared a business plan before then consider doing it now! It’s a great way of focusing on where you are now and exactly what you need to do going forward to achieve your goals. A good business plan will make you look at the following areas of your business: 1. The competition – What are they doing well and where are they weak? What can you learn and what can you take advantage of? 2. The market – Review where you are and where you can increase your market share. What marketing is working for you and what isn’t? 3. Review your products and services looking at the costs you are incurring and the price you are charging your

I have talked about forecasting in previous articles, so I won’t go into any detail here, but it is always good practice to attempt to produce a budget/forecast for the year ahead. This makes you think about what you want to do and achieve in the year ahead and whether there will be any financial barriers to these aims that need to be thought about, such as financing requirements for any expansion plans or acquiring up-to-date machinery and equipment. Typically, two forecasts are needed, namely a profit forecast and a cash flow forecast. 1. Profit forecast This is your forecast of your sales for the next year, less all the costs be they direct costs or costs of overheads, such as rent and rates, stationery and advertising. 2. Cash flow forecast This is your best estimate of likely movements in your business bank account over the next year. This will require you to estimate when customers will pay you and when you will have to pay your suppliers, VAT, PAYE, tax and general overheads.

When it comes to maximising your tax efficiency then have a chat with your accountant or tax adviser in good time so they can help you make crucial choices over how to maximise use of your personal allowances and tax rate bands. This would require having a chat well before the tax year end date of 5 April, so any necessary changes can be implemented and then a plan made for the next tax year well in advance. Your tax advisor can also help you consider the timing of purchasing new equipment and machinery to maximise the tax benefits. Typically this would mean purchasing planned equipment upgrades just before either the year end date if you are a limited company or before the tax year end date of 5 April if you are a sole trader, but it is best to speak with your own advisor to make sure what is best in your specific position. Taking time out to review your plans and goals could make all the difference between an average year and a great year, so make a start today! ■ Visit the member’s area of DTA website to access templates for Profit and Loss Forecasting, Cash Flow Forecasting.

About Peter Blake Peter Blake is a chartered accountant, business coach and master practitioner of NLP. He has his own practice based in Wiltshire, lectures on ﬁnance and mentors new business start-ups for Gloucestershire Enterprise Ltd. For further details, contact Peter on 07912 343 265 or email peterblake@pbcoachingandtraining.com the

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dentaldevicesregulation

■ All change for dental devices Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills

Edmund Proffitt, Policy & Public Affairs Director at the BDIA, brings us up to speed with the EU Medical Devices Regulations that will have a significant impact on dental devices regulation for years to come, wherever Brexit takes us.

■ Educational aim: – to be aware of the latest requirements for meeting EU Medical Devices Regulations regardless of the UK’s exit from Europe

Own brand labelling becomes virtual manufacturing

■ CPD outcome: – to have a better understanding of the main issues and changes impacting dental device regulations

As we move towards the introduction of the MDR, the MHRA has adopted the language of the new regulation, with own brand labelling (OBL) no longer being recognised as a term, being replaced by ‘virtual manufacturing’ (VM).

Whatever the eventual outcome of Brexit negotiations, it is a very safe bet to assume that the ‘new’ medical devices regulations (MDR) will form the backbone of the UK regulatory regime for medical devices for many years to come. Consequently it will have a significant impact on all those companies manufacturing and selling dental devices in the UK. Here’s a summary of some of the main issues and changes:

All sellers of VM products take on the full manufacturer’s responsibility for that product and are thus required to possess the FULL technical files for the VM products sold. To this end the MHRA has recently provided new guidance on VM activity.

legislation will be adopted in one form or another into UK law as the basis of UK device regulation.

The final text & implementation

ith the publication of an ‘agreed’ text of the medical devices regulations (MDR) over the summer of 2016, we are now in a position to start thinking about the steps that will have to be taken to implement this new legislation. The regulations emerging from the European Parliament and the European Council run to nearly 360 pages, and it will still take some time before there is a comprehensive understanding of what it all exactly means and the impact of every one of the changes that the new legislation brings. Implementation will start from early 2020, when the UK may have left the EU, based on the current timetable of the MDR entering into force in May/June 2017, with 3 years for full introduction. It is highly likely that pretty much all of this

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With the introduction of the MDR, notified bodies (NBs) can apply to be designated under the new regulations 6 months after it enters into force e.g. late summer 2017. From that time companies can place products on the market under the requirements of the new MDR if they are certified as such by their NB and the last date that any product can be certified under the ‘old’ requirements is 3 years after the MDR entered into force (i.e. Q2 2017). That product registration could last for five years, so products could technically still be sold under the old legislation until c. 2024/5. However a phase over to certification under the MDR is anticipated to gather momentum towards the end of 2017 and when current certification expires.

As far as the current guidance states, in the case of ‘virtual’ manufacturing where the manufacturer does not hold the rights related to product design, the notified body may accept a technical file from the virtual manufacturer that has redacted proprietary information. This may occur as long as the redacted information is not essential for the purposes of the notified body assessing whether the device complies with the regulatory requirements. Redactions should be as limited as possible. In cases where the virtual manufacturer holds redacted technical documentation, they must have contractual arrangements to ensure full disclosure of all applicable information by the original equipment manufacturer (OEM) directly to the notified body of the virtual manufacturer (without the further need for agreements to be put in place between the notified body and the 3rd party (OEM)).

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regulation The following may constitute proprietary information: ■ Unique material formulas or ingredients which are specific to the device and not in general use which are of high commercial and intellectual benefit to the OEM ■ Unique manufacturing processes which have been designed by the OEM and give them a competitive advantage in the marketplace ■ Technical drawings and technologies (applicable where a patent is also being applied for) but not yet granted ■ Software algorithms For a ‘distributor’, Article 14 makes it clear that where a distributor or importer enters into an agreement with a manufacturer whereby the manufacturer is identified as such on the label and is responsible for meeting the requirements placed on manufacturers in the regulation, the distributor does not assume the obligations of the manufacturer.

Nanomaterials A new version of classification Rule 19 states that medical devices incorporating or consisting of nanomaterial are in Class III if they present a ‘high’ or ‘medium’ potential for internal exposure; in Class IIb if they present a ‘low’ potential for internal exposure and in Class IIa if they present a ‘negligible’ potential for internal exposure. Unfortunately it currently remains far from clear what the definition of ‘high’, ‘medium’, ‘low’ and ‘negligible’ will actually be and until there is some clarification on this by the EU and MHRA, this will remain a grey area. There are concerns that if suitable definitions cannot be agreed, items like alginate impression materials could become Class III medical devices. The dental industry is working with the relevant bodies to try and avoid this and similar situations arising.

Reusable surgical instruments These will remain in Class I, but there will be a requirement for notified body (NB) involvement which will be limited to the aspects related to the reuse of the device, in particular cleaning, disinfection, sterilisation, maintenance and functional testing and the related instructions for use.

The establishment of the database, like most major cross-border IT programmes, is proving to be challenging. The current text requires the UDI to be on the label or package, not the device, which makes it easier to comply. Obviously Brexit discussions will influence any future relationship that the UK may have with the Eudamed database.

Implant cards Dental fillings, dental braces, tooth crowns and screws are amongst devices exempted from the requirement for manufacturers of implantable devices to provide an implant card with described information to the patient.

Implementation of UDI (unique device identification) This requirement is expected to increase the ability of manufacturers and competent authorities to trace specific devices through the supply chain, and to facilitate the prompt and efficient recall of medical devices that have been found to present a safety risk. In addition, the European Database on Medical Devices (Eudamed) should provide more efficient access to information on approved medical devices.

Hazardous materials: nickel, chrome and cobalt … The text states that devices shall only contain in a concentration above 0.1% weight by weight: i) Substances which are carcinogenic, mutagenic or toxic to reproduction of category 1A or 1B, in accordance with Part 3 of Annex VI to Regulation (EC) No. 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures. This approach should hopefully exclude alloys that should avoid the problems of nickel in stainless steel instruments and nickel tungsten wires, and chromium in stainless steel the

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Or ii) Substances having endocrine disrupting properties for which there is scientific evidence of probable serious effects to human health. Manufacturers of restorative materials containing bisphenol A dimethacrylate might be advised to check the level of bisphenol A impurity, although it is likely that it will be well below the 0.1% level.

More stringent clinical evidence The MDR will require device manufacturers to conduct clinical performance studies and provide evidence of safety and performance proportionate with the risk associated with a given device. Device manufacturers will also be required to collect and retain post-market clinical data as part of the ongoing assessment of potential safety risks.

Post-market oversight The legislation will grant NBs increased post-market surveillance authority. Unannounced audits, along with product sample checks and product testing, will strengthen the enforcement regime and help to reduce risks from unsafe devices.

Another new acronym A new body, the Medical Device Coordination Group (MDCG), composed of persons designated by member states, will be set up to contribute to the conformity assessments of NBs in particular for certain Class III and Class IIb devices.

General obligations of market actors – ‘economic operators’ The legislation clearly sets out the general obligations of the ‘economic operator’ i.e. the

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the manufacturer, the authorised representative, the importer, the distributor and the person responsible for regulatory compliance. This is a new requirement of the MDR not found in the current legislation.

Single use devices Reprocessing may only take place where permitted by national law and the reprocessor has to take on the obligations of the manufacturer unless it is a health institution or a reprocessor acting at the request of a health institution. In these cases it is incumbent on member states to ensure that safety and quality are maintained and process validation, risk management and product release quality management are in place. The Commission will prepare a list of single use devices for which

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and chrome cobalt denture alloys. We still require some further information on this and it is anticipated that the European Commission will be issuing guidance, although there are no details as to when.

reprocessing will not be permitted in any circumstances and this article will be reviewed after four years.

More work required … As we move closer to implementation of the MDR, more detail of the regulations, along with further clarification, will come in the form of delegated acts which will be much more specific so the final impact will only become clear once these are enacted. Fifteen acts are required immediately and a further fourteen are critical to the regulation process. Lastly, we cannot be sure what the final shape of any eventual UK legislation will be, but all EU devices will be subject to this legislation, and all UK manufactured devices destined for the EU will have to comply.

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dentaldigitalworld

■ The digital dental world: Part one

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The Technologist launches a series of articles looking at the development of the digital dental world. This issue considers 3D printing and CAD/CAM. Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills

m & e ateria quip ls men t

■ Educational aim: – to gain an overview of computer-aided design (CAD) and computer-aided manufacturing (CAM / 3D printing) ■ CPD outcome: – to gain an understanding of computer-aided design (CAD) and computer-aided manufacturing (CAM / 3D printing) – to be aware of the changes in the UK dental technology workforce and the growth of CAD / CAM in dentistry

ne of the most exciting technologies taking centre stage in the dental arena is 3D printing – or additive manufacturing – which builds up items by depositing materials layer by layer. The technology can create and replicate objects with an intricacy of detail that some other manufacturing methods fail to achieve. The advantages for dentistry are that replacements can be created that match the exact grooves and curves desired in restorations with increasing precision. CEO for 3D printer manufacturer XYZprinting, Simon Shen, has said that 3D printing is not just changing dentistry ‘but taking it to a whole new level of personalisation’. He said, ‘Already hailed as a hugely disruptive technology in the manufacturing, engineering and retail sectors, 3D printing is reshaping the way dentists approach personalised care. ‘Of course the ability to create a tooth while a patient waits in the dental chair has been around for 30 years. For decades, dentists have been able to mill new teeth, crowns and veneers from a

piece of porcelain or zirconia, using scanners and 3D modelling software. Now, however, the 3D printing revolution is taking this service to a whole new level of personalisation.’ Research and Analysis has recently published a new 140-page report showing where the money will be made in 3D printed dentistry. This report estimates that revenues invested in 3D printers and related software, materials and services by the global dentistry sector in 2016 reached $1.6 billion, and predicts that sum will grow to $3.7 billion by 2021. And it doesn’t stop there. Original research published in 2015 estimated the dental 3D printing market to be worth just over $700 million. Since then, and as industry researchers predicted, the levels of 3D printing in dentistry have exploded. Some of the world’s largest dental solutions providers now market their own specialised 3D printers. Meanwhile, low-cost 3DP technologies have begun to catch the attention of dental laboratories and individual dentists, bringing 3D printing

ever closer to the dental patient. Current forecasts now estimate that by 2023, just six years away, 3D printing in the dental arena will be worth as much as $4.3 billion. New developments are also afoot using biocompatible printing materials. The Technologist will report further as more information becomes available.

CAD/CAM As part of his presentation, ‘The advancement of digital dentistry in the lab’, during the Henry Schein Digital Symposium in early 2016, Ashley Byrne from Byrne’s Dental Laboratory, Oxfordshire, told his audience of technicians that CAD/CAM had ‘revolutionised his laboratory and enabled him to increase the number of crowns they make on a daily basis, without needing to increase his workforce’. Ashley highlighted some of the problems facing laboratories globally. He said that the US has seen a more than 40% decline in the number of dental technicians since 1980, with 4000 laboratories closing in 2012 alone, plus it is forecast that 50% of all American the

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laboratory owners are due to retire in the next five years. In the UK the number of GDC-registered dental technicians has dropped from just under 7500 to just over 6000 since 2008. And yet an increasing elderly population will see the demand for dentures, implants and other dental devices grow. Six per cent of the UK’s adult population, some three million people, are currently edentulous. By 2020 it is forecast that the largest population of edentulous people will be in Europe, a fact driven by the huge influx of migrants and refugees from countries with less sophisticated oral healthcare. How can fewer technicians meet the spiralling demand? CAD/CAM is now a factor in about 92% of all dental implant, crown and bridgework, and in Ashley’s opinion the solution lies in utilising the latest CAD/CAM technology in the lab to improve profitability by reducing costs, increasing predictability and increasing reproducibility, while also increasing and simplifying the treatment options available. Using CAD/CAM technology has enabled him to change the tools he uses, but not at the expense of any design principles. It has enabled him to increase his laboratory’s production rate and improve the quality of his team’s work, and to do so much faster than traditional methods with a greater focus on aesthetics. Once the model has been scanned, Ashley’s team uses GC Aadva Lab Scan –

a fully automated and open system lab scanner using a high-end dual camera system with blue LED structured light in combination with GC’s scan technology powered by exocad – they can use CAD/CAM to create diagnostic wax-ups without ever having to pick up a wax knife. Once created they are stored on exocad design software where they can be modified in a matter of minutes if required. Blue light scanning technology and 3D modelling software have revolutionised the workflow in the modern dental laboratory. For example, Evodental, with practices based in Mersey and Heathrow, only places full arch implant-retained restorations. Its in-house dental lab, called Evolab 3D, brings the latest CAD/CAM technology into play – including Medit Dental’s Identica Hybrid blue light 3D scanners and Roland DG’s DWX range of 5-axis table top milling centres. Its skilled technicians are just as much at home in a virtual lab as they are at the workbench, and every organic-looking substructure mounted onto the carefully positioned implants is bespoke designed to match the ‘landscape’ of the patient’s jaw.

The Evodental team don’t talk about dentistry; they talk about bioengineering. They can create abutments perfectly contoured to the patient’s mouth with a taper set for optimum retention. The Medit Identica Hybrid scanner used by Evodental is one of the most advanced in its class. Its scanning technology allows it to read directly into a dental impression and make a virtual model in its software. The time saved by not making a model speeds workflow, increases turnover and goes some way towards providing the answer to how fewer technicians might meet the needs of an increasing number of needy dental patients. And digital dentistry is not just about lab scanners. For example, Hungerford-based Mint Dental Laboratory is an almost purely digital lab. Partners, Ben Page and James Hanks, who founded the lab in 2011, prefer to work directly with intraoral scans provided by dentist clients. Utilising a library of anatomies and other aspects of CAD/CAM, the lab provides a full-service output of implant, crown, and bridgework without ever needing to see a model. They are at the very cutting edge of digital workflow, working with STL files emailed from the dental surgery’s chairside scanner to their lab. Clean and consistent workflow results. ■ In the next article we open out the world of digital dental technology to consider some aspects in more detail.

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■ The use of removable appliances in place of fixed appliance therapy to treat an amateur boxer By Andrea Johnson Andrea Johnson BSc (Hons), LOTA, MDTA. Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to demonstrate how different dental professionals can pool their knowledge and skills and work together as a team to get the best possible treatment outcome for the individual patient’s needs. ■ CPD outcomes: – to become more aware of how your knowledge and skills are of value to the entire dental team – to become conﬁdent enough to put your opinions and suggestions forward to achieve the best possible treatment outcome for your patient

1. Abstract

best possible orthodontic result. It is about accommodating the patient’s wishes and needs at that particular time in their life. This case report looks at a patient with a Class II division 1 malocclusion with impacted canine whose parents stated he could not be fitted with fixed appliances, as he was a promising boxer. The Amateur Boxing Association of England (ABAE)1 regulations state in regard to fixed appliances ‘It is the preferred option that boxers have a letter from the orthodontist confirming that they are allowed to box. Ideally a discussion should be held with whoever fitted the brace to see if boxing is possible’. This is because playing contact sports increases the risk of a dental injury and the risk is increased

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even further if the patient is m wearing fixed & e ateria quip ls orthodontic men t braces. Newsome, PRH, Tran, DC and Cooke, MS state that ‘Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances.’ 2 The patient’s parents felt boxing took precedence at that time. This case report looks at both the patient’s orthodontic needs and the patient’s wishes and describes the compromise reached.

This is a case report about an amateur boxer with a Class II division 1 malocclusion with impacted upper canines. Regulations preclude the use of fixed orthodontic appliances during a contest unless the boxer has a letter from their orthodontist. This patient was treated with removable appliances to improve the alignment of the teeth and the bite. The design and construction of the removable appliance are described.

2. Abbreviations URA – Upper Removable Appliance 3. Introduction Providing the best treatment possible for patients isn’t always about achieving the the

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removableappliances 4. Case report This appliance has been prescribed for a 12-year-old male patient who presented with a Class II division 1 incisor relationship with moderate crowding in the lower arch and severe crowding in the upper arch. The upper right canine was displaced buccally and the upper left canine was impacted palatally. The upper right second premolar had a large restoration. In occlusion the overjet was increased at 7.5 mm and the overbite was average and incomplete. The centrelines were coincident with the facial midline and each other. There were no crossbites; the molar relationship was a full unit, post normal bilaterally. Radiographic examination confirmed the presence of all permanent teeth, including all four third molars. The upper left canine was palatally placed.

The treatment prescribed by the consultant orthodontist was as follows:

5. Appliance design and construction

1. Relief of crowding with the extraction of both of the lower first premolars, the upper second premolar and the upper left canine 2. Growth modification with modified Twin Block functional devices 3. Upper and lower fixed appliances to detail the occlusion

5.1. The design of the modiﬁed Twin Block constructed for this patient by the author

However the patient was a county level competitive boxer and his parents did not consent to the fixed appliance state of treatment so the treatment plan was modified to an upper removable appliance (URA). The patient and his parents were fully informed that this was a compromise treatment plan and that he could have fixed appliances placed at a later stage in his life if he stopped boxing competitively.

Retentive components ■ Adams cribs to the upper right first molar, upper left first premolar and first molar and to the lower first molars ■ Ball hooks between the lower central and lateral incisors Active components ■ Midline expansion screw in the upper appliance ■ Acrylic blocks with advancement screws in the upper blocks ■ Palatal finger spring to retract the upper right first premolar

Fig. 1: Photographs of appliance in situ: a. Right buccal view b. Maxillary occlusal c. Left buccal view d. Lower occlusal

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the bridge of the Adams crib on the upper right first molar. The orthodontist agreed that this design would be a suitable solution and agreed to the alteration of the prescription. This approach to designing the appliance combines the clinical knowledge and skill of the orthodontist with the technical skill and material knowledge of the technician. It demonstrates how a close working relationship between the clinician and their team can benefit the patient.

6. Results and discussion

Fig. 2: a. Completed URA on model – palatal view b. Completed URA – buccal view right hand side

5.2. Design of the URA At the end of the growth modification stage the patient was fitted with a URA. The original prescription for this appliance was for a midline expansion screw to continue the expansion of the upper arch, a palatal finger spring to retract the upper right first premolar and a second palatal finger spring to retract the upper right canine once the upper right first premolar had been retracted. A Z spring would be used to push the upper right lateral incisor into position once the upper right canine had been retracted. However, once the author had cast up the initial working model, she felt that a palatal finger spring to the canine would not be ideal, as it would have to cross

from the palatal area over the saddle area and then up into the buccal sulcus in order to reach. This, she felt, could impair the function of the spring due to its length and cause irritation to the patient’s soft tissues through rubbing when activated. She also felt that the spring would potentially cause an obstruction to the upper right lateral incisor, as the wire would be in between the lateral incisor and canine. With these considerations in mind the author approached the prescribing consultant orthodontist to express her concerns and to offer an alternative design which replaced the finger spring with a buccal canine retractor soldered to

The main concern for this patient and his parents was that he would be able to continue his promising boxing career whilst undergoing orthodontic treatment; however, they were aware that there was an increased risk of dental damage and wished to find a suitable compromise. They discussed these requirements with their consultant orthodontist who agreed to a treatment plan using removable appliances only. However she advised them that the best treatment outcome could not be achieved with removables only and that the patient may continue into a fixed treatment stage at a later date if they so wished. The consultant orthodontist prescribed a series of removable appliances and after discussion with the author agreed on the appliances described in this case study. The reasons for the design modifications are described. When constructing this upper removable appliance the author had to consider the

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each of the required components and its operation to ensure that no one component conflicted or interfered with another, for example, the clasp arm on the mesial of the upper right first molar had to be kept high enough that it would allow the contact points of the first molar and first premolar to eventually meet without gagging the bite open. The ideal alternative to the removable appliances which have been prescribed for this patient is a fixed appliance; these are made up of brackets that are temporarily stuck onto each tooth. A flexible wire runs through the brackets in

each arch and allows the teeth to be moved into the correct position. The patient would still have needed to have his overjet reduced with a functional appliance such as a Clark Twin Block or similar but would have then been able to move on to the fixed appliance therapy, which according to his prescribing orthodontist, would have been able to correct his malocclusion much more quickly, efficiently and completely. The complications of the patient being involved in a contact sport could have been minimised by the wearing of an orthodontic mouth guard as ‘… it is

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important for anyone with a brace to wear a mouth guard over their fixed brace to avoid a laceration to the mouth from the brace; to avoid damage to the brace; and to prevent injury to the teeth.’ 3 An example of an orthodontic mouth guard designed to fit over fixed braces is the OproShield which ‘act like shock absorbers by spreading the force over a larger area, and increasing the time for the force to dissipate.’ They are also designed ‘with a cross-sectional profile which means maximum protection against front and concussive blows whilst keeping the palate clear for improved breathing and speech.’ 4

7. Conclusion The treatment for this patient has been complicated due to his sporting activities and his parent’s reluctance to allow fixed appliances to be used; however, at the end of this phase of active treatment the patient still had an improved occlusion and better aesthetics through the use of the removable appliances. He can opt for fixed appliances at a later stage if he so wishes. The case also demonstrates how effective teamwork and communication between the clinician and technician can benefit the patient to ensure the best treatment outcome possible.

8. Bibliography

Fig. 3: Photographs of appliance in situ a. Palatal view b. buccal view right hand side

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1. England Boxing 2015, ‘Orthodontist braces’ [Online] Available: http://www.abae.co.uk/aba/index.cfm/the -rules-of-boxing/medical/orthodontist-braces [Accessed 25 March 2015]. 2. PRH Newsome, DC Tran and MS Cooke 2001, ‘The role of the mouthguard in the prevention of sportsrelated dental injuries: a review’, International Journal of Paediatric Dentistry, vol. 11, no. 6, pp. 396–404. 3. British Orthodontic Society 2011, ‘Playing Safe – mouthguards for contact sports’ [Online] Available: http://www.bos.org.uk/orthodonticsandyou/orthodontics forschools/playingsafe [Accessed 1 January 2012]. 4. Orthoshop [Online] www.orthoshop.co.uk. Available: http://www.orthoshop.co.uk/acatalog/Mouth_Gards .html [Accessed 2 January 2012].

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startingyourownlab

■ Starting your own Lab Why did you want to start your own lab?

The Technologist’s Editor Vikki Harper interviews dental technician, Petr Mysticka, to discover why and how he launched his own lab. .

I adore the creativity of my job – imitating nature is my challenge. Every patient is different, every case needs a different approach and every day presents new learning opportunities.

he smile of my happy patients makes me very happy. I appreciate good interaction between my role as a dental technician and the dentists I work with – this is very important, as good communication is the key to successful working partnerships in providing high standards in dentistry. I am really glad that lots of good dentists treat dental technicians like a partner and not like someone who just makes crowns or dentures. After my success at the Aesthetic Dentistry Awards, I received a lot of interest in my work from many dentists. This was the opportunity that motivated me to start my own dental lab. I had never run my own business before, so starting by myself was an enormous step to take, especially as I had only been living in the UK for a little over two years. I discussed the new business with my partner, Duncan Jones, who also runs a marketing design business. We formulated a business plan that drew on our individual skills: I would focus solely on the dental work and case study photography and leave the brand, marketing strategy and overall running of the business to Duncan.

What was your vision? Our ambition is to build a well-known UK dental laboratory known for high quality dental products and services. Our short-term business goal is to secure a sound relationship with our dentists and sustain the business while reinvesting in more equipment. Long term, the aim is to

own a state-of-the art dental studio with a highly qualified team providing the best dental work in the UK. After one year of trading, we are now ready to expand our workforce. There is a new generation of dentists in the industry that are very motivated and dynamic. There is a huge potential for these high quality dentists to grow quickly if they secure the support of a good dental laboratory that shares their ethos and our aim is to be their partner in the achievement of that goal.

How did you determine where your lab was situated? PM Dental Studio is located in the City of Brighton and Hove, East Sussex. Our lab is adjacent to Hove Train Station and that has obvious transport link advantages. Brighton and Hove is relatively central to the south-east, which would have logistical advantages when travelling to clients. There are also excellent travel links to London and the rest of the UK. Aside from this, Brighton is our hometown!

Did you do a business plan to present to a bank or to keep you on track? It sounds cliché, but we literally started with a ‘back of an envelope’ plan, but writing a comprehensive business plan was vital in setting up the lab. By following a planned structure we were able to ensure that we gave thought to every aspect of the business. Even with this in place, we are still finding aspects of our business we hadn’t expected. Having been trading for just over a year, the original business plan makes a useful document for reviewing the business to see where we started, where we thought we would go, what objectives we have met, and what new objectives we want to achieve.

How did you finance the set-up of the lab? We had a certain amount of personal financing but the bulk of our set-up costs were funded by a bank loan – another the

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power ceramics and IPS Ivocolor stain and glaze. We have recently invested in the world’s leading CAD system by 3Shape. This allows us to receive digital scans from dentists using the TRIOS intraoral scanner.

How did you go about getting clients from the day you opened? Our use of dental networking and social groups meant we could target market clients that had already expressed a strong interest in our work. reason to have a comprehensive business plan in place! The bank asked a lot of questions about the business and we needed to ensure we had evidence to show how we would cope with potential pitfalls. The company borrowing, combined with personal funding, would cover equipment, start-up costs and initial low revenues in the first months of operation.

Do you have financial (and other) targets and are they supported by a financial plan? Our business plan had specific financial targets mapped out, which we have used to measure the success of the business in

the first year and to plan our ongoing financial targets. Cash flow is key so accurate monitoring of revenue and expenditure allows for financial planning to ensure we can reinvest in the business to meet our revenue and expansion targets.

How did you determine how to kit out your lab? What equipment did you choose and how did you make that decision? We opted to purchase the best equipment available. Anything less would compromise quality. Clearly there are budget constraints with any new business, so we began with the essential equipment that underpinned the products we planned to focus on – crowns, bridges, complete reconstructions, veneers and implants. With careful planning we are able to build our asset base as cash from planned profits becomes available. So we have taken a step approach, generating revenue from our initial investment in order to purchase additional equipment that supports ongoing growth. As an opinion leader for Ivoclar Vivadent, I use the whole range of their products, from the porcelain furnace to the new

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We felt it was important from a business perspective to be active on Facebook and Twitter. While social media has obvious marketing advantages, it also allows us to keep up to date with our colleagues’ businesses and trends in the industry. By posting case studies and high quality images of our work, we opened a dialogue with colleagues in the industry. Discussion, exchange of ideas and being at the forefront of developments in the industry allow us to build stronger relationships with our dentists. Articles in national publications that feature our award-winning cases give a valuable opportunity for us to give our opinion on the future of dental technician work, which has been well received in the industry. This has allowed us to engage with many potential clients from the outset.

Tell me about your brand? As already mentioned, we came about because there was a demand for the high standard and award-winning work that I produce. To that end, I am the brand. My reputation and recognition, in the UK and across the world, was the foundation for the design and development of our brand. Duncan’s marketing design background, which has included the rebranding of

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many dental clinics, has meant that the design and production of our marketing materials has been of the highest quality to complement the quality of the products we produce and the market we are operating in. When we set up the company our brand logo contained the words ‘Petr Mysicka’, so that we could instantly build on Petr's reputation. Now that we are on our way to being established, we have simplified the brand logo to PM Dental Studio whilst retaining the visual engagement of the original brand logo – in other words we have evolved the design of the brand to retain customer engagement. We constantly ask ourselves what our brand says about us. It is key in the development of our business and includes everything, from the first impression of our business cards, through to the exacting standards of dental work, the service we offer our dentists and the experience of our patients. As with every growing business, the engagement of our customers with our brand is extremely important to our ongoing success. We have received a lot of positive feedback about the look of our brand and the ethos it conveys.

needed to revise our business plan several times to review cash flow forecasts and expected sales revenues. We started with a totally blank canvas. We had to decide on everything – equipment to purchase, furniture, layout of the lab and working processes. We mapped out a basic set-up plan, but if we are honest we just rolled up our sleeves and got on with it.

You have just won two awards. Tell us how you feel about such great early recognition.

Anything else? Good symbiosis between dentist and dental technician is essential in creating outstanding results. This is key in establishing good ongoing working relationships to maintain the valuable reputation of the dentists with whom we work. The service we provide is individually tailored to each dentist. Through good collaboration we improve the level of dentistry we provide to our patients.

Absolutely delighted! We entered the National Laboratory Award in four categories and were short-listed in all four.

Excellent customer service goes without saying, whether it is following up with dentists after sending out work or taking teeth shades from a patient. Make everyone feel special!

That in itself was a major achievement for us as a new business, but to win Best Implant Laboratory and Best Crown & Bridge Laboratory was amazing.

For us, good quality dental work and uncompromising high standards in providing first class dentistry must prevail at all times.

It’s very important to have good feedback from our patients but to have it from a panel of judges is just brilliant and we are both extremely proud of what we have achieved in such a short space of time.

Contact details: ■ ■ ■ ■

petr@pmdentalstudio.com www.petrmysicka.com www.facebook.com/pmdentalstudio Tel: 01273 757 697

What surprised you about what is involved in setting up your own lab? Setting up our laboratory has been a step into the unknown. It has been a very steep learning curve and continues to be so. Our first big ‘win’ was securing funding from the bank. This was not an easy task and was new territory. Working with our accountant and the bank manager, we the

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■ Discover the latest in implant-retained The rapid growth in popularity of dental implants has been widely attributed to the impact they can have on a patient’s quality of life. For fully or partially edentulous people, implant therapy offers a fantastic solution, restoring function and aesthetics of the smile while also significantly improving selfconfidence.

s the demand for dental implants has increased, the technologies and techniques used for both the surgical and technical processes have advanced as well. Today, dental technicians have access to a huge armamentarium of cutting-edge products and software that facilitate the creation of outstanding restorations. Professionals are able to design and manufacture everything from custom abutments to specialised implantretained bridge frameworks and double structure removable prostheses with the utmost accuracy, ensuring predictability and longevity of treatment for a wide range of patients. Currently exploring and lecturing on the topic of double structure removable

prostheses is Mr Eugene Royzengurt. He has been working in the dental industry since 1996, beginning as a dental assistant and later becoming an in-house laboratory technician, specialising in removable prosthodontics. Mr Royzengurt’s education includes an Associate’s Degree and certificates in Dental Assistance and Radiology. He is also currently pursuing a degree in Denturism. He has published several peer-reviewed articles on the subject of removable prosthetics and currently lectures in the United States and internationally. Mr Royzengurt has been a member of the Dental Technicians Guild since 2013. He currently resides in Sandy, Utah, where he owns Apple Dental Laboratory L.L.C. Eugene will be speaking at the Dental Technology Showcase (DTS) 2017, delivering a lecture entitled ‘Fabrication protocol for double structure implantretained removable prosthetics’. He comments: ‘In a world where implant-retained removable prosthetics are no longer a novelty item, we cannot afford to present to our patients a prosthesis that has a

typical denture look. The need to balance good function with quality aesthetics can now be addressed with composite veneering of the denture base, and also by choosing a treatment plan that will not only retain a prosthesis, but will also offer superior hygiene and longevity of the implant regions. ‘During my lecture I will discuss protocols for fabrication of the double structure implant-retained removable prosthesis with the use of plunger locks. ‘The lecture will not only include all the proper steps for construction of such a prosthesis, but will also cover some of the common mistakes made and how to avoid and correct them. ‘I hope delegates attending my session will learn how to fabricate a master cast with the use of an accurate and simplified technique. I hope they’ll also leave with a better understanding of several techniques used to create the verification jig and how to properly utilise them for the best results. ‘Finally, delegates should better know how to fabricate a double structure implant-retained prosthesis and how to make it blend with the surrounding oral structures by using composite veneering of the acrylic denture base.’ Eugene will be joined by an array of internationally renowned speakers in the DTS Lecture Theatre, including Bill Marais, Carl Fenwick, Chris Wibberley, Ian Smith, Jason Smithson and Von Grow. Chaired by Phil Reddington, the programme has been designed by the Dental Technicians Guild – a widely respected group of technicians and now dentists who work together to promote high standards in all areas of dentistry.

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prosthetics at DTS 2017

Providing further insight, intrigue and intelligent solutions to everyday problems, the two-day lecture programme at DTS 2017 will cover all bases. Whether you’re interested in dentures, implant-retained prosthetics or orthodontics, there is something for you. Plus, the Dental Business Theatre – delivered by Practice Plan once again – will present a wealth of information and top tips from world-class business experts, helping lab owners streamline their businesses for maximum productivity and profitability.

It will also be the perfect place to catch up with old friends, make new acquaintances and expand your professional network for enhanced career opportunities and business growth in the future.

For all this and much more, don’t miss DTS 2017! ■ DTS and The Dentistry Show 2017 – Friday 12 and Saturday 13 May 2017 – NEC Birmingham ■ For more information visit www.the-dts.co.uk, call +44 (0) 20 7348 5263 or email dts@closerstillmedia.com

What’s more, the extensive trade floor will host more than 100 lab-dedicated exhibitors, each keen to demonstrate the very latest products, materials and innovations to reach the UK market following global launches at IDS only weeks before. Further educational opportunities will be available with various on-stand learning, as well as fun activities and fantastic deals on a wide range of solutions.

Eugene Royzengurt

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continuingprofessionaldevelopment Continuing Professional Development (CPD) Programme The Technologist is pleased to include a continuing professional development (CPD) programme for DTA members in accordance with the UK General Dental Council’s regulations and the FDI World Dental Federation’s guidelines for CPD programmes worldwide. The UK General Dental Council regulations required that from 1 August 2008 all dental technicians must start documenting their CPD. They are required to complete and record a minimum of 150 hours of CPD every five-year cycle, a third of which should be verifiable CPD (50 hours). This should include verifiable CPD in the following core subjects: ■ medical emergencies (10 hours per cycle) ■ disinfection and decontamination (5 hours per cycle) ■ materials and equipment (5 hours per cycle)

The questions in this issue of The Technologist will provide verifiable CPD for those entering the programme. Complete your answers for free online at www.dta-uk.org, or use the answer sheet overleaf (or a photocopy if this is preferred, so as not to remove the page). Return your answer sheet to the DTA Head Office address with your £5 payment (please note that your CPD won’t be processed without payment) before the 17 March 2017. Online and paper responses must be received by the deadline. Dental technicians completing the programme will receive a certificate for the prescribed number of hours of verifiable CPD, together with the answers to the questions either online or by post according to the above guidelines.

Aims and outcomes In accordance with the General Dental Council’s guidance on providing veriﬁable CPD: ■ The aim of The Technologist CPD Programme is to provide articles and material of relevance to dental technicians and to test their understanding of the contents. ■ The anticipated outcomes are that dental technicians will be better informed about recent advances in dental technology and associated subjects and that they might apply their learning to their practice and ultimately to the care of patients. Please use the space on the answer sheet or online to provide any feedback that you would like us to consider.

The use of removable appliances in place of fixed appliances (Materials & equipment cpd – one hour) Q1 – The upper right canine was displaced: A – Palatally B – Buccally C – Lingually D – Mesially

Q2 – Growth modification is to be completed with which appliance? A – Twin Block B – Frankel C – Herbst D – Dynamax

Q3 – At the end of the growth modification stage, what was the patient fitted with? A – LRA B – Hawley C – TPA D – URA

Q4 – The complications of the patient being involved in a contact sport could have been minimised by the wearing of an orthodontic: A – Brace B – Mouth guard C – Retainer D – BRA

Q5 – The patient was a ----------- level competitive boxer? A – County B – Regional C – National D – International

Q6 – This is a case report about an amateur boxer with a --------- malocclusion A – Class I B – Class II Division II C – Class II Division I D – Class III

Q7 – What is the ideal alternative appliance to the appliances that have been prescribed for this patient? A – Retainer B – Removable C – Fixed D – Functional

Q8 – The patient has what issue with his upper canines? A – Impacted B – Missing C – Erupted D – Unerupted

Q9 – How old was the patient at the start of treatment? A – 11 B – 12 C – 13 D – 14

Q10– The Amateur Boxing Association of England (ABAE) regulations state in regard to fixed appliances ‘it is the ............. option that boxers have a letter from the orthodontist confirming that they are allowed to box. A – Sanctioned B – Favoured C – Approved D – Preferred the

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continuingprofessionaldevelopment Whistleblowing (other specific cpd – 30 minutes) Q1 – Principle 8 of the GDC code covering ‘Raising Concerns’ applies to: A – Practice managers only B – Dental labs only C – All dental professionals D – Dentists only

Q2 – The Public Interest Disclosure Act 1998 (PIDA) was designed to: A – Protect businesses from breaches of conﬁdentiality B – Ensure that employees could raise concerns of serious wrongdoing whilst being protected from being treated badly or being dismissed C – Provide the public with access to company information D – Reduce business bureaucracy

Q3 – Employees might typically use ‘whistleblowing’ protections to raise concerns about: A – A danger or illegality or risk to another party B – A personality clash with another employee C – Their appraisal rating D – Their pay review

Q4 – The most effective policies: A – Are available online B – Are available to managers only C – Focus mainly on the legal aspects of the subject D – Provide clear and practical step-by-step guidance and are available to all

Q5 – During the course of any independent investigation, it is good practice to: A – Keep the whistleblower regularly updated on the progress of the investigation B – Suspend the whistleblower C – Suspend the party accused of wrongdoing D – Provide regular updates to all staff

Business planning for 2017 (other specific cpd – 30 minutes) Q1 – The latest date to send P60s to your employees is: A – 5 April B – 31 May C – 31 July D – 31 October

Q2 – The latest date to file your personal tax return is: A – 31 October B – 5 April C – 31 January D – 31 December

Q3 – The ‘O’ in SWOT analysis stands for: A – Opportunities B – Options C – Occurrences D – Overheads

Q4 – The SMART acronym is used in setting: A – Prices B – Goals C – Proﬁt margins D – Overheads

Q5 – The ‘R’ in SMART stands for: A – Radical B – Reliable C – Rudimentary D – Realistic

Q6 – A forecast of future bank account movements is called: A – A proﬁt forecast B – A cash ﬂow forecast C – A sales forecast D – A costing forecast

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continuingprofessionaldevelopment Q6 – The percentage of dental implant, crown and bridgework that now involves CAD/CAM is: A – Just over 50% B – Less than 75% C – About 92% D – Just over 80%

Q7 – The colour light used by some of the latest scanners, such as GCs Aadva Lab Scan and the Medit Identica Hybrid scanner, is: A – Blue B – Ultraviolet C – Infrared D – White

The Digital Dental World (Materials & equipment CPD – one hour) Q1 – 3D printing is also known as: A – Layering B – Additional strata C – Additive manufacturing D – Hard inkjet printing

Q8 – What benefits has CAD/CAM enabled in Ashley’s experience of using it? A – Increased production and improved quality B – Increasing predictability, reproducibility and simplifying treatment options C – Reducing costs and improving proﬁtability D – To work faster whilst focusing more on aesthetics and a,b and c

Q9 – The Evodental team describes its style of dentistry as:

Q2 – XYZprinting CEO, Simon Shen, describes 3D printing as: A – Very annoying B – Hugely disruptive C – A turnkey technology D – Taking dentistry to a whole new level of personalisation and b

Q3 – In 2015 the dental 3D printing market was estimated to be worth $700 million. By 2023 it is forecast to be: A – $4.3 billion B – $1.6 billion C – $3.7 billion D – $5.8 billion

A – Cosmetic B – Bioengineering C – Speedier workﬂow D – Digital dentistry

Q10– The type of file emailed to Mint Dental from the dentists’ chair-side scanners is: A – JPEG B – TIFF C – PDF D – STL

Q4 – Dental technician Ashley Byrne was speaking at: A – Dental Technology Showcase B – BDIA Dental Showcase C – BDA Annual Dental Conference D – Henry Schein Digital Symposium

Q5 – Dental technicians registered with the GDC in 2008 numbered just under 7500. There are now: A – Just over 6000 B – Over 9000 C – There has been no change D – Just over 5700

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Simply fill in the multiple choice answer sheet on the inside back cover and complete the form ...

february 2017

continuingprofessionaldevelopment

answer sheet the technologist february 2017 Please PRINT your details below: First Name*

Last Name*

GDC no.*

Title

DTA Member: Yes

DTA no.*

*Essential information. Certificates cannot be issued without all this information being complete.

Complete free online at <www.dta-uk.org>. First-time users will need to register; those already registered need only log in. Or, either remove this page, or send a photocopy to: Dental Technologists Association, F13a Kestrel Court, Waterwells Business Park, Gloucester GL2 2AT. A £5 payment must be included with your CPD answer sheet – please do not forget! Please note that you must achieve a score of 50% or more to receive a certificate.

Answer sheets must be returned before 17 March 2017 for CPD responses returned in the post and for online CPD users. Answer sheets received after this date will be discarded. Answers Please tick the answer for each question below The use of removable appliances in place of fixed appliances (Materials & equipment cpd – one hour) Question 1:

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Whistleblowing (Other specific cpd – 30 minutes) Question 1:

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Business planning for 2017 (Other specific cpd – 30 minutes) Question 1:

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The Digital Dental World (Materials & equipment cpd – one hour) Question 1:

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B B

Feedback We wish to monitor the quality and value to readers of The Technologist CPD Programme so as to be able to continually improve it. Please use this space to provide any feedback that you would like us to consider.

An important note for non-DTA members Non-DTA members will incur a £25 fee for undertaking CPD provided through this publication. Cheques made out to DTA should accompany your answer sheet. the

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‘ DTA is a reliable resource many technologists should make good use of ’ Jack Thurkettle

Be part of a thriving community of dental technicians – DTA members can access: ■ FREE legal helpline ■ ACCESS to FAQs across all business disciplines: compliance, technical, H&S, Waste management, HR etc. ■ FREE verifiable, core CPD ■ FREE bi-monthly CPD journal and E-newsletter ■ GREAT VALUE indemnity insurance To find out more about the Dental Technologists Association visit: www.dta-uk.org