The Dental Technician Magazine September 2017 by The Dental Technician Magazine

The Dental Technician September 2017/Vol 70 Issue 08

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INSIDE THIS ISSUE Vol 70 No 08

SEPTEMBER 2017 Technical

Technical

Business

Insight

SIMPLIFIED PROTOCOL FOR IMPLANT/MUCOSA SUPPORTED FULL UPPER

ANTERIOR CROWN REHABILITATION USING CELTRA PRESS PRESSABLE CERAMIC

MARKETING SIMPLIFIED ALL ABOUT BLOGGING

DENT-TECH BRAND NEW DENTAL CHARITY LAUNCHED

Page 8 & 10

Page 12 & 15

Page 6 & 11

Page 16

AND SO TO

R WA R R A

Continued on page 4

Ashley Byrne was presented with his fellowship by the DTA at the BDA. Photo © BDA

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E D Q UA Y

Ashley Byrne has just been honoured by the DTA with a fellowship for his contribution to the enlightenment of his fellow technologists right across the country and indeed around the world. Ashley is very positive about the modern techniques and systems that come with the digital dental changes. He clearly believes in the potential for the newer method and warns technicians not to be so slow to change. The evidence would seem to support his positive approach and his

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5 Y

he following three or four months have traditionally been the busiest in our working year. The restorative patients, delayed, because of the spread of the summer holidays and the awareness that Christmas is coming and the teeth will need to be done, to deal with the delights and photos for the family gatherings. Traditional date landmarks such as Christmas and Easter and of course certain birthdays are often used to confirm a commitment to what is often an expensive undertaking for the patient in question. With the increase against the pound because of the Brexit process many of us have stayed in the UK for the summer and hopefully found it cheaper than the inflated overseas costs. Perhaps there will be yet another increase of demand over the coming months.

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The Dental Technician September 2017/Vol 70 Issue 08

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The Dental Technician September 2017/Vol 70 Issue 08

CONTENTS

THE DENTAL TECHNICIAN SEPTEMBER 2017 8

6 & 11

MARKETING SIMPLIFIED

8 & 10

SIMPLIFIED DENTAL PROTOCOL FOR THE CONSTRUCTION OF A REMOVABLE PROSTHESIS WITH IMPLANT / MUCOSAL SUPPORT

NOBEL BIOCARE EVENT

12 & 15

REHABILITATION OF A SINGLE ANTERIOR TOOTH

BRAND NEW CHARITY DEN-TECH LAUNCHES

18 - 19

ICDE 2017 TAKES LEICESTER BY STORM

THE THREE ‘I’S OF DTS

20, 22 & 23 DENTAL NEWS 24

GC’S MAKOTO NAKAO RECEIVES ‘HIGHEST HONOUR´

GDC ANNOUNCEMENTS

28 - 29

VERIFIABLE CPD

ORTHODONTIC CONFERENCE 2017

CLASSIFIED ADVERTS

24 PUBLISHERS: THE DENTAL TECHNICIAN LIMITED, PO BOX 430, LEATHERHEAD KT22 2HT TELEPHONE: 01372 897463 Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH Editor: Larry Browne FBIDST. FDTA, ITI Fellow, LCGI, RDT. Tel: 01372 897461 Email: editor@dentaltechnician.org.uk Subeditor: Sharon (Bazzie) Larder Email: inthedoghousedesign@gmail.com Advertising: Chris Trowbridge Tel: 07399 403602 Email: sales@dentaltechnician.org.uk Editorial advisory board K. Young, RDT (Chairman) // L. Barnett, RDT // P. Broughton, LBIDST, RDT // L. Grice-Roberts, MBE // V. S. J. Jones, LCGI, LOTA, MIMPT // P. Wilks, RDT, LCGI, LBIDST // Sally Wood, LBIDST

THE DENTAL TECHNICIAN WEBSITE IS NOW LIVE! FIND US AT:

dentaltechnician.org.uk THE DENTAL TECHNICIAN is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused. No part of this publication may be reproduced in any form without the express permission of the editor or the publisher.

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Continued from page 1 commitment to making sure his own technical world is ready for the future. He has monitored his laboratory output and confirms a marked move towards digital manufacturing techniques. But he has worked hard to be at the forefront of the new technology and has succeeded in the market place to gain a reputation for quality and consistent output.

Congratulations Ashley for your award, very well deserved. October will bring the BDIA Exhibition at the NEC Birmingham from Thurs. 19th until Sat 21st with the opportunity for us all to see what is being offered by the established dental companies. Three days to see and touch and of course with an educational programme for all areas of dentistry. Another chance

to confirm your interest in the future of your technical dentistry and a real opportunity to have your questions on the new techniques answered. Don’t forget to check out the extent of the back up available, particularly in the early months of working with the new systems. For many of you it is a very big commitment in time and money, to find out and then perhaps to invest in the new equipment. Do your homework and if possible try

the system out thoroughly without investing you hard earned capital. Use the scanning services, if available, to have some restorations made and be sure you buy only what you need to fit your requirements. It can be far too easy to say yes to the glitzy equipment, only to find it sitting in your lab not being used enough to justify you capital commitment. Talk to colleagues and friends and if possible work with them to find out more about what is possible and what really works on the system in question. They are not all the same and some will suit more than others. Do you really need to go digital? It´s a good question, which you alone can answer. Much will depend on the type and amount of work you produce. For sure the digital systems are quicker and once learned, simpler and cheaper to work with. A full Digital scan and manufacture system will allow a very much cleaner and up to date environment. You can dispense with many of the dirtier jobs within the laboratory and quite literally enjoy an environment similar to a design studio with design and planning being the majority of your working day and manufacturing being carried out in a remote location, either within your premises or indeed in Timbuktu! It only takes a bit of organisation. With 3D printing now growing fast in popularity it will not be long before the manufacturing process may be best done remotely. Coping with the advancing technology and the different manufacturing requirements this is the area of deepest consideration for your investment. As the techniques develop the manufacturing units will undoubtedly become more and more complex and expensive. The ideal may be to scan and design and have production by a third party, perhaps the supplying company. While for many of us the idea of sending work to a third party may seem unwelcome it could be better for others to invest in the manufacturing end at least until you can justify the investment needed to have that process in-house. If you are in the “not sure” area it would be good to eliminate as many unanswered questions as possible before committing your hard earned cash. So get to the exhibitions and take a look at the choices. Talk to colleagues, not just the ones working for companies, and find out what really does work. Be assured there is a good deal of useful and life changing systems on offer. So Think, Plan, Commit or Relax and ignore it. Hopefully you will come and visit us on our stand in October. l BDIA. Dental Show Case October 19th - 21st October NEC.

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MARKETING SIMPLIFIED JAN CLARKE BDS FDSRCPS

Jan qualified as a dentist in 1988 and worked in the hospital service and then general practice. She was a practice owner for 17 years and worked as an Advisor with Denplan. Jan now works helping dental businesses with their marketing and business strategy. Web: www.roseand.co Email: Jan@roseand.co

ATTRACTING NEW DENTAL CLIENTS BY BLOGGING HOW DO I START?

Welcome to this regular column discussing marketing and how you can connect with your clients and reach new clients. In my previous article I gave an overview of some of the activities you could apply to your business and over the next few months I will go into more detail with each area. For most businesses your website is the place of maximum information about your business, team, services, products - somewhere that you would like your new clients to arrive at and stay a while. I will spend more time talking about all aspects of your

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website in a future edition but today I am going to talk about a little used aspect that I feel are under utilised in dental businesses - a blog. A blog will be used on your website but if you haven’t got a website you can still have a blog and then incorporate it into a website at a later date when you’re ready. This is something that can be actioned without a large cost, all the tools are available to do this yourself and can add such a great amount of information for your clients - we call this Educated Based Marketing.

WHY WRITE A BLOG?

• A great place to educate dentists regarding the types of work you can

carry out and offering suggestions with case studies perhaps. • To create a source of unique content that can be used in many ways. • A blog keeps your website updated with fresh content and therefore helps with Search Engine Optimisation.

HOW TO START

You and your team are experts in the field of dental technology, showing how you apply the use of different materials/techniques to dental teams will help them with their choices and help guide them to you. Many dentists get stuck using the same techniques and what stops them trying a new type of restoration may be lack of knowledge and understanding of how that will work for their patient. The more information and examples you can show your dentists the better. You also have to show them that you are approachable and available for discussion in order to aid them in their choices. Whilst some of your knowledge in dental technology may seem insignificant to you, to a dentist trying to offer the best choices to their patients, that information may be key to making the best decision for their patient.

Why not be the go to place for real information? Educate your dentists and potential new clients, this builds trust. There is no need to “sell” to dentists, educating and information builds relationships. A blog is an excellent place to start to showcase your talents and knowledge.

CREATING YOUR BLOG

Preferably create your blog on your website so that every time you direct traffic to your blog from your social media channels they will land on your website ready for their journey. Wordpress is a very user friendly Content Management System (CMS) and if your website is built on this platform then you will have the ability to update and post Blogs yourself, even if you are not too adept digitally. If you don’t have a website yet then you can have a stand alone blog, again Wordpress is probably one of the easiest to access and get support with, it can also be integrated into a website at a later date. There are lots of other blogging sites about too, Blogger, Tumblr but Wordpress remains the most popular blogging channel & CMS available at present.

Continued on page 11

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PART 1

SIMPLIFIED DENTAL PROTOCOL FOR THE CONSTRUCTION OF A REMOVABLE PROSTHESIS WITH IMPLANT / MUCOSAL SUPPORT MAURIZIO SEDDA. C.D.T., D.D.S., M.SC., PH.D. AND SIMONE FEDI. C.D.T.

emovable prosthesis with implant - mucosal support combines the aesthetic advantages of a removable prosthesis with the stability given by the implants. The protocol of completing this type of prostheses may be complex, both for the clinician and for the dental technician. In this work it is illustrated as a simplified dental protocol, which begins with the creation of a diagnostic prosthesis. This is used as a template guide for the placement of implants and then duplicated to use as the impression tray and registration of the occlusal relationships and for obtaining an aesthetic prototype. Also the management of milled bar becomes simplified, thanks to the use of attachments with reduced dimensions, and the superstructure, made of PEEK. Following what is illustrated in the article it is possible to provide the patient with an aesthetic prosthesis, stable and easily maintainable from the hygienic point of view. Impression obtained with the prosthesis replica

Placing of the laboratory analogs the prosthesis replica and the artificial gingiva

INTRODUCTION Increasingly, edentulous Patients will be looking for a fixed replacement of their missing teeth especially when wanting an implant solution. So often the necessary bone is not available and the eventual compromise is for a removable prosthesis. While the lower jaw implant-prosthetic treatment presents less of an esthetic challenge, in the upper arch there are a number of variables that are essential to keep in mind during the conception of the treatment plan. If those elements are undervalued, a potential failure may easily occur. The shape of the jawbone and of the soft tissues can impede the patient’s oral hygiene around the implants and the prosthesis that is too often built trying to meet only the aesthetic requirements while ignoring the importance of access for effective cleaning. Thus compromising the potential, longterm success of the treatment

Above left: Master model with the artificial gingiva and analogs in position Above right: Aesthetic prototype

For these reasons, an implantsupported prosthesis should be designed prior to the implant placement to act as a guide for the surgical placement, in line with the prosthetic requirements. Importantly in the upper arch, more than in the in the lower, the shape and position of the lip strongly contributes to the aesthetics. Indeed the perioral tissues must be correctly supported in order to restore facial harmony and phonetics. On the basis of the above, the removable prosthesis with implant and mucosal support finds its application. This type of prosthesis is also called “hybrid” because, on one hand the implants perform a supporting function (like a Toronto Bridge) and not just as retention (as in the over-denture). On the other hand the prosthesis still remains removable for the patient. The Anglo-Saxon definition is often “milled bar over-denture” or “fixed - removable over-denture”. According to the Misch classification the removable prosthesis is classed as “RP-4” when the prosthesis is completely implant supported and removable. It is classed as “RP-5” when the prosthesis is implant and mucosa supported5. Here, we are outlining the latter type (RP-5). Because of the patients wish for a fixed option on implants but the need to be removable to cover the necessary mucosal area and the need for good lip support with an extended flange. With the necessary flange, a fixed option would seriously undermine the patient’s ability to maintain oral hygiene. Which could potentially cause the loss of the implants. Combining the use of

implants and a removable prosthesis the clinician is able to offer the patient a stable, aesthetic, easily cleanable, horseshoe prosthesis, without palatal coverage. The purpose of this article is to provide a simplified technical protocol, compared to the classical one, with the intention to increase the accuracy of the restoration and to decrease the difficulty of implementation and the necessary time of processing.

CLINICAL CASE

The patient, male, 54 years old, non-smoker, with no major diseases, came to the dental office to see if he could improve his situation with regard to the rather poor full upper denture with which he was unhappy. There were some retained lower teeth from 34 to 45. The upper denture was indeed unsatisfactory, causing serious problems for the patient when chewing and speaking. The patient had become very preoccupied with the problems being caused. In relation to his age and the effect on his speech while dealing with work colleagues. He also expressed the wish to replace the removable upper dentures with implants, quoting his own words, “something that will stay fixed in the mouth and without a palate.” The clinician started with the construction in the upper jaw of a new provisional, but still total removable prosthesis, for diagnostic purposes. Following periodontal treatment of the remaining lower standing teeth a provisional partial denture was also constructed. The

Continued on page 10

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Continued from page 8 assessment of the occlusal plane and vertical dimension could now be finalised. It was clear the patient needed the soft tissue support of a buccal flange, in support of the upper lip. With the use of panoramic radiographs and computer tomography a clear diagnosis could be made of the potential implant sites. A treatment plan was agreed with the patient, to place four implants at 14, 12, 22, 24, to support a milled bar for the support and retention of the removable final horseshoe denture. The lower arch responded well to the periodontal treatment and a partial removable denture was proposed to complete the occlusal support from the lower jaw. The implants were carefully placed to fulfill the prosthetic requirements and within sufficient bone to be viable long term. During the osseo-integration period the patient was maintained with the removable upper and lower dentures. The upper denture was modified to allow for the undisturbed healing of the implants. With regular periodontal therapy sessions the clinician could effectively monitor the progress of the healing process.

CONSTRUCTION AND USE OF THE TRANSPARENT ACRYLIC RESIN REPLICA

A hard silicone model (70 Shore –A) was made by pouring the silicone material into the fitting

surfaces of the provisional denture, incorporating the full contour of the denture margins. The prosthesis and model silicone thus obtained were placed in a flask. An Insulating silicone spray (Transformer) was then applied and another silicone was placed between the replica and the cover of the flask. The flask was then closed and held in place until the full curing of the silicone. The prosthesis was removed from the flask and two holes were cut through the upper silicon (one of 0.5 cm diameter for the input channel, and one of 0.3 cm for the output channel) to allow the injection of the transparent acrylic resin. The resin was mixed and injected inside the flask which was maintained at 50°C for 25 min at a pressure of 2.5 bars. Once cured, the flask was opened and the replica was finished with rotary instruments mounted on a laboratory hand piece and delivered to the clinician.

IMPRESSION WITH THE PROSTHESIS REPLICA

The transparent resin replica was used in a single chair side appointment, as customized tray, as a reference of the teeth set-up (control of the vertical dimension, the masticatory plane and the relationship with the antagonist), and as a first test of the aesthetics (smile line, midline, etc.). The clinician proceeded with the insertion of the replica in the oral cavity, checking the occlusion and removing any anomalies. The precise occlusion was

then recorded using a fast setting addition curing silicone. Access holes for the implant hardware had been cut through the clear replica, to allow for placement of the impression pickups. Impression adhesive was applied around the access holes. An addition cured silicone impression material was used with the patient biting down and maintaining the replica in place during the full polymerization process. A face bow recording was obtained before removal of the impression within the replicas denture. Once removed the silicone impression material was cleaned from the access holes to allow placement of the impression pickups directly to the implants. The replica was placed back into the oral cavity and the transfers were screwed on the implants. Keeping the prosthesis in place, the transfers were attached to the replica with a light activated low shrinkage resin. The fixing screws were removed from the transfers and the impression was delivered to the laboratory after the normal disinfection protocol (Photo 1). l Maurizio SEDDA. C.D.T., D.D.S., M.Sc., Ph.D. CO Pistoia - Via del Roccon Rosso 27, 51100, Pistoia. info@mauriziosedda.com Simone FEDI. C.D.T. Technical Laboratory Capecchi e Fedi - Corso Gramsci 60, 51100, Pistoia. fedisimone@icloud.com

BIBLIOGRAPHY

1. Quirynen M, deSote M, Steeberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res 2002;13:1-9. 2. Mombelli A, Van Oosten MAC, Schurch E, et al. The microbia associated with successful or failing osseo-integrated titanium implants. Oral Microbiol Immunol 1987:2:145-51. 3. Misch CE. Considerations of biomechanical stress in treatment with dental implants. Dent Today 2006;25:80-5. 4. Zarb GA, Bolender CL. Prosthodontic Treatment of Edentulous Patients: Complete Dentures and Implant-Supported Prostheses. Twelfth Edition. St. Louis, Mosby, 2004. 5. Misch CE. Prosthetic options in implant dentistry. Int j Oral Implantol 1991:7:17-21. 6. The system and consumables used in this article are from Fast Protec which is distributed in the UK by Panadent Ltd. For more information, please contact: Panadent 01689 88 17 88 or visit www. panadent.co.uk 7. Abstract:

TO BE CONTINUED IN THE OCTOBER ISSUE

THE EVENT WITH ‘WOW’ FACTOR Nobel Biocare is delighted to announce an outstanding programme for the London Symposium this November.

• Paul O’Reilly, Ireland • Isabella Rocchietta, UK • Riz Syed, UK • Susan Tanner, UK

Presenting a real ‘wow’ factor, the speaker line-up alone demonstrates the high calibre of the event, with confirmed speakers including:

Delegates will have a choice of lectures, smaller break-out sessions, hands-on workshops and business forums designed to facilitate discussion and collaboration. There will also be the chance to discover some of the very latest innovations available from Nobel Biocare, to find out how they work and see how they could benefit patient care.

• Tomas Albrektsson, Sweden • Markus Blazt, USA • Ruben , Spain • Andrew Dawood, UK • Richard Elliot, UK • Wail Girgis, UK • Stefan Holst, Switzerland • Robin Horton, UK • Jennifer Huntley, UK • Pascal Kunz, Switzerland • Ian Lane, UK • Ashley Latter, UK • Kevin Lockhead, UK • Scott MacLean, USA • Paulo Malo, Portugal • Guy McLellan, UK • Jose Navarro, UK and Spain

visit nobelbiocare.com/london

The inclusive programme even ensures something for the entire dental team, with the Friday night social event promising to be full of fun and networking opportunities as well. l Make sure you don’t miss the Nobel Biocare London Symposium 2017 on 10th and 11th November in London. For more information, please

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Continued from page 6

HOW DO I WRITE THE BLOG?

I would encourage you to have your own style. You will see all sorts of blogs out in the digital realm of the internet, some a few words, some lengthy but when starting out it is best to follow some guidelines. Use your personality to be authentic. • Write at least 350 words per article. Google likes new content and prefers at least 350 words to recognise new content, however longer than 500 words will probably stop readers reading the article to the end. • Write to your audience. You are trying to attract and educate dental teams, this will mainly be dentists but it may also be dental nurses, who can have quite a sway in which services are used in a dental practice. Dental practice managers, hygienists may also be reading so do include all the team in your writing approach. Whilst jargon is acceptable for this audience, don’t be overly technical, the phrases you are used to using may not be mainstream. You want to build trust by being helpful and informative, try and think about the questions you get asked day in day out and what people really want and need to know. • Break the text up into readable

chunks with images, most will tend to scan read and if there is too much text in a block it just will not be read. Everyone is busy so you are competing for their attention. It is worth spending time on the headline too, what attracts you to read a blog? • Finally, be consistent and post regularly, at least once a month, if possible twice a month. Keep yourself on track and timetable blogs so you know when you need one to be written. Ask team members to write them if you find this overwhelming. Once a pattern is started and you see the benefits you will be encouraged.

WHAT DO I WRITE ABOUT?

Think of your audience as you write, there will be varying degrees of experience in your audience and you will be able to use technical dental terms. It is important to educate and get your message across without confusion but at the same time you don’t want to patronise your audience. You may not have a lot of conversations with your clients, although I would encourage you to change this. The more communication you have with your clients the better you will understand their requirements. Think about the conversations you do have when you meet your dental teams. What do they want to know about? What may seem

obvious to you and trivial to write about may have a big impact on your clients. A blog is a place where you can go into more detail, be specific, maybe offer case studies.

SOME SUGGESTIONS TO GET YOUR STARTED:

• What happens to my work once it arrives at the lab? • Different scanning solutions available, how to choose? • A comparison of the different types of ceramic crowns available and benefits of each • An overview of denture materials available and how they can be used • Getting the shade right • Impression techniques - which seem to produce the best margins • Implant retained restorations - the process We all love stories so the more relevance you include to real people the better, for instance if you can include an actual case study where you worked with a dental team this can showcase not only your skill but how you work together closely for the patient’s benefit. Think about the types of work you would like more of and write about these, there is no point discussing denture materials if you are winding down the denture services.

WHAT CAN I DO WITH MY BLOG ONCE PUBLISHED?

Your blog can be used in lots more ways and recycled over and over again, here are just some suggestions. Some involve the use of Social Media which I will discuss in a future edition too. • Use introductory paragraph for your e-newsletter and link • Break it down into Facebook posts and link • Tweet key phrases and link back use link shorteners • Record as a YouTube video and embed in a blog again • Record as an audio podcast and embed • Offer as a guest blog to sites with the same ideal customer who are not in competition • Submit to article sites ezinearticles.com • Offer to dental publications The use of a Blog to market your dental laboratory and services is under utilised yet other professions realise the advantages. Use this great tool to educate your potential market. I would encourage you to get started and impart your knowledge to the rest of the world, in an enthusiastic manner. Well, at least to potential new dental business clients.

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Rehabilitation of a single anterior tooth ABSTRACT

The Patient is a 39-year-old female with a fractured ceramic crown on her upper left lateral incisor.

THE CHALLENGE

The fractured crown was to be replaced as quickly as possible by a long-lasting and aesthetic restoration.

feldspathic ceramic material. The interaction of the two materials provided coordinated chroma and transparency values and a harmonious interplay between the natural tooth, the framework, and the veneer.

CASE REPORT

The treatment: Minimum repreparation of the tooth and an impression using the putty/wash technique. A Celtra Press crown framework was fabricated and individually veneered with CeltraÂŽ Ceram at the dental laboratory. The new crown exhibited an impressive fit and great aesthetics.

INTRODUCTION

Anterior single-tooth restorations can place high demands in terms of treatment skills and dental materials. The challenge involved in adapting the tooth as precisely as possible to the adjacent teeth requires a highly rational procedure, a high level of craftsmanship, and excellent materials. Light, shade, shape, and the three-dimensional appearance have to be imitated in a natural way. When reproducing the shade of a natural tooth and its internal optical effects in individual anterior crowns, opacity and translucence play an important role. In the interest of greater efficiency, elaborate and complex layering of a large number of ceramic masses should be avoided, and the framework material should ideally already have roughly the same shade as the teeth. In the case presented here, a modern glass-ceramic material was used for the crown framework: the zirconia-reinforced lithium silicate (ZLS) Celtra Press (Dentsply Sirona). Its 3-point bending strength of more than 500 MPa and its biaxial strength of more than 700 MPa is more than comparable glass-ceramic materials can offer. It provides much better optical properties for the framework than zirconia does. The crown was veneered with Celtra Ceram (Dentsply Sirona), a low-fusing, leucite-reinforced,

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The patient was sent home and the impression sent to the dental laboratory. The ceramic framework for the singcrown was to be fabricated using the ceramic pressing technology. The master cast prepared in the laboratory was first scanned and the data transferred to the CAD software (Dental Designer; 3Shape*). The preparation margins were displayed in the CAD software in just a few steps and appropriate settings chosen for parameters relevant for the fit of the restoration (Fig. 5&6).

Fig.10

The CAD crown design was transferred to the CAM software (nesting) and milled From a wax base (CerconÂŽ Base Wax, Dentsply Sirona) (Fig.11 to 13)

Fig.1 Fig.11

Fig.5 Fig.12

Fig.2

The patient presented with a fractured ceramic crown on the maxillary left lateral incisor, tooth 22 She wanted a new prosthetic restoration that would be long-lasting and highly aesthetic. The (Fig.1) tooth was slightly re-prepared, providing a chamfer (Fig. 2). Once a precision impression had been taken in the putty/wash technique, the tooth received a provisional restoration (Fig. 3&4).

Fig.3

Fig.6

Using the familiar procedure, a crown for tooth 22 was designed and its contour partially reduced to accommodate the veneer (Fig.7&8). Fig.13

The fit of the wax coping on the physical die was excellent (Fig. 14). Fig.7

Fig.8

The palatal area was left fully contoured and fine mamelon structures were created in the vestibular region (Fig. 9 & 10) to provide intrinsic support for a lifelike shade of the restoration.

Fig.14

Continued on page 15

Fig.4

Fig.9

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The Dental Technician September 2017/Vol 70 Issue 08

Continued from page 12 In order to convert the wax crown into ceramics, wax sprues 3 mm in diameter were attached, following the specifications for the pressing process (Fig. 15). The object was positioned in the pressing muffle, keeping a distance of approximately 10 mm from the muffle wall (Fig. 16).

veneer and further increases the bending strength of the Celtra Press restoration. The framework thus prepared for veneering exhibited an optimal fit on the master cast after power firing, and its shade already provided the ideal starting point for further processing (Fig. 18). Fig.18

Fig.15

This opalescent effect mass allows for highly delicate yellow/orange shade highlights. The lateral ridges of the crown were accentuated with the opalescent, slightly greyish EE4 Grey (Fig. 22). Here, as so often, less can be more. The Celtra matrix reacts like a “living” material. The build-up was completed with two highly vivid masses (Fig. 22 &23). Fig.22

conditioned (Fig. 27) and the restoration was definitely cemented in place. A glycerine based gel at the restoration edges prevented the formation of an oxygen inhibition layer during polymerization (Fig. 28). The treatment was completed after the final light curing of the adhesive. The ceramic crown was indistinguishable from the adjacent teeth, whose shape, shade, surface texture, and three-dimensional appearance were imitated with a minimum of effort. (Fig. 29&30). Fig.27

With Celtra Ceram, all 16 VITA* A to D shades are available for the veneer, as well as various effects of opal incisal powders. In the present case, the required shade was A2. *VITA is not a registered trademark of Dentsply Sirona.

Fig.23 Fig.28

Fig.16

A special low-viscosity investment material is available for investing (Celtra Press Investment; Dentsply Sirona). Once the investment had set and the muffle had been pre-heated, the crown framework could be pressed from a ceramic pellet (Celtra Press). The post-pressing procedure is straightforward — cooling, divesting, and separating. Since Celtra Press forms only a minimal reaction layer on the ceramic surface, acidification with hydrofluoric acid was unnecessary (Fig. 17).

The tooth shape was largely predetermined by the framework, so that the dental technician could concentrate strictly on the ceramic build-up. The cutback technique requires no dentines, which further simplifies the procedure. First, the incisal edge was built up with enamel effect (EE), highlighting the intensity of the shade. EE5 Sky is ideally suited for this purpose because it allows the slightly bluish appearance of the incisal areas of a natural tooth to be ideally imitated (Fig. 19). A ridge was placed on the incisal edge consisting of a thin layer of Enamel Opal (EO1 Extra-light) (Fig. 20), which supports the naturally opalescent appearance of the incisal edge without affecting the actual basic shade of the buildup. Enamel Opal was specifically designed to increase vitality. This multi-functional material quickly yields impressive results. Fig.19

Fig.20

A power-firing step was performed before the individual veneering of the framework. PowerFire is a special firing program that precedes the first firing of the ceramic

Fig.29

Fig.24

The transitional area to the framework itself was adapted using a very thin layer of EE5 Sunrise on the convex aspect of the tooth (Fig. 21). Fig.21

Fig.30

SUMMARY

Fig.25

Only minimal corrections and a final glaze firing were still required. The crown was then prepared for insertion (Fig. 26). The intraoral try-in confirmed its excellent fit and the natural-looking optical properties. The crown could therefore be delivered directly.

Fig.17

The exact fit, the finely textured and homogeneous surface and “soft” divesting process all made for a fast, safe procedure.

Alternating coatings of E2 Light and EO2 Extra-Light (transparent and opalescent incisal) provided for a transparent and chromatic effect. The crown was already nearly finished after the first firing (Fig.24 & 25)

Fig.26

Depending on the indication, self-adhesive or fully adhesive cementation can be chosen for Celtra Press restorations. After cleaning the crown and the prepared tooth, the surfaces were appropriately

The case presented here shows the great potential of the interaction of Celtra Press (Dentsply Sirona) - in this case used as a framework material- and the Celtra Ceram veneering ceramics. The special microstructure of Celtra Press, which is characterised by a fine crystalline structure and a high proportion of glass, already lends the framework excellent optical properties. The symbiosis of translucency and opalescence provided by Celtra Press also allowed a surprisingly natural chameleon effect in the case shown, an ideal shade basis for the highly delicate veneer. The cut-back framework, which had been reduced only in the vestibular area, was veneered with incisal ceramics only. Thanks to its excellent material properties, Celtra Ceram exhibits no shrinkage, so that the aesthetic goal was achieved in just a few steps, maximizing efficiency. The prepared tooth, framework, and ceramic veneer present a harmonious interplay of shades. The “anterior single crown” challenge was mastered perfectly without a complex ceramic build-up.

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The Dental Technician September 2017/Vol 70 Issue 08

BRAND NEW CHARITY DEN-TECH LAUNCHES

en-Tech is the brainchild of dental technicians Andrea Johnson and Andrew Sinclair who after visiting Uganda with a clinically orientated dental charity, realised that there was a great need for quality dental technology services in the country and other developing countries like it. The Charitable Incorporated Organisation (CIO) they have set up is designed to relieve poverty by the provision of affordable dental appliances to those patients who are in need and unable to afford such items and in furtherance of this, to provide training, mentoring and education for dental technicians in developing countries to enable them to supply appropriate quality dental appliances. This is also in addition to supporting those most needy within our own country - the homeless.

Andrea and Andrew felt very passionately that this should not continue and that if they could set up a high quality, supported working and training dental laboratory in the country they could help provide not only a little help now but a legacy of support and training that could be a leg up to the native people and not just a temporary hand out. They set up their charity called Den-Tech in 2017 and have enlisted a board of trustees who are equally as passionate about using their skills and resources to help out those less fortunate. The board of trustees now comprises of Andrea Johnson, Andrew Sinclair, Delroy Reeves, Edward Mapley, Jade Oakes Stott and Robert Williams, you can view brief biographies of the trustees on Den-Techs website https://www.den-tech.org/

There are many charities, which provide the incredibly valuable service of ‘dental pain clinics’ but no real provision for the restoration of the dentition thereafter. This can leave patients with large gaps where teeth have been extracted meaning that they can quite often struggle to eat and chew their food well, to speak properly and to look and feel normal.

This drive and enthusiasm has now extended to helping out those less fortunate in the UK, the homeless. This new project in addition to the existing overseas ones has received a fantastic amount of support from the dental technician community who are pulling together to provide a full range of dental technology services free to those most vulnerable and needy in our society.

Weʼre raising £1,000 to support Den-Tech with the setting up of their homeless projects and to fund shipping equipment and supplies over to Uganda and Cambodia.

have been extracted meaning that they can quite often struggle to eat and chew their food well, to speak properly and to look and feel normal.

I feel very passionately that this should not continue and intend, along with the trustees of Den-Tech, to set up a high quality, supported working and training dental laboratory in the Uganda to help provide not only a little help now but a legacy of support and training that could be a leg up to the native people and not just a

L to R: Rob Williams, Andrea Johnson, Delroy Reeves, Edward Mapley, Jade Oakes, Andrew Sinclair. Board of trustees for the new charity Dent-Tech

Our wonderful flagship supporters Blueprint Dental who have already donated and continue to donate an incredible amount of dental materials and equipment on behalf of their customers have now put their full weight and resources into helping this project to succeed. It can only go from strength to strength. It is also only through the generosity companies such as Blueprint Dental, DB orthodontics, John Winter, Schottlander and WHW and of course the brilliant community of dental technicians arouthe country that can make this charity a success, so from the bottom of our hearts. We, the Den-Tech trustees thank you and look forward to us all achieving great things together in the months and years to come. We are now looking for additional volunteers from the technician sector as well as any clinicians who would like to donate their time and skills to this really worthwhile cause, especially for the UK projects. If you would like to know more, volunteer your services, donate equipment and supplies or make a donation or get involved in a

temporary hand out. This drive and enthusiasm to help has now extended to helping out those less fortunate in the UK, the homeless. This new project is in addition to the existing overseas ones and has received a fantastic amount of support from the dental technician community who are pulling together to provide a full range of dental technology services free to those most vulnerable and needy in our society.

sponsored event to help raise funds please visit our website on the contact us page or email dentech.chair@gmail.com Those that actively support us also get the exclusive use of our supporter’s logo to display on their web pages, literature, Facebook pages etc so please look out for this as you will know that each one of them is a good person/company who has gone out of their way to help make this world a better place by helping us to restore lives one smile at time. If you would like to become one of our supporters and also receive your copy of our supporter’s logo please do not hesitate to get in touch and see in which ways you can help, it is together that we are stronger and together that we can make a difference to the lives of those less fortunate. l Please visit us on our website: www.den-tech.org Facebook page: https://www. facebook.com/Dentech1/# LinkedIn: https://twitter.com/ DenTech_charity Don’t miss their charitable walk on October 7th, the Glencova two peak sponsored walk.

We need to raise funds to transport donated equipment and supplies over to Uganda and Cambodia but also to fund the setting up of a portable laboratory here in the UK that can provide an onsite facility for basic dentures and repairs for our homeless. l Andrea Johnson BSc (Hons), LOTA, MDTA. Den-Tech Chair (Registered Charity No: 1172889). OTA Secretary & Vice Chair.

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The Dental Technician September 2017/Vol 70 Issue 08

ICDE 2017 TAKES LEICESTER BY STORM I

IMPLEMENTING SOLUTIONS

voclar Vivadent’s reputable ICDE event returned for 2017 in June, with over 200 clinicians and technicians congregating at the impressive Curve Theatre and King Power Stadium for an action-packed two-day event compèred by Dr Milad Shadrooh, aka ‘The Singing Dentist’. Following their recent product launches at IDS in March, the theme for this year’s ICDE aptly centred around three keystones of modern dentistry: ‘Digital, Aesthetics and Efficiency’. Attracting a pleasant mix of clinicians and technicians, ICDE2017 offered a fresh timetable of world-renowned speakers and hot topics to keep delegates busy through a variety of lectures, workshops and handson demonstrations, from digital dentistry and implant aesthetics to marketing in the digital age.

LET’S GET CLINICAL

Now in its fifth year, and building on from the sell-out successes of previous ICDE events, UK and Ireland Managing Director, Darryl Muff, opened proceedings by welcoming guests and thanking them for returning for another year of comprehensive learning and success as he promised to introduce delegates to the latest developments in dental technology and innovation. With a strong emphasis on clinical lectures and case studies on Day One, it was Dr James Russell who took to the stage first with technician Luke Barnett. Together they presented a series of impressive case studies centering round case management, illustrating how through the combination of digital technology and close teamwork, clinicians and technicians can ensure patients are provided with highly aesthetic, predictable, natural restorations. Whether for treatment planning or impression taking, the duo discussed the impact of digital vs analogue techniques within our rapidly changing market and its role in improving communication, predicting a rise in expenditure on next generation 3D printing of $21 billion by 2020!

With audiences enthused by the digital opportunities presented on Day One, Ivoclar Vivadent’s, Carl Fenwick and Vicken Hatsakordzian took the opportunity to use Day Two to explain how, as a leading manufacturer, they’re committed to revolutionising the digital landscape.

Complementing the digital theory, dental technician Petr Mysicka’s key message proved that the success in achieving harmony and lifelike aesthetics with materials such as IPS e.max Press Multi or IPS e.max Power Ceram is a result of the ‘power of planning’. His cases emphasised the role of digital smile design (DSD), a technique which focusses on achieving consistent aesthetics through a systematic approach of diagnosis, communication, treatment planning, execution and case maintenance. It was Dr Nilesh R. Parmar who introduced the impact of digital technology in achieving harmony from an implant perspective, despite the next generation of clinicians being reticent to get involved with this treatment. With this in mind, Nilesh highlighted not only the benefits that implants can bring to patients functionally and aesthetically, but also how the role of digital technology, in the form of CBCT, can support the clinician throughout the treatment planning and case acceptance process, helping make this treatment offering more appealing and rewarding for the modern dentist.

DIGITAL VS. ANALOGUE

With a strong emphasis on digital throughout the two-day event, it was digital pioneer Dr Lee Culp who had truly embraced this method. With his US laboratory being completely digitised, from diagnosis, planning and fabrication, through to communication, his exciting presentation offered a unique insight into the replication of natural aesthetics, while focussing on proper function and occlusal harmony using CAD/CAM technology. Joining him on stage was dentist, Dr Lida Swann, who reiterated that the evolution of digital in dentistry is an opportunity to provide more efficient methods of communication between the dentist, technician and patient alike. She explained that the digital workflow, from start to finish, now gives the profession the ability to share function, aesthetics, diagnosis and treatment plans for truly aesthetic results. Taking an alternative view on the benefits of digital technology, technician Ian Smith and Dr Attiq Rahman explained why we’re not quite ready to lose the skills of the technician’s hands. Their debate compared the analogue techniques used for shade matching, bite registration and impression taking, with today’s up-and-coming digital methods. The aim of this controversial discussion was to help delegates make confident choices from the array of new digital technology entering the market.

Delegates were introduced to the new Ivoclar Digital portfolio, including milling and grinding machines, scanners and new software functionalities and interfaces, all designed to integrate the entire digital dentistry workflow. With these new developments, Ivoclar Vivadent proved they were the ideal partner to assist clinicians and technicians with material selection and digital processes in the design and production of quality restorations.

MARKETING THE DIGITAL WAY

A conclusive end to the two-day event was a captivating presentation on marketing from Chris Barrow who opened his talk with some staggering statistics. His revelation, with 60 trillion websites now online and 1.8 billion photos posted on social media every day, the influence of digital in practice/ laboratory marketing is pivotal to the successful promotion of any business. Chris also offered some insights into how impactful storytelling on your website can be for your business and shared some important trends that the profession should be embracing in the digital age of marketing.

AND FINALLY…

Hands-on demonstrations and networking opportunities were available throughout the event, as delegates could experience firsthand Ivoclar Vivadent’s products, whilst Day One concluded with an impressive casino-themed gala dinner and live entertainment at the King Power Stadium - famously home to Leicester City Football Club. Delegate and dentist, Dr Alif Moosajee, took time out of his Leicester-based practice to attend ICDE2017 and highly recommends the event to any clinician looking to

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enhance their expertise. “ICDE2017 was a brilliant two days, bringing together some fantastic and inspirational speakers. I found myself looking forward to Monday so that I could implement the wonderful stuff I had learned. Having such a high quality educational event on my doorstep in Leicester was ace, and the venue and facilities were excellent too. I will definitely be attending next time.” l For more information on Ivoclar Vivadent events, please call Ivoclar Vivadent UK & Ireland on 0116 284 7880 or visit www.ivoclarvivadent. co.uk or for more ore information on the Ivoclar Digital product portfolio and technical support please contact a Digital Specialist or visit www.ivoclarvivadent.co.uk/ laboratory-professionals • South and Ireland Vicken Hatsakordzian 07772 746780 • Midlands and North Tom Rolling 07817 441320 Twitter: @IvoclarUK Facebook: Ivoclar Vivadent UK & Ireland Instagram: @IvoclarVivadentUK

THE THREE ‘I’S OF DTS INNOVATION - Discover all the latest materials, services and technologies throughout the extensive trade exhibition, featuring more than 100 lab-dedicated suppliers and manufacturers.

INSPIRATION - Hear from an array of industry-leading speakers as they share their knowledge and expertise in the hope of inspiring you to raise the standard of your work.

INTEGRATION - Network with likeminded peers, while also catching up with old friends and new, either throughout the event or at the highly anticipated Dental Awards on Friday evening. With all this, plus hours of verifiable CPD, on-stand learning and live demonstrations, the Dental Technology Showcase (DTS) 2018 promises to be quite an affair. Don’t miss out - save the dates in your diary today! l DTS 2018 will be held on Friday 18th and Saturday 19th May at the NEC in Birmingham, co-located with The Dentistry Show. For further details, visit www.the-dts. co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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The Dental Technician September 2017/Vol 70 Issue 08

DENTAL NEWS uuu ORTHODONTIC TREATMENT PLANNING POSSIBLE WITHOUT RADIATION EXPOSURE NEWS REPORT FROM DENTAL TRIBUNAL INTERNATIONAL AUGUST 2017.

HEIDELBERG, GERMANY: When a patient requires orthodontic treatment, it is common practice to capture the dental malposition with a radiograph. Scientists from the Heidelberg University Hospital have now published a study in which an alternative treatment plan without radiation exposure was investigated. The study showed that magnetic resonance imaging (MRI) technology can provide accurate images of craniofacial structures. The researchers were able to prove that landmarks—important anatomical points in the upper and lower jaws—can be measured with MRI as accurately as in lateral cephalometric radiographs: “Compared with the radiographs,

we had very small differences, within the usual acceptable standard deviations. However, the great advantage of MRI is that it does not require any radiation exposure. Even though the radiation dose is low in dental examinations, it is preferable to avoid such exposure in children and adolescents,” said study lead Prof. Martin Bendszus, who now intends applying the technique on a larger scale. MRI technology could also be applied when 3-D imaging is required for specific orthodontic cases, for example in patients with severe malocclusion. In the study, 20 participants between the ages of 8 and 26 were examined and received an MRI scan and lateral cephalometric radiographs. Two experts then independently

EUROSTAT FIGURES ADD TO CONCERNS OVER SHORTAGES AFTER BREXIT

LUXEMBOURG: Despite some growth in the overall dental workforce within the last five years, the UK still has one of the lowest ratios of dentists per capita in Europe, only ahead of four other countries, latest figures released by Eurostat in Luxembourg indicate. Fewer dentists per 100,000 inhabitants were only found in the Netherlands, Slovakia, Malta and Poland, according to the EU statistical office.

after the Brexit. In a statement released in February, Dr Steve Williams, the Clinical Services Director of mydentist, one of Britain’s largest dental chains, warned that the withdrawal of EU dental professionals from the UK would be devastating and could add to an already understaffed workforce, particularly in rural areas. Currently, almost one-fifth of dentists registered with the General Dental Council are from the EU.

The ratio of dentists per capita in the UK falls significantly short compared with Germany, Sweden and Portugal, which have almost 60 per cent more dentists per 100,000 people. Greece were leading the list of the 28 EU member, states with over 126 dentists per 100,000 in 2014, followed by Bulgaria and Lithuania, which also saw the highest increase of all countries surveyed, with 21 more dentists compared with the number in 2009.

“Dentistry is one of the areas of NHS care that is most heavily dependent on EU-trained professionals. It will be vital to ensure that Brexit does not undermine our ability to provide NHS dental care by inadvertently disrupting the supply of dentists in the UK,” Williams said.

With almost 35,000 active dentists, the UK currently has the fourthlargest dental workforce in the EU after Italy, France and Germany. The figures have been made available at a time when there is increased concern of shortages in UK dental care owing to the large number of EU professionals feared to leave the UK

Similar concerns have been expressed by other medical bodies, like the British Medical Association, which recently conducted a survey among EEA-trained dentists and found that four in ten are contemplating moving to another country, after the UK split from Europe. Prime Minister Theresa May announced earlier this year that the UK would not remain in the single market, which provides freedom of movement, regardless of the trade deal negotiated with Brussels.

identified 18 important landmarks in the jaws, based on which a special computer programme calculated 14 angles and ten distances important for orthodontic treatment planning. A comparison of the data showed a deviation of a maximum of 3° for the angles and a maximum of 3 mm for the distances between the radiographs and the MRI images. According to the experts, these differences are within the tolerance range of imaging methods. Furthermore, especially for young patients, the short recording time of under 10 minutes is an advantage, they said, and the administration of a contrast medium is not required. The researchers see great potential for the new method. “We can improve diagnostics because, in the

future, we will also be able to offer clinical trials using 3-D analysis, which is even more accurate,” said Bendszus. He went on to explain that not only is dental MRI suitable for children, but it can also provide essential additional information in adult dentistry. Particularly for common dental diseases, such as periodontitis, MRI technology can be effective for early diagnosis based on soft-tissue changes. This is in contrast to a radiograph, which only shows changes in the bone structure. The study, titled “Lateral cephalometric analysis for treatment planning in orthodontics based on MRI compared with radiographs: A feasibility study in children and adolescents,” was published online on 23 March in the PLOS ONE journal.

TEN THOUSAND NHS PLACES ANNOUNCED FOR WALES

NEWS FROM THE INTERNATIONAL DENTAL TRIBUNE: JULY

CARDIFF, UK: Up to 10,000 new NHS dental posts are planned to be created in Wales, the national government announced on Tuesday. As part of the investment, over £0.75 million will be given to the Cardiff and Vale University and Aneurin Bevan University health boards, it also said: Overall, the Welsh government has pledged to spend an additional £1.3 million on dental services. In a press release, Health Secretary Vaughan Gething said that the effort is aimed at developing new and improved NHS dental services across Wales, particularly in places with higher needs and neglected areas, such as specialist paediatric dental services. “The investment in specialist paediatric dentistry will help improve NHS dental treatment and care for those children who are affected by dental disease,” he said. In addition to increased spending, the government said it

plans to introduce a clinically led dental e-referral management system. And intends to fund courses and training for people who intend to work as DCP’s dental care professionals.

BDA RESPONSE

According to national statistics, Wales falls significantly short of dentists per capita among all of the home nations. While it welcomed the investment, the British Dental Association said it is insufficient, as millions are taken away from dentistry each year owing to tough contract targets. “This money represents just a quarter of what’s been taken out of the system each year. Creative accounting does not constitute new investment. The best thing the Welsh Government could do is commit to ensure all money set aside for dentistry is actually spent on improving the oral health of children and adults in Wales,” said Katrina Clarke, Chair of the BDA Wales General Dental Practice Committee.

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BSC CENTRE OF DENTAL SCIENCES In September Barnet and Southgate College open the BSC Centre of Dental Sciences within the newly refurbished Southgate Campus, a dedicated state-of-the-art dental science training school. COUR SES O N OFFER: • Foundation Degree in Dental Technology – Level 5 • Higher Apprenticeship Dental Technician – Level 5 • Higher Apprenticeship in Dental Practice Management – Level 4 • BTEC Extended Diploma in Dental Technology – Level 3 020 8266 4000 info@barnetsouthgate.ac.uk www.barnetsouthgate.ac.uk/dentistry @BSCDentistry BarnetSouthgateDentalTechnology

The Dental Technician_Sept issue.indd 21

• Apprenticeship in Dental Laboratory Assistant – Level 3 • Diploma in Dental Nursing – Level 3 • Apprenticeship in Dental Nursing – Level 3 • Technical Certiﬁcate in Working in Dental Settings – Level 2

28/08/2017 20:23

The Dental Technician September 2017/Vol 70 Issue 08

DENTAL NEWS uuu

BITING AND CHEWING TRIGGER TOOTH GROWTH n SYDNEY, AUSTRALIA: Research conducted by the University of Sydney has found chewing and biting to be the cause of adult teeth breaking through the gums rather than an innate, unknown force. The researchers used CT scan images of an eight-year-old child’s mandible to design a 3-D model that could be used to observe the forces produced by the jaw when biting and chewing. The aim of the research was to show the stress dispersion within the jaw as a person bites and chews.

“We designed the hard and soft tissues in the jaw and input the data we had about jaw movements into the

software,” said Dr Babak Sarrafpour, an oral and maxillofacial pathologist and dentist at the University of Sydney. “We simulated both the back teeth and front teeth chewing and we could assess the stress on the teeth, bone and soft tissue.” The multidisciplinary team at the university found that the chewing and biting actions of the jaw deform the thin layer of soft tissue surrounding the teeth that are yet to appear, which forces them outwards. During the study, a number of other hypotheses were investigated that were still unsupported by clinical evidence. “There were a number of

INTEGRATING DENTAL TECHNOLOGY AND PRACTICE n

Dentistry has never been more of a team profession than it is today - everyone from the dental technician to the dentist and practice manager has a role to play in delivering excellent patient care. An integrated team approach is therefore crucial, and this is something brought to the fore at The Dental Technology Showcase (DTS). Co-located with The Dentistry Show, it is

the ideal place to network with both fellow technicians and partners in practice. “I think the co-location with The Dentistry Show is quite novel and it has made the event a lot better. I’m always impressed with the range of products here. I always recommend the show to my colleagues, and bring as many with me as I can.” Gregg Clutton, Technical Team Lead, Manchester Metropolitan University “I come here to see the new products on the market and to meet up with people from the industry. I really like the merger between the dentistry and technology aspects, as it’s really relevant to my role. I have attended lectures on both sides.” - Stephen Wears, Clinical Dental Technician, Your Smile Denture Clinic

hypotheses surrounding how adult teeth erupted. Perhaps it was from the root forming and pushing the tooth towards the oral cavity, maybe it was the blood pressure in the dental pulp or perhaps it was the periodontal ligaments forming and contracting, pushing against the tooth,” said Sarrafpour. However, a number of studies have shown that even with the disconnection of the root and the ligaments from the tooth, the eruption through the bone would still happen. Therefore, the researchers developed another theory. “Perhaps soft tissue dental

follicle around unerupted adult teeth acts as a mechanosensor in response to biting forces and remodels the surrounding bone in a way that carries the tooth to the mouth,” Sarrafpour explained. The team believes that this study could result in further preventive treatments that could change the tooth angle before it erupts, rather than depending on orthodontic bands or braces to realign the tooth later in life. l More information at the University’s of Sydney website.

Obstructive Sleep Apnea causes complications in implant-borne Prostheses REPORTED IN THE DENTAL TRIBUNE AUGUST 2017

for a complication to occur was 73 months’ post-implantation.

Contradictory to their initial hypothesis, the researchers found a high instance of complications related to OSA. Of the 67 patients included in the study, the researchers found that 16 experienced complications; 13 of which had OSA.

During the study, the researchers also noted a strong relation between individuals who suffer from OSA and those who suffer from bruxism. Past studies revealed that those afflicted with bruxism had a higher instance (6/10) of complications with implant prostheses than those without bruxism (13/75). This shows that people suffering from OSA and/or bruxism have a more difficult time with successful prosthetic implantation.

Among these 16 patients with complications, there were 22 prostheses with a total of 30 issues. The researchers found these complications consisted of porcelain fracture, fracture of the screw/ implant, loosening of the screw, and de-cementation. The average time

This study shows that 81 per cent of patients with OSA experienced complications with their prostheses. Given that the success rate of implants is reported to be between 92 and 97per cent, there is a strong correlation between OSA and prosthetic complications

Researchers, at OSI. Araba University Hospital in Victoria, Spain, published a study that investigated how Obstructive Sleep Apnea (OSA) affects implant-borne prostheses. The frequency with which a complication occurred and the type of complication were studied in 67 patients.

l DTS 2018 will be held on Friday 18th and Saturday 19th May at the NEC in Birmingham, co-located with The Dentistry Show. For further details, visit www.thedts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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The Dental Technician September 2017/Vol 70 Issue 08

DENTAL NEWS uuu

ALARM RAISED OVER ORAL HEALTH OF ELDERLY BRITS

NEWS FROM THE DENTAL TRIBUNE INTERNATIONAL AUGUST 2017

LONDON, UK: Oral health care in older people needs drastic improvement, leading dentists have said this week, as almost one in five Brits over the age of 65 are currently suffering from an urgent dental condition. According to a new report published by the Royal College of Surgeons (RCS), at least 1.8 million of over ten million in this age group live with dental pain, oral sepsis or extensive caries in untreated teeth.

government health services, local authorities, care providers and regulators have to step up their efforts to improve access to dental services for older people.

Conditions could become even worse in 20 years, when it is estimated that almost one in two will have severe dental conditions, the report predicts.

“As well as causing pain and making it difficult to speak, eat and take medication, poor oral health is linked to conditions in older people such as malnutrition and aspiration pneumonia,” commented Prof. Michael Escudier, Dean of the Faculty of Dental Surgery at the RCS. “We need to work together to ensure improvements in oral healthcare for older people.”

While adult oral health has seen significant improvement over the last 40 years, according to the RCS, too little is currently being done to help older people to maintain their oral health. It asserted that

In addition to improving access to oral health care for the elderly, the RCS recommended oral health training of key health professionals in acute and community care settings, such as nurses, junior

ANOTHER DENTAL STUDENT CHARGED WITH TERRORIST OFFENSIVES

doctors, pharmacists and geriatricians. It also suggested that social care providers should train their staff about oral health issues and ensure that oral health is covered by those services in their initial health assessments. Further measures should include the development of policies for hospitals to minimise denture loss

and increased efforts to monitor and measure older people’s oral health, the RCS added. “Dental health needs to be viewed as part of older people’s overall health, with health professionals and social care providers being trained to recognise and deal with problems,” Prof. Escudier said.

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AS REPORTED IN THE DENTAL TRIBUNE INTERNATIONAL AUGUST 2017.

LONDON, UK: Local newspapers are reporting that a dental student from Plymouth will have to stand trial for terrorist offences in London next month. The individual, Abdurahman Kaabar, originally of Upperthorpe in Sheffield, is accused of three offences of possessing records of a kind likely to be useful to a person committing or preparing an act of terrorism and four offences of disseminating terrorist publications. It is understood that the 22-year-old is a UK citizen of Libyan descent and is studying

dentistry at Plymouth University. He was arrested last week by South Yorkshire Police after an investigation by the North East Counter Terrorism Unit. Kaabar has been remanded in custody and will appear before the Old Bailey in September. He pleaded not guilty to the charges, according to court documents. It is unknown whether the arrest is connected to the arrest in June of another dental student from Sheffield, who was charged for the early attack planning of a terrorist attack and will stand trial in November.

Saturday 16th September Novotel Hotel, Hammersmith, London Register for free now!

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The Dental Technician September 2017/Vol 70 Issue 08

GC’S MAKOTO NAKAO RECEIVES ‘HIGHEST HONOUR’

mutually beneficial relationship between GC and the University of Turku in Finland has been acknowledged with special recognition for Mr Makoto Nakao (GC Corporation Chairman and President & CEO GC International AG), who has received an Honorary Doctorate from the University’s Faculty of Medicine. Mr Nakao was in good company at the 2017 conferment ceremony, with the faculty’s one only other Honorary Doctorate this year going to world-renowned expert in immunology and stem cell biology Professor Irving Weissman from Stanford University.

Conferment ceremony, University of Turku. Mr Makoto Nakao (2nd from right) LRP

composites for oral healthcare and especially composites for gerodontology. In 2013, this led to the manufacture of a dental composite that has since won five different innovation and quality awards.

Awards are not unusual for the Nakao family, which has run GC since 1921, but Mr Nakao said the doctorate from Turku University was his highest honour to date. “For me, this is the most significant personal recognition that I have received,” he told the audience at the conferment ceremony in Turku. His previous international honours have come from the business sector, science communities and governments. Mr Nakao said he started collaborating with the University of Turku in 1999, and that cooperation became even closer after the founding of the Stick Tech company. GC has had considerable success working with Turku Clinical Biomaterials Centre in developing preventive bioactive

A vital player in the GC-Turku partnership is Professor Pekka Vallittu, Director of the Clinical Biomaterials Centre. Prof Vallittu noted that GC is one of the world’s largest developers, manufacturers and sellers of oral biomaterials. He said that one aim of the collaboration was to give the University’s researchers information about the needs of the industry as early as possible. The 2017 Doctoral Degree conferment ceremony was doubly auspicious because the year marks Finland’s 100th anniversary. Rector Kalervo Väänänen reminded the audience that the Turku Finnish University Society was established just a month before Finland’s Declaration of Independence in 1917. The University of Turku was founded three years later, and honorary conferments began in 1927. l For further information please contact GC UK Ltd on 01908 218999, email info@gcukltd.co.uk or visit www.gceurope.com

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NORTHWOOD HILLS/ MIDDLESEX

DENTAL TECHNICIAN

APPLICATION CLOSING DATE 15TH SEPTEMBER 2017

Ceramist required with a minimum 3 years experience in all aspects of crown and bridgework, including Emax, Zirconia & Implant work. GDC Registration necessary. Salary will be discussed with the right applicant. Please send CV and covering letter to the following email address before the closing date: elaine@schoenitz.co.uk

Schoenitz Recruitment Ad_ful page_sept.indd 1 The Dental Technician_Sept issue.indd 25

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The Dental Technician September 2017/Vol 70 Issue 08

GENERAL DENTAL COUNCIL ANNOUNCEMENTS u

BUYING LEGITIMATE DENTAL EQUIPMENT IS VITAL FOR THE PROTECTION OF PATIENTS, SAYS THE GENERAL DENTAL COUNCIL

he General Dental Council is highlighting the importance of buying safe, legitimate equipment after a Dentist was suspended for three months for repeatedly buying counterfeit items online.

A Fitness to Practise investigation was conducted by the General Dental Council and was heard by the Professional Conduct Committee (PCC) on 7th July, where Hamza Tahir Sheikh admitted to a number of allegations relating to the purchase of the equipment.

“In all the circumstances, the Committee has determined to suspend your registration for a period of three months. In deciding on this period, the Committee took into account that it has no ongoing concerns about public safety.”

At a hearing this month, Hamza Tahir Sheikh admitted to buying noncompliant and counterfeit dental equipment from an online auction website. The equipment included five Yabangbang contra angle fibre optic handpieces, a NSK S Max SG 20 reduction 20:1 handpiece and one Skysea dental handpiece. These pieces of equipment, which he purchased to treat his patients with, were counterfeit and non-compliant - which means that while they may look like a branded product, they are not, and will not be tested to the relevant safety standards.

Mr Sheikh provided a reflective statement to the Committee which focussed on, and addressed, some of the issues which concerned the Council, including his insight. Mr Sheikh said that he had realised his mistakes, had undertook learning to improve his - and his staff’s - knowledge about compliant equipment and now keeps an inventory of all purchases. A spokesperson for the PCC said: “You have shown considerable insight into the findings made against you and have taken sufficient steps to reassure the Committee that a risk of repetition is unlikely.

Mr Sheikh will not be able to work as a dentist until the three-month suspension period has concluded.

The equipment was seized following two separate inspections carried out by the Medicines and Healthcare Products Regulatory Agency (MHRA) at Mr Sheikh’s practice. The MHRA regulate medicines, medical devices and blood components for transfusion in the UK.

“Furthermore, the Committee noted that no concerns have been raised about your skills and competence as a clinician. On the contrary, the Committee heard very positive evidence about your character and practice as a Dentist.

COMMENTS

Jonathan Green, Director of Fitness to Practice at the General Dental Council, said: “This case shows the importance of Dentists and DCPs adhering to the standards around compliant dental equipment. Non-compliant equipment endangers the health of both the patient and those using it and it is vital that all items meet safety requirements. “As set out in our Standards for Dental Professionals, all members of the dental team must understand and follow the law and regulations in this important area, which go to the heart of patient protection. They must always put patients’ interests first.”

Alastair Jeffrey, Head of Enforcement, at the Medicines and Healthcare Products Regulatory Agency (MHRA), said: “MHRA is responsible for protecting public health and we have seen a worrying trend in the number of websites and online market places offering to supply dentists with non-compliant/ counterfeit and potentially dangerous equipment. Dental patients are entitled to expect quality care, including the standard of the instruments and devices used by dental professionals. “It is vital that dentists and dental staff buy equipment from bona fide suppliers and avoid non-compliant or counterfeit devices. I urge all dental professionals to be cautious of seemingly cheap devices which may be unfit for purpose and potentially dangerous to patients and the staff that use them.” The British Dental Industry Association (BDIA), representing the dental industry in the UK, runs a counterfeit and sub-standard instruments and devices initiative highlighting to dental professionals the dangers of using fake and illegal dental instruments, in partnership with the MHRA. The BDIA also offers helpful advice of what dental professionals should do if they come across counterfeit equipment, or if they know another professional who is using them, and publishes a list of its member suppliers which is available here: www.bdia.org.uk Edmund Proffitt, BDIA Chief Executive, said: “The recent GDC hearing is a stark reminder of the seriousness of using of counterfeit dental devices. It may also sound alarm bells for any dentists who may have purchased from unreliable sources and emphasises the importance of purchasing from reputable suppliers.” l The General Dental Council’s role is to protect patients, regulate the dental team and to ensure that the public has confidence in dental services.

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The Dental Technician September 2017/Vol 70 Issue 08

TO ADVERTISE

IN THE DENTAL TECHNICIAN

T: 01372 897462 E: sales@dentaltechnician.org.uk

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The Dental Technician September 2017/Vol 70 Issue 08

FREE VERIFIABLE CPD As before if you wish to submit your CPD online it will be free of charge. Once our web designers give it the all clear there will be a small charge. This will be less than the CPD submitted by post. This offer is open to our subscribers only. To go directly to the CPD page please go to https://dentaltechnician.org.uk/dental-technician-cpd. You will normally have one month from the date you receive your magazine before being able to submit your CPD either online or by post. If you have any issues with the CPD please email us cpd@dentaltechnician.org.uk

4 Hours Verifiable CPD in this issue LEARNING AIM The questions are designed to help dental professionals keep up to date with best practice by reading articles in the present journal covering Clinical, Technical, Business, Personal development and related topics, and checking that this information has been retained and understood. LEARNING OBJECTIVES REVIEW: n Strength of Zirconia. n Implant planning n Customised Special trays n Business of Management LEARNING OUTCOME By completing the Quiz successfully you will have confirmed your ability to understand, retain and reinforce your knowledge related in the chosen articles.

Correct answers from August DT Edition:

Verifiable CPD - SEPTEMBER 2017 1. Your details First Name: . ................................................Last Name: ............................. Title:.................. Address:................................................................................................................................. ............................................................................................................................................... ........................................................................................Postcode:....................................... Telephone: ..................................... Email: . ..........................................GDC No:.................. 2. Your answers. Tick the boxes you consider correct. It may be more than one. Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

Question 9

Question 10 Question 11 Question 12 Question 13 Question 14 Question 15 Question 16

Q1.

Q2.

Q3.

Q4.

Q5.

Q6.

Q7.

...............................................................................................................................................

Q8.

Q9.

...............................................................................................................................................

Q10. B. Q11. C. Q12. C. Q13. B. Q14. C. Q15. B. Q16

3. Evaluation: Tell us how were doing with your CPD Service. All Comments welcome.

As of April 2016 issue CPD will carry a charge of £10.00. per month. Or an annual fee of £99.00 if paid in advance. You can submit your answers in the following ways: 1. Via email: cpd@dentaltechnician.org.uk 2. By post to: THE DENTAL TECHNICIAN, PO BOX 430, LEATHERHEAD KT22 2HT Payment by cheque to: The Dental Technician Magazine Limited. Natwest Sort Code 516135 A/C No 79790852

You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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The Dental Technician September 2017/Vol 70 Issue 08

VERIFIABLE CPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN REMOVABLE IMPLANT RETAINED RESTORATION

Q1. A. B. C. D.

What is the Misch Classification for this case? RP. 2. RP. 3. RP. 4. RP. 5.

Q2. A. B. C. D.

What was the first restoration provided? A reline of the upper denture. A provisional prototype denture. A temporary bridge on the implants. A temporary bridge on provisional implants.

Q3. A. B. C. D.

What treatment was required on the lower remaining teeth? Extractions and provisional crowns. Orthodontic movement. Endodontic treatment. Periodontal treatment.

Q9. A. B. C. D.

What was the first firing of the Celtra Press after pressing.? Power firing. Incisal edge build-up. The dentine build-up. Opaque layer.

Q10. What is the brand new charity? Give Dental. A. Teeth for all. B. Dent-Tech. C. Smile-Away. D. Q11. What is it’s stated Aim? To teach technicians how to make good restorations. A. B. To provide affordable restorations for the needy. To teach Orthodontics in Africa. C. D. To provide low cost technical Instruments. DENTAL NEWS

Q4. A. B. C. D.

Why was a clear replica denture made? As a special tray and for occlusal registration. As an example for the patient to assess. To test for phonetics. To test retention.

Q12. How has the radiation been reduced for Orthodontic patients? A. By Taking Photographs. B. By Using CT Scans. C. By Using Computer Tomography. D. By Using MRI Scans.

Q5. A. B. C. D.

How was the Implant position recorded? With a separate impression. Using a digital scanner. Connected to the replica impression with low shrinkage resin. Using a separate resin matrix.

Q13. In what other dental areas can the Technique be used? A. Shade taking. B. Measuring occlusion C. Finding Caries D. Diagnosing Periodontitus

A SINGLE TOOTH REPLACEMENT.

MARKETING SIMPLIFIED

Q6. A. B. C. D.

What material was used for the new crown? All porcelain re-enforced with Alumina. All porcelain zirconia lithium silicate and feldspathic ceramic. Lithium Disilicate, Zirconia re-enforced. Glass ceramic zirconia re-enforced.

Q14. What is Blogging known as in marketing? A. Gossip driven Marketing B. Discussion driven Marketing C. Educated based Marketing D. Virtual based Marketing

Q7. A. B. C. D.

What is the software used for this construction? Dental Wings D40 Z. Itero 853 T. Dental Designer 3Shape. Sirona 1521.

Q15. A. B. C. D.

How many words per blog are recommended? 650 300 500+ 700

Q8. A. B. C. D.

How was the wax-up produced? By CAD and milling from wax block. Traditional method. By 3D Printing. From pre-formed wax teeth.

Q16. A. B. C. D.

What is particularly good about blogging? Don’t have to talk to the dentist. It improves Communication. Its impersonal You don’t have to do it regularly

Payment by cheque to: The Dental Technician Magazine Limited. NatWest Sort Code 516135 A/C No 79790852

You can submit your answers in the following ways: 1. Via email: cpd@dentaltechnician.org.uk 2. By post to: THE DENTAL TECHNICIAN LIMITED, PO BOX 430, LEATHERHEAD KT22 2HT You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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The Dental Technician September 2017/Vol 70 Issue 08

OTA CONFERENCE 2017 MANCHESTER CONFERENCE CENTRE & THE BRITANNIA HOTEL, SEPTEMBER 15TH AND 16TH 2017

PAUL MALLETT

OTA CONFERENCE CHAIR

Paul is a Maxillofacial laboratory manager for University Hospitals of Morecambe bay NHS Foundation Trust and Consultant MPT. He also works as Associate lecturer at the Manchester Metropolitan University’s courses in Orthodontic Technology. He served as Secretary and now Chairman of the Orthodontic Technicians Association (UK), and as past President for the Dental Technologists Association. He´s also served as co-opted DCP member on the GDC’s registration committee and continues to lecture at the Manchester Metropolitan University’s courses in Orthodontic Technology. In 2014 he was the recipient of the British Orthodontic Technicians Award to an Orthodontic Technician for Distinguished Service.

n 2017, the OTA Conference will be held in Manchester alongside the BOC for the second time. The venue will be the Manchester Conference Centre and the OTA Hotel will be the Britannia Hotel. We hope you are able to attend the conference and look forward to seeing you there. Please see below for registration form and complete either the resident delegate, non resident delegate or sharing resident delegate section of the form.

SPEAKERS AND TOPICS:

CORE CPD WORKSHOP SESSIONS Edward Mapley - Medical emergencies Andrea Johnson - Interactive infection control for the dental team Paul Mallett - Title TBC (Topic: materials and equipment) LECTURES Daniel Shaw and Edward Mapley Innovate to Inspire Change Thomas Bussman - Digital orthodontics - where does the manual work remain?

Roger Harman - Holistic orthodontics: what is behind it and what is there to be learned? Raya Karaganeva - What can we do to increase the usage of custommade mouthguards in sport? Jeff Lewis - Where next for dental technology education? Nicky Mandall - TBC

Stefano Negrini - The new frontier: An overview of digital orthodontics David Sainsbury- Face Transplantation - The Newcastle Experience Hemendra Shah And Pradeep Anand - Title TBC (Topic: orthognathic treatment) l Visit: www.ota-uk.org

REGISTRATION FORM

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The Dental Technician September 2017/Vol 70 Issue 08

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The Dental Technician September 2017/Vol 70 Issue 08

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