The Dental Technician Magazine August 2020 by The Dental Technician Magazine

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VO L 7 3 N O. 8 I A U G U S T 2 0 2 0 I B Y S U B S C R I P T I O N

THIS MONTH...

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

D5 THINGS I CANNOT WORK WITHOUT! BY CHRIS GOLZE PAGE 10

WORKING DURING LOCKDOWN: PART 1

BY ANDREA JOHNSON PAGE 14

THE PAST IS IN YOUR HEAD, THE FUTURE IS IN YOUR HANDS A LOOK AT A CHANGING DENTURE LAB

By Ashley Byrne PAGES 18 & 20

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CONTENTS

Editor Matt Everatt F.O.T.A. E: editor@dentaltechnician.org.uk Designer Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602 Editorial advisory board Andrea Johnson Ashley Byrne Ross Chapman Sharaz Mir Sir Paul Beresford Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician Magazine 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. Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH

Extend your subscription by recommending a colleague There is a major change in CPD coming soon. The Dental Technician Magazine is a must read. Tell your colleagues to subscribe and if they do so we will extend your subscription for 3 months. The only condition is that they have not subscribed to the magazine for more than 12 months. Just ask them to call the Subscriptions Hotline. With four colleagues registered that means your subscription would be extended for a year free of charge. At only £39.95 per year, for UK residents, this must be the cheapest way of keeping up to date. Help your colleagues to keep up to date as well. Ask them to call the subscriptions Hotline on 01202 586 848 now.

CONTENTS

AUGUST 2020

Welcome Welcome from the editor Welcome to your editorial panel

6 8-9

Technicians Insight 5 things I cannot work without! Chris Golze The role of a GDC clinical adviser and clinical exper: Shamir Mehta Work-Life-Balance: A Dental Technicians Story Jinesh Patel

10 11 13

Health & Wellbeing I don’t have time to have a lunch break! Helen Everatt

Focus Working during lockdown: Andrea Johnson 14-15 Returning to work post COVID: A Clinical Dental Technicians perspective: Ross Chapman 17

Digital Dentistry A look at a changing denture lab: Ashley Byrne

18 & 20

Insight From the archives A look at the DTGB Facebook Group

21 22

Marketplace Zirkonzahn/Save Labs, Buy British/VITA

22-23

ECPD Free Verifiable ECPD & ECPD questions

24-25

Business Adopt a growth mindset for your dental laboratory: Matt Everatt An interview with Malcolm Murton Dental laboratory stress and how to overcome it: Mark Oborn A New Normal Day In The Life Of A Product Specialist: David Claridge

26 27-28 28-29 30

Marketing Marketing Simplified by Jan Clarke

Dental Technology Anterior tooth esthetics with VITABLOCS RealLife and VITA Akzent Plus stains Highest quality - it´s always the best choice: Matteo Neroni

Classifieds

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WELCOME

Welcome

TO YOUR AUGUST 2020 ISSUE By Matt Everatt F.O.T.A I Editor

hat a crazy start to the summer as I write my welcome letter in my 2nd Edition as the new Editor. Last month we rightly paid homage to the wonderful late Mr Larry Browne. This month, where we would normally be thinking of closing our labs down or operating a limited service as we think of travelling to sunnier climates, instead lots of us are worrying about the future of the Dental Profession as we begin to ease out of ‘Lockdown’ and start reopening our labs up again.

been poorly represented and on the whole has been forgotten. As a Lab owner, it has been so frustrating and worrying. I do believe lots of labs, particularly those undertaking predominantly NHS work are struggling with low number of cases being received. It appears that the latest news from Sara Hurley – CDO, is another nail in the NHS dentistry coffin. Is this the end of NHS dentistry? If it is, maybe this will be a good thing for labs in general? Despite the previous months being a disaster in terms of business, I am hopeful

for our futures and I wish you all the very best in your jobs and your own businesses. I do hope you enjoy the new features we have introduced to the magazine. The Business and Health/Wellbeing sections are ones close to my heart. As a business owner I am constantly looking for ways to improve my health, wellbeing and improve my business skills. I look forward to hearing feedback from you all and hope to encourage some of you to consider writing some articles and contributing to future issues.

As we look back on the months that have passed us by, lockdown has brought on many challenges for us all personally and professionally. For some, it has been a great time to catch up with families and spend some quality time with those we are usually too busy to be with. For others it may have taken its toll mentally and I have sadly heard of one too many people who have suffered with their mental health, some who have been close to mental breakdowns and sadly those who have taken their own lives. As I return back to working life with some kind of normality, I reflect on my own experience. The first week was fantastic. We had just moved house, what a great time to unpack, get some decorating done and spend some time with the family. Then reality kicked in, boy did it kick in. Will the 15 years we had spent building a business be wiped out overnight? Would we be able to pay the new mortgage? Will we lose staff? Will we ever get back to normal? When on earth will dental practices reopen? My sleep was a mess, I was really overthinking everything. The best distraction was keeping busy and that I did. When I had some downtime from the family, I would scour the dental forums and social media in hope to find some news that this was all over and we can start up again. When the news broke that June the 8th was the day practices could reopen I did a huge sigh of relief. The whole profession has

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WELCOME

WELCOME TO THE EDITORIAL PANEL ANDREA JOHNSON

with us by sending in your articles, technical walkthroughs, hints, tips, job vacancies, funny stories, serious stories and by getting stuck in to the awards scheme recently started up. Please showcase your work, let the world see how awesome you are.

l As a new addition to the editorial panel of the Dental Technician I would like to introduce myself. I am a full time working Orthodontic & Maxillofacial Laboratory Manager, deputy lead for OMFS clinical governance and Quality Improvement Coach at Montagu Hospital, Mexborough. I am also the current Chair and publicity officer for the Orthodontic Technicians Association (OTA) and the cofounder/Chair of registered charity Den-Tech. It is a great honour and privilege to be asked to join the editorial panel of the Dental

Also please ensure you send us any feedback on how we are doing, what we could improve and what you would like included. This is your magazine so let us know what you want from it.

Technician magazine, I hope my knowledge and skills will be of use and I know there are some amazing ortho techs out there who I hope will support the magazine by working

If any of you want to speak to me directly please feel free to email me at andreajohnson0705@gmail.com as I would love to have a chat and help in any way that I can.

ASHLEY BYRNE

Ashley says:

l Ashley is a hands on technician who owns and runs Byrnes Dental Lab near Oxford.

“It is with great honour that I have been invited to join the editorial team of the Dental Technician which was headed up by the legend of a dental technician, Larry Browne.

Ashley has always been passionate about changing the industry by using exciting and cutting edge technology and encouraging the young into this incredible industry. As milling and 3D printing dominates dental technology, Ashley continues work with his team to push the boundaries of high tech manufacturing.

Larry was pivotal in driving change in our industry and I hope I can try and follow in his footsteps. I have been asked to assist Matt and the team on Crown and Bridge, Implants and high tech solutions and hope to take the Dental Technician to new levels, exactly what Larry was aiming to do.”

Out side of work he is a keen cook and BBQ’er and has a small holding for goats and chickens.

ROSS CHAPMAN PG DIP CDT ( UCLAN 2014 ), PG DIP MPT ( MMU 2005 ) , RDT l Ross originally qualified as a dental technician from Newcastle College and Dental Hospital in 1998. He went onto a fulfilling career in the military working as a maxillofacial prosthetist and technologist (MPT) supporting the British forces in both the UK and overseas before founding Chapman Dental Solutions prosthetics laboratory in 2008.

Ross has completed extensive postgraduate training in Clinical Dental Technology at the University of Central Lancashire which qualifies him to work alone or alongside dentists and implant specialists as part of a multidisciplinary team to treat patients, designing and fitting implant retained solutions and his bespoke cosmetic dentures.

Ross is committed to professional development and has completed postgraduate studies in advanced orthodontics, advanced prosthetics, implantology and a postgraduate diploma in and Maxillofacial Prosthetics and Technology at Manchester Metropolitan University. He enjoys all aspects of dental technology with a special interest in treating patients directly in clinic, digital dentistry and implant retained prosthetics.

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Ross works from our own clinic in Whickham and visits dental practices throughout the North East working freelance for clinics as a Clinical Dental Technician to provide patients with implant and denture solutions. Ross is married to Emma and they have two young sons.

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WELCOME

SHARAZ MIR

It seemed foolish having spent so much time in the laboratory market not to be directly involved in it, so 5 years ago we decided that we should enter the laboratory market as we saw we could apply the same personable approach to great effect.

l Having qualified as a technician from Guy’s Hospital in 1993 and knowing then dentistry was my future, I however knew then I didn’t want to spend the rest of my life at then bench, what that was then I still didn’t know, but knew I wanted to continue in education. I went on to complete further degrees in Dental Technology at The University of Sheffield which is where my interest in all things digital came about as my final year dissertation was to develop a Computer Aided Learning (CAL) application teaching dental students how to pour up an impression! CAL was in its infancy at that time, so I wrote and designed the software myself and was lucky enough to present my system around the country at the time, and this is where my paper was actually published in DT magazine, pretty proud moment to be honest! After leaving University I had a brief stint with a pharmaceutical company as a regional sales manager and then ended up at a Sirona specialist dealer as their public sector sales manager looking after the UK sales within the public healthcare and corporate markets. During my time here I specialised in the field of diagnostic imaging becoming one of the very few UK specialists in digital dental imaging for Sirona at the time. I personally managed some of largest public sector projects throughout the UK during the boom in Primary Care Group’s and Trust builds where I gained valuable insight into project management and customer

care. Those 7 years spurred me on to set-up my own company taking those values and applying them to my now 16 year established business, Blueprint Dental. Our philosophy is to offer a personable approach to supply management and have teamed up with a number of quality manufacturers allowing us to facilitate this ‘blueprint’ to the UK market. I have now a keen interest in everything 3D, Imaging and Printing alike with new developing technologies like Optical Coherence Tomography and Multi Wavelength Volumetric 3D Printing, further to my historical involvement in a European CRAFT project to help develop a new intraoral scanner in early 2000.

The lab market has seen major changes in processes over the years, especially as now digital dentistry has established a major foothold here, we can see this are one of the major influencing tools that will progress the industry greatly. We are however still a very analogue based industry, and understandably so, as without this analogue understanding we would not be able to function these new digital technologies. Until we move to 100% digital based industry, which I don’t see for the foreseeable future, and even then, we will still be subjected to many airborne fumes which has potential carcinogenic affects. With the advent of COVID-19, I have been heavily involved in the development and distribution of new affective air purification systems for both surgery and laboratories. I am keen to highlight through DT Magazine that maintaining a clean and hygienic working environment isn’t something to ignore–it’s critical to the dental industry. In a dental laboratory where aluminium oxide, gypsum, glass ceramic, airborne metal particles, zirconia and pathogens can threaten your business, air quality can have a significant impact on the health and wellbeing of you and your team. In the top 10 of ‘Unhealthy Occupations’ the dental industry has five top ten unhealthiest, technicians being Number 7!!

SIR PAUL BERESFORD BDS MP l Paul Beresford is one of a third-generation of New Zealand dental professionals. His grandfather, was head of the Beresford dental family tree, qualified through apprenticeship training in Auckland, New Zealand to practice in Taumarunui in the centre of the North Island. He was renowned for the quality of his gold work particularly anteriorly gold inlays prior to the invention of tooth coloured silicate anterior fillings. He did his own technical work as well as the dentistry. He had two sons, both of whom became dentists through their primary degree from Otago University Dental School in Dunedin New Zealand. Dr Jack Beresford a becoming a practising private orthodontist in the West End of London and long-term consultant at the London Dental Hospital. Second son, Raymond Beresford became renowned for the quality of his denture prosthetics in his private practice in Nelson

New Zealand. Like his father he did all of his Full/Full articulated setups. He married Joan Macdonald a dental technician, trained at Otago University and practising at Dunedin Hospital and Dental School during the tail end of the Second World War. They had two sons. Mark Beresford, the youngest son qualified as a dentist and then postgraduate orthodontist through Otago University, practising in Auckland and consultant at a specialist cleft palate/ hare lip unit in Auckland. Paul, the eldest son also graduated at Otago University Dental School, emigrated to London, practised NHS in East London, in a mixed practice in SW London, private only practice in Park Lane, London. This was coupled with a year at the Eastman restorative dentistry unit. At the Eastman he did his own Crown & Bridge technical work and also like his father preferred to do his denture set ups himself.

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Although now a full-time MP, the House of Commons allowing, practices a few hours of private only dentistry a week, concentrating on restorative dentistry with a specialist Crown Bridge technician working within his practice in South West London. He worked for some time with Larry Browne promoting better understanding and partnership between dental technicians and dentists promoting dentistry as part of health in the UK.

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TECHNICIANS INSIGHT

5 THINGS I CANNOT WORK WITHOUT! With Chris Golze I Owner of XS Guards and Dye & Golze Dental Laboratory - Doncaster 1. SCHEU MINISTAR

This machine gives fantastic results when forming, especially when layering for mouthguards. I’ve used other machines but found the Ministar allows the user to be in control (good if using different brands of foils) and still produce a great press.

2. WEEDING TOOL

Some of the graphics we produce are quite intricate and require the waste material to be removed by hand tool. My weeder is a modified surgery instrument and has saved me many hours of bench time!

3. PHOTOSHOP

This is the first of our new monthly feature where we speak to fellow technicians about the top 5 things they simply could not work without. Chris Golze, owner of XS Guards shares his top 5 with us. We look forward to seeing what other wonderful items technicians cannot work without over the company months.

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Other graphics software is available but personally I’ve not found anything as user friendly! I don’t use anywhere near all of the features it has and I couldn’t produce and manipulate some of the graphics without it! About 15 years old now and superseded by many updates. It’d be worth paying for again!

4. ASH NUMBER 5

Years of use have shape my number 5 into what is probably my favourite hand tool. This has evolved with me throughout my 25+ years in the lab. A hand me down as an apprentice, it’s definitely blunter and looking a bit sorry for itself (a bit like myself ). I don’t think I have enough bench time left to break another one in!

5. MY HANDS

Like a lot of technicians my hands are the most important tool I have. Many of the stages in each field of our profession now involve machines that are computer controlled. These machines and the software are extensions of our hands. The manual skills are still relevant to make something individual stand out from a ‘library’. Embrace the technology but don’t forget that it still requires manual skill to make the best of it.

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TECHNICIANS BAR INSIGHT HEADER

THE ROLE OF A GDC CLINICAL ADVISER AND CLINICAL EXPERT With Shamir Mehta BDS BSc MClinDent (Prosth) (Lond) FICD FFGDP(UK) FDS RCS (Eng) FDS RCPS (Glas) I Senior Clinical Dental Advisor, General Dental Council

gained my BDS qualification from King’s College London (KCL) in 1996. I am a general practitioner, and a Senior Clinical Teacher and Deputy Programme Director for the MSc course in Aesthetic Dentistry at KCL. I’ve been interested in dento-legal matters since I was in my fourth year as an undergraduate. In 2014 I found myself seeking a new and exciting challenge, so decided to apply to become a clinical adviser and clinical expert for the GDC. These roles interested me because they allowed me to broaden my horizon and use my skills and knowledge outside of my normal surgery setting. The thing that made them particularly appealing to me at the time was that they didn’t require any formal legal training or dento-legal experience. What they did require were my skills and experience that came with being a practicing dental professional.

Clinical experts provide a similar role at the hearing stage. Their opinion assists the hearing panel members to reach a decision on concerns raised in relation to conduct or performance. My decision to join the GDC in an associate role was based on the interest that I had developed early in my career, as well as the desire to join a progressive organisation. I felt I would be able to make a valuable contribution towards an improving and fairer system of dental regulation.As a career decision, I am confident that it was the best decision I ever made.

I have very much enjoyed and continue to enjoy my roles at the GDC and am proud to have been involved in some of the policy and strategic changes that have taken place over the past few years. I have found colleagues at the GDC to be very welcoming, willing to listen to dental professionals and have a good understating of the circumstance’s dental professionals experience daily. I would strongly encourage anyone looking to get involved in report writing and working with the GDC to explore the clinical adviser and clinical expert roles.

In my role as a clinical adviser, the primary task is the preparation of clinical advisory reports. The purpose of the clinical advisory report is to provide an opinion relating to an assessment of the dental professional’s standard of professional practice, set against a level that would be reasonably expected of a dental professional working within the same discipline. These reports help caseworkers to determine whether a fitness to practise case may be closed at the assessment stage, or if it needs to be progressed to case examiners, and potentially, a practice committee.

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HEALTH & WELLBEING

I DON’T HAVE TIME TO HAVE A LUNCH BREAK! By Helen Everatt Nutrition Coach

utrition coach Helen discusses the importance of eating healthy and planning breaks in the Dental Laboratory.

Health (as defined by The World Health Organisation): “State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity." How do we ensure our labs are not just absent of diseases and infirmity, but are also places of physical, mental and social well being? I believe nutrition has a significant role to play here. It is well publicised that we are experiencing an obesity epidemic. The cost of obesity related illness, type 2 diabetes, heart disease, stroke… is crippling the NHS. Is it damaging our workplaces too? Our working environments have an important role to play in our health, we are after all spending on average 40% of our waking hours there. In this article I am going to discuss one vital area that affects our health in the workplace, lunch breaks. Skipping meals, eating at our benches or in front of a PC, relying on snacks instead

of a nutritious meal, leaves no time to rest, move, talk and re-focus in preparation for a productive afternoon.

nothing and it could make all the difference, not just to your health but to your productivity in the afternoon too.

Did you know lack of adequate sleep and rest lead to overeating? Restrictions lead to binges. As a Nutrition Coach, I know this only too well. Coaching clients who have in the past or are in the present restricting themselves of meal times and food in general, only end up binging on fast, convenient sugary snacks to give them the pick-up they need to get them through the rest of their working day. Sound familiar?

Snacks are killing the lunch break

“I don’t eat lunch because I don’t have time/I’m not hungry/ I’ve got too much work to do/my boss doesn’t so I don’t feel I can...” sound familiar? Parkinson's law is the adage that "work expands so as to fill the time available for its completion". Deciding at 8:30am that you will be breaking for lunch at noon for 45 minutes gives you a deadline to complete the mornings tasks. There is time, if you decide to make time. It may require planning, staggered lunch breaks, turn taking, even 25 minutes is better than

Eating too frequently, grazing throughout the day is confusing for your body. It disguises hunger and fullness signals, making them harder to identify, often leading to over consumption of food and calories, leading to weight gain. In my experience, despite perhaps the volume of snacks being less than a meal, the calorific value is often far greater (not to mention the sparse nutrient value). This is a topic I regularly discuss in coaching sessions with clients. So, the resolution?

Planning and Preparation

Planning meals ahead of time, writing a shopping list and preparing meals in advance. This doesn’t have to be difficult. It may be as simple as doubling up on the ingredients for dinner the night before and filling tupperware to take to work for lunch. If I have a spare evening I will batch cook chillis, curries and soups and keep dozens of pots in the freezer ready to defrost at lunchtime. It is a chore that once practiced, becomes easier and second nature. It is cost effective and a whole lot healthier than Uber eats. My challenge to you is to lead by example, ditch the snacks, stop the starvation and come to work prepared. Dig out the tupperware, freeze your leftovers or pop to the supermarket and buy some fresh soup, salad or even a fresh healthy microwave meal. Take the time to sit, eat, value the break from a mornings work, enjoy the time catching up with colleagues, nurturing workplace relationships. This is the time to eat nutritious food, get sustenance, nourishment, and refuel. It will have a significant impact not just on your health, but on the health of your working environment too. Helen Everatt, Nutrition Coach, Mission Nutrition W: www.missionnutrition.co.uk Insta: mumonmissionnutrition FB: iloveMissionNutrition

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TECHNICIANS INSIGHT

WORK-LIFEBALANCE: A DENTAL TECHNICIANS STORY

With Jinesh Patel I Managing Director, S4S London limited

or many years, our industry has suffered the wrath of an unhealthy balance of work and lifestyle. Watching it firsthand I would like to share this story for you as readers and hope that we as an industry can look after ourselves and reignite the fire which once encouraged many of us to join this thriving industry. The story starts with my Father a talented artist out of Uganda, Africa – Hiten Patel. His ambitious mindset brought him to a career which he had no knowledge of, but was close to what his heart desired most, Art. He used his exceptional skills in Art and manual dexterity to pursue himself in learning the trade of an orthodontic technician. His career excelled and became one of the most talented technicians I have ever seen with no background in this area of work. He quickly found himself not knowing how to manage the customers who required the work of his hands. So, the only way he knew how was to work long mind bearing hours and for 25+ years he did just that. We have all felt this before and I am sure many of us have had adverse effects in ways that are unimaginable. From health and wealth, family and friends, relationships and marriages all affected by our inability to switch off. So how do we go about resolving this? How do we move our mindset away from this day to day routine that tears us down?

with our workflows and made growth slow. From those days to now we have seen many changes in our business. here are a few things that helped us excel: 1. Introduction of digital printing 2. Digital management of invoices 3. Encouraged hiring of staff (we are not superhuman and we cannot do everything!) 4. Went and actually learnt new techniques to bring to our armoury. 5. And finally, the launch of a new partnership to form S4S London Limited.

ACKNOWLEDGE YOUR STRENGTHS AS AN INDIVIDUAL

Our successes depended on the ability that we acknowledged we cannot do this single handed. We used our strengths to get as far as we could and then started hiring for the areas which required skills that we did not possess. We implemented a manager, process workers and a marketing assistant which abled us to focus on our own individual strengths. Hiten focussed on his technical ability to manufacture jobs in a swift but affective manor, sangita (also known as mum) was our administrative powerhouse and myself who built

EMBRACE CHANGE

FINALLY, FREE UP TIME TO ENJOY OTHER BEAUTIES OF LIFE

Now this is a huge part of breaking the routine. As technicians we do not know how to free up time. We will happily pick up those tools and continue working to get ahead, sometimes working crazy long hours and into the weekend. This was our biggest challenge and time to time we get caught back into it. We set out our strategy to make sure we do a normal 9-5 and then leave work at work and spend the rest of the time focussing on ourselves. The realisation of freedom to the mind was the biggest change in our business which made us make clear cut decisions to succeed. We managed to find a work life balance which got the work done effectively and yet spend those precious moments with our loved ones. We have made some incredible changes in recent times to our mindset which has developed our business and broken our ‘tech’ trend of over working ourselves, being miserable and suffering from our work life imbalances. I would like to finish on the quote ‘Be the change you want to see’ and try and implement this in the three points written in this article; Embrace change, acknowledge your strengths and free up time to enjoy other beauties in life.

One of the hardest things we did was to break routine and embrace change. For years we ran our business in a ‘routine like way’ which disabled us from being able to enable growth. This means that we became content

“

relationships with all our clients provided them a personal experience never to be forgotten. This trio of skills came together and propelled our customer base rapidly and gained the personal touch that or customers know and love us for.

Embrace change, acknowledge your strengths and free up time to enjoy other beauties in life. www.dentaltechnician.org.uk

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FOCUS

WORKING DURING LOCKDOWN By Andrea Johnson

PART ONE

So, I have been told many times, by many people, tell us your story of what you were doing over the lockdown period, they will be interested. This is what I am told, but will I come across as whinging? Probably. Do I have the right to whinge? Not really, but why shouldnâ&#x20AC;&#x2122;t I? I tell you what, you be the judge, because we live in a messed-up world where everything is topsy turvy and all our emotions are all over the place. I must say that although I have tried to keep this fairly short, I have failed miserably and so this will split it into 2 parts and printed over two issues. So where to start? at roughly the beginning I reckon is the best. So end of February ish? There were news stories of Covid-19 reaching us, there was talk of us needing to go into lockdown for an unspecified period of time. I had things I needed to do quickly before I wasnâ&#x20AC;&#x2122;t allowed to do them anymore. I have been working, on behalf of DenTech, with a lady called Dee Weavil who runs a medical centre over in Uganda called the Destiny Medical Centre, she had contacted us for help in setting up a fully functional dental laboratory in the medical centre to compliment the dental clinic that Dentaid were helping her establish within the centre. I had a shed load of donated materials and equipment from DenTech that I had to get to down to Southampton hopefully in time to beat the lockdown so it could be shipped. I hired a van, took a day off work and drove over 500 miles in a one day round trip to get it all collected up from various locations and dropped off in Southampton and back home again. Phew! Did that in time. My daughter called me, she was studying her BSc hons at University of Manchester and said if this is all kicking off and I

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FOCUS am going to have to go into lockdown I would rather do it at home. Yey! I drove to Manchester and picked my kid up and brought her home. This made me a happy mum, she was safe and well and at home with me. Next I wanted to go and see my mum and sister who lives in North Wales - 2.5hr drive from my house in Nottinghamshire. My mum has COPD and no working immune system, would this be the last time I see her alive? I had no idea, at least one of my sisters lives only a 5 minute drive away from my mum so I knew she would be well looked after. My Sister and brother in law are key workers too though and still had to work and my mum was no longer allowed to look after my two nieces. Tricky, sad and stressful for all concerned. Also, what if they got ill and had to self-isolate? Who would look after my mum then? So many things to worry about but also I knew worrying would do no good, it would help no one so we just did what we could and knew we would have to deal with whatever happened when it happened. After all we had no idea how long or how serious any of this would be. After seeing my mum and sister I returned home with only 2 days until the lockdown was official.

To be fair they were all super lovely people who I was now working with, the normal team who did the fit testing were needed elsewhere to train up more staff who had been redeployed into other areas, staff were being moved all over the place, walls were being put up left, right and centre within the hospital to block off key ‘yellow’ covid areas and ‘blue’ non covid areas it was chaos, organised chaos but still.

Pretty much straight after this our world was tipped upside down, all dental related work came crashing to a sudden halt, we had no idea how long for? What were we to do next? We were waiting on word from the Chief Dental Officers office, the government, my NHS trust etc as to what happens from here. Now I am not going to get all political about this because the proverbial really did hit the fan for almost every industry and workplace out there, this was a unique situation and nobody had the faintest idea what we were doing, so ranting about that with the benefit of hindsight really is not fair. I just hope we take some serious lessons from this and are much better prepared should anything like this happen again. Anyway, needless to say I still had a few cases in the lab that needed finishing off, so I cracked on with those while the world was in a frenzy around me. I had these finished within a few days and at the end of the week when I only had admin left to do I saw an opportunity to work from home rather than have the hour each way drive to and from work. Nice I thought…….. I let my line manager know my plans and headed off home for the evening, looking forwards to sitting on my PC in the comfort of my own home the next day and who knows for how many other days?

What a dreamer I was! I mean I work for the NHS for goodness sake. That evening whilst walking my dogs, Phlo, Freda & Pip I got a call from my line manager. ‘Hiya Andrea, Can you head to the DRI site tomorrow please, you have been redeployed to the fit testing team, they are really up against it and need all the help they can get right now.’ ‘Sigh’ so much for working at home. BUT I am a proud NHS worker and helping is what I do so I agreed with no arguments and headed off to the education centre the next day ready to be trained up as a fit tester. Now you may think this is a cushy number, stashed away in the education centre away from any danger fitting a few masks. O.M.G! Nothing at all like that! It was crazy town, we have thousands of staff needing fit testing, a very erratic and unpredictable supply of masks of varying types and an education centre full of noobs having a crash course in fit testing.

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In a very short time I was made one of the senior fit testing team members and was running and supervising quite large fit testing teams on a daily basis. I now had to work in shifts which is new for me, days, evenings, weekends, bank holidays etc – one day was very much the same as the other. Weekends meant nothing as it was quite often just another workday and the days were a good 12 hours long too. I was allowed no annual leave at all. If you had any booked it was cancelled. It was all available hands to the pumps in the NHS. The amount of staff that came in and were saying I am supposed to be here or there on holiday right now was quite sad but it’s not like we could travel anywhere anyway so we were in the same boat as everyone else in that respect. Now I will leave it there for now so I don’t take up to many the pages in the magazine with me, me and oh yeah me but I will continue telling you about my fit testing journey and bring you up to date in the next issue. Until then stay safe and take care, Andrea

15 30/07/2020 16:17

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FOCUS

RETURNING TO WORK POST COVID: A CLINICAL DENTAL TECHNICIANS PERSPECTIVE With Ross Chapman

hat a crazy, crazy few months! A rollercoaster of every possible emotion for us all and I am acutely aware the ride is not quite over just yet. What started out as panic and fear, quickly moved to confusion and apathy as the government and particularly the dental governing bodies fumbled and fudged the handling of COVID at every turn. Closing our clinic and laboratory down for a total of 13 weeks has been one of the most stressful periods of my working life to date, and at points I felt lost as I had no power to change or influence what was happening to our business. However, I do feel now we are returning to some semblance of normality, this whole saga may leave dentistry and particularly dental laboratories in a long-term better position. Now before you laugh that statement off and jump on my social media feed to call me mental just hear me out. As a clinic I am slightly ahead of the labs by a few weeks at least, as it takes time for the new patient consultations to be treatment planned, impressions taken and a case arriving at your laboratory. I know financially lab owners will be hurting enormously, employed technicians and support staff will be worried for their future positions and wondering when, or even if at all, they will be brought back from furlough. However, I’m really starting to believe that we can all turn this into a positive thing for ourselves, our mindsets and change our workflow for a better work life balance, our mental health and the greater good of British dental technology. Our clinic and laboratory officially returned to work post COVID on the 15th June but like most business owners I had already been back

for a few weeks prior planning and writing new standard operating procedures for the “new” normal. Like every other busines we had to install the obvious equipment you will already have become accustomed to such a hand sanitizer stations, safety screens for our front of house team, purchase the overpriced PPE and implement cashless protocols etc. We also took the opportunity to make positive changes to our workspace whilst we had the downtime and minimal disruption to our patients such as installing some new equipment, basic building maintenance and fitting air conditioning throughout the clinic and laboratory. We spent a week training together as team prior to our reopening date and this has been invaluable in helping to iron out any unworkable protocols and adjusting our SOP’s to suit our workflow. The team have been magnificent in both aptitude and attitude in tackling the current situation and the cohesion as a team during this testing times has been very satisfying to see as a business owner. Things were of course very slow for the first few days and rightly so with all unnecessary ventures from your home advised against by the government, but work has quite quickly increased to pre-COVID levels and very importantly for us all, the consumer appetite of the public has not diminished in anyway. The patients are still out there and still wanting our services, the only things stopping them from accessing them currently is guidance from the Chief Dental Officer and the tight purse strings of public funding. The current financial renumeration situation throughout NHS dentistry offers zero incentive for mixed service practices to carry out even the most basic of dental treatments our laboratories need to survive. This combined with the unworkable clinical restrictions imposed on dental practices and denture clinics when we were allowed to reopen on the 8th June, make

“

It is not the strongest of the species that survives, not the most intelligent that survives. It is the one that is the most adaptable to change. - Charles Darwin -

”

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regular dentistry impossible and as we all know all too well, no patients in the chair means no work in the lab. The non-evidence-based restrictions on aerosol generated procedures and the decrease in footfall due to extended fallow time between patients makes running a fixed price dental service economically unviable. This combined with NHS payment policies has basically stopped all NHS dentistry. In a poll on the “Dental Technicians Laboratory Owners” Facebook group this week (w/c 20/0720) only 25% of surveyed labs had returned to preCOVID staffing levels with 33% of labs having reduced their manpower to between 20-40%. We have all had to change during this crisis and some of those changes will be here to stay whether we like it or not. Some of them we as a business have happily embraced, video consultations and remote treatment digital planning for example have allowed us to connect with patients yet keep footfall in the clinic to a minimum. The COVID crisis has exposed the elephant in the room that is NHS dentistry and exactly how much both practices and laboratories subsidise the delivery of this treatment with their private fees. Fortunately, we as a business decided to move away from providing any NHS treatments and laboratory work a few years ago and it was without doubt the best business decision we ever made. If as a lab owner, you have contemplated this and not made the move NOW is the time to consider your options and make this switch. There is no such thing as an NHS dental laboratory, you may of course offer an economy service that a client wishes to offer to their NHS patients, but this cannot be subsidised by your high-end cosmetic cases or implant work, this is economic madness. Dentistry is currently in the middle of a digital revolution with most processes gradually migrating from analogue to digital. COVID has catapulted many belligerent and stubborn patients into embracing digital technology they once would have resisted. My parents for example are both 70 and will happily Zoom or Facetime the grandkids which 6 months ago was unthinkable. In the same way our patients have been forced to adapt, clinics and very importantly laboratories will need to change their mindset and services if they want to not only survive but also prosper in a post COVID landscape.

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DIGITAL DENTISTRY

THE PAST IS IN YOUR HEAD, THE FUTURE IS IN YOUR HANDS. A LOOK AT A CHANGING DENTURE LAB By Ashley Byrne I Byrnes Dental Lab

igital dentistry has been the norm in crown and bridge, and orthodontics for some time now, but the denture and prosthetics of our industry has not seen the same developments or speed of uptake. This is changing and it is changing faster than most of us think. Here at Byrnes, our denture department is going through rapid developments and it’s pretty safe to say that wax isn't just in decline, it will one day disappear and I’m confident to say that it will be sooner than we think.

SPECIAL TRAYS

I remember making 50 shellac trays a day, suffering burnt fingers and a mess of wax spacers and badly bent wire handles. The wax would thin on the teeth and be thick in the sulcus but that was the limit of the materials. Now we scan in the primary impression model or even take an intra oral scan, and from this we can design a special tray like no other. The ‘wax’ spacer is virtual and when we set it to 2.2mm, we get 2.2mm. The tray can then have a variety of handles all stored as .stl files and then we print it. Time taken, 10 minutes. No wax, no mess, no finger prints and a special tray that looks like a medical device with the patients unique reference number on. Clean, hygienic and suitable for the modern dental

18 THE DENTAL TECHNICIAN_AUGUST 2020.indd 18

technician. Let’s face it, post COVID-19, we need to all up our game and patients are expecting impeccable hygiene and trays like this simply nail it. When we have our secondary impression, so beautifully taken in our printed trays, usually we make a bite block with a wax plate but what if there was a better way? A quick scan and we design a simple 2mm base plate, printed in half an hour, its comes out almost ready to use. From this we can check the potential retention of the denture as there is no shrinkage like a normal PMMA base plate. In one small step, we have eliminated the risk of finishing a full denture and having no retention on fit. Imagine saying to your patients “I’m going to give you a smile in wax and I want you to decide your smile, and that will be YOUR SMILE for the next 5-10 years and it will take us about 15 mins”. It’s madness! We test drive a car longer and yet when we do denture tries, we put it in the mouth, let them look in the mirror and that’s that. What about eating? In wax, that’s impossible. But if we printed a tryin the patient can, just like a Mercedes, take it home for the weekend. Okay, it’s all white in colour but they can show their friends, loom in the mirror for hours, smile, laugh, eat u and have time to get to know their smile. p. 20

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DIGITAL DENTISTRY Sounds epic doesn't it? Well it’s all possible we can now scan in the bite block, design the smile (hey, let’s design 2 or 3 of them if they want to pay for it) and print it. Patient can now go home with their try in(s) and really get a feel for it. If they like it, we can make it, if they don’t, we can tweak it and re-print. Once happy, it’s a simple switch to printing the base plate and bonding in the denture teeth. If the family dog eats them, or they want a spare, it’s quick, easy and totally 100% reproducible. That’s pretty awesome all round for the patient. “Chrome doesn’t fit, please remake”, “Patient doesn’t like these clasps so I’ve cut them off, it’s no longer retentive, please fix”. Yuk, we all get it. It’s a painful process and I’m not here to write an article on who’s fault that is but either way, someone is paying for the remake. Imagine if we could stop that? Here at Byrnes we now scan all our models and then design a 3D printed resin try in of the chrome design. The resin try-in is designed on dental CAD software and then we send that to try-in, check fit, clasp positions and retention. If all is good, we then have multiple ways to proceed but you’d be surprised to hear that we still do this in an analogue way. The gypsum model or 3D printed model is then sent to our chrome lab and we ask them to copy the resin design. Of course this could be 3D printed in SLM or the resin frame could be cast, but at this time we feel good old wax and casting is still the gold standard. Or should that be cobalt chrome standard?

TEMPORARY DENTURES

We make them by the bucket load for temps in implant cases and they are a thorn in our side. They need to be cheap but nice and last a long time. Often we have bone respiration or healing abutments snagging them and the fracture rate is pretty high. So now we use CAD software to quickly and easily design a base plate and tooth, both 3D printed on one of our printers. The teeth are luted together and sent out. No acrylic pouring, no single tooth of a card. It’s not as aesthetic but it is cheap and if the patient wants a spare, it’s a simple reprint. Post COVID-19, the stress of work and financials, or maybe just the pressures of life, whatever it is we are seeing a huge rise of splints and tooth grinding appliances in our lab and in our surgeries. Conventional Michegans and Tanners take time, are messy and require a lot of flashing and packing. Using CAD we can do a design of a fully functional occlusal splint in around 15 mins, and it’s printed in an hour (well, actually we print 6-8 in an hour) and then it’s a simple trim off the supports and polish. If the patients wants a spare, you just print another. If the patient grinds through it, dog eats it, kids flush it down the loo etc etc…. you just print another one. No dust, mess, gypsum, molten wax or mixing of PMMA.

20 THE DENTAL TECHNICIAN_AUGUST 2020.indd 20

As I write this article we are seeing major players in our industry investing in dentures and prosthetics faster and with more money than we have seen in any other sector. Printers, materials, milling options, software and patientcentred solutions are being developed behind the scenes like no tomorrow and with millions and millions of pounds being spent. The race is on and this competition is an enormous advantage to us as dental technicians. I do not think that dentures and occlusal splints have been this sexy! I ran this article past one of my denture friends and he said I was a fantasist, it was pie in the sky and dentures should and will

always be made in wax. I smiled and asked him what he’s doing tonight, “Ive got 8 dentures to boil out and 6 splints to make, it’s going to be another all nighter”. I think back to my printers running 12 dentures for a course, 8 splints on the go, 7 special trays and 5 surgical guides that will take me an hour to finish in the morning and then I can go and play golf. I don't think this article sunk into him how powerful this technology can be for us all. It’s not a threat, rather it’s the greatest opportunity we have ever had. I think this article is best left with a small quote one of my team gave me which I used in the title, “The past is in your head, the future is in your hands”.

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INSIGHT

From the archives l

Thank you to Rowland Gardener - Head MPT/Technician Dental Services at King's College Hospital for providing us with a copy of the very 1st Edition of the Dental Technician Magazine. It seems so relevant at the moment to discover this old article as I move into my new Editorial role in the footsteps of the late and great Larry Browne. We rightly dedicated last months issue to Larry and looked at some of the great things he had achieved and we read such warm stories from some of our readers. Disregarding the opening gender related one liner and a further mention later in the article, which was clearly a sign of the times, I think the article by Mr Youles echoes the sentiment of what we envisage The Dental Technician Magazine being. We want the magazine to be the vehicle to share each other’s ideas, be all inclusive irrespective of age, gender, area of interest, private, NHS, small lab at home to huge corporate operation! The sentiment is that this is YOUR magazine, I too hope it will kill the isolation that Dental Technicians have suffered in the past. Please do let us know your feedback, make suggestions of feature sections, send in your letters to the editor. Let’s make this the magazine we deserve and let us go forward!!

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A part-time FdSc in Dental Technology is also available, with much of the practical experiential learning carried out at the student's place of employment. The syllabus is structured to include the General Dental Council's requirements for registration as a Dental Technician. The use of new educational technology, including online video conferencing, enables a much-reduced attendance.

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INSIGHT

A LOOK AT THE DTGB FACEBOOK GROUP

I recently posted in the DTGB Facebook group about my ideas to introduce a ‘Lifestyle’ section in the magazine. I was amazed by the response to my initial post seeing well over 200 comments from the wonderful group members. So many of you shared your interests and hobbies and I even sourced a birthday gift for my wife from Rhonda Cormack who makes some amazing pottery pieces.

I have a particular interest (my wife would call it an obsession) with cars. I was not disappointed by the amount of fast, weird, wonderful and classic cars that appeared in the thread. I was equally impressed by the sporting activities some of the group members were participating in, including ski instructing, scuba diving and

horse riding. It shows there is a lot more to us than the teeth we fiddle with!

The highlight in terms of flexibility is the extra-large Teleskoper Orbit that, partially in combination with special holders, permits to process all common soft and hard material blanks with Ø 95 mm, Ø98 mm, Ø 106 mm or even Ø125 mm. With the Teleskoper Obit blanks can be removed and reinserted back into the orbit with a precision of 5 μm: this is particularly helpful for adjusting the friction of telescopic jobs or for the two-stage fabrication of immediate restorations in case of implant-supported prostheses (with the Double Milling technique).

spaciously designed, optimally illuminated and easily accessible milling chambers as well as with a separated, contamination-protected tool chamber with 21-compartment automatic tool changer (3x21 in the M2 Dual Wet Heavy Metal, M2 Dual Teleskoper and M2 Dual Double Teleskoper). The automatic self-cleaning function, the integrated Cleaning Kit for an easy cleaning of the milling chambers and the Ioniser (optional) ensure a particularly clean elaboration of materials. The performance range of the machines can be extended by integrating different accessories available, e.g. the Glass Ceramic/Raw-Abutment® Holder, JawPositioner support. The M2 Wet Heavy Metal and M2 Dual Wet Heavy Metal milling units can be upgraded to the Teleskoper version through the M2 Dual Upgrade Kit.

I would like to make this lifestyle section a regular feature and judging by the wonderful responses on my post, I really look forward to reading more about what our colleagues get up to in their spare time.

MARKETPLACE NEW M2 MILLING UNIT LINE: OPENDATA FULLY AUTOMATIC MILLING UNITS FOR MODERN OPERATING COMFORT AND FLEXIBILITY w The new M2 series of milling units stands for comfort of use and flexibility. The M2 line includes five different versions: • M2 Wet Heavy Metal Standard version with 1 milling chamber and orbit for Ø 95 mm blanks • M2 Dual Wet Heavy Metal Standard version with 2 milling chambers each equipped with one orbit for Ø 95 mm blanks, for sequential wet and dry processing of all dental materials without in-between cleaning • M2 Teleskoper 1-chamber milling unit quipped by default with 1 Teleskoper orbit for blanks with Ø of 95 mm, 98 mm, 106 mm, 125 mm (holders required) • M2 Dual Teleskoper 2-chamber milling unit equipped by default with 1 orbit for Ø 95mm blanks and 1 Teleskoper Orbit for inserting blanks with Ø of 95 mm, 98 mm, 106 mm, 125 mm (holders required) • M2 Dual Double Teleskoper 2-chamber milling unit quipped by default with 2 Teleskoper orbits for blanks with Ø of 95 mm, 98 mm, 106 mm, 125 mm (holders required)

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All M2 milling units are stand-alone solutions: it is possible to start milling and calibration processes or load elaboration tools directly from the machine via the integrated PC with touchscreen. With the optical tool detection function, the selection of the appropriate burs during milling is ensured. All M2 machines are characterised by

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MARKETPLACE

SAVE LABS, BUY BRITISH DTS w DTS is wholeheartedly supporting the DLA’s Save Labs, Buy British campaign and it would encourage you to get involved too. The initiative aims to encourage dental practices to pay their outstanding lab fees in order to help businesses survive the current crisis. The DLA estimates that 75% of its members have outstanding invoices for work completed before the COVID-19 lockdown. Settling these invoices would make a huge difference to many UK laboratories.

The campaign is also about asking practices to support UK dental labs when they come back to business. Building and strengthening relationships within UK dentistry will help to secure the future of the profession as a whole. Get involved to #SaveLabs. FOR THE LATEST INFORMATION, PLEASE VISIT www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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investment material provides for excellent surface quality, efficient finishing and a precise fit. The innovative formula delivers both improved stability and captivating esthetics. VITA SHADE MATCH FORMULA is also on your side to ensure that you and your customers can always achieve the perfect shade. Make no compromises and rediscover

pressed glass ceramics with the “VITA - perfect match” - for every user, every laboratory, and every situation. FIND OUT MORE: www.vita-zahnfabrik.com/AMBRIA VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

The innovative formula delivers both improved stability and captivating esthetics.

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ECPD

FREE VERIFIABLE ECPD As before if you wish to submit your ECPD 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 ECPD 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 ECPD either online or by post. If you have any issues with the ECPD please email us cpd@dentaltechnician.org.uk

4 HOURS VERIFIABLE ECPD 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 July DT Edition: Q1.

Q2.

VERIFIABLE ECPD - AUGUST 2020 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

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As of April 2016 issue ECPD will carry a charge of £10.00. per month. Or an annual fee of £99.00 if paid in advance.

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3. Evaluation: Tell us how we are doing with your ECPD Service. All comments welcome.

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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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ECPD

VERIFIABLE ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN Payment by cheque to: The Dental Technician Magazine Limited. NatWest Sort Code 516135 A/C No 79790852

EDITORIAL BOARD

Q6. The resin try-in is designed on which software? A - CAD B - ATM C - PTA D- SLK

Q11 . How many microns of deviation do the scanners shoe? A - 20 B - 32 C - 40 D - 42

Q2. Ross Chapman qualified as a dental technician in which year? A - 1998 B - 1996 C - 2000 D - 1999

Q7. Using the chosen software how long does it take to design a fully functional occlusal splint? A - 15 minutes B - 20 minutes C - 25 minutes D - 30 minutes

Q12 . What does David liken the deviation amount to? A - A needle B - Half the width of human hair C - A grain of rice D - Depth of A4 sheet of paper

5 THINGS I CANNOT WORK WITHOUT CHRIS GOLZE

AN INTERVIEW WITH MALCOM MURTON

Q1. Andrea Johnson is currently chair of which organisation? A - FTA B - OTA C - DTS D - LCD

Q3. What graphics software does Chris use? A - Photoshop B - Coral Draw C - Paint D - LYNUX

CLINICAL ADVISER AND CLINICAL EXPERT - SHAMIR MEHTA

Q8. In 1996 how much did the crown and bridge laboratory charge for an NHS bonded crown? A - £10 B - £29.99 C - £32.50 D - £50

Q4. What year did Shamir become a clinical adviser and clinical expert for GDC? A - 2011 B - 2012 C - 2013 D - 2014

Q9. How many hours per week did Malcom and Sara work when starting the laboratory? A - 25 B - 50 C - 75 D- 100

THE PAST IS IN YOUR HEAD, THE FUTURE IS IN YOUR HANDS ASHLEY BYRNE

A NEW NORMAL DAY IN THE LIFE OF A PRODUCT SPECIALIST DAVID CLARIDGE

Q5. How many shellac trays on average per day does Ashley remember making? A - 50 B - 60 C - 70 D - 80

Q10. How many countries does David cover for sales and training? A - 10 B - 15 C - 21 D - 26

Q13. How does David ask dentists to measure the marginal fit of a single crown? A - Running a probe over the area B - With a tape measure C - Using a laser D - Taking a photograph

PURE NATURE - VITA

Q14 . The objective of the application is to? A - Improve speed B - Increase depth C - Reproduce natural colour effects D - Strengthen the tooth Q15 . When applying the shades underneath the dentin layer it is important not to? A - Mix them into the materials B - Apply after the cut-back C - Interfere with screw D - Reduce the vestibular side Q16 . Strain fixation fires at what temperature in degrees celsius? A - 200 B - 360 C - 500 D - 760

YOU CAN SUBMIT YOUR ANSWERS IN THE FOLLOWING WAYS: Via email: cpd@dentaltechnician.org.uk or 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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BUSINESS

ADOPT A GROWTH MINDSET FOR YOUR DENTAL LABORATORY By Matt Everatt FOTA Author & Editor

ave you heard of a growth mindset or fixed mindset? There is a lot of science behind mindsets. Over 30 years ago, Dr Dweck coined the terms ‘fixed mindset and growth mindset’ to describe the underlying beliefs people have about learning and intelligence. Their research showed students who believed they can get smarter, understood that effort makes them stronger, therefore were more likely to put the effort in and achieve better results. Having a fixed mindset will hold you back and make you question yourself from taking the next step forward, hold back on the studying or go and get that new job, or chase your big dream. Our 7-year-old son came home from school last term and told me all about it! Our primary schools are even teaching this stuff to our kids! In a 7 year olds words; 'Daddy, a growth mindset is about believing in yourself and just giving things a go!' They have a song for it, it's a bit of an earworm, granted, however it gives a great message to our kids and we could all do worse than just 'having a go, it's how we grow’. A growth mindset is a set of attitudes and behaviours that does not limit individuals, it encourages innovation and creativity, whilst developing leaders. So what can we learn from our infants and how can we develop a growth mindset?

1. Nurture a culture that is willing to try new things and learn from failures

Continual learning and innovation is key to developing a growth mindset culture. Encourage staff in your lab to suggest new products and services, and be welcoming of new ideas. This is a real key element to getting your team on board and more willing to make a success of a project. Give your team freedom to put those ideas into fruition, if they don’t succeed, learn from those experiences and be mindful not to criticise those for trying.

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2. Share and Learn

Give your team permission to learn, it sounds obvious, however so many labs get this wrong. Don’t just rely on your technicians to fulfil their eCPD requirements and expect them to come to the table with exciting innovations. Encourage them to look at available courses, new products, encourage company representatives to come in to the laboratory. Give your team permission to step out of their daily role, shadow a colleague or you can share some of your experience and knowledge. Setting aside time to do this develops relationships within the team and is likely to improve collaborations and inspire others. Be willing to share your experience and knowledge with other laboratories too. That may sound weird, trust me, it will pay dividends, give and you will receive way more!!

3. Creating commitment and value

It is unsurprising that businesses that have a growth mindset culture get the best out of their team, research has showed that employees feel more committed to their work when they feel they have potential to grow, learn and develop their role within the organisation. Furthermore, the research showed that employees act more transparently and work more so as a team, driving innovation and fuel the growth of the business. Creating and nurturing a growth mindset culture within your dental laboratories is about encouraging, growing, valuing, and seeing potential in every person, moment, failure, and success. A growth mindset will help grow your business and position yourself and your team for growth, increase profits, and success in the future.

www.dentaltechnician.org.uk

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BUSINESS

AN INTERVIEW WITH MALCOLM MURTON

PARTNER AT PRIDE DENTAL LABORATORY IN BEDFORD

Today we interviewed Malcolm Murton from Pride Dental Laboratory in Bedford. Malcolm trained as a Dental Technician at Guys Hopsital in the late 90’s and worked there for 14 years before starting his own dental laboratory business. Malcolm, it is a pleasure to interview you and I am so pleased to see your business grow over the years into something quite special. It seems a life time ago since we worked on the same floor as each other in Guys Tower by London Bridge. In my random interview style, let me ask you some really deep questions and mix in a few random fun ones. Thank you Matt, you’ve not done too badly yourself! Its a pleasure to feature in your first edition as editor and I’m sure the Dental Technician will go from strength to strength under your leadership. You clearly have a passion for your profession. Over the past few years we have seen a lot of unhappiness within our profession what do you think are the main pain points for dental technicians and labs these days? I think the biggest problem is the lack of young people coming into the profession. There’s probably a few reasons causing that, the main ones being length of basic training courses and skills required compared to the relatively low starting and long term salary prospects. There are plenty of other careers with similar or shorter training programs with better immediate and long term salary prospects. Traditionally dental labs also have a reputation for being dusty and dirty environments. After leaving school in 1996 I spent a year in a crown and bridge lab that charged £32.50 for an NHS bonded crown, 24 years later there are a lot of labs who have been forced to charge less than this despite the huge increase in costs during this time. I’ve heard several lab owners say they make a loss on NHS work to pick up their clients private work but personally I don’t believe we should be in a situation where there are loss leaders when the products are hand made custom appliances. If the cheaper end of the market was able to charge more I believe the whole market could charge more creating greater profit that could be spent on higher wages and better working conditions. Dentistry has taken a big kicking from covid19 and whilst the private sector appears

to be largely up and running again it’s looking more difficult for the NHS labs. I believe the NHS side of our profession has been broken for many years and I really hope with the contract changes being made in the NHS and lobbying from the DLA ,there can be a brighter future for dental laboratories providing work to the NHS. Covid19 has been a huge blow for the global economy not to mention the whole of the dental team. How was business going before March and what are your thoughts about the next 12 months? Prior to Covid19 business was going great! We are a small lab, 5 of us in total and over recent years have been in the very fortunate position of turning away work to make sure we don’t become over busy and drop quality. We’ve always been aware that we’ve had a few good years which probably wouldn’t go on forever and felt that our model of being a small lab with low overheads would hopefully help us to weather a storm relatively unscathed. We didn’t expect to sit at home in our garden for 3 months though! We’ve invested heavily over the last few years purchasing a building and fitting out a brand new lab. 2020 for us was going to be a consolidation year with the business and we were planning on spending some much needed funds on our house. Plans obviously change but the initial signs after reopening are positive, in June we achieved 50% of our regular turn over and July is looking like 75%, hopefully this will keep building. It appears unfortunately the country will head into a recession so predicting market conditions with

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possible further covid outbreaks too will be difficult but our goal now for the coming 12 months will be to get through with all of our team intact and all of our overheads, material and staffing costs covered. Anything over that will be a bonus but for sure I feel that being a small business right now will help us. What has been your greatest achievement as a Dental Technician? My biggest achievement is definitely our business. I am very proud of the lab we have created, the team of people that I work with, the working conditions we have and of all of the work that we produce in our lab. Every member of our team works 4 days per week (32 hrs) and i’m not aware of another UK lab that offers their whole team such a good work life balance. Sara and I worked so hard in the beginning, regularly doing 100 hr plus a week so looking at what we have achieved now is very rewarding. And professionally, who have you been most inspired or influenced by? I think the people who have influenced me most in my career are people I have worked with. Rowland Gardener gave me my first real job as a trainee in the School of dental technology at Guy’s hospital, his passion and enthusiasm for dental technology was very clear and some of that rubbed off on me. Jeff Brookshaw was my first boss after qualifying in the Prosthetics production lab at Guy’s, many of Jeff’s ethics and techniques have stayed with me today. Matt Wilde is someone I met about 7 years ago whilst working together at Byrnes dental laboratory in Oxford. At the time I felt I was u

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BUSINESS making nice dentures that unfortunately looked like dentures. Matt re-motivated me and set me on a path of trying to make dentures that look like natural teeth and gums. Fast forward 7 years and i’m now very fortunate to work with Matt at Pride Dental Laboratory. Social media in particular Facebook has been a great source of inspiration. There are so many talented technicians around the world that have inspired me with their work but I think for truly natural looking dentures Richard Greenlees from New Zealand is the greatest inspiration… Check him out on Facebook!

A few quick fire fun questions! Give us an interesting fact about you. I was taught to juggle by an Olympic bronze medalist… In sailing not juggling :) What's the best and worst vehicle (I know you love motorbikes) you have owned? I guess the best vehicle I’ve owned is my current motorbike a Honda Fireblade and whilst it was great fun at the time probably the worst vehicle was my first motorbike a Kawasaki AR50. Cars wise my first car was a Volvo C30 D5 which was great fun but I now own two Citroen Spactoruer vans, practical but not exactly exciting. How many pets do you have? Two black Labradors Sam and Jimmy who come to the lab with us every day. Do you support a Football team, if so who? I used to support Ipswich (my home town) and Arsenal when I lived in London but these days I don’t really have time for football. Motorbike racing is more my sport. If you had a choice between two superpowers, being invisible or flying, which would you choose and why? Flying, I hate getting stuck in traffic!

Back to the serious questions... What type of lab work do you most enjoy? Any case where I know we’re really going to make a difference to the patients life. We do

some oncology and paediatric work and we’re fortunate to use a lot of photos with our cases so seeing how new dentures or restorations can transform a patients smile and seeing happiness in their eyes when the case is fitted is very rewarding. What is your least favourite part of being a lab owner? I don’t like it when cases aren’t going smoothly, this could be for any reason like poor information or clinical work to making a mistake in the lab (we all make them) or simply the patient just changing their mind. All of this stuff causes stress and I probably let it affect me more than I should! Are you embracing the digital technology we have available to us? Tell us a bit about that. Yes! We invested in our first lab scanner nearly 8 years ago and definitely couldn’t be without digital. For many years we used it solely in the crown and bridge to design metal frameworks but now with a switch to chair side digital dentistry we are receiving ever increasing numbers of intra oral scan cases for which we print our own models in house with our Asiga printer. Digital is rapidly growing into the removable denture market also and we regularly use it to design and print temporary bases, implant stents internal chrome strengtheners for implant dentures and Ti frameworks for hybrid bridges. The quality of our end product is extremely important to us which means we will not use digital in any areas where a compromise to our end product will be made. Digital denture materials are improving all the time however our opinion is they are currently not a match in strength or aesthetic properties when compared to conventional techniques, so currently our use of digital in removal prosthetics is limited. Finally, if you had one bit of advice for any technician thinking about starting their own lab, what would that be? Be prepared to work hard, build a great team around you and don’t undercharge! Is that three bits of advice?

DENTAL LABORATORY STRESS AND HOW TO OVERCOME IT l

There was a report recently published that looked at the link between heart disease and stress at work, in the report: “They analysed 13 existing European studies covering nearly 200,000 people and found “job strain” was linked to a 23% increased risk of heart attacks and deaths from coronary heart disease.” So it seems that stress may indeed increase the risk of heart disease, what I’m interested in is the comment by the British Heart Foundation that says it was how people reacted to the work stress that was the key. Considering the current situation reopening our labs or returning to work in this ‘mid/post pandemic’ time, there is no doubt that it brings challenges for everyone and we will hear the words “I am stressed” or “This is too stressful”. This is fundamental to understand, many people use the phrase “I am stressed” – in NLP we call this a complex equivalence, it is where a person is saying that one thing is the same as something else… In other words this person would be identifying ‘stressed’ as something separate to themselves, and then saying that they are that separate thing. This is clearly not true, ‘stressed’ is a state, and is separate to the person themselves. To say ‘I am stressed’ is to suggest that the person is the same as the state. All a person is doing is choosing to do the activity of being stressed, and this activity is separate to themselves as an individual. The first thing anyone needs to do in order to change, and to decide not to be stressed is to realise that ‘stressed’ and themselves as a unique individual are not the same thing, saying ‘I am stressed’ is factually not correct. Once an individual is able to separate themselves from the stressed state/activity then that person has moved into a place of taking control, and once in control change can happen. All the time that an individual believes that they are the same as a stressed state, and does not understand that they are separate to the activity of being stressed then change will never happen. I am a man - this is factually correct. I am English - this is factually correct. I am stressed - is not factually correct, I can choose to do the activity of being stressed but it is impossible for me to actually BE the activity of stressed... It is always something separate to me.

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30/07/2020 16:17

BUSINESS The words we say every day have a profound impact upon our lives, and saying things like ‘I am stressed’ sends a very strong message to our unconscious mind. In order to make changes we need to bring it into the conscious and then make a conscious decision not to draw the equivalence between ourselves and the activity of stress. Profound? Yes, but also true, and when you begin to adopt this thought process you can find that it also allows you to make the changes you need and begin to live longer without the associated heart conditions! The way we use language represent how we view the world around us, and how we use the world around us influences what we do, and ultimately our success as a technician! In the late 1950’s Noam Chomsky completed his Ph.D. thesis Transformational Grammar. In it he explained that there are three processes by which people make sense of the world; Deletions, Distortions and Generalisations. So, if you make sense of your world by deleting, distorting and generalising things, how much clearer would it make it if we knew exactly what those things were? What if there were a way to know what was real and what you have constructed in your head? Many of us have been to parties with friends or family, and yet when we recall that event with those same family or friends we all have a different recollection of the party. We all chosen to delete, distort and generalise different aspects of the party. So let’s look a little bit more about what you might be distorting in the party that is your life! There are many ways that we distort the lives we see around us, I’m going to look at three of them in more detail, and they are cause-andeffect, complex equivalents and modal operators.

CAUSE AND EFFECT

The giveaway is the word ‘makes’. How many times have you heard someone say “he/she makes me angry”? Or perhaps “going to work makes me stressed”. The real key is to know that being angry, or stressed is a choice. It is a choice about how you choose to react to a certain stimulus or input. If a person shouts at you, you have a choice about whether to be angry or not, don’t you? When you go to work you have a choice about whether you decide to let what happens affect you. You may decide that being angry or stressed is how you are going to react. But the event does not make you that way. Understanding that you have distorted the event and decided that it is going to make you do something is the first step to changing.

The next step is to realise that in each of those situations, you have a choice. You can choose to be angry, or you can choose to be stressed. What are you choosing and why?

COMPLEX EQUIVALENTS

The giveaway is the word ‘means’. How many times have you heard someone say “Having no money means I’m not a success” or ” You shouting at me means you don’t love me” for example. Using the word ‘means’ is drawing a direct equivalent between one thing and another, and this equivalence is not reality. Let’s break those sentences down into two halves, half of the sentence before the word ‘means’ and half of the sentence after. “You shouting at me means you don’t love me” - I am going to challenge that sentence, could someone shout at you and still love you? Could someone not shout at you and not love you? If either of these questions are true, then there can never be any direct correlation between shouting and love, can there? It is possible for a person to shout and still love you. It is possible for a person to not be shouting, and yet not to love you. This is definitely a play on the words, but as a Master Practitioner of Neurolinguistic Programming I notice many clients saying this type of thing often. The problem, especially with the love example is that an argument can begin around a statement that is simply not true. And indeed if it is broken down doesn’t seem to make sense any more! Being aware of what it means to use the word ‘means’ means you get it!

MODAL OPERATORS

The give away here is the use of words like ‘need’, ‘should’ or ‘ought’. Using these words implies that there is some form of external force directing us into an action. “I ought to stop/start doing that” The question as a Master Practitioner of Neurolinguistic Programming I would want to know is, ‘who says?’.

I saw a client the other day for weight loss, she wanted to lose weight and when I asked her why she told me that the doctor told her that she should. I repeated my question, and asked again why she wanted to lose weight. She replied once more, “Because the doctor told me I should”. Where is her motivation? What does she get out of losing weight, specifically, that is for her? Until this person realises that they want to lose weight and can see the benefits themselves then change will never happen. Words like ought, should, or need imply an external motivation… And external motivations are never as powerful as internal motivations. “I ought to work longer hours in my lab” “I should take on more private work” These all have those modal operators and the same question applies. Who says? Until my weight loss client replies telling me that she wants to lose weight for herself, and can give me very specific reasons why she wants to that benefit herself I will not be working with her! Change happens when we take charge and control of our own lives, and stop looking to external motivations to make things happen.

SUMMARY

As you can now see we use language and words to distort reality all day long. Most of the time we do it without even thinking about it, and now you know what to look out for I wonder, how many times you will notice yourself using these words over the coming weeks? Make a decision now to start being aware of your language, its meaning and how you distort the world around you Overcoming stress, learning to deal with difficult situations and elegant communication with our clients are all included in my new ‘Performance Academy’ launching August 2020. More details here https:// mysuccessfullife.co.uk/ you have (simply click on the Performance Academy link in the navigation)

About the author Mark Oborn MBA

Mark was a dental technician for 30 years, holds a Masters degree in Business Administration (MBA, is a Master Practitioner of NLP and is a Master NLP coach. He now runs “The Performance Academy", an online learning Academy with a low monthly subscription enabling dental technicians (and others working in the healthcare sector) to improve the success of their laboratory whilst enhancing our own performance. W: https://mysuccessfullife.co.uk/ E: succeed@mysuccessfullife.co.uk

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30/07/2020 16:17

BUSINESS

A NEW NORMAL DAY IN THE LIFE OF A PRODUCT SPECIALIST By David Claridge I Carestream Ostrich joke. It didn’t work last time and it won’t work today. The training and subsequent test is complete. I am very pleased with the product knowledge of at least 85% of the 45 attendees. It really helps that many come from dental backgrounds. Although, one person did ask “What is the difference between intra-oral and extra-oral”. I think he was joking. I pray he was joking. Mid morning heralds a series of 1-1 remote sessions with our existing users in the UK (they’ve just received the next software update). IO scanning is a learned habit, so training, and ongoing training is imperative.

am responsible for sales and training for Carestream Dental’s IO scanners and associated softwares. I train our business partners, dentists, dental technicians, nurses, and any ‘stakeholder’ in the digital workflow. I cover 26 countries. So, from flying everywhere to home working came as a big change, when the world went upside down this year. With immediate effect, adjustments were needed. Not for me, frankly I love working from home, but the PMC (Present Mrs Claridge) has never seen so much of me. I am not sure if she sees this as a benefit. So a new normal day begins. I commute the four metres from home to my office, and I am within arm’s length of everything I need for the day- CS ACCESS, CS 3600, and CS 3700 IO scanners, mic, headphones, various implant, restorative, ortho, denture models, guitar, ukulele, a pint of tea, and 2 kilos of chocolate biscuits. The first of todays webinar starts in 30 mins- this is training our business partners in the Middle East. Note to selfremember…. enthusiasm high, pace slow... to allow delegates to translate. And drop the

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I would like to think my style of training is ‘edutaining’, but alas, sometimes it doesn’t gel well. A few years back I was in a Practice, and I felt the room could use some Claridge Magic and so I said, “If you scan the upper arch when the computer is set to scan the lower, you can press the adjacent button and reverse the images. Or, if you have trouble distinguishing between the upper and lower, the lower is where the tongue is”... an icy silence prevailed. My final webinar of the day is specifically for lab technicians. As 2/3rds of the digital workflow is at the lab, I believe it is imperative that technicians know and understand what they can demand from a client with an IOS. If the dental lab are not receiving the same quality, 95% of the time it is down to training. The technician can expect highly defined scans; multiple bites (labelled), files in .stl .ply .dcm; HD photos; Shade report; overlaid scans (pre and post prep for example); margins marked; undercuts shown (or hopefully not!). However, creep factor can set in over time, and bad habits are introduced. For example, a dentist scans the perfect prep, with good moisture control and retraction in place. But

a minute later notices that he/she has missed a contact point. So, the scanner is reinserted, and the contact point is captured in less than a second. But, if saliva has returned to the prep., then the dentist may have just ruined his previous scans with the newly captured images. What the dentist forgot to do was use the ‘locking tool’ which protects from over scanning.. So, ongoing training also stops ‘creep facture’. Here’s the good news. . Our scanners save the raw data and we can always diagnose what has gone wrong, and therefore correct it from happening again. So IO Scanners and their operators aren’t perfect, but take a look at the accuracy studies and surveys. The scanners I work with show a deviation of only 32microns over a full arch. That’s half the width of a human hair! When I ask dentists how do they measure the marginal fit of a single crown, it’s by running a probe over the area to detect a ‘ridge’. The tip of a new probe averages between 50-90microns. So some context is required I believe. I have a rolling survey in the UK. 7 dental labs have received over 228,000 IO scans. The retake request rate (RRR) was only 0.2%. The RRR from ‘analogue’ impressions averaged at 9%. So, IO scans show a much higher level of consistency. FYI the difference between 0.2% and 9% would result in recalling over 20,000 more patients to possibly have their gag reflexes triggered for a second time! So my ‘new normal’ day comes to an end. I step back from my desk, stand, stretch, and dismiss all thoughts of self importance, as I commute the four metres back to the house and the PMC. If you have any questions, feel free to contact me. T: 07980 680 028, E: david.claridge@csdental.com, or visit Facebook, LinkedIn, etc.

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MARKETING

JAN CLARKE BDS FDSRCPS l 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 and heads up the Social Media Academy at Rose & Co. Web: www.roseand.co Email: jan@roseand.co Facebook: Jan ClarkeTaplin Twitter: @JanetLClarke Instagram: janlclarkeacademy LinkedIn: Jan Clarke BDS FDSRCPS

RECOVERY IN THE DIGITAL AGE

t probably seems like an age away now, those early days when the word “lockdown” started to be mentioned and we realised the Covid-19 virus had hit our shores. I suspect many of you were in a frenzy of providing work for dentists who were keen to quickly finish up items of work in case they had to stop seeing patients, and probably you worked through the night to deliver. Then, all of a sudden, lockdown is announced and dentistry comes to a screeching halt and with it your livelihood. The business I work in was no different, all of a sudden it seemed that dentists did not require any marketing support, who on earth would want to be optimising their website or providing some advertising on Facebook? Then slowly, the picture started to emerge of the grants and support available to smaller businesses, the new job retention scheme which has led to a new word in our vocabulary for most of us!! Furlough! After the initial shock and clients cancelling work with us there seemed a newfound acceptance of the situation and some new decision making. Perhaps the same was true for you? I have no doubt that some of you have had to make truly difficult decisions regarding your business practise and your employees. As the dust settled we found an increase in enquiries and current clients who decided they would take the time to develop their ongoing digital presence. As time went on, we all became incredibly proficient at using Zoom with clients or perhaps House Party with our family. There were endless meetings and information webinars available on Zoom and we connected in a way we hadn’t done before. Some people started talking about Zoom consultations for teeth straightening but for some this was too soon, the wound felt too raw and who would want to be thinking about teeth straightening when so many were dying. But, eventually people did start offering online consultations and maybe it’s because Zoom and House Party meant you were reminded about your teeth every day in a way that doesn’t usually happen, but patients signed up for treatments waiting and ready for when lockdown was to be lifted. Our team reached out to our existing and new clients by offering free of charge social media

engine optimisation became popular and thus marketing became relevant again in a way we could not have foreseen. We have always advocated a non salesy marketing system, especially in social media. Connection and relationships with your clients are of upmost importance and this did not change during the lockdown. Adding value may require time from us with little added revenue but it builds rapport, trust and a relationship.

training. Many dental practices just stopped talking to their patients online and we felt that communication should continue, keeping their patients informed about updates but also helping them with some of the simple problems that could be rectified without a visit to the practice. We have found that the dental practices who kept the lines of communications open with their current and potential patients have picked up many patients from practices who didn’t seem to be available. In fact dentistry often has bad press and it doesn’t take much to exacerbate this. I would say to dental practices, you are not closed, your premises are closed but not your service. Yes there is a massive limitation on how you can help but you are there and being there for your patients will be remembered when all this is over. We found ourselves busy helping dental practices respond to new forms of communication. Finding online booking systems for video consultations to regular Zoom “coffee mornings” with their patients. Interestingly what we saw happen when communication was re-established between patients and their teams was not just a grateful patient but happy teams. It was clear that the teams we worked with had missed their patients and needed that connection just as much as the patient needed their dentist. As the acceptance of the situation took root so did the decision for practices to use the time to develop their digital offering. Using the time to update their website or even build a new one. New terms for search

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You may wonder what all this has to do with dental technicians? The future may look bleak at the moment with little hope for a return to the numbers of units of technical work of the pre Covid era. It is important to use this quieter time to build connections with clients, see how you can help, what services can you change, alter improve? There is no doubt there are many people waiting for and requiring cosmetic work, some who have saved up money from not being able to go on holiday or even eat out. Work with your teams to make it as easy as possible for your dental clients to choose you when the time is right. Remember this doesn’t have to be about being the cheapest, far from it, it is about being available, personable, reliable and trustworthy. Now is the time to build those relationships, spend time on your marketing, update your website, move into a new post Covid era, embrace the digital age. Our small team are now mostly back in the office which has been a massive relief. Working remotely for several months as a design team has big challenges and I am proud as to how we have adapted. What we offered our clients didn’t really change but how we offered it did and we definitely spent a lot more time with clients in Zoom meetings than before. We have learnt that we can continue to use this but probably the greatest lesson was that relationships matter. If your clients trust you and you are available for them your business will succeed. I wish you all the best during this difficult period of transition and should any of you require a face to face chat via Zoom with some pointers for your marketing I am more than happy to offer these free of charge, please just email and I will set up a call.

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DENTAL TECHNOLOGY

PURE NATURE: ANTERIOR TOOTH ESTHETICS WITH VITABLOCS REALLIFE AND VITA AKZENT PLUS STAINS HOW TO USE CERAMIC STAINS TO INDIVIDUALLY ADAPT AND ESTHETICALLY OPTIMIZE RESTORATIONS MADE FROM THREEDIMENSIONAL PREFABRICATED CERAMIC BLOCKS. By Renato Carretti, Zurich

he main field of application of conventional ceramic stains lies in the superficial painting or color characterization of ceramic restorations. The objective of the application is to reproduce natural color effects and anomalies and to add nuance to the veneers with shades. For example, stains are predominantly used to stain tooth necks or approximal surfaces, to accentuate fissures or to depict the translucent secondary dentin on abrasion surfaces. However, the opaque superficial application usually prevents exactly what it should produce - color effect from the depth of the restoration. VITA AKZENT PLUS STAINS from VITA offer many flexible applications. One of these is internal application during the ceramic layering process after a cut-back, when individualizing restorations. With this technique, shade effects which can be achieved easily and effectively, which have a lasting effect on the shade from the depth through the dentin and incisal edge.

also cover very well. I use them to create natural surface effects and a convincing depth effect, in addition to achieving a natural translucency. These materials give me the freedom I need during characterization – down to the smallest detail. A useful tool in the stain assortment is the VITA AKZENT PLUS Shade Chart. This is a transparent template with printed shade samples of all EFFECT and BODY STAINS shades (Fig. 1). Anyone who is unsure about choosing the right BODY STAINS shade can hold the transparent pattern over the still unpainted ceramic restoration. You can anticipate the effect of each shade quite reliably; you can see how the respective shade would affect the restoration before it is applied. This support can also be helpful in the treatment chair when it comes to final shade adjustments that should quickly lead to proper shade matching.

In this article, Renato Carretti, a dental technician in Zurich, Switzerland, shows how he uses the shades internally, what special advantages they offer him and what the user should consider when using the shades. The focus of the article is a challenging case study in which Renato Carretti customizes a CAD/ CAM-manufactured full ceramic anterior crown using the cut-back technique, perfectly aligning it with the neighboring teeth. Multifaceted range of shades, comprehensive field of application VITA AKZENT PLUS Shades are a comprehensive system of glazing and masking stains. They are suitable for all dental ceramic materials and any CTE. The glazing stains (BODY STAINS) are translucent and can be used for shading surfaces and also internally. They cat as a thin shade filter and allow me to modify the shade effect of the base material, while the increased fluorescence of these materials also helps emphasize the natural appearance of the veneer. Because of their intensive shade effect, the fluorescent masking stains (EFFECT STAINS)

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Special strengths – the internal application A specialty of the VITA AKZENT PLUS shades is their internal application. I can apply them while layering the dentin, as I will demonstrate later. Thanks to their fluorescence, they retain their radiance even after firing and appear through the dentine/cutting layer. A simple and effective way to change the shade effect permanently, without the shades looking like they have been painted. It is essential here to have a tactical, targeted approach; after all, we do not want the time advantage of internal shading and the luminance of the shades to be compromised by a second dentin firing. When applying the shades underneath the dentin layer, it is important not to mix them into the materials, but rather to apply them separately and fix them with a stain-fixation firing. While working with INTERNO shades in this internal application can be challenging because of their stronger shades, the VITA AKZENT PLUS shades offer a more discreet shade alternative. You can apply it superficially after the cut-back, layer it again, and keep the fluorescent effects of the shades.

Fig. 1: VITA AKZENT PLUS Shade Chart: A useful tool estimating the shade effect beforehand, especially the glazing BODY STAINS.

Machine preparation - completed manually With this technique, one should discard the idea that a good ceramic veneer always has to be the result of perfect, manually executed layering. In my experience, VITA AKZENT PLUS Shades exhibit particular strengths, especially when they interact with VITABLOCS RealLife for CEREC and inLab (Fig. 2). Thanks to their threedimensional block structure made from a dentin core and surrounding enamel shell, these blocks reduce a large part of my “basic work.”

First impression: life-like thanks to its fluorescent properties Even with the first application, it is evident – VITA AKZENT PLUS shades are fluorescent, a characteristic I already appreciate and often use with the EFFECT LINER materials and INTERNO shades. The fluorescence allows the shades to radiate. The result is that the restoration appears lifelike and natural. This natural appearance gives the impression that stains were not involved, and are the result of skillful layering.

Fig. 2: VITABLOCS RealLife Blocks, with their three-dimensional block structure, reproduce the structure of natural anterior teeth so that individualization can be performed directly with transparency materials.

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DENTAL TECHNOLOGY Unlike other CAD/CAM blocks, in standard situations, I can even achieve a very appealing design without any individualization by incorporating the flexible three-dimensional positioning of the restoration in the block, using the design software. In particularly demanding cases, such as the one shown here, I use the layers of shade already applied in the block as the basis for my individual adaptation. This eliminates the need for base dentin layering because the base shade is already included in the block structure. I do not have to do the shade-providing layering and can work directly with transparency materials after the cut-back. Thorough analysis of the individual tooth characteristics Consider the case of a 40-year-old patient who incurred a fracture to tooth 22 in an occupational accident. The analysis of tooth shade and individual tooth characteristics of the adjacent teeth highlight the requirements that need to be considered during restoration: strong chromatic elements, such as enamel cracks and discoloration, a pronounced whitish-translucent peripheral margin, a shadeintensive tooth body, and an uneven incisal edge with grooved indentations (Fig. 3).

Fig. 4: The rough crown of VITABLOCS RealLife on tooth 22 in the shade 2M2 is tried in to check the base shade in the mouth.

Giving the tooth its individual touch: tooth characteristics I begin the individualization by applying the enamel crack of a mixture of BS05 (orange) and BS06 (rust red) with a fine stroke. I highlight the mesial and distal enamel ridge with a mixture of ES01 (white) and ES02 (cream). I accentuate the body of the tooth with BS03 (orange) (Fig. 5).

Fig. 5: First step: Application of the discolored enamel crack as a fine stroke with BS05 and BS06; highlighting of the mesial and distal enamel ridge with ES01 and ES02; accentuation of the tooth body with BS03.

Following the stain-fixation firing at 760°C, without hold time and without vacuum, it is easy to see where stains have been applied (Fig. 6). They have not bled, but are fixed precisely where I intended them.

Fig. 3: The anterior teeth have very characteristic features which must be taken into consideration for the restoration – cracks in the enamel, whitish translucent marginal ridges and the shadeintense body of the tooth.

To restore the tooth, clinician and patient opt for a full ceramic crown. In the laboratory, the crown is manufactured from VITABLOCS RealLife and individualized after cut-back with VITA VM 9. Since the stump in the core is dark, I use the outstanding masking capability of the RealLife blocks to prevent this from showing through. Creating space for individualization: the cut-back A great advantage of the RealLife blocks for the cut-back is that you only have to reduce the vestibular side and apply individual layers. This not only saves time, it also increases the stability of the restoration. I set the cut-back in the software using the “partially reduce” function so the milling unit grinds the restoration into a reduced form. It grinds the oral side into a full anatomical shape and strips off an additional defined layer on the vestibular side only: about 0.5 mm incisal and only 0.2 mm from the body of the tooth. To check for the correct base shade, the tooth is tried on in the dentist's office (Fig. 4).

Fig. 7: Crown 22 after the stain-fixation firing in situ, in the dry state.

Fig. 8: Crown 22 in situ, moistened with VITA AKZENT PLUS POWDER FLUID. It is clearly visible how the BODY STAINS in the area of the tooth body influence the overall shade effect, and the EFFECT STAINS show the details of the previously applied characteristic features.

So it is noticible that the shade in the area of the mesial and distal marginal ridges does not yet match 100%, and the tooth body still lacks some chroma. Once again, I carefully apply ES01 (white) and ES02 (cream) to the marginal ridges and BS03 (orange) in the body area, and fix the shades again with a fixation firing (Fig. 9). Again, I also moisten the crown with VITA AKZENT PLUS POWDER FLUID and see that the features now match those of the neighboring tooth 21 (Fig. 10).

Fig. 6: The stain-fixation firing fixes the stains where they are intended to be. In this condition, it is easy to see where the stains were applied.

Evaluation of the tooth shade in situ Not every dental technician has the opportunity, like I do, to work closely with his patients. I use this advantage whenever possible for the success of a ceramic work. The information that I gain from an intermediate try-in can hardly be communicated directly without loss.

Fig. 9: Crown in situ in the dry state after another application of EFFECT and BODY STAINS in the area of the marginal ridges and tooth body after another fixation firing.

When dry, the stains appear milky to whitish after fixation firing (Fig. 7). As a result, I cannot really evaluate them. I moisten them with VITA AKZENT PLUS POWDER FLUID, which clearly shows how the BODY STAINS applied in the area of the tooth body alter the overall shade effect in comparison to the raw crown (compare to Fig. 2). Without the “natural” translucency, the RealLife blocks would have suffered. The EFFECT STAINS, which have been applied rather precisely, now clearly show the details of the previously applied characteristic

Fig. 10: After moistening with VITA AKZENT PLUS POWDER FLUID, the shade effect of the staining becomes visible.

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features (Fig. 8). I can now optimally evaluate the shade effect of the previously applied tooth features only in the mouth.

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DENTAL TECHNOLOGY Finishing the form - the dentin layering When layering onto the background characterized with shade, I proceed as follows (Fig. 11):

intended, to its counterpart, tooth 12. For the same reason, I have merely suggested the incisal furrows that mark the cutting edge of tooth 21.

(1) In the cervical area, a mixture of VITA VM 9 BASE DENTINE in shade A3 and NEUTRAL, (2) For the application of various degrees of transparency in the incisal area, NEUTRAL and WINDOW, (3) For the mesial and distal marginal ridges, a circumferential fringe of ENAMEL and NEUTRAL, (4) To enhance the gleaming incisal dentin fringe, a mixture of NEUTRAL with BASE DENTINE in the shade 3M2.

Fig. 13: After moistening the crown surface with VITA AKZENT PLUS POWDER FLUID, the previously applied characteristics appear subtly from the depth of the veneer, thanks to the fluorescence of the stains.

After glaze firing and manual polishing, it becomes apparent in the mouth that with the right layering, the effects are no longer as intense as before the dentin firing, but rather appear from the depth of the veneer. And that gives the veneer the natural touch (Figs. 14 and 15).

Division of labor par excellence The VITA AKZENT PLUS STAINS offer me more flexibility in my veneers. Their internal application also gives me an easy and quick way to apply tooth characteristics to full ceramic crowns during layering. Thanks to their pronounced fluorescence, they have an effect on the overlying layer, especially with their internal application, giving the restoration a natural shade effect from deep within. In conjunction with CAD/CAMmanufactured restorations made of VITABLOCS RealLife blocks, with their three-dimensional structure of dentin core and surrounding enamel shell, I can eliminate the first shade-carrying layer after a cut-back and start directly with the transparency materials. The presented case study demonstrates how precisely I can control the desired shade effect with VITA AKZENT PLUS and adapt a restoration perfectly to its environment. Source: Zahntechnik Magazin 9/2014, Spitta GmbH, Germany. VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

Fig. 11: The finished layering onto the background characterized with shade, using stains.

It is then that the first dentin firing takes place. After supplementing with dentin, window and neutral materials, the tooth shape is a bit fuller. However, as before, after the stain-fixation firing, the applied shades, as well as the previously applied enamel crack, are barely discernible when the surface of the crown is dry (Fig. 12).

Fig. 14: Crown after glaze firing and manual polishing. The incisal grooves have been omitted; they are simply a suggestion.

Fig. 12: Crown after the first dentin firing has been worked out and inserted. The shape of the tooth is now somewhat fuller, the previously applied shades cannot be clearly seen on the dry crown and the previously applied enamel crack can hardly be seen on the dry crown.

Subtle effects – natural impact Thanks to the fluorescence of the stains, and after moistening the crown surface with VITA AKZENT PLUS POWDER FLUID, the tooth characteristics have the intended subtle effect from the depth of the veneer (Fig. 13). However, the effect is not as clear as in its neighboring tooth 21, but corresponds more, as

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Fig. 15: You can see that with the right layering, the effects are no longer as intense as before the dentin layering and firing, but arise from the depth of the veneer.

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HIGHEST QUALITY - ITÂ´S ALWAYS THE BEST CHOICE By Matteo Neroni The last choice was oriented on veneers without preparation, starting the patient treatment. After defining the treatment plan and developing the study impressions, I went to analyze the case in a digital vision. This phase is key to success in digital reconstructions, or the careful choice of the scanning system.

ello to all readers of the magazine "The Dental Technician". In this August edition I would like to deal with a topic concerning aesthetic rehabilitations, without preparation.

I will speak and show the processing paths, digital workflows and the choice of the best machinery to obtain 100% of the success of an extremely aesthetic rehabilitation. Even before designing and prototyping an aesthetic line, it is essential to know the history of the patient and how he got to this aesthetic discomfort, and above all the reasons that drive the aforementioned to change.

I personally am a user of the DOF scanning system, synonymous with accuracy and reliability, with a wide range of extremely valid products but with particular differences in accuracy in scanning.

At this point the dentist turned to me asking for a technical opinion. I reiterated my opinion on a first orthodontic phase and then in the case of prosthesis, with an aesthetic approach in which orthodontics had not met the patient's needs.

First of all there is the UHD version of the DOF system, exceptional on image definition. Having clarified the qualitative starting point on the scanning approach, what I am going to do within my modeling software is to import the scanned images and pair them with the patient's front view, therefore going to work with a 2D DSD, or even more powerful,

In most of the practice I work with, veneers or capsules are not always used, indeed where orthodontics is needed, the patient is pushed as much as possible to undertake a mediumlong term orthodontic trip. In the case that I will present in this edition, it is a male of Moroccan origin with diastemas on the sides and upper canines in both quadrants with the typical yellowish pigmentation that distinguishes the ethnic origin. From a purely clinical point of view, the dentist suggested orthodontic treatment to the patient, but was refused by the patient for personal reasons.

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DENTAL TECHNOLOGY a facial scan would be needed, as shown by me, in the June edition of the magazine. This specific case has a particular peculiarity, it is micro veneers with really thin thicknesses, here the true digitization of the dental technician comes into play, which through the use of CAM software, one of these "Hyperdent" goes to optimize the quality milling, through changes in strategies, easing the milling step, its feedrate and the material offset. In this specific case, I personally went to mark and categorize some areas of interest where I wanted a more accurate recovery of my milling. By deciding the inclination and insertion of the milling planes. Here, having created the aesthetic prototype, we move on to the phase of confrontation with the patient, deciding and outlining the progress of the work with the clinician. The patient is called back to the office, the trial veneers are applied and photos are taken to perform a smile plan, live in the clinic with the patient. In this phase, taking into consideration all the aesthetic and functional aspects of an aesthetic reconstruction in micro facets and the adequate lip support of the patient is of fundamental importance. Once the modifications to be made to the prototypes have been acquired, the photograph on which we have developed the correction of the smile-plan is imported into the modeling software previously used, in order to make the modifications studied in an easy, simple and fast way. The "beauty" of working with these plans is precisely the rapidity of the realization of the products, reducing the margin of error to a minimum and providing the patient with a tangible contribution, making him feel in good hands, involving him, taking his ideas into consideration. The aspect that I want to highlight is the ability and efficiency of the dental practice with which you collaborate, my luck is to collaborate with different studies that range in different types of rehabilitation. This case presented with micro-facets comes from a study in Pescara, Abruzzo. The "Cavallo-Serafini" clinic has always focused its activity on dental aesthetics and minimally invasive treatments, through the use of rehabilitations in integral ceramic only, open to new technologies and with an eye always on the future.

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