The Dental Technician Magazine February 2021

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CAD

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

SOFTWARE FOCUS

- THE DIGITAL EVOLUTION

BY STEVE CAMPBELL

PLUS

EXTENSIVE INSIGHT IN TO EXOCAD

BY DAVID NORTH PAGES 18-22

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TECH INSIGHT: 5 THINGS I CANNOT WORK WITHOUT! I PALLAVI PARDIVALLA P. 6 DENTAL TECHNOLOGY: THE IMPORTANCE OF ORIGINAL SPARE PARTS I KAVO DENTAL P. 14

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CASE STUDY: DENTO ALVEOLAR TRAUMA I PRATEEK BIYANI, DANIEL SHAW, ALEXANDRA THOMPSON & ROBERT ORR P. 28-31

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CONTENTS

CONTENTS I FEBRUARY 2021 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 ÂŁ39.95 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.

Welcome Welcome from the editor

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Insight From the archives

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Technicians Insight 5 things I cannot work without! By Pallavi Pardivalla

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Competition CANDULOR presents the new KunstZahnWerk competition 2021

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Marketing Marketing Simplified. By Jan Clarke

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Dental Technology Importance of Original Parts. KaVo Dental CAD Software - What’s the right choice for you and your lab? By Ashley Byrne Revolutionising dentistry with digital dentures. Dental Tribune International

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Focus A simple overview of Exocad. By David North The Digital Evolution. By Steve Campbell Exocad - An invaluable piece of equipment. By Scott Hippey

18 20-21 22

ECPD Free Verifiable ECPD & ECPD questions

26-27

Case Studies Wheel of misfortune: Dento alveolar trauma

28-31

DTGB The Dental Technician Magazine and Dental Technicians Great Britain Facebook Group

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Health & Wellbeing How your lifestyle choices impact your musculoskeletal health.

By Helen Everatt & John Forde 34-35

Marketplace DTS 2020-2021 Zirkonzahn/Kavo Dental

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Classifieds

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WELCOME

Welcome

TO YOUR FEBRUARY 2021 ISSUE

By Matt Everatt F.O.T.A I Editor

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elcome to your February edition of The Dental Technician Magazine.

So here we are again, another month into Lockdown 3. or is this 3.5 or 4?

This time, we Dental Technicians, seem to have gained a fair amount of sympathy from our Dentist colleagues. I have read several social media posts and a recent article urging dentists to help UK labs by paying on time, using us more and to consider contributing something from their NHS contract payments. It is great news that we are appearing on the radar of many Dentists, this can only be a good thing for all of our futures as Dental Technicians.

Without dwelling too much on Covid19, I am sure we are all sick to the back teeth of it, I want us all to acknowledge this moment in time for what it is and what we are all experiencing. No matter how good or bad our labs have bounced back, we have all suffered and we still are suffering the trauma that Covid has brought to this world, not only due to the illness and deaths caused by the virus, it is much more than that.

Never before have I seen so many colleagues, friends and families divided on their thoughts, beliefs and opinions on everything about Covid. This has not been helped by the fear and worry that is escalated by irresponsible reporting by the media.

I'm sure some of you who had the misfortune to read some of my rants online, will know I shared my opinions on the subject a little too often (I have since deleted them!). I may have offended some and many may have disagreed with me. As much as I was angry and had my opinions, I do also appreciate those of you who disagreed with me, had their opinions and may have also been as angry for different reasons.

To coin a phrase that I have seen many people quote; ‘We aren't in the same boat, we are in the same storm.’ The kicker is some of us have only have canoes, some of don't have boats and some of us can't even swim.

After reading this great post by Simon Sinek, a author and inspirational speaker, it

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really hit home to me that I was traumatised.

I was traumatised and to a degree, still am by this whole Covid world we are currently experiencing. Speaking out about it with those nearest and dearest has helped massively.

It's really easy to be angry, criticise and mock people on their opinions and beliefs, we all have them and we all have the right to express them, some express theirs more eloquently than others!

My main objective for this months ‘Editors Welcome’ was to encourage each other to share any burdens you may have and to know that we can all help lend an ear to a friend or colleague and you a good group of technicians here that are willing to help and lend that ear to you should you need it. If you are already in the Dental Technicians Great Britain (DTGB) group on Facebook, please do ask for help or speak out. If you aren’t in the group, do join us.

Do also feel free to send private messages if you would like to discuss anything that you would rather not share publicly.

So, with the introduction of the vaccines, the early roll out program being inclusive to Dental Technicians, I truly hope we can all see light at the end of the tunnel and look forward to a brighter 2021 when we can de-mask, give each other hugs, shake hands and be together again.

Until next month, I wish you all the very best.

INSIGHT

From the

Archives l

This months archive feature is from the November 1958 edition.

Mr Brian Conroy MBE, writes a fantastic article on the process of making a mechanically retained obturator. I had the great pleasure of meeting Brian back in the mid 1990’s, an ‘Old School’ gentleman who was prolific in Dental and Maxillofacial Technology interviewed me for a ‘Trainee Maxillofacial Prosthetist’ role at Queen Mary’s, Roehampton.

His name was in almost every journal and paper that I had referenced in my studies at Manchester Metropolitan University, to say I was nervous was a huge understatement. I had made the journey down to London from Sheffield the night before and took the offer of ‘overnight accommodation’ at Putney Hospital nearby.

The accommodation was like time had stood still, a steel framed bed with ‘itchy’ woollen

blankets, essentially a hospital cum prison room. It was warm and dry at least, and it was cheap. All the of this added to the drama of the whole interview process and meeting one of Dental Technology’s most renowned people.

He was a charming fella who clearly had commanded respect in the bucket loads by his colleagues, I remember him welcoming me into the interview room calling me ‘Sonny’. On reflection, he had every right to call me ‘Sonny’, I was a fresh faced 20-yearold fresh out of Uni and he was at the end of his incredible career where he had been such an influential character.

The article just brought so many memories flooding back, particularly of Chris Maryan, our Uni tutor. He taught our group this very technique during our Maxillofacial practical classes.

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TECHNICIANS INSIGHT

5 THINGS I CANNOT WORK WITHOUT!

By Pallavi Pardivalla I S4S Dental 1. The first thing I cannot work without is Evident Systems. It’s now been a year since we’ve digitised our lab workflow and we’ve never looked back! Despite it being a huge change that seemed daunting at times, Evident has allowed me to gain more independence in managing my own workflow, as well as increasing traceability.

There’s no more rifling through paperwork, passing lab dockets around or guess-workit’s all logged on Evident. The more we learn about the software and how to make the most of it, the more we’ve been able to increase efficiency in our day-to-day work.

2. Secondly, the internet is something that I absolutely need. My job is essentially made redundant without a good internet connection! I rely on it for my emails, 3Shape and iTero portals, Evident and so much more, which means there’s nothing worse when the internet is down.

3. The next thing I cannot work without is the 3D printer. We currently use a Structo Dentaform for a majority of our 3D printing. There’s been an increase in the number of dentists going digital in recent times so I rely on having a good 3D printer to be able to keep up with the demand on a daily basis. Since I manage the digital workflow, it’s imperative that I am able to get models printed on time to pass over to my team members in production.

4. Considering how much I enjoy having a digital workflow, I always have a notebook and pen on hand to jot down absolutely anything and everything. It’s still by far the best way to organise my thoughts throughout the day, and I really couldn’t work without it. That old school part of me is always going to stay!

Evident System

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5. Lastly, I cannot work without the telephone.

I used to be someone who absolutely dreaded having to make phone calls and would prefer to send over an email instead.

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I’ve now come to learn that some queries take just a 30 second phone call to resolve, which means I can get on with the rest of my work.

If you would like to participate in our ‘5 Things I Cannot Work Without’ feature please email: editor@dentaltechnician.org.uk

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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.

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COMPETITION

HEROES WANTED: PROBABLY THE TOUGHEST KUNSTZAHNWERK CASE WE HAVE EVER HAD

Zurich, January 2021: the Swiss School of Prosthetics by CANDULOR presents the new KunstZahnWerk competition 2021

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t is not about a classic high gloss polished case. It is not about the quick setup for in between. It is not about the KunstZahnWerk as you know it.

Become the hero of your vocation, of your own work. As a dental technician you are well aware: all that glitters is not gold. You learn the standards and these lead you to options.

No two patients are alike and none of them are standardized. However, basic knowledge and experience will assist you in creating the restoration; from the perfect analysis to the most suitable denture.

The procedure After the binding registration, CANDULOR will send the detailed information on the complete patient case, which will make the solution easier, as well as the matching maxilla and mandible plaster casts, the physiognomic bite index, the score sheet and the denture teeth. The finished prosthetics must be submitted exclusively in the CANDULOR articulator or Condylator.

A tough case which demands all your precision and could not be more closely related to the reality of a dental technician's everyday life. A case for true dental technician heroes.

Additional opportunity You can photograph, film and/or write. The KZW documentations are an important centerpiece of the competition and will also receive awards. In other words, it pays to document your work. The best documentations will be published in various professional journals.

When heroes become legends in prosthetics - your jury.

Are you ready to give it all you've got for this jury?

• Peter Lerch • Jürg Stuck • Max Bosshart

The award ceremony The award ceremony will be held online.

The exact date is still to be announced. The best pieces of work will be showcased online on our website. You will be given more information on this at a later date.

The task Fabrication of an upper and lower full denture based on a detailed model analysis as well as a detailed documentation. A dynamic occlusion concept, according to the condylar theory of Prof. Dr. A. Gerber.

The prizes 1nd prize: check for €1,500 2nd prize: check for €1,000 3nd prize: check for €500 As well as non-monetary prizes sponsored by the trade press.

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Registration Please register for the competition no later than 30 April 2021. You can register via our website www.candulor.com or by telephone on +41 44 805 90 36.

CANDULOR AG Boulevard Lilienthal 8 CH-8152 Glattpark (Opfikon) Tel. +41 (0) 44 805 90 00 Fax +41 (0) 44 805 90 90 www.candulor.com candulor@candulor.ch ABOUT CANDULOR AG: CANDULOR AG is a worldwide exporting dental company with its headquarters in Switzerland. CANDULOR's customers benefit from a complete prosthetic system: a combination of esthetics, design and functionality. Together with the sciencebased positioning system according to Prof. Dr. A. Gerber (Condyloform®) the physiological positioning system (Bonartic®) forms the basis of this system. The portfolio also includes the highly esthetic NFC+ tooth lines, products for registration and articulation as well as for completion and characterization. Dental technicians and dentists have trusted the Swiss products for more than 80 years to meet the esthetic demands of their patients. For further information please visit candulor.com

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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

Communication, communication, communication...

W

hen I wrote my last piece about plans for 2021 we hadn’t been thrust into yet another lockdown and as I write this, here in Scotland, we are awaiting news of when the children can go back to school and we will have some relaxation of rules. Vaccinations have started which give hope to us all but it is clear this is a slow process and not a quick fix.

Thankfully, dental practices have been allowed to remain open and continue with their work but there does seem some discrepancy between the types of work being carried out, particularly between private and NHS practices.

Income will be a massive concern to you all and I am sure you will all be looking at expenditure and minimising this rather than investing in new technology.

As I mentioned in my last article, there are many marketing tweeks you can make at the moment without a big spend or even any spend and certainly spending time looking at your business and your processes will be time well spent.

With that in mind I thought I could discuss the way we communicate with our clients and potential clients.

• Being “on brand” means always communicating to your clients in the way your business expects, answering the phone in a particular way, dealing with complaints and problems in a tried and tested manner that you all agree on. There needs to be consistency with how you all communicate with your clients.

• Test your systems by asking someone to “mystery shop” you. This isn’t about trying to trip up your team members but more about fine tuning your responses and ensuring that consistency again I mentioned previously.

• Your team need to be on the look out for opportunities for feedback from clients. Use the opportunities when work is well received to ask for a video testimonial or a google or facebook review. Asking for feedback at the completion of every piece of work should become second nature to your team. You can, of course, make this as easy as possible for your clients. We know everyone is busy and leaving a review is the last thing on their minds but training your team to be pro-active in this department will pay dividends.

To encourage new clients we do need to make it as easy as possible for someone to become a client. We want to make it as easy as possible to find out information about our services and use them. What can we do to achieve this?

• Involve your team in your social media.

Perhaps write a focus post about one of your team and then each week choose a different team member. This not only allows your followers to learn more about your team and their skills but also helps build team spirit and ownership to their position. Encouraging your team to be the best they can is advantageous to all.

Perhaps it’s time to take a look at this and use it in your business? Even for communicating with your dentists about a piece of work coming in, a face to face chat will be so much more powerful than just a telephone call.

• You may also go one step further and ask your team to contribute to social media by providing videos showing them working or maybe writing a blog post.

• To educate existing clients and show them how you work

Your team has all the skills and attributes to be able to “sell” itself without having to spend a single penny, this is all possible within your business.

• To chat with a client and their patient about a piece of work, there are huge benefits to actually being able to see the patient’s face, shape, structure age and so on, perhaps even help with shade taking?

External communications Things will always go wrong in every business but most customers are happy if you accept your faults, apologise and try to rectify. This also means learning from the mistake and putting processes in place to ensure the fault doesn’t happen again. Being great at communicating with your clients will serve you well.

Everyone in the team is responsible for marketing – Internal Communications Many businesses have a Marketing Manager but for most smaller businesses this tends to be the domain of the multi talented, or maybe not so, business owner. As said previously, marketing is everything you do, and in my view this means that every person in the business has a responsibility to market. But what does that really mean.

• Communicate with your team so everyone knows what level of service is expected of them

• All the team should be “on brand” – they should understand the direction and values of the business. This can only happen if you communicate this to them through regular updates, training sessions, a formal work induction and so on.

• Agree together how the phone is answered, who answers the phone, when you have communication with your clients, how problems are managed. By spending time to discuss all these elements your team should be quite clear of their expectations.

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• Consider new technologies for communication.

Many dental practices are now offering online consultations and appointments by Zoom. During lockdown most people have become familiar with the use of Zoom and you may have been using it yourself already for training purposes.

Zoom could be used in many ways • To meet a new client and build some rapport

• To chat to a client about a job

• Moving forward you can consider a Zoom based webinar to invite several new or exiting clients too.

Keeping the channels of communication open with all your team, your clients and their patients will be of great benefit to you and your team.

It’s never easy and for some can really push you out of your comfort zone but all these areas can be achieved with minimum expenditure and maximal gain so I would encourage you to explore increasing your communication in all ways.

As ever I am here to help with any of these issues so do email or connect online with me, I look forward to meeting some of you in cyberspace!

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DENTAL TECHNOLOGY

THE IMPORTANCE OF ORIGINAL SPARE PARTS

By KaVo Dental QUALITY ALWAYS PAYS

We’re all familiar with the phrase “buy cheap, buy twice” but we often forget this applies to the smaller things we buy too.

While you may have decided to invest in good quality high-speed lab drives, turbines and or contra-angle handpieces, when it comes to yearly or ad-hoc maintenance, it’s easy to forget to ask for manufacturer original spare parts for any repairs. After all, we all want things done as quickly and easily as possible.

happen and assures you of continued best performance, time and time again.

instruments. None of which you would be willing to compromise, given the choice.

Choosing to replace parts with manufacturer’s original spare parts means that your instrument remains exactly as it was designed and produced in the first place - with each part running like clockwork in conjunction with every other part.

As Jason Jewitt, Manager at Mi-Tec Handpiece Repairs says: “Just like a car, a dental handpiece these days is a high-grade machine, built using advanced technology and carefully honed parts. Each of those parts needs work together so you can continue to rely on the instrument you’re using.”

THE DEVIL IN THE DETAIL

Just the thought of planning a yearly service for your instruments can add dread, inconvenience and cost to your to-do list.

However, it can also save you a lot of time, money and hassle in the long term.

When it comes to replacing parts of a handpiece, be it a cartridge, ball bearing or even just an ‘o’ ring, if a part is available at a cheaper price than the manufacturer’s original parts, then that must be for a reason. Usually that reason is because it has been manufactured more cheaply in the first place which could indicate that the quality is inferior.

Furthermore, today’s dental handpieces are produced with such precision that there is no margin for error, so any measurement deviations of any of the parts - even of fractions of a millimetre - can adversely affect the instrument’s ability to perform to its optimum capacity, or even affect its conformity as a CE marked product.

Getting your instruments checked and serviced by an approved professional ensures that there are no accidents waiting to

A manufacturer’s original parts, on the other hand, have been designed and made to optimise the performance, safety and reliability of your

Any piece of equipment or dental handpiece has been designed and manufactured with myriad parts, all designed to work with each other in order to optimise that instrument’s performance. It’s like a carefully crafted chain and each link has a bearing on the next.

TIME IS OF THE ESSENCE

CHAIN REACTION

Of course, this includes not just the outer casing and the internal parts but also the consumable items needed to keep the system operating – i.e. oil or spray and the maintenance process. Choosing the best component for each means you’ll never compromise on performance.

As manufacturers, it’s up to us to ensure that chain is never broken and that all the links perform as well as they were intended to.

That way, we deliver you an instrument that works perfectly, again and again and again.

KaVo are delighted to be working with MI-Tec to provide the very best repair, servicing and maintenance of your KaVo handpieces. For more details on the special offers available, please contact Jason Jewitt at MI-Tec. T: 01253 600083 E: KaVoRepairs@ ddgroup.com / info@kavo.co.uk

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15

DENTAL TECHNOLOGY

CAD SOFTWARE - WHAT’S THE RIGHT CHOICE FOR YOU AND YOUR LAB?

By Ashley Byrne I Byrnes Dental Lab

“

It won’t be long before every lab needs and uses CAD, but which system is best for you and how do you choose?

”

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C

omputer aided design, or CAD for short, dominates manufacturing and design industries and dental is no exception. These days it is routine for crown and bridge and ortho labs to be using CAD and now it’s creeping into prosthetics. It won’t be long before every lab needs and uses CAD, but which system is best for you and how do you choose?

There are major dental players - like exocad, 3Shape, Dental Wings from Straumann, and InLab from Dentsply - but there are also many smaller company CAD systems, derivatives of exocad and even nondental CAD software, that can be modified for the dental lab. With over 20 known CAD software systems ranging from free to the thousands of pounds, choosing software can be a risky business.

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At Byrnes we run exocad, 3Shape Dental System, Dental Wings and InLab but we do find that 3Shape and particularly exocad works best for our business and the team. That doesn’t mean it’s necessarily right for you or your lab though. Debating what is the best system on the market is like debating mobiles - if you own an Apple or Samsung, you would swear it was best. Both do the same job and yet people can be passionate about their choice because they’re invested in it (and I’m not just talking the financials). Sadly it is just not that simple! You also need to be aware of the ‘clubs’ phenomena.

If you own a BMW, it’s better than a Mercedes and vice versa - most of those people do not own both makes of car, they're usually staunchly one or the other, so are they really able to give you an unbiased opinion? It is human nature for people to want to get you to buy the same car as them, they want you in their club. It’s not malicious in anyway, but we naturally want people to have the same as what we have.

DENTAL TECHNOLOGY Choosing CAD for your lab comes down to multiple factors like ease of use, ease of training, functionality, price, annual running and upgrade costs, and the ability to customise your software modules specifically to your lab. I would always advise to try and put price to the back of your mind. Cheap (and often free) software can be used but you often find that ‘expensive' software can save you time, and time is an area that we often do not cost into our businesses. We use 3Shape and exocad at our lab and they are without a doubt, the two most costly systems, yet they are fast, easy to use, and we can push units through rapidly, thus saving all of us time. If you are new to CAD then learning and support is key, and that is also a huge factor in choosing the system. To add even more complications to that, some of the big systems like Dental Wings is supported

by Straumann, and InLab is supported by Dentsply Sirona, so it’s a simple one point buy and support. exocad and 3Shape are sold through resellers who both sell and support.

Some resellers are excellent and some, less so.

My advice here is once you have chosen the system for yourself, start talking to the resellers, talk to other users - this is helpful guide to finding great resellers of those systems who match with you and your business.

Most CAD software is modular so if starting out with CAD you may be gobsmacked at the idea of spending £8,000+ for software you may not use, so consider options like buying the base package and then upgrading, or even renting the software and scanner option which some companies and resellers are now doing. The disadvantage to this is it can be a more costly approach as you grow the lab but again, that’s a decision that you have to make for you and your business.

As I said earlier, at Byrnes we use 3Shape and exocad as our main systems with exocad taking around 70% of our working day and 25% on 3Shape. We need these systems and it’s a simple fact that we can’t do without both.

They each have their pros and cons which is where they fit into the way we work at Byrnes - e.g. we run Carbon printers and they simply work better with 3Shape, but all my crown and bridge diagnostic stages and final work is on exocad because we prefer the way it works and the communication tools it offers with our clients. That’s just two examples but the list is honestly into the hundreds.

I can’t personally advise you what system to choose because each lab and lab team is different, and yet it is the question I get most from other lab owners looking to invest in CAD. Keep an open mind, beware of those ‘clubs', check out YouTube tutorials and see if you can follow along, and lastly, build a great relationship with your supplier or reseller - trust me, you will need them as I still do now.

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FOCUS

A SIMPLE OVERVIEW OF EXOCAD

By David North I Metrodent digital specialist

A

fter leaving school at 16 and going straight into a dental lab I never thought I would spend 32 years as a dental ceramist! The number of changes over these years has been incredible, with the first scanner I used being the Procera Piccolo a small touch scanner scanning one die at a time, which some may remember.

And now scanning with the DOF freedom light scanners, using Exocad and Exoplan software in a digital seamless way, scanning full articulated models merging and meshing scans in all aspects of dental cases.

A good comparison of the changes some of us have seen, the TV tennis game I remember as a child to a modern day tennis game on pc or console! I would never had imagined how digital technology would have to progressed to present day. The last 10 years has brought a lot of changes especially Exocad, starting in 2009 as Fraunhofer IDG, who started research into dental computer aided design (CAD). Who would have thought all this digital design technology software and images we see in exocad comes from a simple triangular mesh?

Exocad is the tool for every dental technician who wants to be part of the future in digital dentistry. Already the standard version of Exocad covers a wide variety of indications, making it an attractive choice both for expert users and newcomers in the dental CAD field.

The strength of Exocad is its simplicity. There is no point in creating software that makes your job harder, it is extremely logical and easy to use, because the software emulates the analogue work of a dental technician.

very attractive economic proposition, with all the Exocad modules available, it is not difficult to add these to a new or existing Exocad dongle.

Exocad have put together bundle options with the Ultimate bundle option including every Exocad module available.

(See the table pictured left).

To digitally design a restoration has never been as easy and accessible without the learning curve of the past. Exocad will help you maximize productivity and profits. It is reliable and robust even when dealing with complex cases on a day-to-day basis.

WITH EXOCAD THE CHOICE IS YOURS Easily and seamlessly integrate exocad dental CAD software with all exocad products and modules in a digital workflow. Exceptional usability, performance and flexibility are guaranteed. Thanks to its open and neutral software architecture, you can use Exocad with your existing equipment, such as any open scanner, 3D printer or milling machine. With exocad, you control the desired workflows.

Expand your portfolio with a wide range of addon modules to improve collaboration with clients and service providers alike for reliable results that are cost and time efficient and effective.

It is easy to expand your Exocad standard version according to your needs. With Exocad add-on modules and enhance the feature-set of the standard version. The module system allows great flexibility, and you can purchase just what you need for your lab requirements, making it a

From my point of view with exocad you start learning by using the exocad help wizard, basically exocad software telling you what to do step by step, even telling you, you have forgotten to do specific instructions. When you get confident using the wizard you can easily

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switch to expert mode, then you are telling exocad software what you want it to do. The limits are endless!

And now with the integration of exoplan this brings together the surgery and lab, communicating easily and quickly to produce any dental prosthesis in a digital format.

With a lot of dentists now looking into intra oral scanners, a dental software is key for any dental laboratory looking into digital, so take a look at Exocad you won’t be disappointed. Now with the new release of Exocad Galway 3.0 and Exoplan Galway.

So if you are a crown and bridge lab or a prosthetic lab, Exocad offers a digital design and workflow for all aspects of your lab. Love it or hate it! digital has and is still changing the dental industry.

From being a ceramist in the lab for 32 years, I am now digital specialist at Metrodent installing and supporting the exocad software along with all other digital aspects within the industry Now there’s a change I didn’t see coming!

So, what other changes are coming? Digital dentistry will keep on developing within the industry, there is still a place for conventional work and think there always will be. Exocad can help you be a part of this whole new digital world!

Contact Metrodent to discuss your options and answer any questions.

FOCUS

EXOCAD

THE DIGITAL EVOLUTION

By Steve Campbell I Nexus Dental Laboratories

W

hen asked to share our experiences with Exocad I was unsure where to start. How do you summarize one of the most revolutionary tools to ever enter your lab? A tool that transformed our processes, workflow, quality and consistency?

So, I decided to break it down into the key elements, starting with something I believe is one of the most powerful tools in a digital workflow‌

COMMUNICATION

Exocad has completely transformed the way we communicate with our surgeons and the rest of the team on every element of case processing.

From the initial diagnostic through the stages of framework and final device creation.

The Exocad Webview is an incredible tool for this. Unlike other systems that insisted you and the clients had to have the same system to view a virtual smile design, Exocad simply allows you to make a web link and share it with everyone.

This allows us to communicate very clearly with a surgery or other team partner knowing we all have a solid visual anchor and are not just relying on flat 2D images and a description of the issues.

As you can see from the images below it allows us to plan for an immediate extraction and implant of the 22, but the surgeon sees and approves anything before we all commit to further expense and planning. Once we have used this to discuss and approve we then move to produce the diagnostic model.

EXOCAD WEBVIEW – ENHANCED COMMUNICATION

A diagnostic using Exocad allows us to copy the patients own teeth for an ideal and unique high quality diagnostic proposition that the surgeon can open and assess in their own time.

Laboratory and surgery have the same information to inspect and analyze thanks to Exocad Webview, with the ability to use the sliders to ghost elements in and out. This allows us to discuss elements like occlusion, materials,

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FOCUS CEJ etc. All before we have committed to anything being physically produced.

Approved to produce and below you can see what a digital diagnostic model looks like when approved for production. It’s not the case that a digital diagnostic is a poor version of the old analogue hand wax. By using the Exocad tools effectively we have a beautiful diagnostic that uses the patients own biometric shapes to create a natural result proposition for them The reason I think one of the main advantages is that miscommunication is a major reason for work being rejected or adjustments requests. By agreeing on the outcome before we commit to production, we are transforming the efficiency and effectiveness of our team. It allows us to essentially break geographic locations and work as if we were in the same room with the surgery team. This brings me onto the next powerful tool in the Exocad tool.

FREEDOM FROM GEOGRAPHIC BOUNDARIES

When you embrace the digital workflow you are able to work with the best partners regardless of where they are in the world.

Thomas Telfer worked with us here in the UK for many years, but 2 years ago returned to Tenerife. Thanks to Exocad and their DentalShare platform we still work together in providing cases for our Clients here in the UK. In most cases we are not only working with Thomas on one case, but also skilled technical partners in Belgium, Sweden, and Spain.

We can start a case here, upload in Dentalshare to Thomas who will make his design edits to either produce at his lab in Tenerife, or update the project and we can produce here if just at a diagnostic stage.

As we find it harder to meet the demands of the clients and public for high quality dental medical devices going forward with dwindling technician numbers, it is critical that we all learn to maximize our high value time. Working with partners can help us maintain the high standards or UK dental technology whilst being more efficient than has historically been possible in labs.

Regardless of the fact that we are just a small lab in the Yorkshire Dales, we work within a Global team every day and it allows us to perform as a much larger group, but with the flexibility of being a lean and light operation of a handful of highly skilled technicians.

SUPPORT

The final reason Exocad has become the number one system in our lab is the excellent support we get at every level. From 1st level with David North at Metrodent, all the way through Exocad´s team of trainers back at the HQ in Germany.

We must always remember that at it’s core any digital system is just a new tool. Like any other tool in the lab it must perform day in, day out.

I got sick and tired of error boxes and bugs in other CAD systems that were seriously hurting our efficiency. We are a business, and as such we must be very critical of any systems we pay for if they start to take up our valuable time.

I was so impressed with Exocad´s features and stability that when the opportunity arose to become a trainer for them I jumped at it.

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Exocad has been a game changer for our lab, but behind it all we always remember the team matter the most, and the teams that support us are critical to our success.

With Exocad we have a world of new possibilities backed with fantastic stability and support that will be key to allowing the laboratory industry to meet the demands that will be placed upon us all as the workforce and expectations of our surgery partners changes over the coming years.

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FOCUS

EXOCAD - AN INVALUABLE PIECE OF EQUIPMENT

By Scott Hippey I Halo dental laboratory Ltd

I

have been working as a dental technician for 11 years and graduated from Nottingham college on a day release course, passing FdSc dental technology in 2014 achieving a distinction. Starting off my dental career at age 18, having no idea about the industry, I stumbling across an intriguing job advert for an orthodontic laboratory trainee. Initially casting models, it only took me a couple of weeks of showing interest and intuition before I was moved on to learning the whole workflow and in the two years I worked there i left being able to produce most appliance start to finish.

It was at this point I found myself a job in a private crown and bridge and implant laboratory, here I learned the whole workflow both traditionally and digitally, from waxing, casting and laser welding to digital designing, milling and printing. I have since kept myself in the private crowns and bridge and implant sector and my eagerness and enjoyment of the job has kept me at the forefront of the latests techniques and digital advancements. During my time on the digital side I have used the range of cad softwares extensively as well as a array of milling machines, printers and materials. I personally feel like the digital aspect is like a second language whilst also needing to have the knowledge and understanding of function, morphology and mechanics.

EXOCAD

Exocad is a invaluable piece of equipment, having a range of design software systems at my disposal in the laboratory it is exocad that I pretty much use exclusively these days. It’s not because it produces better results it just produces the results quicker, easier and in a bug free workflow which is more evident when designing larger case such as full arch implant cases and smile designs. The ability to switch into expert mode at anytime giving complete freedom to jump between stages, change the workflow, bring in addional stls and the save scene feature is a absolute god send, allowing one to save all the visable stls on screens as a single stl file but also keeping each mesh individually selectable when using the edit mesh tool.

My passion for both the job and the technology drives me to explore different workflows and find out the box solutions and

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exocad gives the freedom for that to be possible.

An example that comes to mind is when I received a prescription requesting one of our 3D printed pilot drill guides but asking for gutta percha in the drill hole so it could first be used for a CT scan before removing the gutta percha and using it for a pilot guide. I wanted to produce a fully digital workflow so my solution involved my normal stent workflow and then utilising the attachment feature I used a 3mm cylinder attachment to create a hole through the pontic tooth, then I made the cylinder attachment 2.8mmø and proceded to save that as a separate stl which was then milled out of a radio opaque PMMA disc and the slightly slimmer diameter allowed the milled cylinder to fit in the 3mm hole with a tight friction fit then could be pushed out with a tool providing a cleaner and quicker solution than using gutta percha.

A typical example of how one can manipulate the software and use exocads ingenious features to achieve predicatable results utilising the same design throughout the several stages of a case is as followed. A large case will commonly start with a diagnostic wax up that is done digitally using just pontics onto of a model, for a nice symmetrical outcome I will design one half of the mouth then use the cool copy/mirror tooth function, which allows one to do a exact copy or an exact mirror of either a designed tooth or natural tooth from the scan, and I will mirror the teeth i have already design onto the other half. Once the pontics are in place I can used the save scene feature or create wax up model option to create a single stl of the model and pontics that can be 3d printed. I like to use the predefined base option on the model creator which produced a nice study model base and the freedom of exocad allows me to place our company logo on our printed wax up models with ease.

Another handy feature is whilst creating a digital disgnostic wax up, a gingivectomy stent can be designed at the same time for crown lengthening if required by exploiting the design gingiva feature with just a few extra clicks, although not a intended workflow the freedom to think outside the box is there.

Once the wax up has been approved and the new prepped scan or implant scan has been scanned in, the digital wax up scan can be brought into the scene using the add/remove mesh tool and can be imported as either, a wax

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up scan, which the software will copy exactly automatically without the need to place library teeth or as a preop scan that allows one to adapt library teeth to the overlaying preop scan. Not all cases are the same so I will import as either depending on the individual case. Once the scan has been aligned by clicking on recognisable landmarks on both scans the digital wax up scan can be right clicked and select edit mesh, then by allowed selection by click, click the model, the software will highlight just the model stl, not the pontics teeth used in the digital wax up and the model can be deleted leaving just the pontic teeth overlaying the new scan, this allows the software to copy more precisely and get an exact replica for the final restoration.

Another amazing feature with the software is if the above was an implant case, I use dess scan flags that allow me to produce a restoration direct to multi unit abutment level as a open stl, some fixture levels are also available, then I can print a full arch try in that screw into the patients mouth without the need of ti bases or any bonding, and once approved I can then switch from direct to implant to then utilising ti bases at a click of a button without losing any of the design or I can reverse engineer the design into a titanium bar.

The new exocad 3.0 Galway even goes a step further by a giving the user the ability to swap implant libraries with matching ones from other 3rd party manufacturers, for example a scan with genuine straumann scanflags Is now compatible with the dess straumann library so a dess ti base can be used which is a real game changer, especially with intraoral scans on a big increase, putting flexibility back into the technicians hands. True to their erthos, exocad offer complete freedom which is perfect for the passionate dental technician trying to offer the best solutions.

As a digital cad solution I cant recommend exocad enough, from new users or to expand existing digital department, the abitly to link it directly to a wide range of scanners and the different purchase options make its a easy choice and gives the end user a range of set up options. I truly enjoy using exocad and challenge myself to find different solutions and helping others understands how to get the most out the software and i frequently travel around the country to other laboratories giving one to one training and support over the phone or on different social media platforms.

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DENTAL TECHNOLOGY

THE FUTURE IS NOW: REVOLUTIONISING DENTISTRY WITH DIGITAL DENTURES

By Iveta Ramonaite I Dental Tribune International

W

hereas it was previously impossible to imagine a dental laboratory adopting a fully digital workflow, digital dentistry has already redefined the previously established dental procedures and empowered dental professionals and clinicians to take the leap and immerse themselves in a digital future.

The benefits of dental technology can be clearly seen in the introduction of digital dentures - not only has this facilitated denturists’ and dental clinicians’ work by offering more flexibility and efficiency, but it has also improved the patient experience and enabled patients to become more involved in their own care.

Dr Lucio Lo Russo, University of Foggia’s School of Dentistry. (Image: © 3Shape)

“I have been working with 3Shape for about five years. In the beginning, using denture software was not one of my goals; nonetheless, curiosity about the innovation and computeraided design offered by 3Shape allowed me an opportunity to appreciate what appeared to be, for the first time, a real game-changer,” Dr Lucio Lo Russo, associate professor of oral disease at the University of Foggia’s School of Dentistry in Italy, told Dental Tribune International. “Since then, huge developments have been made in denture soft- ware, and it can now be considered essential for those who want to exploit the benefits of innovation and the related opportunities in dental practices and laboratories,” he added.

Germen Versteeg, denturist.

(Image: © 3Shape)

PICTURED RIGHT: Recent advancements in denture software have facilitated the transition to a fully digital workflow, and dental professionals are invited to embrace the benefits of digital dentistry.

(Image: © Sergii Kuchugurnyi/ Shutterctock.com)

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According to Russo, using digital dentures offers higher standardisation. This, in turn, manifests itself in higher quality and a great reduction in processing time and, consequently, increases efficiency and profitability. He noted that switching to digital technology for the fabrication of dentures also results in changes to clinical and laboratory approaches. He stated: “No more physical impressions, no more physical casts, no time-demanding procedures. Each step is precisely defined and optimised to save time and enhance effectiveness.”

A CLEAN AND ENJOYABLE EXPERIENCE Germen Versteeg, a denturist and the owner of DTL Mediaan, one of the first fully digital dental laboratories, told Dental Tribune International that besides obvious advantages such as cost-efficiency, improved denture workflow and scaled-up production, working with digital dentures makes the job much cleaner. Whereas it used to be a messy pro- cess, leaving fine layers of dust on the working surfaces, Versteeg compared walking into a denture shop now with walking into a wellness centre: “It feels like home and it’s really clean,” he said. “We have a smile design room. So when people come in for the first time we drink a cup of coffee, and we discuss their new smile.”

DENTAL TECHNOLOGY Using digital dentures also puts more power into the hands of the patients. Versteeg said: “The patients them- selves are in charge of their aesthetics, and they can discuss the aesthetics with the help of 3D simulations.”

Versteeg noted that fabricating a new denture is fairly uncomplicated, since it only involves creating a 3D pic- ture of the patient, simulating a new smile and scanning the mouth with an intra-oral scanner, such as 3Shape’s TRIOS. He went on to explain that people used to find wearing dentures quite off-putting. However, since it is a necessity rather than a choice, Versteeg believes that people should wear dentures with confidence: “So why can’t we make it a sexier thing, something to be proud of?”

ENDLESS POSSIBILITIES

For those thinking about transitioning to a fully digital production workflow, Versteeg explained that 3Shape software is highly sophisticated.

Whether one wants to work with dental models, intra-oral scanners or impres- sions, all these and more options are already in the software. “You have the flexibility to work in your own way,” Versteeg commented. Additionally, the software pos- sesses older tools, making the transition so much smoother for more conservative dental professionals.

When using a digital workflow, a completely new denture can be made in two to three appointments. This saves time compared with fabricating dentures in a conventional analogue way and consequently boosts patient comfort.

Another clear advantage of using digital dentures is reproducibility. Versteeg explained that, when a patient loses a denture or wants to improve the previous one, the denturist has the option of quickly accessing the software, where the back-ups of all CAD/CAM denture designs are saved, and printing or mailing a new denture in very little time.

WHAT 3SHAPE BRINGS TO THE TABLE

When talking about his experience with using 3Shape denture software, Versteeg explained that both parties benefit from the cooperation.

The dental laboratory pro- vides input and points out the improvements that need to be made in the software or in the workflow, and 3Shape immediately considers the laboratory’s needs and con- stantly updates the software.

As he noted, 3Shape spe- cialises in IT, and dental laboratories perform clinical work, which means that both parties need to give feedback and exchange information that will help improve software quality and increase laboratory productivity.

“The great thing about 3Shape is that they listen to the end user. And I think that’s something that makes them really stand out from all other companies,” Versteeg explained.

GO ALL THE WAY

To make the most of the digital workflow and to truly benefit from it, Versteeg encouraged dental professionals to take the leap and go fully digital from the very beginning. As he highlighted, digital dentures are already being used today, and with every passing day, those who still have not adopted a digital workflow are falling further behind the technology.

“Even in more developed countries, there are millions of edentulous people who have limited access to oral treatments for biological or financial reasons.

We still need effective and efficient rehabilitation of edentulous patients that is focused on their functional needs and favours access to treatment,” Russo noted.

“Digital technologies applied to removable prosthodontics have the potential to make such treatments affordable for these patients and also profitable for oral healthcare providers,” he concluded.

TO ADVERTISE IN THE DENTAL TECHNICIAN

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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.

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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 the January 2021 DT Edition:

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VERIFIABLE ECPD - FEBRUARY 2021 1. Your details First Name: .............................................. Last Name: ........................................................Title:................

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2. Your answers. Tick the boxes you consider correct. It may be more than one.

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

A

A

A

A

A

A

A

A

B

B

B

B

B

B

B

B

C

C

C

C

C

C

C

C

D

D

D

D

D

D

D

D

Question 9

Question 10 Question 11

Question 12

Question 13

Question 14

Question 15

Question 16

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B

Q4.

A

Q5.

A

Q6.

D

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Q7.

B

Q8.

A

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.

Q9.

A

You can submit your answers in the following ways:

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A

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C

1.

2.

Q12.

B

Q13.

A

Q14.

A

Q15.

D

Q16

B

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WHEEL OF MISFORTUNE: DENTO ALVEOLAR TRAUMA Q1.

A B C D

What is the most common cause of dentoalveolar trauma?

Domestic violence Sports accidents Falls Automobile accidents

Q2.

A B C D

What were the choice of antibiotics in this case?

Metronidazole Amoxicillin Co-amoxiclav Tetracycline

Q3.

A B C D

Dental trauma associated with domestic violence tends to peak around what age?

1st–2nd decades 2nd–3rd decades 3rd–4th decades 4th–5th decades

Q4. Dentoalveolar trauma accounts for what percentage of

sports-related facial injuries?

A 10% B 25% C 50% D 75% Q5.

A B C D

Which of the following is not an advantage of utilising an RPD as an immediate method of rehabilitation?

Provides the ability to reline Increased oral hygiene demands Allows for future treatment planning Provides better function

Q6.

A B C D

Which are the most common forms of dentoalveolar trauma?

Crown fractures and subluxation Avulsion and crown fractures Subluxation and intrusion Intrusion and crown fractures

Q7.

A B C D

Avulsion, with an alveolar fracture, is noted in what percentage of cases?

5% 11% 17% 23%

Q8.

A B C D

Success rates with anterior maxillary implants, with bone grafting, have been found to be around?

80% 82% 92% 96%

Q9.

A B C D

What would be the ideal management of a fractured alveolar process?

Removal under local anaesthetic Splinting for 4 weeks Splinting for 1 week Splinting for 8 weeks

Q10. What percentage of physical trauma in non-accidental injury

occurs in the head and neck region?

A 20% B 40% C 50% D 70%

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.

www.dentaltechnician.org.uk

27

CASE STUDIES

WHEEL OF MISFORTUNE: EXTENSIVE DENTOALVEOLAR TRAUMA FOLLOWING A CYCLING ACCIDENT

By Prateek Biyani I Specialty doctor in oral and maxillofacial surgery, Chesterfield Royal Hospital, Chesterfield; Daniel Shaw I Maxillofacial technician, Chesterfield Royal Hospital, Chesterfield; Alexandra Thompson I Specialty registrar in oral and maxillofacial surgery, Royal Hallamshire Hospital,Sheffield and Robert Orr I Consultant in oral and maxillofacial surgery, Chesterfield Royal Hospital, Chesterfield Dentoalveolar trauma is extremely common, particularly amongst children. The majority of this trauma is managed by general dental practitioners, with few cases being referred to emergency departments.

Effective and appropriate management, following published guidelines, is important to achieve the best outcomes for patients.

We present a case report of significant dentoalveolar trauma presenting to the emergency department. We discuss immediate, short-term and long-term management, including the challenges faced along the way.

BACKGROUND Dentoalveolar trauma is extremely common, with a prevalence of approximately 48% amongst all facial trauma.1 Attendance to emergency departments, following dental trauma, has been found to be between 4.610.5%.2,3 Falls are one of the most common causes of dental trauma, particularly in the younger population, closely followed by automobile and motorbike/bicycle collisions.3,4 This case report discusses an incident of significant dental trauma following a bicycle accident.

We also highlight the difficulties and challenges in immediate and short-term rehabilitation of the patient.

CASE PRESENTATION A 13-year-old boy presented to the emergency department after going over the handlebars of his bicycle whilst not wearing a helmet. He had general symptoms of concussion but was otherwise cleared of any major head injury.

He had sustained a buckle fracture of his right

wrist and extensive dentoalveolar injuries.

Despite the extent of trauma, he complained of minimal pain. He was fit and well, with upto-date vaccinations and no allergies.

On clinical assessment of the dentoalveolar trauma, he had avulsed UR1, UL1, UL2 and UL3 along with the buccal alveolar bone and gingival tissue. This was unaccounted for and constituted a fracture of the maxillary alveolar process. Additionally, he had fractured UR2 and UL4 subgingivally (roughly to the coronal third of the root).

The palatal alveolar bone and tissues were intact. Surprisingly, there were no other facial injuries of note. An orthopantomogram (OPT) was not possible on the day of presentation but a chest X-ray confirmed no aspiration of any of the avulsed tissues.

As there was very little immediate action that could be taken, local anaesthetic was given around the wound and the wound was thoroughly irrigated and debrided with saline. Sutures were not possible due to the lack of free tissue. He was prescribed a five-

Fig. 1: Granulation of wound at 1-week post-trauma

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day course of 625 mg co-amoxiclav TDS, as well as chlorhexidine and benzydamine hydrochloride mouthwashes. He was advised to maintain a soft diet for at least four weeks and to take analgesia as required.

The patient was reviewed a week later, where an OPT was taken. He appeared to be coping well with a soft diet and the wound had begun to granulate with no signs of infection (Figure 1). The OPT corroborated the clinical findings, with the UR2 and UL4 being fractured subgingivally (Figure 2).

At this point we decided to involve the maxillofacial technician to start to consider methods of managing the wound. A cover plate was considered at this point but, as the patient was managing a sufficient oral intake and was keeping the area clean, it was decided that this would not be beneficial. Instead we decided to plan for a partial denture once more mucosal healing had occurred.

The decision to wait is discussed later in the ‘Technical aspects of rehabilitation’.

Fig. 2

Fig. 3

We continued with weekly reviews. During this time the patient’s dentist attempted extraction of the UL4 but was unsuccessful and the tooth fractured further.

Approximately six weeks following the injury, the patient had achieved full mucosal coverage and impressions for a partial denture were commenced (Figures 3-5). He had an upper partial denture fitted with excellent aesthetics and retention (Figure 6).

Additionally, a referral was made to the joint orthodontics restorative clinic as it was assumed that the patient would require intervention from other specialities. From here, he was referred to the paediatric dentists at the Charles Clifford Dental Hospital, Sheffield, who advised to maintain the retained roots of UR2 and UL4 in situ to preserve bone. Ultimately, it was decided that he would be referred by his dentist when he turns 18 to the restorative department for dental implants.

TECHNICAL ASPECTS OF REHABILITATION With any form of trauma, the definitive restorative device is better completed following complete healing of the hard tissues, allowing the overlying soft tissues to mature. There is need for a full clinical assessment as to the vitality of any remaining teeth that could be used as fixation structures for the final prosthesis. Furthermore, swelling of the defect area will also give a false indication of its surface topography. With these factors taken into consideration, a reasonable amount of time is given to simply allow the healing process to take place whilst the patient is under regular observation. However, these types of cases prove that treatment must be tailored to the individual and their personal requirements.

Fig. 4 Fig. 5

Fig. 2: OPT demonstrating avulsion of teeth (UR1, UL1, UL2, UL3), along with loss of alveolar bone, in the upper anterior region and fractures to UR2 and UL4 Fig. 3: Frontal view of patient once fully healed, without partial denture Fig. 4: Anterior view following healing, demonstrating good mucosal coverage, loss of alveolar bone and a fractured UR2 Fig. 5: Upper occlusal view demonstrating loss of maxillary bone, altering arch shape due to the trauma

www.dentaltechnician.org.uk

29

u

CASE STUDIES Fig. 6

Fig. 7

With this patient, cosmetics did not appear to be of any concern, therefore we could allow time for the area to heal fully and assess him for a prosthesis after six weeks. Had the patient wanted to wear something in the interim period then this would have been provided, however, it would have taken more appointments for adjustments/additions within the aforementioned healing process.

We had considered a cover plate with attached teeth but discounted this due to the risk of causing further trauma in a patient who was functioning relatively well without a prosthesis.

This patient presented with a full permanent dentition and reasonable oral hygiene. The occlusion was well established with good interdigitation. Upon assessment it was decided to go straight to fit with a partial denture supported on a heat cured acrylic base with 0.8 mm Adams clasps on 64 I 57 (Figures 8-10).

The teeth to be replaced were 21 I 1234 and these were shade matched to A2 (Dentacryl HXL).There was also greater extension of the anterior labial segment due to missing bone that was traumatised. Whilst manufacturing, consideration was given to the full extent of the labial segment and it was decided to potentially reline in Coe- Soft should extra material be required and if there was more stability deemed necessary. This would have been apparent when the patient incised whilst masticating, as the prosthesis would have tipped down at the posterior margin, compromising stability.

DISCUSSION Dentoalveolar trauma is most common under the age of 10 and the majority (81%) of all recorded dental trauma occurs before the age of 30.1 Aetiology is variable, but by far the two most common causes are accidents (at home or while playing) and sports-related trauma (including swimming, skiing and cycling).1,3,4 Dental trauma resulting from assaults, including domestic violence, tends to peak in the second and third decades of life.1 It is important with any dentoalveolar trauma to briefly consider non-accidental injury (NAI) as 50% of physical trauma occurs in the head and neck area.1 Key dentoalveolar signs of NAI include lacerations along the buccal mucosae, a torn labial fraenum, intraoral contusions and burns on intraoral tissues.5 Sports-related dentoalveolar trauma is common in the community, accounting for 50% of all sports-related facial injuries.1 One study found that 13.6% of dentoalveolar trauma that passed through their emergency department specifically cited bicycle-related trauma, much like our presented case.4 The two most common forms of dentoalveolar trauma appear to be crown fractures and subluxations.1,2 Fractures of the alveolar process are relatively rare with various studies reporting a prevalence of 2-9.8%.2,3,6 This particular case would constitute a segmental fracture, which results from more

30

Fig. 8

Fig. 9

Fig. 6: Frontal view at fit of partial denture displaying an excellent aesthetic result Fig. 7: Frontal view taken at joint orthodontic restorative appointment Fig. 8: Anterior view of fitted partial denture with sufficient extension into the labial sulcus Fig. 9: Upper occlusal view demonstrating Adams clasps on 64 I 57

www.dentaltechnician.org.uk

CASE STUDIES severe trauma and involves multiple teeth and their supporting alveolar process.5 The majority of cases with a fractured alveolar process impact the maxilla, and typically involve just two teeth.6 Our case involved avulsion of four teeth and extensive fractures of two, which is extremely rare. Avulsion, along with the alveolar fracture, has been noted in around 11% of cases.6 The rarity of such severe dentoalveolar trauma poses great challenges and complexity in management.

Management of this patient had to be considered in three phases - immediate term, short-term and long-term. Like with any form of dentoalveolar trauma, our first consideration was the Dental Trauma Guidelines set out by the International Association of Dental Trauma (IADT).7 According to these guidelines, the ideal management for this case (had the entire segment not avulsed) would have been to reposition the segment and splint it for four weeks. Along with this, basic conservative advice of a soft diet, analgesia, antibiotics and good oral hygiene should be stressed. Following this, close clinical follow-up would be necessary.

Due to the lack of segment when this patient attended, we were only able to intervene with basic clinical measures and debride the wound.

The lack of loose soft tissue prevented us from placing any sutures.

When considering short and long-term management for this patient, the priorities are function and aesthetics. Dentoalveolar trauma has been found to have major impacts on children’s quality of life (QoL), comparable to patients with cleft lip and palate.8,9 Functional limitations, including taking longer to eat and difficulty with speech, have been reported as being of significant concern to dentoalveolar trauma patients.9 Surprisingly, aesthetics were not a concern for our patient. However, generally it has been found that aesthetics is of a greater concern to children than function.10 This also has implications on the emotional

Fig. 10: Buccal view demonstrating Adams clasps on posterior teeth

wellbeing of children. A large proportion of younger children were found to be upset and shy following their trauma, whilst older children exhibited frustration and concern about how others would see them.9 In order to rehabilitate this patient, in terms of both aesthetics and function, we decided to provide the patient with a removable partial denture. This provided multiple advantages including the ability to reline and adjust the denture during healing, as well as utilise it for treatment planning in the future. However, removable partial dentures are a compromise at this age and ideal rehabilitation would be with dental implants and implant supported restorations. Due to the age of the patient, definitive rehabilitation was not feasible as he was in a growth phase. Children who have had removable partial dentures tended to have more complaints in relation to eating and social interaction.11 For long- term rehabilitation with dental implants, most children will require some type of bone augmentation procedure, such as a bone graft.12 This is something we made the patient aware of early on. This patient was referred to the orthodontist to

determine whether orthodontic extrusion of the remaining fractured teeth may preserve some bone. Ultimately it was determined that there would be no major benefit of extruding the UR2 and UL4, and instead, maintaining them in situ for as long as possible would be sufficient. Success rates of anterior maxillary implants placed with bone grafting have been found to be around 96.8%, suggesting that this would be a predictable long-term solution for these patients.13 Management of dentoalveolar trauma is challenging in most situations. The extent and severity of trauma will heavily influence treatment planning and decision-making.

Dentoalveolar trauma can have impacts physically, mentally and on quality of life. As demonstrated in this case, compromises may sometimes need to be made in the short-term in order to achieve function and aesthetics.

Ultimately, the use of implant supported restorations will provide the best and most predictable results for these patients.

DECLARATION OF INTERESTS We have no conflicts of interest in this case report.

REFERENCES 1.

Gassner R, BĂśsch R, Tuli T, Emshoff R (1999).

Prevalence of dental trauma in 6000 patients with facial injuries. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 87(1): 27-33.

fractures in the permanent dentition. Part 1. Etiology and clinical characteristics. A retrospective analysis of 299 cases involving 815 teeth. Dental Traumatology, 31(6): 442-447.

Galea H (1984). An investigation of dental injuries in an acute care general hospital. The Journal of the American Dental Association, 109(3): 434-438.

3.

Luz J, Mase F (1994). Incidence of dentoalveolar injuries in hospital emergency room patients. Dental Traumatology, 10(4): 188-190.

4.

Blinkhorn F (2000). The aetiology of dento-alveolar injuries and factors influencing attendance for emergency care of adolescents in the North West of England. Dental Traumatology, 16(4): 162-165.

5.

Dale R (2000). Dentoalveolar Trauma. Emergency Medicine Clinics of North America, 18(3): 521-538.

6.

Andreasen J, Lauridsen E (2015). Alveolar process

Andersson L (2012). IADT guidelines for treatment of traumatic dental injuries. Dental Traumatology, 28(1): 1-1.

8.

Traebert J, de Lacerda J, Foster Page L, Thomson W, Bortoluzzi M (2012). Impact of traumatic dental injuries on the quality of life of schoolchildren. Dental Traumatology, 28(6): 423-428.

9.

Berger T, Kenny D, Casas M, Barrett E, Lawrence H (2009). Effects of severe dentoalveolar trauma on the quality of life of children and parents. Dental Traumatology, 25(5): 462-469.

10.

Ilma de Souza Cortes M, Marcenes W, Sheiham A (2002). Impact of traumatic injuries to the permanent

2.

7.

www.dentaltechnician.org.uk

teeth on the oral health-related quality of life in 1214- year-old children. Community Dentistry and Oral Epidemiology, 30(3): 193-198.

11.

Bouchardet F, Ilma de Souza Gruppioni Cortes M, Vilela Bastos J, Alexandra Costa de Morais Caldas I, Franco A, Nuno Pessoa Vieira D (2014). The impact of tooth avulsion on daily life performance using the Brazilian OIDP index in children and young adults.

Journal of Forensic Odontostomatology, 32(1): 9-14.

12.

Schwartz-Arad D, Levin L (2004). Post-traumatic use of dental implants to rehabilitate anterior maxillary teeth. Dental Traumatology, 20(6): 344-347.

13.

Nissan J, Gross O, Mardinger O, Ghelfan O, Sacco R, Chaushu G (2011). Post-traumatic implant-supported restoration of the anterior maxillary teeth using cancellous bone block allografts. Journal of Oral and Maxillofacial Surgery, 69(12): e513-e518.

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Dental Technicians Great Britain and The Dental Technician Magazine are proud to support Den-Tech and Veterans Bite Back and work together to continue raising the profile for the amazing work these charities do. Find out more at den-tech.org

Dental Technicians Great Britain Facebook Group l The Dental Technician Magazine and Dental Technicians Great Britain Facebook Group enters its third year in partnership and we couldn’t more excited for the incentives that are coming up.

As many of you know; the Facebook group is now over 1700 members strong made up of authentic dental technicians across the UK. As far as forums go; this one is special in its field and since 2008 has grown to become arguably

And of course, a couple of “light hearted” posts in there for good measure!

the most popular and active forum for our industry professionals to engage and discuss many matters in the technical world of dentistry.

Of course, in these highly difficult times, members have been seeking advice and support on different issues whilst also sharing excellent examples of their work.

Below are some screenshots of a few posts shared throughout January.

l Complete zirconia restoration on anodised titanium bars.

Made with Prettau® 3 Dispersive® – the new zirconia with GradualTriplex Technology, provided already during the manufacturing process by a triple gradient of colour, translucency and flexural strength.

Made by DT Alexander Lichtmannegger (Zirkonzahn Education Center Brunico, Italy).

VIEW THE VIDEO AT: https://vimeo.com/485932846/973439abbc For more case galleries visit: www.zirkonzahn.com @zirkonzahnworldwide @carmenzirkonzahn

INTERESTED IN JOINING DENTAL TECHNICIANS GREAT BRITAIN ON FACEBOOK FOR FREE? SCAN THE QR CODE TO FIND THE GROUP AND THEN ANSWER THE THREE SIMPLE QUESTIONS - CERTAINLY WORTH YOUR TIME!

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HEALTH & WELLBEING

HOW YOUR LIFESTYLE CHOICES IMPACT YOUR MUSCULOSKELETAL HEALTH

BY JOHN FORDE, PHYSIOTHERAPIST AND KATIE BELL, PHYSIOTHERAPY & WELLNESS

Y

our musculoskeletal health refers to structures in the body relating to muscles, tendons, ligaments, joints and bones. The health of these structures is influenced by a wide variety of factors, which are broadly classified as either internal or external.

Internal health factors include our sex, age, height and a range of genetic factors – these variables cannot be changed. Our external health factors, however, can be changed. These external factors mainly relate to our lifestyle choices, such as exercise, diet, smoking status and alcohol consumption, for example. The role of Dental Technicians often leads to having sedentary type jobs, spending hours sat at your benches, often adopting poor postures.

I hope to make clear how important our lifestyle choices are and how much of an impact they have on our musculoskeletal health.

HEALTHY LIFESTYLE = HEALTHY LIFE THE MOST IMPORTANT HEALTHY LIFESTYLE TOPICS TO BE DISCUSSED: • Living an active lifestyle • Maintaining a healthy weight

LIVING AN ACTIVE LIFESTYLE:

INFOGRAPHICS: PUBLIC HEALTH ENGLAND

Living an active lifestyle is incredibly important for our health. Sadly, many people still worry that exercise can be harmful for their joints – it isn’t! Scientific studies evidence that you have less chance of developing osteoarthritis in the hips and knees if you jog regularly than someone who does not. Regular exercise is not only beneficial for your joints but it also severely cuts the risk of many other major diseases – check out the infographic top right!

That infographic pretty much speaks for itself. So, how much exercise should you be completing? Recent guidelines suggest you should be exercising 150 minutes a week.

But, this can be built into your normal day to day activities.

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HEALTH & WELLBEING The infographic (pictured opposite page bottom) nicely sums up your physical activity weekly recommendations. Finding time to exercise is possible, no matter how busy your schedule. If you are wanting to up your physical activity but are unsure where or how to start, please feel free to ask your therapist or pilates instructor for some advice, as we are more than happy to help!

Maintaining a healthy weight:

Likely no surprises here that maintaining a healthy weight is an important part of keeping you fit and healthy. A healthy diet not only provides your musculoskeletal system with the nutrients they need to stay strong, but it also reduces your risk of all sorts of chronic health problems such as diabetes and heart disease!

So, what are some of the common musculoskeletal health problems that being overweight increase the prevalence of?

Lower back pain, hip and knee osteoarthritis are the big ones, but being overweight negatively influences almost all musculoskeletal problems!

With many musculoskeletal health problems, weight loss can produce amazing reductions in pain and aid in the prevention of many chronic musculoskeletal health problems through the combination of regular exercise and a healthier diet to maintain a healthy weight.

The eat well guide above gives you a general idea of the food you should be eating to help you maintain a healthy weight.

If you struggle maintaining a healthy weight, I would highly recommend booking in with one of our expert physiotherapists so we can create an individualised and tailored exercise programme alongside further in depth healthy lifestyle management with our in-house nutritionist to help you on your fitness journey.

FINDING SUPPORT IN MAINTAINING A HEALTHY LIFESTYLE:

Hopefully some new information for you here which sheds some light on how important our lifestyle choices are for our musculoskeletal health and not only our cardiovascular health.

However, we all understand how challenging it can be to change our unhealthy lifestyle habits and choices but investing into your health can truly make a huge difference to your health and wellbeing.

Please feel free to contact our team on 0114 327 2080 or email hello@katiebell physio.com for further support.

www.dentaltechnician.org.uk

35

MARKETPLACE

BUY RIGHT, BUY ONCE w

Despite the fluctuating situation across the UK, dentistry remains a pillar of care and support for the nation. During the most recent regional and nationwide restrictions, dental practices and laboratories have remained open and able to help their communities out of dental pain. Even with all this going on, it is essential not to lose sight of the direction of your business. Only a well-managed dental lab will be stable enough to continue supporting practices, whatever the future holds. Part of this long-term business stability comes from investing in the lab now, ensuring that the technologies and software in place facilitates clinical excellence and business growth.

The right equipment can significantly improve the quality of products fabricated, predictability and productivity while reducing turnaround times. All of this adds to client satisfaction and that of their patients, boosting the lab’s reputation and encouraging both repeat and new business.

When the time is right for you to invest in new equipment or to upgrade your existing technologies, there are various factors to consider. Buying right the first time means you get maximum benefits and ensures you won’t have to replace equipment before it’s time, optimising return on your investment.

WHAT Start by identifying what piece of equipment or what type of software programme will benefit you most. Perhaps you have seen an enhanced demand for removal orthodontic aligners and need to increase your capacity

with a new 3D printer. Alternatively, you may have developed your implant prosthesis services and now require new materials and/or equipment to optimise quality and productivity. Establishing what you need and why will allow you to set a goal for the investment that you can reflect on to guide your decision-making process.

HOW As with any investment into your lab, it’s important to assess the viability of a purchase. Consider the initial cost as well as whether payment or finance plans are available to spread the cost. This should be balanced by the difference that the technology will make to your services or your team, to the quality and predictability you can produce, to your reputation and to your future revenue. Some suppliers enable you to defer payments for a few months so the equipment can start earning you money before you begin paying it off, which can make an investment all the more attractive.

WHO Whether you are interested in 3D printers, milling machines or lab scanners, the company you buy from should be considered as much as the equipment itself. The company’s reputation, the quality of their products, their accessibility should you have any questions and the aftersales support on offer are all crucial to you maximising on your investment.

Independent research is key to gaining an honest insight into those manufacturers or suppliers you are thinking of working with.

Read online reviews, ask colleagues and make use of demonstrations where you can.

KNOW YOUR OPTIONS Being aware of all the options available to you is important for an informed decision. Collecting all the information you need can be difficult only online – though necessary at times as the past few months have proven. When it is safe to do so, visiting an event like the Dental Technology Showcase (DTS) offers even greater value.

At the show, you will have access to a wide range of manufacturers and suppliers offering the very latest products, equipment and technologies available for dental laboratories. You can watch live demonstrations, get hands-on and seek bespoke advice from product experts. It will also be an ideal opportunity to speak to colleagues and hear their accounts of what solutions have done for their businesses.

DTS 2021 will also once again feature an extensive educational programme catering to dental technicians, orthodontic dental technicians, CDTs and lab owners.

Gain CPD, learn new techniques and get inspired to change the way you do dentistry for the better.

BUILD A BRIGHTER FUTURE Life has been turbulent in dentistry over the past year, but as things start to settle down, it’s important to give your business the attention it deserves. Investing in new equipment might be just what you need to give your lab and your team a new lease of life, helping you to build a bright and stable future.

DTS 2021 WILL BE HELD ON FRIDAY 25TH AND SATURDAY 26TH JUNE, BIRMINGHAM NEC, CO-LOCATED WITH THE BRITISH DENTAL CONFERENCE AND DENTISTRY SHOW. FOR THE LATEST INFORMATION, PLEASE VISIT: www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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MARKETPLACE BAR HEADER ZIRCONIA FROM THE DOLOMITES: PRETTAU® 3 DISPERSIVE® WITH GRADUAL-TRIPLEX TECHNOLOGY. FOR THE PATIENTS YOU VALUE w Prettau® Dispersive® zirconia materials – Provided by the South Tyrolean company Zirkonzahn – are provided with a gentle and natural colour shading already during the manufacturing process thanks to a smooth, dispersive shade transition. With the GradualTriplex-Technology, a triple gradient for the new Prettau® 3 Dispersive® zirconia has been developed: indeed, in addition to the colouring smooth gradient, also translucency and bending strength levels change. Whereas the incisally increasing translucency results in a highly translucent incisal edge, the cervically increasing flexural strength results in an extremely high flexural strength at the tooth neck. Accordingly, Prettau® 3 Dispersive® can be used for all kinds of zirconia restorations, although it is particularly suitable for monolithic rehabilitations.

For a final prosthesis with a colour matching with the patient’s natural tooth, special shade guides are available. Zirkonzahn’s Prettau® Line Shade Guides are composed of monolithic zirconia sample teeth and exist in the shape of a premolar as well as upper and lower incisors (also customisable).

KAVO: BEWARE OF GENERIC PARTS! w They may seem harmless enough, especially when they’re cheap, but Generic Parts could cost more than you bargained for.

Prettau® 3 Dispersive® with Gradual-Triplex-Technology – A triple gradient of natural colour, flexural strength and translucency

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FOR MORE INFORMATION VISIT www.zirkonzahn.com or scan the code.

In fact, replacing original spare parts with generic ones can greatly affect the accuracy of your instruments. If you’ve bought into a quality instrument, they can negate that value by causing unnecessary damage.

WHAT’S THE RISK?

Generic bearings and cartridges need only to vary from the original by a fraction to cause internal damage to an otherwise fully repairable handpiece. The only way to maintain the quality of your instruments is to insist on replacing the parts with those manufactured by the same people who made your handpiece in the first place.

The fact is, if you’re not replacing KaVo parts with KaVo parts then it’s no longer a KaVo instrument and therefore, it’s not going to function like a KaVo instrument. It’s like owning an expensive car with a cheaper model’s engine under the bonnet.

They say a bad workman blames his tools.

A good workman on the other hand takes pride in his tools because they allow him to perform his work to the best standards.

WHAT’S NOW?

Insist on the best. If it’s a KaVo handpiece you work with, keep it that way.

Always ask for Original Spare Parts.

KEEP IT A KAVO. For more information on the best quality repairs available, email info@kavo.co.uk

www.dentaltechnician.org.uk

37

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S A L A RY PAY I N G B E T W E E N £ 2 5 - 4 5 K

DENTAL LABORATORY LEAD CERAMIST JOB DUTIES:

actions by completing forms, reports, logs, and records.

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to produce 10 high quality ceramic units per day and to the client’s satisfaction. l Utilizes

and conserves supplies and equipment by working efficiently. Maintains supplies inventories to ensure adequate levels are always maintained. Orders components & materials. l Uses

equipment only as instructed. Ensures regular maintenance of equipment. l Ensures

that customers and staff are well supported, informed and developed.

Contacts Dentists to discuss case specific requirements.Encourages use of new systems and techniques. Helps other members of staff by good “teamwork” and helps develop their knowledge by sharing experience. l Improves

quality results by studying, evaluating, and re-designing processes; implementing changes.

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dental laboratory technician job knowledge and skills by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations. l Enhances

dental laboratory reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

SKILLS/QUALIFICATIONS: Customer Focus I Customer Service Use of Dental Technology equipment Procedural Skills I Documentation Skills Verbal Communication I Attention to Detail Job Knowledge I Must be GDC registered.

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D5 THINGS I CANNOT WORK WITHOUT!

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THE ONLY IMPLAN WAY FOR PERF T REHABIL EC ITATION? T

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WORKING DURING LOCKDOWN: PART 1

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