The Dental Technician Magazine January 2021 by The Dental Technician Magazine

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ARTICULATORS

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Ashley Byrne PAGE 12

CASE STUDY SMILE MAKEOVER Dr Jan Einfeldt PAGES 8 & 10

3SHAPE SCANNERS Eric Kukucka PAGES 30-33

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CONTENTS

CONTENTS I JANUARY 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

Welcome Welcome from the editor

Insight From the archives Light at the end of the tunnel. By Sir Paul Beresford

Editorial advisory board Andrea Johnson Ashley Byrne Ross Chapman Sharaz Mir Sir Paul Beresford

Marketing

Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463

Smile makeover for a case that didnÂ´t start as one. By Dr Jan Einfeldt Facial Prosthetics Case. By Daniel Shaw

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.

The importance of Vitamin D and regular exercise. By Helen Everatt & John Forde

No part of this publication may be reproduced in any form without the express permission of the editor or the publisher.

5 things I cannot work without! Iain Muir-Nelson

Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH

DAMAS: So much more than a piece of paper or a tick box exercise. By Matt Everatt

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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.

Marketing Simplified. By Jan Clarke

5 25

Case Studies 8 & 10 16-17

Health & Wellbeing 11

Dental Technology Dental Articulators. By Ashley Byrne (Byrnes Dental Lab) Dental Articulators. By Prestige Dental

12 14

Technicians Insight 19

Business 22

ECPD 26-27

Dental News An update from the CDO. By Andrea Johnson VHF supports food banks with Christmas donation

28-29 36

Digital Technology Digital denture workflow for a fully edentulous patient. By Eric Kukucka

30-33

DTS 2021 2021 Future ahead

34-35

Marketplace Zirkonzahn/Carestream Dental 3Shape

37 38

Classifieds

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WELCOME

Welcome

TO YOUR JANUARY 2021 ISSUE By Matt Everatt F.O.T.A I Editor

elcome to your January edition of The Dental Technician Magazine.

What a year 2020 panned out to be! As we started our year, it promised to be an amzing year ahead. Our business was flourishing and the general consensus was that the country was in a good way. The dreaded Coronavirus was stuff that was far enough away from home that it would never come here! How wrong! So let’s not dwell on that too long. Some referred to the time as the ‘Coronacoaster’, it felt like that to me. As much as I loved having lots of time with the family, I have to admit that I had to give my head a bit of a wobble. I had become totally engulfed and to a degree, obsessed with the news and have debates about covid that it became a little unhealthy for me. There are some very uncertain few months ahead of us it seems. One thing hit home to me

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this week. A few years ago I was going through some tough times personally, I was losing sleep and fretting constantly. A very good friend of mine said to me 'You cannot worry about things you cannot control'. He was so right. Whatever comes in the next few weeks and months, there is so much that is beyond our control. Worrying about what we cannot control is not only pointless it is time wasted when you could be putting your time to better use. As a group of professionals we can definitely help each other, even if we just ask how we are all doing from time to time. We don't know what individual struggles some will be having. So let me end this post by wishing you all the very best for 2021 and asking you all to have a think about one positive thing you are going to do today that will make your start to 2021.

INSIGHT

From the archives The page did fall open at a page where City & Guilds results were announced and I was full of nostalgia to read a few familiar names. One in particular, our very own Rowland Gardener. I had the great pleasure of working with Rowland in the late 90’s at Guys Hopsital. He has played a huge part of dental technology during his career.

Firstly, I would like to thank Adrian Kearns for kindly donating a large back catalogue of Dental Technician Magazines dating back to the late 1950’s. Interestingly, I opened up one of the folders on the very month and year I was born, October 1975. I know some of you will be surprised as I don’t look that old! Having thumbed through the edition I was pleased to see some familiar suppliers advertising in the journal, the likes of Metrodent, Wrights and Attenboroughs all with large adverts.

I particularly enjoyed seeing the Job Adverts and these two adverts caught my eye. I wonder if one of you readers took the ‘Golden Opportunity’ Ceramist role in Maidenhead, or if one of you took the Grade 4 position at the University of Birmingham. I would love to hear from you if you did or if you knew the person that took on these roles. And finally, the main advert on the rear of the magazine for the precision soldering miniflam. I inherited one of these in my first role at Rotherham General Hospital in the early 90’s. It was a prized possession

and was well used. It probably still lurks in one of the cupboards there. I would imagine £13.50 was a lot of money in 1975, I purchased a new torch for home use just before Christmas to help me light fires and it was £9.99 from Amazon! I look forward to sharing more gems from the archives with you over the coming editions. If any of you would like me to keep an eye out for old articles I would be delighted to search through the collection. The dates range from 1958 through to the 70’s. I am sure I will find some absolute gems to share with you.

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

WELCOME TO 2021

hat a year 2020 was, this time last year we watched the news of a distant problem in China and little did we realise in three short months the disruption that would occur to UK businesses and life in general. Now, at the start of 2021 we have view of the light at the end of the tunnel following introduction of the biggest vaccination programme in the UK. This gives us hope for a return to normal, including regeneration of businesses throughout the UK.

There is no doubt this has been tough for UK dental technicians with your work being directly related to what is happening in dental practices. 2021 will still be a tough year with challenges ahead but equally there are opportunities. Dentists are reporting an increase in cosmetic dentistry whether that be cosmetic aligners or smile makeovers, there is definitely work to be picked up by dental technicians. 2021 IS THE YEAR TO REBUILD AND SEIZE THE OPPORTUNITIES Now is the time to finely tune your marketing message and reach the right people, spend some time looking from the outside in at your business marketing activities. 1. WEBSITE When was your website last updated? Does it accurately reflect your work and your business? Assessing your own website can be difficult. Perhaps ask one of your clients to have a browse and give a tough critique. Many people over complicate their websites and often simplification is the key. Look at your Google analytics to check which pages are visited most and in particular the bounce rate, this is the length of time someone will stay on a page. 2. SEARCH ENGINE OPTIMISATION SEO can be an expensive business and a bit of a dark art. If you employ an agency to help you then do try and understand their process. You will need to communicate with them your key business objectives and what you hope your website will achieve for you. Essentially SEO is about ensuring the right people find your website. You can test this yourself by carrying out keyword searches. What might your ideal client be searching for?

3. BLOG I am a huge fan of a blog for attracting the right clients and the good news for you is that this is massively underused by dental technicians and you can do this yourself with no or little cost. If you have a WordPress website it is relatively straightforward to add a blog to your site than you can update regularly, preferably twice a month but certainly once a month is a good start. Updating your blog regularly adds new pages to your website which helps with no 2 above, SEO, but a caveat! Do not be tempted to copy text from other websites, use your own words and new content. Copying content will have your website demoted. A blog is a great place to tell your business story, provide education and information. Write about cases, collaborations with dentists, how your team works, the day to day running of your laboratory. Keep the piece short around 350 to 500 words, any shorter and it may not help Google rankings, any longer and your readers may switch off. Break up into small chunks as people tend to scan read first and try and insert relevant images too. A well written blog with good social media activity can sometimes negate the need to carry out SEO on your website and I do think it’s a trick so many business owners are missing. 4. SOCIAL MEDIA I have written about social media before and many of you know I’m a huge fan! I do think in the current day to have some social media presence for your business is essential however it does need to have some direction and purpose. If you want to keep it in house consider handing over to a member of your team who has an enthusiasm for social media. If there is little experience then consider a course, there are lots available online that will help guide you. As GDC registered professionals there are guidelines for marketing available on the Council’s website, do be aware and ensure your team members are too. A well thought out Facebook business page and Instagram page can work wonders, it takes time to build a following organically, don’t be tempted to “buy” followers for vanity as this will be detrimental to your business but post engaging and interesting content to allow potential new clients to have a window into your business.

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5. YOUR TEAM No amounts of marketing spend, fancy websites, SEO, or social media activity will build and sustain your business if your team quite frankly aren’t a team. Having regular updates with your team to discuss your business objectives and receive feedback is a great start. Working together to ensure that the business runs as smoothly as possible and there is a encouraging collaborative approach will be a huge bonus to your business. Are you what you say you are? If your website talks about your friendly team approach then make sure that is actually reflected in your team. 6. YOUR PROCESSES Linked to no 5 above, look at your processes through your business. At the end of 2020 we had a real problem with the postal service and many dental technicians received angry calls from dentists awaiting work back to be fitted only to find they had been held up by the postal services. You can’t control the postal service but you can control how you communicate with your clients and the best way to mitigate as many problems as possible. Where are the weaknesses in your business? Is it in quality assurance, driver pick up or instructions from your prescribing dentists. How about in your lab? Is the phone answered professionally and quickly? How do you ensure that a busy technician can communicate with their dentist when necessary? Spending time considering these issues and regularly reflecting on your business processes is also marketing and in many ways these areas can be just as important than your digital marketing. START 2021 WITH FOCUS No one knows how 2021 will pan out, 2020 definitely took us all by surprise and has taught us many lessons, including how to adapt, be resilient and expect the unexpected! Use some time at the beginning of 2021 to look at your busines critically and start to plan your changes. You will not be able to change all of the above overnight or even in a weekend but small steps to your goal can be achieved and I encourage you to make a start and let 2021 be your year. 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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CASE STUDIES

SMILE MAKEOVER FOR A CASE THAT DIDN´T START AS ONE By Dr Jan Einfeldt

53 year old man attended complaining of pain from an existing bridge UR2 - UL2. It needed to be extracted because several roots were infected and would have required re-RCT, which the patient did not want to do. On closer inspection, the remaining teeth in the upper arch required some work as well (one RCT), but otherwise the teeth had a good prognosis. The options were explained to the patient (implants, bridges/crowns/dentures) and the patient decided to save his remaining teeth. Written and verbal consent was obtained. We took clinical records and a series of DSLR photos and intraoral scanning with the Carestream 3600 intra oral scanner with scan flow software. The CS 3600 was chosen because of the comprehensive restorative features such as checking how much tooth structure has been removed compared to the pre-op tooth shape, as well as checking for any undercuts. The decision was made, to extract the remaining upper incisors and make a temporary bridge from UR3 - UL3 in Luxatemp A3 with no immediate change to tooth shape or smile design. The patient could then recover and consider his options, while no longer in pain. During this time we were working on the smile design process. We decided to let the area heal for 4 months, which would give us enough time to plan and for the patient to decide on his final treatment options. THE PROCESS CHOSEN: 1. digital smile design 2. printed models of wax up 3. clear silicone stent for trial smile 4. prep and living with trial smile for a few days 5. cementation of restorations 6. final review Step 1 and 2 - digital smile design and printed models of wax up Designed to communicate better with the patient. A digital design may look very advanced, however, it is often the printed model of the wax up that makes the case very real to the patient. It can be seen in the excitement the patient experiences, when they hold their ‘new teeth’ in their hands.

ABOVE: Before face. RIGHT TOP ROW: Before lower occlusal, Before retracted in occlusion; 2ND ROW: Before retracted left in occlusion, Before retracted left open; 3RD ROW: Before retracted open, Before retracted right in occlusion; 4TH ROW: Before retracted right open, Before upper occlusal

Step 3 - clear silicone stent for trial smile This is a good way to communicate and verify that this is what the patient wants ( visual consent ), by using the stent to ‘glue in’ just before the preparation. It also helps as a prepthrough guide with depth cutting burs. Step 4 - prep and living with trial smile for a few days This step is much more reassuring for the patient, who used to have no idea what his new teeth would look like before the temporaries would be close to the final result. Now the patient has the confidence to know what his teeth will look and feel like before the preparation. Once the trial smile (the real temporaries) have been fitted, the patient and the dentist can make further changes on the Luxatemp material. Even if no further changes are made, I recommend to re-scan just in case a change has happened during the fitting of the trial smile. For example if the dentist pushes too much or too little on the silicone stent, or the patient moves.

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Step 5 - cementation of restorations Due to the accuracy of intraoral scanning, the digital smile design and computer milled restorations, adjustments at this stage are now usually minor. I should point out that for single unit restorations, I work without printed models, unless in high aesthetics cases. However, for multiple units, I will choose to have printed models, so the technician and I can check all restorations at the same time. Step 6 - final review Giving the patient time to wear the new restorations, allows the patient to discover smaller details often missed when the he or she has been in the dental chair for a few hours and is still numb. In our case, the patient decided in the on a bridge UR3 - UL3, bridge UL4-UL6 and a crown UR6. The patient was going to whiten the lower arch with Enlighten, for guaranteed u B1 and less contrast with the new upper arch. P.10

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CASE STUDIES u

Now it was over to the team at Ambridge From ceramics, who I have worked with for years P.8 and appreciate their input and help with complex cases. A digital smile design film was made with 3Shape Dental Designer. This gives a much better illustration. We chose to include the design also for UR54 for better cosmetic effect, even though the patient didn’t seem to be that concerned about treating UR54 after the temporary bridge solved his immediate problem. The patient liked the

digital design, because it didn’t just ‘show teeth’, but it showed a simulation of teeth superimposed onto the patients face. From experience patients find this very helpful, instead of just looking at a design of teeth. A printed model was produced on a Structo Dentaform 3D printer, a clear silicone stent was made to ‘glue in’ the trial smile, and show the patient what it would look like. The patient liked it so much, that he decided to include UR5,4 after all.

The trial smile was used as a prep though guide and photos were taken for stump shades (ND3). New temporaries were made in B1, and the patient did not want any changes made, to the temporary trial smile. A further scan and photos were made, to give the technician as much information of the process. I know he appreciates and it helps us both to produce a better result. The restorations were milled on a Roland DWX52 DC from Aidite 3DPro SuperTranslucent Zirconia (Bleach shade), hand finished with tertiary anatomy, pre sinter stained with ZirconZahn Prettau effects, post sinter stained and glazed with MIYO. With the skill of the technicians, we could avoid the use of pink porcelain by shaping the bridge carefully, and because the patient did not have a high lip line. The bridges and crowns were tried in with try-in paste (Vitique, water based) for final approval, and to check how all restorations fit individually and at the same time.

LEFT: Trial smile face. ABOVE TOP ROW: trial smile close up, trial smile retracted front; 2ND ROW: trial smile retracted left, trial smile retracted right Immediate post OP face

Cementation was done with Rely X Ultimate (clear, dual cure). No adjustment the occlusion was required, and the patient has been invited to return for a final check whilst not numb. Hence, only a limited amount of photos were taken post-op. The final photos are yet to be taken, however, the patient was very pleased to get his new teeth in time before Christmas. REFLECTION What did I like: The digital process is fantastic for verification of the steps, even whilst the patient is still in the dental chair. It helps technicians, dentists and ultimately the patients in terms of communication, accuracy and cosmetic result. WHAT WOULD I CHANGE: I would consider lab made provisionals for even better gingival health at the prep stage. SUMMARY Technology is constantly improving, and it is important to speak to the dental technicians, to learn from them and how to get better results by giving them the information/photos/scans they need. The communication should ideally be going in both directions, where dentists and technicians tell each other how they can improve and learn from each other.

ABOVE LEFT TO RIGHT: Immediate post OP smile, Restorations on model front below, Restorations on model occlusal

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I’m happy that high end dental technicians are available in the UK, even if it is easier than ever to send and receive work form abroad. However, I think it would be a great loss if this skill was lost in the UK, and urge dentists to chose their technicians carefully. Even if the future is digital, we cannot digitise trust and relationships build over years.

HEALTH & WELLBEING

THE IMPORTANCE OF VITAMIN D & REGULAR EXERCISE By Helen Everatt I Mission Nutrition & John Forde I Physiotherapist at Katie Bell Physiotherapy and Wellness

But how much vitamin D do I need? The NHS advises that adults supplement 10 micrograms of vitamin D per day. These are available over the counter from pharmacies and supermarkets. The full NHS guidelines are available in the link below. In addition to the above recommendation, the NHS also recommend that adults should aim to be physically active everyday, equating to at least 150 minutes of moderate intensity activity each week. With strengthening activities that work all the major muscles on at least 2 days a week.

n important topic at this time of year is Vitamin D. The reason being that between October and March, in the UK, we do not get enough vitamin D from sunlight, especially during these COVID times when weâ&#x20AC;&#x2122;re stuck indoors even more than we usually are during the colder months!

No easy feat, fending off the progressive sedentary aches and pains that result from sedentary working! Pilates has been proven to help with strength and conditioning, it is also fantastic for improving posture, something that many Dental Technicians suffer with. Completing a couple of pilates classes per week ticks off your weekly recommendations.

Full details and NHS guidelines on Vitamin D supplements are available here: https://www. gov.uk/government/publications/vitamin-dsupplements-how-to-take-them-safely We are here to help by offering subscribers of the Dental Technician Magazine a weeks free pass to our online courses. Feel free to check out our Online Class Timetable at https://katiebellphysio. com/class-timetable/#tmup=/w519706/ p/519706-katie-bell-physiotherapy/%23!week-2020-09-01 We are running a full online Pilates schedule which includes Live and PreRecorded classes and we are offering a FREE ONE WEEK ONLINE PASS for our full online timetable: https://goteamup. com/p/519706-katie-bell-physiotherapy-/ memberships/89900/

Vitamin D is an important vitamin as it helps regulate the amount of Calcium and Phosphate in the body. These nutrients are needed to help keep bones, teeth and muscles healthy. A lack of vitamin D can lead to a range of conditions, such as osteomalacia in adults. Even though vitamin D is found in a small number of foods including oily fish, red meat, liver and egg yolks, the NHS specifically advise vitamin D supplementation during the winter months as it is difficult to gain sufficient intake through diet alone.

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DENTAL TECHNOLOGY

ARTICULATORS By Ashley Byrne I Byrnes Dental Lab need to look at semi and fully adjustable articulators. Whilst many academics would say a fully adjustable articulator is ideal, it is still incredible difficult to accurately and easily transfer the data from the mouth to the articulator. We do own a fully adjustable articulator but I have not set one up for over 15 years now and I doubt I will ever use it again. There's a ÂŁ2,000 investment we regret!

rticulators are a key part of any dental lab but with so many types and brands it can sometimes be tricky to choose the right one. Here at Byrnes dental lab we have around 10 different types, all from different companies, but we have our favourites. When I first started in dental technology some 20+ years ago I was using a simple hinge articulator but apart from simple additions or repairs, these basic hinges types do not replicate the jaw in any way or form.

At Byrnes we use semi adjustable articulators for nearly all our stone casts and also for our complex digital cases. Facebows are a popular and easy way to take a record of the condyle position and then roughly transfer that to the articulator. Most of our clients use Denar face bows but we do not tend to use the Denar articulator. Most leading articulator brands tend to offer a transfer jig so other companies face bows can be used. The Kavo Protar articulator is our go to system at Byrnes. The articulator has a Denar face bow transfer jig as well as Kavo producing its own face bow. The articulator is accurate, easy to use and has a huge amount of room around the models which makes both crown and bridge and denture work an ease. It can sit at

Modern artics are now really divided into two areas, analog plaster articulators or small digital artics that are used with printed models. These small almost simple hinge looking articulators are actually a small bit of design genius. iTero and 3Shape dominate the market with these types of articulator that do offer the hinge opening but also have springs that allow lateral and protrusive/retrusive excursions. For small restorations these simple articulators allow all the correct movements and both companies readily allow use of their .stl file with which is easy to add to the model design and print them. By using the .stl files from iTero and 3Shape no plaster is needed so it is a fast and simple solution, however these articulators are not perfect. Due to the small and somewhat basic design, no face bow can be used and the angles of excursions do not mirror the same angles we see in the mouth. For this, we

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45 degrees so when working its a lovely ergonomic piece of kit to use and the top part of the artic has a pin which allows the top to be fully opened and wonâ&#x20AC;&#x2122;t tip or drop off the articulator. Two simple sliding catches switch it from a fixed to excursive movements. The team have found this one of the most user friendly systems we have used to date. The Protar has also been clever in its use of the base plate. These can be poured in the lab using a small magnetic disc and a mould as well as offering various plastic base plates which all helps to keep the costs down. Picking an articulator is very much down to personal choice but quality, accuracy and ease of use and the ability to service the artic through wear and tear is key as well, which the Kavo system offers for us. My advice would always be to look at the key brands and donâ&#x20AC;&#x2122;t scrimp on a cheap system as this can often come back and bite you through adjustments, remakes and even loss off technical time from using a poorly designed system. A good system will see you through years if not decades if looked after well.

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DENTAL TECHNOLOGY

FIRST THINGS

FIRST By Prestige Dental

ndeniably the digital revolution in dentistry is here to stay but it’s important not to throw over the traditional methods for good. As the saying goes ‘there’s a place for everything…’ so here we take a look at the continuing case for physical, hand-held articulators. Historically using articulators was time consuming, each case had to be worked on exactly the same articulator to avoid transfer errors and they were often referred to as ‘clumsy’ – hardly the precision piece of equipment needed for the fine art of occlusion. Back in 2017 there was a lot of excitement with the introduction of the Denar 300 range, designed by Whip Mix in response to the demand for a more user-friendly model with closer interchangeability and fewer wrenches to make articulator adjustments. Remember having to ship articulators back and forth between dentists and labs, and only ship models? The Denar 300 Series addressed all this, whilst also being exceptionally stable. Furthermore, many dentists commented that the interchangeability and repeatability was better than the 20-micron to which Whip Mix gauge. Occlusion is a tricky subject and understanding the basics is paramount in any dentistry career and fundamental to the delivery of first-class dentistry. Ironically, in spite of the critical importance of this subject, dental schools often cannot include comprehensive training in this subject in an already crowded curriculum. Fortunately, additional programmes are now available specifically designed to fill this gap and reveal many of dentistry’s mysteries that escape those untrained in the management of occlusion. Prestige Dental has long championed dental learning and has over the years built up an unrivalled stock of Denar Fig 22 articulators. These are offered on loan in

too far for practitioners for some time to come. Moreover, whilst digital has its place, it’s certainly not for everyone. This together with the significant back-tobasics learning hands-on offers, supports the continuing relevance of a physical articulator in modern dentistry. support of various dental programmes run throughout the UK and are very much in demand. And although lockdown restricted the number of courses in 2020, hands-on socially distanced learning is making a significant return in 2021 if requests for Prestige loan stock is anything to go by. In this way course students get first hand use of quality, precision equipment to learn with – an unrivalled opportunity and invaluable on their occlusal journey. There is absolutely no substitute for that hands-on learning experience - seeing, feeling, touching and working with a physical articulator - to help gain and cement that knowledge. A Denar articulator is a quality, engineered product, and an investment for any individual or business. However digital can be a greater and ongoing investment and, certainly under current difficult trading conditions, may just be a bridge

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Prestige remains proud to support dental learning and continues to be the exclusive UK supplier of Denar articulators Whip Mix | Prestige Dental (prestigedental.co.uk) They even offer a repair and re-calibration service for articulators undertaken by Director Paul Martin. Prestige Dental E: info@prestige-dental.co.uk T: 01274 721567

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CASE STUDIES

FACIAL PROSTHETICS CASE - CLINICAL AND TECHNICAL REPORT By Daniel Shaw A review was planned for two weeks, however before the review the patient was in contact complaining the denture was too loose. At this stage, the denture was relined using Eversoft (Dentpsly Austenal PA USA) and the patient was instructed to use a denture fixative to help prevent further loosening. At the one month follow-up appointment the same complaint was made. The old Eversoft was removed and replaced with an extended section to incorporate a magnet (Maxi-Magnet - Long Lip; Technovent; UK) that was attached to the implant on the left side of the maxilla and on to a Maxi- Cap (Technovent; UK). At this point the denture relied on mucosal support, support from the nasal floor, and the single implant as a locator.

his particular patient was treated for a Squamous Cell Carcinoma (SCC). His surgery involved removal of the anterior section of the Maxilla (HemiMaxillectomy) and his nose (Rhinectomy).

The denture was again loose twentyeight days later, and the implant placed

He was referred to the Maxillofacial Prosthetist (MfPT) following his surgery to provide him with an obturator, to aid with swallowing and speech, and also provide him with a facial prosthesis. A new maxillary impression was necessary to be able to provide the patient with an adequate obturator, as the current denture he had was now obsolete. After small alterations, the obturator (cover plate) fitted loosely and was utilised as an impression tray for the secondary impression. Positioning of the patient was difficult as he had unfortunately also suffered a stroke. The patient had to be seated upright to avoid Alginate flowing down through the facial cavity into the oropharynx, an extremely sensitive area. The impression with the denture was returned to the laboratory, where an extended re-line was performed. Slight alterations were required upon fitting, several hours later, but the patient was then allowed to go home.

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into the maxilla had come out due to the constant load friction. It was discussed that to provide the patient with a well fitting obturator, a facial prosthesis would be helpful in retaining the obturator. A new facial impression was taken for a nasal prosthesis. The wax pattern (incorporating magnetic retention studs) was tried and adjusted due to its shape not matching the patientâ&#x20AC;&#x2122;s previous natural nose and processed in the laboratory. The silicone used was M511 (part of the M72 Prosthetics kit from Technovent) and flocks and colours were used to match the skin tone. Two days before Christmas, the nasal prosthesis was fitted to the patient with no adjustment necessary.

CASE STUDIES

RENEWAL OF THE PROSTHESIS DUE TO SOFT TISSUE CHANGES In the new year, the patient still complained of friction and soreness at various contact points of the obturator/denture. This proved it was necessary to design a denture that incorporated a magnet in an extended labial flange. It was also reported that when the patient wore the prosthesis, his eyes were itchy and watery. After investigation it was thought to be local irritation caused by the edge adhesive used (Technovent UK). Therefore, both components were replaced and the design changed so that a magnet receiver was incorporated into the back of a second nasal prosthesis to give more stability to the denture. This process began with an accurate impression, taken using the exiting denture, and a heat cured acrylic resin (WHW Fast cure, WHW, Hull UK) baseplate was constructed. The device was fitted and acrylic teeth were added in wax, as a try-in. Once the patientâ&#x20AC;&#x2122;s bite was balanced, the denture was processed, in the same heat cured resin. The magnet was also incorporated into the extended labial flange. The patient was fitted with the new denture and Eversoft lining material was used to secure the plate. The patient felt this second denture was extremely comfortable and food and liquid was successfully swallowed without leakage. A replacement nasal prosthesis was manufactured, utilising the magnet and the patient was extremely happy with the result. A six-month follow up review was arranged but in August of the same year, the patient had been again admitted to hospital. DISCUSSION The first obturator/denture was designed to best suit the needs of the patient at that immediate post operative period. Additions and removal of material would be an on going and necessary procedure in order to compensate for the changing healing growth of the nasofacial cavity. Looking at the clinical treatment, when the second device was fitted, there was a huge reduction in the amount of complaints that the patient had. This proved how well

the two components (prosthesis and denture) interlocked to create a more secure device. The failure of the implant in the nasal bone proved how much load was bearing on it through mastication and swallowing, and a second two part device was the only way forward. If it had been possible, more than one implant could have been incorporated into the first obturator, temporarily until the nasal prosthesis had been manufactured. An MfPT is exposed to a wide range of needs but this was my first case of this kind it was necessary to seek help and advice from MfPT colleagues (Jason Watson, Andrew Richmond and Frank Johnson), and this resulted in the successful rehabilitation of this patient. The patient himself was also extremely understanding

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of the level of my experience, but was happy for me to complete the work necessary for his rehabilitation. CONCLUSION As an MfPT, working so closely with a patient of this nature, and developing a relationship with them and their family, it is difficult to not become emotionally involved and writing this case study became difficult and brought back many memories. Fortunately, I can feel confident that I provided this patient with the necessary treatment he required during his rehabilitation and eventual palliative care. The devices provided adequate functionality and the patient was again allowed to feel a sense of normality in his appearance and day to day life.

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TECHNICIANS INSIGHT

5 THINGS I CANNOT WORK WITHOUT! With Iain Muir-Nelson There are many items of equipment and tools to choose from and all of them help me to do my bench-work to varying extents. There are, however, some that have come my way during the years that have made techniques, stages, and steps all the more speedier and simpler, as well as achieving a better result than the squishy organic blob in the chair. 1. COBRA TRIMMING BURS I have used many, many different types of trimming burs from plane stone to gold coated ones. When at college I was blissfully unaware of the importance a bur can have, relying on the guidance of the lecturer and, more significantly, the cost-saving to the college. When I first began training as a Maxillofacial Prosthetist I was still unaware of the significant difference and importance to the technologist, a bur could make. My mentor, George Sweeney, showed me that the old adage of bad workmen blaming tools had its merits so when possible it’s was worth splashing out a little more for burs that save time as they can save money in the long run. The range the Cobra burs come in is excellent. I was first introduced to these burs by C&J but I am very pleased to say that they are available from Skillbond Direct Ltd as I have had to replace the few that have been ‘borrowed’. 2. LARGE DIAMOND-TIPPED STONE DISC Cutting dental stone models has been a frequent necessity during my career from the numerous trauma models to large two-part obturator ones. Fretsaws were great for this but to a point. I always found I wanted a thinner, finer cut but the thinner the fretsaw blade, the more they snapped just at the wrong moment so I was so glad this disc came along. The diamond discs before were too small a diameter so I was pleased to have one that could cut deeper and be so thin. Just be warned, mind your fingers! 3. SPEED MIXER As a Prosthetist I mix a lot of silicones, colours, and acrylics which not only takes a considerable amount of time but also has a considerable effect on the wrists and shoulders and I’m not getting any younger. If we have learnt anything from our predecessors it must be to protect ourselves wherever possible. For example repetitive strain injury being a common concern. Another lecturer and friend

contacted me recently stating the years of using a micromotor for prolonged periods of time has taken its toll leaving him with numbness in his hand so I am all for the introduction of pieces of equipment that will assist us in our roles. This mixer is quite old now but is still invaluable, saving time and possible future injury. There are many types of mixer on the market but this one came from an extremely trusted and helpful company, Polymer Systems Technology Ltd in High Wycombe. It comes with a variety of basket sizes to take differing sizes of pots and makes mixing SO much easier. It also makes mixing a lot less painful. 4. SPECTROMATCH E-SKIN An aspect of my work I have always found challenging is mixing colours into silicones to match patient’s skin shades and tones. Colour is perceived by individuals differently. Depending on many factors, the reproduction of a colour is quite challenging. You only have to Google colour perception to discover how complex it can be. One phenomenon which has always perplexed me in colour perception is metamerism. Two colours can appear to match under one light source but differ significantly under different lighting sources. A colour that can appear to match the patient’s skin under the light of the clinic room can appear quite 1

different when the patient steps out into the street. Thanks to the extensive work done by Charles at Spectromatch Ltd this is no longer a problem for me. The e-Skin hand-held device takes the guesswork out of colouring for me. Held against the skin, the device gives a recipe of colours to add to the silicone of your choice. Taking a base colour has become much simpler and quicker as well as addressing the metamerism issue. 5. THE TEA POT As I mentioned at the beginning, there are so many items that assist me in my benchwork but none that can restore balance or reinvigorate ability, faith, and the soul than the great cup of tea. Over the years I have discovered that I am not alone in these thoughts having visited several labs where the kettle is an ever present, much used item. Right, I’m off to put the kettle on.

If you would like to participate in our ‘5 Things I Cannot Work Without’ feature please email: editor@dentaltechnician.org.uk 4

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With the new Zirkonzahn Shade Guide, the patient's tooth colour can be precisely determined on the basis of monolithic sample teeth made of zirconia. In this way, it is possible to determine the most suitable Prettau® Dispersive® zirconia material in a safe and quick manner. The colour spectrum is inspired by the VITA classic range, comprised of 16 dentine shades (A1 – D4) and 3 Bleach shades. The sample teeth are monolithic and glazed with 3D Base Glaze glaze material. Colour theory shows that shape and surface structure considerably influence the colour effect. Striving for perfection, we build our shade guides in all respective Prettau® Dispersive® zirconia materials, not only in the shape or upper and lower incisors, but also in the shape of a premolar.

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shade will reflect 100 % of the natural tooth colour of the patient (One-toOne function). For individualists, the shade guides are also available with minimally reduced, sintered sample teeth (minimal cutback), which can be further characterised by the application of different incisal materials. This results in truly unique shade guides that exactly reflect the individual approach and own aesthetic demands.

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high flexural strength at the tooth neck. The material is suitable for restorations with up to six units and the colour gradient, well studied and created by Zirkonzahn, permits to achieve excellent aesthetic outcomes, especially for monolithic restorations in the anterior region. FOR MORE INFORMATION VISIT: www.zirkonzahn.com or scan the code.

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BUSINESS

DAMAS - SO MUCH MORE THAN A PIECE OF PAPER OR A TICK BOX EXERCISE By Matt Everatt I Editor & Technical Director S4S (UK) Limited

AMAS is the ‘Dental Appliance Manufacturers Audit Scheme’. It is a quality management system designed specifically for the manufacturers of custom made dental appliances. The DAMAS quality management system is so much more than just a certificate that hangs on a wall to appease our corporate customers. I have read several comments online of lab owners and technicians that reluctantly sign up to become a DAMAS registered laboratory and suggest that it is merely a ‘tick box exercise’ to please their corporate customers. In my experience this could not be further from the truth. In 2005, I entered the commercial world to form what now is known as S4S Dental Laboratory. Our vision was to provide top quality devices, by top quality technicians, to the highest standards, in the best surroundings. From the outset we implemented a Quality Management System and later applied to become ISO9001 certified. ISO9001 is an internationally recognised and certified quality management system for organisations who wish to prove their ability to consistently provide products and services to meet to requirements of international standards.

After several years being ISO certified we took the decision to become DAMAS registered, this coincided with several Dental Body Corporates (DBCs) asking for approved labs to be DAMAS registered. The conversion from ISO to DAMAS was relatively easy, in fact, it improved our Quality Management System as it was specifically geared up around dental appliance manufacturing and tied in nicely with MHRA and MDR.

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Our systems helped us streamline our business and improve efficiencies whilst providing consistent quality work and services. Being DAMAS registered is so much more than just having a piece of paper to show the DBCs. For me, the best thing about our systems is traceability. From the minute a case arrives the process starts and follows a quality process from the minute it enters the building. It eradicates words or terms like, ‘We usually do it this way’ or ‘Sometimes we do it that way’ and ‘I think we handle cases like this’. It adds certainty throughout the whole process. Everyone knows how a case is booked in, they know the process for turnaround times, how it is packed and shipped. On the manufacturing side of things, we have 100% traceability with materials. We have a purchase order process that is efficient and enables us to maintain good stock levels and purchase from approved suppliers. Each case can only be manufactured by a technician that has proven skills to do the appropriate case. This has been integrated in to our Laboratory Management software too, making it run like clockwork. We continually look to improve our QMS and we don’t leave it until the annual audit date. We are very proactive and undertake pre-audits of our DAMAS system. This then means if anything is raised at the annual audit by the DAMAS representative, it is a genuine oversight and leads to further improvements. If you don’t have DAMAS registration, I can honestly say that you should consider it. It should not be seen as a tick box exercise nor should be seen as a piece of paper for that the corporates require. See it as an opportunity to systemise and add a degree of order to your processes. I see it as ‘working smarter not harder’.

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INSIGHT

LIGHT AT THE END OF THE TUNNEL By Sir Paul Beresford

his hackneyed saying is just sometimes appropriate. Saying it during the summer and as we ran into December it proved not to be. That light turned out to be an oncoming train in the form of this new viciously infectious variation of the Covid virus. Estimated to be up to 70% more infectious, it set about our citizens with disastrous effect. The rates of infection made those dreadful graphs, we see daily, logarithmic. This coupled with an increasing rate of hospitalisation threatening to overwhelm hospitals in parts of the country. Some areas, such as London and the South East, are having an intake of hospital patients equivalent to the total number of beds in a major hospital daily. The numbers of deaths also rose rapidly. Christmas was small and New Year celebrations muted for virtually all of us who thankfully obeyed the rules. Sadly, not everybody kept to their family bubble or religiously wore masks and washed hands or even observed the basic social spacing requests. I and my small team counted the emails since the beginning of the first Lockdown giving us a total rising towards 32,000. All most of these emails were responsible pleas for help for grants for their businesses, for furlough extensions for their staff, for a delay in paying business rates or taxation, for helps on examination assessment and university entrance and so on. Thankfully, the astonishing largesse of the Chancellor helped magnificently. As you would expect to an MP’s a proportion were offering advice, argumentative, opposed to anything and everything. Fortunately, that proportion was relatively low. Those excessively emailing, such as the lady who sent me 51 emails over the last three months (disagreeing with every word in my replies) have had it gently explained to them that I had enough penpals. Those making unbelievable and impossible demands were told that these could not be met as I wasn’t the Pope or a magician. Those that said the Government had turned into a dictatorship were told if that was so then the Stasi would be at their door tomorrow.

The top priority has obviously gone to residents and care homes for older adults and their staff.

Of course, being a dentist, I was additionally landed with dental questions from constituents of mine and other MPs, plus from various dental groups. Fortunately, I have a good conversational relationship with Health Ministers, especially Jo Churchill and with Sara Hurley the Chief Dental officer plus even in occasional desperation directly to Boris. It is often said by dental professionals that the Department of Health treats dental health as a Cinderella service. It is certainly not so with these two highly influential ladies who bat on our behalf. The honest and rational amongst us did recognise that shutting dental surgeries at the beginning of the first Lockdown was an absolute necessity. From the point of view of the virus, operative dentistry is an ideal is spreading mechanism. As we hunker down to this Lockdown there is a distinct feeling, at least with me, that the light at the end of the tunnel is not an oncoming train and that the tunnel is getting shorter by the day. Firstly, dental surgeries were allowed to remain working which forestalled a volume of emails to me. Treatment of hospitalised patients now is benefiting from better technology and better use of technology, as well as new drugs. We have a superbly and perhaps overambitious program of vaccinations with the progressive oncoming prospect of several more vaccines soon. Sensibly, to try to reduce the deaths, vaccinations are being undertaken in a ladder of categories from the most vulnerable to the least.

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The second priority was for those over the age of 80, frontline health and social care workers. After considerable campaigning directly with ministers and reiterating persistently that the dental profession is on the frontline from the point of view of vulnerability. Now dentists, their colleagues and staff are in the second category with frontline health workers – which of course we are. I must give the government credit in that they are now considering all dental surgery staff, including dentists, DSA’s, therapists, hygienists, and even the cleaners. Certainly, this would include dental technicians if part of the dental establishment and I believe there is an argument even if they are not part of a particular establishment for their inclusion. It is said that to really obtain herd immunity something like 70% of the population should be vaccinated. This is an enormous task and Boris is leading the charge on ambitiously hoping that the top 4 priority groups would have been offered the first dose by mid-February. If successful will mean more than 13 million Brits will have been vaccinated. A formidable target. To help speed this up where the vaccine is administered in two doses the government has decided to delay the second dose. Of course, the complaints hit my email bag. But as Prof Jonathan Van-Tam put it, “It’s better to give two grandparents 89% protection than to give one 95% and the other none at all!” I deplore those all who have often defiantly ignored the pleas for social distancing, wearing masks, and other measures to diminish Covid to spread. Even more so I am sickened by those who promote the idea that Covid is not real, is a myth, or even more ludicrously that it is conspiracy to dominate and enslave the population. Of this group the worst are the anti-vaccination groups. Fortunately, at least in United Kingdom there are a relative but noisy rarity although increasingly influential. These people will predominantly ultimately be protected by the rest of this who wash our hands, wear our masks, maintain social distancing, and vitally get vaccinated.

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 the December 2020 DT Edition:

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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 DANIEL SHAW - FACIAL PROSTHESIS Q1. What does SCC stand for? A - Separate Cell Carcinoma B - Squamous Cell Carcinoma C - Separate Cell Cover D - Squamous Cell Consistency Q2. What did the patient have to do to avoid Alginate flowing down through the facial cavity? A - Be seated upright B - Be laying down C - Lean head back D - Tilt head to side Q3. After the two week review; the denture was relined using? A - Ratchet Torque Tool B - Eversoft C - Putty D - Technovent Q4. Which silicone was used to match the skin tone? A - M511 B - M522 C - M611 D - M622 Q5. In the new year, what was proved necessary to incorporate into the denture? A - A Magnet B - Chrome stud C - Acrylic D - Porcelain

JAN EINFELDT - SCOTT REDDLEY ARTICLE Q6. What was decided on to extract? A - Central incisor B - Second premolar C - Second molar D - The remaining upper incisors Q7. How long was the area left to heal for A - 2 months B - 4 months C - 6 months D - 8 months

Q8. What was the 3rd step of the final treatment process? A - Clear silicone stent for trial smile B - Digital smile design C - Printed models of wax up D - Prep and living with trial smile for a few days Q9. The patient was going to whiten the lower arch with XXX? A - Englighten B - Dental designer C- Dentaform D- Aidite 3DPro Q10 - The restorations were milled on a XXX? A - Roland DWX52 DC B - Clarke CMD300 C - ETM-2VS Vari Turret D - Sealey SM2502

Q14. The entire denture base is milled except for? A - The intaglio surface B - BiPurilary Line C - Dental arch D - Campers plane Q15. The tooth arch and denture base are milled to approximately? A - 50% B - 60% C - 70% D - 80% Q16. The IvoBase CAD Bond material increase work time of around? A - 5 minutes B - 10 minutes C - 15 minutes D - 20 minutes

ERIC KUKUCKA - DIGITAL DENTURE WORKFLOW FOR A FULLY EDENTULOUS PATIENT Q11 . Eric graduated from George Brown with honours in which year? A - 2008 B - 2009 C - 2010 D - 2011 Q12. What is used to establish a preliminary vertical dimension of occlusion and centric relation? A - Accudent B - A centric tray C - Striking plate D - Monoblock Q13. What impressions are scanned using a 3Shape E-Series lab scanner? A - Maxillary and mandibular B - Preliminary C - Bite D - Final

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You can submit your answers in theÂ 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.

DENTAL NEWS

AN UPDATE FROM THE CDO By Andrea Johnson In the latest press release from the Office of the Chief Dental Officer, Sara Hurley has announced that dental teams are definitely to be prioritised as frontline healthcare workers with regards to receiving the Covid-19 vaccination. This does automatically include dental technicians who are working in CQC registered premises and, of course, CDT's who have their own CQC registered clinics and businesses, not just dental practices. It makes sense that any of us who may have any direct patient contact are fully protected to enable us to keep ourselves, patients, families and colleagues as safe as possible which is why Sara has passionately pushed to make sure that any technician working in any patient facing capacity is able to access the vaccine as a priority/phase 2. The most practical way to manage, monitor & offer this is through the QCQ registration database. If you wish to be kept up to date with the latest from the CDO office as and when it is published please sign up to receive the newsletter at: https://www. england.nhs.uk/email-bulletins/ dentistry-oral-health-update/

AN UPDATE FROM SARA HURLEY, CHIEF DENTAL OFFICER ENGLAND AND ERIC ROONEY AND JASON WONG, DEPUTY CHIEF DENTAL OFFICERS We are delighted to announce that alongside other health and care staff, dental professionals and their teams are now being prioritised for a COVID-19 vaccine. This means that dental teams supporting the NHS, those working in private or mixed practices will all be entitled to a vaccine, this includes specialist practices and clinical dental technicians registered with the CQC. Dental professionals who work for a NHS trust will fall within the vaccination programme co-ordinated through their trust. Locum clinical staff employed by the practice and non-clinical ancillary staff who may have social contact with patients but are not directly involved in patient care (e.g. receptionists and cleaners) are also included. The coronavirus vaccination programme, the largest in the health serviceâ&#x20AC;&#x2122;s history, is off to a strong start having already vaccinated more people than anywhere else in Europe, and it is expanding geographically each week as vaccine supplies increase. As frontline health professionals, it is important that when you are called to be vaccinated you attend. Private practices are advised to ensure their contact details with the CQC are up to date as a matter of urgency. More detail is in this bulletin.

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We have the PPE, we have access to testing, we are sharing the message loud and clear that practices are open and now we have access to the vaccine, too. Dentistry is an essential medical service, not an optional extra. Patients need to and deserve to see their dental teams and the vaccine roll out is another important next step in the fight against COVID-19 and restoring NHS dentistry. More widely, commissioners are able to issue those who work in NHS dental practices with documentation that prove critical worker status. More detail is below. We are also very proud of Satyesh Parmar, Asha Thomson and Heather Pope who were honoured by the Queen in the New Year's Honours List. As I am sure you will agree, they are three shining examples of how our profession improves lives. Sara, Eric and Jason HOW YOU WILL RECEIVE THE COVID-19 VACCINE IF YOU WORK IN NHS PRIMARY CARE DENTISTRY The NHS will contact you, you do not need to contact the NHS, such as a GP surgery. First, the NHS will contact the email address your practice is registered with the NHS on to understand the number of people eligible for the vaccine. Once we know the demand, hospitals, and in some cases local vaccination centres, will then begin contacting you to come forward for the vaccine. This vaccine will in all likelihood be administered at your local hospital. As more information becomes available we will keep you updated.

DENTAL NEWS HOW YOU WILL RECEIVE THE COVID-19 VACCINE IF YOU WORK IN SECONDARY CARE DENTISTRY If you work in a NHS trust then your trust will organise your vaccine as your employer. Please speak to your line manager if you have any questions. HOW YOU WILL RECEIVE THE COVID-19 VACCINE IF YOU WORK IN PRIVATE DENTISTRY *Please forward this bulletin to any colleagues in the private sector* The NHS request providers update their contact records with the Care Quality Commission (CQC) as a matter of urgency. This is because if you work in private sector dentistry and the practice you work in or you personally do not have a NHS contract, then the NHS does not hold any contact details for you. This means we need to get hold of your contact details, or that of your practice, from the regulator the CQC. It is therefore essential that private practice owners ensure the contact details for their practice with the CQC are up to date, especially with an up to date email address. The NHS can then begin the process of vaccinating staff. If you are a locum clinical staff not currently clinically active or between employment we will update you as soon as possible. VOLUNTEERING TO HELP DELIVER THE VACCINE We encourage you to volunteer to support the vaccination programme, if you have capacity after fulfilling clinical responsibilities. Our profession's focus is quite rightly on tackling the backlog in dental care and expanding access, in line with the standard operating procedure. We are delighted that former members of NHS staff, including dental professionals, have applied to support the vaccination programme and actually tens of thousands of people have already completed their online training - these are being processed as quickly as possible and volunteers will be deployed as and when they are required. INFECTION PREVENTION CONTROL RESPONSE TO NEW VARIANT STRAINS A peer review has been undertaken by an expert group of clinicians to assess the new variant strains (SARS-CoV-2 VOC202012/01 and UK VOC122020/02). The evidence review has not identified a change in the mode of transmission between the variants and previous circulating strains of COVID-19, and therefore a consensus agreed that there are no changes to the recommendations set out in the IPC

guidance at this stage. The Scientific Advisory Group for Emergencies (SAGE) has also advised that there is currently no evidence of any association between the new variant and increases in transmission in particular settings and that there is no evidence for differences in routes of transmission or different survival on surfaces. A CAS alert was issued on 24 December outlining actions for the NHS to take in response to the variants. All NHS organisations should ensure thorough application of current IPC recommendations and assurance on adherence, PPE is available and in supply, and that all staff training is up to date. For dental teams, the COVID-19 dental appendix is the key source of guidance. PPE should continue to be worn as per current IPC guidance, with FFP3s to continue to be worn for AGPs. This position is being kept under close review. COVID-19 measures in the workplace should be robustly implemented and adhered to, including reinforcing physical distancing, optimising ventilation, greater patient mask use and enhanced decontamination/cleaning (especially frequently touched surfaces). Emerging evidence and data on variant strains will be continually monitored and reviewed, and the guidance amended accordingly if needed. DOSING SCHEDULES OF COVID -19 VACCINATIONS : THE SAFE COURSE OF ACTION The four UK Chief Medical Officers have written an open letter laying out the scientific and public health rationale for the dosing schedule for the AZ vaccine and the change to the dosing schedule for the second dose of the Pfizer vaccine. As with all decisions during this pandemic it is about balance of risks and benefits. The key points of that letter are: 1. "We have to ensure that we maximise the number of eligible people who receive the vaccine. Currently the main barrier to this is vaccine availability, a global issue, and this will remain the case for several months and, importantly, through the critical winter period. The availability of the AZ vaccine reduces, but does not remove, this major problem. Vaccine shortage is a reality that cannot be wished away. 2. We are confident that based on publicly available data as well as data available to the JCVI, the statutory independent body, that the first dose of either Pfizer or AZ vaccine provides substantial protection within 2-3 weeks of vaccination for clinical disease,

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and in particular severe COVID disease. The JCVI has issued a new evidence statement today. 3. The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy. In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine. 4. In terms of protecting priority groups, a model where we can vaccinate twice the number of people in the next 2 to 3 months is obviously much more preferable in public health terms than one where we vaccinate half the number but with only slightly greater protection. 5. This is why the JCVI has recommended that first doses of vaccine are prioritised for as many people as possible on the Phase 1 JCVI priority list, in advance of second doses which will subsequently provide more assured longer-term protection. It is a classic public health approach centred on doing as much good for as many people in the shortest possible time frame, within the available vaccine supplies, against a background of immediate disease activity and still high population sero-susceptibility (despite the disease burden seen). 6. The JCVI is confident 12 weeks is a reasonable dosing interval to achieve good longer-term protection. 7. The position is strongly supported by the UK Chief Medical Officers on public health grounds of maximising benefit." The letter can be read in full online. PROVING YOU ARE A CRITICAL WORKER WHEN PART OF A NHS DENTAL TEAM Dental professionals and their teams are defined by the Government as critical workers. The Government website says "This includes, but is not limited to, doctors, nurses, midwives, paramedics, social workers, care workers, and other frontline health and social care staff including volunteers". Front line health staff includes dental professionals and their teams. If you need further evidence of this, email your NHS commissioner who can provide a letter from NHS England explaining that you are a critical worker. The British Dental Association has advised the Chief Dental Officer that they will support private practices with a template letter as required.

DIGITAL TECHNOLOGY

DIGITAL DENTURE WORKFLOW FOR A FULLY EDENTULOUS PATIENT

By Eric Kukucka I Denturist I The Denture Center, Canada

BENEFITS OF THE DIGITAL WORKFLOW ACCORDING TO ERIC KUKUCKA

O About Eric Kukucka DD

l Eric graduated from George Brown with

Honors and was named Valedictorian of all health sciences in 2010. Eric lectures globally a as a key opinion leader for Ivoclar Vivadent and in North America for Nobel Biocare. His practices are in Windsor, Ontario, Canada, where he owns and operates three denture clinics ”The Denture Center.” Eric is dedicated to building great relationships within the dental community while always striving to create the highest standard of care for edentulous patients.

ne of the man challenges with the analog denture workflow is the laborious time it takes with resets, due to inaccuracies in occlusion, vertical dimension, and/ or aesthetics. If, for example, our patient’s midlines are skewed, we will have to remove all teeth (as many as 28), remove all wax, re-wax, re-set each tooth individually, redo the wax confinement then invest, process trim and polish. It’s a very burdensome type of procedure. With a digital workflow, these types of corrections take ten to fifteen minutes. In addition, in the case of a digital removable prosthesis, the uniformity of the design is very beneficial. Being able to replicate a patients’ arch form of their palette, at a 2.5 – 2.75 mm of thickness is nothing short of remarkable. We can now have the desired thickness we, as dental profession, have always dreamed of. This improves patients’ comfort and adaptability significantly. I firmly believe that embracing digital technology for today’s dental professionals is imperative. There’s a paradigm shift that is happening globally, with the movement into digital removable fabrication. It’s essential that as dental professionals we make this investment, not only into the technology but into ourselves as individuals. We’re only going to grow with making the investment and our patients will ultimately benefit the most in the end.

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3SHAPE SOLUTIONS USED: • 3Shape E series dental lab scanner • 3Shape Dental System® Denture Design software

CASE BACKGROUND Male, fully edentulous patient in need of a new set of dentures. The patient’s dentition became terminal due to a past drug addiction several years ago. He has been rehabilitated with numerous sets of conventional dentures in the past.

DIGITAL TECHNOLOGY Initial situation of the patient demonstrating the edentulous ridges

A centric tray (Ivoclar Vivadent) is utilized to establish a preliminary vertical dimension of occlusion and centric relation

The UTS CAD (Ivoclar Vivadent) is utilized to establish the BiPupilary Line and Campers plane

Preliminary impressions taken utilizing Accudent XD Material and the centric tray are shown in this figure. These constitute the initial records required for digital denture professionals

The maxillary and mandibular impressions are scanned utilizing the impression fixture in 3Shape (E Series) lab scanner

The maxillary and mandibular impressions are aligned into the centric tray intaglio surface

The maxillary and mandibular impressions are now trimmed to create preliminary casts. The 3rd image represents the maxillary and mandibular impressions articulated with the UTS CAD in place

The Gnathometer CAD striking plate is placed and the patient performs centric and eccentric movements to create the arrow shown. The true physiological centric relation is recorded

The maxillary final impressions with a monophase post dam. The finalized registration of the 3D bite plate with the Gnathometer CAD utilizing Virtual Bite Registration material

The maxillary and mandibular impressions & centric relation are scanned utilizing the impression fixture in the 3Shape scanner. This process allows an accurate scan in the X Y Z axis of the scanner

The design process of the 3D BITE PLATE / Gnathometer CAD (Gothic arch tracing device) is carried out and the manufacturing process utilizing the ProArt CAD try in Demonstrating the virtual scans of the registrations. The master casts are now virtually created and articulated

The centric tray is scanned utilizing the impression fixture (3Shape E Series lab scanner)

Maxillary and mandibular centric tray scanned in 3Shape software

Closed mouth maxillary and mandibular functional final impressions are conducted utilizing SEMCD concept

The UTS CAD (Ivoclar Vivadent) is utilized to re-establish the BiPupilary Line and Campers plane

Model analysis is carried out utilizing anatomical landmarks for proper placement of the dental arch. The denture base outline is also performed. Tooth selection and placement is carried out. It is astounding the way in which we can evaluate our placement of the dental arch in relation to the ridge. This case utilized Phonares II B82L51-NU5- NL5

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DIGITAL TECHNOLOGY The Virticulator ( Virtual Articulator) is utilized to evaluate the centric contact points during excursions. When utilizing a milled tooth arch these modifications can be modified during the manufacturing process reducing chair time during the insertion appointment. Artificial Gingiva is applied and contoured

Finalized Careded tooth workflow denture utilizing Phonares II B82-L51-NU5- NL5

The new Vivodent CAD Multi, a polychromatic (industrially produced DCL PMMA) provides the highest aesthetics by creating unparalleled incisal translucency. New in 3Shape Dental System 2019, you have the capability to section the dental arch

Patients new oral situation

The manufacturing process of the Monoblock try-in utilizing the ProArt CAD try in in conjunction with PM7 Wax can be applied to differentiate the dental arch and base

The Monoblock try in is assessed clinically and any changes are indicated and modified in the software with ease

The Careded manufacturers tooth workflow is indicated for the high aesthetic demands of manufactured teeth . Phonares II , Vivodent SPE, SDCL, Blueline are available in this workflow

The entire denture base is milled except for the intaglio surface. Once the manufactures teeth are bonded into the denture base the disc will be placed back into the mill for finalization of the intaglio surface

The oversized milling process has changed digital denture manufacturing process efficiencies, as well as the accuracy, predictability and overall strength of the restorations. The Ivoclar Digital Denture System has a milling process that provides all of these aspects, the unique â&#x20AC;&#x153;Oversized Milling Process,â&#x20AC;? which eliminates the need for manual removal of excess bonding material. The tooth arch and denture base are milled to approximately 80%, with the base sockets and tooth necks milled to precision. The arches are then bonded together, and the prosthesis is put back in the mill for a final milling

The Denture Base is rough milled (Oversized) utilizing Sr.IvoBase CAD (industrially produced high impact PMMA). The Dental Arch is rough milled utilizing Vivodent CAD Multi (industrially produced DCL PMMA)

The oversized milled denture base and dental arch are passively seated

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The IvoBase CAD Bond: This material is unique due to its extended polymerization process providing the technician increased working time (10 minutes)

Placement of the dental arch into the base utilizing IvoBase CAD bond material

The oversized base and teeth polymerized and placed back into the PM7 for finalization

Results of the milling process directly after milling in the PM7. Note the incisal translucency achieved with the Vivodent CAD Multi

DIGITAL TECHNOLOGY This figure demonstrates the incisal translucency achieved with the Vivodent CAD Multi

Final prosthesis characterized and polished

The patient having some fun demonstrating “biting on the discs.”

Final prosthesis intraorally. The patient is very pleased with the aesthetic results

About 3Shape 3Shape is changing dentistry together with dental professionals across the world by developing innovations that provide superior dental care for patients. Our portfolio of 3D scanners and CAD/CAM software solutions for the dental industry includes the multiple award-winning 3Shape TRIOS® intraoral scanner, the 3Shape X1® CBCT scanner, as well as market-leading scanning and design software solutions for both dental practices and labs. Two graduate students founded 3Shape in Denmark’s capital in the year 2000. Today, 3Shape employees serve customers in over 100 countries from 3Shape offices around the world. 3Shape’s products and innovations continue to challenge traditional methods, enabling dental professionals to treat more patients more effectively.

Demonstration of the uniform thickness provided by Digital Denture fabrication and the incisal translucency achieved with Vivodent CAD Multi

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For more information or to book a free demo, please contact 3Shape UK on ukenquries@3shape.com

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DTS 2021

MARKETING YOUR WAY BACK TO THE TOP

When finances come under scrutiny, the first instinct for many business owners is to pull back on marketing. The initial aim is to reduce outgoings in order to preserve revenue and protect the business, team and clients. However, this is not always the best approach. Streamlining finances is crucial, but reducing or eliminating investment back into the organisation – such as through marketing – can cause more damage in the long-run. It has been a difficult time for UK dental laboratories and finances have definitely taken a hit. But if you’re not attracting new clients or strengthening relationships with existing clients, what will happen to the lab in the next year or two?

WORK SMARTER NOT HARDER So, if we’re suggesting that your marketing should continue, even when you are watching the pennies, you may ask where the money is going to come from. Basically, it’s about making your budget work smarter so that you don’t have to work harder. After all, even a small marketing spend can deliver results when it’s put to good use.

The key is to start small and build up, aiming for quality and consistency. Repetition

is essential for effective promotion of any product or service. You will likely have heard of the ‘rule of 7’, which implies that any message needs to be received at least 7 times before the recipient is motivated to act upon it. While there is little science to prove the exact number of repetitions required, the idea stands true and it is beneficial to use the same or similar messages several times to ensure it sinks in. It is just as important to monitor progress as you go. Calculate how many enquiries you receive from each promotional channel and how many of these turn into paying clients. In doing so, you can identify the avenues working best and focus on them, rather than spreading your money and efforts across lots of different activities that don’t actually bring you any return on investment. In this way, you can ensure that the marketing you do is as effective as it can be.

CAREFUL INVESTMENT

Effective marketing does not always have to be expensive, so if you don’t have a massive budget – or you don’t currently have a budget at all – there are still several things you can do. If you think of marketing like a funnel, with the cheapest options at the bottom

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and more expensive channels towards the top, you have a model for a solid marketing strategy. Especially in challenging times, the majority of your promotions can be lowcost or sometimes even free. For instance, your website (once set-up) and social media accounts cost nothing but time to keep updated. These are highly effective methods by which to communicate key messages with both your existing clients and potential new people. You can share lab news, promote services you offer and highlight your unique selling points to demonstrate why a dentist would benefit from working with you. These are also good platforms to engage with others, to offer advice or share knowledge and resources for the development of all, further boosting your reputation in the profession. If you do have some budget, consider advertising on social media platforms or organising direct marketing activities to dental practices in your area or those that operate within your dental discipline. You can decide how many businesses to contact and what to send them, allowing you to manage your spend accordingly. The material needn’t be flashy or extensive – just stick to your core messages and include a call to action such as a special offer or an introductory fee for new clients to encourage dentists to get in touch.

DTS 2021 BE ORIGINAL

Whatever the focus of your marketing materials, it is crucial to stand out from the crowd in some way and to offer some originality that dentists will remember and respond to. Given the challenges of the last year, you would be forgiven for lacking slightly in inspiration â&#x20AC;&#x201C; so why not look for new ideas and stimulation at an event that promotes positivity and forward-thinking? The Dental Technology Showcase (DTS) 2021 will provide an ideal place to learn from leading lights in the profession and gain practical advice to implement within your own business. There will also be hundreds of like-minded colleagues in attendance to network with, share concerns and hear their perspectives. From marketing to technologies, digital workflows and milling materials, the show will have it all, as well as enhanced CPD, interactive sessions and an extensive trade show! It will be the perfect platform from which to seek expert guidance and get inspired, helping you market your lab back to the top of its game.

DTS 2021 WILL BE HELD ON FRIDAY 21ST AND SATURDAY 22ND MAY 2021 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

ASSOCIATION OF DENTAL IMPLANTOLOGY - A COMMUNITY OF SUPPORT

DENTAL NEWS

The Association of Dental Implantology (ADI) provides an active community of more than 2,400 dental professionals interested in or providing dental implant treatment. The inclusive membership welcomes all members of the dental team from dentists and dental nurses to dental hygienists, dental therapists, practice managers, treatment coordinators and dental technicians. This means there is always someone to turn to with any questions or concerns you may have, whether you wish to share your experiences or seek advice from more experienced colleagues. In addition, there are lots of ways to communicate with the ADI community, including the ADI Membersâ&#x20AC;&#x2122; Only Facebook Page, for optimal convenience. To find out more about these and many other benefits of ADI membership, check out the new website today. For more information or to join the ADI, please visit www.adi.org.uk

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DENTAL NEWS

VHF SUPPORTS FOOD BANKS WITH CHRISTMAS DONATION THE CHARITY ORGANIZATION TAFELN DEUTSCHLAND HELPS NEEDY PEOPLE, SAVES FOOD AND PROTECTS THE CLIMATE AT THE SAME TIME Ammerbuch/Hauppauge, December 17, 2020: Instead of sending presents to customers and partners, vhf donates to charity again this year. With this donation, the milling machine and tool manufacturer would like to support the work of the food banks in Germany, which save around 265,000 tons of food per year, which in turn is given to more than 1.6 million people. “Showing social responsibility is part of our self-image. We would like to support the volunteer work of the food banks with our contribution, as it is especially important to show solidarity this year,” says Ria Brandenberger, member of the board at vhf, about the company’s commitment.

ABOVE: Food distribution behind protective foil: in 2020, the food banks faced special challenges. IMAGE: Lisa-Marie Kaspar.

In 2020, the charity organization is facing special challenges. This is because the Coronarelated lockdowns in spring and November led to fewer food donations at the food banks in many places, a decrease in active volunteers and more expenses for protective measures. The food banks in Germany therefore need additional support to cope with the increased workload and the associated costs. At the same time, the charity organization is seeing a new need for help and a worsening of poverty and social inequality in Germany: people are currently asking for support from the food banks who were not previously dependent on external assistance. These are people who have lost their jobs or part-time jobs due to the Corona pandemic, or selfemployed people whose livelihood is at stake due to a drop in orders. In its poverty report 2020, a German welfare association even speaks of a poverty rate at a record high. For this reason, vhf camfacture AG would like to make a solidarity contribution and financially support the Tafeln Deutschland with its annual Christmas donation.

The charity organization not only helps to curb the waste of edible food and to support people in need. Since the association is Germany’s largest food saver, it also makes an important contribution to climate protection by limiting the otherwise huge waste of resources. ABOUT VHF Founded in 1988, vhf is a leading manufacturer of CNC milling machines, milling tools and CAM software for the dental sector, industry and sign making. Headquartered in Ammer-buch, Germany, vhf employs more than 250 people and is constantly expanding. With its subsidiary vhf Inc. in the state of New York, it provides North American customers with inventory, sales, service, and support. GLOBAL: vhf camfacture AG, Lettenstrasse 10, D-72119 Ammerbuch, Germany. T: +49 7032 97097 000 E: info@vhf.de W: vhf.de THE AMERICAS: vhf Inc. 80 Davids Drive, Suite 5, Hauppauge, NY 11788 USA T: +1 631 524 5252 E: info@vhf.com W: vhf.com ABOUT THE CHARITY ORGANIZATION TAFELN DEUTSCHLAND The 950 non-profit chapters of the food bank in Germany collect perfectly good surplus food from retailers and manufacturers and regularly distribute it to more than 1.6 million poor people across the country. In doing so, they strike a balance between waste and poverty. With around 60,000 volunteers involved in the food bank, they are one of the largest social-ecological movements in Germany.

ABOVE: Food distribution: the charity organization Tafeln Deutschland help fellow human beings in need and save food. IMAGE: Yuki Zipse.

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W: tafel.de

MARKETPLACE BAR HEADER PRETTAU® 3 DISPERSIVE® WITH GRADUAL-TRIPLEX TECHNOLOGY: A TRIPLE GRADIENT OF NATURAL COLOUR, FLEXURAL STRENGTH AND TRANSLUCENCY w Zirkonzahn’s Prettau® Dispersive® zirconia materials are provided with a gentle and natural colour shading already during the manufacturing process thanks to a smooth, dispersive shade transition. With the Gradual-Triplex-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 Prettau® 3 Dispersive® zirconia shade guides are available. Zirkonzahn Shade Guides are composed of monolithic zirconia sample teeth in the shape of

Prettau® 3 Dispersive® with Gradual-Triplex-Technology

a premolar as well as upper and lower incisors (also cusromisable). If the material of the shade guide and the material of the zirconia crown are identical, it is ensured that the colour of the zirconia restoration corresponds 1:1 with the natural tooth colour of the patient. FOR MORE INFORMATION VISIT www.zirkonzahn.com or scan the code.

CARESTREAM DENTAL: GAME, SET AND SHADE MATCH w The demand for exceptional aesthetics only continues to grow as dentistry becomes more advanced. Make sure your laboratory has all of the information it needs to succeed on this front by recommending the CS 3700 intraoral scanner from Carestream Dental to your referring dentists. A smart, fast and accurate scanner, the CS 3700 also has inbuilt innovative shade match technology, meaning it records the exact shade of surrounding dentition and includes this information on the scan. This way, when your lab receives the scan you know exactly what shade will provide an exceptional restoration. Make aesthetics easy by contacting Carestream Dental today. FOR MORE INFORMATION, CONTACT Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk

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MARKETPLACE

3SHAPE: FREE EBOOK - “BECAUSE TREATMENT MATTERS TO ME” WHAT RESEARCH AND PRACTITIONERS TELL US ABOUT INTRAORAL SCANNERS AND TREATMENT QUALITY w Intraoral scanners have been around long enough to have had the treatment quality claims tested and researched extensively by independent sources. We have just published an ebook that summarizes what the clinical studies say and what the dentists that use intraoral scanning in their daily work feel. We also added some tips and tricks, and other useful information. GET YOUR FREE COPY BY SCANNING THE QR CODE .

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AGUE S E E PA GE 3

30/07/2020 16:27 03/06/2020

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