The Dental Technician Magazine January 2022 by The Dental Technician Magazine

VO L 7 5 N O. 1 I J A N U A R Y 2 0 2 2 I B Y S U B S C R I P T I O N

FULL ARCH IMPLANT WORK

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

WHY THE TECHNICIAN IS SO VALUABLE By Ashley Byrne PAGE 34-37

FACING THE DEMAND

MEDENTIKA PAGE 12-13

THE BUSINESS SECRET ALL LAB OWNERS SHOULD KNOW By Steve Campbell PAGE 14-15

THIS MONTH... l

DENTAL NEWS: WINNERS OF THE 2021 WHITE DENTAL BEAUTY AND DENTAL CIRCLE COMPETITION P. 16-17

DENTAL TECHNOLOGY: PRIMARY IMPRESSION - TAKING ON EDENTULOUS CASES I CHRIS WIBBERLEY P. 22-24

COMPANY PROFILE: BAOT SCIENCE AND ART P. 30-32

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CONTENTS

JANUARY 2022 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 MAGAZINE, PO BOX 2279, PULBOROUGH, RH20 9BR. 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.

Welcome Welcome from the editor

Advertorial No news? That is not good news! By Enrico Steger

Mandatory Vaccinations? By Sir Paul Beresford

Technicians Insight 5 things I cannot work without! By Kirsty Lewis, Senior Customer Service at WHW

Dental Technology Medentika - Facing the demand Primary Impression - Taking on Edentulous Cases. By Chris Wibberley Full arch implant work - why the technician is so valuable. By Ashley Byrne

12-13 22-24 34-37

Business The business secret all lab owners should know. By Steve Campbell

14-15

Dental News Optident announces winners of the 2021 White Dental Beauty and Dental Circle Competition Dentsply Sirona appoints Cherée Johnson as General Counsel and Executive Leadership Team member Primescan Atlantis Suprastructures Validation

16-17 18 19

ECPD Free Verifiable ECPD & ECPD questions

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

Company Profile

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.

Insight

SUBSCRIPTIONS

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BAOT Science And Art

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Marketplace Shofu Kemdent/ Zirkonzahn

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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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BAR HEADER WELCOME

From the

Editor Matt Everatt F.O.T.A

Welcome to your January edition and first of 2022

Happy New Year one and all! I am writing this a few days before Christmas, anticipating what may be ahead for us in the coming days. Will we be in another lockdown? Will we be celebrating New Year in our own little bubbles? I am trying my best to refrain from reading what New Year message I put out to readers last year though fear of replication. I can’t help but feel we have a bit of a ground hog day situation. The good news though, it seems like Dental Laboratories have in general, had a good year. Of course, I don’t expect this will be the case for everyone and I would be very keen to hear from our readers on how 2021 was for you.

How will the current consumer confidence translate into Dentistry? I get the feeling that consumer confidence in visiting dentists is very high, in speaking to friends of mine in Dental Practices, they are seeing an upsurge in requests for cosmetic dentistry, orthodontics and tooth whitening and there has been a very positive shift in patients moving over from NHS to private dentistry. It is certainly a changing landscape, one in which our laboratories can and should benefit from. I read an article recently saying that all CQC registered organisations will be required to have all workers vaccinated against COVID-19. I am not sure how the mandate will pan out in Dental practices and I do wonder if this will become a mandate across the whole of our profession. And my final words for 2021….. I do hope you are all still enjoying reading the magazine? I personally would like to see a lot more technical pieces and case presentations from you all. This is where I need everyone’s help. I wrote a social media post asking for people to join the Editorial Board of our Magazine. We have had several Technicians come forward and I would like to encourage more of you to contribute. We have had some amazing fellow technicians sharing their experience and knowledge over the years. Even if you can’t commit to joining the Editorial Board, you may wish to consider sending in the occasional interesting case. It is your magazine; we really want you to enjoy it. Best Wishes Matt Everatt FOTA

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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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ADVERTORIAL

NO NEWS? THAT IS NOT GOOD NEWS! By Enrico Steger

Have you ever been in a room talking with other people and, whatever the debate, you have fully unleashed your extensive and well-grounded knowledge on a particular topic? In silence, stunned by your knowledge, the other participants were actively listening. Their avid attention to your discussion directly relates to how you felt: proud, influential, worthy of respect. In a world of work caught in the whirlwind of the digital transition, an

inquisitive mind open to change is the trump card for establishing yourself as a forerunner of tomorrow and always working one step ahead. Once an important work goal has been achieved or a cutting-edge CAD/CAM has been purchased, you might feel as if you are 'set for life'. This is an easy trap to fall into during the course of one's career! An excellent dental practice or laboratory that you never hear from, a well-known company that indulges in the success of past inventions – falling into predictability and ceasing to be innovative – are destined, one small step at a time, to lose all the competitive advantage they built over the years. A relentless pursuit of what is new is what we possess to overcome the dangers of routine and, above all, it is the best asset to stand out from competitors. After all, the world of work is a mirror of social mechanisms. Think about it: people who are always up-to-date, creative and unpredictable are constantly the object of curiosity and attention. In their originality, they stand out from the crowd,

everyone imitates them, everyone wants to be like them. It is their lifestyle that shapes fashions, not vice versa. In the dental market, and in the general world of work, whoever is up to date with the latest news in the field demonstrates competence, professionalism and versatility. Any dentist would be excited to work with a dental technician who, along with the excellent restorations delivered, can offer an incomparable advisory service on the latest effective working techniques to meet the patients’ demands. My experience as a dental technician and, most importantly, as an entrepreneur, has shaped my deep awareness of the pitfalls of the dental market and I am proud to guide my associate dental technicians through their careers with increasing success, sharing with them everything I develop to excel in our profession. From new working methods, to new materials, through the most advanced CAD/CAM technologies, any new invention aims at bringing the clinical-lab communication to new levels and at finding an everincreasing balance between function,

aesthetics and technical simplification. With the Zirkonzahn School, I offer a variety of online and face-to-face courses for dental technicians and dentists, to whet their appetite for learning and prevent the dental team from settling into the comfort zone of the daily working routine.

As in all battles, the duel against the lazy and dull routine can only be won with an alert and perceptive spirit. There is only one motto that you can shout for victory: “No news is not good news. Always be unpredictable!”

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INSIGHT

MANDATORY

VACCINATIONS?

By Sir Paul Beresford

hile we are all anxiously waiting to see that Christmas 2021 will be a vast improvement on Christmas 2020, Prof Chris Whitty was as positive as I recall he has ever been. He told the Health and Social Care Committee last week that within a few years’ time, maybe even months, “we will have polyvalent vaccines, which will cover a much wider range (of variants). He also bravely said Britain is heading for a “safer haven”. I hope he is right, and I suspect in time he will be. The key is to vaccinate as near as 100% of the population as possible. The western world has managed this before for smallpox and polio as well as variety of dreadful childhood diseases. The problem is the rise of the anti-vaccination believers. My team and I are regularly bombarded by constituents, often intelligent or even very intelligent, who have succumbed to the nonsense peddled against Covid vaccines. There are many examples as to the success of vaccination. The most glaring example, though negative, is that far away the majority of Covid patients in hospital currently have not been vaccinated. It is a form of selfishness when well above 70% of hospital Covid patients, currently have not been vaccinated and are occupying beds which could have been used for those who have other conditions for which they will have to wait for treatment. There has been a call for mandatory vaccination. The reasoning is quite simple in that vaccination reduces the risk of serious illness, fewer deaths and markedly less pressure on our hospitals. It makes our community safe and ultimately will, to a greater or lesser degree, drive Covid out of our lives. After all, we all drink water that has been chlorinated, eat bread that has been made with wheat with folic acid as an additive for health reasons. But the administration of anything into the body brings a different and frequently emotive or irrational response.

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Austria has a plan to introduce mandatory vaccinations for all by February 2022. Austrians will not be forcefully injected. There will be permitted exceptions, but far away the majority of the remaining unvaccinated population will face fines are not getting their injections. Mandatory vaccinations are not unknown in Britain but for specific situations and not for the whole population. Classically, at least until recently it was a mandatory requirement for doctors and dentists working on patients within the UK to have had the BCG inoculation. Governments will have to decide on a push or nudge approach. In Britain, as I think will apply to virtually all nations, the nudge approach will prevail as the push (mandatory) approach will be unacceptable.

I much prefer the “Duty of Care” approach. It is not unreasonable for the management of care homes, hospitals and many other businesses to expect their staff to be vaccinated. It is also not unreasonable for many businesses to expect their clients to be vaccinated or show a clear Covid test. This is part of the “Duty of Care” to the staff and other customers of those businesses. Very early on in the vaccination campaign the CEO of Qantas, proclaimed in a very strong Australian accent, “anyone travelling on my planes must be vaccinated!” While we will never, I believe, reach 100% vaccination against Covid, this nudge approach could make life sufficiently difficult for the unvaccinated to finally recognise that they too should be vaccinated and not rely upon the rest of us to protect them by adding to the numbers required for herd immunity.

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INSIGHT TECHNICIANS INSIGHT

5 THINGS

I CANNOT WORK WITHOUT! By Kirsty Lewis I Senior Customer Service at WHW

1 TEA AND BISCUITS

I don’t know about you but I am most definitely a dunker. It sets me up to be able to deal with all the different challenges of the day. My favourite biscuits are nice. Please feel free to send me copious amounts and please make sure they come to the right address in East Sussex.

2 COLLEAGUES

Begrudgingly, and I do say this with gritted teeth, my colleagues. Only joking we are such a close knit team and have known each other for so long but that doesn’t mean I don’t want to strangle some of them sometimes but isn’t that the same with all families.

3 LAUGHTER

Let’s face it life has been difficult in the last couple of years and we have all faced our own challenges whether that be at work or privately. Without having a laugh (whilst being professional at all times) things would be so much harder.

4 OUR CATALOGUE AND WEBSITE

When people aren’t using it as a doorstop, the catalogue has made a world of difference to us all. Beforehand we were dealing with photocopied pieces of paper like something from the dark ages. The website is always being updated unlike the catalogue and when you constantly launch new things it can be your best friend.

5 WHATSAPP

We have a mobile for the customer service team and now having the ability for technicians to send us photos (not like that please) in real time, while we are on the phone with you has proved invaluable. We all call products by different names and terms and it is the case of a picture does indeed paint a 1000 words. 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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DENTAL TECHNOLOGY

FACING THE DEMAND Preparing the dental laboratory for demanding cases is the most effective way to ensure the success of your fabrications.

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DENTAL TECHNOLOGY

here may be several reasons as to why more complex cases are challenging – it might be due to difficulties communicating with the dental practice, or due to the intricacy of the case, whether its challenges be aesthetic or functional in nature. Your main aim is to satisfy your client through successful prostheses, and ensuring that your lab is prepared to face any demand is the first step to achieving this.

A COLLABORATIVE EFFORT

Communication between the dental lab and the dental practice is the best place to start when considering how you can best manage demanding cases, and ensure reliable outcomes. It can be challenging to establish an effective relationship with the practice, but successful prostheses depend upon a collaborative effort between the two. Miscommunication can be infuriating for both parties, as time and money must be spent remaking or readjusting restorations. Certain communicative methods may be more effective than others – for example, various studiesi ii have noted that work authorisation forms/lab dockets alone have several drawbacks, including a lack of visual interactivity and inadequate information. Digital communication, however, allows technicians and dentists to interact and transfer a greater amount of information faster, as well as make decisions quickly throughout the treatment process. You should consider taking steps to establish an efficient communicative pathway between yourself and your client – you could discuss together your preferable mode of communication, whether that be email, Whatsapp or over the phone. If you have any queries, or require additional information, it can be easily obtained with minimal disruption to your workflow.

YOUR TRAINING

Prioritising training is vastly beneficial, regardless of your experience level. Acquiring further knowledge can help you keep up-to-date on the latest technologies and techniques that are emerging in the field; plus, you’ll be able to continuously assess your strengths and weaknesses and discover ways to improve. Undergoing additional training will also help you to handle complex cases more confidently, as well as expand the capabilities of your laboratory. There are many training pathways that you could take, such as workshops, webinars and hands-on courses.

Once you’ve gained skills in new materials and technologies, you’ll be able to build a comprehensive portfolio and it may even help you to introduce new equipment into the laboratory.

the adoption of digital technology should be considered, to better prepare the dental laboratory and ensure that the prostheses fabricated are accurate, aesthetic and durable.

DIGITAL TECHNOLOGY

For more information, visit the website today: https://www.straumann.com/ medentika/en/professionals.html

Digital technology has aided dental professionals in delivering excellent care to patients with higher-quality solutions and more controllable outcomes. A surveyiii was conducted to ascertain dental technicians’ use of digital technology: it was found that whilst the majority of dental technicians who participated did employ some form of CAD/CAM in their workflow, high initial costs were noted as the most common reason for non-users. All dental professionals should certainly be mindful when deliberating on whether to go digital. However, digital technologies are an investment, so you should consider how you, your team and your clients will benefit in the long-run.

Y, Cheikh, et al. “Study of Effective Dentists Communication with Laboratory Technicians in Removable Partial Prosthesis.” International Journal of Advances in Scientific Research and Engineering. www.academia.edu/44873617/ Study_of_Effective_Dentists_Communication_ with_Laboratory_Technicians_in_Removable_ Partial_Prosthesis. Accessed 6 Dec. 2021.

“Quality of Communication between Dentists and Dental Technicians for Fixed and Removable Prosthodontics.” King Saud University Journal of Dental Sciences. https:// www.sciencedirect.com/science/article/pii/ S2210815712000194#b0005. Accessed 7 Dec. 2021.

Research has shown that digital technologies can help to lower the overall laboratory time,iv v vi which in turn will help streamline the workflow between the lab and the practice. The use of 3D printing for dental protheses, for example, has been shown to be reasonably cost-effective, with the potential to streamline and modernise the dental fabrication workflow.vii The implementation of digital technology will be especially beneficial when dealing with complex cases; as well as improving accuracy and speed during design and production, digital technology has made sharing information much simpler, whether that be through photography, email, digital models or collaborative software.

THE TOOLS OF THE TRADE

The success of prostheses can also depend on the products you use in their production, especially for demanding cases. You’ll want to be conscious about the practicality of the products and components that you use – can they fit seamlessly into your workflow? Are they compatible with other products that you use? Do they facilitate a smooth restorative process for the dentist and patient? The innovative Angulated Screw Channel (ASC) Flex from Medentika®, a Straumann Group brand, has been designed with demanding prosthetic cases in mind. The angled screw channel permits angulation of up to 25º, allowing for impressive restorative accessibility. The varying chimney heights, which reach from 6.5mm down to 3.5mm, allow you to adapt to the situation. Additionally, with an optimised emergence profile, the soft tissue can be supported and protected for clinical outcomes your clients and their patients will appreciate. To ensure that complex restorative cases are successful, effective communication between dental technicians and dentists should be maintained. Plus, ongoing training and

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REFERENCES

Blackwell, E., et al. “Survey on the Use of CAD-CAM Technology by UK and Irish Dental Technicians.” British Dental Journal. https://www. nature.com/articles/sj.bdj.2017.407?proof=t Accessed 6 Dec. 2021.

iii

Mühlemann, Sven, et al. “Randomized Controlled Clinical Trial of Digital and Conventional Workflows for the Fabrication of Zirconia-Ceramic Posterior Fixed Partial Dentures. Part II: Time Efficiency of CAD-CAM versus Conventional Laboratory Procedures.” The Journal of Prosthetic Dentistry. www. sciencedirect.com/science/article/abs/pii/ S0022391318303627. Accessed 6 Dec. 2021.

Mühlemann, Sven, et al. “Is the Use of Digital Technologies for the Fabrication of ImplantSupported Reconstructions More Efficient And/or More Effective than Conventional Techniques: A Systematic Review.” Clinical Oral Implants Research. https://onlinelibrary.wiley. com/doi/full/10.1111/clr.13300. Accessed 7 Dec. 2021. v

Pavlova, Diana, et al. “Investigation of the Dental Technicians’ Readiness to Manufacture Dental Prostheses Using Digital Technologies.” Scripta Scientifica Medicinae Dentalis. https:// journals.mu-varna.bg/index.php/ssmd/ article/view/5041. Accessed 7 Dec. 2021.

Anadioti, Eva, et al. “3D Printed Complete Removable Dental Prostheses: A Narrative Review.” BMC Oral Health. https://bmcoralhealth.biomedcentral.com/ articles/10.1186/s12903-020-01328-8. Accessed 7 Dec. 21.

vii

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BUSINESS

THE BUSINESS SECRET ALL LAB OWNERS SHOULD KNOW T he biggest limitation of a dental implant laboratory is its output capacity as this is what generates income. When I set up mine in 2016, I had limited capital and I knew that I would need to find innovative ways of achieving my target level of output. I also knew that to be successful, that output would need to be of a consistent high quality and delivered within reasonable timeframes.

From the very first day, therefore, I decided to build a digital implant solutions workflow and outsource all our customised abutment requirements to Dentsply Sirona’s Atlantis®. This meant that we could concentrate in-house on creating frameworks and restorations, secure in the knowledge that the abutments would be of the highest quality.

Steve Campbell, experienced technician, DLA President and owner of Nexus Dental Laboratory, reveals his business model for dental implant laboratories and the business secret all lab owners should know.

Five years later, we have 24 people across four sites and actually, we’re still using Atlantis as part of our digital implant solutions workflow.

THE BUSINESS BENEFITS OF DIGITAL The term ‘digital implant solutions workflow’ strikes fear into some in our profession and that’s not a great surprise considering some of the press that digital dentistry has received. But my transition into digital, including my partnership with Atlantis, has proved how business-transforming it can be.

A first-class service Digital breaks down geographical barriers between dental team members. Whereas in analogue days we relied on phone calls and both implant surgeon and technician interpreting as best they could what each other were trying to communicate, now there is no room for misunderstanding. I can send a virtual model of the patient’s teeth and our proposed restoration direct to my surgeon whenever I need to and immediately discuss the case with all the facts before us on screen. Digital scans can often show the surgeon more detail than they were able to see in the clinic, such as a lingual cusp biting down. With the complete 360-degree view in front of them, they often adjust their prescription to provide an even better restoration. It’s about giving the surgeon all the information and time they need to make a good clinical decision. The biggest winner is of course the patient. When the best treatment plan has been identified and agreed upon before any financial commitment has been made by ordering components or materials, there is less compromise. I came across many instances in traditional labs when components had been ordered ahead of time and the budget dictated that these had to be used even when the treatment plan was later altered. In a digital implant solutions workflow, the treatment plan can be perfected before manufacture begins which leads to consistently successful outcomes. This enables us to stand out from our competitors and keeps our clients coming back to us. Increased efficiency A digital implant solutions workflow offers many opportunities to increase lab efficiency. Multitasking is much easier as I can switch between cases more quickly and whilst a client is reviewing the virtual model we’ve sent, my team can be working on other cases. Better communication in the design stage results in fewer remakes or adjustments which have a huge impact on efficiency. Every business must be vigilant on wastage

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BUSINESS

and remakes are the main cause of wastage in a lab. On top of that, output potential is reduced as technicians are called off paying cases to work on remakes. Introducing CAD/CAM software into the lab also opens up opportunities to add more digital equipment, such as a milling machine, which can be integrated with existing software and provide further potential to increase efficiency and accuracy. Companies like Dentsply Sirona have opened up their systems so that it is much easier to build up compatible digital capabilities affordably as the business grows. The flexibility to outsource Many lab owners believe that it’s more profitable to do as much as possible in-house to keep costs low, and then search for the cheapest possible partners when they do need to outsource something like milling an abutment. In my opinion this is a false economy as it fails to take into account the business cost of their technicians’ time and decreased output potential. Outsourcing abutments to Atlantis means we can spend 10 minutes making final adjustments rather than 40 minutes scanning and designing each abutment. Even if the cost per abutment from Atlantis is more, our output is quadrupled by using them and I save on CAD technician hours. I come across so many lab owners who don’t take this into account; it seems to be the best kept business secret there is for implant labs! Moreover, we benefit from access to the experience and expertise of the Atlantis technical team. They say that you can only truly excel at something after 10,000 hours of practising; Atlantis specialise in abutments and design and manufacture them every day. When an Atlantis technician emails me to say there might be a better way of approaching a case, I listen, liaise with the surgeon and it’s normally to the benefit of the case. Finally, it’s so easy with Atlantis 3D Editor, the web-based editing tool I use to review and edit the abutment designs. It takes me about 5 minutes to customise each abutment according to the preferences of my surgeons, allowing me to give that personalised service to each of my clients. What is more, I can do it wherever I am - in the lab, on the train, at home, wherever I have internet access.

A BUSINESS MODEL THAT WORKS From a business point of view, the Atlantis team is an on-demand part of my lab team which I can use as my business demands, meaning I don’t need to worry about a large payroll burden during quiet periods

or meeting deadlines in periods of high demand. If a milling machine fails or a technician is ill, it’s not my responsibility and I can still expect my abutments on time. In the end, the aim of the whole dental team is to do the best for the patient. This is why I work with Dentsply Sirona whose focus is to help dental professionals provide better, safer and faster solutions for their patients. Adopting a digital implant solutions workflow and outsourcing to partners like Atlantis enables me to plan each case well and deliver it well. That’s a great business model and creates a win-win-win situation - for lab, surgeon and patient.

Facebook: @dentsplysirona.uk Twitter: @DENTSPLY_UK Instagram: @dentsplysirona.uk

To find out more about Dentsply Sirona’s Outsourced Digital Implant Workflow please visit: www.dentsplysirona.com/atlantis You can visit the online Dentsply Sirona Academy for a wide range of education resources, video tutorials,

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courses and CPD webinars at: www.dentsplysirona.com/ ukeducation

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DENTAL NEWS

OPTIDENT ANNOUNCES WINNERS OF THE 2021 WHITE DENTAL BEAUTY AND DENTAL CIRCLE COMPETITION Recipients recognised for their excellence in teeth whitening and dental restorations

Ilkley, UK, 15 December 2021. Optident, a Henry Schein company, announced the winners of its second annual White Dental Beauty and Dental Circle Competition, which recognises dental practitioners for their excellence in the use of White Dental Beauty tooth whitening gels and the White Dental Beauty CompoSite restorative system. The competition was organized in partnership with StyleItaliano, a growing community of skilled dental practitioners who contribute their ideas to bring more simplicity and predictability into everyday dental procedures*. Open to dental practitioners located in the United Kingdom, the 2021 competition featured two categories titled, “Bleach” and “Bleach Bond.” Entrants in the “Bleach” category submitted before and after images using White Dental Beauty tooth whitening gels. Entrants in the “Bleach Bond” category submitted photos of restorative cases using both White Dental beauty tooth whitening gels and White Dental Beauty CompoSite (composite direct veneers or posterior cases). StyleItaliano Honorary Member and Scientific Director, Professor Louis Hardan, Head of the Restorative and Aesthetic Department at Saint Joseph University

Beirut, Lebanon, judged the competition, extensively reviewing the many high-quality cases received. Professor Hardan selected three winners for the “Bleach” category of the competition, and three winners for the “Bleach Bond” category of the competition. The winners of the “Bleach” category of the competition are:

• First Place: Akash Singh • Second Place: Amy Harper • Third Place: Niva Shah The winners of the “Bleach Bond” category of the competition are:

• First Place: Hassan Abbas • Second Place: Ashish Soneji • Third Place: Gian-Marco D’Andrea “We are pleased to honor the tremendous work of the 2021 White Dental Beauty and Dental Circle Competition winners,” said Rebecca Haworth-Johnson, Senior Manager Direct Marketing, Optident.

“

This year’s competition was highly successful, and we look forward to the 2022 competition, which we intend to expand outside of the United Kingdom.

”

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“This year’s competition was highly successful, and we look forward to the 2022 competition, which we intend to expand outside of the United Kingdom.” Manufactured by Optident, White Dental Beauty is a professional range of high-quality tooth whitening gels that provide dental practitioners with the versatility and freedom in whitening patients’ teeth and offers patients a professional tooth whitening experience in as little as 30 minutes per treatment. Containing a patented NOVON® formula, White Dental Beauty enables a fast, optimum whitening effect**. In addition, the ‘Mild’ formulation gives patients with sensitive teeth a professional bleaching experience. White Dental Beauty achieves optimal clinical and aesthetic outcomes, minimises tooth sensitivity, and helps keep teeth hydrated while providing visible whitening results in less than a week. CompoSite, part of the White Dental Beauty portfolio, offers a custom palette tailored to whitening and restorative cases. CompoSite provides five shades of white, in addition to two flowables, an enamel and posterior. With accreditation and education by StyleItaliano, CompoSite is backed by invaluable teaching methods. More details about White Dental Beauty can be found at: https://optident.co.uk * Source: StyleItaliano ** NOVON® containing gels can produce a similar whitening effect within a shorter time frame, in comparison to whitening using a regular gel. Alternatively, within the same time frame, a similar level of whitening can be achieved with a lower inclusion level of NOVON® (Hyland et al., 2014).

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DENTAL NEWS

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DENTAL NEWS

DENTSPLY SIRONA APPOINTS CHERÉE JOHNSON AS GENERAL COUNSEL AND EXECUTIVE LEADERSHIP TEAM MEMBER “As a sophisticated, global lawyer, Cherée has deep legal experience and brings significant expertise in important areas, like ESG and M&A to Dentsply Sirona. She has an impressive leadership track record and a tremendous dedication to the customer perspective. We are very excited and fortunate to welcome her to the Dentsply Sirona team,” said Don Casey, CEO of Dentsply Sirona.

Dentsply Sirona, the world’s largest manufacturer of professional dental products and technologies, today announced the appointment of Cherée H. Johnson as SVP, Chief Legal Officer, General Counsel & Secretary. She will also become a member of the Executive Leadership Team and report directly to Don Casey, Chief Executive Officer.

PICTURED RIGHT: Cherée H. Johnson will join Dentsply Sirona on February 28th, 2022 as its Senior Vice President, Chief Legal Officer, General Counsel and Secretary.

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Cherée’s background spans across multiple industries and global operations. She brings tremendous strengths in ESG, compliance, M&A and financial transactions, enterprise risk management, capital markets and securities matters.

Currently, she serves as Senior Vice President, General Counsel, Corporate Secretary and Chief Ethics & Compliance Officer at W.R. Grace, a Standard Industries Company, with global operations. Before joining W.R. Grace, she served as Vice President, Deputy General Counsel and Assistant Corporate Secretary at McCormick & Company, H.J. Heinz Company and Cargill. She held a similar role at 3M Company, where she began her legal career. Cherée Johnson also worked at 3M as a product development lead and chemical engineer.

She succeeds Keith J. Ebling who is leaving the Company in connection with the relocation of his position to Charlotte, NC and will help to ensure a smooth leadership transition.

She earned her law degree from University of Minnesota Law School and her undergraduate degree in Chemical Engineering from Florida A&M University. Cherée Johnson currently serves as a member of the Advisory Board of the Johns Hopkins Bloomberg School of Public Health and is a board member of several nonprofit organizations.

Charlotte, N.C., December 16, 2021. Cherée H. Johnson will join Dentsply Sirona on February 28th, 2022 as its Senior Vice President, Chief Legal Officer, General Counsel and Secretary, and will be based at the Company’s headquarters in Charlotte, NC.

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DENTAL NEWS

PRIMESCAN ATLANTIS SUPRASTRUCTURES VALIDATION w

Intraoral scans taken to restore implants require the highest degree of accuracy and a lot of expertise. Primescan reliably steps up to the challenge! According to a survey, 86 percent of dentists agreed that Primescan delivers a higher accuracy of fit[1]. It is precisely this accuracy that has made Primescan the first intraoral scanner ever to be validated for Atlantis suprastructures on implants for partial and edentulous jaws. Dental Technicians can now order prosthetic components including a complete patient-specific Suprastructure e.g., for an edentulous case, from the Atlantis design and manufacturing sites, the company's own digital laboratory. The base is the scan data from Primescan.

Using Exocad or 3Shape, you can immediately start working on the case coming from Primescan, which creates more efficiency between your lab and your partners.

Validated workflow for predictable results This step makes your work in the lab even easier: You receive a precise scan from your partners in dental offices and can operate the whole case in one validated digital workflow. This is valid for the Astra Tech Implant System, Ankylos and Xive.

As a user, you will experience a faster and more comfortable workflow and achieve predictable results. This gives you and your partners a higher level of satisfaction – with functional and aesthetic implant restorations. ARE YOU INTERESTED? For more information, please visit: dentsplysirona.com/connectmylab. [1] Internal data on file

Ceroplast Digital Dental Laboratory are looking for qualified technicians in all departments. We are a full service laboratory mainly private with a small NHS element of work. Due to the fantastic staff at Ceroplast Digital we now have clients waiting to join us. We only take on new work from clients we are happy to work with and only if we have enough staff to cope with the work. If you are looking for a change and a different working environment we have vacancies in: Digital, Cons metal work, Ceramist, Prosthetics, Ortho and Chrome. We would also be happy to work with partially trained technicians too as we have mentors here to help you develop your career. Salary to be decided between us as usual, depending on what you can do and the skills you have.

Interested? Fancy a change? Then call Andy George on 01905 425151 or email your CV to: andy@ceroplast.uk

www.ceroplast.co.uk

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DENTAL TECHNOLOGY

PRIMARY IMPRESSION TAKING ON EDENTULOUS CASES Chris Wibberley of CW Dentures discusses taking impressions

he subject I’ve chosen to write about in this article is impression taking. The reason is because impression taking is where it all starts! If primary impressions are not taken accurately enough, capturing the detail of all the necessary landmarks, then it doesn’t matter how well teeth are set over the residual ridge, what occlusal scheme has been used, or how pretty the final prosthesis looks. When taken accurately, primary impressions, at the very least serve as a vital diagnostic tool in treatment planning. As CDTs and Prosthetic DTs, we've all taken the decision to cast and work on poor primary impressions with the idea of making up for lost detail with the custom made trays. I would imagine that we are pretty much all guilty of doing this at some point or another during our career, I know I certainly am. If we were to consider every stage of building a

house, I think we’d all agree that the first goal when construction begins is to dig and pour solid foundations. The same principle has to be adopted in primary impression taking. In terms of clinical procedures, if the first steps taken in treatment are inaccurate, then we can’t expect the final prosthesis to be the best possible product we can provide for our patients. Prior to taking primary impressions, we need to understand what landmark detail we need to capture. Taking advantage of and in some cases avoiding certain mucosal landmarks within the oral cavity is fundamental to achieving denture stability. Figures 1.1 and 1.2 show the anatomical landmarks and denture bearing areas of the Maxilla and Mandible. It is important to capture all landmarks shown in the diagrams, so that appropriate custom tray design can

Images: Basker and Davenport (1976)

ABOVE LEFT: Figure 1.1: Anatomical landmarks of the Maxilla. ABOVE RIGHT: Figure 1.2: Anatomical landmarks of the Mandible.

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be achieved. Posterior detail of the primary impression should extend slightly beyond the Fovea Palatinae in the maxilla and slightly beyond the Retromolar Pads in the Mandible. Stock tray selection The stock tray should cover the entire denturebearing area while allowing a uniform space of a few millimetres in between it and the underlying mucosa.

Figure 1.3: Ideal relationship of a stock tray to the sulk and denture-bearing mucosa. Image: Basker and Davenport (1976)

Stock tray requirements • The tray must be rigid and strong, but not too thick • The tray must retain it’s shape throughout the impression procedure, and casting of the impression. • The handle must allow for appropriate relief of lips during impression procedure. Impression materials and techniques Using a material that has a relatively high viscosity is important. This is because a stock tray is unlikely to have a perfect relationship to the denture-bearing tissues of the maxillary and mandibular arches. Impression material with high viscosity will allow for the shortcomings of the fit and extension of the tray.

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DENTAL TECHNOLOGY

Dual phase impression technique In recent years, dual phase impression techniques (like the accudent system) have become increasingly popular. This procedure involves a large, catheter tipped syringe loaded with alginate material (usually of low viscosity), which is used to apply the impression material into the sulcus regions of the maxilla/Mandible followed by insertion of the loaded impression tray. This technique ensures all detail surrounding the residual ridge is captured and an ‘overextended’ impression of either the edentulous maxillary or mandibular ridge is acquired. Overextension of the borders is necessary when taking primary impressions because the primary cast then allows for easy identification of landmarks and markings to which the borders of the custom made tray should be. Traditional impression technique Simply put, this is the procedure where an appropriate stock tray is selected and loaded with impression material. Stock trays are generally perforated, and the clinician will use adhesive to ensure the set material does not separate from the tray when the impression is removed from the patient’s mouth. The image in Figure 1.4 shows the ideal extensions and detailed captured by an edentulous primary impression of the Maxillary arch.

Figure 1.4: An overextended maxillary impression shows the sulcus regions loaded with alginate material in order to provide the optimal cast for custom tray design. Image: CW Dentures

The image shows the material capturing the: • Labial and Buccal Frenal Attachments. • ‘Rolled’ detail of the deep sulcus tissue. • Deep sulcus detail and the Hamular Notch (which sits posterior to the maxillary tuberosity on both sides of the arch). • Full detail of the palatal vault (in long term denture wearers, it is quite possible to capture detail of the current denture border on the hard palate). • The Fovea Palatinae. The image in Figure 1.5 shows the ideal extensions and detailed captured by an edentulous primary impression of the mandibular arch. The image shows the material capturing the: • ‘Rolled’ detail of the deep sulcus tissue labially/buccally and lingually. • The base of the tongue and its positional relationship to the residual ridge. • Full detail of the buccal shelf and other denture bearing areas. • The Fovea Palatinae. The primary impressions in figures 1.4 and 1.5 show the necessary amount of detail captured in order to provide the ‘foundations’ for treatment of the edentulous patient.

Figure 1.5: An overextended Mandibuiar impression shows the sulcus regions loaded with alginate material in order to provide the optimal cast for custom tray design.

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DENTAL TECHNOLOGY

One vital reason for capturing as much detail as possible when taking Primary Impressions is the consideration of the Denture Bearing Areas. As Figure 1.6 shows, overextension of the primary impression is key, because the denture border covers the labial and buccal sulcus regions, as well as the most posterior areas of the hard palate. Jacobson and Kroll (1983) suggested that directing the occlusal forces onto those tissues most resistant to remodelling and resorptive changes is the key to long-term Denture support. When considering the denture-bearing areas of figures 1.6 and 1.7, you can see the key areas for denture support involve heavily-keratinised tissue: Figure 1.6 A Primary Support Areas (Horizontal-Anterio and Posterior-Lateral Hard Palate) B Secondary Support Area (Ridge Crest) C Non-contributing (Shallow Sulcus Depth, Denture Border) R The Midline Suture (requires slight relief ) Figure 1.7 A Primary Support Areas (Buccal Shelf and 2/3 of the Retromolar Pad) B Secondary Support Area (Ridge Crest and Genial Tubercles)

ABOVE LEFT: Figure 1.6: The Denture Bearing Areas of the Edentulous Maxillary Ridge (according to Jacobson & Kroll, 1983). ABOVE RIGHT: Figure 1.7: The Denture Bearing Areas of the Edentulous Mandibular Ridge (according to Jacobson & Kroll, 1983). Images: J Wibberley (2011)

C Non-contributing (Denture Border) R Lingual Ridge Inclines (require slight relief )

IN SUMMARY

Primary Impressions are of vital importance to the overall success of full Denture treatment. They provide the foundations for effective, functional and comfortable prostheses. Correct tray and material

selection is paramount to achieving a detailed impression of an edentulous ridge, along with having knowledge of what landmarks and detail to capture on both the mandibular and maxillary ridges. Maximum detail captured on a primary impression will provide us with the perfect starting point in the construction of ideal Custom-made trays, thus providing extremely accurately fitting Dentures.

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ND4

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LEARNING OBJECTIVES n To understand the importance of the dental technician in the process of a full arch edentulous implant

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Payment by cheque to: The Dental Technician Magazine Limited. NatWest Sort Code 516135 A/C No 79790852 FULL ARCH IMPLANT WORK - WHY THE TECHNICIAN IS SO VALUABLE BY ASHLEY BYRNE

Q1. How many years ago did Ashley begin his implant journey? A - 10 B -15 C - 20 D - 25

Q9. A fixed-removable option helps what? A - Strength B - Cleaning C - Aesthetics D - Price

Q2. The options available were acrylic and XXX?

Q10. What is usually a much more cost effective solution?

Q3. What were the cylinders?

Q11. Nearly all fixed-removable options are what?

Q4. What type of frame was achieved?

Q12. Zirconia can be made super strong by cementing to what?

A - Ceramic B - Gold C - Porcelain D - Zirconia A - UTC B - UCLA C - UKG D - UTLA

A - Clip B - Bar C - Composite D - Studs A - PMMA B - MRP C - PEMA D - Zirconia

A - Passive B - Partial C - False D - Opposite

A - Porcelain B - IMZ C - CoCo D - Ultra-Nano IB

Q5. What was the cost of a gold UCLA? A - Under £200 B - Under £300 C - Over £300 D - Over £500

Q6. The restoration contained how many implants? A - Two B - Four C - Six D - Eight

YOU CAN SUBMIT YOUR ANSWERS IN THE FOLLOWING WAYS:

Q7. The loss of what can cause the upper lip to collapse? A - Bone B - Gum C - Root D - Screw

Q8. The simple solution to restore the lost part is to add a? A - Flange B - Pad C - Weld D - Socket

VIA EMAIL: cpd@dentaltechnician.org.uk OR BY POST TO: The Dental Technician Magazine, PO Box 2279, Pulborough, RH20 9BR. 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 magazine. Certificates will be issued within 60 days of receipt of correct submission.

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MARKETPLACE

SHOFU ZIRGLOSS – ACHIEVE A HIGH GLOSS IN SECONDS w High-performance polishing compound perfects the surfaces of monolithic zirconia and lithium disilicate restorations. Only perfectly polished zirconia surfaces minimise plaque formation and protect the natural antagonists. A perfect polish is crucial to the sustainable aesthetics, durable and precise function, and high wearing comfort of metal-free monolithic restorations. ZirGloss, the new high-performance polishing compound by Shofu Dental, is designed specifically for professionally polishing monolithic, all-ceramic zirconia and lithium disilicate restorations to a high gloss in just a few seconds. Ratingen – Hardness is not the reason why high-strength zirconia restorations may damage antagonist teeth: It is the rough surface of inadequately polished zirconia that abrades natural antagonists to a greater extent than enamel . This makes flawless final surface polishing so important – not only to technicians, but also to clinicians, e.g. after performing occlusal adjustments.

The name says it all ZirGloss allows you to polish zirconia surfaces to a high gloss in a minimum of time. The compound is based on diamond and alumina particles of well-matched grits, which are embedded in a carrier paste and optimise the removal rate and the gloss level. The carrier paste keeps the abrasive mineral particles in the layer that is in contact with the ceramic surface and controllably releases them, depending on the contact pressure applied to a goat or bison hair brush and the temperature development when polishing with a handpiece. You can accurately polish even the finest details of the occlusal anatomy. The result is a dense, high-gloss surface with all contours, virtually eliminating the need for final firing. ZirGloss is very economical to use. Thanks to its firm consistency, the compound does not splatter when loading the brush. Create a perfect surface in three steps Ingo Scholten, the responsible product and project manager at Shofu, sees the use of

ZirGloss as an integral part of a systematic three-step polishing process: “ZirGloss gives restorations the final touch after contouring with the proven Dura-Green DIA diamond abrasives and prepolishing with the ZiLMaster Coarse silicone polishers. This trio reduces the steps needed to create a perfect surface from four to three. Systematically increasing fineness step by step from coarse to fine, the three components quickly create surfaces that are micro-fine and perfectly sealed – as if they were glazed. Nothing has ever saved you so much time.” ZirGloss Polishing Compound comes in 20-g jars and is now available from dental distributors. Please view or download the product brochure https://www.shofu.de/en/ produkt/zirgloss-uk/ FOR FURTHER INFORMATION, PLEASE CONTACT THE SHOFU OFFICE: sales@shofu.co.uk Tel:01732 783580. SHOFU UK: https://www.shofu.de/en/

ZirGloss high-performance polishing compound

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COMPANY PROFILE

BAOT

SCIENCE AND ART ABOUT THE MATERIAL BAOT insists on quality first in the selection of materials, ensuring the stability of linear expansion coefficient, biological properties, chemical properties, and mechanical properties. There is no performance degradation under special environments. The chemical composition of BAOT porcelain powder is silicon oxide, aluminum oxide, potassium oxide, sodium oxide, zirconia, calcium oxide, boron oxide, and etc.

BRAND STORY l Twenty years ago, one group of people, based in the west coast of Pearl River in Guangdong province, where is also the birthplace of Chinese revolutionary pioneer Mr Sun Yat-sen, started various high-end inorganic material research due to one dream of catching up with international advanced technology. The research covers materials like high thermal conductivity Aluminum Nitride used for substrates, PPMgrade wear-resistant materials, titanium dioxide self-cleaning materials, dental porcelain powder and etc.

The company has been developing healthily, and now has a standard workshop, a research and development center, and a high-quality laboratory. As a provincial high-tech enterprise, BAOT has scientists, senior engineers, returnees from overseas. Among the team members, 41% of them have college education. BAOT continuously enriches its product line, not only delivering the best service to customers around the world, but also helping customers create greater value space.

Time went by day by day, but they experienced repeated failures, one project after another. At that time, they were living very hard and almost hopelessly. However, they never gave up. More than ten years have passed, and one day, one project was successful finally. Yes, it is the only successful project - BAOT porcelain powder. Yes, because of the persistence, BAOT people moved the God.

Nowadays, BAOT dental porcelain are available in more than 70 countries and regions. BAOT has got various global certificates, such as National Production License, National Product Registration Certificate, ISO 13485, CE, FDA and other countries registration certificates. Besides, the company has core technology of porcelain powder, invention patent certificate and other patent certificates.

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It is mainly introduced from potassium feldspar, and through catalysis, it crystallizes repeatedly to form garnet crystals, which has good biocompatibility, chemical stability, strength and hardness suitable for oral structure and function. During the crystallization of garnet, through the process control, technical requirements such as translucency and transparency can be achieved to ensure a good artificial aesthetic effect of natural teeth relative to humans. BAOT's latest modifiers like opalescent, transparent blue, fluorescent and other effects have a new improvement in simulation. BAOT's full zirconia external simulation staining paste provides a larger application scenario for full zirconia cases.

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COMPANY PROFILE

Photo. 1

PRODUCT PROPERTIES Various properties of BAOT porcelain powder are higher than ISO, reflecting the excellent physical and chemical properties. (Fig. A)

Photo. 2

shrinks less than the porcelain layer, then the porcelain layer is easily detached from the framework (Figure 2). According to the experiments, the optimal CTE condition is that the CTE of framework is slightly higher than the CTE of the porcelain layer. Porcelain can withstand much more stress than tension. During cooling, the surface of the porcelain layer is rapidly cooled to generate tension, which easily cracks the porcelain, but because the framework is shrinking, it exerts pressure on the porcelain layer and prevents cracks in time. (Figure 3). Fig. 1

Fig. 2

Fig. 3

ANALYSIS OF KEY ELEMENTS

PRODUCT FEATURES Photo 1 shows that the particle structure and distribution of BAOT opaque powder are very uniform. The uniformity of the opaque powder greatly strengthens the adhesion of the porcelain powder and the alloy, and the operating characteristics are optimized to ensure that a milky uniform texture can be obtained after mixing with the special liquid for opaque powder. After mixing, opaque paste can be more easily applied on the sandblasted alloy framework to create the uniform milky surface, which eliminates the generation of air bubbles, so the alloy framework and porcelain achieve a perfect combination. Photo 2 is an electron microscope image at 5000 times after acid etching. It can be seen that the garnet crystals are uniform in the glass phase structure without cracks.

CTE Coefficient of Thermal Expansion usually refers to linear expansion coefficient. It is defined as the increase per unit length when temperature increases 1oC. Use a quartz top pestle thermal expansion meter to measure the CTE value of the product sample (25 ~ 500oC) to ensure The CTE value of each batch of products is within the scope of quality control. The CTE range of BAOT porcelain powder matches more than 90% of the alloy on the market, and the alloy framework and porcelain are closely combined after sintering. If the CTE of framework is significantly lower than the CTE of the porcelain layer, after sintering and cooling, the porcelain layer shrinks more than the framework, then the porcelain layer itself generates huge tension, which causes outward cracks (Figure 1). If the CTE of framework is significantly higher than the CTE of the porcelain layer, after sintering and cooling, the framework

Fig. A

CTE (10-6·K-1) Glass Transition (oC) Flexual Strength (MPa) Bonding Strength (MPa) Chemical Solubility (μg-cm-2)

Three-point flexural strength tester Flexural strength, or called bending strength, refers to the maximum stress that a material can withstand when it is broken under a bending load or reaches a prescribed deflection. The three-point flexural strength reflects a strength index of the product, which can reduce the probability of porcelain cracks after sintering and cracks when contouring. BINDING FORCE

PFM-JC

PFZ-ZCG

ISO Standard

12.9-13.8

8.9-9.6

575

590

118

106

>50

39.5

>25

31.8

≤100

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FLEXUAL STRENGTH

CHEMICAL SOLUBILITY BAOT commissioned a third-party testing company to conduct chemical solubility tests on the products, and the test results meet the standards.

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COMPANY PROFILE

BIOCOMPATIBILITY BAOT commissioned a third-party testing company to perform biocompatibility testing on the product. Test results show that:

COOLING <Taken out at 650OC

>Taken out at 900OC

FIRING PROGRAM

Cooling time is suggested at 4 min after sintering. When temperature drops to 650OC, take porcelain teeth out of furnace to avoid rapid cooling, which will cause cracks due to uneven thermal impacts inside and outside of teeth.

COLOR ART HUE Shades remain accurate as VITAPAN classic and VITA 3D MASTER. TRANSLUCENCY Clear and perfectly reflects the enamel layer of real teeth.

DRYING & HEATING Drying and heating time will affect the permeability of porcelain teeth. If the drying and heating time is insufficient, the water vapor in the porcelain teeth cannot be completely discharged before sintering. During the sintering of porcelain teeth, the surface is easy to vitrify, and the water vapor in the porcelain teeth is blocked inside the porcelain layer, causing the porcelain teeth to become white. Experiments show that the whitening of porcelain teeth can be improved by increasing the sintering temperature.

FLUORESCENT It mimics the characteristics of real teeth and displays fluorescent under UV light.

CUSTOMER FEEDBACK Data show that rework rate in the dental labs, using BAOT dental porcelain, is not higher than 0.5%. These data include implant porcelain cracks and missing part darker shade issues.

VACUUM The internal tests show if vacuum is not applied when sintering, a large number of air bubbles are visible inside the porcelain layer. Therefore, vacuum must be applied when sintering. During the sintering process, the air bubbles in the porcelain are discharged to make the porcelain teeth denser.

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*Sampling statistics of rework due to BAOT porcelain issues in dental labs in a certain month.

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Workstations & Equipment

for 21st Century Lab Technicians WORKSTATIONS Ergonomic Secure Sustainable Modular, unlimited layout possibilities, wide range of materials and colours to suit your laboratory and style

VACUUM MIXERS MODEL TRIMMER Fast Effective Efficient

TWIST mixers create a perfect, homogeneous mass without bubbles, lumps and agglomerates

SANDBLASTER Safe Durable Precise

Strong Fast Effective

Wet or dry operation. High torque and powerful, yet durable and safe

Precise, even sand flow for perfect surface preparation. Hands-free operation with pneumatic foot switch

Head Office & Showroom Trident Court, 1 Oakcroft Road, Chessington, Surrey KT9 1BD T: 0800 228 9828

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E: info@blueprintdental.co.uk

W: blueprintdental.co.uk

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DENTAL TECHNOLOGY

FULL ARCH IMPLANT WORK WHY THE TECHNICIAN IS SO VALUABLE

Milled Ti bar with gold hue (Createch)

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DENTAL TECHNOLOGY

Full arch milled metal work

By Ashley Byrne I Byrnes Dental Laboratory and Editorial Board Member

ull arch edentulous implant work can be challenging when it comes to selecting which one is best for a case, and trying to explain this process in an article isn’t much easier. When I started my implant journey some 25 years ago, the options were incredibly limited and failure risk was high. The options were generally acrylic or ceramic, and both onto a gold cast subframe on gold UCLA cylinders. This would be cast, sectioned, laser-welded, etc., until a passive frame was achieved, and then veneered or wrapped, and even then that process could cause distortion or issues.

These days those options are nearly long gone. Well, certainly the gold subframes are. The other day I looked at the cost of a gold UCLA and at over £300, plus VAT and delivery, with a six implant restoration the lab fee is already over £2,160 before any of us have even sat down at the bench!! Thankfully times have changed, and whilst some labs do still cast implant frames, milling has generally taken over for the majority of these cases.

Implant bar

In an ideal world, implant frameworks should be selected, planned and priced before an implant is even placed. In reality though, I find that doesn’t often happen and even if it does, the complexity of implant work, the human body, and of course, the mind of the patient, often forces that to change. So how do you go about selecting the correct restoration for a patent with a full arch? In no particular order - anatomy, budget, implant numbers, implant positions, implant types, and (last but not least) patient expectations, are all key factors in choosing a full arch. New materials, methods, and patient demands have all been key drivers in the explosion in full arch options, and that is challenging when so many options exist on the market. In my lab we offer 15+ different types of full arch restoration options, and I’m still working with companies to expand those offerings to over 20! That creates a huge issue when it comes to treatment planning and costings for our clients.

Implant bar with over denture on (Chris Powell)

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DENTAL TECHNOLOGY

BUDGET

This has to be the most constrictive lever of all our options because it affects what the lab can produce and it often also affects the number of implants a patient will have in their mouth. If that number is under four, our options immediately become limited to an over denture on either a bar or locators.

OVER DENTURE (FIXED REMOVABLE) OR FIXED BRIDGE?

Full arch implant work has divided many a clinician and technician, and fixed vs fixedremovable (fixed being locators or a bar, and removable being the denture) is probably one of the most contended. In most cases on the lower, both fixed and fixed-removable options work if there are enough implants. However on the upper, we have a very different kettle of fish, and it’s all down to bone loss and lip support. When teeth are lost in the anterior maxilla, the loss of bone can cause the upper lip to collapse and the patient’s face can looked flat and aged. The simple solution to restore that lost bone is to add a flange but whilst that works on a denture, on a fixed bridge even a small flange or ridge lap can cause serious cleaning issues which consequently cause bad breath, soft tissue irritation and potentially implant loss - catastrophic for all involved. Many full arch implant cases are exactly that starting point already because the patient’s oral hygiene has been poor for many years, so even with a new bridge, on many of those cases it is unlikely to improve overnight.

Digital wax up ready for milled Zirconia (Cris Popa)

Milled metal frames and individual zirconia (Vlad Atanasoaie) crowns

One of the main points of contention with upper fixed vs fixed-removable has been the drive to offer a patient a fixed solution, and then changing due to poor planning. The patient signs up to a fixed bridge, but only after the implants are placed and at the try-in stage, we see that lip support is needed. That leaves the options as an un-cleansable fixed solution, or switch to a removable - but the patient was sold on a fixed restoration! It can, and has been, a medical-legal issue for many years. Many clinicians are now wise to this and offer both the fixed and fixed-removable options into treatment plans to ensure the patient is aware of the risks.

Composite hand built lower and Zi milled crowns on ti bar upper (Vlad Atanasoaie)

FIXED-REMOVABLE OPTIONS

If I was to ever need a full arch upper implant bridge, I’d have a fixed-removable option simply to aid in the cleaning. Food will always get stuck somewhere in the mouth and I know how irritating a small piece of meat stuck between two teeth can be, so imagine what can get stuck under a full arch bridge. Removal of the denture allows easy cleaning, even when patients have limited dexterity. The two main options are studlike attachments (often called locators) or bars with various types of friction or clip attachments that hold the denture in securely. The studs are usually a much more cost effective solution but, depending on implant placement, can be less sturdy than a bar and clip, however a bar and clip is vastly more expensive. You can see how this circles back to the budget issue again.

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Ti sleeves mixed with Zi sleeve (Dave Sherrington)

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DENTAL TECHNOLOGY

FIXED OPTIONS

If the implants and biology allow it with no cleaning issues, then fixed options are fantastic. These bridges are what we most commonly see in advertising and social media - beautiful and completely life-like bridges that we bolt into the mouth, then fit and forget. I know most of my feed is full of stunning arches and these restorations can really show off some of the talented dental technicians out there (note: so can dentures but it’s sadly less seen on social media). Fixed solutions do often come down to materials and again, there are many options out there, but the time taken to produce these has a big impact on the budget. It’s also where the materials and technicians knowledge and experience become key to informing the decision making process.

BELOW LEFT & RIGHT: Full contour Zi on Ti bar

Full contour Zi on Ti bar (Dave Sherrington)

MATERIALS

Whilst nearly all fixed-removable options are PMMA with a chrome strengthener, fixed option materials become vastly more complex. In our lab, milled PMMA, composite, Zirconia, and bonded ceramic are the base of all our fixed arches and they each have their pro’s and con’s. Zirconia, for example, comes in multiple versions from super strong materials which have no opacity to ultra translucent and minimal strength. Take the unbreakable version and it looks like a bathroom sink, and yet take the highly translucent material that looks incredible but you’ll be lucky if it lasts to the end of the week. That’s the balancing decision we technicians have to make when choosing our materials for each case. Our milled PMMA bridges are great for temporaries or long term solutions, but not strong enough on their own for definitive between implants. Bonded ceramic is, of course, still considered by many to be the best solution due to its incredible strength, but it takes real talent to make a lifelike full arch, pink colours are limited, and to be cost effective it must be bonded to a CoCr non-precious milled frame.

Full arch bonded work (Vlad Atanasoaie) ABOVE RIGHT: FInished crowns on milled ti bar (Vlad Atanasoaie)

Full arch composite (Vlad Atanasoaie)

MIXING MATERIALS

If, in the last few paragraphs, I have made the full arch choices sound somewhat confusing, it really is because we are spoilt for choice. Now how about mixing the materials to confuse the matter even more? For example, taking a milled Ti-bar and milling a PMMA sleeve on top of it? It is now cheap and super strong, and can be remilled for a very low cost. What about changing that sleeve to Zirconia? The translucent Zirconia can now be made super strong by cementing it to a CoCo or Ti bar. Then of course, we can make individual crowns on a Titanium preparation bar and bond on pink composite. Individual teeth that look stunning and can be re-milled even if we have just a single tooth fracture off that bar. Choices, choices, choices!

FUTURE MATERIALS?

I will always take new materials with a pinch of salt as they make me nervous. Costly remakes are painful from both a financial and

a time perspective. They also waiver trust in the lab from a client and that can be extremely damaging. We have seen plastics and high performance polymers appear with people claiming amazing success. I even saw milled carbon fibre subframes appearing on Instagram recently. I haven’t touched any of these yet. Call me old-fashioned but as the images show, if those results can be achieved when a metal subframe is used, why use anything else?

CONCLUSION

In a very brief conclusion, choosing a full arch implant restoration is tough and, as I have been saying for years, it’s where we dental technicians are still needed for both our skills and our knowledge. Not that long ago, a client said my full arches were too expensive as they knew the cost of milling a bridge was less then half what I was charging. I made no

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defence. My prices are my prices and whilst the cost to mill a Zr frame is indeed much lower than the full price, the cost of my finishing, designing, CAD, CAM, milling machines, extraction, talented team members, time, and of course, 25 years of experience - all comes at a cost. A cost which we dental technicians must charge for. That client is more than welcome to shop around but all the labs I know that have had the failures through innovation; the fractures through pushing the boundaries; the countless cost of lectures, conferences and journals; they all know that the cost of an experienced dental technician is only going to increase as we become less in number, and no chair side milling or overseas outsource centre can provide what we as a UK profession can. Our skills and knowledge must never be under-valued, nor our time. Clinicians who work with dental technicians as one dental team will always achieve the best results, as most of these images show. I am very lucky to have a great selection of teamminded clients, who value our people and the collective knowledge and experience at Byrnes Dental. Choosing an ideal full arch restoration is still is a challenge to us on some cases, and delivering restorative solutions to the patient only comes from teamwork.

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MARKETPLACE

KEMDENT A STABLE CHOICE w When it comes to creating mock-ups and models for exceptional prosthetic work, the materials you use are crucial for accuracy, quality and practitioner satisfaction.

“We have been using Anutex and Anutex High Stability Modelling Wax from Kemdent for about 40 years. We appreciate the latter for its high strength, which providing a better base for dentures. We have never needed to use any other brand.” Romford Denture Lab

The Kemdent Anutex High Stability (HS) Modelling Wax is a favourite for many in the UK because it delivers in the areas that matter most. Stable at high temperatures for easy handling and toral peace of mind, it is a Type 2, Class 2 hard modelling wax that has been designed to minimise potential irritation of the oral tissues when placed in the mouth.

For a highly accurate and reliable prosthetic workflow, Kemdent Anutex HS Modelling wax is the stable choice. For more information about Kemdent Anutex HS Modelling Wax, or any other market - leading solutions available, please visit: www.kemdent.co.uk or call 01793 770 256

The innovative material offers exceptional detail replication, remaining perfectly intact when tried in the mouth for minimal distortion and stimulation of natural gingival features.

ZIRKONZAHN TITANIUM BASES K80 ANGLED SCREW CHANNEL ( ASC) – TITANIUM BASES WITH ANGLED SCREW ACCESS CHANNEL FOR MAXIMUM FLEXIBILITY w Especially in the anterior region, the use of standard titanium bases in case of divergent implants could lead to non-aesthetic results due to the vestibular protrusion of the screw channels. With the new titanium bases K80 Angled Screw Channel (ASC) it is possible to tilt the screw channel from 0°-30° in order to compensate for unfavourable implant positions and thus improving the aesthetics of the final restoration. These new titanium bases ensure optimal stability and force distribution thanks to the high chimney, which is also provided with cut-off marks in order to adjust the height individually with a cutting disc. Depending on their use, these titanium bases are available with or without anti-rotation connection and an additional anti-rotation device located on the chimney prevents the cemented restoration from twisting. All titanium bases from Zirkonzahn are also available in a high-quality gold plating, which increases the biocompatibility and reduces the grey value of the entire restoration. Alternatively, the titanium bases can also be anodised in different colours using the Titanium spectral-coluring Anodizer. The titanium bases K80 Angled Screw Channel (ASC) are best suited for cemented, non-removable restorations. For more information visit: www.zirkonzahn.com T: +39 0474 066 680

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The Dental Technician Magazine January 2022

Articles inside

l DENTAL NEWS: WINNERS OF THE 2021 WHITE DENTAL BEAUTY AND DENTAL CIRCLE COMPETITION