The Dental Technician Magazine March 2021 by The Dental Technician Magazine

VO L 74 N O. 3 I M A R C H 2 0 2 1 I B Y S U B S C R I P T I O N

DIGITAL DENTAL SOLUTIONS BY DR GULSHAN MURGAI PAGES 14 & 20

A STEP BY STEP GUIDE ON HOW TO REGISTER WITH MHRA BY PETER NATT PAGES 30-35

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

THIS MONTH... l

TECH INSIGHT: 5 THINGS I CANNOT WORK WITHOUT! I JAMES McHUGH P. 6

DENTAL TECHNOLOGY: PRIMARY IMPRESSION I CHRIS WIBBERLEY P. 16-17

INTERVIEW: JON DOLDING P. 22-23

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THE FIRST

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CONTENTS

MARCH 2021 Editor: Matt Everatt F.O.T.A. E: editor@dentaltechnician.org.uk Designer: Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager: Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602

EDITORIAL ADVISORY BOARD

Welcome Welcome from the editor

Insight From the archives Goodbye from Phoenix Dental Castings. By David Smith

Marketing

PUBLISHED BY

Dental News

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

SUBSCRIPTIONS

5 things I cannot work without! By James McHugh, Evolve Denture Studio

Marketing Simplified. By Jan Clarke

BDCDS and DTS postponement Henry Schein, inc. recognition How to register With MHRA. By Peter Natt

Digital Dental Solutions. By Dr Gulshan Murgai - Implant Solutions Direct

10 12 30-35

14 & 20

Dental Technology Primary Impression - Taking on Edentulous Cases. By Chris Wibberley Straumann Cosmos resins

16-17 18-19

Interview An interview with Jon Dolding

22-23

Health & Wellbeing Don’t forget the glutes. By John Forde

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Technicians Insight

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Business To EV or not to EV... By Richard T Lishman

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BAR HEADER WELCOME

Welcome

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

elcome to your March edition of The Dental Technician Magazine. We are thundering through the year already, spring is upon us. What a crazy 12 months it has been for us all. Professionally, I do hope that all of our labs are well on the way to recovery. It seems like the vaccine program brings a new hope for us and we should see a return to some semblance of normality this summer time.

have become costly. In that, they may have previously negotiated a deal based on volumes or promise of other work and now don’t look so attractive. An example, we have a client that we used to do study models at a low cost because we did lots of high value orthodontic work for. The high value work all but dried up because the client said she had found a lab to make them cheaper. We had continued to collect the low value study models.

I am trying so hard to not mention the ‘C’ word this month, I want us to look forward at what lies ahead of us this year. For my own business, we have been looking at announcing our 2021/22 prices. Historically, we have spent the first few months looking at our previous years financials, such as; costs of manufacturing, materials, labour and other factors such as capital expenditure, then we play around with a clever excel spreadsheet. The spreadsheet helps to guide us in our decision process on pricing and we may tweak a few manually to suit.

When we looked at the cost of acquisition, we had to collect and deliver the low cost models every couple of days, it was just not worth doing. We decided we were willing to lose the work, as it was no longer profitable. So, we called and explained that we could no longer offer the work at the discounted prices as we had lost the higher value work. If the practice still wanted to use our services we would have to increase the prices for the study models. They agreed. The 30% increase in price now makes the account profitable.

One thing we have look at this year particularly was value of customer. There are a few customers, over the years, that

Why am I writing about this in my editors welcome? I wanted to share the message that we can go into 2021 with a fresh approach, mix it up a little. Don’t just do what you always do. The year 2020 (I didn’t mention the ‘C’ Word!), was a year that we hopefully will not repeat in our lifetimes. I see it as an opportunity to reset and rethink. Do you want to work less hours? Do you want to study? Do you want to be your own boss? Do you want to offer a new service? Just do it! Nothing can be worse than what happened in 2020, make 2021 the year that you give things a try. Hey, you never know, putting your prices up by 20% may mean you lose a few of the worse customers, putting them up by 30% may mean you can do a 4 day week, or work a few less hours and spend some more time with those you love. I wish you all the very best as we hurtle towards summer. Please do get in touch if you want to make any suggestions or would like to contribute any written articles to the magazine. Email me at editor@dentaltechnician.org.uk

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BAR INSIGHT HEADER

From the

Archives By Matt Everatt F.O.T.A I Editor and Author

SEPTEMBER 1972 I felt a little sad reading this article from 1972. I was born in 1975, so this is from a time where my own parents would have been working, so I can relate to the era. It is incredible to think our profession was so badly thought of and the two reports from 1967 and 1968 perhaps set the tone for several decades ahead. Has it got any better? Personally, I think it really has. I know some would debate that those Dental Technicians now qualifying with a degree lack skills or experience, this may be the case, but they have completed a Bachelors Degree and some are incredibly smart individuals. Has registration helped? Again, I personally feel it has. For sure, we still have those technicians that undervalue their own skills and experience and set out their

businesses accordingly, for the majority, I would suggest we are in an era where the majority of our Dental colleagues respect the quality and expertise we have. Pricing and working hours is also another area that is a common theme in our labs. Have we moved on at all? I remember reading a thread on Facebook recently about labs that had been terribly affected by the lack of NHS work coming in. I did share my own opinion on this, that we should move away from offering ‘NHS Price Lists’, we are not funded by the NHS as we have all discovered this year. I would really like to hear back from you on this article from the archives, I think it begs us to ask some questions of where we are today. If you would like to respond to this feature from the archives, please email editor@dentaltechnician.org.uk

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BAR HEADER INSIGHT TECHNICIANS

5 THINGS I CANNOT WORK WITHOUT! By James McHugh I Evolve Denture Studio l Over my time as a technician my top 5 has probably changed several times over, it probably has during the time it took me to write this. But still it was nice to sit there and conjure up this list that I hope many agree with.

1. COFFEE

The first one on the list is easy, and probably I would say universal amongst all technicians, Coffee! Where would we be without this miracle liquid? From the first cup to get going to the last cup on a hard day.

2. MY WAX KNIFE

Out of all my tools, I'd say this one is the best. There are so many applications I use my wax knife for. I honestly think I can make a denture with just a wax knife, except for trimming or polishing that is.

And the amazing thing about wax knifes, is not one is the same ever. Each one feels unique to each technician. You have a bond with a wax knife and it becomes total comfortable to use to you and yourself only. Go pick up a colleagues wax knife and work with it... bit weird isn't it?

3. SOCIAL MEDIA

Until recently I didn't post my work on social media, I didn't see the point. But 2 years ago I started to throw a few things up on Instagram because I felt it was time that family and friends understood what it is that I do. I wasn't however expecting to find a whole community of like-minded technicians, many of whom I call friends these days. Having a group of peers I can bounce ideas or questions off, or just being amazed and inspired by their work.

I do honestly believe it has helped me to push my level higher and brought a new sense of pride to my craft. If you want to follow me search for @j_mchugh80 on Instagram or @evolve_denture_studio

4. MUSIC

Music is an incredible driving force. From the general familiarity of the radio, to the frantic rush of something a little faster from your own collection. Having the right choice of music can improve my mood, or fuel me on a day where the impossible can become possible.

And the last one.... 5. COMMUNICATION!

Whether this is within the team or with our surgeries a clear channel of communication is key to a smooth operating service. If a team member is struggling but never asks for help it can lead to either rush work and an increase in "silly" mistakes or work leaving late...or worse, both. It's OK to ask for a hand, we technicians are super human, but not invincible. Likewise missing or lost notes between surgery and laboratory can lead to a whole world of pain too. We're now in a position where we can take advantage of the technology we all hold our hands. Using WhatsApp to send information about cases, along with photos that are easy to access, or asking a questions regarding shades or set up. Being able to send a work in progress shot to see if both technician and dentist are on the same page. And there ends my waffle for the day. Keep doing all the amazing things we technicians do and stay safe.

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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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

IS THE CUSTOMER ALWAYS RIGHT? T

his week I received a phone call from a company I had bought an online course from. You know the type, free for a week or two, you can try it out but need to cancel the subscription if it’s not up your street.

don’t be afraid to follow your own path. The importance is understanding your offering and how this experience for your customer can be the best it can possibly be within your current constraints.

The phone call was obviously from a busy call centre, there was lots of background noise, the caller was pleasant enough, “I am your assigned tutor”etc etc, We discussed the course and then he went in for the kill, I knew to expect it but I am always intrigued as to how long it takes sales people. The offer was 65% off the cost of the total course if I committed today.

Once you have chosen ideas do set yourself some time to reassess their worth and perhaps revisit in three month’s time. You all need to be accountable and by having regular team meetings you can easily revisit these ideas having appointed one of your team to report about customer service in your meeting.

Personally this tactic is enough to not only switch me off but also to never buy from that company again. Is this short sighted of me or do you feel the same? Most people do not like feeling as though they have been “sold” to. Consumers are bright and can notice the tricks. This started me to think about customer service and what it means to me, in particular, when I had last received fantastic service that I told all my friends and colleagues about it. Unfortunately, despite marketing becoming more and more sophisticated, I think customer service is declining rapidly.

“They may forget what you said but they will never forget how you made them feel.” Carl W. Buehner

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WHAT IS GREAT CUSTOMER SERVICE? This can be different to everyone but everyone will have an experience of how they would like a great experience to be and I’m quite certain everyone will have experienced poor service. With that in mind perhaps a good place to start is to get all your team together and chat about what this means. As you discuss and share experiences there will be a natural flow to finding out what you all agree to be good or great customer service in your own business. Every single member of your team can, and should, be responsible for helping great customer service happen. If there is one weak link in the chain then the whole experience will be poor. It’s important that everyone in your team understands this and that everyone is valued. Too often new “trainees” may feel they can’t contribute so they don’t, this customer service exercise definitely helps shine light on the importance of teamwork for all. IMPLEMENTING IDEAS Some of your ideas may not be practical, but that is fine, discuss which ones you could implement and which ones may need to be aspired to. What is right for one team may not work for another so

PRICE CUTS I’m not sure price cuts ever bring in loyal, regular customers but I do know it is a certain way to upset your regular loyal customers if you have large introductory offers. In my example, a 65% discount will only serve to tell me that the original price is much overinflated. My advice would be to set your fees and stick with them, perhaps discounts for multiple units on a regular basis each month? It is worthwhile revisiting, at this point, your value proposition, your purpose, your “why?”, your ethos, and remember to stay true to this. I know how difficult this can be when you are competing for business but cutting prices is just a race to the bottom. It’s much better to be certain of your offering and then work with your team to make that offering and experience as good as it can be and to stand out from the rest. Share your success stories with the world on your social channels and shine the spotlight on your excellent customer service. As ever I am here to help with any of these issues so do email or connect online with me, I look forward to meeting some of you in cyberspace!

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DENTAL NEWS

THE BRITISH DENTAL CONFERENCE & DENTISTRY SHOW AND THE DENTAL TECHNOLOGY SHOWCASE POSTPONEMENT

CloserStill Media, organisers of the British Dental Conference and Dentistry Show (BDCDS) and the Dental Technology Showcase (DTS), have made the carefully considered decision to postpone the BDCDS and DTS events to May 2022.

The event will now take place on Friday 13th and Saturday 14th May 2022 at the Birmingham NEC, Hall 5. Martin Woodrow, Chief Executive of the BDA commented: “As we are all aware, the COVID-19 situation in England is continually developing, and after careful consideration, the decision to reschedule feels appropriate given current circumstances and ongoing uncertainty. However, I have no doubt that the 2022 conference will be the biggest, best and most impressive event yet!” “Steven Campbell, President of the Dental Laboratories Association (DLA) also commented: “the decision to reschedule has been made out of an abundance of caution.” In the meantime, CloserStill Media will be focusing on how they can support the profession as they continue to work through this, very challenging time for dentistry.

“Over the past few months, we have been diligently assessing the landscape of the return of in-person events for the dentistry community,” said Alex Harden, Event Director BDCDS and DTS at CloserStill Media. “This decision has been made due to the lack of clarity around future government restrictions on large scale gatherings due to COVID-19 and the fact that the safety of our communities is of upmost importance to us. Our team is more devoted than ever to creating engaging, practical resources for continuing education and industry growth in a digital world. Thank you for your continued support during these difficult times and we trust you and your families are safe and well.” The BDCDS is the UK’s leading twoday exhibition and conference for dental professionals, providing clinical, leadership and practical training via an extensive educational programme and hands-on workshops. It is the UK’s largest event of its kind, attracting over 9000 unique delegates and over 400 exhibitors. The DTS is the UK’s leading twoday exhibition and conference for dental laboratory owners and their technicians, providing technical and practical training via an extensive educational programme and

hands-on workshops. It is the UK’s largest event of its kind, attracting over 2000 unique delegates and over 60 exhibitors. CloserStill Media specialises in global professional events, within the healthcare and technology markets. The healthcare portfolio includes some of the UK’s fastestgrowing and award-winning events, such as the Clinical Pharmacy Congress, The Dentistry Show, The Pharmacy Show and Acute & General Medicine. CloserStill delivers unparalleled quality and relevant audiences for all its exhibitions, delivering NHS and private sector healthcare professionals from across occupational therapy, pharmacy, dentistry, primary and secondary care with more than £16m worth of free training. The British Dental Conference and Dentistry Show 13th-14th May 2022, Hall 5, Birmingham NEC, co-located with The Dental Technology Showcase. For all the latest information, visit www.thedentistryshow.co.uk, www. the-dts.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com

THE BRITISH DENTAL CONFERENCE AND DENTISTRY SHOW AND THE DENTAL TECHNOLOGY SHOWCASE IS NOW TAKING PLACE ON THE 13TH - 14TH MAY 2022 AT THE BIRMINGHAM NEC, HALL 5

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DENTAL NEWS

ETHISPHERE ANNOUNCES HENRY SCHEIN, INC. AS ONE OF THE 2021 WORLD'S MOST ETHICAL COMPANIES FOR THE 10TH TIME Recognition honors those companies who understand the importance of leading, making hard but values-based decisions, and their overall commitment to integrity MELVILLE, N.Y. – February 23, 2021 Henry Schein, Inc. (Nasdaq: HSIC), the world’s largest provider of health care solutions to office-based dental and medical practitioners, has been recognized by Ethisphere, a global leader in defining and advancing the standards of ethical business practices, as one of the 2021 World’s Most Ethical Companies. Henry Schein has been recognized for 10 consecutive years and is the only honoree in the Healthcare Products industry. In 2021, 135 honorees were recognized spanning 22 countries and 47 industries. “It is humbling to be honored as a ‘World’s Most Ethical Company’ alongside so many like-minded organizations, especially as Team Schein marks 10 years of recognition,” said Stanley M. Bergman, Chairman of the Board and Chief Executive Officer of Henry Schein. “Since our founding in 1932, Henry Schein’s success has been rooted in ethical business practices and a commitment to accountability. On behalf of more than 19,000 Team Schein Members around the world, I thank the Ethisphere Institute for this tremendous honor.” “Congratulations to Henry Schein for 10 years as one of the ‘World’s Most Ethical Companies,’” said Ethisphere CEO Timothy Erblich. “We commend Team Schein for its steadfast commitment to positively impacting the communities they serve around the world and aligning its strengths as a business with the needs of society.”

ETHICS & PERFORMANCE

According to Ethisphere’s Ethics Index, the publicly listed 2021 World’s Most Ethical Companies honorees outperformed a comparable index of large cap companies by 7.1 percentage points from January 2016 to January 2021.

METHODOLOGY & SCORING

Grounded in Ethisphere’s proprietary Ethics Quotient®, the World’s Most Ethical

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Companies assessment process includes more than 200 questions on culture, environmental and social practices, ethics and compliance activities, governance, diversity, and initiatives to support a strong value chain. The process serves as an operating framework to capture and codify the leading practices of organizations across industries and around the globe. This year, the process was streamlined and question set expanded to gauge how applicants are adapting and responding to the global health pandemic, environmental, social, and governance factors, safety, equity, and inclusion and social justice.

HONOREES

The full list of the 2021 World's Most Ethical Companies can be found at https:// worldsmostethicalcompanies.com/honorees.

About Henry Schein, Inc.

Henry Schein, Inc. (Nasdaq: HSIC) is a solutions company for health care professionals powered by a network of people and technology. With more than 19,000 Team Schein Members worldwide, the Company's network of trusted advisors provides more than 1 million customers globally with more than 300 valued solutions that help improve operational success and clinical outcomes. Our Business, Clinical, Technology, and Supply Chain solutions help office-based dental and medical practitioners work more efficiently so they can provide quality care more effectively. These solutions also support dental laboratories, government and institutional health care clinics, as well as other alternate care sites. Henry Schein operates through a centralized and automated distribution

network, with a selection of more than 120,000 branded products and Henry Schein private-brand products in stock, as well as more than 180,000 additional products available as special-order items. A FORTUNE 500 Company and a member of the S&P 500® index, Henry Schein is headquartered in Melville, N.Y., and has operations or affiliates in 31 countries and territories. The Company's sales reached $10.1 billion in 2020, and have grown at a compound annual rate of approximately 12 percent since Henry Schein became a public company in 1995. For more information, visit Henry Schein at www.henryschein.com, Facebook. com/HenrySchein, Instagram.com/ HenrySchein, and Twitter.com/ HenrySchein

About the Ethisphere Institute

The Ethisphere® Institute is the global leader in defining and advancing the standards of ethical business practices that fuel corporate character, marketplace trust and business success. Ethisphere has deep expertise in measuring and defining core ethics standards using data-driven insights that help companies enhance corporate character and measure and improve culture. Ethisphere honors superior achievement through its World’s Most Ethical Companies recognition program and provides a community of industry experts with the Business Ethics Leadership Alliance (BELA). More information about Ethisphere can be found at: https://ethisphere.com

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INSIGHT

THANK YOU AND GOODBYE FROM PHOENIX DENTAL CASTINGS By David Smith If Sheffield is the land of stainless steel, it also became the home of many orthodontic dental laboratories. Bolton, the cradle of dozens of dental laboratories.

It did not take long to see why this was the capital for Chrome. The management team and the staff were extremely skilled and knowledgeable in the design, manufacture and finishing of beautiful frameworks.

Exeter then, must be recognised as the capital of Cobalt Chrome dental frameworks; for its relatively small size, it certainly had its very fair share of laboratories that specialised in this field.

Almost as soon as I arrived, we suffered from the change in the NHS fee scale where a cap was put on fees and the Part/ Part CoCr denture was no longer available on the NHS. Our sales almost halved overnight.

I first came to Exeter in 1992 as I was appointed Managing Director of Phoenix Dental Castings Ltd. Phoenix had ‘risen from the ashes’ of a previous Chrome laboratory ABC Laboratories.

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Our workforce grew to over 50 and we moved to new premises which we eventually made into a very nice laboratory. After 26 very happy years we sold the business in 2017. Due to COVID-19 the laboratory was closed late last year.

We evolved into a full-service dental laboratory and flourished as the private market slowly made up the short fall of NHS work.

A big thank you from me to everyone who worked at Phoenix and made it the laboratory I was very proud to work with. Thank you to our very loyal customers, both dentists and many laboratories. You were not just customers, but friends too and I really miss our often-long conversations.

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DIGITAL TECHNOLOGY

DIGITAL DENTAL SOLUTIONS – THE STORY OF AN EARLY ADOPTER

By Dr Gulshan Murgai BDS Dip Imp Dent RCS Ed. I Managing Director – ISD. I Lab Owner – 4D Ceramix I Clinical Director – Skin & Smiles Implant Solutions Direct is a supplier of compatible implant components to 26 widely used implant systems. We also provide exocad software solutions to clinical users in general practise as well as technical users in dental laboratories. Furthermore, we have expertise in providing milling and 3D printing hardware installation, training and support to our clients nationwide. Data acquisition both in laboratories and the clinical setting is now heading slowly towards the digital options available. Whilst the uptake is low at around 10% of dentists in the UK, it continues to be a growth market with affordable scanners from the likes of Medit changing the game for many.

have been called many things over the years and most recently have been described as an entrepreneur. One title that I am pleased to accept is that of an “Early Adopter”. At age 27, and before even having the keys to my own practice I spent a rather large amount of money on purchasing my first digital dental system, that being CEREC 3D. I saw the previous version of this system a few years before as an undergraduate and vowed to buy it for my practice as soon as I could afford to.

This can be intra-oral scanners used by the dental team chairside, or bench-top lab scanners used by technicians in labs to take their analogue, cast impressions and turn them into digital data that they can use to design and produce restorations. Labs then have the choice to print or mill the structures that they design in-house or with a production partner such as our centre at 4D Ceramix. The digital dental workflow can be used in-surgery for record keeping, to make accurate comparisons overtime, for orthodontic evaluation and treatment planning, for restorative cases, implant-related planning, and restorative workflows as well as general planning of cases.

The general benefits of digital impressions are one: • High precision • a simple process • not having to need physical impressions which are less tolerable for the patient It may be said that the negative elements include: • the learning curve • initial investment - financial and in the time taken to learn the technique. In general practise, digital dental workflows can be used to follow either a chairside workflow or allow lab-based workflow. Personally, I choose to use both on a regular basis and despite being a long-time user of chairside milling systems, I utilise my lab for cases on a daily basis. In doing so I'm recognising the difference in my skill compared to that of a competent, skilled dental technician. Whilst I have used a variety of different internal scanners over the years my preference is the Medit i500. This helps me deliver accurate digital impressions be that for my chairside or lab workflows. I use software from the exocad family in both my clinical work to design chairside restorations as well as my lab. For both workflows we choose to use milling machines produced by vhf (Siladent Digital). It is not widely known that exocad, as a manufacturer of CAD software for the dental industry have three separate software platforms.

Fast forward 18 years and I cannot go a single day without using digital dentistry either in my own private practice set up in 2004, or in the full production dental lab that I set up six years ago. On a regular basis I could be scanning a patient to design a single restoration, milled at the same appointment, and fit it before the patient leaves, or I could be in the lab designing a quadrant or full arch restoration for a UK or foreign client. Three years ago, I took a further step in my entrepreneurial path and set up a company to provide solutions to both dentists and technicians primarily in the UK but that has now grown to become worldwide provider.

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DENTAL TECHNOLOGY

PRIMARY IMPRESSION - TAKING ON EDENTULOUS CASES By Chris Wibberley I CW Dentures Figure 1.1: Anatomical landmarks of the Maxilla.

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.

ince (at the time of writing this article) we are in complete lockdown and the avoidance of COVID-19 being on everyone’s mind, I thought, for a change, I’d attempt to write an article that provides a small, but hopefully, a very useful amount of CPD. The subject I’ve chosen 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.

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IMPRESSION MATERIALS AND TECHNIQUES Figure 1.2: Anatomical landmarks of the Mandible.

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.

DUAL PHASE IMPRESSION TECHNIQUE

Images: Basker and Davenport (1976)

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 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.

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.

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)

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

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DENTAL TECHNOLOGY

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.

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 denturebearing areas of figures 1.6 and 1.7, you can see the key areas for denture support involve heavily-keratinised tissue: 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 )

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. 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.

• 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. 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

Figure 1.6: The Denture Bearing Areas of the Edentulous Maxillary Ridge (according to Jacobson & Kroll, 1983). Image: J Wibberley (2011)

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A Primary Support Areas (Buccal Shelf and 2/3 of the Retromolar Pad) B Secondary Support Area (Ridge Crest and Genial Tubercles) 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.

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.

Figure 1.7: The Denture Bearing Areas of the Edentulous Mandibular Ridge (according to Jacobson & Kroll, 1983). Image: J Wibberley (2011)

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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DENTAL TECHNOLOGY

STRAUMANN COSMOS RESINS CAN YOU GIVE YOUR CLIENTS THE WORLD?

The key to success in dental technology is ensuring the satisfaction of your clients. This involves many different factors from the quality of products you produce to the turnaround times you meet, the range of services you offer and the extra mile you go to support clinicians and their patients. Sometimes, it can seem like clients are asking for a lot, but the reality is often that they are facing higher demands from patients and therefore need more from you. To meet these standards, technology can be very important. More than this, though, the materials selected to work with these technologies, as well as the skills of the technical team, will ultimately determine the success of the lab business.

PIECES IN A PUZZLE

Take 3D printing. Many people and companies are currently promoting the benefits of 3D printing for dental applications, of which there are several. For example, 3D printing can deliver highly accurate products, from bite splints to surgical guides, temporary restorations, denture teeth or bases and models. It can also often achieve this in less time than conventional methods, with a more streamlined workflow and greater efficiency. Plus, the digitised procedure optimises reproducibility for the reliable consistency that clinicians need from their labs. However, all these advantages are the result of several elements – and we’re not just talking about the quality, capacity and speed of the 3D printer used, either. The skills and experience of the team will impact the precision of the workflow and how well the technology is utilised. They will often need comprehensive training in order to maximise return on investment – both in terms of daily operation and maintenance.

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Another important cog in the wheel of a successful business is the collaboration between dentist and dental technician. This will likely rely on regular and open communication, mutual respect and an understanding of the professional workflow on either end. Effective collaboration is essential for ensuring that technicians fabricate the very best products for each patient. Even with the most advanced technology and talented team in the world, a lab cannot deliver exceptional work without the right information from the clinician.

The final piece to the puzzle is the material used. In any area of dentistry, material selection will influence the durability, aesthetics and function of products created; in turn affecting clinician and patient satisfaction significantly. When it comes to 3D printing, resin materials are the key to success.

THE KEY TO RESIN MATERIAL SELECTION

Resin 3D printing uses photopolymerisation to fabricate objects. This is a chemical reaction to a liquid –

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DENTAL TECHNOLOGY

photopolymer – that changes properties in the presence of light and solidifies. Objects are manufactured in layers, with the light source activating the resin material as it comes into contact with the build plate. The platform moves to allow the liquid resin to come through and form new layers, until the product is fabricated according to the design. Though there are some limitations to the process, including challenges with manufacturing volume, design restrictions and considerable equipment costs, there are various advantages. These include highly detailed products, smooth object surfaces, speed and cost-efficiency for certain applications. The resin materials are, therefore, important to ensure the very best results. They can determine the strength and durability of products, as well as the accuracy and replicability of the manufacturing process. They also need it to be flexible enough to meet the demands of different cases and with the technology brand you have in-lab, while promoting a simple workflow. Cosmos Resin has been developed specifically to meet these demands and to perform with most common 3D orienting technologies. The solutions available provide reliable 3D printing outcomes for a variety of cases, with the Cosmos Resins Universal portfolio offering ultimate cost-effectiveness with comprehensive applications. Embedding the simplicity and versatility of a universal solution, Cosmos Resin Universal is a biocompatible material formulated for precision and reliability in both intra- and extra-oral applications, including surgical guides, indirect bonding trays, bite splints, denture bases and teeth, temporary restorations, dental models, castables and more. As a Straumann Group brand in the UK, you can rest assured that it offers the flexural strength, viscosity and elasticity needed for robust quality control and total peace of mind for you and your clients.

ONLY THE BEST

To maintain high quality standards with simple workflows and cost-efficient processes, several factors need to be considered within your lab. When it comes to resin 3D printing, the resin material used will make a significant difference to your outcomes – so be sure to make the right choice and only work with the best. When you do, you can print the universe for your clients. For more information, please visit https://www.straumann.com/ cosmosresins/en/home.html

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DIGITAL TECHNOLOGY ucontinued from page 14

I have the pleasure in not only being a distributor for exocad but also in using their products on a daily basis, teaching new users how to get the best out of the software platforms and also speaking about their clinical products on the worldwide stage as a key opinion leader. Whilst their primary product dental CAD has now been available for over 10 years, it should be known that in 2018 exocad launched the clinical portfolio of products designed to be used by dental surgeons in general practise as medical devices. Chairside CAD is a product that is comparable to the well-known chairside software provided by Dentsply Sirona known as CEREC. The difference being that exocad software is open and therefore can work with a multitude of different intraoral scanners and then can be linked to a variety of 3D printing hardware and milling hardware. The third software package from exocad is called exoplan. With this product dental surgeons and dental technicians can accurately correlate intra-oral data taken from either an impression that is physical or digital and combine that with CBCT data. Once combined, this package allows for easy and accurate planning of implant placements and then the subsequent design and production of surgical guides for the accurate placement of those implants. Furthermore, the plan can then be used to facilitate immediate loading when used in combination with one of exocad’s CAD programmes.

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To discuss any aspect of digital dentistry or the predictable compatible solutions available for a large variety of implant restorations get in touch with us at Implant Solutions Direct.

www.dentaltechnician.org.uk 04/03/2021 11:13

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04/03/2021 11:13

INTERVIEW

INTERVIEW WITH...

JON DOLDING Recruit4Technicians.com talks to Jon Dolding about recruiting and interviewing staff in his Dental Laboratory, Ceramic Designs, Brighton

What size team do you have at Ceramic Designs?

How long does it usually take to ﬁll a role at Ceramic Designs?

Both departments use CAD/CAM for all things digital. We've got three scanning and designing stations where we use 3Shape and Zirkonzhan keeping the mills busy milling titanium, zirconia, PMMA and wax. The Asiga printer also works hard producing a whole variety of products.

The last time I recruited was 18 months ago. I was introduced to a South African technician working in Johannesburg with the type of digital skills I needed and he was in the process of moving to the UK. After a telephone interview I chose to hold the position for him whilst his visa was approved.

Ceramic Designs have been digital since the lab was set-up, but in the last two years we've deﬁnitely seen a massive increase of intra-oral scans being sent through to us.

I think for Ceramic Designs recruiting is a lot about the personality, not just their skills, so for me doing telephone or video interviews with the person is so important because you get a feel for their personality.

We've got 12 full time staff in the team, they are split fairly evenly between ceramic and prosthetics.

What are the various types of staff members that you employ? (ceramists, prosthetics, ortho, CADCAM, office staff etc.)

Most of my staff are qualified technicians specialising in their chosen field of dental technology, I also have a couple of trainees and one administrator. I'm really fortunate that the lab is in the same building as The Implant Centre, this means that I’m able to utilise some of their office staff for my accounts, Human Resources and pay role.

When you’ve recruited in the past, how difficult have you found it to ﬁnd good quality candidates? Until I started using recruiters, it was an absolute nightmare. I had to sift through so many CV's, screening and verify them as I went. This was so time consuming and often lead nowhere or to disappointment if a suitable candidate had already been snapped up.

Recruiting for Ceramic Designs was tough at the start because it was a new lab with no track record but I’m very happy to see that has all changed as our reputation has grown and with us winning at The Laboratory Awards 2019. Now if I’m looking to ﬁll a senior position I would always use a recruiter.

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I know there's a lot more technicians out there in the marketplace at the moment and I hope that will change soon.

And what methods have you used to ﬁll roles in the past?

I’ve tried lots of methods in the past. My own staff, word of mouth, company rep’s, Lambeth College, other lab owners and recruiters. Brighton is a great location and a couple of my senior technicians, two placed by recruiters, moved from their London jobs to Ceramic Designs as a lifestyle choice as well as a fantastic job opportunity. With regards to junior or less senior roles I will speak to colleges, rep’s and lab owners as I have found these methods quite successful.

Typically, how long does it take to embed a new team member into his/ her new role?

For every new contract of employment there is a short probationary period for both employer and employee and that means that if either party feels that a mistake has been made in ﬁlling the position the employment can cease without notice from either side. In all of the years that the lab has been open, I've only had to let one person go during a probation period.

What makes somebody a good ﬁt for your team (e.g. personality, technical, behavioural, work ethic)? Ethics and personality are just as important as skills. I feel that what we do at Ceramic

Designs is amazing and I want new team members to be amazing too. I'm not saying we're the best lab in the world, but I am saying that they need to adapt their skills to work within our proven protocols giving the lab such consistently high outcomes.

In your experience, what do you think are the most common mistakes that candidates make in an interview?

One of the most common mistakes that candidates make is not listening to question or instructions and when doing a bench test ploughing on when they are not sure exactly what to do. I’d much rather they stopped, thought about what they were doing and then ask. Asking the right questions shows a desire to learn and a desire to interact with other staff. I think one of the biggest things is how that natural interaction happens or doesn't happen. And if it doesn't happen, that person isn't going to get the job. I understand that applicants are nervous, but they should have the conﬁdence and social skills to be able to talk with other technicians.

Without giving names, can you recall a memorable interview moment (good, bad or funny etc)?

One memorable bench test was with a technician I interviewed for a position my Southampton lab when he refused to do a carving exercise. I’ve got to say I was a bit surprised. Anyway that was years ago and he still works with me at Ceramic Designs. Another bench test moment, after a very successful phone interview with an experienced technician, came at the end of a pretty good trial when he just downed tools, turned his back on everyone, got his phone out and started doing whatever on it! Not a word to any of the other technicians, no signs of interest in anybody else or work on the bench. It felt as though he didn’t want to be there. He didn’t get the job. All staff that are here work so closely as a team. It's a small lab - not small in comparison to many labs - all the technicians have their own well equipped work station, good bench space, individual porcelain

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INTERVIEW

furnaces etc, but they still have to work and interact closely with other team members in the lab and also the clinic.

And ﬁnally, what’s the best thing about working for Ceramic Designs?

It’s difficult to put a finger on “the best thing” so I’ll say some of the best things about working for Ceramic Designs are that we are constantly learning, always looking to improve our techniques with close collaboration of working in partnership with The Implant Centre and their amazing team of surgeons, Bill Schaeffer and Guy Barwell, who bring such a wealth of experience and knowledge, along with all the restoring surgeons asking us to attend patient consultations so we get to see firsthand when things are fabulous or not. These patient consultations are so important for our learning. Patient, surgeon and technician satisfaction are unquestionably some of the most important things, and that's what we always like to achieve. I know Ceramic Designs will continue to thrive, develop and improve by being accountable, passionate, innovative and exceptional in everything we do. Through passion and creativity we change people’s lives and smiles.

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HEALTH & WELLBEING

LET’S NOT FORGET OUR GLUTES! 24 DT_MARCH 2021.indd 24

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HEALTH & WELLBEING

WORKOUTS With John Forde I Physiotherapist at Katie Bell Physiotherapy & Wellness

s a group of professionals, Dental Technicians are particularly prone to spending most of the day sat down. We have previously discussed techniques and help for posture and preventing back problems, we must not forget the glutes (aka bum)! It is also likely that most of us will be spending much more time sat on our bottoms than we would normally, be that homeschooling, watching Netflix and generally being less active due to the current lockdown restrictions. There are lots of home exercise programmes you can follow in this time, as well as a great Pilates online programme from the team at Katie Bell - Physiotherapy & Wellness. Be mindful to try and fit 150 minutes of aerobic exercise a week – that’s exercise which increases your heart rate – and two sessions of strengthening activity per week as recommended by NHS England. We know that our gluteus maximus (our bum) is the biggest muscle in the body and is important with pelvic stability, balance, posture and preventing lower back pain. It’s also an

Donkey kicks

important muscle when you are running and cycling and having a strong bum can help prevent knee pain. I have noticed over the past year during lockdown that I have been sat on my bottom more than I would normally. Our gluteus maximus needs to maintain its name of being the strongest muscle in the body due its huge importance for aches, pains and stability. So, we must make sure we are continuing to contract and work our bottom muscles to keep it strong. The exercises below are great ones for getting our bottom muscles working.

GLUTES WORKOUT: 15-20 REPETITIONS ON EACH LEG DONKEY KICKS Start on all fours, hand under shoulders and knees under hips. Make sure you keep your hips level at all times. Lift your leg up to the ceiling keeping it at a 90 degree angle. FIRE HYDRANT Again, start on all fours. Hands under shoulders and knees under hips. Keep your hips level. Lift one knee out to the side until the thigh is parallel to the floor.

Fire hydrant

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CLAM SHELL Start in a side lying position. Rest your head on your outstretched arm, you can use a pillow or rolled up towel to support underneath your head. Bed your knees up and have your heels in line with your bottom. Now keeping the bottom leg on the floor, open up your top knee. The ankles should remain together. You should feel the side of your hip working, this might be a burning feeling, that’s a good sign as you are working the correct muscle. The 3 exercises above are great ones to add to your weekly exercise routine and maintain your gluteus strength. Let’s remember in these times when we are on lockdown to remain positive and maintain our health bodies and healthy minds. Try not to spend too much time sat on your bum! Please feel free to contact our team on 0114 327 2080 or email hello@katiebell physio.com for further support.

Clam shell

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BAR HEADER 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

0.5HRS VERIFIABLE ECPD 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 n To understand where the

anatomical landmarks lie on the Edentulous Maxillary and Mandibular ridges. n To understand the

importance and principles of selecting an appropriate stock tray for Primary Impression taking. n To gain knowledge of capturing as much detail as possible in the primary impression stage of treatment, so that we can take full advantage of the Denture Bearing areas of the edentulous ridge.

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.

VERIFIABLE ECPD - MARCH 2021 1. Your details First Name: .............................................. Last Name: ........................................................Title:................ Address:.............................................................................................................................................................. ................................................................................................................................................................................ ............................................................................................................ Postcode:............................................... Telephone: ......................................................Email: .................................................. GDC No:..................

2. Please write your answers in the space provided on the form on the opposite page. 3. Evaluation: Tell us how we are doing with your ECPD Service. All comments welcome. ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ...............................................................................................................................................................

Correct answers from the February 2021 DT Edition: Q1.

As of April 2016 issue ECPD will carry a charge of £10.00. per month.

Q2.

Or an annual fee of £99.00 if paid in advance.

Q3.

You can submit your answers in the following ways:

Q4.

Q5.

1. 2.

Q6.

Q7.

Q8.

Q9.

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Via email: cpd@dentaltechnician.org.uk By post to: THE DENTAL TECHNICIAN, PO BOX 430, LEATHERHEAD KT22 2HT

Payment by cheque to: The Dental Technician Magazine Limited. Natwest Sort Code 516135 A/C No 79790852 You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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VERIFIABLE ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

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

PRIMARY IMPRESSION - TAKING ON EDENTULOUS CASES Q1.

Prior to taking primary impressions, what must we understand about the edentulous arch?

ANSWER ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ......................................................................................................

Q2.

Why is it important for all landmarks labelled in Figures 1.1 and 1.2 to be captured in the primary impression stage?

Q3.

What are the three main requirements of a stock tray?

Q4.

Q5. Summarise the traditional impression technique. ANSWER ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ......................................................................................................

Q6.

Where do the secondary support areas on a Maxillary ridge lie?

Q7.

Where are the primary support areas on a Mandibular ridge?

Summarise the dual-phase impression technique.

YOU CAN SUBMIT YOUR ANSWERS IN THE FOLLOWING WAYS: Via email: cpd@dentaltechnician.org.uk or by post to: The Dental Technician Limited, Po Box 430, Leatherhead KT22 2HT. You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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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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DENTAL NEWS

HOW TO REGISTER WITH MHRA (MEDICAL HEALTH REGULATORY AUTHORITY) USING THEIR NEW DORS (DEVICE ON-LINE REGISTRATION SYSTEM) INTRODUCTION

I have written this article so as to make it as easy as possible and with the minimum of frustration for Dental Laboratories to Register with MHRA (Medical Healthcare Regulatory Authority) using their new on-line DORS (Device On Line Registration System). Overview

The Medical Devices Regulations has been superseded by the Medical Devices Directive.Anyone who manufactures Medical Devices must comply with the Medical Devices Regulations. Who must comply with the Medical Devices Regulations?

Dental Appliances and Dental Restorations are considered to be Medical Devices which means that anyone that manufactures Dental Appliances and/or Restorations such as Dental Laboratories, Dental Practices and Hospitals must comply in full, with the requirements of the Medical Devices Regulations. What you need to do to comply with the Medical Devices Regulations

1. You must have a recognised and fully documented and accredited Quality Management System in place - a documented version of which must be available at the place of manufacture for inspection at any time. 2. You must be registered with the MHRA (Medical Health Regulatory Authority) and be in possession of an all numeric MHRA (Medical Health Regulatory Authority) Registration Number. (Not a number beginning with CA as these where for the Medical Devices Directive and are now outdated and invalid). Registration can only now be achieved by registering with the new on-line DORS (Device On-Line Registration System) which has been accepting registrations since 01.01.2021. Medical Devices Regulation

The Medical Devices Regulation replaced the Medical Devices Legislation and was drafted as a result of the 2012 scandal surrounding breast implants and the use of inappropriate and dangerous materials used in their manufacture. The Medical Devices Regulation (EU) 2017/745 is a regulation of the European Union on the clinical investigation and sale of medical devices for human use. It repeals Directive 93/42/ EEC, which concerns medical devices, and

30 DT_MARCH 2021.indd 30

Directive 90/385/EEC, which concerns active implantable medical devices, on 26 May 2021. Introduction Date

The Medical Devices Regulation was meant to be introduced in May 2020 but because of the Coronavirus pandemic was delayed and is now being introduced on 26 May 2021. Enforcement and Penalties for Non-Compliance

The Medical Devices Regulation will be enforced by the MHRA (Medical Health Regulatory Authority) who have a team of inspectors who are tasked to carry out routine surveillance inspections. Anyone found not to be compliant can face a fine or a prison sentence. In addition, any appliances constructed by a non-compliant manufacturer may be re-called which could cause major expense to the Manufacturers and inconvenience to the Prescribers (Dental Surgeons) and Patients. In the event of the MHRA (Medical Health Regulatory Authority) finding a dental professional to be responsible for the constructing of a non-compliant dental appliances (i.e they are not registered with the MHRA and/or do not have a Documented Quality system in place) then they may be prosecuted by the MHRA and then if found guilty may then be reported to the GDC (General Dental Council) who may investigate them and take additional action against them, which could result in them loosing their GDC registration status. Are Bleaching Trays, Nightguards and Retainers Classified as Medical Devices?

For the sake of any doubt Bleaching Trays, Nightguards and Retainers are all classified as Medical Devices and can only be constructed by a manufacturer who complies in full, with the requirements of the Medical Devices Regulations. How to apply and submit an on-line application to the DORS (Device On-Line Registration System) of the MHRA (Medical Health Regulatory Authority

Below are details of how to register on the DORS (Device On-Line Registration System) and complete the necessary on-line forms and templates in the registration process. What you will need to prepare before starting to complete the On-Line Registration Process:

1. A desk top or lap top computer connected to the internet and with Microsoft Word

STEP BY STEP GUIDE

BY PETER NATT

Software capable of producing .doc, .docx, .jpg or .pdf documents and Microsoft Excel Spreadsheet Software 2. An E-mail address 3. A Password of at least 8 digits 4. A digital copy of your ‘Statement of Conformity’ which has been updated to comply with the Medical Devices Regulations and also provides the details of the Quality System that you use. 5. A list of all the GMDN (Global Medical Device Nomenclature) codes for all the appliances and restorations that you manufacture (See list below) 6. A Credit/Debit Card to make the On-Line Payment of £100.00p 7. Create a template chart listing each devices product(s) that you manufacture with the following details: • GMDN Code • GMDN Device Name • Product Name • Medical Device Name/Brand Trade/ Proprietary/or Common Name • Model • Category/Reference (Ref ) (See template chart further below) Devices and Products

A Device would be for instance a 38594 Dental Crown Ceramic but the Products it covers would be for instance a Full Porcelain Crown, a Zirconia Crown and a Zirconia Core with a Ceramic Crown constructed on top of it so you need to produce a template which would have all your Devices and Products prepared in advance to make it easy to complete the on-line registration process. Tip! You could use your price list to remind you of all the products that you manufacture and your computer product code could form the basis for the Model and Category/Reference (REF). Please note that the Template below only includes 2 different Devices and 18 Products where as yours will include many more Devices which would each cover many more Products! 38594 Dental Crown Ceramic (Device)

Full Porcelain Crown (Product)

Full Zirconia Crown (Product)

Zirconia Core with Ceramic Crown (Product)

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DENTAL NEWS

GMDN (GLOBAL MEDICAL DEVICE NOMENCLATURE) CODES

These are the GMDN (Gross Medical Device Nomenclature) codes for the Medical Devices that you may manufacture. You will need to add the GMDN (Global Medical Device Nomenclature) Codes for Devices that you manufacture to your On-Line DORS application when you are declaring the Devices that you manufacture. A template chart of GMDN codes is shown right and on the next pages. How to find the latest GMDN codes for the appliances that you make if they are not included in the lists).

• Register with the www.gmdnagency.org website. • Once you are registered take a look at https://www.gmdagency.org/Training which will explain how to search for GMDN Codes. • Go to Help and then the Start Page and then the Search Field and then enter the product name to find the product. • It will then show you the item or a list of items • Then click on the item you want • Then go to details where it will give you a description of the product • Then click the GMDN Code Button to show the numerical code (The free version restricts you to about 12 codes) If you are unable to find a Device Code then complete an ‘Enquiry’ form which you will find under the ‘Help’ tab of your account with the GMDN Agency.

General Government information on Registering Medical Devices to place on the market

• • •

Search for ‘Apply to Register on the Device Online Registration System DORS’ Then find and click on Register Medical Devices to Place on the market GOV. UK or Follow this link: https://www.gov.uk/ guidance/register-medical-devices-toplace-on-the-market#apply-to-registeron-the-device-online-registrationsystem-dors

This will show: The sections are • Who must register

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DENTAL NEWS

• When you must register • Information required when registering your devices with the MHRA • IVDs undergoing Performance Evaluation • Apply to register on the Device Online Registration System (DORS) • Fees • Making changes to your registration • Public register of manufacturers • Reference guides • Video tutorials • Contact To Register with the MHRA (Medical Health Regulatory Authority) DORS Device Online Registration System)

• •

•

Click on the Apply to register on the Device Online Registration System (DORS). Then click on the blue MHRA DOS link which will take you to the below web page: https://mhrabpm.appiancloud.com/suite/ plugins/servlet/registration Fill in the form, check it, and click on the I’m not a robot box, take a screen shot (keep all your details in a safe place) then click the Submit button at the bottom of the page. The MHRA should then get back to you shortly by E-mail.

You will then need to formally Register so take a look at the Video explanation of how to complete the online registration procedure

To find the video showing you how to continue your registration and enter Devices and Products, search for ‘MHRA Video on Medical Devices’ • Click on Regulating medical devices in the UK – GOV.UK • Then go to Register medical devices to place on the market – GOV.UK • Then go to Video Tutorials or Go to this web link for the video showing you how to apply: https://www.gov.uk/guidance/registermedical-devices-to-place-on-the-market • •

Then click on Video tutorials Then click on Registering a custom-made device which will take you to the below link: https://mhra-gov.filecamp.com/s/ mVBdkPgjUHDftXoj/fi

The Registration Process

Log in to your account and you will see the Landing Page with your User Name at the top https://mhrabpm.appiancloud.com/suite/sites/ MHRAServices • • • • • • •

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Click on Medical Devices Click on I Agree Enter the User Name they gave you in their E-mail to you Enter the Password they gave you in their E-mail to you They will ask you to change your password so do this but record it somewhere safe Then Log In Click on the Enter Button and look for the ‘Name’ heading and under it, it will show you your organisations name which you should click on.

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DENTAL NEWS

You will be then taken to the Summary Page where you can check your details. You can now Edit the Organisation details using the tab at the top of the page Edit Organisation Details. • Check your Registration Details • Check your Renewal Date and make a note of it and put it on your calendar as you will need to re-apply in one years time. • Click on the Top Right Tab - Add Devices (You may get a message Draft application available and click on the Yes Button) • Select Device Type from the list and Click on General Medical Device • Enter the GMDN Code or enter the name of a device in the GMDN Code/Term field and search this field and click on the one you choose, i.e. 38594 Dental Crown Ceramic. (You will find a list of GMDN Codes above) Answer all the questions on the page as otherwise it will not let you continue. (Some are optional so you need not complete them). • What Type of device is it? – General Medical Device • GMDN Code Term – Enter the GMDN Code Number or the name of the device or search for it • Is it Custom Made? - Yes

• Which directive/regulations does this device comply with – European Medical Devices Regulations EU 2017/745 What risk classification applies to this device? • Class 1 = Dentures (Removable) • Class 2A = Bridge Devices (Fixed over 30 days continuous use) • Class 2B = Implants (Active Implantable) • Single-use device? – Yes • Reprocessed single-use device? All new appliances - No • Repaired appliances - Yes • Are any of the products related to this device implantable – No • Are any of the products related to this product active? – No • Device Intended to administer and/or remove medical product – No • Intended purpose other than medical (Annex XVI)? – No • Presence of a substance which, if used separately, may be considered to be a medical/ herbal medicinal product derived from human blood or human plasma (optional) - Ignore • Has a Clinical investigation been conducted (optional) – Ignore • Click on the Continue Button

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• Upload a new Self-certification conformity declaration from your computer but make sure it does not contain the details of a patient, a dental surgeon or the patients NHS Number. It must be in .doc, .docx, .pdf, .jpg, .tif, .png, or .odt format • Click Upload and Browse your computer to select the Self-certification conformity declaration statement you wish to upload • Select the Directive or Regulation that your device conforms with and you are given the following choices: CEMDD/IVDD/AIMP CEMRD/IVDR UKCA-MDD/IVDD/AIMP CE/UK NIJMDD/AIMD/IVDP CE (UK NI) MDR IVDR (You will need to consult the organisation that provides the audit for your Quality Manuel to determine which one is the one you should select). • Enter a Reference Number (using no hyphens) for that document • Click Upload Document Button. Document will be pre-selected in the table u • Click the Continue Button

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DENTAL NEWS

• Add Product information For each Device you may have one or a number of different Products. i.e Your Device may be 38594 - Dental Crown Ceramic but this may cover one or more products product’s such as All Ceramic Crowns, All Zirconia Crowns, Zirconia/Ceramic Crowns etc. Adding Products Individually or in bulk using the Template

As mentioned earlier make a chart up first so that you have all the product details at hand (See chart above). You may add the Products individually or in bulk using the downloadable Microsoft Excel template – (see latest instructions for doing this on the web page) but be aware that there are 4 fields to fill in for each product including the Product Status Field! For each Product you will have to add:

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• A Medical Device name (Brand/Trade/ Proprietary or Common Name) = Whatever you want this to be • A Model = Whatever you want this to be • A Catalogue/Reference (Ref ) = Whatever you want this to be • Product Status = GB & NI market The rest of the fields are optional so you can press the Continue Button. • Click the Add Product Button to save details The Preview table will appear and check the details and then go to add another product at the top of the page if you have additional products for that category of Device to add. • Click symbol to preview device details. You can edit here and Click Add Device Button. • Press the Continue Button to Add Another Device i.e. 38589 Complete Lower Denture You can add up to 100 Devices each of which can cover a number of different Products. If you have used the Products Template

then save a copy to your computer and then up-load the template. You can then either download another template and go through the process again until all your Devices and their products have been uploaded. Agree to terms and conditions

Click the Continue Button to go to Payments Page or alternatively Click on Save and Edit if you wish to make further changes before making a payment and registering. Quality System

You will need to have a documented Quality Management System in place to comply with the Medical Devices Regulations. DAMAS is the Quality Management System which is used by the majority of Dental Laboratories within the United Kingdom and their contact details are below.

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DENTAL NEWS

QUESTIONS

If you have any questions regarding this article then please contact Peter Natt the author by Email via The Dental Technician Email: editor@dentaltechnician.org.uk who will be only to pleased to assist you.

CONTACT DETAILS OF RELEVANT ORGANISATIONS Data Integrity Team Manager, Devices Information and Operations Group, Medicines and Healthcare Products Regulatory Agency (MHRA) 10 South Colonnade, Canary Wharf, London, E14 4PU Tel: 020 3080 6000 Press 4 (Customer Service Team) Tel: 020 3080 7272 Device Registration Helpline Tel: 020 3080 7168 Device Registration Helpline Tel: 0800 731 6789 E: info@mhra.gov.uk E: MHRACustomerServices@mhra.gov.uk E: device.registrations@mhra.gov.uk (Enquiries) www.gov.uk/government/organisations/medicines-andhealthcare-products-regulatory-agency https://yellowcard.mhra.gov.uk/contact-us (to report non-compliance) http://aic.mhra.gov.uk/era/pdr.nsf/ device?openpage&start=1001&count=200 MHRA List of Dental Devices and Type i.e. 1 IIA

Global Medical Device Nomenclature Agency Ltd (GMDN) Hamden House, Monument Park, Chalgrove, Oxford Oxfordshire, OX44 7RW Tel: 01235 799759 www.gmdagency.org Dental Appliance Manufacturers Audit Scheme (DAMAS) DAMAS Office, DAMAS International, Office 6, David Lane Nottingham, NG6 0JU Tel: 0115 964 8249 E: damasoffice@btinternet.com www.damas.co.uk Dental Laboratory Association (DLA) 44-46 Wollaton Road, Beeston, Nottingham, NG9 2NR Tel: 0115 925 4888 E: info@dla.org.uk www.dla.org.uk Dental Technologist Association (DTA) Kestrel Court, Waterwells Drive, Waterwells Business Park Gloucester, GL2 2AQ Tel: 01452 886 366 www.dta-uk.org General Dental Council (GDC) 37 Wimpole Street, London, W1G 8DQ Tel: 020 7167 6000 www.gdc-uk.org

http://aic.mhra.gov.uk/era/pdr.nsf/ name?openpage&start=1&count=200 MHRA List of Dental Device Manufacturers

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BUSINESS

TO EV OR NOT TO EV... By Richard T Lishman and Bally Ark I Directors at the 4Dentist Group

roperty costs, staff and equipment are high up on the list of expenses for dental professionals – these costs are more often than not, 100% tax deductible.

A little more complicated, however, is the tax treatment of another significant expense – the cost of running a motor vehicle. In this article, we will get back to basics on the tax treatment of motoring expenses and then explore the tax benefits of driving electric vehicles.

THE TRADING VEHICLE

The tax outcome of purchasing (or hiring) and running a motor vehicle differs wildly depending on whether the business is operated as a: 1. sole trader, expense sharing, partnership, limited liability partnership – which is subject to income tax; or, 2. a limited company – which is subject to corporation tax Most readers will (hopefully) know whether they operate as a limited company or not!!

Such limited business travel often means a very low tax deduction for motoring costs.

2021/22

Annual writing down allowance

If, however, the dentist operates two vehicles - one vehicle for private use eg. traveling to surgery, visiting friends, shopping etc.; and another vehicle for business use – the second vehicle would no doubt offer a higher percentage of business use.

Zero emissions

100%*

1 -50g/km emissions

18%

> 50g/km emissions

LIMITED COMPANY

*Only if purchased new and unused

Motoring costs for vehicles within a limited company will always be 100% tax deductible. However, these company cars are then subject to income tax on the user under the benefit in kind rules. (see below).

CAPITAL ALLOWANCES

This is an annual deduction for the cost of purchasing a car and can range from 6% per annum for the highest emission vehicles to 100% in the year of purchase for the greenest of vehicles. The rate of capital allowances available on the acquisition of a vehicle are dependent on the Co2 emissions of the car, and are the same regardless of whether the dental Technician operates as a sole trade or as a limited company – noting that in the limited company, there is no restriction for private use.

EXAMPLE

Mr Green operates via a limited company whilst Mrs Red operates as a sole trader. They both have a budget of £60,000 with which to purchase a vehicle and want to understand what capital allowances will be available to them to offset against their business profits. They both have 5% business use and 95% personal use. Table 2 illustrates the outcome based on the emissions. Mr Green, operating an electric vehicle with zero emissions via his limited company is the clear tax winner – saving a whopping 19% x £60,000 = £11,400 in tax in the year of purchase.

SOLE TRADE/EXPENSE SHARING/ PARTNERSHIP/LIMITED LIABILITY PARTNERSHIP

For dental technicians operating under this umbrella the tax deduction for motoring costs can be very limited and is based on the percentage of business usage. A regular journey from home to the laboratory is classed as a private journey and so the majority of dential technicians are left with very limited business use - such as travelling to courses, practices and visiting their accountants.

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BUSINESS

TABLE 2 2021/22

Writing down allowance

Type of vehicle

Annual writing down allowance Mr Green

Mrs Red -5% business use

Zero emissions

100%*

£60,000

£3,000

1 -50g/km emissions

18%**

£10,800

£540

> 50g/km emissions

6%**

£3,600

£180

*First year allowance only ** Annual allowance calculated on the reducing written down value

As a higher rate taxpayer, Mrs Red would still save 40% x £3,000 = £1,200 in tax in the year of purchase – but this is still £10,200 less than Mr Green.

TAX TREATMENT OF RUNNING COSTS

When it comes to the running costs of a vehicle - such as insurance, maintenance, fuel, vehicle excise duties - there is no reference to emissions.

Other, non-electric vehicles, such as hybrids, petrol and diesel vehicles registered after 6 April 2020 have a high benefit in kind value as follow:

So, in the above example, Mr Green’s limited company would enjoy 100% tax relief for all running costs, whilst Mrs Red would only secure tax relief for 5% of the running costs.

BENEFIT IN KIND

As a sole trader, Mrs Red would have no further adjustments to her taxes for motoring costs. One aspect of motoring that would impact Mr Green however, is the tax benefit of operating a company car. The provision of a company car, is classed as a perk and will have a value attached to it that is taxable on Mr Green as a director/employee of his limited company. For motor vehicles, the higher the emissions – the higher the taxable benefit. This is where electric vehicles come to the fore. The table below illustrates the additional amount of income tax that Mr Green would pay if he operated a £60,000 electric vehicle until 5 April 2024:

COMPREHENSIVE EXAMPLE

Not a bad outcome!

Co2 (g/km)

2021/ 2022

2022/ 2023

Hybrid up to 50 g/ km with range up to 130 miles

1 -13%

2% - 14% 2% -14%

51-54

14%

15%

55-59

15%

16%

165-169

37%

170+

37%

2023/ 2024

So, if Mr Green had opted for a Jaguar F-Pace with Co2 emissions of 165 g/km his benefit in kind in 2021/22 would be calculated as: £60,000 x 37% = £22,200. With an associated income tax liability at 40% of £8,880.

Tax year

Benefit in kind rates

Dr Green – Benefit in kind

Dr Green – income tax payable at 40%

2020/21

£0

2021/22

£600

£240

2022/23

£1,200

£480

2023/24

£1,200

£480

www.dentaltechnician.org.uk DT_MARCH 2021.indd 37

Mr Green opts to purchase a fully electric Mercedes EQC via his limited company. Mrs Red, however, decides that she would like a petrol powered Jaguar F-Pace. Their comparative tax position would be as follows: Dr Green Dr Red Mercedes Jaguar EQC F-Pace Purchase price

£60,000

Emissions (g/ km)

165

Capital allowances in year of purchase

100%

Writing down allowance in 2021/22 (5% for Dr Red)

£60,000

£180

Corporation/ income tax saved – 19%/40%

£11,400

£72

Benefit in kind rate in 2021/22

N/A

Benefit in kind value

£600

N/A

Tax on benefit in kind @ 40%

£240

N/A

The electric vehicle is the winner hands down with a corporation tax saving of £11,400 compared to the measly £72 of tax saved by Mrs Red who opted for petrol powered Jaguar F-Pace as a sole trader.

CONCLUSION

To EV or not to EV? Well, we think the answer is pretty clear.

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“Taglus is the material of choice for our premium retainers and aligners. It’s an easy material to work with, with the added versatility of bonding with light and self-cure acrylics... pure quality!” Valentine Dzingai - Sitha Designs, London, England

Taglus Tuff - The finest crack-free retainer material custom engineered for superior strength, toughness, and comfort

“With Taglus Tuff I’m happy to have found, at last, a retainer material with a reduced breakage rate” Dr Lars Christensen - Lars Christensen Orthodontics, Oxford, England

To place an order or request free samples please call Forestadent on 01908 227851 or email richard@forestadent.co.uk

www.forestadentuk.com

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