The Dental Technician Magazine December 2018 by The Dental Technician Magazine

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BEST DENTAL INDUSTRY PUBLICATION 2018 UK WE HAVE BEEN CHOSEN AND WE HAVE WON THE ABOVE AWARD!

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DENTAL NEWS WHAT DO YOU KNOW ABOUT MOUTH CANCER? WHAT SHOULD YOU KNOW? PAGE 26

INSIGHT MEMORIES OF AN OLD CODGER NO. 19 BY JOHN WINDIBANK FOA PAGE 18-19

DENTAL OPINION BREXIT IS NIGH BY SIR PAUL BERESFORD, BDS. MP PAGE 6 & 8

YO BY UR R S A EC UB C O S SE OL MM CR E LE EN IPT PA A D IO G GU IN N E E G 3

Inside this month

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

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CONTENTS DECEMBER 2018

Editor - Larry Browne FBIDST. FDTA, ITI Fellow, LCGI, RDT. E: editor@dentaltechnician.org.uk T: 01372 897461 Designer - Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager - Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602 Editorial advisory board K. Young, RDT (Chairman) L. Barnett, RDT P. Broughton, LBIDST, RDT L. Grice-Roberts, MBE V. S. J. Jones, LCGI, LOTA, MIMPT P. Wilks, RDT, LCGI, LBIDST Sally Wood, LBIDST Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician Magazine is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused. No part of this publication may be reproduced in any form without the express permission of the editor or the publisher. Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH

Welcome Thoughts from the Editor

Insight Dental opinion from Sir Paul Beresford, BDS. MP Looking back with John Windibank FOA Dental Technicians: Dangerous role of WW2: Part Seven by Tony Landon

6&8 18 - 19 20 - 21

Marketing Marketing Simplified by Jan Clarke

10 - 11

Digital Dentistry Model casting with additive manufacturing

12 - 13

Company News Kemdent / Shofu

Dental News Cementation of Zirconia Thermoplastic materials (with modern techniques) Dentures can fight infections in older adults Oral Health Foundation - new guidelines for denture What do you know about mouth cancer? A simple guide to help with checking for mouth cancer ADG statement on profession-wide complaints handling iInitiative DCPs risk removal from register over non-compliance

14 - 15 16 - 17 22 23 26 27 30 30

ECPD Free Verifiable ECPD & ECPD questions

Classifieds

28 - 29 31

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THOUGHTS FROM THE EDITOR

WELCOME to your magazine DENTAL TECHNOLOGY GROUPS GATHER TO DISCUSS MHRA DEVELOPMENTS l At a recent meeting hosted by the Dental Technologists Association (DTA), representatives from the Dental Laboratories Association (DLA) and Orthodontic Technicians Association (OTA) met with Larry Browne from the Dental Technician publication and laboratory owners Graham Cobb and David Smith to discuss issues related to MHRA and MDR. The meeting was chaired by DTA’s Tony

Griffin and provided a forum to discuss the statement of manufacture and changes that come into force in 2020. The group identified a number of specific actions to take forward that will support dental laboratories, particularly in relation to inpractice custom made dental devices. The group will initially focus on informing key groups about the legal responsibilities with regard to MHRA and

the GDC, and the changes that MDR and its requirements regarding the statement of manufacture will mean for everyone who makes custom made dental devices. It is the intention of the group to support the GDC’s Shifting the Balance programme by providing information to a range of different groups, dental schools, professional bodies and individuals for the benefit of patient care.

DENTAL TECHNICIANS MATTER! REGISTRATION MATTERS!

An important meeting took place as outlined above between parties who represent organisations and the interests of the Dental Patient and the Dental Technicians. l Following the government’s decision, to change the laws, as a result of the abuses exposed in the Breast Implants Scandal, it was decided the patients’ interest must clearly come first and the conduct of those with the responsibility of their care must be subject to legislation. Doctors and medical staff, Dentists and support staff, all have rules to follow designed to protect the interests of the patient. In our field registration has been tightened up and the requirements are made quite clear. Yet we all still know somebody who is working illegally, i.e. not registered and running their own laboratory. We may all also know of others who are sending their work to the far east or other sources and not providing statements of manufacture. Often not being asked for them. The onus for the patient’ Statement of Manufacture falls squarely on the shoulders of the clinician who is required to have one for each restoration supplied. He must offer it to the patient for the life of the restoration. In simple terms it‘s the patients’ evidence that the work complies with the required registration and has

been constructed by a qualified registrant from materials, which are designated. As manufacturers of bespoke restorations we have a duty to supply that Statement of Manufacture. Is that happening? If clinicians are using illegal laboratories they will not be receiving these statements. So why are there still illegal laboratories and technicians working to prescriptions? Perhaps the answer is in the way the clinicians’ representative organisations have influenced the registration bodies to ignore it because it's a bit of nuisance!! It would seem the risk of technical work not meeting the required standard or actually being dangerous for the patient is so low it can be ignored. A quick check on the various teaching hospitals for undergraduate dentists shows a very poor picture of the new requirements being taught. Some do and many do not. How then can a graduate dentist be sure he is not breaking the law? Because withholding the SOM or not informing the patient

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of its existence is against the law!! But of course this will make the whole process of using illegal laboratories much more easy. Checking with the Nurses representatives it is even a poorer picture with most of those questioned not knowing of any information being passed to members. I suspect the same applies to hygienists and therapists. We agreed that Education of all those involved was an essential path to follow. The dental nurses and clinical assistants, hygienists and therapists all need to know what the rules and responsibilities are. And of course the clinicians will need reminding. It is their responsibility to ensure that the patient is safe and those who are involved in their care and treatment are qualified and registered. I would ask all of you to ensure your clinical colleagues are informed of the requirements and the law. While registration has brought its own frustrations for us all it is in the patients’ interest and eventually may help to raise standards across the professions.

Larry Browne, Editor

DENTAL OPINION FROM SIR PAUL BERESFORD, BDS. MP Dual UK/NZ nationality. New Zealand born, bred and educated, with post graduate education in UK. Worked as an NHS and private dentist in East and South West London. Private dentist in the West End of London then and currently in a very part time capacity in South West London. l Councillor including Leader of Wandsworth Council moving to the House of Commons. l A Minister in the John Major Government, MP for the then Croydon Central, then elected as MP for Mole Valley as a result of the boundary changes for the 1997 election. l

INSIGHT

BREXIT IS NIGH

- FIRST A LITTLE HISTORY

n 26th June 2016 we had a UK wide Referendum. It was a simple question - Do you wish to Remain in the EU or do you wish to Leave the EU (Brexit). The vote was organised and counted on a constituency by constituency basis producing a UK wide result for Brexit I voted Remain as did my constituency but we lost as the majority of the UK voted to leave. In such a referendum the constituency vote is interesting but irrelevant. Virtually every MP, at least in the Tory, Labour and DUP Parties accepts the Referendum result. The Liberals do not but democracy seems to mean whatever is convenient to them at the time. The SNP also do not but they do seem to treat Referendums as repeatable until they get the answer they want.

At the last election both the Conservative Party and the Labour Party campaigned on accepting the Brexit Mandate. Post-election Parliament passed legislation to move EU laws that we currently use in to UK legislation so that legal life would continue post Brexit. We also agreed Article 50 which gave the EU legal notice that we were leaving the EU on Friday 29th March 2019. Call it Brexit Day. Then negotiations on arrangements post Brexit between the EU and the UK commenced. Fortunately, the 27 EU nations appointed the Commission to negotiate rather than each of the 27 individual nations although late in the day some such as the French (of course) and the Spanish are bucking that aim.

As expected the negotiations were exceptionally tough and as ever with the EU nothing was finalized until the absolute last minute. Last Sunday Theresa May, on our behalf signed a deal with the 27 EU nations as the EU. Fortunately it is recognised by both sides that we will be better off obtaining a deal rather than falling off the cliff edge of a No Deal Brexit. The deal is a result of negotiations. That is it is a DEAL. Much of it is good for us but we did not get carte blanche. Equally the EU 27 did not get all they wanted. The Spanish had a flutter about Gibraltar and the French suddenly realised UK fish belonged to the UK Of course the whole procedure opened the media field to difficult MPs and difficult

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INSIGHT journalists. Reading and listening to the various opinions makes me aware of how complex the 585 A4 page deal is and just how many commentators either do not understand or still haven’t even bothered to read it, or worse still even the executive summaries. That doesn’t stop all and sundry having opinions, sometimes prejudiced opinions they have held for years. On Monday 26th November the Prime Minister made a statement to the House of Commons and perhaps a quote verbatim will help. “This is the right deal for Britain because it delivers on the democratic decision of the British people. It takes back control of our borders, and ends the free movement of people in full once and for all, allowing the Government to introduce a new skills-based immigration system. It takes back control of our laws; it ends the jurisdiction of the European Court of Justice in the UK and instead means our laws being made in our Parliaments, enforced by our courts. It takes back control of our money, ending the vast annual payments that we send to Brussels, so that we can instead spend taxpayers’ money on our own priorities, including the £394 million a week of extra investment into our long-term plan for the national health service. By creating a new free trade area with no tariffs, fees, charges, quantitative restrictions or rules of origin checks, this deal protects jobs, including those that rely on integrated supply chains. It protects our security, with a close relationship on defence and on tackling crime and terrorism, which will help to keep all our people safe. It also protects the integrity of our

United Kingdom, meeting our commitments in Northern Ireland and delivering for the whole UK family, including our overseas territories and the Crown dependencies.” There will be a vote in the House of Commons on probably Tuesday 11th December. If the vote is “yes” we will leave on the 29th March 2019 and we can progress with trade negotiations with the rest of the world and continue developing our economy. If the vote is “No” there is a very real prospect of us leaving on the 29th March with a no deal scenario. The UK would revert to World Trade Organisation rules on trade. While Britain would no longer be bound by EU rules, it would have to face the EU’s external tariffs. The price of goods in shops for Britons could go up as businesses would have to place tariffs on goods imported from the EU. Some British-made products may be rejected by the EU as new authorisation and certification might be required. Manufacturers could move their operations to the EU to avoid delays in components coming across the border. Britain would no longer have to adhere to the rulings of the European Court of Justice but it would be bound to the European Court of Human Rights, a non-EU body. The UK would be free to set its own controls on immigration by EU nationals and the bloc could do the same for Britons. There could be long delays at borders if passport and customs checks are heightened.

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The fate of expats – there are 1.3 million Britons in EU countries and 3.7 million Europeans in Britain – in terms of their rights to live and work would be unclear. However Theresa May has stated that EU expats resident in the UK on Brexit Day will be treated as now. Professionals working in the EU might find their qualifications are no longer recognised, meaning they are no longer able to practice. The current deal on the table would allow Britain to start trade negotiations with other countries after 29 March 2019 but any deals would not be implemented until after the transition period of 21 months. With a no deal, Britain could implement the deals whenever the fine print is ready. But deals take years, not months or weeks, to broker. Therefore the UK is not gaining anything by having no transition period in this instance. For example the EU/Canada deal took 9 years to negotiate. The damage to our economy will almost certainly be severe. While I personally believe it is unlikely, flights to and from the EU could be grounded as the necessary safety confirmations to cover both ends of the journey might not be in place. Some commentators and journalists are calling for further negotiations. My daughter when in her late teens had a killer phrase Get Real. If we lift the lid on the agreement it will open the doors both ways. The French fishing boats will sail!

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MARKETING SIMPLIFIED JAN CLARKE BDS FDSRCPS MARKETING

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

CLIENT FEEDBACK

GOOD OR BAD?

s a busy practicing dentist I rarely found the time to call my dental technician to tell him what a great job he had done. On the rare occasion I did because I had the time and realised how important it was, I was always overwhelmed by the response. The other person on the end of the phone delighted to hear how the work was received and I know it will have made their day. As dental technicians Iâ&#x20AC;&#x2122;m sure when a client calls you invariably brace yourself for a problem and rarely to receive praise for a job well done. We are all guilty of it, only saying when things are wrong not when they are right. Feedback is important, without it, you cannot continue to grow and improve your services and this works both for positive and negative feedback. HOW CAN WE CHANGE THIS? Imagine if after every piece of work was fitted you had a frank and honest discussion with your dentist? Sounds great you say but when is this supposed to happen, everyone is busy!

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MARKETING

That’s true, you’re busy, they’re busy and chances are it just will not happen. This is why we need to start looking at the “Completion of Work” protocol and make it as important as casting up models/ finishing porcelain work. A SOURCE OF NEW CLIENTS? Yes, that’s right, your existing clients are the key to a source of new clients that are just like they are. If you can show how well your work is received and show off glowing testimonials from your existing clients then you will attract more of the same. This is a step on from “Word Of Mouth” marketing, rather than relying on your dentists spreading the word, you can actively guide that process. HOW TO START? I would consider designing a system that will work for your business. 1. Delegate a member of your team to be involved in the process, perhaps someone who understands the power of reviews on Facebook, Google, and written testimonials for your website 2. Decide on the post completion course of events 3. Decide how you will feedback this information to your team 4. Decide how you will utilise this information for maximum marketing effect. WHAT DO YOU MEAN BY POST COMPLETION COURSE OF EVENTS? Whilst the work is being constructed in the laboratory you will have a system from start to

finish, to allow quality assurance at every step of the way. This is how we want to approach the post dispatch scenario too.

eventually you will not be able to remember a time you didn’t embrace this system.

1. Sign off at the practice for receipt of work

All the positive feedback you receive can be used and reused over time:

2. Discussion with nurse/dentist to find out how the work fitted

• On social media, Facebook, Twitter, Instagram, Youtube

3. Request for post fitting photographs

• On your website

4. Request for either a. Facebook review b. Google review c. Written testimonial d. Video review

• In your printed material as quotes/testimonials

5. If the work hasn’t gone well, omit step 4 and put reparative work in action a. Identify what went wrong b. Identify where it went wrong c. Identify what can be learned from the mistake and if your in house systems need attention. 6. Collate all the information and feedback to your own team regularly through marketing updates. By designing such a post completion protocol you will start to identify weak areas and stronger areas. This will not only help your business but also help your team. They will have a pride in their work and want to know how it is being received, by receiving regular feedback your team will grow and thrive. It is important that over time you can build up feedback from every item of work, not just occasionally. Once you have set this system in motion it will become part of your process in the same way that receiving work into the business is and

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Let’s educate dentists and their teams to talk to us more and give valuable feedback, even if sometimes it makes us feel a little uncomfortable! By knowing how we are performing we can continue to grow, learn and provide the best service we can. I make no apologies for repeating this definition of marketing: “Marketing is everything a company does, from how they answer the phone, how quickly and effectively they respond to email, to how they handle accounts payable, to how they treat their employees and customers. Done right, marketing integrates a great product or service with PR, sales, advertising, new media, personal contact. In other words, marketing is not a discipline or an activity – it is everything a company is – at least if the company wants to be successful.” B.L. Ochman – President, What’s Next. Start to think with a “Marketing Mindset” and look at every opportunity as a marketing opportunity. 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!

MODEL CASTING

WITH ADDITIVE MANUFACTURING (THAT'S 3D PRINTING TO YOU AND ME)!

BY LUDWIG SCHULTHEISS TEAM MEMBER OF INFINIDENT, GERMANY, OCTOBER 2018

E DIGITAL DENTISTRY

specially for the manufacture of prosthetic restorations made of non-precious metal alloys (NPM), generative manufacturing processes such as laser sintering offer dental laboratories significant advantages over classic analogue conventional casting or ablative CAD/CAM manufacturing processes. Thus far, additive technology, in which micro grained cobalt chromium (CoCr) powder particles (>36m. grain size) are melted in layers using a laser beam, has mainly been used in the fabrication of prosthetic restorations such as single copings and large span bridge frameworks. This allows individual restorations with convincing density and fit to be fabricated in large quantities, free of porosity. The materials usage is particularly efficient. In contrast to ablative processes, such as milling technology as only the exact material is consumed that is actually required for the object digitally designed in the CAD software. Model casting, digitally manufactured (3D Printing) Another application ideally suited for the use of additive manufacturing is the digital fabrication of the classic removable partial denture. Partial dentures, which in Germany falls into the category of "health insurance coverage" is regarded worldwide as the standard treatment for partial dentition and is today usually still produced analogously. However, a great deal of

Additive manufacturing: Laser sintering technology SOURCE: INFINIDENT SOLUTIONS

experience and time consuming manual work processes are required to produce a framework that is largely free of porosity. Due to the large amount of time needed for the dental laboratory, this procedure is usually not economically speaking, well rewarded. Digitalisation, on the other hand, is already making it possible to virtually design any restoration, despite the complex design variations often required, relatively easily, step by step in common with CAD software applications, such as Exocad, 3Shape or Dentsply Sirona. In addition to the individuality of the restoration and the dictates of cost effectiveness, the complexity and diversity of the restoration designs are especially important in 3Dprinting. So itâ&#x20AC;&#x2122;s not surprising that, for example, a study by SmartTech Publishing, predicts high growth for the additive production of 3D printing applications.

Laser sintered 3D printed with support structures and framework finished (above) and centrally 3D printed manufactured (inset). SOURCE: EOS, INFINIDENT SOLUTIONS

Trend towards CAD/CAST processes provides added value for 3D printers? In spite of the above mentioned advantages, a hybrid manufacturing method has been observed since the introduction of cheap 3D printers in the dental laboratory: The so called CAD/CAST process, in which the design is done digitally via the PC and the result is first "printed" from wax using the additive technique, but then finally cast conventionally. This mix of digital and analogue workflow raises the question of the extent to which economic added value can be achieved. All complex analogous work steps of the casting process, model duplicating muffle preparation, preheating procedure, alloy melting, casting procedures, as well as the mechanical disadvantages of the casting technique (risk of shrinkage porosity) still exist.

Digitally constructed model casting (3D printed) Exocad, DentalCad SOURCE: EXOCAD

Forecast for number of additive model castings 2015 to 2027. SOURCE: SMARTECH PUBLISHING, 2018 DENTAL REPORT

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Survival in function

best possible fit of the laser sintered partials. The subsequent necessary stress annealing of the components, as well as the thermal post treatment to obtain ductility (spring elasticity) of the clamps, are also crucial for the later fit. In-house vs. external production

Volume in Cubic Cm. Study result 1: Survival rate of 3D printed partial. Laser sintering vs. casting.

Study result 2: Comparison of the average shrinkage (Volume) distortion of laser sintered vs. casting.

SOURCE: POLYCLINIC FOR DENTAL PROSTHETICS AT THE UNIVERSITY OF MUNICH

In particular, the danger of large volume porosity, which unfortunately remains constant during casting, is largely negligible, in the laser sintering process, due to the homogeneous microstructural properties. Although the number of cavities detected in the additive process is higher, these are purely superficial porosity, which results in a rougher surface which can be easily removed as part of the polishing process. Laser sintered production of restorations can be really efficient with up to 30 model casting restorations fabricated on a so called “mid frame" laser sintering system (EOS M270, construction platform 250 x250 mm) in an average 15 hour construction process. The virtual positioning of the components during data preparation is essential for the final fit of the parts. A lot of experience is required to achieve optimal fitting results. Especially for the virtual setting of support structures on the components, which serve to avoid distortion on the basal as well as oral side of the base, in order to guarantee the ABOUT INFINIDENT SOLUTIONS l INFINIDENT Solutions have over ten years experience in laser sintering technology. The company is one of the leaders in the field of additive

Because 3D printing is usually not considered the dental laboratory’s most popular procedure, out-sourcing is probably the answer. However, because any form of reworking should be avoided as much as possible you must ensure the chosen laboratory source for the 3D printing digital processes, is really up to date and capable of producing the quality the system has to offer. Familiarity with the virtual model creation and design is the essential requirement. The digital system is undoubtedly capable of the very highest of quality demands but it has to be governed by the technician who is designing the Virtual model.

Laser sintered 3D printed partials with support structures on building panel. SOURCE: EOS

By comparing the advantages of purely digital versus conventional production of 3D printing, the added value of purely digital production can be clearly illustrated: Advantages of purely digital manufacturing (3D printing laser sintering process): • Requires a lower number of work stages and therefore an increase in productivity. • Reduced risk of error and casting anomalies, with a lower risk of porosity. • Largely homogeneous microstructural properties guaranteed. • Constant retention forces as well as increased flexibility of the clasps. • Design freedom and simple correction options. • Reproducibility technology for the manufacturing of dental prostheses. For more than three years now 3D printing of these prostheses to other laboratories has been an integral part of its service portfolio.

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It is to be expected that digital manufacturing methods will replace conventional casting in the dental laboratory in the medium term. Laser sintering technology will become established as a suitable manufacturing process, especially for 3D printing. Due to the still high investment costs for plant and equipment for this technology process, it does not seem realistic, however, that these will pay off for use in the medium sized "generic" laboratory. Thus, the use of specialised suppliers is probably a means of choice. However, it is precisely here that clear differences in quality can be seen with regard to the manufacturing service providers active on the market, who already offer digitally produced model castings (3D printing) today. Only those manufacturing service providers who have intensively dealt with application specific production and possess the corresponding technology in the high end quality sector can deliver satisfactory results with regard to fit, surface and clasp ductility, of the laser sintered 3D printed restorations in both the upper and lower Jaw. The advantage of purely digital production based on laser sintering and 3D printing is clear. The high quality plus high volume production potential together with predictable running costs are very desirable. The only disadvantage being the plant and machinery investment required. Out sourcing to a specialist production provider with the necessary expertise seems a good option for the smaller laboratory. With the Understandable restriction on large scale investment it makes great sense to team up with your chosen expert and build a good working relationship. The future use Undoubtedly Digital manufacture is the future, but starting now!

Model casting with support structures after stress relief annealing. SOURCE: EOS

The laboratory provides a suitable scan and can expect return of the metal partial within three days. For more information please visit: www.infinidentsolutions.com

DIGITAL DENTISTRY

Added value of laser sintering process Is the laser sintering process really better suited for the production of partial denture frames? The answer is a resounding yes! This is underlined by a study conducted in 2018 on the mechanical properties of the clasps of laser sintered vs analogue model casting. The client was the company EOS, while the Polyclinic for Dental Prosthetics at the University of Munich conducted the study. The study investigated the staple removal forces, the microstructure quality and the survival rate of laser sintered partials compared to conventionally cast partials. The study showed significant advantages in terms of constant partial removal forces with no loss in retention and a survival rate of >93%. (Based on a simulated survival rate of 60 years). But also demonstrating a much improved and homogenous, microstructure quality of additive production.

ADVANTAGES OF CONVENTIONAL PRODUCTION MODEL CASTING (ANALOGUE PROCEDURE): • The time advantage due to in house production. • The Technicians Familiarity with analogue manufacturing process. • Lower material costs per unit.

DENTAL NEWS

CEMENTATION OF ZIRCONIA BY JIP KREIJNS I JANUARY 18, 2017 I INTERNATIONAL DENTAL TRIBUNAL

en-methacryloyloxydecyl dihydrogen phosphate is a bit of a tongue-twister for anyone not a chemist by profession, so in everyday communication, this adhesive monomer is referred to by its three initial letters, MDP. The monomer was developed by Kuraray Noritake Dental in 1981 to improve the adhesive strength to hydroxyapatite and has proved its strength ever since. It is indispensable in dentistry. For example, reliable adhesive cementation of zirconia restorations would not be possible without MDP. Indirect restorations in modern dentistry must fulfil at least three requirements. First of all, they must preserve tissue. This implies that a full crown is not the first choice, because approximately 70 per cent of the tooth tissue has to be sacrificed for such a restoration. Nevertheless, full crowns are often still indicated by virtue of their mechanical retention. However, given that the retention that can be achieved by adhesive cementation is now sufficiently reliable, a less invasive restoration than a crown should be chosen more often. And this choice may very well be for a zirconia restoration. Combined with the preliminary sandblasting of such an adhesive restoration, this choice is now an appropriate one, owing to MDP. Durability is the second requirement for an indirect restoration. This property of a restoration is largely associated with the flexural strength of the restorative material. While it has become clear that zirconia achieves the best durability scores, it should be pointed out that the cementation method also contributes significantly to the durability of a facing, inlay, onlay or adhesive bridge, etc., which can nowadays all be realised in zirconia. Aesthetic acceptability is the third requirement for a modern indirect restoration. This means that porcelain baked on metal has lost its appeal; all-ceramic materials are now the standard. Zirconia is now available in varying translucencies, and there are even multilayer varieties (KATANA Zirconia ML, STML and UTML; all Kuraray Noritake), and these new zirconia materials no longer have to be porcelainbaked. Obviously, baking is still possible, and partial baking is a choice that is frequently made. One of the results of a multilayer build-up is that the transparency is higher incisally than cervically, as it is in natural dentition. The light falls through the incisal margin, but is blocked at the cingulum of the restoration. With a modern zirconia material such as KATANA Zirconia ML, this variable transparency goes hand in hand with a natural colour gradient from cervical to incisal. In a given colour, A1 for example, the

ABOVE TOP ROW: Katana Zirconia UTML; Katana Zirconia STML; MIDDLE: Katana Zirconia ML; BOTTOM ROW: KATANA Zirconia UTML with Cerabien ZR external stain KURARAY Noritaki; Sandblast at lower pressure.

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SURFACE The new zirconia materials are changing the way dental technicians operate, as illustrated by the experience of Daniele Rondoni, a prominent dental technician from Savona in Italy, who has specialised in the use of multi-layering technology for ceramic materials. According to his philosophy, the choice of restorative materials should be sufficiently wide to realise customised solutions. Among other things, he believes that there is still room for baked porcelain on a core of lithium disilicate or zirconia. Using baked porcelain, the dental technician can modify the surface texture of an aesthetic restoration to lend a certain age to the restoration. As for surface structure, that the material allows for the smooth polishing of the occlusal contacts is crucial to counteract abrasion by the antagonist and to maintain the occlusal balance. In this respect, the hardness of the material selected is not the main factor; the smoothness and resistance of the surface are far more important. FLEXURAL STRENGTH When selecting material for restorations, the dental technician has the option to choose KATANA Zirconia Ultra Translucent MultiLayered (UTML) for veneers or anterior crowns, a zirconia with a translucence comparable to that of

glass. This translucence is especially important for an anterior restoration that is to be fitted between flawless natural teeth, a situation that often occurs after anterior trauma. Such a restoration effected using KATANA Zirconia UTML harmonises with the neighbouring natural teeth, not least because this type of zirconia does not cause the white appearance common in anterior crowns. The second-generation aesthetic zirconia materials are sintered at a temperature of 1,550 °C. This temperature is maintained for 2 hours. The dental technician needs to be aware that this temperature differs from the sintering temperature for KATANA Zirconia High Translucent MultiLayered (1,500 °C). Wide-span bridges can be realised with the latter product, whereas the size of bridges made from KATANA Zirconia Super Translucent Multi-Layer (STML) remains limited to a maximum of four dental elements. KATANA Zirconia UTML can be used for small anterior bridges, but is more suitable for anterior crowns and veneers. The reason for this is that the flexural strength of these highly aesthetic zirconia materials is lower than that of the standard zirconia, of which the flexural strength—1,125 MPa—is sufficient for the production of durable wide-span bridges. The flexural strength of the highly aesthetic zirconia varieties (approximately 750 MPa [STML] and 550 MPa [UTML]) is quite sufficient to ensure the durability of single aesthetic restorations and limited-span bridges.

PREPARATION Flexural strength is not the only decisive factor for durability; the method of preparation is also crucial to properties of this material. Chamfer preparation is the required form of preparation, with no knife-edge outline, no deep shoulder and, obviously, no undercuts. Since the restorations are fixed adhesively, parallel walls or grooves in the preparation are undesirable, and sharp edges and transitions must be rounded off. If a preparation for a full crown has nevertheless been made, a substantial height difference between the vestibular and palatal/lingual outline is contra-indicated. Using the new zirconia materials means that a thickness of only 0.4–0.8 mm need be removed for a veneer in the incisal and cervical areas, and only 0.5 mm is required in the labial plane, which corresponds with the requirement to preserve tissue. For inlays too, only 1 mm is sufficient to achieve a durable result. If the inlay is extended to an onlay, 1 mm is also sufficient for the area where the cusps are capped. For a full crown in the lateral parts, a 1 mm space must be kept as a minimum and this thickness must also be maintained for the upright walls of the preparation. MINIMUM WALL THICKNESS OF KATANA Maintain 0.8 mm thickness of pressed ceramic in all areas. When trimming the zirconia framework, the framework should be at least 0.4 mm.

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cingulum has the corresponding dentine shade body and it passes to incisal in the appropriate enamel colour via two transition shades.

DENTAL NEWS

THERMOPLASTIC MATERIALS (WITH MODERN TECHNIQUES)

TAKEN FROM DENTAL TRIBUNE DENTAL TRIBUNE and the wax boiled out. The plastic material, which is available in the laboratory as granular material, is heated in an injection moulding device and injected into the mould. After a period of cooling, which should not be shorter than specified, the prosthesis is removed from the mould and finished. Special milling cutters are needed because the material tends to become viscid when cut.

Claudia Herrmann Owner and CEO of Dental-Labor Herrmann in Bad TĂślz in Germany. Email: abt@dl-herrmann.de

hermoplastic materials have been used in aviation and space engineering for a long time. Owing to their high mechanical strength and low modulus of elasticity, they have begun to increasingly replace metal in many manufacturing industries too, particularly in those where metal has been the dominant choice until now. Implants for intervertebral discs, as well as hip and knee joints, are made of PEEK, a thermoplastic polymer. Four million implants have been fitted during the last 15 years with outstanding success. In recent years, thermoplastic materials have also been used in dental technology. This article discusses a number of common plastic materials that have become alternatives for use in the manufacture of non-metal telescopic dentures. About 15 years ago, the first attempts were made, not without initial problems, to produce non-metal telescopic dentures. These dentures were made by injection moulding, using a polyamide (PA) in the dental laboratory. A wax mould of the framework, bar and secondary crowns is made as an integral part, embedded in plaster in a flask

Very importantly, absolutely no metal must be entrained. If the denture were to be cut by a tool previously used for cutting metal, minute metal particles could be incorporated into the thermoplastic material by the milling cutter. The good sliding properties and the high friction of the secondary crown particularly surprised us. When inserted, the secondary crown slides over the primary coping and is retained partly by clamping and partly by suction. Our patients found the easy fitting properties and the light weight, comfortable. The modulus of elasticity of PA is very low, which lends flexibility to the material. This gives the patient a sensation of a readily adapting denture, rather than a foreign body, in his or her mouth. The low modulus of elasticity, however, turned out to be the greatest drawback of the material. The moduli of elasticity of all plastic materials used for bonding are very high and two moduli as wide apart as these cannot be bonded reliably for a long time by any means available to dental laboratory technicians. As

a consequence, many dentures develop cracks and defects in the bonds after several months. In addition, the large pores on the surface of the denture led to discoloration, particularly in patients with an altered acidâ&#x20AC;&#x201C;base balance. FPM A short while after PA, the industry launched a successor material with FPM. This thermoplastic fluoropolymer offers some flexibility, but less than that of PA, however. The modulus of elasticity is marginally higher than that of PA, but distinctly lower than that of metal. Consequently, similar problems as those encountered with telescopic dentures of PA occurred. PMMA We have obtained good results with PMMA (Polymethylmethacrylate). This plastic material is very hard and inflexible. Available in different colours, it is used for complete dentures and occlusal splints, as well as for long-term temporary dentures, crowns and bridges. The material is not susceptible to plaque, and discoloration is very rare. The moduli of elasticity of bonding materials and PMMA are similar; thus, cracks and spalls of bonds did not occur. Patients who had previously worn a telescopic prosthesis of PA or fluoropolymer, however, complained that the denture of the new material was uncomfortable to wear. PMMAâ&#x20AC;&#x2122;s lack of flexibility gave patients the sensation of having a foreign body in their mouth. Appliance overview

Anterior view

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PMMA Telescopic Dentures. Note the tooth coloured frameworks

Unfortunately, denture breaks were reported after some time, particularly in free-end situations. Also, dentures not relined regularly and exposed to high force tended to break. We believe one reason for that is the fairly high modulus of elasticity, which makes the material somewhat brittle. The greatest problem, however, is that thermoplastic materials can be difficult to repair. PEEK PEEK (Polyetheretherketone) was first used for telescopic dentures about six years ago. In general medicine, it has been used for hip, knee and intervertebral disc implants for almost 15 years. According to German company, Evonik Industries, as many as four million implants have been fitted and not a single case of proven allergy to that material has been reported. The modulus of elasticity of PEEK is similar to that of bone, with positive consequences for integration. This is one of the reasons that PEEK merits the attention of dental lab oratory technicians. Finally, there is a material with a hardness similar to that of bone, not as soft as PA or FPM plastics and not as hard as PMMA. These very rigid materials often cause dental technicians problems, for example with all-ceramic solutions for the upper jaw, where occlusal problems frequently arise. PEEK is a very light-weight material with a long history of use in space flight. Nonconductive, it has been used in semiconductor technology for a long time. This property also offers benefits for use in the oral cavity.

There are two different methods of manufacture. One is injection moulding and the other is CAD/CAM milling. The minimum thickness of telescopes is 0.6 mm. The minimum thickness of frameworks and bars is distinctly higher, but varies depending on the design and the size of the telescopic prosthesis, as well as the number of available telescopes. Generally, a PEEK telescopic prosthesis will be a little thicker than a metal telescopic prosthesis. It is an absolute necessity that the primary crown be made of zirconia, as abraded metal particles would otherwise collect under the secondary crown. The veneer bond strength was tested in a study at the University of Regensburg, Germany, in 2012. In order to pass the test, a value of 5 MPa had to be achieved. Of all the veneering systems tested, PEEK scored 10 MPa and above and passed all of the bond strength tests. In other tests, such as discoloration and shear strength, it also achieved very positive results, confirming the suitability of PEEK for use in the oral cavity. When subjected to load at fracture tests, a PEEK bridge achieved 2,354 N and was far superior to a ceramic bridge, with 1,702 N. Hence, PEEK can withstand higher loads in the oral cavity than can ceramic material, and so wide-span telescopic dentures can be made of PEEK. It is necessary when handling telescopic dentures of PEEK to apply ceramic guidelines because the material could otherwise be weakened owing to crack propagation. In addition, the prosthetic design must follow certain criteria. For example, a prosthesis

without a transverse bar must always include a backing plate in the secondary part to provide sufficient stability. Dental technicians required to make non-metal telescopic prostheses should therefore receive sufficient training and instruction so that the required high-quality level can be maintained. Those who work with PEEK only rarely and who therefore lack experience, are advised to have telescopic prostheses of PEEK designed and cut in a specialised laboratory. Even in our laboratory, we have come across PEEK prostheses with cracks, but these have invariably been due to manufacturing mistakes. Prostheses made correctly exhibit no cracks. Cracks and surface defects of the veneering of PEEK dentures can be found about as often as in telescopic prostheses of metal - almost never! PEEK is extremely resistant to plaque and inert to acids and chemicals; therefore, the denture can be cleaned with a chemical dental cleaner. Friction is one of the most critical characteristics of telescopic prostheses. The friction fit of PEEK is very good and can be controlled by the careful use of the expansion modelling plaster. However, most important is that friction is permanent. We made our first telescopic prostheses of PEEK about five years ago and we have not observed any loss of friction in that time . CONCLUSION Our laboratory has the experience of having made over 300 non-metal telescopic prostheses over the course of 11 years. After initial problems and several tests, PEEK has finally proven a suitable material for telescopic dentures in the long term. Non-metal telescopic prostheses are in no way inferior to metal telescopic dentures, provided they are made professionally. On the contrary, the light weight, the high wear comfort and the absence of metal, in particular, are compelling arguments for dental technicians and patients alike. This article was published in CAD/CAM international magazine of digital dentistry No. 03/2016.

The pharmaceutical industry uses PEEK in production. Parts in contact with the product are made of PEEK owing to its low discoloration and high resistance to wear and corrosion. Both properties are also very useful for dental technology. PEEK is indicated for removable, as well as conditionally removable, prostheses. Therefore, bridges, crowns, telescopic dentures and attachments, as well as screw retained superstructures, can be fabricated. Patients find them easy to fit and extremely comfortable to wear.

Happy smile from a happy patient

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DENTAL NEWS

PEEK Telescopic Denture designs for Upper and Lower

LOOKING BACK JOHN WINDIBANK FOA INSIGHT

MEMORIES OF AN OLD CODGER 19 PAY & PROBLEMS

ineteen Eighty-Nine to the millennium was for me, the best years of Central Council(CC) where we were able to make a real difference in solving problems. The process of constant change in the health services was on going and the Whitley Councils were drastically changing with committees being amalgamated. On 29th September 1989, a new agreement was signed and Dental technicians found themselves in a new committee, along with 17 other technical groups employed on Professional &Technical B (PTB) pay scales. Your grade, and place on the pay scale would in future be decided by your local heath authority, using guidance set out by the PTB Council. I had been part of the long negotiations for this new grading structure and we had picked over every clause, making sure that all our relevant skills would be recognised as part of our submissions for the new scales. With this new agreement I could see lots of possibilities for us, getting away from the fixed position on pay scales that we had previously worked with. Looking at the new agreement I knew that the employing authorities would offer us pay scales equivalent to those we were at present receiving, which was a Medical Technical Officer(MTO) scale 3 for a chief technician. I thought with a fight and appeal, I might get a MTO grade 4. Cometh the moment, cometh the man and on this occasion his name was Harry Thompson, Chief Technician at Wexham Park Hospital and chairman of Central Council at that time. At this particular meeting delegates arrived and one was boasting that he had achieved a MTO grade 4. Harry opening the meeting, informed the Council that he would not accept anything less than grade 5 at his hospital and he expected to get the maximum discretionary grade points available, which was the highest grade available for the MTO grades. So off we all went, suitably geed up to have a good go at a grade 5. I went home and started work on a job description as part of my submissions for the new grades and I must admit I was very pleased with the

CENTRAL COUNCIL MEETING CC1990 LEFT TO RIGHT: R Winchurch, Birmingham; L Hall, Guys, London (with her back to the photo); R Jackson, Reading; C Cowling, Bristol; H Thompson, Slough; M Cook, Swansea; P Butter, Northampton; I Dawning, Rhyl; Rod Snape, Peterborough.

result. About a week later I received a phone call from Rod Snape Chief Technician at Peterborough Hospital and he asked me how I was getting on with my submissions. Rod said he wasnâ&#x20AC;&#x2122;t happy with how things were going and I sent him a copy of what I had done and a short time later Rod sent me his submission, which was less list like and gave more personal examples. I took on board some of Rodâ&#x20AC;&#x2122;s ideas and he also sent a copy of his submissions to Harry Thompson, who sent them off without alteration as his submissions for the new grade and as Rod said, it even included the same miss spelling he had made.

and none of us there at that Central Council meeting were surprised at his success, Rod Snape eventually achieved MTO5+2 but I had a long and tortuous fight to get there.

Harry Thompson was a pin sharp dresser, he oozed confidence and always carried around one of the first type of mobile phones, which as you will know from old films looked like a brick with a stumpy aerial attached and weighed about as much. Harry had an excellent working relationship with his hospitals chief executive which from my later experience, was the key to success with these and most negotiations. The first grade offer and I repeat, the first offer to Harry was a MTO 5 with 2 discretionary points, which he refused and later he achieved his third discretionary point. The precedent was set

The atmosphere between us was less than cordial and this was how it was when I made my MTO grade submissions. I eventually had to initiate a grievance procedure to get an offer, which was a MTO 3 as I remember, this led of course to an appeal and I also applied for jobs all over the country and accepted one only for us to disagree about the salary and the offer was withdrawn. So it came to my appeal and I asked Harry to represent me and he turned up with his mobile phone and plonked it on the table in front of the hospital panel and I achieved my grade 5 with a review for discretionary points to come.

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Joint staff consultative groups were back then a requirement for hospitals and at the time I was the staff side secretary, and it was my job to raise difficult issues on behalf of the staff. I was always getting into arguments about agreeing the minutes and what had been agreed at the last meeting and the hospital secretary could never see why I felt it was so important.

As the results of the regrading’s came in, it was my responsibility at the CC to collate them and we accumulated every result which made us the experts in the field. I was asked to attend a regional appeal where I was called as an expert witness and the appeal was being opposed by the appellant’s consultant which always made things difficult. I was grilled by the consultant and I put on my happy friendly face for my

replies, but the data was the clincher. The appeals panel were very interested in the awards that other technicians had achieved. Grade MTO 5 was awarded and this was backdated 3 years including the extra holiday entitlement.

specifics were readily available. All sorts of things were now possible, each device could be easily tracked and patients had a printed sheet with all the information about their devices and how to look after them.

1993 saw the European Union regulations for Medical Devices introduced, we had a few years to formally comply and we were fed information from government departments to prepare us. The information was very vague when answering specific questions such as does every device need a CE mark to be compliant? Central Council Organised a seminar in 1997 which was oversubscribed and we arranged for an expert to talk us through the procedures we would need. The meeting was a success, but personally I felt it was full of generalisations and not specific to our technology, so I went back to the directive and working my way through it. I listed what was needed by our technology to comply with the agreement. I designed conformity sheets, wrote out the safety sheets and the working protocols. Then they were all loaded into my new computer program which made the whole process quick and easy. Conformity printouts improved the presentation and record keeping in the lab and records and

Everywhere at this time people were struggling with implementing the directive and I took a display presentation of how I was tackling the problem to the 1998 OTA conference that year. There were at least three displays on Medical devices that year, one was by a commercial firm offering help and Chris Bridle (Chairman of OTA) had been working on his own computer based model which was attracting a lot of attention. Chris was expounding the virtues of spreadsheets and he had the sense to use a Microsoft spreadsheet to implement the program which does not become redundant when computer operating system change. I had a few enquiries about selling my program but I did not feel I was in a position to support the program at distant venues, although a few technicians local to me used it until they retired. Well I was getting to the end of my time as a technician but next time I will describe the bumpy start CC had with DTETAB and some of the problems they were facing. REFERENCE PTB Papers, CC Minutes

LEFT: Medical Devices Computer Program how it is organised ABOVE: OTA Conference 1998. Part of the table display

JOHN WINDIBANK FOTA • •

Senior Chief Technician at West Hill Hospital, Dartford, Kent. Represents OTA at CCHADT & Regional Delegate

PASSED POSTS:

• • •

Member of the first steering committee that founded the OTA. Founder Member of the CCHADT Member of the Whitley Council and Committees for 15 years.

• • • • • •

Dental Technology Representative on the National Health Service Training Advisory Board Member of the City and Guilds Dental Advisory Board Member BTEC Dental Technology Higher Awards Advisory Board Member DTETAB Representing MSF Teacher of Orthodontics at Maidstone & Medway Technical College. Vice Chairman OTA

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• • • • •

Chairman CCHADT Education Officer Minutes Secretary First Treasurer Member of SLC Dental Advisory Committee

HONOURS:

• •

Fellow of the OTA AE Dennison Award for services to Dental Technology

INSIGHT

Appeals were happening all over the country and we were constantly asked for help with submissions, this was OK as I personally sent them a copy of mine which would have been all right if they had read and amended them before submitting. Unfortunately, some did not read them which made thing awkward when they were asked questions. I sat in on one appraisal where the young man was doing a good job working alone and things were going well at his hearing until we came to his health and safety responsibilities and the panel belittled him with questions he could not answer and they tried to stop my intervention. I eventually made the point that if there was a lack of knowledge there was no lack of responsibility and it was the hospitals duty to ensure that all staff should have adequate training in safety matters.

DENTAL TECHNICIANS INSIGHT

DANGEROUS ROLE IN WW2 PART SEVEN

BY TONY LANDON

UTILIZATION OF THE MOBILE PROSTHETIC TRUCKS The U. S. Army Dental Divisions were expected to be delivered with modern dental laboratory equipped trucks that would offer to be able to undertake complete prosthetic technical work facilities near to assault combat zones. As early as July 1942, three mobile units were authorized. But the adequate provision of prosthetic services to all their military personnel throughout North West Africa and Europe proved to be one of the major problems the U. S. Dental Service could not fulfil as expected. Long before the first laboratory trucks were delivered to the U.S. Army across North West Africa or Europe considerable difficulty had been involved in deciding to whom they should be assigned. Their worth had not been proved to all those personnel in command structures. Apparently the forward Army Ground Forces didn’t want the additional responsibility of protecting additional non-combat personnel and their marquees, trucks and equipment near their front lines when they had their hands full with various other enemy activity. The responsibility controversy with their Army Ground Forces was avoided eventually by the recommendation that the mobile dental laboratories would be included with medical units. Thus the actual placement and all organisation of administration and supplies would become the responsibility of the U.S. Army Medical Department. The division dental section allocated mobile dental laboratory would consist ideally of; one, two and half ton cargo truck pulling a one ton trailer. Where available six half ton jeeps that could pull trailers. These were needed not only to ferry servicemen but to also carry supplies as the U.S. Army identified each dental division should be provided with at least ten identified numbered sixties Field Chests, a field kit for each dental officer and a personal kit for each of the dental technicians. The dental laboratory field sets with their hand-operated lathes were however not expected to provide large scale appliance production or repairs to dentures. Nevertheless the essential equipment and materials carted around in trailers brought basic laboratory facilities within close reach of the offensive soldiers.

A North American Army Service Mobile Dental Laboratory

Tony Landon worked with an ex-British Dental Corps dental technician who, when he was stationed in Egypt 1940’s, had the good fortune to have passed onto him for immediate usage German dental laboratory equipment that had been purloined off one of their mobile trucked dental laboratories. This truck was in a retreating convoy when it and its occupants were captured. The German dental equipment proved to be well engineered and the range of rotary burs and stones were of a better quality than those issued to British Dental Corps. THE REPORTED EVALUATIONS OF THE WW2 MOBILE DENTAL LABORATORIES The U.S. Army Medical Department’s general board made a study of their medical activities across Europe at the end of WW2. Their report noted a large number of mobile dental laboratories were required in warfare that involved rapid onward movement of assaulting troops. When such laboratory facilities were attached to fighting divisions they did provide uninterrupted dental care just behind the frontlines thus eliminating the total withdraw of the troop’s edentulous soldiers from divisional offensive areas of combat. The extreme value of the mobile type of prosthetic laboratory unit was proved beyond all question once the engagement frontlines had become extended beyond the point at which central hospital installations were effective in dealing with the orally wounded servicemen without undue time delay.

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However in spite of the success of the mobile dental laboratories, it would be a mistake to regard them as the final, universal answer to all prosthetic problems in the field of conflict. They had brought modern dental equipment and materials to just behind combat zones where they were needed. But, where mobility was of less importance, these prosthetic laboratory trucks could not equal the efficiency of larger, fixed centralised laboratories operating day after day under relatively stable conditions. Although it has proved difficult to obtain figures on the output of the prosthetic teams it has been recorded that five mobile units of the U.S. First Army completed an average of one and half cases per technician per working day over a five month period from 1944 into 1945. Compared to an average for large centrally based dental laboratory which produced two and a half cases per technician per working day. In defence of the mobile dental laboratories lower output. It was noted that the mobile units were admittedly crowded with all their necessary equipment, materials and primus stoves for heating water and polymerising resins, and their own water supply in fitted tanks. This left little clear bench top area to actually carry out laboratory procedures on appliances and restorations. These labs had to be ever mindful of over-riding orders that their trucks would be commandeered to carry essential supplies

or water for divisional emergency needs and support. Essential time was lost in moving their mobile units forward and days might elapse after a change of location before all troops across the extended frontline vicinity were notified that prosthetic services were again available in a new location.

It was further noted that whenever a prosthetic team could expect to be in a given location for any considerable length of time, a lot of their equipment and materials needed to be unloaded and set up in an available permanent shelter. It was therefore suggested that prosthetic teams assigned in the rear of combat zones or in other areas where frequent movement was less essential, should be supplied with cargo trucks and more general dental laboratory equipment designed for use in a building or a marquee-tented area. After the fighting through France, the U.S. First Infantry Division on reaching Belgium obtained a mobile dental laboratory and thereafter this combined prosthetic clinic

Inside the mobile dental laboratory converted bus

operated whenever it could count on a single day in any given location. The U.S. Ninth Infantry Division reported a mobile dental laboratory is essential to meet the prosthetic needs of this division. The U.S. Army gathered evidence indicated that even if the authorized ratio of one mobile prosthetic team for each 30,000 servicemen had been attained during WW2, the full dental laboratory needs of their armies and other major units would not have been met. Colonel Lynn H. Tingay, former dental surgeon of the Mediterranean Theatre of Operations, calculated that a single mobile dental laboratory team with a division would only deal with seventy five per cent of the prosthetic needs of the approximately 15,000 men of that unit. A single mobile dental

Colonel Tingay estimated that an army of nine divisions would need both a fixed dental laboratory and mobile facilities for handling the estimated 1,000 cases a month. To meet this situation he recommended that a dental prosthetic detachment of two dentist officers and six dental technicians per team be authorized for U.S. armies in the ratio of 1 team for each 100,000 servicemen. The necessity for supplying a highly mobile prosthetic service well forward in the combat zone was proved beyond all doubt, but the means by which it would be extensively rendered would probably need to be reexamined periodically in the light of changing conditions of warfare.

Tony’s comment. Now in 2018, it would be how many of our present day soldiers have dentures? Would today’s soldiers with dental implants and, or extensive ceramic bridgework cause more of a problem of being away from the combat zones for even longer if they became wounded or smashed their restorative dental work? Opportunity for readers to engage and have their views published! Write in and share your comments.

YORKSHIRE, WHY NOT?

Throughout the UK there are several regional study groups – so why not in Yorkshire? That’s the question that Prestige Dental kept asking. Canvassing laboratory colleagues, they were delighted to find that many agreed with them – in fact initial interest was overwhelming from technicians and KOL’s alike. So without further ado, Prestige has launched the Yorkshire Dental Study Group (YDSG) based on two simple aims: • To bring together like-minded dental professionals • For education and social networking

Director Paul Martin said: “Establishing my own career in the West End of London, I was surrounded by peers and colleagues in the profession who regularly met to catch up and chat through lab queries, developments and experiences. This exchange was invaluable and although things have changed - including the fact that I am now based up North! – we were keen to replicate this informal learning environment with like-minded professionals, wanting to stay up-to-date with dental technology – and meet locally.”

efficient, profitable Dental Laboratory in an ever changing market” on 23rd May 2019. Places are available to book now. With this level of enthusiasm, the YDSG looks definitely here to stay. So if you’re interested in being part of this exciting Yorkshire initiative, want more information or to book an event, email info@ydsg.uk Prestige Dental Ltd, 7 Oxford Place, Bradford, West Yorkshire BD3 0EF Tel: 01274 721567

With a fully equipped meeting room and presentation facilities for up to 40 at their offices in Bradford, Prestige were happy to host and cater for YSDG events. The first, on Thursday 15th November, got off to a flying start with a fascinating presentation and practical session, by the knowledgeable Richard Egan. 24 delegates booked for “Taking the myth out of dental photography”. The positive feedback and continuing interest means quarterly meetings (all CPD verifiable) are already scheduled well into 2019. The next event is on 28th February 2019 with Chris Wibberley discussing “Creating Natural Dentures”, followed by Ashley Byrne on “Running an

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INSIGHT

The dental professionals were mindful they needed to be near the battle front that was ever progressing, so that emergency procedures and care could be made available to injured soldiers as quickly as possible, but far enough away to avoid unnecessary injuries to all from shelling, mortar bombing or sniper fire.

laboratory component assigned to 30,000 army troops would only be able to complete around thirty five per cent of all needed dental prosthetic appliances and restorations.

DENTAL NEWS

DENTURES CAN FIGHT INFECTIONS IN OLDER ADULTS C ommon oral infections in older adults – such as candidiasis – can be prevented with ‘rechargeable’ bacteria-killing and fungi-killing dentures, designed by researchers at Manchester Metropolitan University.

and antifungal capability, simply by adding more silver to the dental resin. In addition, the resin fights bacteria and fungi without affecting the appearance of the dentures – so the wearer can have a healthy mouth and retain a good smile, with no discolouration.

Candidiasis is a yeast infection that affects many people who wear dentures, causing difficulty eating and drinking – and can lead to serious problems in the blood, heart, brain, eyes and bones.

Dr Lubomira Tosheva, a materials chemist and lead author of the research, said:“Oral infections commonly affect people who wear dentures, and can lead to serious healthcare problems, so it is crucial that dentures have the capability to tackle potential diseases at their root before they occur.

Led by Dr Lubomira Tosheva in the School of Science and the Environment and Dr Sladjana Malic in the School of Healthcare Science, an interdisciplinary research team has developed an acrylic resin for dentures that actively fights bacteria and fungi in the mouth. The dental resin uses a slow-release mechanism, enabling it to work consistently for 45 days. RECHARGING The researchers mixed silver – which has strong, active antimicrobial properties – with zeolite, a microporous material that enables and controls the slow, timed release of the antibacterial activity in the mouth. Dentures can be regularly ‘recharged’ with antimicrobial

“Our interdisciplinary team has successfully developed a new antimicrobial acrylic resin, made with zeolite and silver, which enables dentures to consistently kill oral bacteria and fungus – meaning that denture wearers can now maintain a healthy mouth without too much effort.” EFFECTIVE Dr Sladjana Malic, a Microbiologist from Manchester Metropolitan’s School of Healthcare Science, said: “We tested the dental resin for antimicrobial activity and for toxicity, ensuring that the materials have the

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capability to actively kill bacteria and fungi with no harm to humans. “The results showed that the antimicrobial dental resin is effective for forty-five days, and can be potentially recharged after this time with the addition of more silver. This new dental resin has exciting applications for the prevention of oral diseases such as candidiasis.” Taking too many antibiotics and antifungal medicines can make bacteria and fungi increasingly resistant to treatments, and antimicrobial resistance is a major global health threat – increasing the risk of developing serious infections that cannot be cured. This preventative approach kills bacteria and fungi before oral infections can occur, so avoids contributing to the growing and potentially devastating problem of antimicrobial resistance. REFERENCE Malic S, Rai S, Redfern J et al (2018) Zeolite-embedded silver extends antimicrobial activity of dental acrylics’, is published inColloids and Surfaces B: Biointerfaces. https://doi.org/10.1016/j.colsurfb.2018.09.043 Source: www2.mmu.ac.uk

A global taskforce of academic experts brought together by UK-based charity the Oral Health Foundation has announced new guidelines to address the needs an ageing population worldwide and tackle the wealth of inconsistent and contradictory advice on the best care of dentures. The need for people to have dentures is expected to increase dramatically over the next 30 years as the elderly population increases. It is predicted that by 2050 an estimated two billion people will be over the age of 60. More than double today’s figure. The taskforce labelled current recommendations on denture care ‘confusing’ and ‘unreliable’, adding that many claims lack valid evidence. As a result, the group of experts including representatives from the Oral Health Foundation and King’s College London, have launched a series of simple and effective guidelines on how to look after dentures. Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation believes the new guidelines will help end confusion about how dentures should be looked after. Dr Carter says: “We have found that people with dentures do not know how they should be cleaning them.

Our report shows that denture wearers use everything from soap and water to toothpastes, bleaches and commercial products. But with the variety of recommendations available online and from other sources, it is no surprise that people are confused. “The amount of inconsistent and often unproven advice about cleaning and maintaining dentures is frightening. Incorrect denture care can pose a real threat to both the oral health and general health of denture wearers. We hope these new recommendations can reassure people about the best way to look after their dentures.”

The project, which received an educational grant from GSK, featured a panel of independent and internationally recognised experts from the Netherlands, Belgium, Switzerland, Japan and the UK. The risks associated with poor denture care are wideranging and include inflammation of the mouth, staining, changes in taste and bad breath. It has also been linked to wider health problems such as pneumonia, particularly in the frail elderly. The new guidelines were launched at the FDI World Dental Congress, held in Argentina. “We will now be working with the NHS, local authorities, dental practices and GPs to help adoption of these guidelines across the UK,” adds Dr Carter. The older you get, the more likely you are to have dentures. With an aging population, the demand for correct and trustworthy information on how to look after them becomes even more important. Unclean dentures can have serious consequences to health. Please adopt these guidelines, whether you wear dentures, are a carer to someone that does, or you have a family member that wears them.”

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Higher Specialist Dental Technician Edinburgh Dental Institute Permanent, 37.5 hours per week Band 7, £33,222 - £43,471 per annum

Ref: NHSL/2018/1161/R1

A Higher Specialist Dental Technician is required to join the prosthodontic Section dental laboratory at the Edinburgh Dental Institute. You will be expected to provide a broad range of highly complex removable prosthodontic appliances for clinical staff and postgraduate students. You will demonstrate a high level of manual dexterity and be proficient in the production of a full range of complete and partial prosthesis in both acrylic and cobalt chrome. Experience in the construction of cleft and obturated prosthesis is essential as is a working knowledge of implant retained prosthesis and working knowledge of CAD/CAM systems. You should possess good communication and organisational skills and show a commitment to quality. You must be qualified with BSc or equivalent qualification in Dental Technology plus post graduate qualification in prosthodontic technology and be registered with the General Dental Council. Working in a Hospital based production Laboratory would be beneficial. For enquiries please contact Mark McFadyen on 0131 536 4935. Closing date: 19 December 2018 Apply on-line www.jobs.scot.nhs.uk.

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DENTAL NEWS

NEW GUIDELINES FOR DENTURE ARE TO BE PUBLISHED SAY THE ORAL HEALTH FOUNDATION

COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE KEMDENT FOR GREATER ACCURACY THIS CHRISTMAS w During December, Kemdent are offering a fantastic discount on Kemsil Precise Lab Putty. Buy a 2 x 4.5kg Kemsil Precise Lab Putty for only £53.68 each + VAT RRP: £67.10 + VAT. A distinct advantage of Kemsil Precise addition-cured lab putty is that there is no messy catalyst. It mixes quickly in the hand to produce a very workable putty with a pliable consistency. It is a two-part putty with shore A hardness 90. Kemsil Precise Lab Putty sets in just 5 minutes. It has 70% less shrinkage than condensation cured putties. Offering excellent accuracy, it is ideal for the production of copy denture moulds and processing denture repairs, construction of partial dentures and cold curing CoCr saddles. Take advantage Kemdent’s special Christmas offers, call Kemdent on 01793 770256 or visit our website www.kemdent.co.uk

SHOFU DURABLE AND COLOUR-STABLE HYBRID CERAMICS IN TWO LAYERS AND THREE TYPES

w Whether aesthetic anterior restorations or inlays, onlays and posterior crowns with high colour and surface stability: Shofu Block HC can be used for almost all indications for modern CAD/CAM technology and machined wet or dry in all standard milling units.

Shofu has added two-layer blanks to its line of hy-brid ceramics and fitted blocks with universal holding pins. So Shofu Block HC, a high-performance CAD/CAM material, is now available in three types (Universal, Cerec and Ceramill) and as one and two-layer blocks. Users may choose from various high and lowtranslucency shades and two enamel shades, designed to reliably meet every need in the field of all-ceramic resto-rations. The excellent physical properties of Shofu Block HC allow to make crowns and im-plantsupported restorations characterised by great durability and absorption of oc-clusal forces. Moreover, highly aesthetic restorations can be

created thanks to enamel-like light transmission and the addition of two-layer blocks featuring a smooth, natural shade transition from dentin to enamel. In combination with the HC Primer, which ensures very high bond strengths thanks to its unique infiltration effect, and SHOFU’s gentle polishing and luting systems, a CAD/CAM restoration system with perfectly matched components is provided – for all modern milling units, aesthetic requirements and clinical indications. For further information, please contact Shofu UK on 01732 783 580, email: sales@shofu.co.uk

VITA EVEN CLOSER TO YOU: YOUR TRUSTED PARTNER IN THE UK w VITA has been the reliable partner of technicians and dentists around the globe for over 90 years, providing both materials and technology. VITA’s aspiration is to inspire and support professionals to be able to deliver the most esthetic, functional and long-lasting restorations with an efficient protocol to their patients. To accomplish this mission, VITA provides precise

communication means between the dental lab and practice, based on an accurate digital and visual tooth shade determination. With its high quality, metal-free restoration materials and reliable equipment for shade reproduction, VITA enables technicians and dentists to achieve clinical and economic success.

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Get in touch with your ‘perfect match’ on Facebook or get more detailed information from our representatives and on www.vita-zahnfabrik.com VITA Specialist: Mrs. Nilou Sotouhi Mobile: +44 7725 8710 71 Email: n.sotouhi@vita-zahnfabrik.com Order Department & Customer Service: Mrs. Nicole Vogt Phone: +49 7761 562-281 Email: n.vogt@vita-zahnfabrik.com

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DENTAL NEWS

WHAT DO YOU KNOW ABOUT MOUTH CANCER? WHAT SHOULD YOU KNOW ABOUT MOUTH CANCER? KNOWING THE DANGERS WILL HELP YOU DECIDE AROUND 90 PER CENT OF ALL MOUTH CANCERS ARE LINKED TO LIFESTYLE CHOICES SUCH AS SMOKING AND DRINKING ALCOHOL TO EXCESS

e have just come through November, which was mouth cancer awareness month across the U.K. As technicians we often have the opportunity to help raise awareness amongst patients who we may be meeting directly with, for example, the standard denture repair. Sometimes the denture is obviously not been looked after and is in very poor and sometimes, dirty condition. Be aware that hard deposits on the fit surface of the denture, is a potential irritant, which can lead toto to soft tissues being inflamed. That inflammation, if not addressed can become the source of a potential cancer. While I am not asking any of you to diagnose oral cancer it might be good to have on hand the information leaflets which make patients and their relatives aware of what mouth cancer is and how to check for it. Without you even looking in the patient’s mouth they may volunteer something about a sore spot that won’t go away. Loose dentures can also act as an irritant. Life style choices such as excessive smoking and drinking can contribute greatly to the risk. The problem with mouth cancer is it needs to be detected early in the disease process. It often begins as a small spot, on the soft tissues of the mouth, which may slowly enlarge as the first sign and should be investigated. Caught early the disease is controllable or curable. But left late, and most oral cancers, seem to be, it can result in death or severe disfigurement. Even those patients who have had the tumour removed will face much more complicated restoration options and a continuing increased cost (said to be on average 23 times the normal annual dental care costs). Mouth Cancer is mainly age related, particularly affecting older men, but in recent years, drinking and smoking to excess has become almost normal across the age range so younger people are exposing themselves to the risk. Because of the foolish policy of administering the HPV Virus Vaccine to girls only, many young men are now showing signs of oral cancer and many other related conditions. The Government have finally accepted that the vaccine should be made available to teenage boys from 2019. Very good but we have quite a few years of catching

up to do. The fact that the boys have not been vaccinated has increased the infection rate among teenage girls through social activities. Overall the age of mouth cancer victims is going down and the numbers are going up. Those who know best about this terrible disease will say that the life style which includes heavy drinking and smoking is the biggest cause of the disease. Starting simple regular checks of your soft tissues. Plus awareness not to let the small irritating spot on your tongue or your cheek, which stays around, be ignored. Unfortunately the HPV vaccine will not automatically be included in Northern Ireland for boys. They seem to have decided they don't need it. They are very wrong. For your own sake and that of your family, friends and co- workers, go online to the Dental Health Foundation Website and down load the report. It tells of the risks and what to look for in your own mouth. Take 30 minutes out of your life and spend it learning how you may be able to save someone from suffering from oral cancer. Teach your fellow technicians and staff and encourage patients who turn up for a quick repair to talk about on-going irritations etc. If you sense the patient may well have a problem then you should refer them for a check. People know you work in dentistry and may listen to you. I do

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think that gives you a responsibility to pass on your knowledge. It could save a life. Those of you who are CDTs will already have been trained to keep an eye out for the signs but they are not always easy to interpret. But checking and catching the disease early is the very best approach and passing on the habit of regular checks of the soft tissue by your dentist or hygienist or whomever you see, is the best safeguard. But do make sure that whenever you have your dental check-up your clinical colleague is checking your soft tissue for early signs and symptoms. You might be advised to mention it to ensure it is done. Tooth decay probably won’t kill you but oral cancer certainly will in the majority of cases. Catching it early or avoiding it, are the very best options. Ask your Max Fac. Friends who work on these cases. The pressure they face and the patients they see are probably the reason why there is a higher than normal suicide rate for these particular technical colleagues. The tragedy is that ignorance is the main contributory factor to the growing death rates. Help change that, make your friends and family aware try to avoid it affecting your life. Talk about it at work and at home. Raise awareness, it could save a life and possibly the life of someone close to you.

DENTAL NEWS

A SIMPLE GUIDE TO HELP WITH:

CHECKING FOR MOUTH CANCER

Reproduced from the Oral Health Foundation website www.Oral Health Foundation.org

eating mouth cancer is so dependent on diagnosing it at an early stage. If it is caught early, the chances of surviving mouth cancer are nine out of ten – those odds are pretty good, and that’s why early detection is so important.

is any change in colour. They will run their ﬁnger on the roof of your mouth to feel for any lumps. Tongue Examine your tongue, looking at the surface for any changes in colour or texture. Stick out your tongue or move it from one side to another, again looking for any swelling, change in colour or ulcers. Finally, take a look at the underside of the tongue by placing the tip of your tongue on the roof of your mouth.

Sadly, far too many mouth cancers are not spotted early enough. Mouth Cancer Action Month promotes the message ‘If in doubt, get checked out’. We encourage everybody to be mouthaware and pay more attention to what’s going on inside the mouth. Most importantly, if you notice anything out of the ordinary, it is essential that you tell your dentist or doctor immediately. CHECKING FOR MOUTH CANCER As mouth cancer can strike in a number of places, including the lips, tongue, gums and cheeks, and given that early detection is so crucial for survival, it’s extremely important that we all know what to look out for. Three signs and symptoms not to ignore are: • Mouth ulcers which do not heal in three weeks

• Red and white patches in the mouth • Unusual lumps or swellings in the mouth or head and neck area

When checking for signs of mouth cancer you should follow the following routine: Head and neck Check if both sides look the same and search for any lumps, bumps or swellings that are only on one side of the face. Feel and press along the sides and front of your neck being alert to any tenderness or lumps to the touch.

Floor of the mouth Look at the floor of the mouth for changes in colour that are different than normal. Press your finger along the floor of your mouth and underside of your tongue to feel for any unusual lumps, swellings or ulcers. If you find anything unusual in any of these areas, or are unsure of anything, visit your dentist or doctor as soon as possible. HOW CAN MOUTH CANCER BE DETECTED EARLY? Mouth cancer can often be spotted in its early stages by your dentist during a thorough mouth examination. This happens during your routine dental check-up.

Lips Pull down your lower lip and look inside for any sores or changes in colour. Use your thumb and forefinger to feel the lip for any unusual lumps, bumps or changes in texture. Repeat this on the upper lip. Cheek Use your finger to pull out your cheek so that they can see inside. Look for red, white or dark patches. Then place your index finger inside your cheek, with your opposing thumb on the outside gently squeeze and roll the cheek to check for any lumps, tenderness or ulcers, repeat this action on the other cheek. Roof of the mouth With your head tilted back and mouth open wide, your dentist will look to see if there are any lumps or if there

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VERIFIABLE ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN MODEL CASTING WITH ADDITIVE MANUFACTURING Q1. What is it better know as? A. Split Model Technique B. Pin Model Technique C. 3D Printing D. Duplicate Model Technique Q2. What percentage of material is wasted with this Laser melting technique? A. 23% B. 0 % C. 16% D. 27%

DENTURES CAN FIGHT INFECTION IN ADULTS. Q9. What ingredient is said to have a strong active antimicrobial property? A. Zeolite B. Microporous material C. Silver D. Candidiasis Q10. How is the material contained within the denture? A. A capsule in the base B. Part of the resins chemical makeup C. Applied to the surface at regular intervals D. Within the teeth section

Q3. What number of units, are predicted to be produced by 2025? A. 22.000 B. 27,000 C. 12,000 D. 15,000

NEW GUIDELINES FOR DENTURE WEARERS. Q11. What is the estimated number of elderly by 2050. A. 1.5 Billion B. 2.0 Billion C. 0.5 Billion D. 3.0 Billion

CEMENTATION OF ZIRCONIA Q4. What is noted as the second requirement for modern indirect restorations? A. Flexibility B. Aesthetics C. Durability D. Low sintering temperature

Q12. Who part financed the study? A. The British Dental Association B. The British Hygienists Association C. GSK D. University of London

Q5. What thickness is required of the aesthetic Zirconia in the labial section. A. 1mm B. 1.1 mm C. 0.8mm D. 0.5mm THERMO-PLASTIC MATERIALS WITH MODERN TECHNIQUES Q6. How many polyetheretherketone implants are quoted as been used in the last 15 years? A. 569 B. 15,000 C. 4,000,000 D. 1,200,000 Q.7. A. B. C. D. Q8. A. B. C. D.

What caused the failure of bonding? Poor adhesives Mismatch of Elastic modulus High temperature of manufacture Injection moulding technique

What was the bond strength of PEEK when measured at the University of Revensburg Germany? 10 MPa 2,354 N 1,702 N 300. MPa

Q13. A. B. C. D.

Where were the new guidelines launched? University of Manchester University college London The FDI World Congress Argentina The World congress of Pharmacology Paris

WHAT DO YOU KNOW ABOUT MOUTH CANCER Q14. How many people died from mouth cancer in the U.K. in 2017? A. 2,722 people B. 1,309 people C. 1,843 people D. 3,700 people Q15. How many people were diagnosed with mouth cancer in 2017? A. 2,722 people B. 4,701 people C. 8,302 people D. 6,907 people Q16. How can you best protect yourself from the disease? A. Avoid heavy drinking and smoking B. Have regular soft tissue check-ups C. Be aware of any unusual lumps or spots in your mouth D. Check your own mouth head and neck for possible symptoms

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DENTAL NEWS

ADG STATEMENT ON PROFESSION-WIDE COMPLAINTS HANDLING INITIATIVE By David Worskett, ADG Chair

“The Association of Dental Groups (ADG) was more than happy to be a part of the Working Group for this Profession-wide Complaints Handling Initiative. We fully support its aims in trying to make the process by which patients provide feedback on their dental care provider clearer to both patients and dental professionals. Streamlined protocols are important for the swift and satisfactory resolution of any patient concerns, benefitting all parties involved. ADG members will certainly be actively participating by displaying the available posters and leaflets within their practices and we encourage all other practices to do the same. We believe this will be a vital step towards improved communication between patients and dental care providers, ultimately enhancing the dental services and standard of care available across the profession.”

ADG SUPPORTS COMPLAINTS HANDLING INITIATIVE The Association of Dental Groups (ADG) has been participating as part of the Working Group for the GDC’s Profession-wide Complaints Handling Initiative in an attempt to improve the process by which patients raise concerns about their dental care. David Worskett, ADG Chair, commented: “Streamlined protocols for the swift and satisfactory resolution of patient concerns will benefit all parties involved. ADG members will be displaying the available posters and leaflets within their practices and we encourage all others to do the same. We believe this will be a vital step towards improved communication between patients and dental care providers, ultimately enhancing the dental services and standard of care available across the profession.” For more details about the ADG visit www.dentalgroups.co.uk

DCPS RISK REMOVAL FROM REGISTER OVER NON-COMPLIANCE By Dental Tribune UK, October 22, 2018 LONDON, UK lNearly 900 UK-based dental care professionals (DCPs) could be at risk of removal from the register after failing to make a compliant continuing professional development (CPD) statement to the General Dental Council (GDC).

All DCPs on the 2013–18 CPD cycle, which concluded on 31 July 2018, were required to submit a compliant CPD statement by 28 August 2018. The GDC has reported, however, that there were almost 900 non-compliant DCPs after the deadline had passed and that the regulator was still trying to contact them.

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A spokesperson for the British Dental Association said that it was encouraging dental practices and DCPs to immediately check whether any staff members had reached the end of their CPD cycle in July and, if so, that they had made an end-of-cycle CPD statement.

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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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