The Dental Technician Magazine September 2019 by The Dental Technician Magazine

VO L 7 2 N O. 9 I S E P T E M B E R 2 0 1 9 I B Y S U B S C R I P T I O N I www.dentaltechnician.org.uk

NEW! READERÂ´S LETTERS PAGE 24

DENTAL TECHNOLOGY ALL ON 4 WORKFLOW BY MATTEO NERONI PAGE 8-9

INSIGHT

THE TECHNICIANS MERIT AWARD SCHEME PAGE 22-23

CLEAR ALIGNER THERAPY

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

BEGIN WITH THE END IN MIND BY KEN FISCHER PAGE 10

E X T E N D

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CONTENTS SEPTEMBER 2019

Editor - Larry Browne FBIDST. FDTA, ITI Fellow, LCGI, RDT. E: editor@dentaltechnician.org.uk T: 01372 897461

Welcome

Designer - Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com

Marketing

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.

Marketing By Mike Bond

Dental Technology All On 4 Workflow By Matteo Neroni Clear aligner therapy By Ken Fischer Periodontitis and peri-implantitis prophylaxis through sealing the superstructures

8-9 10 16-17

Dental News 12-13 14 20 21 25

Oral appliances & sleep apnoea Dental Doris Oral Health Foundation - denture adhesive use guidelines UK government announces plan to eliminate smoking by 2030 Align Technology launches first pop-up store

DTS 2020 17

2020 dates for the diary

Focus 22-23

The Technicians Merit Award Scheme

Insight

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NEW! Letter to the Editor

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THOUGHTS FROM THE EDITOR

WELCOME to your magazine THE AUTUMN IS UPON US SO HEADS DOWN AND EARN; FOR THE WINTER AND CHRISTMAS

We are coming up to the time of year when the work should be coming in and there is lots of activity from the companies to get us interested in their products. September will give us our first large scale viewing with the London Dentistry Show at Olympia on Friday 13th and Saturday 14th. Lots of the companies have taken stands and will undoubtedly have the “miracle product” that almost saves having to do any work at all!! But I am sure it will be an opportunity to sample some of London’s delights and perhaps try for a Show in Theatreland or perhaps a really nice meal with all the trimmings. There is an interesting lecture programme with quite a lot of attention to the digital dental areas. You may even win £50.00. in Amazon Vouchers, just by turning up.

approaching one of the awards you just need to nominate yourself and wait.

If you miss that there is always the prospect of a trip to the NEC for the BDIA Dental Showcase October 17th 18th and 19th, which will obviously feature all interested members of the Trade organisation. A lecture programme with a wide spread of speakers will add to the interest. And undoubtedly the latest innovations for dental design and manufacture. It is a bit traditional in that it does not feature many stands of interest to technicians but there are one or two technician speakers on the programme. Undoubtedly the companies who feature products for both technician and clinician will undoubtedly be there. Two days at the NEC meeting old friends and some new ones may be a good thing to do with that time in October.

I have started the Letters Page this month with a bit of a reminisce from one of our long-term readers, James Bennet. James has kindly forwarded a copy of an older submission of his in 1984 and it all make for an interesting story. For those of you like James who are ex RADC there is a reference and information about Aldershot training and facility. It would be good to re-start an active letters page which in turn should lead on to a relevant small adds and Jobs page. If you have a gripe or a bit of new news of something about a new product or technique just send an e mail to larry@lsbrowne.com or if you prefer, send a letter. Hopefully you are all ready to respond. My call goes out to all of you for instances of jobs and cases to feature in the magazine. Single tooth restorations up to full arch restorations are all welcome. Please submit as much a you can.

We are beginning to see the ads for the various dental awards which will be coming thick and fast from September onwards. Starting with the Oral Health awards to be awarded on November 29th. at the Royal Garden Hotel London. No doubt an enjoyable evening to be had by all. The Laboratory Awards 2019 will be at the same venue on November 29th. The following week on the 6th December the Private Dentistry Awards take place at the same venue in London. So quite a lot to keep up with and if you are interested in

Interestingly if you have been following my attempt to get information from the GDC and MHRA I have still not received a reply from Mr Ian Brack, or even one of his aides at the GDC, to my letter which was featured in this magazine and sent in February. The letters receipt at the GDC was acknowledged but not a word more has come back. Mr Ian Brack must be exceedingly busy not to have time to address the questions raised on behalf of our readership! It has been Six Months and still nothing. You would almost think we were not considered important enough to require a reply. It does make you wonder who may be important enough? Are You?

Brexit is coming at us fast but without the least explanation of what we need to do to maintain our businesses. How much will a no deal cost on imports? What goods may we not have access to after the Brexit deadline? What will it mean for those labs working for clients overseas? What will it mean for overseas workers who are working here but originate from other countries and do not have a British Passport? What may it

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mean for their wives and family who may be here with them? A strange situation which does not seem to serve any purpose for those of us working hard in this country. We may get an answer sometime in the near future, but I do suspect it will be long after the event and totally lacking in any measurable detail. If any of you think you know please let us all know by writing into the Magazine. Brexit may encourage us to wave the flag, but to what purpose? There is something to think about after Brexit. We can choose to ignore the European guidelines and laws on a lot of everyday things. The Politically motivated groups with axes to grind may well move towards a self-change in some of the regulations we have come to rely on. The thing that springs to mind with me is the potential for out registration status to be interfered with. The present situation, which allows the executive to ignore perfectly reasonable requests for information, may become the norm. It is fairly obvious that considering the status of Technicians is below their consideration. Will they bring in a change to the present registration process? The present registration, we should all remember, is designed to protect the patient. It is clear that the dental, powers that be, are in fact not interested in the patients’ legal requirements. The legislation stressed the need for the patient to be informed but in practice the dentist is in general ignoring that requirement. The statement of manufacture is the first step in the information trail needed to inform them. Not only are many technicians not including the SOM with their work, but the dentist is ignoring many of the statements that have been sent, with many of them coming back in the delivery box. Unlicensed laboratories run by unregistered personnel are busily supplying many practices with their restorative needs. In other words, Illegal workers making illegal appliances. Will the active political Dental bodies move to remove the need for a Statement and completely nullify the patient rights. Just as it was before the legislation changed? Watch this space.

Larry Browne, Editor

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MARKETING

MIKE BOND – DENTAL MARKETING SPECIALIST MARKETING

l Mike is a self-employed marketing consultant who has worked

in the dental and healthcare sectors for over 25 years.

WHO COULD BE EATING YOUR LUNCH?

MIKE BOND DISCUSSES HOW WE ALL NEED TO CONSIDER MARKET CHANGES TO PROTECT OUR FUTURE

n these highly competitive times, we need to consider who might be trying to eat our lunch and It might not be just another dental lab. Many of the large corporations like Straumann and others are starting to offer direct to dentist services offering to produce all kinds of restorations from Orthodontics to implants and everything in between. Who Moved My Cheese? By Spencer Johnson is a motivational business fable which describes change in work and life, and four typical reactions to those changes by two mice and two "little people", during their hunt for ‘cheese’. A New York Times business bestseller upon release, Who Moved My Cheese? remained on the list for almost five years and spent over 200 weeks on Publishers Weekly's hardcover nonfiction list, selling more than 26 million copies worldwide in 37 languages and remains one of the best-selling business books of all time. Allegorically, Who Moved My Cheese? features four characters: two mice, "Sniff" and "Scurry," and two little people, human metaphor, "Hem" and "Haw." (The names of the little people are taken from the phrase "hem and haw," a term for indecisiveness.) They live in a maze, a representation of one's environment, and look for cheese, representative of happiness and success. Initially without cheese, each group, the mice and humans, paired off and travelled the lengthy corridors searching for cheese. One day both groups happen upon a cheese-filled corridor at "Cheese Station C." Content with their find, the humans establish routines around their daily intake of cheese, slowly becoming arrogant in the process. One day Sniff and Scurry arrive at Cheese Station C to find no cheese left, but they are not surprised. Noticing the cheese supply dwindling, they have mentally prepared beforehand for the arduous but inevitable task of finding more cheese. Leaving Cheese Station C behind, they begin their hunt for new cheese together. Later that day, Hem

him, and he is able to continue his search. Haw realizes that the cheese has not suddenly vanished but has dwindled from continual eating. After a stop at an empty cheese station, Haw begins worrying about the unknown again. Brushing aside his fears, Haw's new mindset allows him to again enjoy life. He has even begun to smile again! He is realizing that "When you move beyond your fear, you feel free." After another empty cheese station, Haw decides to go back for Hem with the few bits of new cheese he has managed to find. and Haw arrive at Cheese Station C only to find the same thing, no cheese. Angered and annoyed, Hem demands, "Who moved my cheese?" The humans have counted on the cheese supply to be constant, and so are unprepared for this eventuality. After deciding that the cheese is indeed gone, they get angry at the unfairness of the situation. Haw suggests a search for new cheese, but Hem is dead-set in his disappointment and dismisses the proposal. Meanwhile, Sniff and Scurry have found "Cheese Station N," and new cheese. But back at Cheese Station C, Hem and Haw are affected by their lack of cheese and blame each other for their problem. Hoping to change, Haw again proposes a search for new cheese. However, Hem is comforted by his old routine and is frightened about the unknown. He knocks the idea again. After a while of being in denial, the humans remain without cheese. One day, having discovered his debilitating fears, Haw begins to chuckle at the situation and stops taking himself so seriously. Realising he should simply move on, Haw enters the maze, but not before chiselling "If You Do Not Change, You Can Become Extinct" on the wall of Cheese Station C for his friend to ponder. Still fearful of his trek, Haw jots "What Would You Do If You Weren't Afraid?" on the wall and, after thinking about that, he begins his venture. Still plagued with worry (perhaps he has waited too long to begin his search...), Haw finds some bits of cheese that nourish

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Uncompromising, Hem refuses the new cheese, to his friend's disappointment. With knowledge learned along the way, Haw heads back into the maze. Getting deeper into the maze, inspired by bits of new cheese here and there, Haw leaves a trail of writings on the wall ("The Handwriting on the Wall"). These clarify his own thinking and give him hope that his friend will find aid in them during his search for new cheese. Still traveling, Haw one day comes across Cheese Station N, abundant with cheese, including some varieties that are strange to him, and he realizes he has found what he was looking for. After eating, Haw reflects on his experience. He ponders a return to see his old friend. But Haw decides to let Hem find his own way. Cautious from past experience, Haw now inspects Cheese Station N daily and explores different parts of the maze regularly to prevent any complacency from setting in. After hearing movement in the maze one day, Haw realizes someone is approaching the station. Unsure, Haw hopes that it is his friend Hem who has found the way. There is no stopping market advancements, but dental laboratories and technicians need to start to consider how market changes will affect them in the future and how they monitor and understand these changes will be an important factor in survival of their businesses. Perhaps take a read of ‘Who move my cheese’ and consider the future!

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DENTAL TECHNOLOGYY

ALL ON 4 WORKFLOW BY MATTEO NERONI

fter several years of total rehabilitation based on four implants, Its popularity has grown and is now accepted as an attractive and successful method of rebuilding the edentulour case.

is able to do with this type of planning; in this specific case in FreeHand (Fig.4) Fig. 4

The fundamental basis of this rehabilitative procedure is planning by means of photographs and RX ( Radiographs). In this first step, an AO4 example of the Mascellar Superior (Maxilla), the dentist alongside his/her dental technician will evaluate the possibility of a bone reduction. This type of evaluation is done by overlaying multiple images of the patient with a frontal photograph of the RX, with which one is able to plan where the new transient line can be found in an extremely accurate way after bone reduction. The patient with a Class11. smile line who is exposing too much of the Gingival tissues. (Fig.1) At this point, facial planning begins. (Fig.2)

Fig. 1

at this point, when you have all the information necessary, you can proceed to the next step. CAD STAGE Once you have entered all the data in the CAD, you go back to work on the golden proportions modifying the blue areas in the 3D scan of the starting prototype (Fig.6). Fig. 6

This type of planning, as I said, succeeds in satisfying the functionality in relation to aesthetics by deciding the inclination of the implants and the exit of the screw channel, while avoiding vital structures (tongue) in the mouth so as not to compromise the harmony of the reconstruction. This is the typical technique of immediate loading by conversion of a total prosthesis, inside which a bar welded to TMC1 will be inserted. After a period of 3 to 6 months necessary for osseointegration of the implants, the patient returns to the clinic to scan the prototype that had been worn during the healing period. New photographs are taken with the prototype in place, as well as 3D facial scans. (Fig.5)

I will now insert my virtual teeth into the CAD space using libraries from which I will select the appropriate set up and aesthetics. Following all the lines I have traced, respecting the proportions and symmetries. I can at this stage change and alter the virtual tooth set up to manage lip support or arrangement or appearance. (Fig .7)

Fig. 2

After the planned bone reduction, the patient's new smile is virtually designed, respecting the golden proportions, the correct curves, and masticatory functions (Fig.3)

Fig. 7

Fig. 3 Fig. 5

This step is extremely vital and fundamental for the laboratory for the success of the case.

After surgery and correct planning, both aesthetic and functional, this is an example of the post-operative AO4 where the perfect symmetry and accuracy is shown, in the position of the implants, which the clinician

The 3D facial scan reveals the exact inclination of the Maxilla and how much lip support our patient has. Facilitating the positioning of the new arch in the virtual space. In the meantime my laboratory will prepare a confirmation Gig, to make sure that the implants are firmly in the starting position. It is

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Once the 3D planning of my reconstruction is complete and after approval by the clinician, milling or 3D printing of a further resin prototype is performed. This is necessary for the patient to approve the aesthetics and comfort and for the clinician to adjust as necessary. Carefully balancing occlusal function, for the patientâ&#x20AC;&#x2122;s comfort. The clinician can change or note patient required changes, and pass them on, for the technician to proceed with the milling of the definitive reconstruction of the complete zirconia arch.

This step enhances the craftsmanship of this craft that comes from, the old school, through the sculpting of Zirconia by obtaining detailed surfaces with regards to textures and separations, giving life to our zirconia block. (Fig.8)

Personally, as a dental technician, I pay a lot of attention to the details in this specific step. For me every Toronto that I sculpt and colour is as if one creates a small work of art every time, that is one-of-a-kind, unrepeatable, unparalleled, and alive! Striving to fully satisfy the aesthetic need of the patient I find myself in front of and carefully selecting the type and shape of my arch, which will fill and soften the visual context for the patient.

DENTAL TECHNOLOGYY

GREEN STAGE I personally think that the green stage is of vital importance. I call it "The Key", in this step the true artistic vein that lies behind the digital figure of modern dental technology emerges.

Why pay more?

FINALIZATION In this step, the only part on which I apply porcelain is on the gum.

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The latter gives vitality and naturalness to my rehabilitation, and with a special colour guide, most of the times I can mask the transition line between fabric and Toronto.

Fig. 8

The care of the gingival surface and the harmonic exit of the tooth from it are of vital importance, giving a three-dimensional effect to our block, which aims to keep and imitate the natural aspect in every little detail. After the sculpting phase there is the colouring of the zirconia, using colours that imbue the surface, thus creating a play of light, shadows and shades. This is to better customize our reconstruction, making it extremely true to what the patient originally had. (Fig.9) (Fig.10)

The surface of the teeth is treated with Basic glaze only, since with the colouring in the Green-stage where I can achieve a natural effect it seems useless to intensify something that is already natural in itself. (Fig.11) In my opinion, the optimal success of a Toronto on an aesthetic level, is precisely finding the right balance between the two distinct parts of the gum and teeth, treating them as two distinct and separate identities. But with the correct relationship between them, they make my every Toronto unique, as unique as the patient who will wear it to smile.

Fig. 11

Fig. 10

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Fig. 9

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DENTAL TECHNOLOGYY

CLEAR ALIGNER THERAPY: BEGIN WITH THE END IN MIND By Ken Fischer, USA I April 28, 2016

“Visualise the end before you begin” In a recent publication in the American version of the Dental Tribune an article on Orthodontics using clear Aligners was published by a recognised and respected Orthodontic specialist Clinician Dr Ken Fischer from California USA. He recalls that his Ortho journey began with wise words from his practice principals, Dr Robert Ricketts and Dr Ruel Bench who emphasised you should begin with the end in mind. It is one of the startingly obvious differences which exist in everyday dentistry between clinician and technician. For a technician to succeed in producing the desired restoration or appliance, they have to know what is going to happen to the teeth once the restoration is fitted. Otherwise they dare not start. To me it is the clearest reason ever for Technicians to be respected as part of the restorative team and the ability to see the end at the beginning is what separates the best from the ordinary. Knowing the end result is a combination of the inherent three D awareness built up over many years and a real understanding of the clinical process and the natural reaction process of teeth and associated tissues.

icketts and Bench developed and promoted the Visual Treatment Objective, or VTO, as a technique to create that visualization.

Today, the emergence of clear aligners as an accepted modality for orthodontic treatment has brought us the digital VTO in the form of a treatment setup. Once the software technician has manipulated the original digital models to represent a satisfactory treatment goal, not only is the new occlusion visualized but the sequential pathway from beginning to end animates how the teeth will move to arrive at their destination. This is precisely what the Diagnostic wax-up is all about whether it is digital or analogue. With the digital model the experienced technician can virtually create the desired result but with the advantage of recognising whether it is right or wrong. The inherent 3D vision of a welltrained technician is part of the job. Having a supportive clinical awareness and knowledge makes the outcome much more secure. Good communication and understanding of the clinician’s choices and desires for the patient, is essential but not always available. Anyone who has moved teeth with clear aligners understands just how important it is for the clinician to master the nuances of the treatment setup. This mastery begins with the information and direction the clinician provides the technician before the software moves a single tooth. Many of the computer driven processes are often just making sure the information, often missing in day to day dentistry, is included in the software package. The computer programmer has the advantages of access to the technical knowledge as well

As with the traditional method of Diagnostic Wax-up or Set-up the clinician’s judgement as to the suitability of the proposed corrections or changes is paramount. Once the original treatment setup is completed, the doctor must approve it to say it is right and will bring the result for the patient. Does it meet the clinician’s objectives for occlusion, interdigitation, appropriate tooth relationship? Will it provide the overbite and overjet, rotation correction, staging of treatment time and facial aesthetics? If the criteria are met, the setup is approved and the fabrication of the aligners begins; if the doctor rejects any part of the setup, the doctor submits his objections and instructions for correcting or improving the identified issues and the setup is revised. Within a couple of days, the review process is repeated. As would be the case with traditional methods. The major advantage of Digital techniques is they do not charge a fee for preparing the treatment setup or even multiple setups in case the doctor would like to visualize alternative treatment plans, e.g., in borderline cases where extraction may result in a more favourable result than non-extraction. Once the clinician has invested in the intraoral scanner and the computer hard and software, they are of course able to call on the software to carry out most of their wishes. The shortcoming will be the ability of the clinician to understand the desired pathway for the end result. As with the traditional diagnostic system showing the patient the proposed outcome will very often stimulate a more serious patient commitment to the treatment process. A big advantage of the Digital process is the inherent ability for visualisation of the process and of the proposed finished result.

PICTURED RIGHT: Photo provided by Ken Fischer, DDS

as the clinical requirements and combines the two from the beginning of the treatment planning. Strangely the better the computer software combines these essential groups of knowledge the more attractive it becomes. Yet it just underlines the essential for good communication between clinic and laboratory. Software packages such as ClearCorrect or Invisalign are often lauded because they automatically combine the necessary knowledge as part of their software.

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DENTAL NEWS In addition to CPAP, an oral appliance may be an effective first-line treatment for some types of sleep apnoea. (PHOTOGRAPH: AMERICAN THORACIC SOCIETY)

ORAL APPLIANCES l

MAY BE HIGHLY

EFFECTIVE IN

TREATING

NEW YORK, U.S.: Certain traits may define a type of obstructive sleep apnoea (OSA) that can be effectively treated with an oral appliance, according to new research. Continuous positive airway pressure (CPAP) is considered the gold standard for preventing the obstruction by blowing air through a mask into the nose and throat. However, many patients have trouble sleeping with CPAP. For these patients, an oral appliance that moves the lower jaw forward to prevent the periods of obstructed airflow offers an alternative.

OBSTRUCTIVE

In a recent study, scientists used a clinically applicable method to estimate the traits that cause sleep apnoea from routine polysomnography, the test used to diagnose sleep apnoea. In the process, they identified five traits that appear to determine the effectiveness of an oral appliance in treating OSA. The researchers analysed polysomnographic data previously gathered from 93 adults who were diagnosed with moderate to severe OSA.

By Dental Tribune International I August 20, 2019

The authors looked at two traits related to the upper airway: pharyngeal

SLEEP APNOEA 12

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“Sleep apnoea is not all the same, but we only recently developed ways to look at a sleep study and determine what traits cause the condition in different patients,” said senior author Dr. Scott Sands, who is an instructor in medicine at Harvard Medical School and an associate physiologist in the Division of Sleep and Circadian Disorders in the Department of Medicine at Brigham and Women’s Hospital. “Since oral appliances work by improving the collapsibility of the upper airway, patients without

really severe collapsibility are more likely to benefit from an oral appliance, while those with sleep apnoea caused by other traits, such as exaggerated reflex responses to drops in oxygen levels, are less likely to benefit.” The researchers also found that three traits unrelated to the upper airway helped predict those patients who would respond less well to an oral appliance: higher loop gain, lower arousal threshold and higher ventilatory response to arousal. Loop gain is a measure of how aggressively the brain and lungs respond to falling oxygen and rising carbon dioxide in the blood. Arousal threshold is a measure of how easily a person wakes up from sleep. Deeper sleep, indicating a higher arousal threshold, promotes better breathing. Based on these five traits, oral appliances were predicted to be effective in treating sleep apnoea in more than half (61%) of the participants. Patients in this group

experienced a 73% reduction in the apnoea–hypopnea index (AHI), which is the number of breathing pauses per hour lasting 10 seconds or longer. With an oral appliance, they had just eight apnoea’s/ hypopneas per hour. The other patient group experienced a smaller reduction in the AHI and had twice the number of breathing pauses with the oral appliance. The authors said that responses to oral appliances in their study could not be predicted by the severity of sleep apnoea or by how overweight the patients were. “Surprisingly, it didn’t seem to matter whether sleep apnoea was moderate or very severe,” Sands said. “Oral appliance therapy was remarkably effective in some quite overweight patients with very severe OSA.” Based on these findings, the authors suggested that, if their results are corroborated in future studies, an oral appliance could be considered, along with CPAP, as a first-line therapy for treating a certain type of OSA.

The study, titled “Polysomnographic endotyping to select obstructive sleep apnoea patients for oral appliances,” was published online on Aug. 9, 2019, in the Annals of the American Thoracic Society, ahead of inclusion in an issue.

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DENTAL NEWS

collapsibility and muscle compensation. It was found that patients without severe collapsibility benefited more from the oral appliance than those with this trait. Those with a weaker reflex response of the throat muscles that act to maintain an open airway (lower muscle compensation) also benefited more than those with a stronger reflex response. Patients with very mild collapsibility, indicating deficits in other traits, responded less well.

INSIGHT

WELCOME TO... DENTAL DORIS DENTAL DORIS HAS WORKED IN DENTISTRY FOR MANY YEARS AND LIKES TO MUSE ABOUT ALL KINDS OF DENTAL AND NON-DENTAL TOPICS

MANAGING YOUR TIME…

ime management can be tough. What is urgent in your life and what is important to your life are often very different things. This is especially true with your health, where the important issues almost never seem urgent even though your life ultimately hangs in the balance. No, going to the gym today isn't urgent, but it is important for your long–term health. No, you won't die from stress today, but if you don't get it figured out soon, you might. No, eating real, unprocessed foods is not required for you to stay alive right now, but will reduce your risk of cancer and disease. Is there anything we can do? If we all have 24 hours in a day, how do we actually use them more effectively? And most importantly, how can we manage our time to live healthier and happier, do the things that we know are important, and still handle the responsibilities that are urgent? I'm battling with that answer just like you are, but in my experience, there are three, time management tips that actually work

in real life and will help you improve your health and productivity.

decision at the end of the day than you are at the beginning.

1. Eliminate half–work at all costs In our age of constant distraction, it's stupidly easy to split our attention between what we should be doing and what society bombards us with. Usually we're balancing the needs of messages, emails, and to–do lists at the same time that we are trying to get something accomplished. It's rare that we are fully engaged in the task at hand. This division of your time and energy is called “half–work.” Like most people, I deal with this problem all of the time and the best way I've found to overcome it is to block out significant time to focus on one project and eliminate everything else. This complete elimination of distractions is the only way I know to get into deep, focused work and avoid fragmented work day where you're merely doing half–work.

For this reason, I do my best to make sure that if there is something important that I need to do, then I do it first.

How much more could you achieve if you did the work you needed to do, the way you needed to do it, and eliminated the half– work, half–wandering that we fill most of our days with?

3. Forget multitasking, try monotasking Multitasking can seem necessary at times, and you might even be praised by your boss for doing it at work.

2. Do the most important thing first Disorder and chaos tend to increase as your day goes on. At the same time, the decisions and choices that you make throughout the day tend to drain your willpower. You're less likely to make a good

If I have an important article to write, I grab a glass of water and start typing as soon as I wake up. Or if I have a difficult conversation with an employee, I make sure I have this the moment I get to the office. If you do the most important thing first, then you’ll never have a day when you didn’t get something important done. By following this simple strategy, you will usually end up having a productive day, even if everything doesn't go to plan. If you actually do the most important thing first each day, it is the only productivity tip you'll ever need.

However, research by American Psychological Association suggests that doing more than one task at a time, especially more than one complex task, takes a serious toll on productivity and results. Not only does it take more time in the end and involve more errors, it also leads to as much as a 40% drop in productivity and increased stress. Furthermore, another study by the Institute of Psychiatry at the University of London concluded that multitasking can reduce your IQ by as much as 10% and cause mental blanks. If you want to be effective in your work and get more done in less time, you need to stop multitasking. Instead of doing many things at half-effort, focus on your most significant tasks, one at a time.

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DENTAL TECHNOLOGY

PERIODONTITIS AND PERI-IMPLANTITIS PROPHYLAXIS THROUGH SEALING THE SUPERSTRUCTURES

recently published paper (Dental Tribune International) on the potential for preventing Periimplantitis infections around restorations illustrated the dangers of not sealing the hardware pathways correctly. The authors pointed to the occurrences of infections around prostheses because the hard and soft tissue remains the weak point with ongoing treatments, whatever the restoration design or integrity. The real cause of an infection is very patient specific, with a potential predisposition to certain components of the disease process and poor oral hygiene. Combined with errors of treatment. The clinical appearance is of course the inflammation in its various forms and degrees of severity. Together with the known causes Periodontal disease can be a result of unrestricted oral fluid exchanges within the microbe filled Oral cavity. The nooks and crannies in and around reconstructions which are often unreachable recesses for the patient. This can be significantly improved by sealing areas of possible colonisation, which are often very large, with a microbe-proof material. THE MICROBE-LADEN ORAL CAVITY AND HOLLOW SPACES AS A CAUSE There are significant hollow spaces in and underneath screw-retained superstructures, hybrid prostheses and partial prostheses from a Microbiological aspect. These hollows are inevitably laden with microbes from the oral cavity. Even patients that have good immune systems and use proven hygienic measures may develop diseases of the hard and soft tissue due to chronic inflammatory irritation from bacteria and their toxins. These may be encouraged by excess prosthesis adhesive, calculus and plaque. Even with our greater understanding of the disease and its causes and our improved and varied therapeutic approaches, peri-implantitis continues to be a problem. Among the factors to be considered is microleakage, which facilitates peri-implantitis through reinfection from microbe-laden implant interior spaces. In addition to surgical treatment, prophylactic options are available as supporting measures, such as sealing the gaps and hollow spaces in multipart implants. These have achieved a significant reduction in infections.1

Filling of an implant bar construction in the mandible with GapSeal. (PHOTOGRAPH: C.U. FRITZEMEIER AND DEBORAH HORCH)

The Multipart design of implant and their components creates micro movement between implants and between their component parts. The movement allows opening and closing of the contacting surfaces sufficient to allow Micro-meter gaps to constantly arise. This can allow free movement of microbes within the micro-gap areas and the oral cavity as a result of capillary action and the movement of the components.The gaps in screw-retained superstructures and those supported by widely varying attachments can be classified in the order of up to several millimetres. The moist environment, the optimum temperature and the favourable breeding grounds, from a microbiological perspective, provide the best opportunities for microbial growth, which causes additional damage to the periodontal tissue. In the literature, the growth of tissue into bridge spaces, for example, is thus included among the periodontal diseases.3 Microbe-proof sealing therefore seems desirable in this case as well. A SIMPLE SOLUTION A highly viscous silicone matrix material, which has now been in use successfully in industry and medicine for many years, ensures a reliable seal, making the colonisation of microbes impossible. First, owing to its volume, the base material works according to the principles that, where something occupies a space, nothing else can occupy it, and if

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the medium is not conducive to colonisation, no bacteria can grow there either. Additional requirements for an effective sealing material are hydrophobic properties and mechanical strength to give it high retention, so that it cannot be washed away. It must also not harden, or else shrinkage could cause gaps to form again. Furthermore, a viscous material facilitates movement into the gaps. GapSeal (Hager & Werken) consists of a specially adapted silicone matrix that prevents the infiltration of bacteria by sealing hollow spaces. Although it is always placed extracorporeally, it has the proven advantage of not having any sensitising (allergenic) effects. In fact, it shows no damaging effects to the organism at all, and it can therefore be used without concern for all patients. The material has additional benefits. Its high viscosity improves the anchorage of telescopic or conical crowns, since with increasing viscosity, retention also increases.4 The thixotropic properties of the base material prevent the formation of calculus, as the silicone film makes sustained adhesion of plaque on the supporting elements impossible. EASY APPLICATION GapSeal is supplied in sterile blister packs containing ten ampoules of 0.06 ml each and an applicator, ensuring sterility even for surgery (Fig. 3). The applicator can be resterilised for reuse. Hollow spaces should be sealed as soon as possible - preferably at the time of restoration.

FIG. 1: Schematic representation of a multipart endosseous implant with a bar construction. The recesses, hollow spaces and gaps in the implant and the superstructure are marked with arrows. FIG. 2: Recesses underneath a mandibular prosthesis supported by an implant bar. FIG. 3: GapSeal.FIG. 4: Filling of an implant bar construction in the mandible with GapSeal.)

After inserting the GapSeal ampoule into the applicator and removing the cap, the clinician applies GapSeal directly by simply turning the wheel. The space is filled with a surplus of material so that there are no air pockets. The ampoules are designed for single use. In the situation that the hollow spaces cannot be loaded with the sealing material until later, it is recommended to clean them thoroughly beforehand with hydrogen peroxide and alcohol. In the case of a prosthesis with retaining screws, the dentist should re-apply GapSeal at recall appointments (Fig. 4). Replacement of GapSeal in the case of removable prostheses can be done by the patients themselves. GapSeal is extremely well retained, which means it only needs replacement after cleaning the prosthesis. For home use by patients, the material should be distributed with a cotton bud after

application if the recesses are sufficiently large. ASTONISHING RESULTS A demonstrable reduction in microbes and healthy periodontal conditions were verified in patients with a variety of prostheses after periodontal therapy and the use of GapSeal to seal any recesses in and underneath the superstructures. Follow-up examinations after more than ten years documented a long-term effect. No patients complained of any adverse effect on taste due to the material. The oral cavity is simply not designed for reconstructions. The hard and soft tissue mainly react negatively to excessive or unphysiological stresses or infectious irritation. The occurrence of infection usually worsens and becomes chronic if oral hygiene is poor. With today’s wide variety of prostheses, there is therefore an emphasis on preventing recesses from becoming infected.

LIST OF REFERENCES 1. Fritzemeier CU, Schmüdderich W. Periimplantitisprophylaxe durch Versiegelung der Implantatinnenräume mit GapSeal®. [Periimplantitis prophylaxis through sealing implant interior spaces with GapSeal®]. Implantologie. 2007 Mar;15(1):71–9. German. 2. Zipprich H, Weigl P, Lange B, Lauer HC. Erfassung, Ursachen und Folgen von Mikrobewegungen am Implantat-AbutmentInterface. [The detection, causes and consequences of micromovements at the implant–abutment interface]. Implantologie. 2007 Mar;15(1):31–46. German. 3. Wolf HF, Rateitschak EM, Rateitschak KH. Band 1: Parodontologie: Farbatlanten der Zahnmedizin. [Periodontology: colour atlases of dentistry]. 3., Aufl. Stuttgart: Thieme; 2012. 544 p. German. 4. Rößler J. Der Haftmechanismus von Galvano-Doppelkronen-Systemen und seine Beeinflussbarkeit durch Zwischenflüssigkeiten [dissertation]. [The adhesion mechanism of Galvano double crown systems and how it can be affected by liquids in-between]. [Jena]: FriedrichSchiller-Universität Jena; 2004. 154 p. German.

DTS 2020

2020 DATES FOR THE DIARY THE DENTAL TECHNOLOGY SHOWCASE (DTS) 2020 WILL BE HELD ON FRIDAY 15TH AND SATURDAY 16TH MAY – MAKE SURE YOU SAVE THE DATES IN YOUR DIARY EARLY! The 2019 event demonstrated why it remains the premier conference for the dental lab community in the UK. Delegate feedback included: “Very well put together with a programme that covers a variety of topics.” – A Kelsey, orthodontic technician “Lots of interesting lectures / speakers and a great display of innovative technology.”

– Liam Rose, dental technician

To ensure you gain access first-class education, enhanced CPD and the very latest innovations, save the dates for DTS 2020! DTS 2020 – Friday 15th and Saturday 16th May – NEC in Birmingham, co-located with the British Dental Conference and Dentistry Show. Visit www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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DENTAL TECHNOLOGY

GapSeal, which has been proven in implantology and clinically tested, now offers new possibilities for prophylaxis even for superstructures. Consistent use of GapSeal will reduce periodontal disease and increase long-term success of treatment.

ADVERTORIAL

MANDIBULAR ADVANCEMENT SPLINTS FOR SNORING & OBSTRUCTIVE SLEEP APNOEA

WHAT DO WE KNOW SO FAR? BY MATT EVERATT, FOTA

WHAT IS SNORING AND OBSTRUCTIVE SLEEP APNOEA? Snoring is the noise resulting from a partial closure of the airway during sleep. It is estimated that over 45% of the population snores, leading to disrupted sleep for the sufferer - and their bed partner (Young et al, 1993). Ranging from 50-100 decibels, the equivalent of a pneumatic drill, snoring can lead to relationship issues, daytime sleepiness, increased stress & depression. Less often, snoring can also take place as part of a more serious condition, obstructive sleep apnoea (OSA), which is potentially life-threatening. OSA is caused by the repeated collapsing of the airway during sleep, resulting in complete (apnoea) or partial (hypopnoea) obstruction of airflow for 10 seconds or more. Left untreated, these regular disruptions can lead to serious consequences for the sufferer, including: increased blood pressure, heightened risk of cardiovascular disease, strokes, diabetes and excessive daytime sleepiness. Not surprisingly, this condition must be diagnosed and treated in an efficacious manner in order to prevent further co-morbidities or worse. OSA TREATMENT Until recent years, OSA has been solely treated with CPAP Therapy (Continuous Positive Airway Pressure). This was seen as the gold standard therapy and for many years it has been prescribed as the only option. The main reason for this was not only due to the proven efficacy, it was that the machines can also monitor compliance. Compliance monitoring was deemed as a necessity and was very much a selling point for manufacturers of CPAP.

EFFICACY V’S COMPLIANCE Without doubt, CPAP has been proven time and time again to be the most effective form of treatment for Severe Sleep Apnoea Sufferers, however Rotenburg et al (2016) suggests that CPAP compliance was still poor following 20 years of data collection and calls into question the concept that CPAP is still been prescribed as the ‘Gold Standard’ therapy. The literature review showed that on average CPAP was being used for as little as 4 hours per night. A study by Johal et al (2016), looked into the use of Mandibular Advancement Splints (MAS) as an alternative to CPAP. The study used an objective compliance monitor incorporated in the MAS. The results of the study showed a highly statistically significant reduction in follow-up Epworth Sleepiness Score (ESS) and Apnoea Hypopnoea Index (AHI) scores, which in turn was evidenced by the calculated therapeutic efficacy of 75.1. The study demonstrates the safe long-term objective measurement of compliance and comparable levels of therapeutic efficacy for MAA (MAS) therapy in patients with moderate OSAHS, providing new evidence of the role of MAA (MAS) therapy as a viable alternative in patients unable to tolerate CPAP. WHAT IS A MANDIBULAR ADVANCEMENT SPLINT (MAS)? An MAS is an oral appliance that repositions the mandible in a protrusive position, creating more space for the tongue to come forward, in turn opening the airway around the oropharynx, nasopharynx and hypopharynx.

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WHAT MAS DEVICES ARE AVAILABLE? There are many types of MAS available. Most laboratories or technicians making them will use devices such as the Silensor, Negus, Herbst and Sleepwell, to name a few. All of which have been proven effective in treating snoring and OSA. Research has shown that appliances that can be advanced incrementally, known as titration, have been proven to be better tolerated by patients. Research has shown that almost all MAS devices are clinically effective in treating snoring and OSA to a degree. Devices such as the Negus devices (pictured left), which is simply two soft EVA sheets that are formed and welded together were used in a clinical study by Johnston et al (2002). Even this device improved OSA in 35% of wearers. The Negus device was one of the first devices used in the UK, the life expectancy is poor as the devices delaminate over time and cannot be titrated. The Silensor device (pictured right) became popular in the late 1990’s. It was a great step forward in terms of titration. Erkodent had introduced a design that could be advanced by the dentist. The titration amount is limited to 3-4mm by changing the buccal arms to shorter ones in order to advance the mandible. MAS devices started to become more sophisticated and many designs came

to market, including orthodontic screws to advance blocks or buccal shields. A patented device with buccal fins came to market in the early 2000s. The design and components have now become commercially available for dental labs to purchase and use. The device such as the Dorsal appliance (pictured above), has the benefits of self titration and can be beneficial in cases with limited dentition for retention. In 2004, a new MAS came to the Dental Sleep market in Australia; The MDSA, now known in the UK as the SleepwellTM. It was popularised by UK Orthodontist, Professor Johal. In 2005, he began presenting a series of lectures to GDPs on the subject of Snoring and Sleep Apnoea. The Sleepwell device was used in one of the largest clinical studies on Snoring and Sleep Apnoea to date. Maree Barnes et al (2004), used the device alongside CPAP (Continuous Positive Airway Pressure) and a Placebo tablet in the study. The Sleepwell device had a success rate of over 80% in treating Snoring and Mild - Moderate OSA and 98% of patients reported that comfort was acceptable. Barnes demonstrated the Sleepwell MAS, with its 9mm of available titration was the most effective MAS to date. This still remains the case, with no other studies of MAS being able to demonstrate such efficacy. A further study of the Sleepwell MAS (Johal et al, 2017) compared the custom made device with a ‘Boil & Bite’ MAS and again proved the significant clinical effectiveness of a custom-made Sleepwell MAS.

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It is without doubt, that MAS devices have a role to play in the treatment of Snoring and OSA. Dental Laboratories and Dental Technicians are well placed to offer their clients some of the most clinically proven devices available.

Full references available on request. IMAGES COURTESY: S4S (UK) Limited www.s4sdental.com

DENTAL NEWS

ORAL HEALTH FOUNDATION ANNOUNCES CLEAR GUIDELINES FOR DENTURE ADHESIVE USE By Dental Tribune International I July 18, 2019

EDITORS COMMENT The following article was published as shown in the July edition of the Dental Tribunal. It is a report on work by a group of clinical researchers from the UK, US, Greece, Japan and Switzerland. The projected figures for the growth of the ageing population to over 2 Billion by 2050 worldwide would suggest that loose Dentures will be a huge problem across the world. My Question is: who is making these dentures and why do they not fit? I do understand the elderly patient’s potential lack of understanding and apathy contribute, but the inclusion of a dental adhesive with a new set of dentures has for too long been a part of our denture services. The Dental adhesive is to easy a fix when patients know no better! Modern denture work, as has been shown in the pages of this magazine, can be exceptionally natural and correctly made, they should function as well as they look. By now we should be having better success for providing dentures that replace the patient’s natural teeth in both function and stability. Denture making is taught in every dental School in the world so how are we getting it so wrong. The Research was sponsored by GSK who obviously manufacture the adhesive. A great future is promised for them!

l RUGBY, UK: The Oral Health Foundation, a UK charity that aims at improving well-being by reducing the harm caused by oral disease, has announced clear, simple and scientifically backed guidelines on using denture adhesive. In this way, the foundation is providing uniform advice that dental professionals can give to completely edentulous patients who use denture adhesive. The guidelines were developed by a global task force and are part of a research project sponsored by GlaxoSmithKline Consumer Healthcare.

GUIDELINES:

1. Make sure the denture is clean and dry. Then put a small amount of denture adhesive cream on to it. This should only be necessary once a day. 2. Put the denture into your mouth and firmly close the mouth for a couple of seconds. If the adhesive cream overflows, you have used too much. Remove any spare adhesive. Do not swallow it and do not eat or drink anything for 5 minutes.

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3. Take your denture out before going to sleep. Clean the denture and the inside of your mouth thoroughly to remove any adhesive. 4. Ask your dentist for a regular appointment so that your mouth and dentures can be checked. These simple steps can improve the retention and stability of dentures, give the wearers greater confidence and comfort, and reduce or eliminate food debris beneath dentures. Dr Nigel Carter, OBE, Chief Executive of the Oral Health Foundation, commented: “The current lack of guidance on the use of denture adhesives may mean that denture wearers are left confused. The evidence is clear; using an adhesive can provide benefits for patients with best-fitting dentures both in terms of function, confidence and comfort. These new guidelines will give dental professionals the confidence to know how and when to recommend denture adhesives for maximum patient benefit”.

l A green paper published by the UK government has outlined an ambitious plan for the UK to be “smoke-free” by 2030. The goal is part of a larger effort to help address health inequalities and tackle major challenges like obesity and mental health.

Currently 14% of British adults smoke cigarettes. The UK government has released a green paper stating that it would like to reduce this figure to zero by 2030. (PHOTOGRAPH: MARC BRUXELLE/SHUTTERSTOCK)

The document states that, though only 14% of British adults smoke cigarettes - one of the lowest rates in Europe - for those who do smoke, it remains the primary risk to their health and the leading cause of early death. Worryingly, smokers are particularly situated in areas of disproportionately high deprivation. One instance quoted is that one in four pregnant women in Blackpool smoke. This compares with one in fifty in Westminster. The Government are said to be considering that tobacco companies should be required to help fund some of the cost of quitting. As is the case in France and the U.S.

ultimatum for industry to make smoked tobacco obsolete by that year. With smokers quitting or moving to the less harmful e-cigarettes.

This Polluter pays approach would be combines with an active ambition for England to be smoke free by 2030. This includes an

Strong links between cigarette smoking and an increased risk of tooth loss, heart disease, pneumonia and cancer have been established

in numerous studies. Awareness of these links has continued to grow in the UK, and consequently, smoking rates have declined. In 1974, 45.6% of British adults smoked cigarettes, according to the Office for National Statistics. This figure has dropped significantly over subsequent decades.

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DENTAL NEWS

UK GOVERNMENT ANNOUNCES PLAN TO ELIMINATE SMOKING BY 2030

ISSUE NO. 1

AUGUST THE TECHNICIANS MERIT AWARDS SCHEME NEWSLETTER An introduction from the Editor - Larry Browne We are delighted to launch the first newsletter for the Dental Technician Magazine. Just as an update on what is going on between issues of the magazine. The biggest news of interest at the moment is the Dental Technicians Merit Awards in conjunction with Dental Technicians Great Britain. Many of the judges have written a short CV and spoken about their involvement in the scheme. If you read their comments you will get a real sense of what it means to them and their commitment to the scheme. There is a clear sense of technicians thinking about the technicians they will judge as an encouragement to every technician working today to get involved in some way with cases, large or smalls, as examples of their Craft potential. I would encourage all of you to think about submitting a piece of work in the various categories and show clearly just how talented you and your colleagues are as Dental Technicians. We are looking for innovation and examples of new thinking as well as very good techniques and restorations. New ideas coupled with very good craftmanship. A beautiful Inlay or a wonderful large bridge case, whichever you have managed to be happy and content to show the world of Dental Technology. Add your name and your work to the growing list of those we already have seen in the magazines and on the Facebook page of the Dental Technicians Great Britain. We all enjoy seeing good case examples so why not be one of those to be written about.

Best Orthodontics Technician Judged by Andrea Johnson (OTA and Den-Tech) For those of you who donâ&#x20AC;&#x2122;t know me I would like to give a brief introduction. The job that pays my bills is my role as Orthodontic & Maxillofacial Laboratory Manager & OMFS Deputy Lead for Quality & Clinical Governance at Montagu Hospital; but I am also, in my not so spare time, the current Chair of the Orthodontic Technicians Association, the current Chair and the cofounder of registered charity Den-Tech. I am invited to lecture at a range of conferences and events both nationally and internationally, I occasionally take on sessional teaching for short periods at Universities and Colleges and have been known to write the odd CPD paper or two. I feel very honoured to have been asked to be a judge for the Technicians Merit Awards Scheme, I know there is some amazing talent out there and I am very much looking forwards to seeing your entries. This awards scheme is designed to reward real talent and effort. I am a very practical person and so as a judge what I am looking for is a demonstration of your technical skill, so how functional an appliance is, seeing ways in which you have thought outside of the box for complex cases and finally the presentation. I wish you all luck and very much looking forwards to seeing the entries! Andrea

Best Innovative Technician Judged by Magnus Underhay (MJ Underhay Dental Lab)

What I am looking for: Some Blue Sky thinking from Technicians showing new/old techniques and products which help improve the quality off our industry and in doing so makes Technicianâ&#x20AC;&#x2122;s lives easier. THE DENTAL TECHNICIAN MAGAZINE AND DENTAL TECHNICIANS GREAT BRITAIN

Best Chrome Technician Judged by Dave Smith (Phoenix Dental Castings)

Best Ceramics/Crown and Bridge Technician Judged by Andrew Wheeler (Precision Ceramics) I started my apprenticeship aged 17 at G Randals Dental Laboratories, after qualifying I moved to South Africa to further my education. I opened my own crown and bridge laboratory 15 years ago, dealing with large complex implant restorations. As well as running the lab I also lecture and teach digital solutions within dental laboratories. It is with great pleasure to be asked to judge the crown and bridge award of The Technicians Merit Awards Scheme. There is a great deal of talent in our industry and the individuals rightly need to be recognised for their skill. With great changes happening in dental technology we need to step out from our benches and show the level of passion that there is. I am particularly interested in creating natural and life like aesthetics, I look forward to seeing the outcomes of difficult cases which come across our benches on a daily basis. Id encourage every technician, new and old, to submit their cases to the scheme. We need to show the dental profession the level of skill out there.

Best Hospital Tech/ Maxfac Judged by Iain Mur-Nelson (St George’s University) Over twenty years in the Maxillofacial Prosthetic profession I have seen a wide variety of facial and body prosthetic devices and appliances. My career began in Exeter then came the move to London and Queen Mary’s Hospital, Roehampton before services moved from there to St George’s University Hospitals NHS. I have been incredibly lucky to have gained experience in these centres working with some extremely knowledgeable and talented maxillofacial and dental technicians. I am looking forward to receiving submissions for the Maxillofacial TMA. Consideration will be given equally to the new and innovative techniques as well as those cases that required the tried and tested experiences to resolve the challenge.

As digital scanning and manufacturing continues to creep into our design and manufacturing process I am pleased to be judging a competition that is looking to measure a technicians’ qualities in what I believe to be one of the most challenging specialties in dental technology. The choice of the entry should be one that shows all your design skills. It is important I understand the rationale behind the design so information for example of the health standing teeth will be important if it has played a part in your choice of standing teeth to use for support and retention. The occlusion is an import aspect too so I will need an opposing model and indication of the bite registration. If teeth have not been prepped for rest seats, has this changed the design? Has the clinician specified a design or some of the requirements? Quality of fit will have to be judged to the model provided. Quality of finish I am afraid is in the eye of the judge! I am not going to make a list here of the do’s and don’ts here, I’m sure you are all aware of them. A cobalt chrome denture which is well designed, makes best use of available support, retention, both direct and indirect, is functional and aesthetic and blends in well with the oral anatomy and finished to a high standard. Please provide copies or photographs showing: prescription (without personal details), survey, your rational for the design, blocked out model, investment model, pattern and spruing, metal work after casting and sandblasting any information you think is important.

Head Judge is Bill Sharpling (LonDEC, King’s College London) It’s a pleasure to be a part of this initiative and see the variety of outstanding cases being submitted. Please give some thought to sharing details of a case you have on the go or coming up. Please make sure any pic’s of models don’t include patient details and of course if you are sharing any pic’s of the patient wearing your work make sure you have their permission to share. Professional photography skills are definitely not needed. Take some snaps with your phone and share away. Include a few details about what you have done whether it be conventional or innovative. If you have had a good experience with the dentist you are working on the case with please share how that has worked also. Any feedback from the patient would of course be good to see too. Simple or complex, small cases or large cases – it doesn’t matter – share away!

THE DENTAL TECHNICIAN MAGAZINE AND DENTAL TECHNICIANS GREAT BRITAIN

INSIGHT

LETTERS

to the Editor

Email your letters to: editor@dentaltechnician.org.uk Following my editorial in an earlier issue, regarding the restarting of a letters page, one of our long- term readers, Mr. James Bennett has sent me a reproduction of his published letter in the December 1984 issue which is pictured below. Thank you, Mr. Bennett, very much appreciated. You will see other comments from readers alongside those of Mr. Bennett. Mr. Bennett is reacting to the threat of VAT being paid on our instruments and materials. See below his latest letter, which also makes a good point about honouring the traditional hard- earned qualifications of the City and Guilds Institute.

“

In the mid 1950s following 4 years day release study including night classes at the Borough Polytechnic, London, with certificates in the Dental Technicians course awarded each year by the Polytechnic. I was then served with call up papers for two years National Service, becoming a private in the Royal Army Dental Corps. The Depot and Training Establishment at Aldershot was an awful shock, stiff uniform, boots, a beret as big as a dinner plate and marching about to shouted orders. One of the things I remember was being told about the Battle of Monte Casino, as being the ‘finest hours’ for the RADC, due to the large numbers of maxillofacial injuries caused by the downwards angle of fire on the troops. Nowadays, cast silver splints and splints with training plates would no longer be part of the work expected of an army dental technician. Nevertheless, before my army service and by being previously employed as an apprentice in a laboratory, where full arch splints were cast in silver, I had already made a ‘Bells’ palsy splint.

RADC Oswestry 1955. James Bennett is pictured fourth from left.

After basic army training and daily attendance at the dental training establishment in Aldershot, I became dental technician class 11, some of the other dental technicians became DCA’s (dental clerk assistant). I was then briefly posted to an army laboratory in Oswestry, followed by a posting to the Malayan Emergency. This overseas posting was to result in the remaining 17 months of my National Service to be spent on active service as a dental technician. Arriving in Singapore and after a couple of days at Nee Soon transit camp, I was issued with a loaded rifle and boarding the overnight train to KL was ordered to stand guard duty on one of the several open platforms at the end of each carriage, the train then moving at no more than 20mph with an armoured engine up front in case the line was blown up. Some might say this doesn't happen to someone in the RADC, as we are said to be non-combatant, but when you are the only private RADC on a train with other soldiers, you do not say no to their brigade sergeant. Onwards travel from KL took me to BMH Kamunting, to replace (in a one-man lab) the DT leaving for the UK, a few weeks later I got two stripes and a posting to HQ Malaya Command. I would say that at any one time there were about 20-30 dental technicians and perhaps 10-15 DCA’s in Malaya during the Emergency, and up until late 1956 when more areas were deemed ‘safe’, we

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would usually carry a gun when travelling. On one occasion when due to travel by train further up country, I did manage to get a revolver (officers issue) rather than a Lee Enfield. So, I do find it insulting that under the heading ‘Historic’, the GDC no longer currently lists the City & Guilds certificate in dental technology or army dental technician class 1,11 or 111. as the qualifications of a non-clinical dental technician and therefore, mine, and other dental technicians hard earned certificates and long hours of study seem to be deemed by the GDC to be of no more significance than just a previous 7 years employment, which allowed registration of a non-clinical dental technician 2006/2008. James Bennett Retired/previously - LIBST, commercial lab owner with a partner & member of the DLA, full time Technical College lecturer in dental technology with teaching certificates in further education, then 18 years as a Dental Ceramist - proprietor ‘Bennett Ceramics’

l The other letter from a Mr. D. Guymer of Lancaster is referring to an earlier article in the Technician on lung diseases connected with dust being created during the manufacture of the appliances and bemoaning the lack of a dust extractor and the poor chances of getting one from the clinical practice owner. Hopefully things have changed for the better in more recent times, but I am sure there are cases of unfairness and poor management which could be commented upon. Are you enjoying the digital changes which are taking over the market? Are you bemoaning your lot as a Dental Technician? Are you happy about Registration? Are you confused by the changes in status and responsibility for Dental Technicians or are you content and want to say so? Why not take the opportunity to begin the interactive practice of letter exchange by writing to our letter page. Do you need advice on something at work or something at the colleges? Let’s talk to each other about challenges and obstacles as well as triumphs, on the letters page. Tell me how well or how badly we are doing at the Dental Technician. If you have something you would like covered or featured, please let me know. Welcome to the new Letters page and thank you Mr James Bennett!!

Align Technology launches first pop-up store in the UK

l LONDON, UK: Align Technology, a worldwide market leader in clear aligner treatment, recently launched its first Invisalign Connect pop-up store at the Westfield London shopping centre. The interactive popup is located in one of the city’s busiest areas, with thousands of daily visitors, according to the company, including prospective patients who may be interested in tooth straightening. The location was launched on 17 July, and its opening was attended by several of Align’s executive team, including Abhishek Ganguly, Vice President of the General Dentist Channel for Europe, the Middle East and Africa (EMEA), and Alexandra van der Stap, Vice President of Consumer. It is intended to provide customers with an opportunity to learn more about Invisalign treatment, to receive a smile assessment or SmileView simulation of what their smiles could look like after treatment, and to gain easy access to a referral to an Invisalign-trained dentist.

Invisalign-trained doctor of their choice. I believe this Invisalign Connect pop-up will make a great addition to our existing consumer programmes in the UK and in the region,” he continued. “Consumer demand for teeth straightening is increasing, making it more important than ever to connect interested consumers with trained Invisalign doctors,” added van der Stap. “We are delighted to launch the first Invisalign Connect location in the EMEA region, and we couldn’t think of a better location than London,” said Markus Sebastian, Senior Vice President and Managing Director of EMEA at Align Technology. “Invisalign Connect is a new consumer programme that taps into Align’s efforts to keep consumers informed about the benefits of clear aligner therapy under a doctor’s supervision, and to connect them with an

“Thanks to this Invisalign Connect programme, we will be able to inform consumers about the benefits of teeth straightening and ensure they visit an Invisalign-trained doctor of their choice who will supervise their treatment, helping them achieve a new, straighter smile,” she concluded. Globally, 6.8 million individuals have been treated with the Invisalign system. More than one million of these patients are in the EMEA region.

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VERIFIABLE ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN ALL ON 4 WORKFLOW Q1. What is the material chosen for the reconstruction? A. Acrylic with metal casting for strength. B. Zirconia Ceramic. C. CADCAM metal base with acrylic teeth and gum-work. D. Raid cure Acrylic. Q2. A. B. C. D.

What information was used to plan and design the final restoration? Digital photographs and radiographs and provisional bridgework. Chairside impression and photographs. Normal Impression techniques and bite recording. Virtual Planning and conception.

Q3. A. B. C. D.

What does the technician author suggest gives the work a natural appearance? The Pink Gum-work. The natural Glaze. Surface characterisation of the Zirconia. Surface polishing after the glaze.

Q4. A. B. C. D.

How was the occlusal scheme arrived at? Using face bows and anatomical articulators. Using copies of the patient’s original teeth. Using bite records and facial measurements. Using CADCAM provisional bridgework.

Q5. A. B. C. D.

For how long did the patient wear the provisional prototype? Two years. Nine months. Three to six months. Four months.

CPAP AND ORAL APPLIANCE THERAPY Q6. What is the conclusion on the use of Oral appliances? A. They offer little or no improvement with the majority of patients. B. They are useful in certain patients with sleep apnoea. C. They should be considered as a first choice to aid patients using CPAP. D. They are useful for patients who are easily woken. Q7. A. B. C. D.

What percentage of the tested group showed improvement with an oral appliance? 83%. 56%. 63%. 72%.

Q8. A. B. C. D.

Of the patients showing improvement what was the positive percentage? 68%. 73%. 82%. 61%.

PERI-IMPLANTITIS PROPHYLAXIS BY SEALING THE RECONSTRUCTION. Q9. What is the source of the infection? A. Smoking. B. Microbial Oral environment. C. Patient’s Diet. D. Patients Oral Hygiene. Q10. A. B. C. D.

How is the infection allowed to spread? Via gaps in the reconstruction components. Poor cleaning regime. Failing to use prophylactic mouthwash. Not using interdental floss effectively.

Q11. A. B. C. D.

What factors compound the potential for infection with or without a good Hygiene regime? Poorly finished castings. Loose fitting components. Undetectable micro-gaps between the components. Eating the wrong food.

Q12. A. B. C. D.

What are the necessary component attributes for the sealing material? It must be aesthetic. It must be properly cemented into position. It must be thixotropic and hydrophobic and remain flexible. It must be applied chairside.

USING CLEAR ALIGNERS FOR ORTHODONTIC SUCCESS Q13. What main advantage does Digital Virtual techniques offer for the patient and operator? A. Less need for impressions. B. More comfortable to manage. C. The diagnostic Visual Treatment Objective potential. D. Push button management. MARKETING Q14. In the book who moved my cheese what are the names of the human characters? A. Tim and Tom. B. Her and Him. C. Haw and Hem. D. Hum and Buz. Q15. A. B. C. D.

Which cheese station was the best discovery? Cheese station C. Cheese Station N. Cheese station A. Cheese station B.

DENTAL DORIS: MANAGING YOUR TIME Q16. What is said to reduce productivity by 40% and your IQ. By 10%? A. Working long hours. B. Multitasking. C. Monotasking. D. Early starts.

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COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE dentistry together: explore with DT Sean Wilkinson, CAD/CAM expert and officially registered ITI-lecturer, the advantages of current and upcoming technologies for a flawless digital workflow:

ZIRKONZAHN LECTURE TOUR w Zirkonzahn lecture tour in Barnet, London, Canterbury and Brighton from October 01-04

• Immediate loading with backward planning • Digital patient analysis and digital axiographs • 3D facial scans as diagnostic tools ... and much more!

“Digital: immediate loading is here!”: after the great success of the latest conference around the UK and Ireland, Zirkonzahn will be back to the UK from 1-4 October for their last lecture tour for 2019. Let’s take a further step into digital

TRYCARE: SOFRELINER TOUGH S & M DENTAL ADVISOR’S TOP PRODUCT 2019! w Trycare Ltd, the UK’s fastest growing dental dealer, is the UK Distributor for the complete Tokuyama range including award winning Sofreliner Tough, voted Top Denture Reline Material 2019 by the Dental Advisor. With a Shore A hardness of 24, Sofreliner Tough Soft is the perfect combination of soft liner and tissue conditioner, whilst with a Shore A Hardness of 43 Sofreliner Tough Medium is an out and out soft lining material. Both options provide long-lasting softness, enabling maximum patient comfort with minimum degradation due to hardening, a problem associate with competitor products. Therefore the patient experiences the same level of comfort from day one to “done”. They also deliver superior tear strength, so that they don’t become worn and torn; have an extremely high stain resistance, so they maintain their appearance for longer even when exposed to the most severe staining agents like coffee and curry; have a very strong adhesion to the denture, so that they don’t peel off around the margins; and maintain a lasting surface

smoothness that alleviates contamination and the risk of odour build-up. They are easily dispensed from an automix gun via an XS mixing tip, which provides 40% less waste than the tips used by other materials. And, when the time comes, it is easily removed from the denture using Tokuyama Silicone Remover. Supplying your Dentists with Tokuyama Sofreliner Tough Soft or Medium linings will delight them because their patients

will be thrilled by the long-lasting comfort, stain resistance and odour-free nature of their dentures. For more information about the complete Sofreliner Tough range, contact your local Trycare Representative, call 01274 885544 or visit www.trycare.co.uk

GC UK LTD: SEE GC TEMP PRINT™ BUILDING BRIDGES IN 3D w Come and see how GC Temp PRINT - printable light curing composite for temporary crowns and bridges - makes complex temporary restorations easier to print, at BDIA Dental Showcase 2019, Stand H20.

materials for DLP systems, enabling the creation of durable, long-term provisionals. As the perfect partner, GC offers a simple solution to add gloss and character to your 3D printed restorations with OPTIGLAZE colour. This light-cured coating is ready to use, easy to handle and saves valuable time in the polishing stage.

Designed for digital light processing (DLP) based 3D printing - GC Temp PRINT is a biocompatible Class IIa material with outstanding mechanical properties that remains stable after storage. GC Temp PRINT is highly filled compared to other

To find out more contact GC UK Ltd on 01908 218999, email Info.uk@gc.dental or visit www.gceurope.com

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COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE SHOFU: VERACIA SA & Q3-PACK. EXCELLENT AESTHETICS – CONSIDERABLE TIME-SAVING w The semi-anatomical tooth line Veracia SA arose from the model of the fully anatomical Veracia teeth and for the first time the wear of the remaining natural teeth was taken into account: a perfect symbiosis of natural aesthetics and function. The functional characteristics of the Veracia teeth were adopted and precisely predetermined sectors were marked with abrasion zones. The result is measurably enhanced chewing performance and pleasant wearing comfort with the stabilised denture while subjecting the jaw joint to substantially less stress. CROSS SYSTEM SETUPS FOR ALL COMMON OCCLUSION CONCEPTS With Veracia SA, you are not committed to any occlusion concept. Due to the clear occlusal

setup, the effective central occlusion and the specifically incorporated spaces, the posterior teeth are clearly and easily set up against the opposite teeth. • Balanced occlusion • Lingual occlusion • Tooth-to-tooth occlusion • Tooth-to-two-teeth occlusion

support – Q3-PACK. With Q3-PACK you consistently achieve an effortless posterior teeth setup in reliable function and quality, regardless of the articulator system used. The setup time for eight Veracia SA posterior teeth is limited to a few minutes; neither time-consuming preparation nor extensive equipment are necessary.

Veracia SA supports the efficiency of your everyday prosthetic work. The unique functional design allows a practically effortless setup of the posterior teeth.

Q3-PACK is precise and always guarantees the correct contact relations for the Veracia SA posterior teeth, reducing function- and grinding corrections to a minimum. Even inexperienced dental technicians can easily achieve these results after positioning the anterior teeth. This creates efficiency including a level of user reliability in the dental laboratory. But the best argument for Q3PACK is: You just save precious time!

Q3-PACK – THE NEW WAY TO SET UP TEETH EFFICIENTLY The physiological design of the Veracia SA posterior teeth enabled the development of a unique wax-free holder with a built-in setup

DENTSPLY SIRONA: 3D PRINTED MODELS – THE NEW ADDITION TO ATLANTIS® SOLUTIONS w Introducing the Atlantis 3D Printed Models, working models for use when ordering Atlantis abutments solutions, part of the Dentsply Sirona Digital Implant Workflow. Atlantis 3D Printed Models can help laboratories grow their business by outsourcing the model-making task to a trusted partner, one that provides high quality products, backed by Atlantis’ renowned quality control. Following 20 years of continual innovation from Atlantis, 3D Printed Models are the latest addition to the product portfolio. They transform intraoral scans which can be submitted from a wide range of scanning systems, into 3D-printed reality, creating an accurate working model when ordering Atlantis abutments. Atlantis Printed Models are produced using a validated manufacturing process

and dimensional inspection to ensure they accurately reflect the submitted scan data. Turnaround time can be reduced and the workflow simplified if the model is ordered at the same time as its corresponding patientspecific Atlantis Abutment, Atlantis Crown, abutment screw and Atlantis Insertion Guide. When used as part of the digital implant workflow, Atlantis Printed Models save laboratories time by removing the need to design or print the models in-house, freeing up technicians’ time to concentrate on more advanced, skilled work. Busy laboratories can reap many benefits by streamlining the outsourced workflow, which can lead to time and efficiency savings as well as all-round business growth. Using an Atlantis 3D models removes the need for hardware investment and reduces the laboratory’s risk of loss of business

due to hardware or software failure. Ask about the Atlantis 3D Printed Models today and give yourself time to focus on the bigger picture of growing your business. To find out more about the Dentsply Sirona extensive range of Atlantis solutions please visit: www.dentsplysirona.com/atlantis You can visit the online Dentsply Sirona Academy for a wide range of education resources, video tutorials, courses and CPD webinars at dentsplysirona.com/ukeducation Facebook: @dentsplysirona.uk Twitter: @DENTSPLY_UK Instagram: @dentsplysirona.uk

KEMDENT: USE BRITISH MADE HIGH QUALITY HIGH IMPACT DENTURE BASE ACRYLIC w One of the most common reasons dentures break prematurely is because of repeated slight flexing from mastication, resulting in stress fractures. Acron Hi – High Impact Denture Base Acrylic utilises Kemdent’s special MultiMatrix technology to produce dentures that are highly

resistant to breakage and fracture. Acron Hi offers the customer greater flexural strength plus high impact strength. Acron Hi has exceptional aesthetics and the dough is ideal for all processing protocols including injection moulding systems. It flows easily and smoothly with a short dough time of 10-20

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minutes compared with competitors. The excellent handling characteristics of Acron Hi makes it ideal for high quality work providing the patient with a long lasting, lifelike denture they can wear with confidence. Visit www.kemdent.co.uk for more information or contact us at 01793 700 256 for our discount offers.

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