The Dental Technician Magazine April 2018 by The Dental Technician Magazine

VO L 7 1 N O. 4 I A P R I L 2 0 1 8 I B Y S U B S C R I P T I O N

A GREAT

VERIFIABLE CPD FOR THE WHOLE DENTAL TEAM

DEBATE THE GREAT CLINICAL PAPER DEBATE FROM BIOHORIZONS AND CAMLOG PAGE 10

Inside this month PAGE 12-14

INITIAL EXPERIENCE WITH SHOFU BLOCKS

IIA. DAVARPANAH. PAGE 7, 8, 18

LOOK MUM NO HANDS

STRAUMANN BIKE RIDE. 500 MILES IN 5 DAYS. SEPT 19TH TO 23RD. LAKE GARDA TO ROME PAGE 23-24

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E BY SU X T R B EN A EC SC D C O O R I YO SE LL MM PT UR E E E IO PA AG ND N G E UE ING 3

THE CONDULATOR ARTICULATOR RE-VISITED DR. GRAHAME E. WHITE. CCOM. PHD. MMEDSCI. FCGI.

Dental & Medical Products Dedicated to supporting dental professionals and laboratories for over 65 years For the very latest information on analogue and digital technology, technical support, equipment servicing and repair, along with fully accredited CPD courses, call Bracon today!

01580 817000 www.bracon.co.uk sales@bracon.co.uk Search ‘Bracon Ltd’

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THERE’S MORE TO THIS THAN MEETS THE EYE

VISIT US AT DTS STAND H15

18TH & 19TH MAY 2018 NEC BIRMINGHAM

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P12 -14

CONTENTS APRIL 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

Welcome Thoughts from the Editor

Digital Technology Initial Experience with SHOFU Block HC Bio Horizons - the great debate GC UK - Lisa Johnson GC Gradia Plus hands-on courses "The Golden Proportions" - VITA

7, 8, 18 10 18 26 - 27

Technical The Condylator Articulator revisited

12 - 14

Dental News

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

GDC - uncertain of MDD regulations Your guide to ECPD for August 1st 2018 Straumann bike ride Harley Street Study Club / DTA appoint a new president

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 Marketing Simplified

15 18 - 19 23 - 24 30

16 & 22

Insight Looking back with John Windibank FOA

20 & 22

CPD

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Company News

There is a major change in CPD coming soon. The Dental Technician Magazine is a must read. Tell your colleagues to subscribe and if they do so we will extend your subscription for 3 months. The only condition is that they have not subscribed to the magazine for more than 12 months. Just ask them to call the Subscriptions Hotline. With four colleagues registered that means your subscription would be extended for a year free of charge. At only ÂŁ39.95 per year, for UK residents, this must be the cheapest way of keeping up to date. Help your colleagues to keep up to date as well. Ask them to call the subscriptions Hotline on 01202 586 848 now.

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THOUGHTS FROM THE EDITOR

WELCOME to your magazine l Wow what a challenging month March turned out to be. Where I am it is only just getting warmer and I do believe many of you have had a worse experience around the country. Its cold and its hard to keep going when the promise of spring looks just that, a Promise!! Perhaps as the year goes along we will have a warmer time. The DTS Show is coming very soon and promises to be better than ever. With an expanded lecture programme and lots of innovations to look over and consider. Yes the Digital pressure continues into the market place and if you have not grasped the chance to see and listen this is perhaps a good occasion to find out more. Alternatively there is the Digital Symposium in London at the Park Plaza Hotel from the 27th to the 28th April. The promoters describe it as the ultimate Digital Experience with 3 SHAPE, 3M, Ivoclar, Vivadent, Dentsply Sirona, together with Henry Schein offerings the Digital options will be well covered. Of course Henry Schein now have a Henry Schein Laboratory division catering especially with the needs of Technicians. I keep hearing a good deal of negative comment on the future for Dental Technicians but with the activity I see happening around the country I cannot understand what is the problem. If you are interested in maintaining your future you should be looking to find out more and discover what you personally need to do to become part of the future growth in current Technology. This digital phase is just that a phase. The industry combining modern design and manufacture techniques and using them to produce superior restorations at a more economic price potential. Get the

system right and there really is a potential to improve your quality and your scope of Technical Dentistry. Get involved by getting access to a Scanner and learn to design and plan your restorations. It may not be a Bunsen burner and a wax knife but it is potentially a real chance to produce restorations from some remarkable materials. The Art and Science of what you know will be very much in demand. Your Technical know how and your ability to convert mediocre impressions and records into the restorations you can now will be greatly enhanced. It requires investment in your time and your money but it will be rewarded. Take advantage of what’s on display at the DTS Show and of course if you can the Digital Symposium. If you are one of the shy ones there are many dealers who run small courses over one or two days. So you understand what I mean by a lot going on the ITI Annual Congress takes place in London at Kings Place London N1. on April 27 and 28th. Vincent Fehmer an ITI Fellow and Meister Technician and winner of the Best Master Programme of the year in Berlin will be speaking on the various materials and there uses now available with Digital Techniques. His will be a really helpful and instructive Presentation. Vincent will be speaking early on Friday 17th morning with many other international speakers making up the rest of the Two Day Programme. Learn more about digital techniques and implant restorations. There will be lots of dentists to meet and chat with and you will get a real sense of the modern market place and the progress of digital techniques in dentistry today.

THE DENTAL TECHNOLOGY SHOWCASE 2018 Takes place in Birmingham on the 18th and 19th of May and The Dental Technician Magazine is still the most trusted journal offering its popular DTS preview and review issues! Contact us today to discuss how you can effectively target our receptive readership with an attractive advertisement or editorial piece in our most popular and in demand April and May issues of the year! Tel: 01372 897462 or email: sales@dentaltechnician.org.uk

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I do hope that you have been reading up on the future requirements of registered technicians and the future demands on laboratory procedures. It is perhaps, a broader but more relevant link between CPD, registration and the reporting. I will continue to bring in reminders for you all until August 1st. But if you do have queries about your responsibilities please contact me. If I don’t have the answer I know a man who will. I have been going on for some time about you, the reader, getting involved in your magazine. It would be nice to hear from you with suggestions, articles, tips and queries. Why not text, e-mail, talk on the phone or write to me at the address listed in the info box on Page 3. The Dental Technician will of course have a stand at the DTS and I look forward to meeting as many of you as can find the time to come and chat. I will of course be busy going around the stands and preparing and photographing points of interest, and who knows I may get a chance to sit in on one of the many presentations for technicians. These few days of exhibition and lectures are very worthwhile. Take a day or two days off and invest your time in keeping up to date with what’s new and what is worth considering. Meet with fellow technical friends and colleagues and compare notes. It could save you a lot of money and help direct you commitment in the right direction. I will keep ypou informed through the pages of the Dental Technician about any specific congresses or meetings, which I am informed about.

Larry Browne, Editor

Start your digital journey together

Imagine sitting next to your clinician whilst taking the impression... “Using CEREC Omnicam Connect means that my clients can start their digital journey with me right by their laboratory, I can view the intraoral scans on my computer, phone or mobile device, allowing me to respond to the clinician, often whilst the patient is still in the chair. Leaving me to work my magic, while my client sits back and waits”. - Lino Adolf, Owner and Dental Technician, Majestic Smile ltd, fully digital laboratory

Lino Adolf

Invite your clinicians to explore CEREC Omnicam Connect with you During the explore session, which will take place in your lab, our consultant will explain and demonstrate exactly how CEREC Omnicam Connect can open up a whole new digital world for your clients.

You can book an explore OMNICAM session for your laboratory now at www.explorecerec.co.uk You can book837318 an Explore OMNICAM session for your laboratory now at www.explorecerec.co.uk or call 01932 quoting reference ‘explore CEREC’ Download the Dentsply Sirona Solution Map App

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INITIAL EXPERIENCE WITH SHOFU BLOCK HC, A CAD/CAM MATERIAL FOR CHAIRSIDE RESTORATIONS Efficient fabrication of single-tooth restorations in one appointment Hybrid ceramics for chairside restorations

First published in DZW Kompakt, March 2017, Zahnärztlicher Fach-Verlag, Herne / Germany

he last 30 years have seen tremendous advances in CAD/CAM dental restorations, making this technology increasingly popular in daily practice. Above all, improvements in intraoral cameras, leading to powder free scans, true colour displays, and smaller camera heads, have substantially simplified the clinical handling of CAD/CAM systems.

The latest software solutions allow dental professionals not only to operate these systems intuitively after a relatively short learning curve, but also to use largely automatic restoration designs [1]. All these aspects have made chairside restorations more efficient in terms of data collection and design procedures. Further innovations have been achieved in the field of CAD/CAM restorative materials. Two directions of development can be observed here: One approach has been to develop new high strength ceramics minimising the risk of material related restoration failure. Both high strength glass ceramics (lithium disilicate, zirconia reinforced lithium silicate) and partially stabilised zirconia have gained acceptance. However, due to their increased strength, these materials usually need to be first milled in a presintered state and then finally sintered in a separate firing process giving them their definitive strength. These processes require additional equipment (furnaces) in dental practices and make restorations more time consuming [2]. Another approach has been to combine ceramics and polymers into a new material type known as hybrid ceramics [2,3]. This group of materials is also described as CAD/CAM high performance polymers. The materials (e.g. SHOFU Block HC, SHOFU Dental GmbH, Ratingen, Germany; Lava Ultimate, 3M Espe, Seefeld, Germany; Cerasmart, GC, Bad Homburg, Germany) are made by embedding nano ceramic particles in a very hard polymer matrix [4]. The industrial polymerisation process of this matrix, using both light and heat, significantly improves material properties. The mechanical properties of hybrid ceramics range between

DIGITAL TECHNOLOGY

Ila Davarpanah, Hanau, Germany 50 restorations can be made with one set of instruments when milling hybrid ceramics [2-4] . Like glass ceramics, hybrid materials also show a chameleon effect facilitating shade matching. And the shades of hybrid ceramic restorations can be relatively easily and quickly individualised using light cured stains. FIG. 1: Post-endodontic restoration with an adhesively cemented zirconia post (CeraPost, Komet Dental, Lemgo, Germany)

those of traditional glass ceramics and light cured composite materials [2-4]. Their filler loads vary between approx. 60 and 80 % by weight, depending on the manufacturer, and their flexural strengths have been found to be 120 to 200 MPa in various studies [5,6]. Their moduli of elasticity range from 9 to 14.5 GPa, coming relatively close to the Emodulus of natural dentin (17-29 GPa) [2-7]. A special hybrid material has been developed by infiltrating a fine structure ceramic network with an acrylate polymer mixture (Vita Enamic, Vita Zahnfabrik, Bad Säckingen, Germany). This material, which is also described as a hybrid ceramic, has filler loads of up to 86 % by weight, leading to a flexural strength of 140 MPa and a modulus of elasticity of 28 GPa [5-7]. Since the modulus of elasticity of hybrid ceramics comes closer to that of natural dentin, restorations can be expected to distribute stresses more homogeneously [2]. Besides, a “damping effect” has been postulated for hybrid ceramics, thanks to the favourable combination of a dentin like modulus of elasticity and lower hardness [4] . Moreover, the low hardness and very good polishability of these materials clearly reduce antagonist abrasion, as compared to traditional ceramics [3,4,8,9]. And the low hardness of hybrid ceramics also makes milling easier and processing times much shorter, as compared to ceramics. What is more, the flexibility of hybrid ceramics is considerably higher than that of traditional ceramics, reducing the risk of marginal chipping during the milling process. This is particularly beneficial when restorations with thin parts have to be made [2]. Besides, it helps to greatly reduce tool wear. Tools may need to be changed after 15-20 units when milling ceramics, whereas more than

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Hybrid ceramics are particularly suitable for chairside restorations, since they combine favourable mechanical properties with quick milling and polishing, so that processing times are short [2-4]. On the basis of the in vitro data currently available, hybrid ceramics are recommended for use as inlay, partial crown and veneer materials. Besides, all hybrid ceramics on the market, except Lava Ultimate, are indicated for anterior and posterior crowns. At present, all hybrid ceramics require adhesive cementation, after surface conditioning by either sandblasting at reduced pressures (1-1.5 bar) or etching with hydrofluoric acid. Irrespective of the conditioning method used, a chemical primer (silane) needs to be applied [10].

CASE REPORT

w This case report describes the chairside production of a posterior crown with the aid of the Cerec system (Omnicam + Cerec MC XL, Sirona Dental Systems GmbH, Bensheim, Germany), using the hybrid ceramic material SHOFU Block HC (SHOFU Dental GmbH, Ratingen, Germany). A 38 year old male patient presented for restoration of tooth 46 with a crown after successful endodontic treatment. It was decided to fabricate a monolithic crown chairside with the Cerec system. The material used was SHOFU Block HC, a hybrid ceramic which has been an option for the Cerec software since its Update 4.4.3. This restorative is available with matching cementation and polishing systems. After post-endodontic restoration with an adhesively cemented post (CeraPost, Komet Dental, Lemgo, Germany) and an adhesive core build up (CoreXflow, Dentsply Sirona Restoratives, Konstanz, Germany) (Fig. 1), a circular chamfer was prepared (1.0 mm reduction), and the occlusal surface was reduced by 1.5 mm. The transitions between axial and occlusal surfaces were rounded, to suit this material.

For digital impression with a powder free scanning system (Cerec Omnicam, Sirona Dental Systems GmbH, Bensheim, Germany), Adstringent Retraction Paste (3M Espe, Seefeld, Germany) was applied around the prepared tooth to temporarily displace the soft tissues and effectively control the bleeding. The paste was thoroughly rinsed off with water after being left undisturbed for 3 minutes, and the preparation was carefully dried (Fig. 2a-b).

DIGITAL TECHNOLOGY

FIG. 2A-B: Placement of Adstringent Retraction Paste (3M Espe, Seefeld, Germany) prior to preparation

Complete bleeding control and soft tissue displacement allowed us to intraorally scan the lower jaw. This was followed by data collection in the 1st quadrant and lateral scanning for assignment of the two partial jaw scans (Fig. 3).

FIG. 3: Assignment of partial jaw scans through lateral scan and preparation analysis

After automatic assignment of the three scans to a virtual model set, the preparation margin was marked, and the insertion path of the restoration was determined.

design FIG. 4: Restoration tware using the Cerec sof (Version 4.4.4)

The preparation analysis confirmed sufficient material reduction, so that we proceeded to the next step, i.e. restoration design (Fig. 4). A minimum material thickness of 1 mm was specified as a restoration parameter. The occlusal milling offset was adjusted to -100 µm, and

FIG. 5: Molar crown milled from the hybrid-ceramic material SHOFU Block HC (SHOFU Dental, Ratingen, Germany)

marginal reinforcement was reduced to 40 µm. For traditional ceramics, 70 µm would be recommended, in order to prevent any marginal chipping. However, since SHOFU Block HC is easier to mill and more flexible, this value could be reduced. The reduction of marginal reinforcement decreases the risk of overcontouring the restoration and the effort needed to finish and polish it after milling. The design suggestion required only minimal corrections at the mesial and distal marginal ridges, plus corrections of the lingual and buccal cusp tip heights. Finally, the occlusal and interproximal contacts were corrected. Ideally, all contact surfaces should appear in light blue. Based on clinical experience, intraoral adjustments are minimised when using these digital design parameters. The material used, SHOFU Block HC, is available in two sizes; each size comes in six low translucency shades (W2-LT, A1-LT, A2-LT, A3LT, A3.5-LT, B3-LT), three high translucency shades (A1-HT, A2-HT, A3-HT), and two enamel shades, OC (Occlusal) and 59 (Incisal). In this case, an A3.5-LT block was selected to match the shade of the adjacent teeth as accurately as possible.

FIG. 9: High-gloss polishing with diamond paste (Dura Polish DIA, SHOFU Dental, Ratingen, Germany)

The adjusted restoration was then finished and polished. After finishing the fissures with a suitable diamond bur (8390.105.016, Komet Dental, Lemgo, Germany) (Fig. 7), “Brownie” and “Greenie” silicone polishers (Amalgam Polishing Kit, SHOFU Dental GmbH, Ratingen, Germany) were used at speeds of 5,000-7,000 rpm (Fig. 8a-b). Finally, diamond polishing paste (Dura Polish DIA, SHOFU Dental GmbH) was used with a brush at a maximum speed of 15,000 rpm to achieve a perfect high gloss polish (Fig. 9). Restoration shades can be individualised with light cured composite stains. Surfaces to be characterised are first roughened with fine grit diamond burs and then cleaned (alcohol/ steam cleaner); after applying a special primer (SHOFU HC Primer), suitable stains (LiteArt, SHOFU Dental, Ratingen, Germany) can be used for characterisation. Before cementation, SHOFU Block HC restorations should be thoroughly cleaned using ultrasonic or steam cleaners. Restorations made of hybrid ceramics always require adhesive cementation.

Conditioning can be done by sandblasting with alumina (30-50 µm) at reduced pressures (1.0-1.5 bar) or etching with hydrofluoric acid (5 %, for 30 seconds). Irrespective of the The crown was made using a wet milling conditioning method used, a chemical primer unit (Cerec MC XL), set to the “fine” mode. (HC Primer, SHOFU Dental, Ratingen, It was milled in just under 10 minutes and Germany) needs to be then prepared for the first intraoral try-in applied (Fig. 10). The FIG. 4: (Fig. 5). The only step required was to remove product of choice for Restoration design using the holding pin from the crown with a rotary adhesive cementation the Cerec diamond bur (835.104.014, Komet Dental, of crowns is a resin software Lemgo, Germany). The crown was tried in, and (Version cement system with a since no further adjustment of the interproximal 4.4.4) self etch bonding agent contact points was needed, we directly checked (ResiCem, SHOFU the occlusal contacts. After the patient had Dental GmbH, marked the occlusal contacts by carefully biting Ratingen, Germany). on articulating foil, the necessary adjustments were done with a fine grit diamond bur The use of a self etch bonding agent eliminates (8390.314.016, Komet Dental) (Fig. 6). phosphoric acid etching and subsequent rinsing. This is particularly beneficial in the case of crown preparations with equigingival or subgingival margins, where etching and rinsing may cause renewed bleeding. When using self etch bonding agents, crown cementation can begin directly after the bonding step. And usually relative isolation should be sufficient for cementation. This is very important, because absolute isolation of full crown preparations with a rubber dam is quite difficult, as compared to partial crown and inlay preparations. FIG. 6: Try-in and occlusal adjustment of the restoration. FIG. 7: Finishing the occlusal fissure relief with a suitable fine-grit diamond bur (8390.104.016, Komet Dental, Lemgo, Germany). FIG. 8A-B: Polishing the restoration with “Brownies” and “Greenies” (Amalgam Polishing Kit, SHOFU Dental, Ratingen, Germany)

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Prior to adhesive cementation with ResiCem, a retraction cord was placed to avoid pressing any excess cement into the sulcus. Then the tooth was cleaned with a fluoride free paste and p18

ADEBATE GREAT

DIGITAL TECHNOLOGY

he Great Clinical Paper Debate from BioHorizons and CAMLOG certainly lived up to its name. Six high profile industry experts faced off in a series of three fascinating debates on 16th February at The Royal College of Physicians in London, to an audience of about 100 dental professionals from across the United Kingdom, Ireland, and beyond.

With implant dentist, Stephen Jacobs, keeping order throughout the day and managing questions from the floor, the first of the day’s debates, “Allograft vs. Xenograft: the natural choice”, between Anthony Summerwill and Rob Oretti, dealt with how to choose between the two grafting materials. Dentists came away with valuable tips to help guide them towards the most appropriate material for a case while witnessing a very heated debate and Q&A session, expertly hosted by Stephen. Next up Adam Nulty and David Murnaghan debated “Digital vs Analogue: the future of implant dentistry”, looking at the current technological state of dentistry and questioning if there was indeed a digital replacement for the human touch. While David presented his cases, and his approach and techniques throughout, Adam advised whether he felt each case could have been ‘bettered’ with a more digital approach. The room agreed, with Stephen Jacob’s support, that the digital move was happening in dentistry whether we ‘liked it or not’ but that it was up to the individual how far that was extended in practice. Concluding that, indeed, while digital was proving a beneficial tool in practice there was often no replacement for a clinician’s handy work. The final debate, “Hard tissue vs. soft tissue: the response to surface technology” was handled by Marcus Breschnidt and Jack Ricci, who discussed the benefits of hard versus

soft tissue in creating primary stability with implants, and examined how each responds to the implant. Again, this was hotly debated, where both parties took opposing stances on cases presented but provided engaging presentations to an inspired room. ISY® The Great Clinical Paper Debate provided the perfect platform for BioHorizons to launch the latest CAMLOG® implant system in the UK and Ireland. iSy® - “The Intelligent System” offers a complete, fully streamlined implant system with high primary stability, one-click fitting and the capability to provide fully digitised restorations. In his one-hour lecture, “Making implant dentistry iSy®”, speaker Carlos Repullo explained that the iSy surgical and prosthetic workflow gives practices the chance to be more effective and efficient. Finally, the surprise guest speaker, Jamil Qureshi, a renowned performance coach and psychologist, finished off the day by delivering a humorous and insightful talk on how to fulfil potential through change and performance management. Motivating the delegates in practice life, Qureshi demonstrated how you are only as strong as your network and how to approach practice

life with renewed vigour and the motivation to change (should you be willing to!) Talking about the Great Clinical Paper Debate Symposium Dr Pretam Gharat wrote “Excellent material and the speakers were excellent with a great amount of knowledge." Dr Brewer said that “It was a really well run and enjoyable course. I didn't expect to enjoy debating as much as I did!" and Dr Ioan Rees concluded that the Allograft vs Xenograft debate was “one of the most useful talks I have been to and very clinically relevant”. As part of Henry Schein, Inc., BioHorizons offers an extensive ECPD educational programme throughout the year for the whole dental team. Alongside national and international symposia, hands on training for beginners and advanced surgery, auxiliary team training BioHorizons is excited to announce a CAMLOG Accreditation Course for Dental Technicians. Upon completion of this one day course delegates will receive an ‘accreditation pack’ which will enable the technician to showcase attendance of training and that the Laboratory is officially accredited to work with the CONELOG Implant System. Taking place on 2nd June 2018 visit www.theimplanthub.com to find out more! For more information on dental education events from BioHorizons, please visit www.theimplanthub.com/education Course information: www.theimplanthub. com/events/camlog-accreditation-coursefor-dental-technicians BioHorizons products are available in 90 markets around the world. For more information, visit biohorizons.com BioHorizons, Richmond House, Oldbury Road, Bracknell, Berkshire, RG12 8TQ. Email: infouk@biohorizons.com Phone: +44 (0) 1344 752560 Visit: www.biohorizons.com

ABOUT BIOHORIZONS

BioHorizons is part of Henry Schein, Inc. (NASDAQ:HSIC) and a leading global provider of dental implants and tissue regeneration products for dentists and dental specialists. The company has a broad product offering, including dental implants, guided surgery, digital restorations and tissue regeneration solutions for the replacement of missing teeth.

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DEDICAM WHERE EVERYTHING JUST FITS. Everything from one company. Custom made, patient specific prosthetics. The quality you are used to from CAMLOG. Everything is possible. Wide range of products and services from inlay to bridge. Everything is efficient. Open interfaces, precise manufacturing and prompt delivery. Everything is comprehensive. Wide range of implant manufacturers supported. Explore DEDICAM - the individual CAD/CAM solution for patient specific, implant prosthetics. Contact BioHorizons, the UK & Ireland distributor for DEDICAM. Phone 01344 752560 or Email dedicamuk@biohorizons.com

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THE CONDYLATOR ARTICULATOR REVISITED This paper is dedicated to the memory of Peter Gerber, 1944-2018

TECHNICAL

INTRODUCTION In 1948, the late Professor Dr Albert Gerber introduced an articulator with the important innovation that the articulator’s temporomandibular joints took account of the anatomical shape of these parts. Called the Translator it was an almost immediate success. Gerber was Professor of Prosthetics at the University of Zurich Dental Institute so his articulator had a good pedigree. His predecessor was the famed Dr Alfred Gysi whose pioneering work on dental occlusion and articulator design had already earned Zurich an international reputation for excellence. Parallel with Gerber’s innovative articulator and its subsequent refinement over the years was his equally important selection and bringing together of techniques, materials and devices which would add to the accuracy and certainty of its use in practice. Soon renamed the Condylator articulator, the whole quickly became known as the Gerber Technique and has remained so for 70 years. Originally intended for removable and fixed prosthodontics, the treatment of temporomandibular joint dysfunction (TMD) came soon afterwards. Figure 1.

This paper looks into some aspects of Condylator Model 6 (Individual and Vario) articulators and methods for their use with more recent dentistry in mind. The Condylator’s design philosophy When the teeth are apart and/or the patient has insufficient teeth to occlude, only the temporomandibular joints (TMJ’s) control mandibular movement. Accordingly, Gerber copied the roof-shaped sliding surfaces of natural TMJ’s for the Condylator fig. 2a, a decision which allowed it to replicate the Bennett movement as well as protrusive and lateral jaw movements. Figure 2b and 2c. The natural three-dimensional condylar guidance envelope of movement produced allowed the usual incisal guidance table to be discarded as a final mandibular movement guide. The occlusion of artificial teeth is refined in finished prostheses by ‘grinding-in’ using fine carborundum paste. Produced is an envelope of smooth gliding tooth contacts which are free from cuspal interferences which in turn increases prosthesis stability and safe bearing. 2A.

FIGURE 1: Condylator Model 6 ‘Individual’ articulator.

2B.

Clearly dentistry has changed enormously since 1948. Still with us are the often-difficult problems of TMD and edentulism, although the latter is getting less in the developed world. The widespread use of dental implants in particular and challenges related to people keeping their teeth longer are now making demands on dentistry which were unimagined in 1948.

2C.

FIGURE 2A: The Condylator’s condyle head representation of the natural condyle head is able to reproduce the Bennett movement. FIGURE 2B: The Bennett movement is not only outwards but is also downwards due to the guidance of the coronal shape of the Glenoid fossae. FIGURE 2C: A forward movement of the condyle head is produced during the Bennett movement by the guidance of the posterior half of the Glenoid fossae.

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Occlusal balance is checked by how the teeth contact and glide over each other in the articulator so replicating what occurs in the mouth. If the occlusion consists of natural and artificial teeth, then the natural teeth and the joints together control jaw movements and occlusion of the artificial teeth is made to conform to this. Compelling evidence of mandibular movement accuracy is that tooth wear facets on upper and lower natural teeth can be brought into contact in the articulator. The angles of the roof-shaped sliding condylar surfaces are provided as average values and not measured for individual patients. Gerber followed a ‘measured accuracy by need’ philosophy throughout his design. He gave increased importance to articulator movements which were critical for occlusal accuracy (such as sagittal condylar path inclination and the exact position of centric relation) and average values where it could be shown that it was the correct form of movement within the obtained envelope of condylar activity that was the most important. The provided complete envelope of movement generated by the Condylator is never used by patients in its entirety; it’s much too large. Depending on individual needs, even changing needs as therapy or a corrected centric relation required, the patient uses that part of the movement envelope individual to their particular needs. Gerber saw that the summit position of the condyle heads in their respective glenoid fossae coincided with the apex of a Gothic arch tracing and that this was centric relation. The found centric relation by this method is a clearlydefined and reproducible position at a given jaw separation. Additionally found was that there was usually a more retruded or ‘strained’ condylar head position posterior to this summit position. This finding led to the use of sliding locks to selectively open and close parts of the articulator’s glenoid fossae to give more selective TMJ control including this retral movement. Figures 3a, 3b, 3c.

3A.

3B.

3C.

FIGURE 3A: The natural and artificial condyle heads in their most stable natural position of centric relation. FIGURE 3B: Natural and artificial condyle heads in mandubular protrusion. Note the curved beginning of this movement from centric relation. FIGURE 3C: Natural and artificial condyle heads in a retrusive position; posterior to centric relation. Note the curved downward path.

In natural joints the condylar path from fully retruded to protrusion is curved and so it is with the Condylator’s mechanical joints. This retral movement and its curved path are used for all occlusions including the treatment of TMD. Complementing the Condylator is a matching light-weight face-bow which is attached to the mandible so moves during jaw movement. When spring-loaded pencil points are located over the palpated position of the condyle heads on the side of the patients face, a protrusive jaw movement allows the pencils to draw individual left and right sagittal condylar path angles onto a card held against the patients face. Measured with a protractor, the found angles are then transferred to the Condylator.

The Vario version of the articulator has innovative adjustable side plates with an engraved sliding Vernier 0.0mm to 1.2mm measurement scale. Where appropriate these plates are adjusted to relieve compression in one or both TMJ’s. Figure 4a and 4b. This adjustment is used mostly in the treatment of TMD and after orthodontic treatment and fixed prosthodontic work which can cause compression of the one or both joints. 4B.

4A. FIGURE 4A. Sliding side plates with measurement scale to relieve compression of the TMJ’s. FIGURE 4B. The natural condyle head in a position of centric relation in its Glenoid fossae.

IMPLANT RETAINED OVERDENTURES Typically, these consist of two free-standing dental implants with or without connecting bar. The prosthesis can be directly connected to the head of the implants by prefabricated retainers or by spring clips grasping the implant connecting bar.

5A.

5B. 5C.

FIGURE 5A: Posterior teeth set over a sloping part of the ridge encourages the denture to move forward when food is between the dentures. FIGURE 5B: Broken overdenture retaining clip caused by repeated forward denture movement during eating. FIGURE 5C: Stability during mastication is improved if the lower teeth follow the curve of the lower ridge. This ensures that occlusal forces are always at right angles (90 degrees) to the surface of the underlying bone.

In edentulous mandibles, the teeth are confined to the flatter parts of the residual alveolar ridges; especially when these are resorbed. Posterior teeth of whatever occlusally balanced refinement which are set over an inclined bone foundation will not prevent this forward propulsion. By this reasoning it is better to omit a posterior tooth if its presence it would cause denture instability. Posterior teeth are arranged so that their collective occlusal surfaces form a curve which follows the curve of the residual lower ridge. The objective is to direct the maximum occlusal loads over the ‘lowest’ part of the ridge and at right angles to the ridge overall. Figure 5c. That this rationale aids stability is confirmed at the chairside by the dentist applying strong finger pressure to the occlusal surfaces of all teeth at the try-in stage. Without connection to its implants, the denture should not move by this test so ensuring stability during eating. Setting-up in this way is possible because conventional compensating curves are not needed with the Condylator; teeth are occlusally balanced using TMJ guided mandibular movement alone, without incisal guidance. (2) IMPLANT RETAINED AND SUPPORTED PROSTHESES Depending on their design these can restore full biting power even to previously edentulous jaws. In providing reliable long-term prosthesis stability it can be thought that the strength and durability of dental implants is sufficient

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to reduce the importance of occlusion. This is a dangerous misconception. Osseointegrated implants have a direct connection with their supporting bone and unlike natural teeth, cannot adjust themselves to accommodate occlusal errors. Occlusal forces are taken directly to the bone and these forces are higher when the occlusal surfaces are metal or porcelain. When provided with an occlusion formed by a natural envelope of mandibular movement, fixed implant supported prostheses can both maintain the TMJ’s in their physiologically correct positions and provide safe bearing of the prosthesis. Without safe-bearing, fixed implant supported prostheses can cause implant failure and bone loss. (3). This is especially the case when newly osseointegrated implants are to be loaded for the first time and the supporting bone is still remodelling. Lauritzen Split-Cast Method for TMJ Dysfunction (TMD). (4) An important part of the assessment of TMD is to determine the positions of the natural condyle heads in their joints when the natural teeth are maximally intercuspated. Revealed by the Lauritzen split-cast technique can be condyle head displacement including compression and distraction of one or both joints. For many patients, this condylar displacement on occluding their teeth or when eating is the seat of their TMD. It is the bringing together into congruity the teeth and joints which forms an important part of TMD treatment.

TECHNICAL

The Condylator’s use for conventional complete and partial removable dentures and bridges is outside the scope of this paper but this information is easily is available elsewhere. The efficacy of the articulator can be demonstrated that ill-fitting and underextended complete dentures can be dramatically stabilised during mastication by experimentally keeping the defective bases and only replacing the posterior teeth using the Condylator. (1)

Dental implants are designed to receive masticatory loads along their long axes and transmit these to their supporting bone in the same direction. They are not designed to withstand lateral forces which can damage their internal screw parts and/or retaining clips. Occlusal forces falling on posterior teeth set over sloping bone foundations are resolved by moving the lower denture in an anterior direction. Such forces can produce damaging implant loading and retainer clip fracture. Figures 5a and 5b.

Having first found the TMJ centric position of both joints, plaster check-bites are made of the teeth in centric relation. The maxillary cast then has several sharply angled cuts made into its base and separator applied before mounting both casts on the Condylator using the checkbites. On removing the checkbites, the articulator is then closed to bring the teeth into intercuspation. If the position of centric relation of the TMJ’s and maximum tooth intercuspation coincide then there will be no separation between the articulating plaster and the maxillary cast. Figure 6a. If however there is a discrepancy between centric relation of the TMJ’s and the intercuspation of the teeth, this will be shown by a gap between the articulating plaster and maxillary cast. Figure 6b. When this gap is held closed, bringing the teeth into maximum intercuspation in the articulator, the artificial ‘condyle heads will move to reveal the position necessary for them to accommodate the occlusion of the teeth. 6A.

6B.

FIGURE 6A: Unchanged maximum intercuspation of the teeth with both TMJ’s in positions of unchanged centric relation.FIGURE 6B: Maximum intercuspation requiring the TMJ’s to be displaced as revealed by the space between the maxillary articulating plaster and upper stone model.

These condylar head displacements are revealed because the Condylator has ‘Condyle heads’ that are not restrained by fixed movement guides as in some articulators figure 7, but are free to move within a condylar aperture. Figure 8. Such evidence provides a platform for TMD treatment therapy. It can also be used to assess the congruity of joints and teeth following orthodontic treatment and after the insertion of fixed prostheses.

FIGURE 7: Parallel sided condyle head movement guides which provide fixed, straight-line control. FIGURE 8: The open condylar aperture which does not restrict condylar displacement accommodations.

TECHNICAL

MAXILLO-FACIAL PROSTHESES Patients with tissue-loss defects involving the face, teeth and jaws need prostheses which will durably restore what has been lost. Whatever the decided treatment plan, the preservation of the remaining hard and soft tissues supporting the prosthesis is an overriding consideration. Maxillo-facial prostheses are now increasingly retained and supported by dental implants rather than the adhesives and spectacle frames of yesteryear. Depending on the position and size of the defects, implants may be placed anywhere where sufficient bone and bone quality will allow, including irradiated bone. Figure 9a. When available bone is remote or sparse, its damage by prosthesis overload is a major catastrophe which can severely limit future treatment options. The smooth gliding tooth contacts produced by the Condylator are exploited to the full to protect the TMJ’s and reduce damaging occlusal loads falling on the implants, retaining clips and bone. That compensating curves and other mechanical rules of setting-up teeth do not apply is a big advantage when setting up for these difficult cases. Figures 9b, 9c and 9d. Patients needing maxillo-facial prostheses do so when surgery is not possible, or has

failed. The loss of remaining bone and/ or implants can serve to only to magnify a patients’ feelings of misfortune.

9A.

9B.

9C.

9D.

FIGURE 9A: In large defects, implants will have to placed wherever there is accessible bone. FIGURE 9B: Four implants with connecting bars and retaining clips. FIGURE 9C: Under-side of obturator prosthesis showing retaining clips. FIGURE 9D: Completed implant-retained and supported obturator prosthesis.

In some cases occlusal load may be shared between the implants and soft tissues when complete implant support is not possible. Here some denture movement under load must be accepted and the teeth organised to minimize underlying bone overload. This is especially important when new implants are supported by newly osseointegrated bone. This work is subject to frequent patient recall reviews which may extend over many years. Convenient for this is that the articulator’s manufacturing number is automatically recorded onto articulating plaster. By this simple device archived work can be returned to the same articulator to maintain accuracy. ORTHODONTICS For good reason, Orthodontics is increasingly concerned to know the positions of the TMJ’s before and after treatment. There is a substantial and worrying literature that draws attention to the onset of TMJ dysfunction (TMD) as a consequence of orthodontic treatment and especially so when there has been a change of jaw relationship. Conventional study casts show before and after tooth movement but not before

DR GRAHAM E. WHITE CCOM. PHD. MMEDSCI. FCGI. Graham White holds C&G final and advanced certificates in dental technology and was a chief C&G examiner in dental technology for Great Britain and eight overseas countries. He has Master of

Medical Science and Doctor of Philosophy degrees by research. For many years a Senior Lecturer in Dental Technology at the Dental School in Sheffield, he also had a diplomatic appointment with a consulate in Sheffield. Author of numerous research papers,

www.dentaltechnician.org.uk

and after positions of the TMJ's following tooth movement. Its self-evident is that an altered occlusion will have effect on the temporomandibular joints. Using the Lauritzen Split-Cast technique, the intercuspation of the teeth existing when both TMJ’s are held in their positions of centric relation can be compared before and after and if necessary during treatment. (5) Conclusion and summary Occlusion is the foundation on which all dentistry rests. Because the Condylator can reproduce the envelope of mandibular movement made by natural temporomandibular joints, the articulator is still relevant, seven decades after its introduction. In 1973, it was said that the Condylator was the first of a second generation of articulators. Although it now has its look-alike imitators, it probably still is. Acknowledgement I wish to thank Mr Christopher White, Senior Maxillo-facial Prosthetist at the London North West Healthcare NHS Trust for providing figures 9a, 9b, 9c and 9d. Dr. Graham E. White. CCOM, PhD, MMedSci, FCGI. Former Senior Lecturer, School of Clinical Dentistry, University of Sheffield. Email: g.e.white@sheffield.ac.uk REFERENCES (1) The importance of occlusal balance in the control of complete dentures. Dubojska A.M., White G.E., Pasiek S. Quint Int. 1998; 29, 6: 289-394. (2) The Gerber articulator and system of full denture construction. White G.E. Part 1. The Condylator Articulator. Dent Tech. 1973; 26, 2: 12-20. The Gerber articulator and system of full denture construction. White G.E. Part 2(a) Dent Tech. 1973; 26, 3: 23-27. The Gerber articulator and system of full denture construction. White G.E. Part 2(b) Setting up the teeth and finishing the dentures. Dent Tech. 1973; 26, 4: 34-39. (3) Osseointegrated Dental Technology. White G.E. Quintessence Pub. Co. Ltd., London. 1993. (4) Occlusal relationships: the split-cast method for articulator techniques. Lauritzen A.G., Wolford L.W. J Prosthet Dent. 1964; 14: 256-265. (5) Orthodontics and the Temporomandibular Joints. White G.E., Dubojska A.M. QJDT. 2007; 5, 3: 192

his best-selling Quintessence book ‘Osseointegrated Dental Technology’ was translated into four languages. Graham has given over 250 invited lectures world-wide on his research and represented Great Britain at international meetings of the International Organization for Standardization (ISO) for casting gold alloys, casting investments and dental implants.

GDC SAYS IT IS UNCERTAIN OF MDD REGULATIONS By I A A Finder

The GDC was asked for: 1. Any documents that indicate to the GDC that dentists that are manufacturing dental devices are exempt from registering with the MHRA, making a Statement of Manufacture and making the patient aware of their right to have the Statement of Manufacture. 2. Any documents that indicate to the GDC that dental nurses that are manufacturing dental devices are exempt from registering with the MHRA, making a Statement of Manufacture and making the patient aware of their right to have the Statement of Manufacture. 3. Any documents that indicate to the GDC that dental hospitals, NHS trusts and similar training institutions that are manufacturing dental devices are exempt from registering with the MHRA, making a Statement of Manufacture and making the patient aware of their right to have the Statement of Manufacture. The GDC replied: We have considered your request under the Freedom of Information Act 2000 (“the FOI Act”) and, for the reasons I go on to explain, we do not hold the information you have asked for and believe it may be more appropriate for your enquiries to be addressed directly to the MHRA itself. You prefaced your queries with an extract from GDC guidance: “Registrants who manufacture dental appliances mainly outside of the mouth (for example- fixed bridges, bleaching trays, crowns, splints, retainers, etc.)

If you make a dental appliance, whether you are a dental technician, dentist, or any other registrant, you must understand and comply with your legal responsibilities as “manufacturer” under the Medical Devices Directive 93/42/EC. This includes the legal requirement to register with the Medicines and Healthcare products Regulatory Agency (MHRA).” As you know, this is taken from Guidance on commissioning and manufacturing dental appliances and I must advise you that guidance would not be drafted in this form if the GDC was aware of any such exemptions as you describe for certain registrants, in certain circumstances, to be exempt from registering with the MHRA. We also make guidance available for patients in connection with this subject: Crowns, bridges and dentures. Do you know what’s going in your mouth? which is available from this page https://www.gdc-uk.org/about/what-we-do/ publications on the GDC website (under “Information for patients”). As you will see, this guidance reinforces the requirement for a statement of manufacture to be available in connection with the supply of a dental appliance and for that statement to include details of “Who prescribed it (and their address)” and “Who it was made by (and their address).” The guidance also makes it clear that it is the MHRA, and not the GDC, who is responsible for enforcing the directive. Very usefully, in addition to giving details of the MHRA website (www.mhra.gov.uk ), the guidance also gives an email address (ERA@mhra.gsi.gov.uk) to which enquiries may be made. The MHRA website also gives this contact email address for specific enquiries: info@mhra.gov.uk If you have not already done so, can I suggest you repeat your exemption queries directly to the MHRA as the body responsible for enforcing the directive? You may also wish to consider contacting the Care Quality Commission as the body responsible for monitoring, inspecting and regulating health and social care services including hospital services. Enquiries details may be found at: http://www.cqc.org.uk/ contact-us COMMENT An interesting response given without a hint of embarrassment. We think our guidance is legally correct but it might not be; we suggest YOU find out for us! As previously reported in the Dental

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The GDC’s response says: “it is the MHRA, and not the GDC, who is responsible for enforcing the directive”. This is true however the GDC regulate people who make dental devices and people who fit dental devices and protects the dental patients they are fitted to. The GDC seem to be suggesting they have no role in understanding the law and taking action if they become aware that their registrants are acting outside the law. Clearly it cannot implement its own internal policy when it becomes aware of illegal activity if it does not understand what illegal activity is. Similarly it cannot lead the education of dental professionals if it does not understand the law that is to be taught. The links provided by the GDC say that “The GDC can investigate concerns about the quality of a dental or DCP education or training programme, especially if there might be risks to patients' safety” and that it can require remedial action to be taken. This also raises the question whether the caseworker guidance is in force while the GDC is uncertain of the law. The DTA thought that it had got a definitive answer to this issue a few years ago, clearly they had not. What is even more extraordinary is the GDC’s suggestion that the Dental Technician should seek to find the answers for it. Taken at face value this response is concerning, implying that the GDC cannot understand the law and work with other regulators involved with dentistry, however the GDC may be pointing to a hidden problem. The GDC might be saying if there is a problem with implementing the law, don’t blame us, the problem is elsewhere! Are they being told not to implement the law? If there is a hidden agenda that the regulators won’t work together this would have the effect of neutralising the whole point of the directive and allowing patients to be put at risk by allowing the possibility of non-compliant devices being fitted to patients. Where does this put the UK Labs that are paying hundreds of pounds to prove compliance with the MDD? For the MDD to be effective and protect patients the GDC and CQC would have to have a clear understanding of the law, have policies in place to deal with it and policies on working with the MHRA. All registrants would then know where they stand. The traditional answer for this situation is a Memorandum of Understanding between all the relevant regulators.

DENTAL NEWS

he Dental Technician continues its look into how technicians are regulated and how the Medical Devices Regulations are implemented. Last month it was revealed that dentists are free to use custom made dental device importers who can be classed as UK manufacturers. These manufacturers can have a UK address, have no training, are outside GDC jurisdiction and can sign the Statement of Manufacture. This month the Dental Technician looks into UK custom made dental device manufacturers that may be exempt from the MDD and MHRA regulation. The medical device legislation provides a reasonable basis on which to manufacture dental devices in a controlled environment. It seems strange that after years of it being a requirement there should continue to be uncertainty over implementation and how regulators work together. In order to shed light on this issue the Dental Technician has asked dentistry’s lead regulator for details of any dental manufacturer exemptions from the Medical Devices Directive (MDD). (If the GDC does not understand the legislation it cannot regulate and protect patients.)

Technician, the MHRA gave the GDC a presentation to make them aware of the thousands of counterfeit dental equipment items that the MHRA is intercepting and preventing being used on UK patients. After this presentation the GDC developed guidance for its caseworkers to help stop counterfeit components and materials from being fitted to a patient’s mouth. It says: 33.12 Registration with the MHRA – Refer to Section 71.2 Any registrant who is manufacturing medical devices as defined in the Medical Devices Directive 93/42/EC and is not registered with the MHRA should be referred to a caseworker and the MHRA notified.

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

FROM YOUR CLIENTS’ PERSPECTIVE: PART 1

ooking at your business from your clients’ perspective may seem simple, but is it? It is almost impossible for you to view it from this angle without asking an independent third party to do this for you. This is exactly what we have done recently for some dental practices and the results have proven to be eye opening for those business owners.

their nurse calls you will she be treated well and listened to? It is worth mystery shopping your business. Ask someone to call in with a potential new client query and see what the response is. If the call leaves you feeling somewhat cold, do not despair, but use it as a point for training. Not everyone is adept at conversations on the telephone and it can often be overwhelming.

Being able to view your business and particularly your marketing activity from the outside-in can be invaluable. Let’s see what you need to do to be able to have a long hard look at your business and perhaps ask someone to help who has no understanding or knowledge of dental technology services. In this article I will discuss the first three elements of this audit, I will talk about the next four elements in part 2 next month.

These are some good pointers when helping your team with phone answering. • Greeting – keep this consistent and friendly • Respond to the enquiry and take control with a broad question asking name and contact details, agree the next steps • Ask questions- seek first to understand • Summarise – this confirms understanding • Explain how you can help • Agree next steps

1. WHAT DO YOUR CLIENTS SEE?

Getting repeat business often depends on how you deal with problems rather than everything always going well. Accepting and taking responsibility for mistakes when they happen will gain respect and help build relationships. By having an open two way dialogue you can build your relationship with your client and can in turn help them and guide them when you think they need to make some changes to their own preps!

• What is your website like, is it easy to find

in searches and with Google maps? • Is your business consistent on branding, website, building, printed material? • How is the phone answered in your business and how are enquiries dealt with? • How is the laboratory work picked up and delivered – consistency of brand? • How does the work look once delivered? A professional approach or a bit slapdash? • If clients come to visit or bring patients is there a suitable place for them to be received and looked after? These are just some of the factors to be considered that will make or break your client relationship. For instance, whoever answers the telephone needs to be knowledgeable about your services and procedures and be able to communicate in a friendly manner. You may be the best dental technician in the world with superb work but if it is difficult to contact you or discuss cases or query cases then your clients will soon find someone they can relate to. Most dentists want to have a good working relationship with their dental technician and that extends to their teams. If

Equally how you are represented outside of your business building will reflect on the relationships you are building and getting more recommendations by word of mouth. How do you arrange pick-ups, are they regular and reliable so dental practices know when to expect you or are they timings erratic? By looking at these areas and adding in some consistency you can change the way your business is perceived.

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Whilst no-one expects a dental laboratory to be a perfectly clean and clinical environment you may want to give some consideration to this if it is usual for you to have dentists and their patients visits for perhaps shade taking. Have a look at how you can factor in a place that this can work, if not arrange to visit the practice instead. 2. HOW EASY IS IT TO BECOME A CLIENT? • Can you download lab slips from your website? • Is your phone answered quickly and by someone with knowledge? • Can you arrange lab work pick-up or postage slips or digital transfer? Decisions about changing dental technician may be made quickly due to a let down in another area, therefore the easier it is to be able to do business with you the better. If you have a six month waiting list to offer for crowns then this may be a sign of how good you are and how in demand but you are unlikely to get new clients quickly (although this may be part of your USP and keep you in demand!). If you can download lab slips from your website this not only reduces your print costs but allows any potential new client to be able to simply and easily access this form, or perhaps even complete it digitally. Consider how easy it is to become one of your clients. If you can offer local pick up then great but if not offer an easy way to post to avoid that business going to a competitor. 3. HOW EASY IS IT TO STAY A CLIENT? • Do you communicate regularly with your clients, keeping them updated with new services? • Do you ask for feedback and how your services can be improved? • Is there a system for keeping an eye on clients who haven’t used you for a while and contacting them p22 for feedback?

GC UK LIMITED DIGITAL TECHNOLOGY

Lisa Johnson GC Gradia Plus hands-on courses. Newport Pagnell, June 2018!

GC UK will be running One Day Intro and Two Day Advanced Gradia Plus Hands-on Courses by Lisa Johnson in their Newport Pagnell Training Campus in June 2018. Lisa Johnson DTG, from Nexus Dental Laboratories in Harrogate, is one of the UK’s top aesthetic technicians with over twenty years’ worth of experience using composite systems, specialising in large implant frameworks. From the early trials, Lisa and Nexus Dental Laboratory were both involved with the development of GC’s Gradia Plus composite resin C&B system. They have layered many frameworks using injectable techniques with Gradia Plus One Body System. On the Gradia Plus Intro Course, which will be held on 5th June 2018, Delegates

u dried. The components of the self etch bonding system (Primers A and B) were mixed at a ratio of 1:1 and applied to the prepared tooth surfaces. Finally, the dual cure cement ResiCem was applied to the inner surface of the crown directly from the automix syringe.

from p8

The restoration was seated and checked for correct fit, and the excess cement was tack cured from the lingual and vestibular aspects for 2-3 seconds. This led to a rubber-like consistency facilitating excess removal. After removing all the excess cement and checking the interproximal spaces for patency, the restoration was fully light cured from the lingual/occlusal and vestibular aspects for 40 seconds each. If the final inspection had shown any need for further occlusal adjustments, fine grit diamonds, “Brownies” and “Greenies” could have been used again for this purpose (Fig. 11).

will construct a metal based anterior crown in order to develop an understanding of this unique opaque system. This will include learning how to layer the crown using Gradia Plus Heavy Body, create internal effects using Gradia Plus Light Body and external effects using Gradia Plus Lustre Paints. They will also master the best composite finishing and polishing techniques. Using the same principles they will also build up a posterior crown using the One Body Injection technique. With 7 hours verifiable CPD, the course fee is just £275.00 and includes all models, copings and materials. On the Advanced Two Day Hands-on Course, which will be held on 6th and 7th June 2018, Delegates will be shown how to use the latest polymer technology composite from Gradia Plus, by both injecting and

FIG. 11: Crown made of the hybrid-ceramic material SHOFU Block HC (SHOFU Dental, Ratingen, Germany) after shade individualisation and adhesive cementation

[1] Santos GC Jr, Santos MJ Jr, Rizkalla AS, Madani DA, El-Mowafy O. Overview of CEREC CAD/ CAM chairside system. Gen Dent. 2013 Jan-Feb; 61(1):36-40; [2] Horvarth S., Spitznagel F., Gierthmühlen P. Neue Gesichtspunkte der restaurativen Zahnmedizin. Hybridmaterialien – Indikation und Bewährung, Zahnärztlich. Mitteilungen 2016; 106: 1134-1140 [3] Mainjot AK, Dupont NM, Oudkerk JC, Dewael TY, Sadoun MJ. From Artisanal to CAD-CAM Blocks: State of the Art of Indirect Composites. J Dent Res. 2016 May;95(5):487-495. [4] Ruse ND, Sadoun MJ. Resin composite blocks for dental CAD/CAM applications. J Dent Res. 2014

For further information please contact Louise Pakes at GC UK Ltd on 01908 218999, e-mail info@gcukltd.co.uk or visit www.gceurope.com

efficiently fabricate single tooth restorations in only one appointment. Additional benefits include dentin like elasticity and low antagonist abrasion. Current in vitro data regarding mechanical characteristics, abrasion behaviour and discoloration tendency seem to be promising. However, it should also be taken into account that there is still a lack of long-term clinical data, which would be indispensable to any further scientific assessment of this innovative material category. So, for the time being, it will be absolutely necessary to observe the restricted indications for use given by the manufacturers, and also the recommended preparation methods and minimum material thicknesses, when using hybrid ceramics in clinical practice. Besides, the use of hybrid ceramics for single tooth restorations can be advised only in combination with a suitable adhesive cementation system.

DISCUSSION Thanks to favourable properties, such as good millability and polishability, the new group of hybrid ceramic materials allows dentists to REFERENCES

layering with Heavy Body and Light Body materials on a six unit anterior titanium framework. The aim of the course being to replicate both the teeth and gingiva from an actual clinical case. Lisa will demonstrate how to achieve natural aesthetics with both fluorescence and opalescence plus surface texturing and polishing, and also demonstrate the simplicity of the injectable One Body technique with light curing flasks. With 12 hours verifiable CPD, the course fee is £ 495.00 including one night’s hotel accommodation, meals and course models. GC anticipate a big demand for both courses so book now to avoid disappointment!

For further details please contact the Shofu office 01732 783580 or sales@shofu.co.uk

Dec;93(12):1232-1234. [5] Stawarczyk, B., Liebermann, A., Eichberger, M., Güth, J.F.: Evaluation of mechanical an optical behaviour of current esthetic dental restorative CAD/CAM composites. J Mech Behav Biomed Mater 55, 1–11 (2015) [6] Awada A, Nathanson D. Mechanical properties of resin ceramic CAD/CAM restorative materials. J Prosthet Dent. 2015 Oct;114(4):587-593. [7] Lauvahutanon S, Takahashi H, Shiozawa M, Iwasaki N, Asakawa Y, Oki M, Finger WJ, Arksornnukit M. Mechanical properties of composite resin blocks for CAD/CAM. Dent Mater J. 2014;33(5):705-710.

www.dentaltechnician.org.uk

[8] Lauvahutanon S, Takahashi H, Oki M, Arksornnukit M, Kanehira M, Finger WJ. In vitro evaluation of the wear resistance of composite resin blocks for CAD/CAM.Dent Mater J. 2015;34(4):495-502. [9] Koizumi H, Saiki O, Nogawa H, Hiraba H, Okazaki T, Matsumura H. Surface roughness and gloss of current CAD/CAM resin composites before and after toothbrush abrasion. Dent Mater J. 2015;34(6):881-887. [10] Spitznagel, F.A., Horvath, S.D., Guess, P.C., Blatz, M.B.: Resin Bond to Indirect Composite and New Ceramic/Polymer Materials: A Review of the Literature. J Esth Rest Dent 2014;26:382–392.

SHOFU Block HC Ceramic Based Aesthetic CAD / CAM Restorative

Stress-absorbing hybrid-ceramic material Wide range of shades and translucencies Two-layer blocks for aesthetic anterior restorations High flexural strength (more than 190 MPa) Easy and efficient polishability

HC Primer provides the perfect surface pretreatment for reliable adhesive bonding of SHOFU Block HC and all other hybrid ceramics.

Lifelike light diffusion and fluorescence

18th & 19th May 2018 / NEC Birmingham

www.shofu.co.uk

Stand F92

LOOKING BACK JOHN WINDIBANK FOA INSIGHT

MEMORIES OF AN OLD CODGER 11 Knowing my place

962 and my apprenticeship was behind me and I had received the best wishes of everyone I had worked with for the last five years, but the card that had said it’s all behind you now was wrong. I still had a lifetimes learning ahead of me and to be a complete technician I had a lot of our technology to learn and qualifications still to take. My first job as a technician was at Lewisham Hospital, South London. The Hospital site was first used as a workhouse in 1612 and the first hospital was built in 1894 and this building was then occupied by a huge Pathological Department which was a leading centre for the treatment of haemophilia, a killer back in the sixties. The hospital had taken a direct hit from a V1 doodlebug during the war and like a lot of the health service was undergoing a massive rebuilding and expansion program with a new out patients department completed in 1958 and a new casualty shortly to be started. The Dental Department was situated in the new out patients unit with one surgery an office a waiting room and a two room laboratory that could easily accommodate four technicians. Stephen Riles was the technician in charge of the lab, I always referred to him as Mr Riles and he was in his sixties when I met him, so he had qualified about the time of the 1921 Dental Act and must have just missed out on becoming a dentist. A small quiet well turned out man he took great pride and pleasure in his work but made sure I knew my place, he was helpful when I made mistakes and showed me the best way to de-flask dentures, a technique that was new to me and involved the skilful use of a well directed hammer. Mr Riles and the senior technician Mr. Ron Edlin had paid

JOHN WINDIBANK FOTA

recommended centralising the specialist laboratories to make the best use of the staff and he wanted that centre in the south east to be at East Grinstead. This was the reason Mr Palmer, the chief technician at East Grinstead had warned me about the lab at Lewisham being closed, but fortunately for me they wanted four technicians to do the work that was currently being done by three and according to Ralph Sharp from the E.G. Lab that's the only reason they left the lab open, such are the whims of fate. I look back on my period at Lewisham as one of my happiest, my senior technicians enjoyed their work and Ron's waxing up was absolutely immaculate and he was a credit to you Mr. Badcock. a lot of money for their apprenticeships, they were immensely capable and received and expected respect from their colleges and peers. Ron was likeable and very prim and proper, he had a public school education and had done his apprenticeship with Mr. J H Badcock and he used to talk about the great man with the usual irreverence of someone you had worked with. I wish now I had been more aware of our dental history at the time as I would now have asked more questions about Badcock as back then to me he was the man who invented the orthodontic screw. The only story Ron told me about his apprenticeship was that Mr. Badcock would occasionally appear at the laboratory door, mumble something about doing a bit of research and then potch about a bit before apologising for disturbing everyone as he left, and to me he sounded like a nice employer to work for. After his war service Ron worked at Dulwich Hospital Laboratory until it was closed down by Sir Terence Ward and the work was sent to East Grinstead (EG). The dental report chaired by Sir Terence had Committees for 15 years.

Eleven fifty a.m. Mr Riles would put down his tools, pick up his coat and attaché case and off he went to the pub just down the road. Later he would return with his bottles of Double Diamond and he and Ron would settle back for a break. I would usually help myself to a hospital dinner, or in the summer I would pop down the road to Bellingham’s open air pool for a swim and in the evenings and weekends I played cricket and table tennis for the hospital. About three years into my work at Lewisham I was chosen as the cricket captain, I certainly wasn't the best player or the most knowledgeable but I could catch and it’s surprising how accommodating the team could be if you hang on to your catches. Certainly the best cricketer in the team was a West Indian called Joe and looking back I think the only reason they picked me as captain was because I was white. Joe had lots of friends who bolstered our team and what a great bunch they were, playing on the local parks the West Indian public would turn out to watch with comments from the boundary of "hit it on the up man" p22 and other help.

Vice Chairman OTA : Chairman CCHADT : Education Officer: Minutes Secretary : First Treasurer l Member of SLC Dental Advisory Committee l

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

PASSED POSTS: Member of the first steering committee that founded the OTA. l Founder Member of the CCHADT l Member of the Whitley Council and l

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

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

INSIGHT

My best friend at the time was a student called Emmanuel (Manny) and one evening he invited me home for a meal, the day was misty and by the evening the mist had turned into a full blown London smog. I had got used to driving in smog, my old Hillman car would allow me to screw out the windscreen which was very cold in the winter but did improve your visibility a little and of course at night you could follow the street lights. So off we set, turning right on to the high street and checking with the street lamps I straightened up only to see a wall looming up in front of me. I slammed on the breaks and swerved left just missing the wall as I came to a stop; totally disoriented I had turned back on myself and had just missed crashing into the hospital I had just left. Shaken a bit we set off again slowly following the lights of the cars in front of us and eventually we reached Manny’s street. Turning into his street I glimpsed cars parked right and left but I could not see past the bonnet of the car as the headlight just threw up a wall of black mist. Manny said "I will get out and walk in front to show you the way" and out he popped only to disappear into the gloom, Manny was Nigerian and had very black skin so in the end we found a newspaper for him to hold which got us to his home. The Orthodontic Consultant at Lewisham Hospital was a Mr K Pringle and he had clinics at Woolwich, Dartford and Guys amongst

MARKETING

u from p16

others, his lab work apart from Lewisham and Guys went to E G and I had been warned by the chaps at E G that he was the complaining sort and nothing was ever right for him. Mr Pringle and Ron used to have long chats about public schools and of course Badcock. Mr Pringle rarely used fixed appliances and almost exclusively he used removable appliances to treat his patients. The registrars used to trot of on courses to America and came back talking Begg, twin wire and edgewise, but Mr Pringle just talked about the latest band wagons and got on with trimming his mono-blocks and adjusting his removable appliances(R/A). Fixed appliances in the sixties were very time consuming, pre formed bands were becoming available but mostly bands were hand made from stainless steel tape and of course no direct bracket bonding back then. Wonderfully complex band forming pliers were available and technicians were called on to make bands on plaster models and make devices for local root movements. Adams cribs were a relatively new development and every one had their own ideas how they should be constructed and what pliers to use and it seemed everyone knew better than Adams himself. I spent a few days with Bert Aldridge in his lab at Great Ormond St. Hospital before I got it right to his satisfaction but curiously it was making some demonstration R/A's for an exhibition that I learned how precise you needed be for them to work properly.

Often we spend a lot of time and effort trying to get new clients that we forget to look after our existing clients. We maybe have offers for new clients and these alone can alienate our loyal existing clients and can see them considering being someone else’s “new client”. Keep a dialogue and communication wherever possible and don’t be afraid to ask for feedback. This can be in the form of an informal conversation or perhaps an actual survey. You can design surveys that can be sent in email and offer incentives for completion. Listening to your clients and understanding them is a great way to build your business and be sure you are spending the right time on the right areas. Newsletters are another great way to keep you in your client’s mind and keep visible especially if your client only uses you occasionally. These can be printed and posted out but also consider electronic versions which are very cost effective and can be sent out instantly. It is worth auditing all of the above areas from time to time to see how your clients are receiving your communications from how the telephone is answered to how your delivery personnel is with the dental practices. You can’t be present in all areas but you probably need to know if you are being wrongly represented. As I have said before, Marketing is everything you do, from how you answer the phone, to how you pay your staff, what your website looks like and so on. It is not one entity but an entire understanding of how your business is and is perceived. Get it right and it will thrive, any defects and you will see problems. Understanding your business from your clients’ perspective can reap rewards a plenty. 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!

The R/A’s were to be displayed on acrylic models and when these were ready I took impressions of the models and produced the devices in my usual way. My customers liked to feel a little grip on the R/A as it was seated in the mouth and to produce this I used to shave a slither from the plaster tooth. Everyone seemed quite happy with what I was doing but when I came to fit my demonstration devices to the models they would not fit in the palate. Horrified I pushed on the palate only for the device to spring back when I realised the pressure. The device fitted anteriorly but was proud at the posterior collets and then I had my eureka moment, the cribs were active. Shaving the teeth where the cribs arrowheads fit activated the crib and with the collets lifting away from the tooth the crib now became a spring moving the teeth palataly, so this must be happening in the mouth! Adjusting the cribs the device fitted perfectly and the devices stayed in place, so after this I left any activation to the surgeons but some activated the appliances before trying them in. For a short time I worked with a surgeon who massively activated the cribs and when I asked him why he replied “they have got to be tight, no arguments”. The cribs for him on average lasted about 3 weeks before breaking, I wonder how many of his patients gave up before treatment was completed?

A WELL ESTABLISHED CROWN AND BRIDGE LABORATORY ARE RECRUITING IN THE FOLLOWING DEPARTMENTS:

CERAMIC DEPT.

Ceramist capable of high quality of work and comfortable working on single and multi-unit cases.

METALWORK DEPT.

Technician to have a good understanding of all substructure requirements and should have experience working on Multi-unit cases, FGC, Inlays ETC…

ALSO PART TIME VACANCIES IN MOST DEPTS. PLEASE TELEPHONE ROD THORN OR JON VENABLES

0116 2760166 Or email your CV

roderick.thorne@btconnect.com This is an excellent opportunity for successful applicant.

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e gathered at the “Look Mom No Hands” Bike center and Café in Old Street , within the City of London to hear the news of the widely anticipated 2018 Straumann Bike ride. The Café is famous as a meeting centre for enthusiastic bikers , where they can also have their bikes serviced or repaired and can buy new accessories or parts for their beloved “Sit Upon”. Up to date Straumann bike rides have raised Some £150,000. 00. and intend to raise a lot more with this years target set at £100.000. There were some familiar faces gathered to hear the news and to listen to some very interesting information about the Mouth, Head and Neck Cancer from some very involved experts with personal and moving accounts from patients and close family of patients who have become victims. The evening, organized by Straumann was on behalf of the Mouth Cancer Foundation who organize and encourage these volunteers to speak to the listening world about their ordeal. It certainly brings home the great need for funding for research and where needed retraining. Hopefully things are changing for the better in the fight against all cancer but the mouth head and neck cancers are steadily on the increase. Justin Annett, Director of marketing for Straumann. Introduced the programme for the evening. He outlined the history of the ride and stressed the success so far. Using that success as a platform he encouraged all involved to go on and raise substantial sums to aid the fight for a Cancer free world. This years target has been set and all participants will be required to raise their share from sponsors or friends and encourage as many who wish to donate to do so.

DENTAL NEWS

LOOK MOM NO HANDS W The organization of travel and accommodation along the 500mile route for all those taking part is in the hands of the Straumann organization. Quite a task, with possibly up to 70 riders taking part. Sarah Gardiner who was there on the evening, has that daunting task to complete.

INTRODUCTION TO THE MOUTH CANCER FOUNDATION The first speaker was Krishan Joshi, cofounder with his father, of the Mouth Cancer Foundation, a Charitable Trust dedicated to education and prevention of these cancers to whom all monies raised will be donated. He spoke of his Fathers determination to build the foundation and his commitment to ensuring it would continue to provide funding and education via their influence and the encouragement of ventures such as the Straumann Charitable bike ride. LIFE AT THE COAL FACE The next speaker, Mahesh Kumar, is Consultant Oral and Maxillofacial, Head and Neck Surgeon working at Hillingdon Hospital and Northwick Park Hospital. He spoke about his everyday involvement with patients and their condition and stressed that there needs to be a greater awareness in order to diagnose those who may have the condition earlier. He stressed that early diagnosis will would greatly improve the survival rates. He showed several of the cases before and after surgery. He demonstrated the potential

damage, which can stay even after the Tumor has been removed. A lot of skill and work goes into the functional and aesthetic re-habilitation of the patients who have been through the life saving surgery. Caught early the necessary damage is often minimal but rather too often the patient presents late and the Tumor has spread to include other tissues and possibly organs. Jaw resections, leaving major facial scarring and profile changes, require a dedicated and hardworking team with the restoration often spreading over many, many months. Unfortunately the incidents of these cancers are on the increase. It is already the 5th most common cancers, more than Cervical Cancers for example. LOSING LOVED ONES TO MOUTH CANCER “If you notice a lump in your mouth that wasn’t there before or a mouth ulcer which lasts for more than 3 weeks, you should see a dentist or doctor immediately.”

DENTAL NEWS

Mr. Kumar, after answering many questions from the audience, was followed by Mrs. Pat Jones who is a people’s ambassador for The Mouth Cancer Foundation. As part of its educational programme, former patients and close family members are often willing to voluntarily speak of their experiences as a way of raising awareness of this terrible disease. They are know as Mouth Cancer Foundation People Ambassadors or Patient Ambassadors and they undertake to educate and encourage all who will listen to be sure they know how to help prevent this disease spreading. Pat Jones, who was there with her Husband spoke of the loss of their lovely daughter Claire while in her early twenties. Pat spoke clearly and with a picture of her daughter as a background. She spoke of the effort her daughter had made to have her condition diagnosed with repeated failure by the professionals to recognize the seriousness of her condition. An ulcer had developed and had stayed around for longer than it should and the young under-graduate had gone to seek advice from several professional practitioners who failed to diagnose the condition until it was too late. Eventually an operation seemed to offer hope of Claire living her life without the fear of the disease. For a couple of years she thought she was clear. Having to deal, as a teenager with the scarring and the fear of a secondary infection. Claire continued her studies and graduated with a First Class Honors degree. Unfortunately the disease returned and Claire died after a second operation, which showed deeper infiltration of the tumor. Claire had spent a great deal of time wanting to ensure that the public awareness was raised and that people were made aware of the dangers. Early diagnosis will mean a high chance of complete recovery. Visiting your dentist once or twice a year for soft tissue check-ups is essential and practicing good oral hygiene habits with your own check for signs of Oral Cancer can save your life. Clair was only too aware of this truth and her Mother and Father have taken real steps to follow in her desire to inform others. After the meeting in London they were due to travel back to Shrewsbury. Pat’s talk had a very deep affect on those present even many of the professionals who have the responsibility of dealing with such cases. We stopped for a break and to enjoy some of the food freshly prepared in the Café. Drinks were also provided and a good deal of chatter and friendly but serious banter. A SURVIVORS STORY The second part of the evening began with the introduction of Mr. Stuart Caplin (pictured left), a Business Consultant at St. James Place Wealth Management who is a survivor of mouth cancer. Mr Caplin accompanied by his wife had come to speak of the experience

normal but is remarkable when you understand what he has been through. He spoke for some time and kept the audience enthralled. We all got a real sense of how difficult it is to overcome the lost tissue and continue to live a normal life. Mr. Caplin counts himself lucky to have come so far and is determined to enjoy his cancer free life style while being determined to inform others so more and more people can avoid the trauma of having to deal with this awful disease. Mr. Caplin does voluntary work for four different Cancer Organisations and continues with a very positive attitude to life. WHY I RIDE “Oral cancer can devastate lives. Riding alongside likeminded dentists to raise funds to help prevent and cure mouth cancer is an incredible opportunity to truly improve patients’ lives.”

and the aftermath. He told us of his battle to have the condition diagnosed. By the time it was realized he was told the only treatment for him would be Chemotherapy combined with Radiotherapy. After completing the combined treatment, which went on over six months, the cancer was found not to have spread but was still there. The expert advice was to have surgery. After a short visit to Paris, to marry his long-term partner and now wife Susan, who was present with him as he spoke. Following Surgery which involve the removal of part of his tongue and a neck dissection to remove some lymph nodes Stuart would be faced with a need to learn to eat and swallow and speak again. He spoke about the many long months of therapy to improve his communication and to overcome the speech impediment, created by the loss of part of his lower Jaw and tongue. With a twinkle he repeated the word jingles which he spent hours practicing . He had a very positive attitude to life and encouraged us all to accept that there will b challenges but to be ready to defeat them. His speech is far from

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The final Speaker of the evening was looking at this year’s forthcoming challenge, Richard Porter (BSc, BDS, MFDS RCS, FDS Consultant in Restorative Dentistry at St. Georges Hospital London. Richard spoke about the terrible effects of this type of cancer on the patients lives and showed some extreme cases of facial destruction and spoke of the challenge to re-build for function and aesthetics. He showed how Dental Implants have helped greatly in overcoming some of the more demanding cases. He is committed to try to raise the awareness of Head, Neck and Mouth Cancer within the profession and across the population. He was looking forward to his bike ride. After many questions, the evening wound down with conversation from all those attending. All committed to support the effort to raise as much money for the cause. With some individual and collective efforts, for the months leading up to the September Start. For event/ride inquiries please contact Sarah Gardiner at Straumann: Tel: +44 (0)1293 651255 Email: sarah.gardiner@straumann.com Visit: www.straumannbikeride.com/donate www.straumannbikeride.com www.straumannbikeride.com/store #dentistsinlycra2018

THE

GOLDEN PROPORTIONS

DIGITAL TECHNOLOGY

ESSENTIAL PRINCIPLES OF SUCCESS FOR ESTHETIC PROSTHETICS

ince ancient times, the search for the “esthetic formula” has been pursued. Research shows that we perceive faces as especially esthetic if they are characterized by a high degree of “order”, “proportionality” and “symmetry.” However, the total symmetry is quickly perceived as unnatural [Fig. 1, 2]. Essential esthetic principles can also be transferred to total and partial restorations. For a restoration to be harmoniously integrated, parameters such as the basic anatomical shape of the anterior teeth, their length/width ratio, the tooth axis and the gingival transition are

FIG. 1: Natural asymmetry. Claus Pukropp, Master Dental Technician, Bad Säckingen, Germany.

extremely important. In his report, Claus Pukropp, Master Dental Technician (Head of Technical Marketing, VITA Zahnfabrik, Bad Säckingen) describes the essential criteria for esthetic results in restorations.

GOLDEN PROPORTIONS AND OTHER RULES

Since the Renaissance, in the visual arts, pleasing proportions with a well-balanced ratio of length and width have been determined using the “golden proportions.” Esthetically pleasing dentures require denture teeth that have not only balanced proportions, but also ideal tooth axis and harmonic curvature and angle features [Fig. 3]. Because esthetic principles have been ignored in the design of teeth, prefabricated teeth in the patient's mouth are often perceived as unnatural despite their functionally correct positioning. We assume that every technician recognizes the following situation from crown and bridge technique: although the finished crown was 100 % shadematched, it shows defects in the axis of the teeth or angular features and is then rejected by the dentist and patient.

“ESTHETIC ANALYSIS” OF PROSTHETIC PRODUCTS

The fact that the industry sometimes fails to pay sufficient attention to esthetic criteria in the development and production of prosthetic teeth is shown by an examination of various prefabricated teeth. It is notable that the tooth design is often mirrored across the quadrants. This means, for instance, that tooth 11 is a

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FIG. 2: Total, unnatural symmetry.

mirror image of tooth 21 [Fig. 4]. This results in total symmetry, which causes the resulting teeth to appear unnatural. It was also determined that some prefabricated products have tooth axis [Fig. 4/red], angle features [Fig. 4], and length/ width ratios that deviate from the ideal. Poorly designed tooth features complicate the creation of a natural-looking reconstruction of the dentition for the technician. Prefabricated teeth in which the proximal interdental marginal ridges are missing [Fig. 4/blue] hardly allow a natural design of the papilla. Finally, some prefabricated products have the disadvantage of a crown that is clearly separate from the neck of the tooth, which makes it difficult for the technician to create a natural-looking restoration [Fig. 5, 6].

TEETH WITH “GOLDEN PROPORTIONS”

The new generation of anterior denture teeth, VITAPAN EXCELL, and the tooth line VITA PHYSIODENS, were designed with the esthetic principles of “golden proportions”. This supports the dental technician in the natural tooth setup and design of the prosthetic base [Fig. 7], and the prostheses look significantly more natural and esthetic, thanks to ideally designed tooth features [Fig. 8, 9]. IMAGE SOURCES: 1 - 7 VITA Zahnfabrik, 8 - 9 Viktor Fürgut, Dental Technician. VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

ABOVE - FIG. 3: Features and proportions according to the natural model using the example of VITAPAN EXCELL. RIGHT - FIG. 4: Tooth features of different selected dental products used as examples. Analysis by expert panel of dental technicians.

FIG. 9: Correct vertical curvature features allow a natural transition from the alveolar/ juga alveolaris process, over the marginal periodontium, to the actual tooth. FIG. 5: VITAPAN EXCELL with a natural cervical design.

DIGITAL TECHNOLOGY

FIG. 6: VIVODENT DCL with clearly separate neck of the tooth.

FIG. 7: Natural gingiva design with VITA PHYSIODENS.

FIG. 8: Proximal interdental margins allow the proper design of the papilla.

FIG. 10: VITAPAN EXCELL anterior tooth; geometry: R49

FREE VERIFIABLE CPD As before if you wish to submit your CPD online it will be free of charge. Once our web designers give it the all clear there will be a small charge. This will be less than the CPD submitted by post. This offer is open to our subscribers only. To go directly to the CPD page please go to https://dentaltechnician.org.uk/dental-technician-cpd. You will normally have one month from the date you receive your magazine before being able to submit your CPD either online or by post. If you have any issues with the CPD please email us cpd@dentaltechnician.org.uk

4 Hours Verifiable CPD in this issue LEARNING AIM

The questions are designed to help dental professionals keep up to date with best practice by reading articles in the present journal covering Clinical, Technical, Business, Personal development and related topics, and checking that this information has been retained and understood.

LEARNING OBJECTIVES REVIEW: n Strength of Zirconia n Implant planning n Customised Special trays n Business of Management

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

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VERIFIABLE CPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN SHOFU BLOCK FOR CADCAM Q1. What are the blocks made from? A. Composite Plastic. B. Nano Ceramic and Polymer. C. Acrylic Compound and Composite D. Glass Ceramics and Light Cured Composite.

MEMOIRS OF AN OLD CODGER. JOHN WINDIBANK. FOA Q9. What honour, other than the OTA Fellowship, did John receive: A. International award for Orthodontics. B. National Award for Orthodontic teaching. C. The E. A. Dennison Award for services to Dentistry. D. The straight wire Award.

Q2. A. B. C. D.

LOOK MOM NO HANDS Q10. How much money are the bikers hoping to raise? A. £25,000. B. £85,000 C. £50,000. D. £100,000.

What is their strength advantage based on? Greater surface hardness. Greater bonding strength. Flexibility matching tooth enamel. Good milling technique.

CONDYLATOR ARTICULATOR REVISITED Q3. What was the major innovation of the Condylator? A. It allowed lateral movement. B. It reproduced the centric position. C. The anterior guide Pin. D. The Roof shaped sliding surfaces at the Condyle elements. Q4. A. B. C. D.

What was a particular feature of the Face Bow? The sprung loaded pencils for tracing the condyle position and movement. It was easy to use. The capture of centric relationship. The positive seating ability.

THE GDC AND THE MDD REGULATIONS Q5. Who is responsible for enforcing the MDD? A. The GDC. B. The BDA. C. The MHRA. D. The RSM. MARKETING SIMPLIFIED Q6. What is the first element of your business audit? A. How your delivery works. B. What do your client see? C. Your telephone manner. D. Your turn around time. Q7. A. B. C. D. Q8. A. B. C. D.

What may help build respect? Accepting responsibility for mistakes. Refusing to respond to complaints. Speaking only to the company principle. Only delivering in the evening. How easily can they become clients? Only by making an appointment. If they follow the instructions on the web site. Letting us know for us to follow up. By writing their request.

Q11. How far are they aiming to travel? A. 800 Miles. B. 500 Miles. C. 450 Miles. D. 750.Miles. Q12. How much have past rides now raised. A. £100,000.00. B. £120,000.00. C. £150,000.00. D. £178,000.00. Q13. How could the fatality rates be reduced? A. Better Hospitals. B. Early diagnosis of the condition. C. Eating better food. D. Drinking more water. Q14. How far and over how many days is the Cycle Ride? A. 120 miles over three days. B. 230 miles over four days. C. 500 miles over five days. D. 560 Miles over six days. Q15. How many cyclists are taking part? A. 45. B. 49 C. 53. D. 70. Q 16. What is the name of the new DTA President? A. Barry Stokes. B. Simon Rumfold. C. Delroy Reeves. D. Tony Ledbetter.

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

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DENTAL NEWS

Harley Technicians Study Club

DTA appoint new President w The Dental Technologists Association (DTA) is delighted to announce that Delroy Reeves has been appointed as President for the coming year.

w On Wednesday 21st March the HTSC, organized their very popular and involving spectacular event "Table Clinic". Four of our Members volunteered to demonstrate their Products and Skills. • Dhrumil Shah, our very new member, showed us the technique he developed in his own laboratory to minimize the number of patient's appointments while having a full arch restored. "Full arch implant restoration, verification and bite" • Richard Tyrell gathered all possible tricks he uses in the lab with his colleagues and shared his knowledge with us... about everything. "Tips and hints" • Simon Newbold came back to show us his Platinum foil porcelain veneers. Blast from the past for some, very new to others. "Old school" ... in fact it's so old, that it is almost new...! • Teresa Baran chose metal free denture frames (courtesy of Byrnes Dental Laboratory and Oak View Restorations) let's discuss pros and cons. "Aesthetic denture framework" Be there, watch, discuss and learn... If you are interesting in sharing the evening with us come along to 11 Chandos Place, Cavendish Square, London W1G 9EB. Usually held one Wednesday in every month. Bring your colleagues. If you are interested you are welcome.

Delroy began working as a dental technician about 40 years ago, completing his initial training at an inhouse dental laboratory in Jamaica. His education continued here in the UK at South London College, where he gained a City and Guilds Final Certificate in 1983 and a City and Guilds Advanced in Crown and Bridge Technology in 1986. He runs his own crown and bridge dental laboratory in London. A member of the Council of DTA since 2011, Delroy is a keen runner and a Deputy Churchwarden in his spare time! Delroy says ‘I’m delighted and honoured to be taking over as DTA President at this time of great change. 2018 marks the 10th anniversary of our member publication, The Technologist, and I believe we have much to celebrate. I look forward to working with colleagues on the DTA team to support our members.’ To find out more about DTA please visit www.dta-uk.org or email to info@dta-uk.org or call 01452 886366. The Dental Technologists Association is a not for profit association representing the interests of dental technicians in the UK.

COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE ACTEON GROUP ACQUIRES PRODONT HOLLIGER w At the heart of France and a region known worldwide for its metal and in particular its blades and knives, Prodont Holliger manufactures reliable, leading-edge tools that are designed by dentist for dentists and technicians for technicians. Carried by a passionate team of skilled

engineers, their unique competence knows no bounds and rigor and precision are key words in every aspect of R&D, production and delivery. Explore the wide range of dental laboratory products from handheld instruments and discs for working with all types of materials, to the new Protorch 4, one of the most reliable and constant burners on the market, with a

precise and adjustable flame and automatic piezo ignition. For more information, a product catalogue or demonstration, call Acteon UK on 01480 477307 or email info.uk@ acteongroup.com

KEMDENT: THE UNIVERSAL CLEANER THAT IS DESIGNED FOR THE DENTAL TECHNICIAN w Kemdent’s Spring offer will save you time and money, buy 1 x 5L PumiceSafe Universal Cleaner for only £16.97 + VAT or buy 2 x 5L at only £12.13 each + VAT RRP: £24.25 + VAT each. This offer is only available during April 2018. PumiceSafe Universal Cleaner is a multi purpose, alcohol free, ready to use

solution that neutralises unpleasant smells from your Pumice tray.

Alcohol free with a glycerine and emollient content it will not irritate a technicians hands.

Designed with the technician in mind, PumiceSafe is Aldehyde and Phenol free, kind to your skin and has a fresh mint fragrance. It can be used in the pumice tray to produce a micro-organism free slurry, it can also be used as a bench surface cleaner plus it is ideal for pre-soaking lathe brushes to reduce the risk of burning the acrylic during polishing.

PumiceSafe Universal Cleaner will save you time plus keep your laboratory clean and fresh with minimal effort.

www.dentaltechnician.org.uk

Find Kemdent at DTS 2018 on stand F02, NEC Birmingham and see what other fantastic offers are available or call Kemdent on 01793 770256, e-mail sales@kemdent.co.uk

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Dental Industry Awards 2017

Be Connected

In association with the

Winner Dental Industry Event of the Year

â&#x20AC;&#x153;Let us put a smile on your face todayâ&#x20AC;? Unravelling the technology needed to get better connected with your laboratory and your patients is often complicated. The Henry Schein ConnectDental team will help improve your efficiency and productivity and deliver all the benefits of a streamlined digital journey. With education, finance, advice and support, ConnectDental makes it easy to integrate the digital workflow at whichever stage you choose. Register today for the 2018 Digital Symposium to unravel the best solution for your practice.

Call 0800 028 4870 hsddigitalsymposium.co.uk