The Dental Technician Magazine January 2018 by The Dental Technician Magazine

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

THE DIGITAL CLINICAL EXPERIENCE AND THE FUTURE OF RESTORATIVE DENTISTRY

THE DENTAL TECHNICIAN

HAS A NEW LOOK FOR 2018!

VERIFIABLE CPD FOR THE WHOLE DENTAL TEAM

Inside this month 3D PRINTING OF OCCLUSAL SPLINTS PAGE 10 - 11

DIGITAL TECHNOLOGY

DIGITAL DENTISTRY - AN AID NOT A REPLACEMENT FOR TECHNICIANS PAGE 23 www.dentaltechnician.org.uk w w w.d e n t a l t e c h n i c i a n .o r g .u k

BUSINESS

COMPANY PROFILE: A LOOK AT BRACON LTD PAGE 12 - 13

E BY SU X T R B EN A EC SC D C O O R I YO M SE LL M PT UR E IO E PA EA ND N G GU IN E 3 E G

TECHNICAL

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CONTENTS

P14

News

Thoughts from the Editor Cleancert: ‘Best practice’ in laboratory infection control Publisher – Michelle Donald E: michelle.donald@dentalcommunications.co.uk T: 07961 026682 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: chris.trowbridge@dentalcommunications.co.uk T: 07399 403602 Editorial advisory board K. Young, RDT (Chairman) L. Barnett, RDT P. Broughton, LBIDST, RDT L. Grice-Roberts, MBE V. S. J. Jones, LCGI, LOTA, MIMPT P. Wilks, RDT, LCGI, LBIDST Sally Wood, LBIDST Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician Magazine is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused. No part of this publication may be reproduced in any form without the express permission of the editor or the publisher. Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH

EXTEND YOUR SUBSCRIPTION BY RECOMMENDING A COLLEAGUE There is a major change in CPD coming soon. The Dental Technician Magazine is a must read. Tell your colleagues to subscribe and if they do so we will extend your subscription for 3 months. The only condition is that they have not subscribed to the magazine for more than 12 months. Just ask them to call the Subscriptions Hotline. With four colleagues registered that means your subscription would be extended for a year free of charge. At only £39.95 per year, for UK residents, this must be the cheapest way of keeping up to date. Help your colleagues to keep up to date as well. Ask them to call the subscriptions Hotline on 01202 586 848 now.

4 6-7

Marketing Marketing Simplified by Jan Clarke BDS FDSRCPS

8 & 17

Technical Adjusted occlusal splints made by 3D printing

10 - 11

Company Profiles Bracon Ltd

12 - 13

Digital dentistry Straumann goes digital with a hands-on day in clinic

14 - 15

GDC News Senior staff moves at the General Dental Council 16 General Dental Council releases statement in response to Department of Health consultation 16 The PSA concludes the GDC has met 23 out of 24 of its standards 16

Company News Marketplace

Team The young ITI

18, 20 - 21

Insight Dental opinion from Sir Paul Beresford, BDS. MP

Digital technology Digital technology is an aid - not a substitute - for the dental technician

Focus Reawaken the passion at DTS 2018

CPD Free Verifiable CPD & CPD questions

26 - 27

Education CEDACORE: Children experiencing dental anxiety: Collaboration on research & education

Dental News King’s Study provides clues to body’s defence against common oral infection Obitury: In memory of Clive Ely Oral health / Oral cancer news

25 29 30

Classifieds

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NEWS

WELCOME TO THE NEW YEAR What´s in store?

l Big deep breath, and start putting in place all those ideas and schemes you have been considering. Your New Year’s resolution for your dental involvement and perhaps I can suggest you include the Dental Technician magazine in your consideration. Not just telling your friends to get it but being more interactive with it yourself. Dental professionals often feel no one is listening or interested in their point of view and subsequently don't express it. I think it might be time to go public on your own concerns about your chosen career and debate it with colleagues, many of whom will be sharing your reservations about the career they have chosen. This year I would like to hear your opinions on Digital Dentistry and your concerns about whether you feel you have a choice in your career path. Perhaps the comparison between your earnings and those of others within technical or indeed clinical dentistry should be aired. Maybe you may be considering going further with your Implant based technology and want to know how. Believe it or not there are many others out in the market place who feel the same. You university or hospital based technologists may feel insulated against the market place but in reality that is not the case. We are working within a small number of Professionals nationwide. Including CDTs and maxillo-facial technicians and technical consultants. We share so many techniques and skills and could greatly benefit from sharing your thoughts and knowledge with your fellow professionals. There does seem to be a tendency for our skill based craftsmen to withdraw, but history has shown us that

meeting and interaction improves our outlook, skill and professional rewards. Why do courses work so well for those who take part? Yes of course, the content and techniques taught improve the work type and range but the interaction with other technicians is often the most memorable and informative part of many such meetings. Finding that others have the same concerns as you may direct your thoughts to the causes and the solutions and how they should be tackled. I would like you to use these pages to express your concerns, hopes and ambitions and perhaps the obstacles you have encountered. I am also calling to the readers in the Irish Republic and those who take the magazine overseas. Please let me know of your situations, whether good or not. Lets all become more actively part of the worldwide community of Dental Technical professionals. Clinic based or indeed clinicians are more than welcome to add their voice. The changes going on in dentistry across the world are truly another industrial revolution. But of course the patients’ best interest must remain the ultimate goal for all of us involved. There are many millions in the world and indeed in our close islands who have no choice of access or indeed choose not to visit a clinician. If you decide to continue with your apathy about dental matters, the vested interests and the politically motivated may continue to take advantage of the disunity and therefore lack of political clout amongst DCPS including technicians. I am convinced by my own contacts that many of you are feeling frustrated or indeed depressed about your futures. Don't

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be, the clinicians needs technicians and their skill more than ever. The chair-side scan and manufacture has already been shown, in daily practice, to be of rather poor quality. Why is that surprising? After all undergraduate clinical dental trainees are no longer taken through the routine of manufacturing the restorative options as they used to be, and are therefore blindfolded about the eventual result. With what you know would you have a chair-side manufactured unit by a dentist in your mouth? I certainly would not!!! Of course there are a rare few clinicians who can produce the results and they are often the offered attraction produced by the equipment manufacturers to show the potential of their particular machine or technique, in reality they know that only a very few can produce the desired result. You may find yourself working within a surgery as the technical expert who designs and produces the restorations, or indeed designs and sends for production to the laboratory. It is already happening like that in other countries. The important thing is you keep up to date with the changes and remain committed to better quality for your patients and improve the status and rewards for yourself. Share your experiences with others and create an expectable norm for your working colleagues and help to improve the patients’ lot. Ask questions and discuss the answers. Where better to do that than through the pages of this, the oldest and most known technicians magazine. 2018 is the year to do it. Don't let me down!!! Larry Browne Editor

Pure Inspiration

Rediscover PFM and Improve Aesthetic Results!

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‘BEST PRACTICE’ IN LABORATORY INFECTION CONTROL

SIMON DAVIES EXAMINES HOW TECHNICIANS CAN STAY SAFE IN THE DENTAL LABORATORY, FROM AN INFECTION CONTROL PERSPECTIVE.

chieving infection control levels that ensure the safety of the dental laboratory team and, subsequently, the practice team and patients, is, of course, absolutely necessary. But is this the reality? In 2010, Almortadi, a Lecturer in the Department of Applied Dental Sciences at Jordan University of Science and Technology, and Chadwick, a Clinical Senior Lecturer in Restorative Dentistry and Honorary Consultant in Restorative Dentistry at the University of Dundee’s Dental School and Hospital, reported on their investigation into whether disinfection of dental impressions achieved compliance with ‘accepted standards’*.1 Stating the need succinctly, they wrote: ‘The responsibility of ensuring impressions have been cleaned and disinfected before dispatch to the dental laboratory lies solely with the dentist. Uncertainty of impression disinfection risks both the health of the receiving dental technician and potential repeat disinfection of an already disinfected impression with detrimental consequences for its dimensions.’1 This is reflected in current guidance from the dental cross-infection ‘bible’ (HTM01/05, sec 7.1b) on impressions, prostheses and

orthodontic appliances: ‘All devices should receive disinfection according to the manufacturer’s instructions. This will involve the use of specific cleaning materials.’ In the past, a variety of studies have indicated that, against the ‘ideal’*, cross infection control between the dental practice and laboratory varies widely, with, for example, nearly a quarter of impressions received by one laboratory found to be visibly contaminated with blood,2 and, in another case, that material had been appropriately disinfected prior to being sent to the laboratory in only 57% of cases.3 Times have changed, of course, and hopefully the infection processes employed have moved along too. However, given that it is not possible for a dental laboratory to confirm whether effective decontamination has been carried out by their customers, an ‘on-receipt’ disinfection process needs to be established to keep technicians safe. ‘BEST PRACTICE’ GUIDANCE Offering guidance on this all-important issue is the Dental Laboratories Association’s (DLA) document ‘Controlling cross infection in the dental laboratory. Best practice guide’.4 It is, by necessity of the significance of this

topic, of greater scope than an article such as this allows. However, important steps to take – but are by no means limited to – include the following: 4

• A separate work area shall be set aside in the laboratory to receive all incoming work. This should ideally be situated next to a fully operational sink with hot and cold running water and adequate drainage. • If there is not enough space to have a separate bench for incoming work and outgoing work, the second best is to make sure that, after dealing with all incoming work, the surface of the work area is thoroughly disinfected before commencing with preparing outgoing work for postage or delivery. • Under no circumstances shall the person handling incoming work be interrupted by unrelated tasks – answering the telephone, tracing work in the laboratory, etc. – because of the danger of contaminating other items and the possibility of missing an incoming item or disinfecting it incorrectly. • Under no circumstances should the person treating incoming work handle outgoing work at the same time. There is a risk that cross infection may occur, and the work being returned to the surgery will be contaminated.

SIMON DAVIES Simon Davies is the Managing Director of CleanCert, a company specialising in innovative dental infection control and water purification products.

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• Under no circumstances should the person carrying out this work eat, drink or smoke while processing the incoming work. In terms of the actual decontamination process of incoming appliances, the DLA’s recommendations include rinsing the appliance under running tap water; do not use a sink with a plaster trap in it, as they are breeding grounds for germs. Furthermore, items should be placed in the disinfection solution using suitable plastic tongs. In addition, a timer should be used to note the length of time the appliance is in the solution.4 EFFECTIVE DECONTAMINATION In practical terms, Almortadi and Chadwick (2010) offer the following advice: ‘To achieve impression disinfection it is generally accepted that different chemical agents may be used. Clearly these should be applied as recommended by the manufacturer of the product.’1

To this end, LabCert offers unrivalled results. Recent independent analysis of swabs taken from 170 prostheses arriving into one of the UK's largest dental laboratories (PDS) showed LabCert achieving a 5-log reduction in a 30-second soak, without any abrasive cleaning action needed. This 30-second contact time is significantly faster than the 10-minute contact time recommended by other dental laboratory disinfectants. LabCert offers a definitive solution to the problem of whether the supplying dental practice has effectively disinfected appliances sent to the laboratory, as it is a powerful, effective and safe disinfectant that can be used on all materials and appliances that are transferred between dental practices and dental laboratories, thus helping to eliminate cross infection risks such as Hepatitis B for your staff.

LabCert is available in a 1-litre spray and 5-litre pour bottles from The Dental Directory or www.cleancert.co.uk FOR FURTHER INFORMATION please email sales@cleancert.co.uk or call 08443 511115.

REFERENCES 1. Almortadi N, Chadwick RG. Disinfection of dental impressions – compliance to accepted standards. BDJ 2010; 209: 607–611 2. Winstanley RB et al. The quality of impressions for crowns and bridges received at commercial dental laboratories. BDJ 1997; 183: 209-213 3. Lynch D, Allen PF. Quality of written prescriptions and master impressions for fixed and removable prosthodontics: a comparative study. BDJ 2005; 198: 17-20 4. Controlling cross infection in the dental laboratory. Best practice guide. Dental Laboratories Association * In Almortadi and Chadwick’s 2010 article on ‘Disinfection of dental impressions – compliance to accepted standards’, the ‘ideal’ and ‘accepted standards’ were based upon the British Dental Association’s Advice Sheet A12: Infection control in dentistry.

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MARKETING SIMPLIFIED BY JAN CLARKE BDS FDSRCPS l Jan qualified as a dentist in 1988 and worked in the hospital service and then general practice. She was a practice owner for 17 years and worked as an Advisor with Denplan. Jan now works helping dental businesses with their marketing and business strategy. Web: www.roseand.co Email: Jan@roseand.co

MARKETING

BEING SOCIAL WITH YOUR MARKETING In the last month I started to talk about social media marketing and how it could work for you and your business. I acknowledge it is not for everyone and there is an “ugly’ side to social media. As a dental professional hopefully you will not experience that side though I have seen a few colleagues caught up in online arguments that they would have been best side stepping. HOW DO I BEHAVE? As GDC registered individuals it does seem that our behavior has to approach saintly most of the time! One of the traps I see people falling into on social media is the trap of confidentiality. Never assume because you are in a private, closed group of professionals or you have locked down your security so only “friends” can see you posts that your activity is not visible to the outside world. If you say something outrageous or rude, chances are someone will “screenshot” it – this is taking a picture of it that can be shared elsewhere without your permission. BIG BROTHER IS ALWAYS WATCHING? To some extent, yes. There are stories about the GDC trawling through social media to check on registrants behavior so a few rules that I feel work well. 1. Consider other peoples views even if you strongly disagree 2. Beware of being goaded into a response 3. Avoid being a keyboard warrior 4. Remember anything you type can potentially be viewed by anyone, including patients and clients 5. If in doubt, don’t reply My final piece of advice here is for those of us who remember the days when social media was having a drink in the pub and mulling over the day!! Don’t say anything on social media that you wouldn’t shout to everyone very loudly in the pub! With those pieces of advice you can still have an opinion and be vocal. To build a presence on social media and thus build your business you want to be considered to be approachable, humble and knowledgeable all rolled into one – not much to ask! FIRST THINGS FIRST Last time I talked mainly about presence on Facebook and creating a page for your business with the type of posts you would post.

There is no right or wrong way to post, you will find what works best for your business. The type of posts that I find work well in dental businesses are: • Video – uploaded directly to Facebook always get a great reach • Posts about your team – people love to know about other people • Education – adding value to your viewers by offering information about subjects they do not fully understand. A good variety of posts with great images and offering a real insight into your business will show your followers that you are someone they would like to do business with. Make it easy for them to connect with you and before you know it you will start to see growth. You can invite your dental contacts and friends to “like” your page and start to grow a following, however, it can be slow. We talk about growth being “organic” – for most a slow trickle. Occasionally you can post some content that becomes viral and your page grows quickly, this is your golden egg and rare to find but worth looking at different ways to achieve this. Look at how the Singing Dentist has achieved this and other very successful dental pages. Another way to grow your page is to buy likes – tempting as this is I would avoid as it will have no impact on your business at all. If your “likes” are fake then all your posts will be served to people who are not your ideal client. It is much

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better to have 100 followers who are your ideal client than 1000 who are not ever going to use a dental technician. The secret is to grow a strong following by adding value and posting great content. Don’t sell but educate, show your potential new client what you do and how you do it. If you are able to manage two social media platforms then Instagram could also be a good platform for a dental technician. By posting pictures of your work and workplace with the right hashtags to reach the right people then anyone thinking about using you will get a good view of your capabilities and variety of work. WHAT ABOUT GROUPS ON FACEBOOK? If you are already active on Facebook some of you may be in one or two groups. Generally these are hobby or interest based. There are many dental groups, some friendlier than others and some more relevant for you. Some dental groups allow all dental affiliated professionals in but all groups will have robust rules about advertising and promotion. Sometimes it is a fine line between being helpful and self promotion so do be wary. Once you join a group introduce yourself and then start to interact. Watch the conversations and the posts, this is when you may well see some behaviors that astound you and don’t be too tempted to be drawn in to any arguments initially. You don’t want to be removed from the group before you’ve p17 even got used to it!

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ADJUSTED OCCLUSAL SPLINTS MADE BY 3D PRINTING TECHNICAL

BY AUTHORS: HEIDELBERG UNIVERSITY HOSPITAL DEPARTMENT OF ORAL, DENTAL AND MAXILLOFACIAL DISEASES PROSTHETIC DENTISTRY DR. MICHAEL LECKEL (CONSULTANT DENTIST) , ALI ILANI, THEO GRIMM ( DENTAL TECHNICIANS)

A REPORT BY DR. MICHAEL LECKEL (CONSULTANT DENTIST), ALI ILANI, THEO GRIMM (DENTAL TECHNICIANS), UNIVERSITY OF HEIDELBERG

cclusally adjusted splints are non-invasive and reversible therapeutic adjuncts that are an integral part of the clinical management of temporomandibular dysfunction. Producing these splints in the laboratory has always been associated with different levels of technical sophistication. The simplest method consisted of thermoforming thermoplastic films (possibly with the additional application of auto-polymerizing resin to obtain an adjusted occlusal surface). A more elaborate approach to splint production – which provided the added stability so beneficial for bruxism patients – was the spray-on technique, similar to the fabrication of orthodontic appliances.

Fig. 1

The spread of CAD/CAM technology has provided two additional options. Both these options begin with an on-screen splint design step (Fig. 1). In the following step, the object is either milled from a PMMA block or additively produced in a 3D printer. The present article will primarily address 3D-printed splints, but add a few concluding remarks about milled splints in terms of efficiency and other economic aspects of their production. To fully leverage the benefits of the high precision associated with a CAD/CAMbased process, exact procedures are advocated already during the various clinical stages of

Batch 3DPrinting of Splints

treatment. This would include, for example, the use of silicone- or polyethylether-based precision impression materials, taking a centric relation record as close as possible to the intended thickness of the splint, and the use of a facebow if minor adjustments to edge-to-edge relations in the articulator are required. Experience has shown that this will shorten the time required for intraoral adjustments of the occlusal splint. Once the casts have been articulated, the situation is scanned according to the specifics of the scanning system used, followed by the on-screen splint design. Whether or not any supplementary modules are required for designing splints or fabricating casts will depend on the make and model of the scanner and CAD/CAM system, but these models are usually already present on the system, so no additional software has to be procured. The completed files will generally be saved in the widely used (stl) format, avoiding conversion problems. The design of a printed splint is in many respects similar to the design of a milled splint. The values for all relevant parameters, such as seating and splint dimensions, must be matched to the printing material and the 3D printer itself. Depending on the manufacturer and the size of the printer, a varying number of splints can be printed concurrently. The Freeform PRO 75 UV by ASIGA (Sydney, Australia), for example, can be used to produce seven splints at once. Each splint is printed in 50-µm increments. If a reduction of the printing time is desired while still obtaining a decent surface quality, 75-mm increments can be selected (Fig. 2).

Fig.2: Splints in 3D Printer

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Fig. 3: Splint on Carrier Plate

After printing, the splints are removed from the carrier plate and cleaned twice for three minutes in an ultrasonic cleaner filled with pure isopropanol. The pre-defined time for the preliminary and main cleaning cycles must not be exceeded (Fig. 3). The supporting structures are separated and light-cured to final hardness using

The scanning of the cast and the design and finishing process require about an hour of laboratory time for either approach. Whichever of the two modes of fabrication is given preference, each represents significant

progress in terms of system precision and material quality compared to conventional production methods. Avoiding undesirable dimensional changes at the polymerization stage or the effects of material break down, has always invariably required enormous skills and experience on the part of the dental technician. In economic terms, the differences are more evident: Milling: Each splint requires a resin blank (approximately 165 g, depending on the size), so the majority of the material goes to cutting waste. Only one splint can be milled at a time. Printing: Low actual material consumption (about 10 g per splint), so the cost of the material amounts to less than €5 per workpiece. Up to seven splints can be printed concurrently Devices used: ASIGA Freeform PRO 75 UV. NK Optik Otoflash G 171. Materials used: DETAX Freeprint® ortho UV. DETAX Freeform® plast / fixgel ASIGA 3D Printer

Otoflash G171 xenon flash-curing device by NK-Optik (Baierbrunn, Germany) (Fig. 4). This requires 2 × 2,000 flashes of light while rotating the object in an protective atmosphere (nitrogen 5.0). This is a crucial step to ensure biocompatibility and to avoid the formation of an inhibition layer on the splint’s surface. Fig.4. Otoflash G.171 Xenon Flash Curing Unit

The workpiece can now be returned to the cast. Given adequate experience in splint design and a proper fabrication approach, minimal, if any, finishing will be required. If the clinical procedure that resulted in the working materials and documents were performed diligently, the effort required to adjust the static and dynamic occlusion will be equally minimal. The finished splint will have to be polished to a high luster in a conventional manner, using pumice powder (Fig. 5). Any corrections requiring the application of additional material after delivery are performed using the light-curing transparent FreeForm® plast/fixgel resin (also by DETAX). Fig. 5: Polished Splint

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TECHNICAL

An economic approach is to design the splints during the day and print them overnight, facilitating speedy delivery in cases where splint therapy becomes necessary on short notice, such as in acute TMD distress. The splint material is the transparent clear Freeprint® ortho UV by DETAX (Ettlingen, Germany), which has been approved as a medical device for the manufacture of drilling and x-ray templates as well as occlusal splints.

Some remarks on the economy and efficiency of the two approaches to computerized splint fabrication will be in order at this point. Our experience so far has been that there are no perceptible differences in terms of fit and, consequently, in terms of the time required at delivery. A key issue, however, could be the materials’ properties, for which adequate long-term evidence is still unavailable. While one type of splint is milled from a homogeneous block of material (subtractive procedure), the other type is built up layer by layer from a resin solution (additive procedure). To what extent this might influence any relevant properties of the material from which the splint is made, such as fracture behavior or long-term abrasion stability, remains to be determined by laboratory testing and clinical trials.

COMPANY PROFILES AS PART OF WHAT IT IS YOU DO EVERY DAY, SOMETHING WILL HAVE COME TO YOU VIA YOUR SUPPLY COMPANY. OTHER THAN WHEN YOU VISIT THEM AT EXHIBITION STANDS ,HOW OFTEN DO YOU THINK OF THEM AND THEIR ORGANISATIONS? OTHER THAN WHEN YOU ARE CHASING SOMETHING VITAL YOU ORDERED LATE AND EXPECTED TO ARRIVE BEFORE YOU THOUGHT OF IT! WHO ARE THE PEOPLE BEHIND THE SUPPLY HOUSES AND HOW DO THEY OPERATE. WHAT DO THEY FEEL ABOUT THEIR CUSTOMERS AND HOW DO THEY TEND TO THE ORDERS AND QUERIES THEY RECEIVE EVERY DAY. IN A EFFORT TO SHOW THE WORLD OF SERVICE THESE COMPANIES LIVE IN I HAVE BEGUN A SERIES OF PROFILES OF THE VARIOUS DENTAL COMPANIES AND INTEND TO PUBLISH ONE EACH MONTH. SO YOU CAN KNOW THE OTHER SIDE OF THE STORY OF YOUR RELATIONSHIP WITH YOUR FAVOURITE SUPPLY HOUSE. WE BEGIN THIS MONTH WITH A LOOK AT:

BRACON LTD COMPANY PROFILES

w Bracon is very much a Laboratory supplier with a long track record of supplying good products and equipment directly to their laboratory customers. The early company was owned and run by Mike Viney who many of you may well remember. He built a successful business but unfortunately died young some 10 years ago. The family connection is as strong as ever with his wife and son Paul still very much involved with the day to day running of the company. I was greeted by Stephen Judge whom I have known for some years. Stephen is a registered Dental Technician and a Clinical Dental Technician, which he continues part time. He is also the Technical and Sales Manager for Bracon, with both technical, clinical and commercial experience The headquarters is housed in a modern unit in a small Industrial Park in Heathfield, East Sussex. Surrounded by lovely wooded rolling hills and green fields. The modern unit is designed with modern office space on the first floor and the whole ground floor given over to warehousing and dispatch. The company has long had a reputation of supplying those special types of everyday things, for which they have managed to become agents.

Ready for Christmas

Open plan office

Scanned image of models

3D printed models

The staff I met were busily getting on with the job and with a smile on their faces. There were many racks of everyday laboratory items safely stacked in locatable areas known to the stock and dispatch workers. They made it seem very straight forward finding their needle in many haystacks. Drawers and drawers of burs of all shapes and designs, collections of stones and polishers and pretty well every sundry you would need in a modern dental laboratory. From innovative waxes and stones to a huge collection of burs and polishers and pretty well every sundry you would need in a modern dental laboratory. ASIGA Freeform Pro 75 UV

Discs for milling

Unique Flash Hardening Unit

They have grasped Digital Dentistry with both hands and continue to run courses from their international training centre for the entire Dental team, on the first floor of their headquarters. Mark Welch, their Digital Specialist, showed me some of the impressive digital processes with scanning for 7 models to quickly produce seven models via 3D printing on their impressive ASIGA Freeform Pro 75 UV 3D Printer, which produces 7 or 8 models or splints or special trays at a time. They demonstrated Scanning, via Exocad or 3Shape and then produced via 3D printing, the models with very sharp definition, reproducing exactly the scanned images. I was also shown their

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range of printer resins, including biomedical resins for drill guides, splints etc. and the complete range of milling materials. Covering every material now being used and with the potential to add many more as the technology progresses. They showed their milling options and some of the materials available in the form of blocks. We are all fascinated by the 3D printing process which can produce from liquid resin patterns for partial chromes, crown and bridgework and all the materials mentioned above. It is remarkable how as technicians we have adapted to the digital changes but when you see the array of new materials for milling we now use you appreciate the effect on the handling companies. With the need to stock discs of PMMA, Zirconium, Resins and Waxes. Then you look at the 3D printing materials, in liquid form for creating the shapes and effects necessary for crowns bridges and partial denture constructions this modern process

has really added to the stock burden for all the handling companies. It is likely that the future will bring other new materials and a further list of additions to what needs to be stocked, in sufficient quantities to supply the Technicians and Laboratories across the country.

Credit control

Teaching lab

This is a company with a long pedigree of service to its customers. The management seem to have accepted the responsibility of dealing with the new and demanding market for Digital processes and are determined to provide teaching and support to their present and future clients. I was shown around their servicing area where they have full time engineering staff dealing with everything from Bunsen burners to digital equipment. One of their engineering senior staff, Peter Relf was awarded the FMC Industry awards Employee of The Year Certificate for the best of service personnel in the Industry. On occasions he has been called to Scotland where he has responded and turned up to repair and service the machinery. Finished, he has jumped in to this van and driven back to Heathfield. The company have recently won the Business of the year and the Team of the year awards . A fantastic achievement and not surprising when on occasions he has been called to Scotland Officially a winning team

with the job and with a smile on their faces. There were many racks of everyday laboratory items safely stacked in locatable known to the stock and dispatch workers. They made it seem very straight forward finding their needle in many haystacks. Drawers and drawers of burs of all shapes and designs, Impression trays and denture boxes of all colours and of course the discs and liquids to accompany the Digital milling and 3D printing. Dispatch room

COMPANY PROFILES

The first floor space is very open plan with separate glass walled rooms around. These rooms house the various managers and departments needed for a modern service to their laboratory customers. Almost half of this space is the teaching area. Well lit with comfortable working benches with lots of room and a real sense of light. They are keen to expand their teaching programme and to include high class private denture creations to meet the growing demand in the marketplace for better prosthetics.

where he has responded and turned up to repair and service equipment. Finished, he has jumped in to his van and driven straight back to Heathfield. The company have recently been finalists in two more categories of the FMC Industry Awards, Outstanding Business of the Year and Team of the Year, they proudly display their award certificates. Every person working here has a real sense of what is required and they are very aware they need to be really on their game to compete with some of the larger resourced players in the market. It’s all about customer service and creating a r Huge amount stock of investment the company has made in. It’s all about service and creating a relationship based on trust and mutual understanding.

One of the stock rooms Stock & dispatch manager

Stock, stock and more stock

Telephone sales are very much a requirement for meeting targets and moving stock through and on time. There was a busy little unit of about 7 staff talking with customers and obviously with a good bit of familiar repartee. While the company has its its team of internal tele-sales and external reps visiting on a regular basis, the modern service industry cannot survive on that alone, Bracon also has its own delivery vans with a team of drivers delivering items to customers on a daily basis. Telephone sales

A walk around the stock and despatch area which occupies the whole of the ground floor of the building, reveals the need for investing in stock, with money which is tied up until such time as the materials or equipment is sold. Stock control is of course the real skill for making sure there is a profit at the end of the processes. The stock controllers and those responsible for the dispatch were very much on the ball with many hundreds of items which may be required “by first post tomorrow please”. The staff I met were busily getting on

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I met the northern sales territory manager, John Gibson, a former warrant officer in the army who has adapted well to the change of career. He reflected all the people I met, who were busily getting on with their work, but were doing so with a smile on their faces, which suggested they really did enjoy being involved with the Bracon brand and the people with whom they work. This was a happy ship with a real sense of doing something worth while. I think we will see them around for a great deal longer. For those heavy items

STRAUMANN GOES DIGITAL WITH A HANDS-ON DAY IN CLINIC

Simon Nocton, Principle at the Implant Surgery, Corn Exchange, London Simon Nocton

Simon answers questions

Simon scans as Sarah watches on

DIGITAL DENTISTRY

e are all aware of the pressure in the market place of the Innovations coming with the Digital workflow and techniques. It can be difficult for busy practitioners to get time to review whatâ&#x20AC;&#x2122;s on offer and the various options for seriously considering adapting to the modern changes, which come with the computer driven revolution. It can be easy, from the outside, to dismiss the new equipment on the basis of the up front cost and the need for learning new techniques but this Press Day, arranged by Straumann, really demonstrated the advantages of being involved with this new technology. The Venue was the Implant Surgery which is based within the Corn Exchange Building, in the City of London. A private practice with 15 surgeries. Simon Nocton, one of the principles, provides a The audience gathers

specialist referral and in house surgery and implant service, which he established almost 20 years ago. LIVE PATIENT DEMONSTRATION Simon had arranged for one of his patients to attend and take part in the hands-on demonstration for the specially invited press guests. Before meeting the patient Simon outlined the history with the practice a Straumann as his supply source for the digital processes. Simon explained that his first choice for an implant system, those many years ago, was the Straumann system. His experience with the company services and products over the years had convinced him to begin his digital dental journey with them. As they supplied his preferred choice of scanning equipment, the 3Shape TriosÂŽ, he was even more drawn to continue his long standing relationship with the company. He explained that he felt it very important to Simon, Sarah, patient

have a committed support group available on the digital journey. There seems so much to learn and absorb that a friendly and helpful word at the right time is essential. The staff at Straumann are highly trained to cope with the potential errors that can occur with the use of any new techniques and systems. We were taken in to meet with his patient, who had been attending the practice for some years and had implant treatment during that time. Just six weeks prior to our visit a Straumann tissue level Roxolid implant had been placed and was now ready for restoration. Simon, with the patients help, took us through the history of the recent implant placement and explained the patient had an earlier implant placed on the opposite side of the arch, which had been there for some time. The patient seemed very positive and there was a really relaxed interaction between the dentist and his patient. Simon led us through the process of using the scanner and pointed out the options available of the handpieces and the handle position which can be adjusted to your preferences. Simon introduced his Dental Nurse Sarah who very professionally got on with looking after both the patient and her boss and was clearly very happy with the digital processes which were now very much part of her daily routine. Simon scanned the mouth and

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Scan of implant site

Virtual articulator

BENEFITS OF THE 3SHAPE TRIOSÂŽ SCANNER

the implant, which were revealed on the colour screen. Throughout the scanning process, which was a continuous series of light captures around the arch, there was a clicking from the scanner, which indicated the images were being recorded and the large screen clearly demonstrated the progress of the image capture. The Implant first scan located its presence but the screen image was of a clear space in the relevant part of the mouth. Simon then introduced the impression transfer on to the implant and scanned it in place. The light identifying characteristics of the implant are automatically integrated to produce a perfect digital transfer of the implant shoulder and position within the full arch scan. The patient remained relaxed and chatty throughout the whole process and was smiling happily knowing the implant restoration would be back within the week to be fitted.

X-ray of implant in-situ

However the very helpful graphics from the soft ware clearly shows the relative nerve position and the final radiograph shows a close but safe positioning. I do think this was a wonderful interactive experience of the Digital process, which really did appeal to the gathered observers. The graphics were clear and the planning made so much more predictable. The whole process encourages communication and understanding for the patient and allows a very relaxed and interactive procedure with everybody involved. LETS GO DIGITAL!!

Simon had explained at the beginning of the review of the patients history that the Implant was just 2mm from the inferior nerve. Obviously a risky area if you do not place very carefully indeed.

Close to inferior nerve but safe

Clear bite record

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DIGITAL DENTISTRY

Implant scanbody in place

Simon explained the interactive nature of the 3Shape handpiece and scanning process and said that Sarah was also very able to take and be critical about the scanning process. The patient confirmed her appreciation of the new technology and was delighted the impression process and bite recording was so straight forward and without lots of different materials being introduced into the mouth. Having had the experience of the traditional impression method she was very positive about the comfort and ease of the photo scan. No bits left in the mouth, no waiting for the impression material to set. The press observers were clearly impressed with the relaxed and apparently simple way of recording the mouth and the implant. All were impressed with the very obvious natural and open communication between Simon the patient and Sarah. The bite recording was equally straightforward with a click of the button to record the MIP position in a stable and refined case. Defined in a virtual articulator shown on the screen and translated into images of the upper and lower arches in contact and then recorded for transfer to the laboratory process.

GDC NEWS SENIOR STAFF MOVES AT THE GENERAL DENTAL COUNCIL 31ST OCTOBER 2017

GDC NEWS

w Jonathan Green, Executive Director, Fitness to Practise, is to leave the General Dental Council (GDC) early in 2018. After nearly five years of hugely valuable service, including three as a member of the Executive Management Team overseeing a much needed and very challenging improvement programme in fitness to practise (FtP), Jonathan is moving on to a new role as Regional Director for London at the Independent Office for Police Conduct – the organisation that will replace the Independent Police Complaints Commission.

Jonathan has played a key role in helping to drive forward the GDC’s work to reform dental regulation to make it better for patients and fairer for professionals. During his tenure, the GDC’s performance against regulatory standards has seen very significant improvement. He championed and implemented a number of key reforms, such as the introduction of support for registrants going through FtP processes and better management of complaints with partner organisations. Bill Moyes, Chair of the GDC Council said: “While we are all sorry to see

Jonathan leave the GDC, he is leaving us at a time when the improvements in FtP processes that he has led are really bearing fruit, and with clear plans for further improvement work in place. We are grateful for all he has done.” Jonathan Green said: “I’m really proud to be leaving the GDC at a time when the hard work to improve its performance is visibly paying off, and when its new direction, set out in Shifting the balance, is really bedding in. I am confident that it will continue to develop and improve.

GENERAL DENTAL COUNCIL RELEASES STATEMENT IN RESPONSE TO DEPARTMENT OF HEALTH CONSULTATION 31ST OCTOBER 2017 w Commenting on the publication of Promoting professionalism, reforming regulation, Ian Brack, Chief Executive and Registrar of the General Dental Council said, “Fundamental reform and modernisation to health professional regulation is overdue – and would benefit the public by delivering a more effective and efficient system. The General Dental Council welcomes the Department of

Health consultation as a step towards this aim, but in the absence of firm legislative plans, reform within the existing legislation needs to be at the centre of proposals for change. “The GDC has set out how we intend to reform dental regulation, detailed in Shifting the balance: a better fairer system of dental regulation, which was published in January.

Crucially, our reform plans are not dependent on legislative change and we are pressing ahead with our proposals, working collaboratively with our partners to develop a model of upstream regulation that involves professionals and their regulator working together in the interests of patient safety and public protection. We will publish our next steps for this reform programme in November.”

THE PSA CONCLUDES THE GDC HAS MET 23 OUT OF 24 OF ITS STANDARDS 1ST NOVEMBER 2017

• all four for standards and guidance, • all four for education and training; all six for registration; • and nine of the 10 fitness to practise (FtP) standards.

helping to ensure only serious cases reach the Practice Committee stage • reducing the time taken between receiving a complaint about a serious case and generating an interim order, which temporarily restricts dental professionals’ practise while an investigation is pending. • working with Samaritans to support vulnerable registrants, improving our Witness Support Service and improving the tone and clarity of our correspondence.

The improved outcome of the PSA review reflects a continuing focus on performance across the organisation and improvements that have been made to the FtP process over the last year. A range of process changes have been made: • signposting to other organisations where a complaint would be better dealt with outside fitness to practise has been improved • introducing Case Examiners in November 2016 to replace the Investigation Committee and streamline the fitness to practise process,

The GDC has also made improvements elsewhere. The Enhance Programme of Continuing Professional Development (ECPD) has been developed and will go live in January for dentists and August for dental care professionals. This has been designed to empower dental professionals to embark on life-long learning, which can be embedded into their practise and tailored to increase their skills and knowledge towards the needs of their patients. This is the first step to a system based

w The Professional Standards Authority (PSA) has concluded that the General Dental Council (GDC) has met 23 out of 24 of its standards in 2017, following its annual review. The GDC has met the following standards:

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on quality of CPD activity rather than quantity. The GDC is also investing in the plans we set out in Shifting the balance, and is working collaboratively with our partners to develop a model of upstream regulation that involves professionals and their regulator working together in the interests of patient safety and public protection. Ian Brack, Chief Executive and Registrar at the General Dental Council, said: “The PSA standards are a helpful indicator of the GDC’s improved performance. The GDC is committed to continuous improvement, with future work planned to ensuring fitness to practise is focused on the most serious, improve how we manage data and information, and developing a system of learning based regulation that is grounded in high quality data and insight. This work will help us to improve how we protect the public and maintain public confidence in dental services.”

THE DENTAL TECHNICIAN MARKETPLACE KEMDENT - GET A FRESH START TO THE NEW YEAR w Unbelievable prices are available from Kemdent this January at 2017 prices!

Dental practices and Dental laboratories no longer need to use unpleasant smelling chemicals when cleaning hard alcohol resistant surfaces and medical devices. Buy 6 x 100/tubs of PracticeSafe Alcohol Based Surface Microfibre Wipes in Lemon fragrance for only £2.99 + VAT each. Or buy

CPD IS CHANGING AND ACTEON ARE HERE TO HELP YOU

In order to keep up with this demand, Acteon UK will endeavour to meet the criteria of the new scheme in order to offer all health care professionals

PracticeSafe Microfibre Wipes in the lemon fragrance is a refreshing and ideal solution for the effective cleaning of busy practices or labs. As well as being alcohol

based, it is highly effective against bacteria including; TB, E.Coli, Enterococcus, Vaccinia, fungi and HBV/HCV/ HIV/BVDV. Keep your Dental Practice or Dental Laboratory smelling fresh with this New Year offer. Call Kemdent on 01793 770256 or visit our website www.kemdent.co.uk

the opportunity to attend courses and hold training sessions that will not only contribute towards the individuals personal development plan but provide high quality, educational training by experienced product specialists and qualified dental professionals.

COMPANY NEWS

w With the GDC’s new ENHANCED CPD scheme starting this year, the demand for verifiable CPD hours will increase.

12 x 100/refills of PracticeSafe Alcohol Based Surface Microfibre Wipes in Natural fragrance for only £2.49 + VAT each.

Contact info.uk@acteongroup.com to find out about our 2018 program.

MARKETING SIMPLIFIED CONTINUED FROM PAGE 8 uBeing in a group allows you to network and make connections so be sociable and when you have a chance, add value. If you are seen to be knowledgeable and can solve others’ problems people will come to you and try you out. It can be quite daunting pushing yourself forward in some groups as you will find some overwhelming characters and generally each group has a “feel” to it with some being very much controlled by bullish characters. Find a group that suits your personality and spend some time there. Of course, you can always start your own group too.

FACEBOOK ADVERTISING Facebook has become a very busy place now, the rumours are that eventually all businesses will have to pay to have their posts read. At the moment that is not true but it is getting harder to reach the right people if your content is not of good quality. Therefore your posts do need to look good with the correct quality and size of images and great content. As I mentioned last time there are any number of online courses to learn the intricacies of creating great posts and I would advise you take one to get the basics right. Because it is a busy place not all the people that like your page will be served your posts. Facebook use an algorithm to decide which posts will pop up on your time line. There is a great post on the Facebook newsroom https://newsroom.fb.com/ from Oct 24th

2017 which explains this very well. On your own page you can see the “reach” your posts have, how many people have seen it. Generally this can be typically just 5% of your following and it is considered that 20% reach is good. Now if you only have a following of 100 then this isn’t going to get you a whole load of new business very quickly. Growth does take time but you do have the possibility of paying for better visibility through Facebook Advertising. The simplest way is to use the Boost button on your posts, a more complicated way is to use Ads Manager and Power Editor, these are not for beginners but they are definitely worth learning about as you progress. Boosting your post will allow you to pay to serve it to your ideal client. You have the ability to target your post with an amazing number of variables. You can choose age, gender, location, job, interests and so on. Straight away you can see how this is a great way to reach other dentists. Once your target audience is chosen you will then apply a budget, this can be anything from a pound or two upwards. I would start low and see what response this has on your reach. Facebook advertising is incredibly flexible and can also be quite complex so using the boost button is the simplest way to achieve better, quicker reach but it is not the best way to achieve a full blown advertising campaign. In those

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circumstances it is probably a good idea to call in professional help. SUMMARY • I would encourage you to get started with social media both personally and professionally. • Connect with colleagues and dental professionals and add value • Don’t be drawn into arguments • Build your own business page • Post regularly and learn how to create great content • Be persistent and consistent • Again add value for your clients/potential clients • Be responsive to messages and comments • Don’t feed the trolls • Learn about Facebook Advertising and start to boost occasional posts to help reach • Have fun with it and find your own personality online 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! CONTACT Email: jan@roseand.co Facebook: Jan ClarkeTaplin Twitter: @JanetLClarke Instagram: janlclarkeacademy LinkedIn: Jan Clarke BDS FDSRCPS

THE YOUNG ITI Bristol. Friday November 10th

he young ITI is an organisation which has been set up by and on behalf of young dentists who are already involved in Implant Dentistry and those who would wish to learn more. The aim is to encourage the interested young practitioner to find colleagues and like minded professionals to share the ambition to engage in this expanding area of restorative dentistry. The ITI is the International Team for Implantology and is dedicated to enhancing the science and understanding of all aspects of this very relevant area for the modern practice of dentistry.

TEAM

The organising committee had invited some interesting guest speakers for the morning session and returned to their successful Tech Pod format for the afternoon session. The meeting, supported by Straumann, who are the ITIâ&#x20AC;&#x2122;s industry partner. With Kathy Jacks (pictured right), the Education and ITI Manager keeping a caring eye on proceedings The interested attendees were welcomed by the young ITI Lead for UK and Ireland Mr Chris Millen (pictured left), Who was looking forward to the Lectures around the main theme and title of Risk Assessment in Implant Dentistry. The first invited speaker was Mr Fadi Barak (pictured right), a specialist in Oral Surgery who is a Director of the VSS Academy and works in London. He is also a visiting lecturer at the University of Central Lancaster (UCLAN).

SAC Esthetic risk table

Mr Barak cautioned the audience to always be aware of the potential risks for an elective invasive procedure such as dental implant placement. He introduced the SAC Tool, which is a risk assessment guide to the operator. First described in 1999 (Sailer and Pajarola) for Wisdom tooth procedures and later that year adapted by the Swiss Society for Oral Implantology (SSOI). In 2003 it was adopted by the ITI and later in 2006, modified, and is now the cornerstone of risk assessment, worldwide, for implant procedures. It acts as a guide for assessing the complexity of any surgical procedure but is particularly suited to aiding the operator to understand their individual competence in any given situation. SAC stands for Simple, Advanced and Complex. The operators assess their ability and knowledge alongside the technical and surgical challenges of each case. The chances of mistakes and over judgements due to inexperience are brought into focus in a very logical way. With implant placement it is not just the surgery which presents a challenge but the assessment of the patients expectations and the oral anatomy which may or may not need modification prior to treatment. As with all restorative procedures the patients wishes are paramount and their fulfilment must be within the operators ability. The SAC tool offers a series of tables and guides to risk assessment in all types of cases. Taking the time to understand this risk assessment is a safe and valuable way to progressively manage successful implant procedures.

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Mr Barak demonstrated with a case of an individual anterior tooth and asked: Is this a successful case. Underlining the fact that the patient and the operator will be the judges of

p20

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THE YOUNG ITI CONTINUED FROM PAGE 18 that. But he stressed the need to understand clearly the patientsâ&#x20AC;&#x2122; expectations and to ensure they could be met or otherwise inform the patient of the 2reason for not being able to fulfil their perception of the eventual outcome. With patients believing that with implants you can do anything it is a reasonable precaution to be clear about any anatomical or even lifestyle reasons why they will not be able to achieve their goal.

While the SAC Tool will help you to determine each phase it does allow individual variation according to experience. However it is important to understand when to say no and when to refer. Mr Chong Lim also assists with post-graduate training at Eastman Institute in London. He pointed out the ITI classification of defect around implants and took each of the four areas and showed with selected cases what the class 1- 4 defects looked like and the recommended treatment required. From class one with a small easily managed lack of bone in the buccal ridge crest area to the class 4 with lack of bone of sufficient volume to surround the implant and which needed prior block grafting to safely manage the outcome required.

OOpsi What Planning?

Classification of Implant sites

Mr Barak went on to show examples of less than good assessment of cases and some examples of what not to do. Clearly words of wisdom, from an experienced and able Oral Surgeon. The assembled and very attentive audience encouraged, by the speaker began a very interesting and lively question time A greatly appreciated and clear presentation from a truly able speaker.

TEAM

The next speaker was Mr Chong Lim (pictured left), a specialist in Periodontology based Nr. Richmond in Surrey. Where he works from his Periodontology and Implant Referral Centre treating patients requiring Periodontal management and of Restoration involving Implants. He continued the theme around the SAC Classification and stressed the importance of learning to identify the variable risk factors during the early stages of assessment. It is planning for the unexpected that gives the real value to treatment planning and risk assessment. Learning to understand the relative importance of Indications, Relative contraIndications and Absolute Contra-Indications.

What Planning ? Class 1

Risk Assessment Chart

Class 1

He showed various examples relative to the cases being discussed and included charts relative to each case. With the heading for each column detailing the relative risk for the examined case as Low, Moderate or High for Anatomy, Bone Volume, Complexity, Complications and Esthetic. Class 4

He stressed the added risk of dealing with the patient expectations and the aesthetic complications and risks, which may arise. Being sure of the patientâ&#x20AC;&#x2122;s requirements is essential from the first stages of assessment. They may indicate an unrealistic expectation when the various factors of the anatomy, suitable bone volume and other oral complications around soft tissues and indeed other standing teeth are considered.

Mr Chong Lim stressed the need to respect the vital structures and showed the relative data on cases with recorded damage to the Inferior nerve. The greatest incidence of damage during surgery is from the removal of wisdom teeth with a 60% share of the recorded cases. Followed by damage through local anaesthetic at 16% with Implant placement and treatment responsible for 15% of all cases. While the wisdom tooth removable and the local anaesthetic damage requires addressing the elective placement of implants is far less justification for nerve damage during procedure and should be avoided. Together with the application of the SAC Classification comes a format for registering the various risks as Serious, Advanced and Complex.

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Lots of questions followed before the break. After a short Coffee break Mr Neel Patel (pictured left),introduced the final speaker of the morning sessions Mr Hiren Patel (pictured right), specialist in Prosthodontics and a ITI Fellow. Mr Patel continued the theme of planning but with further consideration of the restorative cautions and interests. Mr Patel spoke of

the overall consideration of the restorative outcome. Good assessment of the soft tissue and the profile of surrounding structures are essential to be sure of the correct planning for placement. Using Diagnostic wax-up or digital diagnostic tools the essential is to evaluate the risks and consideration needed to optimize the expected aesthetic and restorative outcome. Truly establishing a restorative driven implant planning philosophy. He showed cases to illustrate the potential challenges which each type of restoration presents and referred to the SAC guidelines as helpful when considering each case. It is not unknown for corrective surgery or orthodontics or indeed bone augmentation or soft tissue surgery may be indicated prior to placement. Sometimes this will need careful explaining to the patient, who may believe the implant will direct the new tooth and all its surroundings to their position of choice. There may be a need to increase the space available i.e. between arches or between teeth and the opposing ridge.

Caution

Check and assess

needed for success. There are very valid reasons to follow their guidelines to avoid unnecessary compromise with the final result. There are many factors to consider before placing the implant. The most important is to ensure you have taken care and understand the restrictions on the proximity to other structures. The implant needs to emerge beneath the neck of the proposed tooth. Taking into consideration the bony profile and the relationship to other teeth or gaps and sufficiently within bone to make it viable. The guidelines are published in the ITI Books as are the SAC Guidelines.

advice is you stay within your comfort zone and not beyond your experience and knowledge. This is an elective invasive procedure which requires clear indications of care, ability and experience in order to support your decision to carry it out. Always be aware of that in your decision making and involve other colleagues who may be able to assist. Mr Patel showed several risk assessment charts which illustrated the potential pitfalls awaiting the uninformed. He came back to the risk assessment several times to underline the importance of careful consideration before placement. Restoration in-situ

Pre Implant considerations Diagnostic T

TEAM

A happy patient Surgical Template

Using the diagnostic T can be readily adopted to indicate the available space or indeed the lack of it of it. Between teeth, ridges and other fixtures. There may be too much soft tissue or a lack of it.

Restoration in-situ

Check and assess

Based on their scientific reviews the ITI suggest indications of the necessary space

There is a world wide trend towards same day teeth and many recommended techniques from the â&#x20AC;&#x153;experienced operatorsâ&#x20AC;? but it is recognised that each time you decide to ignore a recommended protocol the risk of compromise or failure increases. The important

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Mr Patel spoke of the advantages and attraction of the Digital Programmes available for planning and showed the digital construction of the surgical template. Produced with the combination of the chair side scans and the radiography and continued to show the completed case in-situ with screw retained restoration. The anterior tissue loss has been restored with the use of clever artificial gumwork. Designed to be cleanable, by the patient who is clearly very happy with the outcome. Because of the care taken with the case planning. All parties were delighted with the result. Pre-planning your restorative cases is a real way of controlling the final outcome. Pre-planning your implant restorative case is an absolute must.

DENTAL OPINION FROM SIR PAUL BERESFORD, BDS. MP INSIGHT

2017 drew to a close and 2018 stretches before us. On January 1st it may seem a long year ahead. To those Ministers involved in Brexit negotiations and Parliamentary debates it will be short and hectic

n the Houses of Parliament the European Union (Withdrawal) Bill occupies long days first in the House of Commons and then in the House of Lords before finally returning to the House of Commons. It is an extraordinarily important piece of legislation for the functioning of our country from the day that we leave the European Union. On the surface it is quite simple in that it is transferring many thousands of pieces of legislation collected over 40 years as members of the European Union, into UK law. Without this transfer vital UK functions could not be carried out as they would not be within our law after Brexit. The committee stage was spread over a considerable number of days in eight-hour daily sections. It proved an absolute field day for Members who are lawyers in particular. Nuances on the interpretation were argued back and forth sometimes leaving more normal individuals struggling to keep up.

A visit to the supermarket makes this obvious. Next time you climb out of your car in the Sainsbury car park look around and count the proportion of Italian, German, French cars we possess. In the actual supermarket hall just casually note the proportion of our fruit, vegetables and manufactured foodstuffs laid out for us to buy which have come across the Channel.

Theresa May, after an initial stumble, finally pulled off the first stages of negotiations so that the enormous discussions, particularly on trade, can commence as we move into 2018. The EU are experts at brinkmanship. Probably, as ever in my experience, agreements will be arrived at just before the final hour. What ever the Brexit deal with Europe it will not be good enough for some from both the UK and from the EU. At least the UK has only one parliament to sign up. The EU has 27, many with very different axes to grind

Post EU however offers us some interesting opportunities. Liam Fox and his team will be looking to trade agreements with other nations. The United States and Japan are two of our major trading nations for dental products. A carefully crafted trade agreement with these nations would be of benefit to us as purchasers but also help our dental manufacturing industry in return.

To my mind it is absolutely vital that we get a deal on trade. Hopefully it will be a free trade agreement so that we can seamlessly, from the point of view of trade at least, move from membership to non-membership of the EU. Trade with us is very important to the EU nations be it fruit and vegetables from the southern EU states, or cars from the northern EU states.

Equally if one did the same in the EU we would see that large numbers of Jaguars, Fords, BMW minis, and the plethora of Japanese cars all manufactured in the UK being driven by EU citizens. To the dental industry there is a similar trade. We have a small but vibrant dental manufacturing industry that trades with the EU. Equally we also import a considerable proportion of our equipment drugs and materials from the EU. A good trade agreement for us dentally is vital.

For many of us, be we dental technicians, dental professionals, or dental manufacturers there will be an opportunity to tackle some of those gold-plated items of EU legislation that are the bane of our life. Secondly, when we change or introduce new legislation or regulation ourselves it will take perhaps weeks or months of negotiations and discussions in consultation before implementation rather than the years required when the legislation involve the EU

A small group of us, with considerable help from the BDA, were involved in the struggle to sort the regulation on the concentration of dental bleaching gel. It took over seven years to get final agreement for the whole of the EU including the UK. Those of us with a keen interest in cosmetic dentistry, of which dental bleaching plays an important part, still require sensible adjustments to the EU bleaching regulations. Post Brexit would be a sensible time for action. With a tighter control of our own borders we may be able to take better action against counterfeit goods, which have been a marginal problem in the UK dentistry. Although I voted â&#x20AC;&#x153;remainâ&#x20AC;? I have not only accepted that we are to leave but that we must make it a success. The gloom merchants both here and overseas make claims that our economy will suffer. This indeed was the case for a short time for Australia and New Zealand when we in the UK joined the EU. However they very quickly recovered and now have strong and vibrant economies. Post Brexit I would anticipate that we are opening doors rather than closing them and have every reason to anticipate our already strong economy improving further. Of course the Government is still struggling with the deficit balancing the need to trim expenditure in the face of cries for increased budgets at every turn. Three quarters of the UK deficit has been cut and although it is taking longer than we initially anticipated that target of reversing the deficit looks definitely feasible. 2018 will be a crucial and complex year for the United Kingdom. I remain increasingly optimistic that as we move into 2019 and 2020 perhaps the United Kingdom will once again become Great Britain.

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

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JASON PEARSON, OWNER OF JUBILEE DENTAL CERAMICS DISCUSSES HOW EMBRACING DIGITAL DENTAL TECHNOLOGY HAS HELPED HIS BUSINESS TO GROW AND HOW IT AIDS, NOT REPLACES, THE WORK OF THE DENTAL TECHNICIAN How did your lab first get involved in digital technology? It started when I first opened the lab in 2015 and decided to purchase a second-hand Straumann® CS2 scanner. I was interested to see what it could do for us and quickly found it served a very useful purpose. We started scanning in-house and outsourcing our production but it soon became clear that if we upgraded the system to include a milling unit it could eventually save us a lot of time and money to keep our production in-house - and that’s exactly what we have done. What digital kit have you gone for? We have a Straumann® CARES® 7Series scanner and M series milling machine that allows us to scan and design up to 30 copings at a time. We have a Straumann® Therm for sintering Zirconia restorations and a Straumann® Argotherm for Sintron® CoCr restorations. Unlike normal CoCr which is very hard and destroys burs, Sintron is basically cobalt chrome that’s in a crumbly wax-like state which is easy to mill. During the subsequent sintering process in the argon gas furnace it turns into proper cobalt chrome. We use Sintron for all our frameworks as it guarantees a precision fit and same thickness of alloy across the copings and we can personalise the fit tolerances for different clients’ needs. Why choose Straumann over other digital providers? Straumann offered us a complete digital workflow that combines interconnected software platforms to ensure everything works seamlessly together and there are no issues with incompatibility. Using coDiagnostiX™ and Synergy™ we share cases between our clients and the lab so that optimal implant planning and restoration design happen simultaneously. Clinicians send us their CBCT scans and we work with them to virtually-place the implants and then mill the guides for them, effectively working

Has going digital made your business more profitable? Moving from an analogue to digital workflow involves a fairly steep learning curve and is not something that happens overnight. However, we are now seeing the business benefits and we are better placed to work with the growing number of dentists adopting digital intraoral impression scanning.

backwards from the end result to the start. The results using coDiagnostiX are amazing and extremely accurate and makes implant work really predictable. Did you struggle with any aspect of the new technology? It’s certainly strange seeing images on screen that are many times larger than the small models I’m used to looking at! I admit I did find it a struggle to begin with but fortunately I have a young team working with me who are quick learners! I think at the start it’s a fear of the unknown (or you’re simply frightened of breaking something!) but we’ve gained confidence and the benefits are across the board in terms of efficiency and working practices. We’ve also received significant help and support from Straumann, in particular our local representative Daniel Thomas and the team at First Level Support. They certainly know what they’re doing and customer support like this is extremely important when you are moving into the world of digital dentistry.

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What has surprised you most about going digital? There’s something that’s always stuck with me - I made the mistake of thinking the scanner could replace the technician. It doesn’t. It’s there to aid technicians, not replace them. Many technicians are scared of adopting digital processes because they think it will result in job losses, but in my experience this is not the case. Digital technology is an aid rather than a substitute, changing technicians’ working lives for the better, doing away with the more mundane manual tasks and allowing us to benefit from an optimised digital workflow. TO FIND OUT MORE ABOUT STRAUMANN’S RANGE OF DIGITAL PRODUCTS, VISIT straumanndigitalperformance.co.uk or contact Straumann on 01293 651230. Web: straumann.co.uk Web: therevu.co.uk Facebook: Straumann UK Twitter: @StraumannUK

DIGITAL TECHNOLOGY

DIGITAL TECHNOLOGY IS AN AID - NOT A SUBSTITUTE FOR THE DENTAL TECHNICIAN

DENTAL TECHNOLOGY SHOWCASE 2018

Reawaken the passion at DTS 2018

o you remember the day you first entered a dental laboratory as a full-time employee? Do you recall excitement bubbling in the pit of your stomach, perhaps mixed with a few nerves? Do you recollect the enthusiasm you had to get stuck in and the ambition you had to develop your skills and thrive in your chosen career? Do you still get the same feelings when you enter the lab on a Monday morning? If not, why not? This is a truly exciting time to be involved in UK dentistry, with new innovations driving standards ever higher while also making life easier for professionals. For dental technicians today, there is an enormous choice of materials, technologies and products designed specifically to provide solutions to the challenges once faced on a daily basis. By simplifying and speeding up workflows, broadening restorative and prosthetic possibilities and improving the accuracy of products crafted, these solutions allow the dental technology team to truly thrive. The consequences of this are multiple. Firstly, more diverse opportunities allow technicians to select what they wish to focus on, enabling them to develop their knowledge and skills. This promotes increased job satisfaction and encourages the fulfilment of career ambitions, while also improving staff retention for the business. Secondly, higher quality, more precise restorations and appliances provide a fantastic service to partnering dentists and their patients. Happy clients mean more referrals and a better reputation – and these are the building blocks of a long and prosperous future for both individual dental technicians and the business overall.

FOCUS

Over time, a busy workload, changing regulations and unexpected events can understandably dampen one’s enthusiasm for their work, but it’s important to take the time to re-ignite the passion. Whether you are looking to give yourself a push or it’s your business and your team that need a boost, there are plenty of things you can do to renew the hunger for excellence. What do you want to do next? Are you looking to learn new skills and if so, what would be of most benefit to you? Do you think a new piece of equipment would make your work more efficient? Does your laboratory need

a re-design in order to better accommodate recent growth in your team? Do you wish the environment were more ergonomic for increased comfort and productivity? If you’re looking for a place where you can find the answers to all these questions and more, the Dental Technology Showcase (DTS) 2018 is a must-attend event for you! The two-day show offers all the information, advice, demonstrations and education you need to re-discover your love for your craft, while also gaining verifiable CPD and enjoying time with friends and colleagues outside the laboratory. LEARNING Between the DTS Lecture Theatre (designed by the Dental Technicians Guild), Digital and Innovation Theatre and on-stand learning throughout the trade exhibition, as well as additional sessions tailored to orthodontic technicians and clinical dental technicians, you will be spoilt for choice when it comes to enhancing your understanding of new and traditional techniques, materials and technologies, with hours of CPD available. Hear from an array of world-class speakers for free, including some of the biggest talents in the profession from here in the UK and across the globe. They’ll share their extensive expertise to introduce innovative new solutions to you and help you make the very most of the equipment and materials you have access to. There is also the chance for discussion among peers, with interactive sessions providing a platform to ask your own questions and seek bespoke advice tailored to your specific needs. For lab owners and managers, the Dental Business Theatre will offer a wealth of practical information and guidance on how to maximise

profits and encourage business growth. The fun-filled programme delivered by Practice Plan once again next year, will have you fired up and ready to take on any challenge that presents itself in the months to come! DISCOVERY The trade floor will host more than 100 lab-dedicated manufacturers, suppliers and training providers, all keen to highlight their latest offerings. Product experts will be on hand to demonstrate key products and you’ll also be able to get hands-on to try new concepts out for yourself. Launchpad UK will highlight the newest innovations on the UK market, giving you fresh ideas on how to upgrade your lab facilities for the benefit of your team and your bottom-line. COMMUNITY The sense of community is rife throughout DTS, as dental technicians, clinical dental technicians, orthodontic technicians and lab owners come together from across the nation. Meet up with friends, expand your professional network and get involved.

DON’T MISS DTS 2018! DTS 2018 will be held on Friday 18th and Saturday 19th May at the NEC in Birmingham, co-located with The Dentistry Show. FOR FURTHER DETAILS, VISIT: www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

KING’S STUDY PROVIDES CLUES TO BODY’S DEFENCE AGAINST COMMON ORAL INFECTION LONDON, NOV. 3, 2017 w An international team, co-led by researchers at King’s College London and the University of Pittsburgh, has identified the mechanism by which the immune system first learns that the fungus Candida albicans, which causes oral thrush, has invaded the body. The culprit is a fungal peptide toxin called Candidalysin, which punches holes in cells lining the mouth and is sensed by the immune system, which then begins to mount a defence. The new findings, published today in the journal Science Immunology, could eventually lead to better treatments for oral thrush, which can produce pain severe enough to cause difficulty eating and swallowing, as well as other serious fungal infections. “The mouth is home to a large number of microbes, termed commensals, which are harmless in healthy individuals. However, suppression of the immune system can lead to severe and reoccurring painful oral infections from these organisms,” explained the study’s co-senior author Julian Naglik, Ph.D., who is Professor of Fungal Pathogenesis and Immunology at King’s College London Dental Institute. One such example is the fungus Candida albicans. The harmless commensal form exists as a small single-celled organism, but when the immune system is compromised, Candida elongates into an invasive form, characterized by long filaments called hyphae, that causes a pervasive infection called oral candidiasis, or “thrush.”

Her lab previously showed that an immune hormone called interleukin-17 (IL-17) and the specific cells that make it - a subclass of immune cells called helper T cells - are essential to immunity against oral thrush. Oral epithelial cells, which are part of the mucous membrane lining the inside of the mouth, are the first cells in the body to encounter Candida. They ignore the yeast until it begins to grow hyphae, at which point the epithelial cells stimulate helper T cells to produce IL-17. In the new study, the researchers used a combination of human oral epithelial cells cultured in laboratory dishes and mice infected orally with Candida, to show the central importance of Candidalysin, a peptide toxin secreted by Candida that allows the fungus to create holes in epithelial cells and invade the tissue. Further experiments revealed that IL-17 and Candidalysin act in a synergistic manner to amplify antifungal signals in cultured epithelial cells. Candidalysin was discovered in 2016 by Professor Naglik at King’s College London, and is the first peptide toxin identified in any fungus that infects humans. “To use a Game of Thrones analogy: the oral epithelial cells form a protective ‘wall’ that keeps the marauding Candida invaders at bay. Patrolling the wall are the helper T cells, which use IL-17 as their weapon to protect the kingdom” said the paper’s first author, Postdoctoral Fellow Akash Verma, Ph.D. Despite millions of fungal infections worldwide, there are no commercially available anti-fungal vaccines. “Our research

provides vital clues to understand the immune defence network at barrier sites of the body. This knowledge may ultimately be harnessed to design antifungal vaccines,” Professor Naglik said. Gaffen and Naglik recently were awarded a large National Institutes of Health (NIH) grant to further explore the role of Candidalysin signalling in oral immunity. The grant received the prestigious MERIT designation given to only 5 percent of grants. Additional authors on the study are: Chunsheng Zhou, B.S., Bianca Coleman, M.S., Kritika Ramani, Ph.D., Mandy McGeachy, Ph.D., Lawrence Kane, Ph.D., and Partha Biswas, Ph.D., all of Pitt; Jonathan Richardson, Ph.D., David Moyes, Ph.D., and Jemima Ho, Ph.D., of King’s College London; Anna Huppler, M.D., of the Medical College of Wisconsin; Ilgiz Mufazalov, Ph.D., and Ari Waisman, Ph.D., of University Medical Centre of JohannesGutenberg University, Germany; and Bernhard Hube, Ph.D., Leibniz Institute for Natural Product Research and Infection Biology, Hans Knoell Institute, Germany. Funding was provided by the Medical Research (MR/M011372/1), Biotechnology & Biological Sciences Research Council (BB/N014677/1), and the National Institute for Health Research at Guys and St Thomas's NHS Foundation Trust, and King's College London Biomedical Research Centre (IS-BRC-1215-20006). CONTACT For more information on the Dental Institute at King’s College London please contact Laura Shepherd, Senior Communications Officer on +44 (0) 207 118 1163 or email laura.2.shepherd@kcl.ac.uk Website: www.kcl.ac.uk/dentistry For more information on the University of Pittsburgh please contact Arvind Suresh, Office: 412-647-9966, mobile: 412-5098207, email: SureshA2@upmc.edu

PAPERS MENTIONED IN THIS ARTICLE Oral epithelial cells orchestrate innate Type 17 responses to Candida albicans through the virulence factor Candidalysin published in Science Immunology on Friday 3 November, 1400 ET

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DENTAL NEWS

The immature immune systems of infants make them particularly susceptible to thrush, which can lead to a failure to thrive and nutritional deficiencies. The infection also is prevalent among HIV/AIDS patients, denture wearers and those on immunosuppressants, including chemotherapy and drugs to prevent the rejection of transplanted organs. In fact, at least 50 percent of HIV patients struggle with repeated thrush infections.

“However, surprisingly little is known about how fungal immunity in the mouth operates, and, until now, it was unclear why Candida does not establish an invasive infection in healthy humans,” said the study’s other co-senior author Sarah L. Gaffen from the University of Pittsburgh School of Medicine.

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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

LEARNING OUTCOME

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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 BEING SOCIAL. MARKETING

Q1. A. B. C. D.

When using social media what should you guard against? Talking about your accounts on line. Talking about techniques. Breaches in Confidentiality. Publishing your Prices List.

3D PRINTING STUDY Q2. A. B. C. D.

What is used to harden the splint material. Blue light. Xenon Flash light. Pressure bath. Microwave oven.

Q5. A. B. C. D.

How did Jason Pearson first begin with digital technology? He invested in a complete set-up from Straumann. With a second hand Scanner. With a CADCAM milling machine. By using a friend’s laboratory.

Q6. A. B. C. D.

What did Jason find strange to start with? Finishing the CADCAM pieces. The third party production The size of the images on screen. Explaining to his clients.

Q7. What are his conclusions now? A. The digital technology will wipe out the technicians. B. The digital technology is an aid to and not a replacement for technicians. C. Digital technology is tough to learn to use. D. Fitting it in to the working day is impossible. Q8. Where are Bracon situated? A. North London. B. Chichester. C. Nr. Exeter. D. East Sussex.

Where was the clinic situated? Harley Street. Wimbledon. City of London. London’s west end.

THE YOUNG ITI? Q11. A. B. C. D.

Q12. A. B. C. D.

DIGITAL TECHNOLOGY IS AN AID

COMPANY PROFILE

STRAUMANN DIGITAL HANDS-ON DAY Q10. A. B. C. D.

Which University established the study? University of Philadelphia. University of Milan. University of Utrecht. Heidelberg University.

Q3. What type of files are used to transfer information. A. JPeg. B. EMO. C. stl. D. ZDR. Q4. A. B. C. D.

Q9. What is the Owners family name? A. Butterfield. B. Viney. C. Schottlander. D. Baxter.

What is the ITI? The International Team for Implantology. The Intelligence Transfer Institute. The International Treatment Institute. The Industry Training Institute. What is their purpose? To create more implant borne crowns etc. To encourage and support research and education about Dental Implants. To supervise all Implant placement. To exclude poor implants.

CONTINUED RISE IN ORAL CANCER

Q13. Who are most affected by this increase? A. Middle aged women. B. Middle aged men. C. Young women. D. Young men. Q14. A. B. C. D.

Why should that be? Increased drinking and smoking. Poor oral hygiene. Beer drinking. Eating fast food.

Q15. A. B. C. D.

How much has it increased? It has doubled. It has increased by 50%. It has increased by nearly 30%. It has shown a 20% increase.

Q16. A. B. C. D.

What other causes particularly affect young men in the UK Longer licencing hours. Low legal age limit. Poor hygiene in bars. The Human Papilloma Virus.

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CEDACORE

CHILDREN EXPERIENCING DENTAL ANXIETY: COLLABORATION ON RESEARCH & EDUCATION COLLABORATION OF LEADING RESEARCHERS FROM UK AND BRAZIL TO HELP ANXIOUS CHILDREN NEEDING DENTAL TREATMENT

ringing together leading academics from King’s College London Dental Institute (UK) and Universidade Federal de Goiás (Brazil), an international research collaboration for helping anxious children who need dental treatment was held from 14-18 October, 2017. Focusing on sedation allied with non-pharmacological techniques, minimally invasive dentistry and cognitive behavioural therapy, it was a unique opportunity for researchers from both sides of the world to join forces and explore the best ways to help anxious children who have tooth decay.

EDUCATION

With its duel focus of training the teachers and researchers, the workshop has led to immediate and long-term benefits in development of child anxiety management in both the UK and Brazil. Coordinated by Professor Marie Therese Hosey from King’s College London (UK) and Professor Luciane Costa from Universidade Federal de Goiás (Brazil), the workshop bought together a group of bright and enthusiastic 39 researchers in the fields of Paediatric Dentistry, Restorative Dentistry and Psychology. Leading researchers Professors Avijit Banerjee, Tim Newton and Marcello Bönecker and Paulo Sucasas were joined by Early Career Researchers from the UK and Brazil. The workshop was funded by the Fundo Newton/Researcher Links scheme, the British Council, and the Fundação de Amparo à Pesquisa do Estado de Goiás (FAPEG) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes).

Dedicated to supporting dental professionals and laboratories for over 65 years, with innovative quality products, equipment and cabinetry. For the very latest information and offers in analogue or digital technology, technical support, equipment servicing or repair and courses with CPD, call Bracon today!

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09/11/2017 16:44

OBITURY

IN MEMORY OF CLIVE ELY

or many years Technicians based in the Harley Street area in London have enjoyed a good reputation for their work excellence and their general aspirations to the very best. Working, as they often have, with the very best of clinical colleagues they were often the realisation of the ambitions of their clients and an example to the wider technical population, of the potential for creating and fulfilling the patients wishes. They sometimes work in the same building as their clinician client and can offer a first hand service to patients. One of the successful Harley Street Laboratory Owner Technicians Clive Ely has recently died at the early age of sixty. He was well established in Harley Street where he took over his fatherâ&#x20AC;&#x2122;s laboratory in the early 70s, when his father died, and had managed to continue successfully since. Clive had completed his training at Kings and gone to Germany where in a large Laboratory had learned a great amount from his German colleagues, with whom he made life long friendships. On his return he joined with his father in 8 Upper Wimpole Street. He worked their until his fathers untimely death.

BORN 14- 4-1957 DIED 1 -3 -2017 Clive working in his laboratory

Suddenly alone to continue the business, left so unexpectedly by his father, he was able to call on several of the local technicians, who pitched in to help and established his presence in the demanding world of private restorative technical dentistry. Friends like Mike Kedge and Clive Quince and Michael Kempton who at that time were very much the technical providers for Dr John McClain and involved in the development of the ceramic innovations, which followed. They were able to pitch in and steady the ship and allow Clive to gain his confidence to carry on the business without his father. Clive with his wife Nicky

Clive later moved to 40 Harley Street to continue the business started by his father. Clive maintained, to the end of his life, his relationship with the Kings personnel and it was not unusual for a dental student to turn up to see a private dental laboratory in action. As the research into ceramics and strengthened versions continued to progress he was in a great place to take advantage. The original Alumina re-enforced frameworks, which have led to todays Zirconia ceramic infrastructures gave Clive a growing interest in the developments within Ceramics and the Digital CADCAM processes. He would research the 15 to 20 years of the history of the materials and continued to do so with visits to the major British players and then to Europe to visit companies in Germany, Switzerland, France and Italy learning a huge amount about the advantages and disadvantages of this incoming technology. A truly professional technician, who will be sadly missed by his fellow local technicians and by very many of his clinical colleagues. Clive during his career had dealt with very many high profile personalities including some from Royalty, Show Business, Sports and Commercial life. Outside of work Clive was devoted to his wife and four children, which included twin Boys followed by a daughter and then another son and will be sorely missed by those he loved.

Clive on the steps of 40 Harley St.

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DENTAL NEWS

A great many people attended Cliveâ&#x20AC;&#x2122;s funeral. Several of his clinician clients made the trip, some from Eire, and a great many of the local villagers wanted to show their respect for a popular and much loved friend.

HOUSEHOLD ENVIRONMENT AT THE MICRO LEVEL MAY PLAY A ROLE IN ORAL HEALTH DENTAL TRIBUNE INTERNATIONAL w LONDON, UK: The role of the household may have an influence not only at the social level, but also at the microbe level. In a study conducted in the UK, researchers have discovered that early environmental influences are far more significant than human genetics in shaping the salivary microbiome, the group of organisms that determine oral and overall health. Dr Adam P. Roberts, senior lecturer in antimicrobial chemotherapy and resistance at the Liverpool School of Tropical Medicine, pointed to periodontitis, which is associated with an altered microbiome, as a key example of how the study may be relevant to people’s oral and general health. “Once we understand the members of the microbiome that are responsible for health, our everyday behaviour could change to shift our microbiome favourably,” he said. Roberts co-led the study, which was conducted during his time at the UCL Eastman Dental Institute in London. The study’s main objective was to discover how the salivary microbiome is established and what factors are most responsible for the mix of bacteria. With access to a unique sample set of DNA and saliva from an Ashkenazi Jewish

family living in various households spread across four cities on three continents, the team asked how much of the variation seen in salivary microbiomes was due to host genetics and how much to the environment. Owing to the family members adhering to ultra-Orthodox Judaism, they shared cultural diets and lifestyles that controlled for many confounding factors. Additionally, because the family members’ DNA had already been sequenced to the level of single changes in the DNA code, the research team had a unique and precise measurement of their genetic relatedness. From this, UCL Genetics Institute graduate student Liam Shaw and the team of researchers sequenced the bacterial DNA signatures present in saliva samples from 157 family members and 27 unrelated Ashkenazi Jewish controls. Across all samples, they found that the core salivary microbiome was made up of bacteria from the Streptococcus, Rothia, Neisseria and Prevotella genera. “What that tells us is that the contact and sharing of microbes that goes on at the very local environment is what determines the differences between individuals,” said Shaw.

To understand what might be driving differences at the bacterial species level, Shaw and the team used statistical methods adopted from ecology to ascertain which factors were responsible for the most variation. When comparing factors such as shared household, city, age and genetic relatedness, the factor that determined who had the most similar saliva microbes was overwhelmingly shared household. Furthermore, spouses, parents and children younger than 10 living in a household together had the most similar salivary microbiomes. According to Roberts, the study shows that environments shared during upbringing play a major role in determining the community of bacteria that is established and knowing that the shared environment drives the microbiome may provide the ability to one day modulate it. The study, titled “The human salivary microbiome is shaped by shared environment rather than genetics: Evidence from a large family of closely related individuals”, was published on 12 September in mBio, an openaccess journal published by the American Society for Microbiology.

SURGE OF ORAL CANCER IN YOUNG MEN NEWS UK & IRELAND DENTAL TRIBUNE

DENTAL NEWS

w LONDON, UK: Young men are more likely to develop oral cancer than any other demographic in the UK, new figures by Cancer Research UK suggest. While men in their twenties and thirties are diagnosed with the condition more often than elderly men, they are also twice as likely to develop oral cancer than women.

consuming alcohol or contracting the human papillomavirus. For example, around two thirds of all male oral and pharyngeal cancers are believed to be caused by smoking. However, the organisation said, that most of the risks could be reduced by people simply rethinking their lifestyle choices.

Currently, over 5,000 men are diagnosed with oral cancer per year, compared to only 2,500 women, according to the organisation. It also said that overall cases have been on the rise in both genders over the past ten years, with rates rising from 10 cases per 100,000 people a year in the mid2000s, to 13 cases per 100,000 last year, making it the eleventh most common cancer in males in the UK.

“It’s a real concern that so many men are getting oral cancer and that it’s been on the rise in both men and women,” Dr Richard Roope, Cancer Research UK’s lead GP, said. “But the vast majority of oral cancer cases are preventable, so the good news is that people can cut their risk by quitting smoking and cutting down on alcohol.”

Cancer Research UK suggested that the surge in new cases, particularly in young men, could be linked to high-risk behaviour, such as smoking tobacco,

“It’s also vital that everyone knows what their mouth, tongue and gums usually feel like, so they can spot anything out of the ordinary. Early diagnosis is absolutely key for the best results, which is why we’re set on helping dentists and GPs catch oral

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cancer sooner,” he also said. Supported by the British Dental Association and accredited by the Royal College of General Practitioners, Cancer Research UK offers a free online educational resource, its Oral Cancer Recognition Toolkit, to help dental professionals and GPs spot the disease earlier. The toolkit includes information on how to identify the signs and symptoms of cancer, how to prevent the disease as well as referral pathways. The toolkit can be downloaded from Cancer Research UK’s website. “Having referred patients with suspected oral cancers, I know that when it’s diagnosed at an earlier stage the chances are better for successful treatment. So it’s crucial that dentists and GPs know the signs to look out for and that patients bring anything suspicious to their attention as soon as possible,” said Nick Stolls from the British Dental Association.

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