The Dental Technician Magazine November 2019 by The Dental Technician Magazine

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

A DESCRIPTIVE STUDY OF PROSTHETIC RESTORATIONS PAGE 14

LAUNCHING CANCER ACTION MONTH 2019 PAGE 19

IMPLANT RETAINED FULL ARCHES MADE EASY UTILISING THE MEDIT T500 LAB SCANNERS PAGE 21-23

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DENTAL NEWS GLOBAL CLINICAL CASE CONTEST: DENTSPLY SIRONA HONORS YOUNG DENTAL TALENTS PAGE 24

INSIGHT DENTAL DORIS: 6 TINY CHANGES TO MAKE YOUR LIFE MORE ENJOYABLE PAGE 8

MARKETING MIKE BOND DISCUSSES SOCIAL MEDIA MARKETING TRENDS 2020 PAGE 6

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

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CONTENTS NOVEMBER 2019

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

Welcome

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

Marketing

Advertising Manager - Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602 Editorial advisory board K. Young, RDT (Chairman) L. Barnett, RDT P. Broughton, LBIDST, RDT L. Grice-Roberts, MBE V. S. J. Jones, LCGI, LOTA, MIMPT P. Wilks, RDT, LCGI, LBIDST Sally Wood, LBIDST Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician Magazine is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused. 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.

Thoughts from the Editor

Marketing By Mike Bond

Insight 8-9 31

Dental Doris Letters to the Editor

Dental Technology When the magic catches on (part two) 10, 12 & 13 Dentsply Sirona presents the new generation5 of CAD/CAM software with OraCheck 16 Connect Case Center 17

Dental News Dental laboratory production of prosthetic restorations in a population in Sofia, Bulgaria BADN responds to reduction in ARF Launching Cancer Action Month 2019 An evening with the Services Veterans Walk-In Centre Portsmouth Global Clinical Case Contest: Dentsply Sirona honors young dental talents VHF wins first prize for the Z4 James Green continues to raise awareness of MDR at BDIA

14 18 19 20 24 25 25

Digital Technology Implant retained full arches made easy utilising the MEDIT T500 Lab Scanners

21-23

ECPD Free Verifiable ECPD & ECPD questions

26-27

Company News Trycare/Zirkonzhan Shofu

28 29

Classifieds

The only condition is that they have not subscribed to the magazine for more than 12 months. Just ask them to call the Subscriptions Hotline. With four colleagues registered that means your subscription would be extended for a year free of charge. At only ÂŁ39.95 per year, for UK residents, this must be the cheapest way of keeping up to date. Help your colleagues to keep up to date as well. Ask them to call the subscriptions Hotline on 01202 586 848 now.

P.20

THOUGHTS FROM THE EDITOR

WELCOME to your magazine

November is here already. It does seem to be rushing by. I still have not heard from the MHRA and GDC with regard to my queries, receipt of which was confirmed in February of 2019! Perhaps we should give them even longer to go on ignoring our very reasonable questions. I am hopeful that the dental organisations and individuals, of some Importance will be getting as impatient as me to hear back, as I do fear there may be a backlash which will be directed at the lower order of DCP!! I have been shocked at the belief by most technicians, I have spoken with, that it is not important to register with the MHRA. It is the law and those who manufacture custom made dental devices, whomever they may be, must comply. They must be able to show they are trained and capable to undertake the work. It not only applies to technicians but to Dentists, Therapists, CDT’s, Dental nurses (perhaps making bleaching trays etc.) and all other professionals dealing with the patient. It does seem as if someone is deciding not to push the subject in order to avoid some potential cost of time and resources. If that is the case then it would be good to advise the government that we as a profession, responsible for looking after patient’s dental heath interest, have decided to ignore that part of the legislation. The Legislation, which was brought in, you may remember, after the scandal of the breast implant debacle. Created by medical professionals not being too professional but clearly mindful of the financial returns. Questions need to be asked as to why the MHRA requirement is not taught at undergraduate level. Why DCP’s are not being advised of the legal requirements? There does seem to be a voluntary wall of silence from the necessary authorities and a reluctance for those affected, such as DCPs in all the

disciplines. Those of you working n the Hospital services should be careful to check your status with the MHRA. They may not be very responsive, but you should be clear about your legal requirements. Just to underline the potential problem. I have far too often heard technicians complaining about their dentists not being able to take a good impression, or a good bite record or are unable to prepare a tooth properly. Often with some pride they talk of doctoring the preps or ignoring the bite record. They know in many cases the work will not fit properly or will be wrong on the bite, but they continue anyway. Well since you are all now to be registered it makes you directly responsible to the patient for the correctness and suitability of the restoration. Yes, you are now responsible if the dentists’ shortcomings are ignored and the case causes problems for the patient. If the patient sues or has a subsequent problem you are directly responsible because you have not used your skill and judgement in the patients’ best interest.

THE DENTAL TECHNICIAN MAGAZINE MERIT AWARDS SCHEME EXPLAINED You may have noticed the discussion on the Dental Technician Magazine web site regarding the Merit award scheme. People are a bit confused about what is required to enter the competition. The competition is set up to reflect the excellent Technical work which is available in these islands and we are looking for examples of cases and individual crowns, dentures, Orthodontic appliances and Maxillofacial treatments which have led to a successful outcome and a happy patient. While it would be ideal to have a set of models with an appliance or restoration to fit, it is impractical to expect that. So written

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case histories with photographs, which could include before and after in-situ shots of successful cases would be very welcome. We have begun to receive some excellent examples of dentures and crown and bridgework but have not had a great deal of interest from our very talented Maxillofacial colleagues or indeed our Orthodontic technicians. The cases will be judged by technicians on the basis of the technical work. It can be a single crown or a good metal or plastic partial denture. The ortho device should be a removable appliance with a perhaps expansion, attachments or photos of the appliance with a progress series of photos showing starting point and progress towards the finished case. With Maxillofacial the appliance will of necessity be a working appliance perhaps with before and after shots if possible of the patient. With the digital innovations It would be good to see the use of this new technology of scanning and fixation butt whatever reflects your ability and the excellence which is available is what we want to see. The intention is to demonstrate the technicians craft and abilities with high quality finish and perhaps innovative techniques. Ceramic layering techniques or examples of natural colour matching. Difficult or challenging casting and modelling techniques overcome. Restorations incorporating occlusal management techniques with descriptions of how and why. We are after all responsible for making teeth to fit the patient and the case prescription so examples of what you do well is what we are looking for. If you have used an unusual approach or have innovated the restorations and the appliances it would be good to see.

Larry Browne, Editor

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MARKETING

MIKE BOND – DENTAL MARKETING SPECIALIST MARKETING

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

in the dental and healthcare sectors for over 25 years.

SOCIAL MEDIA MARKETING TRENDS 2020

ocial media has now become synonymous with digital marketing, going hand-in-hand with most – if not all – digital campaigns. However, social media is far from static and what worked a few months ago may not get you the same good results now. Habits change, platforms evolve, and new platforms come into existence. All of this influences how people use and react to social media marketing, as well as how marketers are able to reach their audience.

It is more important than ever before for labs to understand and stay ahead of the curve when it comes to social media. Doing so ensures you have the right tools at your disposal, an up-to-date strategy, and the required skills to make the most of social media. With this in mind, I’ve taken a look at some of the trends that I believe are going to be important when it comes to social media marketing in 2020. THE DIGITAL DETOX There are now 3.484 billion social media users across the globe, which is a 9% increase compared to last year. This equates to 45% of the world’s population being on social media. It also means that social media adoption has actually beaten previous estimates, which suggested that an estimated 2.82 billion would be using social media in 2019. While this suggests that brands have the opportunity to reach larger audiences than ever before, a new trend is affecting that audience base. DIGITAL AROUND THE WORLD 2019 More people are now choosing to “detox” from social media, deleting apps and profiles in order to step away from it. This is more than just the usual changes we see in terms of people choosing to use one platform less in favour of another – such as Facebook seeing users decline but Instagram attracting more – this trend is seeing people take a temporary or permanent break from all social media. One in three adults in the UK are now reducing their social media use. Some 6% of users have removed an app from their phone, 6% have permanently deleted their accounts and 8% have both deleted their accounts and removed social media mobile apps.

channels, including email marketing and search engine marketing. However, it’s also vital that you ensure that any social media presence you do have is as meaningful as possible. Your lab needs to offer more than memes - you need to deliver content that has a positive and memorable impact on your audience and that provides as much value as possible.

DIGITAL DETOX STATS A big reason for this is that people now feel overloaded by social media, with the permeation of social media affecting their mental health and wellbeing. Others choose to detox because they don’t trust social media platforms, either due to issues like Fake News or because of privacy and data concerns. I think that this year, we'll be seeing more of a change in the way social media users act online; I think that digital detox will become more prevalent this year, with many people trying to limit the amount of time they spend on social media. I also think that there will continue to be a big push towards making social media more private and secure for its users - this has been a big problem recently and many people are just realizing how truly dangerous a lack of online privacy can be. This isn’t to say that social media will become void in terms of digital marketing, but labs do need to understand the impacts it could have. When added to the issues that pay-to-play social media brings, more people taking on a digital detox (whether temporary or permanent) will impact reach and engagement of your posts. This can affect the results of any customer acquisition or brand awareness campaigns you launch across social media platforms. Ultimately, it’s vital that you don’t start putting all your marketing eggs in the social media bucket. You need to ensure that enough budget and resource is still being given to other

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BUILDING SOCIAL MEDIA COMMUNITIES A big part of meaningful and valuable experiences on social media is the way that businesses engage with their audience. While sharing posts that you believe your target audience will enjoy is part of maintaining your social media presence, you also need to encourage and cultivate interactions that are more than a simple like or share. There are a lot of businesses out there who seemingly have large social media followings and yet, when you look more closely at individual posts, their engagement levels are almost nonexistent. Those brands that are seeing more engagement from their followers are doing so by building communities around their content. SMART INSIGHTS FACEBOOK MEMBERS' COMMUNITY This isn’t to say that communities are a new concept, but they are being built by businesses in different ways, which is paying off and will likely continue to do so as we head into 2020. It’s vital to encourage your team to create their own social presence to promote content and increase overall brand trust. This tactic leads to an authentic voice for your lab, Twitter chats help create a strong sense of community through content, bringing thought leaders from all areas together in a real-time conversation. It gives your brand the perfect opportunity to engage directly with current and potential customers. More than ever before, potential buyers want to hear from current customers – so give them a place to do just that. One benefit of building social media communities is that they help with word-ofmouth marketing, which is another big social media marketing trend for 2020.

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INSIGHT

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

6 TINY

CHANGES TO MAKE YOUR

LIFE MORE

ENJOYABLE

think we are all open to making changes in our lives that make us happier and more successful, but few of us follow-through because committing to something that’s going to change our lives is a daunting and massive undertaking, right? Not necessarily. Instead of focusing on huge, radical steps, start moving forward by incorporating these eight changes that are so small and simple that you can implement them immediately. These eight steps can drastically change your life for the better. 1. Reprogram your mind to stay positive Our thoughts and actions are influenced by our feelings. That’s why when you’re just feeling “blah” because the weather is miserable or you had a stressful week all you want to do is stay in bed. Here’s the problem. Negativity is all around us. There’s nothing we can do about that, either, but what we can do is learn how to reprogram our minds to stay positive. You can't trap every negative thought in the happy-clappy end zone of your mind, but can take charge of your thoughts by: • Keeping a gratitude journal. Jot down what you’re thankful for every day instead of

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that you’ve never done before. Try that Thai restaurant. Go snowboarding. Purchase clothes from a different store.

• Creating and repeating positive affirmations that acknowledge the progress you are making in the areas where you want to improve.

Opening ourselves up to new experiences makes us happier, changes our perspectives, helps us recognise new opportunities, boosts energy and makes us more receptive to change. This cycle circles back. New experiences will make you happier.

• Surrounding yourself with positive people who lift your spirits. Remember, emotions are contagious. • Don't acknowledge negative thoughts. • Staying active. Exercise releases endorphins but idleness leads to overanalyzing and overthinking. 2. Set your alarm half an hour earlier One trait many successful individuals have in common is they get up early. While you don’t have to wake up at the ungodly hour of 3:45 a.m.. like Apple’s Tim Cook, you could start setting your early half an hour earlier. So, if you normally set your alarm for 7 a.m., set it for 6:30 a.m. This will give you some extra time in the morning to exercise, meditate, read, check your emails, have breakfast with your family, plan your day or work on something that you’re passionate about. It saves you from rushing out of the door each morning feeling forgetful, unaccomplished and discombobulated. Time tracking is key to self-improvement. 3. Don't over-commit A common theme I notice with self-help advice is how people make goal-setting sound easy. They’ll suggest that you get more exercise or sleep, but that’s easier said than done when you’re working 12 hour days for demanding dentists! I’m not making excuses. Far from it. It’s just easier to commit and follow through successfully if you keep your goals simple and clearly defined. Start small and work your way up. Don't jump into a marathon headfirst if you need more exercise. Start with 10 push-ups a day or a walk around the block after dinner. 4. Don’t be so predictable Doing the same thing each and every day puts us in a rut. One of the best things that you can do for yourself is to stop being so predictable. Break out of your comfort zone at least once a week and do something new

INSIGHT

worrying what you don’t have. Gratitude will make you happier, increase your productivity and help you sleep better at night.

Why pay more?

5. Stop comparing yourself to others Stop losing sleep over what others have and what you don’t. Here’s the truth: there is always going to be someone who has a better paying job, lives in a nicer house, drives a fancier car and goes on more exotic vacations. Your friends may start families before you. Some might get to retire early. Comparing yourself just makes you miserable and unhappily preoccupied about what others consider success. Instead, worry about what you define as success. When I started freelancing, I had friends who mocked me because I wasn’t making as much money as they were. The way I saw it, I had a flexible schedule, got to work wherever I wanted and never complained about work since I enjoyed what I was doing. My friends that gave me a rough time complained constantly about their jobs, colleagues, wakingup so early, etc. Who do you think was happier? 6. Tackle the one thing that you’ve been putting off We all put off that one thing: the phone call to your insurance company, cleaning up your bench, changing the batteries in the smoke alarms. Setting priorities includes making sure certain seemingly small tasks don't build-up until you have to spend an entire day catching up. If you have unfinished tasks, you are carrying a heavy weight around with you all the time, no matter how small each task is. You have to remember it. If possible, when you think of it, do it right then. After you’ve listed your priorities for the day, add a long-standing chore to your to-do-list. For example, at the end of the workday, you’ll make that phone call or organise your workplace since you’ve already gotten all of your most important, and energy-draining, tasks done for the day. You’ll be surprised at how much better, and productive, you’ll feel once you've crossed these items off your list - even if it's just a mental list.

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DENTAL TECHNOLOGY

WHEN THE

MAGIC CATCHES ON CONTINUED FROM OCTOBER ISSUE

SETUP OF THE LOWER POSTERIOR TEETH These are set up according to the GERBER method in tooth-to-tooth relationship. Posterior teeth such as the Condyloform II NFC+, which have a very pronounced centric fossa in the lower jaw and correspondingly large support cusps in the upper jaw according to the mortar-pestle principle are appropriate for this purpose. One starts with teeth 34 and 44. Their buccal cusps positioned on the static line and slightly protrude above the plane of occlusion (Figs. 18, 19, 20). Their axes are slightly inclined distally. Teeth 35 and FIG 18

45 are positioned such that both cusps are at the level of the plane of occclusion (Fig. 21). Their central fissure is positioned on the static line and their axes are also slightly inclined to distal. Due to the spatial conditions, the first lower molars, 36 and 46, were placed after the second lower premolars. The first lower molars each stand on the static line with their central fossa in the area of the marking of the masticatory center (Fig. 22). Viewed from buccal, the mesial cusps are positioned at the level of the the plane of occclusion, the distal cusps slightly above (Fig. 23). In this case, the determined stop line did not allow the setting up of second lower molars.

FIG 19

FIG 20

FIG 22

FIG 21

FIG 24

FIG 23

FIG 26

FIG 27

FIG 30

FIG 31

FIG 25 FIG 28

FIG 29

SETUP OF THE UPPER POSTERIOR TEETH Next, the upper posterior teeth are set up. Here one starts with teeth 14 and 24, which occlude with teeth 34 and 44 in a toothto-tooth relationship. Their axes are slightly inclined distally. The buccal cusps of the lower antagonists (1:1 relationship!) each have contact in the mesial fossa of the upper premolars. The palatal cusps may have slight contact with the distal ones (Fig. 24). Teeth 15 and 25 are set up vertically or with minimal distal inclination (Fig. 25). However, the buccal cusps must not have any contact here (Fig. 26). Their palatal support cusps occlude in the fossa of teeth 35 and 45 (Fig. 27). When setting up teeth 16 and 26, care must also be taken that the buccal cusps are not in contact and that the mesiopalatal support cusps occlude exactly into the fossae of the antagonists as central static support (Figs. 28-31). Excursion movements are only ground in after completion as a matter of principle. However, the centric or static u contacts must already exist clearly and, if necessary, be ground in. p. 12 Fig. 18: Buccal cusps of the lower first premolars extend slightly above the occlusal plane FIG. 19: and are positioned on the static line FIG. 20: Tooth-to-tooth relationship of the first premolars FIG. 21: Teeth 35 and 45 are at the level of the occlusal plane with both cusps FIG. 22: The central fossa of the lower first molars are positioned on the course of the static line in the position of the masticatory center FIG. 23: Viewed from buccal, the mesial cusps are positioned at the level of the plane of occclusion, the distal cusps slightly above FIG. 24: According to GERBER: the buccal cusps of teeth 34 and 44 occlude in the antagonist FIG. 25: Buccal position of teeth 15 or 25 FIG. 26: No buccal contact of the second upper premolars FIG. 27: Support of teeth 15 and 25 only via the palatal cusps FIG. 28: Tooth-to-tooth relationship FIG. 29: Occlusal support of teeth 16 and 26 only palatal FIG. 30: Static stops top FIG. 31: Static stops bottom

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DENTAL TECHNOLOGY

ucontinued from page 10

MUSCLE-GRIPPING DENTURE BODIES The denture bodies are modeled in a musclegripping manner. To this purpose, labial shields for the mouth ring muscle are fabricated in the top and bottom of the anterior region. In the posterior region, buccinator supports are created and the pull line direction (under muscle activity) of the cheek frenulum is tightened. The transitions from the teeth to the gingiva should not be too bulging and undercut ("pockets"), but rather, more rounded and smooth at an obtuse angle.

The metal construction is sandblasted and silanized. Then opaquer is applied. Once these steps have been completed, the waxup is placed on the model and prepared for completion in the flask and then embedded. (Fig. 35). After the plaster has set, the flask is heated and opened. The softened wax can then be removed. The model is then steamed with clean, boiling water; the same applies to the teeth (Fig. 36). The basal contact surfaces of the teeth with the resin are roughened with a carbide cutter. Once the teeth have been placed back into the flask, they were conditioned basally with a silane. Prior to implementation in resin, the lower model was sufficiently watered for approx. 15 minutes, separated (Fig. 37) and the framework screwed on.

FRAMEWORK FABRICATION LOWER HYBRID DENTURE After completing the wax-up of the lower restoration, it is removed from the model and the scan-bodies are screwed onto the implants. Then the model and the counter-bite (model with wax set-up) are scanned. Once the implant positions have been determined, the scan-bodies are removed and the lower wax setup is placed on the model again and also scanned. Both models are then placed back in the articulator and the jaw relation is scanned. Once all the scans have been completed, one switches to the design software and constructs the metal framework (Figs. 32-34), which was then sent to Camlog (Dedicam) as a data set here. After receipt, the framework milled there is checked for surface quality and tension-free fit.

FIG 35

FIG. 38: Preparation for completion in resin: everything was at hand, with cold-curing resin it is always best to cool both components.

CENTRIC OCCLUSION FIG 37

FIG. 32: Scan with scan-bodies FIG 33: Scan with situation and/or wax set-up FIG. 34: Designed framework with screw channels

The first step is to focus on static or centric contacts. Should these not be present optimally after conversion into resin, they are ground in with a spherical diamond.

DYNAMIC OCCLUSION FIG. 35: Embedded wax-up of the upper full denture FIG. 36: Teeth after steaming with clear boiling water FIG. 37: Separating plaster versus resin

FIG 34

In the final step, the resin for the denture base in shade 34 was applied to the model and the teeth, then the flask was closed and placed in the press. After about 5 minutes under pressure, the bracket around the flask was closed tightly and placed in the pressure pot for 30 minutes. After completion of polymerization, divestment was performed. The models with the finished resin work were placed back into the articulator so that the static stops could be corrected and the excursion movements could be ground in.

FIG 36

FIG 32

FIG 33

In the second step, the resin for the vestibular shield was applied to the resin mixture for the papillae up to the vestibular fold. Nevertheless, the required mixing of both components for proper polymerization always has priority.

IMPLEMENTATION IN RESIN Before applying the resin and begin pressing, the components of the denture base resin are dosed, mixed and its swelling phase observed (Fig. 38). Shade 34 was chosen for the base. Shade 34 - mixed with a little yellow and white from the Aesthetic Intensive Colors range - was used in the area of the papillae and the modeled alveolar mounds. For the vestibular shield and the labial frenulum, shade 34 was mixed with RED, BROWN, BLUE and PINK and applied during the modeling phase of the resin in the sequence "papillae - lip shield - base". This meant first applying the resin mixture for the papillae thinly around the teeth with a spatula up to about 1/3 of the distance from the neck of the tooth.

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After the centric stops, this is followed by dynamic occlusion, starting with laterotrusion. It is ground in by first unlocking both articulator joints and moving the support pin transversally on the support pin plate until the buccal cusps or the incisal edges of the canines are positoned above each other. It is important here that there is no canine guidance, as the buccal cusps would otherwise be relieved. With the aid of a green occlusion foil, laterotrusion was ground into the lingual cusp slopes of the lower posterior teeth. Due to the inverse mortar-pestle principle, the first premolars must be excluded from this. In the next step, the protrusion was checked with blue occlusion foil with the joints unlocked, and any interfering early contacts in the anterior region were removed. If there are excessively steep protrusion facets in the posterior region, they must also be removed. To grind in the retrusion, the locking screw provided for this purpose must be loosened on the articulator to simulate this short dorsally directed physiological movement, which is performed during swallowing.

Following static and dynamic grinding of the occlusion, fine diamond grinders were used to restore the occlusal contours of the teeth from an anatomical point of view. To finish the denture bodies, these were removed from the models and machined with fine carbide cutters. First, the tongue, lip and cheek frenula were exposed so that the prostheses were not lifted under muscle activity and associated tightening (Fig. 39). The denture was then finished according to anatomical aspects using different, finely serrated cutter shapes, particularly in the area of the replicated alveolar mounds (Fig. 40). It is important here that as little grinding as possible is performed in the transition from tooth to gingiva, as this area cannot always be optimally polished without damaging the tooth surfaces. Pockets between the tooth and gingiva should also be avoided, as patients may have problems keeping these clean and food residues may accumulate. A slightly rounded smooth transition is optimal. Before the denture was polished to a high gloss, the surface was stippled with rose head burs (Figs. 41, 42). Then it was pre-polished with pumice stone and various brushes and finally polished to a high gloss with polishing paste and a buff.

FIG 39

FIG 40

FIG 41

FIG 42

DENTAL TECHNOLOGY

FINISHING AND POLISHING

FIG. 39: Exposure of the frenula in their pull direction FIG. 40: Fine-grinding of the alveolar mounds FIG. 41: After "stippling" FIG. 42: After "stippling"

MATERIALS (SELECTION) Articulator

Articulator CA 3.0

Candulor

Modeling wax

Aesthetic Wax

Candulor

Modeling wax for color characterization

Aesthetic Color Wax

Candulor

Isolation

Candulor

Denture resin

ISO-K

Candulor

Gingiva characterization

Aesthetic Blue Aesthetic Intensive

Candulor

Prosthetic teeth

Colors

Candulor

Implant system

PhysioStarÂŽ NFC+

Camlog

Alloy

Condyloform II NFC+ Comfour System NPM

Camlog / Dedicam

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DENTAL NEWS

DENTAL LABORATORY PRODUCTION OF PROSTHETIC RESTORATIONS IN A POPULATION IN SOFIA, BULGARIA: A DESCRIPTIVE STUDY NIKOLA D. DAMYANOV1 I DICK J. WITTER2 I ANNELOES E. GERRITSEN2 AND NICO H. J. CREUGERS2

Department of Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University-Sofia, 1, Georgi Sofiiski Boulevard, 1431 Sofia, Bulgaria. 2Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500HB Nijmegen, The Netherlands. 1

Received: 6 September 2010 I Accepted: 27 October 2010 I Academic Editor: Michael E. Razzoog

A LOOK AT RESTORATION CHOICES FROM FIVE LABORATORIES IN SOFIA BULGARIA

ecently published in the International Journal of Dentistry is an interesting study of a Dental patients group requiring restoration in Sofia Bulgaria for a variety of restorative needs. It is interesting as the treatments varied across the group and was considered to reflect the economic situation and the relative cost for the patients making the choice. There is very little funding provision for the Bulgarian National Health service to support the dental services available and prosthodontic replacement is not funded by the service. A total per capita annual spend for all health needs, including dentistry amounts to 132 Euro. The study looked at the production from 5 Dental Laboratories in Sofia (the capital city. The laboratories each serviced between 10 and 40 Dental practices across the city. A varied mix of incomes and dental fees were reflected in the study. The Laboratories were one two-man laboratory and 4 of average size, with between four and ten technicians. The cases records include fixed and removable restorations. The Chief Technician in each laboratory was instructed to record, from the cast models, the standing teeth and the restorations which were completed for each case over a two-week period. The technician also recorded the age and gender of the patient, from the dentists’ prescription, and included the cost of the restoration. Only full arch models were used for this process. The technician further described, in detail, the missing teeth, the presence of restorations in the mouth and included crown preparation and post and cores. The occlusal contact for each tooth was recorded or shown as not contacted. The scarce available data on the oral health of the Bulgarian population indicated high prevalence of missing permanent teeth ranging from 1.3 (20–24 years age group), through 5.3 (35–44 years age group), to 13 (55–64 years age group Since the prevalence of missing teeth is substantial and (oral) health budget is restricted, it is crucial that viable and appropriate management strategies, such as the shortened dental arch concept, are utilized. Being a

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minimal intervention approach, the shortened dental arch concept advocates for a “wait and see” period of monitoring function and stability of the dentition instead of immediate replacement of absent molars. Replacement of absent molars with the sole purpose to restore dental arch morphology irrespective of the degree of functional impairment may be considered overtreatment. A total of 284 orders were received of which 33 did not fit the requirements. (Diagnostic waxups, Orthodontic cases etc) The resulting cases of 251 with a mean age of 46- 14 years with 53% Female patients. The total production consisted of 243 crowns, 16 post and cores, 82 fixed dental prostheses, and 41 removable dentures. Proportions of crowned teeth were significantly different between the samples; proportions of replaced teeth were not. Of the 58 incomplete dentitions analysed, 19 were restored to the level of completeness, 15 resulted in slightly interrupted, and 24 in shortened dentitions. CONCLUSIONS Predominantly fixed restorations were provided to restore mutilated dentitions to a functional level and not necessarily to complete dentitions. The mean laboratory prices for a single crown, a three-unit fixed dental prosthesis, and an acrylic removable partial denture were €22, €75, and €30, respectively. Approximately half of the restorations were produced on 134 partial casts, while 203 dental restorations were produced on 115 complete casts (69 upper and 46 lower). Interestingly only 19 (33%) of the 58 incomplete dentitions were restored to completeness. A shortened arch restoration being accepted. When compared with other published epidemiological studies in Bulgaria this would appear to be the norm. A fixed solution is preferred but the economics would seem to limit the extent of replacement teeth and a shortened dental arch would be the normal expectation. Complete restorations are very much the minority. Perhaps an interesting comparison to restorations in the UK.

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@bracondigital 15

DENTAL TECHNOLOGY

DENTSPLY SIRONA PRESENTS THE NEW GENERATION5 OF CAD/CAM SOFTWARE WITH ORACHECK

he possibilities offered by Primescan, Omnicam and CEREC are noticeably increasing with the new generation 5 software updates: Dentsply Sirona announced today that it has signed an agreement to acquire OraCheck. The new OraCheck 5.0 will enable Dentsply Sirona to offer patient monitoring before, during and after treatment. Additionally, the updated Connect Software 5.1 now offers more digitally feasible treatment options, especially for orthodontics and implant dentistry. CEREC SW 5.1 brings the performance upgrade of CEREC generation 5 also to existing CEREC Omnicam units. All software updates will be available in October. Charlotte/Bensheim, October 7, 2019. The acquisition of OraCheck and applicable updates of its software will enable Dentsply Sirona to provide dentists with a valuable tool for patient analysis. OraCheck offers advanced software and supplements conventional assessment with valuable three-dimensional information developed for dental professionals to register and illustrate changes in the patient's mouth over time. It is a key tool to analyze and follow-up examination. A comparison of the most recently scanned image with an image that was taken at a previous point in time facilitates precise assessment of any changes. The new generation of OraCheck is available for all scanners and carts running with the new Software Generation 5 with of CEREC SW, Connect SW and CEREC Ortho 2.1.

Orthodontics at Dentsply Sirona. "We're realizing our idea that any dental workflow should start with an intraoral scan." OraCheck: more possibilities for dentists In conjunction with a digital optical impression system, OraCheck is designed to visualize three-dimensional change on virtual optical scans on the computer. The changes could include movement, tilting as well as geometric changes to the surface. Depending on the clinical situation as interpreted by the dental professional, these changes could be a hint for abrasion, swelling, recession, plaque build-up and change of tooth position. Connect Software 5.1: expanded options The updated Connect SW 5.1 enables a guided scan with Omnicam and more accurate results when scanning the whole jaw compared to software generation 4. It now offers expanded scan options for aligners, splints, individual impression trays as well as improvements of scan quality for Primescan and Omnicam. For new customers, the Connect Software 5.1 is supplied with every intraoral scanner.

"With Primescan, we took a huge step towards speed, accuracy and ease of use," said Völcker. "With this new software generation, we have taken a further step in digital workflows: the indications have become more extensive, and clinical success can also be ensured in the long-term through monitoring.” Due to different approval and registration times, not all technologies and products are immediately available in all countries.

LEFT: The new OraCheck Software 5.0 offers patient monitoring before, during and after treatment – in a new design and with new options for DI and CEREC users.

Common start for OraCheck and new Software Generation 5 Dentsply Sirona is also launching the latest updates of CEREC SW and Connect SW as part of the new Software Generation 5. All software updates represent a new design and an upgraded, more user-friendly and intelligent interface. Generation 5 SW runs on all Primescan and Omnicam systems and requires Windows 10. Depending on the hardware model, an upgrade might be required. "We are fulfilling an explicit request from customers and providing added value for dentists," explained Dr. Alexander Völcker, Group Vice President CAD/CAM &

CEREC Software 5.1: improved scanning accuracy The updated CEREC Software 5.1 for fabricating chairside restorations has undergone numerous enhancements. The calculation of the 3D model and the quality of the pre-proposals for the restorations benefit from the precise scans of the Omnicam in combination with the CEREC SW 5.1. Automatic artifact removal and artificial intelligence-based algorithms – already introduced with CEREC 5.0 – will find their way into the previous generation CEREC AC. The ability to export STL files is always part of the software now.

RIGHT: The updated CEREC Software 5.1 brings the performance upgrade also to exis ting CEREC Omnica m Units.

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SEND AND MANAGE SCAN DATA QUICKLY AND RELIABLY

seamless transition into digital impressions and CAD/ CAM dentistry: With the new Primescan from Dentsply Sirona, the new Connect software and the Connect Case Center, it’s a breeze. The portal for cooperation with the lab, which has been known as Sirona Connect until now, has been completely overhauled and is now even more convenient and flexible. Validated interfaces enable secure transmission of data to many important partners. Charlotte/Bensheim, July 15, 2019. Easy, quick, and above all, accurate – intraoral scanning with the new Primescan from Dentsply Sirona meets the clinical requirements for impressions, making it a first-class method. The Connect Case Center is a portal for further processing of the scan with versatile options and full flexibility. The Connect Case Center replaces the Sirona Connect Portal which, until now, has enabled practices to link to laboratories that use the inLab software. The basic function of the new platform is the secure transmission of scan data and case information. Photos can also be transmitted to the lab as attachments. If you want to communicate directly with the dental technician, you can make use of the chat function. NUMEROUS INTERFACES, IMPROVED COMMUNICATION WITH THE INBOX The new Connect Case Center has numerous validated interfaces to important partners of the dental practice: The seamless connection to Simplant enables users to use the Dentsply Sirona implant planning service quickly and easily. There is also a seamless

the Inbox generates common open data formats, such as STL and OBJ. The Inbox has proven to be particularly convenient in the workflow with inLab or exocad labs that are connected via appropriate interfaces: It provides provides a format that is validated by exocad that includes model and case data, color information and preparation margins. In this way, dentists also have the option of cooperating with exocad labs in a validated workflow. ABOVE: Dentsply Sirona’s Connect Case Center replaces the Sirona Connect Portal, with both proven and new functions. Via the Inbox, all labs can access the Connect Case Center.

interface to Atlantis, the central production service for patient-specific abutments and suprastructures on implants. The connection to SureSmile was created for the IDS 2019. This enables the user to order full service aligners, a model print, IDB trays for indirect bracket bonding and the production of aligners directly from the practice following the clinical diagnosis and Smile Design in the lab. Labs that work with the inLab software are also seamlessly integrated and can offer CEREC users an attractive design service. One significant new feature is the Connect Case Center Inbox – receiver software that enables all labs to access the Connect Case Center, regardless of their CAD software. The Inbox clearly displays all of the cases that need to be processed with the corresponding information on a dashboard and it also enables a 3D preview of the order, which can be accepted with a mouse click. For further processing with the preferred lab software,

PORTAL FOR ALL INTRAORAL SCANNERS FROM DENTSPLY SIRONA When purchasing a Primescan AC or a new Omnicam AC, dentists also receive the Connect software, which enables quick and easy access to the Connect Case Center. The user also gets a license for the Inbox, which can be passed on to the lab of choice, so that the lab is also able to access the portal. Of course, labs can also buy their own Inbox license to obtain access to the Connect Case Center. “Users of both Primescan and Omnicam benefit from modern digital impression technology, while remaining flexible in selecting partners for the manufacture of restorations, orthodontic devices and implant abutments,” explains Dr. Alexander Völcker, Group Vice President CAD/CAM and Orthodontics at Dentsply Sirona. “The new Connect Case Center thus provides the ideal environment for the digital workflow between laboratory and practice.” Dentsply Sirona’s Connect Case Center replaces the Sirona Connect Portal, with both proven and new functions. Via the Inbox, all labs can access the Connect Case Center.

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DENTAL TECHNOLOGY

CONNECT CASE CENTER

ADN welcomes the very slight reduction by the GDC in the Annual Retention Fee for dental nurses of £2 per year, for the next three years.

However, BADN still strongly believes that £114 per year is an excessive amount for dental nurses – many of them earning only Minimum Wage and often only working part time – particularly in view of the fact that the majority also have to pay for their own indemnity cover, and their CPD costs (which are still not tax-allowable for employees). BADN continues to urge the GDC to lower further the ARF for dental nurses, the lowest paid members of the dental team, instead of banding them with hygienists and therapists, who receive much higher salaries; and to consider a lower rate for all registrants who work part-time.

BADN also urges the GDC, and other dental associations, to lobby HMRC for tax relief on CPD costs for all members of the dental team.

Dental nurses who are BADN members may obtain indemnity cover at preferential member rates; and can also access free CPD in the quarterly digital “British Dental Nurses’ Journal” via the link in the members’ area of the website.

BADN membership costs £50 per year (£44 for part time workers) and also offers free legal and counselling telephone helplines, discounted rates at the National Dental Nursing Conference and other BADN events, members’ area of the BADN website with information and advice; as well as BADN Rewards – a range of money

saving discounts and special offers which can save members up to £609.36* a year on home/car/travel/life insurance, holidays/ hotels/flights/travel, eating out, family days out, cinema visits, gyms, eye tests, magazine subscriptions, spa visits, Apple products, energy suppliers, cars/car servicing/ breakdown cover, and high street shopping. For more information, visit: www.badn.org.uk *T&Cs apply to all benefits. See website for details. Offers and prices subject to change without notice. Average member saving is based on a sample of 203 savings calculator entries with anomalies, repeated entries and top 20% removed. Savings generated from the calculator are not guaranteed and are based on using specific benefits.

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BADN RESPONDS TO REDUCTION IN ARF B

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Made in England

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BY EDITOR, LARRY BROWNE

ust got back in time to catch the publishing time for the November magazine. I have just been to the Houses of Parliament at the behest of Sir Paul Beresford who together with the BDHF and Mouth Cancer organised a Kick Off evening to get the November Mouth Cancer awareness month rolling for 2019. It is always interesting to see the inside of where it all is decided!! A wonderfully Historic building with so many connections to the beating heart of Great Britain. Sir Paul spoke of his father and grandfather, who were both dentists working in New Zealand (South Island). He spoke of his memory of the beginning of machine assisted diagnosis with his grandfather’s X Ray machine, which he remembers as being enormous and needed to be wound to take the X ray of the tooth. With the accompanying winding and ticking noise prior to the shot being taken. He commented on how much we have moved on and how it is so much more possible to use the digital formulae and equipment to make the patients’ experience so much less invasive and comfortable. However, with all this innovation we are seeing an increase in cases of Oral Cancer. Improving patient awareness is of course the main target of the groups’ activities but you must also be aware to check yourself and those close to you for early signs. Talk about it with your friends and colleagues and underline the increase in the younger groups. A disease which traditionally affected men over 60 is now seen to be spreading to the younger men and women with links to the smoking and drinking lifestyle we all assume is normal and harmless. Be sure you attend regularly for a mouth check-up and be sure your dentist checks the soft tissue every time you attend for treatment or a check-up. Catching the disease early gives a 94% plus cure rate. Late detection can be horrendous even if you stop the disease. Sir Paul Beresford spoke about the advances in recent years and Dr. Nigel Carter spoke of the 80 years of the fight against Oral Cancer by his organisation. A patient

The long entrance gallery to the venue

involved with your clinicians and support staff in attending the many events and occasions for the dental team. Make sure your staff know about the risks and signs and of course you who may do dental repairs direct be aware you may be a source for indicating a problem.

who has survived tongue cancer spoke of her experiences. And her determination to continue to live her life as before. We were joined by Dr Nigel Carter who has spent many years guiding and managing the Dental Health Foundation. A truly dedicated professional with an ambition of wiping out this terrible and far too familiar disease. As Technicians you can help by getting involved, raising awareness, and perhaps getting

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Many years ago, I worked with and for a technician who did, very successful dentures, illegally of course. But he had referred so many patients to Eastman hospital with signs, and in many cases oral cancer he was on their referral list as one of their most prolific referrers. DCP’s and those of you doing directly with the patient, please be up to date with the present knowledge, and insure you at least check for any signs. WHAT SIGNS? A spot in the mouth on the soft tissues which won’t go away. Sometimes referred to by the patient as an ulcer. Sometimes a red spot or a very small lump that occasionally gets sore. Don’t ignore it, catch it early and hopefully cure it. Sometimes we may be the front line against this terrible disease. Don’t ignore the possibility.

DENTAL NEWS

LAUNCHING CANCER ACTION MONTH 2019

DENTAL NEWS

AN EVENING WITH THE SERVICES VETERANS WALK-IN CENTRE PORTSMOUTH

n evening to raise funds for the Veterans Walk-In Centre Portsmouth with some help from the charity BITE BACK which is administered by Dent-Tech. Lord Alan Stephen Wright (Dental Technicians UK Facebook Group) is dedicated to drawing attention to the plight of the Services Veterans and it was he who thought up the name BITE BACK to attract some attention from us in the technical end and the trade dentistry. The evening saw the presence of some dental folk and of course a lot of representatives and families of the Veterans support organisation. The evening was set around a James Bond theme and was a black-tie do with OO7 as the Hotel identification of the room for the evening. Everyone attending was asked for a donation of ÂŁ50.00. to go to the Veterans support fund. A very full turn out should hopefully help provide a generous amount towards this very fine cause. Food and wine were provided, and a good deal of interactive chatter soon filled the room. Alan had invited some Technicians and laboratory owners together with their partners and some dental companies were represented with Sharaz Mir of Blueprint Dental and Lucy Gabbitas and Paul Martin of Prestige Dental, who had come a long way south from Bradford to sponsor one of the main prizes which was a Yorkshire Hamper. Raffles were organised to add to the money total raised.

CLOCKWISE FROM TOP LEFT: The Scottish Music Theme, Waiting for the Music, Pipe and drum - the rhythm of the evenint, Lord Alan Wright Lady Wright and friends, Well, someone has to be Bond!! BELOW LEFT: A Hamper for the lucky winner.

It was a good experience to be involved in such an enjoyable evening for a great cause. In the extended break we were entertained to a wonderful Bagpipe Solo from a young lady traditionally dressed in Scottish style. Later she was joined by a drummer and they provided a sufficient distraction, if it were needed. This is the first occasion for the Dental presence and the Bite Back support to be noted. It is clear that retired services personnel have not always received the best support from the governmentâ&#x20AC;&#x2122;s Defence ministry with too many finding the adjustment to civilian life really quite difficult. Together with the non-recognition of PTSD Syndrome which has meant the

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inability for many to resume living in a nonstressful situation in civilian life. They often join the forces as young people and cannot be fully prepared to be involved in and witness many bloody incidents affecting their friends and themselves in action. The Centre in Portsmouth provides support and where necessary arranges treatment for medical conditions and potential drug abuse which can be a consequence of their experiences under fire. There were very many senior military personnel looking resplendent in their uniforms and with their medals and honours on display. A very good support of a worthy cause and a healthy sum of money raised.

DIGITAL TECHNOLOGY

IMPLANT RETAINED FULL ARCHES MADE EASY

UTILISING THE MEDIT T500 LAB SCANNER BLUEPRINT DENTAL UK I LEE MULLINS RDT - THE DENTAL LABORATORY

NACAM® WORKFLOW UTILISING THE DIGITAL PROCESS OF COMPUTER AIDED MANUFACTURE

“The ability to process my frameworks Digitally has allowed me to work smarter, faster and more predictable than before.” www.dentaltechnician.org.uk

here are many approaches to restoring the full arch, whether it be an analogue workflow or a fully digital workflow….with the emphasis on SIMPLIFY, the anaCAM® workflow gives the Dental Technician a combination of these approaches to consider. HANDMADE SKILLS AND DIGITAL TECHNOLOGY IN HARMONY Dipping my toe into Digital Dentistry for all the right reasons with the purchase of my Lab scanner, the Medit T500 from Blueprint Dental has opened the door to a multitude of full arch framework material options…The Medit T500 Lab scanner has completely changed the process for my workflow and although the deed of investing, casting and pressing still has a place in my workflows, the ability to send an STL file of my handmade frames for CAM, can save me time and gives me more predictability when working with some materials. CHEAPER FASTER BETTER Being a high end low volume Laboratory allows me to work the way that suits me, using tried and tested handmade skills and techniques all self taught over the past three decades as a Dental Technician. Digital Dentistry for me is a tool, another piece of equipment that has taken on some of the more labourious tasks in the Lab keeping full control of my designs was key. Finding the right scanner for the job came next. The fact that the Medit T500 comes with the pre installed software ColLab meant that I did not have to purchase any expensive add on design software. The T500 has a module for duplicating dentures “Replica Denture Module” this made my choice of scanner very easy. The accuracy of the scanner is unbelievable. The anaCAM® workflow picks up at second stage, and starts with the supply of verification jigs, custom pick up tray and the clip in clip out tripodised bite rim. Then, working from the Master model the physical try-in is sent out to surgery. Once the try-in is verifed by the patient and Dentist u the information is captured in a set of matrix’s p. 22

DIGITAL TECHNOLOGY

ucontinued from page 21 using the Trasformer Fast Protech system from Panadent UK, which includes a verticulator that captures everything from vertical height, tooth postion and any occlusal adjustments made in surgery, all the information from surgery is locked in to the Trasformer system.

BELOW: Verified try-in, Data captured in Trasformer system, Resverse engineered Resin prototype, Prototype scanned on Medit T500 in replica denture module of ColLab.

Each individual denture tooth is then internally hand prepped and a framework is reverse engineered from the tooth to the implant fixture. The idealised prep and frame for the patients restoration is the result, which in turn makes the design as cleansable and clinical as can be achieved. Once the prototype framework is finalised by hand, we can move on to creating a Digital STL file of the framework. BULLETPROOF - INDIVIDUALLY SUPPORTED SHOCK ABSORBING POLYMER TEETH Using the pre installed software in Replica Denture Module, the Medit T500 scans the framework as a perfect copy with every tiny detail of the handmade and bespoke design of the framework captured. The T500 scans the top of the wax up and then the bottom of the wax up and then meshes the two together to give you a perfect STL file of your wax up with the whole process taking around 6 minutes, and it is this Digital process that saves me time when compared to the analogue routes of investing the framework wax up, burning out and pressing or casting. The file is then sent off to Argen Skillbond where the framework is 3D SLM. Printed in CoCr, with a 3 day turn around service costing approx ÂŁ100 for a ten unit framework.Back in the Lab, the framework is bonded on to the implant abutments inside the Trasformer verticulator which ensures accurate positioning. The individual polymer denture teeth are then too, bonded on to the framework using the Trasformer verticulator to ensure each tooth is in exactly the correct position in line with the verified try in.Next comes the Gingival Composite, VITA VMÂŽLC composite kit. The CoCr is surface treated using the Aquare, which is an Etch and Prime unit that etches the surface of your material to be bonded with a blast of 110 micron blasting medium, at the same time as a jet of 99.9% alcohol which gives the perfect surface to bond to. VITA preopaque and opaque ensure that the gingival composite is retained to the framework for life. The final surface is glazed using VITA Enamic glaze, which gives impervious surface finish.

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Printed SLM CoCr framework with individual teeth and VITA VM®LC Gingival composite bonded together using strict bonding protocols.

DIGITAL TECHNOLOGY

The printed CoCr framework and the polymer teeth are bonded in place acurately inside the Trasformer Verticulator.

“In my opinion, the aesthetic polymer denture tooth is one of the most important developments in dental technology. Along with other Dental Laboratories, I just give them a platform to perform in a cost effective manner.” LEE MULLINS RDT Lee mullins RDT is a Dental Technician of 30 years. He owns a small Laboratory in Leeds UK and specialises in the full arch implant hybrid. Lee is an Official VITA trainer for the UK and has held lectures and workshops domestially and internationally for the past 6 years. The workflows anaCAM® Hybrid, The BDT Technique® and techniques using Pink gingival composite are amongst lee’s areas of expertise. For more information go to leemullinsrdt.com Thanks to Stephen Reid, Smile Time Dental Surgery for the Clinical Images.

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DENTAL NEWS

GLOBAL CLINICAL CASE CONTEST:

DENTSPLY SIRONA HONORS YOUNG DENTAL TALENTS

Every year Dentsply Sirona’s Global Clinical Case Contest (GCCC) honors dental students from around the world who have achieved excellent results in aesthetic dentistry. The three winners of the 14th GCCC presented their successful case studies at the CED-IADR in Madrid where the audience selected its personal winner. CHARLOTTE/KONSTANZ I OCTOBER 8, 2019.

he prospective dentists who have impressed the jury of the Dentsply Sirona Global Clinical Case Contest this year are among the top dental students worldwide. Their work makes their patients smile and gives them new self-confidence. The winners of this year’s Dentsply Sirona Global Clinical Case Contest were announced at the beginning of June in Konstanz, Germany. As a member of the three-person jury, Prof. Rainer Seemann, Vice President Global Clinical Affairs at Dentsply Sirona (Konstanz/Bern), honored the three winners of the final round, which consisted of the 13 best entries. The jury also includes two outside experts. This year they were Prof. Ian Cline (London) and Prof. Gaetano Paolone (Milan). The first prize was awarded to Uwe Walker (University of Tübingen, Germany) for the aesthetic and functional correction of multiple erosive-abrasive tooth defects. Second place went to Yannis Génique (University of Bordeaux, France) for an anterior smile design case, including reshaping a riziform lateral incisor and replacing several aging composite restorations. The third prize went to Mariangela Cernera (University of Naples Federico II, Italy) for her renewal of several large Class II composite restorations in the posterior region. CED-IADR CONGRESS: AUDIENCE VOTING FOR BEST TREATMENT CASE The global winners not only earned special honors, but also the opportunity to present their exemplary treatment outcomes at an international specialist congress. The winners of the GCCC 2018/2019 traveled to Madrid to present their case studies as part of a poster exhibition at the congress of the Continental European Division of the International Association for Dental Research (CED-IADR. At the Dentsply Sirona booth, the audience of renowned specialists decided on a winner via public voting and also chose the work of another participant, namely that of Uwe Walker (University of Tübingen), as the best treatment case in the general voting.

CLOCKWISE FROM TOP LEFT: The three winners of the 14th GCCC and the judges (from left to right): Prof. Ian Cline, Yannis Génique (2nd prize), Prof. Rainer Seemann, Uwe Walker (1st prize), Prof. Gaetano Paolone and Mariangela Cernera (3rd prize); The participants of the global final of 14th GCCC in Konstanz, Germany; The initial situation of the winning case of Uwe Walke; The final situation. The satisfying functional and aesthetic outcome was achieved with a minimally invasive approach using composite resin technology.

MORE THAN 1,200 SUBMISSIONS FROM 140 UNIVERSITIES Dentsply Sirona’s Global Clinical Case Contest (GCCC) has been taking place since 2004/2005. In 2018/2019 alone, Dentsply Sirona received more than 1,200 submissions from a total of 140 universities around the world. Free access to restorative products For direct anterior and posterior restorations, students can use the entire Dentsply Sirona Restorative product line as part of their participation in the GCCC if needed. The competition is aimed at students of dentistry with less than two years of clinical practice. A tutor from their university supports them. The participants document their successful treatment cases in text and images. In the first round of the competition, national or regional winners are chosen. The winners from each country or region then participate in the global final and present their

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cases to a respected international jury that honors the top three participants. “Clinical Affairs plays a key role in connecting our company with top talent globally. Through university collaborations and competitions such as the GCCC, we are bringing together Dentsply Sirona's innovative portfolio of restorative solutions with excellent dentists of the next generation," said Prof. Rainer Seemann. The application phase for the next competition has already begun. The deadline for registration varies from region to region. For further information, or to register for Dentsply Sirona GCCC please contact your local Dentsply Sirona organization. Further information on the Global Clinical Case Contest is available here. Visit www.dentsplysirona.com for more information about Dentsply Sirona and its products.

GERMAN FACHDENTAL AWARD 2019 FOR SAMEDAY DENTISTRY MACHINE VHF WINS FIRST PRIZE FOR THE Z4 l

Ammerbuch/Hauppauge, October 22, 2019: vhf ’s Z4 is still on the road of success by winning this year’s Fachdental Award. The dental milling and grinding machine has received this desired innovation prize of the dental industry, which was awarded for the fifth time at the trade shows Fachdental Leipzig and Fachdental Südwest in Stuttgart, Germany. The Z4 convinced the visitors of the two trade shows: they voted online or on-site to decide which company should receive this seal of quality The competition awards prizes to products that are outstanding in terms of their degree of innovation, offering improvements for patients and work in the practice or laboratory or feature unique design solutions. The Fachdental Award has been presented by Messe Stuttgart since 2015.

The high-precision dental milling machine Z4 combines innovative design with intuitive operation and many automated work steps. Developed for same-day dentistry, it enables patients to receive high-quality restorations much faster. The block material is fixed without tools and can therefore be exchanged in seconds. Thanks to the integrated compressor and Wi-Fi, the machine does not require any supply lines other than a power connection. The Z4 is also validated for all common scanners and CAD software and offers fully integrated workflows. So the users benefit from easy operation with one interface. “We are excited about winning the first place in the Fachdental Award, especially because the trade show visitors decided who was going to be awarded. This is a great reward and a wonderful motivation,” says

Christine McClymont, Head of Marketing and Communications at vhf. Commenting on the award-winning machine, she points out: “The Z4 impresses our users with its superior precision and its openness for materials, scanners and software. I am sure that the Z4 will enable many more users to enter the world of digital dentistry.”

JAMES GREEN CONTINUES TO RAISE AWARENESS OF MDR AT BDIA l

Last week saw prominent UK dental technician James Green give a third invited lecture on the impact that the new Medical Device Regulation (MDR) will have on dental professionals who prescribe or manufacture custom-made devices, such as dentures, crowns, bridges and orthodontic appliances, at the BDIA Dental Showcase in Birmingham. The new regulations have been his main focus since his election as Orthodontic Technicians Association Secretary last year. He has already lectured twice on the topic twice this year – at the Dental Technology Showcase in May and the Dental Professionals Conference in September. James, who is a maxillofacial and dental laboratory manager at Great Ormond Street Hospital for Children, began his presentation by explaining the history of medical device regulation in the UK and the reasons behind the new MDR. He continued by speaking about the current legal obligations under the Medical Devices Directive (MDD), such as

James, who is also the immediate past president of the Dental Technologists Association, addressed delegates at the event’s “Innovation Theatre” where fellow speakers included, Sara Hurley, Chief Dental Officer for England, and Tom Pellereau, a former winner of the BBC television series “The Apprentice.”

ABOVE: James Green speaking at the BDIA Dental Showcase last week RIGHT: James Green (left) pictured with former winner of the BBC television series “The Apprentice, Tom Pellereau.

the requirements of the “patient statement” and how things will change.

There will be another opportunity to see James present his work on this subject at the Northern Dental Summit & Exhibition at the Manchester Central Convention Complex on 22nd November where other big names will include Larry Browne and Andrea Johnson.

He has studied the new regulations extensively and offers a step by step guide to what dental professionals need to do to comply with the MDR. While much of the new regulation does not relate to custommade devices, there are several changes that are relevant such as the need to demonstrate at least two years’ experience in the manufacturing process.

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

4 Hours Verifiable ECPD 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

By completing the Quiz successfully you will have confirmed your ability to understand, retain and reinforce your knowledge related in the chosen articles.

Correct answers from October DT Edition:

ECPD

VERIFIABLE ECPD - NOVEMBER 2019 1. Your details First Name: .............................................. Last Name: ........................................................Title:................ Address:.............................................................................................................................................................. ................................................................................................................................................................................ ............................................................................................................ Postcode:............................................... Telephone: ......................................................Email: .................................................. GDC No:.................. 2. Your answers. Tick the boxes you consider correct. It may be more than one. Question 1

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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 ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN MIKE BOND MARKETING Q1. What percentage of the world population is said to be on social media? A. 45%. B. 15%. C. 37.5% D. 28%. Q2. What percentage of adults in the UK are thought to be reducing their social media use? A. 43%. B. 33%. C. 55%. D. 41%. DENTAL DORIS Q3. What is the third suggestion to stay positive? A. Keep a gratitude journal. B. Don’t acknowledge negative thoughts. C. Pretend all is ok. D. Surround yourself with positive people. WHEN THE MAGIC CATCHES ON Q4. According to the Gerber Principle what overall design dictates the posterior set-up? A. Group function. B. Buccal dis-occlusion. C. Mortar-Pestle Principle of function. D. Disocclusion of rear molars. Q5. A. B. C. D.

According to Gerber principles which buccal cusps must be out of occlusion? 17 47 & 27 37. 15 45 & 25 35 16 46 & 26 36. 13 43 & 23 43.

Q9. What was the reported number of missing teeth in 55- 64year olds? A. 11. B. 18. C. 13. D. 9. Q10. What percentage of the tested group were male? A. 56%. B. 47%. C. 39%. D. 55%. Q11. How many Post and Cores were made in the two week period? A. 32. B. 18. C. 23. D. 16. Q12. How many cases were finished with shortened dentitions? A. 18. B. 24. C. 15. D. 19. JAMES GREEN LECTURE ON THE CHANGES TO THE MDD Q13. How much is required as a minimum of experience to undertake construction of a custom-made device? A. None. B. Four years. C. Two years. D. Seven Years.

HANDMADE SKILLS & DIGITAL TECHNOLOGY IN HARMONY Q14. How is the confirmed Try-in re-captured for processing? A. It is returned to the lab. Q6. How many scans are indicated for metal frame manufacture? B. Using a Transformer Fast Protech System. A. Three scans. C. By scans and an STL file. B. One scan per abutment tooth. D. Using a duplicate denture technique. C. One scan per scan body. D. Two scans per Implant. Q15. How is the metal framework constructed? A. By scan reproduction of the tooth space and transfer via Q7. What material is used to condition the teeth? an STL File A. Monomer. B. By conventional wax up. B. Poly carboxylate. C. By casting the plastic Proforma. C. Silane. D. By Third party via scans. D. Epoxy Resin. Q16. What is the material used to prepare the metal surface for DENTAL LABORATORY PRODUCTION IN SOFIA STUDY composite application? Q8. How many laboratories were involved in the study? A. Composite Opaque material. A. Seven. B. Etched surface with 250 Micron blasting material. B. Fourteen. C. 110micron etch with a 99,9% alcohol jet spray using a C. Twelve. special unit. D. Five. D. Hand roughened metal surface treatment.

You can submit your answers in the following ways: 1. Via email: cpd@dentaltechnician.org.uk 2. By post to: THE DENTAL TECHNICIAN LIMITED, PO BOX 430, LEATHERHEAD KT22 2HT You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE TRYCARE: MONOTRAC MODEL DIE AND ARTICULATOR SYSTEM No more glue, pins or model trimming! w Trycare, the UK’s fastest growing dental dealer, offer an extensive range of Laboratory problem solvers including the Monotrac “cast in place” model die and articulator system, which is available in either the original vps or new V2 options. Dental laboratories face constant changes in technology and increasing competition. Finding and implementing practical tools for efficiency, accuracy and simplicity enabling laboratories to stay competitive and cost effective can be especially tricky when investing in new technology or change. When it comes to model, die and articulation “cost effective, efficient and accurate” are the essence of Monotrac offering more capability, options, accuracy and efficiency than any other model system out there. The integrated articulator, with pinless cone matrix model base, allows a single pour “cast-in-place” set-up that is simple and fast while eliminating labour intensive pinning and basing procedures. Monotrac is a disposable articulator and die making system that can be used for a variety of precision die making procedures –

ZIRKONZAHNOPEN SYSTEM IS OPEN!

triple tray to full arch multiple units, with or without articulation. Quick and easy to set up, Monotrac enables Technicians to produce precision die models without the need for glue or pins, model trimming or a second model. Monotrac dies are easily removed and reseat with solid stable precision. Even lower anteriors, the thinnest of dies, resist lateral sway. Other key features of Monotrac are the flex arm hinge, allowing natural excursive equilibration, and plug-in adjustable vertical stops which are easy to place and eliminate the need for a metal articulator set up.

w In its homeland nestled in the Italian Alps, Zirkonzahn develops and produces - under nearly one roof - CAD/CAM systems, dental materials, elaboration instruments and over 100 implant prosthetic components. What’s more? Zirkonzahn CAD/CAM systems, including the Face Hunter 3D facial scanner, are designed to generate and process open data files (e.g. STL, OBJ). The data are generally compatible with all open CAD software, milling units or 3D printers. Similarly, open scan and design data from other manufacturers can be processed with Zirkonzahn software and milling units. Freedom and flexibility are important aspects to consider. Zirkonzahn’s workflow is therefore crafted to alternate seamlessly between analog and digital. With a workflow permitting seamless transition between digital and analog, Zirkonzahn offers a flexible and complete solution for the fabrication of exceptional dental restorations. By producing almost everything at its manufacturing sites - never surrendering control to others - the family-owned company perfectly calibrates each workflow component to the

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The Monotrac V2 is a full range capable articulator system for all model and die needs in the laboratory. One system which covers it all from refractory to sectional implant models to full arch, it can do it all. Because Monotrac V2 does not require stone basing, cross arch and linear secondary base expansion issues are non-existent. The new Monotrac V2 range is available in an Introductory Kit containing 16 Straight Quad Bases, 4 Radius Quad Bases, 4 Anterior Bases, 2 Full Arch Bases, 13 sets of hinges, 6 stop screws, 12 vertical stops and instructions for just £ 38.50 plus vat. All of these individual components are available separately in refill packs. Whilst the original Monotrac vsp range is also available in an Introductory Pack containing 10 disposable articulators, two full arch vsps, four quadrant vsps, two full arch base moulds, four straight base moulds, a mono clamp, one P20 vertical centric stop, silicone separating spray, a cleaning brush and a training video for just £ 38.50 plus vat. All of these individual components are available separately in refill packs. For more information about Monotrac please contact your local Trycare Representative, call 01274 885544 or visit www.trycare.co.uk

next: Zirkonzahn’s first aim is to provide laboratories a symbiotic ecosystem of innovative hardware, software, restorative materials and implant prosthetic components. This ensures a 100% smooth work process for technicians and clinicians - from patient data acquisition, articulation, virtual design and milling to placing the restoration in the patient’s mouth. For the skeptical or curious readers, it is important to note that, along with data formats, Zirkonzahn’s doors are always open: the South-Tyrolean firm is glad to welcome eager-to-learn dental technicians and dentists to their manufacturing sites, headquarters, dental lab and education centers in the heart of the Alps.

REMEMBER: ZIRKONZAHNOPEN SYSTEM IS OPEN! For more information about open CAD/CAM systems and upcoming events in the Alps: E: carmen.ausserhofer@zirkonzahn.com T: +39 0474 066 662 W: www.zirkonzahn.com

COMPANY NEWS

THE DENTAL TECHNICIAN MARKETPLACE

PINK THE GUM

by German Bär

SHOFU DENTAL GmbH www.shofu.de

PinkTheGum_2S_D+E+IT_297x210.indd 1

24.09.19 16:29

Applying CRB 2, leave for 10 sec, light-curing for 3 min

Applying the whitish parts of the attached gingiva with Ceramage UP ODA1 and a brush

Creating the red blood vessels of the mucosa with Lite Art R (Red)

Creating the blue blood vessels of the mucosa with Lite Art Bl-G (Blue Gray)

Applying Ceramage UP GUM-T

Sculpting and covering the vessels of the mucosa with a flat brush, light-curing for 60 sec

Applying Ceramage GUM-D to the areas between the alveoli and to the interdental papillae

Anatomically presculpting the areas between the alveoli with a flat brush

Anatomically presculpting the interdental papillae with a flat brush

Applying Ceramage GUM-Or to the attached gingiva

Anatomically presculpting the attached gingiva with a flat brush

Applying Ceramage GUM-D to the mucogingival junction

Presculpting the material with a flat brush, blending into the mucosa

Applying the free gingiva with Ceramage GUM-L

Anatomically presculpting the free gingiva with a flat brush

Applying Ceramage GUM-T

Anatomically presculpting the mucogingival junction with a flat brush

Final sculpting and completion with Ceramage GUM-T and a flat brush, light-curing for 60 sec

Applying Oxy-Barrier prior to final polymerisation, then final light-curing for 3 min

Finishing with Dura-Green

Prepolishing with SoftCut

Polishing with Dura-Polish

High-gloss polishing with Dura-Polish DIA

PinkTheGum_2S_D+E+IT_297x210.indd 2

279702 · 09/2019

Applying CRB 1 to a framework sandblasted with 50 µm Al2O3 at 2 bar, leave for 10 sec

24.09.19 16:30

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PINK THE GUM

”The aesthetic quality of prosthetic restorations critically depends on lifelike gingival reconstruction. The combination of Ceramage and Ceramage UP GUM composites with Lite Art stains allows dental technicians to easily, efficiently and reproducibly create the illusion of natural gums with all their characteristic features.“ MDT German Bär, St. Augustin / Germany

Proven high-quality microhybrid composites and stains Different viscosities for selective reconstruction of all gingival zones Excellent sculptability and easy shaping of fine details Very high polishability and surface density Plaque resistance and shade stability Suitable for almost all indications in partial and complete denture prosthetics

Supplied by

www.shofu.co.uk

“

Looking through old Dental Technician magazines, I note in June 1952, under the heading “Ministry Viewpoint” sub heading - “Entry into craft is a trade union affair”. The article continues with: “A deputation formed by representatives from the three official organisations representing dental technicians was received by permanent civil servants of the Ministry of Health towards the latter end of April.” I find the whole article interesting, but a couple of paragraphs catch my attention;“The deputation fought hard for the inclusion of the Registration of Dental Technicians, but they were repeatedly told that the entry into the craft of dental technicians is viewed by the Minister of Health as a trade union problem.” also “The Chairman said that it was understood that some dental technicians were seeking the right as dental technicians to practice direct to the public as far as the provision of dentures are concerned.” “The Minister and the Department would resist this. The Ministry was not of the opinion that this would be a suitable measure to include in the new Dentists’ Bill.” As an apprentice dental technician at Eastman Dental Hospital at the date of the above article, I remember how senior technicians would often talk about how the ‘craft’ should progress towards better recognition as a ‘profession’. I remember it being mentioned, that one way was to obtain by application, membership of the Institute of British Surgical Technicians, and years later, finding no evidence of there ever to be state registration of dental technicians, I applied for and became LIBST, only to give up membership a few years later. The point I am making, is that of the many dental technicians I have known, and never before the date of the 1984 Dentist’s Act, have I ever heard it mentioned or expected, that registration would result in dental technicians having to have a PDP and also having to provide evidence of ECPD.

INSIGHT

LETTERS to the Editor When I was employed at EDH, I found there was always plenty of time to produce work, I would spend all morning, first transferring a facebow to Dentatus articulator and then setting up full/full in balanced occlusion, continuing into the afternoon with wax-up to try-in stage, complete with contouring, festooning, and final spot and carborundum grinding on tooth surfaces. I was also allowed day release to attend the Borough Polytechnic without any deduction of wages. So I would guess that today’s hospital technicians, will have no problem finding the time to attend and obtain verifiable ECPD evidence?

were allowed to become registered dentists. So I would argue there is a distinction between barber/dentists in 1926, and dental technicians in 1984. We technicians had the City and Guilds courses in Dental Technology since about 1940 and thousands of us achieved certificates before the 1984 Dentists Act. In my view, we are entitled to the job description of (non clinical) ‘dental technician’ by qualification, no matter what the GDC rule.

It’s different story for a self-employed manufacturing (non-clinical) dental technician. The work comes in and needs to be completed by appointments already made by the dentist. So taking time off for ECPD must first be a nuisance to the technician and also a considerable loss of earnings. More than that, most technicians I have known, have always striven (without being required), to keep up to date with new techniques. It also makes good business sense to be able to provide dentist clients with the latest development in dental appliances, crown and bridgework etc.

Given a job in a dental laboratory, I would not be an ancillary worker, and it would not be a trade union problem. It would just be that I was not a ‘state registered dental technician’.

I may be over 80years, never ever GDC-DCP registered, and do not have a BTEC, but I cannot see why I shouldn’t now be allowed to take a sedentary job in a dental laboratory without an employer risking sanctions or risk being removed from the GDC-DCP register for employing someone not GDC registered as dental care professional. At the time of the 1926 Dentists Act, those who had for several years been barber/ dentist’s with no paper qualifications at all,

Let’s face it, we just manufacture to the order of a dentist and do not see the public at all.

So, how do readers feel about some of the learning aims, e.g., ‘A’ - ‘communication skills’ and ‘C’-‘radiography’, as found in the ECPD template for (non-clinical) dental technicians WHERE ARE THEY NOW? “The RADC new recruits celebrating and relaxing after basic training 1955 Tournay Barracks, North Camp, Aldershot. Searching on the internet there is hardly anything or photos about the RADC and Tournay Barracks, demolished about 1958. During National Service we had the old barracks as living quarters and training was in what appeared to be an old hospital ward, said at the time to have been many years before, a VD hospital!! If readers could produce more photos of Tournay Barracks, then it should add to and promote the history of dental technicians in the RADC during the Cold War period.”

James Bennett

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