Australasian Dental Practice Jul/Aug 2021

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Organised by Dentevents™ a division™of Main Street Publishing Pty Ltd ABN 74 065 490 655

Organised by Dentevents

a division of Main Street Publishing Pty Ltd ABN 74 065 490 655

www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

www.dentevents.com • info@dentist.com.au • Tel: (02) 9929 1900 • Fax: (02) 9929 1999

www.dentaltechnology.com.au www.dentaltechnology.com.au

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VOLUME 32 | NUMBER 4 JULY/AUGUST 2021

contents | REGULARS

On the cover...

Kerr’s new SimpliShade™ Universal Composite uses just three shades to match all 16 VITA® Classical shades resulting in quicker shade-matching and less patient time in the chair.

management

briefs 8 10 one man’s opinion 12 in my practice 14 mouth wide shut 16 spectrum 54 CPD centre 56 abstracts 58 the cutting edge 154 new products

some dentists dramatically 64 Why outperform their peers financially: Pitfalls in the business of dental practice

guilty of killing your own practice 68 Arein thisyouway? unappreciated virtues of a 70 The blue-collar practice 5 questions your patient should 72 NOT be asking you

marketing

74 The worst article I ever wrote...

READ ME FOR

CPD

facebook.com/dentalpracticenow

finance

76 The benefits of good financial hygiene

twitter.com/adpmagazine

instagram.com/dentevents

www.dentalpractice.com.au

Publisher & Editor: Joseph Allbeury Clinical Editor: Dr David Roessler Technology Editor: Prof. Laurence J. Walsh Infection Control Editor: Prof. Laurence J. Walsh Senior Contributing Editor: Dr Christopher CK Ho Columnists: Dr Georges Fast, Dr Paul Coceancig, Gary Pammer, Phillip Win, Dr David Moffet, Graham Middleton, Simon Palmer, Julie Parker, Jayne Bandy, Angus Pryor Design & Production: Jasper Communications Australasian Dental Practice™ ISSN 1445-5269 is printed in Australia and published six times per year by Main Street Publishing Pty Limited ABN 74 065 490 655 PO Box 586, Cammeray NSW 2062 Tel: (02) 9929-1900 Fax: (02) 9929-1999 Email: info@dentist.com.au

© 2021 All rights reserved. The contents of this magazine are copyright and must not be reproduced without the written permission of the publisher. Permission to reprint may be obtained upon application. Correspondence and manuscripts for publication are welcome. Although all care is taken, the editor and publisher will not accept responsibility for the opinions expressed by contributors to this magazine, or for loss or damage to material submitted for publication.

Subscriptions: Australia and NZ: A$99.00 per year includes OralHygiene™ and eLABORATE™ magazines; Overseas Airmail: A$220.00 per year.

July/August 2021

Australasian Dental Practice

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contents | FEATURES

VOLUME 32 | NUMBER 4 JULY/AUGUST 2021

infection control

clinical excellence 80

116

5 new instruments designed to enhance the adaptability of clear aligners

092 Straumann Pro Arch concept with fully 096 guided implant and abutment placement Replacement of a central incisor using the 104 socket-shield technique and digital workflow ®

Washer disinfectors for dental practice - what does the evidence say?

80 Key things to know about 88 sterilisation pouches?

READ ME FOR

CPD

124

READ ME FOR

CPD

surgery design 140

140 Excellence in dental practice design

148 Purpose-built surgery delivers to the max

110 The digital scan appliance - Mark II Non-invasive microveneer restoration 116 made of the hybrid ceramic VITA ENAMIC Augmentation of width of keratinised tissue 122 around prosthetic restoration Precise prosthetic planning and 124 implant placement: Treatment of a complex full-arch case using guided surgery and immediate loading

134 Bone regeneration with EthOss Vital pulp therapy of a dens evaginatus 136 using Biodentine ®

™

July/August 2021

Australasian Dental Practice

7

briefs | NEWS Stuff...

I

hope that everyone is looking after themselves, physically and mentally, as we continue to endure this particularly stressful and challenging

By Joseph Allbeury period. If you think it sucks, you’re 100% right; if you think it will never end, then I can assure you it definitely will and maybe you should talk that through with a friend, colleague or a counselling service if you’re stressed. Better days are ahead... it is just a matter of when. And when will not be too far away now.

With New South Wales locked down until at least the end of September, we have been forced to move the Digital Dentistry and Dental Technology event to June 3-4, 2022, again at the Novotel Sydney Brighton Beach. The need to move this event is always preceded with tremendous anxiety for me; so much work is involved in organising large scale events and there are so many people involved, it is a very emotional exercise to have to unravel it. We remain committed to staging a fantastic face-to-face event and we hope that with the prospect of overseas travel opening up next year, that we can even welcome some international speakers onto the program. Thank you to everyone who remains registered for the event, thank you to all our amazing speakers and thank you to all of our sponsors and industry partners who are instrumental in the success of the event.

On a more positive note, the investments we continue to make in projects on the internet are being used by the dental profession more and more. The video streaming service we launched a year ago at www.dentevents.tv is continually being expanded with more content and dental professionals are enjoying watching the variety of material available free and on-demand. Our goal for this site has always been to allow the dental profession to share their own videos easily and we have now launched a facility where you can upload your own videos for streaming on Dentevents.TV. Any videos related to dentistry - from humour and opinion, to product reviews, marketing and practice management info to clinical and technical videos - are welcome. Anyone can now login and load their videos with ease. See page 16 for more information.

Our find-a-dentist websites at www.dentist.com.au and www.dentist.co.nz are also enjoying increased visitor numbers from the public looking for dental practices and denture clinics, so please search for yourself on the websites and if your details are missing or incorrect, please go to the new form at dentist.com.au/information-for-dentists and let us know all the correct details.

We also have a new Express Listing facility for events on the Dentevents.com calendar (see page 16). If you’re organising webinars or face-to-face events, you can now submit the information for publishing on the calendar in a minute or two and immediately increase awareness of your event.

I’m looking forward to seeing the last of these lockdowns and getting back to normal (version 2022). Stay safe!

Joseph Allbeury, Editor and Publisher

8 Australasian Dental Practice

NEW BOOK: 6 Ways to Design a Face

Ways to Design a Face: Corrective Jaw Surgery to Optimize Bite, Airway, and Facial Balance written

by Australia’s own Dr Paul Coceancig and published by Quintessence is available now.In this innovative and paradigmbusting book, the author asserts that almost all bad bites have their origin in a small mandible, what he calls anterior mandibular hypoplasia, or AMHypo and further claims that surgical management is the only means to correct it. AMHypo arises because of a small anterior tongue and it leads to dewlap (poor chin-neck contour), dental crowding, impacted third molars, a range of dental malocclusions and retroglossal tongue displacement into the upper airway. Traditional orthodontics often camouflage the small jaw by extracting “extra” teeth that don’t fit and controlling growth with various appliances, effectively leaving the patient in the same medical predicament

6

they were in before having their teeth straightened and their occlusion fixed. After all, for every patient with a bad bite, there are three combined, interwoven, inseparable treatment considerations: occlusion, airway, face. In this book, the author outlines the anthropologic underpinnings of the small jaw and then outlines his six surgical methods of designing the face to optimise bite, airway and facial balance: IMDO, GenioPaully, custom BIMAX, SuperBIMAX, custom PEEK implants and SARME. IMDO, or intermolar mandibular distraction osteogenesis, is surgically less invasive than third molar surgery that can expand the mandible by as much as 16.5 mm and effectively bring the tongue forward to eliminate the potential for airway issues down the line, not to mention improve the patient’s profile dramatically. The surgeries and protocols in this book will have you rethinking your approach to patient care and asking yourself how you can better care for your patient now AND in the future. The author sees no reason why we should not expect to carry all 32 of our teeth for our adult lifetime in a Class I occlusion and free of crowding or impactions or airway collapse. Do you dare to join him? Available online.

July/August 2021

Zita@posortho.net

Progressive Orthodontic Seminars - Australia

@posortho_aus

www.posortho.com

+61 2 9899 9191 or 1800 333 266

spectrum | NEWS Online Resources for the Dental Profession...

One man’s opinion...

I

By Georges Fast

www.dentalcommunity.com.au • Update your personal details • Update your practice on dentist.com.au • Manage your subscriptions • Read 13,500 articles from past magazines • Log your CPD points • Answer CPD Questionnaires • Run your own dental events • Create online discussions • And more...

www.dentevents.com

• Dental education calendar • Register for all popular dental events

www.dentevents.tv

• Watch all the latest videos about dentistry

www.dentist.com.au • Find-a-dentist in Australia

www.dentist.co.nz

• Find-a-dentist in New Zealand

www.dentalpractice.com.au • Australasian Dental Practice™ online

www.oralhygiene.com.au • Oral Hygiene™ magazine online

www.elaborate.com.au

• eLABORATE™ magazine online

Sign up now. It’s Free.

10 Australasian Dental Practice

“Graduate dentists are being paid a lower hourly rate than many senior dental assistants! It is only a matter of time before they abandon dentistry...”

t is 22 years since the editor asked me whether I would be willing to write an occasional opinion piece for this journal. One hundred and twenty opinions later, I thought I’d better scan through some of the things that I’d written in the past. Firstly, to make sure that I’m not repeating myself and secondly, to see if there were any recurring themes over that period.

Of the things that immediately stood out, one was my unyielding belief that the public is best served by independent dental practitioners whose primary aim is to protect the dental health of their patients and ensure that their patients retain a functioning dentition for the whole of their lives.

There is no reason why this altruistic pursuit of a professional ideal cannot coexist with an appropriate financial reward for the dentist.

The other issue that I‘ve always believed to be crucial is that all dental treatment must be the result of common sense, based on proven scientific prin“The reality at the ciples and independent of currently start of the third decade prevailing fashion trends promoted by of the 21st Century is that paid “influencers”.

We are unique amongst the health the provision of dental professions in that we leave a trail services has become because in the majority of cases, we’re dealing with the only part of the body progressively more costly, that doesn’t self-repair. We have a profit margins in dental responsibility to ensure that any treatpractices are shrinking, ment doesn’t compromise its longevity or function - soft tissues can heal, teeth bureaucracy is imposing cannot! Any intervention aimed solely at an ever-increasing burden modifying appearance to conform with and if this trend continues, currently promoted trends which in any way compromises function or longevity quality dental treatment is immoral and unethical. will become a privilege The reality at the start of the third of the wealthy...” decade of the 21st Century is that the provision of dental services has become progressively more costly, profit margins in dental practices are shrinking, bureaucracy is imposing an ever-increasing burden and if this trend continues, quality dental treatment will become a privilege of the wealthy. We’re already witnessing the proliferation of commercially run high volume dental practices where economies of scale are achieved by removing any personal link between practitioner and patient, where the patient is allocated to the next available dentist similar to the operation of checkout counters in a supermarket. Where there is pressure to upsell additional treatment, be it bleaching, snore appliances or tooth aligners regardless of whether they are needed or appropriate.

If future dentists by and large see themselves as employees in a public facility or in corporate practices, they will start to question the value of a dental degree and the personal financial debt that they will need to incur to achieve that degree. We already have a situation where graduate dentists are being paid a lower hourly rate than many senior dental assistants! In the real world, the brightest and the best generally follow the money, it is only a matter of time before they abandon dentistry.

July/August 2021

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spectrum | NEWS

In my practice...

By Christopher Ho

T

“The thin plastic anatomical strip is tapered from one end to the other, meaning that there is a band height for virtually every anterior restoration. You can place the strip interproximally and then slide it until the tooth height is perfectly matched...”

his issue we look into some products and equipment that I use in practice. We look at some recently released new products and elaborate on how their use can be applied in practice. Investing in the right armamentarium allows clinical practice to be simpler and more enjoyable for the wet-fingered dentist and hopefully, this column provides the reader with some of the latest “tools of the trade”.

to zirconia restorations and it contains a silane coupling agent which guarantees strong adhesion to all glass (SiO2)-based ceramic materials. The use of this system allows the use of one bottle rather than having separate silane and zirconia primers.

It does not require any mixing of materials and the primer should be applied to a properly prepared ceramic surface and then dried with air.

Blue View™ VariStrip™ (Garrison Dental Solutions)

OpalDam (Ultradent)

palDam is a light-cured resin barrier. This is a passively adhesive (sealing) methacrylate-based resin barrier used for isolating tissue adjacent to teeth being whitened and for providing extra protection with rubber dam especially when a tight seal has not been attained. For single-tooth whitening, it may be used to protect adjacent teeth. OpalDam resin barrier is light reflecting to minimise heat and tissue sensitivity during curing. It protects soft tissue with an impervious seal and is removed easily. The author also uses OpalDam to hold down restorative matrices, PTFE tape and even can be used with a microbrush to hold indirect restorations as a temporary holder with the resin adapted to the tufts of a microbrush and the indirect restoration.

O

Clearfil Ceramic Primer Plus (Kuraray) learfil Ceramic Primer Plus is a single-component adhesive primer used to enhance the bond strength between resin-based materials, as well as porcelain, composite, hybrid ceramics, metal oxide (zirconia) and lithium disilicate. The product will also adhere to base metal surfaces. In cases where the use of precious metal restorations are used such as gold, the use of an alloy primer should be used. Clearfil Ceramic Primer Plus contains the adhesive monomer MDP for bonding

C

12 Australasian Dental Practice

ecently, I was shown the Blue View™ VariStrip™ which is a contoured anterior matrix that provides the optimum curvature and band height for virtually every anterior restoration. Sometimes the tooth height of the restoration is short, while other times the tooth height is longer and the 0.0020” thin plastic anatomical strip is tapered from one end to the other, meaning that there is a band height for virtually every anterior restoration. You can place the strip interproximally and then slide it until the tooth height is perfectly matched.

The matrix is also curved meaning that the pre-contouring easily recreates the occluso-gingival anatomy, avoiding flat embrasures. It is also provided with a blue tint provides contrast between matrix and tooth structure without compromising composite polymerisation.

R

About the author Dr Christopher Ho is a Specialist Prosthodontist in Sydney.

He graduated with First Class Honours from the University of Sydney and has completed postgraduate qualifications in Oral Implants as well as a Masters of Clinical Dentistry in Prosthodontics from the University of London. He completed his Doctorate in Clinical Dentistry in Prosthodontics at the University of Sydney. He is a Faculty member of GIDE, a Visiting Lecturer at Kings College London and the editor of the Wiley-Blackwell textbook “Practical Procedures in Aesthetic Dentistry”.

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spectrum | NEWS

Going the “SLOW” way is not always the wise way

I

By David Moffet

“In 1996, I was producing double what the average dentist was producing and I was at peace with the world, until I met a dentist who was doing double what I was doing! And all of a sudden I needed to know more. Because my POINT OF REFERENCE had been shattered by reality...

live 130km outside of Sydney. The drive to Sydney is mostly motorway. Sometimes when I drive this trip, I will see a car travelling in the outside lane that is not meant to be IN the outside lane.

You know what I mean, they’re driving too slowly to be in the overtaking lane.

Aren’t these types of drivers annoying?

Sure, they get to their destination EVENTUALLY, but along the way they waste so much time and cause significant disruption to other drivers in a process that should be very simple.

But is “SLOW” always the best way to go?

Many years ago in the Mt Panorama Bathurst Motor Race, an entry was received from a standard Volvo street car... it was a nightmare for all the supercars as they had to negotiate their way past this annoyingly SLOW car that entered the race just to “prove a point”...

Going the “SLOW” way is not always the wise way...

Taking it slow is not always smart.

If you needed to travel from New York to LA, would you do it by plane, or by car? Or by horseback? Or by bicycle?

The guy on the bicycle thinks that he’s making good progress, until a car goes whizzing past him...

And the guy who flew, well he’s down at Long Beach sipping Mai Tais and watching the sunset...

There’s a couple of important lessons here: The first lesson is that if a long journey is going to take a longer time or a shorter time to complete, most people, given the choice, will want to complete the journey over the shorter time so that they can then spend the time saved DOING SOMETHING ELSE. The second lesson is this: It makes sense to think “Bigger Picture” most of the time about things.

This includes asking the question: “Is there a better way?”

And if there is a better way, why am I NOT DOING things in a better way?

Because results are only “relative”...

You will always win the GOLD MEDAL when you’re competing in a competition of only one. It is only when we have a point of reference that we can truly gauge our performance.

Way back in 1992, my dental practice was producing and collecting double what the average dental practice was producing and I thought that was pretty good.

And in 1996, I was still producing double what the average dentist was producing and I was at peace with the world, until I met a dentist who was doing double what I was doing!

And all of a sudden I needed to know more.

Because my POINT OF REFERENCE had been shattered by reality!

14 Australasian Dental Practice

Over the following fifteen years from 1996 to 2011, I increased the collections at my dental practice by a multiple of 8.5X, because each and every year I sought out for myself an answer to this question: There must be a better way...”

Recently I spoke to a dentist who told me that his practice was adding sixty thousand dollars each year to its annual collections and he thought that this was OK...

So I asked him this: “If I could show you a way to add one hundred and twenty thousand dollars or more each year to your annual collections, would that be worth looking at?”

Because results and improvements without a comparison are irrelevantly not relative to anything...

And funnily enough… we live in a land where the population are geared to drive miles out of their way to buy cheaper petrol for their car and save a few cents per tankful...

And yet some dentists happily concede hundreds of thousands of dollars each year to insurance companies setting the fees they can charge, just to be “in a network” or to be “preferred providers”, just so they can be busy and not be profitable...

Hundreds of thousands of dollars each year!

Here are the real numbers: In any population, 20-25% of the population will do business with you and not be concerned how much your competitors are charging because they are more than happy with the service you provide and consider it to be a fair price for what you charge them.

20-25%.

According to the Pareto Principle, these same clients will provide you with 80% or more of your income.

Your aim as a business owner should be to look after these 20-25% of your clients and encourage them to visit more often and refer to your business more often.

You cannot fail in dentistry by building a dental practice that caters for and panders to the wants and the needs of this very specific 20-25% of the population.

Trying to work out [on your own] how to do this in your dental practice is serious SLOW LANE mentality, that will fail.

The ship will have sailed by the time you work it out.

There is a FAST LANE APPROACH...

Good advice is worth paying for. It’s worth paying for over and over and over. Paying for good advice gets you to your destination far more quickly.

And its only then, while you’re sipping on that third Mai Tai, that you realise the benefits of your wise choices.

And not the regrets...

Dr David Moffet is a dentist and a #1 Amazon Bestselling author. He can be contacted at david@theUPE.com or visit www.theUltimatePatientExperience.com.

July/August 2021

See more, do more. Right in your own practice.

CS 8200 3D Family Extended capabilities in a small package Now, see more of what’s beneath the surface with expanded views.

The CS 8200 3D Family covers a broader range of indications with two new FOVs so you can see more and do more – right in your practice. ✓ Extended field of view – up to 12cm x 10cm – best for full arch scans ✓ High-resolution 3D images with limited artifacts and noise ✓ Crystal clear 2D panoramic and cephalometric images

“You don’t know how important a 3D system is to your practice until you have it.”

✓ Powered by CS Imaging Version 8 software

Dr David Goteiner, DDS

CS 2200

CS 1500

CS 7600

Quick, simple and safe

Be more accurate in your diagnoses

Superior workflow

The CS 2200 maximises your diagnostic abilities and improves your workflow with its intuitive and user-friendly design.

Get the visual evidence you need to educate patients and make more accurate diagnoses with the CS 1500—the intraoral camera designed to deliver precise, trueto-life images with each and every shot.

Learn more at ivde.com.au Ivoclar Vivadent Pty Ltd Freephone: 1300 IVOCLAR (486 252) Email: orders.au@ivoclarvivadent.com

With its fully automated and secured x-ray workflow, the CS 7600 provides the essential elements you need to generate outstanding images.

spectrum | NEWS

Simplified universal composite for a simplified restoraive workflow

K

err’s new SimpliShade™ Universal Composite is designed to streamline your restoration workflow and inventory management, without compromising strength or aesthetics. Featuring just three shades (Light, Medium and Dark), SimpliShade makes it quick and easy to match all 16 VITA® Classical shades - resulting in quicker shade-matching and less patient time in the chair. With less product to stock, re-order and track, SimpliShade allows doctors to focus on caring for patients instead of managing inventory. This added simplicity comes with superior strength, lifelike aesthetics and long-lasting performance. With SimpliShade, beautifully strong restorations are easier than ever. Features include:

Simplified shade-matching impliShade matches all 16 VITA classical shades with just 3 shades: Light, Medium, Dark. A Bleach White and Universal Opaque complete the range for all indications.

S

SimpliShade™

Competitor A

Adaptive Response Technology (ART) he ART filler network, a proven technology found in Kerr’s Harmonize® composite, helps you achieve lifelike restorations with exceptional strength and unmatched aesthetics.

T

Streamline inventory management ave time and money with minimal shades to meet almost all your composite needs. Declutter your shelves, avoid the burden of re-ordering too many different part numbers and reduce or eliminate wastage from expired products.

S

Universal for all cavity classes

U

se SimpliShade with confidence in all cavity classes without the need for a blocker.

Competitor B SimpliShade™

Radiograph of a Class II restoration. showing the excellent radiopacity of SimpliShade. The more radiopaque, the easier it is to distinguish the restoration from the tooth structure in an x-ray. SimpliShade at 300% Al is almost twice as radiopaque as a leading universal composite, Competitor A (study completed at the University of Alabama).

Radiograph taken from a human tooth with a Class II restoration.2

16 Australasian Dental Practice

Competitor A

Competitor B

Optimal Translucency: SimpliShade provides ideal opacity to mimic tooth structure, to better mask underlying tooth stains and blend well with surrounding dentition, resulting in a more lifelike restoration.

July/August 2021

VITA Shade Guide Equivalent

LIGHT

A1, B1, B2, C1, D2

MEDIUM

A2, A3, C2, D3, D4

DA R K

SimpliShade Before & After

A3.5, A4, B3, B4, C3, C4

Case images courtesy of Dr Matthew Miller

SimpliShade Light. Case images courtesy of Dr Scott Coleman

SimpliShade Light. Case images courtesy of Dr Scott Coleman

SimpliShade Medium. Case images courtesy of Dr Bruce J LeBlanc

SimpliShade Light. Case images courtesy of Dr Bruce J LeBlanc

CA

SS

Light

CA

SS

CA

Medium

SS

Dark

Better blending: SimpliShade has an enhanced chameleon effect for better blending compared to Competitor A used with a blocker.

July/August 2021

CA – Competitor A with Blocker

SS - SimpliShade™

Australasian Dental Practice

17

spectrum | NEWS

SimpliShade conquers shade selection, saves time, reduces waste

By Dr Aodhan Docherty

Figures 1-2. Before and after showing edgebonding to address wear/tear and outline form (SimpliShade Light).

Figures 3-4. Before and after showing composite resin veneers for poorly shaped incisors (SimpliShade Light).

Figures 5-6. Before and after showing addition of composite resin to address broken front teeth (SimpliShade Medium).

A

s a practice owner and dentist who loves restorative and cosmetic dentistry, there are some major challenges I face day to day.

Shade selection is one of the most common problems that my associate dentists come to me and ask for help with. Many practices often have a fishing tackle box filled with different types of composites, enamel shades, body shades, dentine shades and effect enamels.

We all know that sometimes having too much choice can over complicate things. Secondly, many dentists do not have the technical knowledge on how to perform difficult layering techniques and often we do not have the time to do these in clinical practice.

18 Australasian Dental Practice

From a business perspective having to hold too much stock is not feasible or practical for most. There are many times where composite shades are purchased and then wasted and go out of date, costing the practice needlessly.

Kerr’s new SimpliShade™ universal composite has helped us address these challenges. By simplifying the shade selection right down to 3 choices, there is far less guess work and less time wasted. There is also no need to perform complex layering techniques, however you still have the option to cut back incisal edges and place Harmonize shades or effect enamel. Reducing the inventory/stock is also a major advantage and a big cost saver to the practice overheads.

July/August 2021

LIGHT

A1, B1, B2, C1, D2

MEDIUM

A2, A3, C2, D3, D4

DA R K

Restoratives

A3.5, A4, B3, B4, C3, C4

Restoratives

Case images courtesy of Dr. Matthew Miller

Ordering Information 37001

Syringe, Light

37006

Unidose 20 Pack, Light

37002

Syringe, Medium

37007

Unidose 20 Pack, Medium

37003

Syringe, Dark

37008

Unidose 10 Pack, Dark

37004

Syringe, Bleach White

37009

Unidose 10 Pack, Bleach White

37005

Syringe, Universal Opaque

37010

Unidose 10 Pack, Universal Opaque

SimpliShade

™

Simplified Universal Composite System

SimpliShade™

Simplified Universal Composite System

Contact your local Kerr specialist to know more

Simplify your workflow with just three shades.

References:

1. University of Alabama at Birmingham 2. Kerr. Internal Data. Available upon request.

SimpliShade, powered by Adaptive Response Technology, covers all 16 VITA® classical

Simplify withmanagement just three shades. shades with justyour 3 shades.workflow Simplify your inventory and save yourself time

SimpliShade is a trademark of Kerr Corporation. All other trademarks are properties of their respective owners.

The study by the University of Alabama at Birmingham was a blind study and sponsored by Kerr.

on shade selection while having the confidence in premium handling qualities and highly SimpliShade, poweredKeep

by Adaptive Response Technology, covers 16 VITA® classical esthetic restorations. your patients confidently smiling whileall keeping your workflow shades with SimpliShade. just 3 shades. Simplify your inventory management and save yourself time simple with on shade selection while having the confidence in premium handling qualities and highly 1-800-643-123 | kerrdental.com aesthetic restorations. kavokerr.queries@kavokerr.com Keep your patients confidently smiling while keeping your workflow simple with SimpliShade.

spectrum | NEWS

Precision dentistry: Implications for practice

By Deborah M. Lyle, RDH, BS, MS

T

he oral cavity is a dynamic and complex place to work. There was a time when the goal was simple: remove the plaque and fix the problem. Today we are moving toward precision dental medicine and microbial homeostasis.

Currently, the focus is on evidencebased dentistry. This is a well-known concept that utilises the most current and high level of evidence along with experience and expertise of the practitioner. Additionally, the primary goal is to provide a patient-centred plan that meets the needs and is valued by the individual. Precision dentistry takes this to a new level.

The overarching goal is to provide therapy or prevention that will be effective for the individual with a predictable outcome.1 This seems other worldly but the application in medicine is progressing and the shift to dentistry is not far behind. This focus has been advanced due to the mapping of the human genome and microbiome that have led to ground-breaking research.

A paradigm shift recision dentistry requires a complete shift in thinking. Clinical presentation and oral assessment leading to a diagnosis is not sufficient. A clear understanding of the disease, how it differs from health and diagnostic subgroups, or phenotypes, where each member in the group are the same is needed.1-3 Thus a diagnosis of chronic periodontitis with a recommendation of scaling and root planing is a traditional treatment plan. The outcomes will vary. However, knowing the environment, genetic makeup, biomarkers for health and disease and biological molecules through “omics” research can provide a way to predict or prevent a disease.2

P

20 Australasian Dental Practice

Practice changes he Periodontal Profile Class system is a step toward precision dentistry.1 The system is designed to provide a stage

T

Oral-fluid-based analysis shows disease-related proteins and RNAs for oral cancers, Sjögrens’ syndrome and periodontal diseases. These, along with information about signaling pathways, enzymes and cytokines could facilitate early intervention, more targeted therapeutic care and better monitoring of the disease. Treatment for head and neck squamous cell carcinoma often results in a poor quality of life and a low survival rate. Classifying these tumors based on their molecular features may help to predict which lesions will convert to a malignancy.3

Prevention ral care product research will need to step up the game. Understanding the products’ impact on the microbiome will be a key factor. The use of plaque indices to measure the presence or absence of plaque is not only antiquated but also tells us little about disease risk, prognosis or individual responses. Products like the Waterpik® Water Flosser has shown changes in inflammation on a clinical and microscopic level.5-8 Research has also shown a host modulation effect and new studies are being conducted and published regularly.5,6

O and grade that incorporates the risk of future disease and prognosis.4 Start evaluating your patients based on their risk for decay, tooth loss, disease progression or poor treatment response, instead of an established disease classification.

References 1. Beck JD, Philips K, Moss K, Divarius K, Morelli T, Offenbacker S. Advances in precision oral health. Periodontol 2000 2019;82:268-285. Available from https://onlinelibrary.wiley. com/doi/10.1111/prd.12314 2. Divaris K. Fundamentals of precision medicine. Compen Dontin Educ Dent. 2017 September; 38(8 Suppl):30-32.

Available from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5880533 3. Garcia I, Kuska R, Somerman MJ. Expanding the foundation for personalized medicine: Implications and challenges for dentistry. J Dent Res. 2013 July;92(Suppl 1):3S-10S. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728544 4. Al-Mubarak S, Ciancio S, Aljada A et al. Comparative evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002; 29:295-300 5. Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 2000; 27:134-143 6. Krajewski J, Giblin J, Gargiulo AW. Evaluation of a water pressure cleaning device as an adjunct to periodontal treatment. Periodontics 1964; 2:76-78 7. Lainson PA, Bergquist JJ, Fraleigh CM. A longitudinal study

of pulsating water pressure cleansing devices. J Periodontol 1972; 43:444-446 https://onlinelibrary.wiley.com/doi/10.1111/ prd.12314 2. Divaris K. Fundamentals of precision medicine. Compen Dontin Educ Dent. 2017 September; 38(8 Suppl):30-32. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880533 3. Garcia I, Kuska R, Somerman MJ. Expanding the foundation for personalized medicine: Implications and challenges for dentistry. J Dent Res. 2013 July;92(Suppl 1):3S-10S. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728544 4. Al-Mubarak S, Ciancio S, Aljada A et al. Comparative evaluation of adjunctive oral irrigation in diabetes. J Clin Periodontol 2002; 29:295-300 5. Cutler CW, Stanford TW, Abraham C, Cederberg RA, Boardman TJ, Ross C. Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 2000; 27:134-143 6. Krajewski J, Giblin J, Gargiulo AW. Evaluation of a water pressure cleaning device as an adjunct to periodontal treatment.

Periodontics 1964; 2:76-78 7. Lainson PA, Bergquist JJ, Fraleigh CM. A longitudinal study of pulsating water pressure cleansing devices. J Periodontol 1972; 43:444-446

July/August 2021

The Easy and Most Effective Way to Floss!™

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Clinically Proven Results Untreated

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Removes up to 99.9% of plaque from treated areas2

Up to 50% more effective for improving gum health vs floss2

Up to 2X as effective for improving gum health around implants vs string floss2

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*Dependent upon location of practice. Sessions via face to face or Zoom.

1. Terms & Conditions apply. Please visit Waterpik.com.au/shop for more information. 2. Independent clinical studies. Go to Waterpik.com.au for details.

Visit www.waterpik.com.au for more information or email professionalau@waterpik.com

spectrum | NEWS

Revolutionary new biodegradable nitrile gloves an environmental game-changer

N

itrile exam gloves, used by the hundreds of millions every year in Australian dental and medical practices, end up in landfill and take hundreds of years to break down. In a major step forward for the environment, Mun Global, a subsidiary of Hartalega, the world leader in Nitrile glove manufacturing, has introduced revolutionary biodegradable nitrile gloves to its range.

“Our new GloveOn Avalon range of nitrile exam gloves are a real game changer for the environment,” said Leonard Brown, General Manager of Mun Global Australia. “The Avalon range has been specially formulated to include an organic additive which attracts microbes found exclusively in landfill and anaerobic environments that break down polymers naturally. This mineralisation process only begins once the gloves are surrounded by the microbes present in landfill environments. Under these conditions, the gloves biodegrade up to 30% in less than 7 months and up to 90% in less than 18 months in optimum anaerobic conditions.

“This process only triggers once the gloves are exposed to these specific conditions. Other than that, the gloves perform clinically like any other nitrile glove and can be stored for long periods of time without degrading.

“I should stress that the breakdown of the gloves is a natural, organic process that does not damage the environment,” Mr Brown said. “There are other products on the market claiming biodegradability, but these are only breaking down into micro particles of nitrile rubber which can then end up in our food supply. The technology we have so far incorporated into the GloveOn Avalon range results in a complete organic breakdown that is both natural and safe.”

Mr Brown said that the adoption of this technology was driven by customer feed-

22 Australasian Dental Practice

“Once Avalon gloves are in landfill, they biodegrade up to 30% in less than 7 months and up to 90% in less than 18 months in optimum anaerobic conditions...”

back at the environmental harm caused by the thousands of tonnes of medical waste being generated each year.

“Wearing gloves is a cornerstone of standard precautions in infection control and gloves must be changed between patients. The amount of waste being generated is not lost on clinicians and these concerns are regularly voiced to us. Incorporating this technology into our gloves gives clinicians peace of mind that impact to the environment is being reduced without impacting the efficacy of their infection control regime.”

Mr Brown said that the company intends to incorporate this organic technology into its entire portfolio of nitrile gloves as a priority and without increasing prices.

“This will be the standard moving forward for all of our nitrile gloves,” Mr Brown said.

“We see it as a moral obligation to reduce the environmental impact of our products and there is and never will be any premium to the price of our gloves to adopt a biodegradable product.

If you have a choice of two brands of gloves at the same price and one option is biodegradable, then our customers are telling us they will make the right choice for the environment.”

Mun’s GloveOn Avalon range of biodegradable nitrile exam gloves are now exclusively available from Dentavision. To order, call 1800-806-640 or visit www.dentavision.com.au

July/August 2021

A brand by

munglobal.com.au

spectrum | NEWS

Septodont Ultra Safety Plus Twist: The new gold standard in safe injections

S

eptodont, the world leader in pain management, has always been at the forefront of dentistry, developing, manufacturing and distributing a wide range of high quality dental products all over the world. Now, its French affiliate 100% dedicated to dental needles continues to innovate with Ultra Safety Plus Twist, the upgrade of its gold standard safety injection device. This comes as an important evolution to further help dental professionals to efficiently protect themselves against needle stick injuries (NSI)

ULTRA SAFETY PLUS TWIST

Needle stick safe & easy injuries: a significant risk > Protects you and your staff from needle stick injuries > Complies with latest regulations > Intuitive device > Available with either sterile single use or sterilisable handle

mong the 35 million health workers, the World Health Organization estimated that 3 million suffered from percutaneous exposures to bloodborne pathogens each year.1 The needle stick Passive or active aspiration: security for the patient injuries represent significant risks on: Transparent barrel: • Health: Among health care workers, aspiration is clearly visible about 40% of HBV and HCV infections and 2.5% of HIV infections are due to Sliding protective sheath: protection from needle stick injuries occupational sharps exposures.1 • Cost: Costs for a healthcare organization when a needle stick injury occurs are about $747 (range between $199 and $1,691).2 Two different positions: first Holding Position (reversible) • Legislation: Many health care agenfinal Locking Position (irreversible) cies put in place legislations to prevent needle stick injuries requiring the implementation of safety procedures, the use of safety devices and the prohibition of the recapping of needles

A

Ultra Safety Plus Twist: a safe and easy device ltra Safety Plus has become the gold standard safety device, demonstrating its efficacy at protecting the dental team from needle stick injuries and complying with the latest regulations. New Ultra Safety Plus Twist is safer and easier with its new intuitive patented locking system:

U

24 Australasian Dental Practice

A LONG-PROVEN EFFICACY A study demonstrated that when introduced in a dental school, Ultra Safety Plus was a the key success factor for avoiding needle stick injuries.

FREQUENCY OF NEEDLE STICK INJURIES ULTRA SAFETY PLUS INTRODUCTION

YEAR 1

YEAR 2

YEAR 3

YEAR 4

YEAR 5

With Ultra Safety Plus, needle stick injuries decreased from an average of 11.8 to 0 injuries per 1,000,000 hours worked(1) (1) J.M Zakrzewska et al. Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J 2001 ; 190; 88-92.

only two easy steps are needed for a secure assembly. Also, the device is available as either sterile single use or with a sterilisable handle.

References 1. WHO, The world health report 2002 - Reducing Risks, Promoting Healthy Life, 2002.

2. Mannocci A, De Carli G, Di Bari V, et al. How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel.

Infect Control Hosp Epidemiol. 2016;37(6):635–646. doi:10.1017/ice.2016.48.

24/09/2020 11:03

About Septodont

or over 80 years Septodont has been a global influence in manufacturing dental materials and local anesthetics for the dental community. Today they are a leader in pain management with a presence in over 150 countries with regulatory approvals to match. Septodont has 8 manufacturing facilities on 4 continents; Canada, United States, India, France (3) and Brazil (2). For more information, visit www.septodont.com

F

July/August 2021

Biodentine Biodentine Biodentine

™ ™™ ™ ™

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*

SATISFACTION

PRACTICE PRACTICE EFFICIENCY EFFICIENCY REPUTATION PRACTICE REPUTATION EFFICIENCY •••

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Reverse the Reverse the Reverse the TRUST Reverse the TRUST Irreversible!

SATISFACTION Irreversible!

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SATISFACTION TRUST Irreversible!

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The first and only dentin in a capsule NEW

IS EVERYTHING Biological REPUTATION the right one with Hu-Friedy SEPTANEST Bulk Fill” SEPTANEST Irreversible Pulpitis IS EVERYTHING Irreversible Pulpitis Irreversible Pulpitis SEPTANEST Irreversible Pulpitis he right one with Hu-Friedy Restorative PAIN FOR

table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. discover why dentists favor our impeccable fit. Perfect for your patients. Easy for you. n it comes to the perfect fit, Hu-Friedy is just right.

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Biodentine saves pulpsManagement, EVEN with signs and symptoms As world in Pain Septodont TS LOVE OUR STAINLESS STEELleader PEDO CROWNS: of irreversible pulpitis* ™

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Biodentine saves pulps EVEN with signs and symptoms provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms able outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns.

As world leader in Pain Management, Septodont ™ of irreversible pulpitis* As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : iscover why dentistsprovides favor our impeccable fit.

Perfect for your patients.

Easy for you. ™ you products and services you brings one-of-a-kind benefi tsto forhelp the treatment of ™ dentin wherever it’s damaged.

Biodentine ™ fully replaces Biodentine of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine it comes the perfect fit, Hu-Friedy is just right.experience, amongst those : administer painfree mmed andtopre-crimped for ™ simple placement ™

up to 85%** irreversible pulpitis cases: ™ of brings one-of-a-kind benefi ts for and the treatment of Biodentine one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier faster: Septanest :brings the in first choice of dentists with over ™ As world leader Pain Management, Septodont ™ helps the to 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OURup STAINLESS STEEL PEDO CROWNS: occlusal anatomy that matches the natural tooth pulpitis brings one-of-a-kind benefi ts Biodentine for the treatment of remineralization of dentin, preserves the pulp Biodentine up to 85%** of irreversible cases: 150 million injections per year, provides you high • Pulp healing promotion: proven biocompatibility and bioactivity vitality and promotes pulp healing. It replaces dentin with similar Septanest : the first choice of dentists with over you products and services to you up to Therapy 85%** ofallowing irreversible pulpitis cases: • Vitalprovides complete dentin bridge formation •Pulp Minimally Invasive treatment preserving thehelp tooth structure • Vital Pulp Therapy allowing complete dentin bridge formation ght and mesio-distal width quality you can trust • Reduced risk of failure: strong sealing properties biological and mechanical properties.

150 million injections per year, provides you high administer painfree experience, amongst those : Vital Pulp Therapy allowing complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •forOnly Immediate Pain relief for your patients’ comfort med and pre-crimped simple placement Minimally Invasive treatment preserving the tooth structure • one material to fi ll the cavity from the pulp to the top quality you can trust ™ e occlusal anatomy that matches the natural tooth Improving on Biodentine Minimally treatment preserving the tooth structure • Immediate Pain relief for your comfort Bio-Bulk fiInvasive lling procedure foras an easier protocole •• Similar mechanical behavior natural dentin: ideal for bulk fillingclinical implementation, you can now bond Immediate relief forpatients’ your patients’ comfort Septanest : Pain the first choice of dentists with over the composite onto Biodentine™ in the same visit and perform the • Painprocedure relief patients’ comfort • Bio-Bulk llingenamel procedure forfor anyour easier protocole • Immediate Bio-Bulk filling for an The fifinal restoration will beeasier placedprotocole within 6high months.

150 million injections per year, provides you full restoration in a single session.

NLINE AT HU-FRIEDY.COM/PerfectFit • Bio-Bulk fi lling procedure for an easier protocole quality you can trust

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g.LINE Co., LLC.AT All HU-FRIEDY.COM/PerfectFit rights reserved.

Innovative by nature Innovative by nature Innovative by nature

Co., LLC. All rights reserved.

Exclusively available in New Zealand from

To enjoy the clinical benefits of the first and only dentin in a capsule, ask your dental distributor for Biodentine™.

Exclusively available in Australia from

Please visit our website for more information Call 0508 486 252 Please our website more information www.septodont.com Please visit ourvisit website for morefor information Please visit our website for more information 08 855 www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au www.ivoclarvivadent.co.nz www.septodont.com www.septodont.com *If haemostasis be achieved full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) Please visitwithcannot our website forafter more information Learn more www.septodont.com

08 855 www.henryschein.co.nz ** Taha et al., 2018 the Biodentine™ brochure

Orders 1300 65 88 22 www.henryschein.com.au

ULTRA SAFETY PLUS TWIST safe & easy > Protects you and your staff from needle stick injuries > Complies with latest regulations > Intuitive device > Available with either sterile single use or sterilisable handle

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PRACTICE Irreversible!

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table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. table outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns. discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you. Pulpitis Pulpitis discover why dentists favor our impeccable fit. Perfect for your Irreversible patients. Easy for you.

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MANAGING Pulpitis Irreversible Pulpitis n it comes to the perfect fit, Hu-Friedy is just right.Irreversible MANAGING Pediatrics Endodontics MANAGING Irreversible Pulpitis ™ Biodentine saves pulps EVEN with signs and symptoms As world leader in Pain Management, Septodont TS LOVE OUR STAINLESS STEEL Pediatrics PEDO CROWNS: Endodontics MANAGING ™ Biodentine saves pulps EVEN with signs and symptoms ™ of world irreversible pulpitis* Ultra Safety with the new Twist Lock ™Plus As leader in Pain Management, Septodont Biodentine saves pulps EVEN with signs and symptoms TS OUR STAINLESS STEEL PEDO CROWNS: provides you products and services to help you Biodentine saves pulps EVEN with signs and symptoms ableLOVE outcomes for your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns.

As leader in Pain Management, Septodont ™ of world irreversible pulpitis* ™ pulps Biodentine saves EVEN with signs and symptoms of irreversible pulpitis* provides you products and services to help you As the first all-in-one biocompatible and bioactive dentin substitute, Biodentine saves pulps EVEN with and symptoms eight and width patented design your safety device oflittlest irreversible pulpitis* able outcomes for your with Hu-Friedy Stainless Steel Pedo Crowns. administer experience, amongst those : As world leader inmakes Pain Management, Septodont iscover whymesio-distal dentists favor our patients impeccable fit.

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Easy forsigns you. ™painfree provides you products and services to help you ofbiocompatible Biodentine ™ ™brings one-of-a-kind benefits for the treatment of irreversible pulpitis* ™ dentin wherever As the first all-in-one andMANAGING bioactive dentin substitute, fully replaces it’s damaged.

Biodentine Biodentine saves pulps EVEN with signs and symptoms eight and mesio-distal width of irreversible pulpitis* administer painfree experience, amongst those : For vital pulp therapy, bulk-fi lling the cavity with Biodentine iscover why dentists favor our impeccable fit.

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Easy for you. it comes the perfect fit, Hu-Friedy isproducts just right. ™placement provides you and services to help you even easier to use. administer painfree experience, amongst those mmed andtopre-crimped for simple brings one-of-a-kind benefi ts for the treatment of Biodentine ™ 85%** ™ : up to of irreversible pulpitis cases: MANAGING ™ ™ PRACTICE fully replaces dentin wherever it’s damaged.

Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine of irreversible pulpitis* For vital pulp therapy, bulk-fi lling the cavity with Biodentine brings one-of-a-kind benefi ts for the treatment of Biodentine makes your procedure better, easier and faster: it comes the perfect fit, Hu-Friedy is justfirst right.experience, Septanest :of the choice of tsdentists with over administer painfree amongst those mmed andtopre-crimped for simple placement ™ 85%** ™ : up to irreversible pulpitis cases: world leader inone-of-a-kind Pain Management, Septodont ™CROWNS: helps of dentin, preserves the pulp brings one-of-a-kind benefi for the treatment of the Biodentine to As 85%** of irreversible pulpitis cases: • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OURup STAINLESS STEEL PEDO occlusal anatomy that matches the natural tooth brings benefi ts Biodentine for the treatment of remineralization PRACTICE Biodentine makes your procedure better, easier and faster: up to 85%** of irreversible pulpitis cases: PRACTICE Septanest : the first choice of dentists with over Available with either sterile single-use or ™ bioactivity 150 million injections per year, provides you high • Pulp healing promotion: proven biocompatibility and As world leader in Pain Management, Septodont ™ helps the remineralization of dentin, dentin preserves pulp Biodentine vitality and promotes pulp healing.

It replaces withthe similar Septanest : the first choice of dentists with over up to 85%** of irreversible pulpitis cases: provides you products and services you • Vital Pulp Therapy allowing complete dentin bridge formation SeLOVE OUR•anatomy STAINLESS STEEL PEDO CROWNS: occlusal that matches the natural tooth brings one-of-a-kind benefi tsto forhelp the treatment of up tomillion 85%** ofallowing irreversible pulpitis cases: PRACTICE Vital Pulp Therapy complete dentin bridge formation • Minimally Invasive treatment preserving the tooth structure •Biodentine Vital Pulp Therapy allowing complete dentin bridge formation ght and mesio-distal width 150 injections per year, provides you high • Pulp healing promotion: proven biocompatibility and bioactivity sterilisable handles quality you can trust vitality and promotes pulp healing.

It replaces dentin with similar Reduced risk of failure: strong sealing properties Septanest : the first choice of dentists with over biological and mechanical properties. provides you products and services to help you injections perpulpitis year,dentin provides you high: administer experience, amongst those up tomillion 85%**painfree ofallowing irreversible cases: • Vital150 Pulp Therapy complete bridge formation

IS EVERYTHING he right one withSEPTANEST Hu-Friedy

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08 855 www.septodont.com www.henryschein.co.nz Orders 1300 65 88 22 www.henryschein.com.au ** Taha et al., 2018 www.septodont.com *If haemostasis cannot be achieved after full pulpotomy, a pulpectomy and a RCT should be carried out, provided the tooth is restorable (ESE Position Paper,Duncan et al. 2017) the Biodentine™ brochure

spectrum | NEWS

Expand ortho treatment in your practice

G

aining skills and experience in orthodontics increases your treatment options, quality of patient care and potentially your income!

Joseph Allbeury spoke to Dr Geoff Hall about the opening of The OrthoED Institute’s 2022 enrolments and why this is the must-do program for the new year.

Q A

Dr Hall, please tell us about The OrthoED Institute.

The OrthoED Institute is a private training institution for general dentists that covers the entire gamut of orthodontics, from diagnosis and treatment planning through to early treatment intervention and on to fixed braces. And obviously we also cover what’s very popular now, aligner therapy. It’s the ideal program for any general dentist that wants to learn more about orthodontics. It’s a comprehensive, structured learning program backed up with practical work and full support over a two-year period and beyond.

The system we teach is well-balanced and based on sound orthodontic principles. It’s not based on any specific appliances, bracket systems or aligner types. We’re purely providing orthodontic education to dentists so that they feel comfortable and confident in treating the majority of patients that walk through the door, reducing the need to refer simple cases out. Even more moderate cases can be completed in-house.

We also have an optional accredited post-graduate diploma program which is examination-based to add further weight to your studies.

We’ve tried to cover all the bases so our graduates have both the knowledge and practical experience to confidently treat the majority of the orthodontic needs of their patients.

Q A

Why do dentists need to learn more about orthodontics?

The reality is that every patient that comes in to see you should be orthodontically assessed, but quite often they’re not. This may be because the dentist doesn’t want to refer the patient out,

28 Australasian Dental Practice

but most of the time it’s because they don’t have the training to see that there is a problem in the first place.

Orthodontics is a fundamental part of any type of diagnosis for a patient, whether it be a young child or an adult, but it is often discounted in favour of more “destructive” dentistry like using crowns and veneers, because the dentist is more comfortable with restorative procedures. We want to equip dentists with more conservative techniques, whether it be using fixed braces, appliances or aligner therapy to achieve quality, predictable results efficiently.

Q A

At what stage of your career should you complete the OrthoED program?

That’s an interesting question because when we started, we thought the program would be taken up by dentists in their forties looking to expand their skills. But what we’re finding is that a lot of new graduates are participating because they now realise that orthodontics can be a big part of the treatment completed in general practices. And they want to learn these skills while they’re working for other people. I use the analogy that it’s a bit like referring out an upper central incisor endo case. An endodontist would laugh at it. And there are lots of those types of cases in orthodontics that are really best dealt with in the hands of the general dentist. But rather than referring them out, they’re being overlooked or dealt with in less ideal ways. Equally, it’s important to know when it’s best to refer a patient to a specialist colleague.

Q A

Who teaches the program?

The faculty are all specialist orthodontists and we’re here to support our students both throughout the program and beyond through our alumni program.

One of the questions general dentists often ask me is what happens if a case they are treating orthodontically goes awry and this is where being educated and backed by specialists is important. If there is ever a problem with a case in the future, then we’re here to support you with your diagnosis, planning and treatment delivery, as well as in any other way you may require.

Apart from the core faculty, we also have guest lecturers as well. We have some exciting things happening in 2022 with international lecturers coming out on behalf of OrthoED including Dr Donna Galante, who was the number one Invisalign instructor back in 2000 and 2017.

She’s lecturing exclusively for us on aligner therapy. Dr Galante is probably one of the top five aligner providers in the world.

We also have Dr Peter Sheridan, the expert on dental photography, giving a one day programme.

So we have lots of guests to make the programme even more balanced. We also have optional webinars at night and optional weekly treatment planning sessions, plus on-demand recordings you can watch any time. There is literally as much or as little extracurricular material and support as you want or require.

Q A

Is this a face-to-face program or virtual?

It’s a face-to-face learning program and there are eight modules to complete over a two-year period. There is the opportunity to do it online as well, but we can only offer intensive clinical support to students who are doing the course face-to-face.

It sounds like an amazing program. I believe you also have a treatment planning service for aligners anyone can use?

Q

That’s correct. It’s not just for OrthoED members to use. Aligners are such a big part of general dentistry now and for the future. So we’ve set up a treatment planning service purely for aligner providers whereby we do all of the setups and optimise the case for the dentist. We call this service CAPS - Complete Aligner Planning Service - and it’s open to any dentist. We work with Invisalign, SureSmile, Angel Align and SmileStyler and help general dentists offer aligners without having to worry about the set-up and optimising the digital treatment plan.

A

Thank you very much Dr Hall.

For info, visit www.orthotraining.com.au or email info@orthoed.com.au

July/August 2021

AT AT ORTHOED, ORTHOED, AT ORTHOED, WE’LL BE YOUR YOUR SAFETY NET, WE’LL BE SAFETY NET, YOUR SAFETY NET, WE’LL BE YOUR SAFETY NET, SO CAN TAKE TAKE ON CASES WITH SO YOU YOU CAN ON CASES WITH TAKE ON CASES WITH SO YOU CAN TAKE ON CASES WITH CONFIDENCE. CONFIDENCE. CONFIDENCE. CONFIDENCE. Learn and take take your yourpractice practiceforward forwardwith withThe The Learn Orthodontics Orthodontics and Learn Orthodontics and take your practice forward with The Learn Orthodontics and take your practice forward with The OrthoED Institute.

OrthoED Institute.

OrthoED Institute.

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With case support, support, expert experttuition tuitionfrom fromexperienced experiencedOrthodontists Orthodontistsand and With unrivalled unrivalled case With unrivalled tuitionfrom fromexperienced experienced Orthodontists With unrivalledcase casesupport, support, expert expert tuition Orthodontists andand principle-based learning, OrthoED’s OrthoED’s22year yearMini MiniMasters Mastersprogram programwith withan anoptional optionalPost Post principle-based learning, principle-basedlearning, learning,OrthoED’s OrthoED’s 2 year with anan optional Post principle-based yearMini MiniMasters Mastersprogram program with optional Post Graduate Diploma allows allows you you to toquickly quicklydevelop developthe theconfidence confidenceand andskill skillset settotooffer offer Graduate Graduate Diplomaallows allowsyou you to to quickly quickly develop and skill setset to offer Graduate Diploma developthe theconfidence confidence and skill to offer high standards of Orthodontic Orthodontic treatments,predictably treatments,predictablyand andprofitably profitablyregardless regardlessofofyour your high high standardsofofOrthodontic Orthodontic treatments,predictably treatments,predictably and regardless of your high standards andprofitably profitably regardless of your previous experience. previous previous experience. previous experience.

Increase satisfaction Increasejob jobsatisfaction satisfaction Increase job satisfaction

Provide your patients with better Provideyour your patients with better Provide patients with better Provide your patients with better clinical outcomes clinicaloutcomes outcomes clinical

Improvepatient patientexperience experience Improve patient experience Improve patient experience

Boost referrals Boost patient referrals Boostpatient patient referrals

Increaseprofits profits Increase Increase profits Increase profits

Stand the competition Stand out from the competition Standout outfrom from the competition

Avoidbacklash backlash Avoid Avoid backlash Avoid backlash

Reduce outbound referrals Reduce Reduceoutbound outboundreferrals referrals

clinical outcomes

Boost patient referrals

Stand out from the competition

Reduce outbound referrals

Enrolment for Mini Masters 2022 is now open. Spaces are limited. To learn more

Enrolment for for Mini Masters is now To Enrolment Mini availability, Masters 2022 2022 iswww.orthotraining.com.au nowopen. open.Spaces Spacesare arelimited. limited.

Tolearn learnmore more and check current visit or call Enrolment for Mini Masters 2022 is now open.

Spaces are limited.

To learn more and check check current current availability, visit www.orthotraining.com.au ororcall and availability, visit www.orthotraining.com.au call 1300 073current 427 foravailability, a free information pack today. and check visit www.orthotraining.com.au or call 1300 073 427 for a free information pack 1300 073 427 for a free information packtoday. today.

1300 073 427 for a free information pack today.

spectrum | NEWS

Geistlich takes on stoma instruments

G

eistlich Biomaterials, a world leader in regenerative dentistry, has specialised in regenerative medicine for over 30 years. Geistlich Bio-Oss® and Geistlich Bio-Gide®, the company’s pioneer products, have contributed to the company being the global market leader in regenerative dentistry for many years. Introducing high-end instruments that complement Geistlich’s biomaterials portfolio was a logical next step.

Spirited by the same philosophy and fuelled by “passion for perfection”, Geistlich has partnered with stoma® to become the exclusive distributor for Australia and New Zealand. From their HQ in Liptingen, Germany, stoma has manufactured dental instruments of the highest quality since 1895.

Stoma can look back on a 100-year history with pride. Walter Storz’ pioneering work, which began in 1919, runs like a golden thread through the epochs and generations. Despite the continuously increasing requirements for medical devices, the company is well-positioned for the future. With the untiring pioneer spirit of its founder, the company aspires to carry on the company’s legacy.

The first patent-pending trapping device was a tooth forceps. A pioneering entrepreneur, Walter Storz was granted his first patent in 1934, which would lead to a succession of other patents. Tooth forceps fitted with a trapping device solved the problem of many dentists. Due to the special shape, the extracted tooth and root fragments were “trapped” and could not make their

30 Australasian Dental Practice

way into the patient’s throat cavity. These types of patents were crucial to the young entrepreneur’s success. As a result, Jetter & Scheerer’s own products were being developed, manufactured and sold in addition to those they purchased and an independent fabrication division was created.

In 1956, stoma began manufacturing autoclaves, which completed the product range with an elemental component. Shortly after, stoma was able to successfully file its first patent for autoclaves. A small-scale series produced quickly led to success, but it also opened up the door to an understanding that, 45 years later, would trigger a much-broader decision.

Stoma developed a first-class understanding for the market requirements as well as potential product improvements through the contact with dentists, specialists and users throughout the world. Between 1997 and 1999, strategic innovations and product development culminated in a veritable firework, which has also today contributed to stoma’s success.

The stoma color-stick® program was introduced to the market in 1997 and through its colour coding, offers a significant benefit to the user. One year later, the market enthusiastically embraced the protective organisation concept stoma p.i.c.® with trays, containers and accessories.

Twelve months later, hygienic grip systems were introduced with the stoma Hy-Grip®, which was impressive through ergonomics, haptics and surface design.

For more details on the stoma instrument range, contact the Geistlich customer service team on 1800-776-326.

July/August 2021

With passion for perfection

Dental Instruments by Stoma

®

Experience stoma® Quality Made in Germany

Micro Surgery Kit Bologna Concept Zucchelli

Prof. G. Zucchelli DDS, PhD Department of Periodontology University of Bologna

Perio Surgery Kit Bologna Concept Zucchelli

STO-19915.00 STO-19915.01

Plastic Aesthetic Surgery Kit Concept of Bern Sculean

Prof. Dr. Dr. A. Sculean, M.S. Department of Periodontology University of Bern

Sinus Kit Concept of Olsberg STO-19908.04

made in germany

STO-19608.02

For more information on specialised stoma® kits and stoma® Introductory Surgery Kit please contact your local Geistlich Product Sales Specialists or our customer service team on 1800 776 326.

spectrum | NEWS

Streaming now on www.dentevents.tv

D

entevents.tv is a brand new website for the dental profession that offers a broad range of video-based content focussed on all aspects of dentistry - from clinical, to technology, to management, marketing and more. Sign in for FREE and watch hundreds of on-demand videos, with more being added every day. Some videos even offer CPD! A selection of videos that will interest dentists and specialists appear below - or browse the website for many many more.

Implant Failure Horror Stories A series of Unfortunate Cases Presented by Dr Marina S Kamel Duration 1:07:17 AVAILABLE ON DEMAND CPD 1.0 Hours The failure of a dental implant can be a living nightmare that neither the unfortunate patient nor the attending clinician can wake up from.

Complaints - Why Do We Get Them & What Should We Do About Them?

Presented by Dr Simon D Parsons Duration 0:55:50 AVAILABLE ON DEMAND CPD 1.0 Hours No one enjoys being on the receiving end of a complaint, especially if you take pride in caring for all your patients.

DenTechKnow - Digital Dentures Presented by Terence Whitty Duration 0:17:41 AVAILABLE ON DEMAND In this episode of DenTechKnow, Terry Whitty explores the state-of-the-art of digital dentures. This hot topic has been the focus of digital dentistry for the past few years with hardware, software and materials companies collaborating to try and provide a fully digital solution. Terry investigates what is possible at this point in time when it comes to producing dentures using the various solutions on offer and what we can expect in the future.

Infection Control Boot Camp Presented by Prof. Laurence Walsh Duration 7:08:14 AVAILABLE ON DEMAND CPD 6.0 Hours Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months. This paid online learning program spans 27 video modules watched on-demand over more than 7 hours.

Watch hundreds of videos on-demand for FREE at www.dentevents.tv

32 Australasian Dental Practice

July/August 2021

spectrum | NEWS

8 great websites for dental professionals

www.dentalpractice.com.au Magazine

www.oralhygiene.com.au Magazine

www.elaborate.com.au Magazine

www.dentalcommunity.com.au Professional Portal

www.dentevents.tv Dental Video Streaming

www.dentevents.com Events Calendar

www.dentist.com.au FInd-a-dentist - Australia

www.dentist.co.nz Find-a-dentist - New Zealand

8

websites catering to all the needs of the dental profession have now been updated to optimise their performance across all devices.

Brand new websites have also been created for Australasian Dental Practice, Oral Hygiene and eLABORATE magazines.

34 Australasian Dental Practice

“8 websites may seem like a lot but each fulfils a role in the dental profession,” said Joseph Allbeury, publisher of this magazine and all of the websites. “Whether you are looking for news, product info, events to attend, videos to stream and more, we have it covered. We even help dental practices attract patients through dentist.com.au and dentist.co.nz.”

July/August 2021

kulzer.com/one-shade

ONE FOR THE BASICS

NEW

Scan to learn how Adaptative Light Matching works

Venus Pearl ONE Shade.

Your one shade solution for everyday cases.

Always grab the right shade: With the incredible shade-matching properties of ONE shade the restoration becomes invisible by blending into any surrounding dentition.

Efficient handling: Non-slump qualities for easy carving and sculpting with a creamy, low-stick consistency.

Long-lasting restorations: Exceptional strength to resist chipping and fracture, with over 8 years proven clinical experience.

Try it out for yourself – with our Venus Pearl ONE Shade-Kit kulzer.com/try-one.

Everyday cases with Venus Diamond ONE Shade for a firm consistency and Venus Pearl ONE Shade for a creamy consistency.

For further information, please contact your local Kulzer Restorative Supplier TODAY!

Source: Dr. Edoardo Fossati, Turin, Italy

Source: Prof. Dr. Claus-Peter Ernst, Mainz, Germany

Kulzer Australia P/L E: info.australia@kulzer-dental.com Kulzer.com/australia © 2021 Kulzer GmbH. All Rights Reserved.

dentevents presents...

Infection Control

BOOT CAMP 2020 BOOT CAMP ON DEMAND ONLINE LEARNING PROGRAMME

26 VIDEOS - 6+ HOURS OF EDUCATION INTERACTIVE Q&A SUPPORT WEBINARS Presented by Professor Laurence J. Walsh AO Learn firsthand from Australia’s leading authority on infection prevention and control in dentistry about recent changes in infection control that have come in over the past 12 months, including the new guidelines from NHMRC (May 2019), Hand Hygiene Australia (Sept 2019) and the CDNA (Dec 2018) as well as recent changes in Australian Standards and TGA regulations that are relevant to infection control. The course will provide a summary of how those changes interlink with one another.

6

HOURS CPD

The course will cover practical implementation of the new requirements and what it means for everyday dental practice. Hear about the why and the how and keep up-to-date with the changes that are happening. Bring along your questions in writing or in person for one of the Q&A sessions that will be held during the day.

COURSE TOPICS This one day course will cover changes in regulations and guidelines from 2018 to 2020 including: n n Risk-based precautions. n n Hand

hygiene and hand care practices. n n Addressing common errors in personal protective equipment. n n Biofilm

reduction strategies. n n Efficiency-based measures to improve workflow in instrument reprocessing and patient changeover. n n Correct

operation of mechanical cleaners and steam sterilisers. n n Wrapping and batch control identification. n n Requirements

for record keeping for instrument reprocessing. n n Correct use of chemical and biological indicators.

Register Now: www.boosterinjection.com.au

FULL UPDATE! All the changes to Infection Control Guidelines in 2020

Professor Laurence Walsh AO is a clinically active specialist in special needs dentistry who is based at the University of Queensland in Brisbane. Laurie has been teaching infection control and clinical microbiology for over 25 years at postgraduate level and has been the chief examiner in microbiology for the RACDS for the past 20 years. He has presented invited courses and lectures on infection control across Australia and internationally. Laurie has written over 60 articles on infection control and in addition published over 320 journal papers and a further 190 technical reports and literature reviews. He serves on two committees of Standards Australia (personal protecting equipment; and instrument reprocessing) and in recent years has been an adviser to the Communicable Diseases Network of Australia and the Australian Commission on Safety and Quality in Health Care.

Laurie has been a member of the ADA Infection Control Committee since 1998. He has contributed to various protocols, guidelines and checklists and manuals used in Australia.

REGISTRATION FEES

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Infection Infection Contol Contol Boot Boot Camp Camp is is presented presented by

by Dentevents, Dentevents, aa division division of of Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd ABN ABN 74 74 065 065 490 490 655 655 •• www.dentevents.com www.dentevents.com •• info@dentist.com.au info@dentist.com.au ™ ™ Tel: (02) (02) 9929 Tel: 9929 1900 1900 •• Fax: Fax: (02) (02) 9929 9929 1999 1999 •• Infection Infection Contol Contol Boot Boot Camp Camp™ and and Dentevents Dentevents™ are are trademarks trademarks of of Main Main Street Street Publishing Publishing P/L P/L © © 2020 2020 Main Main Street Street Publishing Publishing Pty Pty Ltd Ltd

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spectrum | NEWS

Acteon PSPIX: Fast, quality images

N

ewly established Randwick practice, Vital Dental, believes getting the vital elements right is the recipe for a success.

Managing director of Vital Dental, Randwick, Andreas Schilling, has over 10 years’ experience in running medical, dental and radiology clinics.

Given his background, Mr Schilling was looking for dependable digital imaging equipment that could provide high quality images and equipment that fitted easily into the practice.

This included dependable Acteon DC digital X-ray generators in each of the surgeries and an Acteon PSPIX phosphor plate image scanner, together with an Acteon Prime CBCT 3D unit.

The Acteon PSPIX is the world’s smallest and fastest phosphor plate imaging unit. It also stands out on image quality, ease of use and speed.

The PSPIX automatically starts scanning as soon as the phosphor plate is inserted, automatically detects the size of the plate, optimises the processing of the image and ejects the plate after scanning.

The image is available in just seconds on a networked computer such as a linked monitor right alongside the patient in the surgery. The unit is so small it can be accommodated on any benchtop – making it suitable as a “personal image scanner” for each surgery in a practice.

Mr Schilling was most impressed with the compact footprint of the PSPIX unit and its great potential to expand with the practice.

“Our experiences with the PSPIX phosphor plate scanner are positive. It’s easy to use and works well. It’s a good solution when having multiple chairs running,” he said.

This latter point is a salient one, given the practice has already been designed to accommodate future expansion and the PSPIX unit can be networked to up to 10 workstations.

38 Australasian Dental Practice

Most importantly, the image quality is extremely high, with excellent clarity and well contrasted images showing hard and soft structures for accurate diagnosis.

PSPIX works perfectly with the Acteon ecosystem of software which is an open platform which easily accepts images from scanners, CBCT and 3D extraoral units, X-ray sensors and intraoral cameras.

Acteon PSPIX, X-ray units and Sopro intraoral cameras are supplied by A-dec Australia dealers nationally and supported by A-dec and locally based Acteon imaging specialists.

Contact 1800-225-010 to find your nearest A-dec dealer or visit australia.a-dec.com

July/August 2021

I AM EXCLUSIVE The first personal imaging plate scanner Compact design and easy to access: the smallest imaging plate scanner on the market for your personal convenience.

Streamline workflow with images in seconds: drop your imaging plate in the PSPIX2 and let it do the rest.

Improved patient experience with various sizes of thin and flexible imaging plates.

Striking contrast for a more reliable diagnosis.

FOR MORE INFORMATION, CONTACT YOUR LOCAL AUTHORISED DISTRIBUTOR

For more information Email: a-dec@a-dec.com.au Phone: 1800 225 010 Visit: www.a-dec.com @A_decAust @A-dec AUS © 2021 A-dec Inc. All rights reserved.

NSW/ACT

Dental Installations Miranda (02) 9526 3500 Minimax Macquarie Park (02) 8084 2900 Pegasus Dental Services South Hurstville (02) 9585 1100 Presidental Warners Bay 1800 773 743 Silverwater 1800 773 743

Southern Dental Tech Services Engadine 0438 702 151 Tristan’s Dental Equipment Service Campbelltown (02) 9820 8086

QLD

Dental Depot Windsor (07) 3857 0011 Medical Dental Solutions NQ Currajong (07) 4728 2055 Loganholme (07) 3801 5797

Presidental Mansfield 1800 773 743 Leading Dental Murarrie (07) 3139 1549 QDS Noosa Heads 1300 770 977

VIC

Alldent Port Melbourne (03) 9646 3939 Medi-Dent Braeside 1300 886 674

SA/NT

Dental Concepts Edwardstown (08) 8177 0600

WA

Dental Intelligence Osborne Park (08) 9244 8888 West Coast Dental Depot Belmont (08) 9479 3244 V99600

Chairs Delivery Systems Lights Monitor Mounts Cabinets Handpieces Maintenance Sterilisation Imaging

spectrum | NEWS

CS 3700 intraoral scanner ranked first in trueness in latest in-vitro study

S

cientific literature has shown intraoral scanners to be highly successful in creating digital impressions for designing short-span restorations and partial prothesis; however, scanning fully edentulous arches is less studied. Now, a new comprehensive in-vitro study testing the trueness of 12 intraoral scanners when scanning fullarch implant impressions has found the CS 3700 intraoral scanner to offer the truest results when capturing scan bodies in an edentulous arch, giving doctors more confidence that they’re getting the best results when creating digital impressions with the CS 3700.

The study compared the trueness - or how closely the digital scans matched the actual object - of 12 intraoral scanners when scanning a stone model of an edentulous arch with scan bodies.

Two methods were used to assess trueness. Method 1 directly evaluated the quality/accuracy of the scan of each intraoral scanner. Method 2 evaluated the resulting accuracy of each intraoral scanner in early stages of prosthetic CAD modelling.

Carestream Dental’s newest scanner, the CS 3700, was shown to have the best trueness, with a mean error 30.4 µm, when tested

by Method 1. The study found the performance differences between the scanners tested to be statistically significant, with CS 3700 outperforming all the other 11 scanners.

40 Australasian Dental Practice

“Being able to confidently scan a fully edentulous arch is every scanner manufacturer’s goal,” Ed Shellard, DMD, chief dental officer, Carestream Dental, said. “The CS 3700 features advanced acquisition software - CS ScanFlow - ensures the accuracy of the dataset while making it 20 percent faster than the Carestream Dental CS 3600 intraoral scanner.”

Taking into consideration the results of both methods, the study ranked the CS 3700’s performance among the intraoral scanners with the highest accuracy, defined as having a mean error of <40 µm with Method 1 analysis and <25µm with Method 2 analysis.

Carestream Dental’s CS 3600 intraoral scanner was also included in the study and was also listed among the scanners with the highest accuracy.

Both scanners are capable of high-speed scanning and include smart features like guide arrows that show users the ideal direction to scan. Users can choose from orthodontic, restorative and implant-borne restorative workflows. They can also capture different bite registrations for fabricating sleep devices.

To learn more about the CS 3700, the CS 3600 or any of Carestream Dental’s solutions, visit carestreamdental.com/en-au or email anz-enquiries@csdental.com.

July/August 2021

CS SCANFLOW Unbounded Workflows. Endless Possibilities.

Enter the next era of intraoral scanning with Carestream Dental CS 3600 and CS 3700 intraoral scanners and CS ScanFlow software. Proven accuracy. Open files. Unlimited workflow capacity.

Expanded processing options. One-click export. Touchscreen capabilities. With completely open workflow and advanced features, the possibilities are endless.

To see what’s new, visit carestreamdental.com/CSScanFlow Contact us on 1800 223 603 or anz-enquiries@csdental.com

spectrum | NEWS

dentevents.tv

Entries Close 31st May

IN!TheUltimate...

W Practice Makeover ORIGINAL productions

Ultimate Practice Makeover winner announced... let the fun begin!

O

ver the past few weeks, the judges have been busy viewing all of the entries for the Ultimate Practice Makeover - an incredible $90,000 makeover including fit out, marketing, software, consulting and much more.

The quality of entries made the judge’s decision quite difficult, but in Iftheyou love being a dentist but recognise that your end, there can only be one winner... practice is not where it needs to be, then take A huge congratulations to Dr Bouchra Enegd of Melbourne heart!

Dental Suite!

For thenow firstthetime ever, you could the “Ultimate And journey begins... as thewin amazing team of sponPractice over This sors beginMakeover” to work withvalued Bouchraatand her $90,000! team to dramatically package of practice products will completely transform her overand the services next 6 months. update the public image of yourthe dental As an integral part of the makeover, wholepractice journey will be and get you and your staff trained and on track for of captured on video and broadcast on Dentevents.TV. Readers business success over a can 6-month journey.

Australasian Dental Practice also look forward to following the be transformation of Melbourne DentalisSuite over coming To eligible to enter, all you need a dental months as and the prize is implemented. practice a smartphone or camera to video your A special thank you to our wonderful sponsors who have entry! made this incredible opportunity possible. Bouchra’s makeover Plus, if you win, you’ll need to be ready for a fun package includes: adventure as your practice is transformed from • Refresh of the waiting area and signage valued at up to $40,000; wallflower to sunflower.

• A full marketing review of the practice with a “SWOT” style analysis conducted by marketing Angus Pryor;on Your practice’s journey will beguru documented • A 12-month subscription to Channelfor D other plus apractices TV for the video and your results published area; toreception see - and follow along - so be prepared for some fun in the spirit reality television practice • Development of of a marketing strategy foras sixyour months; is tuned for maximum success.

• Full branding package - logo, colours, style guide and more...

• New website and SEO package; Australia’s #1 Google ranked dental marketer, • OnlinePryor, marketing premium upgrade; Angus will including managedentist.com.au your makeover, roping in • New uniforms, patient welcome packs and more; a range of experts to help along the way.

Together, ™ • Tabletbring with SpeedPix for of better case conversion; they’ll the publicloaded image your practice • Marketing consultancy for 6 months to help the practice into the 21st century and ensure that you are “stay on plan”; maximising your opportunities for success.

• Training for Dr Enegd and the whole team; By the end answering of the journey, • Telephone training;your practice will look better and presentation function better and your new patient • Treatment coaching; numbers and turnover will grow.and And you will have • New practice management software; a• plan to maintain your success for the future.

A clear roadmap for the practice’s future success.

WIN a complete public image update valued at over $90,000!

The prize, valued at over $90,000, includes a new website, new branding, new uniforms, coaching for you, training for the whole team, an update of your reception area, signage and more (check the website for the growing list).

To enter, you need to make a video on your smartphone or other device and make it fun!

IN!TheUltimate...

W Practice Makeover

Tell us why you want to change! The video should also include: • Information on you, your practice and team show us the team at work • Where your practice is located WINyou a complete public imagehelp update valued at over $90,000!

• Why think you need www.ultimatepracticemakeover.com.au • Any stories of how you’ve tried to grow the practice in the past and what the result was • What you’re really like - don’t be afraid to inject your personality into your video as we want to see the real you!

• Do not include anything in your video you do not want your patients or competitors to see as the videos may be published on Dentevents.TV or elsewhere.

Once selected as the winner by the expert judging panel, the “experiment” begins! Legendary dental marketer Angus Pryor (and a team of other consultants) will work with you over the next 6 months to transform your practice.

Apply now!

Sponsored by... ™

www.ultimatepracticemakeover.com.au 42 Australasian Dental Practice

July/August 2021

Nobel Biocare N1™ Reshaping implantology in just 3 steps nobelbiocare.com/n1

spectrum | NEWS

Nobel Biocare launches the GalvoSurge® Dental Implant Cleaning System

P

eri-implantitis is one of the biggest unsolved problems in dental implantology and its prevalence is expected to increase over time as implant treatment becomes more widespread.1 Implant cleaning is a difficult but essential step in treating peri-implantitis, and the recently launched GalvoSurge Dental Implant Cleaning System offers a new solution that is compatible with most implants on the market.

The GalvoSurge Dental Implant Cleaning System has a unique mode of action that breaks away the biofilm with hydrogen bubbles, leaving the implant completely clean and prepared for additional therapy such as bone regeneration.2,3 An easy-to-use system, the process takes two minutes per implant and cleans hard-to-reach areas including threads, undercuts and microstructures.3 While cleaning methods such as mechanical or instrumental debridement can destroy the implant surface while still leaving bacteria behind, the GalvoSurge system lifts the biofilm matrix from the surface with hydrogen bubbles. This is achieved by spraying an electrolyte solution around the implant and activating an extra-low voltage, creating an electrolysis. This cleaning method does not harm healthy soft and hard tissue.

The first randomised controlled clinical trial has shown excellent results.2 All implant sites treated with the GalvoSurge system were free from inflammation and full or significant bone fill was achieved in all implants depending on the bone defect. Cleaning with GalvoSurge attained an implant surface where complete re-osseointegration is possible.2 In an in vitro study, the GalvoSurge Dental Implant Cleaning System removed oral biofilm and bacteria significantly better than other methods of cleaning dental implants currently available on the market.3 Invented and manufactured by the Swiss company GalvoSurge Dental AG, this dental implant cleaning system is distributed exclusively by Nobel Biocare.

The Swiss Medtech Association has announced that GalvoSurge Dental is a top-three finalist out of fifty candidates for the Swiss Medtech Award 2021, which “recognizes outstanding achievements in the Swiss medical technology industry”. The winner will be declared on September 8th, 2021.

44 Australasian Dental Practice

Co-inventor and co-founder of GalvoSurge Dental AG, Dr Urs Brodbeck, said “As an implant specialist, I have seen firsthand the need to re-think the ways that implant surfaces can be cleaned. With several years’ research and development, we created a cleaning system that’s proven to completely remove the biofilm using a mode of action that outperforms conventional methods. We are delighted in partnering with Nobel Biocare to make the GalvoSurge Dental Implant Cleaning System available to as many practices as possible”.

A non-exhaustive list of implants that can be cleaned with the GalvoSurge Dental Implant Cleaning System GS100 and more information is available at www.nobelbiocare.com/galvosurge 1. Sanz M, Noguerol B, Sanz-Sanchez I, et al. European Association for Osseointegration Delphi study on the trends in Implant Dentistry in Europe for the year 2030. Clinical Oral Implants Research, 30(5), 476-486.

2. Schlee M, Rathe F, Brodbeck U, et al. Treatment of Peri-implantitis-Electrolytic Cleaning Versus Mechanical and Electrolytic Cleaning-A Randomized Controlled Clinical Trial-Six-Month Results. J Clin Med 2019;8(11):1909.

3. Ratka C, Weigl P, Henrich D, et al. The Effect of In Vitro Electrolytic Cleaning on Biofilm-Contaminated Implant Surfaces. J Clin Med 2019;8(9):1397.

July/August 2021

OsseoDirector™

1. Direct

The OsseoDirector is the first instrument in the Nobel Biocare N1™ System site preparation protocol that defines the final implant position.

nobelbiocare.com/n1

contact us

© Nobel Biocare Services AG, 2021. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. All product images are for illustration purposes only and may not be an exact representation of the product. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions.

spectrum | NEWS

Pearls for your practice: Tetric Prime by Ivoclar Vivadent

By Joshua Austin, DDS, MAGD

I

grew up in the 1980s. As a male, that typically means one thing—I was obsessed with Transformers.

Every boy in the ‘80s grew up wilding for these transforming robots where there is more than meets the eye. Toys, cartoons and movies... the trifecta of taking money from kids during this era.

For Christmas in 1985, I got one of my most favourite gifts ever, a first-generation Optimus Prime action figure. It was the coolest toy ever produced. It transformed so smoothly from the leader of the Autobots to a prime mover. I wish I still had it. Anytime I see the word Prime, I

am reminded of that Christmas morning in 1985. It just makes me smile. Optimus Prime—smile. Amazon Prime—smile.

Tetric Prime—smile! Primes never disappoint and Tetric is no different.

Tetric Prime is the newest flagship resin composite from Ivoclar Vivadent.

It is a high-quality universal composite that is focused on great handling properties. It handles very smoothly with perfect adaptation and contouring. It is definitely on the creamy side of the handling spectrum, which works really well for adaptation and shaping. Handling isn’t the only prime time feature of Tetric Prime, though. In addition to superb handling, Tetric Prime can do what you need it to do aesthetically.

46 Australasian Dental Practice

From simple to complex, Tetric Prime is a great choice. It can be used as a single-shade system for posterior teeth or for anterior teeth without major dentine involvement. In situations of anterior teeth with large defects or heavily stained dentin, low-translucency dentine shades are available to layer. Tetric Prime has an amazing chameleon effect due to the refractive index of the monomer matrix. It matches the refractive index of the fillers, which leads to an indistinguishable blend.

“Tetric Prime has an amazing chameleon effect...

It matches the refractive index of the fillers, which leads to an indistinguishable blend...”

In addition to handling and aesthetics, Tetric Prime meets the physical standards as well. With shrinkage stress below 1 megapascal (MPa), Prime can be trusted in posterior restorations with high C-factor.

Tetric Prime is not a bulk-fill material and should be placed in 2 mm increments to achieve this shrinkage stress.

Prime inherits the famous Ivoclar radiopacity. Ivoclar always has some of the most radiopaque materials on the market. Prime is no different.

One of the biggest trends over the last few years has been single-shade composite restorations. Tetric Prime introduces Ivoclar’s version of this, T Shade. T Shade is a highly translucent universal shade that chameleons very well for class I and class II restorations. In addition to T shade, Tetric Prime also comes in Universal A1, A2, A3, A3.5, A4, B1, B2 and C2 shades.

Dentine shades are A2 and A3.5. There is also a BL1 bleach shade.

Tetric Prime gives you everything you need for a flagship universal resin composite. Handling, aesthetics and convenience are high on the list of plusses for Tetric Prime. Just like its namesake Optimus, Tetric Prime is more than meets the eye!

Originally publsihed in Dental Economics May 2021. Reprinted with permission.

July/August 2021

2. Shape The OsseoShaper instrument preserves vital bone due to less trauma with low speed and no irrigation.1*

nobelbiocare.com/n1

contact us

1. Chen CH, Coyac BR, Arioka M, et al. A Novel Osteotomy Preparation Technique to Preserve Implant Site Viability and Enhance Osteogenesis. J Clin Med. 2019;8(2):1-13. * Data on file. © Nobel Biocare Services AG, 2021. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. All product images are for illustration purposes only and may not be an exact representation of the product. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions.

spectrum | NEWS

Load your videos on Dentevents.TV

V

ideos on anything to do with dentistry can now be loaded by anyone through the Dental Comminity portal for streaming on Dentevents.TV. “Since we launched Dentevents.TV last year in response to the first of the COVID-19 lockdowns, we’ve painstakingly loaded hundreds of videos onto the platform on behalf of others,” said Joseph Allbeury, publisher of this magazine and Dentevents.TV. “Now we’ve released new functionality within www.dentalcommunity.com.au to allow anyone to DIY. You simply login, click Manage Your Videos and then Add Video to begin the upload process.

“With this next natural evolution of Dentevents.TV, we’re hoping to attract a more diverse range of content for the platform and in doing so, attract an even larger and more diverse audience.

New Dentevents.TV features include...

Ability to upload your own videos for streaming on www.dentevents.tv n Content can be anything dental! n Engage with your viewers like never before n Allocate CPD for watching your videos with or without a CPD quiz n Create your own channel and build an audience n Create your own private education platform n Monetise your videos to earn $$$ n

“To date, the content is largely based on recorded webinars and information relating to dental products,” Mr Allbeury said. “And we have also started producing our own content series as well, but we need much more. By allowing anyone to upload videos, we hope to be able to help content creators build their profiles.

“Educational content creators will have a platform to stream videos, issue CPD certificates to viewers or ask CPD quizzes.

Content can also be monetised on a payper-view or subscription basis if desired.”

Organising a dental event, l show or we New Expresscongress, Listings fortrade dentevents.com Sign in to www.dentalcommunity.com.au and you can start adding videos today!

D

entevents.com, the dental from that for webinar organisers, and A link will be emailed to you that can profession’s go-to source indeed all event organisers, is that more be used to edit the event if required, again of upcoming post-gradand more dental professionals will check without the need to login. uate dental education and Dentevents.com when looking to find out “Express Listings are not designed to events, has added a new replace Standand and Premium listings,” EXPRESS Listing option Mr Allbeury said. “Express Listings that can be used to rapidly add events to include less information than traditional the calendar without the need to login with Dentevents listings and do not include links a username and password. to the organiser, venue and speaker infor“Overall, we’ve added the new Express mation pages. Express listings also cannot Listing facility to Dentevents.com to accept registrations and payments for increase the number of events being listed events. The Express listings are designed on the calendar by making it a quick to rapidly add events to the calendar if 2-minute process,” said Dentevents.com you do not have a login. For everything publisher, Joseph Allbeury. “And more else, the traditional pathway applies.” specifically, we’re targeting webinar Mr Allbeury said the new Express Listevents with the Express Listing because ings were part of the ongoing evolution of the cycle of these events is far more rapid about upcoming events because the inforDentevents.com to provide a platform to than traditional face-to-face events. mation available is so comprehensive.” help event organisers reach greater audi“We’re seeing webinars promoted a To use the Express Listing, simply ences for their events as well as providing few days to a few weeks ahead of broadvisit www.dentevents.com, select Adding tools to accept registrations and payments, cast and so by facilitating rapid listing Events and then Express Listing. A form manage delegates and allocate CPD. onto Dentevents.com, we will see more is then displayed and once completed, If you’re organising any kind of post-graduate dental education, event or webinars being added. The outcome your eventyour will event be reviewed and posted.

For more information, see dent.events webinar, listing on the dentevents.com continuing education

GO EXPRESS»»»»» calendar is now easier than ever.

2021 48 Australasian Dental Practice No username, no password and no need to login - add yourJuly/August event

Nobel Biocare N1™ Implant System

3. Place

The trioval design of the Nobel Biocare N1 Base with the Xeal™ surface embraces the Mucointegration™ principle. Engineered for stability 1 and early tissue integration2 , the Nobel Biocare N1 Implant is optimised for immediate placement and function.

nobelbiocare.com/n1

contact us

1. Velikov S, Camenzind M, Fabech J, et al. Stability of a New Trioval Implant in Bone Surrogate Model. J Dent Res. 2020;99 (Spec Iss A):3052.

2. Yin X, Li J, Hoffmann W, Gasser A, Brunski JB, Helms JA. Mechanical and Biological Advantages of a Tri-Oval Implant Design. J Clin Med. 2019;8(4):1-13.

GMT 76116 © Nobel Biocare Services AG, 2021. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. All product images are for illustration purposes only and may not be an exact representation of the product. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions.

spectrum | NEWS

Software and implant prosthetics components for more than 140 implant systems from a single source

Z

irkonzahn has acquired a worldwide reputation as a manufacturer of zirconia, materials and CAD/ CAM solutions. However, it is less known that the South Tyrolean firm has become one of the largest suppliers of implant prosthetics components, which are available for more than 140 implant systems.

From the software for planning the implant positions, to analogues for capturing already placed implants, titanium bases, multi-unit abutments and precast abutment blanks with industrially pre-milled implant connections, Zirkonzahn produces everything in its homeland in the Italian Alps, according to the high standards applied to the whole production process: intelligent solutions, precision and quality. Most Zirkonzahn implant prosthetic components are manufactured with high-quality grade 5 titanium. With quality as the highest priority, the company assumes responsibility to ensure that implant products can be used with precision and guarantee: Zirkonzahn implant abutments are warrantied up to 30 years, including the implants from other manufacturers used with Zirkonzahn implant abutments. Zirkonzahn implant prosthetics components are 100% integrated into the workflow and software developed by the firm via corresponding libraries. Exocad and 3Shape users may also download and implement Zirkonzahn components for free in their design software through a dedicated portal (Zirkonzahn Library Download Center).

50 Australasian Dental Practice

With Zirkonzahn.Implant-Planner software, technicians can provide their dentists with all components required for an implant case simultaneously (surgical guides, immediate load restorations, custom impression trays and/or milled models with laboratory analogues). The design of the prosthetic restoration can be considered during the implant planning phase, allowing the dentist to determine the optimal implant position. The software is available in two versions: one for the lab and one for the practice.

Zirkonzahn implant prosthetic components line has recently been expanded with new products. Check if the wide range of components is compatible with your implant system and get to know more about the company’s digital workflow! Visit www.zirkonzahn.com or contact Alphabond Dental Pty Ltd e-mail stan@alphabond.com.au or call (02) 9417-6660.

July/August 2021

Scan to see all available components

H��H �U�L��Y �Y z�R�O�z�H�

IMPLANT PROSTHETICS – ALL COMPONENTS FROM A SINGLE SOURCE WITH UP TO 30 YEARS WARRANTY

*A WIDE R RANG E OF COMPO NENTS!

*NEW! TITANIUM BASES K85, TITANIUM BASES K80 ANGLED SCREW CHANNEL (ASC), MULTI UNIT ABUTMENTS 17°, ZZ LOC-CONNECTORS

Alphabond Dental Pty Ltd – T +61 2 9417 6660 – stan@alphabond.com.au – www.alphabond.com.au Zirkonzahn Worldwide – T +39 0474 066 680 – info@zirkonzahn.com – www.zirkonzahn.com

spectrum | NEWS

Are your details up-to-date on dentist.com.au?

I

t’s now easier than ever to add or update your dental practice on Australia’s #1 find-a-dentist website www.dentist.com.au. A new option allows you to add all your information using a simple form with your practice being added or updated within 24 hours of submission.

“Since we added the new form to make it easy to add or update your details two months ago, we have had more than a hundred submissions,” said Joseph Allbeury, publisher of this magazine and dentist.com.au.

“If you have a login to the Dental Community website, then adding and updating practices has always been easy,” “However, if you’re checking out your information on the web and end up on dentist.com.au, then how to add or update your details was less straighforward.

“By adding this form, it alleviates the need to email or call us and it captures all the information we need. And dentists are using it more and more, particularly while they are working less over the revolving door of lockdowns we’re experiencing at various times around Australia.”

A million searches a year are made on dentist.com.au by the public looking for a dentist. Ensuring your practice is listed and the information is correct will directly result in more patients in your dental chair.

“Dentist.com.au is such a success because it lists every dental practice and every dental practitioner in Australia [and New Zealand on dentist.co.nz],” Mr Allbeury said. “There is no charge to be listed and our goal is to list every private dental practice, corporate practice, health fund clinic, public dental clinic and denture clinic.”

Every dental professional is also entitled to a free login to www.dentalcommunity.com.au where you are able to control your presence on dentist.com.au (and dentist.co.nz) including access to live Google™ Analytics™ info about your listing.

To obtain a free login, click the Sign In button on www.dentalcommunity.com.au or to use the “easy add” function, visit dentist.com.au/information-for-dentists

52 Australasian Dental Practice

International Update

The paper, Could there be a link between oral hygiene and the severity of SARS-CoV-2 infections? (Sampson V et al. British Dental Journal 2020;228(12):971-975), investigates the potential link between SARS-CoV-2 and bacterial load, questioning whether bacteria may play a role in bacterial superinfections and complications such as pneumonia, acute respiratory distress syndrome and sepsis. The four main comorbidities associated with an increased risk of complications and death from COVID-19 are also associated with altered oral biofilms and periodontal disease, hence why the link between poor oral health and COVID-19 complications is suggested. Periodontopathic bacteria are implicated in systemic inflammation, bacteraemia, pneumonia and even death.

Periodontopathic bacteria are present in high levels in patients severely infected with SARS-CoV-2. Bacterial superinfections are common in patients suffering from a severe case of COVID-19, with more than 50% of deaths exhibiting bacterial superinfections.

Respiratory viruses predispose patients to bacterial superinfections, hence oral hygiene and pre-existing oral disease could alter the severity and mortality risk of COVID-19. We recommend that oral hygiene be maintained, if not improved, during a SARS-CoV-2 infection in order to reduce the bacterial load in the mouth and the potential risk of a bacterial superinfection Tooth loss is a risk factor for cognitive impairment and dementia -- and with each tooth lost, the risk of cognitive decline grows, according to a new analysis led by researchers at NYU Rory Meyers College of Nursing and published in The Journal of Post-Acute and Long-Term Care Medicine as Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia.

The study’s senior author, Bei Wu, PhD, Dean’s Professor in Global Health at the College and co-director of the NYU Aging Incubator, said “Given the staggering number of people diagnosed with Alzheimer’s disease and dementia each year and the opportunity to improve oral health across the lifespan, it’s important to gain a deeper understanding of the connection between poor oral health and cognitive decline.” Dr Wu and her colleagues conducted a meta-analysis using longitudinal studies of tooth loss and cognitive impairment. The 14 studies included in their analysis involved a total of 34,074 adults and 4,689 cases of people with diminished cognitive function. The researchers found that adults with more tooth loss had a 1.48 times higher risk of developing cognitive impairment and 1.28 times higher risk of being diagnosed with dementia, even after controlling for other factors. However, adults missing teeth were more likely to have cognitive impairment if they did not have dentures (23.8 percent) compared to those with dentures (16.9 percent); a further analysis revealed that the association between tooth loss and cognitive impairment was not significant when participants had dentures, suggesting that timely treatment with dentures may protect against cognitive decline.

July/August 2021

ARE YOU DOING ALL YOU CAN FOR PAEDIATRIC PATIENTS? Most children have a developing malocclusion which is associated with craniofacial growth, breathing disorders and poor myofunctional habits.

Learn to identify these issues from the comfort of your own home!

START YOUR FREE ONLINE COURSE TODAY myoresearch.com/free-course-adp

ONLINE CPD CENTRE the cutting | EDGE

READ ME FOR CPD

READ ME FOR

CPD

Winning, wasting and whingeing: The importance of understanding fluid flow in dentistry

Washer disinfectors for dental practice - what does the evidence say?

By Emeritus Professor Laurence J. Walsh AO

By Emeritus Professor Laurence J. Walsh AO

G

etting the fundamentals of fluid flow right is essential for safe and effective clinical practice. This article is the first in a series which will address the key concepts around fluid flow and their practical implications for everyday clinical practice. This article will focus on the more basic concepts around positive pressure and fluids. In later articles, we will address negative pressure (including dental suction), as well as more complex phenomena including phase separation and shear thinning.

58 Australasian Dental Practice

Growing up in Australia in the 1960s, I watched many black-and-white television episodes of “Why is it so?”. This popular science program was hosted by the American physicist Julius Sumner Miller, who was famous for his sharp wit and intolerance of error, as well as for his unruly hair (in the style of Boris Johnson) and his hornrimmed eyeglasses.

His TV programs, which continued through to the 1980s, unpacked concepts of serious science for a lay audience. His technique of using short scenarios, which came to be known as Millergrams, is the foundation for the approach that will be used across this series of articles.

July/August 2021

I

ntra-oral dental procedures involve contact of a medical device or surgical instrument with a patient’s oral mucous membranes and in some cases, with their sterile soft or hard tissues. A major risk of any such procedure is the introduction of pathogens that can lead to infection.

A failure to properly reprocess instruments could cause pathogens to be introduced into a site and also spread pathogens from one patient to another.1-3 Ensuring that items are clean is an essential requirement before they are packaged for steam sterilisation. All manual procedures are subject to operator variation as a result of time

constraints or tiredness. Automated cleaning using a washer-disinfector (WD) has the major advantage of being reproducible and able to be tested and repeated.

Multiple studies in many countries have documented that failures to comply with scientifically-based guidelines has led to such events. Deficiencies leading to infection have occurred either from failure to adhere to scientifically based guidelines, or misuse of disinfection or sterilisation processes.4-6 The elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency, is the reason why mechanical cleaning is advocated in reprocessing guidelines around the world. Given this background, the purpose of this article is to lay out the evidence around best practice for use of a washer disinfector in dental practice.

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July/August 2021

Question 1. The internal resistance of a fluid to flow when under stress is called its:

Question 6. Infection control guidelines advocate the use of automated washer disinfectors because:

a. Porosity b. Saturation Point c. Viscosity d. Density

a. All manual procedures are subject to operator variation. b. The process is reproducible and able to be tested and repeated. c. Skin-puncture injuries are reduced. d. All of the above.

Question 2. Fluids that have a constant viscosity independent of stress are termed:

Question 7. A soil test to check the efficacy of a washer disinfector should:

a. Flowable b. Newtonian c. Non-Newtonian d. Dynamic

a. Only contain animal blood. b. Represent light soiling conditions. c. Only contain Synthetic polymers. d. Represent worst-case conditions.

Question 3. An example of a non-Newtonian fluids is:

Question 8. A type of test “soil” used to assess the cleaning performance of a Washer Disinfector is called:

a. Shampoo b. Honey c. Bonding agents d. Fluoride varnish e. All of the above Question 4. In non-Newtonian fluids, the relationship between the applied force and movement of the fluid is not constant: a. True b. False

a. Heparinized 10% goat’s blood. b. Hucker’s soil. c. Milson’s soil. d. Glasgow soil. e. All of the above.

Question 9. Commercial tests for Washer Disinfector efficacy include:

Question 5. The lower the viscosity of a fluid, the greater its resistance to flow:

a. The Browne STF Load Check Indicator. b. gke Clean-Record. c. Chemdye ‘SPLAT’ test. d. Getinge Wash-Checks. e. All of the above.

a. True b. False

Question 10. A washer disinfector is not suitable for cleaning: a. Dental burs. b. Tubing used in the circuits for relative analgesia. c. Hand endodontic files. d. Surgical instruments with hinges. e. Any of the above.

INSTRUCTIONS: Australasian Dental Practice™ is now offering PAID subscribers the ability to gain 2 Hours CPD credit from reading articles in this edition of the magazine and answering the questions above. To participate, log in to the Dental Community website at www.dentalcommunity.com.au (call (02) 9929-1900 if you do not have a login) and click on the CPD Questionnaires link; select the Australasian Dental Practice Jul/Aug 2021 questionnaire and then click START. A score greater than 80% is required to PASS and receive CPD.

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD infection | CONTROL

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Non-invasive microveneer restoration made of the hybrid ceramic VITA ENAMIC With Dr Michael Tsao and Dr Hsuan Chen

P

roducing noninvasive microveneers using CAD/CAM systems has been a major challenge so far, due to the brittleness of ceramic dental materials. The very small wall thicknesses and thinly tapering edge areas of such restorations often showed significant ceramic chipping or fractures after CAM production. The dental team of Dr Michael Tsao and Dr Hsuan Chen systematically examined a variety of ceramic material samples in numerous test runs. They selected the hybrid ceramic VITA ENAMIC (VITA Zahnfabrik, Germany) for their restoration.

Based on their clinical experience, this material still allows a very good marginal integrity even with wall thicknesses of 0.2 mm. In this report, the practitioners show the non-invasive, model-free and fully digital restoration of a diastema.

Key things to know about sterilisation pouches?

S

terilisation pouches are single-use, peel-open pouches designed to hold items during sterilisation.

Not all pouch materials are suitable for use in all types of sterilisation processes, so different pouches are required depending on the sterilisation processes available.

For example, special pouches are needed for hydrogen peroxide gas plasma sterilisation. These differ from those used for steam sterilisation.

Plastic/paper pouches are used for steam sterilisation. The plastic side of the pouch allows clear visualisation of the contents and the chemical indicator. The paper side allows air removal and the sterilant to enter the pouch.

Assessment and planning 29-year-old male patient presented in the practice because he was dissatisfied with his diastema between teeth 11 and 21. He rejected orthodontic therapy. He wanted a time-efficient solution with the greatest possible preservation of the natural tooth substance. The usual production of microveneers on refractory stumps was too lengthy for him. Therefore, the practitioners and patient decided to implement the gap closure in the digital workflow using VITA ENAMIC hybrid ceramics in a single session.

A Recommended use terilisation pouches are recommended for smaller, lightweight, low profile items. They are available in various sizes and configurations to enclose loose groups of instruments and offer various types of built-in chemical indicators. If an instrument appears to be too heavy or large for a pouch, another packaging method should be used.

Sterilisation pouches have four primary objectives: 1. They must allow penetration of the chosen sterilant and be compatible with any other requirements of the sterilisation process; 2. They must be able to maintain the sterility of package contents until opened;

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88 Australasian Dental Practice

3. They must create a package that can be opened without contaminating the contents by the user; and 4. They must permit the contents to be sterile at the point of use.

Pouches should also be “tamper evident” so that a pouch opened in error cannot be resealed without complete reprocessing.

Tooth shade determination and digital design fter meticulous cleaning of the restoration area, the tooth shade was determined with the VITA Toothguide 3D-MASTER (VITA Zahnfabrik, Germany) on the two central incisors in the upper jaw. The tooth shade 1M2 was determined and the corresponding blank selected. After retraction threads were laid, the intraoral scan was performed with CEREC Omnicam (Dentsply Sirona, Germany). Because of the high enamel translucency of the tooth in the approximal region, scanning powder was applied to facilitate intraoral scanning. Sirona Connect transferred the data record to the inLab software. There, the razor-thin microveneers were digitally constructed.

A

Choosing a sterilisation pouch hen choosing a sterilisation pouch made of paper and plastic (transparent polypropylene or polyester), ensure it is of adequate size to accommodate the instruments to be sterilised. Paper bags/ wraps used for steam sterilisation are required to conform to AS 1079.3-1994 Packaging of items (sterile) for patient

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a. 0.5 mm b. 0.4 mm c. 0.3 mm d. 0.2 mm e. 0.1 mm Question 12. The shelf life of a processed sterilisation pouch is: a. 6 months b. 1 year c. 18 months d. 2 years e. Based on how it is stored and handled.

Question 13. At a minimum, a sterilisation pouch should be labelled with: a. Steriliser used b. Cycle/load/batch number c. Date of sterilisation d. All of the above.

Question 14. Pouches used for steam sterilisation should have a built in: a. Class 1 chemical indicator. b. Class 2 chemical indicator. c. Class 3 chemical indicator. d. Class 4 chemical indicator.

Question 15. Paper bags/wraps used for steam sterilisation are required to conform to:

“VITA ENAMIC enables non-invasive treatment of diastemata in a digital workflow...” ceramic-polymer network structure, the hybrid ceramic has a significantly higher elasticity and less brittleness than traditional ceramic CAD/CAM materials. This enables high-precision reconstructions with simultaneously low wall thicknesses. Finally, the graceful restorations were carefully separated from the attachment with a fine diamond, finalised and tried-in.

Conditioning according to proven protocol ITA ENAMIC has a stable, highly networked ceramic matrix. The ceramic portion of the material is 86 percent (wt%). As a result, the hybrid ceramic can be preconditioned using hydrofluoric acid and silane, according to the traditional, all-ceramic protocol. CAD/CAM composites, on the other hand, are sandblasted because they have a polymer matrix in which ceramic fillers are embedded. Sandblasting, however, can lead to damage of the material structure and thin edge areas in reconstructions with low wall thicknesses. In the present case, the microveneers were pretreated with the safer protocol. The enamel was conditioned with phosphoric acid and adhesive. Afterwards, the veneers were fixed with a composite cement. After removal of the composite residues and polishing with the VITA ENAMIC Polishing Set, a highly aesthetic result was achieved efficiently and non-invasively after only one session.

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116 Australasian Dental Practice

July/August 2021

Question 11. Medical-grade paper used in sterilisation pouches has controlled porosity and has no pinholes larger than:

CAM fabrication with a highly precise result or CAM production with the CEREC MC XL System (Dentsply Sirona, Germany), the VITA ENAMIC blanks were fixed in the grinding unit and the corresponding grinding job was carried out. The grinding result showed razor-thin microveneers with absolutely precise edge areas. Thanks to its dual

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July/August 2021

Question 16. Micro veneers produced via Computer Aided Manufacturing... a. Has always been a challenge due to chipping of materials. b. Is easy to do. c. Can only be made with PMMA. d. Is not good for veneers.

Question 17. Vita Enamic in the Denstply Sirona MCXL... a. Cannot create veneers. b. Has been found to create razor thin micro veneers. c. Should only be used for crowns. d. Is very slow to grind.

Question 18. The ceramic portion of Vita Enamic is... a. 96% b. 76% c. 59% d. 86% Question 19. Sandblasting Vita Enamic... a. Can cause damage to thin edge areas. b. Should be done on high pressure. c. Should only be done using glass bead. d. Should only be done using small steel shot.

Question 20. Vita Enamic... a. Is too hard to polish. b. Takes an hour to polish. c. Is easily polished and polishes well. d. Needs no polishing.

a. AS/NZS 4815:2006 b. AS 1079.3-1994 c. AS 1410-2003 d. AS/NZS 4179:2014

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abstracts | 2021

A summary of the latest research

By Emer. Prof. Laurence Walsh AO

A periodontal cytokine storm in a pandemic

eriodontitis has long been attributed to having its pathophysiology rooted in a cytokine response. COVID-19 infection can cause adverse outcomes related to the establishment of a cytokine storm, with elevated serum levels of IL-1, TNF, IL-7, IL-10, IL-17, and other cytokines, and elevated Th17 pathways. Many of these components are shared in common with the cytokine expression profile of periodontitis. This similarity between COVID-19 and periodontal disease argues for stressing maintenance of oral hygiene in the COVID era, and “red flags” patients with periodontitis as having an increased risk of more severe adverse outcomes from COVID infection. Elevated levels of cytokines detected in periodontal sites mirror those in the systemic circulation. Non-surgical periodontal treatment leads to a fall in the levels of inflammatory cytokines such as IL-17 both in the gingival crevicular fluid and in the serum of patients with periodontal disease. Understanding this local and systemic cytokine association underscores the importance of keeping periodontal disease under check, and the value of maintaining meticulous oral hygiene in the COVID-19 era.

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Sahni V, Gupta S. COVID-19 & periodontitis: The cytokine connection.

Med Hypotheses 2020;144:109908. doi: 10.1016/j.mehy.2020.109908.

Sharps injuries during dental education

percutaneous exposure incident (PEI) involves an exposure of cutaneous or mucous membranes to blood and bodily serum, often as a result of a needlestick or sharps injury. This exposure may then lead to the transmission of a bloodborne virus (BBV).

The dental setting poses a constant risk of sustaining a PEI due to the common use of sharp instruments, a small operating field coupled with frequent patient movement. The aim of this study was to retrospectively examine trends in PEIs at an Australian dental school, and to explore underreporting rate of PEIs, current attitudes, and awareness of PEI safety protocols by clinical staff and students in 2019. Retrospective data were collected from deidentified archival incident reports from 2009 to 2019 from a central incident reporting system. As well, cross-sectional data were collected via validated PEI questionnaires completed by clinical staff and students in 2019. There were a total of 1156 injuries reported in the 11-year period, including 618 PEIs. Of the PEIs, some 82.0% occurred in clinics, 12.5% occurred in the preclinical lab setting, and 5.5% in the sterilisation area. Some 79.9% of the reported PEIs involved students. Local anaestheticrelated procedures were the most common cause, resulting in skin penetrating injuries to one finger. Meanwhile, for staff members there was a sustained reduction in incident reports since 2015, which coincided with relocation to a newly constructed clinical facility that had an improved design, including larger sharps containers, instrument cassettes, and mechanised cleaning processes to reduce handling of loose instruments. For the survey, the response rate was 70.8%, with 345 respondents completing the questionnaire. There were 38 PEI exposures in the past 2 years,

A

56 Australasian Dental Practice

but only 22 of these were reported, giving an under-reporting rate of 42.1%. The most common reasons for not reporting were the injury was minor (38.9%), the sharp item was clean and unused (16.7%) and dissatisfaction with delays and injury follow-up procedures (16.7%). Overall, students were at a much higher risk of sustaining a PEI than staff members. Reported knowledge of PEI classification and prevention is inadequate, suggesting that further education on prevention of PEI is needed. Some 80.3% of respondents were receptive to such further education. This present an opportunity for dental schools to provide greater training on sharps handling such as annual safety reviews, to increase awareness and compliance.

Huynh R et al. Identifying trends of percutaneous injuries at an Australian dental school. International Dental Journal 2021: 1-7 (early view online)

Pfizer vaccine results are affected by age

he COVID-19 pandemic has led to an urgent need for vaccines, particularly among persons at high risk for severe disease and death, such as the elderly. However, only 4.3% of participants in the Pfizer vaccine efficacy trial were >75 years of age. Given the elderly generally have weaker immune responses after vaccination, more detailed investigation is necessary. We investigated SARS-CoV-2–specific antibodies, maturation of IgG avidity, and interferon-γ (IFN-γ) release of SARS-CoV-2–specific T cells in 2 cohorts of young and elderly persons in berlin after vaccination with Pfizer. The first cohort consisted of 123 healthcare workers (median age 34 years), while the second cohort consisted of 71 elderly residents of an assisted living facility (median age 81 years). There was a substantial delay and overall reduced antibody response in elderly participants. In addition to antibody responses, we assessed SARS-CoV-2 spike-specific T cell responses by an IFN-γ release assay (IGRA). IFN-γ release was significantly decreased in the elderly compared to younger participants. In summary, vaccination with Pfizer (BNT162b2) induces both arms of adaptive immunity: SARS-CoV-2–specific antibodies and SARS-CoV-2– specific T cells. However, we observed delayed and less robust cellular and humoral immune response among the elderly than among younger adults. Therefore, strategies focused solely on vaccination of high-risk groups might be insufficient to protect those at risk for severe disease. For the elderly, vaccination of caregivers and close contacts should be prioritized. Moreover, a booster vaccination, altered vaccine dose, or different COVID-19 vaccines should be considered for the elderly if further evidence demonstrates high rates of breakthrough infections despite 2-dose Pfizer vaccination.

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Schwarz T et al. Delayed antibody and T-cell response to BNT162b2 vaccination in the elderly, Germany. Emerging Infection Diseases 2021; 27(8), August 2021. https://wwwnc.cdc.gov/eid/article/27/8/21-1145_article

July/August 2021

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Winning, wasting and whingeing: The importance of understanding fluid flow in dentistry

By Emeritus Professor Laurence J. Walsh AO

G

etting the fundamentals of fluid flow right is essential for safe and effective clinical practice. This article is the first in a series which will address the key concepts around fluid flow and their practical implications for everyday clinical practice. This article will focus on the more basic concepts around positive pressure and fluids. In later articles, we will address negative pressure (including dental suction), as well as more complex phenomena including phase separation and shear thinning.

58 Australasian Dental Practice

Growing up in Australia in the 1960s, I watched many black-and-white television episodes of “Why is it so?”. This popular science program was hosted by the American physicist Julius Sumner Miller, who was famous for his sharp wit and intolerance of error, as well as for his unruly hair (in the style of Boris Johnson) and his hornrimmed eyeglasses.

His TV programs, which continued through to the 1980s, unpacked concepts of serious science for a lay audience. His technique of using short scenarios, which came to be known as Millergrams, is the foundation for the approach that will be used across this series of articles.

July/August 2021

the cutting | EDGE Table 1. Examples of fluids according to their behaviour

Newtonian non-Newtonian

Table 2. Viscosity of common items in centipoise (cP)

Water at room temp.

1

water

saliva

simple aqueous solutions

blood

sterile saline

toothpaste

Turpentine

1

EDTA

endodontic medicaments

Cold milk

3

sodium hypochlorite

etching gels

Beer 4

hydrogen peroxide

bleaching gels

Blood 10

mouthrinses

fluoride gels

Kerosene

citric acid

prophy paste

local anaesthetics

bonding agents

Cream 17-20

silver fluoride

impression materials

ethanol

fluoride varnishes

isopropyl alcohol

GIC and cements

acetone

MTA

mercury

dental amalgam

composite resin

Viscosity in dentistry and why it matters iscosity is defined as the internal resistance of a fluid to flow when under stress. The property of viscosity is fundamental to understanding how many common materials in dentistry behave - from etching gels, bleaching gels, fluoride gels varnishes, liners and bases, bulk restoratives and temporary cements, through to many materials used in fixed and removable prosthodontics, including waxes and impression materials. It influences how they flow, slump or drag and how they respond to pressure, whether inside a syringe or cartridge, in a tray or from a dental instrument.

V

Materials with higher viscosity have stronger bonds between the components.

An unset flowable composite resin or glass ionomer cement will flow progressively less well as the material begins to set and it becomes more viscous and eventually sets rigid. The same feature is seen with poly(methyl methacrylate) resins used for lining temporary crowns.

The higher the viscosity of a fluid, the greater its resistance to flow. In almost all cases, as the temperature increases, the viscosity decreases; and - conversely - as the temperature decreases, the viscosity increases. Hence, viscosity will be lower when the temperature is higher (refrigerated vs room temperature vs body temperature).

Newtonian versus non-Newtonian fluids

Resistance to flow luid materials, where the bonds between the molecules are weak are less viscous, will form small drops when pushed through a nozzle or a needle. Examples include water, local anaesthetic solutions and endodontic irrigation solutions.

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July/August 2021

he simplest pattern of fluid behaviour is known as Newtonian. Such fluids are so named because they follow Newton’s law of viscosity, i.e., they have a constant viscosity independent of stress.

T

Water at 1°C

1.8

10

Vegetable oil

35-40

60% sugar syrup

60

Olive oil

84

Glycerin 880 Honey 1,760 Shampoo 3,000 Chocolate syrup 10,000-25,000 Mayonnaise 20,000 Tomato sauce Toothpaste Vaseline Peanut butter

50,000-70,000 70,000 upwards 64,000 500,000

On the other hand, in non-Newtonian fluids, viscosity can change when the fluid is placed under force, to either become more liquid or more solid. Examples of the two different types of fluid are given in Table 1.

When a material is compressed between two flat parallel plates, creating a film between those plates, a force is required to make those plates move, or overcome the fluid’s film friction. Dynamic viscosity is a measurement of a fluid material’s internal friction and it is usually reported in units called centipoise. The viscosity of some common substances (measured in cP) is shown in Table 2.

Australasian Dental Practice

59

the cutting | EDGE How the force is applied to the fluid

Table 3. Combinations of applied force and levels of constraint

Small area and low force

endodontic irrigation - high constraint

application of etching gel - low constraint

LA injection into soft tissue - low constraint

Small area and high force

crown cementation - high constraint

LA injection into the hard palate - moderate constraint

Large area and high force

putty wash impression - high constraint

impression in a custom tray - moderate constraint

impression in a stock tray - low constraint

Taking the same concepts a little further, if a liquid is placed between two parallel plates and a force is applied to one plate, there will be a force that develops on the second plate because of the liquid.

If this secondary force and the resulting fluid movement is proportional to the applied force, the liquid is described as a Newtonian fluid. Twice the force would cause the fluid to move twice as fast.

Water is an example of such, as are simple aqueous solutions such as LA and endodontic irrigants.

Some water-based materials, such as acid etchant gels and bleaching gels, do not behave as Newtonian fluids because of the aggregation of particles of thickeners (like carboxymethyl cellulose) within them when pressure is first applied. The higher the loading of such thickeners, the less responsive the gel will be to the initial application of force through the syringe plunger.

In non-Newtonian fluids, the relationship between the applied force and movement of the fluid is not constant and the fluid can undergo either plastic flow, pseudoplastic flow, or dilatant flow (also called shear thickening). These three differ in how the viscosity and flow change as pressure is applied. In plastic flow, no fluid movement occurs until a certain force threshold is sur-

60 Australasian Dental Practice

passed, which then converts the material to behaving like a Newtonian fluid. The classic examples of this occur in viscous dental materials in tubes, including toothpaste and fluoride varnishes. As force is applied, initially nothing happens, then one squeezes harder and suddenly there is extrusion of material, in a way that is easy to control through the application of force. This pattern of behaviour fits with the broader definition of a plastic material, which is defined as one that does not undergo permanent deformation until a certain stress has been exceeded. Many natural foods are non-Newtonian because of their internal structures of fibers, proteins, carbohydrates, lipids or other components. This is immediately obvious when chewing them.

Materials where solvents evaporate (such as bonding agents and fluoride varnishes), or where the material sets progressively over time (such as flowable resins, sealants, GIC and other cements) are dental examples of non-Newtonian fluids. Domestic examples of this type of fluid include shampoo, honey, Golden syrup, soft cheese, jam, paint, nail polish and tomato sauce. In a later article we will discuss the implications of handling non-Newtonian fluids in the clinic and the implications of effects such as shear thinning of fluid.

n important consideration is the force applied per unit area. Table 3 shows a range of common combinations of applied force in relation to surface area and differing levels of constraint in terms of how the fluid can flow. A high constraint situation exists where there is limited opportunity for fluid to flow and disperse, creating situations where backpressure can arise. This can lead to the fluid being pushed back in the direction of its delivery, or extruded forwards, with unintended consequences. Considerations around constraint are fundamental when cementing crowns and veneers, since the cements must be allowed to flow while force is being applied to the restoration.

Considerations around force apply to both Newtonian and non-Newtonian fluids. Consider the difference between cementing a labial veneer on a lateral incisor, where it is held in place by the dentist, to cementing a full gold crown on a molar. While there is a difference in surface area, for the molar the patient’s masticatory muscles will be used to apply force to fully seat the crown. The net result is a greater force per unit area in that situation.

A

Issues with dental products delivered in syringes onsider the situation where a scheduled dento-alveolar surgical procedure is being planned. The dental assistant will be providing irrigation with sterile saline using a disposable syringe.

The assistant can choose to use a 10 mL, 30 mL or 60 mL disposable syringe. Each syringe has the same nozzle diameter of 2 mm. Let us assume that the saline behaves as a Newtonian fluid and that the dental assistant will apply the same force with her thumb to the plungers of each of the three different types of syringe. The syringe internal diameters are 15 mm, 22 mm and 28 mm, giving plunger surface areas of 1.8, 3.8 and 6.2 cm2, respectively.

This will lead to a variation of some 3.5 fold in the flow rate of saline between the largest syringe and the smallest syringe, simply because the same force is being applied to a much smaller surface area.

The high flow rate of the smallest syringe will also cause this to need to be refilled so often that it becomes impractical.

C

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the cutting | EDGE “When dental staff are dispensing composite resin from syringes, they need to appreciate that there will be a delay between when force is applied to the end of the syringe and when composite material is extruded from the nozzle of the syringe...”

An additional point to consider is the interaction between the plunger and the barrel of the syringe. Generally, this does not lead to any problems, however with some dental materials, especially hydrogen peroxide bleaching solutions, the neoprene or polyisoprene synthetic rubber of the bung becomes sticky due to oxidative degradation. As a result, there is resistance when first applying force to the plunger. Once this is overcome, the hydrogen peroxide solution contained in the syringe will then behave as a Newtonian fluid and be expressed at a surprisingly very high rate. This is why it is considered good practice with hydrogen peroxide bleaching solutions to gently move the plunger forward and backwards several times to loosen this initial attachment, before attempting to apply force to dispense the liquid. Such instructions around dealing with the so-called “sticky plunger” problem are included in the manufacturer’s advice for some in-office bleaching products.

Materials that are dispensed in syringes can suffer from a range of other issues that alter their characteristics in terms of flow. Phosphoric acid etching journals and water-based calcium hydroxide endodontic pastes are typically thickened using carboxymethyl cellulose. These materials typically become quite dry when the cap is left off the syringe or tube, making the material difficult or impossible to express.

62 Australasian Dental Practice

On the other hand, calcium hydroxide endodontic medicaments that contain no water (such as CalMix™) cannot suffer this problem.

It is important that staff who are handling materials appreciate the non-Newtonian nature of many of the most expensive dental materials, including bonding agents and composite resins. As the volatile solvents in bonding agents evaporate, this will change the viscosity and the shear thinning behaviour of the material, both of which influence how well it can be applied onto tooth surfaces. When dental staff are dispensing composite resin from syringes, they need to appreciate that there will be a delay between when force is applied to the end of the syringe and when composite material is extruded from the nozzle of the syringe. Applying high levels of force with the hope of getting the material to extrude faster will only cause waste, because an excessive material will be produced.

Conclusions nderstanding the differences between Newtonian and non-Newtonian fluid behaviour is important for many common dental procedures to reduce waste and to prevent fluids behaving in ways that lead to adverse outcomes. In later parts of this series we will explore in more detail issues around impression materials and how they behave as non-Newtonian fluids. We will

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also examine some of the dynamics around dental suction approaches including high-volume evacuation and purpose designed evacuation (such as EndoVac™ in endodontics).

About the author Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years.

His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

July/August 2021

AALD Australian Association For Laser Dentistry Dental Conference 2022

MAY 13-15 Tangalooma Island Resort Queensland Proudly Sponsored By:

For information on the conference, venue, speakers and scientific program please visit www.aald.asn.au

practice | MANAGEMENT

Why some dentists dramatically outperform their peers financially: Pitfalls in the business of dental practice

By Graham Middleton

“Some accountants have encouraged dentists to add too many chairs, not realising that invisible profit barriers exist because of the principal dentist spending most work time in their own surgery...”

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entists of similar ability at dental school often end up with vastly different long-term financial outcomes. In 2021dollar terms, the difference at point of practice sale and retirement often amounts to several million dollars. Often the cause lies in incorrect decisions taken early in their careers; having locked into irreversible or difficult-to-reverse decisions, dentists who have made bad decisions can find them difficult or in some cases nigh on impossible to reverse. Meanwhile, a fellow graduating class friend made good decisions and the financial outcomes of each diverge at an accelerating rate.

How critical is first employment? hether by luck or choice, some dental graduates are able to secure employment in a well-run privately-owned non-preferred provider practice and soak up the good atmosphere, thus experiencing how a good practice runs. When years later they own their own practice, they emulate that experience. A good practice imparts work and business habits which are not and cannot be taught at

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dental school. Invariably, the principals of successful practices have smooth running surgeries, high fee generation, good follow-up appointment rates and they generate lots of personal referrals, some of which need to be booked to their assistant dentists.

Their assistants will receive good mentoring but must quickly polish their patient communication skills to generate follow-up appointments and, in reasonable time, personal referrals.

Smart dental students cultivate relationships with their dental lecturers and demonstrators because they are sometimes able to connect them with good practices in advance of graduation. While dental graduates are keen to start earning a sound income, the size of that income is not as critical as gaining employment in a suitable practice on graduation.

Well-conducted privately-owned practices rank well ahead of corporate- or health fund-owned practices in this regard. No dentist will ever be anywhere near as successful spending a career as a contractor in a corporate practice as they will be in succeeding to ownership of a good practice and running it well. Nor, all other things being equal, will a dentist with experience in a corporate practice conduct their own practice as well as a dentist with substantial experience in an efficient, privately-owned practice.

July/August 2021

practice | MANAGEMENT Dental premises he best dental premises are usually free-standing premises able to contain three surgeries for sole owners and four surgeries for dual associateship practices located in long-established suburbs of major cities, but not the most exclusive suburbs where dentists tend to be too plentiful and real estate overpriced. Premises offered for rent in major shopping centers tend to have prohibitive rent which so impacts practice profit as to make some practices unsaleable. Some smaller country towns have such low rents that it may be best not to own premises.

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The new graduates jackpot est of all for a well-performed dental graduate is obtaining employment in a profitable non-preferred provider practice located in good premises, the owner of which is likely to retire in about 8 years; in this scenario the dental graduate can position themselves as practice buyer of choice. This is best done by concentrating on both clinical and interpersonal chairside skills, building up personal referrals and hence a portfolio of bonded patients and by doing everything possible to maintain effective helpful relations with the owner and practice staff.

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Positioning yourself financially he new graduate who is fortunate enough to gain employment in a busy practice and earn a significant wage might be tempted to rush out and buy an expensive motor vehicle, but it is more prudent to be content with modest wheels and begin saving a deposit on their first home.

The important issue is to set themselves up with a savings record which will impress bank lenders when they come to purchase a practice. The dentist who has substantial equity in their home will be well-situated.

The dentist who does not have a good savings record may be turned down or receive inferior terms.

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Structuring borrowings deally, home loans are paid down quickly because interest is not tax deductable, but practice purchase loans

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should be maintained on an interest-only basis because the net after tax cost of borrowing is well below the rate at which competent dentists grow their net wealth.

The gap between the long-term financial net worth of dentists who set themselves up with correctly structured loans and those who don’t becomes huge as the years elapse. Having spent over 33 years advising dentists on financial structuring, I have witnessed the disparity in outcomes. When inevitably interest rates rise from their recent historical low point, the advantage of properly structuring loans will become more advantageous.

Buying the wrong assets have long observed that buying residential rental properties turns out to be a serious mistake in the vast majority of cases. The reality is that the two most successful real estate investments for most dentists have been their family home and their practice premises. Their home is a capital gains tax exempt asset. Most dental couples buy a first home, reduce their home loan and then trade up to their “forever” home. Ideally, each time they buy, they select a home which they can afford to pay off within 12 to 14 years.

Invariably, long-term homes are in areas giving better capital appreciation than residential rental houses. The houses which dentists buy to live in give capital appreciation which is capital gains tax free. It is also exempt from the asset test for the capital gains tax concessions applying to the eventual sale of practice goodwill and premises which are classified as active business assets providing conditions are met. Purchase and ownership must be structured correctly. Residential rental properties give very poor net rental returns after the unavoidable landlord expenses which, unlike commercial leases, cannot be passed on to tenants. The worst longterm real estate investments tend to be high rise residential rental units, particularly those bought off the plan. These defy the underlying wisdom of real estate being that land has a scarcity value and wellpositioned properties appreciate because of locational desirability, but buildings deteriorate. Their ownership invariably conflicts with the proper investment in a dentist’s key four asset classes.

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The huge incidence of poor advice from accountants ccounting practices often have prominent signage indicating that they also give “business advice”, but many accountants demonstrate poor knowledge of actual business operations as they spend nearly all their time completing tax returns in a timely manner to fulfill their obligations to the ATO. They mistake doing tax returns for knowledge of the businesses of their clients and in fact have little knowledge as to how dentists gain their patients, how they build up patient relationships and referrals, how the internal allocation of patients should operate, why they may be paying out the wrong debts or what are the differences between good and mediocre practice outcomes. It is often the case that dentists have been advised by an accountant that they are doing well, yet by the standards of their profession their practice outcome is mediocre. Their accountant has a disparate collection of unrelated business clients among which is a dental practice or two and hence they lack valid knowledge on which to compare outcomes. They have a strong tendency to offer poor advice or, when specifically asked about a particular business decision, endorse the wrong course of action.

The consequence of wrong advice from accountants has a huge impact. It can and does contribute to a massive disparity in wealth over the duration of a dental career.

The impact of bad accounting advice is most acute when advising dentists who are buying a practice. Often the accountant is anxious to gain a new business accounting client and is heavily conflicted toward advising a purchase even though the practice has significant problems, or particular features not apparent to somebody with little knowledge of dentists and their practices. The standard approach of averaging three years’ financial outcomes is insufficient, particularly late in the next financial year, when close attention to current fee bankings and patient bookings is essential. Nor should the figures be looked at in isolation from the type of dentistry being performed if a practice is highly specialised and reliant on the outcome of one extremely specialised and talented individual dentist who it is near impossible to replace. The only dentists capable of replicating such an individual are already heavily involved in running their own successful practice.

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practice | MANAGEMENT On many occasions I was contacted by a dentists’ accountant seeking advice on how the accountant could value their client’s practice because according to the accountant, their client wanted them to do it. The conversation usually went like this: Accountant: “What is the formula for valuing a dental practice?”

Response: “Tell me about your client’s practice!”

Accountant: “It’s a dental practice.”

Response: “I got that, but how many dental chairs are in operation?

Accountant: (hesitantly) “I think he has three or four!”

Response: “Is there anything special about the practice?”

Accountant: “What do you mean by special? It’s a dental practice!”

Response: “I understand that, but does the practice place its own implants or refer them to a specialist? Does it do a lot of crown and bridge or refer significant amounts to a prosthodontist? Does the owner have an interest in orthodontics or refer all cases to an orthodontist? What about root canals? Does the practice have a practice manager? Does it employ an hygienist?

What is the rental value of the premises?”

Accountant: “I think I better ask you to do the valuation!”

These conversations indicated that the accountants concerned had at best a superficial knowledge of their client’s dental practices. Subsequently, when sifting through the financial details of the practices to complete valuations, it was revealed that some very costly mistakes had been made of long-term significance.

Yet the dentists concerned had at various career stages taken huge financial decisions based on their accountant’s advice or with their accountant’s agreement!

Many accountants have tended to encourage clients to gear into several residential rental units which have a history of giving poor returns but supplant better financial decisions. They suit the accountant because they add to the annual accounting bill, but represent poor financial choices compared to the upgrade of a dentist’s home, reducing home debt, accelerating superannuation funding through

a combination of concessional and nonconcessional contributions in order to get more capital behind a low tax shield or renovating practice premises to enhance patient appeal and encourage referrals.

Some accountants have encouraged individual dentists to add too many chairs, not realising that invisible profit barriers exist because of the principal dentist spending most work time in their own surgery. It is rare to find accountants who actually understand what drives dental practice profitability.

Expensive and inappropriate marketing advice have conducted many seminars with dentists. My approach developed into one of dealing with a series of individual topics briefly. With each topic I spoke to the subject on the screen, briefly for a few minutes took one or two questions and passed onto the next topic. When I got to marketing, I asked each audience to participate in an interactive, “hands up” survey.

My first question was to ask the dental audience to put up their hands if they attracted many new patients by letter boxing their suburb/town. The response was always that no hands went up.

My next question was to ask each audience to put up their hands if they attracted many new patients from advertising in a local newspaper. The response was always that no hands go up.

My third question was to ask whether they believed that they go nearly all their new patients from the personal referral of their existing patients and a roomful of hands went up.

My fourth question was, “Do you believe that you get lots of new patients from your website?” The response invariably was that one or two hands in the audience moved uncertainly; then somebody said, “New patients don’t hear of us through our website—but they go to it after they have been referred to us to find out our location and contact details”. This was then confirmed with the audience overall.

My conclusions from hundreds of dentists are that:

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• Most money spent on marketing gurus by dentists is wasted; • The personal communication skills and presentation of those in a practice are of the greatest importance in maintaining the loyalty of existing patients and of generating personal referrals; • The appearance of dental premises is significant in the decision of existing patients to recommend a practice to friends. If the appearance is deteriorating, existing patients may tolerate it but will be reluctant to refer. Money spent on periodic repainting and recarpeting, particularly of areas viewed by the patients, is well spent and has the impact of turning the referrals back on; and • A website is important as a reference point for those who have been referred.

A simple uncluttered site with basic information is adequate.

Much money spent on marketing consultants and expensive one-to-three-year programs is wasted. I have observed the financial results of closely located practices where one spent a lot of money on such programs and the other concentrated on the basics above—and the latter outperformed.

Summary hose dentists who are clinically competent, buy established non-preferred provider practices, work hard in their own surgery, concentrate on practice to patient relationships and concentrate their investments on their practice, practice premises, long term home and superannuation funding end up worth far more, sometimes millions of dollars more, than those of their peers who wander from this path.

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About the author Graham Middleton disposed of his interest in Synstrat Group on 30 June 2020 and won’t be starting another business; he retains many friends in the dental profession. He spent 33 years advising health professionals on business and financial matters. Dentists were the most numerous of his clients. He can be contacted at graham.george.middleton@gmail.com

GENERAL ADVICE WARNING: The information contained in this article is unsolicited general information only, without regard to any investor’s individual objectives, financial situation or needs. It is not specific advice for any particular investor and is not intended to be relied upon by any person. Before making any decision about the information provided, an investor should consider the appropriateness of the information in this article, having regard to their objectives, financial situation and needs and consult their adviser. Any indicative information and assumptions used here are summarized, are not a product illustration or quote, and also may change without notice to you, particularly if based on past performance. This notice must not be removed from this document.

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July/August 2021

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practice | MANAGEMENT

Are you guilty of killing your own practice in this way?

By Julie Parker

H

ave you been flossing every day, as I suggested six months ago?”

“You should have come and had this tooth treated sooner. Now the decay has reached the nerve.”

“I can see a fair bit of evidence that you have neglected your teeth over the years.”

going to see all kinds of problems in my mouth”. Some patients even apologise to the practitioner, as if it is the practitioner who bears the repercussions of the poor oral care, not the patient.

One reason why dental practitioners judge their patients may be that they gain a sense of superiority over another in order to feel better about themselves - this is not limited to dentistry and is the reason many of us judge others in various situations.

Shame, shame, shame.

Over the years, I’ve witnessed conversations with patients about their poor oral hygiene and lack of attention to their oral condition. From the practitioner’s perspective, they are simply gathering data and speaking about their findings.

However, the patient can be interpreting the experience quite differently.

In a recent social media post, Angus Pryor, a dental practice marketing expert and fellow contributor of articles to this magazine, posted a question to the public about the reasons behind their dental attendance behaviour.

One of the respondees stated that she used to attend six-monthly maintenance visits for years until a new hygienist continually “shamed” her for not flossing.

This lady said she was “done” and stopped attending the practice. It took 13 years for her to return and get back into the sixmonthly rhythm.

Patients provide clues that they fear being judged for their management of their oral health. When asked about the frequency of their flossing, they lie and say “nearly every day”. Infrequent attendees start their conversation in the surgery with, “just to warn you, you’re

68 Australasian Dental Practice

“A patient used to attend six-monthly maintenance visits for years until a new hygienist continually ‘shamed’ her for not flossing.

This lady said she was ‘done’ and stopped attending the practice. It took 13 years for her to return and get back into the six-monthly rhythm...”

Another, more common reason is habit and so the practitioner simply requires more helpful communication skills when speaking about topics that have the potential to make their patients feel judged and shamed.

Even simply becoming aware of the impact on patients should they feel judged is a big step in the right direction.

If we transposed the communication to a different scenario, it might make us appreciate patient shame and anxiety a little more.

Imagine that you’re substantially overweight. There are reasons you have neglected your physical health. You had small children to raise and a business to manage, as well as an injury that made exercise difficult. But, now it is a high priority to get your health back in order.

You know it’s going to be uncomfortable and possibly a little embarrassing, but you schedule a physical with your doctor to get the advice you need to make a plan to get healthy.

You turn up to the appointment and explain your situation. The doctor weighs you, performs a skin-fold test, asks you the details of what you eat and how frequently you consume calories. You admit how infrequently you exercise.

During the examination, your doctor makes comments such as, “I can see why your knee is still causing trouble; you are carrying too much weight”, and “Why don’t you simply exercise in the mornings? Then you’re done for the day”.

Accurate commentary, but not helpful.

You’re sitting there, at the mercy of this doctor, who displays only mild traits of compassion and doesn’t seem to understand the concept of “motivation”.

You leave feeling disheartened, but at least you ripped the bandaid off.

The preferred alternative outcome in this scenario is that you leave the doctor’s office feeling elated, inspired and hopeful.

The doctor was delighted by your decision to come for a physical because that’s exactly why he became a doctor: to help you to be healthier! Your doctor is excited to work with you to achieve your goals.

Now, what would have needed to happen during your physical for the alternative outcome to be the reality?

July/August 2021

practice | MANAGEMENT The doctor would have needed to: • Practice compassionate enquiry as to what led you to his office and what you were hoping to achieve; • Recognise the impact of self-worth in such a situation and to make encouraging comments such as “I admire you for taking an important step in your health” and “there are many resources you can use to reach your goal. I know you will be successful!”; and • Collaborate with you to design and establish the plan back to better health.

As in the scenario, you want patients to come in for examination and advice.

You want your patients to schedule their appointments and practice home care.

You want them committed to the goal.

So, what can your practice do to encourage patients who fear judgement?

1. Introduce as one of your core practice values “Zero Criticism”. Bring the whole dental team into the process and shift the behaviour of the practice to a judgement-free culture; 2. Gain feedback from your team, family and friends as to what behaviour can be easily construed by patients to be that of

judgement. Discuss and role-play with your team alternative communications that will instead show the patient they are worthy, acceptable and should feel optimistic for a healthier mouth; 3. Allocate more time for examinations of patients who have not been for some years so you can practice effective enquiry of each patient’s unique situation; 4. Offer “come in for a chat” consultations.

These are sessions for patients who already feel ashamed about their oral condition and would jump at the chance to discuss their circumstances without the anxiety of having the oral examination performed. The patient will have the opportunity to get to know, like and trust you before taking this next step; 5. Organise team-development sessions where you discuss and role-play what can be done to show patients warmth and support and how each team member can play a role in facilitating patients thoughtfully through their dental experiences; and 6. Conduct open information nights at your practice for your patients and other members of the community to

come and discover different elements of dental care. No check-ups, no interrogations. Broad information that everyone can use, delivered in a completely judgement-free environment.

Dental patients avoid attending their visits for several reasons. Low finances, time constraints and a low sense of importance over their oral health. As a practitioner, you have limited control or influence over these factors. However, patients avoiding dental care because they fear being judged can be a practice killer.

There is an opportunity here, though.

If you became known in your community as the “Zero Criticism” practice, you may have just identified a large and untapped market.

About the author Julie Parker Practice Success provides dental teams with coaching and training so they can work together and achieve successful outcomes for their dental practice. For more information, please contact Julie on 0407-657-729 or julie@julieparkerpracticesuccess.com.au

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July/August 2021

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practice | MANAGEMENT

The unappreciated virtues of a blue-collar practice

By Simon Palmer and Dr Nauv Kashyap

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ver the years, Practice Sale Search has noticed a distinct difference in the levels of interest that buyers have in different socio-economic areas.

If there were two dental practices for sale with identical figures - one in a blue-collar area and another in a whitecollar area - there would be more buyers interested in the practice in the higher socio-economic area.

Why is this?

If the revenue and profit figures of the practice are the same… why do dentists care? here are many (often ill-founded) reasons that buyers give for this difference in preference. Let’s look at these reasons one by one and give the counter argument:

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1. Lower socio-economic areas will equal lower fees charged per procedure… which means that you need to do greater volume to reach the same place financially ental fees are generally set by the competition present in the area, not the socio-economic status. We’ve seen practices in lower socio-economic (S-E) areas with no competition charging close to $400 for a check-up, clean and X-rays.

Conversely, there are practices in higher S-E areas with significant competition, charging $99 for the same treatment.

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2. Lower socio-economic areas equal a lower chance of treatment plan acceptance here are three arguments against this statement: 1. There is generally a greater need for more comprehensive treatment plans in lower socio-economic areas, giving dentists greater opportunity for work.

2. The main deciding factor for patients to take up a treatment plan is the communication skills of the clinician that presents the treatment plan, rather than the socio economics of the area.

3. Patients in lower socio-economic areas will often accept payment plans much more readily than those in higher S-E areas. Again, this will come down to the skill with which the payment plans are introduced and presented to the patient in the practice.

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3. Discretionary spending on services in lower socio-economic areas is more vulnerable if there is economic downturn hile this may make sense at first glance, anecdotally, what actually happens during an economic downturn seems to be somewhat different.

One of the authors of this article (Dr Nauv Kashyap) has noted that his practices in lower S-E areas experienced more stability and growth than those in higher S-E areas in the face of the GFC and during periods of maximum uncertainty regarding the economic impacts of COVID. Anecdotally, we have heard this counterintuitive consumer

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behaviour repeated in practices across the country.

Why is this?

There are several possible explanations for this consumer behaviour: • Spending habits in higher S-E areas scare easier because people who live there often have larger amounts of debt (residential prices in their areas being much higher, cars, other investments) and are thus more fearful about economic downturn, thereby curbing their spending more readily when times look tough.

• The government has dental programs for the most vulnerable in the form of CBDS, Veterans Affairs and hospital vouchers, which practices in lower S-E areas are the beneficiaries of. These are unaffected by economic downturn and act as a reliable backstop during periods of economic hardship.

4. Owning a practice in a lower socio-economic area means that most dentists will want to live further away from where they practice Living further away from a practice means: a. more time commuting; and b. less community engagement, as the practice owner does not live in, or form part of, the practice’s community and this will limit their success.

HOWEVER...

• Where dentists want to live often has more to do with their ethnic background, proximity to the beach/lifestyle, family and schools than socioeconomics. Sometimes these do coincide with higher socio-economic areas, but certainly not always.

July/August 2021

practice | MANAGEMENT

• EVEN IF the owner doesn’t want to live in the area…the practice’s community engagement does not need to be limited to where the principal lives. Community engagement with the practice, rather than the practice owner, should be the goal. The practice can have community ties through where its staff lives and through its engagement with the community, by sponsoring sporting teams, volunteering the dentist’s time to speak about oral health at the local school, etc.

Conclusion here are many reasons given by buyers for why practices for sale in lower S-E areas experience lower demand, but these reasons are usually ill-founded.

Buyers willing to look deeper at the underlying virtues of these practices will find businesses that are stable and underappreciated and are thus less contested

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About the author “Dental fees are generally set by the competition present in the area, not the socio-economic status. We’ve seen practices in lower socio-economic areas with no competition charging close to $400 for a check-up, clean and X-rays...”

when they come on the market. This, in turn, should mean that a buyer willing to look past the common objections above can have an easier pathway to successful practice ownership.

Simon Palmer is the Managing Director of Practice Sale Search, Australia’s largest dental practice brokerage. If you’d like more information on practice sales or want to have a confidential discussion about your practice’s circumstances, email Simon Palmer at info@practicesalesearch.com.au or call 1300-282-042.

Dr Nauvneel Kashyap is the Founder of Practice Ownership Consulting, which helps employee/associate dentists explore practice ownership opportunities, advising them on their transition to practice owner. He holds seminars throughout the year, which feature a wide range of experts on the many moving parts involved in buying and running a successful dental practice. For more information, contact admin@practiceownership.com.au.

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practice | MANAGEMENT

5 questions your patient should NOT be asking you

By Jayne Bandy

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our patients ask many questions prior to their appointment, but they call you a day or two before their appointment and start asking you these questions: 1. When is my appointment?

2. How long does my appointment go for?

3. What is the appointment for?

4. Who will I be seeing?

5. How much will it cost?

So why are your patients asking these questions before their appointment?

These are questions they should already know the answers to!

When your patients ask these questions, it means they are confused, unclear and in the dark!

This is not the mindset you want your patients to have before they come in for their appointment.

Your patient should be: • Ready; • Clear about the treatment and care they are having; • Focused; and • Informed.

When your patient is unclear about their next step, they lose focus, which means their urgent and important treatment and care becomes unimportant and your patient calls to cancel their appointment.

All because your patient was unclear.

Our duty of care is to always check every patient is clear about their treatment before they leave the practice, or after a New Patient makes their first appointment over the phone.

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I know from time to time your patients do forget their appointment times or forget to write it down somewhere or lose their appointment card.

This seems to happen very often with patients who schedule their preventive care appointment 6 months prior. Contact patients two weeks prior to their appointment just to give them a gentle, “Hi, your appointment’s coming up, we are looking forward to seeing you.” message.

“Ask yourself this: How many patients do you lose each year that you could have kept? Do you know this number?

It’s important that each patient knows the length of their appointment. You know the duration of the scheduled treatment so why not let your patient know this as well, after all their time is just as valuable as yours.

I am shocked when patients are confused what their appointment is for.

When you schedule an appointment for a patient, always mention what the appointment is for and give your patients an idea of what to expect at the appointment.

This is also a great opportunity to ask your patient if they are unsure about anything and any questions they may have.

Best to get any confusion sorted out, while the patient is in front of you or immediately after they have scheduled their appointment over the phone.

Now question #4 “Who will I be seeing?” is a question that makes me a little sad, especially if it is an existing patient. Your patients should know the name of their dentist.

Try this little exercise when you are next, out and about, chatting to people.

Ask people who their dentist is.

You will be surprised at how many people do not know the name of their dentist and even the dental practice name.

Why is this?

When you schedule the appointment for your patient go over the time and day, the type of treatment they will be having and the duration, as well as the name of the dentist they will be seeing.

Make it a habit and do this every time you schedule an appointment. Write the name of the dentist on the appointment card for all New Patients or any message you send prior to their appointment.

This starts to personalise the interaction with the dentist.

Now you never want a patient calling you before their appointment asking you about how much it will all cost.

You must always inform your patient about their treatment and the fees before their appointment.

The last thing you want is a surprised patient at the practice.

When your patient knows the fee for treatment, they are ready and you can have a discussion prior to the appointment in case they need a payment plan to help them manage the payment and more importantly, help them go ahead with the treatment.

July/August 2021

practice | MANAGEMENT Keeping your patient in the dark and avoiding the payment discussion is fraught with danger and no one wins!

If your patient calls you about the payment for their treatment a day or two before their appointment, your patient may decide to cancel their appointment.

Discussions about money and payments is best done while you have the patient in front of you so you can offer solutions ahead of time.

It is so much better if your patients are not calling your office every day with these questions.

You will now have more time to talk with your New Patients when they call and more time with your existing patients when they arrive for their appointment.

To find out how I can teach your team to know what to say and ask your patients, to help them make more kept appointments and prevent cancellations, call me on 1300-378-044 or email jayne@thedpe.com

July/August 2021

About the author

Call Tracking Excellence is not a product IT’S A RESULT! With Call Tracking Excellence your team will learn the SAME exact processes Jayne used to: 1. Dramatically improve new patient call-in conversions to booked appointments.

2. Retain existing patient appointments and...

3. Prevent ongoing losses from appointment cancellations.

Visit www.calltrackingexcellence.com

Jayne began her career as an educator.

After spending several years teaching, she made the jump to dental practice management. Jayne served as a Practice Manager for a renowned dentist in Sydney for more than 25 years, having the opportunity to learn first-hand what works when it comes to building and maintaining patient relationships, how to convert leads over the phone and most importantly - what it takes to reach your practice goals. As the CEO and Founder of Dental Phone Excellence, Jayne strives to help practices convert more calls into appointments, reduce cancellations and help nurture effective patient communication that will result in increased profitability. Her past experience as an educator combined with her passion for practice management gives her a unique set of skills that allows your team to fully understand and take advantage of the tools she presents.

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marketing | INSIGHTS

The worst article I ever wrote...

By Angus Pryor, MBA (Marketing)

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arning! This may be the worst article I ever wrote... or the best. Let me explain.

As a regular writer, I’m forced to come up with fresh content every month or so and sometimes, that process is easier than others. As I found myself looking at a (metaphoric) blank piece of paper, I reflected on the worst article I ever wrote.

In this article, I’m going to take you on a journey. You may think it’s the worst article I ever wrote or maybe, just maybe, there’s an important message for you that you can’t afford to miss.

74 Australasian Dental Practice

The problem s I consider what to write in Australasian Dental Practice, there is a problem I face every edition. You see, I don’t 100% know who’s going to be reading this article. I guess you could email me at thrive@anguspryor.com and tell me a bit about yourself (feel free).

Obviously, this is a magazine for dental practices, but the individual readers could vary enormously - dental principals, associate dentists, dental assistants, practice managers, OHTs, hygienists, non-clinical owners and so on.

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marketing | INSIGHTS And this presents a problem. While all of the above occupations may work together, their needs can be quite different.

If you’re a dental principal, you’re probably carrying the weight of the world on your shoulders, or you have a mind filled with endless possibilities and hope (or a bit of both). To you, perhaps I should speak about marketing strategy and tactics to get the practice growing.

If you’re an associate dentist, my message may be quite different. If you’ve got ownership aspirations (shhh, don’t tell your boss), then you may be interested in the aforementioned marketing strategy and tactics because one day, this will be your world too. But maybe my message to you is to start marketing yourself (with full disclosure to your boss) so you can fill your books with a group of patients slightly different to those usually attracted by the practice.

As a dental assistant, on the one hand, you may feel that marketing has nothing to do with you - that’s the boss’ job. On the other hand, you may see it as a necessary evil to keep the books full and your employment prospects secure. My message to you might be that everything your practice does is branding (which it is) and you can either see yourself as the “passer of instruments”, or someone helping build a dental masterpiece.

If you’re the practice manager, you may feel like you’re constantly juggling several balls. Staffing is definitely a headache at times and the boss can be hard to read. And then there’s marketing to worry about, which, if you were completely honest, you’d say you’re not sure how well it’s working. My message to you might be to get outside help and let you focus on your strengths.

I could go on and on...

Choices o, with a wide range of potential readers, there are really only a few ways to address this situation. I can write an article that: 1. Is broad enough to address the needs of all groups; 2. Speaks just to one group; or 3. Is broken up, where parts of the article relate to each group.

Up until this point, it appears I’ve gone with the third option and that may seem sensible... or is it?

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July/August 2021

Competition ithout competition, option one or three seem like sensible outcomes.

Present something broad enough and some of it is sure to stick. While this looks like a pragmatic way around a tricky situation, there are unintended consequences which cannot be ignored.

You see, there’s this thing called competition. And here’s how.

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“In most locations, there is extensive competition for patients to choose a dentist. However, dentists typically communicate a message that would work well if there were no competition in the market. This is messaging that tries to be all things to all people and if there were no competition, this would not be a problem.

You know the one-size-fits-all messaging I’m talking about...

Our ideal clients are... everyone...”

So, for dentists... hat I’ve done in this article is a deliberate attempt to copy what I see many dental practices doing. And if you think, in doing so, I’ve created the worst article I ever wrote... well, I guess I’ll just let you ponder that thought a little longer.

In most locations, there is extensive competition for patients to choose a dentist. However, dentists typically communicate a message that would work well if there were no competition in the market.

This is messaging that tries to be all things to all people and if there were no competition, this would not be a problem.

You know the one-size-fits-all messaging I’m talking about... “Our ideal clients are everyone - we just love everyone with teeth (or no teeth). We’re friendly, we’re gentle, we’re experienced, we’re great at using the autoclave and our personal oral hygiene is excellent”.

Sorry, but this message is really just blah, blah, blah. On the other hand, what if you could deliver a laser-focused message, delivered to a specific target market?

As a hint, if you check your data, you will see who’s been “voting with their wallet” at your practice. Using this approach, you’d get more of your best clients, but others would still come.

Stick with the current approach... and you may be left with the dental marketing equivalent of the worst article ever.

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Conclusion ’ll leave it up to you to judge whether this is the worst article I’ve ever written, or the best, but the parallel between this story and dentistry is urgent and compelling.

With increasing competition, you have a choice: (i) deliver a generalised message which never really hits the mark, or (ii) go with a more specific message speaking directly to your ideal client and attracting more of them. The choice is yours.

I For me to get YOU to read this article, I am competing against many other things.

This includes competition from other articles in this magazine, competition from you looking at your phone, calling someone, watching TV, spending time with family, etc.

And in the face of extreme competition, a generalised approach is unfortunately, doomed to fail. When time and attention spans are short, it’s really only the most specifically created messages that penetrate the noise.

Recent studies suggest that we are bombarded with between 2000 and 4000 commercial messages every day. If you and I are not laser sharp in our delivery, the message won’t get through.

About Angus Winner of the ADIA 2020 Marketing Award, Practice Growth Specialist, Angus Pryor is a #1 Amazon bestselling author, marketer, and international speaker. For help with attracting more of your ideal patients (and fewer of the ones you don’t want), visit www.AngusPryor.com and book an obligation-free call.

Australasian Dental Practice

75

finance | INVESTMENT

The benefits of good financial hygiene

By Rachael Arnold, Financial Adviser

F

or many, going to the Dentist for the first time in a while is a bit like going to see a Financial Adviser for the first time. Often the decision to go is based on the feeling that something is not quite right. That first visit can feel awkward for the patient as they have their teeth examined just as it does for a new client to lay out their financial situation for a Financial Adviser. There may be feelings of fear from lack of knowledge or embarrassment that things weren’t “kept on top of”.

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Dentists, like Financial Advisers, know that the more regularly you have a “check-up”, the more pain-free the experience can become. During COVID-19, a lot of people have been putting off their dentistry needs, whether it’s from a fear of proximity or a feeling that it is not an essential expense. In much the same way, people have pushed out the decision to go and see a Financial Adviser. Financial advice is still mistakenly seen, at times, as the domain of the prosperous or wealthy. Unfortunately, if you ignore something long enough it might end up costing you more in the future.

July/August 2021

Figure 1. Value of each asset class over 30 years from 1990-2020 investing $10,000.

Like healthy teeth, having healthy finances doesn’t happen from one visit.

The lead time to reach your financial goals - especially for retirement - is long and most people do not want to wait until they retire to see if they can afford their ideal retirement lifestyle. Often, we meet with clients who wish they had come to see us years ago because we can see missed opportunities or mistakes made.

Even those who can comfortably afford retirement wished they had known the good news a little earlier in life!

A very simple example of a missed opportunity is not taking advantage of the opportunity to put additional money into superannuation. Money Smart (www. moneysmart.gov.au) is a government website with a useful tool to show the effects of making additional contributions

to super. If you are aged 40 and earning $120,000 p.a. and you choose to contribute an additional $100 per week to super, by the time you reach age 67 you would have around $167,120 more in super. That could equate to you being able to possibly spend an extra $10,000 p.a. in retirement from contributing an extra $5,200 p.a. (assuming a net return of 4% p.a. in retirement).

SAFety FirSt even fOr yOur

FinAnciAl AFFAirS Whether you’ve just started working, own your own practice or are considering retirement, Profile Financial Services can help you plan and secure your financial future. Just like good dentistry, in investing, prevention is better than cure! A sound financial plan can help anticipate and avoid risks before they damage your portfolio.

How safe are your investments?

To find out, contact Profile now to book an obligation-free initial meeting: (02) 9683 6422 Or visit our website www.profileservices.com.au

BUilDinG WeAltH SecUrity AFSl 226 238

Profile_SafetyAd_v3.indd 1

July/August 2021

FOr OVer 30 yeArS

Wealth managers for the dental industry

18/03/11 2:04 PM

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finance | INVESTMENT $17,273 $15,480

Performance of the S&P 500 - 1990-2019

$11,459

Growth of $1,000

Figure 2.

Being out of the market for one or more of the best performing days can make a big difference to long term performance.

$6,733 $4,314

Source: Dimensional Fund Advisors

$2,235

Total Period

Missed 1 Best Day

Missed 5 Best Single Days

Missed 15 Best Single Days

Missed 25 Best Single Days

One-Month US T-Bills

9.96%

9.56%

8.47%

6.56%

4.99%

2.72%

Annualised Compound Return

able 1. S&P 500 price declines: T Average Time to December 1945 - July 2016 Drop from Duration Recovery Type of Decline Number Peak (%) (Months) (Months)

Pullback (5.0-9.9%)

56

-7

1

2

Correction (10.0-19.9%)

21

-14

5

4

Bear Market (>20%)

12

-33

14

25

“Garden Variety” Bear (20%-39.9%)

9

-26

11

14

“Mega-Meltdown” Bear (>40%)

3

-51

23

58

Source: CFRA and S&P Dow Jones Indices

A mistake we often see is people holding a lot of cash as there is a fear of investing from a lack of knowledge.

In many ways, the biggest risk to your funds is not investing. This difference in the returns of cash compared to other investment asset classes can make a large difference to your end balance.

The chart in Figure 1 shows the value of each asset class over 30 years from 1990-2020 investing $10,000. Cash has grown to $44,172 and Australian Shares have grown to $130,457. This is past performance and isn’t an indication of future performance but generally, investors are rewarded for risk above what they can receive from the haven of cash.

Another mistake we see with investing is selling investments down when markets fall. One of the key problems is, when do you go back in? As seen in Table 1, recovery after a market decline has historically taken 2 months to almost 5 years.

Timing the market entry back in is almost impossible. Figure 2 shows that being out of the market for one or more of

78 Australasian Dental Practice

Courtesy Vanguard Investments

the best performing days can make a big difference to long term performance.

These examples show the importance of creating a plan early and sticking to it.

Irrespective of your age or current situation, a plan is better than no plan! Part of my role as a Financial Adviser is holding clients accountable for their plan and making changes along the way to get the best outcome possible.

About the author Rachael Arnold is a Financial Adviser at Profile Financial Services, with offices in the Sydney CBD, Parramatta, and Mudgee. Profile has operated for over 30 years and specialises in serving the wealth creation and protection needs of professionals and small business owners. Many of Profile’s clients are dentists and they run regular education seminars on financial planning topics.

To find out about upcoming seminars, or to book an obligation-free meeting, call (02) 9683-6422.

“Another mistake we see with investing is selling investments down when markets fall. One of the key problems is, when do you go back in? Timing the market entry back in is almost impossible...”

General advice warning This article is issued by Profile Financial Services Pty Ltd (ABN 32 090 146 802), holder of Australian Financial Services License No 226238. This information might contain unsolicited general information only, without regard to any investor’s individual objectives, financial situation or needs. It is not specific advice for any investor and is not intended to be relied upon by any person.

Before making any decision about the information provided, an investor should consider the appropriateness of the information in this article, having regard to their objectives, financial situation and needs and consult their adviser.

Any indicative information and assumptions used here are summarised, are not a product illustration or quote and may change without notice to you, particularly if based on past performance. This notice must not be removed from this article.

July/August 2021

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READ ME FOR

CPD

Washer disinfectors for dental practice - what does the evidence say?

By Emeritus Professor Laurence J. Walsh AO

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ntra-oral dental procedures involve contact of a medical device or surgical instrument with a patient’s oral mucous membranes and in some cases, with their sterile soft or hard tissues. A major risk of any such procedure is the introduction of pathogens that can lead to infection.

A failure to properly reprocess instruments could cause pathogens to be introduced into a site and also spread pathogens from one patient to another.1-3 Ensuring that items are clean is an essential requirement before they are packaged for steam sterilisation. All manual procedures are subject to operator variation as a result of time

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constraints or tiredness. Automated cleaning using a washer-disinfector (WD) has the major advantage of being reproducible and able to be tested and repeated.

Multiple studies in many countries have documented that failures to comply with scientifically-based guidelines has led to such events. Deficiencies leading to infection have occurred either from failure to adhere to scientifically based guidelines, or misuse of disinfection or sterilisation processes.4-6 The elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency, is the reason why mechanical cleaning is advocated in reprocessing guidelines around the world. Given this background, the purpose of this article is to lay out the evidence around best practice for use of a washer disinfector in dental practice.

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infection | CONTROL Sources of contamination and the challenge of bioburden t the end of a procedure, different levels of microbial contamination will be present on instruments. The microorganisms could belong to the patient’s microbiota, or could be derived from dental unit and equipment waterlines, the staff providing the clinical care, the airconditioning system or the working environment.7-9 It is not possible to guarantee a 100% microorganism-free environment in any clinical practice environment.

Bioburden that remains on instruments after the cleaning process is complete will impair the effectiveness of sterilisation, because microorganisms will be protected by residues of blood, saliva or tissue debris remaining on instruments. An effective cleaning process must lead to complete removal of adsorbed organic material as well as microorganisms.10 Blood is more difficult to remove than saliva.11

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The washer disinfector concept he concept of combining mechanical instrument cleaning with thermal disinfection has been discussed in the literature for over 40 years. The concept is mentioned in standard textbooks of hospital infection control procedures from the 1970s. The thought process at the time for the reprocessing of used surgical instruments was that disinfection should be intrinsically linked to the cleaning procedure. This would protect staff working in central sterile supply departments (CSSD) as they were handling the instruments to package them for sterilisation and prevent their hands from becoming contaminated.

That same logic remains true today.

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Microbial reduction uring a WD cycle, elimination of microorganisms occurs by physical removal (e.g. fluid movement, detergents) and thermal inactivation. A classic study from 198112 measured the bioburden of used surgical instruments before sterilisation, after cleaning only or after cleaning and thermal disinfection. The study was performed using 808 instruments from 109 operations performed in the Huddinge Hospital in Sweden. The instruments were from trays selected at random by the operating nurses after general surgical,

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gynaecological, orthopaedic or ENT operations. The automated WD used at the time employed a final rinse with water at a temperature of 85°C. This WD was found to be highly efficient for treating surgical instruments. A cycle reduced the microbial load dramatically, with 80% of instruments having less than 10 bacteria remaining and 98% of instruments having less than 100 bacteria remaining.

A 2014 study that tested the efficacy of a WD in eliminating selected healthcare-associated pathogens (vancomycin-resistant Enterococcus [VRE], methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa from surgical instruments showed that a WD cycle gave greater than a 7- log10 (10 million fold) reduction in vegetative and in spore-forming bacteria from the surfaces of experimentally contaminated instruments.13 Overall, these results were similar to previous studies published in 1988 and 2007 that showed a 7-log10 reduction in Pseudomonas aeruginosa and Acinetobacter calcoaceticus and in bacteriophage Felix 0114 and an 8-log10 reduction of Enterococcus species.15 It is important to note that such impressive levels of microbial inactivation will not be seen in an instrument washer, such as the Hydrim C51w (SciCan, Canada), because these units, unlike a WD, have no thermal disinfection cycle.

Cleaning performance compared to an ultrasonic bath he elimination of problems associated with manual cleaning, such as poor performance, brushing splatter, a high risk of skin-puncture injuries and low efficiency is the reason why mechanical cleaning using an ultrasonic cleaner or a WD is advocated in reprocessing guidelines around the world. There is strong evidence to support using a WD as a decontamination method for dental instruments. A WD can handle a range of items that are unsuitable for an ultrasonic cleaner, including the tubing used in the circuits for relative analgesia and certain brands of dental handpieces.

Several studies have shown that WD are a very effective method of cleaning small items such as dental burs, whilst at the same time destroying vegetative microorganisms.16-18 There is parallel evidence for WD supporting their routine use for

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surgical instruments (including those with hinges) in the hospital setting.19-20 When individual instruments are being cleaned, they need to be held securely, such as being clamped into place in an instrument. This arrangement also prevents possible sharps injuries to staff during handling. The cassette or other holder must also have an open-sided structure to allow water penetration. A WD is not suitable for cleaning hand endodontic files, which are classified as a single patient use item, to be discarded immediately after use.21

Handling items after processing in the WD n current practice, soiled instruments that have been processed through a washer disinfector (WD) are considered decontaminated and safe to be handled for packaging for terminal sterilisation.

They are rendered free of organic matter which may contain or support the growth of pathogenic microorganisms, with less than 6.5 micrograms of protein per square centimetre of the instrument surface.22,23 Special methods have been developed to detect such low levels of protein on instruments.24,25 The first phase of the WD cycle, which rinses the load items with cold or room temperature water, is designed to prevent coagulation and adhesion of proteins. This initial rinse must not be done with hot water because this would cause proteins to coagulate, making them more difficult to remove.

Later phases of the automated cycle of the WD ensure cleaning and thermal disinfection, after which the items are dried.

The instruments leave the chamber totally dry due to the action of the rinse aid used before the final rinse.15,26,27 WD cycle programs typically have a low temperature prerinse, a wash cycle that includes the use of alkaline detergent (at temperatures between 55 and 85°C), a hot tap water rinse and a final rinse at an elevated temperature (55 to 95°C) to provide thermal disinfection. Depending on the type of instruments to be reprocessed, the WD cycle parameters may include more than one wash cycle, may use purified water (including deionised or reverse osmosis water) rather than tap water for the final rinse and may have a drying cycle that runs at an elevated temperature.

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infection | CONTROL

Figure 1. The MOCOM Tethys washer disinfector range includes both the benchtop H10 (left) and underbench models in two widths.

Instrument management practices he concept of pre-cleaning involves the wiping of instruments at the chairside to remove blood, cements and other materials that would otherwise set on or adhere to instruments. If gross contamination is not removed chairside, subsequent decontamination will be more difficult.

Once they have left the surgery, instruments should not be left to dry, as this will make residues more difficult to remove.

The longer the time interval between leaving the surgery and being loaded into the WD, the more difficult it will be to effectively remove the proteinaceous contaminants on the surfaces of dental instruments. Several studies have demonstrated the importance of keeping surgical instruments in a moist state prior to loading them into a WD.28,29 This underscores the importance of using an instrument soaking solution when it is not possible to load the items into the WD immediately. Bear in mind that a soaking solution will not remove all proteins from the services of instruments, even when it contains enzymatic agents.29,30 When performing a routine inspection of instruments, using the un-aided eye is not recommended, because visual assessment of cleaning in this way is fraught with

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possible error. Large amounts of contamination could pass undetected, especially when present in the box joint of hinged instruments such as artery forceps.31 The haem pigment found in haemoglobin from human blood can easily be seen even at levels as low as 10 mg/ cm2, while bodily fluids without pigments (such as saliva with no blood contamination) are extremely difficult to see, even when present in large quantities.32,33 Using magnification combined with flicker-free illumination (LED light) can give improved performance for the examination of simple instruments (i.e. without hinges). Simple instruments tend to have similar patterns of soiling levels across different regions of the instrument. In contrast, hinged instruments typically show variations between different regions, with the inner hinge region receiving the greatest attention. Discolouration of the instrument surface occurs more readily within the inner hinge region due to a combination of proteinaceous contaminants, corrosion by-products, residues of detergent, scoring of the surface through normal use. When inspecting items, pay particular attention to blood and dental materials (especially cements) that have been trapped in the holes, hinges and serrations of instruments.

A comprehensive process for checking items at the end of a WD cycle involves

evaluating not only cleanliness but also completeness (no missing parts), correct alignment, surface integrity, sharpness of cutting edges, correct functioning, absence of damage (corrosion, pitting, burrs, nicks and cracks) and the absence of wear and chipping of plating. Bear in mind that older instruments will be more challenging to clean well than new ones, because of small surface defects created by corrosion or scratching after repeated cycles of use and reprocessing.34,35

Evaluating performance of the WD cycle he use of a WD is a preferred method for cleaning dental instruments, because the device uses an automated process that can be validated.36,37 A wide range of test soils have been used to assess the cleaning performance of a WD, including 10% serum, heparinized 10% sheep blood or coagulated blood, Hucker’s soil, Miles soil and Edinburgh soil.

The test soil used should represent worst-case conditions and reflect the type of soil to which the device would be exposed during clinical use. Many of the test soils that have been developed contain blood constituents and are designed to be difficult to remove. The more adhesive a test soil is to an instrument or device, the more difficult it will be to wash off.38-43

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July/August 2021

Mocom Tethys under bench washer disinfectors An Automated process providing perfect instrument cleaning and outstanding levels of disinfecton.

Ensures complete operator protection with full compliance to AS/NZS 4187-2014.

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infection | CONTROL

Figure 2. The MELAG MELAtherm 10 delivers fast, automated cleaning of instruments as a precursor to sterilisation. The load size closely matches the volume of a typical dental autoclave for the optimal streamlined instrument reprocessing workflow.

A range of commercial soil tests that use synthetic polymers with properties similar to coagulated blood are available to verify the performance of a WD. These are regarded as a suitable method for monitoring the cleaning efficacy of each cycle.

A key characteristic for such test strips is that the soil is not removed when exposed to room temperature water, but rather is only removed fully after exposure to highly alkaline detergent at a temperature of at least 60°C.22 Existing tests will detect problems such as a suboptimal amount of detergent, low water pressure, overloading, insufficient cleaning time, low temperature or inactive spray arms.44 The Browne STF Load Check Indicator (Albert Browne International Ltd, UK) (Figure 3. A), is claimed to be equivalent to the cleaning efficacy soil test and to be appropriate for checking a WD in accordance with ISO 15883.5. Although its detailed composition is unknown, the lipid and polysaccharide protein-containing red glue deposited on the polymer-structured thin film is not hazardous for dental staff or devices. Studies have confirmed that the STF works properly for load checking in a regular under-bench WD used in dentistry, such as the Miele G7881 automatic WD (93°C, 10-minute cycle using Neodisher; Miele & Cie, Denmark).45,46 Other commercial tests for WD include (Figure 3):

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B. VERIFY All Clean Test (STERIS Corporation; USA). This bright red test soil contains protein, lipids and endotoxin.

The mesh design of the holder mimics difficult-to-clean surfaces.

C. Wash-Checks (Getinge Group; USA).

This red test soil mimics the removal of blood and tissue from surgical instruments. The design of the holder mimics a surgical instrument joint.

D.Chemdye ‘SPLAT’ test (Gallay Medical & Scientific; Mulgrave, VIC). This uses organic components that are red in colour. The design of the holder creates a cleaning challenge.

E. gke Clean-Record (gke GmbH; Germany). This uses a coloured synthetic soil on plastic carriers. Different coloured indicators assess various cleaning challenges. The design of the holder does not create a cleaning challenge.

F. TOSI (Getinge; Sweden). This uses a blood-based red test soil containing haemoglobin, albumin and fibrin. The design of the holder creates a challenge by mimicking the uneven surfaces of surgical instruments.

Feed water he water used for the final rinse must not contain high levels of bacteria, as contaminated rinse water will leave contamination on the instruments.47 It is also important that the water used for the

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final rinse of instruments does not contain high levels of bacterial endotoxin, as this could cause remnants to be left behind on the instruments. Endotoxins are notoriously resistant to the action of heat and hence the instrument once sterilised could still, when used in a surgical procedure, trigger an acute inflammatory reaction in the tissues and also systemically. Such reactions may resemble responses to surgical interventions and hence will not be recognised.48,49 If biofilm formation has occurred in the water supply lines leading to the WD, or within the WD itself, this will elevate the levels of endotoxin that remain on instruments at the end of the cycle.50,51

Implementation experience econtamination equipment represents a significant capital outlay and contributes to practice overheads, due to ongoing costs for utilities (electricity and water), testing, consumables (cleaning chemicals and test strips) and service contracts. While cost may be an initial barrier to adopting a WD, this can be overcome by perceived advantages around efficiency. In larger clinics with more chairs operating simultaneously, the longer time it takes to reprocess instruments will likely not be an issue, as staff will adapt their sterilising room working practices to accommodate it.

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July/August 2021

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infection | CONTROL

Figure 3. Commercial performance tests for washer disinfectors. These monitor performance and also can identify problems in loading the chamber. A, Browne STF indicator and its special holder. B, Verify indicator, showing an unused strip and a strip with a fail result. C, TOSI test sticks. D, SPLAT indicator. E, Wash-Check indicators. Those with a red dot are designed for WDs. Those with a blue dot are intended for ultrasonic cleaners but the manufacturer also states that they can be used in WD. F, gke Clean-Record system, with indicators with varying levels of difficulty in removal of the coloured material.

Useful insight into the use of WD in dental practice can be gained from experiences in the United Kingdom. Use of a WD has been mandatory in both Scotland and Northern Ireland since 2013 and is commonplace (but not mandatory) in both England and Wales. In part, this was

86 Australasian Dental Practice

driven by concerns around transmissible prion disease (variant Creutzfeldt-Jakob disease) in the UK. The UK adopted the ISO 15883 series of technical standards and they were incorporated into clinical decontamination technical guidance documents to help dental practices achieve

a safe and effective standard of instrument decontamination (e.g. HTM 01-05 and in Scotland, SHTM 2010 and SDCEP Decontamination into practice). Best practice guidelines in the UK for instrument decontamination stipulate the need for a dedicated reprocessing room and

July/August 2021

infection | CONTROL the use of a validated washer disinfector to replace manual cleaning wherever possible. Manual cleaning of instruments is restricted to those items incompatible with automated washing. This includes using a handpiece-cleaning device for older handpieces that are not compatible with a WD cycle.

Note that many modern contra-angle or straight low speed and air turbine high speed handpieces are designed to be tolerant for a WD cycle and they are marked permanently with the WDsafe symbol. In the WD is the relevant couplings and plug-in connectors that link to the internal lumens. The handpieces need to be lubricated with service oil after the WD cycle, as per the manufacturer’s instructions.

Surveys of UK dentists52 have shown that dentists saw the WD as a benefit to staff safety compared with other cleaning methods. As well, the workflow in the practice could adapt to the longer cycle time of the WD than an ultrasonic cleaner. This could free up dental assisting staff from the sterilising room to do other tasks.

About the author Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years.

His published research work includes over 330 journal papers, with a citation count of over 15,400 citations in the literature. Laurie holds patents in 7 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

July/August 2021

References 1. Rutala WA, Weber DJ. CDC Guideline for disinfection and sterilization in healthcare facilities, 2008.

2. Rutala WA, Weber DJ. Sterilization, high-level disinfection, and environmental cleaning. Infect Dis Clin N Am. 2011; 25:45-76.

3. McDonnell G, Burke P. Disinfection: is it time to reconsider Spaulding? J Hosp Infect. 2011; 78:163-170.

4. Rutala WA, Weber DJ. How to assess risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Infect Control Hosp Epidemiol. 2007; 28:146-155.

5. Weber DJ, Rutala WA. Assessing the risk of disease transmission to patients when there is a failure to follow recommended disinfection and sterilization guidelines. Am J Infect Control 2013; 41:S67-S71.

6. Dirlam Langlay AM et al. Reported gastrointestinal endoscope reprocessing lapses: The tip of the iceberg. Am J Infect Control 2013; 41:1188-1194.

7. Chu NS et al. Levels of naturally occuring microorganisms on surgical instruments after clinical use and after washing. Am J Infect Control 1999; 27:315-319.

8. Rutala WA et al. Centers for Disease for Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities. 2008. pp.1-158.

9. Pinto FMG et al. Analysis of the microbial load in instruments used in orthopedic surgeries. Am J Infect Control 2010; 38:229-333.

10. Rutala WA, Weber DJ. Creutzfeldt-Jakob disease: recommendations for disinfection and sterilization. Clin Infect Dis. 2001; 32:1348-1356.

11. Zuhlsdorf B, et al. Cleaning efficacy of nine different cleaners in a washer-disinfector designed for flexible endoscopes. J Hosp Infect 2002; 52:206-211.

12. Nystrom, B. Disinfection of surgical instruments. J Hosp Infect 1981; 2:363-368.

13. Rutala WA et al. Efficacy of a washer-disinfector in eliminating healthcare-associated pathogens from surgical instruments. Infect Control Hosp Epidemiol. 2014; 25(7):883-885.

14. Jettte LP, Lambert NG. Evaluation of two hot water washer disinfectors for medical instruments. Infect Control Hosp Epidemiol. 1988; 9(5):194-199.

15. Nicholas G et al. Comparison of the efficiency of cleaning, disinfection and drying of three washer disinfectors: Steris T21, Steris T840 and Getinge 9128. J Hosp Infect. 2007; 67:268-270.

16. Miller CH et al. Cleaning dental instruments: measuring the effectiveness of an instrument washer/disinfector. Am J Dent.

2000; 13:39-43.

17. Whitworth CL et al. A comparison of decontamination methods used for dental burs. Br Dent J. 2004; 197:635-640.

18. Van Eldik DA et al. A SEM evaluation of debris removal from endodontic files after cleaning and steam sterilization procedures. Aust Dent J. 2004; 49:128-135.

19. Alfa MJ et al. Manual methods are suboptimal compared with automated methods for cleaning of single-use biopsy forceps. Infect Control Hosp Epidemiol. 2006; 27:841-846.

20. Alfa MJ, Nemes R. Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures. J Hosp Infect. 2004; 58:50-58.

21. Perakaki K et al. Comparison of an ultrasonic cleaner and a washer disinfector in the cleaning of endodontic files. J Hosp Infect. 2007; 67:355-359.

22. ISO 15583-5. Washer-disinfectors; test soils and methods for demonstrating cleaning efficacy. ISO 15883-5. 2005.

23. Smith A et al. Reducing the risk of iatrogenic CreutzfeldtJakob disease by improving the cleaning of neurosurgical instruments. J Hosp Infect. 2018; 100:e70-e76.

24. Smith A et al. Dental handpiece contamination: a proteomics and surface analysis approach. Biofouling 2014; 30(1):29-39.

25. Herve RC et al. Improved surveillance of surgical instruments reprocessing following the variant Creutzfeldt Jakob disease crisis in England: findings from a three-year survey.

J Hosp Infect 2021; 110:15-25.

26. ISO 15883-1. Washer-disinfectors - Part 1: General requirements, definitions and tests. 2006.

27. ISO 15883-2. Washer-disinfectors; requirements and tests for washer-disinfectors employing thermal disinfection for surgical instruments, anaesthetic equipment, bowls, dishes, receivers, utensils, glassware, etc. 2006.

28. Secker TJ et al. Adsorption of prion and tissue proteins to surgical stainless steel surfaces and the efficacy of decontamination following dry and wet storage conditions. J Hosp Infect.

2011; 78:251-255.

29. Lipscomb IP et al. Effect of drying time, ambient temperature and pre-soaks on prion-infected tissue contamination levels on surgical stainless steel: concerns over prolonged transportation of instruments from theatre to central sterile service departments. J Hosp Infect. 2007; 65:72-77.

30. Howlin RP et al. Application of a fluorescent dual stain to assess decontamination of tissue protein and prion amyloid from surgical stainless steel during simulated washer-disinfector cycles. J Hosp Infect. 2010; 75:66-71.

31. Lipscomb IP et al. Comparison between visual analysis and microscope assessment of surgical instrument cleanliness from sterile service departments. J Hosp Infect 2008; 68:52-58.

32. Quality task group. Cleaning (part 2) - validation of cleaning efficacy. Zentral Steril 2002; 10:60-66.

33. Lipscomb IP et al. Rapid method for the sensitive detection of protein contamination on surgical instruments. J Hosp Infect.

2006; 62:141-148.

34. Wichelhaus A et al. Corrosion of orthodontic pliers using different sterilization procedures. J Orofac Orthop. 2004; 65:501-511.

35. Wu G, Yu X. Influence of usage history, instrument complexity, and different cleaning procedures on the cleanliness of blood-contaminated dental surgical Instruments. Infect Control Hosp Epidemiol 2008; 30(7):702-704.

36. Sanchez E, Macdonald G. Decontaminating dental instruments: testing the effectiveness of selected methods. J Am Dent Assoc 1995; 126:359-362.

37. Scottish Dental Clinical Effectiveness Programme.

Decontamination Into Practice. Part 1—Cleaning of Dental Instruments. 2007.

38. Ransjo U et al. A test for cleaning and disinfection processes in a washer-disinfector. APMIS 2001; 109:299-304.

39. Fruh B, Pfeifer M. Verification of cleaning efficacy in washer-disinfectors during routine operation. Zentr Steril 2003; 11:41-52.

40. Zuhlsdorf B et al. Suitability of the German test method for cleaning efficacy in washer-disinfectors for flexible endoscopes according to prEN ISO 15883. J Hosp Infect. 2005; 61:46-52.

41. Franz A et al. Reprocessing of dental instruments in washer disinfectors: does a representative test soil exist in dentistry?

GMS Krankenhhyg Interdiszip 2012; 7. Doc13.

42. Azizi J et al. Doubt and proof: the need to verify the cleaning process. Biomed Instrum Technol 2012; (Suppl):49-54.

43. Alfa MJ, Olson N. Physical and composition characteristics of clinical secretions compared with test soils used for validation of flexible endoscope cleaning. J Hosp Infect. 2016; 93:83-88.

44. Alfa MJ, Olson N. Comparison of washer-disinfector cleaning indicators: Impact of temperature and cleaning cycle parameters Am J Infect Control 2014; 42:e23-e26.

45. De Blasio A, Barenghi L. Pitfalls of cleaning controls in ultrasonic washers. Am J Infect Control 2015; 43:1374-1375.

46. Alfa MJ. Medical instrument reprocessing: current issues with cleaning and cleaning monitoring. Am J Infect Control 2019; 47:A10-A16.

47. The van Doornmalen Gomez Hoyos JPCM et al. Variability of ATP amount in last rinse water of automated washer disinfectors demands monitoring of every load. J Hospital Infect.

2015; 91: 87-99.

48. Goveia VR et al. Endotoxins in surgical instruments of hip arthroplasty. Rev Esc Enferm USP 2016; 50(3):405-410.

49. Costa DD et al. Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants. Injury 2018; 49(11):2005-2012.

50. Lipscomb IP et al. Comparative study of surgical instruments from sterile-service departments for presence of residual gram-negative endotoxin and proteinaceous deposits. J Clin Microbiol. 2006; 44:3728-3733.

51. Alfa MJ et al. Cleaning efficacy of medical device washers in North American healthcare facilities. J Hosp Infect. 2010; 74:168-177.

52. Stankiewicz N. The experience of dental practices that use automatic washer disinfectors. J Infect Prevent. 2019; 20(1):25-31.

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infection | CONTROL

READ ME FOR

CPD

Key things to know about sterilisation pouches?

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terilisation pouches are single-use, peel-open pouches designed to hold items during sterilisation.

Not all pouch materials are suitable for use in all types of sterilisation processes, so different pouches are required depending on the sterilisation processes available.

For example, special pouches are needed for hydrogen peroxide gas plasma sterilisation. These differ from those used for steam sterilisation.

Plastic/paper pouches are used for steam sterilisation. The plastic side of the pouch allows clear visualisation of the contents and the chemical indicator. The paper side allows air removal and the sterilant to enter the pouch.

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Recommended use terilisation pouches are recommended for smaller, lightweight, low profile items. They are available in various sizes and configurations to enclose loose groups of instruments and offer various types of built-in chemical indicators. If an instrument appears to be too heavy or large for a pouch, another packaging method should be used.

Sterilisation pouches have four primary objectives: 1. They must allow penetration of the chosen sterilant and be compatible with any other requirements of the sterilisation process; 2. They must be able to maintain the sterility of package contents until opened;

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3. They must create a package that can be opened without contaminating the contents by the user; and 4. They must permit the contents to be sterile at the point of use.

Pouches should also be “tamper evident” so that a pouch opened in error cannot be resealed without complete reprocessing.

Choosing a sterilisation pouch hen choosing a sterilisation pouch made of paper and plastic (transparent polypropylene or polyester), ensure it is of adequate size to accommodate the instruments to be sterilised. Paper bags/ wraps used for steam sterilisation are required to conform to AS 1079.3-1994 Packaging of items (sterile) for patient

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infection | CONTROL

care, Part 2: Non-reusable papers - For the wrapping of goods undergoing sterilisation in health care facilities or Part 5: Single-use, non-woven wrapping materials – For goods undergoing sterilisation in health care facilities.

Medical-grade paper used in sterilisation pouches has controlled porosity and has no pinholes larger than 0.5 mm. These factors are critical to allowing steam to enter, whilst also maintaining the sterility of the pouch contents during storage.

Additional considerations may include: • Ease of use; • Ease of storage; • Cost; • Puncture and tear resistance; • Lack of toxic ingredients; and • Non-linting material.

Selecting pouch size t is important to select the appropriate pouch size. A pouch should be large enough to allow the contents to move from side-to-side without compromising the seams or risking punctures. It must also allow the changes in pouch size that occur during sterilisation without causing

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July/August 2021

breaches in the seal. A pouch that is too small may also cause overcrowding that prevents adequate steam penetration and air removal, which could affect drying of instruments. A pouch that is too large may allow excessive movement of the instruments that results in punctures and tearing. For that reason, it is a good idea to have a variety of pouch sizes on hand.

Loading a sterilisation pouch o load a sterilisation pouch, the pouch should be laid flat on a countertop and the instruments should be arranged in a single layer with at least 5 mm of clearance on each side for package contraction and proper circulation.

To allow easy removal and ensure aseptic presentation of the instruments when opening the pouch, position instruments in the pouch as follows: • Place instruments with handles on one end (such as elevators) so the handles can be grasped when the pouch is peeled open. Put the working tip at the pre-sealed end of the pouch; • Hinged instruments should be placed in an open position;

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• Curved instruments like artery clamps should be placed with the curved end toward the plastic side; and • On instruments with sharp tips, use vented tip protectors to prevent punctures through the pouch.

Sealing a sterilisation pouch terilisation pouches are either selfsealing or manually heat-sealed. When using a self-sealing pouch, it is important to carefully follow the fold lines provided by the manufacturer to prevent overlapping and small openings between the package and the sealant. Also, the seal’s fold must be free of wrinkles or creases.

When manually sealing a pouch, ensure that there is ample space at the end of the pouch for users to use their thumb to open the package and present its contents aseptically to the sterile field. This will prevent the contamination of the pouch contents during delivery.

When using a heat-sealed pouch, it is important to follow the manufacturer’s instructions, including proper temperature ranges for the heat sealer.

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infection | CONTROL

Loading pouches into a steriliser hen placing loaded and sealed pouches in the steriliser, it is important to ensure that they do not overlap. Many sterilisers have racks that allow pouches to be placed on their edges (like toast in a vertical toaster).

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Pouch labelling t a minimum, sterile pouches should be labelled with the following: • Steriliser used; • Cycle/load/batch number; and • Date of sterilisation.

To write on pouches, only use inkbased permanent non-toxic ink markers.

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Chemical indicators ouches used for steam sterilisation should have built in Class 1 chemical indicators. If not, use Class 1 autoclave tape, which will change colour on exposure to heat.

Some types of pouches also have builtin internal indicators that are Class 4 or greater in their performance.

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90 Australasian Dental Practice

Medicom SafeSeal ® Quattro selfsealing sterilisation pouches have internal multiparameter indicators, which confirm that exposure to the sterilisation variables of time, temperature and steam has been adequate.

(by checking the external indicator and any internal indicators). Never use items when the packaging has been compromised (e.g. wet, torn or punctured) during storage.

Shelf life of processed pouches

Storing sterilised pouches roper storage and handling of processed pouches is necessary to maintain the sterility of their contents.

Storage temperatures should not be excessive as this causes degradation of pouches. A range from 18°C - 22°C is suitable. As well, the relative humidity should not be too high. A suitable range is from 35%-68%. Refer to the 4th edition (July 2021 version) of the ADA Guidelines for Infection Prevention and Control for more information on the storage of sterilised items.

The area used to store sterile instruments must be clean, dry and dust-free.

Dedicated containers, cupboards and drawers are typically used to protect items from environmental contamination.

Pouches should always be inspected before opening to confirm that they have been through steam sterilisation

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he shelf life of a processed sterilisation pouch is event-related, not time-related and depends on proper handling and storage. It also depends on the quality of the pouch material, the conditions under which the pouch is stored and the amount of handling. A sterile product will remain sterile if the packaging does not become wet, torn, soiled or otherwise damaged.

Over time, degradation of the pouch will occur so it is good practice not to have packages of items kept for extended periods of time (e.g. beyond 2 years). This is in keeping with the typical instructions from the manufacturer regarding the stability of the packaging material over time once it has been through a steam sterilising process. Always rotate sterile stock to prevent older stock from reaching such time limits.

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July/August 2021

COMPLIES TO

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Performance with Protection The Medicom SafeSeal Quattro sterilisation pouches are engineered to provide reliable colour change and seal performance. Made from high quality medical grade paper, they are designed to ensure successful sterilisation processing you can trust.

Every Medicom SafeSeal Quattro Sterilisation Pouch Provides: • Secure, extra wide chevron seal for protection against instrument breaching • Internal and external process indicator for added quality assurance • Thumb notch, perforated fold and wide self-sealing adhesive strip for ease of use • Lightly blue tinted film for easy breach identification

Contact us: 1300 818 168 | cs@medicom-australia.com | www.medicom-australia.com 21072021-DN-AD-024-MAU V1

clinical | EXCELLENCE

5 new instruments designed to enhance the adaptability of clear aligners

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hen Hu-Friedy first introduced the Clear Collection for Clear Aligners, they wanted to make it easier for dental professionals to manipulate invisible aligners without the need to heat the instrument. The original line-up of instruments - The Tear Drop, The Vertical, The Horizontal and The Hole Punch - were a big hit and in the years following their introduction, treatment with clear aligners has only continued to grow in popularity among patients.

Today, the majority of orthodontists and also many general dentists utilise clear aligner therapy in their practice. Naturally, as more patients adopt clear aligners, there is a greater need for additional flexibility when it comes to manipulating aligners chairside.

Indeed, there are many ways to accent, individualise and optimise the biomechanics of invisible aligners. That’s why we again teamed up with Dr Jay Bowman, who originated the design of the Clear Collection. Consequently, Hu-Friedy are introducing five brand-new instruments to provide even more options to enhance aligner treatments.

92 Australasian Dental Practice

Meet the Clear Collection Expansion: The Spot he Spot creates a tiny, rounded dimple for spot contacts to accent small individual tooth movements for added aligner retention.

It can be used to accent movements on any tooth in the aligner that needs “just a nudge”. The Spot’s small depression placed adjacent to the gingival embrasures can also enhance the retentiveness of an aligner or retainer.

Why is this important? Dr Bowman explains: “Occasionally, near the end of a series of aligners, a single tooth is just not in ideal position and could benefit from a little push. In this manner, a small indent in the last few aligners from The Spot instrument may preclude the need for another complete refinement.”

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July/August 2021

YOU REQUIRE REQUIRE MAXIMUM MAXIMUM EFFICIENCY. EFFICIENCY. YOU YOU REQUIRE MAXIMUM EFFIC YOU REQUIRE MAXIMUM EFFICIENCY. YOU DEMAND DEMAND COMPLETE COMPLETE ORGANIZATION. ORGANIZATION. YOU YOU DEMAND COMPLETE YOU DEMAND COMPLETE ORGANIZATION. YOU NEED NEED ENSURED SAFETY. INTRODUCES HUFRIEDYGROUP HUFRIEDYG HUFRIEDYGROUP YOU ENSURED SAFETY. YOU NEED ENSURED S YOU NEED ENSURED SAFETY. INTRODUCES YOU DESERVE DESERVE INFINITE INFINITE CONFIDENCE. CONFIDENCE. ™™ YOU YOU DESERVE YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYGROUP INTRODUCES HUFRIEDYG HUFRIEDYGROUP INTRODUCES

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HFL-482AUS/1220 • Accurate occlusal anatomy thatpractice, matches©2020 the natural tooth • Accurate occlusal anatomy thatpractice, matches the natural tooth protect the efficiency of your while helping protect your patients, your staff and theyour efficiency instrument of your investment. while helping • Accurate occlusal anatomy thatpractice, matches the natural tooth protect your patients, your staff and your instrument investment. the efficiency of your while helping

Learn How to Scale in Perfect Harmony at Hu-Friedy.com/Harmony Hu-Friedy.com/H Hu-Friedy.com/Harmony

To learn more about how IMS can enhance VISIT USCo., ONLINE AT HU-FRIEDY.COM/PerfectFit Hu-Friedy Mfg. LLC, 1666 how E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com To learn more about IMS your practice visit Hu-Friedy.com/Infinity VISIT US ONLINE AT HU-FRIEDY.COM/PerfectFit ToHu-Fried learn more about howcan IMS can enhance ©2016 y Mfg. Co., All rights reserved.

All company and product names are of Hu-Friedy Mfg. Co., LLC, VISIT USLLC.ONLINE ATtrademarks HU-FRIEDY.COM/PerfectFit your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co.,companies, LLC. All rights reserved. its affiliates or related unless otherwise noted.member of ©2017 Hu-Friedy Mfg. Co., LLC. Allis rights reserved.

Hu-Friedy now a proud your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

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To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All is rights now reserved.

Hu-Friedy a proud member of

To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All is rights now reserved.

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©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

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clinical | EXCELLENCE The Petite Punch

imilar in design to the Hole Punch from the original Clear Collection, The Petite Punch cuts a 4.5 millimetre halfmoon cut-out in an aligner for relief of the plastic around bonded buttons for smaller teeth like premolars. This instrument can be used to create cut-outs in either the buccal or lingual marginal plastic, anywhere desired along an aligner. The Petite Punch can also be used to “nip away” plastic at the edge of aligners to provide relief from soft tissue impingement or irritation.

According to Dr Bowman: “The original Hole Punch was created to assist in placing buttons on large molar teeth. In contrast, The Petite Punch was designed to provide clearance for adding bonded buttons on narrower teeth like premolars and canines”.

the mesial or distal side on the facial (near the line angle of the tooth) with the intent of functioning similar to a typical “rotational wedge” used with braces.

This can be combined by using the same Wedge instrument on the lingual side of the aligner, but on the (mesial or distal) line angle on the opposite side of the tooth. In this manner, the two opposing Wedge indents can create the force for a rotational couple.

S

The Clockwise Wedge and the Counter Clockwise Wedge

The Eraser

“These two new Wedge instruments are used to enhance the rotational movement of specific teeth, one of the least predictable movements with aligners.

The Wedges produce an indent in either the mesial or distal side on the facial with the intent of functioning similar to a typical rotational wedge used with braces...”

hese two new Wedge instruments are used to enhance the rotational movement of specific teeth, one of the least predictable movements with aligners.

The Wedges produce an indent in either

T

94 Australasian Dental Practice

to affect a distal rotation of Mandibular Right and Maxillary Left teeth. It is also used to affect a mesial rotation of Mandibular Left and Maxillary Right.

As an alternative, the Wedge instruments can also produce a “reservoir” depression in an aligner (from the inside out) in a location where a bonded attachment is desired. This reservoir is filled with composite, applied to the tooth and cured. A scan or impression can then be taken to create aligners that employ the new attachment(s).

Dr Bowman adds, “Rotational movements, especially of laterals and canines, have been recognised as having poor predictability. This may warrant the application of customised rotational wedges, hence the need for these new Wedge instruments”.

In other words, by producing an indent on the mesial or distal side of the facial plastic and a corresponding, but opposite, depression on the lingual side of the tooth, a rotational force couple is produced. It is important to keep in mind that aligners do flex to accommodate Clear Collection indents. For organisational purposes, The Counter Clockwise Wedge is used to affect a mesial rotation of the Mandibular Right and Maxillary Left teeth. This instrument is also used to affect a distal rotation of Mandibular Left and Maxillary Right. In contrast, The Clockwise Wedge is used

he Eraser is designed to reverse or remove unwanted indents placed by other instruments in the Clear Collection by flattening the plastic where a depression was inadvertently positioned or where the accent indent is no longer required. Indents can be erased with just a few squeezes of the instrument.

As Dr Bowman explains: “Once an accent indent (like from The Spot, The Vertical or The Horizontal instruments) is no longer required in an aligner, The Eraser is used to eliminate them.”

T

Clear aligner manipulation is as much an art as it is a science, and these new instruments provide enhanced flexibility when it comes to making precise adjustments. As dental professionals, that means better outcomes for your patients with less effort. So, add to your Clear Collection today for more transformative smiles.

July/August 2021

YOUYOU REQUIRE MAXIMUM EFFICIENCY. YOU REQUIRE MAXIMUM EFFIC REQUIRE MAXIMUM EFFICIENCY. YOUYOU DEMAND COMPLETE ORGANIZATION. YOU DEMAND COMPLETE DEMAND COMPLETE ORGANIZATION. CLEAR HUFRIEDYGROUP INTRODUCES HUFRIEDYG HUFRIEDYGROUP YOUYOU NEED ENSURED SAFETY. YOU NEED ENSURED S NEED ENSURED SAFETY. INTRODUCES SOLUTIONS ™™ YOU DESERVE INFINITE CONFIDENCE. YOU DESERVE YOU DESERVE INFINITE CONFIDENCE. HUFRIEDYGROUP INTRODUCES HUFRIEDYG HUFRIEDYGROUP FOR INTRODUCES YOU REQUIRE MAXIMUM EFFICIENCY. ™ SCIENTIFICALLY PROVEN ERGONOMIC SCIENTIFICA ™ SCIENTIFICALLY PROVEN ERGONOMIC YOU DEMAND COMPLETE ORGANIZ CUSTOMIZED SCALERS AND CURETTES SCALERS AN SCALERS AND CURETTES HUFRIEDYGROUP YOU NEED ENSURED SAFETY. SCIENTIFICALLY PROVEN ERGONOMIC SCIENTIFICA EFFICIENCY SCIENTIFICALLY PROVEN ERGONOMIC

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1 1 ™ 65% 65% . Its 1optimal proportions idealideal width provides . Its optimal ™ and and Designed with TrueFit Technology, the width optimized Designed with Tp 65% . Its optimal proportions provides Designed with TrueFit Technology, the optimized ™ a secure and nimble grasp, which may alleviate a secure hand and nim shape with double helix grip reduces pinch force shape up tohand with Designed with Tec a secure and nimble grasp, which may alleviate shape with double helix grip reduces pinch force upTrueFit todouble 1 1All and shape with double helix grippr fatigue injury risk due due toand repetitive motions. fatigue injury 1optimal 65%fatigue 65% . Itsand proportions ideal width provides . Its optimal injury risk toand repetitive motions.

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Harmony scalers and cure blades to™efficiently remove calculus while applying blades to ™efficien blades to efficiently remove calculus while applying less pinch forceensuring when holdin ™ working ends, you INFINITY SERIES CASSETTES INFINITY SERIES CASS INFINITY SERIES CASSETTES Learn HowHow to Scale in Perfect Harmony at at Learn Howforce to Sca Learn to Scale in Perfect Harmony less pinch force when holding the handle. less pinch w The most sophisticated solution for instrument management The most sophisticated solution for instru blades to™efficiently remove less pinch force when holding the handle.

The most sophisticated solution for instrument management INFINITY SERIES CASSETTES Hu-Friedy.com/Harmony Hu-Friedy.com/H Learn Howforce to Scale in Perfec Hu-Friedy.com/Harmony less pinch when holdin FIT IS EVERYTHING Introducing Hu-Friedy’s COLLECTION The most sophisticated solution instrument managem That’s right, you deserve it. You deserve Hu-Friedy the peaceCLEAR of mind and confidence of knowing That’s right, you deserve it.for You deserve Hu-Fr the peace FindFind the right one with Find the right one with That’s right, you deserve it. You deserve Hu-Friedy the peace of mind and confidence of knowing the right one with Hu-Friedy.com/Harmony that you are employing the mostHow contemporary method in of processing instruments. thatAs you dentistry’s are employing the mostHow contemporary meth Learn to Scale Perfect Harmony at Learn to Sca that you are employing the most contemporary method of processing instruments.

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You deserve the peace of mind and confid Find the right one with Hu-Friedy How to Scale in Perfect Harmony at Hu-Friedy’s ClearLearn Collection consists of innovative instruments designed to accent, individualize innovator of thefor cassette-based instrument management system, Hu-Friedy ispredictable proud innovator to bring of thethe cassette-based instrument manage that you are employing most contemporary method of processing Ensure predictable outcomes your littlest patients with Hu-Friedy Stainless Steel Pedo Crowns.

Ensure outcomes for your littlest patients with Hu-Friedy Stainle innovator of thefor cassette-based instrument management system, Hu-Friedy is proud toLearn bring How to Scale in Perfeci Ensure predictable outcomes your littlest patients Stainless Pedo Crowns. you the modern design and functionality ofwith theHu-Friedy Infinity Series Steel Cassettes which include: yououtcomes the modern design and functionality of theCrowns.

Infin innovator of the cassette-based instrument management system, Hu-F Hu-Friedy.com/Harmony Hu-Friedy.com/H and optimize the biomechanics of the invisible aligner experience with no heat required.

Ensure predictable for yourdentists littlest patients with Hu-Friedy Stainless Pedo you the modern design and functionality ofyour thepatients.

Infinity Series Cassettes which include: You’ll quickly discover why dentists favor our impeccable fit. Perfect for Easy for you.

You’ll quickly discover why favor our impeccable fit.Steel Perfect for you Hu-Friedy.com/Harmony you the modern design and functionality of the Infinity Series Cassette

INSTRUMENT INSTRUMENT MANAGEMENT MANAGEMENT

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HFL-482AUS/1220 ©2020 Hu-Friedy Mfg. Co., LLC. All rights reser • Color-coded silicone rail Hu-Friedy system that reduces instrument contact • and Color-coded allows silicone rail system that significantly ©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved.

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HFL-482AUS/1220 • Color-coded silicone rail system that reduces instrument contact and allows THE TEAR DROP THE HORIZONTAL THE VERTICAL THE HOLE PUNCH WHY DENTISTS LOVE STAINLESS STEELprotecting PEDO CROWNS: WHY DENTISTS LOVE OUR STAINLESS STEEL PEDO CROWNS: WHY DENTISTS STAINLESS STEEL PEDOwhile CROWNS: forLOVE more water flow while protecting the instruments during reproce moreOUR water flowSTAINLESS while the instruments during reprocessing forOUR more water flow protecting the instrume WHYfor DENTISTS OUR STEELprotecting PEDO CROWNS: forLOVE more watertoflow the instruments during reprocessing Creates a reservoir use while Produces indentations for Produces indentations for Creates half-moon cutouts • Ideal height and mesio-distal width • Easy-to-use, ergonomic latch that allows for one-handed opening All company and productbuttons names are that trademarks of Hu-Friedy Mfg.one-h Co., LLC • Ideal and width • Ideal height and mesio-distal width • height Easy-to-use, ergonomic latch that allows for one-handed opening • Easy-to-use, ergonomic latch allows for withmesio-distal elastic hooks torque & retention rotation & retention for bonded & tissue All company and product trademarks Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise All company noted.scaler anddesigns. product are trademark • Ideal and mesio-distal width • height Easy-to-use, ergonomic latchnames thatare allows forofone-handed opening 1) Compared to other leading Datanames on file. Available req • Pre-trimmed and pre-crimped for simple placement All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC, its affiliates or related companies, unless otherwise noted. in at your best means having confidence what you designs. do.upon Expe 1) Compared to other leading scaler designs. Data on file. Available upon request. •Performing 1) Mfg. Compared torights otherreserved. leading scaler D Hu-Friedy Co., clearance LLC. placement All HFL-482AUS/1220 ™ ©2020impingement • Pre-trimmed and pre-crimped for simple placement Pre-trimmed and pre-crimped for simple Cassettes, and improve Performing at your best means having in what you Experience Infinity Performing Series at your best means having confidence in 1) Compared to confidence other leading scaler designs.

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• Accurate occlusal anatomy that matches the natural tooth the efficiency of your practice, while helping protect your patients, you ™ • Pre-trimmed and pre-crimped for simple placement ©2020best Hu-Friedy Mfg. Co.,having LLC. All rights reserved. HFL-482AUS/1220 ©2020 Hu-Friedy Mfg.improve Co., LLC. All rights reser and Performing at your means confidence in what you do. Experience Infinity Series Cassettes, Hu-Friedy Mfg. Co., LLC. All rights reserved.

HFL-482AUS/1220 • Accurate occlusal anatomy thatpractice, matches©2020 the natural tooth • Accurate occlusal anatomy thatpractice, matches the natural tooth protect the efficiency of your while helping protect your patients, your staff and theyour efficiency instrument of your investment. while helping • Accurate occlusal anatomy thatpractice, matches the natural tooth protect your patients, your staff and your instrument investment. the efficiency of your while helping

Hu-Friedy Mfg. Co., LLC, 1666 how E. Touhy Ave., Desenhance Plaines, IL 60018 | Hu-Friedy.com To learn more about IMS VISIT USVISIT ONLINE AT about HU-FRIEDY.COM/PerfectFit To learn more howcan IMS can enhance To learn more visit Hu-Friedy.com/Clear All company and product names are of Hu-Friedy Mfg. Co., LLC, US ONLINE ATtrademarks HU-FRIEDY.COM/PerfectFit

your practice visit Hu-Friedy.com/Infinity ©2016 Hu-Fried y Mfg. Co., LLC. All is rights reserved. its affiliates or related companies, unless noted.member of Hu-Friedy now aotherwise proud your practice visit Hu-Friedy.com/Infinity

Hu-Friedy is now a proud member of

©2016 Hu-Fried y Mfg. Co., LLC. All rights reserved.

©2021 Hu-Friedy Co.,AllLLC. rights reserved. ©2017 Hu-Friedy Mfg.Mfg. Co., LLC. rightsAll reserved.

©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

Or contact your local Hu-Friedy partner for more information. ©2016 Hu-Friedy Mfg. Co., LLC. All rights reserved.

OrdersOrders 0800 808 855 www.henryschein.co.nz 0800 855 www.henryschein.co.nz Orders 0800 808 855808 www.www.henryschein.co.nz

To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All is rights now reserved.

Hu-Friedy a proud member o

©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

©2017 Hu-Friedy Mfg. Co., LLC. All rights reserved.

Hu-Friedy is now a proud member of

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Hu-Friedy is now a proud member of of Hu-Friedy is now a proud member

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To learn about how IMS can enhance VISIT more US ONLINE AT HU-FRIEDY.COM/PerfectFit your©2016 practice visit Hu-Friedy.com/Infinity Hu-Fried y Mfg. Co., LLC. All is rights now reserved.

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1

clinical | EXCELLENCE

case report

Straumann® Pro Arch concept with fully guided implant and abutment placement

By Nikolay Makarov, DDS, MSc

Framework: Alexandr Dolgolaptev Veneering: Vyacheslav Bakaev

Figure 1.

Figure 2.

Figure 3.

Figure 4.

I

n cases with severe posterior bone atrophy, Straumann Pro Arch is a solution that helps the patient achieve a fixed rehabilitation. Straumann Guided Surgery and the coDiagnostiX® planning software can produce predictable results in cases with complex bone anatomy, or where implants are placed so as to obtain planned multi-unit angulation. With CARES® Visual we can obtain a precise framework fit on the original components, which is fundamental for the final rehabilitation.

96 Australasian Dental Practice

Initial situation 70-year-old female in good general health presented at a private practice with an edentulous maxilla and partially edentulous mandible seeking a complete mouth rehabilitation.

Conditions in the maxilla allowed satisfactory retention of a new complete denture which was accepted by the patient, while the mandible exhibited severe atrophy of the hard and soft tissues in the posterior regions and hopeless teeth in the frontal area, as observed clinically and confirmed by a CT scan (Figure 1).

A

July/August 2021

clinical | EXCELLENCE

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Treatment planning one quality in the mandible allowed placement of four implants in the anterior region, with both lateral implants tilted and did not allow any implants to be placed in the distal area. For these reasons, a Pro Arch concept was chosen as a treatment modality.

As bone conditions in the mandible were very difficult in terms of correct implant placement, it was decided to place them with the help of a surgical guide. The planning included several steps.

First, the hopeless teeth in the mandible were to be extracted, following delivery of a complete immediate denture, as they did not offer any stable support for a surgical guide. Six weeks later, due to the lack of keratinised tissue in the premolar regions, apical repositioning and a free gingival graft were performed (Figure 2).

After 45 days, the denture was relined with a mixture of barium sulfate and resin, transforming the denture into a radiological stent (Figure 3). Another CT scan was recorded with the stent in the mouth (Figure 4). The stone cast of the stent was poured (Figure 5), giving us the actual clinical picture of the mucosa and both cast and stent were scanned to obtain their STL files.

B

July/August 2021

Using the coDiagnostiX planning software, the radiopaque saddle of the stent and the STL scan were matched, which also allowed the stent to be matched with a cast as positive and negative, thus giving us the soft tissue volume. Implants were planned in a prosthetically-driven manner at sites #34, #32, #42 and #44, with corresponding screw-retained abutments (Figure 6).

Because of an open-flap procedure due to the lack of keratinised tissue and the placement of long implants (all BLT 4.1x12 Roxolid®, SLA®), it was decided to make two surgical guides: first, a mucosa-supported guide only for drilling the template fixation pins (Figure 7), second, a pin-supported guide for fully guided implant placement (Figure 8). The software can be used to choose an SRA in implant planning. Also, we can plan abutment placement with the engraving of implant rotation markers on the guide. This planning helps us stop at the right moment in terms of rotation at the very end of implant placement. We planned to convert the denture into an immediate temporary fixed restoration, with delivery of the final restoration in three months after implant placement.

Australasian Dental Practice

97

clinical | EXCELLENCE

Figure 9.

Figure 10.

Figure 11.

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

Figure 18.

98 Australasian Dental Practice

Figure 17.

Figure 19.

July/August 2021

clinical | EXCELLENCE

Figure 20.

Figure 21.

Figure 22.

Figure 23.

Figure 24.

Surgical procedure n the day of surgery, two bites were taken: first with the guide for the pins for stable drilling (Figure 9), then with the existing prosthesis (Figure 10) for its correct conversion into an immediate restoration. The first mucosa-supported guide was used for drilling the sites for Template Fixation Pins (Figure 11).

Next, the guide was removed, the flap was raised and the second guide was fixed with the pins at the corresponding sites (Figure 12).

Implant beds were prepared (Figures 13-14) and Straumann BLT implants placed with a torque setting of more than 35 Ncm, following the protocol to allow correct subsequent SRA placement (Figures 15-16). Bone around the implants was prepared with Bone Profilers for the same reason (Figure 17). The crest was flattened (Figures 18-19), SRA abutments were screwed to

O

July/August 2021

35 Ncm (Figure 20) and covered with healing caps and the wound was sutured (Figure 21).

Prosthetic procedure Provisional restoration n the same day of the surgery, the existing denture was converted into an immediate temporary fixed restoration by adjusting it on temporary abutments directly in the mouth (Figure 22), and an impression was taken as a double check. The restoration was tightened to 15 Ncm (Figure 23). In 10 days, the sutures were removed, the control CT scan was recorded (Figure 24), and the results were assessed with the coDiagnostiX evaluation tool.

O

Australasian Dental Practice

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clinical | EXCELLENCE

Figure 25.

Figure 26.

Figure 27.

Figure 28.

Figure 29.

Figure 30.

100 Australasian Dental Practice

July/August 2021

Helping dentists say goodbye to bad posture, neck pain and eye fatigue.

The world’s first surgical loupes to incorporate PENTAX’s unique PRISMVUE deflection prisms offer the dentist a bright, magnified view of the surgical field whilst maintaining an upright, forward-facing posture. The proper posture prevents the dentist’s head from interfering with the overhead surgical lights and helps you maintain a bright, magnified operating field.

Scan the QR code, visit osseogroup.com.au/pentax or call 1300 029 383 to learn more and book an in-office demo.

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Make the change to PENTAX NF2 PRISMVUE surgical loupes and say goodbye to lousy working posture, neck pain and eye fatigue.

clinical | EXCELLENCE

Figure 25.

Figure 26.

Figure 27.

Figure 28.

Final restoration wo months after the implant placement impressions were taken, the precision was checked with a verification jig (Figures 25-26).

The vertical dimension of the provisional prosthesis was followed when mounting the casts in the articulator (Figure 27-28).

The analog set-up was tried in (Figure 29), then scanned by the Straumann 7 Series scanner together with the model.

The framework on Variobase® abutments for SRA was designed in CARES Visual following the set-up anatomy (Figure 30), then milled from titanium (Figure 31). The passive fit of the framework was checked and it was then veneered with resin with the denture teeth in place (Figures 32-33).

Variobase abutments were cemented into the prosthesis and the final restoration was tightened to 15 Ncm (Figure 34). The screw holes were then closed with Teflon™ tape and composite resin.

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102 Australasian Dental Practice

Treatment outcomes his case shows how digital technologies help achieve good results in complex surgical conditions and facilitate immediate predictable temporisation. It demonstrates that correct prosthetically-driven implant planning results in a satisfactory final restoration.

T

About the author Dr Nikolay Makarov graduated from the Moscow University of Medicine and Dentistry and the University of Siena, Italy. He obtained an MSc at the Sapienza University of Rome and specialised in dental surgery at the Moscow University of Medicine and Dentistry and was an ITI Scholar at the University of Geneva.

He combines private practice with a PhD from the Implant Prosthetic Department at the Sapienza University of Rome where he is also lecturing in a Masters program.

July/August 2021

TAKE TAKE YOUR YOUR PRACTICE PRACTICE TO TO THE THE NEXT NEXT LEVEL LEVEL WITH NEODENT® DIGITAL SOLUTIONS WITH NEODENT® DIGITAL SOLUTIONS

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Contact your Straumann Group Specialist Contact your Straumann Group Specialist or call for information on patient and or call for information on patient and practice benefits practice benefits

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clinical | EXCELLENCE

Replacement of a central incisor using the socket-shield technique and a digital workflow

By Dr Francisco Teixeira Barbosa

Figures 1-2. Initial situation.

A

48-year-old female patient, in good general health with no known pathology, nonsmoker with no allergies and not taking any medication, presented at the practice.

The patient was suffering from the continuous decimation of her crown on the central incisor (Figure 1). Once the crown was removed, we saw that the remaining stump had subgingival margins and the typical appearance of having suffered continued leaks.

The patient’s smile has a high lip line (Figure 2). She shows all four maxillary incisors and about 4 mm of attached gingiva. The restoration requires a highly aesthetic end result, as any faults would be clearly visible. The patient biotype was average and the gingival tissues were not very scalloped.

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Treatment planning The patient was presented with five treatment options: 1. The first option was to reconstruct the remaining tooth structure and make a new crown. This however, would not guarantee a predictable treatment outcome in the medium to long-term.

2. The second option was a Maryland bridge together with alveolar preservation and a connective tissue graft. This option was dismissed as the adjacent fixed ceramic prosthesis would seriously compromise the adhesion of the bridge.

3. Option three was removal of the tooth, with alveolar preservation after the extraction and the subsequent placement of an implant after 4-5 months, in conjunction with a connective tissue graft if necessary.

4. The fourth option, which was to remove the tooth and placing an implant early, typically 4-8 weeks after extraction, was considered a good option as it gives predictable long-term outcomes with acceptable aesthetic results (Buser, 2013).

5. The fifth option was to remove the tooth, immediately place an implant, with or without immediate provisionalisation and within the immediate placement procedure, using the Socket-Shield Technique. Overall, this was considered the best option. The patient agreed on option five.

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Figure 3. Removal of the existing crown.

Figure 4. TRIOS intraoral scan.

Figure 5. Aurea abutment.

Figure 6. Scanning post in place.

Treatment description he first step was the removal of the cemented crown (Figure 3). Once this was done, it was apparent that not enough tooth structure remained to guarantee a high quality fixed restoration long-term.

After the removal of the crown, the coronal aspect of the remaining tooth structure was sectioned mesiodistally and reduced to the level of the gingiva.

It is important at this point not to touch the interproximal bone when using the drill. Using a TRIOS intraoral scanner (3Shape), the scan gave a clear picture of where the remaining root structure was.

This information was used to avoid contact between the provisional restoration and the root (Figure 4). The palatal segment of the root is then removed. This must be done in a way that avoids any force being applied onto the interdental bone or onto the remaining labial half of the root, which still remains in place. Hence, the removal of the palatine root must be done from the palatal aspect, preferably with a periotome.

Once the palatine fragment has been extracted, the remaining labial portion of the root must be properly shaped. It is important to use long burs to access the apex of the fragment and thus be able to shape the apical part as well. For the

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coronal part, the root fragment must be reduced to leave 1 mm of supracrestal structure remaining.

The next step is the usual surgical sequence for the implant system. The drilling sequence for a 4.3 mm diameter, 13 mm long RP platform implant (Phibo®, Spain) was followed. By using a drilling system with a depth stop incorporated in the drill, the sequence with the drills was carried out for a 14.5 mm implant, even if a 13 mm implant is going to be placed.

The reason for this is if the drills for 13 mm long implant were used, the preparation would not be at a suitable length to place the implant. The cap built into the 13 mm drill would touch the root fragment and would not reach the desired length.

After the osteotomy, Emdogain ® (Straumann) was placed over the palatine surface of the remaining fragment before placing the implant. Strictly speaking, this is not required. In fact, while used in early reports (such as Hürzeler in 2010) later reports no longer use Emdogain (such as Bäumer in 2013 and Kan in 2013). Clinically, the only noticeable difference is the greater speed at which the soft tissue heals when Emdogain is used. In cases using a prosthesis made of PMMA based on a digital impression with a provisional prosthesis, we have observed soft tissue growth with advanced healing, as com-

pared to slower healing when growth factors are not used. In Bäumer’s 2013 article, histologically the only difference is that bone is formed faster between the fragment and the implant.

The implant is placed and torqued to 35 Ncm initial torque. The ideal 3-dimensional position in this case is a shoulder 4-5 mm from the gingival margin, slightly towards the palatal aspect, with the emergence at the cingulum level of the tooth to be restored and a minimum distance of 1.5 mm from the adjacent teeth. During the insertion of the implant we can see whether there is contact of the implant with the fragment, or if a gap will be left between the implant and the fragment.

After placement, a measurement of the implant stability (ISQ) is made with Osstell®. The ISQ in the case of provisionalisation of single implants must be at least 70. If it does not reach that ISQ level, the implant must be left submerged.

Next, we proceeded to place the Aurea abutment. This is about 0.8 mm high (Figure 5) and allows disconnection between the prosthesis and the implant.

We then placed the scanning post, with the flat side positioned towards the labial aspect. This was digitally scanned and used to prepare a PMMA provisional restoration using CAD/CAM (3Shape Dental Designer) (Figure 6).

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clinical | EXCELLENCE A milled PMMA provisional prostheses manufactured with CAD/CAM from prepared blocks of PMMA should have minimal release of methyl methacrylate monomer (Güth 2011). This is unlike PMMA prepared chairside, where release of monomer could cause some soft tissue irritation or recession. Another advantage of a PMMA provisionals made using CAD-CAM is that it is designed and manufactured with a digital workflow, with complete control during its CAD design. It also has more consistent mechanical properties. Using the 3Shape TRIOS intraoral scanner, once the scan is made, the order is sent to the laboratory for design of the provisional.

My overall intraoral scanning scan sequence is as follows: 1. Scan the antagonist.

2. Scan the sextant where the implant is placed.

3. Scan the implant with the digital scanning post attached to it 4. Scan the occlusion.

After scanning, we remove the scan post and place a provisional cap on the Aurea abutment. We then add the remaining Emdogain to the area to speed healing.

It’s important to provide clear instructions to the laboratory about the characteristics that this provisional must have. The digital scan delivers greater detail of the scanned area by enabling the visualisation of the root fragment in the digital file (Figure 8). I recommend advising the laboratory to leave 1.5-2 mm distance between the fragment and the provisional.

Another factor to consider is the occlusion: A functional load is not required during the provisionalisation period, so the laboratory should be instructed to leave the provisional out of the occlusion.

This provisional is placed 72 hours after the surgery, at about 15 N·cm torque (Figure 7).

In this case, when the provisional was removed, it was noted that the coronal aspect of the shield was exposed. There are two ways to avoid continuous contact between it and the permanent prosthesis, since this could lead to infection: 1. Design the definitive restoration taking the fragment into account, creating a distance of about 1-2 mm from the shield. Remember that digital scanning allows a perfect visualisation of where the fragment is; or

106 Australasian Dental Practice

Figure 7. Milled PMMA provisional.

Figure 8. Detailed 3Shape TRIOS scan.

Figure 9. Zirconia abutment in situ.

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clinical | EXCELLENCE 2. Slightly reduce the most coronal aspect of the shield with a diamond bur.

Note that this will cause bleeding and coronal epithelialisation.

In this case, a zirconia abutment (Figure 9) was designed to which the final porcelain crown is cemented. It is important that the order to the laboratory includes the location of the abutment margin. This point is critical, since a margin that is too submerged (located more than 2 mm subgingivally), will complicate the removal of the excess cement (Linkevicius 2011).

A location from 0.5 to 1 mm subgingival is recommended. The final result is shown in Figure 10.

Benefits of the digital workflow

Figure 10. Final result.

sing a digital workflow, I am able to control every step of the design and manufacture of the provisional restoration and the definitive restoration. In my view, for designing the provisional and definitive restorations, using a digital workflow is almost mandatory.

Using the TRIOS intraoral scanner gave a clear image of where the labial fragment was. It enabled us to avoid contact between the provisional restoration and that fragment.

For the patient, using an intraoral scanner meant a more minimally invasive procedure and one that gave a good aesthetic outcome. In terms of the digital workflow, using 3Shape Communicate™ made the sharing, planning and execution very effective during the design of the provisional and definitive restoration.

3Shape Communicate enabled me to monitor the case workflow.

U PMMA CAD/CAM Provisional Surgery

72 hours

2° checkup

1° checkup

1° week

1° month

Definitive restoration

2° month

3° month

4° month

Figure 12. In terms of treatment period, the digital workflow was more efficient and required less visits.

About the author Dr Francisco Teixeira Barbosa graduated from the University Alfonso X El Sabio, Madrid, Spain in 2004. He moved his practice to Barcelona where he continued his education at Escuela Superior de Implantologia in Barcelona and at the Maxillofacial department of Hospital del Mar at Barcelona. Francisco started his private practice in Barcelona. Later he finished a degree in Advanced Oral Implantology from Loma Linda University, USA and an MBA from the ESADE Business School. He is the founder of Periospot.

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1. 80% of studies (4 of 5) show patients choose digital impressions over conventional (Chandran et al. 2019).

clinical | EXCELLENCE

The digital scan appliance - Mark II

By Terence Whitty

Figure 1. Upper and lower scan appliances.

Figure 2. Upper and lower models with bite registration.

Figure 3. Scanning the models and bite registration.

n a previous article,1 I discussed and demonstrated a method of taking a patient’s existing denture and duplicating it using an intraoral scanner and 3D printing and creating a CBCT scan appliance. This appliance is then worn by the patient during the CBCT scan and allows us to accurately align the patient’s edentulous model with the CBCT scan so accurate planning of the implants can take place. Ultimately, a surgical guide is manufactured from this so the implants can be placed with confidence.

But what if the patient has no denture to duplicate? We could of course make one in the traditional way, but this takes time.

There is a completely digital technique I have used recently that dramatically speeds up the process and gives excellent results.

It starts with impressions and a bite record. Primary impressions are usually sufficient and a simple wax bite rim with some bite registration material placed on it during the procedure may allow this all to be done in one appointment. Next, the impressions and bite registration are transferred to the lab where the models are poured and the bite registration fit checked with the models.

I

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clinical | EXCELLENCE

Figure 4. exocad upper and lower scanned models with scanned bite registration.

Figure 5. Upper and lower models in correct relationship.

Figure 6. Auto tooth placement.

Figure 7. A few tweaks and you have the teeth setup.

Figure 8. Check occlusion.

Figure 9. Automatic base generation.

Scanning of the models and also the models with bite registration is next. This converts the upper and lower models to digital scans and keeps the correct MMR ready to be loaded into the CAD software.

In this example, I’m using the exocad Full Denture module as it allows a single denture to be made against a stone model antagonist. In this case, it just happens to be a digital model of a full upper denture. This software is very easy to use and speeds up the whole denture process, hence why I chose it for this task.

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Figure 10. Appliance ready for exporting and printing.

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clinical | EXCELLENCE

Figure 11. Setup in Uniz 3D printing software.

Figure 12. UNIZ Slash 2 Printer.

Figure 13. Printing completed.

Figure 14. Appliance cleaned and post cured.

Figure 15. Appliance fitted to model.

Figure 16. Radiopaque lacquer painted on to the appliance.

The software steps you through some basic measurements of the models, then it will automatically select the teeth for you and perform the set-up and most of the hard work is now done.

Because our main aim here is to make a scan appliance, I didn’t fuss with the setup too much; I just gave the teeth a tweak to correct any major issues. Next, I use a software tool to “cut intersections” which will sort out any discrepancies in the bite as it will trim the teeth to the opposing digital model. This can be a real time saver and if you have your tooth setup near enough it, will make sure the bite is spot on without taking too much tooth surface. The software will then create the denture base and most importantly, will merge the teeth and the base files together to create one file ready for 3D printing.

Figure 17. Appliance ready for CBCT scan.

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clinical | EXCELLENCE

Figure 18. CBCT 3D render with the scan appliance in place.

Note the radiopaque teeth and markers.

Figure 19. Merging the optical scan of the edentulous model and the scan appliance with the CBCT.

Figure 20. Merge successful. Note the markers on the base of the model. These will assist with the next merge of the edentulous model scan.

Figure 21. Merging of the edentulous model with the CBCT scan is now done by matching with the previous optical scan. This is the final result we are after as the planning can now be done and the surgical guide can be made with confidence that the merge is accurate.

Transfer this file to the 3D print software and create supports so the appliance will print. This appliance took 90 minutes to print on a UNIZ Slash 2 printer.

Once printed, the appliance is washed with IPA in a series of ultrasonic cleaners and then undergoes a short post curing cycle in a light curing apparatus. The supports are removed and a simple trim and polish is carried out.

As I described in the previous article, we then paint on the radio opaque lacquer over the facial and buccal surfaces of the teeth and create small raised dots of lacquer on the base as pictured.

The result is a completely digitally designed and manufactured scan appliance, made very easily with software and a 3D printer.

So easy, it’s hard to think about going back to the old methods!

About the author

Figure 22. Example of the surgical guide design to be used for this case with stabilisation pins.

1. Whitty, T. The Implaguide Digital Scan Appliance. Australasian Dental Practice Vol. 30 No. 3 May/June 2019. pp 134.

114 Australasian Dental Practice

Terence Whitty is a well-known dental technology key opinion leader and lectures nationally and internationally on a variety of dental technology and material science subjects. He is the founder and owner of Fabdent, a busy dental laboratory in Sydney specialising in high tech manufacturing. Using the latest advances in intra- and extra-oral scanning, CAD/CAM, milling, grinding and 3D printing, most specialties are covered including ortho, fixed and removable prosthetics, computerised implant planning and guidance, TMD, sleep appliances and paediatrics.

July/August 2021

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clinical | EXCELLENCE

READ ME FOR

CPD

Non-invasive microveneer restoration made of the hybrid ceramic VITA ENAMIC With Dr Michael Tsao and Dr Hsuan Chen

P

roducing noninvasive microveneers using CAD/CAM systems has been a major challenge so far, due to the brittleness of ceramic dental materials. The very small wall thicknesses and thinly tapering edge areas of such restorations often showed significant ceramic chipping or fractures after CAM production. The dental team of Dr Michael Tsao and Dr Hsuan Chen systematically examined a variety of ceramic material samples in numerous test runs. They selected the hybrid ceramic VITA ENAMIC (VITA Zahnfabrik, Germany) for their restoration.

Based on their clinical experience, this material still allows a very good marginal integrity even with wall thicknesses of 0.2 mm. In this report, the practitioners show the non-invasive, model-free and fully digital restoration of a diastema.

Assessment and planning 29-year-old male patient presented in the practice because he was dissatisfied with his diastema between teeth 11 and 21. He rejected orthodontic therapy. He wanted a time-efficient solution with the greatest possible preservation of the natural tooth substance. The usual production of microveneers on refractory stumps was too lengthy for him. Therefore, the practitioners and patient decided to implement the gap closure in the digital workflow using VITA ENAMIC hybrid ceramics in a single session.

A

Tooth shade determination and digital design fter meticulous cleaning of the restoration area, the tooth shade was determined with the VITA Toothguide 3D-MASTER (VITA Zahnfabrik, Germany) on the two central incisors in the upper jaw. The tooth shade 1M2 was determined and the corresponding blank selected. After retraction threads were laid, the intraoral scan was performed with CEREC Omnicam (Dentsply Sirona, Germany). Because of the high enamel translucency of the tooth in the approximal region, scanning powder was applied to facilitate intraoral scanning. Sirona Connect transferred the data record to the inLab software. There, the razor-thin microveneers were digitally constructed.

A

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CAM fabrication with a highly precise result or CAM production with the CEREC MC XL System (Dentsply Sirona, Germany), the VITA ENAMIC blanks were fixed in the grinding unit and the corresponding grinding job was carried out. The grinding result showed razor-thin microveneers with absolutely precise edge areas. Thanks to its dual

F

“VITA ENAMIC enables non-invasive treatment of diastemata in a digital workflow...” ceramic-polymer network structure, the hybrid ceramic has a significantly higher elasticity and less brittleness than traditional ceramic CAD/CAM materials. This enables high-precision reconstructions with simultaneously low wall thicknesses. Finally, the graceful restorations were carefully separated from the attachment with a fine diamond, finalised and tried-in.

Conditioning according to proven protocol ITA ENAMIC has a stable, highly networked ceramic matrix. The ceramic portion of the material is 86 percent (wt%). As a result, the hybrid ceramic can be preconditioned using hydrofluoric acid and silane, according to the traditional, all-ceramic protocol. CAD/CAM composites, on the other hand, are sandblasted because they have a polymer matrix in which ceramic fillers are embedded. Sandblasting, however, can lead to damage of the material structure and thin edge areas in reconstructions with low wall thicknesses. In the present case, the microveneers were pretreated with the safer protocol. The enamel was conditioned with phosphoric acid and adhesive. Afterwards, the veneers were fixed with a composite cement. After removal of the composite residues and polishing with the VITA ENAMIC Polishing Set, a highly aesthetic result was achieved efficiently and non-invasively after only one session.

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clinical | EXCELLENCE

Figure 1. Initial sizuation: Young patient with diastema between teeth 11 and 21.

Figure 2. Razor-thin veneers were constructed using inLab software.

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Figure 3. The high-precision result after the grinding process with CEREC MC XL.

Figure 4. The delicate microveneers on tooth 11 and 21 during the clinical try-in.

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clinical | EXCELLENCE

Figure 5. Veneer characterised with light-curing stains before seating.

Figure 6. There was a natural light transmission following the fully adhesive attachment.

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Figure 7. A transition-free and natural appearance was also evident laterally

Figure 8. Final result: The patient was very satisfied with the highly aesthetic result in only one session.

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clinical | EXCELLENCE case report

Augmentation of width of keratinised tissue around prosthetic restoration Surgery by Prof. Dr Mariano Sanz and Dr Ramón Lorenzo (Madrid)1 Aim: Increasing the width of keratinised mucosa around a prosthetic restoration, whilst avoiding the patient morbidity caused by autologous soft tissue grafts.

Figure 1. The presurgical clinical situation demonstrating the deficiency of keratinised mucosa around the premolar and molar sites.

Figure 2. A split-thickness flap is elevated in order to prepare the surgical bed to accommodate the soft tissue biomaterial.

Figure 3. The dimension of the Geistlich Mucograft® collagen matrix is customised to the size of the surgical bed by trimming in a dry state.

Figure 4. Geistlich Mucograft® is positioned and then stabilised to the surgical bed with sutures. This material is designed to be let exposed, allowing for open healing when used for the indication of gaining width of keratinised mucosa.

Figure 5. The clinical situation 10 days after surgery, just prior to suture removal.

Figure 6. The clinical situation immediately following suture removal. Note the rapid re-epithelialisation of the augmented site.

Figure 7. Clinical presentation 1 month post-surgery.

Figure 8. Clinical presentation 3 months post-surgery.

References: References: 1 Sanz M, et al. J Clin Periodontol. 2009 Oct;36(10):868-76 (Clinical study). * Mucograft® (prototype) exhibited highly similar physical, mechanical and biologicalproperties to the final product Geistlich Mucograft® differing only in the porcine collagen source used.

Figure 9. After 6 months of healing, a 4mm band of keratinised tissue is observed at the buccal aspects of the premolar and molar sites.

Conclusion: Geistlich Mucograft® is a xenogeneic biomaterial that appears to be as effective and predictable as the autogenous connective tissue graft (CTG) when used for the purpose of gaining an adequate width of keratinised tissues. The collagen matrix demonstrates excellent handling properties and can be used successfully in an open healing situation, reducing significantly patient morbidity and surgery time when compared to CTG.

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Treatment concept Gain of Keratinised Tissue Soft tissue recession A recent study has shown that lack of keratinised buccal soft tissue around implants caused gingival recession over a period of five years.1

Inflammation and attachment loss There is scientific evidence that the presence of keratinised mucosa has a significant effect on the health and stability of the soft tissue,3,4 while lack of keratinised soft tissue around implants is associated with inflammation and attachment loss.2

Increased plaque accumulation Patients with a low width of keratinised tissue showed increased plaque lingually and more frequent bleeding at the implant.1

Proven effectiveness Therapy with Geistlich Mucograft® yields a similar amount of keratinised tissue gain as with either the connective tissue graft5 (CTG) or free gingival graft (FGG).6 In addition, Geistlich Mucograft® provides higher therapy safety for gaining keratinised tissue around implants compared to connective tissue grafting while eliminating the morbidity of a harvest site.5

Lack of keratinised tissue around implants is associated with

> Gingival recession over a period of five years1 > Soft tissue attachment loss2 > Increased plaque accumulation lingually1 > Inflammation of the soft tissue2 > More frequent bleeding1

Presence of keratinised tissue around implants is associated with

> Significant effect on the health and stability of the soft tissue3,4

Therapy with Geistlich Mucograft® yields

> Gain of keratinised tissue comparable to CTG5 or FGG6 > Higher therapy safety than CTG5 > No harvest-site morbidity5

Schrott AR, et al. Clin Oral implants Res. 2009;20(10):1170–7 (Clinical study) Chung DMT, et al. J Periodontol. 2006;77(8):1410–20 (Clinical study) 3 Block MS & Kent JN. J Oral Maxillofac Surg. 1990;48(11):1153–60 (Clinical study) 4 Bragger U, et al. Clin Oral implants Res. 1997;8(5):412–21 (Clinical study) 5 Lorenzo R, et al. Clin Oral Implants Res. 2012 Mar;23(3):316-24 (Clinical study) 6 Nevins M, et al. Int J Periodontics Restorative Dent. 2011 Jul-Aug;31(4):367-73 (Clinical study) 1

2

clinical | EXCELLENCE case report

Precise prosthetic planning and implant placement: Treatment of a complex full-arch case using guided surgery and immediate loading

By Sergio Piano, DDS, Italy

Figure 1.

Figure 2.

Figure 4.

O

ral health plays an important role in quality of life and even though preventive dentistry has evolved, edentulism remains a prominent public health problem that can affect function, aesthetics and the psychosocial aspects of human life. Thus, the option of replacing teeth with implants plays an important role in overall patient well-being.

124 Australasian Dental Practice

Figure 3.

Figure 5.

Introduction echnological progress, including the proliferation of internet access worldwide, has given patients access to a wealth of information about their oral health and has raised awareness of the range of available treatments, materials and techniques. As a result, patient expectations and behaviour has changed and an ever-increasing number are requesting less invasive, affordable, efficient and immediate solutions.

The Straumann® Pro Arch Concept enables personalised treatment protocols with various treatment options to address specific indications and clinical scenarios. This concept covers all stages of an immediate full arch treatment and includes the use of implants specifically designed for immediate procedures, with a flexible prosthetic portfolio that considers the patient’s aesthetic expectations and financial resources.

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July/August 2021

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

Figure 11.

This case report describes a successful functional and aesthetic prosthetic full-arch implant rehabilitation of a patient with a hopeless maxillary dentition and decreased quality of life due to impaired masticatory function and poor aesthetics.

The Straumann Pro Arch Concept with Straumann Bone Level Tapered (BLT) implants and Straumann Screw Retained abutments (SRA) allowed us to address our patient’s chief complaints by providing an efficient and predictable solution. The immediate treatment workflow involved 4 steps: 1) accurately creating a pre-operative dental model; 2) surgical and prosthetic planning with coDiagnostiX® software; 3) placing the dental implantswith a computer-guided and flapless technique; and 4) finally performing an immediate loading procedure.

This clinical outcome was achieved in a single day and with no complications. The patient was highly satisfied with the positive impact the treatment had on her quality of life due to significantly improved aesthetics and recovery of masticatory function.

The initial comprehensive clinical evaluations revealed partial edentulism, a deep overbite with the lower incisors impinging upon the palatal gingiva and increased overjet. The upper incisors were buccally tilted and presented tooth wear and mobility.

Moreover, there was interference between the lower lip and the anterior teeth in the smile position (Figures 2-5). Intraoral periapical X-rays showed approximately 50-75% alveolar bone loss.

In addition, the patient had an uneven smile line (Figures 6-7).

Initial situation systematically healthy 58-year-old female patient presented to our office with the chief complaint of aesthetic dissatisfaction and impaired masticatory function due to an unstable removable partial denture (Figure 1).

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July/August 2021

Treatment planning he benefits, risks and alternative treatment options were discussed with the patient and a decision was then reached in partnership with the patient. This is a fundamental stage in treatment planning to ensure that the patient’s needs and wishes are met and to achieve a successful outcome. The treatment workflow included the immediate placement of implants into the extraction sockets and immediate loading using computer-guided surgery and a flapless approach. A suitable new removable partial denture was planned as a starting point. Following the clinical documentation, a digital smile design (DSD) preview was created. The dental technician then made a wax-up of the frontal teeth and a model of the posterior area, thereby creating a new dental arrangement. This new model increased the vertical dimension to define an optimal vertical position for the front teeth (Figures 8-9).

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clinical | EXCELLENCE

Figure 12.

Figure 13.

Figure 14.

Figure 15.

Figure 16.

The next step was to transfer this data to the patient’s mouth to verify its accuracy. Using a silicone mask created based on the wax-up and filled with flowable composite, a mock-up of the front teeth was made (Figure 10). A set-up of the posterior teeth was added to the mock-up to complete the previsualisation of the proposed new smile (Figure 11).

A digital smile design was created and included the initial clinical situation, the proposed shape and position of the teeth and the lower lip line position (Figure 12). In addition, the deep bite and the overjet were corrected and the smile was improved. This prosthetic plan was discussed with the patient and then approved (Figures 13-15). The cast model was scanned and an STL file was generated. Moreover, a CBCT exam was requested for the radiographic assessment. This data, including the DICOM files, were imported in coDiagnostiX software for the analysis and treatment planning (Figure 16).

126 Australasian Dental Practice

The prosthetic plan is just as important as the surgical plan. For this, the STL file of the initial situation was compared with the DICOM files (Figures 17-18).

Furthermore, the STL file related to the proposed prosthetic plan was aligned with the rest of the files (Figure 19). Finally, the last pairing was performed by superimposing the STL file with the virtual extraction of the lateral incisors, which were potential sites for implant placement (Figure 20).

After this preliminary phase, all the data related to the initial situation, bone availability, gingival profiles and prosthetic strategy were ready to start the planning of implant positioning.

On this basis, four Straumann Bone Level Tapered implants: • 22: diameter 4.1 length 12; • 15: diameter 4.1 length 12; • 25: diameter 4.1 length 12; and • 12: diameter 3.3 length 12) ...were strategically distributed among the maxilla and fixation pins were considered for the stabilisation of the surgical guide (Figure 21).

Furthermore, suitable screw-retained abutments were chosen and the corresponding sleeves for the implant and pin placement were selected (Figures 22-23).

The implants at sites #16, #12, #22 and #26 were planned according to bone volume, soft tissue position and prosthetic strategy (Figures 24-27).

July/August 2021

clinical | EXCELLENCE

Figure 17.

Figure 18.

Figure 19.

Figure 20.

Figures 21-23.

Figure 24.

Figure 25.

Figure 26.

Figure 27.

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127

Figures 28-30.

Figure 31.

Figure 32.

Figure 33.

Figures 34-35.

The surgical guide for implant placement was designed and the corresponding STL file was sent to the dental laboratory for printing (Figures 28-30). The next step was to prepare the temporary bridge for immediate loading. This is the preliminary phase prior to milling and involves replicating the shape of the dental set-up in a resin disk (Figures 31-33). Once obtained, the temporary bridge was seated and adapted on the master model with implant analogs and the corresponding SRA abutments (Figure 34).

In the final step, occlusion was carefully adjusted (Figure 35).

Figure 36.

128 Australasian Dental Practice

Surgical procedure n the first phase, the hopeless teeth located on the planned implant sites were strategically extracted and the soft tissue removed with a punch for a flapless approach.

The remaining teeth were used to stabilise the guide with the aid of surgical pins as anchorage. Following the optimal stabilisation of the guide, the implants were placed using the dedicated surgical kit, and the screw-retained abutments (SRA) were placed on the implants. The remaining teeth on the arch were then extracted and temporary abutments were placed on the SRAs. The temporary bridge was screwed onto the copings and bonded with flowable resin. Once the occlusion was adjusted, the chimneys were filled with Teflon and covered with temporary composite. The patient was very satisfied with the functional and aesthetic outcome (Figure 36). X-ray images taken at the one-month (Figure 37) and at the three-month follow-up visit showed a favourable outcome and the patient reported no mechanical or biological complications.

I

Figure 37.

July/August 2021

EXCELLENCE IN IMMEDIACY

Straumann® Guided Surgery Immediate treatments with predictable outcomes

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Straumann Pty Ltd/Straumann New Zealand Limited 7 Gateway Court, Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 Email customerservice.au@straumann.com www.straumann.com.au | www.straumann.co.nz © Institut Straumann AG, 2021. All rights reserved. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates.

Immediate Placement

Immediate Restoration

STRGA124 07/21

Surgical Planning with coDiagnostiX®

Figure 38.

Figure 39.

Figure 40.

Figure 41.

Figure 42.

Figure 43.

Figure 44.

Figure 45.

Figure 46.

Figure 47.

Prosthetic procedure t the 3-month follow-up visit, the patient reported no mechanical or biological complications. Moreover, the clinical examination showed uneventful healing with a complete soft tissue maturation (Figures 38-41). At this point, the treatment already met the patient’s expectations, providing the desired aesthetic and functional clinical outcomes (Figures 39-40). To

A

130 Australasian Dental Practice

prepare the final restoration, the temporary bridge was removed and the soft tissues were evaluated (Figure 42). An optical impression with Straumann Virtuo Vivo™ intraoral scanner was taken and a digital model was obtained and guided into occlusion with the lower jaw (Figures 43-45). Then, the initial dental set-up (represented in blue in Figure 46) was matched with the digital model and minor adjustments were made (shown in white in Figure 46) for the final dental display (Figure 47).

July/August 2021

coDiagnostiX®

Implant Planning Software.

PREDICTABILITY

VISUALISATION

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Comprehensive planning for successful digital implant placement.

Better patient communication thanks to sophisticated visualisation features.

Support for digital drill guide design and fabrication directly through your local laboratory.

Contact your local Straumann Specialist now or visit www.straumann.com.au.

Straumann Group Pty Ltd 7 Gateway Court, Port Melbourne VIC 3207, Australia AU Toll Free 1800 660 330 | NZ Toll Free 0800 408 370 customerservice.au@straumann.com www.straumann.com.au

Digital Solutions

clinical | EXCELLENCE

Figure 48.

Figures 49-50.

Figure 51.

Figure 52.

Figure 53.

Figure 54.

Figure 55.

Figures 56-57.

132 Australasian Dental Practice

July/August 2021

clinical | EXCELLENCE

Figure 58.

Figure 59.

Figure 60.

Figure 61.

Figure 62.

Before milling the zirconia framework, it’s important to ensure optimal dental alignment. Therefore, a “test drive” was performed through a rough milled resin bridge with the exact shape of the designed restoration then checked in the patient’s mouth (Figures 48-50).

The overall aesthetic outcome, smile line, emergence profiles of the teeth, lip support and occlusion were carefully verified.

The zirconia bridge was then created accordingly (Figures 51-55). For this, a full-contour zirconia bridge was milled onto which Variobase® copings were cemented (Figure 56). The model was slightly adjusted and refined before delivery (Figure 57).

Responsibility for the outstanding restorations is by dental technician Alessandro Giacometti, who has supported me in this case and provided a state-of-the-art bridges during the treatment.

Treatment outcomes inally, the bridge was screwed in the patient’s mouth. The treatment outcome fulfilled the patient’s aesthetic expectations in terms of natural appearance, harmony and beauty. Furthermore, she reported an improvement in her quality of life due to the recovery of her masticatory function and self-esteem (Figures 58-62).

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July/August 2021

About the author Dr Sergio Piano graduated in Dental Medicine from the University of Genoa, Italy. He was a Visiting Assistant at Geneva University, Switzerland in 1991-92 (Departments of Prosthodontics, Prof. Belser and Implantology, Prof. Bernard) and a Teacher in the Postgraduate Program at Federico II Naples University, Italy (Master in Implantology), Marconi Rome University, Italy (Master in Computer-guided Surgery) and Brescia University, Italy (Master in Digital Dentistry). He is the director of the Dr Sergio Piano private dental clinic in Genoa, Italy and a regular national and international lecturer in more than 30 countries. Dr Piano is the author of several scientific papers in the fields of implantology and aesthetics. He is an active member of IAO (Italian Academy of Osteointegration) and IAED (Italian Academy of Esthetic Dentistry), an affiliate member of EAED (European Academy of Esthetic Dentistry), an ITI Fellow and member of the Lead Team of the Italian Section with the role of Study Club Coordinator.

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clinical | EXCELLENCE

case report

Bone regeneration with EthOss®

By Dr Stuart Kilner

Figure 1. Initial situation.

Figure 2. Radiograph.

Figure 4. Planning.

A

patient presented with a mobile deciduous E (Figures 1-2). There was a clear buccal soft tissue defect and options for improving this were discussed.

Treatment and procedure

hanks to the nature of the deciduous E (loss of root form), the alveolar ridge below the crown was well-healed (Figure 3) offering ideal primary stability and presenting a suitable case for a custom

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134 Australasian Dental Practice

Figure 3. CBCT.

Figure 5. After XLA and 6 weeks healing. healingw abutment using the Cervico system. Six weeks was allowed for soft tissue maturation post extraction. At this stage we proceeded with guided surgical implant placement with a simultaneous EthOss graft (0.5cc) and a premilled custom healing abutment (Figures 4-13).

There are two major benefits of grafting with EthOss in combination with the custom healing abutment.

Firstly, apically advancing the keratinised gingiva manages the buccal soft tissue defect without the need for soft tissue grafting and the co-morbidities associated

with graft harvest sites. Secondly, using an EthOss buccal veneer graft will turnover into new host bone to support the new position of the gingiva.

Conclusion sing the Cervico custom healing abutment at the time of placement alongside EthOss enabled us to develop this site as shown in a single surgery.

This protocol complements our philosophy for improving patient treatment outcomes and treatment predictability.

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July/August 2021

clinical | EXCELLENCE

Figure 6. CBCT.

Figure 7. Guided implant placement.

Figure 8. Placement.

Figure 9. Placement.

Figure 10. Custom healing abutment.

Figure 11. EthOss and healing abutment.

Figure 12. Radiograph.

Figure 13. Surgery and first phase of prosth complete.

Figure 14. Review 1 after 6 months.

The results at 6 months (Figures 14-15) show a stable site which will continue to improve in the long-term as the EthOss graft is resorbed and replaced with regenerated host bone.

About the author Dr Stuart Kilner graduated from the University of Manchester. Since then he has developed his surgical and prosthetic skills working predominantly with dental implants and related restorative prosthetics. He is currently completing a 2-year Postgraduate Master of Science Degree in Advanced Implantology from the prestigious University of Barcelona, Spain. He has spoken in the UK at ADI (Association of Dental Implantology) events and Internationally in Munich and Israel on the topic of Full Arch Implant Therapies. His special interests lie in rehabilitation, digital integration, dental CAD/CAM and 3D manufacturing.

July/August 2021

Figure 15. Review 2 after 6 months.

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clinical | EXCELLENCE

Vital pulp therapy of a dens evaginatus using Biodentine™

By Dr Mark Parhar, DMD, MSc, Dip. Endo

“Biodentine was an excellent material for this case and should be considered in all vital pulp therapy cases due to its superior properties...”

D

ens evaginatus is a rare developmental anomaly of human dentition characterised by the presence of tubercle on the occlusal surface of mandibular premolars and lingual surface of anterior teeth (mainly maxillary lateral incisors (2)). Due to occlusal wear, this tubercle suffers attrition or may fracture thus exposing the pulp that is present within. This may lead to pulp necrosis which may arrest the development of the root. The consequence is an underdeveloped root in which the survival is compromised due to the thin root walls. This case report outlines the treatment of a dens evaginatus of the mandibular second premolar by a partial pulpotomy. Biodentine™ was used as it is bioactive and promotes the pulps ability to heal itself. The symptoms resolved after treatment and the pulp vitality was maintained when seen at a 4 month recall.

136 Australasian Dental Practice

Figure 1. Dens Evaginatus (Courtesy Visual Endodontics).

July/August 2021

Figure 2. Contralateral Bicuspid.

Figure 3. Pre-operative.

Figure 4. Pre-operative Radiograph.

Figure 5. Pre-operative Radiograph.

Figure 6. Inflamed pulp.

Figure 7. Bleeding arrested.

1-6 mm and this will result in a malocclusion as the tooth erupts. The resultant occlusal traumatic force causes abnormal wear or fracture of the tubercle and is the usual manner of pulp exposure for this anomaly. Subsequent pulpal inflammation or infection will most likely ensue.

It is important for the clinician to be able to recognize and treat the entity soon after affected teeth have erupted into the oral cavity to avoid pathological conditions such as pulp necrosis, acute apical periodontitis and acute apical abscess.

Vital pulp therapy of immature teeth is performed to encourage the physiological development and formation of the root to full length and thickness along with apical closure. This will increase the survival of a tooth as thin root walls and decreased pericervicaldentin may lead to increased root fractures or restorative failures.4 Over the years, many materials have been used for vital pulp therapy such as calcium hydroxide and mineral trioxide aggregate (MTA). The bioceramic materials have become the material of choice for these types of procedure.5 If the tooth can be treated before pulp necrosis occurs, then the success rate for the vital pulp therapy utilising a bioceramic material is over 90%.6 Biodentine™ (Septodont, France) is a calcium-silicate based material which has several clinical applications, such as root

perforations, apexification, resorptions, retrograde fillings, pulp capping procedures and dentine replacement. In vital pulp therapy, Biodentine works by inducing biomineralisation after its application which creates an interface that prevents leakage and contamination of the pulp.

Introduction ens evaginatus (DE) is a developmental aberration of a tooth resulting in formation of an accessory cusp whose morphology has been variously described as an abnormal tubercle, elevation, protuberance, excrescence, extrusion or bulge.1 This uncommon anomaly projects above the adjacent tooth surface, exhibiting enamel covering a dentinal core that usually contains pulp tissue that on occasion may have a slender pulp horn which extends various distances up to the full length of the tubercle’s dentine core (Figure 1). The presence of pulp within the cusp-like tubercle has great clinical significance and distinguishes the anomaly from supplemental cusps, such as the cusp of Carabelli, which contain no pulp. DE is predominantly found on the occlusal surface of mandibular premolars and lingual surface of anterior teeth (mainly maxillary lateral incisors).2 DE predominantly occurs in people of Asian descent (including Chinese, Malay, Thai, Japanese, Filipino and Indian populations) with varying estimates reported at 0.5 to 4.3%, depending upon the population group studied.3 It is usually observed as bilateral, symmetric distribution, with a slight sexual predilection for females. The DE tubercle may extend above the occlusal surface anywhere from

D

July/August 2021

Case report 10-year-old Asian female was referred to our office by her dentist to assess and treat the mandibular second premolar that presented with a Dens Evaginatus (DE).

DE was present bilaterally (Figure 2).

She had been having symptoms in the mandibular left side with cold over the past 6 months after the tubercle was fractured due to occlusal forces. Treatment was rendered by the dentist to seal the occlusal surface with composite (Figure 3).

However, cold sensitivity along with intermittent discomfort persisted. PA x-rays (Figures 4 and 5) were taken and an open apex was noted. The tooth responded severely to cold testing without lingering and was mildly responsive to biting.

Upon assessment, a decision was made to perform a partial pulpotomy with the goals of maintaining the vitality of the pulp and promoting the continued development of the root in length and thickness.

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clinical | EXCELLENCE continued root development was noted along with the development of a dentine bridge below the Biodentine (Figures 10 and 11). The findings are suggestive that the pulp vitality has been maintained and that continued root development will take place.

Discussion

Figure 8. Biodentine placed.

Figure 9. Final restoration placed.

Figure 10. 4 month recall.

Figure 11. Dentin bridge formation noted.

Anesthetic was given (Lignospan®, Septodont) via an Inferior Alveolar Nerve Block and then a rubber dam was placed to isolate the tooth. Conservative access was made using a tapered diamond bur in a high speed handpiece and copious water.

When the pulp was entered, moderate bleeding was noted (Figure 6). Approximately 2 mm of the inflamed pulp was cut away and sodium hypochlorite was applied to disinfect and control any excess bleeding. Sterile cotton pellets were also used to arrest the bleeding (Figure 7).

A Biodentine capsule was used as per the manufacturer’s instructions: 5 drops of the liquid was placed into the capsule and the capsule was mixed for 30 seconds.

Biodentine was carefully placed on to the pulp tissue and gently packed with sterile

paper points and a plugger (Figure 8).

After the Biodentine was placed, it was allowed to set for 12 minutes. The tooth was etched with phosphoric acid (Ultra Etch) and then a bonding agent (Clearfil Photo Bond, Kuraray) was placed and light cured for 10 seconds. A dual cure core build-up material was placed (Absolute Dentin) on the Biodentine and the occlusal surface was sealed with composite (Filtek Z100, 3M). The composite was cured for 30 seconds and then finishing and polishing were done (Figure 9).

The patient was seen for a 4 month recall and reported normal functioning without any symptoms. Upon testing, the tooth had a normal cold response similar to the adjacent teeth and without lingering. PA x-rays were taken and the

References 1. M. E. Levitan and V. T. Himel, “Dens evaginatus: literature review, pathophysiology, and comprehensive treatment regimen,” Journal of Endodontics, vol. 32, no. 1, pp. 1–9, 2006.

2. S. Stecker and A. J. DiAngelis, “Dens evaginatus. A diagnostic and treatment challenge,” The Journal of the American Dental Association, vol. 133, no. 2, pp. 190–193, 2002.

3. C. E. Jerome and R. J. Hanlon Jr., “Dental anatomical anomalies in Asians and Pacific Islanders.,” Journal of the California Dental Association, vol. 35, no. 9, pp. 631–636, 2007.

4. P. Sarraf, M. H. Nekoofar, M. S. Sheykhrezae, P. M. H. Dummer, “Fracture Resistance of Immature Incisors Following Root Filling with Various Bioactive Endodontic Cements Using an Experimental Bovine Tooth Model,” Eur J Dent. May; 13(2): 156–160, 2019.

5. M. Haapasalo, M.Parhar, X. Huang, X. Wei, J.Lin, and Y. Shen, “Clinical Use of Bioceramic Materials”, Endodontic Topics, vol 32, pp 97-117, 2015.

6. Witherspoon DE, Small JC, Harris GZ. Mineral trioxide aggregate pulpotomies: A case series outcomes assessment. J Am Dent Assoc. 2006;137:610–8.

138 Australasian Dental Practice

E in mandibular premolars can pose challenges due to the early pulp exposure that can occur, particularly with immature roots. The occlusal forces may damage the tubercle and expose the pulp prematurely, as was the case in this report.

Early recognition and treatment is key for the proper management of these teeth, otherwise pulp necrosis can occur and these teeth will fail to develop adequately which will make these prone to root fractures and a short survival. In this case, the pulp was still vital and vital pulp therapy was indicated. Biodentine is an excellent material for these types of cases as it promotes pulpal health, root development, apex closure and allows the permanent restoration to be placed on top of it in the same appointment.

D

Conclusion ital pulp therapy was performed with success in this case, which was facilitated by the application of Biodentine.

The pulp vitality was maintained, the root continues to develop and the patient can function normally without any discomfort. Further follow-ups are required in the future to monitor the longevity of these types of treatments. Biodentine was an excellent material for this case and should be considered in all vital pulp therapy cases due to its superior properties.

V

About the author Dr Mark A. Parhar was born and raised in Nanaimo, British Columbia, Canada.

He completed his undergraduate degree in Honors Biochemistry from the University of British Columbia and went on to obtain his DMD from the University of British Columbia Faculty of Dentistry in 1997. After practising general dentistry for 11 years, Dr Parhar returned to the University of British Columbia for the Graduate Endodontics program where he received his Diploma in Endodontics and Master’s of Science degree.

July/August 2021

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*If haemostasis cannot be cannot achieved full pulpotomy, a pulpectomy and a RCTand should be carried out,carried provided tooth isthe restorable (ESE Position Paper,Duncan et al. 2017)et al. 2017) *If haemostasis beafter achieved after full pulpotomy, a pulpectomy a RCT should be out,the provided tooth is restorable (ESE Position Paper,Duncan ** Taha et al., 2018et al., 2018 ** Taha

surgery | DESIGN

Excellence in dental practice design

D

ental Excellence, located in the Perth suburb of Mount Hawthorn, is owned and operated by Dr Spiro Agopitis. Dr Agopitas joins a growing list of dentists and dental specialists around Australia that have engaged Medifit for multiple practices. Medifit completed the fitout of Dr Agopitis’s original practice in 2003 and the project was covered in the September/October 2003 edition of this magazine. A further upgrade was undertaken in 2016 as Spiro had outgrown the original practice and this project was again featured in May/June 2017

140 Australasian Dental Practice

The original Dental Excellence was located in a narrow tenancy covering just 76m2. Through careful planning, the space was designed to feel much larger than it’s relatively tiny footprint and the patient base grew steadily over many years.

Eventually, Spiro outgrew the upgraded space and when a larger building became available nearby, he seized the opportunity to re-establish Dental Excellence in a space worthy of his success.

Dental Excellence had built strong links in the community through dedicated involvement with local sporting clubs and organisations. The new premises were formerly a community hall, centrally located in the community and well-known

to many locals. Importantly, the new premises offered more than four times his original practice space.

With a floor area of 316m2, the new Dental Excellence is now a 7-chair practice with of a range of treatment rooms, a generous waiting and reception area, centrally located sterilisation room and dental laboratory and several offices for senior staff. The practice also contains a staff meeting and training room and recovery rooms for patients undergoing dental procedures.

As his third practice setup started to be become a reality, Spiro was clear on what he wanted and needed from the new space.

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surgery | DESIGN

Mount Hawthorn, a well-established suburb just 4km from Perth’s CBD, has always been a desirable area to live and the local population is a mix of professionals and families. An expanding clientele with increased demand for cosmetic dental treatments in addition to general dentistry meant that the new practice needed to evoke a higher-end feel.

Gone is the traditional community hall feel, replaced by a contemporary look that would not be out of place in a major world city like New York or London.

The design aesthetic is modern, loft-inspired with architectural dado concrete finishes and face brick providing a trendy warehouse feel. This is carried through with details including aged iron I-beams at the base of the reception counter and exposed beams throughout which lend the practice an industrial feel.

Purpose-built bespoke light fittings created by the Medifit construction/manufacturing team further express the industrial look.

From the outside, an impressive steel patio with angular panels for signage gives the building a striking streetscape. The patio is anchored to a nib wall of raw brick, foreshadowing the brick walls inside while concrete dado finishes to the front façade of the building echo the interior finishes.

Entering the practice, the modern lines and clean construction detail draw you in and pendant lights throughout reception lead patients to the angled reception counter.

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Summary The Practice The Practice

Dental Excellence

Principals

Dr Spiro Agopitis

Type of Practice

General

Location

Mount Hawthorn, Perth, Western Australia

Size

316 square metres

No of chairs

7

The Team Design

Medifit Design & Construct

Construction

Medifit Design & Construct

Equipment

Leading away from the reception area, a corridor takes patients to the individual treatment rooms. Glazed panels are carefully framed in black whilst white walls and bulkheads contrast with black ceilings to further the industrial feel. The floor to ceiling heights of up to 4.2 meters throughout the practice creates a unique setting not often seen in Australian dental practices.

A centrally located steri and lab is easily accessible from each treatment room ensuring that the day-to-day operation of the practice is efficient. Viewing windows also surround the steri showing off the cleanliness as well as creating a view into the corridor for the staff. Patient refresh is catered for with a dedicated station along with a comfortable and spacious waiting area.

The overall result is a stunning new practice that positions Dr Agopitis for continued success and prosperity.

So as a returning client, how does Spiro rate the Medifit experience? “Medifit has made my vision a reality. From the first day I went to see them, I felt completely confident,” he said. “Their understanding of dental design and construction was exceptional. I was able to concentrate on my dentistry while they took care of the entire project. I highly recommend them to any dentist who requires a professional fitout from beginning to end.”

Medifit’s Sam Koranis added: “I have known Spiro for more than 20 years and was delighted when he once again chose Medifit to help create his new practice. Our pedigree is without equal in the industry and we work hard to bring real value to our clients in terms of productivity and the high-quality practices that we deliver. Medifit has the experience across a full range of services to help dentists and specialists put their best foot forward in a competitive marketplace. It was a challenging project due to the age of the building but the final result that we achieved for Spiro speaks for itself and we wish him well at the new Dental Excellence.”

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Dental Units

Planmeca Compact i

Autoclaves

Mocom B Futura 22 MOCOM Extreme Plus

X-ray

Planmeca Pro

CBCT

Instrumentatrium OP300

Compressor

Dürr Quatro Tandem

Suction

Cattani Turbosmart B

July/August 2021

As individual as you are...

From a funky Manhattan loft inspired architectural statement to an elegant residential conversion, Dentists and Dental Specialists around Australia trust Medifit to create state of the art practices with individual interior designs that boost productivity and enhance levels of care.

Whether it’s a brand new space, a redesign of an existing practice, or a heritage makeover - we’ll help you create a practice that reflects your personal style and complements the way you work. and we do it with a friendly, no fuss approach.

Contact Medifit today for a no obligation consultation and experience our award winning service.

• SITE ASSESSMENTS • LEASE NEGOTIATION • FEASIBILITY STUDIES • COUNCIL SUBMISSIONS • ARCHITECTURAL DESIGN

• INTERIOR DESIGN • BUILDING CONSTRUCTION • PRACTICE FIT-OUTS • RENOVATIONS / REFRESHES • BRANDING & MARKETING

MULTI AWARD WINNING HEALTHCARE DESIGN & CONSTRUCTION

2021 Master Builders Excellence in Construction Awards - Best Healthcare Building & Best Historical or Heritage Restoration or Renovation under $1.5m 2017/18 ASOFIA Best Medical Fitout • 2017/18 ASOFIA Best Use of Sponsors Product • 2017/18 & 2018/19 ASOFIA Best Design - Professional Suites

1300 728 133 www.medifit.com.au

surgery | DESIGN

Purpose-built surgery delivers to the max

By David Petrikas

A

ground-up, purposebuilt dental surgery at Figtree, south of Wollongong, NSW has hit all the right notes for the team at Figtree Family Dental, bringing a combination of contemporary style and modern high tech dental technology.

Having worked within a corporate dentistry setting, highly experienced dentist, Dr Nitin Dhanani – a pioneer in modern surgical techniques including high-end laser procedures - wanted a practice that gave him the freedom to meet all the needs of his patients.

Dr Dhanani’s aim was to bring together the best clinical team and the best equipment in a purpose-built setting and at a

148 Australasian Dental Practice

convenient location in his local area. The new practice really lives up to his slogan of “modern dentistry and integrated care”.

As a clinical professional with a fascination with the application of modern technology in dentistry, Dr Dhanani was happy to hand over the design of his new practice to the professionals.

His brief included a light modern feel, spacious waiting room and surgeries with plenty of room for dedicated dental equipment and provision of child friendly areas.

“I wanted the design to be nice and simple,” Dr Dhanani said. “The more things you put into a building the messier it gets.”

The main part of the building plan was provided by the builder, Goldy Igeska from Custom Design Fitout. “He came up with the right plan. The site had a lot

of slope and we used it well to provide undercover parking and house the plant room,” Dr Dhanani said.

“I just said to the builder ‘give me something to work with - a bit like a Lego set’ which enabled me to change things around in the layout to come up with internal changes, for example ‘make this bigger and make this smaller’.

“As far as the exterior design, I didn’t touch it. We got the maximum out of the building design based on the size of the bock and Goldy did a fantastic job.”

Extraordinarily, the entire build was completed in just 10 weeks from start to finish, aided in part by the drought conditions which meant there were no rain interruptions. All development approvals and liaison with council was taken care of by the builder’s team.

July/August 2021

“It is an exceptionally big block at around 700 square metres.

All patients who saw us before when we were working in another practice in Dapto said the builder did a great job and that it looks fantastic,” Dr Dhanani said.

“Everyone likes it and walk-in patients see that it’s a handy location and looks nice and professional from the outside, which gives them confidence straight away that they will be dealing with an experienced dentist and not a new graduate. We’ve also had good reviews since opening, which is nice.

“The staff love it as it’s modern and new. It also has a very spacious waiting room which is a huge benefit in COVID times as we can have 10 people all socially distanced. People feel comfortable and safe because of the spaciousness in the whole practice and because we have the latest technology and experienced staff.”

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This includes a dedicated oral therapist and hygienist used to dealing with younger and older patients, together with the ability to offer in-house 3D x-rays, digital impressions, laser dentistry and the latest A-dec 500 dental chairs and delivery systems.

Dr Dhanani was one of the first - if not the first - dentist outside of an Australian capital city to install the newest generation A-dec 500 chairs. A long-time user of A-dec equipment, he was guided in his equipment choice by Sydney A-dec dealer, Dental Installations, who also took care of the installation.

He said the equipment supported him in providing clinical excellence and in providing a superior patient experience.

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Dr Dhanani is thrilled with his new A-dec 500 chairs based on their outstanding patient comfort. “Everyone is talking about how comfy the chair is. It is great to sit in and has a broader seat base than other chairs I have used. Also, it is absolutely silent and there are no jerks and starts when reclining the chair and the patients really appreciate that, especially older patients. They don’t even know when the chair is moving. It’s very sturdy.”

The new delivery system with its capacitive “touch” brake release also has advantages over other designs. “Positioning the delivery head is effortless – you don’t have to push a button to move it and it provides the ultimate level of precision and balance and stays in place where you position it,” Dr Dhanani said.

July/August 2021

“

IF YOU DON’T HAVE CHANNEL D, I THINK YOU’RE NUTS...

Almost every day, a patient says to me....

“I love your videos” . Then they tell me something that they never knew before, or ask me a question.

That’s how the conversation starts, and those conversations inevitably lead to more work.

It’s like having a dental guru sitting next to each and every patient in reception, whispering ideas and planting questions in their head. They walk into the operatory interested in the right topics.

Without these conversations, we wouldn’t be doing half the treatments we do.

Look at the maths. I have 2-3 extra relevant conversations per day. That’s 10-15 per week.

40-60 per month. 480-720 per year. This all adds up to a ton of work and many personal referrals. The patients all think I created the content and I get compliments about it because it’s so personal.

This is nothing like boring dental videos showing scary procedures.

It’s a significant business builder and the cost is peanuts. Speaking of peanuts, that leads me back to my original statement, “if you don’t have Channel D, I think you’re nuts”.

Dr Brett Taylor, Sydney General dentist and super happy Channel D user

Try ChannelD for FREE and see the difference it can make to your practice... Sign up at ChannelD.com and use Promo Code AM58

www.channeld.com

Summary The Practice

The Practice The Principal Practice Type Location Size No of chairs

Figtree Family Dental Dr Nitin Dhanani General Figtree, New South Wales 160 square metres 2+1

The Team Design Colour & Design Construction Project Manager Installer

Elena Igeska Panther Signs, Wollongong Custom Design Fitout Pty Ltd Goldy Igeska Dental Installations

Equipment Dental Units Sterilisation

A-dec 500 B Traditional W&H Lisa VA W&H Assistina TWIN X-ray Acteon X-Mind DC with Dürr Vistascan phosphor plate scanner CBCT Carestream CS8100 3D with Ceph Laser Pioon diode laser (triple wavelengths) Fotona LightWalker hard tissue laser Compressor Cattani AC200 Suction Cattani Turbo SMART A Software Oasis Dr Dhanani chose parrot (bright green) coloured quilted upholstery to provide the most comfortable seating option and was motivated by the A-dec colour choices when planning his highend surgery fit-out.

“Aesthetically it looks great and I designed my logo and the complete interior of the practice in colours to complement the A-dec upholstery,” Dr Dhanani said.

Dr Dhanani was adamant that he didn’t want a classic “teeth” logo and sought the assistance of Panther Signs in Wollongong to take care of the logo, together with the internal graphics and artworks.

The result is a stylish and cohesive collection of large prints at the end of the hallway and strategically placed on walls to make the practice feel more inviting and less clinical.

After consulting with Darren Welsh from Dental Installations, Dr Dhanani opted for high-speed turbines with LED lighting and an A-dec electric micro-motor for sectioning roots for extraction and removing metal fillings. He also installed “daylight” balanced A-dec LED chair-mounted operatory lighting for a better view of the oral cavity and to aid with identification of gum tissue health and shade matching of restorations.

Dr Dhanani works in conjunction with oral health therapist, Mrs Yung Starling and unlike in some practices where the hygienist or oral health therapist has an older or cheaper chair, he felt it was important for all

152 Australasian Dental Practice

the practice’s patients to receive the same level of comfort during their procedures and so installed second new A-dec 500.

The strategy appears to have paid off for Figtree Family Dental, with many patients who have consulted Dr Dhanani and his staff in the previous practice where he worked now choosing to be treated in his new surgery.

July/August 2021

A-d ec 300 00 4 c A-de

Ade c5 00

THERE’S AN A-DEC FOR EVERYONE Every dental practice is unique. That’s why A-dec offers a full line of dental chairs, with a wide variety of options and price points, all designed for comfort, performance, and reliability.

From the entry-level A-dec 200, the stylish A-dec 300, to the classic A-dec 400 and the premium A-dec 500, there’s an A-dec chair to fit your practice, your personal style, and your budget.

To see our award-winning family of A-dec dental chairs – scan the QR code and find the one that’s right for you.

V99299

Contact your A-dec dealer today visit australia.a-dec.com/find-a-dealer

new | PRODUCTS Information contained in this section is provided by the manufacturers or distributors.

Australasian Dental Practice does not assume responsibility for the accuracy of the data.

New biodegradable nitrile gloves

VITABLOCS TriLuxe forte in new shades

Once revolutionary new Mun GloveOn Avalon nitrile exam gloves are in landfill, they biodegrade up to 30% in less than 7 months and up to 90% in less than 18 months in optimum anaerobic conditions The gloves have been specially formulated to include an organic additive which attracts microbes found exclusively in landfill and anaerobic digester environments that break down their polymers naturally through mineralisation.

GloveOn Avalon uses drop-in technology that integrates into the existing manufacturing process without compromising product quality. It comprises of an organic additive used to

VITA users know what patients expect from cosmetic shape and shade adjustments they want a smile with bright, natural-looking teeth that can be achieved in just a single visit. Now VITA can meet this need. VITA has extended the VITABLOCS TriLuxe forte range to include bright shades 0M1 and 1M1. With a finelynuanced shade gradient, the proven ceramic block now meets the needs of laboratories and dental offices. More than ever, this makes VITABLOCS TriLuxe forte the material

accelerate the biodegradation rate of gloves in biologically active landfills and anaerobic digesters. The safety and performance of GloveOn Avalon remain the same as any other conventional nitrite gloves.

Available: Dentavision www.dentavision.com.au Tel: 1800-806-640

of choice when it comes to achieving an aesthetic smile using a digital workflow. Once milling is complete, the feldspar ceramic, with its natural play of light and colour, is easy to finish and polish and place using full adhesive, all without the need for firing or glazing.

Available: Henry Schein Tel: 1300-658-822 Dentsply Sirona Tel: 1300-747-662 Innovatio Dental Supplies Tel: (02) 8575-8675

Gold standard in needle stick safety

Kerr SimpliShade™ Universal Composite

Septodont’s Ultra Safety Plus has become the gold standard safety device, demonstrating its efficacy at protecting the dental team from needle stick injuries and complying with the latest regulations. New Ultra Safety Plus Twist is safer and easier with its new intuitive patented locking system: only two easy steps are needed for a secure assembly. Ultra Safety Plus Twist is available with either sterile white single-use or sterilisable blue handles and offers both passive and active

Kerr’s new SimpliShade™ Universal Composite is designed to streamline your restoration workflow and inventory management, without compromising strength or aesthetics.

Featuring just three shades (Light, Medium and Dark), SimpliShade makes it quick and easy to match all 16 VITA ® Classical shades - resulting in quicker shadematching and less patient time in the chair. With less product to stock, re-order and track, SimpliShade allows doctors to focus on caring for patients instead of managing inventory.

This added simplicity comes with superior strength, lifelike

aspiration for the security of the patient, transparent barrel to allow visualisation of aspiration, two different positions: Holding Position (reversible) and Locking Position (irreversible) and a bevel indicator facilitating the appropriate orientation of the bevel.

Available: Henry Schein AU Tel: 1300-658-822 www.henryschein.com.au NZ Tel: 0800-808-855 www.henryschein.co.nz

154 Australasian Dental Practice

aesthetics and long-lasting performance. With SimpliShade, beautifully strong restorations are easier than ever. SimpliShade matches all 16 VITA classical shades with just 3 shades: Light, Medium, Dark.

A Bleach White and Universal Opaque complete the range for all indications. The ART filler network, a proven technology found in Kerr’s Harmonize® composite, helps you achieve lifelike restorations with exceptional strength and unmatched aesthetics.

Available: Kerr Dealers www.kerrdental.com

July/August 2021

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