www.dta-uk.org
September 2018 | volume 5 | issue 4
articulate the bi-monthly e-newsletter of the dental technologists association
This issue contains 60 minutes of CPD for DTA members
Kestrel Court, Waterwells Drive Waterwells Business Park Gloucester GL2 2AT Telephone: 01452 886366 Email: sueadams@dta-uk.org Web: http://www.dta-uk.org
DTA nominated charity of the year 2018 DTA members have selected Den-Tech as DTA’s nominated charity of the year for 2018. If you’d like to find out more about their work, go to www.den-tech.org
Worried about ECPD? Don’t Panic – Help is at Hand!
A
t DTA we know that the introduction of ECPD is somewhat of a worry for some of our members. But there’s no need to worry – for DTA members like you, there’s a wide range of support available as part of your membership package, at no extra charge.
The Technologist will of course provide you with CPD that meets with GDC requirements and will cover all specialisms within the profession.
And remember, there’s no extra charge for this service if you’re a DTA member.
To find out more, go to our website, log in using your membership number, surname and password, and click on ECPD. You’ll then see a drop-down list of options. Choose the option you want, depending on what you’re looking for: ● ECPD – What does it mean for DTs and CDTs? ● ECPD Video Presentation – a 10-minute video explaining what it all means ● Examples of how to create and complete your PDP and Logbook ● Create/View my PDP – an online editable PDP with examples of how to complete your logbook that self populates as you complete your CPD. Both are printable. ● Take ECPD
DTA will help: www.dta-uk.org/ecpd.php
Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4
CPD article (60 Minutes)
A case study in fixed orthodontics and the Essix retainer
T
he term ‘crowding’ is used in dentistry to describe when patients have misaligned teeth. Overcrowding in adults is a form of malocclusion which is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the mandible closes against the maxilla into centric occlusion.
There are three main forms of malocclusions: ● Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth. ● Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth. ● Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.1 To determine whether the patient is in a particular class requires much detailed analysis of the interrelationship of the upper and lower permanent teeth and the use of radiographs by the clinician. For example, the natural upper and lower first permanent molar positions are important and how they
vary from what would be regarded as a normal position. There also needs to be an analysis of the maxilla and mandible bone relationships because in some cases the teeth may be in the correct position and yet the lower jaw may be larger and more forward than normal, suggesting a Class III basal bone jaw relationship. Such determinations are for the orthodontist to decide and then to propose the range of potential treatments and, where necessary, prescribe appliances from the dental laboratory. The British Orthodontic Society (BOS) suggests that: ‘It is sometimes impossible to provide a successful result where there is dental overcrowding without extracting adult teeth to create space for the desired tooth movement. Expansion of the dental arches and/or backward movement of teeth can create space for some patients but this is not appropriate for everybody and there are limitations as to how much space can be created this way. This means that for many people with more severe crowding, extractions may be inevitable to get the best and most stable result.’ 2
Standards for Dental Professionals: Aim: ● To be aware of the treatment of malocclusions using fixed appliances and a dental laboratory method for the construction of an Essix retainer
CPD Outcome(s): ● To gain an understanding of malocclusions ● To be aware of how one patient’s case was treated by fixed appliance orthodontic therapy ● To know how an Essix retainer is fabricated
To provide an insight regarding what is possible with the use of fixed orthodontics we have sourced a very interesting video that shows the treatment planning and a year’s treatment for a young patient who had gross overcrowding. Clinicians may vary in their approach to treatment for such a case, but in the example provided, Dr Cesa’s case presentation shows a series of visual stages of his year-long treatment utilising upper and lower fixed orthodontic treatment with the
More about the Author – AD Griffin MBE Anthony Griffin MBE qualified as a dental technician in 1971, spending his initial years in commercial dental laboratories and then spending 33 years in education. He was a Faculty Director for Health Science before leaving to head a private business consultancy in 2008. He has been actively involved in the pre-registration development of both DTA and CDTA, preparing dental technicians for their professional role and he has a passion for enabling learning. He coordinated the first Foundation Degree in Dental Technology, drove the development of CODTEI, supported the RCS of England and still continues his support for professional education. Since 2012 he has been the Treasurer of DTA and still contributes articles and CPD activities to The Technologist and other publications. In 2014 he was awarded an MBE in the Queen’s Birthday Honours for his services to dental technology.
final result. The video is some 13 minutes long and is purely the visual representation of this single case over a year.3 ● SEE: https://www.youtube.com/ watch?v=TjDdGWn2Bjo
The Essix retainer The Essix retainer is a custom-made dental device that is often prescribed by clinicians once orthodontic therapy is completed. These appliances aim to maintain the natural teeth in their new position. The average time required for the reorganisation of the periodontal fibres after orthodontic treatment is considered to be a minimum of 232 days.4 A Swedish research article5 has indicated that its findings concluded that the Essix retainer is sufficient for maintaining the results after orthodontic treatment and that just night-time wear is adequate. But it is for individual clinicians to determine their preferred regime
Development outcomes: C&D Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
www.dta-uk.org
September 2018 | volume 5 | issue 4
A case study in fixed orthodontics and the Essix retainer... continued... regarding retainers and the period of use. The stabilisation phase of treatment is essential in that it maintains the teeth in their corrected position and without some form of retainer relapse to the previous position can occur. Clinicians therefore often prescribe a form of removable retainer of which the Essix is an often-used appliance. The following three publically shared videos show:
References 1. Malocclusions definitions: https://medlineplus.gov/ency/article/001058.htm [Accessed 13:30 hrs 28-07-2018]. 2. British Orthodontic Society: https://www.bos.org.uk/Public-Patients/ Orthodontics-for-Children-Teens/Fact-File-FAQ/FAQ -for-Children-Teens/Why-are-extractions-sometimes -necessary-as-part-of-orthodontic-treatment [Accessed 13:00 hrs 28-07-2018]. 3. YouTube video by Dr Dean Cesa: https://www.youtube.com/watch?v=TjDdGWn2Bjo [Accessed 15:15 hrs 28-07-2018].
i) an overview of the clinical and manufacturing approach of one clinician: https://www.youtube.com/watch? v=yc_ul3A_6W4 6 (3 minutes) ii) a detailed manufacture of an Essix retainer by an experienced US dental technician using a range of different equipment that allows us all to reflect on the benefits of thinking laterally about our own dental laboratory approach: https://www.youtube.com/watch? v=3Qgr6dAso2c 7 (14 minutes) iii) a further example of the manufacturing of an Essix retainer in Australia: https://www.youtube.com/ watch?v=xbFzzhd5F-g 8 (7 minutes)
4. Proffit and Fields, 2007 Contemporary Orthodontics, William R Proffit, Henry W Fields. David M Sarver. Mosby Elsevier, 2007. 5. Removable thermoplastic appliances as orthodontic retainers – a prospective study of different wear regimens, Sylvia Jäderberg, Ingalill Feldmann, Christer Engström European Journal of Orthodontics, 1 August 2012;34(4): 475–479. 6. Dr Jon Petersen: https://www.youtube.com/watch? v=yc_ul3A_6W4 [Accessed 10:15 hrs 28-07-201]. 7. J Tyler USA: https://www.youtube.com/watch? v=3Qgr6dAso2c [Accessed 11:00 hrs 28-07-2018]. 8. Dr Denvor Maloney BDS: https://www.youtube.com/watch?v=xbFzzhd5F-g [Accessed 9:30 hrs 28-07-2018].
We hope you enjoyed reading and watching the videos, and that you benefit from undertaking the associated CPD questions. Take a moment to reflect on your practice from this learning opportunity.
CPD Questions – Materials & Equipment CPD (60 minutes) Q1 Which anterior tooth was extracted prior to fixed orthodontic treatment? a) b) c) d)
17 and 27 Lower canines 32 41
Q2 All but one of these was shown in this case and used by Dr Cesa in his analysis of this case. Which one is the exception? a) Palatal fovea to incisal edge of upper centrals was measured as 25 mm b) From distal of the right premolar to distal of the left premolar as arch length is 73 mm c) Palatal midline to occlusal fossa of the posterior teeth is measured in mm d) The individual teeth widths are measured from 14 to 24 and in this case came to 80 mm
Q3 What order was planned for the upper tooth movement by a fixed appliance? Using these items, select the correct order: (i) Distal movement of the canines (ii) Distal movement of the upper 1st molars (iii) Distal movement of the upper second premolars (iv) Distal movement of the 14 and 24 a) b) c) d)
(ii), (iii) and then (iv) (i), (ii) and then (iii) (iv), (iii) and then (ii) (i), (ii) and then (iv)
Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4 CPD Questions – Materials & Equipment CPD (60 minutes)... continued... Q4 In this case, a lower fixed appliance is mainly used to provide which function? Which statement is therefore more true?
Q5 What does Jay Tyler use to cut through the main areas of a pull down blank?
Q6 What does Jay Tyler NOT use to create a festooned shape around the labial and buccal side of the Essix retainer?
a) Pull distally the 33 and 43 to create anterior space b) Move the 36 and 46 distally to create posterior space c) To move the 42, 31 and 32 into an ideal arch form d) Hold the arch form with no active involvement
a) b) c) d)
a) A bench lathe and a shaped approx. 8 cm diameter fast cut wheel b) Shaping the fast cut wheel for interdental cutting c) An abrasive rubberised wheel d) Personal protective support vacuum equipment
Q7 What particular hand piece wheel does Jay Tyler use lightly with low/medium speed?
Q8 What minor adjustments related to the gingival crevice does Dr Maloney make to the master cast in the video prior to sucking down the clear blank for an Essix retainer?
a) Rubber abrasive wheel b) Circles of nylon abrasive layered and held together at the centre (Scotchbrite) c) Diamond disc small diameter wheel d) Course grit felt wheel
a) b) c) d)
Diamond disc wheel Scissors A fast cut lathe wheel 1½” carbide cutting wheel
Deepen the gingival sulcus by 0.5 mm Scrap out the interdental papilla area Remove slight faults or blows at the gingiva Mark the extent of the Essex retainer
Q9 What is a Class III malocclusion? a) b) c) d)
Cross bite occlusion Retrognathism Prognathism The bite is normal but the lower teeth stick forwards
Q10 The reorganisation of the periodontal fibres after orthodontic treatment is considered to be, on average, a minimum of how many days? a) 140 b) 232
c) 320 d) 365
Dental Professionals Conference Park Plaza Hotel, Nottingham 14-15 September 2018 Up to 10 hours of CPD : great networking opportunity : black tie gala dinner: early bird delegate rates BOOK NOW
For more details visit www.ota-uk.org Hosted by the Orthodontic Technicians Association Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4
E-NEWS SHOTS
Farewell to Marta The DTA team would like to express its thanks and fond farewell to Marta Wisniewska who is leaving to return to Poland.
Bottle of bubbly on its way to 10th anniversary competition winner Many congratulations to DTA member Samantha Le Cras who is the lucky winner of our 10th anniversary word search competition. A bottle of champagne is winging its way to you! Thanks to everyone who participated!
Retire your old devices and software to ward off your cyber security threats If you have a device such as a smart phone or tablet that is not up to date but enables access to private data, then you may be considered negligent and be at risk of a fine. Most android phones over a year old no longer receive security updates and if you are still using the iPhone 5c or anything earlier, you
will not be receiving any security support. Many tablets older than three or four years are no longer secure and any computers running XP or Vista should be removed as soon as possible in the same way that old customised software that only runs on old machines needs to be replaced. It is necessary to keep your devices and software up to date and that may mean trading them in for newer models that are secure.
DTA Treasurer vacancy ● Would you like to get more involved in running your professional association? ● Would you like to help grow the organisation? ● Could you see yourself co-ordinating the DTA budget?
Marta has been a valued member of the DTA Executive team. We wish her all the best.
● Look out for a more detailed feature on Cyber Security in the November edition of TT.
Falling foul of minimum wage
Tony Griffin, our current Treasurer, is stepping down from the role in March 2019 and a successor is required to ensure the smooth running of the organisation.
LATEST BATCH OF NAMED AND SHAMED EMPLOYERS
If you are interested in this exciting and voluntary role within DTA, please contact Sue Adams in the first instance to request an outline of the activities and to have an informal chat about what the role entails.
Two hundred and sixty employers underpaid a record 16,000 workers who will be reimbursed £1.7m. As a rule, the majority of employers are not deliberately paying under the hourly rate but they do get tripped up and the most common reasons for underpayment were:
● Sue can be contacted via email at sueadams@dta-uk.org or by telephone on 01452 886 366.
● deducting money from pay for uniforms ● not paying for overtime ● failing to pay workers travelling between jobs
The top three offenders were retail, hospitality and hairdressing! Under the National Minimum Wage Regulations, deductions made for a uniform that an employer requires an employee to wear must be taken into account when it comes to calculating the minimum wage. If an employee is required to buy a uniform, this effectively lowers their pay in HMRC’s eyes.
Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4
E-NEWS SHOTS (CONTINUED...)
Development of DTA APP needs your input... We appeal to all members to make an appearance and apprise us of your thoughts on the DTA APP. We appreciate you are busy but it will only take approximately two minutes. No need to make an appointment or feel apprehensive, just click on the link. We applaud you and thank you for your approachability.
Knowing what makes you unique will help you grow your business It’s not so complicated really. If you want to grow your business you have to market it. That means making sure the right people (existing and potential customers) know you exist and understand the benefits of buying from you. Before you can communicate to them it is vital you consider what to say. If ten other dental laboratories also communicated with them, why should that customer choose you? What is it about your approach, about dealing with you that makes you the ideal choice? In other words, what are your unique selling points (USPs)? Dental laboratories and practices often struggle with this concept because they immediately consider what they do: ‘I fix people’s dental problems or give them a nice smile,’ says the dentist. ‘I make dental appliances from a dentist’s prescription,’ says the dental technician. What else is there to say? Lots! It is not so much what you do but how you do it. It is worthwhile sitting down with the team and brainstorming your USPs. You will have them. They may not be the ones you want to advertise – for instance, you could always be late in providing your appliances, which may be unique but not attractive. Being aware of it though would mean you could do something about it! If you are struggling to identify USPs that could apply to your business, we have
provided some illustrative examples to whet your appetite. ● Responsiveness – we answer the phone within 3 rings, we respond to emails within an hour, etc. ● Cleanliness – we have x approach to decontamination, over and above the expected standards, so no risk to you or your team. ● Comprehensive – we provide everything you need under one roof. ● Precise – our colour matching is accurate to 99.9% of … ● Customer satisfaction – we monitor our productivity and we deliver early or on time x%. ● Simplicity – it is easy to do business with us. ● Specialist – we have technical expertise in a particular area. ● Value – we aren’t the cheapest but we provide the greatest value because … ● Low cost – we are the cheapest. Successful businesses, including dental laboratories, have a good understanding of exactly what makes them unique and why their customers should choose them over their competition. Identifying and fulfilling these USPs will make you stand out, and by weaving them into your marketing approach, processes and employee training, you will leapfrog your less-focused competition.
Ceramage UP by Shofu – the state of the art in composite layering! The best of both restorative worlds: technologically sophisticated and aesthetically optimised. Ceramage UP, the new flowable C&B composite system combines all the benefits of composites and ceramics in an innovative high performance material. Its high ceramic filler load and homogeneously compacted nanostructure guarantee excellent abrasion resistance, flexural strength and colour stability. At the same time, its perfectly structured layering concept with opalescent enamel and high translucency colours allow dental technicians to achieve amazingly natural aesthetic results, comparable to layered porcelain restorations. continued overleaf...
Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4
CERAMAGE UP BY SHOFU... CONTINUED...
E-NEWS SHOTS (CONTINUED...)
Ceramage UP is indicated for almost all anterior and posterior restorations and comes in a modular system featuring great ease of use. The individual shades are ready for use, and thixotropic, so that tooth shapes can be freely sculpted using a probe or brush directly after dispensing. To further customise the appearances of anterior and posterior restorations, the flowable materials can be easily mixed with each other or characterised with the lightcured stains of the Lite Art system. Thanks to the additive layering technique, only minor shape adjustments will be necessary. So the Ceramage UP C&B composite system, which is suitable for all types of crowns, bridges, inlays, veneers and long-term temporaries, uniquely combines costeffectiveness, efficiency and aesthetics. ● For further information, please contact the Shofu UK office on 01732 783 580 or sales@shofu.co.uk
The Dental Technology Showcase (DTS) has proven itself time and time again to be the event of the year for all dental technicians, clinical dental technicians, orthodontic technicians and lab owners. Offering two days of first-class education, including several hours of enhanced CPD, as well as copious networking opportunities and an extensive trade exhibition demonstrating the latest innovations, DTS really does have it all.
Delegates at the 2018 event commented: ‘I’ve really enjoyed DTS this year. It’s good to get CPD and to discover the latest methods, materials and courses.’ Saba Zaherdoust, dental technician
‘It’s good to see what’s going on as new solutions – a lot of them digital – come to the market. The event is a fantastic opportunity to mix with other technicians and expand my knowledge for free.’ Hiten Parmer, dental technician To make sure you don’t miss out in 2019, save the dates in your diary today! DTS 2019 will be held on Friday 17 & Saturday 18 May at the NEC in Birmingham, co-located with the British Dental Conference and Dentistry Show. ● For further details, visit www.the-dts .co.uk, call 020 7348 5270 or email dts@closerstillmedia.com
Seamless collaboration Working together with your collaborating dentists is the key to making sure that patients receive the best restorations possible. Created in order to facilitate this relationship, the DTX Studio™ design software from Nobel Biocare is a wonderful choice for technicians who want to make the most of communication with their dentists. Offering enhanced data sharing options, the system gives technicians access to detailed patient case data and allows them to communicate with the dentist throughout the duration of the case.
This up-to-date information, alongside the system’s powerful CAD tools, helps to ensure that restorations are incredibly accurate and also encourages faster turnaround times. These tools are perfectly suited to technicians of any experience level and can be used in various ways. For less experienced technicians, the design tools provide easy-to-follow workflows, whilst for more experienced professionals, the power
of the technology will allow them to tackle even the most complex of cases. A cutting-edge blend of communication and design, see how your laboratory could benefit from the DTX Studio design software by contacting Nobel Biocare today. ● For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com
Dental Technologists Association, Kestrel Court, Waterwells Drive, Waterwells Business Park, Gloucester GL2 2AT. call: 01452 886 366 email: sueadams@dta-uk.org web: www.dta-uk.org
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September 2018 | volume 5 | issue 4
Seeking providers to carry out dental laboratory work including crown and bridge, and partial and full dentures amongst other services relating to the restoration of teeth The Dental Directorate at Guy's and St Thomas' Hospital are looking for providers to carry out dental laboratory work including crown and bridge, and partial and full dentures amongst other services relating to the restoration of teeth. For implant and orthodontic work the Trust will utilise the in-house service but may still use an outside laboratory in case of staff absence. This tender will be run jointly with Kings College Hospital NHS Foundation Trust and University College London Hospital NHS Foundation Trust.
The tender will be run and will be advertised as framework for other NHS Trusts to utilise and award to the supplier/s appointed by Guy's and St Thomas' Hospital, Kings College Hospital NHS Foundation Trust and University College London Hospitals NHS Foundation Trust under the contract resulting from the future tender activity. For any queries please contact shriya.karia@gstt.nhs.uk Deadline for submissions: 2nd October.
IN YOUR 40-PAGE EDITION OF THE TECHNOLOGIST ... ● Kevin Lewis on ethical behaviours for DTs and CDTs ● The latest on infection control ● Learn more about oral cancer and the signs for early detection ● The chain of survival – how well would you respond in a medical emergency? ● Look out for technical articles on C&B, prosthetics and orthodontics
KEEP IN TOUCH WITH DTA
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