The Technologist by Dental Technologists Association

volume 11 issue 3 august 2018

issn 1757-4625

the

technologist the official journal of the dental technologists association

The DT network In this issue: Prosthetic connectors Crowning connections DT connectedness

6.25

HOURS OF VERIFIED CPD

august 2018 1

in this issue the

technologist Editor: Vikki Harper t: 01949 851 723 m: 07932 402 561 e: vikki@goodasmyword.com

news

dta column

tax returns: now is the time to prepare 06

Advertising: Sue Adams t: 01452 886 366 e: sueadams@dta-uk.org

DTA administration: Sue Adams Chief Executive Kestrel Court Waterwells Drive Waterwells Business Park Gloucester GL2 2AQ t: 01452 886 366 e: sueadams@dta-uk.org DTA Council: Delroy Reeves President John Stacey Deputy President Tony Griffin Treasurer Gregg Clutton Gerrard Starnes Andy George James Green Adrian Rollings Barry Tivey

CPD

in conversation: an engaging process

six tips to boost your business mojo

CPD

hr facts: holiday pay q&a

CPD

can you keep a secret? – confidentiality and data protection

CPD

medical emergencies in a dental environment

CPD

prosthetics: connectors

CPD

making crowns to retrofit a denture using digital technology

CPD

30 hearing protection and the workplace 31

CPD

medical devices regulations (MDR) – a heads up to 2020

CPD

the mark of outstanding leadership

Editorial panel: James Green, Tony Griffin, John Stacey

shofu’s eyespecial C-II digital dental camera

Editorial assistant: Dr Keith Winwood

getting to know you ...

32 35 37

Design & production: Kavita Graphics t: 01843 583 084 e: dennis@kavitagraphics.co.uk

The Technologist is published by the Dental Technologists Association and is provided to members as part of a comprehensive membership package.

Published by: Stephen Hancocks w: www.stephenhancocks.com

For details about how to join, please visit: www.dta-uk.org or call 01452 886 366

Find out the 11 reasons to join DTA by visiting:

ISSN: 1757-4625 Views and opinions expressed in the publication are not necessarily those of the Dental Technologists Association.

www.dta-uk.org the

technologist

Cost effective professional indemnity insurance for dental technicians and laboratories

Tel: 01634 662 916

2 august 2018

news&information

■ GDPR AND DIGITAL PARTIAL DENTURES A report from Adrian Rollings, the Health Education England West Midlands Dental Technician and Clinical Dental Support Group Facilitator

he Health Education England West Midlands Dental Technician and Clinical Dental Technician Support Group held its second meeting of the year on Saturday 16 June. This was done in some style, as it was the first meeting at the group’s prestigious new venue, the new Birmingham Dental Hospital. The first presentation was delivered by practice manager Amy Aldrich and covered GDPR. Amy had already assisted several dental laboratories with compliance, so was an ideal speaker. Her approach was grounded in common sense, particularly in terms of data storage and the transfer of goods between laboratory and clinic. In fact, it was refreshing to have somebody providing ‘solutions’ and this made the topic far less intimidating. The world of CAD/CAM and digital technology has largely ignored the removable prosthetics sector until recently. However, there is now a move to digitising these traditional processes. So, the second presentation on Ultaire

AKPTM, provided by Phil Silver and Nathalie Mazur of Solvay, was timely.

new generation polymer materials are here now and here to stay!

Phil highlighted the patient benefit of these materials, detailed the underpinning research and described the hierarchy of biocompatible dental polymers. Meanwhile Nathalie provided a complementary overview of the 3 Shape digital RPD design and the manufacturing processes. She also provided a number of case studies that demonstrated the practical benefit to patients compared to conventional metal-based options.

The group meets three times per year on a Saturday morning and provides an excellent opportunity to share experiences with local peers and keep up to date with technological and legislative advancements. The topic for the autumn meeting will be dental photography covering both the clinical aspects and photographing laboratory work and models. This will be the first session under the new eCPD rules for DCPs, so we will also make a timely review of eCPD and where we are at with our personal development plans. Given the topic area, places will be limited, so please book early to avoid disappointment.

Both presentations were warmly received and as ever there was plenty of lively discussion. Nobody was left in any doubt as to the importance of GDPR compliance or that digital dentistry and

■ PIONEERING INNOVATIONS, PROVEN TRACK RECORD & SECOND ‘We have been working with Nobel Biocare restorative components for nearly 25 years. Over the past twelve years we have scanned, designed and ordered the full range of Nobel

Procera® products – abutments, implant bridges, copings and bars, in all the available materials.’ John Russell, owner of 2nd Nature Dental Design laboratory in Belfast, comments on his long-term working relationship with Nobel Biocare. ‘The finish on the milled components is superb; the titanium bars, in particular, are of exceptional quality. Everything fits first time. Nobel Biocare was milling CAD

the

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solutions years before anybody else offered these services, all based on a sound scientific, manufacturing background. ‘Any time I’ve had to call the Nobel Biocare office, the team’s service and product knowledge has been second to none. Technical support for the scanners and software has been excellent and very friendly. Calls are usually answered right away and if the technical representative is unavailable, you can expect a returned

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news&information ■ EFFECTIVE IN-HOUSE SYSTEMS CAN NIP COMPLAINTS IN THE BUD New evidence shows that having an effective, in-house complaints process in place and displayed in the practice/laboratory can help to avoid complaints escalating into claims and prevent a complaint being made directly to the General Dental Council (GDC), say Dental Protection.

n a YouGov survey, conducted on behalf of Dental Protection, 65% of the public said they are not aware that dentists are required to provide a formal process for managing complaints from their patients. Sixteen per cent of the public surveyed also said they would consider complaining to the GDC about the treatment they received. Dental Protection said it recognised that some dentists may be reluctant to display their complaints procedure for fear of encouraging a complaint, but stressed that timely and effective management of a complaint within the practice can often nip complaints in the bud, and avoid them becoming more serious. Dr Raj Rattan, Dental Director at Dental Protection said: ‘There is often a very small window of opportunity to nip complaints in the bud

and dealing with them promptly within the practice is often the most effective way of doing this. Dentists have an obligation to provide a formal written process for resolving complaints, so every team member knows what to do, and they should ensure patients are also aware of the process. ‘This will help to prevent a patient taking a complaint into another forum, such as a formal complaints handling scheme, the GDC, or into the hands of a ‘no win no fee’ lawyer. While understanding and managing patients’ expectations before commencing treatment is key to avoiding complaints from occurring in the first place, it is just as important that dentists know how to manage a complaint effectively when one is received. This again will help to prevent it escalating. ‘In the YouGov survey, when the public were asked what they would expect to happen if their treatment didn’t go as expected, 74% said they would expect the dentist to offer further treatment to fix the problem at no additional charge, 36% said they would expect the dentist to refer them to someone else to fix the problem,

and 31% said they would expect a refund. Fifty per cent said they would expect an apology. Interestingly, when Dental Protection asked over 1000 of its members the same question, only 27% thought patients would expect an apology. ‘We would always encourage dentists to apologise if treatment does not go as expected. This is not the same as an admission of fault or liability and should be offered at the earliest opportunity. Dentists should then discuss further treatment options with the patient to ensure that any issues can be resolved in the practice. Dental Protection can assist with formulating a response to a complaint and assist and support you through to its satisfactory resolution. We can also work with you to look at why complaints arise and how to minimise the risks of recurrence. ‘There will always be patients who are dissatisfied with their treatment or whose expectations are not met. Grasping the opportunity to resolve complaints at an early stage within the practice reduces the likelihood that the patient will raise the issue outside of the practice. It contains the risk and is likely to lessen the impact a complaint can have on the confidence of the individual team member involved.’

-TO-NONE SERVICE call, normally within the hour. ‘Nobel Biocare pioneered implantology and was a forerunner in digital technology. They have a proven track record and provide innovative solutions for all aspects of patient care and restoration. I would absolutely recommend them.’ ● For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com the

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news&information

■UK DENTAL TECHNICIAN SALARIES – 2018 SURVEY letterstotheeditor From: N Gurney CPD Questions: Can we fix it? Consent considerations for denture Comments: This should apply to dentists as well as technicians. We have to receive repairs never seen by a surgeon that are taken in by a receptionist who doesn’t look at or understand how or why the denture has broken. From: N Clyne CPD Questions: Medical emergencies in a dental environment Comments: Useful not only in the working environment but in private life as well. From: SJ Roots CPD Questions: The developments in hybrid ceramics for CAD/CAM manufacturing Comments: I find it amazing how things move forward with improvements and the fact someone is always thinking about how to move forward with better technology and materials. Thank you for the update. From: N West CPD Questions: Medical emergencies in a dental environment Comments: If a work colleague experienced choking, or even a family member at home or a member of the general public while I was around, it has reminded me of how I could help.

2018 data to date: basic annual salary (Excluding benefits, overtime, bonuses etc.)

● Are you being paid in line with other technicians at your level? ● Would you like to know how your salary compares to other technicians with similar experience to yourself?

can choose to receive a free copy of the survey results.

Whether you are looking for a new job or a pay rise, it helps to understand typical salaries and what your potential earnings could be.

Responses are confidential, as the survey does not collect identifying information, such as your name, email address or IP address. The survey questions will be about your job title, experience and salary.

Closing date is 30 September 2018.

arshall Hunt Recruitment is conducting a research project to find the national average salaries of dental technicians working in the United Kingdom, and to evaluate employee satisfaction with regard to compensation, training and development within British dental laboratories. The survey takes approximately two minutes to complete and all participants

● To participate in the survey, enter this link into your search engine: www.surveymonkey.co.uk/r/5Z6R9CC Note: Your participation is voluntary. If you decide to participate, you can withdraw at any time and all information that you have given will be deleted. The survey is compliant with GDPR policy.

From: K Crawford CPD Questions: Can we fix it? Consent considerations for denture repairs Comments: Made me aware of legal liabilities to the patient – interesting. From: LT Walker CPD Questions: Enhancing your orthodontic technique builds up knowledge Comments: Excellent videos, good to get some orthodontic articles.

2018 data to date: number of years experience you have in your job role. the

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thedtacolumn

ECPD – preparing your personal development plan Enhanced Continuing Professional Development started on 1 August for all dental care professionals. In a nutshell, the changes are: ● the reduction of CPD hours overall for all dental professionals due to the removal of non-verifiable CPD ● 50 hours of verifiable CPD over five years for dental technicians and 75 hours of verifiable CPD over the same time period* for clinical dental technicians ● the requirement to make an annual declaration of CPD hours completed ● the requirement that all registrants must have a personal development plan (PDP) ● the requirement to align CPD activity with the GDC’s ‘new’ learning outcomes ● the requirement for professionals to plan CPD activity according to their individual ‘field(s) of practice’ You will have seen the General Dental Council’s diagram – the plan, do, reflect and record model – and central to the new system will be the requirement for a personal development plan or PDP.

What is a PDP? It’s a flexible plan that helps you plan your CPD that links to your day-to-day job.

● Ensure your evidence matches the verifiable CPD you are declaring each year ● Complete your annual statement ● Complete your end of cycle statement

Your CPD cycle

● Review your activity ● Reflect on impact on your daily practice and patients ● Make a record of your reflection ● Adjust your PDP as needed

Consider what sort of CPD you need to support your particular job in the laboratory. For example, if you work in a crown and bridge lab, and there are plans to go digital, this is something you would want to know about and could feature in the plan for the year. Another example might be if you are a clinical dental technician and seeing patients, then you may want to go on a customer care or professionalism course and this could then feature in your PDP. Having thought about your needs for the coming year, draft a plan and then start to fill in the PDP.

Where to start? Download or view the DTA PDP template on the website – www.dta-uk.org – you’ll be able to see the headings and start thinking about the logistics of designing your own PDP to meet your own requirements.

● Think about your field of practice ● Identify your learning needs ● Link to the GDC’s development outcomes ● Design your PDP

● Complete your CPD activity ● Collect evidence from each activity ● Meet your hours requirement ● Adjust your PDP as needed throughout your cycle

So, from Wednesday 1 August 2018, you will need to: ● meet the hourly requirements ● do it regularly, at least 10 hours every two years ● keep a personal development plan ● keep a record of CPD completed ● make an annual statement You can find out more information on the DTA website (www.dta-uk.org), including watching a video about Enhanced Continuing Professional Development. * If you are midway through your cycle, you need to check the GDC’s transitional arrangements using the online tool @ www.gdc.onlinesurveys.ac.uk/ecpdtool

The headings and examples of how to complete the section Example Heading ■ What do I need to learn or maintain for this cycle?

Maintain my skills and knowledge of dental technology

■ How does this relate to my field of work?

I need to keep up to date with the development and

■ Which development outcome does it link to?

A, B, C or D. Or it might be a combination of

■ How will I meet this learning or maintenance need?

Carry out recommended CPD for dental technicians,

placing on the market of custom-made dental devices

more than one

selected from The Technologist or Articulate. My annual target = X hours of verifiable CPD

■ What benefit will this have to my work?

Ensure that I am aware of developments in design and manufacture of custom-made dental devices and supporting colleagues (team working)

■ When will I complete this activity?

Annual review and declaration on eGDC 20

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6 august 2018

taxreturns

■ Now is the time to prepare By Tony Bowden Bluewave Business Solutions Aim: ■ to be aware of the current HMRC regulations for declaring income and paying tax

CPD Outcome: ■ to be aware of the current requirements for declaring income to HMRC and the timescales for completing returns and paying tax

Development Outcome: B

f you are a sole trader, partnership or director you may be registered for Self-Assessment (SA) with HMRC for your personal tax liabilities. The deadline for submission isn’t until 31 January 2019 for online submissions, but don’t let the long sunny days of summer fool you – it will be here before you know it and it’s best to be prepared. You should have received a P60 from any employment earnings by 31 May 2018 and any P11D Expenses and Benefits forms by 6 July 2018. If you run your own payroll then submission of the P11D(b) for Class 1A National Insurance Contributions (NIC) is also 6 July with payment of those Class 1A contributions to HMRC by 19 July 2018. You may also have a PAYE Settlement Agreement (PSA) in place for any irregular or impractical expenses or benefits that you have agreed to cover (rather than the employee having the liability) – you must report these as soon into the new 2018/19 tax year as possible and the deadline for paying the tax and Class 1B NIC on those is 19 October 2018.

Your SA will also include any other earnings or income, such as rental income, interest on savings and dividends. SA returns are also used to calculate any repayment of child benefit due: those earning between £50,000 and £60,000 pa will need to make a sliding scale repayment of the benefit received in that year; over £60,000 and full repayment is required. Always keep the Child Benefit Office updated of any significant changes in your income to avoid unexpected repayments. Making Tax Digital (see April edition of DTA magazine for more information on MTD) means that many individuals and smaller businesses are now using accounting software packages to keep track of their business and this will also help with your Self-Assessment returns as these online accounts are often connected to your bank account, negating the need to sift through paper statements and can be used to track things such as dividend payments and expenses.

If you choose to engage an accountant to help with your SA return, then be sure to send them the HMRC activation code as soon as you receive it – they cannot file your return for you if they are not registered as your Self-Assessment agent with HMRC. The deadline for payment of any 2017/18 tax liability is 31 January 2019. If your liability is over £1000 then you may also be expected to make a payment on account for 2018/19 by the same deadline, and a further payment on account by 31 July 2019. However, if you have already paid more than 80% of all the tax you owe (for example, through your Pay As You Earn tax), then you may not need to make these payments.

Development Outcome B – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

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Q1 When is the deadline to file the 2017/18 Self-Assessment tax return online? A 31 January 2019 B 5 April 2019 C 31 July 2019 D 31 December 2018 Q2 When is the deadline to pay your 2017/18 tax liability? A 31 January 2019 B 5 April 2019 C 31 July 2019 D 31 December 2018 Q3 By when should you have received your P11D form? A 5 April 2018 B 31 January 2019 C 6 July 2018 D 31 July 2018 Q4 What is the tax liability threshold for the payment on account requirement? A £1185 B £1000 C £2000 D £1500 Q5 Which are examples of things to include on your SA return? A Dividends, rental income and PAYE earnings B Mileage under 45p per mile C Profits made by a company you own D None of the above

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inconversation – anengagingprocess

■ An engaging process Derek Pearson finds himself ‘engaged’ with healthcare, and the royal wedding Something major happened at Windsor Great Park this May. My wife Sue and I turned left when we normally turn around and stroll back down the Long Walk, and as a result we hiked 14 miles instead of the usual five. We enjoy a walk, but crikey! Some little detours take you the long way around.

Zelko Relic

nd, of course, there was a royal wedding. You might have heard about it. It was in all the papers – and on television, at some considerable length. The build-up took forever too, starting from the very moment the couple got engaged, and perhaps that’s why the topic of ‘engagement’ has, this year, followed me from seminar room to exhibition hall and has cropped up in so many interviews. Like the CAD/CAM workflow process and 3D printing, certain subjects barge their way into the limelight, stand centre stage with their hands on their hips and demand our attention. ‘Engagement’ is the latest subject to cement itself into the dental lexicon, but can we really place the blame at Harry and Meghan’s feet? Of course not, any more than we can blame CAD/CAM on Alan Turing. Engagement is simply a topic that has found its time.

Bertalan Meskó

Analogue dentistry and dinosaurs But how does engagement impact the dental team? During the British Dental Conference and Dentistry/DTS Show, I spoke with Zelko Relic, Align Technology’s Chief Technology Officer and Senior Vice President for Global Research & Development. He is a strong advocate for digital technology, which he describes as being: ‘As disruptive for analogue, or traditional dentistry, as the meteor strike in Mexico 66 million years ago was for the dinosaurs’. This does not bode well for analogue dentistry. Other than birds, which thrived and are still with us, there are few surviving dinosaurs alive today other than in Hollywood; I should hate to think of something similar happening to traditional dental technicians. Mr Relic explained that by 2024, the European dental market is forecast to be worth €8.2 billion. It will be raining gravy, but you will need a specific kind of bucket to catch it. He predicted that dental patients, then as now, will expect to see value for money from the dentist, demand a fast, accurate service, exceptional aesthetics, and consistent, precise prosthetics.

People take notice of things they find online before visiting the practice, they know what they want and expect a fast, if not instant, outcome. Analogue dentistry will not and cannot meet such expectations in an acceptable timescale. The old ways move too slowly to survive in the ‘want it now and want it perfect every time’ culture of today’s healthcare. Only digital can, like the birds, thrive. Relic also outlined how smart technology puts power in the hands of the user. In dentistry this means things happen faster and more predictably, and patients can become more engaged in their treatment through visual education tools. It is easier to gain consent when patients can see the proposed outcome before treatment begins, and it enables the dental professional to manage expectations while also easing the patient experience. Zelko Relic is one of the forceful personalities behind the rise and rise of Invisalign clear plastic orthodontic retainers. He believes technicians are as much a part of his product’s success as every other person in the dental team. Scan, plan, design, and deliver are great in theory, but if the dental technical team isn’t hitting the mark every time, the the

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inconversation – anengagingprocess Patrick Thurm

bullet, took the money, provided the crown, and suffered the resultant grief. Sometimes the wisest thing to do in such a toxic situation is to walk away.

Healthcare needs a trip to Mars

Bring the patient into the healthcare team

Back to Patrick Thurm; that morning he, along with 450 entranced delegates, including me, had listened while Bertalan Meskó, the Dental Futurist, told us why healthcare must take a conceptual trip to Mars. To survive on the surface of Mars a colonist must wear a spacesuit, meaning those around them can’t take their pulse if they suffer a cardiac arrest. Colleagues have no way of knowing why their friend just collapsed in a heap.

Real-time digital communication invites dental technicians to become an integral element in patient engagement, thanks to interactive visual displays shared from the lab to the surgery. The patient can see the design work in progress and appreciate how smile design will improve the way they look.

Mission control knows what’s happening, but they are 20 minutes away as the radio signal flies – and it will be another 20 minutes before their response comes back. A lot can go horribly wrong in 40 minutes, as anyone who watches Casualty will appreciate.

process falls flat on its face.

During the Henry Schein Digital Symposium, I spoke with Patrick Thurm, Henry Schein Dental’s Vice President of Technology, Global Prosthetic Solutions. During a lengthy interview, he spoke about engagement as a process that brings the patient into their own healthcare team. A person, he said, has to become a willing participant in their own oral care or the dental professional and everyone else involved is wasting their time and the patient’s money. As a little detour from the principal subject, a dentist I know recently told me that he had refused to provide a patient with a dental crown because of the man’s blatant oral neglect. The crown would be sure to fail, and the dentist knew everyone involved would get the blame – except the patient. You might agree the dentist was right to call that engagement off; there were too many issues in that relationship for it to survive. However, another dentist bit the the

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Meskó compared the space-suited colonist with a patient alone in a hospital bed connected to an array of monitors and with no idea about how, or why, they are being treated. Healthcare professionals are not the ones going

through the healthcare process, he says, the patient is. They should know what’s happening. The patient must be an equal partner in the healthcare process – they need to be engaged, to become part of the team – and recognised as an active element in their own healthcare journey. This is just as important in the dental arena as it is in cardiology or brain surgery. When Meskó concluded his presentation, he said: ‘Never forget, people matter more than technology; what’s important is how we react to change. We should be the ones in charge of technology, not the other way around. The algorithms of developmental science are only there to help make us better. ‘Our engagement with change need not be driven by change itself, it is there to help improve existing skills – not replace them.’ Embrace technological change wisely, and well, become engaged in the process, and, like the birds after the meteor strike, you will thrive.

august 2018 9

businessmojo

■ Six tips to boost your business mojo By Peter Blake As a business owner and entrepreneur, getting and remaining motivated is crucial to your longer-term success. Whether you are attempting to reach a business goal, beginning a new venture or just managing the daily operations of your own business, if you can’t stay enthused and motivated it can eat away at your selfconfidence and harm your potential for success. The more motivated you are, the more momentum you create, making it easier to reach lofty targets and achieve success.

ometimes it’s hard to stay inspired, especially when you have to motivate yourself, so here are six top tips to getting and maintaining your business mojo.

1 Create compelling goals We have looked at goals in a previous article, so you should be familiar with them. Using the SMART goal-setting principle is one way of outlining your objectives establishing how important the goal is to you and creating an action plan for achieving it. If it is a long-term goal then it may be better to break it down into smaller, bite-sized chunks – weekly or even daily action steps – to keep the momentum and your motivation going. Remember: S = Specific M = Measurable A = Achievable R = Realistic T = Time factor

2 Consider new approaches

Aim: ■ to support and generate motivation

CPD Outcomes: ■ to consider some important aspects relating to enthusing and motivating self and others ■ to be aware of six important features of motivation ■ to reflect on the proposed activities

Development Outcome: B

When we have established routines it is easy to get stuck in a rut. The purpose of the routine diminishes and often we carry on doing things simply because that is what we have always done or that is the way we have always done it. Sometimes those routines can create boredom and demotivation. If you notice that the sameness of your business routine has caused your fire to go out, then it is time to shake things up! Start to question your standard processes: why do you do it this way, is it still fit for purpose, could there be a better way? Introduce new ways of thinking around the way you do things, when you do them and how you do them – this will help renew your motivation.

3 Forget ‘should do’ We often fall into the trap of telling ourselves that we ‘should do’ something or ‘have to do’ something. This can be

very demotivating as it becomes an order rather than a desire to improve your enjoyment in your business. This type of thinking can lead to procrastination. Instead of looking at the positive outcomes of completing the task (which would immediately make it a more compelling activity to complete), we are chastising ourselves and insisting that we must just get on and do it! Sounds less appetising now, doesn’t it? Be clearer as to the importance of the task: of how it contributes to your success and moves your business forward. By acknowledging the importance of the outcome, the task itself becomes less onerous.

4 Imagine what it would be like! Close your eyes and imagine your life and what would be different after you achieve your goal. What will you have, what will you be doing, how will you be feeling, what do you see and hear around you?

5 Where possible, work in 90-minute intervals Recent studies have shown that we can significantly improve our output and stay motivated by managing our energy levels. Working in chunks of around 90 minutes tends to be the optimum time for most people before energy levels start to dip. At the end of each 90-minute interval, try and take a break of at least 10 minutes to refresh mind and body before returning to the task at hand. You will find that you get much more done in the day, which is an excellent motivator. the

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businessmojo 6 Relive past successes Go back and remember what it felt like when you achieved something important to you in the past. Think about the process you went through, what you did and how good it felt to succeed! This can give insights and motivation to overcome any hurdles you are experiencing now and get you motivated to move forward. Staying motivated in business will keep you interested, happy and enthused, enabling you to get the most from your business.

Peter Blake Peter is a chartered accountant, business coach and master practitioner of NLP. He has his own practice based in Wiltshire, lectures on finance and mentors new business start-ups for Gloucestershire Enterprise Ltd. For further details, contact Peter on 07912 343 265 or email peterblake@pbcoachingandtraining.com

■ Holiday Pay What is the minimum holiday entitlement?

he minimum amount of annual leave that an employer must provide to a full-time worker is currently 28 days a year (or 5.6 weeks). Bank holidays can still be counted towards this entitlement. However there is no statutory entitlement to bank holidays or to pay them at a premium, although these provisions are often included within individual contracts of employment. Part-time workers are entitled to the 28 days on a pro rata basis. So an employee working 3 full days would be entitled to 3/5 of the full-time equivalent or 16.8 days.

Development Outcome B – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 SMART goals, set in bite-sized chunks, as weekly or even daily action steps: A Enable you to achieve goal setting B Keep motivation going and c) C Maintain the momentum D Provide compelling objectives and a)

What payments do I need to include?

Q2 Reflecting on your standards processes should include questioning: A Why you do it this way B Whether it is still fit for purpose and a) and d) only C Which digital system is worth purchasing D Whether there could be a better way and a) only

● Basic weekly pay ● Contractual overtime – the Employment Rights Act 1996 says that pay for a working week includes basic pay and overtime if this is contractual. Check if there is a specific clause in the contract but also bear in mind that a right can also be established by

Q3 The NLP activity of closing your eyes and imagining your life once you have achieved your set goal helps motivate you and therefore requires that you: A Imagine what would be different after you achieve your goal B Consider what you have and what you will be doing C Understand how you will feel once you have achieved your goal D Acknowledge what you see and hear around you and all the above Q4 Having a refreshment break every … minutes has been found by some to improve productivity: A 60 minutes B 90 minutes C 120 minutes D 180 minutes Q5 What can provide the motivation to overcome hurdles and move you forward? A Reliving past successes in your mind B Having a break and c) C Considering the difficulty of the current hurdle D Setting SMART goals

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When calculating employee holiday pay, the following elements should be included:

Aim: ■ to provide an explanation of how holiday entitlement is currently calculated in the UK

CPD Outcomes: ■ to give an overview of how holiday entitlement is calculated using current UK employers’ guidance ■ to be aware of how variations in holiday entitlement may occur ■ to be aware of how an individual’s period of sickness can affect the use of holiday entitlement

Development Outcome: B the

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hrfacts

Q&A custom and practice even if there is nothing in writing. ● Contractual bonuses or commission or shift work – if an employee’s hours and pay vary, perhaps because of bonuses or commission or shift work, then the average hourly rate over the preceding 12 weeks takes into account the extra payments. When calculating employee holiday pay, the following elements would normally be excluded, unless the contract states otherwise: ● Discretionary bonuses – bonuses that are definitely not contractual are excluded.

● Salary sacrifice schemes – any salary that is sacrificed through such a scheme (e.g. childcare vouchers) may be excluded. ● Pensions, cars, or health cover – a week’s pay will generally not include benefits such as these items.

Development Outcome B – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 What is the minimum amount of annual leave that a full-time worker is entitled to? A 20 days B 28 days C 5.4 weeks D 21 days Q2 Bank holidays … A Are often included in an employee’s minimum entitlement B Must be included in an employee’s minimum entitlement C Must be added to the minimum entitlement D Must be paid for at an enhanced rate Q3 Unless otherwise allowed for in the contract, the following should not be included in calculating holiday pay: A Discretionary bonuses B Basic pay C Contractual bonuses D Contractual overtime

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If a part-time worker increases or decreases their hours part way through the holiday year, the employer may need to increase or decrease the holiday entitlement going forwards, but is not required to change the holidays which have already accrued to date. Reducing hours – If a worker moves from full-time to part-time work, they retain the right to the full untaken holiday that has accrued but has not been taken while they were working full time. The employer is not entitled to adjust the already accrued entitlement to reflect the reduction in working time. However, the ongoing holiday entitlement can be recalculated from the point that the working pattern changes. Increasing hours – Employers should recalculate and increase the holiday entitlement which accrues from the point in time when the hours increase.

What happens to holiday entitlement if employees are on sick leave?

Q4 When an employee reduces their hours, their holiday entitlement: A Stays the same B Is reduced for the full holiday year C Should be recalculated from 1 April D Should be adjusted from the date of change in hours onwards Q5 When an employee is on sick leave, they: A Continue to accrue holiday entitlement B Cease to accrue holiday entitlement C Only accrue holiday entitlement for absences of up to 3 weeks D Must ‘use or lose’ their holiday entitlement in the current holiday year

What happens if an employee changes their hours during the holiday year?

Workers on sick leave can still accrue up to the four weeks’ annual holiday that they are entitled to under the Working Time Directive. (This does not apply to all of the 28 days’ paid holiday applicable under UK legislation.) It is not lawful to provide that the right to annual holiday is lost at the end of a holiday year where the worker has been the

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hrfacts on sick leave. Employers should not force workers to take holidays while on sick leave or to suggest they use the holiday or it will be lost.

confidentialityanddataprotection

■ Can you keep a secret? by Kevin Lewis

An employee who becomes unwell during pre-arranged annual leave can stop their annual leave, take sick leave, then resume the remainder of their annual leave at a later date.

Personal information has certainly been in the spotlight lately. From the hacking of email accounts and even the most sensitive computer systems of major governments, to data security breaches on an industrial scale from financial service providers to major high street brands and even NHS Trusts. Then came the recent Facebook data harvesting scandal, and the endless flow of stories of data theft and identity fraud targeting individuals, almost always for financial gain.

Workers on long-term sick leave could potentially accumulate significant periods of untaken leave, which should be taken, or paid for, once the worker returns to work or leaves. Workers must be allowed to take accrued holidays on their return to work.

ata is big business and most of us will have received something in the post or via a phone call or email, and wondered how on earth the sender obtained our details. It is even more insidious and disturbing when you receive unsolicited approaches from 2 or 3 insurance companies at the precise moment when you are due to renew your property or vehicle insurance. You didn’t give them this information, so who did?

Employers should agree when holidays accrued during sick leave will be taken and make provision for holidays accrued during long-term sick leave to cover any future claims. Accrued statutory holidays not taken due to sickness can be taken at a later date – even if it is during the next holiday year. An employee on sick leave does not have to show he/she was unable to take holidays by reason of his or her illness for it to be carried forward.

Richard Mander Richard is a freelance HR consultant with over 25 years experience in Strategic and Operational HR. He specialises in providing support to SMEs and aims to deliver cost-effective, pragmatic and practical solutions. If you would like to find out more about this topic, or advice on other HR matters, you can contact him at www.manderhr.com 07715 326 568.

Aim: ■ to be aware of changes in legislation affecting the delivery of care

CPD Outcomes: ■ to be aware of the recent changes to the Data Protection Act 1988 and the implementation of GDPR with effect from 25 May 2018 ■ to understand the importance of maintaining patient confidentiality and data protection

Development Outcome: D the

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As healthcare professionals we become privy not just to the kind of ‘basic’ information about individuals that is in the public domain from other sources (name, address) but sometimes much more personal and private information about the patient’s age, health, contact details. Data only becomes ‘personal data’ if an individual can be identified from it. Over the 20 years since the 1998 Data Protection Act came into force, health information (along with ethnicity and religion, for example) has been recognised in law as having particular significance, being included within the legal definition of ‘sensitive personal data’. That special significance is also reflected in the professional, ethical guidance issued by the UK’s dental regulator, the General Dental Council.² Any information that a patient discloses to us in the context of our professional

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– confidentiality and data protection relationship with them, is effectively a secret shared with us on the basis of trust. The expectation is that we will respect that trust, and use that information only for the purpose that it was shared with us, and always in the patient’s interest. We must not use it for any other purpose, nor share it (deliberately or accidentally) with any third party, without the patient’s full knowledge and permission. It is our commitment to respecting the confidentiality of the personal information of our patients that contributes to maintaining public confidence in the dental health professions. With that aim in mind, as well as that of maintaining our own integrity and professionalism, our ethical duty of confidentiality runs in parallel with our legal duty under data protection legislation. On 25 May 2018, the General Data Protection Regulation (GDPR)¹ came into force, this having originated in the European Parliament. Anyone who owns and operates a business or conducts an activity which collects, uses, holds, shares, stores, and disposes of data – in all of its forms as defined by GDPR – needs to be aware of their legal obligations and to have somebody clearly identified as being responsible for data protection compliance. This new legislation includes a new statutory requirement to report any data breach within 72 hours. What happens next will depend upon the individual circumstances, including the nature, seriousness and duration of the breach and the steps taken to prevent it and to remedy the situation after the breach occurred.

significantly higher standard of protection within GDPR than most other forms of personal data. Unlawful disclosure of both personal data and ‘information relating to health’ can take many forms, some of which are more obvious than others. Clinical dental technicians will always take a medical history from the patient and will know details concerning the patient’s health, medication, ethnicity and date of birth. In many cases this information will be stored electronically (i.e. on a computer). A laboratory technician may not know any of this information, but may still meet some patients in connection with selecting a shade or gaining a better appreciation of some other factors of an aesthetic or functional nature in a complex case (or more regularly in the case of an in-house laboratory within a dental practice). Laboratory prescriptions (tickets/dockets) vary in the level of information they supply and disclose and while many are now sent or confirmed electronically, most still tend to be hard

copy (paper/card). Either way, the patient’s name will almost always be provided (while some readers may be asking themselves how it could work without that, others will already be working in systems where the patient is de-identified and/or the information encrypted, with the protected information available only to the intended recipient e.g. by using a password). The ability for other, unauthorised people to identify the person to whom personal information (and/or health information) relates, is the central breach of confidentiality that we are trying to avoid. To take a simple example, study or working models will often bear the patient’s name, and they reveal the state of the patient’s dentition. This is certainly ‘information relating to health’ and arguably falls within GDPR’s deliberately wide definition of ‘biometric data’ too. Patients might reasonably expect that the treating dentist or CDT, and any members

It’s personal GDPR introduces a new specific definition of ‘Information relating to health’, as well as definitions of ‘Genetic data’ and ‘Biometric data’, and this highly personal information rightly commands a the

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confidentialityanddataprotection same effect. But how sure are you that the patient has agreed to having this discussed with others, or the information communicated in this way?

of their immediate clinical or admin staff, will have access to this information, and similarly a dental technician who is involved in their care. But they probably won’t expect anyone else to be given access to this information as a result of the irresponsible disposal of those models. In its professional standards guidance², the GDC reminds us (Principle 4 – Maintaining and Protecting Patient’s Information) of the importance of preserving confidentiality, and at Paragraph 1.9.1 we are also reminded of our duty to keep ourselves up to date with all relevant legislation, and adhere to it at all times. Even the casual mentioning of a patient’s name to third parties not involved in the patient’s care and treatment, or the fact that they wear a denture, or details of your involvement in the dental treatment of a named person, can land you in trouble. You may contact a patient’s home or place of work, to let them know that a repaired denture is ready to collect. You may want to leave a message with someone if you can’t speak directly to the patient, or leave a voicemail, or send a text or email to the

Both GDPR and the GDC’s guidance stress the fact that this is personal and private information, and it should remain so unless the patient has given a specific permission to do otherwise. A helpful rule of thumb is to treat your patient’s information – in all its forms – with the same care, respect and circumspection, as you would hope and expect that others would deal with information about you and other members of your family. One of the stated aims of GDPR is to encourage organisations and individuals to re-think how they approach the challenge of data protection and security. This is a timely moment for us all to do just that. 1 A guide to GDPR is available from the Information Commissioner’s Office (ICO) https://ico.org.uk/ for-organisations/guide-to-the-general-data-protection -regulation-gdpr 2 Standards for the Dental Team: General Dental Council. www.gdc-uk.org

Development Outcome D – 60 minutes

Kevin Lewis, BDS (Lond) LDSRCS (Eng) FDSRCS (Eng) FFGDP (UK) Kevin graduated in London in 1971. He spent 20 years in full-time general dental practice and 10 further years practising part time. He became involved in the medico-legal field in 1989, firstly as a member of the Board of Directors of Dental Protection Limited (part of the Medical Protection Society group of companies). He became a dento-legal adviser in 1992 and from 1998 was the Dental Director of Dental Protection for 18 years and also an executive member of the Council (Board of Directors) and executive management team of the Medical Protection Society, roles from which he stepped down in 2016. He is a trustee and member of the Transition Board of Directors for the proposed College of General Dentistry. Kevin has been writing a regular column in the UK dental press since 1981 – originally as the Associate Editor of Dental Practice and since 2006 as the Consultant Editor of Dentistry magazine. He still writes and lectures regularly all over the world, and has been awarded honorary membership of the British, Irish and New Zealand Dental Associations.

Q2 In the course of our work, we may become aware of many types of information about a patient that has been To complete your CPD, store your records and print a certificate, shared with us (or which we discover from the work we please visit www.dta-uk.org and log in using your member details. are carrying out). All of the following statements are true except one. Which one is not true? Q1 Information about a patient’s health and/or treatment A If the patient tells us their name, we can use it in our provided for them, was recognised by the Data Protection professional interactions with them, but must not reveal it Act 1998 as being especially important and private (along to anyone else, nor use it for any other purpose with certain other personal information). What term was unconnected with the patient’s treatment used to describe this category of information? B Confidentiality only applies to information that the patient A Personal data gives us or that we find out as part of our work. If we B Private data could find out a patient’s address and other facts about C Confidential data them, from other sources, confidentiality does not apply D Sensitive personal data C We must not discuss or disclose details of the patient’s oral/dental condition to any third party, without the Outc ome patient’s agreement D D We must not discuss or disclose details of any oral/dental appliance worn by a patient, with anyone, without the patient’s agreement

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confidentialityanddataprotection Q3 What is the full name of the new European legislation 2016/679 that updates the UK’s Data Protection Act 1998, as from 25 May 2018? A The Updated Data Security Rules B The General Data Protection Regulation C The European Data Processing Requirements D The Loss of Data Prevention Act

Q8 The General Dental Council guidance sets out some principles for Outc ome maintaining and protecting a D patient’s personal information. Indicate the one statement that does not appear in that 60 m guidance: inut es A The patient’s name must not Q4 A bag containing a laboratory instruction sheet, and some appear on any identification marker working and study models, probably contain all but one of inserted into a denture the following under the legal data protection definitions. B Protect the confidentiality of patients’ information Which one is the exception? and only use it for the purpose for which it was given A Personal data C Only release a patient’s information without their B Information relating to health permission in exceptional circumstances C Genetic data D Keep patients’ information secure at all times, whether D Sensitive personal data your records are held on paper or electronically

CPD

Q5 ‘Data processing’ takes many forms. Which one of the Q9 It is possible to breach a patient’s confidentiality in a following statements is not correct? number of ways, including most of the ways described A Collection and storage of personal information is data below. Which one is the exception? processing A Leaving the patient’s details visible on an unattended B Use of personal information (such as a patient’s name) is computer screen in an area where other people have data processing access to it C Sharing information with others, or otherwise making it B Speaking to a patient’s work colleague on the telephone available for others to see/be aware of, is data processing and asking them to pass on a message to the patient, D Erasure/Deletion/Destruction of information/data is no requesting them to ring the laboratory about their denture longer part of data processing repair C Throwing away a bag into the general waste, containing Q6 If you become aware of a data security breach in which one or more models bearing the patient’s name you or an organisation you own/control is involved, you D Emailing a Medical Devices Statement of Manufacture have a legal requirement to do several things (indicate (under Medical Devices Directive 93/42/EC) to a dental the one incorrect answer): practice, using end-to-end encryption to safeguard the A You should establish the facts of the breach, and take information during transmission steps to contain/limit the damage and prevent further breaches of a similar nature Q10 In relation to both the legal requirements of GDPR and B You should try to conceal or cover up the breach and do the ethical duty of professional confidentiality, only one of your best to ensure that nobody finds out about it these statements is true. Which one is it? C You have a legal obligation to self-report the breach to the A No action can be taken against you if more than 12 Information Commissioner’s Office within 72 hours months has elapsed since you inappropriately disclosed D You should inform the patient(s)/individual(s) whose information about a patient personal information has been involved in the breach of B No breach has occurred unless it is possible to identify an data security and provide them with all relevant details individual patient from the information in question C Even if the patient has given their specific permission for Q7 The General Dental Council publishes guidance on the you to share information about them on a particular standards of ethics and professional conduct that they – occasion, in particular circumstances, it is still wrong and and patients – expect. All but one of the statements probably illegal below are described by the GDC as things that patients D If you own a laboratory, you cannot be held responsible in expect. Indicate the one that is not in the GDC’s guidance: any way if a member of your staff happens to breach a A Their personal details will be kept confidential patient’s confidentiality by discussing the patient’s B They must be able to access their dental records treatment with friends in a social setting C Technicians and CDTs should not have access to the patient’s health information under any circumstances D Their records must be stored securely the

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medicalemergencies

■ Medical emergencies in a dental environment by Lorraine Madley, RN, Cert Ed, BSc (Hons)

Introduction ‘A patient could collapse on any premises at any time, whether they have received treatment or not. It is therefore essential that ALL registrants are trained in dealing with medical emergencies …’ (General Dental Council ‘Scope of Practice’, 2013). Additionally, not just registrants but all staff members need to be prepared and knowledgeable in how to deal with medical emergencies at any time (Jevon, 2012).

Aims: ■ to highlight potential medical emergencies within the dental profession ■ to inform the reader of choking, anaphylaxis, epileptic fits and seizures within individuals

CPD Outcomes: ■ to highlight signs and symptoms of choking, anaphylaxis, epileptic fits and seizures ■ to highlight potential treatment of individuals if such an event occurs

Development Outcome: C the

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lthough emergencies occurring in dental laboratories are relatively rare, there is a public expectation that dental healthcare professionals are expected to know how to deal with any emergency, should it occur. This article focuses on anaphylaxis and seizures.

Anaphylaxis Anaphylaxis is a rare but severe, lifethreatening, generalised or systemic hypersensitivity reaction (Resuscitation Council UK, 2012), and although it could be triggered by almost anything the patient comes into contact with, there have been two fatalities in dental surgeries in 2009 and 2011 respectively, where chlorhexidine was considered to be the most likely cause (Pemberton & Gibson, 2012). A speedy ABCDE approach to assessing the patient is required to evaluate the condition and its severity. Signs and symptoms occur in as little as two minutes from contact with the allergen. The patient may have many different symptoms, making anaphylaxis potentially hard to diagnose. It is important to listen to what the patient is telling you and once you suspect anaphylaxis, treatment must commence quickly to avoid cardiac arrest. The main life-threatening symptoms are as follows: A – Airway: swelling anywhere that may cause obstruction. This may only be internal and not easily seen, so what is the patient telling you is happening to them? B – Breathing: will be increasing with an asthma-type wheeze or inspiratory stridor

C – Circulation: increased heart rate, lowered blood pressure – Do NOT stand them up! D – Disability: confusion and decreasing conscious levels E – Exposure: possible urticarial rash (in 80% of cases) Immediately treat anaphylaxis if the onset is sudden and life-threatening airway and/or breathing and/or circulatory problems are present.

Treatment Intramuscular (IM) adrenaline must be administered (see the doses further on). The preferred injection site is the anterolateral aspect of the middle third of the thigh. Speed is of the essence, so you may not have time to remove clothing. If the patient has his or her own auto injector, some assistance may be required in its use. However, if adrenaline is

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available it is much more likely to be in ampoules, which will need to be drawn up and administrated by a dentist. Subsequent doses can be given at fiveminute intervals if the condition fails to improve or deteriorates. Note the time each dose was administered. Note that adrenaline comes in 1 ml vials, so only a portion of the vial is needed as below: ● Adults and children > 12 years: 500 micrograms IM (0.5 ml) ● > 6–12 years: 300 micrograms IM (0.3 ml) ● < 6 years: 150 micrograms IM (0.15 ml) A 999 call must be made – hopefully this can be delegated to another staff member who can then also wait outside for the ambulance. Lay the patient as flat as they can tolerate and if possible raise their legs. Once the initial treatment above has been given, further treatment as suggested below can commence if time allows whilst waiting for the ambulance. ● High flow oxygen via a non rebreathe mask ● Administer antihistamine and corticosteroids if available ● If the patient becomes unconscious, put them in the recovery position ● If the patient stops breathing normally, commence CPR

Epileptic Fits and Seizures Epileptic fits are the fourth most frequent emergencies seen in dental environments (Girdler & Smith, 1999). Seizures can be caused by a variety of reasons and vary from one patient to another, so obtaining a full medical history is paramount. During a convulsive seizure the patient may fall to the ground and shake or make jerky movements (Epilepsy Society, 2015). In the dental chair, assistance will be needed to ensure the patient does not fall out of it. Breathing may be affected and they may go blue or pale, bite their tongue and bleed.

Most seizures will cease unaided and the patient may feel the need to sleep, with no medical intervention required apart from reassurance. However, a 999 call is required if:

During the seizure, if possible check observations, as a low pulse or low blood sugar may be the cause of an unexpected seizure. If hypoglycaemic, treat accordingly.

● the patient’s medical history does not indicate any form of epilepsy or seizures ● the seizure lasts longer than five minutes – so it is important to time the seizure ● the patient has recurrent seizures ● injury occurs during the seizure that needs treating

Once the patient recovers, continue monitoring until fully aware and alert. It may be appropriate to phone for a relative so they do not leave alone. A dentist may need to take account of that many patients have dental injuries during a seizure (Epilepsy Society, 2015) but do not undertake any further dental treatment that day (Aragon & Burneo, 2007) other than to check for any oral injuries following the seizure.

Treatment Regardless of where the patient is, it is imperative that the area around them is made as safe as possible to prevent injury. If the patient is in a dental chair, it needs to be fully lowered and flat. Place the patient on their side to decrease the chance of aspiration of secretions or dental materials; use assistance to ensure they do not fall out. Do not attempt to restrain them.

If, after five minutes the seizure continues, ensure a 999 call is made. Midazolam is often found in dental practices so if available, a dentist should administer in the following doses: ● 1–5 years: 5 mg buccal ● 5–10 years: 7.5 mg buccal ● >10 years: 10 mg buccal the

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medicalemergencies Development Outcome C – 60 minutes Summary Whilst medical emergencies in dental environments are rare, their onset may be sudden and staff will need regular training updates and familiarisation with equipment and drugs kept in order to treat patients quickly and appropriately.

To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 The author reports that the signs and symptoms of anaphylaxis can occur within as little as: A 2 minutes B 3 minutes C 4 minutes D 5 minutes Q2 Urticarial rash occurs within what percentage of anaphylaxis cases? A 50% B 65% C 70% D 80%

Disclaimer The treatment dosages quoted by the author were correct at time of printing. Whilst DTs may not be qualified to inject patients, if the drugs are available within your work environment, you should be aware of their use and preparation. If an emergency does occur, always call 999.

References – Aragon CE & Burneo JG (2007). Understanding the patient with epilepsy and seizures in the dental practice. Journal of the Canadian Dental Association, 73(1): 71 – 76. – Epilepsy Society. First aid for all seizures. [online] 2015 Available at: https://www.epilepsysociety.org.uk/ first-aid-all-seizures#.WWh8ORXyu00 [Accessed July 2017]. – General Dental Council. Scope of Practice. [online] 2013 Available at: https://www.gdc-uk.org/ professionals/standards/st-scope-of-practice [Accessed July 2017]. – Girdler N & Smith D (1999). Prevalence of emergency events in British dental practice and emergency management of skills of British dentists. Resuscitation, 41: 159–167. – Jevon P (2012). Updated guidance on medical emergencies and resuscitation in the dental practice. British Dental Journal, 1, pp.41–43. – Pemberton MN & Gibson J (2012). Chlorhexidine and hypersensitivity reactions in dentistry. British Dental Journal, 11: 547–550. – Resuscitation Council (UK). Quality standards for cardiopulmonary resuscitation practice and training – Primary dental care – Quality Standards. [online] 2013 Available at: https://www.resus.org.uk/quality-standards/ primary-dental-care-quality-standards-for-cpr [Accessed July 2017]. – Resuscitation Council (UK). Adult basic life support and automated external defibrillation. [online] 2015 Available at: https://www.resus.org.uk/resuscitation -guidelines/adult-basic-life-support-and-automated -external-defibrillation/#foreign. [Accessed July 2017]. – Resuscitation Council (UK). Paediatric basic life support. [online] 2015 Available at: https://www.resus.org.uk/ resuscitation-guidelines/paediatric-basic-life-support/ [Accessed July 2017]. – Resuscitation Council (UK). Anaphylaxis [online] 2012 Available at: https://www.resus.org.uk/anaphylaxis/ emergency-treatment-of-anaphylactic-reactions [Accessed July 2017]. – Wong SC & Tariq SM (2011). Cardiac arrest following foreign-body aspiration, Respiratory Care, 56(4): 527–529.

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Q3 What does the author highlight as the fourth most frequent emergency seen in dental environments? A Choking B Asthma attack C Epileptic fits and seizures D Myocardial infarction Q4 An epileptic seizure will often cease unaided with no further medical intervention required. However, a 999 call is required if: A The patient’s medical history does not indicate any form of epilepsy or seizures B The seizure lasts longer than five minutes C The patient has recurrent seizures D Any of the above Q5 How much IM adrenaline is recommended for adults and children over 12 years for anaphylaxis? A 500 micrograms IM (0.5 ml) B 400 micrograms IM (0.4 ml) C 300 micrograms IM (0.3 ml) D 200 micrograms IM (0.2 ml) Q6 In relation to the ABCDE approach for anaphylaxis, what does the C stand for? A Conscious B Confusion C Consciousness D Circulation Q7 Within the ABCDE approach for anaphylaxis, what does the A stand for? A Assessment B Airway C Assess Outc ome D Adrenaline C

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Lorraine Madley Lorraine Madley is a Senior Lecturer in Resuscitation with Middlesex University and has been teaching in dental settings for more than 15 years. Lorraine started her career as a registered nurse in the Queen Alexandra’s Royal Army Nursing Corps in 1985, she commenced teaching in 1998 and completed a Certificate in Education followed by a BSc (Hons) in Life Support Skills Education. Lorraine holds both the Advanced Life Support Providers Certificate and the European Paediatric Life Support Certificate and currently teaches a wide variety of healthcare professionals plus nursing and midwifery students. To keep her practical skills up to date Lorraine maintains university links with a busy London A&E department and works with the East of England Ambulance Service, responding to emergency calls.

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prosthetics:connectors

■ Connectors Aim: ■ to highlight the types of connectors used within removable partial dentures

by JC Davenport,1 RM Basker,2 JR Heath,3 JP Ralph,4 P-O Glantz,5 and P Hammond6 This paper describes the types and functions of connectors for RPDs. It also considers the relative merits and limitations of these connectors.

CPD Outcomes: minor connectors should be kept to a minimum to conform to the key design principle of simplicity.

■ to be aware of major and minor connectors ■ to be aware of the types of connectors for mandibular and maxillary appliances ■ to highlight the advantages and disadvantages of these connectors

Development Outcome: C

In this part, we will discuss: ● major and minor connectors ● connectors for the upper jaw ● connectors for the lower jaw ● non-rigid connectors ● connectors for acrylic dentures All the parts that comprise this series (which have been published in the BDJ) have been included (together with a number of unpublished parts) in the books A Clinical Guide to Removable Partial Dentures (ISBN 0-904588-599) and A Clinical Guide to Removable Partial Denture Design (ISBN 0-904588-637). Available from Macmillan on 01256 302 699.

Fig. 1

Fig. 1: Connectors Connectors can be classified as either minor or major. The minor connectors (coloured red) join the small components, such as rests and clasps, to the saddles or to the major connector. In addition, they may contribute to the functions of bracing and reciprocation as in the RPI system (rest, plate, I-bar clasp) (Figure 6.26*).2 The positioning of the minor connectors joining rests to a saddle will vary according to whether an ‘open’ or ‘closed’ design is to be used (Figure 4.9*).3 The number of

The major connector (coloured black) links the saddles and thus unifies the structure of the denture. The remainder of this article is devoted to the major connector. The major connector may fulfil a variety of functions. In addition to its basic connecting role, it contributes to the support and bracing of a denture by distributing functional loads widely to the teeth, and in appropriate maxillary cases, to the mucosa. It can help to retain the denture by providing indirect retention by contacting guide surfaces, and in the upper jaw, by coverage of palatal mucosa.

Designs of connector for the upper jaw The choice of the shape and location of connectors is greater in the upper jaw because of the area available for coverage offered by the hard palate. A decision on

Fig. 2

First published in British Dental Journal, volume 190, no. 4, and reprinted with permission of publishers Springer Nature

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connectors choice of connector type is based upon the requirements of: ● function (e.g. connection of components, support, retention) ● anatomical constraints ● hygiene ● rigidity ● patient acceptability

Palatal plate Fig. 2: Palatal plate

Fig. 4

The basic functional requirement of a major connector is to link the various saddles and other RPD components. In this tooth-supported RPD a simple midpalatal plate has been used. This is a very satisfactory connector for such situations, as it: ● leaves all gingival margins uncovered ● can be made rigid ● has a simple outline ● is well tolerated as it does not encroach unduly on the highly innervated mucosa of the anterior palate

Fig. 4: Palatal plate Where two or more teeth separate adjacent saddles, it is possible to keep the border of the connector well away from the vulnerable gingival margins. Where only a single tooth intervenes between two saddles (e.g. UR4 (14)) it may not be possible to uncover the gingival margin widely enough to avoid problems of gingival irritation and patient tolerance. However, any opportunity to uncover the gingival margin around even a single tooth should normally be grasped (A Clinical Guide to Removable Partial Denture Design, Statement 15.10).4

Fig. 3: Palatal plate In contrast, the greater extent of the saddles in this tooth – mucosa-supported RPD – represents more of a support problem. The functional forces can be shared between teeth and mucosa by using a larger connector that extends posteriorly to the junction of hard and soft palates. It is still possible to leave the gingival margins of the majority of teeth uncovered.

Fig. 3

Fig. 5: Palatal plate If coverage of the gingival margin by the connector is unavoidable, close contact between the connector and gingival margin should be achieved whenever possible. If ‘gingival relief’ is created, the space is soon obliterated by proliferation of the gingival tissue; this change in shape increases the depth of the periodontal pocket and thus makes plaque control more difficult.

Fig. 5

Fig. 6

Fig. 6: Palatal plate Full palatal coverage with cobalt chromium has two disadvantages. First, the weight of a large metal connector can contribute to displacement of the prosthesis. Second, the position of the post-dam cannot be altered should it prove to be poorly tolerated by the patient. An alternative approach, which may possibly be used to overcome these problems, is illustrated. The posterior part of the casting has a retaining mesh to which an acrylic extension will be attached.

Ring connector Fig. 7: Ring connector A ring connector, outlined here on a cast, may be used in cases where there are multiple saddles widely distributed around the arch, and where tooth support can be obtained. This connector may also be indicated where a prominent palatal torus would contraindicate a mid-palatal plate.

Fig. 8: Ring connector The ring connector exhibits good rigidity for a relatively low bulk of metal. This is because the anterior and posterior bars can be positioned in different planes so that an ‘L’-shaped girder effect is created. Although this connector leaves a large area of the palate uncovered, it does have the

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prosthetics:connectors Fig. 7

Sublingual bar Fig. 9: Sublingual bar The sublingual bar differs from the lingual bar (see below) in that its dimensions are determined by a specialised master impression technique that accurately records the functional depth and width of the lingual sulcus (A Clinical Guide to Removable Partial Dentures, Figs 16.23â&#x20AC;&#x201C;16.25).5

the potential disadvantage that the anterior bar crosses mucosa that is richly innervated and is contacted frequently by the tongue during swallowing and speech. The anterior bar may interfere with these functions and be poorly tolerated as a result. If this design is selected, the anterior bar must be carefully positioned and shaped to blend with the contours of the palatal rugae.

requirements: maintenance of oral hygiene and rigidity. Five of the common connectors are illustrated diagrammatically and clinically.

These sulcus dimensions are retained on the master cast so that the technician waxes up the connector to fill the available sulcus width at its maximum functional depth. This results in a bar whose maximum cross sectional dimension is oriented horizontally. The rigidity of a lingual bar increases by a square factor when its height is increased and by a cube factor when its width is

Fig. 9

Designs of connector for the lower jaw The main anatomical constraint for connector design in the lower jaw is the relatively small distance between the lingual gingival margin and the functional depth of the floor of the mouth. In terms of functional requirements, the mandibular connector does not contribute to support by distributing loads directly to the mucosa. It connects the RPD components and can provide indirect retention and guide surfaces. With gingival recession there is even less room to manoeuvre and it may be difficult to design a connector that satisfies two of the main

Fig. 10

Fig. 8 the

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prosthetics:connectors increased. The increased width of the sublingual bar connector therefore ensures that the important requirement of rigidity is satisfied. This is not invariably the case with a conventional lingual bar. As the vertical height of a sublingual bar is less than a lingual bar it can be used in shallower lingual sulci and be kept further away from the gingival margins.

Fig. 12

Lingual bar Fig. 10: Lingual bar The lingual bar, like the sublingual bar, should be placed as low as the functional depth of the lingual sulcus will allow. The cross section of the lingual bar is determined by the shape of a prefabricated wax pattern either prescribed by the dentist or selected by the dental technician. The maximum cross sectional dimension of this connector is oriented vertically.

Fig. 11: Lingual bar If either a lingual or sublingual bar is to be used and additional bracing and indirect retention are required, bracing arms and rests can be incorporated in the design. There are anatomical constraints in the lower jaw that may prevent the use of sublingual or lingual bars. Mention has already been made of lack of space between the gingival margin and the floor of the mouth. A prominent lingual fraenum may compound the problem and make it impossible to use either of these connectors. A mandibular torus may be of such a size that a sublingual or lingual bar, sitting on top of the bony protuberance, would be excessively prominent, creating major difficulties for the patient in tolerating the prosthesis.

Fig. 11 the

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Dental bar Fig. 12: Dental bar On occasions there is insufficient room between gingival margin and floor of the mouth for either a sublingual or lingual bar. A lingual plate should be avoided wherever possible because it might well tip the delicate balance between health and disease in favour of the latter. An alternative connector, where the clinical crowns are long enough, is the dental bar. Patient tolerance inevitably places some restriction on the cross sectional area of this connector and thus some reduction in rigidity may have to be accepted.

Fig. 13: Dental bar Another connector (sometimes referred to as a â&#x20AC;&#x2DC;Kennedy Barâ&#x20AC;&#x2122; or continuous Fig. 13

clasp) consists of a dental bar, combined with a lingual bar. This combination allows the dimensions of each component to be reduced to a limited extent without compromising the overall rigidity of the connector. However, this is a relatively complex design and is best avoided if any of the simpler alternatives are feasible. Tolerance of the patient must be assessed carefully before prescribing either a dental bar or a lingual bar and continuous clasp.

Fig. 14: Dental bar Spaces between the incisors are likely to preclude the use of the dental bar or continuous clasp on aesthetic grounds as the metal will show through the gaps (arrows). A sublingual or lingual bar would avoid this problem, although a lingual

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prosthetics:connectors Fig. 15

Fig. 14

plate with its superior border notched where it passes behind the spaces is an alternative solution. If the space is small, composite may be added to the adjacent teeth to close it and allow a dental bar to be used.

Lingual plate Fig. 15: Lingual plate The lingual plate covers most of the lingual aspects of the teeth, the gingival margins and the lingual aspect of the ridge. The plate terminates inferiorly at the functional depth of the sulcus. Rigidity is achieved by thickening the lower border to a bar-like section. One of the major drawbacks of the lingual plate is its tendency to encourage plaque formation. Plaque control should therefore be impeccable before a lingual plate can be prescribed with any confidence.

Labial (or buccal) bar Fig. 16: Labial (or buccal) bar Mention has already been made of lingually inclined teeth creating an obstruction to the insertion of an RPD, and how a change in the path of insertion can sometimes avoid this obstruction (A Clinical Guide to Removable Partial Denture Design, Figs 3.23 and 3.24).6 However, on rare occasions the lingual tilt is so severe that it is impossible to use any of the lingual

Fig. 16

connectors. Under such circumstances a labial (or buccal) bar can be used. The cross sectional area of the bar is severely restricted by the limited space available and also by patient tolerance. The combination of limited space for the bar and its increased length as it travels around the outer circumference of the dental arch makes it difficult to achieve rigidity, although in this example, the short spans minimise this problem. A summary of the functions and essential qualities of the mandibular connectors is presented in Table 1 below.

displacement differential between teeth and mucosa is immaterial. The connector should be designed so that it is rigid and thus distributes the functional forces throughout the structure of the denture and thence to the supporting tissues.

Fig. 18: Non-rigid (stress-breaking) connectors A distal extension saddle gains some of its support from teeth and some from the tissues of the edentulous area. This support differential can result in tipping of

Non-rigid (stress-breaking) connectors Fig. 17: Non-rigid (stress-breaking) connectors During loading, a component resting on a tooth will be displaced very much less than one that rests on mucosa. If a denture is entirely tooth supported, the

Fig. 17

Note: On table â&#x153;&#x201D; = Present, ? = Uncertain, and â&#x153;&#x2DC; = Absent the

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prosthetics:connectors Fig. 18

– reducing the area of the artificial occlusal table – maximising coverage of the edentulous area – employing the altered cast technique – using one of the more flexible clasp systems – instituting a regular maintenance programme

Acrylic dentures

Fig. 19

the denture when it is loaded during function, causing an uneven distribution of load over the edentulous area. It will also result in a relatively greater share of the load being taken by the tooth. One way of minimising the problem is to refine the impression surface of the saddle by using the altered cast impression technique (A Clinical Guide to Removable Partial Dentures, Chapter 19).7

Fig. 19: Non-rigid (stress-breaking) connectors An alternative approach is to create a design with ‘independent rear suspension’ by using a flexible connector, such as this split lingual plate. If the saddle component is able to move more than the toothsupported component, a greater proportion of the load will be transmitted to the tissues of the edentulous area and will be more the

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evenly distributed. This is the principle on which the stress-broken denture is based and it has been suggested that perhaps it has its greatest application in the lower jaw. However, research evidence suggests that this desired result is not reliably achieved in practice. Inevitably, the stress-broken design is a more complex construction and thus more costly. It may also pose greater demands on plaque control and be less well tolerated by the patient. The use of a rigid connector may make it easier to design a simple shape. For these reasons, it is our preference to design distal extension saddle RPDs that incorporate the following: ● A rigid connector ● Control of the load distribution to the various tissues by:

Although this article is primarily concerned with the design and construction of dentures with cast metal frameworks, there are occasions when it is appropriate to provide dentures made entirely in acrylic resin. The main advantages of acrylic dentures are their relatively low cost and the ease with which they can be modified. They are therefore most commonly indicated where the life of the denture is expected to be short or where alterations, such as additions or relines, will be needed. Both these reasons may make the expense of a metal denture difficult to justify. Indications for such treatment include the following: 1 When a denture is required during the phase of rapid bone resorption following tooth loss, for example, an immediate denture replacing anterior teeth. In this case, a reline followed by early replacement of the denture is to be expected. 2 When the remaining teeth have a poor prognosis and their extraction and subsequent addition to the denture is anticipated. A transitional denture may be fitted under such circumstances, so that the few remaining teeth can stabilise the prosthesis for a limited period while the patient develops the neuromuscular skills necessary to successfully control a replacement complete denture. 3 When a diagnostic (or interim) denture is required before a definitive treatment plan can be formulated. Such an appliance may be required, for example, to determine whether the patient can tolerate an increase in occlusal vertical dimension required to allow effective restoration of the dentition.

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prosthetics:connectors 4 When a denture must be provided for a young patient where growth of the jaws and development of the dentition are still proceeding.

Fig. 20

In addition, acrylic dentures may also provide a more permanent solution, for example, where only a few isolated teeth remain, an acrylic connector may function just as effectively as one in metal.

Fig. 20: Acrylic dentures Where an acrylic denture is provided as a long-term prosthesis it is particularly important that its potential for tissue damage is minimised by careful design. This is easier to achieve in the upper jaw where the palate allows extensive mucosal coverage for support and retention without the denture necessarily having to cover the gingival margins. A popular form of design for the replacement of one or two anterior teeth in young people is the ‘spoon’ denture. It reduces gingival margin coverage to a minimum, but a potential hazard is the risk of inhalation or ingestion.

Fig. 21: Acrylic dentures A more stable and therefore more widely applicable design is the modified spoon denture. Here, one has the choice of relying on frictional contact between the connector and the palatal surfaces of some of the posterior teeth, or of adding wrought wire clasps.

Fig. 22: Acrylic dentures Another acceptable design is the ‘Every’ denture that can be used for restoring multiple bounded edentulous areas in the

Fig. 21

maxillary jaw. Its characteristics are as follows: ● All connector borders are at least 3 mm from the gingival margins. ● The ‘open’ design of saddle/tooth junction is employed. ● Point contacts between the artificial teeth and abutment teeth are established to reduce lateral stress to a minimum. ● Posterior wire ‘stops’ are included to prevent distal drift of the posterior teeth with consequent opening of the contact points. These ‘stops’ can also contribute to the retention of the RPD posteriorly. ● Flanges are included to assist the bracing of the denture. ● Lateral stresses are reduced by achieving as much balanced occlusion and articulation as possible, or by relying on guidance from the remaining natural teeth to disclude the denture teeth on excursion.

When considering whether or not to provide an RPD in acrylic resin, the limitations of the material should be borne in mind. This material is weaker and less rigid than the metal alloys and therefore the denture is more likely to flex or fracture during function. To minimise these problems, the acrylic connector has to be relatively bulky. This, in turn, can cause problems with tolerance and offers less scope for a design that allows the gingival margins to be left uncovered. Another significant disadvantage of acrylic resin is that it is radiolucent, so that location of the prosthesis can prove difficult if the denture is swallowed or inhaled. Acrylic RPDs in the mandible often lack tooth support, making tissue damage highly probable. Such RPDs should therefore be avoided whenever possible.

Fig. 22 the

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prosthetics:connectors References 1 Emeritus Professor, University of Birmingham, UK; 2 Professor of Dental Prosthetics, University of Leeds and Consultant in Restorative Dentistry, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 3 Honorary Research Fellow, University of Manchester (Formerly Senior Lecturer in Restorative Dentistry, University of Manchester) and Consultant in Restorative Dentistry, Central Manchester Healthcare Trust, Manchester, UK. 4 Consultant in Restorative Dentistry, Leeds Teaching Hospitals NHS Trust and Senior Clinical Lecturer, University of Leeds and Honorary Visiting Professor, Centre for Dental Services Studies, University of York, York, UK.

5 Professor of Prosthetic Dentistry, Consultant in Prosthetic Dentistry, Faculty of Odontology, University of Malmo, Sweden. 6 Professor of Informatics, Eastman Dental Institute for Oral Health Care Sciences, University College London. * A Clinical Guide to Removable Partial Denture Design The authoritative reference for dental practitioners and students – JC Davenport, RM Basker, JR Heath, JP Ralph, P-O Glantz, and P Hammond.

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Development Outcome C – 60 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 In relation to connectors within the maxillary jaw, the decision on the choice of connectors is based upon: A Rigidity B Function (e.g. support and retention) C Anatomical constraints D All of the above Q2 In relation to a lingual plate, what reason do the authors suggest it should be avoided? A They are not a stable major connector B Can be difficult to place C Could increase the risk of oral health and disease D They are too bulky Q3 What can a continuous clasp connector be referred to sometimes? A Kennedy Bar B Franklin Bar C Kelvin Bar D Extended Bar

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Q6 What are the main anatomical constraints for a connector design in the mandible? A Functional depth of the floor of the mouth B Small distance between the lingual gingival margin C The tongue D Both (a) and (b) Q7 The stress-broken design can be: A A more complex design B Less tolerated by the patient C Pose greater demands on plaque control D All of the above Q8 In relation to the ring connector, the anterior and posterior bars can be positioned in different planes. What shape girder effect is created? A LBVCTDI

Q4 What do the authors highlight are uncertain within the functions and essential qualities of a lingual bar? A Bracing B Tolerance C Rigidity D Indirect retention

Q9 9) What do the authors highlight are absent within the functions and essential qualities of a lingual bar? A Bracing B Tolerance C Indirect retention D Both a (a) and (c)

Q5 Within the ‘Every’ denture design, what is the least recommended space for the connector borders from the gingival margins? A 2 mm B 3 mm C 1 mm D 4 mm

Q10 The authors highlight two disadvantages within full palatal coverage of cobalt chromium (Figure 6) within this article. They are: A Difficult to repair and add material B Potential displacement due to weight and post dam cannot be altered C Patients refuse to wear them because they are heavy D Difficult to add material and hygiene

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makingcrowns

■ Making crowns to retrofit a denture using digital technology by Ashley Byrne

As dental technicians, it’s never a prescription we like: ‘Can you please make new crowns to fit an existing denture?’ That’s often made worse when you realise there are milled ledges and a clasp on the denture.

he conventional method for taking an impression of the denture in situ can be challenging for the clinician and the lab. The alternative is to remove the denture but that has its challenges too. Not only is it very difficult to get the denture to fit on a stone cast, it’s also depriving the patient of a denture that’s required for aesthetics and function. There really isn’t a simple analog solution – but what about digital? Digital scanners have come on in leaps and bounds over the last few years and now most labs have at least one CAD/CAM scanner. Advancements in software from major players like Exocad,

Aim: ■ to consider making crowns to retrofit a denture using digital technology

CPD Outcomes: ■ to be able to recognise that manufacturing via digital systems can use novel approaches ■ to be aware of how the writer has used digital systems to overcome a standard dental laboratory manufacturing problem ■ to be aware of how the example of using a digital design system enables the dental technician to create an appropriate restoration

Development Outcome: C

3D Printed denture around the new crowns 3Shape and Dental Wings have allowed us all to rethink how we use digital technology in our labs. Gone are the days where it’s simply a tool to make copings or bridges for milling. This case study shows the potential for using modern scanners and software to eliminate this problem, ensuring the patient can continue wearing their denture and the laboratory has an easy restoration option.

Stage 1 Prior to any impressions being taken, the patient came to our dental laboratory and provided us with the denture whilst they sat in the waiting room. The denture was scanned from the top and then the bottom on the DOF scanner using ScanApp to generate a perfect .stl (standard tessellation file used to generate 3D objects). This process takes around 10 minutes and then we simply store the file for later use. The denture was returned to the patient.

and 6. The denture butts up to all three teeth as well as having a retentive clasp on 5 and a rest on the 4 and 5 marginal ridge. The clinician took the impressions of the crowns and then an impression of the denture in situ.

Stage 3 At the laboratory the models were poured as normal in die stone and die trimmed on a section model. The dies were then scanned in, as was the model of the denture in situ. The scanner used was a DOF running Exocad. This then gives us a reference point of the dies to both the full arch as well as the denture. The .stl previously made of the denture is then imported and referenced to the working model. This denture can then be used when designing the crowns.

Stage 2 The clinician then prepares the teeth for new crowns. In this case, upper right 4, 5

Setting the denture onto the cast virtually the

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makingcrowns

The crowns ready to be 3D printed in CoCr The prescription asked for metal occlusal surfaces and metal contact with the denture, so we can utilise a full contour set up of the teeth and a digital cut back for the porcelain, as shown in the images.

Using the 3D printed denture clasp to do the ceramic retention

Using simple digital wax knives, we can add in the rest seats perfectly and design the copings to fit around the palate of the metal chrome denture. Once the crowns

are designed around the virtual denture, we can simply export the .stl of the units, and then, using selective laser melting (SLM) technology, the crowns are 3D

printed in CoCr. These units were manufactured at Argen in the UK.

Stage 4 Whilst the crowns are effectively designed and finished, apart from polishing to the denture, the next issue is the design of the hand built ceramic and the retention of the clasp. In this case, we used the .stl of the denture and simply printed a solid version of the denture. This was then fitted down to the model and around the crowns and then the ceramic could be built around the 3D printed clasp.

The new crowns designed around the chrome

Once the ceramics were finished, it was simply a case of checking the denture retention with the 3D printer version, polishing the metal, and returning them to the clinician.

Case conclusion The crowns fitted perfectly around the existing denture despite the fact we have not tried them with the actual denture. The accuracy of the scan, the 3D printed denture and the use of the software has allowed us to perfectly manufacture 3 crowns around an existing denture with ease.

The 3D printed denture the

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The patient was only without their denture for around 15 minutes, ensuring a positive solution for everyone involved. This demonstrates the power of CAD/CAM and modern dental technology improving the results for our patients.

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Development Outcome C – 60 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

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Q1 Making a crown to fit a denture is often complicated, says the author, if there are: A Clasp arms and c) B Undercuts C Milled ledges D Accurate tooth contours and c)

Q6 Scanning to take a standard tessellation (or .stl) file was used to: A Create an analogue model B Generate a 3D object C Make a crown shaped by the digital wax knife D Make the crowns by milled CAD/CAM

Q2 The regular method of using the patient’s denture during the fabrication of an adjacent new crown has a major problem: A Needing the opposing denture for the construction period B Ensuring that the denture is disinfected C Making it difficult to get the denture to fit on a stone cast D Needing to modify the denture to fit the cast

Q7 Which components were the new crowns required to fit? A The plate around the patient’s left 4 and 5 and d) only B Palatal plate around 14 and 15 and c) and d) C Occlusal rests and b) only D Retentive clasp arm on second premolar

Q3 What does the writer consider users of digital scanners might consider? A Restricting the use of scanners for bridge work B How to further use digital technology C Keeping to the original specification for use of CAD/CAM scanners D Use for the copings and a) above Q4 Which two components did the writer bring together to digitally solve the problem? A Scanner and d) only B Software and a) only C Analogue impression D Use of patient’s denture and c) only Q5 Where did the patient wait whilst their denture was digitally scanned? A In the dental laboratory B In the CDT practice foyer C In a dedicated waiting room D They sat next to the scanner

Q8 Which other natural tooth was for restoration and is visible on the figures of the patient’s dentition shown? A Left lower 6th tooth B The 16 C The 26 D The upper left first molar Q9 How were the restoration metal structures basically manufactured? A CAD/CAM digital milling from a CoCr section B Using the normal lost wax casting process C Printing the crown by selective laser melting (SLM) D Outsourcing the manufacture and c) Q10 Building the ceramic facings was carried out against: A The patient’s handed-in actual denture B A standard tessellation file printed denture C The digital .stl file digital representation overlaid using the PC D Building the ceramic material around a 3D PC model

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leadership

■ The mark of outstanding leadership Understanding leadership is the first step to creating extraordinary teams. The second step is to implement some key nonnegotiable beliefs as a leader.

s I write this article, I have just returned from a two-day programme for leaders within an organisation. I was beautifully mesmerised by their passion for extraordinary leadership. However, I have to admit to a wry smile when I asked them what leadership actually meant to them. Silence! Now, you have to understand that all of these people were great leaders in their own right and passionate about making a difference, but their response was no different to hundreds of others who have been faced with the same question. Across organisations, people are taking on greater responsibilities in their roles, managing other people or responsible for increased performance, yet few truly understand what ‘leadership’ means. Even the Oxford English dictionary cannot state the definition clearly without using the world ‘lead’ in its explanation. It describes leadership as, ‘The action of leading a group of people or an organisation.’

Yet if you were to search the term on Google, you would get over 2 billion results back. So, why is that so many struggle to understand what leadership is? Is it perhaps that we have over-complicated something that has been a part of the human psyche from the earliest of caveman days? When it comes to leadership, I have my own definition: If you are responsible for other people or the outcomes of circumstances, you are a leader. The truth is that we all hold some level of responsibility for others at some stage of our lives, personally or professionally, thus we are all leaders. The question that now remains is what kind of leader would you want to be? How would you want those affected by you to remember you? Most would answer that they would want to be respected as being a compassionate and visionary leader that developed others. The best leaders are those that have learnt to be fluid and make it seem a natural gift as they seamlessly move from one leadership style to another, adapting to changing landscapes and circumstances

for maximum impact. However, one thing is clear. Great leaders are driven by strong, empowering belief systems and fully ‘walk their talk’. Some of the beliefs that many great leaders hold are: Helping others to grow is a strength. It is very easy in this competitive world for anyone to feel threatened by the smartest or most dynamic members of their team, thinking that they might make them look weak. However, strong leaders will actively encourage people to work to their strengths. A cornerstone of great leadership is the awareness and commitment to develop others to become leaders. I once heard a phrase some 20 years ago that has stuck with me to this day – The mark of an outstanding leader is not how good a leader you are but how many leaders you develop. Employees are individuals. True diversity is about recognising the individual differences in people, understanding that everyone has their own motivation, strengths or learning styles. To figure out these idiosyncrasies would be something that great leaders would see as a personal challenge. Employees are your peers. I have seen many leaders in my time who have allowed their ego to become a part of the leadership thinking. With this you risk the loss of professionalism and respect. The role of a leader is not to ‘enforce’ rules and conditions but to facilitate growth. Exceptional leaders see employees as peers who have something valuable to contribute to the collective goal. Exceptional bosses actively seek out a diverse range of individuals and ideas. They expose themselves and their companies to new ways of thinking. Work is something to enjoy. We all know that we work best when we are

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healthandsafety enjoying what we are doing and the environment that we do it in. Very often, as a leader, I would drop into various sections within my department on a Friday afternoon to hold a quiz for an hour just to allow staff to feel that they were a part of something quite special. It helped to create the ‘one team’ culture. I focused on looking at people’s strengths and interests and allocated work accordingly wherever possible. Change is healthy. How many times have you heard, ‘This is the way we’ve always done it’? There are plenty of examples of organisations that refused to adapt to a changing marketplace only to fail in spectacular fashion. Great leaders see change as an opportunity for improvement and stay ahead of the curve. More importantly, they ensure they communicate change effectively to their teams and take their people along with them. In conclusion to this short introduction to effective leadership you might want to explore what your particular leadership style is and how adaptable you are to changing circumstance. I would absolutely recommend that you explore the fundamental beliefs that you hold as a person and translate those across into your leadership so you come from an authentic place.

Kul Mahay Kul Mahay is a leadership coach, trainer and lecturer using his 20 years’ experience as a senior police leader to help other leaders overcome the stresses and strains these positions can bring by helping them to develop greater self-awareness and management. www.kulmahay.com

■ Hearing protection and the workplace by Katie Mason & Philip Mason BSA Certificate in Otoscopy & Impression Taking and accredited by the British Society of Audiology.

Did you know there are approximately nine million people in the UK that have a hearing loss? This is approximately 19% of the total population, or 1 in 7 persons.1 Around 900,000 people have severe or profound deafness.2 From 2007–2016 there were 1505 new claims for work-related deafness in GB: 1495 men and 10 women.3

earing loss can be age related, but also the environment in which we work or spend our leisure can have an effect on how we preserve our hearing. Hearing loss can be either sensorineural or conductive. Sensorineural hearing loss is the result of damage to the hair cells inside the inner ear, or damage to the hearing nerve, or both. It changes your ability to hear quiet sounds and reduces the quality of the sound you hear. It is permanent. Conductive hearing loss happens when sound cannot pass from your outer ear to your inner ear, often because of a blockage, such as earwax. This hearing loss can be temporary or permanent.2

Aim: ■ to highlight the importance of hearing protection within the workplace

CPD Outcomes: ■ to be aware of hearing loss and the Control of Noise at Work Regulation ■ to be aware of noise levels within the laboratory ■ to highlight the various forms of hearing protection available

Development Outcome: C the

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Loss of hearing can not only be annoying, it can lead to not being able to follow instructions properly, or missing warning signals, and can be debilitating. Along with associated hearing loss there is also something called tinnitus. This is ‘… the sensation of hearing noises in your ear or head when there is no external cause.’4 Some possible causes of tinnitus are exposure to loud noise, Meniere’s disease, otosclerosis, stress and anxiety, or ear infections. In 2005 the Control of Noise at Work Regulation came into being. It was applied to all industry in April 2006, except the music industry, when it came into force in April 2008. Within this regulation are specific limits that should be noted. Regulation 4 states: ‘lower exposure action value 80 dB daily or weekly personal noise exposure … Upper exposure action value 85 dB daily or weekly personal noise exposure’.3 In Regulation 7 of the same document an employer will make available on request hearing protection where the level is at the lower exposure action value. Where the noise level is at the upper exposure action value, the employer must provide hearing protection.3 The noise level of a quiet office or library is around 40 dB. A vacuum cleaner is between 60–85 dB. A person on a motorbike will typically experience levels of between 95–110 dB. An ambulance siren and a rock concert are typically around 120 dB.5

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healthandsafety into the client’s ear. 5 The material is allowed to set for approximately 10 minutes or until set. 6 The ear plug is then removed, shaped, smoothed and marked to show which is left and right. 7 The ear plug is then varnished ready for fitting.

In the dental laboratory, some typical levels that I have personally recorded are: ● a polishing machine with extraction 75 dB ● grinding an acrylic appliance with extraction turned on 80 dB ● using a model grinder to trim plaster models, 85 dB There are various different types of hearing protection on the market. These range from disposable foam ear plugs, over ear defenders, custom made solid ear plugs and electronic/filtered ear plugs. Here, at Ideal Hearing Protection, we deal with custom made silicone ear plugs. These are made from biocompatible silicone putty that is injected into the ear. They are light-weight, flexible and comfortable. If ear plugs are needed for certain applications i.e. industrial manufacturing or food processing, then a metallic traceable silicone can be used. The steps to making a set of custom made ear plugs are as follows: 1 An initial inspection of the ear canal and surface anatomy is carried out to check for irritations, sores or obstructions. A clear view of the ear drum is required. 2 A brief medical history relating to the client’s ear health is taken, enquiring about adverse discharge, pain and surgery. 3 A foam otostop is inserted into the ear canal, past the second bend, to protect the ear drum. 4 The silicone putty is mixed in equal amounts with a hardener then injected the

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Custom made hearing ear plugs are efficient and durable and routinely reduce noise levels by 20 dB. It is generally recommended that a new set is made every 4–5 years. This is not because they wear out, but down to the fact that as we all grow older, our bodies change. So although the ear plug may appear to fit, it may not have as good a seal as it first had when new, and so will not be as efficient. Protect your hearing, as once damaged it

cannot be replaced, merely maintained with hearing aids. Ideal Hearing Protection www.idealhearingprotection.co.uk

Disclaimer This activity is not within the GDC's Scope of Practice of dental technicians.

References 1 http://www.disability.co.uk/sites/default/files/ resources/UKStatistics%26Facts.pdf (Accessed 15th June 2018) 2 http://www.actiononhearingloss.org.uk/about-us/ media/facts-and-figures ( Accessed 15th June 2018) 3 http://www.hse.gov.uk/statistics/causdis/deafness/ index.htm (Accessed 18th June 2018) 4 https://www.tinnitus.org.uk/Pages/FAQs/Category/ what-is-tinnitus (Accessed 18th June 2018) 5 https://www.hearingaidknow.com/how-loud-is-too-loud -decibel-levels-of-common-sounds (Accessed 14 June 2018)

Development Outcome C – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details. Q1 What percentage of the UK has a hearing loss? A 7% B 17% C 9% D 19%

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Q2 Hearing loss can be sensorineural or … A Conducive B Conductive C Painful D Sensitive Q3 Initial inspection of the ear canal and surface structure is carried out to check for: A Size and shape of ear plug B Irritations, sores and obstructions C Decibel rating D Symmetry of ears Q4 An employer will make available on request hearing protection when the decibel level reaches: A 80 dB B 75 dB C 85 dB D 120 dB Q5 In a dental laboratory, what actions might cause a decibel level at the upper exposure action value? A Polishing machine with extraction B Grinding an acrylic appliance with extraction turned on C Using a model grinder to trim plaster models D None of the above Q6 The author suggests that sensorineural hearing loss is caused when: A Ear canal is too large B Eustachian tubes are blocked C The ear drum is not visible on inspection D Hair cells and/or hearing nerve are damaged

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medicaldevicesregulation

■ Medical Devices Regulations (MDR) – a heads up to 2020 In April the DTA was represented at the European Federation of Dental Lab Owners and Dental Technicians (FEPPD) 2018 Symposium in Brussels. The event was attended by approximately 55 representatives from across Europe and took place in the Residence Palace, International Press Centre. The title for the symposium was, ‘The realities for the dental technician in the EU market – Present and future perspectives’.

he scope was to discuss the impact of the new European regulation concerning dental technicians and their businesses. The keynote lecture of interest to UK dental technicians was titled, ‘The impact of the Medical Device Regulation on dental technicians in Europe – overview of the main changes’. The speaker was Mrs Sarah Jacques of ‘Contrast’,1 a Brussels-based law firm specialising in European and business law, who provides legal advice to FEPPD. Her talk focused on the impact of the new Medical Device Regulation (MDR) on dental technicians in Europe which will still be applicable through our UK Medicines and Healthcare products Regulatory Agency (MHRA). The

Medicines and Healthcare products Regulatory Agency regulates medicines, medical devices and blood components for transfusion in the UK. This article is provided in two parts and summarises the highlights of the FEPPD presentation. In this part we cover the timeline, what changes will affect dental technology, and reflect on some of the technical wording.

Changes to the regulations The European Union (EU) regulatory framework for medical devices consists of the Medical Device Directive (MDD) 93/42/EEC2 and Active Implantable Medical Devices (AIMD) Directive 90/385/EEC. In the interests of simplification, both directives have been combined under the MDR, which has been introduced as a regulation rather than a directive. A regulation was deemed to be the appropriate legal instrument as it imposes clear and detailed rules that are not open to different interpretations by member states. Also the regulation ensures that legal requirements are implemented uniformly, and at the same time, throughout the EU. However, member states remain responsible for the implementation of the regulation in their state. The MDR was adopted on 5 April 2017, came into force on 25 May 2017, and will be applied from 26 May 2020. However, devices that comply with the regulation can be ‘placed on the market’ prior to 26 May 2020. Application of the MDR to dental technology is something that all UK dental laboratories will be involved in. Here we outline three important concepts defined within the MDR:

(i) Medical Device (Article 2(1) MDR) This part of the legislation explains what is defined as a medical device. It states that

Aim: ■ to provide an introduction to MDR

CPD Outcomes: ■ to provide an introduction to the changes from MDD to MDR ■ to provide clarification about basic areas of the changes ■ to identify what a manufacturer is under MDR

Development Outcome: B

‘Any instrument, apparatus, appliance, software, implant, reagent, material or other article intended by the manufacturer to be used, alone or in combination, for human beings for one or more of the following specific medical purposes: – diagnosis, prevention, monitoring, prediction, prognosis, treatment or alleviation of disease, – diagnosis, monitoring, treatment, alleviation of, or compensation for, an injury or disability, – investigation, replacement or modification of the anatomy or of a physiological or pathological process or state, – providing information by means of in vitro examination of specimens derived from the human body, including organ, blood and tissue donations, and which does not achieve its principal intended action by pharmacological, immunological or metabolic means, in or on the human body, but which may be assisted in its function by such means. The following products shall also be deemed to be medical devices: – devices for the control or support of conception – products specifically intended for the cleaning, disinfection or sterilisation of devices as referred to in Article 1(4) and of those referred to in the first paragraph of this point’. the

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medicaldevicesregulation

So within this broad detailed outline dental technician-made custom-made dental devices are clearly included.

(ii) Custom-made devices (Article 2 (3) MDR) This includes any device specifically made in accordance with a written prescription of any person authorised by national law by virtue of that person’s professional qualifications, which gives, under that person’s responsibility, specific design characteristics and is intended for the sole use of a particular patient exclusively to meet their conditions and needs. Therefore the ‘lab ticket’ or ‘docket’ needs to be actually acknowledged correctly as the ‘prescription’ from an authorised person i.e. a qualified dentist. The current statement of conformity normally states that This custom-made appliance if for the exclusive use of ........................................... .................................................(patient’s name). However, mass-produced devices to be adapted to meet the specific requirements of any professional user, and devices that are mass produced by means of industrial manufacturing processes in accordance with the written prescriptions of any authorised person, shall not be considered to be custommade devices.

(iii) Manufacturer (Article 2 (30) MDR) The manufacturer is defined as a natural or legal person who manufactures or fully refurbishes a device or has a device designed, manufactured or fully refurbished, and markets that device under its name or trademark. Therefore, no substantial changes in comparison to Medical Device Directive 93/42/EEC (‘MDD’) and signing off appliances as fit for the market by a registered dental technician are still required. A dental technician is a manufacturer of custom-made devices and there are specific obligations and/or exemptions the

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from general obligations for manufacturers of custom-made devices. The focus is on the obligations imposed on manufacturers of custom-made devices. Devices must be designed and manufactured in conformity with the requirements of MDR and manufacturers must carry out the obligations it imposes. Classification is based on risk, as set out in Annex VIII of the MDR. For dental technicians these are generally Class I

Rule 5; Class IIA Rule 5 and for Crown and Bridgework Rule 8. In part two of this article we will look at the statement of custom-made devices, identification within the supply chain, qualified persons and related aspects.

References: 1 https://www.contrast-law.be/en/practice/ competition-eu-law 2 https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/ ?uri=CELEX:32017R0745&from=EN

CPD Outc

ome

Development Outcome B – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

30 m

inut

Q1 When does/did the change to Medical Device Regulation (MDR) come into force? A 2017 B 2018 C 2019 D 2020 Q2 Which two regulations have been brought together under MDR? A Medicines and Healthcare products Regulatory Agency and d) only B Medical Device Directive (MDD) and c) only C Active Implantable Medical Devices (AIMD) Directive D Medical Device Regulation and c) only Q3 Who generally, under MDR, is the manufacturer of custom-made dental devices? A Someone who has a device designed and d) only B Someone who fully refurbishes a device and a) and c) only C A person or company who markets the device under its name or trademark D A natural or legal person who manufactures and all the above Q4 In the UK, who in a commercial dental laboratory must sign off a completed in-house made appliance as ‘fit for the market’? A Registered student and c) only B Owner of the dental laboratory C GDC registered dental technician D The dentist who prescribed it, and all the above Q5 In MDR the risk categories for dental custom-made dental appliances are: A a) Crown and Bridgework Rule 6, Class I Rule 8; Class IIA Rule 3 B Class I Rule 5, for Crown and Bridgework Rule 8 and for Class IIA Rule 5 C Crown and Bridgework Rule 8, also Class I Rule 3 and Class IIA Rule 2 D Class I Rule 8, Class IIA Rule 5 and for Crown and Bridgework Rule 2

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advertorial

■ Shofu’s EyeSpecial C-II Digital Dental Camera – designed with an eye for the practical Digital dental photography is becoming more important in communication, shade selection, documentation and patient information and motivation. To successfully use photography in everyday practice, dental professionals should have some basic knowledge of photo optics and a camera designed specifically for dental use. Shofu’s EyeSpecial C-II has proved itself in our workplace. Thanks to its preset shooting modes, ease of disinfection, and simple operation even with one hand, we have easily and quickly integrated this camera into our daily workflows – a leap in quality for all involved. Dr Ingo Kessel, BornheimSechtem, Germany

igital dental photography has become indispensable to me in everyday practice. More often I press the shutter as my camera facilitates therapy planning, shade selection, reliable documentation and communication with patients and dental technicians. But this has not always been the case! For a long time, I used a single lens reflex (SLR) camera with all the necessary accessories in my practice. In a two-day course with Wolfgang Weisser, I had

Frontal image of a full arch with a cheek retractor, taken with the EyeSpecial C-II

learned the basics of dental photography. Motivated by this course, I initially used my digital camera, especially in interesting cases when I thought the effort was justified, and prepared everything for the shooting in advance. SLR camera: unsuitable for spontaneous shooting Over time, however, I realised this camera was very difficult to integrate into my everyday clinical environment. Whenever I wanted to take a picture of a particular situation, the flash was not ready, the battery was flat, or my second assistant was unavailable. After a while I began to lose interest in spontaneous shooting and at some point I stopped using my SLR. The only camera I still used sporadically was my intraoral camera, as it was always ready for operation and easy to handle. Any equipment you have to find, fetch, plug in and charge will not become an integral part of your approach in the long term. The effort will simply be too great. About two years ago, I happened across the EyeSpecial C-II. On various internet forums I read that other dental professionals were very happy with this new Shofu dental camera. That caught my interest. And even though a few colleagues have repeatedly criticised the price, my investment in this camera has paid off: I use it frequently – at least four or five times a week. An investment in longer-term success With such a special camera I am able to differentiate my work and photos can help motivate my patients to feel more invested in their dental and oral health. For instance, when a patient who has received aesthetic maxillary crowns and veneers sees an image of the completed restorations, he/she may be inclined to have his/her mandibular teeth restored in the same way.

Frontal image of prepared mandibular teeth before restoration Click – It’s that easy to take good photos So what properties of the EyeSpecial C-II have finally won me over? The most important factor is its ease of use and that its features and options have been designed specifically for dental imaging situations. I don’t use it for atmospheric nature photography. I want to take precise, well-illuminated, high-resolution images in the oral cavity. A digital camera should quickly and easily produce high quality images even in confined situations – and this is what it does! The EyeSpecial C-II is really simple and straightforward: I turn it on, select the desired shooting mode on the LED touchscreen and take a good photo – that’s it! This dental camera is so compact and lightweight that I can easily hold and operate it with one hand. I can use my other hand to hold the cheek retractor or the mirror. I do not need anybody’s help, which is a great advantage, especially when I am pressed for time. I can use it more quickly and effectively than an SLR camera in everyday practice; at the same time, it is so easy to handle that photography can also be delegated to my assistants, after some instruction. To have enough light for good, shadowfree photos in the oral cavity, I need a high quality light source. The FlashMatic system with automatic flash settings ensures controlled illumination and truethe

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advertorial with patients, but to observe the hygiene chain, I have to take off my gloves before taking a photo and then I cannot touch the patient anymore.

For optimal assessment of the tooth shade, the Isolate Shade mode uniformly displays the gingiva in grey

colour images. For additional lighting, I can use my operatory light. Image sharpness is also excellent since this camera has been specially optimised for the focal distances used in dental photography. So, if I am unhappy with sharpness once in a while, then it’s almost always due to the fact that the wrong distance has been chosen, meaning: it’s my mistake … Tried and tested: is easily disinfected Maybe these high-tech SLR cameras produce better digital images but I will only get perfect photos if I do everything right, including: • study the whole matter beforehand • know the proper camera settings • have the right lens (zoom or macro?) and flash (lateral or ring?) • have photo holders and help from trained team members because normally an SLR has to be operated with both hands to avoid shaking Another practical drawback is the fact that an SLR camera is usually hard to disinfect. Of course it will rarely come into contact

The Isolate Shade mode for shade assessment the

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So, when using an SLR, I definitely need more time for my patient and here the EyeSpecial C-II comes in handy again. The body is water and chemical-resistant, so it can easily be disinfected, which means I can photograph even when wearing contaminated gloves; the camera will simply be disinfected afterwards. Our patients are happy with the photo documentation we use for information and consultation on restorations and our dental technicians very much appreciate the high quality of our patient photos – which they don’t receive from every dental practice. Colour reproduction does not have to be 100 per cent perfect here; it may be more important to dental technicians to get an overall impression of a patient and his/her oral situation. Our precise digital images also inform technicians about the structures of adjacent teeth and the patient’s smile line. After all, the tooth shade is not everything!

Shade selection with a reference shade in the posterior region I would recommend asking your Shofu sales representative to explain your dental camera, its functions and eight preset shooting modes before using it for the first time. After some brief instruction, digital dental photography will definitely become an integral part of your everyday practice without more ado.

And here is yet another aspect of communication: sometimes I use my digital photos on the computer to discuss interesting or difficult clinical cases with my wife, who works with me in our joint dental practice. Brilliant digital photos without complicated settings The EyeSpecial C-II is really foolproof. It allows me to quickly take a good or usually brilliant photo of any tooth at any time – without any expert knowledge or complicated settings. My camera does all the complicated technical stuff for me. I just need to properly stage the clinical situation and select the ideal shooting distance. The basic photography course I took a few years ago has helped me a lot in this respect. Now I know, for instance, at what angle and distance to take a picture of maxillary anterior teeth while pulling the lip upwards with the retractor and keeping the mirror dry.

Occlusal image of maxillary teeth, taken with a mirror

First published Die Zahnarzt Woche (DZW), issue 20/2018, dated 16 May 2018. For further details: Please contact the Shofu office 01732 783 580 or sales@shofu.co.uk

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gettingtoknowyou

■ Getting To Know You... quite complex oncology and cleft patients. Or from talking to surgeons with patients, offering ideas or solutions to problems or future treatment plans, to day-to-day paperwork and ensuring the lab runs smoothly and within the necessary guidelines. ■ What do you enjoy most about your job? I enjoy imparting knowledge to the students and knowing that the patients having treatment here, such as the oncology patients, get the best work and treatment we can offer so they can carry on with their life to the fullest.

We are pleased to introduce Martin Stevens, lead technician of the removable prosthodontics laboratory at Guy’s – and Doctor Who fan. He is the star of our second Getting To Know You feature, where we interview a prominent person in the world of dental technology. ■ How long have you been involved in dental technology and how did you start? This is my 30th year and it was just by accident that I started. My karate master was a dental technician and there was a job going at Precision Dental studio for a bottom-of-the-rung lab worker where he was working as a dental technician, and I just applied. I think it was the metal work – a hammer, drill gauge and adjustable spanner – that I had made at school that got me the job. ■ What happens on a typical day? What is typical? I am fortunate enough to run a lab in one of the largest dental hospitals in Europe with around 1,000 students and the directorate deals with 20% of the Trust’s outpatients per year. My day could be nothing more than dealing with under or postgraduates, staff queries or work issues, ranging from just simple appliances and treatment plans, to

■ Where is your favourite holiday destination and why? I must be boring but I don’t have one. I’m not a beach person but like to explore the country I’m in. If I were forced to nail it down to a couple, they would be Germany and Italy. ■ Who would you take on a date into space and why? I would like to take Lauren German from the show Lucifer so I could show her the stars.

■ What do you do when you’re not working? I like being with my three children, walking and doing martial arts. I will be taking one if not two black belts this year if I can fit them in, to add to my others. ■ Who are your three heroes? The Doctor Who actors: Tom Baker, Peter Capaldi and the late Patrick Troughton. ■ What was the last gift you gave someone? A Nerf crossbow gun for my 6-year-old boy. ■ If you were stranded on a desert island, what three things would you want to have and why? As I’m not a beach person, I would take a tardis so that I could leave and explore the universe once the desert island got too boring – and it has been a long time since I did any survival training. Lots of pens and paper, as I used to write and I would like to get back into it. Being on this island, I think I would get the time to start again before shooting off around the universe. My Tesco loyalty card so I could pop out to get the shopping in the tardis and bring back a slow-moving person and barbecue stuff for later on. ■ What are the three things you check about your work or business every day? Apart from saying good morning to my team, I would check what needed to be done and completed for that day. I daily quality check the internal lab work and external tendering work. I also ensure that the cases coming into the lab are correct and entered into the workflow. ■ What makes The Technologist journal essential reading for you? I like the step-by-step ‘how to’ guides and getting up to date with current and relevant issues affecting the industry. the

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