TT October 2017

volume 10 issue 5 october 2017

issn 1757-4625

the

technologist the official journal of the dental technologists association

Marta: proud to be a DTA member In this issue:

oral cancer awareness saves lives hygiene under pressure: stay clean & safe getting under overdentures

4.5

HOURS OF VERIFIED CPD PLUS 1 HOUR OF UNVERIFIED CPD IN THIS ISSUE!

october 2017 1

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technologist in this issue Editor: Vikki Harper t: 01949 851 723 m: 07932 402 561 e: vikki@goodasmyword.com Advertising: Sue Adams t: 01452 886 366 e: sueadams@dta-uk.org

DTA administration: Sue Adams Chief Executive F13a Kestrel Court Waterwells Drive Waterwells Business Park Gloucester GL2 2AQ t: 01452 886 366 e: sueadams@dta-uk.org DTA Council: James Green President Delroy Reeves Deputy President Tony Griffin Treasurer John Stacey Gerrard Starnes Marta Wisniewska Social media coordinator

Editorial panel: James Green Tony Griffin

news

02

hr facts: learning from the best

05

CPD

the NLP approach to good customer service

06

CPD

want to make a real difference? join the DTA council!

08

oral cancer: the self-help check

10

CPD

disinfection & decontamination: 12 hygiene under pressure

CPD

praxis: the overdenture concept

CPD

classified advertising

15 19

the digital dental world: part five

20

CPD

continuing professional development

22

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

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

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

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: www.dta-uk.org the

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

Cost effective professional indemnity insurance for dental technicians and laboratories

Tel: 01634 662 916

2 october 2017

news&information

■ THE CROWN THAT RULES THEM ALL For a strong and aesthetic restoration that you can trust, discover the high translucency, multilayered, full-contour zirconia (FCZ) implant crown from Nobel Biocare.

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monolithic material, it significantly reduces the risk of porcelain chipping. The full-contour properties also deliver outstanding aesthetics, for natural-looking restorations your dentists and their patients will be delighted with.

About the FCZ, lab owner Daniel Rosa commented: ‘One of the first things that struck me was the accuracy offered by the NobelProcera production, right down to the occlusal detail.

‘The only word that comes to mind is “exact”’. Basically, whatever we design is then exactly transferred digitally by our NobelProcera 2G Scanner and exactly reproduced back into the physical world in zirconia via the NobelProcera milling centres.

‘I know some technicians have concerns about the aesthetics of full-contour products like this, but I’d suggest they reserve judgment with this one until they’ve tried it.

‘With creative staining techniques, the NobelProcera FCZ Implant Crown can be made to look good in most situations.’

Nobel Biocare is delighted to have extended the FCZ range of solutions to now include implant bridges. Find out more today.

At Nobel Biocare, we want to know how you go about choosing training courses and what topics are of interest to you right now.

■ As such, we would be delighted if you could complete our short and anonymous survey at www.research.net/r/3HWT2GN It will take less than five minutes of your time and will ask you about your preferred course formats, your favourite speakers and lecturers, when and where you’re willing to attend courses and what you would like to learn more about.

■ For more information about Nobel Biocare, please call 0208 756 3300, or visit www.nobelbiocare.com

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october 2017 3

news&information

■ THE EVENT WITH ‘WOW’ FACTOR Nobel Biocare is delighted to announce an outstanding programme for the London Symposium this November.

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resenting a real ‘wow’ factor, the speaker line-up alone demonstrates the high calibre of the event, with confirmed speakers including: ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■

Tomas Albrektsson, Sweden Markus Blazt, USA Ruben Davoo, Spain Andrew Dawood, UK Richard Elliot, UK Wail Girgis, UK Stefan Holst, Switzerland Robin Horton, UK Jennifer Huntley, UK Pascal Kunz, Switzerland Ian Lane, UK Ashley Latter, UK Kevin Lockhead, UK Scott MacLean, USA Paulo Malo, Portugal Guy McLellan, UK Jose Navarro, UK and Spain Paul O’Reilly, Ireland Isabella Rocchietta, UK Riz Syed, UK Susan Tanner, UK

Delegates will have a choice of lectures, smaller break-out sessions, hands-on

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workshops and business forums designed to facilitate discussion and collaboration.

There will also be the chance to discover some of the very latest innovations available from Nobel Biocare, to find out how they work and see how they could benefit patient care. The inclusive programme even ensures something for the entire dental team, with the Friday night social event promising to be full of fun and networking opportunities as well.

■ Make sure you don’t miss the Nobel Biocare London Symposium 2017 on 10th and 11th November in London.

For more information, please visit nobelbiocare.com/london

4 october 2017

news&information

■ NEW CHARITY AIMS TO RESTORE LIVES ONE SMILE AT A TIME

Two dental technicians have launched a new charity to help restore the smiles of those most in need in the UK and abroad.

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en-Tech is the brainchild of Andrea Johnson and Andrew Sinclair who, after visiting Uganda with a dental charity, realised there was a great need for quality dental technology services for those living in developing countries. They also decided to extend this provision to helping homeless people on our shores.

The charity hopes to relieve poverty by providing affordable dental appliances to patients most in need, as well as training, mentoring and education for resident dental technicians in developing countries.

Andrea and Andrew said: ‘There are many charities that provide the incredibly valuable service of “dental pain clinics” but no real provision for the restoration of the dentition thereafter. This can leave patients with large gaps where teeth have been extracted, meaning they can quite often struggle to eat and chew their food well, to speak properly and to look and feel normal.’

The Den-Tech board of trustees Andrea Johnson, Andrew Sinclair, Delroy Reeves, Edward Mapley, Jade Oakes Stott and Robert Williams

They felt passionately that this should not continue and hope to provide not only a little help now but a legacy of support and training that could be a leg up to indigenous people and not just a temporary hand out.

Alongside its flagship supporter Blueprint Dental, which has donated an incredible amount of dental materials and equipment on behalf of its customers, the charity has also been boosted by the dental technician community, who are pulling together to provide a full range of services free to those most vulnerable in our society.

‘It is also only through the generosity of companies such as Blueprint Dental, DB Orthodontics, John Winter, Schottlander and WHW and of course the brilliant community of dental technicians around the country that can make this charity a success, so from the bottom of our hearts we thank you and look forward to us all achieving great things together in the months and years to come,’ they added.

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The charity is now looking for additional volunteers from the technician sector as well as any clinicians who would like to donate their time and skills to this really worthwhile cause, especially for the UK projects.

■ To find out more or get in touch, please email dentech.chair@gmail .com or visit www.den-tech.org, https://www.facebook.com/ Dentech1/# or https://twitter.com/ DenTech_charity

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hrfacts

■ Learning from the best Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to be aware of the link between employee training and development and employee performance ■ CPD outcomes: – to understand how successful companies approach employee development and how it links to the overall strategy of the business – to be aware of the links between approaches to staff development and positive performance outcomes

1. Clarity of purpose

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ne of the most striking characteristics of the most successful companies is the link that they make between individual learning and development activity and the overall business plan. They see learning and development as a true investment and ensure that activity is relevant and aligned to what the business needs to achieve. They also provide a shared vision and an open dialogue on how people are valued and what they need to do to adapt to deliver what is needed.

2. New experiences Does investing in learning and development have a positive impact on the profitability of your business?

Richard Mander looks at a new Chartered Institute of Personnel and Development (CIPD) survey and highlights the common ingredients found in the most successful companies that would suggest there is a strong correlation.

People learn by trying new things in a safe environment where initial mistakes are tolerated. Seventy-four per cent of the top 10% of companies surveyed understand this and actively encourage staff to take on new work experiences as an opportunity to learn. Typically the best will seek to become a trusted brand that keeps its promises and develops innovative, commercial and continuous learning opportunities.

relationships resulting in energy, resilience and growth.

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5. Support and challenge The most successful companies have also identified a key role for their managers in supporting training. Individuals are not left to their own devices but receive coaching and support from their line manager to underpin their learning and development experiences. This ensures that the investment is more likely to pay off as people often struggle to incorporate new skills into the workplace or lose focus part way through a training initiative.

6. Intelligent decision-making Finally, the 2017 survey found that the best companies use data and performance analytics to drive organisational performance and the customer experience. Typically they have identified key performance indicators for each role and measure and provide feedback on these on a regular basis.

3. Knowledge sharing

Richard Mander Richard Mander is a freelance HR consultant with over 25 years’ experience in Strategic and Operational HR with companies including the Granada Group and Ecclesiastical Insurance. He specialises in providing support to smallto medium-sized companies who do not have their own in-house resource 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.

The best organisations have also embraced technology and provide their staff with agile infrastructures to enable them to share knowledge quickly and effectively. This can be achieved through a simple intranet or the latest productivity software packages that allow for collaborative working. They often incentivise new ideas and initiatives to encourage staff to be more creative.

4. Continual engagement The top performing companies surveyed invest significant time in employee communications compared with the average. They see employee engagement as the key to increased productivity and report that well-informed staff will go the extra mile to complete tasks and have a greater focus on quality. They also seek to develop a dynamic workforce that continually builds on business

Additional information: Sample learning and development documents and forms can be found in the membership area of the DTA website.

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6 october 2017

customerservice

■ The NLP approach to good customer Introduction As a master practitioner of neurolinguistic programming (NLP), I am often asked for advice on how to better deal with customers and clients. NLP was developed in the 1970s by Richard Bandler and John Grinder and is effectively the study of excellence. NLP explains how our minds work and how we can use this information to make changes to our behaviours.

Model excellence

Building up great relationships with clients and dealing with their demands and complaints is a crucial part of growing a successful business. Utilising NLP can really help you to improve your customer service and allow you to stand out from the crowd.

Behaviour is very strongly influenced by the beliefs and attitudes we have and NLPbased modelling can highlight how highly performing companies think and act.

Anything learnt could then be incorporated into the way you train yourself and staff in dealing with customers.

Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to reintroduce the concept of NLP and how it might apply to the pursuit of customer service excellence ■ CPD outcomes: – to be aware of what NLP is and how it works – to understand how to apply some principles of NLP in building better relationships, especially with suppliers and customers

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odelling excellence is one of the major contributions that NLP brings to the business world. For you and your business to model excellence, you need to look at and contrast high performing companies with more mediocre ones. Compare and contrast them across a range of areas, including environmental factors, and how they think about their own business, customers and products or services.

With this in mind it is important that you look at your competitors and other companies and businesses that deliver great customer service and note what they do and try to incorporate elements of what they do into your own business.

Think about what has characterised your successful experiences with suppliers or customers, or a positive experience you had as a consumer: What was good about the experience? How did you or the person you communicated with make you feel listened to and understood?

Set goals for outcomes NLP encourages people and businesses to set goals to assist in monitoring and

motivation. These goals can be short term (next month), medium term (six to twelve months) and long term (three, five years and beyond). There are many ways to set goals and one of the popular ones is using the acronym SMART. S M A R T

= = = = =

Specific Measurable Achievable Realistic Time Factor

Every goal you set should be in line with the above five guidelines. In the case of customer service, you could utilise goal setting when recording customer complaints or customer retention. For example, you could set a goal such as, ‘By 31 December 2017 our goal is to reduce customer complaints by 10%’.

This goal is specific and measurable; it is hopefully achievable and realistic, and there is a time factor included. It is then very important that come the 31 December, you review performance to see if you met the goal and if not, why not, and how you can improve things going forward.

Really know your customer!

The way we communicate and the sensory preferences we possess can be a key factor in developing great customer relationships. Communication problems are often just two people speaking with mismatched representational systems.

What are representational systems? These

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How? Simply wear a DTA badge and enter our competition for your chance to win Want to know more?

october 2017 7

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are the methods we use to make sense of the world around us. The three main representational systems are: ■ visual ■ auditory ■ kinaesthetic Put simply, visual people see the world, auditories hear the world and kinaesthetics feel it. Understanding what your main sensory preference is, and that of your customer, is vital. We use all three systems but will generally have one which is our preference.

Building rapport If you can quickly identify a customer’s preference, it allows you to build rapport by utilising their preferred type. You will need to look for clues that can be picked up in the types of words they use most frequently. For example, if someone is using phrases such as ‘I see what you mean’, or ‘I like the look of this’, then that would be a strong indicator that this person had a preferred visual style of communication.

Once you spot this, then you would start to ensure that your responses, be they written or verbal, would be made in the same style. Phrases such as ‘That sounds good to me’, or ‘I hear what you are saying’, would be strong indicators that your customer has a preferred auditory sensory system.

If your customer is more kinaesthetic, then they might use phrases such as ‘That feels right to me’, or ‘I would like to get a firm grasp on this problem’.

Getting trained in active listening and spotting these key words and phrases not only helps you build good customer relations but is also crucial in dealing with angry or disgruntled customers. Building rapport quickly by matching their sensory preference and also trying to match their mood and body language can help to quickly bring an angry customer back down.

When dealing with customer complaints, it is good to be aware of three areas where you can manage your own state. The tone of your voice, the speed at which you speak, and the way you articulate your words, communicates many things about you: whether you are happy to be answering the phone, what your state of mind is, whether you have any emotion

behind your voice, and whether you goo are confident dc servustom and ice er knowledgeable about the business that you are discussing.

In addition you need to learn how to disassociate yourself from your own personal problems and to learn how to protect yourself from the irate caller by using a technique called ‘perceptual positions’. Here you learn how to step into the customer’s shoes in order to find the positive intention of the caller. Then you step into the observer position so that you can disassociate from any negative emotion of the customer, whether angry or frightened, so you can remain objective and handle the situation appropriately to change their state into a resourceful one.

Building and maintaining good customer relationships is crucial to the success of your business. By incorporating some of these NLP techniques into your training, you could quickly have a positive impact on your success.

About Peter Blake Peter Blake 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 the

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Read the enclosed flyer or visit www.dta-uk.org Look out for the gold envelope!

8 october 2017

DTAcouncil

■ Want to make a real difference?

Join the DTA Council!

Marta Wisniewska joined the DTA Council just over a year ago with a mission to boost member numbers and raise the profile of the association. This year she’s upped her game and now wants to encourage more members to join her on the Council.

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he experienced dental technician, who works at Tyler Crown and Bridge in Gloucestershire, has done a great job this year and she firmly believes that the more members we have, the stronger our word will be in the profession and the bigger difference we will be able to make.

‘Firstly, I would like to say thank you to our Council team,’ said Marta. ‘This year has been very intense but I managed to achieve my goals as a DTA Council member.

‘My main aim was to raise member numbers and spread the word about the DTA. At this year’s Birmingham dental show, I met dental technicians face to face, which is really important to us.

‘We don’t treat our members as just file numbers; we like to get to know them better. I spoke about the DTA and encouraged them to join us – which they

did. It’s a privilege to be a DTA member and we are all proud to be with DTA.’ The DTA’s vision is to advance standards within dental technology for the benefit of the oral healthcare of the nation by providing advice guidance and support to members, as well as raising awareness and promoting an exchange of views on key issues affecting the dental profession. We are committed to keeping members in touch with what is going on in dental technology, as well as in the wider dental arena.

Key objectives ■ Develop and support members and the dental technology profession ■ Encourage and promote education, including CPD ■ Forge links with other organisations ■ Promote views to relevant external organisations ■ Adopt and share best practice ■ Provide benefits and employment opportunities ■ Develop and maintain roles and responsibilities The DTA keeps in touch with government departments and other influential bodies within dentistry. It is managed by dental technicians and policies are decided by elected Council members, who are mainly practising dental technicians. The Council is supported by a chief executive (Sue Adams) who is based at the DTA head office in Gloucester.

‘Being on the DTA Council absorbs as much time as you want to spend,’ explained Marta.

‘Some people are able to offer more than others and nobody is forced to do anything. We are a group of friends who want to support DTs and CDTs. Of course we need new blood on the Council!

There is no list of skills that we are looking for, just enthusiasm.

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‘As new blood on the DTA Council, I’m full of energy and new ideas which I successfully carry out. Many of the decisions and projects we are working on are confidential, but I can say that we are progressing. One of my ideas will feature in the next DTA magazine; it’s a campaign called “I’m proud to be a DTA member”.

‘This CPD journal, TT, produces very good quality articles to help our members learn something new, solve problems and gain knowledge about what is happening in our industry. We also support our members with a helpline.’

Marta has also introduced DTA members to speakers and encouraged them to write articles for this magazine. This will help members learn about new technology and techniques.

‘Being a DTA Council member gives me the opportunity to meet fantastic new people and have an influence on the association. My wish is that all dental and clinical technicians support each other and our DTA is proudly doing that.’

■ Do you have enthusiasm for your profession? Please contact 01452 886 366 to learn more about joining the DTA Council.

10 october 2017

oralcancerchecklist

■ The self-help check Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aims: – to raise awareness of the need for early cancer detection – to understand fundamentals of a self-help check ■ CPD outcomes: – to understand a recognised method of selfassessment for oral cancer – to enhance an individual’s skill to undertake a self-assessment on themselves

By Delroy Reeves

Raising awareness is a good thing, especially if it’s about our own health.

Having attended a funeral recently, I was talking to the man’s family and all of them said the same few words: ‘He would still be here if he had gone to the doctor much earlier’.

But we don’t: life is too busy, we hope the lump will just go away, or because it’s not hurting we leave it alone only to find several months later that it’s going to be too late!

Throughout November the Oral Health Foundation is holding its annual ‘Mouth Cancer Action Month’. Members of the dental community are encouraged to spread the word about oral cancer: its key causes and how early detection can save lives. For instance, if during an oral examination a suspicious lesion is found early and referred on to a specialist clinic, then the individual concerned has a 90% chance of survival.1

Survival rates ■ Although the number of mouth cancer cases has increased steadily over the last decade, more people are being treated successfully and living for longer.

■ Early detection for mouth cancer results in a survival outcome of 90%; however, delayed diagnosis means survival rates plummet to as little as 50%.

Being aware Here are some further facts about mouth cancer:

Author – Delroy Reeves

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■ In 2011 there were 6,767 people diagnosed with mouth cancer in the UK. That’s 18 people every day – one person diagnosed every 77 minutes.

■ Mouth cancer cases have increased by a third in the last decade … and it is one of the few cancers that experts predict will continue to increase in the coming years.

■ Mouth cancer is ranked the 16th most common cancer in the UK. ■ The lifetime risk of developing mouth cancer is 1 in 84 for men and 1 in 160 for women.

■ Cancers of the tongue and oral cavity are the most common forms of mouth cancer, followed then by the throat.

Lip, neck and other mouth cancers make up the rest of the cases.

A silent killer ■ More than 2,000 people lose their life to mouth cancer in the UK every year.

■ There are more deaths from mouth cancer than there are through road traffic accidents.

Being aware of what to look for in patients is the responsibility of the clinical team but self-awareness and diagnosis is something we can all be responsible for.

If there is a lump, or a sore patch, or something that just does not feel right in your own mouth, what do you do? If we want to pursue a more health-conscious existence, such as quitting smoking, reducing our alcohol intake, or consuming five portions of fruit or vegetables a day, how does that reduce the threat of mouth cancer? Being aware of the risks and knowing what to do if you are in doubt are vital to our long-term wellbeing.

The guidance provided by the Oral Health Foundation website lists six simple steps to carry out our own personal examination. We are dental professionals but when was the last time you took a good look inside your own mouth!

Here’s a brief guide for undertaking a self-assessment: 1. HEAD and NECK: Look at your face and neck. Do both sides look the same? Look for any lumps or bumps

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oralcancerchecklist

that are only on one side of the face.

2. NECK: Feel and press along the sides and front of your neck. Can you feel any tenderness or lumps?

3. LIPS: Pull down your lower lip and look inside for any sores or changes in colour. Next, use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on the upper lip.

4. CHEEK: Looking in a mirror, use your finger to pull your cheek so that you can see inside. Look for red, white or dark patches. Put your index finger inside your cheeks and your thumb on the outside. Gently squeeze and roll the cheek to check for any lumps, tenderness or ulcers.

5. THE MOUTH: Run your finger on the roof of your mouth to feel for any lumps. Repeat this on the floor of your mouth.

6. TONGUE: Stick out your tongue and look at the surface for any changes in colour or texture. Look at one side first and then the other side, for any swelling, changes in colour, or ulcers.

Examine the underside of the tongue.

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Fig. 12

When visiting clients I have noted the sort of chart they use to record the position and shape of suspicious lesions. Fig. 12 is an example of one part of a simple oral screening chart. So if a suspicious lesion is noted, its location can be recorded and the information used in a referral letter.

On the diagram, some of the main features are: 1) Buccal mucosa, 2) Hard palate, 3) Tongue, 4) Labial mucosa, 5) Labial vestibule, 6) Soft palate, 7) Posterior pillar.

I am told that the picture in Fig. 2 is actually normal. So do your own selfcheck and look after yourself.

Fig. 2: Example of a healthy tongue3

1 Oral Health Foundation website http://www.mouthcancer.org/are-you-mouthaware/ [Accessed 15 August 2017].

2 Diagram drawn by AD Griffin and copyright owned. July 2017.

3 Copyright owned by AD Griffin and patient clearance given July 2017.

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12 october 2017

disinfection&decontamination

■ Hygiene under pressure T Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills

■ Educational aim: – to be aware of the risks posed to you, colleagues and patients by a lack of awareness and rigour towards infection control in your dental laboratory

■ CPD outcomes: – to get a better understanding of the risks and where they originate – to propose the important aspects of a dental laboratory clean policy

Leading dental bodies, including the BDA, state that the responsibility for disinfection of impressions lies with the clinician1 and should be undertaken as soon as practicable after the impression has been taken.

However, because many dental laboratories lack confidence that their dental practice clients have undertaken comprehensive decontamination protocols, research indicates that many laboratories undertake their own decontamination: think what that does to impression accuracy! Most impressions are disinfected twice.

By Prof. RJ Williams, BA (Hons), PhD, DDSc, FHEA, Dental Technology Unit, Cardiff Metropolitan University

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here is much industry advice regarding decontamination best practice but remarkably little on ensuring that items leaving the dental laboratory are safe. In my subjective view, a quick rinse is all they get. If little has been written about disinfecting dental items leaving the laboratory, it is probably even more so the case that in practice, disinfecting finished articles – wax rims, tryins, etc. – before they are dispatched from the dental laboratory, is rarely carried out.

This is quite remarkable when one considers that items such as dentures are often fitted to the elderly and other members of the public who are not well placed to fight infection. Then consider that pumice troughs and pressure vessels have been shown to be excellent sites for microbial growth. A recent study suggested that ‘Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff perform hygiene practices according to recommended guidelines’.2 In fact a study carried out found that ‘The implications for cross infection between clinician, patient and dental technician are apparent and conclude that the levels of contamination in dental laboratories remain high’.3 The same authors point out that regular cleaning and disinfection within the dental laboratory is of paramount importance.

on pressure vessels which could potentially be a source of contamination. There are clear pathways to the vessel from patients, pumice troughs and operators.

Water in a pressure vessel should not rise above 60° Centigrade and rarely reaches this temperature. Warm temperatures are reached for a short time and after use usually decrease to room temperature. These fluctuations offer microbes a good environment for proliferation. It’s not just dental items that are at risk from contamination; there is also exposure to operators.

Despite the hazard Verran et al3 concluded that the dental technologist is not exposed to significant danger.

However a different recommendation to Verran et al, Kohn et al4 recommend that pressure vessels and water baths are particularly susceptible to contamination by microbes and should be cleaned and disinfected even between patients. So there are conflicting recommendations.

It is to the great credit of several students I worked with at Cardiff Metropolitan University who considered such issues and who undertook a study on water in pressure vessels that I would like to highlight.

Ms Mulvey’s research sought to confirm that there was a potential problem with pressure vessels and to identify the microbes typically present. Thirteen water samples were taken from the baths of thirteen different dental laboratories.

Microbe growth from each sample was carried out using agar in petri dishes incubated at 37° Celsius for 24 hours. A colony counter was used and once the count was completed and recorded, further tests such as Gram stain, catalase, oxidase and BBL Crystal ID tests followed to identify the microbes found.

The student responsible was Ms Mulvey who graduated in 2010. She outlined simple procedures that could significantly reduce cross infection from items that have been immersed in a pressure vessel. Many studies have concentrated on identifying microbes in pumice troughs and other equipment, but hardly any have focused

The result was that all pressure vessels, apart from one where the water was changed with every use, had a relatively high level of contamination. This was clearly due to the stagnation of water over a period of time (in this study, generally seven days), which facilitated the formation of biofilms. This in turn

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disinfection&decontamination was a direct cause of the noticeable cloudiness of the water and the distinct smell produced in some of the vessels.

Most of the microbes were gramnegative rods, a group involved in various systemic and periodontal diseases and known to contribute to malodour production. Some of the microbes could even cause infections such as pneumonia, septicaemia, endocarditis and eye infections in

immunocompromised patients. To quote Ms Mulvey regarding her own work, ‘This study clearly demonstrates the potential risks which can occur if the “right” conditions are created’.

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So what exactly should your dental laboratory clean policy be?

One of the valuable aspects of this research was that someone with a good understanding of dental technology

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disinfection&decontamination procedures undertook it and made the following recommendations: ■ Education of dental laboratory staff ■ Pressure pots should be emptied daily, rinsed in tap water and left overnight turned upside down to dry (Microbes don’t proliferate on a dry surface.)

■ More complex units of pressure vessels that require draining should have water changed at least twice a

week. If this is not practical, appropriate disinfectant should be used (although knowledge of the required chemical make-up of a disinfectant is beyond the scope of this study) ■ Regular use of gloves by staff handling repairs ■ Regular washing of hands. Although exposure to soaps and water too frequently may result in hand dermatitis,

hand hygiene is of crucial importance in reducing the microbial growth To conclude, it is easy to carry on as one has always done, but perhaps if an improved clean handling policy only resulted in us having fewer coughs and colds, or lesions healing more quickly, this would be motivation enough.

However, potentially it could prevent far more than this.

References 1 Almortadi N & Chadwick RG, Commentary on disinfection of dental impressions – compliance to accepted standards, British Dental Journal, 2009, Published online: 17 December 2010.

2 Mutters NT, Hägele et al, Compliance with infection control practices in a university hospital dental clinic, Infect Control, 2014 Sept 30;9(3).

3 Verran J, Laverack S, Taylor RL, A study of the microbial contamination of dental prostheses leaving a dental laboratory within a dental hospital, Quintessence Journal of Dental Technology, 2008, 4:274–282.

4 Kohn WG, Collins AS, Harte JA, Cleveland JL, Eklund KJ, Malvitz DM 2003, Guidelines for Infection Control in Dental Health-Care Settings, National Center for Chronic Disease Prevention and Health Promotion, Great Lakes, Illinois, The Forsyth Institute Boston, Massachusetts.

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overdentures

PRAXIS

■ The overdenture concept T Even a single retained sound root in a patient’s mouth can be used to provide good retention (vertical resistance) to a complete denture by using a single magnet or precision attachment retained within a complete denture.

An endodontic specialist has said, ‘… I would conclude that without very good reason, natural teeth should always be saved wherever possible. With good quality root canal treatment they are likely to be effective and healthy teeth in the medium to long term, and avoid the consequential trauma of tooth extraction and implant placement …’1

By AD Griffin, MBE

Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aims: – to raise awareness of the overdenture concept – to understand fundamental aspects related to construction ■ CPD outcomes: – to understand the major aspects related to overdenture construction – to enhance the individual’s ability to offer these appliances

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here is documented clinical evidence that indicates that mechanical and magnetic attachments do not disturb the surrounding gingiva or periodontium, but is dependent on the technical work being correctly carried out. The opportunity to save teeth where feasible, rather than extracting and replacing them with dental implants, is said to be an accepted principle among many clinicians. This is based on such evidence as, ‘It is well documented that properly treated natural teeth with healthy but markedly reduced periodontal support, are capable of carrying extensive fixed prosthesis for a very long time, with survival rates of about 90%, provided the periodontal disease is eradicated and prevented from re-occurring.’3

The use of one or two remaining natural teeth roots to assist in the retention of a complete upper or lower denture is a technique that has been used consistently for more than four decades. What is evidently essential is to ensure that the remaining roots are not over engaged or stressed by the provision of an overdenture and that the shape of the root-covering diaphragm protects the adjacent tissues. The design and fabrication of the diaphragm should assist in maintaining the periodontal tissues that support the root within the alveolar and basal bone. The diaphragm should be extremely smooth and approximately 1.5–2 mm above the gingiva and curved to prevent overgrowth of the adjacent soft mucosa. The area for soldering the retention device should be approximately 3 mm in diameter, being a flat area that is facing the perpendicular displacing force, with a very slight inclination to the

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lingual or palatal aspect. Too much inclination, it has been suggested, may begin to start an orthodontic effect on the retainer root.

There is a limit to what we can expect a single root to provide in respect of retention against vertical displacing forces.

Therefore to suggest the use of a single precision attachment that will never let go until it has nearly extracted the root is not an ideal solution for a simple one or two root supported overdenture. This is where the dental technologist can directly support the clinical team by proposing an alternative precision attachment, such as a product that utilises enhanced frictional fit or small magnets to provide some limited retention. Dental magnets are classified as 1) duo open field system, 2) open field mono system, 3) closed field mono system.4 The open field aluminium-nickelcobalt magnets have been available for many years but they suffer from potential corrosion. Developments have provided magnets made from precious alloys susceptible to magnetism (EFM alloy)5, whilst others are made from rare earth elements such as neodymium-iron-boron (NeFeB) magnetic attachments, or ‘samarium and neodymium which are said to provide a stronger magnetic force’.6 The manufacturers of these magnets utilise various techniques to prevent corrosion, such as providing each magnet within e.g. a laser-welded case. As those dental team members inherently linked to the technology, we share responsibility for delivering the best solution for the patient and therefore being able to recommend alternatives to the clinicians is essential to our role and opens up valuable sales markets. There the

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Fig. 1: Example of a magnetic attachment Zest Locator (image courtesy of Dental News).9 A) Diameter of the locator B) Depth of the locator magnetic retention C) Abutment section

are different working systems for each retentive product and therefore reference to the manufacturer’s guidance is essential e.g. S-A self-adjusting magnetic attachment from Schottlander.7 An alternative friction-based system that is well established is a simple ball (precision attachment) mounted on a post and diaphragm. For over 40 years the Dalbo Ball attachment, designed by Dr Hans

Dalla Bona10, has been used successfully to provide extra retention for complete overdenture cases. In Figure 2 the male ball (patrix) part is placed on the root diaphragm, whilst the flexible outer female (matrix) covering is retained in the removable denture.

A fundamental issue when using attachments for overdentures is for the dental technician to make provision for

Fig. 2: Classic Dalbo® attachment (courtesy of Cendres+Métaux)11

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the compression of the mucous membrane tissues that cover the alveolar bone remnants of the ridge areas.

Complete dentures under vertical loading compress these soft tissues that normally spring back as the load is reduced or removed. The ability of a substance or object to spring back into shape is termed resilience.12 Whilst the compression and resilience of the soft tissues may occur, the area of hard plastic opposing the diaphragm over a retained root will not compress. Occlusal vertical force directed on single teeth, if not correctly allowed for, will cause overloading, as excessive occlusal vertical forces pressing directly onto the few remaining roots are likely to cause periodontal damage. Taking note of this feature, some manufacturers may provide two spacers to be used between the precision attachment (be this magnetic or a friction type) and also for the root-covering diaphragm.

There also needs to be clear relief for the retained root’s gingival areas so that no pressure builds up on this area. Localised disease can occur causing the potential loss of this last retained root with dramatic failure of the available retention.

The complete denture must be in contact with soft tissue (tissue borne) at all times rather than resting on remaining tooth root/s or the hard surfaces’ diaphragm areas covering them e.g. Figure 3 for a Ceka Anchor which was based on the developments of Karl Cluytens. The relevant technical procedures to alleviate the resilience problems with simple overdenture stud/ball/magnetic retention devices are well documented in the individual technical support guides for the particular attachment. As an example, the guide for the ‘Swiss Dalbo® – System’ can be found at www.cmsa.ch/en/ Dental.13 Correct placement of the female component in the denture base is also essential. There are currently two generally applied methods in use that ensure the correct placement to provide

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Tin foil diaphragm spacer

Fig. 3: Example of spacers used with a Ceka Anchor spring clip retainer14

Attachment spacer

and some of these are listed in the table overleaf.

safe and precise working of the components (although reference to the specific attachment guidance should be followed).

1) Attach the matrix component to the processing model and cover any exposed horizontal diaphragm (or other related surface) with a tin foil spacer of approximately 0.5 mm thickness. Then process the denture base with this spacer in place, then during denture finishing remove the tin foil. This provides a high quality finish on the denture fit surface for relief space.

2) Some clinicians prefer to seat the denture in place and then, by a lingual/palatal window, add autopolymerising (cold cure) denture resin around the female part of the attachment via a lingual window cut into the completed denture. The patient is then allowed to lightly close and hold that position until the material has polymerised.

The clinician then makes further additions and adjustments and adds any extra infill as required using further autopolymerising resin. Both of these methods have benefits and drawbacks

Since the mid-1980s, titanium nitride (TiN) and nitrogen ion implanted micro surface coatings previously used in industry were adopted into dentistry.

Implant dentistry, orthodontics, endodontics, prosthodontics, and periodontics use these surface coatings on the associated dental materials. The use of modified variations of these coatings within the precision attachment area are used to provide increased surface hardness, abrasion/wear resistance, and corrosion resistance, lower friction, and for reducing biological build up.

There are versions of overdenture stud retainer friction attachment systems for use with implants, such as LOCATOR R-Tx (ZEST Anchors).16 There are designs said to offer benefits such as dual retention, increased resilience to accommodate significant angulation, low profile heights, low hygiene maintenance, and as in the the

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overdentures Table 1: Issues related to laboratory or clinical fixation of the female stud component Example feature

Processing in the laboratory

Locating and processing in the patient’s mouth

Under control of the dental Accuracy of technician and can be signed off alignment of the female components on the statement of conformity Space between diaphragm and hard denture

Accurate as above

There will always be change. As science and technology develop, we as dental technologist professionals need to maintain our understanding of our technology to ensure that we continue to do the best for our customers and patients. It is therefore interesting to watch how the development of such

Totally under the control of the clinician in a cramped space through a lingual window

May need extra finishing and often left in a finely ground surface. Or a thin layer of clear plastic sealant may be used

associated technology is being used elsewhere e.g. in 1956 discussion was of magnetic retention for facial prosthesis; in 1986 osseointegrated fixtures using implant to support facial prosthesis was then being discussed.

Now, replacement using freestanding magnetic retention for extra oral prosthesis with osseointegrated implants is in regular use.17 Technical developments and opportunities continue to make our integrated role essential as part of a modern dental team.

Fig. 4: LOCATOR R-Tx with pink titanium carbon nitride

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Determined in the surgery either by guesswork or e.g. coverage of the diaphragm in a thin layer of polyester impression material of an approximate thickness

Surface finish under Determined by the surface processed against i.e. tin foil the denture spacer that provides excellent surface finish example of Figure 4 below, a Zest Anchor for use with an implant system with a pink titanium carbon nitride coating that reduces wear.

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References 1 Endodontist publicity http://www.endodontics.co.uk/ patient-info/implants-vs-real-teeth 2 Naert I, Alsaadi G, van Steenberghe D, Quirynen M. A 10-year randomized clinical trial on the influence of splinted and unsplinted oral implants retaining mandibular overdentures: peri-implant outcome.

Int J Oral Maxillofac Implants. 2004;19(5):695–702.

3 Lundgren D, Rylander H, Laurell L. To save or extract, that is the question. Natural teeth or dental implants in periodontitis-susceptible patients: clinical decisionmaking and treatment strategies exemplified with patient case presentations. Periodontology 2000.

2008; 47:27–50.

4 Mechanical properties of magnetic attachments for removable prostheses on teeth and implants (PDF Download Available). Available from https://www.research gate.net/publication/23227886_Mechanical_Properties _of_Magnetic_Attachments_for_Removable_Prosthes es_on_Teeth_and_Implants [accessed Aug 14, 2017].

5 DYNA System http://www.dynadental.com/editor/ download-356/1603-01.08+Dyna+Magnet+Manual +GB.pdf [accessed June 2017].

6 Magnet-retained implant-supported overdentures: Review and 1-year clinical report http://www.jcda.ca/ article/a52 j can dent assoc 2010;76:a52 [accessed June 2017].

7 SA magnetic attachment support manual http://www.schottlander.com/docs/default-source/ dfu-pdf%27s/magfit-sa-manual.pdf?sfvrsn=4 8 Zest Anchor http://www.zestanchors.com/products/ products-locator photograph as reproduced from.

9 Photograph of Zest Anchor courtesy of http://www.dental news.com/2015/07/03/the-locator-useful-attachment -for-overdentures 10 Dr Dalla Bona – Dalbo® attachment, Cendres+Métaux courtesy of CMSA http://www.cmsa.ch/en/Dental/ Products-and-Services/Anchors 11 Cendres+Métaux courtesy of CMSA http://www.cmsa.ch/ en/Dental/Products-and-Services/ Anchors 12 Online dictionary definition https://www.google.co.uk/ ?gfe_rd=cr&ei=px0CWfPcMILHXqf7pPgL&gws_rd= ssl#q=resilience+meaning&spf=398 13 Cendres+Métaux SA, Rue de Boujean 122, CH-2501 Biel/Bienne, Phone +41 58 360 20 00 info@cmsa.ch http://www.multident.nl/nl/pdf/8888889940.pdf 14 Ceka Anchor picture courtesy of http://www.preat dental.com/category/extracoronal-attachments [accessed June 2017].

15 Tin foil suppliers e.g. http://www.goodfellow.com/E/ Tin-Foil.html 16 Picture courtesy of http://www.zestanchors.com/ rtx_landing 17 Kara O, Demir N, Ozturk A N, Keskin M. Implant-retained nasal prosthesis. Eur J Prosthodont. 2015; 3:23–5.

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classifiedadvertising Have you found your envelope?

Editorial Assistant The Dental Technologists Association wants to recruit an Editorial Assistant to support the editors of The Technologist and Articulate. You will be expected to support the editors by sourcing appropriate articles for publication, peer reviewing copy and setting CPD questions. As part of the role, you will be expected to attend DTS and Dental Showcase to develop networks, and an annual planning meeting.

You must have an appropriate dental technology qualification and ideally be registered with the GDC. This is a part time, self-employed post of 1.5 days per month on average, plus expenses for attending meetings. Hourly rate circa £35.00.

For further details please contact the DTA office on 01452 886 366.

Closing date for applications is 30 October 2017

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dentaldigitalworld

■ The digital dental world: Part Five

The Technologist continues its series about the digital dental world by looking at the history and development of dental milling centres.

Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to gain an awareness of the evolution of CAD/CAM and how it can benefit the production of dental appliances ■ CPD outcomes: – to understand the evolution of CAD/CAM – to be aware of the materials used past and present in digital milling – to be aware that skill is still paramount to the success of dental technology regardless of whether CAD/CAM is used or not

O

ver the last two decades or so, two principle things have happened to computer aided design/computer aided machining (CAD/CAM) dental milling centres. First, they have become very much smaller and lighter, and second, they have become much more affordable. The earliest dental milling centres weighed tons, required specially reinforced floors, almost filled a room, and required major capital investment running to hundreds of thousands of pounds. Technicians would discuss whether a three-and-a-half ton milling centre might be as accurate as one weighing in at a massive five tons.

Today, those behemoths – deliberately made heavy to eliminate ‘chatter’ (a juddering effect caused by the milling process itself) – have been replaced with machines that can sit on a desktop without crushing the furniture, and yet are robust and sophisticated enough to be just as precise as their big brothers, if not more so.

Evolution Roland DWX-51D

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Before CAD/CAM milling technology evolved, as we understand it today, there was computer numerical control (CNC), which has been used in many engineering fields to streamline manufacturing processes and improve the quality, consistency and accuracy of the end product.

Parsons worked on many projects for the US Air Force before starting a career with the world-renowned Massachusetts Institute of Technology (MIT) in 1949. It was here that the original prototype CNC machine would be constructed in 1953.

This machine used a tape reader, eight column papers, a Flexowriter that punched instruction codes into paper tape, and a vacuum-tube electronic control system.

Anyone who has watched science fiction movies from the 1950s can imagine how cumbersome this first true computer aided machine must have looked. Even so, these rudimentary machines have much in common with modern CNC machines, although the feedback system has since been replaced by digital encoders that provide far greater precision.

CAD/CAM The original true CAD/CAM machine was developed in cooperation by French manufacturers Renault and Peugeot for the faster and more precise manufacture of car body parts, dies and casts. It resulted in the CAD design of the Peugeot 204 body shell in 1968.

CAD/CAM technology was first applied to dentistry in 1973 by Professor Francois Duret in his thesis ‘Empreinte Optique’ (Optical Impression), written at the Université Claude Bernard, Faculté d’Odontologie, in Lyon. Professor Duret developed his CAD/CAM device, obtained a patent for it in 1984, and took it to the

The early history of CNC milling dates back to just after the Second World War when its precursor, numerically controlled (NC) machining, was used to manufacture parts for the aerospace industry.

The technology was first developed by John T Parsons of Detroit. Working at his father’s factory, Parsons developed computer-controlled templates for manufacturing helicopter rotor blades.

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Sirona Cerec MC

Chicago Midwinter Meeting in 1989. In front of a roomful of dental delegates he manufactured a crown – and it took him just four hours.

When the technology first came into the UK and US dental arenas, its earliest manifestations were considered to be unreliable novelties. How times have changed. Although the majority of CAD/CAM milling machines are still to be found in the laboratory, an increasing number are used in dental surgeries to create single crowns and temps. However some research indicates that 10 per cent of dentists who have invested in the technology don’t use it. Perhaps they found the learning curve too great, or maybe they discovered it was better and more cost effective to leave such work to a skilled technician.

Materials The majority of crowns, temps and crownand-bridge restorations are now produced using CAD/CAM. These are often manufactured by milling modern ceramic materials that evolved from traditional feldspathic porcelain, which was a highly aesthetic but unfortunately low strength and brittle material. These new, clinically successful materials have overcome feldspathic porcelain’s drawbacks thanks to improved strength and resilience – while also providing very acceptable and highly aesthetic outcomes. There is an increasing variety of CAD/CAM materials now available in block form, all formulated to provide more efficient restoration design and production. Technicians can choose

from materials including glass ceramics, resin nano ceramics, zirconia, ceramic composites, ceramics and resin composites. Blue light, contact or laser imaging of the original impression/model – or the latest STL files from chairside intraoral scanners – provide sufficient precise data for the CAD process to design and for the milling machine to quickly and accurately recreate minute natural flaws and detailing in the restoration. The outcome is increasingly lifelike aesthetics.

CAD/CAM restorations can also be layered for a deeper, more natural-looking aesthetic. In some hand-layered crowns and bridges, feldspathic porcelain is fused to glass-infiltrated alumina or zirconia to create a strong and aesthetic metal-free crown or bridge, which, thanks to the lack of dark oxide black lines near the gum line, are very much preferred by patients.

However there can be drawbacks. Zirconia is radiopaque, meaning it blocks X-rays, as does conventional porcelain-to-metal, and traditional gold, as well as any other allmetal material. As a result, over time the dentist will be unable to evaluate the patient’s underlying dental condition.

Alumina, lithium disilicate and some composite resin materials are radiolucent, meaning they don’t block X-rays and allow dentists to track potential decay.

Finally, the accuracy of restorations using CAD/CAM technology is considered by

some to be less consistent than other dental manufacturing processes, but the truth is that the technology is improving at an exponential rate, and experience has proven quite the opposite. CAD/CAM offers a pathway towards faster, more consistent and predictable restorations, and does so in a more cost-effective way.

However it is a truism that even the most advanced and precise CAM milling process is only as accurate as the original impression/scan, and only as good as the CAD software and operator involved. The constantly repeated mantra of speakers during the Henry Schein Digital Symposium in May was the warning that CAD/CAM should not be considered a replacement for thorough technical training. It is not a ‘plug & play’ route to easy dental technical manufacture without first gaining an understanding of dentition and materials. A bad technician will still produce poor work – they will just do it that much faster.

Zirconia disk for milling

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continuingprofessionaldevelopment Continuing Professional Development (CPD) Programme The Technologist is pleased to include a continuing professional development (CPD) programme for DTA members in accordance with the UK General Dental Council’s regulations and the FDI World Dental Federation’s guidelines for CPD programmes worldwide.

The UK General Dental Council regulations required that from 1 August 2008 all dental technicians must start documenting their CPD. They are required to complete and record a minimum of 150 hours of CPD every five-year cycle, a third of which should be verifiable CPD (50 hours). This should include verifiable CPD in the following core subjects: ■ medical emergencies (10 hours per cycle) ■ disinfection and decontamination (5 hours per cycle)

■ materials and equipment (5 hours per cycle) The questions in this issue of The Technologist will provide verifiable CPD for those entering the programme. Complete your answers for free online at www.dta-uk.org, or use the answer sheet overleaf (or a photocopy if this is preferred, so as not to remove the page). Return your answer sheet to the DTA Head Office address with your £5 payment (please note that your CPD won’t be processed without payment) before the 17 November 2017.

Online and paper responses must be received by the deadline. Dental technicians completing the programme will receive a certificate for the prescribed number of hours of verifiable CPD, together with the answers to the questions either online or by post according to the above guidelines.

Aims and outcomes In accordance with the General Dental Council’s guidance on providing verifiable CPD: ■ The aim of The Technologist CPD Programme is to provide articles and material of relevance to dental technicians and to test their understanding of the contents.

■ The anticipated outcomes are that dental technicians will be better informed about recent advances in dental technology and associated subjects and that they might apply their learning to their practice and ultimately to the care of patients.

Please use the space on the answer sheet or online to provide any feedback that you would like us to consider.

Learning & development (Other specific cpd – 30 minutes) Q1 – When it comes to business planning, the most successful companies: A – Allow people to choose what skills they want to develop B – Have strong links between personal development plans and what the business needs to achieve C – Link learning and development to the manager’s priorities D – Have no link between overall strategy and learning

Q2 – The learning culture of the most successful companies: A – Punishes mistakes B – Is focused on identifying what went wrong C – Encourages staff to get better at what they already do D – Is one where people can develop new skills in a safe environment

Q3 – In the area of knowledge sharing, the most successful companies: A – Limit collaboration B – Restrict the use of technology C – Focus on collaboration between managers D – Provide technology that allows people to collaborate

Q4 – The best companies believe that learning and development works best when: A – Delivered online B – Supported throughout by managers C – It is self-managed D – It is paid for partly by the employee

Q5 – The most successful companies use learning and development data and analytics to: A – Manage business processes only B – Make informed decisions about the needs of its people and customers C – Quantify the costs of training D – Provide managers with error rates

NLP & customer service (Other specific cpd – 30 minutes) Q1 – The ‘N’ in NLP stands for: A – New B – Neuro C – Neutron D – Neutral

Q2 – Behaviour is strongly influenced by beliefs and: A – Representational systems B – Age C – Attitudes D – Gender

Q3 – The three main representational systems are visual, auditory and: A – Kinaesthetic B – Kinetic C – Touch D – Internal

Q4 – In the acronym SMART, the R stands for: A – Real B – Registered C – Right D – Realistic

Q5 – The technique used to disassociate from your own personal problems is: A – Swish pattern B – Perceptual positions C – Goal setting D – Anchoring

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continuingprofessionaldevelopment The self-help check (Oral cancer early detection CPD – 30 minutes) Q1 – Early referral for treatment of a lesion is thought to provide a survival rate of: A – 30% B – 55% C – 65% D – 90%

Q2 – Looking at the head and face, look for: A – Changes in texture B – Any lumps or bumps that are only on one side C – Swelling, changes in colour or ulcers D – Red, white or dark patches

Q3 – Within the cheek, look for: A – Changes in texture B – Any lumps or bumps that are only on one side C – Swelling, changes in colour or ulcers D – Red, white or dark patches

Q4 – The position of the posterior pillar is best described as: A – Anterior surface of the mandible B – Being 200 to 400 bumps spread all over the surface C – A vascular process of connective tissue extending from the lingual frenum D – A near vertical column of soft tissue at the back of the mouth

Q5 – The tongue picture clearly shows healthy fungiform papillae: A – On the sublingual gland B – Being 200 to 400 bumps spread all over the top surface C – As a vascular process of connective tissue extending from the lingual frenum D – Across the lingual tonsil area

The digital dental world (Materials & equipment CPD – one hour) Q1 – The juddering effect caused by the milling process is called: A – Clutter B – Chatter C – Blatter D – Clanker

Q4 – The first true CAD/CAM machine was developed in cooperation by: A – Mercedes/Bentley B – Ford/Fiat C – Ferrari/Williams D – Renault/Peugeot

Q5 – Who first applied CAD/CAM to dentistry?

A – Dr Emile Bourdain B – Professor Francois Duret C – Professor Hubert Wallasey D – Dr Christian Freeth

Q6 – When was the first patent granted for a dental CAD/CAM milling machine?

A – 1984 B – 1989 C – 1987 D – 1981

Q7 – How long did it take the inventor to CAD/CAM mill a crown during a demonstration in Chicago?

A – 28 minutes B – 2 hours C – 4 hours D – 1 hour 17 minutes

Q8 – How many dentists have invested in CAD/CAM but don’t use it?

A – 25 per cent B – 15 per cent C – 10 per cent D – 5 per cent

Q9 – Modern ceramic materials evolved from?

A – Glass ionomers B – Pottery glazes C – Traditional Chinese porcelain D – Traditional feldspathic porcelain

Q10– Which dental materials are radiolucent?

A – Alumina, lithium disilicate and some composite resins B – Zirconia and titanium C – Gold and chrome D – Platinum and palladium

Q2 – Numerically controlled machines were first used to manufacture: A – Engine blocks B – Jet engine rotors C – Helicopter rotor blades D – Jewellery

Q3 – What did a Flexwriter do?

A – Punch instruction codes into paper tape B – Take dictation C – Create line-drawn templates D – Allow the operator to work from any position

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continuingprofessionaldevelopment Hygiene under pressure (Disinfection & decontamination cpd – 45 minutes) Q1 – Who do the BDA and other dental bodies state that the responsibility for disinfection of impressions lies with?

A – The patient B – The clinician C – The dental technician D – All participants in the process

Overdenture concept (Materials & equipment cpd – one hour) Q1 – Using an attachment on a retained root provides: A – Lateral resistance B – Vertical retention C – Friction D – Compression support

Q2 – Appropriate root canal treatment can: A – Provide an effective and healthy root B – Likely be used for medium- to long-term restorations C – Avoid the extraction trauma and a) only D – Not require implant and all the above

Q2 – What is the author’s early and subjective view about the disinfection of items leaving the lab?

A – A quick rinse is all they get B – Items leaving the dental laboratory are not safe (and a) C – A thorough process of decontamination occurs before all items leave the lab D – Levels of decontamination in dental laboratories are low

Q3 – Which of the following statements is true with regard to pressure vessels?

A – Water temperatures should not rise about 60° Centigrade B – Fluctuating temperatures offer microbes the right environment to multiply C – Dental technicians are not exposed to significant danger D – Dental items and operators are exposed to danger and all of the above

Q4 – What test criteria best reflect the one used by Ms Mulvey?

A – Thirty water samples were taken from the baths of thirteen different dental laboratories and a, b & c B – Microbe growth from each sample was carried out for 36 hours C – Agar in petri dishes was incubated at 37° Celsius for 24 hours D – Further tests such as gram stain, catalase, oxidase and BBL Crystal ID were undertaken & c

Q5 – What do the results of the study suggest?

A – Levels of contamination weren’t high B – Moving water facilitated the formation of biofilms C – Stagnant water contributed to the formation of dangerous microbes D – Microbes tended to be gram-positive rods

Q6 – What does the article suggest a dental laboratory clean policy include with regard to the operator approach?

A – Staff should be properly educated B – Repairs should be handled by staff wearing gloves C – Good hand hygiene is vital D – All of the above

Q7 – The author recommends: A – Pressure pots are emptied daily & b, c, d B – Pots are turned upside down because microbes don’t proliferate on a dry surface C – Pressure vessels should have their water changed twice a week D – Appropriate disinfectant is used if water in pressure vessels can’t be changed as required

Q3 – Which TWO essentials are indicated to keep retained roots?

A – Periodontal disease is eradicated, and c) only B – Periodontal support is at the ideal level for the tooth, and c) C – Periodontal disease is prevented from re-occurring, and d) D – Disturbed surrounding gingiva is active, and a) only

Q4 – A root-covering diaphragm should: A – Assist in maintaining the periodontal tissues B – Be extremely smooth, and all answers C – Be 1.5–2.00 mm above the gingiva, and d) D – Have 3 mm in diameter soldering area

Q5 – Intraoral dental magnets are UNLIKELY to be made from: A – Aluminium, nickel and cobalt B – Palladium, chromium and cobalt alloy C – Neodymium, iron and boron D – Samarium and neodymium

Q6 – In the classic Dalbo attachment, the item soldered to the diaphragm is the: A – Intraradicular section B – Patrix C – Matrix D – Vertix

Q7 – Overdenture compression of mucous membrane tissues under load requires: A – Precision fit of the denture fit surface to the diaphragm B – A space of at least 2.5 mm over the retained root C – Relief for the root-covering diaphragm D – The use of a cold cure extension in the denture

Q8 – Which fitting method for the matrix does the writer suggest is worthy of MHRA ‘Statement of Conformity’ control?

A – Fitting in the dental surgery B – Dental laboratory manufacturing C – Placement after receipt in the surgery D – After the patient returns to the laboratory for adjustment

Q9 – Micro surface coatings in dentistry are NOT used to: A – Increase surface hardness B – Improve abrasion/wear resistance C – Reduce biological build up D – Reduce corrosion resistance

Q10– Overdenture retention devices are considered to require: A – Low profile height, and c) B – Dual retention and all answers C – Low hygiene maintenance D – Increased resilience, and a) only

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Simply fill in the multiple choice answer sheet on the inside back cover and complete the form ...

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answer sheet the technologist october 2017 Please PRINT your details below: First Name*

Last Name*

GDC no.*

Title

DTA Member: Yes

No

DTA no.*

*Essential information. Certificates cannot be issued without all this information being complete.

Complete free online at <www.dta-uk.org>. First-time users will need to register; those already registered need only log in.

Or, either remove this page, or send a photocopy to: Dental Technologists Association, F13a Kestrel Court, Waterwells Business Park, Gloucester GL2 2AT. A £5 payment must be included with your CPD answer sheet – please do not forget!

Please note that you must achieve a score of 50% or more to receive a certificate.

Answer sheets must be returned before 17 November 2017 for CPD responses returned in the post and for online CPD users. Answer sheets received after this date will be discarded.

Answers Please tick the answer for each question below Learning & development (Other specific cpd – 30 minutes) Question 1:

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C

D

A

C

D

A

C

D

A

B

C

D

C

D

C

D

C

D

C

D

C

D

C

D

C

D

C

D

NLP & customer service (Other specific cpd – 30 minutes) Question 1:

A

B

Question 2:

C

D

A

B

Question 3:

C

D

A

B

Question 5:

Question 4:

B

B

The self-help check (Oral cancer early detection cpd – 30 minutes) Question 1:

A

B

Question 2:

C

D

A

B

Question 3:

C

D

A

B

Question 5:

Question 4:

B

B

The digital dental world (Materials & equipment CPD – one hour) Question 1:

A

B

Question 2:

C

D

A

C

D

A

Question 6:

A

B

B

Question 3:

C

D

C

D

Question 7:

B

A

B

Question 8:

A

B

Question 5:

Question 4:

B

Question 10:

Question 9:

B

B

B

Hygiene under pressure (Disinfection & decontamination CPD – one hour) Question 1:

A

B

Question 2:

C

D

A

C

D

A

Question 6:

A

B

B

Question 3:

C

D

C

D

Question 7:

B

A

B

Question 8:

A

B

Question 5:

Question 4:

B

Question 10:

Question 9:

B

B

B

Overdenture concept (Materials & equipment CPD – one hour) Question 1:

A

B

Question 2:

C

D

A

C

D

A

Question 6:

A

B

B

Question 3:

C

D

C

D

Question 7:

B

A

B

Question 8:

A

B

Question 5:

Question 4:

B

Question 10:

Question 9:

B

B

B

Feedback We wish to monitor the quality and value to readers of The Technologist CPD Programme so as to be able to continually improve it. Please use this space to provide any feedback that you would like us to consider.

An important note for non-DTA members Non-DTA members will incur a £25 fee for undertaking CPD provided through this publication. Cheques made out to DTA should accompany your answer sheet. the

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