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ISSUE 2 January-M arch 2018

Dental I nsi gh ts M AGAZI N E

New Year, New I nsi gh ts, Happy Pati ents!


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Welcome Since the launch Dental Insights, I have been delighted by the outstanding support we have received from the Dentists, Dental Professionals, and Businesses who have contributed to the magazine. Thank you.

Page 20: What?snew?Find out more about the latest new products, including Nacera Hybrid, for chairside and labside restorations.

In equal measure, I would like to thank our growing community of magazine subscribers and social media followers. worldwide. Connecting with all of you has been great. I hope you enjoy Issue 2, it looks like 2018 is going to be an exciting year in Dentistry. I look forward to sharing more Dental Insights with you soon!

Sophia Smit h

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Director

Give Back a Smile:

eW isdom Publicat ions.

how one dentist helped a victim of domestic abuse.

The informat ion, opinions and views present ed in Dent al Insight s Magazine, published by eW isdom Publicat ions Limit ed reflect s t he views of t he aut hors and cont ribut ors of t he art icles and not of t he Dent al Insight s Magazine or eW isdom Publicat ions. Publicat ion of art icles, advert isement s or product informat ion does not const it ut e endorsement or approval by t he journal and/or it s publisher. Dent al Insight s Magazine and/or it s publisher (eW isdom Publicat ions Limit ed) cannot be held responsible for any for any consequences arising from t he use of t he informat ion cont ained in t his journal. Alt hough every effort is made by t he edit orial t eam and t he publishers t o see t hat no inaccurat e or misleading dat a, opinion or st at ement appear in t his publicat ion, t he dat a and opinions appearing in t he art icles including edit orials and advert isement s herein are t he responsibilit y of t he cont ribut ors concerned. The publishers and t he edit orial t eam hold no liabilit y what soever for t he consequences of any such dat a, informat ion, opinion or st at ement in t his magazine. W hilst every effort is made by t he edit orial board and t he publishers t o ensure t hat informat ion is present ed accurat ely, readers are advised t hat new met hods and t echniques involving medical/product usage as described in t his publicat ion, should only be followed in conjunct ion wit h t he expert /manufact urer's own published lit erat ure in t heir own count ry.

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Content s Page 10: 3D Root Canal Preparation Using The XP Shaper? and XP Finisher? Instruments Page 14: Smile Makeover Page 16: The Benefits of Cloud Collaboration Software, by Labtrac Dental Page 20: W hat?s new? The best products & dental technology

Page 28: Page 26: Give Back a Smile Program: how one dentist helped a victim of Domestic abuse

Sugar awareness.

Page 28: Sugar Awareness Page 30: Interview: Learn more about plant-based Dental Products with the founders of Dr. Brite. Page 34: Orthodontic Case Study: Going Digital with Integrated Smile Design Page 46: Business Focus Develop a top performing Dental Practice with strategic planning

Pages 32-44: Orthodontics Case Study, Integrated Smile Design.

Part 2 - "Your dreams are calling you?"

Editorial contact details: editorial@ewisdom-publications.com For advertising opportunities please contact: Sophia Smith +44 (0) 7875 938084 +44 (0) 20 3289 8310 director@dentalinsights-magazine.com

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Editorial Cont ributors

JAMES AQUILINA BDS MSC, REGISTERED SPECIALIST IN ENDODONTICS In 1997 James undertook a part-time MSc in Endodontics at Guy?s Hospital under Prof. Pitt Ford. On completing his Masters degree, James remained at Guy?s for a number of years as a part-time member of staff, teaching Undergraduates, and supervising Postgraduate students as well as treating patients in his own clinical sessions. James also provided an endodontic referral service in several practices during this period. Since leaving Guy?s James has expanded his practice limited solely to Endodontics, in Kent and Essex. James is committed to further education and is a member of the British Endodontic Society, the and the European Endodontic Society, From 2006 until 2012 he has been an active member of the British Endodontic Society council acting as their advertising co-ordinator. James also organises and supervises courses and lectures in Endodontics aimed at general dental practitioners. He is the founder of the Bromley and Beckenham, Bexley, and the Southend Endodontic study clubs. He has been involved with the Endoclinic study club in Maidstone. He also an opinion leader and assesses and reviews new products for Dentsply.

ERIC CALIAN, D.D.S Eric studied at Georgetown University Dental. He is a Member of the American Dental Association, Academy of Cosmetic Dentistry, Academy of Laser Dentistry, 9th District Dental Society, Implant Study Club & the Dental Organization for Conscious Sedation.In his spare time, he loves spending time in New York City his girlfriend, friends and family. He enjoys sports & world travel.

DAMIAN OTWAY, CEO, LABTRAC DENTAL Damian has over 25 years experience in software development working for a number of leading I.T. firms. He has been developing software for the Dental Laboratory industry for over 15 years and was one the original developers of Labtrac. W ithin that time, he has helped shaped most of the innovative features that you will see in the industry today such as cloud portals, technician touchscreens and dynamic scheduling. Labtrac Dental is the leading provider of software solutions for the dental laboratory market. Its products and solutions include order and invoice management, technician work tracking, dentist collaboration and workflow integration.

AZZIE NASER ZADEH Azzie Naser Zadeh is 33 years old, living in Amsterdam, the Netherlands. Born in Tehran (Iran), and moved to the Netherlands at the age of 10. She graduated as a Dentist 10 years ago at the University of Amsterdam (ACTA). Currently, she owns a dental clinic (de Mondhoek) with 2 other Dentists in Apeldoorn. They offer general dentistry, easthetic dentistry, and implantology at the clinic. She is a general dentist and enjoys treating patients of all ages, especially children.

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Cont act Editorial: editorial@ew isdom-publicat ions.com


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Editorial Cont ributors

MATTHEW BOMBECK Matt Bombeck has written for magazines, television and screen. Honors include a long form Writers Guild of America Award. He is from Los Angeles. Matt donated his time to write the article for AACC ?Give Back a Smile?program. included in this Issue.

DANIEL WORICKER BDS Originally from Suffolk, UK, Dan moved to the North East to study Dentistry in 2006 and qualified from Newcastle University in 2011. After qualifying Dan worked in the nearby city of Sunderland at a highly respected practice where he gained large amounts of experience and knowledge in all aspects of dentistry. Dan continued to work as an associate in Sunderland for two more years before moving to Bath in 2014 and is now at Longwell Green Dental & Implant Clinic. MICKEY BERNSTEIN, DDS Dr. Mickey Bernstein has practiced dentistry for 41years in Germantown, Tennessee. He is an Accredited Member and 2008-2009 President of the American Academy of Cosmetic Dentistry. He has received the honor of Fellow in the Academy of General Dentistry, the American College of Dentists, and the International College of Dentists, and is an Alumnus of the L. D. Pankey Institute. Dr. Bernstein enjoys sharing his dental experiences through lecturing and writing on esthetic practice development and cosmetic design and has founded the UT/ AACD Student Esthetic Study Club, serving as mentor and Adjunct Professor. He has lectured nationally and authored articles in dental journals.He has served on numerous committees for the AACD including the Professional Education Committee for 5 years and the Nominating and Leadership Development Committee for 3 years. Dr. Bernstein has a special interest in helping patients with teeth and lives damaged by eating disorders and assisting survivors of domestic abuse through the AACD ?Give Back a Smile?Program. He is very involved with the Kindness Revolution, a non-profit promoting Values and Principles through kindness in businesses, schools, and communities. He is a partner in Bernstein Consulting, helping dental practices, businesses, and organizations achieve their dreams. He spends his remaining time with his wife, Diane, 7 children and 12 grandchildren. DIANE BERNSTEIN Diane Bernstein has been involved in the field of healthcare since 1972. She graduated with honors from the Baptist Hospital School of Radiology Technology, and before changing careers, she managed the Radiology Department of a large Multi-Specialty Medical Practice with 5 locations and 25 employees. She became the Practice Administrator for Germantown Dental Group in 1993; a practice with 4 doctors, and a staff of 21 team members. In 2006 she became the Patient Coordinator for her husband, Dr. Mickey Bernstein. They help dental practices achieve their dreams through Bernstein Dental Consulting. Diane speaks on a variety of dental and personal development topics. Together they enjoy spending their leisure time with their 7 children and 12 grandchildren. Diane enjoys sharing her ability to communicate effectively through lecturing and consulting.

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Cont act Editorial: editorial@ew isdom-publicat ions.com


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3D Root Canal Preparati on Usi ng Th e X P Sh aper? and X P Fi ni sh er? I nstruments By: James Aquilina BDS MSc, Endodont ic Specialist . Over recent years there have been many advancesand changes in endodontics, yet the aims of our treatment remain unchanged. These include the precautions taken to maintain the health of the vital pulp in a tooth, and the treatment of a damaged or necrotic pulp in a tooth to allow it to remain functional in the arch. It is well documented that the primary aetiological factor in periapical disease is bacterial infection of the pulp canal. Endodontically, thisis managed by Chemo-mechanical preparation of the pulpal space. In this article, I will be exploring the new XP instruments from Schottlander and the rationale for how they attempt to achieve three-dimensional preparation of the pulp canal. The aim of mechanical preparat ion is to: -

Remove pulp tissue from the main canal Create sufficient space for irrigation and medication Preservation of the integrity and location of the apical anatomy Avoidance of damage to the root structure and canal system Facilitate filling of the root canal Avoidance of further irritation or infection of the periradicular tissues and the preservation of sound dentine

W ith a multitude of techniques from clearing teeth to micro CT scanning, the complexity of the pulp chamber is well known.

Amongst these complicating anatomical factors, we find lateral canals, fins, isthmuses, apical deltas, as well as bifurcations and other canal divisions.

We now appreciate that the classic descriptions of the basic canal anatomy are frequently challenged in clinical practice. The first and most prevalent on the list is the second mesio-buccal canal in maxillary first molars. There are many others that include maxillary premolars with three roots, mandibular incisors with two canals, mandibular first molars with a third (often distal) root and mandibular molars with a single C shaped canals.

Despite this knowledge, our mechanical preparation has not changed in our approach to shaping the canal. W hether using hand instrumentation with step back or using traditional instrumentation whether rotary or reciprocating, our result is a canal preparation of a predetermined shape irrespective of the original canal shape or dimensions. This would be the equivalent to preparing a tooth for a crown using a milling machine that creates a limited number of predetermined preparation shapes, choosing dimensions that are as close to the original tooth.

Most of these macro anatomical challenges are practically just an exercise in access and location. The solution to these problems is good preoperative assessment using appropriate radiographic assessment, which might include cone beam CT scans. Clinically our access cavities combined with magnification and good illumination will complete our attack strategy to manage these anatomical hurdles. Once within the canals our challenge really begins. There is a multitude of anatomical variations that hinder the thorough debriding of the pulp canal.

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In restorative dentistry, we do not do this. Instead, the tooth?s natural dimensions, occlusal considerations and the material used determine the shape of the preparation and the amount of tooth structure removed. The advantage of using a predetermined shape in endodontics is that systems can be developed where all materials are premade to compliment the final shape of the prepared canal. Paper points, Gutta Percha master cones and even carrier-based obturation materials all nicely fit together making drying and sealing the canal quick and easy.


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There are, however, a number of limitations with these systems. In a narrow canal comparatively much more dentine will be removed than in a larger canal. Invariably the preparation techniques will result in the course of the canal to be changed with straightening the most common change. This can cause iatrogenic complications such as strip perforations on the inner aspects of root curvatures. Non-centric tissue removal will also result in areas of weakness that could predispose the root to fractures during obturation or functional loading. Rotary or reciprocating instruments create round preparations, but the canals are not round. As a result, significant areas of the canal walls will remain untouched by the instrument leaving potentially infected pulp tissue within the canal and dentinal tubules. This is compounded by the mass of the core of the instruments leaving little space for debris and irrigant between the wall of the canal and the instrument. This compacts the dentine chips and irrigant into a mud. During their use, these instruments will force the debris mud into the accessory anatomy such as isthmuses and fins and large areas of the canal will remain un-instrumented. W hat is produced is a well prepared and cleaned round hole running through the canal with debris present within the accessory anatomy.

Image: Traditional round instruments result in large areas of the internal canal anatomy being uninstrumented, and debris to be compacted into the accessory anatomy.

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Image: The XP Shaper? is a size 30 01 instrument that through a series of waves give an 08 taper.

Secondly, a feature of the instrument that is evident is that there is very little mass to the instrument. The internal cross-sectional area is very small. The instrument itself has a 01 taper. These features result in the XP Shaper? instrument being very flexible. Far more flexible than a conventional size 30 08 taper instrument would be. In operation the instrument acts more like a skipping rope. A fine flexible core of material that in rotation cuts an arch many times greater than its own dimensions. During instrumentation of the canal, the instrument will invariably be entering a canal which has a smaller shape than the potential size 30 08 taper of the XP Shaper? . The result is that the instrument will be squeezed to fit into the narrower space. The wavy shape of the instruments acts like a spring with the instrument wanting to return to its original shape. This action will result in the crest of the waves pushing against the walls of the canal. This allows the instrument to collapse and expanding to the available space within the canal producing a variable preparation with a minimum 04 taper and a maximum 08 taper. This results in the instrument adapting to the natural internal shape of the canal with the crest of the waves engaging more of the canal wall. This also allows more uniform removal of dentine along the whole length of the canal. The low core size of the instruments creates a larger area for debris and irrigant to occupy. The dentine chips are therefore not squashed into a dense mud but instead, are kept in a suspension. As a dense mud is not created less debris will be forced into the accessory anatomy. The suspension will also be easier to remove with irrigation:

The XP Shaper? instrument does not look like your classical rotary instrument. The first peculiarity of the instrument is that it is not straight but instead has a series of waves, which increase in amplitude as you ascend the instrument from the tip towards the shank. If the crests of the waves are connected, then the result would be an instrument that has a 08 taper (the width increases by 0.08mm for every millimeter that you ascend up the instrument from the tip). A conventional ISO hand instrument has a 02 taper. The working tip of the instrument is a size 30. The instrument, therefore, has the potential dimensions of a size 30 08 taper instrument 11


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Another collateral effect of the reduced core size is that debris is kept in suspension and not compacted into a mud. This reduction in stress when compared to conventional instruments results in a reduced risk of instrument breakage and microfractures within the tooth structure.

The XP Finisher? is a size 25 00 taper instrument used to activate the irrigation solution. There is a single wave towards the tip of the instrument.

Irrigation is a vital part of disinfecting the root canal system. Even with the advantages of the XP Shaper? there will still be areas of the pulp canal system that will remain un-instrumented. The facilitation of irrigation has considerations that must be met when mechanically preparing the canal. The classic method of irrigating the canal is to use syringes with irrigation needles. For the irrigant to maximally penetrate the entire canal system the needle will have to be able to be inserted to as close to the full working length as possible. This will also increase the hazardous risk of the irrigant being delivered through the apex with its associated painful clinical consequences. The preparation shape must, therefore, be large enough for the irrigation solution to be able to pass past the irrigation needle and into the pulp chamber where it can be aspirated. A gauge 27 irrigation needle is approximately an ISO size 36, which means that the apical preparation will need to be at least a size 40 to allow space for the irrigant to flow into. An Endovac? tip is larger than a size 30 file and therefore if this system is being used a minimum apical preparation of size 35 must be achieved.

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Image: size 25 00 taper XP Finisher?

This shape allows more of the canal walls to be instrumented. The instrument also results in activation of the irrigant further increasing debris removal.

Image below: The use of the XP finisher? instrument results in more of the canal wall being instrumented during preparation.


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"The curvature and flexibility of the XP Shaper? allow the instrument to expand to the internal shape of the canal. The instrument reduces the amount of debris compacted into the accessory anatomy."

Image; The use of the XP Finisher? results in more effective removal of debris.

Image: All four canals prepared with the same instrument but each has a different shape and size.

Because the instrument is used in rotation unlike ultrasonic activation it is not affected by the curvature of the canal. Due to the size of the instrument, the larger preparation needed for other modes of irrigation activation is not required. As the XP Shaper? does tend to produce a narrower preparation the XP Finisher ? is a perfect way to activate the irrigant.

The curvature and flexibility of the XP Shaper? allow the instrument to expand to the internal shape of the canal. The instrument reduces the amount of debris compacted into the accessory anatomy. The curvature of the XP Finisher? allows even more of the internal canal surface to be instrumented whilst activating the irrigant.

The narrow preparation will be an issue with some obturation methods. For example, if vertical compaction is undertaken then the heated plugger tip will need to be able to inserted to within 3mm to 5mm of the working length. The backill needle will then need to reach the apical pack. The narrower shape does, however, lend itself to obturation using bioceramic sealers where hydrostatic pressure caused by seating a Gutta Percha master point causes the sealer to flow into the internal canal anatomy.

The net effect is a better 3D preparation of the root canal with the final shape being determined by the original canal and not dictated by the instrument.

A second consideration that we have with obturation is that the final size of the preparation is dependent on the original canal size and is therefore unknown on completion of the preparation. The canal should be prepared to a minimum of an apical size 30 and 04 taper to allow for irrigation and use of the XP Finisher? . The operator will need to find the appropriate master cone using trial and error and might even have to adapt a point to get a good fit at the working length. To conclude, the XP Shaper? and XP Finisher? instruments allow the aims of mechanical preparation, while they facilitate a more conservative and minimally invasive preparation of the root canal.

By: James Aquilina BDS MSc, Endodontic Specialist. About the author: In 1997 James undertook a part-time MSc in Endodontics at Guy?s Hospital under Prof Pitt Ford. On completing his Masters degree, James remained at Guy?s for a number of years as a part-time member of staff, teaching Undergraduates, and supervising Postgraduate students as well as treating patients in his own clinical sessions. James also provided an endodontic referral service in several practices during this period. Since leaving Guy?s James has expanded his practice limited solely to Endodontics, in Kent and Essex. James is committed to further education and is a member of the British Endodontic Society and the European Endodontic Society. From 2006 until 2012 he has been an active member of the British Endodontic Society council acting as their advertising coordinator. James also organises and supervises courses and lectures in Endodontics aimed at general dental practitioners. He is the founder of the Bromley and Beckenham, Bexley, and the Southend Endodontic study clubs. He has been involved with the Endoclinic study club in Maidstone. He also an opinion leader and assesses and reviews new products for Dentsply.

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Smi l e M ak eov er By: Eric Calian, D.D.S.

"If people smiled more often, the world would be a better place." I am proud to say that 25 years ago I chose to practice dental care in my hometown of W hite Plains because I felt my community should have the best dentistry has to offer not only today but every day forward. I frequently take numerous continuing education courses and seminars so that I can provide my patients with the latest advances in the state-of-the-art dental care. W hen it comes to cosmetic and family dentistry, our team has helped thousands in the Westchester/ New York Metro to obtain their perfect smile. This smile makeover may not seem extreme, but I wanted to show a perfect example of the majority of our customers we see on a daily basis. This patient, in particular, is a 44-year-old female, who was just amazing to work with. Her smile did not match her personality; she was embarrassed to smile because of how her teeth looked.

The patient was diagnosed as having misaligned anterior teeth which were in various shades of grey. In addition, her soft tissues were not symmetrical due to the labial inclination of several teeth. The patient did not want traditional braces or any orthodontic correction. W hen addressing the cosmetic concerns of my patients, I take a conservative approach as I consider each tooth in the mouth more valuable than a diamond. I am able to connect with my patients because of the integrity and care I bring to them. I make sure every patient I treat has my full attention, I always put the patients first. After hearing her concerns, and expectations, I decided that the best approach for her would be to perform laser soft tissue correction, to regain symmetry and place 10 veneers to significantly improve the color and alignment of the teeth. In 2 just weeks, with strategic prep and placement of the ceramics, we were able to give her the smile she has always dreamed of.

"The patient was diagnosed as having misaligned anterior teeth which were in various shadesof grey. In addition, her soft tissues were not symmetrical due to the labial inclination of several teeth."

Imagesleft, before & after treatment: l aser soft tissue correction to regain symmetry, and 10 veneers to improve the color and alignment of the teeth. 14


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Why I became a Dentist:

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I always knew I wanted a profession that would involve some sort of dexterity. As a child, I would find myself building all types of hobby shop models as I was intrigued with building things. Upon entering the phase of choosing my life direction, I initially decided on architecture. Although I excelled in my studies and found myself at the top of my class, I had an epiphany that architecture would not be able to fulfill me. After my third year studying Architecture, I decided to switch direction and to study health science, and become a surgeon in some capacity. After speaking with my family dentist he encouraged me to use my steady hands to help people have a healthy mouth. A light bulb went off; immediately I knew dentistry could fulfill me in a way architecture couldn?t. I then decided on Georgetown University to pivot my career on a path with a purpose. That same purpose I live by now, and that is to change the world one smile at a time. I know I made the right choice. If more people smiled, more often, the world would be a better place. W hen I am not treating patients, I love spending time in New York City with my girlfriend, friends, and family, preferably with a great bottle of Bordeaux. W henever I get the chance, I like to travel and thoroughly enjoy immersing myself in cultures of the world.

Image below: It's all about team work! Eric Calian, D.D.Swith his team at Calian Dental Group, www.caliandental.com

As they say, knowledge is power. I pride myself on staying in shape and being healthy with boxing, and during the winter months, hitting the slopes. Life is too short, so why not enjoy every bit of it?

For more smile makeovers and news from Eric Calian, follow him on Instagram @drericcalian.

"Without my team, my job would be impossible."

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Cl oud col l aborati on more th an j ust sh ari ng f i l es By: Damian Ot way, Labt rac Dent al.

"As w it h all t hings digit al t he pace of change can be overw helming but should be embraced w here possible."

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Dental I nsi gh ts Cloud collaborat ion is and should be so much more t han just sharing files. W ithin only a few years the way of working has changed completely, once phone and fax, then email and now a multitude of apps and connected systems. W ith each shift, not only is there investment in the technology itself but also the need to rethink how the technology fits into your business. Modern collaboration tools go beyond basic sending information in a single direction, whether that?s a message or a document. Instead, it?s about doing more together; thinking of new ways to bring Dentist and Lab together. Dentists and Technicians share a unique way of working together, one without the other doesn?t work, they are both needed to help create the best patient experience. W ithin the modern workflow, there are several touch points where communication is essential to develop a great working relationship. Those don?t have to be about a patient either, simply about building a better relationship around pickups and deliveries. It can take the stress and costs out of the process, giving a Dental Practice a better reason to work with a Lab. Having management software within the Laboratory that is cloud-enabled opens up so many possibilities. For a Laboratory, the primary benefit of the cloud is to have a consistent and ubiquitous experience available for their clients even when the main business may be closed. In the modern world where clients can be in any country or they need to work to varying time zones, it?s important to always have your doors open in the digital world. Faster, bet ter, smarter So what should good collaboration look like? It can start right at the beginning of the patient journey, whether that?s the Dentist entering an order digitally and submitting that to you or just requesting a pickup for impressions or try-ins. By taking away the friction points in managing orders and pickups you no-longer need to ring around practices every morning for your drivers or worry about being interrupted by calls to book couriers. One of the great features of cloud apps is you can link

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several systems together, so just like booking a holiday and having flights, hotels and transfers happen in one go, so can a Lab offer similar stress-free experience. Courier systems can be plugged into your website or ordering portal so when an order is booked so can the pickup along with the Practice address, notifying them and the lab with confirmation details, resulting in one less job for the administrators to worry about. Once the orders have arrived, it?s about enhancing all the touchpoints that usually occur between Technician and Dentist. The most obvious example is sharing photos and other digital documents as well as commenting on these images and having messaging, back and forth between all parties. This might be real-time through video linkup or more likely using messages to continue conversations and threads, making it easy for both sides to pick up from before and respond with any device, in any location. The same goes for communication between Practice staff and Lab Administrators, both are busy, and phone calls can be disruptive on either side. Instead, by using the messaging tools it's much easier to work together, pass on missing information or manage patient diary changes. Collaboration doesn?t need to be restricted to just the Dentist side but can also encompass suppliers. Purchasing workflow systems can be put in place to help with ordering, for example, implant parts can be ordered directly using the Dentist or Labs account details once an order has been approved by the laboratory. Again, trying to remove as much friction and time from the entire process. Finally, when the work is finished by the technicians this is where administration tasks take over. Having systems to help you easily dispatch work with couriers and drivers as well as switching to paperless invoicing is a must. The collaboration doesn?t have to stop there, having an easy way for Practices to query invoices as well as pay, or sign-off on work so payment can be processed at a head-office all help create a great working relationship that both sides benefit from.

"Patient and personal data is under "attack all the time, and legislation will alwaysfollow to try and protect this. Its very important that you have systems in place that you and your end usersknow is safe, secure and compliant with data protection standards."

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"As we move into 2018 having the right management software isbecoming more important than ever. With the constant pressuresto increase productivity and reduce costs, it's often easy to forget about building up and cementing the business relationships with your suppliers and customers."

Right soft w are for compliance, securit y, and ease of use As we move into 2018 having the right management software is becoming more important than ever. W ith the constant pressures to increase productivity and reduce costs, it's often easy to forget about building up and cementing the business relationships with your suppliers and customers. All this can sometimes seem difficult to achieve, so by having systems and processes in place that help you do this; you can start to see the light at the end of the tunnel. However, getting a good working relationship with your customers may not be enough, in the modern digital world, it's equally important to have a system that is both compliant and secure. Patient and personal data is under attack all the time, and legislation will always follow to try and protect this. Its very important that you have systems in place that you and your end users know is safe, secure and compliant with data protection standards. Sharing data is a complex area, and often the quickest and easiest to use routes fall short of the standards you should be following. W hen someone emails you a password for DropBox or any other online sharing tool, and you notice you can view all of their data you should encourage them to change to a more secure route. Offer them an alternative such as a secure web portal with granular access to case and patient information that is limited just to the correct users. Management software alone won?t solve all your problems, but it should give you the platform to implement a great business model while staying compliant and secure in a digital world. By having a system that is easy to use, open and connects you with 18

Dentists, Dental Groups and Suppliers you stand the best chance of embracing change and growing your business. About t he aut hor: Damian Ot w ay, CEO, Labt rac Dent al Damian has over 25 years experience in software development working for a number of leading I.T. firms. He has been developing software for the Dental Laboratory industry for over 15 years and was one the original developers of Labtrac. Within that time, he has helped shape most of the innovative features that you will see in the industry today such as cloud portals, technician touchscreens, and dynamic scheduling. Labtrac Dental is the leading provider of software solutions for the dental laboratory market. Its products and solutions include order and invoice management, technician work tracking, dentist collaboration and workflow integration. As the most innovative dental software company, Labtrac provides the dental industry with comprehensive end-to-end solutions. They develop a full range of desktop, mobile and web applications all powered from the world?s first truly global dental platform. This allows users around the world to access their data securely and safely from any location. We enable teams of all sizes from small start-ups and specialist studios through to large multi-site corporations to grow their business and compete on the global stage.

?At Labtrac Dental we are committed to continually innovating and improving the dental industry through our wide range of quality software solutions. Our goal is to bring best practice along with production and organisational efficiencies to every dental laboratory so they can focus completely on quality giving the best possible patient experience.? Damian Otway, CEO, Labtrac Dental.

For more informat ion, please visit : w w w.labt rac.com


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NEW FEATURED PRODUCTS

Ev ery bl ank i s perf ect: NEW ?anteri or? mul ti l ayer zi rconi a i mpresses w i th natural col ourati on and transl ucency Nacera Pearl Q³ Mult i-Shade (UHT) by Do ceram Medical Ceramics. Building on more than 20 years of industrial ceramic expertise, Doceram Medical Ceramics in Dortmund researches, engineers, and produces innovative zirconium dioxide milled blanks ? with increasing success and an expanding portfolio. Consequently, the globally established Nacera brand has grown to include opaque, highly translucent, pre-coloured, and multilayer variants, along with the recently added easy-to-mill hybrid ceramics for chair-side and lab-side manufacturing. Perfectly blended colouration, simple and precise, produce a naturally translucent effect: Nacera Pearl Q³ Multi-Shade redefines the accuracy of colour and fit of CAD/ CAM restoration materials. The new high-yttrium-stabilised zirconium dioxide series, which Doceram Medical Ceramics is adding to its proven Nacera Pearl Multi-Shade system at IDS, not only offers increased, ultra-high translucency, but also extremely natural light dynamics and colour reproduction that precisely matches the Vita colour system. The photo-optical properties of the new high-performance ceramic are achieved through a range of factors, including a special chemical composition that results in a tetragonal-cubic phase. The resulting optimised light refraction greatly increases dispersion and radiance, helping ceramists more easily fabricate aesthetic masterpieces in zirconia.

Easy, Exact and Efficient : Colour accuracy redefined! Nacera Pearl Q³ Multi-Shade now provides technicians with yet another premium material for aesthetic, CAD/ CAM-based dental prostheses ? with ultra-high translucence, and precisely defined colour accuracy. The new cubic 6Y-PSZ high-performance ceramic from Nacera?s Multi-Shade family relies on a new, proprietary colour blending and calibration method to precisely measure and adjust colour-dependent value and chroma. At the same time, the finely flowing colour gradations from the tooth neck to the

Image: Nacera® Pearl Q³Multi-Shade Benefits & Indication: Revolutionary match of theVITA* shades and lifelike smooth color transitions Make monolithic crowns and bridges up to 3 units, veneers, inlays, onlays Finish in One-Bake, e.g. with ceraMotion® One Touch Your ergonomic system to achieve the most common shades

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edge give the dental prostheses ? either fully anatomical or anatomically reduced ? a natural colour character. These improvements make it easier for ceramists to predictably produce highly aesthetic zirconium dioxide restorations. Thanks to selective control of grain size and density, and the "Instant Fit Process" (a high-precision sintering process) developed by Doceram Medical Ceramics, light transmission and translucency have been further increased, and are now comparable to that of a lithium disilicate ceramic! W ith a bending strength of 700 +/ - 120 MPa, Nacera Pearl Q³ Multi-Shade can be used not only to produce highly aesthetic and durable monolithic single tooth restorations but also three-segment bridges. The new polychrome UHT zirconium blanks are available in 98 mm, with 16 or 20 mm thicknesses. Additionally, all popular shades for posterior, anterior, and bridges up to three units are being offered: A-Light, A-Dark, B-Light, B-Dark and C. Relying on best-in-class technology, dental technicians can now count on Nacera Pearl Q³ Multi-Shade for modern CAD/ CAM restoration material when highly aesthetic restorations are required. Its natural colour and translucency progression easily, reliably and efficiently ? makes it a perfect addition to the Nacera system family.


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NEW h ybri d composi te w i th properti es si mi l ar to many al l -cerami cs Nacera Hybrid Composite for CAD/ CAM by Doceram

M edi cal Cerami cs f or ch ai rsi de and l absi de f abri cati on. Millable Nacera Hybrid Composite matches improved aesthetics with durability: Doceram Medical Ceramics? new Nacera Hybrid meets all the requirements of a modern, multi-functional composite for CAD/ CAM technology? whether it is produced chairside or in the lab! These highly compressed hybrid blanks, combining the best characteristics of ceramics and composite, guarantee not only long-term dental aesthetics and maximum levels of elasticity, but also universal processability and versatility. That means Nacera Hybrid restorations can be repaired or adjusted at any time using typical composite systems. W ith four new Nacera Blend Tissue Flow composites as part of the system, you can design and build customised gingival portions or if desired, remodel them at a later stage.

Images (Left & below) Nacera Hybrid Blocks for chairside and labside applications are available in two block sizes with "M" and "S". Ready-made Nacera Hybrid restorations can also be adjusted and repaired by the dentist directly in the patient?s mouth using commercially available composite materials.

W ith its unique compression strength approaching 500MPa, an extremely low modulus of elasticity (10GPa), and a Vickers hardness similar to dentine (0.71GPa), Nacera Hybrid is currently the leader in stable, flexible and antagonist-friendly CAD/ CAM restoration materials. Furthermore, with a bending strength of 170MPa, its homogeneous hybrid structure places it safely in the ceramics range. The secret lies in its unique chemical composition and the proprietary mixing ratio of 70% glass-ceramics to 30% polymers and nanofillers. The homogenous blending, with improved occlusal/ compressive strength and reduced risk of chipping or fracture, make it the perfect solution patients requiring long-term placement.

Out st anding Flexibilit y and Compression St rengt hs W hether It?s anterior or posterior, millable Nacera Hybrid blocks and discs can be used for classic crowns and bridges, implant-based treatments, minimally invasive inlays and onlays or aesthetic table tops and veneers. Doceram Medical, the Dortmund, Germany based manufacturer, engineered Nacera Hybrid to provide aesthetic translucency at strengths able to withstand the reduced thicknesses required for anterior teeth. And like the finest ceramics, Nacera Hybrid replicates precise shade matching with the chameleon effect of opalescence and fluorescence that mimics the vitality of natural teeth.

Nacera Hybrid is available in two block sizes (15.5 x 38.8mm and 18 x 15mm) and in two-disc sizes (98.3 x 15mm and 98.3 x 20mm) for dental laboratory milling. It is complemented by the Nacera Blend Tissue gingiva set with four colours.

Nacera Hybrid is available in Vita Shades, A1, A2, A3, B1, D2, C2, and BL2. And even though Nacera Hybrid shares many ceramic properties, its composite structure can be repaired or refinished directly in the mouth using composite materials of choice? a great benefit for patients with temporomandibular dysfunctions (TMD) who might need occlusal build-ups.

Versat ile repair composite!

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adjust ment

opt ions

using

Using our four new flowable Nacera Blend Tissue composites, it is possible to complete hybrid-ceramic treatments directly from the syringe with pink/ red aesthetics and apply customised characterisations? chairside, as well as, in the lab. Gingiva-coloured flow materials are also suitable for subsequent corrections or remodeling of gum-colored restoration portions, and for underpinning provisional and definitive implant work following a loss of soft tissue or bone material!

Find out more or to request a sample please visit : w w w.nacera-hybrid.com 21


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TECHNOLOGY FOCUS

Focus on demi neral i sati on Dr Ben Atkins recently received the CALCIVIS imaging system, a new technology that uses a unique photoprotein to bind with the free calcium ions that are indicative of active demineralisation. The resulting bioluminescent (light-emitting) signal will allow the chair side identification of active dental caries at their earliest stages. Describing it as ?innovative?, he believes the CALCIVIS imaging system could be a valuable tool to enable the preventive management of caries and to help educate patients to take responsibility for their oral health in the home. ?It could be a tool to identify behavioural changes in patients, as a method of warning or of encouragement, and provide a visual aid to help patients better understand their own dental hygiene habits, showing them any particular areas that they need to focus on and why,?he says.

?I think focusing on demineralisation to help identify early caries may be as critical a step as X-rays were 20 yearsago, and could be the key to identifying dental decay before cavities form,?

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Once unimaginable, the eradication of dental decay could be a possibility in the future thanks to cutting-edge technology. ?I think focusing on demineralisation to help identify early caries may be as critical a step as X-rays were 20 years ago, and could be the key to identifying dental decay before cavities form,?Ben says.

For more informat ion visit ; w w w.CALCIVIS.com or call +44 (0)131 658 5152 Ben At kins,Clinical Director, Revive Dent al Care w w w.drdenat kins.co.uk w w w.revivedent alcare.co.uk Content supplied by EK Communications Ltd.


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A mazi ng new tech nol ogy f or ch ai r si de restorati ons The MyCrown system is an amazing addition to the practice,? said Dr Richard Pollock from The Chelsea Harbour Dental Practice. ?The technology is excellent and the ease of use for the operator is fantastic. The touchscreen and quality of the images makes the whole process extremely straightforward and it has really transformed the way I practice dentistry. ?MyCrown has taken my practice to a whole new level. I am able to create all types of restorations with the MyCrown system right here at the chair side. It has enhanced the patient experience tremendously because they can be fully involved in the design

process and I am able to deliver high quality, permanent restorations within one hour. ?Many patients ask me if I could make all their teeth as smooth as the MyCrown restorations. They love the feeling of them in the mouth and are delighted by the superior, natural looking aesthetics that can be achieved.? To see your practice reach new levels of dental excellence, discover more about the MyCrown fully integrated CAD CAM and chair side milling system now. For more informat ion, visit : w w w.fonadent al.com/ product s/ mycrow n

?MyCrown has taken my practice to a whole new level. I am able to create all types of restorations with the MyCrown system right here at the chair side."

Content supplied by EK Communications Ltd.

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A ccurate scanni ng-on th e go! W hile the True Definition scanner from 3M Oral Care has exhibited a 99.7 per cent fit rate since launch ? making it one of the profession?s most accurate intraoral scanners* the expert team at 3M Oral Care is not one for resting on its laurels. That?s why it has developed the Mobile True Definition scanner! Maintaining the same benefits of the True Definition Scanner, the new system operate solely on a tablet, making it easy to move from one surgery to another ? and providing you with excellent flexibility.**

For more information about how you could enjoy its truly mobile benefits, contact the 3M Oral Care team today. For more information, call +44 (0) 845 602 5094 or visit: w w w.3m.co.uk/ oralcare 3M and True Definition are trademarks of the 3M Company *3MOral Care Internal Data:99.7% fit rate. Claim 5640 (2016) **3M Oral Care Internal Data:Simple to move. Claim 6631 (2016) Content supplied by EK Communications Ltd. 24


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A n angel i n di sgui se: How one Denti st w ork ed a smi l e mi racl e f or a surv i v or of domesti c abuse "The smallest gesture from us can make a life-changing impact on others. All dentists should be involved in giving back and paying it forward." Dr. Walker.

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By: Mat t Bombeck


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Dawn vividly remembers the day she left her abusive husband. She woke up in a hospital, skull fractured, ribs broken, face scarred. Her teeth were destroyed. She had lost everything: her job, her house, her self-respect. Her first three months of freedom, she slept on a mattress on the floor, still so fearful of her life that she faced the door with a loaded gun. Resilient by nature, Dawn spent months trying to rebuild her confidence, but when she looked in the mirror, she only saw her physical scars, reminders of a painful past. She only found jobs where she could stay hidden, covering up her facial scars with makeup, always putting her hand over her mouth to hide what once was a confident smile. She was ashamed of the way she looked.

January-March 2018

he listened to Dawn's story; a once successful woman, a grandmother who had survived ovarian cancer and still had more to give. Dr. Walker knew that she had the potential to turn her life around. Unfortunately, the extent of Dawn?s dental injuries went beyond Dr. Walker?s scope. Dawn?s dentition was almost non-existent due to long-term abuse and stress from clenching and grinding. Undeterred, Dr. Walker called a local colleague and oral surgeon, Dr., Leslie Fish, who teamed up with Paul to help Dawn. Dawn refers to Dr. Walker and Dr. Fish as her angels. After several visits, Dr. Walker removed her nonrestorable teeth on the maxillary arch and gave her a new denture to restore her smile. The impact on Dawn?s life was enormous.

Struggling financially, there was no way that Dawn could afford the expense of restorative dental work so badly needed.

"GBAS gave me back the dignity my abuser had robbed me of. I no longer look in the mirror and see a tarnished woman. I see a beautiful smile and light in that woman?s eyes. I have become the selfie queen!?

A domestic abuse advocate told her about a dental program called Give Back a Smile that helped victims of domestic violence. Dawn applied to the program, and two months later, she received a letter in the mail from a cosmetic dentist in Chandler, Arizona, Dr. Paul Walker. Summoning her courage, Dawn called Dr. Walker?s office and heard the comforting words, ?We?ve been expecting your call.?

Dr. Walker saw firsthand the enormous difference he and Dr. Fish made in Dawn?s life, not only giving back Dawn's smile but the confidence to move forward. Dawn is now getting her doctorate in counseling and working towards her dream of advocating for other women trapped in abusive relationships.

Inspired by his sister who started a non-profit organization for domestic violence victims, Dr. Walker got involved in Give Back a Smile (GBAS) three years ago by simply wanting to do his part. He was all too familiar with domestic violence cases, not just the physical damage inflicted on victims, but the emotional toll it took as well. On Dawn?s first visit,

Being a part of GBAS has given Dr. Walker a new perspective on his profession. "After being dentists for many years, we forget about what an impact we can make on someone?s life. The smallest gesture from us can make a life-changing impact on others. All dentists should be involved in giving back and paying it forward.?

Images, left: before & after. Domestic violence victim Dawn is delighted with her new smile.

"GBASgave me back the dignity my abuser had robbed me of. I no longer look in the mirror and see a tarnished woman. I see a beautiful smile and light in that woman?seyes. I have become the selfie queen!? If you are inspired by Dawn?s story and interested in becoming part of the GBAS program and helping those in need, please contact the AACD Charitable Foundation. w w w.giveback asm ile.com (+1) 800.543.9220 giveback asm ile@aacd.com

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HEALTH FOCUS

Wh en too much sugar i sn't sw eet...

Dentist Azzie Naser Zadeh has a strong focus on prevention at her clinic. However, despite the fact her patients have a good home oral care routine and regularly book hygienist appointments, the harmful effects of sugary processed foods are a cause for concern when it comes to maintaining their oral health. The relationship between oral health and systemic health has become a topic she cannot ignore. In a bid to educate her patients and the public about

By: Azzie Naser Zadeh sugar consumption, Azzie started an Instagram page

"The message behind my Instagram page is not that we should never eat sugar. However, it is essential to make good, informed choicesabout food."

dedicated to this important issue. On her page (@sugar_spy) she shares sugar awareness visuals that demonstrate the amount of sugar contained in the packaged foods, including products sold to the public as healthy, low fat, and non-sweet.

Images (left and facing page) a selection of sugar awareness visuals based on nutritional information on the food label. Notes: Some low-fat drinks contain more sugar content than beverages traditionally known to be high in sugar, such as soda. Some peppermints (not all peppermints, those that aren't sugar-free) contain as much as one full sugar cube per piece. Juices and flavored water drinks often contain as much sugar as soda, or sometimes more. Some products such as potato chips sold as salty snacks contain as much as three sugar cubes. The ketchup visual demonstrates how much sugar there is in the processed sauces we use every day. Breakfast foods such as cereal and yogurt that are popular with children can be very high in sugar. Images created and owned by: Azzie Naser Zadeh

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"As a child, I was always interested in the human body and wanted to become a doctor. I loved working with my hands and fixing stuff. However, I am also interested in the person behind the body, and that?s why dentistry is the perfect job for me. I get to work with my hands but also interact on a social level with my patients.

As part of my efforts to educate people about the amount of sugar in food products that we all eat every day, I started an Instagram page (@sugar_spy). On the page, I share sugar awareness visuals that demonstrate the number of sugar cubes per food or drink item, based on the nutritional information on the product label.

In the Netherlands, high-quality dentistry services are available, but prevention is also essential. Going to the dentist regularly for check-ups and to the dental hygienist for regular cleaning is normal. At my clinic, we put a lot of time and effort into prevention; this means educating patients.

I noticed there is a current trend in interest for healthy foods growing on social media, so my Instagram page is the perfect platform to reach more people and spread the word about this issue, not only to my patients but people outside of my clinic.

During the last ten years working as a general dentist, I noticed that a good oral hygiene isn't the only factor that prevents oral problems. Another critical issue is the relationship between oral health and systemic health. In other words; a healthy mouth is essential to have a healthy body. Even though I noticed the oral hygiene of my patients had improved during the last years, I wanted to do something more. I began focusing on the effects of diet on oral health.

"I wanted to do something more. I began focusing on the effects of diet on oral health."

I started by asking the parents of children with cavities about their food choices at home, and it became clear that lot of them were not aware of the effects that diet can have on teeth. They were, of course, aware of the harmful effects of foods that traditionally known to be bad for teeth such as candy and chocolate. However, they didn't seem to know about the problems caused by consumptions of sugary drinks such as soda. There was also little knowledge about the "hidden" sugars and sweeteners in foods such as yogurts, sauces, cereals juices and other flavored drinks. Even foods marketed as "low-fat" and "healthy options" to the public have large amounts of sugar and parents are not aware of what they are feeding their children.

The message behind my Instagram page is not that we should never eat sugar. However, it is essential to make good, informed choices about food, and I'm trying to raise awareness about that. Nowadays, when we walk into a supermarket, we have so many food choices. The only way to make the right decision is to look at the food label and to compare.

As the popularity of my page grew, my Instagram followers started asking me dental questions, so as a reaction to this I started regular "Tuesday Tooth Day" posts where I was able to address some of these topics and dental questions. Now, I also have online interactions with patients worldwide, which makes my job even better. My goal is to make Dent ist ry more accessible, and to improve oral healt h aw areness.

You can follow Azzie Naser Zadeh on Instragram @sugar_spy or on Facebook @sugarspydentist

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Dr Brite founders: Dr. Pooneh Ramezani, DDS and Dr. ParisSabo, MD.

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INTERVIEW


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What do you know about plant-based alternative products?

Tak e a l ook at th e Bri te si de "Dr. Brite" founders Dr. Pooneh Ramezani (DDS) and Dr. Paris Sabo, (MD) are a dynamic sister duo on a mission to educate their patients, the public and health professionals about natural alternatives to the mainstream oral care products we all know. The brand consists of plant-based toothpaste, mouthwash, teeth whitening and skin care products, backed by science. With a firm belief that dentists should offer organic products to health-conscious patients, they have launched an innovative professional line named ?Rejuvenate by Dr. Brite.? Their passion for the Brand comes through in the products: formulated to be safe, great tasting, effective and all made from botanical ingredients. Dental Insights Magazine was keen to learn more about this exciting new product line. We had a chat with Dr. Ramezani and Dr. Sabo to find out why they believe plant-based alternatives will be the future of oral care products. W hat is t he inspirat ion and et hos behind Dr. Brite as a brand? Dr. Paris Sabo, MD: Dr. Brite was inspired in large part by my son. W hen he was a toddler, he developed a habit of eating toothpaste, and when I noticed the ingredients found on the back of a toothpaste tube, I was completely shocked! Often, there are warning labels on some oral care products, but do we consider the dangers of exposing ourselves to harmful chemicals? These thoughts and this moment led me on a mission to create a natural option for my family. Dr. Pooneh Ramezani, DDS: Another source of inspiration for creating Dr. Brite came from my knowledge and experience as a practicing dentist. In my 20 years of practicing dentistry, I was recommending conventional oral care products to my patients, friends, and family because they were simply the status quo. It?s what I knew and what was also reinforced in dental school. But now, and with the help of my sister Dr. Sabo, I?ve personally seen the real-life results of using a natural oral care routine through my family and my patients. My sister and I are now on a mission to educate everyone. From patients to consumers, we want to share our knowledge so that people become aware of what?s lurking in their personal care products. Regulations around personal care products, especially in the U.S. are pretty lax and we want to equip people with the knowledge of healthier ingredients. Dr. Brite makes nat ural, plant-based toot hpaste, mout hw ash, teet h w hitening product s and skin care product s t hat are backed by science, made in t he USA. Can you tell us a lit t le more about t he science behind t he product s? For example, t hen tell me more about t he ingredient s in your w hitening product s. Dr. Sabo: Our formulas are specifically created with ingredients to work synergistically. Across our two lines, Dr. Brite and Rejuvenate by Dr. Brite, we?re proud to be one of the few companies that include vitamin C in our formulas to help improve gum health. We also use botanical ingredients like organic coconut oil, which is antibacterial, antifungal, and helps gently whiten

teeth. Organic aloe vera juice helps hydrate and nourish symptoms of dry mouth, while also reducing plaque. Organic neem oil is also another fantastic ingredient that helps prevent gum inflammation and can prevent periodontal disease. We also include just the right amount of white activated charcoal to help gently whiten teeth and detoxify the mouth, so that consumers get the benefits of activated charcoal without a gritty feeling or a possibility of tattooed gums. In addit ion to consumer product s, you also have a professional line named Rejuvenate by Dr. Brite. Can you tell us more about t his line? Dr. Ramezani: More and more, people are becoming health-conscious, which is fantastic. As a result, dental patients are requesting for natural alternatives from their dental professionals and Rejuvenate by Dr. Brite provides a safe, effective, and great-tasting oral care option to help fill this want. All products in our Rejuvenate by Dr. Brite line contain clinical-strength formulas that are stronger than our consumer brand, which makes it a perfect option for dentists to offer their patients. Rejuvenate by Dr. Brite currently has two collections, the Ultimate Teeth W hitening Collection and the Ultimate Oral Health Collection. The Ultimate Teeth W hitening Collections includes Rejuvenate?s Natural Toothpaste that is formulated with activated charcoal, organic coconut oil, and vitamin C to help detoxify the mouth, whiten teeth gently and help boost gum health. Our Natural W hitening Mouth Rinse provides a nourishing clean feel without alcohol, artificial colors or flavorings with the help of organic aloe vera juice. The Advanced Repair and Restore Oral Spray contains organic tea tree oil, gotu kala, cinnamon oil, and sage oil to help calm gum inflammation and help improve gum health. Lastly, our NITE & DAYÂŽ Natural Teeth W hitening Pens offer a quick, easy, and safe teeth whitening system. We use clinical-strength hydrogen peroxide and carbamide peroxide along with an infusion of organic coconut oil, vitamin C, and neem oil so that teeth and gum health is maintained and protected.

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Dental I nsi gh ts January-March 2018 For patients with a dazzling smile and want to maintain this dazzle, the Ultimate Oral Health Collection includes our Natural Toothpaste, Natural W hitening Mouth Rinse, and Advanced Repair and Restore Oral Spray. Is Rejuvenate by Dr. Brite current ly available to Dent ist s in t he USA only or in ot her count ries too? Dr. Ramezani & Dr. Sabo: Rejuvenate by Dr. Brite is available worldwide. We distribute through Henry Schein (henryschein.com) and Patterson Dental (pattersondental.com). Dental professionals interested in carrying Rejuvenate by Dr. Brite can also directly contact us at info@instantrejuvenate.com. There is a grow ing market for plant-based, organic product s. However, w hat obst acles you have had to overcome regarding educat ing Dent al Professionals on t he benefit s of your product s, and encouraging Dent ist s to offer plant-based alternat ives to t heir pat ient s? Dr. Ramezani: Unfortunately, many dental professionals around the world are not trained in regards to ingredient safety. In Europe, for example, around 1,200 ingredients are banned, but this isn?t the case in the U.S. This means that irritating, harmful chemicals can easily be added into oral care products because they?re less expensive. To change mindsets, we provide clinical studies to dental professionals to show the results of patients using Rejuvenate by Dr. Brite. Additionally, we provide information about common ingredients found in status quo oral care and how they can lead to potential irritation to oral cavity tissues. It?s all about educating our fellow dental professionals to think and approach dentistry differently.

It ?s great to see t hat you have created a brand t hat ?s organic, vegan, eco-friendly, and t hat you are also donat ing a percent age of sales revenue to good causes each year. Is giving back import ant to you? Dr. Sabo: Giving back to our local community is incredibly important to us and in fact, we donate 5% of our revenue in the form of cash donations or products throughout the year. This, along with our value to be transparent with our business practices, provide fair wages to our employees and an environmentally-conscious workspace, actually led us to become a Certified B Corporation. B Corps are for-profit companies certified by the nonprofit B Lab to meet rigorous standards of social and environmental performance, accountability, and transparency. We also regularly partner with local non-profits organizations like Jamboree Housing, which is dedicated to providing affordable housing and services for working families, seniors, veterans, formerly homeless, and those with special needs in Southern California. W hat are your fut ure plans for Dr. Brite as a company and how import ant do you t hink it is for dent ist s to offer plant-based, organic product s to pat ient s moving into 2018? Dr. Ramezani & Dr. Sabo: For 2018, we?re looking to expand and continue our mission to educate dental professionals about natural oral care options. We sincerely think it?s incredibly important to bring to light how natural ingredients along with proper oral care habits can be successful.Trends come and go, but we truly believe that patients will continue to request natural alternatives, so why not explore these options?

Find out more about Rejuvenate by Dr.Brite: w w w.inst ant rejuvenate.com

"People are becoming health-conscious, which is fantastic. As a result, dental patients are requesting for natural alternativesfrom their dental professionalsand Rejuvenate by Dr. Brite provides a safe, effective, and great-tasting oral care option to help fill this want."

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Dental I nsi gh ts January-March 2018

CASE STUDY

Goi ng Di gi tal w i th I ntegrated Smi l e Desi gn BY: DANIEL WORICKER BDS Daniel Woricker, who practices at Longwell Green Dental & Implant Clinic in Bristol, has realised the potential and opportunities digital isbringing. Now, more than ever, digital has become an important aspect of peoples lives and it's something he believes patients expect when they walk through the door. Going digital started with the treatment plan and the Integrated Smile Design - something he couldn't do without now having seen the benefits. The patient wasrecommended to Daniel by a friend, whom Daniel had treated. After some needed restorative work was completed, a set of clinical photographs were taken which allowed him to start her treatment plan. Daniel can then start looking at facial proportions, skeletal pattern, occlusal relationships, arch form and tooth positioning.

INTEGRATED SMILE DESIGN

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CASE SUMMARY RELEVANT MEDICAL HISTORY: Nil CLINICAL EXAMINATION: EXTRA-ORAL FEATURES Skeletal pattern: class 2 Frankfort mandibular planes angle: average Facial proportions: average Soft tissues: lips competent TMJ: no abnormality noted 35


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CLINICAL EXAMINATION: INTRA-ORAL FEATURES Asymmetries: none detected Soft tissues: healthy Oral hygiene: moderate Erupted teeth present: U: 7 6 5 3 2 1|1 2 3 5 6 L: 7 6 4 3 2 1|1 2 3 4 6 General dental condition: good Crowding/ spacing: moderate crowding upper arch, mild lower Incisor relationship: class 2 div 1 Overjet: 6mm Overbite: reduced Centrelines: Upper midline shifted 1mm to the left, Lower midline shifted 2mm to the left Displacements: None detected Other occlusal features: distally rotated 22, 16 and 15 tipped palatal and in crossbite, 35 rotated nearly 90deg Once the assessment is completed, the final desired position can be created to improve the patients smile. Once the smile design is completed, simulated treatment outcomes are presented to the patient for discussion. This is a great part of the smile design presentation as the patient is more involved in their treatment planning. The patient agreed that her centrals would appear better proportioned if they were narrower, and she was able to see how doing this also helped to align the teeth and reduce the overjet she disliked. W hen the patient was happy with the proposed plan, Daniel went on to discuss the different options available to achieve this. Examples of different fixed labial brackets, lingual braces and aligners along with there pros/ cons and cost were shown and discussed. The patient decided to go with ICE upper and lower fixed brackets, and was shown how this may look using the smile design.

SMILE DESIGN

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SMILE DESIGN

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SIMULATED TREATMENT

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WATCH VIDEO

TREATMENT PLAN AND PROGRESS TREATMENT AIMS: 1. Relief of crowding 2. Level and align t he arches 3. Correct t he overbite 4. Correct t he overjet 5. Retent ion TREATMENT PLAN 1. Upper and lower fixed appliances 2. W ire sequence - Nit i 0.014, 0.016, 0.018, SS 0.018, NiTi 0.016 x 0.022 3. IPR ? focusing on improving shape of cent rals as very w ide 4. Cross arch elast ics and composite occlusal stops to correct rhs crossbite and expand arch

W hen the presentation of their smile design is complete patients are emailed a pdf presentation to look over, show their family and friends before they decide to go ahead. This gives them time to make sure they are happy with the proposed plan and to bring up any questions they may have. It is also nice as it shows that the smile design is there to help them get the smile they want, not for the clinician to pressure them into any treatment. The smile design given to the patient also includes several slides on all the risks such as pictures of root resorption, decalcification, relapse etc. Finally there are some slides on cost and finance and what to do once they have decided to go ahead.

5. Upper and lower removable and fixed ret ainers 6. W hitening

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BRACES FITTED, 14TH DECEMBER 2016 Patient attended for the fit appointment of her upper and lower ICE brackets. They were indirectly bonded using the vacuum formed guides provided by W ired orthodontics laboratory. The process was quick, simple and the patient found the process comfortable. I like how quickly the brackets can be placed indirectly and the confidence that they are in the correct position saving me from lots of wire bending or bracket repositioning later on. The patient was given wax and good oral hygiene and diet was reinforced. Patient was happy with the appearance of the brace.

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TREATMENT PROGRESS, 23RD JANUARY 2017, Patient attended for her 1st review appointment. Quickties were placed on her upper 2-2 as she was unhappy with staining of the elastic orings. Occlusal view of lower arch showed teeth already in good alignment. Occlusal view of upper showed slight improvement in 11 positioning but 22 still quite rotated. Cross bite on RHS unchanged.

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5 MONTHS INTO TREATMENT, 18TH MAY 2017 Occlusal stops have been placed along with a palatal button on the 16 to help correct the rhs cross bite. This has also expanded the arch and given more space to retrocline the 11. Upper and lower arches have started to align and level. Power chain placed to help retrocline upper centrals and reduce OJ. Patient is very happy with how the treatment is progressing.

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TREATMENT PROGRESS, 17TH JULY 2017 7 months into treatment. Occlusal stops and palatal button removed as rhs cross bite had corrected. LW was shown how to place class 2 elastics to improve occlusion. IPR completed to reduce width of centrals and create space to reduce OJ.

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15TH AUGUST 2017

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COMPARISONS

TREATMENT IN PROGRESS 8 mont hs into t reat ment . Patient is very happy with the result and we are planning to debond soon. Patient was vocal about how good they look which was great to hear. During the treatment patient has also given up smoking thanks to improved pride over the appearance of her teeth and has been told by her family and friends that she is smiling much more than she ever used to. I am looking forward to completing this case and seeing how close we came with the smile design to the final result. The progress so far looks promising!

Learn More about ISD and Digit al by visit ing : https:// wired-orthodontics.co.uk/ index.php?p=services/ training/ 2-day-conference

To Learn More about Digit al Discovery and to Book visit t he W ired Ort hodont ics website 45


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Your dreams are cal l i ng you The first steps in developing a strategic plan for your dental practice. By: Diane Bernstein and Mickey Bernstein DDS, Bernstein Dental Consulting.

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BUSINESS FOCUS


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"Your business is the vehicle which allows the personal dream to approach reality. Your practice should be efficient, low stress, and profitable." The Golden Gate Bridge is an engineering marvel and a beautiful work of art. It first opened to traffic May 28, 1937. Annual Revenue in 2002 was $59,289,000 from tolls. That is a lot of quarters. Annual traffic in 2002 was 40,694,792 vehicles, and the monthly load was 3,391,223 or 111,493 vehicles every day. Today, the Golden Gate Bridge remains the tallest bridge in the United States. The City Engineer, Michael O?Shaughnessy, and Construction Engineer, Joseph Strauss had to first DREAM about an artistic design to connect the City of San Francisco and Marin County and carry an enormous number of vehicles efficiently every day and for many years to come. After they refined their dream, a definitive VISION was developed to present to the political powersof the time. Once accepted, values, operational standards, goals, and daily systems were developed. Methods to measure success and monitorsfor the systemsfollowed. The successful dental team follows a similar process to build a dynamic "Dream Practice" to carry it into the future.

In our previous art icle on St rategic Planning, we out lined t hose logical and necessary steps: 1. 2. 3. 4. 5. 6. 7.

Dreaming Vision Mission Values Clarificat ion St andards Goals/ short and long-term Business and Clinical Systems

PERSONAL DREAM We should all imagine and plan a life that fulfills our desires for our family and ourselves. We spend the majority of our time at work to provide a fulfilling life for our family. W hen developing your dream, ask yourself the following questions; thinking 5-10 years into the future: How much free time do you have to enjoy family, hobbies, sports and health activities? Are you in the same home in 5 years? W hat does it look like? Do you invest more time in your spiritual growth and charitable endeavors? Are you financially independent (and working for joy) or well on your way to retirement? PRACTICE DREAM Your business is the vehicle, which allows the personal dream to approach reality. Your practice should be efficient, low stress, and profitable. To dream about the ideal dental practice in a world that has no barriers, consider the following: Are you in the same remodeled facility or a new building large enough for an expanded patient base or have you downsized to ?lean and mean?? Do you have ?Steward Team Members? who are vested in the ongoing success of your practice and are they students of their respective areas of expertise? Have you introduced new procedures and techniques that you are passionate about and increase profitability? These might include sedation, sleep dentistry, implants, orthodontics, facial enhancement with injectables, or new cosmetic procedures?

This art icle w ill address Dreaming and Vision in more det ail to help you get st arted on your ow n Golden Gate Bridge.

Is there new equipment to support the new techniques?

DREAMING

How do patients arrive at your practice? Are they referred from dental specialists or MDs, a strong internal marketing program, Internet or other marketing, or your new location?

Many doctors and team members (as well as small business owners outside of dentistry) feel that those who sit around dreaming about that which may never happen are wasting time and should be busy doing the hard work. We believe that investing time in the ?right brain?exercise of imagining a world where all your ideal desires do exist will propel you forward into a much loftier reality.

W hat kind of advanced education have you and your team received? Have you received any certifications in Implants, Cosmetics, or Sleep Dentistry?

Do they gladly pay a fair fee to have your quality care? Have you and your team mastered communication and ethical sales?

the art

of

Do you have a well-designed Strategic Plan in written or digital form? Does the entire team understand and embrace the plan? 47


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Have you reduced insurance participation or become insurance independent? How would your patients, vendors, and colleagues describe your Practice Brand? Are there defined systems for all business and clinical activities that allow the practice to function like a finely tuned machine? PRACTICE VISION A living and impactful Vision is the centerpiece of a healthy practice?s decision-making and daily activities. After the entire team puts energy into developing the Vision, daily stressors seem to be minor because the answers are always evident with a clear understanding of your roadmap. Positive DREAMS are the fabric leaders weave together into a VISION to change your practice and the world. A strong leader can see what is possible and then take the next steps to rally and unite the team to create something spectacular. Every great transformation or invention starts with an idea and a vision of what is realistically possible in a given culture and demographic. The leader must be able to articulate and communicate the Vision in a simple, clear, bold, and compelling way that the team members can feel in their gut as the embodiment of the road ahead. The Vision should be written in a Practice Manual in print, digital form, or in the cloud where it is available for all to access. 48

"Positive dreams are the fabric leaders weave together into a vision to change your practice and the world."

W hen designing Team Meetings or considering suggestions to help the practice, always ask yourself: ?Does this idea complement the Vision?? In a favorite book of ours, Leaders Eat Last, Simon Sinek eloquently writes: ?A good vision statement explains in specific terms what the world would look like if everything we did was wildly successful. And if we find that vision inspiring and worthy of our time, then we can easily plan the steps to achieve that vision. The clearer we can see what we are setting out to achieve, the more likely we are to achieve it.? Please join us in the next issue to discuss Mission, Values, and Standards in the best dental practices. About t he Aut hors: Diane Bernstein has enjoyed 35 years in healt hcare and 25 years as Pract ice Administ rator/ Pat ient Coordinator at Germantow n Dent al Group. She is highly skilled at communicat ion skills, coaching teams, and consult ing Doctors for opt imal outcome. Dr. Mickey Bernstein has pract iced cosmet ic dent ist ry for 42 years in Germantow n, TN. He is an Accredited Member of t he American Academy of Cosmet ic Dent ist ry and served as President in 2008-2009. An Alumnus of t he Panky Inst it ute, he also is a Fellow in t he AGD, ACD, and ICD. Toget her Diane and Mickey operate Bernstein Dent al Consult ing helping dent al pract ices achieve t heir dreams. They can be reached at :

w w w.bernsteindent alconsult ing.com


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Contact details Editorial email: editorial@ewisdom-publications.com For magazine advertising & email sponsorship opportunities, please email: Sophia Smith director@ewisdom-publications.com Dental Insights Magazine is published by eWisdom Publications Limited, UK. We would like to thank the authors who contributed to Issue 2 .

The informat ion, opinions and views present ed in Dent al Insight s Magazine, published by eW isdom Publicat ions Limit ed reflect s t he views of t he aut hors and cont ribut ors of t he art icles and not of t he Dent al Insight s Magazine or eW isdom Publicat ions. Publicat ion of art icles, advert isement s or product informat ion does not const it ut e endorsement or approval by t he journal and/or it s publisher. Dent al Insight s Magazine and/or it s publisher (eW isdom Publicat ions Limit ed) cannot be held responsible for any for any consequences arising from t he use of t he informat ion cont ained in t his journal. Alt hough every effort is made by t he edit orial board and t he publishers t o see t hat no inaccurat e or misleading dat a, opinion or st at ement appear in t his publicat ion, t he dat a and opinions appearing in t he art icles including edit orials and advert isement s herein are t he responsibilit y of t he cont ribut ors concerned. The publishers and t he edit orial t eam hold no liabilit y what soever for t he consequences of any such dat a, informat ion, opinion or st at ement in t his magazine. W hilst every effort is made by t he edit orial board and t he publishers t o ensure t hat informat ion is present ed accurat ely, readers are advised t hat new met hods and t echniques involving medical/product usage as described in t his publicat ion, should only be followed in conjunct ion wit h t he expert /manufact urer's own published lit erat ure in t heir own count ry.

Dental Insights Magazine is published by eWisdom Publications Limited, UK. Company registration number: 10806932. 49

Dental Insights Issue 2 US  
Dental Insights Issue 2 US