SADTJ Volume 8 Issue 1 by SADTJ

October 2019 Issue January 2019 • Vol Vol 78Issue 3 1 Business Interruption Insurance • Absenteeism January 2019 • Vol 7 Issue 3 Clinical evaluation of failures in removable partial dentures • Mandibular Response To • The Absenteeism OcclusalSculptures Relief Using A Flat Guidance Miniture Claire Ewart Phipps •bySplint The Mandibular Response To

Occlusal Relief Using A Flat Guidance Operational Benefits of Partial Complete •The A Functional Stress Analysis In The or Maxillary Splint Adaptation of DAMAS Complete Denture, Influenced By The Position Of Artificial Teeth Load Levels Can Still Learn theAnd Peter Principle •We A Functional StressFrom Analysis In The Maxillary Complete Denture, Influenced By The •Grow Corporate Governance In AAnd Time Of Levels YourOfLab and Do Your BestLoad Work by Position Artificial Teeth Starting a Study Complexity AndClub Crisis •Tips Corporate Governance A Time Of To Survive A CCMAInCase Complexity And Crisis

SADTJ

ISSN 2077-2793 ISSN 2077-2793

The Southern African Dental Technology Journal The Southern African Dental Technology Journal

E6 7

13 B8 E6 11.8 E6-6.3 7 13 B8 15.3 B8 -6.3 3.5

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In This Issue SADTJ Vol 8 Issue 1 October 2019 Editor Axel Grabowski Managing Editor Mariaan Roets PUBLISHED BY The Dental Technicians Association of South Africa LAYOUT AND DESIGN Marcel Schoombee ADVERTISING ENQUIRIES m.roets@dentiworks.com ADDRESS CHANGES Elize Morris: dentasa@absamail.co.za ACCOUNTS Elize Morris: dentasa@absamail.co.za Tell: 012 460 1155 Fax: 086 233 7122 DENTASA PO Box 95340, Waterkloof, 0145 Tel: 012 460 1155 Fax: 086 233 7122 dentasa@absamail.co.za www.dentasa.org.za

Dentasa Executive Members

Clinical evaluation of failures in removable partial dentures

Miniture Sculptures by Claire Ewart Phipps

16.

The Operational Benefits of Partial or Complete Adaptation of DAMAS 17. We Can Still Learn From the Peter Principle

21.

Grow Your Lab and Do Your Best Work by Starting a Study Club

23.

Tips To Survive A CCMA Case

28.

STATEMENT OF INTENT The Southern African Dental Technology Journal is published quarterly. The main objective of the Journal is to provide the professional with the opportunity to earn CDP credits through completing the questionnaires, or writing articles. All papers in English, on any aspect of dental laboratory science or related disciplines, will be considered on merit and subject to the review of the editorial board and the CPD accreditation committee. EDITORIAL, ADVERTISING AND COPYRIGHT POLICY Copyright of individual articles appearing in this publication reside with the individual authors. No article appearing in this publication may be reproduced in any manner, or in any format without the express written permission of its author and a release from this publication. All rights are reserved. Opinions and statements, of whatever nature, are published under the authority of the submitting author and should not be taken as the official policy of the Dental Technology Association of South Africa.

DENTASA EXECUTIVE MEMBERS PHONE

Wayne Thornhil

President Gauteng North Branch Chairperson

079 894 4980

wayne.camm@gmail.com

Channell Steenkamp

Vice President Mpumalanga Branch Chairperson

082 804 0929

channell.steenkamp@ yahoo.com

Christopher Polinski

Chief Financial Officer & Kzn Branch Chairperson

082 2142 882

polinskicnn@gmail.com

Itumeleng Motsepe

Exco Member

071 073 2262

ia.motsepe@yahoo.com

BRANCH CHAIRPERSONS

Julian Nel

EASTERN CAPE

076 820 2551

baydental@progen.co.za

Marlene Muller

FREE STATE

082 413 3541

krugermarlene@hotmail. com

Wayne Thornhill

GAUTENG NORTH

079 894 4980

wayne.camm@gmail.com

Johan van der Vyver

GAUTENG SOUTH

083 256 8129

johan.vandervyver@gmail. com

Christopher Polinski

KZN

082 2142 882

polinskicnn@gmail.com

Channell Steenkamp

MPUMALANGA

082 804 0929

channell.steenkamp@ yahoo.com

Melanie Kilian

STUDENT REPRESENTATIVE Student Representative

082 226 1919

boutertjie@gmail.com

IMPORTANT INFORMATION REGARDING CPD

How are the CEUs calculated for the Journal? The Journal falls under Category B: (Measurable) Training and Publications: Dental Technology and related fields, sub-category B8. A maximum of 20 of the required CEUs may be obtained/claimed from this category but not more than 10 from any sub-category, with the exception of B4 which may not exceed 20 CEUâ&#x20AC;&#x2122;s Answer/complete multiple-choice questionnaires (MCQ) in journals, including electronic journals and or professional association News Letters with required pass mark. 70% is needed to pass and 0.2 CEU per standard page of prescribed reading and 0.2 CEU per question is awarded.

CPD via the SADTJ â&#x20AC;&#x201C; Request to Council The DENTASA office has been inundated with phone calls and request from all dental technicians to be allowed to do older SADTJ issues to be able to acquire the additional CPD credits as stipulated by letters received by Council. We have sent a formal request to Council regarding the abovementioned and our correspondence was tabled at the CPD Committee meeting of the SADTC. We in addition tabled a request for Council to remove the maximum CEUs per category limitation to ensure that CPD becomes achievable and accessible to all in the profession. We are now awaiting a response from Council. We will inform you as soon as we receive an answer. Regards, Elize Morris DENTASA Secretary The Dental Technology Association of South Africa Tel: 012-460 1155 www.dentasa.org.za

SADTJ Vol 8 Issue 1

Business Interruption Insurance Do You Need Business Interruption Insurance? Catastrophes like floods and fires do occur and there is insurance to cater for these types of events. There are two different types of insurance cover for these events – one to repair or replace the assets damaged (your normal insurance policy) and one to compensate you for the losses incurred during the time it takes to get the business going again. This latter one is known as ‘Business Interruption’ or ‘Loss of Profits’ insurance. Statistics show that nearly three out of four businesses never recover from a catastrophic event and it is therefore important to ensure that your Business Interruption insurance has been carefully thought through. What to insure for You need to have a good grasp of your costs and expected sales and gross profit. You don’t want to underinsure so if your business is growing reflect that fact – for example if you expect 10% growth (and trends in your business justify this) show this to insurers or you won’t get paid out this additional amount. It is important to make sure that all your projections are well grounded and can be defended as they will be closely scrutinised by loss adjustors in the event of a claim. Thus, the better you understand your costs, the less chance of having a claim either rejected or adjusted downwards.

Let’s look at an example… Bernie has a cosmetics factory and his year end is 31 December.

Bernie’s Cosmetics Factory

Budget for Year Sales Cost of Sales Purchases Wages

120,000 (45,000) (10,000)** (35,000)

= GROSS PROFIT COSTS Salaries Distribution Maintenance Rent

75,000 (46,000) (20,000) (6,000)** (5,000)** (15,000)

= PROFIT

29,000

On January 2, the factory burns down. It will take 12 months to get the factory up and running again.

Business Interruption Claim

ADJUSTED GROSS PROFIT Gross Profit Less Purchases

65,000 75,000 (10,000)

Another critical factor is the indemnity period. This is the time you will be covered for whilst out of business. For example, if you put a sixmonth indemnity period in your policy, you will only get paid out for six months even if it takes twelve months to get the business back on its feet again.

COSTS INCURRED Salaries Rent Preparation Cost

40,000 20,000 15,000 5,000***

= CLAIM

105,000*

You can see from this simple example that this is a very complex process – spend time with your accountant getting to grips with your revenues and costs. Also use a reliable insurance broker.

*Adjusted gross profit plus your incurred costs.

Remember that 43% of businesses that suffer a catastrophe never trade again and a further 29% go out of business within two years

SADTJ Vol 8 Issue 1

**Variable costs which will not be incurred in the 12-month period of re-establishing the factory. ***Putting together claims is a time-consuming task, so include it in your policy NB! Include VAT in the assured amount as insurance pay outs include VAT.

BUSINESS INTERRUPTION INSURANCE

1. What is the additional insurance called you need in case of a catastrophic event like a flood or a fire? A. Normal insurance to replace assets. B. Short term insurance. C. Business interruption insurance D. Life insurance 2. How many businesses do recover from a catastrophic event like a fire? A. 75% B. 25% C. 50% D. 30% 3. Would it be necessary to have projected growth figures available for your insurance company (Trends in your business to justify this) A. Yes B. No 4. Indemnity period means: A. Time you donâ&#x20AC;&#x2122;t have to work B. Period to cover C. Time covered whilst out of business D. Leave without pay 5. Your claim includes (2) two amounts A. Gross profit less purchases B. Gross profit plus purchases C. Adjusted profit D. Adjusted gross profit and cost incurred 6. Complete blank spaces: ________% of business that suffer a catastrophic event never trade again and __________% of business go out of business within two years. A. 60% & 40 % B. 43% & 29 % C. 23% & 45% D. 75% & 25%

SADTJ Vol 8 Issue 1

Journal of Oral Science, Vol. 54, No. 4, 337-342, 2012

Clinical evaluation of failures in removable partial dentures Janaina H. Jorge, Cristiane C. C. Quishida, Carlos E. Vergani, Ana L. Machado, Ana C. Pavarina and Eunice T. Giampaolo Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP – Univ Estadual Paulista, Araraquara, SP, Brazil (Received 23 August and accepted 1 November 2012) Abstract: The aim of this clinical study was to evaluate the effects of removable partial dentures on the support tissues and changes occurring in lower tooth-supported and bilateral distal-extension dentures, 5 years after placement. The study involved analysis of a total of 53 patients who received prosthetic treatment for removable partial dentures. The patients were divided into two groups. In group 1, the patients had a completely edentulous maxilla and an edentulous area with natural teeth remaining in both the anterior and posterior regions. In group 2, the patients had a completely edentulous maxilla and partially edentulous mandible with preserved anterior teeth. Tooth mobility, prevalence of caries, fracture of the abutment teeth, fracture and/or deformation of the removable partial denture components and stability of the denture base were evaluated. The use of a removable partial denture increased tooth mobility, reduced the prevalence of caries, and did not cause loss or fracture of the abutments or damage to their components, when compared with the baseline. It was concluded that there was no difference between the groups as evaluated in terms of tooth mobility, prevalence of caries, loss and fracture of the abutments or damage to the components of the removable partial denture. (J Oral Sci 54, 337-342, 2012)

Correspondence to Dr. Janaina Habib Jorge, Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP – Univ Estadual Paulista, Rua Humaitá, n° 1680, Araraquara, SP, CEP: 14801-903, Brazil Tel: +55-16-3301 6550 Fax: +55-16-3301 6406 Email: janaina@foar.unesp.br & janainahj@bol.com.br

SADTJ Vol 8 Issue 1

Keywords: removable partial denture; abutment teeth; prosthodontics; planning. Introduction Although there are an increasing number of elderly dentate people in countries such as the USA and United Kingdom (1), survey data have indicated that at least one quarter of a million people under the age of 40 have removable partial dentures (2). Removable partial dentures should maintain the health of the remaining dentition and surrounding oral tissue. However, the factors determining the prognosis of removable partial dentures are still unclear. Studies have shown that partial dentures in the mouth increase the formation of biofilm and, consequently, an increase in the occurrence of caries and periodontal disease (1-4). Other research has produced more favorable results, with moderate degrees of injury or practically no periodontal changes (5-7). Therefore, the existing results are inconclusive and sometimes contradictory. The forces applied to the abutment teeth and their effects are very important considerations when designing and constructing removable partial dentures. Adequate planning of a partial denture requires an understanding of the forces generated during mastication and their distribution to supporting structures. If definite principles are followed when planning and constructing the prosthesis, it functions so that the stresses it produces are safely within the range of tissue tolerance, thus enabling it to contribute to periodontal health. Several long-term clinical studies have shown that correctly designed removable partial dentures do not have any detrimental effects on abutment teeth (810). However, some investigations have shown that a higher level of oral hygiene is needed for removable partial denture patients and that the denture design should be as simple as possible,

covering only the essential hard and soft tissues (11). There was a strong correlation between the presence of local pathologic alterations accompanying the use of partial dentures and poor oral hygiene. The distal extension removable partial denture does not have advantages over tooth support, since the residual ridge must be used for both support and retention. Biomechanically, a partial denture is a prosthetic restoration that derives its support principally from the tissues underlying its base, and only to a minor degree from the abutments. The distal extension removable partial denture has a tendency for lateral movement during function. Moderate intermittent forces exerted on the bony ridge by a prosthesis may be stimulating and help preserve, rather than destroy, the bony ridge (12). On the other hand, excessive force causes resorption of the residual ridge (13). As the ridges resorb and tissue contact is lost, the result is a tissueward migration of the denture bases. It is assumed that horizontal and lateral stress on abutment teeth may cause, or favor, the breakdown of periodontal structures and increase tooth mobility. Therefore, the aim of this clinical study was to evaluate the effects of removable partial dentures on the support tissues and the changes occurring in lower toothsupported and bilateral distal-extension dentures, 5 years after placement. These changes included tooth mobility, prevalence of caries, fracture of the abutment teeth, fracture and/or deformation of the removable partial denture components and stability of the denture base.

Materials and Methods Selection of patients The study population comprised 75 patients who, between March and December 2007, were fitted with complete upper and lower removable partial dentures. The mean age of the patients was 68.6 years and none had general health complications. Two types of arch were selected for this investigation: a bilateral edentulous area with abutment corresponding to the first premolar and second molar on each side (Kennedy Class III, mod. 1) and a bilateral distally extended lower with six natural anterior teeth (Kennedy Class I). For the abutments of tooth-support-

ed removable partial dentures, a clasp design with a cast circumferential buccal retentive arm, a rigid reciprocal clasp arm and a rest adjacent to the edentulous ridges was selected (Group 1). In cases with bilateral distal-extension, a clasp design including the T clasp of a Roach retentive arm, a rigid reciprocal arm and a mesial rest were used (Group 2). The undercuts engaged by the retentive arms were limited to 0.25 mm. The framework casts were made in cobalt-chrome alloy (Wironit - Bego - Bremer GoldschlĂ¤gerei Wilh. Herbst GmbH & Co., Bremen, Germany). All biological and mechanical principles of removable partial denture design and construction were followed to minimize the forces transmitted to the supporting tissues or to decrease the movement of the prostheses in relation to them. The altered-cast impression technique was used to provide adequate support. Acrylic resin anatomic posterior teeth were set in balanced occlusion and the denture bases were constructed in acrylic resin. Prior to prosthetic treatment, all the other necessary dental treatments such as periodontal and restorative were carried out. Prosthodontic and periodontal data were recorded immediately after insertion of the partial dentures (baseline). On examination of these patients, each abutment tooth was evaluated for the presence of mobility and caries. The mobility was rated from 0 (76% in Group 1 and 68% in Group 2) to 1 (24% in Group 1 and 32% in Group 2) and none of the abutments presented carious lesions. Oral examinations were carried out by one of two previously calibrated clinicians whose inter- and intra-examiner variability was not significant. All dentures were seated in the mouth before the start of the experiment and checked for accuracy of fit and stability. Some adjustments were made, and affected areas were polished. Patients received oral hygiene instructions and a self-educational manual. Oral instructions included mechanical tooth cleaning three times daily using a soft toothbrush, interproximal flossing and interspace toothbrushing. The cleaning of removable dentures included mechanical cleaning with a soft toothbrush and dentifrice. After 5 years, all patients were contacted either by mail or telephone. Each patient was offered a free examination if they participated in the study, but only 53 of them attended (70 per cent of the original sample). The study was approved by the Human Research Ethics Committee of Araraquara Dental School, and informed consent was obtained from each patient. SADTJ Vol 8 Issue 1 9

Fig. 1 Degree of mobility of removable partial denture abutment teeth at the baseline..

Clinical measurement parameters The parameters listed below were carefully recorded at the baseline and five years after the prostheses had been inserted: 1) Tooth mobility: the abutment tooth mobility was graded clinically by placing a tooth between two metal instrument handles and moving the tooth in as many directions as possible. The following scores were used: (0) no mobility, (1) < 1 mm movement in the horizontal plane, (2) > 1 mm movement in the horizontal plane, (3) movement in an apical direction. 2) Prevalence of caries: the presence or absence of pit and fissure caries was determined with a mirror and explorer. The clinical examination was supplemented by intra-oral radiographs to detect interproximal and recurrent caries. The radiographic examination evaluated the caries status by means of interproximal bitewing radiographs. 3) Abutment loss: abutment tooth losses and extractions were evaluated, based on data collected at the baseline. 4) Fracture of the abutment teeth: fracture of the abutment teeth was assessed clinically and examination was supplemented by intra-oral radiographs to detect root fractures. 5) Fracture and/or deformation of the removable partial denture components: any visible fracture in the following components was observed: rests, clasps, major connector, minor connectors, guiding planes, indirect retention, basal saddle and artificial teeth. 6) Stability of the denture base: stability was tested clinically by applying alternate finger pressure over the extension base in a tissueward direction. Statistical analysis Differences between the baseline and 5-year values were compared in terms of percentages. The 10

SADTJ Vol 8 Issue 1

Fig. 1 Degree of mobility of removable partial denture abutment teeth at the baseline..

chi-squared or Fisher test was used to examine the distribution of fracture and/or deformation of the removable partial denture components, instability of the base and prevalence of caries and fracture of the abutment teeth. Abutment mobility was evaluated using the Mann-Whitney test. Studentâ&#x20AC;&#x2122;s t-test was conducted to evaluate bone loss. The statistical analyses were performed at a 0.05 level of significance.

Results Assessment of clinical parameters at the baseline In Groups 1 and 2, most of the abutments (76% and 68%, respectively) had a score of 0 for mobility (Fig. 1). As described previously, none of the abutments showed carious lesions, or fractures of the abutment teeth and roots. Assessment of clinical parameters in Group 1 and 2 after 5 years Figure 2 presents data for tooth mobility. The results revealed no significant changes in tooth mobility between the groups 5 years after insertion. However, there was a decrease in the frequency of teeth with a mobility score of 0 compared to the baseline. The prevalence of caries (P = 0.9), fracture of the abutment teeth (P = 0.704) and roots (P = 1.0) are shown in Table 1. The results revealed no significant changes between Groups 1 and 2. There was no significant difference in the incidence of abutment loss between the groups (Table 1). Table 2 summarizes the prevalence of fracture and/ or deformation of the removable partial denture components. There were no differences in the prevalence of failure between the types of removable partial dentures (Groups 1 and 2). All the prosthesis failures were fractures, and there were no cases of deformation. The failure rate

for artificial teeth was low (Table 3), being less than 5%, and there were no significant differences in incidence between Groups 1 and 2. The proportion of prostheses with instability of the base is also shown in Table 3. Although 23% of prostheses showed displacement in Group 1 and 48% did so in Group 2, the difference was not significant (P = 0.057).

Discussion In comparison with the baseline, the results of this study showed that values of the clinical parameters studied increased in both Groups 1 and 2, except for fracture of the root and abutment loss. Clinical findings after 5 years showed that almost half of the abutment teeth, in both groups, presented some degree of mobility. However, the present study was not designed to demonstrate any differences between the groups (extension base and tooth-supported base). Movement of the base of an entirely toothborne partial denture toward the edentulous ridge is prevented primarily by rests placed on the abutment teeth located at each end of each edentulous space. As a result, rotation of the tooth-borne partial denture is relatively nonexistent. However, a slight increase of tooth mobility was noted for this group. It has been reported that tooth mobility increases during the life of removable partial dentures. This increased mobility might be attributable to the physiological aging process and concomitant changes in the periodontal structures (14). According to Svanberg et al. (15), tooth mobility may increase as a result of adaptive, non-pathological change in the absence of any inflammatory symptoms. Physiological processes of ageing with associated reduction of the periodontal tissues might possibly explain the increase of mobility in the abutment teeth. Although no significant difference was found between the two groups, the extension-base removable partial dentures showed a tendency for abutments to have more mobility. Considering that forces directly parallel to the long axis of a tooth are better tolerated than tipping or torquing forces (16,17), changes in abutment tooth mobility with time are expected to be more pronounced in distal extension than in tooth-supported removable partial dentures. Bilateral dis-

tal extension removable partial dentures share their support between the abutment teeth and the edentulous ridge (18). Differences in resilience between these supporting elements affect the distribution of force on the abutment teeth and residual alveolar ridges. In addition, alveolar resorption is a continuous process, with resulting loss of fit in local areas (19). The fit of the denture base to the alveolar ridge declines progressively as the alveolar ridge is resorbed. The compromised fit of the denture adversely affects the retention, stability and support of the remov able prostheses. Consequently, this can result in mobility of abutment teeth. These results are contrary to several reports that showed moderate-to-severe damage to the periodontium (20,21). Carlsson et al. (3) also reported an increase of mobility in the abutment teeth when a partial denture (distal extension) was worn by the patient and a decrease in abutment mobility when a partial denture was not worn. When interpreting the results presented in Fig. 2, the percentage of abutments with a mobility degree of 0 was approximately 55% for Group 1 and 38% for Group 2. In addition, the great majority of the abutments in both groups exhibited a mobility degree of 0 or 1. These favorable results could be attributed to planned prosthetic treatment. Properly designed removable partial dentures may provide a homogeneous distribution of occlusal forces, create regular adaptation of periodontal tissue and a decrease in tooth mobility. The results of this study are in agreement with those of Jorge et al. (10), who found no significant changes in tooth mobility between two types of design (extension base and tooth-supported base) during six months of follow-up. In general, in this study, the removable partial denture itself appeared to affect caries status (44% to 46%). Insertion of removable partial dentures has been shown to be associated with a quantitative increase of Streptococcus mutans in saliva, thereby contributing to the increased risk of caries in removable partial denture wearers (22,23). If a poor oral hygiene habit is apparent, then educational and motivational efforts to improve self-care skills are in order. A recent study demonstrated the importance of patient education, good oral self-care and regular professional recall for people who wear removable partial dentures (24). SADTJ Vol 8 Issue 1

There was no significant difference in the incidence of loss and fracture of the abutments for the two groups (Table 1). The results of this study are in agreement with Saito et al. (25), Kratochvil et al. (26) and Chandler and Brudvik (27), who reported that the incidence of abutment tooth loss with removable partial dentures was generally low. On the other hand, this finding is in contrast to the results of Vanzeveren et al. (28), who observed that the number of abutments lost was significantly higher in the presence of freeend edentulous areas as compared with bounded edentulous areas. In this study, the incidence of fracture of the removable partial denture was less than 5% and there were no significant differences in incidence between Groups 1 and 2. Indeed, the fracture percentages of removable partial dentures can be considered low considering the high number of casting defects and inaccuracies mentioned in several studies (29). Vermeulen et al. (24) reported a fracture percentage of 17% after 5 years, increasing to 35% after 10 years. Korber et a1. (30) found a repair percentage of 40% after 5 years, of which 15% was caused exclusively by fractures of metal parts. Because of the small number of prostheses available, the results must be judged carefully. However, the negative effects of removable partial dentures on the support tissues can be dimin12

SADTJ Vol 8 Issue 1

ished by home-care procedures and professional biofilm control recall appointments. Within the limitations of this study, it was concluded that there was no difference between the groups when evaluated in terms of tooth mobility, prevalence of caries, loss and fracture of the abutments, or damage to the components of removable partial dentures.

Acknowledgments This investigation was supported by The State of Sao Paulo Research Foundation (FAPESP; grant No. 05/53105-8). References 1. Preshaw PM, Walls AW, Jakubovics NS, Moynihan PJ, Jepson NJ, Loewy Z (2011) Association of removable partial denture use with oral and systemic health. J Dent 39, 711-719. 2. Hummel SK, Wilson MA, Marker VA, Nunn ME (2002) Quality of removable partial dentures worn by the adult U.S. population. J Prosthet Dent 88, 37-43. 3. Carlsson GE, HedegĂĽrd B, Koivumaa KK (1965) Studies in partial dental prosthesis. IV. Final results of a 4-year longitudinal investigation of dentogingivally supported partial dentures. Acta Odontol Scand 23, 443-472. 4. Bergman B (1987) Periodontal reactions related to removable partial dentures: a literature review. J Prosthet Dent 58, 454-458.

5. Bergman B, Hugoson A, Olsson CO (1971) Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns. A longitudinal two-year study. Acta Odontol Scand 29, 621-638. 6. Bergman B, Hugoson A, Olsson CO (1977) Caries and periodontal status in patients fitted with removable partial dentures. J Clin Periodontol 4, 134-146. 7. Bergman B, Hugoson A, Olsson CO (1982) Caries, periodontal and prosthetic findings in patients with removable partial dentures: a ten-year longitudinal study. J Prosthet Dent 48, 506-514. 8. Kapur KK, Deupree R, Dent RJ, Hasse AL (1994)A randomized clinical trial of two basic removable partial denture designs. Part I: Comparisons of five-year success rates and periodontal health. J Prosthet Dent 72, 268-282. 9. Bergman B, Hugoson A, Olsson CO (1995) A 25-year longitudinal study of patients treated with removable partial dentures. J Oral Rehabil 22, 595-599. 10. Jorge JH, Giampaolo ET, Vergani CE, Machado AL, Pavarina AC, Cardoso de Oliveira MR (2007) Clinical evaluation of abutment teeth of removable partial denture by means of the Periotest method. J Oral Rehabil 34, 222227. 11. Addy M, Bates JF (1979) Plaque accumulation following the wearing of different types of removable partial dentures. J Oral Rehabil 6, 111-117. 12. Carlsson GE, Otterland A, Wennström A, Odont D (1967) Patient factors in appreciation of complete dentures. J Prosthet Dent 17, 322-328. 13. Kelly E (2003) Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent 90, 213-219. 14. Piwowarczyk A, Köhler KC, Bender R, Büchler A, Lauer HC, Ottl P (2007) Prognosis for abutment teeth of removable dentures: a retrospective study. J Prosthodont 16, 377-382. 15. Svanberg GK, King GJ, Gibbs CH (1995) Occlusal considerations in periodontology. Periodontol 2000 9, 106-117.

19. Tallgren A (2003) The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent 89, 427-435. 20. Fenner W, Gerber A, Muhlemann HR (1956) Tooth mobility changes during treatment with partial denture prosthesis. J Prosthet Dent 6, 520-525. 21. Zlatarić DK, Celebić A, Valentić-Peruzović M (2002) The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth. J Periodontol 73, 137-144. 22. Mihalow DM, Tinanoff N (1988) The influence of removable partial dentures on the level of Streptococcus mutans in saliva. J Prosthet Dent 59, 49-51. 23. Mihalow DM, Tinanoff N (1989) Influence of removable partial dentures on the Streptococcus mutans level in saliva. Soproden 5, 245-247. 24. Vermeulen AH, Keltjens HM, van’t Hof MA, Kayser AF (1996) Ten-year evaluation of removable partial dentures: survival rates based on retreatment, not wearing and replacement. J Prosthet Dent 76, 267-272. 25. Saito M, Notani K, Miura Y, Kawasaki T (2002) Complications and failures in removable partial dentures: a clinical evaluation. J Oral Rehabil 29, 627-633. 26. Kratochvil FJ, Davidson PN, Guijt J (1982) Fiveyear survey of treatment with removable partial dentures. Part I. J Prosthet Dent 48, 237-244. 27. Chandler JA, Brudvik JS (1984) Clinical evaluation of patients eight to nine years after placement of removable partial dentures. J Prosthet Dent 51, 736-743. 28. Vanzeveren C, D’Hoore W, Bercy P, Leloup G (2003) Treatment with removable partial dentures: a longitudinal study. Part II. J Oral Rehabil 30, 459-469. 29. Eerikäinen E, Rantanen T (1986) Inaccuracies and defects in frameworks for removable partial dentures. J Oral Rehabil 13, 347-353. 30. Körber E, Lehmann K, Pangidis C (1975) Control studies on periodontal and periodontal-gingival retention of partial prosthesis. Dtsch Zahnarztl Z 30, 77-84.

16. Stewart KL, Rudd KD, Kuebker WA (1992) Components of a removable partial denture: major connectors, minor connectors, rests and rest seats. In: Clinical removable partial prosthodontics, 2nd ed, Ishiyaku Euro America, St Louis, 19-57. 17. McGivney GP, Carr AB (2000) Rests and rest seats. In: McCracken’s removable partial prosthodontics, 10th ed, Mosby, St Louis, 77-95. 18. Ogata K, Miyake T, Okunishi M (1992) Longitudinal study on occlusal force distribution in lower distal-extension removable partial dentures with circumferential clasps. J Oral Rehabil 19, 585-594.

SADTJ Vol 8 Issue 1

Clinical evaluation of failures in removable partial dentures

1. Several long term studies have shown that correctly designed removable partial dentures... A. do not have any detrimental effects on abutment teeth B. do have an effect on abutment teeth C. cause caries and periodontal disease D. need to be replaced every five years E. must cover as much tissue as possible 2. Partial denture designs should... A. cover as much tissue as possible B. be a complicated design C. be a simple design D. cover only essential hard and soft tissue E. a) and b) F. c) and d) 3. Biomechanically a partial denture derives itâ&#x20AC;&#x2122;s support mainly from.... A. the abutments B. the tissues underlying its base C. the clasps D. the postdam E. mesial rests 4. The distal extension removable partial denture has a tendency for which type of movement during function? A. lateral B. vertical C. horizontal D. distal E. lingual 5. Abutment mobility in this article was evaluated using which test? A. fisher test B. chi-squared C. Mann-Whitney test D. Studentâ&#x20AC;&#x2122;s t-test E. Chandler and Brudvik 6. With age the fit of the denture base to the alveolar ridge declines progressively as the alveolar ridge is resorbed. This compromised fit will affect.... A. the retention of the denture B. stability of the denture C. support of the removable prosthesis D. result in mobility of teeth E. all of the above 14 SADTJ Vol 8 Issue 1

DENTASA Summit & AGM 2019

SADTJ Vol 8 Issue 1

Miniture Sculptures by Claire Ewart Phipps It was a hot day in late November when I walked into a lab in Pretoria’s Moot area. The Christmas rush, or lack thereof, was the main topic of discussion, when my eye caught a delightful little creature, so unpretentious that it almost blended in with the rest of the metal on the bench, yet so unique that I couldn’t resist it! “Who made this?” I asked Plank [Mr Johan van der Merwe, owner of Pretoria Dental Laboratory] “Oh, that’s Claire’s work” he answered casually. I was an instant fan. The cheeky little seahorse I held in my hands were skilfully made out of ‘flash’ metal from the casting machine. “How did you come up with this?” I asked her curiously. “Well, it is like seeing forms in a cloud,” she said. “I pick up pieces of scrap metal and see forms upon which I build.” Claire studied Fine Arts at TUT from 2003- 2006. She completed her studies and found a job as a design artist at a Tattoo studio. She assisted customers with the design of artworks that was transformed into tattooed body art. ‘I worked 6 days a week, and my job included working face to face with customers, something I really didn’t enjoy much.” Remembered Claire during our chat. After getting married, Claire’s husband encouraged her to consider a more ‘stable’ career and this led to her enrolling for the Dental Technology program in 2012 at TUT. She qualified in 2015 and started working at Pretoria Dental Laboratory where she is mainly responsible for metal work. The first range of sculptures developed early in her career and mostly included birds and fish. At this point Claire glued together the pieces of metal making up the sculptures. As her skill developed, Claire learnt how to solder the pieces together using ‘copper tack’ for plumbing and careful placement of heatsinks. In Nov/Dec 2018, three of Claire’s miniature sculptures were on display at Longstreet Art lovers 1932, an art gallery in Waterkloof, Pretoria. This exhibition featured various artists and was titled: Miniatures. Artworks in all mediums where included but each had a size restriction to stay in keeping with the theme. Some years ago, Claire also exhibited acrylic paintings in the ABC’s of Life exhibition at the same gallery. Written by Lyra Naomi Fourie 16

SADTJ Vol 8 Issue 1

Operational Management Series: PART 2 By David Avery, AS, CDT, TE

Journal of Dental Technology February 2018

The Operational Benefits of Partial or Complete Adaptation of DAMAS History and Background of DAMAS

“ he DAMAS Standard was originally introduced in the mid-nineties as an alternative to ISO Certification and the Medical Device Directive in Europe. The UK Dental Laboratories Association developed the standard to provide a specific system for dental laboratories. NADL owns the rights to the DAMAS standard in North America and the standard is based closely on FDA quality system regulations. Laboratories can purchase the system manual, which includes templates and the actual specifications directly from NADL. In most cases, it is suggested that laboratories utilize the services of a consultant to help integrate the system. Additionally, laboratories can achieve full certification in the system by completing a third-party audit of compliance.” www.nadl.org/DAMAS There is no formal commitment required for total adaptation and annual auditing when purchasing the DAMAS manual, however the program serves as a great outline for process efficiency, consistency and profit improvement. Currently the NADL reports the sale of 350 DAMAS manuals in recent years, yet only lists a one time high of 75 laboratories DAMAS certified. Currently 50 laboratories are third party audited and formally certified. Many utilize the manual as a blueprint for managing their operation, foregoing the certification and accompanying annual audit. The LEAN Manufacturing Process is a perfect accompa-

Sample Components of the DAMAS Program with author’s notes in italics

Management system

niment to DAMAS, providing detailed guidance through many of the “steps” required by the DAMAS program. The LEAN approach provides maximized efficiencies in workflow while addressing inventory control and minimizing waste. Another key to the LEAN process is eliminating anything that is not of value to the customer.

The commercial dental laboratory shall establish, document and maintain a dental appliance manufacturing system as a means of ensuring dental appliances are manufactured in compliance with the U.S Code of Federal Regulations, FDA Quality System / Good Manufacturing Practices. A defined baseline system is ideal for maintaining Good Manufacturing Practices. This level of documentation is only required for certification. SADTJ Vol 8 Issue 1 17

Documented review of the licensed dental client’s requirements The manufacturer shall ensure that licensed dental client requirements are adequately defined and documented so that the manufacturer can demonstrate an understanding of the manufacturing requirements for the dental appliance design. The manufacturer shall ensure that amendments to licensed dental client requirements are adequately defined and documented. The manufacturer shall maintain a copy of all prescriptions and shall demonstrate that licensed dental client requirements are adequately reviewed. A prescription is required by all State Dental Practice Acts. The real message here is thorough documentation of any amendments to the prescription resulting from telephone or e-mail communication. This is crucial for protecting the laboratory from any future liability claims.

Patient contact materials (Adapted from the FDA statute) Each manufacturer of a device that is intended for surgical implant into the body or to support or sustain life and whose failure to perform when properly used in accordance with instructions for use provided in the labeling can be reasonably expected to result in a significant injury to the user shall establish and maintain procedures for identifying with a control number each unit, lot, or batch of finished devices and where appropriate components This is a federal mandate, not a suggestion. It is a major issue throughout the industry with estimates as low as three percent compliance. This is a major liability and compliance concern. Each manufacturer labels materials with 18

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lot numbers. An example of a laboratory’s compliance when producing a PFM would include documentation of the lot numbers of the alloy and all porcelains used for completion of the case from opaques to veneer materials.

Defined manufacturing processes The manufacturer shall document the dental appliance manufacturing processes, connected with the dental appliances being manufactured, to allow an understanding of these processes. The manufacturer shall ensure that suitably competent persons in compliance with the documentation referred to above manufacture dental appliances. The development of “work instructions” is a valuable step in assuring consistency in results as well as serving as an educational baseline for inhouse training.

Training

ification of personnel qualified as DT’s, RDT’s, MDT’s, or CDT’s or other recognized credential serve this purpose. Records of training and competence in assigned tasks shall be maintained. Establish levels of technical proficiency based on the ability to accomplish different tasks within a department. Upon completion of the level assignment to processes, each technician is assigned a level based on their proven ability. ie., 1 – 4. A training log is required to maintain records and track the progress of each employee’ development.

Maintenance and calibration of equipment Manufacturing plant, manufacturing equipment and measuring and test equipment shall be suitably maintained and calibrated where appropriate. Records shall be maintained of maintenance carried out. This important step ensures proper operation of sensitive equipment and decreases the probability of emergency equipment breakdowns with the associated added expense.

The manufacturer shall establish and maintain procedures for identifying training needs and provide for the training of all personnel carrying out dental appliance manufacturing and management system Cleanliness tasks. Personnel shall be verified as competent to carry out assigned The manufacturer shall establish dental appliance manufacturing and and maintain suitable procedures management system tasks. The verfor the daily, weekly and month-

ly cleaning of the manufacturer’s manufacturing plant and equipment. Records shall be maintained of cleaning carried out. Proof of compliance with U.S. OSHA Bloodborne Pathogen standards will serve this purpose. Dental laboratories tend by the nature of the work to be “messy.” It is important for morale and image that the laboratory be cleaned routinely. A well-organized tidy work environment reinforces an atmosphere of high quality. Cleaning of personal workspace daily and department wide weekly are good minimum requirements. Annual OSHA training with external resources such as Safelink are a good solution for the Blood Borne Pathogens standards.

Documented review of the final product Each manufactured dental appliance shall be given a final inspection by a competent person to complete the evidence of conformance of the finished dental appliance with the licensed dental client’s specified requirements. As a minimum, the final inspection of the finished dental appliance shall address the attributes specified in the DAMAS Final Inspection Checklist. Incoming quality control is extremely important as well for numerous reasons.

1. Assures that all items received are accurate and appropriate for the prescribed restoration. 2. Assures that the communication from the dentist is clearly understood. 3. Assures that the material and type of restoration is the best choice for the particular case. 4. Determines if additional communication is required to address any concerns. 5. Controls complex cases by ensuring they are placed in the hands of appropriate personnel.

Complaints The manufacturer shall establish and maintain a documented system for the effective handling of customer complaints and reports of dental appliance nonconformities. Records of customer complaints, including the cause of complaints and the corrective action taken to alleviate complaints, shall be maintained. The important side benefit to complaint documentation and rectification is awareness of trends within the operation and with specific clients. These red flags should initiate internal training or communication with clients that are getting less than satisfactory results. The immediate resolution of such issues ensures correction within the laboratory team and improved customer retention.

The items discussed here are just a few of the many components of a well-managed laboratory. The scope of the required tasks at times may seem unachievable to a busy owner and management team. As daunting as it appears, it is crucial for the success of any manufacturing group that these areas are taken seriously. There is no time like the present to get started and the smaller the operation, the easier it is. Once systems are in place, it is only a matter of continuing to build on the good foundation you have established.

About the Author David Avery, AS, CDT, TE, received his AAS degree in dental laboratory technology from Durham Technical College and served as an executive team member at Drake Precision Dental Laboratory, CDL, DAMAS, in Charlotte, N.C. for 30 years. He now serves as a fulltime consultant to the dental profession working with manufacturers on product and technology development as well as advising laboratories, dental schools and private practitioners on operational management, technical education and marketing. Mr. Avery has published in numerous laboratory and clinical journals, serves on many editorial boards and has presented more than 700 scientific programs covering every aspect of dental laboratory technology and communication. Davidavery536@ gmail.com SADTJ Vol 8 Issue 1

The Operational Benefits of Partial or Complete Adaptation of DAMAS

1.5

1. Which item is not a key part of the LEAN approach: A. maximised efficiencies in workflow B. inventory control C. minimising waste D. Eliminating anything that is not of value to the customer E. Personnel selection 2. What is crucial for the protection of the Laboratory from any future liability Claims? A. Speaking to your Boss B. Documentation of telephone or email communication C. Putting a work plan in place 3. What does DAMAS stands for? A. Dental Appliance Management Audit System B. Dental Appliance Manufacturers Austerity Solutions C. Dental Appliance Manufacturers Audit System D. Dental Appliance Management Audit Solutions 4. Does a dental appliance need to meet the specifications in the DAMAS Checklist. A. Yes B. No 5. What is the minimum requirement on how often personal work space should be cleaned? A. Three times daily B. Once a day C. Weekly D. Monthly

SADTJ Vol 8 Issue 1

Employers Take Note

We Can Still Learn From the Peter Principle

“Leadership is nature’s way of removing morons from the productive flow” (Dilbert) The ‘Peter Principle’ has been around for nearly fifty years. Recent research has underlined that it is still valid today. It has implications for how we promote staff and the effects this has on our business.

What is it? “Peter Principle, n. - The theory that employees within an organisation will advance to their highest level of competence and then be promoted to and remain at a level at which they are incompetent.” (The Free Dictionary) It is usual in business that people get promoted when they are successful at their jobs. They get promoted despite the fact that very often the skills required for their new position are different from their old position. If they are successful in this position, they get promoted again and again until they lack the skills for the new position and then they experience failure. Once this has happened, they get stuck in their new role – as they are no longer successful, no more promotions are available for them. They have risen to the level of their incompetence. Most organisations are bedevilled with unhappy managers who spend years and years in the same job. Some researchers have even facetiously suggested that, as the skills required for one stratum of an organisation are completely different to those required for the next stratum of the business,

why not promote the worst performing employees? This in Dilbert’s terminology shows that “leadership is nature’s way of removingmorons from the productive flow”.

New studies prove the Peter Principle Recent research of 214 companies reviewed 1,500 promotions in sales organisations. The research also looked at the characteristics of people promoted - whether they worked collaboratively or on their own (people who work collaboratively usually make effective managers). It showed that people were most likely to advance in the business when they were successful in their sales jobs although they were poor managers – in fact sales declined under these promoted managers. Conversely, those who worked collaboratively were usually not promoted.

The lessons today The new research shows that the Peter Principle is alive and well. Whilst many businesses accept the trade-off of promoting successful employees at the expense of having less effective managers, it is appropriate to reconsider how staff should be promoted in an organisation. In the long run it almost certainly pays to promote those who have the potential skills to be good managers. To the high flyers who don’t have the skills to manage, recognise them and give them hefty bonuses. Finally, is it not better to move people who are not performing in a particular position either to another position where they can do a good job, or move them out of the company? This leaves the company with good managers and motivated staff as opposed to having frustrated blocked managers and lower performing employees. SADTJ Vol 8 Issue 1 21

We Can Still Learn From the Peter Principle

2.4

How long as the â&#x20AC;&#x153;Peter Principle â&#x20AC;&#x153; been around for____ years.

A. 50 B. 40 C. 27 D. 37 2.

Promoting employees beyond their skill can make them no longer successful in their jobs

A. True B. False 3.

Why would sales decline under newly promoted managers?

A. B. C. D.

Lack of people skills Too much pressure in new appointment No confidence Successful in sales poor in managment

Who according to this article would make effective managers?

A. B. C. D.

People working on their own Successful sales people People with good ethics People who work collaboratively

What is the lesson of the Peter Principle?

A. B. C. D.

Promote everybody to managers Dismiss employees Transfer them to short staffed department Move employees to correct position according to their skills

SADTJ Vol 8 Issue 1

Journal of Dental Technology May 2017

Grow Your Lab and Do Your Best Work by Starting a Study Club By Steve Ratcliff, DDS, MS

any lab technicians these days find themselves living out what has become a rather common daily narrative: You receive a prescription and impression instructions from the doctor and you follow those instructions to the best of your ability. Despite your skill set, you are often hampered by incomplete instructions and/ or poor records, impressions and photographs. Sound familiar? On top of the materials you receive from your clients, you can easily feel removed from the work that doctors are doing with patients, creating the notion that the lab is on the sideline and detached from the process of properly treating patients.

While this is common, it should certainly not be the case as a lab technician is critical to the interdisciplinary puzzle when it comes to building businesses—both your own lab and the practices of your dentist clients—and doing your best work in the most cost-effective and time-efficient manner. So, how can lab technicians achieve this goal in the wake of a running a busy lab, managing costs and dealing with time constraints? This is a question Grady Crosslin, a veteran Certified Dental Technician and owner of Crosslin Creative Ceramics, once found himself asking. Not only has Crosslin found a practical and accessible answer to the problem, he has built a business around his solution and has become a leader among those in the laboratory side of the dental industry.

Grady Crosslin’s Path to Becoming a Certified Dental Technician Crosslin became interested in lab work before he turned 10 years old. From his childhood, he would go to work with his father and assist him with things around the lab—nothing technical at first, but enough to peak his interest and turn

Lab technicians have the ability to show their interdisciplinary team the undoubtable value of a lab and a perspective that no other member of the study club can provide.

into a passion as he grew older and learned more about the ins and outs of the dental industry. By getting such an early start, he found himself, as he describes, “learning the old-school mentality” of the laboratory side of the business. This “old school” way of doing things is still very much apparent today. Crosslin noticed early on that there was very little teamwork and collaboration involved. “I felt that dental lab education was too sales-oriented and commercial-driven, focusing on the products and techniques and not enough on the overall collaboration and treatment process…I knew that, if I was going to start a career in the lab, that would have to change,” Crosslin said. Change is exactly what he implemented in his own space. Since Crosslin was aware of the state of the industry and observant of the results of his own experiences, he was able to create a laboratory model that inspired him to start his own lab in 2003—Crosslin Creative Ceramics, now with locations in Florida and Texas. “I played off of my strengths working with dentists and surgical specialists,” said Crosslin. “I noticed the benefits of partnering with them.” Since he believed that CDTs had very little clinical training—a

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valuable yet overlooked aspect of education— he made the commitment to clinical education when he started his lab. From the beginning, it became Crosslin’s mission to avoid the common characterization of being a more “behind-thescenes” part of the interdisciplinary team. “In the past, a lot of treatment planning was written by the general practitioner and then given to the laboratory with no connection to the process,” he said. When you’re so removed from so much of the treatment planning process, how can you expect to be producing your best work, let alone the correct work, given the possibility of miscommunication between the lab and doctors doing the case. Crosslin explains that maintaining “open communication” became a vital part of his business, but it wasn’t until a few years ago that Crosslin found an efficient and incredibly effective platform for maximizing his interdisciplinary communication and collaboration efforts.

Starting a Study Club A few years ago, Crosslin partnered with a leading oral surgeon to start a Spear Study Club. These study clubs are built from the same foundational elements on which Crosslin based his entire laboratory career and business: smallgroup interdisciplinary learning and collaborative interaction. Each club consists of up to 12 members who meet approximately eight times a year to study real-life cases provided by Spear. The most successful clubs have representation by at least one surgical specialist, an orthodontist, and of course, a lab technician. Crosslin said, “I always felt that larger labs couldn’t do as well as smaller labs.” Playing off of that notion, the Spear Study Club model emphasizes experiential learning with your peers in a small-group setting, essentially capitalizing on the power of community to support like-minded individuals. Crosslin, who has since helped start eight different study clubs, says meeting regularly with his fellow dental professionals remains an important part of his career and states that understanding the complications and challenges of his referring doctors has helped him become better at his job. “The easiest way to understand clinicians’ problems and challenges is to be around them.”

What Can a Study Club Do for You?

“The easiest way to understand clinicians’ problems and challenges is to be around them.” —grady Crosslin, CDT owner of Crosslin Creative Ceramics

You might be thinking, “Okay, so a study club brings lab technicians together with referring dentists in the community, but how can that really help me as much as it helps them.” Make no mistake, Crosslin says he has discovered that a study club is a great platform for surgeons— and that is exactly why they are great for lab technicians as well. “I can’t restore implants without implants being placed,” said Crosslin. A simple truth, indeed, but one that really cannot be overstated or discounted. Think about it. If a dentist cannot effectively convert a patient to accept an implant, the laboratory is not going to have any work to do. Furthermore, dentists need to be able to move patients in need beyond the single tooth restoration trap. That is, your dentists could be sending more comprehensive and complex cases as they gain confidence and competence. As Crosslin said, “It is easier to help surgical specialists grow their practices by helping GPs see more and do more with each patient because it helps grow the lab business.” There is no question that, by working in a collaborative setting with surgical specialists in your area, there is a good probability that you will increase your client base. In fact, Crosslin describes one of his first study club meetings as having that exact effect. “After one meeting, I picked up some work from doctors that I had not worked with before,” Crosslin said. Bringing in more doctors to work with the lab is certainly one goal, and a very important one, of collaborating through a study club. However, it is only one part of the picture. More is not always better. In this case, more is only better if the quality of each client’s work is up to par. Many lab technicians have stories of cases that they have received that were incomplete, missing valuable materials and, worse, prescribing what might not be the best treatment plan for the patient. By getting together with specialists and GPs in a study club setting, lab technicians are able to share their perspective on things and are able to showcase their own skills, rather than be left feeling disconnected, working away in the lab with poorly planned cases. Without this collaboration, it costs everybody extra time, extra money, and, quite possibly, a dissatisfied patient.

Capitalizing on Communication So, as a lab technician, if you are rarely or never

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personally interacting with your doctors, how will you be able to fix issues clearly and quickly? How can you know for sure that you are doing your best work and running a lab that will be successful and profitable for years to come? The answer is—you can’t. Crosslin says that his collaborative efforts within a Spear Study Club greatly improved his professional relationships. “It has put me in a better place than I was before and has better prepared me to deal with the cases that I do get,” he said. “A lot of technicians miss out on being able to relate with their doctors.” Remember, even the busiest and most talented doctors see only a fraction of the cases that come into the lab. Your perspective may come with far more experience than any of the doctors in a study club. When issues arise, lab technicians can discuss them in detail with their doctors and both parties can learn. Crosslin says that he often finds himself telling doctors what they can do better and how cases they have sent him (or cases that their fellow doctors have sent to other labs) could be improved. Crosslin said, “For me, I end up talking to my dentists a lot about photography [of their patients]…the importance of doing photography and making sure it is of good quality.” Something that may seem so obvious to the lab technician can easily be lost or overlooked by the dentist. When you communicate about those issues, the dentist has the ability to learn from and share his or her challenges with certain aspects of their treatment planning processes. Had the lab technician never said anything, the dentist may very well have continued providing the lab with poorly prepared and incomplete cases, which, again, costs everyone valuable time and money. The Spear Study Club content is developed by Spear Faculty members based on real-life cases and research over thirty-five years. Because the Spear faculty members are accomplished educators, the lab technician will also have the benefit of learning more about restorative and interdisciplinary dentistry through the eyes of the doctors. It makes a big difference when there is understanding of how all of the diagnostic and treatment planning principles can fit into a welldefined system that gives everyone in the club a common language.

Giving the Lab Technician a Voice As you lay out some of the overarching benefits of working with a study club, it becomes clear

“We all need somebody to raise the bar.”

that the lab technician can have a huge impact on the treatment planning process. Lab technicians have the ability to show their interdisciplinary team the undoubtable value of a lab and a perspective that no other member of the study club can provide. Crosslin says plenty of lab technicians want to be a team member and have a say, making them a more proactive part of the entire process, rather than a receiver of pre-chosen treatment options. “A lot of doctors do not know what the relationship could be,” said Crosslin. “Spear Study Club helps facilitate that [relationship], creating a collaborative, supportive environment for that to happen.” Crosslin also explains that a study club allows him to showcase his skill and show that he is a valuable resource in the community, something that all lab technicians can benefit from if they bring value and perspective to their study club meetings. “It is important to provide input and make your voice be known,” states Crosslin. When you are working with the interdisciplinary team, you get to hear everyone’s daily challenges with patients and the practitioner’s own inhibitions, including dealing with bigger restorative cases, such as those involving the edentulous arch. “A lot of restorative doctors shy away from removable cases,” said Crosslin. “The edentulous patient or rapid edentulation—larger full arch cases with immediate placement and provisionalization—they are intimidated by those cases.” Certainly, there is no doubt that many of these cases are not simple in nature, but working with a study club reminds the restorative dentist that he or she does not need to do it alone. Study clubs show us that we can, and should, treatment plan together. “You need counterparts to tell you the pros and cons of each option and make sure possibilities for and realities of patients are not lost,” he said. “All of the work does not need to fall on the restorative dentist or the surgical specialist.” It is a team effort—and that effort creates efficiencies and fluidity in the practice and the lab that, in turn, creates better results, more time for other patients and a positive, profitable interdisciplinary team across the board. How has Crosslin’s experience with Spear Study Club in particular helped the interdisciplinary team tackle those intimidating edentulous arch cases? There are two major factors. First, Spear is a resource for continuing education on topics

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like the edentulous arch and other restorative cases through the Spear Online platform and on-campus seminars and workshops from leading dentists. Second, the Spear faculty has used Straumann’s implant systems for years. Straumann has recognized that not every lab is fully proficient at doing these cases, and so they have created a series of courses designed to prepare the lab to engage in creating fixed hybrid restorations using their system, the Straumann Pro Arch. Combine that with a study club setting and you get the possibility of real synergy and growth. As Crosslin describes it, lab technicians find value in this for three main reasons. “Great communication, a great product, and a platform to listen and be heard,” said Crosslin. “[You must] recognize the platform as an opportunity—a platform for communication that stresses collaboration and the importance of the laboratory in its role.” He explains that another related benefit is the ability to inspire dentists to do their best work and take on cases that they would usually avoid. “We all need somebody to raise the bar—dentists will often focus on one tooth at a time instead of taking on the bigger cases, like [implementing] a Pro Arch.” Furthermore, Crosslin learned an invaluable lesson through his collaborative experience. He says he realized that despite the different roles of the interdisciplinary team, everybody is working toward the same goal and each facing challenges. He said, “Once we start relating to one another, we stop being so demanding and start helping each other out for the benefit of the practice and the patient. You realize that everyone is dealing with the same issues and patient expectations.”

Starting a Study Club Out of the several study clubs that Crosslin has started, he didn’t start a single one on his own. While you can go it alone, he co-leads all of his clubs with the help of a surgical specialist, just like the very first club that he started with an oral surgeon. This benefits the lab technician in more than one way. First, it obviously reduces the load and responsibility of starting a Study Club alone. Secondly, the added leadership from a surgeon means you are leveraging the surgeon’s network, making it easier to fill the club and ensuring you have an engaged team. Crosslin firmly believes that it is important to add members who are not just interested in ob-

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“It is important to emphasize the role of the team.”

serving the videos and case studies, but members who are interested in actively engaging with the team to offer their perspectives. A solid team is predicated on a fully engaged team. Lab technicians who start a study club have the added benefit of holding sessions at the laboratory. This typically means more space, more resources, and the bonus benefit of being able to showcase the laboratory to members that will hopefully become a client.

Conclusion Growing a laboratory business directly correlates with helping other dentists grow their practices. The more value a lab technician can provide to the interdisciplinary team, the more value the lab will get in return. The best way to provide such value is to meet regularly in smallgroup settings with an interdisciplinary team to communicate each other’s successes and shortcomings and collaborate on real-world cases. Perspective is a key variable when it comes to creating successful, fruitful relationships with all team members. Through a platform like Spear Study Club, it is important to emphasize the role of the team when the goal is, as it always is, to perform a higher level of dentistry. By partnering with a surgical specialist to start a study club, both the quantity and the quality of lab referrals will increase, the lab will grow and the lab technician will certainly experience more time-efficient and cost-effective advantages for years to come.

Spear Study Clubs https://www.speareducation.com/study-club

Straumann ProArch Education http://straumanneducation.com/faphybrid-2017.php

Grow Your Lab and Do Your Best Work by

3.5

Starting a Study Club

1. According to Crosslin, how many members should there be in a study club? A. 8 B. 10 C. 12 D. 4 2. How many times a year should the study club meet? A. 4 B. 3 C. 5 D. 8 3. Which one of the following is not an advantage of a study club? A. B. C. D.

Increase your client base Showcase your skill and that you are a valuable resource in the community Disconnect with each other Lab technicians are able to share their perspective on things and showcase their skills.

4. True or False. Study Clubs help facilitate the creation of a collaborative, supportive environment for interdisciplinary relationship can happen A True B False 5. When describing the Spear Study Club, what does NOT fit? A. Platform to listen and be heard B. Stressfull C. Great communication D. A Great Product

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“The LWO assists employers to not only comply with labour law, but also to use it to their advantage to protect their business and rights as an employer. The LWO is a registered employers’ organisation with the Department of Labour and has the right to represent our members at the CCMA, Bargaining Councils and Labour Court. Contact the LWO at ansofie@lwo.co.za.”

Tips To Survive A CCMA Case LWO Employers Organisation

The Commission for Conciliation, Mediation and Arbitration (CCMA) was established as an independent, apolitical dispute resolution body in terms of the Labour Relations Act (LRA), Act 66 of 1995 and is aimed at promoting fair practises and resolving labour disputes within the working environment. An employee can refer a dispute to the CCMA on account of dismissal, wages and working conditions, unfair labour practises, workplace changes and discrimination. Most cases referred to the CCMA pertain to unfair dismissal. In general arbitration awards in favour of the employee are due to incorrect procedures on the employer’s behalf.

pline (consultation and warnings, according to the offence)? • Did the employer apply discipline consistently? • Did the misconduct justify the sanction applied? 3.2. Procedural fairness – the required legal procedure before imposing a sanction. An employer cannot dismiss an employee under any circumstances, even with valid reason, without holding a disciplinary hearing to ensure that a fair procedure is followed. The employer must be able to prove the following:

3.1. Substantive fairness – a valid and fair reason for the sanction imposed. The employer must be able to prove the following on a balance of probability:

• A disciplinary hearing was held; • The employee was notified in writing at least 48 hours (excluding weekends and public holidays) prior to the hearing to prepare for the hearing; • All documentation (notice to attend the hearing and a procedural application form) contained all the necessary information required by legislation; • The chairperson was informed and unbiased; • The accused employee was given every chance to prepare for and defend his/her case; • Aggravating and mitigating circumstances were taken into account; • The outcome of the dismissal was based on the facts presented during the hearing; • The sanction was appropriate according to the offence; • The hearing and outcome was recorded in writing by the chairperson; • The employee received the outcome in writing.

• • • • •

Labour risk is a huge business risk. To ensure the sustainability and profitability of your business, labour risk needs to be managed proactively, as not following the correct procedures can lead to dire consequences with a huge financial impact.

Be proactive with these top tips and ensure that the consequences of a CCMA case do not mean the end of your business: 1. Have clear rules and guidelines in the workplace and ensure that every employee is aware of these rules. Employers must have an up to date disciplinary code that lists offences with the appropriate sanctions to use when rules and procedures are not followed. 2. Apply progressive discipline according to the seriousness of the offence and keep detailed record thereof. 3. Remember the CCMA mainly looks at two elements when an employee refers a dispute:

Was there a rule in the workplace? Was the rule reasonable? Was the employee aware of the rule? Did the employee break the rule? Did the employer apply progressive disciSADTJ Vol 8 Issue 1

TIPS TO SURVIVE A CCMA CASE

2.9

1. An employee can refer a dispute to the CCMA on account of - A B C D

unfair dismissal progressive discipline poor work performance the sustainability of the business

2. The CCMA is - A B C D

a political dispute resolution body aimed at protecting the employee the Labour Relations Act, Act 66 of 1995 a body that assists employers to comply with labour law an independent dispute resolution body aimed at promoting fair labour practice and resolving labour disputes within the working environment

3. The CCMA mainly looks at two elements when an employee refers a dispute: A B C D

profitability and sustainability of the business the background of the chairperson substantive and procedural fairness years of service

4. An employer can dismiss an employee immediately without holding a disciplinary hearing A True B False 5. When holding a disciplinary hearing, the employee must receive at least ______ hoursâ&#x20AC;&#x2122; notice in writing (excluding weekends and public holidays) prior to the hearing in order to prepare for the hearing A 24 B 36 C 12 D 48 6. Who can assist an employer at the CCMA A Labour consultant B Attorney C Employersâ&#x20AC;&#x2122; organisation which is registered with the Department of Labour D Trade union

SADTJ Vol 8 Issue 1