The Dental Technician Magazine February 2020

VO L 7 3 N O. 2 I F E B R U A R Y 2 0 2 0 I B Y S U B S C R I P T I O N

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

DENTAL DORIS A BETTER YOU

PAGE 6

ZIRLUX FROM HENRY SCHEIN A NEW KIND OF ZIRCONIA? PAGE 8-9

CASE STUDY

FULL DENTURES

A COMPLICATED CASE SOLVED ACCORDING TO THE GERBER CONCEPT PAGES 16-18

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DENTAL NEWS DENTAL TRIBUNE INTERNATIONAL: ART AND DENTISTRY COLLABORATE IN LONDON PAGE 34

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CASE STUDIES CASE STUDY WITH AUTHOR AND OPERATING DENTIST, DR. FINLAY SUTTON PAGE 12-15

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BY UR R S A EC UB C O S SE OL MM CR E LE EN IPT PA A D IO G GU IN N E E G 3

INSIGHT 10 GLOBAL TRENDS IN FULL-ARCH TREATMENT PAGE 10-11

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Inside this month...

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CONTENTS

Editor - Larry Browne FBIDST. FDTA, ITI Fellow, LCGI, RDT. E: editor@dentaltechnician.org.uk T: 01372 897461

CONTENTS FEBRUARY 2020

Designer - Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager - Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602 Editorial advisory board K. Young, RDT (Chairman) L. Barnett, RDT P. Broughton, LBIDST, RDT L. Grice-Roberts, MBE V. S. J. Jones, LCGI, LOTA, MIMPT P. Wilks, RDT, LCGI, LBIDST Sally Wood, LBIDST Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician Magazine is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused.

No part of this publication may be reproduced in any form without the express permission of the editor or the publisher.

Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH

Welcome Welcome to your magazine by Editor Larry Browne

Insight Dental Doris 10 global trends in full-arch treatment according to Straumann Letters to the Editor

6 10-11 34

Digital Technology Zirlux from Henry Schein

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Case Studies Case study with author and operating dentist, Dr. Finlay Sutton Full dentures: A complicated case solved according to the GERBER concept

12-15 16-18

Dental News Do dental technicians disadvantage themselves in regulatory matters?

Dental Tribune International: Art and dentistry collaborate in London

20-21 34

DTGB New sponsors announced

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Marketplace 3Shape/Shofu VITA LUMEX AC/WHW/Zirkonzahn

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WELCOME

Welcome

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The Christmas Family fun has now well and truly finished, and we are looking at the working year. Quite a lot of shows coming up and an expected increase in the promotion of the digital dental market to both clinician and technician.

Implant supported restoration continues to grow and a good deal of promotion of various ceramic or composite veneering materials will undoubtedly be evident in the year ahead. Staff training for your ambitious staff member is probably more available through the various commercial promoters of their own implant systems than through the known technical support colleges. Funding and material costs conspire to prevent a full and committed continuing education to cover these areas of interest. Perhaps it may change with universities like Bolton seeming to be able to provide a potentially higher degree of knowledge.

Being good and knowledgeable about the subject will help achieve more contented clients and staff. Being able with confidence to discuss cases and patient needs for each case will help enormously to promote your businesses and a continuing stream of cases.

Those of you who have taken the trouble to attend various courses, whether in the UK or overseas, please let us know of your experience and your impressions of what is offered and if you would, your recommendation as to whether it is a good course to follow. Every year there are lots of mentions of upcoming courses in all the dental magazines, but invariably there is a real lack of feedback as to their quality and benefit. It would be good to identify those, worth spending time on and those that perhaps need a re-think. So many younger technicians are keen to spend some of their time and money to improve their ability and usefulness. They should be encouraged to continue to learn.

Importantly learning the basics about their chosen path in technical dentistry. Learning to improve and become expert in whatever speciality they know. Each area is now influenced by the digital applications and awareness of the best way to achieve the very highest quality result will be a necessary requirement as we go forward. The future for the expert technician is bright but it requires constant work.

There are many new materials about which we need to learn and make choices. CAD/

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TO YOUR FEBRUARY 2020 ISSUE

By Larry Browne I Editor

CAM and various new manufacturing methods have introduced quite a variety of options, and learning and knowing their advantages and disadvantages will become an important knowledge tool. The clinicians will be bombarded with company sales literature and enthusiastic sales personnel from the international companies and will not have any real knowhow of what they are being sold.

Your technical experience with these materials will be invaluable in making the correct choices. Will Zirconium and its derivatives continue to hold an attraction, or will we see improvements in strength and resilience coming through with other materials. What changes and improvements are being seen in the various acrylics and improved strength composites? If they are strong enough to make aircraft and satellite components they may well have all the material requirements for restorative dentistry. There are already some very good examples on the market which compete very well with the Ceramic options, for strength and aesthetics in the area of extended bridgework on implants. They are showing some advantages, and allowing chairside addition and reduction without compromise on the final result. I am sure our love affair with Ceramics is far from over but there will positively be an attraction from the other material options.

There is a bit of a worrying trend with some areas of the market. The procedures for construction via the digital route can be a cheaper and an efficient method for producing greater numbers of restorations.

But too often the Lab owner has not seriously thought through the initial outlay and the ongoing maintenance costs. The cost of replacement parts and the down time caused by malfunctions and poor spare part supply support. Technical dentistry in this country is already woefully cheaper than it should be and in some areas a very low, even cynical, standard.

The new legislation and your agreement to register makes you responsible to the patient, first and foremost. Be sure your chase for a margin does not lead to a total ignoring of the required clinical dental standard.

There are continuing and ongoing discussions and disagreements between the government and the various dental representative bodies. Unfortunately, most of the regular negotiators are in fact clinical

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with the technicians associations acting as the recognised, but to be ignored, grumblers. It is very unlikely the NHS will ever be able to even begin contemplating a sufficient fee to create a situation where NHS restorations are worth considering for those who wish to make working quality restorations. It is hoped that within the various hospitals the standard is being maintained, but with the trend to opt out of the registration process by all and sundry within the hospitals, it is difficult to see how standards of any type can be imposed. It would seem as if the whole registration process oversight does not really exist. With so many ignoring or indeed, finding their “legal” excuse so to do the dentist bodies are more than delighted the registration of technicians will not really be effective. I have already published enough in these pages to illustrate where it is not being applied and the lack of response from the dental organisations just shows the apathy and ignorance, in particular from technicians, about the abuse of the necessary processes. We are repeatedly seeing labs who are not registering with technicians who are not bothering doing work which de facto is illegal. We have yet to see the prosecution of a clinician for using these laboratories.

In fact, illegal work from an illegal source.

Where are the dental organisations? They are supposed to be looking after the rights of their fee-paying members. But do and say nothing. Those who pretend to be the representative bodies at these meetings seem not to have achieved the least forward step in correcting the anomaly, why not? We are talking about dentists and technicians breaking the law. We are talking about these supposed professionals deciding to ignore the requirements (set up in the patients’ interest) because it may mean a bit more pressure on their profit margins.

When are they going to realise that being professional means acting professionally and in particular, in the patients’ interests.

Are you registered? Is your laboratory registered with the MHRA? Are you supplying “statements of manufacture” with your restorations? If the answer to any of these questions is no, you are working illegally. In other words breaking the law. I do believe many of you out there are doing the same. Stupid or what? Let us change it for 2020. Put the patients interest first as required by Law.

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BODY

INSIGHT

WELCOME TO... DENTAL DORIS

Dental Doris has worked in dentistry for many years and likes to muse about all kinds of dental and non-dental topics

A BETTER YOU…

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Energy 2: Mood Looking after your Body energy will keep your next energy, Mood, calm and positive, so you can stay solution-focused rather than reactive. The book can help people to change their moods too by, for example, changing their posture or breathing. It could be placing your feet firmly on the floor for confidence, or consciously relaxing by inhaling for three beats, then slowly exhale for seven.

o you work long hours, drink lots of tea and coffee, eat junk food and do very little exercise? It can be difficult as a busy dental technician to make yourself a priority but if you don’t love yourself before others the chances are life will get the better of you. I recently read a very helpful book that has some simple tools that we could all adopt for a healthier, happy life - The SHED method: energise your life written by Sara Milne Rowe.

SHED STAND FOR - SLEEP / HYDRATION / EXERCISE / DIET Performance coach Sara Milne Rowe has made a career out of teaching business high fliers to achieve their goals.

The SHED Method offers new ways to tackle life’s challenges as it helps you to get the best out of yourself, to find a solution or your direction - and then the steps to take to get on with it - Performance is about flourishing and becoming more of who you think you can be.

Most of Milne Rowe’s work might be focused on turning CEOs into superstars but her method is transferable. Most people want to better at something and the book certainly gives some tips on how to achieve personal dreams and goals and to move towards the life you want.

The framework of the SHED system is about tapping into your five energies - Body, Mood, Mind, Purpose and People. Having now worked with hundreds of clients, Milne Rowe

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discovered that if you manage those energies in a specific order, it can make a huge impact on your ability to be your best.’ Analysing how you’re using your energy will help you break down the puzzle of life, why you’re not feeling great, and so get you back in control.

Remember, nothing is set in stone: you can tweak your energy levels, whether it’s food or a positive mantra or the people you see or when you exercise and see what makes a difference.

‘It’s about becoming a scientist of your own behaviour. There’s no right or wrong. Ask yourself, how was that today?’

THE SHED METHOD EXPLAINED : Energy 1: Body The energy you need to tackle first, is your Body energy, the foundation of all your energies. ‘In our distracted existence, our basic needs get neglected,’ There’s a clue in the name of The SHED Method: which stands for Sleep (which includes rest), Hydration, Exercise (which means any movement) and Diet. When you’re tired, thirsty, out of condition or hungry, you simply can’t function at your best. Once you have refuelled your Body energy, you can be much more imaginative, make more considered choices.

Say you find yourself working at 11.30pm.

‘It’s time to stop! Go to bed! You’ll be so much more effective tomorrow.’

You might already know what boosts your body energy. Maybe it’s an earlier bedtime, carrying a water bottle and healthy snacks, a walk at lunchtime, one less glass of wine, no caffeine after midday. But what if you don’t know what works for you? Think back to a day where you felt completely on your game and try to replicate this.

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Energy 3: Mind Having high mood energy allows space and time for your third energy, Mind. You have to be very specific about where you want to apply this energy as it’s your driver, which allows you to concentrate, solve problems, make better choices, to be curious, to focus on a goal.

Energy 4: People People is a simple concept: Whoever you surround yourself with can either sap or boost your energy. There are people we look forward to seeing because they make us feel good, and people we don't - and who don't. So who you choose to mix with, will affect you. But increasing your people energy will help you in interactions too: be alive and present, show genuine interest, nod and smile as others speak, ask questions. The opposite is looking at your phone while they're talking, thinking about something else, looking frustrated or bored, interrupting or contributing nothing to the conversation.

Energy 5: Purpose Purpose is more profound. Sometimes people have lost excitement about what they do, so it feels like a treadmill. Finding your purpose energy will help you connect to what drives you. It’s usually something outside self-interest. Connect to this, and it has the potential to galvanise all your other energies, and to achieve far more than you imagined possible. The questions that help you identify your purpose might be: Why does this matter to you? and Who else will benefit?

Another way to discover not only your purpose energy but what motivates your mind energy too, is to do the Me Journey exercise.

Why not give the book a read and hopefully it will allow you to make a few small changes to a happier and more fulfilled life… The SHED Method: How to make better choices by Sara Milne Rowe is available from Amazon £8.99.

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DIGITAL TECHNOLOGY

ZIRLUX FROM HENRY SCHEIN A NEW KIND OF ZIRCONIA? MATERIALLY BETTER: A RELATIVELY NEW MATERIAL IN DENTISTRY, ZIRCONIA, HAS TRANSFORMED THE RESTORATIVE PROCESS. ANTHONY GILLIT, LABORATORY PRODUCT MANAGER AT HENRY SCHEIN DENTAL EXPLAINS WHY GRAPHICS: https://zirlux.co.uk/blog-post/zirlux-16-digital-workflow/ Originally published in the BDJ 21 July 2017

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ver the past decade, Zirconia has become a very popular restorative material and there is a wide variety of zirconia materials available in the marketplace, many very attractively priced, but the great thing about Zirlux® is that its range is very extensive.

Nothing is black and white Gone are the days when Zirconia was a blank, bland material that required a lot of post-production work to make it fit for purpose. Now it is a flexible, multipurpose material suitable for a wide range of indications. Henry Schein’s brand of zirconia is Zirlux®, which contains three basic elements in addition to a variety of characterising liquids and finishing materials.

• Anterior-multi – This is a multi-shaded block which allows for a more natural finish.

The block is more opaque towards the base of the restoration and translucent at the incisal edge, so it’s much easier for the technician to select the correct shade according to what has been prescribed, and there is very little work to do post-production, to make the restoration look natural next to the adjacent teeth. In essence, this material removes the need for layering and building-up, which is time consuming and elongates the process.

This Zirlux® option can be milled into a fully monolithic restoration and is likely to be stronger and more fracture resistant than a traditional restoration as there is no layering.

• 16+ pre shaded is a pre-shaded block available in all 16 VITA® shades, offering a complete solution by combining great translucency and exceptional flexural strength.

You can reduce post-production time by consistently matching the appropriate VITA® shade by selecting the most suitable Zirlux® disc before milling.

None of these options is necessarily better than another, they are each suited to different tasks and technicians should select the most suitable for the case at hand. For example, if you were creating a full arch, it would be difficult to get the right matching using the multi-layered discs and the best option would be to mill a single colour block and then apply shading using infiltration liquids, to give texture and tone.

for aesthetics. The choice of material should be determined on a case-by-case basis and is dependent on where the restoration is being placed in the mouth.

• 16+ White – This zirconia is best described as the traditional one, available in 16 VITA® dentine shades, 5 incisal, and 11 effect shades.

Technicians can control the final aesthetics by pairing with Zirlux® Shading to create highly aesthetic, natural looking restorations that blend easily with the surrounding dentition.

Strength Zirlux® anterior-multi has greater flexural strength than regular lithium discilicate, but is not as strong as the traditional single colour version. The fact is that when creating restorations of this type, there is always some element of sacrificing strength

Why use Zirconia?

More and more dentists are prescribing zirconia instead of gold. Ultimately, this provides a financial benefit to the patient, but without necessarily compromising on the aesthetic result. With the growth of digital dentistry – in both labs and

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The hardness of the material can obviously be a factor in terms of the opposing dentition, but once the glaze is added and polished it retains the benefits of any other ceramic.

DIGITAL TECHNOLOGY practices – we are finding that the materials’ manufacturers are investing heavily in producing materials that meet the demands of technicians, dentists and patients.

A rebirth of traditional craftmanship?

Of course, there is an element of the profession that feels that digital techniques are de-skilling the workforce, but the truth is that there are huge benefits for introducing digital workflows, creating more time for technicians to spend on those aspects of their craft that really add value.

The combination of technologies is opening up a whole new world of efficiency for dental technicians, without needing to compromise on quality. Scanning, milling and printing are streamlining all the processes within a laboratory, with less need to outsource. Cases are turned around quicker enabling dental professionals to work together to better meet patient demands for immediacy.

Keeping pace It’s very important that materials’ technology doesn’t start to lag behind the rapid advances in hardware and software. There are only a few places in the world that Zirconia is mined and the material itself is used as a base for a huge and eclectic range of applications,

and quality is largely determined by the methods manufacturers are using to refine the raw material. Zirlux® is Henry Schein’s own brand of Zirconia. It is a very highquality material, with excellent aesthetics but at a realistic price point.

TO ADVERTISE IN THE DENTAL TECHNICIAN MAGAZINE

For more information about Zirlux® and digital workflows, contact Henry Schein Laboratory. Tel: 0800 032 8018 Web: henryschein.co.uk Twitter: @HenryScheinUK Facebook: @HenryScheinUK

TELEPHONE: 01372 897462 EMAIL: sales@dentaltechnician.org.uk

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INSIGHT

10 GLOBAL TRENDS IN FULL-ARCH TREATMENT ACCORDING TO STRAUMANN

morbidity and a quicker path to the final restoration, while saving chair time in the practice. Dentists who take these trends into account in full-arch implantology are thus able to gain significantly more new patients.

Dr. Massimo Frosecchi, Italy “Patients are more informed and more interested to move directly from hopeless dentition to a new fixed implant-supported restoration, and clinics actively compete in offering lowcost full-arch rehabilitations. Digital workflows enable the standardization of cases and the use of a wider variety of prosthetic materials.”

TREND 1: ACTIVE LIFESTYLES OF A RAPIDLY GROWING AGING POPULATION The population is constantly aging, with more than 1.4 billion people over 60 expected to be living on our planet in 2030.1 Today’s 60+ year old patients still have a long-life expectancy, and a much more active lifestyle than previous generations.

Conventional overdentures will not be enough for them anymore!

TREND 2: INCREASING WILLINGNESS TO UNDERGO COMPLEX TREATMENTS Edentulous patients ask for “fixed teeth” and are willing to undergo the necessary treatment. At the same time, immediate treatments are becoming increasingly popular due to faster treatment times.4Conventional overdentures are still frequently offered, but expectations are shifting towards more aesthetic and functional options as well.

TREND 3: PATIENTS KNOW WHAT THEY WANT About 70 percent of patients’ state that online reviews of dentists are just as important for them as a dentist’s professional credentials.

Today’s patients are well informed and aware that implants are a safe solution not only for single tooth replacement. Offering implant treatments for multi-unit indications as well is becoming an important criterion for patients selecting their preferred dental clinic.

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TREND 4: DIFFERENT OPTIONS FOR DIFFERENT PATIENTS On average, one full-arch treatment per week is provided by dental professionals in the US, UK, Italy and Germany.4 Dentists require different treatment options that are tailored to the patient’s specific budget.3 Some situations are still best solved with the classic full-arch approach, while other cases can be managed with fewer implants. Here, fixed-hybrid overdentures accounted for the fastest-growing overdenture market segment in 2017.

TREND 5: LESS INVASIVE, LESS EXPENSIVE – AND FASTER Immediate placement and loading protocols are growing twice as fast as classic delayed implant procedures. Patients prefer shorter overall treatment times and less invasive treatments.

New protocols offer lower postoperative

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Dr. Blackie Swart, South Africa “The main trend I see is in the reduction of implants used for the rehabilitation of the full-arch. This was brought to the notice of the dental implant community especially after scientific evidence-based consensus statements were published in 2018. The improvement in the digital workflow has brought with it better materials to be milled or printed with greater accuracy. Since patients are seeking treatment much earlier, more terminally dentate patients are rehabilitated with fixed prostheses than those with atrophic edentulous jaws.”

INSIGHT TREND 6: DIGITAL DENTISTRY TECHNOLOGIES This is another significant megatrend in dentistry that enables more dentists to provide services in the field of implant dentistry by lessening the educational burden. Booming guided surgery services and intraoral scanners within practices facilitate processes and ensure confidence, reliability and precision also for the less trained practitioners. In the very near future, the precise and predictable fully-digital workflow will become a standard in the treatment of edentulous patients too.

Courtesy of Dr Luis Cuadrado and Dr Arturo Godoy Senties (Dental Technician)

Dr. Luis Cuadrado, Spain “Digital environments, especially for full-arch patients, are the pinnacle of modern implant dentistry”.

Treatment planning with coDiagnostix® Courtesy of Dr. Tadas Korzinkas

TREND 7: INTEGRATED IMPLANT PLANNING WORKFLOWS WITH GUIDED SURGERY With a steady rise in the number of general practitioners placing implants, the use of guided surgery is experiencing double-digit growth (11%) in Europe. Practitioners who are willing to embrace this technology can benefit from higher treatment predictability, more efficient surgical procedures, and maximization of treatment outcomes through fully digital collaborative planning.

Dr. Waldemar Polido, USA “There is a trend towards digital tools to plan the surgery and the restoration, once a full-arch rehabilitation is indicated. Using such tools we can observe many details and perform treatments with increased accuracy and improved outcomes, especially the chance for successful immediate loading.”

TREND 10: COST-EFFECTIVENESS AND PREDICTABILITY Full-arch treatments with four to six tilted or non-tilted implants have recently reached a completely new level of predictability and cost-effectiveness. Today, clinicians can make use of this technique without compromising on reliability, osseointegration and stability.

The exciting field of full-arch restorations is progressing rapidly. Care providers are challenged with new informed patient behavior, scientific findings, and evolving products and technologies, while the overarching megatrend of digitalization is fertilizing all aspects and steps in the dental treatment workflow . All this is opening up new opportunities to further develop professional skills, increase efficiency and realize new potential for the dental practice.

ARE YOU KEEN ON KNOWING WHAT THE OTHERS SAID? Courtesy of Dr Gustavo Harfagar

TREND 8: SHIFT TOWARD CHAIRSIDE 3D PRINTERS 3D printing reduces chair time and costs and is becoming increasingly popular and affordable.

The rapid growth of this market in Europe is stimulating all overdenture segments.

TREND 9: NEW LEVELS OF ESTHETICS WITH NEW MATERIALS New PMMA materials allow for more esthetic solutions in full-arch provisional restorations.

Final full-contour zirconia restorations are able to compete with conventional bar restorations.

Dr. Barbara Sobczak, Poland "Patients ask for immediacy more often – one surgery, one day, immediate teeth. We, as dentists, definitely need not only to be more skilled, but also to be able to use more sophisticated tools to fulfill these demands. In future we will be scanning and printing teeth within one hour of surgery and providing implants that achieve primary stability even in difficult conditions after the extractions, such as the Straumann® BLX Implant System.

The implants we already have, the rest will follow very soon."

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We are all aware of how much working clinicians are influenced by their peers.

Of course, advertising and printed articles are all influential. The above is part of the Straumann advertising campaign for their BLX (Immediate load implant system). It comes complete with a Video of the recommended procedure and is very informative.

FOR MORE INFORMATION ON THE STRAUMANN PRO ARCH BLX SYSTEM CONTACT: Straumann Ltd, Pegasus Place, Gatwick Road,Pegasus Pl, Crawley RH10 9AY. Tel: 0044 1293 651230.

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CASE STUDIES

Previously featured on Facebook...

A very big thank you for the Author and operating dentist, Dr. Finlay Sutton for allowing me to reproduce his very descriptive case for the Dental Technician’s readership. Dr Sutton runs a multi-disciplined referral practice in Garstang, Nr Preston and is heavily involved in ongoing education and training in removable prosthodontics.

THE FOLLOWING CASE DESCRIBES IN STEP

BY STEP DETAIL THE TRANSITION FROM ACRYLIC BASED IMMEDIATE DENTURES TO METAL BASED DEFINITIVE DENTURES. This 52year old man was referred to me from his general dental practitioner in 2018.

Dental History and Concerns:10 years prior to consultation the patient's general dentist diagnosed periodontitis and referred him to Manchester Dental Hospital. He received a treatment plan to manage the periodontitis.

Unfortunately, this was not acted upon.

Four years ago, gaps developed between the upper front teeth. Orthodontic treatment was provided to align the teeth. A bonded 4/ retainer was fitted onto the upper front teeth.

Approximately one year prior to consultation with me the patient noticed the teeth moving again. He consulted his orthodontist, who advised no further orthodontic treatment. One month prior to the consultation with me the upper left central incisor fell out whilst eating.

Social History: Cigarette smoker. 20 per day continuously for over 30 years Dental wish list: “Something fixed which I don’t have to worry about.”“To be able to smile and be confident.”

“I want teeth to look totally natural and healthy.”

“I don’t want to have a cosmetic look – but to look just how they were 2 years ago.”

Diagnoses: Generalised periodontitis; stage IV grade C: currently unstable, risk factors: smoker.

The remaining maxillary teeth had hopeless prognosis in the short term. They exhibited 80 - 100% alveolar bone loss with increased mobility (Grade 2 - 3).

The lower right second premolar and lower left first premolar (LR5 LL4) had hopeless prognosis in the short term. They exhibited 80 100% alveolar bone loss with grade 3 mobility.

The remaining mandibular teeth had approximately 30 - 50% alveolar bone loss with grade 1 mobility.

I did not believe that dental implant supported restorations (fixed or removable) were in this patient’s best interest given the history and extent of the periodontal disease and the smoking history. I advised him that other practitioners may be willing to provide implant supported fixed/removable restorations as an option. He was given time and space to choose his preferred option for valid consent.

Following two discussion appointments with me, the patient decided to have the following treatment plan.

TREATMENT PLAN l Extraction of all upper teeth and LR5 and LL4 and fitting of immediate acrylic based (Mk 1) dentures - complete upper and lower partial. l Periodontal therapy involving smoking cessation advice – with Mr Syed Abad, Specialist in Periodontics at the practice. l Reviews of the immediate dentures and relines as needed over 9 - 12 months. l Definitive dentures (Mk 2) – complete upper metal reinforced, and lower cobalt chromium based partial of hygienic Scandinavian design to be made 9 - 12 months after extractions of all upper teeth and LR5 and LL4.

ABOVE: Visit 1. Mandibular primary impression made in two stages using Accudent XD, Ivoclar.

This allows full extension to record the sulcus. This was used to produce a primary cast on which the immediate denture was constructed. The teeth were too mobile to risk further impressions

Copy of case treatment plan ABOVE: Upper arch pre-treatment.

ABOVE: Pre-treatment with generalised periodontitis; stage IV grade C, unstable, risk factors: smoker. Prior to phase one treatment of immediate complete upper denture and immediate mandibular acrylic based partial denture.

ABOVE: Oral situation and Pre-treatment radiograph indicating bone levels and showing teeth to be removed.

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Treatment planning card containing sequenced treatment plan and quotation. This is how I plan all of my patient’s treatments

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ABOVE: Maxillary registration using Futar D bite registration material in intercuspal position (ICP). The Mk 1 immediate complete denture will conform to ICP. Ideally the immediate complete denture would be fabricated in centric relation (CR)

CASE STUDIES

ABOVE: Modified stock tray with labial wall removed. Red cake compound placed in the palate to aid positioning of the tray.

ABOVE: Mounted casts for Mk 1 denture. Silicone index used as a guide for positioning denture teeth.

TOP ROW L TO R: Maxillary stock tray impression made in alginate (Dentsply Blueprint) recording the palatal and occlusal surfaces of the teeth. I didn't want to extract the teeth in the impression Stage 1; Stage 2 primary impression - Alginate re-seated in the mouth Schottlander Doric Heavy bodied silicone used to record the sulcus depth 2ND ROW L TO R: Careful removal of the impression from the mouth in two pieces - avoiding extraction the mobile teeth; The two parts of the impression ready to be fitted back together with superglue (cyanoacrylate adhesive); The two parts of the impression are fitted back together and glued with superglue (cyanoacrylate adhesive) 3RD ROW L: Cast for making the immediate complete denture with full depth of the sulcus recorded mounted in inter cuspal position f or Mk 1 denture. Mk 2 denture was made to centric relation using central bearing appliance. R: Photos of the patient’s natural dentition he would like reproduced.

TOP ROW L TO R: This pre-treatment photo on the right was used as the basis for the Mk 1 immediate denture; Superimposed photograph of the pre-treatment smile onto the mounted casts.

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ABOVE: UR21 UL2 teeth removed from cast and UR21 UL12 teeth arranged to pre-drifted positions.

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u p. 14

CASE STUDIES

ABOVE: The remaining teeth to be extracted removed from casts with artificial teeth arranged to pre-drifted positions.

ABOVE: Inflamed soft tissue removed from the cast by me (clinician) as this was swollen soft tissue. Making a flange to fit over this would have bulked the lip out massively. Having it socket fitted instead would result in a lack of peripheral seal and denture/gum aesthetic problems.

ABOVE: Inflamed soft tissue indicated on the cast.

ABOVE: Prepared maxillary cast and the finished Mk 1 complete acrylic denture.

ABOVE: Finished Mk1 denture mimicking the natural teeth.

ABOVE: Unprepared definitive cast for lower Mk 1 denture.

ABOVE: Prepared primary mandibular cast. Minimal preparation of the cast apart from careful removal of the teeth to be extracted owing to gross periodontal attachment destruction and alveolar bone loss.

ABOVE: Mandibular immediate acrylic based partial denture. Lingual surfaces extended to the mylohyoid line avoiding lingual frenum. Schottlander Enigmalife teeth.

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CASE STUDIES

ABOVE: Mk 1 immediate acrylic based dentures. Schottlander Enigmalife teeth. 0.9 mm wrought stainless steel clasps on LR4 and LL3.

ABOVE: Visit two: removal of all upper natural teeth, LR5 and LL4.

ABOVE: Mandibular immediate acrylic based partial denture with 0.9 mm wrought stainless steel clasps on LR4 and LL3.

ABOVE: Viscogel reline at fitting (visit 2) appointment.

ABOVE: Visit 2 fitting of Mk 1 upper complete and lower partial immediate dentures.

ABOVE: Wax covering the labial aspect of the upper front teeth preventing run of Viscogel into the interdental embrasures. This helps speed up clean-up of labial surface of the denture. The wax can be pealed off, when the Viscogel is hard enough.

ABOVE: Visit 3 Review 1post extraction of Mk 1 upper complete and lower partial immediate dentures.

ABOVE L to R: Mid treatment thank you card whilst patient had Mk 1 immediate dentures in situ; 3 months post extraction. Mk 1 reline of intaglio surface with Ufi Gel Hard; Ufi Gel chair-side reline of upper Mk 1 denture - showing infill of flange UL45 frenum region.

ABOVE L to R: 4 months post extraction reline impression using light bodied silicone in fitting surface using Doric Flo Light impression material. Firm placement in the mouth to ensure correct seating and border moulding; Dental laboratory reline cast without and with denture.

Patient due to start Treatment for final Denture in 6/7months time. Immediate and relined mark one dentures are serving well, and the patient is happy with appearance and function. To be continued next issue...

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15

CASE STUDIES

FULL DENTURES: A COMPLICATED CASE SOLVED ACCORDING TO THE GERBER CONCEPT REGAINING CHEWING FUNCTION, FACIAL PROPORTIONS AND DENTO-ORAL ESTHETICS

By Vittorio Capezzuto THE PATIENT: l At the time of the prosthetic restoration presented here, the patient Livia (pictured below) was 65 years old. She complained about the poor fit of her full dentures in the upper and lower jaw, in particular the pronounced movement of the lower denture caused her problems. Due to the strong mobility of the gingiva, the movement of the mandibular denture caused profound pressure points in the area of the fold with partially acute decubitus in the sublingual area.

A distinct vertical loss of the lower jaw bone was determined both clinically and radiologically. For prosthetic stabilization, an implant solution with overdenture seemed appropriate and was implemented.

The total maxillary denture was also to be reconstructed, as the posterior teeth were severely impaired due to pronounced wear and thus caused a significant lowering of the vertical relation.

To restore chewing function, a temporary immediate restoration for the upper and lower jaw, was proposed to the patient, which however, she did not agree with for personal reasons.

At her request, rehabilitation was postponed until after the osseointegration of the implants had been completed.

16

Description of the prosthetic planning The prosthetic planning included the adaptation of the previous dentures, the realignment of the occlusal plane as well as gingival conditioning.

The full dentures were fabricated using the GERBER method: a removable mucosasupported full denture in the maxilla and an overdenture with implant-supported SEEGER bar system with passive fit in the mandible.

These solutions were chosen as they can be adapted more simply, to the objective difficulties of the situation that had to be solved. The materials used included PMMA for the denture bases, nano-filled composite teeth (NFC+), a CrCo alloy for the rigid retention part and nylon for the secondary retention.

CASE DESCRIPTION Following the mandatory preliminary examinations, two implants were placed according to the BRANEMARK method in the chin area, as the volume of the bone permitted this and there were no risks of burdening the arteriovenous structures (Fig. 1) After allowing an appropriate period of time for osseointegration, prosthetic rehabilitation of both jaws was performed.

The objective local examination showed a reduction of the jawbone in the anterior region in vertical direction, which was clearly due to insufficient planning of the occlusal plane and thus attributable to an insufficient distribution of the chewing force, which is symptomatic for the KELLY syndrome.

In addition, a loss of vertical dimension due to wear of the existing artificial teeth was detected during the clinical examination; the purely physiognomic examination revealed a "senile-looking" relation between the upper and lower face (Figs. 2, 3, 4, 6).

Fig 2

Fig 3

Fig 1

Fig 4

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CASE STUDIES When the maxillary denture is inserted, the non-parallelism of both planes can be seen clearly for the present case. The occlusal plane extends downwards to the rear and not parallel to the Camper's plane, i.e. to the front and slightly ventrally. The present progression is responsible for the formation of pressure sores and ulcers which, as in this case, led to long-term bone atrophy and caused a KELLY syndrome. Using surgical forceps, the associated mobility of the mucous membrane could be demonstrated in the patient (Figs. 10, 11).

Fig 6

RESTORING THE VERTICAL RELATIONSHIP For the new restoration, the previous dentures were used, as aids for planning the new dentures (Fig. 6). They were used to reconstruct the vertical relationship.

For this purpose, two reference points were marked for distance measurement during the resting position, which is usually two to four mm from the occlusal contact point of the habitual inter-cuspid position (Figs. 7, 8). During the examination for the reconstruction of the occlusal plane, it became obvious that the current dentures were clearly aligned non-parallel to the Camper's plane. This is defined bilaterally at the head and runs from the deepest

point of the nasal wing to the tragus center in the anterolateral part of the outer Ear. (Fig. 9.). Although these parameters deviate slightly from the reference points defined on the skull, in daily practice this deviation has proven to be a negligible variance in the sagittal direction of occlusion for both mucosa-supported full dentures as well as implant-supported overdenture restorations.

The parallelism between Camper's plane and the occlusion plane has an average distance of approx. 34 mm. A bite fork and an occlusionome resp. was used to determine and check parallelism. This aid illustrates the inclination of the plane outside the mouth where the subsequent dentures will occlude.

Fig 10

Fig 11 Fig 12

LEFT: Fig 7, ABOVE TOP: Fig 8 ABOVE BELOW: Fig 9

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As a consequence, the first step was to create parallelism between the Camper's plane and occlusal plane, by applying, at the time of the prosthetic restoration, cold-curing resin for temporary crowns and bridges. To the cleaned and roughened respective surfaces of u the existing artificial teeth. (Fig. 12). p. 18

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CASE STUDIES

Fig 13

Fig 15

Fig 16

Fig 14

Fig 17 Fig 18

The posterior part of the prosthesis was adapted to the Camper's plane similar in manner to a splint preparation with posterior alignment (Fig. 13). In this phase, the incisal edges of the upper anterior teeth were extended appropriately as they were too short, both phonetically and esthetically. To improve parameterization of the increase of the vertical dimension in this phase, reference was made to photos of the patient taken at a young age before the onset of the morpho-functional decay of the two jaws.

more than two millimeters from the occlusal position. After the correct empirical and functional values of the vertical dimension had been restored, upper mucosal conditioning was started, which required a long-term functional impression. To this end, FITT (KERR) was used and the denture was worn for approx. four weeks (Figs. 15, 16, 17, 18).

The maxillary prosthesis was significantly relieved in the premaxillary region, where the fibro-mucosal tissue was considerably affected by the development of the KELLY syndrome.

After completion and polishing of the vertically corrected maxillary prosthesis, the lower prosthesis was adapted in the same manner (Fig. 14), as the selected resting position as a reference deviated significantly

Due to the previous measures, it was also possible to avoid any further stress on this region, which had already been subjected to excessive stress for some time on the anteroposterior, supero-inferior and latero-lateral axes.

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LONG-TERM RELINING The relining material was applied and used in a thin flowing consistency. Satisfactory results were observed after approximately one month and at least four clinical examinations, i.e. a significantly increased prosthetic stability, the absence of Irritation and abrasion to the mucous membrane as well as a functional impression, by using the maxillary denture, which in addition exhibited a therapeutically useful interocclusal position.

To be continued next issue...

DENTAL NEWS

DO DENTAL TECHNICIANS DISADVANTAGE THEMSELVES IN REGULATORY MATTERS?

By Heather Beckett, Barrister and Registered Dental Specialist

PURPOSE: TO INVESTIGATE THE TYPE AND OUTCOMES OF REGULATORY MATTERS FACED BY DENTAL TECHNICIANS. A SUMMARY REPORT. FOR FULL STUDY REPORT SEE: www.Dentalbarrister.co.uk RESULTS: Sixteen (16) Registered Dental Technicians were identified from the filtered database on the GDC website as having had their fitness to practice considered by a Professional Conduct Committee between 01 January 2019 and 31 December 2019.

Eight (8) of the identified 2019 hearings were “resumed/review hearings”, intended to review Orders made at previous hearings.

The other eight (8) identified cases are where fitness to practise was first considered by a Professional Conduct Committee at a hearing during 2019.

CHARGES: Charges against Dental Technicians involved two main primary areas: 1. Working or offering to work outside the registrant’s scope of practice. These featured in ten (10) of the cases.

2. Criminal convictions or cautions/failing to notify the GDC of same. These featured in four (4) of the cases.

In all but two of these fourteen cases, it was charged in addition that the “primary” areas of

alleged misconduct meant that the registrant’s actions were: i. Misleading; and ii. Dishonest.

In a number of cases it was additionally charged that the actions also evidenced a lack of integrity and in one case that a patient’s informed consent was not gained as a result of the treatment provided being outside the registrant’s scope of practice.

A number of charges featured in more than one case: i. Failure to have in place adequate insurance or indemnity cover; ii. Failure to cooperate with the GDC investigation (this was commonly a failure to provide details of insurance or indemnity cover); iii. False declarations to the GDC regarding indemnity insurance; iv. Poor or inadequate record-keeping.

One registrant was also charged with failure to wear gloves while treating a patient (that treatment itself being outside the registrant’s scope of practice), and failure to respond professionally to a patient’s complaint One registrant was charged with misleadingly

and dishonestly representing to GDC counsel that he was enrolled on a CDT program at the time he had treated a patient outside the scope of practice of a Dental Technician and allowing GDC counsel to so submit at an Interim Orders Committee hearing.

One was charged with allowing misleading publication of advertisements and/or misleading information to appear on a website.

Two determinations mentioned registrants’ health, but understandably there were no further details, given the personal and private nature of the health of an individual.

Use of “in guise” (“under guise”) investigations: A particular feature of the evidence in four cases was the use by the GDC of investigators “in-guise” (or “under-guise”), in other words posing as members of the public. The registrants in these cases were charged with having offered to provide services outside their scope of practice during enquiries by the investigators in relation to “fictitious” potential patients, usually described by the investigators as “relatives” during the enquiries.

ATTENDANCE AND REPRESENTATION AT HEARINGS: TABLE 1 SUMMARY OF 8 RESUMED HEARINGS Original Hearing

1st Review

2nd/3rd Review

Attended

Represented

Attended

Represented

Yes

Yes

No

No

Yes

No

No

No

Yes

No

No

No

Yes

No

No

No

Yes

No

No

No

No

No

No

No

No

No

No

20

Attended

Represented

No

Yes

No

No

No

Yes

No

No

No

Yes

No

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DENTAL NEWS

TABLE 2 SUMMARY OF 8 INITIAL HEARINGS Attended

Represented

No

No

No

No

No

No

Yes

No

Yes

No

Yes

No

Yes

Yes

Yes

Yes

TABLE 3 SANCTIONS : SANCTION

NUMBER OF TIMES IMPOSED COMMENT

Reprimand

2

Imposed at first hearing

Conditions (with a review)

1

Imposed at first hearing

Conditions revoked, Suspension imposed at review hearing

1

When registrant failed to continue meaningfully to engage

Suspension (with a review)

11

Imposed at first hearing

Suspension extended (with a review)

8

Where registrant failed to attend a review hearing following an earlier suspension

Suspension lifted, Conditions of practice formulated

2

At review hearing

Conditions extended at review hearing

2

Following imposition of conditions at earlier hearing

Dental Technicians are only infrequently represented by counsel: It has relatively recently been reported1 that a Freedom of Information request by Dental Protection to the GDC illustrated an apparent significant discrepancy between the level of sanctions applied to dentists who are legally represented and those who are not. The general suggestion seems to be that substantially more dental professionals whose fitness to practise is found not to be impaired are legally represented than not. In addition, it seems that many more dentists erased from the register (and therefore unable to continue to practice for a minimum of five years and even then only if they achieve restoration) following a hearing are unrepresented.

As shown in tables 1 and 2, Dental Technicians often fail to attend regulatory hearings and are rarely legally represented. It would seem that this is likely to seriously disadvantage their position.

CONCLUSIONS: Based on this small study, whilst recognising the methodological limitations, it appears that

some registered Dental Technicians are prepared to offer to work and/or actually work outside their scope of practice. The GDC, in line with its statutory duties, takes a robust approach, upon occasions commissioning under-guise investigations where there is suspicion that this is occurring. Where these investigations present to registrants no more than unexceptional scenarios, they are likely to be justifiable.

It is most unwise to accept any opportunity to work outside your scope of practice. Because of the nature of the legal test for dishonesty derived from the Supreme Court case of Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67, it is more likely than not that where a registrant offers to work or actually works outside the scope of practice or fails to inform the GDC of a criminal conviction, their actions will be also found dishonest.

A finding of dishonesty will almost inevitably result in a finding of “current impairment� on public interest grounds. A sanction of suspension of registration at the very least will then result and

the Dental Technician will not be able legally to work as a technician whilst suspended.

It is significant that several Dental Technicians have failed to engage in the regulatory process in a consistent and meaningful way, by failing to appear at hearings. Suspension of registration or extension of suspension is likely to result from such a course of action. Dental Technicians facing a regulatory hearing rarely have professional legal advice and representation but may well benefit from doing so.

To minimise sanctions and damage to income, career and reputation, Dental Technicians should seek legal advice, must attend hearings and should respond to the regulator with equal rigour of case preparation and representation.

FOR ADVICE CONTACT: h.beckett@goldsmithchambers.com Heather Beckett, Barrister, Goldsmith Chambers, Goldsmith Building, Temple London EC4 7BL

REFERENCES: 1 GDPUK website. https://www.gdpuk.com/news/latest-news/3193-dentists-without-legal-representation-face-much-tougher-sanctions-at-gdc-hearings Downloaded on 31 December 2019

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DENTAL TECHNICIANS GREAT BRITAIN

WE ARE ONE WHOLE MONTH IN TO 2020 AND THE NEW DECADE! The Technicians Merit Awards Scheme is ticking along nicely and we have some new sponsors to announce! Sponsorship support is vital for not only allowing all involved to run the scheme but also it creates the excellent chance for suppliers to reach out to dental technicians who are always looking for ways to improve their work!

We are proud to announce our joining with:

BREDENT

Who are sponsors of Best Prosthetics Technician Award.

Judged by Chris Wibberley

IVOCLAR VIVADENT

Sponsoring Best Ceramics/Crown and Bridge Technician Award. Judged by Andrew Wheeler

3SHAPE

Sponsoring Best Hospital Tech/Maxfac Technician Award.

Judged by Iain Mur-Nelson

WHW PLASTICS

Sponsoring the Best Orthodontics Technician Award.

Judged by Andrea Johnson

SHOFU

Sponsoring Best Innovative Technician Award.

Judged by Magnus Underhay

This level of support really will help generate the awareness needed for the awards scheme which is for ALL dental technicians across the UK.

22

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DENTAL TECHNICIANS GREAT BRITAIN

DO YOU KNOW HOW TO ENTER? l Send an example of your work that shows your skills and technique.

We would love to see implant case studies, before/during and after photos. Examples of composites and strengthened ceramics. Examples of plates, either the traditional techniques or Digital CADCAM, 3D printing illustrating the patients reaction.

framework design? Examples of successful 3D printing or Laser printing would be great to see! Full upper and lower dentures showing your expertise at reproducing the natural soft tissue appearance and a natural looking set-up. Did Digital, CADCAM, or 3D printing feature and what other materials were used?

On the Max-Fac side perhaps a Gynatomatic surgery case could be a rebuilding of the jaw using appliances and perhaps digital plates and screws. Or repair of Pteryagoid bone, mid face. What appliances were used to restore?

Not all dental technicians work the same and we want to celebrate that!

Some more classic techniques with traditional metal casting showing

You can send your entry to awards@dentaltechnician.org.uk or join Dental Technicians Great Britain Facebook Group FREE! Pictured right are some recent examples.

Perfect Packaging Solutions

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• Bottles & Plugs • Dropper, Flip & Screw-on Caps • Containers, Boxes & Jars • Scoops & Measures • Spoons & Spatulas • Tubes, Ties & Clips • Spray & Gel Pumps • Bespoke Packaging www.measomfreer.co.uk

Now Buy Online Tel: +44 (0) 116 288 1588 Email: sales@measomfreer.co.uk Web: www.measomfreer.co.uk 37-41 Chartwell Drive, Wigston, Leicestershire, LE18 2FL, England.

Made in England

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23

MARKETPLACE 3SHAPE: EASILY PRODUCE SPLINTS, NIGHT GUARDS AND PROTECTORSÂ w Do you want to add new and highly profitable services to your offerings? Our brand-new Splint Studio with automated design functionality lets you design and manufacture splints, night guards, protectors, and similar dental and orthodontic appliances with just a few clicks.

AUTOMATIC DESIGN

Automatically raise the occlusal surface to the antagonist cusp tips and plane, so you can make slanted bite ramps with just a few clicks.

SEVERAL SPLINT TYPES

Fast and intuitive workflow for the creation of splints, night guards, protectors, and more.

EXTREMELY FAST

The software engine calculates the desired splint design in seconds, ensuring high productivity.

MILL OR PRINT-READY

The splint design is automatically prepared and optimized for your selected manufacturing method.

FIND OUT MORE AT: www.3shape.com or contact ukenquiries@3shape.com

CERAMAGE UP BY SHOFU: THE STATE OF THE ART IN COMPOSITE LAYERING! w The best of both restorative worlds: technologically sophisticated and aesthetically optimised. Ceramage UP, the flowable C&B composite system combines all the benefits of composites and ceramics in an innovative high-performance material.

Its high ceramic filler load and homogeneously compacted nanostructure guarantee excellent abrasion resistance, flexural strength and colour stability. At the same time, its perfectly structured layering concept with opalescent enamel and high-

translucency colours allows dental technicians to achieve amazingly natural aesthetic results, comparable to layered porcelain restorations.

Ceramage UP is indicated for almost all anterior and posterior restorations and comes in a modular system featuring great ease of use.

The individual shades are ready for use and thixotropic, so that tooth shapes can be freely sculpted using a probe or brush directly after dispensing. To further customise the appearances of anterior and posterior restorations, the flowable materials can easily be mixed with each other or characterised with the light-cured stains of the Lite Art system. Thanks to the additive layering technique, only minor shape adjustments will be necessary.

So the Ceramage UP C&B composite system, which is suitable for all types of crowns, bridges, inlays, veneers and longterm temporaries, uniquely combines costeffectiveness, efficiency and aesthetics.

FOR FURTHER INFORMATION PLEASE CONTACT THE SHOFU OFFICE: 01732 783580 or sales@shofu.co.uk

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MARKETPLACE

MARKETPLACE

VITA LUMEX AC: EASY VENEERING CERAMIC FOR ALL! w The ultimate material for all-ceramics – VITA LUMEX AC makes beautiful veneers easy!

Experience a new level of ease and efficiency with the universal ceramic for every ceramic framework. Drawers full of various veneering concepts and ceramic materials are a thing of the past. Anyone can use VITA LUMEX AC! Whether you are a novice technician or an experienced ceramicist, this easy-to-handle material will bring out the best in your individual craftsmanship.

Benefit from a luminous dentin core and well-balanced opacity and translucency.

Effect materials, opalescence and fluorescence provide quick, easy and natural-looking individualization. Even the classic standard

layering offers diverse esthetics and our time-tested VITA shade determination for reliable reproduction of tooth shade. Micro, partial or full veneering – the choice is yours.

Simplify your laboratory workflows with highly esthetic, long-lasting stability. Discover the ease of VITA LUMEX AC – the “VITA – perfect match.” for every user, every laboratory and every situation.

FIND OUT MORE: https://www.vita-zahnfabrik.com/LUMEX VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

A REALLY CLEAN REVENUE STREAM WITH WHW & THE RENFERT GMBH SYMPRO! w WHW, in collaboration with Renfert GmbH, is pleased to announce their latest innovative deal which will help CDT’s and dental laboratory owners to increase revenue as well as to add a valuable service to patients and customers alike.

Efficient, time-saving and profitable, Renfert’s denture cleaning device – Sympro – can be theirs to try for 2 – 4 weeks absolutely free with the purchase of just 2 of either the SymproFLUID Universal or Nicoclean cleaning fluids.

Don’t miss the opportunity to take advantage of this offer.

CONTACT WHW: 0800 009 2444 or speak to your WHW representative when next they call.

Supplied disinfected and completely ready to use, the Sympro will clean dentures, orthodontic appliances and splints 80% faster than conventional methods leaving them free of bacteria, tartar, nicotine stains and other substances.

CREATING EXCELLENCE WITH SPEED AND PRECISION: LECTURE INVITATION TO OUR 2020 LECTURE TOUR AROUND THE UK w Have you already found a way to cut in half time yet creating excellent and precise restorations? Do you know how to switch from a digital to an analogue workflow

and vice versa with no loss of patient data information? If the answers are “no”, join our lectures for dentists and dental technicians and we will teach you how!

Sergio Polisi, CAD/CAM expert dental technician and worldwide lecturer will show you: Digital patient diagnostics and digital axiographs 3D virtual patient reproduction and face animation concepts l Fast design of implant-supported full arches l Innovative solution for mock-up creation l Smooth workflows, the key to selling quality yet saving time l

Monolithic restoration made with the new Prettau® 2 zirconia. Join Zirkonzahn’s lectures with your working partners and team and stand out in the crowd of quality in digital!

l

Discover all upcoming dates and join the lecture with your working partners and team!

CONTACT: E: Carmen.ausserhofer@zirkonzahn.com T: +39 0474 066 662 W: www.zirkonzahn.com

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25

ECPD

FREE VERIFIABLE ECPD As before if you wish to submit your ECPD online it will be free of charge. Once our web designers give it the all clear there will be a small charge.

This will be less than the CPD submitted by post. This offer is open to our subscribers only.

To go directly to the ECPD page please go to https://dentaltechnician.org.uk/dental-technician-cpd.

You will normally have one month from the date you receive your magazine before being able to submit your ECPD either online or by post.

If you have any issues with the ECPD please email us cpd@dentaltechnician.org.uk

4 HOURS VERIFIABLE ECPD IN THIS ISSUE LEARNING AIM

The questions are designed to help dental professionals keep up to date with best practice by reading articles in the present journal covering Clinical, Technical, Business, Personal development and related topics, and checking that this information has been retained and understood.

LEARNING OBJECTIVES REVIEW: n Strength of Zirconia n Implant planning n Customised Special trays n Business of Management

LEARNING OUTCOME

By completing the Quiz successfully you will have confirmed your ability to understand, retain and reinforce your knowledge related in the chosen articles.

Correct answers from January DT Edition:

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VERIFIABLE ECPD - FEBRUARY 2020 1. Your details First Name: .............................................. Last Name: ........................................................Title:................

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2. Your answers. Tick the boxes you consider correct. It may be more than one.

Question 1

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Question 10 Question 11

Question 12

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Question 15

Question 16

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C.

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C.

As of April 2016 issue ECPD will carry a charge of £10.00. per month.

Or an annual fee of £99.00 if paid in advance.

Q9.

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You can submit your answers in the following ways:

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D.

3. Evaluation: Tell us how we are doing with your ECPD Service. All comments welcome.

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Via email: cpd@dentaltechnician.org.uk By post to: THE DENTAL TECHNICIAN, PO BOX 430, LEATHERHEAD KT22 2HT

Payment by cheque to: The Dental Technician Magazine Limited. Natwest Sort Code 516135 A/C No 79790852 You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers.

Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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ECPD

VERIFIABLE ECPD AS YOU NEED IT VIA THE DENTAL TECHNICIAN Dental Doris Q1

Q9. Who removed the excess soft tissue from the model?

What is the method proposed by Doris to improve performance?

A. B. C. D.

Wheelbarrow method.

The Lean towards method.

The Shed Method.

The Elevator Method.

Q2. What is the second energy quoted for tapping into?

A. Mind.

B. Mood.

C. Purpose.

D. People.

A. B. C. D.

Difficult Denture case

Q10. What is said to have been revealed by the

physiognomic examination?

A. B. C. D.

Finlay Sutton Case

The Hygienist.

The Technician.

The Clinician.

The chairside assistant.

A reduction of the Jaw Bone.

Insufficient planning of the Occlusion.

A senile looking upper and lower Jaw relationship.

The KELLY syndrome.

Q3. What was the major cause of patient tooth loss?

Q11. What line indicates the sagittal line of occlusion?

Q4. What was the extent of bone loss diagnosed?

Q12. Why were the teeth extended on the dentures?

A. Periodontal disease and neglect.

B. Ill-fitting dentures.

C. Poor diet.

D. Heredity.

A. B. C. D.

A. B. C. D.

45% -65%.

75%-80%.

85%-100% 60%-75%.

A. B. C. D.

Central occlusal line.

The incisal line.

The Camper’s line.

The Lip Line.

To increase the smile line.

To increase tongue space.

To allow anterior/posterior movement.

To Create parallelism between the Campers line and occlusal plane.

Q5. Why were implants not used?

A. B. C. D.

Poor prognosis for success.

Too expensive.

Patient did not want surgery.

Poor bone.

Q13. How are immediate implant procedures sid to be growing

in practice?

A. B. C. D.

Q6 What Occlusal protocol was used for the primary

immediate denture?

A. B. C. D.

Art and dentistry collaborate in London.

Centric Relation. (CR) Inter-cuspal position. (ICP) Designated centric position. (DCP) Limited posterior occlusion. (LPO).

Q14. Where was the exhibition held.

Q7. Why was the Impression taken in two separate stages?

A. B. C. D.

The impression tray was not big enough.

The patients Sulcus was extra deep.

To show the accuracy of super Glue.

To avoid extracting teeth.

A. B. C. D.

Arcade Bush House.

Kings College.

Guys Hospital.

Charing Cross.

Q15. What was reported as created by poetry?

A. B. C. D.

Q8. What combination of materials were used for the

maxillary impression?

A. B. C. D.

Demand up by 25%.

Demand up by 100%.

Demand down by 25% Demand static.

Silicone and special tray.

Alginate and composite.

Alginate and heavy bodied silicone.

Heavy and light bodied silicone.

Patient behaviour.

Practice Atmosphere.

Stem cell research.

Better Phone Manner.

Q16. What was the objective for the Arts in Dentistry

Innovation Programme?

A. B. C.

D.

To give dentists a hobby focus.

To show the skill of the dental professionals.

To improve understanding and communication between practitioner and patient.

To demonstrate what was available on the NHS.

Payment by cheque to: The Dental Technician Magazine Limited. NatWest Sort Code 516135 A/C No 79790852 You can submit your answers in the following ways: 1. Via email: cpd@dentaltechnician.org.uk 2. By post to: THE DENTAL TECHNICIAN LIMITED, PO BOX 430, LEATHERHEAD KT22 2HT You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers.

Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

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27

DENTAL TECHNOLOGY

TARGETED CONTROL OF SHADE EFFECTS WITH VITA AKZENT PLUS CHROMA STAINS 28

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DENTAL TECHNOLOGY

By DT Urszula Mlynarska I Warsaw I Poland

FIG.1: The initial situation with lifeless, metal-ceramic crowns in the esthetic zone.

O

t’s a familiar situation: The restoration’s shade saturation does not match the natural tooth structure during the try-in. In that case, VITA AKZENT Plus CHROMA STAINS (VITA Zahnfabrik, Bad Säckingen, Germany) allow the chroma within a shade group to be increased systematically, helping to achieve the ideal final shade results. The CHROMA STAINS also make it possible to reproduce intermediate shades – as if with a brushstroke – without having to mix two different DENTINE materials. “These stains help me take tooth esthetics to an even higher level,” says dental technician Urszula Mlynarska.

In the following interview, she explains the reasons behind her enthusiasm, as well as points to consider when applying stains.

In what cases do you use VITA AKZENT Plus CHROMA STAINS? In general, the CHROMA STAINS allow me to work on a very individual basis and to precisely control the color intensity and shade to meet the expectations of dentists and patients. Being able to precisely control the chroma within a shade group and reproduce even the slightest nuance in shading allows me to reach new levels in restoration production.

For restorations with limited space, the stain shades allow me to characterize them internally, helping me to achieve threedimensional color effects.

What was the challenge in this case and how could the new stains help achieve a successful restoration?

The esthetic expectations were very high in this case. The restorations were supposed to be a bit lighter than the natural teeth. When fabricating the crowns, we wanted to achieve natural light dynamics that matched the appearance of the adjacent teeth.

FIG. 2: Full crown preparation for the new, all-ceramic crowns.

The brightness was to be retained in the central area, the shade in the cervical area was to be intensified and the chroma of the incisal edge was to be increased. At the same time it was also necessary to reproduce the base tooth shade of the natural teeth.

How important is the precise reproduction of chromacity for achieving harmonious, color integration of the restoration?

Every color is defined by the dimensions of brightness, color saturation and shade. Each tooth shade must be analyzed in the order mentioned, and this hierarchy also needs to be taken into account during the reproduction.

The brightness of a tooth is relatively easy to determine. It takes more experience to determine chromacity. Identifying the shade requires an even higher, professional level of experience. VITA AKZENT Plus CHROMA STAINS allow targeted control of the

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chromacity, helping me to achieve the most individual, lifelike results possible.

In your experience, how reliably can the shade effect or chromacity of restorations be controlled with the new stains?

VITA stains provide us with a logical approach to reproducing shade effects. For me, they are tools I can use to p ­ recisely reproduce all the nuances of the entire color spectrum of natural tooth structure.

CHROMA STAINS allow the chromaticity of a restoration to be controlled easily and precisely, as the change in color is already visible when the paint is applied.

Why are VITA AKZENT Plus Chroma Stains the ideal material for any dental technician to help achieve excellent and consistent results?

The stains allow ­beginners to achieve the correct u shade quickly, easily and predictably. In addition, p. 30

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DENTAL TECHNOLOGY any experienced ceramist can use them in a more individual and creative way. Because chromacity can be controlled on a very individual level with these stains, which allows for customized characterization and layer protocols.

How do you rate the processing properties of the new VITA AKZENT Plus CHROMA STAINS as compared to stains from other manufacturers?

Application is really easy and you can use the stains in a number of different ways, such as for internal and external characterization. The intensity can be controlled precisely, which makes it possible to apply color efficiently on the restoration surface. The stains only increase the chroma and do not alter the light transmission or UV effects of the restoration. The staining and layering materials essentially merge with each other, resulting in a three-dimensional appearance while not increasing the wall thickness of the reconstruction.

VITAŽ and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

FIG. 3: The situation during the clinical try-in of the raw firing.

FIG. 5: Perfect color harmony once all the crowns have been characterized with CHROMA STAINS and then glazed.

FIG. 6: The final esthetic results after the self-adhesive fixation of the crowns.

FIG. 7: The harmonious integration of the all-ceramic crowns.

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FIG. 4: In the first step, the chroma of crown 21 did not have an optimal match with the rest of the dentition.

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BAOT

DENTAL TECHNOLOGY

A NEW CERAMIC

T

wenty years ago, one group of people, based in the west coast of Pearl River in Guangdong province, where is also the birthplace of Chinese revolutionary pioneer Mr Sun Yat-sen, started various high-end inorganic material research due to one dream of catching up with international advanced technology.

The research covers materials like high thermal conductivity Aluminum Nitride used for substrates, PPM-grade wear-resistant materials, titanium dioxide self-cleaning materials, dental porcelain powder and etc.

Time went by day by day, but they experienced repeated failures, one project after another. At that time, they were living very hard and almost hopelessly. However, they never gave up. More than ten years have passed, and one day, one project was successful finally. Yes, it is the only successful project BAOT porcelain powder.

Yes, because of the persistence, BAOT people moved the God. The company has been developing healthily, and now has a standard workshop, a research and development center, and a high-quality laboratory.

As a provincial high-tech enterprise, BAOT has scientists, senior engineers, returnees from overseas. Among the team members, 41% of them have college education. BAOT continuously enriches its product line, not only delivering the best service to customers around the world, but also helping customers create greater value space.

Nowadays, BAOT dental porcelain are available in more than 70 countries and regions.

BAOT has got various global certificates, such as National Production License, National Product Registration Certificate, ISO 13485, CE, FDA and other countries registration certificates. Besides, the company has core technology of porcelain powder, invention patent certificate and other patent certificates.

ABOUT MATERIAL BAOT insists on quality first in the selection of materials, ensuring the stability of linear expansion coefficient, biological properties, chemical properties, and mechanical properties.

There is no performance degradation under special environments.

The chemical composition of BAOT porcelain powder is silicon oxide, aluminum oxide, potassium oxide, sodium oxide, zirconia, calcium oxide, boron oxide, and etc. It is mainly introduced from potassium feldspar, and through catalysis, it crystallizes repeatedly to form garnet crystals, which has good biocompatibility, chemical stability, strength and hardness suitable for oral structure and function. During the crystallization of garnet, through the process control, technical requirements such as translucency and transparency can be achieved to ensure a good artificial aesthetic effect of natural teeth relative to humans. BAOT's latest modifiers like opalescent, transparent blue, fluorescent and other effects have a new improvement in simulation. BAOT's full zirconia external simulation staining paste provides a larger

application scenario for full zirconia cases.

PRODUCT FEATURES Picture one (left) shows that the particle structure and distribution of BAOT opaque powder are very uniform. The uniformity of the opaque powder greatly strengthens the adhesion of the porcelain powder and the alloy, and the operating characteristics are optimized to ensure that a milky uniform texture can be obtained after mixing with the special liquid for opaque powder. After mixing, opaque paste can be more easily applied on the sandblasted alloy framework to create the uniform milky surface, which eliminates the generation of air bubbles, so the alloy framework and porcelain achieve a u perfect combination. p. 32

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BAR HEADER DENTAL TECHNOLOGY Picture Two (right) is an electron microscope image at 5000 times after acid etching. It can be seen that the garnet crystals are uniform in the glass phase structure without cracks.

PRODUCT PROPERTIES Various properties of BAOT porcelain powder are higher than ISO, reflecting the excellent physical and chemical properties

If the CTE of framework is significantly higher than the CTE of the porcelain layer, after sintering and cooling, the framework shrinks less than the porcelain layer, then the porcelain layer is easily detached from the framework (Figure 2).

BINDING FORCE

Figure 2 Figure 3

CHEMICAL SOLUBILITY BAOT commissioned a third-party testing company to conduct chemical solubility tests on the products, and the test results meet the standards.

ANALYSIS OF KEY ELEMENTS CTE - Coefficient of Thermal Expansion usually refers to linear expansion coefficient.

According to the experiments, the optimal CTE condition is that the CTE of framework is slightly higher than the CTE of the porcelain layer. Porcelain can withstand much more stress than tension. During cooling, the surface of the porcelain layer is rapidly cooled to generate tension, which easily cracks the porcelain, but because the framework is shrinking, it exerts pressure on the porcelain layer and prevents cracks in time. (Figure 3).

Figure 3

It is defined as the increase per unit length when temperature increases 1oC. Use a quartz top pestle thermal expansion meter to measure the CTE value of the product sample (25 ~ 500 oC) to ensure The CTE value of each batch of products is within the scope of quality control. The CTE range of BAOT porcelain powder matches more than 90% of the alloy on the market, and the alloy framework and porcelain are closely combined after sintering. If the CTE of framework is significantly lower than the CTE of the porcelain layer, after sintering and cooling, the porcelain layer shrinks more than the framework, then the porcelain layer itself generates huge tension, which causes outward cracks (Figure 1).

FLEXUAL STRENGTH

Figure 1

Three-point flexural strength tester Flexural strength, or called bending strength, refers to the maximum stress that a material can withstand when it is broken under a bending load or reaches a prescribed deflection. The three-point flexural strength reflects a strength index of the product, which can reduce the probability of porcelain cracks after sintering and cracks when contouring.

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BIOCOMPATIBILITY BAOT commissioned a third-party testing company to perform biocompatibility testing on the product. Test results show that.

DENTAL TECHNOLOGY FIRING PROGRAM

COLOR ART Hue - Shades remain accurate as VITAPAN classic and VITA 3D MASTER.

Translucency - Clear and perfectly reflects the enamel layer of real teeth.

DRYING & HEATING

Fluorescent - It mimics the characteristics of real teeth and displays fluorescent under UV light.

Drying and heating time will affect the permeability of porcelain teeth. If the drying and heating time is insufficient, the water vapor in the porcelain teeth cannot be completely discharged before sintering. During the sintering of porcelain teeth, the surface is easy to vitrify, and the water vapor in the porcelain teeth is blocked inside the porcelain layer, causing the porcelain teeth to become white.

Experiments show that the whitening of porcelain teeth can be improved by increasing the sintering temperature.

VACUUM The internal tests show if vacuum is not applied when sintering, a large number of air bubbles are visible inside the porcelain layer.

Therefore, vacuum must be applied when sintering. During the sintering process, the air bubbles in the porcelain are discharged to make the porcelain teeth denser.

Taken out at 6500C

CUSTOMER FEEDBACK Data show that rework rate in the dental labs, using BAOT dental porcelain, is not higher than 0.5%.

These data include implant porcelain cracks and missing part darker shade issues.

Taken out at 9000C

COOLING Cooling time is suggested at 4 min after sintering. When temperature drops to 6500C, take porcelain teeth out of furnace to avoid rapid cooling, which will cause cracks due to uneven thermal impacts inside and outside of teeth.

*Sampling statistics of rework due to BAOT porcelain issues in dental labs in a certain month.

Email : baot@baot.biz Facebook: https://www.facebook.com/baot.biz/

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33

INSIGHT

LETTERS

to the Editor

Email your letters to: editor@dentaltechnician.org.uk

A Question to the GDC l How is it that on one hand the Government can award a General Service Medal GSM Malaysia, edge engraved RADC to dental technicians who served on active service, yet service in the Royal Army Dental Corps, as a dental technician, trade class, as described in discharge papers and signed by a RADC commanding officer does not entitle registration with the GDC as a DCP for the whole lifetime of the army dental technician?

From James Bennett, Retired DCP, Surrey.

DENTAL NEWS

ART AND DENTISTRY COLLABORATE IN LONDON Dental Tribune International I January 13, 2020

l

LONDON, UK: In the dental clinic setting, communication is key to both successful results and satisfaction. At a recent exhibition, titled “Heads up! Shining a light on innovations in oral health”, the goal was to shine a new light on the Faculty of Dentistry, Oral and Craniofacial Sciences at King’s College London in order to improve understanding from both a practitioner’s and a patient’s point of view.

Held at the Arcade at Bush House from 2 to 13 December, the exhibition was the culmination of the Arts in Dentistry Innovation Programme started in 2018 that offered opportunities for artists and arts organisations to develop new conversations and collaborations with researchers from the faculty.

It showcased how such collaborations can highlight the lived experience of patients and clinicians in an accessible format and offered innovative approaches to student education.

Among the exhibited pieces were projects exploring regenerative dentistry and stem cell research through poetry, utilising virtual reality to see the world from the perspective of someone in a wheelchair, and raising awareness of hearing loss and dry mouth through 3D printing.

Visitors heaped praise on the exhibition, and one commented that “Visualisation and plays of perceptions reminded me to observe and sense, interact and care for the mouth and teeth differently ... I look forward to introducing new notions and aspects of healing approaches to my practice.”

King’s College London commented that the projects demonstrated how cross-collaboration can invite multiple perspectives and change the way areas such as craniofacial research are understood.

Along with the exhibition, a short film about the Arts in Dentistry Innovation collaborations was screened.

There were also a series of creative workshops involving clay making, experimental drawing, modelling stem cells and making mouths with embroidery.

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