The Dental Technician Magazine March 2020

VO L 7 3 N O. 3 I M A R C H 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

CASE STUDY

WITH AUTHOR AND OPERATING DENTIST, DR. FINLAY SUTTON PART TWO PAGES 12-14

HENRY SCHEIN AND 3SHAPE LAB VISION LIVE

INTERVIEW WITH DARREN KELSEY

PAGE 17

PAGE 11

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CONTENTS

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

CONTENTS

MARCH 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

Welcome Welcome to your magazine by Editor Larry Browne

Marketing Marketing By Mike Bond

A visit to the Implant Dentistry Show Henry Schein and 3Shape come together for LAB VISION LIVE

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.

An interview with Darren Kelsey

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Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463

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

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8-9 17

Interview 11

Case Studies Case study with author and operating dentist, Dr. Finlay Sutton. Part 2 Full dentures: A complicated case solved according to the GERBER concept. Part 2

12-14 18-20

Digital Dentistry New kid on the block

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Marketplace Candulor / 3shape/WHW Zirkonzahn/Bredent UK Ltd

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WELCOME

Welcome

TO YOUR MARCH 2020 ISSUE

By Larry Browne I Editor

THE MARCH WINDS MAY BLOW…

l

We are getting into March and the hope of sunshine and not too many showers! You will have gotten your teeth into the workload and occasionally wondering what the DTS may bring in May. This month I got out and about a bit more and have included a couple of reports on the Implant show and Digital working from 3Shape, Henry Schein and IVOCLAR VIVADENT. I hope you have been enjoying the features on full dentures.

I am sorry we have had to run them over three issues, but you will appreciate the magazine would be overcrowded with one or two cases if we chose a different course.

Things seem to have gone a little quiet on the MHRA GDC questions with the official bodies choosing to ignore our interest, after all we only represent Dental Technicians!

There is a working group who are trying to put together a strategy to deal with this apparent indifference and I will keep you up to date with progress. But don’t hold your breath for an easy way forward. The much lauded “team approach to restorative dentistry” is for discussion and only in private situations? The lack of will to ensure the patient knows and receives the Statement of Manufacture and the failure of the Universities to teach clinical staff their responsibility around this openness to the patient, shows clearly a wish not to get involved. After all dentists would have to communicate with their patients for this to work, fat chance!

It does appear that the new legislation is being ignored across the clinical areas and putting the patients interest first is really a pipe dream. It may be an Act of Parliament, it may be the law, but after all these are “Dentists” we are talking about and why should they even, waste their time knowing about the law. The fact that thousands of them are not registered with the MHRA (against the law) seems to be totally ignored.

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It would seem the undergraduate colleges are not teaching the new requirements and even dental nurses do not have any idea of the need to know. It may be the law that registrants who make custom made devices for patients need to be registered with the MHRA but too many people have chosen to ignore the law! I did not know you had an option. The dental nurse who is making the odd bleaching tray or other vacuum formed device for the patient to wear also needs to be qualified so to do and registered as a manufacturer of that device.

Of course, all this is such a nuisance for the poor working dentist. After all it is only recognising the other team members as responsible to the patient and requiring them to be qualified and fit to do the work.

Never had to worry about that before and cannot see why we should now eh!

What on earth do Parliament know about it all anyway? The very idea that a dentist may choose to fit cheaper substandard work is ridiculous. That they may import cheaper metal crowns containing lead is ridiculous!

Or that the Nickel Chrome used in nonprecious metals for bonding porcelain to could not possibly cause an allergy.

The new legislation makes it quite clear that a Registered DCP is directly responsible to the patient and must not ignore abuses of materials and restorations. The potential abuse is why the law was brought in, after the breast implant scandal. All those involved in that problem were fully medically qualified.

It did not stop the problem. The overview of the team members is essential if the legislation is to be supported. Ignoring the legislation is only available if the other responsible team members act professionally and in the best interest of the patient.

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A clear example of the abuse of the law is the number of hospitals who have claimed exemption from the regulations.

Exemptions are severely restricted in Europe where the law applies and which we were committed to following, even out of the common market. Really!!!

It is interesting, when looking at the growth of digital dentistry, the clinicians are lagging behind in taking up the challenge.

Close to 50% of laboratories are already involved in using the technology. While the clinicians are lagging behind, those who do move to digital do not want to move back and they will want to use a laboratory with digital facility even if it is not their first choice for restorations. Those of you who are reluctant to get involved should rethink and look at offering a digital service with the minimum of investment. A scanner design, facility, opens the way to not losing existing clients because they have chosen to try digital dentistry in their practice.

CADCAM and 3Dprinting manufacturing processes are in fact the expensive side of hard and software investments and as the processes are changing the machinery may change. Let the marketplace decide what works and outsource to third party labs who have chosen to invest in their choice.

While up to now CADCAM has dominated the manufacturing processes it looks as if 3Dprinting is a superior choice. But will it be laser melting 3Dprint or will it be another form of heat source. We are talking about thousands of pounds for the machinery etc. so don’t feel you must buy the whole list the companies offer you.

A large professionally run third party facility who have invested in the processes is probably the best road to follow, until your demand exceeds the supply timings.

It is a very big outlay, be sure you can afford the commitment.

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MARKETING

MIKE BOND – DENTAL MARKETING SPECIALIST l Mike is a self-employed marketing consultant who has worked

in the dental and healthcare sectors for over 25 years.

WHAT IS INSTAGRAM, ANYWAY?

W

hat is this trendy thing called Instagram that all the cool kids seem to be into? It's been around for a few years, quietly picking up traction mostly thanks to everybody's new obsession with mobile photography. Instagram is a social networking app made for sharing photos and videos from a smartphone and is perfect to share pictures of your technical work and advanced bits of kit you may have purchased whilst attracting the attention of a potential younger audience.

Understanding Instagram demographics is key…

And once you do, you’ll be able to create a smart Instagram strategy that will attract potential new clients to your laboratory.

But that’s a little easier said than done. After all, the social media platform boasts more than 1 billion users all over the world (more than 1/10th of Earth’s population).

I want to help. That’s why I’ve put together a list of the six Instagram demographics that should really matter to labs who have an Instagram presence (or are thinking of getting one). That way you can make the best decisions when it comes to your social media strategy.

2020 Instagram demographics Instagram launched in October 2010. A decade later, the site has grown into a social media powerhouse with the world’s top brands leveraging the account to create engagement, build an audience, and increase sales.

Here are a few key numbers to keep in mind for context: • 1 billion users worldwide by 2018 • More than 500 million daily active users • 928.5 million people can be reached through Instagram • 90% of users on Instagram follow a business • More than 500 million accounts use Instagram Stories each day Instagram age demographics When it comes to Instagram, Gen Z takes the stage as the largest user base, followed by millennials who have also made a massive impact in shaping what the app is.

Instagram is most popular with younger users: 67% of 18 to 29 year olds use the social

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media site. It isn’t just the younger demographics logging into Instagram, though. In the 50- to 64-year-old demographic, 23% say they’re using Instagram, up from 18% in 2016.

Instagram income demographics Instagram users run the income gamut, from hourly retail employees to CEOs. <£30,000

35%

£30000-£74999

39%

£75000+

42%

This means there’s room on Instagram for all kinds of business - and plenty of followers to go around.

Instagram gender demographics Instagram is also more popular with women than it is with men globally—though only slightly, with 52% female and 48% male users.

Five of the top 10 most-followed Instagram accounts (as of Jan 2020) are owned by women.

1 Instagram 2 Cristiano Ronaldo 3 Ariana Grande 4 Dwayne “The Rock” Johnson 5 Selena Gomez 6 Kylie Jenner 7 Kim Kardashian 8 Lionel Messi 9 Beyoncé ➓ Neymar Users all over the world are adopting the platform - and some countries are seeing massive growth in their number of Instagram users. Here’s a look at the global top 10 for Instagram users: United States

116 million users

India

73 million

Brazil

72 million

Indonesia

60 million

Russia

42 million

Turkey

37 million

Japan

27 million

United Kingdom

22.9 million

Mexico

22 million

Germany

19.9 million

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Instagram education demographics 43% of adults who use Instagram have a university degree or more, meanwhile, 37% of users have some college education.

Instagram demographics are just the beginning 60% of people say they discover new products or services on Instagram - and there are more than 25 million business profiles on Instagram, all working to get the eyes of those 1 billion users on their offerings.

Are you getting your business in front of the right people?

If you’re trying to get more Instagram followers or create the perfect Instagram ad, understanding Instagram statistics and demographics is just a piece of the puzzle in creating your larger Instagram strategy.

Ready to put your Instagram user demographic insights to work? Set up your account to day and start sharing!

FOCUS

A VISIT TO THE IMPLANT DENTISTRY SHOW Saturday 1st February

I

t was called the implant Dentistry Show and the major sponsor was Straumann, but it was somewhat overtaken by a predominance of stands for Digital Dentistry. While I do understand there is a common interest between the two areas It is difficult to see whether it is sustainable. There was certainly a high level of attendance and interest with a some very well, known names speaking to attentive audiences. A reasonable Saturday morning gentle walk!

Prof. Edwin Scher, Chairman for the meeting, proved popular with his resume on Implant complications. What to do when things go wrong? Clearly an experienced operator who was able to reassure his audience.

Dr Marcus Gambroudes. Took the audience through the restoration of the edentulous patient. Today the increase

in demand for full arch restoration with implants has never been greater and looks like a continuing trend. As with all largecale restoration a degree of experience is positively required and the speaker was able to show examples of successful cases together with the cautions needed before undertaking what is expensive and complex work, for both the clinician and of course the patient.

It is clear that a pathway via experience, with able and dedicated fellow surgeons is the best and most rewarding way to gain experience in this complicated, but rewarding, area of restorative dentistry.

Dr Selvaraj Balaji Demonstrated the rapidly developing GBR techniques around finding enough bone. He showed both horizontal and vertical bone augmentation techniques so necessary if correct implant placement is to be performed. The careful

use of membranes and various bone substitute materials were demonstrated by someone who knows how.

Dr Ashok Sethi as a very well-known and experience master in the implant field, tackled the vexed question of Occlusion on implants. The known lack of feedback normally via the epithelium is not present and the potential for parafunctional damage greatly increased if the patientâ&#x20AC;&#x2122;s working occlusion is not managed well.

He presented some clear guidelines for those beginning their Implant restorative journey and cautioned against dogma and blind approaches to this different restorative situation. It was reassuring to hear an acknowledged operator who was clear in his approach.

Dr Neill Millington and Ross Walker presented a new formulae mouthwash which seems to have remarkably good

TOP ROW (L TO R): ADI. Association of Dental Implants; LYRA Galaxy digital and Implant suppliers; CT Dent. 3rd Party Scanning for treatment Planning; Bristol CADCAM LTD. 2ND ROW (L TO R): Zone 1 Lecture theatre with audience gathering; Biohorizons Camlog Implant company; VASACADEMY Surgical training organisation for Implant dentistry; Megagen Implants UK and Ireland. 3RD ROW (L TO R): ITERO Digital Systems; RPA Dental suppliers of clinical equipment and Implants; QUORIS 3D Digital Implant Planning and Restoration; Bien Air Handpieces and Turbines.

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FOCUS

TOP ROW (L TO R): J&S Davis; Full Day Lecture programme at Zone 11; Patterson Restoration Solutions; Ceramet UK /dental solutions.

2ND ROW (L TO R): Osstem UK. Implant system; Click for Teeth Healthcare Specialist Marketing; Zone 11 Lecture just ready to begin; Geistlich Biomaterials.

3RD ROW (L TO R): SPEED UP; Light cured fibre from Speed Up; Example of potential use; Light Cured Splint Creation with light Cured Fibre.

4TH ROW (L TO R): Zirkozahn Digital Laboratory Supplies; Straumann Group; TRIdental Implants; Swallow Dental.

effects within the mouth. Unlike many other mouthwash materials available it does not contain Chlorhexidine. The active ingredients are Sodium Hypochlorite and Phosphoric Acid which effectively removes the Bio-layer and help prevent bacterial build up. An enthusiastic and positive group were confident they had the most effective product for this vital oral hygiene need.

Dr Andrew Dawood is a recognised master in restorative dentistry. His Harley street referral centre is highly respected by his colleagues and fellow professionals.

He tackled the tricky subject of complex implant restorations and dealt with it with confidence and insight, helping all who were in the audience to an overview of clear thinking and ability, combined in a committed specialist dentist.

A timely reminder of the difficulties you may face but the knowledge you may know a man who can help you through it.

Dr Matt Perkins spoke of his introduction into Digital Dentistry.

Like many of us today seeking this new â&#x20AC;&#x153;miracle methodâ&#x20AC;?, he cautioned against going it alone. He stressed the need for knowledgeable back up and support and as you go through the learning curve, of not just changing techniques for everyday dentistry, but getting to know the positives and negatives, of the software package and hardware combination. Very much a topic for today and the coming years. Dental treatments are changing, and the outcomes have the potential to amaze, but not all and so caution with knowledge is required.

Now here was a good idea for clinic or laboratory. A light cured fibre which can be used for the framework for Acrylic bridgework or as an impression aid for transferring implant or crown position from the mouth to the laboratory. Fibre up, light cure and take an overall impression. The material is

www.dentaltechnician.org.uk

impressively rigid and a very useful addition to the modern materials choice.

Other changes in the Market place which may be of interest are the acquisition of Ceramet by Darren Shorrocks. After many years working to maintain the longstanding services to the laboratory market Darren has decided to do it for himself with all the original contacts and materials available as before. With his knowledge of the UK. Market it should be a worthwhile investment on his part. This is when the hard work starts for him.

Always a feature of these days at dental shows is the familiar faces of those with whom you may have worked or had dealings with over your working career. Familiar faces often with unfamiliar companies as those with knowledge and experience often move on to further their career or because the original management systems change. It is always a feature of the visit.

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INTERVIEW

an interview with

DARREN KELSEY

I

I first met Darren Kelsey while I was studying at UCLAN in Preston for a CDT qualification. He looked so young (and indeed was) that it surprised all of us in the year. Darren is a very determined young man and wanted to find a way to improve his qualification and future prospects by learning more about the craft and profession in which he worked. He had come from a background of NHS denture work in Glasgow and had felt for a long time that there had to be more for him to get involved with. He attended the regular classes by getting in his car, very early in the morning and driving to Preston. Quite a few hours for every trip. He was very friendly and very determined but was a bit awed by some of the other members of the class. We were all impressed with his determination and thirst for knowledge. I was surprised by his appearance on the regular lecture circuit and determined to sit and talk about it when I was at Reading.

Darren Qualified via a HNC from Lange side college which allowed him to register with the GDC as a Dental Technician but he was determined to find a way to better his prospects. At 26 he decided it was a good idea to try for a CDT qualification and so committed himself to find a pathway to learning. His wife and brother were attending University and he was feeling very uneducated.

He recalls returning from Preston with the first assignment. Which was two to three thousand

Darren presenting at LAB VISION LIVE

words on the muscles of mastication. With a need to use a computer he had to ask his wife to help him open it and show him how to find Word and make it work. He has come on a lot since then with a real confidence.

He thanks his time at UCLAN for giving him the skills to learn. He has pursued his learning ambition by investing a regular amount a year in attending courses and visiting laboratories in different parts of the world and has travelled over 100000 miles in order to satisfy his appetite for learning. It has certainly paid off and has produced a very confident and capable businessman and Dental professional.

He began his career as a CDT by providing the services to five practices in Glasgow but very soon found the demand far exceeded his will to devote that much time to the process.

In the meantime, with his passion for learning

he took on the newly emerging world of Digital technology. He looked around and decided that IVOCLAR VIVADENT offered the best package and he invested in their P7 system and machinery. He produced digital dentures and with the increased demand for full arch restorations he found himself in a very good place. He is proud of choosing the P7 system as he worked very hard to be sure. He has even said the support staff of 10 technicians almost became free employees as he used their services to the full, during his learning months. He cannot praise them enough for their ability and knowledge. He is now in the happy position of providing full arches for his clinical colleagues but also as a manufacturer for other laboratories who scan and send to him.

I asked what he wants to do in the future. He admitted to wanting to be able to say when he will stop working and spend more time with his children and family. His newfound confidence and enjoyment of the digital manufacturing system is very attractive, and he will have a tussle to draw back from it when the time comes.

I really enjoyed talking with Darren and will keep an eye on his future progress, for progress there will certainly be. If you want to listen to a real technician talking about digital techniques and progressing towards that goal, listen to Darren Kelsey. A genuine and enthusiastic professional for technical dentistry.

REGISTRATION IS NOW OPEN! l Registration for the British Dental Conference and Dentistry Show 2020 is officially open!

Now you can secure your place at the event to make sure you don’t miss out on the extensive education and networking opportunities available.

A world-class speaker line-up has been accrued, with industry-leading professionals sharing their colossal collective experience and expertise.

There will also be an extensive trade floor with dental manufacturers and suppliers demonstrating their latest innovations. Whether you’re looking for digital technologies, restorative materials, software programmes or training courses,

there will be something for you.

• 10,000+ visitors • 400+ exhibitors • 200+ speakers • 100+ hours of education content Don’t miss out and register for free online today!

The British Dental Conference and Dentistry Show 2020 – 15th and 16th May –Birmingham NEC, co-located with DTS. FOR ALL THE LATEST INFORMATION: visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com

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CASE STUDIES Continued from February issue and 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 Technicianâ&#x20AC;&#x2122;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.

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s described in part one (February Issue) the patient attended with a history of Periodontal disease and required the extraction of all the remaining Maxillary teeth. Immediate dentures were made and later relined to serve as transient dentures during healing and to provide a foundation on which to continue with the restoration using removable dentures.

To help provide an improved stability with a reduced bulk of the partial lower denture.

Composite rest seats were created using etched composite on the lingual surfaces of the lower anterior teeth.

Dental laboratory reline cast without and with denture

ABOVE LEFT: Design of metal based lower denture. ABOVE RIGHT: Sandblasting the lingual of the lower anterior teeth prior to provision of composite rest seats to assist in stabilising and supporting the metal based lower denture.

The patientâ&#x20AC;&#x2122;s dental history did not support the use of Implants. The patient responded to the need to reduce his smoking habit and was happy with the appearance of the provisional dentures. He also improved his oral hygiene regime. It was agreed to continue to a final restoration with removable dentures with Cobalt chrome bases for metal strengthening some 6 to 12 months following extraction of original teeth.

And so began the process of restoration with new metal based dentures with the patientâ&#x20AC;&#x2122;s confidence fully behind the removable denture solution.

FIG 1

ABOVE: Etching the lingual of the lower Anterior teeth prior to provision of supporting composite rest seats, placed on the anterior teeth to allow the retention of the metal based lower partial denture.

The old lower partial denture being used as a temporary now needed adjusting to accommodate the newly placed and shaped composite rest seats. A reduction of the lingual fitting surface using Occlude spray to indicate an accurate reduction and a partial reline, using Silicone was undertaken to achieve this. See Fig 3.

FIG 2 FIG 1: 6-12 months post extraction of natural teeth - primary impression lower arch. Part 1 red cake (Kerr) compound to capture saddles and Part 2 impression making with alginate (Dentsply Blueprint). FIG 2: Maxillary primary impression made in two stages using Accudent XD, Ivoclar.

This allows full extension to record the sulci.

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FIG 3: Mk 1 immediate lower partial denture requires adjustment to seat properly over the rest seats using Occlude spray

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The carefully constructed mandibular special trays were border moulded using greenstick to create an accurate and stable fit support for the final impression to be taken using Alginate. See Figs (4/5/6/7/8).

FIG 4

CASE STUDIES

FIG 5

FIG 6

FIG 7

FIG 8

FIG 4 & 5: Mandibular special tray & Mandibular primary cast and special tray for Mk 2 denture (close fitting on saddles spaced over the teeth with perforations) for Mk 2 denture spaced FIG 6: greenstick on saddles border moulded. Adhesive placed (blueprint) alginate mixed, glazed with wet finger and ready to take the impression. FIG 7: Definitive impression in situ after border moulding. FIG 8: Mandibular definitive impression made in alginate

The impression for the Maxilla was equally carefully border moulded with Greenstick to ensure a good and necessary peripheral seal.

See Figs (9/10/11).

FIG 11: Definitive impression made in alginate (Blueprint) with resultant poured definitive cast

FIG 9: Maxillary spaced special tray for alginate

FIG 10: Maxillary special tray border moulded with greenstick compound, ensuring a peripheral seal is obtained.

Capturing the occlusal relationship of the patientâ&#x20AC;&#x2122;s jaws, with some accuracy, and transferring a suitable record for model mounting on the articulator. A series of stages were undertaken, starting with primary wax blocks See (Fig 12).

FIG 13

FIG 12

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FIGS 12 & 13: Primary registration rims used to record the APPROXIMATE centric relation (CR) and occlusal vertical dimension (OVD) to enable mounting of the definitive casts to fabricate the central bearing apparatus plates parallel to each other. Silicone used to secure the bite rims Prior to transfer to the laboratory.

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u p. 14

CASE STUDIES

Construction of Central Bearing Apparatus FIG 14 & 14B

FIG 15

FIG 14: Visit 3 for Mk 2 fabrication. Inter-maxillary registration with central bearing apparatus made on light cured tray maker for accurate CR recording.

FIG 14B: showing fitting surfaces of the central bearing apparatus after use. FIG 15: With inter-maxillary registration with central bearing apparatus made on light cured tray maker for accurate CR recording-mandibular fitting surface.

FIG 16

FIG 17

FIG 18

FIG 19

FIG 16-18: Visit 3 for Mk 2 fabrication. Inter-maxillary registration with central bearing apparatus.

Maxillary plate with china graph pencil marking for scribing the CR arrowhead Mk 2 fabrication.

Maxillary plate with plastic disc with countersunk hole placed over CR arrowhead. This allows the mandibular pin to fit into the hole to enable accurate recording of this inter-maxillary relation.

FIG 20

FIG 19 & 20: Visit 3 for Mk 2 fabrication. Inter-maxillary registration with central bearing apparatus in the mouth with the maxillary and mandibular parts "locked" together in CR by the pin in the hole. Inter-maxillary registration with central bearing apparatus in the mouth with the maxillary and mandibular parts registered together with Futar D bite registration material.

The Occlusal relation record can now be confidently taken to the Laboratory and carefully mounted on the chosen articulator.

The technician will be confident that in following the records he can produce the desired occlusal performance to satisfy the patientâ&#x20AC;&#x2122;s needs.

FIG 21

Using such custom-made devices enables the clinician to confidently capture and transfer to the laboratory a checkable and patient produced CR record.

Together with the patientâ&#x20AC;&#x2122;s own protrusive and lateral movements, traced on the bearing plates. A clear guide to where it is appropriate to place the artificial denture teeth for maximum accurate reproduction of the patients jaw movements.

To be continued next issue...

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FIG 21: 12 months after removal of failing teeth. During this time Mk 1 immediate dentures were fitted, periodontal therapy (including periodontal flap surgery) was provided. The tissue now reflects a potentially infection free situation providing the patient continues to care about his oral hygiene and continues to work diligently to maintain a healthy mouth. The removable design will only help this situation. INSET: Mounted maxillary and mandibular definitive casts at desired OVD using the wax rim with facebow and in CR via the central bearing apparatus.

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DIGITAL DENTISTRY

NEW KID ON THE BLOCK...

By Andrew Wheeler

very different way from what we are used too. To help you along there are clear and easy to follow videos on each module, it doesn’t take long to get to grips with the 3d environment. As a bonus you can log your time as you work through the videos to collect CPD points.

Andrew, working alongside BluePrint Dental, is an accredited instructor for blender4dental and currently runs course on the software.

F

or many years dental laboratories have had a few major players in the CAD market who have led the way in moving the industry towards a fully digital future.

I liken it to the Apple - Android debate, both are very capable platforms but tend to divide opinion even among close colleagues! Once you have nailed your colours to the mast there is little chance of changing, “better the devil you know”.

From here other modules can be purchased.

At present we have the ICP alignment tool, a special tray designer, logo module, implant guide and soft tissue options. Shortly there will be a splint and virtual articulator and there are plans for a crown and bridge and denture module. All of these can be used alone or in conjunction with each other to cover any situation you come across.

So why change? What makes this so attractive is the cost. At present all of the current modules mentioned will set you back £254.00 and with no annual subscription or update costs, it’s too good to ignore. If you are starting out on the digital journey this is an excellent way to get on board. It is fully customizable, in a market where CAD tends to take away the individuality of our work blender4dental gives you a way of standing

apart from the crowd. There are numerous options to design your models in a creative way and with the addition of adding your logo onto models and trays, your laboratory can stand apart.

Both Michael and Wolfgang are very hands on and are open to any requests to change or add features, your feedback to them is very important. An example, recently someone asked about a bleaching tray function adding reservoirs to the teeth, this took them a couple of days to write the relevant code and add it to the model module!

There is plenty of space in the market for all players, but competition is healthy. The ones who will benefit from this will be the technicians, which in the current climate is surely good news.

AW Precision Ceramics E: Precision_ceramics@yahoo.co.uk W: Blenderfordental.com T: 01483 277 070

Well now there is another player that has just entered the market and seems to be making quite a stir. So, what is blender4dental? It stems from a powerful piece of software with no relation to the dental industry. Twenty-six years ago, Ton Roosendaal launched a free and open source 3D creation suite used for creating animated films, visual effects, art, 3D printed models, motion graphics, interactive 3D applications and computer games. Scroll forward and a couple of enterprising guys, Michael and Wolfgang Teiniker saw the potential to use it for dental applications. In their hands they have developed add on dental modules into a useful alternative in the CAD market.

What can it do? Well, nearly as much as the big boys and is rapidly catching up in the other areas. It all begins with the model creator and growing from there. We can create any type of dental model from three file formats, STL, OBJ and PLY, in a straightforward, fast and logical way. Now don’t get me wrong there is some learning involved and the software operates in a

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15

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FOCUS

HENRY SCHEIN AND 3SHAPE COME TOGETHER FOR LAB VISION LIVE

A

n interesting day at 3Shape UK headquarters in Reading where Henry Schein had arranged a very full list of Clinical and technical speakers who presented the digital possibilities for Technicians and Clinicians. Technicians were encouraged to bring a dentist, without charge, to sample the digital potentials and to do so with their technician of choice. A great team building experience for all those who joined in.

It was a relaxed and very enjoyable day with some very good and recognised technical speakers who shared their experiences and knowhow with a considerable number of their fellow technicians and Lab owners.

Many of you will have heard some of the speaker before and will be familiar with their message, but each was up to date and very helpful throughout the day.

Vicken Hatsakordzian a very well qualified dental technician, has spent many years working with and marketing digital dental equipment and is the technical Voice of IVOCLAR Digital in the UK presented a clear and very useful overview of milling in the laboratory. He looked at the potential for covering the full range of digital restorations from a single crown through to F/F dentures.

Dan Holbeck who many of you will have shared questions and ideas with, in his role as Lab product manager for 3Shape.

Introduced the day and speakers programme and welcomed the attendees with a promise they would not be disappointed. I do believe he was right.

Darren Kelsey a highly skilled CDT with a real passion to provide the very best he can for his patients. Darren has a huge appetite for learning more about his chosen

profession and the potential techniques to improve his own potential. His talk on his move to Digital and the benefits it provides for his patients and his technical and clinical colleagues was clearly delivered by a committed and genuine speaker.

Doug Watt a graduate dentist with higher qualifications for restorative dentistry. Doug was awarded membership of the Faculty of General Practitioners in 2005 and continued his restorative training with two years with the Paul Tipton Training in Manchester.

He won the Paul Tipton Training Practical Restorative Dentist of the Year Award in 2009. He is partner at his practice in royal Leamington Spa where he places Implants, enjoys Endodontics and restorative and Aesthetic Dentistry. He is a board member of the International Digital Dentistry Academy.

His understanding of the potential for digital dentistry was genuine and encouraging.

Charley Laity is the Orthodontic Product and Training Specialist at 3Shape UK. Providing consultancy, training and guidance to 3Shape partners and customers across the UK and Ireland. An experience Technician with hands on knowledge of working daily with 3Shape Digital in the commercial environment, before joining 3Shape. He presented the Orthodontic potential of digital techniques and covered the 3Shape Clear Aligner Studio, the Indirect Bonding Studio and the Splint Studio.

Alex Mensikov Graduated from Cardiff Metropolitan University with an FDSC in Dental Technology in 2009.

Having worked daily with digital techniques he is a passionate supporter and now works with Henry Schein as a lab trainer and a remote support technician.

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Stephen Green was an enthusiastic early user of digital techniques with scanning and CADCAM. Stephen, very early, saw the potential for his laboratory with the new digital techniques and has been working with CADCAM for over ten years. He successfully built up his business to a size and reputation to sell it on as a going concern some years ago. He continues to work there and is a soughtafter lecturer on digital techniques and CADCAM.

STEPHEN GREEN TALKS ABOUT MODERN LABORATORY BUSINESS l Stephen Green who is of course a DCP, some years ago studied and obtained an MBA qualification. At the meeting he spoke about his business history and his achievement of building an Award winning, business based around digital dentistry techniques.

Stephen worked very hard but with his business qualification learned well how to achieve his ambition. His Talk titled â&#x20AC;&#x153;A Long and Winding Road,â&#x20AC;? covered the development and strategic application of his business learning.

His awards for Best Team in 2014/15/16//17.

Most Innovative Laboratory (3 times). He spoke of the difficulty of raising money which any new business faces but overcame it. He spoke of the resistance to change from his staff and the need to take them with you on the journey. Stephen spoke of the need to have a clear plan and to stick to it. He put in place an education programme for staff compliant with the GDC recommendations both in house and through approved courses and a new staff recruitment regime which involved a bench test and where appropriate, a test period. It certainly paid off with Stephen reaching and achieving his goal. He spoke of budgeting and learning about finance and talking to the experts in whatever field in which he was not trained.

A very useful and thought-provoking delivery of real merit.

17

CASE STUDIES

FULL DENTURES: A COMPLICATED CASE SOLVED ACCORDING TO THE GERBER CONCEPT PART 2 REGAINING CHEWING FUNCTION, FACIAL PROPORTIONS AND DENTO-ORAL ESTHETICS

CONTINUED FROM FEBRUARY ISSUE

By Vittorio Capezzuto FABRICATION OF TEMPLATES The functional model was fabricated from synthetic super hard plaster type IV as well as vestibular and lingual silicone masks (Fig. 1).

After fabrication of the denture base from cold-curing polymer, the silicone masks were filled with AESTHETIC WAX HARD (CANDULOR). Due to the implants, an impression was taken in the traditional way for the lower model. The bite template was fabricated on the functional model (Fig. 2). In the following clinical visit, the jaw relationship was determined and only in a horizontal plane, as all other references such as the occlusal plane, midline, canine tooth line and smile line were already determined accordingly and correctly beforehand within the context of determining the vertical dimension with the aid of the currently worn dentures (Figs. 3, 4).

The functional models were oriented at average values in the articulator using a dimensionally stable kneading silicone to be able to fabricate the templates for intraoral support pin registration, which were to be used to record the Gothic arch and to retain the set vertical dimension unchanged for this preparation (Fig. 5). To stabilize the registration pin against vertical forces during registration, the lowest point of the ridge is determined on both sides of the mandibular model and marked on the outer surface of the model (Fig. 6).

The writing plate is mounted in the lower jaw by heating the wax there and pressing it in slightly. Vertical reference is the zero position of the articulator support pin with the upper and lower wax walls lying parallel to each other. Here it must be ensured that both wax walls are harmonized. Then the upper butterfly-shaped plate is mounted to accommodate the registration pin. For this purpose, the metallic registration pin is slightly screwed back so that the tip of the registration pin protrudes, so that its position can already be checked during assembly by the contact point on the lower writing plate.

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Fig 1

Fig 2

Fig 3

Fig 6 Fig 4

Fig 5 Fig 8

Fig 7

Fig 9

Fig 10

Fig 11

Fig 12 Fig 14

Fig 13

The plate is also heated for this purpose and carefully pressed onto the upper bite rim.

Ideally, the verification contact should be on the line connecting the two lowest points of the lower lateral ridge (Figs. 7, 8, 9, 10, 11).

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Fig 15

To allow undisturbed and visually controllable lateral and protrusion movements in the mouth, the upper bite rim is now cut back without changing the vertical dimension of the occlusion (Figs. 12, 13, 14,15).

CASE STUDIES SUPPORT PIN REGISTRATION In preparation for intraoral support pin registration, the hinge axis points and the outer wall of the joint cusps are determined on the patient so that the facial bow can be anatomically aligned, the sagittal inclination of the joint can be correctly recorded, and correspondence between the hinge axis of the facial bow and that of the articulator can be ensured. For this purpose, two methods have become established to determine the condylar hinge axis at the head: one is statistical, and one is palpatory.

The statistical version states that the condylar hinge axis is located about 13 mm from the line between the temporal eyelid angle and the tragus. For the palpatory method, which we applied here, the patient is asked to perform small mandibular movements to be able to feel the position of the condyle with the small finger in the area of the joint cusp in front of the tragus (Figs.

16). The DYNAMIC FACEBOW according

to GERBER (GERBER CONDYLATOR) was used as a face bow with recording of the sagittal joint inclination. This is a kinematic facebow whose correct position is determined by the patient assuming (maximum) retrusion without effort to match the tips with the writing leads with the reference points marked on the skin. Here it is best to follow the "clockwise rule" to check the identification of the hinge axis (Figs. 17, 18).

SAGITTAL JOINT PATH MEASUREMENT To record the sagittal joint inclination, the registration cards (Fig. 19) are inserted between the writing lead and the skin so that the lines are parallel to the reference rod of the facial arch (occlusal plane indicator) and thus parallel to the occlusal plane. The patient treated here was asked to perform protrusion movements with her mouth closed. This procedure is repeated three times as a matter of principle to determine the mean value of the sagittal joint path inclination. Here, the

Fig 16

Fig 18

Fig 17 Fig 20

Fig 21

Fig 19 Fig 24

Fig 22

Fig 23 Fig 27

Fig 25

Fig 26 Fig 29

Fig 28

Fig 30

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so-called "functional" part of the recording is of importance, which corresponds to the probable sliding of the condyles on the joint cusp (tuberculum articulare).

INTRAORAL SUPPORT PIN REGISTRATION This was followed by the intraoral registration of the supporting pin, which was recorded in the horizontal plane (Fig. 20). It is used to determine the horizontal position (sagittal and transversal) of the mandible to the maxilla as "therapeutic" position (Figs. 21, 22). The position is found by comparing the neuromuscularly determined centric with the vertex of the Gothic arch. Before, the writing plate (lower jaw) is dyed and the patient, like our patient here, is asked to perform eccentric movements â&#x20AC;&#x201C; protrusion and laterally to the left and right. The movements mentioned above draw the so-called Gothic arch through the supporting pin (in the upper jaw) onto the writing plate positioned in the lower jaw.

The lower registration template is removed, and two lines are drawn on it: the protrusion line and the transversal to the arrowhead. This makes it possible to identify the vertex again and to compare it with the neuromuscular centric. To do this, the surface of the Gothic arch is again dyed before being re-inserted into the mouth. Accordingly, the patient was then asked to perform small opening and closing movements in rapid succession to determine her neuromuscular closing point.

The neuromuscular centric is normally 0.51.0 mm anterior to the vertex of the Gothic arch (Fig. 23). If the vertex of the Gothic arch and the neuromuscular centric, as is the case in this patient, are not more than 0.5 mm apart, a Plexiglas disc is fixed to the vertex of the Gothic arch (Figs. 24, 25). If the distance is greater than 0.5 mm, an intermediate position is determined which is referred to as "therapeutic" and lies between the vertex of the Gothic arch and the neuromuscular centric. However, this position must be perceived as being comfortable by the patient.

Finally, this position is keyed, in this case with fast setting articulator plaster, which was filled into a syringe for application beforehand (Fig. 26). Once the registration templates are keyed, they are transferred to the articulator (Fig. 27). To transfer the models into the articulator, the writing leads are replaced by metallic reference rods on the GERBER facebow. When positioning their tips in the hinge axis of the articulator, it should be ensured that the metallic reference rods are always parallel to the working plane. During the curing of a low as possible expanding plaster and after removing the wax from the two metal plates (supporting pin and writing plate), the existing silicone keys were used in the upper jaw to restore the part removed for the supporting pin registration and to bring it into contact with the lower wax wall (Figs. p20 28, 29,30).

u

19

CASE STUDIES MODEL ANALYSIS The "blueprint" in the form of the model analysis for the wax-up was then prepared in the laboratory. For this purpose, the contour of the alveolar ridge on both sides is transferred to the outer surface of the mandibular model using the profile compass (Figs. 31). The 4 and 6 positions are marked and also transferred to the model outer surface or model margin (Figs. 32, 33). The center of the incisive papilla is determined for the CPC line, the line is extended to the model margin (Figs. 34). This is followed by checking the bilateral ridge profile to determine parallelism or divergence. The stop line is also determined.

According to GERBER, in order to avoid forward movement during sagittal frontal and caudal gliding behind this, it is necessary not to set up a masticatory unit in occlusion, any more, which would also lead to premature wear of the retention part in our case due to the implants.

In the next step of the model analysis, it is assessed whether a normal or a cross bite is present, and it is checked whether the alveolar ridge has a distal or a lingual position (Fig. 35). Of course, an experienced eye can detect the situation to be solved in a few minutes and a few work steps in order to recognize how and where anterior and posterior teeth are to be set up. However, it makes sense to record and document as much information as possible. This way, it is possible to make the design of the dental prosthesis more predictable during the set-up phase (Figs. 36, 37) despite the somewhat higher expenditure of time and also to avoid errors.

Fig 31 Fig 32

Fig 33

Fig 35

Fig 36

Fig 37

To be continued next issue...

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Fig 34

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Dental Technology Showcase

MARKETPLACE CANDULOR AG: RELAUNCHES THE TOOTHSCOUT WITH IMPROVED AND NEW FUNCTIONS IN THE CLEAR CANDULOR LOOK w After nearly 10 years we have revised the ToothScout completely. The usability of apps has changed so much over the course of a decade that customers are now using mobile apps quite differently. Apps should be more intuitive, and of course with a clear benefit.

WHAT HAS CHANGED? WORKING WITH A PROFILE

You create your profile. Your data is stored for you and you can also select your working partner (e.g. dental technician) with whom you would like to exchange information by e-mail.

The focus is always on the patient.

CREATING PATIENT FILES

Create short, succinct and interesting profiles of your patients to help your work partner or yourself, including photos you can take directly

with the app. The photos are only stored in the app, so they don't appear in private folders.

TOOTH SELECTION À LA CANDULOR

A ToothScout would be nothing without teeth. Find the right teeth for your patients.

Enter the width of the alinasal and choose from a variety of tooth molds. We give you the correct references of maxillary molds to mandibular molds and the matching posterior teeth. Whether tooth-to-two-tooth or toothto-tooth setup, everything is available.

SELECTING THE RIGHT DEALER.

If you choose teeth, you also want to use them.

CANDULOR gives you suggestions for dealers in your area. You can store the data and save it in your profile. Write the dealer an e-mail with your list of wishes directly from the app.

WE PROTECT YOUR DATA.

We have opted for professional e-mail

communication to keep the exchange at a business level and not to mix it with private content. Therefore the photos are only saved locally in the app and not under «Photos».

Furthermore, the patient data only remain in the app. These are the property and the responsibility of the user.

CANDULOR has no access to patient data.

AVAILABILITY

The ToothScout was developed for the iPhone and iPad. It can be found in the App Store under CANDULOR or ToothScout.

FOR FURTHER INFORMATION PLEASE VISIT: www.candulor.com T: +41 (0)44 805 90 00 FAX: +41 (0)44 805 90 90 E: candulor@candulor.ch

3SHAPE TRIOS READY: BRINGING THE BEST CLINICS AND LABS TOGETHER w We live in a connected world. The faster and simpler the connection between clinics and labs, the easier it becomes for doctors and technicians to find each other and work together.

CONNECT WITH COUNTLESS NEW CUSTOMERS

More and more dentists and orthodontists are going digital with intraoral scanners like 3Shape TRIOS. Our 3Shape Ready programs allow you to promote your lab to many potential customers and show them that you are qualified to work with

their TRIOS digital impressions.

BENEFIT FOR LABS

Increased confidence Get guidance and practice the complete digital workflow together with 3Shape experts.

Free advertising Your lab is promoted as an approved TRIOS lab in our solutions and on 3Shape.com.

New customers Get access to a wealth of practices - every TRIOS user becomes a potential customer.

FIND OUT MORE AT: https://www.3shape.com/en/ services/ready-programs or contact ukenquiries@3shape.com

WHW: AMANN GIRRBACH CERAMILL® MATIK w The ceramill® matik marks the dawn of a new era in in-house fabrication. As an intelligent production solution, it clearly sets itself apart from conventional milling machines with its blank changers. The fully integrated fabrication unit offers the laboratory the possibility to design its workflow independently and flexibly.

It dramatically reduces the effort and complexity of tool and material management.

Automatic maintenance and cleaning saves time and helps the technician focus on the essential day-to-day work.

36 x Blank Tank – the material manager: RFID supported stock management l 100K Super High Frequency Spindle - the power pack: Hybrid bearing, high performance, super high frequency spindle (100,000 rpm) l

10X DNA control centre – the control unit: 10 axis control for activating the mechanics l 10” Touchscreen – the operating element: Integrated and intuitive order management

l 26 x Tool Stock – the tool manager: RFID supported tool management with exchangeable tool magazine that automatically identifies and assigns the correct tool for the material l 5X Processing Station – the milling unit: High quality dynamic and stable 5X system l Interior HD camera – full view: Camera for remote monitoring of the production process l ceramill® cleanstream –the automation specialist: Integrated self-cleaning system

l

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FOR MORE INFORMATION OR A DEMONSTRATION PLEASE CONTACT WHW on 0800 0092 444

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MARKETPLACE

MARKETPLACE

ZIRKONZAHN: PRETTAU® ZIRCONIA FOR MONOLITHIC DESIGN w Prettau® Bridges (monolithic, 14-unit Prettau® zirconia bridges) have been used for more than 10 years to provide patients with aesthetic and long-lasting restorations.

Now the chosen path towards monolithic design continues. Indeed, the new Prettau® 2 and Prettau® 4 Anterior® zirconia typologies, with their translucency properties, enable a monolithic design in the posterior and anterior regions that permits to avoid ceramic layering.

In their Dispersive® versions (Prettau® 2 Dispersive® and Prettau® 4 Anterior® Dispersive®), ceramic layering and manual colouring are not necessary anymore, since the two materials are provided with a very smooth, natural colour transition already during the manufacturing process. Indeed, colours are not blended into layers but are dispersed evenly through a special technique.

This results in a structure characterised by a merging natural colour transition after sintering, which can be further individualised manually.

PICTURED ABOVE: Prettau® 2 Dispersive® zirconia – 100% monolithic design (13-23), veneering in the gingival area only.

FOR MORE INFORMATION VISIT: www.zirkonzahn.com

Discover our new Prettau® materials firsthand: visit our booth at North of England Dentistry Show in Manchester, March 28th!

BREDENT UK LTD: BOND.LIGN w bredent has, for many years, been at the forefront of priming and bonding protocols.

The development of large-scale restorations involving composite veneering as well as implant restorations involving titanium bases has led to a requirement for the predictable and consistent bonding together of many differing materials.

These combinations include composite to zirconia, composite to pmma, NP metal to pmma, peek to composite or composite and peek to ceramic, lithium silicates or other high strength glass. bredent’s bond.lign products give the busy laboratory reassuringly consistent bonding options.

The range is available separately or as a full kit.

The Full Range Bonding Kit Ref: 5400bond is priced at £399.95 + vat.

Bond.lign products are available direct from bredent UK Ltd.

FOR FURTHER INFORMATION: Speak to your bredent technical specialist or call 01246 559 599 and speak to our friendly and knowledgeable service team.

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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 FEBRUARY DT Edition:

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

Address:.............................................................................................................................................................. ................................................................................................................................................................................ ............................................................................................................ Postcode:...............................................

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

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Question 5

Question 6

Question 7

Question 8

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A

A

A

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Question 10 Question 11

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Question 16

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Q6.

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D.

Q8.

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.

C.

You can submit your answers in the following ways:

Q10.

C.

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C.

1.

2.

Q12.

D.

Q13.

B.

Q14.

A.

Q15.

C.

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C.

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 Darren Kelsey Interview Q1. Where does Darren call home?

A. Edinburgh B. Manchester C. Glasgow D. Preston

Q9.

A. B. C. D.

How is the carefully taken record of the Centric Relation transferred to the Articulator?

Using sticky wax to secure the upper and lower plates Using wax squash-bite to locate plates Using low flex-ability silicone to secure the plates together Using Green stick and silicone

Q2.

A. B. C. D.

How many miles has he travelled to fulfil his learning needs?

30000 Miles 100000 Miles 10000 Miles 150000 Miles

Q10.

A. B. C. D.

What was used to colour the marking plates?

Printers ink Articulating paper Fibre tipped Marker Pen China graph pencil

Q3.

A. B. C. D.

Which Digital Scanner and production unit did he opt for?

The ITERO System The Straumann System The Sirona Dentsply system.

The P7 from IVOCLAR VIVADENT

LAB VISION LIVE Q11. What was the theme of the day?

A. Digital dentistry B. Implant reconstruction techniques C. Implants and Prosthetics D. Digital planning for beginners.

The Implant Dentistry Show Q4. Who was named chairman of this meeting?

A. Professor Edwin Scher B. Dr Andrew Dawood C. Dr Ashok Sethi D. Dr Neill Millington

Difficult Dentures according to the Gerber Techniques Q12. What was used to record the patient’s vertical dimension?

A. Wax Bite Blocks B. The original dentures C. Reproductions of the original dentures with cold cure

plastic bases and hard wax D. Wax copies of the dentures

Dr Finlay Sutton Case Q5. What was used to accurately record the

occlusal relationship?

A. Bite blocks and face bow B. Bite blocks with Central Bearing Apparatus C. Bite blocks with Silicone wafers D. Functional squash bites Q6.

A. B. C. D.

What material was used to closely customize the impression tray?

Moulded hard wax Green stick composition Rapid cure Acrylic Soft reline resin

Q7.

A. B. C. D. Q8.

A.

B. C. D.

Q13.

A. B. C. D.

What material was used for the final impressions?

Kerr’s Permlastic Silicone rubber Alginate & Irreversible hydrochloride Alginate and Reversable hydrochloride

What was done by the clinician to improve the stability of the original lower partial denture?

Careful adjustment of the lingual fit surface around the teeth and a partial reline Replaced the metal with rapid cure plastic Made a new provisional denture Added wrought clasps to the saddles

How were the functional movements recorded?

On a writing plate attached to the mandibular bite block On a writing plate attached to the maxillary bite block On a functional elastic squash bite record On a Shellac based template

Q14. How are lateral and protrusive functional movements controlled?

A. By the use of occlusal marking paper B. By recording movement in silicone impression material C. Visually, by cutting away some of the maxillary wax build-up D. By touch and tactile references.

Q15. Where is the hinge axis said to be located?

A. Just 5mm. anterior to the Tragus B. 13 mm. from the line between the temporal eyelid angle

and the Tragus C. At the posterior end of the Pterygoid process D. Parallel to the opposite side.

New Kid on the Block Q16. What is the name of the new “KID”?

A. Neo Cad Solutions B. Digital Dental Design C. Blender4dental D. Ascoptic-digital design

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 TECHNICIANS GREAT BRITAIN

THE MERIT AWARDS ARE LOOKING GOOD

By Larry Browne I Editor

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We have had a good response to the merit awards, especially in the Prosthetics and Ceramic Crown and Bridge. It would be nice to get a few more examples for Maxillo-Facial and Orthodontics but I do believe that as we show the wonderful work and ability of the UK and Ireland technicians it should stir those who are a bit reticent to shine a light on their own talent. I think you will all be very impressed with the standard of the first entries, selected by the technician judges and I am sure some of you will believe you can do as well if not better. But we wonâ&#x20AC;&#x2122;t know that unless you send your examples to us as entries for the Awards.

The sponsors who are sharing in the project are indeed well known to all of you and we cannot thank them enough for recognising that this really is a technician based, competition judged by technicians for technicians. I know we have had a few overseas entries but at this stage we are limiting our

assessments to UK and Ireland. I do think there will be scope for overseas entries sometime in the near future, but I am anxious to show the excellence we produce here in these Islands. With the curse of the NHS pricing formulae it is often difficult for commercial technicians to break free from the daily pressures from those who donâ&#x20AC;&#x2122;t really understand the nuances of true quality Laboratory work. I know that even under great daily pressure there are technicians out there who just want the chance to be recognised as able and Talented. The Merit Award is a great platform to take a little time to wave the flag for technical dentistry within our Islands.

Inspire the next generation and commit to making Teeth both beautiful and as the patients need them. Let us see the remarkable restorations taking place in the Maxillo-Facial department of our hospitals and the amazing quality all the hospital Technicians are committed

to maintaining. A great big thank you to the Dental Technicians Great Britain Facebook Group for supporting and promoting, online, the whole scheme.

In recent times I have been amazed at how little some young technicians know about the specialities. I suppose it is because they have chosen to follow one or other path for their future work, but it would be nice to shine a light on some of the lesser known areas. Maxillo-Facial is so little mentioned in the general dental magazines, but it really is worth knowing something about the processes.

Orthodontics features very little in the DT magazine and many others but is really in demand across the population. Whether it is for the traditional ortho treatments or indeed in preparation for reconstruction with bridge and crown work. There are some very clever and talented technicians involved daily in these pursuits. I do think we would all like to see more. So if you have any potential to influence the technicians involved to publish one or two pieces, please do.

So far the initial entries are really quite impressive with lots of good examples in prosthetics and crown and bridge.

So, read on and hopefully be impressed.

The awards scheme is running until December this year and we want as many of you to participate!

It couldn't be simpler to submit your entry. If you are a dental technician in the UK, Join Dental Technicians Great Britain Facebook Group and post pictures, a video or anything that showcases your work or talents to be considered by our judging panel. Alternatively you can send to awards@dentaltechnician.org.uk We want to see what you have to offer.

A nomination for each category will be chosen every three months to be shortlisted for the winner in December.

GOOD LUCK!

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DENTAL TECHNICIANS GREAT BRITAIN

TECHNICIAN MERIT AWARDS FIRST ROUND NOMINATIONS HEAD JUDGE:

BILL SHARPLING (LONDEC, KING’S COLLEGE LONDON)

Best Orthodontics Technician Nomination is David Baldry of Atomic Dental Laboratory for the Clarke Twin Block Appliance

Sponsored by WHW Plastics

CLARKE TWIN BLOCK CONSTRUCTION TECHNIQUE David Baldry Atomic Dental Lab E: David@Atomic-Dental.com T: 07810 673 831

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The following detailed procedure is the technique that I use to manufacture Clarke Twin Block appliances in the most efficient way possible, whilst maintaining consistency and quality.

Some steps that are obvious or not adding value have been skipped.

To manufacture a Twin Block appliance, a prescription, upper & lower impressions and protrusive bite are required. The procedure starts after the Lab infection control measures have been followed and after the models have been cast, passed QC and articulated.

Remove the wax bite and if the bite is excessively open or closed, then adjust the articulator so the space between the posterior teeth is approximately 4-5mm.

Follow the prescription for construction of the retention components. In this case its Adams cribs on the upper and lower 6’s & 4’s with ball ended clasps on the lower anteriors.

Wax the components into place and wax out the interdental wires so that the cribs can be adjusted by the clinician if required.

Using a sheet of pink wax, create angled shuttering and attach to the lower model.

The posterior angle of the wax should be

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DENTAL TECHNICIANS GREAT BRITAIN approximately 60 degrees (although the prescription for this case says 45 degrees!).

Line the posterior section of the wax with the mesial interdental wire of the crib on the 6â&#x20AC;&#x2122;s (this will make trimming easier at a later stage). Extend the wax so this it is extends just higher than the tips of the teeth on the opposing model.

Block out the undercut areas of the wax support and repeat for the other side.

Using cold cure acrylic and the salt & pepper technique, create the lower baseplate and twin block pillars. The wax supports that were created help to guide the build up of acrylic. Use the 60 degree angles to create square faced blocks that are approximately 1cm x 1cm and parallel. Cure using the normal method.

Using pink wax, create more shuttering/ acrylic supports on the upper model. The shuttering should be slightly oversized to make manufacturing easier later.

The lower blocks will be used to cut into the un- cured acrylic on the upper model when dripping on.

After basic trimming, it is easy to see that the 60 degree angle has been transferred to the upper appliance.

Create the upper baseplate and add the screw as required. Build the upper blocks with acrylic and when they are at full height, close the articulator and the lower blocks will cut into the un-cured upper blocks and transfer the 60 degree angle into the upper blocks.

Unsure that the upper blocks are nice and square and then add a small layer of acrylic to the face of the blocks to allow for trimming back later. Cure the upper blocks.

Mark the midline and cut a straight line through the upper appliance.

Using a variety of burs, finishing trimming the appliances until they are smooth. Polish on a lathe as per normal procedure. Remove the plastic tab from the screw, and steam clean to remove pumice / residue.

THE FINISHED APPLIANCE

Boil off the wax, and trim the lower appliance taking particular care around the blocks so the the 60 degree angle is maintained. Trim the height of the blocks until the is no contact from the opposing model. Smear a small amount of Vaseline on the surface of the blocks â&#x20AC;&#x201C; this will help to avoid the blocks bonding or sticking in the following stages.

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Boil off the wax and using articulating paper as a guide, trim the upper baseplate and blocks until the articulator closes to its pre-set position.

Slowly and carefully trim the blocks of the upper and lower so that there is good contact on both sides.

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DENTAL TECHNICIANS GREAT BRITAIN

“I am selecting David Baldry’s case as it’s a good example of a classic and still very popular appliance and the accompanying write up would be a great guide for anyone new, coming into the industry or someone not familiar with the construction technique of a cold cured Twin block appliance.”

By judge of Best Orthodontics Technician Andrea Johnson (OTA and Den-Tech)

Best Ceramics/Crown and Bridge Technician Nomination

Sponsored by Ivoclar Vivadent

is Sylwia Arizpe Dtg for emax Crowns

“A truly outstanding piece of Ceramic Crown work with expert and natural surface stippling and texture, and with a natural looking colour transition combined with an integrity of fit without bulking.”

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By judge of Best Ceramics/Crown and Bridge Technician Andrew Wheeler (Precision Ceramics)

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DENTAL TECHNICIANS GREAT BRITAIN

Best Cobalt Chrome Technician Nomination is Dan James - Dentacast

“The anterior strap looks very good. Well-designed and looks to be well fitting. I like the pop through design for the premolar, maximising support. It is a good looking, partial denture with partial gingivally free design. Retentive and stable with good tissue support in the palatal coverage but leaving the anterior palate free for patient comfort and reduced taste interference.

Well finished with a really good fit.”

By judge of Best Cobalt Chrome Technician Dave Smith

Best Prosthetics Technician Nomination is Leon Paul Zanre - Elite Dental Restorations

Sponsored by Bredent

“The case I chose for this month shows: n Natural anterior tooth positioning. I particularly like the subtle irregularity on some of the teeth. n Neat/clean articulation. n Leon has shown that he has a specific protocol for occlusal arrangement. n Very natural appearance of gingiva all the way from the free gingiva down to the alveolar mucosa (tissue in the sulcus). Leon’s subtle use of gum colouring reflects a really true representation of the natural situation, together with his minimal irregularity he has produced a very pleasing and realistic outcome.”

By judge of Best Prosthetics Technician Chris Wibberley (CW Dentures)

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DENTAL TECHNICIANS GREAT BRITAIN

Best Innovative Technician Nomination is Jamie Scarborough

Sponsored by Shofu

“I nominate Jamie Scarborough. I thought that his post showed great knowledge of Dentistry.

Combining old techniques with modern equipment and products. Which will push Technicians to further their skills and dental knowledge. A great example of modern digital design and construction using the very latest in strengthened plastics. Not metal, but a patient friendly tooth colour which will be invisible. A clear step by step demonstration of what is possible when you combine the “old” skill, with modern digital processes.”

By judge of Best Innovative Technician Magnus Underhay (MJ Underhay Dental Lab)

Best Hospital Tech/Maxfac Nomination

is Dhrumil Shah - Harcourt House Dental Studios

Sponsored by 3shape

“Restoring the patient’s smile and function with an obturator overdenture. What a difference some Co/Cr and acrylic can make. Providing soft tissue support for the anterior cheeks and allowing a well designed occlusion.The obturator overlaps the instanding posterior teeth on the patient,s right and left and provides a more normal symetry of tooth exposure when smiling.”

By judge of Best Hospital Tech/Maxfac Iain Mur-Nelson (St George’s University)

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