The Dental Technician Magazine November 2021

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Maxillary Toronto Bridge in Prettau® 2 Dispersive® Zirconia over a cemented titanium bar

BY ZIRKONZAHN I PAGE 12-15

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

5 things I cannot work without!

BY STEPHEN JUDGE I PAGE 16

THIS MONTH... l

DIGITAL TECHNOLOGY: BLENDER4DENTAL - THE STORY SO FAR I ANDREW WHEELER P. 18

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FOCUS: KEMDENT KEMSIL PRECISE LAB PUTTY - GETTING THE JOB DONE WELL I SALVATORE VITALE P. 20

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BUSINESS: STARTING A BUSINESS IN A PANDEMIC I LEON ZANRE P. 34-36

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CONTENTS

NOVEMBER 2021 Editor: Matt Everatt F.O.T.A. E: editor@dentaltechnician.org.uk Designer: Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager: Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602

EDITORIAL ADVISORY BOARD Andrea Johnson Ashley Byrne Ross Chapman Sharaz Mir Sir Paul Beresford

PUBLISHED BY THE DENTAL TECHNICIAN MAGAZINE, PO BOX 2279, PULBOROUGH, RH20 9BR. 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

Welcome 4

Welcome from the editor

Dental News Henry Schein contributes to MoveIt4Smile initiative to raise awareness for oral health and mouth cancer Time to get serious about digital. By Chris Powell

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Dental Technology Maxillary Toronto Bridge in Prettau® 2 Dispersive® Zirconia over a Cemented Titanium Bar Implant overdenture created in combination with 3Shape TRIOS and 3Shape Dental System. By Germen Versteeg The new era. With Giuseppe Musiello and Matteo Neroni

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Technicians Insight 5 things I cannot work without! By Stephen Judge of Bracon

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Digital Technology Blender4Dental - the story so far. By Andrew Wheeler

18

Focus Kemdent Kemsil Precise Lab Putty: Getting the job done well. By Salvatore Vitale Medentika®, a Straumann Group Brand: Collaborate the Optimal Way!

20 20

Case Report The use of removable appliances in place of fixed appliance therapy to treat an amateur boxer. Corresponding author Andrea Johnson

22-23

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24-25

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BAR HEADER WELCOME

From the Editor Matt Everatt F.O.T.A

Welcome to your November edition of The Dental Technician Magazine demand. A quick poll in the DTGB group on Facebook showed overwhelmingly that most labs are busier than they have ever been. With just a few sadly not returned to pre covid levels of work.

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Welcome to your November edition of The Dental Technician Magazine. I cannot quite believe we are so close to the end of the year already, something I'm sure I say every year around this time.

I want to thank all of the readers that took the time to respond to my article 'The Curious Demise of the Dental Technician part 2'. Several social media posts around the same time would suggest that many labs and technicians are beginning to introduce different pricing strategies and thing more business minded about their labs. This can only be a good thing for our corner of the Dental profession, a positive step to retaining staff and encouraging new blood to join us.

As we head into winter, I do so with an optimism that not everyone will share, hopefully many of you will. The pandemic may have taken its toll on a few of our labs, I'd be very keen to hear from those of you who decided to call it a day. For the rest if us who are here to tell the tale, it seems like we are in

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I have my theories on why most labs are busy, if you care to hear them, please do read on. It appears that NHS dentistry is the area that has had the biggest downturn, as we know, NHS practices were told when and how they could open their practices and most still aren't providing the same volumes of service and were able to provide a limited service whilst still being paid their full contract value. Other than the real emergency cases, there has been no real incentive to return to pre covid levels and certainly not when some procedures would require enhanced PPE for longer periods. Many patients found it difficult to get appointments and have since moved over to private dentists. Once they make the jump, they are then open to seeing what types of treatment they can have. So there has been a shift of patients moving over to private dentistry.

I have certainly had many friends and colleagues say they've made the move from NHS to private. Several saying they've left the practice where they have been patients all of their lives.

I also believe that for lots of patients, there is some disposable income floating around. After all, we've been

locked away for almost 18 months, not being on holidays and not going out. We have seen a huge upwards turn in new orthodontic cases coming through our lab, these are predominantly adult and private cases. I suspect the upsurge has been heightened by the fact most of us have been sat glaring at ourselves on Zoom meetings and paying way more attention to our close up appearance than ever before.

Those are my humble opinions on why many of us are experiencing a real boom at the minute. Will it slow down anytime soon? Who knows?

In other news, last month I was delighted to be able to bring forward the 'Statement of Fact' I regards to the GDCs stance on Illegal Manufacturing and Illegal importing of custom made devices. The Dental Technician Magazine will hope to continue the hard work that Larry Browne had committed to this and get some further responses from the GDCs executive committee.

We will of course follow up with any further information in due course.

For now, we hope you enjoy this months edition and look forward to seeing you in December in our run up to the Christmas crazy period.

Best Wishes Matt Everatt FOTA

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DENTAL NEWS

HENRY SCHEIN CONTRIBUTES TO MOVEIT4SMILE INITIATIVE TO RAISE AWARENESS FOR ORAL HEALTH AND MOUTH CANCER Team Schein member joins walk for the good cause l Gillingham - 02 November 2021: Poor oral health and infrequent preventative check-ups and treatment can impact the entire body negatively. Examples are the association between periodontal disease and the risk of vascular diseases such as heart attacks, stroke, or hypertension, and also diabetes, respiratory diseases, or problems during pregnancy. A less well known and worrying area of oral health is mouth cancer. Unlike most other cancers, mouth cancer cases have been on the rise for the last 20 years. Diagnoses have grown by more than 40% in the last decade alone. The incidence of this disease has increased by 97% in the last two decades. It is also one of the few cancers which is predicted to continue to rise in the coming years. Linked with lifestyle factors such as tobacco and alcohol consumption newer, research suggests that the increase is thought to be its links with the human papilloma virus.* MOVEIT4SMILES

The charity MoveIt4Smiles, that partners with the Oral Health Foundation, aims to get moving and raise money in the fight against mouth cancer. It also focuses on helping to increase awareness for good oral health and hygiene that links towards general health, and the important role of dental hygienists and therapists within the dental team.**

TEAM SCHEIN ENGAGEMENT

During a 500 miles MoveIt4Smiles charity walk from Kirriemuir in Scotland to Brighton, England, one of the charity walk founders and passionate crusader for oral health, Dental Hygienist Christina Chatfield, met Chris Hardy, Export and Wholesale Manager of Optident, a Henry Schein company, at one of the legs in Scotland. She told him about the charity walk she was doing and that for the next segment of the tour, she had no-one to walk with her. Chris Hardy loved the idea to support the charity aims and decided to walk the next 20 miles starting the very next day.

Most recently, and with a little more training, Chris joined the latest MoveIt4Smiles challenge that took place on 11 and 12 September 2021 at the Isle of Skye.

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The team of 18 participants completed a 16 kilometre walk on the first and climbed Bla Bheinn mountain on the second day.

In addition to Chris Hardy’s engagement, Henry Schein UK supported the MoveIt4Smiles walk by contributing to the provision of mountain guides, essential to ensure that all participants to complete this challenge safely.

HENRY SCHEIN CARES

Chris Hardy’s activity and the company’s support form part of Henry Schein Cares, the company’s corporate social responsibility programme.

“I am very proud of Team Schein supporting good causes around the globe with such enthusiasm,” said Patrick Allen, Henry Schein’s Managing Director UK, Ireland, Nordics & Southern Africa.

“Through its aim to raise awareness for

the importance of good oral health and to educate about oral cancer, MoveIt4Smiles fits perfectly to what we focus on with our Henry Schein Cares programme.”

Henry Schein Cares stands on five pillars: empowering Team Schein to reach their potential, advancing health equity and expanding access to care for underserved communities, accelerating environmental sustainability, strengthening, and diversifying our supply chain, and maintaining strong ethical governance.

Health care activities supported by Henry Schein Cares focus on four main areas: (1) wellness, treatment, prevention, and education; (2) capacity building; (3) emergency preparedness and disaster response; and (4) health system strengthening. *Source: MoveIt4Smiles **Source: Oral Health Foundation’s Mouth Cancer Action Month’s digital toolkit

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DENTAL NEWS

TIME TO GET SERIOUS ABOUT DIGITAL

By Chris Powell

C

hris Powell, a highly experienced dental technician currently working at Byrnes Dental Lab in Oxfordshire, will speak in the Technicians’ Programme at the ADI Team Congress 2022. About his session, “Digital v Analogue Dentures Version 2.0”, delivered alongside Davide Accetto, he says: “I’m presenting the analogue half of the lecture so I will be talking about managing the transition, sharing my thought processes.

I want to show what I think works with digital and what doesn’t, as well as the steps that are nearly there but need some more R&D. “Despite this seemingly restrained approach to digital, my advice to colleagues still contemplating initial uptake of digital, would be to do it now, before it’s too late!”

About the event, Chris adds: “This is by far one of the best lecture days for technicians out there. It is not only informative and full of modern, forward-thinking education, but it’s also a fantastic social scene. It’s so nice to catch up with other lab technicians and talk shop over a few beers. As technicians, we all have the same issues, so we can all be open and help each other with modern world challenges, including those associated with digital. It’s without a doubt the one date in the technician’s diary you should pencil in and attend - especially as the line-up for 2022 is incredible.”

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ADI members will be able to attend the ADI Team Congress for discounted rates.

JOIN TODAY www.adi.org.uk/congress22

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DENTAL TECHNOLOGY

MAXILLARY TORONTO ® BRIDGE IN PRETTAU 2 ® DISPERSIVE ZIRCONIA OVER A CEMENTED TITANIUM BAR A CUSTOM-MADE SOLUTION – RESTORING EDENTULOUS ATROPHIC MAXILLA WITH FRESH AND YOUNG ZIRCONIA TEETH SUPPORTED BY AN ANATOMICAL BAR Article first published in Labline Magazine: Manacorda, P. and Presicci, D., 2021.

A Custom-Made Solution: Restoring Edentulous Atrophic Maxilla With Fresh And Young Prettau ® 2 Dispersive ® Zirconia Teeth Supported By An Anatomical Bar. Labline Magazine, 11(2), pp.22-31.

CLINICAL SITUATION

The dental technical team of Laboratorio Odontotecnico Lazetera was commissioned with the production of an aesthetic restoration to replace a complete removable maxillary prosthesis that no longer met the patient’s aesthetic and functional requests.

The patient wanted a fresh, implantsupported smile with white and young teeth.

A complete study of OPT and CBCT data showed a severe atrophic condition of the maxillary bone with complete reabsorption of alveolar bone and maxillary vertical dimension. An accurate implantoprosthetic project associated with a virtual guided implant planning showed the opportunity to perform a computer guided implant surgery for immediate loading on six implants.

INTRODUCTION TO THE RESTORATION PRODUCTION

ABOVE: OPT data shows a severe loss of maxillary bone and vertical dimension. Due to the collapse of the upper arch a teeth and gingiva restoration was necessary for functional and aesthetic reasons.

Virtual positioning of implants on the residual bone. Six implants are placed by means of a surgical guide and are immediately loaded with a temporary prosthesis.

LEFT: Implants after guided implant surgery.

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DT Federico Presicci, part of the dental technical team of Laboratorio Odontotecnico Lazetera, was commissioned with the production of the aesthetic restoration. DT Federico Presicci manufactured the restoration with Zirkonzahn’s Prettau® 2 Dispersive® zirconia according to traditional working protocols.

Due to the reduced vertical dimension in the palatal area, the reinforcing titanium bar was individually designed for a perfect fit to the bridge. The Zirkonzahn workflow was utilised, with the new Zirkonzahn.

Modifier add-on software, where innovative automation and workflow greatly facilitate the design of the Toronto bridges.

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DENTAL TECHNOLOGY

CASE REGISTRATION AND FIRST STEPS

“The workflow started with the registration of all patient data in the Zirkonzahn.Archiv software, where the material and restoration typology were selected. I carried out this work according to traditional working methods. I scanned the maxillary and mandibular impressions using White Scanmarkers and based on such digital data I designed the first set-up for the production of a first prototype. The set-up was mounted and articulated into the virtual PS1 articulator in relation with the lower jaw and reference planes were created based on further patient-specific information provided by the dentist”.

FAST DESIGN OF SET- UPS IN THE NEW ZIRKONZAHN.MODIFIER ADD -ON SOFTWARE

“For the prototype design, I transferred the situ-scan data into the new Zirkonzahn.

Modifier software and we created a wax-up. The prototype was designed based on the situscan, improving the old situation according to the dentist’s demands. I eliminated all wear points, compensated impaired masticatory function and optimised intercuspation. By means of the new add-on software, I could design an accurate full arch in a considerably shorter time. Indeed, this software integrates the standard Zikonzahn.

Modellier software with valuable functions and automations that help to design full arches in a much faster way. A few functions that I consider particularly useful are the articulated rooted-tooth library already provided with preset occlusions, the automatic gingiva design as well as the photorealistic preview of the restoration colours. When you select the tooth library, all teeth are already mounted in the optimal position and the gingiva is subsequently designed based on the tooth set-up. For the design of this restoration, I articulated the two jaws virtually to reproduce the patient-specific dynamic movements, I chose the optimal insertion axes blocking out undercuts and once the design was ready, I created a wax-up and transferred it into the Zirkonzahn.Modellier software for integration of the screw channels. The prototype was then milled in resin and layered with composites in the gingival area”.

FROM TOP ROW LEFT TO RIGHT: Case registration in the archive software; The digitised antagonist model (mandibular); Gingival model of the maxilla; Situ scans determine the correct relation of teeth in the mouth; Digital articulation of the set-up and the mandibular scan; Creation of individual reference planes for model adjustment based on patientspecific information (midline, occlusal plan); The models transferred to the add-on software and virtually articulated to reproduce the individual dynamic movements; The articulated rooted-tooth library with already aligned teeth; Photo-realistic preview of the design after automatic creation of the gingiva; Analogue and digital White Scanmarkers are matched in the design software in order to find the correct position and orientation of the laboratory analogues in the digital model; Screw channels are automatically created by the software; The STL file ready to be transferred to the nesting software. LEFT: The resin prototype, layered with composites in the gingival area.

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DENTAL TECHNOLOGY

CONSIDERATIONS ABOUT MATERIAL SELECTION

“After accurate verification during the tryin phase, the clinician made all necessary functional and aesthetic adjustments and sent the prototype back to our dental laboratory for the production of the final restoration. For this treatment, I considered zirconia the best material to meet the patient’s wishes. As long as today’s resins can be functionally and aesthetically pleasant, it is important to look at several factors when choosing the right materials for long-term usage, such as strength values, natural aesthetics, and long-term cost to the patient.

Given these aspects, zirconia was then the material of choice for this treatment.

Not only is zirconia a stronger and more natural-looking material but is also more biocompatible and prevents the risk of gingival disease. Besides, state-ofthe-art CAD/CAM technologies permit manufacturing prostheses with an even more fitprecision, comfort and accuracy”.

“The choice of the material led at this point to further considerations, this time involving the selection of the most appropriate zirconia among all the ones available in the market.

For this case, I chose Prettau® 2 Dispersive® zirconia by Zirkonzahn. I greatly appreciate this new zirconia for its versatility, chromatic fidelity, high degree of translucency and faster processing times. Although ‘traditional’ zirconia shows extremely high flexural strength values, its opaque color requires porcelain veneering to achieve natural aesthetics, which has a primary clinical disadvantage with high rates of porcelain fracture or tooth abrasion.

The solution to the limitations of ‘standard’ zirconia is brought by the newest generation of polychromatic materials and Prettau® 2 Dispersive® falls into this material category.

This material is a perfect compromise of high translucency and flexural strength, which is about 1.200 MPa. Most importantly, the material is already provided during the manufacturing process with a natural colour gradient, which permits a faster processing since characterisation is not required anymore.

The special manufacture technique used does not blend colours into layers but disperses them evenly: the result is not a multilayer effect but a smooth, natural and harmonious colour gradient visible after the sintering process.

For this treatment, to create an even more natural and patient-specific aesthetic result, I carried out a manual minimal cutback on the anterior teeth. In this way, I could apply a slight layer of ceramics in nonfunctional areas only (e.g. the gingival region or non-loadbearing regions), avoiding ceramic chipping.”

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TOP: The bar is designed based on the situ-scan of the prototype tried by the patient. 2ND ROW: The bar is designed anatomically in order to compensate the reduced vertical dimension in the palatal area and provide perfect support to the final prosthesis. 3RD ROW (L): Adaptation of the secondary structure to the scanned bar. (R): The final job ready to be milled in a Prettau® 2 Dispersive® zirconia blank

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DENTAL TECHNOLOGY

PRODUCTION OF THE FINAL RESTORATION

“I scanned the prototype tried by the patient and I imported it into the Zirkonzahn.

Modellier software as a new situ-scan, which helped me determine the volume available for the bar in the structure. I designed the bar anatomically, following the sizes of the adjusted prototype, and I compensated the reduced vertical dimension in the palatal area to provide perfect support to the final prosthesis. Once the design was finished, I milled the bar in a titanium blank and adapted it to the master model. At this point, I scanned again the model with the bar and used the digital data to adapt the prototype wax-up on it. The customised restoration was sent to the nesting software, where the structure was positioned in the Prettau® 2 Dispersive® zirconia blank and the CNC file was calculated. After milling, I personalised the structure with Colour Liquids and once the sintering process was concluded, for an even better natural-looking and individual result I applied a slight layer of ceramics.”

CASE MADE BY:

Dr. Michele Manacorda Studio Manacorda, Milan, Italy

DT Federico Presicci Laboratorio Odontotecnico Lazetera, Savona, Italy

SURGERY PERFORMED BY: Prof. Dr. Raffaele Vinci and Dr. Michele Manacorda

TOP ROW LEFT TO RIGHT: The titanium bar milled and adapted to the master model before re-scanning; The milled restoration. 2ND ROW (L to R) Drafting the minimal cutback in vestibular areas; Mamelons are clearly visible in the minimally reduced structure. 3RD ROW: The refined palatal area. 4TH ROW (L to R): Slight personalisation with Colour Liquids (blue and chromatic dentine colours); The restoration after sintering. 5TH ROW (LEFT & MIDDLE): The sintered restoration with the fit titanium bar; Slight stratification with ceramics for improved individual aesthetics.5TH ROW (R), 6TH & 7TH ROWS: The final restoration: maxillary toronto bridge in Prettau® 2 Dispersive® zirconia over a cemented, anodised titanium bar.

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TECHNICIANS INSIGHT

5 THINGS I CANNOT WORK WITHOUT!

By Stephen Judge of Bracon 1 Firstly and foremostly, everything that my position entails on a daily basis revolves around our customers, be that directly or indirectly. When I say everything, I mean that literally, as without customers I wouldn’t be here in this role. So secondary to this, everything in my list is related to the services which we provide, from technical or clinical support through to sales and engineering.

These days more than ever, a successful company such as Bracon Ltd, has to be on the top of their game and constantly looking at ways to give added value to their customers, that differentiates us from our competitors.

2 GOOD COMMUNICATION

Communication both internally and externally, via telephone, emails, teams or other social media platforms is vital. Since the pandemic we have increased the usage of online platforms such as Zoom, for presentations, courses, product launches and discussion meetings. This has been invaluable in maintaining connections between customers and suppliers. It is never as good as face-to-face meeting in person, but a great alternative, particularly for people in different time zones or people working remotely from home, none of which would be possible without the internet or mobile phones and good software. The added benefit is that

you can look relatively smart and business like from the waist up but be sitting with your shorts on at the same time, or even in the garden with a good office screen background.

I saw some dubious backgrounds last summer; you know who you were...!

3 FANTASTIC TEAMWORK

Fortunately, I work with very dedicated colleagues, those with both dental backgrounds and those without. Their contributions, from sales, purchasing, finance, warehouse, engineering, post room or delivery drivers all counts, every role is valuable and in the daily running of any business things never go to plan. Our strength in teamworking, is always to overcome problems and find solutions for the benefit of our customers, even though many of them would never realise what has gone on behind the scenes and the number of people involved.

4 SUPPLIERS, GREAT PRODUCTS AND SUPPORT

With suppliers from many countries around the world including the USA, China and Australia to name but a few, Bracon is able to bring you the very latest technology. Often that takes a remarkably long time, we spent four years looking for an intraoral scanner, testing

and testing each new one as it came to market and we didn’t launch anything until we were sure that we could bring something special, the Cameo intraoral scanner is a great example of this. But just as importantly as bringing that to you at competitive pricing, it's not all about sales but also after sales support. Particularly with equipment, be that milling machines, dental chairs, 3D printers or micromotors, we know that we need to keep your business rolling and the value in that.

5 HUMOUR, EMPATHY, PATIENCE AND EXPERIENCE

Last but not least, I have to draw on all of the above, on a daily basis and thank goodness for my background in dentistry. Being able to empathise and appreciate the stresses of running a dental laboratory or dental clinic, speaking the same language as our customers, helps greatly.

Although sometimes that’s not common dental terminology, its sometimes goes like this, “a round thing that goes with this thing in my hand” well in those instances a photo speaks a thousand words. Especially when trying to have a conversation with someone grinding plaster models on a model trimmer, whilst using their mobile phone, saying “what did you say, I can’t hear you” Yes, never a dull moment each day, keep smiling!

If you would like to participate in our ‘5 Things I Cannot Work Without’ feature please email: editor@dentaltechnician.org.uk

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DIGITAL TECHNOLOGY

BLENDER4DENTAL THE STORY SO FAR...

By Andrew Wheeler I AW Precision Ceramics beauty of the software; it’s been developed by technicians that have worked at the bench and understand the needs and difficulties that dental technicians face.

The development of the software continues with more implant companies allowing their libraries to be used, expanding the variety available to users. The open-source theme runs alongside the software with users able to create their own tooth libraries and integrate them with the software, utilizing clear and easy to understand video tutorials.

M

uch has happened since the last article I wrote on the ‘new kid on the block’, And as we have come to expect nothing in digital dentistry stay still for very long. So where are we now with this new progressive software that has gain so much traction in the profession?

The biggest leap forward for this software has been the launch of the Crown and Bridge module, completing the suite that started with the Model module. As per the other parts of Blender4Dental the module, once brought, is free of any locked in contracts, no yearly charges, and free updates. You can design fullcontour crowns, bridges, copings and frames, inlays and onlays, porcelain veneer and implant work. The only limit to the extent of this software is one’s own knowledge.

For many years technicians have developed their own workflow and technical abilities to meet their clients demands, and in a strange way this software allows users to maintain that individual artistic side. Yes, there is a learning curve and that might put some off, it is tempting to compare it to other popular CAD programs, but that is missing the point.

It should be looked upon as a rethink of how we manufacture appliances in the digital world, allowing us to still express ourselves through our work, something we have been doing for decades. Once the basics have been mastered, the knowledge of how CAD programs operate become understandable, which in turn gives

the power into the hands of the technician. It is doubtful that many technicians know how their CAD software works as the user interface hides most of the workings, with B4D you get to delve into a world of vertices, surfaces, and edges. You get to inhabit the fascinating world of 3d design moving at will between various stages and not constrained to a pre-set workflow. It would be remiss of me not to mention a large draw and that’s the cost of this software. It opens the door to a section of our industry that are keen to improve and retrain. Leaving behind their wax knifes, lecrons and models they can purchase the software themselves and learn how to become proficient in CAD and therefore placing themselves in a very valuable position as the industry changes.

With more dental laboratories converting to digital it is hard to stand apart from the crowd.

Blender4Dental can certainly help retain the personality we put into our work, as well as meet the challenges the industry as a whole is facing.

Learn more about Blender for Dental, contact Andrew Wheeler @ precision_ ceramics@yahoo.co.uk or visit https:// www.blenderfordental.com

A helpful addition is the weekly zoom meeting that Michael and Wolf, the architects of B4D, hold. These explore many areas of the software that increase the user experience, this alongside a fantastic online community and video tutorials cover all you need to get designing.

Another interesting development which has just been launched is the VertXsplit model system. This allows users to print or buy a base and create a split model that locates inside the base, much the same as the conventional model tray system. This highlights the

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219

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FOCUS

GETTING THE JOB DONE WELL l Salvatore Vitale is a clinical dental technician at V S R Dental Lab who has used Kemdent Kemsil Precise Lab Putty to support his work for over two decades. He shares why he has stuck with the solution for all that time: “Quite simply, I keep using it because I like it and it does what I want it to do. It has a purpose and it does it well. I also appreciate that it’s value for money as you get a lot of product in the big tubs.

“I use the Kemsil lab putty mostly for copying dentures. As a CDT, during a domiciliary visit, it tends to be easier to copy the dentures due to the patient’s situation.

This putty is ideal, ensuring less stress for the patient and enabling me to do a decent job with the new denture.

“The service from Kemdent has always been good as well, with reliable delivery – usually next day, which is as good as it gets.”

For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256

COLLABORATE THE OPTIMAL WAY! l As a technician one of the most integral parts of your day is the collaboration you enjoy with the clients you work with. Suggesting products that aim to provide the best possible outcomes will increase your clientele’s satisfaction, especially for new dentists whom you may still be building a relationship with!

Developed for demanding cases, such as unfavourably positioned implants, the Angulated Screw Channel (ASC) Flex abutment from Medentika®, a Straumann Group Brand, allows for four possible chimney heights and an optimised, slimmer emergence profile which will enhance the outcomes for patients.

The angled screw channel grants up to 25° angulation and allows for increased accessibility for optimum function without aesthetic compromise. So consider this product today and optimise your collaborative experience!

Find out more, visit the website: https://www.straumann.com/ medentika/en/professionals.html

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21 05/11/2021 16:27

CASE REPORT

THE USE OF REMOVABLE APPLIANCES IN PLACE OF FIXED APPLIANCE THERAPY TO TREAT AN AMATEUR BOXER CITATION: ANDREA JOHNSON* *Corresponding Author: Andrea Johnson, Royal Derby Hospital, Uttoxeter Road, Derby, Derbyshire, United Kingdom.

Received: March 06, 2015; Published: April 02, 2015 Andrea Johnson. “The Use of Removable Appliances in Place of Fixed Appliance Therapy to Treat an Amateur Boxer”. EC Dental Science 1.3 (2015): 134-138.

ABBREVIATIONS:

URA: Upper Removable Appliance

ABSTRACT This is a case report about an amateur boxer with a Class II division 1 malocclusion with impacted upper canines.

INTRODUCTION

Providing the best treatment possible for patients isn’t always about achieving the best possible orthodontic result. It is also about ac- commodating the patient’s wishes and needs at that particular time in their life. This case report looks at a patient with a Class II division 1 malocclusion with impacted canine whose parents stated he could not be fitted with fixed appliances as he was a promising boxer. The Amateur Boxing Association of England (ABAE) [1] regulations state in regards to fixed appliances it is the preferred option that boxers have a letter from the orthodontist confirming that they are allowed to box. Ideally a discussion should be held with whoever fitted the brace to see if boxing is possible. This is because playing contact sports increases to the risk of a dental injury and the risk is increased even further if the patient is wearing fixed orthodontic braces. Newsome PRH., et al. [2] state that Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances’. The patient’s parents felt boxing took precedence at that time.

Regulations pre-clude the use of fixed orthodontic appliances during a contest unless the boxer has a letter from their orthodontist.

This case report looks at both the patient’s orthodontic needs and the patient’s wishes and describes the compromise reached.

This patient was treated with removable appliances to improve the alignment of the teeth and the bite. The design and construction the removable appliance are described.

This appliance has been prescribed for a 12 year old male patient who presented with a Class II division 1 incisor relationship with moderate crowding the lower arch and severe crowding in the upper arch. The upper right canine was displaced buccally and the upper left canine was impacted palatally. The upper right second premolar had a large restoration.

In occlusion the over jet was increased at 7.5 mm and the overbite was average and incomplete. The centre lines were coincident with the facial midline and each other. There were no cross bites; the molar relationship was a full unit post normal bilaterally

KEYWORDS: Orthodontic Fixed appliance Removable appliance Unerupted canine Crowding Appliance construction

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CASE REPORT

Radiographic examination confirmed the presence of all permanent teeth including all four third molars. The upper left canine was palatally placed.

The treatment prescribed by the Consultant Orthodontist was as follows: 1. Relief of crowing with the extraction of both of the lower first premolars, the upper second premolar and the upper left canine.

2. Growth modification with modified Twin Block functional devices.

3. Upper and lower fixed appliances to detail the occlusion.

4. However; the patient was a county level competitive boxer and his parents did not consent to the fixed appliance state of treatment so the treatment plan was modified to, 5. Upper removable appliance (URA).

The patient and his parents were fully informed that this was a compromise treatment plan and that he could have fixed appliances placed at a later stage in his life if he stopped boxing competitively.

APPLIANCE DESIGN AND CONSTRUCTION

The design of the modified Twin Block constructed for this patient by the author Retentive components 1. Adams cribs to the upper right first molar, upper left first premolar and first molar and to the lower first molars.

2. Ball hooks between the lower central and lateral incisors.

Active components 1. Midline expansion screw in the upper appliance.

2. Acrylic Blocks with advancement screws in the upper blocks.

3. Palatal finger spring to retract the upper right first premolar.

DESIGN OF THE URA

At the end of the growth modification stage the patient was fitted with an URA. The

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CASE REPORT

original prescription for this appliance was for a midline expansion screw to continue the expansion of the upper arch, a palatal finger spring to retract the upper right first premolar and a second palatal finger spring to retract the upper right canine once the upper right first premolar had been retracted, a Z spring would be used to push the upper right lateral incisor into position once the upper right canine had been retracted. However once the author had cast up the initial working model she felt that a palatal finger spring to the canine would not be ideal as it would have to cross from the palatal area over the saddle area and then up into the buccal sulcus in order to reach, this she felt could impair the function of the spring due to its length and cause irritation to the patients soft tissues through rubbing when activated, she also felt that the spring would potentially cause an obstruction to the upper right lateral incisor as the wire would be in between the lateral incisor and canine.

With these considerations in mind the author approached the prescribing consultant orthodontist to express her concerns and to offer an alternative design, which replaced the finger spring with a buccal canine retractor soldered to the bridge of the Adams crib on the upper right first molar.

The orthodontist agreed that this design would be a suitable solution and agreed to the alteration of the prescription.

This approach to designing the appliance combines the clinical knowledge and skill of the orthodontist with the technical skill and material knowledge of the technician. It demonstrates how a close working relationship between the clinician and their team can benefit the patient.

RESULTS AND DISCUSSION

The main concern for this patient and his parents was that he be able to continue his promising boxing career whilst undergoing orthodontic treatment, however; they were aware that there was an increased risk of dental damage as described by (Newsome, Tran, & Cooke, 2001) and wished to find a suitable compromise. They discussed these requirements with their consultant orthodontist who agreed to a treatment plan using removable appliances only, however; she advised them that the best treatment outcome could not be achieved A

A

B

A. Right buccal view.

B. Maxillary occlusal.

C. Left buccal view.

C

D

D. Lower occlusal.

A

B

Fig 2 (RIGHT): A. Completed URA on model - palatal view. B. Completed URA - buccal view right hand side.

with removable only and that the patient may continue into a fixed treatment stage at a later date if they so wished.

The consultant Orthodontist prescribed a series of removable appliances and after discussion with the author agreed on the appliances described in this case study, the reasons for the design modifications are described.

When constructing this upper removable appliance the author had to consider each of the required components and its operation to ensure that no one component conflicted or interfered with another, for example; the clasp arm on the mesial of the upper right first molar had to be kept high enough that it would allow the contact points of the first molar and first premolar to eventually meet without gagging the bite open.

The ideal alternative to the removable appliances which have been prescribed for this patient is a fixed appliance; these are made up of brackets that are temporarily stuck onto each tooth. A flexible wire runs through the brackets in each arch and allows the teeth to be moved into the correct position.

The patient would still have needed to have his overjet reduced with a functional appliance such as a Clark Twin Block or similar but would have then been able to move on to the fixed appliance therapy which according to his prescribing orthodontist would have been able to correct his malocclusion much more quickly, efficiently and completely. The complications of the patient being involved in

B

Fig 3: Photographs of appliance in situ A. Palatal view B. Buccal view right hand side.

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Fig 1 (LEFT): Photographs of appliance in situ

a contact sport could have been minimized by the wearing of an orthodontic mouth guard as ‘...it is important for anyone with a brace to wear a mouth guard over their fixed brace to avoid a laceration to the mouth from the brace; to avoid damage to the brace; and to prevent injury to the teeth [3]. An example of an orthodontic mouth guard designed to fit over fixed braces is the OproShield which ‘act like shock absorbers by spreading the force over a larger area, and increasing the time for the force to dissipate.’ They are also designed ‘with a cross-sectional profile which means maximum protection against front and concussive blows whilst keeping the palate clear for improved breathing and speech [4].

CONCLUSION

The treatment for this patient has been complicated due to his sporting activities and his parent’s reluctance to allow fixed appliances to be used, however; at the end of this phase of active treatment the patient still had an improved occlusion and better aesthetics through the use of the removable appliances. He can opt for fixed appliances at a later stage if he so wishes.

The case also demonstrates how effective teamwork and communication between the clinician and technician can benefit the patient to ensure the best treatment outcome possible.

BIBLIOGRAPHY 1. England Boxing. “Orthodontist braces”.

2015: (Online).

2. PRH Newsome., et al. “The role of the mouth guard in the prevention of sports-related dental injuries: a review.” International Journal of Paediatric Dentistry 11.6 (2001): 396-404.

3. British Orthodontic Society. “Playing Safemouth guards for contact sports”. (2011): January 01, 2012.

4. http://www.orthoshop.co.uk/acatalog/ Mouth_Gards.html Volume 1 Issue 3 April 2015 © All rights are reserved by Andrea Johnson.

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DTS 2022

Come

Together!

l Spread over two days, the Dental Technology Showcase (DTS) 2022 is ready to reunite technicians across the nation.

Enjoy a plethora of speakers from the profession who will share their expert knowledge with the rest of the community. Hear about the latest technology being used, how it has been utilised in the industry, and top tips from our leading experts.

Not only are world-class speakers a reason to attend but the opportunity to network within your professional community is once again available to you. As the conference spreads over two days there is plenty of time to rub elbows with your fellow technicians.

Come and join the hub for the industry and register your place at the DTS 2022 conference.

Dedicated to your growth l

Enhance your professional education with a conference specifically tailored to you. If you’re yearning to learn and be reunited with the dental lab community this could be the show for you!

The UK’s dental lab market is forecast for serious growth in the next five years and keeping up with the latest advancements in the field is going to be crucial for technicians.

At the Dental Technology Showcase (DTS) 2022, you can enjoy an educational experience tailored for dental technicians. At the upcoming event, the topics you can look forward to learning about include digital dentistry, the next generation of dental technicians, indoor air quality, and financial infrastructure.

Almost 50% of all UK dental laboratory owners attend each year, making the DTS the hub for to industry!

For more information, please visit: https://www.the-dts.co.uk/welcome 24 DT_NOV 2021.indd 24

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DTS 2022

REUNITE AND REBUILD l Throughout the pandemic everyone has experienced isolation and a breakdown in community. Not only on a personal level but also in the workplace. Of course, many companies moved to working online but this can only have so much of an impact when it comes to feeling part of a community and working collaboratively.

EFFECTS OF LOCKDOWN ON DENTISTRY AND THE COMMUNITY l Over the last couple of years dental services have been severely limited due to restrictions, however, the public and patients have also been unsure about what services were available.i Some have even been unwilling or unable to access the oral health care that has been on offer.ii An investigation by the Oral Health Foundation showed that 55% of British adults feel they have neglected their oral health during lockdown and 19% say they haven’t brushed their teeth twice daily, while 20% are now eating unhealthier than before.iii This suggests that the general oral health of the population is going to be in decline post pandemic, but dentists are still playing catchup.

While, of course, the public have been affected by the unforeseen circumstances so have dentists, their practices, and in turn dental technicians.

The financial impact on practices and professionals has been severeiv with 80% of dental business owners reporting a decrease in income in October 2020.v As well as this, the impact on dental technicians could have possibly been greater financially as laboratories have “been in a delicate state for a number of years”vi due to changes in the NHS framework and also the perception that technicians are external to the dental team; this has led to fundamental investment being dismissed by the Department of Health.v The consequences of the last two years have impacted everyone in many ways but dental technicians are still alive and kicking and the demand for their service still exists. So why not come together with the rest of the community? The Dental Technology Showcase 2022 is

going to rejuvenate your connectiveness to the community, educate you on the latest technology, and provide top tips on how best to use it from talks by expert speakers.

BENEFITS OF WORKING TOGETHER l As the pandemic forced many to stay at home on furlough or work from home, and while many became comfortable with this way of life, getting back to the laboratory comes with many benefits that the community thrives within.

There are benefits to working as a team.

Teamwork fosters creativity and learning as people can brainstorm ideas with one another as they need to and this prevents stale ideas or viewpoints. People can combine their unique concepts and come up with something extraordinary, plus teamwork maximises shared knowledge.

It also allows people to blend their strengths by building on the talents of one another, promoting a wider sense of ownership. Working together is also known to improve productivity within a culture of getting things done as well as boosting employee morale because as humans are social creatures we are wired to feel and work better in a team rather than alone.

As well as benefits in the culture of teamwork, dental technicians are part of a profession that is constantly learning and developing the technology they use and the way they work. Collaborative learning as a technique is known to be a promising mode of human interaction since becoming a 21st century trend.vii It develops a social support system, learning communities, and promotes critical thinking skills. Therefore, the chance to attend an event in which the community is reunited and able to engage in learning collaboratively is a great opportunity after being kept apart for so long.

The Dental Technology Showcase 2022 is where dental technicians can thrive on collaboration. Come together with colleagues from across the nation and enjoy a community that strives to protect the future of the profession. The Dental Technology Showcase will be a platform

for positive growth and change with a number of significant changes to ensure that the show represents and aids in overcoming challenges in the industry. As well as boosting the interaction between lab owners and exhibitors in order to foster an environment of collaboration, growth and expansion.

In summary, the isolating restrictions that people have had to endure throughout the pandemic have impacted all areas of the profession and dental technicians are not to be forgotten in this. The impact of coming together again and enhancing one another’s knowledge and expertise can only be positive.

To register your interest today, please visit: https://www.the-dts.co.uk “The Impacts of Covid-19 on Oral Health and Dentistry.” The British Association of Dental Nurses, 2021, www.badn.org.uk/News/Theimpacts-of-COVID-19-on-oral-health-anddentistry.aspx. Accessed 30 Sep. 2021. ii “The Impacts of COVID-19.” General Dental Council, www.gdc-uk.org/informationstandards-guidance/covid-19/the-impacts-ofcovid-19. Accessed 30 Sep. 2021. iii “Lockdown Forces Brits to Become Their Own DIY Dentists.” Oral Health Foundation, 19 Jan. 2021, www.dentalhealth.org/news/ lockdown-forces-brits-to-become-their-owndiy-dentists. Accessed 30 Sept. 2021. iv “The Impact of COVID-19 on Dental Professionals.” Www.gdc-Uk.org, 17 Dec. 2020, www.gdc-uk.org/about-us/what-wedo/research/our-research-library/detail/ report/the-impact-of-covid-19-on-dentalprofessionals. Accessed 30 Sept. 2021. v Scales, Ross. “Financial and Workforce Impacts on Dentistry Will Continue to Be Felt for Some Time.” Www.gdc-Uk.org, 11 Mar. 2021, www.gdc-uk.org/news-blogs/blog/detail/ blogs/2021/03/11/financial-and-workforceimpacts-on-dentistry-will-continue-to-be-felt-forsome-time. Accessed 1 Oct. 2021. vi Westgarth, David. “Dental Labs and Technicians: The Last Ones to Fall?” BDJ in Practice, vol. 33, no. 10, Oct. 2020, pp.

14–18, 10.1038/s41404-020-0533-2.

Accessed 30 Sept. 2021. vii Laal, Marjan, and Seyed Ghodsi. “Benefits of Collaborative Learning.” Procedia Social and Behavioural Sciences, vol. 31, 2011. i

The next DTS will be held on Friday 13th and Saturday 14th May 2022, Birmingham NEC, co-located with the British Dental Conference and Dentistry Show. For the latest information, please visit www.the-dts.co.uk, call 020 7348 5270 or email dts@closerstillmedia.com

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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

0.5HRS VERIFIABLE ECPD

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 n To understand the process of using Zirconzahn Prettau*2 Dispersive Zirconia restoring edentulous Atrophic Maxilla and the benefits compared to standard Zirconia

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 THE OCTOBER 2021 DT EDITION : Q1.

A

Q2.

C

VERIFIABLE ECPD - NOVEMBER 2021 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

Question 2

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

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C

C

D

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D

D

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Question 10 Question 11

Question 12

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Q3.

A

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

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A

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B

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A

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A

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.

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You can submit your answers in the following ways:

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D

1. Via email: cpd@dentaltechnician.org.uk 2. By post to: The Dental Technician Magazine, PO Box 2279, Pulborough, RH20 9BR

Q12.

C

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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

VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

Payment by cheque to: The Dental Technician Magazine Limited. NatWest Sort Code 516135 A/C No 79790852 Q8. The articulated rooted-tooth library provides preset XXX?

MAXILLARY TORONTO BRIDGE IN PRETTAU 2 DISPERSIVE ZIRCONIA OVER A CEMENTED TITANIUM BAR BY ZIRKONZAHN

Q1. What type of restoration was the dental team commissioned with?

A - Implant B - Aesthetic C - Cosmetic D - Crown

Q9. When you select the tooth library, all teeth are already mounted in the XXX position?

Q2. What type of data was studied to reveal its condition?

A - CBCT B - DTA C - OBT D - CDT

A - Posterior B - Alveolar C- Optimal D- Periodontal

Q10. Using Zirconia can limit the risk of XXX?

Q3. What was the condition that was revealed?

A - Advanced Atrophic Maxillary Bone B - Severe Atrophic Maxillary Bone C - Advanced Atrophic Alveolar Bone D - Severe Atrophic Alveolar Bone

A - Gingival Disease B - Periodontal Disease C - Paradontax D - Candidiasis

Q11. Zirconzahn Prettau*2 material has a high translucency and flexural strength which is XXX?

Q4. Implant planning showed the opportunity for immediate loading on how many implants?

A-2 B-4 C-6 D-8

A - 1.200 MPa B - 1.400 MPa C - 1.600 MPa D - 1.800 MPa

Q12. The special manufacture technique used does not blend XXX into layers?

Q5. The reinforced titanium bar was individually designed for a perfect fit to the bridge due to the reduced vertical dimension in what area ?

A - Posterior B - Maxilla C - Paramedian D - Palatal area

Q6. XXX and Mandibular impressions were scanned using White Scanmarkers?

A - Maxillary B - Alginate C - Edentulous D - Preliminary

Q7. During the transferring of situ-scan data in the Zirkonzahn Modifier software what was optimised?

A - Centric Relation B - Intercuspation C - Centric Occlusion D - Dentition

A - Occlusions B - Resorptions C - Impressions D - Malocclusions

A - Zirconia B - Titanium C - Colours D - Polychromatic Materials

YOU CAN SUBMIT YOUR ANSWERS IN THE FOLLOWING WAYS: VIA EMAIL: cpd@dentaltechnician.org.uk OR BY POST TO: The Dental Technician Magazine, PO Box 2279, Pulborough, RH20 9BR. 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 magazine.

Certificates will be issued within 60 days of receipt of correct submission.

www.dentaltechnician.org.uk DT_NOV 2021.indd 27

27 05/11/2021 16:27

DENTAL TECHNOLOGY

Implant overdenture created in combination with 3Shape TRIOS and 3Shape Dental System

By DTL Mediaan & Mediaan Clinic Germen Versteeg I Denturist Subsequently, an intraoral scan was made of the upper and lower jaw, followed by a scan with four Straumann scan flags.

SOLUTIONS FEATURED: 3Shape TRIOS intraoral scanner 3Shape Dental System

CASE INFORMATION

The patient is presented with a loose-fitting upper denture. Upon extraction of her dentition one year earlier, a temporary denture was made by another practice. The patient chose not to wear the temporary denture due to retention complaints.

Upon consultation it was decided, in collaboration with the dental surgeon, to place four implants in the upper jaw. The patient desired a prosthesis without a palate plate. Using implants, maximum retention could be achieved. The patient presently had a beautifully sanitized dentition in the lower jaw.

TREATMENT METHOD

Due to the patient’s desire for an implant-overdenture, it was decided to place four soft tissue level Straumann implants in positions 13, 16, 23 and 26 in collaboration with a dental surgeon.

No additional bone augmentation was required due to the sufficient presence of bone density in the upper jaw.

Prosthetically, two separate bars with an extension were chosen to provide maximum retention and stability of the prosthesis. A metal infra frame was designed and casted over these bars. The prosthesis was milled with an Ivotion base and teeth material.

To improve our consultation with the patient regarding aesthetics, a smile design was created using the “Fabulous Smiles library.” Once a preferred smile was chosen, we seamlessly transferred the aesthetics into the design. Additionally, a Bellus 3D face scan was made of the patient using an iPad Pro.

28 DT_NOV 2021.indd 28

Because the patient was not wearing a prosthesis, there was no bite reference. We measured the resting position and removed the freeway space. The scan flags were then grinded until there was good contact with the antagonist at the correct VOD to record the bite scan.

A denture base was designed in 3Shape Dental System software based from TRIOS IO scans. In the design, as mentioned, we added the Bellus 3D scan and aligned it with the lower dentition.

We then created the order for the design of both bars, adding the prosthesis as an additional scan as a reference for the position of the bars. By means of the copy and append design to preparation scan, we were able to use the scan with the bars when designing the infra frame in the RPD workflow. Finally, we added the scan with the bars and the infraframe back to the order with the denture design to create the exact space on the basal side of the prosthesis for the infraframe and the bars.

The RPD was printed in NextDent casting material and converted into metal. The bars milled by Straumann. A model was printed with four replacable Straumann analogues.

The arch and base were milled in Ivoclar Ivotion teeth and base material.

The bars with matrices and the infra frame were placed on the printed model and separated with vaseline and the milled prosthesis connected to the matrices and the infra frame by means of cold curing acrylic.

After three appointments, the bars with the denture were placed on the implants. The patient now has a fantastic smile again.

CLINICAL BENEFITS

For the clinical situation, we were able to use the TRIOS intraoral scanner. This saved the patient from going through normal conventional impression-taking and making the

ex- perience more comfortable. In addition, because of the TRIOS scan, we were able to use smile design and the Bellus 3D face scan to achieve a more aesthetic result and share the treatment proposal with the patient. The fit of the bars and denture at final placement were also precise due to basing our design from TRIOS intraoral scans.

PATIENT BENEFITS

By using the TRIOS scanner and combining several steps in the design, we saved the patient three appointments. In terms of discussing aesthetics with the patient, the smile design ensured a predictable end-result. We were also able to use the data for the manufacture of the denture.

BENEFITS FOR DENTAL PROFESSIONALS

Normally these types of cases are intensive and time consuming. By collecting all the information during the first consultation and combining the different options in the design, we achieved a time savings of at least 50% in both the clinical and lab side.

CONCLUSION-DISCUSSION

The successful use of an intraoral scanner in combination with a fully implanted prosthesis is demonstrated in this case. The big advantages lie in the clear communication to the patient, the involvement of the patient in the treatment, the reduction of the num- ber of appointments and the large time savings, both clinically and on the lab side.

The use of the TRIOS intraoral scanner in edentulous patients does require some experience from the user. When scanning multiple scan abutments in the same jaw, accuracy in the scan strategy is essential.

By combining several steps in 3Shape Dental System, various parts of the denture could be fabricated externally and joined together in the final phase with a perfect fit.

We believe that the scanning of edentulous patients and the use of the TRIOS for the manufacture of both implant-worn and conventional prosthesis will increasingly, become the standard in the practice.

www.dentaltechnician.org.uk 05/11/2021 16:27

DENTAL TECHNOLOGY

Initial situation without denture

Smile design using Fabulous smiles library

TRIOS intraoral scan of upper jaw and antagonist

Upper jaw scan with Straumann scanflags

Upper jaw with designed bars

Design of the removale partial denture and attached bars

3D printed RPD – NextDent cast

3D printed RPD final result

3D printed model with replaceable Straumann analogs (NextDent model)

3D printed model with bars screwed on analogs

Casted RPD on printed model

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Casted RPD on printed model with milled bars

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DENTAL TECHNOLOGY

Denture set-up with Bellus 3D face scan and Fabulous Smiles library setup

Try-in on patient

Bars placed on implants

Try-in denture printed with NextDent try-in material

Final fit of denture on bars

FINAL RESULT

30 DT_NOV 2021.indd 30

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DT_NOV 2021.indd 31

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DENTAL TECHNOLOGY

THE NEW With Giuseppe Musiello and Matteo Neroni

I

Era

n the last 10 years, the professional relationship between the dentist and the dental technician has undergone a very important change, driven by the desire to improve the effectiveness of a prosthetic rehabilitation.

In the past, the figure of the dental technician had a very marginal role in the development process of the prosthetic case, that is, the figure of the dental technician simply lent itself to realizing what the dentist commissioned.

Very often this type of approach led to misunderstandings between these two figures, thus undermining the fluidity in the patient's rehabilitation process.

Giuseppe Musiello

This involved in a high percentage of cases the rehabilitation of the rehabilitation, creating disappointment in the patient.

With the advent of the digital age, the figure of the dentist and the dental technician have come closer because out of necessity they have begun to interface with each other no longer as an employer and employee relationship but as close collaborators.

Nowdays in the most advanced clinics , one for which I provide training and support periodically, “the multi-specialty clinic San Pio di Vincenzo Torraco” located in Ortanova in the province of , which sees Dr. Giuseppe Musiello at the head of the clinical team, surgeons and dentist, expert in rehabilitations on implants, the figure of the dental technician is implemented within the clinic itself, so that the dentist has the possibility to interface with the technician in real time.

Matteo Neroni

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reality, nowadays not all dentists or clinics use this type of processing, as they are anchored to old ideologies.

Those clinics that instead make use of this new technical figure, have found enormous benefits, giving examples I am talking about precision, quality and extremely fast prosthetic manufacturing times.

LlllSpeaking from my personal experience, the figure I cover within my working channels being a technician specialized in the digital field, is extremely vast, that is my participation in the flow of a rehabilitation.

It goes from the very first approach to the patient To finalization of the case. I like to call it the winning triad or the relationship From the first appointment, the clinician makes use of my figure, to support him and advise him in real time, the best ways, to be advised to the patient at the beginning of the treatment plan.

Bringing a practical example during the consultation, the clinician acquires the x-ray of the patient, and at the same time i acquire the facial scan and a set of photographs, which will then be useful for the realization of the prosthetic case. The reason why I believe the presence of the dental technician from the first session is of fundamental importance.

In 80% of cases, i am able, digitally speaking, to create a smile design in real time, so that the patient from the first session he perceives how he will be at the end of the established treatment plan.

In the eyes of the patient this type of collaboration is extremely professional, and gives the patient a sense of extreme trust.

This is an exceptional weapon, which the clinician uses in the event that the patient is fearful or hesitant to proceed to the next step, that is the beginning of the treatment.

As for the digital approach, this has seen the dental technician as a pioneer of this new

With this new type of approach, I enable the clinician to drastically reduce the number

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DENTAL TECHNOLOGY

of patient sessions, which are reduced to a minimum of two to maximum three.

Clinical-technician-patient

The first, And the consultation, where you know the patient, you take note of the needs and reasons that pushed him, to want to improve his smile. Most of the patients during the counseling session remain incredulous when i show them, how they will be at the end of the treatment, using the smile design done in real time, and to my great satisfaction,i can say that it is in 90% of cases the patients accept the treatment plan from me and the proposed clinician.

The second, and the realization of an aesthetic temporary artifact, this serves to define the aesthetic and functional plans that the final rehabilitation will have. In this step the patient is personally involved in providing his impressions, the merit of the provisional artifact, conferring greater personalized properties to the artifact, of course, in the case of a rehabilitation on the upper jaw, I am talking about the aesthetic group that goes from canine to canine . The posterior group of the arch is often little considered by the patient, but of fundamental importance for the dentist and the technician.

Third, it is called delivery. In the best of situations if you have worked with precision and effectiveness, the duration of this third appointment is almost close to a maximum of 30 minutes in duration. I am proud to say that this last session almost always ends with the patient’s embrace towards the clinician.

This type of approach is used by me for any type of rehabilitation, from the most complicated such as immediate loading to the creation of a single crown. Working as a team is the only way to achieve 100% success in any type of rehabilitation. My figure as a dental technician has evolved, Becoming a very important collaborator alongside the clinician, It is obvious that the two figures, clinician, technician will never have the same relevance, but they can easily travel in parallel and be complementary to each other.

This new figure of Dental Technician requires great commitment, dedication and study, since being part of a team within a clinic requires the mastery of medical concepts, which combined with study and research, make the technician considered a fundamental piece.

I want to conclude by saying, and underlining that the communication between the patient, the clinician and the technician is the only way, to provide an extremely professional service, in order to retain the patient for the future years, since it will place the necessary trust, to recommend the structure to his parents and closest friends.

“Becoming a family” www.dentaltechnician.org.uk

DT_NOV 2021.indd 33

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BUSINESS

STARTING A BUSINESS IN A PANDEMIC MY METHOD ON WAXING UP AND FINISHING DENTURES

By Leon Zanre I Alpha Dental Laboratory

S

tarting any business can be a daunting aspect for anyone but when you add Covid- 19 into the mix things can get complicated.

This is my journey.

After I graduated from Lambeth in London (2012) I found myself at a cross roads and I felt like I had out grown the area and I was in need of a fresh start. So, at the time my partner and I moved down to Portsmouth. I worked in great Laboratory for many years, Happy dental laboratory.

I'm a firm believer as a prosthetic dental technician, the first thing you learn is the speed of a conventional NHS/PRIVATE laboratory. This ability not only gives you a valuable attribute but you understand the pressure of a busy day to day laboratory and how it functions. I was lucky enough to work with a great team at happy dental in Portsmouth and as the months went past I became faster but at the same time also finessing my skills.

I was very eager to learn more, knowing I could do more. So I decided to enrol onto some courses, on one of these courses everything was going to change for me.

I followed a lot of work online and was always mesmerized with it, I always kept thinking how do you make the tissue of gums look so real with wax. So with that I did a few courses (true-to-life) with Roy Davies CDT. After the courses I always tried to implement what I learnt on the courses into my daily working hours. But any busy lab time is essential you can't spend hours waxing up a job when you have 10 more waiting for you. At this point I knew something had to change. I was looking on Facebook at the time and I saw a job position at Oak View

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Restorations where Roy Davies CDT worked.

Never in a million years did I think I would get it, but not only that at the time it was 180 miles round trip from where I was living. I thought why not, nothing to lose.

Incredibly, I was successful and got the job.

But I faced a real dilemma, the commuting.

The issue was my wife now was pregnant and we just signed a year tenancy in Portsmouth, I decided to commute, yes commute from Portsmouth to High Wycombe for 12 months. In the 12 months I pushed myself to learn as much as possible from Roy Davies CDT. When commuting got too much I would stay in a local truck stop as money was tight. I often took some demo cases back to my small dingy room and I would practice all night. Looking at images of soft tissue and trying to replicate that. At one point I even slept in the car. I did all of this because I knew the opportunity I had in front of me to learn and become better.

The time I spent with Oak View and learning from Roy Davies CDT I learnt less is more and how to blend the colours to mimic soft tissue. I also learned how to use the pourable system to finish Dentures and how to use colour staining in the flask. To this day, I still use the same system. I also learned flexible dentures and becoming very skilled in manufacturing them. I always tried to put my own spin on things trying to save time and get a better outcome. Surprisingly, I found a tool, to this day I can't be without.

It is a simple large bristle brush that sits in my hand piece. What I do with the tool is take wax off the teeth in a matter of seconds saving so much time and also contour with it and create soft tissue resemblance with it. This tool has enabled me to create nice private try-ins in the same amount of time as a NHS try-in this method has taken me a long time to achieve, the outcome you can see with the pictures in this article.

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BUSINESS

After spending some time away from family and now me and my wife are parents we made the decision to move back home to our family and after only being home for 3 months the dreaded Covid happened. I was briefly working for a lab before lock down.

But I had the once in a life time opportunity to start my own business up, so I made the decision to do it. You can imagine at the time what everyone was saying to me. I had everything against me, Covid, money, I had no reputation, nothing. The only thing I had was my skills that no one could take from me. The skills that I worked so hard for the ambition and determination that I knew I could do it. My skills were acknowledged and I actually featured in The Dental Technician Magazine. I was nominated for Best Prosthetic Technician 2020. I started to offer surgeries demo cases in my area so they could see what I could do and offer them and their patients, I implemented into these cases everything that I have learnt to get some money into the business straight away.

As the weeks went on I started to pick up new clients and surgeries, by 4 months I was so busy I was practically sleeping at the lab. In business you learn every day, I knew I needed help but I was so worried about another lock down. I didn't employ anyone so inevitably my health was dropping and I was exhausted every day. After a few months I took the plunge and employed someone to help me.

Now almost 17 months later, the business is doing well and my health is getting better.

Hopefully, it will continue to grow.

MY METHODS ON WAXING AND FINISHING DENTURES

I know there can be a stigma on doing fancy wax ups for try-ins. We have all been there, spent hours doing one and comes back with shade change or the bite is wrong. Beautiful wax-ups don’t need to take hours, this is how I do fast nice wax ups.

I mentioned earlier, I use a unique tool to not only to clean the teeth of wax but also to blend colours and create tissue texture.

Firstly let's start with a F/- wax up once the teeth are set up and ready to go I start a layer process. I always start with the lighter colour around the gingiva And darker colours down by the sulcus. You don't want the darker colours on the top layer of wax. So I start with like a light pink or ivory around the gingiva with the light pink I mimic roots contour with the colour once I'm happy with that I will just get a normal Anutex pink wax sheet and then go over that so it's barely visible between the sulcus and gingiva.

I will put a small amount of blue red pink and at the sulcus. I will do maybe a like a dark red and then the same again normal pink Anutex to cover that until it barely visible. This whole process has not even taken me 10 minutes.

Once I'm happy with the thickness and tones I've applied I will now use my tool to clean the teeth should take me approximately 30-40 seconds. Once the teeth are clean I use a ash 5 or any kind of sculpture tool. I literally just get a faint outline of the roots ect . Then with my tool in my hand piece I start to slowly blend the colours slowly taking the Anutex pink away and slowly uncovering the light and dark pink underneath. This gives you a lot of control as you need to have a balance, too much red could cause the patient to look like they have gum disease, too much light pink may look anemic. While I'm blending the colours I'm also creating tissue effects with the brush. Once I'm happy, I will sharpen up the gingiva and sometimes I will add muscle attachments. These are done with a lighter shade of wax maybe a light pink. Last but not least, I always use a hot air gun this keeps all of your beautiful blending of colours as I found out a pin flame can be quite harsh.

www.dentaltechnician.org.uk DT_NOV 2021.indd 35

FINISHING A DENTURE POURABLE

For me, packing and flasking, I've always hated! So, as I mentioned earlier, I had the opportunity to learn how to pour with Roy Davies CDT. In my business now everything is poured, no packing and flasking at all. For me, I find it easier, faster and cleaner than flasking and packing.

My top tips for POURABLE Dentures; Always make sure your wax up has enough detail on it so when you do the staining the gel will pick it up. Always make sure the gel is not too hot as it could distort your wax up inside the flask without you knowing.

When boiling the wax off the teeth you have to make sure they are 100% clean, any contamination could cause a tooth to debond. Once the teeth are clean always prep the teeth cut into the base of the tooth.

This creates a better bond with the acrylic.

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BUSINESS

Doing any staining can be difficult as you can’t really see how it looks until it's cured but I try to use the same technique. Starting from the gingiva with a light pink, now I will blend the light pink, going thinner towards the sulcus. Doing this will eliminate a band look, less is more when it comes to staining as the colours are very intense. The same with the blue red and the dark red on the sulcus, always blending and overlapping the colours I will always remember the order I did them in on the wax up stage to ensure the same result.

Once I'm happy with the staining, the model has be soaked and separated, then I will pour.

When you pour the acrylic you go slow, too fast will cause air bubbles to get trapped. Once the sprue holes have both filled up you wait until a skin has developed you slowly build a little nipple of ACRYLIC on both sides. What this does is, when the ACRYLIC starts to set it creates a vacuum pulling in from the sprue holes, if there is not enough ACRYLIC you will get holes on the tuberosity area.

Once I've done that the Denture will cure for around 20-35 mins around 40 degrees.

To recap on everything, the last couple years has been tough on every business and every person mentally and physically. So I urge anyone that wants to start their own business or even learn something new, you can do it!

Thank you for taking the time and reading about my journey and my techniques.

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