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Chief dental offi cer awarded CBE / News / Company Promotion / News & Opinions / ENDO TRIBUNE 1/2010 (part1) / ENDO TRIBUNE 1/2010 (part2) / ENDO TRIBUNE 1/2010 (part3) / Practice Management / Breaking through the barriers / Retirement – can you rely on the NHS? / Behind the spin / Time for change? / ‘Class II Challenge’ / Open to options / Industry News / Classified

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Table of contents

January 25-31, 2010

PUBLISHED IN LONDON
News in Brief
Tories ﬁne patients
Dentists will be able to fine patients who consistently miss
appointments, under Tories’
NHS plans. The smallprint
of the Conservatives’ Reform
Plan For The NHS, said We
will introduce a new dentistry
contract that will allow dentists to ﬁne people who consistently miss appointments. The
fine is expected to be around
£20. Andy Burnham criticised
the proposal and said: “People
who are most in need of care
will be hit hardest by fines
from their own dentists.”
Scottish waiting lists
Patients are calling on the
Scottish government to look
again at its oral health care
provision after it was revealed
that the total number of patients on the waiting list in
Scotland has reached a standstill and is not decreasing.
Despite waiting figures dropping from 82,166 last year to
79,375 this year in many rural
areas waiting list numbers
have grown. NHS Grampian
revealed that the number of
patients on its waiting lists
has grown from 30,936 to
31,798.
Smile-on and AOG
Smile-on, healthcare education and training provider, has
joined forces with the AngloAsian Odontological Group.
On 7 May, Smile-on and the
AOG are hosting a charity ball
with proceeds going towards
charitable projects in East Africa. The event will be sponsored by the Dental Directory.
The AOG is a social network
for dentists, promoting professionalism and friendship.
It works hard to help charities
both at home and abroad.

www.dental-tribune.co.uk

News

Endo Tribune

Feature

Dentistry goes mobile

New service launched to help
ease access problems in rural
communities

DAP review

Dental Tribune looks at the
progress made since the launch
of the Dental Access Programme

page 6

VOL. 4 NO. 1/2

page 7

Practice Management

The ‘other side’

Case report

Dr Kendel Garretson illustrates principles of diagnosis and
treatment

Simon Thackeray on working a
company stand at BDTA

page 16

page 22

Chief dental ofﬁcer awarded CBE
New Year’s Honours List sees both CDO and former GDC president named

he chief dental officer for
England and the GDC’s
former president were
both awarded CBEs in the New
Year Honour List. CDO Barry
Cockcroft received a CBE for
his contribution to dentistry and
public health in Britain.
Prior to joining the Department of Health, Dr Cockcroft,
chief dental officer since June
2006, worked as a NHS general
practitioner for 27 years.
He commissioned Prof Steele
to carry out the Steele Report,
an independent review of NHS
dentistry, following the House of
Commons Select Committee review of the new contract.
Dr Cockcroft is currently
working on behalf of the government to carry out the recommendations of the report.
Former President of the General Dental Council’s (GDC)

Hew Mathewson was awarded a
CBE in the New Year’s Honours
list for his services to healthcare.
Mr Mathewson has been a
member of the GDC since 1996
and was president from 2003
until September 2009 when he
became the Council’s first ever
chair. He handed over to Alison
Lockyer in January 2010.
Ms Lockyer said: “No one
could have done more for the
GDC than Hew over the six
years he was at the helm. We’re
indebted to him for his assiduous efforts. This award is really
well deserved.”
Interim chief executive, Alison White, called his commitment to improving protection for
patients ‘unwavering’ and said:
“I’d like to take this opportunity
to congratulate Hew most warmly. This CBE recognises all of his
hard work and achievements at
the General Dental Council.”

EARTHQUAKE APPEAL
We have all been shocked by the emergency situation in the Republic
of Haiti after the earthquake which has claimed thousands of lives
and left the survivors in turmoil. Dental Tribune is appealing to all
readers who wish to help by donating much needed funds to help
the relief effort to Médecins Sans Frontières (MSF), an international, independent, medical humanitarian organisation that delivers
emergency aid to people affected by armed conflict, epidemics,
healthcare exclusion and natural or man-made disasters. What
makes this all the more poignant is that the team at MSF responding
to this disaster is still trying to account for colleagues who were
already working in Haiti, and who may have not survived.
To help, go to www.msf.org.uk/supportus.aspx and click on the link to
donate to the Haiti relief fund. Thanks in advance for your support.

She added: “We are absolutely delighted to see his dedication
to healthcare is being recognised
by this honour.”
Janet Clarke, former chair
of the Central Committee for
Community and Public Health
Dentistry, of the BDA and member of the Steele Review, was also
honoured with an MBE.
MBEs were also given to
Donna Hough, dental workforce development lead for
DCPs, North Western and Mersey Postgraduate Deaneries and
Laura Mitchell, consultant
orthodontist and clinical lead
at St Luke’s Hospital Bradford
Teaching Hospitals NHS Foundation Trust.
Mrs Mitchell has worked
at the hospital since 1995 and
last year co-wrote the Oxford
Handbook of Clinical Dentistry
with her husband. The book has
been translated into nine differ-

ent languages, selling more than
100,000 copies.
Angus Robertson, principal fellow in clinical illustration, Leeds Dental Institute, was
has also been awarded an MBE.
Mr Robertson has been a practising clinical photographer
for more than 36 years. He has
specialised in dental photography since he took up a position as head of medical and
dental illustration at the Leeds
Dental Institute in 1985.
A spokesman for the Institute of Medical Illustrators
said: ‘His dedicated contribution to the medical illustration
profession has been great and
this was recognised when in
1993, IMI awarded him its
most prestigious award, the
Norman K. Harrison Gold
Medal. Our sincerest congratulations go to both Angus and
his family for this well deserved
award.’ DT

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2 News

If so don’t hesitate to write to:
The Editor,
Dental Tribune UK Ltd,
4th Floor, Treasure House,
19-21 Hatton Garden,
London, EC1 8BA
Or email:
lisa@dentaltribuneuk.com

Editorial comment
It’s s-now a New Year! Welcome to 2010

‘

Hello and welcome to
the first issue of 2010! I
hope everyone has been
enjoying the glorious
wintery weather, with
picture postcard scenes, snow
days letting children go sledging in the park, and next to no

work coming your way as people
struggle to get out of their front
doors! (see, you thought all that
snow had gone to my head then!)
Still, it is a new year and in
time honoured tradition our congratulations go to those mentio-

ned in the New Year’s Honours
List; especially those connected
with the dental profession.
You will notice in the issues
to come that I will be talking a
great deal about Bridge2Aid and
its work in the village of Buku-

January 25-31, 2010

mbi in Tanzania. This is because
Dental Tribune, and particularly
myself now have a vested interest in the work as I will be travelling out there in April with
colleagues from Schülke and
Henry Schein to help build a
community centre at the Bukumbi Care Centre. This vital
project is the perfect opportunity
for us non-clinical folk to help
Bridge2Aid’s work.
Anyone who wishes to donate funds to this worthy cause is
welcome to do so at www.justgiving.com/bukumbibound
- my dedicated fundraising page
for this trip. A special thanks
already goes to Smile-on and
Practice Plan who have supported me; and I hope DT readers will get behind me as
well. Just think what £1
from every reader could
do to the lives of ordinary
Tanzanians! DT

‘

Do you have an opinion or something to say on any Dental Tribune
UK article? Or would you like to
write your own opinion for our
guest comment page?

United Kingdom Edition

BDA NI gets
public apology

he British Dental Association in Northern Ireland has received a public apology after a government
body released inaccurate figures
inflating the incomes of NHS
dental practices.
The figures were given to the
Belfast Telegraph by the Business
Services Organisation following a
freedom of information request.
The British Dental Association
(BDA) claimed that the figures reported by the Belfast Telegraph in
December were wrong in six out
of 20 cases, and overstated dental
practice turnovers on the health
service by up to 73 per cent.
The Belfast Telegraph reported that three practices in Northern Ireland received more than
£1m last year from the Department of Health.
The BDA said that releasing
this incorrect information damaged the reputation of these dentists and their practices.
Claudette Christie, BDA director for Northern Ireland,
said: “This has caused personal
distress directly to a number of
hardworking dentists and to the
wider profession.”
She added: “Dentists across
Northern Ireland are at the heart
of their communities, working
hard to care for their patients.
They devote their professional
lives to building relationships
with their patients that enable them to provide the best
possible standards of care for
each individual. To have those
relationships swept away by the
failure of a government agency to quality assure its figures
is devastating.” DT

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News 3

United Kingdom Edition January 25-31, 2010

Smile-on reaches the big 1-0

ducation
and
training provider, Smile-on,
has been celebrating, as
January 2010 saw the company
enter its 10th year.
Smile-on provides education and training solutions that
are flexible and inspirational for everyone in the dental
profession.
A spokeswoman for Smileon said: “The company’s key

values of partnership, imagination,
innovation,
creativity and potential have helped
evolve the products from simple
training courses into the multi-media learning platforms
of today, and helped Smile-on
become the source for cutting edge software and training
resources.”

tal professionals yet another
outstanding
conference
for
2010 - May 7-8 at the Royal
College of Physicians in Regent’s
Park, London.

After the success of last year’s
Clinical Innovation Conference,
Smile-on will be offering den-

International speakers will be
delivering inspirational speeches
alongside exhibitors offering the

Delegates will be able to gain
an insight into new technologies,
materials and ground-breaking
techniques in dentistry.

latest dental technologies from
all over the globe.

be sponsored by the Dental
Directory.

Smile-on has announced
that this year they will be
working in conjunction with
the
Anglo-Asian
Odontological Group (AOG) and will

For more information call
020 7400 8989 or email info@
smile-on.com or to become a
CIC sponsor visit www.clinicalinnovations.co.uk. DT

Help at last for dental entrepreneurs

ental entrepreneurs can
now turn their dental inventions into a business
opportunity with the support of
the first dental business incubator company.
Dental companies spend
millions on the research and
development of new products,
with Nobel Biocare, one of the
biggest spenders in the dental
industry spending about 4–5 per
cent of its annual turnover on
research and development.

However there are thousands of ideas developed by individual dentists that will never
be implemented because their
inventors lack the funds or expertise to market their ideas or

are downsized by shrinking research and development budgets in difficult economic times.
These individuals can now
turn to Dentcubator, the first
dentistry incubating network.
The programme helps entrepreneurial companies through
support resources and services,
such as finding legal help, funding prototypes and finding distribution channels.
Dentcubator was founded
last year in America from a
loose network of renowned
dental specialists around the
globe and so far the programme has evaluated 48 submissions and it aims to support as

‘Gruelling’ bike ride
for charity

he director of the Dental
Clinic will be taking part
in a ‘gruelling’ 874-mile
cycle ride to raise vital funds for
a children’s charity.

It normally takes cyclists ten
to fourteen days to complete, and
walkers two to three months.
The Wooden Spoon challenge, titled ‘End 2 End’ has been
held annually since 2000.
Dr O’Hooley said: ‘Wooden
Spoon is a well established charity, and really a cause close to
my heart. I’m keen on trying to
help child poverty and I feel that
because they have such a history
of successful and well-organised

Dentcubator is a virtual entity, which means that its members meet by phone, e-mail or
through webinars.
Once an idea is submitted
through one of the committees, it undergoes a four-week
screening process to evaluate its
marketing potential.
Special emphasis is placed
on the ability to re-design a
product for emerging markets
such as Asia or Latin America.
“By testing each submission
for its applicability to emerging
market countries, we have the

he respected clinical expert, Dr Avijit Banerjee, is
to join the panel of speakers at the 2010 British Dental
Conference and Exhibition

Dr Banerjee, senior lecturer
and honorary consultant in restorative dentistry at King’s College
London (KCL) Dental Institute at
Guy’s Hospital will be delivering a

The Dental Clinic is one of
the largest private provider of
dental services in the UK, offering services ranging from general dentistry to teeth whitening
and cosmetic dentistry. DT

The network provides its
services with compensation taken in equity in the ownership of
the idea, once the idea has been
approved for funding.
The process typically takes up
to three months to be completed.
Once Dentcubator becomes
an equity partner and develops
and protects the idea, discussions are initiated with the direc-

presentation entitled Revolutions
in caries management – minimal
invasive dentistry in practice.
The presentation includes:
• The methods for monitoring
patients with a high risk of developing caries
• Understanding the pathology of
caries
• How to bond to caries - affected dentine and the therapeutic
effects
Dr Banerjee has carried out extensive clinical research into cari-

A recent study found that
incubating programmes which
support start-up companies to
develop new products enable
nearly 90 per cent to stay in business for the long-term.
Dentcubator sees itself as a
complement to traditional research and development and as
an alternative source for funding, development and access to
market resources.
“We are under no circumstances in the business of replacing research and development
budgets. We are the nursery
which takes the small seed of
an idea, grows it and then
brings it to market,” the representative said. DT
ology, caries removal techniques,
microbiology and microscopic
imaging of dental caries. He also
won 2009 Kings College London
Teacher of the Year Award.
A spokeswoman for the conference said: “His passion for
translating scientific research
into clinical practice will ensure
that his guidance will feature
the latest clinical findings, delivered in a manner relevant to
today’s GDPs.”
For more information on the
conference and exhibition, register on www.bda.org/conference
or call 0870 166 6625. DT

International Imprint

charity events I feel I can be confident in them.’
Wooden Spoon, founded in
1983, is a children’s charity supporting disadvantaged children
and youth across the UK and Ireland. Wooden Spoon has raised
more than £15m since its inception, and benefited more than
half a million young people.

opportunity to offer the products and techniques associated
with outstanding oral health
care to a broader audience
than the typical markets of
Western Europe, Japan or the
United States,” said a Dentcubator representative.

British Dental Conference

The conference and exhibition will be held 20-22 May 2010
at the Liverpool Arena and Convention Centre (ACC).

The Dental Clinic and Optical Express will be sponsoring
Dominic O’Hooley in his bid
to cycle from John O’ Groats to
Land’s End to raise funds for the
Wooden Spoon charity.
With a group of thirty riders,
O’Hooley aims to complete the
874-mile journey in just eight
days, starting on the 21 and ending on 28 August.

many as 80 over the course of
the next five years.

tors of acquisition or research
and development departments of
global dental companies.

Executive Vice President
Marketing & Sales

Peter Witteczek
p.witteczek@dental-tribune.com

Dental Tribune UK Ltd

4th Floor, Treasure House, 19–21 Hatton Garden, London, EC1N 8BA

Chairman
Torsten Oemus
t.oemus@dental-tribune.com

Published by Dental Tribune UK Ltd
© 2010, Dental Tribune UK Ltd. All rights reserved.
Dental Tribune UK Ltd makes every effort to report clinical
information and manufacturer’s product news accurately, but
cannot assume responsibility for the validity of product claims,
or for typographical errors. The publishers also do not assume
responsibility for product names or claims, or statements made
by advertisers. Opinions expressed by authors are their own and
may not reflect those of Dental Tribune International.

Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Editor
Lisa Townshend
Tel.: 020 7400 8979
Lisa@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com
Clinical Editor
Dr. Liviu Steier, PhD
lsteier@gmail.com

Advertising Director
Joe Aspis
Tel.: 020 7400 8969
Joe@dentaltribuneuk.com
Sales Executive
Sam Volk
Tel.: 020 7400 8964
Sam@dentaltribuneuk.com
Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com
Design & Production
Keem Chung
Keem@dentaltribuneuk.com

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4 News

United Kingdom Edition

January 25-31, 2010

Transitions: Dental Protection
launches event for Scottish dentists

D

ental Protection is pleased
to announce a brand new
event called Transitions
which will be staged in Scotland
this April.
The full-day event is scheduled for Saturday April 17 in

Cumbernauld near Glasgow. The
programme is suitable for dentists
at all stages of their career and will
provide keynote lectures on the
recommended CPD topics, complaint handling and ethics.

three renowned speakers, Hugh
Harvie, Kevin Lewis and James
Foster who will explore complaints
and ethical dilemmas based on actual cases drawn from Dental Protection’s extensive archive.

The programme will feature

The day will also include an

interactive workshop session,
which will demonstrate problems which any dentist might
encounter at some time in their
career, and will examine the issues which could effect the way
in which the dentist handles the
situation. Sessions on law and
ethics and complaint handling
will explore the role of communication skills in effective complaint handling.
Describing the event, Hugh
Harvie, Head of Dental Services
Scotland said: “DPL is pleased
to launch an exciting new event
for the benefit of our members
in Scotland. The programme will
address the recommended CPD
needs of all dentists, and will
serve as a useful introduction, or
a reminder, to dentists regardless of what stage they may have
reached in their career.”
Tickets for the event cost £75
(£50 for VDPs and DPL Xtra
members).and will provide 5.5
hours verifiable CPD.
Delegates are advised to
register their interest in the
DPL programme early to avoid
disappointment. DT

BDA nominated as Business
Superbrand

T

he British Dental Association has been shortlisted
as one of this year’s Business Superbrands.
An independent panel of experts from The Centre for Brand
Analysis, along with 1,500 individual business professionals,
examined thousands of applications, before selecting only 500
‘Superbrands’.
In order to qualify as a Business Superbrand, an organisation has to have established the
finest reputation in its field, and
offer customers significant emotional and/or tangible advantages over its competitors.
The brand has to display
that it represents quality products and services, can deliver a
consistent and reliable customer
service and be distinctly unique
within its market.
A spokeswoman for the BDA
said: “Being nominated as a
Business Superbrand is testament to the determined efforts
made by the BDA team to ensure
that it continues to offer members advice, support and improve the nation’s oral health.” DT

[5] => dtuk1031_page1-4.indd

Company promotion 5

United Kingdom Edition January 25-31, 2010

Credit Crunch Clinic

This increased primary stability comes from
the multi-platform design and double-

Dentists drop price of dental implants & increase sales
One dentist who has been able to drop his prices
by 30% after switching to DIO implants is Dr.
David Fairclough, who's prime interests are
dental implants and cosmetic dentistry. He believes that using implants of this kind could lead
to them becoming cheaper for patients across
Britain, currently one of the most expensive
places in Europe for dental implants.
In a recent interview Dr. Fairclough said,
“There is no reason why it can’t be as cheap
here as it is abroad, when you factor in travel

A company selling dental implants
for almost half the price of other
suppliers are giving dentists the
opportunity to pass this saving on
to their patients, potentially dropping the price of dental implants in
Britain without compromising on
patient care.

threaded head which offers high stability in
low bone density. Alongside this, the stability offered by the root form design reduces
the possibility of interference with other
teeth.

“

One of my big criticisms of

implant companies is that they sell
you the implants and then you get
very little from them again. There’s

poor back-up. This hasn’t been the
case with DIO.

”

and accommodation expenses. The savings I

DIO UK aims to assist all of its dentists

am making have meant that I’ve been able to
reduce my prices by 30%, so it has made a
huge difference. It means that those people
imwho are thinking about going abroad for im
plants may consider staying in Britain and
those who thought they couldn’t afford im-

during the integration stages in understanding the implant system. Rather than hosting
clinical days attended by large numbers of

plants can now consider it an option.”
Dr. Fairclough was initially drawn to DIO by

dentists, DIO involves new clients in live implant placements alongside an existing user,
often without a DIO representative being
present. This allows the session to be very
open between the two dentists meaning they
are free to discuss the implants candidly. It

their lower prices, however he changed suppliers when he found that their implants were
easier to place as well as acheiving more aesthetically pleasing results than implants he had

also means that the dentist new to the system
benefits from one-on-one tutoring.

DIO Implant of South Korea is now operating

used previously.

in the UK after recently identifying a gap in
the UK market. DIO UK is offering dental
implants at prices less than half that of the
most established of UK brands (e.g. DIO
grade-4 titanium RBM fixtures for under

Dr Fairclough said, “I’ve been doing dental implants for over 20 years now and I’ve tried
most systems. When I came across DIO’s

been invaluable.” said Dr Faiclough, “One of
my big criticisms of implant companies is
that they sell you the implants and then you
get very little from them again. There’s poor

£98.00). DIO Implant has been around for
over 25 years and is one of the largest
implant
la
manufacturers in Asia.

system it seemed to be the easiest to use at an
affordable price. The implants are very easy to
place and they have very good primary stability
which is important.”

“The back-up service I have been given has

back-up. This hasn’t been the case with
DIO.”
Dr David Fairclough
BDS(Lond.) LDS RCS
Fai
(Eng.), Circus House, Bennett Street, Bath

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[6] => dtuk1031_page1-4.indd

6 News & Opinions

United Kingdom Edition January 25-31, 2010

Nationwide mobile dental practice launched

T

he first nationwide mobile dental practice has
been launched in the UK.
DentalXpress hopes to improve
acute access to dental care with
its fleet of multi-clinic room
portable dental units.
The idea is that in areas
where a dental practice is
needed, DentalXpress will be
able to plug the gap with one of
its mobile units.
DentalXpress
spokesman
Amarjit Gill said: “The population of the UK is projected
to rise to 67m by 2031 and as
NHS dentistry budgets decline,
there is going to be even greater
pressure on already limited resources, as funding is further
stretched. Primary Care Trusts
are constantly looking for innovative solutions and don’t want
to invest in fixed practices at a
cost of £500,000 to £750,000 if
the demand for dentistry does
not materialise.”
Data from the NHS Information Centre released recently
shows that only 58.3 per cent
of the population saw an NHS
dentist in the two years ending
March 2009.

The government said in May
this year ‘we aim to ensure that
everyone who wants to see an
NHS dentist can by March 2011’.
However the same data
source showed that last year
nearly 50 per cent of NHS
dentists did not take on any
new patients.

ciliary care homes for the elderly, universities and the homeless.
The mobile units offer all the
amenities expected in a normal
bricks and mortar practice; they

dental nurses and served by one
receptionist who will work continuously throughout the day.
There will be a computer and
telephone booking system (with
a freephone number) and confir-

The dentists undertaking sessions for DentalXpress will be encouraged to join local Managed
Clinical Networks, to liaise with
other dental providers in the area
to whom they may want to refer
and establishing good local relationships.

NHS Leicestershire County
and Rutland is the first Primary
Care Trust in the country to introduce the service and DentalXpress is currently in discussions
with six further PCTs to launch
similar services in their areas.
Leicestershire is opening the
first DentalXpress practice in the
Syston area of the county and
aims to provide NHS dental care
for 400 people a month.
DentalXpress is a social enterprise with an ethical principle
to deliver lasting social change.
It has pledged to reinvest 75
per cent of any profits it makes
delivering NHS dentistry back
into expanding its service and
is currently exploring ways it
can expand its provision to serve
schools, the armed forces, domi-

have a reception area, four interconnecting treatment rooms, a
disabled toilet and a staff room.
Wherever possible all the
dental instruments used will be
disposable.
The organisation’s logistical
expert will carry out an assessment of each location; the size
of the space required to accommodate the mobile unit as well
as access roads, power, drainage
and so on.
Each unit will be staffed by
two to three dentists and three

mations will be offered via email
and text.
The aim is to set up a DentalXpress service in each PCT
area it serves for four-six weeks
and return to each of these areas
on a four-six weekly basis.
The organisation is currently recruiting dentists locally to
serve a particular community,
which will help them build relationships with the patients they
treat and local practices to which
they will need to refer.
The objective is that these

Success for student orthodontic therapists

A

ll fifteen students on the
University of Central
Lancashire’s first Orthodontic Therapy programme have
passed its examination and are
now eligible to practise as qualified orthodontic therapists.

She said: “I have gained
more confidence in myself and
my abilities through doing the
course, which I’ve really enjoyed. I liked the practical side
of the course and as I gained

more experience and got further
into the course it was good to
put the information I had
received in lectures into practice and see my new skills
at work.”

Course leader Hemant Patel
said: “I’m delighted to see our
first cohort of UCLan therapists
do so well. They have all worked
so hard and their success is welldeserved. The course has been

The new one-year taught programme began last January with
students attending a one month
full-time training programme
delivered by the course leader Dr
Hemant Patel and other specialist orthodontists in the Institute
for Postgraduate Dental Education at University of Central Lancashire (UCLan).
After this period the students
returned to their clinical practices and worked with their clinical
mentors (again specialist orthodontists) to treat patients under
close supervision.
Over the past year, students
have returned to Preston each
month to pick up further clinical
skills, working in the phantom
head room in the university’s
Greenbank Building, and having
ongoing clinical and academic
assessments.
One of the first successful
students to pass the course was
39 year-old Linda Rice from
Barking in Essex.

dentists will work as self employed practitioners on a sessional basis and will be paid according to the number of patients
they see, which should encourage
them to build up a local following.

Dental nurses will be employed by the company and will
work with the same dentist in
pairings to encourage team building and each unit team will have
a receptionist.
Toby Cobb, managing director of DentalXpress said: “We applaud NHS Leicestershire County and Rutland’s forward looking
approach to providing additional
dental services for those currently without access to an NHS dentist. We anticipate that it won’t be
long before many other Primary
Care Trusts will be announcing
similar arrangements for every
resident within their boundaries
who needs an NHS dentist.” DT

a fantastic success and I think
it’s wonderful that orthodontic
staff now have the opportunity
to move their careers in such an
exciting direction.”
For more information on UCLan’s Orthodontic Therapy programme call 01772 895865 or visit www.uclan.ac.uk/dentistry DT

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[7] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

News & Opinions 7
Tribune_jan05:Precision

5/1/10

15:35

Page 1

Programme Progress
D

epartment of Health (DH)
national director for NHS
dental access, Dr Mike Warburton, has iterated that the template
agreement, launched in November
to procure additional dental access
for patients through the Dental Access Programme (DAP), is having a
positive impact.
Wolverhampton City, Brighton &
Hove, Newham and County Durham
PCTs have been chosen to participate
in dental access communication pilots. These are intended to develop
and assess methods of improving
public perception about NHS dental
access, through public engagement
campaigns.
Speaking at a DH press conference in December Dr Warburton
said: “The access programme is responding to patients’ demands with
regards to improved access. This is
to be achieved through giving support to PCTs in the procurement
of new services, contracts and improved communications.”
He emphasised that the DoH is
working closely with PCTs and providers to make them aware of the
details about how to procure services. He said ongoing meetings with
Strategic Health Authorities to talk
through relevant details and ensure
clarity about the national guidance
on the frequency of patient attendance, had been well attended. He
explained: “These meetings are organised to take providers and bidders through the rationale of the
content. There seems to be interest
in procurements and there has been
a good response to adverts to date,
which hopefully will continue.
“We are working with PCTs to
improve contract commissioning
and are launching a dental contract
management handbook contract
care handbook, as well as ongoing
workshops to facilitate.
Fuller dental contract change
proposals will emerge out of the
contract pilots, which are scheduled
to start in March. These are in line
with the implementation of Professor Jimmy Steele’s NHS Dentistry
Review, NHS dental services in England, published in June last year.
The DAP is undertaking local
patient experience surveys before
the four campaigns begin and also
afterwards to evaluate their success. Dr Warburton said the new
patient experience indicator survey
was an essential component of the
programme. He said: “The patient
experience indicator is validated
as high when there is good NHS
dental access and low when there is
bad access.”
He added: “The survey will go to
large numbers of people from each
PCT and so we will know accordingly if we are meeting the demand.

Patients need to know that there is
good access and it is important to increase perception of this.”

Excellent Quality
Excellent Value

The first PCTs will get their survey results in June 2010.
Chief Dental Officer for England,
Dr Barry Cockcroft added: “The
Which report last year stated that 88
per cent of patients who tried to access NHS dentistry, could do so.”
Dr Cockcroft said the latest NHS
dental access data showed that
939,000 people have been able to
access an NHS dentist in the last
five quarters. But he did admit that
although there was good access in
some areas of the country, in other
areas it was much lower.
More than £2.25bn of the £90bn
NHS budget is allocated to NHS
dental services each year, with patient charges adding a further £550£600m. In 2008-09, the national
budget for NHS dentistry was increased by 11 per cent, with a further 8.5 per cent in 2009-2010 to enable improvements.
PCT commissioners are being
encouraged to make use of the new
template agreement to procure additional access for patients which
the DH claims, contains quality and
access measures for the first time.
This allows contract holders to be
rewarded for high quality provision through specification of service
quality standards by PCTs. The DH
believes the measures will also enable providers to better understand
what is required and price their
services accordingly.
The DAP was set up by the DH in
March last year to support the NHS
to deliver its commitment of NHS
dental access for all who actively
seek it, at the latest, by March 2011.
The programme aims to:
 increase access through opening
new dental surgeries,
 improve management of existing
contracts to ensure patients receive
the best service
 ensure better information to patients about available NHS appointments
 develop access measures based on
patients’ actual experience.
A template letter for PCTs to send
to their dentists, letting them know
what is going on to improve dental
access at both national and local level is available for PCTs to download
and send out.

... Why compromise
Dr Mike Warburton

Results are expected to be evaluated in March this year.
What is gleaned from the use of
the new agreement, along with the
inclusion of Key Performance Indicators (KPIs), will be fed into the
overall contract review process. Sue
Gregory, deputy chief dental officer
for England, said KPIs would be set
according to the local situation of a
given area.
Other key factors of the agreement are that it is more specific
and thereby could facilitate more
effective contract management by
the PCT. It is also underpinned
by new national data collection
arrangements.
The Government’s commitment
is that by March 2011, access to an
NHS dentist will be available to all
who seek it. But the British Dental
Association’s General Dental Practice Committee (GDPC) is of the view
that providers should seek advice
first before entering into any agreement. The GDPC thinks that dental
access funding contracts are unnecessarily complex. The body believes
that fundamental new provisions,
such as the payment mechanism,
the need to comply with new KPIs
and the ‘dental care assessment’ of
patients should have been developed
and piloted in conjunction with the
wider profession through the implementation of the Steele review.
GDPC chairman, ,John Milne,
said: “Although it must be an individual business decision, we advise
dentists to think very carefully and
seek advice before taking on one
of these contracts as the dangers of
breach are rife, and the consequences of breach may be very damaging
to practices.”
However, initial feedback from
providers with whom the template
has been discussed, suggests that
there will be sufficient providers
willing and able to tender for these
services.

Dr Warburton said PCTs were
already carrying out innovations
to let patients know about the programme, such as placing advertisements on buses.

The, publication of the DH’s Delivering Better Oral Health toolkit
last year, has also made an impact
on the accessibility of dental health,
with significant increases by patients in the use of high-concentration fluoride products.

“We are looking at what works
best, whether leaflets, ads or radio
campaigns.”

The draft access agreement, can
be viewed on the BDA website, at:
www.bda.org.uk DT

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[8] => dtuk1031_page1-4.indd

8 News & Opinions

United Kingdom Edition January 25-31, 2010

Out with the old?
Chris Hindle asks ‘what impact a Conservative
government would have on NHS dentists?’

ith a possible change of
government looming
on the horizon, it is interesting to contemplate potential
changes that a Tory government
may make to the running of NHS
dentistry should Mr Cameron et
al achieve power.

Transforming NHS Dentistry,
published last year by the Conservatives, received a cautious
welcome from BDA General Practice chair John Milne. Mr Milne
stated: ‘The dental contract introduced in 2006 has created significant problems for dentists and pa-

tients. These problems have been
well documented by the BDA, patient groups and the Health Select
Committee. In seeking to address
those problems, it will be important to afford access to dentists to
all and ensure that dentists can
provide modern, preventive care’.

Traditional thinking
Much of the proposed policy expressed in the document fits in
with traditional Tory philosophy
and thinking – such as reducing
bureaucracy, less state interference, greater access to information, more patient choice, further
opening up of the dental services
market and financial incentives
for dentists to increase capacity.
One of the lynchpins of the
proposals centres around dentists
being able and encouraged to of-

fer preventative treatment – can
this be paid for though by the anticipated cost saving it is hoped
will be brought about by an assumed, consequent decrease in
curative and restorative activities?
The idea of providing increased statistical data to the
public domain amounts to more
bureaucracy rather than less.
Dentists will be concerned to
see which of their activities will
be measured and how the data
is presented.
Patient charges
Dentists may find themselves involved as enforcers to some new,
hard-line, money-saving measures – being able to fine patients
who miss appointments for example and also, although only a point
for consultation at this stage, as to
how they can help in preventing
patient fraud. There is a belief
that dental care funding is losing
out as a result of patients wrongly
claiming exemptions. A figure of
£120m has been quoted as the figure the PCTs lost in income, since
the introduction of the new dental
contracts, due to patient charges
being lower than anticipated.
A welcome change
There is though plenty in the proposals that dentists may welcome
– such as dentists having the opportunity to achieve more control
over their own destinies. The current target-based contracts system would be phased out when
the time-limited contracts expire.
This also raises the worrying
prospect of already overburdened
PCTs having to take on and run a
dual system. The proposals would
allow dentists to return to having
their own lists of registered patients – and for those practices it
would certainly make it easier to
define what is meant by practice
goodwill; thus meeting a much
welcome requirement of dentists
to make it easier to buy, sell and
fund NHS practices.
Some dentists will welcome
proposals to allow a child-only
NHS facility at their practices, no
doubt helping the envisaged Tory
crusade on encouraging prevention rather than cure.
Whether or not the Tory proposals have the substance the profession wants for reform remains
to be seen; the Tories certainly
seem to have taken note of dentists’ cries for reform. Any changes though will take a lot of time,
energy and of course money. DT

About the author
Chris Hindle is a commercial solicitor who
has for some time specialised in dental practice sales and purchases
including in particular,
the sale and purchase of
practices with NHS contracts and/or
capitation schemes. To contact Cohen
Cramer Solicitors, call 0113 2440597,
email
dental.team@cohencramer.
co.uk or visit www.cohencramer.co.uk.

[9] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

News & Opinions

9

Access over quality = prescribed neglect?
Although high-need patients can be seen for dental treatment, Neel Kothari thinks the
jury is out as to whether they are getting the treatment that best meets their needs

O

ver the last few days,
I witnessed a miraculous cure to my writer’s
block when a patient I recently
treated brought to my attention
some of the issues that can still
be seen within NHS dentistry.
This patient is a young
lady of around 25 who presented in a great deal of pain
from a lower abscessed molar tooth, as well as rampant
caries elsewhere. I asked her
when she had last seen a dentist
and she replied: “Only last
week, I booked in to see a dentist under the NHS, but at the
end of my session I was told that
this was only an emergency visit and they did not have the time
to see me for treatment.” She
was told to find another dentist
and was given a prescription for
antibiotics, but still could not
sleep or eat.
Funnily enough, this is not
the first time this has happened
and I am sure that many of
you may have encountered
something similar. The problem here in my opinion cannot
purely be put down to the new
contract, but when any system
is based solely on ‘improving NHS patient numbers’
rather than ‘improving quality’, surely the architects of the
new contract must accept some
culpability for introducing a
system that, through a lack
of proper piloting, has effect-

ively prescribed neglect across
the nation.
The good news for the Department of Health (DH) is that
this patient will now probably
count twice in the access figures! Leading me to question,
just how exactly does the Government collate access figures?
Meeting bottom line
While I have some sympathy
for dentists having to provide
an unlimited mass of dental
treatment for a fixed level of
remuneration, surely there can
be no excuse for kicking out patients in pain and agony while
cherry picking those patients
who help to better meet the bottom line? Cases like these do
raise important questions as to
how the profession deals with
those patients needing much
restorative intervention. When
trying to find out what the ‘powers that be’ (various PCTs and
dental unions) seem to think, I
was not surprisingly bombarded with a myriad of different
options ranging from treating
all dental disease within one
course of treatment, to treating some of the major problems, stabilising the patient and
spreading the treatment over
multiple courses.
While they all agreed that it
was unacceptable to leave a patient in pain, I’m afraid across
the nation, many dentists are

apparently still working in different ways and it is clear that
we still all have different interpretations of exactly how the
new dental contract should be
implemented. One problem
still remains: when one dentist
chooses to cherry pick patients,
this leaves others to unfairly
pick up the pieces.
Disastrous consequences
Ten years ago, in September
1999, Tony Blair told the Labour Party Conference: “Everyone will have access to an
NHS dentist within two years.”
Ten years later the drive to
(still) try and achieve this has
clearly had disastrous consequences. Rather than improve
quality, access and patient
satisfaction with the service,
the reality of the situation is
that in real terms we have gone
backwards.
The promises made at the
recent Labour Party Conference
should really be measured up
against Labour’s own record.
This in fact shows loss of access. After the introduction of
the new contract, the number
of people accessing NHS
dentistry fell by one million.
Some 7.5 million people are not
going to an NHS dentist, because it is hard to find one. Fewer children are accessing NHS
dentistry – more than 100,000
fewer than before the new dental contract and dental caries

is now the third most common
reason for children’s admission
to hospital.
A key driver?
Regardless of how the Government dresses up various new
schemes and initiatives to improve NHS dentistry, it does
not take long to realise that
‘improving access’ tends to be
the key driver. But how sens-

subjected to a massive number
of patients, many of whom may
require treatment for years of
dental neglect. That’s great,
you may say? Surely that’s exactly what a new dental practice needs, isn’t it? Well, yes and
no; we hear a lot about NHS
efficiency savings and getting
more for less, but there comes
a point where less is definitely
less and if PCTs choose to fund

‘Of course everyone who needs a dentist
should be able to get one, especially as
it’s called a National Health Service, but
exactly what are they getting?’
ible is this aim? Of course everyone who needs a dentist should
be able to get one, especially
as it’s called a National Health
Service, but exactly what are
they getting?
In Hampshire and the Isle
of Wight, access figures are
clearly well below average. Regardless of how much investment into dentistry has been
made here in recent years, according to prospective Parliamentary candidate Terry Scriven, thousands of people across
the New Forest still have no access to an NHS dentist.
One of the problems here
is that any new practice commissioned by the PCT would be

new services based around
improving access rather than
quality, just exactly who are
they accountable to? And at
what point does this transgress
from governing to influencing
clinical decisions?
Of course since the inception of the NHS, dentistry has
always been used as a political
football where successive governments have incentivised
clinical choices they deem favourable. However in incentivising access over quality, while
high-need patients are able to
be seen for dental treatment
(according the DH), for me the
jury is out as to whether they
are getting the treatment that
best meets their needs. DT

About the author
Neel Kothari qualified as a dentist
from Bristol University
Dental
School in 2005, and
currently works in
Cambridge as an
associate
within
the NHS. He has
completed a yearlong postgraduate
certificate in implantology at UCL’s
Eastman Dental Institute, and regularly attends postgraduate courses to keep
up-to-date with current best practice.
Immediately post graduation, he was
able to work in the older NHS system
and see the changes brought about
through the introduction of the new
NHS system. Like many other dentists,
he has concerns for what the future
holds within the NHS and as an NHS
dentist, appreciates some of the difficulties in providing dental healthcare
within this widely criticised system.
Since the inception of the NHS, dentistry has always been used as a political football

[10] => dtuk1031_page1-4.indd

Endo Tribune
Clinical

Clinical

Clinical

Clinical

Clinical

See the diference

Old dogs, new tricks

A matter of principle

Them’s the breaks

Molar management

Dr Craig Barrington discusses
the use of dental operating microscopes in crown preps

Dr Rafael Michiels shows how
old principles are still a successful using new techniques
and materials

Single canalled teeth and principles of diagnosis and treatment by Dr Kendel Garretson

Prof Leandro Pereira discusses
the retrieval of damaged endo
files using microsurgery

Dr Mark Dreyer highlights the
importance of meticulous root
canal therapy

page 16

page 17-20

page 21

page 11-13

page 14-15

ESE holds record
meeting in Scotland
Daniel Zimmermann, recalls a successful meeting in Edinburgh
for the European Society of Endodontology

T

he auditorium filled with
the sound of Scottish bagpipes, but not playing
the familiar tunes of folk classics such as Amazing Grace or
Auld Lang Syne; it was the famous guitar intro from AC/DC’s
1990 track Thunderstruck as
re-interpreted by the Red Hot
Chilli Pipers. The performance
by the Scottish ensemble, who
won the BBC’s When Will I Be

Famous television show in 2007
and conquering stages in Scotland and worldwide with energetic bagpipe rock, was one of
the highlights of this year’s European Society of Endodontology
(ESE) congress in Edinburgh.
The 14th biennial ESE meeting, which was the second held
in the UK (the first was the
London congress in 1993), saw

a record attendance of more
than 1,400 endodontic specialists from 50 countries. They had
been invited to join a comprehensive lecture programme discussing key issues such as the
rights and wrongs of different instrumentation as well as the realities of microbial biofilms and
the challenges of 3-D imaging.
New this year was a significant
offering of 20-minute presentations that illustrated the latest
clinical findings from research
groups throughout Europe and
further afield.
At the accompanying trade
show, the company W&H pre-

The bustling city of Edinburgh played host to the congress

sented its new anaesthetic
system Anesto that allows targeted local anaesthetisation of
individual. SybronEndo, a gold
sponsor of the meeting, said that
its successful TF rotary NiTi files
are now available in apical sizes
30, 35 and 40. French Acteon had
its EndoSuccess range of tips for
apical surgery on display.
“This was a record-breaking
blockbuster for the ESE and we
were delighted to have been able
to host an event of such quality and size in Edinburgh. Each
of our invited speakers brought
their own style and insights, producing a varied and balanced
programme
for
a large and diverse audience.
ESE has become
a beacon meet-

Red Hot Chilli Pipers with a creative blend of ‘bagpipe rock’

ing, an exceptional gathering
for scholarship, fellowship and
discovery,” said Prof John Whitworth from Newcastle University
and President of the British Endodontic Society.
Delegates at the General Assembly elected former ESE secretary Prof Claus Löst as new
president. Prof Löst is currently
Clinical Director of the Center
of Dentistry, Oral Medicine and
Maxillofacial Surgery at the Tübingen University Hospital in
Germany. He will succeed incumbent president Prof Gunnar
Bergenholtz from Sweden at the
beginning of 2010. More staff
changes are expected to be announced soon. Amongst others,
treasurer Prof Dag Ørstavik from
Norway will step down.
The Executive Board proposed the co-funding of a symposium in July 2010 with the Pulp
Biology and Regeneration Group
of the International Association
for Dental Research, which will
address the topics of inflammation and regeneration.
ESE, founded in April 1982,
is a federal organisation representing national endodontic and
dental societies in 27 European
countries. The next congresses
will take place in Rome (Italy)
in 2011 and in Lisbon (Portugal)
in 2013. DT

ESE immediate past president Prof Gunnar Bergenholtz

[11] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Of visual importance
Dr Craig Barrington discusses crown preparation
techniques utilising the dental operating microscope

uccessful crown preparations start at the diagnosis.
Early detection of the need
for full coverage restoration can
minimise many difficulties associated with the preparation of
a tooth for a crown, obtaining
an accurate impression, and the
achievement of a precise fitting,
long-lasting, esthetic restoration.
Proper diagnosis is the all important first step.
The importance of vision
The second most important ingredient is vision. The dental operating microscope (DOM) has
shown itself to be valuable in endodontics, but it is just as valuable
or more valuable with restorative
efforts. High magnification above
4X is necessary to impose/create
good finish lines that are easy to
impress and temporise. Magnification of 2X-24X is available with
the DOM. Management of gingival health and biologic width is
important to the overall final look

of the crown and the cleansability by the patient. A poor finish line and a poorly positioned
finish line results not only in
poor impressions and final restoration fit but also makes for poor
fitting provisionals.
If one cannot find their own
finish line, one cannot properly
trim and fit the provisional restoration and remove any temporary
cement properly. When patients
return, gingival tissues can be irritated making the placement of
the final restoration challenging.
If by chance one does achieve
a good fit, then when the soft
tissue heals, the junction of the
final restoration and the tooth
may be visible and the overall
esthetics ruined.
Good patient management
Working at high magnification
with the DOM requires good
patient and procedural management. If the patient is moving or

uncomfortable, then the operator
cannot focus and concentrate on
proper reduction or the task of
placing a solid, conservative finish line on the tooth. Therefore,
the third most important ingredient in crown prep success is the
dental rubber dam.
For most, using a dental dam
for a crown prep is a widely
misunderstood concept. Simply
put, the rubber dam is the most
under-utilised, inexpensive and
simple piece of equipment an operator can incorporate into his/
her crown preparation protocol.
With a little training, dentists and
assistants can learn techniques
that will benefit all individuals
involved in the restoration of a
tooth or teeth. Note in all of the
photographs that a dental dam is
in place before and after.
Tissue management is the
fourth concern and this points
back to the number one concern

Slides 1-10 are before and after photos of crown
preparations accomplished on the shown teeth.

Slide 3

14d

14a

14b

10a

14c

15a

15b

15c

15d

15e

Slide 14 and 15 show the final restoration cemented

10b

of early diagnosis versus waiting until a tooth
is severely decayed or
broken down. Working
deep subgingival and
in irritated tissues exponentially complicates
the task of crown preparation.
Hemorrhagic
areas, or those that are
deep subgingival, can
be difficult to visualise and control. Early
dagnosis can minimise
these tissue complicaà DT page 12

[12] => dtuk1031_page1-4.indd

12 Endo Tribune
ß DT page 11

tions. Good tissue management
protocol is paramount to the success of the final restoration.
Radiosurgery instruments
Lasers have been in dentistry
for quite some time but their
cost and other fundamental
limitations make them difficult
to acquire and use. However,
radiosurgery has been around
for years and is an affordable
and useful instrument that can

solve many problems regarding finish line visualisation, finish line exposure, and hemorrhage control. In addition, this
simple, conservative machine
can make cord placement quick
and simple by preserving the
gingival architecture.
The Parkell unit with a
#118 tip allows the creation of
a very conservative “trough” or
“trench” around a tooth. In combination with good visualisation
from the dental operating micro-

United Kingdom Edition

scope (DOM), and good patient
and procedural management
with the rubber dam, we can
reliably create a finish line, expose it, place a cord if necessary
and impress it.
With a radiosurgical unit,
inflamed tissue can be removed
such that the healthier tissue
is exposed to our hemostatic
agents. Healthy hemorrhagic
tissue responds better to hemostatic agents than inflamed hemorrhagic tissue. When inflamed

tissue are encountered, use of
high magnification and the radiosurgical tip to conservatively
contour or remove this nuisance
tissue can providea predictable
result. Removing tissue “thickness” and not modifying tissue
“height” can leave the gingival
tissue in proper position such
that we achieve nice esthetics in
our final result.
Handpiece and bur choices
The final item and of least concern in this protocol is handpiece

January 25-31, 2010

choice and bur choices. There is
existing debate between electric
versus air driven hand pieces
and over which bur is best for
which task. The specification of
a particular handpiece or bur,
would be similar to directing an
artist over which paintbrush to
use. “What works in one’s hands”
is the most important factor and
that changes from individual to
individual and situation to clinical situation. If a practitioner will
meet the diagnosis, magnification, isolation and tissue management protocol, then burs and
handpiece choices will fall into
place on their own with time and
experience. I typically use an air
driven handpiece and an assortment of Axis turbo diamonds.
In a stepwise fashion for an
individual crown prep, the primary concern is achievement
of proper anesthesia such that
the patient is comfortable in all
capacities. Once this is done,
the rubber dam is placed. I use
a split or “slit” dam technique.
The key to success with this rubber dam technique and crown
preperations is the distance at
which the holes or place apart
from each other. Generally
speaking, holes are punched too
close together for this technique.
It is best to punch the holes at a
distance from each other on the
dam that essentially matches
the true anatomical distance between the teeth to be isolated.
Next step: occlusal reduction
Once the tooth is isolated and the
patient is confirmed to be comfortable, the next step is the occlusal reduction. This makes the
tooth shorter and allows better
access and visualisation for the
axial reduction. If there is an existing restoration in the form of
an alloy or composite filling, it
is removed, and the tooth is reduced to the level of the depth
of this restoration. Existing restorations usually provide a fine
guide to getting nice occlusal
clearance without having to verify prior to the next step. Hopefully, I have not diminished the
importance of this step as I know
this can make or literally break a
final restoration.
Doing the occlusal reduction
first allows me to get “warmed
up” and work out any kinks in
terms of patient issues, patient
positioning, handpiece water
flow or bur choice etc, before
moving to the more complicated
axial reduction. On the upper
arch the full crown preparation
is done with a mirror and indirect vision.
The microscope puts us in
an ergonomic position for doing this and the rubber dam creates a nice situation for a high
volume suction to create an air
flow that will keep our mirrors
clean(er) of the water spray from
the handpiece. On the lower
arch, I will do ¾ of the procedure

DM Indesign.indd 1

29/10/09 13:35:27

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United Kingdom Edition January 25-31, 2010

in place, the cord placement is a
simple, pressureless and quick
step followed by copious air/
water syringe rinse. In the time
that it takes to place the cord and
rinse, most, if any hemorrhage
will be controlled.

19a

Slide 19a is the final restoration for the tooth and crown prep shown in slide 10

with direct vision and then finish certain corners through indirect vision. Indirect vision on
the lower arch is not a common
technique but with understanding and desire, it is an easy task/
technique to master.
The axial surface reduced
first depends on which tooth is
being treated. For example, I am
right-handed, so on an upper
right first molar I reduce the palatal side first and then move to
the interproximals. On an upper
right first molar I break contact
on the mesial first, moving from
the palatal side breaking the
contact towards the buccal side.
This is the easier of the two
surfaces to break. First, it is further forward in the mouth and
therefore easier to reach and second, it is a shorter contact as it
is against a premolar. Following
the mesial contact break, I continue around the tooth through
the mesio-buccal line angle onto
the buccal surface. I then break
the distal contact, also moving
from the palatal side to buccal
direction. The most challenging
area to prep on an upper right
first molar is the disto-buccal
line angle. So I prepare the tooth
as far as I can through the distal contact and around the distobuccal line angle. I then complete the buccal reduction and
connect the buccal finish line at
the disto-buccal line angle.
Mirror position is critical
to achieve a solid finish line on
the entire tooth including the
DB line angle. These steps, for
me, remain true for most upper
right teeth with difficulties being
increased as we move more posteriorly and considering patient
limitations in anatomy, patient
attitude, tooth anatomy and existing restorations or decay.
Axial reduction
The steps for axial reduction
on the upper right arch mirror
themselves on the upper left
arch. On the upper left arch I first
reduce the buccal and break contact from the buccal to palatal direction. The difficult area to prepare in an upper left tooth is the
disto-palalal/lingual line angle.
The difficulty varies depending
on the tooth being treated and/or
patient, tooth limitations.

The lower arch is different
from the upper arch in that direct
vision can be utilised for most
of the preparation. The buccal
reduction is done first on both
lower arches and interproximal
contact is broken in a buccal to
lingual direction starting with
the mesial contact first. Once
both mesial and distal contacts
have been broken, the lingual
reduction is accomplished. For
a lower tooth, the disto-lingual
line angle tends to be the most
difficult area to visualise so this
is the part that is refined using
indirect vision.
Tissue management and
cord placement
Once all occlusal and axial reduction has been accomplished,
the next step is tissue management and cord placement. I start
with the radiosurgical unit with
a #118 tip to create a conservative trough around the tooth;
mostly removing tissue thickness and/or reducing any volume of inflamed tissue. This is a
very conservative step under the
microscope. The DOM allows
precise and accurate tissue removal. The DOM also increases
tactile sense and the steadiness
of our hands.
Size 00 cord is soaked in a
hemostatic agent from the start
of the procedure. Literature supports that a cord soaked for 15 20 minutes in a hemostatic agent
works better than any other alternative cord/hemostatic agent
combination or method. Personal
clinical experience and observations find this to be true. Having
the radiosurgical gingival trough

About the author
Dr Craig M Barrington, DDS is a
1996 graduate of
the University of
Texas Health Science Center San Antonio. He practices
general
dentistry
in
Waxahachie,
Texas with his wife,
and has particular
interests in endodontics and microscope dentistry. Dr
Barrington is also a part-time clinical
associate professor in the Department
of Advance Education in General Dentistry at Texas A&M Baylor College of
Dentistry in Dallas. Dr Barrington is a
member of the American Dental Association, the Texas Dental Association,
Omicron Kappa Upsilon, and he is an
associate member of the American
Academy of Endodontists. To contact
him, call 001 972/973 0374.

Now the sharpness and position of the finish line can be
re-evaluated and refined. An
ultrasonic unit is used, with the
irrigation on, to clean the
crown preparation of calculus and/or other debris. Occasionally, a Buc 1 endodontic
tip (which is about the same
size and shape as a 1DT diamond bur) can be used in
the ultrasonic unit to refine
the crown preparation finish lines. This is done with
the irrigation feature turned
off on the ultrasonic unit. To
sharpen, slightly refine, or
minimally move a finish line,
I may occasionally run the
handpiece at a very low speed
without water.

Endo Tribune 13
gles or irregularities in the prep.
Full-arch impressions
A full-arch impression is taken
with a single tray for the arch
that contains the prepared
tooth. For the opposing arch, a
full arch alginate impression is
taken. With full-arch impressions, a bite registration is usually not required. Most often one
chair side assistant is utilised

for the entire procedure, but
for the difficult and challenging
impressions, a second assistant may be utilised for saliva or
tongue control.
Once all the impressions
are taken, a provisional is fabricated, refined, polished and
cemented. Shades are taken and
the patient is released with postoperative instructions. DT

Rinsing and drying
Once all refinements are accomplished, the preparation
is rinsed and dried and for the
first time, the entire preparation is evaluated in one view.
The uniformity of the axial
reduction and the position of
the gums with relation to the
cord, and the cord with relation to the finish line are all
evaluated. The axial reduction should have uniform
thickness throughout the different positions as different
areas need more reduction
and some need less based
on matieral and esthetic demands. There should be no
areas where the gingiva is
over the cord. If this does
occur, that area is refined with
the radiosurgical unit, to insure
a full view of the cord 360
degrees around the tooth of
“tooth-tissue-cord”.
One of the main reasons
we use polyvinyl siloxane
impression materials is because they are repourable. If
adequate strength and thickness of this material is not
obtained, through proper radiosurgical troughing technique, then it may tear upon
separation of the model. Having an impression tear after
the first pour, limits the ability to fabricate a well fitting
restoration.
When a clear “toothtissue-cord”, visible, sharp
finish line is present, the
rubber dam is removed and
the preparation is evaluated in all dimensions with
the naked eye. At times the
DOM can create a “can’t see
the forest for the trees” type
of situation, so it is always
valuable to take another look
from a different perspective
without the DOM. This can
allow one to catch sharp an-

DP Medical Systems Ltd
15a Oakcroft Road, Chessington, Surrey, England, KT9 1RH
Tel: 0800 1300 766 Fax: 020 8397 1262

www.dpmedicalsys.com

[14] => dtuk1031_page1-4.indd

14 Endo Tribune

United Kingdom Edition

January 25-31, 2010

Treating a calcified mandibular
molar: A Modern Day Protocol
Rafaël Michiels, DDS, MSc presents a case study showing old dogs can use new
tricks for success

ndodontics has evolved
enormously the last few
decades. However, the basic principles from the past are
still up to date. This case report
gives an example of how the old
principles are carried out with
newer techniques, devices and
materials.
History & Diagnosis
A 37-year-old female patient,
was referred to our practice for
a problem with the lower right
second mandibular molar (#4.7).
She had no health issues, and
was given an ASA score of 1.
The referring dentist opened
the tooth, because of an acute
pulpitis due to an extensive carious lesion disto-lingually. She
had difficulties in locating the
mesial canals because the pulp
chamber was heavily calicified.
She placed calciumhydroxide
upon the orifices of the canals
and sealed the tooth with a cotton
pellet and a temporary restoration, before referring the patient
to our office. The patient had
no clinical symptoms when she
came to our office for treatment.
Treatment & Discussion
A diagnostic radiograph (Fig.1)
was taken to see the extent of
the lesion and to have a look at
the anatomy of the roots. It is essential to determine your strategy. The patient was then anesthetised by giving a lower alveolar
nerve block with articaïne 4 per
cent - 1/100000 epinefrine (Septanest Spécial, Septodont, Brussels, Belgium). The temporary
filling and cotton pellet were
removed exposing a large carious lesion. In order to facilitate
the temporary restoration after
treatment, an automatrix (Dentsply Caulk, Milford, USA) was
placed. This also enables better
isolation. The tooth was then isolated with a rubberdam (Coltène/
Whaledent, Langenau, Germany)
(Fig. 2).
Isolation is one of the fundamental principles in endodontics
and is more than 100 years old.
Already in 1864 Sanford C. Barnum developed the rubber dam
and it was generally accepted
that its use was necessary to

achieve a good isolation and a
better prognosis.(1)

adapter (Carl Zeiss Belgium, Zaventem, Belgium).

“The first step in the treatment of a tooth… is the adjustment of rubber dam over the
diseased tooth to preclude the
possibility of the entrance of
germs in the oral secretions into
the pulp chamber. This should
be the invariable rule.”(2)

Next, I removed the carious
dentine with LN burs (Dentsply
Maillefer, Ballaigues, Switzerland). There was a lot of calcified tissue in the pulp chamber
(Fig.3), this was also removed
with LN burs. The calciumhydroxide was easily removed with
citric acid 10 per cent.

However in a recent survey
only 3,4 per cent of general dental
practioners used the rubber dam
in their endodontic routine.(3)
Visualisation and magnification can greatly help clinicians
in cases like this one. Without
the use of a surgical operating
microscope it is very difficult
to locate canals when there is
much calcification. “You cannot
treat, what you cannot see.” is
a quote that is regularly heard,
but it hits the nail on the head.
Visualisation and magnification
were obtained through the surgical operating microscope (Opmi
Pico, Carl Zeiss Belgium, Zaventem, Belgium). Photos were taken with a Canon powershot A650
IS (Canon Belgium, Diegem, Belgium) mounted on the Flexiostill

By now, a clean opening
cavity was created. From here
on, I could start with the actual
root canal treatment. Two mesial canals were located and coronally pre-flared with Protaper

SX (Dentsply Maillefer, Ballaigues, Switzerland)(Fig.4). Working length was determined with
a ISO size 10 K-file (Dentsply
Maillefer, Ballaigues, Switzerland)(Table 1) and the Root ZX
mini apex locator (J. Morita Europe, Dietzenbach, Germany).
A glide path was then established with K-flexofiles sizes 15
and 20.
Cleaning was performed with
NaOCl 3 per cent, which was ultrasonically activated with an
Irrisafe tip (Satelec, Mérignac
Cedex, France) several times
throughout the procedure. The
ultrasonic activation of the irrigating solution results in more
removal of organic tissue, debris
and planktonic bacteria.(4) It is a

very easy and cheap procedure
and should be incorporated in
every endodontic routine.
Shaping was done with Protapers S1, S2 and F1 in the mesial
canals and up to Protaper F2 in
the distal canal. This gives the
canal sufficient taper, but a small
apical diameter. Many controversies are present about shaping the apical diameter. I prefer
an apical diameter of at least
a size 30, because I rinse with
a 30-gauge irrigation needle.
In this manner the NaOCl can
come into direct contact with the
apical dentine.(5) This results in
a significant better removal of
debris out of the apical part of
the root.(6) In order to get a bigger apical diameter, a Profile

Fig. 3 Calcified tissue in the pulp chamber

Fig. 1 Diagnostic Radiograph

Fig. 2 Placement of rubber dam
and automatrix

Fig. 4 Locating the mesial canals

Fig. 5 Fractured Irrisafe tip

Fig. 8 Obturation of the isthmus

Fig. 6 Removed Irrisafe tip

Fig. 9 Pulp chamber after obturation and removal
of excess sealer

Fig. 7 Confirmation Radiograph

References
1. Dr. CAMPBELL. The preparation of roots for crowning, and gold crowns. Dominion Dent J 1895 7(2):41-45 2. Dr. EIDT. Treatment of blind abscess. Dominion Dent J 1900 12(7):231-233 3. SLAUS G, BOTTENBERG P. A survey of
endodontic practice amongst Flemish dentists. Int Endod J 2002 Sep;35(9):759-67. 4. VAN DER SLUIS LW, VERSLUIS M, WU MK, WESSELINK PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod
J 2007 Jun;40(6):415-26. 5. BAUGH D, WALLACE J. The role of apical instrumentation in root canal treatment: a review of the literature. J Endod 2005 May;31(5):333-40. 6. WU MK, WESSELINK PR. Efficacy of three techniques
in cleaning the apical portion of curved root canals. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995 Apr;79(4):492-6. 7. McGILL S, GULABIVALA K, MORDAN N, NG YL. The efficacy of dynamic irrigation using a commercially available system (RinsEndo) determined by removal of a collagen ‘bio-molecular film’ from an ex vivo model. Int Endod J 2008 Jul;41(7):602-8.

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Endo Tribune 15

United Kingdom Edition January 25-31, 2010

30.06 (Dentsply Maillefer, Ballaigues, Switzerland) was taken
to working length in the mesial canals and a Profile 35.06
in the distal canal. Patency was
kept in all three canals throughout the entire treatment, with
a ISO size 10 K-file. After the
canals were shaped, they were
rinsed with citric acid 10 per
cent, which was ultrasonically
activated, three times for 20 seconds, with an Irrisafe tip. During the third activation, the tip
fractured and got stuck in the
isthmus between the mesial
canals. Cotton pellets were
placed in the mesio-lingual and
distal canal to avoid that the instrument would fall into these
canals during its retrieval (Fig.
5). Retrieval was done with another Irrisafe tip (Fig. 6). A final
rinse was performed with NaOCl
3 per cent, which was warmed
by giving a few bursts with the
System B (Elements Obturation
Unit, Sybronendo, Orange, USA).
Finally, cone pumping was
performed with a tapered 06
guttapercha. Cone pumping is
known in the literature as manual dynamic irrigation and it
has been showed that manual
dynanic irrigation is more effective than regular irrigation.(7)

Table 1: Working lengths and apical diameters of the canals
Canal

Working length

MAF

Reference Point

21,5mm

DB cusp

21,5mm

MB cusp

22,5mm

ML cusp

struments and others which
we cannot think away anymore.
In the present we are still holding on to these revolutions,
but we are using evolutions of
the originals to make treatment

easier, better controlled and to
gain a favourable outcome. I
presented this case to give an
overview of the current evolutions which are used in modern
day endodontics. DT

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A confirmation radiograph
was then taken with guttapercha master cones (Dentsply
Maillefer, Ballaigues, Switzerland) in place (Fig. 7). The canals
were dried with paper points
(Roeko, Langenau, Germany).
Obturation was performed
with a hybrid technique in
which cold lateral condensation is used to ﬁll the apical
4mm. After that the System
B needle is taken into the canal, four mm short of working
length. Backﬁll was performed
with the Elements Extruder in
small increments of two mm
each time, to reduce shrinkage.
Topseal (Dentsply Maillefer,
Ballaigues, Switzerland) was
used as a sealer. During the backfill, I could see the isthmus being
obturated with guttapercha (Fig.
8), which is a desirable result.
If tissue would have been left in
the isthmus, it could have led to
failure. After obturation, the excess of sealer in the pulp chamber was removed with alcohol 96
per cent (Fig. 9). A temporary
restoration was then placed
with Fuji IX Fast A2 (GC Europe,
Leuven, Belgium).
Final radiographs (Figs. 10 &
11) were taken and the patiënt
was sent home with instructions about post-op discomfort and a prescription for ibuprofen 400mg.
Conclusion
In the past there have been several revolutions in the field of
endodontics. These comprise
the isolation procedure with
the rubber dam, cleaning with
NaOCl, shaping with rotary in-

Fig. 11 Final position

Fig. 10 Final radiograph

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Eagle strip 1 89x266mm:Layout 1

8/10/08

13:40

Page 1

16 Endo Tribune

United Kingdom Edition

January 25-31, 2010

KaVo – ESTETICA E80

Illustrating principles of
diagnosis and treatment
A case report by Dr Kendel Garretson

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ndodontic anatomy varies greatly and single canalled teeth provide an
opportunity to illustrate principles of diagnosis and treatment.
In this case (Figure 1), a patient
presented with a “toothache”.
Medical history was non-contributory. Diagnostic testing revealed a necrotic maxillary central incisor with symptomatic
periradicular periodontitis. Even
in cases with obvious pathology,
thorough endodontic diagnosis
is completed to determine the
proper pulpal and periradicular status of teeth in the affected
area, including examination
of the affected sextant and the
opposing arch.
Based on these findings, a
decision was made to treat the
tooth in two visits. Emphasising
debridement in a crown down
fashion, the canal system was
entered and flared coronally. A
variety of instruments can be
used for this purpose, including

Gates –Glidden drills as used in
this case, followed by tapered rotary nickel titanium instruments.
No attempt is yet made to instrument to full length until coronal
flaring and preliminary disinfection can be completed. The goal
is to minimise the risk of pushing debris through the apical
foramen. A preliminary canal
length is established, followed
by a definitive working length as
treatment progresses.

aged with small k-files used in
an exploratory fashion.

Apical preparation
The apical preparation was sized
and finalised with non-tapered
rotary instruments (LSX, Discus
Dental.) Again, a variety of instruments can be used for this
purpose. The goal is to thoroughly debride the apical extent
of canal system, and prepare the
tooth for obturation. Irrigation
was accomplished with sodium
hypochlorite, as well as aqueous
EDTA. Irrigants were activated
with sonic agitation and copious
irrigant exchange was encour-

The patient returned in two
weeks to complete treatment.
Symptoms resolved within a day
or two of the initial visit. Use of
aqueous EDTA, with sonic activation and instrumentation,
assisted removal of the dressing. The apical preparation was
again verified prior to obturation. Since the tooth was prepared with LSX, a corresponding Simplifill (Discus Dental)
gutta percha obturator was used.
This allows for excellent apical
control and compaction of gutta
percha, and this was followed
by a backfill from a heated gutta
percha delivery injection device. Composite resin was then
used to complete access closure.
Several lateral canals are noted
after obturation, demonstrating
hydraulic pressure and thorough
obturation of the canal system.
(Figure 2).

After drying, a non-setting
calcium hydroxide paste was delivered to length in the canal and
a secure interim restoration was
placed. Calcium hydroxide aids
in tissue digestion, disinfection,
and neutralisation of LPS. Other
agents may also be used, both as
irrigants or dressings, to help optimise microbial control.

Predictable healing
A second case is included, previously treated, with similar presentation and preparation philosophy,
along with a 16-month control
image (Figures 3,4). By adhering
to biologically based treatment
philosophies which flow from a
thorough diagnosis, our patients
can expect predictable healing
and disease prevention. DT
Fig 1, Tooth number 11, pre-operative

Fig 2, Tooth number 11, immediate
post-operative

CALL US ON FREEPHONE
0800 281 020

Fig 3, Tooth number 45, immediate
post-operative

KaVo Dental Limited
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Tel. 01494 733000 · Fax 01494 431168
mail: sales@kavo.com · www.kavo.com

Fig 4, Tooth number 45, 16 month control

About the author
Dr
D
Kendel
Garretson is a
1989 graduate of
the University of
Texas Health Science Center at San
Antonio,
Dental
School. Since 2004
Dr Garretson has
limited his practice to endodontics
and lectured on a
regular basis to AEGD residents on
a variety of endodontic topics. He is a
member of the ADA and an associate
member of the AAE, and maintains a
private practice in San Antonio, Texas.
Questions and comments welcomed at
onlyendo@gmail.com.

References
Effects of Chemomechanical Preparation With 2.5 per cent Sodium Hypochlorite and Intracanal Medication With Calcium Hydroxide
on Cultivable Bacteria in Infected Root Canal. José F. Siqueira, Tatiana Guimarães-Pinto, Isabela N. Rôças. Journal of Endodontics,
July 2007 (Vol. 33, Issue 7, Pages 800-805). Factors affecting the long-term results of endodontic treatment. Ulf Sjögren, Björn Hägglund, Göran Sundqvist, Kenneth Wing. Journal of Endodontics, October 1990 (Vol. 16, Issue 10, Pages 498-504). Clinical Efficacy of
Treatment Procedures in Endodontic Infection Control and One Year Follow-Up of Periapical Healing. Tuomas Waltimo, Martin Trope,
Markus Haapasalo, Dag Ørstavik. Journal of Endodontics, December 2005 (Vol. 31, Issue 12, Pages 863-866).

[17] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Endo Tribune 17

Periapical microsurgery for removal
of a fractured endodontic instrument
Leandro AP Pereira details a case presentation using a piezoelectric device for
removal of a fractured endodontic instrument

uring endodontic treatment, procedural errors
may occur, such as the
breakage of endodontic files.
These accidents may compromise the treatment and prognosis of the clinical case. Frequently, it is necessary to perform
additional procedures to resolve
the problem.
With the development of
cleaning and shaping endodontic systems, there is decreasing
frequency of procedural problems in dental practice1. However, concern persists that rotary
NiTi instruments are more susceptible to breakage. This has
been the second most common
reason for dentists not using
rotary instruments2.

Failure to remove the fractured endodontic instrument results in deficient cleaning, shap-

ing and filling of the root canal
system. Under these conditions,
in addition to the endodontic

diagnosis, the time during treatment when the instrument fracture occurs is of great importance

in the prognosis of the case10.
à DT page 18

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A recent study has shown
that the incidence of broken
instruments accounts for 11.7
per cent of all endodontic malpractice cases3. The incidence
of NiTi file fractures has been
shown to range from 0.4 to five
per cent and their use is considerabed safe4, 5, 6. Fractures can
occur through torsional failure
or as a result of flexural fatigue.
Minimising breakages
To minimise these incidents,
care must be taken as follows:
evaluate the tooth anatomy carefully before treatment; ensure
a straight-line access; create a
“glide path” with small hand
files; use the crown-down technique; use a torque-controlled
motor; keep files moving in and
out of the canal and control the
number of times files are used
discarding files after a specified
number and types of canals.
Fractures of endodontic instruments inside canals may
be classified according to their
intraradicular position as occurring in the cervical, middle
or apical thirds. The success
rate for removing fractured instruments in the cervical and
middle thirds is higher than it
is in the apical third, and the
incidence of iatrogenies during
the attempt to remove them is
lower7, 8, 9.
The prognosis of treatment
can be altered as a result of the
presence or absence of endodontic infection. Cases of pulp
necrosis have a worse prognosis than cases with live pulp, as
the presence of a large quantity
of bacteria and the limitation of
correctly eliminating them may
lead to treatment failure.

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[18] => dtuk1031_page1-4.indd

18 Endo Tribune
ß DT page 17

When instrument fracture
in a contaminated canal occurs
at the beginning of treatment,
the prognosis is worse, because
there is still a large quantity of
bacteria, and the presence of
the instrument may prevent adequate microbiological control.
The presence of the instrument
may also contribute to inadequate endodontic filling. The
prognosis is better when the
fracture occurs near the end of
the canal-cleaning and shaping
process, as it is a more advanced
stage of endodontic microbiological control.
In situations of instrument
fractures associated with pulp
vitality, the prognosis does not
change significantly10.
Fig 1: Initial clinical aspect

Removing broken instruments
When taking the decision to
remove the instrument, factors
such as pulp diagnosis, location, root curvature and length,
size and type of fractured instrument, remaining dentinal thickness, and risks of iatrogenies
during the attempted removal
must be taken into consideration.

A technique commonly used
for removing fractured instruments is to achieve a bypass
with a manual file, so that the
fragment can be drawn to the
pulp chamber and be removed.
Another removal technique is by
means of ultrasonic vibration of
the fractured fragment, associated with the use of an operating microscope. The application
of ultrasonic energy causes the

United Kingdom Edition

fractured instrument to vibrate,
causing it to detach from the
canal wall, and it can then be
drawn to the pulp chamber and
finally removed7.
The application of these
methods in atresic canals may
result in excessive wear of the
root walls; therefore their use
associated with the operating
microscope is safer, due to the
possibility of improving visualisation through the magnification and illumination provided
by the microscope.
In cases of unsuccessful removal of the instrument
and control of infection, with
persistence of signs and symptoms of endodontic disease, surgical removal of the fragment
may be indicated.

A clinical example
This article demonstrates the
resolution of a clinical case in
which there was fracture of a
K3 rotary instrument in the apical third, extending out of the
root apex.
The patient, a healthy
44-year-old
woman,
pulse
68bpm, BP 115X 65 mmHb,
SpO2 98 per cent, temperature 36.5oC, came to the dental office complaining of constant, low intensity, spontaneous pain, in the vestibular apical
region of tooth 24, and presented
intra-oral edema, pain on chewing and vertical percussion.
She reported having undergone endodontic treatment in
tooth 24 more than six years
previously. In the periapical
radiographic exam it was pos-

Fig 4: Gutta-percha removal without solvents

Fig 5: 2.5% Sodium Hypochlorite

Fig 7: After filling, with broken file still in place, and
before microsurgery

Fig 8a: Broken file - surgical view

Fig 2: Initial Xray

Fig 3: Initial occlusal clinical aspect

January 25-31, 2010

sible to visualise deficient endodontic treatment and the presence of apical bone rarefaction
(Figures 1, 2). The diagnosis
of acute periapical abscess
was made.
The proposed treatment was
endodontic re-treatment, because
in the previously performed treatment there was inadequate canal
cleaning and shaping, leading
to filling with empty spaces and
maintaining the intracanal endodontic infection. Periapical surgery was contra-indicated due
to the presence of deficient endodontic treatment.
Endodontic
re-treatment
began with access to the pulp
chamber, with removal of the
occlusal resin restoration, using ultrasonic diamond inserts

Fig 6: After shaping

[19] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

CVDentus CR1 (Figure 3)11. Filling was removed from the root
canals with the use of ultrasound
and type K hand files, without
the use of solvents (Figure 4). As
auxiliary chemical substances,
2.5 per cent Sodium Hypochlorite, ENDO-PTC and 17 per cent
EDTA-T were used.

Fig 8b: Broken file (micro-mirror view)

Fig 8d: Apical root fragment

Endo Tribune 19
Fig 8e: Sutures

After removing the fillings
from the canals and establishing the working length by means
of the apical locator, Elements
Diagnostics (SybronEndo), root
canal preparation began with oscillating hand endodontic files in
M4 handpiece up to type K #20
file. After this, preparation of
the canals continued with K3
Sybron Endo VTVT Pack files,
driven by an NSK electric motor
with torque control adjusted to
1.2N and speed of 350rpm.
At the time of using instrument K3 30.04 in the apical region, there was no adequate
control of the pre-established
working length and the instrument overtook the root apex and
fractured. The fractured fragment measured 3mm, and approximately 1mm of it was outside of the apex.
The bypass technique
Several attempts were made to
remove it using the bypass technique associated with the use of
ultrasound and operating microscopy. In spite of making the
bypass with a type K#08 file, and
successively with type K#10, #
15, #20 and #25 files, the fragment did not come out. The position of the instrument in the
apical third, associated with the
root curvature in the region was
responsible for the failed attempt
to remove it.
At this stage of the treatment,
disinfection of the root canal system had not yet been concluded.
The present of the instrument,
made it impossible to sanitise the
canals correctly and the sign and
symptoms of endodontic infection persisted.
In an endeavor to perform
additional
decontamination,
Calcium Hydroxide was used as
intracanal medication for three
weeks, but the signs and symptoms of endodontic infection did
not yield. As a result of failure
to control the infection, in this
case, complementary surgery
was proposed to remove the
apical root third, since it was
not possible to shape and
disinfect it due to the presence of
the instrument.

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For the complete resolution
of infection, the root canals were
filled and after this, piezoelectric periapical microsurgery was
performed to resection the apical
third of the root.
A full thickness flap was

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81%1)OD*21$QZ%WZJCXGP)GTOCP[6GN 0) (CZ 0) YYYXQEQEQO

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20 Endo Tribune
ß DT page 19

United Kingdom Edition

Fig 8e: Sutures

The quality of the root remainder filling was evaluated by introducing a micromirror into the
apical bone recess and reviewing
the root remainder filling, considered satisfactory as it uniformly
filled the root canals (Figure 8c).
This was the criterion used for
not performing retropreparation
and retrofilling of the root canals,
since this region of the canal had
been adequately cleaned, shaped
and filled.

made with a semilunar incision. The option for this type of
incision was determined by the
absence of a large, radiographically visible bone defect (Figure
2) and also for esthetic reasons.
This type of incision does not
carry the risk of post-operative
gingival recession.
After raising the surgical flap,
it was possible to note the integrity of the cortical vestibular
bone. The osteotomy was performed with surgical piezoelectric ultrasound and CVDentus®
W1-0 insert for more precise of
control of the cut, followed by
apicectomy, also performed with
ultrasound.

Fig 9: Post-operative Xray

The benefits of
ultrasound
There are technical
and biological advantages to osteotomy performed with
ultrasound
when
compared with the
use of high or low
speed burs. Ultrasound has highly selective tissue cutting
ability. Its action occurs only on mineralized tissues such
as bone and tooth,
preserving soft tissues such as nerves,
vessels and mucosas. During osteotomy, the amplitude
of the micro-movements generated by
the ultrasonic insert
ranged between 60
and 210 micrometers making the
hard tissue cut extremely precise. This is associated with the formation of acoustic
microstreams and cavitation in
the operative field, which promote a clean field, as observed in
Figures 8a, 8b and 8c 13, 14, 15, 16, 17,
18 ,19, 20
.

The sutures were made with
the aid of the operating microscope. Two simple stitches with
Vicryl 6-0 thread were made to stabilise the flap, and another continuous stitch with Vicryl 9-0 thread
to coapt the edges (Figure 9).

Fig 8f: Vicryl 8-0 sutures (X 12.5)

Clinical control was performed after seven, 30 and 90
days. There was remission of all
the clinical signs and symptoms
of endodontic infection. DT

About the author

faster increase in morphogenetic bone proteins and modulates
the inflammatory reaction, in
addition to stimulating healing14.

The biological benefits of piezoelectric surgery particularly
involve the maintenance of cellular viability in the operated
region, so that the first post-operative stages of the bone repair
process are better. It induces a

The fractured instrument
was removed together with the
apical root third in the apicectomy (Figure 8d). The apical root
cut was performed at an angle
of 900 to the long axis of the
root, to expose the smallest
quantity of dentinal tubules

References
1. Molander A, Warfvinge J, Reit C, Kvist T. Clinical and radiographic evaluation of one- and two-visit endodontic treatment of asymptomatic necrotic teeth with apical periodontitis: a randomized clinical trial. J Endod. 2007 Oct;33(10):1145-8.

2. Parashos P, Messer HH

Questionnaire survey on the use of rotary nickel-titanium endodontic instruments by Australian dentists.Int Endod J. 2004 Apr;37(4):24959. 3. Bjørndal L, Reit C. Endodontic malpractice claims in Denmark 1995-2004. Int Endod J. 2008 Dec;41(12):1059-65. 4. Al-Fouzan KS.
Incidence of rotatory ProFile instrument fracture and potential for passing in vivo. Int Endod J 2003;36:864-867. 5. Pettiette MT, Conner
D, Trope M. Procedural errors with use of nickel-titanium rotatory instruments in undergraduate endodontics. J Endod 2002;28:259

Schäfer E, Schulz-Bongert U, Tulus G. Comparison of hand stainless steel and nickel titanium rotatory instrumentation: a clinical study.
J Endod 2004;30:432-435. 7. Ward JR, Parashos P, Messer HH. Evaluation of an ultrasonic technique to remove fractured rotary nickeltitanium endodontic instruments from root canals: clinical cases. J Endod. 2003 Nov;29(11):764-7. 8. Ward JR, Parashos P, Messer HH.
Evaluation of an ultrasonic technique to remove fractured rotary nickel-titanium endodontic instruments from root canals: an experimental study. J Endod. 2003 Nov;29(11):756-63. 9. Souter NJ, Messer HH. Complications associated with fractured file removal using an
ultrasonic technique. J Endod. 2005 Jun;31(6):450-2. 10. Spili P, Parashos P, Messer HH. The impact of instrument fracture on outcome
of endodontic treatment. J Endod. 2005 Dec;31(12):845-50. 11. Predebon JC, Flório FM, Basting RT. Use of CVDentUS Diamond Tips for
Ultrasound in Cavity Preparation. J Contemp Dent Pract. 2006 July;(7)3:050-058

12. http://www.sybronendo.com/index/cms-filesystem-

action?file=SybronEndo-PDF/k3-brochure-english.pdf 13. Labanca M, Azzola F, Vinci R, Rodella LF. Piezoelectric surgery: twenty years of
use. British Journal of Oral and Maxillofacial Surgery. 2008;46:265–269. 14. Preti G, Martinasso G, Peirone B, et al. Cytokines and growth
factors involved in the osseointegration of oral titanium implants positioned using piezoelectric bone surgery versus a drill technique: a
pilot study in minipigs. J Periodontol. 2007;78:716–22 15. Horton JE, Tarpley Jr TM, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol. 1981;51:236–42. 16. Lee SJ, Park KH. Ultrasonic energy
in endoscopic surgery. Yonsei Med J. 1999;40:545–9.

17. Sherman JA, Davies HT. Ultracision: the harmonic scalpel and its possible uses

in maxillofacial surgery. Br J Oral Maxillofac Surg. 2000;38:530–2.

18. Sortino F, Pedullà E, Masoli V. The piezoelectric and rotatory

osteotomy technique in impacted third molar surgery: comparison of postoperative recovery. Journal of Oral and Maxillofacial Surgery.
2008;66(12):2444-2448.

January 25-31, 2010

19. Bowen EA, Peñarrocha M. An update in periapical surgery. Medicina oral, patología oral y cirugía bucal.

2006;11(6):E503-509. 20. Xu Q, C Yi-yang, L Jun-qi, G Hai-jing, L Jian-wei. Clinical evaluation of periapical endodontic surgery for endodontic failure.Zhonghua Kou Qiang Yi Xue Za Zhi; 2009;44 (2):79-81. 21. Gilheani PA, Figdor D, Tyas MJ. Apical dentin permeability
and microleakage associated with root end resection and retrograde filling. J Endod. 1994;20:22-26.

Leandro AP Pereira is a specialist
in
Endodontics;
Professor of the
specialist
Course
in Endodontics at
the School of Dentistry, São Leopoldo
Mandic, Campinas,
Sao Paolo, Brazil;
Professor of Inhalation Sedation at
the School of Dentistry, São Leopoldo
Mandic, Campinas Campinas, Sao
Paolo, Brazil; Professor of the Specialist Endodontics course, EAP “Associação dos Cirurgiões Dentistas de
Campinas”, Campinas, Sao Paolo, Brazil. He is also studying for a Masters
in Pharmacology, Anesthesiology and
Therapeutics at the Piracicaba Dental
School, University of Campinas Brazil
and preserve the most root exand runs his own private clinical, also
tension, favoring microbiologiin Campinas, Sao Paolo Brazil. To concal
control
and
function
of
the
tact Page
him, email
Feb 10 Tribune KE 18/1/10 09:47
1 leandroapp@sedcare.
com.br or visit www.sedcare.com.br.
dental remainder 21.

[21] => dtuk1031_page1-4.indd

dtuk0927_osspray_ad_pg2.pdf 1 18/01/2010 09:54:20

United Kingdom Edition January 25-31, 2010

Managing maxilliary
molars - case study
How meticulous root-canal therapy lays the
foundation for successful long-term retention
and restorative care - Dr Mark Dreyer

axillary first molars are
notable for their complex root canal system
morphology. The mesio-buccal
roots are characterised by an irregular ovoid morphology, resulting in an isthmus or fin of
pulpal tissue extending in the
palatal direction off of the principle mesio-buccal canal. This case
report presents steps taken to address this anatomy to maximise
the disinfection and debridement
of the root canal system. Failure
to address this anatomic complexity may lead to persistence or
recurrence of endodontic disease.
Endodontic evaluation
A 58-year-old female patient
presented for endodontic evaluation and therapy in the upper
left quadrant. Mild pain was reported by the patient for several
days prior to the appointment.
Medical history was non-contributory and dental history was
remarkable for multiple existing
large amalgam restorations (Figures 1, 2, 3). Clinical examination and diagnostic evaluation
were performed for all posterior
teeth on the right side, including
cold testing, percussion, palpation, periodontal probing and
bite challenge. Findings led to
a pre-operative diagnosis of
irreversible pulpitis/maxillary
right first molar with normal
peri-radicular.
After anesthesia, and isolation with the rubber dam, entry
was made into a calcified pulp
chamber. Use of the dental operating microscope greatly enhances lighting and visibility
allowing for careful and deliberate clearing of reparative dentin,
pulp stones, and other potential
impediments to canal orifices.
It is important to stress resisting
the urge to take files into the canals prior to developing proper
access form. In such cases, ledging and blockages can easily occur, needlessly compromising
and complicating treatment. The
palatal pulp tissue was calcified
and extirpated in toto, as seen in
Figure 4.
Ultrasonic tips
In this case, ultrasonic tips were
used to plane the pulpal floor
and increase visibility. These
instruments are available from
many manufacturers in a variety of sizes and shapes designed to address specific case

needs. In this case, the orifice
of the MB2 canal was located
toward the palatal orifice in an
unusual presentation (Figures
5, 6). This stresses the importance of continuing to examine
the pulpal floor with the microscope throughout the procedure,
as irrigants and instrumentation constantly alter the presentation of subtle cues and clues
to orifice location.

oneself with this anatomy, examine extracted teeth or see Brown
and Herbranson’s Tooth Atlas, a
rich source of 3D imagery. The
final radiographs demonstrate
placement of an orifice barrier,
subsequent to temporisation and
referral back to the restorative
dentist. Image (not included)
shows the easily identifiable
bonded high contrast composite
used for this purpose.

Once orifice location is
completed, canal negotiation
and instrumentation is carried
to completion. Warm vertical
compaction of gutta percha and
ZOE sealer is used in this case,
demonstrating the treated canal
morphology (Figures 7, 8, 9). The
MB2 canal was addressed as a
completely separate canal. One
study examined more than 1,700
teeth, which included more than
1,000 first molars. The presence
of the MB2 canal was demonstrated in 93 per cent of these
teeth (Stropko, JOE June 1999).

A complex system
This case presented an opportunity to demonstrate the complex
canal system anatomy present
in maxillary molars. Use of
the dental-operating microscope
throughout a carefully executed coronal and radicular access procedure maximises the
ability to disinfect and debride
these teeth.

Endo Tribune 21

Introducing a

dental technology
so advanced,

it revolutionises

preventive care.

CMY

These findings are not surprising given the morphology of
the mesio-bucaal root in maxillary molars. To better acquaint
K

Ultrasonic instrumentation
allows for the judicious removal of dentin required to prevent
iatrogenic mishaps and unnecessary weakening of the tooth.
When patients present with endodontic disease, meticulous
root-canal therapy lays the foundation for successful long-term
retention and restorative care. DT

Fig 2
Fig 1

Fig 3

Fig 4

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22 Practice Management

United Kingdom Edition January 25-31, 2010

The 10th dimension… the power of 10
Ed Bonner and Adrianne Morris discuss the underrated art of listening

n
oft-quoted
expression is that we are give
two ears and one mouth
and that we should use these
in the same proportion. Put
more simply, we should talk
less and listen more. But even
if we did ‘listen’ more, would
we actually hear more or
learn more?

An analysis of modes of listening would suggest very much
the contrary. Consider the following ten types of listening, and
how many of them apply to you:

‘On-off’ listening
It has been estimated that
most people think four times
faster than most people speak.
This means that for every minute
someone listens, they have
45 seconds available to think:
15 seconds on, 45 seconds
off. This spare ‘thinking’ time
is used to think of personal

affairs, trouble and concerns, sex
or any other interests instead of
attentive listening.

‘Red-flag’ listening
To almost all of us, certain
words are button-pushers, like
waving a red flag at a bull. When
we hear, words, such as ‘should’,
‘must’, ‘have to’, or ‘new contract’,
‘government’, ‘GDC’, and a myriad
others, we get irritated, annoyed,
angry or upset. There is an automatic response: we stop listening
and tune out on the speaker.

‘Open-eyed/closed mind’
listening
Oft-times we decide that either the
speaker or the subject is boring or
does not make sense. In such circumstances, we may jump to conclusions about what the speaker
knows and/or attempt to predict
what the speaker will say. Either
way, we have decided that there is
no need to listen, because we will

not learn anything new.

‘Glassy-eyed’ listening
Has it ever happened that you
look intently at a person and seem
to be listening intently whereas in
fact your mind may be on something else completely? When you
do this, you drop back into the
comfort of your own thoughts and
become glassy-eyed or develop a
dreamy expression on your face.
But you should know that, when
someone does this to you, you will
not be fooled, so nor will they!

‘Too deep for me!’ listening
This is a variation of being
glassy-eyed, but is brought on
by having little understanding
of what is being said and not having the wit to ask. There is the big
risk here that one will shut off
completely and not listen at all.

‘Matter-over-mind’ listening
When our opinions, pet ideas,

My day on ‘the other side’
Dentist Simon Thackeray details a BDTA Dental
Showcase visit with a twist...

his year’s BDTA Showcase
was just a little different for dental plan pro-

vider Practice Plan, as it wasn’t
just them manning their stand;
some of their customers helped

Something to
Smile about!...
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OPROshield – a self-fit guard enabling patients
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NightGuards – the most comfortable and effective way
to protect teeth from bruxism.
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whitening teeth.
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OPROrefresh – mouthguard and tray
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Firstly, I have to say it
was a privilege to be asked
to represent Practice Plan at
the recent BDTA Showcase.
At first I wasn’t sure about
what to expect, and never
having experienced “the other side” of the BDTA before, it
certainly was an eye-opener
for me!
It was great to support
a company that has helped
me so much in the past, and
I hope that I did the honour
justice, by telling prospective
customers the truth about
my experiences with Practice
Plan over the last five years.

Custom-fitting Mouthguards* – the best protection for teeth
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email info@smileguard.co.uk or call 01707 251252

too! Simon Thackeray of Thackeray Dental Care tells us about
his unique experience at the Birmingham NEC Arena back
in November...

part of the oprogroup
7320_09_3

Having met the majority of the team at one time
or another, I can say I don’t
think there can be a more
friendly, genuine, professional and thorough team
in UK dentistry today (except my team)! They know
the industry, they care about
their clients, but they have an
approachability and a complete lack of ego that is so
refreshing to see. They share
the same values as I do, with
regard to the care of patient
and customers, and they nev-

prejudices and points of view are
overturned or our judgments challenged, we generally do not like
this, and so what we do is when
the listener starts talking in response, we become defensive and
start planning a counter-attack –
and of course this means we are
no longer listening.

‘Subject-centred’ listening
Sometimes we concentrate
on the problem and not on
the person with the problem.
Detail and fact about an inci-dent
become more important than
what people are saying about
themselves.

‘Fact’ listening
‘Often when we listen to another person speaking, we try to
remember the facts and repeat
them to ourselves over and over
again to drive them home. As
we do this, the speaker has gone
onto new facts, which we lose

er fail to make me feel like I am
their most valued and important
client.
Being on the stand was so
different to visiting the show. I
couldn’t believe how busy I was in
the first couple of hours, and even
forgot about taking some time
for lunch until I was reminded!
Throughout the day there were
people who chatted to me about
problems that they thought were
unique to them, but who suddenly
realised when talking to me that
I had been through the same kind
of situation, and that there was
a way that Practice Plan could
help.
People were interested to know
what was behind my decision to
convert to private practice and
I explained that I had watched
the developments of the new contract unfold and observed how
it would potentially result in me
losing control of my practice and
prevent me from caring for my
patients to the highest standards,
so the verdict on converting was
pretty straightforward.
I was thorough in my research
when looking at the range of dental plan providers. I realised I
needed some form of mechanism
to allow my patients to budget for
their treatment, but felt that those
patients that had more complex
treatments would have to pay
more than others for their maintenance. Practice Plan stepped in
and provided me with a plan that
could cater for my range of patients and the product they offered
me was competitive, comprehensive and good value for money.
The continuous support I re-

because we are stuck with the
previous one.

‘Pencil’ listening
Trying to put down on
paper everything said by a speaker usually means that we leave
out some of it, because the person
speaks quicker than we are able
to write. We also lose eye contact.

‘Hubbub’ listening
When there are any distractions clamoring for our attention (TV, radio, music, someone
else’s conversation), noise, movement etc., the hubbub distracts
from what we should be giving
total attention to.
So now you are able to
identify exactly what kind of
listener (or perhaps more to
the point, non-listener) you are,
you can go away and practice
listening better and maybe even
talking less. DT

ceive from Practice Plan is fantastic, and I regularly use all of
the support tools that they have
to offer. The Marketing Team has
helped us with the design and
print of our welcome packs, referral packs, newsletters, customised
stationery, and all our business
and referral cards. A one-stop
shop with someone who ‘gets’
what our practice is all about is
invaluable.
And, it was these experiences
I tried to share with the attendees
of the BDTA, because I’ve been
there and done it and know from
experience what benefits working
with Practice Plan can provide.
There was a huge amount
of fun on our stand too, especially with the Cocktail bar,
which is one of the great
things
about
the
ethos
of Practice Plan - you can
be
totally
committed
to
the
customer
and
totally
professional, but still have a
good time.
I would certainly be more than
happy to offer my time again if I
were asked!
Thackeray Dental Care
Once nearly a 100 per cent NHS
practice, Thackeray Dental Care
in Nottinghamshire now runs
an successful private practice
with a reputation for delivering innovative and high-quality
dentistry, especially the more
complex type of work. The
team, made up of three dentists, six nurses and a therapist
pride themselves in providing
the very best dental care, whilst
in a warm and welcoming
atmosphere. DT

[23] => dtuk1031_page1-4.indd

Galileos 390x90 ad

20/11/09

11:17

Page 1

United Kingdom Edition January 25-31, 2010
IMAGING SYSTEMS | TREATMENT CENTRES |
HANDPIECES | HYGIENE SYSTEMS | CAD/CAM SYSTEMS

Hitting a high note
Here, Dr Solanki outlines how to make sure that your
potential customers know you’re out there

he practice is looking fresh,
the most up-to-date, modern equipment has been installed and the crack team that you
have recruited to help you in your
quest is champing at the bit. It’s
now time to announce your arrival
and get a steady stream of patients
through the door.
If you are looking to spread the
word about your services and your
work, how can you ensure you’re
not throwing money down the
drain? Is there such a thing as a reliable marketing plan?
Define your services
The most efficient way of spreading the word about what you do is
to firstly define what services you
are going to push and the audience
that will require them now or in the
future. Capturing an audience or
a demographic of people that find
your services engaging and potentially a beneficial option that they
would like to explore is how to turn
marketing into money.
As discussed in parts one and
two of this series, there are many
factors that contribute to a successful marketing plan. If patients are
going to invest considerable sums
of money in your services, make
sure that your practice image conveys excellence. This is both the
aesthetic appearance of your practice and also the image of your literature.
Maintain professionalism
A few pounds spent on good-quality
business cards, appointment cards
and letterheads can make all the
difference when you are dealing
with potential clients. If you are
wishing to attract patients who desire life-changing work, then your
practice literature, treatments plans
and welcome pack will need to reflect this.
What logo or image represents
your work? The point of having a
recognisable logo/brand is so that
when patients view your practice
image they will associate it with
you and the care that you provide.
You may already have a logo that
you are happy with. If not, investing
in a recognisable image or brand
will more than pay you back in the
medium and long term. Ask around
and find out from your patients
what images they would associate
with your practice and also take
advice from a creative agency. Designing your literature (in line with
a corporate image or logo) will require you to employ a professional
design agency. This may not be as
expensive as you think.
Creating your literature
There are a few things to remember when you’re deciding on your

brand literature. Here are a few tips:
Keep it simple. This is the golden rule with your ALL your literature either digitally or on paper. Remember a good logo/image should
be eye catching not cluttered with
lots of information. If you are advertising will it stand out on the page
if placed next to your competitor?
Does your digital literature and online information pages (including
your website) clearly display your
telephone number?

ble directory service is a great way
to encourage online traffic to your
site, and customers to your practice.
Nothing is free
Remember just as you are unique,
marketing also comes in all forms,
shapes and sizes. You could call
in help from a professional PR
and marketing company to help
you spread the word. Remember a
few key things when spending
money on any marketing ploy or
with a company.

Get the TOTAL cost from the
creative agency. You don’t want to
pay for amendments if you’re not
happy with the ideas the agency
has designed or the time they spent
designing an image you are not
happy with. Arrange a time to meet
with the agency and invite them to
come to your practice. The more
they understand you and your services, the easier it will be for them to
translate your unique selling points
(USPs).

1. What is the heritage? Is the company/website etc established?
2. Who do they work for or who
uses their services? Have the big
guns employed them or advertised
with them and if so have they given
any testimonials as to their services? What do your colleagues say?
(Although word of mouth is somewhat slow, it is an excellent marketing tool!)
3. If it sounds too good to be true, it
probably is! If it’s free ask why?

Shop around. A great logo
doesn’t mean a great expense. Many
up-and-coming designers will have
an excellent eye for design and will
be keen to get work. Tell the designers as clearly as you can your ideas
and if you don’t have any, write
down your USPs so they can create
images for you. Have you seen an
image recently that you quite like?
The more information you give to
the agency, the better chance you
have of successful representation.

 What do they need from you?
 What information do they require?
 If the service is performance
based, what are the clear success
indicators?

Making an effort
Consider this, would you spend
thousands of pounds with someone who has guaranteed a beautiful aesthetic finish when their brochure is a printed Microsoft Word
document?
In terms of content, your brochure should cover the practice
philosophy and details of services
available, opening times, maps and
contact details etc. Providing patient
testimonials and pictures of work
that has been previously carried
out is also a nice touch that instils
confidence in potential patients.
As important as the appearance
of your paper literature, your website should be smart, crisp and easy
to navigate. More and more people
use the web to buy and search for
services online and it is now more
important than ever to have an online presence. In creating a practice
website you should clearly display:
Your services
 Contact details
 A strong image of your practice
 Email contact form
If you are looking for new patients then enrolling on a reputa-

As the old adage goes nothing is
for free. Investigate the small print
and look into what you are being
offered. You end up paying excessive amounts in the long run.

Welcome to the 3rd dimension
with GALILEOS

A total 3D
imaging solution
with endless
possibilities
Sirona’s 3D cone beam tomography
sets new standards
• One short, single scan with low radiation dosage
• 3 way fast collimation
• Superior diagnostics with intuitive software
• Workflow integration of planning systems and
surgical guides for implantology
GALILEOS brings a new dimension in security and
quality of diagnosis
Enjoy every day. With Sirona.
Sirona Dental Systems Ltd., 7 Devonhurst Place,
Heathfield Terrace, Chiswick, London W4 4JD
Telephone: 0845 0715040
e-mail: info@sironadental.co.uk
www.sironadental.co.uk

Remember marketing takes
time and setting yourself realistic goals from your campaign is a
great way to measure your marketing activity. Have you received
any exposure? Are the companies
you have employed helping to extend this exposure by investigating
opportunities for you or just spending money on advertising for you?
Is there more online activity on
your website?
A marketing plan will take some
time to build up steam, but with the
right plan in place, you will benefit from a raised profile and an increased profit margin.
To find out more about anything
within this article visit www.cosmeticdentistryguide.co.uk. DT

About the author
Dr Solanki studied medicine at the University of Oxford followed by a PhD. Having
come from a business-orientated family he
followed his passion of starting up a dental
marketing company with its strengths in
online search marketing in early 2007. Since
then, he has undertaken extensive search
engine optimisation (SEO) training from
some of the world’s leading experts in this
field and continues to do so. He offers advice
on SEO, business consultancy and strategic
marketing campaigns for his clients. He is
also the founder of www.cosmeticdentistryguide.co.uk. Dr Solanki now offers dedicated
marketing strategies for practices on a referral only basis.

The Dental Company

[24] => dtuk1031_page1-4.indd

24 Education

United Kingdom Edition

Breaking through the barriers
During a check-up, is it acceptable to comment on how to make their
teeth look better cosmetically, or wait to be asked? Jacob Krikor explores
likely don’t mind the discoloured
filling on their incisor. But how
many times have I found myself
mistaken? patients have asked often me what I could do to improve
their smiles, at which point I feel
triumphant when I start talking
through the options.

Fig 2. Before 2

Fig 1. Before 1

Fig 3. After 1

Fig 4. After 2

hether as a dentist, it’s
your job to recommend
cosmetic
enhancements while carrying out an annual check up is a difficult question, and one I ask myself a few
times each week. As patients sit
in the chair and open wide waiting for me to investigate caries and
perio problems, I find it difficult to
forget about the discoloured crack
I find in the middle of the upper
central incisors or the retroclined

incisors that are making the laterals stick out more than they deserve. Or in the case of the young
lady who spends hours on her
make-up ignoring the fact that her
teeth and her smile, in fact all her
face, could look much more attractive with brighter teeth.
Of course I still have my preconceptions: this patient would
most likely not bother about the
front teeth, are not interested in
having brighter teeth and most

Asking the question
I have recently started asking patients that I have been seeing for
many years that very question
which I did not have the courage
to ask before. Many patients follow make-over programmes on
TV and think that the dentistry offered there is probably too expensive or too Harley Street or only
done by celebrity dentists.
So, unless you show your
patients what you can offer and
what your team is capable of
achieving, they will always have
that misconception.
I am not advocating going
crazy and looking at every patient as a make-over case. I am
simply explaining how I found

myself developing into a more
confident dentist trying not only
to correct the function, but also
the aesthetics.
The worst thing that can happen now is when the patient
says: ‘Ah, I’ve had it for so long
that I’m not bothered anymore’.
That’s it. You can then go on digging in the molars and inspect
the palate and shuffle the tongue
from right to left.
A happy patient
I have a lady who is an existing patient of mine that I have been seeing for few years now. I’ve made
her a bridge from the UL1 to UL3
some years ago to match the right
side to replace an old bridge that
she wasn’t happy with, without
me seeing the bigger picture. Until a couple of months ago, and for
some reason, I asked whether she
wanted to have something done to
improve her smile. It didn’t take
long before she explained how
much she was aware of her teeth
and how often she hid them when
she smiled. . (See Figures 1 to 4.)

January 25-31, 2010

I decided then to take some
impressions for before-and-after
wax-up models. When we met
again and after showing her
the models and the improvement we could achieve, she knew
straight away that this was what
she wanted. Today she is a new
woman with a new found confidence smiling even wider to show
her teeth.
Before this case, I always
thought of the plastic surgeons
Sean McNamara and Christian
Troy in the glamorous American
series Nip/Tuck and the way they
start their conversation with their
patients: “So, what don’t you like
about yourself?” And I’ll be honest
with you, I did not like the sound
of it simply because I wasn’t one
of them. Today, I ask my patients
the same question and I like the
sound of it because I am a dentist
with the power to improve smiles
every day. DT

About the author
Jacob Krikor graduated from Dental
School (Odontologen) in Gothenburg,
Sweden in 1998. After working in general practice in Sweden for two years,
he moved to the UK and now has his
own practice in Bexhill on Sea. Jacob is
also the founder of two websites: www.
askyourdentist.com for patient information and www.odonti.com, created
to make life easier for dental professionals. To contact him, email drjacobkrikor@odonti.com.

FGDP(UK) Diploma in Restorative Dentistry
Recognised by primary care trusts and
regulatory organisations worldwide.
• Special interest modules including endodontics,
periodontics and implant-related prosthodontics
• Tutoring support at each contact learning unit
• Eligibility for an MSc with the University of Leeds
• Compatible with Dentists with Special
Interests (DwSI) competencies
• 120 FGDP(UK) Career Pathway credits available
Cost:

£13,495 FGDP(UK) members
£14,495 non-members

Duration:

Two-year part-time course

Structure:

15 full-day contact learning units

Application deadline:

5 February 2010

Start Date:

May 2010

Location:

The Royal College of Surgeons of England
& Guy’s Hospital, London

Delegates can qualify for up to 150 hours of verifiable CPD on completion

Email fgdp-education@rcseng.ac.uk or call 020 7869 6760 to find out more, quoting reference DR10DT1.
www.fgdp.org.uk

Promoting excellence in dentistry

Registered charity no. 212808

[25] => dtuk1031_page1-4.indd

Money Matters 25

United Kingdom Edition January 25-31, 2010

Retirement – can you rely on the NHS?

D

entists should reduce
their reliance on the
NHS pension to fund
their retirement. Massive government debt includes a public
sector pension liability of £650
bn. Both Gordon Brown and
David Cameron have vowed to
reduce the MPs’ pension scheme
so they can ‘look other public
employees in the eye’ when introducing pension reform.
We predict that dentists under
the age of 35 may well be most
heavily affected. Dentists under 35
may have adequate time to build a
back-up strategy but need to start
now to achieve this. Few commentators expect the NHS pension scheme to exist in the current
format by 2035. Sweeping changes
to the scheme in 2008, including
increased contributions and an
extended retirement age of 65 for
new joiners just won’t be enough
to withstand the political and economic pressure the NHS pension
scheme faces.

We advise all dentists to continue with NHS pension contributions where possible. However
a personal pension could offer an
additional and valuable source of
income especially for practitioners with some private fee income.
Personal pensions offer the prospect of significant tax breaks and
the advantage of a long-term investment horizon. Tax relief is still
available for most dentists this is
how it works for higher rate tax
payers:
TAX relief example
• You pay £500 per month
• The government adds £125 per
month
• Your total contribution becomes £625 per month
• You reclaim £125 per month
through self assessment
• A £625 contribution costs you
£375 net of tax
The elephant in the room –
Private fee income
Individual dentists may have
little power to prevent changes
to the NHS scheme benefits or
the political agenda. Our experience of helping practitioners
with their retirement planning
reveals that the greatest threat to
retirement income is often a failure to take account of increas-

ing private fee income and the
resulting loss of valuable NHS
Pension benefits. Here we look at
two practitioners and how their
career choice of fee income affects their financial future.
Case studies
The NHS dental practitioner:
Mr Brown retires at 60 with 37
years of NHS service. He has

enjoyed a long career treating
NHS patients. He can expect to
receive an index-linked pension
of £50,000 pa and a lump sum of
£150,000.
The Private dental practitioner:
Mr Cameron retires at 60 with 15
years NHS Service. At age 38 he
stopped treating patients on the
NHS and then enjoyed 22 years

of private fee income. His total
net profits remained the same as
Mr Brown yet he can expect to
receive an index-linked pension
of only £20,200 pa and a lump
sum of £60,800.
Our private practitioner receives a pension and lump sum
which is nearly 60% less than
the NHS practitioner.

How to take account of private fee income
A good independent financial
adviser (and one who understands the NHS Pension) should
recommend suitable strategies
to mitigate a reduced NHS pension. This may well involve
personal pension contributions
which still attract tax relief at
your highest rate. DT

More than just a
dental plan provider...
“Always supportive and never intrusive,
Practice Plan helps us in so many ways;
including developing our brand in a way
which truly reflects our individual style.”
Lisa Bainham, Practice Manager, The Old Surgery Dental Practice, Cheshire
Marketing your practice has never been more important. This is exactly why we
have a team of dedicated marketing advisors and designers who can help you build
a strong brand and develop the marketing activity that is right for your practice.
From constructing a website to creating a brand which encompasses
your practice ethos, image and goals, we’ll provide the level of support
that’s right for you. When it’s right for you.

About the author
Jon Drysdale BA
(Hons) Cert PFS is
a qualified independent financial
adviser and director of Practice Financial
Management Ltd (PFM).
PFM offers specialist and independent
financial advice for dentists in England
Scotland and Wales. For a review of
your NHS pension and retirement
planning contact Jon Drysdale at PFM
on 01904 670820 or contact Jon on jon.
drysdale@pfmdental.co.uk

01691 684135 www.practiceplan.co.uk
bespoke dental plans
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[26] => dtuk1031_page1-4.indd

26 Money Matters

United Kingdom Edition January 25-31, 2010

Behind the spin

tax

ASPD member Greg Penfold looks at what’s in store
this year in terms of the Government’s Budget plans
and how it could affect dentists and their practices

his year’s Budget supposedly sees belt-tightening
measures
across
the
board, including a public sector
pay cap and a rise in National
Insurance contributions, that is.
This seems at odds with Gordon
Brown’s existing pledge to boost
spending, and it has been speculated that Treasury officials had
wanted to announce even more
spending cuts in order to lend
credibility to their plan to halve
the £178 billion deficit within
four years.
Whatever happens, the PreBudget Report (PRB) contains
a number of detailed proposals
behind the spin. The following
article gives a brief overview
of what next year may have in
store, and how dentists can use
this information to plan for their
economic future.
Public sector pay and pensions
One of the biggest measures announced in the PBR is a cap of
one per cent on public sector
pay settlements in 2011/12 and
2012/13, and reforms to public
sector pensions from 2012/13.
This news will no doubt come
as a blow to dental professionals in the NHS, many of whom
will already feel disgruntled by
recent changes in the industry,
where morale is already at a low.
Personal tax
Practitioners should pay close attention to any increase in their
earnings over the next few years.
If they do rise, more and more
people will find themselves having to pay substantially higher
taxes as they fall into new, higher tax brackets.

Normally, tax-free allowances and the threshold for higher
rate tax are increased by inflation, but due to the dire economic situation these figures have
all been frozen at their 2009/10
levels. The PBR included the
long-term announcement that
the threshold for higher rate
tax will be frozen in 2012/13 at
the same levels as in 2011/12.
This means that if your annual
earnings reach the £37,400 to
£150,000 category that year, you
will be liable to pay 40 per cent
tax. If your earnings creep above
the £150,000 mark you will pay
50 per cent tax.

charge of the difference between
the higher rate relief they would
expect and the basic rate relief
that they would be entitled to in
2011.

Pension contributions
With regards to pensions contributions the rules are complex,
and anyone who has had a total
income approaching £150,000
in any of the last three years
should seek professional advice before paying a pension
contribution totaling more than
£20,000 in a year.

Value Added Tax
Rumours that the Chancellor
would increase the rate or the
scope of VAT went unfounded
after the release of the PBR, unless of course he plans to break
the news to us after the general
election. The standard rate goes
back up from 15 per cent to 17.5
per cent on 1st January 2010, but
there is no indication that it will
go up again after that, or be applied to any of the categories that
are currently VAT-free such as
food, children’s clothes, newspa-

As it stands, people who earn
in excess of £150,000 and make a
“special pension contribution” of
more than £20,000 may suffer a

Dental business is their business
An ASPD member has:
■ An unprecedented track record working
with the dental profession throughout the UK
■ A true and expert understanding of all current
issues within NHS and Private Dentistry
■ All members enjoy an enviable reputation as being
some of the best Providers within their specialist areas

Inheritance tax
Inheritance tax limit was set
to rise to £350,000 in 2010 but
the Chancellor made a U-turn
in the PBR, meaning that levels
will stay at £325,000 (effectively
£650,000 for a married couple
or civil partnership) in 2010/11.
As property prices are now back
on the rise, increasing numbers
of properties will fall in line with
the current allowance.

pers and new houses.
Other measures
Yet again, practitioners are reminded that they should stay on
the right side of HM Revenue and
Customs. If a taxpayer fails to file
a tax return on time, they may
be issued with an estimation by
HMRC. In the past, HMRC have
offered a relief called “equitable
liability” where if it was clear
their estimation was excessive,
they would not collect the tax.
The bad news is that recently
a number of concessions have
been withdrawn, including equitable liability. The good news
is however, the liability will now
be included in the law itself. To
qualify for this relief, a taxpayer
must be able to show that the
amount of tax demanded of them
is too large, and must bring his
or her tax affairs up to date by filing appropriate tax returns and
paying outstanding tax, interest
and penalties. However, prevention is better than cure, and it
still pays to fill out your tax return in a timely manner rather
than relying on this new rule as
a get-out clause.
In short, the Chancellor’s
Pre-Budget Report will not make
good reading for everyone, and
it is still unclear as to whether
the Prime Minister’s plans to increase spending are just a ploy to
hide the bitter taste of cut-backs
and debt for which we will all
have to foot the bill. DT

About the author
Greg Penfold is
an
accountant
with Humphrey
& Co, chartered
accountants,
business and tax
advisers. He specialises in acting
for dentists and
is a member of
the Association
of Specialist Providers to Dentists
(ASPD). To contact him, call 01323 730631 or email
gpenfold@humph.co.uk or visit www.
humph.co.uk. For more information
on the ASPD call 0800 458 6773 or visit
www.aspd.co.uk

[27] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Time for change?
Now’s a good time to make sure your practice and
its team are prepared should difficult times continue into 2010. Mhari Coxon offers some ideas

Their proven track records with
successful practices encourage
others to take the step to change.
They do come with a price tag
which some may balk at. But
they would not still be here if
their programmes, books and
advice did not succeed. A costeffective way of dipping a toe in
the water is to attend a one-day
seminar as a group.

went to visit Tate Modern
recently and walked into
Miroslaw Balka’s dark hole
piece. It is a large metal structure
lined with black velvet, making
it almost impossible to see once
you get inside. On walking towards it, I felt slight apprehension, a need to slow down and
watch my footing. Although I
couldn’t see in front of me I was
determined to reach the end.
When I did finally touch the wall
at the end, I turned and saw that
it was not so dark looking out. It
was interesting to watch the caution of those walking in from my
vantage position.

been scraping by this year may
fall when the recovery is not as
quick as they had hoped.

I am trying to use the impression this piece of art has left on
me, to see a way out of this dark
year. If the media and those in
the know (who are they by the
way?) are to be believed then

And so, we as a practice are
looking at ways to keep our turnover increasing in the coming
months. As part of our plan we
have already utilised Kimberley
as our oral health adviser, im-

‘The positive is that this is the perfect time
to build a plan for each staff member, listing some targets they would like to achieve
– team targets can be a good way to get us
all working together .’
the worst of the downturn in the
market is over and the recession
has bottomed out. Although history tells us it might take a good
few years more for this country
to get back on track.
2009 in dentistry
Over 15 per cent of the UK public
have cancelled a dental appointment due to cost, says a new
study by Saga Health Cash Plan.
Routine healthcare is becoming
a victim of the current economic
climate, with over a quarter (27
per cent) of Brits cancelling feebased appointments.
If you and your practices have
been fortunate, this year may
have seen a slowdown on cosmetic cases, but otherwise things
have remained stable.
I am grateful that, five years
in, my practice has a large list of
patients who appreciate the need
for maintenance as part of their
oral hygiene routine. This has
been subsidised by a flow, but
not a flood, of new patients.
Time to plan
Now that we are turning back to
look at the light, I can’t help feeling we still have a tough year or
two ahead. I think we can see the
change, but it does not mean that
2010 will see the rapid recovery
we all desire. Many who have

pression taker and tray maker.
The latter makes bleaching an
affordable boost to our patient’s
smiles. We have resourced a lot
of our consumables and have
checked costs more regularly
instead of settling with one supplier. Labs are interested in negotiating as work slows.
Developing the team
The positive is that this is the
perfect time to build a plan for
each staff member, listing some
targets they would like to achieve
– team targets can be a good way
to get us all working together.
HTM01-05 brings the need for
change in most practices as
well as relative costs. High selfefficacy needs to be developed
and motivation needs to be encouraged. It is not always possible to see the best solution
from inside. Sometimes we need
to look to others to provide the
boost to change.
Speculate to accumulate
Although all the things I have
mentioned are ways of improving the practice without cost,
the reality is you get what you
pay for. Sometimes an injection
of new ideas and being open to
someone else’s experience is all
you need to get the growth of the
practice back on track. In recent
years, the number of dentalrelated advisors has increased.

Infection control compliance
Now could be the time to build
the business plan and make a
time line for the practice to comply. Many companies have highly educated colleagues working with them to support the
change in practice. Carmel Maher, working with Optident is a
perfect example, having worked
closely with Mike Martin and
Martin Fulford.
Cementing your team
Team building can help to unite
everyone in difficult times and
can become a practice builder in
its own right as most patients enjoy a friendly, supportive atmosphere that is based on respect.
The more we can work as a
close team, the more flawless
and smooth the patient experience becomes. Team building
doesn’t have to be expensive;
taking time each day to meet and
listen to each other is not a waste
of time or money and is a simple
way of building the respect.
For those who fancy challenging themselves and their
team, try somewhere like teambuildevents.co.uk which has lots
of options you can choose from
to help reduce your weaknesses
as a team.
Make the change
Whatever changes you decide to
implement in practice, remember that the team is working hard
to keep things going in this difficult time and should be recognised for this. It is too easy to find
fault when things are not how
we would like them to be. Lead
by example. DT

About the author
Mhari Coxon is
a dental hygienist
practising in Central London. She
is chairman of the
London
British
Society of Dental Hygiene and
Therapy (BSDHT)
regional
group
and is on the publications committee
of its journal, Dental Health. She is also
clinical director of CPDforDCP, which
provides CPD courses for all DCPs. To
contact her, email mhari.coxon@cpdfordcp.co.uk.

DCPs 27

[28] => dtuk1031_page1-4.indd

[29] => dtuk1031_page1-4.indd

Clinical 29

United Kingdom Edition January 25-31, 2010

‘Class II Challenge’
Robert Lowe discusses various clinical solutions to common problems dental
professionals face when placing class II direct composites

irect composite restorations that involve posterior proximal surfaces
are still a common finding in
many dental patients. Unlike
dental amalgam, which can be
a very forgiving material technically and can be condensed
against a matrix band to create a
proximal contact, proper placement of composite restorative
materials present a unique set of
challenges for the operative dentist. The adhesion process itself
is well understood by most clinicians as far as isolation and execution, however, there are some
steps in the placement process
that cause difficulty and ultimately lead to a less than desirable end result. In this article we
will look at three specific areas,
1) Management of the soft tissue in the interproximal region,
2) Creation of proximal contour
and contact and 3) Finishing and
polishing of the restoration.
Management of the Interproximal Gingival Tissue
The most common area for the
adhesion process to fail is the
proximal gingival margin. Compounding this problem is the
inability to gain access to the
area to affect a repair without
removal of the entire restoration.
As stated by Dr. Ron Jackson,
bonded restorations are unique
in that minor defects (decay or
microleakage) at the marginal
interface can often be “renewed”,
or repaired by removal of the
affected tooth structure and repair with additional composite
restorative material. Because of
the bond of the restorative material to enamel and dentin, the recurrence is usually self limiting.
This is not true with metallic restorations that are not bonded to
tooth structure. However, if the
defective area is at the proximal
gingival margin or line angle,
access is not possible. Therefore
precise marginal adaptation of
the direct composite restorative
material and the seal of this margin in the absence of moisture or
sulcular fluid contamination is
of paramount importance! However, whether due to the subgingival level of decay and/or gingival inflammation, it can be hard
to seal the gingival margin with
a matrix in the presence of blood.
Proximal Contact and Contour
Another challenge for the dentist has always been to recreate
contact to the adjacent tooth and
at the same time, restore proper
interproximal anatomic form
given the limitations of conventional matrix systems. The thickness of the matrix band and the

ability to compress the periodontal ligaments of the tooth being
restored and the one adjacent to
it can sometimes make the restoration of proximal tooth contact
arduous at best. Anatomically,
the posterior proximal surface
is convex occlusally and concave
gingivally. The proximal contact
is elliptical in the buccolingual
direction and located approximately one millimeter apical
to the height of the marginal
ridge. As the surface of the tooth
progresses gingivally from the
contact point toward the cementoenamel junction, a concavity
exists that houses the interdental
papilla. Conventional matrix systems are made of thin, flat metallic strips that are placed circumferentially around the tooth to be
restored and affixed with some
sort of retaining device. While
contact with the adjacent tooth
can be made with a circumferential matrix band, it is practically impossible to recreate the
natural convex/concave anatomy of the posterior proximal
surface because of the inherent
limitations of these systems. Attempts to “shape” or “burnish”
matrix bands with elliptical instrumentation may help create
nonanatomic contact, but only

“distorts”, or “indents” the band
and does not recreate complete
natural interproximal contours.
Without the support of tooth contour, the interdental papilla may
not completely fill the gingival
embrasure leading to potential
food traps and areas for excess
plaque accumulation. Direct
Class II composite restorations
can present even more of a challenge to place for the dentist because of the inability of resin materials to be compressed against
a matrix to the same degree as
amalgam making it difficult to
create a proximal contact.
Finishing and Polishing Composite Restorations
Direct composite material does
not carve like amalgam, although many clinicians wish
that it did! Unfortunately this
means that most posterior composites are carved with a bur.
This is not part of the finishing
and polishing of the restoration.
It must be remembered that cuspal forms are convex and cannot
be carved with a convex rotary
instrument that imparts a concave surface to the restorative
material. Composite should be
incrementally placed and sculpted to proper occlusal form prior

to light curing. The finishing and
polishing process is done to accomplish precise marginal adaptation and make minor occlusal
adjustments. Rubber abrasives
further refine the surface of the
composite, and surface sealants
are used to gain additional marginal seal beyond the limitations
of our instrumentation.
Case Report:
The patient shown in Figure
1 presented with radiographic
decay on the mesial proximal
surface of tooth number 3. The
operative area is isolated using
an OptiDam (Kerr Hawe). The
decay is minimal, so the operative plan is to keep the preparation very conservative.
After removal of the decay,
and completion of the proximal
and occlusal cavity form, the
operative area is isolated with a
rubber dam in preparation for
the restorative process. Figure 2
clearly shows that the proximal
gingival tissue was abraded during cavity preparation and there
is evidence of hemorrhage. It is
not advisable to try and “wash”
the hemorrhage away with water and quickly apply the matrix

band. Even if this is successful, it
is likely that blood will infiltrate
into the preparation in the gingival area and make etching and
placement of the dentin bonding
adhesive without contamination
impossible. An excellent way
to manage the proximal tissue
hemorrhage quickly and completely to apply Expa-syl (Kerr
Corporation) to the area, tap it
to place with a dry cotton pellet,
and wait one-two minutes (Figure 3). Using air-water mixture,
rinse away the Expa-syl leaving
a little bit of the material on top
of the tissue, but below the gingival margin of the preparation
(Figure 4). The Expa-syl will
deflect the tissue away from the
preparation margin, maintain
control of any hemorrhage, and
facilitate placement of the proximal matrix without the risk of
contamination of the operative
field. Class II preparations that
need a matrix band for restoration will require rebuilding of
the marginal ridge, proximal
contact, and often a large portion
of the interproximal surface. The
goal of composite placement is
to do so in such a way that the
amount of rotary instrumentation for contouring and finishing is limited. This is especially

Fig1

Fig2

Figure 1:
This occlusal preoperative view shows a maxillary molar that has radiographic decay on
the mesio-proximal surface.

Figures 2–4:
2) After the cavity preparation is completed, bleeding is seen in the proximal area. 3)
Expa-syl (Kerr Corporation) is placed into the proximal area with the delivery syringe
then tapped to place using a dry cotton pellet. 4) After rinsing away the majority of the
Expa-syl, (note that a small amount of Expa-syl remains sub marginal for additional hemorrhage control) the proximal tissue is deflected away and bleeding is absent allowing
for easy placement of the sectional matrix band.

Fig3

Fig4

[30] => dtuk1031_page1-4.indd

30 Clinical

United Kingdom Edition

Fig6

Fig5

unique blade configuration does
the work of two burs with one.
An excellent surface quality on
composite and natural tooth is
achieved due to the cross cut design of the cutting instrument.

Fig7

Fig6a

Figures 5–7:
5) A sectional matrix band gripped by Composi-Tight® Matrix Forceps, an instrument that enables precise placement of sectional matrix bands
without deformation. 6) The WedgeWand® during clinical application with the wedge bent at a 90˚ angle to the handle. 6a) WedgeWands
provide an excellent seal. 7) The Soft Face™ 3D-Ring in place. Note the precision of the cavosurface and marginal seal by the sectional matrix.
true for the interproximal surface. Because of the constraints
of clinical access to the proximal
area, it is extremely difficult to
sculpt and correctly contour this
surface of the restoration. Proper
reconstitution of this surface is
largely due to the shape of the
matrix band and the accuracy of
its placement. After removal of
caries and old restorative material, the outline form of the cavity preparation is assessed. If any
portion of the proximal contact
remains, it does not necessarily
need to be removed. Conserve as
much healthy, unaffected tooth
structure as possible. If the matrix band cannot be easily positioned through the remaining
contact, the contact can be lightened using a Fine Diamond Strip
(DS25F - Komet USA).
The Composi-Tight 3D™ Matrix System has been chosen to
aid in the anatomic restoration of
the mesial proximal tooth morphology of this maxillary first
molar. The appropriate matrix
band is chosen which will best
correspond anatomically to the
tooth being restored and also, to
the width and height of the proximal surface.
The height of the sectional
matrix should be no higher than
the adjacent marginal ridge
when properly placed. Because
of the concave anatomic shape,
the proximal contact will be located approximately one millimeter apical to the height of the
marginal ridge. The ComposiTight® Matrix Forceps is used
to place the selected sectional
matrix band in the correct orien-

tation in the proximal area. The
positive grip of this instrument
will allow for more exact placement than a cotton plier, which
could damage, or crimp the matrix band. The sectional matrix
band (Garrison Dental Solutions) is positioned and placed
using the Composi-Tight Matrix
Forceps to the mesial proximal
area of tooth number 14 (Figure
5). The orientation of the band
and the positive fit in the makes
precise placement possible, even
in posterior areas with tight access. Next, the gingival portion of
the band is stabilized and sealed
against the cavosurface margin
of the preparation using the appropriate size.
WedgeWand®
flexible
wedge (Figure 6). The size of
the WedgeWand flexible wedge
should be wide enough to hold
the gingival portion of the matrix
band sealed against the cavosurface of the preparation, while the
opposite side of the wedge sits
firmly against the adjacent tooth
surface. To place the wedge, the
Wedge Wand is bent to 90 degrees
where the wedge meets the handle. The flexible wedge can now
be placed with pressure conveniently, without the use of cotton
forceps, that often times can be
very clumsy. Once the wedge is
in the correct orientation, a twist
of the wand releases the wedge.
The G-Ring® forceps is then
used to place the Soft Face™ 3DRing into position. The feet of the
Soft Face 3D-Ring are placed on
either side of the flexible wedge
and the ring is released from the
forceps. The force of the 3DRing
causes a slight separation of the

teeth due to periodontal ligament
compression and the unique
pads of the Soft Face 3D ring hug
the proximal morphology of the
buccal and lingual surfaces of
the adjacent teeth while at the
same time creating a unbelievably precise adaptation of the
sectional matrix to the tooth cavosurface margins! (Figure 7).
Once the sectional matrix is
properly wedged and the Soft
Face 3D-Ring is in place, the restorative process can be started.
A 15-second total etch technique,
10 seconds on enamel margins
and five seconds on dentin surfaces is performed using a 37
per cent phosphoric etch. The
etchant is then rinsed off for a
minimum of 15 to 20 seconds to
ensure complete removal. The
preparation is then air-dried and
rewet with AcQuaSeal desensitiser (AcQuaMed Technologies)
to disinfect the cavity surface,
create a moist surface for bonding, and begin initial penetration
of HEMA into the dentinal tubules. A fifth generation bonding
agent (Optibond Solo Plus: Kerr
Corporation) is then placed on
all cavity surfaces. The solvent is
evaporated by spraying a gentle
stream of air across the surface
of the preparation. The adhesive
is then light cured for 20 seconds. The first layer of composite
is placed using a flowable composite
(Revolution 2: Kerr Corporation) to a thickness of about .5
millimetres. The flowable composite will “flow” into all the irregular areas of the preparation
and create an oxygeninhibited

January 25-31, 2010

layer to bond subsequent layers
of microhybrid material. After
light curing for 20 seconds, the
next step is to layer in the microhybrid material. First, using a
unidose delivery, the first increment of microhybrid composite
(Premise: Kerr Corporation) is
placed into the proximal box of
the preparation. A smooth ended
condensing instrument is used to
adapt the restorative material to
the inside of the sectional matrix
and preparation. This first increment should be no more than
two millimetres thick. After light
curing the first increment, the
next increment should extend
to the apical portion of the interproximal contact and extend
across the pulpal floor. Facial and
lingual increments are placed
and sculpted using a Goldstein
Flexithin Mini 4 (Hu Friedy). A
#2 Keystone brush (Patterson
Dental) is lightly dipped in resin
and used to feather the material
toward the margins and smooth
the surface of the composite. Figure 8 shows the restoration after
completion of the enamel layer
prior to matrix band removal.
The Composi-Tight Matrix Forceps is used to remove the sectional matrix after removal of the
flexible wedge and Soft Face
3D-Ring.
The
ComposiTight™ 3D-Ring reduces flash
to a minimum. Finishing and
polishing will be accomplished
using Q-Finisher Carbide Finishing Burs (Komet USA). Typically,
three grits and correspondingly,
three different burs are used
to finish composite materials.
With the Q-Finisher system, the
blueyellow-striped bur with its

The small, pointed (H134Q 014) Q Finisher is used to make
minor occlusal adjustments on
the restorative surface as needed
and to smooth and refine the
marginal areas of the restorative material where accessible
(Figure 9). The fine, white stripe
(H134UF - 014) ultra fine finishing bur is used in the adjusted
areas for precise fine finishing
(Figure 10). Komet Diamond
Composite
polishing
points
(Green – Polishing and Gray –
High Shine) are then used to
polish and refine the restorative
surface (Figure 11). Once polishing is complete, the final step is to
place a surface sealant (Seal and
Shine:Pulpdent Corporation) to
seal and protect any microscopic
imperfections at the restorative
marginal interface that may be
left as a result of our inability to
access these areas on the micron
level. Remember, an explorer
can “feel” a 30-micron marginal
gap at best. Bacteria are 1 micron
in diameter. The purpose of the
Seal and Shine is to fill these areas. Figure 12 shows an occlusal
view of the completed Class II
composite restoration. Conclusion A technique has been described
1) to control proximal tissue
bleeding prior to matrix placement with Expa-syl (Kerr Corporation), 2) utilise a sectional matrix system (Composi-Tight 3D™,
WedgeWand®: Garrison Dental
Solutions) and a nanofilled microhybrid composite (Premise:
Kerr Corporation) to create an
anatomically precise proximal
surface, and 3) Use the Q Finisher, two bur composite finishing system (Komet USA) to finish
then polish with diamond composite abrasives (Komet USA)
refining marginal integrity without destroying occlusal anatomic
form. The interproximal surface
has been recreated with natural
anatomic contour and has a predictable, elliptical contact with
the adjacent tooth. With proper
occlusal and proximal form, this
“invisible” direct composite restoration will service the patient
for many years to come. DT

About the author
A. Lowe, D.D.S.,
F.A.G.D.,
F.I.C.D.,
F.A.D.I.,
F.A.C.D.
Dr. Robert A. Lowe,
DDS, FAGD, FICD,
FADI, FACD, maintains a private practice in Charlotte,
N.C. A Diplomate
of the American
Board of Aesthetic
Dentistry, Dr. Lowe
lectures internationally and is chairman of the Advanstar Dental Media’s
continuing education advisory board.
He can be reached at 704-364-4711 or
at boblowedds@aol.com

[31] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Special Feature 31

Open to options
Sandy Brown discusses the steps private practices can take to ensure their bank balance benefits in these troubling financial times

A

lthough there does seem
to be light at the end of
the tunnel in the current
economic climate, it is still certainly proving to be an unstable
entity. As a result, many businesses, including dental practices are anxious about changing
their providers, services or moving away from their established
working methods.
It would be unrealistic to
assume that dental practices
are immune to the effects of the
recession and, in fact, many are
still noticing changes in how
their patients spend their money. However, it is possible for
all dental practices to not only
survive in the recession - but
thrive. The following tips look at
the support and guidance available for private practices to ensure financial security in these
difficult times.
Support for patients
Providing your patients with a
range of options to pay for their
treatment will not only ensure
their loyalty but will also provide
you with a guaranteed regular
income. It can also help you differentiate your practice from the
competition, attract new patients
and increase your chances of
success. In fact, a recent report
in the New York Times stated that
consumers are more inclined to
take a preventive approach to
their health during a recession,
believing that taking better care
of themselves will avoid paying
out for costly treatments.
A recent national consumer
survey by Denplan monitored
delaying behaviours among
dental patients, both private and
NHS, to understand those most
likely to delay or cancel appointments. It found that the proportion of people who say they attend the dentist every six months
has declined from 59 per cent to
43 per cent over the past year.
Overall, 69 per cent of people
regularly attend, compared with
77 per cent in 2008 – the lowest
figures since 2001. Private payment-plan patients are still least
likely to delay a check-up and
are also least likely to cancel a
scale and polish.
Patient loans
Clearly people are still spend-

‘It is possible for all
dental practices to
not only survive in
the recession - but
thrive.’

ing money on high value dental treatments such as cosmetic
whitening and orthodontic treatments, despite the financial climate, but instead of raiding their
savings, they are using interest-

free loans. In fact, interest-free
loans can also benefit the dentists, as it provides them with
the confidence to recommend
modern, higher value treatments
and some dentists have even at-

tributed patient growth to their
ability to offer interest-free loans.
Development for you and
your team
Support isn’t just for your pa-

tients. Developing yourself and
your practice to differentiate
it from the competiton should
be a key consideration when
purse-strings everywhere are
being tightened.
Some payment plan providers
offer a range of training events
for the whole practice team. This
type of development is not only
encouraging and motivating for
staff, making them feel valued,
à DT page 32

[32] => dtuk1031_page1-4.indd

32 special Feature
ß DT page 31

but it can also improve the efficiency of the practice and your
patients’ experiences. Topics
are many and varied and can
give your team the confidence
to turn new patient enquiries
into firm appointments. Many
training courses can also count
towards verifiable Continuing
Professional Development (CPD)
when undertaken in accordance
with GDC requirements and is
an ideal way for staff in similar

roles to meet and learn together,
benefiting both your employees
and your practice.
Make your marketing work
harder
Retaining existing patients is
much more cost effective than
recruiting new ones, so it’s vital
to keep existing patients satisfied.
In fact, a single lost patient over
the lifetime of the practice can
amount to as much as £3,600.
Therefore, assessing your return
on investment during the cur-

United Kingdom Edition

‘Retaining existing patients is much more
cost effective than recruiting new ones, so
it’s vital to keep existing patients satisfied.’
rent climate is crucial, and making sure you are getting results
from your marketing activity is
part of this too. Some payment
plan providers can not only offer you support and guidance on
marketing strategies and press
activity, but they can also help

you produce literature, practice
newsletters and news stories to
release to your local press.
Profiling your patient database (age, income level, attitudes
etc) can also provide a clearer
picture and greater understand-

Have you
had enough of...
Yes?

Get Reassurance

In one evening, you can get
answers to any questions
about moving to private practice.

Guest speaker, Raj Rattan, will
help you think strategically to
make your practice prosper.

One and a half hours of your
time could make a world of
difference to your future.

Whichever methods you
choose to employ to get you
through the recession, it is good
to know that there is support and
advice available to help you. It’s
even better to know that these
methods don’t have to affect your
bank balance and could help to
ensure that you keep your existing patients, attract new ones
and maintain financial security
in these difficult times. DT

It’s free to attend and provides 1.5 hours verifiable CPD.
Warrington, Park Royal

Tues 27 April

Guildford, Holiday Inn

Weds 10 March Northampton, Marriott

Thurs 29 April

Birmingham, St John’s Hotel

Tues 2 March

Tues 16 March

Bromley, Sundridge Park Manor

Weds 5 May

Swansea, Marriott

Tues 30 March

Newcastle, Marriott Metrocentre

Weds 12 May

Leeds, Thorpe Park Hotel

Weds 31 March

Darlington, Barcelo Redworth Hall

Weds 26 May

Falmouth, Royal Duchy Hotel

About the author
Sandy Brown
joined Denplan
in 1992 as a
Denplan Care
Consultant
for
Scotland,
Northern Ireland and the
North of England. Sandy’s
entire
career
at Denplan has
been sales and
customer-service focused. In
2001,
Sandy
became the director of Denplan Sales, and in 2006 he
was appointed director of marketing
and sales.

To join us call 0800 169 9934, or visit
www.denplan.co.uk/dentists and
click on Denplan Events.
CAM249 01-10

CAM249 Have you had enough Ad for Dental Tribune 01-10.indd 1

Be open to opportunities
By keeping up a consistent presence in your local media, you
can not only remind your existing patients of the valuable service you offer, but also encourage
potential patients to contact you.
The key to gaining positive press
coverage is to keep a constant
look-out for opportunities to
raise your profile.

Practice news is also of interest to your local publications,
especially if you have expanded
your offering in some way. The
appointment of a new dentist,
relocation of your practice, refurbishment of your premises
or an award or accreditation
will all remind local people you
are there, giving them a reason
to contact you, book an overdue
appointment or sign up as a new
patient. There are also providers who can guide you on how
to produce effective news stories
and offer advice on what topics
would gain the best coverage.

Are you a dentist with an NHS contract? Then take the
opportunity to talk to colleagues who understand what you’re
going through by coming to an evening with Denplan and guests.

Get Options

ing of your patients and their
needs, ensuring you are constantly addressing these needs
and giving direction to your
business and marketing plans.
Not only can it help identify similar types of people and where
they reside in proximity to your
practice, it can also provide an
indication of which services are
appropriate for current and potential patients.

Topics most likely to gain
coverage are usually about people. Before-and-after case studies and practice news that link
up with the national campaigns
such as Mouth Cancer Awareness Month are an effective way
to catch journalists’ attention.
Holding events such as open evenings or encouraging your practice team to become involved in
charity fundraising activities can
also be a good basis for a story.

• The limited treatment options you can offer your patients?
• Extracting teeth rather than choosing other treatments?
• Chasing targets and delivering UDA’s?
• The PCT’s involvement in your practice?

Get Answers

January 25-31, 2010

14/1/10 10:34:06

[33] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Ledermix: An Invaluable Endodontic
Medicament
When dealing with patients presenting
endodontic symptoms, the priority
is often relieving the pain being
experienced. A useful tool in any
surgery is Ledermix Dental Paste.
Simple to use, versatile and costeffective, Ledermix Dental Paste is an
ideal intracanal medicament. Its antiinflammatory and antibiotic elements
assist in providing pain relief effectively,
until definitive root canal therapy can be performed.
Ledermix is available in combination kits including the Dental Paste, the
Dental Cement and Hardeners for fast or slow setting. The Cement is excellent
as a pulp-capping agent and can be used as a temporary sublining for deep
cavities where no exposure has occurred.
Ledermix Dental Paste is also water-soluble, so it can be easily rinsed out of
the treatment site in preparation for further treatment.
Blackwell Supplies has also produced a free patient leaflet giving advice on oral
care, available for all practices.
For a copy of the Summary of Product Characteristics (SPC)
please call John Jesshop of Blackwell Supplies on 07971 128077
or email john.jesshop@blackwellsupplies.co.uk

Smartseal is highly commended
The smartseal team knows all
about innovation and the creation
of ideal working conditions. By
developing and launching a range
of products that prefer to work
in wet, irregular environments,
smartseal has revolutionised the
outcome of root canal treatment
for dentists and patients.
The smartseal team was delighted to receive a highly commended award for
demonstrating a high standard of stand design and layout, and a proactive
approach to exhibiting and selling products and services. Jerry Watson,
Chief Executive of smartseal, says: “The entire team had a hand in the design
of our stand so we are all absolutely delighted that our efforts have been
acknowledged so positively. Our aim was to provide the ideal environment for
dentists to try products from the smartseal range.”
The striking, water-themed stand included cylindrical bubble displays in the
trademark pink smartseal uses for its packaging, large screens displaying
product information and white podiums where smartseal representatives
could give demonstrations. The overall effect was eye-catching, futuristic and
welcoming, ideal for attracting visitors to the stand to find out about the full
range of smartseal’s innovative products.

Cerec meets Galileos
Sirona Dental Systems
are proud to announce
the arrival of their latest
news in Galileos CBCT
software. This exciting
development in CBCT
technology allows the
integration
between
Sirona’s CEREC CAD/CAM
software and Sirona’s
Galileos CBCT X-ray data.
Surgical and prosthetic
planning can now be
performed precisely and safely in a single visit. Until now CBCT was limited
to hard tissue images and lacked the ability to capture periodontal tissue
data. For the very first time in CBCT imaging, the periodontal tissues can now
be evaluated for location and thickness in 3D as it relates to the hard tissue thanks to CEREC surface data

DENTSPLY Innovation!
The X-Smart Dual Apex Locator
and Endo Motor
From the creators of Protaper,
the leading NiTi system in the UK,
DENTSPLY now introduces the
simple to use, ergonomic and lightweight motor handpiece, the X-Smart Dual
2-in-1 Apex Locator and Endo Motor.
The new X-Smart Dual is ideal for any practitioner looking to increase the
convenience and safety of their endodontic treatment. Featuring a large
LCD screen that displays the location of the file, the X-Smart Dual affords the
practitioner a clear view of the progression within the canal.
The Apex Locator delivers position feedback directly to the motor’s drive
electronics, so the intuitive torque control and auto-reverse functions can act
to minimise the risk of file breakage and over-preparation.
With an easy to use control panel allowing for nine customised program
settings, the X-Smart Dual 2-in-1 Endo motor and Apex Locator from DENTSPLY
offers simplicity, reliability and exceptional control every time.
For more information please contact your local representative, Freephone +44
0800 072 3313 Or visit www.dentsply.co.uk

Endodontics 33
The simple way to faster, more effective surgery
Ash® Rubber Dam from DENTSPLY
The advantages of the use of a rubber dam in
endodontic procedures are well known, and the
Ash® Rubber Dam from DENTSPLY can greatly
contribute to success in endodontic treatments.
When properly in place, an Ash® Rubber Dam helps practitioners maintain a
clean, dry work field. Complete moisture control helps improve visibility and
eliminates salivary contamination, thus protecting the preparation area from
re-infection.
Patient safety remains at the forefront for DENTSPLY. The use of an Ash® Rubber
Dam assists with this greatly, as it protects the patient against the accidental
inhalation of an instrument or material. A relaxed patient is likely to allow
better access to the mouth, meaning that procedures can be carried out
effectively and efficiently.
The Ash® Rubber Dam from DENTSPLY helps simplify endodontic procedures,
offering a more efficient service for both practitioners and patients.
For more information, or to book an appointment with your local DENTSPLY
Product Specialist, call 0800 072 3313 or visit www.dentsply.co.uk

Prima Classic Endo Diamonds

Quality Endodontic Distributors Limited

Prima Dental manufacture a range of 5 burs
specifically designed to make endodontic work easier.
For example the Endo Access Bur ( pattern 164) from
combines a round and taper shaped coarse diamond
which allows ready access into the pulp chamber and
preparation of the chamber walls in one operation.

New Gutta Percha Trimmer
The quick and easy way to cut the end off GP
Points
With over 20 years endodontic expertise, Quality
Endodontic Distributors Limited have recently
introduced a NEW Gutta Percha Trimmer which
cuts the end off gutta percha points at the touch
of a button, it is generating a lot of interest from
GDPs and Endodontic Specialists alike.

The safe ended tip diamond bur is used to remove
the pulp chamber roof without damaging the
chamber floor. The Specialist Long Taper Shape is
ideal for opening the pulp chamber to a funnel shape and access to the root
canal entries. The unique multi-layer diamond application process results in a
longer lasting diamond bur. The unique safe-end (non-cutting) tip prevents
perforation of both the pulp chamber floor and root canal walls.
Manufactured in the UK to exacting standards, Prima Dental group’s high
quality yet cost effective burs make your working life more pleasurable.
For further information please contact Prima Dental Group on (0044) 1452 307
171 or visit www.primadentalgroup.com

Cordless for optimum flexibility and convenience, it is extremely lightweight,
which helps minimise operator fatigue, and is extremely fast and easy to use.
Enabling clinicians to accurately and precisely cut the ends off any gutta percha
point, the kit comes complete with a handpiece, four interchangeable cutting
tips, a handpiece holder, two rechargeable batteries and a battery charger.
QED’s NEW Gutta Percha Trimmer is just one of the new endodontic
innovations detailed within their NEW Endodontic Catalogue and featured on
www.qedendo.co.uk, the online version.
For further information telephone Quality Endodontic Distributors Ltd on
01733 404999, email sales@qedendo.co.uk, fax 01733 361243 visit www.
qedendo.co.uk or contact your local QED Salesperson.

Support Chairs Highline
Bespoke Endodontic Storage Solutions
Highline bespoke healthcare storage solutions,
from Support Chairs, are the ultimate answer
in mobile storage systems. Their Endodontic
Trolleys incorporate a variety of features
designed to make Root Canal Therapy even
easier and more efficient.
Composed of modules, containing sets of 4
different drawer sizes, they can be combined
in one of nine models to create units of the
required height, width and mixture of drawer
sizes. Some models feature an open space for storing equipment etc or a glass
fronted lockable cupboard with a height adjustable shelf.
Stylish and efficient, Highline Endodontic Trolleys are constructed from
aluminium, steel and high quality plastics, which are resistant to most stains
including blood. Drawer fronts are available in either simulated aluminium or
navy metallic finish. Additional extra options include drawer locks and various
instrument trays and drawer dividers.
Highline offers a very economical alternative to traditional fixed cabinetry.

For further information please contact:
Sirona Dental Systems 0845 071 5040
Info@sironadental.co.uk

Excellent: Rebilda Post System
Dental Advisor - Complete Set from
VOCO gets best rating
The Dental Advisor, the renowned
United
States
institute,
has
distinguished Rebilda Post System,
the complete set for post-endodontic
treatment, with 5 out of 5 possible
points (+++++) and thus the “Editors’
Choice”, the best rating possible. American dentists tested Rebilda Post System
in over 200 applications and were amazed by this VOCO development for postendodontic treatment.
The system concept
Rebilda Post is a component of a complete, coordinated post build-up system
(Rebilda DC, Futurabond DC, Ceramic Bond and accessories). As with Rebilda
DC, the proven core build-up material, the new endodontic post consists of a
dimethacrylate matrix, so that a reliable bond is achieved under the buildup
of a stable mono-block. With Futurabond DC, a secure bond to the dentine is
also achieved in a simple, time-saving application. The post-endodontic work
is simplified with the new endo-brushes (VOCO Endo Tim) and endo-tips.
Manufacturer: VOCO GmbH, PO Box 767, 27457 Cuxhaven, Germany,
www.voco.com Sales Manager UK: Tim McCarthy, Mobile: 07500-769-613,
t.mccarthy@voco.com

For further information telephone Support Chairs on 01296 581764, fax 01296
586583, email sales@supportstool.co.uk or visit www.supportstool.co.uk.

Support Chairs
Ergonomically designed for optimum comfort!
Support Stools, from Support Chairs, are the
product of world class Swedish furniture design
by Bruno Mathsson. They have been developed
for professionals working in sedentary positions,
where both body support and the ability to move
freely are essential. The seat and back of the
Support Stool is designed to take the weight off the
incumbent’s back and provide maximum comfort.
Each seat is manufactured to order so that they meet all the incumbent’s needs
including specific requirements on colours and materials. Support Chairs also
offer a wide range of accessories so that the Stool can be customised to the
operator’s specific needs. These include foot rings, which can take the weight
off the legs when working in a high position; and Hydro Armrests, which allow
the arm to move freely in both the horizontal and vertical plane.
Support Stools are now also available with a new Swing and Swing Mini
Armrest.
For further information contact your regular Dental Dealer or Support Chairs
on 01296 581764, fax 01296 586583, email sales@supportstool.co.uk or visit
www.supportstool.co.uk.

Finally, a Simple Rotary System for Everyday Endodontics!
The R&S range of endodontic instruments are market leaders across Europe
and with Dental Sky as the exclusive UK distributors they are sure to be a
success in the UK.
The latest addition to the range is the new CMA nickel-titanium rotary file
system. The CMA System was designed to simplify endodontic treatments
by minimising the number of instruments necessary and providing one
uncomplicated sequence for both treatment and retreatment.
CMA stands for Coronal, Median and Apical and provides a simple sequence
with only 4 instruments in the range: Coronal C to flare out the coronal portion
of the canal, Median M to enlarge the middle part of the canal and Apical Fine
A1 and Apical A2 to enlarge the apical portion of the canal.
CMA provides safe, secure and reliable rotary instruments with several unique
design features including a shorter handle to improve ease of access to molars
and a helical shape to aid removal of debris from the canal. CMA instruments
also have a cross-section with 3 cutting angles for excellent cutting efficiency
and feature a non-cutting tip to ensure the instruments respect the trajectory
of the root canal.
CMA files are available in starter kits in 21mm or 25 mm or in refill packs of 6
instruments.
To download the full CMA product brochure and view a demonstration video
please visit www.dentalsky.com or for further information please contact
Dental Sky on 0800 294 4700.

[34] => dtuk1031_page1-4.indd

34 Private Practice
SYNERGY® D6
The aesthetic nano
composite for simplified
filling therapy
Coltène/Whaledent presents
something
new
and
innovative, SYNERGY® D6
composite. The idea for the
development of SYNERGY®
D6 came from experience
with MIRIS™, the natural
shade system with its uncompromising aesthetics, and also from the years
of experience with the SYNERGY® Duo Shade System with low shrinkage,
optimum processing properties, fast polish ability and high resistance
to exposure to operating lights. The Duo Shade System uses one shade
component for two Vita™* shades to simplify selection. SYNERGY® D6 provides
the user with a simple, safe and highly aesthetic filling procedure with easily
blended shades. Simple selection of shades is a special feature; the result is a
selection with only 6 dentin and 2 enamel shades. The shade is selected with
the unique anatomically shaped shade guide, which is manufactured from
composite. The two components, dentin and enamel, can be nested together
and the dentist can select the matching shade combinations easily. It’s so
simple! For further information contact your preferred dealer or call free phone
0500 295454 exts 223/224 www.coltenewhaledent.com

Educational Courses for 2010.....
Now has never been a better time to start planning your education for 2010
and where better than with the UK’s leading full service dental dealer, Henry
Schein Minerva, providing anything and everything you could possibly need
for your practice...even education!
Education and development is a top priority for Henry Schein Minerva, who
have reinforced their commitment to the dental industry with their new and
improved Education and Development programme. Promising to contribute
to the effective running of your practice, Henry Schein Minerva offer a range
of educational programmes from practice-building CEREC® seminars to more
practical hands-on endodontic courses, to name just a few.
Led by some of the UK’s leading and most influential practitioners, Henry
Schein Minerva’s range of courses are suitable for all members of the dental
team in both Private and NHS practice, and will be running throughout 2010
at a location near you.
For more information please call Sue O’Rourke on 02920 442 818 or email
education@henryschein.co.uk

Tavom Sets New Standards in Ergonomics,
Style and Comfort
Tavom has been supplying dental practices
with high quality furniture, cabinetry
and equipment since 1975, and today is
renowned as a committed market leader with
unparalleled expertise in this specialised field.
With a vast product range benefiting from the latest materials and technology,
Tavom offers ergonomic, cost effective and durable solutions to every
furnishing dilemma.
To meet patients’ rising expectations of the dental experience, as well as to
attract and retain quality staff, the surgery environment must be welcoming
as well as functional. Tavom has trained consultants able to offer advice on
the emotional impact of colour compatibility and product suitability for
specific purposes.

United Kingdom Edition January 25-31, 2010

We’ve refocused our vision…
Evident’s new range of
loupes and lights are expertly
custom-made
by
leading
supplier
ExamVision™;
a
manufacturer committed to
delivering superior design
and craftsmanship, qualities which perfectly complement our 16 years of
unrivalled loupes experience and outstanding customer service.
Available in two styles, three frame colours, three frame sizes and four
magnifications, each ExamVision™ loupe is individually crafted to your
personal measurements and requirements. Whether you normally wear glasses
or not, ExamVision’s™ lightweight, high-definition loupes will vastly improve
your detailed vision of the whole treatment area, whilst also improving your
comfort, making it easier to work and reducing stress.
Evident are the UK’s No.1 supplier of loupes and lights and our vision is to
supply the very best precision products, combining exceptional quality and
service with outstanding design.
Interested in loupes? FreeCall 0500 321111 or visit our website www.evident.
co.uk

For further information please contact GC UK Ltd on 01908 218999, e-mail
gcuk@btinternet.com or visit www.gceurope.com

When buying new equipment,
it’s comforting to know that a
colleague has the same model
and has found it to be reliable.
How much more reassured would
you be to know that it has been
endorsed by the senior engineer
at Guy’s & St Thomas’ NHS
Foundation Trust?

With 51 million mobile phone users in the UK,
the introduction of an SMS alert system is a fast,
immediate and effective way of reminding your
patients about appointments by simply sending a text message.
This up-to-the-minute technology allows you to automatically send an SMS
reminder to your patients up to 3 hours before their appointment, uniquely
showing the delivery status of messages in the EXACT™ appointment book.
With the cost of sending a text being significantly lower than sending a letter,
your practice can save money and time and benefit from increased profitability
through having a significantly lower amount of missed appointments.
Don’t let your patients miss an appointment! Call 0845 345 5767 to find out
more about Software of Excellence’s SMS capabilities.

Techceram Ltd
Techceram Announce Lava Loyalty Scheme
Techceram Ltd is delighted to announce details of their
Lava Loyalty Scheme, operated in association with 3M
ESPE.
Every time you place a Lava Restoration you will be
supplied, via your Laboratory, with a card incorporating
the appropriate number of Lava Loyalty labels. The labels
have unique codes and represent one Lava Loyalty Point
for each unit of the restoration.
Lava Loyalty Points can be redeemed against a wide range of options including
3M Espe products, £100 Professional Development Course Fee Sponsorships,
Customised Lava Promotional Materials, Lava Demonstration Models and even
a Flat Screen TV including a Lava Patient DVD.
Similarly patient’s will soon be able to Register their Lava 5 year guarantee by
visiting the www.3mespe.co.uk/guarantee website.

For further information please contact Techceram Ltd on 01274 416664 or visit
www.techceram.com.

RAYSAFE
Radiation Quality Assurance tool – for daily checking
The Unfors Raysfae is the first radiation monitoring tool
to be widely available to dentists in the UK. Designed
to test the output of Intra-oral x-ray units, the Raysafe is
installed and calibrated by a Velopex Technician to one specific Intra-oral x-ray
unit in your clinic.

Quality and unbeatable value!
KaVo offers a complete range of
equipment including dental units
to meet the needs and budgets of
the discerning dental professional,
a full range of imaging products
and handpieces.
The KaVo range
includes the Estetica E70 and E80, the
inspirational new treatment units with
its innovative suspended chair concept
which can be optimally adapted to the everyday needs of the dental practice.
Also included is the Primus 1058 unit is available in standard and break leg
options.
KaVo combines it unbeatable range with a skilled Specialist Equipment Team
all of whom are trained to offer valuable support during the surgery planning
process, making KaVo the best possible option.
All KaVo units are designed to combine superior levels of ergonomics and
efficiency whilst providing comfort and a practical, functional, relaxed,
working position. All units have smooth, easy to clean surfaces and seam-free
cushioning on the chairs.

The price includes calibration and installation by a Velopex service technician
For more information, please call:
Mark Chapman
Director Sales & Marketing
Mobile: 07734 044877
E-mail: mark@velopex.com

Your patients and your practice with benefit from saliva testing as part of your
practice philosophy. Your diagnostics will be greatly enhanced in terms of
early detection of oral problems with improved patient communication and
motivation combined with an increased dental awareness of your patients.

Missed appointments are all too apparent for
both private and NHS dental practices, in fact
recent research of NHS practices shows that an
average of 11% of appointments are missed due
to “no shows” by the patient.

Whatever your refurbishment or replacement needs, call Tavom UK on 0870
752 1121 for specialist advice and a professional solution.

Unfors Raysafe supported by Velopex
Single unit: £499.00 + VAT
Discounts available for multiple installations

Once the problem has been recognised you are able to implement an
appropriate prevention and remineralisation programme to rebalance the oral
environment thus helping to prevent further effects from demineralisation of
the tooth structure.

Remarkable Quality

In addition to the Lava Loyalty Scheme for Dentists, Techceram also offer a
unique “Quality Feedback Card” system which ensures that full traceability is
available.

Your safety and the safety of your patients and staff could depend on it.

It is well known that saliva
protects the teeth from
demineralisation. When a
patient presents with sensitivity, caries or eroded lesions a solution can be
found to correct or control these problems when it has been determined why
the saliva is not adequately protecting the teeth.

Txt 2 Remind Ur Patients

As well as incorporating the benefits of ongoing research into materials and
design, all Tavom products are backed by standards of customer service
celebrated throughout the industry.

The Traffic light display indicates: Green, OK, the x-ray unit is functioning within
calibration perameters; Orange, OK to use, the x-ray unit is within 10% of the
calibrated level; Red, Stop using the x-ray unit and call for service, your Intraoral x-ray unit is more than 10% from the calibrated level.

Saliva Testing Protecting
Your Patients
GC strongly believes that
dentists should use saliva
routinely as a diagnostic tool.

For information or to arrange a visit from a KaVo Equipment Specialist,
regarding the full range of KaVo products and services including units, imaging
products, surgery planning and cabinetry and flexible finance options please
contact us on Freephone 0800 218020.

Equipment in dental hospitals
gets a substantial amount of use
by a wide variety of clinicians
and students, meaning that some
of the usual parameters of wear and tear become exaggerated. Guy’s & St
Thomas’ have used Takara Belmont treatment centres for several years and are
pleased with the equipment’s solid reliability.
“Ease of servicing is another huge plus for Takara Belmont’s units,” Dave
commented. “I have numerous pieces of equipment to look after in the
hospital, so always favour those that keep clinics running smoothly. Both
teaching staff and students find breakages frustrating. Thankfully our chairs
don’t let us down”.

Does your private practice need a
check-up of its own?
Do you feel the time has come to give your private practice a thorough
examination and make sure your business is running as smoothly as possible?
If so, you could benefit from a practice health check from The Dentistry
Business, who offer a wide range of solutions designed to help improve your
private provision.
They will make sure you have the vital skills to develop practice systems
that work well, control your business so it stays on track every month,
organise development plans to attract and retain the best team, improve
communication skills and treatment plan management to boost patient
acceptance and increase sales.
The Dentistry Business is a three-man team comprising Lester Ellman and
Carl Parnell, two well-known and respected dentists with solid reputations for
building and running private practices.
If you’d like help from the people who have been there and done it all,
please call The Dentistry Business on 0161 928 5995 or email them at info@
thedentistrybusiness.com

Make Treatment Affordable
with Patient Referral Plans
Munroe Sutton offers the
perfect solution for making
dental treatment affordable
for patients who are finding themselves having to budget carefully during a
recession.
Dental Plans are a tried and tested solution to affordable dental care, offering
discounts to patients while maintaining profitability for the practitioner.
Patients pay a nominal monthly fee to join the Plan and then receive 20% off
most treatments from a participating dentist, and are able to pay at time of
service.
Joining the scheme for dentists is FREE and practitioners additionally enjoy
free marketing and promotion of their practice, access to a substantial pooled
patient list, as well as discounts on certain lab fees.
Patient Referral Plans provide excellent benefits for both practitioner and
patient in difficult times, increasing treatment plan acceptance rates for the
practitioner and ensuring that patients can still keep their dental appointments,
avoiding any long term health impacts from a lack of regular dental care.
For more information please call 0808 234 3558
Or visit www.munroesutton.co.uk/dentist

[35] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Specialist Expertise from the ASPD
How can you guarantee a totally professional,
quality service from a company that
understands the challenges of modern dental
practice?
The Association of Specialist Providers to
Dentists (ASPD) comprises highly reputable
businesses across wide ranging specialities,
providing a range of professional services
tailored to meet the specific needs of
individual dentists and dental Practices.

Learn how to separate yourself from the
competition
The British Academy of Cosmetic Dentistry
are pleased to announce their next meeting,
to be held on the 23rd of April 2010.
James Goolnik and Chris Barrow will provide
the guidance necessary for practitioners to
create their own Dental Branded Experience™
as a way of standing out from the competition.
Explaining the importance of branding, how and when to brand and how to
convert potential into revenue, delegates will benefit from the knowledge and
experience of two leading figures in corporate dentistry.

Industry News 35
British Dental Conference and Exhibition 2010
The British Dental Association’s annual conference
and exhibition (20 - 22 May 2010 at the ACC,
Liverpool) is a vital diary date for all dental
professionals who are looking for inspiration for
their practices.
Prefer to say:
The BDA’s British Dental Conference and Exhibition (20 - 22 May 2010 at the
ACC, Liverpool) is a vital diary date for all dental professionals who are looking
for inspiration for their practices.
The conference programme includes sessions on:

Membership at the ASPD takes more than a signature and is by recommendation
only. Prospective members must undergo a rigorous application process and
each member has the unique quality that they are all confident to recommend
each fellow member to you.

For over 12 years Chris Barrow has been a consultant, trainer and coach to the
UK dental profession, and can offer a wealth of experience having delivered a
business-coaching programme to over 400 UK dental practices.

ASPD companies have access to the resources and expertise of their fellow
members, so complicated situations can be resolved by combining the
strengths and experience of more than one adviser, a distinct advantage of
engaging a professional who specialises in working with dentists.

President of the BACD, James Goolnik is also the owner and founder of Bow
Lane Dental Group. Voted London Practice of the Year in 2006, James has gone
on to establish his own training company, Smiles by James Ltd, as well as the
whitening system, Smilestrips.

The exhibition will see all the industry’s most prominent suppliers and a
number of new entries to the market it will also be a chance for delegates to
explore hundreds of new products and technologies.

For further information on the ASPD, its members and services, call 0800 458
6773 or visit www.aspd.co.uk

For more information or a booking form please contact Suzy Rowlands on
0208 241 8526 or email suzy@bacd.com.

For more information on the conference and exhibition, register on www.bda.
org/conference or call 0870 166 6625.

Quality for your patients
Dental Professionals seeking to deliver a quick,
perfect aesthetic service to their patients
should turn to Biterite Dental Laboratory.
Specialising in high quality, affordable, private and cosmetic crown and
bridgework, Biterite offers your patients marginal fit, occlusion, anatomical
conturing, and shade matching.
Biterite also guarantees everything it sells for three years and delivers the
goods within ten working days.

Keeping a Clear View
Hogies eyewear is well known for its
provision of uncompromised safety
combined with stylish design. Now the
Hogies Plus Eyeguard range features
some new improvements.
The high quality polycarbonate lenses have enhanced scratch, fog and solvent
resistance on both sides, as well as a resilient water-repellent coating. These
make the Hogies Eyeguards easy to keep crystal clear, even when using
infection control products.

Predictable occlusion and guidance in everyday practice
Dental decontamination in England: complying with HTM 01-05
The future of dentistry: one united profession?
Maximising your business opportunities in the current financial climate

World-class dental hygiene event
comes to Glasgow in 2010
The 18th International Federation of
Dental Hygienists (IFDH) International
Symposium on Dental Hygiene (ISDH)
will take place at the Scottish Exhibition &
Conference Centre (SECC), Glasgow from 1
to 3 July 2010.
Held only every three years, this is a major
event in the dental calendar and the
selection of Glasgow as the venue is akin
to London hosting the Olympics.

Combining quality standards and values of the traditional dental laboratory,
with the contemporary work ethics of today’s dentist, Biterite delivers
affordable solutions of outstanding quality.

Made from medical grade silicone and stainless steel, the nosepiece is fully
adjustable for optimum positioning and incredibly comfortable to wear.

Dental Professionals who want the best for their patients should consider
Biterite Dental Laboratory and try the fresh approach to cosmetic crown and
bridgework.

As well as being stylishly designed and available in a range of colours, the
Hogies Eyeguard range gives unrivalled comfort and airflow, helping to
prevent the lens fogging and the view clear.

Why not try the fresh approach to working with a dental lab? To demonstrate
the quality of all work created by Biterite, your second piece of work will be
done completely complimentary!

The lightweight Eyeguards from Hogies clearly offers the best protection for
your eyes.

Registration is from 14:00 on Thursday 1 July with the welcome address by
Marina Harris, BSDHT President, at 16:00. Following a full programme of
speakers, an exhibition and social events, the symposium finishes with a
closing ceremony beginning at 16:45 on Saturday 3 July.

For more information please call John Jesshop of Blackwell Supplies
on 020 7224 1457 or fax 020 7224 1694

For more information, to ensure they receive regular updates and to book a
place, those interested should visit www.bsdht.org.uk.

Introductory and Advanced Courses in Clearstep
Clearstep is pleased to announce the dates for this
year’s Introductory Seminars to the most advanced
GDP-friendly orthodontic solution.
The Clearstep System is an innovative five-step programme that is simple to
use, providing patients with a beautiful smile, and GDPs with the ability to offer
orthodontic treatment.

Is your skin treatment competitive?
Association for Facial Aesthetics benchmarking reveals
growing competition
CODE – The Association for Facial Aesthetics has just
published the results of its annual survey of facial
aesthetics treatment and prices. The survey, which
provides an essential insight into fees being charged for
different procedures, includes for the first time newer
treatments such as Dermaroller and IPL treatments, which have become more
prominent during 2009.
The benchmarking, completed by CODE AFA members, provides some
evidence that practices feel the need to demonstrate price competiveness, as
the average fees for most treatments have not increased and in the case of
volumisers, they have even dropped this year.

Call 0208 455 5321 or go to www.bite-rite.co.uk to see the Biterite difference.

A-Dec 500: the Best Choice for Practitioner
and Patient
Dr Matthew Jones holds a Master’s degree from
the University of Birmingham and is experienced
in general dental practice and oral surgery.
He is the principal of Ivory Bespoke Dentistry
in Henley-in-Arden, a practice which he established to further his interest in
patient-led treatment planning and excellence in dental treatment.
Dr Jones recently upgraded to the A-Dec 500, supplied by Clark Dental, as the
best choice for him and his patients. “I like the continental delivery system,
thin backrest and head support and general styling. The streamlined design
of A-Dec chairs allows excellent access for treatment and I would highly
recommend the A-Dec 500.” He adds, “The general styling also helps create the
right image for the surgery.”
In addition to its surgery design and build service, Clark Dental provides
practices with a range of superior products, from dental chairs and cabinetry
to top specification equipment including the Schick Technologies range
Sirona Galileos 3D ,the Dentaloscope, Nomad portable X-ray, Florida Probe
and CarieScan Pro™.
For more information contact Clark Dental Wickford Essex Office on 01268
733146 or email enquiries@clarkdental.co.uk

Gentle and Effective Cleaning with Curaprox
Curaprox are providers of high quality oral
healthcare products and know that clean teeth
and healthy gums means happy patients.
Using the right toothbrush is the first step in
effective preventative care, and hard bristles can
cause gum damage. In response, Curaprox have developed a range of soft
bristle brushes for gentle, yet effective cleaning.
CS1560 – Perfect choice to introduce patients to soft bristle brushes, featuring
a softer head than traditional items

Learn more about the Clearstep system and process at one of the introductory
seminars:
Thursday 28th Jan - Leeds, Cosmopolitan Hotel
Tuesday 30th March - London, Royal Society of Medicine
Thursday 27th May - Belfast, Hilton Country Club
For the practice member the day will include a morning lecture, lunch with the
team and then a talk on impression taking, Clearstep processes, Clearview, (the
new way to see the finished results) and the financial side.
For those already familiar with the system, Clearstep offer an Advanced
course, to develop the skills and expertise to offer even more treatment
options, with the opportunity to practice on phantom heads.
Wed 7th – Friday 9th April - London, British Orthodontic Society
To book your place on any of the above courses, or for more information,
call +44 (0)1342 337910 or e-mail info@clearstep.co.uk

By using the recommended soft bristle Curaprox brush, patients will
immediately see an improvement in their oral health, whilst protecting their
teeth and gums.

Curaprox Celebrates a
Successful iTOP Sustainable
Prophylaxis Seminar
Curaprox are delighted by
the overwhelmingly positive
response from their recent UK
iTOP seminar on sustainable
prophylaxis.
Held at the luxury Champney
Springs Resort in Ashby de la Zouch, Leicestershire, attendees found a wealth
of useful information that they can now take back and implement into their
daily patient care.
With intensive practical workshops held on the 30th – 31st October, the
delegates enjoyed getting ‘hands on’ experience with the range of innovative
oral hygiene equipment from Curaprox.
Led by Professor Kirsten Warrer, professor of Periodontology at the University
of Aarhus, Denmark, the practitioners will benefit from learning about a
revolutionary approach to individual prophylaxis as well as knowledge of how
to use the latest tools correctly.
Attendees also benefited from a free relaxing spa treatment from the experts
at the Champney Springs Resort, courtesy of Curaprox.

For free samples please email clare@curaprox.co.uk
For more information please call 01480 862084, email info@curaprox.co.uk or
visit www.curaprox.co.uk

For free samples please email clare@curaprox.co.uk
For more information please call 01480 862084
www.curaprox.co.uk

CS3960 – With 3960 filaments, this intermediate brush will clean effectively
while the patient learns to exert less pressure, helping to keep the gum-line
intact
CS5460 – The softest and most dense number of bristles in the series. No risk of
gum trauma as only smallest amount of pressure is needed.

The International Symposium on Dental Hygiene is entitled New Concepts for
the New Millennium and will include a full programme of eminent speakers
from around the globe as well as an exhibition and social events.

Interestingly, though, this year’s results reveal a much wider discrepancy
between the highest and lowest fees being charged for botulinum toxin
treatment compared with last year, with the fee for three areas of treatment
ranging from £167 to £317 and one area of treatment being offered for as little
at £97.
The full report is issued free to CODE AFA members. For more information
about the report or more about CODE AFA membership, please visit www.
the-face.co.uk, email info@the-FACE.co.uk or phone 01409 254 354. To watch
videos on facial aesthetic treatments visit the YouTube channel paulatcode

Protect your practice today with
DentalAir
DentalAir is the only specialist
organisation that focuses on supplying
clean compressed air systems to
NHS clinics and private practices.
Dentists wishing to revolutionise their
compressed air systems will benefit
greatly from entering into a relationship
with DentalAir.
By not maintaining a compressed air system, dentists are running the risk
of having serious pathogens enter their air instruments. Mineral oil fuelled
compressor systems could be harbouring potentially lethal pathogens. High
levels of moisture and the presence of mineral oil is a breeding ground for
bacteria, hazardous not only to patients but practice staff as well.
Enter into the most productive relationship of your career with DentalAir, and
provide your patients with clean, pathogen free air during procedures. Rely
on the best customer and technical support with regular updates to keep you
informed.
Call Dental Air on FREEPHONE 0800 542 7575 and ask for a FREE Practice
Manager’s Guide, or visit www.dentalair.co.uk

[36] => dtuk1031_page1-4.indd

36 Industry News
Dental Phobia
Dental phobia is a surprisingly common,
yet usually completely unfounded
condition.
Some sufferers cope by avoiding the
dentist altogether and risking their oral
health, and many do not realise that their
condition is not only recognised, but also
very treatable.
Currently the highest rated site on google.
co.uk for the key phrase “Dental Phobia,”
the website offers features including
patient case studies, Q and A boards for
discussion and detailed explanations of the most common dental procedures.
Dentalphobia.co.uk also offers patients an extensive directory of Dental
Phobia Certified practioners across the country. This extensive database helps
clients find a dentist who understands their fears and can offer the level of care
and sympathy that they need.
Promoting the fact that a practice is understanding, and offers a tailored
service for nervous patients will not only improve all patient-practice
relationships, but also encourage nervous patients to face up to their oral
health, and help them conquer their fears.
For more information about Dental Phobia Certification or to find out how to
qualify for placement on the dental phobia directory, visit www.dentalphobia.
co.uk

United Kingdom Edition January 25-31, 2010

DENTSPLY Cavitron THINsert
Recently developed and launched in the
USA with phenomenal success, DENTSPLY,
world leaders in scaling inserts, are now
bringing the new Cavitron™ THINsert™ to
the UK. With a tip diameter 40% thinner
than the existing Slimline insert, this new
tip allows excellent access in all areas, superior biofilm removal and greater
patient comfort.
The insert works with any 30k Cavitron ultrasonic scaler to reach inter-proximal
surfaces, concavities and locations with tight tissue attachment, without losing
the tactile sensation you rely upon.
Developed with the input and reviewed by distinguished dental professionals,
the THINsert has received much support already. Testimonials received include:
• ‘I couldn’t believe how well I could access areas that were almost impossible
to reach before.’
• ‘Excellent adaptation to facials on anteriors and in furcations’.
• ‘I love it! I want one now!’
The new THINsert is available to purchase from your dental supplier.
For more information, please call freephone +44 (0)800 072 3313 or visit www.
dentsply.co.uk

One Tip – One Clinical Indication:
Start-X ultrasonic tips from
DENTSPLY
Well-prepared access cavities and
simple location of canal openings
are key factors in the provision of
effective endodontic treatment.
Start-X™ tips from DENTSPLY help
practitioners achieve maximum
control and precision in this area.
Developed in conjunction with some of the world’s leading endodontic
specialists, the Start-X™ range of five ultrasonic tips offers users a high level of
working precision and an incomparable view of the canal.
Based on the simple concept of ONE TIP – ONE CLINICAL INDICATION, each tip
in the range offers practitioners a different benefit.
Start-X™ Tip 1 refines the access of the cavity walls by removing restorations,
caries and dentine inferences from the access cavity walls.
Start-X™ Tip 3 removes calcifications from the pulp or from the root canal
coronal third.
Start-X™ Tip 4 will remove screw or cast metal posts.
Start-X™ tips from DENTSPLY simplify the most popular endodontic
procedures, offering a more efficient service for both practitioners and patients.
For more information, or to book an appointment with your local DENTSPLY
Product Specialist, call 0800 072 3313 or visit www.dentsply.co.uk

UCL Postgraduate Certificate in Dental
Sedation and Pain Management
(Conscious Sedation)

BDJ Online CPD Statistics Show Steady Rise
Recent figures have shown that the BDJ Online
CPD courses are becoming more popular. So far this year there have been
78,193 visits to the site, up from 71,000 in 2008.
DENTSPLY listens to Professor Steele
Practitioners have always shared the belief that prevention is better than cure,
and with Professor Steele’s recent report, this belief is further reinforced.
The Cavitron™ ultrasonic scaler system is number one in the market for a
reason; it effectively removes subgingival biofilm to help towards improving
periodontal health. The Cavitron can be used with a variety of inserts, including
the new Cavitron™ THINsert for subgingival root surface debridement, to
the Cavitron™ SoftTip™ insert, which allows comprehensive scaling around
titanium implants.

Currently, there are over 14,000 registered users, with approximately 6,000 logins per month from 3,500 individuals. The most popular location of users is the
UK, followed by Australia and then the United States, but the site has been
accessed from 135 countries around the world.
In total, 558,000 pages have been viewed.
These statistics provide an interesting view on how dental practitioners
from around the world are using the BDJ Online CPD website to fulfil their
requirements for verifiable CPD.

Oraqix® (25/25mg per g periodontal gel, lidocaine, prilocaine) is a noninjectable, local anaesthetic which has been designed for use in scaling and
root planing procedures. Designed with a quick onset of just 30 seconds and a
relatively short duration (20 minutes), it is both quick for the practitioner and
short lasting for improved patient comfort.

UCL Eastman CPD offers a wide range of on-site opportunities to support all
areas of clinical practice from traditional short hands-on courses to innovative
CPD challenges. The UCL Eastman Dental Institute is also committed to
providing access to lifelong learning through a wide range of flexible-learning
Certificate, Diploma and Masters courses.

For more information, or to book an appointment with your local DENTSPLY
Product Specialist, call +44 (0)800 072 3313 or visit www.dentsply.co.uk

For more details about the UCL Eastman Dental Institute,
Please visit www.eastman.ucl.ac.uk or telephone 020 7915 1039

Third Edition of Medical Statistics at a Glance
Now Available
The UCL Eastman Dental Institute is pleased to
announce that the third edition of an important
reference text is now available.

Professor Crispian Scully receives BMA Medical Book Award
commendation
The UCL Eastman Dental Institute is delighted to report that
the British Medical Association (BMA) has awarded a highly
commended certificate to Professor Crispian Scully CBE.

Medical Statistics at a Glance has been written by
Aviva Petrie, Head of Biostatistics and Senior Lecturer
at the EDI, along with Caroline Sabin, Professor of
Medical Statistics and Epidemiology at the UCL

The Professor received the certificate for his textbook Oral &
Maxillofacial Medicine: The Basis of Diagnosis and Treatment (second edition
Elsevier) in the 2009 round of its Medical Book Awards.

Medical School.
Published by Wiley-Blackwell, this popular reference text offers a concise,
accessible introduction and revision aid for this complex subject. The selfcontained chapters explain the underlying concepts of statistics in medicine and
dentistry, and provide a guide to the most commonly used statistical procedures.
The third edition includes a new chapter on developing prognostic
scores, with new and expanded material on: study management,
multi-centre studies, sequential trials, multiple comparisons, ROC
curves and checking assumptions in a logistic regression analysis.
There is also a companion website at www.medstatsaag.com, which contains
supplementary material. For more details about the UCL Eastman Dental
Institute, please visit www.eastman.ucl.ac.uk or telephone 020 7915 1038

The BMA annual competition awards prizes in 26 categories and aims
to encourage and reward excellence in medical publishing: Oral and
Maxillofacial Medicine was commended in the Medical Book category. The
book offers up-to-date, practical guidance on the whole range of common
and potentially serious disorders affecting the oral and maxillofacial region.
The first edition of the textbook won the New Authored Book Award from the
Society of Authors and Royal Society of Medicine Prize in 2004.
Professor Crispian Scully is one of the most prolific authors in Dentistry
worldwide, and his books have received extensive acknowledgment, including
the Doody Prize in 1999.
For more details about the UCL Eastman Dental Institute, please visit www.
eastman.ucl.ac.uk or telephone 020 7915 1038

It’s an impressive background, and one that will augment SPS’ team well. The
Essex based company already have an impressive track record in technical
excellence and customer service. As a supplier of both equipment and after
sales maintenance services, a 96% success rate in providing an engineer on site
within 24hours is impressive indeed. For more information please call without
obligation on 0800-458 9903.

The emphasis of the course is to equip clinicians with the knowledge, skills,
and confidence to provide effective and safe sedation for their patients. The
speakers are all leaders in their field with a wealth of practical knowledge to
share. Topics to be covered include:
• Patient assessment and clinical examination
• Behavioural management techniques
• Treatment planning and pain management
• Prevention and management of sedation complications
• Basic life support – resuscitation and medical emergencies
• Pharmacology of sedation
For more information, please contact the Course Administration Team on 020
7905 1234 or email cpd@eastman.ucl.ac.uk

Working with proven specialists will help to
achieve the best results for your budget
Genus has been applying workplace partnering
concepts to its innovative practice design,
refurbishment and new build projects since 1992,
and has refined this unique approach to meet the
high expectations of today’s dentist, who need a
stylish, well-planned environment in which to treat
patients if a competitive edge is to be retained.
Understanding the requirements of the dental
industry, Genus uses Best Practice Workshops to
develop strong communication with the involved parties, with this approach,
Genus ensures:
 The best results and improved designs  Projects completed to budget
and within timeframe  Obstacles overcome thanks to pooled expertise
 Cost-effectiveness  Quality assurance  A non-adversarial approach
making the most of resources and skills
Working with proven specialists in the trade to produce excellent bespoke
practices, Genus really does deliver.
For more information, contact Genus on 01582 840484
or email chris.davies@genusgroup.co.uk
www.genusinteriors.co.uk

RON JACKSON SEMINAR A COMPLETE
SUCCESS
The recent Ivoclar Vivadent seminar held at the
new state-of-the-art London Dental Education
Centre (LonDEC) in conjunction with renowned
international aesthetic dentistry speaker Ron
Jackson proved a resounding success.

Experience Matters
We seek experience and expertise, in
all aspects of day to day life. It seems
obvious but you wouldn’t ask your
doctor to help with a tax return, nor
would you make an appointment with
an accountant if you were feeling ill! Each
profession brings expert knowledge to
different areas, and the dental industry
is no different.
Ian has gained a wealth of experience
in almost thirty years in the dental
industry. He began on the engineering
side, overseeing installations and service
work, both in teaching schools and
general practice. He broadened his knowledge base further by working in
equipment sales, project management and surgery planning.

Commencing in May 2010, the UCL Eastman Dental Institute and the
University of the Western Cape offer the next course ideal for dental or medical
practitioners with little or no previous experience in conscious sedation, as
well as those wanting to update their knowledge and skills.

The new centres high specification facilities include a comprehensive training
suite and dental skills training room, equipped with 26 state of the art clinical
simulation units. Practitioners’ clinical skills will greatly benefit from the
availability of LonDEC.
www.inventorycircle.com
More and more dental suppliers are listing their products every week!
Inventory Circle is the place for you to find dental supplies and equipment at
greatly reduced rates. Thousands of dentists worldwide have signed up (for
FREE) to benefit from:
 Time sensitive (soon to expire) supplies
 Returned equipment and supplies
 Used equipment
 Refurbished equipment
 End of line supplies
Visit www.inventorycircle.com today and see how much you could save?

Dr. Jackson stressed the importance of maintaining high standards and
discussed meeting the challenges faced by modern dentists today. Focal
points included gaining an appreciation for the versatility of composite resin
and methods used to achieve life-like restorations.
Participants had the opportunity to use some of the products in the Ivoclar
Vivadent range including the new, IPS Empress Direct composite system.
Further specialist seminars will be held nationally throughout 2010, the next
one being with ‘A Team Approach’, with Oliver Brix at the Guildhall, Bath
11th February. As places get reserved quickly it is advised to contact Ivoclar
Vivadent directly on 0116 284 7880 to confirm your attendance.

[37] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Press release for January 2010
issue
Monthly Prize Draw winner
Kemdent were very pleased
to send Michael Fullforth of
the Family Dental Practice in
Lancashire £100.00 of Marks and
Spencers vouchers. Mr Fullworth
was the Kemdent prize draw
winner for October. He completed a Clinical Evaluation form for Diamond
Capsules and it was entered into the Kemdent monthly prize draw.
Kemdent are currently funding a project to carry out extensive research into
Diamond GIC Dental materials, with the support of Exeter University and Bristol
Dental School. Kemdent have always valued the contribution of experienced
dentists to help them research their products.
The completed evaluation forms will provide a valuable contribution to the
project. For this reason Kemdent is offering an added incentive. Completed
evaluation forms will be entered into a monthly prize draw with a chance to
win £100.00 of M & S vouchers.
For information on all Kemdent products call Jackie or Helen at Kemdent on
01793 77 00 90. or visit our website www.kemdent.co.uk.

Dentomycin:
The Best Adjunctive Treatment for
Periodontal Disease
Available from Blackwell Supplies,
Dentomycin is a periodontal gel that
effectively reduces pocket depths and
bacteria levels while actively promoting
periodontal healing. The gel contains 2%
Minocycline, an antibiotic well known for
its ability to eliminate key periodontal
pathogens.
Used in conjunction with scaling and root planing (SRP), Dentomycin
achieves a marked reduction in bacteria in patients with periodontal disease.
It has a positive anti-inflammatory action, which promotes connective tissue
attachment.
Dentomycin binds to the tooth surface and is released slowly, attacking the
bacteria; clinical studies have shown that Dentomycin treatment reduces the
bacteria that cause periodontitis and reduces the depth of treated pockets.
These changes indicate an improvement in gum health.
Dentomycin is supplied in easy to use, pre-filled applicators that allow the
delivery of the gel directly into the periodontal pocket for immediate effect.
For more information please call John Jesshop of Blackwell Supplies
on 020 7224 1457, fax 020 7224 1694 or email john.jesshop@blackwellsupplies.
co.uk

Sinus Grafting and Bone Augmentation With Hands-on Cadaver Surgery
Advanced Certificate Course
The 2009 Sinus Grafting and Bone Augmentation with Hands-on Cadaver
Surgery received an incredible response from delegates and offered
outstanding training including:
 Hands-on dissection and live surgery  Aetiology of bone loss  Surgical
anatomy of the maxillary sinus  Indications for sinus augmentation and
grafting  Evidence base for maxillary sinus grafting procedures  Closed
and open sinus lift procedures  Regenerative materials, science, handling,
equipment and instrumentation  Intra-oral bone harvesting techniques
including block grafting for lateral augmentation  Patient communications
and fee setting
Dr. Koray Feran, Professor Cemal Ucer and Professor Vishy Mahadevan are
pleased to be accepting new enrolment for this outstanding course on
Thursday 8th- Saturday 10th July 2010.
Places are limited to ensure quality so please book early to avoid
disappointment. Contact Dr Koray Feran on 020 7224 1488 or email koray@
korayferan.co.uk or ucer@oral-implants.com

Access to More Patients with Munroe Sutton
at the Sixth Annual BACD Conference
Delegates of the sixth annual BACD at the
EICC in Edinburgh were introduced by Munroe
Sutton to a truly world class Patient Referral
Plan to successfully grow their patient base and
encourage returning clients.
The Patient Referral Plan has been developed by dentists, for dentists, and
proven successful in the US for three decades. Now tailored to the UK market,
Munroe Sutton’s outstanding solution lets practices:
Increase cashflow with payment at time of service
Reach out to more patients with FREE marketing solutions
Offer a seamless service with an automated patient verification system
…and treat MORE patients!
Munroe Sutton was proud to sponsor the 2009 BACD and delighted with
the success of the conference. Delegates to the Munroe Sutton stand
were introduced to the first step towards growing their practice with full
appointment books, cost-effective treatment plans, happy patients and the
support of a world leader in highly effective patient referral plans.
For more information please call 0808 234 3558
or visit www.munroesutton.co.uk

A brighter future: Whitening bucks the
recession
Despite the recession there appears to be a
burgeoning rise in patient demand for tooth
whitening. A recent survey conducted by market
research group Mintel identified that patients
consider the look of their teeth as of the upmost importance.
Guaranteed to whiten
Philips can provide a cost-effective way for patients to achieve whiter looking
teeth as its Sonicare HealthyWhite brush is clinically proven to whiten teeth by
up to two shades in just two weeks. The brush has a Clean & White mode which
is specifically designed to enhance the effectiveness of whitening treatments
and whitening toothpaste and helps remove everyday extrinsic stains, such as
coffee, red wine and tobacco.
Sweet talk
Philips has also made it easy to explain the benefits of HealthyWhite to patients
through its ‘Patient Profiles’ information cards and fact sheets which have been
created to help Dental Professionals communicate more effectively with their
patients.
If you would like more information about HealthyWhite or would like to use
the ‘Patient Profiles’ material, please visit www.sonicare.co.uk/dp or call 0800
0567 222.

Superior Sterilisation – SpectruM6
A leading infection control solutions provider, YoYo
Dental delivers dental professionals with advanced
autoclaves and washer disinfectors, fully compliant
to HTM 01-05 guidelines.
YoYo’s groundbreaking SpectruM6 autoclave
features:
 True Air Detection System – User executed test cycle, a predetermined
volume of air can be detected and let into chamber during sterilising phase
 Redundancy Engineered Independent Cycle Validation System – Duel
independent temperature and pressure sensors give optimum cycle reliability
and performance
 Safety and Sensing Systems – System sensor, automatic temperature
resetting and pressure cut out systems operate to rapidly and clearly report
areas that require user attention
 Fully Removable Waste Tank - Easy to remove large onboard waste tank,
cooling system ensures waste is cooled to a safe temperature
A unique chamber filling system with volumetric water dosing gives fast
and economic chamber filling, and SpectruM6 stackable design enables two
machines to be safely mounted and operated one above the other without
additional shelving.

Solve Staffing Shortages!
The New Year is a time when staff can often look for a new career and new
opportunities. However, if you run a practice then that can make January a
staffing headache for you!
But, all the staff that you need could be just a click away. Visit PracticeCity.com
and you place your vacancy and you can reach thousands! Simply place your
ad whether it be for an associate, hygienist or dental nurse and you’re sure to
find the right person for you!
Visit www.PracticeCity.com today and solve your staffing issues.

Flexichange®: Get your hands on the
most successful instruments
It is not difficult to understand why DENTSPLY’s
Flexichange® range is such a successful brand
within the UK Hand Instrument Market.
Ergonomically designed with soft-grip silicone handles, Flexichange® hand
instruments fit perfectly in your hand. With a wide grip at the working end
and a narrow centre, the dimpled design helps stop hand fatigue and prevent
‘pinching’ of the handle, thus improving grip and rotational control.
Flexichange® tips are replaceable, so should one break or be over sharpened,
they can be easily replaced.
The complete range of DENTSPLY Flexichange® products are guaranteed to
simplify even the most complex procedures, and help provide a more efficient
service for both practitioners and patients.

Industry News 37
Take control of your financial future
Lansdell & Rose understand a
practitioner’s unique needs and
goals, and offer a package of tailor
made services including; accounting,
incorporation, tax compliance and
financial planning. Part of Lansdell &
Rose’s firm of Chartered Accountants,
Lansdell & Rose Independent Financial Planners, provide fully independent
advice and a complete review of personal or business financial circumstances
in various areas:
Pensions – planning for retirement, self-invested pensions (SIPP), small selfadministered pension schemes (SSAS) and review of existing arrangements
Property purchase or re-mortgage – full mortgage service on residential or
commercial/industrial properties, owner occupied and buy-to-let
Investment – risk analysis, regular savings, investment strategy for targeting
income or growth, regular savings and tax considerations
Protection - income protection, mortgage and family security from critical
illness, disability or death
Whatever your personal or practice needs, Lansdell & Rose can help. With an
interest in the overall success of your practice, Lansdell & Rose provide dentists
with specialist, bespoke fee-based advice and consulting services.
For more information please visit www.lansdellrose.co.uk or call Lansdell &
Rose on 020 7376 9333

Don’t Clean Mirrors, Use Everclear
The first dental mirror that self-cleans, Everclear from
Nuview, is a ground breaking Swiss design that uses
the latest precision micro-technology to create a tool
dentists can trust to provide constant visual clarity.
Everclear uses a high optical-polish mirror that spins
away spray and debris to provide continuous visibility. Powered by a quiet
motor, its micromagnets allow an instant change of the double-sided mirrors,
which are floating on aerospace ceramic ball bearings.
The advantages of Everclear are obvious:
 Visual acuity is increased and time is saved with no repetitive cleaning.
 Ergonomically balanced with a cordless, non-slip medical stainless steel
handle.
 Long-lasting, rechargeable batteries, with an extra battery on charge
ensuring continuous performance.
 Fully autoclavable despite its cutting edge technology.
Providing uninterrupted crystal-clear image reflection, the EverClear dental
mirror is a revolution in dental technology and an essential daily tool for every
dentist.
For more information please call Nuview on 01453 759659, email info@
nuview-ltd.com or visit www.voroscopes.co.uk

‘Super’ MAX-WIPE
Topdental introduce the new ‘Super’ Max-Wipe
hard surface disinfection wet wipe.
Topdental manufacture a range of Infection
control products and wipes, the ‘Super’ MaxWipe is the latest introduction to this family.
The ‘Super’ wipe is effective against the
following : MRSA, H1N1 Human Influenza Virus, E-Coli, Pseudomonas
aeruginosa, Enterococcus hirae, Mycobacterium tuberculosis (TB), Clostridium
Difficile vegetative cell formation (growing cells) of Gram positive organisms,
HIV 1, Human Influenza B Virus (HIBV), Staphylococcus Aureus, Hepatitis C Virus
(HCV), Aspergillus niger, Candida albicans
And is tested to BS EN14476, BS EN13727, BS EN14204, BS EN13704 and BS
EN13624.
The product is also currently under testing for the highest European DGHM
standards.
Each economy dispenser bucket contains 500 wipes, each wipe being
190x230mm, the wipes are in a inner poly pouch in order to prevent premature
evaporation of the product. The wipe concentrate is Ethanol, Propanol and
Chlorhexidine Digluconate with a pleasing lemon aroma.
In order to be able to re-use the plastic bucket container ‘Super’ Max-Wipe is
also available in a refill pack.
To order or for further information telephone : 0844 414 0471
Or visit our web site : www.topdental.org

New Year Saving with Snappy
The key for Dental Professionals
treating children this year is to find
that happy medium where the
patient can be given valuable chair
time without causing unnecessary
delays in the waiting room.
Snappy restorative GIC from
Kemdent can save significantly on
treatment times, meaning the patient can enjoy shorter dental visits whilst
retaining quality dentistry.
Diamond Snappy GIC is easy to pack and place, genuinely releases fluoride,
leaves no bitter after taste and sets in less than 3 minutes from a starting mix of
23° C. It offers resistance to saliva as soon as the cavity is filled, targeting large
cavities in deciduous teeth. It comes in a natural white shade with translucency
continuing to improve with time.
The perfect solution for lively children visiting the dentist in 2010.

For a limited time DENTSPLY is offering a promotion on Flexichange® hand
instruments; buy 5 and get 1 free (copy invoice to DENTSPLY, please see web
site for address)

Special offer:- Buy 2 Snappy packs and receive 1 box free. Quote ref SS1
Offer valid until 31stFebruary 2010

For more information, or for a FREE compliance survey, please call Yoyo on
0845 241 5776 or email info@yoyodental.com
www.yoyodental.com

The whole range is available to view online at www.dentsply.co.uk, or for
more information, book an appointment with your local DENTSPLY Product
Specialist by calling 0800 072 3313.

For further information or to place orders call Jackie or Helen on 01793 770090
or visit our website www.kemdent.co.uk.

[38] => dtuk1031_page1-4.indd

38 Industry News
“The best conference I’ve EVER been to!”
The British Academy of Cosmetic Dentistry’s
Sixth Annual Conference 2009 ‘The Future
of Dentistry’ was a huge success, according
to delegates’ comments. The conference
received widespread praise and approval for
its location, catering, facilities and suitability
for future meetings.
Enthusiastic delegates’ comments included:
“The best conference I’ve EVER been to (seriously!)”
“Well organised meeting, which has convinced me to join the BACD. I look
forward to the next meeting.”
“A very friendly group of dentists.”
“Very high quality of speakers and presentation.”
“Dr S Weinberg was a very entertaining speaker. Lecture material and
veneer cementation tips were particularly useful.”
“Great congress, good speakers and interesting topics.”
The BACD aims to provide all dental healthcare professionals interested
in cosmetic dentistry with a forum where they can meet and share their
knowledge. The Academy promotes excellence through education and
actively encourages professional development.
For more information contact Suzy Rowlands on 0207 612 4166
or email info@bacd.com www.bacd.com

Welcome To EndoCare!
Working to ensure your patients the ultimate
care and expert specialist treatments!
Many dentists have trusted the specialist team at Endocare to treat and care
for their patients for a number of years and have found the process “effortless”
and “stress-free”.
EndoCare are at the forefront of their field in terms of technology and training.
The most important element for the practice is to focus on the human factor;
the health and satisfaction of the patient is a priority as well as maintaining
relationships with referring practitioners.
Clinical Director Michael Sultan calls the Endocare team “dedicated to ensuring
your patients’ well-being”. As part of their aftercare service, EndoCare also
schedule a free appointment for patients to return in 6 months to ensure
the team can check on the treatment and chat with the patient about their
recovery.

United Kingdom Edition January 25-31, 2010

Kent Implant Studio Referral Evening
The Kent Implant Studio is delighted to welcome referring dentists from all
over the county to an open evening at the Maidstone studio on March 2, 2010,
from 6.30 pm.
Principal dentist Dr Shushill Dattani will be available to speak with throughout
the evening, and he can advise on the ways in which working alongside the
Kent Implant Studio could benefit you r practice, and patients:
• The highly-skilled team are happy to work as an extension of your own
practice team, either at the Kent Implant studio or at your practice.
• The Kent Implant Studio works hard to build long-lasting, ongoing
relationships with referring dentists, and as such ensures that patients are
always returned to the referring surgery when surgery is completed, ready for
any further treatment and regular check-ups.
• Both referring dentists and their patients have access to excellent advice,
treatment options, support and information for the duration of treatment.

For further information on the Kent Implant Studio or to obtain a referral pack
and Dental Nurse Courses please contact 01622 671 265.

Bossklein wipes and foam for infection control
Single-use disinfecting products are both effective
and gentle on your equipment. The new Bossklein’s
wipes and foam prevent the degrading of dental
loupes, protect from pathogens, without causing
dryness.
Bossklein Wet Wipes have been proven to combat non-enveloped Adenovirus
and enveloped viruses including Hepatitis B, C and HIV, with a 60-second
bactericidal effect, as well as being biodegradable and kind to the environment.
Bossklein Foam is a ready to use solution. Proven against Hepatitis B and HIV
in under 5 minutes (HBsAg antigen test), fungi and bacteria in 10 minutes,
and also combats c-difficile NCTC 11204, bacillus, listeria and streptococcus, it
comes in a biodegradable dispenser.

EndoCare works as a part of your team to deliver outstanding, successful
treatment and a level of customer care that is exceptional.

With the freshly scented Wet Wipes packaged in sealed tubs of 100 and the
Foam in dispensers of 50 ml, Bossklein products, exclusively distributed by
Blackwell Supplies, ensure that dentists can depend on quick, reliable, nondamaging disinfection aids being to hand when they need them.

For more information about EndoCare or to receive your free referral pack
please call 020 7224 0999 email reception@endocare.co.uk or visit www.
endocare.co.uk

For more information please call John Jesshop of Blackwell Supplies on
020 7224 1457, or fax 020 7224 1694, or email john.jesshop@blackwellsupplies.
co.uk

Innovative HTM 01-05 compliant
Disinfection Solutions for Dentists
Nuview is constantly seeking to
improve our Continu range to make
life easier for dental professionals.
HTM 01-05 has led to a re-thinking
of infection control procedures
and Nuview has responded with a
number of new products:
Anti Microbial Dental Impression
Mix, which disinfects impressions
at source using Continu to mix the alginate rather than water to effectively
inhibiting bacterial and fungal growth for several weeks without any shrinkage
or distortion. Each bottle includes HTM 01-05 compliant labels
The Continu alcohol free hand wash and sanitising foam products are now
available in sealed disposable cartridges and wall mounted dispensers to
comply with HTM 01-05
A12 now clearly states that, “Alcohol…binds to blood protein and stainless
steel; it should therefore be avoided.” Continu alcohol free disinfectant wipes
and surface spray provide the next generation solution
Let Nuview help you to achieve best practice in infection control with our
Continu range of alcohol free disinfectant solutions.

Happy birthday Smile-on!
Team celebrate providing expert
training solutions
There was cause for celebration at the
Smile-on headquarters, as January 2010
saw the company enter its 10th year.
The company’s key values of partnership, imagination, innovation, creativity
and potential have helped evolve the products from simple training courses
into the multi-media learning platforms of today, and helped Smile-on become
the source for cutting edge software and training resources.
Smile-on now offer a wide range of training options to dental professionals,
including:
Interactive learning products such as e-learning packages to meet all
revalidation and CPD requirements
Legislation driven governance schemes for health authorities and individuals
Bespoke learning solutions for all clinical staff
Live web events such as webinars and online conferences
The Smile-on team are always working to ensure that the programmes are
responsive to the needs of the dental professional, and continue to offer expert
guidance and help boost standards in the UK dental industry by promoting
excellent patient care and career satisfaction through education and training.
For more information call 020 7400 8989 or visit www.smile-on.com

For more information please call Nuview on 01453 759659, email info@
nuview-ltd.com or visit www.voroscopes.co.uk

Kavo Everest CAD/CAM
One of the most respected UK dental suppliers,
Wright Cottrell, has been working alongside
dental teams for many years, supplying an
incredible range of quality products for all
indications.
Wright Cottrell works hard to deliver the latest
innovations and cutting edge equipment, including the Kavo Everest CAD/
CAM system.
A complete processing system for strong and highly aesthetic solutions for
all ceramic restorations, the KaVo Everest CAD/CAM system is an outstanding
example of holistic design in dental laboratory technology.
The system comprises of four components:
Everest scan pro – Measuring unit with exact scanning of the models
Everest engine – Milling and grinding unit for high precision and automated
processing
Everest Therm – Sintering unit for perfect sintering
Everest Elements – 12 Materials that cover all physical chemical and
biocompatibility requirements of modern dentistry.
The benefits of scanning with this innovative solution have opened doors to
all dental professionals by offering fast and accurate results.
For more information about how you can benefit from outstanding service
and a world-class product range, freephone Wright Cottrell on 0800 66 88 99
or visit www.wrighthealthgroup.com

‘Welcome Back Lisa’
The market leader for evidence-based solutions,
Nobel Biocare is delighted to welcome back Lisa
Roche to the UK and Ireland team. Well known
for her expertise in the field of dentistry, Lisa’s
experience and skills will be a great advantage to
Nobel Biocare in their ongoing commitment to
science, innovation, customer care and outstanding
education for professionals.
‘I am very excited about returning to Nobel Biocare.’
Said Lisa. ‘I am looking forward to working closely
with leading clinicians and educators around the world to help build the
market for Nobel Biocare’s line of superb products.’

Backed By Science
In order to help patients protect their
gingival and periodontal tissues, dental
professionals obviously want to recommend
the most effective means to allow them to
achieve these goals, one of which is the use
of power brushes.
A convincing endorsement of those using
an oscillating-rotating action comes as
follows: “Power brushes with an oscillatingrotating action removed plaque and
reduced gingivitis more effectively than
manual toothbrushes in the short term and
reduced gingivitis scores in studies over three months. No other powered
designs were as consistently superior to manual toothbrushes.”
These words do not come from Oral-B, who developed the oscillating-rotating
technology but from The Cochrane Oral Health Group, an independent
organisation in the UK, set up to provide systematic reviews.
Oral-B power toothbrushes are also the most used and recommended brand
by dental professionals. It’s not surprising then, that the Oral-B Triumph (&
Oral-B Triumph SmartGuide) are the only power brushes accredited by the
British Dental Health Foundation.

Facilitate™ - Computer Guided Implant
Treatment
Facilitate is a perfect planning tool
for efficient, accurate and predictable
implant treatment. Facilitate helps to ensure accuracy and can help to avoid
unpleasant surprises during implant surgery. The concept is based on a 3D
visualisation of the patient’s anatomy and the software helps you to measure and
locate vital structures, such as the mandibular nerve, sinus cavities and nasal floor.
The software program also contains 3D images of implants, abutments
and teeth. This ensures efficient, accurate and reliable planning of implant
positions, sizes and number of implants and abutments to be used. When you
finish planning a case using Facilitate, you send the plan and order production
of your patient’s customised surgical guide.
For full information about Facilitate, contact your local Astra Tech sales
specialist or give us a call on 0 845 4500586 or e-mail implants.uk@astratech.
com

Under Armour Performance Mouthwear™
Introduces Jaw-Dropping Technology
An innovative product that helps enhance
performance has been launched onto the
UK market. Under Armour Performance
Mouthwear™ gives athletes the ability to
unlock their full potential.
Fitted only by dentists and exclusively
distributed by The Dental Directory, UA Performance Mouthwear can help:
 Improve strength, endurance and reaction time
 Reduce athletic stress, fatigue and distraction
Based on centuries of knowledge and with 15 years of rigorous research and
development, the comfortable, custom-fitted product unlocks a previously
untapped resource: the jaw.
UA Performance Mouthwear is powered by ArmourBite™ Technology. Built
into mouthpieces for non-contact, or mouthguards for contact sports, the
patented ‘Power Wedge’ prevents the teeth from clenching together.
By doing so, pressure on the temporomandibular joint is relieved, the airway
is opened for better oxygen exchange, and performance-sapping hormones
are inhibited.
The result: improved athletic performance.
For more information on how your patients can benefit from Under Armour
Performance Mouthwear, call The Dental Directory free on 0800 585 586 or
visit www.dental-directory.co.uk or call Eric Solem on 07590 573 668

Ergonomics at its Best
70 years of advanced research is reflected in
Castellini’s intuitively designed Vector and Rondo
dental stools. Focussed on improving comfort in
the dental environment, these stools have been
crafted using the very best materials, the latest
technology and like all Castellini systems, demonstrate ergonomics at its best.
The Vector stool features a height-adjustable, tilting, swivel backrest for
optimum manoeuvrability. When the backrest is inclined using a simple lever
mechanism, it will remain in position and swivel at any set inclination. The
robust design and overall adjustable height enhances the stability of the stool
and supports all shapes and sizes.

2009 has seen the launch of many exciting new products from Nobel Biocare.
Products include NobelProcera, a package including the latest technologies
in scanning, CAD/CAM software and materials, NobelActive, an innovative
implant designed to offer stability in soft bone and extraction sockets.

Both stools are height adjustable with the use of a lever, simply lifted, then
released when the desired height is reached. The backrest height can be
adjusted using a release mechanism mounted on the back.

The global market leader in restorative and aesthetic dental solutions, Nobel
Biocare is committed to building partnerships that create value and growth for
UK Dentists and their practices.

Castellini’s superb quality and dedication to the dental environment is
reflected in their full range of dental equipment. To see the whole product
catalogue, visit www.castellini.com.

For further information please call: +44 01895 452 912, or visit www.
nobelbiocare.com

For further information about the comprehensive range of Castellini products
call 0870 756 0219

[39] => dtuk1031_page1-4.indd

United Kingdom Edition January 25-31, 2010

Untitled-4 1

Geoff Long
2010

19/10/09 17:03:31

FCA

Tax Planning Slate
Now Available!

office@dentax.biz

Call 01438 7222242

All you need to
know is we’re
the dental
legal experts.
James Shedlow
Solicitor
Specialist Dental Division

And here is how to get in contact with us.
For a FIXED FEE quotation please call FREEPHONE 0800 542 9408
dental.team@cohencramer.co.uk
www.cohencramer.co.uk/services-to-dentists-services.html

Classified 39

[40] => dtuk1031_page1-4.indd

PE

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X

YEARS O

RTISE

C

L

SODY
R
O

M CARE

DUAL CARE FOR
GUMS AND TEETH

CORSODYL DAILY GUM & TOOTH PASTE IS DIFFERENT
FROM REGULAR DENTIFRICES
The only formulation to contain
sodium bicarbonate, 1400 ppm
fluoride and six natural plant
extracts

Over 67% of the ingredients are
for the care of gingiva and teeth
– compared to 25% in many
other regular dentifrices

Free from sodium lauryl
sulfate – suitable for patients
using 0.2% chlorhexidine
digluconate mouthwash

Corsodyl Daily Gum & Tooth Paste is a clinically proven dentifrice,
which can kill bacteria that can cause gum disease1.
With regular brushing, it helps maintain firm and tight gums and a low gingival index2.

Recommend Corsodyl Daily Gum & Tooth Paste
because teeth need gum care too
References: 1. Arweiler N, Auschill T, Reich E , Netuschil L. Substantivity of toothpaste slurries and their effect on re-establishment of the dental
biofilm. J Clin Perio 2002, 29, 615-621. 2. Yankell SL, Emling RC. Two month evaluation of Parodontax dentifrice. J Clin Dent 1988 Suppl A, A41-3.

CORSODYL is a registered trade mark of the GlaxoSmithKline group of companies.

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[cover] => DT UK

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