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Murder trial dentist charged with assaulting female patients / News / Unlocking the secrets / Who is in control of your future profits? / The 10th dimension… the power of ten / ENDO TRIBUNE 2/2010 (part1) / ENDO TRIBUNE 2/2010 (part2) / ENDO TRIBUNE 2/2010 (part3) / On-the-job training / Company Promotion / Do you have permission to practice? / Industry News / Care in the community / Classified

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Table of contents

July 19-25, 2010

PUBLISHED IN LONDON
News in Brief

News

Event Review

VOL. 4 NO. 19
Endo Tribune

Events

Dental access improves
Access to NHS dental services
has improved in the last six
months, according to a recent
patient survey.
The GP Patient Survey is a
quarterly survey of GP adult
patients, which is managed
by Ipsos MORI on behalf of
the Department of Health.
This is the first time that dental
questions have been included
in the survey. The survey carried out between January and
March 2010 revealed that 92
per cent of people had been
able to access NHS dental
services in the last two years.
The results also found that access to services has improved
in recent months, with 95 per
cent claiming they were able
to arrange an appointment in
the last three to six months.
Forty-one per cent of people
had not tried to get an appointment with an NHS dentist in the last two years.
The most frequent reason for
not trying for an NHS dental
appointment in the previous
two years was ‘I stayed with
my dentist when they moved
from NHS to private’ which
was mentioned by 21 per
cent of adults. Eighteen per
cent of people said: ‘I didn’t
think I could get an NHS dental appointment’.
For 78 per cent of adults the
last NHS appointment sought
was for routine dentistry; 18
per cent were seeking an urgent appointment and two
per cent didn’t remember the
type of appointment. Eightyone per cent of the most recent appointments sought
were with the dental practice
previously attended. North
East Strategic Health Authority (SHA) had the largest percentage of the adult population seeking an NHS dental
appointment in the last two
years, at 66 per cent, whilst
South Central SHA had the
smallest, where 52 per cent
sought an NHS appointment.
Employee wellbeing
Three quarters of organisations believe a dental plan
enhances employee wellbeing, according to the 2010
Dental Benefits Survey by
Denplan. The survey also
found 34 per cent of respondents that are considering
adding or removing benefits
in 2010 were considering
adding a dental plan. More
than half (62 per cent) of the
companies said that regularity of use is an important factor when choosing employeepaid benefits.
www.dental-tribune.co.uk

Licking a cricket bat

Oral Health Month

Colgate launches month-long
public campaign

page 2

A look at Professor Lewis’ ISDH
2010 lecture

pages 6-7

Get involved

Useful tool

Dr Paul Jones discusses CBCT
in Endodontic treatment

pages 11-22

Share your skills with
Bridge2Aid

page30

Murder trial dentist
charged with assaulting
female patients
Murder case takes bizarre twist as six patients now complain of
indecent assault charges against dentist

dentist who is standing
trial for murdering his
wife and his lover’s husband, has now also been charged
with assaulting six of his female
patients.

lystrone Road, Coleraine, were
having an affair at the time of the
alleged murders.

Colin Howell and his ex-lover
Hazel Stewart were charged earlier this year with murdering his
wife Lesley, 31, and Stewart’s
husband, 31.

Howell will now undergo a
second criminal trial for the 17
indecent assault charges which
are alleged to have taken place
over a 10-year period on six women at his dental practice. He is accused of assaulting one of them
six times, and another four times.

The victims’ bodies were
found in a car filled with exhaust
fumes at a garage behind a row
of houses in Castlerock, Co Londonderry in May 1991.

The 17 indecent assault
charges were put to him at a brief
preliminary inquiry hearing at
North Antrim Magistrates’ Court
in Coleraine, Co Londonderry.

A coroner originally ruled
that Mrs Howell and RUC constable Trevor Buchanan had taken
their own lives, but the case was
reopened after new information
was given to the police.

The identities of the six
women have been banned from
publication after district judge
Richard Wilson agreed to a
request by a representative
from the Public Prosecution Service for reporting restrictions to
be applied in respect of the
names.

Howell, from Sea Road, Castlerock and Stewart, from Bal-

Dentist Colin Howell faces a second trial for alledgedly assaulting female patients

Howell, who once ran a dental
implant clinic in Ballymoney, Co
Antrim, has been in custody since
his arrest.

lecturing in the Middle East and
was hired by King Abdullah II to
teach his own team of dentists the
latest techniques.

Stewart was granted continuing bail but she must report daily
to police in Coleraine. She has already handed over her passport.

He had two dental practices
in Ballymoney and Bangor and
charged more than £2,000 for
each dental implant.

Howell was known as a top
implant specialist. He did a lot of

The next hearing in the case
will be in September. DT

[2] =>

2 News

United Kingdom Edition July 19-25, 2010

2010 Colgate Oral Health Month

olgate is promoting oral
health in the UK with its
2010 Colgate Oral Health
Month with the help of the British Dental Association.
The initiative was unveiled
at the British Dental Conference,
which was held in Liverpool.
Colgate Oral Health Month
promotes
improved
oral
health. The theme for the 2010
campaign is ‘Discover three Essentials for an Even Healthier
Mouth’, which are:
• Brush teeth twice a day with
fluoride toothpaste and replace
toothbrushes regularly
• Avoid sugary snacks between
meals
• Visit the dentist regularly.
The
launch
included
presentations from Dr Tony
Jenner and Dr Gill Davies.
Dr Jenner, a specialist in
Dental Public Health and the

immediate past deputy chief
dental officer for England, talked
about the guidance document
Delivering Better Oral Health
– An evidence-based toolkit for
prevention.
Dr Jenner said: ‘‘Successful adult dental health surveys
show the population of adults
in England with no teeth has
reduced dramatically. This is a
very encouraging picture but
the longevity of the dentition
does however give its own problems. As we keep our teeth for
longer, root caries also has the
potential to become a serious
problem that is difficult to treat.
The 1998 National Dental Health
Survey shows 66 per cent of
adults had root surfaces that were
exposed, worn, filled or decayed.
The same survey shows periodontal disease being an increasing problem with the aging
population.’’
Dr Gill Davies, also a specialist in Dental Public Health, then

spoke about how the evidence
in the toolkit can be put into
practice.
She said: ‘‘I am delighted that
Colgate has asked me to give
particular focus on prevention
for adults. Since the launch of
the toolkit we have tended to focus on child prevention, leaving
out prevention messages for gum
disease and older adults.
‘‘Adults who visit the dentist
have an obvious opportunity to
come into contact with a credible source giving appropriate
advice. In fact, patients turn
up and they expect to be advised by their clinician on
what they should be doing to
look after their own teeth. It’s
about maximising the effects
of prevention and mobilising our clinical teams to make
the most of this opportunity.’’
Dr Davies then reviewed the
evidence for the preventive messages and treatment of caries in

adults, as well as the prevention
of periodontal disease.
Putting Evidence into Practice
will form the basis of the Colgate
Oral Health Month 2010 CPD
programme.
This verifiable CPD Programme is available to all dental
professionals.

Dr Paul Langmaid, Dr Amarjit Gill, Rhona Wilkie (Colgate) with Professor Damien Walmsley

To participate, visit www.colgateohm.co.uk from 1 September
2010 and download this interactive programme.

drive the awareness of improved
oral health by creating their own
oral health month practice displays.

Colgate Oral Health Month
2010 will run throughout the
month of September. Colgate is
once again looking to partner
with the dental profession for
better oral health by providing
Colgate Oral Health Month 2010
practice packs.

If your practice has not been
involved in Colgate Oral Health
Month before and would like to
register to receive a Colgate Oral
Health Month pack, please call
Colgate on 0161 665 5881.

These packs contain educational materials, motivational
stickers, patient samples and
materials to help dental teams

Please note that one pack per
practice will be delivered at the
end of August, subject to availability. DT

Dental hygiene clinic puts film on YouTube

dental hygiene clinic in
London is using social
marketing to attract customers by putting a short film
on the video sharing website
YouTube.
Smile Pod, a walk in dental
hygiene studio based in London’s
Covent Garden, offers a range
of treatments for cleaning and
whitening teeth as well as botox
and other cosmetic procedures.
In the film, journalist and TV
presenter Zoe Griffin explains
that not only did she have her
teeth professionally whitened at
Smile Pod but she has been using a
Sonicare ‘to make her bright
white smile last’.

Carina Leney, marketing
manager for Philips was invited to support and participate
in the programme and can be
seen being interviewed in the
film. She explains the benefits of the new FlexCare+
in a coffee shop chat – giving the film a conversational
and relaxed feel which makes
the recommendations appear to
come from a friend.
Zoe
Griffin
can
then
be seen in a lively vox pop
session showing Sonicare to
shoppers in the street and
asking for their opinions.
The whole Smilepod concept
focuses on people getting their

teeth cleaned in the same convenient way they get their nails or
hair fixed.
Mike Hutter Smilepod’s director said: ‘‘For too many people,
finding a dentist and overcoming personal fears are big barriers to achieving a healthy mouth.
Smilepod brings high-quality
professional dental care to the
high street in the form of walk-in
dental hygiene.
‘‘Our pledge is to make the
very best oral care available to
all, in an inviting environment
and at an affordable price. Our
highly-trained team of dentists can, like hygienists, clean
or whiten teeth in a friend-

ly, informal atmosphere. In
this way, we can help people
defeat their ‘tooth demons’,
giving them the know-how and
support they need to enjoy
a healthy mouth for life.’’

The short film can be seen
at
http://www.youtube.com/
watch?v=XbFRAQQ4LjM. DT

Philips’ Carina Leney added:
‘‘We were delighted when this
creative and energetic practice
invited us to participate and
you will see from the finished
film which has been posted onto Smile Pod’s website and
YouTube that the power of
word of mouth marketing
cannot be underestimated. It is
exciting to work with innovative practices seeking novel ways
to leverage the power of social
networking.’

Published by Dental Tribune UK Ltd

Course on improving communication in the practice

raining provider Smileon has teamed up with
Dental Protection Ltd to
offer a course on how to improve
communication in the practice.
The three module programme, Communication in
the Practice is for all members
of the dental team.

The course is divided into
three modules, each of which
counts towards one hour of verifiable CPD:
Module 1: The essentials of communication
Module 2: Communication with
patients
Module 3: Communication within teams

The course includes authentic examples of how skilful and
flexible communication in the
workplace can help to reduce
and even prevent complaints, legal claims and ultimately, loss of
business.

A spokeswoman for Smile-on
said: ‘‘Designed with the entire
dental team in mind, the course
is guaranteed to stimulate discussion Smile-on will also soon
be releasing additional course
modules 4, 5 and 6.’’

As, a result the team will
learn how to build longer-lasting
relationships with patients.

For more information call
020 7400 8989 or email info@
smile-on.com. DT

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
Director
Noam Tamir
Noam@dentaltribuneuk.com
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Features Editor
Ellie Pratt
Ellie@dentaltribuneuk.com

Features Editor

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
Ellen Sawle
ellen@dentaltribuneuk.com

Dr Liviu Steier
Liviu Steier [lsteier@
gmail.com]

Dental Tribune UK Ltd
4th Floor, Treasure House, 19–21 Hatton
Garden, London, EC1N 8BA

[3] =>

News 3

United Kingdom Edition July 19-25 2010

Editorial comment

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?

Time to break free?
Whoever
said
that the summer
months are when
things get a little
quieter
has
certainly not been seen
around here lately!
From a Dental Tribune point of view, it has been
crazy enough with symposia
and press visits aplenty; but
the political situation continues to heat up with the news
that the NHS is to be liberated
from the shackles of Whitehall
and put in the hands of health
professionals
and
patients,
creating a truly local service
for patients. While the story
has yet to fully unfold to see

how this will affect both dental
professionals and dental services working under the NHS,
rest assured Dental Tribune
will be analysing the situation,
bringing ProRelief
you all A4the
news and
ad_Sept 09.pdf
opinion as we find it. Watch
this space.

A few weeks ago I attended
the International Symposium
on Dental Hygiene in Glasgow.
It was a wonderful event, made
all the more special by my first
taste
of Haggis!
Joking aside,
1
11/09/2009
13:05
this was an extremely interesting conference, full of great in-

ternational speakers and a real
buzz of enthusiasm
from delegates, who
were very positive
about everything the
conference and Glasgow had to offer. Well
done BSDHT!

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

NEW
Instant & lasting sensitivity relief
with Pro-Argin™ Technology

Lucky 7
for GDC

T

he General Dental Council has successfully prosecuted seven cases of illegal practice this year.
Its most recent prosecution was at Lincoln Magistrates’
Court, where Russell Beedham
pleaded guilty to the charge of
holding himself out as being
prepared to practise dentistry in
connection with the fitting, insertion and fixing of dentures at
1 Almond Crescent, Swanpool.
C

M

Y

CM

Since he is not registered
with the GDC, this is a criminal
offence under the Dentists Act.
MY

CY

Pro-Argin™ Technology, comprised of arginine and an insoluble calcium compound in the form of calcium carbonate,
is based on a natural process of tubule occlusion. It plugs open tubules to help block the pain sensations.

CMY

Mr Beedham has been conditionally discharged for 12
months and ordered to pay £400
in costs within 28 days.
K

Interim chief executive and
registrar of the GDC, Ian Todd
said: “The GDC is committed
to prosecuting those who practise illegally and hopes that
the recent series of successful
prosecutions demonstrates this
objective in action. Those who
practise without the appropriate
registration should be aware that
the GDC is tackling this issue robustly and will continue to prosecute in every appropriate case.
The Council’s priorities are public protection and professional
regulation.”
If you would like to report
someone you believe to be practising illegally you can do so by
sending an email to illegalpractice@gdc-uk.org, by writing to
Illegal Practice, The General
Dental Council, 44 Baker Street,
London, W1U 7AL or by calling
0845 222 4141. DT

Colgate® Sensitive Pro-Relief ™ with Pro-Argin™ Technology is the first toothpaste that is clinically proven to provide instant & lasting sensitivity relief 1- 6 :
• Instant relief when applied directly to the sensitive tooth with the ﬁngertip
and gently massaged for one minute1
• Clinical studies demonstrated signiﬁcantly greater sensitivity reduction
with twice daily brushing compared to control toothpaste with potassium ions4
• 1450 ppm ﬂuoride for caries prevention
• Contains the Pro-Argin™ Technology
as in the Colgate® Sensitive Pro-Relief™
Desensitising Polishing Paste
Colgate® Sensitive Pro-Relief™ Toothpaste
for the daily oral care of sensitive teeth
1 Nathoo S et al J Clin Dent 2009; 20 (Spec Iss): 123-130
2 Ayad F et al J Clin Dent 2009; 20 (Spec Iss): 115-122
3 Schiff T et al J Clin Dent 2009; 20 (Spec Iss): 131-136

Colgate Customer Care Team: 01483 401 901

4 Docimo R et al J Clin Dent 2009; 20 (Spec Iss): 17-22
5 Ayad F et al J Clin Dent 2009; 20 (Spec Iss): 10-16
6 Docimo R et al J Clin Dent 2009; 20 (Spec Iss): 137-143

www.colgateprofessional.co.uk

[4] =>

4 News

United Kingdom Edition

July 19-25 2010

Welsh hospitals ban sugar
in tea and coffee

S

ugar has been banned
from tea and coffee sold
from vending machines in
hospitals across Wales, because
it poses a ‘risk to health; say
NHS chiefs.
Dried fruit, juice, seeds
and water have been recommended as healthier alternatives to vending machines
and cheddar cheese sandwiches have been banned as

they contain too much fat.
The ban is being put in place
as sugar in tea or coffee offers
no nutritional value, and can
have a negative impact on dental health.
A spokesman for the Welsh
Assembly Government said:
“Hospitals are visited by a very
broad cross-section of society
and, as such, the whole hospital

environment should reflect the
importance of healthy living.”
The Department of Health
has said it is not planning to follow the Welsh example.
Chief executive of the British Dental Health Foundation,
Dr Nigel Carter, called it ‘positive news that the NHS in Wales
is looking into ways to improve
dental health within hospitals’. DT

Tea, no sugar - Welsh hospitals to ban the sweet stuff

Vice dean of Kings College awarded fellowship

T

he vice dean of Kings
College London has been
made a fellow of the
college. Professor Stephen Challacombe was given the award
in recognition of his service
to the college and its constituent schools and for his contributions to dental research.
He said: “I am very pleased
that my work and that of my col-

leagues who have made my time
so enjoyable has been recognised
by the college and consider this
award a great honour both to
myself and the Dental Institute. I
hope that the Institute can continue to be one of the leading schools
within King’s College London.”
During his tenure with Guy’s
Hospital Medical and Dental
Schools, UMDS and then the

Dental Institute of King’s College London, Prof Challacombe
has served on the Governing
Councils of Guy’s, UMDS and
King’s as well as numerous
other administrative roles, most
recently as dean of External
Affairs of the King’s Health
Schools, chairman of the King’s
Science
Academic
Promotions Panel and vice dean of the
Dental Institute.

He has been author or coauthor of more than 200 peer
reviewed papers and 160 other
publications on mucosal immunity; immunological, dermatological and microbiological aspects of oral diseases and
oral medicine, and has been
editor or co-editor of seven books, as well as having
supervised
20
PhD
and MD theses.

His work has been recognised
by his election to the presidencies of the British Society
for
Dental
Research,
the
British Society for Oral Medicine, the European Association
of Oral Medicine and the International Association of Dental
Research and by election to the
prestigious Academy of Medical
Sciences. DT

without the need to have their
own teeth removed often opted
for removable gold teeth.

reserved look for work or social functions, the look became
widespread.

“This gave them the ability
to put on and take out gold teeth
at will. Because it was possible
to display a rich smile while
going out but maintain a more

“Almost ten years later, however, the owners of these ‘fronts’,
as the temporary gold teeth are
called, have grown up and fashion has moved on.” DT

Cash for gold...teeth

P

eople in Britain are selling
their gold teeth and fillings
to a company that offers
cash for gold.
Gold fillings cost 10 times
more than other fillings such
as amalgam and composite fillings. Therefore, many people

are opting to sell their gold teeth
for cash to gold companies and
getting alternative fillings.
The
company
Postgoldforcash.com, as well as receiving old fillings, has also
received many temporary gold
teeth.

A spokeswoman for the company said: “Gold front teeth were
one of the fashion fads of the early noughties.
“While some celebrities actually went so far as to have their
gold teeth permanently attached
to existing teeth, ordinary people

Winchester City Football Club
gets extended sponsorship deal

D

enplan has extended its
five-year sponsorship of
Winchester City Football Club in a deal that secures
the future of the club through to
2012.
The club will continue to be
called the Denplan City Ground.

Steve
Gates,
managing
director of Denplan, said:
‘Denplan is delighted to be
part of the continued success of the club as it aims to
build on its run of eight unbeaten games at the end of
the season to secure promotion
in 2011.’

He added: ‘As a company we
believe it’s important to support activities in the local community that make Winchester a
vibrant place to work. Our support of this and other community projects around Winchester demonstrates our continued
commitment to the city.’ DT
Denplan FC - Winchester City gets corporate boost

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

[5] =>

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[6] =>

6 Event Review

United Kingdom Edition

July 19-25, 2010

Unlocking the secrets

Dental Tribune attended the truly global International Symposium on Dental
Hygiene, held in Glasgow’s SECC in July

he international Symposium on Dental Hygiene,
held at the SECC in
Glasgow, was a truly global
event with more than 1300 delegates attending from all parts of
the globe.

The conference was well supported by the trade, with more
than 50 companies taking exhibition stands.

With a host of speakers covering a wide range of topics
it really was difficult to choose
which lectures to see! Speakers included Prof Iain LC Chapple, Prof Christof Dörfer, Warren
Greshes, and Prof John Thomas.

With so much to see, I managed to attend a few lectures,

including Warren Greshes’ Adding value to the dental practice
and Patient centred therapy and
outcomes: effective management
of dentine hypersensitivity by
Prof Philip Preshaw and Dr Martin Ashley. However, one of the

Prof Lewis is professor of oral
medicine and associate dean
for post graduate studies in the
school of dentistry and Cardiff
University. He is also dean of the
dental faculty and vice-president
of the Royal College of Physicians and Surgeons of Glasgow.
With more than 200 scientific
articles published and six medical textbooks co-authored, it is
no surprise that Prof Lewis’ lecture was packed with delegates
eager to hear how they can help
their patients suffering from
dry mouth.

80% extra protection

against future acid erosion1

The lecture began with Prof
Lewis setting the scene with his
alternative title Unlocking the secrets of saliva. He explained that
his aim was to inform delegates:
Where saliva comes from; Components; What it does; Effects
of reduced salivary production;
Causes of xerostomia; What can
be done to help patients.

Studies show that the combination of Sensodyne Pronamel
daily toothpaste and Sensodyne Pronamel Daily Mouthwash
can provide up to 80% extra protection against future acid
erosion.*1 Sensodyne Pronamel Daily Mouthwash is an
alcohol free 450 ppm fluoride mouthwash with tri-hydra™
polymers, which help build more protection against acid

Where saliva comes from
Prof Lewis explained that there
are three major paired glands
which produce 95 per cent of saliva: the parotid (60 per cent), the
submandibular (30 per cent) and
the sublingual (five per cent).
The rest is produced by more
than 600 minor or accessory
glands mainly found in the lips,
cheek and palate.

erosion than standard fluoride mouthwashes.2-4

* compared to brushing with Sensodyne Pronamel
daily toothpaste alone

The real interest for me is
how saliva is made up. Having
always thought of saliva as a single secretion, I was surprised to
discover that it is a mix of two
secretions; serous and mucous.
The serous saliva is mainly watery and is primarily produced
by the parotid glands; the other
glands are responsible for the
production of the more viscous
mucous saliva. The content and
consistency of a patient’s saliva
is then dependent on flow rate;
this is where the causes and effects of reduced salivary flow
come into their own.

For patient samples visit
www.gsk-dentalprofessionals.co.uk
References:
1. GlaxoSmithKline data on file Guibert et al 2010.
2. Fowler C et al. J Den Res 88 (Spec Iss A): 3377, 2009.
3. Gracia L et al. J Den Res 88 (Spec Iss A), 3376, 2009.
4. GlaxoSmithKline data on file Young and Willson 2008.

Cause and Effect
Prof Lewis detailed how salivary
flow rate is neurally controlled
– it is excited by taste and mechanical stimuli but inhibited
by feelings such as anxiety. With
its importance in functions such
lubrication for speech, a buffer
against acid attack, cleansing antimicrobial actions etc, a reduced
flow rate soon manifests as a
problem. Symptoms often mentioned by patients include a lack

SENSODYNE and PRONAMEL are registered trade marks of the GlaxoSmithKline group of companies.

RECOMMEND PRONAMEL PROTECTION FOR YOUR PATIENTS

SM1836_2 PN Mwash ad LONG.indd 1

stand-out lectures for me at the
Symposium was Prof Michael
Lewis’ presentation The role of
the dental hygienist in the diagnosis and management of dry
mouth in association with GSK.

4/6/10 10:44:37

[7] =>

Event Review 7

United Kingdom Edition July 19-25,
12-21, 2010

A4 - Pdf Ripper.qxd:Text pasting Document.qxd 13/04/2010 11:26
often stick to the buccal mucosa
if there is reduced saliva) etc);
salivary flow rate tests; haematological tests (especially important for diabetes diagnosis);
sialography (the infusion of a radio-opaque contrast fluid into the
gland which will the reveal any
defects in a radiograph); labial
gland biopsy (very effective in
diagnosing Sjögren’s Syndrome).

For more information contact your
Dealer or call SHOFU today on
01732 783580
SHOFU U K

Riverside House, River Lawn Road,
Tonbridge, Kent TN9 1EP UK
Tel: 01732 783580 Fa x : 01732 783581
Emai l: sales@shofu.co.uk
Web: www.shofu.co.uk
© 2006 SHOFU Dental Products Ltd. E & OE

Failing restorations and dental caries are often seen in patients suffering from dry mouth.
Image courtesy of Professor MAO Lewis, Cardiff University

Collecting saliva. Image courtesy of Professor MAO Lewis, Cardiff University

of taste; difficulty in swallowing;
increased effort when speaking.
As clinicians, immediate signs
manifesting in the mouth include
no saliva pooling in the mouth;
frothy or cloudy saliva; sticky/
erythematous mucosa; atrophic
tongue dorsum; candidosis; angular cheilitis. One big marker
for xerostomia, explained Prof
Lewis, is the occurrence of cervical caries and failed restorations.

Undiagnosed or poorly controlled diabetes: dry mouth is
an often forgotten marker for
diabetes, caused by increased
blood sugar levels resulting in
fluid loss.

Xerostomia is often a complaint from patients with underlying causes, including:

Absence of salivary glands: this
has been reported but is an extremely rare condition.

Drugs: many prescribed medications have dry mouth as a side
effect. Drug categories including
tricyclic antidepressants, antihistamines, diuretics and sedatives
are all associated with causing
dry mouth.

Investigating xerostomia
Moving from the theoretical,
Prof Lewis then discussed what
clinicians can do for patients
presenting with dry mouth in
their surgeries. He stressed the
importance of investigation into
the causes of dry mouth for
that patient, to ensure any underlying condition has been identified or particular medication use
is explored.

Sjögren’s Syndrome: This immunological condition is characterised by the destruction of
glandular acini, part of the salivary production process.
Radiotherapy: Salivary tissue is
extremely sensitive to radiation,
so patients receiving radiotherapy for malignant disease can find
their salivary flow compromised.

Dehydration: reduction in general fluid level will naturally decrease salivary flow – after all,
saliva is made of 99.4 per cent
water!

Means of investigation can
include clinical exam (discussion with patient, appearance
of patient (ie face, hands, gait),
appearance of saliva, ‘mirror
sticks test’ (a dental mirror will

Diagram illustrating location of the major salivary glands. Image courtesy of Professor
MAO Lewis, Cardiff University

Managing xerostomia
Once the cause of the condition
has been indentified it can then
focus the minds of both clinician
and patient on how to manage it,
commented Prof Lewis. For example, it may be possible to suggest a change in medication to
one that does not list dry mouth
as a side effect; or a diagnosis of
diabetes should see improved
glycaemic control on behalf of
the patient and a resolution of
dry mouth symptoms.
There are many salivary
substitutes which can be recommended, many of which are
listed in the British National Formulary and so can be prescribed.
Prof Lewis described a few of
them, plus the benefits and disadvantages of using them. The
most graphic disadvantage was
for Salinum, which was described as ‘like licking a cricket
bat’! Oral care systems such as
the Biotène range has proved
very popular with patients due to
its formulation and ease of use.
Prof Lewis also discussed
other helpful measures such as
chewing sugar-free gum, use of
systemic salivary stimulants, frequent sips of water to maintain
hydration levels, oral health regime including the use of a daily
fluoride rinse and twice daily
brushes and the limitation of
the intake of alcohol and coffee.
One anecdotal measure he mentioned was a daily one gram dose
of evening primrose.
Conclusion
Professor Lewis’ easy delivery
style and obvious enthusiasm
for the subject matter made this
lecture a resounding success for
me. It was both informative and
practical, allowing delegates to
really think about the diagnosis
and management of xerostomia
in patients as well as highlighting once more how the oral cavity can be a window into the overall health of the human body.
Also congratulations to the
British Society of Dental Hygiene
and Therapy, who in association
with the International Federation of Dental Hygienists put on
a fantastic conference. Every delegate I spoke to over the two days
I attended were full of praise for
both the scientific programme
and the social programme, and
are already looking forward to
the next ISDH in two year’s time
in Cape Town, South Africa. DT

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[8] =>

[9] =>

United Kingdom Edition July 19-25, 2010

Who is in control of
your future profits?
asks Seema Sharma

I

t looks like £60-£80 billion of
NHS funds may be handed to
general practitioners by the
conservatives, making them responsible for their own budgets
and cutting out layers and layers
of middle management.
Responsibility will be handed
to GPs working in local groups,
who will commission services or
provide them by working in rotas
with each other. The health secretary Mr Lansley believes that
if GPs are responsible for their
own budgets and have to commission out-of-hours care, most
will decide to go back to offering weekend and evening cover
themselves or in local groups.
At present, funds are given by
the Government to PCTs, which
pay for patients from their area to
be treated in hospital. Under new
plans, GPs — who are currently
not responsible for paying for
hospital referrals — would receive
the money instead and pay the
hospitals directly for each patient
they refer!
As dentists, we have spent
the last three years bemoaning
the UDA system and the general
lack of understanding of what it
costs to run a successful dental
practice. What would happen if
we were given the same opportunity as GPs? Is there a glimmer of
hope that we might hold our own
funding too in the future, and if
so would we be able to show the
world that in the hands of clinicians, dentistry would make the
headlines for the right reasons
instead of the wrong reasons?
Last year, my PCT Tower
Hamlets set up the first dental
practice-based
commissioning
group in the country, of which I
am co-chair. It has been a journey
of revelation for my colleagues
and I, and we have realised the
opportunities are enormous, as
are the responsibilities. If dentists were entrusted as clinical
commissioners and we came to
realise that huge chunks of our
budgets were being gobbled up
by specialist opinions for patients
with three mm overjets, or periodontal opinions for patients with
localised gingivitis, might we be
tempted to explore ideas to keep
more patients (and some of that
funding) in our practices?
Perhaps we could develop a
GDP budget for in house IOTN
screening and upskill ourselves.
Perhaps we would allocate funds
for DCPs to work on the NHS in
general practice, freeing the dentist up to concentrate on more

technical work and reserving expert hospital care for those with
more severe periodontal disease.
Alternatively, we might prefer to
concentrate on funding innovative children centred schemes
and establish joint initiatives
with midwives, health workers,
schools and children’s centres, to
get to the heart of dental prevention from a young age. Perhaps
we would buy in fluoride toothpaste for dentists to give away,
knowing it was the most effective
antidote to caries.
For some time we would still
have to concentrate on the ravages of damage that already exist
in our ageing population and incentivise the use of dentists with
special interests and specialists
in primary care. This would bring
higher skills and funds into practices, and provide patients with
a better choice of services under
one roof. Perhaps we would fulfil the access dream by taking
turns with colleagues to provide
evening and weekend care, instead of offering to keep nurses
at work, away from their children
until 8pm every night, in our desperate bid to win NHS tenders.
Would we spend huge amounts
on performance management
or would we move from a stick
based to a carrot based approach?
In fact any and all of these
are possible – we could do things
differently, we could do different
things and we could do things
for different people – and all of
them could work if they were correctly funded.
The reality in any dental
practice is that if we get practice
revenue numbers right, cutting
salaries and personnel costs and
causing disenchantment throughout the practice would not be necessary. Practices have base costs
which are impossible to circumvent – the fixed costs of equipment and premises, and those of
compliance and a core complement of staff.
The financial profile of a dental practice is not rocket science.
Sadly, when figures of 25-40 per
cent profit are reported, and dentists are considered greedy, a little investigation shows financial
naivety not greed, clinical hats
not small business hats, and an
inability on the part of the assessor to interpret practice figures - a
job that accountants and practice
valuers could probably do on the
back of an envelope.
Many dentists own the
premises they work in – if they

rented their premises to another dentist to run the practice,
as landlord they would receive
rental income from their investment in property, and the tenant would show a lower practice
profit. However because practice
owners do not charge themselves
rent, they mistakenly count the
“rent savings” as “dental practice
profit”, when it is actually direct
return on investment in property
and nothing to do with the practice per se.
The other source of extra perceived “profit” is a direct result of
practice owners providing a significant chunk of clinical services
themselves. Often the practice
owner working in the business as
a clinician throws his own blood,
sweat and tears into the profit arena too, so dentists are horrified to
learn that if they paid themselves
the same rate they paid their associates, the profit figures for the
practice would look unsustainable. This dependence on the owner of the practice has resulted in
smaller practices being particularly hard hit recently. Along with
the economic crisis, the reality of
reallocating work to DCPs, reallocating clinical time to unfunded
administration, or engaging more
experienced managers is an impact on the bottom line.
Would you like to increase
your revenue streams, prepare
for a new way of working under the new government, meet
the regulations of Care Quality
Comission and be in control of
your own profits? Email the author at seema.sharma@dentabyte.co.uk or log onto www.
dentabyte.co.uk to find out more
about our PEP conference on 1st
October 2010, when Seema, Andy
Action of Frank Taylor Associates and Kevin Lewis of Dental
Protection will take you through
the secrets of succeeding in the
changing clinical and commercial environment by “pepping up
your practice”! DT

About the author
Seema
Sharma
qualified as a dentist but gave up
clinical work after
10 years in practice
to go into full time
practice management. Today she
runs three practices, including one
which is a multi-disciplinary specialist
centre. Seema established Dentabyte
Ltd to provide affordable “real-world”
practice management programmes to
help practice managers and practice
owners keep pace with the changing
clinical and commercial environment
facing them today. Visit www.Dentabyte.co.uk to register for updates on
practice management or email Seema
at seema.sharma@dentabyte.co.uk to
find out more.

Feature 9

[10] =>

10 Feature

United Kingdom Edition July 19-25, 2010

The 10th dimension… the power of ten
Ed Bonner and Adrianne Morris consider the ways to alleviate stress

he American Institute of
Stress estimates that an
element of stress is related to 75 to 90 per cent of visits to primary–care doctors. It is
likely that being a professional
of any sort carries with it a fairly
high level of stress, and it is also
likely that dental professionals are in the top percentage of
stressed professionals. Stress can
manifest physically: headaches,

shoulder and neck ache, nausea
and stomach disorders are just
some of the symptoms; it can
also manifest at a psychological
or mental level through anxiety
or depression.

to be in our interest to give the
whole notion of stress serious
consideration, not only as to how
we can protect ourselves, but
also how we can alleviate it for
others.

It would also be true to say
that the overwhelming majority
of patients who attend for dental
treatment arrive in a state of fearrelated stress. It seems therefore

Ten things we can do for ourselves:
1. Acknowledge it, but push on
2. Take medication

3. Exercise: strengthen our outer
core and maximise endorphin
response
4. Practice stress-relieving activities, such as yoga and meditation
5. Seek counselling
6. Seek medical help
7. Lifestyle change
8. Develop realistic rather than
unrealistic expectations of ourselves and others; perfectionism
is a very demanding taskmaster

9. Become less judgmental of
ourselves and others
10. Set realistic and attainable
goals.
For our patients, we can:
1. Treat patients: not only their
teeth, but develop an empathetic
attitude to our patients’ problems rather than a ‘what’s that
got to do with me?’ dismissive
approach
2. Inform before we perform, and
be honest at all times. Inform
them of benefits and risks, but
where possible, emphasise the
benefits
3. Avoid keeping patients waiting
– the notion and term ‘waiting
room’ is bad karma
4. Give everyone the respect you
would hope others would always
give you. Treat every patient as
you would a friend, and every
friend as you would a patient –
give more than they expect
5. Offer TLC in abundance
6. Create a pleasing and relaxed
ambiance and working environment – pleasant to the eye, smell
and ear
7. Cut out the fear of lack of physical safety
8. Keep up with all current ideas
and techniques for minimising
pain and implement these in
your daily practice
9. Approach every situation with
a sense of humour and a touch of
lightness, no matter how tricky
or unpleasant the circumstances
– teach your staff to do the same
10. Smile – often! DT

About the author
Adrianne Morris is a highly
trained success coach whose
aim is to get people from where
they are now to where they want
to be, in clear measured steps.
Ed Bonner has owned many
practices, and now consults with
and coaches dentists and their
staff to achieve their potential.
For a free consultation, or a complementary copy of The Power
of Ten e-zine, email Adrianne at
alplifecoach@yahoo.com or Ed
on bonner.edwin@gmail.com, or
visit www.thepoweroften.co.uk.

[11] =>

Endo Tribune
Endo Tribune

Endo Tribune

See what you
are missing...
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Doing the twist

Under the enamel

Beat the Bugs

Richard Mounce looks at twisted files

Diana Dumiriu discovers there’s more to teeth
than you think

Michael Sultan discusses ways to battle bacteria

page 12-14

pages 21-22

pages 15-16

New developments in
esthetic dentistry

Carl Zeiss
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Dr Michael B Miller reveals some secrets you may
not know about the new developments in esthetic dentistry

sthetic dentistry, which really
encompasses a major part of
many dental practices, continues to become more sophisticated in
this digital era. Unfortunately, with
this sophistication also comes complication. Everything we as clinicians
do today requires more thought, more
training, and more attention to detail
for success to follow. After reviewing
products and techniques for more
than 23 years for the Reality Research
Laboratory, I am always amazed how
little is known about new products
when they finally hit the market.
Constant pressure
Manufacturers are under constant
pressure to introduce products before they are really ready for use on
patients. One problem that continues
unabated is the almost universal issue of poor directions for use (DFU).
If a manufacturer cannot tell a clinician exactly and explicitly how to use
its product, then failures are bound
to occur.
Let’s take bonding agents as an
example. Most of these products perform optimally when the surface of
the preparation is left in a specific
moisture status. This means that if
you need to leave the preparation glis-

teningly wet, then you should be instructed by the manufacturer exactly
how to achieve that status. But too often, DFUs use ambiguous terms such
as “slightly moist” or “lightly dry”. In
the Reality Research Lab, we created
three, very specific protocols for testing bonding agents. These protocols
are dry, moist, and wet, with each
protocol accompanied by clinically
relevant methods of achieving them.
If we can provide this information,
why is it that manufacturers continue
to keep us in the dark?
Curing light
Another minefield is the trend to cure
composites in only five to 10 seconds. One new curing light is even
making the claim that it will cure to
a five mm depth in only three seconds! While it may be possible to
cure a shallow Class V restoration
in 10 seconds using a light with adequate power placed virtually in contact with the restorative material that
is also sufficiently translucent, it is
dramatically different when curing
a material at the bottom of a Class II
proximal box.
In the latter situation, our tests
are very definitive – extended curing
times of usually 40 seconds are still

necessary to achieve a proper cure. I
feel that it is irresponsible for manufacturers not to give clinicians this
information, but it’s even worse when
the manufacturers don’t even test this
scenario before making the claim.
The three-second cure claim is even
more absurd!
On the other hand, there is also a
trend to simplify procedures. Product categories that typify this trend
include self-adhesive, resin cements,
one-component, self-etching bonding
agents, and self-adhesive restorative
materials. While it is laudatory for
manufacturers to try to give us products that are easier to use, our tests
show you usually don’t get optimal
performance out of these “advances”. In my way of thinking, a simple
procedure is only better than a more
complicated one if the results are at
least on par. Why would you deliberately perform a procedure knowing
you are going to get worse results?
Too good to be true?
What all this means for clinicians is
that the old cliché still applies – if it
sounds too good to be true, it probably
is. Remember that no manufacturer is
going to show up at your office, compensate you for having to replace a
failed restoration, and tell the patient
that it wasn’t your fault. That’s nirvana, not reality! DT

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About the author
Dr Miller is a Fellow of the Academy
of General Dentistry,
a Founding and Accredited Member, and
Fellow of the American
Academy of Cosmetic
Dentistry, and has
memberships in the International Association of Dental Research, Academy of Dental
Materials, and Academy of Operative Dentistry. He is also a founding board member of the
National Children’s Oral Health Foundation,
which is dedicated to fostering the development of local dental heath and education facilities for underserved children. In addition,
Dr Miller is the co-founder, President, and
Editor-in-Chief of Reality and maintains a
dental practice in Houston, Texas.

For details of Carl Zeiss and our wide range of other
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Web: www.voroscopes.co.uk

[12] =>

12 Endo Tribune

United Kingdom Edition

July 19-25, 2010

Using a New and InnoFlexibility is our Strength vative Technology for
Routine Endodontics:
The Twisted File
Richard Mounce looks at the use of twisted files in
treatment for patients

T

he goals of canal preparation
are:
• To leave the minor constriction (MC) of the apical foramen
in its original position
• To leave the MC at its original size
• To leave the canal in its initial
position and only enlarge it as described here
• To optimise the taper of the prepared canal for ideal irrigation and
obturation hydraulics
• To prepare a tapering funnel from
orifice to apex with narrowing cross
sectional diameters
• To prepare a taper that achieves the
above objectives without risk of perforation and long-term vertical root
fracture
While a comprehensive description of previous systems used to
achieve these objectives is beyond the
scope of this article, one new method is described here - the Twisted
File (TF) (SybronEndo, Orange, CA,
USA). TF allows these objectives to
be achieved with the least number
of instruments and fewest insertions
of any rotary nickel titanium (RNT)
system currently available. Evidence
exists in the scientific endodontic literature that TF provides the greatest
flexibility, fracture resistance and
cutting ability of any commercially
available system.
Clinical Considerations in the
Use of the Twisted File
• TF is inserted passively to resistance. The file should always be either
inserted or withdrawn but never held
stationary in the canal
• TF, as with all RNT files, should be
used with copious irrigation
• Irrigation and recapitulation should
follow every insertion
• The flutes of TF should be wiped
clean after every insertion
• TF insertion should be a smooth
and continuous single insertion that
lasts two-three seconds followed by
withdrawal. The file is not pumped
up and down into the canal
• TF can be rotated at 500-900 RPM
and can be used with any electric
motor desired with or without torque
control
Clinical Use of the Twisted File
As mentioned above, TF requires
fewer files, fewer insertions and allows the preparation of larger tapers
and master apical diameters than
many other systems. It does so safely

Fig 1: Clinical cases treated with Twisted Files* in the manner described in the article using RealSeal*
master cones via the Elements Obturation Unit* and SystemB technique.

Fig 2: Clinical cases treated with Twisted Files* in the manner described in the article using RealSeal
One Bonded Obturators.*

and predictably as described with the
following steps:
• An estimate of the true working
length is made before starting the
treatment. This is known as the estimated working length (EWL)
• Access is a straight line and all canals are located before commencing
orifice shaping
• The cervical dentinal triangle is
removed using the .08/25 TF with a
brushing motion up and away from
the furcation. The intention is to remove the cervical dentinal triangle,
define the orifice, and provide efficient tactile control over the subsequent insertion of hand K files (HKF)
into the root
• Using TF, after orifice shaping, the
clinician should achieve apical pat-

ency with a small HKF (usually a #6
or #8 HKF). A #6 HKF is often the first
file to routinely achieve or verify apical patency. This #6 HKF is optimally
precurved with the EndoBender* pliers, a modified orthodontic pliers,
which delivers the desired curvature
to the HKF. Curved canals are more
effectively negotiated using curved
HKFs. HKFs used for achievement of
patency are inserted gently and passively with an intention to find the canal path. At this stage in the process,
HKFs are used only to obtain patency
and not to shape the canal. In a complex three-dimensional curvature
and/or calcified canal it may take a
number of insertions at different angles to obtain patency, especially if a
blockage is present.

[13] =>

EndoTribune 13

United Kingdom Edition July 19-25, 2010

• Once the first HKF reaches the
EWL, the clinician should attempt to obtain a true working
length (TWL) with an electronic
apex locator (EAL). It is important that if the clinician is mentally focused on the resistance of
the HKF, they may feel a tactile
‘pop’ as the HKF passes through
the MC. This tactile sensation
should correlate quite accurately
with the measurements of the
TWL obtained by the EAL.
After apical patency is obtained, reciprocation can be invaluable in making the canal
ready for TF (and all RNT files).
Reciprocation is the non-rotational movement of a HKF moving, for example, in a 30-degree
clockwise and 30-degree counter
clockwise motion. This action is
a highly efficient means to enlarge a canal from a #6 HKF to
a #8 HKF size, a #8 HKF size to
a #10 HKF size, etc. One means
of delivering reciprocation to a
HKF is the M4 Safety Handpiece.*

tions until the TWL is reached.
in large roots, as defined above,
If excessive pressure is required
a .10 TF can be inserted to the
to move the .08/25 TF down the
TWL in approximately threecanal, the .06/25 TF should be
four insertions. In more interused instead in tandem with the
mediate sized roots, this means
.08/25 TF. If the .06/25 TF rea .08 TF can be inserted to the
quires more pressure to insert
TWL in approximately threeapically than desired, the .04/25
four insertions. In more complex
TF can be used in tandem in the
roots, this means a .06 TF can be
sequence of .08/25, .06/25 and
inserted to the TWL in approxi.04/25 TF. In any event, TF (and
mately three-four insertions. If
all RNT files) are used primarily
a .08 taper is the final taper decrown down to prepare the basic
sired, generally, if the canal will
endo inno III uk_europe 10 july_Layout 2 6/30/10 9:23 AM Page 1
taper, that is, from larger tapers
accept the single .08/25 TF file,
and tip sizes to smaller. If for exit is used with successive inser-

• Prior to starting treatment, the
clinician should decide what the
final anticipated taper of the root
will be and have some reasonable idea of the anticipated master
apical diameter. With regard to
taper, large roots are usually prepared to a .10 TF taper. Medium
sized orifices and roots are usually prepared to a .08 TF taper.
Small and highly curved roots
are usually prepared to either a
.08 or a .06 TF taper.
• To prepare the basic taper of
the final preparation, TF is used
in diminishing tapers to the
TWL. Generally, this means that

• To prepare the ideal master
apical diameter, TF is used step
back, ie from smaller tip sizes to
larger. With TF, this means that
the .06/30, .06/35 and .04/40 TF
are used in succession from the
apex up. Because each of these
files is only cutting on its tip,
generally these files will reach

EndoInnovations III

the apex in one insertion.
• After preparation, the canal
is irrigated, the smear layer removed and the canal dried and
obturated as per the clinicians
chosen technique. Irrigation can
be optimised through the use of
either ultrasonic activation (MiniEndo*) or negative pressure
(EndoVac II, Discus Dental, Culver City, CA, USA) depending on
the clinician’s preferences. The
EndoVac II uses a macro cannula
à DT page 14

FEWER FILES.
LESS WASTE.

SybronEndo offers you advanced technology for safer,
more efficient procedures.

‘TF requires fewer
files, fewer insertions and allows
the preparation of
larger tapers and
master apical diameters than many
other systems.’
Clinically, to use M4 reciprocation for the initial enlargement
of the canal, the HKF is inserted
to the TWL. The HKF is left in the
canal and while under the rubber dam, the M4 is attached onto
the file handle. Using a one-three
mm amplitude movement for 1530 seconds, the HKF is reciprocated. The M4 attachment fits
into any E type attachment on an
electric endodontic motor at 900
RPM at the 18:1 setting. Using
the M4 clinically, in 15-30 seconds, reciprocating the #6 HKF
placed to the TWL will create the
diameter of a #8 hand file in the
manner described here. Because
reciprocating the #10 HKF creates the diameter of a #15 HKF,
the canal is ready for TF shaping.
Dentin debris produced by the
M4 is routinely channelled onto
the pulpal floor where it can be
easily irrigated away.

ample, the .06/25 was the first
file in this sequence to reach the
TWL, the .08/25 TF can inserted
again to prepare the larger taper
(.08 taper versus .06) as desired.

REALSEAL 1 Warm-Bonded
Obturator
All the components of RealSeal 1™ –
sealer, filler and core – are resin-based
materials that chemically bond with
each other to form a superior seal. As
an added benefit, this system’s core is
engineered to be easily seen on a
radiograph.

EXTRAORDINARY FLEXBILITY – TF® files from
SybronEndo are up to 70% more flexible than other
rotary NiTi files.* The proven design of TF significantly reduces file breakage and allows you to work
with greater efficiency and confidence.
TF REQUIRES JUST 1, 2 OR 3 FILES FOR MOST
CASES – TF’s variable pitch design and improved
surface finish ensure fast, ideal canal shaping
every time.
CONFIDENCE IN ENDODONTICS – TF provides
unsurpassed safety and ease of use.
*Data on file, Sybron Dental Specialties, Inc.

< This case required just 1 file.
For a copy of the Single TF File
Technique by Dr. Mounce, email
keith.morgan @ sybrondental.com

Everyday Endo
SybronEndo Europe, Basicweg 20, 3821 BR Amersfoort, The Netherlands
tel: +31 33 4536 159 fax: +31 33 4536 153 email: endo@sybrondental.com
UK local number 01442 876 002 or email keith.morgan@sybrondental.com
©2010 SybronEndo

[14] =>

14 Endo Tribune

United Kingdom Edition

July 19-25, 2010

Fig 5: The M4 Safety Handpiece*

ß DT page 13

and a micro cannula to remove
gross debris and fine canal debris; that has been flushed from
the canal by the action of pulling
irrigants down the canal as they
are simultaneous expressed in
the pulp chamber with a syringe.
In any event, ultrasonic and
negative pressure irrigation has
been shown to provide a statistically significant improvement
in canal cleanliness, especially
when compared to passive syringe irrigation.
FAQ:
Can I use TF with any commercially available electric
motor?
TF can be used with any electric
motor.
What is optimal rotational
speed for TF?
500-900 rpm.
Do I need to use torque
control?
Using torque control is a matter
of personal preference.
Can TF be used for retreatment?
Yes, TF can be used to remove
gutta percha and can grind out
the plastic of carrier-based systems if the action is performed
correctly.
How do I obturate TF preparations? What master cones do
I use and how do I match my
preparations with these master
cones?
TF preparations are obturated
exactly as any other preparations. I use bonded obturation
in the form of RealSeal* Master
Cones and RealSeal One Bonded obturators*. When using the
master cones, I trim the .06/20
RealSeal Master cones and
downpack them with the SystemB technique via the Elements
Obturation unit*. If for example
the master apical diameter is
an ISO tip size #50 preparation,
five mm are trimmed from the
end of the .06/20 master cone to
provide a master cone with an

tip diameter of .5 mm. RealSeal
has been shown in in-vitro and
in vivo studies to reduce coronal
leakage across the totality of the
canal relative to gutta percha.
How does the use of TF differ
from other RNT files?
Are not all RNT files the same?
In many canal anatomies, the
entire preparation can be made
with one single file, the .08/25
TF if the master apical diameter
chosen is a #25. In more complex anatomies, the .06/25 may
also be needed to prepare the
basic taper. As mentioned above,
these files are introduced crown
down, from larger tapers and tip
sizes to smaller to prepare the
basic taper of the canal. Once

‘Ultrasonic and
negative pressure
irrigation has been
shown to provide a
statistically significant improvement
in canal cleanliness,
especially when
compared to passive
syringe irrigation.’
the basic taper is prepared, the
master apical diameter can be
enhanced. If, for example, the
clinician were preparing a #50
master apical diameter the clinician would prepare the master
apical diameter with the .06/30,
.06/35, .04/40 and .04/50 TF in
succession. The insertion of
these additional files to enhance
the master apical diameter occurs with one insertion of each
of the instruments after the basic
preparation is made.
TF can prepare larger tapers
more rapidly with fewer files
and fewer insertions than files
manufactured by a traditional
grinding process. Routinely, this
means that for an average molar

Fig 4: The Twisted File*

tooth, the final prepared taper
will be .08 and the master apical
diameter is easily prepared as
described above. A .08 taper can
be prepared with one .08/25 TF
file in approximately 75 per cent
of the clinical cases encountered,
with the .08/25 and .06/25 in 20
per cent of clinical cases encountered and the .08/25, .06/25 and
.04/25 in five per cent of clinical cases encountered. In the
creation of the basic taper, each
file needs usually no more than
three-four insertions to reach the
TWL. As mentioned above, the
preparation of the master apical
diameter is performed with one
insertion of each of the instruments designed for this purpose
(.06/30, .06/35, .04/40 and .04/50
TF).
How important is it to have a
glide path?
TF is not to be used without first
assuring patency, preparing a
glide path and/or without lubrication. Using the M4 Safety hand
piece attachment, reciprocating
the #10 HKF provides the initial
minimal diameter of a #15 HKF.
In essence, once the #10 HKF is
reciprocated, the canal is ready
for TF preparation.
Can TF be blended with
other RNT systems?
Yes, but there is no reason for
incorporating other files into the
TF technique. TF is an independent system. For many canals, as
described, a single TF file can
prepare the entire canal if the
glide path is prepared correctly.
This article has described a
new RNT file manufactured by
twisting NT while in the rhombohedral crystalline phase configuration. Emphasis has been
placed on glide path creation,
copious irrigation, lighting and
magnification as well as the efficiency, safety and predictability
of TF canal preparation as evidenced by the increased tapers,
master apical diameters as well
as fewer insertions and files
needed for canal preparation. I
welcome your feedback. DT
*SybronEndo (Orange, CA,
USA)

About the author
Dr. Mounce is the author of the nonfiction book Dead Stuck, “one man’s
stories of adventure, parenting, and
marriage told without heaping platitudes of political correctness.” Pacific
Sky Publishing. DeadStuck.com. Dr.
Mounce lectures globally and is widely
published. He is in private practice in
Endodontics in Vancouver, WA, USA.
Fig 3: RealSeal One Bonded Obturators*

[15] =>

United Kingdom Edition July 19-25, 2010

Endo Tribune 15

What’s inside a tooth
A tooth, you would think, is a pretty simple structure. But take a look inside and
you will be amazed at what you find, says Diana Dumitriu

ooking inside a tooth and
you will see that pulpal
space is not a simple hollow space and root canals are not
straight tubules, but rather complicated anatomical structures
with intricate communications
and ramifications.
The thing I love the most
about endodontics is that it is a
great game of imagination. Most
often, the only images we have
are radiographs – CBCT images are still not widely available
¬– so we have two-dimensional
images of complex three-dimensional objects. It is advised to take
at least two radiographs from different angles before any root canal treatment is carried out, but
you will still be only getting mere
hints of the configuration of pulpal space. The rest is your imagination based on knowledge and
experience.

Lower lateral incisor, mesial view 1

Having mentioned my love
of endodontics, I enrolled in a
master’s degree at Warwick University – after all, what is life
without a master degree? This
is a new programme only in its
first year, with strong European
roots. Along with the first assignment, we have been taught how
to clear teeth according to professor Castellucci’s protocol. That is,
how to make natural extracted
teeth transparent after staining
the pulpal space with India ink
or methylene blue. Not only have

Upper first molar , mesial view 1

we been taught to clear the teeth,
we have also benefited from a
photography lessons from a professional photographer, which
really boosted my photography
skills. The results are the photos
with this article.

Endodontic failures
Missed anatomy is the main
cause of endodontic failure. Often, the entire root canal or a
significant part of it is not instrumented, disinfected and filled,
thus enabling microbes to thrive

in the endodontic space and
consequently form an abscess
of the periapical area leading to
endodontic failure. A canal
may be left untreated because
the dentist fails to recognise
its presence. Understanding that

the root-canal system is complex
is essential.
One point that is perhaps
worth noting is the upper first
molar, the tooth with the most anà DT page 16

[16] =>

16 Endo Tribune

United Kingdom Edition

July 19-25, 2010

ß DT page 15

atomical variations. It has three
roots and can have up to seven
canals. Most often it has four root
canals, two root canals on the
mesial-buccal root (up to 95.2
per cent according to research),
but sometimes it has three mesio-buccal root canals (see upper
first molar, mesial view 1).
Endodontists agree that only
magnification and illumination
(loupes and a microscope) enable the location of the MB2.
Without them and this root
canal could be located only in
18.2 per cent of the cases. Fortunately, the two mesial-buccal
root canals most often merge to
open in a single apical foramen,
but still not in all of the cases.
When a root contains two root
canals that merge, it is worth noticing that most often, the lingual
or palatal root has straighter access to the apex.
All oval roots should be
suspected of containing two
root canals with communications (isthmuses) between them,
sometimes fully formed other
times incomplete. Also, a canal
can split (see the lateral lower
incisor), sometimes canals can
split and rejoin again (see the
upper second premolar). There
are root canals that merge
inapproaching apex to open
in a single apical foramen
(see mesial root on the lower molar).

Upper second premolar mesial , older pt 1

Lower first molar , lingual view 1

cal foramen has an oval shape,
hence the need to enlarge the
root canal to a size superior to
the file used for apical gauging.
Calcification of the canal
Often with age we notice significant calcification of the root canals that makes root canal therapy more time demanding. This
is a real problem as we see an
ageing population retaining their
natural teeth and for sure they
have great expectations from
their dentist.
Notice the wide canals on an
upper premolar extracted from
a young patient for orthodontic reasons compared with an
upper premolar from an older
patient with a rather intricate
anatomy. Endodontic treatment
on a tooth of a young patient if
such a situation arises may seem
easier but in fact it is not, as special care must be taken because
apical constriction is absent
and over instrumentation and
overfilling may occur frequently.

Of great interest is the fact
If we deal with an oval cathat the apical foramen, the orinal located on an oval root, it is
fice where the pulp ends and the
wise to treat it as two separate
periodontal space begins, is very
canals with a communication,
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rarely located at the radiologic
to achieve the best shaping and
apex. Often it is located on a side
cleaning. Most often the api-

Lower first molar, mesial view 1

and is up to three mm from the
anatomical tip of the root (see
the lower molar both mesial and
distal root). Hence some root
fillings may appear short on
radiographs with a puff of sealer somewhere on the side of
the root.
To complicate the situation
even more, we have to be aware
of the presence of accessory
canals, which are branches of
the main pulp canal or chamber
that communicates with the exterior of the root. Among accessory canals are the furcal canals
(on behalf of which interradicular radioluscenscy on necrotic
teeth can be accounted).
Lateral canals are located on
the coronal third or middle part
of the root. They cannot be accessed or instrumented as most
often are horizontal from the
main root canal. With a thorough irrigation protocol they can
still be debrided and due to the
hydrodynamics of the root filling material, appear filled on
post-operational radiographs.
From the start, anatomy of
the tooth has perhaps the greatest importance in predicting the
success of endodontic therapy.

Of course, we all want good,
predictable results for our patients, so carefully evaluating pulpal space anatomy is of
paramount importance. This
factor dictates the choices of
therapeutic method for mechanical preparation, irrigation to
filling.
I have to admit that before
starting the master’s degree
course at Warwick, I thought
success in endodontics was
found in rotary files. And like
many others, I was hoping
to find a file that would
miraculously carry out all the
treatment Unfortunately, there
is no such thing. Perhaps the
greatest miracle of all is realising there are no miracles, at least
not in the medical world. It is all
about understanding biological
and evidence-based concepts, in
order to take the best decisions
for your cases.
Understanding
endodontic
anatomy has helped me tremendously. From the start, the access
cavity has to be extended so that
it can provide straight-line access
to the root canal. I think about
all the curvatures and figure
how much and where I need to
extend, bearing in mind that

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every canal has a degree of curvature. I now understand ribbonshaped canals, oval canals and
the need to adjust shaping and
filling techniques.
A challenging area
Root canal therapy is maybe
one of the most challenging areas of dentistry. It is important to
understand all the factors that
lead to success, to be able to give
our patients all the options and
help them make the best choice.
After all, our patients want
us to help them keep their
natural dentition their entire
life. And this is certain to make
them happy and bring a smile to
their faces. DT

About the author
Diana Dumitriu
graduated
in
2000 from Bucharest
Dental
School and has
worked in private
practice, also in
Bucharest, from
2001 to 2008. In
January
2008,
she started practising in UK. She has a special interest
in endodontics and is currently enrolled in the MSc course in endodontics at Warwick University and working at Chard NHS Dental Practice in
Somerset.

W
IN

Ze 2
rm n
at ig
t/S h
wi ts
tze
rla
nd

[17] =>

Endo Tribune 17

United Kingdom Edition July 19-25, 2010

Back to school
Ali Baloch tells Dental Tribune how the MSc in
Endodontics at Warwick University has been one
of the most positive steps in his career to date

Just as I was anticipating
things getting worse, the phone
rang. This turned out to be one of
the best moments of my week. It
was Dr John Hall from Warwick
Dentistry, part of the University
of Warwick, who wanted to discuss the application that I had
submitted to apply for a place on
Warwick Dentistry’s new MSc in
Endodontics programme.
After a telephone interview
with Dr Hall where we discussed
my background, current skills
and knowledge in more detail,
Dr Hall then advised me that I
had been selected for the course!
I was on cloud nine and could
not believe that I was going to be
part of one of the most prestigious institutions in the UK. This
didn’t just mean another degree;
it meant that I would experience
a huge learning and knowledge
opportunity from the experienced and well-qualified faculty
at Warwick.
Although driving 600 miles
every month just to get to the
University was slightly inconvenient, my passion for this field
helped me to shrug off such
problems. It was made easier
that the course is part-time, giving me the flexibility to fit the 10
taught days around my normal
working practice schedule.

gram, but my motivation kept
me going without any tiredness.
The faculty at Warwick
One the first day I was introduced to Course Leader, Prof
Liviu Steier. This meeting endorsed that I had made the correct decision in applying for the
MSc programme. Prof Steier has
a warm, welcoming and friendly
personality. He immediately put
me at ease and introduced me to
Mr Giampiaro Rossi Fedele and
Dr Sia Mirfendereski, the fellow
teaching faculty. I was also introduced to the course co-ordinator,
Mrs Rose Bradley, who was a
charming and helpful lady.
I was then introduced to my
fellow students, who came
from diverse backgrounds and
a wealth of experience. At that
point, I was concerned I would
the least experienced amongst
the group, but in reality the
teaching faculty and the experience of my fellow students, provided me with any help and support that I needed.
The course induction
The first few days gave us an induction. This involved taking the
tour of the University. I was impressed by the facilities of Warwick Dentistry, which included a
library, IT facilities and support,
student societies and accommodation to name a few.
Over the next few days, we
went through the course syllabus, which included guides and
explanations of the contents of
each year. Year one would consist of five modules and four
assignments. Each module had
theory sessions and a handson class.

I was really excited on my
first day at Warwick Dentistry.
The theory side of the course
There were rigorous classes
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Hands-on Sessions
As a clinician, the hands-on
content of the programme was
what I was most interested in.
To my satisfaction, I found that
each module had a hands-on
section spread over a full day.
These sessions involved working with state-of-the-art equipment, including microscopes.
This brought a new meaning
to my perceptions of endodontics, and I realised that microscopes make up an important
part of a root-canal treatment
armamentarium.
During these sessions, we
were introduced to different filing, ultrasonic and obturation
techniques. Some of these sessions were led by well-known
endodontists, who came from all
over the world to teach us on a
variety of modern concepts that
are used in endodontics today.
The best aspect of these
hands-on classes was the personalised supervision provided
by the teaching faculty. I was
by no means disappointed with
the sessions and feel that this
MSc strikes the perfect balance
between practical sessions and
theoretical knowledge.
Problem-based learning
This concept of teaching was
interesting and extremely effective. This meant that all the clinical scenarios that students came
across in their clinics and at the
hands-on sessions were high-

Trial kit of tips

Some of the radiographs from the latest hands-on demonstration

lighted and discussed in detail.
Prof Steier and Mr Fedele would
explain this under the light of
existing literature and their own
experience, further adding to our
knowledge as students.
Writing Assignments
During the first year, students
have to complete a total of four
assignments. These range from a
variety of practical to theoretical
tasks. These assignments were
useful as they were all purposebuilt and ensured definitive
learning and the achievement of
set goals.
Regional Training Centre
I believe that watching Prof Steier
and Mr Fedele perform endodontic treatments was the most valuable part of the course. This element consisted of five days, and
included a variety of simple and
more complex endodontic treatments at the regional training
centre at Wimpole Street, London. The regional training
centre is equipped with the latest technology for carrying out
advanced
procedures
and
teaching students. Every treatment session was followed by a
group discussion with an in-

depth analysis of the procedure.
My conclusion
I find myself extremely grateful
to have been given the opportunity to study for the MSc in Endodontics at Warwick Dentistry. I
am immensely satisfied with the
amount of learning that I have
received, and it has certainly
helped me to be more confident
in my field. I now feel that I have
a greater command of the field of
endodontics, which in turn helps
me to treat my patients in a more
effective manner. DT

About the author
Dr Aitazaz Ali Baloch
BDS (Hons) graduated with a distinction
in Orthodontics from
de’Montmorency College of Dentistry Lahore, Pakistan in 2004.
He worked at a multidisciplinary
group
practice in Islamabad
for a couple of years and developed
special interest in Endodontics and
Oral surgery. He moved to UK in 2007
and cleared his Overseas Registration
Exams. Dr Baloch then worked as an
SHO in Oral and Maxillofacial surgery at Aberdeen Royal Infirmary and
Southend University Hospitals where
he underwent training. He is now practising in Falkirk, Scotland as a Dentist
with special interest in Endodontics.
He is also a part time student in MSc
Endodontics at Warwick University.

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reading and individual reading.
The general reading consisted
of research papers on selected
topics, followed by group discussions. The individual reading
element involved assigning specific papers to students for reading, followed by presentation and
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t was a cold November morning in Falkirk, one of those
depressing days when things
weren’t likely to go my way. I had
been doing long hours for a week
so I was feeling drained, and to
make things even worse, I was
suffering with a fever too.

[18] =>

18 EndoTribune

United Kingdom Edition

July 19-25, 2010

A useful tool
Dr Paul Jones explains how CBCT can play an
important part in endodontics

W

3D ING 15-07-2008 9:57 Pagina 1

hen our associate took
a class on Cone Beam
CT (1), I said to myself,
why would an endodontist need
a CBCT? A few months later, I
had what I called my “aha moment”. I saw a CBCT taken by an

Colori compositi

oral surgeon on a patient I had
C
seen twice, but had been unable
to locate which upper posterior
tooth was causing her pain. It
was clear from the CBCT (Fig 2)
that the upper second molar had
a large periapical lesion that was

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sinus on my periapical images
(Fig 1). I was hooked. Now it was
clear why CBCT would be useful in my endodontic practice.
The more I use CBCT, the more
valuable it has become. Here are

Affordable
Cone Beam 3D.

Fig 1: PA which tooth?

some indications for using it in
an endodontic office.
Diagnosis and treatment
planning
Inconclusive
diagnosis
like
my first case, most of us occa-

Fig 2: CBCT upper second molar

sionally struggle with locating
the tooth causing the patient’s
symptoms. No tooth is any more
tender to percussion, palpation or mastication than any
other. Nothing shows on the
X-ray. The patient often can’t
even tell if the problem is upper
or lower. If the pathology has
progressed enough to cause
apical periodontitis, it should
show on the CBCT. In the past,
I sent that patient away and had
them wait for the problem to
localise. Using CBCT, I can
usually find and treat the
problem earlier.

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Fig 3: PA upper cuspid

Fig 4: CBCT fractured root upper cuspid
(arrow)

Fig 5: PA lower molar

Low et al (2) showed that 34
per cent of lesions detected with
cone beam tomography were
missed with periapical radiography in maxillary premolars and
molars.
Suspected fractures
The second most frustrating diagnosis endodontists face is the

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Fig 13: CBCT shows first molar is cause of
pain and swelling.

[19] =>

United Kingdom Edition July 19-25, 2010

Endo Tribune 19
loss caused by them. Fig 5 shows
a PA that is inconclusive. Fig 6
shows bone loss on the second
molar consistent with vertical
root fracture. (arrow)
Internal or external
resorption
Fortunately, resorption is much
rarer that fractures; it can be
no less frustrating to demonstrate the location and extent of
the defect on conventional two

Fig 10: CBCT EIRR (arrows)

à DT page 20
Fig 6: CBCT lower molar

location and extent of root fractures. Bernardes et al concluded
that: CBCT provides enhanced
and accurate information for
the diagnosis of root fractures,
thereby constituting an excellent
alternative for diagnosis in the
dental practice. (3) Hassan et al (4)
found CBCT better than periapical radiographs in detecting vertical root fractures. Although one
can’t predictably demonstrate

Fig 7: shows a suspected horizontal fracture of the bicuspid (arrow)

Fig 8: CBCT shows that only the palatal
root is fractured (arrow)

Fig 9: PA EIRR mesial of first molar
(arrow)

incomplete root fractures on
CBCT, I have seen some rather
dramatic cases.
Fig 3 shows a periapical image of an upper cuspid with a
lateral bony lesion mid root.
Lateral periodontal cyst, lateral
canal, non-healing endo, and
fractured root were included
in my differential diagnosis.
CBCT (Fig 4) clearly shows a
fractured root was the cause of
the lesion.
Even if you can’t see the fracture on CBCT, you can often see
the amount and location of bone

Fig 11: CBCT EIRR (arrows)

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[20] =>

20 Endo Tribune

United Kingdom Edition

July 19-25, 2010

Fig 19: CBCT axial view shows, three
canals in the mesial root of a lower second
molar.
Fig 21: CBCT Perio not endo

Fig 12: PA upper molars
Fig 18: PA-How many canals in mesial root
of lower second molar?

Fig 14: CBCT sinus perforation by lesion
(arrow)

Fig 15: fractured lower molar

Fig 17: CBCT Missed ML canal.

ß DT page 19

dimensional periapical X-rays.
CBCT makes this a breeze. Carlos Estrela, et al (5) concluded
that: ‘CBCT seems to be useful
in the evaluation of IRR [inflammatory root resorption] and
its diagnostic performance was
better than that of periapical
radiography.’
Fig 9 shows a PA with
suspected external inflammatory
root resorption on the mesial of
the second molar. Figs 10 and 11
show the location and extent of
the defect much more precisely
on CBCT. One can even measure
how close to the pulp it gets!
Difficult anatomy (upper
molars especially), dens-indente, severe curves, etc
Here is another case where the
anatomy hid the lesion. The PA
was inconclusive (Fig 12). The
patient was swollen and all the
teeth quite tender. Instead of
guessing, I could tell for certain
which tooth was the cause of his
pain and swelling with CBCT
(see Fig 13).
Maxillary sinus involvement
The patient in Figs 12 and 13 is
an MD radiologist who was diagnosed by a fellow radiologist
with a sinusitis. Unfortunately
they missed that an infected upper first molar was the source of
the sinus infection. Fig 14 shows
the lesion on the palatal root
had perforated the sinus floor.
Fig 14a is a medical CT that
shows the sinus infection but not
the dental cause.
Gaggers, physically challenged, patients unable to

Fig 23: oops

Fig 16: PA Failure etiology uncertain

Fig 20: CBCT coronal view shows it too!

Fig 22: Implant planning

Fig 24: exact length measured on CBCT

tolerate intraoral X-rays
We all have a few of these. Some
patients tolerate treatment just
fine, but cannot stand to have
film, the sensor, or a phosphor
plate in their mouth. Pre and
post treatment X-rays taken with
CBCT is a breeze for them.

Calcified canals
Location and existence of calcified canals are easier visualised
on 3D CBCT than on 2D periapical radiographs.

Implant planning and placement
This is a whole presentation in
itself. Hans-Joachim Nickenig
et al (7) concluded that CBCT
guided implant placement is
“significantly more accurate
than free-hand insertion”. If
you are placing implants, it
is much easier to treatment
plan and place them with a
guide generated by CBCT than
to just “eye ball” it. Even basic
software allows measurement
of bone, tracing the nerve and
virtual placement of implants
(Fig 22).

more predictable.

Trauma cases
Are the roots fractured, is the
bone fractured? You often can’t
tell if the buccal plate is broken
and the tooth subluxated in a
trauma case. CBCT will usually show the extent of such injuries. Fig 15 illustrates a badly
fractured tooth from trauma.
It is easy to see the extent of
the fracture.
Retreatment etiology (perforation, missed canals, inadequate root canal
filling etc)
I routinely take CBCT on any
retreatment case. Knowing that
there is a missed canal, a perforation, inadequate filled canals,
or some other etiology invisible
on 2D images gives me an advantage in recommending retreatment versus surgery, versus
extraction.
Surgery planning (apico,
reimplant, endo/perio,
perforations, mental nerve,
inferior alveolar nerve, maxillary sinus)
Knowing the size and extent of
the peripical lesion as well as
its proximity to the nerve or sinus, takes the guess work out of
endodontic surgery.
Suspected pathologic lesions
size and location
Again, it is good to know what
you are up against.

Locate extra canals, calcified
canals, MB2 MB3)
Do you need to chase the MB2 canal until you perforate or does it
join the MB1 just a couple of mm
beyond where you are searching? Preoperative CBCT tells you
that for sure. Here is a case (see
Figs 18,19,20) with three canals
in the mesial root of a lower second molar. Not common, but you
know they are probably there. I
found it with a scope and didn’t
have a pre treatment CBCT but
it looks cool on the report to the
referring doctor.
Facial pain cases to rule out
odontogenic etiology
It makes you more confident in
making the referral to the oral
facial pain specialist or neurologist when you can be sure there
isn’t a lesion on the tooth the patient thinks is the cause of their
neuralgia and you get a normal
response to pulp tests.
Endo-perio cases
CBCT is very useful in determining the extent and location of
periodontal bone loss. Fuhrmann et al (6) showed that only
one out of 14 furcation defects
were visible on periapical xrays where all 14 were visible on CBCT. How much bone
is lost, does the endo lesion
communicate with the perio
defect? Here is a case of an upper
bicuspid (Fig 21) with e
xtensive periodontal bone loss to
the apex. The pulp remained vital to cold tests.

Here is a case (Fig 23) from a
well-respected oral surgeon who
does a lot of implants and probably wishes he had taken a CBCT
to guide him in this case.
Measure canal length
In most cases, my CBCT is more
accurate in determining tooth
and canal length than an intratreatment 2D image or an apex
locator. Figure 24 shows case I
measured accurately on CBCT
without using trial length PA or
apex locator.
Intra-operative to find canals
It is easy to demonstrate with
two-dimensional if you are off to
the mesial or distal on a calcified
canal but what if you don’t know
if the canal is to the lingual of
buccal of where you are searching. Three-dimensional CBCT
shows that precisely and saves
time and anxiety.
Implant placement guidance
Using
a
CBCT
generated
surgical guide certainly helps
avoid misplacing implants and
makes the whole process much

References
1) What is Cone Beam CT and how does it work? Scarfe &. Farman, Dent Clin N Am 52 (2008), 707–730
2) Comparison of Periapical Radiography and Limited Cone-Beam Tomography in Posterior Maxillary Teeth Referred for Apical Surgery: Low, Kenneth et al (JOE, Vol 34, Number
5, May 2008 3) Use of cone-beam volumetric tomography in the diagnosis of root fractures, Bernardes et al (OOOOE 2009; 108: 270-277) 4) Detection of Vertical Root Fractures in
Endodontically Treated Teeth by a Cone Beam Computed Tomography Scan, Hassan et al (JOE 2009; 35:719–722) 5) Method to Evaluate Inflammatory Root Resorption by Using Cone
Beam Computed Tomography. Carlos Estrela, et al. JOE November 2009 (Vol. 35, Issue 11, Pages 1491-1497) 6) Furcation involvement: comparison of dental radiographs and HR-Ct
slices in human specimens. Fuhrmann RA, Bucker A, Diedrich PR. J Periodontal Res 1997;32:409 –18 7) Evaluation of the difference in accuracy between implant placement by virtual
planning data and surgical guide templates versus the conventional free-hand method – a combined in vivo – in vitro technique using cone-beam CT (Part II) Hans-Joachim Nickenig et
al. Journal of Cranio-Maxillofacial Surgery DOI: 10.1016/j.jcms.2009.10.023

Post-treatment evaluation
for healing
Several articles describe how
useful CBCT is for recall to determine if lesions are healing
or not.
Conclusions
Can we practice endodontics
without CBCT? Yes, we did it for
years, but then some of us used
to work without microscopes,
digital x-rays, and apex locators.
Why not have the best information available to make your diagnosis and treatment plan?
The more you know about the
patient’s anatomy and the shape
and number of roots and canals
in those roots, the better you will
be to diagnose and treat their
dental disease. We live and treat
patients in a 3D world. Why not
use 3D CBCT to better visualise
anatomy and pathology? DT

About the author
Dr Jones has been in private practice
limited to endodontics in the greater
Kansas City area for 31 years. He received a certificate and Masters of Science in Dentistry in endodontics from
the University of Nebraska, Lincoln in
1978. He practiced general dentistry in
Lawrence, Kansas for over 2 years after graduating in 1973 with distinction
with a DDS from University of Missouri, Kansas City. Prior to dental school,
he attended the University Of Kansas
School Of Pharmacy. He was one of the
first Endodontists in his area to utilise
computers in the office (late 1980s),
digital radiography (early 1990s) and
Cone Beam CT (2009). He has lectured
on Endodontic Diagnosis, Maximising
the Use of Technology in Your Personal
and Professional Life, Dental Implants
from an Endodontist Prospective, and
Three Dimensional Cone Beam Computed Tomography in Dentistry. He is
a member of Omicron Kappa Upsilon
and Phi Kappa Phi honorary societies.
He is a member of the American Association of Endodontists, the American
Dental Association, the Kansas Dental
Association, the Fifth District Dental
Society, the Chicago Dental Society,
the Kansas City Dental Implant Study
Club, the Dental Abstract Study Club,
and the American Academy of Oral and
Maxillofacial Radiology. He is an associate professor in Endodontics at the
University Of Missori, Kansas City School
Of Dentistry.

[21] =>

United Kingdom Edition July 19-25, 2010

Endo Tribune 21

The fight against bacteria

Dr Michael Sultan discusses the importance of cleanliness in the field
of Endodontics

D

same instrument on more than
Surprisingly, despite the recentistry often involves a
one patient. Aside from the obviommendations that files should
battle against bacteria
ous risks this poses to patients’
be for single-use only, the sales
– the invisible invaders
health and cross infection conof such instruments for endothat wreak havoc with our oral
print_Mise en page 1 03.06.10 11:59 Page1
trol, this also contravenes Dedontics have actually fallen over
health, infiltrating into gums and
partment of Health legislation
the years, suggesting that some
teeth causing tenderness, pain
which states: “Dentists should
practitioners are reusing the
and sensitivity. The basic premise
of endodontic procedures is to remove inflamed and infected tissue from the tooth, to clean the
root canal system and to seal the
tooth back up again. In short, endodontics is all about infection
control;one of the fundamental
elements of good dentistry.
The rubber dam
It goes without saying that maintaining cleanliness throughout
the endodontic procedure should
be key to a successful outcome.
Nevertheless, teeth are incredibly complex structures and it is
impossible to get the tooth sufficiently clean for it to be considered completely sterile.

ensure that Endodontic reamers and files are treated as single
use in order to reduce the risk of
prion transmission in dentistry”.

My life, my job and my Easy

This thin square of latex rubber serves to isolate the tooth
from its environment, in particular from bacteria in the oral
cavity, permitting a clean, dry
operative field and enabling
the treatment of the appropriate tooth without contamination
from blood or saliva. I actually
find that most patients prefer to
have a rubber dam in place as a
protective barrier. Medico-legally, one of the first questions to
be asked following a mishap is
whether a rubber dam was used
during the procedure, so this device not only protects the tooth
and the patient but also the practitioner.

Nevertheless, they are vital
for opening up the canals so that
they are accessible to our chemicals for disinfection.

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items

is

Chemical options
Most endodontists use chemi-

If we are to protect the health
of our patients and their teeth,

The endodontist needs to
carry out everything within
their powers to facilitate infection control to reduce the risk of
failure. For this reason, placing a
rubber dam during treatment is
mandatory.

Single-use instruments
The roots of teeth contain very
fine, narrow and tortuous channels, some of which can be easily missed or undetected. Despite
continuing advances in dental
technology, the equipment at the
dentist’s disposal is hopelessly
inadequate for the job it has been
designed to do. Relying on a
small, stainless steel file or even
super flexible nickel titanium
files to successfully clean, shape
and decontaminate the nooks
and crannies within the tooth is
really quite unrealistic.

reusing single use
simply not an option.

à DT page 22

[22] =>

22 Endo Tribune
ß DT page 21

cals such as sodium hypochlorite (bleach), EDTA and iodine to
clean the intricate canal systems.
Bleach is usually the medicament of choice due to its efficacy
against pathogenic organisms
and pulp digestion, and its concentration for use varies from 0.5
per cent to 5.25 per cent. At low
concentrations it is bactericidal
whereas at higher concentrations tissue dissolution is improved.

United Kingdom Edition

However, some forms of bacteria such as enterococcus faecalis are resistant to bleach. This
microorganism is commonly detected in teeth with asymptomatic,
persistent endodontic infections
and its prevalence in such infections ranges from 24 per cent to 77
per cent. Enterococci faecalis are
hardy bacteria able to compete
with other microorganisms, invade dentinal tubules, and resist
nutritional deprivation. Currently the most effective methods used to combat these bac-

July 19-25, 2010

teria within the root canal
systems of teeth include the use of
good aseptic technique, and
soaking the tooth in iodine for
ten minutes during treatment.
After the root has been successfully treated and bacteria
eliminated, the next challenge
that must be overcome is how
to keep bacteria out. Although
the endodontist often will place
a temporary seal after treatment,
the duty of fitting a permanent
restoration with a good coronal

Once you are rid of the bacteria - you have to keep them out!

seal usually falls to the GDP.
This will prevent coronal leakage, which will inevitably compromise the long-term prognosis
of a root canal treated tooth.
This should be done as soon
as possible to protect the tooth
and reduce the chance of fracture. Similarly, if the tooth lacks
sufficient structure to hold the
restoration and a post has to be
placed, the post hole should be
left empty for the minimum time
possible and ideally dressed with
calcium hydroxide.

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Indeed, no matter how well
the root is treated, if the coronal seal is poor, the root treated
canal may well fail and the patient will have to return for further treatment.
Can it be cleaned?
In short, the clinician needs to
ask themselves two fundamental questions when considering
Endodontic treatment: Can the
root be cleaned and can we keep
it that way? If the answer to both
questions is yes, then endodontic treatment is a very effective
option to reduce infection and
relieve oral discomfort. With
the help of a well-trained and
efficient nurse who also appreciates the fundamental importance of cleanliness in Endodontics, the patient can enjoy a very
high success rate and make use
of their natural teeth for many
more years to come. DT

About the author

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Dr Michael Sultan
BDS MSc DFO is
a specialist in Endodontics and the
clinical director of
EndoCare. Michael
qualified at Bristol University in
1986. He worked
as a general dental
practitioner for five
years before commencing specialist
studies at Guy’s hospital, London. He
completed his MSc and in Endodontics in 1993 and worked as an in-house
endodontist in various practices before
setting up in Harley St, London in 2000.
He was admitted onto the specialist
register in endodontics in 1999 and has
lectured extensively to postgraduate
dental groups as well as lecturing on
Endodontic courses at Eastman CPD,
University of London. He has been involved with numerous dental groups
and has been chairman of the Alpha
Omega dental fraternity. In 2008, he
became clinical director of Endocare
a group of specialist practices. To talk
to a member of the Endocare team call
020 7224 0999 or email reception@endocare.co.uk or for more information
please visit www.endocare.co.uk.

[23] =>

United Kingdom Edition July 19-25, 2010

On-the-job training
When it comes to vocational placements, don’t be
daunted. Each situation is a learning opportunity and
ultimately, you are only going to get out what you put
in, says Sarah Armstrong

T

he stress of finals behind
you, vocational training (VT)
launches new dental graduates across the country into general
dental practice. Although it’s a daunting time, it’s also one of great opportunity, gaining clinical freedom,
financial independence and moving
away from the never-ending stream
of assessments that go hand-in-hand
with dental school. That said, you’re
not going to be abandoned now that
you’ve qualified and VT provides a
fantastic support network to aid in
making the transition from student
to professional.
In your first month, you really
need to be thinking about what you
want to gain from the training year,
and for this it’s useful to start thinking
about what your strengths and weaknesses are and where you see your
career progressing. Are there certain
aspects of dentistry that you’d like to
gain more experience in? Are there
certain procedures that you don’t feel
confident carrying out?
Keep an open mind
If your dentures are awful, don’t just
try and avoid providing the treatments you find challenging, discuss
things with your trainer, other associates or vocational dental trainees
(VDPs), highlight several challenging
cases and book some protected time
to undertake these getting assistance
where necessary, struggling on regardless won’t help anyone. Don’t
think purely clinical either, working
in practice requires diverse knowledge rarely discussed within dental

school – employment contracts, UDA
targets, staff management, legislation
and even maintaining equipment all
form a key role in practice life.
Although you will have more freedom, there are assessments conducted throughout the year, the nature
of which depends on your Deanery.
Usually these include several observed clinical situations, an audit,
a case presentation, patient satisfaction questionnaires, and a key skills
portfolio. You will also be required to
complete a portfolio of professional
development. Again, these vary between Deaneries, although usually
tend to require reflection on clinical
activities and study days that you’ve
undertaken on a weekly/monthly basis and include appraisals regarding
your general progression which allow
comments to be added by your vocational trainer and advisor.
Although often viewed as tedious
and time consuming, the portfolio is a
useful tool to accumulate a record of
your experience, can highlight useful
information about your progression
and can be useful as evidence as you
progress through your dental career.
Hitting the books
Study days form a fundamental part of the VT year. For a start,
it’s nice to have a break from practice
one day a week, as diving into
five days of full-time dentistry from
the relatively slow-paced world of
dental school can be a shock to the
system! They are a great opportunity meet others VDPs to share each
other’s experiences, ideas and
techniques.

Often VT schemes are formed
from VDPs who graduated from a
range of dental schools, which brings
a great mix to the group and really
highlights the huge variations in ideas/techniques taught. The program of
study days varies though tend to include updates on clinical subjects, financial topics, practice management,
and often a few away days – usually to
the young dentist careers conference
and to the BDA conference. By the end
of the year you will have CPD hours
spilling out of your ears!
Testing times
Exams may be the last thing on your
mind following your slog through finals, but now really is the best time
to take MFDS/MJDF examinations
while all the information is fresh in
your head and your finals revision
notes aren’t yet stowed in the loft. Although challenging, the depth of information required is not dissimilar
to finals and you’ll find it much easier
to get your head down and revise now
than a few years down the line when
you are out of the habit!
That said, it’s important to remember that there’s more to life than
dentistry. Dentistry has an unnerving
ability to take over your life, and it’s
really not helpful to stew for days over
that 3:15pm patient with the sclerosed buccal canals you’ve been trying
to RCT or the distal margins of the
crown prep you cut on the patient
with the gag reflex!
Expect to be tired. Dental school
may have felt like hard work at the
time, but you will now be seeing
many more patients per day and be
taking responsibility for all your decision making during VT so it’s important to eat well and get enough sleep!
Different experiences
Everyone’s VT experience is different
depending on your location, practice
size and type, and the attitudes/support of your trainer. Some VDPs will
have the newest, flashest equipment
at their disposal, where as others
may have to learn how to perfect their
techniques with a more limited armamentarium. Some VDPs may have
proactive motivated trainers whereas
others will be more laid back who
promote your clinical independence
and enable your confidence to grow.
Each have their pros and cons so try
and take every situation as a learning
opportunity and ultimately, you are
only going to get out of VT year what
you put in. DT

About the author

From the classroom to the practice - VT bridges the gap

Sarah Armstrong
qualified
from
Newcastle University in 2008 and is
currently working
as a maxillofacial
surgery
senior
house officer at
Newcastle General Hospital.

Education 23

[24] =>

The Dental Directory:
Experts on Digital
Imaging Equipment
D

igital Imaging is an
extremely fast
growing area
within today’s dentistry
field, and one that may
require a dentist to make a
substantial investment in
terms of equipment. Due
to the complex nature of
Digital Imaging, the
necessary equipment
currently available is often
highly advanced and
relatively new to the

market. With this in mind,
it is vital that suppliers
keep up to speed with
industry developments;
and one that has is The
Dental Directory.

Dr Boota S Ubhi is the
Specialist Periodontist and
Implant Surgeon at the
Birmingham Periodontal
and Implant Centre. He
works alongside Dr Tuss
Tambra who is an
American trained Specialist
Prosthodontist. The
practice is a large specialist
centre based in Harborne,
Birmingham and has a
wide referral base covering
most of the Midlands. He
has been a client of The

Dental Directory for the
last thirteen years,

‘ I have been using the
services of The Dental
Directory since 1997 and
have had only positive
experiences in all of my
dealings with them.
Initially The Dental
Directory offered me a
very good deal on a
particular product, the

service was excellent, and
as a result I’ve been a
client ever since. I decided
that I would seek the
assistance of The Dental
Directory when it came to
choosing and installing new
Digital Imaging equipment
in my practice, and it
paid off.’

Dr Ubhi’s multidisciplinary
practice specialises in
treating patients with
advanced periodontal
problems, fixed and
removable prosthodontics
and Implant therapy. Dr
Ubhi was entered onto the
General Dental Council’s
Specialist Register in
Periodontics in 2000 and

has been accepting
referrals for advanced
dental care since 1996. Dr
Tambra is a registered
specialist Prosthodontist in
Canada, UK and USA.

In addition to this, the
practice facilities which
include a large lecture
room and dedicated
surgical suite allow them to
provide training to

and after treatment.
Five years ago, Dr Ubhi
changed to using both the
intra-oral and extra-oral
digital imaging supplied by
The Dental Directory. He
was extremely pleased with
how this worked out and
investigated the CT
scanner options.

Having read research
produced by the University

‘The equipment arrived
promptly and was exactly
to spec; I was delighted.
The whole experience was
thoroughly well-planned,
low stress and professional;
qualities that I’ve come to
expect from The Dental
Directory.’
referring dentists and their
staff to enable them to gain
the understanding and
confidence to deal with
advanced dental care. The
Surgical and Prosthodontic
10 day modular implant
course is now in its 5th
year. This course covers
surgical implant therapy,
sinus and bone grafting,
bone augmentation and the
Prosthodontic aspect of
Implant therapy. Nurse’s
courses are also run and
cover a range of topics
including basic implant
techniques, care of
instruments, sterile
techniques, implant kits
and care of patients before

of Manchester, Dr Ubhi
learned that the i-CAT
scanner provided the best
quality images, and most
importantly, the lowest
dose of radiation available
on the current market.
After intensive
consultation, The Dental
Directory supplied Dr
Ubhi with a Gendex
GXCB-500 CBCT System.

‘After considering the
necessary specifications, I
approached several
different suppliers, one of
which was The Dental
Directory. I discussed my
requirements with them

and they were extremely
knowledgeable. They have
a dedicated Digital Imaging
Manager, Mohammed Latif
who is on hand to offer
advice and explanation.
Their expertise was
invaluable and made me
feel confident that my
choice of equipment and
supplier was the right one.’

The Gendex GXCB-500
provides powerful,
instantaneous diagnostic
and treatment planning
tools; giving distortion-free
images to reveal critical
anatomical details. This
scanner is one of many
pieces of Digital Imaging
equipment available from
The Dental Directory, and
Dr Ubhi is extremely
happy with his purchase.
He feels that the addition
of 3D imaging to his
practice means that he is
providing a much higher
standard of care for his
Implant cases. The
planning and execution of
his treatment is much
quicker and safer due to
the on site CT scanner.
He explains,

‘The i-CAT scanner is
fantastic. The installation
was arranged efficiently by
The Dental Directory and
needed very little input
from me. The engineers
arrived at 8am to set up the
i-CAT, and by late
afternoon I had taken my
first scan! The equipment
arrived promptly and was
exactly to spec; I was
delighted. The whole
experience was thoroughly

[25] =>

[26] =>

26 Practice Management

United Kingdom Edition

July 19- 25, 2010

Do you have permission to practice?
It’s essential that planning permission is in place and planning conditions are complied with if you’re considering buying or selling a practice, says Lucy Gilman

lanning permission might
not be a subject dentists
think is of particular relevance to them. However, it is
when it comes to dealing with
practice sales and purchases.
There are many instances where
dental practices lack the relevant
permission to use a property as a
dental surgery, or where they are
in breach of conditions attached
to any permission for such a use.
The consequences of noncompliance, or indeed lack of
planning permission, can be
costly and time-consuming to
rectify.
Such ramifications include
enforcement proceedings for
breach of conditions or lack of
planning permission, which can
be very costly to defend. To give
dentists an appreciation of the
planning system, set out below
is a brief outline, together with a
few specific points of interest to
dentists in particular.
Town planning
The modern-day planning system is concerned with making
decisions about the future of our

works (LDFs) – these are produced by local planning authorities with the aim of outlining
how planning will be managed
in that particular area.
However, with the election of
the coalition government in May
this year, there promises to be
some considerable changes to
the planning system. The Government’s programme of reform
includes promoting the radical
devolution of power to local government and community groups
and includes:
• Abolishing regional strategies
and returning decision-making
powers to local councils
• Giving neighbourhoods far
more ability to determine what
development takes place in their
area
• It also aims to publish a consolidated national planning framework covering all forms of development which sets out national,
economic, environmental and
social priorities.
Planning permission
Planning permission is gener-

‘It is imperative for dentists who are either
considering buying or selling a dental surgery to ensure that planning permission is
in place and that all planning conditions
have been complied with’
cities, towns, and the countryside around us. It is important
that we can balance the need
to develop and grow our towns
and cities and provide housing
for all, with the need to protect
the countryside and environment in general.

ally required where there is to
be development of the land or a
change in the way that the land
is used. The Town and Country Planning Act 1990 (Section
55) provides that development
means:

The planning system is a
plan-led system and has, since
2004, developed two main levels
of plans:

‘The carrying out of building, engineering, mining or other
operations in, on, over or under
land, or the making of any material change in the use of any
buildings or other land.’

1. Regional Spatial Strategies
(RSSs) – these are very broad
plans which are drawn up to set
out how a region should look in
the next 15 to 20 years; and
2. Local Development Frame-

However, it is always worthwhile checking with the Local
Planning Authority whether
planning permission is required.

Planning permission is not always essential. It is not generally
required for internal building
works, or for small alterations
to the outside of a property. In
addition, other small changes such as putting up boundary walls and fences below
a certain height (1.8m) have
a “general planning permission” for which a specific application is not required. This
is known as permitted development. In addition, certain
changes in the use of property
are also permitted, however, as a
general rule, the change must be
within the same use class.
Planning applications
There are two main types of
planning application:
Outline application:
For a new building, you
may be able to make an outline application to find out whether the development is acceptable
in principle. This usually means
that detailed drawings are not
needed. However, the local
planning authority can require
additional information, or insist that a particular application
be made as a full application.
If outline permission is granted,
you will need to get approval
of the details (known as
‘reserved matters’) before work
can start. These comprise:
- Siting
- Design
- External appearance
- Means of access
- Landscaping
What you propose must be
consistent with the outline permission. If your proposal changes, you may be asked to start
again with a fresh application.
Full application:
A full planning application
requires the submission of all
details of the proposal. It would
be appropriate if you wish to
change the use of land or buildings, or if you want to start work
quickly.
If the Local Planning Authority decides to grant planning per-

mission, a decision notice will
be issued setting out the conditions of that planning permission.
Those conditions must be complied with otherwise the development may be in danger of attracting enforcement proceedings.

use. The local authority will assess the application on its merits
and in conjunction with the provisions of the LDF.
3. Planning permission if it
is necessary to obtain planning

‘However, with the election of the coalition
government in May, there promises to be
some changes to the planning system’
If planning permission is refused, there is the right of appeal
to the Secretary of State for Communities and Local Government.
There are three types of appeal:
- Written representations
- Informal hearing
- Public enquiry
The type of appeal will be
based on the complexity.
Issues to consider
While it may not appear to be
hugely relevant to dentists, there
are certain issues which dentists
may come across.
1. Use The use of a property
for the provision of dental services falls within D1 of the Town
and Country Planning (Use
Classes) Order 1987 (as amended). As such, it is important when
considering taking on premises
or when selling premises that
the premises have the requisite
“dental use”.
2. Certificate of Lawful Existing Use or Development
(“CLEUD”)As stated above, it
is a requirement for a practice
to have a D1 use. If it does not,
then there are options, which include an application to the local
planning authority for a CLEUD.
If the use of the property as a
dental surgery has subsisted for
more than 10 years, then an application to the local planning
authority accompanied by supporting evidence (for example,
business rate invoices) is appropriate. If the use has subsisted
for less than 10 years, it would be
advisable to make an application
to the local planning authority
for planning permission for that

permission in respect of the
premises (either for change of
use or for building operations), it
is essential to consider any conditions attached to that planning
permission. These conditions
must be complied with and may,
for example, restrict the hours of
use or the number of car parking
spaces that can be provided. It is
always advisable to work closely
with the planning department to
try and achieve a workable planning permission.
4. Indemnity insurance if it
becomes evident that the property you occupy (or are intending to occupy) does not have
the requisite D1 use or planning
permission, there is always the
option to take out an indemnity
policy to insure against any potential problems. The cost of
such insurance will depend upon
various factors, such as how long
the building has been used as a
dental surgery, when the development or change or use took
place, the purchase price of the
building or the annual rent and
term of lease. A one-off premium
would be payable and would insure against any potential action
by the local planning authority.
This is undoubtedly quicker than
an application for a CLEUD or
planning permission but the cost
could be higher. DT

About the author
Lucy Gilman joined
Cohen Cramer in
2008 and is a key
member of the dental team working on
dental practice sales
and acquisitions. Her
particular area of expertise is property
with specific experience in planning
related issues. To contact Cohen Cramer solicitors, call 0113 2440597, email
dental.team@cohencramer.co.uk
or
visit www.cohencramer.co.uk.

Have you ordered your free Patient Referral Leaflets?
Call 0844 335 6354 or visit www.waterpik.co.uk

[27] =>

27 Endodontics
ParaPost Taper Lux
Translucent Esthetic Post System
Coltène Whaledent
New from Coltène Whaledent, the
latest addition to the prestigious
ParaPost range, ParaPost Taper Lux
which has been specifically produced
to provide the dentist with a post that
fits closer into the canal with a crowndown greater taper file technique.
This tapered post is better suited for
narrow, thin root canals that require
minimal amount of tooth structure removal during preparation of post
space. The translucent fiber resin material in ParaPost Taper Lux eliminates
shadows, transmits polymerization light for fast cementation and the unique
rounded head design reduces stress points and locks in core material, also with
retention ledges and tapered in apical third (.04) to match rotary tapered canal
preparations. ParaPost Taper Lux is radiopague, readily removed and adheres
to standard ParaPost sizes in a colour-coded system.
For further information call free phone 0500 295454 exts 223/224 or visit our
website www.coltenewhaledent.com

United Kingdom Edition July 19-25, 2010

Why not go single-use with
UnoDent and Classic
Endodontic Instruments?
With
greater
emphasis
on
sterilisation and decontamination
than ever before there has never
been a better time to switch
to single-use instruments. The
UnoDent and Classic range
exclusively available through The
Dental Directory offer a high quality yet cost effective solution.
The UnoDent and Classic range of single-use endodontic instruments are
designed and manufactured in answer to the Department of Health guidelines
on the use of single-use reamers and files. Both the UnoDent and Classic
instruments are available in a wide variety of types including Hedstrom files,
S-Files, K-Files, Reamers and Paste Fillers.
With prices starting from as little as £2.40 for a pack of 6, these instruments
offer a very cost-effective single-use solution. For further information or to
order call The Dental Directory on 0800 585 586
or visit www.dental-directory.co.uk

EndoCare congratulates Beverly Street
on award win
The team at EndoCare would like to
congratulate Operations Manager, Beverly
Street, for being awarded the Business
and Professional Services Award for the
employed student who has made the best
use of studies from Kingston College in
London.
Beverly has been studying for a Certificate
in Business Management (Level 3) in
her spare time alongside her full time
employment at the Harley Street branch
of the endodontic practice, taking the skills
she developed in the classroom and putting them into practice at work.
Principal practitioner and owner Dr Michael Sultan is committed to ensuring
his staff are well trained and perform to the best of their abilities so that his
patients receive the very best dental experience.
Winners of the 2009 Private Dentistry award for Best Referral Practice,
EndoCare is renowned for its referral service in the endodontic world. The
surgeries are equipped with the latest technologies, ensuring your patient
receives the most effective treatment, and is returned to your surgery quickly,
ready for you to take over.
For more information about EndoCare please call 020 7224 0999
or visit www.endocare.co.uk

Outstanding Vision With
EyeMag Pro Loupes
EyeMag Pro Loupes are an
invaluable asset to dental
professionals working in
a variety fields. Suitable
for use in endodontic
treatment,
restoration
procedures and enabling
quick and accurate examinations, the EyeMag Pro provides the optimum view
of the treatment site.
Good posture is essential and the EyeMag Pro is expertly designed to promote
ergonomic comfort whilst supporting the very highest standard of treatment.
Users can select from several magnification options from 3.2x to 5x as well
as an array of working distances from 300mm to 500mm to find the very
best position for their individual requirements. The excellent view extends
into the peripheral areas, and makes the identification of structures very
straightforward.
Aftercare is vital with precision equipment and Nuview is proud to offer onsite equipment surveys, installation and in-depth training to help dental
professionals secure the very best EyeMag for their needs - and enjoy the
benefits immediately. The Nuview team is also able to assist with the practice’s
need for alcohol-free disinfectant products such as Continu.

Nuview – High Quality Images
Guaranteed
All dentists, at some point in
their career, have probably found
themselves wishing that they could
see the treatment site more clearly.
Nuview offers an extensive range of
magnification solutions designed by
the most reputable name in advanced
visualisation technologies, Carl Zeiss.
Renowned for their outstanding image quality and stylish, ergonomic design,
Nuview’s microscopes enhance the quality of both your diagnosis and your
treatment. The OPMI pico microscope is a true advancement in the prevention
of neck strain and back problems. The five-step magnification changer delivers
incredible images – from an overview of the working field, to the finest of details.
Objective lenses with focal lengths of 200 mm, 250 mm 300 mm,350mm
and 400mm are available to precisely match the microscope to your personal
working distance.
Many customers want to use the Carl Zeiss OPMI pico in general dentistry, and
although the microscope is excellent for specialist dentistry, its features give it the
versatility to meet the needs of every dentist.
Nuview offers its clients a wide array of magnification and illumination products
in addition to exemplary customer care that includes full installation and training.

For more information call Nuview on 01453 872 266
or email info@nuview-ltd.com
www.voroscopes.co.uk

For more information call 01453 872266 or email info@nuview-ltd.com
www.voroscopes.co.uk

Obtura Max
Enhancing endodontic
success
Quality
Endodontic
Distributors Ltd are the UK
distributors of the Obtura
Max heated gutta percha
system, the proven answer
to enhance endodontic
success.
Supported by emphatic clinical history, the Obtura Max heated gutta
percha system rapidly fills and obturates even the most difficult root canals
more completely, in less time, and with less patient discomfort than any
other method.
Used by key opinion leaders worldwide, the Obtura system has been an
integral part of the armamentarium of successful endodontists for over 20
years. It delivers controlled and predictable results, ensuring the most effective
and efficient “backfilling” technique possible. With a choice of different size
needles, condensable thermosoftened gutta percha can be used to “backfill”
any root canal system without leaving voids.
The sleek modern design of the Obtura Max unit includes five pre-set
programmes, soft touch controls and easy clean surfaces. While the lightweight,
ergonomically designed handpiece helps reduce operator fatigue.
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.

TENEO plus ApexLocator:
Delivers the highest
levels of precision thanks
to high-tech measuring
process
The TENEO treatment centre
can soon be equipped with the high-precision
digital ApexLocator. In other words, the TENEO is the only treatment
centre on the market with a built-in apex localization function.
This saves space and time, as the dentist can dispense with a separate
tabletop device
The ApexLocator operates on the principle of differential multifrequency
impedance measurement. These measurements are very
precise and are error free even with fluids in the tooth (e.g. blood and
sodium hypochlorite).
The ApexLocator is easy to operate and delivers ultra-precise
measurements. It does not need to be calibrated and is always ready
for immediate use. The position of the file in the root canal is
visualized on the 7” EasyTouch display of the TENEO treatment
centre. In addition, the dentist receives acoustic and visual guidance
during the preparation procedure.
In combination with the Endodontics function auto stop and auto
reverse are activated as soon as the predetermined torque setting is
reached.
For further information please contact:Sirona Dental Systems 0845 071 5040
info@sironadental.co.uk

Morita Tri Auto ZX
The only endodontic handpiece with built in
apex locator
Quality Endodontic Distributors Ltd are the UK
distributors of the Tri Auto ZX, the only endodontic
handpiece with built in apex locator.
The Tri Auto ZX has three automatic functions that
significantly increase the accuracy and safety of root
canal treatment. Automatic start / stop, whereby the
file starts rotating automatically when inserted in the
canal and stops when taken out. Auto torque reverse
where if the torque load exceeds a set limit the file
automatically stops and reverses its rotation. It is
designed to stop files binding. When the file tip reaches the
working length set it automatically stops and reverses. Finally auto apical slow
down means the motor automatically slows down as the file tip approaches
the apical constriction. This enhances safety when preparing the apical region.
Suitable for use with most nickel titanium rotary systems the unit comes
complete with charger, apex locator leads and stand.
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
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; a foot activator, which allows
height adjustment using only the feet; Relax Armrests, which allow the arm to
move freely in the horizontal 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.

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.
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.

Looking for Sirona Equipment, get it from
Sident!
If you are looking for any Sirona equipment,
including specialist items for endodontic treatment,
get it from Sident Dental Systems, the UK’s only
Specialist Supplier of Siemens /Sirona equipment.
Only Sident Dental Systems can offer you:• Comprehensive bespoke Project Management
Service for Surgery refurbishments
• Factory Trained Engineers
• Product Specialists to advise on design, installation and on-site training
• Low cost finance packages for all products
• Established 28 years
Sirona Specialists, Sident Dental Systems offer the choice from the complete
range of Sirona Treatment Centres, 2D and 3D digital and film based x-ray
apparatus – including the very latest Galileos 3D digital cone-beam equipment,
their extensive range of Sirona handpieces, and auxiliary items including
SiroLaser, SIROEndo and the DAC Universal sterilisation unit.
Wherever possible potential clients are invited to visit The Courtyard, Sident’s
state-of-the-art training and showroom facility, where they will be able see the
complete product range in action.
Finally Sident will undertake a complete Project Management Service, including
installation and post installation service support, to enable these dreams to
become reality.
For further information call Sident Dental Systems on 01932 582900
or email j.colville@sident.co.uk

Aseptico HandiDam Pre-Framed
Latex-Free Dam (Mauve)
The team at Velopex are delighted to
announce the introduction, into stock
of HandiDam Latex-Free (Mauve).
HandiDam is the most significant
innovation in ‘rubber dam’ technology
to come along in years and is now
available Latex-Free. This synthetic
material has excellent elasticity and
tear resistance with the innovative pre-framed characteristic that has hade
Hanidam a favourite.
This pre-framed sheets of HandiDam eliminate the need for the old-fashioned
and uncomfortable frame. HandiDam is easy to place on the patient. It allows
easy access to the oral cavity and specific treatment sites during the dental
procedure.
It not only saves time in the surgery but it allows the patient to be much more
comfortable than conventional rubber dam.
It is especially great for endodontics.
It is packed in boxes of 100 and priced at: £203.67 + VAT
To order, please call Velopex Sales on 020 8965 2913 and ask for product code I/
MAC8923F, Aseptico HandiDam Pre-Framed Latex Rubber Dam (Blue).
Aseptico products in the UK, supported by Velopex

[28] =>

United Kingdom Edition July 12-18, 2010

UCL Eastman unit wins
award in Restorative
Dentistry
The UCL Eastman Dental Institute would like to congratulate members of their
Prosthodontics unit, who recently won an award from the British Society for
Restorative Dentistry (BSRD) for best poster for postgraduate research.
The poster summarised a recent study undertaken by Dr Chris Tredwin, Senior
Lecturer in Prosthodontics, Mr Michael Nesbit, Senior Instructor Technician and
Mr Fred Mukwenda, a former student on the MSc in Conservative Dentistry
programme at the UCL Eastman Dental Institute. Posters are presented
annually at the BSRD’s May Scientific Meeting. Entrants are required to focus
on subjects that will advance knowledge in the area of restorative dentistry.
Michael Nesbit was present to accept the prize of £250 on behalf of the
Eastman team, which was presented at the recent BSRD meeting, which took
place at the Lensbury conference centre in Teddington, London in May.
The Unit of Prosthodontics at the UCL Eastman Dental Institute focuses
on research and treatment in the areas of Conservative Dentistry, Oral and
Maxillofacial Implantology and Prosthodontics.
For more details about the UCL Eastman Dental Institute, please visit www.
eastman.ucl.ac.uk or telephone 020 7915 1038

Delight staff and patient alike with Skyinside
Clark Dental has an outstanding reputation for innovative
design, an accolade recently confirmed by enabling
clinicians to bring the vastness and beauty of the sky
inside.
With Skyinside, you can choose from a range of exquisite
virtual skylights that engage people with authentic
illusions of nature, and trigger beneficial responses of
relaxation, vitality, tranquillity and well-being for mind
and body.
Skyinside ceilings are available in a variety of shapes:
• Rectilinear
• Circular
• Elliptical
• EcoSlim LED
• Custom
For practices restricted on space, Skyinside can provide the illusion of windows
that add a unique and uplifting ambience to the practice, and a sense of calm for
patients during procedures.
Skyinside even gives clients the option of having a custom made ceiling created for
them to fulfil the individual criteria of a project.
Clark Dental is the UK and Irelands agent for Skyinside products and with an
established reputation for providing innovative technology along with exceptional
after-sales customer care and technical support, you can be sure that your practice
is in safe hands.For more information contact Clark Dental on: 01270 613 750 or
email sales@clarkdentalsales.co.uk

Enjoy successful
marketing with Munroe
Sutton
Dentistry
in
the
UK
is
becoming
more
competitive, and as a result dentists are required to be considerably more
business savvy. It’s not enough anymore to simply provide treatment to
patients; practitioners must also have the range of skills needed to run a
successful business
Frequently overlooked in the healthcare sector, but incredibly important
nonetheless, is marketing. As the leading dental care plan provider in the
US, Munroe Sutton can help market your practice in a number of ways. For
example:
• Online provider search with over 250,000 hits every month
• Multi-lingual assistance to aid patients in finding the most appropriate
treatment provide
• Daily database updates with groups and agents
• Printed directories
By enlisting the help of Munroe Sutton you can save yourself time and money
by no longer marketing to the wrong audiences,
‘We have seen an increase in our patient base – without impacting our
treatment decisions. That’s the beauty of this plan, the patients pay at the time
of service.’ – Diana Gavic, Family & Cosmetic Gentle Dentistry.
For more information call 0808 234 3558

Outstanding surgery
design from Clark Dental
Having
worked
with
dentists for over thirty years,
Clark Dental has a strong
understanding of how much your new surgery says about you and your
business. Everything about it, from its style, quality and equipment used to
the right furnishings and décor, conveys a message to your patients of your
professional expertise and standards.

www.munroesutton.co.uk

For further information, contact Clark Dental on: 01268 733 146
Email: enquiried@clarkdental.co.uk or sales@clarkdental.co.uk

Fantastic Customer Care makes a real
difference
Dr. Raj Naidu has been using Schick
Technologies in his practice since 2002
and has been delighted not only with the
equipment, but also with the customer
service he receives.
“I know the team from Clark Dental well and
have come to rely on their support. They
recommended the digital OPG system and RVG sensors from Schick and they
have made a big difference from the start.
The two areas that have improved are the instant results and the consistency
in imagery the Schick equipment provides. The old fashioned system always
gave us lots of problems, but now if I have any issues, they are dealt with
immediately; they really are fantastic!
The main benefit, apart from the product, is the service we receive; it really is
excellent. We’ve now subscribed to a service package, which gives us support
both on-site and over the telephone, which has been very useful for upgrades
and such.

Chairs need cleaning after every patient
ChairSafe disinfectant foam cleaner is available in 200ml
bottles and 1L and 5L refill containers and with the new
Kemdent range of durable and economy wipes. These
extra large ChairSafe wipes mean that you can clean a chair
for just a few pence after each patient, protecting all the
Dental Professionals in your practice.
HTM 01-05 a guidance published by the DOH, recommends
that Dental Chairs be cleaned between every patient to
minimise the dispersal of microorganisms. ChairSafe foam
and ChairSafe wipes are specially formulated to clean
sensitive surfaces and equipment, including the leather
and synthetic facings of dental chairs.
ChairSafe foam and wipes are alcohol free. They are effective against HBV/HIV/HCV/
BVDV/vaccinia, bactericidal and fungicidal microorganisms within one minute of
application. Kemdent ChairSafe foam and wipes used correctly, guarantee a safe
inactivation of influenza A (H1N1)- viruses (pathogens of swine flu). These products
should be used for daily disinfection of surfaces close to the patient/frequently
touched surfaces (eg. dental chairs, door handles, work surfaces).For further
information on special offers or to place orders call Jackie or Helen on 01793 770256
or visit our website www.kemdent.co.uk.
Issued by Belinda Mayoh –Kemdent email belinda@kemdent.co.ukTel: 01793
770256, Fax: 01793 772256 Date:05/05/2010Ref: prom05052010

The quality of the service we receive makes all the difference.”
For more information contact Schick Technologies GB Wickford Essex Office on
01268 733151 or email sales@schicktech.co.uk
Or at Nantwich Cheshire Office on 01270 613750
or email sales@clarkdental.co.uk

Don’t miss DENTSPLY’s Endodontic Roadshow
Clinicians with an interest in endodontics should
not miss DENTSPLY’s 2010 Endodontic Roadshow
during September, where they can gain the latest
advice on how to use some of the market’s leading
endodontic products such as ProTaper, along with
recent innovations including PathFiles and the
Calamus Dual.
Hosted over one and a half days and at four
venues, internationally renowned speaker,
Dr. Arnaldo Castellucci (visiting Professor of
Endodontics at the University of Florence Dental
School, Italy) will be joined by a guest speaker at each event.
Dates and Venues
Guest Speaker
15 & 16 Sept Manchester – Mottram Hall -Dr Mike Horrocks
17 & 18 Sept Edinburgh – Norton House - Professor William Saunders
20 & 21 Sept Dublin – Radisson Blu, St Helens - Dr Hal Duncan
22 & 23 Sept Cardiff – Vale of Glamorgan - Professor Phil J. Lumley
Day 1Lecture £100 + VAT (£117.50)
Day 1 and Day 2 £175 + VAT (192.50)
Receive free DENTSPLY products up to £175RRP
Dentists are urged to reserve their place quickly as tickets are expected to sell
out fast.
For more information or to book your spot on the course call 0800 072 3313,
email enquiry-uk@dentsply.com or visit www.dentsply.co.uk.

SENSODYNE OFFERS A
RAPID* RELIEF FORMULA FOR
PATIENTS WITH SENSITIVE
TEETH
Sensodyne is the UK’s number
one sensitive toothpaste brand
and has leading expertise in
dentine hypersensitivity. As part of their commitment to the UK’s sensitivity
sufferers, the brand has an ongoing clinical development plan. Recent research
highlights that when the strontium acetate formula of Sensodyne Rapid Relief
is massaged on to the base of the sensitive tooth for 60 seconds, patients get
rapid relief from their sensitivity . Long-lasting protection can be achieved by
regular twice daily brushing .
1 in 3 patients suffer from the pain of dentine hypersensitivity yet incredibly
over 50% fail to seek the advice of a dental professional for their symptoms
. In addition consumer research shows that more than 75% of sufferers have
never used a desensitising toothpaste, or only use one occasionally . Research
by the Sensodyne brand highlights a need for fast relief for patients with one
UK patient commenting “Give me something that works fast and I might be
interested”.
Sensodyne Rapid Relief is clinically proven2, 3, and the strontium acetate
formulation works by creating deep, acid-resistant occlusion of the dentinal
tubules. In vitro studies show that the occlusion formed by the strontium

Industry News 28

Enter A New Dimension
Gendex is taking dental imaging to another
level with the GXCB-500 – the latest in Cone
Beam 3D dental imaging.

enables a view of 14 x 8cm.

Powered by i-CAT, the industry’s leading
technology and dynamic software for 3D
imaging, the GXCB-500 features an Amorphous
Silicon Flat Panel Sensor that delivers accurate
images at a scan time of only 8.9 seconds with
full 3D reconstruction in less than 20 seconds.
The unique single sensor design allows staff
to effortlessly switch from 3D to 2D imaging,
which saving time. It has a standard field of
view of 8 x 8cm while its special EDS shot

This high quality equipment offers dental professionals a unique ‘medium field
of view’. This enables immediate diagnostic information to allow dentists to
precisely plan implant treatment. The GXCB-500 is perfect for Implantology,
with nerve canals easily identified by nerve marking estimation. This
breakthrough technology is easily incorporated into the practice and on-site
training is available.
For more information, please contact KaVo on 01494 733 000, email: sales@
kavo.com or visit www.kavo.com

acetate formulation is robust, with occlusion being maintained even after a
10 minute acid challenge whereas a competitor arginine formulation may be
more vulnerable to acid challenges7.
Sensodyne Rapid Relief, which also contains sodium fluoride, is part of the
Sensodyne range of toothpastes for sensitive teeth.
To request trial size packs of Sensodyne Rapid Relief for your dental patients
please visit www.gsk-dentalprofessionals.co.uk

The very latest in computer-aided design is used to ensure that you have the
clearest vision possible of the proposed design changes. By using CAD, Clark
Dental can easily make adjustments to your specifications, and be sure that the
final design meets your every requirement.
With Clark Dental, you are guaranteed the complete package and total peace
of mind. From the initial discussions and planning, right through to project
completion, Clark Dental will assist you in every aspect of the work including:
conforming to the latest regulations and installation and training for any new
equipment.
Clark Dental works with the leading suppliers of dental equipment, cabinetry
and units and can provide a tailored solution to your own unique requirements.

Associated Dental Products Ltd. Kemdent Works, Purton, Swindon, Wiltshire
SN5 4HT.

Topdental (Products) Ltd have this
month issued their biggest summer
offer sheet ever.
The summer issue, available through
July, August and September features
the launch of an exciting new range
of uniforms from the highly regarded
Bossklein brand of dental products.
The range comprises of stylish “Mock
Wrap” Tops and Bootleg Trousers. Made
from hard wearing poly cotton with the
Dickies quality label you can trust. The
tops are currently available in 3 stylish
colour combinations and the trousers in practical black.
Launch special offer of 25% off uniforms available now!
Over the summer we are also offering free gifts*, and have many special offers
and price cuts on infection control products, handpieces, disposable items and
small equipment.
The offer sheet is available for download from www.topdental.org or ring free
on 0800 132 373 and request your copy.
*Conditions apply. See offer sheet for more details.
Topdental (Products) Ltd. Tel: 01535 652750
Email: sales@topdental.co.uk
www.topdental.org

Badge of honour
- Sonicare For Kids accredited by the British
Dental Health Foundation
Three pieces of good news relating to Sonicare
For Kids have been released today by Philips. It has just been announced that
Sonicare For Kids has been accredited by the British Dental Health Association.
An independent panel of dental academics drawn together by the BDHF assessed
the basis for a number of claims made by Philips about the Sonicare For Kids and
approved them. This allows dental professionals to reinforce the benefits of using
the pioneering sonic toothbrush it designed especially for children, safe in the
knowledge that they have been independently verified.
The BDHF accreditation logo will soon be appearing on Sonicare For Kids
packaging and practice and patient literature giving recommenders and
dispensers alike, even more reassurance that the product has been professionally
assessed and the veracity of its claims confirmed.
Philips Sonicare has also developed some new patient materials to encourage
young people to become more eager to brush their teeth regularly. A ‘Brilliant
Brushers’ reward chart and badge template has been designed to encourage
regular and effective brushing. These elements are designed to help parents
establish and maintain a good brushing routine and reward their children for
their consistency and compliance. A website and animated game is also being
developed which is due for imminent launch – and the reward chart and badge
template will be free to download from these. More information about the
launch date for the website will follow shortly.
For more professional information about Sonicare For Kids visit
www.sonicare.co.uk.dp or call 0800 0567 222.

[29] =>

The Clearstep System

Comprehensive invisible orthodontics made easy
The Clearstep System is a fully comprehensive, invisible
orthodontic system, able to treat patients as young as 7.
It is based around 5 key elements, including
expansion,space closure/creation, alignment, final
detailing and extra treatment options such as functional
jaw correction.
GDP friendly, with our with our Diagnostic Faculty providing
full specialist diagnostic input and treatment planning, no
orthodontic experience is necessary. As your complete
orthodontic toolbox, Clearstep empowers the General
Practitioner to step into the world of orthodontics and
benefit not only their patients, but their practice too.

Accreditation Seminar
This accreditation seminar is aimed at General
Practitioners, providing you with all the knowledge and
skills required to begin using The Clearstep System
right away.

Personal Accreditation
Receive a visit from a Clearstep Account Manager,
providing a personal accreditation in your practice at a
time convenient to you.

Accreditation Seminars for 2010
30th March
London
27th May
Ireland
13th July
London
9th September
Birmingham
30th November
London
Further Courses
Once accredited, further your orthodontic expertise with
our Hands On Course, where you will learn sectional
fixed skills and other methods to reduce your costs and
treatment times.

Clearstep Advanced Hands On Course
dates for 2010
7th - 9th April
London
25th - 27th October
London
To find out what Clearstep can do for you
contact us today.

01342 337910
info@clearstep.co.uk
www.clearstep.co.uk

[30] =>

30 Events

United Kingdom Edition July 19-25, 2010

Care in the community
Pass on your skills to local healthcare personnel
in Tanzania with Bridge2Aid

he Bridge2Aid Dental Volunteer Programme (DVP)
was developed to allow
qualified dental professionals to
pass on their skills to local health
care personnel in Tanzania.
Each 13-day trip has spaces
for up to 12 dentists and eight

nurses (or hygienists willing to
act as hygienists/nurses) who
are willing to work in remote rural clinics developing the skills
of clinical officers and delivering basic dental services to the
community.
Places get filled up fast but

there are some spaces left,
although a minimum of one
full years’ post-graduate experience for dentist applicants is
required. To apply for your place,
read onto the bottom of this page!
History of the B2A DVP
The Bridge2Aid Dental Volun-

A training session of a Rural Clinical Officer (RCO) by a dental volunteer

teer Programme was developed
in partnership with Dentaid
during 2004, and we are very grateful for their support in helping
to establish the visits. Since
then we have run the programme ourselves.

PracticeWorks

Rural Clinical Officers receiving their pass
certificates after being trained by dental
volunteers in January 2010

Questions about DVP?
Dentist Liz Stringer closed her
Knebworth practice while she
went out on the February 2008
DVP with her two nurses - Su
Mills and Tracey Evans. She
loved every minute of her experience. ‘Having started the planning of this trip more than a year
People queuing to see the volunteers in the
rural tooth camps wait patiently for hours
after walking for several km.

R4 Practice Management Software
Access your practice data
on your iPhone
or Blackberry

More RCO training - January 2010

ago, I must admit that, as we set
out for Heathrow Airport on that
Saturday morning, I was more
than a little anxious. I have never
been away from the family on
my own for more than a few days
and so this was definitely a big
step into the unknown. My fears,
however, were quickly dispelled.
Our team, comprising fourteen
dentists and eight nurses, rapidly became close friends, with
whom we shared amazing experiences, some of them extremely
emotional. Far from being depressing, it was a truly uplifting
and rewarding time.’ To read
more, visit www.bridge2aid.org/
cm/general/dvpexp1.
Who will oversee my trip?
Administration of these events
is carried out by Ruth Bowyer,
our visits administrator in the
UK. If you have any questions
not answered in the FAQ section of the website, or to find out
more about specific areas of the
programme, call Ruth on 07748
643006.

Another breakthrough from PracticeWorks
Being able to access your practice management system from your smart phone
is just one of the new software innovations we’re rolling out this year.
Book your demonstration now and see just how advanced R4 is.

For more information or to place an order please call 0800 169 9692
or visit www.practiceworks.co.uk

PracticeWorks

Book your place
Places are now being booked on
the January and February 2011
trips. You will need to download
an application form from the
Bridge2Aid website. Visit www.
bridge2aid.org/cm/general/dvp
and scroll down the page and
click on the button ‘download
your application pack’. DT

[31] =>

Classified 31

United Kingdom Edition July 19-25, 2010

Something to
Smile about!...
SmileGuard is part of the OPRO Group, internationally renowned for revolutionising the
world of custom-fitting mouthguards. Our task is to support the dental professional with
the very latest and best oral protection and thermoformed products available today.

Custom-fitting Mouthguards* – the best protection for teeth
against sporting oro-facial injuries and concussion.
OPROshield – a self-fit guard enabling patients
to play sport whilst awaiting their custom–fit guard.
NightGuards – the most comfortable and effective way
to protect teeth from bruxism.
Bleaching Trays – the simplest and best method for
whitening teeth.
Snoreguards – snugly fitting appliances to
reduce or eradicate snoring.
OPROrefresh – mouthguard and tray
cleaning tablets.

In 2007, OPRO was granted the UK's most prestigious business award,
the Queen's Award in recognition of outstanding innovation.

www.smileguard.co.uk
email info@smileguard.co.uk or call 01707 251252

part of the oprogroup

* SmileGuard - the first to provide independent certification relating to
EC Directive 89/686/EEC and CE marking for mouthguards.

7320_09_3

Geoff Long
2010

FCA

info@medicsfinancialservices.com
www.medicsfinancialservices.com
+44 (0) 1403 780 770

mouthguard and tray
cleaning tablets

Tax Planning Slate
Now Available!

Very competitive fixed rates - House and Practice
Finance
Surgery Finance - Bank of England Base
(from) + 1.00%
100% Mortgage Finance - House and Practice
Extremely Enhanced Income Multiples

office@dentax.biz

Call 01438 7222242

Enhanced income
multiples, market
leading rates & highly
competitive
mortgage solutions

for Dentists

+44 (0) 1403 780 770

Your home may be repossessed if you do not keep up repayments on your mortgage. Medics Professional Mortgage Services is a trading style of Global Mortgages Ltd.,
which is an Appointed Representative of Home of Choice Ltd., which is authorised and regulated by the Financial Services Authority.

MPMS 95x50 Dentists.indd 1

11/12/2006 21:56:19

[32] =>

“Give me something that works fast
and I might be interested”
Patient, UK

Sensodyne Rapid Relief – rapid* and long-lasting**
relief from the pain of dentine hypersensitivity1,2
The strontium acetate formulation of Sensodyne
Rapid Relief forms a deep occlusive plug within
the dentinal tubules3,4 providing:
• Clinically proven relief.1,2
Works in 60 seconds*1

The robust occlusion formed by Sensodyne Rapid
Relief is still maintained after an acid challenge4
Unoccluded
dentine

After treatment
and a 30 second
acid challenge

After treatment
and a 10 minute
acid challenge

• Proven long-lasting relief
with twice daily brushing2
• A deep, acid-resistant occlusion3,4
• Fluoride to strengthen tooth enamel

In vitro study of dentinal tubule patency following an acid challenge
(immersion in grapefruit juice, pH 3.3) applied after dabbing and massaging
for one minute with Sensodyne Rapid Relief. Adapted from4.

Recommend Sensodyne Rapid Relief for rapid relief
from the pain of dentine hypersensitivity
* when directly applied with finger tip for one minute

** when used twice daily

SENSODYNE and THE RINGS DEVICE are registered trade marks of the GlaxoSmithKline group of companies.
References: 1. GlaxoSmithKline data on file, Study Z4010664, 2010. 2. GlaxoSmithKline data on file, Study
Z4010686, 2010. 3. Banfield N and Addy M. J Clin Periodontol 2004; 31: 325–335. 4. GlaxoSmithKline data on file,
Study SF/EU/02/10, 2010.

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[cover] => DT UK 1910

[toc] => Array ( [0] => Array ( [title] => Murder trial dentist charged with assaulting female patients [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Unlocking the secrets [page] => 06 ) [3] => Array ( [title] => Who is in control of your future profits? [page] => 09 ) [4] => Array ( [title] => The 10th dimension… the power of ten [page] => 10 ) [5] => Array ( [title] => ENDO TRIBUNE 2/2010 (part1) [page] => 11 ) [6] => Array ( [title] => ENDO TRIBUNE 2/2010 (part2) [page] => 15 ) [7] => Array ( [title] => ENDO TRIBUNE 2/2010 (part3) [page] => 19 ) [8] => Array ( [title] => On-the-job training [page] => 23 ) [9] => Array ( [title] => Company Promotion [page] => 24 ) [10] => Array ( [title] => Do you have permission to practice? [page] => 26 ) [11] => Array ( [title] => Industry News [page] => 27 ) [12] => Array ( [title] => Care in the community [page] => 30 ) [13] => Array ( [title] => Classified [page] => 31 ) ) [toc_html] =>

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