DT UK 2210

Survey - access is still biggest problem for PCTs / News / One Lord a talkin’ - exclusively to DT / Making things simpler for our customers / Teaming up / How busy is your hygienist book? / Following the rules / Delivering patient experience / Small things make big difference / The bigger picture / Getting in at the deep end / An Evidence-Based Endodontic Implant Algorithm:Back to the Egg; Concluding Part / Growing pains / Why learn occlusion? / Aesthetic Zone needing Augmentation / Industry News / The long way down / Classified

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Table of contents

September 20-26 2010

PUBLISHED IN LONDON
News in Brief
24,000 BDA members
Memberships of the British Dental Association has
reached 24,000 for the first
time ever – in the same year
that the BDA celebrates its
130th anniversary. The figure
is made up of nearly 20,000
(19,940) fully qualified dentists and more than 4,000 dental students. British Dental
Association (BDA) chief executive Peter Ward welcomed
the news and said: ‘‘2010 is a
particularly challenging time
for the dental profession in the
UK with reform, uncertainty
and regulatory changes facing practitioners. It’s fantastic
news that more dentists than
ever recognise the value of the
support the BDA can give them
in meeting those challenges.’’
He added: ‘‘The BDA strives
hard to assist its members in
all aspects of their work and
we look forward to being there
for our enlarged family as we
navigate the challenges ahead
together’.’
Babies’ dental project
The University and NHS Salford are launching a two year
project to prevent tooth decay
in young children and babies.
The project is in partnership
with Salford City Council with
funding from the National Institute for Health Research.
Children in the North West
have one of the highest levels
of tooth decay in England. The
project aims to prevent, rather
than cure, tooth decay by targeting the parents of babies
and following them until the
children are three years old.
The participants will be split
into three groups, all of which
will have access to dental
services via a dental practice
linked to their local children’s
centre. Two of the groups will
be given an additional service. This will be either the application of fluoride varnish
to teeth every six months or
educational work with parents
designed to establish good
oral hygiene and diet routines.
The university will analyse
data on the number of decayed, missing or filled teeth
that children develop and use
the results to decide which of
the services is the most successful. Prof Cynthia Pine, the
principal investigator and executive dean of the Faculty of
Health & Social Care said: ‘‘A
project of this size has never
been carried out in very young
children before. Our focus is
to improve children’s dental
health in Salford and I’m delighted we can work in partnership across the city.’’
For more information or to
take part call 0161 295 5095
or email fhsc-salfordbrightsmiles@salford.ac.uk
www.dental-tribune.co.uk

News

Feature

Interview

See the light

Charity warns over gimmick of
solar powered toothbrush

page 4

VOL. 4 NO. 22

‘Perverse Incentives’

Dental Tribune speaks to Lord
Howe

Case Study

Augmentation

Little Things

A look at one dentist’s tiny tooth
world

A case presentation involving an
implant supported crown

page 16

page 27

pages 7-8

Survey - access is still
biggest problem for PCTs
Commissioning survey by the British Dental Association
shows growing experience of commissioning staff

nsuring that people have
access to NHS dentists
is still one of the biggest
problems for primary care trusts,
according to a recent survey.

those surveyed had been in their
role for under a year according to
the 2010 survey, while more than
a quarter had served for such a
short period in 2009.

The 2010 British Dental Association (BDA) Local Commissioning Survey found that significant challenges remain for the
commissioning of dentistry in
England, despite the growing experience of commissioning staff
and consensus on priorities.

However, many of the commissioning leads questioned this
year said they did not have an adequate workforce.

The research found that access to care remains the top priority for primary care trust (PCT)
dental commissioning leads, with
89 per cent of PCTs naming it as
one of their top three priorities:
This echoes the findings of research by the British Dental Association in 2009. Quality was next,
which appeared in the top three
concerns of just over a quarter
(28.4 per cent) of PCTs.
The research sought insight
into the experience of PCT dental commissioning, staff commissioning and the level of support they enjoyed from strategic
health authorities (SHAs), revisiting themes addressed by the 2009
research.
This year’s survey found that
61 per cent receive performance
monitoring advice, 46 per cent
contracting advice and guidance
and 18 per cent receive support
with their dental strategy.
The growing experience of
dental commissioning staff is noticeable. Less than 10 per cent of

Almost three-quarters said
they needed additional support,
with 18 per cent declaring they did
not benefit from the expertise of a
consultant in dental public health.
The research also identified
significant under spending of
dental budgets. Just under a fifth
(16.4 per cent) of PCTs said they
had spent less than 95 per cent
of their ring fenced dental
budgets in 2009/10, although it
is not clear whether the remaining funds were completely
unspent or diverted to nondental spending.
John Milne, chair of the BDA’s
General Dental Practice Committee, said: ‘‘This research illustrates the challenges that persist
with the commissioning of primary dental care and underlines
some of the issues the national
commissioning board will face
when it assumes its duties.’’
He added: ‘‘It is clear that
whoever is responsible for commissioning dental care must be
properly supported and have access to appropriate expertise.
The experience and knowledge of consultants in dental

public health and dental practice
advisers are particularly valuable in helping PCTs provide
effective care to patients. This
study stresses the gradual
accumulation
of
experience
by PCTs. Arrangements for
the handover of commissioning responsibility must seek to
ensure that experience is not lost.’’

Under the coalition government, the transfer of responsibility for dental commissioning will
pass in 2012 from the PCTs to the
national commissioning board.
It is not yet clear whether the
board will have regional offices
and, if it does, how these will be
organised across the country. DT

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Call Max on 01737 221020 EXT 2042
or email DTacquisitions@adp-dental.com

[2] =>

2 News
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?
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

United Kingdom Edition September 20-26, 2010

Editorial comment

A

big
thank
you and even
bigger congratulations to Baldeesh Chana and the
British Association
of Dental Therapists
as they celebrated
50 years of dental therapy at
their Annual Scientific Meeting
in London recently. I was in-

vited to attend the meeting and
was very impressed by the high
calibre speakers and in-depth
subjects covered (to say nothing
of the fabulous food and great
company at the dinner!). Keep a
look out in further issues for a
review of the event.
The Care Quality Commission and the uncertainty

surrounding the finer details
of registration with CQC is
gathering pace as the launch
date for dentist registration gets
nearer. The CQC has acknowledged this by extending the
opening hours of their ‘contact
centre’ to help answer queries
from suitably confused practices. I must admit to feeling quite
pleased that I currently don’t

have to register with them (but
with the way their reach has
extended, I am keeping tabs on
when the dental press fall under
their jurisdiction)!
In true journo-style though,
I feel that as we can share queries and challenges in a public
format, we can all benefit. So,
if you have a question regarding CQC that you don’t feel you
have had a proper explanation
to, email me and I
will see what I can
do. That way we
may all just get over
this latest hurdle
facing practices! DT

Colgate Oral
Health Month

A

round 9,000 dental practices in the UK are set
to take part in this year’s
Colgate Oral Health Month.
Participating practices have
been issued with a pack containing educational materials and
motivational materials to promote the campaign’s messages.
The theme for the 2010 campaign is ‘Discover 3 Essentials
for an Even Healthier Mouth’,
which are brush your teeth twice
a day with fluoride toothpaste
and replace your toothbrush
regularly; avoid sugary snacks
between meals and visit the dentist regularly.
Colgate is organising and running a UK roadshow throughout
September as part of the campaign. The company aims to use
the road shows to help raise the
awareness concerning the importance of good oral hygiene
and care standards.
The campaign also contains
a CPD programme, which focuses on the theme of delivering
prevention in practice based on
the principles contained in the
Department of Health’s toolkit,
Delivering Better Oral Health An Evidence Based Toolkit (2nd
edition, July 2009).
The verifiable CPD, Putting
Evidence into Practice, is available to all dental professionals, by
downloading the interactive programme from www.colgateohm.
co.uk. DT

[3] =>

News 3

United Kingdom Edition September 20-26, 2010

Dentist to treat Berber Tribe in Morocco

dentist in Hull is travelling to Morocco to give
vital dental treatment to
the Berber Tribe.
The tribe of 50,000 has just
one doctor and no dentists.
Chris Branfield, from Castle
Park Dental Care in Cottingham,
has helped to set up the charity
to give dental treatment to people
in remote parts of the world.
He and seven other dentists
will be taking part in the eight

-day expedition to treat the Berber Tribe in North East Morocco.
In a Berber village by the
Mediterranean Sea, the group
of eight dentists will be treating
both men and women whose
biggest problem is gingivitis
(inflammation of the gums surrounding the teeth).

Dr Branfield said: ‘‘In ten
years’ time, the day will come
when the Berber Tribe, its land
and its traditions, will be swallowed up into mainstream soci-

ety - just as the Red Indians and
Aborigines did before them. But
today, the privilege to experience
the tribe in their natural habitat,
is available to a very few.’’

Money is being raised by
Castle Park Dental Care for supplies and materials to help the
Berber Tribe and the cost of the
trip is being personally met by
Dr Branfield.
If you wish to sponsor the expedition, go to www.castleparkdental.co.uk. DT

The Moroccan Berber Tribe

Tenth anniversary of the Premier Symposium

his year, the risk management conference, Premier Symposium, will be
celebrating its tenth anniversary.
It is celebrating the event
with a compelling line-up of
speakers. Organised by Dental
Protection, the leading indemnity organisation for dental professionals in the UK and by schülke,
the international name in crossinfection control, this year’s Premier Symposium will take place
on Saturday 5 December 2010 at
Kings College, London.
A spokeswoman for Dental
Protection said: ‘‘The opportu-

nity to hear well-informed and
entertaining speakers in comfortable and spacious surroundings ensures that this meeting remains a highlight of the
dental calendar.
‘‘The Premier Symposium
2010 will feature a range of topical lectures including the transformation of dental care through
the use of implants and the risks
associated with them, nerve injuries, their cause and management, and the HTM 01-05 guidelines one year on.’’
The programme features the
following speakers and lecture

topics: Professor Richard Palmer
on implants – new risks for old;
Professor Tara Renton on nerve
injuries – their cause and management, Paul Jenkins on the
HTM 01-05 watershed - where
are we now; Paul Redmond, talking ‘bout my generation (communicating across ‘generation
gaps’) and Peter Briggs on risks
and responsibilities in periodontal care.
The event will also include
the presentation of the Premier Awards, a series of six risk
management prizes presented
to dental professionals who have
produced original work which

aims to improve patient safety.
The event is an ideal practice
day out, with team tickets available for DPL Xtra Practice Programme members, and a chance
for all members of the dental
team to attend this informative
pre-Christmas symposium.
Including six hours verifiable
CPD, tickets are now on sale for
this year’s Premier Symposium.
The conference was a sellout last year, and delegates are
advised to order their tickets
as soon as possible in order to
avoid disappointment. Tickets

are available from events@dentalprotection.org or telephone
020 7399 1339. Or for more
information, please visit the
Dental Protection website at:
http://www.dentalprotection.
org/uk/newsnevents/events/
premier2010
Tickets for this year’s Symposium are priced at £110 For
DPL members and £255 for
non-members. The team package (available to DPL Xtra practice programme members only)
costs £190 for two places, or £280
for three places when booked together. All prices include VAT at
the standard rate. DT

CQC extends opening hours to help dentists prepare

n order to help dentists
prepare to apply for registration, the Care Quality Commission is extending its national
contact centre’s opening hours.

The new hours are 8.30am
to 8pm Monday to Thursday,
from 8.30am to 5.30pm on
Friday and from 8am to 4pm on
Saturdays. In addition, the Care
Quality Commission (CQC) has
also published ‘A new system
of registration: Guide for providers of primary dental care
services’ to help practitioners.

The new guidance provides
more information on the application process, which was
refined following a series of
pilot projects in June/July of
this year.
General dental practitioners
will be invited to start applying soon, so that all providers
are registered by 1 April 2011
and the CQC expects – from the
available data – to register more
than 8,500 providers. Due to
this expected large amount of
applications, dentists will be

put into groups with each group
given an application window
within which to apply. Providers (essentially ‘practices’) will
be registered against the new
essential standards of quality
and safety that apply across the
care sector; the British Dental
Association has produced dental-specific guidance on this.
The CQC’s director, Linda
Hutchinson said: ‘‘We appreciate that this type of regulation is very new to the dental sector and that people will

Smile-on produces learning
programme for dental nurses

he
dental
education
provider, Smile-on, has
produced an online/CDRom training programme specifically for dental nurses.

DNNET II is a learning programme produced by Smile-on available on CD-Rom or online.
The comprehensive programme
is designed specifically for dental nurses studying towards the
National Certificate, the NVQ
level three in Oral Health Care
Dental Nursing or as an update
for established nurses.

As a learning package, DNNET II incorporates dynamic
audio and video footage, animations and detailed diagrams
that immediately make learning
more engaging.
The DNNET II programme
covers health and safety, infection control, oral health
education, patient assessment,
processing radiography, periodontics and restoration, equality and diversity, minor oral
surgery, surgical periodontal
therapy, orthodontics, commu-

nication, prosthetics and endodontic treatment.
By using DNNET II, dental nurses are given full access
to all of the knowledge that
they will need to pursue a
fulfilling career as well as
preparing them for their examination after registration at an
accredited assessment centre.
For more information on
DNNET II call 020 7400 8989 or
email info@smile-on.com DT

have a lot of questions. We
publish regular updates on
our website, but we know that
some people would prefer to
talk things through over the
telephone.
‘‘We want to make sure
our helpline is available to answer questions at times that are
convenient to dentists, taking their working hours into
consideration. We’re also working closely with the General
Dental Council to avoid any
overlap in our actions and

Published by Dental Tribune UK Ltd
© 2010, Dental Tribune UK Ltd.
All rights reserved.

Dental Tribune UK Ltd makes every
effort to report clinical information and
manufacturer’s product news accurately,
but cannot assume responsibility for
Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com

to minimise any potential regulatory burden for providers.’’
Ms Hutchinson added: ‘‘Ultimately, our objective is to protect service users and to encourage improvement in the care
people receive.’’
The Care Quality Commission will be also writing to dentists to advise what will happen
next and about what further action needs to be taken. DT

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.

Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.com

Sales Executive
Sam Volk
Tel: 020 7400 8964
Sam@dentaltribuneuk.com

Editorial Assistant
Laura Hatton

Design & Production
Ellen Sawle
Ellen@dentaltribuneuk.com

Laura..hatton@dentaltribuneuk.com

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

[4] =>

4 News

United Kingdom Edition

September 20-26, 2010

Warning issued over
solar powered brush

he British Dental Health
Foundation has issued a
warning over a new toothbrush that cleans your teeth with
solar power.
The Soladey-3 ionic toothbrush from Japan claims to get
rid of plaque with electrons that
work with saliva to remove it
from your teeth.
A solar panel attached to the
handle absorbs electrons from
light and transmits them to
your teeth through ionized water
and a titanium oxide semiconductor in the upper shaft of the
toothbrush.
You can still use toothpaste
but Soladey claims it loosens
plaque effectively using only electrons. However the British Dental
Health Foundation has expressed
its concern over the new invention and is advising people to
continue using toothpaste.
Chief executive of the British
Dental Health Foundation, Dr Nigel Carter, said: ‘‘It is absolutely
vital that we stick with fluoride
toothpaste when brushing our
teeth, in order to maintain the
good modern day levels of oral
health. Good toothpastes, along
with a steady brushing action,
can remove harmful plaque and
bacteria from the mouth, preventing such diseases as caries, gum
disease and tooth loss.
‘‘Over the last century, the ingredients in toothpaste have de-

veloped to such an extent that it
now offers us an exceptional level
of protection against oral diseases
such as decay and gum disease.’’
The addition of fluoride for
instance, which became common in toothpaste from the 1970s,
helps strengthen enamel and
makes the teeth more resistant to
tooth decay.
Other important components
in toothpastes include antibacterial agents such as Triclosan
and zinc, which helps thwart gingivitis. If untreated, it can lead
to periodontal disease, the most
common cause of tooth loss
in adults.
Dr Carter is warning people to
be cautious about the new Japanese brush, which is currently in
the prototype stage.
The solar-powered brush is
the idea of Dr Kunio Komiyama,
who is now a professor of den-

tistry at Canada’s University of
Saskatchewan. The brush itself is
called the Soladey-J3X.
Dr Carter said: ‘‘The components that make up today’s
toothpaste are far too complex,
for what essentially is a ‘gadget’,
to replicate. I’m certain that more
tests need to be undergone to see
if the brush can do what it claims
and, in addition, to measure any
potential long-term effects not
using toothpaste may have on
an individual.
‘‘As we know of, there is yet
no substitute for brushing our
teeth twice a day with a fluoride
toothpaste – and I cannot see
that changing.’’
The
company
responsible for the brush is currently
conducting a study to determine
how teenagers rate the solar
powered toothbrush in comparison with a regular toothbrush. DT

Free research event for dental care professionals

he Faculty of General
Dental Practice (UK) will
be hosting the second in a
series of free research events for
dental care professionals.
This free event on 27th November builds on the highly successful introductory event in June
2009, which was aimed to promote research activities among
dental care professionals (DCPs).
The Research Day will once
again be a collaboration between
the FGDP (UK) and the British Society for Dental Hygienists
and Therapists, with additional
sponsorship from partners in the
British Dental Trade.
The programme will focus
on the progress made since June
2009 and will include a report of
a pilot study into DCP skills usage
and plans for a national study of
dental hygienists skills usage and
job satisfaction.
There will be a series of pres-

entations from DCPs on their
achievements in the field of
research.

the small minority who have
become involved and the results
that they have achieved.

The programme will also
include essential information
on the opportunities for further
progression in research, including presentations on retrospective studies, undertaking a PhD
and literature review. Delegates
will have the opportunity to take
part in breakout group sessions
on producing research abstracts
and posters; these will be led by
DCPs and dentists who have produced and presented research
posters and abstracts. They will
also take part in research topic
selections and literature searching in small groups.

‘‘I am particularly pleased by
feedback I have received from
DCPs and that the deeper insights they have obtained from
research has changed the way in
which they treat their patients.’’

Ken Eaton, FGDP (UK) national research facilitator and
leader of the initiative said: ‘‘Although in the past active involvement in research has not been
of interest to the vast majority of
DCPs, it has been very encouraging to see the enthusiasm of

The Research Day is open to
all DCPs who are involved or interested in developing in the field
of research.
There is no fee for the meeting and certificates for five hours
of verifiable CPD will be provided to delegates.
Registration will be at 10am
The Research Day starts at
10.30am and will finish at 4pm.
For further details and to
register for the event please
contact the Amrita Narain on
020 7869 6750 or email
anarain@rcseng.ac.uk DT

[5] =>

United Kingdom Edition September 20-26, 2010

Company Promotion 5

Dentistry Capitalising on Recession
“How to grow your dental business in an adverse economic climate”, as presented by
Iain Forster, Managing Director of DIO UK, at the Royal Society of Medicine, London

In his presentation Iain said
that it was a good time to be in
dentistry, with the population
increasing and costs decreasing.
He also put a positive spin on the
recession saying that companies
that promoted heavily during a
recession were often the first to
emerge from it and the most successful in the following years.

Bringing marketing right up
to date Iain urged dentists that
they should embrace social media and the opportunities it provides. Twitter, Facebook, LinkedIn and many more all provide

•Maximising patient conversions;
• Search Engine Optimisation
(SEO);
• Pay-Per-Click (PPC) campaigns
… and much more.

unprecedented opportunities for
dentists to reach out to a wider
market, for little or no cost. Not
only are these outlets easy to use
they are also essential for those
practices who do not want to be
left behind as the old marketing
techniques are superseded by
newer, cheaper, more effective
methods.
In closing Iain introduced the
new “21st Century Dental Marketing” workshops which help
dentists to take advantage of the
opportunities they have available
to market their businesses in the
modern climate. The workshops
cover:
• The use of PR and how to do it;
• Best practices for web page layout;
• How to use a CMS system to
keep your website up to date;

To book your place on the
next 21st Century Dental Marketing workshop, go to: www.dentalmarketinguk.com
Iain is now presenting his lecture as a free online webinar. Delegates can register for the online
seminar by going to www.dentalwebinar.co.uk or visit http://www.
dentala.co.uk/seminars/dentistrymarketingwebinar.html.
DIO Implant is a global supplier of dental implant technology. Established for over 20 years,
DIO is rapidly expanding in the
UK and has already taken a sizeable share of the market with its

combination of high quality, sensible pricing and clear communication. The company’s focus on
marketing education is part of
its strategy to build effective and
profitable business partnerships
throughout the dental industry.
Further editorial information
from:
Charlotte Freestone
The Words Workshop Ltd.
Tel: 01908 695500 Fax: 01908
690099
E-mail: charlotte@thewordsworkshop.co.uk
Web: www.thewordsworkshop.
co.uk
All business enquiries to:
Iain Forster -Managing Director
DIO Corporation Ltd (UK)
Tel/Fax: 0845 123 3996
E-mail: info@DIOUK.com
Web: www.DIOimplant.co.uk

Despite encouraging dentists
to promote their services during
a recession, Iain urged caution.
He said that companies should
not over spend and should test
marketing methods to determine
what worked best for them and

focus on those that proved to be
most successful. “It pays to start
small and build confidence,” he
said.
Iain was confident that the
economic climate is right for dentists to promote their businesses
as the country emerges from recession. He went on to explain
that it is however essential that
practices remain focussed, targeting those people with whom
they already have a relationship
before spending too much money
looking further afield. He drew a
distinction between internal marketing to reach out to the local
population, educating their own
practice teams and the importance of the Internet; and external marketing that was designed
to open up new markets over an
extended period. “Internal marketing gives us business tomorrow,” he said. “External marketing gives us business next year.”

ain Forster, Managing Director of DIO UK, presented his
marketing advice and ideas
to delegates at the Royal Society
of Medicine on Friday 3rd September. The 45-minute session
was well attended and there was
much interest shown both in the
content of his presentation and
the follow-up series of marketing
workshops Iain is holding over
the next few months to help dentists make the most of their marketing budgets.

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[6] =>

6 News

United Kingdom Edition

September 20-26, 2010

Closure of NHS Direct will affect
dental health most, says charity
T
NHS Direct, which was
formed in 1998, was staffed by
nurses and health advisers at
33 sites around the United
Kingdom and received around
five million calls a year to its

core services, as well as an additional five million people
who used its online health and
symptoms checker.

line is currently being tested
in the North East region, with
further trials to be carried out
across the UK over the coming
three years.

A trial of the new 111 phone-

The axing of the 24-hour
nurse-led service is set to leave
the future of 1,400 nurses uncertain, as well as 15,000 callers
a day who rely on its professional advice. The government has
said it will replace the service
with the new NHS 111 service.
However, Dr Carter claimed
this is not an adequate alternative and said: ‘‘NHS Direct was
a quality service and an essential source of information for
the public. Sadly, they have replaced it with a facility which
will simply struggle to offer the
same standard of assistance.’’
The new 111 service will
employ fewer qualified nurses
and will instead turn to nonspecialist ‘call advisors’ who
have completed a 60-hour training programme.
‘‘Unfortunately, when looking to slash costs, the temptation is to look to cut staff, their
wages or to introduce cheaper
employees
altogether.
This
seems to be the case with the
111 service.

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‘NHS Direct was a
quality service and
an essential source
of information for
the public.’
‘‘Time will tell on how it
will be received in the longrun by the public and whether
the same standard of advice
can be replicated by nonprofessionals.’’
He added: ‘‘Regrettably, it
will be dental health that will
suffer the most. The now abandoned NHS Direct service regularly took more calls related to
dentistry than any other area
and if you consider on top of
that the potential cuts to local
PCTs, it leaves us asking just
who is going to fill the void in
terms of giving qualified information to the public?’’
He hopes that people will
turn to the National Dental
Helpline, which is staffed by
fully-qualified dental nurses,
who offer free advice at a localrate number.

The online version of the
service is set to remain, in addition to the phone service in both
Scotland and Wales. DT

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he chief executive of the
British Dental Health
Foundation, Dr Nigel
Carter, claims it will be people’s oral health that will suffer
most as a result of the closure
of the medical advice helpline
NHS Direct.

[7] =>

United Kingdom Edition September 20-26, 2010

Interview 7

One Lord a talkin’ - exclusively to DT
Dental Tribune recently met with Lord Howe, Parliamentary Under Secretary of State
(Department of Health) with responsibility for dentistry, and asked him about his feelings about the current dental system and where he feels improvements could be made.

ord Howe has had a
long involvement with
health issues, having
been opposition spokesman
for health since 1997. Although
never a specific responsibility
of Howe’s, dentistry is something that has been a part of
the general issues surrounding
healthcare. “I have always been
well aware of the general issues
that the area of dentistry involved; it was no accident that
my party colleagues and I,
in preparing our manifesato,
made specific promises about
dentistry. As the minister now
charged with looking after dentistry I am very pleased that I
have this responsibility.
Key Representatives
“Although I have only been here
for a few months I have made it
my business to have meetings
with key representatives from
the profession to bring myself
up to speed. I’ve met the BDA
twice and I attended a reception
in Westminster where I spoke
with a number of stakeholders.
I have met Prof [Jimmy] Steele
informally, and I am due to
meet him again within the next
few weeks. In addition, I’ve received a number of invitations
to visit dental providers and
have already visited a clinic in
Cambridge, which was extremely valuable to me.’’
The political place dentistry
seemed to hold in this year’s
General Election shows exactly how much of a key issue for
the voters it is. “I think dentistry
is as much a priority for us as
it is for the public. It’s become
more salient as a health issue
for the voter than maybe it was
a few years ago, we certainly
sensed this when we were in
opposition.

still exist around the country,
calling it ‘the biggest challenge’.
He is keen to see the adoption of a number of approaches
to improve the picture in terms
of child oral health, many focusing directly on the dental
contract. “The statistics that I
have seen on children, which
is a particular area of concern
that I have, are quite encouraging in that oral health in children seems to have improved
much over the last 20 years. Yet if
you drill down into those
figures you do see a pretty horrific picture in terms of those
children whose oral health is
poor and I think that there are
a number of approaches we can
adopt to this.
“The reform of the dental
contract lies at the centre of this.
You will have seen in our election manifesto that we built in
an undertaking to reform the
dental contract. I have asked officials to take that work forward
- obviously it can’t happen instantly - but the principles on
which a new contract should be
built are there.
“There needs to be a pronounced emphasis on prevention and a move away from unintended perverse incentives.
Although the current contract
was formulated with extremely
good intentions - one mustn’t decry its good features - I’m afraid
there have been some perverse
consequences arising from it and
I think both dentists and patients
have been aware of these.
End of UDAs?
“Does that spell the end of
UDAs? We’re looking at all of
that. I think that the Steele re-

view had a great deal of information in it which will inform the
work we do on modifying the
contract; on the whole the
Steele review met with a good
response. So, I am taking stock
of all that before deciding in any
detail how we are going to take
the reform forward.”
Of course time is a major
factor in the reforms and Howe
is very conscious of the balance
between getting things done and
rushing the process. “One can
never do things as quickly as
one wants because there are
so many things that are subject to consultation and detailed
work - it can’t be done in a
hurry. I can’t tell you that in a
year’s time we will be on the
brink of as new contract, that
would be too soon, because any
new contract will have to be
piloted, we have to be sure it is
going to do what we all want
it to do, so we’re looking reasonably far down the track in
terms of this Parliament. By the
middle of this Parliament I would
hope to be very much further
with the new contract.”
Centralised control
The biggest topic that has been
discussed over recent times is
the White Paper and the implications that it will have for
dentistry. Speaking of the proposed return to more centralised
control over dental commissioning Lord Howe said: “The
point of that proposal is that we
should first of all have a commissioning mechanism designed
to ensure consistency, as I
mentioned, and in the standard of consistency. One of the
commissioning board’s tasks
will be to promote equality

Dentistry on the radar
“The importance of oral health
in terms of how it plays into general health is certainly not lost
on us and I hope you will have
felt from the Health White Paper that dentistry is very much
on our radar. Of course we have
got to work out exactly how the
system is configured but we are
clear that we want an architecture for the health service that
promotes quality, that promotes
the prevention agenda and that
gives consistency in commissioning services.’’
Lord Howe is by no means
immune to the size of the task
facing dentistry in tackling the
oral health inequalities that

‘One can never do things as quickly as
one wants because there are so many things
that are subject to consultation and
detailed work.’
and access, and its access to a
service that delivers quality that
I think lies at the heart of this.
“Also I think that we felt
that it wasn’t appropriate to give
GP consortia the commissioning responsibility for dentistry.
I think that it sits more logically with the board as it does
with services like Pharmacy and
we’re looking at other areas
which may more logically sit
with the NHS commissioning
board, nothing to do with dentistry. How the board configures
itself is a matter for them. But
I would be surprised if it didn’t
consider regional outposts so
that services such as dentistry
are commissioned with a view to
the needs to a local population.”
One of the major fears expressed over the new proposals
is what is going to happen in
the period between PCT control
and the taking over of the reigns
by the NHS Commissioning
Board. Many practitioners are
concerned about how they’re
going to be able to interact with
their PCTs in the interim period,
and Lord Howe was quick to
reassure: “This is a very important question and it’s one
that we’re looking at across the
piece. I would like to reassure
practitioners that we are alive
to the risks in all of this but we
believe it to be manageable and
we have time in which to make

sure that nothing slips between
the cracks, not least dentistry.
“PCTs are clear as are strategic health authorities that
they have a very important role
to play in making sure that
this transition works smoothly, we will be setting up the
NHS Commissioning Board in
shadow form quite soon, so that
by the time it starts its role for
real we should have sorted out
most of the transfer functions.
Of course we don’t plan to abolish PCTs until we are absolutely sure that the transition has
occurred. I can understand the
anxiety of dentists but I think
they need to be assured that I
am very much with them on
this. I am not going to take
risks with the way that NHS
dentistry is made available to
patients and there certainly
will be no hiatus in terms of
administration.”
HTM 01-05
Another controversial topic in
dentistry is the issue of cross
infection control and the HTM
01-05 guidelines. Lord Howe,
though reluctant to revisit the
guidelines, did say he believed
that they needed more clarity:
“HTM 01-05 is going to stay in
force as it is, but the messaging
has to be clear because there
has been a lack of clarity in this.
Clearly, patients expect to be
treated in a safe environment,
and dentists and dental staff expect to work in a safe environment, that I don’t think is a matter for argument.
‘‘Currently the HTM 0105 guidance sets out two distinct things; it sets out essential
quality requirements, which
practices have to achieve by
the end of this year. Now I
have looked at this in some
detail with CDO Barry Cockcroft’s help and I’m absolutely
clear that no self- respecting
dentist would wish to do anything other than to meet essential quality requirements and
actually the HTM 01-05 guidance does no more than reflect
existing guidance. The essential quality requirements differ

Lord Howe: I think dentistry is as much a priority for us as it is for the public

à DT page 8

[8] =>

8 Interview

United Kingdom Edition September 20-26, 2010

ß DT page 7

‘I have looked at this in some detail with
CDO Barry Cockcroft’s help and I’m absolutely clear that no self- respecting dentist
would wish to do anything other than to
Estetica A4
SELECTED:Layout
1 25/2/09requirements
13:42 Page 1 .’
meet
essential quality

slightly from the pre-existing
guidance that were set out in the
BDA infection control document
(A12), so I think its wholly appropriate that dentists meet those
requirements to reduce the risk
of transferring infections and the
evidence that the requirements
have the effect of doing that is
also pretty clear.
‘‘The other side of the guidance of course is best practice,
which is quite separate. We

have been quite deliberate in
not setting a timetable for dentists to meet best practice as we
know that for many practices
this is difficult and for some it
isn’t. What we’ve said is that we
expect dentists to have a plan
to work towards best practice;
there is no mandatory timetable
involved. The HTM 01-05 guidance is an evidence based-document and for that reason I’m
not minded to revisit it, other
than to obviously update it as

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time goes on and our knowledge improves.”
Lord Howe definitely seems
to be taking dentistry to his heart,
especially focusing on the longer-term aspects of improving
oral health in children. “What
I want to see is us doing a lot
better with children’s dental health. We need to find a
way through the public health
agenda, accessing young mums
in particular and getting the
right messages across to them.
There’s some quite promising
work going on in Scotland in
this area and we can perhaps
learn from that. I just think
that improving children’s oral
health and getting the young
into good habits early on is
massively important. When you
look at children with poor oral
health, you can see it impacts
on them adversely throughout
their lives. It’s the most damaging way to start your life. So I’m
keen to look at ways in which
we can help children avoid tooth
decay and get them into good
habits. It is a long-term challenge, it’s not going to happen in
a hurry but I wanted to mention
that because it very much permeates the thinking we’re doing
on the dental contract and public
health planning.” DT

Lord Howe - Biography
Earl Howe was born in 1951. He
was educated at Rugby School and
Christ Church, Oxford, where he
read Mods and Greats. After leaving
University in 1973, he joined Barclays Bank and served in a number of
managerial and senior managerial
posts both overseas and in London.
In 1987 he was appointed London
director of Adam & Co. plc, the Scottish-based private bank, where he remained until 1990.
In 1991, Lord Howe became a
government whip in the House of
Lords with responsibilities, successively, for transport, employment,
defence and environment. Following the General Election of 1992 he
was
appointed
Parliamentary
Secretary (Lords) at the Ministry
of Agriculture, Fisheries and Food;
and in 1995 Parliamentary UnderSecretary of State at the Ministry of
Defence, a post he relinquished at
the 1997 General Election.
He has been opposition spokesman
for Health and Social Services in the
House of Lords since 1997. He is an
elected hereditary peer under the provisions of the House of Lords Act 1999.
In May 2010, Earl Howe was appointed Parliamentary Under Secretary of
State at the Department of Health.

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[9] =>

United Kingdom Edition September 20-26, 2010

Company Profile 9

Making things simpler
for our customers

See what you
are missing...

Managing Director at KaVo, Sonia Tracey,
discusses a change in direction for the dental equipment provider with Dental Tribune

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ental Tribune: Tell us
a little about your career.

Sonia Tracey (ST): My dental career started at Ivoclar Vivadent as a territory sales manager. Since then I have worked
within the industry and more
recently within the medical industry as a field sales manager
and later as sales director. I also
spent seven years working as
the northern sales manager for
another well known headpiece
manufacturer.
I started at KaVo in June 2007
as public sector manager for the
UK and Ireland. In November
2008 I accepted the position of
Managing Director at KaVo. It’s
been a big challenge but an extremely enjoyable one.
DT: I understand that there
is some major news from
KaVo, can you tell us more
about it?
ST: Obviously we’ve had a
couple of really good years and
we want to continue to build on
that success and improve the
products and service we offer
to our customers. With that in
mind, we have taken the deci-

DT: What has made KaVo
choose this new strategy?
ST: This decision has not
been taken lightly, we have
been working on this model for
some time and we believe that in
order to build on our recent
record breaking successes and
continue to grow our business
that this is the right direction for
KaVo to follow.
The dynamics of the dental
profession and industry are continually changing, the market is
becoming more competitive, for
example National Framework
Agreements are being put in
place. In addition the way consumers are purchasing goods
has changed - customers are
looking to use a single supplier
to fulfil all their equipment and
consumable needs.
DT: When will this change
go live?
ST: September 2010. It has
very much been a work in
progress, KaVo have been looking at this model for a period of
time and have already used the
same go-to-market model very
successfully in a number of other European subsidiaries.

‘The dynamics of the dental profession and
industry are continually changing, the
market is becoming more competitive. In
addition, the way consumers are purchasing goods has changed - customers are
looking to use a single supplier to fulfil all
their equipment and consumable needs.’
sion to restructure our distribution channels in order to guarantee greater flexibility when
purchasing KaVo products. Instead of selling direct to the clinician we are going to take our
distribution exclusively through
selected dealers. We believe that
by distributing our products in
this way, customers will now
have the opportunity to purchase
KaVo products from their chosen
company along with their complete consumable needs. In these
times of pressurised working environment, our aim is to make
life easier for our customers and
improve the purchasing process
making it as easy and convenient
as possible.

DT: Do you think that
your previous experience had
anything to do with why you
were chosen to head up this
new strategy?
ST: It does help to have had
experience of a wholesale background. My previous roles have
shown me that working with distribution partners gives a more
successful and secure business
model. This strategy will allow
greater market penetration and
we believe fulfil the needs of
our customers.
DT: How do you think this
news will affect current KaVo
customers?

Carl Zeiss
OPMI® Pico

ST: We believe that it will
provide our customers with
greater flexibility and purchasing power. Our goal is to enable
us to offer an improved service
through their trusted suppliers.
Our team of product specialists
will still be visiting customers to
advise them on their needs within the dental practice.

Carl Zeiss
EyeMag Smart
2.5x loupes

Of course we will continue
to support KaVo products in the
market place with technical support.
DT: Do you think that customers are looking to use a
single supplier to fulfil all
their equipment and consumable needs?
ST: Yes, we can see that purchasing patterns are changing, if
we look in the public arena we
shop at hyper markets, and we
book holidays on line. Consumers are looking for easier purchasing options including onestop shops, this is no different in
the dental profession.

Carl Zeiss
EyeMag Pro
prismatic
loupes

DT: So, what is KaVo
looking to achieve with this
strategy?
ST: The main emphasis of
KaVo’s policy lies in the total
satisfaction of our customers,
who represent the key to the
success of the company. In line
with our motto, KaVo, Dental
-Excellence, we aim to implement the KaVo vision through
our highly trained workforce,
our efficient organisation and
excellent technical backup from
our headquarters in Biberach,
Southern Germany.

Carl Zeiss
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By fulfilling all applicable
customer, statutory and regulatory requirements, we guarantee
high-quality,
environmentally
friendly products, reliability and
customer satisfaction. DT

For details of Carl Zeiss and our wide range of other
dental products contact:
Nuview Ltd, Vine House, Selsley Road,
North Woodchester, Gloucestershire GL5 5NN
Tel: 01453 872266 Fax: 01453 872288
E-mail: info@nuview-ltd.com
Web: www.voroscopes.co.uk

[10] =>

10 Money Matters

United Kingdom Edition September 20-26, 2010

Teaming up

is therefore unpopular.

If you’re buying or selling a share of a practice you’ll need to
consider partnership options and the impact it will have on the
value of goodwill, says Martyn Bradshaw

artnership
structures
within a dental practice
commonly fall into one

of two types: expense sharing
or true partnership. Some practices adopt a hybrid of the two.

Under a true partnership, profits
are split equally, regardless of
the individual partners’ fee, in-

come, or days worked. The risk
of inequalities makes this a potentially flawed agreement and

The expense-sharing route,
where the principals split either
some or all of the expenses, allows for a profit distribution
more in line with individual fees
produced. A hybrid arrangement
may involve the partners taking a
percentage of the fees produced
as the first layer of income (similar to an associate), with residual
profit or loss then split equally.
Goodwill valuations
A goodwill valuation should take
account of the partnership structure. If you are considering expense sharing, it is not relevant
to simply undertake a valuation
on the whole practice and divide
it by the number of partners. The
valuation should be based on the
actual share being purchased,
which involves an analysis of the
purchaser’s potential gross fees
and share of the remaining associate income. An experienced
valuer will combine this analysis with a projected profit and
loss account for the purchaser
to ensure that the structure is financially viable.
Sole-owners considering the
part sale of their practice run the
risk of devaluing their retained
interest at the point of their final
exit. However a balanced view is
called for, as the partial sale may
produce some advantages in the
form of raising capital, sharing
managerial and administrative
duties and not least the opportunity to continue work with similar rates of pay.
Partnerships – dispute prevention and protection
A formal partnership agreement
should be written by a specialist
dental solicitor (see www.apsd.
co.uk) to reduce the likelihood
of a future dispute.
Partnership protection insurance is recommended to protect
dependents and surviving business partners in the event of a
partner’s death. This enables
surviving business partners to
retain control of the business
and ‘buy out’ the (non-clinical)
dependents of their deceased
business partner, without the
need to raise finance. Crucially,
the deceased’s dependents can
offload their inherited business shareholding and release
the cash value of the inherited
goodwill, for which they have no
use. This arrangement should
be supported by a ‘cross option
agreement’ written into the partnership deed/agreement. DT

About PFM
For further information on
practice valuations and sales,
independent financial advice
for dentists, contact Martyn
Bradshaw at PFM on 01904
670820 or visit www.pfmdental.co.uk.

[11] =>

[12] =>

12 Practice Management

United Kingdom Edition

September 20-26, 2009

How busy is your
hygienist book?

Sheila Scott offers eight immediate ways to
transform your hygienist’s appointment book

ould your hygiene book
be busier? Are you seeing
an increase in cancelled
hygiene appointments or failures
to attend? If you can relate to either of these two questions, the
advice in this article could help
you to (re)build your hygiene
service and ensure greater patient health and practice stability.
I believe the ideal private,
preventively-orientated general
practice should be keeping a hygienist busy for four out of every
five days of general dentistry
availability. Here are my eight
immediate recommendations for
transforming your hygiene appointment book.
1. Communicate the benefits
Do communicate the benefits of
hygiene visits to every patient
you see for a regular exam. It’s
not enough to suggest patients
see your hygienist for a ‘scale
and polish’ or a ‘cleaning’ as this
does not adequately explain why
the appointment is necessary. It
is also misleading and unhelpful
to indicate that the hygiene appointment is for a ‘clean’ – after
all, patients believe they can do
this for themselves.
By far the most important part
of the hygiene appointment for
most patients will be in helping
them develop skills and habits
that will reduce their chances of
developing gum disease, tooth
decay, heart disease, etc, and I
believe it’s the job of dentists and
hygienists to communicate this
information every time they see
a patient.
It doesn’t have to be complicated, your message could be: ‘You
do have signs of damage in your
mouth from bacterial plaque.
I recommend you see Natalie, our
hygienist, for regular appointments to help you work on the
skills you need to control this
plaque damage at home – this will
help you stay dentally healthy
and reduce your chances of developing dental problems later.’
2. A consistent message
Please don’t change your communication of what your focus is without letting your
whole team know, particularly your hygienist. Ideally,
call a team meeting to discuss
how your hygienist helps periodontally compromised patients
in their appointments, and fine
tune your communications to re-

flect the actual pattern of advice
given in the appointments.
3. Involve reception
Make sure your reception team
has some good verbal ammunition for discussing the impact
of broken, cancelled or failed
hygiene appointments with patients. It’s not good for your
patients or your professional
standing to just let your patients
cancel their appointments or fail
to book them.
Your receptionist should have
your blessing to tell patients that
hygiene appointments can be
more important for some patients than their dental visits –
because hygienists help patients
prevent dental problems – which
might reduce their risks for treatment in the future. For example,
if a dentist has recommended
a hygiene visit then the receptionist can suggest to the patient
that they would benefit from
some help in either treating gum
problems or preventing them.
4. Stock what’s recommended
If your hygienist recommends
a patient uses a certain brush,
paste, mouthwash, floss or colour of interdental aid, please
make sure you stock these. It
doesn’t matter if the local shops
sell your preferred electric toothbrushes for less than you buy
them for (in which case I’d suggest going to the shop and buying a dozen and selling them for
the same price). You should be
stocking recommended items as
a service to patients – because
you care that they use the right
tools for controlling the factors
that damage teeth, gums and
heart health.
Every hygienist and oral health
educator knows that if a patient
can buy the recommended item
just after the discussions held,
they are more likely to start using them at home, than if they
have to wait a day or two until
they’re in the vicinity of a certain
chain of shops - who knows if
they’ll really buy their suggested
toothbrush then?
5 Hygiene & cosmetic dentistry
If you’re a provider of regular
crown and bridgework, or cosmetic dentistry, build in the
cost of a hygiene visit to each
course of treatment and offer a
‘free’ hygiene visit after the treatment. For example: ‘Now you’ve
spent this money on your treat-

ment, Mrs, X, I’d like you to see
our hygienist so that she can
show you how to look after it in
the best possible way. If we can
help you keep this new tooth free
of plaque, it should last much
longer and your mouth will be
healthier in the long term.’
6. Focus on children
Why not develop a programme
for all children in the practice, where they see your hygienist for a ‘family skills
and habits’ appointment at
least once a year – perhaps in
the holidays? Full-priced hygiene appointments can be
immensely valuable – and great
fun for competing siblings, if the
focus is on who is best at removing every last bit of (disclosed)
plaque. In addition, a parent
should be encouraged to supervise and coach each one to do
this well at home.
7. Work as a team
Make sure dentists and hygienists ‘huddle’ together to discuss
individual patients, their suggested patterns of hygiene appointments, response and any
changes to advice or treatment
etc. Don’t let your hygienist work
in isolation. Improving patients’
dental health is a team game and
the game needs the whole team
to play actively.
8. Involve your hygienist
Finally, include your hygienist in
all practice meetings. Talk about
advances in advice, treatments,
approaches and the framework
of the usual appointments in
the practice. I understand that
perio approaches are changing
hugely at the moment and I also
know that the majority of patients want, more than anything,
for their practice to help them
achieve a healthier mouth.*
Practices can organise for almost all patients to benefit from
hygiene visits and increase profits while doing so; however, the
game requires focus and good
communication with patients. DT
* Data from patient questionnaires provided by Sheila Scott

About the author
Sheila Scott has dedicated the
last 20 years to helping dentists
and their teams grow and prosper. See her website www.sheilascott.co.uk for more details, or
contact her on 01343 862930.

[13] =>

United Kingdom Edition September 20-26, 2010

Practice Management 13

relax...

Following the rules
Chris Hindle looks at how measures flowing
from the Health and Social Care Act 2008 will
affect dentists and their business plans

s a solicitor dealing predominantly with the
business affairs of dentists, I am acutely aware of the
concerns in the dental profession, which flow from the Health
and Social Care Act 2008, over
measures being introduced. The
Act contains 173 sections, 15
schedules and provides for the
introduction of further regulations, codes of practice and guidance to be published by the Secretary of State if required.
Subsequently, there have
now been 28 published regulations setting out certain essential
and politically correct standards
of quality and safety that dentists
are required to acknowledge.
The outcomes are apparently
meant to be helpful by providing dentists with prompts to help
them comply. On top of all this,
there is written guidance to help
interpret the regulations.
The main objective of the Act
is a sweeping one: to protect and
promote the health, safety and
welfare of people who use the
health and social care services
(s.3 (1)).
The Care Quality Commission
In order to provide services all
dental practices, NHS and private, have to be registered with
the newly created, integrated
regulatory UK public body, The
Care Quality Commission (CQC),
by 1 April next year: Thereafter,
they can look forward to compliance monitoring.
Eager dentists can enrol
from 1 October, although there
is some suggestion that the CQC
still doesn’t know what it wants
from dentists to facilitate this. At
least doctors are more fortunate
as they have a year longer to register. There are harsh potential
penalties for not registering, with
fines of up to £50,000, 12 months’
imprisonment, or both.
Under Section 86 of the Act,
dentists could be issued with
fixed penalty notices for noncompliance and there will be
powers for the CQC to take enforcement action if practices are
not up to scratch; practices may
even have to have their own registered managers.
Practitioners can seemingly
take no comfort at all, considering one of the stated aims of the
CQC, which is a commitment to
reducing bureaucracy and unnecessary regulatory burden - to
avoid duplication and promote

“joined up care”. They seem to
be doing the reverse of the statement: they think that by saying
what they are not going to do
will fool us, and that nobody will
notice when they go on and do
exactly the opposite.
Local decontamination units
One of the main issues for primary care dentists is, of course,
the requirement to have on site
their very own Local Decontamination Unit (LDU) - a sterile unit for the decontamination
of reusable dental equipment.
The 95-page best practice advice booklet, A Health Technical
Memoranda, gives full details.

‘Concerns that dental practices might
have to close, due to
the cost of creating
LDUs or because of
a lack of available
installation space,
appear unfounded.’
Incidentally, this is only part of a
suite of nine such useful memoranda, comprising assorted core
health subjects. The LDU issue
is an important one and seems
in part to have originated in
2001 with The Glennie Report,
which reviewed the sterile service provision across the NHS in
Scotland.
There is of course a question
mark as to the effectiveness of
LDUs; the sterile equipment is
inevitably moved into the nonsterile environment of the surgery where there is no effective
control over what happens to it.
Nevertheless, one of the proffered objectives behind LDUs
is to try and counter the risk of
the human variant of CJD/mad
cow disease being caught from
re-usable, steel dental instruments; add to this further concerns about passing on MRSA
and hepatitis B – one can hardly
deny a highlighted need for patient safety.
Negative impact?
Concerns that dental practices
might have to close, due to the
cost of creating LDUs or because
of a lack of available installation
space, appear unfounded. One
product manufacturer found on
the internet is advertising a 2.7m
by 1.6m LDU for a reasonable
£2,499, although many dentists
remain sceptical of their benefits and feel coerced into buying
expensive equipment on the ba-

sis of what they feel is inconclusive evidence.
Undoubtedly, the work of
the CQC has created a new range
of work for some manufacturers
and also those eager to advise
dentists on their new responsibilities – best-practice advisers
and CPD providers, to name a
few.

Published information on
Wikipedia about the CQC does
not help inspire confidence. A
recent staff survey identified
that 86 per cent of them have no
confidence in the executive team
and 82 per cent thought it unsafe
to speak up and challenge what
they were doing. The high-profile CQC Chairman, the Baroness Young of Old Scone, resigned
her post at the beginning of the
year in an apparent breakdown
with Labour Ministers; raising
serious questions about Lady
Young’s confidence in the Government and the Health Service.
The future
It does seem that despite the
change in government and the
promise of less bureaucratic
interference and state control
in all our lives, this is an area
where the influence of the ‘Nanny State’ continues to dominate.
Looking to the future, one also
wonders how far compliance
with the new quality rules, aside
from pleasing patients, will be
used as a pre-requisite to qualify
dentists to undertake NHS work
and indeed also qualify them for
membership of organisations
such as Denplan and Practice
Plan. Compliance will certainly
help all those bodies, private
and public, in determining
who they favour. DT

converting to
private practice
can be easier than
you think
If you’re thinking of opting out of
the NHS please give us a call,
we have the plans and expertise
to help you make it happen.

01691 684135
www.practiceplan.co.uk

About the author
Chris Hindle
qualified
as a solicitor
in 1991 and is
a partner with
Leeds-based
specialist dental
lawyers,
Cohen Cramer.
He has extensive experience
acting for clients who are buying and selling property and of
landlord and tenant matters,
including drafting leases and
landlord consents. He acts for
clients in the acquisition of
development sites and retail/
industrial estates. To contact
him, email Chris.hindle@cohencramer.co.uk.

G12236 PP relax 390x90mm ad.indd 1

13/9/10 16:41:55

[14] =>

14 Event Review

United Kingdom Edition

September 20-26, 2010

Delivering patient experience
If you have focused your team on delivering the best possible experience to patients, your business is sure to flourish, says Lesley Bailey

I allow a few moments, as
enjoyed a positive experience at
e know that word-ofthey ponder the answer to this
your practice. So my next quesmouth referrals will
question before reminding them
tion to my clients is: ‘What score
always be your strongthat it is only their patients
would you give yourself for your
est marketing tool and that pawho can provide the answer and
customer care when one is low
tients will only recommend your
9361 DBG ClinicalGov The probe 338x244.qxd:Layout 1 1/7/10 13:39 Page 1
that to try and judge it from their
and 10 is high?’
services to others if they have

Clinical Governance including
Patient Quality Measures Is your practice compliant?

own perspective is actually a
waste of time.
So before I encourage my clients to invest any money in marketing their practice, we assess

Step one: benchmarking
Therefore, the first step to take
before beginning any marketing
project is to benchmark the current level of patient care. There
are a variety of ways to do this.
Try assessing the first impression new callers have when they
contact your practice or ask your
patients informally to comment
upon your service and care and
establish whether there is any aspect of their experience that could
be improved upon. Or you can
undertake more structured patient satisfaction surveys – I recommend all these methods are
used to assess your service levels.
Limitations in practice resources
can make it almost impossible to
find the time to carry out mystery
caller and patient surveys, but
I always urge my clients to find
the means to carry out this vital
benchmarking exercise. The results can often be surprising and
provide important business intelligence to help you develop your
patients’ experience.

Are you waiting to find out when
the Care Quality Commission*
inspect your practice?
Have you addressed all 28 CQC
outcomes?
Your compliance with Clinical Governance
and Patient Outcomes will be questioned
with the introduction of the Care Quality
Commission*, HTM 01-05 and the increase
in PCT practice inspections.
Would you like to know how you would fare when your
practice is inspected and have the opportunity to take
corrective action?
The DBG Clinical Governance Assessment is the all
important experience of a practice audit visit rather than
the reliance on a self audit which can lead to a false sense
of compliance. The assessment is designed to give you
reassurance that you have fulfilled your obligations and
highlight any potential problems. We will provide help
and advice on the latest guidance throughout the visit.

The areas the DBG assesses are:

premises including access, facilities, security, fire
• Your
precautions, third parties and business continuity plans.
governance including Freedom of Information Act,
• Information
manual and computerised records, Data Protection and security.
• Training, documentation and certificates.
• Radiography including IRR99 and IR(ME)R2000 compliance.
infection and decontamination including HTM 01-05
• Cross
compliance and surgery audits.
emergencies including resuscitation, drugs,
• Medical
equipments and protocols.
• Training, documentation and certificates.
• Waste disposal and documentation and storage.
• Practice policies and written procedures.
• Clinical audit and patient outcomes including quality measures.

The assessment will take approximately four hours of your Practice Manager’s time depending on the number of surgeries and we
will require access to all areas of your practice. A report will be despatched to you confirming the results of our assessment. If you have
an inspection imminent then we suggest that you arrange your DBG assessment at least one month before the inspection to allow you time
to carry out any recommendations if required. Following the assessment you may wish to have access to the DBG Clinical Governance
Package with on-line compliance manuals.

For more information and a quote contact the DBG on 0845 00 66 112

20
YEARS

www.thedbg.co.uk
Please Note: Errors and omissions excluded. Any prices quoted are subject to VAT. The DBG reserves the right to alter
or withdraw any of their services at any time without prior notice.

the level of service being delivered to ensure it is consistently
excellent. In this way we can ensure money invested in marketing provides the best possible return and that the business grows
organically through increased
Word of Mouth referrals.

*England only.

Step two: develop your patient experience
You will need to act upon any areas which patients have identified
for improvement and work with
your team to create a consistently
excellent experience for each
and every patient when they call
or visit your practice. Don’t forget, your patients will not judge
you necessarily upon the quality
of the dentistry you provide for
them – in fact they will take that
as a given. They will also judge
you on your professionalism, efficiency, warmth and many of the
small human gestures that
develop rapport and illustrate the value you place
upon them. The surroundings, facilities, printed material and in fact anything which
patients see and hear or feel will
create an impact.
A neutral experience
Ask yourself a question. When do
you begin to judge the quality of
the meal you will eat in a restaurant you have not dined at before?
If you think about it, it is before
you see, smell or taste your food.

Humans are hard wired to
absorb the visual and audible environment around them and this
together with the interactions
we have with other people form

[15] =>

Event Review 15

United Kingdom Edition September 20-26, 2010

lasting opinions about the experiences we have.
Step three: gather management information
Let us assume you have benchmarked your current levels of
patient satisfaction and that you
have reviewed and refined the experience you will provide systematically to every patient who calls
or visits the practice.
The next step is to ensure
you have a system in place
to record each enquiry and
the referral source for each
new
business
opportunity.

state practice, I usually recommend around two per cent of
gross income.
Carry out an analysis on your
local marketplace, including your
competition and how you compare. Decide who your target
market is as a cover all approach
rarely works.
Many practice teams forget
that their most important target
market is their existing patients
– these individuals have already

There is little point in investing in a variety of marketing opportunities if you do not record
the response you receive from
each activity. Your front of house
team must ensure they record
each new enquiry, the reason for
their call, secure a contact point if
possible and find out how the enquirer heard about the practice.

The next area to focus on
in your sphere of influence is
other interested parties and
your plan should cover marketing which will reach out to your
target market. This could include
a variety of marketing activities
including; events, display advertising, window posters, advertising boards etc.

A small fortune
One of the most valuable lessons I
have learnt is that sometimes the
most effective marketing is the
least expensive.
Certainly, if you have focused
your team on delivering the best
possible experience to patients,
your business will grow organi-

cally. The investment you do
make in marketing will pay dividends as new patients joining
your practice through marketing
will become great advocates of
your business. DT

About the author
Lesley Bailey is a partner in Yes!
Results, a business that offers a range
of patient communication services to
dental and other businesses. For more
information about how Yes!Results can
help you maximise your revenue and
profit through effective communication with patients visit www.yesresults.co.uk call 08456 43 50 12 or email
info@yesresults.co.uk to find out more

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This system may be developed further by tracking the patient as they attend, ensuring they
have been referred to the dental
hygienist and if they are proceeding with their prescribed treatment. More than 25 per cent of
a dentist’s revenue can be lost
because patients do not proceed
with treatment. Few practices
have the time, skill or resource to
address this aspect of their business and don’t invest in finding
out why patients don’t go ahead
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Few practices work out the return on investment in marketing.
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For this example we will assume a gross profit margin of 65
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revenue.

Step five: set a budget and
develop a marketing plan
If you do not already allocate a
marketing budget, consider the
sum of money you are prepared
to invest in the development of
your business. This amount will
depend upon the current status
of your business, but in a steady

Finally your plan should include some activity to “the rest of
the world”, i.e direct mailing, radio advertising or PR.

Latex

You can analyse this information to establish the ratio between
enquiries and consultations and
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If you invest £2,000 on a large
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income to break even. £3,077 income x 65 per cent gross profit =
£2,000.05 gross profit or sufficient
profit to cover the advert cost.

bought into your products and
services so the first part of your
plan should include marketing
internally to existing patients.

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cartridges) should not be exceeded. Elderly or debilitated patients require smaller doses. CONTRA-INDICATIONS, PRECAUTIONS, WARNINGS ETC: Contra-indications: Hypersensitivity to amide anaesthetics
or any other of the solution’s components. Anaemia, congenital or acquired methaemoglobinaemia. Precautions: Caution must be taken to avoid accidental i.v. injection as it may give rise to rapid onset of toxicity. Use
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anticipated. Avoid injection if site is inflamed. Facilities for resuscitation should be available. Side effects: Extremely rare in dental practice and usually the result of excessive blood concentrations. Nervousness, dizziness,
blurred vision, tremors, drowsiness, convulsions, unconsciousness, hypotension, myocardial depression, bradycardia and possibly respiratory or cardiac arrest. Allergic reactions. Methaemoglobinaemia; consider giving 1%
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at www.yellowcard.gov.uk. CITANEST® is a trademark of DENTSPLY International and / or its subsidiaries

DENT-Citanestadvert-aw19.indd 1

26/7/10 12:46:08

[16] =>

16 Feature

United Kingdom Edition

Septemnber 20-26, 2010

Small things make big difference
Dental Tribune’s Laura Hatton discovers there’s more than meets the eye in the
small world of ToothVille

G

ummy Bear attacks?
Scuba divers treating
root canals? Decorators
performing tooth whitening sessions? Sound like an ordinary
day at the dentist? Invite the
miniature world of ToothVille
into your waiting room and your
ordinary day will be just that not forgetting meeting with the
builders to discuss that cavity restoration. In hindsight,
the incredible world of ToothVille should have been partnered alongside Colgate Oral
Health Month, which runs this
month; with the campaign fast
becoming a regular date in the
dentistry calendar, ideas on how
to inform and educate both children and adults on maintaining
good oral health always need to
be revamped.
Two Passions
Being a keen photographer,
London-based dentist Dr Ian
Davis (pictured, bottom right)
has combined his two passions
of dentistry and photography
to create ToothVille, a world of
model mouth moulds where
various dental treatments are
carried out by miniature figurines. Inspired firstly by the
artwork of Slinkachu (www.
slinkachu.com) and the thought
of what it would be like if teeth
were large, Ian has created a
storm of creative inspiration for
the dental world using the power of these little men. The ToothVille sculptures include decorators carefully whitening a set of
teeth, scuba divers carrying out
root canal treatments, emergency teams rescuing broken teeth
and workmen guarding teeth
from a sugar attack from threescary looking Gummy Bears!
With a serious need to turn teeth
and dentistry into accessible
and approachable subjects for
the public, ToothVille could be
the perfect answer.
Patients at Ian’s surgery are
experiencing a waiting room

Affinis celebration ad horiz

quite unlike any other; children and adults alike are being
drawn into the unique world of
ToothVille, describing the experience as anything from ‘amazing and funny’ to ‘quirky’. From
laughing and giggling as they
see the Gummy Bear attack, to
cringing at the implant photographs, ToothVille “demystifies
the treatment”; teaching patients about cavity prevention
and restoration in a way that no
other product has yet achieved.
Small things
The main purpose of ToothVille
is to visually show how ‘small
things make a big difference’the small things being brushing and flossing, the big things
being saving your teeth- and
with more than 80 per cent of
dental practices taking part in
this year’s Colgate Oral Health
Month Campaign, the introduction of these miniature creations
into practice waiting rooms
could definitely help encourage
the theme of the 2010 campaign
- ‘Discover 3 Essentials for an
Even Healthier Mouth’:
1) brush your teeth,
2) avoid sugary snacks, and
3) visit your dentist regularly.
Having placed pictures along
corridors and throughout his
waiting room, Ian has also produced a book, mainly aimed
at the younger generation, although adults also can’t seem
to put it down! The picturebook, aiming to inspire prevention in all areas of tooth decay,
begins with the least invasive
treatments of Cavity Preparation and Restoration and leads
onto emergency dentistry, before embarking on photographic images of miniature model
scuba divers recreating root
canal treatments. Whilst tiny
workmen defend another set
of teeth from sugar attacks the
book comes to an end with further photographs, carried out in
pure ToothVille style, recreating

13/9/10

16:54

Page 1

the invasive treatment of an implant; the final destination that
all teeth want to avoid!
Originally spurred on by his
photographic hobby, Ian’s passion for combining dentistry
and photography under one
roof is certainly becoming that
of a business, and with the British Dental Trade Association on
14-16th October, we will hopefully see a display of the iconic
ToothVille series on public view.
Future models of ToothVille will
see regular sugar attacks (as
these seemed to go down rather
well with all ages!) and further
creations will be modelled on
orthodontic treatment and tooth
loss. Like existing ToothVille
models, future photographs of
the moulds will visually demonstrate different treatments, casting a brighter light on orthodontic treatments and expressing
how tooth loss can be avoided,
and in serious cases, repaired.
Even though Ian is continually
focused on improving the models that he has already created,
the “icing on the cake” would
be to publish a children’s book,
providing the younger generation with a chance to understand dental health in an entertaining and interesting way.
Making Patients Smile
With the miniature workmen as
visual metaphorical representations of the ‘small things’ in
dental care, the models are fast
becoming a useful way of conveying the message of maintaining
good oral health. In response to
ToothVille, Ian said: “ToothVille
is quirky and makes the patients
smile in the waiting room”.
If this is the response that
every dentist wants, then surely
ToothVille is the way to get that
perfect smile.
Photos of the ToothVille series are available for sale at
www.toothville.co.uk DT

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[17] =>

United Kingdom Edition September 20-26, 2010

Education 17

The bigger picture
Dr Koray Feran looks at how restorative dentistry has progressed in the past few
years and compares some of the materials on the market

O

ver the past five years or
so I have noticed a gradual move from piecemeal dentistry (the product of
the National Health Service) to
a more holistic, full-mouth approach and the increasing involvement of other disciplines,
such as facial aesthetics. The
use of CAD/CAM technology,
both to manufacture dental
restorations and in the planning and execution of surgical
procedures has also grown; the
adoption of magnification and
illumination by more and more
clinicians has also risen.
Interestingly, we have seen a
gradual, but distinct consensus
across the disciplines, so that
the procedures we are carrying
out are backed up with stronger
evidence. We seem to have developed a much better understanding and agreement of the
treatments we carry out for our
patients. Of course, there are
still gaps, but we are all heading
in the right direction.
Behind the scenes
I have great admiration for the
unseen supporters of our profes-

miracle and underpins the success of what we do in our practices. Not enough recognition
is given to such people by our
profession. The John McLean
Memorial symposium, which
was organised by Dr David
Winkler just before the European Academy of Aesthetic
Dentistry meeting, took place
on May 26 in London and offered a tribute to one such man,
who gave us glass ionomers and
dental ceramics.
While the materials we
have now are excellent, I’m
sure somewhere there is always a team of people who
feel they can do better! However, although we are continually provided with better
materials, the techniques adopted by practitioners must be
skilful and consistent enough to
utilise the optimum properties
of these materials: If you take
clinical shortcuts, no material
will save you for very long!
The greatest advances
I would have to say though that
the greatest advances have been
seen in postgraduate educa-

‘Although it may sometimes seem
overwhelming, the huge choice of materials
and equipment available to us is a
minor miracle and underpins the success
of what we do’
sion that are continually striving
to create better materials and
more efficient equipment. This
requires an intricate knowledge
of chemistry, biology, electronics and material science.
Although it may sometimes
seem overwhelming, the huge
choice of materials and equipment available to us is a minor

tion. There is a proliferation of
courses, conferences, symposia,
mentoring and publications. My
personal feeling is that people
are talking to each other more
freely than they did before; they
show more willingness to share
their experiences and their failures, discussing the black holes
in our knowledge that people
use to shy away from in the past.

Technology such as CAD/CAM design and digital impressions are aiding treatment plans for better aesthetics

As far as one particular item
is concerned, the profession has
put a lot of faith in zirconia and
especially CAD/CAM manufactured zirconia restorations. The
material itself is pretty tough
and easily the most durable ceramic we have at our disposal;
however, the problems experienced with adhesion of veneering porcelain and cement to this
material – as well as its degradation over time when exposed
to the punishing oral environment – is still a subject for intensive debate.
I hope that the problems are
ironed out and we can keep zirconia. However, some very experienced practitioners around
the world are finding a greater
cumulative failure rate of zirconia-based restorations as
years go by, so this might be one
technology where I would recommend not putting all of your
eggs in one basket just yet.
How patients benefit
One would hope that through
better knowledge and acquisition of more advanced skills,

more of us are in a position
to assist our patients with the
problems they face. The use of
stronger aesthetic materials that
bond better to teeth will hopefully mean less frequent revision being necessary during the
patient’s lifetime and greater reliability of our treatment. However, again it must be stressed
that this will only occur if the
clinical techniques and control
with which these materials are
used is of a high standard.
As for the future, who knows?
I would like to see a drive towards better 3-D documentation, such as digital impressions
and digital studies of dynamic
mandibular movement to assess
occlusal function and balance in
larger restorative cases.
I would also like to see an
improvement of communication and workflow between clinicians and laboratory technicians and to hopefully see an
increase in the compactness of
some of the equipment we use
such as curing lights, implant
motors, piezosurgery devices,

x-ray sensors and apex locators,
for example, which take up such
a huge amount of room in our
surgeries.
Of course we all await the
advances in genetic engineering that will allow the growth of
new teeth. Maybe not during the
next five years...although you
never know. DT

About the author
Dr Koray Feran qualified in 1989 from
Guy’s Dental Hospital, winning the
Final Year Prize for overall excellence
and the SJ Kaye Prize in Oral Medicine
and Pathology. He remained at Guy’s
for two separate House Surgeon appointments in Prosthetic Dentistry and
then Oral and Maxillofacial surgery
till 1991 when he went into general
practice in North London. After completing the Master of Science degree
in Periodontology from Guy’s Hospital,
he obtained a (Restorative Dentistry)
Fellowship in Dental Surgery from the
Royal College of Surgeons of England.
He has since been in practice dedicated
to quality dental care, having a special
interest in multi-disciplinary cases that
require detailed planning and co-ordination of several specialist branches
of dentistry. For more information or
to refer to Koray, contact The London
Centre for Implant and Aesthetic Dentistry on 020 7224 1488, koray@korayferan.co.uk or by visiting www.korayferan.co.uk.

[18] =>

18 Education

United Kingdom Edition September 20-26, 2009

Getting in at the deep end
There’s no substitute for first-hand experience, as Sarah Armstrong found out in
her new role as a maxillofacial surgery senior house officer

he first week as a
maxillofacial
surgery
senior
house
officer (SHO), as the majority of past and present SHOs

will tell you (and the ones that
don’t are lying!) is a scary business. The learning curve at first
seems impossibly steep and suddenly being required to func-

tion in a hospital environment
is
an
overwhelming
and
daunting prospect. It doesn’t matter how much you prepare beforehand, there is no substitute for

getting in there and experiencing
the job first- hand.
I can vividly remember feeling completely shell-shocked,

crawling into bed fully clothed
and curling up into a ball after
my first day on-call. My legs hurt.
My brain hurt. I wondered just
what I’d got myself into. Eleven
months on and looking back,
it’s incredible to see how far my
colleagues and I have come compared to the startled rabbits we
were in August 2009 when we
started!
Of course, we by no means
know it all and it would be ignorant of us to think that, but gain-

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‘Teamwork’ always seems to be a
buzzword thrown
around a lot in the
workplace environment, but within the
hospital setting I’ve
seen first-hand how
essential it is.’

ing an understanding of how a
maxillofacial department works,
enables us to follow the right
pathways and ask the right people to manage most situations.
An important skill
Working as part of the maxillofacial team is probably the most
important skill to master early
on. ‘‘Teamwork’ always seems
to be a buzzword thrown around
a lot in the workplace environment, but within the hospital
setting I’ve seen first-hand how
essential it is. Everyone in the department – SHOs, middle grades,
consultants, receptionists, secretaries, nursing staff, theatre
staff, technicians, etc, all work
together to provide continued
care to the patient. As soon as
one part of the team fails to carry
out their role, the system begins
to break down and places additional strain on the others.
The SHOs in particular are
frequently involved in communication between staff members
and it’s absolutely paramount in
keeping the cogs of the department system running smoothly.
As soon as communication breaks
down theatre lists can be delayed,
important investigations are omitted and most significantly the patient’s management suffers.
The duties of an SHO vary
hugely depending on the unit

[19] =>

United Kingdom Edition September 20-26, 2010

you work within, though typically, this will involve working on
consultant clinics, pre-assessing
patients for theatre, conducting
your own minor oral surgery
lists, ward duties and of course,
being the dreaded SHO ‘on-call’
for the department, which tends
to be the most demanding, exhausting and exciting part of the
job – you never get the same day
twice! Knowing when you are out
of your depth is vital.

First point of contact
Being the on-call SHO means being the first point of contact for
the department. Receiving referrals from other hospitals, A and
E departments, walk-in centres,
GPs and GDPs across your region, one of the most important
skills to master early on is to attain a thorough history over the
phone to assess the urgency and
appropriateness of the referral to
assess whether a patient is fit for
transfer. The nature of referrals
varies widely and often depends
on the department you work in.
From my experience from working in a busy city centre hospital
in the North East of England,
a significant volume of referrals tend to be for facial trauma
(frequently including facial lacerations, zygoma, mandible and
infra-orbital floor fractures to the
more severe complex poly trauma cases).

done and more importantly prioritise who must be treated first
– something which can be really
tricky when A and E staff start
breathing down your neck about
patients who are close to ‘breaching’, but you’ve got to put your
patients interests first rather than
work to targets.

For me, the major stresses
came not so much from the nature of the work, but the sheer
volume. You have to constantly
reassess the tasks that need to be

Learning curve
There are times when it’ll feel
like the worst job in the world,
but equally there are times
when your shift ends and look-

ing back you can’t believe what
you’ve managed to achieve and
what you’ve learnt. Nothing beats
the job for hands-on surgical
experience. You’ll pick up some
fantastic skills in examining patients, facial suturing, dento-alveolar surgery and so on, as well as
other, slightly more bizarre skills,
like the ability to go from fast
asleep to running down the corridor in 10 seconds flat and being
able to present a ward round of
patients coherently to a room full
of consultants after being awake

all night closing lacerations. I’m
just concerned I’ll find going back
to dentistry a little dull in comparison…! DT

About the author
S a r a h
Armstrong
qualified from
Newcastle University in 2008
and is currently working as
a maxillofacial surgery senior house officer at Newcastle
General Hospital.

us
e he
se t t e
d a as
an Q7 wc r
e
o
m and Sh be
Co St tal cto
O
on en in
D

There’s no shame in calling
your registrar if you’re stuck, and
all the team members (nurses in
particular) have a huge breadth
of knowledge and can be an
invaluable source of information – remember they have seen
years of SHOs come through the
department, making the same
mistakes; filling out X-ray forms
incorrectly, struggling with cannulas, fainting in theatre…

There will be times when
you feel exhausted and tempted
to dropkick the on-call phone
across an overflowing A and
E department at 4am on a Saturday night as the revellers begin
to roll in, and you sometimes will
be on shifts where you feel totally
overwhelmed.

Education 19

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‘The dreaded ring
tone will be etched
in your brain and
it’s an amusing phenomenon watching
a room full of SHOs
jump in unison as
soon as it rings!’
could be coming your way the
next time the phone rings. The
dreaded ring tone will be etched
in your brain and it’s an amusing
phenomenon watching a room
full of SHOs jump in unison as
soon as it rings! Though you can’t
beat the sudden burst of adrenaline (and panic!) when you hear
the words from a tense sounding
A and E registrar “I’m in resus,
we need you here now!”

A breakthrough from Carestream Dental
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© Carestream Dental Ltd., 2010.
The Kodak trademark and trade dress are used under license from Kodak.

[20] =>

20 Clinical

United Kingdom Edition September 20-26, 2009

An Evidence-Based Endodontic
Implant Algorithm:Back to the
Egg; Concluding Part
Kenneth S. Serota, DDS, MMSc

n
increased
uniform
amount of coronal dentin
significantly amplifies the
fracture resistance of endodontically treated teeth, regardless
of the post system used or the
choice of material for the fullcoverage restoration45. A recent
article by Coppede et al demonstrated that friction-locking
mechanics and the solid design
of internal conical abutments
provided greater resistance to
deformation and fracture under oblique compressive loading
when compared to internal hex
abutments46. These two “seemingly” disparate observations
define the inherent continuum
between natural tooth engineering and the principles of engineering necessary to orthobiologically replicate the native state.
The use of a ferrule or collet
and a bonded or intimately fit
post-core to restore function and
form to an endodontically treated
tooth is analogous to the use of a
long, tapered friction fit interface
with a retaining screw (Morse taper), to secure an abutment to a
fixture. In both cases, the role of
contact pressure between mating surfaces to generate frictional
resistance provides a locked connection. This has been shown to
affect the long-term stability of
crestal bone support for the overlying gingival tissues and maintains a healthy protective and
esthetic periodontal attachment
apparatus47.

Human symmetry
The Roman architect Vitruvius’
(Marcus Vitruvius Pollio) description of the perfect human form in
geometrical terms was a source
of inspiration for Leonardo da
Vinci, who successfully illustrated the proportions outlined in
Fig 8

Vitruvius’ work ‘De Architectura’.
The result, the Vitruvian man, is
one of the most recognised drawings in the world and is accepted
as the standard of human physical beauty. Vitruvius theorised
that the essential symmetry of the
human body, with arms and legs
extended, should fit into the perfect geometric forms; the circle
and the square. However, Leonardo Da Vinci recognised that the
circle and the square were only
tangent at one place, the base.
Observe the insert in Fig 8. The
stabilising platform for the human outlined form begins at that
tangent; the intersection is graphically analogous to the structural
configuration of platform switching.
In geometry, an oval is a curve
resembling an egg or an ellipse.
Architects and engineers have
used smooth ovate curves to support the weight of structures over
an open space literally since the
second millennium BC. These
arches, vaults and domes can be
seen in buildings and bridges all
over the world; the most pervasive example being the keystone
arches used by the Romans for
aqueducts and mills.
An arch directs pressure along
its form so that it compresses the
building material from which it
is constructed. Even a concrete
block is readily broken if you hit
it on the side with a sledge. But
under compression forces from
above, the block is incredibly
strong and unyielding. Many
will remember the weight bearing tripod experiments from
grade school where an egg acts
as one of three supporting legs of
a square section of wood bearing
books as the load. The structure
could support over sixty books,

almost twenty pounds, before
breaking the supporting egg. One
need only look at the root trunk
and coronal tooth structure of a
multi-rooted teeth and it becomes
apparent that strength of the tooth
form is dependent upon an arch
form for its integrity (Figs 8 & 9).
Optimal engineering
Is it possible for this natural feat of
engineering to be biomimetically
replicated to the design parameters of osseo-integrated implants?
There are a number of paradigms
that continue to fuel debate in
the dental clinical and scientific
communities pertaining to the
optimal engineering predicates
for implant design. These include smooth vs. rough surfaces,
submerged vs. non-submerged
installation techniques, mixed
tooth-implant vs. solely implantsupported reconstructions, Morse
taper abutment fixation vs. a buttjoint interface and titanium abutments vs. esthetic abutments in
clinical situations where esthetics
is of primary concern.
The cone-screw abutment has
been shown to diminish micromovement by reducing the burden of component loosening and
fracture. This enables the identification of the effects of the parameters such as friction, geometric
properties of the screw, the taper
angle, and the elastic properties
of the materials on the mechanics
of the system.
In particular, a relation between the tightening torque and
the screw pretension is identified.
It was shown that the loosening
torque is smaller than the tightening torque for typical values
of the parameters. Most of the
tightening load is carried by the
tapered section of the abutment,
Fig 9

and in certain combinations of
the parameters, the pretension in
the screw may become zero.
This enables the identification of the effects of the parameters such as friction, geometric
properties of the screw, the taper
angle, and the elastic properties
of the materials on the mechanics of the system. In particular, a
relation between the tightening
torque and the screw pretension
is identified. It was shown that
the loosening torque is smaller
than the tightening torque for
typical values of the parameters.
Most of the tightening load
is carried by the tapered section
of the abutment, and in certain
combinations of the parameters
the pretension in the screw may
become zero. This tapered abutment connection provides high
resistance to bending and rotational torque during clinical function, which significantly reduces
the possibilities of screw fracture
or loosening.
Biomechanics
‘The seed of a tree has the nature
of a branch or twig or bud. It is
a part of the tree, but if separated
and set in the earth to be better
nourished, the embryo or young
tree contained in it takes root and
grows into a new tree,’ Isaac Newton.
Pressure on the cervical cortical plate, micro-movement of the
fixture-abutment interface (FAI)
as well as microflora leakage and
colonisation at and within the FAI
are some of the pathologic vectors
associated with osseous remodeling, both crestal and peripheral
to dental implants 48.
Occlusal considerations engi-

neered into fixture design should
enable optimum load distribution
for permanent load stability during functional loading, reduce
functional stress transfer to the
interfacial tissues and enhance
the biologic reaction of interfacial
tissues to occlusally generated
stress transfer conditions 49.
Future modifications to implant biomechanics should focus
on designs wherein the osseous
trabecular framework retaining the fixture will adapt to the
amount and the direction of applied mechanical forces, cope
with off-axis loading, compensate for occlusal plane to implant
height ratios differences as well
as adjusting to mandibular flexion and torsion50.
In this new era of implant
driven treatment planning, fixtures should be engineered to
support single crowns with cantilevers instead of implant/implant
or implant/teeth connections for
a span of any degree. These engineering design iterations will
minimise high-stress torque load
at the implant abutment interface
and obviate areas with degrees of
bone insufficiency.
The goal should be to biomimetically replicate the natural
state to the greatest degree (Figures 10a and 10b) in regard to
load bearing capacity.
Measuring success
Stable crestal bone levels are the
yardstick by which treatment
success and health are measured in the orofacial ecosystem,
whether it relates to natural tooth
retention or restorative and/or
replacement rehabilitation. It
is therefore surprising that the
treatment outcome standards for
Fig 10a

[21] =>

Clinical 21

United Kingdom Edition September 20-26, 2009

The concept of “biological
width” outlines the minimum
soft tissue dimension that is physiologically necessary to protect
and separate the osseous crest
from a healthy gingival margin
surrounding teeth and the periimplant environment.
A bacteria-proof seal, the lack
of micro-movement associated
with a friction grip interface and
a minimally invasive secondstage surgery (where indicated)
without any major trauma to the
periosteal tissues, are also important factors in preventing cervical
bone loss. The literature suggests
that the stability of the implant/
abutment interface may have an
important early role to play in determining crestal bone levels 52.

Tarnow’s seminal study on
crestal bone height support for
the interdental papilla clearly
showed the influence of the bony
crest on the presence or absence
of papillae between implants and
adjacent teeth 53. Twenty years later, logic dictates that anticipated
early crestal bone loss and diminished, albeit continual loss, during successive years of function,
should have been engineered out
of the substitution algorithm for
peri-implant tissues 54.
Platform switching: By default or by design
‘There is no logical way to the discovery of elemental laws. There is
only the way of intuition, which is
helped by a feeling for the order
lying behind the appearance,’ Albert Einstein.
Platform switching theorises
that by using an abutment diameter of a lesser dimension than the
Fig 10b

Fig 11a

periphery of the implant fixture,
horizontal relocation of the implant-abutment connection will
reduce remodeling and resorption of crestal bone after insertion
and loading.
The concept implies that periimplant hard tissue stability will
engender soft tissue and papilla
preservation. Maeda et al reported that stress levels in the cervical
bone area peripheral to a fixture
were reduced when a narrow diameter abutment was connected
in comparison to a size commensurate with the fixture diameter
55
.

Matrix

The authors concluded that
the biomechanical advantage
of shifting stress concentrations
away from the cervical area will
diminish their impact on the biologic dimension of hard and soft
tissue extending apically from
the FAI (Fig 11a, 11b and 11c).
The inherent disadvantage is that
it shifts stress to the abutment
screw with the potential for loosening or fracture.

Inserts like a
wedge

Mimics natural
contour

Compressing wedge
mimics natural separation
and prevents overhangs

Flexible wing exerts
pressure for maintained
separation and cervical
adaption

Ericsson et al 56 detected neutrophilic infiltrate in the connective tissue zone contacting the
implant-abutment interface. The
facility by which platform switching/shifting reduces bone loss
around implants has been investigated by Lazzara et al 57. The
authors hypothesised, that if the
abutment diameter matches that
of the implant, the inflammatory
cell infiltrate is formed in the connective tissue contacting the microgap created at the FAI.
If an abutment of narrower
diameter is connected to wider
neck implant, the FAI is shifted
away from the outer edge of the
implant, thus distancing inflammatory cell infiltrate away from
bone. Hypothetically, less crestal
bone loss is expected and an increased implant/abutent disparity
allows more stable peri-implant
soft tissue integration.

Fig 11b

Baggi et al conducted a finite
element analysis experiment to
define stress distribution and
magnitude in the crestal area
around three commercially available implants – ITI Straumann®
(Institut Straumann AG, Basel
CH), Nobel Biocare (Nobel Biocare AB, Goteborg SE) and Ankylos C/X (Dentsply-Friadent, Manheim, DE) 58. Numerical models
of maxillary and mandibular molar bone segments were generated from computed tomography
images and local stress vectors
were introduced to allow for the
assessment of bone overload risk.
Different crestal bone geometries
were also modeled.
Type II bone quality was approximated and complete osseous integration was assumed.
It was concluded that the Ankylos
C/X implant based on its platform
à DT page 22

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[22] =>

22 Clinical

United Kingdom Edition

ß DT page 21

Fig 12b

September 20-26, 2010

Fig 11c

switched and subcrestally positioned design demonstrated
better stress based performance and lower risk of bone
overload than the other implant
systems
evaluated.
Essential features
Platform switching, together
with a stable implant-abutment
connection are increasingly accepted essential implant design
features required to reduce or
eliminate early crestal bone
loss. A bacteria-proof seal, a
lack of micro-movement due
to a long friction grip tapered
channel and minimally invasive
second-stage surgery without
any major trauma for the periosteal tissues are also important
factors in preventing cervical
bone loss.
A preconfigured platform
switched design has a significant impact on the implant treatment in esthetic areas as not
only is the tissue biotype preserved, but it has been shown to

Fig 12a

be enhanced by osseous generation over the collar of the fixture
(Figs 12a and 12b)59,60.
The endodontic implant algorithm parallels the question,
which came first, the chicken or
the egg as an example of circular
cause and consequence. It could
be reformulated as follows:
‘Which came first, X that can’t
come without Y, or Y that can’t

come without X?’ An equivalent
situation arises in engineering
and science known as circular
reference, in which a parameter is required to calculate that
parameter itself. This is the essence of foundational dentistry.
Nature wisely created a
structure that could harmoniously interpolate hard and soft
tissue, act as the portal of nu-

trition and communication for
the body and be the gatekeeper on guard and in function throughout our lifetime.
As such, our role is to ensure
that however we reengineer
nature,
we
must
adhere
to its rules, its logic and
fundamentals.
The best evidence
This is not an easy task, as filtering out the best range of
evidence from a wide range
of sources, presenting clear,
comprehensive analyses and
incorporating patient experience is a Herculean task. In
many ways, this is analogous to
Alice’s Adventures in Wonderland as so much of what we
do grows ‘curiouser and curiouser’ as each new innovation
demands that we go through
the looking glass and determine
what Alice found there.

Are you meeting your
requirements for CPD?

Core CPD for
Dentists and
Dental Care
Professionals

‘There’s no use trying,’
said Alice. ‘One can’t believe
impossible things.’ ‘I daresay
you haven’t had much practice,’
said the Queen. ‘When I was
your age, I always did it for
half an hour a day. Why, sometimes I’ve believed as many as
six impossible things before
breakfast?’ Lewis Carroll. DT

About the author
Kenneth S Serota, DDS, MMSc graduated from the University of Toronto,
Faculty of Dentistry in 1973 and was
awarded the George W Switzer Memorial Key for excellence in Prosthodontics. He received his Certificate in
Endodontics and Master of Medical
Sciences Degree from the HarvardForsyth Dental Center in Boston, MA.
The founder of ROOTS – an online
educational forum for dentists from
around the world who wish to learn
cutting edge endodontic therapy, he
recently launched IMPLANTS (www.
rximplants.com) and www.tdsonline.
org in order to provide a clear understanding of the endodontic/implant algorithm in foundational dentistry.

Thursday 18th November 2010, Leeds
References

4th National
Conference on
Decontamination
of Dental Instruments
Friday 19th November 2010, Leeds

• Meet your requirements
for verifiable CPD
• Update your knowledge
• Hear and meet a group of the
UK’s leading experts
• Networking opportunities
• Exhibitor area

TO BOOK OR TO REQUEST
A CONFERENCE LEAFLET
Visit http://www.gla.ac.uk/departments/dentalschool/
or
Call 0141 201 9353/9264/0674

45. Ma PS, Nicholls JI, Junge T, Phillips KM. Load fatigue of teeth with different ferrule lengths, restored with fiber posts, composite resin cores, and all-ceramic crowns. J
Prosthet Dent 2009 Oct;102(4):229-34 46. Coppedê AR, Bersani E, de Mattos Mda G, et
al. Fracture resistance of the implant-abutment connection in implants with internal hex
and internal conical connections under oblique compressive loading: an in vitro study.
Int J Prosthodont 2009 May-Jun;22(3):283-6 47. Steinebrunner L, Wolfart S et al. In-vitro
evaluation of bacterial leakage along the implant-abutment interface of different implant
systems. Int J Oral Maxillofac Implants 2005 Nov-Dec;20(6):875-81 48. Tesmer M, Wallet
S et al. Bacterial Colonization of the DentalImplant Fixture–Abutment Interface: An In
Vitro Study. J Periodontol December 2009;80(12):1991-7 49. Brunski JB, Puleo DA, Nanci
A. Biomaterials and biomechanics of oral and maxillofacial implants: Current status
and future developments. Int J Oral Maxillofac Implants 2000 Jan-Feb;15(1):15-46 50.
English CE. Biomechanical concerns with fixed partial dentures involving implants.
Implant Dentistry1993;2(4):221-242 51. Lazzara RJ, Porter SS. Platform switching: a
new concept in implant dentistry for controlling post restorative crestal bone levels. Int J
Periodontics Restorative Dent Feb 2006;26(1):9-17 52. Oh TJ, Yoon J, Misch CE, Wang HL.
The causes of early implant bone loss: Myth or science? Journal of Periodontology March
2002;73(3):322-333 53. Tarnow DP, Magner AW, Fletcher P. The effect of the distance
from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992 Dec;63(12):995-6 54. Chiapasco M, Zaniboni M.
Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review. Clin Oral Implants Res 2009 Sep;20 Suppl 4:113-23 55. Maeda
Y, Miura J, Taki I, Sogo M. Biomechanical analysis on platform switching: Is there any
biomechanical rationale? Clin Oral Implants Res 2007;18:581-584 56. Ericsson I, Persson
LG, Berglundh T et al. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Periodontol 1995;22:255-261 57. Lazzara RJ, Porter SS. Platform switching:
A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int
J Periodontics Restorative Dent 2006;26:9-17 58. Baggi L, Cappelloni I, Di GM, Maceri F,
Vairo G. The influence of implant diameterand length on stress distribution of osseointegrated implants related to crestal bone geometry: A three-dimensional finite element
analysis. J Prosthet Dent 2008;100:422-431 59. Nentwig, GN. The Ankylos implant system:
Concept and clinical application. J Oral Implantology 2004;30:171-177 60. Zipprich H,
Weigl P, Lange B, Lauer H-C. Erfassung, Ursachen und Folgen von Mikrobewegungen am
Implantat-Abutment-Interface. Implantologie 2007;15:31-46

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[24] =>

24 Advertorial

United Kingdom Edition

September 20-26, 2010

Comprehensive Dentistry and Occlusion
Q. Why is the Dawson Academy
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The reason Dr, Dawson became
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Secondly, the title of Dr. Dawson’s
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or comprehensive dentistry includes not only the tooth problems, periodontal problems and
tissue problems that dentistry has
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but also deals with occlusal issues. Not only does occlusion
touch almost every aspect of den-

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complex implant treatments, but
as people are keeping their teeth
longer more people are suffering the effects of occlusal disease
- particularly worn teeth. While
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with how to deal with occlusal
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Q. How does this all fit with
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function
in harmony
with one
lower posterior2010
teeth
and
upper
posterior
teeth
2010 Nov 4
Cardiff
6.00 pm
£49 + VAT
2011 Feb 5
Copenhagen To be
£49 + VAT
another A comprehensive
understanding
of how the TM
joint,confirmed
muscles, proprioceptive
2010 Nov 5
NE Newcastle
2.00 pm
£49 + VAT
Denmark

input, lower anterior teeth, upper anterior teeth, lower posterior teeth and
upper posterior teeth are designed to function in harmony with one
2010 Nov 6

Leeds

9.30 am

£49 + VAT

To book please call 0151 342 0410
or email dawsonacademy@bdseminars.com

in blending Dr. Dawson’s timeless
principles with cutting edge research, materials and philosophy.
Q. How about treatment planning? Dentistry is all about the
balance between function, aesthetics, biology and structure.
Sometimes keeping all these
things in mind can be tricky.
That’s why we have developed
logical systems and processes to
ensure that nothing is missed and
we have a definite starting point.
The “Big Picture” system is
our “4 Steps to Predictable Dentistry”. Firstly, we need to visualise where the teeth need to fit in
the face. Then we need to transfer this vision to mounted models
to produce a diagnostic wax-up.
This allows us to produce the matrices we need to ensure minimal
but adequate preparation and to
provide excellent temporary restorations, the third stage of the
process. Once these are approved
it then becomes a predictable and
stress-free process to produce exceptional final restorations, the
fourth part of the process.
Q. So do you just deal with
restorative dentistry? Absolutely not! Since the cosmetic
wave hit dentistry a number of
years ago and everything needed
a porcelain veneer (!!) there is
now a move away from this and
much talk of minimally invasive
dentistry and orthodontic options. Well, forty years ago Dr.
Dawson was talking and writing
about just this. He outlined his
treatment options in a specific
sequence: Reshape, Reposition,
Restoration or Surgical. Once
we have decided where the teeth
need to go to fulfil our functional
and aesthetic goals we can then
apply the treatment options in the
above order. Sometimes teeth can
simply be reshaped to fulfil the
requirements e.g. equilibration.
If the teeth are in good condition
but in the wrong place, repositioning (orthodontics) is usually
the most appropriate option. Only
once these two options have been
considered should restoration be
contemplated. Commonly, complex treatment requires a combination of two or more options.
If these treatment options are applied in this order, you will truly
be able to solve your patients’
problems whilst providing as little dentistry as possible.
Dr. Dawson also had another
rule that sat over everything he did
- the WIDIOM rule (Would I Do It
On Me?). If you wouldn’t accept
the treatment yourself, why give
it to patients? I’m sure that many
good dentists have applied this rule
in their career. However, it takes
a wise man to point out the obvious. This is why we talk of Dr.
Dawson’s timeless principles. DT

[25] =>

DCPs 25

United Kingdom Edition September 20-26, 2010
A4 - Pdf Ripper.qxd:Text pasting Document.qxd 13/04/2010 11:26 Page 1

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 Fax : 01732 783581
Emai l: sales@shofu.co.uk
Web: www.shofu.co.uk
© 2006 SHOFU Dental Products Ltd. E & OE

SuperBuff
Paste-impregnated
felt disk for high
gloss composite
polishing, ideal for
difficult areas

Brownie
& Greenie
Fast results on
precious metals
and amalgam

Growing pains
Getting a new team of people to respect
you takes patience as you learn to reward them, praise them, lead and motivate them, says Sharon Holmes

have been in management
for so long that I sometimes
forget how painful it can be.
Recently we incorporated two
new practices into the Dental
Arts Studio; I had a feeling we
may meet with some resistance,
but I hadn’t anticipated just how
painful it was going to be for everyone involved, particularly one
of the new practice teams.

practice was a challenge to start
with. Dr Solanki and I spent a lot
of time there in the initial takeover and this team has thrived
well. They have taken on board
all the training that has been put
their way. They have only been
with us since April and we have
seen a massive desire within the
team; they want to achieve the
very best possible customer care.

After much clenching of teeth
and a few sleepless nights, it occurred to me that perhaps the
team from one of the new practices was worried about being
separated from their departing
principal dentist. To overcome

Not only have we had to
train the whole team in customer care and deportment, but
we have had to train them in
our management infrastructure,
with regards to administration:
this is a challenge being faced

‘Note to self: I never want to be described as
“miserable”. My motto is and always will
be, to ‘lead by example’.
Dura-Green &
Dura-White
Speedy, chip-free
contouring and
finishing of porcelain,
composites and other
materials

One Gloss
Allows finishing and
polishing of composite
with the same
instrument – just alter
the contact pressure

Super-Snap
Simple, quick
and reliable
contouring,
finishing, polishing
and super-polishing
of composites

Brilliance at every turn!
The SHOFU range of finishers and
polishers give you the high-qulaity
finish you demand for every
indication - quickly and easily.

Take a look at the choice!

this problem, I had to establish trust in them, to enable me
to pass on our vision of what
we want the Dental Arts Studio
to represent.
Future vision
To encourage them to follow our
lead I realised that I had to set the
scene for them and make them
feel comfortable; I had to create
a reliable and attractive vision
for the future that they would respect and believe in.
As managers and leaders we
should never forget that staff
look to those in leadership roles
for confidence, a sense of calm
and direction. The most import
thing to remember is to make
good decisions when under pressure; with confidence you have
done the necessary work needed
for these decisions to be right.
To make a judgment without
investigating the implications
can lead to serious disharmony
among your staff.
One can never determine the
outcome of investing in a new
practice; this is something that
should be exciting and a challenge - as I have now realised,
it is exciting for the purchaser,
but not so much for the team left
behind.
Best customer care
We took over two practices at
the same time and the second

by both practice managers on a
large scale. We have been developing our administration system
over seven years now and it is
comprehensive, but very effective. Again, this means dealing
with stressed staff. The training,
however, must continue until
they are able to work singlehanded without too much micromanagement.
You have to show patience
and you have to continually encourage your team as they grow
into the new systems put before
them. It is not only about systems
and progress; it is about giving
your new team the time they
need to adjust.
A happy environment
Creating a good atmosphere is
not only easy, it is also essential.
For your team to respect you, you
have to learn to reward them,
praise them, lead and motivate
them. Deal with issues head on
- don’t ignore friction as it does
not go away, otherwise this will
be the undoing of your team.
It is difficult when you are
responsible for a team of people
you did not chose and you may
not like. In return, they may not
like you and on top of this you
have to do your job well. This
might seem like a rather tall order, but as a manager you have
been given a trusted and privileged position. You are a man-

ager – so you must manage.
Not very long ago I met a
nurse at a dental function and
most of our conversation was
based on how miserable their
practice manager was; as a result, the staff were too frightened
to approach her on practice issues to such a degree that the
staff were unable to self-develop.
I asked her why they did not approach the principal dentist and
she sadly informed me that he
was not interested as she did a
good job with the administration.
Note to self: I never want to
be described as “miserable”. My
motto is and always will be, to
‘lead by example’. A good manager is there to help the team grow
and develop, even if you have
a larger team to manage. You
could utilise part-time staff to
cover for people to go on courses
to further their self-development.
As Peter F Drucker says:
‘Management is doing things
right; leadership is doing the
right things’. DT

About the author
Originally
from
South
Africa,
Sharon
Holmes
has
worked
in the field of
dental
practice management since 1992. She received
hands-on training from the
first dentist who employed
her in 1992, which gave her
a broad experience in knowing what’s involved in providing dental treatment. Arriving
in the UK in 2002, she took
a post in a mixed NHS and
private practice in Wimbledon, eventually taking over its
management, converting it to
a fully private practice. In 2003,
she moved to London City
Dental Practice where after
18 months, was responsible for
managing four practices in the
group. The London City Dental
Practice is now part of a mini
co-operative group called
the Dental Arts Studio, of which
she has been instrumental in its creation. She holds
the position of operations director and manages every
aspect of the group alongside
her principal dentists.

[26] =>

26 Feature

United Kingdom Edition

September 20-26, 2010

Why learn occlusion?
Dr Lawrence Murray presents a compelling case for finding out more about occlusion and its relationship with patient care

O

cclusion touches on
every aspect of dentistry
and it is one of the most
important factors in determining the longevity of our restorations, it is amazing how long
any crown will last if it is not
in occlusion with a tooth on the
opposite arch.
Pressure
There is a pressure today for
everyone to have perfect teeth
and as dentists we frequently place crowns or veneers to
achieve the aesthetic improvements the patients desire, it is

to
provide
the
necessary
strength to prevent the restorations fracturing.

occlusion was then copied and
composite temporaries placed
on the teeth.

A full history was taken and
the patient stated that she was
aware of grinding her teeth,
had headaches and neck aches
and had a disturbed sleep pattern. A full occlusal examination
was taken, study casts mounted
on a Denar mark 11 articulator using a slidematic facebow
transfer and centric relation
record. A large deflective contact was identified on a molar
and there was a large Maxi-

These were placed to ascertain if the new occlusal pattern
was acceptable to the patient,
they are also useful in that if
they fracture or fall off it indicates that some aspect of
planned prescription is incorrect. These were adjusted on
two occasions and were in place
for three weeks; impressions
were taken and mounted in
(MICP) which was now coincident with (CR). Then a custom
incisal table was constructed
for the articulator based on the
guidance established on the
temporaries, thus enabling us
to recreate this in the final restorations. Five teeth
(11,21,22,23,24) were prepared
for feldspathic veneers. Care
was taken to keep the preparations in enamel and it was not
necessary to involved the unaffected incisors as we felt we
could achieve a good result with
the minimum of tooth loss

‘Patients arrive with worn or chipped
teeth and many practitioners are
encouraged by the patients desire to quickly
restore the lost tooth substance without
always looking at what caused the tooth
loss in the first place.’
well documented that patients
are less willing to accept problems from elective treatment
than treatment necessitated by
pain.
Patients arrive with worn or
chipped teeth and many practitioners are encouraged by the
patients desire to quickly restore
the lost tooth substance without
always looking at what caused
the tooth loss in the first place, if
patients can wear down enamel
they can easily wear down or
more likely fracture our restorative materials.
Case Study
This 52 year old lady was referred to me by a local practitioner,
she had been to see a “cosmetic
dentist’’ but was unhappy with
the treatment that was offered,
she was also given no explanation as to how or why her tooth
loss had occurred. She was
advised that she needed full
coverage metal ceramic crowns

mum
InterCuspal
Position
(MICP) Centric Relation (CR)
discrepancy.
A hard acrylic splint was constructed and adjusted so there
were even simultaneous posterior contact and no anterior contact in CR, immediate anterior
contact on excursive movement
allowing posterior disclusion.
This is called mutually protected
occlusion and after two weeks
she reported that she was free
from headaches and neck aches
for the first time in many years.
Stabilised joint position
She wore the splint for three
months until there was no further adjustment needed as her
joint position had stabilised. I
then equilibrated her teeth to
establish even posterior contacts
and smooth anterior guidance
within the limitations caused by
the loss of the canine cusp on
the left side. A diagnostic wax
up of the proposed new anterior

Fig 2

Five veneers were cemented
using standard protocol and final
excursive movements adjusted
to ensure smooth and immediate
disclusion.
Delighted patient
The patient was delighted with
the result both aesthetically and
that she had lost her headaches,
neck aches and had an uninterrupted sleep pattern.
I would like to thank Naomi
Greaves for the beautiful porcelain work.
There are many courses
that can teach the preparation
and cementation of veneers but
few that can teach the manual skills needed to be able to
fabricate and adjust splints,
there are even fewer that teach
practitioners how to equilibrate
on actual patients as it is very
different to doing a model exercise. The International Partnership for the Study of Occlusion
(IPSO) is one of these and it
was with them that I learned
my occlusal training, they have
been teaching in the United
Kingdom since 1986 alongside
and after a one year hiatus they
are back with their three-day introductory course in Mansfield
in November. DT
Further details for this
course are available from Crystal Walsh at The Academy of
Clinical Excellence. Tel: 0845
201 1515

Fig4

Fig 1

Fig 3

Fig 5

Fig 6

[27] =>

Case Study 27

United Kingdom Edition September 13-19, 2010

Aesthetic Zone needing Augmentation
Dr Shushil Dattani presents an interesting case

r W was referred to the
Kent Implant Studio
wishing to replace his
upper left central incisor. The
patient was wearing a partial
denture which he was unhappy
with, and did not like the idea of
a conventional bridge. The patient was medically fit, healthy
and a non-smoker.
After discussions with the
patient and the referring dentist,
it was decided the tooth would
be replaced with an implant
supported crown.
There was a buccal defect apparent. The history of the tooth
was a trauma incident (cricket
bat) which led to the tooth frac-

defect at the edge of the ridge
narrowing to the shape of the
previous tooth. There seemed
to be a height defect buccally
compared to palatally of around
2mm. These measurements
were confirmed during the reflection of the flap during surgery. If an increase in width was
needed, ridge widening could
be considered, however, the defect on ridge mapping measures
1mm at crestal level; a difficult
procedure considering this case.
There also seemed to be a buccal
height defect, which cannot be
corrected with ridge widening.
Therefore,
augmentation
was the proposed option. This
could be either guided tissue

OPG and identifiable throughout on the right hand side, the
right Ramus was the more
ideal site.

incision, with the incision point
more palatally, thus allowing
a bulking effect of the gingivae
buccally.

all the stages. The patient was
returned to the referring dentist
for routine care. DT

A ramus graft was obtained
from the right ramus as planned
and positioned in the upper
left central incisor area. Three
months were allowed for bone
healing, and subsequently an
implant length of 14mm and
width 4.5mm (Ankylos B14).

The already chosen abutment with the correct angle
(22.5 degrees) was fitted and an
already constructed temporary
acrylic crown was fitted. The
crown was adjusted at the gingival margins so to define the final
contouring of the gingivae. The
final restoration was fitted after
three weeks of gingival healing.

Dr
Shushil
Dattani
BDS,
MFGDP(UK), DipImpDent RCS
(Eng)
Principal of the Kent Implant Studio
and Kent Smile Studio in Maidtstone,
Shushil qualified from the Royal London in 2000, after which he completed
a two-year programme and membership to the Faculty of General Dental
Practice at the Royal College of Surgeons. He is accredited with a Diploma
in Implant Dentistry at the Royal College of Surgeons of England and is a
member of the Association of Dental
Implantologists, the American Academy of Cosmetic Dentists and regularly
trains and attends courses around the
world including the pioneering American and British Cosmetic Dentists. For
more information or to refer to the
Kent Implant Studio please call 01622
754 662

Primary stage impressions
were obtained (an impression at
the stage of implant placement).
six months were allowed for
implant integration, and subsequently the implant was exposed using a small ‘H’ shaped

The patient was delighted
with the end result, and was
surprised the treatment was not
painful and that he was able to
fully function the next day after

About the author

‘The patient was delighted with the end
result, and was surprised the treatment was
not painful and that he was able to fully
function the next day after all the stages’

turing and needing endodontic
treatment around 30 years ago.
The tooth subsequently needed
an apicectomy. The apicected
site was apparent with a soft tissue area apical of the previous
tooth. There was also a buccal
defect present 12mm from the
edge of the ridge. Ridge Mapping
clearly indicated a bony defect
of at least 12mm in height. Soft
tissue analysis showed 8mm of

regeneration with the use of
bovine/irradiated bone or grafting procedures using intra-oral
donor sites. The defect was of
height and width, and a J shaped
bone graft would be of more
use: therefore the ideal site for
a donor would be the Ramus. As
the patient was missing both his
wisdom teeth, either side could
be considered. As the ID canal
was more clearly visible on the

The buccal defect is apparent in the clinical photos. An implant without bone grafting
would produce an incorrect emergence profile leading to an aesthetic compromise.

Clinical pictures: note the correct emergence profile duplicated the adjacent incisor and the increased buccal width.

[28] =>

28 Industry News

United Kingdom Edition September 20-26, 2010

BioHorizons introduces
The Ultimate Implant Year
Course
BioHorizons is pleased to
announce the second edition of their highly successful implant course run
by Dr Ken Nicholson. Jointly sponsored by BioHorizons and SmileTube. The
Ultimate Implant Year Course will run from February 2011.
Having spent the last ten years heavily involved in dental implant education Dr
Ken Nicholson has listened to his students, the GDC and academic colleagues
and combined his own wealth of practical experience to provide a learning
medium that will offer delegates the necessary education and training to
introduce dental implant treatment to their dental practice.
The Ultimate Implant Course includes 3 residential days, 10 clinical days, 65
hours of online lectures as well as delegates playing an integral role in placing
and restoring implants on live cases.
For short implantology courses in October and November 2010 and the Year
course from February 2011 – call BioHorizons (on +44 1344 752560 or +44
7843 089155) or call NIDIC (from ROI on 048 92617471 or from UK on 02892
617471) for details.

GALILEOS - The new dimension in 3D
diagnostics
The GALILEOS from Sirona represents the
future of dentistry, combining the lowest
radiation dosage with superior image quality, it
is now available in two versions: the GALILEOS
Comfort and the GALILEOS Compact.
Available from Clark Dental, both versions
offer optimised clinical workflow and intuitive
operation, providing efficiency in both 3D diagnostics and dentistry alike.
The GALILEOS Comfort and the GALILEOS Compact can both be collimated
to offer maxillary or mandibular views only, and provide a valuable choice for
each individual practice, depending largely on clinical needs and financial
structure.
The GALILEOS Compact provides excellent image quality and an optimised
field of vision of 12x15x15cm3. This can be fully upgraded to the GALILEOS
Comfort, which offers a larger field of vision and additional cephlalometric
capabilities with 3D slice navigation. The GALILEOS Comfort is ideal for oral
and maxillofacial surgeons, private clinics, orthodontists and dental clinics,
whilst the GALILEOS Compact is the perfect digital imaging solution for
general practitioners, oral surgeons and dental implant practices.

Further information is also available at www.SmileTube.tv
For more information on cutting edge equipment solutions, call Clark Dental
on: 01268 733146 or email: enquiries@clarkdental.co.uk

The Dental Directory: Key
Distributor of Citanest® and
Xylocaine® - DENTSPLY’s leading
anaesthetics
The Dental Directory, the UK’s largest
full service dental dealer, is now the
UK’s key distributor for DENTSPLY’s
leading anaesthetic products: Citanest®
and Xylocaine®
Stock is readily available and with free next day delivery, The Dental Directory
offers the best knockout prices on the following anaesthetics:
• Citanest Standard: 2.2ml box of 100 best price £32.75
• Citanest Self-Aspirating: 2.2ml box of 100 best price £32.75
• Xylocaine: 2.2ml box of 100 –best price £30.75
• Xylocaine Self Aspirating: 2.2ml box of 100 best price £30.75
With The Dental Directory it couldn’t be easier, dispatching leading
anaesthetics and sundries all from under one roof, convenience and customer
satisfaction is guaranteed.
To order, simply contact your local Dental Directory Representative, call 0800
585 586, or alternatively visit: www.dental-directory.co.uk.

A goldmine of information
Marketing your practice’s cosmetic services is a
great way to grow your business - just as long as you
target the right audience! Even the most creative
of campaigns will fall on deaf ears if directed at the
wrong people.
The best audience to reach are those who are
actively searching for cosmetic dental treatment,
many of whom are likely to use the internet as their primary source of
information.
Rated as the top visited site on Google for the search term ‘cosmetic dentistry’,
www.cosmeticdentistryguide.co.uk is full of information for patients
considering undergoing all kinds of cosmetic treatment. The site provides
comprehensive, reliable information on the subject, as well as a panel of
cosmetic practitioners on hand to answer any questions patients and dentists
might have.
As well as being a goldmine of information for patients, www.
cosmeticdentistryguide.co.uk also includes the ‘Find a Cosmetic Dentist’
database that allows patients to find their closest, most suitable practice.
With over 160,000 visitors a month, the website boasts an incredible amount
of online traffic, letting thousands of potential new patients know about the
services you offer.
To find out more visit www.cosmeticdentistryguide.co.uk

UCL Eastman graduate wins
orthodontic prize
The UCL Eastman Dental Institute
would like to congratulate Joanne
Birdsall, an orthodontic graduate
student who recently won the
prestigious J K Williams medal.
The JK Williams medal is awarded
annually in memory of John Williams, Consultant Orthodontist and outstanding
teacher who was based at Wakefield and Leeds and a former Board member of
the Faculty of Dental Surgery.
Joanne is based at Watford General Hospital for her clinical training, under
the supervision of Mr Howard Moseley, Consultant Trainer, and undertakes
her academic component at the UCL Eastman Dental Institute.The Unit of
Orthodontics at the UCL Eastman Dental Institute, run by Professor Nigel Hunt,
has a national and international reputation which comes from over 50 years
experience of specialist training.
Following completion of her three-year training, Joanne plans to continue
pursuing a career as a hospital consultant, and is hoping to start a post-CCST
training post in October 2010.
The UCL Eastman Dental Institute would like to congratulate Joanne on her
outstanding achievement.

David Brewer joins Frank Taylor and
Associates
David Brewer is joining Frank Taylor and
Associates in the role of Healthcare Business
Development Manager.
A former bank
manager who has been working with the
dental profession for over 15 years, David
has acted for over 1000 dentists providing
guidance and advice in practice purchase, new
start -ups and retirement planning. He has
developed a strong reputation for providing
a reliable, pro-active, and as importantly, a
friendly hassle free service.

Enabling you to concentrate on dentistry - David will undertake the ‘leg
work’ for you and with his many contacts at the major banks and specialist
niche healthcare lenders. He is able to source a wide range of innovative and
flexible finance packages specifically tailored to and for dentists. With his
extensive knowledge of the banking ‘process’ he will ensure that your proposal
is structured to ensure maximum chance of success at the most competitive
terms.

For more details about the UCL Eastman Dental Institute, please
visit www.eastman.ucl.ac.uk or telephone 020 7915 1038

For further information contact David Brewer on 07817758548 or e-mail
david.brewer@ft-associates.com

Don’t forget your
Associate’s Agreement
Taking on a new associate
can
be
an
exciting
experience for everyone
involved, but you will need
to clarify everyone’s duties and responsibilities on paper. One way of doing this
is to draft a watertight associate’s agreement with the help of an experienced
solicitor.
Consider how you would address your colleague’s underperformance of
UDA targets or how you would deal with negligent work. A legally binding
associate’s agreement will set in stone everyone’s obligations. This will cover
issues such as:
• Financial arrangements
• Bad debts
• Termination
• Non-competition
• Dispute resolution
• Emergency arrangements
Goodman Legal, Lawyers for Dentists will listen closely to the requirements of
each individual practice and will draw up a foolproof associate’s agreement.
Goodman Legal’s team of solicitors is well placed to advise all parties on the
most advantageous arrangements for them in the long run.
For more information please contact Ray Goodman, Goodman Legal, Lawyers
for Dentists on 0151 707 0090, email rng@goodmanlegal.co.uk or visit
www.goodmanlegal.co.uk

EMBARGOED UNTIL 2ND
SEPTEMBER
Sensodyne toothpaste – The brand
most often recommended by
Dental Professionals for patients
with Dentine Hypersensitivity
After over 45 years Sensodyne
toothpaste has reinforced its
position as a brand of ‘firsts’
after becoming one of the first, if not the first, toothpaste brand to feature
a dental professional in their TV advertisement, following a change in the
broadcast advertising code. The new creative, which features dentists from
across the country, highlights the popularity amongst dental professionals of
the Sensodyne variants Sensodyne Rapid Relief, Sensodyne Total Care Gentle
Whitening and Sensodyne Total Care Extra Fresh.
As a brand Sensodyne has been responsible for a number of innovations
within the sensitive toothpaste category for more than 45 years:
• Sensodyne was the first sensitive toothpaste with Sensodyne Original
• Sensodyne was the first sensitive toothpaste to contain fluoride with the
launch of Sensodyne F3
• Sensodyne was the first sensitive toothpaste brand to be detailed by a full
time team of representatives to dental professionals
• Sensodyne was the first sensitive toothpaste brand advertised on TV

INSTRUMENTS, CUPS AND BRUSHES
FOR PROFESSIONAL CARE OF
IMPLANTS
The Hawe Recall Set is a kit containing
everything needed for professional
implant care and is - together with the
new Hawe Implant Paste – completing
KerrHawe’s attractive range of products
for professional hygiene-sessions.
For gentle and efficient elimination of soft deposits around and on implant
surfaces, it is recommended to use KerrHawe‘s metal-free and autoclavable
Implant Deplaquers. These unique carbon-fiber reinforced plastic instruments
are available in two shapes: Universal (for more topical applications) and
Orofacial (for larger, lateral surfaces). This procedure can ideally be finished
with a gentle cleaning and polishing session, using the new Hawe Implant
Paste. For this purpose, a selection KerrHawe‘s most popular cups and brushes
are included in the set (latch- and screw-type, including mandrels to adapt
screw-type products to latch-handpieces).
The Hawe Implant Recall Set is complemented by the further addition of the
unique and autoclavable colour-coded Perio-Probe, allowing an easy first
examination and evaluation of periodontal pockets around implants. These
plastic instruments do not scratch the implant surface, thereby offering a fast
and safe solution for the dental professional.

Trial size packs of Sensodyne Rapid Relief and Sensodyne Total Care Extra Fresh
are available for dental surgeries from www.gsk-dentalprofessionals.co.uk

To see how you can benefit from using Kerr’s products please telephone 01733
892292 or visit www.kerrdental.co.uk.

Guiding practitioners towards implant success
The NobelGuide™ state-of-the-art computer based
implant rehabilitation system assists dentists with
pre-planned, predictable guided implant surgery
to accomplish both provisional and final prosthetic
results.
In four simple steps, NobelGuide will assist in quick,
effective dental treatment, reducing the time the
overall time the patient spends in the chair:
1. Planning
2. The surgical procedure
3. The temporary prosthetic solution
4. The final prosthetic solution
NobelGuide can be used with conventional model-based techniques, or CT
scanning and 3D CAD/CAM software. The system allows you to plan the exact
positions and depths of implants before commencing surgery and also to plan
for prosthetics well in advance. Nobel Biocare will then produce a detailed
surgical template, incorporating the exact data from your own scanning and
planning.
This innovative tool will enable dentists to offer their patients efficient and
precise implant treatment, whilst all the while maintaining their profitability.
Patients leave the practice with a natural looking and functional smile.

Versatile Magnification Solutions With
The OPMI Pico
Designed specifically to meet the needs
of dental professionals, the OPMI Pico
Dental Microscope harnesses the expertise
of world-renowned manufacturer Carl
Zeiss. Useful in every field of cutting
edge dentistry, this powerful microscope
puts state of the art magnification and
illumination within easy reach of every practice.
Options are available to suit every budget. With an excellent quality image due
to the world-class appochromatic optics and illumination that is comparative
to daylight colour temperatures, dental professionals across the UK are
discovering how an investment in design excellence can benefit restorative,
endodontic and general dentistry.
Being able to work in absolute comfort is key when the seeking to provide
the very best in diagnosis and treatment. The OPMI Pico promotes the ideal
working position, so that the dental professional can focus completely on the
procedure at hand.
Nuview strive to ensure that dental professionals are able to maximise the
opportunities provided by such high specification equipment. The OPMI Pico
is coupled with a service that includes on-site surveys, efficient installation and
convenient training sessions, supported by reliable aftercare.
For more information call Nuview on 01453 872 266
or email info@nuview-ltd.com
www.voroscopes.co.uk

PDS Dental Laboratory: Large enough to
meet all your dental needs but small enough
to care…
Technician-owned and run, PDS Dental
Laboratory prides itself on being able to provide
clinicians with up-to-the-minute expertise,
consistent quality workmanship and the ability
to perform all work in-house within its state-ofthe-art facilities.
Now local to Newcastle, PDS strives to provide dentists in the area with
competitive set rates on implant work and works hard to build close working
relationships with all its dental clients.

For more information, contact Nobel Biocare on 0208 756 3300
visit www.nobelbiocare.com

or

Dr Rob Wain, practice principal of Dovetail Bespoke Dental Solutions in
Newcastle, trusts PDS with all of his restorative and smile design work:
“I began using PDS Dental Laboratories 5 years ago following a
recommendation from a respected colleague. Over the years I have entrusted
increasingly complex cases to their team, and their knowledge, feedback and
expertise have proved to be invaluable.”
Thanks to their efficient, personalised service and high quality workmanship,
PDS is the ideal partner for dentists looking for a trusted partner who can meet
all their implant and restoration needs.
For more information and a Laboratory Pack, call 0191 232 4844 or
visit www.pdsdental.co.uk and www.futureveneers.com

[29] =>

United Kingdom Edition September 20-26, 2010

Xerostom – a new oral hygiene line for
treating dry mouth
Xerostom is a new oral hygiene product from
Swiss oral care specialist, Curaprox that is
specially formulated for patients suffering
from xerostomia or dry mouth. This fast-acting
formulation helps to clean and lubricate the
oral cavity, whilst also soothing the tissues and
replenishing moisture.
Xerostom contains several naturally-derived
ingredients, such as olive oil and xylitol, both of which are known for their
anti-bacterial and anti-septic qualities which help to prevent bad breath and
microbial attacks on the teeth and gums. Betaine soothes and moisturises the
oral tissues while Vitamins B5 and E help to supply antioxidant protection.
Other key ingredients include:
• Allantoin
• Fluoride
Alcohol-free and suitable for diabetics, Xerostom has been shown to reduce
pain and thirst symptoms, as well as increase saliva flow by almost 200 per cent
within one week of treatment.
Xerostom is also available in several formulations, including mouthwash,
toothpaste, oral spray, gel, dental gum, capsules or pastilles.

Petersfield’s First Velopex Picasso
Laser
Petersfield in Hampshire is now well
and truly on the map! Their first Velopex
Picasso Laser has been installed at the
Dental Practice at 28 Collage Road which
can now offer all patients the availability
of laser treatments as well as the high
quality dentistry previously offered.
The Velopex Diode Laser contains two lasers: a 10 Watt Gallium Aluminium
Arsenate (GaAlAs) diode laser and a small laser pointer. The GaAlAs laser is ideal
for soft tissue (gum) work – as it does not interact with teeth or bone.
Drs Khalessi, who is no strangers to lasers said of the Velopex Diode Laser: “This
is a super unit, neat compact and easy to use.”.
The Velopex Picasso Laser is very easy to operate with a user friendly, menu
based, control system that is easy to navigate. The unit itself can fit neatly onto
standard dental cabinets or on a small trolley – the unit is the size of a large
laptop.
Patient feedback continues to be very positive with many patients
commenting positively on the laser.
Mark Chapman
Medivance Instruments Ltd
Barretts Green Road, LONDON, NW10 7AP
Tel 07734 044877 Fax 020 8963 1270

Industry News 29
The Dental Directory is cheaper
than Henry Schein Minerva on 200
of its bestselling branded products!
The Dental Directory slams Henry
Schein Minerva in branded product
price comparison!
When dental dealer The Dental
Directory compared 200 of its
bestselling branded products with rival dealer Henry Schein Minerva, the
results revealed the exact same products at Henry Schein Minerva were a
staggering 27.9% more expensive!
By purchasing from The Dental Directory’s Pricewatch 18 product range, your
practice will make massive savings on exactly the same quality brands that are
listed in Henry Schein Minerva’s 2010-2011 catalogue.
The Pricewatch 18 range includes the dealer’s most popular restorative and
orthodontic items and surgical equipment, from needles and syringes to face
masks and disinfectants; just another reason for dental professionals to use The
Dental Directory as their number one dental supplier!
To order, simply contact your local Dental Directory Representative, call 0800
585 586, or alternatively visit: www.dental-directory.co.uk.

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

The DAC Universal combination autoclave,
cleans, lubricates and sterilises 6 instruments
in 12 minutes!
The DAC UNIVERSAL supports the practice staff by
automatically cleaning, lubricating andsterilizing
handpieces intended for non-critical, semicritical and critical applications. The function
of the NITRASEAL unit is to wrap instruments
prior to sterilization in the DAC PROFESSIONAL.
According to the hygiene guidelines of the Robert Koch Institute, “non-critical”
applications do not involve any contact with the mucous membranes. “Semicritical” applications involve contact with the mucous membranes, whereas
“critical” applications involve contact with diseased tissue. The Sirona DAC
PROFESSIONAL autoclave handles large sterilization loads quickly and with the
utmost reliability. The DAC PROFESSIONAL is the ideal complement to Sirona’s
DAC UNIVERSAL and NITRASEAL systems. With the introduction of the newDAC
PROFESSIONAL Sirona Dental Systems has closed a gapin the sterilizer market.
Firstly, this autoclave can accommodate up to six trays. Secondly, it can be
preheated, which significantly reduces cycle times. It is designed to process
difficult materials (for example, A+B category hollow objects, surgical cassettes
and textiles) with perfect results. During the sterilization cycle microprocessor
continuously monitors the parameters time, pressure and temperature.

Admor adds Charity Calendars to its 2010 Christmas
Collection
As part of its dedication to the marketing needs of
dental practitioners, Admor is delighted to announce the
addition of a new range of Charity Calendars to its popular
collection of personalised Christmas products.
The calendars offer dentists the opportunity to support
two worthwhile dental charities, namely Dentaid and the
Benevolent Fund, whilst also providing practices with a
way to stand out from the crowd with their customised
corporate stationery.
In keeping with the Christmas spirit, Admor will donate
10% of all calendar sales to charity, five percent of which
will go to the Benevolent Fund, a registered charity that provides financial
assistance to dentists in need through a scheme of grants and interest free
loans. The other five percent will be donated to Dentaid, a UK-based charity
dedicated to improving the oral health of disadvantaged communities around
the world. And for every Christmas card purchased, 5p will be donated to each
of the above charities.
With over 30 years of experience, and a wide range of high quality, affordable
products, Admor is well-placed to help your business attract and impress
patients.

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

For more information or to purchase your cards, call 01903 858910 or visit
www.admor.co.uk

Digital Dental
The NEW Flex3D
As easy as 1 .. 2 .. 3D!
Digital Dental, the UK’s leading
independent digital imaging company,
offer the complete range of digital imaging
units from Vatech & E Woo, the world’s
no.1 Digital Dental Radiography & CT
manufacturer. This includes the impressive

General Medical
OsteoBiol MP3
The perfect answer to Sinus Lift GBR
General Medical are UK Distributors for the
complete range of OsteoBiol bone graft
materials and membranes including MP3, the
perfect answer to Sinus Lift GBR.
Ideally suited to lateral access sinus lift
procedures, MP3 consists of prehydrated
OsteoBiol granules, in a choice of either porcine
or equine origin, in a sterile syringe delivery
presentation. Consequently using MP3 facilitates easier and more convenient
handling with minimal waste compared with utilising conventional granules
which require hydration prior to placement.
Manufactured by an exclusive and patented process, the OsteoBiol range
also includes a choice of Genos granules for traditional bone regeneration
procedures; and Putty for post extraction alveolar regeneration and
periodontal defects. Both of which are also available in a choice of porcine or
equine derived options. The range also includes Evolution Membranes, in a
choice of thicknesses to suit different applications. Clinicians report that using
OsteoBiol products is easier and more convenient than using similar materials
made from other available products.

new Flex3D.
The most adaptable and feature-rich digital imaging unit available on the
market, the new Flex3D enables the practice to switch from conventional
panoramic to Cone Beam imaging as easily as 1…2…3D! This enables Practices
to select the most appropriate technology, in terms of image quality and
patient exposure, for every situation. It also offers an extremely cost effective
and simple way to upgrade from panoramic to Cone Beam when the time is
right!
In its Cone Beam format, the Flex3D offers a choice of two optimum fields of
view – 5cm x 5cm for single-site implants, complex endo, perio and surgical
applications; and 8cm x 5cm for guided implant surgery and larger procedures.
The new Ez3D 2009 3D viewer software offers a powerful yet easy to use
planning and diagnostic software interface and is compatible with various
surgical guidance software including Simplant and Procera.
For further information call Digital Dental on 0800 027 8393, email sales@
digitaldental.co.uk or visit www.digitaldental.co.uk.

The world’s Number One
dental Implant provider Straumann
Long recognised as one of
the leading providers of
dental implants, Straumann has now officially been recognised as the world’s
number one provider of dental implant solutions in figures released earlier this
year.
Straumann’s success is built on the founding tripartite principles of reliability,
simplicity and versatility and these principles, backed by an unrivalled level
of over 20 years of clinical research have led to Straumann rightly claiming
to have “the most extensively documented, clinically validated and practiceproven implant system in the market.”
As the most practice-proven system on the market, the Straumann® Dental
Implant System provides a unique combination of reduced healing time,
long-term reliability, simplicity of use and a high degree of versatility. The
Straumann® Dental Implant System requires only one surgical procedure
and if appropriate, can be ‘immediately loaded’, to help practitioners achieve
predictable results in any clinical indication.
Now, Straumann’s pioneering approach encompasses not only dental
implants, but also tissue regeneration and digital solutions.
For more information contact Straumann on 01293 651230 or visit www.
straumann.com

For further information telephone General Medical on 01380 734990, visit
www.generalmedical.co.uk or email info@generalmedical.co.uk

DENTSPLY enjoys successful exhibit at ISDH
2010
DENTSPLY was pleased to both attend and
sponsor this year’s International Symposium
on Dental Health, the only global conference
specifically aimed at dental hygienists and dental
therapists, which was held in Glasgow in early
July.
Delegates responded extremely well to the lecture
delivered by Marie George and Cindy Sensabaugh on myths surrounding
insert selection, with many clinicians using the hands-on session afterwards to
try out some of the DENTSPLY cutting-edge equipment mentioned in the talk.
These included the Cavitron™ ultrasonic scaler, which provides proven scaling
efficacy, and is available in a range of options to suit every budget.
Members of the DENTSPLY team were also on hand to inform delegates about
products such as the THINsert™, designed to support the Cavitron ultrasonic
scaler. 47% finer than any other slimline insert on the market, the THINsert™
offers superior access for improved biofilm removal.
DENTSPLY recognises the important role played by dental hygienists and
therapists in advancing preventative dentistry andlooks forward to another
successful event in 2011.
For more information please contact your local representative, Freephone
+44 0800 072 3313 Or visit www.dentsply.co.uk

BACD Study Clubs - Stay ahead of the game
Committed to excellence in cosmetic dentistry and CPDverified since 2005, the BACD encourages the pursuit of
best practice and innovation through education.
BACD regional Study Clubs help to keep members
abreast of the most up-to-date information on advances
within dentistry, including the latest techniques and
ideas, from a range of speakers from around the globe,
all of whom are at the forefront of their field.
Upcoming events during 2010 include:
• Birmingham Study Club – ‘Realistic, Fast, Fixed Cosmetic
Orthodontics for GDPs by Dr Anoop Maini on Friday the 16th of September
• Belfast Study Club – ‘10 Top Tips To Survive And Prosper In The Next 10 Years’
by Mr Chris Barrow on Wednesday the 27th of October
– BACD Accreditation Workshop by Dr Christopher Orr on Thursday the 16th
September
• Bristol Study Club – ‘The Million Pound Dental Practice’ by Mr Chris Barrow on
Tuesday the 19th of October
– Empress Direct Hands-On Road Show by Mr Chris Parker on Thursday 18
November. This session is STRICTLY limited to 12 participants, so book early!

The Right Choice for Implant Surgery
NSK now brings dental professionals a combination
of powerful, innovative equipment designed
specifically to meet the everyday clinical demands of
implant dentists. The powerful surgical micromotor
Surgic XT Plus, ultrasonic surgical system
VarioSurg and the newly launched iSD900 cordless
prosthodontic implant screwdriver, each deliver
power and control that enables implant dentists to
tackle even the most complex cases with confidence.
Developed and designed with advice from the profession, the Surgic XT Plus
brings a new dimension of control through the innovative application of
Advanced Torque Calibration (ATC). ATC ensures that you are always working
with the optimum torque and speed settings for accurate, safe and smooth
operation. The new iSD900 cordless prosthodontic screwdriver also features
NSK’s unique Torque Calibration System (TCS) which ensures that the correct
torque is applied at all times. This helps the clinician to screw and unscrew
abutments reliably and without risk, eliminating tiring and strenuous manual
procedures. For more information on the NSK surgical product range contact
Jane White at NSK on 0800 6341909 or visit www.nsk-uk.com
*The iSD900 cordless prosthodontic screwdriver is available exclusively from
Straumann UK, phone 01293 651230 for more details.

Increase Your Implantology Expectations with the
Chiropro L
Created with practitioners for practitioners the BienAir Chiropro L ultra-efficient, extremely versatile
implantology system leaves nothing to chance. The
Chiropro L has been designed with efficiency and
comfort in mind. The intuitive interface can be managed
by the control pedal. The patented peristaltic pump with
disposable irrigation lines and insertion support ensures
easy handling and optimum infection control.
The Chiropro L System includes the MX-LED self-ventilating motor, which is
the most powerful on the market to offer LED lighting at equal intensity at
both high and low speeds. Incorporating 7 of the leading brands of implants
with their complete sequences the Chiropro L can also be customised to your
individual requirements.
With the world’s first internal irrigation system the 20:1 contra-angle handpiece
incorporates the smallest head on the market allowing access to the tightest of
areas. Fitted with an exclusive double optical glass rod system, the handpiece
provides uniform lighting of the operative field.This user-friendly system has
proved to meet the demands of implantologists worldwide and more.
For further information please contact Bien-Air on 01306 711 303 or visit www.
bienair.com

[30] =>

30 Events

United Kingdom Edition

The long way down
Four exciting abseil events with Bridge2Aid
to challenge yourself with this autumn

T

EAOM_CPDAdvertA4
11:53 Page
This1autumn, however, we’d like to
anzania is14/12/2009
4,500 miles

south from the UK – that’s a
long way down from here!

ask you to travel not quite as far to
make a big difference to our work.

Pick one (or all!) from the following and by travelling a little
you can make an impact on the

lives of thousands of people in
the Mwanza region of Tanzania,
giving them access to safe, emer-

10th Biennial Conference of
EAOM incorporating the World
Workshop on Oral Medicine
Central Hall Westminister, London
– 21st to 25th September 2010
Please join us for innovative CPD
sessions for the whole dental team

CPD sessions:
■ The dental team and oral mucosal disease management
■ Contemporary oral medicine
■ Restorative rehabilitation of the diseased mouth
■ Infectious diseases in primary care
Principal Sponsors:
Integrated
Dental
Holdings

Hosted jointly by the three London Dental Schools:

September 20-26, 2010

gency dentistry. Imagine hanging 50 metres above the ground
while controlling your own descent at some of the most impressive sites around the UK…
26 September – Mersey Ventilation Shaft: The 50m Mersey
Tunnels Ventilation Shaft located
in Birkenhead provides an exhilarating abseil with fantastic
views across the River Mersey.
2 October – Walsall Art Gallery: This iconic building in
Walsall, West Midlands provides
an exciting 30-metre abseil in
the heart of the town.
3 October – Carlisle Civic
Centre: The Civic Centre abseil
located in the centre of town provides a great view of Carlisle in
Cumbria and an exciting abseil.
To take part
• Choose your challenge
• Send your registration form to
Long Way Down, Bridge2Aid, PO
Box 649, Chichester, PO19 9JB
• Pay £20 registration fee
• Raise £100 minimum sponsorship, we’ll give you support.
The fee includes rental and
preparation of the venue, qualified and professional instructors,
all equipment, registration and
management on the day.
If you’d like to travel a little
way to help people a long way
away, contact us now by emailing fundraising@bridge2aid.org
or calling 01243 780102.
Bridge2Aid (B2A) is a dental
and community development
charity working in the Mwanza
region of North West Tanzania.
We started full scale operations
in 2004 and work closely with
the Tanzanian Government to
deliver aspects of their dental
strategy. We operate a not-forprofit dental clinic in the city of
Mwanza (Hope Dental Centre)
and have a community development programme for the disabled community based at Bukumbi Care Centre.
The four key aspects
Bridge2Aid’s vision are:

of

- To provide primary dental care
and oral health education to
communities in Tanzania
- To equip and further train local health personnel to provide
emergency dentistry to rural
communities
- To care for and empower the
poor and marginalised in Tanzanian society

European Association of Oral Medicine
For further information please go to:
www.eaom2010.com or contact admin@eaom2010.com

- To provide opportunities for UK
dental professionals and others
to use their skills to serve Tanzania, as locums or participants on
the Dental Volunteer Programme
(DVP). DT

[31] =>

Classified 31

United Kingdom Edition September 20-26, 2010

Geoff Long
2010

FCA

Tax Planning Slate
Now Available!

office@dentax.biz

Call 01438 7222242

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

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

To advertise here please contact Sam Volk
on 0207 400 8964

[32] =>

CORSODYL MOUTHWASH
SODY
R
O

YEARS O

RTISE

NEW

ALCOHOL FREE

M CARE

COMPARABLE TO CORSODYL
MINT MOUTHWASH IN –
• INHIBITING PLAQUE REGROWTH1
• REDUCING ORAL BACTERIA2
• SUBSTANTIVITY3
chlorhexidine digluconate

Now when you wish to recommend an alcohol free chlorhexidine mouthwash
recommend NEW alcohol free Corsodyl Mouthwash with confidence.

Product Information: Corsodyl Mint Mouthwash (clear, chlorhexidine digluconate 0.2%), Corsodyl 0.2% Mouthwash (alcohol free) (clear, chlorhexidine digluconate 0.2%) Indications: Plaque inhibition;
gingivitis; maintenance of oral hygiene; post periodontal surgery or treatment; aphthous ulceration; oral candida. Dosage & Administration: Adults and children 12 years and over: 10ml rinse for 1 minute twice
daily or pre-surgery. Soak dentures for 15 minutes twice daily. Treatment length: gingivitis 1 month; ulcers, oral candida 48 hours after clinical resolution. Children under 12 on healthcare professional advice only.
Contraindications: Hypersensitivity to chlorhexidine or excipients. Precautions: Keep out of eyes and ears, do not swallow, separate use from conventional dentifrices (e.g. rinse mouth between applications). In
case of soreness, swelling or irritation of the mouth cease use of the product. Side effects: Superficial discolouration of tongue, teeth and tooth-coloured restorations, usually reversible; transient taste disturbances
and burning sensation of tongue on initial use; oral desquamation; parotid swelling; irritative skin reactions; extremely rare, generalised allergic reactions, hypersensitivity and anaphylaxis. Legal category: GSL. PL
Numbers and RSP excl. VAT: Mint Mouthwash: PL 00079/0312 300ml £3.99, 600ml £7.82. Alcohol-free PL 00079/0608 300ml £4.08. Licence Holder: GlaxoSmithKline Consumer Healthcare, Brentford, TW8
9GS, U.K. Date of preparation: May 2010.
References: 1. Veihelmann S, Mangold S, Beck P, Lemkamp V, Schmid F-G, Schlagenhauf U. Hemmung des Plaquewiederbewuchses auf Zähnen durch die Chlorhexamed alkoholfrei Mundspüllösung [Inhibition
of plaque-regrowth on teeth by Chlorhexamed alkoholfrei mouthrinse]. Parodontologie 2008; 19 (3): 326. 2. GlaxoSmithKline data on file, Bacteria Kill Test, In Vitro, SGS 2007. 3. GlaxoSmithKline data on file,
substantivity report, Hill 2007.

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

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[cover] => DT UK 2210

[toc] => Array ( [0] => Array ( [title] => Survey - access is still biggest problem for PCTs [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => One Lord a talkin’ - exclusively to DT [page] => 07 ) [3] => Array ( [title] => Making things simpler for our customers [page] => 09 ) [4] => Array ( [title] => Teaming up [page] => 10 ) [5] => Array ( [title] => How busy is your hygienist book? [page] => 12 ) [6] => Array ( [title] => Following the rules [page] => 13 ) [7] => Array ( [title] => Delivering patient experience [page] => 14 ) [8] => Array ( [title] => Small things make big difference [page] => 16 ) [9] => Array ( [title] => The bigger picture [page] => 17 ) [10] => Array ( [title] => Getting in at the deep end [page] => 18 ) [11] => Array ( [title] => An Evidence-Based Endodontic Implant Algorithm:Back to the Egg; Concluding Part [page] => 20 ) [12] => Array ( [title] => Growing pains [page] => 25 ) [13] => Array ( [title] => Why learn occlusion? [page] => 26 ) [14] => Array ( [title] => Aesthetic Zone needing Augmentation [page] => 27 ) [15] => Array ( [title] => Industry News [page] => 28 ) [16] => Array ( [title] => The long way down [page] => 30 ) [17] => Array ( [title] => Classified [page] => 31 ) ) [toc_html] =>

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