DT UK 2909

HTM 01-05 battle continues after BDA claims / News / News & Opinions / Home from home / LAB TRIBUNE (part1) / LAB TRIBUNE (part2) / It’s time to think about the bigger picture / Incorporating incorporation into your practice / BDTA Show Review / Industry News / Endodontic re-treatment or implants? / BOS announces new event

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Table of contents

November 30-December 6, 2009

PUBLISHED IN LONDON
News in Brief
To have & to hold
True love may be the key to
a long and happy marriage –
but being a dentist helps, too,
according to new research. A
paper that correlates occupations with divorce and separation rates, published this
week in the Journal of Police
and Criminal Psychology, reveals that dancers and choreographers, bartenders, massage therapists and telephone
operators are most likely to
split up. Those looking for
a life of fidelity and loyalty,
however, should marry agricultural engineers, optometrists, dentists, members of
the clergy and podiatrists. Dr
Michael Aamodt, an industrial psychologist and professor
of Industrial and Organisational Psychology at Radford
University in Virginia, has invented a formula to work out
the likelihood of success for a
marriage, based on the percentage of people in 449 occupations who had been in a
marital relationship, but were
no longer with their spouses.
Using census information,
Aamodt rated professions and
trades according to their likelihood of achieving a successful marriage. His study found
that chefs and mathematicians shared a 20 per cent
chance of getting divorced or
separated. Despite their long
hours, or perhaps because of
them, chief executives had
only a 9.81 per cent chance of
experiencing marriage breakdown, slightly above pharmacists, dentists and farmers.
New Modules Launched
After the success of Communication in Dentistry: Stories
from the Practice, Smile-on
in association with Dental
Protection Ltd (DPL) have
launched the next three modules of this flexible approach
to dental training. Modules
four to six of Communication
in Dentistry consist of: Module four: Complaint handling
and dealing with difficult patients; Module five: Consent
and communicating choices;
Module six: Recording communications. The cutting edge
technology and informative
content offers users a flexible approach to promoting
effective and reliable working
systems to help practices enjoy greater success and safeguard themselves from legal
action. Smile-on is proud to
support all dental professionals by offering flexible education and accessible learning
to help build fulfilling and
successful dental careers.For
more information please call
020 7400 8989 or email info@
smile-on.com
www.dental-tribune.co.uk

News

World Diabetic Day

New guidelines for diabetics
highlight importabce of good
periodontal health

page 2

VOL. 3 NO. 29

Lab Tribune

View of the mouth

Dental Tribune speaks to Prof
Stephen Porter about the efficacy
of dielectrophoresis

page 5

CAD/CAM technology

A laboratory and a clinical perspective of the advantages of
CAD/CAM in treatment

Money Matters

Incorporation

James Shedlow discusses the
pros and cons of incorporating
your practice

page 10-21

page 24-25

HTM 01-05 battle continues
after BDA claims
British Dental Association calls for evidence to be examined by NICE

he British Dental Association (BDA) has made
the bizarre claim that the
Department of Health’s (DH)
chief dental officer has refused to
publish documentation on contamination he has already committed - in a letter to the British
Dental Journal - to publishing if
required.
In a letter to the DH, the BDA
has renewed its 2007 request for
a full review of the evidencebase for the HTM 01-05 guidance
document on decontamination
in dental surgeries.
The BDA claims that three
areas of the guidance have been
amended before printing the
document, which includes permission to use potable water for
the rinse stage of decontamination. The BDA claims this is a
climb-down from the previously
intended requirement for reverse osmosis and freshly distilled
water.
The association also objects
to an increase in the period during which instruments can be
stored after processing in a validated vacuum sterilizer, from 30
to 60 days.
It also draw attention to the
revision of the requirement of
two sinks for decontamination,
to allowing two bowls in a single
unit.
The association claims that
concern about these changes has
been heightened by a ‘consistent failure’ by the DH to publish
references for the document’s
evidence-base.

BDA executive board chairman, Dr Susie Sanderson, said:
“It is telling that changes to the
content of HTM 01-05 have had
to be made already. The changes
expose the uncertain evidence
base on which the document is
founded and will be a cause of
great concern to dentists. These
doubts can only be exacerbated
by the failure of the DH to publish its evidence base for the
document.
“To establish that evidence
base the BDA believes the guidance must be looked at in detail
by NICE.”
Dr Barry Cockcroft, chief
dental officer for England, said:
“Improving patient safety is a priority for the DH and we make no
apology for updating our guidance to make sure dentists have
the most up-to-date scientific
advice available. The document
must reflect the latest knowledge
and needs to be up-to-date. We
will therefore be constantly refreshing it.
“As the BDA is aware, we have
already committed to publishing
the list of references for all our
latest evidence at the earliest opportunity.”
He stressed it was a living
document, which was updated to
reflect changing evidence.
He added: “The knowledge
base has moved on in the first
two areas mentioned by the BDA.
“Regarding point three, this is
not new guidance, it has just been
re-positioned within the document.

“In addition, the BDA were
also members of the expert
working group and commented
on working drafts over quite a
long period of time.”
He said the clinical section of
the guidance had been available
online since October 2008.
Dr Cockcroft continued: “The
new guidance has essential quality requirements, which are not

much greater than the existing requirements defined in the
BDA’s own guidance document.
However the aim is to move towards best practice as defined in
the new document.”
Over the last five years, the
DH has introduced a Clean, Safe
Care Strategy, resulting in cleaner hospitals and significant reductions in MRSA and C. difficile
infections. DT

[2] =>

2 News

United Kingdom Edition November 30-December 6, 2009

BDTA prize winner

avid Tomkins was the
lucky winner of the holiday for two to the luxurious Caribbean Island of Barbados.
The official Showcase prize
draw, provided with compliments of the BDTA, was designed
to link in with the Showcase 2009
‘Treasures of Dentistry’ theme
and was open to everyone who
registered in advance for tickets
to the event and attended on one
or more of the exhibition days.
David is a dentist at Prescot
House Dental Surgery in Merseyside and was ‘gobsmacked’ when
he received the news of his win.

World Diabetes Day lights up the London Eye

Gum Disease Linked with Diabetes

linical guidelines recently released by the
International
Diabetes
Foundation (IDF) emphasise the
importance of periodontal health
for people with diabetes, which
affects about 246 million people
worldwide.
World Diabetes Day (WDD)
on November 14 shone a spotlight on the condition, with iconic buildings such as the London
Eye, lit up with the blue WDD
circle logo.
Founded by the IDF and
the World Health Organization
(WHO) in 1991, WDD aims to
raise awareness of diabetes. This
year sees the first of a five-year
campaign addressing the growing need for diabetes education
and prevention programmes.
The new IDF oral health clinical guidelines support research
which suggests that the management of periodontal disease which affects the gums and other supporting tissues around the
teeth - can help reduce the risk of
a person developing diabetes and
can also help those with diabetes
control their blood sugar levels.
The IDF guideline contains

clinical recommendations on
periodontal care, written in collaboration with the World Dental
Federation (FDI). These encourage health professionals look
out for symptoms of periodontal
disease such as swollen or red
gums, or bleeding during tooth
brushing and to educate patients
with diabetes about the implications of the condition on oral
health.
“Educating people about the
risk factors of diabetes and promoting action to encourage early
diagnosis, is vital in tackling the
worldwide diabetes epidemic,”
said Sir Michael Hirst, presidentelect of the IDF.
Samuel Low, associate dean
and professor of periodontology
at the University of Florida College of Dentistry, also emphasised prevention.
He said: “Everyone should
maintain healthy teeth and gums
to avoid periodontal disease, but
people with diabetes should pay
extra attention.
“Periodontal disease triggers
the body’s inflammatory responses, which can affect insulin
sensitivity and ultimately lead

to unhealthy blood sugar levels.
Establishing routine periodontal
care is one way to help keep diabetes under control.”
He added: “I know that these
clinical recommendations will
be helpful for those professionals
who work with and treat people
with diabetes. I also encourage the
medical and dental communities
to work together to provide the
best possible care for our patients.”
In the UK alone, diabetic diagnosis has increased from 1.4
million in 1996, to 2.5 million in
2008. By 2025, there are predicted to be more than four million
people with diabetes in the UK.
It also is estimated that there are
around half a million people currently living with undiagnosed
type 2 diabetes in the UK.
Viggo Mortensen is UK &
Ireland vice-president of global
healthcare company, Novo Nordisk, which helped sponsor WDD.
He said: “As a world leader in diabetes care, we are truly committed
to defeating this disease. Promoting greater awareness of the risk
factors for diabetes and encouraging best-practice sharing in diabetes prevention and management is
key to achieving this.” DT

Tony Reed, executive director
at the BDTA, said: “Thousands of
visitors entered the prize draw
which proved popular with visitors. We originally developed the
‘Treasures of Dentistry’ theme to
conjure up images of clear blue
skies, white sandy beaches and
bring a little sunshine into November at Dental Showcase. I’m

ental Defence Union
(DDU) members facing
a General Dental Council (GDC) investigation now have
extra help on hand in the form of
a newly launched podcast.

Published by Dental Tribune UK Ltd
© 2009, Dental Tribune UK Ltd. All rights reserved.
Dental Tribune UK Ltd makes every effort to report clinical
information and manufacturer’s product news accurately, but
cannot assume responsibility for the validity of product claims,
or for typographical errors. The publishers also do not assume
responsibility for product names or claims, or statements made
by advertisers. Opinions expressed by authors are their own and
may not reflect those of Dental Tribune International.

Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Editor
Lisa Townshend
Tel.: 020 7400 8979
Lisa@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com

by the GDC at Stage 1 of, Fitness
to Practise, compared to 2007.

Entitled, A letter from the
General Dental Council, the podcast offers practical advice for
members, during what could be
one of the most stressful times of
their professional lives.
DDU dento-legal adviser Leo
Briggs, who is interviewed on the
podcast, said: “This is particularly timely, because last year, there
was a 20 per cent increase in
the number of complaints about
dental professionals considered

“The good news is that 89 per
cent of complaints considered by
the GDC investigating committee in 2008 - in which DDU inhouse lawyers assisted members
-did not proceed to a, Fitness to
Practise, hearing.”
The podcast covers important
advice relevant to GDC complaints and investigations. This
includes calling the DDU advice
line soon after receiving a letter from the GDC and acknowledging it promptly. Dentists are
also advised to contact the DDU
if they are asked to give comment or answer criticisms during the investigation process, as
the union has an expert team of
dento-legal advisers and lawyers
to support and advise members
throughout.

Advertising Director
Joe Aspis
Tel.: 020 7400 8969
Joe@dentaltribuneuk.com
Sales Executive
Sam Volk
Tel.: 020 7400 8964
Sam@dentaltribuneuk.com

If contacted by journalists, the
DDU advises dentists to contact
the union first before responding
to media queries.

Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com
Design & Production
Keem Chung
Keem@dentaltribuneuk.com

Put the dates in your diary
BDTA Dental Showcase 2010
takes place at ExCeL London,
14-16 October 2010. For further
information, visit www.dentalshowcase.com. DT

“While only a handful of
complaints will reach a, Fitness
to Practise, panel, we believe that
it is helpful for dental professionals in this position to have some
understanding of the process and
how they can give themselves the
best chance, by seeking expert
help from the outset from their
dental defence organisation.

Peter Witteczek
Dental Tribune UK Ltd
p.witteczek@dental-tribune.com 4th Floor, Treasure House, 19–21 Hatton Garden, London, EC1N 8BA
Chairman
Torsten Oemus
t.oemus@dental-tribune.com

sure David will experience all of
this on the trip and thank you to
everyone who entered the draw.”

Podcast helps dentists
under investigation

International Imprint
Executive Vice President
Marketing & Sales

Tony Reed draws the winning ticket

The podcast covers important advice relevant to GDC complaints and investigations.

For a copy of the podcast, log
onto: www.the-ddu.com DT

[3] =>

News 3

United Kingdom Edition November 30-December 6, 2009

‘

Editorial comment

Cross-infection controversy - HTM 01-05

‘

HTM 01-05 has seemingly been causing much
controversy amongst the
profession. Conspiracy
theories abound; it’s a
con perpetrated by the washer-disinfector manufacturers wanting to
sell more equipment, a regulatory
minefield designed to drive more
dentists out of business, part of an
alien invasion plot and other theories have been touted (ok, maybe I
made the alien one up – Ed).
It may not be a conspiracy, but
HTM 01-05 is certainly causing
controversy. These latest claims

Edinburgh
practice on
OH mission

E

dinburgh practice Stafford Street Dental Care
has launched a dental
health campaign by distributing
3,000 cards with top dental tips.
The brainchild of surgery
owners, Yann and Gilly Maidment
and
their
team,
the campaign
aims to reduce restoraGilly and Yann Maidment
tive treatment
in the practice. The Maidments
estimate that more than 100
people a year take advantage of
their Relief and Rescue, package
for non-registered patients who
need to see a dentist urgently.
Mrs Maidment said: “When
we realised how many patients
we were seeing who wished
they had been better informed,
we decided it was time to take
pre-emptive action and reach
out into Edinburgh homes and
workplaces to get people thinking how they could improve
their dental health.”
The Scottish 2008 health survey showed that 56 per cent of
adults over 65 had no teeth, with
41 per cent of Scottish adults reporting dental pain in the previous ten months. It acknowledged
that Scotland’s oral health is poor
compared to other European
countries, exacerbated by poor
diet, poverty and tobacco use.
tips include keeping sugary
snacks and drinks to mealtimes.
The advice is based on the Department of Health report, Delivering Better Oral Health - the evidence-based prevention toolkit
of 2007. DT

by the British Dental Association
of non-publishing of the evidence
base for the guidelines by the Department of Health will keep the
‘he said/ she said’ argument going
for some time!
Love it or loathe it, disinfection and decontamination guide-

lines are here to stay and dentists
should do their best to be ahead of
the game in terms of best practice
within the limitations of their individual surgery setups.
In lighter news, dental professionals make for great marriage
material! Research published in

the Journal of Police and Criminal
Psychology doesn’t give reasons
beyond the formula used to work
out the data, but I have my own
theories – the uniform,
unlimited access to Lidocaine, exotic CPD trips involving activities such as
skiing or golf.... DT

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

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

[4] =>

4 News

United Kingdom Edition November 30-December 6, 2009

Access contracts ‘risky’ claims Dental Committee

T

that by March 2011, anyone wanting NHS dentistry can access it in
‘This special dena reasonable time. Through the
tal access template,
PCT procurement framework, the
DH aims to support PCTs particiwill help us to move
pating in the programme to comfurther and faster
mission NHS dental services to
deliver ‘fair, robust and competiin improving access
tive procurements’. To this end,
and quality of denthe DH has produced best practice
tal services.’
guidance and
template procureThe DH’s
national dental ac-Ad-A4:Layout
DH19351
DS Cherokee-Toffeln
1 10/8/09
15:19 Page 1
ment documents, which will need
cess programme wants to ensure
he new Department of
Health’s (DH) template
contracts for dental access funding are ‘unnecessarily complex’, which makes them
‘risky and inappropriate for dental practice’, according to the
BDA’s General Dental Practice
Committee. (GDPC)

PCTs’ input to make them appropriate for their requirements.
However, although taking up a
‘PDS Plus’ contract is not mandatory, John Milne, GDPC chairman,
said dentists should exercise great
caution before making a decision
to do so, despite changes made by
the DH.
He said: “Although it must be

an individual business decision,
we advise dentists to think very
carefully and seek advice before
taking on one of these contracts, as
the dangers of breach are rife and
the consequences of breach may be
very damaging to practices.
“The GDPC, advised by specialist lawyers, has spent more
than four months explaining in
detail to DH why its proposed
contract was unsuitable, onesided and unsafe for practitioners.
“The first version, based upon a
medical model, was wholly unacceptable and we advised members not to sign it. While DH has
made some significant changes,
we still do not feel that the contract is acceptable.”
The GDPC is of the opinion
that  fundamental new provisions,
such as the payment mechanism,
the need to comply with new key
performance indicators and the
‘dental care assessment’ of patients
should have been developed and
piloted in conjunction with the
wider profession through the implementation of the Steele review.

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Mr Milne added that the contract still incorporates too many
controlling provisions, which
could lead to intrusive micromanagement. He said: “Practices will
need to devote considerable resources to managing the contract
and ensuring that requirements
are met. For most practices, this
will require a dedicated contract
manager and for the contract
value to reflect the risks and extra
work required.”

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The final version of the, ‘PDS
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Chief Dental Officer for England, Dr Barry Cockcroft said:
“The NHS has made a commitment that everyone who wants
access to NHS dentistry can get it
by March 2011. To support this,
PCTs have had significant increases in resources with an additional £380m of funding over the
last two years taking central dental funding to a record £2,257m.
“To ensure we improve people’s
access to NHS dentistry, we have
developed a template agreement
that PCTs can use to commission
new services. The agreement will
allow PCTs to count the number of
new patients as well as the amount
of work that dentists do, and enable them to reward dentists for the
quality of the services they provide.
“This doesn’t replace the current NHS dental contract system,
which is working well. But this
special dental access template,
will help us to move further and
faster in improving access and
quality of dental services. DT

[5] =>

United Kingdom Edition November 30-December 6, 2009

News & Opinions
DTads_May6:Precision

12/10/09

17:14

Page 1

View of the Mouth – Oral Cancer
Dental Tribune talks to Professor Stephen Porter
about the dangers of oral cancer and an innovative diagnostic technique, with the potential for
speedy diagnosis and referral for patients

n the UK, about 3,500 patients annually are diagnosed with oral cancer, of
which 900 are fatalities. Elsewhere in Europe there has been
a six-fold rise over the past 40
years among young adults with
the most frequent tumour of
the mouth - oral squamous cell
carcinoma - (OSCC) with numbers predicted to rise.

Prof Stephen Porter confirmed that although oral
cancer had a fairly low public profile, it was increasingly common. He said: “OSCC
is possibly the eighth most
common cancer worldwide
and thus more common than
diseases such as cervical
malignancy.”
Researchers from the UCL
Eastman Dental Institute and
the University of Surrey are
conducting a study over the
next year on the potential efficacy of dielectrophoresis, a
non-invasive technique of diagnosing oral cancer. Prof Porter
explained: “If successful, this
new technique would provide
a simple and quick means for
a dentist or doctor to determine
whether a lesion in the mouth
was potentially cancerous.
“It could lead to a chairside
test for potentially malignant
disease, which would give an
immediate result and lead to
early referral.”
The technique’s methodology uses a brush placed over a
suspicious oral lesion to collect
cells, which are then examined
in the laboratory to detect any
changes in electro-physiological properties.
Prof Porter said studies
were investigating ways of
encouraging people to change
behaviour that increases the
risk of oral cancer. He said although the main risk groups
are those who smoke and/or
drink alcohol, there is increasing evidence that sexual lifestyle may also play a role in
increasing risk.
Heavy smokers have a sixfold greater risk of oral cancer.
In addition, alcohol acts synergistically with tobacco, which
means that people who drink
and smoke heavily are 24 times
more at risk of contracting oral
cancer. Therefore, early diagnosis is crucial.”

He commented that poor oral
hygiene is also a possible contributory factor, although the
precise impact of alcohol-containing mouthwashes remains
uncertain. Additional risk factors
include a diet with a lack of fresh
fruit and vegetables.

Although diagnosis of mouth
cancer is generally based upon
clinical detection by a dentist or
doctor confirmed by biopsy of
the lesion, Prof Porter said many
patients presented with late and
therefore extensive oral disease,
so overall five-year survival rates
could be as little as 50 per cent.

‘The difficulty is
that many who are
in a risk group are
also economically
deprived and do
not readily access health care,
perhaps especially
dentistry.’

He added: “In addition,
patients have a one in five chance
of developing new tumours in
the mouth or upper airways,
hence lifelong clinical review is
important.”

He added: “Other less common factors which may predispose to mouth cancer include
immunologically-mediated disease such as oral lichen planus
and rare genetic disorders, for
example, Fanconi’s anaemia. A
small number of people do however develop mouth cancer without having any of the aforementioned risk factors. This suggests
that subtle, perhaps geneticallydriven, factors may influence the
development of this tumour.”
Prof Porter said it is vital to
run any oral cancer screening
programme hand-in-hand with
an education programme on
risk factors. But he warned: “Any
education programme must be
targeted at the groups at greatest
risk of mouth cancer. The difficulty is that many who are in a
risk group are also economically
deprived and do not readily access health care, perhaps especially dentistry.
“Therefore, this group may
well miss out on programmes
centred around health care providers. It would therefore seem
better to screen people in more
public locations such as supermarkets.
“Education is difficult. Already cigarette packets have
warnings about oral cancer risks,
and in Scotland there was a national campaign on mouth cancer. Any educational package
must be simple and target those
at greatest risk. It would seem
sensible and cost effective to ‘piggy back’ education on oral cancer
into programmes allied to smoking, drink and sexual lifestyle.”

Prof Porter sees dielectrophoresis as a potential warning
to at-risk groups to change their
lifestyles, but he said: “Lifestyle
changes do not cause an immediate reduction in the risk of oral
cancer. It may take 10-15 years
for the influence of tobacco upon
the mouth to diminish. So we
would hope that the technique
will detect the changes that precede the actual development of
mouth cancer.”
In some cases it is hoped that
the technique could prevent an
oral lesion from developing further. Prof Porter explained: “If the
lesion is potentially malignant
then it could be removed and the
patient regularly reviewed. But
there is a 30 per cent risk that
it could return. However, early
detection and treatment would
avoid the possibility of cancer
developing. The exact influence
of cessation of tobacco and/or alcohol upon the risk of future disease is unclear, but certainly if
the patient continues with these
activities, the risk of future disease is unlikely to fall.”
A final word of warning:
“Even if the lesion is cancerous and is treated appropriately,
there still remains a one in eight
chance of the patient developing
further potentially malignant or
malignant disease.” DT

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[6] =>

6 News & Opinions
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20/11/09

11:17

United Kingdom Edition November 30-December 6, 2009

Page 1

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T

his group of specialists
has evolved from a select
study club to a respected
group, which is hosting a major European event in London
next year.
BLOS chairman, Rob Slater,
is an orthodontic specialist as
well as a member of the organising committee for the European
Society for Lingual Orthodontics
meeting in July 2010. He regards
lingual orthodontics as one of
the most important dental developments of the century.
He said: “We had Edgewise
at the start of the 20th century,
Begg in the 1920s, Straightwire
in the 1970s, aligner systems in
the 1990s and now lingual today.”
He added that more and
more general dental practitioners are recommending orthodontic treatment to patients
who needed gaps closed or
opened, prior to a course of restorative treatment.

on the market had overcome
previous mechanical challenges.
“Overjet reduction is easier
with lingual and overbite reduction can also be more effectively
achieved.”

Rob Slater The British Lingual Orthodontic Society (BLOS) is spearheading the
rising demand for lingual orthodontics
in the UK.

He added: “Dentists have refrained from suggesting orthodontics in the past because they
knew their patients wouldn’t
tolerate looking like a teenager.
But when the appliances can be
fitted behind the teeth, it’s a different story. BLOS members are
already seeing more referrals
from dentist colleagues.”
He said the newest systems

BLOS members have made
links with orthodontists in Europe and further afield, which
has led to joint meetings with the
Italian counterpart to BLOS - Associazione Italiana Ortodonzia
Linguale.
Mr Slater hopes that the transformation of BLOS from niche to
national will be complete in 2010
and that lingual orthodontics
will become established as part
of the armamentarium of every
ambitious orthodontic specialist.
For more information about
BLOS, log onto: www.blos.co.uk
or to find out more about the European meeting, go to www.eslocongress.com DT

Compliance with decontamination rules

D

entists
in
Scotland
must comply with new
Scottish
Government
guidance on dental decontamination and ensure their validation is up to scratch, warns the
UK-wide MDDUS.
All primary dental care practices received updated guidance
from the chief dental officer
for
Scotland
this
month.
These included information about
the timescales for compliance
with decontamination requirements, as well as other actions
which need to be taken by
December 2009.
Aubrey Craig, head of the
dental division of the MDDUS,
said: “It is welcome news that the
other home countries are devel-

oping processes for decontamination in dental surgeries. Scotland has been the lead on this for
a number of years.
“It was reassuring to see that
Dr Margie Taylor, upon taking
up her post as chief dental officer
for Scotland, wished to gather
information prior to formulating
the guidance.”
But he continued with a word
of warning: “However, there
is no way out for practitioners.
They will have to comply with
the guidance and ensure that
their Health Board is fully aware
of their plans.”
The situation in England is
different in that all dental practices will have to meet essential

requirements of the Department
of Health’s guidance on dental decontamination by April
2010 – twelve months after the
publication of the HTM 01-05
guidelines. To assist practice
owners, model protocols and
audit tools have been included
with the implementation of
HTM 01-05.
It is anticipated that the
guidelines will be adopted in
Wales as well as Northern Ireland, but amendments will be
applied in the province.
MDDUS advises that HTM
01-05 does not apply in Scotland
as dentists there are in receipt of
guidance documents from various organisations that provide
advice on such matters. DT

Age equality consultation launched

T

The consultation asks for
comments on the recommendations of a review into the implications for health and social care
of new age requirements in the
Equality Bill.

Sir Ian Carruthers and Jan
Ormondroyd were asked by the
Government to lead a review of
equality in the NHS and social
care. They found that:

cial care should have wholesale
exemption from the legislation;
• where possible, age as a criteria for assessing care provision,
should be replaced by more pertinent and individualised evidence;
• local authorities review their assessment procedures; and
• all professional regulatory organisations review and, if necessary, revise their standards, codes
of conduct and education programmes.

The Bill will ban age discrimination against adults in public
services. This has particular implications for health and social
care because age can be a factor

• health and social care services
should implement the new requirements in the same time as
other sectors - 2012;
• no areas within health and so-

The consultation will close
on 15th February 2010. Responses can be made at:http://www.
dh.gov.uk/en/Consultations/
Liveconsultations/DH_108887 DT

o prepare health and social care services for new
anti-age
discrimination
laws, the Government is calling
for peoples’ views on the likely
implications.

The Dental Company

in decisions about some treatments and services. The Health
Secretary, Andy Burnham has
already signalled his support for
implementing the new laws in
2012 when other sectors will do
the same.

[7] =>

United Kingdom Edition November 30-December 6, 2009

News & Opinions

7

[8] =>

8 News & Opinions

United Kingdom Edition November 30-December 6, 2009

Regular Brushing Could Keep Thinking Sharp Dental
Pessimism

causing inflammation in the
body, which they claim can be
a risk factor in the loss of good
mental functioning.

Researchers from Columbia
College of Physicians and Surgeons in New York claim that
gum disease can influence the
functioning of the brain through

The study, which was based
on adults aged 60 and above,
found that those with serious
gum disease were three times
more likely to have trouble recalling a three-word sequence

aintaining good oral
health could help keep
thinking skills intact in
the ageing population, according
to an American study.

after a specified period of time.

The research project also
found that adults with the highest levels of the pathogen which
causes gum disease, were two
times more likely to fail threedigit reverse subtraction tests.
They were also nearly three
times more likely to struggle
with verbal memory tests and

twice as likely to fail on verbal
recall and subtraction tests.

The study, which was reported in the Journal of Neurology,
Neurosurgery, and Psychiatry,
was based on more than 2,350
men and women who were tested for periodontitis and completed numerous thinking skills tests
as part of a national survey. DT

New Zealand study has
revealed that people with
a negative view of the
world could be more likely to
suffer from poor oral health, including decayed or missing teeth.
The findings came after
the anxiety levels of 1,037 people were compared with their
dental records.
Experts at the University of
Otago, discovered that a quarter
of participants could be classed
as having anxious personalities, which included a fear of
the dentist.

‘These people tended to be the glasshalf-empty personality type’
Some were so scared that
they would avoid the dentist altogether until the problem became so serious that treatment
could no longer be avoided.
As a result, people who developed “dental anxiety” tended
to have more tooth decay than
those who were not concerned
or worried about treatment.
Statistics showed that, compared to the average population,
people who were very nervous
about visiting a dentist, had double the average number of rotten
or missing teeth and fillings by
the time they were 32.
Professor Murray Thomson,
who led the study, said: “These
people tended to be the glasshalf-empty personality type people who, as a rule, would be
anxious about other things, such
as heights.
“Some in this group were
also anxious due to bad dental
experiences in the past. Usually,
these people become more and
more anxious through a vicious
cycle of avoiding the dentist, to
the point where their dental
condition becomes much worse.
“They then require more unpleasant treatment options such
as lancing an abscess, root canal
treatment or a tooth extraction.
This reinforces their dental anxiety and makes it even less likely
that they will attend the dentist
next time they have a problem.”
He said the study, published
in the journal of, Community
Dentistry and Oral Epidemiology, showed that if people avoided dental care, then in the long
run they would be worse off, not
only dentally but also in terms of
their appearance, social interactions and quality of life. DT

[9] =>

United Kingdom Edition November 30-December 6, 2009

Home from home
In part two of this three-part series, Dr Solanki
asks you to consider your practice image and
what message it’s giving to your patients

any factors contribute
to a successful marketing plan, but if we were
to start at the very beginning
there are a few things that firstly
need to be addressed in order to
establish that you are you ready
to start marketing and pushing
your services. Remember that
you only have one chance to
make a good impression.
How do you feel when you
walk into your practice? Have
you taken the time to sit in your
waiting room and just look
around? Possibly one of the most
important things to consider is
not only getting new patients,
but also keeping them.
You won’t be judged on your
dental expertise, patients do not
know about this; instead they
judge you on the presentation
of your practice. A significant
sum of money will need to be
spent so that your practice décor
matches up to your aspirations.
It is also worth noting that due to
the Department of Health’s HTM
01-05 Decontamination guidelines, infection control must also
be considered. Compliance will
soon be mandatory and a disorganised, cramped and cluttered
surgery with cracked worktops,
etc means even the strictest hygiene measures can easily be
compromised and this will need
to be addressed.
The extra mile
Either mandatory or self motivated, going the extra mile and
putting on the fine touches will
have patients feeling like a trip
to your practice is like a visit to
the health spa. Is the carpet new
or old and grim? Is the seating
comfortable and what year do
the magazines date back to? Can
patients get a cup of tea or a cold
drink, and what about their other half? Do they have to sit in the
car? The list goes on.
Your practice environment
is what will have the most impact in the eyes of your patients
and this does not only include
the aesthetic appearance, this
also includes how your patients
are treated by your staff. Training your staff and spending time
with all of the team will help you
to ensure that they are working
toward the same goal as you.
Without one vision and one common goal that you and your team
share, it is likely that it will fail.
How do your team currently
answer the telephone? Do they
listen attentively to all patient
enquiries? Do they know enough

about the treatments on offer to
answer a patients’ question?

practice the kind of place that potential patients wish to visit, it is
then the perfect time to investigate
EMSOnce
DIN you
A4 have
29.10.2009
11:15
Uhr
Seite 1 strategy and explore
a marketing
invested your
your future possibilities by encourtime and money in making your

Practice Management

aging growth for your
practice and a steady
flow of business for you
and your team.
In the next part of
this series, we will look
at what kind of marketing options you have
available, highlight the
pros and cons of marketing and how to ensure
that your budget is used
as an investment back
into your practice. DT

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

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[10] =>

Lab Tribune
Clinical

Clinical

All-ceramic restorations

Clinical

CAD/CAM technology

Dr Stephen Ball presents a clinical case

pages 11-13

A perspective by Hans Geiselhöringer
and Stefan Holst

The challenge of aesthetics
pages 14-17

Markus Jedlinski discusses the
HeraCeram Matrix system

pages 18-20

State-of-the-Art Dental Machining
Demonstrated by Sescoi and Partners

S

escoi, DentalWings, Agie
Charmilles and Seco recently came together to
run a free seminar demonstrating the latest advances in dental
machining. More than a hundred participants, including delegates from many of France’s
dental companies and prosthetic manufacturers attended the
seminar hosted by the ENSAM
School (Ecole Nationale Superieure d’Arts et Métiers) based in
Cluny, France.

of prosthetics manufacturing,
starting with scanning and manipulating a model in DentalWings software, and automatic
programming of the high speed
toolpath in WorkNC Dental au-

Sescoi works regularly with
ENSAM’s major R&D Centre,
and the latter’s support for the
seminar is a significant endorsement of the state-of-the-art technology presented. Delegates
were able to follow every stage

tomatic CAM system followed up
5-axis machining of the prosthetic frameworks on a Mikron HSM
400U using Seco tooling.

chining of a dental framework
in difficult to machine materials such as cobalt, titanium or
zirconia can be completed in a
few minutes, making it possible
to produce between 150 and 260

‘By using the techniques proposed in the
seminar, the machining of a dental framework in difficult to machine materials such
as cobalt, titanium or zirconia’

By using the techniques proposed in the seminar, the ma-

parts per day while maintaining
full traceability.
WorkNC Dental has been designed for ease of use. Tailored to
the needs of dental professionals,
the software enables the scanned

Lab link with new system

A

HI-TECH link between
an expanding dental supplier and dental practices
across the UK and Ireland has
been created by Sheffield IT specialist Richlyn Systems.
Richlyn was called in by
Crown & Bridge to help it meet
the needs of a growing number
of private and NHS practices by
providing a new website and
web-based order processing, accounting and logistics systems.
“An increasing number of UK
dental practices are realising the
benefits of our products in terms
of both quality and cost,” said
Crown & Bridge managing director Marcus Rickard.
“An effective website is critical to our growth and Richlyn
have provided a superb bespoke

solution – there is nothing else
like it on the market.”
Marcus added: “We have received great feedback from dentists, practice managers and the
financial directors of our corporate group members, who have
found that our system enables to
keep better control of their laboratory bills.”
“In addition to running our
own administration, the website
allows our dentist clients’ to view
prices and products, track orders, product passports and print
statements.”
In the future, the site
(www.crownandbridge.co.uk)
will also allow the company’s
clients to order direct online,
sending scanned dental impressions rather than the traditional

moulds. The Crown & Bridge
package marks a further expansion into the UK dental sector for
Richlyn.
The company has also developed a tailor-made website
solution which is being used
by practices in Sheffield, Leeds,
Manchester, Nottingham, Wakefield and Mansfield.
“More dentists are seeking to
market their practices effectively
as they enter the private sector
and they realise that a stylish,
informative website is essential,”
commented Richlyn director
Rick Cusimano.
“Where required, we can also
provide bespoke software solutions, tailored to a client’s individual needs – as was the case
with Crown & Bridge.” LT

information to be imported, orientated and nested ready for
manufacture. Machining wizards guide the user through the
programming, making it simple
to produce collision free 5-axis
toolpaths optimised for the special materials used in dentistry.
The reliability of the software
gives complete confidence in the
results, while the wizards enable
technicians not familiar with
CNC machining to produce dental part easily and right first time.
Sescoi developed WorkNC
Dental in close collaboration
with dental technicians, adapting
its ‘One Button’ CAM software to
suit the needs of dental laboratories. Intelligent technology within the system selects tools and

cutting strategies that have been
specially adapted to high speed
5-axis machining, while considering the kinematics and limits
of the machine tool to automatically produce highly accurate
implants with an extremely fine
surface finish. Further information and machining videos can
be viewed on the Sescoi site.
Sescoi is also the software
partner in the ambitious ‘Prodentic’ dental prosthesis ‘open
manufacturing’ project. This
30-month, French governmentfunded project is lead by the
French UNPPD (Union Nationale Patronale des Prothesistes
Dentaires) and AFNET, an association that promotes common
standards in data exchange. LT

New GDC Council confirmed

T

he Appointments Commission has confirmed
the names of the members it has appointed to the restructured Council of the General Dental Council (GDC), which
took office in October.
The GDC works to protect
patients and promote confidence
in dental professionals by:
• registering qualified professionals
• setting high standards of dental
practice and behaviour
• quality-assuring dental education
• making sure dentists and DCPs
keep up to date
• helping patients make a complaint about a dentist or dental
care professional.
GDC chief executive and registrar Duncan Rudkin said: “The

General Dental Council is moving into a new era and I look forward to the challenges ahead as
we continue to strive for excellence in patient protection and
healthcare regulation.
I would like to thank all the
current Council members for
their hard work and dedication.
With their help we have come
through an exciting period of
change with the statutory registration of all dental nurses and
dental technologists. We couldn’t
have done it without them. I look
forward to working with the newly appointed Council.”
In making the structural
changes, the Council was keen
to ensure the GDC of the future
could continue to command
the confidence of the profession
whilst fulfilling its public protection role. LT

[11] =>

United Kingdom Edition November 30-December 6, 2009

Lab Tribune 11

All-ceramic restorations
Dr Stephen Ball presents a clinical case showing the replacement of aesthetically
failing bonded porcelain crown and bridgework with all-ceramic restorations

BSTRACT
As we face increasing demands from our patients
for highly conservative restorations that are true reproductions
of natural tooth structure, traditional porcelain bonded to metal
systems have competition from
newer all-ceramic materials.
These materials combine natural
aesthetics with adequate compressive and flexural strengths
to allow their use in bridgework
and also in posterior areas of the
mouth. This article will showcase
a clinical application of the Ivoclar Vivadent IPS e.max system to
replace aesthetically failing anterior bonded porcelain crown and
bridgework.
During the initial cosmetic
consultation appointment, this

48-year-old male patient’s chief
complaint was the poor appearance of his existing anterior
crown and bridgework. (Figures
1, 2, 3 and 4.)
Although the restorations
were approximately 12 years
old and clinically satisfactory in
terms of marginal fit and periapical health, they were aesthetically
poor due to:
■ Unnatural opaque shade
■ Lack of interdental papilla
between central incisors – “Black
triangle”
■ Poor adaptation to ideal smile
line.

leading to inadequate clearance
for a satisfactory porcelain thickness. After a long discussion with
the patient, he was adamant that
he did not want any metal in the
new restorations and he was also
keen to avoid any further tooth
reduction.
Appropriate informed consent
was obtained and the decision
was made to replace the anterior
restorations with an all-ceramic alternative – in this case IPS
e.max. The UR1 is a single unit
crown and UL1 is a retainer for
a cantilevered pontic replacing
UL2.

oughly and taking a pre-operative
impression of the upper arch, the
old restorations were cut off and
the preparations refined to proper
requirements for this type of restoration, namely:
■ 1.5mm to 2mm incisal reduction
■ 1.0mm to 1.5mm labial reduction
■ 1.5mm occlusal clearance in
intercuspal position (ICP) and
lateral excursions
■ 1.0mm reduction at gingival
margin
■ Shoulder margin
■ Rounded internal line angles.
(Figure 5.)

Introduction
The probable reason for the
opaque appearance was underpreparation of the tooth structure

Preparing for treatment
After numbing the patient thor-

Fortunately following removal of the old restorations, there
was a well-proportioned ovate

10.

11.

pontic site at the UL2 region already. The red appearance here
was not due to the presence of
inflammation but rather that of
hypokeratinised tissue.
Final preparations were completed, tissue retracted, and final
master impressions made with
an addition cured silicone impression material (Take1 – Kerr).
Care was taken to provide the
laboratory with an accurate impression with detailed crisp marginal definition. A silicone bite
registration was made over the
preparations only at ICP.
To assist with accurate shade
determination, photos were taken
with two shade tabs thought to
be closest to the correct shade in
the frame and these were sent to

1. Pre-operative smile
2. 1:1 Right pre-operative view
3. 1:1 Anterior pre-operative view
4. 1:1 Left pre-operative view
5. View of refined tooth preparations
6. Shade tab photograph to aid shade determination
7. Post-operative smile
8. 1:1 Right post-operative view
9. 1:1 Anterior post-operative view
10. 1:1 Left pre-operative view
11. Post-operative radiograph

[12] =>

12 Lab Tribune
the laboratory along with the impressions. The shade in this case,
despite having been improved
by home whitening, was rather
challenging as the patient had
suffered from tetracycline staining. (Figure 6.)

United Kingdom Edition November 30-December 6, 2009

were then cemented with a noneugenol containing temporary
cement. Homecare instructions
were given and the patient was
seen two weeks later for the fitting appointment.

fit, shade and occlusion. The patient was then asked to look at the
restorations in-situ and approve
them before cementation. Following approval from the patient,
the restorations were cleaned internally with alcohol soaked cotton wool pledgets, dried with oilfree compressed air and silanated
(MonobondS – Ivoclar Vivadent)
as per manufacturers instructions.

Approval before cementation
Following removal of the temCustom-fit temporary restoraporary restorations, the preparations were fabricated from a dual
tions were cleaned with a slurry
cured bis-acryl composite tempoof pumice and water with a prorary crown and bridge material
Following isolation of the
phy brush in a slow speed hand(Quicktemp2 – Schottlander) usteeth using rubber dam, the preppiece. The restorations were then
ing the upper preoperative imOPT_DentalTribune_210x297_NOV_PressAd:Layout 1 24/9/09 20:33 Page 1
arations were dried with oil-free
tried in and assessed for marginal
pression as a template and these

compressed air and the restorations were cemented using a selfetching, dual-cured resin cement
(Multilink – Ivoclar Vivadent).
Great care was taken to remove
all excess cement following polymerisation. Postoperative photographs were taken three days
later at a review appointment.
(Figures 7, 8, 9 and 10)
The emergence profile and
gingival condition associated
with the new restorations is
highly satisfactory. The incisal

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edges also follow the curve of
the patient’s lower lip in a much
more aesthetically pleasing way.
Unfortunately, it was not possible
to completely eradicate the black
triangle effect between the central
incisors. If we examine the periapical radiograph taken following cementation, we can see that
due to loss of alveolar crest height
caused by previous periodontal
disease, the distance from the
bone level to the contact point is
approximately 6.5mm. The maximum distance between the alveolar crest level and contact point
between adjacent natural teeth
to guarantee 100 per cent papilla
infill is 5.0mm (Tarnow 1992).
(Figure 11.)
Fortunately in this case the
patient has a low lip line, which
means that this problem is relatively unnoticeable on a full smile
and the patient was extremely
pleased with the appearance and
function of his new restorations.
Topics for discussion
Significant developments in allceramic materials have created
great opportunities for the fabrication of lifelike restorations
that provide reliable, long-term
results. In 2005 Ivoclar Vivadent
introduced IPS e.max lithium
disilicate glass ceramic, a material that provides optimal aesthetics, yet has the strength to
enable conventional or adhesive
cementation. IPS e.max lithium
disilicate has a needle-like crystal structure that offers excellent
strength and durability as well
as outstanding optical properties. IPS e.max lithium disilicate
can be traditionally pressed or
contemporarily processed via
CAD/CAM technology. Due to its
strength and versatility, the material can be utilised for the following applications:
■ Anterior/posterior crowns
■ Inlays/onlays
■ Veneers
■ Thin veneers
■ Telescopic crowns
■ Implant restorations
■ Anterior three-unit bridgework
up to the second premolar (press
only)
Glass ceramics are categorised according to their chemical composition and/or application. The IPS e.max lithium
disilicate is composed of quartz,
lithium dioxide, phosphor oxide,
alumina, potassium oxide, and
other components. These powders are combined to produce a
glass melt. Once the proper viscosity is achieved, similar to that
of honey, the glass melt is poured
into a separable steel mould of
the proper shape. The material is
then left to cool in the mould until
it reaches a temperature that no
deformations occur.
This process produces minimal pores or other internal defects due to the glass flow process
and provides for easy quality con-

[13] =>

United Kingdom Edition November 30-December 6, 2009

Table1
Flexural strength (biaxial) [MPa]

400

Fracture toughness [MPa m0.5]

2.75

Modulus of elasticity [GPa]

Vickers hardness [MPa]

5800

Chemical solubility [µg/cm2]

Press temperature [°C]

915-920

Table1: Basic physical properties of IPS e.max Press
trol due to the translucent nature
of the glass. The blocks or ingots
are produced in one batch depending on the shade and size of
the materials. Overall, this composition yields a highly thermal
shock-resistant glass ceramic
due to the low thermal expansion
that results when it is manufactured. The glass ingots or blocks
are then processed using the lostwax hot pressing techniques (IPS
e.max Press) or CAD/CAM milling procedures (IPS e.max CAD).
The
restorations
shown
here were fabricated using the
press technique with IPS e.max
Press ingots.
The pressable lithium disilicate is produced according to
a bulk casting production method, which involves a continuous
manufacturing process based on
glass technology (melting, cooling, simultaneous nucleation of
two different crystals, and growth
of crystals) that is constantly optimized in order to prevent the
formation of defects. The microstructure of the pressable lithium
disilicate material consists of
approximately 70 per cent volume of needle-like lithium disilicate crystals that are crystallised
in a glassy matrix. These crystals
measure approximately three µm
to six µm in length.
The basic physical properties
for IPS e.max Press are displayed
in Table 1.
This means that a restoration
fabricated to full contour using
the pressing technique delivers
400MPa of strength throughout
creating a monolithic structure.
Overall, these materials dem-

About the author

Mr Stephen D Ball BDS is a general
dental practitioner with a special interest in cosmetic dentistry and aesthetic
restorative dentistry. To contact him,
call 01709 364404, visit www.pdental.
co.uk or email pdfaltd@gmail.com.

onstrate specific advantages including higher edge strength vs.
traditional glass ceramic materials (i.e., can be finished thinner
without chipping). Additionally,
the low viscosity of heated ingots
enables pressing to very thin dimension (i.e., enabling minimal
prep or no-prep veneers) and
creation of the chameleon effect‚
due to their higher translucency.
Conclusion
There are several clinical advantages to the use of all ceramic

Lab Tribune 13

systems compared with porcelain
bonded to metal alternatives.

allow their use in patients with
metal allergies.

These are:
■ Less tooth reduction required
and thus lower level of
pulpal insult during tooth
preparation,
■ Improved aesthetics due to the
lack of opaque porcelain needed
to mask out metal substructures,
■ Chemical bonding capabilities
between porcelain and enamel/
dentine substrates,
■ Improved biocompatibility to

From a clinical standpoint,
the restorations demonstrate excellent aesthetics, are easy to cement using standard procedures
and materials, and are durable
enough to provide an excellent
and conservative alternative to
metal-ceramic restorations.
Thanks to Mr Andrew Taylor of
Pacor Dental Ceramics for his excellent technical work in this case. LT

[14] =>

14 Lab Tribune

United Kingdom Edition November 30-December 6, 2009

Advantages of CAD/CAM technology –
a laboratory and a clinical perspective
By Hans Geiselhöringer and Stefan Holst

years and will continue to exbstract
pand in the years to come. While
CAD/CAM
technology
initially15:21:59
CAD/CAM technology
has
had a considerable
msc_ad_source_uk.pdf
1
03/08/2009
was commonly associated with
impact in dentistry in the past

zirconia-based
restorations,
modern systems offer an extensive range of materials and solutions for both natural teeth and

implants. The benefit is not only
limited to a more cost-efficient
manufacture of dental restorations in the laboratory, but the

benefit for both the patient and
the practitioner from the technology. A selection of eminent
advantages from a laboratory
and clinical perspective is provided below.
The laboratory perspective
CAD/CAM
(Computer-Aided
Design/Computer-Aided Manufacturing) technology has revolutionised dental laboratory
techniques and protocols significantly. Advantages related
to material and manufacturing
processes will promote the continuous adoption of CAD/CAM
systems over conventional casting techniques as the technology
offers several benefits compared
to conventional framework fabrication. This is not an unfavourable development, but provides true benefits for the dental
laboratory, the practitioner and
above all, the patient. The benefits of the technology and the
new NobelProcera system from
a laboratory perspective are obvious. Cost-efficient and time
saving workflows with only one
CAD/CAM system in the dental
laboratory, high-quality products with unrivalled precision
and free-virtual design options,
and centralised production. And
there are many benefits to the
laboratory.
Cost-efficient workflows
In the competitive market of
dentistry, cost efficiency is a very
important aspect of a CAD/CAM
system. There are several aspects
that should be considered. One is
the versatility a system offers. As
implant dentistry is currently offered in most dental practices, a
CAD/CAM system must allow a
broader application than simply
the fabrication of conventional
crowns and bridges. Customised
implant abutments, multi-unit
screw-retained implant superstructures and a broad variety of
removable solutions on implants
is a mandatory requirement.
Basis for all CAD/CAM manufactured restorations however is
the most precise scan technology
and a easy to use and intuitive
software to design the restorations.
Product design and material
selection
A wide range of materials can be
selected and manufactured with
CAD/CAM technology today.
While zirconia-based restorations have often exclusively been
associated with CAD/CAM technology, advanced systems such
as the NobelProcera system offer
a broad range of materials rang-

[15] =>

United Kingdom Edition November 30-December 6, 2009

Lab Tribune 15

Kav Eagle strip 1 89x266mm:Layout 1

8/10/08

13:40

KaVo – ESTETICA E80

Fig.1: The new NobelProcera system scanner. The application of the conoscopic holography principle ensures high-precision data
acquisition of different materials (such as gypsum, impression materials, etc.) without prior surface coating and due to the colinarity of the laser-beam deep concavities (e.g. impression scanning) digitised.

ing from aluminum and zirconia
based oxide ceramics, titanium,
acrylics and non-precious alloys
(Figs.1-3).
Important aspects to consider
include long-term stability in
the oral cavity, biocompatibility, and post-processing options
(for example, the type of veneering material). A true and unique
benefit of the system is the anatomic tooth library, which does
not only eliminate the need for a
wax up in partial edentulous situations, but allows for automatic
and homogenous framework reduction to allow for a uniform
layer of veneering material.
This mere “click-on-a-button”
results in a reduction of clinical complications such as chipping of the veneering material in
zirconia-based restorations, and
the potential for fracture due to
continuous control of adequate
framework dimension (Fig.4).
Centralised production
Another aspect of cost effectiveness and safety is the feasibility
of centralised manufacturing of
products. Centralised milling
clearly outclasses in-house systems: all workflows are permanently monitored, industrialised
fabrication guarantees consistent
quality, materials can be ordered
as needed for any particular situation which eliminates the need
for stock components, and time
and money consuming adjustments, updates, or repairs do not
accumulate (Fig.5). From a costsavings perspectives the fact that
all metal frameworks are delivered highly polished and “readyto-use” adds to the true benefits
of centralised manufacturing
(Fig.6). The additional five-year
warranty on all products cannot
be met by conventional fabrication techniques. The warranty
ensures that if complications
occur during clinical function,
a new product can be ordered
free of charge. Here again the
uniqueness of virtual planning
comes into play, as all data is always available even after years
and merely require a click on a
button to reorder.
The clinical perspective
From a clinical perspective CAD/

Fig.2a:

Fig.2b:

ESTETICA E80
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• More comfortable
positioning for patient
• Integrated technology
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harmonised system
• Includes free
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Fig.2: Coloured zirconia frameworks for both conventional frameworks (a:
NobelProcera Bridge Shaded Zirconia) and screw-retained implant restorations (b:
NobelProcera Implant Bridge Shaded Zirconia) allow for maximum esthetics and
strength of a restoration. The benefit of industrial shading is a homogenous pigments
distribution resulting in reliable strength values and colour.

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Fig.3: Patients’ demands and clinical situations require the availability of different
material options on different implant systems. Whether a titanium framework (here:
NobelProcera Implant Bridge titanium on AstraTech implants) is used as a temporary or definitive solution, depend on the preferences of the clinician and the request
by the patient. As all products are delivered highly polished and ready for veneering,
time consuming adjustments are eliminated.

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[16] =>

16 Lab Tribune
Fig.4a:

United Kingdom Edition November 30-December 6, 2009

Fig.4b:

Fig.4: Intuitive and user-friendly software (NobelProcera system software) supports the user in fast and efficient framework design.
Providing custom design components for the specific clinical situation does not only support the veneering material or surrounding
soft tissue but ensures clinical long-term success through adequate design and material thickness.

CAM technology offers significant advantages compared to
conventional
manufacturing
techniques. Fabricating high
quality prosthetic restorations
was always associated with time consuming laboratory processes
requiring meticulous care and
experience in the dental laboratory. The application of CAD/
CAM technology offers, amongst
others, three significant benefits.
The availability of biocompatible
materials such as oxide ceramics, homogenous materials and a

W
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standardised precision as well as
reasonably low costs paired with
clinical versatility. There are several clinical benefits.
Oxide ceramics
Oxide ceramics where introduced to the dental market in
conjunction with advancements
in CAD/CAM technology, since
they cannot be manufactured by
conventional means. While initially the esthetic potential was
in the focus of applying highstrength all ceramic restorations,
the true benefit of eg Y-TZP/ZrO2
(yttria stabilised polycrystalline
tetragonal zirconia) is its excellent biocompatiblity paired with
flexural strength values that allow for application in any area
of the oral cavity for both natural teeth and dental implants.
When in close contact with the
surrounding tissues, the reduced
plaque and bacterial accumulation as well as the development
of currently undefined pseudoattachments leads to long-term
tissue stability around these
components (Fig.7).
Homogenous materials and
standardised precision
Casting a multi-unit framework
requires a dental technician
with considerable knowledge
and skills, and is often associated with time consuming adjustments that the dentist and
technician must perform in order to achieve an adequate fit.
There are several steps that are
prone to potential error. In many
clinical situations, cast bars or
frameworks must be sectioned
and splinted intraorally during a
try-in examination, followed by
soldering the sections together
in the laboratory to improve
the fit.
Soldering and resoldering
can result in weakened inhomogeneous material quality at the
solder joints. With the application of CAD/CAM technology
restorations are not only milled

About the author

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Hans Geiselhöringer, first trained to
become a dental
technician in Germany. In 1991 and
1992, he embarked
on further training
in New York, USA
focusing mainly on
anaplastology/epithetics, followed by
further education to
become a technical
business administrator, completing his
studies in 1994. After this, he took up
the position of business manager and
laboratory manager, concentrating
on implantology and ceramics until
1998. Since 1998, he has worked on an
independent basis with the company
he founded in Munich - a laboratory
specialising in CAD/CAM technology,
implantology, anaplastology as well
as functional and aesthetic reconstructions. His expertise is reckoned
by multinational enterprises who he
advises as a consultant. Besides being
a member of multiple professional organisations he is a distinguished and
highly respected lecturer throughout the world, and since 2008, Hans
Geiselhöringer is Global Head of the
new NobelProcera and Guided Surgery
business unit at Nobel Biocare, Zurich.

[17] =>

Lab Tribune 17

United Kingdom Edition November 30-December 6, 2009

Fig.7a:

Fig.5: Only established and industrial
manufacturing processes can ensure a
consistent product quality and precision
of fit (here: NobelProcera framework
milling unit).

from homogenous block material such as titanium, non-precious alloys (eg CoCr) or ZrO2,
but the high precision of industrial milling machines reduces
the risk for subsequent clinical adjustments and recurring
complications such as abutment
screw loosening or fracture of
components upon long-term
clinical loading.
Versatility and low cost
One of the greatest advantages
of CAD/CAM technology is its
clinical versatility, not only the
clinical situation, but also patients’ expectations and means
can be met. Whether a low-cost
non-precious alloy substructure
is veneered with resin or ceramic material or a high-end allceramic solution is requested,
whether a conventional denture
set-up is retained by an overdenture bar or an implant retained
removable restoration is finished with custom all ceramic
teeth and individualised gingiva-colored composite, the base
components such as copings,
frameworks and bars always
guarantee maximum precision,
material homogeneity and stability for all patients. LT

Fig.6: Zirconiumdioxide is ideally suited
for restorations in close contact with the
surrounding tissues (NobelProcera Abutment Shaded Zirconia).

Fig.7b:

Fig.7: Removable implant-retained overdentures have been quite cost-intensive in the past, as manufacturing required time, skills
and large quantities of materials such as gold-alloys and castable burn-out copings. The new CAD/CAM software system allows for
complete virtual design of any type of bar structured needed following a mere scan of the master model/impression and a wax-up
(a,b). Industrial manufacture will provide highly polished frameworks with excellent precision of fit and a broad range of additional attachments to be selected (c,d) – here NobelProcera Overdenture bar with Locator attachments on XiVe, Friadent, implants.

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20th June 2010
- Venue: Mayfair Clinic
(www.swiss-smile.com)

Advanced 2-day Theory
7th & 8th January 2011

About the author
Dr Stefan Holst
studied dentistry
at the Medical
University
of
Hanover and obtained his doctorate in 2000,
and until 2001
he attended a
postgraduate
program in the
Department of
Prosthodontics
at
Louisiana
State University,
USA. He was
appointed assistant professor at
the Dental Clinic 2 – Prosthodontics,
Friedrich-Alexander-University
Erlangen-Nuremberg, Germany in 2001.
In 2006, he completed his habilitation
thesis and obtained his Dr med. dent.
habil. (PhD equiv) degree from the
University of Erlangen-Nuremberg.
His field of specialisation encompasses
esthetic dentistry with an emphasis on
implantology, perio-prosthetics and
complex interdisciplinary treatments.
His research work focuses primarily
on digital dentistry, all ceramic restorations and material sciences and
biomechanics. Dr Holst is appointed
clinical associate professor and senior
lecturer and heads the research laboratory for digital dentistry at the Dental Clinic, University Erlangen. He has
authored several papers on implant
prosthodontics, esthetics and various
prosthodontic subjects. Since 2009 he
is Associate Editor of the Quintessence
International journal.

- Venue: British Dental Association
(www.bda.org)

Hands-on Clinical Component

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9th January 2011
- Venue: Mayfair Clinic

PH: +61 2 8338 9420
or: jane@personal-equilibrium.co.uk FAX: +61 2 8338 9418

info@confidentsmiles.org

(www.swiss-smile.com)

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[18] =>

18 Lab Tribune

United Kingdom Edition November 30-December 6, 2009

The challenge of aesthetics
Markus Jedlinski explains how the HeraCeram Matrix system from Heraeus can
help to create perfect aesthetic restorations

I

t’s a constant challenge for
dental technicians to fabricate natural, aesthetic restorations.
The ability to carry out aesthetics dos not require a crea-

Figure 1_ Initial situation

tive spirit, but the ability to
copy to produce the perfect
imitation. Success, however,
also depends on which materials can most perfectly imitate the
optical properties of the natural
tooth structure. The HeraCeram

Matrix system from Heraeus
has been used in the following
case history.

Figure 1a_Initial situation

Figure 2_Wax-up

Case study
First assessment of the initial
situation indicated a highly

abraded dentition (Figure 1).
The patient wanted the natural
tooth shape and length restored.
A slight diastema was also to
be closed. The purpose of treatment was to restore the anterior/
canine guidance as well as to

correct premature contact of the
occlusion.
The aim was to fabricate a
perfect restoration taking aesthetic and functional aspects into
consideration. In consultation

Figure 3_Wax-up laterotrusion

Figure 4_Wax-up posterior teeth

Figure 5_Veneer framework

Figure 6_Direct spruing

Figure 7_After devesting

Figure 8_Prepared framework

Figure 9_Check of the space available

Figure 10_Dentine build-up

Figure 11_Dentine build-up after cut back

Figure 12_Preparing the mamelons

[19] =>

United Kingdom Edition November 30-December 6, 2009

with the dentist, it was decided
that the best option was full rehabilitation of the upper dentition, which should be as minimally invasive as possible.
The canine was so heavily
abraded in the initial situation
that the premolars had already
assumed laterotrusion guidance
(Figure 1a). The dentist therefore decided to raise the bite by
two millimetres in order to reconstruct the anterior teeth to
the correct length.
First wax-up
With extensive restorations, as
in this case, it is helpful to fabricate a wax-up first. This is
particularly practical when correcting malocclusions in order
to identify and remedy any faults
at the beginning of treatment.
The wax-up gives an idea of the
planned restoration.
Before pouring the model,
the impression was degreased
using a silicone wetting agent to
ensure a porous-free model. The
dental arch was then trimmed,
pinned, based and provided with
a split cast.

on the anterior/canine guidance and contour of the occlusal
and proximal contacts. Only the
fine details of the form and function of the teeth still had to be
completed – with constant monitoring of the extrusion movements of the mandible (Figure 3
and 4).
The advantage of such a detailed, contoured wax-up is that
virtually any region can be the
starting point for fabricating the
restoration. Try-in of the diag-

nostic wax-up provided information relating to the axis alignment, midline and final tooth
length. A silicone index of the
wax-up was then used to fabricate a veneer framework with an
anatomically scaled down tooth
contour (Figure 5).
The first stage after pressing
was usually to devest the veneer
frameworks using two-bar pressure and 50 mμ glass beads. The
next stage was then to sandblast
the frameworks using approxi-

Lab Tribune 19

mately 0.7-1.0 bar. This removed
any remaining investment from
the frameworks (Figure 7).
The frameworks were also
prepared under a microscope.
High spots on the inside of the
framework and any overextended margins were removed. The
gingival mask fabricated earlier
was used to the check the available space (Figure 9).
The build-up concept
There was a certain amount

of flexibility, as full rehabilitation of the upper was planned.
The patient wanted the shade to
match the lower teeth. The shade
of the lower teeth was between
A3 and A3.5. The natural teeth
also had staining. This allowed
characterisation to be slightly
more pronounced.
There are a number of options and techniques for fabricating all-porcelain restorations.
HeraCeram porcelain from Heraeus was selected in this case.

Improve your surgical technique
and treat more complex cases

The upper model was then
mounted on an articulator according to the cranial relationship and the lower model was articulated using a myocentric bite
registration. A removable gingival mask is recommended to
integrate the gingival situation
into the subsequent working
stages. A silicone index is fabricated on the unsectioned working model and the mask silicone
can then be syringed into the
index after the model has been
sawn and prepared.

Mandibular excursions should be taken into account when
fabricating a diagnostic wax-up.
The anterior teeth were waxed
up to the premolar region using
thin wax veneers of natural anterior teeth, which corresponded
approximately to the correct
shape and size (Figure 02).
Focus on the occlusal and
proximal contacts
The next stage was to wax up
the upper posterior teeth. When
waxing up the posterior teeth
particular focus should be placed

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Preparation under the
microscope
The preparation margins were
carefully exposed and marked
under a microscope. The die
segments were prepared for the
gingival mask. The intention
was to reproduce the anatomical
root shape of the teeth to about
the middle of the proximal area.
This created an adequate thickness for the gingival mask. The
remaining dies were trimmed
on a die trimmer, hardened with
superglue and replaced in the
model base. It is important to
ensure accurate repositioning of
the silicone index.

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[20] =>

20 Lab Tribune
The excellent light optical results
and high stability attained with
HeraCeram are very beneficial
for the patient – not only with respect to the aesthetics but also in
terms of reliability.
Top marks for optimum
aesthetics
High aesthetic standards are attained using the opalescent and
fluorescent porcelains of the
HeraCeram Matrix range (Fig-

United Kingdom Edition November 30-December 6, 2009

ures 10 – 15 + 18). Opal incisal
and opal transparent porcelains are used for final adjustments to the shape of the teeth
(Figure 19).
After the second dentine firing, all the crowns were subjected to spot grinding and the fine
details of the shape were adjusted. The interdental spaces were
contoured to ensure that the interdental brush could be inserted

by applying only light pressure
to the gingiva (Figure 20).
The occlusal contact points
were placed on plateaus (Figure 22) and the proximal contacts contoured spherically in
order not to disrupt mandibular
immediate side shift. This simplifies subsequent oral hygiene
measures.
After glaze firing, the buccal

surfaces were polished
with pumice powder.
This produces a natural
abrasion effect on the
ridges and a satin glaze
finish.
The result: The allporcelain restoration is
impressive and not simply because of its optimal aesthetics (Figure
27 and 28). LT

About the author
Markus Jedlinski is a dental technician. He started his apprenticeship in 1997 in a German dental
laboratory and after graduating, he’s worked at several different labs, including Jan Langner GmbH in
Schwäbisch Gmünd for 1.5 years. Since 2003 he’s
worked as a dental technician at Dental Technik
Günther Knab GmbH in Crailsheim.
Dental Technik
Günther Knab GmbH
Markus Jedlinski
Postplatz 2
74564 Crailsheim
E-Mail: markusjedlinski@t-online.de

Figure 13_Incisal edge with transparent porcelain

Figure 14_Completion of the build-up with various incisal porcelains

Figure 15_After the first dentine firing

Figure 16_Build-up of the canine and premolar

Figure 17_Adding the incisal porcelains

Figure 18_ Restoration after the first dentine firing

Figure 19_Dentine and incisal porcelains

Figure 20_Before glaze firing

Figure 21_Posterior crowns before glaze firing

Figure 22_Occlusal contact points

Figure 27_Transillumantion to illustrate a superb shine though

Figure 28_Transillumantion to illustrate a superb shine though

Fig 24.: Lingual view after glaze firing.
Fig. 25.: Buccal view after glaze firing.
Fig. 27 &. 28: Transillumantion to illustrate a superb shine though.

[21] =>

United Kingdom Edition November 30-December 6, 2009

Lab Tribune 21

Yesterday’s Quality, Today’s Technology
Designer Dental Ltd.

Is your lab working hard to bring you excellent customer care and quality
cosmetic crown and bridgework solutions?

Specialists in crown and bridge work, implants and metal free restorations
(Zirconia, Emax Press, Stick, Gradia)

Does your lab offer you:
Quality
Perfect aesthetics for your patients, including marginal fit, occlusion,
anatomical contouring and shade matching?
Personal Service
A solid relationship with tailor made solutions and options that fully suit the
needs of your practice?
Guarantees
What guarantees will your lab offer you and your patients? Don’t settle for
anything less than a guarantee for at least three years on everything it sells,
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Delivery
Does your lab have a delivery guarantee so you can continue to schedule
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AND 30% off your first order?
Biterite combines the standards and values of the traditional dental laboratory
with the contemporary work ethics of today’s dentist. Why not talk to the team
from Biterite and try the fresh approach to working with a dental Laboratory to
see difference for yourself.
Call 0208 455 5321 or go to www.bite-rite.co.uk

The Ceramic Arts Dental Studio
Introduces the NobelProcera™ Scanner
Synonymous for producing cosmetic restorations of exceptional quality,
The Ceramic Arts Dental Studio is setting new standards in the design and
production of dental prosthetics.

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The Ceramic Arts Dental Studio now offers new levels of expertise and quality
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NobelProcera™ Scanner.

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This new Scanner uses conoscopic holographic optical scanning; this is the first
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All technicians registered with the G.D.C
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For price list and current offers please contact K Casey tel. 029 20340607 email
designer.dental@tesco.net
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The new NobelProcera™ accurately and quickly scans impressions and enables
the Ceramic Arts Dental Studio’s technicians a highly advanced CAD dentistry
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The result is dental professionals have access to The Ceramic Arts Studio’s
highly skilled technicians, quality restorations as well as outstanding solutions
to patient treatment.
The Ceramic Arts Dental Studio prides itself on being a specialist team who
provides traditional good service by utilising the latest technologies.
For more information or for a referral pack, please call The Ceramic Arts Dental
Studio on 0191 427 1096 or visit www.ceramic-art-dental.co.uk
with the contemporary work ethics of today’s dentist. Why not talk to the team
from Biterite and try the fresh approach to working with a dental Laboratory to
see difference for yourself.
Call 0208 455 5321 or go to www.bite-rite.co.uk

Haddon Williams is a Damas accredited dental laboratory specialising in all
forms of crown and bridgework. Two of our team are members of the British
Academy of Cosmetic Dentistry.
We were the first laboratory in the South West of England to purchase a cadcam milling centre and our technicians now have over five years experience of
milling zirconium crown and bridge sub structures.
We have produced in excess of 10,000 units from single units to full mouth
restorals. To compliment our zirconium sub structures our highly skilled
ceramists use Noritake one of the best Japanese porcelains on the market.
At Haddon Williams we are also able to produce a wide range of products from
traditional metal bonded to the latest E-max pressing systems, including an
implant department specialising in all forms of systems with over 15 years
experience. In addition to this we have recently opened an in house prosthetic
facility offering a range of high quality dentures.

MediMatch dental laboratory is a fully equipped dental laboratory based in
West Ealing, London. Our product line ranges from simple NHS products to
complex private full restorations (E.max; Cercon Zirconia; various Implant
brands; Combination work, Flexible denture work; etc).
MediMatch will deliver fantastic products with the best available service for a
very competitive price.
Try our services to benefit from our introductory offer, where purchase of a
second unit is FREE of charge! (terms and conditions apply)
A FREE UK wide collection service is available.
Give our laboratory a try and we surely will NOT disappoint you!
“”
MediMatch Dental Laboratory
Orion Business Park, Unit A
Northfield Avenue
West Ealing
London
W13 9SJ
T: 08444993888
M: 07701073356
www.medimatch.co.uk

Have you claimed your free gift yet?
Stuart R. Hulley dental lab offers your practice the unrivalled ceramic IPS e.max
plus over 20 years experience to deliver more aesthetic restorations for your
patients.
We have teamed up with Ivoclar Vivadent to offer you a free gift, call us today
and request a brochure to receive your free gift voucher!
Our Laboratory is based in Ashton-under-Lyne near Manchester, we serve a
wide range of practices reaching as far afield as Southern Ireland.
Our Success is built on a commitment to excellence and an ongoing
programme of investment in the latest technology.
If your patient wants the truly exceptional aesthetics delivered by the IPS
e.max, and you would like to work with a team that shares your passion for
excellence then call us today to receive our brochure, which includes examples
of our fantastic work and pick up your free gift today.
Contact Stuart R. Hulley 0161 330 6868

[22] =>

22 Company Promotion

United Kingdom Edition

November 30-December 6, 2009

It’s time to think about
the bigger picture
Henry Schein Minerva helps practices look at their business from a different perspective

ow do I generate more
profit? How do I attract
more patients and keep
them? Can Iget my team to work
better together? These are the
questions on the lips of most
dental practitioners these days.
Wouldn’t it be fantastic to
have a better understanding of
how you could make more profit or get your practice team to
perform better? Well, help is at
hand and it might not be from a
source you expected.
Henry Schein Minerva have
some of the most experienced
field sales consultants in the
industry and all have been expertly trained to offer practices
help and advice in all kinds of
ways and on all kinds of topics
including the ‘business of dentistry’.
As a field sales consultant
in Yorkshire, Steve Coustol has
worked for Henry Schein Minerva since 2004, although his
experience in dentistry actually
spans over 20 years. During this
time, Steve has seen a considerable change in the way practices
operate – and the demands they
place on their suppliers – and
has come to realise that a dentist’s main concern is not which
dental products to choose, but
the day-to-day running of their

about your business and then I’ll
try to help you solve your practice business issues, from purchasing to profit, from staffing
issues to patient pricing audits.’

invaluable, giving him a solid
grounding in this increasingly
climate, Steve is finding this
service is an increasingly valuable resource.

‘Once a dentist tries some of our business ideas and is successful
they want to continue. If I can help my customers become more
successful then I can be more successful and they want to work
with me and so it goes on. We all gain experience and knowledge
and that helps us in the future. It’s a real partnership.’

business and how to make it
more efficient, profitable and
therefore successful. Working
with Henry Schein Minerva is
not just about offering dentists
the best prices, it’s about value
for money and adding value to
their practice on a daily basis
and when Steve invites his practices to join him for a Business
Discovery Meeting, all he asks
for is a little of their time.
I say to them: ‘Give me an
hour of your time, we’ll chat

Steve has a rounded professional background and a
wealth of experience perfect to
help practices in all kinds of
ways. He originally trained as a
teacher graduating with a BEd
Hons Degree and has held several teaching roles in the industry. Whilst working in financial
services, Steve held the Chartered Institute of Insurers’ Financial Planning Certificates 1,
2 and 3 and, although no longer
authorised to give financial advice, the knowledge has proved

He helps practitioners understand that practice management is about much more
than product discounts, and he
clearly sets out the options open
to practice principals ‘Hopefully, the Business Discovery
Meeting, subsequent plan and
ideas for change, opens the
minds of my customers so that
they stop concentrating on very
small, individual matters and
understand that they can grow
their business through better
time management, the use of

new technology and a “team”
mentality’.
For Steve, the relationships
he builds with his customers is
vital and, obviously, to get the
most from his experience, it is
necessary for the practitioner to
fully embrace the proposition
and have confidence in him as a
person. Steve’s relaxed and approachable manner allows dentists to easily express their concerns and they fully understand
that he wants to look after their
best interests.
For Steve, his consultancy
work with a large number and
variety of practices is testament to the success of this approach.
‘Once a dentist tries some of
our business ideas and is successful they want to continue.
If I can help my customers become more successful then I
can be more successful and
they want to work with me and
so it goes on. We all gain experience and knowledge and that
helps us in the future. It’s a real
partnership.’

Henry Schein Minerva’s
mission is to do everything
possible to help dentists deliver quality patient care, Steve
and his colleagues are able to
help them do this in a practical
sense, not only by discovering
the individual’s goals and objectives but by also providing
the practical means by which
such plans can be put in place.
So, next time you’re thinking
about how to run your business
more efficiently, think about
the bigger picture and give Steve or your local Henry Schein
Minerva field sales consultant a
call. The chances are they can
help increase your profits and
develop your business, giving
you a return many times more
than the value of the average
practice’s sundries bill.

For more information email:
me@henryschein.co.uk

[23] =>

Me & Henry Schein
“The Business Discovery Meeting, subsequent plan and ideas
for change, open the minds of my customers so that they stop
concentrating on very small, individual matters and understand
that real cost savings can be made by better time management,
the use of new technology and a ‘team’ mentality.”
Steve Coustol – Henry Schein Minerva Field Sales Consultant

Partnership in Practice

Practice Software

To develop your partnership

Business Solutions
Consultancy Services

email: me@henryschein.co.uk

Surgery Design & Installation

www.henryschein.co.uk

Best Value Dental Consumables

Henry Schein Minerva Dental Centurion Close Gillingham Kent ME8 0SB
08700 10 20 43

London

Cardiff

Glasgow

Belfast

[24] =>

24 Money Matters

United Kingdom Edition November 30-December 6, 2009

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Incorporating incorporation into your practice
You too could become the next Gordon Gecko, says James Shedlow, if you consider
converting your dental practice into a limited company

I

n recent years, the concept of
‘incorporation’ has enjoyed
a meteoric rise in its profile
within dental circles to the point
that it is now a de rigeur consideration for any modern-day
practitioner.

Its innovative application
and accompanying advantages against the traditional sole
practitioner/partnership backdrop has gained the concept
considerable support in some
corners as a modern alternative, and solicitors are receiving
increasing numbers of instructions from dental practitioners in
this regard.
In such a climate, this article
is aimed at the dental practitioner flirting with the idea of trading
his whites for the kind of braces
favoured by Gordon Gecko, Wall
Street’s infamous anti-hero, and
sets out some of the issues that
such a practitioner might expect
to encounter both during and
following incorporation.
The Pros:

Sale of the practice
Besides the fact that there may be
significant tax advantages associated with incorporating a dental practice, incorporation can
also be extremely helpful when
it comes to selling the practice.
Ultimately, a company is
owned by its shareholders.
Accordingly, when selling a
dental practice that is owned
and run as a limited company,
the sale will not involve the
separate transfer of any property, equipment, goodwill or
staff comprising the practice.
Instead it is simply a case of the
shares of the limited company
being transferred to the third
party purchaser. Unfortunately,

these types of contract tend to be
populated with endless tax warranties, necessitating far greater
input from your accountant
than would be the case if the
individual assets of the practice
were being sold.
Furthermore, it should be
noted that the NHS rules in England and Wales do not include a
right to assign or transfer either
a General Dental Services (GDS)
contract or a Personal Dental
Services (PDS) agreement. It
is possible to transfer an NHS
contract held in the name of a
limited company because when
the shares of the company are
sold the contract held should
simply transfer to the new owners as part of the assets of the
company. In such a scenario
there is no change of contractor from the perspective of the
primary care trust (PCT), and
the company remains the legal
holder of the contract.

be concluded within this nine
-month window.
Incorporation can help in this
scenario on the basis that the
NHS contract would continue to
be held by the company despite
the death of an individual director of the company.

However, please be aware
that the PCT can terminate an
NHS contract held by a company where the majority of the
directors cease to be dentists or
dental care professionals (DCPs)
registered with the General Dental Council (GDC). To ensure
that the contract would continue

‘This article is aimed at the dental
practitioner flirting with the idea of
trading his whites for the kind of braces
favoured by Gordon Gecko, Wall Street’s
infamous anti-hero.’

In the event of death
Incorporation may serve to
protect a dental practitioner’s
NHS contract and the value of
the goodwill in their business,
in the event of the death of the
particular dental practitioner
concerned.
An NHS contract held in the
name of such an individual will
terminate seven days from the
date of that individual’s death,
unless the PCT receives written confirmation from the deceased’s personal representatives that they are looking to sell
the practice and that there are
adequate arrangements in place
to ensure the performance of
dental services under the contract in the meantime. In such
circumstances, the regulations
provide for the contract to continue for three months with provision for extension by a further
six months.
While this might potentially
allow nine months to arrange
the sale of the practice, ultimately there is no obligation on
the PCT to transfer the NHS contract to a prospective buyer. Furthermore, there is no guarantee
that the sale of the practice will

Are you looking to be like Wall Street’s Gordon Gecko?

in the event of such a death, it
would be necessary to make sure
that there were sufficient dentists
or registered DCPs on the board
of the company to maintain such
a majority.
Facilitating investment
There is no requirement for the
shareholders of the limited company to be dentists or DCPs, or
for the shareholders and directors of such a company to be the
same people.
Accordingly, this facilitates
financial investment in the practice by non-dentist family members or third party investors
who, in return, would acquire a

[25] =>

United Kingdom Edition November 30-December 6, 2009

shareholding within the relevant
limited company.
However, such a transfer of
any substantial shareholding
in the limited company to an
investor would inevitably involve
the surrender of a significant
element of control of the
company, and potentially result
in disputes arising in the long
term in connection with the direction and management of the
limited company.
The Cons:

Issues of NHS contracting
If you hold an NHS contract as a
sole practitioner or partnership
and want to incorporate, please
be aware that there is no right
obliging the NHS to contract
with the incorporated practice.
Accordingly, it would be necessary to have the PCT’s agreement in advance that they would
be willing to issue a new contract in the name of the limited
company.
It is fundamentally important
that a new contract is issued to
the limited company and signed
by both parties before trading
commences, as failure to do so
could result in tax and accounting confusion as well as issues
relating to the validity of NHS
claims.
Issues arising upon a change
of control
In the event that an NHS contract
is issued to the limited company
set up, whilst the standard GDS
and PDS terms permit the sale
of a company and therefore the
effective transfer of an NHS contract held by the company, many
PCTs now require ‘change of
control’ clauses to be inserted

‘If you hold an
NHS contract as
a sole practitioner
or partnership
and want to incorporate, please be
aware that there
is no right obliging the NHS to
contract with the
incorporated
practice.’

into GDS contracts or PDS agreements granted to limited companies. Such clauses can potentially prevent the transfer of the
NHS contract.

ly problematic and such clauses
would need to be negotiated with
great care with the PCT.

An informed choice
In conclusion, it is clear that the
concept of incorporation offers
The drafting of such clauses
a number of advantages and
varies depending on the PCT
will be of particular interest to
involved. Some clauses provide
practitioners in certain circumfor the contract to automatically
stances, but that at the same
terminate if there is a change in
time there are clearly a number
the ownership of the company,
of pitfalls that need to be carewhilst others require the PCT to
fully considered
before the decigive prior
consent to a change of 20/10/09
a4_ad_doormat_uk_20oct.pdf
13:36:59
sion is made.
control. This is clearly potential-

Money Matters 25

Any practitioner considering incorporation should seek
legal and accountancy advice
before taking any steps forward and, in the context of
the
acquisition/disposal
of
a practice, advise its legal
representatives at the first
opportunity of any intention
to incorporate as this could
have important ramification
in terms of concluding the
transaction in a manner that
fulfils the intentions of the
respective parties. DT

About the author
James
Shedlow
joined
Cohen
Cramer in 2008
and is a key member of the dental
team working on
practice sale and
acquisition transactions. His particular
area of expertise
is in the corporate
field, specialising in the preparation
of expense share agreements and the
incorporation of dental practices. To
contact Cohen Cramer solicitors, call
0113 2440597, email dental.team@cohencramer.co.uk or visit www.cohencramer.co.uk.

[26] =>

26 BDTA Show Review
1,276 brush with Philips
Sonicare at the BDTA to support
the Mouth Cancer Foundation
Mouth Cancer kills one person
every three hours and during 27
hours of exhibition time at the
BDTA Showcase, 9 people will
have lost their lives. In order to
help reduce these grim statistics,
Philips gave over part of its
exhibition stand at the show to
the Mouth Cancer Foundation.

United Kingdom Edition November 30-December 6, 2009

SMARTSEAL HAILS PRODUCT LAUNCH AT DENTAL
SHOWCASE. A HUGE SUCCESS
INNOVATIVE endodontic system creator smartseal
has hailed its new product launch at the BDTA’s Dental
Showcase in Birmingham in November, a huge success.
Thousands of clinicians visited the impressive water-themed stand during the
three-day show and watched demonstrations of its new bio compatible root
canal sealer, smartpaste bio.
smartpaste bio, the latest member of the smartseal familiy - which includes
smartpoint and smartpointPT - uses bioceramics which have exceptional
dimensional stability and are non resorbable inside the root canal.

Strengthen the bond between practice and patient
with Denticom
Denticom were delighted with the uptake of their
product, the Denticom Patient Point at the 2009 BDTA
Dental Showcase. Providing patients with the very
best in customer care, the Patient Point provides a
multi-functional check-in service, improving the entire patient journey and
strengthening the bond between practice and patient.
Constructed by experienced leaders in the dental market, Patient Point is ideal
for busy practices, easing queues and congestion at the desk, and lessening
the pressures on staff.
As well as improving internal communications within practices, Denticom also
has a wealth of other customer contact solutions including:

Carina Leney Philips’ Professional Marketing Manager announced that “A total
of 1,276 people brushed on our stand during the event, and we were delighted
to present a donation of £1,276 to the Mouth Cancer Foundation’s Dr Vinod
Joshi at the conclusion of the show.”

This new product is instantly recognisable due to its pink packaging and
comes individually presented in 1ml (2g) pre-loaded syringes – meaning no
mixing is required and no material is wasted.

With attendance up by over 1,200 to 13,178 it was a busy Showcase for Philips.
Visitors were attracted to the Company’s high-tech stand which changed
colours to reflect the colourful décor panels on its newly launched Sonicare
For Kids.

Jerry Watson, Chief Executive of smartseal, says: “We are delighted with
the enormous number of people who visited our stand and watched
demonstrations of smartpaste bio. It provided us with the ideal opportunity
to showcase this new product to dental practitioners.”

• Patient Partner - A system allowing patients to book, cancel, check or change
appointments at any time of day or night over the telephone. The system
integrates seamlessly with electronic appointment books, easing the pain of
early morning congestion and extending reception-opening hours.
• Patient Text – sends text messages to patients to remind them of their
appointments, thus reducing ‘no-shows’ by up to 50%!

To brush up on the latest facts visit www.sonicare.co.uk/dp or call 0800 0567 222.
For more information about the charity visit www.mouthcancerawareness.org

smartseal’s special offers and information on forthcoming lunch & learn
seminars also proved popular.

To find out why practices across the country are choosing Denticom as their
technology partner call 0844 573 3000 or visit www.denticom.co.uk

KaVo Gendex- Proud to have offered the
Profession Dental Excellence for over a
CenturyOne of the most famous names
in dentistry, and a byword for excellence
throughout the industry, KaVo continued
to celebrate its 100th Anniversary at Dental Showcase this year with an
extremely successful show.
2009 has been an exciting year for KaVo Gendex as they were able to show a
number of new, innovative products, which further enhance their high quality
range. KaVo works with the Dental Profession to develop products that are
ergonomically designed to improve the efficiency, aesthetics and working
environment of dental surgeries.
Showcase 2009 saw the launch of amongst other innovative products, the new
E70 dental unit, the new improved ORTHOralix 8500DDE digital panoramic
and the GXC300 intraoral camera. In addition KaVo were proud to launch their
new LED.

Dental professionals were able to see in person
the full variety of features the Castellini dental
chair range provides and to see how they offer the potential for improving the
provision of care.
With its extensive range of adjustable controls, accessed by the soft-touch
control panel and LCD display, dentists were able to see how easy it is to
modify the instruments’ settings to suit specific treatment requirements.
As well as the impressive user-friendly systems for controlling the chair
position and light intensity, the visitors to the Castellini stand were impressed
with the elegant and ergonomic designs of the chairs.

Also on show were the GXCB500 Cone Beam 3D Dental Imaging system,
powered by i-CAT, the top of the range E80 dental unit and a comprehensive
range of top quality handpieces designed to meet all clinical needs.

Castellini dental products are a synthesis of aesthetically pleasing designs
coupled with practicality and functionality. Their stylish appearance belies the
rigorous research and development undertaken to ensure these chairs not
only look great but also help dentists provide the highest quality care.

To find out more contact KaVo on 01494 733 000 or email sales@kavo.com or
visit www.kavo.com.

For more information contact Castellini on 0870 756 0219 or visit www.
castellini.com

CaviCide creates waves at BDTA showcase
Kerr reinforced its commitment to protect people
in dentistry at the BDTA showcase exhibition
with the focus on their stand being CaviCide, the
number 1 disinfectant in the USA and Canada.
Hoards of people visited the Kerr stand to receive
their free samples, and due to the unprecedented
level of orders special offer packs sold out! Kerr was able to call on European
colleagues to replenish stock levels to match the demand.

Munroe Sutton’s Path to More Patients
Tailor made for the UK dental market, Munroe
Sutton offered the delegates visiting their
stand at this year’s BDTA Dental Showcase,
held at the NEC in Birmingham between the
12th and 14th of November, a plan developed
for dentists by dentists.

CaviCide does the job of three products – it is a cleaner, disinfectant and
decontaminant, quickly saving time and money. Kerr are committed to
providing protection for people in dentistry with this efficient, non-toxic, high
performance cleaner and disinfectant.
If you missed the opportunity to receive your free sample at the Kerr stand or
would like to find out more about CaviCide, please call 01733 892 292 and will
arrange for your local Kerr area manager to deliver a free sample.
Contact Person:
Paul Byfleet
KERR, 4 Flag Business Exchange,
Vicarage Farm Road, Peterborough PE1 5TX
Tel: 01733 892 292 fax: 01733 891 299 Mobile: 07711 750618
E-mail: paul.byfleet@kerrhawe.com

Expert Knowledge at BDTA 2009
The Association of Specialist Providers to Dentists
(ASPD) members were at the BDTA Dental
Showcase, NEC Birmingham 12th- 14th November
2009 offering expert knowledge and guidance to
delegates. Members attending included:
• Essential Money Ltd, Stand G04 – Expert advice
and FREE guides on Mortgages, Income Protection, Retirement Planning, and
Investments
• Lease UK, Stand R14 – Professionals in practice equipment leasing and
finance, delegates will receive information on Lease purchase and Loans
• Lloyds TSB, Stand N03 – Benefits of holding a practice account include Direct
email and telephone access to Healthcare Relationship Manager and Assistant
• Money4Dentists, Stand G04 – Independent Financial Advisers offering FREE
guides on Mortgages, Income Protection, and 106 Money Saving Ideas for
Dentists
• Royal Bank of Scotland, U09 – Account holders receive dental industry
specialist teams and local expert support
ASPD members are dedicated to delivering experienced advice that clients
can be confident in, and are happy to work together to offer a solution to any
challenge.
For more information please visit www.apsd.co.uk or call 0800 458 6773

Evident…It Is All About Quality

Combining Art and Science
The team from Castellini have been delighted with
the overwhelmingly positive response from the
attendees of the BDTA who visited their stand.

At this years’ Dental Showcase Evident wowed
delegates not only with their magnificent new stand
but with their beautifully designed loupes and lights.
Evident’s dedicated and experienced team of
consultants, including dispensing opticians, were
kept busy demonstrating the custom-made loupes
by leading supplier ExamVision™. Considering their
superior design and craftsmanship it’s clear to see why these ExamVision™
loupes proved to be so popular.
Evident also demonstrated their highly desirable consumable products, most
of which are from leading US dental company Danville. Danville developed
their range of “Adhesive Dentistry” products with the help of leading US dentist
Dr. Raymond Bertolotti. These include Prelude; the ONLY system you need for
dentine and enamel bonding, Accolade SRO; a super radiopaque, flowable
composite and the Accolade PV veneer placement system.
All of the products in the Danville range are designed to enhance daily working
practice, helping to offer patients the very best in modern clinical dentistry.
If you would like more information about Evident’s range of quality products
simply FreeCall 0500 321111, Email enquiries@evident.co.uk or visit www.
evident.co.uk

BDTA Showcase Review 2009 Stand U02
Periproducts would like to take this
opportunity to thank all who came onto the
stand to talk to us about our products and
passed on such fantastic feedback. Many
great Showcase offers were available and there is still time to place an order.
Offers end 11th December 2009. Please call 0208 8681500. For more details

With over 30 years of experience in the design
and management of Patient Referral Schemes, dental professionals were
interested to see how their practice could reach out to more patients with
Munroe Sutton’s marketing solutions.
Delegates were able to see the benefits of membership include:
• Reaching out to more patients with FREE marketing solutions
• Increasing cash flow with payment at time of service
• Access to a patient verification system
• Increasing patient numbers!
The team from Munroe Sutton were also pleased to explain the discounted
prices offered by Sutton Laboratories, to which members gain exclusive access.
Munroe Sutton are also delighted to sponsor the 2009 BDA Benevolent Fund
Christmas Draw. For more information please call 080 234 3558
or visit www.munroesutton.co.uk/dentist

Reach for the Sky!
Many dental professionals took the time to meet
the Dental Sky team at Showcase this year. A much
welcomed chance to sit down and have a cup of coffee
was on offer.
Following on from their success at last year’s Showcase,
Dental Sky again had a huge presence with customers
new and old taking the time to chat to the 10 members
of the Dental Sky team. They picked up the new 500 page catalogue and
entered the Prize Draw to win a Samsung 50” Flat Screen HD TV.
The Prize Draw took place at 2.00 pm on the Saturday afternoon when the
lucky winner was picked out by a Captain Jack Sparrow lookalike. The winner,
Diane Fenton from Middleton, Manchester, was picked from the treasure chest
from the hundreds of entries both on the website www.dentalsky.com and
from cards completed on the stand.
Many top branded products as well as Dental Sky’s own exclusive branded
products were on offer at Showcase this year. The newly exclusive Cherokee
Authentic Scrubs and Toffeln Footwear ranges attracted a lot of attention from
the visitors.
If you have not already received Dental Sky’s new 2010 catalogue please call
Dental Sky directly on 0800 294 4700 for your copy.

Two of our featured products that received a lot of interest were:SensiShield is Bio mimetic Technology
The Advance Bio-Technology formula of SensiShield Toothpaste mimics the
way saliva in the mouth naturally re-calcifies dentine and tooth surface enamel.
And
Denti-Brush Interproximal Brushes
The main benefit is that each brush has a flexible handle and brush to increase
control and access to difficult areas. This reduces the pressure and stress on
the wire holding the interdental brush head in place, therefore minimising
potential breakage. Luigi Castellano, Accounts Manager said ‘After three days
of demonstrating the pivot technology by bending the brush head backwards
and forwards the brush head was still in tact.
To place an order, receive further information or samples to try
please call 0208 8681500

Special Guest Launches New Hogies Range at BDTA
2009
Amongst the visitors to the Blackwell stand at the 2009
BDTA Dental Showcase were two very special guests.
Helping to launch the new range of Hogies Eyewear was
the developer of the original Hogies, Martin Hogan, with
his son Jason, the current CEO of Hogies Australia.
Since the original was released, Hogies eyewear has gone on to develop a solid
reputation for providing excellent eye protection combined with lightweight
and stylish designs. The Hogans were happy to chat with delegates about
their combined experience of over 50 years, which now includes advising the
Australian Air Force.
Blackwell supply the new and improved Hogies Eyeguard range, which
features high quality lenses resistant to cleaning solvents and therefore easier
to keep scratch-free. Delegates appreciated the stylish design constructed
from lightweight materials and featuring an adjustable nosepiece for optimum
comfort.
Dental practitioners from all disciplines could also appreciate the superb
design that allows for improved airflow, preventing the lens from fogging and
keeping the view crystal clear. For more information please call John Jesshop
of Blackwell Supplies on 020 7224 1457 or fax 020 7224 1694

[27] =>

United Kingdom Edition November 30-December 6, 2009

Tavom: Continuing to Exceed All Expectations
Tavom have continued to demonstrate why their
reputation as a leading supplier of dental cabinetry is
well deserved.
At the recent BDTA Dental Showcase, held between the
12th and 14th of November at the Birmingham NEC,
Tavom had an impressive display featuring some of their most popular designs.
The sleek lines and user-friendly designs on display impressed delegates
visiting the stand; especially the new Mitto range.
With infection control a renewed priority, dental practitioners were interested
to see how Tavom’s specially designed CAD software was able to demonstrate
the full range of options available from the Kamal LDU Room range; designs
that would clearly complement any practice.
With their reputation for an uncompromising approach to achieving
perfection, the Tavom team were kept busy with enquiries for their services.
Built on a reputation gained from over 30 years of experience, Tavom continue
to demonstrate the high levels of customer service and quality products
expected by today’s dental profession.
For more information please call Tavom UK on 0870 752 1121

A Successful Showcase for the Team from Nuview
Delegates visiting stand L05 at this year’s BDTA Dental
Showcase, held on the 12-14th November at the
Birmingham NEC, were clearly impressed with the
products and service provided by Nuview.
There was a great deal of interest in the range of loupes available from
Nuview, with the EyeMag Pro and EyeMag Smart both attracting a great deal
of attention, thanks to the superb image quality and magnification levels.
The lightweight materials ensure maximum comfort for the wearer during
procedures.
Dental professionals were also impressed with the quality of service offered
by Nuview, both pre and post purchase, with in-depth equipment surveys and
ongoing aftercare to guarantee optimum usage.

Dental professionals from all areas of clinical practice
were amongst the many interested visitors to the UCL
Eastman Dental Institute’s stand R12 at this year’s BDTA
Dental Showcase, which took place from the 12th to the
14th of November at the Birmingham NEC.
Regarded as a leading provider of CPD and graduate dental education, many
visitors to the Eastman stand were keen to learn more about the wide range of
flexible and full time programmes available at certificate, diploma and masters
level, such as the Restorative Dental Practice programme which currently has
over 500 enrolled graduate students.

The Eastman also fielded a large number of enquiries about its on-site
educational opportunities that offer support for all areas of clinical practice,
tailored to suit the specific requirements of each and every dental professional.

Used for just seven days, Xerostom will significantly increase unstimulated
salivary flow rates, leading to a decrease in thirst. As a result patients can enjoy
an improved quality of life, with less chance of suffering from periodontitis.

For more information:
For taught or research programmes, please contact the Admissions Officer on
020 7915 1092 or academic@eastman.ucl.ac.uk or
For CPD programmes and e-learning, please contact the Administration Team
on 020 7905 1234 or cpd@eastman.ucl.ac.uk

The Xerostom range comes in a variety of applications to suit all requirements,
is suitable for diabetics and is now available from Curaprox UK.

Clearstep’s Complete Orthodontic System Brings a Smile
to the BDTA 2009 Dental Showcase
Clearstep have enjoyed a busy and productive time at the
BDTA 2009 Dental Showcase exhibition, with delegates keen
to find out how the Clearstep System, alongside their exciting
new product; Clearview, can open the door to greater patient
numbers.
Stand T15 at the exhibition was a hive of activity with the
Clearstep Team explaining to GDPs the 5 key elements within the system (PreAlignment, Space Closure, Alignment, Finishing / Detailing, Extras) which,
when combined, offer a solution to a range of malocclusions without specialist
referral, but with specialist support.
Visitors were fascinated to see how appliances such as the CODA and Closing
Spring were easily used to help treat patients within the GDP practice, and
many visitors were left feeling confident their patients could benefit from the
Clearstep system.

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

For more information call the OPT Laboratory & Diagnostic Facility
on 01342 337910 or email info@clearstep.co.uk www.clearstep.co.uk

• Processors (Intra-X on stand)
• Aquacut (demo)
• Compressor (demo)
• Trolley
• Laser
• Digital (demo)
• Aseptico (demo)
• Vischeck Reader (demo)
• All other products via catalogue
There were a number of existing customers who came to the stand to order
consumables or accessories. All had positive things to say about the products.

From Dental Innovations to Charitable
Donations
Everyone loves a ‘try before you buy’ opportunity
and nowhere was this more evident than at the
Henry Schein Minerva stand, where visitors were
able to put an extensive range of products and
equipment to the test.
2009 Dental Showcase saw the launch of Dental
Innovations; Henry Schein Minerva’s new
specialist division, bringing dentists the latest
and most innovative dental products from some
of the industry’s leading brands.
This new and exciting offering encouraged visitors to see and experience for
themselves the state-of-the-art CADCAM system CEREC; boasting shorter
milling time, unrivalled precision and complete ease of use.

There were a number of potential customers who we were able to discuss the
range of products with – generally positive, with a number placing orders.

But it didn’t stop there; the Henry Schein Minerva team played a huge role
in the success of the Bridge2Aid Ball held on the evening of Friday 13th
November raising over £13,000 for Bridge2Aid, a fast growing dental and
community development charity working in Tanzania.

No one approached with an issue that couldn’t be solved in discussion about
cleaning or needing a service (processor). The range of products on display,
associated with the 2 Screens with moving images acted as a draw to the stand.

If you missed the 2009 BDTA Dental Showcase but would like to speak to a
member of the Henry Schein Minerva team, please call 08700 10 20 43 or visit
www.henryschein.co.uk

Delivering Superb Design and Build Solutions
Genus had another successful year at the 2009
BDTA Dental Showcase, held at the NEC in
Birmingham on the 12th – 14th of November.
A sizable crowd were often seen gathered round
the Genus team as they were demonstrating
their expertise in CAD and 3D rendering, giving practitioners a clear idea of
how their dream practice would look.
Delegates were also able to speak to the team about how they are experienced
in overseeing the entire project, with wraparound services including site
assessment and move management to ensure a seamless transition to the
new facilities.
The fact that Genus are an independent interior construction company meant
whichever equipment practitioners chose at the show, the Genus team were
happy to discuss and advise on ways to work these into the interior designs of
new practices, something which was of great interest to many of the visitors.
The result is a refurbished practice that looks stunning.
For more information please call the Genus Group on 01582 840 484 or email
info@genusgroup.co.uk
www.genusinteriors.co.uk

Suffering from xerostomia can be a significant detractor from patients’ quality
of life, with the lack of saliva often causing serious oral health conditions.
Available from Curaprox, Xerostom is a new oral hygiene product line especially
formulated to bring relief. The combination of ingredients works to replenish
moisture in the oral cavity, soothing the tissues whilst cleaning and protecting
the mouth from harmful bacteria.

The exhibition also saw the launch of Clearview, which offers patients a
computer-generated video of the predicted movements of their teeth,
achieved by the treatment: a fantastic tool to show the possible outcome of
treatment.

This year at the BDTA Dental
Showcase, NEC, Velopex Products
featured:

Exciting New Product Range Launched at the
BSDHT Exhibition
One of the industry’s leading developers of dental
products took the opportunity of the BDTA Oral Health
Conference and Exhibition, held in Bournemouth on the
16th and 17th of October, to launch an exciting new
product.

This is complemented by www.dentalbites.co.uk which hosts core subjects and
more for dental nurses, hygienists and therapists delivered via downloadable
podcourses which offer CPD in a fun, accessible and cost effective.

The team from Nuview was also pleased to see the new products in their
catalogue being of interest, most notably the Continu range of alcohol- free
antimicrobial cleaning products. With their powerful Biocidal formulation to
inhibit re-contamination of treated areas, even several days after application,
the Continu range offers powerful decontamination on virtually all surfaces.

BDTA 2009 Review

BDTA Show Review 27

Breathe safe, dry air into your practice
Dental Professionals can revolutionise their
practices by entering into a new relationship with
Dental Air. Practices may be pleasing to the eye,
but without the most up to date air compressor
systems working with their instruments, Dentists
might not be meeting new standards.
Dental Air provides a no obligation survey for all UK Mainland practices,
allowing them to see how their systems can be improved by converting to
oil-free compressors. Too many Dentists still rely on mineral oil to power their
compressor systems, unaware of the dangers. Particulates and high levels of
moisture can also leave your compressed air instruments at risk of damage if
they are not maintained correctly.
Dentists wishing to provide the best possible care for their patients in all
elements of their treatment should understand the importance of safe,
infection free compressed air in their dental instruments. By entering into
a relationship with Dental Air, customers will receive updated relevant
information on all new systems and access to an excellent break down service
for their Compressed Air System.
Call Dental Air on FREEPHONE 0800 542 7575 and ask for a FREE Practice
Manager’s Guide, or visit www.dentalair.co.uk

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

GC Helping You to Help Your
Patients
GC’s stand at the recent Showcase
Exhibition proved to be as popular
as ever. The Company were promoting the Minimal Intervention programme
with two new products. GC Saliva-Check Mutans adds another dimension by
showing whether a patient carries a high level of Streptococcus mutan in the
saliva.
Dry Mouth Gel from GC UK is a unique, sugar-free product that has been
specifically developed to help relieve dry mouths. With a unique neutral pH
(unlike more acidic competitor products) it provides ultimate patient comfort
combined with an immediate soothing effect.
To make your denture patients more comfortable, allowing time for the soft
tissue to adjust particularly after implant surgery, GC has introduced Tissue
Conditioner. This all-in-one soft reline and conditioning material is classed as
the next generation of acrylic soft reline materials, patented by GC. Another
new product within GC’s portfolio is GC Initial IQ; the new One Body, Pressover-Metal and Press-over-Zircon systems. These feldspar based pressable
ceramics demonstrate unsurpassed lifelike aesthetics in no time!
For further information please contact GC UK on 01908 218 999.

“Simply, our most successful Showcase to
date”.
This year the Ivoclar Vivadent stand generated
much attention at the BDTA Show at the NEC
in Birmingham with the company’s latest
innovations and technical developments
drawing much attention from visitors.
New Empress Direct Composite and recent additions to the new IPS e.max
System proved a resounding success being quoted by one visitor as “products
with the right solutions to help move practices and laboratories forward”.
With over 15 new products on display including AdheSE One F bonding
system, Phonares Denture Teeth and the innovative BluePhase Curing Light
family the company drew impressive attention. Another great attraction was
the in-depth knowledge and product range within the field of CAD/CAM
Dentistry... IPS Empress CAD, IPS e.max CAD and the CS (Chair side) Furnace
were all on display and proved popular.
The company is proud of the progress made within the past years and the
innovate solutions offered by the whole dental team …
Darryl Muff, General Manager commented, “Simply, this was our most
successful Showcase to date. It gives me real optimism for the year ahead”.

Pioneering Technological Solutions from
Clark Dental
Clark Dental did not disappoint at the 2009
Dental Showcase, with an eye-catching display
of Edarredo and Apex cabinetry, which now
includes a new LED lighting system.
Placed either around the plinth or under the work surface, a choice of seven
LED colours can be remote-controlled, for creating a modern ambience to suit
any surgery.
Included on the innovative stand was a selection the latest stylish and
functional dental chairs from leading manufacturers such as Adec, Anthos and
Stern Webber.
Clark Dental is synonymous with the latest technology that benefits both
patient and dentist. Examples of this were the lightweight Nomad portable
X-ray generator, and the Dentaloscope 2D and 3D, which offer incredible
clarity of image for both dentist and patient.
Preventative dentistry also played a major element, with the Florida Probe,
which offers patients a unique examination experience, as well as the
CarieScan PRO: an innovative method for accurately detecting carious teeth.
For more information contact Clark Dental Wickford Essex Office on 01268
733146 or email enquiries@clarkdental.co.uk or Clark Dental Nantwich
Cheshire Office on 01270 613750 or email sales@clarkdental.co.uk

[28] =>

28 Industry News
The Complete Smile Academy
Facilitating world-class education
Visit www.completesmileacademy.co.uk for 2010
courses
The Complete Smile Academy is at the forefront
of Implant and restorative dental education with
intensive training programmes for dental professionals
throughout the UK looking to extend their knowledge
and understanding of dental implants and restorative
dentistry.
The Academy is purpose-built for dental education and is the perfect
environment to learn professional skills, with facilities including phantom
heads for realistic hands-on clinical practise. Workstations are linked to the
multimedia-supported facilities, including cameras to show live cases and
technical demonstrations in great detail.
The team, led by Allen Branley, comprises technicians who are recognised
trainers and lecturers. Furthermore, a range of specialists and renowned
international speakers in cosmetic dentistry and implants provide contributions
to the modules and courses provided at the Complete Smile Academy.
Courses on Implants, Occlusion, Smile design and Aesthetics are held
throughout the year and the Complete Smile Academy aims for every delegate
to receive an intensive and rewarding learning opportunity in a technologically
advanced, supportive environment.
For full information on 2010 courses please call 0191 427 1029

United Kingdom Edition

Time for a Check-up
With forecasters cautiously predicting a slow return
to economic stability over the next year, now is the
time to give your practice a financial health check.
Whether you are planning to maintain your current situation or make lasting
changes to the structure of your business, the starting point is a no-nonsense,
realistic assessment of your current financial situation.
Our extensive experience of working with the dental industry means that
DPCS is ideally placed to provide an in-depth financial evaluation from which
the future can be planned.
From guidance on arranging Practice Contractual Agreements between
partners, associates or PCTs to undertaking evaluations for both sellers and
purchasers of practices, the aim at DPCS is to give a full range of financial and
business related advice specifically for the dental profession.
As one of the leading UK dental practice consultancy agencies, DPCS has the
expertise to support you through to achieving your goals from your business.
For more information, contact the Dental Practice Consultancy Service
on 0870 444 3742, email info@dentalconsultancy.co.uk or visit www.
dentalconsultancy.co.uk

Which toothbrush?
- Which Magazine awards Sonicare toothbrushes
not 1 but 3 ‘Best Buy’ accolades!
The November 2009 issue of Which? Magazine
has awarded three Sonicare toothbrushes with its
‘Best Buy’ status. The magazine which undertakes
independent product tests and produces over 450 comprehensive guides,
gives potential purchasers impartial straightforward, expert and trusted
advice. As it does not take advertising, Which? is not influenced by commercial
bias, making it one of the most trusted buying guides available.
Oral cancer- Routine tests save lives
New ViziLite® Plus helps the dental practitioner see what eyes alone may
not. Available in simple, easy to use, disposable kits, the system utilises
chemiluminescent technology to help identify early epithelial changes that
could be precancerous. By identifying oral abnormalities, the patient can be
referred immediately and confidently for further treatment. Using a unique
‘TBlue’ marker system, precision is guaranteed in marking and documenting
lesions. ViziLite® Plus has quickly become a critical element of the dental
surgeon’s preventative practice, contributing to the accepted fact that better
screening really does save lives. ViziLite® Plus is available in a 40-unit pack
£622.78 plus VAT or in 20-unit pack £311.40 plus VAT. Call Panadent 01689 88
17 88 to ask about special offers or to order your pack.

Support Chairs
The Perfect Saddle Stool
The Art Of Sitting
Ideally suited for anyone involved in two-handed forward
reaching type work, Support Chairs’ Perfect Saddle Stools
have solved lower back problems for thousands of people.
Consequently, they are regularly recommended by
Orthopaedic Specialists and Physiotherapists.
Compact, it allows incumbents to move around freely, even when space is
limited. It is available in Classic and Advanced versions, the latter featuring an
indentation in the front and a groove across the seat for better ventilation and
to relieve pressure on the vertebrae. A lever on the left side facilitates vertical
adjustment and another on the right adjusts the tilt. Together they enable the
Perfect Saddle Stool’s easy adjustment to the incumbent’s optimised seating
position and lets them get closer to their work.
When a person sits on the Perfect Saddle Stool the occupant automatically
assumes the position that produces least stress for muscles, ligaments and
joints.
Perfect Saddle Stools are available in a vast array of colours in Genuine
Scandinavian Leather, vinyl or textile.
For further information contact your regular Dental Dealer or Support Chairs
on 01296 581764, fax 01296 586583, email sales@supportstool.co.uk or visit
www.supportstool.co.uk.

Kemdent products provide Effective protection
against Swine Flu
Kemdent Practicesafe Spray and wipes and Kemdent
Chairsafe foam and wipes used correctly, guarantee a safe
inactivation of influenza A (H1N1)- viruses (pathogens
of swine flu). These products should be used for daily
disinfection of surfaces close to the patient/frequently
touched surfaces (eg. dental chairs, door handles, work surfaces).
The disinfection of hands and surfaces and also contaminated instruments
play a major role in preventing the human-to–human transmission of the
currently circulating swine-flu virus which belongs to the group of influenza
A viruses, type H1N1.
All equipment/medical devices in direct contact to the patient have to be
disinfected and
sterilised after use and before use on another patient. Kemdent InstrumentSafe
is suitable for the safe inactivation of influenza A viruses at the respective
concentration rates and exposure times of the product.
Using Kemdent Cross-infection control products will help a Practice maintain
their high standards of patient care.
For further information on special offers or to place orders call Helen on 01793
770256 or visit our website www.kemdent.co.uk.

In achieving ‘Best Buy’ status for three of its Sonicare toothbrushes in the
edition published in the run up to Christmas, Philips could not have hoped for
a greater accolade at a better time. So which brush to give?
There are two award-winning brushes which make it possible for patients to
enjoy a White Christmas and get up to two shades whiter teeth in just two
weeks with the HealthyWhite in Clean & White mode, or they can opt for
Which?
If you would like to find out why these Sonicare are Which? Magazine Best
Buys, please visit www.sonicare.co.uk/dp or call 0800 0567 222.

December 30-6, 2009

IVOCLAR VIVADENT TAKES A TEAM APPROACH WITH OLIVER BRIX AND
DANIEL EDELHOFF
Ivoclar Vivadent is taking a ‘Team Approach’ to lecturing by hosting an event
on all ceramic restorations, in conjunction with Oliver Brix and Daniel Edelhoff.
February 2010 sees Mr Brix return to discuss aesthetic and functional
rehabilitation of complex cases with new all-ceramics at the prestigious
Guildhall in Bath. Joined by Daniel Edelhoff C.D.T., Dr. Med. Dent., Ph.D, this
offers practitioners a wonderful opportunity to see both the clinician and
technician presenting together.
As severe tooth wear and erosion becomes a constantly increasing problem
particularly in young patients the ‘Team Approach’ lecture will focus on proven
treatment concepts for all ranges of indications.
The introduction of the latest innovative Ivoclar Vivadent all-ceramic systems
fulfils these demands. The entire range of indications of the new systems
available will be presented by numerous step-by-step case reports ranging
from single tooth restorations to full mouth rehabilitations.
As this will undoubtedly be very popular, numbers will be limited and tickets
will be offered on a strictly first come, first served basis. For further information
please call 0116 284 7880 to guarantee your place at this prestigious event.

Support Chairs
Ergonomically designed for optimum comfort!
It is universally accepted that maintaining a correct
posture whilst at the chairside is essential for operator
efficiency, comfort and health. This is particularly
important during procedures, where the clinician
spends long periods bent over a patient, staying
relatively still in order to perform intricate procedures.
Manufactured to order they meet all the incumbent’s needs including specific
requirements on colours and materials. Support Chairs also offer a wide range
of accessories including new Swing and Swing Mini Armrests.
Easy to fit and convert between left and right handed operators, the Swing
Armrest offers a number of options for varied seating positions and is easy to
use with Support Chairs’ complete range. It gives the incumbent’s upper body
a comfortable and stable support; and its soft padding can be upholstered
in the same material and colour as the Support Stool or Perfect Saddle Stool.
Combined with Perfect Saddle Stools it can be used as a temporary backrest
if desired.
For further information contact your regular Dental Dealer or Support Chairs
on 01296 581764, fax 01296 586583, email sales@supportstool.co.uk or visit
www.supportstool.co.uk.

Highline
Bespoke Storage Solutions
Highline bespoke healthcare storage
solutions, from Support Chair, are the
ultimate answer in mobile storage
systems.
Available in a choice of nine formats they are extremely versatile and meet
the exact storage requirements for each and every individual. Probably the
reason why Highline cabinets are becoming so widely used in clinics, surgeries,
laboratories and treatment rooms.

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

The BDTA Dental Showcase 2009 at the NEC in Birmingham was a great success
for Purity Laboratories. With record breaking attendees it was a terrific and well
organised event that gave us the opportunity to showcase the Beverly Hills
Formula range. Using the motto “Upgrade to the healthier side of whitening
and stop Gingivitis before it starts” the innovative Beverly Hills Formula
product range drew a lot of interest from dentists and dental professionals.
As the whole Oral Care industry finds themselves moving towards price and
performance, the dental industry supports and demands the type of benefits
that go beyond traditional attributes and which are offered by the Beverly Hills
Formula range. All Beverly Hills Formula products have a unique combination
of anti-bacterial agents, low abrasion and anti-stain polishers to protect and
whiten teeth. The toothpaste is proven to effectively remove tooth staining
and offers maximum whitening power, whilst maintaining extremely low
abrasion. Tests conducted by the BBC Watchdog revealed that Beverly Hills
Formula toothpaste removed over 90% of staining. For further information,
please visit: www.beverlyhillsformula.com

Leading the way with flowable innovations
Accolade PV Veneer Placement System is a
fantastic innovation from leading US company
Danville and is available in the UK from leading
supplier Evident.

Lava chairside oral scanner takes aesthetic perfection
to new heights
Pioneers of 3M ESPE’s revolutionary digital device the Lava
chairside oral scanner (C.O.S) are reaching new levels of
perfection in aesthetic dentistry.

Accolade PV includes a unique try-in paste,
which is placed directly on the silane, allowing the veneer to be simultaneously
tried-in for fit and colour. Accolade PV’s try-in paste and bonding composite
are the same material, however the try-in paste has no light sensitive initiators,
allowing accurate colour evaluation with nearly unlimited try-in time. Using a
composite rather than a glycerine based try-in material not only speeds-up the
procedure but also eliminates the possibility of contamination by the try-in
material.

Using interactive imaging technology the Lava C.O.S
collects 3D data directly from the patient’s mouth using a
narrow oral wand measuring just 13.2mm wide at its tip.

Composed of modules, which contain sets of 4 different drawer sizes, they
can be combined in one of nine models to create units of the required height,
width and mixture of drawer sizes to suit the individual. Some of the models
feature an open space for storing equipment, if required, or a glass fronted
lockable cupboard with a height adjustable shelf.
Stylish and efficient, Highline bespoke storage solutions are engineered to last.
They are constructed from a combination of aluminium, steel and high quality
plastics, which are resistant to most stains including blood. The drawer fronts
are available in either simulated aluminium or navy metallic finish.

Two of the best selling flowable composites in the US are Danville’s StarFlow
and Accolade SRO. StarFlow had the highest compressive strength in CRA
testing and was found to be stronger than some “packable” composites.

This hottest new device in dentistry is more accurate than traditional
impression taking processes, helping dentists to produce perfect aesthetics
and restoratives from the patient’s first appointment.
This unique level of accuracy is enabled by the Lava C.O.S technology, which
allows every part of the impression to be viewed precisely by rotating and
enlarging the 3D images.

These innovative flowable composite materials deliver reliable, practiceenhancing results with ease.

If you feel your dental practice is ready to take aesthetic perfection to the next
level please call 3M ESPE today on 0845 602 5094 or visit www.3mespe.co.uk/
lavacos

Accolade PV, Starflow and Accolade SRO are available exclusively from Evident.
For more information please contact Evident on FreeCall 0500 321111 or visit
www.evident.co.uk

www.3mespe.co.uk
3M ESPE Dental Products UK & Ireland
Tel +44 (0) 1509 611611 email: 3mespeuk@mmm.com

[29] =>

United Kingdom Edition November 30-December 6, 2009

Advertorial 29

Endodontic re-treatment or implants?
Endodontic treatment is a growing field of dentistry but it is not an infallible science.
What to do when endodontic treatment fails...
Why does endodontic treatment fail?
There are a number of factors
that could result in endodontic
failure, including:
• An unexpected number of or
unusually shaped root canals
with branches or forks that are
difficult to detect and therefore
overlooked during treatment
• Undetected cracks in the root of
the tooth
• Defective or inadequate dental
restoration allowing bacteria to
cause re-contamination
• Unstable tooth structure, which
may break as a result of the treatment and require restorative
work
• New tooth decay or gum disease
Implants – the way forward?
A natural reaction to endodontic
failure is extraction, which often
leads to the use of implants.
Implants have been available for years and are commonly
used with high success rates.
However, they are not immune
to complications or even failure;
for example, success rates have
been seen to be notably lower in
smokers, patients with diabetes
or type IV bones.
Furthermore,
successful
implants can still present the
patient with problems such as
pain, paraesthesia, hematomas
or even loose/fractured screws.
It is therefore important to consider endodontic re-treatment as
well as implants.
What about endodontic
re-treatment?
Endodontic treatment is naturally more complicated when being
carried out on already treated
teeth. This is because the treatment was never meant to be reversed; not only do you need to
remove the solid root material
from the root canal but you may
also be faced with additional obstacles such as posts or crowns.
However, although implants may
be a worthy alternative, preserving the original tooth is often the
best option for your patient.
A new MSc in Endodontics
The University of Warwick will
launch a new MSc in Endodontics in January 2010. The programme will be delivered by
leading professionals, academics
and researchers in the field of
endodontic dentistry, and supported by respected academics
from the field of continuing professional development.
As a part-time course, it has
been designed to offer a flexible training pathway tailored
to individual requirements and

circumstances. The programme
will allow students to improve
and increase the scope of endodontic treatment in their practices through the study of a wide
range of topics, such as tooth
morphology, mechanical shaping, chemical disinfection and

pain management in endodontics.
Learning will take place
through traditional seminars
and practical work, performed in
labs and at regional training centres. Students will gain a thor-

ough understanding of modern
technologies, using materials
and instruments such as surgical
microscopes and cone beam CT.
Applications are being accepted now and further information about the course can be

found at www.warwick.ac.uk/
go/dentistry.

[30] =>

30 Events

United Kingdom Edition November 30-December 6, 2009

BOS announces new event
The British Orthodontic Society’s first-ever
National Orthodontic Week campaign will
be held in London next year

T

National Orthodontic Week (NOW) new website www.nowsmile.org

he British Orthodontic
Society has announced
that the first-ever National Orthodontic Week will
be launched on 22 March,

2010. The aim of the week is
to create a cohesive vehicle
for all providers of orthodontic treatment to come together
and communicate a strong and

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well-informed message about
orthodontics to the public and to
the wider dental profession. This
will be an annual event, which it
is hoped will encourage enquiries and dialogue about orthodontics; will highlight the expertise
of the orthodontic profession;
will educate patients about the
various types of treatment and
will clarify what can be expected
from treatment.
The launch of NOW will
take place at The National Portrait Gallery on 22 March, 2010,
when the NOW initiatives will
be announced during a private
viewing of the Irving Penn celebrity portrait exhibition. Penn was
famous for taking the photos of
the most glamorous faces in Hollywood; working for many years
for Vogue magazine creating
some of the most iconic images
of the 20th Century.
Do it NOW
The BOS is making the announcement NOW to give the profession plenty of time to gear up for
the event and make preparations
for local and practice initiatives
which will benefit them and their
patients. A new website, www.
nowsmile.org, has been created and dental professionals
are being encouraged to log on
NOW to find out how they can
get involved with the campaign;
download free material for their
practices and even read the blog
being written by an orthodontist
to describe how his practice will
be gearing up for NOW. A visit
to the site will also give dental
professionals the chance to win
one of 50 places to attend the
private viewing at the National
Portrait Gallery on launch day.
A colourful image
Visitors to the site will see at a
glance the bold and colourful
brand image, which has been
created to draw attention to the
profession and the possibilities
offered by orthodontic treatment. Orthodontists will be able
to download a flyer they can use
to promote the week and each
BOS member will be sent free
posters to display in their waiting rooms. They will also be able
to download templates for press
releases they can use to promote
NOW and their practices in their
local press. Also available will
be an expanding menu of suggestions about ways in which
practices might want to run
NOW promotions in their area.
To participate in NOW or to
find out more, please visit www.
nowsmile.org. DT

[31] =>

United Kingdom Edition November 23-29, 2009

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

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

Classified 31

[32] =>

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[cover] => DT UK 2909

[toc] => Array ( [0] => Array ( [title] => HTM 01-05 battle continues after BDA claims [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => News & Opinions [page] => 05 ) [3] => Array ( [title] => Home from home [page] => 09 ) [4] => Array ( [title] => LAB TRIBUNE (part1) [page] => 10 ) [5] => Array ( [title] => LAB TRIBUNE (part2) [page] => 16 ) [6] => Array ( [title] => It’s time to think about the bigger picture [page] => 22 ) [7] => Array ( [title] => Incorporating incorporation into your practice [page] => 24 ) [8] => Array ( [title] => BDTA Show Review [page] => 26 ) [9] => Array ( [title] => Industry News [page] => 28 ) [10] => Array ( [title] => Endodontic re-treatment or implants? [page] => 29 ) [11] => Array ( [title] => BOS announces new event [page] => 30 ) ) [toc_html] =>

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