DT UK No. 11, 2013

News / Opinion: The rot runs deep / Comment: Amit’s Corner - Close Quarters Combat (CQC) / A guide to the NHS England National Performers List / Implant Tribune / Thriving on all-ceramics - Ivoclar Vivadent prepares for the future / Brand new website for one of the UK’s most established private dental training firms / Industry News

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September 2013

PUBLISHED IN LONDON
News in Brief
Stress fuels cancer spread
Scientists have linked the activation of a stress gene in
immune-system cells to the
spread of breast cancer to other parts of the body. The study,
published in the Journal of
Clinical Investigation, suggests
that the gene, ATF3, may be
the crucial link between stress
and cancer, including the major cause of cancer death – its
spread, or metastasis. Tsonwin Hai, professor of molecular and cellular biochemistry
at the Ohio State University
and lead author of the study
said: “If your body does not
help cancer cells, they cannot
spread as far. The rest of the
cells in the body help cancer
cells to move, to set up shop
at distant sites. And one of
the unifying themes here is
stress.”
P&G call for relaxed teeth
whitening laws
Procter & Gamble is asking European regulators to
loosen rules that stop it from
selling teeth-whitening products. P&G’s Whitestrips contain between six and ten per
cent bleach, and its 3DWhite
mouthwash contains 1.5 per
cent bleach. Under EU regulations, products in which the
bleach or hydrogen peroxide
content is between 0.1 and six
per cent can only be offered by
dentists. Products higher than
six per cent are illegal in the
EU. A P&G executive has said
that the US group was pushing
Brussels to ease the restrictions.
Dentist struck off for offering
female circumcision surgery
A dentist has been struck off by
the GDC after it was found that
he conducted an inappropriate intimate examination on
a woman and offered to perform female circumcision on
two children. The allegations
against Omar Sheikh Mohamed Addow included meeting with a woman at his surgery, conducting an intimate
examination of the woman’s
private areas despite not being
a doctor registered with the
GMC; and offering to perform
female circumcision, otherwise known as ‘female genital mutilation’ (FGM), upon
two children. The Committee
stated: “Mr Addow’s conduct
fell far short of the standards expected of a registered
dental
practitioner when he performed
an
intimate
examination
upon the journalist in his dental surgery. He also acted in
a manner that was totally unacceptable for a registered dentist
when he talked with her about,
and planned to perform, FGM
on two children.” DT
www.dental-tribune.co.uk

News

Earnings down for dentists

Amit’s corner

Guided treatment

Stem cells

Amit Rai on the CQC

Dr Pelegrine discusses regenerative medecine

page 8

page 2

Implant Tribune

Comment

Earnings

VOL. 7 NO 11

Dr Kunkela sings the praises of
CAD/CAM and CBCT

pages 13-16

pages 17-20

Steve Field named CQC Chief
Inspector of General Practice
Professor Steve Field has been named as the Care Quality
Commission’s (CQC) first Chief Inspector of General Practice
that we’ve established, but I am
looking forward to working with
Mike Richards again and joining
David Behan’s executive team,
which has been making great
strides in moving the CQC forward in a very positive direction.”
CQC Chief Executive, David Behan said: “It is important
that the Chief Inspector of GenProf Field will lead the CQC’s inspection services

rofessor Field, a GP and
past Chair of the Royal
College of General Practitioners, joins CQC from NHS
England, where he was its deputy national medical director responsible for addressing health
inequalities.
The Chief Inspector of General Practice will lead CQC’s inspection and regulation of providers of primary care services
across the public, private and
independent sectors.
Professor Field’s new role
will involve working in the interests of people who use primary
medical and dental services and
make judgments about the quality of care provided. He will ensure that the CQC is providing
assurance that the health and
adult social care services join up
from the perspective of people
who use services.
He will also introduce
a ratings system for registered
primary care providers. The system will identify good as well
as poor care in order to support

commissioning decisions and a
more informed user choice, as
well as providing assurance that
the fundamental standards are
met and action is taken where
improvements are needed.
Professor Field said: “I
am thrilled at being appointed the first Chief Inspector of
General Practice in England.
I see this as a wonderful opportunity to highlight what’s good in
general practice and dentistry,
and to shine a light on what isn’t.
It’s an opportunity to make sure
that all organisations are encouraged to live up to the standards of the best.
“I have had a long-standing
commitment to address health
inequalities and this role will enable me to ensure that primary
medical services put this increasingly important issue high
on their agendas. It will also allow me to focus on making sure
that people receive health and
care services that are integrated.
“I am sad to be leaving NHS
England, and the great team

eral Practice is trusted not only
by his peers in primary care,
but leaders, staff, and managers
throughout the NHS. Steve Field
is known and respected across
healthcare and is the ideal person to lead our work in primary
medical and dental services as
well as to ensure that those services link well with other health
services and with social care.” DT

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[2] =>

2 News

United Kingdom Edition

September 2013

Study boosts confidence in dental implants
The studies both reported
very high implant survival rates
of more than 98 per cent with
practically no bone loss around
the implants.
The first study was a randomised controlled clinical trial (RCT) at 11 clinical centres
in Europe, USA and Australia.

esults from two of the
largest
international
clinical
studies
performed to date with dental implants have just been published
and demonstrate excellent
clinical performance. Together, the studies have evaluated more than one thousand
Straumann Bone Level implants in Europe, the US and
Australia.

This RCT has evaluated 106
patients each treated with one
implant and followed for three
years. The investigators compared the outcomes of two different approaches – the first
involving two surgical steps, in
which the implant is covered
with gum tissue (‘submerged’)
during healing, and the second
involving just a single step, in

which part of the implant is left
exposed (‘transmucosal’) thus
saving a second surgical operation. Only a single implant was
lost, yielding three-year implantsurvival rates of 98.1 per cent
and 100 per cent for the transmucosal and submerged groups
respectively.
Because bone loss around
implants has been documented
as a common undesirable effect
of implant treatment, this study
looked carefully at bone level
changes. It showed that bone
level was impressively stable
over three years after implant
placement, with mean decreases
of less than 0.7 mm and 0.6 mm
in the submerged and transmucosal groups respectively.

While RCTs demonstrate that
products or treatments work
well, they are usually conducted
by specialists in selected and
strictly-controlled populations.
This study was performed by
dental practices and University
clinics that are highly specialised
in dental implantology, which
raises the question of whether its
excellent results can be reproduced in daily dental practice. To
answer this, a large study using
the same implant was conducted
in Europe and the US, in which
the dentists had to follow the
product guidelines but were able
to use the implant as they would
in normal daily practice. The
strength of this type of investigation, which is known as ‘non-interventional study’ (NIS), is that

it documents real-life situations,
in which indications, patients
and conditions all vary widely.
In this study, a total of 908
implants were evaluated in 538
patients at more than a hundred
dental practices in six countries,
revealing an implant survival
rate of 98.5 per cent after one
year (the risk of failure is highest in the first year after implant
placement). Besides the very
high survival rates, the bone
level remained very stable in the
majority of cases. The investigators therefore concluded that
treatment with Straumann Bone
Level Implants yielded very
successful outcomes in ‘real
life’ conditions. DT

Earnings down for dentists Dentist hopes to

clone John Lennon

n 2011, dentist Michael Zuk
purchased John Lennon’s
tooth at auction and has
since made a line of DNA pendants from it. Now he has gone
one step further, and given the
tooth to scientists in the hope
that they will be able to use the
DNA and clone Lennon.

he annual ‘Dental Earnings and Expenses’ report
has now been published.

The report covers England
and Wales 2011-12, and provides
a detailed study of the earnings
and expenses of full and part
time self-employed primary care
dentists who carried out some
NHS work in England or Wales
during 2011-12.

The report found that the average taxable income from NHS
and private dentistry for Providing-Performer dentists was
£112,800, compared to £61,800
for Performer Only dentists. For
all self-employed primary care
dentists this figure was £74,000.
The average gross earnings
for Providing-Performer dentists were £358,400, compared

“I am nervous and excited at the possibility that we
will be able to fully sequence
John Lennon’s DNA,” he said.
“With researchers working
on ways to clone mammoths,
the same technology certainly
could make human cloning a
reality.” DT

to £96,200 for Performer Only
dentists. The average total expenses for Providing-Performer
dentists were £245,600, compared to £34,500 for Performer
Only dentists.
These figures are down
from last year’s report, which
showed that the all incomes
and expenses were higher in
2010-11. DT

Michael Zuk hopes to clones Lennon from his tooth

Welsh cancer patients ‘denied new drugs’
Published by Dental Tribune UK Ltd
© 2013, 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.

Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@healthcare-learning.
com

Sales Executive
Joe Ackah
Tel: 020 7400 8964
Joe.ackah@
healthcare-learning.com

Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@healthcare-learning.
com

Editorial Assistant
Angharad Jones
Angharad.jones@healthcarelearning.com

Design & Production
Ellen Sawle
Tel: 020 7400 8970
ellen@healthcare-learning.
com

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

ancer patients in Wales are
more than four times less
likely to receive a newer
drug on the NHS than those in
England, it is claimed.
The Rarer Cancers Foundation (RCF) said the Welsh government’s figures show the full extent
of inequality in access to cancer
drugs across the country. Health
ministers in England set up a
special fund worth £200m a year
in 2010, to help pay for expensive
new cancer drugs. In contrast,
patients in Wales have to make
individual requests for funding

through their doctor if a new medicine has not yet been approved by
the watchdog NICE.
Andrew Wilson, chief executive of the RCF, claims cancer
patients in Wales are paying the
price for a failure to fix the broken system. “The Welsh Assembly
Government’s own figures reveal
the extent of inequality in access
to cancer drugs in Wales. Cancer
patients are paying the price for a
failure to fix this broken system.
“The needs of cancer patients
are no less pressing on one side of

a border than they are on another,
nor are treatments any less effective. Urgent action is needed to
end this inequality.”
A spokesperson for the Welsh
Government said: We care greatly
about providing the best care for
the people of Wales and our commitment is to provide evidencebased, cost-effective treatments
fairly to everyone.
“A cancer drugs fund would
unfairly disadvantage many patients with serious conditions other than cancer.” DT

[3] =>

United Kingdom Edition

News 3

September 2013

Editorial comment

ello all and
welcome to the
latest edition of
Dental Tribune UK. I
hope you all had time
to enjoy the summer and are
back refreshed and ready to go
for the rest of the year!
You may have noticed
that DTUK has undergone a
couple of changes, the biggest
of which is how many times
it is being published. With immediate effect, Dental Tribune UK will now be published
monthly.
The editorial team will still
strive to maintain the usual mix
of high quality clinical and business articles, news and views.
We have our new columnist,
Amit Rai, who will be taking a
regular look at the world of den-

Letter to
the Editor

ear Editor,
Last spring it was
widely reported that
dangerous x-ray machines from
China, which emit harmful xrays both to the dentist operating the machine and the patient,
had been bought by some dental practices. I had thought this
would have been clamped down
on by now by the authorities.
However, the BBC 1 programme “Fake Britain” recently
reported that this is still occurring. These fake dental x-ray
machines do not have the lead
protection inside, so the patient’s whole face is exposed
to radiation and the operator’s
hands and body receive x-rays,
which can cause cancer. The
thyroid gland is particularly
damaged by radiation.
The programme stated that
all kinds of dangerous fake dental instruments are being sold to
dental practices, including drills
which could explode and shatter in a patient’s mouth while
being used. The results could
be horrific.
Why are these not being
prevented from entering the
country, and I wonder if any
investigations being done by
the authorities to check if dental practices have unknowingly
bought dangerous fake dental
equipment? This is necessary
for the health of both dental
staff and patients.
Best wishes,

tistry and giving his comments.
Neel Kothari is as ever a regular
feature, and you’ll still see plenty of news and analysis.
As always, if you’d like to
give feedback or want to contribute with an article or clinical
case study please get in touch.

This month the big news
is the appointment of Professor Steve Field as the CQC’s
Chief Inspector of General Practice. Now, we all know that any
lead job at the CQC will make
you about as popular as, well,
an inspector on your doorstep from the CQC, and Prof
Field will have his work cut

out for him as he brings in a
ratings system for inspected
services and strives to provide
consistency across all inspections, including those of dental
practices.
Good luck to Prof
Field! 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@healthcare-learning.com

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4 News

United Kingdom Edition

September 2013

Ban lifted on healthcare workers with HIV

ealthcare workers with
HIV will be able to return
to practice, Chief Medical Officer Dame Sally Davies has
announced.
Following independent scientific advice, the Department of
Health will lift the ban on healthcare workers with HIV being able
to carry out certain dental and
surgical procedures. Strict rules

on treatment, monitoring and
testing will be in place to safeguard patients.
The regulations were brought
in after the publicity associated
with the death of an American
dental patient in 1990, one of six
patients believed to have been
infected with HIV in an unresolved Florida case. Regulatory
bodies in most countries respond-

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“The announcement brings
England into line with nations
including Sweden, France, Canada and New Zealand, and is
good news for patients and HIVpositive dentists alike. We look
forward to seeing its implementation.”
Kevin Lewis, Dental Director
at Dental Protection, said: “This is
a huge victory for human rights.
After decades of living in fear and
dealing with prejudice, dentists
can finally return to their professional calling, although regrettably it is too late for some to do
so. Patient safety should be at the
forefront of healthcare, but the
original rules were introduced
as a reaction to a mysterious
and exceptional case, the likes of
which we have not seen before or
since.”
Allan Reid is a dentist with
HIV, and as a result has been
unable to practice since 2008.
Speaking to Dental Tribune UK,
he said the lift on the ban was “a
great step forward. It’s the correct thing to do; there’s a massive
body of evidence that healthcare
workers won’t pass on the virus
to patients, but the timescale
[from implementing the ban to
lifting it] has been huge.”

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He is, however, concerned
about the level of support healthcare workers will receive if they
want to return to practice: “I’m
worried about the number of
careers that have been lost, and
I hope these people won’t be forgotten about. It’s really important
that those who want to go back
into practice are re-trained and
given full support.”

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As for Allan, he is currently
training as a consultant in public
health, but says he would very
much like to go back to practicing
dentistry – provided he is given
the appropriate training to make
up for five years that he has been
unable to practise. DT

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The policy will be put in place
from April 2014. Decided on a
case-by-case basis, HIV-infected
healthcare workers may be allowed to undertake certain procedures if they are on effective
combination antiretroviral drug
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fecting patients reported worldwide and the last of these was
more than a decade ago.

The British Dental Association’s scientific adviser Professor
Damien Walmsley said: “Dentists
in the UK comply with rigorous
infection control procedures to
protect both patients and the dental team against the risk of transmission of blood-borne infections.

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This change will bring the
United Kingdom in line with most
other Western countries. Under
the new system, patients will
have more chance – around one
in five million – of being struck
by lightning than being infected
with HIV by a healthcare worker.
There is no record of any patient
ever being infected through this
route in the UK. There have been
just four cases of clinicians in-

ed to the case differently – the UK
banned all HIV-infected healthcare professionals from undertaking exposure-prone procedures, leading to health workers
becoming deskilled, losing their
careers, or suffering in silence.
Since most dental procedures
are classified as exposure prone,
the ban had a devastating significance for dentists diagnosed with
the disease.

28/08/2013 11:04

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Two of the UK’s most respected education and academic organisations have joined forces to provide an
innovative, technology driven MSc in Restorative and Aesthetic Dentistry. Healthcare Learning Smile-on,
the UK’s pre-eminent healthcare education provider and the University of Manchester, one of the top
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live learning and print.

The programme is
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his/her own learning.
The emphasis is on a
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approach.

Students will be able
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a diverse multi-ethnic
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will also share residential get-togethers in
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around the world.

This innovative programme establishes
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[6] =>

United Kingdom Edition

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The rot runs deep
Stephen Hudson discusses modern dentistry

n my mind, there is a problem that the profession
is not addressing, which
can easily be displayed by
the publication you are presently reading. I want you to
scan though it and look at all
the adverts for postgraduate
courses:
What do you see?
You see lots of courses on
how to do smile makeovers,
ortho, veneers, implants and
aesthetics.
What don’t you see?

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September 2013

You see nothing on perio,
rapport building, diagnostics,
LA techniques, minimal intervention dentistry, caries removal or hands on RCT.
Not the fault of the Dental
Tribune, because they have
no control over the advertising sent to them. And whilst
on a local level there is a fair
bit of these latter courses offered though the deaneries,
whenever I go on these courses, it’s always the same faces I
keep seeing. And many of the
courses are mediocre at best,
with some notable exceptions
of course.
And then I hear that at least
one dental school has dropped
the “treatment of a patient under exam conditions” from the
finals exam. That makes no
sense to me whatsoever. I just
can’t comprehend the thinking
behind that and am amazed
that (assuming they have been
told of this event) the GDC inspections have allowed it. I’m
also hearing reports that graduates are leaving dental school
never having done a molar
endo, and never having made
a F/F. Now I’m sure the powers that be know what they are
doing, and it all looks a little
short sighted from where I’m
sat.
It worries me.
Now have a chat with any
dental adviser from DPL or
DDU and they will tell you
how claims are rising, even
with the governments actions
on no win no fee. And barring
the fact that “stuff happens”
that we can’t predict, claims
are rising because of two main
factors:
Dentists are doing things
they shouldn’t be doing on
people they shouldn’t be treating; and dentists aren’t doing

things on people they should
be treating.
We are making a rod for
our own backs, and the lawyers, often quite rightly, are
getting very rich because of it.
Then we hear that some figures state that almost 30 per
cent of all claims are down to
what one dentist says about
another dentist’s work (usually without being in full awareness of all the facts) and there
is a huge tsunami threatening
to wash over the “profession”.
It’s a tsunami of our own
making, and down to either
our own greed and egos, or
the fact that many practitioners, devoid of passion and

‘Dentists are doing things they
shouldn’t be doing on people they
shouldn’t be treating; and dentists
aren’t doing things
on people they
should be treating’

hope end up in a spiral of
despair, doing as little as possible with retirement the
only thing keeping them going. And then we season with
one more statistic; that all the
complaints received by dentists often make up just three
per cent of those who COULD
legitimately complain. It actually looks like we’ve been getting off lightly.
So, what exactly am I
saying?
I am saying that, on the
whole, we have lost our way.
I am not saying there is anything wrong with doing six
veneers on a patient, but I am
saying that if you didn’t specifically warn that patient of the
risks and the chances of having to redo all that work on a
regular basis, then I’m going
to give you a concerned look.
If that patient didn’t walk into
having that treatment with the
eyes wide open and the knowledge that the UL2 could blow
up and need endo, then that
treatment wasn’t done in the

patient’s best interest. Hiding
those warnings in a sevenpage treatment plan that the
patient probably didn’t read
doesn’t absolve you in my
book.
Of course, that’s just my
opinion. It doesn’t mean I’m
right, it just means I have an
opinion. I think sticking porcelain on people’s teeth should
be way down the list of options
and should be considered as
a last resort. For example, I
struggle to see how a dentist
can sell a “course of veneers”
on one of those cut price deals
websites without even seeing
the patient first.
I just don’t get it.
There is of course the media image of the celebrity smile
which some patients clamour
for, and it is surely our duty
to say “hold on, that might
not be right for you”. I often
hear dentists who want to be
the next Dr X, or the next Dr
Y, sucked into the glow of being a “dental celebrity” which
lets the ego get in the way of
the important things. Like the
fact that happiness and self
respect come from the inside,
not from the external. That
our interpretation of what we
look like is a thousand miles
away from what other people
see. That most people don’t
notice your slightly rotated
upper left central, because
they are too bothered worrying about how their own
image is being perceived by
those around them. If we think
our slightly crooked smile, or
our darkened teeth will effect
how others view you, we will
often manifest evidence to
prove this. If we don’t that evidence often strangely doesn’t
appear.
The true judge of an individual is not their perceived
physical attractiveness. The
true judge is the person’s
character.
Maxwell Maltz became
one of New York’s most successful plastic surgeons from
a squat practice, by sending
his patients away for 30 days
to do visualisation exercises
to change their self perception of what they deemed to be
their problem. Fifty per cent of
his clients reported that they
no longer needed the surgery
at the end of the 30 days. But
the referrals from the patients
who respected him so much
kept him busier than ever.

[7] =>

United Kingdom Edition

And so I ask; where is the
training?
There are 30,000 dentists
in this country. Where is the
mandatory national training
pathway that we should be
following? Airline Pilots can’t
get off the ground without being tested every six months,
and surgeons can’t operate
without regular peer reviewed
examination. Why does this
not apply to us? Oh I know
FGDP do a pathway of sorts,
but it’s not cheap and has limited places.
Go into any lab in the
country and ask them to show

‘When I talk to the
oral surgeons that
I know, they tell
me that at least 40
per cent of all the
implants placed
in this country are
badly done. Forty
per cent’

you the preps they are making crowns on. Look at the
imps they are being sent. It
will shock you; it certainly
shocked me when I last did it.
There aren’t many courses out
there that get you to cut a posterior gold onlay prep in peer
reviewed conditions. But there
are plenty of courses to show
you how to coat teeth with
porcelain.
When I talk to the oral surgeons that I know, they tell
me that at least 40 per cent of
all the implants placed in this
country are badly done. Forty
per cent. If correct, that’s a
staggering number and one
that I am sure the indemnity
providers are seriously worrying about. Whilst I know
we have to start somewhere,
we should not be doing treatments we are not competent
to do. We shouldn’t be doing
treatments that aren’t in the
best interest of the patients,
and we shouldn’t be doing
treatments solely because it
will pay for the next instalment on the Jag. And most of
all, we shouldn’t be doing such
advanced treatments (some
would argue any treatments)
on patients we don’t have rapport with.
That’s not what dentistry
is about.
We need courses that are

comprehensive, that cover the
basics and which cover the
more advanced stuff. Failing
to spot and treat perio problems is one of the biggest
case loads facing dental indemnifiers at the moment.
Where are the nationally
run hands on courses to correct this? Why are dentist allowed to place implants after a
weekend course at Gatwick?
Why do the GDC’s core subjects not cover anything to

Opinion 7

September 2013

do with clinical dentistry?
That’s obscene. Ok, you can
handle a complaint, but how’s
about having rapport skills
so that the complaint never
arose, and the clinical skills
that meant your six veneers
didn’t keep dropping off in the
first place.
What I do know is that we,
as a profession, will not correct
this ourselves. We will spiral
down into a hole of our own

making until someone turns
around and MAKES us change.
And then we will likely end up
like the USA where everything
gets farmed out to specialists,
increasing the costs, and increasing the inconvenience to
the patient.
And you know what; I have
no idea how to correct this.
That’s my confession. It will
take a smarter person than me
to build a barrier against the

incoming tsunami.
That’s the way it looks from
here. DT

About the author
Dr Stephen Hudson BDS, MFGDP,
MSc is a dental practice owner working in Chesterfield. When he qualified in 1995, he soon realised that the
way most dentists treadmilled their
dentistry was slowly killing them,
and decided he needed to try and do
something to reverse this trend. This
was why he set up the website www.
gdpresources.co.uk.

[8] =>

8 Comment

Amit’s Corner
Close Quarters Combat (CQC)

T

he Sale of Goods Act 1979
(as amended) lays down
conditions that all goods
sold by a trader must meet, including those of the goods being “fit for purpose”. These three
words have also been increas-

ingly used to question the role of
the CQC following the recently alleged “cover up” of their failure to
spot problems within the University Hospitals of Morecambe Bay
Foundation Trust.

United Kingdom Edition

The CQC began operating in
April 2009, as the single regulator for health and adult social
care, replacing the Healthcare
Commission, the Commission
for Social Care Inspection and the
Mental Health Act Commission.
This integrated approach gave
rise to a generalist system of inspections and an inherent conflict
of interest whereby the CQC was
involved in both the identification and rectification of quality of
care issues. Many commentators

have said that this generalist system evidences the way in which
the previous government actively
sought to dis-empower clinicians
in inspections - possibly because
they would speak the uncomfortable truth. With the recent NHS reforms placing the emphasis right
back on grass roots clinicians,
perhaps this could change.
The events of Morecambe
Bay have certainly cast the spotlight back on the CQC’s methods

September 2013

of inspections post-Francis. And
Jeremy Hunt, health secretary,
has touched upon what most of
us have been thinking for years,
how can the same inspector reliably inspect such different facilities as a dental practice, a GP surgery, a hospital and a care home?
Anecdotally, this is perhaps
the reason many GDPs fear CQC
inspections, sometimes referring
to them as Close Quarters Combat
(CQC) – defined as a type of warfare in which small units (one or
two inspectors) engage the enemy
(GDP teams) with weapons (clipboard and pen) at very short range.
Although many professions
may jump to their own defence
with cries of “uniqueness”, the
practise of general dentistry is truly unique in that the investigation,
diagnosis, prevention and treatment of disease all takes place
within the same four walls, by the
same clinician.
A cursory scan of the thread of
comments provided by readers in
response to the HSJ article Investigators reveal CQC ‘cover up’ over
Morecambe Bay reveals some
support for the CQC to conduct
more unannounced inspections.
However, many would argue that
the “dawn raid” of services won’t
really provide an indication of the
quality of care being provided, but
rather an indication of how well
registered managers and their
teams act under pressure.
It strikes many as rather ironic
that the same regulator which advocates patient feedback and positively acting upon criticism has
been blamed for not tolerating it,
according to Dr Heather Wood, a
former CQC inspector.
These are certainly tough
times for the CQC as they have
openly named the people, including former chief executive Cynthia
Bower, present when the decision
was taken to allegedly suppress a
report identifying weaknesses in
their inspections of the University Hospitals of Morecambe Bay
Foundation Trust. However, as
Hunt noted, this action is a “sign
that the NHS is changing”. Time
will tell whether this change is for
the better, but irrespectively, we
should all spare a thought for the
families of the up to 16 babies and
two mothers feared to have died
in the maternity unit at the Barrow-in-Furness hospital between
2001 and 2012.
*The views expressed in this column are
those of the author and do not reflect the
views of, and should not be attributed to,
any organisation or institute he works for.

About the author
Amit Rai is a General Dental Practitioner, Dental Educator and Advisor
with a Dento-Legal
background.

[9] =>

United Kingdom Edition

NHS 9

September 2013

A guide to the NHS England National Performers List
If you are a dentist who currently performs NHS treatment or a dentist wishing to begin performing NHS treatment then this article provides a practical guide to assist

entists who would like
to carry out treatment
under an NHS contract
must be registered on the NHS
England National Performers
List, which was introduced on
1st April 2013 following the
abolition of the PCTs.
The list was set up to provide additional reassurance to
the public that health care providers like dentists were suitably qualified, trained including
having appropriate language
skills and that they had passed
other requirements such as
having a clear Disclosure and
Barring Service check (the old
eCRB check).
New Performers
A dentist who has never performed NHS treatment prior to
1st April 2013 must apply to be
registered on the NHS England
National Performers List.

tificate or alternative
h. The outcome of a recent appraisal (if available)
i. Work permit (if applicable)

j. Evidence of membership of
a recognised defence organisation
k. Completed DBS form or existing eCRB (not more than

three months old) together with further documents
as may be required by the
Disclosure and Barring Service in order to provide a DSB
check

I’d like to study over a
one or two year period
and gain a recognised
qualification in dental
practice management

If the dentist is making the
application from outside of
England then there are only
six specialised Area Teams
à DT page 10

I’m looking for a one year
programme without the
stress of formal assessments

A completed Performers
List Application Form will
need to be submitted to the
Local Area Team in charge of

‘The list was set up
to provide additional reassurance
to the public that
health care providers like dentists
were suitably qualified, trained including having appropriate language
skills and that they
had passed other
requirements’
the area the dentist wishes to
work in together with the following documents:
a. Passport or photo driving licence

I need a one year university accredited
postgraduate programme that will help
me run my business better

Flexible business learning for principals,
managers and ambitious team members

b. Full registration with the
GDC
c. Graduation certificate
d. Completion of Vocation
Training Certificate or Certificate of Prescribed/Equivalent
Experience
e. Recent Occupational Health
Report (if available)
f. A detailed Curriculum Vitae
or details of your work history
g. Language Knowledge Cer-

0161 928 5995
sim@thedentistrybusiness.com
www.thedentistrybusiness.com

All programmes available*
in Birmingham, Bristol
Durham, London,
Manchester and Norwich.
dependent on demand

[10] =>

10 NHS

United Kingdom Edition

5. Merseyside AT for performers whose address is in Northern Ireland

ß DT page 9

who can process the application as follows:
1. Cumbria, Northumbria and
Tyne and Wear AT for performers whose address is in
Scotland
2. Shropshire/Staffordshire AT
for performers whose address
is in North Wales

‘NHS England recognises that there is
a need for a uniform approach to
transfers and has drafted a new policy’

3.
Arden,
Hereford
and
Worcester AT for performers whose address is in South
Wales

4. Wessex AT for performers
whose address is in the Channel Islands

6. London North West AT for
performers whose address is
outside the UK
On submission of the form
to the relevant Local Area
Team, it takes six to eight
weeks until the dentist is added to the performer list if they
are happy with the information provided.

September 2013

Existing Performers
A dentist who performed NHS
treatment prior to 1st April
2013 will have already been
registered on a PCT performer list. These lists have now
been amalgamated and have
become the NHS England National Performer List. This list
is accessible by all Local Area
Teams (LATs) who now oversee the performance of dental
contracts.
If a dentist wishes to move
from one area to another they
must contact the new LAT under which they wish to perform. NHS services will then
be able to access their details
on the National Performer’s
List. Each LAT will have different requirements but they
should all be able to facilitate
the transfer of a dentist from
performing under one LAT to
another.
The new LAT will liaise
with the old LAT and will carry
out checks in relation to the
dentist’s qualifications and records. The LAT the dentist is
leaving will then give a declaration to the new LAT that
there are no issues concerning
the dentist and the dentist will
then be able to perform NHS
treatment under the authority
of the new LAT. This should
take around two weeks.
NHS England recognises that there is a need for a
uniform approach to transfers and has drafted a new
policy with an expected release date of 1st August 2013.
Until then, dentists will have
to simply follow the ad hoc
transfer procedure required
by each LAT.
At the time of going to press
no policy has been published
by NHS England, and having
spoken to a number of LATs
across the country, whilst they
are aware of this policy and its
imminent release, no policy
has been issued as yet. DT

About the author
Hewi Ma is a Trainee
Solicitor at Goodman
Grant. For more information call Goodman Grant on 0151
707 0090 or email
rng@goodmanlegal.
co.uk or email jmg@
goodmangrant.co.uk

[11] =>

Implant Tribune
Implant Tribune

Implant Tribune

Implant Tribune

Prevention of failure

One-visit guided treatment

Stem Cells

Dr Almog on preventing failures in implantology

Dr Kunkela sings the praises of CAD/CAM and CBCT

Dr Pelegrine discusses regenerative medicine

pages 11-12

pages 17-20

pages 13-16

Prevention of failures in
oral implantology
Dr Dov M Almog

Fig 1: Implant fracture

I

ntra-oral and panoramic
images are not 3-D and
clinicians can obtain only
vague measurements from
them owing to magnification
changes due to positioning.
In addition, they are not efficient for viewing certain pathologies. In response to these
limitations, CBCT 3-D imaging
technologies were developed.
CBCT 3-D captures a volume
of data and, through a reconstruction process, it delivers
images that do not contain
magnification, distortion and/
or overlapping anatomy.

Fig 2: Impingement on adjacent tooth

In recent years, CBCT 3-D
has begun to make significant
inroads into every discipline
in our dental profession, expanding the horizons of clinical dental practice by adding a
third dimension to cranio-facial treatment planning. CBCT
uses advanced 3-D technology
to provide the most complete
anatomical information on a
patient’s mouth, face and jaws
areas, leading to enhanced
treatment planning and predictable treatment outcomes.
Essentially, this represents

a paradigm shift, where measurements and anatomical re-

ships. According to dental
practitioners using this tech-

‘In recent years, CBCT 3-D has begun to
make significant inroads into every discipline in our dental profession, expanding
the horizons of clinical dental practice’
lationships are precise and
provide practitioners with a
clear understanding of their
patients’ anatomical relation-

ogy, it is estimated that growth
in implant-based dental reconstruction products will
outstrip all other areas of dentistry, according to Kalorama
Information1. The traditional
method of replacing a tooth
with a dental bridge has been
shown to be problematic, and
more permanent solutions are
urgently needed.

nology, it helps them perform
treatment more efficiently.

With a rapidly ageing population in the developed world
and the resulting enormous

Regarding oral implantol-

à DT page 12

[12] =>

12 Implant Tribune

United Kingdom Edition

September 2013

ß DT page 11

need for dental restoration, a
large number of companies
have seen the opportunity to
adopt these sophisticated dental techniques. And indeed,
as some have predicted, the
growth in dental implant based
procedures has increased considerably in recent years.
As a result, there has been
a rapid increase in the number of practitioners involved

Fig 3: Perforation of lingual undercut Fig 4: Left sinus perforation

in implant placement, including specialists and generalists,
with different levels of expertise. At the same time, a num-

Fig 5: Implants displaced into the maxillary sinus

ber of unusual complications
associated with these procedures have arisen. A literature
and web search revealed sev-

eral published reports of such
complications, which include
implant fractures (Fig 1), impingement on adjacent teeth

(Fig 2), perforation of the lingual undercut (Fig 3), sinus
perforations (Fig 4) and implants displaced into the maxillary sinus (Fig 5).
The clinical management
associated with some of these
complications is difficult at
times and considered very invasive. Therefore, while the
quantitative relationship be-

‘The clinical management associated
with some of these
complications is
difficult at times
and considered
very invasive’

tween successful outcomes in
dental implant treatment and
CBCT-based dental imaging
is unknown and awaits discovery through large prospective clinical trials, I strongly
believe that using CBCT- and
3D-based dental imaging is
becoming a reliable procedure
from a precautionary standpoint based on a series of recent preliminary clinical studies and case reports.
I also strongly believe that
by taking 3D CBCT images prior to placing dental implants,
many of the above-mentioned
complications can be circumvented. DT

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Reference
1. Kalorama Information, “Implant-based
dental reconstruction: The worldwide
implant and bone graft market”,
2007 www.kaloramainformation.com/
pub/1099235.html,
accessed 6 June 2011.

About the author

Email: jsdsales@js-davis.co.uk
Visit: www.js-davis.co.uk

Dr Dov Almog is
a
prosthodontist
with more than 30
years of diversified
professional
experience in clinical, academic and
research environments. His publications include articles on CBCT, dental implants, carotid
artery calcifications and practice management. In 2003, in acknowledgment
of his research on incidental findings
of carotid artery calcifications on panoramic radiographs, he received the
Arthur H. Wuehrmann Award from the
American Academy of Oral and Maxillofacial Radiology. Dr Almog currently
serves as chief of the dental service for
the VA New Jersey Health Care System
of the US Department of Veterans Affairs.

[13] =>

United Kingdom Edition

September 2013

Implant Tribune 13

Stem cells in implant dentistry
Dr André Antonio Pelegrine discusses regenerative medicine and its applications
in implant dentistry

he human body encompasses more than 200 different types of cells, which
are organised into tissues and organs that perform all the tasks required to maintain the viability of
the system and reproduction. In
healthy adult tissues, the cell population size is the result of a fine
balance between proliferation,
differentiation and cell death.

It has long been observed
that tissues can present a wide
variety of cells and in the case of
blood, skin and the gastric lining,
the differentiated cells possess a
short half-life and are incapable

tissue. Research into stem cell is
inspired in the desire to understand how the tissues are maintained and repaired in adulthood
and how so many cell types can
be derived from human embryos.

of renewing themselves. This has
led to the idea that some tissues
may be maintained by stem cells,
which are defined as cells with a
huge renewal capacity (self-replication) and the ability to generate

daughter cells with the capacity
of differentiation. Such cells, also
known as adult stem cells, will
only produce the appropriate cell
à DT page 14

Following tissue injury, cell
proliferation begins to repair the
damage. In order to achieve this,
quiescent cells (dormant cells) in
the tissue become proliferative or
stem cells are activated and differentiate into the appropriate cell
type needed to repair the damaged

Fig 1. Stem Cell following either selfreplication or differentiation pathway

Fig 2. Different tissues originated from
mesenchymal stem

Fig 3. Diversity of cell types present in the
bone

honigum.
Overcoming opposites.
Fig 4a. Point of needle puncture for access
to the bone marrow space in the pelvic
bone

Often times, compromises have to be made when developing impression materials. Because normally the rheological
properties of stability and good flow characteristics would
stand in each other’s way. DMG’s Honigum overcomes these
contradictions. Thanks to its unique rheological active

matrix, Honigum yields highest ratings in both disciplines.
We are very pleased to see that even the noted test institute
»The Dental Advisor« values that fact: Among 50 VPS
Honigum received the best »clinical ratings«*
www.dmg-dental.com

2012
Fig 4b. Needle inside the bone marrow

Fig 5a. Bone graft being harvested from
the chin (mentum)

2010 Pr

e f e r r e d Pr o du
c ts

* The Dental Advisor, Vol. 23, No. 3, p 2-5

AZM_Honigum_DeEnItFr_1203.indd 1

02.04.12 09:47

[14] =>

14 Implant Tribune
ß DT page 13

lines for the tissues in which they
reside (Fig 1).
Not only can stem cells be isolated from both adult and embryo
tissues, they can also be kept in
cultures as undifferentiated cells.
The embryo stem cells have the
ability to produce all the differentiated cells of the adult. Their
potential can therefore be extended beyond the conventional
mesodermal lineage to include
differentiation into liver, kidney,

muscle, skin, as well as cardiac
and nerve cells (Fig 2).
The recognition of the stem
cell potential unearthed a new
age in Medicine - the Regeneration Medicine Age. It has made it
possible to consider that an otherwise lost organ or damaged tissue
could be regenerated. Because
the use of embryo stem cells stirs
up ethical issues for obvious reasons, most scientific studies focus
on the applications of adult stem
cells, although these are not con-

United Kingdom Edition

sidered as versatile as the embryo
stem cells, since most researchers
regard them as multipotent, ie capable of giving rise to some types
of specific cells/tissues, whereas
the embryo stem cells can differentiate into any and all types of
cell/tissue groups. With the advance of scientific research, some
tissues were noted to have greater difficulty regenerating, such as
the nervous tissue, whereas bone
and blood, for instance, are considered more suitable for stem
cell therapy.

In dentistry, the pulp from
deciduous teeth has been thoroughly investigated as a potential
source of stem cells with promising results. However, the regeneration of an entire tooth, also
known as THIRD DENTITION, is
a highly complex process, which
despite some promising results
with animals, remains very far
from clinical applicability. The
opposite has been observed in
the area of jawbone regeneration, where there is a higher level
of scientific evidence on its clini-

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Bone marrow is regarded as a
hematopoietic organ, ie capable
of producing all the blood cells.

Fig 5c. Bone graft being harvested from
the angle of the skull (calvaria)

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cal applications. Currently, adult
stem cells have been harvested
from some tissues, such as bone
marrow and fat.

Fig 5b. Bone graft being harvested from
the angle of the mandible (ramus)

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Fig 5d. Bone graft being harvested from
the angle of the leg (tibia or fibula)

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Fig 6. Critical bony defect created in the
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Fig 7. Primary culture of adult mesenchymal stem cells from the bone marrow
after 21 days of culture

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Fig 8a. Computerised Tomography of the
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with stem cells (note how the bony defect
has practically resolved)

[15] =>

United Kingdom Edition

Since the 1950s, when Nobel Prize
winner Dr E Donnall Thomas
demonstrated the viability of bone
marrow transplants in patients
with leukemia, many lives have

been saved using this approach
for a variety of immunological and
hematopoietic illnesses. However,
the bone marrow contains more
than just hematopoietic stem cells
(which give rise to red and white
blood cells as well as platelets,
for example), it is also home to
mesenchymal stem cells (which
will become bone, muscle and
fat tissues, for instance) (Fig 3).
Bone marrow harvesting is
carried out under local anesthesia using an aspiration needle

Implant Tribune 15

September 2013

through the iliac (pelvic) bone.
Despite requiring a competent
doctor to perform such task, it is
not regarded as an excessively invasive or complex procedure. It is
also not associated with high levels of discomfort either intra- or
post-operatively. (Figs 4a-b).
Bone reconstruction is a challenge in dentistry (also in orthopedics and oncology), since rebuilding bony defects caused by
trauma, infections, tumors and
dental extractions requires bone

grafting. The lack of bone in the
jaws may impede the placement of
dental implants, thus adversely
affecting patients’ quality of life. In
order to remedy bone scarcity, a
bone graft is traditionally harvested from the chin region or the angle
of the mandible. If the amount required is too large, bone from the
skull, legs or pelvis may be used.
Differently from the bone marrow,
the process involved in obtaining
larger bone grafts is often associated with high levels of discomfort
and, occasionally, inevitable post-

operative sequelae (Figs 5a-e).
All the problems related to
bone grafting have been encouraging the use of bone substitutes
(synthetic materials, human or
bovine donors). However, such
materials show inferior results
compared to autologous bone
grafts since they lack autologous
proteins. Therefore, in critical
bony defects, ie those requiring
specific therapy to recover its
à DT page 16

Fig 8b. Computerised Tomography of the
rabbit skull after bone-sparing grafting
with stem cells (note how the bony defect
has practically resolved)

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[16] =>

16 Implant Tribune

United Kingdom Edition

ß DT page 15

original contour, a novel concept
to prevent autologous grafting,
consisting in the use of bonesparing material associated with
stem cells from the same patient,
has been gaining ground as a
more modern philosophy of treatment. Consequently, in detriment
of traditional bone grafting (with
all its inherent problems), this
new method of associating stem
cells to mineralised materials allows, for the first time, the use of a
viable graft with cells from the pa-

Fig 11d. Bone marrow combined with
Ficoll (to aid cell separation)

Fig 11e. Pipette-collection of the interphase containing mononuclear cells
(where the stem cells are present)
Fig 11g. Pellet containing the bone marrow mononuclear cells after the second
centrifuge spin

Fig 11f. Second centrifuge spin

Fig 11h. Bovine bone graft combined with
marrow stem cell concentrate

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for surgical bone harvesting.

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Despite the concept of using
bone marrow stem cells for bone
reconstruction, there were no studies, until recently, comparing the
different methods available. Here
we shall summarise a study developed by our research team, which
consisted in the creation of critical
bony defects in rabbits and subsequently applying each of the four
main stem cell methods used
globally, in order to compare
their effectiveness in terms of
bone healing1: Fresh bone marrow (without processing); Bone
marrow stem cell concentrate;
Bone marrow stem cell culture;
Fat stem cell culture (Figs 6-7).
In a fifth group of animals,
no cell therapy method (Control
Group) was used. The results
showed that the groups in which
a bone marrow stem cell concentrate (2) and a bone marrow stem
cell culture (3) were used revealed the best bone regeneration
results and that the control group
showed the worst results. It was
suggested that stem cells from
the bone marrow would be more
suitable than those from fat tissue for bone reconstruction and
that a simple method of stem cell
concentrate (which takes a few
hours) revealed similar results to
those obtained from complex cell
culture procedures (which take
on average three-four weeks).
(Figs 8a-b)
Similar studies performed in
humans have been reinforcing
the finding that bone marrow
stem cells improve the repair of
bony defects caused by trauma,
dental extractions or tumors. The
histological images below illustrate the higher potential of bonesparing materials when combined with stem cells for bone
reconstruction (Fig 9). It is clear
that the level of mineralised tissue is significantly higher in those
areas where stem cells were applied. (Figs 10a-b)
Evidently, despite the bone
marrow stem cell techniques for
bone reconstruction being close to
routine clinical use, much caution must be exercised before indicating such procedure, as it demands an appropriately trained
surgical and lab team, as well as
the availability of the necessary
resources (see images taken during lab manipulation of marrow
stem cells at Sao Leopoldo Mandic Dental School) (Figs 11a-h) DT
*Images courtesy of Células Tronco em Implantodontia

About the author
Dr. André Antonio Pelegrine is a specialist
dental surgeon in periodontology and implant
dentistry (CFO) with an
MSc in Implant Dentistry (UNISA), and a PhD in clinical
medicine (University of Campinas).
He is an associate lecturer in implant
dentistry at São Leopoldo Mandic
dental school and coordinator of the
perio-prosthodontic-implant dentistry
team at the University of Campinas
in Brazil. He can be contacted at pelegrineandre@gmail.com.

[17] =>

United Kingdom Edition

Implant Tribune 17

September 2013

One visit guided treatment
Author_ Dr Josef Kunkela

U

ntil very recently, my patients would have considered undergoing complete
treatment including a ceramic
crown or a bridge in one visit science fiction. The science of CAD/
CAM technology has progressed
at a staggering pace, enabling me
to treat a case that represents a
new level in the field.
This case report demonstrates
a procedure that allows the treatment of a patient who has lost
a tooth or had one extracted. In
one visit, he or she can receive an
implant using a while-you-wait,
made-on-demand implant guide.
Furthermore, modelling of the
individual abutment or placing of
a solid titanium abutment with a

temporary crown, or a permanent
ceramic crown, based on the indication and diagnosis, can be performed in the same visit.
The implant guide that is
produced while the patient waits
(CEREC Guide, Sirona) speeds

up the entire process, owing to a
precisely mapped location in a 3D
CBCT scan using GALAXIS and
GALILEOS Implant (both Sirona)
visualisation software. Moreover,
it also enables implantation using
the flapless technique. Immediate
fabrication and use of the implant
guide is even more important in
immediate implant placement
after extraction of multi-rooted

teeth, for which freehand implantation is extremely difficult.
In addition to CEREC Guide,
we can order and use the CLASSICGUIDE (SICAT), made on the
basis of a conventional impression, or OPTIGUIDE (SICAT), a
stent that is manufactured without bite plates and impressions,
requiring only a digital scan of the

patient’s mouth with CEREC AC
(Sirona) and a CBCT scan of the
patient’s jaws (using GALILEOS
or ORTHOPHOS XG 3D). Of all
three guides that could be used, a
pilot drill, sleeve in sleeve or completely guided stents, only CEREC
Guide can be produced in-office
immediately. CEREC Guide was
used in the following case report.
à DT page 18

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[18] =>

18 Implant Tribune
ß DT page 17

patient was healthy and had no
hereditary disease.

Clinical case report
A 55-year-old male patient refused orthodontic treatment to
move tooth 13 into proper position
while making space for a replacement of tooth 12. The patient had
been chewing on primary tooth
53, which was extracted about 14
days before implantation. Figure
1 shows the gap after extracting
tooth 53. Tooth 12 was missing
and tooth 13 had moved mesially
into the space (Fig 2). Overall, the

In this case, we began the
treatment by taking a conventional impression of the jaw in
which we were considering placing an implant to replace a missing tooth. We used quicksetting
plaster well suited to fabricating
the stone model (Fig 3). We placed
a reference body in the location
of planned implantation on the
stone model to determine the correct size (three sizes are available:

United Kingdom Edition

small, medium and large).
The reference body should
about against the adjacent teeth
and fill the gap with the largest
possible area but it should not
become lodged between the adjacent teeth during placement. Once
we had determined the optimal
size, we wet the stone model with
water and applied thermoplastic
stent material softened with warm
water to cover one to two adjacent
teeth on each side ideally. The
properly heated stent compound

appears to be glassy/transparent,
which by its transparency also
indicates plasticity interval. Once
the colour changes to opaque, setting has begun. While the stent
compound was still warm and
adapted to the stone model, we
inserted the reference body (medium in this case; Fig 4). When
the thermoplastic is still clear, it
is possible to observe and review
how the reference body relates to
the edentulous space. Corrections
can still be made until the material
becomes opaque. Undercuts on the

stone model can be blocked out beforeusing,forexample,acomposite
compound (not wax) to allow
easier detachment of the thermoplastic stent material with the
reference body from the model.
Personally, I do not block out undercuts to ensure the most accurate
mounting. Even in the ensuing test
in the patient’s mouth, one must
hear the characteristic click sound.
Once satisfied with the placement and retention of the stent
with the reference body in the
patient’s mouth, we captured a
Fig 8

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September 2013

[19] =>

United Kingdom Edition

CBCT scan of the patient using
GALILEOS or ORTHOPHOS XG
3D. One needs to ensure that the
large fiducial-containing portion
of the reference body faces orally
as depicted in Fig 4 and not buccally in ORTHOPHOS XG 3D, as
there may be a tendency to cut this
portion off in its 8cm×8cm field of
view. While waiting for the image to load on the PC, we scan
the implant space layout on the
model using an intra-oral scanner
(CEREC AC) and software modFig 15

elling of the proposed crown follows, in terms of suitable shape,
size and location in the future implant position.1
Once the CBCT scan has loaded, we open the GALAXIS software and begin the planning. The
first step is to insert the exported
CEREC crown proposal in *.ssi
format because this is the only
CEREC crown proposal format
that GALAXIS software can read
(Fig. 5). The exact placement of
the proposed CAD/CAM crown in

Implant Tribune 19

September 2013

the CBCT scan will allow precise
read-out of borders between hard
and soft tissue (Figs 6–8) and the
digital implant placement under
the crown in such a way that the
future connection of the implant
and crown using an abutment is
prosthodontically possible (Fig 9).
After the digital implant had been
imported into GALAXIS, the need
to use CEREC Guide (or another
guided-surgery technique) became apparent in this case owing
to a dramatic conical apical narrowing of the roots of the adjacent

teeth 14 and 13 in the intended
implant space (Fig 10). Owing to
the lack of space between these
roots, we chose a 3.3/8mm implant (SwishPlus, Implant Direct).
After digital implant placement,
we select to continue and edit the
sleeve system. After selecting this
option, a new dialog box marked
“reference body” appears. On
this screen, we mark the fiducial
points using the lever underneath
the image and move the lever
until the fiducials appear to be as
round and clear as possible. Fi-

nally, we double click on the three
most clear fiducial points and the
software will then automatically
search for and determine the remaining fiducials (Fig 11). Next,
we confirm that the fiducials have
been found and the reference
body appears on the 2D and 3D
images (Fig 12). In order to better visualise the interaction of the
drill path and drill body with the
implant, the final drill path and pilot drill path must be turned on in
à DT page 20

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[20] =>

20 Implant Tribune
ß DT page 19

United Kingdom Edition

Fig 24

Fig 25

minus 1mm, which is the thickness of the implant guide handle.
In our case, for the 8mm implant,
this value was 23mm (the 24mm
drill minus the 1mm handle). The
D1 value changes with the D2 value automatically (Fig 14).

port this arrangement data back
to the CEREC AC unit as a *.cmg
or *.dxd file. After opening the correct file in CEREC Software 4.xx,
the drill body proposal will appear
in the milling preview (Fig 15).
Now we can place the appropriate
block size (in our case this was “M”)
into the milling unit (MCXL on

Fig 26

the 2D views (Fig 13). The reference body must fit exactly within
the drill path in order to be milled.
The most important part of
CEREC Guide production is setting the D2 value. The D2 value,
also known as the drill stop length,
is the distance from the apex of the
implant to the top of the guide. If
we measure the length of the drill
from its cutting tip to the drill stop,
the D2 value will be that length

In order to continue, we ex-

inLab MC XL, Sirona) and select
“mill”. Milling time is approximately 12-16 minutes (Fig 16). We
break the drill body out of the block
and remove the sprue carefully.
Next, we remove the reference
body from the thermoplastic stent
and, using a scalper or bur at a very

September 2013

low speed; cut away a thin layer of
the thermoplastic material from
the bottom of the guide to allow
the drill to pass through the guide.
When snapping the drill body
into the thermoplastic stent, it is
important to ensure that the drill
body is inserted with the correct
vestibulo-oral orientation (Fig 17).
Sirona produces specific guide
handles for each block size (again
in small, medium and large) and
for several implant guide kits. In
our case, we used the guide handles for Straumann for the next
step because these handles are
compatible with the Implant Direct implant used.
Surgery
We begin with anesthetising the
tissue around the work area and
placing the cleaned and disinfected
CEREC Guide in the mouth, followed by the fit evaluation. The
guide should feel secure and not
move over the teeth. As we performed the flapless technique, we
began by punching the tissue with
the appropriate puncher (Fig 18).
We then removed the guide and
easily separated and removed
the punched tissue (Fig 19). We
placed the CEREC Guide back into
position and continued with subsequent drills and guide handles.
Using the guide kit for Straumann (Sirona CEREC Guide Drill
Key Set ST), we started with the M
2.2 handle and 2.2mm pilot drill
(Fig 20), followed by the M 2.8
handle and 2.8mm drill (Fig 21).
Finally, we removed the CEREC
Guide and inserted the 3.3/8mm
SwishPlus implant without the
guide, that is, freehand (Fig 22).
Temporary
We screwed a solid abutment
(Implant Direct; Fig 23) into the
inner part of the implant, and
covered the screw-hole with Teflon. This was immediately followed with an intra-oral scan. As
scanning powder cannot be used
for an unhealed soft-tissue margin, we used the new powderfree CEREC Omnicam camera.
Next, we proceeded through the
steps of CEREC Software 4.xx
(Fig 24) to mill the temporary
crown from a LAVA Ultimate
block (3M ESPE; Fig 25). While
it is acknowledged that dentistry
is not Formula One, the patient
was very satisfied with a total
treatment time of 115 minutes.
Conclusion
This case report has demonstrated the workflow and manufacture of CEREC guides. Anyone
interested in this procedure and
its processes is invited to visit our
training centre in the Czech Republic, where one can view patient surgeries live and participate

About the author
Dr Josef Kunkela Czech
Society of CAD/CAM
Dentistry
Tel.: +420 737 210 565
kunkela@dentalpoint.cz
www.gototraining.cz

[21] =>

United Kingdom Edition

September 2013

Company Spotlight 21

Thriving on all-ceramics, Ivoclar
Vivadent prepares for the future
Dental Tribune International recently visited the company’s headquarters
in Liechtenstein
ceramics, for example. The IPS
e.max CAD range has been expanded and now covers all possible indications, from light veneers to hybrid abutments and
bridges with three or more units.
To make it easier for customers to
navigate their way through Ivoclar Vivadent’s extensive product
offering, the entire portfolio was
redesigned into three main categories: direct restoratives, and
fixed and removable prosthetics.

Josef Richter (left) and Christian Brutzer talking to Dental Tribune. (DTI/Photos Annemarie Fischer, Germany)

W

alled off by the majestic elevations of the Rätikon mountain range
and the Appenzell Alps, several
industrial hydraulic mixers are
continuously at work. Every now
and then, a worker brings new
barrels filled with raw materials
that are turned into a new compound that forms the base for
IPS e.max blocks from Ivoclar
Vivadent.
Launched on dental markets
for the first time seven years
ago, the game-changing dental
restorative system has earned
Ivoclar Vivadent from the small
European principality of Liechtenstein wide international acclaim as a provider of materials
for highly aesthetic all-ceramic
dental restorations. According to
some industry sources, it has also
defined the new gold standard in
the field.
Comprising lithium disilicate
glass-ceramic, zirconium oxide
materials and veneering ceramics for the press and CAD/CAM
techniques, it has an impressive
clinical track record and has
won the company a number of
acknowledgements, including a
Celebration of Excellence Award
for Outstanding Innovation in
Cosmetic Dentistry at the recent
annual meeting of the American
Academy of Cosmetic Dentistry
in Seattle in the US in June.
With double-digit growth last
year, the materials, whose composition remains a well-kept secret, have also become one of the
company’s most important drivers of economic success. Ivoclar

Vivadent held an international expert symposium last year in Germany for the first time that was
focused entirely on the system
and the treatment results dentists are able to achieve with it in
daily practice. According to Chief
Sales Officer Josef Richter, the
system still has much potential.
“With IPS e.max, it is fair to
say that we started a revolution
in the field of fixed prosthetics,
as it provides a highly aesthetic
and durable solution not only for
single-tooth restorations but also
for far more complex indications,
like three-unit bridges,” he recently told Dental Tribune International.

“Driven by our core business and
innovations, our goal is to come
out higher than the market average next year.”
Among the recent developments Ivoclar Vivadent launched
this year is Tetric EvoCeram
Bulk Fill, a further development
of its nano-hybrid composite
line, which the company says
was designed with a powerful
initiator for use with the bulk-fill
technique and for tooth restorations in the posterior regions
that are difficult to reach. It also
introduced BioUniversal KFG, a
golden, high-expansion universal casting for milling and the telescopic crown technique suited
to veneering low-melting special

The company has invested
heavily in its infrastructure recently, with Euro 16m reported to
have been spent on a new building expanding its headquarters in
Liechtenstein, which is intended
to increase storage capacity and
hosts highend dental facilities
where the latest developments
are regularly put to the test under
clinical conditions. Moreover, the
manufacturing plants in nearby
Bürs in Austria, where Ivoclar
Vivadent produces dental equipment, such as its Bluephase curing light, and in Amherst near
Buffalo in the US have been expanded too. New sales offices
and subsidiaries are planned
in Russia and Ukraine, among
other countries, a step that will
expand the company’s already
large reach in 120 countries.
“A few years back, we decided to specifically target emerging
markets, which now helps us to
compensate for moderate growth
in established regions like Europe or North America,” Global
Region Head Asia/Pacific Christian Brutzer explained. “In In-

In addition to the high market acceptance of its poster child
product, Richter said that his
company performed above the
market average last year with its
entire portfolio, including removable prosthetics and filling materials. Sales of clinical equipment
and luting cements like Multilink Automix and Vario link II
increased by over 10 per cent, he
said, despite unfavourable conditions that make it more difficult
for the company to operate in
regions affected by the economic
crisis, such as Southern Europe.
“Market reports from most
of our offices show that fewer
patients are currently visiting a
dentist than potentially should,
which is a matter of concern. As a
result, we expect 2013 to be a difficult business year for the industry. However, expansion is still
possible, if the market is growing
slightly or at all,” he predicted.

Richter is confident his company can grow in 2013

dia, for example, we have grown
from only 10 people in 2009 to
more than 80.”
According to Brutzer, the
emphasis on increased local
presence has not only facilitated
growth in most of these regions,
but also dramatically changed
the way the company is perceived
there. Education according to its
own standards is considered a
key factor for longterm development, a concept that has found its
way into customer relationships
through the establishment of International Centres for Dental
Education, which are intended
to offer training to existing and
future customers through lectures and practical courses. Currently, the company maintains 25
of these centres worldwide, with
the largest one in Schaan itself,
where training laboratories are
occupied almost around the clock
by dentists and technicians from
all over the globe.
“All of our subsidiaries or
sales offices currently provide
some form of training. No other
company in the market invests so
much in education,” Richter said.
“The increase in solutions
available on the market has led to
confusion among many customers
of what is right for them,” he continued. “Therefore, we want our
customers to understand the fundamental advantages that come
with buying a product from us. In
this respect, we see an opportunity to provide them with confidence and peace of mind.” DT

[22] =>

22 Advertorial

United Kingdom Edition

September 2013

Brand new website for one of the UK’s most
established private dental training firms
Every year Tipton Alumni
win awards for their practices and build reputations on
the foundation the firm has
provided.
Dr Tipton goes on to explain that the academy’s

ing knowledge and changing
dentistry practices within the
syllabuses we teach.
“A great example of this is
our restorative course, which
is now in its 24th year. Demand for this area of dentistry

‘Each course offers delegates practical
training, combined with theoretical lectures and seminars, under the direct supervision of experienced lectures and some of
the UK’s leading practitioners’
purpose is to increase the
levels of confidence and selfbelief in its delegates, so that
they have the skillsets required to excel in a forwardthinking profession:

O

ne of the country’s
most reputable and
prestigious
private
dental training companies
is set to launch a new website
designed to give its prospective delegates access to the
information and skills they
need to provide the quality
dental services needed for private practices.

supervision of experienced
lectures and some of the UK’s
leading practitioners.

Tipton Training, which
is situated within the heart
of Manchester, has been providing
dental
professionals from across the UK with
the very best educational
training for the best part of
25 years.

Dr Paul Tipton, founder of
Tipton Training, said: “One
of our enduring qualities
throughout the last 24 years
has been our ability to keep
up with the pace of change
in dentistry. Revamping our
website allows our delegates
easier access to the information, research, skills and techniques required to progress in

The new website will inform dental professionals of

In addition, the academy’s
new website will feature a
programme
of
web-based
learning for dental professionals looking for a more flexible
way of getting the knowledge
they need to succeed.

‘One of our enduring qualities throughout the last 24 years has been our
ability to keep up with the pace of change
in dentistry’

the additional learning they
can undertake within the
fields of restorative, implant
and cosmetic and aesthetic
dentistry.
Each course offers delegates practical training, combined with theoretical lectures
and seminars, under the direct

private dentistry.”
“The whole Tipton Training team cannot wait to for
the new site to go live. We’re
absolutely certain that our delegates will enjoy the new website experience.”
Tipton Training was found-

ed by Dr Tipton, who is widely
regarded as one of the most
influential dental practitioners in the UK, in 1988. To date,
more than 2,500 dental professionals have taken courses at
the academy.

“The truth is that dentistry
is an extremely fast moving
field. As technological advances are made and new ways
of thinking are introduced,
it’s paramount that dental professionals keep up to
date with the latest techniques
and make themselves aware
of important progress within
their field.”
“This means our courses
are constantly evolving too. We
strive to incorporate advanc-

has dramatically increased
over that last two decades. Our
course content year-on-year
prepares dentists to compete
effectively”
Along with providing delegates with new dentistry
skills and knowledge, Tipton
Training can also share expert
advice with dentists on how
to structure their practices to
attract new patients and improve profitability.
For further information
about Tipton Training and
their dental training courses,
please visit www.tiptontraining.co.uk or call +44 (0)161
348 7848. DT

[23] =>

United Kingdom Edition

Introducing
GoodmanGrant: Lawyers
for Dentists
This July members of the
dental press gathered at
the St Pancras Renaissance
Hotel for the announcement
of a new specialist firm of
dental lawyers. GoodmanGrant is the result of a merger between Ray Goodman
of Goodman Legal and John Grant former Head of the Dental Team at Cohen
Cramer. Both have an extensive career assisting dental professionals with their
legal affairs and the team at GoodmanGrant has a combined experience of
more than 75 years.
The firm brings together the current Chairman of the NASDAL lawyers group
and the immediate past Chairman of ASPD. Along with dedicated expert
solicitors in all practice areas, Goodman Grant is able to provide its clients with
extensive legal advice on all aspects of the dental industry.
With offices in London, Liverpool and Leeds, Goodman Grant is able to offer its
unique brand of accessible and comprehensive advice to clients in all parts of
England and Wales.
For more call Ray Goodman on 0151 707 0090 or email rng@goodmanlegal.
co.uk; call John Grant on 0113 8343705 or email jmg@goodmangrant.co.uk

Honigum-MixStar Heavy:
Straumann’s & Brånemark’s
material of choice
DMG UK’s Honigum-MixStar
Heavy has been selected by
Brånemark and Straumann
as their material of choice for
implant impressions.
At the Brånemark Centre they
treat every type of implant
case. They evaluate every stage
of treatment in order to find the optimal combination from osseointegration
to optimal precision of the prosthetic reconstruction. Their conclusion is that
Honigum-MixStar Heavy is the material of choice, best fulfilling the demands for
precision and handling. Dr Nannmark says: “Honigum-MixStar Heavy ensures
improvement and simplification of our prosthetic treatment. In our clinic, every
patient is a lifelong commitment where we take full responsibility of follow up and
long-term results.”
Honigum-MixStar Heavy is designed for use in combination with DMG’s MixStar
and MixStar-eMotion automatic mixing units, 3M ESPE’s Pentamix™ and other
similar machines.
For information contact your local dental dealer or DMG Dental Products (UK) Ltd
on 01656 789401, email info@dmg-dental.co.uk or visit www.dmg-dental.com

High quality, home grown dental
products from Sparkle Dental Labs Ltd
Sparkle Dental Labs Ltd is a dental
laboratory based in Yorkshire, with the
aim of reinvigorating the UK’s waning
dental technician trade. Ten years ago
there were more than 12,000 dental
technicians operating in the UK, today
this figure stands at 5,000 technicians
and is still depleting by more than 200
technicians a year. With its state of the
art laboratory in Leeds, Sparkle Dental
Labs is hoping that it can attract a new generation of technicians to this
dwindling profession.
With a high frequency of lab work now being referred to overseas laboratories,
Sparkle Dental Labs are hoping to regain the interest of dentists in home
grown dental products by ensuring that they are of the highest quality and are
reasonably priced.
As one of the only labs to be recognised with MHRA, DAMAS and ISO quality
assurance marks, you can be sure that Sparkle Dental Labs are working hard to
bring you the very best dental products from a team of highly skilled technicians.
For more call 0800 138 6255 or email customerservice@sparkledentallabs.com
or visit: www.sparkledentallabs.com

Temporary C&B material celebrates
its 20th Anniversary
To be successful internationally for 20
years is a remarkable achievement
for a temporary crown and bridge
material, but DMG’s Luxatemp can lay
claim to that.
The Luxatemp range of bisacryl
composite temporary crown and bridge materials, market leader in the USA since
1997, can look back on a long history of the highest accolades. Multi-award-winning
Luxatemp was acclaimed Top Provisional Material and Best of the Best*; whilst
Luxatemp Star, the new faster setting version, has already been awarded the highest
possible rating of 5 stars by REALITY, an independent testing lab in the USA**.
During its assessment Luxatemp Star received top marks for fracture resistance
and flexural strength, which help ensure its reputation for dependable stability
and durability. Long-term shade stability has also been optimised. What’s more,
Luxatemp Star attains its final hardness in just 5 minutes, making it even faster than
conventional Luxatemp.
For further information contact your local dental dealer or DMG Dental Products (UK)
Ltd on 01656 789401, fax 01656 360100, email info@dmg-dental.co.uk or visit www.
dmg-dental.com

* The Dental Advisor, Vol. 28, No. 01 Jan/Feb 2011, Pg. 9 **REALITY now, Oct 2011, No. 228, Pg. 1 (
Luxatemp Star is sold in the USA as “Luxatemp Ultra” and was also tested under this name).

September 2013

Enjoy Maximum Portability,
Flexibility and Integration with
CS Solutions from Carestream
Dental
The new CS Solutions from
Carestream combines innovative
technologies to enable you to scan,
design, mill and place restorations in
a single appointment.
Designed to maximise your workflow in terms of time, material costs and quality of
patient experience, the system has been designed specifically to meet your needs.
Available as a complete comprehensive system, or as individual products, the CS
Solutions consists of: CS 9300/CS 9000 CBCT impressioning machine; CS 3500
intraoral scanner; CS Restore software; CS 3000 Milling Machine; and CS Connect
Each system utilises the most advanced technology in the industry, while remaining
simple-to-use. All solutions are also easily portable for your convenience, and can be
fully integrated into your current practice management software.

Industry News 23
Rextar X - The NEW safe handheld x-ray unit
from Digital Dental
Rextar X is the new safe hand-held
intraoral x-ray unit from Digital
Dental.
Why can you hold it? The new
Rextar X has a sealed dual-shield
design and a backscatter screen to
protect the operator. The new 70kv
generator ensures a shorter exposure time, higher image quality and a very
low dose for the patient. This means the operator dose from the new Rextar X
is similar or less than using a wall-mounted x-ray unit. You now don’t have to
leave the room so you can take x-rays faster and it helps reduce retakes.
The Rextar X is similar in price to a high quality wall-mounted unit. It is
lightweight and portable, so you can share it between surgeries or have an
instant back up for your existing x-ray units. Rextar X is programmable for easy
one-touch use with film, sensors or phosphor plates.

With the guarantee of eXceed – the business corporate programme ensuring quality
customer service – the Carestream Dental experts are always on hand to offer more
information and bespoke advice.

Manufactured to the highest standards and CE certified, Rextar X is the future
of intraoral x-ray units.

For more information from Carestream Dental, telephone 0800 169 9692 or visit
www.carestreamdental.co.uk

Visit www.digitaldental.co.uk or call 0800 756 5642 for more details. Visit stand
B08 at the Dental Showcase.

Giving your business a new lease
of life - Tavom UK at BDTA Dental
Showcase 2013
If the time has come to refresh and
refurbish your dental practice or
laboratory, you need look no further
than Tavom UK.

The all new General Medical
Specialist Catalogue
Issue 11 out now!
Containing more than ever
before it includes everything the
modern dental practice could
wish for, and is designed to
make the provision of treatment
quicker,
easier
and
more
profitable. Now including an even
wider selection of innovations
including
the
Quicksleeper
4 digitally controlled local
anaesthetic delivery system,
the NEW Zest LODI Locator
Overdenture Implant System, the revolutionary iChiropro from Bien Air
and the complete range of Mectron curing lights and prophylaxis units.

Exhibiting at this year’s BDTA Dental
Showcase, Tavom UK will be on
hand to provide any information or advice you could need.
With extensive knowledge and experience specifically within the dental industry,
the Tavom UK experts understand the demands you and your team face. They
are dedicated to helping you design an efficient working environment that
encourages staff satisfaction, while making the very most of the space available.
All cabinetry is made for maximum durability and is easily cleanable for full
compliance with HTM 01-05 regulations. It is also available in a range of colours,
finishes and surfaces materials, enabling you to design a premises unique to you.
So whether it is your dental practice or laboratory in need of a new lease of life,
be sure to discover the options available to you from Tavom UK at stand Q03 at
the BDTA Dental Showcase 2013.

In addition to the General Medical Catalogue all of these products are
detailed on the General Medical website www.generalmedical.co.uk with
On-line ordering facility.
To obtain your copy of Issue 11 of the General Medical Catalogue
telephone 01380 734990, visit www.generalmedical.co.uk or email info@
generalmedical.co.uk

For more information on Tavom UK, please visit www.tavomuk.com

Topdental Launch Virofex Pro Test –
Protein Testing Kit
Topdental’s new protein testing kit, Virofex
Pro Test is a unique and comprehensive disinfectant for the high level surface cleaning and
disinfecting of non-invasive medical devices.
Virofex Pro Test has been designed and developed to verify the effectiveness of
the market leading medical device disinfectant spray, Virofex.
Virofex Pro Test is an indicator, which can be used safely to determine the
effectiveness of the surgery’s infection control procedures. Protein residues
on medical equipment indicate that bacteria are present and there is a lack of
adequate cleaning procedures. In addition, these kinds of residues on medical
equipment are the sign that the risk of infection is present.
This product is developed using the latest technology to determine residues
at low concentrations (~1 µg). By using Virofex Pro Test, you can easily identify
protein residues by visible colour change. This process provides an easy
identification of protein residues on equipment.
The Virofex Pro Test kit is an essential cost effective option for all dental
surgeries and is available from either Dental Directory on 0800 585 586 or from
Topdental Products Ltd on 01535 259 871. Free in surgery demonstrations are
available from Dental Directory. www.virofex.com www.topdental.org

Most Effective ADIN Implants now
available in the UK!
Independently judged one of the most
effective implants evaluated in a study by
the New York University, ADIN implants are
available in the UK from Trycare.
In their study, NYU measured the quality of
new bone formation and bone contact of
five different implant systems (ADIN, Astra,
IL, Nobel and Straumann) over a six week
period. It showed that all five produced very
similar results, though ADIN out-performed
the competitors, which are up to three times
more expensive, in various aspects. Therefore
Trycare can reasonably claim ADIN to be the most effective.
Toureg CloseFit implants offer a strong and solid conical-hex connection
that is interchangeable with Nobel Active. This Morse Taper connection
minimises micro movements, thereby minimising undesirable crestal
bone loss.
For further information ask your local Trycare Representative, contact
Trycare on 01274 885544, email dental@trycare.co.uk or visit the Adin.
co.uk website

Boost your patient base
with Zesty
The popularity of television
programmes like The Only
Way is Essex have caused a
surge in interest in cosmetic dentistry. With this area of dentistry flourishing,
now is the time to let Zesty help you bring patients looking for whitening and
other cosmetic treatments to your practice.
Zesty is an online booking service that makes finding new patients simple. The
service allows patients looking for cosmetic services to find your practice and
book an appointment with only a few of clicks of a button. With enquiries about
clear braces rising by 177 per cent and laser whitening treatment increasing by
116 per cent, there has never been a better opportunity for cosmetic dentists
to boost their patient base.
Zesty is also able to accommodate the introduction of Direct Access, allowing
patients to find and book appointments with hygienists and therapists quickly
and simply.
With more than one million people searching for dental appointments every
month in London alone, Zesty is a truly modern approach to booking a dental
appointment that will help to keep your practice busy.
Simply email: hello@zesty.co.uk, visit www.zesty.co.uk or call 020 3287 5416
for more details.

All Day Bad Breath Protection with
new, long lasting CB12
In up to 90% of cases, bad breath is
the result of oral bacteria breaking
down food particles in the mouth. It’s
estimated that half the population
suffers from some degree of bad breath
(halitosis), and for many the problem can
have a huge effect on both their private
and professional relationships.
CB12 is a new, patented mouth rinse whose formula is proven to outperform
existing mouthwash solutions and deliver security from the embarrassment
of bad breath for 12 hours. CB12 contains two complementary ingredients,
zinc acetate and chlorhexidine diacetate, which work together to neutralise
the gaseous VSCs (volatile sulphur compounds) which cause bad breath. CB12
also contains fluoride to help protect teeth and to help patients maintain a
high standard of oral health.
While many ‘fresh breath’ products simply mask the odour of bad breath, CB12
attacks the problem at its source, neutralising the odour-causing bacteria and
preventing reoccurrence for up to 12 hours.
For more information on CB12 please visit www.cb12.com

[24] =>

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[cover] => DT UK No. 11, 2013

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => Opinion: The rot runs deep [page] => 06 ) [2] => Array ( [title] => Comment: Amit’s Corner - Close Quarters Combat (CQC) [page] => 08 ) [3] => Array ( [title] => A guide to the NHS England National Performers List [page] => 09 ) [4] => Array ( [title] => Implant Tribune [page] => 11 ) [5] => Array ( [title] => Thriving on all-ceramics - Ivoclar Vivadent prepares for the future [page] => 21 ) [6] => Array ( [title] => Brand new website for one of the UK’s most established private dental training firms [page] => 22 ) [7] => Array ( [title] => Industry News [page] => 23 ) ) [toc_html] =>

Table of contents

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