Bite magazine is a business and current affairs magazine for the dental industry. Content is of interest to dentists, hygienists, assistants, practice managers and anyone with an interest in the dental health industry.
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Drill-free dentistry Associate Professor Wendell Evans and colleagues have opened a clinic that could hopefully spell the end of the ‘drill-and-fill’ approach to the profession Sleep on it What you don’t know about conscious sedation (and what you should know), page 20 Picture this How and why 3D imaging software increases case acceptance, page 28 Big solutions for small teams The design plan that lit up a small surgery, page 24 Dental as anything Meet the band of dentists who can both fix your teeth and rock your world OCTOBER 2012, $5.95 INC. GST PRINT POST APPROVED NO: 255003/07512 SPECIAL REPORT Implant products guide, page 35
Transcript
Drill-free dentistryAssociate Professor Wendell Evans and colleagues have opened a clinic that could hopefully spell the end of the ‘drill-and-fill’ approach to the profession
Sleep on itWhat you don’t know about conscious sedation (and what you should know), page 20
Picture this How and why 3D imaging software increases case acceptance, page 28
Big solutions for small teams The design plan that lit up a small surgery, page 24
Dental as anythingMeet the band of dentists who can both fix your teeth and rock your world
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COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFECONTENTS
03
ContentsNews & eveNts4. Closing the gapNew research shows there’s been changes in the use of sealants on kids’ teeth; changes are afoot with importation rules; and more
your world12. Making business a pleasureDr Toni Surace, a dentist with 20 years’ experience, was juggling a young family and her own busy practice in Bulleen, Victoria, when a case of rheumatoid arthritis forced her to rethink her work-life balance
your busiNess 20. Sedation rulesAssociate Professor Doug Stewart believes there are some real problems with the way conscious sedation is currently handled, and he’s not afraid to speak up about it
24. Double visionary A small office space was converted into a bright and pragmatic Hobart practice in this award-winning design
28. Getting animatedWhile 3D software is a fun gadget to have on the computer, can it really have a measureable impact on case acceptance? Yes it can, say the experts your tools 10. New productsThe best new gear and gadgets from suppliers you can trust
35. Implant product guide Everything you need to know about the latest in implants
33. Tools of the tradeReviews of your favourite products by your peers
your life46. Dental as anything Dr Stuart Garraway of BOH Dental, Brisbane, is happy for his rock band to perform for weddings, parties and a few school fetes
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Cover story
Death of the drillIs this the beginning of the end of the ‘drill-and-fill’? Westmead Hospital’s No Drill Clinic opens next year, looking to tackle caries before it’s too late
October 2012
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7,927 - CAB Audited as at March, 2012
Editorial Director Rob Johnson
Sub-editor Kerryn Ramsey
Creative Director Tim Donnellan
Contributors Sharon Aris, John Burfitt, Kerryn Ramsey, Susanna Nelson, Chris Sheedy, Gary Smith
Commercial Director Mark Brown
Bite magazine is published 11 times a year by Engage Media, Suite 4.08, The Cooperage, 56 Bowman Street, Pyrmont NSW 2009 ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printed by Bright Print Group
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COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFENEWS & EVENTS
04
The use of fissure sealants to protect children’s teeth has fallen since 2001, accord-ing to a report released by
the Australian Institute of Health and Welfare (AIHW).
The report, Fissure sealant use among children attending school dental services: The Child Dental Health Survey Australia 2008, looks at the oral health of Australian children examined by school dental service (SDS) staff in 2008.
The findings are drawn from the 2008 Child Dental Health Survey (CDHS) including nearly 64,000 chil-dren aged six-to-12 from all states and territories except New South Wales and Victoria.
“Fissure sealants are materi-als that are applied to the pits and fissure surfaces of the teeth. They protect teeth from decay by creating a thin barrier that protects the sealed surface from the bacteria that cause decay,” said AIHW spokesperson Professor Kaye Roberts-Thomson.
The report shows that from 1989 to 2001, fissure-sealed teeth in
12-year-olds increased threefold, after which it decreased.
“Despite the use of fissure seal-ants falling since 2001, there has been an increasing tendency to provide fissure sealants for children who are at risk of decay,” Professor Roberts-Thomson said.
“For example, among all children aged six-to-12, only 17 per cent of those with no dental decay experi-ence had fissure sealants, while the proportion of children with dental decay who had fissure sealants was almost 30 per cent.
“So, despite the use of fissure seal-ants dropping from 2001, we have seen an increasing tendency from 2006 to provide fissure sealants as a preventive measure.
About 52 per cent of children aged six had one or more decayed, missing or filled deciduous teeth.
“Among 12-year-old children, 45 per cent had experienced decay in their permanent teeth, and on average 12-year-olds as a group had just over one affected tooth,” Professor Roberts-Thomson said.
Standards set for imported dental lab productsThe Australian Government has confirmed that dentists and resellers of imported dental laboratory work are subject to the same statutory obligations as local laboratories. The advice is contained in the Australian Government’s response to a Senate committee inquiry into the regulatory standards for medical devices released last week.
The findings of the committee were that the Therapeutic Goods Administration (TGA) should subject imported laboratory work to the same regulatory standards as locally produced products.
The Australian Dental Industry Association (ADIA) tendered advice to the Senate committee. “ADIA sought to create a level playing field for local suppliers and to a large extent this is the outcome,” said Troy Williams, ADIA chief executive officer.
The Australian Government’s response stated that importers of dental laboratory work must hold certain details about the device including information identifying the manufacturer and any special characteristics of the device.
“The Government’s response has confirmed that dentists and resellers of laboratory work still have the option of using imported goods. However, the Government has clearly stated that imported products, like locally manufac-tured products, are subject to Australian regulatory standards,” Mr Williams said. An importer of laboratory work does not need to place such products on the Australian Register of Therapeutic Goods (ARTG). However, import-ers do need to comply with all other aspects of the Therapeutic Goods Act (Cth) 1989 relating to medical devices. To raise aware-ness among dental professionals, the Government will consult with the Dental Board.
Closing the gapNew research shows there has been a drop in fissure sealant use in children’s teeth
Despite the overall use of fissure sealants falling, there is a growing trend to use them treating children at high risk of decay.
NEWS & EVENTS
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Bite.indd 1 20/09/2012 10:55:08 AM
COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFENEWS & EVENTS
06
Coconut oil could combat tooth decay
Digested coconut oil is able to attack the bacteria that cause tooth decay because it is a natural antibiotic that could be incorporated into commercial dental care products, scientists from Athlone Institute of Technology (AIT) in Ireland discov-ered in a recent study. The team from AIT tested the antibacte-rial action of coconut oil in its natural state and coconut oil that had been treated with enzymes, in a process similar to diges-tion. The oils were tested against strains of Streptococcus bacteria which are common inhabitants of the mouth. They found that enzyme-modified coconut oil strongly inhibited the growth of most strains of Streptococcus bacteria includ-ing S. mutans. The researchers in AIT’s Bioscience Research Institute, led by Dr Damien Brady, presented their work at the Society for General Microbiology’s autumn conference. Many previous studies have shown that partially digested foodstuffs are active against micro-organisms. Earlier work on enzyme-modified milk showed that it was able to reduce the binding of S. mutans to tooth enamel. That prompted the group to investigate the effect of other enzyme-modified foods on bac-teria. “Our research has shown that digested milk protein re-duced the adherence of harmful bacteria to human intestinal cells and prevented some of them from gaining entrance into the cell.,” said Dr Brady. “We are currently researching other enzyme-modified foodstuffs to identify how they interfere with the way bacteria cause illness and disease.”
Paediatricians and dentists combine to further child oral health
The Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Dental Surgeons (RACDS) have called for the elevation of oral health awareness in the train-ing of all health professionals who work with children and young people.
Addressing oral health in children and young people can significantly improve lifelong oral health, which is a key determinant of health and wellbeing throughout the life of the individual, according to Associate Professor Sharon Goldfeld, chair of the P&CHD Paediatric Oral Health Working Group.
“Very few infants see dentists specifically, so dental thera-pists and oral health therapists in conjunction with non-dental healthcare professionals, such as paediatricians and general practitioners, must be proactive in promoting good child oral health,” said Associate Professor Goldfeld.
“Integrating awareness of oral health into training for paediatricians and other health practitioners who work with children is an important step that can improve early inter-vention and supports prevention strategies, particularly in vulnerable populations, such as indigenous communities and those in remote and rural areas.”
The RACP and the RACDS, through their child oral health statement, have called for oral health awareness in the train-ing of all health professionals who work with children.
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COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFENEWS & EVENTS
08
Dental Sleep Medicine Academy looking for members
The Australasian Academy of Dental Sleep Medicine (AustADSM) was launched at a Sydney seminar recently, and is keen find members from anyone connected with the provision of treatment to snoring or obstructive sleep apnoea (OSA) patients, according to founder Dr Derek Mahony.
“It is clear that in Australia, we are lagging behind the Americans and most of Europe in this field. To help encour-age more effective treatments, we propose that an associa-tion of all interested parties should be organised so that we can educate and support ourselves,” Dr Mahony said.
Dr Mahony explained that this is a relatively new field of therapy that has allowed the dental team to help manage a medical problem—sleep-related breathing disorders rang-ing from benign snoring to severe obstructive sleep apnoea. Dentists are an important link in the chain. They can often identify abnormal conditions in their patients and screen for medical problems.
The AustADSM intends to help educate practitioner dentists through clinical meetings, and webinars, that keep leading-edge ideas accessible and establish and maintain an appropriate treatment protocol. Anyone connected with the provision of treatment to snoring/OSA patients would be welcome to join. For further information please contact [email protected] or call 02 9700 9173.
Beating bone lossA University of Louisville scientist has found a way to prevent inflammation and bone loss surrounding the teeth by block-ing a natural signaling pathway of the enzyme GSK3b, which plays an important role in directing the immune response.
The discovery of UofL School of Dentistry researcher David Scott, PhD, and his team recently published on-line first in the journal Molecular Medicine. The finding not only has implications in preventing periodontal disease, but also may have relevance to other chronic inflammatory diseases. Since GSK3b is involved in multiple inflammatory signaling pathways, it is associated with a number of diseases and also is being tested by scientists for its impact in Alzheimer’s disease, Type II diabetes and some forms of cancer, to name a few. “The traditional approach to dealing with periodontal disease is to prevent plaque from forming at the gum-line or prevent the consequences of periodontal disease progres-sion,” Scott said. “Our approach manipulates a natural mechanism within our bodies to prevent inflammation and subsequent degradation when exposed to the bacterium P. gingivalis.”
GSK3b is known to facilitate the inflammation that occurs during bacterial infections, so blocking this enzyme from completing its normal function by using the GSK3-specific inhibitor, SB216763, stopped the inflammation process and subsequent bone loss induced by the key periodontal patho-gen, P. gingivalis, Scott said.
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New 3M™ ESPE™ Astringent Retraction paste provides effective gingival retraction in half the time Time-saving alternative to retraction cord and traditional retrac-tion paste, 3M ESPE introduces its latest impression-taking breakthrough: the 3M™ ESPE™ Astringent Retraction Paste. Designed with an extra-fine tip that can be inserted right into the sulcus, the retraction capsule is the first gingival retraction sys-tem that delivers astringent retraction paste using common com-posite dispensers. The time-savings enabled by the retraction capsule make it a convenient alternative to traditional gingival retraction methods such as retraction cord and other retrac-tion pastes. 3M ESPE developed the retraction capsule to give dentists a simple and time-saving solution for effective retraction. The capsule’s patented extra-fine tip is designed to actively open the sulcus and easily deliver the high-viscous astringent paste into the sulcus. The capsule also has a flexible, soft-edge tip and an orientation ring, like a perio probe. Both of these features allow more precise control and easy intra-oral handling.
The process to use the product is easy: the dental profes-sional can simply fix the retraction capsule in a composite dispenser, then insert its tip into the sulcus and slowly inject the material. After two minutes, the retraction paste can be removed with an air-water spray. Each unit-dose retraction capsule contains 15 per cent aluminum chloride, recently recognised by researchers as being as effective as epinephrine soaked cord in reducing the flow of sulcular fluid. The single-use capsule also helps dentists avoid problems caused by cross-contamination. Because it’s disposable, there are fewer preparation and process steps than competitive pastes.
Astringent Retraction paste capsules are suited for any situa-tion where a temporary retraction of the marginal gingiva and a dry and clean sulcus are required. For more information please contact your 3M ESPE representative: 3M ESPE Australia: Tel. 1300 363 454, www.3MESPE.com.au, or 3M ESPE New Zealand: Tel. 0800 80 81 82, www.3MESPE.co.nz.
New productsNew-release products from here and around the world
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Only Cavitron® systems deliver NEW Tap-On™ Technology: The next big step in ultrasonic scaling DENTSPLY Australia is pleased to announce the release of the Cavitron Plus and Cavitron JET Plus with new Tap-On Technology.
Over the years, Cavitron systems have become synonymous with ultrasonic scaling. Dedicated to providing end-to-end solutions in dental hygiene, Cavitron products have continued to evolve to best serve you, your patients and your practice.
Now, the Cavitron Plus and Cavitron Jet Plus units have been redesigned with ergonomics and performance in mind. For improved operator comfort and reduction of leg and ankle strain, the new Tap-On technology activates scaling or air polishing with a single tap of the 360° wireless foot pedal, allowing your foot to rest during the procedure. The new Prophy Mode Auto Cycles on the Cavitron JET Plus unit automatically alternate between air polish and rinse without the need to touch the foot pedal.
For enhanced efficiency, a single-push turbo mode for up to 25 per cent greater power has been added for a longer lasting increase in power. The water control on the handpiece has been fine-tuned for more precise water control.
These features are in addition to all the other benefits you have come to expect from Cavitron including; the patented Sustained Performance System; BlueZone™ for improved patient comfort; an autoclavable handpiece with a 330° swivel to reduce cable drag; and a diagnostic display with an automatic purge mode.
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For further information, to place an order, or for a product demonstration at your surgery, please contact your local DENTSPLY sales specialist or client services on 1300 55 29 29 (Australia) or 0800 DENTSPLY (33 68 77) (New Zealand).
Only Cavitron® systems deliver NEW Tap-On™ Technology:
The next big step in ultrasonic scaling DENTSPLY Australia is pleased to announce the release of the Cavitron Plus and Cavitron JET Plus with NEW
Tap-On Technology.
Over the years, Cavitron systems have become synonymous with ultrasonic scaling. Dedicated to providing end
to end solutions in dental hygiene, Cavitron products have continued to evolve to best serve you, your patients
and your practice.
Now, the Cavitron Plus and Cavitron Jet Plus units have been redesigned with ergonomics and performance in
mind. For improved operator comfort and reduction of leg and ankle strain, the new Tap-On technology
activates scaling or air polishing with a single tap of the 360° wireless foot pedal, allowing your foot to rest
during the procedure. The new Prophy Mode Auto Cycles on the Cavitron JET Plus unit automatically alternate
between air polish and rinse without the need to touch the foot pedal.
For enhanced efficiency, a single-push turbo mode for up to 25% greater power has been added for a longer
lasting increase in power. The water control on the handpiece has been fine-tuned for more precise water
control.
These features are in addition to all the other benefits you have come to expect from Cavitron including; the
patented Sustained Performance System; BlueZone™ for improved patient comfort; an autoclavable handpiece
with a 330° swivel to reduce cable drag; and a diagnostic display with an automatic purge mode.
There’s only one Cavitron. Scan the barcode with your smart phone.
For further information, to place an order, or for a product demonstration at your surgery, please contact your
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NEWS & EVENTS COVER STORY YOUR TOOLS YOUR LIFE
012
YOUR WORLD
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ecalling the event, Dr Surace says, “I was obviously upset about the arthritis and I thought ‘I can’t keep killing myself
seeing people every 15 minutes—there must be a better way’.”
For Dr Surace, that “better way” came in the form of a 30-month practice management course with Momentum Management. The Momentum program, which Dr Surace describes as a “mini MBA”, involved 10 workshops over 30 months with goal-setting guided by a personal coach. The program deals with the management, rather than clinical, aspects of running a dental practice, working on every facet of the business to cover topics such as hiring and firing, appointment scheduling, communica-tion, relationship building, stock man-agement, patient debriefs and handoffs, and even answering the phone.
These days, Dr Surace is a self-con-fessed “Momentum geek”, and has the management of her own practice down. “I actually became a bit bored to tell you the truth—I had it running so well that I didn’t have to be there!” she says.
Dr Surace started coaching, training, and presenting for Momentum and, a few short months ago when the previous owner had to step down due to family commitments, Dr Surace bought the company. It was her love of helping peo-ple that prompted her to begin a career in dentistry and coaching other dentists was a natural progression. Through Mo-mentum, she feels that she is genuinely making a difference in dentists’ lives by giving them the skills to automate their businesses. It’s the dentists who are her real patients now.
So, which is easier, running her own
practice or telling other people how to run theirs?
Dr Surace says the two present their own unique challenges, but the toughest challenge at Momentum is helping peo-ple understand how to help themselves, and giving themselves the permission to delegate control.
While Dr Surace believes the program helps take the stress away from run-ning a practice, she acknowledges that success in the program calls for a lot of hard work. “You get out of it what you put into it. You need to be real about it, there is going to be a certain amount of work that you need to do. You need to be prepared and want to have different outcomes.”
For Dr Surace, the program was as
much about personal growth as it was about business growth and she has seen many other dentists on the pro-gram experience the same depth of per-sonal change. According to Surace, the dental profession is rife with workahol-ics; “Perfectionism was a huge thing for me, as it is for a lot of dentists. I needed
Making business a
Dr Toni Surace, a dentist with 20 years’ experience, was juggling a young family and her own busy practice in Bulleen, Victoria when a case of rheumatoid arthritis forced her to rethink her work-life balance. Amanda Lohan investigates
Opposite: Dr Toni Surace was so im-pressed by Momentum Management, she bought the company.
“I actually became a bit bored to tell you the truth—I had it running so well that I didn’t have to be there!”
Quote Dr Toni Surace
YOUR WORLD
14
to realise that perfection was probably never really attainable. It’s a moving target—as soon as you’re perfect, you set the bar higher.” Staff members, too, have grown as a result of the program, with the opportunity for personal devel-opment invariably leading to improved rates of staff retention.
One of the biggest learning points for dentists attending the course is the re-alisation that they are underdiagnosing. The Momentum program teaches that it is important to keep personal feelings and assumptions aside to present what the patient really needs,.“Somebody walks in with scruffy jeans so we won’t present a crown to them—it’s making a judgement,” says Surace. “Or a dentist is not confident in prepping a crown so they might not present it—they need to further their skills.”
Dr Surace says many dentists under-diagnose or fail to provide referrals for fear of losing the patient, however when they feel confident enough to build trust and relationships with their clients, this is no longer a problem.
Another key learning point for many
dentists is that they need to stop trying to be all things to all people. With the number of dentists increasing all the time, Dr Surace says it’s important to make yourself stand out, and to get the edge you first need to choose a market. Ideally, dentists should use their new business management skills to free up the hours they would normally spend on administration to devote more time to total mouth care. This allows them
to move into higher end dentistry and provide comprehensive care instead of just “drill and fill”.
The secret, according to Surace, is goal-setting. “You’re not taught how to run a business in dental school… It’s amazing how much of a difference it can make when life is organised and you know what you’re aiming for. My motto is ‘success is the only option’. Going in with that mindset, you can’t help but win.”
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YOUR WORLD
Finding that elusive work-life balanceDoctor Toni Surace has some sure-fire strategies for dentists looking to improve their own work-life balance:
■ Recognise that you are not alone. “In my experience dentists tend to be workaholics, but a lot of that stress can be relieved when you start talking about it.”■ Seek help when necessary. “Help is out there. I thought it was going to be expensive but I paid for my investment many times over in the first year.”
■ Be a sponge for information, whether it’s business or dental is-sues. “Get as much as you can from everyone and keep learning.”■ Work smart, not hard. “Have all of your systems set up so that your practice is runs automatically.”■ Learn from the best. “Why reinvent the wheel when it’s already been done for you?”
Opportunities are now available for experienced Dentists, including Specialists who are looking to expand their earning capacity by practicing 2-3 days a week in outer urban and inner regional areas of New South Wales, Victoria and Queensland.
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Opportunities are now available for experienced Dentists, including Specialists who are looking to expand their earning capacity by practicing 2-3 days a week in outer urban and inner regional areas of New South Wales, Victoria and Queensland.
Pacific Smiles Group has 32 Dental Centres, many located within 1-3 hours drive of the city. Stay overnight and practice back to back days with accommodation provided. Let us assist you in establishing your part time country practice.
Enjoy country practice benefits including high patient demand while still maintaining your life in the city.
Your country practice is waiting!
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NEWS & EVENTS YOUR BUSINESS YOUR TOOLS YOUR LIFECOVER STORY
he purple and lime-green brushes lie on the side of the basin; mirrors that cover the walls create the illusion of a room swimming in light. Models of heads sit on a bench, their bleached white teeth in a perfect smile. It’s a scene that could be mistaken for a hair dressing salon, yet this will be the set-up of the No Drill Clinic that is introducing
a new innovative approach to preventive dental health and arousing the interest of insurance companies and governments around the world.
As dental students roll back into classes next year, they will be ushering the first patients into the No Drill Clinic at The Westmead Hospital in Sydney’s west. It offers a service that has been developed to implement the Caries Management System, a 10-step protocol for arresting tooth decay well before the drill need ever be used. From next year dental students at the University of Sydney will not only be provided with a theoretical approach to preventive dental care, they will now be required to put those basic measures into practice.
“The goals of the No Drill Clinic are twofold; firstly, to man-age oral hygiene behaviour change; and secondly, to manage
those tooth sites that have early, but non-cavitated, decay where the goal is to prevent cavitation. This is achieved by the intensive program of fluoride therapy,” says Associate Profes-sor Wendell Evans, Faculty of Dentistry, University of Sydney.
No longer will patients receive the routine drill-and-fill dental service for all decayed teeth as the protocols advocate an en-tirely different approach to dentistry. From the beginning each young student will coach tooth brushing skills to their patients, first on a model, and then in the patient’s mouth.
Guiding the young students through the application will be a very new initiative where a psychologist will train dentists in the gentle art of motivational interviewing.
A patient will be offered intensive coaching not just in one session, but through multiple visits to the clinic—first weekly, then fortnightly and finally every third week until there is an identifiable change in the health of their mouth.
In the clinic a student will be instructed on how to treat early signs of decay by non-surgical means. “Thankfully we have this long window of opportunity, as it can take up to eight years for a cavity to develop. If a patient comes in too late, yes they will need a filling but for patients who attend for dental care regularly, then early decay should be picked up and stopped.”
This is part of the risk-based Caries Management System
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Is this the beginning of the end of the ‘drill-and-fill’? Westmead Hospital’s No Drill Clinic opens next year, looking to tackle caries before it’s too late. By Mary Banfield
Opposite: Associate Professor Wendell Evans, pictured at the No Drill Clinic, says we have a long window to arrest the development of caries.
COVER STORY
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that advocates a non-invasive treatment program, unless fillings are absolutely unavoidable.
With the application of topical fluoride, along with sealants that protect the vulnerable chewing sur-faces of the back teeth, the prospect of arresting decay is high, avoiding the drill in the long term.
Over time, as students graduate, Professor Evans believes that a whole new approach to preventive dentistry will be injected into the field.
For many years Professor Evans has been passionate about preventive dentistry, questioning why it is that public policy, education and finally the dental profession are focused almost exclu-sively on treating decay with a drill rather than with early non-surgical intervention.
“There is a need for dental practice to change. Demands for change will have to come from patients as well or dentists are likely to carry on as they have al-ways done. To date dentistry has been a surgical disci-pline and surgeons always find surgical solutions.”
It is not only a problem in dental practices, but as a profession there has been no discipline special-ly established to research and embed a preventive model for caries or tooth decay management into the profession.
“Dentistry has many spe-cialities, there are about 10. For gum disease there is the speciality of periodontics, and there is speciality of orthodontics, but the main disease, dental caries, has no associated speciality, so there is no particular body of specialists to drive educational reform,” says Professor Evans.
Using the Caries Manage-
ment System, he believes that the health benefits for patients will be enormous.
For the past seven years, a trial has been running in which 22 dental practices were monitored, half of whom had agreed to follow the Caries Management System. The outcome will be compared to a control group of the remain-ing 11 practices.
While the final outcome of the research is being released in the next few months, the first stage has already shown the
enormous benefits this approach has had for the majority of patients.
After three years, the out-come was clear—it may cost the average patient a little more, but the benefits were astounding. The prediction is that as we grow older, and if treatment follows the Caries Management System, fewer teeth will go on to develop cavities, and so diminishes the need for fillings and possibly crowns or root canal treatment.
“This person here would be predicted to save 10 teeth from becoming de-cayed but it would cost them an extra $4000 more over their lifetime,” says Professor Evans, detailing one of the many case studies who have already benefited from early intervention.
For high-risk patients there are significant financial benefits as the
cost of early intervention far outweighs the future cost of extensive complex dental treatments.
Adding weight to the need for the No Drill Clinic was a publication released in 2008 by Dr Alexandra Sbaraini, Research Associ-ate, Faculty of Dentistry and Sydney Medical School, University of Sydney. This was a groundbreaking study, the first to evaluate the Caries Management System, but this time the research was monitoring some of the highest risk
patients to be seen by the Dental Hospital.
Volunteers signed up for the program includ-ing methadone
users, cancer patients, a number of people with diabetes or a mental illness, and all participants had a mouth full of untreated cavi-ties and broken teeth.
The program aimed to change the behaviour of patients who “would initially bring coke to the dental ap-pointment”, says Dr Sbara-ini. “The majority of those we saw had never brushed their teeth as adults and some of them had never brushed their teeth before!”
For three months, den-tists would watch and listen while teaching patients about oral health, hygiene and diet—even going back to the basics of how to hold
a toothbrush. At the conclusion of
the research, it was that special relationship that had developed between the patient and their den-tist that was responsible behavioural change, and ultimately transforming the mouths of patients.
“What we don’t realise is that most people’s experience of the dentist is to sit in the dentist chair and open their mouth. For the first time someone had taken the time to talk to them and these guys appreciated that ‘hey this dentist knows all my prob-lems,’” says Dr Sbaraini.
At the beginning of the trial it was clear that all of the volunteers had gum disease, but by the end of the period, the remaining 20 participants showed no sign of bleeding nor gum inflammation.
“After six months, a 42 per cent increase in gingival sites having Gingival Index scores of zero (healthy gums), and a 21 per cent decrease in sites having Gingival Index scores of 2 (moderate inflammation and bleeding on probing) compared to baseline.” This was reported in Caries risk reduction in patients attend-ing a caries management clinic, by Dr Sbaraini.
It was this outcome that showed such an enormous benefit to high-risk patients that has set the grounds for the No Drill Clinic at West-mead Hospital.
It is estimated that by the end of next year the clinic will be servicing up to 200 people.
While Sydney University is leading the implemen-tation of this innovative approach, there have also been welcome signs of some serious international interest in the protocols.
COVER STORY
“The main disease, dental caries, has no associated speciality, so there is no particular body of specialists to drive educational reform.”
QuoteAssociate Professor Wendell Evans, Faculty of Dentistry, University of Sydney
19
Professor Evans has just stepped off a plane after a lightning trip to America where the Car-ies Management System has triggered intense interest from universities around the world and insurance companies.
External pressures are adding to the interest, particularly since the World Health Organization (WHO) has raised alarm bells about the dangerous levels of mercury entering the atmosphere. “What is happening is that the WHO is looking into the contamination of the world by heavy metals and they have a focus on mercury.”
With mercury being
one of the major compo-nents of amalgam fillings, political influences are seeking solutions to reduce the use of this heavy metal in dentistry.
Today it’s predicted that the price of amalgam fillings are set to rise. “It is likely that mercury will become very expen-sive—doubling, tripling maybe even more,” says Professor Evans.
Whether it be for financial incentives, or a commitment to preven-tive health, it seems that the pressure is on to change the way dentistry is practised in Australia and globally.
For patients, what is on
offer is the potential of a filling-free future but that comes down, in part to their dentists’ commitment to intervene early to prevent cavities, and their ability to change our behaviour in home, when it comes to brushing properly.
The dentist is the key, “I don’t know if dentists realise they have such power. You don’t learn these things at uni. What you learn is just to be very technical and do fillings and all that. In our re-search patients said that if you value the relationship with your dentist then you would do whatever the dentist tells you to do,” says Dr Sbaraini.
The clinic aims to offer a “filling-free future”, says Associate Professor Wendell Evans, through training dentists in a Car-ies Management System.
NEWS & EVENTS COVER STORY YOUR TOOLS YOUR LIFE
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YOUR bUSINESS
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ental phobia is an excep-tionally stubborn form of neuroses, and it affects the unlikeliest of victims. Even soldiers, police officers and paramedics get it—and can’t shake it. As veteran practi-tioners know too well, many otherwise stout-hearted people would rather let their teeth rot than face a dental drill.
More and more, Australian dentists are realising they can’t afford to ignore the fear factor, and there’s been a correspond-ing uptick in the number of sedation training courses. When it comes to rigorously aligning sedation practices with patient safety, however, there’s room for more progress.
It doesn’t help that official conscious sedation guidelines in Australia have only been around for a couple of years. At the moment there’s an unofficial two-tiered system in operation. The Dental Board laid down firm rules about training require-ments for practising standard conscious sedation in guidelines released in 2010 and updated in August this year, but it’s less precise on the subject of minimal sedation, or anxiolysis. The Board defines it as the use of a single low-dose oral or inhala-tion drug “for treating anxious patients”. The general rule is that the dose “should be no more than the maximum recom-mended dose of a drug that can be prescribed for unmoni-tored home use”.
In case there’s any confusion, the guidelines explicitly spell
out the fact that they do not cover “anxiolysis technique”. But, given the “unmonitored home use” standard, is there
really any technique to it? Many dentists who have been handing out drugs to fearful patients for years would say no. Where’s the need for training when the safety protocol is self-evident: keep the dose as low as practicable, and keep an eye on the patient.
The University of Sydney’s Clinical Associate Professor Doug Stewart, who directs the School of Dentistry’s Conscious Sedation and Pain Control program, says that sort of thinking leaves out a critical detail—what to do when things go wrong. The safety requirements for conscious sedation, let alone general anaesthesia, are appropriately more stringent than for anxiolysis, Dr Stewart acknowledges, but that doesn’t mean that giving patients powerful drugs, especially children, is risk-free. Worse, dentists may be engaging in polypharmacy—mixing drugs to reduce anxiety—while operating under the loose anxiolysis guidelines.
In effect, that would mean practising a more dangerous form of sedation without having to undergo safety training or have resuscitative equipment on hand. Dr Stewart suspects that such “under the regulations” activity is widespread.
Australia’s failure to tighten safety standards and catch up with the rest of the world on this point has Dr Stewart in a state somewhere between dismay and outrage. Both the World Federation of Societies of Anaesthesiologists and Society for Intravenous Anaesthesia endorse tougher standards. But there’s also outrage on the part of those who view his cam-paign to apply conscious sedation training requirements to anxiolysis as “overkill”. Dr Stewart has been on the receiving
Sedation rulesAn academic maverick explains why better safety standards are essential in the dental profession. By Andy Kollmorgen
YOUR bUSINESS
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end of more than a few emotionally charged emails, letters and phone calls from practitioners who have not embraced the idea of having to pay for training and equipment they’ve been doing just fine without.
Dr Stewart, whose sedation credentials are demonstrably top-notch, is having none of it. “I practised in the UK for about 10 years, and when I came back I was shocked to find it was not compulsory for dentists to have life-saving equipment. Everyone just seems to think dentistry is inherently safe, but there are a lot of variables at play when you’re using any kind of anaesthesia. It affects each patient differently.”
In a discussion paper on anxiolysis recently submitted to the Dental Board, Dr Stewart summed up his key point: “Dentists offering minimal sedation must ensure that they and their staff are trained in advanced life support to the standards required by the Australian Resuscitation Council”. The alternative, Dr Stewart says, is to lag behind the curve in modern dentistry. “A lot of the negative reactions we’ve received seemed to be about dentists protecting their own interests. But all we’re really about is patient safety.”
It’s no secret that the administering of any type of anaes-thesia can be perilous if things don’t go to plan. A widely cited simulation exercise conducted by the Stanford University School of Medicine in California suggested that medical profession-als across all disciplines are under-trained when it comes to
anaesthesia crisis management. The study found that, among the simulation participants, “no-one was taught how to act in managing a critical event or crisis” and that “sound medical and technical knowledge is not enough”. Dr Stewart says the resulting Anesthesia Crisis Resource Management Guidelines should be in every sedationist’s reference library.
Also, people have died. In 2002 a dental patient under intravenous sedation was lost in NSW after being treated by a dentist with a graduate diploma in clinical dentistry/conscious sedation and pain control from the University of Sydney. The patient slipped into progressively deeper states of hypoxaemia (insufficient amounts of oxygen in the blood), which culminat-ed in cardiac arrest. The incident was cited in a retrospective study published in April last year by Dr André Viljoen, also of the University of Sydney Faculty of Dentistry. One of Viljoen’s aims was to determine whether safe oxygen saturation levels could be maintained by a single sedationist, provided the sedationist was operating within guidelines adhering to both the Royal Australasian College of Dental Surgeons and the Australian and New Zealand College of Anaesthetists.
The conclusion was that one sedationist could handle it, but the study also found that risk levels varied significantly depending on gender, age and body weight. The differences were dramatic. Males posed
three times the risk factor as compared to females; patients 45 years or older were nearly eight times more likely to experience unsafe blood oxygen levels than patients 25 or younger; and overweight people were twice as likely to have issues than low and medium weight people.
The variables underscore Dr Stewart’s argument. “Some people are at one end of the spectrum, and some people at the other. And you can’t predict that. The issue here is what
happens when you inadvertently give a patient too much of a drug. Are you trained to cope with unconscious patients? Do you have the right equipment available? If Woolworths and Coles can have defibrillators available, so can dental offices. Sometimes people seem to forget that dentists are healthcare professionals,” says Dr Stewart.
One inherent challenge is that it’s not an exact science. A study conducted by the American Association of Oral and Maxillofacial Surgeons and published in June last year con-cluded that the question of whether to use sedation or general anaesthesia was situational. Conscious sedation was the right choice in “appropriately selected patients”.
YOUR bUSINESS
“I practised in the UK for about ten years, and when I came back I was shocked to find it was not compulsory for dentists to have life- saving equipment.”
QuoteClinical Associate Professor Doug Stewart, Sydney University
Although dentists have excellent training in other elements of the profession, it is lacking when it comes to sedation.
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NEWS & EVENTS COVER STORY YOUR TOOLS YOUR LIFE
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YOUR BUSINESS
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hen Dr Tony Hill was relocat-ing his dental practice in Hobart, he decided to do something different with the interior design. The new space needed to be efficient yet patients should feel comfortable and welcomed
as soon as they entered. It was to be a calm, beautiful surgery with no stark white walls, no bland furniture and no references to teeth, smiles or brushes.
He found his future practice in an old Education Department building. “It was a stripped-out office and not a lot else—just an empty space with a few internal dividing walls,” says Dr Hill. There were a few things in its favour though. It was well situated
in the centre of Hobart with much better parking than his old building. The office also had a view of the mountains, and the cost of the lease was within his budget.
Dr Hill turned to the design team at Liminal Spaces in Hobart. He already knew one of the partners, Elvio Brianese, extremely well—in fact, Brianese was a patient of Dr Hill’s. Peta Heffer-nan, the principal of Liminal Spaces, and architect Jeremy Hol-loway also became involved in creating Dr Hill’s dental surgery from scratch.
“Tony was a brilliant client,” says Heffernan. “He wanted something stylish and welcoming but his major concern was with the efficiencies of the practice. As long as we addressed
Double visionaryA small office space was converted into a bright and pragmatic practice in this award-winning design. By Kerryn Ramsey
Above and right: Dr Tony Hill wanted his practice to be stylish but efficient, given the limited staff and small space.
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the pragmatics, we were able to be creative in the design.” The new office was only 100 square metres in size so Heffernan intended to use all the tricks of the trade to make it look and feel more spacious.
Dr Hill is the only dentist on staff and the receptionist works double duty by looking after all the sterilisation. The efficiency of the space was maximised so she is able to complete her behind-the-scenes work while retaining a view of the desk and waiting room. Dr Hill also employs a dental assistant and a hygienist.
Two surgeries were set up side by side with an interview room between them. “It was really important I had a small office where I could speak to patients away from the clinic environ-ment,” says Dr Hill. The design allows for him to move between the surgeries without going into the public areas. A third surgery is used solely by the hygienist.
All three surgeries are bounded by opaque glass walls. This allows outside light into the waiting area and reception that are both internal rooms. The glass walls make the space feel larger while retaining privacy for patients in the surgeries.
For the interior, Heffernan drew inspiration from a mosaic
facade on the front elevation of the building. Created by Tas-manian artist Max Angus in the late ’50s, the mosaic was very Mondrian in its design. “We wanted to bring in something that had a bit of meaning and would provide the conceptual frame-work for how the spaces were divided,” says Heffernan. They worked around the existing mechanical systems, reused some of the light fittings and recycled as much as possible. Following the lineal aspect of the mosaic, the space was divided using a rectangular grid.
It’s the colour palette, however, that gives the practice its unique look. Chocolate brown and burnt orange—a combina-tion possibly never seen in a dental surgery before—provides a calming ambience with a slightly retro feel. While not reproduc-ing the exact colours of the facade, the retro element stems from that dramatic artwork.
While Heffernan was certain that the colour combination would work, she was slightly apprehensive when presenting it to Dr Hill. “We had put a lot of thought into it,” says Heffernan, “and Dr Hill brought his wife Teresa along to get a second opinion.” There was no need to worry, though. As soon as they saw it, Dr Hill and Teresa loved the concept and approved the colour scheme.
A dramatic chocolate-coloured wall dominates the waiting area with low, chunky and very comfortable seating along its base. A soft lineal light washes down the wall and orange stripes recede down the hallway. The flooring design pays hom-age to the Angus mosaic and the feel is one of spaciousness. The cold clinical aspect of most surgeries has been successfully
YOUR BUSINESS
“It was really important I had a small office where I could speak to patients away from the clinic environment.”
Quote Dr Tony Hill, Hobart
eliminated from this elegant practice.Heffernan was also very aware that the space needed a
high level of cleanliness. “We avoided fussy detailing because that can be a collection point for dirt and dust,” explains the Tasmanian architect. All three surgeries are built with clean, simple lines and have no unnecessary ledges. Each surgery has an inbuilt seat for carers, children or parents to watch proceed-ings. This unobtrusive seating fits seamlessly into the room. Everything can be cleaned down easily while the simple lines and sleek styling reduces visual noise.
The result of all this hard work has been an overwhelming success. The Tony Hill Dental practice received an Australian Institute of Architects (Tasmania chapter) interior architec-ture commendation in 2012. It’s also been shortlisted for the national Interior Design Excellence Award. “You don’t expect those kind of awards for a dental surgery,” says Heffernan, who is undoubtedly chuffed. “We were up against snazzy cafes and moody wine bars. It’s a bit of a first for a dental surgery to get a look in. We are really happy.”
And as Dr Hill says, “It’s certainly come up trumps. I’ve had very positive responses from all my patients.”
It’s often said of medical practitioners that they don’t like to spend too much money on the front-of-house in case their patients think that’s why everything is so expensive. This has undoubtedly kept a vast number of surgeries looking a little on the bland side. Peta Heffernan, however, has a different view. “I’m a big believer that the space impacts on your wellbe-ing and your psychology—so I hope there’s a shift to making surgeries less hostile and clinical. I’m very thankful that we had a client like Tony who is a bit of a visionary.”
The design allows the receptionist to see the front desk while performing behind-the-scenes work.
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here’s a nervous patient sitting in your office. You’re confident that the treatment you’re recommending is the right one and you’re trying to explain to her, but she’s worried about the proce-dure. It sounds complex—and painful. Technical language isn’t helping and she’s having real trouble coming to
grips with what’s ahead. She’s not sure whether or not to take your advice.
Meanwhile, there’s another patient masking their nerves
with bravado. He’s been doing research about his discomfort on the world wide web and has a few ideas about what sort of treatment he needs. So he’s not immediately receptive to your diagnosis and wants a detailed explanation of all his treatment options.
These are situations that are familiar to many dental prac-titioners. “People are scared of the unknown,” says Dr Frank Papadopoulos. “Having the ability to convey information effectively to a patient reduces that fear.” Dr Papadopoulos is a dentist, and he’s also the man behind Centaur Software, which sells practice management software to dentists.
Getting animatedWhile 3D software is a fun gadget to have on the computer, can it really have a measureable impact on case acceptance? Yes it can, say the experts. By Catri Menzies-Pike
YOUR bUSINESS
According to Papadopoulos, patients often have difficulty grasping 2D models of procedures and physical models “can be cumbersome” especially when time is short. Technologi-cal advances mean that the memory and processing speed required to generate 3D models of dental procedures on screen are now affordable. He’s added a 3D charting module to Centaur’s popular dental4windows to help dentists explain procedures to their patients. “It’s the next generation of charting software and it leaves the old methods far behind, as far as accuracy and accessibility go,” he says.
Dr Nathaniel Goldstein is also very enthusiastic about 3D patient education software. He’s another dentist who’s now working in the software game. His company Golden Medi-cal imports DentalMaster software and he argues that it’s a vital step forward for dentists. Like Dr Papadopoulos, he stresses the role of 3D models of procedures in calming the nerves of anxious patients. Dentists, he says, aren’t always good at explaining themselves. “Many dentists are very bad salespeople,” and they need help when it comes to clearly communicating the procedures they plan to undertake.
There’s been a rapid evolution in patient education tech-nologies. Once upon a time, dentists relied on pen and paper diagrams, X-ray monitors and photographs to show patients how they planned to undertake a procedure. The first com-puterised patient education tools weren’t a great deal more sophisticated than these. Diagrams were still 2D affairs. As
a rule, these diagrams didn’t do a great job in depicting the complexity of the oral cavity.
3D models “capture the reality of what’s in a patient’s mouth”, says Papadopoulos. Rather than being presented with a set of still images of what will take place, patients can be shown an animation of what will happen during a proce-dure. The dentist can pause the animation at any moment to explain, or to zoom in to see more detail. It’s tremendously effective, according to Dr Goldstein, and takes some of the mystery out of dental surgery. “It creates confidence in pa-tients that the treatments are more simple than they fear.”
Dr Goldstein’s software allows dentists to customise the animations to fit their patients. If a patient has a missing tooth or has had a root canal, it’s simple to incorporate that into the model. It’s one step further than the out-of-the-box animations and is designed to reassure patients that they’re consenting to treatment that exactly matches their mouth.
As far as detail is concerned, 3D modelling represents a huge advance. 2D charting can cover roughly five-to-seven chartable surfaces of each tooth, says Dr Papadopoulos, whereas 3D modelling can cover up to 40. That means den-tists can give their patients a close-up and accurate view of their teeth, and the procedure. It’s unclear whether this level of detail is necessary to achieve the optimum patient under-standing of a procedure. There’s only anecdotal evidence as to whether patients benefit from this level of detail—but it’s
The 3D images like those offered by Centaur (above) save dentists time and help them explain procedures.
30
within reach, and for some practitioners it’s very desirable.The high level of functionality of this software may not be
necessary for all dentists. If a dentist is reasonably eloquent, it’s worth asking whether this software serves a useful func-tion. If dentists have been explaining complex procedures without these tools, do they really need to add another snazzy gadget to their office set-up? The answer to this question rests, to a large extent, on the individual dentist. The provid-ers tell Bite that better software was developed in response to a perception that there’s a limit to what can be verbally explained, especially within the relatively brief window of a consultation. Dentists who feel they are able to communicate comfortably with patients may not need additional tools. Those who struggle in this regard might well benefit.
Certainly the software on offer can be easily incorporated into the day-to-day running of a practice. 3D educational products can be integrated into practice management software without a hitch and there are options available for small and large practices. Drs Papadopoulos and Goldstein are adamant that their software systems are easy to use and offer online tutorials to help dentists get up to speed. Most 3D suites can plug into record keeping systems, allowing dentists to keep close track of procedures, and add anima-tions to the X-rays, intra-oral photos, videos in a patient’s record. Goldstein adds that there are legal protections that can arise from using this software as patients are able to give much more meaningful consent to procedures.
The leap from paper to computer was a huge move and 3D animations allow dentists to explain themselves to anxious
patients in more detail than ever. The models can already be customised and Dr Goldstein says there’s more to come. Once patients have adjusted to the shock of seeing detailed customised animations, they’ll have to get used to the idea of animations built from X-rays and photographs of their own mouth. The patient—and the dentist—will be able to witness a modelled animation of a procedure taking place on screen before them. That’s the next frontier of tech-driven patient education, and it’s not far away.
YOUR bUSINESS
Most 3D suites can plug into record keeping systems, allowing dentists to keep close track of procedures, and add animations to the X-rays, intra-oral photos, videos in a patient’s record.
The other advantage of imaging software is the ease with which it can be incorporated into the practice.
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NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFEYOuR TOOLS
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Tools of the tradeThe electric stuff, the flexible stuff, the slippery stuff and more are all in the spotlight this month
(continued on page 34)
Elements Diagnostic Unitby Dr Kate Fiore, Cannon Hill Dental, Cannon Hill, QLD
This apex locator from SybronEndo also tests the health of the tooth’s pulp. I started at Cannon Hill Dental about two-and-a-half years ago and have used this unit regularly in that time. The machine has been here for about 10 years.
What’s good about itIt gives really reliable results and useful information on pulp sensibility. I use it with every root canal to check the position of the foramen. It sends a current through the tooth and that current is completed by linking a small attachment to the patient’s cheek. It lets you assess if the nerve in the tooth is healthy. It also aids in the diagnosis of trauma cases by providing baseline and follow-up monitoring. It comes with an extra display that can be placed on the patient’s bib. I really like this option as I don’t have to strain my neck to look at the main display.
It can be quite a talking point with patients. They’re always interested in the procedure of pulp testing and what it means for their tooth.
What’s not so goodThe electric pulp test is subject to bias as it’s based on the patient’s response. They need to let the dentist know when they feel a current in the tooth. Nervous patients might be more sensitive or think they feel it earlier than they actually do. You also need to be careful when using it with people who have cardiac pacemakers or implantable electronic devices.
Where did you get itHenry Schein Halas.
Roeko Flexi Damby Dr Soo-Wee Ong, Dewhurst Dental, Armidale, NSW
Even though I have long known that all restorations should be accompanied with the use of a rubber dam, I haven’t always been consistent in using them. However, ever since switching to the Roeko Flexi Dam about 12 months ago, it’s now a no-brainer.
What’s good about itIt helps make the working environment stress free and also speeds up the work. It rarely tears and makes placement a breeze. I now use this rubber dam for isolation with almost all operative procedures including simple restorations, root canal procedures, quadrant work, and even crown preparations. It makes everything so much easier for myself, my assistant and the patient.
Getting the right clamp is important and I mainly use the 26N or 27N clamp depending on the situation. For most operative procedures, I isolate the whole quadrant, often using a split dam technique. For root canal procedures, I keep it simple with a winged clamp and single tooth isolation. I can honestly say that my patients have welcomed the use of a rubber dam for all their operative procedures. They are much more comfortable.
What’s not so good about itIf you’re not a regular user of a rubber dam, you have to get into the habit of using it and ensuring your technique is efficient so placement takes less than a few seconds. Also, it is more expensive than traditional rubber dams.
Where did you get itHenry Schein Halas.
NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFEYOuR TOOLS
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Tools of the trade (continued from page 33)
Sopro 717 intraoral cameraby Dr Joseph Paino, Enhance Dental, Melbourne, VIC
I just can’t go past my intraoral camera when it comes to a dental instrument I would be lost without. I’ve been using them regularly for over 17 years and purchased the Sopro about six years ago.
What’s good about itThis is an excellent educational tool simply because a picture speaks a thousand words. I use the intraoral camera to help give my patients an understanding about the condition of their teeth, even if they have no symptoms. This often helps them to be more proactive, take ownership of their dental health and any treatment recommendations.
I use it with virtually every procedure. I like to show before-and-after images so patients can see and appreciate the treatment they have received. I store all the images from the camera into my Dental4Windows software. Whenever I pull up a file, I have the X-rays and a bank of digital images with which to refer.
The camera is connected to a 42-inch LCD TV so the patient has a very clear view. The quad view option brings up four images at once so I can show side-by-side, before-and-after images.
Finally, with litigation becoming more of an issue these days, you have a much better trail with a digital camera.
What’s not so goodIt takes a little while to learn how to comfortably navigate around the mouth and focus correctly. The Sopro’s illumination comes from an LED light so you have to remember to flick off the overhead light. Failure to do so creates a false colour image.
Where did you get itActeon Group.
Vaselineby Dr John Chiang, Picton Dental, Picton, NSW
I have read Tools of the Trade for years now, and always enjoyed the reviews of cheap generic products.
It’s easy to rave about a $200,000 cone-beam CT scanner and how it improves our dentistry but it is also interesting to read about the ingenious ways dentists use everyday products. I have found Vaseline to be a very useful product.
What’s good about itIt’s pretty basic—Vaseline lubricates and stops things sticking together. When I was a dental student, we used it on patients’ lips to prevent cracking. Since then I’ve found many other uses for it.
A coating on chrome casting clasps and rest areas at try-in helps with seating and unseating. I also apply it to chrome rest areas when retro-fitting composite fillings.
A layer of Vaseline on my finger when moulding temporary inlay/onlay material onto a tooth will stop it from sticking. Likewise, a thin layer applied to a matrix band will stop GIC from sticking during band removal.
I also apply it very lightly with a micro-brush around the external margin of crowns and bridges to help clean luting material, especially in interproximal areas. It makes flossing through much easier as well.
I rely on Vaseline multiple times a day and there’s never any need to be stingy. And it’s dirt cheap to purchase compared to other dental products.
What’s not so goodIt’s hard to find anything negative about this product. It’s cheap, readily available and effective.
Where did you get itAny chemist or supermarket.
NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFEpROduCT guidE
Implant product guideThe most comprehensive guide to the best implant products
available on the market today.
35
NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFE
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Implant product guide
W&H a leader in implantology
36
W&H has been a leader in precision dental instruments for over 120 years and is one of
the most trusted names among dental professionals.
Nowhere is this more apparent than the field of oral surgery and implantol-ogy where dental professionals have welcomed the release of the newest W&H Implantmed surgical motor.
The key new feature of the latest Im-plantmed is an automatic thread cutter function, which allows the surgeon to focus on the job at hand with precision and safety.
Andrew Holmes, from leading implant manufacturer BioHorizons AU/NZ, said integrating the automatic thread cutter function into the new Im-plantmed offered tremendous support to the Implantologist when inserting implants in hard bone.
“Cutting or tapping a thread into dense bone before placing the implant prevents excessive compression and potentially inhibits the likelihood of pressure necrosis during the important healing phase,” Andrew said.
Because it is fully automated with inbuilt stop and reverse action, the thread cutting function means sur-geons can concentrate on the task at hand. Preset torque from 5 to 70 Ncm ensures safety throughout procedures. In thread cutter mode, the torque can be increased in 5 steps (20, 30, 40, 50 and 60 Ncm) by foot pedal.
“In the past, surgeons have had to stop, manually put the motor in reverse and switch on again. If an operator did not know the machine well, there was a possibility of accidentally going from 300 to 40,000 RPM.
“The new Implantmed has found ready demand among implantologists, periodontists and those general practi-tioners performing implant work.”
The latest W&H Implantmed is complemented by the range of W&H surgical handpieces which include class-leading LED+ technology.
The W&H precision range of straight and contra-angle Surgical handpieces includes handpieces which can be fully dismantled and thermo disinfected and sterilized up to 135° C.
W&H handpieces are lightweight, powerful and strong, making them the perfect equipment for oral surgical procedures, backed by the W&H Implantmed which provides intuitive foot control and an automated stop and reverse function for maximum precision and safety of all implant and surgical proce-dures.
SI-923 ImplantmedKey features:Simplicity of operation Powerful motor (up to 70 Ncm on the rotary instrument) Automatic thread cutter function Precise torque control Large, easy-to-read display Intuitive foot control Easy to clean Ergonomic design
Below: The new W&H Implantmed features auto thread cutter function to reduce bone compression and aid healing around the implant.
Below left: Andrew Holmes and Mark Sorensen from Biohorizons with the new W&H ImplantMed on show at the ADANSW convention.
Now even more innovative.
PEOPLE HAVE PRIORITY
Easy to dismantle. Easy to assemble. As simple as they are efficient: both the S-11 LED G and the WS-75 LED G can be completely dismantled. And, of course,they can be put back together again. Quick, simple and risk-free: meaning that youtoo are able to eliminate any risks and work in truly optimum hygienic conditions. Get the new standard for yourself: perfect light, global compatibility,precision, ergonomics – and complete safety.
Easy-to-dismantle surgical instruments with LED and generator
For more information please ask your local dental dealer. wh.com
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Now even more innovative.
PEOPLE HAVE PRIORITY
Easy to dismantle. Easy to assemble. As simple as they are efficient: both the S-11 LED G and the WS-75 LED G can be completely dismantled. And, of course,they can be put back together again. Quick, simple and risk-free: meaning that youtoo are able to eliminate any risks and work in truly optimum hygienic conditions. Get the new standard for yourself: perfect light, global compatibility,precision, ergonomics – and complete safety.
Easy-to-dismantle surgical instruments with LED and generator
For more information please ask your local dental dealer. wh.com
100304_WH_AD_CHIRURGIE_AEN_A4:Layout 1 04.03.10 09:29 Seite 1
For more information Email: [email protected]: 1800 225 010 Visit: www.wh.com
1637-29_AA_LED Full Page AD Mag_WF_1A.indd 1 23/03/11 5:23 PM
NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFE
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Implant product guide
Simple Solutions abutments with Laser-Lok® technology
38
With the success of BioHorizons Laser-Lok technology on im-plants, BioHorizons breaks new ground by applying this innovative
technology to abutments. The Simple Solutions abutment with Laser-Lok is designed to be seated at the time of implant placement or uncovery and remain in place through final restoration 2,3. This establishes and maintains the connective tissue attachment.
Laser-Lok has been shown to: Inhibit epithelial down growth 1,4 Attract a physical connective tissue attach- ment 1,4 (unlike Sharpey fiber attachment) Preserve the coronal level of bone 1,4
In a recent study, Laser-Lok abutments and standard abutments were randomly placed on implants with a grit-blasted surface to evalu-ate the differences. In this proof-of-principle study, a small band of Laser-Lok microchannels was shown to inhibit epithelial downgrowth and establish a connective tissue attachment (unlike Sharpey fibers) similar to Laser-Lok implants.1
In these cases, an epithelial barrier and a su-pracrestal connective tissue barrier was created, even when the implants had a machined collar.1 The resulting crestal bone levels were higher than what was seen with standard abutments and pro-vides some insight into the role soft tissue stability around the abutment and implant may play in maintaining crestal bone health.
1. Histologic Evidence of a Connective Tissue Attachment to Laser Microgrooved Abutments: A Canine Study. M Nevins, DM Kim, SH Jun, K Guze, P Schupbach, ML Nevins. International Journal of Periodontics & Restorative Dentistry. Vol. 30, No. 3, 2010.2. Adequate primary stability required.3. Removing the abutment after initial placement may disrupt the connective tissue attachment.4. Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim. International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.
Laser-Lok microchannels
Epithelial downgrowth
Connective tissue
New boneBone loss
Standard abutment at 3 months
Laser-Lok abutment at 3 months*
Laser-Lok microchannels with soft tissue attachment
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For further information please contact
Customer Care 1300 13 12 19 or shop online at www.biohorizons.com
Laser-Lok 3.0 is the first 3mm implant that incorporates Laser-Lok technology to create a biologic seal and maintain crestal bone on the implant collar1. Designed specifically for limited spaces in the esthetic zone, the Laser-Lok 3.0 comes with a broad array of prosthetic options making it the perfect choice for high profile cases.
1. Radiographic Analysis of Crestal Bone Levels on Laser-Lok Collar Dental Implants. CA Shapoff, B Lahey, ‘ PA Wasserlauf , DM Kim, IJPRD, Vol 30, No 2, 2010. 2. Implant strength & fatigue testing done in accordance with ISO standard 14801.3. Initial clinical efficacy of 3-mm implants immediately placed into function in conditions of limited spacing. Reddy MS, O’Neal SJ, Haigh S, Aponte-Wesson R, Geurs NC. Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):281-288.4. Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim. International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.
• Two-piece 3mm design offers restorative flexibility in narrow spaces • Implant design is more than 20% stronger than competitor implant2
• 3mm threadform shown to be effective when immediately loaded3
Radiograph shows proper implant spacing in limited site.
Laser-Lok 3.0 placed in esthetic zone.
Image courtesy of Michael Reddy, DDS Image courtesy of Cary Shapoff, DDS
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Implant product guide
Brener Implant Institute– safe and predictable2013 Comprehensive Structured Certificate Program, Including Surgical Observation, Hands On Surgery, Laboratory Participation And Prosthodontics.
40
Dr Brener has developed his Structured Implant Program to help set and elevate the standard of care in implant
dentistry using a hands-on approach. This approach will provide the most progres-sive, well documented information with hands on experience to make implant placement safe and predictable.
Dr Brener graduated in Dentistry from the Sydney University Dentistry faculty in 1983 and was awarded the Port Dental Prize as well as prizes for Restorative and Prosthetic Dentistry. He was awarded his
Master of Dental Science in Prosthodon-tics at Sydney University in 1987 and is a Member of The Royal Australasian College of Dental Surgeons (MRACDS).
Dr Dan Brener is registered as a Prosthodontist with the Dental Board of New South Wales and is in full time clinical private practice. He currently holds the position of Clinical Associate in the Faculty of Dentistry, The University of Sydney. He is involved in the planning and teach-ing of the Post Graduate Prosthodontic Programme at Clinical and Academic and examination levels and is a member of
the Prosthodontic Post Graduate Planning Committee. In additional to these roles, he is a lecturer to the University of Sydney Im-plant Diploma and The Australian Society Of Implant Dentistry.
Over 200 dentists have attended the program since its inception in 2003.The program will provide participants with the most successful and “state of the art” implant techniques. The course will introduce the novice to this field, and the experienced Practitioner who completes this program will advance his present
Dr Dan Brener (second from left)is registered as a Prosthodontist with the Dental Board of New South Wales and is in full time clinical private practice.
experience in implant dentistry greatly. Attending 20 meetings by 100 different
lecturers over a five-year period does not provide the experience and
knowledge attainable through a struc-tured one-year program.
This is still the only program where the participant can perform all the forms of dento-alveolar grafting and surgical im-plant related procedures under supervi-sion, on their own patients.
Completion of the Certificate Program will give the graduate confidence to perform three-dimensional prosthetically driven treatment planning, bone grafting, implant placement and prosthetics.A 5% increase in success rate can equate to thousands of dollars each year.The 3 Prosthetic and 5 Surgical and 2 Advanced Surgical sessions are given throughout the year to maximise your learning experience. The information is contemporary and evidence based. The course earns you 162 hours CPD recognition.
Participating doctors are encouraged to perform surgery on their patients under supervision during the surgical sessions. Appropriate sound medico-legal docu-mentation will be provided to assist you with preparing your patients for surgical attendance and giving you correct surgi-cal and prosthetic work flow procedures.
Faculty Members Associate Professor Robert Mitchell BDS MDS FRACS (OMS) FADI Oral & Maxillofacial Surgeon Dr Bree Belford Emergency Medi-cine Doctor – Sedation Dr Martin Forer MB.BCH FRACS Ear, Nose & Throat Surgeon Mr Wallis Franklin Ceramist Dr Christine Wallace BDS, MDSc, FRACDS, MRACDS (Pros), Cert MaxFac Pros (Iowa), Grad Cert Social Sciences (Higher Ed) Prosthodontist Dr John Barbat BDSc (Qld) MDSc (Melb) Endodontist Dr Brian Johnston BDS (Belfast) Sur-gical and Prosthetic Supervision
For more information visit www.brener.com.auEmail: [email protected]: 02-9922-4455.
2013 Structured Implant Program
Common 1 Patient evaluation and Treatment Planning
15-17 Feb
Prosthetic 2 Single Tooth and Quadrant Prosthetics
15-17 March
Surgical 2 Implant Placement 12-14 April
Prosthetic 3 Full Arch and Removable Prosthetics
10-12 May
Surgical 3 Particulate and Membrane Grafting
14-16 June
Advanced 1 Soft Tissue – Plastic Surgery Program
20-21 July
Surgical 4 The Posterior Maxilla – Including Sinus Grafts
16-18 August
Surgical 5 Advanced Bone Grafting – Block Graft Harvests
18-20 October
Advanced 2 Frozen Cadaver Surgical Implant Program
16-17 November
Participating doctors are encouraged to perform
surgery on their patients under supervision during
the surgical sessions
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Implant product guide
Neoss–advancing the science of dental implant treatment2013 Comprehensive Structured Certificate Program, Including Surgical Observation, Hands On Surgery, Laboratory Participation And Prosthodontics.
42
eoss is founded on the passion and inspiration of individuals, clinicians, academics and engineers
- all seeking to create a better future for patients
It’s this passion that helps us put together a system above all others, a system you can trust and a system that makes a connection which stays forever.
The foundations of our system can be seen in forty years of provenance in the rapidly evolving world of dental implants. We are proud to be at the forefront of this evolution with a system that challenges traditional conventions through the simplicity of having just one platform.
Coupled with this rich heritage of ex-perience comes our strong affiliations with some of the worlds leading medi-cal device companies and a unique research and development pipeline that creates timeless technologies.
All operated in a market where sim-plicity is commonly claimed, we have redefined its meaning to achieve the highest level of flexibility and function-ality with excellent results for our patients.
Our Vision is to advance the science of dental implant treatment.
For 2013 course event details contact Neoss on 07 3216 0165 or [email protected].
product catalogueAdvancing the science of dental implant treatmentApril 2012
[ science and simplicity ]www.neoss.com
a fusion ofscience and simplicity
[ science and simplicity ]
www.neoss.comNeoss Australia Pty. Ltd, PO Box 404, New Farm, QLD 4005T +61 7 3216 0165
At Neoss, our investment in science and simplicity has led to the evolution of one of the most comprehensive and sophisticated
dental implant systems.
one connection one surgical kit one ProActive surface
Greater freedom True versatility
Highly innovative
Neoss FMC 190 x 256 advert aw - AU.indd 1 18/06/2012 12:12
NEWS & EVENTS COVER STORY YOuR buSiNESS YOuR LiFE
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Implant product guide
Sirona creates a fully integrated implant workflow
44
The world of implant plan-ning and placement is changing at a rapid rate. The technologies around
this including 3D Imaging, implant planning software, CAD/CAM and the use of surgical guides are getting more innovative, and the demand to have a completely integrated solu-tion is becoming a priority.
Sirona has managed to create a fully integrated workflow, from the large field of view 3D imaging that GALILEOS offers, and now the true hybrid unit ORTHOPHOS XG 3D which can acquire panoramic and ceph images (changing to its 3D sensor automatically at the touch of a button), through to creating a virtual prosthetic proposal with aid of CEREC software. You can integrate CAD/CAM and 3D imaging data to fully plan your implants. You have the ability to order your surgical guides through the implant planning software GALAXIS. The SICAT surgi-cal guide with guaranteed accuracy (the only surgical guide company to offer this) can be ordered online and generally delivered to your practice within a few days.
The next exciting step in this evolution will be the ability to mill your surgical guides in-house with CEREC. This workflow is called CEREC Guide. The implant is then planned and the 3D data is exported from the 3D X-ray software into the CEREC software. In the final exciting step, the surgical guide drilling body is milled ready for surgery. This is regarded in the dental community as a huge leap forward for the surgical guide manufacturing process.
The benefit of having the full workflow in-house is the control over each stage of the treatment. This alleviates the need for the patient to attend multiple appointments
or to travel to radiography centres, therefore cutting out the waiting time for images to make it back to the surgery and the need for a fol-low up appointment. This ability to achieve simultaneous surgical and prosthetic planning in a single visit provides advantages to both patient and dentist resulting in convenience of treatment and improvement in productivity.
The GALAXIS software also simpli-fies findings, which can be marked easily in the x-ray volume. For areas of concern where a second opin-ion may be required, a radiological report can quickly be created from within the software.
Sirona also prides itself of produc-
ing the best quality equipment, man-ufactured in Germany, with an R&D annual spend larger than any other dental equipment manufacturer. This means you can rely on Sirona to continue to produce the most innovative products in the dental industry with a fully integrated focus. Through working with Sirona you are dealing directly with the manufactur-er with no reseller in-between. With over 130 years of dental experience you can rest assured Sirona has the depth of expertise and experience to provide you with full confidence. You will be looked after through every stage of your purchase and beyond, creating an ongoing relationship into the future.
The ORTHOPHOS XG 3D and GALILEOS are changing the
implant world.
Appointment 1 Appointment 2
Contact your local Sirona representative for more information.1300 747 662 www.sirona.com.au
CEREC meets 3D
Integrated Implantology
1. CEREC intra-oral scan & design
2. Integration of CEREC& 3D X-ray scan
3. Implant planning & surgical guide ordered
4. Surgery with precision surgical guide
Appointment 1 Appointment 2
Contact your local Sirona representative for more information.1300 747 662 www.sirona.com.au
CEREC meets 3D
Integrated Implantology
1. CEREC intra-oral scan & design
2. Integration of CEREC& 3D X-ray scan
3. Implant planning & surgical guide ordered
4. Surgery with precision surgical guide
YOUR LIFENEWS & EVENTS COVER STORY YOUR BUSINESS YOUR TOOLS
46
Inte
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ew: K
err
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am
sey.
Dental as anythingDr Stuart Garraway of BOH Dental, Brisbane, is happy for his rock band to perform for weddings, parties and a few school fetes
Our band is called the Usual Fee and I play bass and rhythm guitar. we started about 10 years ago with a gig at a medical confer-
ence on the Gold Coast. the band ranges in size from a three-piece to a seven-piece and we play anything from the ’60s to the ’80s. we’ve had numerous name changes over the years. we were short for Bob for a while, then had a brief time under the name Crowded mouth. the Usual Fee had its origins from someone asking how much we were getting paid. Our drummer answered it was the usual fee—nothing! when people book us, they pay for hire of the Pa system, the sound technician and any other equipment; however, we don’t get paid. It’s more a labour of love. we’re just a bunch of amateurs who thoroughly enjoy themselves. we’ve played at dental conferences, weddings, birthday parties and school fetes.
“I’ve always had a keen interest in music, but not a keen interest in practising. I’m pretty much self-taught but unable to read music so I play it all by ear. so at age 42, I finally started getting some lessons. they’re helping to get rid of my bad habits and replacing them with
good ones. the core of the band has stayed the same since the beginning—myself, Chris Chahoud who’s an oral maxillofacial surgeon, and our drummer Dave wilt-shire. even though we have a floating line-up, we three core members have played every gig. It’s been a really nice thing with no bad split-ups, no ‘musical differences’ and no-one choking on their own vomit. I really look forward to getting together and playing with them.”
We don’t get paid for gigs. It’s more a labour of love.
Medical and Dental Finance
Out of the Ordinar y
Specialist Bank
Deposit products are issued by Investec Bank (Australia) Limited ABN 55 071 292 594, AFSL 234975 (Investec Bank). Before making any investment decisions, please contact us for a copy of the Product Disclosure Statement. The information contained in this document does not take into account your personal financial or investment needs or circumstances. The above rates are current as at 20 July 2012. The plus 1% promotion is available for the first 90 days on new notice accounts opened with up to $250 000 deposit. Balances over $250 000 earn the standard variable rate. Interest is paid monthly. Offer valid from 1 August 2012 to 31 October 2012 and is subject to change without notice. Deposits placed with Investec Bank are guaranteed by the Australian Government as part of the Financial Claims Scheme. For further information regarding this scheme, please refer to www.apra.gov.au
Medical and Dental Finance
Make the most of your business, retirement or personal savings. We know that it’s tough constantly chasing the best rate for your savings. But it doesn’t have to be.
• Availableforbalancesupto$250000
• Availabletomedicalanddentalprofessionalsonly
• Bonusrateconfirmedfor90days
• 32daysnoticetowithdrawfunds
• Interestpaidmonthly
• Onlinebankingfunctionality
This offer is open to new deposit clients and for new accounts.
To apply call 1300 160 160 or visit www.investec.com.au/notice
32 day notice account
Earn an extra 1% above our current rate of 5.15%
A big plus for savers
YOUR LIFE
Medical and Dental Finance
Out of the Ordinar y
Specialist Bank
Deposit products are issued by Investec Bank (Australia) Limited ABN 55 071 292 594, AFSL 234975 (Investec Bank). Before making any investment decisions, please contact us for a copy of the Product Disclosure Statement. The information contained in this document does not take into account your personal financial or investment needs or circumstances. The above rates are current as at 20 July 2012. The plus 1% promotion is available for the first 90 days on new notice accounts opened with up to $250 000 deposit. Balances over $250 000 earn the standard variable rate. Interest is paid monthly. Offer valid from 1 August 2012 to 31 October 2012 and is subject to change without notice. Deposits placed with Investec Bank are guaranteed by the Australian Government as part of the Financial Claims Scheme. For further information regarding this scheme, please refer to www.apra.gov.au
Medical and Dental Finance
Make the most of your business, retirement or personal savings. We know that it’s tough constantly chasing the best rate for your savings. But it doesn’t have to be.
• Availableforbalancesupto$250000
• Availabletomedicalanddentalprofessionalsonly
• Bonusrateconfirmedfor90days
• 32daysnoticetowithdrawfunds
• Interestpaidmonthly
• Onlinebankingfunctionality
This offer is open to new deposit clients and for new accounts.
To apply call 1300 160 160 or visit www.investec.com.au/notice
32 day notice account
Earn an extra 1% above our current rate of 5.15%
A big plus for savers
Did you know?People with diabetes are more susceptible to gum disease1.
Visit www.colgate.com.au for further details
Diabetes & Dental Health
It is recommended that people with diabetes make regular visits to a dental professional to detect and treat gum disease. The twice daily use of an antimicrobial toothpaste is also recommended to minimise the progression of gum disease2.
Colgate Total has a clinically proven antibacterial formula
Colgate Total toothpaste reduces up to 90% of plaque germs that can cause gum disease3. Colgate Total has a clinically proven antibacterial formula which works by removing the plaque bacteria on the surface of teeth and gums. Its formula also helps prevent plaque bacteria reappearing for up to 12 hours by creating a protective barrier around the teeth and gums.
Always read the label. Use only as directed. See your dentist if symptoms persist. 1) Taylor and Borgnakke, (2008). Oral Diseases, 14: 191-203; Khader, Albashaireh and Hammad, (2008). La Revue de Sante de la Mediterranee orientale, Vol 14, No.3: 654-661; 2) Blinkhorn, et al. (2009), British Dental Journal, Vol 207, No.3: 117-205; funded by Colgate-Palmolive Pty Ltd, Australia. 3) Fine, et al. (2006). Journal of the American Dental
Association, 137: 1406-1413; funded by Colgate-Palmolive Co, New York.
