issn 1616-7390 • Vol. 15 • Issue 1/2024 1/24 international magazine of dental laboratories F DENTAL T RIB O S R A E Y 0 2 & E DIA UN E I N T . • 3 0 Y E A R S OF OE M U S M industry news Quality and inventory management in the dental laboratory case report Monolithic multilayer zirconia crowns in the aesthetic zone features Back and neck pain in dentistry: A new reality

editorial | Magda Wojtkiewicz Managing Editor Exploring the power of CAD/CAM technology Welcome to the latest issue of our CAD/CAM magazine, where we delve into the exciting advancements and applications shaping the modern dental landscape. As digital technology continues to revolutionise dentistry, it has become increasingly indispensable for both dentists and dental technicians alike. In recent years, CAD/CAM technology has undergone remarkable development, transforming the way dental professionals approach treatment planning, restoration fabrication and patient communication. Embraced by dentists and dental technicians worldwide, CAD/CAM technology has become an integral component of modern dental practices and laboratories. The growing adoption of digital workflows has paved the way for enhanced precision, efficiency and aesthetic outcomes in dental treatments. With CAD/CAM technology, dental professionals can now design and fabricate resto- rations with unparalleled accuracy, ensuring optimal fit, function and aesthetics for their patients. Industry has played a pivotal role in driving the advance- ment of CAD/CAM technology. Many companies globally have launched cutting-edge surgical guides, milled im- plant abutments, and milling blocks and discs, among other products, offering dental professionals innovative solutions for restorative dentistry. Additionally, advance- ments in quality and inventory management have streamlined workflows in dental laboratories, optimising efficiency and productivity. for orthodontic treatment, providing patients with more efficient and discreet alternatives. As digital technology continues to evolve, so too do the trends and applications shaping modern dentistry. This CAD/CAM issue explores the Personal Oral Protocol concept, pioneered by dental technician Eric Berger, which exemplifies the personalised approach enabled by digital technology, tailoring treatment plans to individual patient needs and preferences. In this issue of CAD/CAM magazine, we also present capti- vating case reports, showcasing the digital workflow of imme- diate implant placement and restoration, full-mouth prosthetic reconstruction with implant-supported overdentures and the use of monolithic multilayer zirconia crowns in the aesthetic zone. We also address important topics like ergonomic con- siderations in dentistry, featuring an interview with physical therapist Timothy Caruso on managing back and neck pain, and we highlight the growing trend of eco-friendly dentistry, giving insights from Peter Suresh on sustainable practices in dental care. Lastly, our practice management section offers valuable advice on motivating dental teams, courtesy of productivity expert Jerko Bozikovic, and our meetings section provides a list of upcoming international events and a review of the recent exocad Insights 2024 conference. In this issue of our magazine, we celebrate the transfor- mative power of CAD/CAM technology and its profound impact on modern dentistry. We hope you find inspiration, innovation and practical insights to elevate your practice or laboratory to new heights of excellence. Digital workflows have simplified complex treatments such as implant treatment, and several platforms offer comprehensive digital solutions that enhance treatment planning, surgical precision and prosthetic outcomes. Similarly, new digital solutions have expanded options Sincerely, Magda Wojtkiewicz Managing Editor CAD/CAM 1 2024 03

The Partnership that Elevates ©2024 ClearCorrect | Approved for global use | Acc.1901_en_01 ClearCorrect® is excited to unveil new products and features designed to elevate your practice to its full potential. Updates to our Empowering Digital Workflow and Practice Growth Resources all work together, putting your needs front and center. To become a partner or learn more visit: clearcorrect.com

Anatomically shaped , individualised PEEK gingiva formers and impression posts formers and impression posts Do you want to reduce patient times and increase patient comfort? Features Patient-specific emergence profile Made of biocompatible PEEK Can be ordered individually or from the same dataset as a “gingiva former + impression post set” camlog.com/en/products/cadcam The individual DEDICAM PEEK gingiva formers and impression posts are offered for the CAMLOG®, CONELOG®, iSy®, CERALOG® and BioHorizons® implant systems. Only open impression posts can be ordered for BioHorizons®. DEDICAM® services are not available in all countries. Please ask your local Camlog / BioHorizons® representative if you have access to our CAD/CAM services. DEDICAM®, CAMLOG®, CONELOG®, iSy® and CERALOG® are registered trademarks of CAMLOG Biotechnologies GmbH. BioHorizons is a registered trademark of BioHorizons. All rights reserved. Not all products are available in all countries.

NEW Screw-retained w-retained restorations rations ny tooth for any tooth with the new NobelProcera® ASC Titanium Abutment asier handling with Omnigrip® asier access in the posterior Improved esthetics nobelbiocare.com/procera GMT 90209 GB 2405 Printed in the EU © Nobel Biocare Services AG, 2024. All rights reserved. 209 GB 2405 Printed in the EU © Nobel Biocare Services AG, 2024. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or , the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. 3Shape® and 3Shape om the context in a certain case, trademarks of Nobel Biocare. 3Shape® and 3Shape Dental System™ are trademarks of 3Shape A/S. Please refer to nobelbiocare.com/trademarks for ™ are trademarks of 3Shape A/S. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. All product images are for illustration ormation. Product images are not necessarily to scale. All product images are for illustration purposes only and may not be an exact representation of the product. Disclaimer: Some products and may not be an exact representation of the product. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare egulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability. For prescription use only. Caution: sales office for current product assortment and availability. For prescription use only. Caution: Federal (United States) law restricts this device to sale by or on the order of a licensed clinician, Federal (United States) law restricts this device to sale by or on the order of a licensed clinician, medical professional or physician. See Instructions For Use for full prescribing information, including medical professional or physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions. indications, contraindications, warnings and precautions.

news | Technological innovations and industry collaboration In various Asia Pacific countries, a synergy between dental laboratories and dental practices is driving tech nological advancements in digital dentistry, seeking to enhance the quality of dental prostheses fabricated using 3D-printing technologies. Technological innovations, especially in China, are driving international market supply through substantial exports of advanced CAD/CAM materials and 3D printers. Together, these efforts, by leading to improved products and enhanced patient outcomes, have positioned Asia Pacific at the forefront of global dental technology markets and are boosting the value of the Asia Pacific dental prosthesis and 3D-printing printer markets.4 Challenges and prospects While the digital dentistry market in Asia Pacific is experi- encing notable growth, a range of often interconnected factors are constraining its expansion, particularly re- garding adoption of advanced digital dentistry pro- cedures and prostheses. These include economic considerations and technological nuances.5 In certain Asia Pacific countries, patients’ limited purchasing power may restrict access. Furthermore, although competitive pricing is a normal part of market dynamics, aggressive pricing strategies, especially in tender processes— a significant aspect of China’s market dynamics—may lead to compromised product quality and may hinder the growth of competitors. Cost pressures and the scarcity of well-educated, skilled technicians contribute to compromises in the quality of the manufactured prosthetics can affect the effectiveness and longevity of dental prosthetics. Such compromises can undermine the effectiveness and durability of these pros thetics, resulting in less-than-optimal patient out- comes. This situation not only affects patient satisfaction but also challenges the integrity and perceived value of digital dentistry solutions in the region. To elevate the digital dentistry sector in the Asia Pacific, a two-pronged strategy is essential: first, enhance the edu- cational framework for technicians by extending program lengths and enriching curricula with comprehensive, up-to-date content to ensure a highly skilled workforce. Second, align the quality standards for dental materials with those of European and American markets (EMA and FDA) through adoption and enforcement of quality and safety standards. This dual approach, supported by collaboration among educational institutions, industry stakeholders, and regulatory bodies, will significantly improve the quality, effectiveness and trust in digital dentistry solutions, setting the Asia Pacific on a path to significant improvements in dental care quality and innovation.6 Value of the Asia Pacific digital dentistry market in 2020–2030: A visual journey through the growth of the markets in Australia, China, Japan, India and South Korea. (Image: © iData Research) Summary In the Asia Pacific, the integration of CAD/CAM technology and 3D printing into dentistry marks a significant leap forward, positioning the region as a pivotal player in the global dental industry. Spearheaded by countries like Japan’s and South Korea’s in CAD/CAM, along with China’s rapid growth in 3D printing in particular, position the region as a unique hub for technological advancements. Despite the rapid advancements and potential for sub- stantial market growth, the sector faces hurdles including economic barriers, the need for improved educational standards for technicians and aligning material quality with international norms. Addressing these challenges through strategic collaboration among industry players, educational institutions and regulatory bodies is crucial for leveraging digital dentistry’s full potential in the Asia Pacific. Editorial note: This article was first published in today IDEM Singapore 2024. Please scan the QR code for the list of references. about Ali Arabnejad is a research analyst at iData Research, where he is responsible for developing and compiling syndicated research projects focused on the medical device industry. His publications report on the dental prosthesis and digital dentistry markets in Asia Pacific, among others. Dr Kamran Zamanian is the CEO and a founding partner of iData Research. He has spent over 20 years working in the market research industry and is specifically focused on medical devices used to promote the health of patients all over the globe. CAD/CAM 1 2024 11

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industry news | our insistence on the quality of the manufacturing pro- cess to achieve the most aesthetic product and optimal mechanical properties. High-precision shrinkage and stable coefficient of thermal expansion values for exceptional fit Outstanding deformation stability during the sintering pro- cedure contributes to the stability during the final sintering process in the dental laboratory, providing for an excep- tional fit of large-span bridges and other restorations. High-speed sintering program The unique powder formulation, refinement process, and pressing and pre-sintering technique are crucial for enabling our customers to produce up to three-unit bridges without compromising on aesthetics or mechan- ical properties using the 54-minute high-speed sintering process.* This high-quality production method results in an exceptionally dense material that ensures that the quality and aesthetics are already present at the point of manufacture and are maintained during milling. Once the discs have been sintered, their characteristics support the delivery of high-strength final restorations with excellent aesthetics. Multilayered structure and ease of positioning of restorations in the blank To enhance the aesthetic qualities, KATANA Zirconia YML discs are designed using ratios rather than fixed measure- ments of different layers in the multilayered structure. This means that regardless of disc thickness, there is always a consistent ratio of 35% of raw material that constitutes the translucent enamel zone. Hence, discs with an increased height—which are typically used for the production of larger restorations—always offer suffi- cient space in the enamel zone, whereas smaller discs are optimised for smaller restorations. KATANA Zirconia YML: One disc for all indications This single material is suitable for everything from single crowns to full-arch prostheses and for full-contour designs to conventional frameworks, without compromising on aesthetics. For finishing, we offer a well-coordinated portfolio of solutions designed for internal and external staining, micro-layering and full layering. Explore our website for a wealth of resources, clinical cases and FAQs Visit our website to discover more about KATANA Zirconia YML. Among the many useful materials we provide are a bro- chure, a technical guide and in-depth technical information. If you would like to see the material in action, browse the blog section of our website for a variety of clinical cases and articles by world-renowned experts showcasing and proving the versatility and aesthetics of KATANA Zirconia YML. The qualities of KATANA Zirconia YML empower dental laboratory owners to deliver a wide range of restorations. * The material is removed from the furnace at 800 °C. A furnace with a configurable YML firing program is required. CAD/CAM 1 2024 15

industry news | “MIS has been investing in digital solutions for many years, and the company has watched with enthusiasm as its digital workflow has been adopted by clinicians around the world.” or laboratory. They include implant-level and tissue- level solutions and enable implant-to-crown proce- dures. For example, the company’s workflow for conical connection implants begins with a Primescan intra- oral scan and efficient prosthetically driven MSOFT planning, assisted by the MCENTER team, which provides comprehensive digital dentistry services and detailed surgical plans. In the surgical step, bone aug- mentation is done with the use of OSSIX biomaterials, and clinicians benefit from the advantages of the unique MGUIDE surgical guides. The C1 implant and MIS CONNECT stay-in abutment provide primary and long-term stability and offer the ability to maximise tissue- level restoration, and the use of a computer-guided approach contributes to the reduction of patient visits, treatment steps and corrections. For final restoration, MIS customers are offered a wide range of implant-level and tissue-level digital prosthetic solutions, all imple- mented in leading CAD software. Kario said that being a Dentsply Sirona company allows MIS to offer clinicians significant advantages. She explained: “MIS can offer its customers a com- plete digital workflow that incorporates the MIS guided surgery system, the unique implant connections and the comprehensive digital prosthetic line, in combi- nation with Dentsply Sirona equipment and materials, all under one roof. We believe that providing tools of this quality strengthens the brand and contributes to customer trust.” What can clinicians and laboratories gain from adopting the digital workflow? Kario emphasised: “Digital workflows address procedural challenges that impact clinical efficiency, may improve profit potential and drive actual practice growth.” To learn more, visit www.mis-implants.com/products/ digital-workflow. CAD/CAM 1 2024 17

4 5 6 Fig. 4: Florian Kirsch, head of the orthodontic business unit and Connected Customer Solutions at the Straumann Group. Fig. 5: ClearCorrect’s new practice growth resources include designated kits and handy guides. Fig. 6: Dr Mostafa Altalibi, chief orthodontist at the Canadian dental practice Transforme Ortho. ClearCorrect Sync 2.0 Practice growth offering Clinicians can further simplify their workflows with the latest version of the ClearCorrect Sync app, digitising their operations for greater efficiency in practice man- agement. The app now has an expanded range of features that enable clinicians to start, review and manage cases easily: – View all cases from the Doctor Portal. – Receive notifications for cases that need attention. – Access case details, such as shipment tracking. – Access the Doctor Portal and ClearPilot directly in the app. ClearCorrect Sync 2.0 offers clinicians a seamless digital end-to-end experience, streamlining the collection and submission of records and the review and management of cases. ClearPilot 8.0 ClearPilot 8.0 gives clinicians greater control and an improved user experience. The latest version of the software empowers clinicians in their treatment planning with advanced editing tools. Bite jump editing allows the position of the jaw to be adjusted in order to more accu- rately visualise potential treatment outcomes when using advanced techniques. Tilt/cant positioning allows adjustment of the 3D model’s position to more accurately reflect the jaw position and match the patient’s facial lines. Multiple inter- proximal reduction editing applies and distributes interproximal reduction values among several teeth at once. The user interface of ClearPilot 8.0 has also been improved with a keyboard shortcut guide, enhanced visualisation and optimised utility for a better user experience. “This launch is about transforming smiles and lives. I am excited to witness the positive impact that ClearCorrect’s digital workflow and practice growth offering will have on clinicians, their staff and their patients,” said Florian Kirsch, head of the orthodontic business unit and Connected Customer Solutions at the Straumann Group. ClearCorrect’s practice growth offering provides a comprehensive suite of marketing, education and busi- ness resources to empower clinicians and their staff to offer ClearCorrect with confidence and to grow their practices. These resources include a patient marketing kit, a patient conversion kit, and practice growth edu cation and guides. The partnership that elevates “As an orthodontist, ClearCorrect has been my trusted ally in crafting countless smiles, each one a testament to its power and reliability. Now, with the launch of the new software, I cannot wait for even more precision and efficiency that it will bring to my treatments, enabling me to do more, in less time and with less effort,” said Dr Mostafa Altalibi, chief orthodontist at the Canadian dental practice Transforme Ortho. Created by dentists for dentists and aspiring to be the world’s most customer-centric aligner brand, ClearCorrect carefully listens to the needs of clinicians, swiftly responding with solutions they need to reach their practice goals, ultimately changing patients’ lives. With a foundation clinicians can trust, along with comprehensive continuing education options, ClearCorrect is proud to offer a part- nership that helps clinicians build a thriving practice. ClearCorrect is committed to the empowerment of clinicians, development of their staff and elevation of their practices. ClearCorrect is backed by the Straumann Group, which encompasses brands with a history of over 70 years of research and innovation. This support enables the creation of cutting-edge products featuring advanced technology and fully integrated digital workflows. These products are complemented by outstanding service, support and educational offerings. All of this had established ClearCorrect as the partner in clinical excellence. To date, the company has supported partners across more than 60 countries and transformed over a million smiles. Together with clinicians, ClearCorrect looks forward to creating healthier, more confident smiles around the world. CAD/CAM 1 2024 19

trends & applications | 5 6 7 8 9 Fig. 5: Plurality in the choice of intra-oral scanner. Fig. 6: Shade taking with a spectrophotometer using the Rayplicker Cobra (Borea) or VITA Easy-Shade V (VITA Zahnfabrik). Fig. 7: Mandibular dynamics in Twim (Modjaw). Fig. 8: Synchronisation of 2D and 3D images. Fig. 9: Smile design in inLab CAD SW 22.0 (Dentsply Sirona). Optimisation of the design process The POP uses advanced digital tools such as CAD and 3D printing to facilitate the design and fabrication process of prostheses. This ensures more precise results and reduces manufacturing times. Adaptability to changes The POP allows for treatment adjustments based on changes in the patient’s oral health. If adjustments are needed over time, the personalised treatment facilitates modifying the prostheses to meet the patient’s evolving needs. Necessary information Detailed prescription A precise prescription must be provided by the dentist, clearly describing the patient’s aesthetic expectations and technical specifications for the prosthesis. Objective colour measurement A spectrophotometer is used to objectively measure the colour of the patient’s teeth. Unlike visual observation, which can be subject to subjective interpretations, the spectrophotometer provides precise quantitative data, ensuring an accurate match between the colour of the prosthesis and that of the patient’s natural teeth. Comparison with reference samples The spectrophotometer compares the measured colour with reference samples, such as standardised shade guides, to find the closest match to the patient’s natural tooth colour. This ensures an accurate match with the colour desired by the patient or prescribed by the dentist. Intra-oral photographs Detailed intra-oral photographs of the patient can be useful for the dental technician to better understand the mor phology and colour of the patient’s teeth. Accurate digital impressions High-quality digital impressions of the patient’s oral cavity must be taken to obtain an accurate model of the teeth and gingivae. Smile line indications The dentist can indicate the smile line, that is, the alignment and desired position of the edges of the teeth when smiling. 10 11 Fig. 10: Mandibular dynamics in inLab CAD SW 22.0. Fig. 11: Complete prosthetic simulation. CAD/CAM 1 2024 21

trends & applications | Follow-up and prosthesis adaptability Digital data is also useful for patient follow-up and prosthesis adaptability over time. If adjustments are necessary, digital data allows the dental professional to quickly make the required modifications. Patient data back-up The POP allows for the back-up of the patient’s digital data, making it easier to create replacement prostheses if needed. The data can be used as a reference for future prosthetic interventions. The immediate future: Collaborative telecommunication—POP 2.0 Digital communication facilitates collaboration between dental technicians, dentists and laboratories. Digital files of prostheses can be instantly shared via secure platforms, allowing the different actors involved in the process to work synchronously and efficiently, even if they are geographically distant. Developmental trends Real-time communication Collaborative telecommunication enables real-time ex- change, meaning participants can communicate instantly through messaging or voice or video calls. This real- time communication fosters quick problem- solving and informed decision-making, leading to better coordi - nation in planning and executing prosthetic treat- ments. Asynchronous communication In addition to real-time communication, collaborative tele- communication facilitates asynchronous communication. This allows users to share information and collaborate at their own pace. File and document sharing Collaborative telecommunication tools allow for easy sharing of files and other digital resources. This enables members to work together on projects, review documents and access relevant information. Online collaboration tools Collaborative telecommunication often includes online collaboration tools, such as project management plat- forms, virtual whiteboards and shared storage spaces, which facilitate activity coordination and information visualisation. Multiplatform accessibility Collaborative telecommunication solutions are generally accessible on various platforms, including desktop computers, mobile devices and tablets, allowing users to collaborate anytime and anywhere. 15 16 Fig. 15: Final CIELAB colour space check of a prosthesis. Fig. 16: Satisfied patient, the result of good collaboration between the laboratory and dental office (Drs Christian Moussally and Ty Vallée). Security and privacy Collaborative telecommunication prioritises the security and confidentiality of data exchanged between users. Security measures are often put in place to protect sen sitive information. Summary In summary, the POP optimises the employment of digital data in dental prosthetics, allowing for precise data collec- tion, personalised and accurate design, patient validation, high-quality 3D-printing-based fabrication, and long-term follow-up and prosthesis adaptability. By closely collaborat- ing and providing comprehensive information, the dentist and dental technician can improve the quality, efficiency and overall satisfaction of prosthetic treatments for patients. about Eric Berger is a dental technician who graduated from the Institut Supérieur National de l’Artisanat in Metz in France and is recognised as a master dental prosthetist. After completing his education, he pursued further training and specialisation in Germany before establishing his own laboratory, which has since evolved into a VITA Master Lab. At his laboratory, he and his team specialise in various aspects of prosthesis creation. They emphasise close collaboration between dentists and prosthetists as a key factor in achieving exceptional quality. The laboratory’s expertise in dental ceramics, including metal–ceramic and CAD techniques, has led to the development of unique ceramic materials. Since 2006, Berger has served as a trainer for what is now Dentsply Sirona and was the first in France to test and approve its Sirona Connect system. His commitment to excellence and continuous innovation has established him as a respected figure in the field of dental technology. Throughout his career, Berger has been dedicated to upholding high standards of quality in denture craftsmanship. He can be contacted at dtbfrance@aol.com. CAD/CAM 1 2024 23

interview | 1c 1d Figs. 1a–d: NobelProcera abutment designs in the study. NobelProcera full-contour/cutback zirconia implant crown (n = 105; a). NobelProcera customised zirconia angulated screw channel abutment (n = 117; b). NobelProcera customised zirconia abutment (n = 146; c). NobelProcera customised titanium abutment (n = 95; d). that beta-tested this abutment in 2014. Since then, we have routinely used it in our restoration for many implant cases. In fact, in the last five years, the laboratory delivered over 2,000 single-unit ASC abutments to internal clinicians and external clients. It is a very stable and well-tested solution for us. In our study, we’ve investigated over 460 abutments across a wide range of implant types, all from Nobel Biocare, and a wide range of abutment types as well: NobelProcera ASC, titanium, zirconia, full-contour (Figs. 1a–d & 2a–h). What are the study’s conclusions? The conclusions really match with the very low complica- tion rates that we’ve found in our own clinical practice. There was a 98% prosthetic survival rate and only nine failures. In clinical practice, we have also audited nearly 1,300 ASC abutments and found very similar low complication rates. Finally, patient and clinician satisfac- tion is high at 96% and 98%, respectively. In summary, industrially manufactured individualised abutments offer excellent prosthetic stability and retrievability and Results of the study 98.1% prosthetic survival rate after up to 6.4-year follow-up 96.5% of the patients and 98.3% of the clinicians were satisfied with the restoration 1.5% technical complications, which were repaired intra- orally or after temporary removal a low rate of complications, providing great patient and clinician satisfaction. Reference 1. Fabbri G, Staas T, Lane I, Pitino A, Fossati E, Aghasadeh A, Kübler F. Factors associated with prosthetic complications with individualized abutments: real-world data. Clin Oral Implants Res. 2022 Sep [cited 10 Jun 2024];33(S24):66–7. Available from: https://www.for.org/en/learn/scientific-poster/factors-associated- prosthetic-complications-individualized-abutments-real-world-data 2a 2b 2c 2d 2e 2f 2g 2h Figs. 2a–h: Demonstration of the study results through the case of a non-smoking 34-year-old female patient with a missing maxillary central incisor. Radiograph (a) and clinical view at insertion of a narrow-platform 15 mm NobelActive implant (b). Immediate temporary crown (c) and intra-oral view 32 weeks post-op (d). Healing abutment (e) and the resulting contoured tissue at 12 weeks post-op (f). Radiograph (g) and clinical view at the seven-year follow-up (h). CAD/CAM 1 2024 25

case report | tive experiences at times resulted in untreatable aes- thetic complications as well as a few sleepless nights. At the beginning, the restorative process was dominated by time-consuming chairside fabrication of provisional restorations, and there was a high risk of contamination of the surgical site. I learned that these major shortcomings can be over- come when adopting a reasonable digital workflow and soon started utilising a CAD/CAM-fabricated surgical guide as a first step into digitalisation. This was followed by the preoperative fabrication of provisional restorations. As I gained experience in digital methods, I tried to inte- grate all digital methods into my portfolio of problem solvers in order to find suitable treatment options for dif- ferent clinical situations and patient demands. 7 Fig. 7: Planning for implantation via dynamic navigation. A CONELOG SCREW-LINE implant with integrated platform switching was to be placed immediately, slightly below bone level. The following case report could have been finished in different ways, choosing other digital methods. I choose this workflow for several reasons: 4. Digital duplication of the transitional emergence profile is very predictable for the final abutment and crown. Clinical case 1. An intra-oral scanner and CBCT device can acquire digital data directly. 2. Dynamic navigation is an efficient and time-saving method for guided surgery. 3. Digital design and production of immediate resto- rations after implant insertion is more accurate than a surgical guide, as with a guide small deviations from the planned implant position may cause major diffi- culties in placing the prefabricated restoration. A 38-year-old male patient presented to our den- tal clinic seeking therapy for a discoloured central inci- sor which, according to the patient, had increasingly been moving mesially since a trauma 20 years before. The displacement of the tooth towards the midline of the upper jaw had led to closure of an originally existing diastema and caused loss of papilla distal to the central incisor (Figs. 1 & 2). The CBCT scan showed that the tooth 8 11 9 10 12 Fig. 8: Occlusal view after careful tooth extraction. Fig. 9: Occlusal view after immediate implant placement (the insertion post was still in place). Compared with the position of the tooth, the implant was placed in a little more palatal position and in a more distal position to correct the displacement of the tooth after trauma. Fig. 10: Preparation for the intra-oral scan just after implant placement. With the CONELOG scan body, only the position of the implant needed to be captured (as the scan of the complete intra-oral situation had been performed prior to surgery). Fig. 11: A xenograft was used to fill the gap between the implant and the buccal wall. Fig. 12: A healing abutment was placed temporarily to avoid collapse of the soft tissue during the production process of the provisional restoration (about 30 minutes). CAD/CAM 1 2024 27

case report | Fig. 13: The digital model imported into 3Shape Dental Manager. Fig. 14: Matching of the CONELOG scan body. Figs. 15 & 16: Selecting a titanium base with a 2 mm gingival height for model-free design. Fig. 17: Emergence profile design. Figs. 18 & 19: The provisional restoration. Symmetry was established between the central incisors. Fig. 20: The crown was fabricated and bonded to the titanium base. had undergone endodontic treatment in the past and suffered external apical root resorption. The buccal wall appeared to be small in width (> 1 mm) but intact (Fig. 3). Based on the clinical symptoms of increased mobility of the tooth, the radiographic findings of a failed endodon- tic treatment and the patient’s willingness to have the aesthetic anterior area restored, it was decided to ex- tract the hopeless tooth and replace it with an implant. The prerequisites were promising. Enough bone volume apically if additional stability was needed through apical anchoring, an intact buccal wall and a thick gingival bio- type supported immediate placement as our first choice. Combined with an immediate provisional restoration, this would help us to maintain the soft-tissue contour in the aesthetic zone. The patient was informed about the risks, the cost and alternatives of the planned procedure and gave written consent. Preparation before surgery Implant selection was made based on the need for inte- grated platform switching and proven effectiveness in pre- serving marginal bone level. I defined the exact 3D position of the chosen implant, and the data acquisition was initiated to prepare for dynamic navigation. Compared with working with a surgical guide—and its fabrication 21 22 Figs. 21 & 22: Provisional restoration in place. Note the preservation of soft tissue. leading to additional cost and delay in the treatment process—dynamic navigation is for us a more effective way to plan and perform surgery in the same clinical visit. A CBCT scan with a fiducial clip was taken for naviga- tion surgery (Fig. 4). A digital model was prepared on the basis of an intra-oral scan before surgery. At the im- plant site, data was erased to enable for rapid capture of the implant position during the surgery (Figs. 5 & 6). The 3D position of the CONELOG SCREW-LINE implant (CAMLOG) was carefully designed in dynamic navigation software before surgery (Fig. 7). Day of surgery The hopeless tooth was carefully extracted atraumatically (Fig. 8). Immediately after the extraction, a CONELOG SCREW-LINE implant of 3.8 mm in diameter and 13.0 mm in length was placed, guided by the navigation system (Fig. 9). Before simultaneous augmentation with biomaterial, the CONELOG scan body (3.8 mm) was placed to capture 23 25 24 26 Figs. 23 & 24: The CBCT scan scan after immediate implantation and restoration confirmed that the 3D position of the implant was as planned. Figs. 25 & 26: Labial and occlusal views after three months. Note the symmetry of the gingival contour. CAD/CAM 1 2024 29

case report | “By using digital methods reasonably, mistakes can effectively be avoided.” After surgery Approximately 30 minutes after surgery, the healing abutment—which was intended to prevent collapse of the soft tissue—was removed and the provisional crown was fixed in the patient’s mouth (Figs. 21 & 22). A CBCT scan captured after immediate implantation and restoration confirmed that the implant had been placed correctly in the planned 3D position (Figs. 23 & 24). Fabrication of final crown Three months after surgery, the labial gingival contour of both central incisors was symmetrical (Figs. 25 & 26). The patient wanted the diastema to be closed with the final restoration. As the provisional restoration had pre- served the soft-tissue contour, we considered it unnec- essary to recapture the implant position and emergence profile. We used the immediate implant scan and provi- sional restoration design, adopting the data, to design the final restoration accordingly (Figs. 27 & 28). 33 35 34 36 Figs. 33 & 34: The final abutment in place and preparation for the veneer. Figs. 35: Labial view of the restorations in place. Note the symmetry of the two incisors. Figs. 36: Radiographic view after three months. Note the perfect integration of the CONELOG implant and bone growing over the implant shoulder. It proves that the perfect design of the outer geometry and connection and the availability of comprehensive digital workflow components are crucial for the final results of an immediate placement protocol in the aesthetic zone. To close the diastema and to minimise the lack of soft tis- sue, we marginally increased the mesiodistal dimensions of both the restoration on the implant and the contralateral central incisor. To increase the gingival volume, a veneer was planned for the other central incisor (Figs. 29 & 30). the path we use to treat our patients in comparison with several years ago. With that in mind, I hope I can take you on the journey and share the positive impact this development can have on more complicated cases in the near future. A titanium base-supported customised final abutment was created to maintain the emergence profile, and the crown and automatic cut-back were designed to accom- modate the zirconia mesostructure (Figs. 31 & 32). The customised abutment was placed and the mesial area of the right central incisor prepared, based on a silicone impression (Figs. 33 & 34). The final implant-borne res- toration and the veneer on the right central incisor were placed (Figs. 35 & 36). Conclusion Experience is important but not always reliable. By using digital methods reasonably, mistakes can effectively be avoided. It is not always about the digital equipment you own; it is about thinking differently, assessing a challenge from an alternate angle. It is the desire to start digitalising your workflow, step by step, perhaps starting with one small step at the beginning but with the mindset of doing more. In this manner, I am convinced you will explore the digital world and find it more and more beneficial. Editorial note: This article was first published in digital— international magazine of digital dentistry, Vol. 3, Issue 1/2022. about Dr Gang Chen is the director of U-dental implant centre and U-dental implant training centre in Shenzhen in China. He received his PhD in oral and maxillofacial surgery from Peking University in China and since then has focused on restoring implant cases efficiently using digital techniques. He has been a visiting dentist at Implant and Prosthetic Department of Tuebingen University in Germany and Okayama University’s dental school in Japan and holds certification in implantology from the European Association for Osseointegration. Dr Chen spends almost half of his time giving training and lectures on how to perform digital dentistry and aesthetic treatments on international level. Although the case presented can be classified as a routine example of our daily work, we have significantly changed Dr Jingyi Zhang is a renowned implantologist from China. She advocates for science-based education through her numerous publications and presentations at national conferences. CAD/CAM 1 2024 31

case report | 8 9 10 Fig. 8: Transitional complete dentures, extra-oral frontal view. Fig. 9: Transitional complete dentures, extra-oral three-quarter view showing the adequate lip support provided by the buccal flange of the denture. Fig. 10: CBCT panoramic view showing gutta-percha points in the sites of interest. Clinical case Initial situation A 65-year-old female patient with a medical history of Type 2 diabetes controlled with medication presented to the clinic with severe aesthetic and functional problems due to complete edentulism as a result of generalised Stage IV periodontitis (Figs. 1–3). Her chief complaint concerned impaired mastication of all types of food and a compromised aesthetic appear- ance. Clinical examination and CBCT digital analysis revealed alveolar ridge deficiency attributed to extraction of the remaining teeth several months before (Figs. 4–7). Treatment planning Based on the initial intra-oral and extra-oral clinical as- sessment, CBCT digital analysis, the patient’s functional and aesthetic requirements, and financial aspects, a de- finitive treatment plan was created. The proposed treat- ment plan was the prosthetic reconstruction of both the maxilla and mandible with prostheses that the patient would be able to remove and easily maintain and that would simultaneously fulfil the high functional and aes- 11 13 12 14 Fig. 11: Maxillary implant surgery. Occlusal view of the alveolar ridge before implant placement. Fig. 12: Maxillary implant surgery. Occlusal view of the implants placed, one in the position of the right central incisor, two in the positions of the right and left canines, and two in the positions of the second premolar sites. Fig. 13: Mandibular implant surgery. Frontal view of the four implants placed. Fig. 14: Mandibular implant surgery. Occlusal view of the four implants placed. CAD/CAM 1 2024 33

case report | 23 24 Figs. 23–25: Virtual design of the maxillary telescopic crowns. thetic expectations. Therefore, an implant-supported fixed/detachable maxillary overdenture with a palate-less design and an implant-supported overdenture employ- ing the Novaloc system were selected as definitive res- torations. The fabrication of transitional acrylic complete dentures (Figs. 8 & 9) with customised teeth and the proposed functional and aesthetic parameters was carried out in order to set the final tooth position before implant place- ment. This restoration-driven concept aims to optimise implant planning and placement according to the de- sired prosthetic reconstruction. The transitional dentures were duplicated in clear radiographic guides with gutta- percha points. These were placed in the potential areas of interest and served as surgical templates as well (Fig. 10). Surgical procedure After local anaesthesia, a crestal incision in the maxilla was performed slightly palatally in order to preserve the attached gingiva, and a full-thickness flap was raised with 25 the purpose of reducing the alveolar ridge to create an adequate platform, assuring the vertical space required for the definitive prostheses (Fig. 11). After the osteot- omy, five implants (four Straumann Bone Level Tapered, Roxolid SLActive; diameter: 3.3 mm; length: 12.0 mm; and one Straumann Bone Level Tapered, Roxolid SLActive; diameter: 4.1 mm; length: 8.0 mm) were placed in a straight position well distributed across the arch (Fig. 12). 26 27 Fig. 26: Polished maxillary telescopic zirconia crowns cemented on to Variobase abutments (Straumann). Fig. 27: Secondary friction elements milled in PEEK material, ultimately cemented on to the final denture base structure. CAD/CAM 1 2024 35

case report | 36 37 Fig. 36: Intra-oral occlusal view of the five telescopic abutments screwed in and torqued to 35 Ncm. Fig. 37: Intra-oral occlusal view of the maxillary implant overdenture incorporated. The primary wound closure was performed with a mod- ified continuous sling suture using non-resorbable PTFE monofilament suture material. After four weeks, in the second implant surgery, four narrow- diameter implants (Straumann Bone Level Tapered, Roxolid SLActive; diameter: 3.3 mm; length: 10.0 mm) were placed in a straight position in the mandible in inter- foraminal distribution (canine and second pre molar), avoiding important anatomical structures in the molar sites and the severely reabsorbed anterior mandible (Figs. 13 & 14). The implants were left with closure screws for two- phase submucosal healing (Fig. 15), and a conventional loading protocol was selected for both the maxilla and the mandible according to the International Team for Implantology consensus statement on loading proto- cols for implant-supported overdentures in edentulous jaws. After eight weeks of healing, a second surgery was performed to uncover the implants and place heal- ing abutments to preserve the attached gingiva (Figs. 16 & 17). 38 39 40 Figs. 38 & 39: Novaloc abutments (Straumann) presented in the model with artificial soft tissue showing the correct abutment gingival height. Fig. 40: Novaloc retention system. CAD/CAM 1 2024 37

case report | 47 48 49 50 Figs. 47–50: Final extra-oral view. A very pleasant and natural smile was achieved with the implant-supported prosthesis. After data acquisition (with a laboratory scanner) and merging in the CAD software, the digital design process of the definitive restorations was initiated. The CAD soft- ware allows full control of the prosthesis with 3D data of the aesthetic and functional parameters, verifying oc- clusal contacts and excursive movements in the virtual articulator (Figs. 19–22). For the maxillary arch, five monolithic zirconia telescopic crowns were designed and milled according to the pre- vious digital set-up (Figs. 23–27) and cemented on to Straumann Variobase abutments (four Narrow CrossFit; diameter: 3.8 mm; height: 3.5 mm; gingiva height: 1.0 mm; and one Regular CrossFit; diameter: 4.5 mm; height: 3.5 mm; gingiva height: 1.0 mm). The definitive prosthesis consisted of an overdenture CAD/CAM base material milled in ceramic- reinforced PEEK with anatomical reduction to receive customised monolithic ceramic denture teeth (Figs. 28–31). Lastly, indirect pink veneering composite was used to reproduce the gingival anatomy (Figs. 32–35). The tele- scopic crowns were screwed on and torqued to 35 Ncm, the access holes were blocked with PTFE and the definitive prosthesis was incorporated (Figs. 36 & 37). The fabrication of the definitive restoration for the man- dible included a milled implant-supported overdenture in pink PMMA denture base material with CAD/CAM polymer denture teeth customised with layering composite. Four straight Straumann Narrow CrossFit Novaloc abutments (diameter: 3.8 mm; height: 3.0 mm) were selected as the retention system for definitive prosthesis (Figs. 38–40). These abutments have the advantage of requiring min- imal vertical prosthetic space, have high patient sat- isfaction owing to excellent and long-lasting retention properties, and have significantly higher wear resistance in comparison with other stud-type attachments. The intra-oral pick-up process of the abutments was per- formed using dual-polymerising self-adhesive pink com- posite (Figs. 41–44). Subsequently, finishing and polishing were done, and PEEK Novaloc retention inserts with light retention force (white colour) were placed. Treatment outcomes Final intra-oral and extra-oral views six months postop- eratively illustrated the very pleasant and natural result achieved (Figs. 45–50). The patient was very satisfied with the aesthetic outcome and, more importantly, the func- tional outcome and reported her ability to chew different types of food, describing it as a life-changing experience. Editorial note: This article was first published in digital— international magazine of digital dentistry, Vol. 2, Issue 1/2021. about Dr Said Sánchez is a dentist specialised in prosthodontics and oral implantology. His areas of focus are implant dentistry, aesthetic dentistry, digital technology and adhesive oral rehabilitation. He is a lecturer in the postgraduate department of prosthodontics and implant dentistry of the University of De La Salle Bajío in León in Mexico and is in private practice limited to prosthodontics and implant dentistry in León. He is a fellow of the International Team for Implantology (ITI), joint director of the ITI study club in León, an ITI speaker, and communications officer of the ITI Mexican, Central America and Caribbean section. CAD/CAM 1 2024 39

case report | CAD/CAM 1 2024 41 7 Fig. 7: Laboratory-made temporary restorations. “During the last decade, zirconia has increasingly become established as the material of choice in prosthodontics.” dramatically. The multilayered zirconia used nowadays (e.g. KATANA Zirconia YML, Kuraray Noritake Dental) offers well- balanced mechanical properties, trans- lucency and colour. It allows dental technicians all over the world to produce aesthetic full-contour restorations that only require staining. Even in the anterior region, stained monolithic resto- rations may be an option. Factors such as the age of the patient, the internal colour structure of the adjacent dentition, the number of teeth to be restored (one ver- sus four or all six maxillary anterior teeth), the aesthetic demands of the patient and financial aspects should be taken into account in the material selection process. In the case described in this article, full-contour zirconia was selected for several reasons. 8 9 Fig. 8: Long-term temporary restorations in place, lateral view from the right. Fig. 9: Long-term temporary restorations in place, frontal view. Fig. 10: Long-term temporary restorations in place, lateral view from the left. 10

case report | 13 14 15 Fig. 13: Immediate treatment outcome, facial view. Fig. 14: Immediate treatment outcome, frontal view. Fig. 15: Immediate treatment outcome, occlusal view. (KT.314.016 CeraTip, Komet) at the buccal aspect of teeth #21 and 22. “The patient was happy After the patient’s approval of the aesthetics, phonetics and function of the temporary restoration, the situa- tion was captured with an intra-oral scanner again. This allowed the team to duplicate the shape of the restoration. Based on the data acquired, two pairs of splinted temporary crowns were milled from PMMA (HUGE Multilayer PMMA, HUGE Dental) in Shade A3 in the laboratory (Figs. 5–7). They were placed to allow the patient to further evaluate the appearance and function for several weeks (Figs. 8–10). The patient was happy with the phonetics, function and appearance of the crowns, noting only that they were slightly too bright in comparison with the adjacent teeth, and she ap- proved the shape for the production of the permanent restorations. Final restoration: Production and cementation Based on the data set of the temporary restorations, four separate crowns—one for the implant and three for the teeth—were designed in full contour. Without any anatomical reduction, the restorations were milled from KATANA Zirconia YML. Based on the evaluation of the temporary restorations, the shade selected this time was Shade A3.5. CERABIEN ZR FC Paste Stain (Kuraray Noritake Dental) was used for external staining and glazing of the surface. The laboratory also cemented the implant-based crown to the gold-shaded titanium abutment (Elos Medtech) with PANAVIA V5 (Kuraray Noritake Dental) in the shade Opaque for an improved masking effect (Fig. 11). In the office, the abutment–crown was screwed on to the implant and the screw access hole closed with composite, and the three tooth-based crowns were then placed using PANAVIA SA Cement Universal (Figs. 12–15). Conclusion Multilayered zirconia is a suitable material for many clinical situations. Owing to the availability of highly with the phonetics, function and appearance of the crowns [...].” translucent multilayered blanks, it is now possible to produce aesthetic outcomes even when using the material monolithically, and this is true not only in the posterior region but in the aesthetic zone in some cases too. The present case demonstrated that very good results and patient satisfaction can be obtained. Moreover, as a result of the material’s outstanding mechanical properties, these outcomes may be expected to last for a long time. about Dr Wissam Dirawi is prosthodontist and a senior adviser at the Swedish dental care chain Aqua Dental. He holds a DDS and obtained his master’s degree in dentistry in 2000. Having over two decades of experience in the field, Dr Dirawi worked as a general dentist in both public dental care and private practice from 2000 to 2018. Additionally, he has contributed to education and research, having worked as a part-time teacher and researcher at the Faculty of Odontology of Malmö University in Sweden from 2011 to 2018. In 2018, Dr Dirawi attained the status of specialist in prosthodontics and assumed the role of senior clinical adviser and lecturer, sharing his expertise with his peers and students alike. CAD/CAM 1 2024 43

features | According to physical therapist Timothy Caruso, basic stretches are a good start to enhancing the strength and flexibility of practitioners. set-up of the operatory and being mindful of maintaining dental ergonomics throughout the day. How do you envision the advancement of ergonomics in dentistry? Now, more than ever, we are working harder than we have done in the past. The expense of running a practice and the constraints of insurance and re imbursement create a new reality, perhaps a new survival of the fittest. AD THE GLOBAL DENTAL CE COMMUNITY REGISTER FOR FREE DT Study Club – e-learning community www.dtstudyclub.com @DTStudyClub Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH. © Marcin Balcerzak/Shutterstock.com

features | What are some of the most important findings of your recent study? There is a long list of small changes that can be easily implemented in dental practices across the globe in order to reduce the carbon footprint of dental care. If dental professionals want to make an effort to reduce their carbon footprint, this study provides research evidence behind the recommendations made by the Green Impact Toolkit and will guide them in their decision-making so that they can make the most appropriate and effective changes for greater sustainability in procurement, waste and water in the dental practice. Based on the findings, what simple steps could dentists take to make their dental practices more sustainable? Making simple changes such as e-mailing appointment notices and referral letters as opposed to using traditional physical post, photocopying on both sides of paper in- stead of on one side, saving and reusing scrap paper, shredding only confidential documents, and using and reusing envelopes without plastic windows can reduce the carbon impact associated with paper usage per patient. Additionally, using water harvested from a rainwater collection tank, having dual-flush toilets and washing dishes with running water in the staff canteen, as op- posed to using a dishwasher or filled sink, can reduce the carbon impact of water usage in a practice. Additionally, recycling used toothbrushes and adopting reusable metal tips instead of single-use disposable plastic tips in a three-in-one air–water syringe can save carbon emissions associated with waste. In your opinion, what is the greatest obstacle to sustainability in dentistry? Prevention of diseases of the oral cavity is the most sustainable way for dentistry to progress in the future. I believe that the biggest obstacle faced by sustainability in dentistry is the need for dentists to treat diseases of the oral cavity rather than preventing them from occurring in the first place. More-complex treatment of diseases of greater severity involves more appointments, time and resources, thus increasing the carbon footprint asso- ciated with patient care. A preventive approach to care is of paramount importance and will eliminate the need for the treatment of oral disease in patients, reducing carbon footprint and improving the quality of life of all patients. Would you like to add anything else? When it comes to dental practices delivering care more sustainably, the best time to start was yesterday. The next best time is now. Editorial note: The study, titled “A life cycle analysis of the environmental impact of procurement, waste and water in the dental practice”, was published online on 12 April 2024 in the British Dental Journal. CAD/CAM 1 2024 47 Sustainability is a recurring topic in dentistry as the dental industry seeks to minimise its environmental impact while maintaining high standards of patient care. the topic further with lead author Peter Suresh, an under- graduate student in dental science at Dublin Dental University Hospital in Ireland. Mr Suresh, how important is sustainability in den- tistry? Have you noticed a shift in dental profes- sionals’ awareness of sustainable practice in recent years? Climate change is one of the biggest challenges faced by our generation, and I think that sustainability has never been more important. The impact of carbon emissions and pollution on climate change has been well explored, and it has been established in the literature that dentistry has a significant carbon footprint. With so much coverage of climate change in the media in recent times, people around the world, including den- tists, are becoming more aware of their carbon footprint and more conscious of making small changes to their everyday activities in order to become more sustainable. The tide is turning, and there is an increased emphasis on meeting the dental treatment needs of the present without compromising the ability of future generations to meet these needs.

manufacturer news* | Custom indirect bonding tray V-Print IBT from VOCO—precise bracket positioning, shorter treatment time and maximum comfort A digitally designed indirect bonding tray (IBT) enables the precise transfer of orthodontic brackets to the ideal positions on the teeth based on the virtual planning. This enables not only more accurate positioning but also a more efficient treatment procedure. The data set for the IBT is generated from dedicated software, and then in hardly any time at all, a custom IBT can be fabricated from VOCO’s specially developed 3D-printing material V-Print IBT. Easy handling with V-Print IBT For the indirect bonding process, easy handling of the tray is essential. The translucent V-Print IBT is flexible, allowing easy tray placement in and removal from the patient’s mouth. The optimised flexibility makes V-Print IBT a reliable solution, even for the treatment of patients with severe dysgnathia. In combination with the high degree of elastic recovery, the reversible deformation of the tray allows precise bracket positioning without requiring a common direction of insertion. Enhanced treatment ergonomics The indirect bonding technique significantly improves the ergo- nomics of treatment, in both the planning and implementation phases. In addition, compared with conventional methods, the clinical phase of bonding is significantly shortened, saving both patients and orthodontists a great deal of time. No shaking needed Requiring no shaking, V-Print IBT is ready for use, supporting its ease of use and speeding up the production process. Further information on V-Print IBT can be found online. www.voco.dental CAD/CAM 1 2024 49 * The articles in this category are provided by the manufacturers or distributors and do not reflect the opinion of the editorial team.

practice management | an informal way, in between patients, for example, or at the start or end of the working day, as well as in a formal way individually or in a group during meetings. Regarding meetings, do you have a clearly set-out meeting structure? The other day I was working on team communication with a practice in Belgium, and one of the major takeaways for management was that they had no structured meeting culture, so feedback was given sometimes and sometimes not. Decisions were shared sometimes and sometimes not. Half of the staff were aware of certain information, decisions and changes, and the other half not. The staff thus decided to establish different meeting structures with different time frames: meetings in smaller groups, depending on roles and responsibilities, on a more regular basis, and then entire staff meetings on a monthly basis. They decided not to book patients during the timings of these meetings in order to be completely focused. The encouraging thing about that team com- munication day was that it was the team members who asked to set up more meetings, and the orthodontists and management staff listened. How you motivate your team matters How do you motivate your team? This question is one I love to ask during training and coaching sessions. I ask people to write down all the things they do, or their clinic does, to motivate their team. Actually, you might want to do this exercise as well quickly. The answers we normally get—and maybe you will give similar ones— are things like: – offering good working hours; – providing an adequate salary; – respecting employees; – listening to employees; – giving employees the flexibility to choose their holiday dates; – giving employees nice work clothing; – arranging team-building activities; – celebrating birthdays and big holidays, such as with the giving of Christmas gifts; – communicating a clear vision of the direction the clinic is evolving in; – being open to feedback; – empowering employees by giving them responsibilities and autonomy; and – offering employees training. Do you have any others? Now let me introduce you to the motivation–hygiene theory. Frederick Herzberg et al. developed this theory and published it in the book Motivation to Work. Influenced by Maslow’s hierarchy of needs, Herzberg et al. concluded CAD/CAM 1 2024 51 © Skyline Graphics/Shutterstock.com

practice management | Hygienic factors. new uniforms and who wanted to have these nice uni- forms in the first place. She wanted the staff to have these uniforms and thought it was important. For her staff, these were just an outfit they needed to wear every day at work but not something that made them feel appreciated or offered them additional value in the workplace. In another example, employees had to park their cars in an unlit parking area, so when it was dark in the mornings or the evenings, they felt quite unsafe. This influenced their energy and motivation negatively. Therefore, management decided to install large light fixtures to illuminate the parking area and thus create a feeling of safety for the employees. Management was then disappointed that the team’s motivation was not improved by this. Why was this so? When hygienic factors are not fulfilled, this is always a source of demotivation. Because employ- ees expect these factors to be in place, when a lack in this regard is addressed, employees take it for granted. If the baseline represents zero, then a lack in hygienic factors will reduce motivation to below zero. Solving this lack will just bring motivation back to zero. If you want to go above zero, you need to employ motivators, such as providing growth opportunities, celebrating achieve- ments, offering team-building activities, giving recognition and creating unexpected moments. Do you need to make some changes to how you approach motivating your team? I hope that you will now be able to reflect on whether you are solving hygienic factor issues or adding motivators. I wish you all the best in this journey of moving towards true motivators, and both are important but have a different approach and different outcome. Editorial note: This article was first published in aligners—international magazine of aligner orthodontics vol. 3, issue 1/2024. about Jerko Bozikovic is a specialist in communication skills, emotional intelligence, time and stress management, leadership, and change management. He is fascinated by human behavior and finds working with people on personal development to be a daily challenge and blessing. He speaks seven languages and has offered his training courses in four languages since 2001. He embraces and embodies the motto “Love the life you live; live the life you love”. Jerko can be contacted via LinkedIn. CAD/CAM 1 2024 53 © Luna_2631/Shutterstock.com

meetings | Master dental technician Vincent Fehmer from Switzerland opened the event by presenting the latest innovations and techniques in prosthetic materials. sionals. After a rigorous educational agenda on the first day, attendees were able to unwind during an evening celebration with a “pearly white” theme. Once again, exocad offered attendees the chance to participate in its charity drive by buying limited-edition exocad Insights T-shirts. The company said that the funds collected would again go towards supporting non-profit dental organisations. Exocad Insights offers enhanced opportunities for superior results At the press briefing, Steinbrecher announced that the event had sold out and discussed how AI can enhance dental care. He highlighted two main benefits: improving efficiency and increasing patient acceptance through engaging visualisa- tions. The software produces not only attractive images of potential treatment outcomes but also realistic video render- ings that can engage patients emotionally. While AI facilitates these realistic renderings, users maintain control, allowing them to add their personal touch. This integration of AI and user skills combines efficiency with personalised care. Savic shared that the feedback from attendees had been overwhelmingly positive, noting that the high level of insights at the event encouraged companies to launch new products. Evoking the event’s theme, he said, “You need to be innova- tive to lead,” and he stressed the importance of networking to foster innovation and introduce new ideas. The team presentation by Ashley Byrne and Dr Marcos White from the UK focused on the iTero-exocad Connector and its benefits for collaboration between labs and dentists. CAD/CAM 1 2024 55

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