The Dental & Skin Clinic aims to make dentistry enjoyable and professional skin health treatments accessible.

By Danny Chan

About six years ago, Dr Rita Trak went to a cosmetic dentist seeking a solution for the lines on her forehead and was treated with anti-wrinkle injections. That was shortly before she attended a course on cosmetic injectables, from which she learned that the creases on her forehead were not wrinkles but the result of dehydration – a diagnosis that negates the injectables approach.

“That episode pretty much sums up what I think of dentists providing injectable treatment without having an in-depth knowledge of skin health,” she says.

The same negative experience drove the cosmetic dentist to delve deeper into skin health, pursuing courses on the subject with fervour. This also led to her founding of Dental & Skin Clinic in January.

In a way, the clinic bears testimony to Dr Trak’s successful journey, traversing professional domains from the smile to the skin. The East Bentleigh practice, however, is more than just a vehicle to display the Practice Principal’s unique fusion of talents.

Universal challenge
Its online manifesto reveals multifaceted goals: “Working inwards towards the smile, we capture, protect and amplify the face’s natural charisma and beauty through our cosmetic dentistry, dental veneers and facial treatments.”

This corroborates the dentist’s response, when asked the three most unique elements of her practice: Natural aesthetics; integrating cosmetic dentistry with professional skin care; and making dentistry enjoyable and professional skin care services accessible.

Making dentistry enjoyable, she adds, is the most challenging of the goals.

“The universal problem is that no one likes going to the dentist. How can we make people actually enjoy coming to see us?” she asks earnestly.

Dr Trak, whose dream profession since the age of 12 is to become a cosmetic dentist, believes the answer to that question is foundational to what she does for a living.

“I was always drawn to the fact that a good smile has such a great impact on someone’s mental health and I like the idea of being responsible for someone’s happiness.”

Where dentistry meets skin health
Whereas in the past the bosses would veto her “crazy” suggestions, Dr Trak is now free to walk the talk in Dental & Skin Clinic. The very concept of combining dentistry with professional skin health services is revolutionary.

The operative word is “professional”, which encompasses skin services you wouldn’t normally associate with a dental clinic: Skin needling, medical-grade chemical peels, mono threads, etc.

“The reason why I chose these specific skin treatments is because they chemically change the skin, so we’re not using the typical brands offered by other dentists,” she says. “It was really important to me that the skin services that we do offer are on a medical level.”

Dr Trak is proud that Dental & Skin Clinic is one of the only dental clinics in the world to gain Clinical Partner status with Skinceuticals, an American brand traditionally aligned with plastic surgeons and dermatologists.

Skin treatment hierarchy
Although Dr Trak is certified in cosmetic injectables, the service ranks low on her hierarchy of skin care treatment protocol.

“Dentists are versed in the knowledge and practice of conservative dentistry. There’s such a thing as conservative skin care too, and injectables is just one part of it,” she explains.

Dr Trak advocates the need to diagnose skin before offering injectables. 

A typical skin treatment at Dental & Skin Clinic begins with a complimentary consultation, during which she commonly advises against wrong skin care regimes.

“Most clients are not aware of what to use for their skin type or they’re using products that are actually detrimental to their skin health,” she says.

“And if they’re using the right products, they may not be using them in the right order, thus diluting the active ingredients.”

These conversations have yielded a high conversion rate, with up to 90% of her dental customers, ending up receiving a skin treatment.

“We’re known for offering a natural makeover with our dental veneers, which accounts for about 70% of our clients,” she adds.

“With our veneer customers, we’re already having conversations about facial proportions, facial thirds, eye level, jaw line, jaw angle and so on. So it’s not weird going from that to talking about skin health.”

Numbing experience
Clients are also drawn to the added benefits of receiving skin treatments from a cosmetic dentist.

For example, dentists are authorised and skilled in applying local anaesthesia. When it comes to procedures like skin needling, cosmetic dentists enjoy a clear advantage over a beauty therapist who can only apply numbing cream that requires 30 minutes to an hour to take effect, and it’s only able to superficially numb the face. 

“I can completely numb my client’s face within seconds, and achieve more depth with my skin needling – up to 2.5mm deep as opposed to the typical 1mm depth,” says Dr Trak.

“The deeper I can go, the better the skin rejuvenation – which also translates to faster results and fewer treatments. Skin needling is great for wrinkles, lines, pigmentation, acne scars.”

In addition to the local anaesthetic providing a complete numb for a more comfortable treatment, Dr Trak goes one step further to also minimise the discomfort of the numbing process.  

When administering anaesthetics, she uses DentaPen, an electronic pen that she says delivers anaesthetics through little impulses affording better control of the injection and a reduction in pain for the patient.

“I want to make dentistry enjoyable, so it’s not enough to just numb clients. The actual process to numb needs to be just as comfortable,” she adds.

Customers don’t want to leave
To say that Dental & Skin Clinic treats its customers well would be an understatement. Clients here get the sort of treatment you’d expect from a day spa.  

As you enter a cosy lounge-like waiting area bathed in soft mood lighting, you are greeted by smiling staff members resembling airline stewardesses with their perfectly coiffured hair and fetching uniforms. They offer a welcome note and drink – your choice of tea, latte or sugar-free hot chocolate. Muesli bars, pretzels and popcorn are also on the complimentary menu.

While sipping your favourite beverage, you apply tingling creams and luxurious lotions, comparing different skin care products – available in test bottles – as you would in a classy beauty salon.

You can also opt for a “Duo Clean” that essentially follows up a dental clean-and-examination session with a skin-rejuvenation facial, leaving you sufficiently refreshed – in mind, body and breath.

This is what Dr Trak means when she waxes about making dentistry enjoyable. And her customers are responding exactly as she had hoped – lingering around long after a treatment. Some have even commented that they don’t want to leave.

“Clients have remarked that it feels like a hotel or retreat. If they are looking forward to the next visit, we would be achieving our goals.”

Due to overwhelming demand, the practice went from being operational two days a week to four days within eight weeks of opening. It was fully booked by the third month. While customers are voting with their wallets, Dr Trak insists that’s not the primary motivation.

“For a cosmetic dentist, transactional relationships with patients simply do not work, because cosmetic treatments are permanent,” she says.
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“Personally, I’m not driven by money but genuinely invested in the client’s happiness. I believe it shows.”

An abiding passion for his practice, work and patients prompted Dr Nabil Ishak to continue working for his practice buyer.

By Danny Chan

When it’s time to bow out of your practice, there are many paths to consider. Some choose to simply sell and leave. Others bank on creating rapid growth and hiring associate dentists to spread the workload, then gradually cutting back on hours until they are ready to sell. Then there are those who would hire a young dentist to groom as the heir apparent to satisfy a buyer-in-waiting.

Yet another option is to stay on as an associate and continue to work for the organisation that buys your practice. If you truly enjoy doing dentistry, the latter option may provide the ideal transition from active practice to full retirement.

That is certainly the position of Dr Nabil Ishak. After handing the keys over to practice acquisition firm Ekera Dental in October, the experienced dentist chose to stay on.

“Yes, because I love what I do, I love my practice, and I love my patients. I’ve been seeing them and their families for generations,” says Dr Ishak.

“I have been working in this practice for 30 years so I wouldn’t just leave my patients and the community.”

Through the years
Dr Ishak established the Melton Dental Group (MDG) back when Melton was only a satellite town. Rapid suburban growth has turned it into a commuter town in the Melbourne-Ballarat growth corridor, now poised for merging into Melbourne’s future conurbation.

From the outset, Dr Ishak’s goal was to provide family-oriented dentistry using cutting edge tools and techniques. Always pushing the envelope, he would engage specialist dentists to deliver hands-on training workshops to his team on site.

MDG eventually became the first in the area to deliver treatments such as dental implants, all-on-4 implants and dentistry under intravenous sedation and full general anaesthesia.

Besides offering forward-looking dentistry, MDG is also known for enhancing the “stress-free” and “pain-free” patient experience.

Lounging with a cuppa, plugging into your choice of in-chair entertainment or immersing in the iPad Play Centre, the clinic offers an array of modern comforts and convenience. In addition, their use of light-handed dentistry, and availing of Nitrous Oxide and local anaesthesia help to promote a welcoming atmosphere for nervous patients and those requiring more complex treatments.   

Over the years, these patient-centred qualities have endeared MDG to Melton locals and patients from neighbouring suburbs, extending from Gisborne, Macedon, Bacchus Marsh, to Ballan and beyond.

Aligned visions
As part of his exit strategy, Dr Ishak wanted to preserve the foundational principles behind MDG’s hard-earned reputation.

“I put my heart and soul into my practice and I wanted to hand it over to a group that would respect my ideas and ethos and continue to run it according to my vision and goals so that the practice would remain as a source of high quality, honest and trusted dentistry in the region,” he enthuses.

“I still had many years of dentistry in me and wanted to plan a smooth transition for the future. A corporation was the best option, as I was happy to continue working, but I needed to find the right corporation for me.”

Introduced to Ekera Dental by a friend familiar with his selling motivations, Dr Ishak found their corporate model appealing after doing his own research. His first meeting with Ekera Chairman, Dr Anthony Coulepis, reinforced that notion.

“We felt that we were like-minded in the level of honesty, ethics and professionalism,” he recalls.

Non-threatening support
Dr Ishak reveals that a major factor deciding the sale was Ekera’s hands-off management approach.

“They respected how we operated and trusted us to continue to run the practice as we see fit. They did not force and impose corporate ideologies and processes on us or our staff,” he says.

“They did not dictate how we are to run the practice or how we deal with our staff. The transition was so smooth, our staff did not at any point feel uneasy or threatened,” he says.

Staying on as the principal dentist, Dr Ishak appreciates the fact that Ekera’s hands-off approach does not equate to a lack of support – rather, it’s there when you need it.

“A stand out feature of this experience is that Tony’s door is always open and he is truly only a phone call or email away,” says the impressed clinician.

“His finger is on the pulse and he is always aware of everything taking place within his operations and management team.”  

The MDG operations enjoy Ekera’s backbone support in many areas: Marketing; IT; online presence; management; human resources; bulk buying of stock; legal; as well as corporate representation in insurance matters, industry bodies and associations.

In addition, Ekera facilitated the purchase of a new intraoral scanner with smile design; an OPG/ Lat Ceph and CBCT machine; and a new compressor.

“No questions were asked,” Dr Ishak attests. “They simply trusted our judgement and case presentation.”

Secure in the knowledge
Overall, the passionate dentist would describe his post-sale experience as being “very positive and encouraging”. Having heard cautionary tales from colleagues with negative experiences selling to corporates, Dr Ishak is glad to offer a counter perspective:

“Ekera Dental has lived up to all of the promises that were made prior to the sale. They honoured every deal and promise and this is something that I value very much.”

“As a dentist, my experience has also been positive,” he adds. “They respect and value my professional judgement and experience.

“On a personal level my experience has been one of reassurance and liberation in the knowledge that I am now on my way to reducing my stress and responsibility for the practice that was my heart and soul for so long.
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“I am comforted by the knowledge that the practice will continue to operate according to the ethos and culture that I had established.”

In this second instalment, Australasian Dentist continues the broad-ranging conversation with one of Australia’s leading orthodontic educators.

By Danny Chan       

Tell us about your initial interaction with your mentor, Dr Rohit Sachdeva, and how you came to embrace his clinical methodologies?

When I first met Rohit about 10 years ago, he requested me to show him 10 cases that I was doing. I showed him the photos as well as the braces and wires. On two or three of those cases, he predicted that there would be certain problems and specified exactly what to expect.

I was thinking this guy was full of garbage, basing his predictions on the initial photos and seeing some brackets. Photos of two to four months later showed that he was right with every prediction, in every case.

When I started doing my mentorship with Rohit, it felt like my first day in orthodontic school. My business partner Martin Poon, who joined Rohit’s program a year after me, felt exactly the same way.

Rohit trained under Charles Burstone, who is considered the father of orthodontic biomechanics. Rohit is an amazing thinker who managed to distil everything Charlie taught him and put into a methodical practical clinical approach. Those principles he has taught me over time are what we now deliver to our OrthoED students.

The average treatment time for orthodontics is about two years. If you know what you’re doing and using the right force system – which is very easy to understand once you understand the principles – you can treat about 80% of cases in about 14 months. The reason it usually takes others two years is because treatment and tooth movement is out of control and they end up spending a lot of time fixing what should never have happened in the first place.

Rohit’s principals requires not only proper planning at the beginning of the treatment, but also understanding the forces at work. It’s not about putting braces on every tooth but understanding what is going to happen, when it will happen  and why.

What are the biggest myths in orthodontics?

Myth 1: The majority of orthodontic cases require extractions. In reality, about 80% of our patients are treated without extractions.

Myth 2: With aligner therapy, all you need to do is put the case in to the aligner company and they will take care of the rest.

If that is true, what’s the difference between a dentist-administered aligner treatment and that supplied from a company like Smile Club Direct? In probably 99% of cases, a system that completely relies on the technician for the set-up without any input from the dentist is likely to fail. I’ve never been involved in an aligner case where I have not modified it at least four times.

The bottom line is, whether for aligner therapy or orthodontic treatment planning, you cannot depend on a one-size-fits-all system. Cookie cutters only work for cookies.

What sort of resistance did you face because you tailored your training courses for GPs, and how did you overcome them?

I’ve received threatening letters from orthodontic bodies – one of them asked me to leave simply because I was teaching general dentists. It’s the only professional body that I know of that actually tells you not to teach other dentists.

The training ethos of the ADA actually encourages specialists to mentor the general dentists and to help them. But I was told not to do that.

How did I deal with that? Unfortunately, with potential litigation and that stopped any further negativity. I used to get upset in the early days but now it’s like water off a duck’s back. My general feeling is if they are upset with me, I must be doing something right.

Perhaps as a form of vindication, I’ve had specialist orthodontists attend my courses over the years – both Smilefast and the full-on orthodontic programs – and not one of them has been able to criticise my teaching or my courses but instead have been full of compliments.

Has the Covid-19 pandemic affected your courses in any way?

It disrupted our physical sessions, but fortunately, also pushed us in a positive way.

Due to Covid-19, we actually set up a dedicated TV recording studio here in my business office in Melbourne. We were able to live-stream all the lectures last year as part of our efforts to deal with the situation. We’ve also kept all the recordings and will be putting them together into an online course that we will be launching in February.

If people cannot make it for our face-to-face courses, they can now choose to attend the online course instead. The physical course attendees will get the online recordings as well, as a refresher education to listen to at their convenience. On top of that, we hold weekly treatment planning sessions and webinars which are included as part of the course program.

The online course was always something we were going to do but the Covid situation fast-tracked it.

What’s the future outlook for you and the profession?

I’ve probably got another five years of practice in me, and maybe eight to nine years of teaching before I say “enough is enough”.

As for the profession, I remember the famous words of Dr David Penn, one of brightest dentists I’ve ever come across.

He believes the future of a dentist is to become a mini specialist. A GP can be a mini specialist in two or more areas of specialty. You will end up in a practice with four to five dentists who cross-refer to each other.

In 10 to 15 years’ time, if you wish to be a specialist orthodontist, you would have to be a really good specialist – treating the toughest of tough patients and you’re going to have to charge accordingly. That’s because increasingly, general dentists will be exposed to the work that used to fall under the domain of specialists.
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Unlike the old days when everyone did well, many more dentists will be joining our ranks (and performing orthodontics) in the future and it’s going to be tough for everyone.

A Melburnian dentist recounts the bittersweet journey building up and selling her beloved practice.

By Danny Chan

During her time as owner and principal dentist of My Smile Dental (MSD), Dr Melly Salih hardly gave herself a chance to relax.

Her adherence to the golden rule of treating every patient as you would a friend or family member is a major reason. To provide the veritable “personalised touch” in a growing, multi-million dollar dental business, Dr Salih’s personal time ended up becoming the expendable resource.

If she was attending to a patient late in the afternoon or close to the weekend, and thought there was a likelihood of post-procedural pain, Dr Salih would give the patient her personal phone number, thereby making herself available after-hours. And that’s just one example of how the high-octane practice ended up commanding all of her attention.

“It is 24/7. You never really switch off. Even to this day, I’m only starting to relax a bit,” she lets on.

Although Dr Salih has been slowly releasing the pressure off the pedal for some years now, she finally decided to take her foot off completely. On December 1, she sold her practice to Ekera Dental Group (Ekera), deciding it was time to move in a different direction.

The milestone decision can be traced to a health issue that started about five years ago. As the result of a neck surgery, Dr Salih suffered damage to her arm tissues, which over time eroded the ability for fine movement and touch sensation in her fingers. The usually hands-on clinician had to roll back and eventually halt her surgical involvement. The idea of selling the practice had been firmly planted by then.

Point of difference
Having spent 35 years as a dentist, 20 of them as owner of My Smile Dental, Dr Salih has devoted the bulk of her career to making the practice the success it is.

She started her entrepreneurial journey in 2000, operating from rented space in a local medical centre in Sydenham. When the practice had outgrown the premises five years later, Dr Salih together with her husband, Erdem Salih, decided to construct a purpose-built surgery across the street from the centre. 

Better known in the industry as owner and MD of dental supplies company, Orien Group, Erdem, who has an engineering background and vast experience coordinating large-scale building projects, managed the construction of the new practice building.

The Salihs shared a common vision to create the bespoke practice building centred on the “dental spa” concept, which at the time was just beginning to take off in the States. After conducting extensive research – including visits to dental spas in the US – the couple successfully introduced the novel concept to Sydenham, then regarded as one of Melbourne’s projected growth corridors.

“From the customised building design through the relaxing environment, the welcoming ambience to the unique business offering, we wanted to create a point of difference from the get go,” says Erdem.

Despite having two established competitors within a 500-metre proximity, MSD’s new concept and building perfectly dovetailed Dr Salih’s patient-focused ways, and continued to generate healthy word-of-mouth. MSD’s growth was also ascribed to a stable and efficient back-end support.

By the time MSD moved into the new building, the practice had for a couple of years been using the services of a dental management consultancy firm, which at this critical juncture proved essential in guiding the transition.

Throughout the five years working with the consultancy firm, the MSD team benefited immensely from their professional guidance and training in several key support functions, including: Managing the appointment books and optimising them for profit; financial reporting; reception KPIs; patient recall system, etc.

“Although their consultancy services weren’t cheap – in fact, their fees use to take up a chunk of our profits in the early days – looking back, we can safely say it was money well spent,” says Erdem.

Smooth handover
My Smile Dental’s efficient workflow and optimised back-end support were integral to its attractiveness as a long-term investment for Ekera. They even helped to smoothen the handover process.

“I think the folks at Ekera were pleasantly surprised by how easy the handover was. All the systems were already working optimally so it was really a case of “okay, here you go” and that was it,” Dr Salih beams.

The changing of the guard was made even more pleasant by the Ekera team, who made an effort to immediately introduce themselves to MSD’s dentists and staff members following the sale. All of the dentists and staff chose to stay.

“That was a really important and reassuring gesture to let the MSD team know that they remain in good hands,” says Dr Salih.

“I didn’t want the MSD team, including the dentists and employees of the practice, to be short-changed in any way because of the sale. I was really happy to inform them that nothing would change, apart from the name on their paychecks,” she quips.

Perhaps the biggest assurance from Ekera, and one of the primary reasons that motivated the sale for the Salihs, lies in the absence of any post-acquisition disruptions. While other corporates are eager to put their stamp on a newly acquired practice, Dr Salih says Ekera’s model of “staying at an arm’s length” assures that the business continues to thrive on its uniquely forged path of efficiency and profitability.

The changeover will be even less noticeable to MSD’s customers, with whom Dr Salih has built a trusted dentist-patient relationship. Although the Melburnian dentist started taking a backseat following her neck surgery, she still made it a point to greet patients and strike up conversations with both new and familiar faces.

“We’ve come to a point where we’ve seen three generations of the same family come to us for dental care, and its only a 20-year old practice,” she adds.
 
These long-standing connections, Dr Salih says, are what she treasures – and would miss – the most.

Future is bright
Broadly viewed as a period for reflection and rejuvenation, 2021 began as a season of significant change for Dr Salih. She is looking forward to spending more time with her grandchildren and hopes to travel when the pandemic situation abates.

Having gotten used to a 24/7 working habit, the dentist finds herself still adjusting to her newfound freedom. Compared with dentists who sell their practice to corporates and stay on as principals until retirement, Dr Salih’s transition from the clinic is not as gradual.
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“Ekera is quite happy for me to go back to the surgery to say hello to the patients from time to time, but I’ll still be missing out on the day-to-day connections.”
 
The relational dentist is nonetheless relieved that Ekera is taking over the business, confident in the new management’s ability to preserve the patient goodwill that she has painstakingly cultivated over the years.
 
“The surgery that I’ve sold to Ekera is one that I’m proud to have built from scratch and placed in their good hands,” she says.
 
“I walk away with my head held high knowing it would continue to do well in the future.”

Dialogue with one of Australia’s leading educators of orthodontics – and die-hard advocate of imparting the lucrative trade to GPs.

By Danny Chan       

One thing becomes clear when you speak to Dr Geoffrey Hall: he doesn’t mince his words. Especially when discussing issues close to his heart – like clinical orthodontics and orthodontic training – Dr Hall is not averse to making bold, and even controversial, claims.

The Specialist Orthodontist is extremely candid about what he believes in, and what he doesn’t. For example, he openly counters the protective posture of those within specialist camps that preclude general dentists from learning or practising orthodontics.

He charges that the majority of dentists would simply accept an aligner company’s algorithmic recommendations without any scrutiny.

The orthodontic educator tacitly questions the veracity of undergraduate and specialist programs, confident the short and long-form training courses offered by OrthoED, the training institute he founded, would enlighten even seasoned clinicians.

For over 30 years, the self-professed myth-busting orthodontist has treated more than 10,000 cases. Known for high profile roles such as specialist clinician, practice partner (MP Orthodontics), international lecturer (GAC/ORMCO) and founder/principal of teaching institute (OrthoED), he also holds little known credentials like orthodontic innovator and pioneering tech adopter. On the latter note, he was certified as the first Invisalign accredited orthodontist outside of North America.

In this two-part article, we chat with the straight-talking orthodontist, discussing everything from his training courses to passions and motivations. Of course, he also delivers unvarnished views of the industry – where it stands and where it is headed.

What led you to study orthodontics and made you so passionate about it?

After finishing dental training in 1983 at Melbourne University, there was a point in time when I became frustrated that whatever I did in general dentistry, somebody could do it better.

Influenced by my brother, a rheumatologist who at the time was training at the Mayo Clinic, I went to the United States to undergo specialist orthodontic training at the University of Pennsylvania in 1988, becoming the first Aussie to do so.  

It was at the University where I had the opportunity to train with some of the greatest orthodontists in the world. At least once a month, I would be attending different courses, going around America being trained by – and making friends with – elite orthodontists such as Drs Vince Kokich, David Sarver, Ron Roncone Norm Cetlin and Dwight Damon, who developed the Damon bracket.

At the university, I was trained by the likes of Dr Brainerd “Barney” Swain, who invented the Siamese twin bracket, and my infamous chairman Dr Slick Vanarsdall.

One of the great things about going to America is that it gave me “the fire in the belly”. Even after completing the specialist orthodontic program, I used to visit the States every year and ended up bringing Invisalign, the Herbst appliance and micro implants to Australia.

What made you decide to teach orthodontics?

The more I learned from these prominent orthodontists, the more I enjoyed being at the cutting edge of this branch of dentistry. As a result, I became an international lecturer and speaker for GAC (now owned by Dentsply) and eventually became the key opinion leader and international speaker for ORMCO.

During this period, I developed a genuine interest in teaching other dentists. I really believe that one of the biggest problems of orthodontics is that my colleagues have kept it as a closed shop. They don’t teach GPs properly and everybody thinks that it’s too hard, when in fact, it’s not very hard at all, if you understand the correct principles.

If someone were to sit down and explain orthodontics to you properly, you would quickly realise that it’s not rocket science. There are far more difficult areas in dentistry than orthodontics. But it has never been properly taught to GPs.

How did Smilefast and OrthoED come about?

When I first had the idea to develop an orthodontic training course for GPs, some general dentists and a couple of orthodontists were already teaching it in Australia. Unfortunately, most of them had a vested interest in what they were teaching.

Some of these courses were run by dental labs and the training content was built around the use of appliances that they produced and sold. A lot of those appliances really aren’t needed at all.

Prior to setting up Smilefast as a short-term introductory course to orthodontics for GPs, I’ve already had several years of experience teaching orthodontists.

Smilefast is a two-day course that gives general practitioners the ability to straighten teeth in 75% of adult orthodontic cases. The feedback was great and the dentists we trained were asking for more.

This led us to develop a 9-module, 2-year Mini Master’s Program. It was designed to equip graduate GPs with the skills to treat 95% of all orthodontic patients – without having to refer them to specialists.

The idea with Smilefast and the OrthoED Mini Master’s was to provide a total program of orthodontic education, based on sound principals and good mentorship, which was lacking in the marketplace.

You often talk about the need to rethink orthodontics and orthodontic training. Was there a turning point in your own understanding?

My turning point came when I met Dr Rohit Sachdeva about 10 years ago. I consider him the brightest and most intelligent orthodontist alive today. It was Dr Sachdeva who taught me a fundamental principal that completely changed my thinking: with proper planning and proper risk management, 99% of patients can undergo orthodontic therapy with no surprises.

What I’ve learned from him, I would say not more than one per cent of orthodontists understand. I’ve since passed on a lot of these learnings to all of my dental clients. Based on what I call risk management, these principles take your orthodontic knowledge to a whole new level that protects you from unwanted problems.

What most orthodontists do, and that’s what we have been taught in universities, is that you put all your braces on and the teeth miraculously line up – but that’s only true in 70 per cent of cases.

They can actually get worse in 30 per cent of the cases, and that has to do with what we call the bracket/wire geometry. We teach our course attendees about the difference between a consistent and inconsistent force system. In the inconsistent system, simply putting the brackets on the conventional way will result in teeth moving the wrong way.

Our job is to identify which cases fall into which category and once we do, we have to identify the mechanics to change from the inconsistent force system to a consistent one.
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Once this knowledge is learnt, orthodontic tooth movement and treatment can be very easy and predictable.

Vatech’s 10-year warranty on their sensors was enough to convert a Gold Coast dentist to the Green 16 Cone Beam CT.

By Danny Chan 

Dr Mark Taylor sees himself as more than just an early adopter of dental technology. Staying on the cusp of technology, he believes, is both a passion and means to an end. He is laser-focused on making sure that his cutting-edge dental gear assist to better the patient experience, which to him is what defines an astute investment.

Notably, he is one of the first dentists in Australia to own a particular high-end model of an American dental chair brand. He also installed the world’s first Vatech Green 16 CBCT with an Insight Pan function.

The Green16 is an advanced 4-in-1 digital X-ray imaging system that incorporates PANO, CEPH (Optional), CBCT and MODEL Scan.  

Do the right thing
Dr Taylor’s insistence on working with the best gear and support team stems from his practice philosophy: “using the best available tools to provide high quality and easily accessible treatments at reasonable prices”.

Robina Quays Dental Care (RQDC) is a newly set-up three-chair surgery that houses top-of-line European and American equipment. The Gold Coast family-based practice, which began operations last November, relies strictly on reputable local labs and uses only genuine components for Dr Taylor’s implant work. 

“Knowing that you’ve done your best by the patient,” the Principal Dentist opines, “helps you sleep better at night.”
Originally from England, Dr Taylor is an experienced clinician/ surgeon who has been providing the full range of general dental services and advanced cosmetic and dental implant treatments in England and the Gold Coast for over 25 years.

Dr Taylor, who has a special interest in placing and restoring implants, was among the first ten dentists in Australia to undertake the pioneering Clinical Dental Implant Masters programme at Griffith University’s School of Oral Health on the Gold coast.

For 17 years, he was Principal and Dentist of a Southport practice, before he sold it to a corporate group. The old moniker “Taylor Dental Implants & Aesthetics” has been retained under the RQDC banner.

Confidence backed by warranty
When shopping for a CBCT, Dr Taylor initially wanted to stick to a familiar American model that he was using prior at the Southport practice.

After doing some research and hearing from a periodontist friend who owns a Vatech unit, he found the Vatech CBCT made a more sound investment. While Vatech offered a 10-year warranty on their sensors and tubes, the reseller of the American brand could only offer five years, which Dr Taylor found unsatisfactory.

“The sensors cost around $30,000 to replace. It was Vatech’s confidence in the quality of their sensors that gave me the confidence to give them a go,” he says.

“Sensors are absolutely critical to the machine’s longevity. We were looking for reliable, long-lasting equipment such that if I were to sell my practice in 10 years, I could sell all my equipment with it and they won’t be out-dated by then.”

Despite having no prior knowledge of the Korean brand, Dr Taylor knew enough about the country’s high-technology manufacturing base that produces some of the world’s top semi-conductors, mobile phones and automotive products.

The other reason that tipped Dr Taylor’s decision towards Vatech was the strong endorsement by Jane Miller from Medical Dental Supplies.

“She was the one who supplied all the dental chairs and other equipment for my new practice,” he adds,  “and I respected her opinion as a very trustworthy, ethical and knowledgeable individual.”

Standout features
“I was primarily drawn to the quality of the Green 16 and what it could do for my work,” he says, “But I have to say that I was further impressed by the software that contained a lot of extra information for patients like videos and movies.”

Dr Taylor was referring to the pre-loaded treatment videos that explained to patients what to expect during clinical procedures. The video presentations, he adds, offer quick treatment synopses at the click of a button, making for a very useful patient communication tool.

Another standout feature for him is the 3D model scanner. Dr Taylor was bowled over by how easily the x-ray unit allowed him to convert the CT scan of an impression into an STL file ready for 3D model printing.

“If you want to do a surgical guide, you can also transfer the model scan digitally, without sending any models to the lab,” he beams.

Insight Pan gives clinical edge
Dr Taylor is thrilled with the Insight Pan function, which is capable of taking multi-layered images, providing in-depth images across a single trough. With the Insight Pan, users have the option to choose from 41 images when exploring their region of interest – unlike conventional panoramic systems that may miss important details that land outside of the focal trough.

“You can easily flick through the images to find the best one. It’s got a much better panoramic image depth than most OPGs, and much lower radiation, to give a better image,” says Dr Taylor.

“It’s definitely a clinical advantage for treatment planning, diagnosis and even for explaining the treatment plan to patients.”

Patient comfort and safety, he insists, come first. From the unit’s low-dose radiation to its lowered position that allows wheelchair-bound patients easy access, Dr Taylor says the Green 16 ticks both boxes.

The CBCT’s versatile positioning also lines up well with the practice’s thoughtful space design that is fully compliant with access standards for patients with special needs.

In terms of image quality, Dr Taylor would put the Green 16 right at the top, among the best x-ray machines out there.
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“The more I use the Green 16, the more I think I should use it,” he says, “because you start to see things that you would normally miss.”

Is there room in the Australian market for a new clear aligner system? Southern Cross Dental has three good reasons why it does.

By Danny Chan

Few dental labs, if any, can boast 35 years of experience servicing Australia’s orthodontic community or claim 10 years of providing treatment planning support and organising educational programs for clear aligner dentist providers. Southern Cross Dental (SCD) celebrated both milestones last year.

Just as the confetti begins to settle, the dental lab is already heralding their support of a new clear aligner system: TrioClear. This is exciting news coming from a lab that has reviewed and provided treatment-planning support for over 15,000 clear aligner treatment plans.     

TrioClear is a brand new clear aligner system, developed by SCD’s parent company, Modern Dental Group (MDG). The Group’s Hong Kong-based team is responsible for all the system’s development, case design and manufacture. 

“Although the product is new, it builds and improves on a number of concepts already in the market,” says Dr Albert Sharp, General Manager Clinical at Southern Cross Dental.

“The market for clear aligners is growing rapidly, and we see aligner treatment becoming a standard for most general dentists. We see a gap in the market for a truly great innovative aligner system, available at an affordable price made possible by the Modern Dental relationship.”

TrioClear offers a three-step clear aligner solution that uses clinical simulation software to accurately predict alignment and movement in advance. According to the company, TrioClear’s three-step solution allows more movement per step than most other systems. Allowing a quicker, high quality result with fewer attachments and stains.

The trays progress from soft to medium to hard, with aligner thickness (0.5mm-0.6mm-0.7mm) increasing in correspondence to days spent per set (4-7-10 days).

“The unique 3-step approach is the ultimate in patient comfort and predictability without compromising the results,” Dr Sharp enthuses.

“There is a huge comfort advantage for patients to start off with a softer layer before progressing to medium then hard. It really helps those ligaments stretch and initiate the bone remodelling in the most gradual way possible. Also, fewer attachments helps.”

Thanks to TrioDim Force, the aligners stay in place with few attachments. TrioClear uses carefully designed and placed TrioDim divot spots to create highly targeted rotation forces.

Despite offering similar benefits to other clear aligner systems on the market, Dr Sharp says SCD can provide support services to TrioClear at more competitive prices.

“In general, it is more competitively priced than other premium systems for a like case. To have our own line of aligners allows us more flexibility with pricing and promotions to our customers.”

SCD has had a long-standing relationship with Invisalign, providing both treatment planning and training support for the popular aligner brand. Dr Sharp was one of the first general dentists in Australia to be accredited for treating patients with the Invisalign System and for many years was the primary presenter for the Invisalign Training Course for GP dentists.

But the experienced clinician maintains that there is no conflict of interest.

“SCD is still a distributor, and a big fan of Invisalign, and we will continue to support that product. Trio Clear is a great alternative option for those dentists who wish to use that instead.”

Dentists and orthodontists can also look forward to a fast and efficient workflow. They may submit intraoral scans or traditional impressions to TrioClear, along with a prescription form they will need to fill. TrioClear would review the files, prepare a treatment plan and send it back for approval. The trays are 3D printed in medical grade FDA approved materials.

An optional advanced feature for root simulation – available to all practitioners with access to low dose CBCT technology – is offered for cases where predicting clinical crown movement is not enough. Ideal for cases that have poor root configuration or thin buccal bone, the feature allows predicting root movement and limitations with accuracy.

“The fantastic option to integrate a cone beam study of bone and root anatomy can help the dentist plan more accurately and safely,” Dr Sharp adds.

As Southern Cross Dental charts a new course in the clear aligner space, they have also opened up an avenue of choice for Australian dentists. If practitioners are looking for a reliable solution backed by the right expertise and experience, that’s what Dr Sharp says he and his team have put on the table.

“SCD has over 10 years experience in teaching and supporting dentists in the clear aligner space. We will continue to support their Trio Clear cases and provide options catering to their level of confidence,” he says.
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“Some will prefer to do all the planning themselves. Other dentists will prefer some extra treatment planning assistance, and we have the expertise to guide them through this.”
 

As part of Ivoclar Vivadent’s International Expert Symposium, Prof. Dr Petra Gierthmühlen gave an online presentation titled “Digital Chairside: Myths and Reality”.
 
By Danny Chan
 
The webinar provides insight into the emerging technologies for chairside dentistry – mainly that which highlights the advantages of modern CAD/CAM materials and comprehensive digital workflows.
 
Dr Gierthmühlen is the Professor and Chair of the Department of Prosthodontics at the Heinrich Heine University in Duesseldorf, Germany. Her lecture takes a look at the current state of chairside milling that enables faster fabrication times with protocols that are adjusted to the respective CAD/CAM material.
 
Based on the digital treatment concept of the Heinrich Heine University, Dr Gierthmühlen provided scientific evidence for the clinical success of CAD/CAM materials and the corresponding preparation designs.
 
The webinar began with a single tooth restoration case, and moved to each new case with increasing level of complexities.
 
The first case, focusing on the chairside CAD/CAM enabled placement of inlays and onlays, shows the digital design of the occlusal anatomy and digital fabrication process.
 
Dr Gierthmühlen then provided comparison study between CAD/CAM fabricated onlays and press fabricated onlays – showing high survival rates and hardly any discernible differences in split-mouth study survival rate (100% press fabricated vs CAD/CAM fabricated 97.5%) after long-term performance (7 years).
 
For her next case, a Lithiumdisilicate Anterior Crown Restoration, the Professor presented on how chairside dentistry was employed to restore two fractured central incisors using a straightforward digital workflow.
 
Dr Gierthmühlen showed that reasonable aesthetic outcomes and high survival rates (based on long-term studies) were obtained for the endodontically-treated incisors.
 
The following case for Lithiumdisilicate Posterior Screw-retained Implant Restoration related to a patient who had presented with molars that needed to be extracted due to endodontical complications.
 
Using guided surgery along with chairside CAD/CAM dentistry, Dr Gierthmühlen showed how proper angulation of the implant and ideal screw channel axis were achieved in the digital workflow, with help from a newly acquired CEREC Omnicam.
 
Long-term clinical studies, based on a 7-year recall, showed the restorations remain in very good shape with no fractures at all.
 
The lecture also moved on to more complex cases – including that of a Lithiumdisilicate CAD/CAM Anterior implant crown.
 
Case: An implant that was placed to replace central incisor developed peri-implant mukositis and needed therapy to control the peri-implant infection. Once accomplished, the patient needed a new anterior crown as there was also misfit of margin within the old implant crown.
 
After removing the implant crown and scanning the peri-implant tissue to get an outline for the restoration, scan posts were inserted to determine location of implants. The scan posts were then transferred into software for production of zirconia abutment. At the try-in of the abutment, zirconia abutment was scanned to produce the chairside implant crown for this zirconia abutment.
 
The 5axis-milling machine PMOne produced a very precise crown margin.
The fit and form was excellent in blue and try-in stage followed by surface characterization, to create a beautiful final restoration.  
 
Finally, the lecture moved on to the highest level of complexity: Full Arch cases.
 
Case: Patient treated more than 5 years ago presented with caries lesions; dramatically changed occlusal anatomy; dentin exposure on teeth; and suffering from hypersensitivity due to erosion.
 
To obtain orientation, Facescan was used to capture digital orientation of patient’s upper/ lower jaw, then on position of teeth to get full orientation of new vertical dimension of occlusion to design reference for tooth shade.
 
Digital mock-up and try-in was also used to develop a digitally milled prototype. This high-predictability, 100% digitally simulated workflow lets the patient decide whether he wants to proceed with treatment, based on the digital results.
 
The digital lab-side CAD/CAM workflow – because chairside CAD/CAM was not available at the time – was able to restore occlusal anatomy and function for patient in both upper and lower jaw and increase his vertical dimension of occlusion.
 
The 5-year clinical result shows high predictability for the complex full arch case: there were no fractures, gingival recession, or debonding in lower jaw. The patient also retains a similar smile line.
 
This is an excerpt of a webinar presented at the International Expert Symposium (IES). The IES is a digital platform Ivoclar Vivadent launched to host a series of free live-steamed and on-demand webinars.
 
For more information, visit: www.ivoclarvivadentacademy.com
 
 
 
 
 

What would a safe practice look like in the post-pandemic future? Vatech Australasia gives a tour of its “human-oriented innovations” to help dentists transition into the New Normal practice.
 
By Danny Chan
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In the midst of the COVID-19 pandemic, the dental practice has been navigating various measures put in place to safeguard the health and wellbeing of their patients and staff.
 
In so doing, they are coming to terms with what has been called the New Normal, which involves a rethink of how a practice is being managed daily – with particular emphasis on hygiene and infection control.
 
During this critical transitionary period, Vatech Australasia has provided a list of essential products and services – from its comprehensive range of “human-oriented innovations” – to assist the Australasian dental practice on the road to recovery.
 
Extra-oral x-rays the way to go – Vatech’s Premium Panoramic Solutions
 
To minimize the risk of transmission, several global organisations, including the American Dental Association, have recommended the taking of extra-oral radiographs where possible – because as the Association puts it, “intraoral techniques may induce coughing”. The Royal College of Surgeons of England suggested that “oblique lateral (extraoral) radiographs may be employed where this facility is available.”
 
Vatech’s OPG units are built to assist with easy and efficient radiographs.
 
In times like these, their fast-scan times, versatile capture modes (partial pano, bitewing, bitewing left, bitewing right, etc.) and easy patient positioning features do more than simply promote efficiency. They allow your staff to get accurate diagnostic results while minimising contact with patients, hence reducing their exposure to infection risks.
 
Vatech’s proprietary Insight Pan feature, with its 41 multi-layer PANO technology, provides depth-added information. It is the classic example of how technology can help to reduce the number of intraoral x-rays taken without compromising your diagnostic ability.
 
Less referrals improve patient safety – Green CT
 
The Green CT is Vatech’s kid- and eco-friendly 3D CBCT. Its Green Technology –embodied by its low-dose, fast-scan and superior image quality – is something that every dentist can appreciate.
 
As a child-friendly imaging equipment, the Green CT allows rapid scans and flexible patient positioning without compromising image quality or patient comfort. Again, this translates into an overall fast and efficient radiographic workflow that minimises patient contact.
 
As importantly, having a Green CT unit installed in-house has the added advantage of eliminating patient referrals to radiography centres. Apart from the obvious convenience factor, having an in-house 3D imaging facility dramatically reduces your patient’s exposure to infection because they don’t have to travel to multiple places for their dental treatment.
 
Breath of fresh air – EzPure UV
 
On 7 July, the World Health Organisation acknowledged emerging evidence of airborne Covid-19 transmission, following an open letter signed by 239 scientists in 32 countries, urging the agency to take the matter more seriously.
 
The issue of in-office air-quality contamination is now new, but the COVID-19 airborne threat would likely be more acutely felt by dental patients in the coming months and years. 
 
Designed with the dental environment in mind, the Vatech EzPure UV is an air-purifying solution that helps to protect against the invisible enemy.
 
Equipped with 4 UVC lamps, the germ-fighting innovation boasts a high and efficient treatment capacity at 120m^3/hour. It uses Ultraviolet Radiation at controlled wavelengths to perform intensive microbicidal and virucide activity on numerous microorganisms.
 
More importantly, it is safe for use. The shorter wavelengths of the UVC means the rays are particularly effective at killing airborne pathogens, yet are safer for people because they are absorbed by the proteins in the outer layer of dead skin cells before reaching the DNA in the living cells.
 
An article in the World Economic Forum looking at the occupations most exposed to COVID-19 risk, unsurprisingly, found dental hygienists to have “one of the riskiest non-hospital jobs during a pandemic”. Dentists are near the top of the list.
 
By using Vatech EzPure UV, you are protecting your most important resource – you and your staff.
 
Pro-active and advanced customer service – Remote check-up
 
In keeping with social distancing protocols, Vatech is providing advanced services including remote check-up service.
 
Even before their customers turn to them for help, the company has taken the pro-active approach by contacting them and assisting them regarding the safe use of their products. This is important during the lockdown period when certain equipment may be used less frequently or have missed their maintenance cycles.
 
Through the remote check-up system, Vatech has been checking the usage history of its products and offering tips on using their products in a smarter and safer way.
 
“It is important for manufacturers to develop ‘untact’ (online) service methods to maintain high quality service regardless of any sudden challengeable situation,” says Esther Lee, Managing Director at Vatech Australasia.
 
The ‘untact’ service, enabled by smart digital devices and advanced technologies, is a new concept of facilitating customer encounters without the need for face-to-face contact.
 
Accessible training – E-learning Centre
 
To promote contactless training, Vatech has established its E-learning Centre on Facebook exclusively for its users.
 
“Facebook is easily Australia’s most widely used social network, which more than 80 per cent of Australian adults visit. We wanted our users to visit our learning platform easily with less sign-up barriers, so established our E-Learning Centre on this popular site,” says Roy In, Sales & Marketing team manager at Vatech Australasia.
 
Through the easy-to-navigate online Centre, dentists can find software demonstration videos of actual clinical cases such as implant treatment, TMJ, wisdom tooth extraction, and so on. They can also find positioning guide videos to capture X-ray images more clearly and safely.
 
Taking the necessary precautions
 
During the launch of the Vatech Assurance Program last year, Esther was commenting on how the company was taking the preventive approach in product training.
 
“The idea is to build a training program that helps dentists predict what may go wrong and taking necessary precautionary steps to make sure that they don’t,” Esther explains. “Why wait until it’s too late if you can nip it in the bud?”
 
In the same way, Vatech is playing a constructive role to their partners and customers during the pandemic crisis.
 
They are highlighting the ways in which their innovative products and services can usher the Australasian practice into a COVID-Safe work environment, and by providing the kind of reliable support that is badly needed in a time of uncertainty.
 
Just like their maxim for maintaining an Vatech equipment, a COVID-Safe practice is ultimately one that takes the necessary precautions – now, before it’s too late.
 
For more information, contact Vatech Australasia (1300 789 454).

By Danny Chan
 
Dr Derek Mahony is a world-renowned Registered Specialist Orthodontist and expert in Dentofacial Orthopaedics who has trained thousands of dentists. He is also the Owner and Practice Principal at Full Face Orthodontics & Dental Sleep Medicine, a group practice based in NSW with six locations.
 
In this interview excerpt, Dr Mahony shares his insights on what orthodontic practices can do in advance of lowered restriction levels in the post-coronavirus environment.
 
Most, if not all, of the ideas and examples shared by the Specialist Orthodontist are drawn from pre-existing and enhanced infection and hygiene control protocols adopted in his own clinics:
 
1. Call patients
 
We make the effort of ringing every patient to say that we have re-opened and inform about the changes that they can expect. We’ve got a prepared script/checklist that our staff use when making these calls.
 
The calls are designed to:

• Reassure patients by providing an overview of our sterilisation and sanitisation procedures.

 

• Point them to our social media posts and emails to help them stay informed of latest practice updates.

 
2. Book short appointments
 
With 5000 patients in active treatments, we’re making short in-person appointments (each lasting about 5-10 minutes) to provide them an update, evaluate where they are in their treatment, and advise on what the next step is.
 
This way we’re seeing all of them without too much of a delay. We have stopped our operations for six weeks now and the patients are getting a bit antsy.
 
3. Re-organise office

• Most orthodontic clinics have an open plan in which multiple chairs are positioned right next to each other. Due to social distancing rules, our dental chairs are moved apart by a minimum 6-foot (1.8 metres) distance.

 

• Re-organised our waiting room such that all the non-essential items – like magazines, toys, coffee/tea station, etc. – are stowed away. This is to minimise the potential spread of infection through contaminated objects so anything that people are prone to touch is put away.

 

• Limit certain procedures in the office. For orthodontists, the only procedure that we do that has the potential to generate aerosols is the removal of braces, so we’ve put a hold on that for the moment.

 

• Incorporate the use of a new electric motor handpiece (for removal of braces) because it generates lesser aerosols than a high-speed handpiece.

 

• Upgraded waterlines using ozone, which effectively provides sterile water in every dental chair.

 

• Stagger the scheduling of patients in such a way that abides by social distancing regulations.

 

• All patients need to sanitise their hands at the sanitisation station located near the entrance of every clinic, before entering the premises. 

 

• Patients are asked to rinse their mouths with a 1% hydrogen peroxide rinse that reduces the bacterial flow of saliva.

 

• Instead of checking in via a computer terminal at the clinic, which is our usual practice, patients now check-in via a text message – usually done in their cars. We also respond via text to inform them when it’s their turn to come inside. 

 

• We see a lot of young patients who are accompanied by adults. To maintain social distancing measures, we now limit each appointment to allow only one adult per child.

 

• We’re now using N95 masks, which is an expensive change (from $1– $10 per mask). The clinicians and nurses are required to change an outer mask for each patient they see, and an inner mask every hour.

 
4. Pre-screening
 
Before patients come to the office, we will pre-screen them over the phone.
 
We ask patients whether they:

• Have recently participated in any large gatherings.

 

• Travelled outside of Australia.

 

• They or any member of their family have been sick or had a fever in the last 14 days

 
We would consider re-scheduling anyone who answers ‘yes’ to these questions. The only exception applies to high-school students answering the first question, because some children were still going to school during this period of time.