Narrow band (light) imagingBusy denture clinic in dawson Creek, BC looking for a licensed or intern denturist to join our team. Please fax résumés to 250-782-6083. denture clinic

D e n t u r o l o g i e

the Journal of Canadian Denturism le Journal de la Denturologie Du Canadasp

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Also

Narrow band (light) imagingof oral mucosa in routine dental patients

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100 CUSTOMER SATISFACTIONG U A R A N T E E D

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ACCrEditAtiOn the following Canadian schools of denturism are accredited by the denturist Association of Canada

George Brown College of Applied Arts amp Technology Toronto OntarioNorthern Alberta Institute of Technology Edmonton AlbertaVancouver Community College City Centre Vancouver British Columbia

den

turi

st C

olle

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Pro

gra

ms

PresidentMichael Vout DDPhone (613) 966-7363Fax (613) 966-1663E-mail mvoutbellnetca

1st Vice PresidentPaul Hrynchuk DDPhone (204) 669-0888Fax (204) 669-0971E-mail kellydcshawbizca

2nd Vice PresidentDaniel Robichaud DDPhone (506) 382-1106Fax (506) 855-9941E-mail dentureguynbaibncom

Vice President - AdministrationBenoit Talbot dd365 boul Greber 304Gatineau QC J8T 5R3Phone (819) 561-2121Fax (819) 561-9831E-mail benoittalbotvideotronca

Vice President - FinanceMaria Green RDPhone (604) 521-6424E-mail airamntelusnet

Past PresidentDavid L Hicks DD209-1700 Corydon AvenueWinnipeg MB R3N 0K1Phone (204) 487-7237Fax (204) 487-3969E-mail dlh44hotmailcom

national Office Administrative AssistantMallory Potter66 Dundas Street EastBelleville ON K8N 1C1Tel (613) 968-9467Toll Free 1 (877) 538-3123E-mail dacdenturistbellnetca

northern Alberta institute of technology11762-106th Street Edmonton AB T5G 2R1Tel (780) 471-7683 Fax (780) 491-3149Attention Doreen DunkleyE-mail dentalnaitabca

CandEC Canadian denture Education CentreClinical and Technical Precision Hands on Courses and InstructionSandra Goergen CDTNancy Tomkins DT(dip) DDTel (519) 754-4746

denturist Program George Brown College of Applied Arts and technologyPO Box 1015 Toronto ON M5T 2T9Tel (416) 415-5000 Ext 3038 or 1-800-265-2002 Ext 4580Fax (416) 415-4794 Attention Gina Lampracos-Gionnas E-mail glampracgbrownconca

deacutepartement de denturologieCollegravege Edouard-Montpetit945 chemin de Chambly Longueuil QC J4H 3M6Tel (450) 679-2630 Fax(450) 679-5570Attention Patrice Deshamps dd

denturist technologyVancouver Community College City Centre250 W Pender Street Vancouver BC V6B 1S9Tel (604) 443-8501 Fax (604) 443-8588Attention Dr Keith Milton E-mail kmiltonvccca

denturist technologynorthern Alberta institute of technology11762-106th Street Edmonton AB T5G 2R1Tel (780) 471-7686 Fax (780) 491-3149Attention Maureen Symmes E-mail maureensnaitabca

denturist Association of British ColumbiaC312-9801 King George BlvdSurrey BC V3T 5H5Attn Lynne Alfreds Executive SecretaryTel (604) 582-6823 Fax (604) 582-0317E-mail infodenturistbccaWebsite wwwdenturistbcca

denturist Association of Alberta4920 ndash 45th Avenue Sylvan Lake AB T4S 1J9Attention Don Tower PresidentTel (403) 887-6272Fax (403) 887-6271E-mail sylvdentshawca

the denturist Society of Saskatchewan507 - 100A StreetTisdale SK S0E 1T0Attn Darryl Kuny PresidentTel (306) 873-4858Fax (306) 873-4857E-mail smilestylersasktelnet

denturist Association of ManitobaPO Box 70006 1ndash1660 Kenaston BoulevardWinnipeg MB R3P 0X6Attn Jennifer PetersTel (204) 897-1087 Fax (204) 488-2872E-mail administratordenturistmborgWebsite wwwdenturistmborg

the denturist Association of Ontario5780 Timberlea Blvd Suite 106Mississauga ON L4W 4W8Attn Susan Tobin Chief Administrative OfficerTel (800) 284-7311 Tel (905) 238-6090 Fax (905) 238-7090E-mail infodenturistassociationcaWebsite wwwdenturistassociationca

LrsquoAssociation des denturologistes du Queacutebec8150 boul Meacutetropolitain Est Bureau 230Anjou QC HIK 1A1Atten Kristiane Coulombe Responsable Service aux membresTel (514) 252-0270 Fax (514) 252-0392E-mail denturoadq-qccom Website wwwadq-qccom

the new Brunswick denturists Society La Socieacuteteacute des denturologistes du n-B288 West Boulevard St PierrePO Box 5566 Caraquet NB E1W 1B7Attn Claudette Boudreau Exec SecTel (506) 727-7411 Fax (506) 727-6728E-mail claudetteboudreaunbaibncom

denturist Society of nova Scotia3951 South River RoadAntigonish NS B2G 2H6Tel (902) 863-3131Attn Diane Carrigan - Weir Presidentdiane-weirdhotmailcom

denturist Association of newfoundland Labrador323 Freshwater RoadSt Johnrsquos NL A1C 2W5Attn Steve Browne DD PresidentTel (709) 722-7900E-mailbrowne_steveyahooca

denturist Society of Prince Edward island191 Pope Road Unit ASummerside PE C1N 5C6Tel (902) 436-3235Attn Lisa MacKintosh Presidentssidedentcliniceastlinkca

Yukon denturist Association1-106 Main StreetWhitehorse YT Y1A 2A7Attn Peter Allen DD PresidentTel (867) 668-6818 Fax (867) 668-6811E-mail pjallennorthwestelnet

Honorary MembersAustin J Carbone BSc BEd DDThe Honourable Mr Justice Robert M Hall

Denturist AssociAtion of cAnADALrsquoAssociAtion Des DenturoLogistes Du cAnADA

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contentsFor display advertising contact Craig Kelman amp Associates Ltd For subscriptions or classified advertising contact the Denturist Association of Canada National Office

The challenge of this publication is to provide an overview of denturism nationally and internationally and a forum for thought and discussion Any person who has opinions stories photographs drawings ideas research or other information to support this goal is requested to contact the Editor to have the material considered for publication Statements of opinion and supposed fact published herein do not necessarily express the views of the Publisher its Officers Directors or members of the Editorial Board and do not imply endorsement of any product or service The Editorial Board reserves the right to edit all copy submitted for publication

copy2012 Craig Kelman amp Associates Ltd All rights reserved The contents of this publication may not be reproduced by any means in whole or in part without prior written consent from the publisher

ISSN 1480-2023

Editor-in-Chief Hussein Amery MSc PsyD DD FCAD 112 2675 - 36 Street NE Calgary Alberta T1Y 6H6Phone 403-291-2272e-mail ameryhktelusnet

National Liaison Mallory Potter66 Dundas Street EastBelleville ON K8N 1C1Tel 613-968-9467Fax 613-968-9235Toll Free 1-877-538-3123Email dacdenturistbellnetcawwwdenturistorg

Published by

Printed on paper certified by the Forest Stewardship Councilreg (FSCreg)

This magazine is printed with vegetable oil-based inks Please do your part for the

environment by reusing and recycling

spRing pRintemps 2012

FeaturesAsk Dr Lemay 18

In this feature Dr Bruno Lemay addresses the most frequently asked questions about the new mini-implant technique

Narrow band (light) imaging of oral mucosa in routine dental patients 23

Part I Assessment of value in detection of mucosal changes The purpose of this investigation was to determine the value of adding narrow band (light) imaging (NBI) to the standard oral soft tissue examination process used to detect mucosal change

Technorama 2012 33A preview of Technorama April 20-21 2012 at the Hilton Suites TorontoMarkham

23

18DepartmentsPresidentrsquos Message 8

Le mot du preacutesident 10

Editorrsquos Message 12

Insurance 15

Practice Management 16

Un-comfort Zone 39

Industry News 43

Classifieds48

Reach Our Advertisers 50

3rd Floor 2020 Portage Avenue Winnipeg MB R3J 0K4 Tel (204) 985-9780 Fax (204) 985-9795 e-mail cherylkelmancawwwkelmanca

Managing Editor Cheryl Parisien DesignLayout Vadim BrodskyMarketing Manager Chad MorrisonAdvertising Coordinator Lauren Campbell

Send change of address todacdenturistbellnetca

Return undeliverable Canadian addresses toe-mail kellykelmancaPublication Mail Agreement 40065075

337spring printemps 2012

Click here to return to the Table of Contents

michael C Vout DD

Winds of change

As I write this message Irsquod like to wish all our readers a very happy and

prosperous New YearFor us in Ontario this has been a

very mild and comfortable winter one we havenrsquot seen in years Maybe global warming is in fact creating an effect that we in North America are beginning to realize

The winds of change are upon us ndash from the weather to the DAC move to Ontario DACnetrsquos move to LrsquoAssociation des Denturologistes du Quebec to the recognition of denturism in another European country and to changes at the College of Denturists of Ontario

Our move to Ontario has been at times quite challenging but also rewarding in that we have been able to review our operational procedures to streamline our business This has made us more efficient in communicating with our members related companies and institutions

We will be reviewing all of our archived material and records we have some 45 boxes for which we have compiled a list of contents for future reference Materials which are no longer relevant and not part of DAC history will be purged from the system

The Curriculum Advisory Committee has put many hours of hard work and devotion into the Accreditation Documents These documents were in November printed bound and distributed to the schools provincial associations and regulatory bodies throughout Canada

We have had a very positive response to our Accreditation Documents with George Brown College and Northern Alberta Insti-tute of Technology having said that they will be proceeding with the new accreditation process and site visits this year

George Brown College indicated that the Dental Sciences Programs will

be moving to the new campus in 2012 This new state-of-the-art facility will have a 90-chair clinic with fully digitized radiography and two surgical implant suites as well as all-new laboratories We congratulate and commend George Brown College on their expansion and commitment to the profession

Jamshid Zehtab-Jadid the chair of the Curriculum Advisory Committee (CAC) welcomes the opportunity to move forward with our educational institutions in the accreditation process

The CAC consists of the following members Jamshid Zehtab-Jadid Chair (Manitoba) Nathan Hoffer Vice-Chair (Saskatchewan) Daniel Robichaud (New Brunswick) Benoit Talbot (Quebec) Jason Kasper (British Columbia) and Bill Lloy (Nova Scotia)

We anticipate a very busy year for the CAC with the pending site visits

As Canadarsquos representative to the International Federation of Denturists (IFD) I am pleased to report that the IFD representative from Switzerland Urban Christen-Mendez has let us know that denturism in Switzerland is now recognized in certain cantons or regions

We have extended our congratulations to Urban and his fellow denturists in Swit-zerland for his continued efforts to promote and develop denturism in his country

As denturism continues to cross borders so does the opportunity for all other countries in the European Union looking to implement the profession With recognition in various countries the EU must under its mandate of freedom of movement look toward permitting denturism as a legal profession This may take some time but the winds of change are in motion

Denturists from around the world are working together to be the primary provider of quality prosthodontic services for our patients Be it on the local national and international level we will continue to convince governments that denturism is a viable and required profession within the healthcare system

The gentle winds of change are having an effect of the operational functionality of the College of Denturists of Ontario (CDO) The staff of the CDO advised its members on February 2 2012 that effective immediately Mr Salim Kaderali is no longer the registrar of the CDO They indicated that an engagement process is currently under way for the purpose of securing an acting registrar The council will begin a recruitment process for a permanent registrar using a best practices approach within the next three months

DAC continues to work with the Denturist Association of Ontario in any way we can to contribute to a harmonized and unified voice to the public and government As such we must continue to share ideas and knowledge from forward-thinking individuals of this profession The winds of change will propel us to look forward and work for the betterment longevity and enhancement of denturism

As we move into 2012 I see this year as one of mutual participation and breakthroughs Denturism is like a new emerging market we have the people and expertise to create new solutions for new opportunities We must continue to focus on the fundamental pursuit of the continued advancement of our profession

Yours in DenturismMichael C Vout DD

pResiDentrsquos message

8 spring printemps 2012

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Le mOt Du pReacutesiDentmichael C Vout DD

laquo La denturologie deacutepasse les frontiegraveres et cela ouvre de nouvelles possibiliteacutes pour tous les pays de lrsquoUnion europeacuteenne qui cherchent agrave instaurer cette profession raquo

Jrsquoaimerais profiter de cette occasion pour souhaiter agrave tous nos lecteurs

une heureuse et fructueuse anneacuteeIci en Ontario lrsquohiver a eacuteteacute tregraves doux

et agreacuteable un hiver comme nous nrsquoen avions pas eu depuis des anneacutees Peut-ecirctre que les effets du reacutechauffement climatique mondial se font effectivement sentir en Ameacuterique du Nord et que nous commenccedilons agrave lrsquoobserver

Un vent de changement srsquoapprecircte agrave souffler sur nos activiteacutes ndash je fais reacutefeacuterence non seulement au climat mais aussi au deacutemeacutenagement de lrsquoADC au transfert du reacuteseau DACnet agrave lrsquoAssociation des denturologistes du Queacutebec agrave la reconnaissance de la denturologie dans un autre pays europeacuteen ainsi qursquoaux changements qui surviennent au College of Denturists of Ontario

Notre deacutemeacutenagement en Ontario nous a parfois causeacute quelques soucis mais la deacutemarche srsquoest aveacutereacutee des plus enrichissantes car elle nous a permis de revoir nos processus internes et de rationnaliser nos activiteacutes Il en ressort que les communications avec nos membres nos entreprises partenaires et autres organismes sont plus efficaces

Nous allons trier toutes nos archives la documentation comme les dossiers Nous avons environ 45 boicirctes dont le contenu a eacuteteacute recenseacute agrave des fins de reacutefeacuterence Tout ce qui nrsquoest plus utile ou nrsquoa pas trait agrave lrsquohistoire de lrsquoADC sera eacutelimineacute du systegraveme

Les membres du Comiteacute consultatif des programmes drsquoeacutetudes ont vaillam-ment consacreacute de nombreuses heures aux documents relatifs agrave lrsquoagreacutement En novembre ces documents ont eacuteteacute impri-meacutes relieacutes et diffuseacutes aupregraves drsquoeacutecoles

un vent de changement

drsquoassociations provinciales et drsquoorganis-mes de reacuteglementation un peu partout au Canada

Nous avons reccedilu des commentaires tregraves positifs au sujet de nos documents drsquoagreacutement Notamment le George Brown College et le Northern Alberta Institute of Technology ont indiqueacute qursquoils mettront en œuvre le nouveau processus drsquoagreacutement ainsi que les visites degraves cette anneacutee

Le George Brown College a en outre annonceacute que les programmes de sciences dentaires seront transfeacutereacutes au nouveau campus en 2012 Dans les nouvelles installations agrave la fine pointe de la technologie on trouvera une clinique de 90 chaises doteacutee drsquoun systegraveme de radiographie entiegraverement numeacuteriseacute et de deux salles drsquoopeacuteration pour les implants ainsi que des laboratoires tout neufs Feacutelicitations au George Brown College pour sa croissance et son engagement agrave lrsquoeacutegard de la profession

Jamshid Zehtab-Jadid preacutesident du Comiteacute consultatif des programmes drsquoeacutetudes (CCPE) se reacutejouit drsquoaller de lrsquoavant avec les eacutetablissements drsquoenseignement pour ce qui est du processus drsquoagreacutement

Le CCPE est composeacute des membres suivants Jamshid Zehtab-Jadid preacutesident (Manitoba) Nathan Hoffer vice-preacutesident (Saskatchewan) Daniel Robichaud (Nouveau-Brunswick) Benoicirct Talbot (Queacutebec) Jason Kasper (Colombie-Britannique) et Bill Lloy (Nouvelle-Eacutecosse)

Lrsquoanneacutee qui commence srsquoannonce fort occupeacutee pour le CCPE eacutetant donneacute les visites planifieacutees

Agrave titre de repreacutesentant du Canada agrave lrsquoInternational Federation of Denturists (IFD) jrsquoai le plaisir de relayer lrsquoannonce que nous a communiqueacutee Urban Christen-Mendez repreacutesentant de la Suisse aupregraves de lrsquoIFD agrave savoir que la denturologie est deacutesormais reconnue dans certains cantons

Nous transmettons nos feacutelicitations agrave Urban et agrave ses collegravegues denturologistes suisses pour leurs inlassables efforts en vue de promouvoir la denturologie dans ce pays

La denturologie deacutepasse les frontiegraveres et cela ouvre de nouvelles possibiliteacutes pour tous les pays de lrsquoUnion europeacuteenne qui cherchent agrave instaurer cette profession Puisque cette derniegravere est reconnue dans divers pays LrsquoUE doit en vertu de son mandat de liberteacute de circulation



Le mOt Du pReacutesiDent

envisager de permettre lrsquoexercice de la denturologie agrave titre de profession juridiquement reconnue Il faudra peut-ecirctre du temps mais le vent du changement a commenceacute agrave faire bouger les choses

Les denturologistes partout dans le monde travaillent de concert pour ecirctre les principaux fournisseurs de services de prosthodontie de qualiteacute aux patients Tant agrave lrsquoeacutechelle locale que nationale et internationale nous continuerons de deacutemontrer aux gouvernements de faccedilon convaincante que la denturologie est une profession viable et neacutecessaire dans le systegraveme de soins de santeacute

Le vent du changement agit aussi sur les activiteacutes du College of Denturists of Ontario (CDO) En effet le 2 feacutevrier 2012 le personnel du CDO a aviseacute les membres

que M Salim Kaderali nrsquoest plus registraire de lrsquoorganisme changement qui entrait en vigueur le jour mecircme Il eacutetait preacuteciseacute qursquoun processus drsquoembauche est en cours afin de trouver un registraire par inteacuterim Le conseil enclenchera un processus fondeacute sur des pratiques exemplaires en vue de recruter un registraire permanent dans les trois prochains mois

LrsquoADC continue de collaborer avec la Denturist Association of Ontario dans tous les dossiers pertinents afin de parler drsquoune mecircme voix harmoniseacutee et unifieacutee aupregraves des instances gouvernementales et du grand public Dans cette optique nous devons continuer de mettre en commun des ideacutees et le savoir de gens avant-

gardistes Le vent du changement nous poussera agrave nous tourner vers lrsquoavenir ainsi qursquoagrave travailler agrave lrsquoameacutelioration agrave la peacuterenniteacute et agrave lrsquoenrichissement de la denturologie

Jrsquoentrevois lrsquoanneacutee 2012 sous le signe de la participation mutuelle et de perceacutees importantes Notre situation srsquoapparente agrave celle drsquoun marcheacute eacutemergent nous avons les ressources humaines et lrsquoexpertise pour apporter de nouvelles solutions agrave des nouveaux deacutefis Nous devons continuer de centrer nos efforts sur la poursuite fondamentale de lrsquoavancement de notre profession

Chaleureuses salutationsMichael C Vout DD

denturist

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eDitORrsquos messageHussein amery msc psy D DD FCaD

Our worst enemies are our bad habits For some of us that includes improper

diet and exercise smoking poor time management and even drinking too much

The same is true in business ndash balance is the key to success During the last sev-eral years I have had the pleasure of meet-ing many denturists from not only across the country but from around the globe and they vary in their lifestyles as they do in their stories about their successes and challenges in the profession

The most successful amongst us are the ones on a mission to transform or maintain their physical personal and business health and are continually trying to realize their full potential

So what are they doing Well most are working out eating well and actually taking the required time to preserve their health first (physical and professional)

Recently I have been approached by new graduates or newly licensed denturists who are seeking business advice from industry gurus and other professionals of potential pitfalls in opening or purchasing a clinic So the easiest thing to do for new grads is to not start with the bad habits and for those experienced individuals replace the bad ones with good ones

A guerilla marketer once told an audience that the business equivalent of smoking was eating your seed money too quickly He quoted the proverb of building your barn before your house as in donrsquot take the profits out too early Just when you think your business is ready to take off you realize you need another major injection of cash and instead you decided to take that Hawaiian vacation Most people who double down on their business investment just as profits are

friends are and surround yourself with the smartest people Emulate and find the details of how they live Is there anything they donrsquot do that you consistently do For instance perhaps it can be as simple as how they are never late for appointments whereas you are perpetually late Thatrsquos a bad habit you should stop immediately

Reaching your goals requires developing new habits and staying focused no matter what stage of your career you are in Make no exceptions and once you decide to break a bad habit stick with it

Letrsquos take working with patients as an examplebull If you donrsquot have enough patients

thatrsquos because yoursquove developed the habit of NOT doing enough to generate the volume you need

bull If your patients pay you late thatrsquos because yoursquove developed the habit of accepting that kind of treatment

bull If you are working with patients who do not appreciate your work or skill sets thatrsquos because yoursquove developed the habit of BEING OK with patients like that

Your habits create your world and there is nothing hard or boring about reaching your full potential in every area of life Start today make that a top priority identify them replace the bad habits with good ones and you will be well on your way to making significant improvements in your personal and professional life

tough opponents

starting to roll in continue to experience exponential growth long after the initial influx Whereas those who chose to be somewhat lavish too quickly may experience a much longer success curve or worse That is a very bad habit that you do not want to get into

Drinking too much was equivalent to taking uncalculated risks Always make decisions based upon facts and research and in a clear non-emotional mental state And a poor diet was likened to not getting continued education and professional and personal renewal There is a lot of so-called ldquoinformational fast foodrdquo out there and that has to be separated from the ldquohealthy greensrdquo Some of the best strategies are to find one or two mentors who offer clear well-laid-out approaches and try and learn as much from them until you are sure that the matrix is right for you and your situation This may seem like a difficult habit to break but really requires focus and a small amount of discipline

Poor time management is likened to wastefulness and indecisiveness When breaking this bad habit the beginning is the toughest It does require an enormous amount of energy and self-restraint and then the willpower to continue becomes easier

Lastly the equivalent of poor or lack of exercise was likened to hanging out with the wrong crowd This group includes pessimists losers detractors and whiners Consider who your business

ldquoReaching your goals requires developing new habits and staying focused no matter

what stage of your career you are inrdquo



On March 9 2011 the Minister of Health and Long-Term Care in Ontario (the

ldquoMinisterrdquo) announced an operational review and audit of the activities of the College of Denturists of Ontario (the ldquoCDOrdquo) The Minister stated that in light of the volume and nature of concerns from different organizations and individuals regarding the operation of the College and the Council ldquoconfidence in the Council and the College to serve and protect public interest while regulating the profession of denturism has been shakenrdquo

As part of the March 9 announcement the Minister also placed ldquorequirementsrdquo on the CDO Council Among other things the Council was to refrain from making any new by-laws related to a mandatory professional liability insurance program that the CDO was seeking to impose on its members Council was also to suspend all efforts at implementing the professional liability insurance program until such time as Council satisfied the Minister that the concerns of the College members and stakeholders had been fully and satisfactorily addressed

The Ministry appointed PricewaterhouseCoopers (PwC) in May 2011 to conduct the operational review and audit and a report was prepared (the ldquoAudit Reportrdquo)

On December 8 2011 the Minister sent a copy of the PwC Audit Report to the CDO Council and advised that she intended to recommend to the Lieutenant Governor in Council that a College supervisor be appointed

The Minister described the Audit Report as identifying serious concerns and deficiencies

ldquoThe report identifies a number of significant deficiencies in the Collegersquos

practices and procedures It raises serious concerns about the quality of the administration and management of the College its ability to administer the legislative scheme and perform the functions and powers imposed on the College its Council and committees under the Regulated Health Professions Act 1991 (ldquoRHPArdquo) and the Denturism Act 1991rdquo

In her letter the Minister also noted the failure of Council to comply with requirements that had been placed on the Council

ldquoOn March 11 2011 Council approved an amendment to by-law 3715 relating to professional liability insurance Further the College proceeded to undertake activities to attempt to implement the new professional liability insurance program In my view this conduct constitutes a failure of the Council to comply with the Requirement Documentrdquo

As part of the December 8 communication CDO Council was given 45 days to make written submissions after which the Minister would make her decision whether to recommend the appointment of a College supervisor The CDO provided written submissions in January 2012

Despite requests for disclosure the CDO Council has refused to release copies of either the Audit Report or its written submissions

On December 15 2011 the College published a brief response to the Ministerrsquos letter and the Audit Report suggesting that there are inaccuracies in the PwC report However no specifics were mentioned

In the Collegersquos response of December 15 the CDO President also stated that

ldquoFinally your Council calls on all current and former staff Registrars Council members registrants member associations and stakeholders to work cooperatively to answer and meet the challenge that the Minister has given to this profession ndash that is to put aside differences and work together to implement policies and procedures necessary to put this profession and college at the highest standards expected by the public Registrants and the Ministryrdquo

The DAO has expressed to Council that it has lost confidence in the Registrar and Executive of the CDO The DAO has advised the Council that while it remains willing to work collaboratively with leadership that conducts itself with transparency honesty and accountability without access to the Audit Report the Association cannot provide meaningful feedback or assistance The Association has explained that it will not accept blindly the interpretation of the Audit Report given by Council

The CDO now awaits the decision of the Minister If she decides to appoint a supervisor under the RHPA the supervisor could be granted the exclusive right to exercise all powers of Council

The CDO Council announced on February 2 2012 that effective immediately Mr Salim Kaderali is no longer the registrar for the CDO No further details regarding that development have been released

The Minister has made it clear on several occasions that her concerns pertain only to the CDO Council and she has repeatedly said that her actions should not be seen as impugning the profession

The DenTurisT assOciaTiOn Of OnTariO challenges iTs regulaTOry cOllege


Often imitated Never duplicated

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Joe pignatelli RHu insuRanCe

Life insurance is the foundation of a good financial plan As you build on

that foundation by building your assets and net worth you may need to reassess your level of coverage Here is why love for others is at the root of life insurance planning

You have family responsibilities Adequate coverage allows a surviving spouse andor surviving family to maintain their current lifestyle

You support a stay-at-home parent caring for your children If one parentrsquos income is currently relied on to provide all living expenses the death of that individual may cause financial insecurity for all family members especially where there will be a stay-at-home parent caring for the children

Life insurance protects the children The coverage needed will be affected bybull The number of children and their agesbull Educational expenses of the childrenbull The current value of your assetsbull Your current incomebull Debt accumulationbull Your future employment goals versus

stay-at-home parentingbull Your overall financial goalsYou can place young children as secondary or contingent beneficiaries thus allowing them to receive the death benefit if your spouse or the primary beneficiary predeceases them A trust can manage funds on behalf of the children It can direct investing the proceeds of the death benefit to create necessary guardian income

Continue coverage throughout college or university When children go to college many of us tap into our savings to help meet their tuition and housing expenses We may purchase a childrsquos first car or pay himher an income for one or more years If you die without providing

continuing support your adult child may need to quit seeking a higher education due to shortage of funds

Protect your income in case of disability Have you thought about how becoming ill or injured could affect your

childrenrsquos financial security Would your income be reduced placing them under duress Disability insurance is designed to replace approximately 70 per cent of your pre-disability income and is especially necessary for the self-employed

Why is life insurance coverage motivated by love



pRaCtiCe managementJanice Wheeler President The Art of Management Inc

Per a recent poll on the Internet asking What is the single biggest factor

limiting practice success The choices were (1) clinical skills (2) location or (3) practice management Answer 8 clinical 25 location 50 practice management and 13 other factors

The three aspects could be likened to a three-legged stool where if you take away any one of the legs the stool collapses In other words all are important issues to growth and success

With respect to clinical skills most healthcare professionals including dentur-ists have continuing education require-ments on an ongoing basis and there are many courses and options available for continual upgrading of clinical skills

Location is an entirely different matter Your main concerns should be visibility ndash ie is the practice easily seen and found how is the accessibility (parking and no stairs) and so on Another issue is the appearance external as well as internal many practices are overdue for facelifts and this is a promotional action in itself

We know wersquore biased buthellip However it is clear from the above poll that practice owners feel that the practice management leg is the most important one and we couldnrsquot agree more Yet it is also a well-known fact that this is the arena where you have little to no training

For instance few practitioners know what to do when they have a practice that is rocketing upwards and how to isolate strengthen and reinforce the correct growth factors to maintain a consistent growth pattern Likewise few practitioners know what to do when the practice stats all of a sudden take a nosedive or even a slow coast downwards

We find it amazing how many practitio-ners manage their practices with no idea of statistics whether they are going up or down on a weekly or monthly basis and further how profitable the practice actually is on a monthly basis

How to achieve successHere is the big question What exactly does ldquosuccessful practice managementrdquo encompass Below is a partial compilation of management issues we have found to be key areas to improve upon in order to achieve practice successbull A visible attractive location with enough

space to expand intobull A hiring system for acquiring ideal staffbull An updated practice policy manual and

job descriptionsbull A system for training staff efficiently and

effectivelybull Practice service points identified and

enhancedbull Financial management including

budgeting inventory control and monitoring thereof

bull Managing by statistics for maximum speed of growth

bull Treatment presentation skills well trained in on staff and denturist for ideal care to the patient

bull An established fee guide and discount policies

bull Computerization to streamline procedures and protocols

bull Sterilization standards as required by local authorities

bull Making the patientrsquos visits as enjoyable and informative as possible

bull A formalized organized and implemented external marketing plan that attracts into the practice an abundance of new patients

bull Properly scheduled appointment times etc that maximize efficiency and minimize stress

bull A well systematized lab which regularly provides well constructed dentures in a timely fashion

bull Continuing education for the denturist AND all staff

bull Quality control procedures handling com-plaints and correcting dentures and staff

bull Develop and implement an effective recall system

bull Set up cross-referral system with dentistsbull Create enthusiastic patients who refer all

their friends

think small stay small ndash think big grow bigWhile this is by no means a complete list working on getting at least the above would cause your practice to be a LOT more successful Growing your practice DOES NOT mean more trouble more stress out of control or any other bad word With properly trained management skills it is way more fun than sitting and wishing Thinking small and staying small can be painful and non-remunerative and can lull you into apathy and close your mind to the bigger world THINK BIG instead

We have been nonstop training and consulting healthcare professionals (includ-ing 150 denturists) over the last 23 years on the above issues and would be delighted to be of service to you as well

practice success

Janice Wheeler is the president and co-owner

of the The Art of Management Inc a practice

management company dedicated to helping

denturists and other healthcare practitioners

reach their full potential For more information

call 416-466-6217 or 800-563-3994

e-mail infoamicancom wwwamicancom


Two registration sets from Candulor for practical simple and time-saving procedures in intraoral registration

CRS Set 10 Set for intraoral registration to determine the vertical and centric relation for full dentures

CRS Set 15 Set for intraoral registra tion to determine the vertical and centric relation for dentulous or partially dentu-lous jaws Also for reocclusion of full dentures

Candulor Registration SetSimplify the intraoral registration

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this feature Dr Bruno Lemay addresses the most frequently asked questions

about the new mini-implant technique If you would like to submit a question to Dr Lemay please send an e-mail to infogetminica

For more on this topic to receive information about advanced training opportunities offered across Canada or to view clinical videos visit wwwgetminica

Question 1 What should we tell a patient who is inquiring about the long term prognosis of mini-implants

Your answer should be based on your personal experience My experience shows good and totally stable results for full or partial denture stabilization cases lasting over 11 years in most of my cases (95) Because I started in 2001 I do not have longer results but some cases are documented over 14 years with other dentists With single or multiple fixed restoration cases I have experience only for eight years However failure will most often occur during the first year following insertion After the first year very stable results are observed and by extrapolating we could easily expect mini-implants will last longer then that Once implants are completely osteointegrated and if the denture is fabricated in

compliance with the basic rules to avoid wear of the balls and atypical forces there is no reason why implants would suddenly disintegrate especially after years of good integration but it is always possible if the health status or hygiene changes drastically If I would see a 5 mm loss per year we could not expect that long but it is not the case so I am confident that the 11-year cases will go on for a long time But so far these are the longest-term results I can prove

Of course the answer will vary depending on the implant insertion technique used the quality of the implant as well as the quality of the fabricated denture

So for now the long-term prognosis is 11 years for removable applications and eight years for fixed cases with totally stable results for over 95 success based on my own results

Dr Lemay

in

Bruno Lemay DmD Cmi instituteAsk



you do when the mesiodistal space for a 25 is limited to 35 mm Wouldnrsquot it be advantageous in those cases to offer an alternative treatment and retain the patient

Question 4 If I were to offer mini-implants wouldnrsquot I start losing money

Once again the answer is simple You

Question 2 Why integrate the mini-implant technique in onersquos practice

The main reason is money-based If we lived in a world where all treatments were free there would be few reasons to use the mini-implant technique However this is not the case For example you can offer the use of mini-implants in lieu of six standard implants to stabilize a lower denture for one-quarter of the total cost As most of our patients are older people whose income is often limited it is advan-tageous to be able to offer alternative solutions that have proven themselves in the long run Generally what most dentists and denturists are telling me during my classes are that only 10 of their patients can afford denture stabiliza-tion treatment with four to six standard implants with or without a retention bar This means that close to 90 of their patients cannot afford standard treat-ments ndash which is a huge number There are also other important reasons such as immediate stabilization no waiting period the procedure can sometimes be performed without surgery and you can use mini-implants in areas where available bone is limited

Question 3 I have been inserting standard implants for more than 15 years Why would mini-implants be of interest

The answer is very simple Do you succeed in selling 100 of your treatment plans Is there always sufficient bone to insert standard implants whether the insertion is buccolingual or mesiodistal What do

need to understand that mini-implants do not replace standard implants They are merely an alternative technique If your patient cannot afford a denture stabilization treatment with standard implants and is about to walk away or go elsewhere wouldnrsquot it be better to retain him and earn $3500 for one hour of treatment Furthermore the treatment

Figure 1

The Canadian Institute of Mini-Implants is solely dedicated to the Mini dental implant technique and offers more then 18 hours of different courses starting with an incomparable basic training with a hands-on session up to the total mastering of the most complicated cases

Dr Lemay has perfected his technique with mini-implants since 2001 and can now achieve long term success with this revolutionary technique His courses will help you in your own practice If some of your patients suffer with their dentures but cannot afford standard implants the alternative of small diameter implants can be

the best solution for them Come see for yourself what this is all about You will learn and benefit from his day to day experience and learn the real tricks what you can expect how to make your life easier and enjoy the technique and reach a long-term success

Location for training

Course 1Basic training + hands-on + problem solving

Course 2Advanced training alternative options for mini-implants

in Englishin French

830 am to 6 pm

830 am to 6 pm

Montreal Friday March 30Friday July 6

Saturday March 31Saturday July 7

Quebec Friday May 11 Saturday May 12

Toronto Friday March 2Friday June 15

Saturday March 3Saturday June 16

Calgary Friday March 16 Saturday March 17

Vancouver Friday April 27Friday June 29

Saturday April 28 Saturday June 30

$90 for 18 education credits and free patient education book (value $69)

For more details

wwwgetminica1-877-350-6464 or refer tohellip



part I have persevered and I have tried to understand and modify the technique until I achieved acceptable results For example I was taught at the beginning that this technique is always non-surgical However experience has proven different Though many cases can be achieved without surgery in some instances a flap must be opened and the underlying bone exposed or else failure is guaranteed As with all techniques the first years of trial will always be fraught with failures For example there were a lot more failures with standard implants 30 years ago than there are today The quality of the implants we use today has greatly improved compared to those used 10 years ago That also contributes to achieving greater results

Question 6 Are all mini-implants identical

Absolutely not There are five or six dif-ferent types on the market offering vari-ous stabilization attachments (O-ball with O-ring or zest-type attachments) Sizes also vary with manufacturers offering implants in diameters of 18 20 21 22 24 25 29 and 30 mm Surfaces vary from one manufacturer to another from

sandblast to the Intra-Lock Ossean (a calcium-phosphate bioactive coating that allows for quicker osteointegration) The thread configuration can also vary from one manufacturer to another The most important thing to remember is that smaller diameter implants must have narrow threading to allow anchoring in dense bone and larger diameter implants must have larger and more aggressive thread-ing to be inserted in less dense bone You should always stock at least three different diameters (2 25 and 30 mm) to answer all clinical situations Finally you should use a system that adapts to both removable fixation and permanently affixed fixations as in some instances the patient wearing a removable restoration may request after a few years to have a fixed restoration

Question 7 Can the bio-active surface have a true impact on the long-term success of mini-implants

First you must understand what the term ldquobio-active surfacerdquo means Even the earlier acid-etch implants were bio-active in the sense that osteoblast gene expression can be changed in direct proportion to the surface roughness The

might only cost $3500 but it does not mean that you will be earning less than if you were to charge $12000 You must include in your calculation the costs of material the time spent in chair for the procedure and the number of post-op follow-ups You may also start thinking about the number of $3500-per-hour cases you can garner in the pool of the 90 of patients who cannot afford standard implants as well as the profitability afforded by the ease and quickness of the treatment

Question 5 I have witnessed many mini-implant failures in my career Can you explain how you have achieved a long-term success rate of 95

It took me 10 years of practice including failures and trying out different techniques to finally develop my own specific technique for restoration with mini-implants Many dentists have tried the technique and stopped using it after their first unsuccessful case For my

Figure 2 After 11 years in the mouth

ldquoThe quality of the implants we use today has greatly improved compared to those

used 10 years agordquo

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Your premier choice for artificial teeth



most recent calcium-phosphate surface however works on two levels One is nano-roughness alone that facilitates thrombin adhesion and platelet aggregation leading to earlier growth factor release Second is the action of free cytosolic calcium that upregulates osteoblast metabolism at a rate that far exceeds acid etch implants This is what is responsible for the dramatic increase in early bone bonding This is vital for early and immediate load cases as mini-implant cases are not for just better initial stability but also to retain crestal bone volume and height

Question 8 Can mini-implants be used for single tooth fixed restoration cases

Mini-implants for fixed restoration have only been used for seven to eight years However the long-term results are already exceptional For my part I have achieved in the last seven years a more than 95 success rate in single or multiple cases alike Furthermore with the recent introduction of 30 mm mini-implants I am anticipating that there will be more mini-implant fixed restorations especially if space is limited or if the patient cannot afford standard implant treatment

Figures 4 and 5 Upper lateral on a 25 mm implant after seven years

Figure 3 Impregnation of calcium phosphate on surface of Intra-lock implant to activate osteoblast activity and osteointegration

wwwoxydentalcomcarolynJ

to learn more about the benefits for you and your practice pleaseContact me via email

dentalhealthrogerscom or call 705-327-7935 1-800-364-1649

to leave a messagei will also be glad to send you a free product

sample and next steps for your practice

Help your patientsproteCt tHeir inVestment amp Your WorK

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ldquoThankstoOxyfreshourpatientsrequire feweradjustmentstheirdenturesfitmuch bettertheyhavenooralmalodorandthe numberofnewpatientreferralswegetfromhappypatientshasincreasedsignificantlyrdquoEllen and Dave Thomas DD Red Deer AB

ldquoThe Oxyfreshcolleaguereferralprogramallowedmetoreplacemy6-figurepracticeincome in18monthsofpart-timeeffortsothatIwas abletoretirefrommypracticeOxyfresh has paidmeasix-figureincomeeveryyearforthepast13yearsasaresultofmyinitialeffortsrdquo

Joseph S Rubino DMD Boxford Massachusetts


VELscope VxIncludes 16 VELcaps amp 16 VELsheaths

(791-0012)

Disposable Starter KitTwo 128-count boxes of VELcaps amp one 250-count box of VELsheaths

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Illumination with VELscope Vxreveals area of cancer

Illumination with VELscope VxTissue under normal light

bull 620 PATIENTS SCREENEDbull 28 LESIONS UNDISCOVERED WITH THE NAKED EYEbull 5 DYSPLASIASVELSCOPE DIDNrsquoT MISS ANY

Edmond L Truelove et al General Dentistry JulyAugust 2011 281-289

Life-Saving Power in the Palm of Your HandA recent study of routine patients by the University of Washington highlighted the potential benefits of complementing the standard oral-soft-tissue examination with a fluorescence visualization device The cordless fluorescence-based VELscope Vx is an easy-to-use and affordable screening tool that involves no messy dyes Add a VELscope Vx and know that yoursquore doing everything in your power to help detect oral cancer and other oral disease

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The purpose of this investigation was to determine the value of adding narrow band (light) imaging (NBI) to the standard oral soft tissue examination process used to detect mucosal change A total of 620 dental patients who came to the clinic for regular dental evaluation or for treatment of acute dental problems were given a standard oral soft tissue examination by dental students under faculty supervision The results of the white light examination were recorded after the tissues were examined with NBI at which point areas with a loss of fluorescence (LOF) were recorded The nature of the tissue change was classified clinically as normal variation inflammatory traumatic dysplastic or other and patients were categorized depending on their clinical findings normal need follow-up visit or immediate biopsy Risk factors related to oral dysplasia also

were recorded The addition of NBI added between one and two minutes to the examination process

Of the 620 examinations an area with an LOF suggestive of pathology was detected in 69 subjects (111) After a second immedi-ate evaluation 28 of the 69 subjects were scheduled for follow-up or biopsy None of the lesions discovered in these 28 subjects had been detected using standard (white light) examination

Adding NBI to the routine clinical exami-nation resulted in detection of changes not seen with white light examination in 111 of patients of these a small but important number were found to have otherwise undetected persistent changes representing inflammatory lesions or potentially dangerous oral dysplasia Adding NBI as an adjunctive diagnostic procedure improved the quality and outcome of the examination process

An important component of dental practice is the detection of changes to the oral mucosa and jaws that represent serious threats to health Among these threats the risk of oral cancer is a chief concern Although the overall risk for cancer of the mouth and throat is relatively small data from the American Cancer Society and National Cancer Institute predict that the lifetime risk of oral cancer is 1 in every 152 females and 1 in every 71 males1 The lifetime risk for developing oral cancer is greater than the lifetime risk for cancers of the brain esophagus and lymphomas conditions that receive frequent public scrutiny as important risks for reduction in life expectancy1 Oral cancer also is a significant problem because survival rates have improved only marginally during the past 50 years with the five-year survival rate still only 53 (1)

Edmond L Truelove DDS MSD David Dean DDS Samuel Maltby Matthew Griffith Kimberly Huggins RDH Mickealla Griffith DDS Stuart Taylor DDS MSD

of oral mucosa in routine dental patients

Part I Assessment of value in detection of mucosal changes

Narrow band (light) imaging



Important risk factors for oral cancer include age ethnic status tobacco use excess alcohol consumption family history of cancer and prior cancers (2) The pres-ence of some types of mucosal change including leukoplakia erythroplakia pro-liferative verrucous leukoplakia and lichen planus also has been associated with an increased risk (3-6) Poor oral hygiene and lack of regular dental care are among suggestions as potential risk factors either because of local inflammatory irritation or because patients with poor access to care do not benefit from earlier detection of mucosal changes (7)

Chronic mucosal infections including candidiasis herpes simplex and human papilloma virus also have been postulated as causing an increased risk for oral cancer (8-10)

A factor that could be associated with poor prognosis is a delay in the detection and treatment of early oral cancers how-ever data to support that hypothesis are not extensive (111-13) Still if oral cancer behaves like most other cancers it is logical to assume that very early detection and treatment is likely to result in better survival than delayed detection which usually is associated with wider spread metastatic nodes and regional spread to other organs Some data exist that identify rates of pro-gression from benign and premalignant to malignant for several types of oral lesions but little actual data have been collected to demonstrate the value of routine oral examination of patients on reducing the risk of cancer and cancer morbidity (11112) Some authors have suggested that there is little significant information to support the use of routine oral examination as a valuable tool to reduce morbidity or mortality (13)

One of the difficulties associated with the clinical assessment of patients who could be at risk for oral cancer is that until very recently the only diagnostic method available has been visual and tactile examination of the oral mucosa While that diagnostic process is reasonable it cannot detect cellular changes that have not evolved enough to be visible to the unaided eye

Fig 1 Clinical photograph of the lateral tongue

Fig 2 Photograph of the same area as in Fig 1 demonstrating LOF that represents dysplasia

Fig 3 Clinical photograph of the ventral tongue showing normal to slightly atypical mucosa


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In the past cancer detection and surveillance in other organ systems have suffered from the same limitations with purely clinical observations proving to be inadequate in detecting premalignant or early malignant changes Two excellent examples include the poor predictive value of visual inspection of the uterine cervix and breast self-examination Until initiation of colposcopy and Pap smear evaluation of the cervix cancer rates and deaths were significantly higher while mammography has greatly improved detection and survival of patients with breast cancer (1415) All three techniques are considered adjunctive diagnostic procedures designed to provide data to the clinician which when included in a symptom report and risk factor assess-ment can lead to more effective decision-making about the likelihood that a finding represents a potential neoplastic process that requires a biopsy or other more sophisticated diagnostic procedures

The lack of effective adjunctive clinical diagnostic methods has clearly limited the ability of dental professionals to detect very early changes that could predict the presence of emerging inflammatory premalignant and dysplastic changes leaving only visual inspection as the chief diagnostic tool After visual detection of an observable change in the mucosa clini-cians have had access to two adjunctive diagnostic tools and one definitive tool to guide their decision-making cytology toluidine blue tissue staining and biopsy (1617) These methods have helped clini-cians to decide whether a finding deserves more careful follow-up and management and while all three methods remain impor-tant and valuable they still are limited due to their dependence on the presence of visible tissue changes to alert the clinician that further assessment is needed

Methods to improve early detection of mucosal changes prior to their progres-sion to a frank clinical lesion state could improve prognosis and limit the morbidity associated with treatment Narrow band (light) imaging (NBI) of tissues has been used extensively in other areas of the body as a means of identifying tissue changes

that are either not visible to the unaided eye or uncharacteristic of a neoplastic process (18-20) This method has been used to evalu-ate bronchial tissues and the mucosa of the intestinal tract with findings that have dem-onstrated its potential utility (18-20)

Recently studies funded by the NIH have investigated the use of NBI for the detec-tion of changes in the oral mucosa associ-ated with neoplasia or premalignant cellular change (2122) These studies have shown that NBI has value in the detection of malig-nant disease and in the determination of sur-gical margins (23) One result of these studies has been the development FDA approval and marketing of a NBI instrument VEL-scope (LED Dental Inc) that is designed for use in general practice settings (24) Similar instruments are currently under development

NBI uses a blue light directed at the oral mucosa and observed through an eyepiece that filters the light Tissues with different physical vascular and cellular characteris-tic reflect or absorb the blue light resulting in an image as viewed through the scope with different visual characteristics The blue light augments the fluorescence properties of some tissue components generating a green-white appearance On the other hand the optical characteristics of some tissues result in a loss of fluorescence (LOF) caus-ing a dark pattern when the tissues are observed through the scope Inflamed and highly vascularized tissues absorb the light and appear dark compared to the same tissue without inflammation Oral dysplasia and oral cancer also absorb the light and appear darker than the corresponding tissue without cancer or dysplasia Dysplastic tissues with significant keratinization (leuko-plakia) can exhibit increased fluorescence (whiteness) with LOF (darkness) around the periphery of the lesion Obviously because inflammatory lesions absorb the light and appear dark traumatic viral and aphthous lesions demonstrate an LOF as do migratory glossitis and lymphoid tissue (Fig 1-8)

Critics of the use of NBI have argued that the results are not sensitive or specific enough and can result in ldquofalse positiverdquo findings that cause patients to be at risk for unnecessary invasive procedures (2425) Others argue that

Fig 5 Clinical photograph of herpes simplex of the palate

Fig 6 Photograph of the same area as in Fig 5 demonstrating LOF that represents acute inflammation

Fig 7 Clinical photograph of the anterior tonsil pillar illustrating the lymphoid tissues

Fig 8 Photograph of the same area as in Fig 7 demonstrating LOF that represents chronic inflammatory change



the use of such adjunctive diagnostic devices is not necessary because risky mucosal changes are visible and can be detected with the unaided eye (26)

The difficulty with those opinions is that very early changes at the cellular level occur before the gross physical characteristics of the tissue have changed enough to create a clearly visible lesion that when seen by the clinician registers as a potentially important inflammatory or dysplastic lesion Also most adjunctive diagnostic methods are merely that ndash adjunctive ndash and are not intended to be definitive diagnostic tests Application of strict standards of sensitivity and specificity in judging the relative value of these adjunctive methods could underestimate their potential for guiding the initial clinical decisionmaking as part of an overall assessment algorithm Their chief use is to help clinicians discover changes that otherwise might not be observed or be of such a subtle nature that the clinician disregards the potential significance of the finding

One study that assessed the value of NBI and toluidine blue in determining the nature of clinically detected lesions in a large group of adults who received oral examina-tions concluded that use did not improve the diagnosis of oral cancer however NBI was applied to only those patients who had clearly detectable oral lesions rather than being used as an adjunctive diagnostic process for all of the examinations (24) Had this been done it is likely that more cases of early dysplasia would have been detected Application of the technology on all patients could have helped the examin-ers to identify changes that otherwise would have escaped recognition because of their nonspecific characteristics or lack of pro-gression to a clearly visible state Unfortu-nately only a few studies have evaluated the application of NBI in routine dental practice but one study has shown detection of premalignant changes that otherwise would have escaped detection (27)

ObjectivesThe purpose of this study was to evaluate the value of adding NBI of the oral mucosa for the detection of tissue changes to a

standard oral examination in routine dental patients The study also aimed to assess the relative value of NBI in the detection of inflammatory dysplastic and other tissue changes The goal of the study was to assess the value of adding NBI for the detection of oral changes not readily seen during normal white-light examination of the oral mucosa The purpose of the study was not to determine the absolute value of NBI in the detection of oral dysplasia or oral cancer but to assess whether its use as an adjunctive diagnostic method adds value to standard examination processes The study also was designed to test the value of this adjunctive method after only a brief exami-nation to determine its value in normal gen-eral practice settings rather than in settings where the modality would be employed by experts who regularly engage in diagnosis and management of mucosal lesions

Materials and MethOdsSubjectsPatients seeking routine dental care or treatment for dental symptoms (pain toothache and so forth) were invited to participate in the study protocol The study was approved as a quality improvement study by the institutional review board of the University of Washington and all patients entered into the study and signed

consent after being informed of the study by one of the study investigators

Study protocolThe study protocol included the following elements Introduction of the patient to the study and obtaining consent to participate routine social medical and dental histories a head and neck physical examination oral soft tissue assessment and dental examination recording of visual findings using a data collection form scoring of tissue changes and level of dysplasia suspicion (0-4) examination of mucosal tissues using a narrow band light source (VELscope) followed by recording the findings scoring of type of tissue change and level of dysplasia suspicion (again on a 0-4 scale) recording follow-up designations as None Two-week Fourweek Biopsy Next Visit Biopsy This Visit and Other and recording of risk factors including none tobacco alcohol immunosuppressive disorder immunosuppressive medication cancer history diabetes and family history of cancer

All patients were examined intially by third- and fourth-year dental students then by the attending faculty of the clinic Students were provided with a tutorial on conduct of the clinical and NBI methods with examples of normal findings normal variation changes caused by inflammatory

Fig 9 VELscope with light shield



disorders and changes caused by dysplasia The faculty of the clinic was provided with the same information as the students in a computer-based tutorial format In addition students and faculty were provided with an instruction packet for each patient enrolled in the study that described the quality assurance study methodologies in addition to containing illustrated scoring sheets Photographs of normal variations of normal and abnormal findings were provided digitally and in printed illustrations The tutorial activity encompassed approximately one hour of information and instruction

To facilitate efficiency a total of five VEL-scopes were stationed in the clinic which has a total of 12 operatories and students accessed the VELscopes as they finished the clinical examination Faculty supervised use of the VELscopes and interpretation of the clinical and NBI findings The NBI was not carried out under the most ideal condi-tions because the clinic is a large open facility and it was not possible to reduce the ambient room light For this reason each VELscope was fitted with a 12- or 14-inch black plastic disc with a hole in the center for the scope This shield created a large shadow over the patientrsquos mouth greatly improving visualization for LOF however the viewing environment still was not as ideal as it would have been with the room light reduced Nevertheless this approach allowed for the detection of many areas of LOF Figure 9 illustrates the VELscope equipped with the black shield for use in rooms that could not be completely dimmed

resultsFive percent of subjects declined participa-tion in the study after reading the consent form and discussing the study with an investigator The most typical reason for a patient declining was concern that the light could cause harm or fear that an abnormal-ity would be detected Overall patients were very accepting of the procedure and expressed great appreciation that an adjunc-tive noninvasive diagnostic aid was available for their evaluation The addition of the NBI protocol to the examination process added one to two minutes to the visit not includ-

ing the study consent process that is not part of a routine diagnostic procedure Many patients reported personal experiences with friends or relatives who had developed oral cancer and other diseases of the mouth and commented positively about the thorough process being employed at the clinic

Patients ranged in age from 18ndash85 and 55 of the 620 patients were women Of the patients who reported tobacco use 215 reported active use and 155 reported prior tobacco use with only a few patients reporting the use of smokeless tobacco Nine percent of patients reported a prior history of some type of cancer and

57 reported a family history of cancer Nine percent of patients were diabetic and currently under treatment while 75 identified themselves as having an immunological disorder or having used an immunosuppressive medication (Table 1)

LOF in areas that were reported as normal during the white light examination was detected in 69 patients After immediate re-evaluation 41 patients were determined to have a region of subtle LOF that could be explained by normal variations in tissue char-acteristics while 28 patients were scheduled for either immediate biopsy or a follow-up appointment Five of those patients agreed

Table 1 Oral cancer risk factors for patients in this study (n = 620)

Risk factor Percentage of all patients enrolled

Percentage of patients with significant LOF (n = 28)

Current tobacco use 215 321

Prior tobacco use 155 210

History of excess alcohol use 35 50

Poor oral hygiene 145 156

Diabetic in active treatment 95 115

History of any type of cancer 90 125

History of autoimmune disease or immunosuppressive medication

75 142

This magazine is printed on Forest Stewardship Councilreg (FSCreg) certified paper with vegetableoil-based inks Please do your part for the environment by reusing and recycling

Our cOncern fOr the environment is mOre than just talk



to an immediate biopsy and four decided to follow up with their primary dental provider The remaining 19 patients were sched-uled for follow-up in two weeks Of the 15 patients who returned for reassessment the area of LOF had resolved and no clini-cal or NBI abnormality could be detected for 11 of them this left four patients with persistent LOF compared to correspond-ing tissues These LOF sites were biopsied in the same manner as the sites in the five patients who agreed to an immediate biopsy In all nine patients (five during the initial assessment and four at the follow-up visit) were found to have tissue changes detected with NBI but not white light that were significant enough when considered in conjunction with the patientrsquos history to require further diagnostic assessment After the findings and risks were explained in addition to the alternatives to biopsy all nine patients consented to biopsy although two of them received the biopsy at another facility due to insurance issues

Of the nine patients who underwent biopsy three were classified by histopatho-logical assessment as having mild dysplasia and two were classified as having mild to

lesions with inflammatory components demonstrated LOF and in most cases the LOF provided a more dramatic presentation of the extent and severity of the inflammatory change than the clinical examination did (Fig 5-8)

The mucosal changes detected with white light both white light and NBI or NBI only were widely distributed throughout the mouth with no distinct difference in pattern noted between the two different methods of assessment

As previously described a number of patients had mucosal changes detected with one or both types of visual assessments Changes were noted in nearly half of all patients (305 of 620) however the vast majority of them were found to be normal or minor variants and did not appear to represent significant pathology The most common lesion was cheek bite while the second most common was trauma to the tongue Inflammatory changes to the oropharyngeal and tonsil areas also were common Cheilitis and changes to the epithelium of the lips also were common and represented a range of etiologies that included habitual lip biting and actinic changes of the lower lip A number of cases of lichen planus and generalized glossitis also were detected during the white light examination

Although the study size was reasonably large the diverse nature of lesions found and the wide range of risk factors associ-ated with the development of oral lesions precluded development of specific associa-tions between risk of mucosal change and a host of factors including age gender tobacco use diabetes immunodeficiency immunosuppressive medications cancer history family cancer history and oral health status Nevertheless it is interesting to note that the patients with changes detected with white light NBI or both were more likely to carry one or more of the risk fac-tors compared to those who had no areas of mucosal change with 54 of 69 patients (78) who demonstrated LOF having either a history of tobacco use or current tobacco use Those with mucosal lesions also were more likely to have poor oral hygiene

Patients seeking routine dental evaluation and urgent care (n = 652)

enrolled(n = 620)

refused enrollment(n = 32)

Area judged as low risk or normal variant (n = 41)

Loss of fluorescence(n = 69)

Lost to follow-up(n = 4)

follow-up visit(n = 19)

Biopsied at follow-up (n = 4)

Area judged to require further evaluation (n = 28)

Area resolved(n = 15)

returned for evaluation (n = 19)

Immediate biopsy(n = 5)

Dysplasia(n = 5)

Chart 1 Flow diagram of the study results

moderate dysplasia (Chart 1) Two other patients were diagnosed as being histologi-cally compatible with lichen planus and the remaining two patients had inflammatory lesions (Table 2) Lesions detected during the white light examination are not included in this discussion and were handled in the routine manner used to manage visible oral lesions The five dysplastic lesions that were detected with NBI were located in the buccal mucosa the lateral border of the tongue the lip the palate and the alveolar ridge

The white light examination resulted in the detection of a variety of soft tissue lesions of the mucosa but this study did not focus on those that were easily detected using standard visual inspection techniques For the sake of completeness a brief summary of the types of soft tissue lesions encountered using white light and NBI is listed in Table 3 These lesions included cheek bites aphthous ulcers herpetic lesions migratory glossitis fissured tongue lichen planus inflamed minor salivary duct openings candidiasis and cheilitis Tonsillitis pharyngitis papillomas scars leukoplakia and draining abscesses also were detected Those



There are several possible explanations for why oral cancer deaths and the stage of oral cancer at the time of diagnosis have not changed dramatically in the past 50 years (1) The lack of improvement could relate to a number of factors but when considering that the percentage of the population that receives regular dental care has increased in the past 50 years it appears obvious that current diagnostic methods could benefit from one or more adjunctive approaches Early detection of dysplasia in other organ systems has been acknowledged to be an important component in improving survival so it is difficult to believe that early detection of potentially significant mucosal changes whether they are inflammatory or dysplastic would not lead to improvements in cancer-related outcomes

Because oral cancer is a relatively uncommon condition the authors did not expect to detect a large number of cases of dysplasia with either the white light examination or the use of NBI and were surprised that five cases of early dysplasia were identified Of additional interest is the observation that NBI detected many areas of inflammation and vascular change not identified during the white light examination suggesting that this methodology also could be useful in cataloguing instances of chronic irritation and inflammatory change that over time could lead to irreversible conditions such as fibrosis scarring and leukoplakia

While some might be concerned that detection of five unobserved cases of dys-plasia seems higher than would normally be expected it is important to point out that most experts believe that cellular atypia and early stages of dysplasia might not uniformly progress to more severe stages of oral cancer and that several cases of dysplasia exist for each case of oral cancer (611) Therefore it is not quite so surprising that the rate of dysplasia found in the current study was 08 American Cancer Society statis-tics state that the lifetime risk for developing oral cancer is less than 1 in 90 or approxi-mately 1 a figure not far from the 08 found in the population in the current study (27) On the other hand the rate detected in the current study might have been higher

than expected among routine dental patients seen in private practice settings because more than 60 of the patients enrolled in the study were seeking urgent care and might have had more risk factors (tobacco poor oral hygiene systemic disease and so forth) than normal dental populations

The study methodology was limited because it was carried out in a clinical setting that did not allow for a reduced ambient light examination environment Based on the authorsrsquo experience in the use of NBI in darker settings it is likely that a number of lesions viewed at the clinic with LOF went undetected It is possible that one or more of these lesions might even have been dys-plastic or an inflammatory change that could have benefited from further follow-up

The study also was limited because the authors deliberately decided to use relatively inexperienced examiners which might have resulted in lower rates of detection of mucosal changes for either method The authors wanted to test the use of NBI in an environment that resembled a general dental setting more than a specialty clinic that focuses on the detection of mucosal lesions and disease To that end the results demonstrate the value of NBI when added to routine examination methods

The study also could have been limited because it occurred in a university setting where students and attending faculty might be more focused on mucosal assessment processes A larger multiple private office study would be useful with general dentists and dental hygienists providing the white light and NBI process during normal patient care for both new and recall patients It is encouraging however that this adjunc-tive diagnostic aid appeared to improve the detection of mucosal changes not easily visible with white light examination

The authors were pleased that adding the NBI to the examination process did not significantly increase the time required to evaluate patients when the study consent process was excluded The authors also were pleased that patient response was strongly positive and that the study appeared to raise awareness among patients that the dental examination process extends beyond

Table 2 Biopsy results

Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3

Mild to moderate dysplasia 2

Type of mucosal lesion deatected

Relative frequency

Traumatic injury Common

Lichen planus Occasional

Dysplasia Rare

Cheilitis Common

Migratory glossitis Occasional

Fissured tongue Occasional

Pharyngitis and tonsillitis Common

Herpes simplex Occasional

Recurrent aphthous Occasional

Candidiasis Occasional

Leukoplakia Occasional

Mucosal bacterial infections Rare

Inflamed minor salivary ducts Occasional

Near 1 prevalence in this studyrsquos population

Table 3 Types of lesions detected with combined clinical and NBI diagnosis methods

Common = 10 or greater occasional = lt10 rare = lt1

discussiOnThe purpose of this quality improvement study was to gain information about the clinical utility of one simple adjunctive diagnostic method (NBI) for the detection of mucosal changes The rationale for the study assumed that such a diagnostic adjunctive method is not necessary to detect mucosal changes readily seen with normal white light examination methods Existing data suggest that current examination methods are not sufficient for the earliest detection of mucosal changes that could represent inflammatory damage or the presence of very early dysplasia This could partly account for the only modest reduction in oral cancer deaths since 1960 (113)



potentially malignant disorder involving periodontal sites J Periodontol 200980(2)274-281

10 Skamagas M Breen TL LeRoith D Update on diabetes mellitus Prevention treatment and association with oral diseases Oral Dis 2008 14(2)105-114

11 Napier SS Speight PM Natural history of potentially malignant oral lesions and conditions An overview of the literature J Oral Pathol Med 200837(1)1-10

12 Weijers M Ten Hove I Allard RH Bezemer DP van der Waal I Patients with oral cancer developing from pre-existing oral leukoplakia Do they do better than those with de novo oral cancer J Oral Pathol Med 200837(3)134-136

13 Shuman AG Entezami P Chernin AS Wallace NE Taylor JM Hogikyan ND Demographics and efficacy of head and neck cancer screening Otolaryngol Head Neck Surg 2010143(3)353-360

14 Pimple SA Amin G Goswami S Shastri SS Evaluation of colposcopy vs cytology as secondary test to triage women found positive on visual inspection test Indian J Cancer 201047(3) 308-313

15 Ahmed NU Haber G Semenya KA Hargreaves MK Randomized controlled trial of mammography intervention in insured very low-income women Cancer Epidemiol Biomarkers Prev 201019(7)1790-1798

16 Gupta A Singh M Ibrahim R Mehrotra R Utility of toluidine blue staining and brush biopsy in precancerous and cancerous oral lesions Acta Cytol 200751(5)788-794

17 Mehrotra R Singh MK Pandya S Singh M The use of an oral brush biopsy without computerassisted analysis in the evaluation of oral lesions A study of 94 patients Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008 106(2)246-253

18 Lee CT Chang CY Lee YC Tai CM Wang WL Tseng PH Hwang JC Hwang TZ Wang CC Lin JT Narrow-band imaging with magnifying

Feuer EJ Cronin KA Edwards BK eds SEER cancer statistics review 1975-2008 Bethesda MD National Cancer Institute2010 Available online at httpseer cancergovcsr1975_2008 based on November 2010 SEER data submission posted to the SEER website 2011

2 Divaris K Olshan AF Smith J Bell ME Weissler MC Funkhouser WK Bradshaw PT Oral health and risk for head and neck squamous cell carcinoma The Carolina Head and Neck Cancer Study Cancer Causes Control 201021(4)567- 575

3 Jaber MA Oral epithelial dysplasia in non-users of tobacco and alcohol An analysis of clinicopathologic characteristics and treatment outcome J Oral Sci 201052(1)13-21

4 Wang YP Chen HM Kuo RC Yu CH Sun A Liu BY Kuo YS Chiang CP Oral verrucous hyperplasia Histologic classification prognosis and clinical implications J Oral Pathol Med 200938(8) 651-656

5 Szarka K Tar I Feher E Gall T Kis A Toth ED Boda R Marton I Gergely L Progressive increase of human papillomavirus carriage rates in potentially malignant and malignant oral disorders with increasing malignant potential Oral Microbiol Immunol 200924(4)314-318

6 van der Waal I Potentially malignant disorders of the oral and oropharyngeal mucosa Terminology classification and present concepts of management Oral Oncol 200945(4-5)317-323

7 Schildt EB Eriksson M Hardell L Magnuson A Oral infections and dental factors in relation to oral cancer A Swedish case-control study Eur J Cancer Prev 19987(3)201-206

8 Yang SW Lee YS Chen TA Wu CJ Tsai CN Human papillomavirus in oral leukoplakia is no prognostic indicator of malignant transformation Cancer Epidemiol 200933(2)118-122

9 Gandolfo S Castellani R Pentenero M Proliferative verrucous leukoplakia A

purely odontogenic issues and can encom-pass the detection of disorders that could have more severe and wider implications on their health

cOnclusiOnThe findings of this study support the use of NBI as a simple adjunctive diagnostic device that when used as one component of a standard diagnostic protocol could help clinicians to detect inflammatory and dysplastic tissues Use of this technology could improve cliniciansrsquo ability to monitor and follow initially detected changes and to better judge progression versus resolution and response to nonsurgical treatments These findings need to be further explored in other settings to determine overall utility in general practice but based on these findings NBI appears to have the potential to assist general practitioners in assessment and decision-making related to mucosal tissues and lesions

acknOwledgeMentsThis study was made possible with funding from NIH grant T32 DE07132 and LED Dental Inc

authOr infOrMatiOnDr Truelove is a professor Department of Oral Medicine University of Washington Seattle where Dr Taylor is a part-time faculty member and director of the urgent care clinic Dr Griffith is a full-time faculty member and teaches in the Diagnosis and Urgent Care Clinic Ms Huggins is a full-time affiliate faculty member and a member of the professional staff in the departments of Oral Medicine and Dental Public Health and Mr Maltby and Mr Griffith are senior dental students Dr Taylor also maintains a private practice of oral medicine in Federal Way WA Dr Dean is in private practice in Bellevue WA

references1 Howlader N Noone AM Krapcho

M Neyman N Aminou R Waldron W Altekruse SF Kosary CL Ruhl J Tatalovich Z Cho H Mariotto A Eisner MP Lewis DR Chen HS



endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers Endoscopy 201042(8)613-619

19 Mannath J Subramanian V Hawkey CJ Ragunath K Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrettrsquos esophagus A meta-analysis Endoscopy 201042(5)351-359

20 Katada C Tanabe S Koizumi W Higuchi K Sasaki T Azuma M Katada N Masaki T Nakayama M Okamoto M Muto M Narrow band imaging for detecting superficial squamous cell carcinoma of the head and neck in patients with esophageal squamous cell carcinoma Endoscopy 201042(3)185-190

21 Poh CF Zhang L Anderson DW Durham JS Williams PM Priddy RW Berean KW Ng S Tseng OL MacAulay C Rosin MP Fluorescence

visualization detection of field alterations in tumor margins of oral cancer patients Clin Cancer Res 200612(22)6716-6722

22 Poh CF Ng SP Williams PM Zhang L Laronde DM Lane P Macaulay C Rosin MP Direct fluorescence visualization of clinically occult highrisk oral premalignant disease using a simple hand-held device Head Neck 200729(1)71-76

23 Poh CF Zhang L Anderson DW Durham JS Williams PM Priddy RW Berean KW Ng S Tseng OL MacAulay C Rosin MP Fluorescence visualization detection of field alterations in tumor margins of oral cancer patients Clin Cancer Res 200612(22)6716-6722

24 Mehrotra R Singh M Thomas S Nair P Pandya S Nigam NS Shukla P A cross-sectional study evaluating chemiluminescence and autofluorescence in the detection of

clinically innocuous precancerous and cancerous oral lesions J Am Dent Assoc 2010141(2)151-156

25 Patton LL Epstein JB Kerr AR Adjunctive techniques for oral cancer examination and lesion diagnosis A systematic review of the literature J Am Dent Assoc 2008139(7)896-905

26 Jemal A Siegel R Xu J Ward E Cancer statistics 2010 CA Cancer J Clin 201060(5)277-300

27 Huff K Stark PC Solomon LW Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice Gen Dent 200957(1)34-38

ManufacturersLED Dental Inc Burnaby British Columbia Canada 8885414614 wwwvelscopecom

Published with permission by the Acad-emy of General Dentistry copy Copyright 2011 by the Academy of General Dentistry All rights reserved

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DAO tO hOst seminArsamp AnnuAl generAl meeting

FriDAy April 20

100 pm tO 400 pm

DaO members onlyFree of chargepre-registration is required

100 pm tO 230 pm

Professional liability insurance (malpractice) A comparison of dAO policy with CdO policy ndash what is all the fusspresented by neil mcgruer from simmlandsThe DAO board of directors has undertaken to have our Professional Liability Insurance (PLI) policy evaluated to ensure that it meets the CDOrsquos PLI requirements Long before the RHPA legislated regulatory health professions to require all registrants to carry mandatory insurance the DAO required all members to obtain PLI How good is your policy Have you read and understood your policy A comparison of the DAOrsquos policy with other policies will be presented by an

objective third-party insurance company What you hear may surprise you

245 pm tO 415 pm

Bill 168 ndash are you compliantViolence and harassment in the workplacepresented by patrick evangelistoViolence in the workplace legislation has been in place since June of 2010 This is a result of many workers in the province feel-ing threatened in either a physical sexual or psychological manner while at work It has resulted in high levels of stress physi-cal harm and even death

Employers regardless of size of their organizations are supposed to have in place a plan to protect workers from vari-ous forms of violence potential violence and harassment from co-workers custom-ers suppliers and the general public In addition to this employers are to be made aware of the potential of domestic violence entering a workplace from the spouse or family member of a worker

You are expected to have risk assess-ment needs in your workplace Policies need to be written and protocols need to be established followed by mandatory staff training This seminar is presented by the same speaker who presented at last yearrsquos PYP Pat is a knowledgeable entertaining speaker

300 pm tO 900 pm

Technorama Exhibit Showroom

before Technorama opens

Agm

sAturDAy April 21

930 Am tO 230 pm

denturist Association of Ontario Annual General Meeting (AGM)This year elections will take place For more information check DAO

website and your AGM packages

mailed to you by March 19th

Registration is required Lunch will

be served



FriDAy April 20 2012

time COmpAny title speAker

500 - 600 pm Bego CanadaIdentifying Opportunities and Exploiting

Potential for Your Dental Laboratory Using Bego CADCAM

Andreas Klie RDT

500 - 600 pm 3M ESPEThe Denturist-Dentist Relationship

Creating the Win-win with Mini Dental Implants

Dr Ian Erwood

500 - 600 pm DenplusEnigma Cosmetic ndash

The Teeth Tell the TruthLouis Pelletier

615 - 715 pm VidentIntro to Titanium CeramicsReview

of VMK Master PorcelainKen Chizick RDT CDT

615 - 715 pm Henry Schein Advanced Buisness

Management for Denturists ndash DOMx

Dean Fenwick

615 - 715 pm Dentsply CanadaPreventing Traumatic Sports Injuries With

Pressure Thermoformed Sports MouthguardsDr Amin Babul

730 - 830 pm DentauramTriceram Natures Creation

(ti and zr ceramic) Bassam Haddad

730 - 830 pm Dent-Line Attachments Fixed amp Removable Prosthetics

Take the Mystery out of the Treatment Planning

Peter Pontsa RDT

730 - 830 pm Ivoclar VivadentOcclusion and Attachments ndash

The Underlying Scheme for Successful Overdentures

Dennis Urban CDT

2012 Technorama

hilTon suiTes conference cenTre markham onTario

prOgrAm sCheDule



sAturDAy April 21 2012


930 - 1030 am ArgenCADCAM Designed Laser Sintered Metal

Copings with Argen CanadaLou Azzara Richard Nixon

930 - 1030 am 3M ESPE New Materials for Implant

Restorative Prosthetics Roger Johansen

930 - 1030 am Nobel BiocareAdvanced Solutions

for Implant ComplicationsDr Herman Kupeyan Dr Gordon McDowell

1045 - 1145 am NordentaEconomical Alternatives to Milled Implant Bars

Andrew Long RDT

1045 - 1145 am Laserdenta5 Axis Open Architecture

System with Scanner and Milling Machine

Valerie Poon

1045 - 1145 am Henry Schein The Complete System for Your

Everyday Implant PracticeDennis Sarrasin

1130 am - 1230 pm Vident Implant Retained Denture Dennis Purinton

1130 am - 1230 pm AuShaw Pressing Matters David Goldshaw

1130 am - 1230 pm DiademDigitally Design Diazir Full Contour Zirconia

featuring 3ShapeMitch Jula RDT


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tHe un-COmFORt ZOneBy Robert Wilson

King George III asked Benjamin West his American painter what George

Washington would do if he prevailed in the Revolutionary War West replied ldquoHe will return to his farmrdquo The British monarch incredulously said ldquoIf he does that he will be the greatest man in the worldrdquo On December 23 1783 Washington did just that and retired to Mount Vernon ndash despite the encouragement of many to stay in power Despite the willingness of Americans to crown him king Thirteen years later he would do it once again

In 1787 Washington was coaxed back to Philadelphia to attend the Constitutional Convention While there he provided the leadership necessary to get the fractious delegates to settle down and complete the work of designing a new constitution Afterwards in 1789 he was elected the first president of the United States He reluctantly ran for a second term in 1792 He refused to run for a third term setting a precedent that lasted 150 years and retired once again to his farm

Abraham Lincoln said ldquoIf you want to test a manrsquos character ndash give him powerrdquo George Washington passed that test Twice in his life he walked away from power and proved that he was indeed the greatest man in the world He demonstrated that leadership is something that you give ndash not take ndash and that power should be used responsibly

Washington died in 1799 the year that Napoleon Bonaparte became the ruler of France In contrast to Washington Napoleon could not acquire enough power His legendary lust for command drove him to take over much of Europe ldquoPower is my mistressrdquo he once claimed ldquoI have worked too hard at her conquest to allow anyone to take her away from merdquo

Leadership vs power



tHe un-COmFORt ZOne

Years later having lost all power and living in exile he lamented ldquoThey wanted me to be another Washingtonrdquo

History is rife with stories of people who abused their power Abuse of power however is not just reserved for politicians and tyrants It can be abused by managers spouses parents peers and the list goes on It is the lure of dominance over others when it motivates people toward leadership roles that is revealing It reveals uncertainty lack of confidence and fear

It is said that power corrupts but more often than not it is a corrupted individual who is attracted to power It is a feeling of inferiority sometimes called a Napoleon Complex that drives someone to control other people and to micro-manage their surroundings Today we call such a person a control freak Science fiction author Robert Heinlein noted ldquoAnyone who wants to be a politician shouldnrsquot be allowed to be onerdquo

When we look at Abraham Maslowrsquos hierarchy of human motivation (survival

safety social esteem fulfillment) we see that someone who hungers for power is stuck in the second to bottom level which is safety A true leader has self-esteem and self-confidence and does not seek power to bolster his or her feeling of self worth Thomas Jefferson observed that ldquoAn honest man can feel no pleasure in the exercise of power over his fellow citizensrdquo

A true leader is motivated by a goal a goal common to his group whether that group is a company or a country If you find yourself attracted to leadership stop and check your motivation Are you driven

to share your gift of understanding in the endeavor of achieving a goal or are you motivated by perquisites of position and the power you have over others As John Quincy Adams said ldquoIf your actions inspire others to dream more learn more do more and become more you are a leaderrdquo

Robert Evans Wilson Jr is a motivational speaker and humorist He works with companies that want to be more competitive and with people who want to think like innovators For more information on Robertrsquos programs please visit wwwjumpstartyourmeetingcom

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VOCO is introducing with Quick Up an innovative and complete implant pick-up system that virtually eliminates the risk of inter-

locking and cuts chairside time in halfDesigned specifically for bonding attachments such as ball

Locatorreg and telescopic attachments as well as other attachments in acrylic-based dentures Quick Up can also be used for reattach-ing secondary elements in a denture such as bar retainers With everything in one system Quick Up improves workflow and chairside efficiency ndash saving time and money The system includes Quick Up self-curing composite in the QuickMix syringe Easy to use Quick Up SC demonstrates exceptionally high strength Other components of the system include Fit Test CampB used to check whether the openings in the denture base provide enough space to receive the attachments and for blocking out undercuts in the overdenture Quick Up adhesive a strong adhesive material that is applied to the underside of the den-ture to improve composite retention and Quick Up LC a light-cure composite used to correct minor surface defects in the denture

new Quick up method eliminates the risk and cuts procedure time

In the new Quick Up technique the recess holes will be filled only 23 with the self-cured Quick Up SC and after intraoral setting finished with the light cured Quick Up fill LC This procedure does not require vent hole preparation and excess material removal polishing time is significant reduced The overall procedure time is cut in half compared to the classic methods



inDustRy neWs

One of the misconceptions about going digital is that it requires expensive equipment to get started Many denturists these

days can attest to the contrary Together with a digital signature pad scanner and point-and-shoot camera you have all you need to go from traditional paper charts and join the chartless digital era All this equipment can be purchased for between $600 and $2000 and will allow you to get rid of inefficient paper charts

Going digital means more than simply using computers for recordkeeping With sophisticated practice management applications like Tracker it is about using technology to increase workflow efficiency and enhance your patientsrsquo experience From new patient registration to case presentation to clinical patient photos and notes every step of the way is covered Tracker also enables you to take advantage of the revolutionary visual charting concept

Going digital is about more than technology You need the right people We realize that change can be intimidating Our team of

digital integration specialists has transitioned hundreds of offices and will use this experience to guide you through the process We have the answers to all the questions such as ldquoWhat do I do with my paper

chartsrdquo and ldquoHow do I get my staff fully on boardrdquo

Itrsquos time to implement technology to promote greater patient satisfaction and increased referrals So what are you waiting for

See wwwbridge-networkcomgoingdigital for more information on going digital and how to avoid the pitfalls

John Legourdas is Client Services amp Support Manager for The Bridge Network a Canadian software development and technology-consulting company With more than 14 years of experience in the dental healthcare industry John manages the technical support department and is active in the implementation of The Bridge Net-workrsquos chartless applications as a technology specialist For more information on how you can go chartless you can contact John at 416-222-0123 or 1-800-922-7434 email johnbridge-networkcom

going digital What are you waiting for



CLassiFieDs

CLINICS FOR SALE A well-known denturist office in West Vancouver is for

sale for $118000 Low rent ($1800 gross) steady income over 25 years of business practice Patient database lots of parking renovated office and equipment Asking $118000 Contact Virgina Thorburn at 604-922-3309

denture clinic for sale in Kamloops BC Well-kept office with excellent growth potential Current owner is retiring and is the only denturist serving a large population base on the north shore of Kamloops Great relationship with a referring dentist in the area Low overhead with a cash flow of $140000 in 2010 based on a three-day week with extra time away for vacations Owner is asking $65000 and is open to offers Contact ldtwaghotmailcom for more info or pictures or call 250-554-0055

denture clinic for sale in Victoria BC RampD Denture Clinic established in 2001 is located in busy and popular Shopping Centre Mall one of the best areas in Victoria Modern clinical and laboratory equipment and office design Priced at $75000 Serious inquiries only Contact Sergei Khartchenko 250-881-8560 or newdiatechshawca

Opportunity of a lifetime If you are looking to achieve better worklife balance this is an opportunity to relocate to Southwest Ontario With a large senior population in our area we have a loyal patient base and a continual substantial annual growth The business is based on high-quality denture construction It is the only denture clinic in town with an excellent location modern fully equipped and professionally designed Low overhead patients and dental referrals make this clinic very profitable The extra space gives the possibility to sublease Current owner willing to stay on to ensure a smooth transition if needed For more information call Daniela at 519-995-5533

Fort McMurray Practice FT or PT in a very busy dental office Joint advertising and referrals will quickly fill your practice Financial incentives available Easy commute by WJ or AC direct from Edmonton Calgary and Toronto Email wrfamily3gmailcom

denture clinic for sale in delta BC Contact Jack Lillico 604-802-6378

Victoria BC two denture clinics for sale Burnside Denture Clinic established in 1980 and Mayfair Dental Centre established 1984 located in the biggest shopping centre in greater Victo-ria Outstanding dentist referral base to the only denturist located within dentistrsaquos practice Main office is in the centre of Victoria on major bus routes Two operatories large sterilization area fully vented and air-conditioned office in an owned strata building Wheelchair accessible on ground floor lots of parking for patients Owner retiring and willing to help in transition according to buyerrsquos schedule wwwburnsidedenturecliniccom wwwmayfairdentalca For more information robbburnsidedenturecliniccom

DENTURISTS WANTED Busy denture clinic in dawson Creek BC looking for a

licensed or intern denturist to join our team Please fax reacutesumeacutes to 250-782-6083

denture clinic in central London looking for a team memberassociate to complete our circle of expertise Beautiful modern four operatory clinic located on a busy central road Potential to buy in the future to the right candidate Must be able to provide a high level of service and product Must be self-motivated and have a neat appearance Dedication with an energetic personality is an asset Contact 1-519-858-9700 and fax experience to 1-519-858-9600

SALETHE

DENTURE CENTRE HOBART

Become part of the Tasmaniarsquos largest private denture centre group with seven centres around Tasmania

The Denture Centre was established in 1972 and is one of Tasmaniarsquos oldest established denture practices and laboratories A loyal patient base supports two prosthetists two dental assistants a part time accounts and practice manager and a part time assets maintenance person with the option of expanding for a third prosthetist and laboratory work

The Denture Centre has Tamaniarsquos best equipped surgeries and a large laboratory

The Denture Centre is established in one of Hobartrsquos leading shopping suburbs with main road exposure level wheel chair access and off street parking

The Denture Centre is offered for sale as both the building and denture practice or as dental practice only and lease of building with option to buy at a later stage

Full photos available upon request

Enquiries in strict confdence toRodney Williams

118 Main Road Moonah Tasmania Australia 7009email denturecentrebigpondcom

tASMAniA AuStrALiA



CLassiFieDs

to submit a classified ad please contact

Or

Looking for a newly graduated denturist or a denturist looking to buy into a well established dental practice in Central Vancouver Island This is a fantastic opportunity for the right person Please contact Brian at 250-246-4674 or thehappydenturistshawca for details

Licensed denturist wanted immediately for well-established busy and progressive Calgary practice We offer excellent benefits wage compensation and other incentives perks The ideal candidate will possess a current Canadian denturist practice permit and proficiency in both clinical and technical abilities Great communication skills and willingness to work in a team setting are assets Respond to saforaazizshawca All inquiries confidential

Certified denturist andor a denture technician wanted Denture clinic located in the town of High River Alberta just 20 minutes south of Calgary is seeking a certified denturist andor a denture technician The ideal candidate will have a denture certificatediploma Also will have a minimum of three to five yearsrsquo experience with making dentures and technical expertise also preparing plaster moulds packing moulds to form dentures set up and waxing up casting preparing and fabricating dentures This is a fast-paced environment Please email highcountrydentureshawca or mail to High Country Denture Clinic 111 C Macleod Trail S High River AB T1V 1M9

We are looking for denturists to come and work in New Brunswick Call 1-800-382-1106 or email dentureguynbaibncomnous cherchons pour des denturologistes qui veulent venir travailler au Nouveau-Brunswick Appeler 1-800-382-1106 or par courriel dentureguynbaibncom

EQUIPMENT FOR SALE Variety of equipment for sale

Model trimmer flasks trays denture press hydraulic press articulators porcelain oven and materials micro-motor ring press tools and much more Please call Gabriel for details or to arrange an appointment at 416-424-3201 KAVO boil-out and polishing unit Ticomium shell blaster

for sale Boilout $5000 obo polishing unit $3000 obo Polishing unit specifications and images may be viewed at wwwwasserrmandentalcom (Model wp-ex80) Ticonium shell blaster suitable for casting lab $3000 obo If interested please call 519-622-4500 for additional information

Equipment for sale 1 Modern complete dental unit with compressor and pieces (tur-bine and micro motor) 2 Laboratory compressor 3 Almore thermoregulated Pressure Pot allowing program pressure and tem-perature 4 Dry air pressure Polimerisator 5 Mechanical denture press 6 Regular metal flacks 7 A metal trays 8 Wax hitter 9 Model Trimmer 10 Metalloceramic porcelain material (Vita set) 11 Metalloplastic dental material (Vita set) Please contact Sergei Khartchenko 250-881-8560 or newdiatechshawca

Denturist association of Canada66 Dundas street eastBelleville ontario K8n 1C1Tel 1-613-968-9467Toll Free 1-877-538-3123Emaildacdenturistbellnetca

managing editorTelephone 866-985-9784Email cherylkelmanca

rates are free for members and $75 for non-members

FiBER FORCEreg is a sys-tem of pre-impregnatedlight-curable meshesbraids and UD fibers

bull Fast easy and inexpensive

bull Bonds to acrylic and adds no weight

bull Esthetically pleasing

Call SYNCA today or visit our website

wwwfiberforcedentalcom1-888-582-8115in Canada 1-800-667-9622

FiBER FORCEreg IT NOWFiBER FORCEreg IT NOW o r f i x i t l a t e r

fiberforce ad Denturism 2012-02 (13) eng_Layout 1 12-02-09 1126 AM Page 1


Many patients often experience retention and stability issues with their lower dentures due to narrowat lower ridge bone-loss intensive ow of saliva or an active tongue dislodging the lower dentures Securereg is a patented non-water soluble denture adhesive that prevents

adhesive from dissolving while eating or drinking for up to 12 hours Conventional denture adhesives are water soluble and work by thickening saliva to improve suction between the denture and gum However the adhesive can wash away while they are eating and

drinking resulting in reapplication Try Securereg Denture Adhesive and give your patients a condent and care-free day

Long lasting bond holds for up to 12 hours

For more information visit wwwGUMbrandcom or call 1-800-265-8353

The Only Non Water-Soluble Denture Adhesive

For more information visit wwwGUMbrandcom or call 1-800-265-8353Secure is a registered trademark of Fittydent Internationalcopy2012 Sunstar Americas Inc C12029


ReaCH OuR aDVeRtiseRs

Denturism Canada would not be possible without the advertising support of the following companies and organizations Please think of them when you require a product or service We have tried to make it easier for you to contact these suppliers by including their telephone numbers and websites You can also go the electronic version at wwwdenturistorg and access direct links to any of these companies

to reach denturists across Canada through Denturism Canada magazine and its targeted readership please contact Chad morrison directly at

toll Free 866-985-9788 toll Free Fax 866-985-9799 e-mail chadkelmanca

COMPAnY PAGE PHOnE WEBSitE

Aluwax Dental Products 15 616-895-4385 wwwaluwaxdentalcom

Aurum Ceramic Dental Labs 9 800-661-1169 wwwaurumgroupcom

BEGO Canada IBC 800-463-2680 wwwbegocanadacom

BIOMET 3i 45 800-363-1980 wwwbiomet3icom

Candulor AG 17 41 (0) 44 805 90 00 wwwcandulorcom

Central Dental Ltd OBC 416-694-1118 wwwcentraldentalltdcom

CMI Institute 19 877-350-6464 wwwgetminica

Dental Industry Association of Canada 32 519-221-3144 wwwtechnoramadiacca

Dentsply Canada 14 905-851-6060 wwwdentsplyca

Denturist Maxident Software 11 800-663-7199 wwwmaximsoftwarecom

Global Dental Science LLC 3 855-282-3368 wwwAvadentcom

Impact Dental Lab 46 800-668-4691 wwwimpact-dentalcom

Implant Direct 6 604-730-1337 wwwimplantdirectcom

Ivoclar Vivadent 4 800-263-8182 wwwivoclarvivadentcom

Laboratoire Dentaire Concorde 31 800-668-3389 infoldccca

Lang Dental Manufacturing Company 36 800-222-5264 wwwlangdentalcom

Mid-Continental 38 800-882-7341 wwwmid-continentalcom

Nobel Biocare 41 800-939-9394 wwwnobelbiocarecomdental

Oxyfresh 21 800-364-1649 wwwoxydentalcomcarolynj

Pro-Art Dental Laboratory 43 416-469-4121 wwwpro-artdentallabcom

Rodney Williams 47 0418-123-056 wwwthedenturecentrecomau

Specialized Office Systems 40 800-495-8771 wwwdenturistsoftwarecom

Specialty Tooth Supply 20 800-661-2044 wwwspecialtytoothsupplycom

Sunstar Americas Inc 49 800-265-8353 wwwGUMbrandcom

Synca Marketing 48 800-667-9622 wwwsyncacom

The Bridge Network Inc 44 800-922-7434 wwwbridge-networkcom

Vident IFC 800-263-4778 wwwvidentcom

Voco Canada 42 888-658-2584 wwwvococom

Westan Dental Products Group 24 888-477-9378 wwwwestanca

Zahn Canada A Division of Henry Schein Canada Inc 22 800-496-9500 wwwzahncanadaca


WHY PAY MORE

European Laboratory and Clinical Furniture SolutionsDurable ndash Steel with Oven-cured Electrostatic Paint FinishDesign - Wide array of colours for choice Work Surface ndash Laminate Hardwood Synthetic Resin amp Stainless SteelChoice of Lights ndash Bendable Arms or Straight Fixed PositionRegulatory - ESA ApprovedPlanning - 3-D CAD Drawings to Assist in Design

Good Qualityhellip Great Value Lab Stool

NEWNEW

$295Good Qualityhellip Great Value

For more information Call 18002684442wwwcentraldentalltdcom

BOLD NEW DENTURE TEETH FROM VITABecause failure is not an option choose denture teeth from the brand you rely on

VITAPANreg Plus anterior denture teeth are the result of two years of intensive research with dental technicians around the world VITAPAN Plus offer true-to-nature tooth anatomy and a well-proportioned design insuring coverage for any indication And VITAPAN Plus are made with high-quality Microfiller Reinforced

Polyacrylic for superior plaque resistance and wear as well as strength values that satisfy even the highest patient demands Available in a compact assortment of popular moulds in VITA Classical shades VITAPAN PLUS are perfect for use with all VITA posterior denture teeth

800-263-4778 wwwvidentcom

copy Vident 2012 Vitapan is a registered trademark of VITA Zahnfabrik

Available from these fine providers

Central Dental(800) 268-4442

DenPlus(888) 344-4424

Henry Schein Inc(800) 496-9500

Patterson DentalDentaire(800) 570-6356

Sinclair DentalDentaire(800) 663-7393

Specialty Tooth Supply(800) 661-2044

Westan Dental (800) 661-7429

facebookcomVident

Introducing








Create a smile


ivoclarvivadentcom


More than dentures





Exe

cuti

ve 2

010-

2012

Mem

ber

s an

d P

rovi

nci

al O

ffic

es

Co

nti

nu

ing

Ed

uca

tio

n P

rog

ram

s



den

turi

st C

olle

ge

Pro

gra

ms




































30mmDImplant

AttachmentsGPStrade

30mmDImplant






ScrewIndirectreg






ISSN 1480-2023



Published by










23




Insurance 15


Un-comfort Zone 39

Industry News 43

Classifieds48








michael C Vout DD

Winds of change




































TOLL FREE1-800-661-1169

































denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

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ervi

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AG

2

01

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All

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No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW



Introducing








Create a smile


ivoclarvivadentcom


More than dentures





Exe

cuti

ve 2

010-

2012

Mem

ber

s an

d P

rovi

nci

al O

ffic

es

Co

nti

nu

ing

Ed

uca

tio

n P

rog

ram

s



den

turi

st C

olle

ge

Pro

gra

ms




































30mmDImplant

AttachmentsGPStrade

30mmDImplant






ScrewIndirectreg






ISSN 1480-2023



Published by










23




Insurance 15


Un-comfort Zone 39

Industry News 43

Classifieds48








michael C Vout DD

Winds of change




































TOLL FREE1-800-661-1169

































denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW




Create a smile


ivoclarvivadentcom


More than dentures





Exe

cuti

ve 2

010-

2012

Mem

ber

s an

d P

rovi

nci

al O

ffic

es

Co

nti

nu

ing

Ed

uca

tio

n P

rog

ram

s



den

turi

st C

olle

ge

Pro

gra

ms




































30mmDImplant

AttachmentsGPStrade

30mmDImplant






ScrewIndirectreg






ISSN 1480-2023



Published by










23




Insurance 15


Un-comfort Zone 39

Industry News 43

Classifieds48








michael C Vout DD

Winds of change




































TOLL FREE1-800-661-1169

































denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW



Exe

cuti

ve 2

010-

2012

Mem

ber

s an

d P

rovi

nci

al O

ffic

es

Co

nti

nu

ing

Ed

uca

tio

n P

rog

ram

s



den

turi

st C

olle

ge

Pro

gra

ms




































30mmDImplant

AttachmentsGPStrade

30mmDImplant






ScrewIndirectreg






ISSN 1480-2023



Published by










23




Insurance 15


Un-comfort Zone 39

Industry News 43

Classifieds48








michael C Vout DD

Winds of change




































TOLL FREE1-800-661-1169

































denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW












30mmDImplant

AttachmentsGPStrade

30mmDImplant






ScrewIndirectreg






ISSN 1480-2023



Published by










23




Insurance 15


Un-comfort Zone 39

Industry News 43

Classifieds48








michael C Vout DD

Winds of change




































TOLL FREE1-800-661-1169

































denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





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Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

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01

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e N

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ll o

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if

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lse

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tate

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NobelProceraTM



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EW



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michael C Vout DD

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denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

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if

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is s

tate

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xt in

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tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

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el B

ioca

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AG

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01

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th

e N

ob

el B

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typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

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Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










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inDustRy neWs








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CLassiFieDs












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Or

































































WHY PAY MORE



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denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

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erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW













denturist
























tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW



















tough opponents














































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW









































































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW



















































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW














































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW
































their friends



practice success






call 416-466-6217 or 800-563-3994












$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

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Bio

care

th

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ob

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a c

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in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










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inDustRy neWs








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$ 16695$ 17995











Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW












Dr Lemay

in












Figure 1







in Englishin French

830 am to 6 pm

830 am to 6 pm










For more details











































(791-0012)


(791-0015)











274900

39900

49900



















































































75 142












enrolled(n = 620)











Dysplasia(n = 5)















Lesion diagnosis

Number of patients

Lichen planus 2

Inflammation 2

Mild dysplasia 3



Relative frequency



Dysplasia Rare

Cheilitis Common


































































FriDAy April 20

100 pm tO 400 pm


100 pm tO 230 pm



245 pm tO 415 pm




300 pm tO 900 pm



Agm

sAturDAy April 21

930 Am tO 230 pm





be served







Andreas Klie RDT



Dr Ian Erwood







Dean Fenwick







Peter Pontsa RDT



Dennis Urban CDT

2012 Technorama


prOgrAm sCheDule












Andrew Long RDT



Valerie Poon








Lang Dental knows

how important it is


commitment to your














every time gt





Aquaprestrade

Flexacryl Soft


Flexacryl Hard


Immediate








Leadership vs power



tHe un-COmFORt ZOne


















wwwnobelbiocarecom


copy N

ob

el B

ioca

re S

ervi

ces

AG

2

01

1

All

rig

hts

res

erve

d

No

bel

Bio

care

th

e N

ob

el B

ioca

re lo

go

typ

e an

d a

ll o

ther

tra

dem

arks

are

if

no

thin

g e

lse

is s

tate

d o

r is

evi

den

t fr

om

th

e co

nte

xt in

a c

erta

in c

ase

tra

dem

arks

of

No

bel

Bio

care

NobelProceraTM



removable solutions



at tissue level



EW



Call 1-888-658-2584










Quick Up


inDustRy neWs








inDustRy neWs













CLassiFieDs












SALETHE










tASMAniA AuStrALiA



CLassiFieDs


Or

































































WHY PAY MORE



NEWNEW

