YOUR DENT MAGAZINE BY KULZER #3 THE NEW NORMAL VIEWS Dentists worldwide, p. 4 KNOWLEDGE IOS, p. 10 CASE Fillings, p. 14 EXPIERENCE Kulzer Mobile Academy, p. 19

DEAR CUSTOMERS The pandemic continues to control our daily lives, routines and the way we work. We, as your global Kulzer team, want to thank you for your trust and loyalty during these – for all of us – challenging times. Please let me assure you: We are here for you without compromise! Our local teams work tirelessly to support you in maintaining the oral health of your patients; as we know their oral health is integral to their overall health. Please reach out to us whenever we can assist you. Together we will gain strength again and together we will overcome this crisis – because: We are better together. In the current WE issue we want to give you insights into how your colleagues around the world cope with the challenges arising through COVID-19. Kulzer employees from Germany, USA and Brazil share their experiences in a personal interview. Having yours and our employees’ safety in mind Kulzer decided to not attend various trade shows – this includes the world’s largest dental fair, the Inter national Dental Show in Cologne, Germany. Since this decision we have been working on an alternative event format that would offer you added value while giving us control and flexibility – especially in view of the pandemic. The solution we are now developing for you, our customers, is the Kulzer Mobile Academy, a concept that combines training and trade fair, personal meetings and digital exchange – close to you. Get curious and first insights in the magazine. We are all in this together. Together we are able to find solutions to stay connected, together we will gain strength again and together we will overcome this crisis – because: We are better together. Take care and stay healthy, Marc Berendes CEO Kulzer Write to us! Do you have any comments on this topic? We are always grateful for your suggestions – recommendations, questions, criticism – by e-mail: we@kulzer-dental.com #3 3

Members of my “Think Adhesive Group” and I were forced to use communication systems, until then little exploited, such as call conferences, video calls, and webinars. We saw a great need for help, so we published an ebook called “Dentist and Covid-19: how to manage the dental practice in the post-emergency” and a series of educational hand-outs called “Think Adhesive Pills”. This only goes to show how a highly critical situation can stimulate and trigger positive reaction mechanisms for the future! Dr. Riccardo Becciani, Dentist in Impruneta, Italy I learned that mankind can adapt to any situation, and everything is a mind-set that the brain can adapt to. During the lockdown, I adapted to a lifestyle I never thought I would be capable of: staying home, spending time with the family, and giving myself a goal every day. I have had a very active professional life in the last few years with lots of travel. I even had seven professional trips planned to conferences and courses where I was speaking in the months of the lockdown. All of them got cancelled, and I ended up at home with the only place I could travel being my backyard. Dr. Amir HadjHamou, Director of Elite Academy, Dubai, UAE Since the outbreak of COVID-19, what struck me most was the great effort put forth by the Chinese government and the dental industry to contain the pandemic. I did not pay enough attention myself at first, and thought that, as a dentist, my routine protective measures should be sufficient to prevent any respiratory infectious disease. Later, the dental departments were voluntarily closed in order to cut off any possible transmission path of the COVID-19 virus, even though the government had not intervened in the opening of public hospitals. Wenjia Wei, Phd. Head of dental Dept. of Shanghai Tongren Hospital, China Some lessons I have learned: stay connected with others, keep working, and keep yourself busy. Learn something new (I took up photography). Take a daily walk in nature. Read articles and watch webinars. And finally, don’t forget to enjoy a cup of tea or coffee with your family and keep hoping for a better world and future. Mr. Elie Fares, Dental technician, Lebanon #3 WHAT DO YOU THINK? Did you change already your behaviour or do you think things will get back to normal after a vaccine is found? Tell us under we@kulzer-dental.com! 5 5

Position Cost of materials and external services Salary costs Rent Other fixed costs Interest and redemption payments Employer’s salary Cost 10,000.00 € 20,000.00 € 5,000.00 € 5,000.00 € 2,000.00 € 8,000.00 € Total monthly regular payments 50,000.00 € As the owner of a dental practice, you are familiar with the monthly continuous flow of payments and withdrawals from day-to-day busi- ness. First determine – as shown in the example – the costs for materials, personnel, rent, and other running costs of administration and maintenance. Also take into account payments for loans and interest as well as private withdrawals in sole proprietorships and partnerships as imputed entrepreneurial income. This sum of regu- lar monthly payments, here 50,000 euros, should be the minimum amount available on the business bank account at the end of the month – after transfer of the total costs including wage and salary payments. This would pre-finance one month of daily business. Solid financing prevents unpleasant surprises Do you know the golden rule of financing? It requires the temporal correspondence between the raising of capital and its use as assets. Imagine your practice needs a new X-ray machine. It has a useful life of eight years. The loan you use to finance the purchase should run for the same period. The capital borrowed and the assets financed with it must therefore have the same maturity. The bottom line: calculate the financing to ensure sufficient liquid- ity. At the end of the day, you’ll be better off if you base your busi- ness activities on these two basic economic rules described in this article, understanding liquidity and smart financing. In the second part of this article, you will learn five concrete, detailed tips that will effectively support you in this. HANS-GERD HEBINCK Business consultant from Soest, Germany, helps dental laboratories and practices to improve their performance and profitability, e. g. through communication and team training. hebinck-unternehmensberater.de … and its possible consequences Liquidity is defined as the ability to meet all payment obligations – when they are due. Even if scarce liquidity does not necessarily lead to insolvency, it does increase costs compared with a company that has sufficient capital at hand. Common consequences of liquidity problems include: expensive interest due to exceeding credit lines extortion by banks in loan negotiations and poor financing conditions financing cancellations and loss of innovative strength lost profits from unused discount drawing possibilities costs from reminder fees and late payment surcharges due to late payment loss of reputation and poorer conditions with suppliers because payments are transferred too late loss of reputation among employees due to late salary payments and limited room for manoeuvring when deciding on salary increases The top priority should always be ensuring sufficient and appropri- ate liquidity. But how much short-term liquidity is advisable? Let's take a look at the following simplified figures, which are intended as a guideline for “good times” with a normal economic cycle: #3 7

4 4: Recognise and utilise leeway Conversely, some businesses have rather ample liquidity reserves in the form of large bank deposits. In such cases, there is a risk of a loss of profitability, e. g. due to a lack of interest or inflation. However, the effect of the low return on uninvested funds can be neglected at present – if one takes into account the low interest rate phase which is likely to con- tinue for a long time. In the case of large bank balances, however, consideration should be given to distributing these balances over accounts at several banks. The possible advantages: it may be possible to avoid or reduce negative interest rates and increase deposit insurance in the event of a banking cri- sis. If you have large bank balances, ask your house banks what deposit protection they currently guarantee. 5 5: Choose financing formats that are easy to calculate Do you know the difference between bullet loans and annuity loans? The annuity loan is the safe option: with financing calculated on the basis of the term. Here, the financing lasts as long as the actual use. In contrast, with bullet loans, the loan is not repaid over the term. Instead, an investment fund or a life insurance policy is saved at the same time – with the aim of having saved enough capital at the end of the term so that the loan can be repaid in one amount. Bankers or financial service providers usually promise that a considerable amount of capital will be saved in addition to the amount of the loan for retirement. That sounds good at first. But what if, for example, far too long repayment terms were chosen for practice start-up loans, and at the same time, the financial products for the savings do not yield the planned (and necessary) return? This often happens, with the consequence of financing gaps that have to be covered at an advanced age. A further disadvantage is the fees that are charged twice: as interest on the loan over the entire term, as well as for high commissions and/or expenditure premiums for the savings product. So always separate financing from investment transactions and avoid bullet loans – even if they are sold to you as a tax-saving model. CONCLUSION A good businessperson in a small or medium-sized company finances investments smartly and calculably, thereby ensuring sufficient liquidity in their dental practice. In good and less good times, it’s important to remain as independent of banks as possible, and you will be able to withstand even harder crises. WHAT EXPERIENCES DID YOU MAKE DURING CORONA-TIME? Share your views to the economic impact in your country under we@kulzer-dental.com #3 9 9 45

What are the advantages of an intraoral scanner during a pandemic? Is the 3D data not too large to send? Dr. Natalie Nöller: There are shorter, and fewer contact points due to digital data acquisition and transmission. When considering all the measures that are needed for taking conventional impressions – such as preparation of the tray, model making, tray cleaning and disinfec- tion, demoulding and trimming of the model – then digital impression taking is significantly faster (cf. das dental labor, 07.2020). In general, with the digital workflow patients also have to be called in less frequently and the treatment time is shorter overall. Furthermore, the exchange of impressions between practice and laboratory is no longer necessary, which reduces the risk of cross-contamination. Plus, intraoral scans have less direct contact with saliva and blood, which reduces the risk of infection among practice staff – even when there isn’t a pandemic. Are there other benefits with regards to COVID-19? Dr. Natalie Nöller: If the tray impression is not thoroughly cleaned and disinfected, the viruses can reach the laboratory via the impression. If the laboratory works with several dentists, the chain of infection can quickly become very long. With the intraoral scanner, cleaning and disinfection are limited to the device and the removable scanner tips, which are autoclavable. Cleaning and disinfection of the impression is no longer necessary, because the transmission to the laboratory is completely digital. Patient saliva and/or blood, droplets, and aerosols containing SARS-CoV-2 viruses can contaminate dental impressions. If not adequately disinfected, the contamination can be transferred to the plaster models (Papi P, Di Murro B et al., 2020). Ursula Schäfer: Depending on the scanner model or the associated software, there are also other advantages. An interesting function is, for example, Case Talk. This allows the patient to be sent home directly after the scan. The patient calls up the scan on his home PC or tablet via a secure link. The dentist then discusses treatment options and costs with the patient, and visualises the current situa- tion – all from a safe distance, e.g. over the phone. Cooperation with the dental master laboratory is also easier. Dentist and laboratory can discuss the patients’ cases unerringly and at a distance, and always remain in digital exchange even during ongoing work. Dr. Natalie Nöller: In this context, another advantage of an intraoral scan comes into play. In contrast to a conventional impression, which is a negative impression, the intraoral scan or its software generates a positive impression. This makes it easier for the patient to understand the oral situation, recognise possible problem areas, and be more open to treatment. Ursula Schäfer: On the contrary – for example with our intraoral scanner cara i500 – the file size for a full arch scan in high resolu- tion is 40 to 60 MB. This comparatively small file size also makes intraoral scans interesting for archiving purposes, i.e. since they are part of dental documentation and must usually be kept for 10 years. Dr. Natalie Nöller: This can reduce the storage space in the practice, which is taken up by physical models, which have to be archived. In addition, the low storage space requirement opens up further possibilities, for example patient monitoring. An annual full jaw scan can be compared with previous years to better detect changes. The scan data can also be used in the event of accidents involving tooth damage or loss, in order to be able to reproduce the dentition in detail. How does an intraoral scanner facilitate the dentist's daily routine? Dr. Natalie Nöller: In my opinion, the main advantage for the dentist is saving time while getting the high advantages. No time- consuming preparation and final cleaning of the impression trays is necessary. Instead, scanning times are short and the digital impression can be directly dispatched to the laboratory. In addition, failed impressions do not have to be repeated in a time-consuming and material-intensive manner. Insufficiently impressioned areas can be rescanned without difficulty. The good visualization makes it easier to explain the clinical situation and the planned treatment to the patient. Ursula Schäfer: The scanner and software optimise the workflow in the practice by automating previously manual work steps. For example, the Smart Scan Filtering function automatically removes unneeded areas – such as soft tissue – during the scanning pro- cess. An intraoral scanner also supports patient communication. The 3D images are a helpful tool for explaining a patient’s need for treatment, pathological findings, and for advising them. Are there indications that I cannot cover with an intraoral scanner? Dr. Natalie Nöller: For an implant-supported full jaw restoration or edentulous jaws, a conventional impression is still necessary. A conventional functional impression also proves to be more advanta- geous for the fabrication of digital total prostheses, as the movable mucosa areas cannot be scanned correctly, and functional aspects are not taken into account. In general, the intraoral scanner is spe- cialised for smaller works. Ursula Schäfer: The manufacturers are continuously developing their systems. A large part of the further development is taking place on the software level, while the hardware or handpiece remains unchanged. This gives the dentist the security to profit from their investment for as long as possible. #3 11 11

TRAINING 2.0 WEBINARS DURING COVID-19 CRISIS Dentists cannot do their work from home. Still, many lockdowns in countries put dentists in the situation that they were not allowed to treat patients, or that patients only went to the dentist in the case of emergency. What to do with the extra free-time? Where to get new information, stay up-to-date, or improve your knowledge in dental fields? Workshops or in-person clinical education were no longer possible. That’s when another new normal stepped in: webinars. At Kulzer, we adapted to the new situation as well, and have been providing more webinars for our customers. Thanks to many years of innovation in all dentistry fields, and good contact to experts in the dental world, we were able to organise various webinars on diverse subjects. We also trained our own staff, providing training to 1,052 people in 62 webinars! Here are some details about our customer webinars from March to September 2020: Countries: Belarus, Benelux, Brazil, France, Germany, India, Italy, Kazakhstan, Mexico, Middle East, Poland, Russia, Spain, USA Topics/Purpose: 32.1 % 18.9 % 11.3 % 7.5 % 5.7 % Restoration Impression Bonding Teeth Prosthetics Digital Signum Ceramics Scrap Others 5.7 % 5.7 % 3.8 % 3.8 % 5.7 % Example of a webinar Webinar with the most participants: Indirect Mock-up, Speaker Dr. Amir Hajdhamou, 6,100 participants Webinars held: 66 Participants: 31,363 YOU WANT TO JOIN ONE OF OUR WEBINARS? Then go to kulzer.com/we-elearning and click on your country to see whether and which webinars are being offered! #3 13

So how can dentists react appropriately to this shift in patients’ needs without compromising quality? In light of a mutual interest, it can be beneficial to replace prosthetic works with direct fillings. Of course, the tooth should have suffi- cient residual stability for a filling therapy. Advantages include: • • • Reduce the exposure for infection, because only one appointment is needed. Patients will welcome a solution which allows them to save money. Direct restorations as well as intraoral repairs of restorations preserve more tooth structure than indirect restorations. In the past, only small and mid-sized cavities were considered an indication for direct compos- ite restorations. This limited the application of direct composites in stress-bearing posterior areas to the reconstruction of single cusps. But are these recommendations still valid in light of the tremendous developments of resin composite materials in recent years? Dental practitioners increasingly use direct adhe- sive composite restorations in heavily restored anterior and posterior teeth. Additionally, recent research and development has improved physical properties and introduced composite materials containing nanoparticles, which have increased the existing range of possibilities for direct com- posite resins. New matrix chemistries like TCD and optimised filler systems have extended the indications of direct composite restoratives. Kulzer’s universal nanohybrid composite Charisma Diamond was developed to minimise the primary causes of restoration failures, i.e. fractures and secondary caries with restorations in the posterior area1. Instead of the conventional Bis-GMA chemistry, Kulzer’s TCD-urethane crosslinkers are used in Charisma Diamond. This special monomer has a high reactivity that leads to a strong and dense network. Together with an optimised filler system, the mechanical resistance to masticatory forces is increased. This special crosslinker has a further effect: its high packing density prior polymerisation leads to a lower shrinkage. This effect accompa- nied by a high elasticity of the monomer reduces shrinkage stress, which is one of the precondi- tions for a good, long-term marginal quality. These properties were already confirmed by various studies within the last decade. The shade concept of Charisma Diamond is based on three levels of translucency. It is suitable for all kinds of restorations, ranging from simple mono-shade fillings up to multi- shade restorations for high aesthetic situations. To complete the shade range of Charisma Diamond, in 2020 Kulzer has introduced the additional ONE shade. This shade has an adaptive light matching effect. Consequently, for basic restorations mainly in the posterior area, ONE adapts to the colour of the surround- ing tooth. The practitioner does not need to select a shade anymore as ONE can match any tooth shade. COVID-19 has definitely changed our way of thinking and behaving. With the right materials like Charisma Diamond and its new option in ONE shading, dentists can meet patients’ needs easily and efficiently and still keep up restoration quality and aesthetics. 1 Demarco FF et al.: Longevity of posterior composite restorations: Not only a matter of materials. Dental Materials 28 (2012):87-101. TRY IT OUT FOR YOURSELF: kulzer.com/try-charisma-one Find the filling – it’s time for a short quiz! kulzer.com/ we-charisma-one-quiz #3 15 15

Case 2: Case 3: The ONE shade effect in a basic posterior restoration by Prof. Dr. Nicola Scotti, University of Turin, Italy 1 2 59-year-old male patient presenting a secondary caries on the amalgam restoration of tooth 26. After rubber dam application, the cavity was excavated and prepared. 3 4 The cavity was bonded using GLUMA Bond Universal after a selective enamel etching. Charisma Diamond ONE Shade was used to restore the proximal wall. After light curing, the dentine was covered by a 0.5 mm thick Charisma Opal Flow layer. The restoration was layered in an oblique layering technique using Charisma Diamond ONE Shade. 5 6 Fissures were characterised by a brown staining resin. Final Charisma Diamond ONE Shade resto- ration after finishing and polishing. The entire treatment time was 24 minutes. Charisma Diamond ONE Shade allows efficient and aesthetic basic restorations. Direct posterior restorations of Charisma Diamond instead of inlays, (partial) crowns by Dr. Sanjay Sethi, Squaremile Dental Centre, London, UK Amalgam fillings of teeth 24, 25, 26 and 27 had to be replaced due to underlying caries. Teeth 26 and 27 were both planned to have core fillings and later crowns due to the extent of the cavities after excavation. Before any indirect cuspal coverage resto- rations, it needs to be ensured whether the pulpal status is still fine. For this reason, Charisma Diamond direct composite resto- rations (except tooth 26) were placed. 1 Pre-operative view of the upper left quadrant. The amalgam fillings were replaced due to underlying caries. Teeth 26 and 27 were both planned to have core fillings and later be finalised with crowns due to extent of the cavities. 2 Post-operative view of the upper left quadrant restored with Charisma Diamond direct composite restorations (except tooth 26). Teeth 24 and 25 had the definitive restorations whereas teeth 26 and 27 were due to have crowns placed at a future date. This example shows an alternative treat- ment strategy for the COVID-19 times. Extended direct fillings can be placed as a long-term provisional to postpone indirect restorations #3 #3 17 17

UPSKILLING WITH THE KULZER MOBILE ACADEMY TRADE SHOW FEELING DESPITE COVID-19 How can knowledge transfer and new products, personal exchange and digital dialogue formats be combined? We have developed a solution for our customers and partners which, despite COVID-19, offers a certain trade show feeling: The Kulzer Mobile Academy. STEFAN KLOMANN Chief Marketing Officer “After our decision not to take part in the coming IDS, we worked on finding an alternative event for- mat that would offer our customers real added value while giving us control and flexibility – especially in view of the pandemic,” says Stefan Klomann, Chief Marketing Officer at Kulzer. The Mobile Academy, with which Kulzer will be touring the world from 1 March 2021, is a new training concept and is entirely dedicated to further training: customers are invited to expand their knowledge and skills with Kulzer training courses and at the same time get to know new Kulzer products. Customers do not need to go on an extensive journey – the Mobile Academy brings the most important information about the fair directly to their doorstep in a trailer. The Hanau-based dental company is heading to more than 200 locations in Germany, neighbouring European countries and the USA with the Mobile Academy Pavilion, whilst observing the local Covid 19 guidelines. The Mobile Academy will start on 1 March 2021 at the Kulzer headquarters in Hanau, accompanied by reports in the social media, such as live streams of the lectures. There will also be online services throughout the entire truck tour, so that the dental experts will be able to participate virtually in the tour or in individual lectures and training sessions. With this concept, we want to offer our customers a way to enjoy a relaxed event close to their place of work during this extraordinary time without the long journey, the hustle and bustle of the trade fair and the associated uncertainties. FOLLOW US ON FACEBOOK OR INSTAGRAM and stay up-to-date when we announce our tour plan for the Kulzer Mobile Academy! https://www.facebook.com/kulzerinternational/ https://www.instagram.com/kulzerinternational/ #3 19