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INFORMATION FOR CANDIDATES POST OF: Specialist Orthodontic/Maxillofacial Technologist BASE: University Hospital, Crosshouse REF NO: T/769/13 Thank you for applying for the above post with NHS Ayrshire & Arran. This information sheet summarises the terms and conditions related to the post. Please note if you provide us with an email address on your application form any future correspondence regarding this post will be emailed to you. If you do not wish to receive this correspondence by email then please contact us as soon as possible. A job description and person specification for the post are attached. This post is Permanent. The salary for the post is based on the Band 7 salary scale which is currently £30,764 to £40,558 per annum (pro rata for part time posts). The hours for the post are 37.5 hours per week. DISCLOSURE SCOTLAND PROTECTION OF VULNERABLE GROUPS (PVG) SCHEME The following provides information relevant to the post you have applied for and requires your attention and completion. PVG MEMBERSHIP The post you have applied for is considered to be in the category of “Regulated Work” as defined by the above scheme and successful candidate(s) will be required to be a member of the scheme prior to commencing employment. Membership currently costs £59.00. The cost of membership, if you are successful in your application, will be paid by NHS Ayrshire and Arran. EXISTING PVG MEMBER Applicants who are already a PVG member will require to confirm their membership and the regulated workforce this covers, eg, Adults, Children or both. Prior to employment, NHS Ayrshire and Arran will determine whether the current level of membership is appropriate for the post offered. If further membership to cover another regulated workforce is required, the conditions of membership as stated above will be applied. If however the level of current membership is appropriate, NHS Ayrshire and Arran will seek a Scheme Record Update (SRU) and will both pay and incur the costs associated with obtaining the update. Further information on the scheme can be found on the Disclosure Scotland website at www.disclosurescotland.co.uk D7 (26 September 2012) 1 PVG SCHEME MEMBERSHIP MANDATE (Please complete Sections 1+2 and return with your application) Section 1. Personal details (* circle as applicable) Name ____________________________ Post Reference Number: Post Applied for: ___________________ ___________ Are you currently a member of the PVG Scheme *YES/NO If YES, please provide Membership Number _________________ Date of Membership _______________ Date of last Scheme Record Update (if applicable) Member of which Regulated Workforce: *Adult __________________________ *Children *Both Section 2. Declaration I understand if my application for this position is successful, I will require to become a member of the scheme covering the appropriate regulated workforce. Signed: Name: ______________________________ ______________________________ Section 3 - For office use only Full membership required Yes/No Update only: Yes/No SPN: Date: _______________________ Post Ref no: _________________ Regulated workforce: Adult / Children / Both _____________________________ D7 (26 September 2012) 2 GENERAL CONDITIONS: Conditions of Service - The conditions of service are those laid down and amended from time to time by the appropriate negotiating bodies e.g. NHS Staff Council/NHS Pay Negotiating Council. Annual Leave – The leave year runs from 1 April to 31 March. Annual leave entitlement for full time staff on appointment is 202.5 hours (27 days), with 217.5 hours (29 days) upon completion of 5 years NHS service and 247.50 hours (33 days) after 10 years NHS service. Entitlements for part time will be pro rata. Public Holidays – Public holiday entitlement for full time staff is 60 hours based on the 8 designated Public Holidays per annum, and on a 5 day week working 7.5 hours per day. The 60 hours entitlement is due to all whole time staff irrespective of work pattern. For part time staff, this will be applied on a pro rata basis and also allocated in hours. KSF - The NHS Knowledge and Skills Framework is essentially a development tool but will also contribute to decisions about pay progression. It will promote equality for and diversity of all staff, having the same opportunities for learning, development and review. It will promote effectiveness at work – with managers and staff being clear about what is required within a post. It will support effective learning and development of individuals – with all members of staff being supported to learn throughout their careers. Pensions - Employees are automatically opted into the NHS (Scotland) Superannuation Scheme. Contributions are at the rate of 9%. Employees may opt out by obtaining and completing the relevant Opt Out form from the Scottish Public Pensions Agency website. Disabled Applicants - A disability or health problem does not preclude full consideration for the job and applications from people with disabilities are welcome. All information will be treated as confidential. NHS Ayrshire & Arran has been approved, by the Employment Services Department, as an Equal Opportunities employer with a positive policy towards employment of disabled people. NHS Ayrshire & Arran guarantees to interview all applicants with disabilities who meet the minimum criteria for the post. You will note on our application form we ask for relevant information with regards to your disability. This is simply to ensure that we can assist you, if you are called for interview, to have every opportunity to present your application in full. We may call you to discuss your needs in more detail if you are selected for interview. Asylum and Immigration Act 1996 and 2004 (Section 8) - The Asylum and Immigration Act 1996 and 2004 requires employment checks to ensure that all employees are legally employed in the United Kingdom. Candidates will be asked to provide relevant original documents prior to an offer of employment being made. Any offer of employment will only be made when the organisation is satisfied that the candidate is the rightful holder of the documents and is legally eligible for employment within the United Kingdom. Medical Examination - Any offer of employment is conditional upon a satisfactory medical report from our Occupational Health Services. You may be offered employment conditional on confirmation that you are medically fit for employment. A commencement date for employment will only be agreed following this confirmation. D7 (26 September 2012) 3 Policy Relating to Staff with Bloodborne Virus Infection - Candidates for posts which involve exposure prone procedures will not be allowed to commence employment until they have been assessed as fit to perform EPPs by Occupational Health. The preemployment screening must be completed prior to any job offer being made. Where a candidate is not able to perform EPPs, Occupational Health will notify the appropriate manager that the candidate is ‘fit with restrictions’ and is unable to perform EPPs. The health status of the individual will not normally be notified to management. Where the restrictions recommended by Occupational Health are unable to be accommodated due to the clinical duties of any of the posts within the staff groups specified in the policy, an offer of employment to the post will not be made. Candidates who are not offered employment due to being deemed unfit to undertake EPPs as an essential requirement for a post, may be offered the opportunity to apply for another advertised vacant post and be considered with other applicants. The preemployment screening for EPP posts above do not apply to staff undertaking non-EPP posts who could have direct contact with blood, bloodstained body fluids or patients’ tissue in the course of their work activities. These staff will be offered and strongly advised to be immunised against Hepatitis B in line with the Immunisation Policy including recall for boosters and further antibody checks. References - Two satisfactory written references must be obtained prior to any offer of employment being made. These should include current and previous employers as requested in the job application form. This is in line with the Recruitment and Selection Policy. YOUR APPLICATION: Informal Enquiries - Informal enquiries are welcomed by Mr Iain Mathieson, Senior Chief Maxillofacial Prosthetist & Technologist, Oral Facial Laboratory, University Hospital, Crosshouse, who can be contacted on 01563 827320 or e-mail [email protected] Closing Date - Your completed application form should be submitted by Friday 6th December via the online application form on the SHOW website. Alternatively your completed application form can be returned to the address below or can be e-mailed to [email protected] Department of O&HR Development 63A Lister Street University Hospital Crosshouse KILMARNOCK Ayrshire KA2 0BE D7 (26 September 2012) 4 1. JOB IDENTIFICATION Job Title: Technologist Highly Specialist Orthodontic Technician/Maxillofacial Prosthetist and Responsible to (insert job title): Senior Chief Maxillofacial Prosthetist and Technologist Department(s): Oral Facial Laboratory Directorate: Planned Care (Head and Neck) Operating Division: Patient Services Job Reference: No of Job Holders: 1 Last Update (insert date): 09/10/2013 2. JOB PURPOSE Provide scientific and advisory services to patients for their rehabilitation by restoration utilising implants, splints, active/passive appliances and prostheses. 3. DIMENSIONS The Oral Facial Laboratory is the sole unit of its kind serving the patient population of Ayrshire and Arran and beyond by providing clinical, technical and advisory services to the Maxillofacial, Ophthalmology, Advanced Restorative Dentistry, E.N.T. and Orthodontic services. Specialist in the provision of the orthognathic model planning service This post is responsible for supervising and training junior members of staff and students so that timely and high quality technical support is provided for all service users Designated signatory for i.e. non- stock and stock requisitions, purchase orders and invoice certification Providing through design and fabrication, complex and highly complex range of appliances for the Maxillofacial, Orthodontic, Restorative, Ophthalmology, Ear Nose and Throat Specialised Services. Providing clinical and technical service to ophthalmology patients when requested by the Senior Chief Maxillofacial Prosthetist and Technologist Providing clinical and technical service to E.N.T./Maxillofacial patients in the provision of facial prostheses when requested by the Senior Chief Maxillofacial Prosthetist and Technologist. D7 (26 September 2012) 5 4. ORGANISATIONAL POSITION Senior Chief Maxillofacial Prosthetist and Technologist Secretary Highly Specialist Orthodontic Technician Post holder Specialist Orthodontic Technician Specialist Orthodontic Technician Students 5. ROLE OF DEPARTMENT Provide scientific and advisory services to the patient population of Ayrshire & Arran and beyond through provision of the following: Artificial Eye design, fabrication and fitting service Facial Prosthesis design, fabrication and fitting service Orthognathic Surgical Planning service Orthodontic Appliance design and fabrication service Maxillofacial Appliance design and fabrication service Restorative Appliance design and fabrication service Osseointegration Implantology design, fabrication and fitting service All of the above specialised services require the necessity to liaise with consultants, junior medical staff, patients and other relevant parties to ensure up to date information and episodes relating to patient care and future planning of treatment. D7 (26 September 2012) 6 6. KEY RESULT AREAS Provision of a broad and extensive range of restorative appliances incorporating innovative design and fabrication techniques for the restoration of speech, mastication and facial form Provision of a broad and extensive range of highly complex orthodontic appliances incorporating innovative design and fabrication techniques for the correction of patients’ malocclusions and tempromandibular joint dysfunction Provision of highly specialised intra oral osseointegrated implantology retaining systems incorporating consultation, design, fabrication, fitting and maintenance for use in retaining oral prosthetics in situations where normal means of prosthetic retention is impossible, e.g. patients with atrophic mandibular/maxillary edentulous ridges, oncology patients having undergone radical ablative surgery for tumour removal etc Provision of a broad and extensive range of highly complex maxillofacial appliances incorporating innovative design and fabrication techniques in the treatment of craniofacial injuries. Ability to deputise on a rotational basis for the Senior Chief Maxillofacial Prosthetist and Technologist by being responsible for the departments capital and revenue budgets to ensure the operational efficiency, quality of work, purchasing of equipment/supplies and contracting out of work to external laboratories provides value for money. Provide risk assessments for designated laboratory areas. Supervise and training of junior staff or students and fellow professionals and to prepare material for post graduate courses as required Practitioner in the delivery of clinical, technical and advisory expertise in the provision of the orthognathic surgical planning service for the correction of mandibular/maxillary skeletal jaw discrepancies requiring osteotomy surgical intervention. Involvement in the care of facial/ocular patients who require regular maintenance of their prosthesis Identify action research and development as required for own mandatory Continuous Personal Development. Required to support and be involved in clinical trials and equipment testing Participate in Continuous and Personal Development Plans through regular appraisals with Senior Chief Maxillofacial Prosthetist and Technologist Participate with clinicians as appropriate and advise other health care professionals relevant to scope of own knowledge and practice on matters specific to the Oral Facial Laboratory specialised services Provide clinical and technical information regarding the long term management of a medical device Use and programme computerised systems in the production of medical devices Observe and comply with current Health and Safety and COSHH legislation to safely handle and use laboratory equipment Comply with Medical Devices Directive 93/42/EEC ensuring all materials, component parts and processes for appliance patient provision meet national guidelines Adhere to departmental policy/guidelines regarding cross infection Monitoring the administration of laboratory work as necessary Maintain the strictest confidences in relation to personal related information of patients Set up, use and maintain computer controlled equipment in the production of medical devices IT communication skills required, e.g. email, word processing to produce written reports, internet for research purposes and compiling presentation materials. D7 (26 September 2012) 7 7a. EQUIPMENT AND MACHINERY Socket Extractors - for the removal of ocular prosthesis from anophthalmic/eye sockets. Torque Driver - a specialised instrument incorporating a torque limiter to ensure that when screwing Branemark Osseointegrated Implant components into the connecting abutments or implant fixtures which are embedded in facial/mandible maxillary cortical bone, that the correct amount of torque required to connect the components together is supplied (very important as over tightening can result in implant failure). Branemark Magnetic Screwdrivers - utilised for the connection/removal of magna caps/magna abutments to osseointegrated Branemark/Bonefit implant systems, abutments and fixtures which are imbedded in cortical bone. Branemark Implant Screwdriver – a specialised instrument required for torquing gold screws into Branemark osseointegrated implant components for retention purposes. Hanau Face bow - used to record and transfer patients facial/skeletal information, e.g. face bow recording is taken by attaching bow to condyler heads of patient's mandible, bite fork to maxilla and orbital pointer is placed on lower border of orbital bone. This records 3 points of reference for data transfer on to a specialised recording instrument called an articulator prior to orthognathic model surgery planning taking place. Centrifugal Casting Machine - used in the casting of metals for the provision of silver cast cap splints required in the treatment of facial, mandibular, maxillary bone fractures by relocating and stabilising the fractured fragments in place to permit bone healing to take place. Also used in the casting of metals for the provision of silver cast cap orthodontic expansion appliances required in the treatment of patient malocclusions. Furnace - required for heating and burning out of wax from splint investment models prior to casting of silver cast cap splints and rapid expansion orthodontic appliances. Computer Controlled Dry Heat Electric Oven - required for the processing of various types of materials by changing the materials from, e.g. acrylics from dough stage to hard acrylic stage, silicones from a runny/stringy stage to a soft solid stage in the manufacture of prosthesis, in the treatment of hemi/partial maxillectomy patients, restorative, maxillofacial and orthodontic appliances. Computer Controlled Soldering Unit - required for the soldering of gold, stainless steel appliance and system components, e.g. gold bars onto gold abutments as a process in the forming of implant retention systems. Stainless steel wires and tubes in the fabrication of orthodontic appliances, etc. Gas-Air Blow Torch - required for soldering of nickel silver wire in the fabrication of mandibular/maxillary arch bars for the stabilisation of fractured bone fragments in the treatment of patients’ trauma injuries; heating of investment moulds and subsequent soldering of gold bar/implantology components in fabrication of intra-oral retention systems. Polishing/Abrading Units Incorporating Internal Extraction Systems - utilised in the abrading/polishing processes of appliance fabrication. External Fume Extraction Systems – utilised for the safe removal of harmful fumes created in the fabrication of medical devices, e.g. soldering, metal casting, heating of investment moulds, etc. Sandblaster - required for removal of contaminants from the surfaces of metal splints (cast cap) and appliances. D7 (26 September 2012) 8 Computer Controlled Electrically Heated Pressure Vessel - utilised in the manufacture of auto polymerising acrylic resin materials, e.g. changing the state of acrylic resin from a fluid material into a hard surface material in the forming of orthodontic, maxillofacial appliances and devices, etc. Light Cure Processing Unit - utilised for fabrication of patients’ impression trays, additions of occlusal cover to restorative orthodontic appliance, appliance fabrication where patients have sensitivity to acrylic resins. Microwave - required for quick method heating of reversible hydrocolloid material for model duplication purposes. Dry Heat Oven - utilised for heating and drying of working and study models and preparation of models prior to orthognathic surgery planning. Fridge - utilised for the storage of materials to extend shelf life. Computer Controlled Hydromat Boiling Out/Processing Unit - required for automatically flushing wax from plaster moulds and then processing acrylic resin material under pressure for a pre-programmed period of time changing material state from dough to solid. Computer Controlled Safety Cell Trimming Units Incorporating Integral Dust Extraction Systems and Micro Motor Hand Pieces - for the trimming, shaping of appliances utilising computerised electrical micromotors with constant adjustable dust extraction employed. High Speed Grinder - required for the trimming to shape of extremely hard metals such as cobalt chromium. Computer Controlled Downflow Fume Extraction Systems - employed to remove harmful methyl-methacrylate fumes in the mixing and spraying techniques involved in acrylic resin appliance /prosthesis fabrication. Steam Cleaner – required for removing residue from appliance surfaces following deflasking process. Magnifiers – for enlargement of intricate and extremely fine items of work. Computer Controlled Duplicating Machine – utilised for the duplication of large numbers of plaster models. Computer Controlled Vacuum Mixer - required for the mixing of plaster of paris/stone model materials producing a vacuum to ensure that all air is removed from the material prior to use in model casting. Electrical Orthodontic Plaster Trimmer - required for trimming of plaster/stone models essential for the production of orthodontic study/working models and orthognathic surgical planning models. Disinfection Baths – utilised for disinfection of body and oral impressions. Workstation Dust Extraction Systems - required for removal of harmful acrylic/metal dusts created through shaping and trimming process. Natural Daylight Lighting - required for tissue matching patient’s skin tones with suitable shaded silicones so that body prosthesis mimics natural tissue tones of individual patients. Workstation Natural Daylight Lighting – essential for fabrication of extremely fine appliance wires, components in the provision of patient prosthetics and the modelling of dental waxes. D7 (26 September 2012) 9 Laptop Computer - for viewing records of patient’s body appearance and providing presentations to members of staff and visitors - providing presentations. Electric Carving Knife - required for trimming excess vacuum forming material from soft and hard laminated mouthguards, anti-snoring appliances, essix retainers, etc. Vacuum Forming Machine -utilised for adapting various types of plastic material closely to working models in the fabrication process of mouthguards, anti-snoring devices, essix orthodontic retainers, vacuum trauma splints, etc. Glue Gun - utilised for dispensing specialised adhesive glues onto soft laminate materials for bonding of maxillary/mandibular components when fabricating anti-snoring devices. Dental Surveyor Parallelometer - utilised for analysing the path of insertion and planning and tracing of plates and clasps by locating and recording undercut depths present in patients’ maxillary/mandibular arches, prior to appliance fabrication. Various Types of Anatomical Articulators - utilised for orthognathic model planning following transfer of patients data by face bow and appropriate model surgery employed establishing the required movements of the maxillary/mandible through splitting or resetting of jaw in theatre to establish normalised jaw relationship ensuring balanced occlusion of prosthodontic/maxillofacial appliances. Full Sets of Orthodontic Pliers and Cutters - required for the forming of extremely intricate, fine wire components in the fabrication of all types of orthodontic and certain maxillofacial appliances. Full Sets of Carving and Modelling Instruments - required for the sculpting and modelling of various consistencies of wax to form nipple areola prosthesis/oral prosthetics/certain types of orthodontic appliances, etc. Sterile Instrument Kits for Orthognathic Appliance- required for the recording of facial data in the treatment of orthognathic appliance fabrication. Bunsen Burners – required for heating of various types of waxes for sculpting, modelling purposes in the prosthesis/appliance fabrication. Micro-torches - required for flaming and smoothing of modelling/carving/casting waxes during sculpting and modelling procedures. X-Ray Viewer - utilised when viewing patients’ radiographs prior to orthognathic model planning surgery/immobilisation of jaw/facial fractures, etc. Positioning of implantology fixtures in cortical bone (determining ideal position). Clinic Patient Chair - required for treatment of patients. Electronic Weighing Scales - required for calculating ratio of silicone body elastomer to be mixed with silicone catalyst to provide a patient prosthesis of the desired specifics, e.g. degree of softness required in relation to shore hardness, etc. Computerised Vernier Gauge - required for measurement of appliance components, base plate, occlusal, anterior bite platforms, etc. Calipers – for recording material thickness of appliances to microns of accuracy Plaster Oscillator - utilised for the removal of occluded air from plaster/investment material during casting/investing procedures. Ultrasonic Bath - utilised for the removal of ingrained materials from appliances following de-flasking of appliance from plaster or investment moulds. Also used in conjunction with ammoniated cleaning fluid for the removal of tarnish from metals. D7 (26 September 2012) 10 Computer - for producing typewritten documents, maintenance of databases, retrieval of information, accessing email, internet for research and development purposes, etc. Printer/Scanner/Copier - producing hard copies of work stored on computer. Fax Machine - sending and receiving facsimile documents. 7b. SYSTEMS Manual Records – appliance prescription cards stored chronologically for retrieval by technical/admin staff; diaries of appliance/work requests updated daily; files holding information on Laboratory staff for leave, training, etc; paper diaries of staff; resource files for reference purposes, e.g. Safety Health and Environmental Manual, Child Protection Protocol Manual, requisitions placed retained for reference/invoice processing purposes, brochures of supply companies, etc Patients’ medical photography - filing systems on J-peg, slide and photographic prints which can be accessed at future dates for patients review purposes. Also for teaching and training purposes for Junior Members of staff/students, e.g. presentations, etc where permission has been explicitly given by patients. Medical Devices Directive Recording and Tracking System - This system is utilised for the documenting of C marked materials and components which are provided to patients through the provision of prosthesis and appliances on completion of their treatment plans. This also permits the tracking of components and materials to their supplying company where LOT numbers can be checked for conformity where failure of material component has occurred. These forms are filed in chronological order and retained for 5 years. Safe Systems of Work - Located through resource file and computerised information system. carrying out the work to ensure adherence to the approved systems. A reference system requiring to be complied with to ensure that approved and documented safe systems of work are followed in the day to day fabrication and provision of appliances. Risk Management - Located through resource file and computerised information systems. A system requiring to be accessed and complied with to determine the risks arising from identified hazards and the appropriate precautions to be taken within the workplace. Osseointegrated Implantology Systems - Employed in the production of patients restorative appliances. Customised components required for patients are ordered in advance from supplier, with patients’ details provided for medical device certification to be issued with components specific to the individual patients. Components are then fitted to patients at various stages of treatment gradually building up the retaining systems of choice and fabricating the individual system components together to permit engagement and retention of the restorative device to the osseointegrated implantology fixtures previously embedded in the maxillary/mandibular cortical bone. D7 (26 September 2012) 11 8. ASSIGNMENT AND REVIEW OF WORK Work which is referred to the laboratory from the specialist orthodontic, maxillofacial and restorative clinics has the appliance type, time and date information transferred from supplied work cards into laboratory work book. Appliances which are referred for fabrication from external clinicians for income generation purposes would be assigned to postholder by the Senior Chief Maxillofacial Prosthetist. Complex/highly complex work which is appropriate for the post is allocated daily by self and undertaken under own initiative. Work which is of a non familiar/highly complex nature would be issued by the Senior Chief Maxillofacial Prosthetist. Work is reviewed by Senior Chief Maxillofacial Prosthetist and Technologist/Head of Department through regular personal contact and formal meetings, written reports, e.g. Personal Development Planning. Quality assurance of work is achieved and maintained through conformity on a daily basis with Medical Devices Directive 93/42/EEC. This is an appliance/prosthesis recording system for material/component conformity and quality control checking system for adherence to prescription plans which is countersigned by senior members of staff. 9. DECISIONS & JUDGMENT Postholder is required to supervise the junior members of staff/students, on occasions when the Senior Chief Maxillofacial Prosthetist is unavailable. These situations, although rare, do require utilisation of supervisory skills to ensure that service delivery is unaffected . Typical judgements required of the post may involve: In the provision of restorative prosthesis for the re-establishment of mastication, speech and facial aesthetics for patients who have undergone major oral surgery, e.g. partial removal of mandible/maxilla, etc. and where prosthetics retention is unachievable through conventional methods, innovative highly specialised advanced retaining systems are often required to be employed, such a system would require thorough analysis of radiographs, 3D models and case conferencing with restorative, Maxillofacial consultants involved to determine the position and number of implant fixtures to be placed in the patients central mandibular/maxillary bone. Further judgements are made as to the type/design of highly complex osseointegrated intra oral implant retention system which would best aid patients denture stability by analysing the amount of space available between abutments, vertical height, available space between abutments and fitting surface of denture, assessment of patients masticatory force and jaw relationship etc before deciding on the definitive system to be utilised, e.g. gold bar and clip, closed field magnetic, ball attachment, combination of magnet and bar, etc. Assessment of occlusal bite registration supplied by clinician prior to fabrication of highly complex functional orthodontic appliance, e.g. clark twin block, andresen etc to ensure that the mandible has been advanced in association with increased vertical dimension within set parameters required for successful muscular action to be channelled into active skeletal base and tooth movement. When occlusal bite registrations do not adhere to the above parameters, a discussion would take place with clinician involved and a new 12 D7 (26 September 2012) occlusal registration requested. Typical decisions and judgements would include requirement to design appliance (when clinicians do not complete appliance cards and rely on the knowledge of the technician) and construct highly complex functional appliances which are invariably used in the treatment of the most severe malocclusions; functional component analysis, i.e. patient requirement and appliance capability, is essential preliminary to the design of the functional appliance; be able to assess the accuracy of the clinical records; position and type of retentive and active components; assessment of the retentive and active components for an adequate anchorage; depth of buccal shields when constructing Frankel appliance; position and angulation of the occlusal planes is crucial to efficiency in correcting arch relationships when constructing Twin Block appliances. Required to design and construct highly complex intra oral obturation devices for patients who have undergone ablative surgery, e.g. hemi-maxillectomy, where a large proportion of the maxilla has been surgically removed. Analysis of the tissue morphology of the defect area is essential to determine the type of obturation system best suited depending on analysis of undercut areas present in defect site and patient’s tissue condition. After close examination, a decision would be made as to the type of material to be used, e.g. heat cure/self cure/light cure acrylics, soft silicone, expanding foam, etc. Additional means of support required for retention of the prosthesis, e.g. lever system, buccal springs, implantology system incorporating retentive framework within prosthesis with full analysis and consideration given to the prosthetic ramifications involved. Orthognathic Model Surgery When treating patients requiring orthognathic surgical model planning prior to theatre admission for the correction of mandibular/maxillary skeletal jaw discrepancies requiring osteotomy/ostectomy surgical intervention. As practitioner in the technical aspects of this field of work, all problems encountered in relation to the surgical model planning would be resolved by self following on from establishing patient information across multi-disciplines case-conferencing with specialist maxillofacial consultant surgeons, orthodontic consultants and junior medical staff. For example, determining timescale for various stages of surgical planning to be completed to ensure that the final surgical plan is achieved prior to patients scheduled theatre date. The completed surgical plan will have incorporated analysis, calculations and orientation of segmented model sections simulating the corrective mandibular/maxillary bone fractures and movements to be achieved in theatre. Recording of patient data pertaining to initial jaw positions prior to planning and final position of jaws following corrective post surgical position of mandible and maxilla, e.g. level of advance, impaction, occlusal cant, rotation centre, line movement, etc. Analysis, calculations and recording of data would be involved in the design and fabrication stages of fixation devices required for the holding and positioning of the fractured jaw segments in theatre, e.g. splints, arch bars, intermediate and final wafers, anterior projection bars locking plates, etc Further analysis, calculations and recording of data pertaining to model accuracy would be undertaken by self, e.g. orthodontic adjustment, cuspal modifications, occlusal relationship positioning, etc. Following on from taking face bow recording of patient in clinic and final adjustment of intermediate and final wafers when fitting over patient’s teeth to D7 (26 September 2012) 13 ensure that no premature contacts exist. The treatment details would be recorded in patient’s casenotes. 10. MOST CHALLENGING PARTS OF THE JOB The number of specialties that the post requires to provide direct services to, and the diversity of knowledge and skills required for the provision and implementation of each individual service, inevitably can result in difficulties being experienced through the frequency of unavoidable interruptions. Due to the nature of the post, keeping up to date with the latest innovative techniques for each specialised service becomes very challenging as many units in the country have departments specialising in a single individual specialty only. This post has to achieve and maintain similar high levels of knowledge and skills in not one but three separate specialties in the provision of high quality services to patients. When treating oncology patients who have undergone radical ablative surgery for the removal of malignant oral tumours resulting in a large area of palate removal (hemimaxillectomy) – these patients require provision of dental obturators to fill the defect site to 1. prevent food particles and fluid entering the nasal cavity; 2. restore mastication and speech; 3. restore facial contour. Additional retention may be required through the utilisation of implantology systems. Jaw movement may be inhibited through damage to tempromandibular joint as a result of radiotherapy treatment. Rehabilitation of the joint movement may be required through the fabrication of a trismus screw in an attempt to re-establish jaw opening to facilitate impression taking and prosthetic appliance provision. Due to the high complexity of the patient treatment plan, difficulty is often experienced with providing this type of patient with a successful functional, stable and aesthetically pleasing device. Non-conventional approaches have often to be employed requiring lateral thinking to surmount the many technical problems encountered. During the numerous treatment appointments that these patients have to endure, distressing situations can be experienced due to the patient’s prognosis which can be of a terminal nature. 11. COMMUNICATIONS AND RELATIONSHIPS Orthodontic, Maxillofacial, Restorative Consultants and Junior Medical Staff – require frequent communication face to face and by telephone for information sharing on appliance design Theatre Staff – face to face when requested to attend theatre for advisory purposes regarding obturation intra oral implant patients, etc. Nurses – frequent communication face to face and by telephone for training of nurses and information sharing regarding timescale for appliance construction/disinfection of impressions, etc to ensure appliances are delivered to external hospitals on due date/time and to ensure collection and distribution of work takes place Laboratory Secretary – frequent communication face to face/written information regarding used material items for stock control purposes. Information regarding equipment repair and liaising with Secretary regarding admin aspects of training, patient prescriptions, updating personnel records. D7 (26 September 2012) 14 Patients –frequent communication face to face, e.g. constructing. relieving/adjusting patients’ prosthesis/ appliances at chairside witnessing consent forms for medical photography; giving opinion/reassurance regarding cosmetic result of facial/ocular prosthesis; Clinical appointments for fitting orthognathic facebow recording device to patients for establishing points of reference data and subsequently transferring information into the model plan prior to surgery, these patients often require persuasion/reassurance due to the complexity of the apparatus involved which can be very off-putting for the patient. Many patients require to be shown empathy in regard to recent ablative surgery due to trauma, disease or congenital defects. College/University Lecturers – Face to face, email, telephone communication required when attending post graduate courses. Sales Representatives – Telephone, face to face communication when receiving information regarding laboratory materials, equipment and products. Involvement in specialised prototype component testing, attending company demonstrations. Education Department– Face to face/email/telephone/written communication when providing table top demonstrations/presentations to public, e.g. to large groups of school leavers who have an interest in medicine as a career and Open Days. Also in relation to distance learning when taking part Various internal departments - e.g. human resources, IT and Communication and Works Departments – face to face, telephone, written and email regarding information sharing and reporting. External Laboratory Contractors – telephone, written communication for relaying appointments/invoices/technical information and involvement in provision of specialised training courses. Medical Photography – face to face/telephone contact requesting picture format, quantity and viewing angle to be taken of patient/prosthesis for reference purposes Other Laboratory Staff – daily face to face/telephone/written/email contact regarding, e.g. information sharing, workload issues, advice and guidance training, laboratory staff meetings including requirement to participate in delivery of technical presentations. Technicians From Other Health Board and External Laboratories – face to face, telephone, written and email communication regarding information sharing, design of appliances requested, quality of work issues, etc. Medical Records- Requesting and returning patient case records. 12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB PHYSICAL EFFORT/SKILLS: Highly developed manual dexterity skills required when constructing precision appliances by the use of specialised instruments and equipment for the manipulation of extremely fine and intricate components such as micro screw systems, osseointegrated implantology components and associated materials. Highly developed artistic skills are a pre requisite for sculpting and shaping synthetic materials to imitate and recreate the form of lost human tissue. Excellent colour differentiation is a requirement for colour matching the synthetic prosthesis to the natural human tissue shades around the defect site. Keyboard skills required for communication purposes. Physical effort needed for the job - frequent standing or sitting for long periods, sudden lifting effort for short periods. D7 (26 September 2012) 15 Standing for protracted periods of time attending theatre, various stages of prosthesis\appliance fabrication e.g. flasking\packing\polishing. Clinic sessions e.g. tissue matching, etc. Sitting for protracted periods of time fabricating orthodontic\maxillofacial\prosthodontic appliances\ prosthesis etc. Lifting requiring sudden short bursts of effort e.g. lifting heavy 25kg bags of plaster, manoeuvring patients into chair, carrying\lifting material\equipment deliveries into stock cupboard etc. Sitting for periods of time at computer using keyboard skills for word processing and using internet for research and development purposes MENTAL EFFORT/SKILLS: Requirement for frequent intense prolonged concentration when dealing with orthognathic surgery planning. Intense concentration required when colour matching patients’ tissue tones with appropriate pigments to produce a colour matched prosthesis. Daily concentration required when intra oral implants are involved, complex and highly complex orthodontic\maxillofacial and prosthodontic appliances, obturation cases etc. Due to the extremely broad spectrum of specialised work undertaken and the nature of that work being of a non routine nature it is inevitable that perpetual interruptions complicate the working day. ENVIRONMENTAL AND WORKING CONDITIONS OF THE JOB: Regular contact with body fluids when treating patients e.g. as part of patient hygiene control cleansing mucopurulent matter from ocular patients anophthalmic sockets, cleansing blood and debris from around osseointegrated implant abutment sites, dealing with patient sickness, registering face bow recording in patients mouth, and fitting orthognathic wafers onto patient’s teeth, handling appliances removed from oral cavity. Monomeric fumes from acrylic resins used in prosthesis\appliance fabrication, fine pumice dusts created during abrading of appliances, fine dusts\fumes when heating and abrading nickel\silver during the fabrication of arch bars for the stabilisation of fractured bone segments in trauma treatment, risk of inhalation of fine silica dust particles during the investment stage of metal cast cap splint construction used for the stabilisation of fractured bone segments, inhalation of fine plaster dusts when model casting etc. Working alone with patients, where the potential for exposure to verbal\physical aggression inevitably exists. Noise pollution during operation of laboratory machinery and equipment. EMOTIONAL DEMANDS OF THE JOB: Due to the nature of the post which involves the rehabilitation through the prosthetic restoration of patients who have undergone radical ablative surgery, distressing circumstances are routinely encountered when treating this patient group. Examples of such circumstances are as follows. D7 (26 September 2012) 16 Treatment of patients who have recently been diagnosed as terminally ill. Empathising with terminally ill patients’ family. Treatment of malignancy patients who have undergone extensive radical ablative surgery. These types of patients are often mentally traumatised due to the extent of their disfigurement and require to be shown considerable empathy and given continuous reassurance and motivation. WORKING CONDITIONS: Frequent exposure to controlled harmful substances, e.g. monomeric fumes from acrylic resins involved in appliance construction. Inhalation of fine dusts during abrading/polishing/casting/ procedures. Vibration of hand when using micromotors. Inhalation of fumes during soldering process. Contact with body fluids during various patient procedures. Potential for exposure to verbal/physical aggression by patients during clinic appointments. 13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB BSc (Hons) Degree in Dental Sciences or equivalent. + MSc in Maxillofacial & Craniofacial Technology (3 years) or equivalent to gain membership of the Institute of Maxillofacial Prosthetists and Technologists. + Postgraduate Diploma in Orthodontic Technology (2 years) plus further experience and training in a range of advanced orthodontic technical procedures to Masters Degree level equivalent. + Substantial knowledge and experience of highly complex Technology (5years) advanced Prosthodontic + Registration with the General Dental Council + Registration with the Institute of Maxillofacial Prosthetists and Technologists Computer proficient requiring a working knowledge of Microsoft Software Packages. Experience of teaching students and other fellow professionals in clinical/technical aspects of undergraduate and postgraduate course content. D7 (26 September 2012) 17 Experience of invasive intra-oral and extra-oral, clinical procedures and operating theatre practice. Knowledge of advanced craniofacial techniques associated with extra-oral osseointegrated implantology. In depth knowledge and experience of advanced restorative techniques associated with intra-oral osseointegrated implantology. Knowledge and experience of orthognathic surgical planning systems. In depth highly specialised knowledge and a minimum of 5 years postgraduate experience of orthodontic functional, fixed and removal appliances. In depth highly specialised knowledge and experience of restorative obturation devices. Fully conversant with legislation covering data protection and patient confidentiality. Knowledge of current COSHH, health and safety legislation to safely handle and use laboratory equipment and materials. Knowledge of legislation relating to Medical Devices Directive 93/42/EEC ensuring all material, component parts and processes for prosthesis and appliance patient provision meet national guidelines through knowledge of relevant materials science, use of biocompatible materials, chemistry, rheology and toxicology. D7 (26 September 2012) 18 NHS Ayrshire and Arran Person Specification Post Title Highly Specialist Orthodontic Technician/Maxillofacial Prosthetist & Technologist Post Reference Number Selection Factors (Person Specification) QUALIFICATIONS & TRAINING Criteria Essential BSc (Hons) Degree in Dental Sciences or equivalent; Postgraduate Diploma in Orthondontic Technology plus further experience and training in a range of advanced orthodontic technical procedures to masters degree level equivalent; MSc in Maxillofacial & Craniofacial Technology or equivalent Desirable Full Membership of the Institute of Maxillofacial Prosthetists & Technologists (IMPT) EXPERIENCE Essential Desirable KNOWLEDGE Essential Desirable COMPETENCIES & SKILLS Essential Desirable PERSONAL CHARACTERISTICS AND Essential Substantial post qualification experience in orthodontic technology Substantial experience in advanced prosthodontic technology Relevant post qualification experience in maxillofacial and craniofacial technology Experience of working in a multi-disciplinary team Understanding of Windows applications Understanding of advanced restorative techniques associated with intra-oral osseointegrated implantology and obturator devices Understanding of advanced orthodontic design and fabrication techniques Understanding of the processes involved in Orthognathic surgical planning Understanding of craniofacial techniques associated with extra-oral osseointegrated implantology Understanding of ocular prosthetics and patient management Good written and oral communication skills Good organisational skills Maintains responsibility for own Continuous Professional Development (CPD) High level of manual dexterity skills Understanding of Clinical Governance Competent in the role of Risk Assessor Constructively respond to knowledgeable assessment of own conduct and proactive ability to self-motivate and work on own initiative D7 (26 September 2012) 19 Ability to work effectively under pressure OTHER Desirable D7 (26 September 2012) 20