2 UK NEWS Dental Tribune United Kingdom Edition | 7/2017 Britain’s Silver Generation Collaboration meets creativity British Society of Paediatric Dentistry invites to 2017 conference in Manchester MANCHESTER UK: Collaboration between clinicians, healthcare of- fi cials and researchers will be the theme of this year’s annual confer- ence of the British Society of Pae- diatric Dentistry in Manchester, the organiser has said. At the event, a number of renowned speakers from all over the country will present scientifi c develop- ments resulting from trials or inter-hospital collaborations they are involved in. Treatment of children with complex needs for which collabo- ration is essential will be particu- larly in focus of the conference. Latest insights in that topic will be given, among others, by Healing © Debu55y /shutterstock.com Foundation director and Univer- sity of Manchester professor Kevin O’Brien, who will start off the event with his talk “Working to keep it simple – complex problems in complex children. “ together Innovative and crea- tive concepts in caries prevention and manage- ment will be provided by Dr Sondos Albadri and Yang See Chau from the Northern Alliance col- laboration as well as Prof. Marie Therese Hosey from King’s College in London. Drs Mechelle Collard from Cardiff and Joanna May from Manchester will further provide an paediatric perspective on why collaboration is essential in management of children with cleft disorders. Other highlights include a ses- sion with the Chief Dental Offi cers from Scotland, Wales and England, Margie Taylor, Colette Bridgman and Sara Hurley, who will look at oral health initiatives across the home nations. The three-day conference, which will be held at the Lowry Arts Centre in Salford Keys in Manchester, takes place from 19–22 September. “It’s the fi rst time in 20 years that the BSPD conference has come back to Manchester and, as an organising committee, we plan to showcase both a great city and some very exciting creative collab- orations,” said BSPD president Claire Stevens. “What we hope is that all our delegates will experi- ence the buzz of being in Man- chester and hearing fi rst class speakers but at the same time, they leave feeling refreshed and relaxed by the well-being activities that we have lined up.” More information about the event is available online at www. bspdconference.org. For the fi rst time, delegates will have access to a new mobile application, which provides easy-to-fi nd information about the conference and the pro- gramme. Health and well-being activities for delegates will also be offered during the three congress days. IMPRINT GROUP EDITOR/MANAGING EDITOR DT UK: Daniel ZIMMERMANN newsroom@dental-tribune.com Tel.: +44 161 223 1830 EDITORS: Kristin HÜBNER Yvonne BACHMANN ONLINE EDITOR/SOCIAL MEDIA MANAGER: Claudia DUSCHEK MANAGING EDITOR & HEAD OF DTI COMMUNICATION SERVICES: Marc CHALUPSKY JUNIOR PR EDITOR: Brendan DAY Julia Maciejek COPY EDITORS: Ann-Katrin PAULICK Sabrina RAAFF CLINICAL EDITORS: Magda WOJTKIEWICZ Nathalie SCHÜLLER PUBLISHER/PRESIDENT/CEO: Torsten R. 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Krejci, Conservative Dentistry, Switzerland Dr Edward Lynch, Restorative, Ireland Dr Ziv Mazor, Implantology, Israel Prof. Dr Georg Meyer, Restorative, Germany Prof. Dr Rudolph Slavicek, Function, Austria Dr Marius Steigmann, Implantology, Germany Published by DTI DENTAL TRIBUNE INTERNATIONAL Holbeinstr. 29, 04229, Leipzig, Germany Tel.: +49 341 48474-302 Fax: +49 341 48474-173 info@dental-tribune.com www.dental-tribune.com Regional Offi ces: UNITED KINGDOM 535, Stillwater Drive 5 Manchester M11 4TF Tel.: +44 161 223 1830 www.dental-tribune.co.uk DT ASIA PACIFIC LTD. c/o Yonto Risio Communications Ltd, Room 1406, Rightful Centre, 12 Tak Hing Street, Jordan, Kowloon, Hong Kong Tel.: +852 3113 6177 Fax: +852 3113 6199 DENTAL TRIBUNE AMERICA, LLC 116 West 23rd Street, Suite 500, New York, NY 10011, USA Tel.: +1 212 244 7181 Fax: +1 212 224 7185 © 2017, Dental Tribune International GmbH All rights reserved. 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4 UK NEWS Dental Tribune United Kingdom Edition | 7/2017 GDC announces warning after suspension over fake dental products BY DTI © Marian Weyo/Shutterstock.com LONDON, UK: The General Dental Council (GDC) has strongly ad- vised dental professionals in the UK not to buy products from sources that are not compliant with existing standards and regu- lations. The warning comes after a dentist from North West England was suspended recently for repeat- edly having bought counterfeit dental handpieces online. According to the UK regulator, the 32-year-old purchased risky equipment on an internet auction website at least three times. It was seized earlier this year during in- spections by the Medicines and Healthcare products Regulatory Agency (MHRA) at his practice in Preston in Lancashire. After his hearing in July, he will not be able to practise dentistry for three months, the GDC said. the “This case shows im- portance of dentists and dental care professionals adhering to the standards around compliant dental equipment,” Jonathan Green, GDC Director of Fitness to Practise, com- mented. “Non-compliant equip - ment endangers the health of both the patient and those using it and it is vital that all items meet safety re- quirements.” “As set out in our Standards for Dental Professionals, all members of the dental team must under- stand and follow the law and regu- Critical equipment is easily available on websites like eBay and Google. lations in this important area, which go to the heart of patient protection. They must always put patients’ interests first,” he added. According to MHRA, which regulates all medical devices in the UK, over 10,000 individual pieces of non-complaint or counterfeit dental equipment are seized in dental practices per year. To coun- ter the worrying trend, the agency has been running an awareness campaign in partnership with the British Dental Industry Associa- tion since 2014. “Dental patients are entitled to expect quality care, including the standard of the instruments and devices used by dental profes- sionals. It is vital that dentists and dental staff buy equipment from bona fide suppliers and avoid non-compliant or counterfeit de- vices. I urge all dental profession- als to be cautious of seemingly cheap devices which may be unfit for purpose and potentially dan- gerous to patients and the staff that use them,” Head of Enforce- ment at MHRA, Alastair Jeffrey, said. Dental students charged with terrorist offences BY DTI LONDON, UK: Local newspapers are report- ing that a dental student from Plymouth will have to stand trial for terrorist offences in London this month. The individual, Abdu- rahman Kaabar, originally of Upperthorpe in Sheffield, is accused of three offences of possessing records of a kind likely to be use- ful to a person committing or preparing an act of terrorism and four offences of dissem- inating terrorist publications. It is understood that the 22-year-old is a UK citizen of Libyan descent and is studying dentistry at Plymouth University. He was ar- rested in August by South Yorkshire Police after an investigation by the North East Counter Terrorism Unit (NECTU). Kaabar has been remanded in custody and will appear before the Old Bailey in September. He pleaded not guilty to the charges, according to court documents. It is unknown whether the arrest is con- nected to the arrest in June of another den- tal student from Sheffield, who was charged for the early attack planning of a terrorist at- tack and will stand trial in November. The 24-year-old, who is originally from Hudders- field in West Yorkshire, was arrested in his flat after the NECTU was tipped off about suspicious behaviour. He is accused of hav- ing engaged in the preparation of and hav- ing possessed material that could be useful in preparing an act of terrorism. The arrests are the latest in a number of counterterrorism activities after the devas- tating terror attacks of recent months. How- ever, they are not related to any recent inci- dences, like the Manchester Arena bombing or the Westminster Bridge attack in London, NECTU officials said. According to the Home Office, police in the UK arrested a record number of terrorist suspects last year and an estimated 3,000 persons are still under ob- servation by authorities nationwide. South Yorkshire Police Assistant Chief Constable David Hartley said, “If you have any concerns around any suspicious activity, I would encourage you to please call the confi- dential Anti-Terrorist hotline on 0800 789321.” Nurse from practice with largest recall suspended for life By DTI LONDON, UK: A dental nurse working for a Nottingham dentist responsible for the larg- est recall of patients in NHS history has been suspended from practice indefinitely. The decision came after a hearing by the General Dental Council (GDC) in August after her initial suspension in 2016. The nurse was accused of having put pa- tients at risk by failing to ensure that an ad- equate standard of cross-infection control was maintained at the practice in which she worked in 2014. According to the GDC, she has not engaged with the regulatory body to remedy her failings and does not wish to practise as a dental nurse again. “I feel I have let myself down as a dental nurse as well as my patients, although I would never intentionally do anything to put their health at risk. We were a very busy practice and I often felt it was almost impos- sible to meet CQC [Care Quality Commis- sion] standards at all times due to the amount of patients coming through the door,” she stated in a letter sent to the GDC. The nurse’s former employer was re- moved for reasons of misconduct owing to 55 allegations of failure to maintain basic standards of infection control or prescribe antibiotics without a thorough assessment of patients’ needs. As a result, more than 22,000 patients were offered a recall for blood tests owing to the risk of exposure to infection in 2014. The dentist’s actions were revealed by a whistle-blower, who recorded some of the failings on video. The filmings showed that he did not change his gloves or surgical mask and wiped his hands on his trousers instead of washing them, among other gravely hazardous practices.

6 WORLD NEWS Dental Tribune United Kingdom Edition | 7/2017 DTI introduces new international magazine on prevention By DTI MANCHESTER, UK/LEIPZIG, Germany: How can the importance of pre- vention be communicated to dentists and their patients, and how can dental practices become even more profitable through prophylaxis? A new publication, prevention—international maga- zine for oral health—provides in- formation, products and busi- ness models for those practices interested in expanding their prophylaxis offerings. Dental Tribune International (DTI) has published the first edition in time for the FDI World Dental Congress in Madrid in Spain, and dental professionals can already read the magazine on the DTI website. Oral science has advanced to such a degree that dentists have a good understanding of biofilm, caries and periodontal disease. Yet, while dentists have all the tools and knowledge necessary to pre- vent disease, interdisciplinary col- laboration between preventative and restorative dentistry has only just begun, particularly regarding diagnosis and treatment. Commu- nication with and motivation of the patient remain critical in achieving long-term health, while new devices and protocols have yet to enter prophylaxis-focused dental practices. AD Esthetics in many colors Perfect shade determination with VITA Easyshade® V The editors of the new prevention magazine agree that preventative dentistry needs to become an integral part of every dental practice. They also agree that dentists should adopt a gen- eral health approach to caring for their patients, seeing them multi- ple times per year for prophylac- tic treatment and saliva or blood tests. Ideally, they should also re- fer patients to other medical doc- tors when necessary and them- selves from other doctors when their exper- tise is required. Dentists would then be considered medical prac- titioners specialising in oral health. This role shift would in- volve changing the patient’s view of dentistry and oral health through education, motivation and repetition. receive referrals A new approach to oral health Against this background, the prevention magazine adopts an interdisciplinary approach to oral health. The English-language publication covers a range of re- lated topics, including oral hy- giene and prophylaxis and new aspects in oral and general health. prevention also presents the lat- est research on primary, second- ary and tertiary prophylaxis. Ow- ing to its interdisciplinary and ed- ucational focus, the magazine re- inforces the relationship between dentistry and other medical disci- plines. prevention also provides a new approach to magazine con- tent and design. Unique lifestyle articles with full-page photo- graph galleries, inspirational in- terviews with key opinion leaders and advertorials are combined with case reports, event previews and reviews, and business and product news. For the first edition of preven- tion, interview highlights include conversations with opinion lead- ers from the European Federa- tion of Periodontology and the International Federation of Den- tal Hygienists. The publication will be distributed at all major in- ternational dental congresses and exhibitions. In addition, e-newsletters on prevention will be sent to prophylaxis-focused practices worldwide. DTI would like to thank adver- tisers Curaden, EMS, Dentognos- tics and Andjana for supporting the first edition through advertis- ing and the provision of unique content. From 2018, prevention will be published twice a year with a print run of 4,000 copies. An e-paper edition of the maga- zine is available free of charge via the DTI online print archive. Den- tal professionals can subscribe to the magazine via subscriptions@ dental-tribune.com. A4 C2 A1 B2 A2 C3 E 8 0 5 3 VITA Easyshade® V Shade determination has never been more innovative, re- for your daily business. The result is perfect esthetics. The liable, and above all, more precise than with the new VITA Easyshade V impresses with maximum convenience VITA Easyshade V. It now combines all that modern digi- and an elegant design, as well as with unprecedented val- tal shade determination and communication has to offer ue for money. So why settle for less? www.vita-zahnfabrik.com facebook.com/vita.zahnfabrik

8 BUSINESS Dental Tribune United Kingdom Edition | 7/2017 A future path for entrepreneurial dentists By Dr Mitesh Badiani, UK It is easy to generalise, but I think that most people would agree that we live in changing—and challeng- ing—times. While technology is moving on apace, pushing all aspects of work and life forward and chang- ing the way that we do even the most ordinary of things, uncertainty lingers over the future of our govern- ment, economy and commerce, not to mention the foot-dragging nego- tiations of Brexit or the numerous and frightening affairs overseas. It is difficult to predict which way things will go, whether you look at them a micro or a macro level. Things are no different in den- tistry. Disruption is afoot with the old, closed-door approach being slowly replaced by transparency and patient choice. New clinical in- dicators will increase the pressure to achieve higher quality and out- comes framework scores, and new regulations will ensure that the ‘rogue traders’ who occasionally blighted the name of the service – as they have so many others – can no longer gain a toe-hold, let alone a foot. All this change creates fer- tile ground for the entrepreneur, and yet they still face a perennial problem with financing their am- bitions. It is an unfortunate fact, but at the heart of any business is money. Whatever ethos drives a company, whether in the charitable sector, healthcare, public services, retail, or a brand within the FTSE 100, it can get nowhere without sustaina- ble funding. This is a problem in- creasingly faced by dental practi- tioners, especially those looking to expand their business. Ask around, and few dentists will say that they originally em- © wavebreakmedia/Shutterstock.com “The partnership group model is the ideal compromise.“ barked upon their chosen career because they wished to go into business. There are far quicker and easier ways to do that. However, for those with a passion for the sci- ence, skills and service of den- tistry, private practice offers the opportunity to take control and provides that invaluable commod- ity time. It might also mean spe- cialising in one niche area, diversi- fying practice offerings or expan- sion through the creation of a portfolio of practices. Each of these options requires funding, but while traditional business loans can be accessible to the sin- gle practice owner, the entrepre- neurial dentist with an eye on ex- pansion will soon discover the ne- cessity of looking elsewhere in or- der to finance their plans. The pitfalls of inde- pendent dental prac- tice portfolio growth Developing a small portfolio of dental practices brings particu- lar challenges when it comes to se- curing sufficient funding. Despite the fact that they are free from the restraints that often bind prac- tices that are part of corporate chains, independent practices with multiple outlets face their own issues. Not only do they tend to be too big to sell when retire- ment beckons – because who can secure that kind of funding? – but it can be next to impossible to raise the finance for further growth or investment. If you can- not find the funds to run a prac- tice well, there is no point in run- ning one at all. Finance as an isolated issue research, needs methodical backed up by a comprehensive ac- tion plan and supported by a wide-ranging business plan. How- ever, while practice owners and managers may wish to spend sig- nificant time looking for and se- curing the practices bring other demands, including profit and loss (P&L), existing fi- nancial management, compli- ance, and of course, the small mat- ter of delivering outstanding pa- tient care, which will always be first and foremost for any reputa- ble dental practitioner. funding, That commitment to patient care will also require time spent on hiring a team who share your philosophy, and delivering a training package that ensures that every member of the team shares the same ethos when it comes to the delivery of clinical excellence. All of this takes time, even be- fore you have moved on to compli- ance, an area not to be neglected but which is incredibly time-con- suming. Compliance is often cited as the number one concern for dentists. Time must be spent en- suring your practice meets the regulations and interpreting the guidelines to ensure your practice is fully compliant. It should also go without say- ing that staying on top of both P&L and financial management is imperative to the continued suc-

10 BUSINESS Dental Tribune United Kingdom Edition | 7/2017 What would Dr Mo Lar do? Part 5 Steps to take when married with a young family By Richard Lishman, UK Over the course of this series, the 4dentists group will explore ways to tackle a number of personal and professional challenges by provid- ing advice and guidance to fi ctional character Dr Mo Lar. In this article, the fi fth in the series, steps he should take now that he is married with a young family are considered. Since the last article, Lar has undergone many changes in his personal life: as well as marrying, he has become a proud father of a baby boy. As the main breadwin- ner of the family, Lar feels respon- sible for the fi nancial welfare of his loved ones, prompting him to re- view his fi nances and level of pro- tection. Between utilities, mort- gage repayments, general ex- penses and the cost of raising a child—which to amount to about £ 231,843 by the thought is AD age of 211—there is a great deal that he must account for were any- thing to happen. As such, the best place to start would be critical illness. Critical illness cover is in- tended to pay out a single tax-free lump sum in the event that the claimant is diagnosed with a seri- ous illness or condition, such as cancer, multiple sclerosis, stroke or Parkinson’s disease. To ensure that he receives a payout, Lar would need to choose a policy that covers a wide range of potential illnesses, being careful to disclose all relevant details, such as exist- ing health problems, age and life- style, to the insurer. Luckily, Lar is in good health, but if he did have a pre-existing illness, there would be a possibility that it would affect his claim. For that reason, it is al- register for FREE www. DTStudyClub.com ways wise to seek guidance from a specialist adviser. – education everywhere and anytime – live and interactive webinars – more than 1,000 archived courses – a focused discussion forum – free membership – no travel costs – no time away from the practice – interaction with colleagues and experts across the globe – a growing database of scientific articles and case reports – ADA CERP-recognized credit administration Join the largest educational network in dentistry! ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Saying that, taking the exam- ple of a well-known insurance company, over 95 per cent of criti- cal illness claims were paid out in 2016, with just 5 per cent rejected owing to misrepresentation and not meeting the terms of the pol- icy2; still, one can never be too careful. For a suitable payout, Lar would be advised to take out cover to the value of his mortgage, debts (for example, his student loan) and living expenses. Then there is income protec- tion. While it is necessary to pre- pare for the worst-case scenario, Lar must also give thought to everyday sickness or injury. Ac- cording to the Health and Safety Executive, 30.4 million working days were lost owing to work-re- lated illness or injury in 2015/16, averaging 16 days per person.3 It can happen and dentists are no ex- ception. In fact, it is well known that dentists are at risk of develop- ing musculoskeletal disorders and suffering from mental health dis- orders such as depression and anxiety, so it is crucial that Lar should cover himself against such eventualities—especially as he is a self-employed associate at a pre- dominantly NHS practice. Indeed, NHS sickness leave payments are restricted for den- tists, so if Lar was to experience an accident or illness that forced him out of work temporarily and he was not covered, he would only be eligible for statutory sick pay. As the main breadwinner, £89.35 per week would not be suffi cient to cover the food bill for his young family, let alone his other fi nancial commitments. However, as Lar is extremely risk-averse and prudent with his fi nances, it would be wise for him to take out a policy with the help of an independent fi nan- cial adviser, such as those at mon- ey4dentists. To make sure that no stone is left unturned, Lar would also be advised to enlist the services of a lawyer to compile a will, as it will ensure that his hard-earned money is inherited by his closest loved ones. In this instance, Lar wishes for his assets to go to his wife and that she should take on the role as trustee for their son’s inheritance until he turns 18. Any estate worth over £ 250,000 is au- tomatically divided between the surviving spouse and children if there is no will to decree other- wise, so it is crucial that Lar should put his instructions in writing if he is to ensure his assets are divided as he wishes. With his life insur- ance taken into account, Lar’s es- tate is worth over £ 325,000, so he will also need to consider the im- pact of inheritance tax and the best way to maximise the benefi t of available reliefs and exemp- tions. You can take great comfort in knowing that your family will be taken care of fi nancially in the event of illness or death. For peace of mind, follow in Lar’s steps and take out the right protection to- day. Next part: Lar looks to becoming a principal. Editorial note: A complete list of references is available from the publisher. Richard Lishman is the Managing Direc- tor of money4dentists, a fi rm of special- ist independent fi nancial advisers who help dentists across the UK manage their money and achieve their fi nancial and lifestyle goals.

12 TRENDS & APPLICATIONS Dental Tribune United Kingdom Edition | 7/2017 European dental imaging equipment market in a state of change By Sasha Stephanian & Jeffrey Wong, Canada The market for dental imaging equipment in Europe is quite satu- rated and has not experienced any significant growth over the past sev- eral years. However, in recent years cone beam computed tomography (CBCT) scanners have increasingly begun incorporating 2-D capabilities into their systems, as well as offering a broad range of fields of view to pro- vide greater flexibility. Clinical appli- cations of CBCT systems include im- plant planning, root configuration, sinus augmentation, root-canal pro- cedures and bony defect detection. As several of these applications are expected to increase in number, the demand and need for CBCT scanners will continue to grow considerably throughout Europe over the next decade. Intraoral X-ray imaging device market in transition Analogue technology is a thing of the past and while it is still declin- ing, the transition away from these types of systems has already taken place, resulting in a more stable market situation. Companies now offer two digital alternatives: pho- tostimulable phosphor (PSP) sys- tems and digital sensors. Larger clinics with several rooms, espe- cially those who only recently made the switch to digital technology, typically opt for PSP systems due to the affordability of PSP plates and the similarity in equipment han- dling compared to conventional an- alogue film. In countries such as France and Italy, which are largely dominated by smaller clinics with only a single examination room, dentists often opt to use digital sen- sors instead. Although the split between PSP systems and digital sensors is quite even, the PSP market has shown strong signs of growth, particularly in countries that were traditionally dominated by sensors, such as Spain, and will continue to be one of the main drivers in a rather stag- nant market for imaging equip- ment as a whole. Part of this trend can be attributed to the fact that the thickness and rigidity of sensors are a greater nuisance when it comes to patient comfort, as well as the frail- ness of these sensors compared to PSP scanners. Furthermore, digital sensors are much more expensive than PSP scanners, and include parts that are prone to wear, such as cords that can be easily damaged, which further argues the case to switch to PSP systems. 2-D extraoral X-ray imaging vs 3-D CBCT scanners Extraoral X-ray imaging sys- tems are predominantly used for viewing a patient’s teeth relative to his or her jaw and skull. They aid in monitoring impacted teeth, tempo- romandibular joint disorder, and possible tumours in and around the intraoral cavity. These specific uses of extraoral X-ray systems are lim- ited to procedures performed by or- thodontists, prosthodontists and oral surgeons, resulting in a rela- tively small market. Most profes- sionals prefer working with a CBCT scanner, which has 3-D imaging ca- pabilities and can perform at a much greater capacity than tradi- tional 2-D extraoral imaging sys- tems, but are limited by the high ac- quisition cost of these systems. Re- cently, however, not only have prices of CBCT scanners dropped significantly, but it is now standard for these systems to also incorpo- rate both panoramic and cephalo- metric capabilities, resulting in so- called ‘combo-units’, which has re- sulted in a drastic change in the market. The popularity of these CBCT ‘combo-units’ has increased significantly in recent years and is Fig. 1: Intraoral X-ray system market breakdown, Europe, 2023. Fig. 2: Cone beam computed tomography scanner market breakdown, Europe, 2023. expected to continue outpacing all other market segments in terms of growth. Consequently, the outlook of the extraoral X-ray system market in Europe is negative. Already being a replacement market without much innovation, the demand for traditional 2-D systems is on the de- cline as consumers continue to opt for technologically superior CBCT scanners. Manufacturers have also recognised this, and as such have shifted their focus to capitalise on this trend, investing in producing combo 2-D and 3-D units with the option for future upgrades, greatly improving the marketability of these systems. Analysis of the current situation of CBCT scanners CBCT scanners are extremely efficient machines that are capable of performing a quick and non- invasive scan, resulting in a high level of patient comfort. It is also possible to instantly show the pa- tients a 3-D image of their jaw and teeth structure, making it easier for dental professionals using these scanners to convince patients re- garding necessary treatments. However, the biggest advantage of CBCT scanners is their low cost rela- tive to traditional CT systems found in hospitals. While CBCT scanners are quite a bit more expensive than other dental imaging equipment, they are a much more affordable al- ternative for capturing 3-D images of a patient’s jaw compared to past methods. In the European market, sales of CBCT systems have increased con- siderably, with growth rates sur- passing that of nearly all other den- tal imaging devices. This will most likely continue to be the case throughout the next several years as the technology is constantly im- proving and prices are dropping. Al- though most units now offer a vari- ety of field of views (FOVs), the most popular choice continues to be 8 cm x 8 cm, as this size is sufficient to capture the complete maxilla or mandible in one image. Anything above this size has a much more niche usage and typically comes at a greater cost, thus dentists opting to purchase a CBCT scanner are less likely to be persuaded by anything larger, as it is more of a luxury than a necessity. As such, all of the major competitors, including Carestream, Planmeca, Sirona, Danaher Group, Vatech, and Cefla Group, have mul- tiple systems with this size already incorporated into their product line. Today, smaller FOV (sizes smaller than 8 x 8) scanners have es- sentially all been consolidated with medium FOV scanners, and large FOV scanners are extremely expen- sive and represent only a very mi- nor percentage of the market. Final thoughts All in all, the market for dental imaging equipment in Europe is relatively static in terms of growth, but it is in a state of transition. Com- panies are continuously improving the technology in their products, and the stiff competition is placing intense pressures on prices. Conse- quently, a growing demand for CBCT scanners is neutered by these falling prices, and in the end, the companies that will be the most successful are the ones who provide the greatest value with their prod- ucts. The intraoral X-ray imaging sector has almost completely tran- sitioned into a digital market, but is now split between digital sensors and PSP scanners. With new en- trants in various segments of the market, the future of this market seems promising and exciting, with many new opportunities on the ho- rizon. Sasha Stephanian is a research analyst at iData Research and was the lead re- searcher for the 2016 European Dental Operatory Equipment and CAD/CAM Materials, U.S. Medical and Dental Imaging Equipment, 2017 European Robotics and Surgical Navigation, U.S. and European Dental Lasers, and Euro- pean Dental Imaging Devices Market Report Suites. His current work in- cludes the 2017 U.S. Soft Tissue Regen- eration Market Report Suite. Jeffrey Wong is the strategic analyst manager at iData Research and has been heavily involved with the com- pany’s dental division throughout his tenure. As a research analyst, he led several research projects on the global dental markets, including dental pros- thetics, digital dentistry, CAD/CAM materials, dental implants, bone graft substitutes, hygiene, dental imaging and dental lasers.

14 TRENDS & APPLICATIONS Dental Tribune United Kingdom Edition | 7/2017 Applying evidence-based practice in oral hygiene education By Rachael England, UAE I have worked as a dental hygienist for the last 11 years, since qualifying in the Royal Air Force in 2006, and have practised throughout the UK in a whole range of settings, mili- tary, NHS hospital and private prac- tice. I have also served in dental units of humanitarian initiatives, such as a mobile clinic in Kenya. Currently, I am working in a private practice in Dubai and delighted to be a key opinion leader for Philips. Throughout that time, I have con- sistently recommended one brand to my patients and anyone else ask- ing for help choosing an electric toothbrush. Clinically, I have seen an improvement in oral health when people begin using Philips Sonicare toothbrushes and most recently toothbrushes from the DiamondClean range. Philips Sonicare has rein- forced its commitment to patient and professional partnership by continually developing new prod- ucts, which undergo rigorous test- ing and clinical trials to demon- strate their safety and effi cacy. Philips is committed to improv- ing the lives of three billion peo- ple a year by 2025, through its on- going collaboration with scientifi c experts, research scientists and dental professionals. The associations between oral and systemic health are being dis- covered year on year, including se- rious conditions, such as diabetes, atherosclerosis, preterm or low birth weight babies, Alzheimer’s disease, chronic kidney disease and certain cancers.1 We know that gingival infl ammation and perio- dontal disease are initiated by the complex microbial biofi lm, and the destruction of the supporting tissue, including the periodontal ligament, bone and cementum, is mainly caused by the host-medi- ated innate and adaptive immune response.1 Periodontal disease is the most prevalent ailment affect- ing humankind globally, and se- vere periodontitis is responsible for the absolute majority of tooth loss and edentulousness in adults.2 Clinicians are thus constantly on the lookout for the most reliable and evidence-based aids to enable their patients to manage their oral health. With the publishing of the lat- est research carried out by Philips in a special issue of the Journal of Clinical Dentistry, I can be sure that the advice I am giving patients is evidence based. High on the evi- dence pyramid are systematic re- views with meta-analyses, which provide reliable conclusions be- cause they integrate all the rele- vant evidence.3 This meta-analysis comparing the effectiveness of Study 1 Comparison of Gingivitis Reduction and Plaque Removal by Philips Sonicare DiamondClean and a Manual Toothbrush Delaurenti M, Ward M, Souza S, Jenkins W, Putt MS, Milleman KR, Milleman JL. J Clin Dent 2017;28(Spec Iss A):A1-6. Products Subjects Design Results - Percent reduction at Week 4 Philips Sonicare DiamondClean vs. MTB 141 week 2 >> 4 Mean age: 42.1 Randomized, Sonicare MTB Gingivitis 25.5% 19.1% Bleeding 57.4% 31.4% parallel, single-blind Plaque 34.9% 8.0% Key conclusion Twice daily brushing with Philips Sonicare DiamondClean is significantly better than using a manual toothbrush for reducing plaque and improving gingival inflammation and gingival bleeding within just two weeks, persisting to four weeks. Study 2 Comparison of Plaque and Gingivitis Reduction by Philips Sonicare FlexCare Platinum with Premium Plaque Control Brush Head and a Manual Toothbrush Jenkins W, Souza S, Ward M, Defenbaugh J, Milleman KR, Milleman JL J Clin Dent 2017;28(Spec Iss A):A7-12. Products Subjects Design Results - Percent reduction at Week 6 Philips Sonicare FlexCare Platinum vs. MTB 143 week 2 >> 6 Mean age: 40.6 Randomized, Sonicare MTB Gingivitis 45.79% -0.71% Bleeding 58.36% -3.14% parallel, single-blind Plaque 46.55% -1.58% Key conclusion Twice daily brushing with Philips Sonicare FlexCare Platinum with Premium plaque control* brush head is significantly better than using a manual toothbrush for reducing plaque and improving gingival inflammation and gingival bleeding within just two weeks. Statistically significant dierences in all metrics persisted until study completion at Week 6. *Brush head formerly called AdaptiveClean Study 3 The Eectiveness of Manual versus High-Frequency, High-Amplitude, Sonic-Powered Toothbrushes for Oral Health: A Meta-Analysis de Jager M, Rmaile A, Darch O, Bikker JW. J Clin Dent 2017;28(Spec Iss A):A13-28. Products Subjects Design Results Percentage change after everyday use High-frequency, high-amplitude power toothbrushes vs. MTB 1,870 4 weeks >> 3 months Studies: 18 Randomized, controlled clinical trials removal 20% more plaque 10% greater decrease in gingivitis Key conclusion Results of this comprehensive meta-analysis showed that high-frequency, high-amplitude, sonic-powered toothbrushes decrease plaque and gingivitis significantly more eectively than manual toothbrushes in everyday use, in studies lasting up to three months. manual versus high-frequency, high-amplitude sonic powered toothbrushes showed that plaque removal was increased by 20 % and gingivitis was decreased by 10 %,4 thus reducing the systemic infl ammation and improving the patient’s oral and general health. In order to encourage patients to swap from a manual to an elec- tric toothbrush, I tell them it is like comparing riding a bicycle with a motorcycle: one is much more ef- fi cient and doing the work for them. This is confi rmed by studies comparing gingivitis reduction using a Philips Sonicare Diamond- Clean versus a manual toothbrush. After just two weeks, the Diamond- Clean realised a 52.2 % reduction in gingival bleeding compared with only 17.0 % using a manual tooth- brush. After four weeks, the Son- icare achieved a 57.4 % reduction in gingival bleeding compared with 31.4 % using a manual toothbrush.5 Patients often ask which model they should buy, as there are so many. The high-frequency, high-amplitude technology used in all Philips Sonicare brushes is

16 Study 4 TRENDS & APPLICATIONS Dental Tribune United Kingdom Edition | 7/2017 An Assessment of Gingivitis Reduction and Plaque Removal by Philips Sonicare DiamondClean with Premium Plaque Control Brush Head and Oral-B 7000 with CrossAction Brush Head Starke M, Delaurenti M, Ward M, Souza S, Milleman KR, Milleman JL. J Clin Dent 2017;28(Spec Iss A):A29-35. Products Subjects Design Results - Percent reduction at Week 6 Philips Sonicare DiamondClean vs. Oral-B 7000 284 week 2 >> 6 Mean age: 38.6 Randomized, Sonicare Oral-B Gingivitis 45.68% 26.83% Bleeding 75.81% 58.76% parallel, single-blind Plaque 37.58% 20.70% Key conclusion Philips Sonicare DiamondClean with Premium plaque control* brush head is statistically superior to Oral-B 7000® with CrossAction™ brush head and SmartGuide accessory in reducing gingival inflammation, gingival bleeding and surface plaque. *Brush head formerly called AdaptiveClean Study 5 A Study to Assess the Eects of Philips Sonicare AirFloss Pro, when Used with Antimicrobial Rinse, on Gum Health and Plaque Removal Mwatha A, Olson M, Souza S, Ward M, Jenkins W, Amini P, Gallob J, Fafard T J Clin Dent 2017;28(Spec Iss A):A36-44. Products Subjects Design Results - Percent reduction at Week 4 286 week 2 >> 4 Mean age: 35.6 Randomized, MTB + AirFloss Pro + rinse MTB Gingivitis 8.52% 1.10% Bleeding 36.79% 4.03% parallel, single-blind Plaque 22.41% 5.70% Philips Sonicare AirFloss Pro and antimicrobial rinse vs. MTB and string oss vs. MTB Key conclusion Daily use of Philips Sonicare AirFloss Pro with antimicrobial rinse as an adjunct to manual toothbrushing was shown to improve gum health and reduce plaque significantly better than manual toothbrushing alone. Moreover, a non-inferiority test showed AirFloss Pro to be similar to string floss in reducing plaque and gingivitis. AD refl ected in a study comparing the Sonicare FlexCare Platinum and Premium plaque defense* brush head with a manual tooth- brush. After two weeks of use, the 154 participants showed a 47.97 % reduction in gingival bleeding us- ing a FlexCare Platinum com- pared with only 8.64 % for a man- ual toothbrush, and after six weeks, a 58.36 % reduction versus 3.14 % with manual brushing. Similarly, the FlexCare Platinum showed a 50.59 % plaque reduc- tion after two weeks and manual brushing a 3.08 % reduction, and after six weeks, 46.55 % and 1.58 %, respectively.6 The next common question is whether to use sonic or rotary. I have always said that, if one had 100 dental hygienists in a room and asked their opinions, there would be a 50/50 split. However, in a recent comparative study with a statistically signifi cant number of participants, the Philips Sonicare DiamondClean and Premium plaque defense brush head showed gingival in- fl ammation reduced by 44.73 % af- ter two weeks, compared with just 27.92% using the Oral-B 7000 with CrossAction brush head, and by 45.68 % and 26.83 %, respectively, after six weeks.7 Gingival bleeding indices are often used as a benchmark for dental hygienists to commence periodontal therapy, encouraging patient compliance with treat- ment and better clinical results. In a study, using a Sonicare Dia- mondClean for two weeks reduced gingival bleeding by 66.75 %, com- pared with 49.38 % using an Oral-B 7000, and for six weeks resulted in an impressive 75.81 % reduction in gingival bleeding, compared with 58.76 % for the Oral-B brush. Eliminating plaque is critical to ensuring ongoing oral health. After two weeks of using a Philips Sonicare DiamondClean with a Premium plaque defense brush head, participants recorded a 38.68 % reduction in plaque com- pared with just 18.28 % using an Oral-B 7000 with CrossAction brush head. This trend continued after six weeks of use, with the Sonicare achieving a 37.58 % re- duction and Oral-B 20.70 %.7 I am sure all dental profes- sionals will agree that gaining pa- tient compliance regarding daily interdental cleaning is one of our greatest challenges. Patients cite diffi culty fl ossing or interdental brushes that bend or break as the main barriers. The Philips Sonicare AirFloss Pro offers an ef- fective and easy-to-use alterna- tive. When fi lled with an antimi- crobial rinse and used daily, it is as effective as fl ossing. In a study, af- ter two weeks of use, fl oss achieved a 26.90 % reduction in gingival bleeding, compared with 24.61 % using an AirFloss Pro and BreathRx mouthrinse. After four weeks, this remained consistent at 43.31 % for fl oss and 36.79 % for the AirFloss Pro and BreathRx.8 Dental health is a basic human right, and I believe that as dental and public health professionals it is our duty to ensure our patients, friends and family are using the most effective aids to fi ght the global epidemic of oral disease. Editorial note: This article origi- nally appeared in Dental Tribune Middle East & Africa No.4/2017. A list of references is available from the publisher. Confl ict of interest: Rachael Eng- land is a key opinion leader for Philips Middle East. * Also known as ROW, Premium plaque control in NA only. Rachael England is a dental hygienist and clinic manager in Dubai in the UAE.

18 ORTHO OPINION Ortho Tribune United Kingdom Edition | 7/2017 Technology, the ageing population, regulation: Pondering the future of orthodontics By Chris Barrow, UK One of my blogging heroes, Seth Godin, once commented “don’t write about what you know, write about what fascinates you”. Yet many of the writing assignments we are given request that we tackle the former and let the readers know how much we know about a given subject. At this year’s British Ortho- dontic Society conference, I will be speaking on marketing for the or- thodontic practice, what works, what does not and how to get the best return on investment from your marketing. It would be simple enough to recreate that content here so that those unable to attend can obtain the knowledge—but I have the devil in me this morning, half way through a week of project work at my desk, and want to do something different. So, I have de- cided to write about what fasci- nates me in the world of orthodon- tics right now, observing from the perspective of helping clients to grow successful businesses and maintain a decent balance between their personal and professional lives. Here are my Top 10 current ponderings. 1. I wonder for how much longer goodwill values will stay at their historically high level. The figures are astonishing and only an institutional in- vestor speculating on a four- year turnaround or an insur- ance company to cross-sell products and ser- vices can really swallow the crazy multiples of earnings now quoted. looking AD 2. I wonder how many principals over the age of 50 are going to stick around for much longer. It is becoming more difficult to run a dental business and it takes more energy every year to stay connected with all that is happening in business and in the profession. The juxtapo- sition of an ageing population of owners and the aforemen- tioned high goodwill values creates an environment in which now is a good time to go. 3. I wonder who is going to buy the practices left to sell. Are the institutions still prepared to speculate given the macro-eco- nomic situation in the UK? Are younger dentists (with or with- out family money) prepared to take part in a gold rush that is beginning to sound like history and not current affairs? It was the late Sir James Goldsmith who said, “if you can see a band- wagon, it’s too late to get on it”. 4. I wonder when the regulatory backlash will hit those general dental practitioners and spe- cialists who have been flogging short-term orthodontics like hot cakes. There are early signs of patients whose expecta- tions have been raised beyond the capacity of a system or a clinician to deliver—patients who are disappointed, savvy and motivated to litigate. Den- tists should be cautioned by this environment or by those who are training them. 5. I wonder how many more sys- tems will appear in the market- place offering either “cheaper” or “quicker” as their unique selling proposition. To cite Godin again, the greatest dan- ger in a race to the bottom is winning it. We have already seen the spectacular demise of some dental businesses offer- ing orthodontics at deep dis- count (and I have been in- volved in belatedly rescuing others who followed the same fool’s gold). 6. I wonder for how much longer orthodontic associates will be able to make a decent living. As the profit margins on dental work erode and the number of dental care professionals in- creases, ever more downward pressure on associate remu- neration is created. Is ortho- dontics still a viable career choice? 7. I wonder how technology will affect the delivery of dentistry in the future, as well as the pa- tient experience and business systems. Digital dentistry has become a buzz phrase in re- cent years. As Apple prepares to launch iOS 11 and introduce ARKit reality built into iPhones and iPads), the worlds of e-commerce and social media are poised to un- dergo an augmented reality revolution that will be as cul- turally influential as the in- dustrial, technology and in- (augmented formation revolutions that heralded the last two centu- ries. Technology must affect the clinical delivery of ortho- dontics, as well as the patient experience. 8. I wonder what skill set will be required of the practice/busi- ness manager in the next five years. With the advent of re- sponsibilities in financial anal- ysis, branding, marketing, user experience, treatment coordi- nation, governance, compli- ance, operations and human resources, will the future man- ager be of MBA standard? 9. I wonder how dental teams will develop in orthodontics. Will you still be able to hire teleph- onists, receptionists, nurses and administrative staff at rel- atively low wages, on the basis that support people are dis- posable and replaceable, or will you have to take a differ- ent view that people are an as- set on your balance sheet and not an overhead on your profit and loss statement? Will the savvy principal realise that customer service is how you positively differentiate your- self from the corporate/retail competition and from price wars and that customer ser- vice requires a significant in- vestment in your people? 10. Finally, I wonder what our pa- tients will look like in five years. We live in an age in which not just augmented re- ality is about to change the landscape. Say hello to weara- ble technology, to fibretronics, to predictive (not preventa- tive) health care. Our patients are already living an average of 25 years longer than their grandparents, a bonus 25 years in which they are exploring the world around them and their inner selves. That bonus period is going to extend. Some predict that there are in- dividuals in our current gener- ation of children who will live good lives until the age of 135. Dental health and appearance are a part of that extended lifespan and the profession will have to adapt and adopt new techniques. Is it not all just fascinating? I cannot wait to see what happens, who the winners will be and what they do to win. Chris Barrow is the founder of Coach Bar- row consultancy practice. An ac- tive con sultant, a trainer and a coach to the UK dental profession, he regularly contributes to the dental press, so- cial media and online. Chris Barrow can be contacted at coachbarrow@ me.com. Dental Tribune International ESSENTIAL DENTAL MEDIA www.dental-tribune.com

20 ORTHO NEWS Ortho Tribune United Kingdom Edition | 7/2017 Early orthodontic treatment and oral health-related quality of life m o c . k c o t s r e t t u h S / y a d u B a n N i Relationship confirmed by University of Sheffield’s School of Clinical Dentistry study © By DTI SHEFFIELD, UK: In Western coun- tries like the UK, between 10 and 20 per cent of adolescents un- dergo orthodontic measures in some form. A recent meta-analysis conducted by researchers at the University of Sheffield’s School of Clinical Dentistry has indicated that treatment in those younger years may have a measurable im- pact on a person’s oral health-re- lated quality of life (OHRQoL). In their review, they found that levels of emotional and social well-being AD The study revealed first evidence that orthodontic treatment in early age im- proves oral health-related quality of life. concerning OHRQoL improved moderately in patients who were treated orthodontically before they were 18 years old. The find- ings are relevant, because, until now, there has been little evidence that treatment actually improves OHRQoL. The researchers included data from over a dozen studies report- ing outcomes before and after or- thodontic treatment that were conducted within the last ten years in countries like Australia, Brazil, Canada, China, Italy, the UK and the US. Of these, four were finally selected for using similar ques- tionnaires to measure what young people thought about their teeth and how their dental appearance affected their life, before and after orthodontic treatment. All showed measurable and moderately large improvement in the areas of emo- tional and social well-being, ac- cording to the researchers. “As practicing orthodontists we are constantly being told by our patients that they are pleased they had their teeth straightened and that they are no longer embar- rassed to smile or to be photo- graphed,” explained co-author Prof. Philip Benson, who is also Di- rector of Research at the British Orthodontic Society. “We wanted to find all the research that has tried to measure this effect with young people.” While the findings are a first step to establishing a platform for exploring this issue further, Ben- son admitted that the number of participants included in the stud- ies was small and that high- er-quality data to substantiate the conclusions. A follow-up investigating OHRQoL in the under-18 age group under the supervision of co-author and student Hanieh Javidi as part of her doctoral research project is underway at the School of Clinical Dentistry. is needed study The study, titled “Does ortho- dontic treatment before the age of 18 years improve oral health-re- lated quality of life? A systematic review and meta-analysis,” was published in the April issue of the American Journal of Orthodontics and Dentofacial Orthopedics.

22 ORTHO TRENDS Ortho Tribune United Kingdom Edition | 7/2017 Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report Prof. Carlo Fornaini, Drs Aldo Oppici, Luigi Cella & Elisabetta Merigo, Italy orthodontic In recent decades, we have wit- nessed the substantial develop- ment and expansion of the use of fi xed appliances. While their application has many advantages, several problems re- lated to the health of the soft tis- sue may sometimes appear during treatment. In fact, the use of fi xed orthodontic appliances may pro- voke labial desquamation,1 ery- thema multiforme,2 gingivitis3 and gingival enlargement.4 therapy, even Gingival enlargement is a very common complication dur- ing orthodontic treatment,5 but fortunately, it seems to be transi- tory and generally resolves after orthodontic if sometimes incompletely. Gingi- val overgrowth induced by ortho- dontic treatment shows a specifi c fi brous and thickened gingival appearance, different from frag- ile gingiva with marginal gingival redness common in allergic or in- fl ammatory gingival lesions.6 Increases Several clinical studies sug- gest that orthodontic treatment may be associated with a de- crease in periodontal health, causing a hypertrophic form of gingivitis. However, the actual pathogenesis of gingival enlarge- ment is not yet completely un- derstood, although probably in- volves increased production by fi - broblasts of amorphous ground substance with a high level of gly- cosaminoglycans. in mRNA expression of Type I colla- gen and upregulation of kerati- nocyte growth factor receptor could play an important role in excessive proliferation of epithe- lial cells and increased develop- ment of gingival enlargement, on the basis of some studies, in cases of poor oral hygiene status.7 How- ever, there is no clear defi nition on its aetiology, although it is probably associated with the in- fl ammatory response induced by the corrosion of orthodontic ap- pliances, particularly those of nickel,8 linked to an infl amma- tory response considered a Type IV hypersensitivity and mani- fested as nickel-induced allergic contact stomatitis, even if its aetiology has not yet clearly been defi ned.9 The treatment of these con- ditions is surgical. Histological and histochemical studies have demonstrated that the removal of the gingival papilla can pro- mote the formation of normal connective tissue.10 Because the classic intervention performed 1 3 5 2 4 6 Fig. 1: Clinical view, showing gingival enlargement, just before the debonding procedure. – Fig. 2: Application of a topical anaesthetic. – Fig. 3: Surgical laser-assisted treatment via laser gingivectomy. – Fig. 4: Clinical view just after surgery. – Fig. 5: Healing fi ve days after surgery. – Fig. 6: One month follow-up. Prof. Carlo Fornaini is a lecturer at the MICORALIS Laboratory of the Côte d’Azur University in Nice, France, and a dentist at the “Special Needs and Max- illofacial Surgery Unit” of the “Gugliel- mo da Saliceto” hospital in Piacenza, Italy. He can be contacted at: carlo@fornainident.it Dr Aldo Oppici is the Head of “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. A.Oppici@ausl.pc.it Dr Elisabetta Merigo is a lecturer at the MICORALIS Laboratory of the Côte d’Azur University in Nice, France, and a dentist at the “Special Needs and Maxil- lofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. elisabetta.merigo@gmail.com by scalpel has some disadvan- tages, mainly linked to the dis- comfort for the patient (e.g. an- aesthesia by injection and su- tures), there has been great inter- est in the utilisation of laser technology. Case report A 14-year-old female patient was referred to our department by the orthodontics unit because, at the end of fi xed orthodontic treatment, she had developed gingival enlargement in the up- per arch (Fig. 1), probably related to the fast closure of the spaces associated with very poor oral hy- giene due to bleeding during toothbrushing. Just after the re- moval of the appliance, a topical anaesthetic (EMLA, AstraZeneca) was applied to the gingivae (Fig. 2) and a gingivectomy was per- formed using a diode laser (XD-2, Fotona) according to the tech- nique of removal of the interden- tal papillae (Fig. 3). The parame- ters used were as follows: a wave- length of 808 nm, 3 W in continu- ous wave, a 320 µm fi bre in contact mode. The intervention had a duration of 375 seconds, and the patient did not feel any pain (Fig. 4). After the interven- tion, the patient did not take any kind of pain medication, and the healing process was completed in fi ve days (Fig. 5). Discussion The fi rst laser appliance was built by Maiman in 1960, and some years later, it was success- fully employed in medicine and in oral surgery with several ad- vantages. It may provide excel- lent incision performance with sealing of small blood and lym- phatic vessels, resulting in hae- mostasis and reduced postopera- tive oedema. Furthermore, target tissues are disinfected as a result of local heating and pro- duction of an eschar layer, which results in a decreased amount of scarring owing to decreased post-operative tissue shrinkage, allowing one to avoid the use of sutures. Diodes, the last generation of laser used in dentistry, have several advantages, such as re- duced cost and size, and offer the operator the possibility to work both incontinuous and chopped mode. Based on our experience, we can confi rm that this technol- ogy may represent a new ap- proach to the resolution of gingi- val enlargement during ortho- dontic treatment, with better comfort for the patient during and after surgery. Editorial note: A list of references is available from the publisher. This article was originally pub- lished in the Ortho magazine No.2/2017 Dr Luigi Cella is a maxillofacial surgeon at the “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Sali- ceto” hospital in Piacenza, Italy. L.CELLA@ausl.pc.it

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