Ontario Dental Association Annual Spring Meeting · Thursday, May 9, 2019 Vol. 6, No. 1 New scanner might force you to go digital Faster, easier and more accurate: If you’ve been on the fence, this scanner just might nudge you off. A camera designed for dentistry It has easy presets for clinical photography, and it’s easy to disinfect with a sterilizing towelette. Breakthrough in guided surgery ‘Trace and Place’ navigation changes everything about guided implant surgery. »Page 6 »Page 8 »Page 10 Spring into Toronto 5 ASM19 features more than 330 exhibitors and 90 speakers — and quick access to Toronto’s world- class dining, shopping, arts, culture and entertainment. (Photo/Provided by Tourism Toronto) Two days of exhibits, three days of education, nights ﬁlled with fun n Welcome to one of the largest and most respected dental conventions in North America, the Ontario Dental Association’s Annual Spring Meeting. The meeting includes three days of education and also includes a two-day trade show — capped each day with a complimentary cocktail reception on the exhibit floor. In the days ahead, more than 90 internationally renowned speakers will cover a broad and diverse range of clinical, practice-management and personal development topics. The exhibit floor features more than 330 companies and organizations offering a wide range of tried-and-true and new-and-innovative dental products, services and technology for attendees to test and compare. The lectures, workshops and exhib- its serve dentists, dental hygienists, dental assistants and all other mem- bers of a dental practice’s staff. The 8see SPRING, page 3 AD
4 exhibitors 2019 ASM — May 9, 2019 New: Hands-free infrared technology By Designs for Vision Staff n Designs for Vision is introducing patented hands-free infrared technol- ogy with the WireLess™ IR HDi™ and the Micro IR HDi headlights. These headlights feature HDi, high-definition imaging, Designs for Vision’s exclusive advanced photonic design that pro- vides uniform light distribution with maximum intensity. The patent-pending HDi technology optically focuses the light from the LED to provide 45 percent more light with uniform distribution. The patented IR feature enables better infection control by letting you operate the headlight without touch- ing the system. The IR headlights use a built-in infrared signal to enable you to turn the light on or off simply and safely. Onboard biometrics sense the position of the headlight to filter out unintended signals while working. Designs for Vision has added the high-definition imaging to all of its headlights, including the LED Day- AD 5 The new HDi headlights from Designs for Vision can provide up to 45 percent more light with uniform distribution. (Photo/ Provided by Designs for Vision) Here in Toronto You can see the Visible Difference® yourself by visiting Designs for Vision’s booth, No. 630, or contact the company to arrange a visit in your of- fice by calling (800) 345-4009 or email- ing firstname.lastname@example.org. Lite® WireLess IR and the LED DayLite WireLess Mini, providing a lightweight cordless solution with light intensity comparable to many corded headlights. You can choose high-definition imaging with either a wired or wireless design to meet your preference, and any of the HDi headlights will illuminate the entire oral cavity. Designs for Vision’s WireLess head- lights free you from being tethered to a battery pack. The simple modular designs uncouple the headlights from a specific frame or single pair of loupes. Prior technology married a cordless light to one pair of loupes via a cumber- some integration of the batteries and electronics into the frame. The com- pact design of the LED DayLite Wire- Less headlights are independent of any frame/loupes. The LED DayLite Micro HDi uses the new high definition imaging with a very lightweight headlight in combina- tion with the Micro power pack. The Micro power pack is the lightest and smallest power pack. The complete unit includes two power packs, and each power pack can run up to 10 hours. Designs for Vision is also featuring the REALITY 5-Star rated Micro 3.5EF Scopes and Micro 4.5EF Scopes util- izing a revolutionary optical design that reduces the size of the prismatic telescope by 50 percent and reduces the weight by 40 percent while provid- ing an expanded field view of the oral cavity. Designs for Vision is excited to announce that it recently expanded into a new 67,500 square foot loca- tion on Long Island at 4000 Veterans Memorial Highway, Bohemia, N.Y.
2019 ASM — May 9, 2019 exhibitors 5 Align University Training Institute opens in Shanghai 5 Julie Tay (second from right), Align Technology senior vice president and managing director, Asia Pacific, and Jin Xiang (middle), Align Technology managing director, China, at the ribbon-cutting ceremony of Align University Shanghai Training Institute. (Photo/Provided by Align Technology) AD By Align Technology Staff n Align Technology Inc. has opened the Align University Training Institute in Shanghai, China. This is Align’s second training facility in China. The company opened its Chengdu training center in 2017. This newest center represents the company’s commitment to clinical education and support for dentists in China. It will be a major training facil- ity that will enable Align to educate dentists and showcase the company’s latest product and technology innov- ation in orthodontic treatment and digital dentistry. “We see enormous potential in China, with a growing demand for Invisalign clear aligners,” said Julie Tay, Align Technology senior vice president and managing director, Asia Pacific. “As consumer demand grows, we want to ensure we provide our doctors with the latest innovation and training to deliver great outcomes for Invisalign patients — and ultimately more beautiful smiles. This is another important investment we are making in China to provide localized train- ing and support to our doctors, as we continue to lead the industry in clear aligners and digital dentistry.” According to the company, the Align University Shanghai Training Institute features state-of-the-art technology, including iTero intraoral scanners and dental simulation equipment. It holds three training rooms, including one multiple training room, a ClinCheck workshop room and a demonstration lab for iTero intraoral scanners and dental simulation equipment. The institute will provide training, clinical education programs and dem- onstrations of the tools and processes used in a range of treatment options. China is the second largest market for Align. The company opened its first office in Shanghai in 2011 and today has more than 1,200 employees in seven offices across China. To date, Align has trained more than 150,000 Invisalign practitioners worldwide. Align Technology designs and manufactures the Invisalign® system — one of the most advanced clear- aligner systems in the world — and iTero® intraoral scanners and services. Align’s products help dental profes- sionals to achieve the clinical results they expect and to deliver effective, cutting-edge dental options to their patients. You can visit www.aligntech. com for more information. Here in Toronto You can visit Align Technology in booth No. 204 to learn more about the Invis- align system and iTero digital scanning.
6 exhibitors 2019 ASM — May 9, 2019 New scanner could move digital fence-sitters By Dr. Hsuan Chen Here in Toronto You can experience the ease of use and accuracy of the recently released Primescan intraoral scanning system in the Dentsply Sirona booth (No. 1103). A more detailed version of this article, “New Kid on the Block: Primescan and What It Means for Current and Potential Users,” can be accessed at www.cerecdigest.net. n The Primescan is the new intraoral scanner from Dentsply Sirona. For the dental professionals who are on the fence about join- ing digital dentistry, the Primescan presents an interesting choice. For the current CEREC users, on the other hand, social media might have just imploded with a collective, “It’s about time!” But how much of it is hype, and how much is grounded in practical truth? Our very own Dr. Michael Tsao spent some time with this new machine and noted both its apparent strengths and weaknesses. In this article, I will attempt to distil our internal discus- sions and offer some insights and analy- sis on this fascinating device. What is Primescan? You can read all about its technical achievements and specifications at www.dentsplysirona.com/primescan. In short, Primescan promises to be faster, easier to use and more accur- ate. At face value, these claims might not seem bold or even interesting, since every other major brand of intra- oral scanners have said similar things about their scanners. This time, how- ever, it seems like these promises are more than just marketing platitudes, as our analysis will show. But first, let’s talk about some physical comparisons between the Primescan and the Omni- cam. The interface The Primescan kept the same cart design as the Omnicam, albeit with some distinct differences in how you control the user interface. The mouse cursor is now controlled with a touch pad, with two smaller regions under- neath corresponding to the left and right mouse buttons. For CEREC users accustomed to the old scroll-wheel, it will take some getting used to. Not only is the track ball gone, the keyboard is removed as well for a clean and minimalist look. The battery is also apparently larger and actually able to support the use of Primescan without a power socket connection. The new touch screen is also 16:9 instead of 4:3, giving the user plenty more real estate to work with. Personally, I’ve had no complaints with the original design on the Omnicam, but these are definitely nice quality-of-life changes. If you want, you can also control the software via the touchscreen itself. The screen is able to move and tilt like the Surface Studio from Microsoft, offering an intuitive method of moving the 3-D models around. One the most common 5 The Primescan scanner. 5 The software can be controlled via a touchscreen that moves and tilts the perspective, providing a highly intuitive method of manipulating the 3-D images. (Photos/Provided by Dentsply Sirona). issues we see from new CEREC users at our training centre is their struggle with the track ball. It’s nice to see an update that shows some love for users who are probably already masters of the touch screen on their phones and tablets. In addition to its larger scanning field, the Primescan also uses specific wave- lengths of blue light that, according to Dentsply Sirona, can more accurately capture the surface data. Don’t confuse this blue light with the CEREC Bluecam, however, as the new Primescan uses a completely new patented technology of image capture. As you will see in our analysis later on in this article, all this technology does seem to make signifi- cant differences. The software Admittedly, one of the changes that I am most excited about is the new design of CEREC 5.0 software. The blue background and button designs used in previous CEREC 4.x definitely looked dated (it was released in 2012, to be fair). Personally, I think they did a good job cleaning up the software interface. During the event, Dentsply Sirona placed heavy emphasis on the new A.I. in the CEREC software. And that’s why it’s exciting to see the new CEREC 5.0 A.I., because it is capable of self- learning. The more time you work with it, the better its automatic margins and restoration designs will be. The even better news is that the learning processes are aggregated and central- ized at a main server controlled by Dentsply Sirona, then distributed to all the end-users. This means that as a new Primescan or Omnicam owner, you can immediately take advantage of the most mature and smartest version of the software, trained by dentists all around the world. Hands-on verdicts So, about those three claims made by Dentsply Sirona, let’s take a look at each one by one. Is Primescan faster? Yes. Primescan does feel noticeably faster than the Omnicam, but keep in mind that the Omnicam is currently already one of the fastest scanners available. So how fast do you need, really? Is Primescan easier to use? Yes. As a veteran Omnicam user, Tsao had no trouble adjusting to the Primescan on the first try. The new scanner’s large imaging area and increased depth of field (up to 20 mm) seems to keep the image capture more continuous with- out breaks. Note that the scanner is also bulkier and heavier, so if you’re not into heavy scanners this might be a small issue. Is Primescan more accurate? Accur- acy can be divided into two compon- ents: trueness and precision. Trueness is how closely the data conform to reality (or the best approxi- mation of reality), while precision is how closely the data conform to each other. These two concepts are mutually exclusive, and therefore can be tested separately. According to tests completed at the University of Zurich, Primescan can achieve a local accuracy trueness of 14 µm and precision of 10 µm; and a global accuracy trueness of 32 µm and preci- sion of 30 µm. (Results of other scanners can be found in the Journal of Applied Oral Science article “Local accuracy values for desktop and intraoral scan- ners,” Heike, 2016 at www.ncbi.nlm.nih. gov/pmc/articles/PMC4775014). Final thoughts The release of Primescan at this time, along with its complementary soft- ware, is intriguing because it signals Dentsply Sirona’s push to capture a bigger share of the digital impression (DI) market. While in this article I focus almost entirely on the scanner, it is actually just the gateway into a whole slew of systems. For dental professionals looking to purchase their first intraoral scanner, the ease of use and accuracy offers immediate short-term benefits. At the same time, the A.I., the optional mod- ular software and great support com- munities such as CERECDoctors.com are valuable assets for the longer term. For current CEREC users, Primescan offers a fork in the road that we’re already traveling on. Assuming that the Omnicam will indeed get all the latest software updates, I feel that cur- rent users will be just as happy with either the Omnicam or the Primescan. If you are planning a gradual con- version to the new digital workflow in restoratives, implantology or orthodon- tics, then the DI-focused Primescan is a great first step into the ecosystem. About the author Formerly from Van- couver, Dr. Hsuan Chen now practices full-time in Taiwan. Chen is a lecturer at the CEREC Asia Training Facility and has a background in engineering. As chief editor of CEREC digest (www. cerecdigest.net), he writes primar- ily about the technological aspects of digital dentistry. 5 Dr. Hsuan Chen
8 exhibitors 2019 ASM — May 9, 2019 New dental camera engages entire team 5 The new and improved EyeSpecial C-III digital dental camera helps dental practices and laboratories increase patient acceptance and productivity. (Photos/Provided by Shofu Dental) Revolutionizing clinical photography: Pre-programmed shooting modes enable dental camera users to navigate through tasks without extensive photographic skills or experience By Shofu Dental Staff n Dentists who strive to increase the effectiveness of clear aligner ther- apies in their practice seek products that can engage their team members and improve the experience of a patient. Digital photography plays a key role in documenting treatments. With the right camera, team mem- bers can help increase the patient’s understanding of the clear aligner treatment for easy case acceptance. The EyeSpecial C-III camera from Shofu enables staff to take impressive images for case documentation, diag- nosis, treatment planning, and patient communication and education. This digital dental camera has eight pre- programmed shooting modes so that clinicians and their team members can complete their photo series with ease and consistency. For every step of orthodontic pho- tography, the EyeSpecial C-III will automatically set the appropriate f-stop, aperture and focal length to deliver consistent ideal photographs, leaving the camera’s operator to sim- ply select a suitable mode. Incorporat- ing intuitive functions tailored spe- cifically for dentistry, the EyeSpecial C-III is designed to handle all clinical applications regardless of who is tak- ing the photos. Combining the photos with a draw/ edit function, which allows for mak- ing notes directly on images, is a unique attribute for effective treat- ment evaluation or a discussion about 5 The heavy-duty camera’s body is water-, chemical- and scratch- resistant, and it can be swiftly disinfected with a sterilizing towelette. Here in Toronto Find Shofu products in the Au-Shaw Dental Productions booth, No. 1638, and online at www.shofu.com. the progress or challenges associated with the modality. Engineered to provide functionality, the ultralight (weighing ca. 1lb) EyeSpecial C-III complies with infection control proto- cols. The camera’s body is water-, chemical- and scratch-resistant, and it can be disinfected with a steriliz- ing wipe, reducing the possibility of cross-contamination.
10 exhibitors 2019 ASM — May 9, 2019 A revolutionary paradigm shift in dynamic surgical navigation By George Mandelaris, DDS n A revolution in surgical guidance is afoot. A new dynamic navigation technology called “Trace and Place” (TaP for short), was developed by ClaroNav and will soon become avail- able with its Navident system. I have had the opportunity to try the technol- ogy in a range of cases, and I am very impressed. Here’s a brief description of my experience. Registration is accomplished using any recent CT scan of the jaw by select- ing on-screen and then tracing three of the patient’s teeth or other structures (such as braces or abutments). The pro- cess is done in the chair, immediately before surgery. No stent or guide needs to be prepared, and the entire registra- tion process is typically accomplished in about three minutes. In the rare case something goes wrong during registration and an accuracy check fails to demonstrate the accuracy expected, the registra- tion can be immediately repeated by tracing the same or other structures. Once the jaw is registered with its CT scan, on-screen guidance of the drill position and orientation is provided. The jaw surface is fully exposed, just like with free-hand drilling. Because the jaw often moves during the operation, the system continu- ously tracks the position of the jaw and adjusts the registration to keep the jaw and its on-screen image in accurate alignment. Tracking the upper jaw is accomplished using a special head- tracking frame, which is not affected by movements of the lower jaw or changes in facial expressions. Tracking the lower jaw is accom- plished by connecting a lightweight plastic “jaw tracker” part, marked with optical targets, to a single tooth using a light-cured composite. The motions of the drill are tracked using another plastic part marked with optical targets. Streamlined and simpliﬁed After only a short experience with Trace and Place technology in my practice, I have come to believe that it is a real tipping point for dynamic navigation guidance. It has streamlined and simplified the workflow in both the diagnostic and surgical phases to allow state-of- the-art technology to be an everyday component of my surgical implant practice. I can’t imagine going back! 5 Registration is accomplished using any recent CT scan of the jaw by selecting on- screen and then tracing three of the patient’s teeth or other structures (such as braces or abutments). (Photos/ Provided by ClaroNav) Here in Toronto Learn more about Navident 2.0 “Trace and Place” dynamic navigation tech- nology in the ClaroNav booth (No. 1946).
12 dental news 2019 ASM — May 9, 2019 More dentists are detecting oral cancers in Ontario — earlier 11-year study conﬁrms dental professionals’ growing role in early detection of the deadly disease By University of Toronto Faculty of Dentistry Staff n After examining data gathered over an 11-year period in a first-of- its-kind provincial study, University of Toronto clinician-scientist Marco Magalhaes has one vital message: Dentists in Ontario are detecting more cases of oral cancer and pre-can- cer than ever — and it’s saving lives. Magalhaes, lead author of the study that appears in the Journal of the American Dental Association, is an assistant professor at the Univer- sity of Toronto’s Faculty of Dentistry, and one of the oral pathologists at the Toronto Oral Pathology Service (TOPS). Operated by the Faculty of Dentistry, TOPS is one of the lar- gest oral pathology services in Can- ada, which provides comprehensive evaluation of biopsy specimens — the overwhelming majority of which are submitted by dentists. For the study Magalhaes looked at 63,483 biopsies submitted to the service between 2005 and 2015. “We wanted to look at the scope of oral biopsies performed by dentists, what they’re seeing in practice,” says Mag- alhaes of the study’s design. The biopsy data from TOPS were then com- pared to numbers collected by the Ontario Cancer registry, Cancer Care Ontario, which tracks all reported cancers in the province. Surprisingly, the data showed a steep rise in the overall numbers of carcinomas (oral cancers) and dyspla- sia (pre-cancerous lesions) detected by dentists. Overall, 828 cases of oral cancer were diagnosed by the U of T oral pathology service between 2005 to 2015, along with 2,679 premalignant lesions. But over time, the percentage of oral cancer detection by oral health 5 From left, research associate Denise Lopes Eymael and assistant professor Marco Magalhaes, who is the lead author of the study. (Photo/Jeff Comber, senior photographer, University of Toronto Faculty of Dentistry, IITS) Here in Toronto You can visit the University of Toronto Faculty of Dentistry in the ASM19 ex- hibit hall at booth No. 1600. professionals rose significantly. In 2005, only 56 cases of oral cancer and 99 cases of oral epithelial dysplasia were detected through biopsy. By 2015, though, the number of cancers detected through the biopsy service had nearly doubled, rising to 103 cases of oral cancer. Dysplasia cases more than tripled from 2005, rising to 374 cases. “These numbers are important, because the number of diagnosed cases outpaced both the rise in popu- lation in Ontario and the increased number of dentists in Ontario,” says Magalhaes. licensed In fact, the number of cases detected at TOPS was significantly higher than the overall increase of oral cancers recorded in the province over that same period — just 30 per cent — compared to the 180 per cent rise at TOPS. Cancer Care Ontario identified a total of 9,045 cases of oral cancer between 2005 and 2015. So what does it all mean? For one, argues Magalhaes, dentists in Ontario are playing an important role in detecting the deadly disease. And more comprehensive train- ing and continuing education pro- grams for oral health professionals may be behind the dramatic rise in detection rates. While advanced oral cancers are fairly easy to detect, says Magalhaes, premalignant lesions and early cancer can be easy to miss without specialized training. Early detection of oral cancers, meanwhile, is “critical” to survival rates, he explains. Calling the Toronto Oral Pathol- ogy service “extraordinary,” Michael Glogauer, acting chief dentist at the Princess Margaret Cancer Centre and professor at the University of Toron- to’s Faculty of Dentistry, agrees that strong training is likely playing a role in the higher detection rates. “The focus on oral cancer educa- tion throughout the universities and (in) continuing education in the area of cancer has led to the increased surveillance by dentists, and valid- ates the focus that the dentists in this province are placing on this import- ant health initiative,” says Glogauer. Tracking precancerous links An added dimension of the data col- lected in this study is that research- ers may learn to pinpoint which — and how many — precancerous lesions will, over time, turn cancerous. While the data of the study provide evidence that TOPS was involved in the diagno- sis of approximately 10 per cent of all oral cancers in the province, it also demonstrates a dramatic increase in the number of precancerous lesions identified by these health care pro- viders. Importantly, the provincial cancer agency does not keep statistical data on precancerous lesions, making the TOPS biopsy data especially relevant in the hunt to discover which prema- lignant lesions will become cancers. “This is the first time that we have assessed dysplasia detected by den- tists over such a long period of time,” says Magalhaes. Early detection is key Oral cancer survival rates have remained steady over the past sev- eral decades. What that means, says Magalhaes, is that “advancements in treatment have minimally improved survival rates.” Yet, treated in its early stages, patients with oral cancer have the highest survival rates: around 80 per cent over five years. That statistic drops to approximately 30 per cent over five years when the cancer is detected at an advanced stage. “This supports the fact that early detection really is the most important step here,” Magalhaes adds. And, as the study suggests, regular check-ups at the dentist’s office may be our best line of defense.
14 explore toronto 2019 ASM — May 9, 2019 5 Host to many Toronto events, the Rogers Centre, formerly known as SkyDome, is the city’s indoor/outdoor multi-purpose stadium and home of the Toronto Blue Jays. It even includes a luxury hotel, the Toronto Marriott City Centre Hotel. You can book a room with floor-to-ceiling windows to provide an unobstructed view of Rogers Centre and enjoy a professional baseball game from the comfort of your own room. Note: the official ASM19 block of preferred-rate rooms sold out weeks ago. (Photos/Provided by Toronto Marriott City Centre Hotel) You can see the Toronto Blue Jays play during ASM 2019 n Toronto Blue Jays home games once again nicely coincide with the Annual Spring Meeting this year. You can try to catch a Blue Jays game just a few blocks away at Rogers Centre, considered to be one of the most versatile entertain- ment centres in the world. Last night the Blue Jays were schedule to close out a three-game series with the Minnesota Twins. But another three-game series at the Blue Jays home park starts Friday evening with the Chicago White Sox. You can visit www.mlb.com/bluejays for details. If you’re remaining in the Toronto area for a few days, the following games are on tap through Sunday: Toronto Blue Jays vs. Chicago White Sox Friday, 7:07 p.m. EDT Saturday, 3:07 p.m. EDT Sunday, 1:07 p.m. EDT (Mother’s Day!) (Source: mlb.com/bluejays/schedule) (Photo/Provided by Tourism Toronto)